Wednesday, January 17, 2018

A Breakfast You Can Tolerate

This is a story about a factory. It’s not the best job in the world, but it’s not the worst job either. After several years, the factory starts to have some success and increases its profits. The owner of the factory decides to enhance worker morale by providing free plain bagels in the morning for breakfast. The factory workers are immediately pleased with the free bagels and it becomes a treat to look forward to every morning. The workers happily praise the factory owner for his kindness providing the delightful free bagel breakfast every work day.

After a few weeks since the bagel breakfast experiment is going so well, the factory begins to provide a variety of types of bagels for the factory workers including various flavored cream cheeses. The factory also provides coffee and juice for the factory workers free breakfast. The workers are even happier. Not much later, again since the breakfast program is working so well, the owner hires a part time breakfast cook to make eggs and bacon for deluxe bagel sandwiches. Soon, a variety of flavored gourmet coffee choices are offered as well. As expected, with each added improvement, the factory workers are more and more pleased with the free breakfast program and all of the positive changes.
After a while, the factory gets another huge contract which increases profits even more. Since the free breakfast program is going so well, the owner decides to provide a full breakfast buffet every morning with a full omelet station, as well as added choices of waffles, pancakes, sausage, bacon, fresh fruit, fried potatoes, hash browns, with many choices of drinks, flavored syrups and toppings. The factory workers are ecstatic with this amazing breakfast program which increases morale, attendance and gets workers to work early every day.

After several months at the factory however, things start to change. For one thing, the factory workers attitude declines. The free breakfast buffet was once viewed as a special luxury and treat but soon is viewed as a necessity and some less grateful workers begin to complain about various aspects of the buffet. Other factory workers start treating the breakfast buffet with less appreciation by wasting food and leaving a huge mess behind in the morning.
Around the same time, the factory’s profits start to dwindle due to problems in the economy and the breakfast buffet becomes too much too for the factory owner to afford. As a way to trim the budget the owner goes back to just providing basic bagels and coffee for the workers in the morning. The workers respond with the “Great Bagel Riot” in which several employees end up getting fired for throwing bagels in anger and protest. Some workers even quit in anger and they could be heard grumbling about the owners “cheap, lousy breakfast” as they walked off the job. The owner thinks to himself about how just a few months ago, everyone was so happy with the free bagels and coffee and how things had really changed for the worse rather quickly.
What is the moral of the story? It has nothing to do with breakfast. This story is an illustration of a common substance use related phenomenon of tolerance. Most people are quite familiar with tolerance:

Tolerance, n. – the power of enduring or resisting the action of a drug (Usually occurring over time with regular use)

Questions for Discussion:
Can you explain how the breakfast story illustrated tolerance? (Think about how it took more and more to get the effect desired by the owner) – How can you compare this with substance use?

How has tolerance come into play in your life particularly with substance use? (If you had a high tolerance, please explain without bragging about it)

How does tolerance play a role in the process of substance use progressing to substance dependence and then even possibly addiction in some cases?

Wednesday, January 3, 2018

To Control or Not to Control...Is that the Question?

For most people who have been around the topic of substance use, abuse and addiction, the topic of “control” surely is nothing new. Looking at some of the issues surrounding the topic of control is worthwhile. A lot of attention in the substance use and addiction world is focused on identifying those things in life that we cannot control. It is helpful to realize our limitations when it comes to control and it is also important to learn to take an objective look at evidence in our lives that suggests we are not in control of something (such as substance use, for example) This internal battle surrounding coming to a personal conclusion about control vs. loss of control and substance use is at the heart of any discussion on addiction. Each individual has to learn for themselves based on their own combination of experience, open-mindedness, and wisdom in this area. Someone else telling you that you are not in control of your substance use, for example, has far less of an impact than coming to that conclusion honestly on your own. That in part is one of the goals of substance use treatment programs: to assist individuals attending those programs to come to their own conclusion about substance use and control (or lack of control)
Nevertheless, to just blindly just look at life from the perspective that there is nothing at all that can be controlled can be misleading. To approach life as if we are a leaf floating aimlessly down a stream involves surrendering our power over the things in life that we can and should try to control. Even when it comes to things in life that we seemingly have absolutely no control of in life, it can be extremely helpful to shift our perspective to the aspect of that issue that we can choose to exert a positive influence over. This may sound confusing at first but consider some examples below for evaluation and discussion as a group:

We cannot control other people – Efforts to control others almost always end up in failed relationships and can feel much like banging your own head against the wall –

Still – How can we exert a positive influence over others today? Are there things we can do today to increase the likelihood that others will treat us with respect and trust? Can respect be earned? (Think about attitude for example) –

We cannot control the past -Yes it is true that the past is gone and there is nothing we can do to change it. What’s done is done, as the saying goes.

Still – How can we exert a positive influence over our lives today in spite of our past? Are there things we can do to leave the past in the past instead of dragging the past along with us each day in our present? How can time and positive behavior change help influence putting the past behind us? (Consider example a man who was violent for the first part of his whole life who one day changes and becomes peaceful. Is he making it easier to put his violent past farther behind him?)

We cannot control the fact that life often is not fair – Sadly bad things happen even to good people in this world in spite of our best efforts to prevent these types of things from happening. Accidents, injuries, misfortune, victimization, injustice, poor health, losses and many other unfortunate or even hurtful things can happen even when someone is doing the right thing and it just is not always fair.

Still – How can we exert a positive influence over our reaction to unfair life events? – For example, consider a horrifying accident causing a man to lose both of his legs. That man can spend the rest of his life bitter and angry over the struggles that came with the loss of his ability to walk, thus preventing that man from moving forward with his life until the day he dies. Or, that man can decide to become the best person he can be in spite of his unfair loss by learning to adapt and move on and look for opportunities he can find and goals he can achieve even still as a man without legs. In your situation, how can you move forward in a positive direction in spite of unfair or even hurtful life events that you have personally experienced?


Monday, December 4, 2017

Slices of Truth

The word “manipulative” gets thrown around a lot in the world of mental health and addiction. It can be very unfair to simply just label another person as “manipulative” as if it’s a black or white (yes or no) issue by saying that some people are completely manipulative while others aren’t manipulative at all. Rather, it makes a lot more sense to look at manipulation the same way as we view many other behaviors: as occurring along a spectrum with varying degrees depending upon circumstances, motives and overall intent.

One thing in common is that all of us want to get our needs met.  So if an individual is simply trying to get their needs met that is does not automatically qualify as a form of “manipulation” in the pejorative sense. What qualifies an action or behavior as manipulation is the tactics someone is willing to employ in order to get their needs met. Based on this perspective, if an individual is willing to use unfair or unethical means to get their needs me, then that would then fall under the umbrella of “manipulation” Still, when it comes to what is actually considered to be ethical and fair there can be a debate from one person to another so still there always may be some gray area when determining if a behavior is manipulative or not.  Nevertheless, there are some tactics for getting one’s needs met that are more clear-cut than others from an ethical perspective and therefore are tell-tale signs of manipulation. Let’s consider just one example – The manipulation of information to get one’s needs met in an unfair or unethical manner:

The Manipulation of Information: Twisting, altering, modifying, misrepresenting or selectively withholding information in a deliberate or deceptive manner in one’s own favor in order to elicit or evoke one of the following:
  • To confuse or create a diversion from the truth
  • To elicit strong emotion in others in order to trigger a desired behavior from them
  • To cleverly appear to be a victim to evoke sympathy and assistance from others
  • To make others feel guilt or shame so that they will alter their behavior in a manner that is favorable to one's own insincere motives
  • To delude or mislead others to accept an unfair deal or agreement

Questions for discussion:

How have you been a victim of any of these examples of manipulation? – When describing, try to include how you felt (Try to use feeling words)

Self-searching – Have you ever used any of these tactics? (Group should refrain from passing judgement as just about everyone has been manipulative at one time or another in life)

For a more complete and in-depth group activity focused on manipulation and getting one's needs met - Click here to view (Printable format for group)

Thursday, November 2, 2017

Planning for Inspiration

Most people are familiar with what it is like to start a campfire. If you ever started a campfire yourself, it unlikely that you just aimlessly grabbed some twigs then lit them on fire impulsively, without much thinking or planning. If someone were to lite a fire that way without firewood it is likely that the newly started fire would soon go out due to lack of fuel. Instead, reasonably speaking, when one wants to start a campfire, first he must gather a good amount of twigs, kindling, sticks and finally logs to not only start the fire but then keep it going strong.

Inspiration is just like that campfire. If we don’t plan ahead to keep the fire burning then it can easily go out as quickly as it started. Almost everyone is familiar with this fast burning fire phenomenon. An example would be suddenly getting inspired to lose weight then going to the gym for 2 hours the first few days but quickly stopping when the pain of the workout sets in and the motivation begins to fade. Similarly, the vast majority of people who quit smoking can tell many stories of dozens of quit attempts that fizzled as quickly as they started

Therefore, “inspiration planning” is a key process when it comes to building then sustaining motivation for positive change. As important as it is to become inspired at the start of a change attempt, keeping that inspiration “burning” can often be even more important. Below is a checklist with some key aspects of inspiration planning (or planning ahead to sustain insight and motivation on a long term basis.) Review the following list and check any areas that you feel that you may need to work on. Also, underline at least one area of strength. Discuss this as a group

Maintaining Insight – There are two things to remember when it       comes to preserving insight
  1. Remembering what you have learned from your own experiences and then not forgetting
  2. Awareness of when you may lie or trick yourself with harmful thoughts such as “I’ll quit tomorrow

Establishing External Motivation – This has three key components:
  1. Remembering consequences in a way that will help you stay on the right path 
  2. Incentives – Staying aware of the rewards and benefits of staying the course and making changes
  3. Support- Having people around who can help and encourage you, especially in times of struggle

Sustaining Internal Motivation – Three key factors that can help energize an internal drive for change are:
  1. Values – Continuously working toward prioritizing what is important even when the most valued path isn’t necessarily the easiest or quickest way to relieve stress, struggle or pain
  2. Hope – Keeping a sincere desire for a better life, alive as a reality in your heart and mind
  3. Courage – Having the strength not to give up even when things are fearful, difficult, strenuous or uncomfortable

For a printable format of this information click here

Better: For an extended group exercise based on this information click here

Additional group therapy activity for internal motivation building - click

Monday, October 2, 2017

Three Paths: An Effective Way to Answer the “Is Marijuana a Gateway Drug” Question

“Is marijuana a gateway drug?” – Any substance abuse counselor at this point is probably sick of hearing that redundant and often misleading question. The following explanation is time-tested, reasonable and easy to understand for just about everyone. See for yourself:
First, just in case there is anyone out there who doesn’t understand the question: “Is marijuana a gateway drug?” – Here is clarification of what that question means, starting with the definition:
Gateway - allowing entry, access, or progress to a more extreme form: gateway drug,
Therefore, viewing marijuana as a “gateway drug” would indicate that a person who starts using marijuana first will eventually end up using “harder” (more severe and dangerous) drugs at some point (such as cocaine, benzos, heroin, etc.)

The “Three Paths” Explanation to the Gateway Drug Discussion
First of all, one major mistake that many people make when discussing whether or not marijuana is a gateway drug is by looking at the discussion as if it is a “black or white” (Yes or No) issue. To look at only the two foremost extremes of the issue, by saying that marijuana either definitively is or is not a gateway drug, ignores a lot of the “middle ground”. The “Three Paths” answer to the marijuana gateway question is not as limited or polarizing as simply saying it is or is not a gateway, and it is a much more comprehensive and conceivable way to view this issue, than simply answering the question ”yes” or “no”.
The Three Paths Explained: The fact is that there is usually one of three eventual outcomes when someone starts using marijuana regularly at an early age. (Hence there are three paths one will go down when starting to use marijuana in one’s youth)
Path 1“The Phase”  - Some individuals use marijuana for a time period starting some time in their youth, perhaps then using for many years afterward but then they eventually just stop on their own. Marijuana use in this case was just a phase that started and one day and then ended after the passage of time. This is often due to some form advancement in maturity or increased levels of responsibility or an individual may just simply grow tired of smoking weed and therefore stop. For example, there are many people who smoked weed in high school, college and perhaps into their 20’s or even 30’s who end up just giving it up on their own one day with little or no struggle. Circumstances such as having children, or career advancement can play a role and at other times some people simply “grow out of it” when it comes to their desire to smoke marijuana later in life. Many people reading this article right now can identify with this category or path which in itself contradicts the gateway concept.
Path 2 – “The Lifetime User” – Within this path there are a wide variety of potential variables. The person who ends up on this path uses marijuana on some level for the rest of their lives deep into adulthood and at times beyond. Some of the individuals in this category smoke marijuana to a level that inhibits their full potential to some degree and there may even be some regrettable consequences. However, others in this category may use marijuana and still end up leading what would be considered to be a productive and in some cases even successful lives with no visible or noticeable consequences associated with their marijuana use. The common thread amongst people on this path is that the marijuana use is continued, but it never really leads to any sustained use of harder drugs. In other words, the person on this path never becomes addicted to a more dangerous drug such as heroin in spite of ongoing long term marijuana use. This path too, defies the marijuana-gateway concept. Nowadays, many people may know someone whose life course followed this path.
Path 3 –“The Gateway” – Although the first two paths spurn the gateway theory, this path legitimizes and validates the idea of marijuana as an actual gateway substance. There are those individuals who start at first using marijuana who one day develop some form of lasting dependency and prolonged tolerance. In this case, marijuana eventually may no longer suit its “purpose” thus prompting a person on this path to try other drugs to get the desired level of “high” as marijuana alone over time may no longer do the trick. The individuals on this gateway path therefore often end up addicted to harder drugs such as heroin. Some kids start using marijuana in high school at age 15 or 16 then may use for years, perhaps even for a decade into their 20’s but eventually find themselves sticking a needle in their arm or using some other drugs at some later point in life. The many, many heroin and other “hard” drug users out there who first started with marijuana but then progressed on more severe drugs validate the impossible to ignore reality that this third gateway path does exist for some unfortunate individuals.  Many individuals with more serious addictive issues will testify to this process occurring in their own lives. (E.g. The heroin dependent individual who testifies to the fact that “it all started with weed”)
So what does all of this mean? Is marijuana a gateway drug or not? Clearly, based on the three paths explanation, the correct and rational answer to the marijuana gateway question is that marijuana can be a gateway to other drugs. It’s not that it is or isn’t a gateway drug but that there is the possibility for some people who use marijuana to progress to harder drugs. The gateway phenomenon happens to some people however it does not happen to many others. Some people who use marijuana progress to a more serious level and some do not. Most people would agree that this is a rational and logical explanation to this “debate”. However, this discussion does not end here. There is one more key factor to consider in the three paths explanation: The role of choice.
Finally, Examining the Role of “Choice” in this Gateway Discussion
A young person who is smoking marijuana who hears the three paths explanation to the gateway idea will likely say something like, “I’ll smoke weed now but when I get older I’ll just stop on my own, no problem”  (Choice: Path 1) Or they may say something like “This sounds good to me, I’ll just be one of those successful marijuana users and continue to smoke weed without any consequences and live happily ever after” (Choice: Path 2)  It only makes sense that a young person smoking marijuana would reason this way because few people ever ahead of time envision an eventual  life of suffering with serious and chronically progressive drug addiction. For example, what young marijuana user has ever said anything such as: ““I am just smoking weed right now but one day I eventually see myself moving on to a painful life of heroin addiction!”   (Choice? Path 3). No chooses to live a life of hard core drug addiction.  No one starts using marijuana with the plan that it is going to be a springboard into something worse. In fact it is very common for a young adult who is dependent on heroin to look back on their youth of marijuana use and say “I never saw this coming”.

The truth is that there are many factors that can contribute to an increased likelihood of addiction including genetic predisposition, various psychological and emotional factors, age of onset, trauma history and many other factors which can be beyond an individual’s full control. These factors in combination often play a much larger role with regard to which one of the three paths one follows, as opposed to just choice alone dictating the answer. If the path an individual followed was only dependent upon choosing wisely then very few people would become addicted to drugs like heroin and crack, starting from marijuana, because few if any people would ever deliberately choose that painful path. So the conclusion to the marijuana gateway discussion in short is that there are three paths one can take when using marijuana, however not everyone gets to choose the outcome. 
Key Points:
Ø  Thankfully, most people who smoke marijuana never move on to becoming addicted to harder drugs.
Ø  However, some marijuana smokers, in spite of their best intentions, will in fact become addicted to more severe drugs at some point sooner or later.
Ø  There are many factors that can play a role with regard to the marijuana gateway drug phenomenon including genetics, trauma, family, social and emotional factors, therefore choice alone does not determine the outcome. (A young person simply saying “I will never move on to harder drugs” by itself not enough to prevent that from occurring)


Thursday, September 7, 2017

Overreaction: Putting Things in Perspective with Gratitude

Most people have heard of catastrophizing but sometimes the prevalence of catastrophizing can be overlooked. For anyone who doesn’t know what it means to catastrophize, here is one simple definition:
Catastrophize – verb: To view or talk about an event or situation as worse than it actually is, or as if it was a catastrophe

Just about everyone catastrophizes at one time or another. Catastrophic thinking (thinking that something is worse than it really is) often results in an emotional or behavioral overreaction. A simple example that many people have witnessed is to view the common reaction someone may display when they drop their food.

Depending upon how hungry you may feel, dropping the food you that you think you may be about to enjoy can bring about a catastrophic overreaction.

Fortunately many of us have strengths when it comes to preventing overreaction as there are likely some things that we can handle calmly without losing control of words or emotions. Still it is important to be self-aware of life areas which may provoke an overreaction that we may later regret. When we increase our self-awareness of these sensitive triggers for catastrophizing, this can help us to know ahead of time to take a step back and cool down before going overboard with our reaction.

Question for Discussion – What was one time when you may have catastrophized a situation in your own mind (blew it out of proportion) that resulted in an overreaction that you later regretted?:
“I was sitting in my car in traffic at a red light not paying attention and then someone behind me beeped their horn to tell me the light turned green because I wasn’t moving but instead of just going forward I immediately started screaming and cursing out the window and then I realized it was my kid’s school teacher in the car behind me”

We all have sensitive areas where we may be prone to overreacting. 
Discuss the following:
Being forced to waitSome people are naturally patient and can calmly wait, but others may freak out when lines or wait times are much longer than expected – How about you?

Listening to others opinions: Can you calmly handle listening to someone outwardly profess views that you strongly disagree with or do you find yourself losing your cool and wanting to argue or fight?

Criticism – Can you accept being told that you did something wrong, without getting overly upset, sad, defensive or angry?

RejectionHow are you at handling disappointing situations like breakups, not getting a highly desired job after an interview, failing a test, etc.? Does it ever feel like it’s the end of the world in those instances?

Other: Honestly using your own perceptive powers of insight and self-awareness, identify any other situations or life areas which you may overreact and share them with the group

“It is not stress that kills us, it is our reaction to it” 
(Hans Selye, Endocrinologist)

What is the solution for dealing with catastrophizing? There are several ways to keep oneself from catastrophizing. Some of these include: Getting the right amount of sleep, rest and exercise, practicing acceptance and optimism (looking at the bright side especially in a seemingly negative situation.)

Another excellent way to deal with catastrophizing is “Putting things in perspective” which is the follow up group exercise for this topic:

Click this link to get a printable format of this article plus much more for group therapy discussion and activities on this topic of:

Overreaction: Putting Things in Perspective with Gratitude - Downloadable PDF format for group therapy with bonus group materials

Tuesday, August 15, 2017

I Know How this Movie Ends

Did you ever watch the same movie a second time even though you knew the ending was tragic and sad? If you feel for the main character in the film, watching the movie the second time can be a painful experience especially if you find yourself wishing that this time everything could work out instead of watching the tragic ending all over again. Another similar real life example would be witnessing a young person who you care about follow a course that you know ends up in a bad place, like failing in school or getting in trouble with the law at an early age. Maybe from your own experience you know how the story of that “movie” ends.

What about you? Are you following some kind of proverbial “script” that common sense may say will likely lead to an unhappy ending? Obviously there are exceptions to every rule when someone follows an unwise or unhealthy life course but it still works out okay (Like for instance the 95 year old woman who smoked 2 packs of cigarettes per day for her whole life and never got cancer) Still, using common sense (which at times ain’t too common) and being honest with yourself, try to think about how some of these all too common stories end:

Johnny struggled with alcohol use problems for decades but now after a solid period of abstinence says he is going to go out with the boys again to the bar and just drink sodas

Sally finally kicked intravenous heroin and has been sober for 3 months but she convinces herself that she is just going to sniff a bag now and then just to relax and that’s it

Mary has been broken up with her on again off again boyfriend who emotionally abused and cheated on repeatedly for years but she is considering meeting up with him again because he swears that “this time he’s changed”

Perhaps you are thinking to yourself, “I get it but those types of things can’t happen to me, I know better than those people” and hopefully that is true. Still, many of us have at least one challenging life struggle or experience in which we may have put our hand in the fire repeatedly before we were fully convinced that we would get burned, only to still do it again a few more times anyway before we really learned our lesson.
With all of this in mind, trying to be as honest, insightful, open and self-aware as possible, discuss some of the following:

PAST – Do you have a life experience from your past in which you may have neglected to see the signs or fail to listen to the advice of others, telling you that you were headed in the wrong direction?

(Example – “When I was a kid, everyone told me to put more effort into school and stop hanging with people who got into trouble and now as an adult I feel like I could have been much better off if I had just listened back then)

PRESENT – Is there a life area now that you may be struggling with in which you have a sense of concern about where things may be headed but you are having difficulty changing anyway?

(Examples – “I get so depressed over how much debt I am in, but then I still keep on spending and wasting money anyway and it just gets worse and worse” – “I have a pattern of getting into bad relationships over and over again and as I keep promising myself I won’t do it again but then I find a new one and it starts all over”)

FUTURE – Comparing your current life circumstances to a movie, what can you do now in order to increase the likelihood that your current situation has a happier ending?