Treatment

Inpatient vs. Outpatient Treatment: Two Different Approaches

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Inpatient rehab and outpatient rehab are two different approaches to treating substance abuse or addiction. The main difference between the two lies in the level of care and the setting in which the treatment takes place. Here’s a breakdown of each:

Inpatient Rehab:

  • Inpatient rehab, also known as residential rehab, involves staying at a treatment facility for a specified period, typically ranging from a few weeks to several months.
  • It provides a highly structured and immersive environment where individuals receive 24/7 care and support from a team of healthcare professionals.
  • Inpatient rehab is recommended for individuals with severe addiction, those with co-occurring mental health disorders, or those who have tried outpatient treatment and continue to experience repeated relapses.
  • The program includes a combination of individual therapy, group counseling, support groups, medical detoxification (if needed), medication management, and various holistic activities.
  • Inpatient rehab offers a safe and controlled environment, removing individuals from triggers and enabling them to focus solely on their recovery. Engagement with others who are going through a similar situation has also been found to be encouraging. The collective group consciousness and connecting with others who understand the challenges and difficulties of recovery, can be highly motivating.
  • In-patient treatment requires a significant time commitment and can be more expensive than outpatient treatment.

Outpatient Rehab:

  • Outpatient treatment allows individuals to live at home and continue their daily routines while attending scheduled treatment sessions at a facility.
  • It provides flexibility and is suitable for individuals with a supportive home environment, strong motivation, and a mild to moderate addiction.
  • Outpatient programs vary in intensity, with options ranging from a few hours of therapy per week to several sessions per day, depending on the individual’s needs.
  • Treatment typically involves individual counseling, group therapy, educational sessions, and relapse prevention techniques.
  • Outpatient treatment allows individuals to practice applying the skills they learn in treatment to real-life situations immediately.
  • It is generally more affordable than inpatient programs and can be an effective option for those with responsibilities such as work, school, or caregiving.
  • Exposure to daily life stressors and triggers may pose challenges for some individuals, potentially increasing the risk of relapse.

The choice between inpatient rehab and outpatient rehab depends on various factors, including the severity of the addiction, the presence of co-occurring disorders, personal circumstances, support system, financial variables, and individual preferences. It is essential to consult with healthcare professionals or addiction specialists to determine the most appropriate treatment approach for your specific situation.

Realize Behavioral Health is an outpatient level of care and has treatment options for dual-diagnosis, co-occurring disorders, harm reduction, moderation support, family support, and general mental health options. If you or a loved one are encountering challenges with alcohol, substance use, relationship problems, or mental health, call today for a free consultation. If we are not the right fit for your situation, we will assist you in finding appropriate care. 

Moderating Alcohol: Is it even possible?

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Many clients seeking our addiction services are hoping to have a different relationship with alcohol. While this blog is focused on alcohol, moderating any problematic behavior or substance use can be paralleled. Moderation is necessary for certain behavioral addictions such as eating and shopping, and let’s be honest, for most people sex (although abstinence is an option of course). In this article I will provide some best practices for moderating alcohol and always encourage working with a professional for best results. 

Moderation with alcohol refers to consuming alcoholic beverages in a responsible and controlled manner, absent of excessive or binge drinking. Moderate alcohol consumption is typically defined as no more than one drink per day for women and up to two drinks per day for men, according to the Dietary Guidelines for Americans. When we work with clients seeking moderation, I meet them where they are at and within their own framework of what moderate drinking would look like for them. 

Practicing moderation with alcohol can have several benefits, including:

  1. Reduced health risks: Excessive alcohol consumption is associated with various health problems such as liver disease, cardiovascular issues, and increased risk of certain types of cancer. By drinking in moderation, you can lower these risks.
  2. Better judgment and decision-making: Alcohol can impair your judgment, coordination, and reaction times. Drinking in moderation helps ensure that you remain in control and make responsible decisions.
  3. Avoidance of addiction and dependency: Regular excessive drinking can lead to alcohol dependence or addiction. Moderation reduces the likelihood of developing these problems and helps maintain a healthier relationship with alcohol.
  4. Improved overall well-being: Moderate alcohol consumption has been associated with certain health benefits, such as a reduced risk of heart disease. However, it’s important to note that these potential benefits should not encourage individuals who do not drink to start consuming alcohol. This may be correlated with reduced stress from the atmosphere of drinking (ie in social settings with friends/loved ones). 

Here are some tips for practicing moderation with alcohol:

  1. Set limits: Determine how many drinks you will have in advance and stick to that limit. Pace yourself, sip, and drink mindfully to avoid drinking too quickly.
  2. Alternate with non-alcoholic beverages: Drink water, soda, or other non-alcoholic beverages in between alcoholic drinks to slow down your alcohol consumption and stay hydrated.
  3. Be mindful of alcohol content: Different alcoholic beverages have varying alcohol content. Be aware of the strength of the drinks you consume and adjust your intake accordingly. I usually encourage the avoidance of shots.
  4. Don’t drink on an empty stomach: Eating food before and while drinking slows down the absorption of alcohol into your bloodstream, reducing its effects.
  5. Know your personal limits: Everyone’s tolerance to alcohol is different. Pay attention to how alcohol affects you personally and respect your limits. If you are feeling buzzed, you are likely going down a slippery slope. More on this to come…
  6. Plan alternative activities: Instead of focusing solely on drinking, engage in other activities during social gatherings or events that don’t revolve around alcohol. This can help shift the focus away from excessive drinking.

One of the biggest shifts required for moderating alcohol relates to one’s intention with drinking. Oftentimes, the goal of moderating equals a desire to get a good buzz without any negative consequences. Drinking 1-2 drinks over the course of a dinner outing is unlikely to get us buzzed if we have been accustomed to drinking multiple drinks. For this reason, I frequently encourage a sustained period of abstinence in order to reset one’s tolerance that may have grown due to chronic alcohol consumption. 

Remember, if you have a history of alcohol-related problems, or if you’re taking medications that interact with alcohol, it’s essential to consult with a healthcare professional for personalized advice regarding alcohol consumption. Call us today for a free consultation if you or a loved one are struggling with alcohol or any other addiction. We will meet you where you are and work on equipping you with the techniques and approaches to succeed with your goals.  

The Use of Labels: Alcoholic and Addict

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Labels can have powerful effects on our conscious and subconscious beliefs about ourselves and the future actions we engage in. This can be seen well in the world of sports when we think about transcendent athletes such as Michael Jackson, or Tiger Woods. Their belief and self-talk that they are the best to do it was a major factor in the various moments they found themselves in when being neck and neck with an opponent. Labels can often have a self-fulling nature, and can work for us, or against us.

I am often asked about the use of common labels in recovery such as alcoholic and drug addict. It is my belief that anyone can use whichever labels they find helpful for themselves, while I do not personally use either of those labels when referring to myself (as someone who had an opiate addiction) or others. In the 12-Step approach, identifying as an alcoholic or addict is actively encouraged with the intent of pushing people through their denial of the problem and as an indelible reminder of where their addiction took them. This identification can be helpful for some, and for others it can feel disheartening and triggering.

Chemical addiction is a spectrum disorder, with distinctions between mild, moderate and severe. There are associations of the stereotypical “addict/alcoholic” living on the streets, with no family, job, resources or self-care that come to mind for many of my clients which discourage the use of these labels on themselves. All one needs to do is attend a 12-Step meeting and they will be given plenty of examples of others similar to themselves, yet there is still an adverse response when using this label on themselves or when loved ones use it on them or encourage them to accept that is what they are. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (APA, 2013), is the clinical book used by mental health professionals to diagnose mental health disorders. Addict and alcoholic are not words used to describe substance disorders, instead, they are called alcohol use disorder, opiate use disorder, stimulant use disorder etc.

While someone may have a dependence on alcohol, they are not an alcoholic. They are struggling with an alcohol use disorder, and if they are no longer meeting that criteria after a full year, then they are in sustained remission (APA, 2013). Labels are powerful, and when taking a self-empowering approach, which I am a proponent of, it can be helpful to ditch the use of labels and instead acknowledge that there has been a dependency on a substance and lifestyle that is no longer working. When asked if I am an addict, I tell people that in the past I struggled with problematic substance use, and today I do not. I encourage clients to use whatever verbiage works for them, as I have worked with many clients in a 12-step program who chose to identify with the words addict/alcoholic. If you find power in those labels, who am I to tell you to not use them! On the other hand, if you feel repulsed or put off by them, know that you do not have to use them, and there is plenty of evidence that their use can be detrimental to progress for many. Afterall, what does an addict/alcoholic do? They drink and use, relapse, hurt those around them, fail to live up to their commitments, and struggle to succeed in life. Those labels can often run through one’s mind right before a relapse, with the mind saying, “well you are an alcoholic so you might as well take that drink, after all, that is what you do.”

Working in a self-empowering program, people are taught to focus on their strengths and the goals in which they want to achieve. Instead of focusing on not drinking today, we strive to focus on the things we want to achieve for the day and aligning our behaviors with our identified values. These are skills and philosophies that we teach at Realize Recovery, both to individuals and to loved ones who may only know the mainstream 12-step alcohol/addict philosophy. Please keep in mind, this is not a demonizing of the 12-step program, as it worked and continues to work for many people, it is simply an alternative perspective to be used in conjunction with the 12-steps, or as an alternative.

What is Cross Addiction?

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

The nature of addiction can be pernicious. Once we have overcome one problematic behavior, another can seemingly sprout up and take its place. In the addiction field, this is often referred to as cross addiction. It has often been stated in various programs and literature that just about everyone has some form of addiction that if not obliged causes irritability, unease and crankiness, to a host of more intense withdrawal symptoms.

Cross addiction is something that is helpful to be aware of early in recovery, as well as for those who have years of experience with recovery. It can often develop very subtly and outside of our conscious awareness, until we realize we have fallen prey to another form of problematic addiction. One of the main reasons cross addiction can be very subtle and innocent in the beginning is because when someone is overcoming an addiction to alcohol, opiates, gambling, or sex addiction, other “lesser” addictions are easily minimized in their capacity to cause harm and disaster. We may be so close to the consequences of our recent addiction that it is hard to imagine anything else causing such pain, especially if there have never been problems with the behavior.

Common cross addictions for people early in recovery are nicotine, pornography, sweets and processed foods, shopping, and sex. While cross addiction can come in many seemingly bad forms, it can also cloak itself in good behaviors, which can turn problematic. Exercise is often encouraged and since it is viewed as healthy some can use exercise in a problematic way early in recovery in an attempt to re-write the wrongs of our past substance use. Exercise addiction can cause physical harm through overuse of muscles, reproductive harm in females through intense exercise and dieting which can halt or interfere with menstruation and exacerbate other mental health disorders such as body image and restrictive dieting.

Mindfulness and awareness of what we are replacing our addictions with is key to notice if and when cross addiction is happening. All of us will at times develop some habits and behaviors which are compulsive and create discomfort when they are not engaged in, and for most, these are not life changing, nor require professional help. If you feel you have conquered one addiction, just to be pulled into the vortex by another behavior, give Realize Recovery a call and one of our addiction professionals will be able to provide guidance and insight on what might be helpful.

Desensitization of Triggers and Urge Reprocessing

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

DeTUR™ (Desensitization of Triggers and Urge Reprocessing) is an empirically supported method developed and refined by AJ Popky, Ph.D. DeTur integrates elements of cognitive-behavioral therapy (CBT), and the Alternative Information Processing (AIP) model of Eye Movement Desensitization Reprocessing Therapy (EMDR). Cognitive therapy (inter-weaves) are utilized during the bi-lateral stimulation of EMDR Therapy to rapidly process the desensitization of relapse triggers and accelerate the recovery and healing process. Unlike Standard EMDR where the focus is more on the clients past DeTUR is focused more on the present and future.

Successful results have been reported across the spectrum of addictions and dysfunctional behaviors: chemical substances (nicotine, marijuana, alcohol, methamphetamine, cocaine, crack, heroin/methadone, and others), eating disorders such as compulsive overeating, anorexia and bulimia, along with other behaviors such as sex, gambling, shoplifting, anger outbursts, and impulsive control disorders (such as trichotillomania and intermittent explosive disorder).

The key elements of DeTUR are described by Popsky in his 2020 paper: AAIP DeTUR (Desensitization of Triggers and Urge Reprocessing) Accelerated Adaptive Information Model based on the EMDR Protocol.

  1. Client’s attention is directed towards a positive, attractive, achievable, compelling goal of coping and functioning, NOT, away from a negative behavior. While most therapy sessions start with the therapist asking the client “What’s your problem?” DeTUR begins by asking clients to recall a time when they experienced feelings of being resourceful, powerful and in-control and direct them to those to notice the powerful feelings, and then install and strengthen these powerful feelings with the bi-lateral stimulation of EMDR Therapy .
  2. Abstinence, though highly recommended, is not required in the definition of the treatment goal; coping and functioning in a positive manner as described by the client is the treatment goal. 
  3. Relapse is reframed from failure to new targets of opportunity to be addressed in following sessions.
  4. Chemical withdrawal and anxiety appear to be addressed since the process seems to take place out of the client’s conscious level of awareness, not requiring constant attention on the part of the client.  Clients often report surprise that at the end of the day they had not engaged in the negative behavior, had–but not as often, or had noticed urges to engage and could put them aside.
  5. Targeting the individual triggers for desensitization allows this model to be used with clients early in recovery. DeTUR™ targets the triggers that bring up the uncomfortable feelings leading to the urges and reprocesses the triggers linking a positive state to the triggering urge. Similar to the stimulus-response mechanism, this is replacing the using response with the positive response that has been anchored and set into the individual’s physiology.  Whenever the stimulus is activated the response of a positive state of being comes up that is aligned to their values, helping individuals in functioning more successfully in life.

Perry Passaro, Ph.D. a Realize Recovery Staff member is extensively trained in CBT, EMDR and DeTUR. He can be reached at PerryPassaro@Icloud.com or 714-488-8814.