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The Urge: A History of Addiction in the United States
2022-04-05
2022-04-05

Carl Erik Fisher’s new book The Urge is “one of those hybrid history/memoirs that illuminates an important subject through personal experience,” wrote Chris Vognar in his review for the Boston Globe. “Fisher digs deep into the history of addiction. He uses sociology, literature, criminology, and, yes, psychology, to explore how societal attitudes have fluctuated through the centuries, from condemning addicts as deadbeats to treating addiction as a disease. Doggedly researched, layered with empathy, The Urge pulls back multiple curtains at once in examining an ailment that will likely never go away.”Learned behavior, brain disease, or self-medication: compulsive substance use and behavioral addictions are hard to pin down. In part one of The Urge, Fischer provides a historical overview of the perplexing “behavior in search of a name.” Addiction is “not a tumor or a bacterium” but is “often explained in terms of a dichotomy of free choice versus total compulsion” but “many people with addiction feel themselves occupying a confusing middle ground between free choice and total loss of control.” We learn that the first person to use the word “addict” was apparently John Frith in 1533, who had converted to Protestantism and was burned alive for heresy. Fisher refers to Augustine’s Confessions as “the first addiction memoir,” and throughout the book, he talks about his own alcohol use disorder and subsequent recovery.Dr. Fisher identifies four main approaches to addiction over the years: prohibitionist, therapeutic, reductionist, and mutual help. The prohibitionist approach is exemplified by the eponymous Prohibition of the 1920s and the now much-discredited “War on Drugs” of the 1970s. As most people understand by now, outlawing particular substances and treating users as criminals have not put an end to addiction in America. According to Fisher, the history of addiction is filled with “overly simplistic attempts to reduce complex phenomena” which have “often misled more than they have helped.” Reductionist approaches have led to many harmful “cures”: “Though it’s a crowded field, Leslie Keeley … probably takes first prize,” Fisher writes. Keeley’s "Double Chloride of Gold" treatment “made millions of dollars, more than 500,000 people with addiction took his cure between 1880 and 1920.” Keeley—a medical doctor—famously claimed that “drunkenness is a disease and I can cure it.”Dr. Keeley’s evidence-free cure counts as quackery today, of course, but Fisher is also somewhat skeptical of the brain disease paradigm promoted by the National Institute on Drug Abuse (NIDA). Calling addiction “primarily” a brain disease goes too far for Fisher. “A single scientific explanatory model cannot possibly explain the essence of a complex system.” Therapies should be evidence-based and although not medical treatment, Fisher praises the “grassroots wisdom of mutual-help” groups—even if they may not be right for everybody. Like Maia Szalavitz in her influential 2016 book Unbroken Brain, Fisher emphasizes that addiction is not primarily about substances. “Addiction does not proceed inevitably from use. Most people who use drugs — including crack, methamphetamine, and heroin — do not develop significant problems. In studies spanning decades, no more than 10 to 30 percent of people who use drugs develop significant substance use disorders. Drugs are not ‘addictive’ in themselves; they don’t cause addictions in isolation.”This echoes Szalavitz’s conclusion in Unbroken Brain: “By itself, nothing is addictive; drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables. Addiction isn’t just taking drugs. It is a pattern of learned behavior.”Addiction journalist Johann Hari, the author of Chasing the Scream, a history of drug criminalization, famously stated that the opposite of addiction isn't sobriety but connection. Fisher would agree. His book analyzes in detail settings and cultural variables that were important factors in recurring drug epidemics around the world such as the British “Gin Craze” of the 18th century or the more recent American opioid epidemic. “When addiction epidemics strike, we want to know why,” writes Fisher. But a complex situation with a multitude of factors is too often reduced to a simplistic scenario. “What is necessarily a complex web of intersecting forces is too often reduced to one simplistic story: trauma, brain disease, an evil and unstoppable drug, a bad pill-mill doctor, a hereditary taint, or a weak will, or poor morals.” While certain alcohol, pharma, and tobacco industries cannot exactly be viewed as blameless—Fisher regards many such companies as “addiction supply industries”—they are only part of the problem. “Epidemics are never caused solely by an inherent power of the drugs themselves, or the efforts of the addiction supply industries; there is often if not always, social wounding underneath, driving the substance use.” In 2016, Surgeon General Vivek Murthy opened his landmark report on addiction in America with the blunt statement that “the United States has a serious substance misuse problem.” Despite decades of expense and effort “substance misuse remains a public health crisis,” he wrote then. Among other steps, Dr. Murthy called for improved access to evidence-based treatment services but six years later, still only ten percent of people with addiction receive any kind of treatment. In The Urge, Dr. Fisher accuses the medical system of “coming up woefully short in its treatment of addiction.” There are “massive barriers to receiving mental healthcare in general but the problem is even more pronounced for people with substance use disorder.” The medical profession “must embrace the care of this population, as stigmatized attitudes about addiction remain a tremendous barrier to care.” Like many other physicians, Fisher advocates the full use of the FDA-approved medications for opioid use disorder, but he also emphasizes that each case of addiction is different and that “a growing body of research on recovery outcomes has clearly shown that people overcome addiction in a variety of ways.”There is no need to demonize addiction, as it is “profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering.”Valiant Living Professionals Program for Men strives to restore lives from addictions, intimacy disorders, and their influence on all aspects of life. Our trained staff utilizes the most progressive therapy techniques to offer the highest quality of care. We provide individual therapy, group therapy, psycho-educational classes, workshops, and more to help restore the focus on a purposeful life disrupted by intimacy disorders and substance addictions.If you or a loved one has turned to drugs or alcohol to keep up with work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-952-5035.

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Colorado-Based Addiction Treatment Center Names New Wellness Director
2022-07-13
2022-07-13

 

[Greenwood Village, CO, July 13, 2022] — Valiant Living, a Colorado-based addiction treatment program for professional men, today named Malissa Schwamm its new wellness director. Schwamm is an experienced yoga and mindfulness instructor with more than 20 years of experience teaching, mentoring, and designing mindfulness programs for clients. She is passionate about helping clients on their healing journey through freedom in movement, mind/body harmony, and connecting more deeply with nature.

 

“One of the best ways to stabilize people in early recovery is the practice of mindfulness,” says Schwamm. “Mindfulness allows patients to be more at peace, calmer, more grounded, more centered when they are triggered to use.”

 

Many people with addiction misuse substances to suppress difficult emotions. They want to avoid being present and attempt to escape from their emotional pain, if only for a short while.

Mindfulness offers a different, much healthier solution. Instead of avoiding difficult emotions, mindfulness enables us to just be with them without being overwhelmed.

 

Schwamm likes to emphasize the element of trust. “I work from a space of empathy to create a sense of trust—it’s about building relationships with clients. People who come to a rehab program are looking for people they can trust. They want someone to see them, they need someone to hear them. I cultivate that space of trust with yoga and mindfulness.”

 

Valiant Living

 

If you are seeking a more comprehensive start for addiction treatment, contact Valiant Living Detox and Assessment at 303-647-4932 and get the individualized attention you need for stabilization, assessment, and discerning the best next steps in your journey.

 

The Professionals Program at Valiant Living helps male professionals understand and harmonize their minds and, thus, helps them and their family system heal. If you or a loved one has turned to drugs or alcohol to keep up at work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-952-5035.

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April is Alcohol Awareness Month
2022-04-06
2022-04-06

Alcohol Awareness Month was established in 1987. Every April, the campaign formerly sponsored by the National Council for Alcoholism and Drug Dependence aims to raise awareness for communities and help understand the causes of alcohol misuse and treatments available for one of the biggest health issues in America. Alcohol Awareness Month also aims to reduce the social stigma associated with alcohol use disorder (AUD, also referred to as alcoholism) and to educate people on how the disease can be addressed, offering help and advice for families as well as direct engagement with those afflicted with alcohol addiction. We have strong reasons to support alcohol awareness this year. There are clear indications that the COVID-19 pandemic has severely exacerbated America’s substance misuse crisis. Drug overdose deaths are believed to have exceeded 100,000 in 2021 for the first time in a 12-month period and alcohol-related fatalities have increased dramatically as well. Elevated drinking rates during the pandemic—from binge drinking to increased social acceptance of drinking—reportedly have led to a large increase in alcohol-related deaths in 2020. “There was a 25 percent increase, from nearly 79,000 in 2019 to more than 99,000 alcohol-related deaths documented in 2020, according to a study published recently in the Journal of the American Medical Association. That compares with an annual average increase of 3.6 percent between 1999 and 2019,” reported Kate Carey-Trull for Hartford HealthCare in March. “Alcohol is a familiar and culturally acceptable source of relief from stress, anxiety, and even boredom,” said Dr. J. Craig Allen, Medical Director of Rushford, part of the Hartford HealthCare Behavioral Health Network. “However, subjective symptom improvement from an addictive substance is often short-lived with the solution becoming a problem of its own. Risky use of alcohol can lead to full-blown depressive, anxiety, and substance use disorders.”The study found that “rates increased for all age groups, with the largest increases occurring for people aged 35 to 44 years (from 22.9 to 32.0 per 100 000 [39.7 percent]) and 25 to 34 years (from 11.8 to 16.1 per 100 000 [37.0 percent]).” “Deaths involving alcohol reflect hidden tolls of the pandemic,” wrote study authors White, Castle, Powell, et al. “Increased drinking to cope with pandemic-related stressors, shifting alcohol policies, and disrupted treatment access are all possible contributing factors. Whether alcohol-related deaths will decline as the pandemic wanes and whether policy changes could help reduce such deaths, warrants consideration.”In his landmark report on addiction, Surgeon General Vivek Murthy stated that “one in ten deaths among working adults are due to alcohol misuse” and that “alcohol misuse and alcohol use disorders alone cost the United States approximately $249 billion in lost productivity, health care expenses, law enforcement, and other criminal justice costs.”Alcohol remains the most widely used addictive substance in America. In most cases, it can be legally obtained and is more likely to harm people than all illegal drugs combined. According to the 2019 National Survey on Drug Use and Health, nearly 15 million people ages 12 and older had AUD. This number includes 9 million men and 5.5 million women. An estimated 414,000 adolescents between the ages of 12 and 17 had AUD. AUD is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social or health consequences. It is frequently driven by a desire to numb emotional pain, extreme stress, or trauma. It is not the result of moral turpitude or lack of willpower.Considered a psychiatric disorder, AUD can be mild, moderate, or severe. Lasting changes in the brain caused by the disease perpetuate alcohol misuse and make individuals vulnerable to relapse. The good news is that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and/or medications can help people with AUD achieve and maintain recovery.Professionals such as physicians, lawyers, airline pilots, and others are often exposed to long hours at work and stressful situations. Successful professionals can live lives of unbalance, sacrificing their families and themselves while prioritizing work above all. Their intense work environment may lead to alcohol and drug misuse or intimacy issues. Effective treatment must address all issues related to the substance or behavioral addiction. Drugs and alcohol are primarily addictive in the context of setting, dose, and numerous other personal, biological, and cultural variables. Addiction is much more complicated than drinking too much alcohol or taking drugs. The Valiant Living Professionals Program for Men strives to restore lives from addictions, intimacy disorders, and their impact on all aspects of life. Our excellent staff utilizes modern, evidence-based therapy techniques to offer the highest quality care. We know that professional clients need to balance a deep search for recovery with a work-life that demands attention. Our Professionals Program is designed to do just that, with a number of therapeutic options for men with challenging careers and busy lifestyles. If you or a loved one has turned to drugs or alcohol to keep up at work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-816-3571.

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How the Internal Family Systems Model Views Individuals as Systems
2021-12-30
2021-12-30

Internal Family Systems (IFS) is a powerfully transformative, evidence-based model of psychotherapy, based on the idea that the mind is naturally multiple. This multifaceted mind is considered normal and not pathological. “Our inner parts contain valuable qualities and our core Self knows how to heal, allowing us to become integrated and whole,” explains the IFS Institute on its website. The Internal Family Systems model is an integrative approach to individual psychotherapy developed by Richard C. Schwartz in the 1980s. It combines systems thinking with the view that the mind is made up of relatively discrete subpersonalities, each with its own unique viewpoint and qualities. IFS uses family systems theory to understand how these subpersonalities relate to each other. “Systems thinking entered psychotherapy in the 1970s through the nascent field of family therapy, and I was fortunate to be steeped in it before I encountered the inner world of parts,” remembered Schwartz in Internal Family Systems Therapy. “As a result, rather than focusing on the qualities of each part, I was quickly intrigued by their relational patterns and how those patterns affected the larger system in which they were embedded—the person.”Numerous conversations with clients revealed to Schwartz that “the chattering mind denotes a non-unitary, relational mind. Throughout the day all of us pass from one personality to the next.” One of his clients said she heard a “confusing cacophony of what she called ‘parts’ and ‘voices’ arguing in her mind.” He asked other clients and heard “remarkably similar stories.”The interaction of the parts of the mind reminded Dr. Schwartz of families. “Each inner voice was idiosyncratic in character, complete with temperament, desires, and a distinct way of communicating. Moreover, parts had alliances and polarities.” Interestingly, in the case of a mental disorder, most parts—regardless of their role—apparently did not trust the client to lead.Schwartz labeled that aspect of a person’s personality the “Self.” From birth, this Self has all the “necessary qualities of good leadership, including compassion, perspective, curiosity, acceptance, and confidence.” The Self is the best “inner leader” and the parts are “organized to protect the Self.” Like a family system, this inner set-up seeks homeostasis but can be disrupted by trauma and other external influences. IFS therapy encourages clients to give their parts names such as “sad part,” and “angry part,” etc. to better understand their roles. “All parts are precious and want to be constructive, though some are forced into extreme, destructive roles by external influences as well as by the self-perpetuating nature of inner polarizations and imbalances,” wrote Schwartz in Internal Family Systems Therapy. “When parts become frozen in the past, take on burdens, and assume leadership, their internal relations shift from harmony to conflict.” In their effort to protect the Self, parts can be driven to maladaptive behaviors that include self-medication with drugs and alcohol. This is the scenario the therapist has to reverse. “Even highly polarized inner systems can heal themselves if the therapist is able to create a safe, caring environment and point the person in certain directions.” If a person lives in an activating or dangerous environment, harmonizing the inner system will be difficult. When the Self stays present and leads the way, on the other hand, the client’s parts feel understood and negative feelings will subside."In IFS, all parts are welcome, including those parts of us that many treatment centers try to push away and shame, like our addictive parts,” says Valiant Living’s executive director Michael Simms who is a certified IFS therapist. “We believe that parts become extreme when an injury turns into an identity that starts living in the past. What once was helpful and adaptive becomes harmful and maladaptive. Therapy is about approaching these parts with compassion and understanding—it’s through understanding that our parts and our Self can make a decision to change."Valiant Living’s therapists frequently utilize IFS in their addiction treatment approach in order to help professionals understand and harmonize their minds and, thus, help them heal. We know that such clients need to balance a deep search for recovery with a work-life that demands attention. Our Professionals Program is designed to do just that, with a number of therapeutic options for men with challenging careers and a busy lifestyle. If you or a loved one has turned to drugs or alcohol to keep up at work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 720-669-1285.

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The Impact of Internalized Stigma on Recovery from Addiction
2022-03-21
2022-03-21

“Our understanding of substance use disorders as chronic but treatable health conditions has come a long way since the dark days when they were thought of as character flaws—or worse,” wrote Nora Volkow, MD, the director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health in 2021. “Yet societal norms surrounding drug use and addiction continue to be informed by myths and misconceptions. Among the most harmful of these is the scientifically unfounded belief that compulsive drug-taking by individuals with addiction reflects ongoing deliberate antisocial or deviant choices.” This belief continues to contribute to the stigmatization of people with addiction. The stigma is most unhelpful because it actually “impedes access to treatment and care delivery” and also “contributes to the disorder on the individual level,” Dr. Volkow wrote in April 2020 in the New England Journal of Medicine. Blaming people with substance use disorder (SUD) for their disease has a long history in the United States. “Tacit beliefs or assumptions about personal responsibility—and the false belief that willpower should be sufficient to stop drug use—are never entirely absent from most people’s thoughts when they interact with someone with a drug problem,” Volkow wrote. Social stigma is a treatment barrier for addicted individuals who often feel guilty and unworthy of care. But, as Dr. Volkow pointed out, “stigma plays an even larger role in this crisis, one that has been less discussed: when internalized, stigma and the painful isolation it produces encourage further drug-taking, directly exacerbating the disease.”The National Alliance on Mental Illness (NAMI) lists four types of self-stigma:

  • Alienation: Feeling embarrassed, ashamed, inferior, or disappointed in yourself. Feeling that your illness is your fault.
  • Stereotype endorsement: Applying existing stereotypes to themselves
  • Discrimination: Feeling discriminated against; feeling incapable of achieving much.
  • Social withdrawal: Avoiding to socialize or talk about yourself because you feel like a burden, inadequate, a potential embarrassment to loved ones.

There are wide-ranging consequences of self-stigma, warns NAMI. “It can be a barrier to recovery, increase depression, reduce self-esteem, reduce recovery orientation, reduce empowerment and increase perceived devaluation and discrimination, among other consequences. A study also showed a strong correlation between loneliness and self-stigma.”Crapanzano, Hammarlund, et al. looked at the association between perceived stigma and substance use disorder treatment outcomes in 2018. Their review of studies of recovery outcomes in individuals seeking treatment for SUDs suggested a “negative, though perhaps indirect, role for self-stigma and perceived social stigma.” “The qualitative studies demonstrated the complexity of emotions and processing that needs to occur for people who are attempting to recover from addiction. For that reason, in spite of the much-needed advances in pharmacotherapy interventions for addiction that are occurring, continued attention to the psychological needs of the recovering person is important as well.” This confirms once more that effective addiction treatment needs to address all relevant underlying issues of the patient, not just the substance use. SUDs and behavioral addictions are frequently driven by trauma, depression, anxiety, and other co-occurring conditions. Additional alienation, social withdrawal, and loneliness as a result of internalized stigma are not conducive to successful therapy. “Although stigma against addiction may be a protective factor that deters non-users from experimenting with substance use, it paradoxically promotes continued use once an individual has entered the drug culture and may prevent access to treatment services,” wrote Crapanzano, Hammarlund, et al. in their review. “Furthermore, while societal stigma against mental illness is recognized as a problem, stigma against people with addiction is more complicated, and people with SUDs are more frequently blamed for their condition. When perceived societal stigma is internalized (ie, self-stigma), it can result in loss of self-respect, decreased self-esteem, and loss of self-efficacy. These feelings may harm the individual’s chances of recovery from addiction.”In Internal Family Systems Therapy (IFS), utilized at Valiant Living, stigma frequently corresponds to what IFS calls “cultural legacy burdens”—extreme beliefs, emotions, and energies that were absorbed from family, ethnic group, or culture. Other such burdens are “racism, patriarchy, individualism, and materialism,” wrote IFS founder Richard Schwartz in his book No Bad Parts. “Each of these legacy burdens combines with the others to create the pervasive sense that we are all disconnected and on our own in a dangerous, dog-eat-dog world.” Successful professionals who value the ability to take responsibility and often sacrifice their families and themselves to prioritize work may be particularly susceptible to self-stigmatization and feelings of extreme guilt over their substance misuse and other self-soothing behaviors. Valiant Living’s therapists frequently utilize IFS in their treatment approach in order to help professionals understand and harmonize their minds and, thus, help them heal. We know that such clients need to balance a deep search for recovery with a work-life that demands attention. Our Professionals Program is designed to do just that, with a number of therapeutic options for men with challenging careers and a busy lifestyle. If you or a loved one has turned to drugs or alcohol to keep up at work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-816-3571.

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Renowned Addiction Psychiatrist Laura F. Martin, MD Joins Valiant Living as Medical Director
2022-02-25
2022-02-25

Laura F. Martin, MD, is the new medical director of Valiant Living. Dr. Martin has a long, impressive track record as an addiction psychiatrist. She graduated from the Wake Forest University School of Medicine in 1997 and subsequently pursued residency training in psychiatry and a research fellowship at the University of Colorado and the Denver Veterans Medical Center."We are excited to bring on Dr. Martin in this new role as she is a perfect embodiment of the values and mission at Valiant Living," added Chief Operating Officer Scott Lister, BSN, RN, CARN. "She will help us continue to improve on the high quality of standards in patient care that we believe in."Dr. Martin is board-certified in general psychiatry and addiction medicine. She has published numerous peer-reviewed manuscripts in both general and addiction psychiatry. Dr. Martin worked with Valiant CEO Michael Dineen in a previous partnership where Dinneen served hundreds of patients for over a decade and was responsible for designing and implementing key parts of the clinical programming, including the 30-day primary program, the 60-day extended care program, the 71-day professionals program, and the intimacy disorder track. “I was super excited to work with Mike again, I really respect the work that he does,” says Martin. “He has a great passion for serving patients with addiction.” Martin and Dineen also share an interest in the same specialty: addiction treatment for professional men. “My specialty, along with Mike, is treating professionals who have substance misuse issues as well as process addictions, so I am passionate about working with that population” explains Dr. Martin. “I had relatives in my own family—physicians who suffered from substance use disorder and behavioral addictions. There is still a lot of stigma out there about addiction and it’s great that at Valiant Living I will be able to provide treatment that is trauma-informed, respectful, and full of compassion for patients.”As medical director, Martin will oversee the Valiant Living Detox and Assessment program as well as the partial hospitalization (PHP) and intensive outpatient (IOP) programs. “All those levels of care are already better integrated than at most places.” Martin is also very impressed with the emphasis on secondary intervention for patients in the detox program. “No program is for everybody as it should fit individual needs,” she says. “An effective secondary intervention is crucial because finding the best fit for patients keeps them in treatment long enough to get better. At Valiant Living, it’s about the patient—outcomes are better if we get them into the right place after detox.”To make that all-important transition more effective, Valiant Living Detox and Assessment created a transitional short-term residential program to make it easier for clients to consider the best way forward after the medical detox. The program helps clients and their families understand often unfamiliar treatment options better. Its emphasis is on post-detox stabilization and it prioritizes treatment planning and next-step care coordination.“It’s important to provide clients with a strong recommendation for secondary intervention based on a careful assessment of each individual case,” says Martin. Not everybody can go into full residential treatment at Valiant Living as it’s primarily a program for professional men while Valiant Living Detox and Assessment accepts patients of most ages and all genders.Most detox clients require follow-up intervention in another treatment program and ideally aftercare following that. Addiction is a chronic disease and the risk of relapse is high without maintaining an appropriate level of care. That’s why it’s crucial to find a program that fits the needs of each individual patient.Dr. Martin is most impressed with the enormous heart and compassion everybody at Valiant brings to the job. “It’s a value-based and patient-centered approach where everybody is always driven to learn more to provide better services.”If you are seeking a more comprehensive start for your treatment of addiction, contact us at 303-647-4932. We provide a safe, supportive haven in the earliest stages of recovery. Get the individualized attention you need for stabilization, assessment, and discerning the best next steps in your journey.

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