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| What To Do When Everything Else Fails: Six Powerful Adjuncts To Treatment |
| Columns - Professional Development | ||||||||
| Saturday, 30 November 2002 | ||||||||
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As I glanced at Mr. Townsend's chart my heart sunk. He nervously joked with me that he was the poster child for substance abuse recidivism. His record indicated that he previously had been in rehab 34 times and had participated in a bevy of outpatient treatments. "I've been through treatment so many times I can run the groups for you if you wish," he chided. Certainly his remark was accurate. Since Mr. Townsend's brother was a major television celebrity, his treatment stints included some of the top centers in the nation. Now granted, our addiction treatment center was affiliated with a major hospital. Nonetheless, the question that begged in my mind was: What in the world were we going to do that the other centers, therapists, addiction counselors, medical addictionologists, and psychiatrists didn't do before?The ultimate answer was that we did almost precisely what the treatment centers did before us, and Mr. Townsend was back on the street using within days of leaving our center. We often tell clients that insanity is doing the same thing over and over again and expecting different results, but how often do we as treatment specialists heed our own warning? But that was then and this is now. Today we have a valuable collection of supplemental treatment protocols. Desperate times call for desperate measures. The good news is that this article will outline a course of alternative treatments for cases where traditional treatment has failed. Each of these methods can be used as a sole adjunct, however, in most instances an integrative approach that draws on several - if not all - of these modalities is preferable. There is one caveat I must emphasize and that is that I am not in any way shape or form suggesting that any of these strategies replace the program in your treatment center. The client can and should participate in your program and aftercare plan in its entirety. These techniques are intended to be supplements and nearly every case will not stand on its own two feet as a viable cure. I must also warn you that some (though not all) of these methods are still considered a bit controversial or on the fringe. My armchair prediction is that many of these methods will be considered mainstream in the coming years. A bevy of supplemental treatments Assertiveness Training. This the most conservative supplemental intervention strategy and some centers already use assertiveness training as part of the treatment plan. The behavioral psychologist Andrew Salter (often cited as the father of behavior therapy and assertiveness training) believed that all psychological disturbances including addictions could benefit from proper expression of emotions. Salter called his approach "Conditioned Reflex Therapy" and it was later refined in the 1970s into the assertiveness training movement. The basic idea is that assertive communication is best and that the client learns to discern nonassertive, assertive, and aggressive styles of relating to others. We once surveyed all the clients who went through a stress center and substance abuse center we were running and asked them a simple, yet poignant question: What do you think helped you the most? We were amazed - perhaps shocked would be a more accurate term - that the most common answer was "the assertiveness training sessions." Don't underestimate this therapeutic powerhouse. Hypnosis. I once worked with a client who worked as a major drug dealer. He had tried everything (including the rehab center I was working with!) to ameliorate his pernicious cocaine and crack addictions. The client turned out to be a stellar hypnotic subject and he overcame his addiction in a matter of sessions! Some clients improve because they believe they will improve, however, some Ericksonian hypnotists have noted that resistant clients often make the best improvement. The truth of the matter is that nobody is 100 percent certain why hypnosis works. Contrary to what some of the ads promise, hypnosis doesn't work in every case and generally takes several sessions when it is effective. A quick word of caution is in order when making a referral for hypnosis. In some states virtually anyone can call himself or herself a hypnotist and indeed they do. I thus wholeheartedly recommend that you refer the client only to a practitioner who has a minimum of a master's degree and a license (e.g., psychology or counseling). Nutritional Supplements. There is enough literature on this topic, much of it performed overseas, to fill a battleship. Nevertheless, I am baffled at the small number of clients who have tried nutritional supplements. Most counselors are well aware that addicts medicate themselves with alcohol and other drugs in order to ease their depression and other psychiatric conditions. A number of highly effective non-addictive natural remedies such as St. John's Wort, SAMe, L-Tyrosine, Omega 3 fish oils and 5-HTP are readily available without a prescription at economical prices. Dr. Roger J. Williams, whose laboratory discovered numerous vitamins, once told me that he could prevent alcoholism in animals by raising their vitamin B-5 Pantothenic Acid levels. Although, the problem in humans is vastly more complex, more and more physicians are prescribing extra dosages of non-yeast B-vitamins for addiction. Needless to say, supplements that guarantee their potency are highly recommended. Since in rare cases these supplements can interfere with prescription medications, I insist that your client check with a licensed allopathic or alternative health practitioner before embarking on any nutritional regiment. Biofeedback. "I use drugs, alcohol, and gambling to relax and unwind." We've all heard that one before. The fact is that research does support the notion that a high percentage of folks truly cannot relax. That is to say, when some people appear to be relaxing they are actually becoming more tense! The answer: biofeedback. Biofeedback machines don't do anything to you. These sophisticated electronic devices merely allow you to monitor your level of tension or relaxation (e.g., on a meter, computer screen, or by listening to it on headphones). Like hypnosis, nobody knows for sure how it works, but suffice it to say that for a high percentage of folks it does. Like assertiveness training - many stress centers and addiction treatment facilities have made biofeedback training mandatory for all clients in the program. Negative Ion Generators. Okay, now we've come to a fringe treatment. Scientists have discovered that people are healthier and happier when the air carries a negative charge. Modern living such as synthetic clothing, closed heating and cooling systems, and car engines produce a plethora of positive ions that are detrimental to our mental health. Many air purifiers now have onboard negative ion generators. Putting a negative ion generator in the client's house is not going to totally cure the client but it could help a little. And when you are working with a client who has tried everything I can safely say that you need every little bit of help you can get! Up to this point in time no negative side effects have been evident. Full-spectrum lighting. People deprived of sunlight often become depressed. Seasonal Affective Disorder or SAD is a bonafide diagnosis in the DSM. The lights in our houses and fluorescent tubes do not provide the antidepressant qualities of the sun. Full spectrum bulbs that are similar to sunlight are now readily available at pet shops and home improvement stores. These bulbs cost quite a bit more than a standard bulb but they last a lot longer too. Moreover, some clients report their vision is better when using full spectrum lighting. Some companies market full spectrum psychotherapeutic light machines that are much stronger than merely replacing a bulb in your reading lamp although they may carry a fairly steep price tag. I once shared an office with a psychiatrist who had a rather large full-spectrum light apparatus in her office. When I met her I commended her for her use of this innovative form of treatment. "Oh, I don't have that here for my patients," she remarked, "I use it so I won't become very depressed myself when deprived of eight or so hours of sunlight each day." Of course there are numerous other adjuncts such as chiropractic work, mild exercise, or even massage. Adjuncts are not always ego boosters and, in fact, can serve to keep us humble. For a number of years I worked very closely with clients who wanted to quit smoking. Anecdotal reports suggested that if a client could keep his or her system alkaline by gargling or swallowing a tad of baking soda it would rapidly abate one's desire for a cigarette. You can imagine how I felt sitting there armed with 11 or 12 years of formal education; a wall full of licenses and certifications, and being told, on occasion, that a couple sips of baking soda made the most impact in their treatment process. The bottom line is merely that when the tried and true doesn't work it is time to admit (like your clients) that you have a problem and add some additional firepower to the treatment package. Howard Rosenthal, EdD, CCMHC, is the Program Coordinator of the Human Services Program at St. Louis Community College at Florissant Valley. His book Favorite Counseling and Therapy Homework Assignments includes contributions from more famous therapists than any book of its ilk. His web site is www.a-zuc.com/counseling.
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