How to Support Recovery and

Not Addiction

How to Support Recovery and

Not Addiction

Dawn Farm Education SeriesMay 15, 2012

Charles F. Gehrke MD, FACP, FASAM

Dawn Farm Education SeriesMay 15, 2012

Charles F. Gehrke MD, FACP, FASAM

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For the next 75- 90 minutes:For the next 75- 90 minutes:

1. Remember the title of the presentation is: “Support Recovery” - not create or cause it.

2. Put aside any preconceived notions and ideas about addiction and recovery.

3. Put aside your rational thinking for a short time.

1. Remember the title of the presentation is: “Support Recovery” - not create or cause it.

2. Put aside any preconceived notions and ideas about addiction and recovery.

3. Put aside your rational thinking for a short time.

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ObjectivesObjectives

Learn what we do that supports addiction. Learn how we have to change. Learn what we can do to support recovery.

Learn what we do that supports addiction. Learn how we have to change. Learn what we can do to support recovery.

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DefinitionsDefinitions Addiction - is a primary, chronic, progressive,

relapsing disease which may be (often is) fatal. Recovery - is a process of overcoming both

physical and psychological dependence on a psychoactive drug and is a commitment to abstinence based sobriety. (ASAM Textbook of Addiction

Medicine ,4th edition) Disease - is a state of ill health characterized

by the abnormal function of one or more organs, a definable set of signs and symptoms, a predictable course and outcome with or without a known cause.

Addiction - is a primary, chronic, progressive, relapsing disease which may be (often is) fatal.

Recovery - is a process of overcoming both physical and psychological dependence on a psychoactive drug and is a commitment to abstinence based sobriety. (ASAM Textbook of Addiction

Medicine ,4th edition) Disease - is a state of ill health characterized

by the abnormal function of one or more organs, a definable set of signs and symptoms, a predictable course and outcome with or without a known cause.

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Progression of Addiction and CodependencyProgression of Addiction and Codependency

Addict Early Middle Late

no detectable effects beginning to have uses to prevent impact on daily life withdrawal without treatment consequences increase _____________________________________________________________

Codependent’s Progression no visible effects beginning to feel responsible feels compelled to

help for the addict - feels compelled feels scared, insecure to help - feelings of guilt overwhelmed,

desperate

Addict Early Middle Late

no detectable effects beginning to have uses to prevent impact on daily life withdrawal without treatment consequences increase _____________________________________________________________

Codependent’s Progression no visible effects beginning to feel responsible feels compelled to

help for the addict - feels compelled feels scared, insecure to help - feelings of guilt overwhelmed,

desperate

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Famil y Recovery

BOTTOM

ArgumentsDistrust

UnhappinessReligious needs

Denial (fantasy)Threats made but not fulfilled

Takes responsibilityLoss of interest

Imaginary illnessesFaçade

Uses prescribed drugsLoss of self respect

RemorseSocial withdrawalPatent medicine use

Indefinable fearsDrug abuser

Bankruptcy of alibisAdmits defeat

Chronic depressionSuicide attempts

BluesIntolerance

SuspicionProblems multiply

WorryIrritability

Seeps helpAvoiding reference

ExtravaganceSelf-defense

DepressionIrrational behavior

Self-neglectAlibi

DishonestyInfidelity

IsolationBlames others

EscapeJealousy

At ease with lifeReturn of respect

Appreciates spiritual valuesReturn of confidence

New interests developGuilt is gone

Return of self-esteemDiminishing fears

Daily living pattern improvesDevelops optimism

Begins to relaxCover-up ceases

Becomes willing to changeShares with others

Need to control lessensRecognition of role

Seeks helpAcceptance

Recognizes disease Sincere desire for help

Joy

Courage

Love

Makes amends

Peace of mind

Service

New friends

Spiritual examination

Release

Trust, openness

Honesty

Prepared by

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Support Addiction Support RecoverySupport Addiction Support Recovery

Lack of knowledge about addiction

*Using is a choice *Responding to the behaviors *Enabling * Taking care of it myself

Lack of knowledge about addiction

*Using is a choice *Responding to the behaviors *Enabling * Taking care of it myself

Education about addiction

*Addiction is a disease *Responding to the disease

* Detachment

*Ask for help

Education about addiction

*Addiction is a disease *Responding to the disease

* Detachment

*Ask for help

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Education: Believing the behaviors we see are a choice supports the disease. Education: Believing the behaviors we see are a choice supports the disease.

“I wish he would…….” “Why doesn’t she………. “ “He should…… “ “If only she would…..” “Why can’t he…..” “Doesn’t she see ….”

“I wish he would…….” “Why doesn’t she………. “ “He should…… “ “If only she would…..” “Why can’t he…..” “Doesn’t she see ….”

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Education: Understanding addiction is a disease supports recovery.Education: Understanding addiction is a disease supports recovery.

Definition of disease A disease is: a state of ill health with

the abnormal function of one

or more organs definable set of Si/Sx predictable course and outcome known or unknown cause

Definition of disease A disease is: a state of ill health with

the abnormal function of one

or more organs definable set of Si/Sx predictable course and outcome known or unknown cause

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Defined set of Predictable course & Si’s/Sx’s outcome

Defined set of Predictable course & Si’s/Sx’s outcome

Craving Loss of control Compulsion to

use Continued use in

spite of bad consequences

Craving Loss of control Compulsion to

use Continued use in

spite of bad consequences

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Education: Addiction is a disease Why? (con’t) Education: Addiction is a disease Why? (con’t)

*Cause may or may not be known.

Currently our understanding of addiction indicates two factors play a major role in the development of addiction.

genetics and environmental factors

Nature (genetics) loads the gun Environment pulls the trigger

However: there are addicts who have no apparent genetic predisposition nor significant environmental risks.

*Cause may or may not be known.

Currently our understanding of addiction indicates two factors play a major role in the development of addiction.

genetics and environmental factors

Nature (genetics) loads the gun Environment pulls the trigger

However: there are addicts who have no apparent genetic predisposition nor significant environmental risks.

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Education: responding to the behaviors

and not the disease supports the disease. Education: responding to the behaviors

and not the disease supports the disease. Everyone/everything revolves around the

addict - what they do and do not do. We work to connect with the addict - to

maintain a relationship - by exaggerating our response to a behavior

anger rage concern panic frustration retaliation authority dominance persuasion manipulation disagreement hostility * All these responses are motivated by: Fear

Everyone/everything revolves around the addict - what they do and do not do.

We work to connect with the addict - to maintain a relationship - by exaggerating our response to a behavior

anger rage concern panic frustration retaliation authority dominance persuasion manipulation disagreement hostility * All these responses are motivated by: Fear

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Education: responding to behaviors and not the disease supports the disease.

Education: responding to behaviors and not the disease supports the disease.

Anger: (often results from: fear, guilt, hurt) Three purposes: instruct the addict protect the addict make emotional connections Two kinds: protest against unkind or inconsiderate

treatment hurts of the past and fear of the future The second is very nonproductive and harmful.

Anger: (often results from: fear, guilt, hurt) Three purposes: instruct the addict protect the addict make emotional connections Two kinds: protest against unkind or inconsiderate

treatment hurts of the past and fear of the future The second is very nonproductive and harmful.

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Education: responding to behaviors and not the disease supports the disease.Education: responding to behaviors and not the disease supports the disease.

Perfectionism: unable to control the addict so keep everything else under control.

Procrastination: sees disaster in everything they might do or try - so why even try.

Caretaking: they take care of everything - pay the rent, make excuses, lend the car, buy the beer!!, clean up all the messes.

Blaming: transfers responsibility to someone else - so I can wait until they get their act together.

Perfectionism: unable to control the addict so keep everything else under control.

Procrastination: sees disaster in everything they might do or try - so why even try.

Caretaking: they take care of everything - pay the rent, make excuses, lend the car, buy the beer!!, clean up all the messes.

Blaming: transfers responsibility to someone else - so I can wait until they get their act together.

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Education: Enabling supports the disease.Education: Enabling supports the disease.

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Education: definition of enabling:Education: definition of enabling:

Anything we do or do not do that gets between the addict and the consequences of his/her use of drugs and/or alcohol.

Anything we do or do not do that gets between the addict and the consequences of his/her use of drugs and/or alcohol.

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Education: Enabling - why do we do it?Education: Enabling - why do we do it? Believe using is a choice. (remember the part of

the brain involved) Believe using is a response to circumstances. Believe using is a lack of will power. Believe using continues because of a lack

understanding of the consequences. Believe using is a moral short coming.

Believing that doing something to correct these conditions will fix (end) the addiction and the behaviors.

Believe using is a choice. (remember the part of the

brain involved) Believe using is a response to circumstances. Believe using is a lack of will power. Believe using continues because of a lack

understanding of the consequences. Believe using is a moral short coming.

Believing that doing something to correct these conditions will fix (end) the addiction and the behaviors.

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Education: Enabling behaviorsEducation: Enabling behaviors

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Education: Don’t enable - detach which supports recovery.Education: Don’t enable - detach which supports recovery.

Definition: is to separate ourselves emotionally and spiritually from the damaging effects of our relationship with the addict, to be objective.

we can continue to love and care for them because we are detaching from their damaging behaviors not them learning to detach is difficult and takes practice and time -it is a process-

Definition: is to separate ourselves emotionally and spiritually from the damaging effects of our relationship with the addict, to be objective.

we can continue to love and care for them because we are detaching from their damaging behaviors not them learning to detach is difficult and takes practice and time -it is a process-

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Education: Don’t enable - detach to support recovery. (con’t)

Education: Don’t enable - detach to support recovery. (con’t)

Practical applications of detachment: do not do things for the addict he/she should be

doing for themselves do not save/rescue them from the consequences

of their actions. (legal, financial, family, job, etc.) do not cover for their mistakes of omission or

commission neither feel guilty nor responsible for their

disease or actions. Detachment: is not getting emotionally

wrapped up in the destructive behavior (the drama) - does not mean doing nothing

Practical applications of detachment: do not do things for the addict he/she should be

doing for themselves do not save/rescue them from the consequences

of their actions. (legal, financial, family, job, etc.) do not cover for their mistakes of omission or

commission neither feel guilty nor responsible for their

disease or actions. Detachment: is not getting emotionally

wrapped up in the destructive behavior (the drama) - does not mean doing nothing

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Education: We will take care of it ourselves supports the disease. Education: We will take care of it ourselves supports the disease. Common misconception: problems in the

addict’s life are causing the addiction. Common misconception: addiction is the result

of a bad decision or an unfortunate turn of events. So fix the “problems” - fix the addiction give him/her a fresh start provide for an education provide means to start a business Try to “shake some sense” into the addict threaten, punish, relent - cycle

Common misconception: problems in the addict’s life are causing the addiction.

Common misconception: addiction is the result of

a bad decision or an unfortunate turn of events. So fix the “problems” - fix the addiction give him/her a fresh start provide for an education provide means to start a business Try to “shake some sense” into the addict threaten, punish, relent - cycle

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Education: Get help/assistance which supports recovery and responds to the disease.

Education: Get help/assistance which supports recovery and responds to the disease.

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Education: Get help/assistance which supports recovery and responds to the disease.

Education: Get help/assistance which supports recovery and responds to the disease. First Step: Ask “Is what I/we are doing working”? or “Does it just seem like it should work”?

Second Step: Be willing to admit I/we may be incorrect in our

assumptions i.e. I/we are wrong/made a mistake!!

Third Step: Ask “Am I/we willing to endure the pain/discomfort of change”? (in attitude, focus)

First Step: Ask “Is what I/we are doing working”? or “Does it just seem like it should work”?

Second Step: Be willing to admit I/we may be incorrect in our

assumptions i.e. I/we are wrong/made a mistake!!

Third Step: Ask “Am I/we willing to endure the pain/discomfort of change”? (in attitude, focus)

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Education: Get help/assistance which supports recovery and responds to the disease.

Education: Get help/assistance which supports recovery and responds to the disease.

How/where do I/we get help/assistance? *Education: about addiction and

codependency books, conferences, pamphlets, people in recovery

(recovering families, recovering addicts), open AA mtgs.

*Therapy: individual or family - therapist with experience addressing addiction and codependency

*Mutual Support Groups: Al-Anon, Nar-Anon, Alateen, Families Anonymous, others

* Interventionist:

How/where do I/we get help/assistance? *Education: about addiction and

codependency books, conferences, pamphlets, people in recovery

(recovering families, recovering addicts), open AA mtgs.

*Therapy: individual or family - therapist with experience addressing addiction and codependency

*Mutual Support Groups: Al-Anon, Nar-Anon, Alateen, Families Anonymous, others

* Interventionist:

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ConclusionsConclusions Remember: 1. You didn’t cause it, can’t control it, and

can’t cure it. 2. Taking care of yourself is one the best

ways to help someone else. 3. Supporting recovery is like planting seeds -

it takes time to see results, you have to sow lots of seeds to get results and there could be a crop failure.

4. Get an education about addiction. 5. Ask for and accept help. 6. Set boundaries/limits - that you can and will

enforce -be firm and specific. 7. Be certain the addict/alcoholic knows help

and support is available. 8. Ask the addict/alcoholic ”How can I help

you to support your recovery”?

Remember: 1. You didn’t cause it, can’t control it, and

can’t cure it. 2. Taking care of yourself is one the best

ways to help someone else. 3. Supporting recovery is like planting seeds -

it takes time to see results, you have to sow lots of seeds to get results and there could be a crop failure.

4. Get an education about addiction. 5. Ask for and accept help. 6. Set boundaries/limits - that you can and will

enforce -be firm and specific. 7. Be certain the addict/alcoholic knows help

and support is available. 8. Ask the addict/alcoholic ”How can I help

you to support your recovery”?

9. And most important of all:9. And most important of all:

Remember: “Addicts and alcoholics are not bad people trying to be good but sick people trying to get well”. Connecticut Nursing News 3/02

Remember: “Addicts and alcoholics are not bad people trying to be good but sick people trying to get well”. Connecticut Nursing News 3/02