This month, Dr. Tian Dayton gives us all the opportunity to take part in a study she is conducting on Adult Children of Alcoholism or Addiction (ACOA). Just click on the link in her article to take the survey and you’ll receive data once it has been compiled.

Resolutions are something that most people are either making or thinking about making right about now, and none quite so important than the resolution to get clean. Angie Carter knows a thing or two about this and how challenging the following-through part can be. She shares her journey and a few things she learned along the way about Resolve, Relapse and Regret.

Larry Smith provides us with a very user-friendly guide to affirmations to begin the reprogramming of all the negative thoughts that can sabotage recovery – and, indeed, peace of mind and wellbeing in general.

Moving us into a completely separate topic, Catherine Auman begins the discussion about sex addiction: is there such a thing or not? It is currently the addiction de rigueur for many a celebrity caught in an indiscretion, but how accurate a description is it? An interesting and relevant topic, to be sure.

Yet another hot topic in the mental health field these days is ADHD. But a relatively unexamined aspect of it is how it affects girls, which, new research reveals is significantly different from boys. Dr. Jack Hinman breaks down the differences, providing an important and largely unexamined perspective.

Kansas Cafferty shares his personal journey from client to counselor and the lessons he learned along the way, particularly about how one relates to the other. He compares the “tough love” approach to a more gentle, loving approach, addresses the pros and cons and concludes that love may just be all you need.

New RecoveryView.com contributor, Dr. Meghan Marcum, discusses the importance of relaxation on mental health and an overall sense of wellbeing. And she goes one step further to provide a simple guide to meditation to kick off the New Year with a nice, deep breath.

And from another RecoveryView.com newcomer, Dr. Daniel Tomasulo, we learn that expressing gratitude to someone – even if, especially if, that person is not actually a person but God – can reduce symptoms of anxiety and depression. Through the experiential technique of the Virtual Gratitude Visit, a person may experience benefits long after the actual “visit”, making it worth a try.

Our first featured RecoveryView.com member is Connect for Healthcare, a revolutionary but simple way to stay connected with loved ones in treatment centers of all kinds – recovery or otherwise. Founders Neil Moore and Craig Gordon, childhood friends who reconnected after more than 20 years, bring not only their professional expertise to the company, but also their personal experience and, therefore, passion to every aspect of Connect for Healthcare.
Shahan Suzmeyan, Director of Marketing for CRC Health’s West Coast treatment facilities, has walked down an oft-winding and challenging path to get where he is now, which, of course, makes for a really interesting story. His desire to connect people – be it addicts to appropriate treatment centers, or the members of the very community in which he lives – drives him to creative solutions to often complicated issues. We’re excited to connect you to his story in this issue.

Our book club highlights frequent RecoveryView.com contributor, Dr. Stephen Grinstead’s book, Freedom from Suffering: A Journey of Hope, which is packed with valuable information about his long-standing work and research into chronic pain. We also selected to highlight Jennifer Storm’s memoir, Blackout Girl. An unflinching view of her struggles with drug and alcohol abuse and addiction, and her eventual freedom from it, her story will no doubt touch a chord with many readers, as well as inspire them and give them hope.

Please enjoy our New Year’s gift to you, and be sure to give yourself the gift of a more peaceful, saner existence through positive choices for you and your family. All the best!

Which characteristics do you identify with and to what extent? This is something of a self-test and a survey. If you are an Adult Child of Alcoholism or Addiction (ACOA), you may have been both traumatized and strengthened by that experience. Following is a survey of both the positive and the pathological characteristics that can be the result of growing up in a family where there is trauma. Each list is culled from the research in each area that has spanned the past two decades. Can you please take a moment to fill it out, and we will get back to you with the results of the data once it’s crunched? Thank you for your time!

http://www.surveymonkey.com/s/WWTNTML

This time of year many resolutions are made, only to be quietly dismissed shortly thereafter. But how can such a determined resolution to quit drinking end in another failed attempt to stop a behavior that can be so harmful to self and others? One would think such a person is either very weak or just doesn’t care. It is easy to see how others can come to this conclusion about the problem drinker if they are judging him based on his actions. Sometimes opinions can be formed based on what a person says, but when it comes down to intentions or what a person actually does, the latter will usually make the determination about who we think he or she is.

I am a recovering alcoholic and very grateful to be in long-term recovery. In my drinking days, I would get intoxicated and inevitably hurt someone with my behavior. It might be physically, verbally or simply not following through with a commitment or a promise. I would offer up an honest apology and a solemn oath to quit, only to return to a similar behavior somewhere down the road. As such, my apologies became hollow. My intention was not to hurt anyone, but my behavior said something else. That is the precise reason why alcoholics do not have the trust of those around them. Their actions do not show a history of consistent, trustworthy behaviors.

I experienced much regret, guilt and shame as a result of my drinking. Common sense would surely guide a person in the direction of not repeating a behavior over and over when it causes such angst and turmoil. It would appear that a person is not learning from her mistakes when repeating this negative behavior. This is one of the reasons it is so hard to understand alcoholics. Who in their right mind would exhibit this irrational behavior? Why can’t they see what they are doing and just quit? Loved ones can fall into the trap of trying to help them by repeatedly explaining the impact of their drinking behaviors. The more the alcoholic continues their irrational behavior, the more the family members try to reason with them. Loved ones of a practicing addict can be significantly affected by this powerful disease, thus leading to their own desperate and bizarre behavior.

Addiction is a very powerful and complex process that takes place in the primal part of the brain. When this process is active, it will very often override the thinking brain and push out any type of reasonable thinking. It replaces common sense and rational thought with distorted, magical thinking that becomes paramount. Denial assists in this process. In addition, alcohol is a depressant, and the more alcohol a person consumes, the more it depresses or puts to sleep different areas of the brain, starting with the frontal lobe (the decision-making center). If this area of our brain is inhibited, it is much easier to chase that euphoric feeling that is created through the chemical changes of drinking or drugging. The thinking becomes: if one is good, then more is better.

Many helpful books and loads of materials have been written on relapse. Counselors, treatments center and self-help groups around the world are familiar with it, study it and offer ideas, methods, tips and tools to try to help a person prevent it. There is no single proven method, no magic pill and sometimes seemingly no rhythm or reason to relapse.

Typically, though, there are warning signs that a relapse is about to occur. One thing I can share about relapse is that it does not have to mean hopelessness. I have witnessed many chronic relapsers come up out of the ashes of deep-rooted addiction and get clean and sober. It is important to note that family members do not have to tolerate unacceptable behavior until a person reaches the point of wanting to get sober. Strong, firm boundaries need to be in place while the person goes through the process of their addiction.

I have much faith in the person who continually to tries to get sober. My message to alcoholics would be, don’t ever give up, it can happen. It is not impossible nor is it hopeless. Family members and loved ones need to tend to their own journey and take care of themselves when dealing with someone who struggles with relapse. Left unchecked, this illness can also take them hostage. They, too, can experience a relapse and return to the crazy behavior of trying to stop, control or cure the alcoholic.

I have experienced relapse, and getting back on track was difficult. But I needed that experience because I was convinced I could get sober by myself. My relapse taught me I needed help from those who were sober. Also, learning about my triggers and relapse warning signs helped me to avoid those pitfalls.

The good news is that relapse doesn’t have to continually occur; long-term sobriety is possible; and family members can also lead a sane and serene life.

More sophisticated affirmations can be derived by adding meaningful words:
• “I am wonderfully rich in consciousness.”
• “I am aware of God’s divine presence with me.”
• “I am completely at peace and totally in acceptance.”
• “I am connected with the beauty of nature.”
• “I live in abundance and prosperity.”
• “My true nature is to be of love and service to my fellow man.”

Affirmations help us change our belief systems and reinvent how we live our lives daily. I adjust my daily affirmations to coincide with the area of my life I am trying to improve.
Remember: The most important conversation you will ever have will be the one you have with yourself. –Unknown Author

Some stimulant medications used to treat ADHD decrease appetite, creating a risk of abuse among girls with ADHD who are also struggling with body-image issues and/or an eating disorder.

While boys with ADHD tend to externalize their acting-out behaviors through aggression and substance abuse, girls, by contrast, tend to internalize their symptoms through mood symptoms and eating disorders.

2. Social Problems Among Girls with ADHD (Ohan & Johnston, 2007)
Even more so than their male counterparts, girls with ADHD tend to have a high incidence of peer difficulties. These difficulties include:

• Basic social-skill deficits
• Alienation of their peers (Gaub & Carlson, 1997)
• Aggression (Silverthron, 1996)
• Gossip and social exclusion (relational aggression)
• Deficits in pro-social behavior
• Fewer friends (Blachman & Hinshaw, 2002)
• Less awareness of social cues
• Decreased ability to regulate anger in social situations
• Lack of specific positive behaviors necessary for acquiring and maintaining friendships
• Social awkwardness
Not only are the symptoms of ADHD exaggerated in girls, but the consequences of these symptoms are exacerbated by basic differences in how girls and boys socialize. The social deficits caused by ADHD may be more destructive in the context of a girl’s tighter, more intimate social milieu than they are in a boy’s looser, more active social network (Crick, 1996; Maccoby, 1998).
3. Increased Risk of Anxiety and Depression (Bauermeister, 2007)
Girls with ADHD also struggle with higher rates of separation anxiety, generalized anxiety disorder and depression than boys with ADHD.

4. Difficulties with Executive Functioning (Hinshaw & Carte, 2007)
Again, girls even more than boys, experience a high rate of difficulty with executive functioning. These cognitive functions include some basic abilities critical to day-to-day social, academic and work activities. Girls experience a high rate of difficulty with:
• Planning
• Mental shifting (i.e. from one mental task to another)
• Interference control
• Working memory

5. Difficulties with Detection
Girls with ADHD are more likely to go undetected than their male counterparts because their symptoms are less obvious. They tend to exhibit, for instance, inattention rather than outward hyperactivity. Girls are also less likely to be identified and treated for ADHD because their “acting-in” behaviors are less frustrating to parents and teachers than a boy’s acting-out behaviors. Girls are more likely to be diagnosed for ADHD when comorbidity is present; in other words, when one or more secondary issues capture the attention of parents, educators, and/or professionals. It is, therefore, when a girl is being diagnosed and treated for a secondary condition that the primary condition of ADHD is typically detected.
Sources:
• Ohan & Johntson (2006) What is the Social Impact of AHDH in Girls? A multi-Method Assessment Journal of Abnormal Child Psychology, 35:239-250
• Ascribe Newswire: Health (2008) Adolscent Girls With ADHD at Increased Risk for Eating Disorders
• Woosely, L (2006) ADHD Ignores Gender: Neurological disorder also proves debilitating to girls Tulsa World
• Mikami & Patterson (2008) Eating Pathology Among Adolescent Girl With Attention-Deficit/Hyperactivity Disorder Journal of Abnormal Psychology, Vol. 117, No.1. 225-235
• Bauermeister, J (2007) ADHD and Gender: are risks and sequela of ADHD the same for boys and girls? Journal of Child Psychology and Psychiatry 48:8

I have been in the field of addiction treatment for close to 15 years. During this time, we as a field have changed quite a bit, as have many of our methods. I am among those in our field who went through treatment the “old-fashioned” way. I attended a social detoxification program without the benefit of any type of medication to curb the symptoms of my disease. The program itself was primarily a social model program that had very few of what I could call “clinicians.” The program relied heavily upon 12-step programs to fuel its success, and the staff members were well-meaning members of those programs with little to no professional qualifications or experience.

I went through treatment during a time when confrontation was the tool of choice and “tough love” was the preferred method. Obviously, this influenced me early in my career. I often projected my own treatment experience into the ideas I had about what would work and what would not. Mind you, I was very young at the time and had virtually no education, but I had a misperception in the beginning that psychiatric medication should be avoided and that medical assistance during the detox process was only to be used in the most extreme circumstances to avoid death. Aside from those situations, I believed that “sweating it out” was better because it would scare the addict from picking up again. Today I believe it scares them out of getting help or causes them to prematurely terminate treatment more often than not. These are some of many ideas I have changed over the years.

As my career progressed, I learned about treatment approaches such as motivational interviewing. Miller and Rollnick taught our field the truth about confrontation and its dire consequences to addicts. I watched tough love destroy families while addicts died anyway. While new information and experience flowed toward me, I was mentored by fantastic clinicians. They taught me how to be kind, patient and effective at the same time. One of the things I find interesting about this today is that at the time, I presumed I was more empathic and compassionate to the addicts I worked with than they were because I had personal experience with addiction. I was wrong. The truth was, oftentimes they had taken a much kinder view of the symptoms of addiction than I did. When I would blame the patient for my ineffectiveness, they would help me to explore what was blocking me from being helpful to my patients. Was it my own judgment? My own regrets? Arrogance? At some point or another, all of these have been true.

I purposely wrote this article in the first person, rather than the observational, reporting tone of most professional articles. I have always benefited greatly from thoughtfully written articles that were written this way, and I believe they have impacted my attitudes about counseling greatly. Possibly this is because right, wrong or indifferent, they were true, at least for the writer. Just as I teach my clients to speak in the first person about their lives, sometimes it is best to do the same when I speak to my professional peers. The fact for me is that overwhelming fear of the codependency monster and the medical practice of extreme detachment has never worked for me. I have found that being effective for me includes loving my clients. I am not stating this in a general, “I love my work” kind of way. This statement is exactly as written. Part of the counseling process is loving my clients.

Now before the codependency fear-mongers jump to any conclusions, I want to clarify that this is not without boundaries. Boundaries are incredibly important to treatment. I recall once telling a clinician I was treating that I could not refer to them due to how they were dealing with certain problems. This was a hard thing to say to this person whom I loved, but my honesty and boundary later became a central tenet of the therapy, because the modeling of integrity and boundaries was powerful and inspiring for the client. Being kind, being patient and using a non-confrontational approach to treatment does not mean cowering away from issues. Loving them does not mean I have lost who I am in the vortex of who they are.

In my experience, these attitudes and treatment ideals have fostered closeness, bonding and ultimately healing for many, many addicts I have worked with. They fostered a sense of respect for my clients, and the honesty of the relationship gave weight to my words and suggestions that might have never been there in the past. These clients did not change, heal and grow because I was perfect at this model of counseling or that. They changed, healed and grew because they felt safe, loved and received honest feedback in a kind, compassionate way. As a counselor, I was not interfering with their growth, but was facilitating it and joining them in it. For any reader that sees this as a bunch of fluff, I assure you my approach is anything but. There is no co-signing of anything here. But there is no abuse either.

I urge other counselors, both new and experienced to constantly re-evaluate and remain open to new ideas. Explore ethics and yourself. Try writing your own ethical code in addition to the one that your certifying or licensing board has recommended. Engage in your own therapy process, whether you need it or not. Ask yourself, what in you prevents you from loving a certain client or patient. What is at risk for you? The answers may surprise you and they are certainly fantastic fodder for your own growth in supervision, therapy and as a clinician. In the end, you will not only benefit, but your clients will as well.

With the New Year and holidays just past, we were most likely constantly on the go. While a time of celebration, the holidays can also bring stress and anxiety to our lives. It’s important to remember to take time to unwind from all the busy hustling and bustling during this time of year.

Relaxation is one of the most fundamental components of good mental health. An article published in the American Journal of Public Health reports significant benefits to work and overall wellbeing as a result of daily relaxation (American Journal of Public Health, Vol. 67 Issue 10, p946-952). Research also points to other benefits, including brain wellness, decreased stress levels, improved sleep and decreased anxiety. That yoga class at the gym might seem a bit more enticing considering these significant payoffs.

Just consider, if spending a few minutes each day to meditate or calm yourself can have such a considerable effect (without taking a drug/medication), why not make it a part of your regular routine? It makes sense when you consider that relaxation is the opposite of stress on the spectrum of anxiety. Once you learn to relax, the scales become much more balanced.

Basic Tips for Relaxation

Make scheduling time for relaxation a priority. For example, when you wake up (or just before bed), spend 10 to 15 minutes on relaxation techniques. Continually take long, slow breaths: inhale through your nose, exhale through your mouth. Place your focus on breathing, calm and soothing thoughts and pay attention to all five senses. You might want to think of a soothing color, say a prayer or imagine what a perfect day might look like. Notice any intruding thoughts; let them float away, then return your focus to words that remind you of feeling calm, safe and free.

Go ahead relax!

The gratitude visit (Seligman, Steen and Peterson, 2005) is one of the best-known and most-quoted of the positive psychology interventions. The intervention is simple: people are asked to deliver a letter of gratitude to a person who had been particularly kind to them, but whom they never properly thanked. This has had positive effects, with greater scores on happiness and lower scores on depression, for a month following the exercise. Yet I believe this is only the tip of the iceberg of what can come from a gratitude visit, particularly if it is virtual rather than in vivo. Psychodrama (Moreno & Fox, 1987; Moreno & Jennings, 1953) is an experiential form of therapy and theory originally developed by Jacob Moreno. It is a widely employed therapeutic model, which has a variety of therapeutic uses from educational role-playing through trauma work (Tomasulo, 1998). The gratitude visit lends itself to psychodrama when the person you wish to extend your gratitude to may be unavailable or deceased, and may even be used on a fictional or historical character. In fact, based on some new research in the Journal of Positive Psychology (Rosmarin, Purutinsky, Cohen, Galler, & Krumrei, 2011), it is possible the VGV may be effectively done with God. Using this technique, a person would be asked to write a letter of gratitude to someone who isn’t available for direct contact. Two chairs would be arranged, one for the writer (the protagonist) and the other, empty chair for the unavailable person (the auxiliary position). The protagonist arranges the chairs in a way that symbolically depicts the relationship: Are the chairs close? Far apart? Side by side? One behind the other? The chairs’ arrangement sets the emotional tone for the encounter.

The protagonist then sits in his or her chair and reads the letter that has been prepared for the person symbolized by the empty chair. Following the completion of the reading, the protagonist would reverse roles and become the auxiliary. By becoming the auxiliary, the person would respond as if the letter had just been read to him or her.
Following this, the auxiliary role would be relinquished, and the protagonist would return to the original chair and respond to the auxiliary’s empty chair. This ends the enactment.
If this were done in private, the protagonist would write down his or her feelings. If a coach or therapist were involved, they would debrief the protagonist. If this were done as part of a group, the group members would share with the protagonist what it was like to witness this encounter. In an experiential group setting, this would most likely lead to others doing such an enactment. Finally, the protagonist would share with the group what it felt like to engage in the process.
Using the above format, there is evidence to suggest that gratitude toward God (religious gratitude) is a powerful mediator between religious commitment and gratitude. Rosmarin et al, (2011) collaborated to apply an evidence-based approach to religious vs. non-religious gratitude. They asked whether gratitude to God is better for well-being than generalized gratitude. The study looked at the relationship between dimensions of gratitude and measures of religious commitment and mental and physical well-being. The authors, like other researchers, found that gratitude was significantly correlated with religious commitment. But these researchers also found that the relationship between these two variables was fully mediated by having gratitude directed toward God. In other words, gratitude is more potent when you have both religious commitment and your gratitude is directed specifically toward God (Tomasulo, 2011). Through an online survey, the researchers looked at 405 adults of varying religious backgrounds and used gratitude questionnaires that measured both religious and non-religious expressions of gratitude. These results were then compared to measures of religious commitment. (Religious commitment was determined by a person’s degree of belief in god, importance of religion and religious identity.) Happiness, satisfaction with life, positive and negative affect and physical and mental health were measured using well-known scales or adaptations of them. What the research found was that general gratitude was predicted for all the outcome variables. This means that gratitude in general, as other studies have shown, works very well. The degree to which a person is religiously committed was found to actually enhance gratitude’s effect. As the authors put it, “we propose that religion facilitates gratitude through a religious lens” (p. 393). In this way, a VGV with God, thanking him for his grace may be enacted psychodramatically. This would combine one of the most successful experiential techniques with perhaps the most effective form of gratefulness.
 
References

Moreno, J. L., & Fox, J. (1987). The essential moreno: Writings on psychodrama, group method, and spontaneity Springer Publishing Company.

Moreno, J. L., & Jennings, H. H. (1953). Who shall survive? Beacon House New York.

Rosmarin, D.H., Pirutinsky, S., Cohen. A.,Galler, Y., & Krumrei, E.J. (2011). Grateful to God or just plain grateful? A study of religious and non-religious gratitude. Journal of Positive Psychology, 6(5), 389-396.

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410.

Tomasulo, D. J. (1998). Action methods in group psychotherapy: Practical aspects Taylor & Francis.

Tomasulo, D. (2011). Can God and Gratitude Help Your Mental Health?. Psych Central. Retrieved on December 16, 2011, from http://psychcentral.com/blog/archives/
2011/12/11/can-god-and-gratitude-help-your-mental-health/