Ready, Set, Go!: Addiction Management for People in Recovery

By Sandra Rasmussen

This book is for people in recovery. We ask and answer basic questions about addiction, relapse, and recovery. We believe addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry, characterized by craving, loss of control, physical dependence, and tolerance. Genetics, together with bio-psycho-social-spiritual factors, account for the likelihood a person will develop an addiction or related disorder. Relapse happens: a return to drinking, using, other addictive behavior, or an increase in harm from addiction. Yet, recovery is an idea whose time has come. Recovery is a different, better way of life with purpose and meaning. We suggest addiction management as a way recovering people can maintain change (abstinence or harm reduction), reduce risks for relapse, prevent relapse, develop a recovery lifestyle, confront relapse when necessary, and achieve well-being. Current research, recognized theories, and the lived experiences of hundreds of people in recovery ground and guide book content. The book has three parts and fifteen chapters. A person in recovery introduces each chapter. We show how to develop, implement, and evaluate addiction management plans. Each chapter ends with summary statements and addiction management applications. References and a list of websites complete the book. Family and friends of recovering people will find the material useful. Addiction professionals can use the book to help clients realize recovery and prevent relapse. Are you ready? Get set. Go!

• Language: English
• Publisher: Balboa Press
• Release date: Feb 10, 2015
• ISBN: 9781504326438

Sandra Rasmussen

Sandra Rasmussen (PhD, RN, LMHC, and CAS-F) is a certified addiction specialist in alcohol, other drugs, and gambling. This book reflects over thirty years of personal and professional experience with addiction, relapse, and recovery. Dr. Rasmussen currently divides her time among practice, teaching, and service as a parish nurse.

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Copyright © 2015 Sandra Rasmussen.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event you use any of the information in this book for yourself, which is your constitutional right, the author and the publisher assume no responsibility for your actions.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

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ISBN: 978-1-5043-2642-1 (sc)

ISBN: 978-1-5043-2644-5 (hc)

ISBN: 978-1-5043-2643-8 (e)

Library of Congress Control Number: 2015900401

Balboa Press rev. date: 02/04/2015

CONTENTS

Preface

I.

Addiction Management

Are you ready?

1. Addiction Today

2. Recovery

3. Addiction Management

4. Addiction Principles

II.

Addiction Management Resources

Get set.

5. Self

6. Surroundings

7. Management

8. Self-Efficacy

III.

Addiction Management Milestones and Roadblocks

Go!

9. Change

10. Risks For Relapse

11. Relapse Prevention

12. Lifestyle

13. Relapse

14. Well-Being

*********

15. Addiction Management 2020

References

Websites

PREFACE

This book is for people in recovery. We ask and answer basic questions about addiction, relapse, and recovery. We believe addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry, characterized by craving, loss of control, physical dependence, and tolerance. Genetics, together with bio-psycho-social-spiritual factors, account for the likelihood a person will develop an addiction or related disorder. Relapse happens: a return to drinking, using, other addictive behavior, or an increase in harm from addiction. Yet, recovery is an idea whose time has come. Recovery is a different, better way of life with purpose and meaning. We suggest addiction management as a way recovering people can maintain change (abstinence or harm reduction), reduce risks for relapse, prevent relapse, develop a recovery lifestyle, confront relapse when necessary, and achieve well-being. Current research, recognized theories, and the lived experiences of hundreds of people in recovery ground and guide book content. The book has three parts and 15 chapters. A person in recovery introduces each chapter. We show how to develop, implement, and evaluate Addiction Management Plans. Each chapter ends with Summary Statements and Addiction Management Applications. References and a list of Websites complete the book. Family and friends of recovering people will find the material useful. Addiction professionals can use the book to help clients realize recovery and prevent relapse. Are you ready? Get set. Go!

Part I. Are you ready?

Chapter 1 looks at the many faces of addiction. It reviews the descriptive, diagnostic, and researched-based definitions of addiction; it discusses addiction severity and treatment intensity. The chapter also examines the incidence and prevalence of addiction. Chapter 2 chronicles the shift from the traditional medical psychiatric model of care toward the concept of recovery. Recovery is an idea whose time has come. Having listened to the voices of thousands of recovering men and women, and building upon several Federal initiatives, we define recovery as a different, better way of life with purpose and meaning. In Chapter 3 we describe a way to manage addiction: more specifically, how to maintain change, reduce risks for relapse, prevent relapse, develop a recovery lifestyle, confront relapse, and achieve well-being. Ten constructs or major ideas make up the structure, process, and outcome for addiction management. A sample Addiction Management Plan shows how to achieve goals. Chapter 4 reviews the principles that ground addiction management. An ecological paradigm supports the structure of addiction management. Empowerment theory governs addiction management process. Evidence-based practice suggests ways to evaluate outcome and demonstrate the effectiveness of addiction management.

Part II. Get set.

Chapter 5 reviews the self construct and its role in addiction management. We examine holistic self, age, gender, race and ethnicity. We review major theories and concepts that support the self construct. Chapter 6 reviews the construct surroundings, that is, our physical and social world: people, places, and things. What is the role of surroundings in addiction management? We look at nature and technology as well as friends and family, community, society, and culture. Chapter 7 discusses the construct management: the ability to direct or handle something skillfully, effectively; to accomplish something; or to achieve one’s purpose. Management strategies direct addiction management. Do you remember the children’s book, The Little Engine That Could? When other engines refuse to rescue the stranded train full of toys and food for good boys and girls, Little Blue Engine responds: "I think I can, I think I can, I think I can." The engine overcomes insurmountable odds and pulls the train up the towering mountain to the other side. Self-efficacy is the belief I can act effectively here and now. Self-efficacy is the dynamic that drives addiction management. In Chapter 8, we examine the origins of the idea self-efficacy and identify self-efficacy actions to achieve addiction management goals.

Part III. Go!

Chapter 9 addresses change: the first addiction management milestone. Change in this context means stopping an addictive behavior or reducing harm from addiction. And perhaps most important, as it relates addiction recovery, how do people in recovery maintain change? Risks for relapse are legion. Chapter 10 examines craving, cross-addiction, complacency, non-compliance, and co-morbidity: risks that originate in the self. We also identify risks that stem from the environment (surroundings) including cues, circumstances, and crises. Chapter 11 describes ways to prevent relapse. Relapse prevention is our second addiction management milestone. We cite the work of G. Alan Marlatt and his cognitive-behavioral theory of relapse, together with the many contributions of Terrance T. Gorski, especially The Phases and Warning Signs of Relapse. Recovery is more than stopping an addictive behavior or reducing addiction harm. Lifestyle, the third addiction management milestone, is a pattern of change over time: a different way of being, thinking, feeling, and believing together with new ways of connecting with people, places, and things. Chapter 12 explores addictive and recovery lifestyles. Relapse happens. In Chapter 13, we examine this reality. Relapse is a return to drinking, using, gambling, or other addictive behaviors after a period of abstinence. For some individuals, relapse means an increase in harm associated with addiction. Bio-psychos-social theories of addiction help explain relapse. Chapter 14 explores the construct well-being, the fourth addiction management milestone. Well-being is the capacity to affirm and advance a lifestyle with purpose and meaning. Well-being embodies wholeness and epitomizes quality of life. In our final Chapter 15, we examine the vision, mission, goals, and change mandate for 2015–2018 advanced by the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve the nation’s behavioral health and reduce the impact of substance abuse and mental illness in America’s communities. We also fast forward and forecast what addiction, relapse, recovery, and addiction management might look like in 2020.

1

ADDICTION TODAY

I thought I was a bad boy who did stupid things. I got caught, charged, and convicted of possession of a CS with intent to sell. But I sweet-talked my social worker into letting me enroll in the Substance Treatment Program in jail. Seriously, though, I learned that I am not bad nor stupid. I have a mental health problem called addiction. It has something to do with my genes and brain. This helped explain some of my behavior and why I needed instant rewards like drugs, sex, or even crime to feel good. Lots of people are addicted to something. Chapter 1 looks at the many faces of addiction. It reviews the descriptive, diagnostic, and researched-based definitions of addiction; it discusses addiction severity and treatment intensity. The chapter also examines the incidence and prevalence of addiction.

The Faces of Addiction

We believe addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry, characterized by craving, loss of control, physical dependence, and tolerance Genetics, together with bio-psycho-social-spiritual factors, account for the likelihood one will develop an addiction or related disorder. Addiction jeopardizes the health and well-being of individuals, families, communities, even society itself. Addiction across the lifespan wears many faces.

• An infant born six weeks premature to a mother who is addicted to alcohol and cocaine.

• Two little girls playing dress-up and drawing red lines up their arms with lipstick to look like their mom: an IV drug user.

• Four high school seniors high on Adderall before taking their Scholastic Aptitude Tests (SATs).

• A 16-year old girl, dumped by her 25-year old boyfriend, admitted to the psychiatric unit after ingesting a quart of vodka and 50 Tylenol.

• What do you have: gold or green OCs? asks a teen to a street drug dealer.

• A young adult dead of cardiac arrest after a 40-hour marathon session of Diablo 3, an action role-playing game that features elements of the hack and slash, and dungeon crawl genres.

• An evening TV news anchor and sports gambler praying for a long commercial so he can check scores on his cell phone.

• A homeless soldier with four deployments to Iraq and Afghanistan admitted to a Veterans Administration (VA) Hospital with delirium tremens (DTs).

• A board-certified oncologist dismissed from his position at a prestigious University Hospital facing loss of license and incarceration for selling pain prescriptions to finance his gambling addiction.

• A hospice nurse, employee of the year, who has been suspended from work because she diverted narcotics to self-medicate her back pain.

• An executive vice president of a major insurance company admitted to a locked psychiatric ward for self-inflicted gun shots wounds, a botched suicide attempt, related to embezzlement to pay gambling debts.

• A retired electric utility worker who drinks himself into a stupor every evening to cope with his depression after the recent death of his wife.

• A 78-year old woman visiting her daughter and family who gets up during the night, falls, and breaks a hip. Her daughter discovers prescribed medications for Percocet, Xanax, and Ambien in her purse.

What is Addiction?

What do we really mean by addiction? Addiction is a broad, evolving construct that reflects a persistent, recurrent, maladaptive pattern of substance use, gambling, or other behavior that results in adverse consequences for self and others and can lead to clinically significant distress, marked impairment, or death. Substance use includes many legal products such alcohol, nicotine, prescription medications, over-the-counter (OTC) drugs, as well as a host of herbal and natural products that have brain altering properties. Marijuana, cocaine, methamphetamine, heroin, and designer drugs make up popular illicit drugs. Many household products like solvents, sprays, or glue have psychoactive effects, especially when inhaled.

Obsessive/compulsive/impulsive behaviors that can become addictive include gambling, eating, sex, and shopping; internet use and the cell phone; internet gaming and video games; and many more. Several terms describe gambling addiction—pathological gambling, compulsive gambling, problem gambling, or gambling disorder. Cross addiction or replacement addiction is common with substance use and other addictive behaviors.

Definitions of addiction are descriptive, diagnostic, and research-based. Many people in recovery, together with addiction professionals, consider addiction as a bio-psycho-social disorder; Howard J. Shaffer, a recognized addiction scholar, describes an addiction syndrome. The American Psychiatric Association and the World Health Organization offer diagnostic definitions respectively in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Increasingly, definitions of addiction reflect basic research, for example the work of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Drug Abuse (NIDA), as well as the genetic research of Kenneth Blum and colleagues and the idea of a reward deficiency syndrome (RDS). The American Society of Addiction Medicine (ASAM) defines addiction as a brain-based chronic disease.

Addiction is a Bio-psycho-social Disorder

Addiction is a bio-psycho-social disorder in etiology, expression, treatment, and recovery. A bio-psycho-social perspective includes and integrates aspects of biological, psychological, and socio-cultural theories of addiction, reflecting a holistic view of individuals. Today, assessment, diagnosis, treatment planning, intervention, evaluation, and related documentation of addiction address bio-psycho-social variables. Best addiction practice models as well as program accreditation standards and criteria reflect a bio-psycho-social model of addiction.

The Addiction Syndrome

Howard J. Shaffer, editor of American Psychological Association publication Addiction Syndrome Handbook: Volume 1 Foundations, Influences, and Expressions of Addiction; Volume 2 Recovery, Prevention, and Other Issues (2012), has long held the idea of an addiction syndrome which recognizes the similarities in etiology, expression, and treatment response among different addictive disorders. Leading addiction scholars embrace the idea of an addiction syndrome model and write extensively about addiction from this perspective in these volumes.

American Psychiatric Association (APA)

For many years, addiction professionals have used the Diagnostic and Statistical Manuals developed by the American Psychiatric Association to diagnose substance-related disorders, pathological gambling, and other mental disorders: the widely-used DSM-IV-TR, published in 2000. Both general and specific changes in the DSM-5, published in 2013, affect addiction diagnoses. First, the multi-axial system has been removed. Second, the DSM-5 (2013) does not differentiate between substance abuse and substance dependence; instead, it suggests a continuum for substance-use disorders using the number of criteria to determine mild to moderate to severe problems. Substance-related disorders encompass ten separate classes of drugs including alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco; and other substances. Craving has been added as a diagnostic criterion for substance use disorders. Pathological gambling has been reclassified from an impulse-control disorder in the DSM-IV-TR to the category Substance-Related and Addictive Disorders in the DSM-5. Other areas of interest in the DSM-5 that relate to addiction include diagnostic criteria for binge-eating disorder and the emergence of internet gaming disorder. Although many addiction professionals work with individuals with compulsive sexual behaviors, sexual addiction or hypersexual disorder was rejected for inclusion as a disorder in the DSM-5.

World Health Association (WHO)

The official diagnostic system in the United States is based on the International Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO). The ICD is the global standard for diagnostic classification, health reporting, and clinical applications of mental disorders and other medical conditions.

Major mental health providers and many insurance companies use the ICD-10-CM, introduced in 2013, for third-party billing and reporting. At present, there are differences between the ICD-10-CM and the DSM-5. For example, the ICD includes codes for substance abuse and substance dependence. As stated above, the DSM-5 eliminates this difference and suggests a continuum for substance use disorders using a number of criteria to diagnose the problem as mild, moderate, or severe. It is important that people in recovery, who may need addiction services, and addiction professionals keep abreast of development of the ICD-11, expected in 2015, especially similarities or differences with