I usually do not blog about something I read, something I attended, or something I saw. I think that experiencing anything in life is usually personal and may not be what others have experienced. I also feel that my interpretation may be wrong and never want to write anything, in case I missed an important point or my misunderstanding affects the person who made the presentation.
In this case, I want to make an exception. I went to a supper this Thursday and the guess of honor was Chris Herren, the former Boston College, Fresno State, Denver Nugget, and Boston Celtic who discussed very frankly about his past issues with addiction. Now, I will not pretend I am a basketball fan, as I am a fair weather fan. I am a lifelong Celtic supporter but to say I am a fan would be a lie. So when I attended, I had only limited knowledge about Chris.
Chris arrived early and shook hands with everyone. I joked with him prior to him speaking and he was very humble and laughed politely at my bad joke. As he started to speak, I learned more about him but more importantly, I learned how bad your decision making gets when substances such as opiates take over your life. Chris is a local kid who got many chances to play basketball, but alcohol and drugs got in his way so many times, he let many opportunities pass him by and it almost costed him his family and his life.
Many things struck me: when he discussed how his college opportunities were wasted away when he had a choice between successes (being a 1st round pick) and his own demons (cocaine, alcohol). Even when he got to the NBA, he was offered many opportunities, including playing with his hometown team, or completing the summer league, getting a golden contract, or restarting his career in Europe but at every turn, he chose his demons instead of career success. He was brutally honest about it and did not pull punches, which I admire.
What really struck me though is how honest he was about the impact on his family and friends. I was particularly touched by his description of the impact on his children and how he felt about it. I had tears in my eyes several times when he spoke about them. The other thing is his honesty about his ODs, as well as his desires to end his life. This is such a hard thing to admit. I rarely hear that. He told us about his homelessness, the places he ended up, the loss of his wife and kids, and how he wished it could end...How many people are willing to discuss that? He also talked about one of the most impactful counselor he ever had: he was brutal, he was honest, and it made a great positive impact on Chris.
He let us know how he got out of it too: Treatment and AA. It saved his life. He talked about his sobriety since August 2008 and how he has been since then. He has been featured on ESPN "Unguarded" and has written a book. I have never bought a book at these type of talks: without hesitation, I bought one and he signed it. He was very humble, very nice, and talked with everyone who spoke to him. Can't wait to read it. I am now a huge fan of his. He also made me feel that my style of counseling may impact someone one day. If you ever have a chance to hear him speak, I strongly encourage you to go.
Thanks Chris, count me as a huge lifelong fan!
Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts
Sunday, June 10, 2012
Sunday, May 6, 2012
Taking the Stigma Out of Counseling
Recently, a very prominent former football player died of an apparent suicide at a very young age. I will not be discussing his case, as I feel it is disrespectful due to not knowing all the details, nor what happened or what was happening in their life.
After a hard time in your life, it can be difficult to admit that you may need some help. I don't want to pretend that counseling is the only solution. After all, you have friends, family, neighbors, people you trust that can be open to listening to you, help you out, give you a sense of direction, and make you feel good. I think that some of you can name one or two people in our lives that are like that. If you can, you are lucky. It is a great gift and you keep these people close to you.
However, sometimes, the best intentions do not help you. We can also all remember a time that we reached out to a trusted person about something and we kind of left scratching our heads, angrier, more upset, and/or more confused. It is not because their intentions were not good (although, it can happen that the intentions weren't that great) but it may not be what you were looking for. Or maybe they took another person's side and didn't get your point of view. Or you were unable to open up about stuff that can be hard to discuss.
If I have to say it, I will: "I am cheating on my partner"; "I am not sure if I am gay, straight, or bisexual"; "I am stealing from others"; "I've been addicted to a substance and cannot stop"; "I sometimes think of ending it all"; "I have a plan to get rid of my problems"; "I don't know what to do: I am in serious debt"; "I hate not working anymore"; "I sometimes just don't want to be a parent anymore". Think about it: How easy are any of those subjects to discuss with someone, even someone you trust? I know most people do not have those thoughts...or do they? I really think the issue is not talking about it, it is finding a person to talk about these things.
I think most of the questions I mentioned have something in common: Stigma. I mean those subjects are pretty taboo. It is not cool, it is not OK, it is not acceptable to think these things, never mind say them out loud. A strong person, particularly men, don't have these problems. And if you are a celebrity or a sports figure, what gives you the right to think these things? You have the whole world in your hand, don't think these things!
Of course, reality is that EVERYBODY has a right to think these things. And if you recognize that they are wrong, why wouldn't you reach out? Shame, of course comes to mind, as well as pride. And if you are in the limelight, it is hard to get help, as reaching out can be in the public eye. And sometimes, people don't understand HIPPA and go to the wrong people. And if you are a man, deal with your problems as a man.
Reaching out is a brave act but unfortunately, it is not always recognize as such, especially by the person who does reach out. Other people also will find ways to use these problems as a psychological edge on others, which is especially true in sports or celebrity circles. But guess what? After celebrity and your sports career is over, you still may have these problems. Then what? Reaching out and having the public support it is the key to start the reaching out of troubled thoughts. It is also a safe, effective way to deal with your issues. And maybe, just maybe, you get the right treatment, the right time and your future gets better.
It may be brain injury related, it may be inherited, but frankly the Social setting (particularly changing public perception) is the key to avoid future tragedies. Now, do you have the testicular fortitude to support this?
If I have to say it, I will: "I am cheating on my partner"; "I am not sure if I am gay, straight, or bisexual"; "I am stealing from others"; "I've been addicted to a substance and cannot stop"; "I sometimes think of ending it all"; "I have a plan to get rid of my problems"; "I don't know what to do: I am in serious debt"; "I hate not working anymore"; "I sometimes just don't want to be a parent anymore". Think about it: How easy are any of those subjects to discuss with someone, even someone you trust? I know most people do not have those thoughts...or do they? I really think the issue is not talking about it, it is finding a person to talk about these things.
I think most of the questions I mentioned have something in common: Stigma. I mean those subjects are pretty taboo. It is not cool, it is not OK, it is not acceptable to think these things, never mind say them out loud. A strong person, particularly men, don't have these problems. And if you are a celebrity or a sports figure, what gives you the right to think these things? You have the whole world in your hand, don't think these things!
Of course, reality is that EVERYBODY has a right to think these things. And if you recognize that they are wrong, why wouldn't you reach out? Shame, of course comes to mind, as well as pride. And if you are in the limelight, it is hard to get help, as reaching out can be in the public eye. And sometimes, people don't understand HIPPA and go to the wrong people. And if you are a man, deal with your problems as a man.
Reaching out is a brave act but unfortunately, it is not always recognize as such, especially by the person who does reach out. Other people also will find ways to use these problems as a psychological edge on others, which is especially true in sports or celebrity circles. But guess what? After celebrity and your sports career is over, you still may have these problems. Then what? Reaching out and having the public support it is the key to start the reaching out of troubled thoughts. It is also a safe, effective way to deal with your issues. And maybe, just maybe, you get the right treatment, the right time and your future gets better.
It may be brain injury related, it may be inherited, but frankly the Social setting (particularly changing public perception) is the key to avoid future tragedies. Now, do you have the testicular fortitude to support this?
Sunday, March 25, 2012
Substance Abuse
This subject can be controversial. Treatment for substance abuse is generally: "Wait until they hit rock bottom (jail, OD, hospitalization, losing everything, etc.), use motivational interviewing until then, send them to detox, do some counseling and send them to AA". I know it is not everyone's opinion, but I am looking at the general view of the treatment.
Let's address this one by one. Let's get one thing out of the way: AA (Alcoholics Anonymous), NA, CA, or __A is NOT treatment. Do I believe in AA? Well, let me put it this way: I have seen it work for some people, I have seen people hate going there for various reasons (triggering, boring, too Higher Power oriented, steps are too complicated), I have seen it grow on people. I believe that AA has good intentions and it has help many people, but to put all individuals in the same boat is wrong. Think about it this way: When you have diabetes, there are several options for treatment, from diet change, to regular insulin, and everything in between. Self-help groups can be part of treatment, but it cannot be the only way a person remains sober.
Motivational interviewing is based on stages of change and meeting the person where they are at. The 6 stages of change, and yes there are 6, are: pre-contemplative, contemplative, preparation, action, maintenance, and relapse. At anytime, the theory is the individual is at one part of these stages. I work with stages, not cycles. I think that an individual can jump stages, fall back, stay "stuck" at one point or the other. Again, meeting as person where they are currently and making sure they get information they need at that time is the best practice. Oh, and yes, relapse is part of it. Relapse may bring you to a different stage, including maintenance. But to assume relapse brings you back to pre-contemplative is shaming.
Shame: what a powerful emotion. I think that most individuals who have a substance use issue have been through shame most of the time they have been using. Using shame in counseling is probably the worse thing you can do, unless, of course, you want the person to really fall back to pre-contemplative. A person goes through enough shame when this happen, why add to it? I think we need to work on looking for the strengths and how they can be used in order to get the sobriety goal met again.
The rock bottom theory: while in principal that is great, I believe that if you wait until then, you might not be able to help that person. Think about it: an overdose can be fatal or even cause permanent damage, a crime can lead to a lifelong conviction, etc. Why wait until then? Will they change before that? Who knows. But giving up is not always the solution. I have worked with people who told me that I was the first person in a long time that actually asked them how they are doing and why they are still using. The "why" is usually the key. Some people believe some drugs are "harmless" (FYI, none are like that if consumed daily), some are too addicted and don't want to go through withdrawals or even detox, some don't know how to ask and others are tired of being told to "hit a meeting". Rock bottom is not good the answer.
As for detox, only certain "drugs" can be a reason for admission to detox (good luck getting a detox for marijuana) but most drugs lead to detox symptoms. Most of them do not lead to death but not being able to smoke may lead to increase anxiety, panic attacks, and feeling helpless. No physical addiction does not equate no detox symptoms. Most people feel misunderstood and also do not want to deal with these symptoms. Acknowledging those symptoms and finding ways to address them is the key when a person is stopping their drug.
As for maintenance, the use of medication assisted treatment (MAT) (suboxone, methadone) are extremely controversial. I believe again that you have to use a personal fit when thinking about these solution. Some people believe it is a legal high. Others see it as a crutch. And others swear by it. Again, you need to explore what will best work for you. If you are going to use MATs, I strongly encourage counseling (most doctors who prescribe these meds actually expect it). The doctor, the counselor, and the person using MAT should have open communication with no BS. And this is where I also differ: MATs were originally prescribed to help individuals get completely off all drugs, including these meds. But there is no money in that. The manufacturers of these meds, in collaboration with the doctors, now push a lifetime use of these meds. I strongly suggest that, if you use MATs, you should have an exit strategy, off the meds. These meds should not be substitute, they should be just a part of a long term plan.
Is counseling the only solution? Of course not. It is one of the solutions. But most experts agree that a combination of motivational interviewing with cognitive behavioral treatment is probably the optimal way to address these issues. However, it is not the only solution...Hope you get my drift.
Let's address this one by one. Let's get one thing out of the way: AA (Alcoholics Anonymous), NA, CA, or __A is NOT treatment. Do I believe in AA? Well, let me put it this way: I have seen it work for some people, I have seen people hate going there for various reasons (triggering, boring, too Higher Power oriented, steps are too complicated), I have seen it grow on people. I believe that AA has good intentions and it has help many people, but to put all individuals in the same boat is wrong. Think about it this way: When you have diabetes, there are several options for treatment, from diet change, to regular insulin, and everything in between. Self-help groups can be part of treatment, but it cannot be the only way a person remains sober.
Motivational interviewing is based on stages of change and meeting the person where they are at. The 6 stages of change, and yes there are 6, are: pre-contemplative, contemplative, preparation, action, maintenance, and relapse. At anytime, the theory is the individual is at one part of these stages. I work with stages, not cycles. I think that an individual can jump stages, fall back, stay "stuck" at one point or the other. Again, meeting as person where they are currently and making sure they get information they need at that time is the best practice. Oh, and yes, relapse is part of it. Relapse may bring you to a different stage, including maintenance. But to assume relapse brings you back to pre-contemplative is shaming.
Shame: what a powerful emotion. I think that most individuals who have a substance use issue have been through shame most of the time they have been using. Using shame in counseling is probably the worse thing you can do, unless, of course, you want the person to really fall back to pre-contemplative. A person goes through enough shame when this happen, why add to it? I think we need to work on looking for the strengths and how they can be used in order to get the sobriety goal met again.
The rock bottom theory: while in principal that is great, I believe that if you wait until then, you might not be able to help that person. Think about it: an overdose can be fatal or even cause permanent damage, a crime can lead to a lifelong conviction, etc. Why wait until then? Will they change before that? Who knows. But giving up is not always the solution. I have worked with people who told me that I was the first person in a long time that actually asked them how they are doing and why they are still using. The "why" is usually the key. Some people believe some drugs are "harmless" (FYI, none are like that if consumed daily), some are too addicted and don't want to go through withdrawals or even detox, some don't know how to ask and others are tired of being told to "hit a meeting". Rock bottom is not good the answer.
As for detox, only certain "drugs" can be a reason for admission to detox (good luck getting a detox for marijuana) but most drugs lead to detox symptoms. Most of them do not lead to death but not being able to smoke may lead to increase anxiety, panic attacks, and feeling helpless. No physical addiction does not equate no detox symptoms. Most people feel misunderstood and also do not want to deal with these symptoms. Acknowledging those symptoms and finding ways to address them is the key when a person is stopping their drug.
As for maintenance, the use of medication assisted treatment (MAT) (suboxone, methadone) are extremely controversial. I believe again that you have to use a personal fit when thinking about these solution. Some people believe it is a legal high. Others see it as a crutch. And others swear by it. Again, you need to explore what will best work for you. If you are going to use MATs, I strongly encourage counseling (most doctors who prescribe these meds actually expect it). The doctor, the counselor, and the person using MAT should have open communication with no BS. And this is where I also differ: MATs were originally prescribed to help individuals get completely off all drugs, including these meds. But there is no money in that. The manufacturers of these meds, in collaboration with the doctors, now push a lifetime use of these meds. I strongly suggest that, if you use MATs, you should have an exit strategy, off the meds. These meds should not be substitute, they should be just a part of a long term plan.
Is counseling the only solution? Of course not. It is one of the solutions. But most experts agree that a combination of motivational interviewing with cognitive behavioral treatment is probably the optimal way to address these issues. However, it is not the only solution...Hope you get my drift.
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