Cyndi Turner's Blog, page 18

41st National Association of Addiction Treatment Providers (NAATP) Conference held in Washington, DC.

Cyndi Turner and Craig James attended the 41st National Association of Addiction Treatment Providers (NAATP) Conference held at the Omni Shoreham Hotel in Washington, DC.  With the conference theme, Establishing and Implementing the Core Competencies of Addiction Treatment Operation, the emphasis was the need for treatment facilities to create an environment of accountability and standards amongst one another. This was accentuated in the breakout sessions with topics such as ethical marketing practices, brand integrity, transparency, and enhancing patient care and recovery through outcome measures.  The highlight of the conference was the release of the NAATP Treatment Provider Outcomes Measurement Toolkit.  The Toolkit was a year-long multisite study that had 748 participants from eight residential facilities nationally that included the locally run Ashley Treatmentand Caron Treatment Centers.  Each of the sites participated in the collection of survey data with the purpose of closing the gap between research and best practices.  The outcomes measured the impact of treatment for patients with substance use disorders to help the treatment field with:

Client engagement,
Improve effective treatment practices, and
Increase the ability to promote the value of treatment provider services.

The Toolkit serves as a guide for organizations to learn about patients’ experiences in treatment and ongoing recovery after treatment.  The conference concluded with the National Hill Day where organizations were provided an opportunity to speak with political leadership about public policy changes.

Cyndi and Craig had an opportunity to meet national and local exhibitors at the CEO Luncheon where strategies for leadership and culture in a treatment delivery was discussed.  They also had an opportunity to continue with collaborations during a dinner sponsored by Maryland Addiction Recovery Center and Cirque Lodge.

Cyndi was also interviewed by Neil Scott of Recovery – Coast to Coast.  She discussed how the current state of the addiction industry has been reluctant to embrace Harm Reduction thereby only addressing the needs of those with a Severe Alcohol Use Disorder, not the majority of people who struggle with a mild or moderate use disorder as outlined in her current book, Can I Keep Drinking? How You Can Decide When Enough is Enough.  There was also discussion of her second and third books, The Clinician’s Guide to Alcohol Moderation: Alternative Methods and Management Techniques and Practicing Alcohol Moderation: A Comprehensive Workbook, scheduled for release in March 2020

 

 

 

 

Post-Partum Depression: You Are Not Alone

Many women struggle with adjusting to motherhood following the birth of a child. Not all women are prepared for the major changes that come with the new role of parenting. Some have difficulty balancing old roles such as at work or in relationships and the new demands of caring for children. Add in sleep deprivation and a woman can really become overwhelmed and have a hard time functioning in day-to-day life as a new mom.

Signs of Post-Partum Depression Include:

Sadness most or all of the day
Avoiding social interactions with others or feeling isolated
Inability to care for yourself or meet the needs of the baby due to worry or sadness
Challenges with bonding with the baby, feeling disconnected
Extreme worry of the health and safety of the baby, worry about not being a good mother
Difficulty sleeping (beyond the normal sleep disruption from a newborn)
In extreme cases, thoughts of harming yourself or the baby

Although some women have enough symptoms to get diagnosed with Post-Partum Depression, many more experience a few of the symptoms and are suffering with impaired functioning in their lives.

Symptoms typically come on immediately after birth but can emerge a few months to a year following the birth of a child. Women with depression or anxiety prior to pregnancy or following previous pregnancies may be at increased risk.

If you are struggling with any of these symptoms, reach out to your OBGYN or a therapist that specializes in treating these issues. Know you are not alone. In fact, about 10-20% of women suffer following the birth of their child.

To learn more about available services to help with post-partum anxiety and depression such as therapy or medication management visit www.insightactiontherapy.com.

Angie Harris, LCSW, MAC, MA, is a therapist with Insight Into Action Therapy. She enjoys helping girls and women manage gender-specific life stressors and working through their problems with a solution-focused lens. Angie has been training on a number of issues, such as post-partum depression and anxiety, as well as strategies to support women, such as through Cognitive Behavioral Therapy (CBT) and Dialectal Behavior Therapy (DBT) skill building. If you are interested in therapy services with her, give her a call at (703) 646-7664 or aharris@insightactiontherapy.com.

 

Leadership Loudoun Think Tank Project in Leesburg, VA

On April 18, 2019 Craig James was on a panel with Michelle Petruzzello, Mental Health Substance Abuse & Developmental Services, Dr. Tracy Jackson, Loudoun County Public Schools, and Carol Jameson, HealthWorks of Northern Virginia.  The event held at Leesburg Junction was the result of Leadership Loudoun Think Tank Project regarding the current challenges with Health and Human Services in Loudoun County.  As part of the discussion regarding the demographic and clientele served at Insight Into Action Therapy, Craig was asked to speak to several barriers areas highlighted by the project:

Stigma associated with mental health – While both shame or embarrassment remain, the stigma surrounding mental health is not what it used to be. This can be attributed to increased awareness surrounding mental health in conjunction with so many sharing their struggles with anxiety and depression and how therapy and medication have helped.
Access to quality care – Is not solely attributed to who has the means to pay out of pocket, but included available credentialed or licenses professionals who are competent in the specific area of need and have availability for new clients. The project concluded that within Loudoun County there was a shortage and therefore a significant need.
Commercial insurance – While Mental Health Parity and Addiction Equity Act of 2008 was designed to create equity within benefits, there still remains the experience of so many that access to medical care/injury is faster than that of mental health and/or substance use. This could be because the consumer is not getting a return call from a provider, the provider site is not update, or there are not enough paneled providers (due in part to the administrative demands and the SIGNIFICANTLY low reimbursement rates)

Newport Academy Professionals at Bards Alley in Vienna, VA

Craig James, LCSW, LSATP, MAC and Angie Harris, LCSW, LSATP, MAC, MA attended a networking event hosted by Newport Academy on April 9, 2019 to learn more about their therapeutic residential program to launch soon in Fairfax County.  The event held at Bards Alley allowed Angie and Craig to provide an overview of the adolescent Dual Diagnosis Recovery Program© (DDRP) offered at IIAT. DDRP allows adolescents to attend process and psychoeducational group therapy in Ashburn, VA while their parents attend a clinician-directed support and process group. DDRP also helps maintain accountability with on-site drug tests. Craig and Angie learned about the clinical programming offered at Newport Academy when youth in DDRP might demonstrate behavioral health needs that exceed the capabilities of community-based services.

Anxiety: Common and Treatable

Anxiety is a very common and very human experience. So common in fact that all human beings experience some degree of anxiety.

But there is a distinct difference between anxiety as a brief, understandable concern that occurs when thinking about the future (such as an exam, bills, or a life change) and the debilitating form of anxiety that affects day to day functioning and takes over your daily life. That’s when its likely to be an anxiety disorder.

Anxiety disorders are the most common reason why people seek help from mental health professionals. According to the Anxiety and Depression Association of America, around 40 million adults suffer from an anxiety disorder. That’s about 18% of the population! Yet many feel ashamed to admit to even having such symptoms. In one survey, only a third of people receivedtreatment for their anxiety disorder.

This is unfortunate, because as a practicing psychiatrist, I can tell you that these disorders are treatable, which can transform the quality of your life.

Let’s start with some definitions: Anxiety is an exaggerated fear of an anticipated threat to oneself. That can mean anything that you believe jeopardizes your existing life—your relationships, career, finances, etc. It can take the form of both thoughts and feelings.

Both of these can affect your behavior or decisions in predictable ways. Oftentimes these predictable, but maladaptive coping behaviors reinforce anxiety. Avoidance and alcohol/substance use are typically the most common maladaptive coping behaviors.

Thoughts can take the form of excessive worrying or overthinking and be hard to control. They are called ruminations. These can be intrusive, cause mental discomfort, and affect concentration or sleep. Ruminations also make a person irritable or experience anger outbursts.

People who ruminate can become “stuck in their head.”  By investing so much into the content of such repetitive worries they tend to avoid the very thing they fear. However, this only ends up making their anxiety worse.

Those who experience anxiety describe it as: a sinking feeling in the pit of my stomach, a sense of dread or impending doom, butterflies in my stomach, feeling keyed up, or tension in the head or muscles. Sometimes these can lead to a rapid heartbeat, shortness of breath, tremors, dry mouth or sweating.

If abrupt in onset, symptoms felt in the body can increase anxious thoughts, which could then be misinterpreted as a heart attack or feeling like you are about to pass out and die. This is called a panic attack.

Having talked patients down from panic attacks, I can tell you that the most common reaction to one is usually rapid, shallow breathing (hyperventilating). This can make the panicky feelings even worse because it makes the person feel light headed, thereby leading to a cascade of worsening anxiety.

Though not dangerous or fatal, panic attacks are the most dreaded of all anxiety symptoms. They typically lead to people escaping a situation, reaching for alcohol or drugs, or feeling paralyzed by their anxiety.

There are various different types of anxiety disorders including: Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder and specific phobias such as a fear of flying or certain animals. Debilitating symptoms can be an aspect of mood disorders such as Major Depressive Disorder and Bipolar Disorder. People can have more than one type of anxiety disorder.

Next, let’s talk about treatments. Both medications and therapy are crucial in treating anxiety disorders. When utilized together, it has been repeatedly proven that outcomes are much more positive.

Medications can be used as short-term and long-term treatment for anxiety disorders. Short-term treatments for anxiety can include medications like benzodiazepines. They can be very effective in reducing acute, severe (somatic) anxiety, including panic attacks. However, patients can become psychologically and physically dependent upon these medications if they are used over the course of months or years. This is because their effectiveness can wear off, as patients  become tolerant to their therapeutic effect. Be aware that if you have been prescribed these for long periods, you may experience dangerous withdrawal symptoms if they are stopped abruptly and without medical supervision.

Long-term treatments include some types of antidepressants and some mood-stabilizers. If taken consistently, and at the right dosage, they help to reduce the frequency and intensity of anxiety symptoms, allowing the person to benefit more from psychological treatments such as therapy.

In my opinion therapy is underutilized compared to medication. This is partly because advertising by drug companies gives the impression that medications are instant miracle cures. It may also be due to the influence of stereotypes in pop culture that portray therapy as somehow outdated, unscientific or ineffective. Research has shown that nothing could be further from the truth.

In fact, I strongly encourage my patients with anxiety disorders to regularly engage in therapy in order to properly educate themselves about their disorder and develop coping strategies.

The most consistently proven effective therapy for the anxiety disorders is cognitive behavioral therapy, which breaks down anxious thoughts into various types of distorted thoughts. Some include black and white thinking, catastrophizing, and jumping to conclusions. These types of thoughts need to be challenged and replaced with healthier ones. Therapy can help you recognize your patterns and develop different strategies to manage anxiety.

My own adage is: you are not your thinking. I also tell my patients: therapy is work. It requires active participation in your recovery. But it can also lead to lifelong rewards in freeing you from negative thinking patterns.

While this is a basic summary of anxiety disorders, nothing is better than having a face to face conversation about anxiety with a trained mental health professional. This may be the most valuable decision you make as you embark on the rewarding journey towards resolving anxiety symptoms.

 

 

How To Solve the Opioid Epidemic

Q: What can therapists do about the Opioid Epidemic?

A: You can’t avoid the news without hearing that opioid use has become an epidemic in the United States. Drug overdose is now responsible for more deaths than automobile accidents. The president declared it a public health emergency and numerous government officials and treatment providers have made it a key issue.

Ask anyone who has become addicted to heroin, loves someone who uses it, or works with people who are trying to quit and they will tell you heroin and opiate addiction is horrific. It’s a living hell. After one of my clients had gone through withdrawal, he said, “I did not think I could feel that bad and still be alive.” But, I am telling you: we are focusing on the wrong issue.  There is another way to solve the opioid epidemic.

I’ve been a therapist working with those struggling with dual diagnoses (both drug/alcohol and mental health disorders) for nearly a quarter of a century.

I am a trained Narcan provider.  If I see someone who is overdosing on an opioid, I can spray this drug and reverse their overdose, potentially saving their life. But guess what, I have never had to do this.  And, of the thousands of clients I have worked with during my career, I can probably count less than one hundred people who have been dependent on heroin or painkillers.  I am the co-founder and Clinical Director of an outpatient private practice.  I would likely see more opioid dependent clients if I worked in a detoxification unit, emergency department, or an inpatient addiction center. However, most psychotherapists are in an outpatient setting like me.

Take a moment and ask yourself about the clients you see and the members of your community:

Parents: are you more likely to find an empty beer bottle or a needle in your child’s room?
School administrators: do kids get sent to your office for smelling like marijuana or nodding out in class from opioid use?
Legal professionals: are you more likely to see a Driving Under the Influence or a possession of heroin?
Therapists: will someone come to you for help with for depression and anxiety or injecting heroin?
Colleges: are you more likely to break up a keg party or a trap house?
Spiritual leaders: do your parishioners come to you because of drinking too much or taking too many pills?

The National Survey on Drug Use and Health (NSDUH) reports that marijuana is the most widely used illicit drug. Approximately 37 million people in the United States admit to it. That’s the about the amount of people who live in California. Yet only 948,000 people are using heroin—the population of San Francisco. Yes, this number is too large and too many people’s lives are ruined, but I still say that we are focusing on the wrong drug issue.

The Centers for Disease Control and Prevention (CDC) found that more than nine of ten people who used heroin also used at least one other drug. And that heroin rarely is the first drug of abuse. The CDC also notes that one of the main risks factors for using heroin is first being addicted to marijuana and alcohol.

Are you beginning to see the problem?  There is a clear connection between alcohol and marijuana use that can lead to the more lethal addiction of heroin. The earlier it starts, the more serious it becomes. Why are we not treating marijuana and alcohol use as the epidemic waiting instead until people are hooked on opioids?

The evidence shows that we need to intervene much earlier. As we know from the number of lethal overdoses from heroin and fentanyl by the time in gets to this point, it may be too late. We have to do something sooner.

Here is how I handled a family who called me when they found a homemade bong in their 16-year-old son’s room.  I met with the parents without their son as he refused to attend the session. The soft-spoken mother voiced her concerns that had seen changes in his attitude at home and who he spent time with, along with finding the bong and empty beer bottles.  The father was angry at having to come to my office, saying that he had smoked pot as a kid and turned out fine, and that his wife just “babied” their son.  He argued that his son still got good grades and played lacrosse.  Then he said the two most common rationalizations I hear: “It’s not like he is shooting heroin and weed is practically legal.”

Now any good therapist knows not to argue back with a client about the flaws in his statements.  There was no point in arguing with his defenses.  This told me where he stood and gave me clues of how to intervene with him.  The mother was already more on board, as she knew something was not okay with her son, thus would be more open to recommendations.

I first acknowledged how much they must love their son to spend the time and money to meet with me. I was very careful not to side with either parent as the child was already taking advantage of their different viewpoints.  I asked questions about their son, making sure to focus on changes to what was normal for him. Stereotypes still show “pot heads” as listening to a certain type of music, talking slow, and not doing well in school.  It can be hard to distinguish between what is the normal separation and individuation of an adolescent and the developing signs of a marijuana use disorder.

In my years of experience, I have found that one of the most telling signs of regular substance use is having paraphernalia or being in possession of alcohol.  This young man had made his own bong.  This signals a red flag to me that he is likely using it frequently, has probably purchased it, and may be using it alone.  When probed the parents also admitted that they had noticed him smelling strongly of cologne (to hide the smell of marijuana smoke), heard a rumor that a new teen he was spending time with was a “bad kid”, and allowed him to have beer with his friends, thinking it was better to know where he was and that he was not driving.  The couple also found vomit in the backyard a few weekends ago. While adolescence is a period of testing limits, taking risks, and rebelling against authority, regular drug or alcohol use is not.

Trying marijuana or alcohol at a party junior or senior year is within normal limits.  I find it critical for the parents and adults in kids’ lives to send the message that drug and alcohol use is not acceptable.  Teens often see things in black and white. Their pre-frontal cortex— a part of the brain that forms judgments, weighs outcomes, and controls impulses and emotions— is not fully developed until around age 26. Biologically adolescents are not able to see the shades of grey that an adult can.

For example, if healthy adults chose to consume alcohol (I have many thoughts on marijuana, but will not get into them here!) they assess their responsibilities, make sure those are taken care of, find a ride home, etc.  These actions reduce the likelihood of significant consequences.  Additionally, alcohol is more activating for adolescents while more sedating for adults.  This mean that the more a teen drinks, the more likely he or she is to become aggressive or reckless, while an adult typically gets sleepier. At this age, teenagers’ brains are wired to seek pleasure and not think through consequences. These skills we develop with age and experience.

Once I gathered additional information from the parents about the young man, I suspected that he might be experiencing a mild to moderate marijuana use disorder.  But I also needed to meet with him.  I wanted to know why he was making the choices he was.  Could there be trauma? An underlying mood disorder? Problems at home or school that would explain what he was hoping the drug would do for him? Oftentimes when kids are using chemicals “just to have fun” they generally stop after the first or second time they get caught and consequenced. This young man’s behaviors had been found out on several occasions.

Now remember that this young man refused to attend the session.  No problem, rarely do my clients voluntarily come to see me.  It is a myth that people have to “hit bottom” before they get help. Most often the reason people are in my office are because of external reasons like getting caught by a parent, spouse, employer, school, or law enforcement.

With adolescents, I prefer to first offer options. I recommended to these parents that they go home and let their son know that they spent the session talking about him. Most people are uncomfortable with this and want to be able to tell their side of the story.  I told them to say that I wanted to meet him before I ever gave any direction on what to do; that they might even being doing something wrong (this has hooked many adolescents). He knew his parents had differing views on how to handle consequences.  When the father was angry he had threatened military school or a wilderness program.  The mother cried and wondered if he needed to go into rehab.

I prefer parents offer reluctant teens incentives for therapy.  Parents of most kids over the age of twelve know their most powerful weapon: the cell phone.  “Son, you can have your phone back once you have your appointment.”

Lastly, if the teen still refuses, we give consequences. “You can’t drive the car, go out, and get your allowance, etc. until you complete your evaluation.”

Many times by the time I see an adolescent in my office, their substance use has been occurring between six months and two years.  They are not kids who got caught on their first use.  There are often behavioral, academic, interpersonal and sometimes mental health and legal issues that are occurring.  A typical recommendation I give in this situation is once a week individual and group therapy for the teen with random drug and alcohol screening. I also educate parents on the signs and symptoms and how to provide consistent, predictable, and fair consequences. I rarely recommend an out of home placement unless there is a severe substance use disorder that includes multiple daily drug use and a mental health diagnosis that interrupts activities of daily living.  We have to be careful of using the most intensive treatment option as a first choice unless there is a life threatening symptom or behavior. To be a dual diagnosis therapist you have to be comfortable high-risk actions, resistant behaviors, and confrontation.

Research has repeatedly shown that the younger someone starts using a substance, the greater likelihood there is that they will become addicted to it.  In fact, if someone begins using before age 15, they have about a 50% chance of developing a severe substance use disorder—addiction.  It is also well documentedthat 90 percent of people who develop a substance use disorder began using chemicals in their teens.

We need to take adolescents’ drinking alcohol and smoking marijuana seriously because these can be the early warning signs of a developing addiction. It may not just be “kids being kids”, “experimentation” or “everybody doing it.”  This use may be the first symptoms of heroin addiction. We need to address it.

When I am meeting with concerned adults I often use shock value to get their attention. I ask parents again how many children they have.  Often it is two.  I then look them both clearly in their eyes, “Which one are you willing to give up?”

This may sound extreme, but I need families to hear how dangerous early drug use is.

I tell parents that they will never regret meeting with a licensed therapist who is credentialed in substance use disorders and has experience in treating adolescents. Just like talking about sex is not going to make them go out and have relations, talking about substance use is not going to make them suddenly take a drink or take a hit.  Requesting a drug screen from a teen who is already using substances is going to yield a very different response that one from a teen who has not been under the influence.

The majority of adolescents are not experiencing addiction. Yet.

Don’t wait to do something until it is out of control.

Yes, there is a heroin epidemic. But that epidemic usually starts with alcohol and marijuana use. As a community we have the opportunity and responsibility to prevent one more overdose by taking action sooner.

 

 

Fairfax Community Professionals

On April 4, 2019 Nancy Kirk, LCSW, CSAC, CSAT-C represented IIAT at the Fairfax Community Professionalsin Fairfax, VA. The Fairfax Community Professionals (FCP) is a network of mental health professionals dedicated to responding in a timely way to mental health needs of teens in central Fairfax County.  We offer a directory of available licensed mental health practitioners to high school personnel so that students and families can connect with private practitioners quickly and efficiently. FCP also provides triage to other mental health services in the community, participates in workshops and community education activities, and provides speakers on a range of mental health topics. Nancy connected with many other professionals sharing the mission of supporting local youth in Fairfax County. She was able to highlight her unique specialty areas of providing Spanish speaking services and substance use treatment offered in the City of Fairfax.

Inaugural Training and Networking Event at Amen Clinic-DC in Reston, VA

[image error]On March 29, 2019 Angie Harris, LCSW, LSATP, MAC, MA attended the inaugural training and networking event at Amen Clinic-DC in Reston, VA.

Angie connected with other professionals specializing in complementary services such as art therapy, therapeutic yoga, eating disorder treatment, psychological testing, naturopath and aromatherapy treatment, as well as home healthcare specialists.

One area where IIAT continues to stand out among those treating behavioral health is offering moderation alcohol management. IIAT wants to thank the Amen Clinic for hosting this event and providing a brain-healthy breakfast. We look forward to continued collaborative efforts and trainings with other professionals throughout Northern Virginia.

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What Are Process Addictions?

In 2014, The Institute for Addiction Study recognized and included ten addictions to behaviors with dopamine-releasing substances to include in the Periodic Table of the Intoxicants. Due to the problems presented by individuals that met the Diagnostic and Statistical Manual (DSM-5) criteria for an addiction, these ten behaviors were added: gambling, media, relationships, codependency, performance, shopping, sex, cults, food/sugar, and rage. When the behaviors are out of control they are called process addictions.

Much has been written about food addicts, compulsive gamblers, workaholics, and those addicted to shopping. Many have also been affected by addictions to video gaming, social media and pornography.

As a Trauma-focused Therapist and Drug and Alcohol Counselor, I began studying process addictions to better help the people who are struggling with these behaviors. Both within these areas and outside of the stated ten process addictions, I have had the privilege of working with clients struggling to understand and control compulsions to acting out sexually, exercising daily to the point of exhaustion, shop-lifting resulting in repeated arrests, extreme self-mutilating (cutting), and under-taking multiple plastic surgeries without achieving desired satisfaction.

What happens when a behavior that used to bring a rush of excitement (releasing dopamine) or provided a place for where one could park anxiety (releasing GABA) becomes an addiction? Similar to the effects of chemical addiction, a process addiction rewires the prefrontal cortex and results in high jacking the rewards process.

A time comes for every person suffering with an addiction or overwhelming compulsion when the consequences are so great or the pain is so bad that they admit life is out of control because of  (fill in the blank).

Sometimes this moment becomes a turning point in an addict’s relationship with their drug of choice. At this point the individual summons the will to reach out and start the recovery process.

As more is understood about how addictions to behaviors take place, the stigma of process addictions is being combated by 12-Step recovery groups, the Fight the New Drug movement, faith-based organizations and newer modalities of therapy focusing on process addictions.

Often those struggling with a process addiction describe a recovery process that removes the addictive behavior leaving a vacuum which leads to isolating, a recurrence of acting out, shame and despair. Without a program incorporating healthy habits, effective coping skills, a solid support system and insight oriented therapies, they often fall back into patterns which result in relapse.

Just as every individual is unique, every compulsion that leads to addiction develops in its own unique way. Each individual struggling with a compulsion deserves an individualized treatment program, a personalized roadmap to recovery. For this reason, it is important that the affected individual find a therapist that understands the manifestations of their particular process compulsion/addiction.

 

Nancy is a candidate to become a Certified Sex Addiction Therapist. If you or a significant other is struggling with a process addiction please contact Nancy Kirk at (703) 646-7664 x15 or nkirk@insightactiontherapy.com.

 

VAAP Annual Meeting

As a board member of Virginia Association of Addiction Professionals, Craig James showed his support by attending the 2019 Annual Meeting & Training at The Holiday Inn Oceanside, Virginia Beach on March 15th. He and Cyndi Turner attended Cynthia Moreno’s Conflict Resolution and Linda Handcock’s JUUL and Vapes: New Technology Impacting Nicotine & Marijuana Addiction.Cyndi and Craig plan to use this training when working with adolescents and young adults in their Dual Diagnosis Program©.