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Objectives
~ What are Co-occurring Disorders
~ Chicken and Egg Dilemma
~ Awareness and Mindfulness
~ Self-Esteem
~ Sleep
~ Nutrition
~ Depressed and/or Anxious Mood

  • Co-Occurring Disorders are any physical or mental health disorder that occurs at the same time as an addiction, can cause clinically significant impairment on its own, and creates a hurdle in the recovery process.
  • If people do not feel worthy of recovery/happiness, they will not stay motivated for it.
  • Water aids in digestion which makes minerals and nutrients more accessible to the body, enables your body to excrete waste, gives the brain the electrical energy for all brain functions, including thought and memory processes and delivers nutrients to the brain and removes toxins.
  • There are many common themes that can be identified and addressed in early recovery to enhance self esteem, empower the client, and begin creating a resiliency narrative.
  • Chicken and the Egg.  Which to address first—Mental Health or Addiction, Both! assuming the person is motivated.
    ~ Addiction (Goal is progress not perfection)
    ~ What are your triggers for use?
    ~ What have you done in the past that has helped you not use?
    ~ What can you do to help yourself stay clean/not use now?
    ~ How can you do that? / How can I help?
    ~ Mental and/or Physical Health Issues
    ~ What MH/PH issues do you have that contribute to your use?
    ~ What can you do that helps make those things less distressing?
    ~ How can you do that? / How can I help?
  • Awareness
    ~ Most people in early recovery are on autopilot
    ~ The powerlessness to change the situation often prompts disconnection emotionally, mentally, physically and spiritually
    ~ Part of the definition of addiction is experiencing difficulties in multiple areas of life as a result of use which often results in guilt, resentment, depression, grief, negative self-image
    ~ Life is about survival =  avoiding the intolerable pain
  • Awareness –Interventions

~ Turn off Autopilot
~ Mindfulness
~ How I feel right now
~ Meeting my needs
~ Thoughts Feelings, Urges and Behaviors that keep me unhappy
~ Thoughts Feelings, Urges and Behaviors that will help me start changing
~ Deal with thoughts and feelings that prevent self awareness
~ Guilt (I need to ignore my needs and make up for…)
~ Fear (If I tune in, I might get overwhelmed)
~ Apathy (What’s the point?)
~ Self-Hatred/Negative Internal Voice (Suck it up!)

Self-Esteem
~ Low Self Esteem
~ Powerless
~ Walk the middle path, identifying what you do and do not have control over
~ Learn from prior failures
~ Create a Success Mantra
~ If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~ Change the Dialogue
~ Undeserving of happiness (refusal to forgive self)
~ What would it mean if you forgave yourself?
~ What are you afraid will happen?
~ What makes someone deserving of happiness?
~ Change the Dialogue
~ Unlovable or fallible?
~ What makes someone lovable?
~ Useless/purposeless or undirected?
~ What skills/qualities/attributes do you have?
~ How can you use those?

Sleep
~ Sleep is disrupted by
~ Addictions
~ Stress/Depression/Anxiety
~ Physical Pain
~ Poor Nutrition
~ Sufficient quality sleep improves
~ Focus/Concentration
~ Energy
~ Hormone levels
~ Appetite
~ Mood
~ Interventions
~ 3-Step sleep routine
~ Eliminate caffeine, nicotine and alcohol before bed
~ Avoid sleep aids when possible (Medications for the treatment of sleep disorders) as they reduce deep sleep.
~ Try guided imagery or at least thinking about something non-stressful
~ Address pain, allergy and apnea issues that wake you up

Nutrition
~ More than half of the population is meeting or exceeding total grain and total protein foods recommendations
~ Grains are refined and not “whole” greatly reducing nutrient value
~ Fortified grains do not provide vitamins and minerals in the “natural” most bioavailable ratio
~ About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
~ Potentially causing deficiencies in Vitamin C, calcium and magnesium

Nutrition– Water
~ Aids on digestion which makes minerals and nutrients more accessible to the body
~ Enables your body to excrete waste.
~ The brain is approximately 85% water
~ Water gives the brain the electrical energy for all brain functions, including thought and memory processes. (Dr. Corinne Allen)
~ Water delivers nutrients to the brain and removes toxins.
~ If you are 1% dehydrated  5% decrease in cognitive function.
~ 2 percent% dehydration  fuzzy short-term memory, problems with focusing

Mood
~ Depression
~ Hopelessness
~ Complete the sentence… I don’t think there is any hope that…
~ For each sentence identify why the person believes there is no hope.
~ What would have to change to give him or her hope?
~ How can you start to make that happen
~ Hope Chest…
~ Each day add a card with something that indicates things are going better

~ Helplessness
~ Nothing I do will change it
~ What have other people done?
~ What has worked in the past?
~ What is keeping that from working now?
~ Validate steps already taken
~ Identify next steps
~ Create successes to increase self-efficacy and empowerment.

~ Apathy
~ Exhaustion “Sick and tired of being sick and tired”
~ Learned helplessness
~ Identify bad events
~ Determine which parts were uncontrollable
~ Explore which parts are, in the present, controllable

Mood
~ Anxiety/Worry
~ Loss of control
~ What do you most worry about being out of control of, and why?
~ What parts of that situation are in your control?
~ When you have lost control of that before, what happened?
~ Inability to cope
~ How do you cope
~ What are some of the most difficult things you have coped with and how?

Emotional Dysregulation
~ Inability to tolerate/handle any more stress
~ Prevention
~ What stressors can you eliminate
~ Who can handle other stressors (bills, picking up kids)
~ What are the current stressors you are dealing with
~ Put each on an index card (add cards as needed)
~ Prioritize (urgency then stressfulness)
~ Address one to 3 each week
~ Intervention
~ 4 things you can do when you get stressed out/angry
~ Practice the pause by…
~ Distract don’t react by…
~ Improve the moment by…
~ Turning your attention by…
~ What are 3 helpful problem solving skills
~ Create a win/win
~ Brainstorming
~ Focus on the parts in my control

Interpersonal Issues
~ What have this person’s relationships been like?
~ What does he/she think a healthy relationship look like?
~ What has caused prior relationships to end?
~ What can be learned from those relationships?
~ What does he/she most need in a best friend and why?
~ Which of those characteristics does he/she bring?

Summary
~ People with addictions should be expected to have mood issues
~ Addiction isn’t diagnosed until there are multiple problems (which can cause mood issues)
~ There are many common themes that can be identified and addressed in early recovery to
~ Enhance self esteem
~ Empower the client
~ Begin creating a resiliency narrative.