Addiction and Social Justice

Loneliness, like addiction, may be among the inescapable features of our modern industrial communities. Yet since these conditions are generally treated as individual problems originating in either maladaptive behaviour or biologically determined predispositions, treatment plans offered to depressed, addicted and disconnected people rarely take into consideration what author George Monbiot calls Western society’s “epidemic of loneliness”:

Ebola is unlikely ever to kill as many people as the disease strikes down. Social isolation is as potent a cause of death as smoking 15 cigarettes a day; loneliness, research suggests, is twice as deadly as obesity. Dementia, high blood pressure, alcoholism and accidents—all these, like depression, paranoia, anxiety and suicide, become more prevalent when connections are cut. We cannot cope alone.

Loneliness has become a major public health issue, with multiple other associated illnesses. The commonness of the phenomenon of loneliness reflects the relative health of our communities as a whole, and how they tend to inspire or undermine empathetic connecting. When communities fail to provide sufficient opportunities to meaningfully connect, mass addiction is one of the unfortunate results.

Psychology researcher Bruce Alexander has shown that communities based on free market capitalism lack socialization opportunities in a way that would otherwise prevent conditions like addiction from becoming epidemic-like crises: “There is little drug consumption in the natural environment and a lot when the people or animals are placed in an environment that produces social and cultural isolation.” The rats in Alexander’s Rat Park experiments only pushed the levers for cocaine or heroin when the creatures were kept isolated from their rat-buddies. Yet isolating the rodents in cages had characterized almost every experiment on drug addiction until Rat Park. When Alexander instead gave the little rats generous opportunities to connect, the results were dramatic: addiction waned and even disappeared in rat communities predicated on socialization. When he put the rats back into individual cages, the animals again developed severe addictions.

So if rats are such socially needy creatures that they become heroin addicts by merely being alone, how much more vulnerable are humans to the forces of isolation and a lack of what Dr Alexander calls, “the psychologically sustaining” aspect of culture?

From another angle, consider also how routinely market capitalist forces inspire a sense of disconnection in how they market their products. Advertisements in the beauty industry design campaigns to erode the consumer’s sense of social well-being, exploiting feelings of disconnection and shame. It helps to sell something expensive if your customers believe it will fill an existential hole that your industry created in the first place! At that point they’ll pretty much buy anything from you.

Furthermore we are currently exposed to ever more sophisticated marketing that relies on the same equation: lonely people buy things in order to repair feelings of disconnection. Heroin is only one of a zillion answers to this kind of thing. Addiction to social media has become another. 

Research keeps piling up on the possibility that platforms like Facebook exploit powerful feelings of disconnection among users. Rather than fulfilling the vague promise to revolutionize democratic information sharing, which most of us bought as an idea in the 1980s and 90s, the age of the internet is now dominated by silicon-valley oligarchies. Mark Zukerberg announces that his company is addressing fake news or other bits of bad information, without ever addressing the possibility that the platform itself is a set up for disconnection, setting in motion the very substrate of addictive behaviour.

The social media companies we now rely upon for our daily activities, furthermore employ algorithms designed specifically to make users feel like we are in conflict or crises. Multiple whistleblowers from within the hallowed vestiges of these massive corporations have now come forward to advise users to quit until the owners of these platforms take seriously the addictive and corrosive nature of their company’s product. Such people have outed the fact that these platforms were designed from their inception to encourage feelings of fear and loneliness- not unlike the manner and design of casinos, which make lavish profits from gamblers feelings of loss (Lanier, Jared, 10 Arguments).

For these reasons, loneliness and addiction are not just individual problems, and a paradigm shift is required for us to see that we may have become more like the rats in the cages, than we are like the rats in the park. Treatment strategies such as psychotherapy and pharmacology work for sufferers of addiction, in part since they are aimed at helping us feel more connected. But these must also somehow address the vast oppression of loneliness, otherwise we can only meet the problem half way.

An analysis of how we structure our communities should be urgently undertaken- especially by the politically motivated left- so that therapies can continue to accommodate the known socio-cultural factors that play into mental health problems. A fractured, siloed, us-versus them approach, which unfortunately characterizes many of our political aims, will simply not be sufficient to address people’s underlying feelings of loneliness and shame.

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Yoga As Phase One Trauma Treatment in EMDR

Before a course of trauma therapy gets into a client’s troubling experiences, they and their therapist usually work diligently to establish a sense of safety and calm in the present moment. I use yoga for this purpose as well. It helps me help clients to develop inner and outer resources required for the treatment of their trauma, because it connects people to their bodies and helps them feel strong and relaxed. Yoga can be felt as increased resiliency, relaxation and more adaptive thinking.

Safety and calm are trauma recovery skills. Traditional EMDR teaches the use of visualization exercises to increase these, but there is a wide set of available skills to increase or establish safety that do not require visualizations. Learning to feel safe and calm is what we are really after, not that we “know” the course of a particular mindfulness routine. Safe/calm place exercises are thus called affect regulation skills- where we make ourselves feel better. The body and breath are allies in this journey to increase regulation.

What inner resources and skills are you already using for the things you find stressful in your life? What helps you feel like you are rebounding after stressful things happen? Maybe therapy, maybe music, maybe your partner, friends and allies. Hatha yoga is simply another type to add.

Hatha yoga- generally speaking the physical branch of yoga- is a means to create space for inner awareness. It includes ancient as well as ever-evolving sets of techniques that remain viable thousands years later for millions of people due in part to the benefits of slowing down the mind’s compulsive thought-emotion-behavior patterns. Yoga increases awareness of and control over the body, necessary parts of the creation of a sense of safety and calm.

Neuroception

Polyvagal theory explains why yoga and other mindfulness are so helpful in phase one trauma treatment. Polyvagal postulates that the body is specially equipped to quickly sense safety and danger, which through the vagus nerve accumulates information and sends it back to the brain, informing it about the environment. This talent is called “neuroception.” Polyvagal shows that when we strategically engage and relax some of these parts of the body, our entire nervous system including the brain benefits, leading to various gains related to stress resiliency and trauma recovery.

Polyvagal refers to a set of three possible responses to our circumstances. It seems we had first conceived of two possible responses to our outside worlds: Sympathetic fight/ flight, and parasympathetic rest/digest. The third response third response – socialization- is considered in polyvagal to come first. We first try to resolve things with cooperating and communicating. It is only when this fails that we end up fighting, fleeing or freezing (parasympathetic from this standpoint talked of as freeze).

Associated with more recent evolution, this third response is also called our “smart vagus.”

Smart vagus is critical to having a functional relationship to our environment. Since fight, fight and freeze are less adaptive and require more caloric energy, they are less sustainable than connecting. Polyvagal’s developer Stephen Porges sstates,“To switch effectively from defensive to social engagement strategies, the nervous system must do two things: (1) Assess risk, and (2) if the environment looks safe, inhibit the primitive defensive reactions to fight, flee, or freeze.” Our intelligence and communication skills act as brakes on our more primitive responses.

When a person experiences trauma, socialization and problem solving responses are sacrificed. Sometimes this becomes a tragic and permanent transformation. We can become stuck in fight, flight or freeze responses. But we have reason to hope: We can re-teach the mind-body that we are safe in the world. Socialization and problem solving can again take precedence in our lives, keeping less adaptive and defensive thinking in the background. That is the promise of neuroception.

Hatha yoga may be a kind of neuroceptive activity, where chronic defense activations associated with trauma are re-written by controlling certain aspects of our physical lives. Yoga teaches we are simply at our best more often when we are not only relaxed, but when we know we can make ourselves relaxed, an empowerment that is indispensible to trauma recovery plans.

Stage one trauma work is about practicing the talents of safety, trust, strength and connection. Yoga provides the psychotherapy space with a host of specific techniques, such as asana and pranayama, each with hundreds of exercises to choose from. Coordinating with a trained yoga instructor- better yet one who knows therapeutic yoga- can play an important role in helping psychotherapy clients gain control of their inherent abilities to relax and be present. Hatha yoga is also a good alternative for clients who do not respond to verbally-guided mindfulness meditations. Adding coordinated breath and physical movement to relaxation programs can draw such clients in, make them want to try different things, and ultimately reap more of the the benefits of phase one trauma treatment.

Choline Supplementation and Schizophrenia

Schizophrenia is a serious malady of the brain that affects over 1% of our population. Though drugs such as quetiapine and olanzapine are prescribed to people suffering schizophrenia have proved effective, their side effect profiles and dubious long-term impacts give rise to the question as to whether other agents might contribute to the healing of this condition.  

Choline is one such substance. Choline is an essential compound that we must derive from our environments. It has an impact on multiple biologic systems, including those concerned with brain function. Cholinergic supplementation appears to have potential to prevent and treat aspects of schizophrenia. A host of choline-like drugs such as centrophenoxine and CDP-choline, have shown effective in not only treating the symptoms of this disease but could turn out to ameliorate some of it’s causes. Cholinergic supplements generally do not cause unwanted side effects, are not expensive, thus client non-compliance issues seen in other antipsychotics would not characterize their use. Most of them are safe and non-toxic.

For these reasons, cholinergic supplements like centrophenoxine could be utilized more commonly by people presenting with this often devastating mental illness.

It is important to point out, that as a result of the era of patented allopathic drugs, many people in Western societies have become accustomed to the idea that only doctor-prescribed, novel chemical compounds produced by pharmaceutical organizations are legitimate. Abram Hoffer’s used orthomolecular medicine like megadoses of b-vitamins with schizophrenics to surprising success, outlined in his prolific publications. Centrophenoxine, which has been used to treat dementia conditions for several decades, remains a viable addition to mental health recovery plans.

Choline supplements work in part by assisting what is called cortical gating- basically the mind’s ability to process and inhibit certain types of information. For example, if we heard a click coming from something in the environment, our mind would quickly decide whether to inhibit our attention on a second, third and fourth clicks, should the clicking be deemed trivial. People with schizophrenia sometimes lack a robust ability to “cortically gate,” clicking sounds. These can indeed become bothersome and even frightening if only the sufferer’s mind deems the sound important.

On a practical, psychotherapeutic basis, people with schizophrenia often lack a normal relationship to the mundane, as they often see great significance in otherwise unimportant stimuli.

Schizophrenia thus appears to be not just a chemical imbalance as has been and continues to be proposed, even if only informally by highly influential pharmaceutical marketing campaigns. The ads say things like, “Seroquel works on the brains dopamine system, but we don’t know how…” What’s missing from these conceptualizations is that schizophrenia pertains to multiple, intersecting systems as divergent as to include the functioning of our cortex and limbic systems, our ability to adapt to the environment, trauma, and even our ability to digest carbohydrates

The carbohydrate connection with schizophrenia is interesting. it’s related to what Abram Hoffer found out about how niacin assists digestion of carbs, and that this is related to reversing the disease, where there often exists a compromised ability to process carbohydrates. Like the research on choline, it’s there, but we don’t often give strict diets, megadoses of niacin or choline to people with schizophrenia, I believe an example of what is called the knowledge-to-practice gap in science.

In one case study, “the abrupt resolution of longstanding schizophrenic symptoms was observed after the initiation of a low-carbohydrate, ketogenic diet used for weight loss (Westman & Kraft, 2009).” One possible explanation for the effect of carbohydrates- and especially gluten- on people with schizophrenia, is their effect on mood in people who consume them excessively. We know that carb intake causes mood imbalances in people. We also know that experiencing psychosis can cause severe anxiety or depression. A person with schizophrenia could thus be less likely to tolerate the ups and downs of mood caused by excessive consumption of sugar and flour, which could lead to increased symptoms. Given what we know about the poor moods inherent to this disease, sufferers of schizophrenia should consider diet a potentially helpful strategy in addition to their ongoing medications and therapy.

Quetiapine, another hugely prescribed antipsychotic, is known to cause cravings for sugar, especially at the high dose at which the drug is given for the treatment of schizophrenia. The drug’s capacity to lessen the symptoms is hampered by its exacerbation of dysfunction in the metabolic system, which is known to poorly impact the disease in multiple ways.

In one study on another very popular antipsychotic, the authors found that, “Olanzapine, [is] highly associated with weight gain, causes significant elevations in postprandial insulin, glucagon-like peptide 1 (GLP-1), and glucagon coincident with insulin resistance compared with placebo (Teff et al, 2013).” Now I’m not pretending to know what all that means, but what these authors showed is that this drug acts specifically on the body’s insulin system, such that people who take it often develop the symptoms of diabetes.

Though choline-type drugs are not without side effects, it is safe to say they are generally fewer than most popular antipsychotic drugs. This is important, since patient-compliance on essential medications is predictable by the side effects of those drugs. People quit Olanzipine due to excessive weight gain, drowsiness, blood-sugar problems, secondary parkinsonism, and tardive dyskinesia. Yet consider that a paper from 1995 states that CDP-Choline has, “no serious [poor] effects on the cholinergic system and it is perfectly tolerated (Secades, Frontera, 1995).”

Also, because CDP choline, centrophenoxine or things like alpha-gpc increase memory-capacity (the reason they are considered “smart drugs”) they are regularly taken worldwide for Alzheimer’s, dementia and traumatic brain injury. We therefore have lengthy studies from decades of work to demonstrate these drug’s safety and non-toxicity.

Even more promising is the fact that centrophenoxine appears to have neuro-protective effects which exist beyond the scope of the drug’s remediation of psychiatric symptoms. Centophenoxine is used, for example, to treat some of the chemical causes of Parkinson’s. We know that Parkinsons is associated with a decrease in dopamine levels in certain parts of the brain. At the same time, anti-psychotic drugs like quetiapine can induce parkinsonism, because they act in part by reducing sensitivity to dopamine (Hae-Won Shin & Sun Ju Chung, 2012). Thus, since people are generally prescribed quetiapine for lengthy periods of time for schizophrenia, their risk for developing parkinsonism increases. Centrophenoxine may reverse this risk by protecting the brain from this pernicious cycle of events, in the same way that the drug is used to treat actual Parkinson’s.

One study of the neuroprotective characteristics of choline supplementation on conditions such as Alzheimer’s found that dietary choline may even possess epigenetic effects in the brain, altering gene expressions that we once thought to be the unalterable foundations of certain disorders. Prenatal supplementation of choline-like substances by expectant moms has also been shown to prevent schizophrenia in rat babies. Also, in studies of Alzheimer’s in rats, researchers used choline supplements to not only reverse amyloidosis, but also general cholinergic dysfunction and inflammation in the brain.

Brain inflammation is strongly connected as a precursor in Alzheimer’s, brain injury and schizophrenia, and is partly what connects the experience of trauma, since trauma increases inflammatory markers in the brain and the consequent likelihood of developing serious mental health problems. Any compound capable of both crossing the blood brain barrier and reducing inflammation would seem to hold strong potential as a truly beneficial supplement.

Choline supplements are therefore non toxic and supportive of natural healing, information processing and development systems in the brain. They should be thought of as helpful chemical allies to those suffering with schizophrenia, as well as those looking to prevent major mental health problems.

Reflections on Mind-Body Transformation

The body teaches me things that help me understand my mind. In this piece I compare the deepening of hatha, physically-based yoga practice to the way clients improve during psychotherapy.

Most people in the West consider body and mind as separate entities. One of the grandfathers of modern science, Rene Descartes, defined our bodies as “distinct” from our minds, a viewpoint that has come to be known as body-mind dualism. Healing on physical -psychological levels is the subject of multiple Western sciences, medical protocols, treatments and kinds of holistic care, and most of these subscribe in one way or another to Descartes’ view of mind-body separateness.

Yet plenty of other cultures and their medicines do not presume this. Some that easily come to mind, include healthcare practices from India like yoga and Ayurveda, and those that come from indigenous cultures around the world. These tend to view dualism as dilemma rather than gift which is at the heart of the way that human beings feel sick or out of place in the world.

Yoga is considered a science. After practicing I now understand why: The title of India’s inconceivably wonderful contribution to the world of healing, Yoga, literally means “to yoke” or “to connect,” and connecting mind and body is one of the most basic, but everlasting lessons in Yoga.

Treating dualism with yoga is simple really. Yoga teaches by it’s very practice, that our separation of things, one from another, convinces the us that life is an enduring suffering. We are just another separate thing in a vast universe of other separate things, most of which care little for each others daily lives. We have concepts of God, but these usually place him at “the head” of the whole affair, in much the same way that we view ourselves as the “commander” of our bodies.

In the Vedic philosophy from which Yoga emanated the term maya refers to this ability of the human mind to conjure illusions which we then act upon as if they were real. Separateness is one such belief. Yoga teaches rather that the universe is deeply in love with the individual, and that we are not any sort of genetic accident, as the scientific materialists insist. Beyond the mind, the state of moksha exists, where student experiences this deep connected state. We are threads in the very fabric of the unfolding universe.

Yoga reconciles our smallness and vulnerability as we become our higher Selves. “We are lions,” as Swami Vivekenanda states in the yoga classic, Pathways to Joy. We are not weak or alone by any means. In fact, the whole universe is said to be behind each and every person. They are as raindrops to a lake.

Breath work is an antidote to this kind of existential pain, especially insofar as it creates a relationship to the body The separated pattern of thought is so strong, that we in the West even experience maya about our own bodies- which we somehow see as separate from our selves. Breath work pranayama is practice (yama) of breath (prana). It is one of yoga’s most basic ingredients. More, pranayama is actually the practice our life-force, a concept very similar to Chi. Life force transcends mind- body, self -spirit, object- subject paradoxes of consciousness. The breath is where union can take place, and out of which our health radiates like a byproduct.

In the West, body is normally suppressed by mind and not the other way around. Maya keeps us from developing a relationship with our own bodies, therefore developing a relationship to our bodies inspires healing. For people with mental health concerns, the experience of tragic separateness is actually very traumatizing. If one ruminates on thoughts like it, they can make us sick. I have noticed in my practice that people with psychotic conditions are particularly affected by the widespread belief in dualism. Descrates’ dilemma is not harmless. It is like a delusion, indeed, except one that large numbers of people believe, and yoga often wrings these assumptions out of students in a short order of practice.

I have met a number of previously seriously mentally ill people who nearly reversed their conditions with a powerful yoga practice. One, a full blown schizophrenic who had been homeless for 12 years though he had been brought up in wealth, used daily Bikram Yoga and the fellowships of AA to regain his entire life back.

Have you ever seen those pictures of the iceberg, whose mass is largely contained below the surface of the water? This is a common metaphor for the unconscious mind / body. The unconscious mind and unconscious body remain unexamined until we happen upon them, often following some kind of sickness. So long as the body remains below our awareness, its ability to provide stability, love and a sense of connection are left largely untapped. For people with health conditions such as trauma or cancer, the body is dangerous territory, which at best people submit to experts in bodily function. Furthermore, the West’s medical paradigm assumes a largely pathology orientation. Wellness on the other hand has for the most part been a contribution from the East, such as in Traditional Chinese Medicine, which is as comfortable treating well people as it is the sick. Imagine that.

In psychotherapy, our thoughts can explore the depths or nuances of the mind in similar ways to how our bodies get deeper into yoga poses by daily practice. Therapists use reinforcement strategies to make sure client progress is maintained in the same way that more and more satisfaction is wrought from life by doing yoga. A sense of strength and clarity ensues. One’s hips move slowly towards being pointed fully forward in Warrior 1, and a sense of physical alignment is paralleled by feelings of mental alignment. We put our bodies into therapeutic positions, then breathing as we do to “reinforce” them. It could take weeks or months for a client to be able to stop drinking, as each of their particular efforts at the cause bear fruit and hold steady.

Just like yoga and the physical body, the mind takes various shapes during therapy. States such as a deep sense of connection or the desire to recall traumatic things in session, both entail a non-ordinary state of mind. Deep trust and safety are not the condition of most ordinary people’s lives (unfortunately). So behavioral or emotional change is the product of slow and steady gains. A client with trauma has a hard time feeling anything, but they pull themselves closer to permanent feelings of connection each time they practice it with their therapist.  

Physical and mental well being go hand in hand.

There is true power, (often) locked away in the human body. Release it, like melting an iceberg, and we release into our minds. And hatha yoga is really only an entry-level yoga practice. There are seven other limbs of yoga, physical asana being only one! Each is concerned with developing this ability “to yoke” and create a sense of moksha.

Also, I should mention that there are plenty of Western psychotherapies that defy mind-body dualism. Solution Focused techniques are a good example. Solution Focused therapists make fewer assumptions about people’s inner lives, or other dualistic concepts. These therapies come from a different philosophical standpoint than traditional psychotherapies. They de-mystify healing by refusing to play expert in other people’s lives. This alone is a break from conventional psychotherapy dualities. Phenomenological approaches are another example.

At one point while practicing Warrior 1, my yoga instructor wondered aloud, “What adjustments to this body-position can you make that would enable you to remain in this position indefinitely?” The answer was immediately, to relax both mind and body as a means of conservation. My mind’s rigidity and perfectionism was reduced, and as I became softer and more resilient, so did my body. It is so important that people reflect on the changes they are making, and how far they have come.

Psychotherapists and their clients can capitalize on reversing the erroneous belief of separation between body and mind, in the same way yoga does.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an advanced psychotherapy technique used primarily to treat trauma. Known for it’s potent, predictable and relatively fast treatment effects, EMDR is supported by a wide body of research literature. It is an excellent treatment option for conditions like PTSD, addiction, dissociation and anxiety.

EMDR compliments and indeed relies upon the success of other psychotherapy strategies, while also being totally unique. EMDR uses bilateral stimulation (BLS) during recall of traumatic memories to induce the mind’s own information processing/ healing systems. If eye movement is chosen as the BLS, client follows therapist’s hand to the left and right.

The central explanation put forth regarding EMDR’s effect is the Adaptive Information Processing model (AIP). This theory suggests that the mind normally stores memories in adaptive ways, which creates homeostasis and a sense of resilience after stressful things happen. According to AIP, we come to understand troubling memories in their rightful context as the mind inherently processes information.

But sometimes, what happens to us is so troubling, that the mind is hindered from normal integration of an experience. Childhood abuse, for example. Car accidents. In such cases, the mind’s natural ability to process information is impaired, and memories are stored in dysfunctional ways. Therapy is generally aimed at accessing these memories to resolve them.

Traumatic events can therefore damage the mind’s inherent ability to store memories in adaptive ways. This means that dysfunctional material is not connected to adaptive thinking and is easily activated in the present. It is quite literally as if the part of the mind of trauma sufferers lives in the past. This leads people to re-experience, have nightmares and be afraid- the hallmarks of traumatic injury.

EMDR clinician and client carefully access these maladaptive memory networks through 8 phases of treatment. As these are carried out, memory and physical sensations are reorganized from a state-specific, trauma-induced form, into an adaptive form. EMDR assists the mind to create new neural networks around old material, such as a car accident. Signs that new neural networks are forming around old material during sessions include relief of knots in the stomach, new perspectives on the disturbing event, clearer recall of the event, and a general feeling of calm and safety… in relation to the trauma.

 For those of you well versed in this kind of work, you can understand the importance of this distinction. EMDR in essence has the power to connect disconnected parts of the self. It reaches into the client’s very own history, heals it, and instills permanent gains in the various presentations of traumatic injury.

I am so excited to be offering this technique.

How it Works

As with any psychotherapy technique, EMDR relies upon general therapist skills such as rapport building, the ability to hold space, grounding techniques, and awareness of client readiness factors. The therapist’s job is to build a solid relationship and helps client develop self-soothing skills. It is then that reprocessing can begin.

This technique is very specific. As with any psychotherapy, its power to heal can also be the capacity to do harm. Maintaining fidelity to the core aspects of the technique is a must. Unskilled or amateur practitioners in EMDR could be a hazard to people dealing with real trauma.

To help clients prepare, EMDR therapists also use The Window of Tolerance model. I teach it to my clients. It can act as a form of biofeedback, similar to the SUD (subjective units of distress) scale. As such it is a valuable skill as well as a theoretical model.

The Window depicts a zone of optimal arousal, where feelings of safety and connectedness pervade the individual’s experience. This is sandwiched between zones of hyper and hypo arousal, where the client experiences fight/flight/bite/ freeze responses, typical to trauma. The EMDR therapist guides their client into these dysfunctional states to reprocess them, while working to keep the client in optimal (connected) arousal. This is a skill known as dual awareness- one foot in the past and one foot safely in the present. You and your therapist work towards developing dual awareness prior to reprocessing the memories you have selected.

SUDs from 1-10 help clients subjectively gauge their current level of upset for targeted memories. Each SUD adds to therapist’s growing clinical picture of what and how the client has been affected. A sense of competence emerges in clients through history-taking, as they begin to look forward to ameliorating problems that have been holding them back.

EMDR empowers clients to be bold. We can resolve our trauma! EMDR is one of the psychotherapy techniques that make this statement true.

You will be introduced to bilateral stimulation. Eye movement is my preferred method. I use hand pulsars or headphone beeps as a second option. Everything is explained as part of informed consent. Sometimes clients used to talk therapy find this technique feels quite different. EMDR does not place a high priority on the words that occur between sets as healing is taking place. Words spoken between sets are noted, held compassionately, but then followed up by another set of bilateral stimulation and processing is resumed immediately. There is a debrief after each session, where the things which did come up in reprocessing are discussed at greater length.

Clients can expect relatively rapid resolution of traumatic memories during EMDR. One of the best things about being an EMDR clinician is the effect seen in clients, often regarding issues that have proven resistant to other forms of therapy.

I am excited to be fully trained in a psychotherapy technique with the impact of properly conducted EMDR therapy. I offer free 20 minute telephone conversations to anyone interested in finding out if this kind of therapy is right for you.

 

 

 

 

A Range-Based View on Addiction

A Range-Based, Continuum Conceptualization of Addiction

How should therapists view addiction? Haha, tricked you. There are no shoulds… You’re a therapist you should know that!!

But seriously. A range-and-continuum based conceptualization of this disease could add to the lenses you may already use as a psychotherapist to view and treat addiction.

The notion that a concrete threshold divides addicted states from non-addicted states, or addicted people from the non-addicted, has been challenged through various addictions research. The illness may not be absolute. Pneumonia: one either has it or not. Addiction: a chronic disease is more likely to wax and wane through time.

Also to bolster this idea is the fact that people quit addictions/ behavior permanently all the time. One of the addictions we know the very most about is tobacco, and there are literally millions of easily tracked success stories which exemplify how treatment and education around tobacco help people quit. Also, there are large numbers of people in long term abstinence based recovery such as NA, who demonstrate the idea that addiction can be stopped.

This is defining addiction in the simplest terms: That addiction takes place when one engages in substance/ behavior, but then ceases to exist- or exists in a less severe way- as one’s use wanes or vanishes. Adopting this notion even temporarily is important as it gives a simple success marker: when addicted clients stop or reduce their substance use, their lives will likely dramatically improve.

This basic definition of addiction does not, however, conceptualize how addiction creates traits in people that support addictive behavior in the first place. For example, addicted people often isolate themselves, and this isolation tends to follow the client into their recovery. It must therefore be resolved.

Isolation is also one of the hallmarks in trauma survivors, and resolving trauma is essential for people in recovery. However, a simple definition of addiction as the actual use of substance makes sense, especially given that it’s a straightforward way for clients and clinicians to gauge the effectiveness of treatment strategies.

Also, the harm reduction model and other models stemming from it like the Stages of Change, already use the idea that people engage and disengage from addictive behaviors in cycles. From a Stages of Change perspective, it is routine for people enter, but then exit, addictive states.

Thinking this way may present challenges, especially for folks who feel certain that addiction has been perfectly defined. Yet an exact set of criteria for addiction has always remained imperfect and continues to evolve. In the book, Alcoholics Anonymous, which had a large impact on the American medical community at the time, its author Bill Wilson mused whether the compulsion that follows a single drink by an alcoholic might be the product of an allergy. Following the publication of the book in the 1930’s, members of the medical community used the notion of allergy to explain why alcoholics experienced the act of drinking differently than normal people. The traits they exhibited, which had been universally noted by doctors treating drunks in sanitariums, included a “phenomenon of craving” which ensued following a single drink of alcohol.

Since that time, studies have indeed shown, for example, that certain people’s livers do not process alcohol as effectively, leaving it in their bodies and brains longer. This means that they derive extra pleasure from the experience, which in turn makes it more addictive. These findings generally point to biology and genetics as the predicates for addiction.

Yet another compelling descriptor has also emerged in research about this very phenomenon, which differs from hereditary theories of addiction. That is the integration of the research on trauma. Trauma and addictions research have shown us that the “compulsion-following-one” phenomenon seen in addicts can be partly explained by understanding how chronic stress resulting from trauma affects the body and brain. When the mind and body are exposed to ongoing trauma, cortisol and other fight/flight/freeze chemicals induce chronic inflammation, which produces lasting biologic changes in sufferers. This sets them up to crave. For example, in certain clients with PTSD, a single glass of red wine or dose of oxycodone feels like deep, inexplicable relief. And yet this explanation makes good sense, does it not? This “added relief” provides the user with an experience that is incomparable to how a person without trauma feels after doing some partying.

Thus, there are various ways to describe and treat addiction. Some of the most compelling of these address environmental factors and how these intersect with biology to produce the symptoms of addiction.

Addiction varies in other ways. It widens as a diagnostic phenomenon over time as we learn. For example, the current, 5th edition of the DSM from 2013 defines addictive gaming use as a “disorder not yet classified.” Gaming addiction, however, will likely possess a distinct diagnostic category of disease in the next DSM same as gambling does now. My point is that if addiction can mean both “gaming” and “IV heroin abuse,” then our concept of addiction varies greatly both clinically and diagnostically. From this perspective, the addicts therapists see in their office day to day, are a puzzle. Each one must be considered from multiple angles of both etiology and treatment, even as the categories of what constitutes addiction radically change over time. .

A range and continuum based model might add something of value to how clinicians see addiction. I have found that clients generally inhabit a distinct range of severity. For example a client who meets the criteria for alcoholic drinking but who maintains a host of friends, a successful career and a family, will occupy a range of severity of overall addictive behaviors lower on the continuum than a crack cocaine addict who is homeless and ill from hepatitis c. If your client is more the latter, their gambling is likely also often severe. For example, I have met numerous methamphetamine addicts who spend hundreds each payday on scratch tickets or other legal gambling. You may find similar associations, such as amphetamine abuse and sex addiction, especially among men. Severity in one substance or behavior is often accompanied by severity in another one.

We also know that experiences such as having a drug-abuse related illness like hep-c will be more likely to make your client’s addiction worse, not the other way around. Unfortunately, the worse it gets, the worse it usually gets.

Defining addiction as something that ebbs and wanes through time, encompasses a more complete spectrum of addictive intensities, as they would typically present in a client. A range-based view of addiction captures an organic cycle of severity. This cycle evolves into (hopefully) lower ranges on the continuum through time, therapy and healing.

Picturing a range of severity is also consistent with the Stages of Change model, which explains the cyclical nature of motivation amongst addicted people. The range based view is a small lens amongst all the other lenses therapists use, to understand and treat the large percentage of clients who may never be extremely addicted but who, we are discovering, compulsively chase reward-stimulation, such that their lives suffer in even some small way due to this behavior.

 

 

 

Three Reflections on My Spine

Three reflections on my low back:

  1. If you work construction, don’t do it every day.
  2. Massage therapists: You were right all along.
  3. Yoga practice is to spinal mobility is to back pain.

 

Point 1:

This first one is a bit hard to remedy without time travel. It’s less an insight about my back pain and more a directive to all those young at heart, who are thinking about a career in construction. From here in 2018, all I can do is warn against it. I can’t go back in time, quit the roofing company where I worked for almost 3 years, convince my 20 year old self to a sit down with a career counsellor, then get back to the future in time for dinner.

By the way, if anyone reading this has an “in” on a machine like that, let me know. Even if it’s just a make-believe cardboard box with a door cut into it that dad made the kids, I’d probably still try it. Lord knows I’ve tried everything else including those electrified suction cup sponge thingies that they put on my butt at physio. I honestly have no idea what those things do.

So point 1 for me is about making choices based on the future health of my spine. This includes everything from being careful with movements such as lifting, to making sure I stay mobile if I’m seated for lengthy periods of the day. Avoiding as much as possible extremely hard work like roofing is part of that equation. Count within that bricklaying, landscape construction, concrete work, and flooring. Those were the hardest types of work I ever did.

One thing construction taught me about my spine was about how bent forward I was for much of my working life. Whether picking stuff up, or carrying pails of paint, or helping friends move, even sweeping up….I hunched a lot. I discovered everyone tends to hunch forward and is a general posture problem. Now that I work at a computer a lot, I can see that sitting pitches me forward as well.

It might sound simplistic, but one of my solutions to bent-forward shapes, is to make bent backward shapes as counterpoint. Lengthen upwards and bend backwards, my spine simply love it. These movements maintain a functional active spine, even if spontaneously breaking into warrior 3 or camel pose during your day will surely earn you some funny nicknames from you coworkers. Yoga Bob is the most common one. Not too bad, right?

Well, I’m yoga Bob, and Yoga Bob lengthens and bends his spine nearly every day, because they make my back feel better. Even when Im on a construction site and the other fellows snicker.

Point 2:

Yes, fine, ok? Public admission: Massage therapists, you were right, and I was wrong. Can I go now? Would you prefer a video confession? I admit, I asked you to massage the most painful lower eight inches of my spinal muscles for an hour straight until your hands would have probably lit up a smoke out of boredom.

Thankfully you went right ahead and worked on my hips, gluts and the other portions of my spine, after I fell asleep on the table. In fact, it was massage therapists that helped me identify trigger points. The most serious one is a small section where my lower ribs start, that is locked into engagement. That area, not as painful as my lower back, actually holds a larger pattern of dysfunctional movement/ immobility in place. Because of this section, my spine struggles to act “as a whole,” as the lower and upper back are blocked from coordinating better as a unit. Even a little bit of tennis ball work on this area, as advised by RMTs I’ve seen, has produced good results.

Also, Ive learned that self-image, or body-image, plays a role in spinal dysfunction. The spine is a dancer. It loves revolving, and swaying and making waves. But I didn’t see it or experience it that way. I didn’t see my body as fluid, relaxed, and powerful.

Instead, my general approach to body has always been fuelled by the desire to look athletic, or be strong. To be hard. On top of construction, I always played sports, where I could fantasize about being invincible. I would look into the mirror and desire a harder, faster and tougher me. But trying to run faster or be more athletic has resulted in, amongst other things, a lack of full movement in my hips. I have basically trained them to do one or two things well, forgetting about them otherwise. So rather than possessing an entire range of motion in my hips and low back, I have quite a bit of immobility. But I know now that I literally trained these areas to be immobile.

Immobility is the central idea that has assisted me in reversing my spinal issues. Rather than seeing in terms of pain, I see my pain in terms of immobility.

I’ve learned mobility- making my spine a bit more of a dancer than a worker- has involved un-learning as much as learning. As I’ve hung around yogis, I’ve met a great number of people whose hips were fluid, open and strong. Their bodies express “ease.” So now, I look into the mirror and try to motivate myself to realize “ease.” Idealizing a more relaxed state is making my spine more mobile.

Kundalini is a yoga that should be mentioned in yoga-for-back-pain-discussions. It is a yoga designed, amongst other things, to release power from the lowest spine, (and lower self) into the upper spine (into the higher self). In Kundalini, this power is imagined as a coiled serpent of physical and spiritual energy, awakened through the yoga.

The Kundalini serpent of energy reveals that there is locked power in some of the most seemingly injured parts of my body. That sounds fairly radical. It opens up a whole different way of approaching certain kinds of injury. Rather than avoiding painful areas entirely, I have learned I must go into them. The pain in my low spine, incidentally, correlates almost perfectly to the coiled Kundalini at the sacrum. When released with  movements, parts of me are awakened. One of those awakenings is simply more movement in my spine.

This contextualizes injury and recovery in spiritual terms, as I believe they are.

It has been problematic to view physical pain from only an “injury” perspective. Seeing painful areas of the body as “un-released” power rather than “weak,” even momentarily, gives me the motivation to enter into relationship with these areas. There is something about an injured part of the body that says, “don’t go there.” And so, as many pain specialists will confirm, the mind is also locked into place with these kinds of injury.

There are many yoga exercises that produce spinal and lower-region mobility, such as seated spinal flexes, which work best when the movement originates from the very bottom of the pelvis, where the butt touches the floor. That makes the work come almost perfectly from the exact areas of the tight, sore and immobile hips/ low back. They can be done very gently. Another example is cat-cow, done at various paces. Quicker, I use a pumping breath or even breath of fire, where cat-cow transforms into a cardio exercise. Building internal heat builds limberness.

Point 3. Yoga has been voted one of the activities least likely to make your spinal issues worse. What was once perhaps a curious trend is now widely accepted and encouraged by Western medicine, especially those involved in healing pain. In my opinion, this is because unlike many forms of fitness, yoga facilitates ease as much as it does strength. It actually connects the two.

One reason is that yoga has a very different notion of strength working in the background of both its philosophy and practice. At its most distilled, prana or pranayama, denotes life force, much like “Qi,” in Chinese medicine. Yogis quickly refer to the breath when defining prana to students, but the concept is much wider than breath alone. There is an esoteric aspect to prana, in that by practicing prana, the student engages the very power of nature itself. This corresponds to a sense of connection and a great feeling of ease. Prana work can confirm experientially that we are indispensably connected to the whole. Prana entails energy that is beyond the individual. It is the condition of life itself, and pranayama is a way of practicing relationship to that vast source-power from which we emanate.

What does this have to do with a low back pain? Pranayama is the practice of relaxation and strength at the same time. Pranayama is also a kind of intelligence contained in the body, so it is instructive. There is a part of me that knows exactly what to do for my spine. My practice is strongest when I let that part of me guide it. There have been occasions fairly rare up to now during yoga, where the breath work produced a sense of energy in the pit of my stomach that seemed to be guiding the entire affair. In that frame of mind, the body’s complaints and stiffness are put into very different perspective. It’s like I can’t wait for what comes next in the practice.