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Harm Reduction = Person Centered Care.

Harm reduction is care that is self-directed and focused on the goals and priorities of the person served. This is the heart of “motivational interviewing”. “Harm reduction” accepts that many people have too much pain in their lives and too few internal and external resources to completely give up using substances. While treatment may focus on abstinence if appropriate, harm reduction also focuses on keeping people engaged, helping them feel and function better, bringing them into therapeutic relationships, offering trust, removing judgment and providing acceptance.   There are multiple pathways to recovery and our job is to help each person find their way forward. Thinking long-term: Recurrences can offer insight and are opportunities to stay engaged and maintain hope. Better is better. It is important to accept improvement as a sign of progress.

In this era of epidemic deaths by overdose, maintaining engagement is critical to the survival of people struggling with addictions. This is the same approach used in general medical practice with folks struggling with management of diabetes, heart and lung disease etc.. They are not “fired” from their provider’s care due to not having their illness under control.

In 2011, The Substance Abuse and Mental Health Services Administration of the Federal Government updated definition of recovery to no longer include abstinence:

2009: “Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.”

2011: “Recovery from Mental Disorders and Substance Use Disorders:  A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

https://www.samhsa.gov/programs

Clinic based individualized treatment that help resolve the root causes of problematic substances show high rates of success in treating a wide variety of addictions. Ninety percent of people who completed treatment at Minnesota Alternatives reported good quality of life, and stable functioning 12 months post treatment. Success should be defined as meeting the goals you have, reduction in overall use, improvement in psychiatric symptoms, improved overall functioning and quality of life.

Clients who enter residential programs (30-90 days) often report their stay in treatment as very helpful – finding great benefit from the external controls/structure and the “built in” community. However, once out of a controlled setting and faced with the stressors of their day-to-day life, people often return to use. The formula for long-term, sustained growth and recovery requires getting treatment that addresses the root causes and is directed by you while you live your real life with the availability of ongoing treatment and support as needed rather than episodic, program based care only.

Yes. At Expanse, we recognize the need to treat both psychiatric conditions and addictions at the same time. Addiction research clearly shows much improved outcomes when both disorders are addressed simultaneously. Our providers are well trained and experienced in providing treatment of your mental health and addiction needs.

There are many highly effective medications for addiction that are used in conjunction with evidence-based psychotherapies. Unfortunately, studies show that less than 10% of people diagnosed with alcohol use disorder are even offered medication in treatment. Less than 40% of treatment programs offer opioid replacement therapy for opioid use disorder (the only treatment shown in research to reduce mortality (death) by up to 70% even without any psychotherapy or other treatment).

https://www.niaaa.nih.gov/alcohols-effects-health

https://www.rethinkingdrinking.niaaa.nih.gov/

You and your psychiatric provider will decide what medications are appropriate for you and your unique circumstances. Appropriate treatment of disorders such as ADHD and anxiety can be critical to success in reducing substance use and may require the prescribing of controlled substances in a responsible manner. These concerns, unfortunately, are due to the perpetuation of the myth of “cross-addiction”. There is no credible research to support the idea that “cross addiction” exists. Addictions are highly complex neurobiological disorders each with its own natural history and genetic pattern. The concept that all addictions are the same is simply not accurate.

Imagine if your doctor gave you penicillin and you had an allergic reaction. The doctor then told you that you had an allergy to “medicine”, and you can never take any kind of “medicine” again. That would make no sense. Medications are all structurally different, affect different receptors, are metabolized differently based on certain genetic patterns, and affect different physiological systems in the body. An apt analogy demonstrating that the concept of “cross addiction” has no validity.

Skills are important tools in addressing trauma. Mindfulness (the ability to be in the present moment) and meditation (the ability to watch your thoughts and notice your body) are essential to this process.

Mindfulness as a gateway to self-regulation:

• Mindful awareness provides a gateway to self-regulation and a key to unlocking automatic patterns.
• A teaching in Buddhism — the way to deal with the mind is to become an impartial, compassionate observer of it.
• A battle against any part of our selves leads to inner discord and more distress. Reflection on the addicted brain, not willful resistance to it, is the way to tame it.

For those who struggle with more “reflective” meditation or mindfulness exercises, here is an example of a “moving meditation” from the Center for Mind-Body Medicine in Washington, D.C., the work of Harvard trained psychiatrist, Dr. James Gordon:

“Shaking and Dancing”

Stand with your feet shoulder width apart. If you are in a group (family), reassure that all will have eyes closed and this works best if you just ignore your feelings that you look silly (you all will but no one is looking). Put on any lively music that you enjoy. Close your eyes if you are comfortable. Slightly bend your knees. Let your body shake as seen in the video below for 5-6 minutes. At the end of that. Stop. Take a moment to ground yourself.
 

 
In addition to psychedelic assisted somatic psychotherapy we offer EMDR, Brainspotting, CBT, Narrative and Prolonged Exposure, explained below:

• EMDR: During Eye Movement Desensitization Reprocessing therapy, the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used. Shapiro (1995, 2001) hypothesizes that EMDR therapy facilitates the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.
• Brainspotting: Brainspotting, like EMDR has been developed around the client’s line of vision. EMDR utilizes eye movements as a form of bilateral stimulation, while Brainspotting focuses the eye on a fixed gaze position. The position of your eyes, or where your gaze is directed, can actually unlock some deeper insights that have not yet been recognized. It is a powerful, focused treatment method that works by identifying, processing and releasing core neurophysiological sources of emotional/body pain, trauma, dissociation and a variety of other challenging symptoms. Brainspotting is a simultaneous form of diagnosis and treatment, enhanced with Bilateral sound, which is deep, direct, and powerful yet focused and containing.
• CBT: Cognitive Behavioral Therapy places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior. CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.
• Narrative: Narrative therapy is a method of therapy that separates a person from their problem. It encourages people to rely on their own skills to minimize problems that exist in their lives. Throughout life, personal experiences become personal stories. People give these stories meaning, and the stories help shape a person’s identity. Narrative therapy uses the power of these stories to help people discover their life purpose. This is often done by assigning that person the role of “narrator” in their own story.
• Prolonged Exposure: Prolonged Exposure is an intervention strategy commonly used in cognitive behavioral therapy to help individuals confront fears. Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. Most people want to avoid anything that reminds them of the trauma they experienced but doing so reinforces their fear. By facing what has been avoided, a person can decrease symptoms of PTSD by actively learning that the trauma-related memories and cues are not dangerous and do not need to be avoided.

We are only able to use medications which are legally accessible in the Minnesota/ the United States. Currently we can use ketamine, in an off-label manner, and medical cannabis for those accessing this through the state medical cannabis program. Once other psychedelics are FDA approved, hopefully in 2022 or 2023, we will be able to incorporate these as well.

Ketamine has been misused on the street in very high doses for its dissociative effects. In the therapy we use, Psychedelic Somatic Interactional Psychotherapy (PSIP), we are using ketamine at much lower and safer doses, typically administered as oral troches. In PSIP the medication is truly a facilitator of the therapy and not the therapy in and of itself. The medication facilitates much more rapid and effective access to the traumatic issues allowing more rapid resolution which is longer lasting.

There are no quick fixes for complex trauma. Simple traumatic experiences may be resolved in a relatively short period of time. Complex trauma, attachment disorders, abandonment issues from early childhood and chronic PTSD take much longer to resolve. Psychedelic therapy is a more effective and efficient way to resolve these issues than what we have seen with other psychotherapeutic modalities.

As Jon Kabat Zinn, the godfather of westernized mindfulness meditation therapy once said, “mindfulness is not for the faint of heart”. The same can be said of psychedelic psychotherapy.

Working with trauma in any form of trauma therapy can lead to some level of “destabilization” (worsening of symptoms) in the early part of therapy, before one will experience improvement. The reason for this is that symptoms of PTSD such as dissociation (shutting down) and compartmentalization are your body, mind and brain’s way of coping and protecting you from the trauma.

Although you may not experience the trauma overtly, it does manifest in other ways such as mood disorders, anxiety, addiction, physical symptoms, and relational problems. These coping/resourcing processes, which have been ingrained for years, begin to break down during the course of treatment, as these “work arounds” are no longer needed to protect you. The gates to your psyche begin to open, tapping into the core of what has been unconsciously fueling your symptoms and struggles.

Psychedelic psychotherapy is not always easy, but it does provide access to the peace of mind and wellness you may never have experienced before. Your therapy is conducted by our highly trained and skilled therapists; it is an intelligent experience that will make sense to you. For some people the destabilization that occurs is significant, but they are able to function at an acceptable level at work and with family, though may not be on their “A game”. Others may require more intensive support to help them through these early difficult experiences and the focus of therapy will be on building the appropriate skills and resourcing to be able to tolerate processing their underlying trauma.

You are not alone. Countless people have dealt with difficulties that are the same or much like yours. While that may not lessen your pain, you may take hope from knowing that many “concerned others” and/or their loved ones have resolved their problems and are living more productive and satisfying lives.

You can catch more flies with honey than vinegar. Loved ones are much more likely to listen and respond to loving words than to criticism. No matter how small, noticing and giving “pats on the back” for positive changes or “what you like” about your loved one will be far more effective.

You have as many tries as you want or need – and so do they. Relationships and change are processes – and processes take time. We get as many tries at improvement as we wish.  People can be helped at any time.

You can live a happier life whether your concerned others use of alcohol and/or drugs improves. An important part of CRAFT is learning to take care of yourself, regardless of your loved one’s behavior.

Helping yourself helps your family. When you approach life in a more resilient upbeat way with a healthy attitude, it can be infectious. You can become a positive role model for others in your life.

All people have problems and substance misuse is just that, a problem. You did not cause it and your loved one did not set out to have the problem. Although you can help by learning new strategies, it’s not up to you to fix the problems.

The world is not black and white. Most people have problems that vary in degree and difficulty. Do not assume that sending your loved one into a treatment program will “cure them”. Lasting change comes from learning skills to manage life’s day to day stressors.

Change happens in steps, a little at a time. It is gradually shaped and molded into the desirable behavior or it becomes closer to what we’d like it to be. Think long term and “better is better”.

Change is usually easier if people have more than one option. Giving people choices increases the odds that they will have a more desirable treatment outcome.

Labels can do more harm than good. Labels such as alcoholic, addict, or loser can deter people from seeking the help they need. Name-calling is usually counter-productive.

Limits or boundaries are essential and help your loved one understand that other people have needs too. Limits promote accountability. Use “I” statements and only you can decide when “enough is enough”.