Category Archives: Recovery Science

Treating Men with Co-Occurring PTSD and SUD

The co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is of increasing concern to treatment professionals. Estimates of PTSD prevalence rates among persons presenting for substance abuse treatment range from 35 to 50% (Boden et al., 2012). This is clinically significant because persons who present with co-occurring PTSD and SUD exhibit high symptom severity in both disorders and worse treatment outcomes, including higher relapse rates, than those with only one of the conditions (van Dam, Vedel, Ehring, & Emmelkamp, 2012).

KindesmisshandlungFurthermore, men experience lifetime rates of trauma which are significantly higher than that experienced by women (60.7% as compared to 51.2%) (Najavits, Schmitz, Gotthardt, & Weiss, 2005). Studies have shown that men with PTSD are at greater risk to develop SUD with lifetime rates of alcohol use disorder estimated at 51.9% and other substance use disorders at 34.5% (Najavits et al., 2005). Given these numbers, evaluating which approaches are most effective in treating men with co-occurring PTSD and SUD is of paramount importance. As such, the purpose of this article shall be to address the following effectiveness-based question through survey of the research literature: For men who present with co-occurring PTSD and SUD, what interventions are most effective in improving treatment outcomes by reducing symptoms of both disorders.

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Assessment Protocols for Adults with Substance Use Disorders

According the Substance Abuse and Mental Health Services Administration (2013), an estimated 23.9 million Americans are current illicit drug users. These numbers raise serious concerns given the devastating consequences of addiction borne by individuals, families, communities and society as a whole. Furthermore, The National Institute on Drug Abuse (2012) estimates that addiction costs the nation in excess of $600 billion annually. Given this, it is important to evaluate instruments and measures utilized by treatment professionals to assess and diagnose substance use disorders. The purpose of this paper shall be to undertake such an evaluation of two widely used assessment protocols – the Substance Abuse Subtle Screening Inventory (SASSI) and the Addiction Severity Index (ASI) – by appraising the reliability, validity, feasibility, accessibility, and overall appropriateness of these measures in screening and assessing adults with substance use disorders.


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Exercise and Relapse Prevention

Some researchers have stressed the importance of helping individuals in early recovery to develop “positive addictions” such as increased physical activity and/or meditation.  And even though lifestyle modification is one of the main components of Marlatt’s relapse prevention model, this element has received the least attention in substance abuse treatment programs.  Nevertheless, engaging in regular exercise provides a number of potential benefits including allowing individuals to experience positive mood states without the use of drugs; helping to reduce depressive symptoms which have been tied to risk of relapse; improving sleep and cognitive functioning (each of which have been identified as being disrupted in early recovery and predictive of relapse); and increasing self-efficacy while decreasing stress-reactivity.

The following presentation describes the results of a single subject design research project undertaken by the Site Administrator investigating the impact of aerobic exercise on perceived stress.  It was recorded by the Site Administrator in March 2014 in partial fulfillment of the Masters of Science in Social Work degree at the University of Louisville.

Mindfulness Meditation and Substance Use Disorders

A Systematic Review of Literature

(This systematic review of the literature was written in March 2014 by the Site Administrator in partial fulfillment of the Masters of Science in Social Work at the University of Louisville)

In 2010, between 153 million and 300 million people aged 15-64 worldwide used an illicit substance at least once in the previous year (UNODC, 2012).  According to the Substance Abuse and Mental Health Services Administration (2013), in America alone, an estimated 23.9 million persons age 12 and older are current illicit drug users.  Of these, an estimated 22.2 million persons aged 12 and older were classified with substance dependence or abuse in the past year (SAMHSA, 2013).  These numbers raise serious concerns because addiction has far reaching health and social consequences.  It is estimated that there were between 99,000 and 253,000 deaths globally in 2010 as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma (such as vehicle accidents) (UNODC, 2012).  Additionally, drug abuse leads to maladaptive behaviors that interfere with the individual’s ability to function normally in the family, at work, and in the community at a cost to the nation in excess of $600 billion annually (National Institute on Drug Abuse, 2012).  Given the prevalence of addiction in the population and the toll it takes on individuals and society, the development of effective treatment interventions is of utmost importance.

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Mindful Living: A Proposed Relapse Prevention Project

Substance abuse prevention is generally thought to involve primary and secondary prevention strategies which target populations that have either not yet engaged in use of alcohol and drugs (though they may be at risk to do so), or those who are in the very early stages of alcohol and drug use (Wilson & Kolander, 2011). Though efforts to prevent the onset of addiction are important, of equal concern is substance use relapse prevention wherein the stabilization brought about during treatment is preserved, and long-term abstinence is promoted.

Unfortunately, it appears that relapse prevention is often viewed as an afterthought of treatment wherein patients are discharged with little meaningful guidance nor provision of resources to aid them moving forward in recovery (McClellan, Lewis, O’Brien, & Kleber, 2000). As experts in the field continue to acknowledge that addiction is a chronic rather than acute condition, the provision of continuing care for those who have completed treatment must likewise adapt to meet this emerging awareness. To this end, the following substance use relapse prevention project, Mindful Living, is proposed.
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The Karma Effect

I am the owner of my karma.
I inherit my karma.
I am born of my karma.
I am related to my karma.
I live supported by my karma.
Whatever karma I create, whether good or evil, I shall inherit.

— The Buddha —

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The Philosophy of Unconditional Acceptance

Dr. Albert Ellis (1913 – 2007)

The Greek Stoic Philosopher, Epictetus, wisely observed that

“Men are disturbed not by things, but by the views which they take of them.” 

Though the statement itself may be short and simple, the philosophy behind it is profound.  It is a philosophy that was not lost on Dr. Albert Ellis who, as a result of his own neurotic self-disturbing, learned at an early age what Stoics like Epictetus had known long before — we are, with few exceptions, responsible for our own psychological well-being and that, for the most part, we create our own neurotic tendencies.  It is upon the foundation of this simple philosophy that Ellis created the forerunner of all cognitive-behavior therapies — Rational Emotive Behavior Therapy (REBT).  It is a therapeutic approach which empowers the individual by exposing the myth of self-esteem, and by offering instead the philosophical approach of unconditional acceptance.

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The Obituary of Albert Ellis

(originally published in the Obituary Section of The Guardian on August 10, 2007)

Albert Ellis (1913-2007)

Shyness was among the many problems successfully treated by the American psychotherapist Albert Ellis, who has died aged 93. But it was not an affliction that it was wise to bring along to his legendary Friday night workshops, on Manhattan’s Upper East Side: there, patients were hauled up on stage in front of an audience of hundreds, to be rigorously cross-questioned by Ellis, usually with plenty of swearing. “Let me tell you why people are always making you so angry,” he informed a troubled young woman, one warm evening in 2005. “Because they’re screwed up! They’re out of their fucking minds! We’re all out of our fucking minds!”

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On Human Nature

Discourse on human nature tends to focus on those natural characteristics which appear to distinguish humans from other forms of life. The general theme is usually anthropocentric and goes something like “that which makes us different is that which defines our humanity.”  While comparing differences is informative in some contexts, it is an exercise that is too often undertaken as a means to demonstrate a special, preordained standing in nature for mankind and moral supremacy.  In fact, the essence of human nature is not that which sets us apart from or above other forms of life, but those characteristics which we share in a common evolutionary history.

It is along this continuum that core human operational modules — such as survival, socialization, and the pursuit of happiness — have developed by natural selection.  Thus, it is from the broad perspective of unity and inclusion that human nature is best described and from which an understanding of morality may be gained.

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Believing Again

Aristotle and Plato engage in philosophical discussion.

To say that the human mind is complex is a vast understatement.  Cognitive functions such as believing, hoping, and desiring are intertwined and interrelated to such an extent that each resists reduction to simple explanation.  The relationships between these processes are at times unilateral, and at times multilateral; parallel at times and perpindicular at others.

Further complicating matters is the nexus which forms between multiple disciplines when  studying the workings of the human mind.  The principles of philosophy, psychology, sociology, logic, and linguistics all come to bear with equally convincing force upon the subject.  Notwithstanding these and other limiting factors, the concept of belief is explored.

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