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Mar142017Mar142017

Alcohol & The Choices We Make

Articles, Australia, International, Understanding Addiction

Alcohol – the most popular and widely accepted recreational drug in the 21st century. The manufacture and sales of wines, spirits and beers is a $300 billion industry. No wonder governments are in no rush to outlaw it and effectively curb their own taxed income. Should they, though?

As one of the oldest recreational drugs in human history, alcohol is not strictly bad for you. As with most things, if consumed in moderation and care, they have proven to reduce the risk of heart disease and stroke. We know that humanity first started consuming alcohol around 8000 B.C., which coincides with the birth of agriculture. Alcohol does occur naturally, but can not be harvested in large quantities and would take more effort and time than to grow the ingredients and ferment or distil them ourselves, in carefully regulated environments ensuring the best yield and quality.

Why does a substance that many ancient civilizations considered to be a gift from the gods and treated with respect and reverie, has been killing over four million people a year?

Instant Gratification

We live in a time when all it takes to get a drink is to visit your local grocery store. Age of instant gratification. There are even alcohol delivery options available in some cities! Too much of a good thing can be extremely detrimental, especially if said thing helps us be less shy around opposite sex, make us feel more charismatic and overall have more fun. Until your liver gives out and you die a slow and painful death.

Ancient Babylonians did not have access to alcohol the same way we do. It took skilled craftsmen a long time to gather the ingredients, prepare the tools and apparatus required to produce it and even longer time and effort to distribute it to people nearby. An average Babylonian never even tried alcohol, it was so exclusive and expensive that only the brewmaster himself and his closest friends and family got to enjoy this elixir.

You, however, just need to open a fridge and you have a cold beer in your hand. Modern logistics and industrialization have allowed alcohol to become the widespread phenomenon it is today. And with it, comparably cheap prices and ease of access.

Choices.

Human beings parse information and make decisions and choices on a daily basis. Using their prefrontal lobe of their brain they decide if it would be a good idea to approach a desirable mate or pick a fight with a person much less desirable. Introduce alcohol to that process and these decisions seem much more straight forward and easier to make. Alcohol is mostly consumed due to its inhibition and inner barrier removal properties. A few drinks in you suddenly have no issues with doing that karaoke song in front of all those strangers, it is just singing after all. Embarrassing yourself in front of a crowd is least of your worries while drunk, most often it can make the user aggressive and brave. Sadly, alcohol and bravery do not go well together, as it also impairs not only judgment of the user but also his motor skills, equilibrium, and vision.

Alcohol is infamous for being the source of poor decisions. The more alcohol is consumed the worse it gets. Sadly, alcohol is also a highly addictive substance and millions of people die of alcoholism and its corresponding symptoms every year.

Alcohol hyperstimulates the midbrain of its user. It draws most of the blood that would usually be distributed evenly. It handicaps the prefrontal lobe, the center of decisions, values, and critical thinking. Decisions are made based purely on instant gratification, once dear values are discarded and ability to rational thinking slowly dims. The longer a user is abusing alcohol, the more intense these drawbacks become and more time is required for the human brain to stabilize its own natural chemistry.

The so-called high-functioning alcoholics, while being addicted to the substance can still maintain relationships and keep their job. They are a rare kind of alcoholic. While being more able than most, they still put their own health at risk of liver scarring or cirrhosis, stroke and respiratory arrest.

Those who are not so strong succumb to a downward spiral of unfortunate and self-impaired results. Loss of care for friends and family, inability to hold meaningful relationships, inability to maintain a job and in extreme cases total disregard for one’s own hygiene and well-being.

Alcohol affects our choices. There is no way around it. The very first and most important choice is whether or not to use it at all. Its potential small dose benefits are not worth the potential life threatening addiction. For long lasting alcoholics a rehabilitation course of carefully monitored detoxification procedures is required to regain any semblance of their life and their ability to make significant decisions.

Mar132017Mar142017

Treatment In All of Its Forms

Articles, Australia, International, Understanding Addiction

Every addiction case is different. It has been repeated over and over again, so it is no secret. It also happens to be true because addiction as a disease is mostly in the addict’s head. We all have our personalities, things that make us unique. The way we react to certain stimuli, anger, fear, excitement or affection. Addiction piggy-backs on the most important and personality defining organ we each have – the brain. No two minds are the same, even identical twins have broadly varying opinions on an equally broad list of things.

This complicates addiction treatment because as radically different as people can be, so can their addiction and its manifestation. Further still, there are many different approaches to addicts recovery based on the severity of their addiction.

Weekend warriors.
There are those who have a vice. They use a drug, but use it responsibly and without the need to “top up”. They perhaps look at it as a treat or something to do on special occasions. They may succumb to its use only on weekends, knowing all too well, that if used mid-week would disturb their actual life and cause problems in work and personal life. Simple AA meetings and group therapy are all that is required to remind the addict, that their choice of recreational drug is a slippery slope that leads only to misery and despair. So far their responsible use has staved off this rapid decline, but for how long?

Careless abusers.
Not all addiction issues are the same. There are those who can not be classified as fully addicted to alcohol, for example. The person in question does not have alcohol dependency and does not feel the need to consume alcohol on a daily basis. Instead, he has no control those rare times he does get a drink. A non-stop three-day binge ensues every time the patient has a drink and then it could be months until next episode. It would be rather useless to check such a patient in an inpatient rehabilitation center. There is no alcohol dependency to combat, so detoxification course is unnecessary as well. Furthermore, there are no cravings or ingrained need to consume, so a safe haven from such thoughts and stimuli is also rarely necessary for such a patient. An intensive outpatient rehabilitation course or is usually the best approach for people like this. A safe place to talk about things that go through the person’s head when he has had a few, to find out the root and stem of the cause that drives him to drink uncontrollably and binge for days on end. The defining factor here is that the patient is fully aware of his episodes and decides to ignore the warnings. They know they will have a fight with their spouse or be unable to perform their parental or work duties and responsibilities and yet they binge anyway. This is a very dangerous behavior and needs to be interfered with as soon as possible and kept on a short leash. The intensive outpatient program is more hands-on and requires a significant will to successfully become clean and usually require a minimum of three or four meetings a week.

Lifeless zombies.
The last rung on this ladder of addiction is the one rehabilitation centers are made for. The truly addicted and dependant. It follows in the same steps as the case mentioned earlier, yet consumption and use has become a problem in personal life. It is causing rifts in relationships, problems at work and neglected responsibilities. The need to use is constant and more often than not is satisfied, albeit for a very short time, on a daily basis. The addict in this stage is stuck in a vicious cycle where his addiction and drug or alcohol abuse is creating problems and these problems are driving the addict to use even more just to escape them for a little while longer. Burying their heads in the sand they keep using until there are no more relationships to mend or no more life to piece back together, essentially turning the user into a lifeless zombie with no reason to live. A lethal overdose is not far away. This kind of situation is no time to play coy and hold back. A full two-month minimum inpatient rehabilitation course is a must. First, their physiological dependence is tackled through a rigorous detoxification program and then come the counseling and re-learning a long list of life-skills that will help the addict remain on their path to full recovery. Inpatient rehab ensures that the patient is isolated from negative influence and the factors that drove him to use in the first place. The course itself may be only a few months, but the battle will take a lifetime of self-restraint and control, achieved by a wide range of practices and techniques, yoga and mindfulness program to name a few.

Whatever your stage of addiction, time is of the essence. Every hit has a greater and greater chance to bring you over the edge of no return, not on your own anyway. Do not hesitate to seek help because the only thing worse than ignoring an ever-approaching addiction is to try and fight it on your own, losing the battle and giving up on possible recovery for good.

Mar102017Mar102017

Tallest Towers To Climb During Recovery

Articles, Australia, International, Understanding Addiction

Addiction. A scary word for most, those who have never encountered it. People are afraid of things they don’t know, things they do not understand. Honestly, to say that anyone fully understands addiction would be a fallacy if not a blatant lie. Addictions and their varieties are as different as people that are plagued by them. Most people get to know what an addiction really is only when they succumb to it themselves or witness it firsthand in their own family or in a circle of close friends. Lucky ones learn what it is, come to terms with it and tackle it head on. Procrastination kills when it comes to addiction. Then there are those who will fight tooth and claw but in the wrong direction. Instead of admitting to themselves their shortcomings and channeling that energy and determination towards becoming clean, they often deny the existence of the problem while staring it directly in the face.

There are many different obstacles an addict has to overcome during their voyage towards recovery. As varied as people can be with their own dreams, fears, plans for future or lack thereof. Most of these obstacles and addict build up themselves. It is a battle that is mostly fought inside the addict’s head. To call an addict clean one must do much more than just get him physiologically clean and free of substance dependency. He must also be shown a great many ugly truths. What could they be? Let us have a glimpse at few of them.

Lack of commitment.

At first, most addicts do not believe that their problem is that big. They think it is blown out of proportion and if by some miracle they are convinced to check in rehab they do not do it for themselves but rather someone else. Usually family members or friends.

How many times have you finished your homework back in the day, not because you wanted to strengthen your knowledge in a school subject, but just to make your mother shut up about it, all that whining made you mad, did it not? It was easier just to get it over and done with, usually with lackluster results, but it counted and she could finally get off your back.

We are not children anymore. It is time to take responsibility for ourselves and our actions. Recovery is a commitment for life, to switch from self-destructive behavior into a learning experience.

Not their fault.

Speaking of responsibility. Many simply can not face the ugly truth that they are responsible for the situation they are in. They would rather blame God, their landlord, spouse or even their parents – all in a desperate bid to avoid looking in the mirror.

Blaming others for their own problems is much easier than dealing with them yourself because that would take strength and courage, an ounce of self-respect and some backbone. Most addicts lack in this department – if they were strong, courageous and have any respect for themselves and grew a backbone at some point, they would not be addicted. It is a vicious loop – the very qualities that the addict lacks lead them to become addicted as well as resist most attempts at conscious need to become clean.

Reluctancy to make changes.

You can wash your feet till they bleed, but as soon as you put on your old dirty boots they will get soiled again. Most addicts do not understand or rather don’t want to admit that they are a product of their environment. To become clean an addict must commit to drastic and often unpleasant lifestyle changes. If bad relationship is a contributing factor to your addiction it must be resolved or put behind you. If you are deeply depressed and unhappy in your current job, it does not matter how long you will spend in a rehab, you will sooner or later relapse and be back to square one. To start on the path to recovery some proverbial bridges must be burned because given the chance you will return to addiction. You may be clean and serene when you finish your rehabilitation course, but as soon as you return to the environment that drove you to use of addictive substances, it will happen again, it is just a matter of time.

To be brutally honest with yourself is probably the most required thing on your path to recovery as an addict. Take responsibility for your actions (or inaction), step away from the contagious factors that contribute to your drug abuse, double down and recognize that you must do this for the benefit of yourself first and foremost. These things don’t come easy, but the best things in life are rarely easy. Luckily, there are many options to become clean, countless people willing to help and assist on your journey. Family, friends and educated professionals in various types or rehabilitation. All for your benefit. Step up, admit and commit today – procrastination kills.

Mar072017Mar072017

The Working Alliance & Therapeutic Alliance!

Articles

OPEN RELATIONSHIPS

Raymond Guddah

BSc, Dip, MBACP

Senior Counsellor at DARA Koh Chang

CLIENT CONFLICT

I began my career as a counselor in London, and as a member of an ethnic minority group, initially I found it very difficult. Clients would question me about my credentials, and quiz me on the criteria for being a counselor, in an effort to assess whether I was ‘good enough’ for them.

These early challenges left me wondering whether I had in fact chosen the right career path. Luckily however, I received mentorship from other counselors, which allowed me to experience a very useful paradigm shift, and a resultant bump in confidence. This gave me insight into what was really important if I was to create positive outcomes for my clients.

I discovered that, according to the researcher Alexandra Bachelor, successful therapy needs to be based on a relationship of authenticity, trust respect and empathy between therapist and client ¹

So, my concern switched from ‘how can I validate myself to my client’ to how can I foster trust, empathy and mutual respect in a genuine way?’

CULTURAL CONTEXT

The UK is a multiculturally diverse place, and therefore my focus was often on establishing a good therapeutic rapport with clients who were from culturally different backgrounds to me. I realised the importance of viewing people as not only existing within a cultural context, but also as unique individuals. I had to develop wide-ranging skills to assess, intervene, approach and engage clients if we were to emerge with a positive outcome from therapy.

Counselling is a nurturing and meaningful interaction between two or more individuals where goals are set and challenged with trust, respect and empathy, with a focus on a robust prediction of the outcome of the quality of counsellor and client relationship. ² I therefore decided to aim on working with the transference and counter transference feelings within my relationship with my clients.

Transference is a phenomena which often arises in therapy, and is simply when a client redirects feelings for others onto me in my role as therapist.

Countertransference can happen as a reaction to transference, and it occurs if I transfer emotions back to the person in therapy.

It is worth acknowledging that in most therapies, there could be moments when tensions and probably strong feelings (i.e anger, frustration, disappointment) may arise between the therapist and the client. Feelings of boredom, frustration or a sense of being ‘stuck’ in therapy can actually serve to highlight potential challenges in the establishment of a good therapeutic alliance. Once highlighted, these challenges can then be worked through.

Based on these factors, my goal then was to start making my clients feel safe by being non-judgmental, authentic and congruent and being aware that what one client might consider safe, may not be safe for another.

WHO ARE YOU?

I was also frequently checking in and identifying with who ‘I was’ to my client. This was important because if the relationship lacked authenticity, my client would not feel safe and there wouldn’t be a genuine investment in the work from both the therapist and the client.

A relationship based on trust is crucial in multi-cultural therapy and it requires patience and exploration of the clients’ perspective of the nature of therapy they feel they require. It is also helpful to explore and process painful and difficult experiences of racial, cultural and social nature right from the beginning of therapy. ³

As a Therapist, I started to consider the role of my identity and professional awareness of competence surrounding issues of ethnicity, power and privilege, as these are fundamental in building a therapeutic relationship. ⁴ With this in mind, I started developing the practice of listening actively to my clients.

I would allow my clients to ‘Feel their feelings’ and to be ‘themselves’ without telling me what they felt I needed to hear. I would ensure that my client had enough confidence in me to acknowledge that I knew what I was doing and not show any sign that I could or would reject them.

CREATING THE SPACE FOR CHANGE

As a therapist I feel that our clients need to know that we are hearing them and for us not to jump in to ‘save’ or advise them and this experience of feeling heard and acknowledged (maybe for the first time for some) can be transformative. Clients who have had the opportunity to express their feelings, fantasies, fears and desires in a safe process can then make sense of the need to consider change.

Working with transference has been very significant for me with my background in Psychodynamic Psychotherapy. I am aware of the possible triggers that lie within my role, my personality, my cultural background and my ethnicity. Transference is neither good nor bad, and sometimes it is almost unavoidable!

Sometimes it can actually be a useful tool to work with thus providing therapist and client with an opportunity to address the issue of the ‘elephant in the room’. For example, let’s say I remind my client of an abusive partner in terms of appearance, accent, mannerisms, whatever. The realization of this and acknowledgement by the client that I inadvertently bring up these emotions in them and they are projecting assumptions onto me as a result, can give us vital material which we can then work through to help the client deal with these difficult thoughts feelings and emotions.

I have managed to admit to myself that as a social being my core values, core beliefs and my perceptions of the world, can influence the development of my therapeutic relationships with my clients. I am still ‘learning’ to allow myself to embrace the concept of ‘openness’ in order to address issues of race, culture and its relevance to my work.

1 Bachelor, A. (1995). Clients’ perception of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42(3), 323.

2 Lambert, M. J. (2013). Outcome in psychotherapy: the past and important advances.

3 Lopez, F. G., Ramos, K., Nisenbaum, M., Thind, N., & Ortiz-Rodriguez, T. (2015). Predicting the presence and search for life meaning: Test of an attachment theory-driven model. Journal of Happiness Studies, 16(1), 103-116.

4 Helms, J. E., & Cook, D. A. (1999). Using race and culture in counseling and psychotherapy: Theory and process. Allyn & Bacon.

Feb282017Apr252025

Drug Policy Around the World

Articles

Philip Townshend

PhD, PG Dip Clin Psych

pills

This is a really interesting time for drug policy as jurisdictions around the world are implementing extreme and widely divergent approaches to dealing with recreational drug use. These measures will essentially amount to an amazing series of social experiments into how to address drug problems.

PARADIGM SHIFT IN PORTUGAL

Portugal represents one end of a liberalisation continuum. Since the early 2000s they have approached drug use as a ‘health’ rather than a ‘justice’ issue, thus encouraging treatment protocols, whilst still conforming to the World Health Organisation’s (WHO) treaties on dealing with class A, B and C drug categories.

Some Public Health proponents predicted that the result of such a paradigm shift towards more lenient policies would result in increased drug use as a result of increased availability. In fact, the reverse has been true, with most categories of drug use declining and a significant decrease in the reporting of drug related health problems and criminal events. The resultant health benefits include fewer overdose deaths and transmissions of blood borne viruses. The crime rate has of course dropped, in part because the police and judicial system were no longer prosecuting drug users, however the reduction was greater than could be accounted for by this alone. Most notably there were disproportionately significant reductions in drug related violence, theft and road accidents. The resulting openness about drug issues seems to have increased treatment utilization and the approach is widely acknowledged as having been effective.

Liberalisation has worked in Portugal, however these policies may not be able to be exported ‘wholesale’ to other countries, on account of cultural or demographic factors which might inhibit such a shift towards leniency from gaining sufficient grass roots support.

PUNTIVIE MEASURES IN THE PHILLIPINES

On the other end of the liberalization continuum lies the Philippines. Their hard line President Rodrigo Duterte has announced a policy of killing drug users and dealers – often without trial. Some of these assassinations are carried out by police and some by vigilante contractors.

The Philippines’ stance represents an extreme interpretation of the ‘war on drugs’ phenomenon. This approach of a kind of abstract war mongering – vigorously promulgated by polititians and policy makers across the world – has been all but abandoned by many states and countries due to its ineffectiveness. The US saw its prison population quintuple as a result of its own ‘war on drugs’. There had previously been a shift to downgrade the criminality of minor misdemeanours such as possession under Obama, but future policy directions of the US remain to be seen under the new Trump government.

Furthermore, liberalisation of drug policy is currently inhibited by the WHO conventions on drugs[i]. This convention places drugs into categories that have been politically assessed in terms of drug harm and judicial responses to the use or sale of drugs within these categories is thus prescribed. This politically based assessment of relative drug harm is often at odds with the scientific assessment of ‘harm’[ii].

NORTH AMERICAN CHALLENGE

canada

Many countries have recently challenged these conventions, most notably Canada, which is leading a move to change the WHO drug rules and is intending to legalize cannabis in 2017. Many states in the US are similarly moving towards legalisation of cannabis. In Colorado for example, advertising of cannabis products is allowed as long as no more than 30% of expected viewers are under 21.

The issue of addictive drug use in the States is by no means confined to substances that are categorised as ‘illegal’ in the classical sense of the word. Prescribed opioids (that are directly marketed to the public) were associated with 28,000 overdose deaths in 2014. This represented a 200% increase since 2000. Half of these deaths were attributed to prescribed opioid pain relievers, in particular oxycodone and hydrocodone. This means that ‘big pharma’ is now a significant dealer in dangerous recreational drugs. With its political clout, intervention and regulation may prove difficult.

ANARCHY IN THE UK

Finally, no discussion of drug policy could exclude the UK 2016 drug laws that have been widely criticised. Any psychoactive substance is categorized as a drug, potentially including foods and vitamins, but notably alcohol (that significantly accounted for the deaths of over 8,000+ people in the UK last year), and nicotine (which accounted for the deaths of approximately 80,000 people), are excluded.

INTERNATIONAL APPROACH AT DARA

At DARA we are truly an international rehab. In 2015 alone we hosted clients from 52 different countries. This gives us a unique view on the effects of drug policy in various countries, in terms of how they affect the addicts themselves. We notice huge global differences in terms of the relative prevalence and abuse of different varieties of drugs. What is popular in one region may be essentially an unknown entity in another. This represents a challenge for the clinical team, as different drugs can have markedly different effects and withdrawal profiles. Regardless of nationality or substance of choice however, the essentials of treatment remain the same. At DARA we treat people with dignity and understanding. By improving knowledge and increasing self-awareness we aim to provide clients with the tools for recovery, wherever they are from.

[i] There are three drug related major drug related treaties, as below, the first two codify internationally applicable measures in order to ensure the availability of “narcotic drugs and psychotropic substances” for medical use and to prevent their diversion into illicit channels. The three treaties are:

The Single Convention on Narcotic Drugs of 1961 Amended 1972
The Convention od Psychotropic Substances 1971
The United Nations Convention against Illicit Traffic in Narcotic and Psychotropic Substances 1988

[ii] Development of a rational scale to assess the harm of drugs of potential misuse,

Prof David Nutt, Leslie A King, PhD. William Saulsbury, MA, Prof Colin Blakemore, FRS

Published: 24 March 2007

DOI: http://dx.doi.org/10.1016/S0140-6736(07)60464-4