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How to Support Recovery and Not Addiction

Dawn Farm Education Series May 15, 2012 Charles F. Gehrke MD, FACP, FASAM

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.

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

Definitions
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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Definitions
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.

Progression of Addiction and Codependency


Addict
Early
no detectable effects

Middle
beginning to have impact on daily life

Late

uses to prevent withdrawal without treatment consequences increase _____________________________________________________________

Codependents Progression
no visible effects beginning to feel responsible for the addict - feels compelled to help - feelings of guilt feels compelled to help feels scared, insecure overwhelmed, desperate

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Family Recovery
Blues Intolerance Suspicion Problems multiply Worry Irritability Seeps help Avoiding reference Arguments Extravagance Distrust Self-defense Unhappiness Depression Religious needs Irrational behavior Denial (fantasy) Self-neglect Threats made but not fulfilled Alibi Takes responsibility Dishonesty Loss of interest Infidelity Imaginary illnesses Isolation Faade Blames others Uses prescribed drugs Escape Loss of self respect Jealousy Remorse Social withdrawal Patent medicine use Indefinable fears Drug abuser Bankruptcy of alibis Admits defeat Chronic depression Suicide attempts Joy Courage Love Makes amends Peace of mind Service New friends

At ease with life Return of respect Appreciates spiritual values Return of confidence Release New interests develop Trust, openness Guilt is gone Return of self-esteem Honesty Diminishing fears Daily living pattern improves Develops optimism Begins to relax Cover-up ceases Becomes willing to change Shares with others Need to control lessens Recognition of role Seeks help Acceptance Recognizes disease BOTTOM Sincere desire for help Spiritual examination

W IT H

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UT HO

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Prepared by

Support Addiction
Lack of knowledge about addiction
*Using is a choice *Responding to the behaviors *Enabling * Taking care of it myself

Support Recovery

Education: Believing the behaviors we see are


a choice supports the disease.

Education about addiction *Addiction is a disease


*Responding to the disease * Detachment *Ask for help

I wish he would. Why doesnt she. He should If only she would.. Why cant he.. Doesnt she see .

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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

Defined set of Sis/Sxs


Craving Loss of control Compulsion to use Continued use in spite of bad consequences

Predictable course & outcome

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Education: Addiction is a disease Why? *Cause may or may not be known.

(cont)

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
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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 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.

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.

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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.

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.

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Education: Enabling behaviors

Education: Dont 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-

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Education: Dont enable - detach to support


recovery.
(cont)

Education: We will take care of it


ourselves supports the disease.
Common misconception: problems in the addicts 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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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) doing nothing
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does not mean

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)

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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.

Conclusions
Remember:
1. You didnt cause it, cant control it, and cant 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?
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*Therapy: individual or family - therapist with experience addressing addiction and codependency *Mutual Support Groups: Al-Anon, Nar-Anon,
Alateen, Families Anonymous, others *
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Interventionist:
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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