Blog Archives - Page 12 of 27 - Lindner Center of HOPE

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Several suicides among local high school students has the Cincinnati community mourning these losses and searching for answers. WCPO’s Tanya O’Rourke spoke with Lindner Center of HOPE Medical Director of Inpatient and Partial Hospital Program Services Dr. Tracy Cummings about what families need to know about suicide prevention for themselves and their children.

According to Dr. Cummings, suicide has become more prevalent in recent years. “It’s striking actually – up to almost 30% increase since 1999.” This may be a conservative estimate due to stigma discouraging people from self-reporting suicide attempts.

Cummings cites risk factors that correlate with suicide attempts, including a family history of suicide, previous attempts, or a recent loss among close relatives or friends. Dr. Cummings also refers to a “contagion effect,” where one suicide within a community may trigger additional attempts by people who are suffering.

Social media use can also affect teens. Suggestions are offered on how parents can approach their kids on the topic of self-harm. Parents should not worry about “implanting” thoughts into their children’s minds by asking them directly about suicide. Rather, it is imperative that parents start a direct conversation with their children.

Watch both parts of Dr. Cummings’ two-segment interview on WCPO’s YouTube Page

Part 1

Part 2

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The statistics surrounding addiction are shocking and the impact is devastating.

In 2017, 70,000 people[i] in the U.S. died from drug overdoses – the highest number in history. Hamilton County accounted for 570 of those deaths[ii]. The City of Cincinnati alone saw a 79% increase in overdose deaths from 2014 to 2017.

The region, including Kentucky and Indiana, continues to be hit especially hard by the opioid epidemic. Overdose death rates[iii] here are among the highest in the country. As a result, children in our communities experience parental loss rates that nearly double the national average.

For someone with addiction, sobriety can be a long and painful process. As addiction becomes better understood as a mental illness[iv], new approaches are being implemented to help people maintain long-term recovery.

Lindner Center of HOPE recently unveiled a new 10-day, in-patient substance use disorder detox and evaluation program that increases our community’s capacity for treatment, and employs the latest proven methods.

The approach includes a comprehensive evaluation for each person, and each visit is uniquely designed to meet that person’s needs. Upon completion of the program, patients receive an individualized plan-of-action to increase the odds of continued sobriety.

“Our expert addictions team found that a one-size-fits-all treatment approach doesn’t work for sobriety,” said Paul E. Keck, MD, president and CEO of Lindner Center of HOPE. “Each individual must have a personalized path to success. That’s what this program is designed to do.”

Treating the Whole Patient

According to the Substance Abuse and Mental Health Services Administration [v], 80 percent of people who have a substance use disorder also have a mental illness. So a personalized approach to recovery is vital.

Program participants first complete detoxification with close medical supervision. The in-patient portion of the program includes about nine hours of daily programming. The patient also participates in an additional 10 hours of internal addiction programming and access to community support groups.

While completing the inpatient portion, patients stay in Lindner Center’s Sibcy House – a one-of-a-kind facility dedicated to individualized, compassionate comprehensive care. Each patient resides in a private room, complete with a full bath. The program includes:

Sessions with a psychiatrist, social work and addictions therapist
Testing determined by an addictions therapist
Coaching sessions with a chemical dependency specialist
Patients also participate in additional programming tailored to their individual needs.

For more information about the program, visit Lindner Center of HOPE’s website or call 513/449-8415.

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Addictions Expertise

Lindner Center of HOPE treats most substance and behavioral addictions. Plans may include medication-assisted treatment, therapy or support groups, and screenings for underlying issues like depression and anxiety.

About Lindner Center of HOPE

Lindner Center of HOPE, located in Mason, OH, is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. Learn more at LindnerCenterofHope.org.

[i] WKRC. (2018, November 30). Acting Attorney General addresses the opioid epidemic during Cincinnati visit. https://local12.com/news/local/acting-attorney-general-to-address-the-opioid-epidemic-during-cincinnati-visit

[ii] WCPO Staff. (2018, July 30). Staggering numbers in Cincinnati’s opioid crisis, but health officials see progress. https://www.wcpo.com/news/local-news/hamilton-county/cincinnati/staggering-numbers-in-cincinnati-s-opioid-crisis-but-health-officials-see-progress

[iii] Demio, T. (2018, Aug. 3). Children here experience parental loss at higher rate than national average

[iv] National Institute of Mental Health. (2016, May). Substance Abuse and Mental Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health/index.shtml

[v] Substance Abuse and Mental Health Services Administration. (2019, Jan. 30). Mental Health and Substance Abuse Disorders. https://www.samhsa.gov/find-help/disorders

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Services, resources and research unmatched in Midwest

Mental illness is a condition that affects one in five Americans[i]. While more celebrities are revealing their own struggles, and research has led to new understanding and treatments, mental illness remains shrouded in stigma. Many barriers prevent access to treatment as well, including cost.

Communities across the country are stepping up to confront these challenges. Cincinnati is increasingly being recognized as one of the leaders.

When Frances and Craig Lindner founded Lindner Center of HOPE, their dream was to build the nation’s leading mental healthcare facility. That was in 2008.

Today, Lindner Center of HOPE is a nonprofit renowned regionally and nationally for the depth and breadth of services offered in one location. Mental health researchers around the world look to Lindner Center’s research team for the latest findings in the field.

How did the Lindner Center of HOPE earn its distinguished reputation? And what does this mean for tri-state residents and families looking for help with mental illness?

Lindner Center of HOPE is a Leading-Edge Care Center

It starts by staying on top of emerging trends in mental healthcare. The Lindner Center has launched programs to meet needs for current issues like Internet and gaming addiction [ii] and substance abuse detoxification [iii], while continuing to treat a comprehensive list of mental disorders.

Having the right people and partnerships in place is also vital. Since 1996, Lindner Center president and CEO Paul E. Keck, MD, has been among the world’s top 10 most cited scientists in the field of psychiatry and psychology. Susan L. McElroy, MD, chief research officer, was the eighth most cited in the same period.

In the decade since the Lindner Center of HOPE opened its doors, it has cared for more than 37,000 patients from all 50 states and 10 countries. Its multidisciplinary, team approach provides continuous personalized care for each individual.

Local Collaboration Leads to Better Treatment

Partnerships between the Lindner Center, UC Health and Cincinnati Children’s Hospital mean each of these world-class healthcare providers connect seamlessly to give local patients access to the latest treatments available, and a broad array of specialized medical services.

Together with the University of Cincinnati, the Lindner Center was among the initial members that established a national network of mental health centers similar to those established for cancer and cardiac care. A founder of the National Network of Depression Centers, Lindner Center has conducted more than 100 studies with renowned health research organizations like Mayo Clinic and Cincinnati Children’s. This work has brought new, effective treatments first to members of the local community who have lost hope for a better life.

This level of collaboration between world-leading institutions, and the breadth of services offered at Lindner Center is unmatched in the Midwest and among the best nationally.

As one patient’s parents said, “Without the Center, it’s doubtful (our son) would be alive today and certainly not the productive young man he is now.”

Continuing the Fight

We have never had better evidenced-based treatment and achievable recovery for psychiatric disorders than we do now. Yet, the scale of the problem is growing.

Americans are now 2.5 times[iv] more likely to suffer from a major psychiatric disorder in their lifetime than cancer, heart disease and diabetes combined. Fewer than half of the people who need care receive help, often due to stigmas associated with the disease. Insurance reimbursement for mental healthcare in Cincinnati is among the lowest in the U.S.

The Lindner Center of HOPE is uniquely positioned to fight this crisis. In addition to new and ongoing programs, community leaders Linda and Harry Fath, and Frances and Craig Lindner, pledged $75 million[v] to the Center to further enhance treatment and reduce stigma.

As a non-profit, the Lindner Center depends on financial support to meet the high demand for essential services. Philanthropic gifts have enabled the Center’s clinicians to enhance thousands of lives, while expanding our community education and critical research programs.

There is no better time than now to help others who are suffering. A recent combined $75 million donation from Cincinnati humanitarians Linda and Harry Fath and Frances and Craig Lindner is the foundation of the Center’s Challenge Of Hope campaign, with the goal of raising an additional $50 million.

Your donation will help make unprecedented strides in removing barriers for people taking needed steps toward mental wellness.

To share your gift of HOPE today, please go to: LindnerCenterofHope.org/donate

About the Lindner Center of HOPE

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[i] National Alliance on Mental Illness. Mental Health by the Numbers. https://www.nami.org/learn-more/mental-health-by-the-numbers

[ii] Borter G. (2019, Jan. 27). The digital drug: Internet addiction spawns U.S. treatment programs. https://www.reuters.com/article/us-usa-internet-addiction-feature/the-digital-drug-internet-addiction-spawns-u-s-treatment-programs-idUSKCN1PL0AG

[iii] Lindner Center of HOPE. 10-Day Substance Use Disorder Detox and Evaluation. https://lindnercenterofhope.org/residential-treatment-programs/detox/

[iv] Reuben, A. (2017, July 14). Mental Illness Is Far More Common Than We Knew. https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/

[v] Lindner Center of HOPE. (2017, Dec. 18). Lindner Center of HOPE Receives Commitments Totaling $75 Million from Community Leaders Linda and Harry Fath, and Frances and S. Craig Lindner. https://lindnercenterofhope.org/news/lindner-center-of-hope-receives-commitments-totaling-75-million-from-community-leaders-linda-and-harry-fath-and-frances-and-s-craig-lindner/

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A New Way to Balance Digital Usage

It’s a concern for parents across the country.

Teenagers are consumed by countless digital distractions. Smart phones, gaming consoles, or any number of devices connected to the Internet compete for their attention.

Concerns over growing and habitual media use are nothing new, but the broad availability of portable devices seem to have “leveled up” the problem. Now, more children are becoming addicted to online content and gaming.

Popular video games like Fortnite are played by more than 200 million people. Some teens spend as much as 12 hours or more[i] a day playing online, while others spend the same amount of time engaged in social networks. This obsession can affect health as well as school and work performance.

A 2012 study estimated In 2018, The World Health Organization even classified video game addiction[iii] as a mental health disorder.

But how do you know when a habit has crossed over into an addiction? And what do you do when it is clear your son or daughter is addicted?

For children who show signs of internet addiction, a recent study[iv] suggests each child needs to be evaluated in context of their own unique situation. Personality traits, type of game(s) played, life situations and cultural expectations can all explain excessive gaming. For example, if the habit is used to replace real-life social interactions or escape from life traumas and stress, an Internet or gaming addiction may be in play.

“Today’s society is dependent upon technology, mobile devices, social media, and the Internet,” says Dr. Chris J. Tuell, clinical director of addiction services at Lindner Center of HOPE. “However, when dependence crosses over to an addiction, it’s time to take steps to regain control.”

Several habitual behaviors can indicate Internet and gaming addiction. “The three C’s of addiction also apply to Internet addiction,” says Dr. Tuell. “If someone exhibits a loss of control, a compulsion/obsession to be online, irritability when offline, or continues to use technology despite negative consequences, they may be suffering from Internet addiction.”

The Reboot Program

To combat Internet and gaming addiction, and provide a resource for families who need help, Lindner Center of HOPE has introduced a new program called “Reboot.” The first two weeks of the Reboot program involve a comprehensive assessment of the teenager to draft a course of treatment. The second two weeks focus on developing better habits with technology.

“For those struggling with self-control, this program helps them re-center their lives and avoid additional complications,” said Dr. Tuell.

According to Mental Health America [v], the nation’s leading non-profit mental health advocacy organization, children with Internet addiction often struggle with other mental health problems like alcohol and substance use, depression, and/or aggression.

Addiction experts at Lindner Center of HOPE assess if patients are suffering from one or more co-occurring disorders, like depression. Identifying underlying mental health conditions helps to personalize treatment plans for each “Reboot” patient – increasing their odds of winning the battle with internet and gaming addiction.

Addictions Expertise

In addition to internet and gaming addictions, Lindner Center of HOPE treats most substance and behavioral addictions, including heroin, morphine, hydrocodone, oxycodone, amphetamine, methamphetamine, LSD, alcohol, cocaine, marijuana and tobacco, gambling and pornography. Plans may include medication-assisted treatment, therapy or support groups, and screenings for underlying issues like depression and anxiety.

About Lindner Center of HOPE

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[i] Feely, J. & Palmeri, C. (2018, Nov. 27). Fortnite Addiction Is Forcing Kids Into Video-Game Rehab. https://www.bloomberg.com/news/articles/2018-11-27/fortnite-addiction-prompts-parents-to-turn-to-video-game-rehab

[ii] Cash, H., Rae, C. D., Steel, A. H., & Winkler, A. (2012). Internet Addiction: A Brief Summary of Research and Practice. Current psychiatry reviews, 8(4), 292-298. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480687/

[iii] Price, L. & Snider, M. (2018, June 19). Video game addiction is a mental health disorder, WHO says, but some health experts don’t agree. https://www.cincinnati.com/story/tech/nation-now/2018/06/18/gaming-disorder-who-classifies-video-game-addiction-health-disorder/709574002/

[iv] Kuss D. J. (2013). Internet gaming addiction: current perspectives. Psychology research and behavior management, 6, 125-37. doi:10.2147/PRBM.S39476 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832462/

[v] Mental Health America. Risky Business: Internet Addiction. http://www.mentalhealthamerica.net/conditions/risky-business-internet-addiction

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Reuters featured the success story of a teenager who found help with Internet and gaming addiction through a new treatment program at the Lindner Center of HOPE. The story explains why more medical professionals are taking Internet addiction seriously and how the Lindner Center has pioneered a program to meet this modern condition.

A 2012 study estimates that between 1.5 percent and 8.2 percent of people in the U.S. and Europe experience “problematic computer use.” In 2018, The World Health Organization even classified video game addiction as a mental health disorder.

To combat Internet and gaming addiction, and provide a resource for families who need help, Lindner Center of HOPE has introduced a new program, called “Reboot.”

“This program helps those struggling with a loss of control to re-center their lives to avoid additional complications,” said Dr. Chris J. Tuell, Lindner Center of HOPE Clinical Director of Addiction Services.

Your donation will help more people like Danny recover from mental illness and return to feeling more like themselves. Donate here:

- Link:https://www.reuters.com/article/us-usa-internet-addiction-feature/the-digital-drug-internet-addiction-spawns-u-s-treatment-programs-idUSKCN1PL0AG

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Lindner Center of HOPE Clinical Director of Addiction Services Dr. Chris J. Tuell joined Fox & Friends on January 28, 2019 to talk about a new program at the Lindner Center designed to identify and treat Internet addiction.

“This program helps those struggling with a loss of control to re-center their lives to avoid additional complications,” said Dr. Tuell.

According to Mental Health America, children with Internet addiction often struggle with other mental health problems like alcohol and substance use, depression, and/or aggression.

Addiction experts at the Lindner Center of HOPE assess if patients are suffering from one or more co-occurring disorders, like depression, in addition to unhealthy Internet habits. Studies have suggested pre-existing depression or anxiety could lead to a gaming addiction. Identifying underlying mental health conditions can help personalize treatment plans for each “Reboot” patient.

Your donation can help the Lindner Center of HOPE continue similar services to help patients find help on their road to wellness. Donate here:

Watch more: https://video.foxnews.com/v/5995373867001/#sp=show-clips

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Michael O’Hearn, MSW, LISW-S

Odum’s Paradigm

Odum’s (1988) Self-Organization, Transformity, and Information is a conceptual framework for this intervention. It is supported by two traditional pillars of economic theory: (1) the production-consumption model (“supply and demand”), and (2) production-consumption growth equilibrium. This is a social currency system, not a monetary system; the currency is energy and information. Odum adds “recycling” to the first component, constituting the following model:

Source > Production > Consumption > Recycle >

The output from production-consumption-recycle iterations is recycled into more concentrated and refined products (components) and by-products (process fractals). Both are recycled as source input of subsequent iterations, and simultaneously constitutes a control parameter fortifying production (Odum, 1988). Products and by-products of partner interactions are recycled as source input, control production, and either fortify or inhibit development over time.

Production components are contributions and defections; each generates products and by-products. Gottman (2012) outlines behavioral correlates that sustain or erode cooperation and trust in relationships. These are discerned as inventories of contribution products and by-products, and defection products and by-products.

Contributions. Contribution products and by-products can help regulate autonomic nervous system (ANS) triggering, fortify cooperation, and trust in relationships. Four advantages of demonstrated trust in relationships are: (1) trust reduces complexity of all transactions, (2) trust permits action with incomplete information (benefit of the doubt), (3) trust minimizes transaction costs, and (4) trust increases relationship resilience as complexity naturally increases over time (Gottman, 2012, p.78).

Some partner contribution products can include: (1) neutral narrative of subjective views, (2) minimum 4:1 positive to negative interaction frequency, (3) soft start to difficult conversations, (4) accept influence, change behavior to meet partner’s needs, and recognize partner’s change efforts, (5) tolerate partner’s negative emotion, and focus on the problem at hand, (6) set limits on behavioral expression of negative emotions, (7) accept responsibility and apologies, and (8) make positive statements of needs (Gottman, 2012).

Examples of contribution by-products can include: (1) overall positive perspective and “us-ness,” (2) shared meaning, purpose, fondness, and admiration, (3) eye contact and touch are soothing in conflict, (4) prioritize understanding, (7) non-defensive listening to partner’s negative emotion, (8) effective dialogue and problem solving on perpetual issues, (9) offer and accept apologies, and (10) cooperation and trust (Gottman, 2012).

Defections. Defection products and by-products reinforce elevated and protracted ANS activation, entropy conservation, and erosion of cooperation and trust in relationships. Criticism, contempt, defensiveness, and stonewalling are correlates of marital dissatisfaction and divorce (Gottman, 2012).

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Dr. Nicole Bosse appeared on FOX19’s Morning Show (Cincinnati) to talk about Seasonal Affective Disorder and how local residents can recognize the signs of SAD in themselves and others, help themselves avoid seasonal depression and find help through treatment at the Lindner Center of HOPE.

Seasonal affective disorder (SAD) is a form of depression triggered by a change in seasons.

In fact, more than half a million people in the U.S. suffer from SAD. In fact, 4 in 5 people who suffer from SAD are women.

“It is important to not think of seasonal depression as a minor case of the “winter blues,” said Nicole Bosse, PsyD, staff psychologist and member of the OCD and anxiety team at the Lindner Center of HOPE. “SAD is a type of depression and needs to be treated seriously. We urge people to seek professional help if they feel their mood is atypical this time of year.”

Your donation can help the Lindner Center continue state-of-the-science research and treatment to help patients get the care they need for a number of conditions, including SAD. Donate here:

Watch more:

Link: http://www.fox19.com/video/2019/01/11/how-combat-seasonal-affective-disorder-sad/

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Nicole Mori RN, MSN, APRN-BC
Nurse Practitioner
Lindner Center of HOPE

Obesity is an important comorbidity among psychiatric patients and is associated with increased morbidity and a complicated clinical course. Many frequently used psychotropic medications can contribute to weight gain, which commonly accompanies adverse metabolic outcomes. Weight gain is distressing to patients and leads to decreased quality of life and lower adherence. Psychotropic-mediated weight gain is particularly problematic for patients with bipolar disorder who, regardless of treatment status, experience higher rates of overweight and metabolic abnormalities than the general population. Patients with bipolar disorder face additional risks for weight gain because the mainstay treatments for bipolar disorder such as mood stabilizers (e.g., Lithium and Valproate) and atypical antipsychotics carry a risk for accelerated weight gain and metabolic disturbances. The effect of many psychotropic medications on histamine, alpha-1 and serotonin 5HT 2A and 5HT 2C receptors has been associated with higher weight gain potential. In addition, many psychotropic medications can interfere with the activity of leptin, which regulates food intake. The effects of antipsychotics and mood stabilizers can also lead to dysregulation in lipid biosynthesis, insulin resistance and increased risk for type 2 diabetes.

Strategies for managing weight changes include lifestyle interventions aimed at improving diet and increasing physical activity, selecting medications with a lower weight gain liability and prescribing medications aimed at promoting weight loss or mitigating the weight gain effects of psychotropics. Selecting medications with lower risk for weight gain or switching medications can be helpful but this may not always be possible due to efficacy considerations. Studies show that lifestyle modifications can be modestly helpful in mitigating the effects of psychotropic medications on weight, but weight loss is often insufficient and difficult to maintain.

Some medications have been studied and used off label for their potential to attenuate the effects of antipsychotics and mood stabilizers on weight. Metformin has the most data for efficacy and safety, especially when used in combination with lifestyle modification. In addition, metformin has shown significant benefits in improving glycemic control and dyslipidemia. Metformin requires monitoring of renal function and carries a risk for metabolic acidosis (rare) and hypoglycemia. Gastrointestinal adverse effects associated with metformin (flatulence and diarrhea) can be a barrier to dose escalation and tolerability. There is some evidence supporting the use of topiramate for mitigating the weight gain effect of psychotropics. However, rates of discontinuation are high due to adverse events such as dizziness, paresthesia and cognitive impairment. Norepinephrine reuptake inhibitors have shown a marginal effect on weight gain, and carry a potential for adverse effects on heart rate, blood pressure and psychiatric symptoms, which limits their use.

Although the FDA has approved a handful of new antiobesity medications in the past decade (lorcaserin (Belviq), topiramate/phentermine (Qsymia), bupropion/naltrexone (Contrave) and liraglutide (Saxenda)) there is little research on the efficacy and safety of anti-obesity medications in patients for bipolar disorder. Orlistat is one of the few FDA-approved medications with clinical trial data for use in psychiatric patients but study results were mixed and the subject population was limited to patients with schizophrenia. Although orlistat carries a relatively low risk for mood destabilization, it can decrease the absorption of certain medications (including antiepileptics, warfarin and levothyroxine) and is associated with intolerable gastrointestinal side effects (flatulence and incontinence) that lead to discontinuation. There is no published data on the use of the new antiobesity medications for patients with bipolar disorder. Most antiobesity medications are combinations of drugs that target the central nervous system and modulate neurotransmitters, raising concerns for risk of destabilization and drug-drug interactions for patients with bipolar disorder. Liraglutide is the only recently approved medication that primarily targets the gastrointestinal system, and in theory, carries a lower potential for effects on the central nervous system.

There is a need for safe and effective treatments to prevent psychotropic-induced weight gain or enhance weight loss in overweight patients with bipolar disorder. Until research brings new treatments to market, timely detection and management of weight gain and metabolic abnormalities remains the most important intervention to reverse or attenuate these undesirable effects from psychotropic medications.

References

Dent, R., Blackmore, A., Peterson, J., Habib, R., Kay, G. P., Gervais, A., … & Wells, G. (2012). Changes in body weight and psychotropic drugs: a systematic synthesis of the literature. PLoS One, 7(6), e36889.

G Fiedorowicz, J., D Miller, D., R Bishop, J., A Calarge, C., L Ellingrod, V., & G Haynes, W. (2012). Systematic review and meta-analysis of pharmacological interventions for weight gain from antipsychotics and mood stabilizers. Current psychiatry reviews, 8(1), 25-36.

Saunders, K. H., Umashanker, D., Igel, L. I., Kumar, R. B., & Aronne, L. J. (2018). Obesity pharmacotherapy. Medical Clinics, 102(1), 135-148.

The Lindner Center of HOPE is conducting a randomized, placebo-controlled study of Liraglutide in overweight patients with Bipolar disorder. For information, please call 513-0704 or visit https://is.gd/weightlossbipolar

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Peter White, M.A., LPCC, Lindner Center of HOPE, Addictions Counselor

Many loved ones of people with substance use disorders are often discouraged by the severity and duration of distress initiated and endured by their loved ones. In a related manner, many professionals working with people with substance use disorders become disillusioned and discouraged by the extent of problems, and a lack of progress in treatment. It seems that experiencing burnout, or feeling just plain burnt, are two common emotional consequences of committing time and energy in trying to help people with substance use disorders. I would argue that one of the most important things we can do, being the people who care, is revisit our understanding of the fundamentals of substance use disorders, and reorient our recovery approach in a manner that aligns with these fundamentals.

Substance use disorders are chronic, behavioral disease conditions that if not addressed will progress into increasingly diseased states up to critical illness and death. They do not have a cure.

It is easy to be initially discouraged by this reality, until we consider an additional reality – substance use disorders are imminently recoverable. That is to say, at any time a person with a substance use disorder can make the changes that stop the progression of his or her disease process, ( a major accomplishment in itself,) and begin the process of establishing and consolidating a healthy and rewarding recovery. The bad news is that there is no cure. The good news is that once we accept this, we are then free to focus on the ever present possibility of sobriety, health and growth taking root as our loved one’s lifestyle.

Our real challenge is to remain continually present, authentic and hopeful as we develop interventions and support over the course of a disease and recovery process that will often endure for decades. Think about that. If we appreciate the nature of a chronic condition, then we acknowledge that the process of growth, as well as the potential threat to growth, is never over. In a way, I would say that the experience of burnout isn’t logical, because people with terrible conditions can and do get better all the time. It is the maintenance of this very realistic hope for the advancement of recovery in the face of the loss and distress of alcohol and drug use that is the most effective way to help our loved ones, as well as to prevent burnout for ourselves.

I once asked clients during a group to state what their definition of recovery was. I noticed that their answers really focused on the establishment and expansion of behaviors that were in line with their values much more than they were focused on the cessation of drug use -“Dealing with responsibilities, ”Complete change of focus, ”Knowing I can change and grow,” Doing my best- healthy, clean, sober, ”Becoming self-reliant.” It was a very reassuring moment for me as a helping professional in that the clients were not searching for a tabulation of “clean” days vs. “using” days. What they were really focused on was a direction that would incorporate every part of their lives away from risk, disease and loss, and towards the pride and enjoyment of health and growth that I think all people desire.

Let me end on a note where we do acknowledge that substance use disorders are often very destructive. If you are a loved one or a professional who is becoming overwhelmed or burdened too long by the losses you’ve encountered, lets acknowledge that disengagement and the establishment of boundaries are often the healthiest option for all involved. Disengagement does not need to be related to the rejection of people or the abandonment of hope for recovery. It is most often a very appreciable need for self-care in the face of risk and loss. Just as we help those with substance use disorders by decreasing our focus on the multiplicity and duration of problems, let’s help ourselves by not focusing on all the problems that we find we can’t deal with. Instead let’s focus ourselves on our limits relative to all the help we have or might offer, and remind ourselves that our own growth is imminently available, and that we should honor any rest we need until we able to make ourselves available for help once more.