Morningside Recovery (866) 725-8565

Trouble Brewing in Energy Drinks

2008-06-23T18:47:00.000-07:00

For the past two decades the addiction treatment field has had growing concerns over the misuse of caffeine. From the late seventies through the late eighties, treatment centers across t United States took a careful look at the use of caffeinated beverages. Demographics pointed to the fact that many leading centers treating alcohol and other drug addiction were seeing over 70 percent of their admissions with a primary drug of choice, cocaine. Cocaine with the advent of "read rock" better know as crack was at epidemic proportions in this country. Treatment administrators saw it necessary to cut down on the use of caffeine in their respected centers. "It made no sense to see all our patients jacked up on coffee and craving Cocaine", said one leading expert of those times.

Today our industry has to make a stand again with the growing numbers of beverages that promise quick energy as well as performance and nutritional benefits it is one of concern to the recovering community. A growing number of these drinks are aimed at those who want to stay UP, boost energy, raise alertness, promise a high followed by a long lasting energy buzz. If we advocate for our patients and clients to be drug free then we need to enforce policies against the use of energy drinks in our facilities. At Morningside Recovery in Newport Beach, CA, that has been the position for several years. Morningside Recovery sees the health risks involved including dehydration and overstimulation which both can have adverse effects on the person recovering from alcoholism and drug addiction. It is also known that caffeine can speed up a person’s heart and raise blood pressure. In treatment programs we want our clients/patients to not get over stimulated but to concentrate on what is being taught to them. That is they are here in treatment to help safe their lives for they have a life threatening chronic illness that if not put into remission with cause premature death.

Morningside Academic Institute at soberinstitute.org

2008-05-22T07:26:00.000-07:00

Morningside Recovery is proud to announce the launch of their new website for Morningside Academic Institute at soberinstitute.org. The Morningside Academic Institute was developed and established in the Fall of 2006 by Brendan Bickley, Director of Education, and Jana Triplett, Director of The College Program.

Sharing the visions of NAATP, the National Association of Addiction Treatment Providers, "to promote, assist and enhance the delivery of ethical, effective, research-based treatment for alcoholism and other drug addictions" Morningside Recovery's Academic Institute was established. Comparisons of addiction treatment programs coupled with academic programs and addiction treatment programs without academic programs found success rates with academic programs surpassed those without.

Morningside Recovery's Brendan Bickley specifically studied the affects of pairing an academic program with a recovery program. Examining the T.E.A.C.H. Program, a voluntary program placing clients in addiction counselor training classes at a local community college, to discern the success of clients enrolled in an academic program opposed to those not enrolled see "An Evaluation of the T.E.A.C.H. Program: Addiction Treatment Coupled with Higher Education" by Paul Alexander and Brendan Bickley for the Department of Criminology, Law & Society, University of California, Irvine.

Morningside Academic Institute provides the unique opportunity to continue academic studies while in recovery.

Before going into treatment I had dropped out of college and didn't know where I was headed with my life. I had no idea what to do. I was using drugs and drinking all the time. I went into treatment and spent ninety days in Morningside's residential program before transferring into the college program. It was just what I needed. I needed the structure and help the program offered because before when I tried to do college on my own I couldn't do it. The therapists and counselors were all great. The Academic Institute helped me get on track with school and even helped me to figure out what I wanted to do with my life. I got a 4.0 my first semester and a 4.0 my second semester and I'm planning on transferring to the University of California, Irvine next year. It truly was a great, life changing experience.

What does an "Academic Program" entail?

The components of our academic program extend beyond just class time. Morningside Recovery's Academic Institute builds life skills and clients work towards new academic and career goals with direction and focus. Counseling and strategic planning are a continuous and ongoing part of our program. Morningside Academic Institute supports students in not only their journey to sobriety, but supports students in their studies, academic plans and future careers.

Academic Counseling: academic assessment, additional testing, transcript review, academic credit transfer, and the creation of a Strategic Academic Action Plan

Life Skills: Debt management, interpersonal relationships, time management, budget planning

What kind of academic programs are available?

Academic programs can be tailored to fit many circumstances. Whether a client is working towards a GED, rebuilding a college transcript after experiencing an academic crisis or gaining entrance to a graduate program an education counselor will meet with the client and design a program specifically for their recovery goals. Careful consideration is taken to ensure the client's ongoing recovery is balanced with their academic program. Morningside Recovery has experience in helping clients navigate the application and transfer process.

Vocational Training: Drug & Alcohol Counseling Classes to become a licensed addiction treatment expert, Nursing, Psychiatric Technician, Massage Therapist, Chef or Culinary Arts Graphic Design, Firefighter, Paramedic, Court Reporter
MAI Students have enrolled in programs at: Orange Coast Community College, The Art Institute, FIDM, Chapman University, and Saddleback College in Mission Viejo among others
MAI Students have continued their studies at: University of California Irvine, University of California Los Angeles, University of California Berkley, Cal State Fullerton, University of Chicago, Tulane University, New York University, University of Texas Austin, Pepperdine University, Cal State Long Beach, Rutgers University, Chapman University

For more information on Morningside Recovery's Academic Institute please visit our new site at soberinstitute.org.

For immediate assistance to help a loved on in need of a drug or alcohol intervention please call us at (866) 725-8565.

The National Association of Addiction Treatment Providers (NAATP)

2008-05-20T10:50:00.000-07:00

The NAATP 2008 Annual Addiction Treatment Leadership Conference is currently being held at the Renaissance Esmeralda Resort in Indian Wells May 18-21, 2008.

"The National Association of Addiction Treatment Providers shall be the organization that enables addiction treatment providers to grow and thrive in a changing healthcare and political environment."--NAATP Vision Statement.

As we look into the 21st century the demand for a coherent unified voice from the addiction health care advocates remain. Addiction is a health issue, sharing more in common with chronic diseases such as diabetes, heart disease and asthma, yet the majority of patients remain untreated and undertreated.

NAATP is the organization which draws from the various addiction disciplines to create a single voice in the arena of addiction. With proper research, education, and public policy we can help to change the landscape from one of shame and blame to one of healing, treatment, hope and understanding.

Bipolar Disorder in Teens

2008-05-19T10:26:00.000-07:00

Bipolar Disorder (also know as manic depression) often reveals itself in teens as severe moodiness and unhappiness. Often the first diagnosis is one of depression. Frequently bipolar disorder is initially misdiagnosed. It can take time to properly diagnos bipolar disorder. Treatment includes a combination of carefully monitored medication and professional counseling.

Bipolar disorder manifests differently in teens than in adults. Adolescent cycles are more rapid, adult cylces can be over weeks or months, in children cycles can occur within the same day.

Drug and alcohol use in adolescents with bipolar disorder is common. Dual-Diagnosis is the term used to describe the process of treating a mood disorder along side a substance abuse problem. Symptoms must be analyzed and treated accordingly. Careful and caring counseling, as well a medical attention and proper prescribed medication, are used to treat this combination.

Other conditions which contribute to the risk of adolescents developing a bipolar mood disorder increase with:

family history of bipolar disorder or other mood disorder
family history of drug or alcohol abuse
episodes of severe depression

Factors which can contribute to manic episodes include:

changes in routine or sleep patterns
certain antidepressants can trigger manic episodes
traumatic life event
abuse or neglect of medication
using alcohol or drugs

Newport Beach Drug Rehab from Street View

2008-05-15T06:38:00.000-07:00

Using Google Street View come take a look at our beautiful Newport Beach neighborhood. Morningside Recovery is located on historic Lido Isle. Take a tour of our Drug Rehab and Dual Diagnosis Treatment facility.

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Percocet: Prescription Medication Addiction

2008-05-12T11:41:00.000-07:00

Prescription Drug Warning: Percocet

You are a woman, about 35 years old. You are not feeling well and you go to the doctor. He prescribes a medication that will alleviate your pain. You take this medication, just as the doctor ordered, for a few weeks. You feel great. After three weeks, you stop, and start getting nausea, your legs start cramping, and you can't sleep. What is the problem?

The problem is that on top of your original physical condition you are now addicted to a prescription drug: Percocet.

Addiction to prescription medication can begin innocently with a prescription legally obtained from a physician. The strength and addictive qualities of this commonly prescribed medication can trigger addictive behaviors in those using percocet as prescribed.

Use Prescription Drugs Safely

Always follow medication directions carefully.
Don't increase or decrease doses without talking with your doctor.
Don't stop taking medication on your own.
Don't crush or break pills.
Be clear about the drug's effects on driving and other daily tasks.
Learn about the drug's potential interactions with alcohol, other prescription medicines, and over-the-counter medicines.
Inform your doctor about your past history of substance abuse.
Don't use other people's prescription medications and don't share yours.

Types of Addiction

2008-03-25T08:17:00.000-07:00

Drug Addiction

Drug addicts are typically those individuals who are addicted to some substance other than alcohol. Drug addiction is a three stage process according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). They are preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. The Drug Addict, as opposed to the alcoholic, can be addicted to anything. It is common for drug addicts to have a "drug of choice," or a particular drug that they prefer over other drugs. There are typically "upper" people who prefer stimulant drugs such as cocaine and/or methamphetamine, and there are "downer" people who prefer drugs such as heroin, prescription pain killers, and marijuana. Recently there has been an influx of multidrug addicts who use both uppers and downers.

The drug addict can also be addicted to alcohol and many drug addicts who assume that they are not alcoholics and attempt to drink without doing drugs find this a difficult task to accomplish. Many drug addict are alcoholics and visa versa.

Alcohol Addiction

There are many types of alcoholics. Some are binge drinkers and others have developed into daily drinkers. According to the DSM-IV, the alcoholic is someone who continues to drink despite negative consequences. Often the dependent alcoholic will develop severe withdrawal and tolerance to alcohol. The alcoholic will also have a preoccupation with drinking.

It is currently unclear what causes a person to become an alcoholic, but the general consensus is that it is a combination of environmental and genetic factors. Many people assume that a person must enjoy alcohol to be an alcoholic, but this is not true. An alcoholic may detest alcohol, but drink it anyway. An alcoholic drinks alcohol essentially because they like the effect produced by alcohol.

Coke Addiction

Cocaine is essentially a dopamine reuptake inhibitor. It suppresses appetite, produces a euphoric feeling, and increases energy. Cocaine can be smoked (freebasing), inhaled (Insufflation), or injected. Often people begin using the drug recreationally by inhaling into the nasal passage (snorting or sniffing). Cocaine is a highly addictive drug. People who use the drug only once or twice can become addicted to the drug physically. Cocaine is almost never pure. Cocaine is mixed with other substances such as baby laxative by dealers looking to increase their profit.

Crack Addiction

Crack is the most addictive form of cocaine. It produces and intense high that only last for minutes. Only half of Crack is made up of actual cocaine. The rest is often baking soda or some other adulterant. Crack addiction is hard to treat. The euphoric recall of the drug is intense and often people in recovery who's primary drug of choice is Crack tend to have a lower chance of success in treatment. Crack cocaine releases a tremendous amount of dopamine quickly and then the level of dopamine drops suddenly, causing depression and an intense feeling of sadness. The extreme highs and lows of the drug is what often creates psychological addiction.

Meth Addiction

Methamphetamine or Meth is a cheap and highly addictive drug. There are often methamphetamine epidemics in towns across America as methamphetamine labs pop up and people begin to abuse the drug and then offer it to their friends, who then become addicted. There have been reports that the methamphetamine currently being produced in makeshift labs across the country is the most addictive drug there is. Methamphetamine produces a tremendous amount of energy coupled with euphoria. Methamphetamine addicts can stay awake for days and even weeks at a time. Methamphetamine often causes symptoms identical to Paranoid Schizophrenia after extended periods of use (Amphetamine induced psychosis). The symptoms often dissipate after drug use stops, but sometimes the symptoms persist for some time. The drug can be smoked, inhaled, ingested, or injected.

Post-traumatic Stress Disorder and Addiction

2008-03-24T09:48:00.000-07:00

In recovery from substance abuse, it is important to not only address the addiction itself, but also any mental health issues that the addict suffers from as well. Here, trauma and Post-traumatic Stress Disorder will be discussed as it relates to addiction.

Trauma, the experience of being emotionally overwhelmed by something that is not to be expected in your childhood or lifetime, is commonly reported by addicts as they enter treatment. Post-traumatic Stress Disorder (PTSD), a set of emotional problems that can occur after someone has experienced a trauma, is a common diagnosis for addicts in drug and alcohol treatment. Among women in treatment for substance abuse, 30%-59% have a current PTSD diagnosis. Among men in treatment, 11%-38% have a current PTSD diagnosis. These statistics only include those "reporting" the symptoms, but it is believed that the percentages are actually higher. For instance, it is estimated that 90% of women in treatment have experienced trauma in their lifetime.

With these rates of trauma and PTSD, it is clear that addiction and trauma/PTSD are linked. It is important for the addict to understand the link and also to understand the symptoms that can occur with PTSD- nightmares, flashbacks, or intrusive images, numbing, dissociation, and hypervigilance. For some, the addiction follows a trauma and is utilized as a coping strategy. For others, the addiction has already begun when they experience the trauma and then spirals afterward. Once the addict enters treatment, it is common to have traumatic events from the past and PTSD symptoms surface early in recovery, so it is important to have a treatment program that offers treatment from both.

Trauma/PTSD recovery is possible as you heal from addiction. As in recovery around addiction, trauma recovery happens in stages. The first stage in healing is safety. This stage is the stage all addicts are in when they enter treatment for addiction. At this stage, you are to become clean and sober, remove yourself from destructive situations/relationships, learn skills to stabilize your mood and any PTSD symptoms, and attain stability.

Stage two is mourning. In this stage you are already feeling safe within yourself and your environment. This is a time of grieving about the past and the losses that resulted from the trauma. The work at this stage is usually done with a therapist who can assist in the process and support you through this time. Stage three is reconnection. After you have completed stage two you can begin to connect to your environment and others in a new way.

It is important for these stages to be completed in order, to assure that you are safe and able to work through the grief and loss in a healthy way. Many addicts have used drugs and alcohol to numb the pain experienced around their trauma or PTSD symptoms. If the addict isn't safe before processing the trauma in recovery, it can lead to relapse and/or self-destructive behavior.

Recovery from alcohol and drug addiction and recovery from trauma/PTSD are similar in that they require stabilization first and then exploration into other issues. Part of that stabilization for trauma/PTSD is working with professionals to learn skills to cope with the symptoms, gain better understanding of the symptoms and to begin to take medications if necessary. Recovery from trauma/PTSD is possible and many have healed from both the trauma and addiction.

Click here for help with Post-traumatic Stress Disorder and Addiction

Bipolar Disorder, AKA Manic Depression

2008-03-21T08:35:00.000-07:00

Bipolar disorder, also known as manic depression, is a mental disease that causes severe shifts in a person's mood. The ups and downs experienced from a bipolar disorder are much different from the normal mood changes everyone goes through. These emotional extremes can result in damage to a person's degree of daily functioning.

Bipolar disorder typically develops in early adulthood. Some may experience symptoms in late adolescence however, it is not recognized as an illness. A person can suffer from symptoms for many years until the bipolar disorder is properly diagnosed and treated.

In bipolar disorder, changes in mood are experienced on a spectrum or continuous range. The changes in mood can bring on severe changes in attitude and behavior. A person with a bipolar disorder will experience periods of highs and lows. These highs and lows are called episodes of mania and depression.

A bipolar disorder is diagnosed when a combination of manic and depressive symptoms are present. Symptoms of mania may include, increased energy, racing thoughts, or unrealistic beliefs in one's abilities and powers. Depressive symptoms can include, feelings of worthlessness, loss of interest, or thoughts of death or suicide.

Severe episodes of mania or depression can include psychotic symptoms. These symptoms may include hearing voices, seeing things that are not there, or strongly believing false concepts. People that have a bipolar disorder are sometimes incorrectly diagnosed as having another severe mental illness such as, schizophrenia.

Most scientists agree that there is no single cause for bipolar disorder. It has been suggested that bipolar disorders may result from a specific gene, passed down from family generations. Other research suggests a combination of factors including a person's environment to be the cause of the disease. Whatever the cause, a bipolar disorder can be treated and the person can lead a productive life.

Proper treatment can help reduce the manic and depressive episodes experienced by people with a bipolar disorder. Bipolar disorder can be a life long struggle, therefore long-term treatment is strongly recommended. A combination of psychotherapy and medication management has proven to be an effective form of treatment for a bipolar disorder.

Medication management is a crucial component in the treatment of a bipolar disorder. Medications known as "mood stabilizers" can be prescribed to help control the extreme levels of highs and lows. Popular medications for treating a bipolar disorder include, Lithium, Depakote, or Neurontin. Side effects from medications may include weight gain, nausea, or anxiety.

Working closely with a doctor and therapist can improve daily symptoms experienced by a person with a bipolar disorder. A therapist can provide education and insight to a person with a bipolar disorder and their families. The most common forms of therapy used with a bipolar disorder are cognitive behavioral therapy and family therapy.

It is important to keep in mind that a bipolar disorder is a life long mental illness. Even when a person is feeling at their best, they must continue treatment. The mania and depression episodes can occur at anytime and currently has no cure. However, if a person is properly diagnosed and remains aware of their symptoms, they can lead a fulfilling life.

Have questions and need help with Bipolar Disorder or Manic Depression? Click Here

Heroin Addiction

2008-03-20T07:17:00.000-07:00

Heroin is a highly addictive drug which enters the brain rapidly. It particularly affects those regions of the brain responsible for producing physical dependence.

Slang, Smack, Horse, Mud, Brown Sugar, Junk, Black Tar, Big H, Dope, Skag.

History of Heroin:

Heroin which is a very popular drug of choice on the American drug culture today is not a new drug that just showed up in the late 1960's nor is its negative effects unique to modern times. Heroin is an opium derivative and, as with any of the opium derivatives, there is a severe physical/mental dependency that develops when it's abused.

Get the Facts:

Heroin affects your brain. Heroin enters the brain quickly. It slows down the way you think, slows down reaction time, and slows down memory. This affects the way you act and make decisions.

Heroin affects your body. Heroin poses special problems for those who inject it because of the risks of HIV, hepatitis B and C, and other diseases that can occur from sharing needles. These health problems can be passed on to sexual partners and newborns.

Heroin is super-addictive: Heroin is highly addictive because it enters the brain so rapidly. It particularly affects those regions of the brain responsible for producing physical dependence.

Signs and symptoms of heroin abuse are:

1. Euphoria
2. Drowsiness
3. Impaired mental functioning
4. Slowed down respiration
5. Constricted pupils
6. Nausea

Signs of heroin overdose:

1. Shallow breathing
2. Pinpoint pupils
3. Clammy skin
4. Convulsions
5. Coma

Heroin can and will kill you. Heroin is one of the top two frequently reported drugs by medical examiners in drug abuse deaths.

Click here for help with Heroin Addiction

Marijuana The Safe Drug?

2008-03-18T09:27:00.000-07:00

There are many illegal drugs being abused by people throughout the United States today, methamphetamines, cocaine, crack, heroin, benzodiazepines, opiates, alcohol, etc.; of all of these drugs, marijuana is the most common. Often described as the 'gateway' drug, the myths surrounding marijuana abuse are many. This article is written to debunk those myths and expose the truth behind the dangers of marijuana use.

Marijuana has been described as a "safe" drug that is no more harmful than alcohol, that it is a normal part of the coming of age process. Marijuana abuse has become so common place in today's society that it has become socially acceptable. These ambivalent attitudes towards marijuana usage have led many people to be lulled into the belief that it is harmless. The facts surrounding marijuana are quite different than what one would expect.

Marijuana is not the same drug that was introduced to today's adults in the 1960's. Advances in technology as it relates to cultivating, harvesting, and preparing the drug for sale has led to dramatic increases in THC levels. THC levels have risen from 6% in 1975 to as high as 33% in 2003. Modern marijuana is a much more dangerous drug than it was when it was first introduced many years ago. Parents need to keep this in mind when they are educating their children about the harmful effects of its use.

Marijuana dealers have also introduced far more dangerous substances into the drug; recent tests have revealed an ever increasing amount of codeine, formaldehyde, cocaine, and PCP. As worldwide marijuana distribution becomes much more commonplace, users have little to no knowledge as to where their drug of choice is originating from and would have no idea that it could be enhanced with lethal drugs such as the ones mentioned above.

The affects of marijuana can be felt almost immediately after ingestion, either by smoking or eating. Some physiological effects can include increased heart rate, blood shot eyes, enhanced feelings of hunger or thirst, and heavy breathing.

Psychological effects can include intensification of sound, sight, and physical touch, extreme relaxation, along with impaired motor skills. These feelings can last any length of time, depending upon method of ingestion and the amount of THC levels in the marijuana. Usually the effects last from 1 to 4 hours.

Marijuana is psychologically addictive and is very harmful to the health; any statement to the contrary is false. Extended use of marijuana leads to extreme cravings combined with compulsive use of the drug without regard to the consequences. After a relatively short time of habitual use, the marijuana user will require ever more increased amounts of the drug, combined with using it more frequently throughout the day, sometimes ingesting the drug up to 10 times per day. This habitual use often leads to mixing the drug with even more dangerous drugs such as heroin, cocaine, alcohol, etc. in order to increase the effects. This is why marijuana is the 'gateway' drug and nothing to shy away from when it comes to treating the habitual user and educating the casual user.

Porn Addiction

2008-03-17T07:44:00.000-07:00

Pornography often becomes an addiction that people resort to both when they are high on drugs and when they are sober. With the accessibility of pornography at an all time high, we are seeing much higher rates of pornography addiction. Most rehabilitation facilities have strict policies prohibiting all pornographic material.

The problem with pornography, despite its growing acceptance in America, is that it tends to be a damaging element when introduced into committed relationships and marriages. From an addiction standpoint, the problem with pornography is the same as that for cocaine, heroin, speed, ect. There is no end to the hunger it creates. The hunger is never satisfied. Lust is never satisfied when it comes to pornography. So, people addicted to pornography tend to search for more and more of the pornography drug so to speak. They may start out with rather mild, tame pornography, but sooner or later they will graduate to more extreme pornography in an effort to satisfy the growing lustful curiosity. Eventually, and inevitably, it will manifest itself in their lives.

For addicts and alcoholics, it is possible that pornography addiction could lead to a relapse if unchecked.

Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse Treatment Conclusion

2008-02-25T08:56:00.000-08:00

For substance abuse patients, and therapy in general, the effectiveness of treatment is determined as much by the therapist as by any theoretical orientation or patient characteristics. With this dual-diagnosis population, it is often difficult to provide effective therapy. Therapist processes emphasized in Seeking Safety include compassion for patients' experiences; using coping skills; giving patients control whenever possible to counteract the loss of control inherent in trauma and substance abuse; promoting honesty in contrast to the secrecy, denial and lying that may occur in trauma and substance abuse; meeting patients more than halfway doing whatever is possible within professional bounds to help patients get better; and obtaining feedback about how patients view the treatment. The more severe the patient, the more likely that negative processes may impede the treatment. This includes harsh confrontation, sadism, difficulty holding patients accountable due to misguided sympathy, becoming victim to the patient's abusiveness, power struggles, and in group treatment, allowing a patient to be made a scapegoat.

What the evidence does suggest, however, is that it is first necessary for clinicians and researchers in the field to begin to address the severity and unique profile presented by dual-diagnosis PTSD and substance abuse victims, particularly women.

Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 4

2008-02-24T08:55:00.000-08:00

A third study of a hundred inner-city outpatient women compared Seeking Safety with relapse prevention treatment (RPT), both in individual format, with a treatment-as-usual (TAU) control condition in a randomized controlled trial (Hien, Cohen, Litt, Miele and Capstick). At the end of treatment, patients in both Seeking Safety and RPT had significant reductions in substance use frequency and intensity, PTSD symptoms, and psychiatric symptom severity, whereas subjects in the TAU comparison group did not show any significant changes. Improvements in PTSD severity were sustained at the six-month follow-up point but not at nine months, for participants in Seeking Safety and RPT. Although statistically significant improvements in substance use and psychiatric severity were not maintained for Seeking Safety or RPT at the six-month follow-up, trends in the direction of lower substance use and psychiatric severity were found.
Finally, a fourth study evaluated a combination of Seeking Safety and exposure therapy for PTSD in a sample of five men (Najavits, Weiss, Shaw, and Muenz). Significant improvements were found in drug use, family and social functioning, trauma symptoms, anxiety, dissociation, sexuality, hostility, overall functioning, meaningfulness, and feelings and thoughts related to safety. Treatment attendance, satisfaction and alliance were very high.

Najavits (2000) contends that Seeking Safety is designed to treat PTSD and substance abuse at the same time. An integrated model is recommended by experts as more likely to succeed, more sensitive to patient needs and more cost-effective than sequential treatment of the disorders. It also is preferred by patients. Yet, many treatment systems for substance abuse and mental health remain separate, leaving patients to integrate treatment themselves. In correctional settings, adding Seeking Safety treatment to existing programming appeared to work well.

It is important to note that integration in Seeking Safety means attention to both disorders in the present. It does not mean asking patients to discuss their pasts in detail. Despite the known efficacy of trauma processing for PTSD, such work may not be safe for substance abusers until they have achieved a period of stable abstinence and functionality. Correctional settings, in particular, may be unsafe, as inmates may be destabilized by such treatment. In Seeking Safety, integrated treatment means helping patients understand the two disorders and why they so frequently co-occur; teaching safe coping skills that apply to both; exploring the relationship between the two disorders in the present, such as using a substance to cope with flashbacks; and helping patients understand that healing from each disorder requires attention to both.

For example, the topic "honesty" combats denial, lying and the "false self." "Commitment" is the opposite of irresponsibility and impulsivity. "Taking good care of yourself" is a solution for the bodily self-neglect of PTSD and substance abuse. The language throughout emphasizes values such as respect, care, integration and healing. By aiming for what can be, the hope is that patients can summon the motivation for the hard work of recovery from both disorders. (Najavits, 2000)

While originally designed as a cognitive-behavioral intervention, the treatment was expanded to include equally strong attention to interpersonal and case management issues. Interpersonal topics now comprise one-third of the sessions, and case management begins in the first session and is addressed at every subsequent session throughout treatment. The interpersonal domain is an area of special need because PTSD most commonly arises from traumas inflicted by others, both for women and men. Interpersonal issues include when to trust others and how to avoid re-enactments of abusive power, both as victims and perpetrators. Similarly, substance abuse often is initiated and encouraged in negative relationships. The case management component of the treatment helps patients obtain help with problems such as housing, job counseling, HIV testing, domestic violence and child care.

Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 3

2008-02-23T10:53:00.000-08:00

Stephanie Covington has created a trauma specific model for women as well in 2003. In the introduction to her program, Covington (2003) discusses the integrated treatment approach focusing on women. "The connection between addiction and trauma for women is intricate and not easily disentangled" (p. 16). She goes on to discuss that the treatment provider cannot assume, when reviewing a patient with both addiction and trauma, that one is a primary problem and the other a secondary one. "Nor is it always beneficial to delay working on trauma symptoms until the client as been abstinent for a minimum time" (Covington, 2003, p. 16).

Women exposed to trauma and addicted to alcohol or another drug are considered to be at higher risk of mental disorder (Covington, 2003, p. 16). Studies, including those by Najavits, Weiss, and Shaw (1997) that indicate that comorbid mental disorders, medical problems, psychological problems, inpatient admissions, interpersonal problems; lower levels of functioning, compliance with aftercare, and motivation for treatment; and other significant life problems are more common among those with PTSD and substance abuse compared to among those that have one or other of the problems.

Co-occurring disorders are complex and the historical division in the fields of mental health and substance abuse typically result in contradictory treatments (Covington, 2003, p. 16).

Her model calls for a self-guided, quasi-self-help approach to healing dual-diagnosis PTSD and substance abuse. For example, the outline for one session focuses around asking the client to think of "recent incidents" (p. 191) of trauma, "substance use, self-harm, or other recent acting out behaviors". The purpose of the exercise is to put the patient in touch with their "red-flags", the triggers of their self-harm behavior.

Long-term reviews of treatment courses have yet to be conducted and a great deal more information must be assembled before it is possible to draw sustained conclusions about the methods of treatment that have a high degree of success for dual-diagnosis patients. There are a number of reviews of Seeking Safety, however. To date, four studies have evaluated Seeking Safety, the treatment program developed by Lisa Najavits; one of the four studies was conducted in a correctional setting. In all the studies, the patients had PTSD and substance use disorder. The first two studies evaluated groups that met twice a week for three months. The first study was a pilot, with the treatment in group format (Najavits, L.M. et al. 1998). Of twenty-seven outpatient women enrolled, seventeen (63%) completed the minimum six sessions. Results for these seventeen women showed an average attendance rate of 67% of sessions, as well as significant improvements in substance use, trauma-related symptoms, suicidal thoughts and risk, social adjustment, family functioning, problem-solving, depression, cognitions about substance use and didactic knowledge related to treatment.

The second study evaluated Seeking Safety in a correctional setting (Zlotnick, Najavits, and Rohsenow). Seventeen women participated in the trial, which used a group version of the treatment. The attendance rate was 83% of sessions and measures of client satisfaction were high. Of the seventeen women, nine (53%) no longer met criteria for PTSD by the end of the three-month treatment period; at a follow-up three months later, 46% still no longer met criteria for PTSD. Substance use could not be assessed while the women were in the prison's controlled environment, but a follow-up six weeks after release from prison indicated that 70% did not meet criteria for substance use disorder. The recidivism rate was 39% at a three-month follow-up, which is typical of this population. A study is under way to evaluate whether providing additional Seeking Safety sessions after release from prison might be beneficial.

Dual Diagnosis PTSD and Substance Abuse Treatments and Issues

2008-02-21T08:47:00.000-08:00

Najavits et al (1997), identify treatment as crucial, "not only because of the prevalence and severity of co-occurring PTSD and substance abuse, but also because treatments that are typically used for PTSD or substance abuse alone may be insufficient for their combination". Problems of using treatments suited to one or other of the disorders with patients that have dial diagnosis are numerous. One problem is that specific treatments for PTSD or substance abuse issues may have negative effects on patients who have both disorders; two researchers (Abueg and Fairbank, 1991; Solomon, Gerrity, and Muff, 1992) suggested that "behavioral exposure and flooding models, which are quite successful for PTSD-alone, are…ill-advised for patients with substance abuse because their emotional intensity might too easily trigger a substance abuse relapse" (Najavits et al, 1997). Other issues with established treatment methods are discussed: Alcoholics Anonymous (AA) and other twelve-step self-help groups are identified as potentially problematic for dual-diagnosis patients because of elements such as "the presence of males at most meetings, the philosophy of not focusing on the past, and [the idea of surrendering to a higher power as part of the AA philosophy]" (Najavits et al, 1997); substance abuse treatments that are heavily confrontational in approach may re-evoke traumatic experiences (Najavits et al, 1997; Nace, Davis, and Gaspari, 1991). Issues with clients I have observed with my own clients include an inability to sit in meetings due to high activation, relational and trust problems with other group members and their sponsor, lack of understanding within the fellowship regarding PTSD, some who are on medications are shamed for this because they are "not really clean", although that seems to be shifting some. As a result of some of these conflicts, the client may feel further shame and may then turn to substances to cope.

No empirically validated standard of care exists for PTSD-alone although Curtois, Chu, and Briere have each developed models for treatment. In her own review of treatment practices, Curtois (1999) also attempts to establish the history of PTSD treatment and current standards in Chapter Nine of her treatment principles and guidelines for dealing with PTSD sufferers who were also victims of sexual assault.

The model of integrated treatment, methods for treating both the PTSD and substance abuse together in dual-diagnosis patients has much evidence to support its efficiency and, at the very least, it appears valid that dual diagnosis PTSD and substance abuse is not the same as either PTSD-alone or substance abuse-alone. As to what constitutes the most effective treatment for women with PTSD and substance abuse, only one study (Najavits et al, 1997) has addressed the issue with any real effort and only one publication (Najavits, 2002) covers the subject in any depth. In one journal, Najavits specifically explores the issue of counselor training. The effort, however, was in a very limited context. The article "Training Clinicians in the Seeking Safety Treatment Protocol for Traumatic Stress Disorder and Substance Abuse" (Najavits, 2000), clearly focuses on the specific treatment procedures outlined by Najavits in her own publication. She indicates that research on substance abuse treatment over the past decade has confirmed that clinicians differing widely in their impact on outcomes. The differences in outcomes are identified as severe; studies such as Christensen and Jacobson (1994), Najavits and Weiss (1994), Najavits, Crits-Christoph, and Dierberger (2000) all identify the best-case role of the clinician as "life-saving" versus the worst case scenario being a "damaging" role (Najavits, 2000, p. 3)

The findings of these two research efforts revealed a significant reduction in PTSD and substance abuse symptoms after a 24-session cognitive-behavioral group therapy specifically designed for a population of women with dual-diagnosis PTSD and substance abuse issues (Najavits et al, 1997).

Najavits (1997) and other studies such as Gatz et al (2005) paved the way for many in terms of grants and funding to implement programs in substance abuse treatment centers with a PTSD focus. However, there is not an immediate or large shift in treatment for substance abuse treatment centers.

Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse / Part 3

2008-02-20T08:46:00.000-08:00

Although early research on PTSD and substance abuse focused almost exclusively on male combat veterans whose substance abuse was connected to war trauma (Keane and Wolfe, 1990), research has expanded its focus to now include review of the clinical profile of women with PTSD and substance abuse issues (Najavits et al, 1997). Evidence indicates that women typically have different profiles from men (Najavits et al, 1997).

The combination of PTSD and substance abuse is more common among women than it is among men (Najavits et al, 1997). Two studies are cited by Najavits et al (1997) for having compared women and men with dual diagnosis PTSD and substance abuse. The findings indicated that women have more than two to nearly four times the rate of PTSD, with 43% of women versus 12% of men (Brown, Recupero, and Stout, 1995), and 30% of women versus 15% of men (Najavits et al, 1995) reported by the two studies respectively.

Other interesting findings presented by Najavits et al (1997) that warrant review here, were the range of life problems associated with women with dual diagnosis PTSD and substance abuse. Findings from several studies found that dual diagnosis PTSD and substance abuse victims have higher rates of a whole range of issues, including mood and anxiety disorders (Najavits et al, 1995; Brady et al, 1994; Kofoed et al, 1993), medical problems (Najavits et al, 1995), psychological symptoms (Najavits et al, 1995), inpatient admissions (Brown et al, 1995), and interpersonal problems (Najavits et al, 1995). They also demonstrated lower global level of functioning (Najavits et al, 1995), compliance with aftercare (Brady et al, 1994), and motivation for treatment (Najavits et al, 1995). Additionally, women with PTSD and substance abuse issues also report a range of co-occurring life problems such as homelessness (Smith, North, and Spitznagel, 1993; Paone, Chavkin, Willets, et al, 1992), loss of child custody (Fullilove, Kinscherff, and Fenton, 1992), maltreatment of their children (Famularo et al , 1992), and instance of battered woman syndrome (Levit, 1991).

According to the National Institute for Drug Abuse [NIDA] (2000), while men are more likely to have the opportunity to use drugs, men and women are equally likely to develop an addiction. Women and men do, however, differ in their vulnerability. While men are more likely to abuse marijuana and alcohol, women are more likely to become addicted or dependent on depressants and sedatives. Men and women are equally likely to become addicted to or dependent on cocaine, heroin, hallucinogens, tobacco, and inhalants. Women are more likely to look to depress sleeplessness and anxiety with sedatives.

Of course, women are also more likely to be exposed to certain kinds of trauma (NIDA, 2000) and are at greater risk of revictimization in the context of substance abuse combined with PTSD.

Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse / Part 2

2008-02-19T08:41:00.000-08:00

Najavits, Weiss, and Shaw (1997) specifically discuss the relationship between PTSD and substance abuse, identifying that "the syndromes appear to be strongly linked. For example, the presence of either disorder alone can increase the risk of developing the other disorder." Najavits et al (1997) also supports the findings that he disorders consistently co-occur across various types of traumas and substances (Keane and Wolfe, 1990; Kofeod, Friedman, and Peck, 1993).

Najavits (2002) also discusses many of the key features of dual-diagnosis PTSD and substance abuse. Most people with PTSD and substance abuse are vulnerable to repeat trauma (Fullilove et al, 1993; Herman, 1992). The risk is found to be greater with dual-diagnosis patients than with those who only have substance abuse issues (Dansky, Brady, and Saladin, 1998). PTSD and substance abuse have also consistently been found to co-occur, regardless of the nature of the trauma or the type of substance use (Keane and Wolfe, 1990; Kofoed et al, 1993).

In Najavits et al (1998), the severity of addiction is compared to trauma and PTSD. The findings of this study demonstrated that a high rate of co-occurring PTSD in patients with substance use disorder (SUD). One study found that 59% of inner-city female drug users had a history of PTSD (Fullilove et al, 1993). Fifty-eight percent of male substance abuse inpatient veterans (Triffleman, 1993), 25% of inpatients in substance abuse treatment (Brown et al, 1995), and 20.5% of cocaine-dependent outpatients (Najavits et a, 1995; Rounsaville et al, 1982; Yandow, 1989). The conclusion drawn by Najavits et al (1998) and these other studies is that the association between PTSD and SUD is definitely clinically significant, "not just because of its frequency but because of the increased treatment difficulties presented by [dual-diagnosis patients]" (p. 3).

Evidence supports that women are increasingly susceptible to PTSD. A study of the link between substance abuse and post traumatic stress disorder undertaken by Najavits et al (1997) also revealed the particularly high rates of dual diagnosis PTSD and substance abuse in women; rates were reported to be between 30% and 59%. It is important to note that none of these articles take complex PTSD into account, thus, if those suffering multiple traumas presenting with the Complex PTSD were included, it is estimated that the statistics would be much higher for women.

The study also found strong links between PTSD diagnosis and histories of repetitive childhood physical or sexual assault among the women featured in the study (Najavits et al, 1997). Instances of dual diagnosis PTSD and substance abuse are two to three times lower among men.

Among women with substance abuse, studies have found frequent histories of childhood physical and sexual assault; the rates range from 32% to 66%: sexual assault, 66% (Miller, Downs, and Testa, 1993); sexual assault and physical assault (Fullilove, Fullilove, Smith, et al, 1993); sexual assault (Grice, Brady, Dustan, et al, 1995); physical or sexual assault (Brady, Killeen, Saladin, et al, 1994); sexual assault and physical assault (Najavits, Gastfriend, Barber, et al, 1995).

Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse

2008-02-18T10:15:00.000-08:00

Dual-diagnosis PTSD and substance abuse has a complex history and position within the field of psychiatry and the context of treatments for mental disorders.

One of perhaps the most relevant studies on dual-diagnosis published by Najavits and Weiss (1999), assessing the clinical characteristics of twenty-eight women with dual diagnosis PTSD and substance abuse compared to the characteristics of twenty-nine women who had only PTSD. The findings demonstrated that the twenty-eight women with dual diagnosis PTSD and substance abuse consistently had "a more severe clinical profile, including worse life conditions (e.g. physical appearance, opportunities in life) both as children and as adults; greater criminal behavior; a higher number of lifetime suicide attempts; a greater number having a sibling with a drug problem; and fewer outpatient psychiatric treatments" (Najavits and Weiss, 1999). The two groups did not differ in the number or type of lifetime traumas, PTSD onset or severity, family history of substance use; coping styles, functioning level, psychiatric symptoms, or sociodemographic characteristics (Najavits and Weiss, 1999).

The findings of this study and a number of other similar studies strongly suggest that severe PTSD leads to substance abuse, PTSD-sufferers with "severe clinical profiles" are at high risk for substance abuse issues, likely brought on as a means of coping with symptoms and issues related to PTSD (Najavits and Weiss, 1999; Back, Sonne, Killeen, Danksy, and Brady, 2003; Mills, Lynskey, Teesson Ross, and Darke, 2005). Najavits et al. (1997) also points out that substance abuse itself, can put a client in situations that are high risk for trauma experiences. Therefore, the substance abuse can facilitate later trauma and PTSD. An example of this may be a woman who has a substance abuse problem, who is then raped after a night of drinking in a bar.

Mills et al (2005), explored the links between post-traumatic stress disorder among people with heroin dependence, documenting the "high rates of psychiatric comorbidity among [heroine addicts], most commonly mood disorders, anxiety disorder, and anti-social personality disorder." Links between these psychiatric conditions and substance abuse have also been identified by other researchers (see Brooner et al, 1997; Darke and Ross, 1997; Darke et al, 1994; Krausz et al, 1998) but only a few studies are identified as having explored the link between PTSD and heroine dependency (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995).

The study undertaken by Mills et al (2005) demonstrated trauma exposure affecting 92% of the study participants, with lifetime PTSD affecting 41% of the study participants. The study also found that PTSD was more common among those in treatment, affecting 52% of those in residential rehabilitation, 42% in maintenance therapies, and 37% detoxification. The study also found that although men and women are both affected by trauma (93% of men and 89% of women reported exposure to traumatic events) women were more likely to develop longtime PTSD. Interestingly, approximately 72% of individuals in methadone maintenance treatment have been exposed to trauma (Clark et al, 2001). Between 14% and 29% have been diagnosed with lifetime PTSD, and 19% and 31% have been diagnosed with current PTSD (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995), although the results of these studies offer only a limited view of the link between heroin use and PTSD outside of methadone maintenance treatment programs in the US (Mills et al, 2005).

How To Find Recovery - Morningside Recovery

2008-02-01T08:49:00.000-08:00

Morningside Recovery 3404 A Via Lido, Newport Beach, CA 92663

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Non-Sexual Dual Relationships - Conclusion

2008-01-28T06:44:00.000-08:00

One of the core problems in blurred, dual, or conflictual relationships is the core idea presented by Pope. Pope made the claim that, " non-sexual dual relationships, while unethical and harmful per se, foster sexual dual relationships". The great fear and ethical taboo among therapists is sex with a client. According to Pope's reasoning, the primary rationale for avoiding all dual-relationships has been that they may eventually lead to a sexual relationship. This is not the only fear, but it is one of the greatest among professionals. Obviously not all non-sexual dual relationships lead to sexual ones, but it is likely that almost all sexual relationships have had to pass through a dual relationship stage at some point before turning into a fully sexual relationship. But, is it possible that some dual relationships can be beneficial to a client? In some circumstances they may be.

In the survey previously mentioned it was found that respondents considered some dual relationships to be useful. For example, some dual relationships provide role modeling, nurturing and a giving quality to therapy. This is one of the main dilemmas that people working in residential addiction treatment programs face. In many cases, the counselor/therapist can provide vital role modeling to clients.

Throughout the history of addiction treatment, addiction treatment professionals have struggled with this dual relationship dilemma. A national survey of 827 certified drug and alcohol counselors was conducted to determine their ethical beliefs and practices in the area of dual relationships. The results were compared to a national study of psychologists, psychiatrists, and social workers around 13 areas of practice behavior involving dual relationship situations and no significant difference was found between the groups. The results indicate that the same concerns over dual relationships plague professionals in many different counseling fields, not just those with graduate degrees.

Often professionals working in the field of residential addiction treatment are in recovery themselves. This presents both a unique problem and a unique opportunity for both the client and the clinician. Clinicians working in addiction treatment who are also recovering addicts are able to provide a model for recovery from addiction. However, problems arise when the clinician's recovery program coincides with the client's recovery program. This presents an unusual and tricky situation when clients, current or former, attend publicly held recovery meetings (Alcoholics Anonymous meetings, Narcotics Anonymous meetings, and other 12-step based community meetings) within their community.

The situation is this: A clinician attends her regular, local 12-step based recovery meeting. She walks into the meeting and suddenly one of her former, or perhaps current, clients waves at her from across the room. At first this may appear no different from any other situation where a professional runs into a client in a social setting, but the main difference here lies in the nature of the situation. When the addiction treatment clinician attends a recovery meeting and happens to encounter his client in the same meeting, the clinician is suddenly presented with an awkward situation. The therapist's role is now compromised. She is both therapist and patient.

The positive aspect of this particular compromising situation is that the addiction counselor is modeling positive behavior in the above example. The therapist/counselor is living what she is prescribing to the client, namely that addiction is something that can be overcome and something that she continues to address by attending recovery meetings. In this situation the dual role can be beneficial to the client.

At one time, ethical guidelines for addiction counselors were full of varying opinions on how to handle the situation mentioned above. Only recently have most of the addiction treatment licensing organizations adopted the wording of the APA ethical guidelines regarding dual relationships. According to Dr. Jerry Brown, an experienced clinical psychologist with over 20 years of experience working in the field of addiction treatment, in the past the general consensus among professionals working in the addiction treatment field was that no addiction treatment professional should attend a 12-step based meeting where his or her client(s) were also in attendance. In these situations it was suggested that the counselor or treatment professional immediately leave the meeting upon seeing the former or current client. This rule has widely been abandoned for more general statements in their ethical guidelines regarding dual relationships. The Department of Alcohol and Drug Programs Text of Final Regulations §13060 (c)(4) now states the following regarding dual relationships: "Engaging in social or business relationships for personal gain with program participants, patients, or residents, their family members or other persons who are significant to them" is prohibited. The attempt at defining what to do in certain situations, once an aspiration of addiction treatment licensing organizations, has become a thing of the past.

The law remains intentionally vague in certain areas so as to leave the judge and lawyers room to argue a particular angle based on the facts and circumstances of a case. It seems that the APA has chosen to do the same thing with its ethical code regarding dual relationships. If the APA were to attempt to do what addiction licensing boards have attempted to do in the past and define particular instances where dual relationships might occur and as far as to outline what the professional should do in each situation, then the APA would undoubtedly produce an exhaustive volume of rules and regulations that not even the most astute and cautious psychologist would read. Perhaps it is better that the APA keep the guidelines on dual relationships as they are and leave the interpretation to professionals. As discussed previously, not all dual relationships are harmful to the patient, but it is better left to the psychologist, the psychiatrist, the social worker and the addiction counselor as to where the line should be drawn.
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Non-Sexual Dual Relationships - Surveys

2008-01-25T06:55:00.000-08:00

A survey was conducted of 4,800 psychiatrists, psychologists, and social workers to determine their ethical attitudes and practices towards dual relationships It was determined that most of those surveyed believed that dual role behaviors were unethical in most circumstances and most reported that they had rarely, if ever, engaged in such behavior. This being said, "sexual and nonsexual relationships form the major basis of financial losses in malpractice suits, licensing disciplinary actions, and ethics complaints against psychologists (Ethics Committee of the APA,".

The survey conducted by Pope and Borys examined eighteen dual relationship situations that are common among health professionals:

1. Accepting a gift worth under $10.
2. Accepting a client's invitation to a special occasion.
3. Accepting a service or product as payment for therapy.
4. Becoming friends with a client after termination.
5. Selling a product to a client.
6. Accepting a gift worth over $50.
7. Providing therapy to an employee.
8. Engaging in sexual activity with a client after termination.
9. Disclosing details of current personal stresses to a client.
10. Inviting clients to an office/clinic open house.
11. Employing a client.
12. Going out to eat with a client after a session.
13. Buying goods or services from a client.
14. Engaging in sexual activity with a client.
15. Inviting clients to a personal party or social event.
16. Providing individual therapy to a relative, friend, or lover of an ongoing client.
17. Providing therapy to a current student or supervisee.
18. Allowing a client to enroll in one's class for a grade.

The above situations are common among health professionals, but even more so among health professionals in certain situations, particularly settings where dual relationships exist naturally. As mentioned previously, this often occurs in small rural communities, military settings, and residential alcohol and drug treatment programs. In these settings therapists are forced into relationships that according to the definition of dual relationships in the code of ethics would be considered unethical. For example, active duty military psychologists fulfill dual roles as therapists and commissioned military officers, which means that they not only have a professional duty to their clients, but also to the military or Department of Defense.

For this reason, many professionals have called for further clarification of the definition of dual relationships. In a study conducted by Kenneth Pope, a leading expert in the field of ethics, and Valerie Vetter a random sample of 1,319 members of the American Psychological Association were asked to describe incidents that they found ethically troublesome. Their intention was to gather information that might be useful in considering possible revisions of the code.

Their report produced the following statement from Pope and Vetter regarding dual relationships:

A national survey of psychologists resulted in a call for changes to the APA ethical principles in the areas of dual relationships, multiple relationships, and boundary issues so that the ethics code would:

(1) define dual relationships more carefully and specify clearly conditions under which they might be therapeutically indicated or acceptable,

(2) address clearly and realistically the situations of those who practice in small towns, rural communities, remote locales, and similar contexts (emphasizing that neither the current code in place at the time nor the draft revision under consideration at that time fully acknowledged or adequately addressed such contexts), and

(3) distinguish between dual relationships and accidental or incidental extra-therapeutic contacts (e.g., running into a patient at the grocery market or unexpectedly seeing a client at a party) and to address realistically the awkward entanglements into which even the most careful therapist can fall.

Non-Sexual Dual Relationships - Intro

2008-01-23T08:06:00.000-08:00

Non-sexual dual relationships within the field of counseling are a controversial issue. The essential question to be answered is, where is the professional boundary line between counselor and client? Underneath this general ethical umbrella lies many more specific questions that ethicists struggle with. Among these are: Is it alright to provide therapy to a friend or relative? Is it OK to borrow money from clients? If so, how much is OK? Is it OK to go into business with a client? If not, what about going into business with a client's father? These are just a few of the questions that abound within the questionable, debatable ethical realm of dual relationships.

Ethical questions are determined on a case-by-case basis. There are no clear black and white rules that do not warrant debatable alternatives to be discussed and considered. There is one golden rule which stands above the rest within the clinical world of counseling: Do not have sex with a patient. But, apart from this golden rule, there is little that cannot be discussed and deliberated.

Within the counselor's office there is little left to the imagination as to what is ethical and what is not. It is an ethical embassy of sorts, a sanctuary where client exists on one side and counselor, or psychologist, is on the other. The line between them is palatable. The relationship begins and ends within the confines of a physical space. Patient enters and patient leaves. The more difficult dual relationship questions arise when the physical safety of the ethical embassy, which is the counselor's office, becomes invaded, or perhaps does not exist. Small rural communities, military bases, and residential addiction treatment communities are just a few places where the confines of an office are sometimes limited and less geographically defined and private. Even if a psychologist practices in one location and lives in another, there are situations that may occur which puts the psychologist in the middle of a dual relationship ethical dilemma. What is worse is when there are situations or circumstances that inevitably place the psychologist in a dual relationship situation.

All major mental health professional codes contain a proscription against dual relationship. Role theory is often used to describe the process of dual relationships. "Social roles contain inherent expectations about how a person in a particular role is to behave as well as the rights and obligations which pertain to that role". Conflicts within these relationships arise when either role's expectations of the other exceed that which is inherent. When expectations are exceeded, dual relationships are created.

Although dual relationships are generally frowned upon, not all dual relationships are bad. The American Psychological Association ethical principles recognize multiple or dual relationships as something that is sometimes unavoidable. The APA states that, "it may not be feasible or reasonable for psychologists to avoid social or other nonprofessional contact with persons such as patients". The primary warning is in developing a dual relationship when it appears likely that the relationship will interfere with the therapeutic process. If, "it appears likely that such a relationship reasonably might impair the psychologist's objectivity or otherwise interfere with the psychologist's effectively performing his or her functions as a psychologist, or might harm or exploit the other party".

Spy Games - Conclusion

2008-01-22T09:31:00.000-08:00

There is nothing normal about STC treatment centers. It is unique in its organization and structure. The staff at STC are trained in reading moods, testing the reliability of information, and adept at detecting lies. It was thought that a drug and alcohol treatment center located in the middle of a party town like Newport Beach would never succeed. Plus, the logistics of sober houses spread over several blocks and interwoven with party houses didn't seem to indicate a healthy environment. Add to the odd mix clients mobility, easy access to alcohol and drugs, and lack of apparent supervision, and STC becomes a frightening place to send your children for help.

What surprises skeptics is that STC not only functions more efficiently than most in-patient treatment centers, but that it also allows the clients to recover in "the real world" which is the kind of environment they will eventually face. It is remarkable that STC clients are not only able to maintain sobriety, but they do so for a much longer time than they do coming from other treatment centers. The sheer numbers of former STC clients that stay in the local Newport Beach community makes STC an unusual facility and a successful one.

To try and duplicate the structure and operations of STC would be close to impossible (perhaps more possible with this report, but very unlikely). The geographic coincidences, the strong recovery community in the area, the knowledgeable staff of former STC clients, and the sophisticated network of communications, all work to create a recipe part brilliance, part devotion, and part divine intervention, or luck, if you prefer.

In the future, further studies must be conducted within successful treatment facilities to aid in the creation and redesign of programs that are not as successful. Former Governor Gray Davis of California, in association with Professor Allen Mobley of the University of California Irvine, is conducting a study of the most unique and successful treatment programs in correction institutions across California. We need the same type of research effort to analyze the treatment centers across the country. Better rehabilitation will benefit society. Programs, like the one at STC, need to be reproduced in other communities, if at all possible.

The benefits of the STC living community have yet to be fully investigated. It is apparent from this study that clients at STC benefit from being involved in the outside Newport Beach community. It is evident that many clients choose to stay in the community because of the connections that they have made at the Club. The length of stay is also a determining factor in the effective treatment of the clients at STC. The longer the client's stay at STC, even if it is the minimum 90 days, the greater the knowledge the staff will have of the client's behavior and recovery progress. A quantitative research study would also be necessary to further validate the statistical success of treatment at STC.

Your thoughts?

Spy Games - The Club

2008-01-21T06:53:00.000-08:00

The Club is a building located within STC territory. Recovery meetings are held all day long, every day of the week. There are many clubs like this one, but chances are that the general community which hosts one of these clubs is unaware it exists. They are not secret clubs, but they treasure anonymity. The Club is an unmarked, two-story building that has three meeting rooms. At any given time during the day, a recovery meeting is in progress. The first meeting of the day begins at 6:30am and the last one normally ends at 9:00pm. STC clients are required to attend certain meetings at this club during the week. These are considered "outside meetings" and STC has absolutely no financial interest or control in the club, yet it is one of the biggest pieces of the STC puzzle.

Clients ride their bikes to meetings at the Club and mix socially with the recovering members. Sponsors are obtained. These sponsors have no affiliation with STC, but the chances of the sponsor knowing about STC, or having once been a client at STC, are 95%. This is the point in the research where STC is shown to be an anomaly. One of the main reasons why STC would be impossible to duplicate is this proximity to the Club and the recovery community that has built up around the club.

In contrast to other treatment facilities, STC clients have a tendency to remain within a fifteen-mile radius of STC and the Club after they have been discharged from STC. This results in a recovery community consisting of countless former STC clients. This is not common. Of course, part of the lure is that Newport Beach is arguably one of the most beautiful places to live in the country. In addition, most of the client's come from outside the state of California. Many clients who had chosen to remain in town after treatment said that they liked the weather in California better than where they previously lived. However, the most common reason given by former STC clients for their decision to stay in the Newport Beach area was the recovery community.