A3 Verified – KLEAN West Hollywood

February 5th, 2012

The A3 Rehab-Finder is happy to announce the full verification of The KLEAN Treatment Center in West Hollywood (call them at 323-391-4032).

The KLEAN Center is a licensed residential treatment facility and detox working with those suffering from alcohol and drug addiction as well as related co-occurring disorders. KLEAN’s clients receive the best of care with three weekly individual sessions with licensed staff including a psychiatrist, psychologists, and other clinical staff. For clients interested in the program, KLEAN offers a variety of residential treatment and aftercare alternatives including, Intensive Out Patient (IOP) treatment, alumni networking and a family education program. KLEAN’s mission is to create a safe environment, provide each resident with a unique continuum of care, and ensure a healthy transition into a sober life.

Nestled in the heart of West Hollywood, KLEAN is an urban sanctuary. Clients live in beautifully decorated private and semi-private cottages with no more than two people per room. KLEAN even allows clients to bring their pets along onto their dog friendly grounds!

During the day, KLEAN clients attend psycho-educational groups led by prestigious clinicians and group facilitators. KLEAN’s groups are grounded in evidence-based modalities, including cognitive-behavioral, psycho-dynamic, motivational interviewing, and somatic experiencing.

Each KLEAN client is assigned a case manager, a licensed clinician who provides them individual counseling sessions, as well as contact with referral agent, family members, physicians, and more. In addition, clients receive a weekly counseling session from our Director of Recovery Services.

KLEAN also places an emphasis on spirituality, through daily reflections and meditation, yoga and other health-wellness activities.

The KLEAN Center is an excellent place to get well mentally, physically, and spiritually, and now as an A3 verified provider treatment seekers can rest assured that Klean’s programs, facilities, and clinicians are able to provide the high quality of care they expect and need.

Posted in:  Education Tags: center, clients, klean, klean treatment center, residential treatment, treatment

Negative self-talk and addiction recovery

January 29th, 2012

Everyone has internal beliefs about what they are, or aren’t, good at. For many these have become an implicit reality – facts about life that are rarely examined and never questioned. The “gravity” of our lives.

When I review these internal beliefs with clients, especially those in early recovery but also others who don’t have trouble with addiction per se, we often find that they are packed full of negative self-beliefs and self-talk. Phrases like “I’m impatient/rude/stupid,” “I’m not good at doing _____,” or “I can’t handle _____” are so commonplace in psychotherapy circles that restructuring them can often become the focus of many sessions. And negative self-beliefs are a huge source of shame, and you know how I feel about that.

Inevitably these negative self-beliefs and the associated shame are often the remnants of past experience, whether personal or “other” inflicted. Poor performance in some childhood activity, ridicule by peers, or harsh words from misguided parents can lead to seemingly permanent imprints on the world-view of the young, and then the older. Ironically, even seemingly self-assured views like “I am in control of my life” can become defeating when they turn into “I am a failure because I can’t handle this on my own.” We get that one a lot in addiction treatment from clients who think that they are weak because they’ve found themselves needing help. Again, this thought pattern leads to shame and often resistance to receiving the necessary addiction help.

As usual, a big part of dealing with these issues, from both a cognitive behavioral therapy (CBT) point of view and a humanistic one, is to examine their sources and test their appropriateness. It’s rare that these statements prove universally true and it’s even more infrequent that they turn out to have no connection to a small set of past hurts that happened long ago. In recovery from addiction, I often have clients look at how many other things in life they’ve needed help with – learning how to read, how to play sports, or how to do well at their job. We’re constantly relying on others for help, but when it comes to our psychological functioning we believe that we should be masters regardless of our level of training – a belief that I see as having no basis. But then again, I am a psychologist…

How to break negative self-talk and self-belief cycles

For readers who want to test their own beliefs and the existence of their own negative self-talks it helps to keep a written journal. Make a list of such negative self-beliefs that you are already aware of and try to be as aware as possible of negative self-talk as it happens over the course of one whole day. Write those down too. Now, using a whole line on a piece of paper (or a spread-sheet if you want to be super organized about this) create little spaces (columns) to write down a single situation in which those thoughts and beliefs come up for you in everyday life. In the nest column put down an objective assessment of what actually happened. In the last column write a short assessment of how close your initial internal dialog was to the “truth.”

Let’s use an example – Imagine getting an upset email from your boss that brings up your good old “I’m never going to succeed” negative self-belief. When you go to your journal and find the line for that specific negative belief you write “got upset email from boss” in column one and “boss was upset that I forgot to send out update email yesterday as expected” in column two. Now examine your current level of functioning at work in light of this specific mistake, past work occurrences, and the very near future.

If you’ve been held back from advancement repeatedly and been scolded, fired, or nearly fired for forgetting these sorts of things in the past, the belief might be a sign that you need to become active about finding ways to improve on this sort of forgetfulness in the future. But if such occurrences are relatively rare and haven’t caused negative consequences at work or other environments, then it sounds like the belief is an exaggeration of a much less frightening reality along the lines of “I don’t always perform perfectly at work.” I don’t know about you, but that sort of internal belief I can live with.

Now go on and do your homework – or are you a slacker?!

Posted in:  Education, For addicts, For others, Tips Tags: addiction, belief, beliefs, negative, negative self, negative self beliefs, negative self talk, self, self beliefs

Naltrexone the addiction cure?

January 23rd, 2012

CNN released a news article a little while back titled “With anti-addiction pill, ‘no urge, no craving‘” that seems to suggest that a cure for addiction has been found. As usual, news reporting on these sort of topics revolves around a kernel of truth, with nice window dressing an a serving of embellishment.

While naltrexone, and topiramate, have been shown to improve outcomes in addiction treatment, they have by no means revealed anything that would warrant giving them the title “anti-addiction pills.”

Indeed, there are now a few different preparations of Naltrexone, including a long acting version called Vivitrol that while relatively expensive, has been shown to be relatively effective at cutting relapse rates for both alcoholics AND heroin (or opiate addicts). Note the difference though here between my language and that used by CNN; Naltrexone has been shown to reduce relapse rates, not eliminate them, and current research seems to show that it is most effective only for specific groups of alcoholics who have a specific type of Mu opioid receptor.

As the article points out, a combination of therapies, including behavioral therapies, medications, and social-support, are still the best option when it comes to addiction treatment.

We’re a long way off from finding anything that can be considered a cure for addiction, no matter what some treatment centers like to claim, but these pills should help us stem the tide while we keep looking…

Posted in:  Education, Medications, Opinions, Treatment Tags: addiction, addiction cure, addiction pill, alcoholics, anti addiction, CNN, cure, cure addiction, heroin, mu, naltrexone, news, opiate, opioid receptor, pill, relapse rates, topiramate, treatment, vivitrol

Rubber-band addiction recovery – No shame

January 15th, 2012

There’s a specific issue that keeps coming up with nearly every addiction client I work with who is in early recovery. Regardless of whether they’re trying to stop unhealthy alcohol or drug use, sex or gambling behavior, or anything else, this issue keeps returning. It doesn’t even seem to matter if this is their first attempt at addiction recovery or if they’ve already been here many times before.

The issue: Shame about a desire to return to old behaviors and stopping their recovery.

At the Matrix Institute on Addiction where I see some clients, they call this “The Wall” suggesting that it usually comes right after a relatively easy period of recovery in which clients are self-assured and confident that they’ve got their addiction beat. “The Wall” is supposed to be marked by anhedonia, depression, severe cravings, irritability, and more fun stuff like that. After the wall is the promised land of long-term recovery. By identifying the specific stages of recovery addicts are supposed to gain more understanding of their process and experience less shame. I love the Matrix method, but I see things a little differently.  The way I see it, “The Wall” is far from a single point in time, but is instead part of a larger pattern I like to call Rubber-band Recovery.

Rubber-band Recovery in Addiction

I’m sure everyone reading this has at some point played with a rubber band, stretching it and letting it snap back to its original state or pulling it between two fingers and playing it like a string (another name for this approach could be String Recovery, but that might get confused with theoretical physics and we don’t want that). When pulling the rubber-band one way, its internal structure pulls back, trying to get back to its natural state. The body can be thought to do the same when placed under chronic alcohol and drug use in addiction – it has a slew of internal processes that work hard to keep the body in its natural state, at homeostasis. Naturally, due to the pharmacological mechanisms of alcohol, cocaine, methamphetamine, marijuana, and many other drugs, these systems usually fail at setting everything back to normal especially during the use itself, which is why we get high. However, their work in a body that consumes drugs on a regular basis is obvious – reductions in the production of specific chemicals (like relevant neurotransmitters), changes in the structure of the brain itself (like producing less receptors or even removing some from the brain’s cells), and production of chemicals that combat the drugs’ actions.

All in all, the body and brain of a long-time, chronic, heavy user of alcohol and drugs are different from the body and brain they started with in important ways that specifically relate to their alcohol and drug use. They are like the stretched rubber band, similar but obviously not the same as it was in its relaxed state.

Individuals in early recovery from addiction essentially experience what happens when that taut, stretched, rubber band is let loose. Hurrying up to get back to its natural state, to homeostasis, it releases all that pent up energy and rushes through its original state, overcompensating and stretching a bit in the other direction. For the addict in early recovery, this is the process of withdrawal. As we’ve spoken about numerous times before when discussing withdrawal, a brain that has reduced its own production of dopamine because of large amounts of methamphetamine that flood its dopamine reserves will still be left with very low dopamine when the crystal meth stops coming in. Low dopamine will bring about many effects that look exactly like the opposite of a methamphetamine high – a large appetite, low energy, and reduced movement and motivation. For heroin addicts, the drug that’s caused them to feel no pain and become constipated will cause their bodies severe pain, diarrhea, and trembling when it’s removed from the equation. Some withdrawal is actually life threatening due to the extreme changes in body chemistry and structure that happen after long term use. In addition to all of the direct effects of the drugs and alcohol, those internal processes that have been working hard to counteract the effects of the drugs (they’re called “opponent processes” by some addiction researcher like Dr. Christopher Evans from UCLA) are still turned up to 10 and are going to take a little time to get back to their original state as well. All in all, that leaves addicts feeling pretty crappy to say the least during withdrawal, the worst part of early recovery from addiction.

But like that good old rubber-band addiction recovery than quickly turns around. Having overcome the worst part of withdrawal, addicts in early recovery often experience joy, confidence, energy, and clarity they probably haven’t felt in a long time. That along with the environmental influence of loved ones who are extremely happy to see an addict quit (especially the first time around) give those in very early recovery a feeling of great well being and happiness, like a nice pink-cloud they get to ride on for a bit. Remember, the rubber band is moving back in the direction it came from during active addiction and it’s likely that brain processes are doing a little overcompensating the other way now too, turning down those opponent processes and flooding the brain with the chemicals it’s been missing.

But alas, this little turn doesn’t last too long and back we go into the darker place of negativity, low energy, anhedonia, and more. But instead of calling this stage “The Wall,” I understand it as one of the inevitable turns in what is sure to be a back and forth, seesaw like trip of recovery ups and downs. Periods of confidence in our ability to overcome our demons are followed by others that make us feel week and irritable. The good news is that just like with a rubber-band, each successive cycle on this seesaw gets a little less intense, which means that confidence, elation, depression, and anger turn into comfort, contentment, and ease – our new homeostasis. After a ride like that most addicts really need a little rest and when we reach this stage (no matter what it looks like specifically for each person), long-term recovery feels like the norm instead of an effort. This is the real end goal of recovery – a state of being that feels normal and that doesn’t involve unhealthy alcohol or drug use, sexual acting out, or gambling.

At the end of the rubber-band game we get back to just a good old unstretched rubber-band, and it feels good. In the process, it makes little sense to feel guilty, or ashamed, at all the intermediate stages. They’re part of the game of recovery and they’re essentially impossible to avoid completely. Intense cravings come during specific parts because of internal, biological, and external, environmental influences. Being ashamed of that would be essentially the same as being ashamed of extreme hunger when you haven’t eaten in 5 hours and see a commercial for your favorite food – silly and useless. I can guarantee that the rubber band doesn’t feel ashamed about they way it behaves when snapping back…

Posted in:  Education Tags: addiction, alcohol drug, alcohol drug use, anhedonia, ashamed, band, biological, cravings, depression, drug use, early recovery, early recovery addiction, long term recovery, recovery, rubber, rubber band, UCLA, unhealthy, withdrawal

Heavy alcohol users Vs. Addicts – Stress response

January 4th, 2012

I can’t even count how many times I’ve talked about the difference between alcohol or drug users and alcoholics or addicts (see here, here, and here for some examples and keep reading). The quick summary: Many people use drugs and many abuse them at times, a small percentage meet criteria for addiction at some point in their life and an even smaller percentage is the type of addict we’ve been taught to think of – chronically relapsing and seemingly incapable of quitting no matter how crappy their life gets.

One of the main reasons we study drug and alcohol abuse is because of the huge health impact of this stuff – we spend billions and billions of dollars every year on health-care that is directly or indirectly related to the abuse of nicotine, alcohol, and pretty much every other drug on earth (marijuana can certainly help some conditions but heavy use of marijuana can bring its own consequences). One of the major players in these health problems is the effect of alcohol and drug use on stress in the body. Stress increases death rates in several ways including: Heart attacks, strokes, cancer, and more.

Well, a recent study in Amsterdam looked at alcohol (yes, you read that right, the Dutch care about more than weed) consumption, alcohol addiction (alcoholism) diagnosis, and effects on the body’s stress system, also known as the HPA (Hypothalamic-Pituitary-Adrenal) Axis. If nothing else, the study helped confirm that an alcoholism diagnosis is not necessarily the same as an indication of heavy drinking and that excessive drinking is no bueno, regardless of whether it meets addiction criteria or not.

Alcohol drinking, alcoholism, and stress regulation

I’m not going to go into this in detail (look here and here for more) but just as our brains and bodies have systems for decision making, they also have complex stress management systems. The latter rely heavily on hormones, including Cortisol, to keep our bodies in the right states whether those be fight, flight, or reading a book before sleep (see figure on left for over-simplified cortisol levels throughout the day in a normal person). We’re supposed to have the most cortisol right upon waking with constant reductions throughout the day until we fall asleep, and back again. Individuals with mental health disorders like anxiety and depression have substantially different cortisol level patterns throughout the day and are less effective at regulating cortisol (in case you needed another reason why our biology affects our states of being and behavior).

The dutch study tested cortisol levels at 7 different times throughout the day after giving their subjects a 4 hour battery of tests. They also assessed their cardiac functioning by assessing different measures related to heart beat regulation that allows for adapting across challenging situations by affecting the sympathetic nervous system (excitatory processes) and parasympathetic nervous system (inhibitory processes).

They looked at these measures as a way of assessing the relative functioning of the HPA Axes’ of different groups. Specifically, they looked at:

1. Non-drinkers
2. Moderate drinkers (less than 3 drinks per day)
3. Heavy drinkers (more than 3 drinks per day)
4. Non alcoholics
5. Remitted alcoholics (met criteria for alcoholism previously but not in past 12 months)
6. Current alcoholics.

One of the most interesting findings, as far as I’m concerned, was that among remitted alcoholics the average amount of drinking was around 1.3 drinks per day with a lot of variability, a little higher than that of moderate drinkers (0.8 drinks per day) but lower than that of heavy drinkers (4.0 drinks per day). I see this as a little more proof that people who met criteria for alcoholism at one point don’t necessarily abstain forever and don’t necessarily continue to have drinking problems (per Moderation Management, spontaneous remission, or some other means of stopping their alcoholic drinking).*

You can blame improper diagnostic criteria, a continuum of addiction severity, or anything else as far as I’m concerned but as I pointed out in my first paragraph, we’ve talked about this topic repeatedly and I see no end coming soon. The bottom line is that meeting criteria for alcoholism at one point in life tells me something, but far from everything, about a person’s drinking habits or drinking problems later in life.

But back to stress. As you might have already guessed, since it is heavy drinking that causes serious dysregulation of the body’s stress response, what the researchers found was that meeting criteria for alcoholism now, or in the past, didn’t have any major effect over their participants’ HPA functioning. Instead, all that mattered was how heavy their drinking was now. Heavy drinkers had higher waking cortisol levels, higher night-time cortisol, and increased sympathetic (excitatory) control. In short – heavy drinkers were less able to regulate their stress and excitation response, likely leading to increased stress on their bodies.

As a side note, this study also found that if anything, moderate drinking conferred health benefits when it came to stress over not-drinking at all – far from the first study to note this but another set of reinforcing evidence that drinking alcohol is not in itself bad for you while over-drinking is.

So – Drinking a lot of alcohol causes disruptions to your body’s stress regulation system that will likely increase the likelihood of heart problems, depression, anxiety, and more. Those disruptions are there whether you meet criteria for alcoholism or not.

Obviously, there are many alcoholics who drink a lot of alcohol, but there are also people who meet (now or in the past) criteria for alcoholism who are binge drinkers and therefore don’t drink daily and have lower “drink numbers.” As we mentioned before, addiction is not about quantity, in fact, the criteria for addiction barely mentions quantity – when it states that addicts consume “more than intended” or that tolerance creates a state where an person needs greater quantity to reach the same effect of the drug. Drinking or using a lot of drugs or alcohol does not an addict make.

*Note: Given the variability in the remitted-alcoholics groups their is little doubt that some of them had stopped drinking while others drank to excess. Additionally, it should be pointed out that alcohol abuse was not assessed in this sample, so it could still be a problem for at least some of those now-drinking past-alcoholics.

Citations:

Lynn Boschloo, Nicole Vogelzangs, Carmilla M.M. Licht, Sophie A. Vreeburg, Johannes H. Smit, Wim van den Brink, Dick J. Veltman, Eco J.C. de Geus, Aartjan T.F. Beekman, Brenda W.J.H. Penninx (2011). Heavy alcohol use, rather than alcohol dependence, is associated with dysregulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Drug and Alcohol Dependence 116, 170–176.

Heather M. Burke, Mary C. Davis, Christian Otte, David C. Mohr, (2005).  Depression and cortisol responses to psychological stress: A meta-analysis, Psychoneuroendocrinology, Volume 30, Issue 9, Pages 846-856.

Posted in:  Alcohol, Education Tags: Alcohol, alcoholism, cortisol, criteria, criteria alcoholism, drinking, heavy drinkers, hypothalamic pituitary adrenal, stress

New Year’s Eve without drugs or drinking alcohol?

December 30th, 2011

For many people all around the world, New Year’s Eve celebrations mean a lot of partying. Often, that partying includes drinking alcohol, doing drugs, and generally engaging in one last night of “things you’ll forget about” in the year that has passed. I know the ritual and I took part in it often. Hell, the virtual symbol of NYE is the Champagne toast (talk about a trigger).

Since high-school, NYE celebrations meant little more than getting so &#@$-faced that I wouldn’t be able to remember what happened the next morning. Actually that’s not true – I’ve only experienced one blackout in my life – I always remembered what I did on New Year’s Eve. From my early days of drinking as close to an entire bottle of vodka as I could along with some gravity bong hits for my CB1 and CB2 receptors to fully light up to later parties that involved acid (LSD), ecstasy (MDMA), cocaine, and finally crystal meth, it was all about excess in its rawest form.

Humans enjoy celebrations in a way that other animals simply don’t. It comes with our keen awareness of past, present, and future. It’s the way we mark special events that only have true meaning because we assigned it to them. It’s part of what makes us the most social of animals and is tightly connected to our brains and their massive supply of executive function. But none of that matters when you’re loaded on drugs or alcohol on New Year’s Eve. All that matters is that you’re having fun.

For most people, this sort of partying doesn’t cause any problems. As long as they don’t drive under the influence, getting a little messed up is just not that big a deal. Hey, getting high on drugs and alcohol has left us with some of the best art, music, and writing I can think of and out livers and kidneys can handle the stress pretty well. But for some people, that same seemingly innocent set of behaviors can lead to a far darker place.

For addicts who have become dependent on drugs or alcohol, or for those people teetering on the edge of addiction with drugs and alcohol as still fully functional crutches that make the world slightly more tolerable, that same partying can get dangerous. It can lead to memory loss and accidental death. It can lead to the destruction of property, relationships, and self-esteem. It can lead to handcuffs and metal bars that don’t go away when the effect of the drugs or alcohol wears off.

As I’ve talked about so often here, we’re still pretty bad at telling the difference between those who are simply partying hard and those who have a real problem. We can tell after the fact, looking back at how long someone struggled (hard-core addicts can spend decades struggling with addiction while the more tame abusers/addicts only last a few years) but that doesn’t do anyone much good now does it?

I’ve sat in many groups with addicts trying to plan for these holidays so that they can make it to the other end without throwing away everything they’ve worked so hard for. The temptation of shooting up, smoking a bowl, or drinking a fifth of your favorite liqueur (or 2 bottles of wine)  can be too much when everyone around you makes it seem like so much fun. Many make it through with little more than resolved anxiety and a sense of relief. But every year, a few get left behind, some to return a bit later with a little more of a war story than they had previously.

The point – Making it through the holidays

The holidays, and New Year’s Eve in particular, are a bad time to try to figure out which of these groups you belong to exactly because everyone else is being excessive too. An addict can easily cross the line and seem no different. Until the next day that is. So this holiday, do yourself a favor and hold off on any grand experiment. Take it easy, spend some time with real friends who have your best interest at heart, and make it to the next year in style. You can always test yourself another day.

Posted in:  Education Tags: addicts, Alcohol, blackout, Drugs, drugs alcohol, handcuffs, jail, liquer, new year's, new year's eve, NYE, partying, wine, year's eve

Recovery = Abstinence… Or not

December 25th, 2011

The Substance Abuse and Mental Health Services Administration (SAMHSA) just release a new definition of “recovery” from mental health and addiction:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

I’ll give you 10 seconds to find a key missing ingredient in this definition of recovery without peeking at our title. Hey! No Looking!!!

The definition calls recovery a process the provides improvements in well-being and that allows people to gain control of their life. It seems that abstinence is simply nowhere to be found in this new SAMHSA definition.

I have no doubt that some people will be upset about the decision not to include abstinence in the definition of recovery, but I won’t be one of them. I’ve been saying that we should be moving to a different definition, one that focuses on improvement in quality of life, as the basis for whether someone is in recovery or not. You see as far as I’m concerned it doesn’t matter whether a person is using any substances – all I care about is the impact of such use on their well being, their “quality of life.”

We’ve already written a few article on All About Addiction making this exact point (see here and here for some examples) and there have been some addiction researchers calling for the same when measuring success in addiction treatment research (see here and here).

Most addiction treatment research simply measures abstinence when individuals finish treatment (especially outpatient treatment) and then maybe 6 or 12 months later. But as the research I linked to earlier shows, there are a whole slew of people who are not abstinent a year after their release from addiction treatment but are without a doubt involved in recovery: Their substance use is either fully under control or is at least producing much less of a problem than it had before. As far as I’m concerned that is a success, and if the use begins being troublesome again, then it is possible that more treatment, and perhaps complete abstinence, is necessary.

This whole thought process can easily lead us right down the harm reduction, substitution therapy, and legalization argument rabbit hole, and I’m all for that discussion. I’m also sure that I will once again get some more hate-mail from readers who think I’m being irresponsible by suggesting that people who have at one point had trouble with substance abuse may be able to use anything (even substances that were not their drug of choice) ever again. They’ll accuse me of being responsible for those who decide to try such methods and fail while taking absolutely no responsibility for the countless who try their approach and relapse. Fortunately for me I’ve learned to ignore those emails.

Posted in:  Education Tags: 12 months, addiction, definition, definition recovery, recovery, SAMHSA, substance abuse and mental health services administration, treatment