By Claudia Black, Ph.D., Senior Fellow and Clinical Architect of the Claudia Black Young Adult Center at The Meadows
Triggers are specific memories, behaviors, thoughts and situations that jeopardize recovery - signals you are entering a stage that brings you closer to a relapse. The process is much like riding a roller coaster that loops over itself. Once the roller coaster car gets to a certain spot in the track, a threshold is met, there is no turning back, and it starts the downward loop. Just as gravity has a motivating effect on a roller coaster, brain chemistry has a similar effect motivating triggers. When people use substances or engage in escape behaviors the brain releases neurotransmitters such as adrenaline and dopamine that trigger the brain’s pleasure/reward center; or it may release serotonin which lessens anxiety and depression.
Will power alone is not a defense against a relapse. Recovery is achieved, maintained and enjoyed through a series of actions. Learn to identify your triggers, and with each one identify a plan that anticipates and de-escalates the power of the trigger. With that, your reward is another day of sobriety and endless possibilities.
Romanticizing involves a tunnel focus only on the positive feelings you associate with the behavior, it is glamorizing using behaviors and in the moment totally forgetting about the negative consequences.
Getting overwhelmed at times is to be expected, but it’s very easy to slip into romanticizing without any insight as to how you got there and at that moment you enter a slippery zone, touching the trigger. While romanticizing is in and of itself a trigger, it is often in tandem with an external trigger such as noises, sights, sounds or even tastes. You could be watching a movie and the next thing you know it is depicting the power of alcohol, drugs and sex in a positive way and you are off into romanticizing. Or you’re listening to the radio and an advertisement for a drug comes on, and you think about your pain pills as the commercial goes on to tell you how much better you’ll feel, and off you go. Or you’re watching a ball game on TV and as you watch you can almost smell the popcorn and peanuts and you see the spectators drinking large cups of beer and everyone is smiling like it’s only a good time.
Take a few moments to think about how you romanticize your addictive behavior: What do I find yourself thinking about? What is the romanticizing covering up? What am I forgetting to take into account?
Recovery is the ability to tolerate your feelings without the need to medicate, engage in self-destructive or self-defeating behaviors and thoughts. Addicts have used their behaviors and substances for years to separate from their emotional states. And there is so much to feel about—guilt for how your behavior has hurt others; sadness for your losses; anger with yourself; fear of what is in front of you; shame for thinking you are inadequate, not worthy. You can act out in response to every feeling imaginable.
Any person or situation can trigger threatening feelings. You are upset when you realize your friends are reluctant to include you on a weekend outing because you created a scene last time. You want the people you work with to like you but you are anxious that you will be rejected, or not welcomed. Your sister won’t let you babysit her kids anymore and you feel guilty, sad and angry. You just met with your ex-wife and you walk away angry, like always when you see her.
You are working hard in your recovery and you know you are doing pretty well, but it still isn’t easy to have these feelings and not be reactive. You lessen or get rid of feelings when you own them, talk about them, or in some cases engage in problem-solving. It is when you try to divert, ignore, and numb that you get into trouble. Feelings are a part of the human condition and you can’t escape them, so the goal is to learn how to tolerate the feelings.
Recognize the gifts that come with feelings. Feelings are cues and indicators telling you what you need. Loneliness tells you in your humanness you need connection, fear can offer you protection, sadness offers growth, guilt is your conscious, offering direction for amends. It is critical for you to have this insight, and more importantly to start to take ownership of recognizing the feelings when you have them. It is vital to learn how to be with the feeling and how to appropriately express it. It is also necessary to find safe people in which to share your emotional experiences.
So when you recognize your feelings ask yourself …
What do I need? What feelings are ones I go to any length to avoid? What is the price you pay for hiding or masking those feelings?
Coupled with the trigger of feelings is the fact those feelings are often associated with loss. By the time you get to recovery you have had multiple losses in your life, often losses related to childhood, many times due to being raised with abuse, addiction, mental illness, etc. While you may have experienced trauma within your original family, the pain of loss may be from a specific situation; You may have experienced the loss of relationship with your parents or children; or the death of friends, family; or abortions, career or work opportunities missed. As an addict, you are likely to have losses related to health issues. Perhaps you have Hepatitis C, or HIV, or injuries due to accidents.
The goal is not to dwell on your losses, but to not live in the pain and anguish of them which is what happens when you don’t acknowledge them and what they mean, triggering you back to your using behavior. With some loss, you can only grieve, and ultimately come to find some meaning from your experience, with others in time, you can attempt to repair damaged relationships.
Resentment is also a feeling but I think it warrants its own place as a significant trigger. Resentments are often built on assumptions, When you don’t look at me I assume you think you are better than me. When you don’t include me in a social gathering, I am assuming you think I am not good enough to be with you and your friends. They are also built on entitlement, which is a form of unrealistic expectations and impatience. For example:
I have been in recovery six weeks now. I resent the fact that my wife still doesn’t trust me. Now that I am clean and sober my boss should give me that promotion I deserve.
The attitude in both examples is not just that you should be rewarded for doing well, but that you should be rewarded for the sacrifices made. After all, you have given up your alcohol, your drugs, and/or the addictive behavior and therefore deserve to be rewarded. The problem here is that you are still more connected to the loss than to the gifts of sobriety. Ways to move from resentments are – when assuming, check it out; put yourself in someone else’s shoes (it may allow expectations to be more realistic); identify and own the feelings the resentment is covering (often it’s a cover for feelings of inadequacy and/or fear); be willing to live and let live.
Some questions to consider:
What does it mean for me to hang onto resentments? What would it mean to accept that I have been hurt or wronged and that I can no longer change that? What does it mean to take responsibility for my own feelings? Ultimately who pays the price for hanging onto resentments? Today am I willing to let go of resentments?
You need to identify specific triggers that are people, places, and situations that are high risk. Slippery people could be your ex-lover, certain family members, past using/party buddies. A slippery place might be a bar you used to frequent, a casino or an area in your community where you cruised. Slippery situations could be an emotionally charged social gathering, such as a wedding, a family event, or vacation setting. In essence, any place that triggers a positive association with the use of your drug of choice.
Medication may be also a trigger for which you need to be accountable. While there are situations where medication is needed, you are at high risk of abuse. You need to be proactive in how you are going to cope with this situation because it is likely your brain is going to remember a good feeling, saying more is better. Just because you are agitated, doesn’t mean you need a prescription pill. Again, there are situations where medications are necessary, but self-diagnosis and/or self-prescribing only create a recipe for disaster.
What are the people, places or situations that are potential triggers? What creates the greatest safety for me to not get triggered? What triggers can I avoid? If I can’t avoid a certain place, can I lessen the contact or time? Is going into this slippery situation worth the risk?
While some decisions around triggers are absolute, others are not necessary for your entire life. Know your triggers and make a plan accordingly. In the face of a trigger, what do you need to do? What do you need to tell yourself? Who can you reach out to for support and or problem solving?
1) Practice staying in the present, don’t sit in the past or project into the future
2) Validate the gifts of recovery for the day – practice gratitude daily
3) Identify, build and use a support system – you need to stay connected. History and experience has proven time and time again, that recovery is not a solitary process, and cannot be sustained in isolation.
4) Trust your Higher Power is on your side
Whether you are new to treatment or transitioning from inpatient treatment, you may need a program that helps you to build skills for maintaining your sobriety. In addition to its “mainstream” intensive outpatient program, The Meadows Outpatient Center offers a program designed specifically for young adults, ages 18 – 26. The Claudia Black Young Adult Outpatient Program is designed to foster the development of the individual while helping them build skills to prevent relapse as they transition into a more fulfilling and self-sufficient life. Call today for more information: 800-244-4949.
On Friday, June 24, 2016, The Meadows will celebrate its 40 years of excellence in helping patients struggling with addiction and behavioral health disorders. An open house event will take place at The Meadows Outpatient Center in Scottsdale, Arizona from 11 a.m. – 4 p.m. MST.
There will be several guest speakers on-hand to talk about The Meadows’ legacy and its impact on the gradual acknowledgment throughout the behavioral health community of childhood trauma as a key factor in addiction and other disorders.
The Meadows was one of the first addiction treatment programs in Arizona. When the first patient was admitted on June 18, 1976, the program was focused primarily on alcoholism and was geared toward men.
In the 40 years since, The Meadows has expanded to treat both men and women with a wide variety of addictions, trauma, and mental health issues. It has also added several specialty programs including Gentle Path at The Meadows for men struggling with sex addiction; The Claudia Black Young Adult Center for people aged 18 – 26 with addiction and behavioral health issues; Remuda Ranch at The Meadows for women and girls with eating disorders; and The Meadows Outpatient Center for those who need treatment in an intensive outpatient setting. They also recently opened the Rio Retreat Center at The Meadows where they host five-day intensive workshops exploring a wide range of emotional growth, relationship, and personal growth topics.
Throughout the years, The Meadows has also stayed on the cutting edge of treatment modalities. From the beginning, they were one of the first to recognize childhood trauma as a root cause of addiction and behavioral health disorders and pioneered treatment methods for helping patients overcome their trauma and harmful self-beliefs. Still, to this day, they are often among the first to add the latest, scientifically proven methods for helping patients regulate their emotions and overcome their addictions and disorders—methods like EMDR, Somatic Experiencing®, and most recently, neurofeedback through their cutting-edge Brain Center.
“It is hard to find an area of mental health or addiction recovery that hasn’t been influenced in one way or another by The Meadows,” says Sean Walsh, Chief Executive Officer. “When I think of the thousands upon thousands of patients and families whose lives have been forever changed as a result of The Meadows it is an overwhelming and very humbling experience. The Meadows history and legacy inspires me to strive every day to ensure we are pursuing excellence and that we do all we can to be a source of hope and light to those we are honored to treat.”
To RSVP for the 40 th Anniversary celebration, contact Shannon Spollen at firstname.lastname@example.org.
Most psychiatrists and behavioral health professionals agree that addiction is a complex disorder caused by a combination of genetic, environmental, and behavioral factors. It can also vary in intensity; The DSM-5 defines addiction as a spectrum disorder that can be categorized as “mild,” “moderate,” or “severe.” Many other mental health disorders, like depression and anxiety, can be described in much the same way. Because there can be so much variation in the causes and severity of an individual’s disorder, there are varying levels of treatment to meet patients’ differing needs.
Generally speaking, behavioral health and addiction treatment programs can be described as inpatient, outpatient, or intensive outpatient (IOP). The biggest differences among each of the three are in the complexity and severity of the conditions they treat, the length of the programs, and the patients’ living arrangements.
Before you make a decision about treatment, it’s important that you are fully assessed by a qualified professional—a therapist, addiction counselor, psychiatrist, or maybe even one of our Intake specialists. They can give you feedback and help you decide what might be best for you. It is crucial that you make your decision based on what you truly need to be able to reach and maintain recovery. Entering a treatment program that does not match the level of severity you’re experiencing in your illness can put you at a greater risk for relapse and a greater risk of serious harm. Addiction and mental illnesses can be deadly diseases.
Inpatient treatment programs, also sometimes called residential treatment programs, aim to treat the most severe and complex addictions and disorders. They are full-time programs that are usually anywhere from 28 days to 6 months long. They provide patients with a controlled environment in which they can begin untangling the web of physical, emotional, and interpersonal havoc that their out-of-control conditions have wrought.
In an inpatient treatment facility, patients have no access to drugs or alcohol; so, the chances of them relapsing while they are in treatment are extremely low. They live at the treatment center—away from work, friends, and family— so that they can focus exclusively on working through their emotional trauma and behavioral and on developing new coping skills to help them succeed in their recovery.
A good inpatient treatment center will also offer 24-hour access to medical care. (The Meadows’ programs, for example, are certified by the Joint Commission, due to their commitment to excellence in providing medical services.) They also will have experienced well-qualified and credentialed psychologists, counselors, and psychiatrists available to assess patients, develop individualized treatment programs for them, and meet with patients individually and in group settings.
It is also ideal for inpatient programs to have a family component, to extend the healing process to throughout the patient’s family and help them learn how to build a stronger support system for one another. The Meadows has a Family Week, for example, where family members are invited to join the patient on campus and work with them through group and individual counseling sessions.
Outpatient treatment programs are part-time programs usually requiring 4 – 10 hours per week of meetings including individual and group therapy that focus on the development of real-world coping skills for maintaining sobriety. Outpatient programs typically last for three to six months.
Patients who are in an outpatient program can continue to work, attend school, and even live at home; though, sometimes it is recommended that patients stay in transitional, sober living housing where they can get additional support from their peers in recovery and get away from any undue influences enabling their addictions. Meetings and counseling sessions at an outpatient center are typically held at night or in the early morning so that people can continue on with regular daily schedules.
Outpatient treatment is not the right choice for everyone. Addiction professionals typically do not recommend outpatient treatment to those who face a high level of danger from their particular disorders. Outpatient treatment can, however, be a good option for someone with a mild addiction, or for someone “stepping down” from inpatient treatment. Many people in recovery choose to transition from inpatient rehab to an intensive outpatient or outpatient program so that they can practice applying the skills they learned in inpatient treatment to the real-world while still getting the extra support and guidance they need.
Intensive Outpatient Programs (IOPs) fall somewhere between inpatient treatment and outpatient treatment. The main difference between an outpatient program and an intensive outpatient program is the amount of time spent in treatment and related activities each week. Many IOPs require at least 12 hours per week, sometimes more. The Meadows IOP, for example, requires three hours of group therapy per day, four days per week; an individual therapy session each week, and an hour long psychiatry session each week.
IOPs are great for people who need a higher level of care than a non-intensive outpatient program can provide, but whose conditions aren’t quite severe enough to require an inpatient program. They are also great for those who are transitioning from an inpatient program and into full independent living.
Both inpatient and outpatient programs offer services such as individual counseling sessions, therapeutic groups, 12 step meetings and family therapy. A good IOP will also offer a number of additional support services, like weekly individual meetings with psychiatrists, small groups lead by experienced and well-trained therapists, expressive arts, yoga, and more.
Addiction, depression, anxiety and other behavioral health disorders are often described as chronic illnesses; Recovery from them is a continual process. It is not unusual for a person on the severe end of the spectrum to need to complete both an inpatient and an outpatient program. It is also not unusual for a person on the “mild” to “moderate” to scale to need only an outpatient program.
The most important thing is to be honest with yourself about what your needs are. It can be difficult to leave your friends, family, or job behind for a month or more to enter inpatient treatment or to move into sober living housing for an IOP. But, as hard as making that change can be, living with an addiction or disorder if often even harder, both on you and on the people you love. Make sure you get the kind of treatment you need and deserve.
The Meadows has four different inpatient programs in Wickenburg, Arizona helping people overcome drug and alcohol addiction, sex addiction, eating disorders and many other mood disorders and personality disorders. The Meadows also has an Intensive Outpatient Program (IOP) in the beautiful McDowell mountains of Scottsdale, Arizona, that is perfect for those transitioning from inpatient treatment or entering recovery for the first time.
If you need help but aren’t sure where to start, please call one of our Intake coordinators today. They can help you determine which program may be right for you. 800-244-4949.
Natalie felt lost. She didn’t quite understand why, but everything just felt wrong somehow. Even though it was hard for her to admit that she needed help, she reached out.
She found The Meadows Survivors workshop where, for the first time, she began to understand where she came from, where she was going, and where she wanted to be.
Survivors I is an essential component of The Meadows inpatient treatment programs. It is also offered as a stand-alone workshop for anyone who’s interested in learning more about the ways in which self-defeating thoughts and behaviors learned in childhood continue to affect their daily lives.
The intensive, 5-day workshop helps participants identify their specific emotional wounds and understand the impact they have had on their self-esteem, boundary system, level of dependency, and ability to achieve balance and harmony. For more information call 800-244-4949.
“I checked myself in because I think I was at point in my life when I needed something to change…”
These were the words of Michael Phelps, the most decorated Olympian in history, in an interview with Matt Lauer on The Today Show. But, they are also the words of so many people in recovery as they look back on a very difficult time in their lives, and their decision to enter treatment.
Watch the interview here.
Even people who have achieved tremendous success in their lives can have a lot of hidden pain. When left unaddressed, that pain can—and often will—lead to problems with drugs, alcohol, pornography, sex, depression, anxiety, and other behavioral health issues.
Our treatment programs specialize in helping people find the root causes of their daily emotional struggles and develop healthier coping skills for the immense pressures and scrutiny they often face. If you feel that you, or a loved one, are racing toward disaster, give us a call at 1-800-244-4949.