From our blog, articles tagged: Outpatient

When it is time to start searching for an addiction treatment center, you may have many questions.

In fact, the whole process may seem overwhelming to you right now. Whether the treatment center is for you or a loved one, when you don't know very much about the treatment process or even finding a good treatment center, it can feel daunting.

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We previously posted a list of 60 substance abuse group therapy activities to give readers an idea of what kinds of topics they might encounter during a theme/support group.

We received positive feedback on the list, so we found 60 more to keep you inspired!

Please note that Two Dreams utilizes process groups as opposed to theme/support groups. Process groups are focused on self-exploration and giving/receiving feedback. They provide a safe environment in which members can practice newfound interpersonal skills and behaviors. Process groups are mostly unstructured with no singular topic of discussion. Theme groups are focused on support and finding commonalities between members. They tend to have more structure than process groups and focus on a single topic.

Two Dreams prefers to hold process groups in order to enhance the holistic treatment experience and to help clients equip themselves with the tools needed for their own recovery.

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Hope is the driving force behind recovery. You can see it in the glowing smile of the elderly man who finally made it through a full year without a drink. You can feel it in the bouncing step of the middle-aged woman whose regular physical therapy sessions have caused her pain levels to decrease. You can hear it in the proud applause of parents watching their now drug-free son walk across the stage to receive his college diploma. You can taste it in the glass of water that the teenage girl chooses to drink instead of alcohol at a friend’s party.

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Addictive drugs directly activate the brain’s reward pathway, a system involved in behavior reinforcement and memory production.

Activation of the reward system can be so intense that normal activities, like eating and sleeping, may be forgotten and/or neglected. Drugs of abuse characteristically enhance dopamine signaling in an area of the reward pathway called the nucleus accumbens (NA.) The NA is sometimes called the “pleasure center” of the brain. It releases dopamine when the brain senses a rewarding stimulus, such as a narcotic, and this rush of chemicals reinforces the behavior that caused the sensation, for example ingesting a pill. Thus, the cycle of pleasure seeking begins and an addiction is cultivated. 

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Addiction is a difficult disease to define. When does therapeutic drug use cross over into abuse? What is the difference between frequent social drinking and alcohol use disorder? Should comfort-seeking drug use (such as mild-sedative ingestion before bed every night) be considered a disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has acknowledged the difficulty at hand, and set forth guidelines to help users know when to seek help, and to help physicians make accurate diagnoses.

Prior to the publication of the current DSM-5, the manual distinguished between abuse and dependence in terms of severity, with “abuse” being on the mild end of the continuum and “dependence” being towards the critical end. The DSM-5 erases that distinction and instead combines the former classifications of “substance abuse” and “substance dependence” into one comprehensive category called “substance use disorder.” This broader category is meant to better encompass the reality of true patient experiences; clinical manifestations of addictions are hardly black and white or able to be sorted perfectly into a category.

The DSM-V suggests that a certain number of criteria must be met in order to define substance use as disordered: 2-3 for mild diagnoses, 4-5 for moderate diagnoses, and 6-7 for severe diagnoses. Their list of criteria is as follows:

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Dream Journal

Andrea Barthwell MDNote From Dr B.

The idea of making a “New Year’s Resolution” is appealing to individuals across the globe, but it also adds a great deal of pressure to the actions of the upcoming year. People oftentimes make unrealistic promises (ex. I will exercise every single day from now on) and end up disappointed when they are unable to live up to the standard of perfection they set for themselves. So, as a means of relieving ourselves of this unnecessary stress, I propose that we all strive for progress in this upcoming year instead of perfection. Start out small; for example, you could resolve to exercise twice a week instead of “an hour each day for the rest of my life.” You could promise to start journaling at night, instead of vowing to keep your emotions under control at all times. When we are honest with ourselves about our abilities and limitations, we are better able to achieve our goals. Living a healthy lifestyle is not about making the right choices all the time; it’s about balance and staying in tune with your body’s signals. You don’t have to be flawless; you just have to move forward.

Sincerely,

Dr. B

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Dream Journal

Dr Andrea Barthwell MD FASAMNote from Dr. B.

The holidays can be a difficult time for individuals in recovery: frustrating family members, crazy Christmas parties, stressful shopping trips, etc. You don’t have to let the season get you down though! There are plenty of ways to stay centered and sober during the winter season. Make sure to listen to your body and avoid letting yourself get hungry. Maintain a regular meal plan full of nutritious fruits and vegetables. Eating a plateful of cookies may seem like a good idea when you’re at an event, but the inevitable sugar crash is likely to make you feel irritable and fatigued shortly afterwards. Negative emotions can be a precursor to relapse, so try to avoid the unhealthy snack table as much as you can. I recommend bringing a bag of healthy trail mix to events so that you’ll be prepared if you get hungry.

Sleepiness can also cause irritability and negativity. You are more likely to make irrational decisions when you’re running on a couple of hours of sleep, so try to get at least 7-8 hours of shut-eye every night. Waking up and going to bed at the same time every night will help to keep your body functioning regularly, so try to avoid attending too many late night events. It is also important to sleep in a dark environment, so keep the Christmas lights and glowing decorations out of the bedroom.

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Dream Journal

Note from Dr. B.

The ongoing opioid overdose crisis has prompted the CDC to take action in the form of developing new guidelines for qualified prescribers. First and foremost, the CDC stresses that opioid therapy should be utilized only if all other treatment options have been exhausted. Opioids can vastly improve functionality and quality of life, but the benefits must be weighed against the risks of tolerance, addiction, overdose, etc. If opioids are absolutely necessary, the prescribing physician and patient should work together to formulate a safe plan of approach and establish realistic treatment goals before starting therapy.

These goals should be re-assessed throughout the course of treatment to ensure that the patient is still experiencing significant improvement. The CDC recommends that patients start off their therapy by taking low doses of short-acting opioids. The use of high dosage and/or extended-release (long acting) opioids is risky and warned against unless the alternatives are ineffective. Additional precautions should be taken when increasing dosage to 50mg or more per day in morphine equivalents, and increasing dosage by 90 mg or more per day is strongly discouraged. Patients with acute pain should be given a minimal amount of pills initially, as studies have shown that a three-day supply is usually sufficient for non-traumatic instances. This policy would lower the likelihood of abuse and protect short-term users from addiction.

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The Dream Journal

Note from Dr. B.

Dr Andrea Barthwell MD

The Walk on Washington was a great success! The Two Dreams staff gathered in Washington DC on October 4th in a collective effort to support policies that will improve addiction recovery and end the stigma against those with the disease. Major media networks covered the event, so our voices were heard all across the nation. Fall is a time of transformation, and we look forward to affecting more change as we move towards the end of the year.

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Dream Journal

Note from Dr. B.

Dr Andrea Barthwell MD

September is National Recovery Month, a time to celebrate healing and to speak out against the stigma surrounding addiction. The Two Dreams staff members stayed busy this month, especially on the 26th. Clients and staff alike attended the 6th Annual Walk Against Addiction in North Carolina, which was designed to raise awareness of the epidemic that addiction is becoming in America. Our Clinical Director for Two Dreams Outer Banks, Brett Dunning, was a featured speaker at the event. He spoke out against the stigma that patients experience, and emphasized that everyone is susceptible to addiction. Dunning is also currently serving on the Board of Directors for Project Purple, which educates middle school and high school students about addiction and holds events throughout the year. Additionally, the Two Dreams staff is preparing to gather in Washington DC on October 4th for the Walk on Washington. This walk is a collective effort to support policies that will improve addiction recovery and end the stigma against those with the disease.

This month has also been a celebration for the recovering families, the mending friendships, and the reestablished peer-groups of addicts. When an addict makes the choice to pursue treatment, they start a ripple effect of positivity and healing for a multitude of individuals. The sheer magnitude of the impact a person can have by embarking on the recovery process is astounding, yet often overlooked. In short, let’s take time this month to appreciate just how much of a difference once person can really make. Let’s celebrate the shared experience of recovery.

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Nancy Davis, our Two Dreams New Orleans Outreach coordinator and Administrator, recently attended the Innovations in Behavioral Health Conference in Nashville on June 22-23. Innovations in Behavioral Health is a new conference being offered by Foundations Recovery Network, and is beneficial for those looking to broaden their knowledge and skill set in the treatment industry, medical field, and business management.

With our new IOP and OP treatment facility in New Orleans fast approaching its opening day, we thought Nancy Davis would be the perfect person to attend this conference. We recently sat down with Nancy to discuss her experience at the Innovations in Behavioral Health Conference to get the inside scoop on how this conference will benefit our New Orleans facility.

 

How was your experience at Innovations in Behavioral Health Conference?

Nancy: It was a fantastic conference, full of educational information pertaining to the addiction field. Many were in attendance and overall, I think the conference was a huge success. I’m excited for next year, as there is talk that the conference may add an additional day.

 

What topics were discussed at the Innovations in Behavioral Conference?

Nancy: Physical, mental, and spiritual aspects of treatment were discussed in great length at the conference, which are so important when dealing with addiction. At Two Dreams, we believe in a holistic approach to treatment and our 3-7-3 model of treatment emphasizes this approach. Addiction must be combated from multiple angles, and gaining additional insights and tools used in treating those with addiction was very helpful. In addition, practices for treating mental health conditions, approaches for timely interventions, and insights into revenue management were also topics covered. The information I gathered from this conference will definitely help our New Orleans facility.

 

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What is group therapy used for?

Group therapy is used to guide clients through the process of gaining insight about themselves, others, and the world around them.

Through the group dynamic, clients foster hope and examine core issues that exacerbate their addictive disorders. They also work to develop their communication skills and learn to engage in fun, healthy social experiences. The group dynamic encourages honest feedback and facilitates bonding between individuals with shared experiences. Clients weigh in on the issues of others in order to offer suggestions or provide outside perspectives, broadening the individual’s understanding of the conflict.

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Light regulates circadian rhythms

Why and How We Live Rhythmically at Two Dreams

The chains of habit are generally too small to be felt until they are too strong to be broken

- Samuel Johnson

Every living organism has a natural rhythm. These rhythms are disrupted by illness, particularly drug and alcohol use. A drug can create false sleep. A drug can stimulate alertness. A drug can suppress appetite. Another can stimulate appetite.

The science behind living rhythmically, strategies that promote and restore natural rhythms, and the role of sleep, nutrition, meditation, and exercise in the 21st century approach to healing oneself in recovery are all important aspects of your journey at Two Dreams.

At Two Dreams the concept of living in the NOW (No Other Way) is central to living a life in recovery. Similarly, mindfulness is a state of active, open, non-judgmental attention on the present. Many treatment programs and practitioners are employing mindfulness in the care and management of patients with mood, anxiety, and substance use disorders- diseases and symptoms which tend to cluster together.

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