I’m Sober, Now What?

1. I’m Sober, Now What? Annette Pearson MS, LADC Vinland NationalCenter BIA of MN 24th Annual Conference April 23rd, 2009

2. This is what we hope for but …

3. this is what we sometimes get. Addiction can feel like ‘a devil on ones back’ that just won’t 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.

4. 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.

5. 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 Why return to use chemicals?

6. 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 Additional risk factors for individuals with disabilities

7. 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 toSTOP. 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.

8. 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.

9. The Pleasure Center – Dopamine life’s “Happy Chemical”

11. 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

12. 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

13. Remember with ADDICTION: • We did not cause it • We can not control it • We can not cure it • We can help support sobriety.

14. 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

15. Let’s shed some light on this

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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 • Don’t power struggle over a UA at the moment, just document and notify the team

25. 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 Playing Sherlock Holmes

26. 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 Oh where, oh where

27. 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 Creativity at its best

28. 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

29. 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

30. Frustrations with 12 Step Meetings • Abstract nature • Labels • Traditions/unwritten rules • Isolation • Feeling misunderstood • Confusion over expectations • Lack of structure in some meeting types

31. 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

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.

38. 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?

39. 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

40. 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

41. 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

42. 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

43. 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.

44. 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?

45. Causes and Coping with stress • 3) Conflicts with people • Teach how to pick and choose one’s 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

46. 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

47. 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.

48. 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

49. 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

50. 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.