Not everyone who seeks substance abuse treatment is fully motivated for drug abstinence. As a matter of fact, only 20% of people who seek treatment are in the action stage of change. That leaves 80% who are undecided or still considering their options. Unfortunately, many programs will not accept them unless they are prepared for total drug abstinence. This leaves them vulnerable to the escalation of their addiction, possibly to the point of death. Ideally, we want more people in treatment than less, and we want to keep them safe. What can we do for these people? Listen to a group of people who have been addicted to opiates discuss this dilema.

Discussion Guide:

Stages of change are pre-contemplation, contemplation, planning, action and maintenance. When you entered treatment, what stage of change were you in?

Have you been denied substance abuse treatment because you were not fully committed to drug abstinence?

Have you been terminated from a program due to ongoing drug use?

Should a program institute restrictions for ongoing drug use, or terminate them from the program?

Have you been denied social services such as a shelter or employment because you are on a medication for your addiction?

What do you recommend to assist people who are in the pre-contemplation and contemplation stage of change?

Supplemental Reading:

Brooke Feldman, When 'All or Nothing' Means Life or Death, http://www.huffingtonpost.com/entry/when-all-or-nothing-means-life-or-death_us_57ca2756e4b06c750dda134f

It is no surprise that many people who have become addicted to opioids serve time in jail or prison. These same opioid addicts are at risk for overdose death immediately after release. Medication Assisted Treatment greatly reduces this risk. And yet some people make choices that directly put them at risk of death by refusing medication treatment. Why is this? Listen in to a group of recovering opiate addicts discuss the reasons why someone would choose to decline this medication.

Discussion Guide:

Do you know people who have died immediately after release from prison of drug overdose?

Have you been incarcerated? Did the facility allow Methadone or Suboxone administration? Did they provide comprehensive addiction treatment?

If given a choice, would you continue medication assisted treatment while incarcerated? Why?

If you were in a prison based medication assisted treatment program, would you choose to stay on the medication on release, or cease the medication before release? Why?

Supplemental Reading:

Among incarcerated populations, opioid agonist therapy has been shown to reduce the risk of post-release mortality by up to 75%, so why do some patients not want it?  http://www.recoveryanswers.org/pressrelease/newsouthwales/

Cognitive therapy is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. It states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. It is valuable in treating alcoholism and drug addiction. In this recovery group one member shared a distressing situation while we walked through a series of steps to examine her thoughts. As a result, she felt some relief. Listen in to this podcast to see what helps.

Discussion Guideline:

Situation – Describe a distressing situation. What happened? Where? When? Who with? How?

Identify Emotions/Mood – What emotion did you feel at that time? What else? How intense was the emotion?

Physical Sensations – What did you notice in your body? Where did you feel it?

Unhelpful Thoughts – What went through your mind? What did those thoughts/images mean to you? What would be the worst thing about that, or that could happen?

Alternative, realistic thoughts – Is there another way of seeing it? Is your reaction in proportion to the actual event?

What is the best response? – What would be more effective? What will be most helpful for me or the situation?

Supplements:

Thought Record Sheet, http://www.getselfhelp.co.uk/docs/ThoughtRecordSheet7.pdf

 

Relapses are often a result of poorly handled emotions. Alcohol, drugs or addictive behaviors used to provide temporary relief from those feelings, but recovery provides an opportunity to learn new coping skills. Addicts need effective ways of tolerating, managing and making sense of the negative feelings encountered in daily life. Listen in to this group of people in recovery discuss their emotions.

Discussion Guide:

Complete the sentences using the following emotions: Shame, Love, Anger, Sadness, Fear, Grief, Anxiety, Embarrassment

What I learned as a child about (fill in the emotion) is.

How I came to cope with (fill in the emotion) is.

What I now know about (fill in the emotion) is.

How I cope now with (fill in the emotion) is.

Which feelings are the easiest for you to manage?

Which feelings are the hardest for you to manage?

Supplemental Resources:

Communication Technique to deal with intense emotion: (complete the sentence)

1. I notice that (state the facts of the upsetting event in a neutral way).

2. My vulnerable emotion is (state the feelings that underlie anger).

3. My request is (what would you like to have happen in this situation).

The Emotional Barometer, Bright Futures Treatment Center, http://blog.brightfuturestreatment.com/substance-abuse/relapse-prevention-emotional-barometer/

Addiction disrupts relationships. It is a third party that interferes with the relationship and destroys trust. Did you know that couples with substance problems are four times more likely to divorce? One therapy model, the Gottman Method Couples Therapy, helps couples have conversations they have not been able to have, in a healthier way than was previously possible, when both partners engage in couples' recovery. Robert Navarra developed a therapy approach for couples who have been disrupted by an addiction, in conjunction with Dr. John Gottman and Dr. Julie Gottman. Listen in to this podcast as we discuss the elements of a stable relationship and tips for improving them.

Discussion Guidelines:

How has your addiction effected your primary relationships?

Does your partner have symptoms of second hand addiction, such as negative emotions, hypervigilence and chronic distrust?

Do you feel that you have good relationship skills?

Do you know what the characteristics of a healthy relationship are? What are they?

What makes it difficult for you to stay connected to your partners in a healthy way?

Supplemental Resources:

Robert Navarra, http://www.robertnavarra.net

John Gottman Ph.D. and Nan Silver, The Seven Principles for Making Marriage Work

John Gottman Ph.D. The relationship Cure: A 5 Step Guide to Strengthening Your Marriage, Family and Friendships

John Gottman Ph.D. What Makes Love Last? How To Build Trust and Avoid Betrayal

Dr. Sarz Maxwell is a psychiatrist who specializes in addiction. She joined our opiate recovery group to speak about Dual Diagnosis for people who struggle with both mental health and substance abuse issues. Listen in.

Discussion Guide:

Many people (75%) who abuse substances also struggle with mental illness. Is that true for you?

Have you received treatment for both?

Dr. Maxwell talks about medications that help vs. medications that work. Some medications mask the symptoms of psychiatric conditions and are therefore temporarily helpful, but don't treat the condition. Benzodiazepines don't work for anything (including anxiety) yet are widely used and misused. Have you used a benzodiazepine with the belief that it works? Have you become psychologically or physically dependent upon them?

Some people wonder about the chicken and the egg. Which came first, the mental illness or the addiction? Do you think one has to be treated first? Or at the same time?

Which of the mental health diagnoses do you think are the most prevalent among people with a substance abuse addiction?

If you are an opiate addict, you have a chronic illness and will have to battle the disease for a lifetime. The only question is whether you want to be winning or losing the battle. What do you intend to do to win the battle?

How long do you think you need to be on a medication to treat your opiate addiction?

What are the similarities and differences between Methadone and Suboxone?

 

 

 

It is not easy to watch a substance abuser crash and burn. The people who love them want to intervene and will attempt to talk to them about their substance problem. But not all words are helpful. Even if well intentioned, some words can be misguided or detrimental. Brian Whitney wrote "Eleven Things NOT to Say to the Addict in Your Life". Listen to this group of opiate addict's experiences of words that were hurtful to them.

Discussion Guide:

What have people said regarding your addiction that has been hurtful or unhelpful to you?

How did you respond to these remarks?

What do you recommend to others about how to talk to an addict?

Supplemental Reading:

Eleven Things NOT To Say to the Addict in Your Life, Whitney, Brian, https://www.thefix.com/eleven-things-not-say-addict-your-life

It's election time and United States political leaders are advancing their party platforms to curb addiction and increase research. In the news this week I found that Hillary Clinton supports a proposal to tax opioids and she'd like to change the Schedule II classification for marijuana.  Also, the republican party suggests that heterosexual marriage prevents drug addicts. Yes, you heard me. The GOP suggests that marriage between man and woman prevents drug addicts. Listen in to this group of opiate addicts weigh in with their opinions.

Discussion Guide:

Do you believe that heterosexual marriage prevents drug addiction? And do you believe that same sex marriage contributes to substance abusing children?

To what degree, if at all, are parents responsible for their children's addiction?

Do you believe that opioid manufacturers or importers should be taxed? If so, how do you suggest that the money be used; ex: Naloxone, research, treatment, physician training?

Should doctors be given full disclosure of a patient's addiction history? What are the pros and cons of this disclosure?

Should marijuana be moved from DEA classification Schedule I to a Schedule II drug? What are the pros and cons of this change?

Supplemental Reading:

GOP Suggests Marriage Between Man and Woman Prevents Drug Addicts, Fitzgerald, Kelly https://www.thefix.com/gop-suggests-marriage-between-man-woman-prevents-drug-addicts

Hillary Clinton Supports Proposal To Tax Opioids, McCarton Ackerman, https://www.thefix.com/hillary-clinton-supports-proposal-tax-opioids

Hillary Clinton Wants Schedule II Classification for Marijuana, McCarton Ackerman, https://www.thefix.com/hillary-clinton-wants-schedule-ii-classification-marijuana

Victoria B. wrote a blog entitled "Your Friends In Sobriety Can Make or Break You". In this, she writes about the importance of fellowship with people in recovery. Most people cannot sustain drug abstinence without a strong support network. Listen in to a group of people in recovery from opiate dependence share their thoughts on social connections.

Discussion Guide:

Have you developed a healthy support network in recovery?

What's at risk if you continue to associate with drug users?

Not everyone who attends a recovery support group are drug free. What steps did you take to weed out healthy from unhealthy recovery friendships?

Could you maintain drug abstinence without a support network?

Many people relapse because they are bored or lonely. Have you developed hobbies and activities to enjoy life?

Supplemental Reading:

Your Friends In Sobriety Can Make or Break You, Victoria B. https://800recoveryhubblog.wordpress.com/2016/09/23/your-friends-in-sobriety-can-make-or-break-you/

 

For newer people in recovery, long-term drug abstinence seems like an impossible feat. Even getting through the day can be overwhelming. Seeing others celebrate recovery milestones and anniversaries helps enforce the fact that sobriety and recovery is attainable and that there is hope. In this podcast we celebrate our member's successes.

Discussion Guide:

What are your recovery successes?

What are the changes you've made with recovery?

What rewards would you find meaningful to mark your achievements?

Supplemental Reading:

Incentives Promote Abstinence, NIDA Director, Nora D. Volkow, M.D. https://www.drugabuse.gov/news-events/nida-notes/2010/12/incentives-promote-abstinence