Essentials of Early Recovery Geoff Kane MD MPH Brattleboro VT February 12 2013 people will forget what you said people will forget what you did but people will never forget how you ID: 370717
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Two Pillars – A Metaphor for the Bare Essentials of Early Recovery
Geoff Kane, MD, MPHBrattleboro, VTFebruary 12, 2013Slide2
“…people will forget what
you said, people will forget what you did, but people will never forget how you made them feel.”- Maya AngelouSlide3
OverviewLaws of nature and personal responsibilityNeurobiologyBehavior
AddictionPowerlessnessRecoveryThe Two Pillars of RecoveryPeople matter mostSlide4
“Addiction is like gravity; it is governed by the laws of nature and never takes
time off.” Slide5
Addictive chemical substances change the brain and change behavior.Slide6
“…the essence of addiction: uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences.”
- Alan Leshner, PhDSlide7
AddictionSubjective: Powerlessness (loss of control)Objective: Persistent use despite adverse consequencesSlide8
neurobiology of behavior
plusneurobiology of addictionequalsneurobiology of powerlessnessSlide9
There is more to who we are and more to why we do the things we do than what meets our own minds.Slide10
Lower centers of the Central Nervous System can act independently of higher centers.Slide11
“New research shows that emotions have a separate system of nerve pathways, through the limbic system to the cortex, allowing emotional signals to avoid conscious control.”
-Robert Ornstein, 1991Slide12
-Robert Ornstein
“…unconscious decisions for action
go on constantly inside the head.”Slide13
-Robert Ornstein
“We’re worse off than Freud thought, because many actions proceed without our knowing anything about them.”Slide14
“Our limbic system sets the mind’s
emotional tone and stores ourhighly charged emotional memories.”- Tian Dayton, PhDSlide15Slide16
Addictive chemical substances change the brain and change behavior.Slide17Slide18
“I have a passion for alcohol.”
- 25 year old femaleSlide19
“Any addict knows, you’ll do anything to get it.”
- 23 year old maleSlide20
Violate their own rules for behavior/values
when under the influence? Break promises to themselves about use? Pay an emotional price for using (shame, guilt, fear, remorse, anger at self)? See a different version of their own
drinking/drugging than other witnesses?
Would become defensive or lie if asked these
questions?
- John and Pat O’Neill
in
Help to Get Help
Are they really hooked?Slide21
RELAPSE RATE OVER TIME
Abstainers (%)
Time (Months)
0 1 2 3 4 5 6 7 8 9 10 11 12
2 Weeks
100
90
80
70
60
50
40
30
20
10
0
Heroin
Smoking
AlcoholSlide22Slide23
Two Pillars of Addiction RecoveryKeep your distance!Ask for help!Slide24
“The treatment of addiction is [still] people.” Slide25
Suggestions Made in Addiction Treatment90 meetings in 90 daysObtain and use sponsorDo some Step work
Participate in an aftercare groupParticipate in counseling/ psychotherapySlide26
Counseling TipsBe Empathic, NonconfrontationalOffer Choices
Emphasize Patient’s ResponsibilityConvey Confidence In Patient’s Ability To ChangeSlide27
Determinants of Client “Change”Client factors 40%Relationship factors 30%Expectancy & Hope 15%Model/technique 15%
- Michael Clark, MSWSlide28
Positive interpersonal relationships change the brain and change behavior.Slide29
“Neural repatterning comes
as we enter into and sustain new types of relationships that allow us to reregulate our sense impressionsslowly and over time.”
- Tian Dayton, PhDSlide30
“Interpersonal experience shapes the
mind as it continues to develop throughout the lifespan… Interactions with the environment, especially relationships with other people, directly shape the development of the brain’s structure and function.”
- Daniel J. Siegel, MDSlide31
“ …the amygdala, along with related
areas…, plays a crucial role in coordinating perceptions with memory and behavior. These regions are especially sensitive to social interactions.”
- Daniel J. Siegel, MDSlide32Slide33Slide34Slide35
Abstinence results from Skill Power not Will Power Slide36
Some Recovery Skills/TipsBe honestEmbrace your painMistrust yourselfKeep your distanceSeek people, not chemicalsPay attention!Slide37
CRAVING
ADDICTIONHABITCOPING
Docherty’s Craving TriangleSlide38Slide39
SpiritualityInvolves Relationships With:SelfOther Human BeingsNatureCreator, God, Higher PowerSlide40
Patients help ensure recovery success when they embrace:AbstinenceMental and emotional changes
Spiritual changesDaily spiritual practiceSlide41
Providers help ensure recovery success when they promote continuity of:HealthcareCaringAccountabilitySlide42
Treatment/Recovery EssentialsPatientUnderstand &
accept “laws”Avoid or manage “triggers”Use supports, human & spiritualAvoid abusive relationshipsTake meds when appropriateCommunityUnderstand “laws”Reduce drug availability
Make professional and other positive relationships available
continuously
Protect people from abusive relationships
Make appropriate meds availableSlide43
A Model for RecoveryEmotional ArousalSense of HopeSense of MasteryLove and Humor
- Modified from Jerome Frank, MD