12 Steps Archives - Integrative Psychiatry Online, Ron Parks, MD

Meditation, mindfulness, happiness - zen garden with massage stones and waterlily

Meditation – Mental Health Essential

Written by Ron Parks, MD on January 16, 2018. Posted in ADD/ADHD, Addiction, Anxiety & Panic, Bipolarity, Commentary on Health and Well-being, Depression, Happiness, Holistic Views on Mental Health Issues, Integrative Therapies, Meditation/Mindfulness, Mood, Neuroplasticity, Spirituality & Health.

Meditation, Mindfulness, or Introspective Practices

have well proven their value in holistic mental health work for mood, anxiety, addiction, and health issues. Meditation can be an essential tool for happiness and mental health. Enhancement of longevity and decrease in brain aging has also been demonstrated as an added benefit. In many other areas, there are proven benefits as in work, school, athletic performance, sleep, and creativity. The mere awareness in meditation – that thoughts and emotion are of a changing and transient nature – is enlightening for those felt imprisoned by harsh negative thoughts and emotions.

Hurricanes, Depression, and Recovery

Written by Ron Parks, MD on September 16, 2017. Posted in Depression, Holistic Views on Mental Health Issues, Integrative Therapies, Mood, PTSD, Spirituality & Health, Trauma.

“Hurricanes, Depression, and Recovery” article is a story of one person’s tragedy from severe depression and hurricane losses. Experiencing a larger force of nature brought him not only to a deeper understanding of his life but to healing and recovery. The hurricane calamity also affected the multitude of people living in the same destructive path. The devastating hurricane or a storm can be compared to depressive illness: both need a path to recovery. A story presents one man’s journey of despair and loss, to redemption and healing.

Addictions Uncovered

Written by Ron Parks, MD on April 30, 2017. Posted in Addiction, Holistic Views on Mental Health Issues.

Current statistics show the immensity and seriousness of unrecognized substance abuse disorders and addictions.

An integrative psychiatry perspective looks beyond labels, symptoms, or a few illness characteristics to find understanding and positive treatment options for addictions.

Several questions arise about addictions.

Who is addicted and how is addictive illness defined?
Who is at risk?
How does addiction become a destructive disease with health and social consequences?
What are the indicators and early signs of addiction?
What are integrative psychiatry approaches to addiction, brain change, and neuroplasticity?
What resources are available if substance use is a problem?

How serious is the problem?

In a 1999 substance abuse survey, 14.8 million Americans used illicit drugs at least once during the prior month. About 3.5 million were dependent on illicit drugs, and an extra 8.2 million were dependent on alcohol. Only 8.1% of people with alcohol use disorders actually receive needed treatment. An estimated 30% of primary care patients with alcohol use disorders did not receive treatment. In 1992 alone, the total economic cost of addictions, alcohol, and drug abuse was estimated to be $245.7 billion – including:

Expense of treatment and preventive programs
Related health care costs
Reduced job productivity and loss of earnings
Increased crime with resulting personal and public costs
Social welfare needs

An addiction epidemic now exists to heroin, morphine and other prescription opioid pain relievers.

In the past decade, pain medicine prescriptions, like opiates, have increased 300%. It is estimated that two million people in the United States have substance use problems – most are from opioid pain relievers. About 26% of individuals, who are prescribed opioids for pain, develop opioid use disorders (Dr. Mercola, 2016). “In 2015, 52,404 Americans died from drug overdoses; 33,091 of them involved an opioid and nearly one-third of them, 15,281, were by prescription,” (Mercola, 2017); (SAMHSA); (Elinore F. McCance-Katz, MD, Ph.D., 2015).

Physicians and dentists in the past were taught to treat pain with drugs, which are now known to cause addiction. Patients were led to believe that pain would be controlled with a low risk of future addiction. As a result, we are now in a national healthcare crisis. In North Carolina, since 1999, more than 13,000 individuals have died from pain medication overdoses. Last year, North Carolina dispensed nearly 10 million opioid prescriptions (DHHS Secretary Mandy Cohen, MD, 2017).

“Since 1999, opioid overdose deaths have quadrupled, and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet, the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C. As many as 1 in 4 receiving long-term opioid therapy in primary care settings struggle with opioid addiction.” (LETTER FROM THE SURGEON GENERAL, 2017 – The Surgeon General’s Call to End the Opioid Crisis)

Addiction to refined carbohydrates, sugar, is now a major costly health crisis, contributing to obesity, diabetes, heart disease, and other significant health issues. Though a major problem, it is often overlooked, especially with the massive marketing of the sweetened products and their ready availability – as in soft drinks, and at many food outlets and restaurants. Some of the characteristics of sugar addiction are similar to cocaine addiction.

Addictions defined.

The American Society of Addiction Medicine, 2017 (ASAM) defines addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” Addictions present characteristically in several ways:

Pathologically pursuing of reward and relief by substance use and other behaviors
Inability to consistently abstain
Impairment in behavioral control
Craving
Diminished recognition of significant problems with one’s behaviors and interpersonal relationships
Dysfunctional emotional response
Cycles of relapse and remission

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) from the American Psychiatric Association replaced the term addiction with “substance use disorder.” The replacement was done because of the term, “addiction’s” uncertain definition and possible negative connotations. Also, it was felt that “substance use disorder” would be a more neutral term and describe a wider range of dysfunction, from mild to the severe state of “chronic relapsing compulsive drug taking and alcohol use.” However, the word “addiction” is still commonly employed in the USA and other countries where there is the persistence of severe substance abuse problems.

The DSM-5 describes alcohol and opioid in a similar manner as both are considered “use disorders with a problematic pattern of use leading to clinically significant impairment or distress.”

The manifestation is demonstrated by at least two significant occurrences within a 12 month period:

The substances are taken in larger amounts or over a longer period than was intended
There is a persistent desire or unsuccessful effort to cut down or control the substance use
Lots of time is spent in activities necessary to get the substance, use the substance, or recover from its effects
Craving or a strong desire to use the substance
Continued use, despite having persistent or recurrent social or interpersonal problems, caused or exacerbated by effects of the substance
Important social, occupational, or recreational activities are given up or reduced because of the substance use
Recurrent substance use in situations in which it is physically hazardous
Continued use despite knowledge of having a persistent or current physical or psychological problem that is likely to have been caused or exacerbated by the substance
Tolerance, which develops, is defined as a need for markedly increased amounts of the substance to achieve the desired effect. Also, there is the occurrence of a diminished effect with continued use of the same amount of the substance
The withdrawal shows the characteristics withdrawal syndrome for the particular substance
Related substances are used to relieve or avoid withdrawal symptoms (American Psychiatric Assoc. Publishing 2013) (DMS-5)

There are many factors that can increase the risk of developing an addiction.

A family history of addiction can increase the likelihood of substance use disorders in relatives. A National Co-morbidity Survey showed that individuals with a mood disorder are 2.3 times more likely to have a substance use disorder than those without a mood disorder. For bipolar disorder, there is 9.7 times greater chance of having alcohol dependence and 8.4 times higher chance of having another type of drug dependence problem. Trauma-related conditions, as the experience of a traumatic childhood or adult life events, are found to be a common substrate in addiction illness. Attention deficit (ADHD), anxiety, obsessive-compulsive, and schizophrenic disorders are associated with higher rates of substance abuse. Recognition and treatment of any condition that can potentiate or put one at risk for addiction need attention as soon as possible (see reference and resource page).

There are early warning signs of drug and alcohol abuse.

Increased drinking or use of other drugs
Changes in job or school performance
Changes in attitude and mood as depression, irritability, suicidal threats, or actions
Unexplained changes in eating, sleeping habits, physical appearance, physical complaints, blackouts, or temporarily memory loss
Behavioral problems as dishonesty, sexual promiscuity, and stealing
Change in relationships especially with new friends known to drink or use drugs
Alcohol on breath, slurred speech, staggering, appearing spaced out
Missing alcohol, medications, or money from around the house
The presence of drug paraphernalia as pipes, pill boxes, etc.

Recognition, early interventions, and treatment are critical.

The goal would be to reduce pain and suffering and the staggering cost to society. Because addictions can switch, all types of addictions need early recognition and intervention. Examples would be compulsive eating, gambling, the Internet, computer, sexual, and pornography addictions (see Addiction Reference and Resources page); (Hugh Myrick, MD, 2016).

There are valuable screening tools and questionnaires that are available to identify addictions. The AUDIT for alcohol (WHO) and the SBIRT (SAMSHA) for alcohol and substance abuse are helpful (Marc Schuckit, MD, 2014).

It is useful to learn how the brain develops, perpetuates addictions, and how it can heal itself. There are robust mechanisms in our nervous systems and brain that serve positive purposes. Theses critical brain operations are for survival, food, shelter, reward, gratification, and reproduction. The same processes are also the miraculous pathway for the achievement of success and accomplishments. Misdirection can occur however into debilitating addiction and substance use disorders (William Yvorchuk, MD, 2015).

New findings in brain research give promise for successful addiction treatment.

The brain can adapt, change, and lay down new neurocircuitry (nerve pathways). Less used neurocircuitry are removed in a healing and regenerative process. Information is needed about the brain’s operations, functioning, and influencers. The application of gained knowledge in neuro research can lead to positive treatment outcomes. The goal would be for prevention, restoration of health, and addiction recovery.

“Neuroplasticity” is the descriptive name for the ability of the brain to change. This process represents the changes that can occur with training and to positive addiction treatment programs. Change in neurotransmitter patterns can result in new positive habits and behaviors. The training, repetition of positive experience in supportive social settings supports these brain changes (Ron Parks, MD, 2016); (Frank Lawlis 2015).

Other approaches as trauma-oriented therapies as EMDR and Spiritual Emergence are potentially valuable additions to treatment programs. The Center for Spiritual Emergence, as an example, aims to help people live to their fullest potential. A transpersonally-based, systems-oriented, body-centered, and trauma-integrated approach is provided to foster healing and spiritual emergence from spiritual emergencies, mental health issues, and substance use disorders. The physical, emotional, mental, social, and spiritual dimensions of patients’ concerns as well as health and wellness are addressed as a pathway to wholeness.

Integrative and comprehensive approaches to addiction treatment are essential.

A thorough approach to addiction treatment looks at environmental, child to adulthood influences, psychosocial factors, trauma, and neuro-developmental issues. The importance of how other factors affect brain processes and human behavior need continuing investigation.

An intervention or treatment program can be set-up once a qualified individual or program completes an addiction assessment. An Integrative Psychiatrist and Addiction Specialist addition to the treatment team is recommended as there is a high degree of co-existing problems. Co-existing issues may need attention before addiction treatment can be successful or sustained. Treatment needs to be done for contributing medical and mental health concerns. Areas of concern may be nutritional, hormonal, allergy, immune, metabolic problems, trauma, behavioral, psychological, or emotional related conditions. Early medical interventions may look at nutritional deficiencies, inflammation, digestive, hormone, or metabolic problems as insulin resistance, early diabetes, or thyroid problems. Deficiencies of minerals or vitamins such as magnesium, copper, zinc, amino acids, essential fatty acids, B6, B12, or folic acid all can be corrected with appropriate assessment. (see Ten Holistic Steps for Mental Health)

Integrative psychiatry and addiction programs may include:

Education
Counseling
Psychotherapy
Inpatient rehabilitation
Outpatient programs
Partial hospitalization
Halfway houses
Cognitive behavioral therapy
Motivational interviewing
12-step programs
Mutual help groups
Mind-body-spiritual and sensory-based therapies
Natural complementary therapies

Possible medication augmentation can be considered, especially when other interventions are not successful. Drugs that help reduce cravings and relapses are most effective for opioids and tobacco. The medications currently available are only moderately effective for alcohol and minimally useful for stimulants, cannabis, inhalants, other substances (Petros Levounis, 2015).

If you, or a significant other, such as a spouse, friend or employer, see early signs of addiction, do not ignore, as you may inadvertently be a contributor to the severity of the problem.

With the dramatic rise in death from heroin overdoses and the devastating effects of both drugs and alcohol on individuals, families, and children – addiction is a problem that can’t be ignored. Seek help and information for both recognition and treatment of addictions to prevent serious consequences.

Find resources locally, in your community, or on the Internet. Seek out or consult with:

Health care providers or your primary care physician
Addiction specialists, treatment centers, or programs
Integrative psychiatrists or, holistic health practitioners
Twelve step programs as Alcoholics Anonymous or Narcotics Anonymous
Other resources as listed under addictions on our Resource page (see below)

The Substance Abuse Mental Health Service Administration (SAMHSA) can be contacted 24 hours a day at 1-800-622-HELP

By Ron Parks, MD & edited by Shan Parks

Questions:

What would be your first step if addiction is a concern for you or a significant other? Comment below.

References & Resources:

See: Addiction References & Resources

Neuroplasticity – Recovery & Transformation

Written by Ron Parks, MD on July 27, 2016. Posted in Anxiety & Panic, Bipolarity, Depression, Holistic Views on Mental Health Issues, Neuroplasticity, PTSD, Spirituality & Health, Trauma. 2 Comments

Recovery and Transformation are often felt to be impossible for individuals with addictions or mental health problem as depression, anxiety, Post-Traumatic Stress Disorder, and other stress or painful conditions.

There is new hope with the advances in neuroplasticity, neuroscience and its technology to identify, modify or change neuro-circuitry, behavior, responses and reactions. Progress in better understandings of the psychology of the human mind and behavior have contributed to greater success in overcoming what was known previously, which in the past was considered hopeless and beyond the reach of those who had been affected by unrelenting, disabling conditions. The study of other healing methods and traditions, as the 12-Step-Programs for addictions, also has led to more successful integrative treatment programs.

As in the first two steps of 12-Step-Programs, for addiction recovery, there must first be the acceptance of the disease as such, and realization of the impossibility of recovery without profound change. Pursuing treatment on a superficial level for an addiction or any other persistent or chronic illness often fails, such as making limited attempts to make cosmetic changes in one personal way, learned habits, or in the expectation that medication will help. To the person afflicted, life has become unmanageable, and the individual “me” admits to being powerless to make the deep changes needed for recovery. The nature of the illness often has led to feeling hopeless, helpless and powerlessness.

The reason for repeated failures or relapses is that a person unsuccessfully tries to use what was learned from earlier life as:

non-effective coping
use of manipulation and attempts to control others and the environment
efforts to rebuild failing relationships to fulfill unmet needs for nurturance, love, and acceptance
repeated ineffective efforts to feel sufficient, empowered and adequate

To recover and transform, one has to get beyond ego, personality, habits, reactions, and behaviors.

If there comes a realization of the powerlessness to change the existing status quo, the opportunity exists to embrace the insight that there are the greater potentiality and possibilities beyond a person’s individual ways and self-identity. When one can’t find any viable alternatives from the repertoire of prior failed actions and behaviors – one has “hit the wall” or “rock bottom” – survival is threatened, the need to tap into a greater “well of resourcefulness” hopefully becomes apparent. After running out of the “customary” choices for survival, there has to be a willingness to let go of the old and embrace options out of the larger sphere of positive possibilities – turning one’s life over to a “higher power.”

The idea for acceptance of a higher power is confusing to some that come to 12-Step-Programs, who may associate this with earlier life negative religious experiences or associations with an abusive authoritarian or dominating figure, especially if there has been traumatic abuse. Gaining flexibility to explore and invest in behaviors or practices to bring about recovery and transformation is what is needed. When stuck in an inflexible state of a rigid self, one needs to shift from an unproductive personal belief about power and control existing in the limitation of individual development and programming since birth, to the realization that there is much more: a greater potentiality, a higher resource beyond the personal limitations and rigid entrapments.

One of the barriers to change relates to deep held core beliefs of:

not being safe
not being loved
not being enough
not being worthy – burdened with guilt and shame

Arriving at a place of great despair, a “dark night of the soul,” there is a need of letting go of the established, old limiting “ego identity.” Embracing spiritual attunement becomes the only viable option, with an acceptance that there is a greater field of possibilities and potentialities, where love, acceptance, and inclusion prevail. Embracing the essence of being – the higher power – allows for profound empowerment and motivation for the steps required for transformation – restoration of “sanity” as identified in the 2nd of the 12 Steps.

Spiritual emergence

is the experience of personal awakening, beyond the constriction and restriction, set by the trained and programmed part of the mind (the ego) – to a higher level of perception, realization, and functioning. A new developing integrative addiction treatment program in Asheville, NC – Center for Spiritual Emergence (see their website) – describes spiritual emergence as a “natural opening and awakening that many people experience as a result of coming to terms with the difficulties of life, through an established faith tradition, as a result of systematic spiritual practices or through unexpected peak experiences. Spiritual emergences gently allow one to experience and embrace their natural connection to the transcendent domain, forever changing their limiting self-concepts into a more integrative, awakened self”.

Psychoneuroplasticity (PNP)

as presented by Lawlis in his well-done book – Psychoneuroplasticity Protocols for Addictions (Lawlis et al. 2015) is portrayed as an evidence-based science with restorative, rehabilitation, and transformational tools and applications. PNP is founded on developments in neuroscience, neural therapies, rehabilitation medicine, addiction and other integrative approaches to mental health treatments. Though the book focuses on evidence-based treatment approaches for addiction, it is very applicable to the care of other mental health issues and problems and supports the value of integrative approaches and therapies. Brain plasticity is based on the understanding of brain activity, neuronal circuitry, and the ability for the stimulation, modification, retraining, and growth of nerve cells and their complex networks.

Positive brain plasticity can be helpful in many problematic areas as:

cognitive processing, worries, physical pain, migraines
emotions, depression, anger, reactiveness, stress
anxiety, fear, phobias, obsessiveness, distractibility
alertness, focus, arousal, ADHD, brain fog, fatigue
PTSD, sleep disturbance, addictions, cravings, over-weight

To set the stage for healing, recovery, transformation, and neuroplasticity, any difficulties in above noted areas, may need to be addressed early on. Several are discussed in greater detail below.

Anxiety and fear

can be a disabling condition and a major interference with life and productivity and can act as a barrier to recovery from other mental health condition, including addictions and other health problems. The following can contribute to anxiety or panic like conditions:

unmanaged stress
prior life losses and trauma
lack of adequate parenting or an early life nurturing environment
adverse effects from medication and drugs
life-threatening physical illness

Resulting impairment can become chronic with only temporary relief, if any, from drugs or use of substances that could be harmful to one’s health and well-being. Studies of brain waves often will show high-frequency beta waves in localized regions of the brain suggesting increased activation and the need to retrain and repair the brain’s neural networks to more relaxed frequencies and a healthier state. Mental health professionals sometimes will label people as having other mental health conditions or personality disorders, like borderline personality disorders, because they have not been able to grow and mature emotionally. The behaviors and personality may be related to earlier life abuse, persistent severe anxiety, and feelings of being overwhelmed – resulting in resistance or the inability to resolve severe chronic anxiety that blocks healthy development around their families, social network, and peers.

Traumatic life events

can lead to post-traumatic stress disorder (PTSD), which can either be of a simple type where there has only been one major traumatic event or complex where there have been multiple accumulative traumas. A person’s life development can get stuck in a time-relation to an earlier trauma. Integrative type treatment protocols and therapies focusing on treatment of trauma, as those presented by Lawlis (Lawlis et al. 2015) have the potential to bring relief by relieving the emotional connection to trauma memories and supporting positive brain changes and plasticity . The use of neurofeedback type treatments as the BAUD (bioacoustical utilization device) can disrupt the reconsolidation of traumatic memory and has been shown to relieve symptoms of PTSD (RESET Therapy). Relaxation or stress-reducing therapies, music, meditation practices, breathing techniques, nutritional diet, neuro-biofeedback and skill development can be a part of neuroplasticity enhancing protocols. Other sensory or trauma-focused therapies as EMDR, are also utilized to form new and healthy neuro-circuitry and response patterns.

Depression

can interfere with recovery and be due a multitude of factors including:

response to negative life events, chronic stress, trauma, and losses
low self-esteem
genetics, nutritional deficiencies, and medical illness
toxic environmental exposure including to drugs and alcohol

With depression there may be associated: ruminations and obsessional thought, as seen in OCD (Obsessive Compulsive Disorder); anxiety; loss of productivity; feelings of loss of control; loss of interest in things; a downward spiral of increasing depression and development of suicidal thinking, which can lead to loss of life or complication with other medical illness. If suicidal thinking occurs, immediate help should be sought from mental health professionals.

The brain, if studied with EEG brain wave studies in identified areas of the brain, will show a pattern of under activation and low voltage waves. Neuroplasticity focused protocols look for healthy interventions to bring these areas of the nervous system back online and restore responsive feelings, energy, joy and happiness without the individual resorting to using potentially dangerous drugs or chemicals. Intervention may include therapies as noted above including:

neurofeedback or neuro-therapies, BAUD
psychotherapies including trauma-focused therapies as EMDR
exercise, nutritional diet, supplements
sound, rhythm, aroma, movement, and dance therapy
mindful meditation, breathing techniques
social network development with active peer support
coping, relapse prevention, and social skill development

Cyclic patterns of disturbed emotions and behavior

can interfere with recovery. These can present as periods of irritability, rage, heightened anxiety, obsessiveness, sleep disturbance, periods of dramatic increase in activity and hyper focus alternating with times of fatigue, depression, loss of motivation and loss of interest in things. These patterns are sometimes labeled as being in the Bipolar Spectrum (see Dr. Parks article) but can also be related to PTSD and prior accumulative trauma. Many of the above-noted treatments and others are considerations to correct altered behavioral pattern, skill deficits, dysfunctional brain patterns, and neuro-circuitry.

Consider broader integrative or neuroplasticity related approaches if you or a loved one has difficulties with any the above-discussed symptoms or conditions. Seek out competent and well-trained health care practitioners trained in these areas.

Written by Ron Parks, MD, edited by Shan Parks

Question:

What symptoms or conditions do you or a significant other have that may be helped by one of the above-discussed approaches? I would be interested in your comments or opinions. Please respond below.

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