Relapse prevention in early recovery

In terms of substance abuse and addiction treatment, relapse prevention is one of the core areas of treatment which is at times overlooked by people who are seeking treatment. Often people feel that after they have stopped using drugs or alcohol, that this is all the work that they need to do. Unfortunately, this is not the case and many people can attest to the fact that during their early recovery, that the lack of follow through in their treatment meant that they put themselves at risk of using again.


For people who have had significant issues with drug or alcohol use, to the point that they need to seek treatment and this use has caused negative effects on their lives, it is important to ensure that after ceasing abusive levels of use, that there is a time when the person does not use at all. Many treatments now state that people who have suffered from a substance abuse disorder should stay away from drugs and alcohol altogether (remain abstinent). This long term abstinence is due to the fact that drugs can alter the way the brain rewards itself and communicates with itself. Due to the ‘high’ of alcohol and drug use, these behaviours are strongly reinforced (despite negative consequences) and as a result they tend to occur more and more frequently. These pathways become stronger and the brain craves the high and as a result the individual starts using more of the substance as a coping mechanism. The disease model of addiction states that, even when abstinent, these pathways can remain dormant, ready for any potential future use, hence the reason for an insistence on long term abstinence.


The work that it takes to get clean and sober is only the first step, and often when leaving primary treatment, clients will be advised that discharge is when recovery starts, rather than ends. This is one of the most important parts of recovery, being able to work with being clean and sober and doing this on your own, rather than in a primary treatment setting. Aftercare treatment can involve ongoing therapy, twelve step fellowship meetings such as Alcoholic’s and Narcotic’s Anonymous. Your relapse prevention plan may also engage with online counselling, which provides you with access to treatment anytime and anywhere, meaning that there are limited gaps in your recovery.


The main issue of importance, however, is to remember that your recovery relies on you being consistent and ensuring that you have a good post primary care plan, so that you do not fall into old traps of using.

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Regrets of the dying

This article has been around for a bit and outlines the experiences of a palliative care nurse and the responses that those who are dying have to the process and the regrets that they have. This is one of those articles that really brings back to the fore what is actually important in our lives, not money or possessions, not the ability to achieve or be ‘famous’ but rather the things that are there with us everyday and that we may not even see – our family and friends, the need to express ourselves for who we are, and the shedding of the expectation of others.
Too often we forget the things that are important in our lives, the friends and family who surround us, and too often we forget that often muttered phrase about wealth “You can’t take it with you” (when you die, this is). But yet, we throw ourselves so fool hardily into work and believe that the achievement or wealth and financial stability will lead to happiness in the end. The more that I think about the reference article, the less that I think that work even matters.

Regardless of your philosophical or religious outlook on life, it is imperative that we use life for living and experiencing those around us, rather than simply focussing on work. Society is consumptive and as a result we find that we need to work harder in order to afford and buy this things that we really only just want. In order to get back to normalcy, we need to look at what our real priorities are and if you take a look at the list in the linked article, what, if any, regrets will you have?
One of the core principles in psychological therapy and mental wellness has to be that of balance and that is what we need to seek in our everyday lives, rather than seeking an excess of one thing in the belief that it will make up for something else is fallacious and only leads to pain and heartache. Through health care practice, it is obvious that no-one is immune to the pitfalls of life, whether they be mental illness, illness, or death of those around us. The amount of wealth or achievement that you have is not a direct correlation to having no struggles in your life.

Ask yourself, without work, what are you? Who are you?

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Advances in addiction treatment

I have just returned from the Australasian Professional Society on Addictive Disorders (APSAD) conference in Brisbane, Australia which focussed on the current research and practice evidence in relation to addictive disorders and their treatment. I presented on the treatment method of The Cabin, Chiang Mai, which was well received and as noted it is rare that private facilities are so open to their methods being researched and investigated, which is refreshing. This is even more important in light of recent funding cuts to science and research in Australia, meaning that research that could be done, may not be simply due to funding issues. The abstract to the paper can he found here (Page 27) with a potential journal article off the back of this currently in development.


There was a great focus on the use of smart phone applications as a method to engage clients suffering from substance misuse. Despite some mixed results that were reported at the conference, the area of technology in therapy is one which is further and further building ground and evidence behind it. The fact that the vast majority of people now own a smart phone and the burden of disease of substance abuse and mental health are growing, it would be remiss to ignore the fact that technology can be used to very good effect to keep people engaged, or to even provide treatment at a one on one level.


Other reports that were particularly interesting were that of David Nutt, providing further evidence on the neuroscience behind addiction. From Nutt’s research there is now a suggestion that Dopamine is not the only neurotransmitter which is implicated in substance use and abuse, but rather that different drugs actually have different effects on different neurotransmitters. This evidence further adds to the neuroscience research and starts to build a body of work that will be aimed at being able to provide specific and tailored treatment to certain substances of abuse (with the talk of vaccinations, even, for drugs like cocaine).


In relation to funding cuts it is also with sadness that the peak body for the alcohol and other drug workforce, ADCA has announced that it will cease operations due to a cut in funding from the Federal government. With such a high burden of disease based on the abuse of substances, especially alcohol, this seems like a step in the wrong direction, especially considering that ADCA has been around for almost 5 decades. As we see the frontiers change in addiction research and science, it is sad to see that the support of the industry has now been pulled out from under it, with no plan to reinstate the same or similar service.

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Just don’t die – on the similarities of religion

Skeptic's Guide to Life

Religion is a funny little thing really, belief systems (mostly) aimed at transcendence of daily struggles, but often doing a whole lot of segregating humans into little sects that see the world through different, albeit very similar lenses. This essay is not a religion-hate piece, nor an exercise in Atheistic apologetics, just my views on what religion is to me.

Recently I was riding home from work and off to the East there was a storm building, a big black and shiny thing that crackled and spat, and being on a bike, I have to say that I was somewhat intimidated and I had a quick ‘I hope that doesn’t hit any time soon’ and with this thought I came to briefly reflect on how ancient civilisations must have viewed storms such as these. I live in a world that understands storms for what they are, relatively benign events that…

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Chasing Supermen

I recently asked a client who was stuck with where to go in life a simple question, “Who do you look up to, what of their values do you admire?” The client was a young man who had been stuck in an apathetic depression, not wanting to do anything because it was all too hard, so he had given up. In this giving up, however, there was something that was dissonant for him, that was rubbing him wrong, so he had attended therapy to work it out, to get out of his rut and move forward. In reply to the question he was initially a little perplexed, why did this even matter, but I outlined my rationale that the purpose was to start to identify values which were important to him so that he could name them and then possibly action them. At the end of the session he felt a little relieved, and he left back into a world where the fog had lifted, if just a little. He returned the next week, morose and down and somewhat worse than before, the fog had closed back in and was crushing him, he had started to compare himself to others and in the comparing he found the things that he didn’t like, the reasons he needed to escape himself.

I reassessed after this, what had gone wrong, why had he turned so far down and not had any positive benefit, and I realised that it was not just comparison to others, but more the comparison to heroes and figures that he idolised that did it. We live in a culture that idolises heroes and they are abound in everyday life, we see them on the sports field, the television and we hear about them on the news. They are the figures whose achievements are larger than life. We talk about heroes, and whether they be sports people, actors, politicians or activists and we take on what their values are in life. But unfortunately these may not actually represent their real values at all, just the values which work the best for them when they are in the spotlight, and especially in the case of actors and sports people who may not need to stand behind any cause for a significant amount of time, but just show an interest for a little while for a single brief lived cause. The main issue is that when we idolise other humans for their deeds and the things that they achieve we start to seek to follow only that – their achievements. What his notion fails to do is recognise that the individual whom we idolise has their own flaws and follies that go along with just being them, the part that we never see, the everyday minutiae of their existences.

A lot of the work that I do in clinical practice involves people who want to ‘change’ themselves, people who want to be less like the person that they currently are, rather than to change their behaviour, they want to change their being. My feeling is that we far underrate our own ability to adapt, rather than change. One of the most worthwhile lessons that I tfeel that I teach clients is that being ‘yourself’ doesn’t mean having to change values, opinions or personal ‘weaknesses’ and in this lesson clients learn that without trying to be something different they make the decision to be themselves. This is an oft heard cliche “just be yourself and everything will be fine/people will love you for it” but my thought is that this is the wrong sentiment, that we shouldn’t be so much trying to be ourselves because in trying we look outside at the things that we need to do, rather than look inside at the things that we can accept.

The other issue that I have with this idolism is that this also means that if we are aiming to be ‘something else’, that we must be sincere to that something else and never waver from it. Activists are strong in prison, they never had a bad day; actors are deliriously happy with their lives due to amount of money that they have, CEOs live a self actualised life where they never question the direction of their lives. These are messages, both overt and subtle that are fed to us by the media, but they aren’t true. There are actors out there who have their own feelings of failure, and who do not like themselves for who they are. Who struggle with finances, or get angry when their children don’t do what they are told. These things are all the reality of being simply human. But we chase these super men and women, and focus on how we can get what they have and ignore the fact that what they have isn’t all that great some days, that the only positive feelings that they have sometimes is when they are working, when they are being anything but themselves.

So given that if you were to stay the same person that you are now faults and all, how do you accept that?

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Men and Therapy

As this week is Men’s Health week, I thought that it would only be apt to talk about my area of knowledge, men’s mental health. This isn’t another article about ‘men suffer mental illness too’ which we all know, but rather it is a post about what therapy is like for men, to try to banish some of the myths and misconceptions (that the media may or may not be responsible for) about what therapy is and what it is not.


I will be ‘read’

Psychologists and therapists do rely on their training to read body language, tone of voice and speech content, however, this type of observation is nothing like the Sherlock Holmes-esque reading that we sometimes see on TV. I don’t know what you are thinking (most of the time) nor do I know what you have eaten for lunch or whether you have recently taken a stroll in a densely wooded area where the predominant foliage is a Norfolk pine. I can however use the way that you sit or talk about something to inform you about how you may be perceived by others.


You must cry in therapy

Absolutely not. Crying in therapy is common for people under psychological distress, however crying does not occur for everyone. Not crying does NOT mean that you aren’t ‘accessing your deep down emotions’ and other pop-psychology phrases. If it feels right, do it, if not, don’t.


It is all about your mother

Movies and pop-culture have a significant lean towards psycho-analytic type therapy and it’s tendency to lean towards the ‘mother’ figure as the cause of mental illness. This is not typical of the vast majority of therapy today. Psychologists who work for insurance companies, or who are Government reimbursed are required to use therapies that are evidence-based and also that are focussed, meaning that patients have an understanding of where the endpoint of therapy is, rather than a more open ended arrangement, as in psycho-analysis. There is no evidence to suggest that the majority of mental health concerns some from unresolved childhood conflict and most current psychotherapy reflects this in practice.


How does that make you feel?

Ah yes, that old chestnut…does the question get asked, sure it does, but is it the main question in the repertoire of the psychologist? No. Sure, you will probably be asked about your feelings, but this is to try to access what is going on for you in your life.


Therapy takes FOREVER

Again this may be a bit of a myth that is perpetuated by Hollywood, the belief that when you start therapy that it is for the long term, rather than the short term. The more likely scenario is that your therapy experience (depending on symptoms, presentation etc) will be based more on alleviating current symptoms and working on learning new strategies to deal with any stress that may arise after therapy ends. A lot of therapy works in a guided fashion, see above, and as a result works towards your treatment goals and not vague and non-descript issues that don’t cause issues for you at the present time. On another note, I have heard people (therapists included) say that ‘you need to take time for it to work.’ Again this is true, in part. Give your therapist and the process a chance say 3-4 sessions, but if it isn’t working and you see no change, say something! Psychologists are not (I repeat) mind readers, and do not know what is happening in your life if it is left unsaid.

My last piece of advice is if you feel that you aren’t being listened to by your therapist, or that you aren’t making process, don’t let that put you off therapy for good. Change therapists, talk to your doctor about other options, but just don’t give up on your own mental health, for your family’s sake, but most importantly, for your own sake.

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Ketamine for Depression and expectations of therapy

So I came across this article recently in relation to the trial of Ketamine for the treatment of depression Anesthetic for Depression? Mayo Clinic Study Finds Low-Dose Ketamine Effective and being interested in new treatments and appraoches to the treatment of depression, I checked it out. There are a few issues that I have with this release. Number one being the fact that this study is tiny and I don’t mean a small study, but it is minicule, there were 10 participants in it! 8 of which responded to the treatment and only 2 of which were depression free just 4 weeks after the study. Firstly, how does this even warrant a release of news? Surely if only 20% of treatment participants had an ongoing effect, it doesn’t necessarily mean that it was effective, was there a placebo effect or other variable (for instance getting an injection is not a normal treatment for depression, is the social contact with a clinician a variable that needs consideration?). The release does indicate that more research is needed, but why not make a public statement when that research is already on the way, rather than with this sample. A bigger sample will indicate treatment effects better, will allow for blinding and will be a better indicator of population side effects.

Another issue that I have is that the study was not controlled at all, that is that the researchers knew what they were looking for, targeted specific patients for the treatment, gave them the treatment and then tested for the results that they expected. I know that this is just first steps (and as a matter of fact there are other trials of Ketamine currently going on), but my concern is that these first steps should be kept within the scientific community primarily (unless they are searched for) and not disseminated until further trials are conducted. The issue that I see is that the headlines of both the link and the later news articles which came from the link make out that Ketamine is the next cure for depression, that brand new, stout information has been released, but this is not the case at all. 

A quick disclaimer, that I do not disapprove of the use of medication for the treatment of mental illness, however I do disapprove of the poor use of data and statistics that skews the public’s perception of what they should expect from certain medications.

Lastly, I feel that these kind of research studies minimise the importance of ongoing psycho-social care and further medicalise a problem that doesn’t need to be (for the majority of people). By this I mean that Ketamine (or whatever the new wonder drug is) becomes the buzzword in treatment, people expect that to get better from depression the best thing is to take medication, but this is not always the case. Too often I see people who have been prescribed medication and had it not work as effectively as they expected (again the ‘Magic Bullet’ syndrome) and they give up, thinking ‘well, if medication doesn’t work nothing will.’ As a result the therapeutic process is set back and has to commence work on breaking down these expectations rather than working on the presenting issues systematically.



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