Category Archives: Alcoholism

Books that Shaped America

Posted on February 27, 2017 by Melissa Killeen

The Interior of the Library of Congress

This week’s post is a guest post by Steve Devlin, a recovery coach from Philadelphia PA.

Recently,  I was in Washington, D.C. for two days. It was a gorgeous day with temperatures almost getting to 60 degrees and the sun shining brightly. A perfect day to walk and see the sights. I have been blessed to visit Washington many times so finding new museums or monuments to visit is not easy. I have walked along the National Mall and visited every sight from the Lincoln Memorial to the U.S. Capital. I have walked around Arlington National Cemetery and The White House. I was determined to go someplace new on this visit.

Out of all the places I have wandered I have never been to either the U.S. Supreme Court of the Library of Congress. So, off I went on my adventure on a lovely day in mid-December. My initial interest in going to the Library of Congress was to see an exhibit of the actual 6,487 books which Thomas Jefferson donated in 1815 to replace the original library which was destroyed in the War of 1812. It was very cool to his collection, but cooler still was an exhibit called Books That Shaped America. In 2012 the Library of Congress started a project that first identified 88 books by American authors. Then they opened it up to voting. The top 25 vote getters were designated as the books which had a profound impact on American life.

As you might expect these 25 books looked like the books you would read in high school or college. For me the real surprise was #10 on the list. Sitting right between two Nobel Prize winning authors was the A.A. Big Book. This 1939 first edition was described as “the famous 12-step program for stopping addiction has sold more than 30 million copies. Millions of men and women worldwide have turned to the program co-founded by Bill W and Dr. Bob to recover from alcoholism. The ‘Big Book’ as it is known spawned similar programs for other forms of addiction.”

My first reaction to seeing The Big Book was complete surprise. I almost yelled “That’s my book.” While other books on display broadened my education, and added pieces to my life, no other book as changed my life so profoundly. It was the source of hope when I was hopeless and provided a guide out of the darkness of my addiction. I should use the present tense here. This book is a part of my daily life. When I feel confused about choices, I remember my 4th step. When I wonder if I need to apologize for a harmful word or act, I know how to make amends. And when I wonder about the purpose of my life, I remember the 12th step.

A great novel is good to read, but in the end, it goes back on the shelf to collect dust. The Big Book is my guide to life. It is part of me and it is no wonder that I feel it is “my” book. The voices in it could be my own, because it was written by two people experiencing the horrors of addiction and the miracles of recovery, one day at a time, one step at a time, and one page at a time. It is my favorite book because it continues to shape my life.

May I ask you- How has The Big Book shaped your life?

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Getting through the tough times

Posted on December 6, 2016 by Melissa Killeen

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As a recovery coach, I often see my clients need some help getting through the tough times, without using drugs, picking up a drink or acting out. Recently, I personally encountered some rough patches in my own life, so I went to my library of recovery books. Reading books on recovery is an import tool I use regularly in my practice. Several years ago, I was curious about Buddhist recovery, so I became an avid reader of the books by Pema Chodron.

Pema Chodron Celebrates 80 Years

Pema Chodron, is a Buddhist nun, she was born in 1936, in New York City, and is celebrating her 80th year. After a divorce, in her mid-thirties, Pema traveled to the French Alps and encountered Buddhist teacher Lama Chime Rinpoche, and she studied with him for several years. She became a novice Buddhist nun in 1974. Pema moved to rural Cape Breton, Nova Scotia in 1984, ­­­to be the director of Gampo Abbey and worked to establish a place to teach the Buddhist monastic traditions (waking before sunrise, chanting scriptures, daily chores, communal meals and providing blessings for the laity). In Nova Scotia and through the Chodron Foundation, she works with others, sharing her ideas and teachings. She has written several books, and in my time of deep spiritual need, I went to her book “When Things Fall Apart”.

Drawn from traditional Buddhist wisdom, Pema’s radical and compassionate advice for what to do when things fall apart in our lives helped me. There is not only one approach to suffering that is of lasting benefit, Pema teaches several approaches that involve moving toward the painful situation and relaxing us to realize the essential groundlessness of our situation. It is in this book, I discovered a simple breathing exercise I can use during these chaotic times so I can move into a better space. Pema advocates this tool as a breathing exercise, although this exercise could also be considered a mindful meditation.

I use Chodron’s tool whenever and wherever life hits me below the belt. I share this tool with my clients. It is all about breathing and consciously repeating words to yourself to accompany the breathing. Since we breathe every day, it is indiscernible whether you are using this tool as you travel on the bus commuting home from work, in a conference room with your boss, or when you are feeling low and want to curl up in a ball and die.

Breathe

Pema explains in her book, when things get way too complicated; step back and breathe. When the force of the world, the politics of the U.S., Great Britain or Italy start weighing heavily on your mind, breathe. When you look at all the pain around you and feel powerless to do anything, breathe.

Pema explains, inhale and say silently to yourself breathe in the pain, then exhale and say breathe out relief. Then, inhale, and say silently to yourself breathe in the relief, and exhale and say breathe out the pain. I find I need about 15 minutes of conscious breathing in this way. After doing this, I find I have new energy or something else crosses my path to move me into a different space.

If I continue to be in that negative space of worry or feeling powerless, then absolutely nothing will be accomplished that day. I know we all have something to accomplish every day, whether it is just getting out of bed, taking a shower and brushing our teeth or running a Fortune 500 company, this exercise gets us from zero to ten in fifteen minutes. Chodron’s exercise moves me to the space I need to be in, so I can function. It is what I need.

So, I invite you to try this simple exercise…and remember…keep breathing.

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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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