During the holidays and after the beginning of the new year, therapists often see an uptick in people who are stressed out and feeling depressed.   If this sounds like you, then you may also be at higher risk of relapse whether it be due to alcohol, drugs, sex and pornography, eating, spending or gambling.   Here are 15 suggestions that may help you avoid relapse and stay physically and mentally healthy this holiday season:

  1. Avoid certain unhealthy or triggering people, places and things. Part of relapse prevention is to learn to identify the what, who, and why of addiction, and then to avoid them.  This includes the familiar traps associated with a return or increase in use. Your therapist can help you recognize that relapse is a process of reverting to a learned behavior can make all the difference in terms of being in the driver’s seat over the problem behavior.
  2. Develop a strategy. Related to #1 above, it is crucial to know thyself and to pattern a strategy to NOT relapse. To NOT plan to stay abstinent is to plan to lose control or to relapse.
  3. Increase your support by making an appointment with your therapist or going to additional AA or group therapy meetings.
  4. Attend a Michigan Psychodrama Center workshop. The MPC offers numerous groups and workshops aimed at assisting those with addictive struggles.
  5. Address the emotional triggers that fuel out of control behavior. Many times, childhood pain surfaces during the holidays. Family get-togethers challenge most of us, but when there has been alcoholism, drug use, or other dysfunction in one’s family environment, the feelings when seeing family members or reliving memories at this time of year can be overwhelming. Talk to a professional or other “safe” person about these feelings. Otherwise, you may find yourself numbing the pain with substances or other addictions.
  6. Eat well, exercise, do yoga or mediate. All of these activities boost the body’s natural endorphins and sense of well-being and calm. It is Michigan, meaning there is little sun during the winter, so you may want to check your vitamin D levels. Low vitamin D can signal fatigue and bring on poor eating and sleeping habits.
  7. Manage your expectations. Avoid Facebook and comparing yourself to others. Most people exaggerate their successes and avoid posting their difficulties. Don’t fall into the trap of believing you are less worthy than others.
  8. Volunteer. Assisting others who are in need, worshiping or serving at a spiritual institution or giving of yourself in other ways boosts the mood and shifts the focus from your own feelings.
  9. Manage your thoughts. Read about cognitive therapy and learn how to spot cognitive distortions and reframe them. Dr. Corby is a certified cognitive therapist and can provide guidance.
  10. Maintain good sleeping habits and sleep hygiene. Sleep deprivation can lower your resistance to relapse and can also make you feel depressed. Talk to your therapist to determine if your sleep issues are psychological, and consider having a sleep study done to rule out things like apnea.
  11. Practice good self-care. Prioritize your schedule, balance it, don’t overdo it or overpromise to others. Perfectionism is the enemy to self-love.
  12. Don’t expect that you will feel festive just because it is the holidays. Allow yourself to be authentic and cry, write feelings in a journal, feel your frustration over the past and present, and feel down, so you can clear those feelings away for moments of joy that might pop up.
  13. Remember that this season is temporary. Staying centered, real and supported can help you ride out the urges and vulnerability to relapse and arrive on the other side of the season stronger than ever.

 


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Dr. Charles R. Schuster came to Wayne State University School of Medicine in 1995 to take responsibility for forming a substance abuse research center. He had recently left his position as Director of the National Institute for Drug Abuse, National Institute for Health (NIH) where he had served for the prior 8 years under then President Clinton.

While at WSU Dr. Schuster was very successful in establishing a unit that specialized in human drug abuse research that also provided excellent clinical care.  Dr. Elizabeth Corby began her post-doctoral work under mentors Dr. Schuster and his wife Dr. Chris-Ellyn Johanson in 1996 at the clinical research division on substance abuse.

In 1997, Dr. Corby became an assistant professor in the Department of Psychiatry and Behavioral Neuroscience, where she continued to work with Dr. Schuster until 2000 when she left to become a senior staff psychologist at Henry Ford Hospital’s chemical dependency treatment program, Maplegrove center.

According to Dr. Schuster’s obituary:

“By the time Dr. Schuster came to WSU he had already built up an impressive resume of accomplishments in the research and treatment of addition, particularly related to opioid addiction. The university offered him an opportunity to work with addict patients. Bob developed a strong research group embracing pharmacology, psychology and psychiatry with collaborative relations with a number of colleagues in these disciplines.”

Dr. Corby feels very fortunate to have spent part of her career working with Drs. Schuster and Johanson, and has many fond memories of their work together. Dr. Schuster was a giant on whose shoulders many of us stand, and he will be deeply missed.


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Psychodrama is a deep action method developed by Jacob Levy Moreno (1889-1974), in which people enact scenes from their lives, dreams or fantasies in an effort to gain new insights and understandings, and practice new and more satisfying behaviors.[i]

Psychodrama is an amazingly versatile modality.  As a method of healing it has been used in group therapy and in one-on-one therapy (as an extension of Freudian “talk” therapy).  And Sociodrama, as a sub-set of psychodrama , had even more far reaching application, and allows further expansion of the method’s versatility.

Sociodrama is a type of psychodrama, but rather than using the methods to address individual issues, sociodrama identifies and explores group issues.  It is “a learning method that creates deep understanding of the social systems that shape us individually and collectively”[ii]

Sociodrama, is used in the classroom and in businesses.  It is also used for exploring literature and deepening religious understanding, such as with bibliodrama.

A blend of psychodrama and sociodrama is also used by trial lawyers. According to psychodramatist John Nolte, “as many as 1500 trial lawyers have been exposed to psychodrama through Gerry Spence’s Trial Lawyer College.”[iii]  Lawyers (staff and students) “have gone far beyond this goal (of personal development) by developing unique and creative ways of utilizing the psychodramatic method in training and their work.”[iv]

It is fascinating to observe how creative and spontaneous trial lawyers are and can be when bringing the tools of psychodrama to the courtroom.  For example, lawyers will often use the various methods of role reversal, doubling, chair back, and soliloquy to help deepen their understanding of their client’s case.  This can allow them to become better story-tellers in the courtroom.

Trial lawyers use psychodrama to increase their own creativity and spontaneity. They can then use the information they gain from these exercises to help bring their cases to life.

According to one lawyer deeply steeped in the method:

Trials are frequently likened to a drama. The comparison is an easy one to accept since both theater and trial involve storytelling. One of the lessons we can take from the theater is the notion that credibility originates with the inner feelings the actor is experiencing and not the action itself.[v]

As finally, as John Nolte eloquently explains, trial lawyers “have reinforced strongly my long-held conviction that psychodrama is indeed the road to spontaneity-creativity and that psychodrama is for everybody.”[vi]

 

 


[i] Garcia, Buchanan, Current Approaches in Drama Therapy, Chapter 9, pg.162 (2000).

[ii] Browne, R. Towards a framework for sociodrama. Thesis for Board of Examiners of the Australian and New Zealand Psychodrama Association, (2005).

[iii] Nolte, Non-Clinical Psychodrama: Lawyers and the Psychodramatic Method, The Journal of Psychodrama, Sociometry and Group Psychotherapy, Vol. 60, No. 2, pg. 7 (2012).

[iv] Id.

[v] Cole, Psychodrama and the Training of Trial Lawyers; Finding the Story, The Warrior, Winter (2002).

[vi][vi] Nolte, Non-Clinical Psychodrama: Lawyers and the Psychodramatic Method, The Journal of Psychodrama, Sociometry and Group Psychotherapy, Vol. 60, No. 2, pg. 13 (2012).


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 A promising new type of cognitive therapy called “brain training” has been demonstrated to be useful in treating drug addiction, according to an article recently published in the recent issue of Biological Psychiatry:

Warren K. Bickel, Richard Yi, Reid D. Landes, Paul F. Hill, Carole Baxter. Remember the Future: Working Memory Training Decreases Delay Discounting Among Stimulant Addicts. Biological Psychiatry, 2011; 69 (3).

 I use this type of therapy in my office to treat all types of problems ranging from depression, to AD/HD, to addictive problems. This new study adds significant weight to earlier preliminary results that brain training is highly useful for problematic substance abuse.

We have come to learn that drug addiction leads to changes in the actual structure and function of the brain. People with compulsive addictions, especially those that are substance in nature, tend to exhibit a trait called “delay discounting”, or the tendency to devalue rewards and punishments that occur in the future. People with addictions may at the same time have a predisposition towards what is called “reward myopia” which is the tendency towards the immediate gratification that drugs can provide with addictions.

Warren Bickel, Ph.D., a pioneer in Brain Training and his colleagues at the Center for Addiction Research in Little Rock, Arkansas borrowed a rehabilitation approach used successfully with patients suffering from stroke, or traumatic brain injury. The therapy approach involved stretching general memory capabilities. Subjects addicted to stimulants were given brain exercises that focused on strengthening the areas of the brain associated with storing and managing information reasoning to guide behavior. Dr. Bickel’s team found that by strengthening the brain circuitry, they also reduced the addicts devaluation of longer term rewards.

Dr. John Krystal, Editor of Biological Psychiatry comments on the article:“The legal punishments and medical damages associated with the consumption of drugs of abuse may be meaningless to the addict in the moment when they have to choose whether or not to take their drug. Their mind is filled with the imagination of the pleasure to follow. We now see evidence that this myopic view of immediate pleasures and delayed punishments is not a fixed feature of addiction. Perhaps cognitive training is one tool that clinicians may employ to end the hijacking of imagination by drugs of abuse.”

My experience with Brain Training has been equally exciting, in terms of seeing clients learn to develop competing thoughts and goals that not only challenge their maladaptive patterns (e.g., depression, anxiety, impulse delay with AD/HD or substance abuse), but replace those thoughts with real expectations of rewards in the future, if the client were to change his or her old pattern. This “old versus new” brain idea is explained to clients as offering a choice – either clients can revert to old “reptilian” responses that keep them locked in their psychic pain, or give a good mental workout to new neuroconnections that satisfy and encourage new thought and behavior patterns, and rewards! Putting it another way, if we envision in our minds new positive possibilities, we can not only get excited about those potential outcomes in our lives, but we can actually increase our brain’s likelihood that the brain “muscle” will train and grow in response to our cognitive strengthening exercises. How cool is that! So maximize your “brain
plasticity.” Cognitive Brain Training is an extremely useful addition to another great technique I use, Mindfulness Based Cognitive Therapy (MBCT), which will be the topic of my next blog. Stay tuned.


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