Understanding the 12 Steps: Step 1 (Honesty)

Understanding the 12 Steps: Step 1 (Honesty)

by | Aug 6, 2024 | 12 Steps, Counselling, Finding Help, Therapeuo

“We admitted we were powerless over alcohol — that our lives had become unmanageable.”

Step 1, Alcoholics Anonymous

“Watch and pray that you may not enter into temptation. The spirit indeed is willing, but the flesh is weak.”

Jesus, Matthew 26:41

The first step to overcoming – the first step towards solving the problem of addiction or any other compulsive behaviour/impulse – is to admit that there is a problem.

We cannot fix what is not broken – and we are all broken in some way or the other – we just don’t care to admit it.

Jesus said to His disciples that they must watch and pray to ensure they do not enter into temptation. The flesh, inherently, is weak.

The Twelve Steps of Alcoholics Anonymous offers a set of simple spiritual principles that, if put into practice, will lead to freedom. This freedom is offered to Alcoholics and Addicts around the world but is not limited to the realm of drugs and drink. It can be applied to a myriad of problems. From compulsive shopping, pornography consumption, codependency, depression and anxiety, gambling and even love and sex.

The spiritual principle behind step 1 is HONESTY.

The Big Book of Alcoholics Anonymous says this: “Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.” (Chapter 5, Alcoholics Anonymous)

Jesus famously said: THE TRUTH SHALL SET YOU FREE.

For us to overcome our spiritual malady and the weakness of the flesh we need to first of all be HONEST – admitting to OURSELVES that there is something that needs fixing – that our lives have become unmanageable and that we, in ourselves, are powerless.

We need to admit to ourselves that we cannot do this on our own.

Too often the shame of our secret has kept us sick – it is shame that keeps us from reaching out, it is foolish pride that keeps us from asking for help – and so we try to do it on our own.

But there is nothing to be ashamed about. Yes, we might have done things that we regret, we might’ve done things that we resent – and we might feel deeply ashamed about these things – but there is no shame in asking for help, and there is definitely no shame in expressing the desire to fix what is broken.

On the contrary, reaching out and owning our struggle is an admirable thing to do. It is a difficult task that shows much courage.

The First Step – this step of being honest with oneself – is probably the hardest step to take. Once we can make a decision to be honest about our weakness, our powerlessness, we can start taking steps towards our healing and restoration.

I came to the conclusion that something was wrong when I got arrested for drug possession. On that cold concrete floor I had nothing else to do but think about all the ways that my life was falling apart around me.

Is your addiction or behaviour causing chaos in your life? Is it leading to the loss of income? The loss of stability? The breakdown of family relationships? Is your addiction or behaviour affecting your health – physical or mental?

Are you tired and burdened? Heavy laden by guilt and shame? Do you feel powerless and unable to change?

From personal experience I can tell you that there is hope. You can overcome! But it starts with you being honest with yourself.

It starts by admitting that we are powerless over our situation or circumstance, addiction or behaviour – and this honesty then puts us in the position to seek the right kind of help.

Prayer: Lord, if there is anything in my life that needs changing, I pray that You will show me. I ask Lord that You will point out where I might’ve strayed from Your plan for my life and that You will help me get back on it. Give me wisdom, strength and the power to endure on the journey that lies ahead. In Jesus Name. Amen.

If you have come to the conclusion that there is something wrong, something in need of fixing – that your life has become unmanageable and chaotic – reach out: andre@adlabuschagne.co.za / 0653703806.

We will do our best to help you find the help you need.

Views and Definitions of Addiction

Views and Definitions of Addiction

by | Jul 8, 2024 | Articles, Counselling, Understanding Addiction

Why the definitions matter:

With sobriety comes clarity. When leaving the fog of addiction we find that the haze that shrouded our judgement is gone and that there is hope. Where before everything seemed somewhat shrouded, or sometimes even completely blacked out by the hopelessness of addiction – the unceasing cycle of withdrawal, craving and the next high – we find that now we can look back on the time spent in active addiction and learn quite a bit about ourselves. At least that is my experience. So much so that under the lens of introspection, examining what was before, a lot of things suddenly make sense.

For example, in my own life, before I even tried any kind of mind altering substance there was a certain impulsiveness to my decisions.

Depression in my early teens, left untreated, would also become a ticking time bomb later in life when I found myself in the ‘real world.’

In my personal testimony of how I got clean and sober, I explain how up until this day I cannot remember what went through my mind when I took my first line. I cannot blame any person or situation for my decision to pick up, and even though throughout this reading I might make reference to certain behavioral patterns or traumatic experiences, etc., these are just facets of a greater whole.

Definitions of addiction, or more properly, substance use disorder, have changed over the years. The view has shifted from it being a purely moral and ethical decision, towards it being a chronic disease.

The original term, addiction, is derived from the Latin addicere – “to adore or surrender oneself to a master.”

And this has been misinterpreted especially by the church.

I remember trying to get clean a year prior to my first fellowship meeting.

I went to two pastoral counselors who in my opinion were not very cut out for the job of addiction counseling, even though they had helped one or two addicts before.

It was made clear to me that I was transgressing against God, that I had to repent of my sin and turn to Jesus – and in the long run their sessions with me only led to deep seated guilt and relapse. Their heart was in the right place, but they were not equipped for the process and did not achieve much.

A friend of mine attended a fellowship group during his first few months of sobriety which was completely faith based and without therapeutic value.

The addicts were assembled in a room, and the families gathered in another. Once seated they were told that they were sinners, that they had to repent and this was followed by a verbal beating from the family members who were instructed to practice ‘tough love’. Apparently it was quite brutal and the experience comes up quite often in conversation.

These kinds of counseling methods do more harm than good. No one berates a diabetic for being sick, and no one goes up to a cancer patient and tells them to repent.

Addiction, according to current definitions, is a very real, often life threatening chronic illness and needs to be treated as such.

I believe that God heals. His Word makes it clear that He has paid for our restoration and healing – but I also believe in divine healing through wisdom imparted to professionals – where men and women are the hands and feet of God.

I’ve seen miracles. I’ve seen and even experienced physical healing through prayer, but I’ve also come to understand that sometimes God is in the process.

My addiction wasn’t just spiritual.

It was not some demonic force that plagued me and had to be driven out. It was my own brokenness, a brokenness that had been hidden in my heart since a very young age, that was seeking reprieve. I wasn’t doing drugs or drinking because the devil told me to do it. I wasn’t an addict because of some generational curse. It was very much a mental infirmity – one which, through the proper course of treatment, has gone into remission.

My hope is that in sharing this with the church we can move away from outdated models of thinking, outdated and frankly stupid ways of helping and move towards a way of reaching out to our fellows – the captives Christ promised to set free – and bring them back into the fold.

I did not choose to be an addict, but I did choose to get better. I chose recovery over addiction and continue to do so day after day.

My hope is that the love of Christ will shape our understanding, and that I might be able to share some knowledge with you that will empower you to help someone struggling with drugs and/or alcohol. That you will become equipped to assist broken families in finding hope and healing. That you might be ready and willing, armed with the necessary know-how to perhaps actually save a life.

And it starts with understanding what addiction is.

Below are some of the models we use to understand addiction. It might seem like a lot of information, especially when we start researching and delving into each one. My purpose here is just to show you the broader picture. And God will do the rest.

Definitions of Addiction

The Moral Model: Dating back to the 19th century, this model explores addiction as a moral failure of character. The idea is that individuals have free will and therefore is absolutely responsible for their decisions and behavior.

The Spirituality Model has close parallels with this (in my humble opinion) outdated way of thinking about substance use disorder. The spirituality approach believes that addiction is a spiritual malady and therefore is caused by a lack of connection to a Higher Power. The early Oxford Groups which would later influence the Twelve Step programs that we have today, believed that it could fix the problem of addiction by developing in clients a morality aligned with God. The Twelve Steps having evolved from this line of thinking, in parallel with earlier versions of the Disease/Medical model, seek to address this malady by encouraging a relationship with a Higher Power/God. Although this way of thinking seems outdated, and although I do not agree with the idea that addiction is solely the consequence of moral failure, it has played a big role in my own personal recovery. It has allowed me to confront certain defects of character, address certain ways of thinking and learn the value of mercy, compassion and forgiveness as well as asking for forgiveness.

The Self Medication Model: In the 1960’s psychoanalysts started exploring the idea that people often start using mind altering substances as a way of coping with hardship, mental illness and other problems present in their lives. It should me made clear that this model should be used in conjunction rather than competition with other ways of approaching addiction. (See Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.)

Medical/Disease Model: The Disease/Medical model, first proposed in 1810 but only officially recognized in 1945 by the American Medical Association and thereafter accepted by the World Health Organization, proposes that addiction is a relapsing brain disorder and not a mental disorder or moral failure. It is defined as a severely harmful and potentially fatal illness which might go into remission with the proper treatment and care, but for which there is no known cure. A great documentary on this model is Pleasure Unwoven and it is my suggestion that anyone struggling with addiction, or who has a loved one struggling with addiction, find and watch it for some insight into what addiction is and what it is not.

Although the Impulse-Control Disorder model is a generally new way of approaching and trying to understand the problem of addiction, I would categorize it with the medical/disease model.

The basic premise of the Impulse-Control Disorder model is that there is a neurobiological or genetic defect that makes an individual unable to control and regulate impulsive behaviors. Under the wrong conditions such individuals will put themselves at risk, engaging in self-destructive behaviors such as pyromania or substance abuse.

Over the course of the last three decades there have been leaps and strides in medical science which have discover certain Genetic Predispositions in some individuals to alcohol, tobacco and other substances of abuse. Studies in the field of epidemiology have hypothesized that 40-60% for an individuals potential for addiction to opiates, alcohol or cocaine might be genetic.

More and more genetic researchers are starting to believe that different classes of substances might be connected with genetic preferences.

Along with this pre-existing preference the Bio-Medical model, proposed in the 90’s, supposes that the repeated use of mind altering substances over time physically changes brain structure and function and that these changes and the effects thereof might persist long after the individual has stopped using the substance. (Leshner, 2001).

Besides Medical and Spiritual models, we also look at possible social roots of addiction.

For example, Social Learning and Erroneous Thought Patterns.

“Social learning theorist Albert Bandura (1977, 1986) indicates four stages of social learning: (1) Attention—The individual makes a conscious cognitive choice to observe the desired behavior; (2) Memory—The individual recalls what he has observed from the modeling; (3) Imitation—The individual repeats the actions that she has observed; and (4) Motivation—The individual client must have some internal motivation for wanting to carry out the modeled behavior.” (The Addiction Counselors Desk Reference).

We see that a cognitive choice is involved in the first, where as the second concerning thought patterns, could be the result of social learning, or might have its roots in something else entirely – for example a lack of education or even mental illness.

These two approaches, in my opinion, can be considered branches of Biopsychosocial model. This model is based on the idea that addiction vulnerability – your chances of becoming an addict – is affected by the complex interactions between your physical and psychological states as well as social dynamics, or the way we interact with the world and the world interacts with us.

In my experience all of these models give us insight into the problem of substance use disorder as well as other addictions, however, I do believe that they should all be studied and used together – parallel and not in competition with one another.

The disease of addiction is not always an easy situation to understand. It is complex, and definitely more so than just a simple decision that someone takes, and although the solution is often simple – the road of recovery starts with one single step – actually understanding your client or yourself is not as easy as it might appear.

Humans are beautifully complicated, and because of this the task of actually helping our brothers and sisters – especially in the field of pastoral counseling – is sometimes a daunting task – but there is hope.

I have seen God use our knowledge and turn it into wisdom. I pray that as we seek to understand, as we read and contemplate and pray, God will lead and guide us towards comprehension and compassion.

The solution to the problem and disease of addiction is simple – and it starts with what Jesus taught us. Love your neighbour as He has loved us.

Love like Jesus loved, and this love will be a lamp unto our feet, will lead us on.

If you or a loved one is struggling with addiction – please reach out: 065 370 3806.

Understanding Addiction: Stages of Drug Use

Understanding Addiction: Stages of Drug Use

by | Jul 8, 2024 | Articles, Counselling, Therapeuo, Understanding Addiction

As with most things in life, addictions do not form overnight. No one expressly decides to become an addict. It happens over time.

Drug addiction can therefore be viewed as a series of developmental stages. Drawing from the work of Kandel (2002) and Wallen (1993) we can suggest these stages as the logical progression of the disease of addiction: Initiation, Escalation, Maintenance, Discontinuation and Relapse, and finally Recovery.

This is by no means a certain road map, but most users do tend to follow this trend in their patterns of use and abuse. Some users may, however, escalate quicker or relapse more often or not at all. Nonetheless, these developmental stages give us some insight into the general progression of the disease of addiction.

Initiation

Often the typical user is introduced to psychoactive substances by friends or relatives as a social gesture. It is common for adolescents to start experimenting with alcohol or tobacco in a social setting and for this experimentation to continue with other substances in similar settings.

In the case of prescription medications initiation usually happens when the initiate is legally prescribed a potentially addictive substance or a friend/relative decides to share their medication with the initiate.

Initial use of a substance does not necessarily lead to addiction. Without the stages of escalation and maintenance it automatically progresses to discontinuation and cessation. In cases where the user is at risk we find that the dependence will develop following initial use and continued experimentation.

Escalation

The period of initiation differs from person to person, and is often a period of casual or occasional use. As experimentation continues the addict will inevitably find themselves using more regularly. They might see an increase in their preoccupation with psychoactive substances, or socialize more frequently with other users – reinforcing the idea of intoxication as normal or fun. As the usage escalates the patterns of their use become more risky and harmful.

The variety of substances being used may increase. Priorities might start taking a backseat to the substance during this time, jobs and families might be neglected, self-care gives way to self-destruction as the obsession slowly starts taking root and dependence upon the substance starts to develop.

Typically there will be little or no concern as to how the drugs or behavior might impair, impact or influence their future or health.

Maintenance

As tolerance and dependence builds the user finds themselves on a quest to recreate that original euphoria. This, however, proves elusive and it becomes a non-stop search for normalcy. A quest to just feel okay.

As this progresses it becomes even harder to feel just that and the search for the substance becomes a matter of survival. Where the non-addict prioritizes food, shelter and clothing as necessities for survival, the addict brain prioritizes the mind altering substance before all else. Eventually this obsession becomes all-consuming bypassing any and all other instincts and moral inclinations.

Drugs are no longer something that is done “just for fun” but now slowly starts becoming the be-all and end-all of the users day to day life. The user finds themselves in a downward spiral in which their psychological and physical health starts deteriorating, social support systems start collapsing and economic resources start drying up.

Discontinuation and Relapse

There are various reasons why an individual might discontinue or stop their use of a mind altering substance.

These reasons may range from a feeling of having hit ‘rock bottom’, the collapse of family relationships or social support networks, the dwindling of economic resources. Some may stop abruptly following an overdose or sudden medical complication. Others still stop temporarily because of incarceration or court mandated rehabilitation/treatment.

Sometimes the downward spiral of loss and adversity might lead the addict to realize that drugs are not the solution, but a contributing factor to the problems in their lives and seek help.

Over two thirds of those who abuse alcohol often quit by themselves with no need for intervention. Those addicted to other drugs usually require a much more hands-on and supportive approach.

Many individuals do however recover from addiction by ‘white knuckling’, pushing through and getting sober. This however does not work for everyone – especially when there are co-occurring conditions such as chronic pain or mental illness.

Since addiction, more properly referred to as Substance Use Disorder, is a chronic relapsing brain disorder it is important to seek the right help, find the right program and build the right support system to prevent relapse.

There are as many reasons for relapse as there are to get sober. From personal tragedy and trauma to economic despair and health problems, the addicted brain can find many good reasons to go back to drugs and/or alcohol.

Relapse, however, is not failure but rather just a step back. We can always recover if we are open minded and willing to change.

Recovery

Recovery starts when the addict acknowledges that their use of mind altering substances has become a problem and that they need help, when they decide that the complete cessation of their use of these substances is necessary.

It is a process. Just like the addiction was not built over night, recovery requires persistence and perseverance. It requires dedication and a willingness to work on yourself.

At first the addict might grieve the loss of their drug lifestyle, but in time as the hallmarks of this previous life are replaced by more healthy alternatives.

Old using buddies and acquaintances are replaced by new friends and stronger support systems.

Physical health might start to recover, usually much quicker than emotional or mental health as the addict has to regain lost emotional development and growth. The addicted client might be older, but developmentally might still be ‘stuck’ at the mental/emotional age where they stopped dealing with life and started using drugs. Emotional and mental growth has been stunted by the use of these substances and the individual might need extra help to get back on track.

There is no shame in this. There is hope – and we just need to work the program, commit to change and work towards building ourselves up again.

Fortunately, if the individual is resolute about ‘dealing with life on life’s terms’ without psychoactive substances we will find that the emotional growth we are fighting tooth and nail to achieve will be accelerated. This process might be absolutely terrifying at first, but it is so worth it – exhilarating and thrilling – as the pain and terror of addiction gives way to an abundance of life.

Early Recovery

In the first six months of recovery the risk and rate of relapse is much higher. Everything is new, and it can be quite overwhelming. During this time we learn how to cope with daily life, deal with stressors in work environments and relationships in healthy, non-chemical ways, and build new support networks, usually through attendance of 12-step Fellowships.

This is the time during which we start the process of moving away from people,places and things associated with our using and towards a new way of thinking and living.

During this time mood swings and depression is common and we need to be mindful about these episodes since they can derail treatment.

Usually after 6 months we start grappling less with our routines and socializing and start focusing more on the real psychological and societal adjustments of sobriety. Feelings and emotions start returning, and the grieving over the old way of life might continue.

For example, as our eating habits start normalizing we might be concerned about our sudden weight gain. We might be unsure about how to deal with our unnecessarily harsh boss or team leader. Family problems might seem to push us close to the edge. However, it is important for us to focus on what we can change rather than that which is beyond our control.

The work continues as we start learning what self care and love is all about and re-establish our ability to feel and deal with the complications of life without the use of drugs or alcohol.

Later Recovery

Roughly a year into recovery we start gaining confidence as we apply the tools we have learnt from the programs and treatment. As we practice the principles of recovery in all our affairs we find an increasing state of serenity and contentment, increasing stability and comfort as we continue to work on ourselves and build our social support networks and work to restore old ones that might have collapsed (like family relationships).

Many start to advance in terms of their careers or studies, or go on to help others as a way of giving back.

The promises of recovery are not always as clear cut as it might seem.

But they are real and will materialize if we work for them.

If you or a loved one are struggling with addiction – please reach out: 065 370 3806.

5 Types of Drug User

5 Types of Drug User

by | Jul 8, 2024 | Articles, Counselling, Therapeuo, Understanding Addiction

When I was an active drug user I was always baffled by the individuals who could use with us and then abruptly stop. Those who could try cocaine or meth and just not like it. Those who were able to wake up in the morning after a hard night out and not crave a little something to get them going. Those fortunate individuals with the self-control and soundness of mind to party on a Friday night, and stay in watching movies and drinking tea on a Saturday.

For me it was not that simple. I needed drugs to get up in the morning. I needed to smoke a joint at work just to cope with my co-workers. I needed a drink at night to go to bed. It was as if I couldn’t do anything without a vast amount of chemicals running through my system.

It took me a while in recovery to understand this phenomenon. Even the Alcoholics Anonymous Big Book makes a distinction between different types of drinkers – from the teetotaler to the casual drunk and the full blown alcoholic – we come to realize that there are different kinds of users, and therefore different interventions for each individual case.

In terms of addiction the UN World Drug Report sheds some light on the matter.Their report indicates that more than 247 million people have experimented with drugs, and that from that total about 10% have a substance use disorder/addiction.

If you question whether or not you might have a substance use disorder and if you might need help, consider this: has your use of a substance led to disorder in any one or more facets of your life? If yes, please consider reaching out.

Below we will look at 5 types of drug users with a brief discussion of each.

It is important as we look into the classifications to realize that these are the ideal types. Most users will not fit neatly into any specific category, yet these definitions do remain quite useful for classification.

An abstainer or teetotaler might once in a while, for example have a drink.Others might shift from one category to another as context and circumstances change.

It is also important to understand that psychological dependence varies by degree.

This set of classifications, unlike the stages of addiction, does not follow a linear pattern. It is not a progression from one to the other. Simply these are the relative position one might find oneself in in terms of the use of substances. A description of condition dependent on circumstance, context and situation.

There is no predictable progression between categories, and one might find an individual user swinging from one extreme to the other.The full blown addict might abruptly discontinue his usage of mind altering substances and become an abstainer, or an individual might try crack for the first time and become completely physically and psychologically dependant.

The Abstainer

People might abstain from drugs and alcohol, or even certain behaviors like gambling or sex, for various reasons. Whether for religious (for example 7th Day Adventists going as far as abstaining from tea and coffee because of the caffeine content) or moral reasons, or as the after effect of a series of traumatic experiences (growing up in an alcoholic household) certain people abstain because of the belief that drugs or alcohol is inherently wrong. Others still become abstainers later in life after having seen or lived the horrors of active addiction or having had a bad drug or alcohol experience.

The Social User

This type of drug use is the most common and constitutes the majority of the drug using population. A social user is an individual who uses alcohol or other psychoactive substances but are able to limit their use, using only in social settings or once in a while.

Mind altering substances are seen as a way to enhance the pleasure of a social setting and is used to accomplish social goals.

Not every social user becomes dependent although the likelihood of addiction depends on the substance being used.

The danger however does come in with reinforcement of the behaviour.

“There is still considerable debate whether people can experiment with certain mind-altering drugs (e.g., marijuana, methamphetamine, crack, or heroin) without escalating into misuse (Type 3) or dependency (Types 4 and 5). With some drugs, like alcohol, most people seem to be able to continue indefinitely as social users (Type 2); research shows only about 20% appear to develop a more depen-

dent relationship. However, a larger percentage of marijuana users (as many as 25%) escalate into dependency if they regularly use over an extended time.” (The Addiction Counselors Desk Reference, Coombs and Howatt, 2005)

Drug Abuser

Where the social user might enjoy the use of mind and mood altering substances as part of a social experience where the use of the drug itself is not the priority, the drug abusers main goal in these same settings is intoxication.

The drug abusers usage patterns might still be sporadic, unlike the dependant, but might include binges and more risky use of the drug.

The motivation changes from social reward and becomes way more internal.

Some might start using drugs to avoid or numb unwanted feelings, to change mood or personality or even to enhance performance (eg. Amphetamines for studying, or marijuana to be more ‘creative).

Others use drugs and go on binges to escape from the reality of their responsibilities at home, work or school, or just be less themselves.

Physical Dependence

Physically dependent users are not necessarily psychological addicted to the substance they are using, but because of prolonged use and tolerance these users often have to continue their use of the substance because of the severe discomforts of detox and withdrawal. We see this especially in those addicted to their prescription medication.

The physically but not psychologically dependent user might even come to despise the medications or drugs they are on and might want to stop, but discontinuation poses certain challenges.

Detox can be between 3-5 days for fast acting substances like heroin, alcohol or cocaine, or up to two weeks in the case of drugs like benzodiazepines or methadone.

“Situational addicts, such as some Vietnam veterans, offer another example of Type 4 addicts. Although numerous enlisted men became addicted to narcotics while serving in Southeast Asia, many stopped without aid on their return to the United States. They returned to normal living by reconnecting with schools, families, churches, and other social support structures that provided the psychological nourishment psychoactive drugs only simulate. After detoxifying, a large percentage walked away from drugs, or used them only intermittently for recreation. Surprisingly, full recovery did not require abstinence. Although nearly half of Vietnam veterans who became addicted tried narcotics again after their return, only 6% became readdicted.” (The Addiction Counselors Desk Reference, Coombs and Howatt, 2005)

Physically and Psychologically Dependent

“Unlike Vietnam veterans, individuals in this condition cannot simply walk away from their addictions and resume a normal life. They depend on psychoactive drugs to cope with life. When the reward-pain ratio shifts and unpleasant and disruptive events accelerate, rather than discontinuing the drugs as Type 4 users do, they increase the dosage, switch to other drugs, or try to titrate various substances. Instead of blaming drugs for their spiraling decline, they regard

them as the solution and often mourn their loss just as one mourns the death of a loved one.” (The Addiction Counselors Desk Reference, Coombs and Howatt, 2005)

Type 5 users have become fully dependent on the drug and cannot return to being a social user. This is the kind of solution that AA and other 12-step fellowships offer. Complete abstinence is the cure for this obsession of the mind and allergy of the body.

Besides the physical consequences that comes with physical dependence, the psychologically dependent user is completely hooked and obsessed with the next fix. Drug-seeking behaviour becomes a survival instinct and users of this type will continue to use and self-medicate their feelings.

Even guilt or a desire to stop can cause the psychologically addicted user to reinforce his use as he tries to escape the feeling of impending doom and hopelessness that comes with abuse, hoping he can dig down and out of the hole he has found himself in.

These users might try to stop, but cannot do so without a healthy support system and a program. Relapse is common among this kind of user, and this condition is the most severe.

If the Type 5 user does go back to trying a mind-altering substance in a social setting relapse is almost certain as they cannot stop once they start. As the AA adage goes ‘1 is too much and a 1000 never enough.’

Unlike other categories of users the Type 5 user has a permanent, chronic chemical dependence and left untreated will almost inevitably lead to debilitation or death.

Reach Out

If you believe you might have a substance use disorder or fall into one of these categories, reach out today. There are so many options available, you do not have to do it alone. Contact us on 0653703806 or via email.

You are not alone.

Finding Help: The Matrix Model

Finding Help: The Matrix Model

by | Jul 8, 2024 | Articles, Counselling, Therapeuo, Treatment Modalities

The Matrix Model is a highly structured 16 week program originally developed in the 80’s to treat stimulant dependent users. It was originally developed as a response to the growing problem of cocaine addiction and is still one of the most effective approaches in the treatment of stimulant (eg. cocaine and methamphetamine) abuse. During a time where most rehabilitation programs and centers were geared towards addressing heroin and alcohol abuse, focusing on 28 day in patient programs and relying heavily on the twelve step fellowships, the Matrix model was thought to be a more targeted approach to benefit this new group of users who had started showing up at treatment facilities all over Southern California.

Built on empirical evidence from clinical studies this mode of treatment has been proven to be effective in reducing the use of alcohol and substance abuse as well as improvements in psychological indicators.

Where many other treatment plans find their basis in a singular psychological orientation, the Matrix Model is an integrative approach which makes use of a variety of treatment styles and methods.

This includes CBT (Cognitive Behavioral Therapy), motivational interviewing, behaviorism, supportive person centred therapy, family/couples/marriage counseling, group therapy with an emphasis on social skills and twelve step fellowship meetings.

Being highly integrative and adaptable the Matrix Model can be customized to suit the individual client. Incorporating the most effective tools and facets of various approaches this treatment model is proven to be highly successful in treating those who are new to recovery and those who have not found other approaches helpful.

The methods are tried and tested for their appropriateness and effectiveness in the population being treated.

The focus of this treatment model is to teach individuals about addiction and recovery, to prevent relapse and to teach social skills, especially within a drug-free environment. This approach also encourages family members to participate in the recovery of their loved through education and counseling – whether group, family, marriage or individual counseling.

Relapse prevention and contingency management is often prioritized. In contrast to alcoholics, those who use cocaine or other stimulants often have shorter histories of use, experience periods of abstinence followed by relapse and are generally not in denial of their addiction. Since the craving the client experiences for the stimulant in question can be so overwhelming contingency management and relapse prevention is a key issue in this approach to therapy.

To encourage participation and program compliance this outpatient program also includes weekly drug testing over the course of the 16 week period to monitor and assess recovery progress.

The most common incarnation of this treatment model is as an outpatient program meaning that clients will come in weekly to the treatment facility or provider and then return home.

Some studies have observed:

  • A 1985 pilot study found that users who chose the Matrix Model program over a 28-day inpatient hospital program or a 12-step group showed lower rates of cocaine use 8 months after they were treated, compared to those who participated in those other types of treatment.
  • Another study of methamphetamine users who were treated using the Matrix Model found that this group had significantly reduced their meth and other drug use 2 to 5 years after treatment. Many of these people also had also become gainfully employed and stayed out of jail.
  • A 48-session alternative Matrix Model program for gay and bisexual men who abused methamphetamines found those who participated were less likely engage in risky sexual behaviors (due to their reductions in drug use), an important factor in preventing the spread of HIV.

The Matrix model can also, as previously asserted, be adapted to treat other substance use disorders as well.

A Matrix Model therapist must be properly acquainted and familiar with a variety of styles and therapeutic methods while also being adaptable.

The most appropriate kind of therapist/counselor would be someone who is experienced in CBT, motivational interviewing and the physiology as well as pharmacology of addiction.

Since this treatment model is non-confrontational the therapist will often take on the role of a teacher or coach, and it will be his/her duty to create a safe space – free of judgement – an environment based on openness and positivity. Empathy and a solid understanding of the clients needs is of the utmost importance.

The therapist facilitates group, individual and family counseling sessions, encourages attendance and participation in 12 step groups, engages the client in notions of CBT to understand connections between thoughts, feelings and behaviors as well as coordinating with other therapists and social services to see to the needs of the client.

The therapist is also there to praise and reward desired behavior and to provide consistency and structure to the client’s recovery journey.

Since this is an intensive program it would require that the client participates daily – attending formal therapy more or less three days a week and informal treatment like fellowship meetings on every other day.

The main components of the program are as follows:

Individual Therapy Sessions: These sessions often involve treatment planning and checking in to assess the client’s progress in the program. It may also invole family members or significant others.

Early Recovery Groups: These groups are for individuals in the first few months of sobriety and aims to build a support community for the recovering addict while also teaching valuable social skills and coping mechanisms.

Relapse Prevention Groups: In these sessions users focus on learning strategies to maintain their sobriety. These groups are very organized and the curriculum includes 32 different topics on preventing relapse. Such as changing behavioral patterns, altering ways of thinking and getting involved in 12 step fellowships.

Family Education: Usually facilitated as a therapeutic group, these sessions take place over the course of 12 weeks and teach family members about the physiology of addiction, the health affects of drugs, the conditioning of addiction and the effects of addiction on the family.

Social Support Groups: In the last month of treatment the client will attend these group sessions to focus on finding drug-free activities and healthier drug-free relationships.

Twelve Step Meetings: An integral part of most approaches to the treatment of SUD is introducing participants to the 12 steps and encouraging them to attend meetings. Some programs even have onsite meetings.

CBT/Cognitive Behavioral Therapy: CBT is a type of therapy which aims to help users understand how their thoughts influence their behavior. They learn how to replace negative thoughts that can lead to self-destructive behaviors with positive thoughts and healthier behaviors.

Motivational Interviewing: A counseling technique which is used to identify the users motivation for getting clean and make positive changes in their life. The therapist/client relationship is a partnership, and this technique is used to bolster rapport, overcome their resistance to quiting drugs and to encourage the client to engage in their recovery.

Contingency Management: This strategy rewards drug free behavior – such as attending 12 step meetings – or withholding rewards or even implementing consequences for drug-using behaviors – for example, failing a drug test or not taking prescribed medication.

Progress in terms of the program is monitored through goals set during individual sessions as well as random weekly drug testing. The drug testing is imperative to keeping the client accountable and to reward sobriety – it is never used to punish or break down a user.

A failed drug test may indicate the need for more structure in the program.

As stated before, this program is highly adaptable and can be used in a variety of settings and circumstances to provide the appropriate treatment for the individual.

If you need help finding a facility or treatment center you can contact us today.

We are always willing to help you find the right help.

You are not alone.

If you or a loved one is struggling with drug or alcohol addiction phone us today on 0653703806.

 

Stages of Change: The Transtheoretical Model

Stages of Change: The Transtheoretical Model

by | Jun 10, 2024 | Counselling, Therapeuo, Treatment Modalities

Change does not happen over night – it is usually a process.

Developed by Prochaska, Di Clemente and colleagues first proposed the Transtheoretical model in the late 1970’s and drew from various theories and schools of psychotherapy. It evolved as they studied and compared the experiences of smokers who quit on their own and those who required further treatment. It was an attempt to understand why certain individuals were capable of quitting on their own.

In the end it was established that people quit smoking when they are ready to do so.

The Transtheoretical Model focuses on the processes and stages involved in the decision making of the individual. It can be seen as a model of intentional change.

The assumption is that people do not just wake up one morning and change behaviors or thinking patterns – there is no quick fix and decisions often take some time. Change occurs, especially in terms of habitual behaviour, over time through a continuous, cyclical process.

The Transtheoretical Model, or TTM, has proven effective in helping with smoking cessation, treatment of alcohol abuse and the reduction of domestic violence. It has also been used to encourage compliance in hypertension mediation, and in regards to condom use under at risk populations, organ donation and needlesharing.

This model is highly adaptable and therefore has been used in a variety of settings. It can be adapted to the needs of the individual.

It is used by health promotion organizations, hospitals, addiction programs and corporate settings. TTM is considered the dominant model in the field of behaviour change, although it has received some criticism. These criticisms do seem to be more in regards to the more practical applications of the model, but for our purposes – that is to understand the decision making process of the addict or alcoholic, it proves sufficient.

The model relies on four key core constructs, self-efficacy, decisional balance, the stages of change and the processes of change.

For an individual to progress through the changes of stage the following needs to happen:

Self-Efficacy – The individual must have confidence that they can in fact make and maintain the change in situations where the temptation of relapse exists.

Decisional Balance – the individual must have a growing awareness that the advantages of the target behavior outweigh the disadvantages thereof.

Processes of Change – Strategies to help the individual make and maintain the change.

Stages of Change

In the Transtheoretical model change is considered a process involving progress through various stages. (Prochaska, 1997)

This means an individual will move from one stage to the next until action is eventually taken and maintained. Although researchers have tried to quantify this progression in terms of a time-frame it is often the most critiqued facet of the model. Because some individuals can take longer in making a decision, or act quicker, it is near impossible to accurately put a time-frame to the process.

The Stages of Change as proposed by Prochaska are:

  • Precontemplation (“not ready”) – “People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic”
  • Contemplation (“getting ready”) – “People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions”
  • Preparation (“ready”) – “People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change”
  • Action – “People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours”
  • Maintenance – “People have been able to sustain action for at least six months and are working to prevent relapse”
  • Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

The Preparation and Termination stages were originally excluded but added later, and relapse was originally considered one of the stages as well, but later came to be a return from Action or Maintenance to an earlier stage.

Prochaska and his colleagues concluded that interventions to change behaviour are more effective when they are ‘stage-matched’ – that is to say, appropriately matched to the individual’s stage of change.

Self-Efficacy

Self-Efficacy can be described as “the situation-specific confidence people have that they can cope with high-risk situations without relapsing to their unhealthy or high risk-habit”. (Prochaska, 1997)

According to Bandura self-efficacy refers to an individual’s belief in his or her capacity to execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997).

It affects every area of human endeavour. It determines the beliefs we hold regarding our power to affect or change situations – and therefore influences the power a person has to face challenges competently as well as the choices we are likely to make.

Individuals with a strong sense of self-efficacy tend to see challenges in life as something to be mastered – eg. grabbing the bull by the horns – rather than a threat to avoi, or rather, running away from the “bull” altogether.

A strong sense of self-efficacy leads to a more positive outlook on life, fosters a sense of accomplishment and a better sense of personal well-being. People with a high level of self-efficacy are more resilient and recover from failure easier. They tend to handle setbacks like molehills rather than mountains. They are also more likely to attribute failure to a lack of effort, approaching even threatening situations with a belief that it is within their control. These characteristics have been linked to lower levels of stress and lower vulnerability to depression.

People with lower levels of self-efficacy tend to lose faith in their own abilities after failure or a setback. They tend to look at the skills they don’t have rather than the skills they do have, and difficult tasks are often taken as personal threats and avoided.

Self-efficacy plays a role in our decision making process – it determines whether or not we are ready to take action to facilitate the necessary change in our lives.

Higher levels of self-efficacy do not necessarily imply success – for example, the student who believes he is ‘good at languages’ and can be described as over-efficacious will be likely to study less and even fail in an academic setting. Where self-efficacy is important is not in its ability to lead to success, but to change.

Greater levels of self-efficacy lead to greater changes in behaviour.

It measures the confidence a person has to act and change a harmful or problem behaviour.

Decisional Balance

Decisions are not always simple and easy. There might be a lot of things to consider – one desicion could have both positive and negative impacts on your life.

Irving Janis and Leon Mann introduced the phrase ‘decisional balance sheet’ in 1959 and used the concept to look at decision making. It was later used by Prochaska in the development of TTM and suggested that, in general, for people to succeed at changing their behavior, the advantages of the change should outweigh the disadvantages before they move from Precontemplation to the action stage.

In TTM the Decisional Balance sheet is not only an informal measure of readiness for change but also an aid for decision making.

When dealing with an alcoholic, for example, the concept of decisional balance can lead to personal insight. Asking the alcoholic what they might see as the pros of drinking versus the cons is often more effective than bluntly asking them to think about the negative aspects of the problem behaviour as this might foster psychological resistance later in treatment.

In weighing the pros and cons of a behaviour, or future change, we are forced to really examine what would be best for us and the ideal self we are striving towards.

The more the advantages outweigh the disadvantages the more likely the individual is to make the necessary change.

It is therefore then counselors job to help the client understand the pros and the cons of a decision and lead them to action to quit, replace or abstain from harmful behaviour and engage in more positive behaviour.

As the individual moves through the different stages of change we see a gradual change in attitude before the person acts. Most of the processes of change are aimed at evaluating and reevaluating as well as reinforcing specific elements of current and target behaviors.

Processes of Change

Defined as the covert and overt activities and experiences that those attempting to modify problem behaviors engage in, the processes of change are broad categories encompassing multiple techniques, methods and interventions.

For example Stimulus Control which is the control of situational and other triggers which might cause relapse includes multiple interventions such as adding stimuli that encourage alternative behaviors, restructuring the environment, avoiding high risk cues, or fading techniques.

As with the rest of the model, the processes are drawn from various disciplines and theories and adapted to the individual.

Although there were only 10 processes originally, as proposed by Prochaska et al, helath researchers have extended the original with 21 additional processes.

The original 10 are outlined below:

  1. Consciousness-raising (Get the facts)

  2. Dramatic relief (Pay attention to feelings)

  3. Self-reevaluation (Create a new self-image)

  4. Environmental reevaluation (Notice your effect on others)

  5. Social liberation (Notice public support)

  6. Self-liberation (Make a commitment)

  7. Helping relationships (Get support)

  8. Counterconditioning (Use substitutes)

  9. Reinforcement management (Use rewards)

  10. Stimulus control (Manage your environment)

These processes are used by those wanting to effect change in their lives in various ways and in various combinations, adapted to the individual.

As a whole, drawing from a multitude of theories, schools of thought and approaches to therapy, the Transtheoretical Model provides us with a framework to not only understand the driving factors behind decision making and change, but also a place from which to offer hope and encouragement towards a new way forward.