Self-medication and PTSD: A Path to Greater Complexity and Addiction?
Readers familiar with their own journeys or observing the struggles that loved ones endure know that PTSD symptoms sometimes demand immediate relief. Mood-altering chemicals, especially alcohol and marijuana, often provide temporary relief from anxiety, anger, depression, and other "limbic" surges. For many, alcohol and marijuana "take the edge off." They numb intense feelings, appear to quiet repetitive thinking, and afford some sleep and relief from the aftermath of trauma. In fact, in Western culture, alcohol has been a favored method of "recovering" among warriors, firefighters, and others who engage in vital but dangerous missions. Temporary relief usually comes in the form of "feeling no pain."
Actually, for a small but significant percentage of survivors, alcohol and other chemicals permit relief from the absence of feeling. In other words, getting drunk or high permits some feeling - any feeling - to break through the numbing produced by PTSD. Self-medicating is a devilishly seductive way of managing trauma. Self-medication provides temporary relief - a shortcut with the illusion of healing - but, oh, the price you pay! Alcohol, for example, will add to depression, confuse thinking, poison core relationships and, for some, set off violent behavior. For many, self-medicating will become a full-blown addictive disorder. Instead of one problem (PTSD), they now have two! Self-medication can involve food, sex, and the usual suspects: cocaine, opiates, amphetamines, cigarettes, alcohol and marijuana.
Academics and clinicians differentiate drugs from medicines: Drugs are self-administered without controls for dose, purity, etc. Medicines are taken only as prescribed (but often abused by active addicts). It's an oversimplification to say that all medicines are good, and all self-medication is evil. Many medicines cause harm; benzodiazepines and some sleep medicines can become addictive. However, in the hands of a skilled practitioner, medicines can provide much-needed symptom relief while the patient masters natural techniques that are highly effective in managing PTSD's multidimensional symptoms.
Recovery takes hard work and support. Re-stabilizing one's body and soul requires more than simple, singular solutions, sayings or insights; it is a process we know works. Self-medicating is not only risky, it is often tragic. Too many soldiers and civilians have been further injured by self-medicating. Simplistic, seductive, addictive, compulsive, and self-administered "treatments" too often result in broken marriages, broken careers and broken bodies. Life is hard enough without trauma, and trauma is hard enough outside of addiction.
The path to healing takes work, and work sometimes requires peer and professional support. John Barleycorn and Jack Daniels are not healthy supports or tools for recovery. If you are new on the journey of healing, do not be seduced by the temporary fixes offered by alcohol, drugs or other self-medicating behaviors. Recovery requires new skills. It's a process of integrating and healing, achieving and connecting - not masking, numbing or avoiding. Keep it simple and do not be intimidated, distracted or seduced by the siren song of medicating oneself.
Peter Levine, PhD, Clinical Consultant for The Meadows, and author of Waking The Tiger and Trauma Proofing Your Kids, talks about how parents can help their worried children and "bounce back." Click Here
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness
The Meadows presents Peter Levine, PhD
December 3, 2010 Austin, Texas
Trauma is neither a disease nor a disorder, but is rather an injury caused by paralyzing fright, helplessness and loss. If we enlist the wisdom of the living, sensing body and engage our innate capacity to self-regulate high states of arousal and intense emotion, we can transform trauma and be healed. We will explore the roots of addiction in unresolved trauma, insecure attachment and habitual childhood frustration. Drawing on more than 40 years as a pioneering body-oriented clinician, as well as a parallel study of stress, biology, child development and discoveries in the neurosciences, Dr. Levine shows that it is possible to live life robustly with pleasure and creativity, even in the face of the most painful assaults to our humanity- and in the face of deceptively trivial ones. From an evolutionary understanding of the source of trauma, to a spiritual dimension of how we as human beings can be strengthened by traumatic healing, this journey unfolds- if we learn to attend to the "unspoken voice of the body."
This presentation will teach participants the following:
• To recognize the biological and naturalistic roots of trauma and their implications for treatment.
• To explain how sensate awareness is an important vehicle for regulating high arousal states and intense emotions in transforming trauma.
• To describe the relationship between developmental issues, unresolved trauma and addictive processes.
Peter A. Levine, PhD, Clinical Consultant of The Meadows and Mellody House, has a background in medical biophysics, stress and psychology. He is the originator of Somatic Experiencing®, which he has developed during the past 40 years. He teaches this method throughout the world. Levine is the author of the best-selling book Waking the Tiger and the book/CD Healing Trauma. He is also the co-author, with Maggie Kline, of Trauma Through a Child's Eyes: Awakening the Ordinary Miracle of Healing.
Sheraton Austin Hotel
at the Capitol
701 East 11th Street
Austin, Texas 78701
Self-parking at hotel is included.
5.5 Continuing Education Credits
To Register: http://www.themeadows.org/events/index.php?rm=event_details¶m1=show¶m2=135&
Recently John Bradshaw, Clinical Consultant for The Meadows, and author of three New York Times bestselling books including Homecoming: Reclaiming and Championing Your Inner Child; Creating Love; and Healing the Shame That Binds You, was quoted in an article on NBC's Ivillage with his thoughts about alcohol addiction. See http://www.ivillage.com/once-addict-always-train-wreck/4-a-296860
@Meadowsrecovery is just one more way of keeping in touch to help us ensure that you won't miss out on any content. Come follow us today!
The Meadows Maureen Canning was interviewed twice recently on the topic of sexual addiction.
Maureen first appeared on the Radio Health Journal podcast, an award-wining half-hour weekly radio magazine on issues in health, medicine and society. This program is now available for audio download.
The second interview was done with Bottom Line's Daily Health News, in an article titled "Is anyone you know addicted to sex?"
Published in last Sunday's New York Times (May 4th) is as an excellent article titled High Functioning, But Still Alcoholics.
Chronicled by Times writer Jane Brody, the piece reviews a new book from author Sarah Allen Benton, "Understanding the High-Functioning Alcoholic" (Praeger Publishers), and describes a familiar scenario:
"high-functioning alcoholics are able to maintain respectable, even high-profile lives, usually with a home, family, job and friends. That balancing act continues until something dreadful happens that reveals the truth - to themselves or to others - and forces the person to enter a treatment program or lose everything that means anything."
An excellent article noted by many here at The Meadows.
Note: This article was originally published in the Winter 2007 edition of MeadowLark, the Meadows' alumni magazine.
Spirituality is Something You Are: Forgiving, Loving, Finding Serenity
An excerpt from Changing Course: Healing from Loss, Abandonment and Fear
by Claudia Black, PhD, MSW
When you set out on a new course in your life, the course of recovery, you are on a spiritual path. It is a path that leads to forgiving, accepting, loving, and finding serenity within yourself and with others. This spiritual path promises to lead you from aloneness and emptiness to a sense of connection and meaning in your life.
On this new journey, we are often involved in a process of spiritual growth before we recognize the spirituality of it. Looking back, the turning point came when we allowed ourselves to begin letting go of our fears and defenses to hear the truth:
There is another reality than the one I live.
I want it. This insight led us to learn more about the "other reality" and to learn more of the truth. The truth is that we are all human, both unique and ordinary, filled with dark and light. The truth is that all of our life experiences, whether admitted or denied, form the ground we stand on now. And the truth is that - in spite of our imperfections, our past and present pain, and the roles we've adapted to survive - we now know that we are free to choose how we live our own lives. Realizing this, the victim's passive plea, "Why me?," becomes a new, proactive question instead: "What can I do now?" This shift brings us to another turning point and another awareness:
I am responsible for the choices I make in my life.
When we accept our humanness and exercise our responsibility for making our own choices - for example, choosing what we do when we are angry, lonely, or sad - we are involved in a spiritual process. Our spirituality must be based on a vision that attends to our whole self and honors our whole experience, while at the same time acknowledges that we are accountable in the present for our own feelings, beliefs, and behaviors.
In The Spirituality of Imperfection, Ernest Kurtz writes that we have suffered zerrissenheit, or "torn-to-pieces-hood." Spirituality, as he describes it, is the healing process of "making whole." Spirituality helps us first to see and then to understand, and eventually to accept the imperfection that lies at the core of our human be-ing.
Accepting our human limitation brings us inner peace. What a relief it is to put an end to the fight within ourselves. Also, as we find the permission to be the imperfect beings that we are, we become able to let others be who they are.
The experience of inner peace is foreign to those of us from shame-based families because there was so little peace and harmony in our lives. We didn't have the models that projected unconditional love, acceptance, or gratitude. As a result, we came to believe that if we were anything less than perfect we were inferior and of little value. So, we sought perfection, believing it was our only avenue to acceptance and love.
We were so hurt by the absence of the nurturing we needed to thrive that we have spent a great portion of our lives trying to make that unconditional love happen in the present, hoping somehow to make up for the past. Paradoxically, when we are willing to believe that we cannot change the past, then we become willing to let go of our pain.
Think about the family being a house with many rooms. Our growing up years were lived in our parents' room, which was connected to their parents' room, and their siblings' room, and so on. The present day is the room where we have lived our adult lives. A mixture of experiences has taken place in all of these rooms. Some experiences were good, some caused a lot of pain. We need to realize that all families are imperfect, as all of us are imperfect people. Those of us who don't understand or want to accept that truth remain actively in denial. As Thomas Moore writes in Care of the Soul, "The sentimental image of family that we present publicly is a defense for the pain of proclaiming the family for what it is - a sometimes comforting, sometimes devastating house of life and memory."
To deny or disown any part of our experience leaves us dangerously incomplete and especially vulnerable to our shame. The lifeblood of shame is secrecy, fed by the dark fear of being found out. To grow toward wholeness in the context of our family home, we have to open all the doors and windows to let in air and light. Then for us at last, healing will begin.
"You and I are children of mud, earthy and moist," Jane Smiley writes in A Thousand Acres. "We're not all fire and light - no matter how much we wish otherwise." Facing this truth, we reach another turning point:
It is in the acceptance of all that was and is that our spirits become whole.
Bill Moyers described acceptance as wholeness and health in an interview about his book, Healing and the Mind:
"Health is... a state of mind that recognizes the history of life, which includes moments of great delight and moments of deep sorrow. When we see all these parts of our being as connected, we come to terms with where we come from, who we are and where we're going. Health is a whole."
In the process of becoming whole, we may say we "have spirituality." But spirituality isn't an event or a possession. It's a way of living and being. Spirituality doesn't mean we never get hurt again, or that we are always smiling, always happy, never angry, and never scared. In part, spirituality means that when we are hurt or afraid we can respond without making matters worse. Also, as we change course and take steps on this spiritual road, we are able to enjoy the good feelings of being solidly balanced, open and unguarded, peaceful about the past and generally positive about how we are living in the present.
Note: This article was originally published in the Winter 2007 edition of MeadowLark, the magazine for The Meadows alumni.
Techniques for Managing Post-Traumatic Stress Disorder
By Lara Rosenberg
This article is based on a workshop that Lara gave February 13 - 14, 2006, in Sri Lanka hosted by the INGO RedR. The workshop is focused on staff working with individuals, families, and communities that have experienced or continue to experience traumatic events. It was an introductory workshop of particular value for staff having community experience, but limited or no psychological training. It was assumed that participants had prior knowledge of stress.
Stress affects us in many ways: cognitively, affectively, physiologically, and behaviorally. "Stress" is a broad term. It's part of all of our lives; each individual has his own ideas of how to define it. There are many definitions given to stress, but the important underlying factor is that stress results from a change in one's environment and requires an adjustment. The environmental changes that require us to adapt and adjust are known as "stressors" they can include anything out of the ordinary. Many think of stress as only negative, but it can be positive and necessary to our healthy development. The ways in which we adapt to our environments leave some stimulated and others with feelings of fear, nervousness, and confusion, which lead us to either solve or avoid a problem. Change always brings extra pressure, as individuals have to adapt to new circumstances.
Humans and animals are born with the capacity to react to threatening situations in adaptive ways; the "fight or flight response" allows individuals to experience resilience in response to danger. Bessel van der Kolk (1994) describes the fight response as hyper-arousal or protest and the flight response as freezing or numbing sensations, which allow individuals to avoid consciously experiencing the event.
Trauma is caused by a stressful occurrence "that is outside the range of usual human experience, and that would be markedly distressing to almost anyone" (Peter Levine, 1997). Post-traumatic stress disorder (PTSD) causes one to experience a prolonged or delayed reaction to an intensely stressful event. According to The DSM-IV Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, PTSD occurs when an individual experiences a threat (actual or perceived) of death or serious injury to self or others with a response of "intense fear, helplessness, or horror." PTSD can occur in adults and children from all socio-economic backgrounds. Most people who are exposed to a traumatic, stressful event experience some symptoms of PTSD in the days and weeks following exposure. According to the National Center for PTSD, data suggest that approximately 8 percent of men and 20 percent of women exposed to trauma develop PTSD; of that group, 30 percent develop a chronic form that persists throughout their lifetimes.
The World Health Organization (WHO) states that the prevalence of mild and moderate common mental disorders in the general population is 10% and can increase to 20% after a disaster. As stated by Dr. Daya Somasundaram from the Department of Psychiatry at the University of Jaffna, Sri Lanka (WHO, 2005), "WHO estimated that 50% may have problems and 5-10% have serious problems needing treatment. One [non-WHO] survey found 40% post-traumatic stress disorder (PTSD) in children," referring to people in Sri Lanka. Other data suggest that the mental health burden in Sri Lanka is even higher. Dr. Roy Lubit (2006), as well as Pia Mellody, a pioneer on the effects of childhood trauma, stresses that the full impact of trauma may not be experienced until a child reaches adulthood, engages in adult relationships and responsibilities, and develops more sophisticated cognitive capabilities.
The National Center for PTSD states that one of every three disaster survivors experiences some or all of the severe stress symptoms that may lead to lasting PTSD, anxiety disorders, or depression. Severe stress symptoms are extreme attempts to avoid memories and feelings. In order to numb their emotional pain, individuals will stay unusually busy, withdraw, and exhibit addictive behaviors. Violent behaviors often become prevalent.
Individuals can experience severe depression as part of PTSD, suffering a complete loss of hope, self-worth, motivation, and purpose. Some might experience disassociation, feeling outside of oneself as if living in a dream, or may become vacant for periods of time. Intrusive re-experiencing can occur through terrifying memories, nightmares, or flashbacks. For some, hyper-arousal manifests in panic attacks, rage, extreme irritability, or intense agitation. Other manifestations include severe anxiety, paralyzing worry, extreme helplessness, obsessive and compulsive behaviors, and feeling responsible for the event. Children often re-experience traumatic or stressful events through recurrent memories, nightmares, and play. Some children become very aroused, exhibiting nervousness, irritability, anger, disorganization, or agitation. Children also shun thoughts, feelings, or places that evoke memories of the event. Occasionally, they experience a loss of developmental patterns or skills, separation anxiety, bed-wetting, and learning difficulties. An 8-year old boy in Sri Lanka could not see for 10 weeks after enduring the terrifying experience of the tsunami, in which he lost his mother and home. This example of physical impairment demonstrates the freezing response described by Bessel van der Kolk (1996), as well as Peter Levine (1997) in his Somatic Experiencing® work.
Disaster stress may revive memories of prior trauma; pre-existing social, economic, spiritual, psychological, or medical problems can intensify. Individuals at higher risk for severe stress symptoms and lasting PTSD include those who have been exposed to other traumas, such as abuse, assault, or combat. Chronic poverty, homelessness, unemployment, or discrimination will often intensify the traumatic event, as can chronic illness and psychological disorders.
Most likely to develop PTSD are those who experience stress at a greater intensity, with unpredictability, uncontrollability, and real or perceived responsibility. Factors such as genetics, early-onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events also contribute to the disorder. Those who report a greater perceived threat, suffering, terror, and fear are at risk for developing PTSD, and a social environment that produces shame, guilt, stigmatization, or self-hatred can affect sufferers as well.
Individuals experiencing PTSD face an increased likelihood of co-occurring disorders such as alcohol/drug abuse and dependence, major depressive episodes, conduct disorders, and social phobias. According to the National Center for PTSD, "In a large-scale study, it was found that 88% of men and 79% of women with PTSD met the criteria for another psychiatric disorder." Some experience difficulty in their psychosocial functioning, with profound problems in their daily lives. Concurrent prevalent physical problems include headaches, dizziness, chest pain, and other aches and pains. Often medical doctors treat only the symptoms, without considering PSTD development.
At the same time, stressful or traumatic experiences can facilitate personal growth. In treating sufferers, it is most important to restore safety in their lives, build coping strategies, and reduce pain. It is necessary to find out how they are coping with the situation and stress. Healthy coping mechanisms should be slowly introduced if behavior patterns reflect unhealthy habits such as smoking, drinking, or staying unusually busy. When dealing with disclosure, it is important that a secure and confidential environment is maintained. Humanitarian aid workers should teach survivors of trauma that they are not alone in order to help reduce a sense of isolation and rebuild trust. The aid worker should acknowledge and validate the person's feelings and experiences by offering comfort and support.
Aid workers should assume people are doing their best to cope and should empower them to feel as in-control as possible. Victims should not be asked to reveal emotional information, but if they volunteer it, helpers should listen. Access to mental and physical health services should be provided. In addition to reducing anxiety and depression, valued and meaningful goals help individuals regain hope and purpose. Improved access to education and employment opportunities encourages achievement. It is important to restore individual dignity and value, create opportunities for pleasure, and foster connections by maintaining or re-establishing communication with family and the community. Expressing oneself through journaling, reading, or becoming aware of experiences helps to release stress. Eliminating self-blame for what is occurring allows people to grow. Relaxation methods such as walking, breathing, meditation, yoga, prayer, and listening to music also promote healing, as do self-care behaviors such as brushing teeth, showering, and taking care of one's living environment. Small goals should gradually lead to a focus on the big picture.
The majority of trauma survivors will prove resilient; their feelings of fear and anxiety, along with urges to avoid or relive the experience, will decrease over time. Everyone handles life experiences differently, and it is necessary to allow each individual to heal at his or her own pace. The experience will always be a part of this person's life; however, the possibility of growing from the experience becomes more attainable when anxiety is reduced.
Note: This article originally appeared in the Winter 2007 edition of MeadowLark, the magazine for alumni of The Meadows.
A Miracle is Just a Shift in Perception
By Colleen DeRango
In working with clients to help them heal their trauma, many of us in the Somatic Experiencing® community have come to recognize that one component preceding a shift in perception may not be a thought at all: It may be the body's "felt sense" of moving from a state of calm to anxiety and then to calm again, or what is called "pendulation."
Peter Levine's influence at Mellody House has generated a subtle shift in the way we work with clients; our focus is on supporting clients in establishing a sense of "internal resourcing," as opposed to concentrating on difficulties or problem areas. Somatic Experiencing reinforces this focus and gives us the necessary tools and language.
Consider an example: A cat attentively and expectantly watches a mole dig a tunnel under the lawn. The cat waits with positive expectancy for the mole to move. This visual image represents the idea of seizing or grabbing hold of the positive. As counselors, we do this by supporting the client in reconnecting with the felt sense of "I can."Sometimes this "I can" sensation is expressed in a bodily movement. Other times, the client experiences a bodily change, wherein he feels "less tight, less anxious, less painful, less stuck." Gently encouraging the client to experience his "felt sense" of this less painful state is often the beginning of the miracle of moving from "I can't" to "I can." Clients are adept at sensing their own states of non-calm; so we focus on beginning from a place of "safety, calm, centeredness - or when they last felt most like themselves." We reflect on how they experienced these states and, from this place of resource, we support them in "touching into" the edges of the more difficult sensations of "tightness, strain or constriction."
Therapists support clients in listening to what their bodies are sensing, and we challenge them to trust it. For example, in a guided meditation or group session, if a client begins to feel "closed-in" or "anxious," he's encouraged to do what he wants to do - and to experience it from a "felt sense." Oftentimes this includes leaving the room while sensing what it is like to be able to get up and leave. When we introduced this strategy, we thought perhaps clients wouldn't return. Yet they have always returned and quite often shared with the group their sensations of empowerment.
Additionally, we give clients choices; for example, in meditation sessions, they are welcome to follow the guided meditation or to make a choice about how they want to meditate and then do so. Choice, when given to trauma survivors, is powerful; clients often share that they experienced the act of choosing as a felt sense of power, as opposed to the powerlessness many experienced during past traumatic events.
Knowing that trauma is about disconnection and that healing is about reconnection, the client experiences the sensation of being able to move, versus the trauma of being forced to stay. We wondered if clients would use their ability to choose as an excuse to leave group. Interestingly, the clients who left once rarely left again; they shared that they experienced a "sensation of empowerment" as a "life force" versus "life depletion." In SE language, we would identify this as the "miracle" of self-regulation, i.e., activation and deactivation. In SE we also learn that the body has the ability to self-regulate and that "trauma disconnect" interrupts this capability.
Somatic Experiencing® meshes well with The Meadows' model, which is trauma-based. In the powerful Survivors' Workshop, an experiential exercise encourages the client to "identify with his functional adult caring for his inner child." He then shares his reality with the people in his life who have been "abusive, neglectful or abandoning." This involves resourcing prior to touching into the anxiety or pain. The workshop is completed within a community of five or six other clients. As in SE, healing work is meant to be processed with someone, versus by oneself.
At Mellody House, we reinforce the value of community in working toward trauma healing and recovering from addictions and self defeating, addictive behavior patterns. In essence, we encourage clients to support themselves and one another from a place of compassion. Following the SE approach of giving counselors permission to make mistakes while training, we encourage our clients to "experiment and make mistakes," encouraging the "try" without the limitation of the expectation of perfection. The successful part of the try is "pounced on positively," not only by counselors, but by other clients as well. As the client experiences the "felt sense" of "I can do this," energy becomes available to "touch into" more pain, anxiety, frustration or "stuckness." The "I can" part of self-regulation is restored, and the result is a client who senses new empowerment. "I cannot drink" becomes a "felt sense" experience of "I CAN not drink."
Clients who have achieved "self-empowerment" have an energy about them, a "coherence" that other clients seem to move toward. And somewhere along the way, the shift toward healing gains momentum, stronger than perhaps the "triggers to use." As a client discovers that "more of me is available to use my strategic thought" to manage the triggers, he develops resiliency.
I realized early on that I could talk at length with clients about their problems and still not know how to restore their resiliency. But if we can "pounce on the positive" and support clients in identifying their "felt senses" within, their human systems move into healing. The "I can" capacity of the human system is amazing.
In considering the recent Somatic Experiencing Conference, where many of us gathered to learn and to share our experiences, I think about the simple enjoyment of connecting with others in this community. My sensation of restored resiliency was reinforced by a wonderful "ventral vagal" connection with so many SE practitioners. What a strong reminder to balance work with fun, connection and growth.
In closing, instead of saying, "A miracle is just a shift in perception," one might say, "A miracle is the ability to shift and change perception." Either way, I believe in miracles.