Disagreements are normal in relationships

Posted on June 16, 2016 by Melissa Killeen

Expect every relationship to have a disagreement along the way. Disagreements are normal in relationships. Disagreements, however, can trigger other feelings, such as loss of control, powerlessness, or feelings of abuse. Mix into this situation your partner’s personality, the triggers the disagreements bring up for both of you, and a dash of how we saw disagreements resolved in our childhood and you may have a very dysfunctional approach to resolving conflict.

Are you willing to change? Most importantly, is your partner willing to change, too?

IntimacySome disagreements are not disagreements but break downs in communication, or misinterpreted statements. Sometimes the way a message is delivered (i.e. in a text or email) can open the door for miscommunication and result in a fight between partners. Your partner may be upset over reading an email, or hearing your message on their voicemail and you may not know why there is such high level of upset. The answer usually is: they misinterpreted your statement.

Simple miscommunication

Miscommunication typically results from not explaining yourself clearly, specifically and completely. All very difficult to do in a voice mail, text or email. So make a rule that all difficult conversations be made face to face. Your partner deserves this quality of conversation and you deserve not to be in the realm of upset over this predicament.

When communicating with your loved one, ask yourself the following, are you:

  1. Communicating with a lack of emotion in your voice?
  2. Leaving out information you assume your partner should know about?
  3. Are you really saying what you want to say?
  4. Is there a hidden agenda lurking behind this communication? Perhaps all of these things you have reviewed, resolved, cleaned up and cleared out. It was a simple miscommunication, end of story. Now, you both can move on to your weekend chores or favorite Netflix program.

It’s a bigger thing . . .

If this is more than a miscommunication problem, the next step is picking a time to discuss it, calmly, quietly and with no interruptions. Maybe at lunch on Sunday, or after the kids go to bed, most definitely when both of you have cooled down. Plan on sitting down with your partner and starting with an opening statement affirming your love and commitment to the relationship. Pledge that this meeting is an attempt to change how you communicate. Make fastidious notes regarding your presentation, because you may have to make an appointment with your partner to discuss this again, in a few days. Chances are you will forget all about your thoughts and feelings about this miscommunication, so keep your notes handy. If your partner is not looking you in the eye, or multitasking on their cell phone while you are attempting a conversation, maybe they had some difficulties coming to this meeting. Kindly ask, with a lack of emotion in your voice, the following:

  1. Ask if they heard your request to discuss this problem
  2. If there would be a better time to have this discussion when you could have their full attention
  3. Are they bringing up old resentments from past conflicts, if so, ask them to set these resentments aside for a time
  4. Is something really bothering them about this problem, and would they like to speak first?

Identify avoidance

Couples become very good at avoiding conflict. Sometimes one partner is so good at it, they teach the other partner avoidance through osmosis. Soon both partners are adept at sidestepping the real issues, and all conflicts because they won’t like the results. Remember your intimate relationship with your partner is not a win/lose proposition. Avoidance leaves one or both partners feeling unloved, not respected and upset that they are not being “heard.” It is important to work through a few of these exercises, so each partner can realize that discussing and resolving conflict is very important for a healthy, intimate relationship.

Avoidance looks and feels like this:

  1. You are so resentful at your partner that you are unwilling to do anything to resolve it
  2. All conversations like this devolve into conflict, anger, shouting and negative outcomes
  3. You don’t see any problem to discuss
  4. These meetings are a waste of time, dull boring and I could be mowing the lawn, paying bills or doing the wash instead of doing this
  5. If you have to have these discussions at the therapist’s office, a common thought is, I would rather spend my money on something other than this.

How to prepare for the meeting to resolve a problem

Before your meeting, identify your “hot button” issues. You know the ones, identify your pattern in most of your arguments. Does talking about money set you off, does mention of your domineering mother make you defensive, does worrying about your partner leaving you bring up actions you would rather not display (like aggression) or when things aren’t going your way do you start to cry? Review your reactions to your hot-button issues before hand, come up with some solutions to control your reactions (bite your lip, light a cigarette, hold a teddy bear) this will help you cope better during this meeting. Here are some ground rules both you and your partner should read and agree on prior to this meeting:

  1. Pick a time to discuss a problem so it can be resolved. Don’t discuss a problem when either of you are angry
  2. In this discussion, stay focus on the one problem. Use the specific example of your “upset” over this problem. Even if you have to repeat this specific example several times, stay focused
  3. Have a goal in mind when you discuss this problem. What are the changes you hope to make by discussing this problem? Why is it important for you to discuss this problem? Is this problem something you and your partner can change? Can you both commit to the change?
  4. Tell your partner what has upset you and what you are willing to do to change things going forward. Ask your partner what he/she is willing to do or change
  5. Be courteous when speaking to your partner, no back stabbing, knife twisting or “I’m better than you” comments
  6. Express positive messages, focus on the good attributes your partner has. As in the Jungle Book, “Accentuate the positive.” Or as in Mary Poppins, “A spoonful of sugar helps the medicine go down.”
  7. Ask for changes to this problem in a positive way, avoid a cynical tone of voice or aggressive body language
  8. Do something nice for your partner, without expecting something in return.
  9. Complain about the things that matter. Attempt to limit your complaints to one thing that will make a difference or has to be acted upon immediately
  10. Let go of the past. Don’t allow yourself to bring up old problems, behaviors or incidents from the past. This will derail this conversation and it will devolve into a shouting match
  11. Be open to compromise. Intimate relationships are not a winner-take-all environment. Be open to your partner’s ideas
  12. Remove ultimatums from your vocabulary. Phrases like “I am leaving you” or “Pack your bags” should be turned into a “Let’s cool down and discuss this at another time.”

Using these tools to improve your intimate relationship is just like going to a board retreat or a workshop to improve your job performance. Isn’t it worth it to improve your intimate relationship’s performance? To advance change with the person you trust more than your boss, manager or administrator?

In an intimate relationship, the ultimate goal is not to dominate, control, or win. It is, instead, to create nourishing and mutually supportive intimacy; that is, to fully see your partner and to be fully seen; to be lovingly held by your partner (and vice versa) and to listen to them. The highest priority is on the relationship itself, on creating and maintaining an empathetic, loving environment. Acknowledging there is no boss, no subordinate, no winners, no losers. In other words, an intimate relationship is a place where two people, sometimes being in direct opposition or conflict, ultimately, trust the other’s predominant values enough to find equilibrium.

Go at it!

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Is Recovery Coaching Effective?

Posted on June 2, 2016 by Melissa Killeen

20150609_223702 (2)Treatment professionals and researchers are calling for a change in the treatment model for substance use disorders (SUD). This change calls for shedding the acute care model (28 days of SUD treatment will fix you) to a continuum of care models, similar to how chronic diseases like diabetes or arthritis are treated. (Humphreys & Tucker, 2002; Institute of Medicine, 2005; McLellan et al., 2000; White, Boyle, Loveland, & Corrington, 2005).

At the same time, the mental health and the substance abuse treatment fields have merged, creating the behavioral health field. With this merger, the recovery-oriented systems of care model (ROSC) has become the accepted approach to treatment for those with mental and substance use disorders. This holistic approach, rather than focusing on the addiction, considers the whole person and how they interact in real life. ROSC emphasizes that recovery depends on the connection of mind, body, and spirit, motivating addicts to choose to improve their mental health, their physical health, and to embrace a spiritual component of their recovery (SAMHSA, 2011). This multi-system approach has ROSC counselors encouraging visits to the general practitioner, the OBGyn and the dentist. They assess for co-occurring disorders and embrace one-on-one therapeutic treatment and group therapy. And ROSC practitioners embrace mutual support programs, such as AA, NA or even nontraditional mutual support groups like SOS, or Women for Sobriety. A spiritual program is also encouraged. Lastly, the newest introduction to the treatment field is the recovery coach.

As mental health and addiction treatment services are adopting this recovery-oriented approach, the emphasis on incorporating various forms of recovery coaching or peer-based recovery support into treatment services is growing rapidly. Peer-based recovery support services are defined as

“the process of giving and receiving nonprofessional, nonclinical assistance to achieve long-term recovery from mental health and substance use disorders” (Borkman, 1999)

This support is provided by “peers,” “peer-recovery support specialists,” “recovery coaches,” “peer mentors,” or “peer support specialists” who have lived and experienced personal recovery (Borkman, 1999). The peers assist others in initiating, maintaining and embracing recovery from their mental health or substance use disorders.

As recovery coaches and peers begin to infiltrate treatment centers and recovery support, community organizations, there is a needling question that arises: are recovery coaches effective in the recovery process?

Studies have been completed on the effectiveness of recovery coaches aiding in individuals achieving long-term recovery since 2005. Many were small studies, some were not exactly scientific, nor could other studies stand up to researcher’s scrutiny. None of the studies had the critical mass to come to a clear conclusion. Ellen L. Bassuk, M.D., Justine Hanson, Ph.D., R. Neil Greene, M.A., Molly Richard, B.A., and Alexandre Laudet, PhD began examining the 1,221 studies that analyze the effectiveness of peer-delivered, recovery support services for individuals in recovery. They wrote a systematic review called Peer Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

This compilation of all the current studies is to create an appraisal, and summarization of the success of peer-delivered, recovery support services, using strict scientific criteria. As part of their review process, the 1,221 studies were screened, but only nine studies were deemed to meet the strict review requirements.

The nine studies examined the effectiveness of recovery support services that were delivered by a peer using a wide range of interventions and models. These studies also examined the variety of locations that offered peer support, including peer-run, drop-in centers (Ja et al., 2009), peer-run, recovery community organizations (Kamon & Turner, 2013), and Veteran’s Administration medical outpatient clinics (Bernstein et al., 2005).

This review showed peer-delivered recovery support services accomplished the following successful outcomes:

  1. Decreased alcohol use
  2. Decreased drinking to intoxication by reducing the odds of drinking to intoxication by 2.9 percent (Smelson et al. 2013)
  3. Peer participation lowered re-hospitalization rates, meaning only 62 percent of participants from the peer based support group were re-hospitalized compared to 73 percent of those not receiving peer based support (Min et al. (2007)
  4. Increased post-discharge sobriety time was achieved by the individuals receiving the peer intervention (O’Connell et al. 2014)
  5. If peers led groups in life-skills training, those participants had 14.8 fewer days drinking
  6. Peer recovery support affected those discharged from inpatient treatment by maintaining a post-discharge sobriety rate of 43 percent to 48 percent as compared to 33 percent sobriety for those not receiving peer based support (Tracy et al. 2011)

Overall, the review of these studies indicate that peers involved in recovery support interventions have beneficial effects on participants. While the reviewers can conclude that there is evidence supporting the effectiveness of peer-delivered, recovery support services, they acknowledge that additional research is necessary to determine the usefulness of peer support services. While this knowledge is encouraging, research in this area is just emerging, and there is a strong need to improve outcomes by completing future studies.

References

  1. Humphreys, K., & Tucker, J. (2002). Toward more responsive and effective intervention systems for alcohol-related problems. Addiction, 97(2), 126–132.
  2. Institute of Medicine (2005). Improving the quality of health care for mental and substance use conditions. Washington, DC: National Academy Press.
  3. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695.
  4. White, W., Boyle, M., Loveland, D., & Corrington, P. (2005). What is behavioral health recovery management? A brief primer. (Retrieved from www.addictionmanagement.org/recovery%20management.pdf).
  5. Substance Abuse and Mental Health Services Administration (SAMHSA) (2011). SAMHSA’s Working Definition of Recovery. (Retrieved from http://www.samhsa.gov/recovery/).
  6. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
  7. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
  8. Ja, D. Y., Gee, M., Savolainen, J.,Wu, S., & Forghani, S. (2009). Peers Reaching Out Supporting Peers to Embrace Recovery (PROPSPER): A final evaluation report. San Francisco, CA: DYJ, Inc. for Walden House, Inc. and the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (Retrieved from http://www.dyja./com/sites/default/files/u24/PROSPER%20Final%20Evaluation%20Report.pdf).
  9. Kamon, J., & Turner,W. (2013). Recovery coaching in recovery centers: What the initial data suggest: A brief report from the Vermont Recovery Network. Montpelier, Vermont Evidence-Based Solutions (Retrieved form https://vtrecoverynetwork.org/PDF/VRN_RC_eval_report.pdf).
  10. Bernstein, E., Bernstein, J., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77, 49–59
  11. Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychological Services, 10(2), 161–167.
  12. Min, S. Y., Whitecraft, E., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons with co-occurring disorders and community tenure: A survival analysis. Psychiatric Rehabilitation Journal, 30(3), 207–213. http://dx.doi.org/10.2975/30.3.2007.207.213.
  13. O’Connell, M. J., Flanagan, E., Delphin, M., & Davidson, L. (2014). Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery supports. Unpublished manuscript.
  14. Tracy, K., Burton, M., Nich, C., & Rounsaville, B. (2011). Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. The American Journal of Drug and Alcohol Abuse, 37(6), 525–531
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Posted in Addiction Recovery Posts, alcohol, Alcoholism, Drug Abuse, Health, Recovery Coaching, Research | Tagged , , , , , , , , , , , , , , , | 2 Comments

A Call for Clinical Humility in Addiction Treatment

Posted on May 26, 2016 by Melissa Killeen

by William White and Chris Budnick,  video featuring Chris Budnick

The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3, below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

The challenges for each of us who work in this special service ministry and forwilliam_l_white_portrait_1 the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU

Chris-Budnick LCSW,LCAS,CC,MSWMy name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993. 

There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.”  “We can’t help her tonight.”  She was killed within hours of this decision leaving behind a 2-year-old daughter.  I told the officer that we pledge to do better.

This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

  • I’m sorry for all the barriers you confront when trying to access help.
  • I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
  • I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
  • I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
  • I am sorry for creating unrealistic expectations of you.
  • I’m sorry for provider success statistics that have misled you and your family.
  • I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
  • I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
  • I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
  • I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
  • I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
  • I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
  • I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
  • I’m sorry for turning you away from treatment because you’ve “been here too many times.”
  • I’m sorry for not referring you to different services when you have not responded to the services I offer.
  • I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
  • I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
  • I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
  • I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
  • I’m sorry for letting society maintain the belief that you used again because you chose to.
  • I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
  • I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
  • I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
  • I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
  • I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
  • I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
  • I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
  • I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

    This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

                                      – Chris Budnick,  Licensed Clinical Addiction Specialist

This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.  WW

I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse.  Truly such client-centered treatment can change the course of recovery for many. MK

Endnotes:

This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick have authorized this reposting.

 

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