Self deception part 1: Denial

When it comes to addiction treatment; therapists, clients, and families they defiantly discuss denial as an important aspect. There is a lot of literature available on Denial.

Here we will try and understand denial as a self-deception tenancy. My post on deadly D's has an explanation on self-deception. In short, self-deception is something which prohibits the recognition and acceptance of the disease and the negative consequences. Denial is the first part of self-deception which always help the addict to be in illusion that nothing to worry..... I can stop using anytime....... or I can control my using...... I know there is nothing wrong if I drink or use....etc.

Eventually, addicts come across the negative consequences but their denial never allows them to see the reality. E.g. few addicts justify drinking saying that limited amount of drinking is good for the heart, good for xyz....etc but they fail to understand that when liver report clearly indicates the dysfunction due to the excessive, harmful use of a substance. They still stick to the selective information which supports the using. 

DENIAL IS REFUSING TO ACKNOWLEDGE THE HARMFUL CONSEQUENCES OF ALCOHOL OR DRUG USE.

What I observed during my practice so far is we can make few categories according to the responses of various addicts which shows the patterns of denial.

1. Denial by defining the problem
2. Denial by blaming or by creating problems with external factors.
3. Denial by minimization.

Let me explain all three points elaborately.

1. DENIAL by defining the problem: addicts feel that if they can give strong reason to use no one will blame them. The other type is kept on proving people that they are functional and able to achieve something.

Like this kind of people, they say that 'look! I have a good job I am earning then how can I be an alcoholic or addict?'
My doctor only prescribed me those pills.... so I am using them.... how can I be an addict then.

But the reality is they fail to see the whole picture. They overlook the other evidence such as the withdrawals, preoccupation, cravings, family conflicts due to use, accidents under influence, fail to cut down or stop using.

2. DENIAL by Blaming or by creating problems with external factors: Most of the addicts throw the blame on external factors. they mention rather justifies that how other people and their behavior is only causing the problem. This kind of addicts may mention job pressures as the reason for alcohol/drug use. they may mention that they drink because of critical wife, physical pain, someone is trying to corner etc. 

They look at the substance as a remedial part but they fail to understand that abusing alcohol or substance is putting them again into a problem rather aggravating the problem instead of solving them. Eventually, they create new problems for them. E.g; if one keep on blaming that wife is a reason for drinking; in turn, he makes his relationship more stressful with a wife. He never puts any efforts to talk about how is he getting affected by his wife's behavior or never makes an effort to openly talk to her. after some period he faces separation. then he again starts drinking more saying that his wife left him. 

3. DENIAL by minimizing: To avoid the confrontation many times addicts stops defending themselves but in such situations, they opt for minimizing the amount they use and also minimizing the harmful consequences they face so far. 

this kind of people they say ...... yes! I drink.... BUTTTT no as much as you think... Just 2 pegs... 

No...believe me! my accidents were not under influence. I do drink but its not as bad as XYZ. 

Eventually, addicts get confronted with harmful consequences. that point they are unable to deny the use &/or negative consequences of addiction. However, the story doesn't end here. 

Unknowingly, once denial stops working they go to the next level of self-deception. 

To know more read my next article.... 

SHEETAL BIDKAR

Breaking the behavioural CYCLE

We are responsible for our behavior. It is true that social, psychological & environmental pressures may influenced ones drinking/using behavior. In order to make a change one need to categorized these pressures.
i. Pressures come form others
ii. Pressures come from within ourselves.
iii. Pressures come from environment

People in addiction complains that they want to change but other people & environmental things pulled them back to substance abuse. As I mentioned earlier we will discuss the above mention pressures  one by one.

I. Pressures come from others: in many communities takings alcohol in social gatherings is very common.  This gathering is an external factor which can pull the individual in a risky situation. Social acceptance may influence how much we drink, what we drink, it may also effect the place and time one may opt for drinking. Social pressures also influence the attitude and perception towards alcohol use.

I I. Pressures comes from within ourselves: alcohol, drugs alter our mood one may use it as a coping mechanism. The unhealthy coping mechanism eventually doesn't work and people get confronted with the real harsh consequences of their choices.  Fears, insecurities, resentments and other negative feelings aggregate the intensity of the discomfort and people feels that substance may help them to handle these discomforts.  Our pattern of conditioning our behavior and beliefs definitely influences the acceptance of substances.

III. Pressures come from the environment: availability of substance, peer influence, weather conditions are examples of environmental factors which may influence the decision of substance use.


In order to break the behaviour cycle one needed to use new behaviours for dealing with social and psychological pressures.  Some suggestions are as below.

1. An aviod situation which you feel you may not be able to handle.
2. Plan your reactions to handling peer pressure.
3. Learning new coping mechanisms.
4. If the stress or tension is chronic then seek professional advice.
5. Know your triggers and plan for healthy precautions.
6. Find the positive, healthy alternative activities.
7. Socialisation with self help group members will be very useful.
8. Taking efforts to understand the exact nature of the disease will help us to set some do's and don'ts for ourselves.

Practicing new behaviours will lead to develop healthy behaviour cycle.


Sheetal

Why is Self regulation A Key of recovery.

Self-Regulation

The recovery rate among addicts is very poor all over the world. Various treatment models, different facilities during the treatment, culture-specific models of  treatment are facing the challenge of poor recovery rate. The disease of addiction is known for it's cunning, baffling, progressive nature. One of the reasons for the poor recovery rate is a lack of continuity or consistent motivation during recovery.  Here are some steps for self-Regulation.  Self-Regulation will help people to maintain a long-term abstinence period. The self-Regulation is a key of recovery. Regulating our own thoughts and behaviour will definitely increase the self-esteem and self-respect too. Recovery is a process so one need clarity about why they are seeking the way out from their addictive life? What are the desirable changes they are looking for? What are the motivating factors                                                                                     for recovery?

If you want to take charge of your recovery then here are few steps for you:

1. Self-determined goals: people most of the time start working with the ambiguous mind. The experimenting approach of people makes them less committed. Back of the mind, the thought of escaping from hard work make them feel secure.  If this doesn't work I will do XYZ .... before thinking about recovery one should confront own self to understand the significance of the decision. one of the most common motivation factors for abstinence is fear of death. Such people are only looking for detoxification and a safe place for some time. Once they feel they got the physical energy back then they don't mind discontinuing the treatment.  On the other hand, people who are in an early recovery phase don't mind using the half way home facilities provided by various rehabilitation centers.

2. Self-monitoring: patients they honestly start reporting their craving levels, mood swings, and other difficulties during the early abstinence period.  They also become more vigilant towards their self-talk and their thoughts etc. They ask for help if they observe any new or abnormal though or behaviour occurs.  Self-monitoring minimises the risk of relapse. People understands their triggers, high-risk situations etc.

3. Self-instructions: patients give selves instructions either loud or quietly to help guide actions. They appreciate themselves for taking right decisions or practicing relaxation methods or for avoiding arguments, reacting assertively etc. Self-instructions help the individual to achieve the desirable goals without getting distracted. It also works as a self-reward technique.

4. Self-evaluation: people judge the quality of their performance.  They are willing to analyse their behaviour objectively.  This the one of the most difficult phase in self-Regulation.  One need to work on own biases and need to improve the open mindedness in this phase. Self-evaluation makes people rational about their choices.

Thus, these four steps help patients to regularise their recovery.

Sheetal Bidkar

Sending your loved one's for addiction treatment

Addiction is a family disease. Most of the time family kills lot of  time in taking decision about long term in-house treatment. Unlike other countries in India family can take decision  to admit addicts & mentally ill people by the help of law. If the patients can not take rational & helpful decisions for themselves family can take decision for them with the help of law. So if you are sending your loved once to rehab you should be aware about following things:

1. The stay in rehab will not be comfortable for both the patient & his family.

2. Patient may try some tricks to come out of rehab by giving false reasons like: food or hygiene etc. It is always good to see the place & discuss the facilities, treatment plan with the people in the centre.

3. Have trust: You need to have a trust on people who are there in rehabilitation centre, You must take regular feedback from people over there about patient.

4. Understand the process of treatment: If there is a family meetings or open sessions put more efforts to understand that how this can help your loved once.

5. Give all the possible information: Legal cases, health complications, behavioural abnormalities etc all information give in detail.

6. Do not send things like extra medications, gold chains etc. because patient may misuse them.

7. Stop enabling: Do not become obsessive or over anxious about the client even if he is not cooperating for therapy he is at least maintaining the abstinence.

8. discuss all the do's & don'ts with counsellor before discharge

9. Discuss the post discharge plan with therapists & take dates for follow up.

10. have a back up plan: Patient may relapse after the treatment also be aware about the fact & set a realistic back up plan. i.e. what you should do if he/she goes back to addiction. etc.

Remember Big Journey starts with small steps ............

Sheetal Bidkar

Interviewing Relapsed patient

Treating a relapsed patient takes lots of efforts. They have fixed view towards treatment, Counsellors & therapy structure. Many of them carry a belief that they know the program & that is not helping them.  They feel that relapse is a outcome of treatment failure. Almost all the de-addiction rehabilitation centres introduced 12 step program & relapse patients they feel there is nothing new I am learning in repeated admissions. Here are some important things therapist can keep in mind before interviewing relapse patients.

1.       Understanding his perception towards treatment: Mostly the structure, timetable & sometimes therapeutic program may have similarities with the previous treatment experience for the client, so allowing him to talk about the past good & bad experiences with the treatment centre or self help group is very important. Though sometimes it sounds irrational but gives the clear idea about his beliefs.     

2.       Allow catharsis: Patients has their own analysis of relapse, what triggered them or why they refused help etc, one need to understand that because that is the reality for the patient. Immediate confrontation with the patient may push him to the shell; He will not feel comfortable to talk anything after that. Giving them a chance of catharsis strength the rapport with him.

3.       Making a partnership: Motivating a client to participate in individual & group therapies is very important. It gives them a message that they are responsible for their recovery. Sometimes they feel that doctors will take care of my disease, I need not do anything about it. After detoxification therapist should clearly mention patient’s role & therapist’s role in his recovery. Making a partnership will motivate them to cooperate with treatment.

4.       Tailor-made Program:  Each client has unique & has different issues, one has to address the client’s needs. Same assignments & treatment may not be effective with everyone. 

Why In-patient Treatment for addicts?

Nobody likes the confinement, we all love freedom. Addicts compare jails with in- patient treatment. However family also sometimes feels that outpatient treatment will be a better option but it eventually gets fail. An addict is pre-occupied with the thought of using substance it is difficult for him to participate in individual counselling sessions with this mind set, There are high chances of addict to use substances as a result of uncontrollable cravings. He may feel ashamed or guilty to go to therapist after drinking or using substance. An addict always gives first preference to his substance so adherence to outpatient treatment becomes challenging.  There are few rational for suggesting a in-house treatment for an addict; the reasons are as below:

1.     No access to substance: In a natural environment addict has open access to substances or alcohol. In-patient treatment automatically turns in to compulsive abstinence as rehabilitation caters doesn’t allow the patients to use any chemicals once they are admitted.  
  

2.     Structured routine: after detoxification, patients are supposed to follow the structured timetable in the rehab. It includes fixed timings for food, exercise, sleep etc. An active addict doesn’t have a structured day in natural environment. He sleeps whenever he wants or he don’t mind skipping food for days together which may worsen his health condition. 

  

3.     Peer help: In the rehabilitation units he gets the peer group like him who is also fighting with the addiction, the peer educators works as role model & he can get motivated.   

4.     Less deviation: patient is able to avoid the unnecessary deviations like meeting the using friends or responding somebody on phone or mails by being in the in-house treatment.

5.     Focus on self: Less deviation, good positive peer support, in puts by therapists allow the patients to focus on themselves and change their thoughts, attitudes towards substances. They will be able to put conscious efforts for bringing the desirable changes. 
  

6.     Under observation: While taking the in-patient treatments there counsellors, therapists, doctors are supposed to give a feedback, that means the patient will be under observation & he will get the right suggestions during the treatment. It saves lot of time & patient gets good directions to mould his behaviour.

7.     Helps to introspect: The suggestions, psycho education, peer feedback, etc helps the individual to introspect his behaviour & learn from the past mistakes.

8.     Managing cravings & triggers without substance: During the treatment patients learn that they can overcome the craving & stress & negative emotions without the substance; they learn the new coping mechanisms & become confident.  
    


     Sheetal Bidkar

Group Therapy in addiction treatment

Counseling is the backbone of almost any major addiction treatment program.   Addiction counseling usually comes in one of two forms: individual or group sessions.  Individual counseling is private, and features the recovering addict meeting one-on-one with the therapist to unearth and address the root causes of the addictive behavior.

Group counseling in drug rehab features a counselor/therapist to lead the program, but that is where the similarities end.  Rather than privacy, discussion and openness are the stock-in-trade of a group meeting.  It is a chance for like-minded individuals to come together and discuss their addiction, their lives and their aspiration.  Here I would like to tell some rules for therapist to cunduct effective Group therapy. 

ROLE OF THERAPIST

1.    All members should sit in a half moon circle. This facilitates maintaining eye contact with the group members.

2.    Rules should be explained briefly every day before the start of the session.

3.    Introduce the topic for discussion with appropriate examples before the session. When the topic is clear, the group will progress well.

4.    Be receptive towards any positive message or activity discussed in the group.

5.    Be patient and attentive while listening to the group members.

6.    Make sure your clarity of thoughts and ideas reach the group members.

7.    Clarify and restate what is appropriate behavior related to the topic.

8.    Actively facilitate sharing with clear focus on specific issues.

9.    Handle denial skillfully and tactfully.

10.                       Motivate the group members towards positive change to lead an addiction free life.

11.                       Be alert to changes in the tempo of the group.

12.                       Encourage group participation in views expressed and appreciate important contributions made by the group members.

13.                       Intervene only to sharpen the focus and provide useful inputs to handle complex issues.

14.                       Have a non- judgmental attitude and maintain confidentiality.

15.                       Be supportive and accepting, this can be communicated through verbal and non-verbal behavior.

16.                       At the end of each session, facilitate feedback and don’t give answers readily. Help the group members give feedback, summarize their responses and than give your comments.

S       Sheetal Bidkar

TO BE OR NOT TO BE: What is the best time to stop drinking?

How true: the above mention quote is really touching isn’t it?

Many of my patients has a confusion in their minds about the right time to quit the drinking. Most of them argue that they want to come out of addiction but not now. I always post them the following question

What is the best time to stop drinking? 

My Answer is

TODAY: Right Now 

No matter how you are physically & mentally? How much you drink? How much you lost as a result of your addiction or using; think about the following points. I am sure it will help you to take a decision.

You may ask why right now? My answer is as below:

1.     Before you get permanent damages:  Think about the gifts or assets of yours you can still preserve. Many addicts they die before they get message of recovery, many addicts they are still suffering but not able to get the message of recovery and many addicts meet with the serious accidents & permanently become handicapped. Before one get the permanent damage it’s wise to come in to recovery/ Stop drinking & using.

2.     No Boundary for recovery: Most of the recovering people expresses that they are leading healthy life physically & emotionally too. If we compare addiction with other serious diseases the fact will come out. The fact is all serious diseases have a boundary to recover; like once you develop heart disease you cannot work rigorously, your physical heath does not allow you to do certain heavy jobs - rigorous exercise, climbing mountains, working physically hard, taking stressful jobs, thrill seeking activities etc. Mental illness also requires continuous efforts & medication still the patients experience the boundary of recovery. Some of the tasks remain difficult or impossible for them- Multi tasking etc.

But with recovering addicts there is absolutely no boundary for recovery,

They can lead a very healthy life without any physical or mental health issues.  

3.     Enjoy recovery more than suffering: The earlier one comes to recovery the more he gets the time to enjoy the recovery. Life is for limited years one need to choose that he wants to spend in the suffering or he want to come out of that and enjoy sober life.

Life doesn’t wait for anyone.  In short, longer the person remains addicted the less time they will have to enjoy sobriety.

4.     Not to hurt more: Longer the person remains in addiction; more they will get hurt people by their behaviour. Soon an addict will lose family, friends, well wishers etc. Value the people you have.  

5.     To Be or Not to Be: Only decision is not enough for recovery one need to act according to the decision. Come out Of this mind set of to be and not to be, don’t kill more time by being confuse. Ask yourself real hard questions & be action oriented. Remember, Logically no one can justify addiction or using.

feel free to give your views

Sheetal 

Adopting the Addiction Culture

One of the definitions of culture is the behaviours & beliefs characteristic of a particular social, ethnic or age group: the youth culture; the drug culture.

It shows the social acceptance pattern of behaviour among a specific community. It also talks about the living hood of that society.

Being addict is a process. People slowly turned in the category of addict. The transformation of this phases passes through this phage called adapting the culture of addiction.

In simple words, people make some changes in their outward appearance & in the behaviour to fit in to the addicts group. 

I remember around 2007; a teenager was referred to me by the school. The complains was breaking rules, arguing with staff, bullying students, coming late in nights, hanging out with senor students, not receptive for suggestions etc.

2 yrs after that in 2009 the same case has come for counselling this time he was exhibiting different changes. He was significantly different than his Premorbid personality, he was wearing all dark cloths, long red & yellow coloured hairs, all right hand was with full of tattoos, no eye contact. Parents were complaining about drug (ganja) use.

2013 when I saw him, I realized drug use has changed him a lot. I was noting down my observations. Each time there was a significant change. He incorporated many new irrational beliefs in him. This time the shirt was sleeveless & buttons were open, big rings in all the fingers, was wearing Bermuda, some repetitive abnormal gestures like bending neck towards left side shoulder &   rubbing his nose with right thumb. He was wearing big white stone ear ring. I feel I am talking with the different person. Addiction has entirely changed him as a person. Some of his using friends were Nigerians.

He was just imitating their dressing pattern, tone & accent, gesture & reaction pattern too. This time complains were being physically aggressive, breaking articles, engaged in illegal activities etc. He was using all kind of drugs since morning to night. He was very apathetic towards family & was running away from home after assaults or stealing. Frequent accidents & hospitalizations were there during last year.

One can see the progression of the behavioural symptoms each time.

Over the period, he was struggling to fit into the culture of addiction. He was moulding himself according to his using friends, blindly imitating some of their behaviours like: dressing hairstyle, gestures etc.

 Many addicts admit that they consciously changed their language, dressing style, reaction pattern, eating patterns as a result of increased substance abuse. In order to fit in to the peer group, support addiction without money, escape from the guilt & shame of ding wrong one s this culture.

Adapting addition culture is red alarm which clearly indicates that the person needs long term treatment for substance abuse.

HOW TO IDENTIFY:

1.       Sudden change in friends

2.       Sudden change in dressing sense

3.       Demand resistance

4.       Opposite deviant behaviour

5.       Attention seeking  

6.       Breaking rules

7.       mood swings  

8.       Difficulty in managing money

9.       Manipulating behaviour

10.   Careless attitudes

Sheetal 

Deadly D’s: What keeps you stuck in the disease?

“There are two ways to be fooled. One is to believe what isn't true; the other is to refuse to believe what is true.” 
Søren Kierkegaard

Few years back I decided to publish my research work, for that I was interviewing people with one or more substance dependence. Few of them were undergoing the treatment for almost for fourth or fifth time. However the liver reports or health condition is clearly showing the evidences of physical deterioration & unmanageability in important areas of life; many of them were still bend upon an irrational thought that they are not addicts. 

I was thinking about only one question

What is that keep addict stuck in the disease?

I started reading & collecting the information which can help me to solve this puzzle. I got the answer when I was studying about the self deception tendencies of addicts. 

We all want to defence ourselves from various physical or emotional threats. some of  us feels offense is the best defence, some of us feels prevention is better than cure; likewise an addict also wanted to protect himself by using the self defence techniques. 

Some may use rational techniques to protect the self image & some may use irrational as well. 

Some of the defensive techniques don’t help the addict to come out of the problem but it just gave a temporary relief from the threats he perceived. 

It’s hard for human being to accept & admit the defence. Once the addict starts experiencing the damages then this unhealthy defence mechanism comes in play to rescue. Addicts will eventually face harmful consequences & realities of disease.  This defence mechanism stopped working. An addict reaches to the following phases.

   Denial

   Detour

   Delay

   Dilemma

   Defeat

   Dry/Die

   Decision

I would like to discuss each one of them separately in this series of articles. I would like to discuss some of the relevant cases.  

Till then think on the pointsJ

Substance Abuse and risk of HIV

Substance Abuse and risk of HIV

In 2002, National institute on Alcohol Abuse and Alcoholism conducted research and findings clearly show that the use of alcohol and other substance of abuse is a factor in the spread of HIV and can complicate the long-term health outcomes of HIV-positive individual. Every year the number of newly infected people through Injective drug use in increasing and it’s a alarming

 How does drug abuse predispose to HIV-AIDS?

1.    The most common method of transmission is by sharing infected injection equipment like needles and syringes among people who inject drugs.

2.    There is sexual transmission of virus between those who injects drugs and their sexual partners.

3.    HIV may be transmitted from a addicted mother who is HIV positive during pregnancy, delivery or child birth.

4.    Even non injecting use of drugs like alcohol, cannabis, heroin can lead to high risk sexual behavior as alcohol/drug use can interfere with judgment about sexual (and other) behavior.

5.    Exchanging sex for alcohol/drug is a common risk behavior pattern adapted by many addicts.  

Why is injecting drugs a risk for HIV?

§  Direct syringe sharing / sharing drug equipment carries a high risk of HIV transmission through:

§  Using blood contaminated syringes to prepare drug

§  Reusing bottle caps, spoons or other containers like spoons and cookers used to dissolve drugs in water and to heat drug solutions

§  Reuse water

§  Reusing small pieces of cotton or cigarette filters (cottons) used to filter out particles that could block the needles

§  ‘Street sellers’ of syringes may repackage use syringes and sell them as sterile syringes.

Points to remember

v  Take treatment for alcohol and/or Drug abuse.

v  Stop using drugs.

v  Avoid mixing alcohol or other drugs with sexual activities.

v  Never share needles and syringes, water or drug preparation equipment, if you are a injection drug user and follow safe injection practices.

v  Safely dispose of syringes after one use.

v  Abstain from casual and unprotected vaginal, oral or anal sex.

v  Avoid multiple partners.

v  Take immediate treatment for sexually transmitted diseases.

v  Get yourself tested for HIV if you are a drug user or have indulged in other high risk behavior even once.

And always remember DRUGS DRAG YOU DOWN.

The Ghost within

The Ghost within...........

One fine morning I was getting ready for office, I ate my breakfast I was fine & clam. I got a call from a fake agency as I won some fat amount from UK. I was happy & wanted to share the good news with my wife. 

She replied.... ''Hey! The greedy Ghost within you making you believe the stupid gift?'' It's fake 

I started looking in the mirror & I got the answer.

My Wife was right the ghost lives within me................ & that is nothing but  

 

‘MY ADDICTIVE SELF’

Easy Money, impulsive acts, irrational planning, grandiosity, false pride within one second started dominating me. I was thinking that one need to at least enquire about it. Why will somebody call you just like that? I lost control on my thoughts. I was just planning to act.  

My Addictive self was telling me, ’It’s better to get this easy money then struggling every day.’

 I am staying way from alcohol from last almost 4 years but still the thought process is not streamlined.

My addiction has changed me as a person. I was self cantered, impulsive, not empathic during my active addiction days. I quit taking alcohol but still I have to work consciously on my thinking style & attitude as the ghost within me is still alive.....  

Sheetal