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Substance-Abuse

Substance-Induced Disorder Treatment

by Morningside Recovery Blog on February 16, 2009

Substance-induced disorders are distinct from independent co-occurring mental disorders in that all or most of the psychiatric symptoms are the direct result of substance use. This is not to state that substance-induced disorders preclude co-occurring mental disorders, only that the specific symptom cluster at a specific point in time is more likely the result of substance use, abuse, intoxication, or withdrawal than of underlying mental illness. A client might even have both independent and substance-induced mental disorders. For example, a client may present with well-established independent and controlled bipolar disorder and alcohol dependence in remission, but the same client could be experiencing amphetamine-induced auditory hallucinations and paranoia from an amphetamine abuse relapse over the last 3 weeks.

Symptoms of substance-induced disorders run the gamut from mild anxiety and depression (these are the most common across all substances) to full-blown manic and other psychotic reactions (much less common). The “teeter-totter principle”-i.e., what goes up must come down is useful to predict what kind of syndrome or symptoms might be caused by what substances. For example, acute withdrawal symptoms from physiological depressants such as alcohol and benzodiazepines are hyperactivity, elevated blood pressure, agitation, and anxiety (i.e., the shakes). On the other hand, those who “crash” from stimulants are tired, withdrawn, and depressed. Virtually any substance taken in very large quantities over a long enough period can lead to a psychotic state.

Because clients vary greatly in how they respond to both intoxication and withdrawal given the same exposure to the same substance, and also because different substances may be taken at the same time, prediction of any particular substance-related syndrome has its limits. What is most important is to continue to evaluate psychiatric symptoms and their relationship to abstinence or ongoing substance abuse over time. Most substance-induced symptoms begin to improve within hours or days after substance use has stopped. Notable exceptions to this are psychotic symptoms caused by heavy and long-term amphetamine abuse and the dementia (problems with memory, concentration, and problem solving) caused by using substances directly toxic to the brain, which most commonly include alcohol, inhalants like gasoline, and again amphetamines.

Diagnoses of substance-induced mental disorders will typically be provisional and will require reevaluation-sometimes repeatedly. Many apparent acute mental disorders may really be substance-induced disorders, such as in those clients who use substances and who are acutely suicidal.
Some people who have what appear to be substance-induced disorders may turn out to have both a substance-induced disorder and an independent mental disorder (dual-diagnosis). For most people who are addicted to substances, drugs eventually become more important than jobs, friends, family, and even children. These changes in priorities often look, sound, and feel like a personality disorder, but diagnostic clarity regarding personality disorders in general is difficult, and in clients with substance-related disorders the true diagnostic picture might not emerge or reveal itself for weeks or months. Moreover, it is not unusual for the symptoms of a personality disorder to clear with abstinence sometimes even fairly early in recovery. Preexisting mood state, personal expectations, drug dosage, and environmental surroundings all warrant consideration in developing an understanding of how a particular client might experience a substance-induced disorder. Treatment of the substance use disorder and an abstinent period of weeks or months may be required for a definitive diagnosis of an independent, co-occurring mental disorder. Our substance abuse treatment program and clinical staff can concentrate on screening for mental disorders and determining the severity and acuity of symptoms, along with an understanding of the client’s support network and overall life situation.

Morningside Recovery Drug Rehab program is an individualized and personalized treatment experience. Each client’s addiction treatment plan is formulated by all of our clinical staff, including our medical doctors, psychiatrists, psychologists, and addiction treatment professionals. We know that generalized programming is not always beneficial to clients and that the individual needs of client may vary. We focus on both addiction treatment and alcohol treatment, or one or the other if needed.

We believe that one-on-one treatment produces the best results. It is the rapport that develops between the client and the clinician that produces the most favorable results. Often clients have experienced trauma in their lives and this may be one of the many factors contributing to their drug and alcohol abuse. We provide a private, exclusive and comfortable environment in Newport Beach, CA to begin healing from these issues.

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Ted Williams and the Steps to Recovery

by Morningside Recovery Blog on November 21, 2008

Ted Williams was one of the greatest hitters ever to play baseball. It is said he could read the stitches on a ball traveling more than 90 mph. Yet it’s rumored that his first attempt at hitting a golf ball was a complete failure. He missed it completely – several times!

That’s because the golf swing is unnatural. There are many things to remember. It feels completely uncomfortable. Only with practice – years of it – does it begin to feel “right.”

Maintaining sobriety via a recovery fellowship such as AA brings similar challenges. It does not come naturally. There’s a lot to learn and much to remember. This article presents 12 practical tips that a person might consider in trying to maintain sobriety via a fellowship-based recovery program. I encourage readers to share this information with all clients – newcomers and long-timers alike.

One caveat: Sometimes the newcomer is just too raw to embrace suggestions such as these. We can only hope that this person will keep an open mind – and just keep coming to meetings. Fortunately, there are no rules in recovery, only suggestions offered by those who have gone before us.

Here, then, are 12 tips for your clients:

1. Go, even if you don’t want to.
AA and similar programs don’t make house calls. To get your medicine, you have to show up whether you want to or not. Ironically, most people agree that once they actually get to a meeting, they’re glad they went.

2. Show up early.
Let’s face it; groups don’t drink – individuals do. So one of your main purposes is to connect with other safe and sober individuals. (Of course, you’re also there to hear something useful and to learn more about yourself and your disease.)Initially, you’ll want to identify people in the group, to determine which of them you might enjoy meeting. You’ll also be identifying those whom you’ll want to avoid. The best way to accomplish this is to show up early and to observe who’s doing and saying what. If you’re comfortable doing so, offer to help set up the chairs or make the coffee.If the group is doing its job, someone will recognize you as a newcomer and will extend a welcoming handshake. But all of this is most likely to happen if you’re there for the “meeting before the meeting.”

3. Let people know you.
If the group has a tradition of handing out chips or keychains to acknowledge various lengths of sobriety, stand up and get your applause. It’s not to satisfy your ego, but to let people in the group know where you are in your recovery. If the group doesn’t give out these tokens, it’ll be up to you to share the information when it seems appropriate.

4. Join a group, get involved.
This is really part two of the previous section. A great way to get connected in the fellowship is to pick one group and make it your “home group.” This is the one meeting each week that you won’t miss no matter what. Get a job in that group (greeter, coffee maker, etc.). This will ease your introduction to other group members and will enhance the likelihood that you’ll meet someone who might eventually become your sponsor.

Many groups speak at other meetings or at institutions such as hospitals, detox centers, and jails. Travel with them as they fulfill these commitments. Even if you’re not willing or eligible to speak (some groups require 90 days of sobriety before you speak at another meeting), traveling with your group will help you to know members on a more intimate level – and to further your bond with these important people.

5. Speak only when you’re ready.
Opinions differ here, but I’ve known people who stay away from recovery meetings because of their fear of public speaking. No one, in my opinion, should be badgered into speaking, although a gentle push from a trusted sponsor might be very useful indeed.

6. Go to the same meetings each week.
Again, your goal is to connect with others in recovery. Going to the same meetings each week will make it easier for you to identify and bond with the “right” collection of people. It’ll also make it easier to remember which meeting you’ll be attending on a given day. (”If it’s Tuesday, I’ll be at the hospital meeting tonight.”)

7. Go to different types of meetings, if possible.
There might be a variety of meeting types in your area. These might include discussion meetings where you can raise your hand and share what’s on your mind; speaker meetings where a few speakers share their experience, strength, and hope; and literature meetings that examine certain pieces of recovery writing. You also might find meetings that serve a specific constituency, such as men or women, gay/lesbian, Hispanic, young people, etc. It is generally recommended that you include different types of meetings in your recovery program if possible.

8. Sit up front.
If you’re easily distracted, please consider sitting up front – in the “intensive care unit.” Even after the meeting has begun, it’s so tempting to see who’s walking in the door, who’s chatting with whom, whose cell phone is ringing, etc. Sitting up front will help you hear the message that perhaps you need to hear.

9. Listen to the message, not the messenger.
No doubt, you’ll develop opinions about the people in recovery meetings. No doubt, some of these people will be (at least in your opinion) inappropriate, obnoxious, self-indulgent egomaniacs. Ironically, these same people just might be saying things that you need to hear. So try to ignore who is speaking and focus on the words, the message. Some of the most annoying people have experience and opinions that you can use. This is a learned skill. Work on it.

10. Ask for help.
Perhaps you don’t have a driver’s license or a vehicle. It is completely appropriate to ask if anyone in the group can give you a ride home after the meeting. You’ll not only get the needed ride, but you’ll also get to know people who might be willing to participate in your recovery efforts.And as long as you’re there to enhance your recovery, it is appropriate to ask for help in other ways. Maybe you need help moving a washing machine – or you’re looking for a certain type of employment. Speak up. You might not get the help you need, but it’s OK to ask. (Asking for financial help is generally not a good idea.)

11. Leave your partner at home.
If you absolutely need to bring your spouse/partner for moral support, go ahead. Do whatever it takes to get yourself to a meeting. But your job, ultimately, is to connect with others in recovery. If your partner is sitting beside you, you’ll be less able to meet others – and less inclined to speak openly about what’s going on in your life.

12. Have fun.
Many of us have to learn how to have fun without alcohol and drugs. Initially we fear that fun will be impossible without our “social lubricants.” Over time, we learn how to have sober fun. We learn new hobbies, develop new skills, and build our self-confidence. And we do all this with our new, sober friends.

If Ted Williams learned the game of golf, he did it by listening to the experts, learning some uncomfortable habits, and practicing his swing – year after year. The suggestions in this article might be awkward to implement at first, but they might help you get the most out of your recovery meetings – and enhance your quest for sobriety and serenity.

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Post-traumatic Stress Disorder and Addiction

March 24, 2008

In recovery from substance abuse, it is important to not only address the addiction itself, but also any mental health issues that the addict suffers from as well. Here, trauma and Post-traumatic Stress Disorder will be discussed as it relates to addiction.
Trauma, the experience of being emotionally overwhelmed by something that is not to [...]

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Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse Treatment Conclusion

February 25, 2008

For substance abuse patients, and therapy in general, the effectiveness of treatment is determined as much by the therapist as by any theoretical orientation or patient characteristics. With this dual-diagnosis population, it is often difficult to provide effective therapy. Therapist processes emphasized in Seeking Safety include compassion for patients’ experiences; using coping skills; giving [...]

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Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 4

February 24, 2008

A third study of a hundred inner-city outpatient women compared Seeking Safety with relapse prevention treatment (RPT), both in individual format, with a treatment-as-usual (TAU) control condition in a randomized controlled trial (Hien, Cohen, Litt, Miele and Capstick). At the end of treatment, patients in both Seeking Safety and RPT had significant reductions in substance [...]

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Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 3

February 23, 2008

Stephanie Covington has created a trauma specific model for women as well in 2003. In the introduction to her program, Covington (2003) discusses the integrated treatment approach focusing on women. “The connection between addiction and trauma for women is intricate and not easily disentangled” (p. 16). She goes on to discuss that the treatment provider [...]

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Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 2

February 22, 2008

Programs other than ‘Seeking Safety’ have been introduced, but few have any research backing. The ATRIUM Model, Addiction, Trauma, Recovery — Integrated Model, was introduced in 2001 by Dusty Miller and Laurie Guidy. They contended that twelve sessions of treatment per week running to 1.5 hours at a time, structured according to their treatment [...]

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Dual Diagnosis PTSD and Substance Abuse Treatments and Issues

February 21, 2008

Najavits et al (1997), identify treatment as crucial, “not only because of the prevalence and severity of co-occurring PTSD and substance abuse, but also because treatments that are typically used for PTSD or substance abuse alone may be insufficient for their combination”. Problems of using treatments suited to one or other of the disorders with [...]

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Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse

February 18, 2008

Dual-diagnosis PTSD and substance abuse has a complex history and position within the field of psychiatry and the context of treatments for mental disorders.
One of perhaps the most relevant studies on dual-diagnosis published by Najavits and Weiss (1999), assessing the clinical characteristics of twenty-eight women with dual diagnosis PTSD and substance abuse compared to the [...]

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