Im Sober, Now What

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Im Sober, Now What?

• Annette Pearson MS, LADC
• Vinland National Center
• BIA of MN 24th Annual
• Conference
• April 23rd, 2009

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This is what we hope for but
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this is what we sometimes get.

• Addiction can feel like a devil on ones back
  that just wont go away.
• Treatment can teach the skills however, sobriety
  takes practice and help from others. Making sure
  the person is in treatment that meets his or her
  needs is critical.

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• BAD NEWS Research has shown that disability does
  no more to cure drinking/ drug use than any other
  consequences including job loss, divorce and
  other forms of trauma.
• In fact, a study conducted by SAMSHA,
  showed that almost 30 of individuals with brain
  injury reported use of illegal chemicals, they
  did not ask about alcohol.
• GOOD NEWS personal injury often contributes to a
  users awareness of a drug or alcohol related
  problem, thus the period following injury may be
  a particularly productive time at which to
  intervene.

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Why return to use chemicals?

• Coping with depression
• Pain Management
• Coping with perceived negative emotions
• Loneliness/Looking for a date
• Poor stress management
• Culturally accepted

• Leveling the playing field/Normalization
• Socialization
• Role Identification/Loss of roles
• Boredom and lack of structure
• Peer pressure

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Additional risk factors for individuals with
disabilities

• Easy access to medications
• Social limitations
• Economic issues
• Less ability to learn how to be social
• Hidden disabilities
• History of Family use
• Legal issues
• Impulsivity

• Poor health habits
• Enabling
• Guilt/Shame
• Disinhibition
• Impaired judgment
• Lack of support
• Lack of education
• Lack of vocational identity

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The Brain Addicted

• In general, what defines an addiction
• as compared to an acceptable behavior
• is that the participation in the activity
• carries adverse or negative consequences.
• The obvious solution is to STOP.
• But the brain is hardwired to repeat behavior
• that allow us to survive and is pleasurable.
• This reward circuit has strong connections
• to the part of your brain that is responsible
• for basic emotions and body function.

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The Brain Addicted

• Addictive drugs have such as strong effect that
  they act on the very part of the brain that is in
  charge of survival instincts. The urge is use or
  do is so strong that it overrides all other
  processes, mimicking survival needs.

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The Pleasure Center Dopamine lifes Happy
Chemical
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Relapse Prevention Planning

• Relapse prevention requires a PLAN, in writing,
  that is structured in a way the person is not
  overwhelmed or bored
• Make sure they have a copy of the plan before
  they leave treatment.
• Use a weekly or monthly calendar and write
  appointments, meetings, etc. on it.
• Remember to think about transportation and
  funding
• The plan needs to address the persons level of
  cognitive functioning, motivators and memory
  strategies

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Relapse Prevention Planning

• Ask the provider to
• Write out abbreviations
• List addresses, telephone numbers, title and what
  the person is going to the appointment for on the
  plan
• Include maps if needed
• List memory aides on the plan and have the person
  practice WHILE in treatment
• List support meetings and people on the plan with
  telephone numbers
• List the reasons why the participant stated they
  wanted to stay sober on the plan

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Remember with ADDICTION

• We did not cause it
• We can not control it
• We can not cure it
• We can help support sobriety.

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Challenges with sobriety

• Are they using, how do we know?
• They came home after using, now what?
• Oh where, oh where to look?
• Good ideas that ended up enabling
• Using 12 steps and meetings as support.
• The triggers of socialization and normalization
• The trigger of poor stress Management
• Remembering NOT to use

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Lets shed some light on this
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Red Flags of Chemical Use

• Use recent behavior as a baseline
• Abrupt changes- work, school, appearance
• Social isolation or withdrawal
• Emotion control changes
• Missed or unscheduled appointments
• Increased impulsivity
• Unusual borrowing or spending of money

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Red Flags of Chemical Use

• Needle marks, pick marks and/or increased
  physical injuries
• Increased vomiting, sweating
• Increased colds, sore throats, coughing
• Increased bladder infections diarrhea
• Consistent run down condition and neglecting
  health

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Red Flags of Chemical Use

• Needle marks, pick marks and/or increased
  physical injuries
• Increased vomiting, sweating
• Increased colds, sore throats, coughing
• Increased bladder infections diarrhea
• Consistent run down condition and neglecting
  health

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Chemical Detection

• Alcohol Up to 24 hours
• Cannabis Up to 6 weeks
• Cocaine and Crack 2 to 4 days
• Methamphetamine, Crank and other Amphetamines
  1 to 3 days
• Inhalents 1 day to 4 weeks

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Chemical Detection

• Barbiturates 1 to 21 days
• Benzodiazepines Up to 7 days
• Methadone Up to 14 days
• PCP Up to 10 days
• Opiates 2 to 4 days
• MDMA (Ecstasy) 2 to 4 days

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Relapse Management

• Supportive care
• Stay calm- manage your anger and fear by
  practicing relaxation tech.
• Remember that the fear and anger is a reaction to
  behavior not the participant
• NO SITUATION IS CONTROLLED WITHOUT SELF CONTROL

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Relapse Management

• Get to the level the person is at
• Give the person some space and try to get them
  away from others in a quiet place
• Manage your anger and fear by breathing calmly
  and slowly-deep breaths
• Make sure your body language matches your tone by
  taking hands out of pockets, uncrossing your arms
  - Have a relaxed body
• Introduce yourself or remind them who your are.
• Use there name frequently

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Relapse Management

• Reassure them that you are trying to help
• Be confident and direct but not confrontational
  avoid debating and use short open ended questions
• Do not blame, yell, label or threaten this will
  only escalate the situation
• Maintain eye contact

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Relapse Management

• Allow the person to vent their feelings but
  should set limits on the behavior permitted,
  gently, firmly consistently
• Use short simple, sentences
• Agree with the 10 that is true
• Communicate with others
• Dont power struggle over a UA at the moment,
  just document and notify the team

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Playing Sherlock Holmes

• Hems in pants, shorts, jackets
• Linings in hats and jackets
• Balled up in socks, undies, others
• In pockets of clothes wore infrequently
• Fingers of mittens

• In between clothes
• In jewelry boxes
• Empty pill or other types of containers
• Taped under or behind drawers
• Top of fan blades
• Curtain folds or pleats

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Oh where, oh where

• In wall sockets
• Hollowed out towel, shower curtain, toilet paper
  holders
• In the back of the toilet tank
• Bottom of tissue boxes

• Under liner in garbage can
• Buried in plants
• In empty battery places such as alarm clocks,
  boom box
• In hollow fan stands
• In CD, DVD, etc cases

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Creativity at its best

• Behind DVD, VCR players
• In hollowed out knick knacks
• Behind books
• Under the microwave
• Under loose floorboards

• In empty candy or food containers
• In between the bottom of a cup and the liner
• Behind pictures
• Between mattress's
• In ceiling tiles

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Good ideas that we tried . . .

• Avoiding and ignoring problem behaviors
• Shielding the individual from situations and
  consequences
• Attempting to control use or access to chemicals
• Taking over responsibilities
• Rationalizing use

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However, they did not work the way we had hoped.

• Accepting manipulations and dishonesty
• Cooperating and compromising
• Not following through with consequences
• Rescuing from consequences
• Sub serving by limiting access to things that
  will create consequences

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Frustrations with 12 Step Meetings

• Abstract nature
• Labels
• Traditions/unwritten
• rules
• Isolation
• Feeling misunderstood
• Confusion over expectations
• Lack of structure in some meeting types

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12 Steps

• Step 1
• Admit that if you drink and/or use drugs your
  life will continue to be out of control. Admit
  that alcohol and drugs are not making your
  problems better.
• We admitted that we were powerless over our
  addiction, that our lives had become unmanageable

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12 Steps

• Step 2
• You start to believe that someone can help you
  put your life in order. This someone could be
  God, an AA group, counselor, sponsor, etc.
• We came to believe that a power greater than
  ourselves could restore us to sanity.

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12 Steps

• Step 3
• You decide to get help from others and/or God.
  You open yourself up to letting the people you
  are believing in from step 2, help you with your
  problems.
• Made a decision to turn our will and our lives
  over to the care of our higher power as we
  understand them.

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12 Steps

• Step 4
• You will make a list of the negative behaviors
  in your past and current behavior problems. You
  will make a list of positive behaviors in your
  past and in the present.
• Made a searching and fearless moral inventory of
  ourselves.

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12 Steps

• Step 5
• Meet with someone you can trust and discuss
  what you wrote in Step 4.
• Admitted to our higher power, to ourselves and to
  another human being the exact nature of our
  wrongs.

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12 Steps

• Step 6
• Make the decision to sincerely try to change
  your negative behaviors and strengthen your
  positive ones.
• Were entirely ready to have our higher power
  remove all the defects of character.

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12 Step Meetings

• What works? Teach/Do
• 1. What I am doing is hurting me and I need to
  stop.
• 2. In order to stop, I need help.
• 3. In order to get help, I need to get along
  better with others and take better care of
  myself.
• 4. Have a buddy or peer attend the meeting with
  them and role play meetings.
• 5. Determine the meetings policy of medications
  and label use.

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Normalizing and Socializing

• Many individuals use chemicals to feel part of
  the group or to minimize differences.
• Many individuals use chemicals to cope with
  loneliness, boredom, depression and isolation.
• Having sober fun and pleasure is a need that all
  of us have. We need to plan it and make it a
  priority to avoid the return to chemicals.
• Chemicals are reliable and predictable, are we?

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Supporting Sobriety

• Set up hobbies both with others and alone
• Provide enjoyable structure, fun and pleasure
  daily
• Plan for co-worker/peer encouragement to
  use/practice saying no
• Remember, individuals want to fit in and make
  friends Encourage this
• Be a good role model by trying and doing new
  things
• Reward good choices look for them not just
  negative behaviors

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Supporting Sobriety

• Listen when someone is talking about a craving
  they are like waves, it will pass but talking
  helps.
• Have a list of meetings available
• Go to a meeting and be supportive
• Help set up a temp. sponsor
• Have a taped or written positive message to
  reinforce the positive choices

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Supporting Sobriety

• Learn how the person learns so you can teach them
  that way
• Ask for help, get professionals and others
• in the family/friend base to back you up
• Talk to a counselor if you are feeling survivor
  guilt or any other negative feelings

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Teach Stress Management

• Many triggers become overwhelming when stress is
  not managed and use is an easy way to cope with
  stress
• Teach the physical, emotional and mental signs of
  stress use a checklist or pictures
• Discuss how using chemicals esp. stimulants makes
  stress worse
• Relationships tend to be effected first

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Causes and Coping

• 1) Not enough time or too much to do.
• Evaluate the number of expectations, prioritize
  and do the most unpleasant tasks first. Be
  honest and tell people what your limitations are.
  Are you taking on too much? Give private time
  daily even if it is 5 minutes to recharge.

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Causes and Coping with stress

• 2) Unhealthy lifestyle
• Have a healthier diet, work off stress by
  exercising daily, get more sleep, learn how to
  relax, clear mind and refocus. Put it on your
  schedule. Are we being good role models?

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Causes and Coping with stress

• 3) Conflicts with people
• Teach how to pick and choose ones battles, share
  your problems with a neutral party, focus on your
  reaction and feelings around the situation are
  the extreme? Do something positive for someone

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Causes and Coping with stress

• 4) Inability to accept change and see the humor
  in situations.
• Talk over changes and frame in positive light,
  look past today and into the future, look at
  change as a challenge, find a fun hobby either
  with others or alone, take time to watch a funny
  show or movie, read a good book or listen to
  motivating music

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Causes and Coping with stress

• 5) Bottling up emotions
• Suppressing feelings is only temporary, Have a
  good laugh or a good cry, share with a friend,
  journal, tape record feelings, ask for help from
  others, take control over the parts of the
  situation that you can. Try to have something to
  look forward to every day and something for the
  long term.

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Causes and Coping with stress

• 6) Trying to relax when your stressed causing
  more stress
• Learn to relax when you are stable, use a tape,
  DVD, class, etc. Have a space and private time,
  learn to pay attention to how you breathe,
  practice, become aware of where your stress is

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Remembering not to use

• Sometimes, STOP and THINK is the best way to stop
  a relapse.
• Learning how a person learns is critical to
  finding the best memory aid

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Memory Strategies

• Memory aides are one easy reminder tool that can
  help with those impulses. Most of us use memory
  aides daily and adding sobriety is a simple stop
  think tech.
• Memory aides can be anything that the person is
  using or is motivating.
• The discharge and/or relapse plan may have some
  ideas. Set these up prior to the person
  returning home or on the first day of treatment.

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Memory Strategies

• Note card in wallet or purse, on refrigerator, in
  bathroom
• Visual reminder on person bracelet, necklace or
  medallion
• Create a checklist for household jobs and daily
  chores Have sobriety as a daily goal or as
  multiple goals
• Calendars with sober reminder stickers or notes
• Note by the phone with instructions for saying NO

• Record a positive message on cell phone, voice
  mail, tape recorder
• Use a verbal or visual reminder in planners
• schedules/memory notebooks
• Computer programs/Blackberries
• Alarm and text watches
• Post it notes esp on money
• Put stop sign on planner and/or notebook
• Relapse plan in places the person will use it

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Memory Strategies

• Pictures of motivating people, events, etc.
• Use direct deposit for checks and for bills
• Use check card with limited funds
• Note card in with money with reminders to say NO
• Use post its on money with purpose
• Representative payees
• Check or gift card with picture of motivator on
  it with limited funds

• Drive or take the bus on a new route the day
  before your appointment
• Make a file of index cards for appointments with
  maps and directions
• Have maps of bus routes
• Plan a route where you do not get off the bus
  near a bar or liquor store
• Park or get off the bus in the same location
• Have back up transportation and money