addiction

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. 

How the Abstinence Violation Effect Affects Recovery

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Have you ever made a determination to start a new habit and have you been able to stay 100% dedicated to it through the remainder of your life? (insert cricket sound…) Of course, if you are reading this then you are still living and cannot confirm nor deny the attainment of this goal. If you are like most people, you set a goal to establish some new behavior which can be performed consistently and probably have sometimes where you fall short of your idealized expectations. Perhaps you said you would start waking up an hour earlier so you can exercise, or you’ve sworn off some specific type of food, only to find yourself having periodic success.

This is all a normal part of the change process. Setting a goal, taking steps to achieve it, and at times falling short. For those struggling with some form of addiction, this is a very relatable topic. Making a commitment to stop drinking only to find yourself days, weeks, months or years down the road ingesting alcohol. If you can relate with this, I’d like you to think of a time when you deviated from your goal to abstain and what your mind told you the moment you veered off that path. Did it say something to the effect of “Well, you’ve had one so you might as well drink the rest of the 6 pack…” or “I knew I couldn’t do this, afterall I am an alcoholic and I always screw things up and get drunk”, or even “I slipped yesterday so I am only at day one so I might as well keep going and I can start again tomorrow”. This type of thinking is a prime example of the Abstinence Violation Effect, or AVE.

The Abstinence Violation Effect is when there is any deviation from a desired behavior goal and this deviation is viewed as a total failure. This viewpoint that the deviation is a total failure is then used as a further justification to continue using or doing the addictive behavior. I have had clients that expressed after having one sip of a drink, they felt so badly and shameful for failing that this was the permission giving thought that getting drunk wouldn’t be any worse. After 5 years of sobriety, someone had a glass of champagne at a wedding and then felt that they had wasted their 5 years of sobriety and would have to start over anyway, so they ended up going on a binge for the next 18 months for fear of having to “start over”.

While this phenomenon is common with all types of people, it is often seen the most in those who put a strong emphasis on total consecutive days sober, as opposed to cumulative days sober. If you’ve struggled with an addiction, imagine the most acute period when you were struggling, and then imagine if someone told you that you would have 5 years sober, with only a glass of champagne, or one use of your addiction over the course of those 5 years.  Would you see that as a victory, or would you focus on the fact that you had one day out of 1,825 days where you engaged in your addiction and therefore failed?

It is suggested to work on staying in the moment and not beating yourself up for deviating from the path of your desired goal. Just like your phone navigation system will autocorrect when you drive off the assigned path, so too can you make a course correction if you fall back into an old behavior pattern, however short or long in duration. One sip is better than one beer, one beer is better than dusting off the whole 12 pack and so on. We need not use one slip to justify continued slips. An old quote I enjoy: Start where you are, use what you have, and do what you can!

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.

Reducing Harms Associated with Substance Abuse

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

For many who have been using alcohol or drugs problematically, the advice given from loved ones and many mental health professionals is they must remain abstinent from all mind-altering substances and any deviation from complete abstinence is a cause for major concern. This approach to substance abuse follows an all-or-nothing model that does not consider all the gray areas between severe problematic addiction and complete abstinence, and can often have devastating consequences when a slip, or a lapse, occurs.

Harm reduction is about reducing the harms associated with substance abuse. It can be applied to any circumstance where there is less harm, or the potential occurrence of harm, due to specific interventions or actions to reduce, substitute, or replace the use of a harmful substance. In the case of alcohol, if someone were drinking a fifth of vodka a day, and is now drinking a bottle of wine, the harm would be reduced because a bottle of wine has much less alcohol content.  If someone has been using heroin and now strictly uses cannabis, they will have reduced the harm of a potential lethal overdose. 

Harm reduction can come in many forms and will be greatly needed during a time when addiction is expected to climb 100% over the next two years (CCAPP, 2020). For opioid use disorder, there are two main medications, Naltrexone and Buprenorphine, both of which can come in oral or subcutaneous once-monthly injections. Naltrexone can also be used for those who are wishing to stop drinking or reduce their alcohol intake as it helps with cravings and reduces the euphoric effects of alcohol. Often times, people may not want to use medications to help them cut back, taper or assist them in maintaining their abstinence, but harm reduction approaches have been shown to be highly effective when compared with total days sober, and not just total days abstinent (Peele, 2020).  

When working with clients, my goal is to always help them find ways to reduce the harm, or the potential for harm, caused by their problematic use.  Expecting or demanding complete abstinence, when that is not the goal or desire for someone only sets them up for guilt, shame, and a potential self-fulling prophecy if a slip occurs, giving them the opportunity to tell themselves, “See, I knew I would fail at this.” Following a harm reduction model for those who are seeking it or require it based on medical necessity helps individuals build the self-efficacy and belief that they have power to change their behaviors and live a balanced life, free from the grasp of addiction.  

If you or a loved one have been told abstinence is the ONLY WAY, give Realize Recovery a call today and we can discuss options and provide education on the evidenced based treatments that have been proven to work. 

Peele, S. (2020, March 19). So Alcoholics Anonymous Is “Proven” to Work After All? Not So Fast. Retrieved October 12, 2020, from https://filtermag.org/alcoholics-anonymous-cochrane/

The Disease of Addiction Thrives on Isolation (Rep.). (2020, May 12). Retrieved https://www.ccapp.us/application/files/9715/8932/2072/Addiction_Thrives_on_Isolation.pdf

Supporting a Loved One with Addiction

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Having a loved one who is struggling with addiction can feel overwhelming, create disharmony in the relationship and feel downright hopeless at times.  The most well-known model used to help someone get into some form of treatment has been the Johnson Intervention method.  Many have seen this model used on various television shows, filled with high drama, intense music and emotional reactions from both the loved ones and the individual struggling with addiction.  This form of intervention typically involves hiring an interventionist who coaches the loved ones on how to effectively confront the addict and set expectations that they either go to treatment or face the reality of not being involved in their loved ones lives anymore, to greater or lesser degrees.  

Research has shown that this approach is effective only 30% of the time and can often decrease the likelihood that treatment will be as effective for the individual who is “forced” to enter treatment (Myers, et.al, 2002). Those who are forced to attend treatment may not be ready to make a change in their behavior and this can cause resentment and resistance during the treatment process.   

Another approach that has not yet hit the main stream world of addiction is called CRAFT, community reinforcement and family training.  This approach was created by Robert Meyers and colleagues at the University of New Mexico and has been shown to have a roughly 65% success rate in getting a loved one into some form of treatment.  CRAFT was developed to assist loved ones in learning new effective ways to interact with the substance user in a kind and loving fashion, with the intention of reducing or stopping their substance use or drinking, and encourage them to enter into some form of treatment.  

Since friends and families lives often become completely consumed by their loved one’s addiction, CRAFT emphasizes learning coping skills on how to effectively care for themselves and take back control of their life.  By practicing self-care regularly, LO are better able to handle stress, express their feelings in more tactful ways, and maintain a positive outlook on the situation which influences more helpful interactions that with the struggling individual and increases the chances they will choose to seek treatment. 

While this approach may sound utopian and like all that is done is cater and be nice to the individual who is seemingly causing so much chaos and discord–there is a helpful way to approach the treatment conversations where someone is more likely to be open and receptive to the conversation.  Nagging, pleading and threatening typically don’t work on us when someone wants to get us to engage in something so why would we think it would be helpful to do the same to a loved one?   

Addressing conversations with a loved one, letting them know how you feel, and what you would like to see happen going forward is important.  A few tips below that may be helpful in starting this process.  If you would like further reading on this topic, I suggest reading How to Get Your Loved One Sober, by Robert Meyers and Brenda Wolf.  

  • Do not have conversations with your loved one when they are under the influence.  Remove yourself from the situation and let them know in a calm, matter-of-fact manner that they appear to be under the influence, how it makes you feel, and that you would like to have the conversation when they are sober.  Remove yourself from the situation and do not reinforce their use by spending time with them or engaging in conversation.  No argument or fighting, simply walk away and distance yourself.
  • Address your loved ones use at a time when they are most likely to be receptive, using the PIUS formula to address your wants, needs and feelings.  
    • P:  Positive communication that focuses on what you do like and want for the relationship, not what you don’t like and want them to stop.  Instead of saying “you always ruin dinner by getting drunk”, try “I enjoy having meals with you so much when you are sober”. 
    • I:  use “I” statements to express how you are feeling.  Using I statements lowers the defenses of the other person and allows them to be more receptive because the focus is on your feelings and not on their defects of character
    • U:  show understanding to your loved one’s situation and express how hard it must be to change as an example.  This too helps lower defenses and shows that you are empathizing with their feelings and difficulties. 
    • S:  Share responsibility to some extent for the current circumstances you all find yourselves in.  How can you help and support your loved one during the change process and how has your mindset and behaviors potentially influenced the situation?  While you are taking some responsibility for the problem, you are also taking some responsibility for developing a solution and path to a healthier, more loving relationship. 

If you or a loved one is struggling with problematic substance use, we are here to help you find a solution.  Even if we are not the best fit for you or your loved one, we can help you find someone who is.