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Mental Health

Creating and Supporting Developmental Communities


Kids are going to need more than just developmentally supportive relationships with adults. They also need developmentally supportive communities. 

The Search Institute has been researching developmental assets for youth for the better part of 50 years. The higher number of assets a young person has the higher the likelihood they will become thriving and contributing adults. The lower the number of assets, the higher the likelihood they will engage in unhealthy behaviors, such as bullying, substance use, or unsafe sexual practices. These behaviors often carry over into adulthood.

Conversations on the Fringe initiatives aims to equip individuals, organizations, and communities with tools to become asset rich and therefore increase the number of assets available to developing youth. We believe this will dramatically impact the outcomes of their journey into adulthood.

In 2017, we are highlighting three community-based asset developing programs. Each program exists to equip adults, organizations, and communities with real skills, tools, knowledge, and experiences to make a greater impact in the lives of the young they love and serve. You can choose and customize the program that best fits the needs of your youth and community.

RealTalkRealTalk Drug Prevention Program

RealTalk Drug Prevention programs are geared towards those who wish to have honest conversations about drugs and alcohol, providing science-based research drugs of abuse and adolescent brain development science.

bullyinglogoNOT IN MY SCHOOL: Anti-Bullying Program

This program helps to nurture safe school and social environments through empathy and character development by equipping students with skills to increase emotional and social intelligence.

No automatic alt text available.True North Student Leadership Intensives

Every student has leadership potential waiting to be nurtured and released. When young people assert their leadership they have the potential to unleash a powerful force for creativity and change.
Contact us today to find out about cost or if you are interested in scheduling one of our community-based program at your school, church, or organization.

Conversations on the Fringe

P.O. Box 74

Delavan, Illinois 61734

Phone: 309.360.6115

Email: cschaffner@fringeconversations.com

Check out our other Fringe Initiatives too!

Conversations on the Fringe: 2016 Year in Review


2016 was our busiest and most fruitful year to date. There’s so much that happened over the year that we’d love to share with you but we’ve condensed it down to the highlights. Thanks for making 2016 an awesome year. We’re looking forward to journeying through 2017 with you.

Grace and peace,

Chris Schaffner

Founder of Conversations on the Fringe

 

Top 10 Blog Posts

  1. Youth Ministry and the Post-modern Learner
  2. Teen Gender Dysphoria and Christmas Shopping
  3. Sex, Aggression, and Adolescents
  4. How to Talk About Intimate Partner Violence with Your Students: A Guide For Youth Workers
  5. Stages of Sexual Identity Development for LGBTQ Youth
  6. Imaginative Hope
  7. Trauma-Informed Youth Ministry
  8. White Privilege
  9. Protecting Against Sexual Abuse In Youth Programs
  10. This is Your Brain On Opiates

 

Highlights

  • Youth Specialties Facebook Live Q&A Series (self-harm, addiction, depression/suicide)
  • Can the Church Be Good News to LGBTQ Youth for the Illinois Mennonite Conference
  • Can the Church Be Good News to LGBTQ Youth at Simply Youth Ministry Conference
  • Conflict Management at Youth Leadership Academy at Elgin Community College
  • Reimagining Adolescence at the Faith Forward Gathering
  • Racial Reconciliation Experience at National Youth Worker Convention
  • Student Retreat at Heights Cumberland Presbyterian Church in Albuquerque, NM
  • Guest Lecturing at Eureka College on Systemic Abandonment and Moral Disengagement for the Juvenile Criminal Justice Program

 

New Initiative in 2016

Innovative Disruption – Helping churches disrupt the status quo and discover innovative ways to reach marginalized and vulnerable youth.

Fringe Life Support Training – Helping churches help hurting youth through pastoral counseling, spiritual direction, and mentoring.

RealTalk Drug Prevention – Working with communities who desire to have honest conversations about effective drugs and alcohol prevention among area youth. We offer a variety of educational opportunities for students, parents, schools, and communities.

Reimagining Adolescence – We explore the developmental, physiological, social, cultural, and spiritual complexities of guiding adolescents through contemporary society. This event is perfect for parents, grandparents, teachers, social workers, coaches, youth workers, or anyone else that love kids and desire to walk with them as they navigate an increasingly difficult world.

AND…CHRIS RAN INTO BILL MURRAY!!! (That was a personal highlight, even though he locked up and could barely talk to him.)

 

Dreams for 2017

True North Youth Leadership Training Online Cohort – This online student leadership cohort is aimed at nurturing and activating your student’s leadership through individual and group projects that will directly impact the community they live in.

Fringe Learning Labs – Learning Labs fill in the gap that traditional youth ministry education doesn’t address. We provide an affordable, customized training experience for volunteer and staff youth workers to explore difficult issues facing yout today; issues such as race, gender, disability, sexual orientation, and mental health.

Prisoners of Love: Teen Dating Violence Education

Dirty Little Secrets: dealing with the Problem of Porn

Digital and printed resources for youth, parents, and youth workers

Incorporation as a 501c3 nonprofit organization

Youth Ministry and the Post-Modern Learner


I facilitate group therapy for beautiful people. We have people of color, various sexual orientations and genders, abled and disabled, employed and unemployed, affluent and poor, mentally ill, substance abusing, and a host of others who don’t fit into a neatly defined category. The thing they all have in common is they have come to me to learn. Some hope to learn the bare minimum they needs to learn to complete the program. Others are looking for a significant life change as a result of their engagement in this learning space.

I use to hold the belief that I had something they needed and my job was to share it with them and their role was to sit passively and consume this information. It was also their job to practice these principles in their affairs when they left, often without direct feedback from others who knew what they were trying to do. I took the same approach for years in youth ministry. These teens were empty vessels that needed me to pour into their lives and fill them with the knowledge of what they needed to follow Jesus (defined by our church community and tradition).

Fortunately, I’m curious and like to ask for feedback from those who are sitting in the learning space. I also love research. I love to read it, break it down, and try to apply it in real time. Here’s a summary of what I’ve learned over the years about how people learn best and why I think we need to reimagined how we pass on our faith to the current and future generations.

  1. Students must be at the center of what happens in the learning spaces – If teenagers are going to manage their emotions and become self-motivated learners they will have to be at the center of the learning experience. Often, in our youth ministry settings, it is the your worker that is at the center of the gathering. We are the ones on the stage, behind the pulpit, in the center of the circle, hoarding the words allowed to be spoken, setting the agenda and goals for the learning. Students rarely have anything to say about what they are being taught, how they are being taught, or the reasons they are being taught. This needs to change is we hope to create self-directed learners instead of mindless consumers.
  2. Students learn better in groups and rarely happens alone – We are social beings and we learn by interacting with each other. We learn when someone takes an idea you shared and extrapolate or pushes back. This pushing and pulling of ideas, in a collaborative setting, is what sharpens our vision and understanding of the subject matter being discussed.
  3. Our most powerful memories are connected to strong emotions – Faith communities have discounted the power of emotions in spiritual formation, citing their instability as a reason they can’t be counted on. As a result, we have stripped down our faith experiences to a simple set of academic memes we cognitively ascend to. The heart and soul is largely missing in the church today. The power of emotions to motivate one to learn cannot be overlooked. Consider this, if a student has high levels of stress at home or school, they won’t learn well. Similarly, keeping a student motivated (hungry) to learn about God, mankind, and their shared story, is the starting point of faith formation. If they understand why it matters, their journey becomes more important to them.
  4. Individual learning styles are a thing – Multiple learning styles have been largely ignored among the evangelical traditions of the Christian faith. We are still perpetuating the idea that people learn best and are spiritually formed best when one person stands before them and speaks words at them about a particular subject. This style of communication only engages one, or at best two, of the senses, decreasing the likelihood of retention and transformation. Post-modern learners almost need IEP (Individualized Educational Plans). Not because there is anything wrong with them as learners but because it is the better way forward. We live in a visual, digital, social world, and they are natives in this land. We cannot afford to try and make the information fit our outdated styles of teaching but must, instead, adapt our style of communication to the mediums that are culturally dominant today. We must strive for practices and processes that help leaders engage each student where they are.                                                                                                            Image result for kolb's learning styles And then there are multiple intelligences…but that’s a post for another time.
  5. Push but don’t break – We don’t want to push beyond a learner’s capacity, where they might just give up because the rules are too hard and instead engage in “shallow compliance” to the Ways of Jesus. We also don’t want to deny accountability to excellence or striving for righteousness. We are called to take up our cross daily. This requires concentrated effort and focus and self-control but, it shouldn’t exasperate the student to the point of giving up. There’s a sweet spot where they can experience a measure of success and still experience the challenge of discovery. We must seek discernment on our facilitation of either.
  6. Learning needs to be connected across intersections – Formation needs to reach out into the real world. Life change cannot be meaningful or lasting if the students don’t know why the knowledge is useful to them, or how it can be applied in life. Understanding the connections between subjects and ideas is essential for the ability to transfer skills and adapt. Often, our faith is taught in a disjointed manner. How does our quest for social justice intersect with our real lives where we come face to face with racism? How does Jesus’ call to be peacemakers intersect with the real life violence on the streets of our cities? How do we, as people formed in the image of God, be the answer to Jesus’ prayer to see the will of His Father lived out on earth, as it is in heaven?

Most of these ideas are like water to a fish to good teachers. They seem like no-brainers. To others though, they can seem impossible to achieve within an archaic faith tradition that is bureaucratic and slow to change. What might be some practical steps you can take towards a more innovative formation culture?

  • Invite dialogue regarding the subject matter. Our church practices large group Lectio Divina at the beginning of every sermon. Often, the pastor will read a significant portion of scripture and illicit immediate feedback, saying “What did you notice?” or “What connected with you?” or “What seemed odd or weird in this story?”. This is driven by the belief the the Holy Spirit speaks in and through the entire community and prevents a single voice saying there is only one way to see or understand a passage.
  • Creating space for silence. It can be very hard to learn when there is so much noise in the learning space. Whether it be audible or visual noise, it can make it difficult to focus, be still, and allow the material being taught/discussed to penetrate at a deeper level.
    Retelling the story in your own words. This is a common practice among teachers in public schools. When information can be consumed, processed, and regurgitated in our own words there is a level of brain connection that occurs that goes beyond simply memorizing content. Try having your students rewrite Jesus’ parable with content from their lives today. This will also help take an abstract idea and make it more concrete.
  • Multi-sensory is the pathway to integrated learning. We learn best when we see, hear, touch, smell, and taste that which we’re working with. You might not be able to accommodate all five senses into every gathering but being mindful of them and intentional will go a long way to creating memorable learning experiences for your students.
  • Service-Learning Projects. Think creatively beyond a short-term mission project or a weekend service project. Have the students identify an issue from scripture (i.e., poverty) and have them research that topic in their own community. Let them discover the scope of the issue for themselves and then walk them through the process of addressing the problem. Imagine this…your students learn about the story of the Good Samaritan. As a result, they were moved and impacted by a story of someone in need of critical medical care. They then research their community and discover that many of the elderly in their town don’t have access to a myriad of medical/health resources. One of your students tells a story about how their grandmother can’t afford her prescription medication and has a hard time driving to the pharmacy. Now, imagine these same students decide to go talk to the pharmacy to see if they would consider starting a medication delivery for the elderly. Imagine they also create an educational program for the community to dispose of unused medications and work with the police department to create a medication drop off center to properly dispose of these medications because this will reduce the potential of teens accessing dangerous drugs of abuse from their grandparents medicine cabinets.

If transformation is the goal of formation we must be intentional about how we cultivate learning and formation experiences. This requires more effort from the one facilitating the learning in preparing. This isn’t just a lazy form of teaching. This will require more focus and thoughtfulness up front but the end result, I believe, will be deeper transformation of our students as they journey with Jesus throughout their lives.

Here’s a link to a free resource on spiritual formation you can use with your students, volunteers, or for yourself.

Fringe Spiritual Formation Guide

The Voices Project – Anonymous Girl part 2


We recently received this email from an anonymous girl who wanted to tell her story. These are her words and we are honored to share it on her behalf. Her story is long so we have decided to post it in two parts. This is the second part of her story. You can find part 1 here. We pray for her continued healing and hope that she is surrounded by love, where ever she may be.

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The holding cell was just a big room with a bench along one side and a toilet in the corner behind a half wall. The last thing in the world I wanted to do was get sick and have to use that toilet. Eventually, I did because when you’re dope sick it comes out of both ends. It’s a horrible feeling but you don’t care because you’re miserable. I seriously wanted to die so bad but there was absolutely no way I could make that happen. Not only did I not have anything to do it with there was also a giant one-way mirrored window through which we would be watched. I just laid in the corner under the bench, as far away from the others as I could get.

After five days a mental health therapist came to talk to me. She evaluated my current drug use; how much, how often, and how long. She asked if I wanted to go to treatment and I said I did. Inside, I knew I didn’t really want treatment but I didn’t want to be homeless or hungry. I had already gotten over the worst of my withdrawals so they would be able to get me in relatively quickly. I still had to wait three more days.

Treatment was not new to me. I had watched my mom go in and out most of my life. He NA sponsor would come over from time to time. I saw all the books and stuff lying around the house too. I even learned the things they say, like “Just take it one day at a time”, and “But for the grace of God, go I”. I could recite them like they were a part of the pledge of allegiance at grade school. But, I had no personal experience with those in recovery.

My counselor was a nice woman and was really good at listening to me but I just didn’t connect with her. She had a good heart and all but I never got the sense that she really knew what I had gone through in my life. Now, the people at Sanity (local NA meeting), that was another story. Those people knew their shit. It’s like they knew my every thought before I thought it.

My first meeting I was welcomed and they read something called step one. I don’t remember much of that meeting or what they talked about but what I do remember was this group told me they wanted me to come back. That’s it. No strings attached. They simply wanted me to come back. I can’t tell you how good it felt to hear those words. It’s like all the things I’ve done and were ashamed of kept me from wanting to be around other people but I had a real sense that these people already knew about the crap that had happened in my life and they still wanted me to come back.

I have relapsed on a few occasions. Heroin imprints in your body and brain and because of that my brain has learned about a level of pleasure it was never intended to know. Each time I dragged my sorry ass back through the doors of that meeting room, I was greeted with, “We’re glad you made it back”. It’s like there was a force field at the front door that keeps shame from entering that space. My relapses got shorter each time and my sobriety got longer between relapses.

I am now clean 9 months and I’m working. I don’t know if I’ll use again. I hope not but it’s always there, in the back of my mind. It’s like a bear that’s hibernating. If I just leave the bear alone it will stay asleep. If I poke the bear, it will wake up and start devouring everything around it and I’m afraid I won’t be able to put it back to sleep. For today, I’m sober. I like who I am. I miss my mom and wish she was able to find a community like I did. I still have nightmares about the sexual abuse I’ve experienced but I’m working that out with my therapist. I’m living with people in recovery and go to meetings nearly every night. Sometimes I go and pick up the girls from the local treatment center. It’s cool to see them at the beginning. It reminds me where I came from and how far I’ve come.

You can post this on your blog if you want. I’m not giving my name because I still have a long way to go but if my story will help someone else then please use it. Thanks for making a place for people to share their stories. This was hard for me to write but it feels important for me to do this.

Thanks.

Youth Ministries That Nurture Resiliency In Vulnerable Youth


Young people are living in a world that seems hell-bent on breaking those who try to navigate it successfully. Likewise, the church in America has a tendency to break people as well, especially its young. If our students, children, and community youth are going to move out of adolescence into functional adulthood they will need to be resilient.

So, what exactly is resilience? Resilience is the ability to ‘bounce back’ after a tough situation or difficult time and then get back to feeling just about as good as you felt before. It’s also the ability to adapt to difficult circumstances that you can’t change, and keep on thriving.

Rick Little and the fine folks over at the Positive Youth Development Movement have identified the 7 Cs: Essential Building Blocks of Resilience. They say “Young people live up or down to expectations we set for them. They need adults who believe in them unconditionally and hold them to the high expectations of being compassionate, generous, and creative.”

Competence: When we notice what young people are doing right and give them opportunities to develop important skills, they feel competent. We undermine competence when we don’t allow young people to recover themselves after a fall.

Confidence: Young people need confidence to be able to navigate the world, think outside the box, and recover from challenges.

Connection: Connections with other people, schools, and communities offer young people the security that allows them to stand on their own and develop creative solutions.

Character: Young people need a clear sense of right and wrong and a commitment to integrity.

Contribution: Young people who contribute to the well-being of others will receive gratitude rather than condemnation. They will learn that contributing feels good and may therefore more easily turn to others, and do so without shame.

Coping: Young people who possess a variety of healthy coping strategies will be less likely to turn to dangerous quick fixes when stressed.

Control: Young people who understand privileges and respect are earned through demonstrated responsibility will learn to make wise choices and feel a sense of control.

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This is a great grid to think through when creating programs, purchasing curriculum, and planning events. Can our efforts increase resilience in the most vulnerable youth? I think they can but it will take thoughtful intentionality.

  • What if our we created more opportunities for students to lead (in big church)? Would that increase their competence to have their leadership validated and nurtured by other leaders?
  • What if we taught a series on confidence (I can do all things through Christ who strengthens me)? Sound familiar? Are we driving this truth deep into the hearts of young people? I’m not talking about the notion that I can achieve but more the notion that I can overcome.
  • What if we continued to beat the drum of integrity and character but laced it with grace so when they fail they are able to get back on track without having to avoid the shame monster?
  • What if we did more than just allow our kids to babysit for the Women’s Fellowship Coffee? What if we actually gave our students meaningful work in the church and community? What if they led teams with adults? What if they helped plan services? What if they researched their community needs and church leaders valued their work so much that it might actually alter the organization’s mission?
  • What if we offered more than shallow platitudes to manage the hurt and pain they experience as they navigate life? What if we deliberately included emotional and social intelligence in all our teaching and small group curriculum? What if we actually modeled self-control and appropriate vulnerability of emotions? What if we taught coping skills to kids in our youth group?
  • What if we allowed teens the power of choice? What if we allowed them to make wrong choices and were there to help them process the consequences of those choices? What if we encouraged rebellion (minor rebellion) and autonomy instead of conformity? What if we didn’t overindulge youth so they develop a sense of entitlement and instead taught them the value of work and earning respect?

I wish I had learned many of these lessons growing up. More than that, I wish I had been surrounded by a great herd of adults that walked alongside me while I learned these lessons, encouraging me, walking beside me, challenging me by raising the bar, modeling resilience, and not giving up on me when I screwed up. I imagine that sounds a little like heaven to a vulnerable teenager and that’s the point, isn’t it?

Trauma-Informed Youth Ministry


I went to a training on creating trauma-informed systems of care. I was impacted by the implications on schools and youth ministries. People often took to the church for hope in the midst of tragedy. The church can be a place of good new and healing if they take steps to be trauma-informed in what they do.

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Trauma studies report 70% of all adults have experienced some form of trauma. Trauma experiences can range from a simple car accident that results in injury, to gang violence in the city, to physical or sexual assault, to repeated name calling, to being in high stress environments such as jail or prison. 90% of those people suffering from trauma end up in public behavioral health systems seeking support and therapy. 70% of teens who seek treatment for addiction report having traumatic experiences in their young lives, often repeated trauma. New research has revealed trauma can actually derail normal development of the body, brain, and cognition.

SAMHSA (2012) reports “individuals can be retraumatized by those whose intent it is to help”. Trauma clearly interferes with healthy brain development and coping measure become problematic (i.e., substance use, avoidance, aggression, risky behaviors).

As we engage youth in our programs (especially schools and churches) we must understand the principles of trauma informed care.

Understanding attachment theory should be required for all who work with children and adolescents. Attachment theory is best explained as the type of connection (attachment) one has with their primary care givers as a child. When the infant/child is cared for and nurtured the growing infant develops a sense of security that their needs will be taken care of. As a result, the child will likely develop into an adolescent/young adult who is autonomous, self-controlled emotionally and behaviorally, well-formed identity, and can adapt to changing circumstances.

A child who experiences high levels of stress or trauma is more likely to develop insecure or avoidant attachment styles of interacting with the world around them. If they are victimized, they will likely be extra weary of people and see the world as unsafe. Due to this worldview, the child has to develop maladaptive ways to interact with the dangerous world they live in.

When a child experiences trauma the architecture of the brain is changed and emotions and cognition are not integrated. The separate regions of the brain do not communicate effectively with one another so, when something triggers a memory of trauma that fear signal cannot be challenged with rational thought because the pathways have been disrupted. This means everything is a potential trigger for re-activating the trauma.

One example of this is when a young person, that has been sexually abused and threatened or coerced into not reporting the abuse, is told by a well-meaning youth worker that she cannot have her cell phone on the retreat away from home. The reason for this is so the student can focus on God without the distraction of modern mobile technology. Unfortunately, a trauma-impacted student may experience this as a loss of safety that reignites the feeling of being powerless to call for help if needed.

Children and youth are vulnerable populations but there are intersections that increase their vulnerability because we live in a society that marginalizes anyone that is different from the norm (i.e., LGBT, people of color, disables, gender, religion, class, etc.). The greater the number of identity intersections the higher the likelihood of victimization and trauma. Think about the homeless black teenage girl who was kicked out of her house because she identifies as a lesbian. She also recently dropped out of school because she has a learning disability. Now, in order to survive on the streets, she resorts to survival sex with strangers just for a warm bed and a hot meal. This is traumatizing if it happens just once but for many marginalized youth, this becomes a way of life.

If a young person is handled with care, healing can occur. Our school or church can help this precious child begin the healing by creating a trauma informed program or ministry. This starts by educating staff and volunteers. Bring a local therapist, who specializes in trauma, to speak to your team about the impact of trauma and how to be more informed as a team. There are also plenty of resources on the web. Conversations on the Fringe has several blog posts dedicated to trauma.

Another way we can help a hurting student is by creating safe spaces for them to walk with Jesus. Their journey may not be as linear as most of their peers. Cultivating an environment for vulnerability is of the utmost importance but remembering the classroom or youth ministry room is no replacement for a qualified and trained therapist.

Trauma impacts whole family systems. They will need support as they begin the journey to freedom and healing. Trauma alienates and can lead to isolation for families who are ashamed, embarrassed, overwhelmed, and hurting themselves. They need your friendship more than anything. Be present. Sit quietly. Cry with them. Bring meals to families sorting out their trauma stories. Incarnate real love and support. Prayer is good and essential but no replacement for a hug or wiping away tears or a warm dinner.

Lastly, creating a trauma-informed program is a justice issue. If a traumatized young person is to ever recovery a sense of goodness and justice in the world, if they are ever to let go of the natural anxiety of being victimized and move out into the world a whole-hearted person, they need to know and experience goodness that brings balance to their life. Trauma leaves such a powerful and deep impact on the mind and soul that it will take good people doing good to re-establish equilibrium to their mind and soul. The issue of justice cannot be avoided in human service or ministry organization because, it is the heart of why people seek help for trauma in the first place.

What does justice work look like for victims of trauma? What does it look like for perpetrators of trauma?

What Does Effective Treatment Look Like (part 5)


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The treatment of prescription drug and heroin use is one of the most pressing issues facing our country right now. Across the country, opiate related overdose deaths, fueled by prescription pain killers, now takes more lives that car accidents, with nearly 100 Americans dying from an overdose EVERY DAY.

Given the current state of affairs related to opiate use and abuse, current legal, regulatory, and budgetary constraints, federal agencies and the White House have been working hard to develop guidelines for effective treatment  and to generate and direct resource at this epidemic. But, on the frontlines, counselors and treatment professionals are trying to figure out what will really help and what doesn’t.

There is no silver bullet for a disease as complex as opioid addiction. Research does reveal the longer a person is involved in treatment the better the outcomes. There needs to be an alignment of the stars to get all the wheels of treatment and recovery to move in the same direction. It is not impossible but, without the needed resources, it is very difficult. Let’s take a look at what effective treatment looks like.

1. Individualized Treatment Planning
Each individual comes to treatment with a unique set of circumstances. Some are caught in a domestic abuse situation, others at involved with Children and Family Services, yet others are facing serious legal consequences. Most are simply aware that the path they are on will end in death. Because of the myriad variable in each story, effective treatment must be responsive to the individual needs and considerations. That doesn’t mean there aren’t universal skills each person will need, such as relapse prevention skills, it simply means that a cookie-cutter approach isn’t helpful when everybody starts at a different place.

2. Level of Motivation
Besides the unique process that led an individual to seek treatment there is also a unique level of motivation for each that should be considered. Many develop a sense of hopelessness that they can every get this monkey off their back. Others, while drug dependent, haven’t been motivated by the consequences to quit yet. One of the ways humans resolve the cognitive dissonance between what we do and how that impacts our lives and the lives of those we love, is denial. It’s a protective mechanism that keeps us from being overwhelmed with guilt, shame, and remorse, but also enables ongoing drug use. Understanding a person’s level of motivation is key in helping them through the process, when they are motivated.

3. Understanding the Science of Addiction
We have learned so much in the last 10 years about the brain that we struggle with presenting current information because what we are learning is outpacing our ability to integrate it into treatment. But, people desire to know how the brain works and how drugs affect it. The more you understand that science of behavior and addiction and what is happening in the brain the greater the sense of being able to control what is happening. For example, if a person in treatment learned about how the brain is rewired through drug use and what new behaviors will help the brain heal and rewire into healthier behaviors, that is empowering. There is meaning and understanding to the choices they make. Plus, science is cool.

4. Cognitive Behavioral Therapy
There is a direct connection between how we think about ourselves and the world we live in and how we behave. If someone is afraid of flying and they believe planes are unsafe, they will not likely fly anywhere. But, when that thinking is challenged with rational thinking, such as how safe flying actually is, and that you are more likely to be injured in a car accident that have your plane fall from the sky, you are more likely to fly. Good treatment helps the individual challenge and replace irrational thinking and evaluate it in the light of reality. When you live under the fog of addiction you live in survival mode. There is so much deluded thinking that is necessary to navigate that world but is problematic once an individual enters recovery.

5. Wellness
The mind and the body and intricately connected. The benefits of healthy habits are well documented. For the opiate dependent sleep, exercise, and nutrition are essential to quality recovery.

6. Family Engagement
Just because the wind from the storm is over doesn’t mean there still isn’t work that needs done. The family has taken a toll because of their loved one’s addiction. Work needs to occur to rebuild trust and habits of relating to each other. Imaging living with someone and you both speak English (the language of addiction/anger/stress) and then someone goes to treatment or seeks out recovery. In recovery they speak French (recovery, therapy). Now, you have two parties trying to co-exist and they can’t communicate because they speak different languages. Both groups need to be speaking the same language if restoration of relationships is to occur.

7. Accountability
Drug use monitoring is an important part of the recovery process. Drug screens and medication counts help bring accountability to the person in recovery. Because old habits die hard, the need for someone to ask tough questions and to provoke honest dialogue is also necessary. This is most effective when there is trust and rapport between the two parties.

8. Co-occurring Conditions
Many times drug using individuals are self-medicating because of a co-occurring condition, such as PTSD, depression or anxiety. Taking opiates, benzos, or other depressants can give temporary relief to an often debilitating condition. If these conditions are not treated, relapse is imminent.

9. Employment Support
Studies show one of the biggest predictors of sustained recovery is gainful employment. Working gives the individual a sense of purpose, accomplishment, and independence. This can be a challenge if you have a felony record or a spotty work history. Having someone trained to walk alongside you while job seeking can be an indispensable source of encouragement and support.

10. Pro-Social Recreation
Anhedonia is the inability to experience pleasure. This often occurs when the reward center has been hijacked due to years of opiate misuse. When you experience pleasure so off the charts over and over again, the brain rewires to that level as the new default. Anything less than that is no longer experienced as pleasure. Boredom is a HUGE trigger for people early in recovery precisely for this reason. Who wants to live an existence where they experience no or low levels of pleasure in anything. Retraining the brain to enjoy (pleasure) life is also an important part of the recovery process. Developing new hobbies that are not related to using drugs, listening to music without getting high, being sexually intimate without having to use first are all difficult for the person early in recovery.

11. Criminogenic Needs
Do you know what you get when you sober up a horse thief? A sober horse thief. Criminal attitudes and behavior are a part of the lifestyle associated with drug use. The mere fact that someone uses drugs means they are engaged in a criminal act. Along with behaving in a criminal manner means adopting criminal attitudes that support or endorse your behavior. This needs to be undone if someone is going to thrive in recovery.

12. Case Management
Because the person can be caught up in other systems there is a need for effective case management. It is possible that a drug using individual ca be on probation, Children and Family Services, Drug Court, see another therapist for past trauma, or a host of other service, all aimed at helping them get back on the right path. Effectively communicating with these other services is necessary, as is making appropriate referrals to address these needs.

13. Harm Reduction
I won’t say much about this now because I’m designating a future blog to this but Harm Reduction is the idea, that if an individual is not willing or struggling to abstain from drug use, how can we support them where they’re at? For example, providing clean needles is proven to prevent the spread of blood born disease common among IV needle users. This also reduces the associated cost of health care for treating someone, likely without insurance, in the emergency room and ongoing treatment for Hepatitis C, a commonly spread disease among IV needle users. This is a controversial strategy but one that is often misunderstood. We’ll explore this in greater detail.

14. Intersections
Individuals are unique and complex. There are other intersections to consider when providing effective treatment, race, ethnicity, gender, religion, sexual orientation, ability/disability, age, educational levels, and a host of other considerations. All which need to be addressed when providing individualized treatment.

15. Recovery Community
Yes, addiction has biological hooks. The pleasure is such a powerful reward that it draws a user back with powerful cravings. But, more often that not it is reinforced by the community of peers we surround ourselves with when using. Recovery is no different. Creating the community we crave, that was denies by our addiction, is one of the most powerful reinforcers of remaining clean or returning after a relapse. Recovery has more to do with being connected in meaningful ways than just about anything else. The pain of alienation and isolation, the pain of being marginalized and feeling outcast, the deep hurt of feeling utterly unloved and unlovable will drive addiction to dark places we never knew existed. If we are going to heal our those addicted in our communities we must be willing to venture into those dark places and lead them out.

We are constantly learning more about what it means to be a person dependent on opiates every day. In spite of the progress we are making, not everyone who needs treatment can access it when they need it or are motivated to seek it. We’ll address barriers to treatment in our next post. 

Medication Assisted Treatment (part 4)


In our last post we explored the neurological changes that occur in the brain when a person misuses opiates (heroin or prescription pain pills). We learned that the brain’s natural endorphin system shuts down and becomes dependent on an external source, such as heroin or prescription narcotics. We also learned the body requires endorphins to function normally; to manage pain, energy, and mood. So, an individual MUST continue using because it is a physiological necessity.

If a diabetic requires a medication to correct an internal imbalance, they would have the needed support from friends and family to do whatever they needed to do to get better. Yet, there is so much stigma, due to lack of understanding about the nature or opiate dependency, that creates unnecessary barriers to people getting the help they need, especially help that is proven to be the most effective form of treatment for this particular condition.

So how does one break the need to use opiates once these changes occur?

Methadone and Suboxone are both medications that can be prescribed to manage opiate withdrawals and craving while the brain begins the process of rebuilding its internal endorphin workforce.

Methadone is a full agonist opiate, meaning it has the potential to act like any other opiate. It has the potential to satisfy withdrawals and cravings but also has an abuse potential. Suboxone has less risk involved but is expensive and doesn’t work for everyone.

Methadone

Methadone is a synthetic opiate that sits in the brain’s opiate receptors. When prescribed a therapeutic dose, methadone will sit in the opiate receptor and do the necessary jobs of preventing withdrawal, stifling cravings, provide energy, stabilize mood, and manage pain, just like the natural endorphins will eventually begin doing again.

The length of time it takes each person’s brain to fully recovery varies based on many variable, such as; length of time using drugs, quantity and quality of the drugs consumed frequency of consumptions, personal physiology, psychological state, level of physical activity, nutrition, sleep habits, and recovery support.

There is the potential for abuse but if managed well this can be avoided. The methadone clinic providing the medication should always strive for conservative dosing (prevent withdrawal without sedation), random drug screens, diversionary practices, laboratory testing, and ensuring there is adequate recovery capital before allowing take homes.

Methadone tends to work better for individuals with a chronic opiate use disorder. These individuals are more likely to thrive when they have controlled dosing, daily engagement at the clinic, accountability and encouragement, case management and counseling.

Suboxone

Suboxone tends to work better for individuals who already have some measure of recovery capital. These individuals also are more likely to have jobs, transportation, stable housing, and supportive relationships. These individuals are also more likely to have used prescription narcotics vs. street heroin, although some long time users report significant benefits from using Suboxone.

Suboxone is a partial agonist, which means it only does part of the job of an opiate. There are two medications combined to make up Suboxone, the first is Buprenorphine. It will sit in the brain’s opiate receptors but won’t activate the brain’s pleasure/reward center. This is good news because that means there is very little chance of misusing this medication. It also has built in protective factors. There is a ceiling to how much Suboxone you can take. There is a max dose a person can take before they stop receiving benefit from the medication. This reduces the potential for using the medication to “get high”.

There is also naloxone in the medication. This is the same medication they give to someone who overdose on opiates. It is more commonly known as NARCAN. NARCAN, when introduced to the body with “kick” the opiates out of the opiate receptors and reverse an over dose (we’ll talk about NARCAN in greater detail in a future post). If someone on Suboxone tries to misuse this medication or, they try to use other opiates while on the medication, it has the potential to send them into immediate withdrawal. Because of this, there is very little risk that the individual will be able to misuse or abuse the Suboxone.

Because there is less while on Suboxone the consumer has a tendency to stabilize fairly quickly. Methadone takes slightly longer as the individual and treatment team work to establish a therapeutic dose by adjusting the medication over time.

The likelihood of an individual in severe withdrawal engaging in treatment, rebuilding relational trust, or going to work or caring for the kids is very low, if not nearly impossible. There will always be exceptions to this but it is not the norm. The brain will eventually begin to rebuild its own endorphin system and in time, many are able to taper off these medication altogether. There are a number of people who have used in such a way that their brain will never fully recover and will require medication for the remainder of their life.

So, once an individual becomes stable on medication, what does effective treatment for the opiate dependent individual look like. We’ll explore that in our next post.

 

Opiate Tolerance and Withdrawal (part 3)


Tolerance

The struggle that Adam and Eve discovered in the garden, on that fateful day when they ate the apple, was that they learned about something they were never intended to know. Much like the Adam and Eve narrative, when we use opiates our brain learns about something it never knew existed, the increased capacity to experience higher levels of dopamine output. If that sounds too clinical for you then let me make it simple; they (opiate users) discovered a higher, more intense level of pleasure than they ever knew possible. It is so powerful in its reward that it almost immediately sets a new default for pleasure that the brain will always try to attain again.

Our brain is amazing. It is very plastic and adaptive. When it sets its “mind” on something it obsesses on it (cravings/urges) and if we surrender to those cravings we strengthen our connection to that which we are craving.

In the case of the opiate user our brains, the pathways that support the natural endorphin production work just fine but compared to the new superhighway of heroin/prescription narcotics it pales in comparison. The brain is flooded with significantly more endorphins and the brain has to create new pathways and places for them to land. This causes the brain to change and actually grow new endorphin landing sites, which in turn requires more of whatever it is that is flooding the brain with larger amounts of dopamine. Repeat the process. This is called tolerance and the brain is designed to make this happen.

Meanwhile, the old pathways that the naturally produced endorphins use to travel and growing old and less used. Imagine old rural county highways that are overgrown with grass, wore out and crumbled, with cracks and dirt beginning to cover them. They are becoming less traveled because of the nearby superhighway that is allowing more endorphins to travel at higher speeds to the reward center of the brain. In time, nothing will travel on those old roads and if they do it is likely to get lost along the way.

So, what use to give us pleasure; sex, food, relationships, work, recreation, movies, candy, etc. now pale in comparison and no longer deliver what it use to. Now, try to imagine that for a minute…nothing gives you pleasure except the medication your doctor prescribed you for your back pain. You quickly learn the only thing worth pursuing is the next fix, because, as well talk about next, withdrawal is so bad you’ll wish you were dead.

Withdrawal

You’ve been using these pills for several months now. They no longer work like the use to because you’ve developed a tolerance and your doctor is starting to become concerned about the frequency of which you ask for refills and is beginning to talk about not prescribing them anymore. You start to panic and begin visiting different urgent care centers hoping to score some Vicodin.

Instead, you decide to just stop taking the pills. They are costing a fortune and you don’t like the feeling of needing them just to help the kids get ready for school in the morning. So you just stop taking them one day.

REVOLT!

The brain has become dependent on the level of medication you’ve been giving it daily for the last nine months. It shut down its own production of natural endorphins and now relies on you to give it what it needs to function normally, to just get out of bed and not hurt. When the brain revolts like this it makes you feel deathly sick. It is reported that you feel like you’re dying but it never comes.

Common withdrawal symptoms are:

  • Sweating
  • Nausea
  • Muscle cramps
  • Diarrhea
  • Cold sweats/fever
  • Tremors
  • Pain
  • Depression
  • Possible seizures

Your stomach and digestive system has opiate receptors as well and since one of the side-effects of opiate use is constipation, diarrhea would result when in withdrawal. These symptoms are so severe that they would drive you to temporarily suspend your morality and do things you never imagined doing, such as; lying, cheating, stealing, manipulating, breaking the law, becoming violent, all to get money to get more opiates so you won’t be sick any longer. The criminal behavior often associated with drug use is typically a function of the drug use not a personality or character flaw. Stealing and selling possessions, lying or coercing others to get money is simply to not be sick any longer and so they can just get up and take care of their family, house, job, etc.

It is here that sympathies break down. When someone addicted to opiates begins to steal from a loved one we tend to become less empathetic. It’s important to remember at this time that your loved one is suffering from a brain altering dependency on an opiate. Nobody grows up hoping to become a heroin addict.

The brain is a fickle organ. It wants what it wants when it wants it and when it gets it over and over and over again it changes its neurological make-up to accommodate it. This is the nature of a brain disease/disorder that has biological, environmental, behaviors, cognitive, and personality variables influencing the outcome of dependency. At some point the person dependent on opiates loses their ability to choose. They MUST continue to use.

*in our next post we’ll explore the role of medications like methadone and suboxone in helping someone overcome opiate dependency.

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