Category Archives: mental health

A Call for Clinical Humility in Addiction Treatment

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.

 

Share
Posted in Addiction Recovery Posts, alcohol, Alcoholism, Drug Abuse, Family Dynamics, Gambling, Health, internet addiction disorder, mental health, Opioid addiction, Parents, Recovery Coaching, Relapse, Research, Uncategorized | Tagged , , , , , , , , | Comments Off on A Call for Clinical Humility in Addiction Treatment

How Adverse Childhood Experiences affects long term health – a TED MED Talk by Dr. Nadine Burke Harris

Nadine Burke Harris

Dr. Nadine Burke Harris, during her TED MED talk presents the results of the Adverse Childhood Experiences (ACE) study and the substantiated affects the study has brought forth on how childhood trauma can affect the quality of one’s health and length of a person’s lifespan. The San Francisco based pediatrician explains that the repeated stress of abuse, experience of neglect and living with parents struggling with mental health or substance abuse issues has real, tangible effects on the development of child’s brain. The ACE study concludes that those who’ve experienced chronic, and high levels of trauma are at triple the risk for heart disease, addictions and lung cancer. She gives an impassioned plea for clinicians to use the Adverse Childhood Experiences questions during the intact of all patients and confront the prevention and treatment of trauma, head-on.

Share
Posted in Addiction Recovery Posts, alcohol, Alcoholism, Drug Abuse, Family Dynamics, Health, mental health, Parents, Recovery Coaching, Research | Tagged , , , , | Comments Off on How Adverse Childhood Experiences affects long term health – a TED MED Talk by Dr. Nadine Burke Harris

7 Questions Wives of Porn Addicts Ask

ella hutchinson photoPornography addiction is a form of sex addiction. Wives of porn addicts are baffled by this addiction and feel like they are partially responsible for their husband’s behavior. The reasons for this are numerous and include the shame associated with this addiction for both the addict and the spouse, the sense of betrayal, and stereotypes linked to the addiction. Ella Hutchinson, a counselor from Katy, Texas, specializes in counseling wives of sex addicts. She sees women who haven’t told anyone about their husband’s addiction, sometimes for months, years and often, they never disclose. The lack of support available to spouses, and often inaccurate information being put out about partners of sexual addicts can cause a wife to suffer additional trauma. Ella has formulated 7 questions wives of porn addicts ask.

#1: How can my husband love me and look at porn when he knows it hurts me?

 It is possible for your husband to love you, even though he is looking at pornography? In fact the two are completely unrelated. Men are better than women at compartmentalization. A man’s brain can be compared to a waffle. There are many different compartments so that he can divide his life up into separate components that don’t touch each other. His marriage and family can be in one compartment, his job in another…you get the point. This is a benefit when a man is fighting in a war and able to focus on the task at hand without worrying about his family back home. But it also makes a man able to look at pornography without thinking about how it may hurt you or his marriage. Women’s brains are more like spaghetti where everything is connected. Women are more likely to be worrying about our kids when we are at work and thinking about work when we are at home.

When a man becomes addicted to pornography, it can become a perceived need rather than a choice for him until he becomes willing to reach out for help. His use of porn causes a release of the same chemicals involved when a drug is ingested. At the height of his addiction, nothing, not even the risk of losing his job or his marriage, is enough to stop him. This explains how a politician or celebrity can make such risky, career-destroying moves without stopping to consider the consequences.

Later Ella will discuss the kinds of consequences that can catapult an addict into reality.

#2: Why does my husband prefer porn and masturbation to sex with me?

 Norman Doidge, psychiatrist and author of the acclaimed book, The Brain That Changes Itself, studied porn addicts. He stated,

They reported increasing difficulty in being turned on by their actual sexual partners, spouses, or girlfriends, though they still considered them objectively attractive. When I asked if this phenomenon had any relationship to viewing pornography, they answered that it initially helped them get more excited during sex but over time had the opposite effect.

Your husband had this addiction, or the proclivity toward it, before he ever met you, regardless of what he says. In spite of what you think or even what he might have said, nothing you could do could be enough to sexually satisfy your porn addicted spouse. Pornography presents an unrealistic reality that damages a person’s brain. They become engrossed in this fantasy world where they don’t have to worry about pleasing anyone but themselves and no emotional connection is required.

While a porn addict desperately craves love and intimacy (something he is probably unaware of), he seeks it out in the exact place that will cause him to become less and less able to experience it. As a counselor, Ella hears sexual addicts talk about their past, it becomes apparent why they are so uncomfortable with the idea of intimacy. This topic is beyond our scope here, but it is important for a wife to be aware that there is a reason her husband became addicted to porn, and that reason is not her.

#3: Why am I not enough if I am sexually available to him?

Beyond the intimacy issue, pornography offers the thrill of what is forbidden. The more taboo, the more exciting. This is why a porn addict may progress to looking at more hardcore porn and even pornography involving aspects that a healthy person would consider offensive and grotesque.

Gary Wilson, human sciences instructor, and Marnia Robinson, author of Cupid’s Poisoned Arrow: From Habit to Harmony in Sexual Relationships, state:

 The uniqueness of Internet porn can goad a user relentlessly, as it possesses all the elements that keep dopamine surging. The excitement of the hunt for the perfect image releases dopamine. Moreover, there’s always something new, always something kinkier. Dopamine is released when something is more arousing than anticipated, causing nerve cells to fire like crazy. In contrast, sex with your spouse is not always better than expected. Nor does it offer endless variety. This can cause problems because a primitive part of your brain assumes quantity of dopamine equals value of activity, even when it doesn’t. Indeed, porn’s dopamine fireworks can produce a drug-like high that is more compelling than sex with a familiar mate.

#4: He says he looks at porn because I don’t have sex with him enough, am I not pretty enough, am I  too fat, etc. What can I do?

Ella hears this a lot and it is called justification. Your husband doesn’t want to believe he is sick. If he is not ready to admit he is an addict and take responsibility for his own behavior, he will say anything to convince you, and even himself, that he does not have a problem. Blaming you is an easy way to save face.

There is nothing you could do to be appealing enough to make your husband stop looking at porn. We see very beautiful women whose husbands no longer desire them, couples where the wife looks like she belongs on the cover of Cosmopolitan magazine or on a model runway, and the husband has admitted to her that he is physically repulsed by her. Ella speaks of another couple who has sex every day, yet she still catches him looking at porn and frequenting adult bookstores. There is simply no credibility to the argument that a wife causes or contributes to her husband’s use of pornography.

#5: My husband says all men do it. Am I making too big a deal out of this?

It is unfortunate, but true, that pornography use is overwhelmingly common. This does not make it okay or mean you should turn a blind eye. Ella often hears women say that their husband’s porn use makes them feel cheated on. This makes sense. When a man uses porn he is finding sexual satisfaction from someone other than his wife. So the betrayal a woman feels is natural. God created sex to be between a man and his wife. The Ten Commandments interpret looking at a woman with lust is the same as committing adultery with her in his heart. Looking at porn is purposely choosing to lust.

#6: My husband refuses to get help or admit this is a problem. How can I make him stop? What are the risks if he doesn’t stop?

In short, you cannot make him stop. It usually takes something significant to get a man to the point where he is ready to admit his porn addiction. This is what they call “hitting rock bottom”. Sometimes, for a man who has hidden his porn use for years, just getting caught is enough. But more often, it takes losing his job, his wife leaving him, or another monumental event to shake him to the core and wake him up to reality. It may be his porn use progressing to acting out with another person or other people and facing the multiple possible consequences of this, to cause him to recognize his need for help.

You can insist your husband stop his porn use and you have every right to do so. The compulsive use of porn will, without exception, do damage to your marriage and your family. It affects a person’s sense of right and wrong. It can cause your husband to lose respect for you. You will likely feel him pulling further away from you and your family as he gets more entrenched in this sinful lifestyle. If he refuses help, it will only get worse. Your pleading that he stop will fall on deaf ears if he isn’t ready to hear it. This is a harsh reality, but one too many women just do not get. Some women beg and plead for decades until they grow cold and bitter. Then they tell me that they wish they had left years ago and feel they have wasted most of their life.

When porn is an issue, it is likely that extramarital affairs are or will become an issue. This means you are at risk of more than the heartache of discovering your husband has been sexual with another person. You are also at risk of STDs or your husband fathering another woman’s child. Additionally, your children are almost guaranteed early exposure to porn, something that was likely a contributing factor in your husband’s addiction.

#7: Is there hope? Can a man like this change?

Recovery from sexual addiction is very much possible. Men who get out feel a sense of freedom, as if a huge boulder has been lifted off their chest. It is such a liberating feeling that many men forget that their wives are still grieving from his actions and likely will be for some time.

For some men, simply the threat of their wife leaving is enough to cause them to get help. But for many others, they need something more. This can cause you, as the wife, to feel helpless. You are not helpless. You can’t control your husband’s recovery, but as the injured spouse, you can control your own. The fact that you need recovery does not mean you are sick or that something is wrong with you, but that you have likely been traumatized by your husband’s behavior. Your recovery includes building up a support system for yourself. Don’t keep silent. Reach out to a trusted friend, your pastor, or a therapist. Keeping this secret will cause feelings of shame, loneliness, and isolation. Finding a support group for wives of sex/porn addicts can be very helpful. If there is not one in your area, there are phone support groups available, led by trained life coaches and therapists who have been in your shoes. Finally, learn to recognize your unmet needs and what it will take to meet them. A skilled therapist can help you with this. The absolute best book written for wives is Your Sexually Addicted Spouse, by Barbara Steffens and Marsha Means. Ella strongly encourages you to find a therapist (individual and marriage) who is familiar with this book and subscribes to the treatment model described in it. If your therapist isn’t familiar, ask if they’d be willing to read it.

Beyond self-care, Ella recommends that you take some time to come up with some clear, firm boundaries for your marriage. While this may not result in the desired outcome, it is worth it to put in the effort. At the very least, this is a first step toward helping you get to a place where you can make an informed decision about the direction of your relationship. This means bottom-line behaviors you will not tolerate and actions you need to see happening in order for you to feel safe in your marriage. Your list of unacceptable behaviors may include viewing pornography in the home, inappropriate conversations or relationships with other people, and other possible abusive behaviors toward you that are often present in a sexual addict. The actions you need to see your husband take might be installing a filter on computers and phones, open discussions about where all the money is going with you having access to all accounts, attending sexual purity or sexual addiction support groups, counseling, and talking to a pastor.

Before you present this to your husband, make sure you are prepared to follow through with consequences if he refuses or does not stick to what he agreed to do. Consequences can be anything from insisting one of you move to a separate bedroom (an in-house separation) to one of you moving out of the home. Your husband will likely be resistant to you setting these boundaries and may accuse you of being demanding and giving him an ultimatum. Do not engage in any kind of manipulative or accusatory conversations with your husband. Learn to recognize this behavior and refuse to participate. It is important that you wait to address your new boundaries until you are able to do so in a calm manner. A therapist’s presence (and guidance beforehand) is a good idea. A good book on this topic is The Gaslight Effect by Dr. Robin Stern.

If your husband does not follow the boundaries you set, you now have a choice to make. You can choose to accept that your husband is simply not ready to stop his porn use. This means letting go of the nagging, criticism, and efforts to control (which should have stopped already by this point since you have learned they don’t work). If you choose to to not follow through with the consequences, even though he has made it clear through his words or actions that he is not willing to stop, you are choosing to accept his behavior. This will probably require a good deal of emotional detachment on your part. It may be a marriage that looks more like you are roommates. Ella says she has not yet met a woman who has chosen this arrangement and found any kind of long-term life satisfaction in it, but it is an option.

Your choices may need to include making the necessary preparations in case you need to leave. This may mean getting a job if you don’t work and starting to put money aside. Separation does not mean divorce, but it can be a prelude to it. Ideally, that should not be the goal for separation. The purpose is to show your husband that you are unwilling to share him with pornography. Once he sees you are serious and can no longer be placated with words and half-hearted attempts that don’t last, he is also more likely to take his addiction seriously. Also, getting physical space between you and him can make it easier for you to clear your mind, spend more time in prayer and God’s Word, and make objective decisions about your future. A good Christian counselor can guide you through a therapeutic separation where rules are put in place for you both to follow during this time.

Many men have escaped the chains of sexual addiction. Here is an important truth to be aware of. Your husband has probably tried to stop more times than he can count. He is not deriving pleasure from his lifestyle. He keeps going back, trying to fill a void that porn will never fill. Willpower is not enough. Recovery from sexual addiction is multifaceted, but includes reaching out to other men who have been there, and often requires professional help as well.

God must be the central focus in recovery. However, many men have learned the hard way, in the words of author, speaker, therapist and recovering addict, Dr. Mark Laaser, “You can’t pray it away.” If prayer was all we needed then we wouldn’t have to have jobs or pay bills. We could just pray about it and our bank account would never run out and the bills would get paid. If prayer was enough we could eat and drink whatever we want and every check-up would reveal a clean bill of health. But God wants us to do the work, and keep doing it.

Once a man has decided to become serious about recovery from sexual addiction, there are more steps to take to help the marriage heal. After all, just because the behavior has stopped, it doesn’t mean the damage that has been done will go away. Marriage counseling with a skilled sex addiction therapist is important. Couple’s Intensives are a great way to get a jump start on recovery for the couple. Ella recommends the book Hope and Freedom by Milton Magness to learn more about recovery for you, your husband, and your marriage and to learn about intensives. You can also read about intensives and other issues surrounding marriage and sexual addiction on Ella’s website, Comfort Christian Counseling.

. . . .

Ella Hutchinson, is a Licensed Professional Counselor with a Bachelor of Science degree in Psychology and a Master’s degree in Counseling from St. Edward’s University in Austin, TX. She is also a member of the American Association of Christian Counselors. In addition, Ella is certified in treating sex addiction and specializes in counseling partners of sexual addicts. She practices at:

Comfort Christian Counseling,

2900 Commercial Center Blvd #101, Katy, TX 77494

You can contact Ella at:

http://comfortchristiancounseling.com/

 

 

 

 

 

Share
Posted in Addiction Recovery Posts, Family Dynamics, love addiction, mental health, Pornography, pornography addiction, Research, Sex Addiction | Tagged , , , , , , , , , , , , , , , | Comments Off on 7 Questions Wives of Porn Addicts Ask