What Questions to Ask When Looking into Addiction Treatment

In late February the National Institute on Drug Abuse (NIDA), a government agency dedicated to studying addiction, published a free resource on what to ask when looking into addiction treatment programs. This short booklet, which can be viewed online or downloaded for free, lists 5 questions to ask any addiction treatment provider you are considering seeing and offers the reasons why it is important to ask these particular 5 questions. As part of the description of their reasoning the booklet’s authors provide useful information about the types of available addiction treatments, as well as the important elements of effective addiction treatments. In looking over the booklet I began to think about additional questions that might be helpful to ask when pursuing addiction treatment. In no particular order, here are the:

Additional questions you may want to consider. 

  • What is the treatment philosophy or model? Many programs include or heavily emphasize the 12 steps (AA, NA) approach. Although the 12 step model can be very helpful to people in recovery, it may not be the best fit for some. If you are not a fan of the 12 steps, be sure to ask if there are alternative programs available (e.g., SMART Recovery).
  • What resources are available after treatment ends? Check to see if the treatment program offers monthly groups or other services once the intensive phase (i.e., the phase where you participate in treatment frequently) is over. As stated in the booklet, treatment needs to be long enough to work; research suggests that a minimum of 3 months of treatment is needed for many people to stop or decrease drug/alcohol use. This does not mean that you need 3 months of inpatient treatment (i.e., you live at a facility where you receive treatment), but it does mean that you may need to stay in some type of treatment, whether it’s weekly group meetings, one-on-one meetings with a therapist, etc., for at least 3 months. When looking into treatment programs, be sure to ask what treatment is available after the intensive phase is complete to make sure you have the resources you need to be successful.
  • What about family or couples therapy? The booklet briefly mentions that family therapy may be needed as part of treatment, but if you are looking for or think you may need family or couples therapy be sure to ask about them directly. You may be wondering why you would need family or couples therapy. When a person is addicted to drugs or alcohol it not only affects the person, but the person’s relationships with his/her family or partner. Many family members and partners have learned how to relate to their loved one when he/she was addicted; it can be quite difficult to learn how to relate to a loved one when he/she is sober. Some family members feel at a loss as to how to best support their loved one’s sobriety, or worse, they may unknowingly interact with their loved ones in ways that are detrimental to their loved one’s recovery. This does not mean that family members cause loved ones to use! The choice to use still resides with the person who uses, but family members can be positive or negative influences in a person’s path to recovery (one type of therapy that works with family members and partners to be allies in their loved one’s recovery is called Community Reinforcement and Family Training (CRAFT). CRAFT is a highly effective treatment for family members and for people with addictions). Family and couples therapy can help family members and partners heal from their loved one’s use and to learn new, supportive ways of interacting with their loved ones while they are recovering.
  • Depending on your needs, you may need to ask about:
    • Whether the program will meet requirements for assessment and/or treatment that is court-ordered (e.g., DUII).
    • Assistance with job placement, housing, or other needs.
    • Spiritual services. Does the treatment program offer the opportunity to continue with your spiritual practices?
    • Insurance and payment options.

Of course, the above is not a complete list of questions to consider, but hopefully it helps you start thinking about what your own unique needs may be and what questions you want answered before committing to treatment.

Finding the right treatment can be difficult, but knowing your needs and the types of questions to ask, can put you on the path to finding the treatment program that will work best for you.

Help! How Do I find Resources for My Loved One with an Addiction?

Recently a colleague alerted me to an article in the Chicago Tribune about CRAFT (Community Reinforcement and Family Training). A few months back I wrote a blog post about CRAFT that described the research support and basic ideas of the treatment. Briefly, CRAFT teaches family members with loved ones with addictions how to non-confrontationally change their loved one’s substance use. Additionally, CRAFT helps family members learn skills to improve the quality of their lives by breaking free of the cycle of their loved one’s addiction.

First, I think it’s awesome that CRAFT is getting noticed by the mainstream press and that people may learn about the treatment and, as a result, get help for themselves. The article offers interesting facts about the rise of prescription pain killer dependence, as well as tips for helping your loved one. While the tips for getting you and your loved one help were useful, I felt they were incomplete. Additionally, the article didn’t offer resources to help family members access services, get support, or learn the skills discussed in the article. With so many people affected by addiction, I think an opportunity to provide resources for substance use related issues was missed.

How to Find Help for Yourself and Your Loved One:  Some Tips and Resources

While this isn’t a complete list, here are some ideas on how and where you might find the resources mentioned in the Chicago Tribune article.

  • Ask people you trust about resources. Talk to your friends, a family physician, a spiritual leader, and family members about substance use treatment programs, counselors/therapists who specialize in addiction, or community programs tailored to you or your family members’ needs. For example, Dual Recovery Anonymous is a peer-run 12-step program for people experiencing addictions AND mental health problems.
  • Check out your local hospital. Many hospitals offer substance use treatment (e.g., detox, outpatient treatment). Contact your local hospital’s psychiatry department to see what options are available. In the Portland area some hospitals that offer substance use treatment are Providence and Cedar Hills.
  • Check out peer support organizations.
    • 12-step organizations for individuals with addictions (AA, NA) and for family members (Al-Anon, Nar-Anon) offer support and have information on substance use treatment programs in your community.
    • People who prefer not to use the 12-step approach are encouraged to check out SMART Recovery, an alternative to the 12-step approach that uses evidence-based principles to help people overcome their addictions. SMART Recovery also has meetings and resources for family members (SMART Recovery Family Resources). SMART Recovery has a list of national providers and substance use treatment programs that use CRAFT or therapies similar to CRAFT.
  • Check out your state’s department of health website. The websites for your state’s department of health often include a list of mental health and substance use treatment centers that are licensed by the department of health to provide these services. In Oregon, go to:  http://www.oregon.gov/OHA/addiction/index.shtml.
  • If you are experiencing domestic violence, or there is threat of domestic violence, contact local or national domestic violence agencies.  

Two Cool Addiction Web Resources to Add to Your Favorites Folder

A couple weeks back I was perusing the news on the internet when I came across an interesting story and really cool idea in addictions research. Researchers at the Virginia Tech Carilion Research Institute in Roanoke, Virginia have created a National Quit & Recovery Registry. To better understand how people quit using drugs and alcohol, as well as how people remain in recovery from drug and alcohol problems, researchers at the institute created an online database where people share what helped them quit and what helps them in recovery. The researchers are asking people who have at least 1 year in recovery from an addiction (including overeating, nicotine, or “other harmful behavior”) to describe their personal strategies for quitting and staying in recovery. People who share their stories can do it anonymously or confidentially and will be offered the opportunity to participate in various research studies aimed at better understanding addiction and recovery. Based on the registry’s website, it looks fairly easy to contribute your “success story.” If you are a person who is in recovery from addiction this seems like a great way to share your own personal strategies for successfully quitting an addiction and also contribute to science.

Why The Registry is Awesome (in My Personal Opinion)

Many of you who follow the blog know that my colleagues and I really value science and the research process. One reason why I’m excited about this registry is that it will likely yield a wealth of research studies that will improve our understanding of addiction and ultimately lead to better addiction treatment. Although mental health researchers and professionals have done a wonderful job in creating effective therapies for addiction, we know that these treatments do not help everyone and that relapses are common. I am excited about the possibility that we can improve addiction treatment and help reduce the suffering of people with addiction, their families, and their loved ones.

A second reason why I’m excited about the registry is that comes from a person-centered perspective. What do I mean by this? Person-centered refers to a focus on the individual, including the unique factors that are related to a person’s personality and mental health. Prior to my work here at Portland Psychotherapy, I worked with individuals experiencing serious mental illness (e.g., schizophrenia). At the clinic where I worked there was a strong emphasis on putting the person first, not their mental illness. As result of my experiences working in a place that heavily emphasized person-centered care, I continue to value this perspective in mental health and addiction treatment. I think it can be easy to fall into the trap of only seeing the addiction and forgetting about the person with the addiction. I believe there is great value in gaining from perspectives of people who have quit using and who continue in their recovery from drugs and alcohol. I really like the blending of science with a person-centered perspective.

A Second Cool Addiction Website

Another interesting internet resource I came across recently is Dirk Hanson’s blog “Addiction Inbox.” Dirk Hanson is a science reporter who has done a fair amount of writing on addiction and recently had a book on the science of addiction published. His blog is a treasure trove of posts about addiction. Although I disagree with some of Mr. Hanson’s points, I find his blog to be informative and accessible to a wide audience. I particularly like his posts about new research studies on addiction, as well as his posts about emerging substances that may be potentially addictive, but not yet recognized by the government as such (e.g. “Spice”). I appreciate Mr. Hanson’s ability to take complex research and to simplify it to its most interesting (and possibly most useful) points.

With so many addiction websites and blogs available, it can be difficult to find ones that are easy to understand and science-based. I believe the two websites offered in this post are accessible to a wide range of people and give people the opportunity to look behind the veil of scientific research on addiction. I hope you will find these websites as useful as I have.

Riding the Wave: Using Mindfulness to Help Cope with Urges

Changing a habit is hard. Anyone who has tried to change their eating habits, quit smoking, start an exercise program, or stop drinking or using drugs can tell you how difficult it can be at times to change old habits. In my last post I discussed how slipping (i.e., falling back into an old habit) can sometimes set us up for a relapse (i.e., continuing a habit beyond the initial slip) due to a phenomenon known as the Abstinence Violation Effect. In this post, I’d like to talk about a technique that can help you before you slip, a technique called “urge surfing.”

What is Urge Surfing?

Urge surfing is a technique attributed to the late psychologist Alan Marlatt, Ph.D., a pioneer in the field of addictions treatment. We can think of an urge as an impulse to engage in an old habit, such as drinking or using, and they are often experienced as physical sensations in the body. Urges are like waves in that they rise in intensity, peak, and eventually crash.

Here’s a brief exercise you can do to explore this technique: Stop for a moment and think about an urge that you recently experienced. As you think about this urge, see if you can notice all the sensations that come up as you think about it; see if you notice how these sensations shift across time. Use your breath to help you ride out the waves (i.e., the urge); like a surfboard, you can simply observe your breath as you ride out each wave that arises. Congratulations! You just successfully surfed your first urge!

Urges usually peak between 20 – 30 minutes, if we let them. What I mean by this last phrase is this:  if we adopt an open and curious attitude about the urge and watch it without doing battle with it, then the urge will subside. However, if we go to battle with our urges (e.g., “I can’t stand this urge! I have to get rid of it right now!”), they will subside more slowly. Worse, by giving into urges we can actually strengthen them and we can lose confidence in our abilities to change our old habits.

How to Surf an Urge

There are slight variations of the urge surfing technique, but most include the following steps:

  1. Take a few moments to notice where you experience urges in your body. You can do this by taking some time to sit in a quiet place, and if you are comfortable doing so, closing your eyes, and just allowing your attention to go to the place(s) in your body where you tend to feel urges. For some people they notice that urges are most connected to sensations in their abdomens; for others, they notice urges in their mouth (e.g., their mouths water when experiencing an urge to drink). There is no right or wrong place for an urge to be located. What is most important is that you notice where in your body you most notice urges when they show up. If you are having trouble noticing urges, think back to a time when you experienced an urge to engage in an old habit. If you are concerned that thinking about a particular instance when you had an urge will lead to doing the habit, pick a situation where the urge was less strong or you successfully prevented yourself from acting on the urge. Picture the situation as clearly as you can in your imagination. Once the situation is clear in your mind notice where in your body you are experiencing the urge.
  2. Once you have noticed what part of your body is most connected to the urge, focus your attention on it (if you notice that more than 1 area of your body is connected to an urge, start with the place that you most intensely notice the urge). Take note of the sensations you are having in this body part. What do the sensations feel like? Does it feel like pressure, tingling, warmth, or coolness? How much space do these sensations take up in this place in your body? Try to draw an outline around the place where the sensations are felt. See if the sensations have any movement. Some people tend to associate sensations with colors or temperatures. Check to see if you notice any colors or temperature associated with these sensations. For some people it can be helpful to silently describe the sensations in an objective and non-judgmental manner (e.g., I notice warmth and tingling in my belly). If more than one part of your body is associated with an urge, go through this exercise with each body part.
  3. Bring your attention to your breath. You do not need to change your breathing at all. Notice your breath for the next 1-2 minutes. Some people find it helpful to bring their attention to a particular place in their body where they notice their breath (e.g., the abdomen); some find it helpful to say phrases like “breathe in,” “breathe out” as they inhale and exhale.
  4. Gently shift your attention back to the part(s) of your body where you notice the urge. Allow yourself to notice whatever sensations come up in these places. If it becomes overwhelming to notice the sensations, gently return your attention back to breath for a few moments and then go back to noticing the sensations connected to the urge. You may find it helpful to imagine sending your breath to the parts of your body that are associated with the urge (e.g., you can breathe into your shoulders and let your breath fill up that part of your body). Notice if and how the sensations change as you watch them. Be sure to practice this step for at least 1 minute, but longer is probably better.
  5. This next step is optional, but I have found it to be helpful in my own life and in working with people with addictions. Imagine that the sensations connected with your urge are a wave. Watch the wave rise and fall over and over again as the intensity of your sensations peak and subside. Your job is to use your breath as a surfboard to ride these waves. No matter how big the wave gets, no matter how much you feel as if the wave will consume you, you are a skilled surfer and you will use your breath to ride each wave as it comes. Practice this for at least 1 minute, but again, longer is probably better, particularly the first few times you practice this.
  6. As you’re riding the wave (or just noticing the sensations), you may find it helpful to silently describe the sensations in an objective and non-judgmental way (e.g., I notice warmth in my belly that is increasing…the warmth in my belly is decreasing and my belly feels cooler).
  7. When you are done surfing the urge, take a moment to thank yourself for taking the time and being willing to do something different with your urges. You can also use this time to set your intention for the next few minutes, hour, or day.

That’s it! With practice urge surfing gets easier and you may discover that you are an excellent surfer. You can practice this technique in two ways:

  1. You can start urge surfing whenever you notice yourself having an urge.  This can be a particularly useful technique when you notice urges to go back to old habit that you are trying to break.
  2. You can practice this on a regular basis by setting aside time to practice using the technique. Many people find that listening to an audio recording of the technique is useful at first.  Through this kind of formal practice, you can get better at urge surfing so that you’re better at it when you need it.

You’ll find that, with practice, urges will become easier to ride out. You may even start to feel a sense of pride or accomplishment as you successfully surf urges and act according to your values, instead of according to your urges.

If you would like to learn more about how to use techniques like urge surfing to cope with urges, the book below is a good option:

Help! My Loved One Won’t Stop Drinking!

If you’re reading this post then most likely you are a family member, partner, or friend of someone who’s drinking concerns you. You’ve most likely tried everything you can think of to help this person seek treatment:  nagging, pleading, threatening, leaving, staying, bargaining, contracting, and much more. Perhaps you’ve thought about signing up for the T.V. show “Intervention” on A&E, or staging your own intervention for your loved one. Maybe you have given up and no longer interact with your loved one; you have cut them out of your life completely. It may feel like you have used every tool at your disposal and yet, you are still fighting the same battle. Luckily, there is a new research-based approach to helping family members get their loved ones into treatment and to take back their lives from a loved one’s substance or alcohol use. This new approach is called Community Reinforcement and Family Training (CRAFT, for short) and it is starting to gain traction in addiction treatment.

The version of CRAFT that is practiced today originated at the University of New Mexico by Robert Meyers, Ph.D. and colleagues. Research on CRAFT shows that about 70% of families who go through the training are able to successfully engage their loved in treatment over the next year.  CRAFT also helps family members improve their own lives, whether their loved one ends up seeking treatment or not.

What is CRAFT?

CRAFT is an approach that works with family members, partners, friends, or employers of people using drugs or alcohol (in CRAFT, the term Concerned Significant Others, or CSOs, is used) to do the following:

  1. Help the CSO learn non-confrontational ways of breaking the person’s pattern of substance use;
  2. Empower the CSO to live a life not centered on the person’s use of or consequences related to the person’s addiction.

You are not to blame, but you can do something to help

  1.  You ARE NOT responsible for your loved one’s use of substances. You may be involved in situations related to your loved one’s use (e.g., getting into arguments with your partner) or the consequences related to his/her use (e.g., picking them up from the bar), but you did NOT make your loved one use substances. Your loved one is responsible for his/her behavior, just as you are responsible for your behavior. You CANNOT make a person drink or use drugs.
  2. At the same time, as a loved one of someone who uses drugs or alcohol, you have access to a wealth of knowledge about this person’s patterns of substance use. Also, you are a source of potential rewards for the person using substances. Your time, love, and attention are valuable resources that can help shift your loved one’s relationship with substances and with you.

CRAFT is non-confrontational

Unlike the interventions conducted on A&E’s show “Intervention,” family members in CRAFT do NOT use a confrontation to persuade their loved one to enter treatment. Instead, family members learn to recognize their loved one’s patterns of use and their own unintentional participation in these patterns. Family members learn how to stop their participation in these patterns in ways that keep them safe, set appropriate boundaries, and are consistent with the type of partner/daughter/parent/employer/etc. they want to be. For example, a mother will learn to stop arguing about her son’s drinking and instead, calmly express her desire that they not talk about this issue while he is drinking and then leave the situation to pursue a more rewarding activity (e.g., calling a friend, taking a bath). Additionally, CRAFT empowers family members by helping them engage in self-care and pursue their personal values and goals. For more information about CRAFT, stay tuned to this blog.

Resources on CRAFT:

To find a local CRAFT therapist for you or a loved one call 503-610-3370 or go to soberfamilies.com

Here’s  great self help book which summarizes the approach called: Get your loved one sober:  Alternatives to nagging, pleading, and threatening.

Center on Alcoholism, Substance Abuse, and Addictions (CASAA):  http://casaa.unm.edu/craftinfo.html

Website for Dr. Meyers with information about CRAFT:  http://www.robertjmeyersphd.com/craft.html