Fine Tuning Recovery

8/10/2019 Fine Tuning Recovery

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Fine Tuning Recovery

Moving Toward a Wellness Model in the Treatment of AddictionsAddiction Studies Institute 2014

Steven J. Rendina, MTS, LICDC, LMT, ADS


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Presented by: Steven J. Rendina, MTS, LICDC, LMT ADSwho practices tuinaChinese medical

massage and teaches qigongfor healingto numerous recovery groups andclasses in the Columbus area.

He has been a counselor and educatorin the addictions field for over 20 years.

Clinical Developer for the House of Hope

Adjunct faculty at Columbus StateCommunity College and the University ofCincinnati

www.finetunehealthcare.com

[email protected]
http://www.finetunehealthcare.com/http://www.finetunehealthcare.com/


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Fine Tuning Recovery - Outline

Explore the growing use of holistic, naturopathic, andtraditional Chinese medical principles and theirtherapeutic application in the treatment of substance use

disorders.

A model for wellness - optimizing healthful living - will becompared with the generally accepted medical/diseasemodel.

Practical clinical applications and original research will bepresented.


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Recent studiestend to supportthe idea that

addiction is abrain disease

with markedchanges in thephysiologicalfunction of thebrainnotunlikephysiological

changes to theheart thatcan bemeasured inheart disease

patients.www.drugabuse.gov


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When compared to other chronic illnesses that involvesome type of behavioral management or self-care, relapseratesor a return to active symptomsare similar.

www.drugabuse.gov


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Premise

If addictions are diseaseprocesses at workcanthey not also be treatedas other chronic

diseaseswith basicchanges to improvehealth including propernutrition, adequateexercise, rest, sunlight,fresh air, plenty ofwater, and stressreduction techniques?


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What are some relevant principles of

Naturopathic Medicine? Naturopathic medicine is a distinct primary health

care profession, emphasizing prevention, treatment,and optimal health through the use of therapeutic

methods and substances that encourage individualsinherent self-healing process.

The practice of naturopathic medicine includesmodern and traditional, scientific, and empirical

methods.

http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59


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Naturopathic Medicine?Treat the Whole Person:

Naturopathic practitioners treat each patient by takinginto account individual physical, mental, emotional,genetic, environmental, social, and other factors. Sincetotal health also includes spiritual health, naturopathicphysicians encourage individuals to pursue theirpersonal spiritual development.



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Prevention:

Naturopathic practitioners emphasize the prevention ofdisease by assessing risk factors, heredityand susceptibility to disease, and by makingappropriate interventions in partnership with theirpatients to prevent illness.



Naturopathic Medicine?


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The Healing Power of Nature:

Naturopathic medicine recognizes an inherent self-healing process in people that is ordered andintelligent. Naturopathic physicians act to identify andremove obstacles to healing and recovery, and to

facilitate and augment this inherent self-healingprocess.



Naturopathic Medicine?


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Whole Person

Holistic medicine is a form of healing that considers thewhole person -- body, mind, spirit, and emotions -- inthe quest for optimal health and wellness. According tothe holistic medicine philosophy, one can achieve

optimal health -- the primary goal of holistic medicinepractice -- by gaining proper balance in life.


Holistic Medicine?

http://www.webmd.com/balance/guide/what-is-holistic-medicine


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Interdependent/Balanced

Holistic medicine practitioners believe that the wholeperson is made up of interdependent parts and if onepart is not working properly, all the other parts will beaffected. In this way, if people have imbalances(physical, emotional, or spiritual) in their lives, it cannegatively affect their overall health.


Holistic Medicine?

http://www.webmd.com/balance/guide/what-is-holistic-medicine


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Naturopathy and Holistic Medicine

Natures Seven Doctors

Sunlight


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Fresh Air


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Exercise




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Rest




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Clean Water




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Whole Nutrition




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Quiet/Relaxed

Mind




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Chinese Medicineis a holistic

philosophy ofhealing and carethat looks at thehumanrelationship

within nature

What are the relevant principles of TCM?


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Qialso known aschi, ki, prana,universal lifeforce, vital

energy, ruachorspirit, breath oflifeit is the ein the formulae=mc2


The Chinese character for qi is the image of steamarising from a pot of rice cooking over an open fire

It is the invisible force that is present in all things


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Yin and Yang

The energy of qiis expressedin a dynamic ever-changinginteraction of thecomplementary forces of yinand yang. Some of theseyin/yang polarities include darkand light, cold and warm,

night and day, female andmale, lifting/sinking,

expanding/contracting, etc.



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Addiction from the perspective ofChinese medicine

Empty Fire


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Chinese medical theory is based on the conceptof yin and yang, which are dynamic andcomplementary opposites observed in all the

processes of nature.

In a healthy individual, yin and yang are inrelative balance. Addicts often suffer from adeficiency of yin.

Steve Phillips, L.Ac.


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Chinese medical theory, which comprehendsthe body metaphorically, relates yin tosubstance (being centered), quiescence (innerpeace), and the element of water (able to

flow).

Yang relates to function (sense of purpose),activity (doing as opposed to being), and the

element of fire (passionate intensity).Yinnourishes, and yang consumes.



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When yin, or the water element, is deficient,fire is not held in check and rages out ofcontrol.

Since it is the product of a deficit, it is calledempty firebecause it has no substance tofuel it. On a psychological level, such an

imbalance creates feelings of emptiness anddesperation.



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Physiologically, it manifests as frenetichyperactivity. The addict is driven to useand abuse, but the drug exacerbates the fire

and further depletes the yin; hence, thefeeling of power he or she gains isexaggerated and merely temporary, leading toeven more desperation.



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Putting out the fire of addiction

The goal or intention of anapproach to addictiontreatment using ChineseMedicine is toput out thefire

Increasing the level of

inner calm, yin energy iscrucial to the effectivenessof this recovery process


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The Generally Accepted Medical Model

Medical proceduresinclude a diagnosis, atreatment plan, and aprognosis.

Drug therapy is the mostcommon treatmentapproach.

Medical model is criticizedfor labeling (diagnosing)and "imposing" treatmenton individuals.


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American Society of Addictive Medicine - ASAM

New Public Policy Statement: Definition of Addiction

Addiction is a primary, chronic disease of brain reward,motivation, memory and related circuitry.

Dysfunction in these circuits leads to characteristicbiological, psychological, social and spiritualmanifestations.

This is reflected in an individual pathologically pursuingreward and/or relief by substance use and otherbehaviors.

http://www.asam.org/DefinitionofAddiction-LongVersion.html
http://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.html


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American Society of Addictive Medicine - ASAM

New Public Policy Statement: Definition of Addiction

Addiction is characterized by inability to consistentlyabstain, impairment in behavioral control, craving,diminished recognition of significant problems with onesbehaviors and interpersonal relationships, and adysfunctional emotional response.

Like other chronic diseases, addiction often involvescycles of relapse and remission.

Without treatment or engagement in recovery activities,addiction is progressive and can result in disability orpremature death.

http://www.asam.org/DefinitionofAddiction-LongVersion.html
http://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.html


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Harm Reduction and ReplacementTherapies

The medical model is moving in the direction ofHarm Reduction and Replacement Therapies

not unlike medical approaches to other types ofchronic illness

Suboxone, methadone, chantrix, etc

Needle exchanges, Moderation management

Patches, e-cigarettes


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New brain scan studies are showing that behavioraltreatments (i.e., psychotherapy) and medications worksimilarly in changing brain function. So addiction is a

brain disease that can be treated by changing brainfunction, through several types of treatments.

* Adapted from Myths of Addiction. Carlton K. Erickson, Ph.D., University of Texas Addiction Science


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Stop and Think!

The medical and replacement approachhas caused much controversyforexample: must we continue to give opiatereplacements on a long-term basis ratherthan as a short-term aid to detoxification?


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WellnessOptimizing Health


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WellnessDefined

Wellness is much more than simply an absenceof illness and/or disease. Wellness is a proactiveand preventativeapproach thats designed to

provide optimum levels of health, emotional andsocial functioning.

http://wellnessproposals.com/wellness-articles/definition-of-wellness/


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WellnessDefined

Wellness involves our recognition that we havepsychological, physical, spiritual and social needs

that are necessary for us to have higher levels offunctioning.



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WellnessDefined

Wellness emphasizes the whole individual. Its

the integration of the spirit, body and the mind;and the understanding that everything we do,feel, think and believe has a direct impact onyour state of health.



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The wellness model is moving in thedirection of prevention and holistic care

http://www.nationalwellness.org/?page=Six_Dimensions


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Why Wellness is Essential to Recovery

Repairing damage to mind and body

Safeguarding against relapse

Replacing negative behavior and anchoringclients in their recovery

Promoting quality sobrietyand helping clientsADD DECADES to their life expectancies!

Dr. John Newport http://www.wellnessandrecovery.com/


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How A Wellness Lifestyle Can HelpPrevent Relapse

Helps anchor clients in their recovery,reinforcing their commitment to clean and soberliving.

Helps safeguard against relapse during earlyrecoverywhen mind and body are mostvulnerable.

Fosters resiliency needed to deal with lifes upsand downs, without having to turn to drugs.



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Alcoholism and Nicotine asCo-Addictions

Cigarette smoking is the LEADING CAUSE OFDEATH for people in recovery!

Between 80-95 percent of Alcoholics smoke cigarettesand 70 percent are heavy smokers

Many alcoholics/addicts carry their Nicotine Addiction

with them into recovery, although the majority reportthat they would like to quit!


http://blog.kerrygaynormethod.com/3-of-the-most-common-excuses-for-smoking-debunked/


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http://blog.kerrygaynormethod.com/3 of the most common excuses for smoking debunked/

Many of the pioneers of twentieth century addiction treatment and

recovery mutual aid societies died of smoking-related disordersincluding the co-founders of AA

Bill W. (emphysema) Dr. Bob S. (cancer)

-White, W. (2011). Smoking and addiction recovery. For people in recovery. Posted at www.williamwhitepapers.org


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Perhaps we should see the continued acceptance of

tobacco use in drug and alcohol treatment for whatit isanother harm reduction/replacement therapy


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Your Clients Have a CHOICE

Addiction vs. Recovery

Quality of RecoveryCarrying a toxic lifestyleinto their recoveryOR Reaping the benefitsassociated with High Level Wellness(WellnessIllness Continuum)



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Dean Ornisha model for otherchronic diseases

For more than 30 years,Dr. Dean Ornish hasdirected a series of

scientific research studiesshowing, for the first time,that the progression ofeven severe coronaryheart disease can often be

reversed by makingcomprehensive lifestylechanges.

http://www.pmri.org/lifestyle_program.html


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A very low-fat diet including predominantly fruits,vegetables, whole grains, legumes, and soy products intheir natural, unrefined forms

Moderate exercise such as walking, tai chi, qigong

various stress management techniques including yoga-based stretching, breathing, meditation, and imagery

enhanced love and social support, which may includesupport groups.


Dean Ornish - Program


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Dean Ornish - Program

These studies also documented that other chronicdiseases may be reversible simply by makingcomprehensive lifestyle changes.

These findings are giving millions of peopleworldwide new hope and new choices, options thatare more caring and compassionate that are also

more cost effective and competent.



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Lets apply a version of theDean Ornish program to recovery

http://www.mentalhealthmn.org/be-informed/mental-health-resources/wellness-and-recovery-resources


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Fine Tuning Recovery atthe House of Hopes Wellness Center


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What is Stress?

Life would be a daily grind of repetition, therewould be no ups or downs, no joy orsorrow, no excitement or vitality.

And ultimately, death is the occasion when allstress stops and we are flat lining. Noheartbeat, no respiration, no brain activity.

When we stress somethingit literally means to put an emphasis on it.

Without emphasis, for example speech patterns would be a boringmonotone.

Music would be without any dynamics, no tension or relief, it would

evoke no emotion or feeling.


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What is Stress?

We need stress in our lives to make them meaningful, enjoyable,challenging, and vital. Since stress is truly a part of life, our healthis dependent on our ability to manage stress, and to reduceunnecessary or excessive stressors.

Robert Sapolsky, in his highly acclaimed book Why Zebras Dont Get

Ulcers

describes a process in human life where the stress responsefight or flightbecomes a chronic condition rather than amomentary experience as experienced by wild animals.


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What is Stress?

It is this chronic excess that produces a physical and mental overloadwhich contributes to disease, depression, and destructive anddistorted patterns of coping.

Our stress management becomes crucial to whether we are healthy orsick.


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Managing Stress

When stressors build uppressuresfrom work, family, school, etc. -we need effective means tomanage those pressures. Astension builds, the weakest aspectsof ourselves are vulnerable andreach a breaking point. The samedynamics that work in the physicalnature of things can also beapplied to the psychologicalpressures that we feel.

In the linked video, the forces ofnature applied to the weakestpoints of this bridge cause it tocollapse.

http://www.youtube.com/watch?v=j-zczJXSxnw
http://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnw


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Relapse as a stress relief process

Relapse can often best be understood in the context of aninternal process, creating stress and tension,

which leads up to a need for resolution


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Managing Stress

Flexibility- the ability to bend without breaking becomes a critical

skill in learning about stress management.

If I have two sticks, one dry and the other green, when I applypressurethe dry one snaps while the green one bends withoutbreaking.

The dry wood is dead and breaks easily, the green wood is alive andflexible.


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Effective Stress Management

Many effective stress management techniques are thus focused on

increasing vitality and flexibility. Exercise systems such as yogaor tai chi and qi gong are excellent examples.


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Qigong as harmonizerbreath-body-mind

3 tunings: breath, body, mind Breathing Methodslow,

deep, smooth, even, fine,round, natural/relaxed

Postural Correctionfinepoints of standing, sinkingweight, lifting bones

Heart-Mind Intentcalm,empty, quiet, alert, aware,open, present, non-

judgmental


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What is Qigong?

Fluid Dynamics of Weight Shiftingtheocean within

Walking Dynamicsthe redwood tree andthe water strider

Three CsCircularity, Continuity,

Complementarity

Repetitionsnines


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What is Qigong?

70% ruletake it easy, build results slowly overtime (pain = no gain)

100 days to changeneuroscience confirms,neural networks grow


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Contraindications

It is best to avoid doing vigorous qigong exercise if one is feelingweak or ill. Breath work and use of meditation and healing soundswhile lying or sitting may be all one can do until strength returns.

It is possible to feel faint or weak after practice while one is buildingstrength and health. Nausea from exertion and holding posturestoo long for one's current level of vitality may also occur.

Muscles may become sore from being used in new ways. Take iteasy if need be. Avoid exercising in cold drafts or excess heat.Keep hydrated. It is best to avoid practice right after eating.

Practice is often best in the morning as a foundation for the day butmay be done at any time. Rarely, a person will develop obsessiveor compulsive desires to overdo it. If you have such tendencies, bereasonable.

It may be necessary to find a teacher who understands the 70%rule. Be aware of your own limitations. If you experience pain,modify or avoid the specific exercise. Stay in tune with yourself.


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Benefits of Qigong for Recovery

Negative, resentful, and self-critical thinking can get inthe way of recovery. Qigong practice can help theindividual cultivate a more positive, uplifted frame ofmind.

You may find that the early days of sobriety are like anemotional rollercoaster. Additionally, one of the mainobstacles to achieving long-term recovery is to developemotional stability. Qigong grounding and centeringexercises can help to manage volatile moods and buildself-control.

Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/


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Anger and stress resolution as well as problem-solvingskill building each are enhanced through the mind-body-breath harmonies found in regular qigong practice.

Addicts tend to suffer from low self-esteem and feelingsof shame. Regular practice of the qigong principle ofmind-intent helps to develop a sense of mastery overones own body with the mind, bringing improvedconfidence and self-esteem.



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One fairly common and unpleasant symptom for addictswho have stopped using is mental fog. Regular qigongpractice helps to improve mental clarity and focus.Practicing qigong exercises, breath-work, self-massage,and self-care routines can also help develop a normalsleeping pattern.

Triggers and cues to alcohol or drug use can bemanaged through the self-discipline of regular qigongpractice. Cravings can be reduced or re-directedthrough the principles of relaxation, sinking, and letting

go that are central to many of these qigong exercises.


U f t bl l t h i l t f


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Uncomfortable, unpleasant physical symptoms ofwithdrawal and issues of un-medicated physical andemotional pain can be eased through specific qigongpractices.

When people are active in addiction they typically havecaused significant damage to their health. Qigong helpsrestore physical vitality and promotes healing of thebody. Specific qigong exercises are directed towardpromoting healthy functioning of all internal organsincluding lungs, heart, liver, kidneys, and digestion.

Boredom can be a problem for people in early recovery,and it is a common reason for why certain peoplerelapse. Developing balance, patience, and self-disciplineadd to a meaningful life in sobriety helping the individualto keep things in perspective and avoid relapse.



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Those who are newly sober will likely need to distancethemselves from drinking or drugging friends. Qigongpractice groups offer a good opportunity to socialize andmeet new people. Support networks themselves are

beneficial for strengthening and healing.

Following a spiritual path can provide one with apurpose in recovery. Qigong meditations and breathing

exercises can be good tools to strengthen the spiritualwarrior.



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Original Research OutcomesPre-Session - UNIVERSAL PAIN ASSESSMENT TOOL

AlertSmiling

No HumorSerious / Flat

Furrowed BrowPursed Lips

Holding Breath

Wrinkled NoseRaised Upper LipRapid Breathing

Slow BlinkOpen Mouth

Eyes ClosedCrying

Moaning

No Pain Can Be Ignored Interferes WithTasks

Interferes WithConcentration

Interferes WithBasic Needs

Bed Rest Required

0 1 2 3 4 5 6 7 8 9 10

Circle the number that best fits your experience

E l R h O t P i


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Early Research Outcomes - Pain

0

5

10

15

20

25

30

35

1 2 3 4 5 6 7 8 9 10 11 12 13 14

PainPre

PainPost

Pre Session Pain compared to Post Session Pain

290 total Pre 189 total Post

35% decrease in Perceived Pain


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Original Research OutcomesPre-Session PERCEIVED ANXIETY / STRESS

Calm / PeacefulAt Ease

Mild WorryConcern

Mild Stress

Tense / AnxiousNervousWorried

FrustratedPressuredRestless

Angry / UpsetEdgy

Losing Control

PanickyOverwhelmedOut of Control

No Anxiety or Stress Able to Relax Interferes WithThoughts

Interferes WithActions

Interferes WithHealthy Coping

Unmanageable

0 1 2 3 4 5 6 7 8 9 10

Circle the number that best fits your experience

E l R h O t A i t


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Early Research Outcomes - Anxiety

Pre Session Anxiety compared to Post Session Anxiety

325 total Pre 152 total Post

53% decrease in Perceived Anxiety/Stress

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4 5 6 7 8 9 10 11 12 13 14

AnxietyPre

AnxietyPost


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Sample exercises and programming

Cravings and Urge Surfing Meditation

Self-Massage and Joint Mobilization forDrug-free Pain Management

Five Animals for Mood and Stress Management


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Working through triggers and urges to usealcohol, drugs, or tobacco can be like riding awave.

Instead of fighting the urgelearn to ride it out.

Waves come and gothey rise to a crest thenbreakwhen they reach the shore, they losetheir energy and disappear.

If you can learn to ride out your cravings, theytoo will soon pass.

Qigong standing practice gives you a simplemethod to manage your energy, develop self-control, patience, and the confidence to defeataddictive craving and compulsion.

C i d U S fi M dit ti


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Be Centered - The breath is

fundamental to our life process.When we are born, we must takeour first breath to stay alive. Ourfinal act before death is to take

our last breath. So breath is whatconnects us to life, and it is ourmost readily available tool to useto effectively change our mental,emotional, and even physicalstate. Use deep, slow, evenbreaths into your abdominal corea process that helps us to keepcentered.

C i d U S fi M dit ti


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Be Grounded - Aligning ourposture so that our spine islengthened and the headlifted, while simultaneously

sinking the weight of thebody into the feet andground is a consciouspractice that helps us feelmore rooted, more solid, less

easily swayed by distractionsand the opinions of others.We become moregrounded.

C a ings and U ge S fing Meditation


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Be Uplifted - keeping our mind

free of distractions,complications, and worryallows for the developmentof a more positive outlook

on life, we develop thefeeling of being uplifted.This is reflected in the waywe carry ourselves:confident, comfortable, andfully conscious of ourcapacity to be well. Feeluplifted.

Standing Practice


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Standing Practice

Find the balance!


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Practice, Practice, Practice

Be Prepared- by tuning the mind, breath, andbody - one becomes able to handle stressorsmore effectively. But this only works withpractice. Emergency responders, the firemenwho rush into a burning building practice theirdrills until the actions become a natural part of

them, in a crisis they can act without havingto think cautiously of each next move.

It is the same for you. Become a trained firemanwho can put out the fire of addiction. Onceyou have practiced these fundamentals forseveral months, it becomes second nature toyou. When a crisis or challenge hits, you don'thave to calm yourself, you remain calm,because that is where you live.


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Next time

Benefits of massage for recovery


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Fine Tuning Recovery

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