The Meadows Blog

The Meadows Alumni Association is pleased to host monthly alumni workshops in Houston, Texas, for alumni, family and friends. Meadows' trained professionals will lead the meetings May 22 through July 24, 2012, from 7:00 to 8:30pm. It will be held at The Council on Alcohol and Drugs in Houston and no registration is required to attend.

The following is the schedule for the upcoming workshops:

May 22

Doug Sorensen, LCSW, LCDC, CSAT

"Needs and Wants"

June 26

Joni Ogle, LCSW, CSAT and Taruno Steffensen, ICADAC, SEP

"Perfectly Imperfect"

July 24

Cara Weed, LCSW

"Boundaries"

Additional alumni workshop dates will be announced in the future. For more information, contact Betty Ewing Dicken, LCDC, at 972.612.7443 or bdicken@themeadows.com or visit www.themeadows.com/alumni.

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

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Often, during the first week of treatment at The Meadows, people will skeptically inquire, "Do experiences in childhood really continue to affect my life as an adult?" While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and well-being. However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD's, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts. Of course, this resonates completely with our clinical experience and treatment model at The Meadows. However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood. In fact, results such as these have led some people to elevate childhood maltreatment to the level of a "public health threat". Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment). Over fifty years ago, John Bowlby (the "father" of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

One way that attachment security may contribute to positive health outcomes is by fostering an open, flexible, and optimistic approach to life's diverse and often unpredictable challenges. The development of such a resilient approach to life may come about as repeated experiences in secure attachment relationships organize and optimize emotion-regulation strategies and cognitive representations of self and others (i.e., internal working models). Consistent with this view, attachment insecurity has been associated with rigid, maladaptive responses to environmental demands and difficulties in appropriately understanding, expressing, and regulating emotions.

As a central feature of attachment theory and resiliency, the regulation of emotion may be an important variable linking childhood adversity to the various mental, emotional, physical, and social problems described in the ACE study. To address this clinically relevant question, my mentor and esteemed colleague, Phil Shaver, and I conducted a research study2 that has been accepted for publication in the journal of Individual Differences Research. In this study, 388 young adults completed questionnaires regarding adult attachment style (e.g., secure, avoidant, anxious), emotion regulation tendencies (e.g., emotional suppression, cognitive rumination, negative affect, emotional clarity, mood repair), and resiliency (i.e., an open, flexible, and adaptive approach to life).

Consistent with our hypotheses, the results indicated that, compared to attachment security, the two dimensions of attachment insecurity (i.e., anxiety and avoidance) were associated with lower levels of emotion regulation and resiliency. Interestingly, attachment-related anxiety and avoidance were connected to these outcomes through distinct cognitive-emotional pathways. For example, people scoring high in attachment-related anxiety reported a greater tendency to ruminate on negative thoughts and experience negative emotions, while people scoring high in attachment-related avoidance frequently relied on suppression of emotion and reported problems in clearly understanding their emotional states.

These results are very congruent with general theories on attachment and with my clinical experience at The Meadows. Attachment-related anxiety (similar to Love Addiction in The Meadows model) is characterized by hyperactivation of the attachment system, involving energetic and insistent attempts to attain proximity, support, and love. Generally, these individuals are hypervigilant to possible relationship threats (i.e., rejection or separation) and respond to such threats with intense mental rumination and high levels of negative emotion (e.g., anxiety, fear, shame, or anger). On the other hand, attachment-related avoidance (similar to Love Avoidance) involves deactivation of the attachment system, inhibition of the quest for support, and a commitment to deal with threats alone. These individuals divert attention away from possible relationship threats and tend to suppress their emotions, which contributes to a lack of understanding about the nature of their emotional states.

In contrast, repeated experiences with sensitive and responsive attachment figures increase a person's general sense of safety and security and foster optimistic beliefs about others' trustworthiness and one's own ability to effectively manage distress. Security-based strategies integrate cognitive and affective processes so that emotions can be openly acknowledged and clearly understood, while at the same time, metabolized and expressed without one's becoming excessively distressed or disorganized. In summary, the results of our study suggest that secure attachment relationships optimally organize emotion regulation capacities in a manner that enhances flexible adaptation to life's demands. This relationally acquired resiliency may be underdeveloped in people who have experienced childhood adversity and may contribute to diminished health and wellness.

Fortunately, recent evidence suggests there is considerable plasticity in the neurobiological systems underpinning social-emotional processes, which means there can be meaningful changes in emotion regulation and intimate relationships. Therefore, people who have experienced childhood adversity and relational trauma are not destined to experience the negative outcomes described in the ACE study. In fact, many professionals think of the alliance between therapist and patient as a type of attachment relationship where the capacity for emotion regulation, intimacy, and resiliency can be cultivated in an environment of safety and security. Treatment is available and there is hope for recovery.

1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks, JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 1998;14:245-258.

2. Caldwell JG, Shaver PR. Exploring the Cognitive-Emotional Pathways Between Adult Attachment and Ego-Resiliency. Individual Differences Research, 2012 (Manuscript accepted for publication; available upon request).

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The Meadows is pleased to announce a contract with TriWest Healthcare Alliance, a sub-contractor of TRICARE health program. Under this agreement, The Meadows has become an approved TriWest provider for behavioral health and substance abuse inpatient services to eligible beneficiaries.

The TriWest Healthcare Alliance is contracted with the Department of Defense to administer the TRICARE West Region program in the 21-state region. As an approved TriWest provider, The Meadows' inpatient substance abuse and psychiatric services are now available to nearly 2.9 million military members, retirees and their families. The convenient location of The Meadows, just 1.5 hours north of the Phoenix airport, offers easy accessibility to soldiers and their families. This could prove to be extremely beneficial to beneficiaries associated with the seven military bases located in the state of Arizona.

"We are confident that the impeccable reputation of The Meadows combined with our breathtaking campus and state-of-the-art treatment was a critical factor in choosing The Meadows as a network provider," stated Jim Dredge, CEO of The Meadows. "The Meadows has a commitment to servicing our heroes. We have enormous gratitude to those who protect and defend our freedom. It is a great honor to be a network provider for active duty, families and retired enrollees of the TriWest program."

According to Dr. Jerry Boriskin, a Senior Fellow at The Meadows and a consulting expert to the Veterans Administration, this contract is significant because there is a benefit to having as many options available in the various sectors due to the need for occasionally higher levels of care.

Dr. Boriskin, who has worked with the veteran population for 30 years, commented that "The core challenge is to get the veteran or the civilian, for that matter, to work on acceptance, forgiveness, and most importantly self-forgiveness because things were out of control and they were horrible."

Dr. Stephen Brockway, Chief of Psychiatry at The Meadows, explains that treatment for the veteran allows a move to take place from "It's me against the world" to "There are others like me" to "I'm part of the community again."

To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers or in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

Published in Blog
Monday, 19 March 2012 20:00

What Caused Sgt. Bales to Snap?

A group I facilitate for Vietnam Veterans struggled with this question even before the name of the accused sergeant was released. Violence, injury, death and war stir intense emotions in all, particularly among veterans who have been up close and personal. The issue of atrocity and slaughter of civilians is, naturally, an incredibly intense and sensitive subject.

My group members wrestled with this for 90 minutes; most had extreme empathy for the cumulative damage war has upon warriors. They could not even begin to grasp the immense pressure put upon younger soldiers, some of whom serve three, four, and up to nine tours. They/we are humbled by shocking reports of soldiers committing sudden violence, some of which is toward family, but more often towards self. They embraced the contributing factors that need be considered: alcoholism, traumatic brain injury, post traumatic stress disorder (PTSD), financial problems, issues of unemployment, possible relationship problems, a passed over promotion, an unwanted next tour, recent injury, and experiencing the wounding or killing of fellow warriors.

Reports indicated that Sgt. Bales was suffering from many of these factors; he was also reported to be highly decorated, a model soldier, and has saved lives of civilians and Americans in some of the hottest conflicts in Iraq. How could a highly trained soldier, a member of an elite unit, trained sniper and leader of men possibly commit such an atrocity? Our group struggled with this question and did not come to a clear explanation. They had empathy and contempt; some launched into politics of the current wars, some blamed the military for too many rotations, some defended the military, others discussed the role of combat, loss of recent friends, PTSD, alcohol, and tbi (traumatic brain injury). The discussions were intense and a few favored certain factors, but no consensus or full explanation was derived.

One thing we did derive: in certain situations our usual narratives fall apart. If the conditions are right, we are all capable of sudden violence or extreme behavior. The media will no doubt speculate on which factor(s) were critical in this current horror. Forensic experts will attempt to definitively opine, but we may never fully know why this particular soldier "snapped" in such a dramatic and horrific fashion. Thousands of soldiers carry the burdens of war. Most struggle in silence and harm no one, and if they do injure anyone, they hurt or punish themselves.

We may never know the full explanation of what went wrong. My personal speculation is that alcohol played a large factor. It is the most common variable in violence: domestic, self or toward others. It also works in tandem with PTSD and traumatic brain injury. What will probably emerge is a complex picture of a determined and accomplished soldier worn down by many variables, military and domestic. Early reports suggest Sgt. Bales and others were drinking heavily that evening, against military rules. Those early reports also suggested drinking to levels of blackout. Sgt. Bales allegedly had a drunk driving hit and run episode while stateside. Whereas not the sole factor, alcohol might have been the "tipping point". Alcohol is a common way of "self-medicating" or "de-stressing", but it can have an almost "evil" impact in unleashing primitive emotions. In fact, it is a common but often understated factor in the surging suicide numbers in young soldiers. Alcohol has a long history of violence in so many settings, especially the home. Unfortunately, we continue to deny alcohol's power or even its presence. Mr. Bale's attorney alleged his client had not been drinking.

We will know more as facts emerge, but we may never fully grasp what went wrong or why. We do know that war is ugly; it changes people and distorts mind, body and soul. The results of war can make you feel "untouchable" and unique. My hope is that veterans or military personnel reading this blog will recognize that their worst fears are not reflected in the rare disasters. Most people, even civilians, have a fear of "snapping". Exposure to the horrors of war intensify that fear beyond that which most observers can express or comprehend. The vast majority of those who develop PTSD do not snap. Instead, they suffer quietly and deconstruct their lives. PTSD, especially with co-occurring addiction, is complicated and destructive, but highly treatable. Recovery requires Sleep, Safety and Sobriety, the three "S's" that are the first steps in separating you from the demons of war.

Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness.

For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.

Published in Blog
Sunday, 30 January 2011 19:00

Why Extended Care?

by Kathy Golden, Director/Manager of Extended Care at The Meadows

Most people seem to come to primary treatment because they are sick and tired of being sick and tired. When they near the end of their primary treatment, the counselor starts recommending extended care. The client may think, "I can't do this. I have a job; I can't afford to spend the money. I don't want to spend more time away from my husband, children, family..." They feel the best they've felt, perhaps in many years, and can't imagine why they need to continue treatment. I always ask my clients to consider treatment as one little inch out of the mile that is life. Clients most likely have spent years developing acting-out patterns, being depressed, wondering why they are so reactive to things that don't seem to bother other people, being filled with shame that they continue to sabotage their lives.

I ask them: "Do you think you have completely addressed all of your issues in the space of 29 to 35 days? Do you believe that you have worked through all of the trauma issues that have developed throughout your life journey?" The "pink cloud"that most people have as they near the end of treatment soon dissipates as they hit the real world and the reality of their life journey. They may have changed, or at least begun to make changes, however their best friends haven't changed with them. Those co-workers they can't get along with haven't changed or been to treatment. Perhaps their family attended Family Week sessions and has good intentions, without the benefit of 30 days in treatment.

The benefits of extended care can be immeasurable. They provide the chance to continue to address trauma issues, solidify the best relapse-prevention plan possible, encourage necessary self-examination, and provide time to incorporate the tools learned in primary care so they become a new way of life- a life of recovery and health. Extended care allows a recovering person to transition into the real world through supported outside activities, outside 12 Step meetings, a relationship with a sponsor, Step work, limit setting, and structure development. Those with co-occurring disorders can benefit greatly from extended care; the extra time, support, and scope of an extended-care treatment process can make a significant difference.

Statistics show that, the longer a person can remain in extended care, the lower the probability of relapse. In a study by Castle Craig Hospital, 48 percent of those who completed a recommended period of continued treatment had "maintained unbroken continuous abstinence (from all drugs including alcohol and cannabis), and a further 14 percent were in a good outcome category, abstinent at the time of follow-up. The abstinent and improved outcome figures for this group of treatment completers was 62 percent. The results, therefore, for this group of clients who completed an average of 17 weeks in extended care are very good indeed."

Extended care at The Meadows helps a client develop a personalized treatment plan, continue trauma-reduction work, and settle into a new life of recovery. We recommend a minimum 90-day stay: 30 days in primary care at The Meadows and another 60 or more at Mellody House, Dakota, or The Meadows Texas. Each of these facilities addresses trauma reduction through use of Pia Mellody's model. Additionally, Dakota helps clients continue to address compulsive sexual behaviors, while The Meadows Texas provides a safe place for women to continue their recovery journeys.

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