FHE Health offers a partial hospitalization and intensive outpatient treatment program. These programs are designed for recovering patients to help them transition smoothly back into their everyday lives, able to face the challenges of a busy, high expectation society. Florida these days, like the rest of the world expects a lot of people. Work is busy, kids have to be everywhere at once and their schedules sometimes seem busier than an adults.
Even if you don’t have kids, adults are expected to work and do more than ever before. With all of these pressures someone may suffer from more than enough stress to drive them head long into relapse, even without any dual diagnosis or co-occurring disorders that they may face. Transitioning from inpatient rehab to the world outside can be jarring. FHE offers solutions through their outpatient and partial hospitalization programs.
The Truth About Relapse
When someone gives everything they have to their medically supervised alcohol or drug detox, and their rehab program they may finish the treatment scared of nothing more than the devastating possibility of relapse. Without consistent continuing relapse prevention therapy, the worse can feel like an inevitability to an addict. Like at any moment they may react strongly to a trigger or fall into one of their cravings and not be able to stop it. This sense of helplessness or lack of control over their disease is more than problematic and indeed can itself lead to a devastating relapse.
When it feels like their substance of choice is just waiting for a chance to, at any moment, take over their life again, the way the same intoxicant ran and ruined their life before they went through a drug or alcohol detox and rehab treatment, every moment can be anxiety ridden. If they suffer from a dual diagnosis or co-occurring mental health disorder this type of stress regarding relapse can really easily trigger a relapse. The anxiety the person suffers from can become all encompassing, resulting in a person reaching for something to calm their mental health disorder, and landing them right back to the place they started – broken, and wasted, and ashamed. A relapse, when experienced, can be very scary and statistics show that relapses have a higher rate of fatal overdose.
Once someone reaches active recovery – the phase of recovery when someone has reached sobriety – they need to continue managing their symptoms through consistent and ongoing relapse prevention treatment. Addiction is a chronic illness. It never goes fully away and there is no possibility of a cure, but through aftercare treatment it is more than possible to manage the symptoms of addiction so that the person who has an addiction to drugs or alcohol can live a relatively normal and happy life. Through FHE’s outpatient and partial hospitalization programs, a person recovering from addiction can find a place where the person struggling with chronic disease can transition more smoothly into the community, without the metaphoric whiplash that a lot of programs trigger when they shove addicts directly out into the world without any protection against relapse when they still suffer from unrefined life skills to withstand triggers and cravings.
A healthy respect for how serious and common relapse is is a necessary mindset for avoiding the incident. It means that someone is ready to live a life without the substance. However, the kind of intense fear of relapse that happens to so many can easily lead the person down the deepest rabbit trail that deposits them in the worst place of all, back in the arms of their chemical dependence. However, rather than falling into this trap a recovering addict can take intentional steps to safeguard against relapse. It is vital to create a life with the kind of infrastructure necessary to allow the addict to build healthy boundaries so that they can continue to be strong against triggers and cravings, remaining in active recovery and managing their sobriety effectively with the life skills they learned in rehab. The most important thing to do to succeed in this effort is to continue the work that started all the way back in detox in FHE Health outpatient or partial hospitalization relapse prevention therapy program.
Relapsing is unfortunately part of most chronic diseases. This fact is true and should help an addict to realize once again that their addiction is not a fault, it is a disease and if relapse happens they must not blame themselves. But it is also vital that relapse is not underestimated. If someone revisits their substance of choice, the results can be tragic because they so often do not consider the fact that they have been sober since detox. Their body no longer wants the drug and it certainly does not want the amount of the substance that the person had previously consumed in order to keep up with what was at the time a growing tolerance.
People usually can justify anything to themselves if they are facing the right trigger or craving. If their defences are down and they don’t have the skills necessary to help them hold their ground the wrong kind of bad day can easily get them to pick up the pipe, or the glass and enter into that tragic habit once again. Hundreds of thousands of drug related deaths happen every year due to relapse because users take the same dose they were taking when they left the drug and walked up to the detox and rehab center and asked for the help.
When an addict makes their way back to the previous dose that made them feel just right before detox and before the rehabilitation therapy, the length of time they have been without the drug in their bodies will often cause an overdose and more often than before someone gets help this type of relapse can end in death. Though tolerance can accelerate quickly, it still needs time to build up in the system. Often people who overdose want just one hit, maybe they just want one taste of their old addiction, the sense of wellbeing they once felt, and they forget that there is no way to walk away clean. If the worst does not happen and they survive the intoxication, they will likely become prisoner again to chemical dependence and emotional addiction.
Continuous aftercare treatment in the form of continuing behavioral therapy with individual therapy sessions, group therapy, a 12 step program, among others. Likely the program will include a number of these different strategies. These programs help the addict sharpen their emotional intelligence and teaches them ways to be more resilient in the face of real world triggers and cravings. These types of group programs can feel harder sometimes to people. Programs like group therapy and any number of 12 step programs out there, but they offer a support system that addicts desperately need after rehab. It really isn’t possible to have too many people pulling for a person who is struggling with addiction.
While detox and wellness centers are everywhere these days FHE Health offers best in class quality of service, licensed medical staff as well as a qualified florida psychiatric services staff. Our advanced neuro treatment program can help us diagnose mental health disorders or dual diagnosis so that treatment programs can truly be individualized. This kind of treatment can allow for a lessened likelihood of relapse, along with the outpatient, partial hospitalization program.
According to the National Alliance on Mental Illness (https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis) a dual diagnosis, otherwise known as a co-occurring disorder or a comorbidity, is when an addict suffers from both chemical dependency on a substance, be it alcohol, prescription medications, or lllicit drugs, as well as some form of mental illness. The addict experiences symptoms from both disorders at the same time. It doesn’t matter which came first the mental illness or the chemical dependency and emotional addiction to an intoxicating substance, the two disorders will frustrate each other and ultimately lead to more persistent and life threatening addiction as well as a more dangerous and formidable mental health disorder. In order to avoid relapse, a person with co-occuring mental health issues must treat the disorder simultaneous to the addiction. In FHE’s partial hospitalization program, the addict can be sure that there is proper treatment for both disorders.
What Does a Co-occuring Disorder Look Like?
Dual diagnosis, or co-occurring disorders, come in many different forms. Because that is true there are countless different symptoms and consequences that an addict may need to deal with. Drugs and mental illnesses alike range from high energy to no energy for instance, from eating too much to malnutrition and everything in between. Having a deeper understanding of common co-occurring disorders will widen the perspective on what could be causing a person to suffer ever deeper with their addiction. Learning more about psychology and mental health disorders also offers the addict the ability to grow empathy for those who suffer from other disorders. People whom they may meet in rehab or outside of the programs at FHE will appreciate the understanding just the way the addict themselves would appreciate the same type of empathy and understanding .
Common Mental Health Disorders That Can Act As a Dual Diagnosis to Drug or Alcohol Addiction Are:
- Post Traumatic Stress Disorder, or PTSD – PTSD is a mental health disorder that often occurs in someone who has themselves experienced or witnessed some kind of traumatic event like a natural disaster, a violent crime, a tour of duty, among other traumatic events. People with PTSD have thoughts and emotions that cycle through their brain constantly and remind them of their trauma, consequently disrupting their lives. Flashbacks, nightmares, and overwhelming fear become ever present without proper treatment and can indeed send them falling into an addiction.
- Major Depressive Disorder – Major Depressive Disorder is a mental health disorder where the person struggles with low energy stores, loss of interest in the things the person was previously excited about, extreme weight loss or gain, severe insomnia, and suicidal ideation.
- Generalized Anxiety Disorder, or GAD – People who struggle with GAD present with a more or less constant foreboding about any number of different issues in their lives, rational or irrational. Some common anxieties are career related, financial in nature, family stuff, or other anxieties. Due to a deep fear of being out of control, GAD patients try to proactively take control of risky or possibly worry inducing situations which can sometimes lead to even worse outcomes. GAD patients often end up reaching for some type of substance to calm their worry.
- Bipolar Disorder – Bipolar disorder is characterized by a person who experiences cycling moods. These moods can range from manic, hypomanic, depressive, and deep depressive state.
- Eating Disorders – Eating disorders are another kind of mental illness where the person has to deal with not only the side effects of their eating disorder, but a deep and abiding stigma from the community and wider society around them. It is clear that social stigma plays a disturbing role in sustaining the disorder for those suffering. The thing that someone who hasn’t had experience with this type of disorder either themselves or through a loved one, might not know is that eating disorders are emphatically, an illness, a mental health disease. It is not a choice made by the suffering person. Eating disorders are more complicated than society believes. Eating Disorders are common in someone who has experienced any kind of trauma
- Personality Disorder – Personality disorder is a type of mental health disorder causing a person to suffer in their relationships and can often result in complications with in people’s careers and personal lives. There are a few different types of personality disorders and the different kinds of personality disorder have their own sets of symptoms, however all of them tend to have a hard time dealing with everyday stressors, leading people to some form of addiction.
- Panic Disorder – Panic disorder is mental health disorder under the category of an anxiety disorder. The person who suffers from this disorder experiences panic attacks which are overwhelming and sudden feelings of deep fear and loss of control. Usually there are also physical symptoms present like sped up heart rate, or a heavy weight on the chest.
- Obsessive Compulsive Disorder – Commonly called OCD, this disorder presents through a person’s reactions to their own rational or irrational thoughts and obsessive fear or paranoia. The person suffering from OCD sufferers great discomfort and from these obsessions. They haunt the person with the disorder. Unable to escape their own disturbing and often terrifying thoughts and specific anxieties, the afflicted person develops compulsive habits. These compulsions are the efforts of the person’s mind to try and ease their obsessions, and to try and work against the constant anxiety and obsessive fear in some way.
Treatment for Substance Use Disorder with a Dual Diagnosis at the FHE PHP
FHE’s partial hospitalization program and intensive outpatient programs are just as focused on treating dual diagnosis properly as our intensive inpatient programs are. The trickiest part of a dual diagnosis is dealing with making sure treatment is lined up simultaneous between the two disorders. As noted, the person struggling to recover from drug or alcohol addiction who also suffers from a dual diagnosis cannot avoid the fact that they must address both addiction and mental health. If they do not they will . invariably will fail. Even when it seems like one disorder has been addressed the substance abuse or mental health issues will return with a vengeance again as they calm the symptoms of the other disorder. The two disorders will hold each other up and keep each other strong until treatment for both simultaneously is found.
Before a deeper understanding of the way mental health disorders and co-occurring addiction function together, from years of scientific study, became more widely accepted, even doctors were a part of the stigma problem. Some doctors in fact might have refused treatment to a person suffering from both substance use disorder and dual diagnosis mental health disorder. They would explain, falsely that they were unable to treat mental health because of the way the believed that the person “insisted” on continuing to drink or use. Even doctors who just in terms of their biological expertise should have understood otherwise, allowed their judgement to be clouded by cultural and societal norms. Luckily, these days, most doctors would never turn someone away due to either type of disorder, be it mental illness or addiction. But not long ago even physicians treated these disorders like they are a choice made by the addict’s themselves. One that they could easily walk away from if they weren’t so flawed.
Society has come to the realization, or is at least on it’s way, and have learned through great suffering in our communities that both of these disorders are very much medical problems and both of them must be treated immediately and concurrently in order for the patient to truly reach remission in either one.
At FHE Health our qualified staff of licensed professionals support the dual diagnosis patient from detox through outpatient relapse prevention aftercare. We believe that addressing each individual’s state of mental health when creating a treatment plan is vital to the success of treatment. Our PHP program can help the person struggling with dual diagnosis in Florida – psychiatric services in addition to medical treatment can pave the way for sustained sobriety and recovery.
Behavioral Therapy Takes Many Different Shapes
Behavioral Therapy comes in many forms but the goal is always to cause some type of change in someone’s behavior. Some kinds of behavioral therapies are more well known than others. As a whole behavioral therapies of late have garnered much attention as being a sort of bedrock for substance abuse therapy treatment. In fact the addiction treatment world has seen a significant increase in focus on all kinds of behavioral therapies throughout treatment facilities in Florida and across the united states. Drug detox and rehab can be paired with some in depth behavioral therapy to increase the likelihood of a successful life lived in sobriety for the recovering user even after the transition from PHP or outpatient recovery takes place
Behavioral therapy is a kind of treatment that includes teaching those who suffer from drug and alcohol addiction the life skills they need to be able to recognize their triggers and the way they respond to different difficult situations. Being aware of the way their behavioral and emotional responses form in an effort to effect change in behavioral habits, the very same habits that likely led them to this place at this time is a vital part of being able to face the outside world. This kind of therapy affords the patient an opportunity to put away the kinds of coping mechanisms that were maybe even survival coping skills to begin with, but that are no longer functional for them, and indeed may be leading them down a path of self destruction. FHE offers dialectic behavioral therapy and there are many behavioral therapies that an addict may adopt as they move though aftercare.
Some of the more common behavioral therapies used for substance abuse and addiction recovery therapy are:
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Motivational Interviewing Therapy
- Contingency Management Therapy
Cognitive Behavioral Therapy
Cognitive behavioral therapy is a therapy centered around teaching patients the kinds of skills they need to face challenging moments and behave in the way they want to. This takes underlying skills like being able to recognize shifts in mood and emotional response. It takes a profound and fundamental understanding of one’s own self for the person struggling with the chemical dependency, and an understanding of addiction and the substance used itself.
This kind of intentional self awareness teaches someone struggling with addiction how that person came to their addiction, what addiction itself is at its core, the way the patient’s prefered substance changes or shapes what that all means, how the patients individual addiction functions and how it feeds off of other elements in a person’s life. Learning these things can be overwhelming. It can be intense to come to fuller understanding about what a drug has been doing to one’s body. It can be terrifying to confront our own shame and un dealt with trauma, but all of this allows the recovering user to learn the tools they need to alter the way they allow triggers to affect them, it helps them shift their reactions to cravings no matter how strong.
One of the most important aspects of cognitive behavioral therapy is that it can help recovering addicts to be able to find compassion for themselves, resist the shame spiral this adds to not only higher quality of life, but generally increases the chances of success in the recovery of any person struggling with substance abuse and chemical dependency. This is especially valuable to the person who has a dual diagnosis, or co-occurring disorder and is struggling with an addiction to a drug or to alcohol also suffers from some form of mental illness such as schizophrenia, personality disorder, generalized anxiety disorder or depression.
CBT is created based on a few foundational principles. Those include:
- Behavioral problems are often based on improper learning, incorrect or inappropriate understandings of one’s self and the world around.
- Practice makes perfect but practice also makes a bad and wrong habit. If you practice 2 + 2 = 3 too many times you may solidify that thought as a habit. If you believe that you’re worthless and tell yourself that too many times, or hear it from someone else too many times, you will literally have a habit of believing that about yourself. This can drive anyone to addiction.
- It is possible to unlearn thinking patterns and learn new ways to cope with the world around. Old coping methods may have started out as survival coping skills especially in abuse or neglect survivors, but have since become problem behaviors as you grew out of the need for them. CBT can help relieve the need for them, and not only that, CBT can make it so you fully realize that you no longer need them anymore.
Dialectical Behavior Therapy
Dialectical behavior therapy, or DBT, is a cognitive behavioral treatment developed by Dr. Marsha Linehan, an adjunct professor of psychology and psychiatry at the University of Washington. Linehan received a lifetime achievement award due to the book she wrote on dialectical behavioral therapy, the therapy she developed. Linehan also has a practice and is still researching how to develop and treat serious mental health disorders. The therapy that puts the focus on individual therapy as well as group therapy skills training sessions. Linehan originally created DBT to treat patients with borderline personality disorder, a serious mental health disorder that can have a side effect of a patient having chronic suicidal ideation. Indeed, DBT has become the best in class standard psychological treatment option for those with chronic suicidal thoughts, especially who suffer from BPD. But dialectical behavior therapy hasn’t stopped there. Linehan’s research and then development treatment has changed the lives of those suffering in so many different ways. There are a myriad of disorders that can be treated through the use of dialectical behavior therapy including:
- Those with dual diagnosis substance abuse
- Generalized Anxiety Disorder
- Post Traumatic Stress Disorder, or PTSD
- Eating Disorders
The Four Stages of Dialectical Behavior Therapy
- 1st Stage of DBT: The first stage of dialectical behavioral therapy is meant to be able to address a person in their most chaotic moments. Regardless of if the person suffers from a substance addiction, a mental health disorder, or a dual diagnosis, they will be able to successfully, with the help of a therapist and a lot of hard work on their own part, be able to enter into DBT to come out the other side of these four stages with more life skills that they can apply to their full recovery. This first stage is often met by a patient with suicidal ideation or who has expressed an interest end their life. Maybe the new patient is coming to DBT because they are practicing some type of self harm, perhaps by cutting themselves, by overworking themselves, or by abusing some type of drug or alcohol, whether it is an illicit substance or just alcohol. The vital thing in the first step of DBT is that patients grow from being or feeling an inability to control their lives to being able to intentionally decide how they want to act in any given moment.
- 2nd Stage of DBT: The second stage of recovery finds the patient more proficient at withstanding the urge to behave inappropriately or destructively toward themselves physically or mentally, as well as to others. It is likely that they will still feel some desperation, hopelessness or even an overwhelming loneliness. This suffering could well be because of trauma that has remained unprocessed up until this point. This dispare cannot go unchecked or it may lead directly back to the same behavior that was present for the patient in the beginning of the therapy. Step 2 has a goal of taking a patient from that silent despair to allowing themselves to feel their emotions in spite of the fear that may come with it.
- 3rd Stage of DBT: The third stage of DBT finds the patient no longer living in a dangerous sort of chaos because they have gained control over their own behaviors and habits. Now that they can allow themselves to experience the emotions they are feeling and fully experience each moment while still behaving the way they want to, it is time for the patient to rebuild their life. They will use these new understandings of self and tools built through DBT homework and therapy sessions to make goals and lead a normal everyday life, able to deal with whatever comes their way, good times or bad.
- 4th Stage of DBT: Not everyone goes through the fourth stage of DBT, but some patients find the therapy can play a role in a spiritual experience for them. Dr. Marsha Linehan created the fourth step to allow the person struggling to have a goal of spiritual fulfillment. In this step the hope is that the patient can move from feeling incomplete, like they have holes in their heart or like they are empty inside, to finding comfort and safety in a connection with something greater than themselves.
Motivational Interviewing Therapy
Motivational interviewing therapy is a kind of therapy that is meant to create a kind of intrinsic thirst within the recovery patient to change old detrimental behavioral habits and build the skills necessary to thrive in their new way of life. This method of therapy starts with a therapist interviewing the patient. They may talk about why they are seeking help with their addiction, and what kind of motivations are behind the change they are seeking. As the patient talks, they begin to reaffirm their motivations for treatment and their need for a new way of living.
The goals of the therapist as they are in the first steps will be to first express compassion and solid support to the patient. This includes making the patient feel respected, cared for, and more important than anything else in this kind of therapy, listened to. The therapist will hold a non threatening stance within the therapy sessions, without judgement. They won’t push back too much when the patient pushes. This therapy requires that the person with the substance use disorder be the one who must come to the decisions around their own life goals and come to their conclusions themselves first so that the interest in following those goals is central to the addict’s understanding of what it means to recover from their disorder.
The next phase of motivational interviewing is a process wherein the therapist moves through the motivations and history of the recovering drug or alcohol addict. This phase confirms once again a patient’s need for change. It reminds them and makes real one more time and from a different and outside source that there is a need for change, and it requires that they agree that change is vital. As the person struggling with addiction affirms the determination to change something intrinsic changes in their priorities and the hope is that the therapy drives their recovery to its success. The therapy itself is short term in nature, but the benefits can last forever. That kind of breaking down of goal and motivation is an education in how to effectively self evaluate and change bad habits as needed. Motivational Interviewing can be a valuable tool for some recovering addicts.
Some common reasons motivational interviewing could be used in recovery
- Generalized Anxiety Disorder
- Compulsive Gambling Addiction
- Illicit drug abuse or chemical dependency
- Prescription drug abuse or chemical dependency
The most important elements of Motivational Interviewing:
- Collaboration with the therapist
- Evocation of intrinsic self care and preservation, intrinsic motivation building and then using that intrinsic desire to be the best a person can be to dedicate themselves to building a safe and functional sober life moving forward.
- Autonomy is offered to the patient in motivational interviewing therapy because the power in this kind of therapy largely does end up in the hands of the addict. It is the recovering addict who is responsible for laying out their story and their motivations so the therapist can help them wrap those struggles into a picture of recovery through reaffirmed motivations and thirst for change.
Contingency Management Therapy (CMT)
Contingency management therapy is a highly tempting therapy even though some people say that it is too impractical to be a valuable form of treatment. Contingency Management Therapy happens in the reward system that sometimes involves both negative and positive consequences for an addict to maneuver around, but the idea of it is based around the idea that positive reinforcement really is a better way to change behavior.
Kathleen M Carroll in her article Behavioral Therapies for Drug Abuse in The American Journal of Psychiatry says the following about contingency management therapy, “Contingency management, in which patients receive incentives or rewards for meeting specific behavioral goals (e.g., verified abstinence), has particularly strong, consistent, and robust empirical support across a range of types of drug use” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633201/). Carroll also says that contingency management therapy is based on the principles of behavioral pharmacology and operant conditioning – positive conditioning creating positive results.
The CMT strategy works because it focuses on working within the reward system of the human brain. It’s the same part of the central nervous system that opioids target. It uses the reward system of the brain, the section of the brain known to be linked to and co-opted by some of the deadliest forms of drug addiction out there. Taking a page from addiction’s playbook and turning it around on itself, by targeting the reward center of the brain, can cause some impressive end game results.
Even though CMT has a tendency to produce good results and in many cases very sustainable success for those seeking to live a life of sobriety, many detox and rehab facilities in Florida do not utilize CMT due to the high cost of treatment. The ability to order testing for the consistent drug testing needed and for the physical rewards themselves, can indeed make CMT not a viable option for every treatment center or every addict for that matter.
FHE Health Partial Hospitalization and Intensive Outpatient Programs
FHE Health Partial Hospitalization and intensive outpatient programs are made for an addict who wants to manage everyday life but is still looking for an extra umph of treatment before they are ready to be apart of the real world fully. They may need to stay with their children or maybe their job can’t let them go. The flexibility they are offered through FHE can be invaluable and in and of itself help set the addict up for success.
FHE Health offers the following skills in their PHP and intensive outpatient programs:
- Individual Therapy
- Group Therapy
- Self-Help Groups
- Recovery Support Workshops
- Life Skills
- Relapse Prevention
- Specialized Services
Depending on the person’s unique needs and the seriousness of their situation they may need a more specialized treatment program and they may want to look into intensive inpatient treatment. Call FHE today to learn more about our PHP program as well as the other offered programs.