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Announcing CMC:DC!

We are delighted to announce that we are opening a Center for Motivation and Change (CMC:DC) in Washington, D.C. on April 15, 2019. Dr. Siobhan Donnelly came to us a year ago saying she had plans to move to DC. Since she is one of our favorite people and an awesome psychologist, we decided to keep her part of our team by opening CMC:DC. We also say a great opportunity to bring CMC’s blend of science and kindness to the DC area. The office is conveniently located 2 blocks from Union Station, and adjacent to Penn Quarter, Capitol Hill, and NOMA neighborhoods. We are grateful for this opportunity to grow and provide clients and their families in the D.C. area with the highest quality, evidence-based treatment for substance use disorders, other compulsive behaviors, and trauma.

If you are a provider in the DC area and would like to know more about CMC:DC, please call us at 212.683.3339, ext 151. We’d also like to hear about your practice, so please get in contact and let us know about you!

You can also go to our website, www.motivationandchange.com, for more information about our services, and our mission.

The post Announcing CMC:DC! appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/announcing-cmcdc/

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Responding to Ambivalence

Have you ever wished someone you love would change? Wished they would eat healthier or quit smoking. Wished they would stop spending so much money on things they can’t afford? Wished they would go see a doctor since they are so clearly depressed? If the answer is yes, you probably have some experience interacting with your loved one’s ambivalence about change.

Waffling, lacking resolve, vacillating, wavering, hemming and hawing are all value-laden words we use to describe a state of ambivalence. Due to the stigma around substance use disorders, there are even more negatively charged words to describe the ambivalence many people feel as they approach changing their use of substances. Denial, character flaws, selfishness and needing to hit rock bottom are just a few, and there are many, many more. All of these paint ambivalence as something that is negative; it’s a problem that we have to overcome or grow out of. Unfortunately, seeing ambivalence in this light can quickly lead you to feeling frustrated and even judgemental towards someone who is ambivalent and you can miss the reality that ambivalence is a state we all experience as we go about our day and make decisions.

You can see ambivalence in your own life on a daily basis! As you drive home from work feeling tired, do you order pizza or take the time to cook myself a well-rounded, healthy dinner? You are trying to stick to that diet, so you’re pulled to cook dinner. And, at the same time, you really want to just order pizza and make it easy! That is ambivalence in action, on a smaller scale. If you blow that up, it can look like trying to decide between having a drink and feeling relaxed after work, or having to work even more at the end of the day in order to avoid that drink (and feel good about keeping your goals). By acknowledging the normalcy of ambivalence you will be less frustrated by it and in turn you can communicate more effectively in the face of it.

Rolling with Ambivalence

Even when we are prepared for it, it can be difficult to roll with someone’s ambivalence. Here are some tips to make ambivalence a little bit easier to sit with.

Remember: Ambivalence Is Normal. If you feel strongly that someone should change some part of their behavior in a particular direction, this can be hard to remember. Feeling one way about a potential change, like excited and motivated and also another, like sad and doubtful is human nature.

It’s normal to get stuck in a state of ambivalence. You might have a good reason for changing, but then start to think about the good reasons for things to stay the same. The reasons for not changing are how you got into the habit in the first place! and they can then lead you to avoid thinking about any of it since acknowledging ambivalence can feel uncomfortable.

Don’t Take Sides. When you feel ambivalent and someone strongly argues one side of the decision, like telling you that you need to stop drinking, it is natural to argue for the opposite side. If someone comes down hard on one side, it’s natural to want to even out the scales of ambivalence by arguing the other side and in arguing that other side, you may get convinced it weighs more! You may think you will break through to someone by strongly pointing out one side of a decision, but there is a significant risk you will just be pushing them to hang onto the other side with more tenacity.

The way to find a pathway through ambivalence is to shed light on both sides of the coin – making space for the validity of both the reasons to stay the same and also the reasons for change. This reduces the person’s pull to fight for one side (which is usually the opposite side you want them to take!) and gives them space to find their way through the ambivalence.

Having this frame of understanding about ambivalence can help us lessen our frustration. When we really let it sink in that ambivalence is normal and that it’s common for people to get stuck there sometimes, then it’s easier to resist telling someone what they should do since you know it may push them in the other direction. Instead, you can start to have meaningful conversations that include asking open-ended questions and reflecting back what you’re hearing (on both sides of the argument!). You can even affirm your ability to understand why they feel stuck.

A conversation where Option A and Option B are both seen clearly and non-judgmentally in the light of day (by the person who really needs to decide) is often the kind of conversation that helps to resolve ambivalence and makes way for change to happen.

For more helpful communication strategies to consider in the face of ambivalence, see Listening Well: The Art of Empathic Understanding, by William R Miller

The post Responding to Ambivalence appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/responding-to-ambivalence/

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The Willingness to Change

If you or someone you love is considering making a behavior change, you may want to spend some time thinking about the concept of willingness. It’s something you’ve likely heard before, the idea of being willing to change or willing to engage in something that is difficult.

The dictionary definition of willingness is the state of being prepared to do something, to take action. When it comes to behavior change, it usually means being ready to engage in an action or series of actions that leads to the desired outcome and includes the ability or willingness to work towards the goal even though the process may not be fun, or rewarding, or enjoyable. There are lots of things that people do in life that involve having to accept painful or difficult feelings in pursuit of a meaningful, valued goal.

For example, a person might decide that working with underprivileged youths is so important to them that they go to work every day even though some days are filled with feelings of helplessness, sadness, anger about the systemic issues that cause the problems the kids face and anxiety about what will happen to them.

On the face of it, this doesn’t sound like a fun job. And you can tell yourself, “knowing that you’re helping a kid thrive is such an amazing reward!” While that may be true overall, there will be days (many days!) where it is very hard to connect with that feeling and you may even think about giving up at times as the problems just seem to big to bear.

So, why would you, or anyone, accept a job that might come along with so many uncomfortable or unwanted feelings? Because, even though it makes your heart ache or is incredibly frustrating at times, you care so much about it that you’re willing to accept all the feelings that come along with the job. This is also the case when you’re trying to change behaviors; it is a job that you are accepting that is ultimately very rewarding, even though the process is often painful and difficult.

If you’re trying to change a long-standing behavior pattern in your own life like drinking too much, over eating, or smoking, you have to be willing to endure all the bumps and bruises that come along with making that change. For example, if you’re giving up alcohol, you’re going to have to put up with your brain screaming at you to “JUST DRINK!” Why? Because your brain knows that this is how you can feel better, and it just wants you to do it! You might also have to face painful things like distancing yourself from heavy drinking friends or avoiding places that are familiar and fun but linked with drinking too much like your local bar. If you are going to drink less or not at all, you’re going to have to put up with the discomfort of feeling things you may have been avoiding with alcohol. And you’ll have to struggle through situations that were once made easier, or more tolerable, by drinking.

And if you’re someone who cares about a person who is working to change, there will be many times where you see your loved one do well, and many moments where they will struggle and fall. You will likely have to watch as they endure the pain that comes along with change and moments where they say they can’t do it. And on top of having to watch someone you love struggle over and over again, you will likely face the discomfort of realizing you don’t have control of the outcome and can only offer help and encourage the process. Your willingness to engage in this process during painful moments can help you tolerate and stay engaged for the long haul.

So again, why would anyone ever work to change a behavior if discomfort is part of the process? We do it because it matters. The changes we are making, or helping someone else make, matter so much to us, that we are willing to take on the pain, frustration, fear, worry, anxiety, and even the moments of joy and excitement, all of it.

So, if in reading this you find that you are willing to take this on in an effort to change, you may wonder how do you actually do it? The answer is to stop and take a moment to pause and think about and connect to why you’re making the change or why you are wanting to help someone change.Why is it important to you to step into the fire, knowing that you’re going to feel the flames. Why is making this change, or helping someone else change, important to you.

After you’ve connected with the meaning behind your actions, give yourself permission to have your feelings about the process. Give yourself permission to feel bad, or to feel down, or to feel frustrated. Or, maybe you’ll feel really great (which can also be a difficult emotion for a lot of people!). Whatever you’re feeling, give yourself permission to feel it.

Being willing to take on discomfort is not an easy thing to do but in being willing you can open up to the process of change in both the short and the long term.

The post The Willingness to Change appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/the-willingness-to-change/

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Drug Addicts Simple Can’t be Trusted?

We are quite sure you have heard the phrase “drug addicts can’t be trusted” in the media, from someone you know as they talk about someone with a substance use problem, or maybe even your doctor or a treatment professional. Have you ever paused to consider the impact uttering that phrase could have on someone who struggles with their use of drugs or alcohol?

People struggling with substances live in a world of stigma, shame and shunning, and their interactions with most everyone, from family and friends to medical and treatment professionals is one that is fraught with fear, invisibility, and a sense they will not be listened to, understood, or believed. Gross generalizations like “drug addicts can’t be trusted” contribute to this problem. If you believed someone was going to approach you with those preconceptions about you (i.e. you are not to be believed, listened to, and on some fundamental level, seen as a person), how would you act? Would you feel comfortable acknowledging you have a problem? Would you have any faith that the person you are hoping can help you has any understanding of what you are experiencing?

Granted, people using substances in problematic ways often engage in behaviors that make them seem untrustworthy, like lying about their use, faking drug tests, saying they want to change and then engaging in the behavior again, etc. On the surface, you could say that this is proof that they simply cannot be trusted!

But if you step back and look at the context around them, there are likely all sorts of reasons why their behaviors actually make a lot of sense. Many people do not know how to change, but know everyone in their life needs or wants them to. They often lie about their use in an effort to prevent those around them from getting upset, angry, or scared. Knowing that being honest about their struggle would be met with fear and at times outright contempt can be a big reason to lie! Additionally, the motivation to change is impacted by lots of internal (e.g., emotional states) and external (e.g., a fight with a friend) experiences, and the pull to use can be both physical (I’m in withdrawal) and emotional (I don’t know how to deal with this feelings). Changing the way you use or learning not to use is hard for most people and requires making profound changes in almost all areas of your life and always involves setbacks. When the world around you reacts to those setbacks with contempt, suspicion or punishment, one can come up with all sorts of reasons to hide (and therefore lie about) the process.

By resisting the urge to make blanket statements such as “drug addicts can’t be trusted” we all can make it easier for people who struggle with their substance use to ask for help. As treatment providers, family, friends, members of law enforcement, clergy and teachers, we can help people actually consider their situation openly, feel safe to speak about their struggle realistically, and come to understand why change is important to them. People who misuse substances are engaged in motivated behavior (not crazy, sociopathic behavior) and by being more careful about how we talk about the problem we can create a place for them to tell us the truth.

Stigma and distrust have killed many people in our country. When we create environments in our homes, institutions and communities where people with problems are as a whole not trusted or treated equally, we can guarantee that they will go underground and the problem will go unaddressed. In the case of substance use, a person may die and their family engulfed in pain and loss.

People who use drugs and alcohol to cope are people struggling to escape pain, avoid a difficult life, deal with PTSD, chronic pain, a bad marriage etc etc etc. Hearing people out about how they got where they got is a huge and still rare conversation for most people struggling this way. By assuming they cannot be trusted: there could not be a more surefire way to never have this conversation, and to lose a chance to start a life-saving path of change.

The post Drug Addicts Simple Can’t be Trusted? appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/drug-addicts-simple-cant-be-trusted/

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When Substances Aren’t The Only Issue

For many people who struggle with mental health conditions like mood disorders, substance use is a common co-occurring problem. Studies have found that 47.3% of people with any bipolar disorder will have a substance use disorder at some point in their lifetime (that number goes up to 60.3% if we limit it to just Bipolar I disorder). For people struggling with major depression, 40.3% will develop alcohol use disorder at some point and 17.2% will develop a drug use disorder. Even with this significant overlap, many people are not aware of how to treat co-occurring mood and substance use disorders. Here are some tips on how you can cope if you are one of the many people struggling with both.

Why Does This Happen?

Many people end up using drugs and alcohol to manage some of the symptoms associated with these illnesses. For example, even though alcohol is a central nervous system depressant, which might make it seem an odd choice for a depressed person to use, the effect initially is euphoric. So, while your depression may pull you to isolate and hide under your covers, making it difficult to go and spend time with your friends, a drink may feel like it will pick up your spirits or give you enough energy to go that football game. Similarly, alcohol and benzodiazepines (like Xanax) are frequently used by people who are trying to calm symptoms of mania (this time using the depressive qualities to calm down their brain).

Put in context, it makes perfect sense why people who have a mood disorder might want to turn to substances. They are incredibly powerful and good at what they do, they are reliable (I get the effect I am looking for each time), and even if they aren’t actually helping, they appear to be helping. And when you’re “desperate” for something to change, which is what many people with a mood disorders feel, the appearance of helping is a very powerful motivator. At the same time, using a substance to manage a mood disorder can make the problem worse and last longer than it might if treated with therapy and appropriate medications.

Another Path

While it can be challenging to live with a mood disorder there are several things that are in your control and can improve your odds of managing your mood without using substances. While part of coping with a mood disorder is accepting that there are things you cannot control, like your brain chemistry, there are things you can target and have an influence over that can help. Consider the the chain of events that leads you to behave in particular ways. We know that specific environmental circumstances (including certain people, situations, and times) can act as “triggers” both to mood symptoms and substance use. We also know that there are some emotions that are related to not using. Understanding and keeping track of what triggers you to want to use and what helps you avoid using can help you make choices to engage with or avoid situations and people that will lead you towards use. In this way, you’ve impacted your behaviors without the use of substances!

Mindful Awareness

A lack of awareness about your symptoms and what to do about them can contribute to mood episodes staying in place for longer periods of time and becoming more severe and disruptive to your life. Stigma and shame often prevent people from openly trying to understand what is happening to them. Instead of explaining to a doctor how horrible they feel, many people will self-medicate and hope they can solve the problem themselves. For example, someone with severe depression who often contemplates suicide can look like the life of the party when using alcohol and cocaine.

Stressful life events, both positive and negative can have a profound impact on a person’s mood. A change in school or job, getting married, the death of a loved one, a new baby, divorce or a move can all create a shift in mood. It is also not uncommon for people to have certain mood patterns around certain holidays or anniversaries (i.e., getting depressed after the holiday season or the yearly anniversary of a loss of a loved one). Many people with mood disorders also have a biological rhythm that seems to come in quite predictable patterns. These patterns can be seasonal, such as a shift to hypomania in the spring and depression in the fall. Many women also have symptoms that get worse depending on hormonal fluctuations.

Increasing your awareness of what triggers both your mood symptoms and your desire to use substances can help you figure out what kinds of skills and supports you need in order to maintain your goals. And, the more you know about what sets you off, the more you can be mindful of when those thoughts/feelings/behaviors are showing up! Increasing your mindful awareness of what is happening to you internally can help you make better choices.

Get Support

If you are trying not to use substances to manage underlying mood symptoms, it is very important to identify and enlist the help of treatment professionals, family and friends who can help. People who care about you can give you feedback regarding your thinking, mood, and behavior. It is often difficult to see mood symptoms because they can feel normal and just like part of life. An outside observer can give perspective and may act as a helpful early warning system before an episode gets really problematic. Your support systems can arrange appointments and help with treatment planning or help you address you environment at home and work to to reduce stimulation (in the case of mania) and increase stimulation (in the case of depression).

And, don’t forget about medications. Research suggests that the best outcomes are the result of a combination of medication and behavioral modification strategies. If you are struggling with both a mood disorder and a substance use disorder, working with an addiction psychiatrist (who knows about how to treat both sets of issues) can help you attain your goals.

The post When Substances Aren’t The Only Issue appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/when-substances-arent-the-only-issue/

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Finding Your True North

If you’ve ever used a compass, you know that the little metal pointer inside is always pointing north. This is how people throughout time have been able to find their way through the wilderness. If you know where north is, you can orient yourself and get where you want to go. Even in the most treacherous terrain, knowing how to locate North means that you know where you are going, and how to get there.

In our own lives, the compass we use to help us find our way are our values; those things that we hold most dear, that drive us and direct us about how we want to live our lives. We have discussed the importance of values when it comes to behavior change in the past, and encourage everyone we work with to think about their values and how they can be working towards a values-driven life.

But something has happened … magnetic north has moved! That’s right, that magnetic force that pulls our compasses to the north, the guide that helps us through the wilderness, has shifted from a spot in Northern Canada and is moving quickly towards Siberia. Is “North” supposed to shift? And does that mean that a values compass is no longer an apt metaphor for our lives?

Actually, the opposite is true! The movement of magnetic north makes this metaphor even more accurate to our lives. You see, values are not static ideas that hold steady throughout our lives, values are things that grow and change with us. They flow, they move, and they change over time as our priorities and our lives change. Our own true north is different at different times in our lives, and it is important for us to take a moment to re-evaluate our values and how they relate to our lives.

Some people may be wondering how to think about values in the first place. Sure, they are there, and you may even know some of them, but do you really feel like you know your values well enough to determine if your behaviors are moving you towards your values? If you’re not sure enough about what your values are, or if you feel like it’s time to check up on them, try the following:

First, take a look at the following list of values words. This is not a complete list of values, it’s just a sampling of words that you might relate to, or that might give rise to some other ideas. When you’re looking at the list, don’t get too caught up in the exact meaning of the words, rather think about what they mean to you, and see which ones catch your eye. Our goal is to end up with three to focus on. Why three? Because more than three can feel overwhelming, and less than three can be limiting. You can always pick different ones in the future, so these are just a beginning.

Adventure Balance Confidence Creativity Discipline Education Excitement Faith Family Financial Security Friendship Fulfillment Forgiveness Fun Generosity Gratitude Health Hope Honesty Humor Identity Independence Inner Peace Integrity Intimacy Kindness Knowledge Love Loyalty Mindfulness Moderation Passion Personal growth Physical fitness Security Self-compassion Self-reliance Service Social Justice Spirituality Strength Success Tolerance Truth Wisdom

Next, think about specific behaviors, people, and thoughts that move you towards each of those values, and behaviors, people, and thoughts that move you away from them. For example, you may have put family as one of your values, and a specific way to move towards that value could be spending more quality time with your children. Something that moves you away from that value could be going to drinks after work, which is fun, but then you miss that time with your kids. Listing what moves you towards your values and what moves you away from them can help you clarify not only what is important to you, but also what gets in the way of you staying on your values-driven path.

Values help guide us in our lives, and they help us change our behaviors by showing us what is most important to us. And, values change over time! Periodically checking to see what values are the most important to you in this moment can help make sure that you’re on the path you want to be in your life.

The post Finding Your True North appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/finding-your-true-north/

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No Pain, No Gain

People don’t use substances because they’re crazy. People don’t use substances because they’re bad people. People use substances because they get something they like, or want, or need out of it. As human animals, the things we do are motivated by what happens next: we repeat or increase our behavior if something good happens. These good things can be “outside of ourselves” like recognition from others (a raise, pat on the back, a compliment) or “inside ourselves” (a feeling of calmness, positive mood, less anger). And while we repeat things that work for us in some way, we decrease or stop a behavior if it doesn’t’ work or something negative happens.

Tolerating The Pain

When you are trying to change a behavior that in the short term feels good, like drinking, you will have to tolerate not having that desired outcome. Maybe drinking helps reduce anxiety or depression, or maybe it helps you feel more accepted by your friends. When you work to change your substance use, whatever it is that you get from drinking or using, you’re not going to get anymore. And that is a difficult thing for people to tolerate! To resist engaging in that behavior pattern, you have to decide to allow pain, discomfort, and other not-so-great feelings in as you figure out something else to do. To pursue paths we feel are important, like stopping smoking, trying to spend less, or reducing your drinking, we have to be open to the discomfort of not engaging in the habit.

It is always an option to try to NOT experience this discomfort; it makes a lot of sense, especially when things already feel really rocky. While avoiding discomfort might feel like the best path to take, there are unintended consequences – you also lose something valuable that is connected with the pain. For example, if you avoid social interactions because you aren’t drinking, you don’t have to face a potentially awkward conversation. You also avoid having moments with your friends, the ability to gain support from them (or be a support for them), and opportunities to build stronger bonds.

Does This Mean You Can’t Avoid Pain?

We are not saying getting away from the pain is “bad!” Sometimes it’s good self care (e.g. resting at home instead of going to a party that makes you uncomfortable) to take a step away from something that is painful. Choosing to step back to regroup because things have gotten very intense is important to do at times so that you have enough energy to maintain your behavior changes in the long term. The goal is to just be mindful and conscious about what you stand to gain from avoiding a painful moment, and also what you lose.

Discomfort is a part of behavior change. So is positive gain. Sometimes, in our efforts to reduce discomfort, we also lose out on some of the positives that would come if we could tolerate it. Knowing what you stand to gain, working on tolerating discomfort, and know when it is in your best interest to step away are keys to making and maintaining long-lasting change.

The post No Pain, No Gain appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/no-pain-no-gain/

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Changing Behaviors with Honey

If you loved one is using substance in a way that is causing them problems and negatively impacting your family, you probably just want them to stop! You wish they would get their act together and cut it out. Or you are completely confused and scared by the choices they are making. Or nine million other feelings that are perfectly understandably.

When thinking about the problem, most family members focus on that decreasing, stopping, or “suppressing” problematic behaviors. This is a very natural response to problematic behaviors. When you see something you don’t like, you want to make it stop! It makes sense that our first response would be to target what we don’t like and work to eliminate it. The problem that arises is that it is very hard to get rid of behaviors like that! Your loved one’s use makes sense, to them at least, and they get something from using. Simply stopping a behavior also stops the reward, which is very difficult for people. We need another way.

That “other way” is to focus on the behaviors you would like to see – the behaviors that you would like to take the place of the ones you would like to reduce (substance use, fighting, shutting down, spending etc). For example, if your partner avoids talking to you at home because of past arguments; a healthy alternative would be to try and have a conversation about a topic they have tried to raise in the past or something that interests them. Talking to you is the opposite of sitting in the other room having a drink and, if the conversation goes well, it may open the door for more engagement and reduced drinking. Similarly, if your friend is constantly going outside to smoke cigarettes because they are anxious, you might suggest going to a yoga class with them with the hope you can support the use of a different coping strategy.

Focusing on the behaviors you want to see, instead of the ones that you want to get rid of, is helpful in many ways. First, it may be difficult to convince someone to stop doing something that they find rewarding or are ambivalent about. Focusing on adding something else into their lives may be more palatable for them. A core part of behavior change is adding new behaviors, not subtracting out or erasing old behaviors. It is very difficult, and often impossible, to erase old behaviors. Reinforcement is the way new behaviors get added. Second, when you focus on behaviors you want to see, those behaviors start to compete with drug and alcohol use which helps build a foundation for longer term change.

When you’re thinking about how to help your loved one change, think less about the behaviors you would like to see them change and instead identify a specific, alternative, healthy behaviors you would be willing to support. The more you can focus on reinforcing a new behavior, the more likely they will be able to change.

The post Changing Behaviors with Honey appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/changing-behaviors-with-honey/

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This is Your Brain on Drugs

For many people, there is an iconic commercial from the 1980’s about the influence of drugs on your brain. A man holds an egg, which is meant to represent your brain, has a hot skillet, which represents drugs, and he cracks the egg into the pan, which begins to sizzle and cook as he says “this is your brain on drugs. Any questions?”

This commercial was meant to be a way to both teach people about the negative impact that drugs has on your brain, as well as to motivate people stop using drugs from the fear that their brains will, in fact, be fried like that egg. The issue with this commercial is that it doesn’t explain what actually happens in the brain when drugs are introduced, and that over-simplification (drug use = fried brain) doesn’t jive with most people’s experience of drug use. So, what does happen in the brain when you use drugs or alcohol, and how can that lead to addiction?

This is your Brain

Let’s begin by understanding a little bit about how the brain works. This is a very simple model, but it will get to the heart of it all. Brains are made up of about 100 billion neurons, or nerve cells, which send messages to one another using chemicals called neurotransmitters. These neurotransmitters (there are about 100 of them that we know of now) tell the nerves to either activate, or turn off, which then goes on to the next nerve, and so on.

While many neurotransmitters are involved in substance use, there’s one that seems to play an outsized role in learning and behavior (including addiction). Dopamine is a neurotransmitter that is mainly found in an ancient part of the brain called the limbic system, which is located in the middle of the brain. This part of the brain is associated with things like mood, basic emotions, and rewards.

The limbic system activates when it sees something you like, and releases dopamine, which stimulates the brain and feels very good! For example, if you are a caveperson walking along and you see a bush full of blueberries, your limbic system will activate, flooding your brain with dopamine, and you’ll want to come back to that bush and even look around it for more blueberry bushes, because blueberries could be the key to your survival! This same process happens today … if you walk past a new store that has amazing looking doughnuts in the window, your brain releases a lot of dopamine (because we are still programmed to love fats and sugars, and doughnuts are delicious!).

This process is not really dependent on actual need; you might not be hungry when you pass that store, but you may still be pulled to get a doughnut in that moment. The dopamine system is all about “more,” and pushes you to do more or have more of the things that will release more dopamine. Why? In the old days (like, the really old days!), you needed to stock up on what you could when you had the chance, and we still function in this way today.

There’s something else that happens with dopamine. When dopamine is released, the brain takes in where you are, what you’re feeling and doing, who you are with, etc and associates that with the release of dopamine. So, if you have an amazing doughnut experience while your with a friend you don’t see that often, when you see them next you may be reminded and crave a doughnut. This is how dopamine connects with learning, and pushes you towards repeating actions again and again.

This is Your Brain on Drugs

So, that’s how the brain functions, and how dopamine impacts learning. (For a more in-depth look at this, check out the book The Molecule of More, by Daniel Lieberman.) Drug and alcohol use throw a bit of a wrench into the natural system of dopamine release and learning. Specifically, drug and alcohol use targets the dopamine system directly, bypassing all of the natural checks and balances that the brain has, and stimulates the release of dopamine at levels that you don’t usually see in natural releases. That is why cocaine is a more powerful reinforcer than a doughnut; it stimulates significantly larger dopamine releases which has a more powerful impact on the brain.

When the brain releases dopamine due to substance use, it continues to do what it always does: associate the dopamine release to what you are doing, how you are feeling, etc. Because substance use releases more dopamine than people are used to, the brain creates even stronger associations, especially with repeated use. So, someone who drinks when they feel stressed in order to relax might very strongly associate any kind of stress with the desire to drink. Over time, whenever they feel any kind of stress, their brains will start to search for dopamine release in the form of alcohol in an effort to achieve relaxation! Thus, and addictive cycle has begun.

Any Questions?

You may be asking yourself, “this is interesting, but why is this important to understand?” That is a great question, and one that needs answering. When one has an understanding of how the brain is functioning and how it is feeding into problematic behaviors like substance use, it helps us understand that addiction is a natural brain process gone awry. It is not a problem with willpower, or an issue of weakness or moral depravity. And that knowledge can help reduce the stigma associated with substance use, can help increase empathy towards and understanding of people who are struggling with their substance use, and can increase the odds that they might be willing to get help.

The increasing understanding and empathy is particularly important, because one of the things that defines substance use disorder is repeated use despite negative consequences of use. From an outsiders point-of-view, a substance user’s behaviors might not make any sense; why do they keep using when it is clearly ruining their life? When you begin to think about substance use as the brain’s search for more dopamine, you can begin to understand that their behaviors make sense, in their brain at least! This shift in understanding can be the difference between feeling burnt out by someone’s use and the ability to help them a little bit longer. And that extra time could be the difference between life and death.

The next time you notice yourself craving a doughnut, or a slice of pizza, or a glass of wine after work, think about how the dopamine system in your brain is working. And in that context, see if you are able to extend that to someone around you who is struggling with substance use and build a little more understanding and empathy for them. It might just feel good!

The post This is Your Brain on Drugs appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/this-is-your-brain-on-drugs/

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Your Body’s Built-In Alarm

Imagine the following scenario: You are driving home from work at night, you pull into your driveway, and no lights are on at your house. It’s darker out than you’d expect, and as you walk to your front door, you hear something rustling in the bushes by the front door. In a moment, your whole demeanor changes. You don’t know if it’s the neighbor’s cat or something more sinister, but you’re ready for anything. That change is your body’s alarm system, which is commonly known as your “fight or flight response,” and it is one of the body’s oldest and most valuable survival tools. But, what exactly is it and do we still need it today?

What is it?

The fight-flight response if a common term for what all people experience when specific parts of the brain and body have been activated. When you perceive a possible threat in your environment, a part of the primitive, emotional center of your brain, the hypothalamus, triggers a neurochemical sequence that activates your sympathetic nervous system. As the sympathetic nervous system engages, your kidneys release two chemicals, adrenaline and noradrenaline. These chemicals initiate a sequence of events within your body that prepare you either to flee quickly from danger or to stay and fight in a way that causes as little harm to yourself as possible.

In layman’s terms, when you feel threatened, your body’s alarm system sets things in motion to try and keep you safe, either by running away or fighting. If we think back to our caveman ancestors, there were times when they were exposed to large, dangerous predators and needed to react quickly in order to survive- leaving no time for slow, rational thinking. This is exactly what the fight or flight response allows for, and a part of what has allowed our species to survive.

This response still helps to protect us today, even if the threats we face are slightly different than they were for our ancestors. And, today we can experience this slightly differently than our ancestors did! People can experience this either as panic attacks or as a general increase in physical arousal with a number of specific physical symptoms.

The third option: Freeze response

While fight and flight get a lot of attention, there is also a third response that humans can experience in the face of danger- the freeze response, in which people do not move and may feel disconnected from their bodies or from reality. Freezing in the face of danger can seem completely counterintuitive, and many people who experience this response blame themselves or feel tremendous shame for responding in this way. At the same time, we know though that this response is actually very adaptive in some situations!

The freeze response is useful when a person is faced with a threat that you cannot fight off or outrun. Fighting or fleeing in this situation would likely only result in further harm to you while freezing may actually give you the best chance of escaping the situation unscathed. And, in case you don’t get away without a fight, while we are frozen our bodies secrete endorphins that act to reduce pain, so that any physical or psychological injury is felt with less intensity.

Sometimes not fighting back is the best solution. You may dissuade a threat from causing you further harm, or you may escape it all together. Other times, it is unhelpful, especially when this happens outside of dangerous situations.

This feels awful. Is there a way to turn this response off?

It can be uncomfortable to experience the fight-flight-freeze reaction. Sometimes, it may feel that the reaction and the flow of adrenaline will never stop, or that you may never feel “normal” again. Your body and emotions have their own gravity – what goes up must come down. In time, you will again come back to your own baseline and feel back to normal.

The fight-flight-freeze response is an absolutely crucial part of your body. In fact, in incredibly rare cases, some people are biologically unable to feel fear and to experience this fight or flight response. What we know from these cases, unfortunately, is that these individuals are likely at increased risk for injury and traumatic experiences. When your body cannot experience danger at the biological level and engage your sympathetic nervous system as expected, you cannot react quickly to keep yourself safe from potential threats. You need your alarm system. (For a fascinating listen on what it’s like to live without being able to experience fear, listen to the Invisibilia podcast episode “Fearless” starting at 9:37).

So, the next time that you experience an uncomfortable or potentially unsafe situation, and you get that familiar kick of adrenaline (or panicky kick of adrenaline, however you experience it), know that this is your body doing exactly what it is supposed to do, and that it will not last forever.

The post Your Body’s Built-In Alarm appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/your-bodys-built-in-alarm/

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How to Help Your Loved One During the Holidays

While the holidays can be a special time full of warm, happy, reflective moments, they can also be fraught with stress, exposure to family dynamics and high social demands. If your loved one is trying to change their relationship with substances, the holiday season can be an especially difficult time as they have to navigate heavy drinking social events as well as potential emotional triggers, like family conflict or demands. As you try to help, remember that people use substances because they are rewarding in some way. For example, your loved one may drink in response to stress or smoke pot in an effort to manage social anxiety. If this is the case, the holidays will be a time full of temptation and the pull to use their substance of choice. The rewards your loved one gets from substances can be physical, emotional, and social and they can be quite powerful during the holidays.

Here are 5 tips to consider using if you want to help your loved one abstain from substances or maintain a moderation goal.

First, talk to your loved one and ask how you can be supportive.

It is easy to make assumptions and in the process be over or under supportive. Ask if your loved one has thought about the holiday weeks and ask if you can be supportive of their goals in any way. For example, if they want to abstain but also really want to go to the holiday work event, ask if it would help if you came along as a sober side kick. If you are planning family events, ask if they want the party to be alcohol free? Ask if they have people they would like to invite that would be supportive of their goals. Ask if there things you can do together that would reduce stress or keep them motivated?

Examine traditions and holiday expectations and see if things need to change in order for your loved one to succeed in reaching their goals.

Consider swapping large rowdy holiday parties for mellow, intimate get-togethers with people who support your loved one. Be open to skipping some events and work together to replace them with activities that are rewarding in some other way. Think about creating new traditions. For example, instead of going over to aunt Rita’s house where everyone over drinks, arrange for the family to meet at the ice skating rink to learn something new and catch the holiday spirit in another way.

Model the behavior you hope to see.

It is not uncommon for family members to want their loved one to stay sober or maintain a moderation goal, only to over indulge themselves. Be willing to look at your own substance use patterns. As you try to help your loved one, be mindful of your own use and demonstrate ways to enjoy the holidays without substances playing a major role.

If you are hosting an event, provide fun mocktails.

It can be hard to be the person walking around with a glass of seltzer water when everyone else is sipping champagne or drinking a fun special cocktail. Ask you loved one what kind of mocktail they would enjoy and have it on hand.

Work to support and possibly even create pleasurable non-using experiences.

These experiences should be experienced as rewarding, ideally for your loved one and you! If you know your loved one needs to manage their stress level in order to be successful, offer to do a chore for them or cook them a nice meal. If you know they are struggling with social anxiety as they approach holiday parties, make an effort to help them navigate it by bring them into conversations about topics they enjoy discussing.

And don’t forget the value of a compliment or expression of affection. Squeezing your loved ones hand and telling them you appreciate what they are trying to do can go a long ways towards helping them sustain their motivation.

The post How to Help Your Loved One During the Holidays appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/how-to-help-your-loved-one-during-the-holidays/

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Holiday Planning and Coping

The holidays are back! And, just like every year, they can be alive with joy, friends and family, and a whole slew of issues to navigate. Conversations about politics, too much time with extended family, endless holiday parties and constant advertisements for drinks and jolly times, can make the holidays a difficult time for everyone. If you are trying to change your relationship with substances or are trying to improve your overall health, the holiday season presents a unique set of stressors. Here are some tips on how to plan and cope with it.

Tip #1: Set REASONABLE Expectations

One thing that makes the holiday season so difficult for people is that there is an expectation, both real and imagined, that you are supposed to A) have a great time, B) attend everything (while having a great time), C) look great in your holiday sweater, and D) do all this while monitoring your consumption (or even be sober). If you are trying to implement a healthy habit, like eating well or not drinking, your have to be pretty thoughtful as you navigate holiday parties with their mounds of food, cookies and free flowing booze. And it’s likely that making conscious choices at holiday parties will run a bit counter to the expectation that you relax and be able to cut loose over the holidays.

One way to survive the holiday season is to set reasonable expectations for yourself and for the events that you will be attending. For example, step back and think through the party invitations you have received and consider turning down a few of them (even ones that sound really appealing and fun!) if it isn’t in your best interest to be stretched so thin. If you decide to turn down an invite, send the host a nice “thank you for inviting me” gift and then commit to spending that time doing something that feels supportive of your larger goals. Knowing what your limits are can make it easier for you to make choices that are consistent with your goals.

Tip #2: Recruit some Compatriots

Human beings are pack animals, meaning that we don’t really like being alone. Sure, we all benefit from some alone time, but overall we thrive when we are part of a group (especially if that group is like-minded). This is especially true over the holidays for a few reasons. First, we are bombarded at every moment with images of happy families and fun holiday parties, when the reality is that for many, the holidays are not as cheery as they are made out to be as time is crunched, demands are high and exposure to family is complicated. Dealing with a potentially difficult situation is much easier if you aren’t doing it alone.

As you think through the holiday events you are facing, try reaching out to some people who you think are like-minded and/or supportive. Let them know what you are facing and how they can help; the more specific you can be, the better! For example, if you know your father’s snarky comments about your appearance tend to make you want grab a drink, ask your friend if you can call to blow off steam and stay connected to your goal of not drinking. And remember, your compatriot does not have to be going to the event or even live nearby, if they can be reachable by phone or text, then they count! Just knowing that you have at least one person on your side can be extremely helpful as you navigate holiday events.

Tip #3: Give Back

Volunteering during the holiday season can see cliche, as some estimates put a 200% increase in volunteering during the holiday season than other times of the year! Wanting to give back, help those who don’t have as much, and the desire to spread some good-will around are all really great reasons to volunteer!

There is however another reason to volunteer around the holidays and all year round! It turns out, volunteering reducing stress for the person who is the volunteer! According to one study, on days when participants volunteered, they had a neurological response that made them less reactive to stressful situations. So, not only are you helping other people when you volunteer, but you’re also helping yourself get through some potentially difficult holiday moments! Everyone’s a winner!

The holidays can be difficult. With a little bit of planning and a lot of coping, it may be easier to tolerate the stress that comes along with them and you may even be able to feel the joy!

The post Holiday Planning and Coping appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/holiday-planning-and-coping/

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5 Tools Parents Can Use to Help Their Children (and Themselves!)

Being a parent is hard under the best circumstances. Being a parent of a child who is using substances can feel like you’re being forced to run a marathon with a lead vest on! It can feel like you’re all alone and have to juggle everything in your own life while at the same time being your child’s support. This stress can be enough to make you feel more than a little crazy, frantic, angry or so overwhelmed you just want to give up.

There is hope! There are many skills that parents can use to help reduce the difficulty and distress associated with parenting a substance using child. These tools can help you help your children change their substance use as well as help you help yourself survive the process! While there are many skills to choose from (for a concise and useful version of them, look at the20minuteguide.com), the following 5 are easy to implement and can have an immediate positive impact on both you and your child.

1. Talk about it!

The impulse for many, if not most parents who are dealing with a child struggling with substances is to keep it all quiet. The thinking might go something like this: “this is difficult enough, do I really want to involve more people, and more ideas into this?” And, “I’m really ashamed! What if they judge me? What if they judge my child? I’m better off dealing with this alone.”

This style of thinking makes a lot of sense. Often, when we bring up a “problem” with other people, they try and “solve” it, even if they don’t know all the information, so it seems easier to just keep it to yourself. Or, if there doesn’t seem to be a solution, sharing it can make you feel like your being a burden to someone else.

The problem with thinking like this is that when you don’t discuss what’s going on for you, you end up isolated and alone. And in this space many other problems can take hold like despair and depression. Parents we work with repeat over and over that the moment that they found a group of people they could talk to, the faster they felt like they had the support and strength to keep being an effective helper for their children.

2. Practice Listening

The default position of most helpers, myself included, is to try and offer help. We talk and give suggestions, ideas, thoughts, and feedback. The problem is, sometimes the best way to help is not to talk at all. Sometimes, what’s called for is listening.

When we listen, really listen, we can gather information that we would never have otherwise had access to. And, when we listen actively, meaning that we listen with no other distractions, and give visual signs that we are listening (like nodding your head and making eye contact), we encourage the other person to share more. This seemingly simple act is difficult, so you have to practice. See if you can spend 2 minutes doing nothing but listening. And, when you’re ready, try some of these listening skills to take your listening to the next level. [link to 20 MG OARS skills]

3. Find Alternate Behaviors

Let’s face it, substance use is reinforcing. Maybe it helps you feel relaxed. Maybe it helps you have more fun, or be more social. Perhaps it helps you by getting rid of things you don’t like, like anxiety or sadness or fear. In any of these situations, using a substance is reinforcing to the person who is using it, which makes it harder for them to be willing or interested in stopping.

If you can use your listening skills from before to help recognize what your child gets from using substances, then you can start to work on finding alternative ways of helping them get that result. So, if your child feels that substances helps them connect with friends more, see if you can find something that they can do that doesn’t have substances, like going to a game, or inviting people over to hang at your house. If it’s relaxation, perhaps helping your child find other ways of relaxing, like getting a massage. If you can find out what they are getting from their substance use, you may be able to help them find alternatives as well.

4. Catch Them Being Good

When a child is getting attention for misbehaving, it can be a major drag on them, and on you. When they are getting attention for being good, everyone’s mood and spirits rise. If you can shift your attention to what they are doing well versus what they are doing wrong, you can help change the script at home and in their lives.

For this one, you may have to start small and search hard for those moments where they are doing something well. Did they remember to pick up their clothes off the floor? That counts! Did they get their homework in on time this week? Check! Even if they are still slipping, but you can see them trying, we can point that out. Noticing that they are working towards change and doing things well can help foster an environment that competes with substance use.

5. Be Kind to Yourself!

All behavior change is a slow process. Changing substance use behaviors is especially slow. And, you’re a human being, who isn’t always going to get everything right! Be kind to yourself when your struggling, and generous to yourself when you’re feeling weak. Change takes time, and comes with many missteps along the way. If you can treat yourself the way you would treat a friend who was going through something similar, with compassion and caring, you can weather the long road ahead.

Like I said, being a parent is hard. And, being skillful can make the difficult process of change for your child and your family easier.

The post 5 Tools Parents Can Use to Help Their Children (and Themselves!) appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/5-tools-parents-can-use-to-help-their-children-and-themselves/

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3 Truths About Change

If you or someone you love struggles with substances, how you understand the problem you face matters a lot! If you approach it from the perspective that substance problems are the result of a weak will, a shaky moral compass or an innate set of character flaws, you are going to face unnecessary obstacles like shame and a desire to isolate away from it all.

Thankfully, over 50 years of scientific research and clinical experience have given us a new way to understand substance use problems. Here’s what’s important to understand. First, behaviors make sense, including using substances. What do we mean? We humans ALL engage in a variety of behaviors (like exercising, sleeping, drinking alcohol, taking pain pills, eating cookies), because we get something out of it. The behaviors we choose to engage in might help us feel good or reduce depression and anxiety. They might helps us feel accepted by our friends or be more focused or even stop nightmares and reduce pain. The choice to use substances is like any other behavioral choice we make, if we choose to keep doing it, it must be working in some way.

The second thing to understand is that one size doesn’t fit all. Instead of assuming “all addicts are the same” or that you are just “doing what addicts do”, work to understand why and how the behavior pattern came to be and then think through the why and how of the change process. Do you think the soldier with PTSD who drinks to cope with his nightmares is going to respond to the same treatment and supports as the insecure teen who is smoking pot to fit in with his peer group? Does the grieving 60 yr old who lost her husband last year and is overtaking her xanax need the same helps as the firefighter who is taking more and more opiates to deal with his chronic pain from falling through a floor? The truth is, we are all different and we develop problems for different reasons and we change behavior patterns in different ways. Some people need to go to AA meetings every day, others need to see a therapist and work on their marriage. Some need to do both. It is important to think through what you may need, or the person you love and want to help may need, as you approach the change process.

Finally, change takes time and practice. Why? Because when we try to give up a behavior pattern that “works” in some way there is understandably “ambivalence”. Ambivalence is normal, and to be expected as part of change. When someone returns to an old pattern, like using, it does not necessarily mean they are “in denial”. The person may really know how bad using is for them, yet the pull to return to old, familiar patterns is strong because the new things (like exercise, meditation, meetings, connection) that they are trying to learn to replace the old behavior are not comfortable yet. And the new behaviors may not work as well as the original behavior. Meditation may be the perfect long-term antidote to a drinking problem that developed in response to anxiety, but it’s not going to work right away! Learning to meditate is actually pretty difficult and takes lots of practice and repetition. Picking up a drink is easy and works very quickly! So it’s hard to give up! If you or someone you love is trying to quit or reduce using substances, try to have compassion for the learning process. Learning not to use and learning to do something different to cope with the underlying reason for using takes time, repetition, and commitment.

All of these understandings are compassionate ways to approach the change process.

The post 3 Truths About Change appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/3-truths-about-change/

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What Is Your Body Telling You

Recent events have brought the impact of trauma, whether it be from natural disasters or sexual assault, to the forefront of many people’s minds. Unfortunately, the content of the news can trigger trauma memories for many people. Sometimes the trigger and memory are clear (e.g., if I have been raped, watching women talk about being raped on the news or social media causes me to feel incredibly angry or physically exhausted). Sometimes the trigger and memory are less clear (I am watching the news a lot and find I am getting headaches and am not sleeping well). If you are someone whose has experienced trauma (an emotional shock that results in fear and anxiety), it is worth taking some time to listen to what you body may be telling you and engage in self-care.

How Does the Body React to Trauma?

When a person perceives a physical or emotional threat, the body activates its stress response to prepare for emergency. This occurs both in the brain and the body; adrenaline and cortisol (stress hormones) are released to attend to the immediate needs of the body, while processes associated with long-term functioning, such as digestion, immune system functioning, and cell repair, are shut down. Blood pressure and blood sugar increase, sending increased strength to our muscles. This helps us go into survival mode, often experienced as “fight, flight, or freeze.”

This response to trauma is evolutionary in nature. Think about a mother bear fighting to protect her cub (fight), a goat running from a tiger (flight), or a deer in headlights (freeze). As humans, we experience trauma as threats to our wellbeing, and we respond in similar ways, whether or not we believe our life is in danger. Trauma threatens our sense of safety and security, altering our belief systems, worldviews, and–very often–trust in others and ourselves.

Long Term Impact on the Body

Due to the range of physiological responses experienced under extreme threat, our bodies often hold on to traumatic experiences years after the trauma occurred. This can show up in subtle or not-no-subtle ways, both of which can be easy to ignore even when processing your experiences in therapy.

If you turn your awareness to your body, you might notice that you experience frequent stomach aches without explanation; migraines when discussing trauma in therapy or seemingly out of the blue; slight numbness in one area of your body when thinking about the event; dizziness when sharing a traumatic experience with a friend; nerve or muscle pain that flares up at certain times of day.

These are just a few examples of somatic symptoms that you may experience regularly, and might actually be symptoms of your traumatic experience. People often spend years visiting doctors and undergoing various medical treatments without experiencing relief, and without exploring the possible link to earlier trauma. Sometimes people use substances to numb or regulate physical or emotional pain associated with trauma, and become newly aware of somatic symptoms after reducing or discontinuing substance use.

How to Incorporate the Body into Therapy

If you’ve experienced trauma, it is important to discuss any physiological symptoms you observe with your therapist, even if you aren’t sure whether they are connected to your trauma. Your therapist might integrate more mindfulness and somatic techniques into your sessions, encourage you to engage in a yoga practice, recommend acupuncture or massage therapy, or encourage you to consult with a physician.

It is important, in collaboration with your therapist, to develop a mindful awareness of your body while you are processing your trauma and to pay attention to how it responds to your distress. Awareness of your body and the messages it sends you can, with practice, help challenge the fight, flight, or freeze responses that occurred during trauma, and move you toward healthier forms of self-regulation. Being able to listen to and regulate physiological distress can help improve the relationship we have with our bodies, making them more comfortable spaces to inhabit.

The post What Is Your Body Telling You appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/trauma-what-is-your-body-telling-you/

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When The News is Triggering: Coping with Trauma in the News 

“No news is good news.” It’s a familiar enough phrase, and one that I’ve heard in increasing numbers over the last few weeks. Between accounts of natural disasters, sexual assault, child abuse and maltreatment in detention centers and violence against racial, ethnic, and sexual orientation and gender minorities, there is more than enough going on in the world to lead one to feel anxious and sad. These emotions and reactions, along with a number of other thoughts and feelings, are challenging enough to cope with. For people who have survived a trauma, this barrage of information can be particularly overwhelming and can result in feelings of hopelessness, despair, paralyzing fear, and rage at the people and systems who commit or condone violence.

What is trauma and how can it affect people?

A traumatic experience can mean a number of different things, from being a victim of some form of abuse or life-threatening situation to witnessing any event where a person’s life or physical safety is threatened or where sexual violence occurs. Many people report few symptoms or are able to bounce back relatively quickly after experiencing a trauma. And while resilience is our natural tendency as humans, some people find that the typical course of healing goes astray and many symptoms remain. This persistence of symptoms is known as post-traumatic stress disorder (PTSD).

PTSD symptoms, including nightmares, upsetting memories of the event, avoiding reminders of the trauma, and increased depression, anxiety, guilt, shame, and irritability or anger, can remain with a person for a long time, even many years, after the initial traumatic event is over. These longer lasting symptoms can interfere with our lives and prevent people from achieving some of the goals that may be most important to them, including performing well at work or school, or forming close and trusting connections with friends and loved ones.

How do trauma and substance use relate?

We know that the relationship between the two works in both directions: people who have trauma histories are more likely to misuse substances as a way of treating their emotional distress, and people who misuse substances may be more likely to experience a traumatic event due to their use. Recent studies indicate that almost half of patients with PTSD also met criteria for a substance use disorder, and 75% of people who have a substance use disorder have experienced a trauma during their lives. Additionally, many people who abuse substances may have underlying factors, such as a tendency to experience more negative emotions or a tendency to avoid unpleasant emotions, that may lead to a person to develop PTSD.

While substance use may help alleviate the symptoms associated with trauma in the short term by helping a person avoid experiencing their distress, this avoidance interferes with the natural recovery from trauma.

What should I do if the news is reminding me of my own trauma?

While many of us would like to protect ourselves from the feelings associated with traumatic events, the reality is that sometimes we cannot avoid our feelings and sometimes it may not be helpful to avoid them. This is especially true when the news cycles are reminders of one’s particular trauma. When these reminders interfere with your daily life, these five tips can help you to cope in the moment.

Check in with yourself. Identify what you are feeling in this moment- are you angry? Sad? Scared? Ashamed? Before you can cope with the situation and your emotions, you need to know what you’re feeling. It can be helpful to write down what you’re experiencing.

Ask yourself what your goal is in this moment. Are you at work and have a big project you need to finish? Do you have a paper that is due tomorrow for school? Are you at a party with people who you don’t know very well? If you answered “yes” to any of these questions (or something similar), now is probably not the best time to act on any emotions you may be feeling or launch into a heated discussion of whatever event was triggering. Instead, focus on your goal in the moment, turn off notifications on your news sources and social media, even delete those apps from your phone if you need to! Don’t watch the news or read the newspaper. It’s OK to step away from something triggering for a short period of time (especially if it’s not a good time for you to engage with it!).

If your emotions are especially intense and overwhelming or you are feeling disconnected from your body or your emotions, give yourself some time to take a break and take care of yourself. That can look like a lot of different things for different people … do you need to self-soothe with a bubble bath and some herbal tea? Watch your favorite comedy show and have a good hard laugh? Remind yourself of the people in the world who are fighting for the rights and dignity of all people? Whatever your go-to ways of coping with distress are, now is the time to use them. You can’t help others or meet your own goals if you aren’t taking care of yourself.

Reach out for support from trusted friends or family members. You don’t need to talk about your trauma, and it is your choice with whom you share this information. You can ask to talk about whatever you would like or request whatever support would be useful – a dinner to catch up, a walk in the park, a hug.

If you’re in a place where you can notice your emotions but are not completely overwhelmed by them, this can actually be a great time to figure out how you can address the problem itself. Our emotions are an important source of information, and they can drive us to useful action. Are you concerned about the way immigrants, women, people of color, the LGBTQ community, or survivors of sexual assault are being treated? See if there’s a way that you can contribute to one of these causes, whether by donating, volunteering, or figuring out how you can support change in your own community.

What if this list isn’t enough?

There are a number of effective, evidence-based treatments for treating PTSD and the long-term effects of trauma, as well asa number of trained and compassionate clinicians who are available to provide these treatments. Look for clinicians who have training and experience in working with survivors of trauma and who will believe your story and support you on your path to healing and reclaiming your life.

Healing from the effects of trauma can be a difficult and emotional process, and those emotions can be intensified when the news reminds you of your own trauma. While following these tips do not replace treatment for PTSD, they can help you to ride out the most challenging moments and act in line with your values, even in the midst of triggering news cycles.

The post When The News is Triggering: Coping with Trauma in the News  appeared first on The Center for Motivation & Change.

from https://motivationandchange.com/coping-with-trauma-in-the-news/

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How to Support The Process of Change

Are you worried about a loved one’s use of substances? Do you see your partner’s health declining? Do you worry about some of the decisions your sister is making? Do you wish your teenage son would hang out with different kids? Do you think your girlfriend has one too many drinks, too often?

Maybe you have tried to talk to your loved one and feel hopeless because the conversation either goes nowhere or turns into a fight. As you try to find ways to help them change, one of the most important things you can do is to work on how you understand the problem. By understanding the foundations of behavior change and how behavioral choices are actually encouraged or discouraged, you can start to have an impact. You might even make some healthy changes in your own life!

People repeat actions that are either rewarding or reinforcing. In other words, people do things that are worth it to them somehow. And as you might expect, behavioral change is much easier to start and maintain when it feels worth it! For all of us, the reasons to change a behavior have to feel weightier than what you’re getting out of the current behavior.

The following example is one many can relate to: if coffee tastes good to you and helps you have energy in the morning (you get something out of it, there are benefits to using it), you’re unlikely to change the habit of drinking it every day, unless you have a pretty compelling reason! Even if you start having heart palpitations or you have to bleach your teeth, you might not want to stop, because you really enjoy the taste or you dread the headache you might get from stopping. Adding to all that, it might feel like you miss out on things you enjoy like sharing a morning coffee with your partner or coffee break with your colleagues. These downsides of change can start to add up and may eclipse your view of the reasons in favor of changing.

Now imagine the potential benefits of other drugs of abuse like alcohol, nicotine, and opiates which are quite powerful in their ability to make people feel things that are reinforcing. Alcohol reduces anxiety/stress and increasing social ease. Nicotine increases concentration and opiates decrease pain. These are all experiences that some people enjoy and may even feel they need because they don’t have any other way to have those experiences.

While it may be difficult, try to sit down and write out all the benefits your loved one might associate with their substance use. What do they get out of it? What do they like about it? Doing this exercise will help you understand with a good deal more empathy why your loved one is doing what he/she is doing, even when it hurts or frightens you. When your husband’s alcohol use is threatening his health and you can only see it as “totally crazy,” that can be really hard to take. When you see that his alcohol use (the same behavior that is still threatening his health) is also the only moment in his life that he feels calm and able to unwind from the stress of his day or connect with his friends, maybe you will still worry about his health but have more empathy for his actions. When you understand the reinforcers involved for him, you can talk through and find other solutions for the problem.

Not only are there benefits to your loved one’s use, but there are downsides to changing. For example, if your husband gives up drinking he might feel more anxious and find himself not being able to fall asleep. Maybe he will have to distance himself from some of his friends, and while you don’t like them, maybe they have been a presence in his life for a long time and will feel like a big loss.

In order to change, the benefits of a person’s choices have to be addressed AND the downsides of changing have to either be pretty small to begin with or be shrunk down. That process of shrinking the downsides of change — or alternatively, increasing the salient reasons to change — is something the people around the substance user can actively participate in!! You can help make change feel really worth it and you can help mitigate some of the downsides of changing.

Start by brainstorming about the different upsides and downsides of change that are within your control to influence. Are there ways you can reinforce or reward non-using behavior? Many family members treat their loved one the same way whether they are using or not (“I’m mad at you when you’re drinking, but still mad at you when you’re sober because I’m thinking about when you were drinking!”). Instead, it can be helpful to reward and reinforce times when they are abstinent or trying not to use. Noticing them (“I appreciated that you came home last night on time”), complimenting (“I really think you are doing a good job trying to resist using with your friends, I know it’s hard”) and cooking a nice meal to share if they are sober can all reward their efforts to reduce their use.

It can also be helpful to think through ways you can support non-using behavior. In particular, it can be very helpful to think of activities that might compete with substance use (e.g., at the same time or filling a similar function as the substances) and work to bring them into your loved one’s day-to-day life.

Many family members hear about positive reinforcement and worry that being nice, using any rewards, or reinforcing through kindness and attention will make them weak or a sucker. The reality is that reinforcing positive change just requires more strategic and thoughtful planning about when to be reinforcing. And being kind and creative about suggesting non-substance using activities and joining in with these activities does nothing but support positive, healthy behaviors that are alternatives to substance use. The bottom line is that you can have your limits and boundaries in important ways AND have a really positive influence with kindness. The two things do not have to cancel each other out. What does cancel things out in terms of putting a damper on a change-supportive environment, is hostility, yelling, and coercion. Setting healthy limits and boundaries in a kind way can be much more effective.

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