Counselor Toolbox Podcast

Medication assisted therapy is becoming a very hotly debated topic.  Some of these medications block cravings or the “high,” while others address the underlying mood and mental health issues that may be maintaining the addiction.  In this episode we will examine the potential benefits and drawbacks of these medications.   Show Notes Medication Assisted Therapy Alcohol and Opiates Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Objectives Review some myths about Medication Assisted Treatment Identify medications used to treat opiate dependence Identify medications used to treat alcohol dependence Discuss the mechanisms of action Evaluate pros and cons of each Myths Medications are a crutch We do what is more rewarding than the alternative Medications can make sobriety “feel better” by addressing underlying neurochemical imbalances Medications can remove the rewards from use by Making it unpleasant (Antabuse) Removing the “high” (Buprenorphine, Naltrexone) Both (Suboxone) Remember recovery is more than just NOT using. Medications can help ease the transition until the brain has rebalanced and the new lifestyle is in full swing Myths Using medication goes against 12-Step Philosophy Alcoholics Anonymous does not encourage AA participants to not use prescribed medications or to discontinue taking prescribed medications The Big Book states, “God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such person …Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” Pros Medications Can… Increase energy and motivation (dopamine and norepinephrine) while the person’s brain and body are recovering Remove some of the reinforcing effects of the drugs Prevent relapse by making relapse very unpleasant Reduce the intensity of co-occurring disorders Reduce conflict/improve social support Reduce absenteeism from work Cons of Medication Physicians who are educated about addiction treatment and endorse a biopsychosocial model of treatment are difficult to find Medications can give a false sense of security Medications may provide false hope Medications have side effects There is a stigma associated with the use of medications Costs money Opiate Dependence Neurotransmitters Mainly dopamine Patients report feeling Less pain Less anxiety Medications for opiate dependence Buprenorphine Methadone Naltrexone Naloxone (for opioid overdose) Buprenorphine & Naloxone (Suboxone) Buprenorphine Is as partial opioid agonist (ceiling effect) Reduces the symptoms of withdrawal from misused opiates Can be abused Methadone Full Mu opiate agonist (suppresses cravings) Lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs Considered relatively safe during pregnancy and breastfeeding Opiate w/d during pregnancy can trigger contractions and miscarriage SAMHSA TIP 43 MAT for Opioid Addiction Naltrexone Decreases the pleasurable effects of alcohol or opiates by blocking opiate receptors Alcohol abstinence is not required, but opiate abstinence is Naltrexone will cause opiate withdrawal in dependent users Third-Party Payer Acceptance: Oral is covered by most major insurance carriers, Medicare, Medicaid, and the VA Vivitrol is not covered in many cases Naloxone Blocks opioid receptors

Relapse means returning to a previous state.  It is vital to understand that relapse does not just mean a return to addictive behaviors, nor does it mean just using.  Relapses can happen in terms of people's mood, thinking patterns and behaviors.  In actuality, a person's thinking patterns and behavior often become problematic long before they start showing symptoms of addiction or depression again.  Some people call this return to old ways of thinking, behaving and feeling as “relapse warning signs”  or “lapses.”  In my mind, it is actually the beginning of a relapse. That doesn't mean that the behaviors have to be continued to the point of using again.  A relapse can stopped and corrected at any point.  The earlier these old behaviors and ways of thinking are stopped, the less more likely the person is to stay healthy and happy.  In this episode we will discuss ways to remain mindful in order to address any potential issues before they start impacting recovery.   Show Notes Relapse Prevention for Co-Occurring Disorders Part of the Co-Occurring Disorders Recovery Coaching Series Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Objectives Define Relapse Explore the acronym DREAM Define and identify vulnerabilities Define and identify exceptions Develop a relapse prevention plan Why I Care/How It Impacts Recovery Relapse indicates that the old behaviors have returned either because New skills were ineffective Old behaviors were more rewarding Recovery involves understanding what triggers each individual person’s relapse Dare to DREAM Determination Resilience Exceptions Awareness of vulnerabilities Motivation Determination Recovery is not easy People need a high level of tenacity to get through the rough points In their addicted selves, people behave impulsively. Recovery involves being able to forgo the easy or immediate reward to achieve longer term goals Resilience The ability to bounce back Part of resilience is hardiness Commitment can be considered motivation Control How much control is rewarding? How can too much or too little control be unmotivating? Challenge Why is it rewarding when something is challenging? Why are things that are easy not as rewarding? Resilience Qualities of Resilience Self-Awareness and Self-Care Healthy Habits (Vulnerability Prevention) Distress tolerance Rational, accurate cognitive habits Social Engagement Generosity Integrity Authenticity Humility/Compassion Identifying as a survivor, not a victim Resilience Qualities of Resilience Meaning Purpose Gratitude Hope Optimism Attention and Focus Curiosity Flexibility Persistence Problem Solving Skills Here and Now focus Exceptions Nothing is done all the time Exceptions are what people are doing when they are NOT engaging in the target behavior To identify exceptions, ask questions like… Before this problem started What was different? How did you deal with stress? In the past 6 months when you were not [engaging in the target behavior] What was different? How did you deal with stress? Exceptions Once you identify exceptions, help the client Strengthen those Do those things more Awareness of Vulnerabilities & Relapse Warning Signs Strengths/Vulnerabilities Sleep Nutrition Medication Chronic pain Hormones Estrogen Testosterone Social Supports Awareness of Vulnerabilities & Relapse Warning Signs Relapse warning signs are the way people act when relapse

In addictive behaviors, triggers make you want to use and cravings are the repetitive thoughts reminding you over and over again that you want to use.  We have triggers for just about everything.  Some are obvious, like the sight of alcohol may trigger people to start craving a drink.  Some are not so obvious,  the impending anniversary of a loss may trigger a person to want to use alcohol or drugs to escape from the grief.  In this presentation we will cover what triggers are, discuss ways to identify personal triggers and explore ways of dealing with triggers and cravings. Show Notes Objectives Define Triggers Define Cravings Explore ways to identify triggers and cravings Discuss methods to deal with triggers and cravings Why I Care/How It Impacts Recovery People, places, things and times can trigger The desire to use Anxiety Depression Grief Understanding your triggers is the first step in being able to avoid or deal with them so a relapse doesn’t “sneak up out of the clear ble” What are triggers Triggers are anything that prompt you to think about and/or do something. Touching a hot stove is a trigger for… The alarm clock is a trigger for… A commercial for a bacon double cheeseburger is a trigger for… A billboard advertising vodka is a trigger for… The smell of freshly baked brownies is a trigger for… Triggers Learn to recognize triggers Exposure to the addictive substance or behavior People, places, things, times of day Particular emotions (even good ones) Physical feelings (sick, shaky, tense) Triggers are things that: Remind you of the good feeling the addiction provided Make you want to escape What are triggers Sometimes triggers are not super obvious Habits You get up in the morning you… When you are watching television you… When you hear a certain song on the radio… Random Associations Telephone rings The smell of exhaust fumes Football games Why are Triggers Important You do things that are rewarding and avoid things that are punishing Triggers are like push notifications for the brain Many people return to their addictive behaviors when they are depressed or anxious and cannot figure out why (unidentified triggers) Ralph and the Mice Trigger Identification Mindfulness Practice being aware of Your surroundings Sights Smells Sounds Your self Breathing Muscle tension Thoughts  (Head) Mood/Feelings (Heart) Intuition (Gut) Addressing Triggers Increase those things that help you feel Positive/clear headed Happy/content Safe/comfortable Decrease those things that trigger feelings of Confusion Mental turmoil/frustration Depression Anxiety Guilt Resentment Hypervigilence Addressing Triggers Some triggers cannot be eliminated or avoided Distract don’t react Change your dialogue/positive self-talk Recondition it to trigger something positive Payday Sporting events Holidays Work Deal with it Cravings A craving is a repetitive, consuming thought or desire for something Commercials use the trigger/craving concept to motivate you to buy things Cravings generally fulfill some real or artificially created need Cravings Cinnamon Buns (smelling them at the mall) Escape (stress, boredom, cruise commercial) Drugs/Alcohol Dealing with Cravings Triggers exist and cravings will happen When you are triggered and have a craving Ride the wave Distract don’t react Identify what you really need or want and find an alternative Stop—Look—Listen—Feel Cravings are often

Counseling Continuing Education hours are available for this podcast at:  https://www.allceus.com/member/cart/index/product/id/493/c/ In American society food is often associated with good times and happiness.  Highly processed foods also have a significant impact on the neurochemicals in the brain.    For millions of people eating becomes a coping mechanism of sorts.  In this episode we will differentiate between over eating and food addiction, identify triggers and interventions for food addiction.  This is a very cursory overview at a problem that is contributing to the high rates of obesity in America.   Show Notes Objectives Examine the difference between overeating and food addiction Evaluate myths about food addiction Explore the behavioral and biological mechanisms underlying food addiction Identify ways to address food addiction triggers Why I Care/How It Impacts Recovery Excessive food consumption is socially acceptable and food addiction rarely causes imminent legal problems, so it can go unchecked for a long time For some people, addictive behaviors  started with food addiction For others, when their substance of choice was removed, food was available for self-soothing Regularly using food to self-soothe is, at the very least, a relapse warning sign if not a full-blown relapse. Food Addiction vs. Overeating Food can become an addiction, when it is used to Escape from negative feeling states   AND Continues to be used despite negative consequences The person experiences psychological withdrawals and cravings when he or she cannot access food to cope Overeating is often a bad habit, but can be stopped with education, planning and mindfulness Food Addiction vs. Overeating Experiments show that, for some people, the same reward and pleasure centers of the brain that are triggered by other addictions are also activated by food, especially highly palatable foods. Highly palatable foods are foods rich in: Sugar Fat Salt Signs and Symptoms You frequently crave certain foods You often eat even when you are not hungry. You eat much more than you intended to, sometimes to the point of feeling excessively “stuffed.” You often feel guilty after eating particular foods You sometimes make excuses in your head about why you should eat something that you are craving. You have repeatedly tried to quit eating or setting rules (includes cheat meals/days) about certain foods, but been unsuccessful. You often hide your consumption of unhealthy foods from others. You feel unable to control your consumption of unhealthy foods, despite knowing that they are causing you physical harm (includes weight gain). Signs and Symptoms cont… You eat certain foods so often or in such large amounts that you start eating food instead of working, spending time with the family, or doing recreational activities. You avoid social situations where certain foods are available because of fear of overeating. You have problems functioning effectively at your job or school because of food and eating. When you cut down on certain foods (excluding caffeinated beverages), you have symptoms such as anxiety, agitation Eating food causes problems such as depression, anxiety, self-loathing, or guilt. You find yourself eating more and more often due to stress Myths Food addiction is an excuse for over eating FALSE: Someone with a food addiction is using food to cope and activate reward pathways to help them feel “normal” or “calm.” Any emotional eating is wrong FALSE: Just like having a few drinks occasionally after a hard day does NOT qualify a person as an alcoholic, occasionally eating to self soothe is a no

Only recently have we begun to identify the huge impact that sex and pornography addiction have on people and their relationships.   Like food addiction sex is something for which total abstinence may not be an appropriate goal.  In this episode we will discuss how and why sex and /or pornography can develop into an addiction, explore interventions and identify other resources for people who are wanting to break their addiction. CEs available here: https://www.allceus.com/member/cart/index/product/id/333/c/ Show Notes Objectives Define Sex Addiction Discuss Similarities and Differences Between Drug Addiction and Sex Addiction Explore Interventions for Sex Addiction Addiction A person, activity or substance used to escape from negative feelings (physical or emotional) despite experiencing negative consequences Sex Addiction Similar to Other Addictions Dopamine surge/High Cravings Triggers/Conditioned Stimuli Brain changes (Worse with younger age) May start as recreational Relationship, Financial, Emotional Problems Sex Addiction Differs from other addictions Biologically driven urge Eat, Sleep, Procreate  Survive Coolidge Effect Cannot abstain forever “Socially sanctioned” Symptoms Needing more of the same substance to get the same high Tolerance Dopamine system self-regulating Coolidge Effect In response to worsening problems Symptoms cont… Using more or for longer than intended Online porn sites, dating apps  Novelty Unsuccessful efforts to cut down Biologically driven urge for stimulation as well as procreation Symptoms cont… Spending significant time and/or resources (i.e. money) thinking about, preparing for, acquiring, using and/or recovering from use Symptoms cont… Continued use despite negative consequences in one or more areas of life due to the addiction Relationship Financial Work Emotional (Anxiety, Motivation, Depression) Characteristics Driven by survival mechanisms Reduce pain (emotional, physical) Safety (Eliminate threats) Food/water Maintained by positive and negative reinforcement Solutions: Reboot Give your brain a rest from the rush Take care of yourself to allow your brain to recover Sleep Nutrition Exercise Consider pharmacological interventions Identify other things that make you (or used to make you) happy Find activities to occupy your time Solution: Rewire Identify and eliminate or recondition things that trigger your cravings People, places, things (including TV shows), emotions, times of day Engage in competing behaviors Identify the function of your behavior and develop alternatives. Rewire cont… Only allow yourself to experience sexual pleasure with a single other person in a monogamous relationship. Understand that during the rewire, there may be a period when you cannot get aroused. Procreation is genetically programmed, once your brain recovers, arousal will be possible again. Solutions for Motivation Address loss of motivation through Goal setting Decisional balance exercises Rewards Remember that as the dopamine system recovers motivation will return Mindfulness Skills Live in the present instead of the past /future Observing/Awareness External and Internal Vulnerabilities and Assets Describing Accept without judgment Act with Awareness / Purposeful Action Distress Tolerance Cope with crisis situations/urges in healthier, less self-destructive ways Examples: Urge Surfing Alternate activities Less p

CoDependency is a term we throw around a lot, but the definition can be somewhat elusive.  In this presentation we will examine the characteristics of someone with codependency; compare and contrast codependency with other addictions and propose avenues for interventions. CEU On-Demand Course Show Notes Co-Dependency Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs.com Objectives Define codependency Identify characteristics of the codependent relationship Explore the motivations for these behaviors Hypothesize alternate, healthier behaviors Why I Care/How It Impacts Recovery Co-dependency can serve as an alternate addiction or distraction Co-Dependents may use relationships to try to deal with depression or anxiety Ultimately codependency is self-defeating because one of the few things that cannot be controlled is the will of another person. Definition Codependency describes a type of relationship in which One partner defines his or her worth or goodness based on someone else The codependent person often chooses relationships in which the other person needs to be rescued, thereby making himself or herself indispensable. The Mantras “I don’t understand why she refuses to change.  I have done everything for her.” “Helping someone who doesn’t want help is an exercise in futility, but what are you supposed to do if you don’t help?” Co-Dependency as an Addiction Tolerance Need more of the same substance/activity In a codependent relationship, as time passes, the codependent’s identity becomes increasingly defined by the relationship with the other person Withdrawal Not getting the substance, being around the person results in physical or psychological withdrawals When apart from or unable to control the other person, the codependent experiences extreme anxiety and/or depression Co-Dependency as an Addiction Spending more time thinking about, engaging in or recovering from the behavior Co-dependents are always hypervigilant to other peoples behavior, and obsessing about what they are or are not doing Co-dependents spend large amounts of time rescuing or covering up for the other person  “fixing it” The codependent gets exhausted taking care of the other person, but cannot stop because they rely on the other person to tell them Co-Dependency as an Addiction Foregoing other interests in order to maintain the addiction The relationship is the “drug” of choice in the codependents’ lives Having that person in their life makes them feel “okay” or “whole” The relationship takes the place of self-love Co-Dependency as an Addiction Continuing the addiction/relationship despite negative consequences Emotional (depression, anxiety, anger, resentment) Social (Loss of other friends) Physical (stress-related physical issues) Occupational (poor job performance) Addicts and Codependents Low self esteem Depression, anxiety Need to control Fear of abandonment Relationship comforts/numbs Relationship becomes the addict’s primary focus Minimizing, denying, blaming to protect the relationship Stinkin’ Thinkin’ Have difficulty identifying what they are feeling. Lack empathy for the feelings and needs of others. Mask pain in various ways such as anger, humor, or isolation. Experience significant aggression/resentment and negativity Have difficulty making decisions. Judge what they think, say, or do harshly, as never good enough. Value others’ approval of their thinking, feelings, and behavior over their own. Do not perceive themselves as lovable or worthwhile persons Seek re