Week 9: Maintenance and Relapse Prevention

I remember when I was at home with my son and working limited part-time hours as a copy editor when he was a toddler. It was around then that I started to gain a lot of weight. Things had become strained in my marriage (my husband and I wound up getting divorced when my son was 10 years old after 21 years of marriage). I started eating more out of stress and it was not the healthy kind of eating. I had been trying to use my self-control to be a good mother and organize the days at home for my son and me, but it did not come naturally. We had moved to a new area where I felt uprooted and so my resources had already felt drained. Not having the support of a strong marriage also had made me feel depleted so I turned to chocolate and simple carbohydrates to comfort myself. One day I was just tired of the weight I had gained — 67 pounds in all — and I decided I had to do something. I had been reading about Overeaters Anonymous every week as a copy editor at my job and decided to give it a try out of desperation. There I got the support I finally needed, in conjunction with counseling that I also sought at the time, to lose the weight, which I did over the next eight months. That was eight years ago and I have kept most of the weight off in the years since. I can still see that at times in my life when there is a lot of overuse of my self-control in many areas of my life, there can be adverse effects on my eating. That is why it is vital to my physical, emotional, and spiritual health that I get to as many OA meetings as possible and practice the 12-step philosophy in my life.

Week 8: 12-Step Facilitation of Treatment

I wholeheartedly endorse the 12-step philosophy and believe it not only facilitates and supports treatment, but it has personally facilitated and supported my own treatment through the years, most importantly through my membership primarily of Overeaters Anonymous, but to a lesser extent Alcoholics Anonymous, as well. I have tried to fully integrate the 12 steps into my life over the years and have found the results to have been far more gratifying than I could have ever expected or desired. However, one’s work is never complete and is measured as the saying goes, “One day at a time.” The addict must continue to work at recovery to stay recovered.

The aspect of the 12-steps that I struggle with the most Step 3, which requires turning my will and my life over to the care of God as I understand him. As a spiritual person who is non-religious this has been a stumbling block at times, more because I have been unsure how to define my Higher Power. Definitions for Higher Power I am aware of include the 12-step group, itself, along with nature and existential freedom. But overall, despite my struggles with the concept of a Higher Power, I believe the tenets of the 12-step philosophy make a lot of sense and have helped make it easier for me to live with myself.

Furthermore, I think the 12-step philosophy is compatible with my counseling orientation, which is a combination of cognitive-behavioral, humanistic and existential therapies. I have also read many books about the 12 steps, and when boiled down to their essential principles, I believe they are founded on tenets that many people live by and are, therefore, readily embraced by most people with addictions. I think 12-step groups are an excellent way for individuals struggling with addiction to come together for self-help, education and social support.

Week 7: Benefits of Pharmacotherapy

I support the use of pharmacotherapy in the treatment of addictions for several reasons. First, for many clients who become addicted to substances, their neurotransmitters and hormones are behaving differently, often due to a predisposition to addiction or co-occurring conditions. Secondly, once certain addicted clients are placed on the appropriate medications they are better able to function in their lives. In addition, research has indicated that mental health interventions targeting pharmacotherapy adherence enhance the outcomes of addiction treatment (Reid, Teesson, Sannibale, Matsuda, & Haber, 2005, as cited in Capuzzi & Stauffer, 2012, p. 219). I have mentioned in previous posts that I work in a Methadone and Suboxone clinic and see everyday firsthand the difference these drugs make for the patients who do not have to experience the severe heroin cravings that forced them on the streets every day to steal and prostitute themselves to get their fix. I agree with our text when it says, “As a professional counselor, you are under an ethical obligation to provide your clients treatment based not upon bias but upon scientific evidence of effectiveness”  (Capuzzi & Stauffer, 2012, p. 211).

In addition, our text states that in encouraging our clients to get the support they need from others like themselves out in the community they may encounter a bias against using medication to deal with their addiction at 12-step meetings. While this may be the true at some meetings, I have not found this to be the case with people I have typically encountered at the 12-step meetings I have attended as a member, which have included both AA and Overeaters Anonymous. For the most part, I believe our society, including the counseling profession, as well the individuals who make up the array of 12-step programs that exist, are becoming more enlightened about the needs and treatment of those who are addicted. There is new scientific evidence and information revealed about the brain every day. To ignore the benefits of pharmacotherapy would be equivalent to leaving people suffering in the psychological Dark Ages.

References:
Capuzzi, D. & Stauffer, M. D. (2012). Foundations of addictions counseling. (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Reid, S., Teesson, M. Sannibale, C. Matsuda, M., & Haber, P. S. (2005). The efficacy of compliance therapy for alcohol dependence: A randomized controlled trial. Journal of Studies on Alcohol, 66, 833-841.

Week 6: Relating to the Client

— A quote from your text states: “… we get so involved in the role of counselor that we sometimes forget the counselor inside of us. It can become habit to separate ourselves from our clients with a sense of self-righteousness that we do not have the problems they do.” Do you see this tendency in yourself? How do you stay in contact with your inner client? What does that mean for you?

I do not see this tendency in myself because I personally struggle with addiction. I definitely do not feel self-righteous about myself because I have gone through similar defeats in trying to control my unhealthy attachments. I currently work at a methadone clinic for my practicum and it is common for counselors to draw upon their own addiction experiences in relating to their clients. The challenge for me at this point in my career is to not self-disclose too much about my own issues with addiction, particularly to alcohol and food. I believe it is valuable to reveal to my clients information regarding my “experience, strength and hope,” in the tradition of the 12-step philosophy, as a means of educating clients and building therapeutic rapport; however, I need to make sure I do not cross over the line and disclose for the sake of trying to meet my own needs. I also stay in contact with my inner client by dealing with my addictions on a continuing basis by regularly attending 12-step meetings.

— What beliefs about yourself do you have that will allow you to find commonalities with your clients so that you do not see it as “us” versus “them”?

Even though I struggle with addiction myself, there are times that I find myself comparing severities of addictions. I suppose this could amount to an us-versus-them mentality when dealing with clients with addictions to intravenous drugs, which are considered society’s biggest taboo. But I haven’t really found that to be the case in my experience so far in my practicum because I catch myself when this happens and tell myself that we all struggle with some behavior(s) and/or substances we wish we had better control over. That attitude really keeps any inclinations of superiority in check.

Reference:

Capuzzi, D. & Stauffer,  M. D. (2012). Foundations of Addictions Counseling (2nd ed.). Pearson, NJ: Upper Saddle River.

Week 5 Treatment of Addictions

I am most comfortable with the foundational counseling philosophies of cognitive behavioral and humanistic therapies in the treatment of addictions, along with solution-focused counseling. According to W. R. Miller’s et al.’s (2003) review of alcoholism treatment approaches, “CB interventions are well represented among the most effective treatments” (as cited in Capuzzi & Stauffer, 2012, p. 144). Furthermore, I currently work at a methodone treatment center for my practicum, which identifies itself as the oldest in the country, as well as a DUI referral practice, and both programs primarily utilize cognitive behavioral therapy with their clients. In addition, I believe humanistic theory is the cornerstone of good counseling and helps establish a strong therapeutic alliance.

I am attracted to solution-focused counseling because it centers on clients strengths as opposed to continually looking at what is wrong with clients, which can fuel the cycle of addiction. It is easy for counselors and clients, alike, to get caught in the negativity of the client’s life. Solution-focused therapy does just what it sounds like — it keeps the focus on solutions. By keeping the language centered on change and how things can be different, clients can, hopefully, make transformations both small and large. The law of attraction says that what you focus on gets larger in your life. Solution-focused therapy is based on that premise. As a counselor, I believe I am there to help my client find new language and discover the solutions to their concerns and issues by working with them to discover their strengths and resources.

As far as my tolerance for addicted individuals, I believe I have a great deal of compassion. I have heroin and alcohol addiction in my family and am a recovering alcoholic and food addict myself. I currently attend 12-step meetings and believe I am open-minded about other people’s addiction. At the risk of too much self-disclosure, I think one of my deficits, at times, is that I struggle with a lack of confidence that stems from my struggles with depression. Because of this, I believe I also sometimes suffer from a lack of hope, which could negatively impact my clients. I do everything I can to take care of myself, get counseling and treatment for the depression, seek supervision when I need it, attend 12-step meetings and enlist social support. I also look at the other side of the situation, which is I have tremendous empathy for those clients struggling with addiction and coexisting conditions, as well. I understand what they are going through because I have walked their path myself.

 

 

 

Reference

Capuzzi, D. & Stauffer, M. D. (2012). Foundations of addictions counseling. (2^nd ed.). Upper Saddle River, NJ: Pearson.