recovery

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. 

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.

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.

Abstinence vs. Moderation

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Many clients seeking services for addiction are often ambivalent about whether or not they have to completely quit, forever, or if they will ever be able to use moderately.  This is a frequent conundrum for those in early recovery, and something that we at Realize Recovery often explore with clients uncertain in which direction they want to go.  Pressures from loved ones, work, the legal system and societal beliefs from a predominantly 12-Step philosophy often play a role in the push for complete abstinence.  

Uncertainty about which direction to choose is normal at the early stages of recovery and can remain for years to come.  If you are considering which path may be best for you, it can be helpful to first identify what your main goals are with your substance for the near future.  It is often recommended for those with their minds set on moderation to experience a period of complete abstinence in order to have something to compare abstinence with.  If one has been using some form of mind altering substance for years on end, it will be hard to gauge if moderation or abstinence is right, when abstinence has not been experienced since childhood, or years in the past.  Taking a break from all substances for at least 30 days (if possible) gives one the opportunity to compare how they feel being sober, versus having a mood altering substance affecting their perception.  I have often worked with people set on moderating, only to go a month or two abstinent and then report that they have never felt better and have no desire to return to using their substance of choice.  

Why Moderation?

            Moderation can be helpful for those that are unwilling to abstain and are fearful of a life without their substance.  Considering moderation may still be a scary decision for the person who has been using heavily for a long period of time and would be considered a harm reduction approach.  Harm reduction seeks to reduce the harm in a person’s life caused by the substance.  If one is used to drinking 12 beers a day and now drinks 6, that would be reducing the harm in the individual’s life and a step in the direction towards moderation.  This can open the door to change for someone who is resistant to stopping their addiction, while helping them gain momentum in a value driven direction. 

            Moderation can also work for a lot of people who do not see any consequences from their substance use and therefore have little desire or internal motivation to change.  For those with comorbid disorders, or dual-diagnosis,moderation may work once the individual has worked on their mental health and feel they are in a good place as substances are often used to self-medicate.  Individuals who are dual-diagnosis may have used their substance as their primary coping mechanism and in some cases may be able to drink moderately upon receiving the mental health they need. 

            For behavioral addictions such as shopping, eating and in some cases sex, moderation is a necessity and therefore points to the ability for individuals to be able to learn how to have a different relationship with their addiction.  

Why Abstinence?

            For those struggling with a severe addiction, the easiest and safest way to avoid negative consequences is to abstain.  It can be much easier for many people to set their mind to complete abstinence instead of dealing with all the decisions on when it is okay to use, how much, under what circumstances etc.  Research has shown that the number aspect for those maintaining long-term sobriety is a commitment to complete abstinence.  This makes a lot of sense as it takes out the guesswork and allows the mind to simply focus on one thing–abstinence under all circumstances. 

            Certain substances can also be deadly and pose dangers legally and professionally, and one may find it easier to abstain instead of risking severe long term consequences for short, fleeting euphoria, with no long term payment comparable to the degree of possible long term consequences. 

Is there a Right Way?

            There are no absolutes in the world of relativity, and therefore there are no right or wrong answers to this question.  Each individual is free to decide which path they choose, as each individual gets to experience the positive or negative consequences of their choices.  Thinking back to past experiences with both approaches and getting honest with oneself is often the first step to take.  Regardless of what has happened in the past, know that those patterns do not have to carry on moving forward.  

            Realize Recovery works with all clients regardless of which approach they prefer and can help you or your loved one sift through the pros and cons of each approach based on their unique experiences.  There are interventions and methodologies that can be implemented to test and experiment with moderation if one so chooses to take that route.  We are not here to tell anyone what to believe or how to live their life, rather we work within your values and help each individual to come to the best conclusions for themselves.  

Being Comfortable Feeling Uncomfortable

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Getting comfortable feeling uncomfortable, is one of my favorite recovery sayings because I feel it really sums up what is necessary to live a life free from problematic substance use.  Those who use chemicals to change their emotional state may have begun using, as a means of making a fun time even better, but once the consequences of use outweigh the benefits. The addictive behavior or chemical becomes the primary coping mechanism to avoid temporary discomfort.  At this point it may not even be about fun, but an attempt to feel normal and function in day-to-day activities.  

Choosing to reduce ones use, or to be abstinent, will inevitably push the individual to experience varying levels of discomfort since the body and mind have been conditioned to turn to the addiction as an attempt to relieve the discomfort.  For those who have been through this, we know this relief is fleeting at best.  The choice to stop this pattern is not an easy one and requires one to learn new ways of acting and thinking that will assist in developing tolerance of discomfort.  While the minds initial response will want to be to run away from the discomfort and use whatever is quick and easy, following through with this method will only keep us in the throes of the addictive lifestyle we so hope to escape. 

Understanding and accepting that discomfort is a natural part of life, and really any behavioral change, can be uncomforting during this process.  Dietary changes, deciding to wake up earlier, exercise, communicating better with a spouse, are all examples of changes that will be uncomfortable at first and stopping or reducing a chemical addiction is no different.  Remind yourself that change is uncomfortable at first, and over time this change will become more normalized which will therefore gradually reduce the discomfort as it becomes part of your new lifestyle.  

Avoidance is a common feature of addiction and is the antithesis of engaging in the behaviors that will bring you long-term, sustainable happiness.  We start using substances for a conduit to happiness, and paradoxically people choose to stop using substances to regain their happiness.  Learning to cope with discomfort is mandatory to maintain positive changes because discomfort is what we seek to avoid by having a drink, taking a pill, or smoking something.  

There are many ways to deal with discomfort in healthy ways and when done consistently become easier and easier over time.  I have found acceptance, mindfulness, and engagement in distractions to be some of the most powerful tools to get through temporary discomfort.  The mind will want to think about the future and how the discomfort will always be there, but how can you know what the future brings and how you will feel one day, one month or one year from now?  

Almost everyone I know who has been living a sober lifestyle states the urges and cravings diminish over time and many have gotten to the point where their addictive substance no longer holds any sway over their life.  By focusing on the moment at hand, and not projecting our current discomfort to how we will always feel in the future lessens its power and allows us to experience the transitory nature of all feelings.  Here one moment and shifting the next.  By learning to get comfortable feeling uncomfortable, we no longer make demands that “bad” feelings must be avoided and should not be tolerated.  Instead, we accept life has ups and downs and are able to push through these moments without having to turn to a substance to give us short term relief, while incurring long-term consequences as a result of their use.