Addiction or recovery? Enabling change. Dr Clare Fleming GP, Compass Health
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1 Addiction or recovery? Enabling change Dr Clare Fleming GP, Compass Health
2 Cycle of Change
3 Stages of change Not ready (pre-contemplation) Unsure (contemplation) Ready (preparation) Change in awareness Change in attitude Change in behaviour Relapse Changed (maintenance) Changing (action)
4 Why do people? Smoke Take drugs Drink alcohol Eat too much Have promiscuous sex Gamble machines or money markets
5 Why do people? Work excessive hours Go on spending sprees Take compulsive exercise Have co-dependent relationships
6 Reasons to drink 1. I like it; it makes me feel good 2. It helps me stop feeling bad 3. If I don t drink I feel ill 4. Dependence is the shift from: I want it I need it
7 B M S
8 B M S
9 Biopsychosocial Body genetics, neurochemistry, nutrition, organ damage Mind brain damage / thought patterns / habits Spirit Relationships: with self & others / culture / meaning of life IDENTITY Context external environment
10 Relationship Don t jump in Listen Build relationship Develop trust
11 Model of change Prochaska & DiClemente
12 PC Pre-contemplation Not even thinking about it
13
14 Denial The truth will set you free How do you find the truth that pierces through denial?
15 Reality check No. 1 feature of alcohol dependence is denial The underlying emotions are guilt & shame Is there a safe person with whom to look at the truth?
16 Take home key It s not what you do but who you are AUTHENTICITY
17 Motivational Style Empathy Am I different to you? Avoiding arguments I want a detox NO Rolling with resistance eg Toddlers Highlighting ambivalence: where their undesired behaviour contradicts their ambitions and self-image You said x and y Bolstering confidence that they can change for the better You have already
18 Consequences: Costs and benefits What good things happen when drink? What bad things can I avoid by drinking? What bad things happen when I drink? What good things do I miss out on if I drink?
19 Contemplation The thinking about it stage C
20 Frustration of the drinker I don t like this I think there is a problem I try to stop I can t What next?
21 Step 1: We admitted that we were powerless over alcohol, that our lives had become unmanageable
22 Step 2: We came to believe that a Power greater than ourselves could restore us to sanity.
23 Is there any hope? Able to accept help?
24
25 Attitude + - Authentic Kind Hopeful Expecting the best Consequence: Empowers the best Positive feedback loop Critical, hypocritical Rejecting Stigmatising Expecting the worst Outcome: Empowers the worst Negative feedback loop
26 Barriers to relationship?
27 Drug & alcohol Malnutrition Biochemical
28 Communication skills Education Illiteracy Reading glasses Memory poor
29 Mental health Personality disorders Attention Deficit and Hyperactivity Disorder Aspergers, autism Psychosis eg foot washing Depression & anxiety Examination issues (h/o abuse?)
30 Dual Diagnosis
31 Past experience - tinted spectacles Trauma: 80% homeless people had childhood trauma
32 Past experience Prejudice or abuse from people in authority (eg Pete s story) Medical experiences (eg A&E)
33 Self worth Rejection eg ball in park story Prioritising own needs Hygiene - waiting room / examination
34 Self worth
35 Environment - stability
36 Isolation & loneliness Lack of family / friend / support / advocate
37 Coping strategies Anger / aggression Short fuse Fear /avoidance / denial eg PR bleeding story upload.wikimedia.org/wikipedia/commons/thumb/0/0e/anger_controlls_him.jpg/640px-anger_controlls_him.jpg
38 Coping strategies Disconnection / emotional numbness
39 What do you do to mood alter? Have you ever thought about changing this habit? Have you ever tried to change it? How did you get on?
40 What makes change harder? H ungry? A ngry? L onely? T ired?
41 Ready for change? Is drink a friend or foe? What have you lost? Which is harder to carry on as you are or to change? What are the barriers to change?
42 Tipping point for change Pain of the status quo > pain of change
43 Preparation I know I want to, but I m not ready yet P
44 Increasing motivation for change Drinking Stop drinking + -
45 Bristol ROADS BSDAS =Secondary care BDP = Primary care DHI = carers and peers Also: Colston Fort =Secondary care alcohol
46 Bristol Specialist Drug & Alcohol Service Refer to ROADS Colston Fort Stokes Croft 6 Hub practices Acer Unit = in-patient DHI (Blackberry Centre) = South Glos DHI = BANES ARA = NS
47 Think wider Housing? Support? Food / fluids? Vitamins? What first? start simple make plans
48 Build on success What have you done before that went well? What skills enabled you to do that?
49 Action Doing it A
50 Maintenance Keeping to it, reinforcing change M
51 Relapse Going backwards R
52 Relapse Relapse is part of recovery What went well? Reinforce the positives What went wrong? Be specific What did you learn? What will you do differently next time? When to try again?
53 The way ahead: Recovery community People who live with a recovery mindset have a great capacity to inspire change in others. Social Networks Crabs in the bucket
54 The way ahead: Recovery community Are we a healthy community? Are we addicted to trying to make others better and ignoring our own needs? Recovery begins with Step 1: We admitted we were powerless over that our lives had become unmanageable.
55 Additional resources 12 step fellowship: AA 94 per week CBT model: SMART recovery 7 per week 12 step Dual diagnosis
56 Carer support Alcohol famanon.org.uk Drugs National Association for Children of Alcoholics Bristol S Bristol
57 Information resources Services throughout the region BME, crack use Sexual violence Bristol Against Violence & Abuse
58 Take home key It s not what you do but who you are
59 Take home keys Attitude: mutual respect Relentless kindness Firm boundaries Hope Listen for the story Think whole person/family Be realistic
60 Pro / con chart Body/mind/spirit Pictures Take home tools Drinking Stop drinking + -
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