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Posts Tagged ‘SMART Recovery

Stopping a slip from becoming a relapse

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Stopping a slip from becoming a relapse

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

For many with serious substance abuse problems, any drug or alcohol use can be problematic. These people must abstain.  If they drink or drug again, they can slip into full-blown relapse, even after months or years of abstinence.  For some, even a brief lapse may generate so much self-doubt, guilt, and a belief about personal failure, that the person gives up and continues to use.  This tendency is referred to as the abstinence violation effect.

So does this mean that even a brief lapse must lead to a full-blown relapse?  Does it mean a person must continue to drink or drug until the use returns to the initial level?   Is spiraling out of control inevitable?   Simply put, no.  A lapse need not become a relapse.  After a slip, you have not unlearned all that you have learned.  You have not unchanged all that you have changed in your life to support your recovery.  You do not have to start counting again from day one.

If you view your lapse as a mistake and as a product of external triggers, rather than as a personal failure, research shows that you will have a much better chance of return to abstinence quickly.  Your lapse becomes a tool to move forward and to strengthen your motivation to change, your identification of triggers and urge-controlling techniques, your rational coping skills, and the lifestyle changes needed to lead a more balanced life.

Does this mean that a person should view these lapses as a good thing?   Of course not!   Clearly, if one wants to abstain, lapses are not preferred.  But by recognizing that mistakes can happen and learning how to quickly right oneself, long-term abstinence can be achieved.   Lapses may occur, but relapse is not inevitable.

Copyright ( 2012) Julie Myers, PysD:  Psychologist in San Diego.  All Rights Reserved.

The SMART Recovery® Activities Scale (SRAS)

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The SMART Recovery® Activities Scale (SRAS)

by Julie Myers, PsyD and Donald Meichenbaum, PhD

The SMART Recovery® Activities Scale (SRAS) is a new tool to help those engaged with SMART Recovery®.   The SRAS was developed by Julie Myers, Psy.D.1 and Donald Meichenbaum, Ph.D.2   

The SRAS can be used by participants to assess how far they have come in their own recovery, by facilitators, and by professional therapists/counselors with their clients.  Professionals may wish to use the SRAS in order to:

  1. Assess what SMART Recovery® activities clients have already engaged in and what SMART Recovery® beliefs they have embraced.
  2. Assess the reasons why clients have or have not engaged in these activities (possible barriers, lack of motivation, confidence, or skills) and how these obstacles can be addressed.
  3. Engage would-be participants to join SMART Recovery® and treatment, highlighting what new members may get out of some form of treatment

The SRAS for participants is available on-line in an easy-to-use PDF format, which can be filled-out on-line or can be saved and printed.  (http://www.smartrecovery.org/resources/library/Tools_and_Homework/Quick_Reference/SRAS_for_participants.pdf

 The SRAS for therapists/facilitators containing additional instructions is available at http://www.smartrecovery.org/resources/library/Tools_and_Homework/Quick_Reference/SRAS_for_therapists.pdf

Dr. Meichenbaum and Dr. Myers are seeking feedback about your experience with the SRAS.  Your feedback is greatly appreciated, as it will help to refine the scale and  help develop other SMART Recovery® materials that will have wide distribution throughout the world.  Please direct your e-mail to Julie.Myers100@gmail.com.
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1 Dr. Myers is a Licensed Clinical Psychologist in San Diego, California

2 Dr Meichenbaum is one of the founders of Cogntivie Behavior Therapy and is presently Research Director of the Melissa Institute for Violence Prevention in Miami ( www.melissainstitute.org)


Making Changes in Recovery, Step-by-step

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Making Changes in Recovery, Step-by-Step

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

 

Have you ever wanted to make changes in your life, but felt so overwhelmed by the situation that you didn’t know where to start?  Sometimes it helps to break the change down, working through the situation step by step using pencil and paper.  (A useful worksheet can be found at http://www.smartrecovery.org/resources/library/Tools_and_Homework/Facilitators_Handout/Change_Plan_Worksheet.pdf).  First, think about why you want to make the change and then work through the steps you will need to get there. As you do this, you may find that the change you want to make really requires more than one significant change.

For example, let’s say you want to start exercising in the morning. As you work through the steps, you find that to do this, you will have to leave earlier in the morning, which means that you need to be more organized in the morning, which requires that you go to bed earlier, which means that you need to leave work earlier, which requires that you have lunch by noon.  Too many major changes means overwhelm!

Instead of becoming frustrated, break each of these steps into a different change plan, starting with the easiest change (such as having lunch earlier!)  By doing this, you will feel less overwhelmed, be more successful, and will feel better about your ability to make changes. With thoughtful forethought, you will be amazed at the changes you can make!

– Julie Myers, PsyD, MSCP

http://www.DrJulieMyers.com


Assumptions About Substance Abuse: An Opinion

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Assumptions About Substance Abuse:  An Opinion

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego;  http://www.DrJulieMyers.com

 

There are many different models of addiction, including moral, psychological (cognitive-behavioral, learning, psychodynamic, and personality), biological (genetic, biomedical, disease, medical) and socio-cultural (McNeese, 2005.)  Each of these different models operates under a different set of assumptions.  The disagreement between the models rests on the different political motivations, ideologies, personal interests, and professional training of the individual (McNeese, 2005.)  Substance abuse counselors, for example, have generally adopted the 12-step approach to the disease model, since it is what they themselves experienced.  Probably the most commonly held is the disease model. “The disease model of addiction rests on three primary assumptions: a predisposition to use a drug, loss of control over use, and progression” (Krivanek, 1988, p. 202.)  It has its roots in Alcoholics Anonymous (Yalisove, 1998.)

The World Health Organization has adopted the word drug dependence to describe the addiction process. “The general term (drug dependence) will help to indicate a relationship by drawing attention to a common feature associated with drug abuse and at the same time permit more exact description and differentiation of specific characteristics according to the nature of the agent involved.” (WHO, 1964.)

Perhaps the stress-diathesis model best describes substance abuse, dependence, and addiction.  This model describe a basis of genetic and neurological susceptibilities to addiction, either because of the genetic susceptibility to the substance (or behaviors) or because of the genetic susceptibility to certain mental disorders, which increases the likelihood of self-medication and the abuse of substances (or behaviors.)  For example, those with Bipolar
Disorder have a 50-80% increase in substance abuse, which is thought to be largely self-medication. Given a person’s susceptibility, the environmental factors then influence whether or not any one individual develops a problem with substances (or behaviors.)  Upbringing, peers, experiences, and culture all shape one’s use of substances.  How the individual responds and copes with environmental stressors in large part determines their use.  Addictions represent a maladaptive coping mechanism to these environmental stressors.

It may not be necessary to know the etiology of substance abuse to treat it.  Although such information is interesting scientifically, and it can perhaps lead to better identification of susceptible individuals, treatment should concentrate on identifying those individuals with addictive problems and implementing effective treatment.  The identification of addiction problems can be culturally influenced.  Although the scope of the problem throughout the world is massive, the definition of it as an “addiction”, “abuse” or “dependence” must be understood in light of cultural norms.

The DSM-IV (APA, 1994) defines substance abuse and dependence as:

  • Substance Abuse is a maladaptive pattern of substance use which results in clinically significant impairment, with one (or more) categories occurring within a 12 months:  failure to fulfill major obligations, use in hazardous situations, legal problems, or social problems.
  • Substance Dependence is a maladaptive pattern of substance use, which results in clinically significant impairment, with three (or more) categories occurring in the same 12 months: physical tolerance, withdrawal symptoms, a large amount consumed over a long period, a lot of time spent, negative consequences, and continued use despite recurrent problems.

Although the DSM criteria states that three criteria must be met, in my opinion, for any particularly individual, simply displaying one of these criteria could signify abuse/dependence.   For example, continued use, despite knowledge of significant problems may be enough to signify that there may be an addictive disorder.  Setting the criteria for dependence as three/five criteria may be necessary for those individuals for whom there is less clear evidence of maladaptive behaviors.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.  

Copyright (2011):  Julie Myers, PsyD.  All Rights Reserved

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APA.  (1994).  Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington DC: American Psychiatric Association.

Bergh, C., T. Eklund, P. Sodersten, & C. Nordin (1997).  Altered dopamine function in pathological gambling.  Psychological Medicine, 27: 473-475.

Doweiko, H. (2006). Concepts of chemical dependency. 6th ed. Belmont, CA: Thompson .

Goudriaan, A., J. Oosterlaan, E. de Beurs, & W. Van Den Brink (2004). Pathological gambling: a comprehensive review of biobehavioral findings.  Neuroscience & Biobehavioral Reviews.  28(2), pp.123-141.

Krivanek, (1988), p. 202., Addictions.  Sydney: Allen & Unwin.)

McNeese, C. & D. DiNitto (2005).  Chemical Dependency. United States: Pearson Education, Inc.

Sunderwirth, S., &H. Milkman (1991). Behavioral and neurochemical commonalities in addiction, Contemporary Family Therapy , 13(5 ) pp. 421-433

WHO (1964), Expert Committee on Addiction-producing Drugs: Thirteenth report, p. 53 -55.

Yalisove, A. (1998). The origins and evolution of the disease concept of treatment.  Journal of Studies on Alcohol, 59, 469-476.

Change in Recovery Takes Work!

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Change in Recovery Takes Work!

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego, California

 

Change in recovery takes work, just like learning any other new skill. It rarely happens without effort. Try these simple tips to make faster progress in your recovery:

  • Write down a list of tools you can use and keep it handy, such as in your wallet, purse, or phone.
  • Complete a Cost/Benefit Analysis and keep it close for quick review.
  • Post motivating coping statements where you can see them often, such a mirror, refrigerator, or car.
  • Use a planner or calendar to plan your day out to include non-using, fulfilling activities.
  • Work through exercises, with pen and paper. You will be surprised the difference actually doing the exercises will have.
  • Participate fully in Recovery meetings. Volunteer to have your problem as the focus of the meeting.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.  

Change Planning

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Change Planning

by Julie Myers, PsyD, MSCP

Clinical Psychologist in San Diego, California

Change doesn’t necessarily happen without careful deliberation and planning. If we just expect things to happen on their own, we can end up repeating the same behaviors we hoped to change. For example, let’s say the change I want to make is to add more positive social interactions into my life. If I don’t think about how I’m going to accomplish this, I can easily fall back into the habit of working too much, engaging in non-fulfilling activities (such as watching TV), or drinking/ drugging.

Instead, if I consciously plan-out the steps I need to take to engage in social activities – such as limiting work hours, setting up appointments with friends, signing-up for a class – I am more likely to actually follow-through. Also, exploratory why I want to make this change will help me build the motivation to stick to my plans.

So the next time you want to make a change in your life, try some thoughtful planning with pencil and paper. SMART Recovery has a great worksheet to help you with your planning, which you can find at http://www.smartrecovery.org/resources/library/Tools_and_Homework/Facilitators_Handout/Change_Plan_Worksheet.pdf

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.  

Get help with SMART Recovery – A checklist

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Are you looking for a way to see how you’re doing in recovery?   Just posted on the SMART® Recovery website is a new tool to help people determine where they are with their recovery.   You can find it at http://smartrecovery.org/resources/latestnews.htm#checklist

Dr. Julie Myers and Dr. Donald Meichenbaum are debuting a SMART Recovery Participant Checklist, designed to be used to determine how much you are learning as you participate in the SMART Recovery Program.

This easy-to-use PDF form allows you to check off items, and save a copy on your computer, or you may print it out and use it.

Feedback is being sought by those who use it, and your participation is most welcome! A feedback survey link is provided within the PDF file.

Julie Myers, PsyD, MSCP

Licensed Psychologist, MS Clinical Psychopharmacology, Master Addiction Counselor, Board Certified Biofeedbachttp://www.DrJulieMyers.com.  

Written by Julie Myers, PsyD, MSCP

February 8, 2011 at 3:30 pm

Internet Services to Help Problem Drinkers

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Internet Services to Help Problem Drinkers

A Review by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego

“Can targeting nondependent problem drinkers and providing internet-based services expand access to assistance for alcohol problems?   A study of the moderation management self-help/mutual aid organization”

by K. Humphreys and E. Klaw

There has been a call for alcohol programs to broaden the base of alcohol intervention, reaching out to those who do not normally seek treatment (Tucker et al., 1999.)  By offering programs targeted to nondependent drinkers and by using electronic media, those who do not normally seek treatment may be included.  In this study, Humphreys and Klaw surveyed members of the self-help group known as Moderation Management (MM) to determine if the group has reached this underserved population.

Moderation Management is a non-12-step based self-help group, which helps those who wish to moderate their drinking.  Although there are other non-12-step based sobriety programs – such as SMART® Recovery, Rational Recovery, and Women for Sobriety — the authors claim that MM is the only self-help organization to target nondependent problem drinkers and to allow moderate drinking rather than abstinence.

The authors examined the characteristics of members of the group through survey self-reports.  The survey included demographic characteristics, alcohol consumption patterns, life functioning, religious tendencies, and participation in other self-help groups. It also explored the participation in the group via internet-based resources to determine if members in these groups differed from members involved in face-to-face meetings.   177 surveys were returned, which represented a large proportion of surveys given out in face-to-face meetings and an unknown proportion of electronic surveys.

The results showed that those in MM tend to be white, employed, college educated, not strongly religious, and early middle-aged.  Those returning the online surveys were more likely to be female, more educated and atheistic, and have greater markers for dependency.  Few respondents were likely to have other drug dependencies.  Overall, MM does not attract those who are highly dependent, who would more likely benefit from an abstinence approach.  For those who attended online meetings, their stated reason for using the electronic resources were its availability and ability to access the resource at any time of day, the privacy afforded, and because they found it easier to write about their feelings than speak about them.

This study brings to attention the need for and availability of alternative alcohol self-help groups.  However, the study was clearly limited in its ability to conclusively determine characteristics of the self-help group members.  This was largely due to the experimental design, which used self-report measures.   Also, the surveys returned clearly biased the results in favor of those who were highly motivated to return the surveys (or who really needed the $20 payment!)   It is likely that those who were more highly educated and who preferred writing about their problems were more likely to complete the survey.  It would be interesting to conduct a survey with a randomly selected sample population, something unlikely with such a small organization of voluntary members.

In my opinion, the authors did not seem particularly knowledgeable about other self-help groups, often misrepresenting them.  They state that other self-help groups have claimed a “niche” market.  SMART® Recovery, for example, is a broadly-based group that includes members with a wide variety of addictive behaviors and socio-economic backgrounds.  The only niche that I see in this group is that it is not Alcoholics Anonymous (AA).  The authors also include Rational Recovery in their discussion of self-help groups, even though they have not existed as a self-help group for some time and are not abstinence based.

The authors propose that one reason that more women use the online self-help group than men is because men may be more dedicated to abstinence.  This is highly speculative and does not seem very well informed, in my opinion.   There are many more plausible explanations for this, including the greater likelihood that women completed the survey and the social climate of AA, which is the most well attended abstinence based self-help group.  Women are more likely to have a strong social network then men, thus they are less likely to rely on a self-help group for social contact; men tend to have fewer social contacts, especially those that do not use alcohol, and thus may seek out the social support of AA.   A random sample would help tease this out.

Also, I believe that men are more likely to receive court-appointed treatment than women, thus they are more likely to be mandated to abstinence-based programs.  As far as I know, MM does not comply with court mandates for treatment.  Mandated treatment is a significant reason why people attend self-help groups.  It would be interesting to ask members why they are attending treatment in further surveys.  It would also be interesting to ask if their ultimate goal was abstinence.

The authors stated purpose was to explore how services could be tailored to non-dependent drinkers and to those wishing to use the internet.   It would have been interesting if the authors speculated about how this group could have been tailored to meet that need.  Given the data collected, how could MM attract more members or a more diverse group of members?

– Julie Myers, Psy.D.

http://www.DrJulieMyers.com

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References

Humphreys, K. & E. Klaw (2001) Can targeting nondependent problem drinkers and providing internet-based services expand access to assistance for alcohol problems? a study of the moderation management self-help/mutual aid organization.  In Journal of Studies on Alcohol: 62(4), pp. 528-532.

Moderation Management, February, 17, 2007.  <http://www.moderation.org/&gt;

Tucker, J., D. Donovan, & G.  Hiarlati (Eds.) (1999), Changing Addictive Behavior: Bridging Clinical and Public Health Strategies, New York: Guilford Press.