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Failed New Year’s Resolutions to Cut Back on Drinking: Time to “Think about Your Drinking”

Published blog post on Psychology Today.com by Sarah Benton

Was your New Year’s resolution to cut back or to stop drinking? Have you been able to stick to it or are your struggling? If you have succeeded, how are you feeling?

If someone has an alcohol problem or is alcoholic then it may not be as simple as setting a “resolution” to solve the issue. In fact, when an alcoholic stops drinking on their own, they often feel worse than when they were drinking-not exactly positive reinforcement. However, this makes sense considering that alcohol masks underlying conditions and emotions, so when an alcoholic stops drinking those symptoms rise to the surface.

Alcoholics who are trying to either “cure” themselves or prove to themselves that they do not have a problem may attempt to give up alcohol for religious reasons such as Lent or for secular reasons such as a New Year’s resolution. However, it is important that they ask themselves how they are feeling during the time that they stopped drinking and if they are still obsessing about alcohol, using another substance or engaging in addictive behavior as a substitution (ie, food, gambling, sex). Or are they counting down the days until they can drink again? In contrast, a normal drinker who takes a break from drinking is indifferent about their choice, will usually feel healthier not drinking and does not obsess about the fact that they are not drinking- they just don’t drink. In fact, even a problem drinker who wants to cut back on drinking will be able to self-correct and return to low risk drinking limits (women: under 7 drinks per week, no more than 3 per sitting men: under 15 drinks per week and no more than 4 per sitting). However, a red flag is that alcoholics may attempt to cut back but will not be able to adhere to these low risk drinking limits.

If you or someone you know is taking a break or cutting back on drinking as a New Year’s resolution then maybe it is time to “Think about Your Drinking”. Here are some questions to help you or a loved one to get honest:

Examining Your “Relationship” with Alcohol:
o Why do you drink? How often do you drink? Can you go more than a week without drinking?
o Have you tried to control your drinking and if so, how much time do you spend thinking about drinking   or about how not to drink too much?
o Can you imagine your life without alcohol?

Friendships:
o What activities do you and your friends like to do together?
o Do you have friends who do not drink?
o Can you socialize or go to parties without drinking?

Interests:
o What is your favorite thing to do?
o Do you have interests, activities and hobbies that do not involve drinking?
o Does drinking alcohol distract you from taking part in these things?

Work and Academics:
o Does drinking interfere with your work or academic performance?
o Do you excel professionally or academically and use your success as an excuse to drink?
o Is alcohol your reward for doing well?

Family:
o Do you hide your drinking from your family?
o Do you have different drinking habits when you know you will be around your family than when you are with your friends?
o Do you have a family history of alcohol problems?

The NIAAA “Rethinking Drinking” online program is a resource to help people to cut back and assess their drinking: www.rethinkingdrinking.niaaa.nih.gov/

January 22, 2015 0 Comments

Parenting High-Functioning Teens Around Drinking and Drugs

Many parents have questions and concerns about their teenager’s alcohol and drug usage, including how best to set limits and rules within the household.  These issues may become concealed and more complicated when these individuals are high-functioning—in that they are performing well in school, are engaged in extra-curricular activities, socialize with friends and appear healthy.  Adolescence is also a time period of experimentation and identity formation as well as “rebellion”.  Therefore, it can be challenging to find a balance between creating realistic rules, encouraging honesty and finding humor and joy in parenting teenagers.

Elizabeth Driscoll Jorgensen, Founder and Owner of Insight Counseling in Ridgefield, Connecticut (insightcounselingllc.com) has over 26 years of experience specializing in adolescent psychotherapy and substance abuse counseling. She is a nationally recognized expert in substance abuse counseling, engaging resistant teens and motivating them to change. She is a popular (and humorous!) speaker on parenting pre-teens and teenagers and has presented nationally, including at Harvard University and Dartmouth College. She is also a recipient of two Congressional Awards (1994 and 2008) for her work as an educator and community prevention activist.  Given Liz’s expertise and years of experience, I wanted to ask her questions that many readers may have.  This is the first of a 2 part interview with Liz Jorgensen that will be posted separately:

1. What is the most common challenge that parents come to therapy asking your guidance with related to alcohol and drug usage?

When parents call for help, it is usually after a period of time that they have had strong ‘gut feelings’ that something was not right with their teen, or even after they have caught their teen a few times with alcohol or marijuana and believed their child’s nonsense excuses.  I feel that parents often believe that they don’t have the right to seek help based solely on their own fear or intuition. I coach parents about this often with the following advice, “You can always apologize to your child for dragging her in to talk to a therapist, but you can’t take back the possible risks of waiting.” I also remind parents that they didn’t hesitate to act on their ‘gut feelings’ when their child was young—suspicions about their child’s safety or honesty regarding alcohol and other drug use are also potential threats.  I also encounter many parents who mistake the widespread use of alcohol and marijuana among teens as an inevitability that they cannot influence—this is not true, as teens need and want limits.

2. Is it more challenging for parents to address alcohol and drug issues with a “high-functioning” teen versus lower functioning (having more difficulty fulfilling daily expectations)?

Yes, absolutely. When a teens’ grades are faltering or they are not able to retain their functioning, parents can give their child rational feedback about this connection to their drinking behaviors. High-functioning teens who drink will often defend their behavior with the explanation “I am on high honors!” “My GPA is a 4.0”, etc. Parents need to keep the emphasis on safety, and on their love and concern, which is consistent regardless of a child’s grades. In fact, there is mounting evidence that highly driven teens sometimes see alcohol use on the weekends as a reward for their hard driving work all week (similar to the rationalization that high-functioning adults use to excuse their drinking!)

Parents need to set and maintain safety limits regardless of a child’s functioning in other areas. I use the following example to illustrate this. If your child began refusing to wear a seat belt or drive safely because “I am on high honors!” most parents would laugh and take the car keys. The issue of drinking is exactly the same. Keep it as a safety issue in your own head and describe it as such to your child.

In general, I want parents to remember that even if their teen is brilliant and highly accomplished, their brain is not fully “online” and functioning optimally until they are at least 21-24 years old. The pre-frontal cortex (the seat of all higher order planning, impulse regulation, emotional regulation and other important functions) is the last part of the brain to develop and it literally doesn’t work in teens when they are behaving irrationally and impulsively in order to get something that they want.  Parents need to be the “pre-frontal cortex” for their teen, make the safe decision for them and then ’walk away’ from the crazy, intense arguments that may ensue.  Smart kids cannot regulate their emotions and behaviors any better than average kids- they just make better excuses and lies!

3. What general and statistical information about alcohol and drug usage is most useful for parents to know and for parents to pass along to their teenagers?

When parents are attempting to influence their ‘high-functioning’ teens, hard facts need to be repeated over and over again. All teens assume they are ‘smarter’ than adults (in some ways) and they are very skeptical about data they don’t want to believe.  I tell parents to keep it ‘short and sweet’ and challenge teens to look up the facts themselves and come back with a factual argument.

Binge drinking rates are higher in affluent areas in the U.S.—that is a fact. The adolescent brain is especially vulnerable to damage of the gray matter when teens binge drink. Gray matter does not grow back and there are multiple studies that show a real impact. Parents need to define “binge” the way researchers do: three or more drinks per drinking event for teen girls and 4 or more drinks for boys. I remind teens that a drink is one 12 once beer, or one 1.5 once ‘shot’ of hard liquor. Most teens cringe, because their drinking is often much higher than this amount.

The other data I tell parents to share is the “delay and prevent” method.  We know undisputedly that the longer teens delay drinking behavior the less damage is done to their developing brain and the less likely they are to become addicted. Instead of getting into a power struggle, or circular argument about teens drinking at all, I beg them to delay their use. It’s harder to argue against!

4. Is there such a thing as “normal” alcohol and drug usage for minors?

This is the toughest question to answer well, and one that I receive often. “Normal” if defined by an average or a social norm is not good at all, as currently binge drinking is a norm for teens who drink. That being said, even if parents are very clear with rules, expectations and boundaries, teens may try alcohol as a “normative” experiment—precisely because drinking behavior is so prevalent and “OK” among teens and many parents. Parents who ‘catch’ their child breaking a set rule or expectation now have a unique chance to guide and teach their child to act wisely DESPITE the immense social pressure to binge drink.

5. What type of leverage or incentives can parents use to help their teens to make positive choices with alcohol and drugs?

Parents need to be absolutely clear about their expectations for sobriety from alcohol and all other drugs and they need to share their love and worry about what could happen to their child, rather than threats of consequences. Guilt is the best protective device ever invented to help parents keep teens safe (“I love you with all my heart and I couldn’t bear if something happened to you”). That being said parents need to articulate their expectations very clearly but in a manner teens can hear. For example, “I know you are attending a homecoming event tonight where there may be alcohol that is snuck in.  We expect you to stay away from any alcohol or drug use even if your friends are drinking and  call or text us to get you if it gets crazy.“  I share the idea of a family contract and a family safety password at all my workshops. The family contract says things like “We promise not to abuse alcohol or other drugs ourselves and we will do everything we can to keep you safe and let you have freedom socially” and then families can customize their individual expectations. The safety “password” says that at any time, for any reason your child can call or text you using the password and that means “Come get me/us now. Things are not good”.   The other part of the safety password agreement is that parents promise not to “freak out” when they do pick their child up and that their teen’s honesty and good judgment will be rewarded either by no consequence or a milder consequence depending on the situation. Teens do often respond to this and use it in the correct manner.

The second part of this 2 part interview will follow- stay tuned!

January 10, 2015 0 Comments

What Type of Addiction Services Do I Need?

Published post on Psychology Today.com by Sarah Benton

There is an overwhelming amount of information on the internet about addiction treatment. Many people email me and have no idea where to begin or what type of care that they or their loved one may need. There is common terminology that is important for those seeking treatment and their loved ones to understand when reaching out for help. In doing a “Google search” for the terms ‘addiction treatment levels of care’ I was unable to find a Website that explained this information. Therefore, I wanted to briefly describe the various types of addiction treatment based on levels of care, starting from the most intensive and ending with the least intensive.

Detoxification (“detox”) and Inpatient treatment: This is the highest level of care and individuals are placed in a locked unit generally in a hospital setting. Most alcoholics are placed in this type of care in order to be medically monitored while they are detoxifying from alcohol. They will meet with a therapist/case manager, psychiatrist and may attend minimal groups. However, this level of care is not intended to be “treatment” for alcoholism, it is the beginning of the process in that it leads to physical sobriety, but true recovery is a longer journey. Some detox programs are part of a residential rehab program. Some alcoholics will end up in an inpatient treatment program as a result of suicide attempts while under the influence or other safety issues. Individuals are held in these types of programs until they are physically and psychologically stabilized. Insurance generally pays for this level of care and the length of stay is based on the medical necessity and insurance coverage.

Residential treatment (“rehab”): All residential treatment programs require that an individual live at the program during treatment, but it is not “locked”. There are many types of programs and locations to choose from in terms of this type of care, as well as various price points. These programs typically involve attending group therapy much of the day, individual therapy sessions, and medication management (if needed). Some programs offer alternative forms of treatment such as equine therapy, wilderness excursions, acupuncture, yoga, massage, expressive therapy and many others. Some programs do take insurance, but many are self pay. Many rehab programs are 30 days in length, and it is crucial that comprehensive aftercare is established in order that the individual continue to receive some form of care upon discharge-rehab is not sufficient to “fix” alcoholism.

Transitional living programs: Individuals are generally expected to stay in this type of program for several months, as this is intended as a bridge from treatment to the real world. Many of these programs require that the individual has attended a rehab program at some point in the past. There seem to be fewer of these types of programs. Some are connected to residential treatment programs, and offered as a “step down” option and others are independent programs. These programs require that individuals will be living at the program, engaging in various forms of treatment such as individual and group therapy. Additionally, it is expected that they will seek out vocational and/or academic pursuits that they can then continue once they leave the program. Insurance does not generally pay for this form of treatment.

Sober living: There are many sober living houses around the country, with a large number located in California and Florida. Sober living is the lowest level of residential care in terms and generally no clinical services are provided within those houses- but alcohol/drug testing is standard. Individuals will often be connected with therapy and medication management outside of the house. Many sober houses require that those residing there will be engaged in at least 20-25 hours of activities outside of the house per week. Houses are usually gender specific. Insurance does not pay for sober living, and there are a range of prices for this type of housing. An example of a national chain of inexpensive sober houses is Oxford Houses and their Website provides directories of the various houses around the country www.oxfordhouse.org.

Partial Hospitalization program (“day treatment”): These programs are run out of clinics or hospitals and allow an individual to attend treatment throughout the day while living at home. Individuals who are attending a partial program generally need to take time off from work or are not currently working in order to attend, as the hours can run from about 9:00am-3:00pm. These programs involve mainly group therapy, along with individual therapy/case management and medication management (if needed). Individuals attend partial programs for generally about 2 weeks depending on the program, their insurance and ability to self-pay. The intention is to then step individuals down to an outpatient treatment plan upon discharge from the program. If an individual is continuing to relapse during or after attending a partial program, than this may indicate that they need a higher level of care such as detox or rehab.

Intensive outpatient programs (IOP): An IOP is a program that is also generally run out of a clinic or hospital and generally is about 3-4 hours per day, allowing for individuals to also attend part time work or school. Some IOP programs are in the evening, allowing for those being treated to maintain full time work. These programs involve mainly group therapy, along with individual therapy/case management and medication management as well. These programs can run for various lengths of time (weeks-months), as individuals are able to engage in work, volunteering or academics simultaneously. They are both insurance based and self pay.

Intensive case management or community outreach programs: These types of programs involve a variety of program structures. However, many bring their services directly to the client and are able to meet them in various locations (ie, at their apartment, coffee shop, college, etc.). These programs also range in the level of intensity depending on the clinical needs of the individual and the fee is often determined by the number of weekly clinical contact hours. The services may include individual therapy and case management, medication management, vocational counseling, family meetings, etc.

Outpatient services: This is the lowest level of care and often the most desirable for those who want to seek out discreet addiction care. Outpatient care may involve receiving treatment from a therapist, psychiatrist (prescribe medication), psychiatric nurse practitioner, or addiction counselor in private practice or who may be part of a clinic. They may or may not take insurance. Some outpatient clinics may also provide therapy groups and alcohol/drug testing, which can lead to a more comprehensive treatment plan. Additionally, it is recommended that individuals attend mutual help meetings in addition to receiving these types of services (ie, A.A., SMART Recovery, Women for Sobriety). The outpatient level of care can be a starting point for many alcoholics or those questioning their drinking and if they find that they are still relapsing, then it is clear that they may need to utilize a higher level of care. I presently conduct indivirdual, family and group outpatient services at Insight Counseling in Ridgefield, CT www.insightcounselingllc.com

Often, insurance companies will not cover treatment for individuals requesting a higher level of care, such as residential , without the individual had unsuccessful attempts of staying sober at a lower level of care. It can also be helpful to obtain a substance abuse assessment by an outpatient addiction therapist in order to help determine a treatment plan that is appropriate. However, if an individual is physically addicted to alcohol it is imperative that they receive medical attention before abstaining from alcohol. This person could be seen and assessed at any local ER and many addiction programs require that an individual is “medically cleared” by an ER before they admit that person for further treatment. ER’s can sometimes be helpful in finding an available detox bed for the individual as well. Additionally, contacting your Primary Care Physician (PCP) for addiction referral suggestions can be a great place to start. I am fortunate to work at McLean Hospital in Belmont, MA, as they offer a many of levels of care mentioned above as well as both insurance based and self-pay programs which are all listed in a pdf grid available at: http://www.mclean.harvard.edu/patient/adult/adatp.php

January 10, 2015 0 Comments