Category Archives: Recovery and Resiliency

Getting your tools dirty.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Assorted tools

Tools.

Your recovery tools.

What shape are your tools in? We all have our tools. Many men and some women like new shiny ones. Other people have craft tools or cooking tools. I was thinking a lot today about tools and how we use them.

Counselors talk with their clients about learning new tools, relationship tools, anger management tools, tools for sober living.

In school, they taught us the “tools” we would need to do our jobs once we graduated. When I teach classes for beginning counselors they learn not only the tools they will need to teach their clients but also the tools they will need to be good counselors.

So with all the tools out there why is this job of recovery so difficult? Why do people try things in life over and over and still they don’t seem to come out right? What is wrong with our tools?

Recently I moved. We had looked forward to the new place. It was larger and it was in a better neighborhood, besides it had a nice yard. In preparation for the move, I bought some new tools. They were so nice and shiny. I had a few old ones from the last place but a new home requires a few new tools. I put them on the workbench in the garage when we moved in. A brand new circular saw, a good shovel for planting in the yard, I had all the tools I thought I would need.

I was talking to a client today about tools. This is his – well let’s not say how many times he has been in a treatment program. I was talking to him about the tools he needed to stay clean and sober and the tools he would need to keep his mental illness at bay. Then it struck me. What tools could I offer him that he had not gotten at other programs before? That got me thinking about all those tools I had bought for the new house and what had happened to them.

A week after we moved in, maybe two, we bought a couple of bushes to go by the back fence. They were small bushes and the ground was damp. They didn’t need a very big hole. So rather than go to the garage for the new spade, I grabbed the old one that was leaning against the shed in the backyard. It worked OK so I saved a trip to the house to get the new one. To this day the new shovel has not been used.

I needed shelves but never got around to buying lumber. Some used metal ones were available at a place on my way home from work. I bought the used shelves. The new saw is still in the box.

I got busy and so instead of doing the yard work the way I had planned, I paid someone to mow the lawn. The net result? All those pretty, shiny, new tools are still sitting there in their original packaging, still unused.

As I talked with my client he explained what went wrong with his previous treatment programs. What had happened that he learned all those new tools but kept getting the same old result? He didn’t need more tools, he had plenty.

He looked at me and then he said – “I didn’t get my tools dirty.”

Then it struck me. We all have tools. We go to seminars, read self-help books, participate in counseling and therapy but we stay stuck in the same old pain and dysfunction. The reason so much learning does not change us?

Sometimes recovery is a messy business. It takes work and effort. We have to practice new skills. But between the learning and the practice – we forget to use those tools.

We forget to get our tools dirty.

For more on this see the posts on Stages of Change especially the Maintenance Step.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Happy enough to make the bed?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Happy faces

Happiness.
Photo courtesy of Pixabay.com

So how do you know when you are happy?

What things say for you “today I am doing well; today my recovery is on track?” It is most often not the big things, the jobs or relationships. It is easy to feel happy when something great, new, and novel happens. People, most of the time, get happy when something good happens. Not being able to take joy or pleasure out of something that used to make you happy is a sure sign of depression setting in.

Not being able to feel pleasure, professional counselors call that anhedonia is one of the things we look for in diagnosing depression. Happiness is about more than just not being clinically depressed. How do you tell if you are really happy deep down? If someone were visiting with you how would they know today was one of those happy days?

In interviews, I ask clients “What makes you happy.” They tell me not about big things, but mostly about little things, everyday things, that results in them feeling happy. Those things also reflect happiness. Most times it is those little things that are making them happy.

When someone is functioning well, when life is worth living, they take better care of themselves. One way we as outsiders looking in can tell if someone is happy is to look at how they care for themselves. We call these self-care habits “activities of daily life.” Someone who is able to do their “activities of daily life” is headed in a good direction. They are having a good day.

Someone who is unable to do those same activities, we worry about them.

So did you make your bed today? People who get up and make the bed may have a large head start on happiness compared to those who don’t. You need to decide for yourself if making your bed says “happy day” to you. But many people find that on the days they are able to make their bed, this says to them today will be a good day.

It goes farther than making the bed is a barometer for happiness. People tell me that when they get into a habit of doing things to care for themselves it becomes easier to keep up that habit.

Do you feel better or worse on days that you brush your teeth, fix your hair and put on your good clothes? Doing self-care even on days you don’t feel like it can improve your mood.

One client told me he and his partner used to go for walks every morning. He could judge the quality of their relationship by how often they walked. During periods of conflict, they just did not feel like going for the daily walk. If one of them was depressed they did not feel like a morning walk that day. The result was that their communication got worse, the depression increased and the happiness disappeared.

Once we discovered this connection between the morning walk and the feeling of happiness with the relationship, they made a commitment to walk together every morning whether they felt like it or not. They found that more walk time resulted in more and better communication and that created more happiness on both people’s part.

There is an old twelve step expression “fake it till you make it.” That expression is not about being dishonest or showing a false face to others. It is telling us that when we go through the actions of a happy person we become happy. The opposite can happen also. Isolate, avoid others and you become lonely and sad.

So what daily rituals tell you that you are on the right track? Will you commit to yourself to take better care of yourself? Try it for a week and tell us how your commitment to self-care affected your mood and your success.

Are you happy enough to make your bed today?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

More ways to mess up your mind

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

Drug use articles making news – parents beware.

Over the last week, a lot of articles have appeared in the news about the effects of new trends in drug use. In a previous post, I talked about new drugs and drug trends. Here are the latest developments on that front.

Drug use during pregnancy.

A recent study reported that there are more and longer-term effects of methamphetamine use on children. My experience in counseling in California’s central valley led me to expect to see more of this and now we are. A large multi-site study shows that children with perinatal exposure to Meth have long-term problems with behavior. The symptoms look a lot like ADHD but include lots of other behavior problems and learning disabilities.

Counselors have learned to be skeptical of these kinds of studies, but this one is different. A lot was made out of the phenomenon of “Crack babies.”  Long-term studies were not as certain. Crack babies were being born prematurely and with low birth weight, but given good care, they did catch up. Many of the early problems in “Crack babies” diminished as the child matured. Not so with meth babies.

Meth babies are often born prematurely with low birth weight also. Yes given good care, they put on the weight and mature also. But unlike Crack babies, the Meth children do not seem to be outgrowing their problems.

Now in all fairness and the interest of honesty here, pregnant women who knowingly use meth during pregnancy are not the largest part of the problem.

The injury done to the unborn by the mother’s use of drugs depends on the point in the pregnancy at which the mother consumes the drugs. A whole lot of damage gets done during the first trimester of pregnancy when women do not yet know they are pregnant. This is particularly an issue for young women who may underestimate the chance of getting pregnant for the first time.

We should also remember that no matter how serious the damage which was done to the unborn by meth or cocaine, there is another drug that is doing more damage. One drug alone accounts for more than half of all the avoidable birth defects – and that one drug is – Alcohol.

Kratom use is picking up in the U. S.

This drug is banned in its native country but is being produced in the U. S. now. It is also more available than ever via the internet. Like most other drugs that some people use to get high, this drug now has a fan club that wants to promote the benefits of “Medical Kratom.”

Synthetic Marijuana use goes up.

Doctors in emergency rooms are seeing and sometimes missing overdoses of synthetic marijuana. Clients in substance abuse programs have been caught smoking these products to get high because they think they will not get detected by drug tests. The synthetic marijuana’s does show up in the toxicology screens but E. R. doctors are missing this because the symptoms can vary so much from one person to another. Over ten percent of high school students are reporting they have smoked synthetic marijuana. Symptoms go anywhere from a mild high to psychosis and catatonia. Hearing voices and not being able to move is not what people expect from smoking this drug but it can happen.

Energy drinks send their users to the E. R.

Getting your energy from a bottle or a can may not be all we thought it was. Hospital emergency room visits for people, mainly men, under the influence of energy drinks has gone up 1,000% since 2005. Some brands contain not only caffeine but lots of other stimulant chemicals. When the stimulants kick in especially when combined with coffee or other caffeinated beverages the symptoms can look like a heart attack.

Even more serious is the combination of energy drinks and alcohol. People think they are ok because of the stimulant in the energy drink but are impaired by the alcohol without knowing it.

Khat may be banned in the Netherlands.

Now when a country with notoriously liberal drug laws bans a new drug we have to wonder what is up with this one. Some people are suggesting that the reason the Netherlands is banning Khat is racially motivated, most Khat users are also ethnic Somali or from eastern African. The official government version is that this is not about race but because of the problems they are seeing with those who use Khat on a regular basis.

The liberal drug laws of Amsterdam may be fading away. What the Netherlands has found is that while liberal drug laws may have helped control some diseases in the population it has also attracted a lot of drug addicts from other European countries. Some articles suggest that even Amsterdam is no longer enthralled with being the drug tourist attraction it once was.

So there you have it. Some updates to my last post about new drug trends parents should keep in mind.

Till next time, David Miller, LMFT, LPCC

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Clear Values

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

When you are struggling with life’s problems it is difficult to keep your priorities straight. People who have anxiety disorders find everything is so important they run from task to task with never a chance to rest. People with depression find any and all tasks overwhelming. Sometimes it is hard to take any action. Recovering people are often faced with the need to decide what is really important in their life. What things need to be kept and what things can be let go. We call this process “values clarification.”

“Values Clarification” is also an exercise that we sometimes run in group therapy. It goes something like this. Each member of the group is asked for two things that are important to them. We go around the group and everyone gets a chance to tell us about two things that are important in their life. I like to write this on a board or paper in front of the group as I go. Sometimes we get several things that seem almost the same and need to be lumped together. For example, one person may say my job and another says his career. I make a bigger category of employment.

These lists contain quite a variety of things. Some people nominate material items, a car, money, or a place to live. Other people list self-improvement things like education, sobriety, or achieving a life goal. Many people mention relationships, like with their wife, husband, or children. Some people include spiritual values like God or religion. And there are often nominations for global goods like peace, health, ending pollution, and saving endangered species.

Now I have found that the list I get varies a lot depending on the group involved in this exercise. People in a locked hospital because of psychosis are likely to mention basic needs of life, like food or a place to live. People in substance abuse treatment are more likely to mention things like sobriety and attending twelve-step meetings. They are also more likely to look at internal personal things as important like peace of mind and self-respect.

The next step in the process involves clarifying these values. Son and daughter might be combined to make children and so on. Each member of the group is then given three votes for items on our refined list. This requires them to vote for at least one thing they did not nominate. It also allows people to change their minds and vote for things that they did not think of before. In the process of voting a strange thing takes place.

The list has some items with a lot of votes and others with few or no votes. In almost every case I have ever done this, relationships, family, and friends rose to the top of the list. So did intangibles. Peace, happiness, sobriety, and security, which beat the heck out of money, cars, and pleasure most every time. In recovery, we find that the values we hold drive our actions. It is important to be clear about what really matters.

So if relationships and peace of mind are so important to us – why do so many people spend all their time and effort on making money and getting things?

What is important to you? What do you spend your time pursuing?  Care to comment and share what you value most?

Special thanks to Irene Aparicio, LCSW, an early supervisor in my career who taught me this exercise.

Till next time, David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Bipolar – misdiagnosed or missing diagnosis?

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18

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Diagnosing Bipolar Disorder.

Why is it so hard for people with Bipolar Disorder to get diagnosed and treated? For mental and emotional problems, the sooner the diagnosis, the sooner the treatment begins, the less the suffering. The more entrenched the illness the longer and more difficult the recovery. We continue to have difficulty with Bipolar Disorder. Why?

Almost 70% of people with a Bipolar Diagnosis had another diagnosis first. On average they get four other diagnoses before the Bipolar one. Usually, somewhere along the line, they are diagnosed with Major Depressive Disorder, given an anti-depressant. At this point, on an antidepressant, 40% of clients with Bipolar experience an episode of mania or hypomania. Antidepressants given to people with Bipolar disorder also increase the likelihood they will become rapid cyclers.

Our understanding of this condition has changed over the years. To be honest the mental health profession’s understanding of most illnesses has changed a lot over the years. We used to call Bipolar Disorder by another name – Manic Depressive disorder. Clients continue to come into facilities and tell us that they have Manic Depressive Disorder and Bipolar, not understanding that both are the same thing, just a new name.

Currently, there are two principle camps in this debate – those who think too many people are being diagnosed with Bipolar Disorder and those who think that professionals are missing a lot of Bipolar Disorder. The controversy goes back to the first efforts at classifying anything, the lumpers, and the splitters. Some people would like a different name for every possible type of dog; other people are content to consider them all dogs, the same with mental illnesses. So what difference does it make? It could make a lot of difference.

Ira Glick, up at Stanford wrote an article a while back called Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. This is not a really new article but it is important as we think about how the diagnosis is likely to change in the next few years when the DSM-5 comes out. Glick suggests that the true rate of Bipolar may be as much more than what is being diagnosed. We used to expect Bipolar Disorder to run 1% to 2 % of the population; recently it has been diagnosed closer to 7%.

We are starting to think of this condition as a spectrum disorder. So there is a range of symptoms and the ones with less noticeable symptoms are not getting diagnosed.

Does it matter if some mild cases are getting missed and not treated? Yes, it matters and the clients with the less prominent symptoms are not necessarily milder cases. Currently, we separate cases into Bipolar I and Bipolar II.  People who have Bipolar II don’t have pronounced episodes of mania. They do have other significant differences.

People with Bipolar II have way more unemployment. They get divorced more often; have more thoughts of suicide and more suicide attempts. This one disorder, according to Glick, accounts for more suicide attempts than any other mental illness, excluding personality disorders. This is a big problem since Bipolar II looks like Major Depression until the mania or hypomania kicks in.

Many people who eventually get the Bipolar Diagnosis are first seen by their primary care physician. Primary care doctors treat more than half of all the depression and anxiety. There are a lot of medical problems that are especially problematic for people with Bipolar Disorder. People with bipolar disorder are more likely to have migraines, diabetes, or obesity.

Medications for people with Bipolar are especially problematic. People with Bipolar II get antidepressants till they have a manic episode then they may get all sorts of meds. People with Bipolar I have the more pronounced psychosis and may get all kinds of heavy-duty antipsychotics. Sometimes people with depression have distorted thinking and we see psychosis. Sometimes the psychosis in Bipolar II looks a lot like Schizophrenia, Schizoaffective disorder, and a lot of other things.

We are also not sure how much of all this is a result of genetics and how much is learning. Some authors have talked about how personality traits, those supposed unchanging characteristic ways of behaving may be related to Bipolar Disorder.

In fact, there is some question as to which mental health issues are district illnesses and which are symptoms. A cough is easy to notice but what causes the cough can vary a lot from person to person.

Despite all the issues with diagnosis, Bipolar disorder in all its forms causes a significant amount of suffering. It is also a difficult disorder to manage for the client and for the professional. If there is a chance you or someone you know has this disorder get a professional evaluation. If you have Bipolar disorder become a knowledgeable client, and don’t give up hope, the treatment options continue to improve.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

The Inside and Outside of Relapse triggers.

Posted on by
10

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Relapse

Relapse.
Photo courtesy of Pixabay.com

Relapse triggers, either internal or external, are those things that set off cravings in a recovering person. The failure to do maintenance steps in the process of change increase the risk of giving into triggers.

External triggers are the things outside ourselves that place us at risk to resume old behaviors and give up on the progress of recovery. Shorthand ways of understanding these triggers are people, places, and things.

People are one of the biggest reasons people relapse. There is a huge temptation to look up old friends. Often the only thing that you have in common with an old friend is a history of using drugs or drinking. Sometimes there was a history of other dysfunctional activities, codependency, or abusive relationships. If the people you had around you in the past supported your addiction or if they were not affirming, or made you feel bad about yourself, being around them can take you back there. Avoiding people who are bad for you is not being selfish.it is being self-caring. In early recovery it is suggested you not make a change you can’t take back like changing jobs or relationships. Surround yourself with people who support your recovery.

Places are another important external trigger to pay attention to. Alcoholics need to avoid bars; drug addicts should avoid dope houses. But there are other places to avoid. People with relationship issues should avoid revisiting places they used to go with a partner who is no longer in your life. Should someone on a diet visit a candy store? I wouldn’t recommend it. Think about places that you may need to avoid if you want to be secure in your recovery. Is there a family member or former friend who triggers your issues?

Things can also reignite thoughts of returning to an old lifestyle. Music can be a powerful memory trigger, so can some smells. People with relationship issues, sometimes we call these people love-addicts, find it hard to let a relationship go. They keep the old moments out. They think about the things they did together. One last call to see how that person is doing is likely to set off a new round of problems. Carrying lots of cash can trigger some people, especially gambling addicts and former drug dealers. Sometimes it is a pipe or a lighter you find hard to get rid of. Is there something that reminds you of your issue but which you find hard to give up?

Internal triggers are the other part of the equation. The things going on inside our bodies and our minds are also relapse triggers. The word HALT standing for, Hungry, Angry, Lonely, and Tired is used as a reminder of those triggers.

Hunger, thirst, and many other physical sensations can make you feel restless, irritable, and unleash the cravings. Negative emotions are powerful relapse triggers. Feeling anger fear or resentment, any number of negative emotions can cause someone to catch a case of “who cares.” Loneliness sends people back to their disorder quickly. Being tired is likely to upset recovery also. All of these internal triggers have to do with not taking care of ourselves. It is a short hop from not taking care of yourself to thinking you don’t deserve care, after that why should you hang on? Why not go back to the old life? People who don’t provide good self-care don’t encourage others to care for them. They start believing they don’t deserve to be treated well and then they stop treating themselves well.

Another way of understanding internal and external triggers is to look at the two main causes of relapse, romances, and finances. Romances are all about your feelings, feelings of loving and being loved, self-worth, and self-esteem. Finances, mostly money, is the ultimate thing. Lack of money can sap our will to change. Having a lot of money makes some people feel they are invincible; the rules don’t apply to them. Pay attention to the healthiness of your relationships with things and with people. When one of these relationships gets out of balance, your life is headed out of balance.

These are only some of the things that might cause you to relapse. We each have our own triggers. What are yours? Knowing your triggers and how to defuse them strengthens your recovery.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Maintenance is a part of change

Posted on by
12

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Changing your life

Time for a life change?
Photo courtesy of Pixabay.com

How do you stay changed?

How can maintenance be a part of change? Isn’t maintenance what you do, as needed after the successful results of change are obvious? No, not at all. Not including maintenance as a step in the change process is where many improvement projects, public and private get themselves into trouble. Let me give you a more visual example.

The other day I drove through an older part of town. This part of town, built throughout the Victorian era to the turn of the century was really something once. Today this part of town is a poor neighborhood. While there are still a few houses that reflect the old glory days most of them are getting run down now. A couple of houses are slated for demolition. What happened to those grand old houses? There was no earthquake or fire, nothing dramatic, just the slow process of decomposition.

A roof was torn off, the owner had not bothered to get it fixed and the rain had rotted out the lumber. Another has a porch that has fallen down. Lots of homes have not been painted in a while, broken windows are covered with cardboard, and sometimes there is an old blue tarp over the destruction. Realtors describe these homes as having “deferred maintenance.” Last time I talked with you about relapse as the result of the failure to do a maintenance step. Relapse is a sort of deferred maintenance.

What do we hear from people who relapsed on substances? You hear the story so often it starts to sound like a well-rehearsed poem. The recovering person says they, stopped going to meetings, stopped calling their sponsor, and started hanging out at the old spots. The dieter gets the goal pounds off and then eases up on the diet. The change has been a short-term project and now the deferral of maintenance starts. Eventually, when the change is completely reversed by the relapse the person starts to wonder when they tried to make that change in the first place.

We tell recovering people that whatever you did to get better, you need to keep doing it to stay recovered. Most people don’t want to accept the idea that what was needed was not a quick repair but an ongoing plan of preventative maintenance.

One important component of that relapse prevention plan is learning to provide good self-care. Having a good support system is also vital. People who have positive people in their life, people that want them to do well, are more likely to succeed. Never get to busy to call your support system. One study found that schizophrenics with a warm supportive person in the home with them cut their risk of ending up in a psychiatric hospital by almost 50%. People who attend AA drink less even if they don’t stop altogether. Many weight loss programs include a group component. Being surrounded by others who are also working on their own recovery is likely to strengthen your recovery.

Real lasting change has to include a commitment to a different lifestyle. This does not mean that every self-improvement plan needs to take over your life. If the changes you make are hard to do the chances are that you will stop doing them when the urgency is gone. Urgency is an often-overlooked factor. If your doctor tells you to lose twenty pounds or he can’t do a life-saving surgery, that is motivation. If the judge says to stay off drugs or you will go back to prison that is motivation. But if the diet is a lot of work to keep up it will probably be forgotten way too soon.

The end of this tale is that whatever got you better, diet, meetings, a religious practice, or time with friends, keep doing them. Don’t give up these positive things as you see results from your change efforts.

That is the story of my understanding of stages of change. In future blog posts, I want to talk more about relapse prevention and triggers. We should also talk more about the connection between depression, bipolar, and abuse of a couple of substances. There is a huge connection between mood disorders and substances and not always in the direction you might think. I also want to talk about why it seems there is so much controversy, especially among professionals about the diagnosis of bipolar disorder.

I read your comments and appreciate them. I also try to read as many blogs as I can that are written by recovering people of all types. The things you say remind me of things I need to talk about.

There is a lot of pain out there and we know how to help more than ever before – so why is it hard for people to find the help they need?  Why doesn’t therapy always work? What makes counseling helpful? I will give you my take on these issues and would appreciate yours.

I also want to talk to all of you, very soon, about how you might find help when you don’t have the money to pay for the help you need. Till then, here is wishing you all a happy life.

Other posts on this topic can be found at Pre-contemplation, Contemplation, Preparation, Early Action, Late Action, Maintenance, relapse, recovery, triggers, support system, more on support systems, Resiliency

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Is Relapse a part of recovery?

Posted on by
11

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Relapse

Relapse.
Photo courtesy of Pixabay.com

At some point, every recovery program has to tackle the issue of relapse. Why after losing all that weight do people suddenly put it back on? Do all alcoholics; sooner or later pick up a drink? Once you have depression you will always have recurrent bouts right? The way in which relapses are understood separates the Stages of change model from almost every other model of recovery. I have been told more than once that relapse is a part of recovery. I am not buying that! It doesn’t have to be that way.

So if relapse were a part of recovery, every person signing up for a self-improvement program should get out their calendar on day one and plan for their relapse. Doesn’t AA even say a relapse is a part of recovery? No, it doesn’t. The AA book says that a certain percentage of people get it the first time and don’t relapse. Bill W. estimated that percentage at 50%. In the early days, it appears that a lot of people who really wanted the program and stuck with it got it the first time around. He also said that there were some people, maybe 25% who tried a few times and eventually got it. The rest were better while they were in the program but kept going in and out. The stages of change model agrees with that thinking.

So why do people say that relapse is a part of recovery? Mostly, people say that because relapse happens a lot. And if relapse does happen, rather than giving up, the objective is to pick yourself up and try again. One article I read said smokers typically have to try to quit seven times. Now some people quit on the first try, a few people become nonsmokers in a few tries and there may be some people who just don’t seem to be able to quit. Any self-change is like that. It takes more than trying hard.

It is not the quitting of bad habits that is the problem. Some people quit drinking 5 or 6 times in one day. It is the staying quit that is harder. So how does someone make a change, give up a bad habit, make an improvement in their life, and then stay changed?

The stages of change model says that after all that effort, that process of change, there is one more thing you need to do to stay changed. See change is not a one-time thing. Real lasting change is an ongoing process. Why do people think that they can excessive like crazy, take off a few pounds, and then once they lose the weight they can stop the exercise?  How many days off Heroin before it would be safe to try some drugs again? The truth is that change is not a thing – it is a process. Once you make the change you have to keep doing the process to maintain the change.

The thing you need to do to stay changed is called maintenance. To stay changed you will need to do some maintenance. If you mow a lawn once will it grow back? So if it took an increase in exercise or an improvement in healthy eating to lose weight it will require you to keep doing that work to keep the weight off. The addicted person can’t just put down the substance; they need to keep doing the things that got them sober.  In the stages of change, relapse is not seen as something that is part of change it is understood as a failure to do the one remaining step in the process of change – doing maintenance.

Now, this is easier to see when we talk about weight loss or addiction but what about depression or bipolar disorder? With any of life’s problems, there are things that you can do to make the problem grow and other things that make the problem shrink. Taking good care of yourself is especially important for mental and emotional issues. So if taking good care of yourself makes you less depressed, what might happen if you stopped eating and sleeping well? Your depression might grow. The maintenance step is needed for holding onto any change you made, it is the best antidote to a relapse, whether that relapse is weight gain, addiction, or depression.

Next time we will talk about the last stage of change – maintenance. After that, I want to talk a bit about some related problems like triggers and finding help when you have few resources. Till then –

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Stages of change – Late Action

Posted on by
10

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Change

Change.
Photo courtesy of Pixabay.com

Late Action – The change accelerates.

Last time we talked about how I might be full of enthusiasm as my self-improvement program gets going. In the weight loss example, I begin to exercise and maybe even get interested in nutrition and diet. Are deep-fried Twinkies a healthy diet? The diet guru says no. I eat low-fat and lots of greens. I hate greens but I eat them anyway. My efforts at change are taking shape and encouraged by my own persistence I may even expand my efforts.

On days when I can’t get to the gym, workdays, I start walking on my lunch hour. It is a mile around the park. If I walk fast I can make two trips and eat during my lunch period. I discover that if I bring a healthy lunch, a sandwich, and some low-fat yogurt, and I walk around the park fast, some days I lose weight. Even if I don’t actually lose weight, at least those days I do not gain any more. At this point, the intensity of my workouts is increasing. I am really getting into this.

In substance abuse recovery terms, the person involved may not only be attending meetings, but they also have a regular home group they go to every week, maybe even a fellowship they attend every night. Some people “get into service” meaning they make coffee, take out the trash, and so on. We get trainers, sponsors, and a support system. At this point, my change is beginning to be something I tell people about.

For people who have an emotional problem, like depression or anxiety, their recovery action might be seeing their therapist on a regular basis, improving self-care, or journaling. There is a huge connection between emotional issues and eating problems. One of the key issues a professional looks for in making a mental health diagnosis is changes in eating and sleep. Binge eating, overeating or not being able to eat, as well as sleeping too much or too little are all symptoms of problems. They can also be causes. More about that mind-body connection and the relationship between sleep, eating, and other life problems in a future blog.

So in late action, I am getting somewhere on my self-change program. Losing a few pounds, not drinking or drugging and I am no longer so depressed I don’t want to get out of bed. Everything should be going fine. Right?

Then what happens? Why do so many people successfully make a change only to return to the place they were before? Why do most weight loss programs, diet, and exercise, end in putting on more pounds than we lost? Why do so many people get a thirty-day sober chip only to drink again? And how is it that depression and anxiety return after a period of time?

I start wondering, am I fixed? Do I have to give up those quadruple thick burgers with the pound of fries? How long will I need to take these psych meds? Can’t I just have a donut or a glass of wine? What kind of wine goes best with donuts? My mind starts looking for ways out of the change process.

For substance abuse, we call this relapse. For depression or anxiety, we are starting to think in those terms also. For weight loss programs the part that we don’t like to talk about is why after losing twenty pounds, do I put it all back on and then some. Every time I have been on a diet I have needed to get new larger clothes.

This is the point where people start talking to us about maintenance plans.  You mean I can’t just crash diet off ten pounds and then I will be able to eat like other people? Can’t you AA folks just teach me to control my drinking? So my depression is gone. I will never feel that way again. Time to get back to the way things were before my self-improvement program. So next time let’s talk about putting the weight back on, the relapse, and the return of emotional problems.

Other posts on this topic can be found at Pre-contemplation, Contemplation, Preparation, Early Action, Late Action, Maintenance, relapse, recovery, triggers, support system, more on support systems, Resiliency

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Stages of change – early action

Posted on by
10

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Change

Change.
Photo courtesy of Pixabay.com

Early Action – the beginning of visible change.

So here we are in that process of change at the point where we start to do some action steps. Up till now, we have had someone or something that created a reason to consider the need for change. No catalyst and probably most people would never embark on the journey. So we were pre-contemplative. Then we started thinking about the problem, gathering information. We called that contemplation. At some point, people get into preparation, join groups, buy books seek out resources. Still, no change has occurred, not real lasting change anyway. But now it is time for the do or die part, – getting into action.

Stage of change four – Early Action.

Some authors only have five stages of change and they have only one stage for action. I am separating action here into early and late stages as we find that the things people do at the beginning of their recovery process is often different from what they do later on. I got this formulation from Ken Minkhoff and Christine Cline at Zia Partners. You might want to check out their website and the Change Agent Movement they have spawned. The difference between early and late action is easier to see when people have multiple problems, like substance abuse and depression, this is a condition we call co-occurring disorders or complex clients. For someone with depression and a drug problem and a weight loss problem, in the beginning, all they may be able to do is get dressed and go somewhere. For them, this may be early action. Later they will be able to do more.

Now on with our story, first the weight loss example and then examples of other possible changes we might want to make.

So remember my story. I discovered others though I was gaining weight even though I hadn’t noticed. I weighed myself and gathering information and decided I needed to lose weight, maybe even change to some healthier habits. I joined a gym and bought some exercise videos maybe even some getting healthy books. Now I am at the point of starting to do something. I am ready to start exercising and eating healthier.

So at the gym, I seek out a trainer or a fellow member he shows me how to use the equipment, the routines, and the whole culture of healthy living. I like the hanging out and the talking about fitness, the exercises not so much but I do it anyway. Right now my goal is to lose that weight, get that old suit to button closed again, and generally shut up my friends who say I am fat.

At first, I wander around the gym. I try out a machine or two. I check out the weights to see what I can lift. I talk with people who show me how to do things. It amazed me how friendly some people at the gym where and how much they were willing to help a newcomer. The same things happen at AA or other self-help groups, people trying to help each other. In gyms and recovery centers there are professionals also, trainers or therapists, and counselors; they can be especially helpful.

So the workouts continue. The weight is coming off, a little anyway, and I am feeling better and better about myself. The scale still is not saying I have lost that much weight but I always suspected it of being out to get me. One thing I noticed was that even when I was not exercising at the gym, just wandering around, the whole time I was not eating. Even if I wasn’t losing weight I had stopped gaining.

If this were a substance abuse example the person would be going to AA meetings, getting a book, and a sponsor. They might start to share at meetings. There is an old adage that a closed mouth does not get feed so you need to talk as well as listening. Now just like the guy at the gym, the person at AA might still be having thoughts of drinking, but they start to notice that while they are at meetings, they are not drinking. If they can make it from meeting to meeting without drinking the periods of sobriety start getting longer.

Each different recovery group, AA, overeaters anonymous, gamblers anonymous, or weight watchers has its own culture. You need to find one that is comfortable for you. There are over 200 twelve-step groups now and hundreds more of peer and self-help groups. Some gyms program is about exercise and flexibility other groups are all about weight lifting and setting records. A group for cancer patients is not much help to an alcoholic unless they have cancer also. Find the group that is right for you.

Eventually I settle into a routine. I am doing the things I need to do to recover, but I am not there yet. I also am not sure I want to keep this up after I lose the weight. Here is where we start to hear the word maintenance and we also start to talk about relapse. The question becomes – is what I am currently doing enough or is there more. Many people quit drinking or take off the planned weight and then they are good with that. Others want a new healthy lifestyle. So what will it be for you?

So in my weight loss example, I have started an exercise routine, lost a few pounds, though the buttons on that suit are still tight. For a substance abuser, they have made it two or three days without their drug, maybe even three weeks. So now what? What will I do next? Next blog we can talk about how my weight loss or substance abuse recovery program may change as my action moves from a few times to a regular routine.

Other posts on this topic can be found at Pre-contemplation, Contemplation, Preparation, Early Action, Late Action, Maintenance, relapse, recovery, triggers, support system, more on support systems, Resiliency

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel