Ellenhorn New Perspectives Series: Cultivating curiosity and motivation: cornerstones of change behavior in tri-occuring recovery

On May 2, 2022, Ellenhorn hosted the second of five talks in our 2022 New Perspectives on treatment series. This presentation was done by Zoi Andalcio, LMHC, Ellenhorn’s Director of IDDT Services and Katherine Clemens, LICSW, Ellenhorn’s Clinical Director.

Curiosity is something that we are all born with and is foundational to our cognitive development. As we develop from infants to adolescents to adults, however, our curiosity, or our intrinsic desire to know and understand, is subverted by multiple forces. This presentation will address the macro- and micro-level ways in which stymied curiosity results in an environment lacking in motivation to change, as well as examine mental-health treatment for “tri-occurring” recovery. Speakers discuss their own work with clients who are seeking recovery from tri-occurring challenges, as well as the ways in which they cultivate curiosity as essential motivation toward change.

2022 Shifting the Addiction Paradigm Conference Recordings

On April 1, 2022, Ellenhorn and the Menninger Clinic partnered to put on Shifting the Addiction Paradigm – a hybrid virtual/in-person conference aiding the shift toward humanistic and client-centered values in behavioral care. This year we were fortunate enough to have four presentations from experts in the harm reduction/addiction treatment field. You can view the presentations below.

Special thank you to our speakers, Ross Ellenhorn, Andrew Tatarsky, Sam Rivera, and Julie Holland, for all their hard work and wonderful presentations!

How We Approach The Co-Occurring Issues of Addiction and Mental Health Issues

In keeping with all treatment approaches at Ellenhorn, we take a whole-person approach to people with co-occurring issues. We believe addiction often must be approached seriously as a physical disease that can have significant and even life-threatening consequences. We also understand addiction as something deeply connected to the less-scientific concepts of hope, faith, connection to others, a sense of purpose and personal autonomy. Last, and specific to our program, we understand that the ravages of addiction and psychiatric issues often cause what we call psychosocial trauma.

Psychosocial trauma is the wound caused by the loss of social role, social status and identity suffered by people who spend a significant amount of time in treatment, and who are often removed from the world during this treatment. We believe that most of our clients, whether they engage in addictive behaviors or not, struggle with psychosocial injuries. These injuries cause them to disengage from others, to lose hope in their own future, and to lose faith in their fortitude to effectively face life challenges.

Taking seriously the impact of psychosocial trauma, we at Ellenhorn view what is considered the dual problem of psychiatric distress and addiction as, in reality, a tri-occurring problem that involves experiencing difficult psychological states, engaging in addictive behavior, and also suffering from psychosocial injury.

Many treatment approaches to co-occurring disorders only focus on the interplay between psychiatric issues and addiction, viewing the latter problem as a form of “self-medication” — a person’s attempt to manage psychiatric symptoms with harmful substances or other forms of addiction. In contrast, Ellenhorn takes the social injuries suffered by individuals who have been diagnosed and treated as mentally ill so seriously that we usually view addictive behavior and pain from these injuries as the key relationship in this triad, seeing psychosocial injury as often one cause of addictive behaviors, and in addition, as a very important factor in a person’s willingness to change this behavior. (Click here for Dr. Ellenhorn’s article on the concept of tri-occurring issues and the importance of community integration in mental health and addictions recovery.)

… Ellenhorn takes the social injuries suffered by individuals who have been diagnosed and treated as mentally ill so seriously that we usually view addictive behavior and pain from these injuries as the key relationship in this triad, seeing psychosocial injury as often one cause of addictive behaviors, and in addition, as a very important factor in a person’s willingness to change this behavior.

We are gratified that our tri-pronged approach is endorsed by current research on the most effective treatment for co-occurring issues of psychiatric experience and addiction.   The Substance Abuse and Mental Health Services Administration (SAMHSA) has conducted extensive research to determine which treatment model works best for people with co-occurring issues of mental illness and substance abuse.   SAMHSA found that Integrated Dual Disorder Treatment (IDDT) works best of all current treatment approaches, designating IDDT as SAMHSA’s evidence-based model.

What is IDDT?

IDDT stands for Integrated Dual Disorder Treatment.  IDDT teams are unique among co-occurring programs for at least three reasons: 1) They focus on helping people return to vocational, educational and family roles as a core source of recovery, rather than viewing these involvements as dependent on recovery; 2) They are interdisciplinary teams, in which all therapeutic work is integrated in a whole-person approach; and 3) They are mobile and outreach-oriented, conducting much of their work outside clinical settings. 

Ellenhorn is a national leader in using evidence-based IDDT as the sole model for our co-occurring disorders program. Ellenhorn meets and often exceeds SAMHSA best-practice measures.

Ellenhorn delivers IDDT care through high-intensity multidisciplinary outreach teams that collaboratively provide integrated substance abuse, medical, mental health, family and psychosocial care from one source, outside institutional settings.  Our teams use non-confrontational therapeutic approaches to substance abuse, while actively helping people pursue vocational, educational and familial goals.

Why does focusing on work, school and family promote good outcomes?

Ellenhorn’s IDDT teams support clients in getting back on a life track – whether returning to school, finding employment, or engaging in healthy relationships with their families. Working closely with clients to create meaningful futures fosters real human connection and promotes a sense of hope, while profoundly addressing substance abuse, mental health and psychosocial recovery.

Too often, co-occurring programs focus most of their efforts on helping people understand how to recover, rather than helping them see why they should.   Along with family and social connections, work and school are the “why.”  These activities offer hope, a belief in one’s own future, and a path toward success.  For years, community mental health programs have endorsed this view, seeing psychosocial recovery not only as a behavioral target, but also as the means to help people recover. Decades of research on psychiatric outcomes support this approach. 

Repeatedly, addiction research shows that a sense of purpose and meaning are intricately intertwined with recovery.   When a person can see a road ahead, one in which he or she has a meaningful role in society, that person has a reason to be sober beyond sobriety itself. 

From day one, Ellenhorn’s IDDT teams keep each client’s future front and center, by simultaneously helping clients pursue career, education and familial goals as they receive treatment.  At Ellenhorn, we do not view moving ahead with one’s life as conditional upon abstinence from substances – as if it is a reward or the result of passing a test. Rather, getting on a life track is a major component of achieving sobriety.

A harm reduction outlook

To build a partnering relationship, we want to have honest discussion with our clients about current use.  That means we need them to trust that talking about use with us will not lead towards negative consequences.  We thus rarely expel people from our program if they engage in addictive behavior, and we often take a non-judgmental approach to their use.   We take, what is called, a “harm reduction” approach.

To put it plainly, we work with clients even if they are currently using substances or are engaging in other addictive behaviors. While we may help someone transfer temporarily to a higher level of care if their use is putting them in serious medical danger, our larger goal is to serve our clients, whether they are abstinent from addictive behavior or not. Our approach is to meet people where they are, without preconditions.

… we work with clients even if they are currently using substances or are engaging in other addictive behaviors.

Some forms of treatment rely on people “hitting rock bottom” as a motivation to finally make changes. Many treatments also make abstinence from addiction a precondition for care. We see grave problems with these approaches. For our clients, hitting rock bottom probably means not only facing difficult and stressful quality-of-life situations, but potentially destructive psychiatric experiences. For them, being terminated from treatment means that the part of them that needs psychiatric and psychosocial help is also being discharged.

Our approach, has as its goal to keep working with people while they use. By “harm reduction,” we refer to a way of approaching ongoing substance abuse in which those around the person try to reduce the risky consequences of that abuse.  If we can lower the chance of harm, we can keep clients in our program, and thus continue our relationship with them, which is a pillar of their recovery.

Why does an integrated treatment approach work?

All too often, dual diagnosis programs described as “evidence-based” offer techniques or interventions on a piecemeal basis: They supplement psychiatric work with a substance abuse add-on; or add a mental health component to substance abuse work. Yet evidence shows that this piecemeal approach has little effect.  Real co-occurring work takes as its premise that the two issues of substance abuse and psychiatric disturbance cannot be separated from one another.  As parts of a single complex syndrome, both problems must be treated simultaneously, using an integrated approach. This means that co-occurring treatment is not simply a matter of using the right technique. It requires a particular system of care, one that balances the two issues at once.  IDDT is this kind of system of care. 

But IDDT is much more than a way to combine substance abuse and mental health treatments.  It is a “whole-person” approach, whose practitioners view every individual as distinct, and who see behavioral challenges as emerging from complex and unique tangles of roots.  That is why Ellenhorn’s teams are made up of professionals with diverse expertise. 

Why does a mobile community-based approach work? 

IDDT is the only evidence-based treatment model for co-occurring disorders that works with people while they live in the community.  That means people receive IDDT right where their challenges are, while also developing competency and confidence in dealing with those challenges, pride in what they have achieved, and a motivating life-direction.

Consider this irony:  In the United States, we spend significant resources on temporary ways to help people, provided in artificial surroundings that remove people from life challenges.  But we spend minimal resources on supporting these people once they leave institutional care (whether a hospital or residential setting) and must face the challenges of real life. Ellenhorn IDDT teams step into the gap, providing flexible levels of support so people with co-occurring issues learn to deal successfully with the stresses of life, thereby forming the foundation of lifetime recovery. 

Treatment in the community not only helps people meet their challenges, it also enables them to find sustainable natural supports for sobriety.  There is mounting evidence that recovery from addiction happens when people mend and form connections — to people and to their community – and when they develop a sense of purpose. These resources are only temporarily provided within institutional settings.  They are readily available in the community. 

The Ellenhorn treatment approach for co-occurring disorders is guided by this core belief: Being engaged in meaningful relationships and having a sense of a future are powerful determinants in a person’s desire to recover. Hope and connection are our targets.

VIDEO: Laurie Damsky, PMHNP appears as guest on Recovery X

On July 23rd, 2018, Laurie Damsky, PMHNP, appeared as a guest on Recovery X with Dan Sevingy. Laurie and Dan talk about what Ellenhorn does, mainly surrounding addiction, and how it is unique, more effective, and better for the client as a whole than other treatment models. The use of the PACT model, IDDT, A4CIP, and why Ellenhorn does what it does are all topics that are explored in depth in this interview.

“[Addiction and mental health issues] are not separate, they are completely intwined with each other.”

To learn more about any of the topics covered in this interview please visit our website, www.ellenhorn.com. Here you will find more detailed information about all of the topics Laurie and Dan covered in their conversation together. For questions about admissions, please contact Laurie Damsky, PMHNP through email at ldamsky@ellenhorn.com or by phone at 617-491-2070.

Laurie Damsky, PMHNP-BC of Ellenhorn – Integrated Dual Diagnosis Treatment (IDDT)❌ WANT TO HELP US SAVE LIVES? ❌We offer addiction sufferers and their families with free addiction recovery resources, like educational videos and one-on-one help finding treatment.You can help educate and save lives by donating to the show here:➡https://pages.donately.com/recoveryx/donate$1 or $1,000. One-time or Monthly.It all helps!Thank you for your support of the causeMentioned in this episode:Ellenhorn – https://www.ellenhorn.com/Laurie Damsky, PMHNP-BC – ldamsky@ellenhorn.comAssociation for Community Integrated Programs – http://a4cip.org/

Posted by Recovery X – Addiction Recovery Experts on Monday, July 23, 2018

CRAFT: A Compassion-Based Approach to Family Addiction Treatment

While we take a client-centered approach to addictions at Ellenhorn, we are also keenly aware that we are treating an individual who is part of a system and community. Often the community that is most fraught for the client struggling with substance use is their family and loved ones. As those who have been in its grip can attest to, substance abuse has a way of radiating its negative influences out towards family members, loved ones and those with whom the client may live. In fact, it can affect those in the user’s community in a way that is just as significant as the effects on the user herself. This can result in a scenario in which the family’s attempts to curtail substance use and/or get the user into treatment only drives the user deeper into their dependence and the family into more chaos.

To address this dynamic we employ the Community Reinforcement And Family Training (CRAFT) approach, which is an evidence-based motivational family therapy model developed by Robert Meyers, Ph.D.

It is at this point that you may be bracing yourself for an onslaught of jargon, statistics and clinical rationale for this method. However, the best thing about CRAFT is that it is not that complicated. It is also non-confrontational. It is simply a positivity-based approach that relies on love and compassion for both the substance user and their concerned family. This is also in line with our view of addiction as an attachment issue. Rather than “detach with love” as other programs suggest, we prefer for clients to stay attached to their loved one. But this must be done in an intentional way if things are to change.

In the CRAFT model, the “client” is the Concerned Significant Other (CSO) of the Identified Patient (IP), who is the substance user. Okay, you got me. There is a little bit of jargon! The CSO can be a parent, sibling, friend, teacher, co-worker, or anyone in the IP’s community whose life is being negatively affected by the IP’s substance use. At Ellenhorn, the CSO’s typically tend to be family members.

The goals of CRAFT are as follows:

  • To increase the CSO’s well-being
  • To encourage the IP towards treatment and/or change

Relieving the anxiety, anger and worries of the CSO is a vital part of this process. Many family members have seen the quality of their lives plunge due to the substance use of a loved one. Often this is directly related to the behaviors they have been employing to get the user to change. These are the classic techniques of nagging, expressing anger and/or ignoring the person. While we can all identify with these behaviors, they do nothing for the CSO’s well-being nor do they encourage the IP towards treatment. In fact, they do the exact opposite of that. They frustrate the CSO as well as the IP and this keeps the pinwheel of use twirling.

The first step towards love and compassion for the IP is for the CSO to start to take care of themselves. Understanding that the IP is much further from change, the CSO learns that the best way to start is changing their own behaviors for their own benefit. CRAFT offers many tools for the CSO in this process that they and the counselor can choose as they move along. The concept of “Community Reinforcement’ refers to the steps that a CSO can then take to create a loving environment that not only makes sobriety more attractive for the IP but also reinforces any steps the IP takes in that direction.

For example, rather than nagging or detaching, a CSO can learn to say to a loved one who is abusing substances things like, “while I love you, I’m not interested in spending any time with you when you’re drunk but I’ll be here for you when your sober.” In this situation, we can see that the CSO is setting a healthy boundary for themselves in not allowing the IP’s substance use to affect their well-being. At the same time, the CSO is using the power of attachment, a.k.a. the loving relationship, to create an environment in which sobriety is more attractive. If this IP wishes to spend time with the CSO, they will have to start to consider some change.

This quick and simple example is just one slice of how the CRAFT dynamic works within families. One thing that needs to be emphasized in this process is the power of positivity and the avoidance of the negative. Many users are especially attuned to insults or any attempt to control them and respond in a highly negative way. In CRAFT work the clinician and CSO must take special care to express things in a positive way. This includes validating an IP’s experience even if you don’t agree or understand, using the language of love while holding one’s boundaries and treating the IP with respect and compassion rather than as “an addict.” This takes practice, for both clinician and CSO, and CRAFT provides tools and trainings to address this specific task.

In the brief example given above, think about the things the CSO didn’t do. They didn’t use harsh language, throw down ultimatums or threaten to kick the user out of the house. Ponder for a moment:  would the IP living on the street increase or decrease the CSO’s anxiety? What would living on the street do for an IP’s dependency problem? If the answer to both is “it would make it worse,” then these are not effective love and compassion-based methods.

CRAFT takes the stance that love and compassion are what anyone caught in the grips of substance abuse needs to heal. No matter what part of that system you are, either a user or loved one, IP or CSO, there is a healing power one can access through loving and attachment. CRAFT merely provides space and tools for people to express these in an intentional way with the hopes of increasing their own well-being and gently encouraging their loved one towards change.

VIDEO: Ross Ellenhorn on Integrated Dual Disorder Treatment and a Whole-Person Approach

Integrated Dual Disorder Treatment

On September 9th, Dr. Ellenhorn gave a talk at the Cape Cod Symposium on Addictive Disorders to a room filled beyond capacity. Titled, “‘Readiness’ is when the Client Says So: Integrated Dual Disorder Treatment and a Whole-Person Approach,” the talk addressed the best-practice model we use at Ellenhorn for individuals who are struggling with both addiction and psychiatric issues. It continues a series of lectures Dr. Ellenhorn is giving regarding his theories about the powerful link between human attachments, community integration and successful sobriety.