B.A.S.E.S.

Brain Training for Addiction Recovery

D. SCOTT KELLY

$10.00

BASES Brain Training for Addiction Recovery
D. Scott Kelly

BASESTeenCenter.org

Copyright 2011 First Printing ISBN 1-58241-394-0 © 2011 D. Scott Kelly. All rights reserved. No part of this book may be reproduced in any form without written permission from the author. BASES Brain Training for Addiction Recovery, written and edited by D. Scott Kelly. Produced by Harbor House Publishers, Inc. Manufactured in the United States of America. While every effort has been made to ensure the accuracy of the information presented, the author and the publisher do not guarantee accuracy and are not liable for any omissions or errors. Please report any new information to the author. Harbor House Publishers, Inc. 221 Water Street, Boyne City, Michigan 49712 USA 800-491-1760 • harbor@harborhouse.com • www.harborhouse.com

Introduction / i

Introduction

hy this book, this subject, right now? In the old days, several generations ago, we understood that a bit of the creative forces of the universe lived within us. Our job in the past was to listen to this internal voice and act accordingly. As our world has become more capitalistic, market focused and individual consumer oriented around our new god, the almighty dollar, our brains have been hijacked. Those who want to influence our spending choices battle every day for our beliefs, our values and our perceptions because they know this becomes income for them.

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Twelve step programs have been around for over 75 years. The solution found in these programs attempts to bring people back into connection with an internal sense of an individualized “higher power.” Twelve step programs knew years ago that the addict’s brain has already been hijacked so the issue became how to discern the different “voices” inside our head. The Oxford Group outlined the Higher Power’s will as being unselfish, loving, pure and honest. The AA method as outlined by Bill W. focused on identifying self-will – selfishness, resentment, fear and dishonesty. As we choose a higher path, our lives experience an upward spiral to greater levels of health, prosperity and meaning. This book outlines solutions and guide posts along this journey. It is important that we learn how to live in accordance with our universal life energy and learn how to recognize this in others. As we realize we are all made of the same stuff, we take on more compassion and empathy for one another. Learning how to share and get along with one another are still the keys to our survival – whether it be the pre-school playground or international affairs – same solution, same process. The message from the great ones has always been the same. The difference has been for those who put it into practice. Ghandi said, “The greatest form of violence is poverty.” Jesus said, “Love one another,” and on and on. But, we don’t have the luxuries of having them with us here and now so we need to awaken to our internal voice and listen to the voice of love. May this become our legacy to our children – the great transformation of our times was to return to an open mind and heart that was receptive to the love that has been with us all along.

Foreword / iii

Foreword

cott Kelly’s book about recovery approaches the critical issue of how to achieve sobriety from all directions. From my experience in over 20 years of working with substance dependent people in the court system, that’s what it takes to make lasting progress, an all fronts plan. In the court system we often experience short term fixes, or “behavior interruptions,” only to have relapse occur once the pressure is off. Anyone who has tried to quit smoking knows what I mean. By the same token, everyone who has been in smoking recovery for some time knows that long term remission can occur, 29 smoke free years and counting for me. But like recovery from substance abuse you have to incorporate new ways of living your everyday life. As this book points out there are many facets of your life that are all in play together and affect sobriety in inter-related ways every day. What you put into your body and your mind. Who you spend your time with and what you do with your time. And, of course, how you handle or process life’s continuous series of unexpected events. Everything counts. In the court system we see people who have not only broken the law but have also done serious damage to their family relationships, employment opportunities, and their long term health. Young people fall behind in school and drift into situ-

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ations and relationships that can impair the rest of their lives. As a judge trying to respond to substance users, I am humbled by the limits of what the law alone can accomplish. For persons with addiction and serious abuse issues more is needed. In our counties we have emphasized a community approach that combines the efforts of the court, local school systems and area substance abuse professionals. In this model the court and its probation staff operate court schools that partner with local school districts to provide safe, sober, and respectful learning environments. This is combined with the critically important recovery treatment and education provided by local professionals like Scott and Celia Kelly. Recovery is like a bicycle wheel with numerous spokes required to keep the wheel in round. The spokes may need continuous and appropriate adjustment to keep rolling. BASES Brain Training offers over fifty spokes that may work for your own wheel or the wheel of some one important to you. Fred Mulhauser Probate and Family Court Judge

EDITORS NOTE: The Honorable Frederick R. Mulhauser is a currently serving Michigan trial court judge for Charlevoix and Emmet counties. Judge Mulhauser was first elected in 1988 and in addition to the normal court docket currently presides over the juvenile drug court, a community centered problem solving program.

Table of Contents / v

Table of Contents
Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 How did we get here? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 The King is Naked! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Addiction is a Brain Illness . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Adverse Reactions to Prescription Drugs Leading Cause of Death in U.S. . . . . . . . . . . . . . . . . .10 TFM-CSS – The brain’s warning lights . . . . . . . . . . . . . . . . .11 DABDA – The stages of grief . . . . . . . . . . . . . . . . . . . . . . . . .13 NBA – What teens need . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 We need to learn how to TLC – Think, Learn, Cope with Change . . . . . . . . . . . . . . . . . . . . . . . . . . .17 SMART – How do we make smart decisions? . . . . . . . . . . . .20

Chapter 10 HOW – How do we get better? . . . . . . . . . . . . . . . . . . . . . . .22 Chapter 11 “168” – How many hours in a week? . . . . . . . . . . . . . . . . . .24 Chapter 12 Committed or involved – the pig or the chicken? . . . . . . . .26 Chapter 13 ALL – What do we need to do to recover from addictions? . .28 Chapter 14 What is enabling? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Chapter 15 CCC – What are the key ingredients in healthy relationships? . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Chapter 16 CCC – How do we deal with other people’s addictions? . . .34 Chapter 17 4-3-2-1 What are ten stress reducing activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Chapter 18 HSLMP – Healthy decisions are made when we “Help Someone Learn My Plan” for making healthy decisions . . . . . . . . . . . . . . . .41 Chapter 19 WWHPD – What would healthy people do? . . . . . . . . . . . .43 Chapter 20 TFAUR’s – What internal experiences do I need to learn how to identify and communicate with others? . . . . .46 Chapter 21 ISAC – What are the stages of adolescent development? . . .48 Chapter 22 DMR – Developmental Model of Recovery . . . . . . . . . . . . .51 Chapter 23 Relapse is a Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 Chapter 24 PCPAM – Stages of Change . . . . . . . . . . . . . . . . . . . . . . . . .63 Chapter 25 SIR – The hero’s journey . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Chapter 26 PMA – Positive Mental Attitude . . . . . . . . . . . . . . . . . . . . . .70

vi / BASES Brain Training for Addiction Recovery Chapter 27 Play Smart or Don’t Play Long . . . . . . . . . . . . . . . . . . . . . . .72 Chapter 28 “-10 to +10” Scale – Healthy is in the Middle . . . . . . . . . . .73 Chapter 29 Addictive Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Chapter 30 ASP – Anti Social Personality . . . . . . . . . . . . . . . . . . . . . . . .78 Chapter 31 Levels of Intimacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Chapter 32 “0-10” Scale – Symptom Severity Charting . . . . . . . . . . . . .86 Chapter 33 History of Alcoholism Treatment . . . . . . . . . . . . . . . . . . . . .88 Chapter 34 GIATKI – Give it away to keep it . . . . . . . . . . . . . . . . . . . . . .91 Chapter 35 Surrender, Sharing, Restitution, Guidance . . . . . . . . . . . . . .94 Chapter 36 Rise Above – Don’t define the events of life, it’s just the way it is . . . . . . . . . . . . . . . . . . . .96 Chapter 37 May my gratitude be reflected in my actions today . . . . . . .98 Chapter 38 To pause… that is what makes all the difference . . . . . . . . .99 Chapter 39 It’s not them – the 2% rule . . . . . . . . . . . . . . . . . . . . . . . . .101 Chapter 40 Boiling a live frog – outside help is needed! . . . . . . . . . . . .103 Chapter 41 Chinese Bamboo – sometimes the changes show up all at once . . . . . . . . . . . . . . . . . . . . .105 Chapter 42 Be Nice, Pay Attention, and Be Honest . . . . . . . . . . . . . . .107 Chapter 43 Bird in the Barnyard morals of the story . . . . . . . . . . . . . .111 Chapter 44 I have survived countless disasters – 1% of which actually happened! . . . . . . . . . . . . . . . . . . . .112 Chapter 45 Parenting Suggestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 Chapter 46 Refusal Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116 Chapter 47 Dealing with unhealthy people . . . . . . . . . . . . . . . . . . . . . .118 Chapter 48 GIGO – Garbage In, Garbage Out . . . . . . . . . . . . . . . . . . .120 Chapter 49 Healthy Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122 Chapter 50 Peer Selection Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124 Chapter 51 7 of Diamonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Chapter 52 Book flop with Eddie – What is faith? . . . . . . . . . . . . . . . .128 Final Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 Brain Training Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Select Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136

How did we get here? / 1

1

How did we get here?

ay Area Substance Education Services (BASES) is a nonprofit corporation that was founded in 1993 by my wife Celia and I to address the needs of local youth and their families experiencing substance abuse problems. My job at Boyne City, Michigan schools as a student assistance social worker ended in 1994 due to a failed millage election. Nearly 100 of the students that I had been working with protested the loss of my position by walking out of school and picketing along the highway. I avoided the local media blitz and returned home to join Celia at BASES to come up with a plan which is the basis of this book. In 1995, BASES became involved with a group of county representatives to brainstorm about how to address the issues of adolescent substance abuse. We had directors from the intermediate school district, a local school, probate court, hospital, law enforcement and local agencies meeting on a regular basis brainstorming ideas about how to provide more intensive services for our local youth. At that time, teens that needed inpatient or residential treatment were sent to programs three or four hours away and the parents could rarely participate due to the distance. These services typically cost $8-$12,000 per month and teens that completed these programs often resumed using within two weeks of returning home. In 1996, we learned of a planning grant whereby representatives from the county could participate in a county-wide

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needs assessment investigating the issues of juvenile delinquency and substance abuse. This was based on a program called Communities That Care (CTC) which was developed by Hawkins and Catalano in the Seattle area following their ten years of research. The new local needs assessment showed that teen alcohol and drug use was above the regional, state and national levels. The results of this needs assessment made us eligible for a four year federal grant. The elevated risk factors from the CTC model that we chose to address included: a) community laws and norms favorable toward drug use, and b) friends who engage in problematic behavior. One goal to address the laws and norms involved the development of four community teams in the county where local groups could learn about the findings of the county-wide study and begin to look at their specific community needs. These four community groups were located in Charlevoix, Boyne City, East Jordan and Beaver Island, Michigan. We also wanted to start weekly groups for parents of high risk teens to address these community laws and norms issues. Another goal of the project was to provide substance abuse education and support services for high risk teens in the county to create more non-using peers by starting two teen groups per week. We utilized local recovering teens between the ages of 18-20 as “Peer Helpers” and had them model healthy behaviors and attitudes about staying clean and sober. This was done by having them work with small groups to develop positive relationships with these teens. Each session first had a large group presentation of key information, concepts and an overview of activities to develop healthy life skills. This was followed by small groups of three to five teens to practice these new skills, develop new friendships, and discuss the things being presented with their peer helper. It took two years to develop all of the various components

How did we get here? / 3

of an adolescent residential substance abuse intervention program. In those two years we added three additional evening groups, four after school groups, transportation services, specially trained foster homes, individual counseling services, extensive drug testing and expanded involvement in the court school program. The sum of these components has become Recovery High — a developmentally appropriate substance abuse intervention program that incorporated weekend home visits into the final eight weekends of the twelve week program. This feature was added as we found that practicing these new skills at home and in their own community was critical and was missing from other programs. Nearly thirteen years later, BASES and the Recovery High program are still here! We’ve seen over 490 teens participate in the residential program with 44 different counties in Michigan sending teens to the program. Over 25% of those teens in the residential component have come from our local area, Charlevoix and Emmet counties. The Recovery High program includes a number of attractive components: • Cost-effective intervention services compared to juvenile detention where no services, if any, are offered • Educational services, where teens have an opportunity to earn credits based on their efforts • Living accommodations in a family setting with trained foster parents • Socialization in a supportive, therapeutic environment that addresses teen developmental needs BASES facility is a teen center where participants have ample opportunity to work on their socialization skills with three pool tables, two ping pong tables, foosball, video games, cards, music, movies, board games and with dozens of comfortable couches and sofas to sit and relax. BASES is a licensed substance abuse program with the State of Michigan. Some detention facilities say they offer substance abuse services, but do not have a sub-

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stance abuse license. This is a major legal liability. The three fulltime staff members at BASES are all certified addictions counselors with over 60 years professional experience. These professionals are also in recovery themselves, with over 65 years of recovery getting sober at ages 17, 18 and 26 respectively. We lead by example and we talk from experience. Teens in the residential program receive individual counseling each week that addresses their personal issues. These issues commonly include traumatic events that are frequently being talked about for the first time. More than 50% of our clients have co-occurring disorders where they have a mental health diagnosis in addition to chemical dependency. Keeping them clean is the first step in helping them get back on track. After four weeks, we normally see significant improvement in their brain functioning. If they came in with medications, we may need to have them re-evaluated by their doctor or psychiatrist to see if the medications can be reduced or discontinued altogether. Other teens may not show improved functioning over time, so we focus on developing their skills in specific areas to help them cope in non-chemical ways. While we are not opposed to medications, we are concerned about the tendency toward over-medicating; a disturbing trend, here in the United States. Our web-site has a number of links with much more information about this subject area. We strongly encourage parents to educate themselves about the issue of medications with teens and young adults. Gwen Olsen’s 2005 book, Confessions of an Rx Drug Pusher, provides great details about this subject. James Patterson’s 2008 #1 New York Times bestselling book, Against Medical Advice, outlines the harrowing story of a youngster’s experiences with medications. Over the years, we have had nearly a dozen groups of people sit down with our collaborative team in hopes of replicating our program in their area. One of the biggest obstacles that prevents others from being successful involves the cooperative

How did we get here? / 5

nature of the three very different systems of the probate court, school and social agency. We have learned that trust, fiscal accountability and ongoing communication between the three systems are crucial to success. Each organization is meeting their financial needs to stay afloat while no one is getting greedy. Each organization is striving to become more efficient and effective while taking care of their respective staff members to prevent burnout. Another unique component of our program involves the opportunity for local teens that do not require residential services to participate in our groups and classes in a preventive intervention approach. Those teens that are evaluated and found to have elevated risk factors for further substance abuse problems may be recommended to participate in our Life Skills classes or in our Discovery / Recovery Groups where they can gain drug education and abstinence skills. If the teen does well, remains alcohol and drug-free shown by clean drug tests and positive reports from the family, their intervention may be completed after attendance at ten or twenty classes. If there are additional concerns, they may be recommended to attend two or three group sessions per week for a period of at least three months. About 5% of our teens fall into this escalating intervention track. Of the 95% of teens that complete their classes and groups successfully, about 10% of this group gets referred back to our program sometime before their 18th birthday due to family, school or court recommendation. With this second contact, they are bumped into the 2-3 group sessions per week category and are requested to stay problem-free for a period of three to six months. Some of this group work their way into group participation five times per week while still living at home and attending their own school. It is hoped that the family is involved throughout this process and attending the weekly parent groups to learn about normal adolescent development, common substances being abused these days and

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ways to avoid enabling behaviors. For the teens that do not require residential services, they have access to the teen and parent groups at no cost to the family. Local fund raising efforts help support this component of the program. It is rare to have a family with the financial means to pay for these services. For those with financial means, they frequently make voluntary contributions to the organization. The remainder of this writing will focus on some of the lessons that are emphasized in our program. At BASES, we teach that addiction is a brain illness and recovery is about brain training. This brain training comes from learning and applying the following lessons that are a sampling of some of the key things that we teach, life skills that we believe are important and key information to help you be a more intelligent consumer and citizen. “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” —Chinese Proverb It is our hope that your reading of this material will help you learn for a lifetime.

The King is Naked! / 7

2

The King is Naked!

f you haven’t noticed yet, there is something terribly wrong and backwards about our approach to health in the United States. I say, “The king is naked!” in the spirit of the little child who spoiled the scam of the emperor’s new clothes as he paraded through town in his new invisible robes in the Hans Christian Anderson fairytale. In the spirit of common sense, let’s return to using our brain and thinking for ourselves. It’s time to make common sense become common practice in as many areas as we possibly can. According to numerous studies and articles that are linked on our web-site, prescription drugs and “iatrogenic” illnesses are some of the leading causes of death in the United States. Iatrogenic means illness resulting from medical treatment. It is time that we become educated and learn non-chemical coping skills. In order to make this possible, we will need to address our “quick fix” urges and learn how to look at our internal dis-ease as a symptom rather than the root problem. This includes addiction. All addictions fit into an obsessive-compulsive system where these various addictive behaviors serve as a distraction to the internal disease. Denial and shifting responsibility for these issues to someone else can no longer be our approach. It’s time to call it like we see it — if the king has no clothes, then obviously, The King is Naked!

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3

Addiction is a Brain Illness

ddiction is a brain illness – recovery is about brain training. We have learned more about the brain and how it works in the past ten years than we've known in all of recorded history. The National Institute of Health is now explaining addiction as a brain illness or disease that is shown by “uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences.” [National Institute of Health, “The Brain: Understanding Neurobiology Through the Study of Addiction,” 2000] Drugs significantly alter brain functioning and some drugs are showing long-term changes weeks and months after discontinuing their use. Many of the young people we see begin using in an attempt to alleviate pain or make themselves feel better through the euphoric effects of the chemicals. These drug experiences are unlike anything they have been exposed to and many think, "If it makes me feel this good, I want more of it." As their use progresses, tolerance develops as the brain begins to change due to the presence of the chemicals. The young person responds with more use, or changing chemicals in search of the euphoric feeling. As they use more and more, they begin to experience loss of control and find themselves in trouble in a variety of ways. They don’t realize that when triggered, a part of their brain is activated and they experience an urge to use. Without training and proper skills, this trigger to use becomes an uncontrollable

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Addiction is a Brain Illness / 9

desire to mood alter. We sometimes refer to this as the awakened grizzly bear that wants to be fed. With no defense against these cravings, the urge demands to be fed – in spite of negative consequences. This is addiction. The primary goal of treatment is to regain control over drug craving, seeking and use. By better understanding the dynamics of the brain, young people begin to feel empowered as they learn new skills and make healthier choices. We have seen many teens develop these new skills, effectively deal with their triggers, make healthier choices and allow their brains the opportunity to learn and grow. By training the brain how to deal with triggers, we can learn how to abstain from chemicals. By challenging some of our fears about changing, we can develop new social skills and healthy peer selection skills. By changing our mistaken beliefs (such as “drugs are good for me”), we can learn how to take control of our lives and set out on the course of our own choice. Addiction is a brain illness – recovery is about brain training. I learned _______________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ I need to _______________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ I commit to ____________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

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