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The Importance of Long-Term Residential Treatment and Why

Shea Barakatt LCSW, LCDC, EMDR Trained

Clinical Director, Burning Tree Recovery Ranch

I have been blessed for many years learning from clients, families, staff and my own personal experiences about the processes that allow an individual the best chances of living a substance-free life. I have always lived my life as an individual who will call it like it is, who is up front, who tells anyone who is inquiring about the no-holds-barred truth of a situation. The truth about this inquiry is that I will not be spouting out long clinical terms that make me look smart because no one will get that. But what I can share is my experience. I can share my experience on the miracles that have happened over long periods of time. I can share my experience working with clients for over a year, helping facilitate families heal, and developing new tools for communication and functionality. Yes, I may have lots of education, but I value my experiences and I love to share with others what I see as valuable.

There are so many treatment centers in the United States that discuss how their centers and modalities are the “best.” There are many great treatment centers out there that facilitate success for many addicts and alcoholics. What I will be discussing is the type of client that cannot stay substance-free but will continue to ride on the circuit of multiple treatment centers, only to seem to fall deeper in their disease, while in the meantime exhausting all financial means for themselves and their family. Their family begs for a solution to the chaos, destruction and the wreckage that occurs in the path of the client. I am referring to the client that belongs in Long Term-Treatment. The National Institute on Drug Abuse defines Long Term-Treatment as 6 months or more in residential care. Residential care is where long term treatment is given in a setting where the individual is living at the facility, receiving clinical services and supervised by staff twenty-four hours a day. I will discuss why this is so important for the chronic substance user.

Time- The concept of time is so important. This is the first factor that most clients and their family discount. Most individuals discuss how they must return to work, their family, and their life. The truth is, most of that is wrecked anyway, not to mention possible legal consequences? Most clients that enter Long Term-Treatment have destroyed most of what they deem to be important. This delusion about “saving time” must be smashed. Without recovery, most of what they say they value, and love will be gone anyway if the time is not put into all the processes and experiences necessary for the individual to recover. In Long-Term Treatment, the staff must have time to work with the whole family, not just the individual. A family will send their loved one to treatment to fix the “identified problem,” the substance abuse. Well, guess what, that is not the case. Addiction is a family disease and we must have the time to separate each individual and help them work on themselves first. We then bring everyone back together to work on the family unit. Each individual had been playing a role that was not working. With this disease, the staff needs time to identify, solidify and unify solutions for each individual to help promote change in the family. This is a process and the process can be messy, but if everyone is willing and gets into action, change is just around the corner.

Time is very important to identify and treat the individual. Any co-occurring disorder may continue to precipitate active use. Most individuals that enter treatment have some form of secondary diagnosis, such as depression, anxiety, bi-polar, PTSD, etc. This also is why time is so valuable. Most chronic substance users have had multiple diagnoses over the years, and most of those diagnoses have been made while the client was either still using substances or in a matter of days or weeks after abstinence. What we know is that it takes time for the brain to reach some form of homeostasis. There are multiple studies that show it can take anywhere from 9 months to a year for the brain of a recovering addict to reach a baseline. These numbers all depend on the age of the individual, time in active substance use and the substances used. We must first treat acute symptoms for stabilization and then continue to evaluate the client over time to see if symptoms go away after the mind, body and spirit begin to heal. This is vital for an accurate diagnosis and the identification of the correct treatment. The process of medication management, clinical interventions and repetition will rule out what was actually behaviors and symptoms of either withdrawal from substances or active substance use.

Time is important to identify trauma in clients that have had these identified experiences. Many therapists have started using the modality of EMDR (Eye Movement Desensitizing and Reprocessing). This modality is very effective when practiced over periods of months in a safe environment such as Long-Term Residential Treatment. EMDR can be harmful to an individual when dealing with complex trauma outside of a safe environment and/or when practiced in a short-term setting. I believe it is unethical to start this treatment with an individual who will be leaving treatment in two or three weeks. There are a lot of memories and there is central nervous system disruption that can occur with this process. Therefore, the client and the therapist will need a long period of time to safely open and close each target to reach healing and a cognition shift. This is done effectively with an informed and experienced staff that can monitor, evaluate and process over time. EMDR is used in outpatient settings with clients that are more emotionally stable and have tools to deal with life on life’s terms in between sessions.

The final elements that demonstrate the importance of time are discipline and repetition. Behaviors and thought processes do not change in 90 days. Clients must have a consistent environment that pushes them to practice the tools learned. A client can be informed and given information. But if the client is not forced to put the information into practice over a long period of time, there may be no change in behavior or shift in thinking. This is vital in recovery. The addicted individual must have new muscle memory to carry out a new way of being in their new life. Change is not comfortable and most change is resisted. I always say the first step to new behavior is being “comfortable” with being “uncomfortable.” When this is acknowledged, new behaviors, solutions, and thinking can be initiated. And all of this takes time.

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Why Just Stopping Drugs and Alcohol is Not the Solution

By: Megan Souther, Alumna

The Problem:

When working in treatment, I’ve seen and heard it all. “Drugs made me feel better at first, and then I felt empty.” “I got sober for a little while, and then the depression came back.” If drugs and alcohol were my only problem, then I would be fixed once I went detox and got it all out of my system. The problem lies in the spirit, mind and body. A spiritual malady is a “disease or ailment.” Regarding alcoholism, it means that feelings have become unmanageable. The unmanageability has nothing to do with the consequences that have occurred due to addiction. As an addict or an alcoholic, I use drugs or drink to change the way I feel. Examples of the spiritual malady are loneliness, depression, irritability, restlessness, discontentment, anxiety, etc.

Addiction is a spiritual problem that no drug or drink can fix. The Big Book of Alcoholics Anonymous states on pg. 64 that “Our liquor was but a symptom. So we had to get down to causes and conditions.” The causes and conditions are those unbearable feelings and those lies we tell ourselves that we think make it okay to get high or drunk. Addicts and alcoholics are unable to see the truth from the false. As an addict, I may think, “it will be different this time,” or “this time I won’t go to jail.” But, addicts and alcoholics use drugs and alcohol to fill a void that only a Higher Power can fix. This spiritual malady demands to be treated. I might treat it with substances, food, sex, gambling, etc., or I treat it with a Higher Power.

There are only two alternatives. One is to go on to the bitter end, blotting out the consciousness of our intolerable situation as best as we can. The other alternative is to accept spiritual help (pg.25 of The Big Book of Alcoholics Anonymous). Most addicts and alcoholics search for that third option, but they will not find it. Once the problem is clear, then the solution is attainable. But it requires action.

 

The Solution:

An internal problem can be treated with the 12-steps and by building a relationship with and connecting to a Higher Power. The 12-steps are one way that I can work towards my own recovery. Burning Tree is a 12-step program where the clients work the steps and focus on learning to cope with their feelings by building a relationship with a Higher Power. Throughout the Big Book there are promises of how to overcome the spiritual malady. By working the steps, these promises come true. An example is the 9th step promises: “We are going to know a new freedom and a new happiness. That feeling of uselessness and self-pity will disappear” (pg.85 and 86 of The Big Book of Alcoholics Anonymous). The promises of the 9th step occur when I as an addict make amends for my behavior. But the promises are all throughout the book and occur long before this step. Getting connected to a higher power is possible and can create a life of joy and peace. At Burning Tree Ranch, our goal is helping our clients achieve lifelong sobriety and to live happy, useful lives.

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The Heart of a Runaway

Ever since I can remember, I was a runner. When I was eight years old, difficult feelings would come up and I would pack my little Lion King backpack and go set up camp down the street. Eventually, I would come back after I had calmed down. This was the beginning of not knowing how to deal with what I know now as the ‘spiritual malady.’ That irritability, restlessness, discontentedness, fear and anger would appear long before I used substances. I would run from jobs, towns, relationships, feelings and most of all, rehabs. The problem was that wherever I went, there I was. I couldn’t get away from me.

Past attempts at treatment had been unsuccessful. I would stay removed from drugs and alcohol, but never dealt with the other ways I tried to change the way I felt. I could skate under the radar, say the right things, get out early and would relapse within days.

I desperately needed healthy ways to cope that did not involve a bottle and some dope. I thought Burning Tree would be the same as all my other attempts at sobriety. I arrived terrified to face life without my crutch. I thought that removing the substances would cure my deep desire to flee. What I saw was that my tendencies to run away in other ways still persisted. My feet were now planted, but I still had the heart of a runaway. What I ran away from was God. I tried to control, manage and seek comfort anyway I could in my first few years of sobriety. I did this in unhealthy ways – through men, cutting and my eating disorder. Those behaviors blocked me off from being the woman that I was attended to be.

This time was different. Burning Tree was a place I couldn’t hide. I was in treatment long enough where my true colors came out. I had never been in a place where I could see that all my issues were connected and all stemmed from the same place. I had a malady and that the only solution was a spiritual one.
Even in my recovery today, there have been periods of time where I have drifted away from God. Old behaviors started to return. I told myself so many lies to make it okay. I was falling back asleep. Slowly, I began to shorten my prayer and meditation one day at a time and then stopped meditating all together. I would cut down on meetings. I found comfort in work and men yet again. I was experiencing the pain of self. I am grateful that I had the tools and accountability that I had learned in long-term treatment to bring me back. My friends and sponsor let me know how I was showing up because I couldn’t see it. Now when these issues arise, I can lean in and stand still. I don’t have to run anymore.

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Casey Pachall TCU quarterback in inpatient treatment

According to an ESPN report, TCU quarterback Casey Pachall plans to enter an inpatient facility and withdraw from school, coach Gary Patterson said Tuesday. Texas Christian University is located in Fort Worth, Texas. Patterson said that Pachall may already be at the treatment facility, less than one week after being arrested on suspicion of driving while intoxicated.

Pachall won’t play football in 2012, and will try to seek help with drug and alcohol addiction. Patterson said the door will be open for Pachall to return in the future.

Patterson said he met with Pachall and his parents earlier this week. The coach also met with the university’s chancellor and athletic director on Sunday. “I don’t think one game, three games would have made a difference,” Patterson said. “You try to change people’s lives. That’s what this is all about.”

Whether Coach Patterson realizes it or not, the decision to change must come from the individual struggling with addiction. Consequences of some one’s addiction may play into a decision, but if the person be a true addict or alcoholic, the mind will be clouded with the desire to get drunk or high once again.

TCU made national news with a campus drug bust that included TCU football players, including Pachell. Football fans all over the country, and in nearby Dallas/Fort Worth area, were snickering and joking that TCU should now be known as Texas Cocaine University. Just two weeks after the drug bust in which Pachell admitted to using drugs, TCU confirmed that Pachall had failed a university-administered drug test on Feb. 1.

Pachall is not the first high profile football player to seek treatment for drug and alcohol addiction. Heisman Trophy finalist Tyrann Mathieu recently made the life-changing decision to enter drug rehab and try to come out better on the other side. Like Pachall, the former LSU player Mathieu decided to begin treatment in a drug rehab center to work on issues that caused him to be dismissed from his college football career at LSU after several documented failed drug tests.

With concussions and player safety occupying all the headlines and energy of football commissioners across the nation, off-field drug and alcohol abuse isn’t getting the attention it deserves. No red flags have been noticed on the field quite yet, no one seems to want to challenge the trend of more and more athletes seeking treatment for drug and alcohol treatment.

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Linda Hogan arrested for DUI

Linda Hogan, ex-wife of famous wrestler Hulk Hogan, was arrested yesterday in Malibu on suspicion of DUI, according to TMZ.

Law enforcement sources tell TMZ, Linda — real name Linda Bollea — was arrested at 1:34 AM Thursday morning and taken to a nearby police station where she was booked and put behind bars. She was released several hours later on $5,000 bail.

She was also booked for driving on a suspended license.

A rep for Linda tells TMZ, Linda was on her way home from a function in L.A. where she drank a glass of champagne on an empty stomach. We’re told she has also been on antibiotics and the drugs exacerbated the effects of the alcohol. She had been attending a jewelry event in the area and was heading home to Simi Valley when she was taken into custody; she allegedly had a blood-alcohol level just over the legal limit of 0.08.

“A deputy saw a black Mercedes-Benz driving erratically on the westbound 101 Freeway. The deputy made traffic stop of the vehicle on the Ventura Freeway at Kanan Road, Calabasas, to conduct a drunk-driving investigation,” a sheriff’s statement said.

“She’s a mom, so she’s embarrassed about it,” her lawyer, Raymond Rafool, told the New York Daily News.

Rafool qualifies Hogan as a mom by saying she is embarrassed about the incident. It’s as if Rafool is instigating that if Hogan never did get caught for breaking the law by driving under the influence, she has no right to feel embarrassed. It’s the ole “I broke the law, and I won” belief.

If an individual is struggling with addiction, and a DUI arrest does not qualify someone as an addict or alcoholic, the embarrassment, shame, guilt, pain that go along with an arrest, incident, or situation isn’t as powerful as the effect produced by taking that next drug or drink. Being a mom, dad, sister, brother, aunt, uncle, friend, or foe doesn’t enter the mind of someone struggling with addiction; in fact, it drives them further away from being one.

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Bath Salts being used as cut for heroin

When you hear the names, Ivory Wave, Red Dove, Pure Ivory, Bliss, Blue Silk, White Lightning, Cloud Nine, Meow Meow, and Vanilla Sky, you can easily be transported to a place where stress dissolves and relaxation surges through your body.

Ivory Wave, Red Dove, Pure Ivory, Bliss, Blue Silk, White Lightning, Cloud Nine, Meow Meow, and Vanilla Sky are the most common names for a synthetic drug called bath salts. Bath salts have no recognized medical use in the U.S.; hence, it’s marketed on the Internet or sold in the U.S. as a novelty item.

While the names it is marketed under seem pleasant, the smell or aftermath is anything but that. Users describe it as having an unpleasant odor, similar to bleach and/or urine. It’s often a chunky white to light-yellow powder with some varieties being gray or even light blue. It can be snorted, smoked, vaporized, injected or eaten. The crystal-like powder acts as a stimulant, much like cocaine or methamphetamine. It often contains lab-produced chemicals such as mephedrone and MDPV (methylenedioxypyrovalerone). The stimulants can cause paranoia, hallucinations, rapid heart rate, insomnia, and even suicidal tendencies.

According to a recent ABC News report, one of the factors contributing to abuse of bath salts may be the restriction of sales of pseudoephedrine, a key ingredient in making methamphetamine. Evidence and first-hand knowledge from individuals seeking treatment points to many bath salt users being meth and heroin addicts, but substituting drugs due to easier access and availability.

Are bath salts becoming more of a trend in the United States?

The American Association of Poison Control Centers, reports that in 2010 there were 302 calls regarding bath salts. In 2011 poison control centers took 6,138 calls that pertained to the use of bath salts. As of May 2012, they have received 1,302 calls regarding bath salts, which seem to be more popular in people ages 20 to 29.

Arrests and convictions of individuals abusing bath salts are too many to name, but convictions for selling bath salts are just starting. One of the first reported in Texas is Jimmy Wayne Wright, the 67-year-old Odessa man who owned B&L Bookstore. Wright pleaded guilty in federal court to the possession with intent to distribute the drug commonly known as bath salts.

Assistant U.S. Attorney John Klassen said the man, whose bookstore was raided by DEA Agents on Jan. 31 for possible cocaine charges, also was charged with several counts of possessing cutting agents for cocaine and for possessing multiple firearms as a convicted felon.

Klassen said the bath salts were often marketed as pipe cleaner, plant food and stain remover. It’s also further proof of what many law enforcement agents have suspected for a short time now. Individuals are mixing, cutting, or “lacing,” bath salts with illegal street drugs such as cocaine and meth.

When talking about treating individuals who are addicted to synthetic drugs, such as bath salts, the National Institute on Drug Abuse (NIDA) recommends detoxification, followed by medication (where applicable) and behavioral therapy, followed by relapse prevention.
According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community- or family-based recovery support systems.

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Black Market for Prescription Pain Killers – The Real Killer

The pain killer black market has become big business for those looking to make a quick buck, regardless of the ripple effect of the enterprise.  Florida, in particular has become the El Dorado of black marketeers because of its inadequate tracking and monitoring of prescription pain relieving medications.

Even though prescription painkillers, especially oxycontin and its close relative oxycodone, are among the most addictive and dangerous of substances, in Florida acquiring these painkillers is as easy as asking. Legislative loopholes have made parts of southern Florida a haven for those seeking easy access to these substances.

A black market for these medications has exploded because the gray market conditions of Florida have fostered its growth. People from all over the country come to Florida to take advantage of the situation – acquire a prescription, have it filled, then return to home to reap the windfall that makes drug dealing an attractive and lucrative business, albeit illegal. With the burgeoning problem of prescription drug abuse, the cycle can easily continue unabated.

To compound the problem of poor controls, there are a growing number of less than scrupulous individuals who have entered the prescription medication market simply to profit off the demand. News reports abound concerning people setting up clinics staffed by doctors who prescribe medications with no consideration given to making a valid diagnosis. There is little, if any, regard for the effects that abuse brings; the only concern is to make a buck – lots of bucks.

But is this a simple question of supply and demand? If so, which is the driving force – is supply fueling demand or is demand creating the market for supply? While this question may be an exercise in circular logic for economists, the fact remains that there is a problem stemming from the easy availability of prescription medications. The problem is such that almost half of all emergency room admissions for drug overdoses are for prescription drug abuse.

While many may argue it is ultimately the responsibility of consumers to control what they do and do not buy, this is not the same as buying a candy bar or a soft drink (although it seems just as easy). Because at some point the enterprise becomes illegal, checks needs to be instituted to curtail the ease of acquisition of the medications. Otherwise, the problem may continue spiraling out of control.

History has shown that it is impossible to completely prevent people from acquiring that which they desire – of that, there is no doubt. However, when a product becomes difficult to obtain, fewer people bother trying to acquire it. In the case of prescription painkillers, closing the doors on the gray market will minimize the business hours of the black market.

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