From our blog, articles tagged: Dream Journal

Dream Journal

Andrea Barthwell MDNote From Dr B.

People aren’t expected to recover from a life-threatening illness without care and we use the dimension of professional guidance to represent how we help an individual do the things that are necessary to recover. That professional guidance during the first phase might be helping them to get up in the morning to re-establish their circadian rhythms. Later on, it’s an individual therapy where they can delve deeply into emotional hurts that they’ve experienced about their life and share them with another person, sometimes for the first time in their lives, or it could be in having someone just direct you to a particular app that’s going to allow you to celebrate the days that you have in recovery.

Professional guidance is extremely important because individuals who can get sober in AA alone did. They’re not in treatment, and those are individuals who need some professional assistance to help decide what elements to put together and what specific way they need to approach treatment in order to recover. Our staff is passionate, caring, and dedicated to helping others achieve the best outcomes possible.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Peer support is probably the most important thing that you can experience in treatment and it’s experienced in different ways depending upon the phase that you’re in in treatment. Coming into treatment, you look around and you see that other people have the same kind of problems that you’ve had and you learn to identify and understand that you’re not unique in what you’re feeling or what you’ve gone through to get here. You also see people who are a little further along in treatment than you are who are doing better than you could have ever imagined for yourself. You begin to want what they have and you become hopeful that it’s possible.

Peer groups also provide a form of support and understanding. They are a way in which people express their love for others in their humanity. They are a way to identify. They are a way to stay accountable. Additionally, people who have gone through what you’ve gone through understand what you’re experiencing and when you may talk about something that’s happened in your past but minimize the impact or change the way in which you describe a situation, somebody who has actually experienced that situation may be able to help you find a deeper truth in your story-telling.

Peers are extremely important in the program and being able to feel free enough to experience and love another person for who they are is one of the first things that we can do to heal ourselves.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Abstinence is critical for recovery. The individual who’s been using alcohol or drugs or other devices has to stop and return the body to as near-as-makes-no-difference-to-normal state in order to start the process of recovery. However, just taking the drugs out of your system doesn’t give you recovery; it gives you an opportunity to step back and then put together a life that one can lead in recovery.

This dimension is very critical and it can be done in a way where the individual goes through detoxification or maybe on medication-assisted reductions to what they’ve been taking or even medication-assisted recovery if necessary. Somehow, though, we have to be able to clear the mind and stop the cycle of using and recovering from the use in order to have the energy to engage in the recovery process.

It is also important to note that abstinence not only means abstaining from drugs and alcohol, but dysfunctional elements in life as well. For example, individuals in recovery should abstain from negative thoughts, codependent behaviors, self-defeating communication styles, and other individual issues that hold them back from achieving mental peace, physical well-being, and personal productivity.

We insist upon abstinence here at Two Dreams and encourage graduates of our program to continue abstaining throughout their long-term recovery as well.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

I created the "3-7-3" philosophy as part of my commitment to holistic, evidence-based treatment that is both all-inclusive and highly effective. Patients are required to examine their progress introspectively throughout their stay at Two Dreams and spend every day working to complete the three phases of treatment via our seven dimensions of treatment. When both the patient and the staff feel that the individual has achieved the three main outcomes of recovery, mental peace, physical wellbeing, and personal productivity, they are ready to transition out of our facility.

The first few editions of the Dream Journal this year are going to focus on the first "3" of the "3-7-3" philosophy, a number that represents the three phases of treatment at Two Dreams. The three phases are a naturally occurring progression; they are not time limited, and clients can transition in and out of them depending on several clinical factors. The third phase, and the subject of this edition of the Dream Journal, is the "Looking Out Phase."

 

Stretching in the morning

 

The Looking Out Phase, as the name suggests, is all about looking outward and meditating on a future in long-term recovery. Patients in this phase have all the tools they need from treatment and may begin making decisions about where to go and what to do after Two Dreams. They make a plan to continue building on the gains they made while in primary treatment, including working on managing cravings, managing relationships, and reintegrating into their next living environment. This phase provides a supportive environment in which to practice newly gained skills and outlooks. Our professional staff continues to guide clients by encouraging them to utilize their strengths and the positive attributes revealed to them during their stay at Two Dreams.

Please call us today at 708-613-4750 for more information about the Looking Out Phase or our treatment program in general. We look forward to speaking with you.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

I created the “3-7-3” philosophy as part of my commitment to holistic, evidence-based treatment that is both all-inclusive and highly effective. Patients are required to examine their progress introspectively throughout their stay at Two Dreams and spend every day working to complete the three phases of treatment via our seven dimensions of treatment. When both the patient and the staff feel that the individual has achieved the three main outcomes of recovery, mental peace, physical wellbeing, and personal productivity, they are ready to transition out of our facility.

The first few editions of the Dream Journal this year are going to focus on the first “3” of the “3-7-3” philosophy, a number that represents the three phases of treatment at Two Dreams. The three phases are a naturally occurring progression; they are not time limited, and clients can transition in and out of them depending on several clinical factors. The second phase, and the subject of this edition of the Dream Journal, is the “Looking In Phase.”

 

Inner peace

 

The Looking In Phase, as the name suggests, is all about introspection and the therapeutic discovery of ones core beliefs and emotions. Patients learn to recognize, respect, and connect their thoughts, feelings, and aspirations, while simultaneously banishing negativity and forming a more whole and healthy sense of self. Process groups involve sharing with others on a deeper level than in the first Coming In Phase and a frequent discussion topic is acting intentionally as opposed to reacting emotionally when faced with stimuli from either the internal or external world. Patients are ready to transition into the last phase, the Looking Out Phase, when they have demonstrated an ability to acknowledge their addiction, commit to their recovery in a heartfelt manner, and reduce or eliminate inducements to use in the future.

Please call us today at 504-510-2331 for more information about the Looking In Phase or our treatment program in general. We look forward to speaking with you.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

I created the “3-7-3” philosophy as part of my commitment to holistic, evidence-based treatment that is both all-inclusive and highly effective. Patients are required to examine their progress introspectively throughout their stay at Two Dreams and spend every day working to complete the three phases of treatment via our seven dimensions of treatment. When both the patient and the staff feel that the individual has achieved the three main outcomes of recovery, mental peace, physical wellbeing, and personal productivity, they are ready to transition out of our facility.

The first few editions of the Dream Journal this year are going to focus on the first “3” of the “3-7-3” philosophy, a number that represents the three phases of treatment at Two Dreams. The three phases are a naturally occurring progression; they are not time limited, and clients can transition in and out of them depending on several clinical factors. The first phase, and the subject of this edition of the Dream Journal, is the "Coming In Phase."

The Coming In Phase is about easing into recovery and making a conscious commitment to health and wellness. It is about establishing a feeling of safety and comfort around the staff and peers in the program in order to create a platform on which to build the recovery experience. It is about engaging in the development of healthy rituals, and building the self-confidence necessary for achievement in therapy and the following treatment phases. It is also about exploring new behaviors, as well as becoming aware of existing thought processes and coping mechanisms. Patients must embrace their stories fully and honestly, and learn to share their experiences, as difficult as that might be.

Although the Coming In Phase is introductory, it is vital to the continuation of recovery. Without embracing the self, patients cannot possibly continue the therapeutic work necessary for developing new life skills and holistic wellness. This phase is challenging of course, but our caring, professional staff is consistently able to guide patients through their obstacles and towards the end-goal of self-actualization.

Please call us today at 504-510-2331 for more information about the Coming In Phase or our treatment program in general. We look forward to speaking with you.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

In 2011, researchers from Case Western Reserve University published an article in Alcoholism Treatment Quarterly indicating that volunteer work and service to others are integral to the recovery process. This finding is consistent with the stated purpose of Alcoholics Anonymous, to stay sober and help others achieve sobriety as well.

At Two Dreams, clients embrace the power of service to themselves and others through regular group therapy sessions. Clients help each other process their emotions and provide feedback on their progress in their recovery. We encourage clients to keep in touch after leaving the facility and we stress the importance of open communication in the milieu. We find that clients are able to build deep relationships with each other based upon their common experiences, and they are therefore able to help each other through difficult challenges and emotions that come along with addiction. Helping others at different stages of treatment also reminds clients of where they have been or where they aim to go in terms of recovery. This enforces a commitment to combatting the addiction and increases the determination needed to succeed.

During this holiday season, it is especially important for us to remember that giving should not be followed by the expectation of receiving. Give of yourself freely because you can make the world a better place.

Happy Holidays and Happy New Year,

Dr. B

Sources cited:

https://www.sciencedaily.com/releases/2011/01/110128104242.htm
http://alcoholrehab.com/addiction-recovery/service-in-recovery/

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Addiction is a disease of learning, memory, motivation, and choice that results in biological, social, psychological, intellectual, and spiritual alterations. In this edition of the Dream Journal, I want to focus on the spiritual aspect.

One of my favorite definitions of spirituality comes from a 2000 edition of "The Physician Executive," in an article entitled "Spirituality and the Physician Executive: Reconciling the Inner Self and the Business of Health Care." The author, Kaiser, claims that spirituality "…refers to a broad set of principles that transcend all religions. Spirituality is about the relationship between ourselves and something larger. That something can be the good of the community or the people who are served by your agency or school or with energies greater than ourselves. Spirituality means being in the right relationship with all that is. It is a stance of harmlessness toward all living beings and an understanding of their mutual interdependence." (Kaiser 2000)

According to this definition, spiritual alterations occur when one’s individualized ability to seek purpose and meaning is changed. In this sense, spirituality is not necessarily synonymous with religion; it is more strongly associated with a connection to the universe in some capacity.

The Big Book stresses surrender to a "Higher Power," which many people take to mean "God," but it actually means so much more than that; it transcends mere religion. It is nature. It is music. It is art. It is the relationship between family and friends. It is existence. It is resonance. It is love.

At Two Dreams, clients are encouraged to carve their own spiritual paths and choose their own Higher Power. The staff works with each individual to create a personalized recovery plan so that the lessons learned in treatment resonate long after discharge. Everyone expresses spirituality in his or her own way, and Two Dreams embraces that amazing piece of the human condition in order to help each client find mental peace, physical wellbeing, and personal productivity.

Sincerely,

Dr. B

Source:

Kaiser, L. (2000). "Spirituality and the Physician Executive: Reconciling the Inner Self and the Business of Health Care. The Physician Executive. 26(2). March/April.

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Before I was officially sworn in as Deputy Director for Demand Reduction in the Office of National Drug Control Policy under the Executive Office of The President, I went through a period of indecision and stress. In short, the President announced that I would be appointed to the position, but then the statement was withdrawn because of controversy in the White House at the time. Recovery advocates were planning to march in protest on my behalf, but a friend suggested to me that I try to prevent the march on Washington because what you do is always open for review and critique and how I handled the situation would stick around throughout my career.

That thought has helped to define my attitude: you only get one shot at a first shot, and the only thing you have in this life is your reputation. Sometimes things don’t work out and you can be disappointed, and other times opportunities come out of nowhere and you get lucky. No matter what, though, you must always conduct yourself with dignity. Even when situations don't go according to plan, I try to maintain a positive attitude and remember the ever-changing nature of life and luck.

Acceptance is key; we can only control our reactions.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

When we harbor resentment towards others, we cause nervous system dysregulation, or a buildup of negative energy in the body. This leads to the increased production of cortisol and adrenaline, as well as an over-stimulated amygdala, a part of the brain that plays a large role in emotional control. This state of chronic anxiety may lead to health issues and truly hurts us more than it hurts the person we harbor resentment against.

So let go of your resentments. Let go of your negative feelings. Forgive your oppressors for your own benefit; if they refuse to hear you or forgive you, they’re only hurting themselves. We cannot control the actions of others, but we can control the actions in which we choose to engage. Do it for you.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

The suggestion associated with the 12-step principle of "discipline and action" is as follows: "We are continuing to remove the barriers than can block forward sober growth. We are getting ready to sweep our side of the street clean. Make a list of all those people you have harmed both through actions and not being present or living up to obligations." In the context of recovery, the term "discipline" is synonymous with self-control. It does not refer to punishment, nor does it refer to a harsh, unforgiving way of life. The term "action" suggests both making amends and being present during recovery. Taking action is meant to ease the transition into sobriety and strengthen connections that were weakened during the period of active addiction.

At Two Dreams, clients engage in both process groups and individual therapy sessions to explore wrongdoings and brainstorm possible solutions. We encourage reconciliatory conversations with friends and family, and offer guidance on strengthening social connections. Additionally, we encourage self-discipline in the form of mindfulness. Clients engage in HALT (hungry, angry, lonely, tired) checks throughout the day to monitor their vital signs and moods. Instead of acting irrationally in response to triggers, these regular checks are designed to keep clients disciplined and planning ahead of low moods. Discipline and action are cornerstones of the Two Dreams curriculum; call 504-510-2331 today if you are interested in learning more about our program.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Humility is a critical component of the recovery process. It not only necessitates modesty, but also perspective. Oftentimes, addiction causes the individual to become self-centered, leading to low or elevated mood, so clients at Two Dreams use process groups to develop an appropriate understanding of themselves and the world around them. Processing emotions and situations in a group therapy setting allows for a more balanced mood and a more realistic outlook on life.

Humility is not self-deprecation, nor is it a weakness. One can still be strong and proud while possessing the personal quality of humbleness. Without humility, the full benefit of a recovery program is lost to pride and conflict. There is a middle group between “being a doormat” and being arrogant, and we strive to help our clients find it.

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Summer is upon us, and with it comes the inevitable lethargy brought on by the intense heat. All over town you can hear cries of, “it’s too hot; let’s just do something else!” Similarly, in addiction treatment, we often hear clients complain that it’s too difficult to work through recovery, that they’d rather just stay in their diseased state than go through the steps necessary for living a healthy lifestyle. That’s where the theme of the month, willingness, comes into play.

Individuals in recovery need to be willing to push past the initial roadblocks to find sobriety. They must be willing to be introspective and engage in beneficial behavioral changes. They must be willing to listen to the rhythms of their bodies, and they must be willing to pause before they act. Recovery is a humbling experience, but it is also one of the most rewarding processes you will ever go through.

At Two Dreams, we encourage clients to keep an open mind and remain willing to try new things. We schedule activities that might push some clients outside of their comfort zone, such as improv classes or dancing. We suggest that everyone try new foods while living in our residential facility, even if they initially seem unappealing. We ask that everyone speak up during group therapy, even if they have to break through a shell of shyness to do so. The willingness to do work is one of the most important parts of breaking the addictive cycle, and is therefore a key component of our recovery program here. Are you willing to make changes that will better your life?

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Spring is in full bloom at Two Dreams, even at our Chicago office, and my favorite flowers have been emerging for weeks. Before Dr. David and I downsized our home, I would watch a parade of flowers emerge from the snow along our front walkway. While I do miss the floral ceremony, I appreciate that the freedom of our smaller home allows me more opportunities to travel between the various Two Dreams locations. The crocus, daffodil, and highly fragrant hyacinth remind me that there is beauty and peace in the earth. They also remind me that, when nurtured with light and warmth, the flora will emerge. Each individual in treatment and recovery needs similar light and warmth to stimulate their own exciting growth path and develop their own integrity, which is incidentally the theme of this month’s Dream Journal.

You may have noticed that our Dream Journal themes this year follow the principles underlying the Twelve Steps of Alcoholics Anonymous. Last month our theme was courage; this month our theme is integrity; and next month we are going to work with the concept of willingness. These three concepts are reflected in the cluster of AA steps that are sometimes referred to as the "cleaning it up" steps (in contrast with the “giving it up” steps [1-3], “making it up” steps [7-9] and “keeping it up” steps [10-12]). The searching, fearless moral inventory of the fourth step requires courage to complete, as it promotes honesty and sharing in relationships. The fifth step, admitting we were wrong, promotes honesty and integrity in intimate relationships. Finally, the sixth step, a readiness to remove our shortcomings, requires self-awareness and willingness, which we will discuss next month.

Integrity is needed to work this fifth step, but what is integrity? Integrity is the quality of being honest and having strong moral principles; it is moral uprightness and the state of being whole and undivided. It is more than just simple honesty, though. As clinical psychologist Henry Cloud proposes, people with integrity: 1) are able to connect with others and build trust, 2) are oriented toward reality, 3) finish well, 4) embrace the negative, 5) are oriented toward increase, and 6) have an understanding of the transcendent.

Individuals who succeed in recovery display resilience buttressed with flexibility. In contrast, one area in which steadfastness is required over flexibility is personal integrity, as it is neither conditional nor mercurial. I am reminded of the old adage, "to thine own self be true," or as Frederick Douglass put it, "I prefer to be true to myself, even at the hazard of incurring the ridicule of others, rather than to be false and to incur my own abhorrence." When you find that inner strength, the growth path to recovery becomes clear; the little voice from an internal GPS guides every decision.

Integrity guides us in our work of making amends to people we have harmed, except when doing so would harm them or others. There are no guarantees when making amends and "coming clean;” in fact, there is often a fear that, in dealing with material related to our transgressions, we will be judged and rejected. If we are trying to create a certain outcome, such as winning someone back, gaining forgiveness, etc., we are certain to be disappointed…we might even lose the love, if not the respect, of someone important to us. But, in the process we gain the respect of the most important person on the planet to each of us: ourselves. The truest concept in the world, which has been shown to be true over and over again, is that the unexposed fact is more powerful than the exposed one. We have a saying here at Two Dreams: “mold does not grow where the sun shines.” Shine a light on that which you fear most and start your growth journey. Part of the treatment process is the identification of your personal holdbacks, asking yourself “what have I not been able to explore, admit, discuss, embrace, stare down in prior treatment episodes?” These holdbacks sap our energy and diminish our self-esteem. When we live with integrity, we live life knowing who we are and what we want, and we are able to ask for these things. The growth journey is one of harmony and we feel discordant when we are in the presence of people who don't have our best interests at heart…and speaking of the heart, it beats free.

I hope you enjoy the following thoughts about a character from Juan Mascaro. Please be careful about what you allow your mind to dwell on; negative thoughts are called "stinking thinking" for a reason. Even though our thoughts seem unavailable to others, remember that they are not just in your head; they are in your character.

“The thought manifests the word;
The word manifests the deed;
The deed develops into habit;
And habit hardens into character;
So watch the thought and its ways with care,
And let them spring forth from love
Born out of compassion for all beings.
As the shadow follows the body, as we think, so we become.”

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

The Ancient Greeks identified four Cardinal (pivotal) Virtues sustained in the face of difficulty: prudence (or wisdom over time), justice, courage, and temperance. Courage is sometimes equated with endurance, the ability to stand firm and immovable in the midst of danger, toils, and certain death. It is the midpoint between cowardice and recklessness, which are the objects of fear and daring, respectively. Fear is a powerful feeling that arises when we sense danger, and when level of danger increases we feel more fear. Cowardice is the shortage of courage keeping us from acting in the face of, or in spite of, fear. Daring is a way of being that ignores danger; it allows us to take action in the face of danger. When the level of danger increases, our daring is reduced/checked. If we ignore the increasing level of danger, we show recklessness and act with an excess of courage.

While at Two Dreams, clients “face weakness with strength and fear with courage .” The process of identifying and expressing feelings is an important part of recovery work. What do we fear as we begin the journey of recovery? Do we fear the loss of devotion to a substance, even though giving it up will save our lives? Do we fear living life with an aching desire that will forever go unfulfilled? Do we fear losing time that can never be recaptured? Do we fear failure? Do we fear success? In my pain blog (https://drbarthwell.wordpress.com/) I talk about the fear of getting my hopes up, only to have them dashed again. I found it more tolerable to be in pain than to contemplate investing in yet another program or activity that might not work.

Nietzsche writes ”the great epochs of our life are the occasions when we gain the courage to re-baptize our evil qualities as our best quality.” At Two Dreams, clients learn that “who you are is not defined by your mistakes, but by your potential” and to “accept the past so you can create your future.” It takes a shortage of courage, or cowardice, to bully friends and family members. If you are looking around and the only people in your life are those who support or tolerate your addiction you need to find your courage to call. It takes an excess of chemical-fueled courage to recklessly stare down death every day, every injection, every huff, every swallow. Channel that daring “to take stock and take care in a place where your best interests are not only looked after but discovered.”

The Serenity Prayer, attributed to Protestant Theologian Reinhold Niebuhr, has been used by AA since the 1940s. This prayer speaks to the serenity of acceptance, the courage of change, and the wisdom of prudence. The courage of change starts with 1) imagining a different life, 2) the self-investigation to generate insight, the recognition that a problem exists paired with a desire to change it, and 3) taking an action, and having the preparation and fortitude to hold a course against inertia, the resistance to change.

Can you imagine a life different than the one you have now?

Sincerely,

Dr. B

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Dream Journal

Andrea Barthwell MDNote From Dr B.

Faith has been a significant part of my recovery journey with chronic pain. It keeps me optimistic in the face of surgeries and steroidal injections. It allows me to push through agonizing physical therapy sessions, knowing that I will come out on the other side stronger and more relaxed. It prevents me from submitting to the pain, even when I feel that shifting focus is impossible. It inspires me to keep stretching, even when I want to give up.

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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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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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