Emerge

Treating Substance Use Issues

Not every person who has issues with their substance use has a severe substance use disorder—that is, “addiction.” Many people are still fully volitional when they begin to notice some difficulties in their relationship to alcohol or other mind-altering drugs. With some techniques for managing use and emphasizing health, most people who are not addicts can take control of their use or stop entirely.

Not everyone is so fortunate, however. When that is the case, we at Emerge have a solution. The Holistic Treatment Model for severe substance use disorders that we use at Emerge is grounded in the process of evolution through the Stages of Change. We do not believe that “one size fits all” for recovery. We are also careful to avoid the trap of the dogmatism that can be found in some ways that practitioners employ approaches in both the Harm Reduction model and the Total Abstinence model.

We don’t believe in dogma, we believe in the evidence. We trust that if you are able to control your substance use, you will do so with some useful tools. And if you cannot, we know that your addiction doesn’t care about you, but we do.

Our treatment model usually involves beginning with the client—and perhaps also the client’s family—at the place where the client arrives and with the motivation the client has in that moment. There are tools such as Motivational Interviewing that we can use, but we employ the best tools for the specific patients to address the situation in a way that prioritizes a compassionate approach to what works. We work with the client through the process of incremental change toward a clear goal of actual recovery. We believe in actual recovery from addiction. 

We advise only essential medication (sometimes important in managing brain chemistry difficulties and other issues), perhaps especially for initial withdrawal, for which we refer patients to medical detox and/or prescribing practitioners. After that, our treatments focus on the overall “mind, body, and spirit” approach. We advocate healthy food and diet, yoga and other forms of exercise, and intention and meditation. We will refer to acupuncturists and others to help you with your process.

We accompany the individual on the journey, looking at the individual’s cluster of symptoms and syndromes (addiction, anxiety, depression, family dynamics, etc.), and seek out the Cognitive-Behavioral Therapies (CBT) and adjunct methods that will address not only the maladaptive habitual behaviors, but also the co-occurring and perhaps underlying mental and emotional distress.

Additionally, for those who wish to do the enduring work by the time-tested Twelve Step approach, we provide treatment from the evidence-based Twelve Step Facilitation (TSF) treatment model. Twelve Step was one of the first recovery programs developed and is used by many treatment facilities. The decisive shift of Twelve Step from earlier views of addiction was to see addiction scientifically and medically as a disease rather than as a personal moral failure. The disease is thus far incurable, but it has been proven that it can be placed into remission. One can enter recovery by frequent group meetings and working the 12 steps of recovery to encourage a shift in awareness that assists in rebuilding and reinforcing the ability to make rational choices. Aftercare usually incorporates, among other things, 12 step meetings in one’s local area for support, which is a boon, since practically every city has them and they are usually very easy to find.

Refuge Recovery has adapted Mindfulness Psychology and the core teachings of the Buddha Siddhartha as a treatment of addiction. Buddhism recognizes a nontheistic approach to spiritual practice. The Refuge Recovery program of recovery does not ask anyone to believe anything, only to trust the process and do the hard work of recovery in community.

For those who feel that they cannot choose the Twelve Step path, we recommend and facilitate using the tools of SMART Recovery. We also might recommend the Refuge Recovery program. This treatment model usually avoids (or even opposes) belief in the scientific/medical model that addiction is a disease, instead focusing on it as a breakdown of the capacity to make rational decisions. The Rational-Emotive Behavior Therapy basis of SMART Recovery is an expansion of CBT that seeks to rebuild and reinforce rational decision-making.

This “Stages of Change” model is one that we believe can be ideally tailored to the person seeking help with substance use issues.

 

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The environmental, transpersonal, and somatic (holistic psychotherapy) worldview: Humans are multidimensional sentient beings comprised of spirit, mind, and body, and the human being exists within an interactive contingent reality composed of systems and environments. Humans have awareness (consciousness) about their inner lives and their outer interactions, as well as sub-awareness (a subconscious which is not operating at the level of mindfulness), and a hidden awareness (unconscious buried material that impacts cognitions/feelings and behaviors, and which has an individual locus but is also connected to a collective locus). Humans, for good or ill (depending on their superconscious formations), act to meet their five great instincts, and they generally use agency to do so in either a pro-social ("productive orientation") or anti-social ("entropic orientation") manner.

The five great instincts:

1. To be part-of
2. To have power to achieve
3. To exercise liberty of individual agency
4. To play and relax.
5. To sustain one's survival

When a person or a relationship system recognizes dysfunction and seeks to -- or is made to seek to -- fix it, the environmental, transpersonal, and somatic worldview utilizes an approach based on fourth-order cybernetics.

The following are some of the better treatment techniques for mental and emotional health function concerns (apart from specific medication and touch interventions), and they all build on each other:

1) Experiential/Symbolic Therapy (authenticity and humane rapport; relatedness even in mentorship; collaboration, playfulness)
2) Object Relations Therapy and Control-Mastery Therapy (how did we developmentally get here and how do we master the tough parts?) plus Integrative Meaning Therapy and Acceptance and Commitment Therapy (existential and values approaches)
3) Rational Emotive Behavior Therapy, Motivational Interviewing, and Strategic Therapy (direct instruction, reality-testing, comparing internal and external logic to achieve reason, rolling with resistance, confronting irrationality)
4) Emotionally Focused Therapy (genuine and open feeling, relying on trusted team members, having healthy boundaries and attachments, more fulfilling experience of being part-of)
5) Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, Bowen Family Therapy, (seeing the schemes, empowering "right-sized" self-esteem, challenging the scripts, writing new ones, mindfulness, distress tolerance, self-regulating of emotional reactions, strategic and deep/honest communicating, restructuring thought and feeling and action by using countervailing behaviors)
6) Gestalt Therapy (feel it rather than simply intellectualize it, look at somatic and work on them, consciously integrate the environment, the systems, and the internal compartments).
7) Solution-Focused (envision your ideal, reduce risk and harm to personally acceptable levels, build on strengths) Therapy

A good therapist who has a theoretical orientation that is environmental, transpersonal, and somatic, will integrate tools from all of these therapeutic techniques. The therapist will not be bound to the theory behind the techniques, but will conduct an integrative therapy based from within the environmental, somatic, and transpersonal (holistic psychotherapy) theoretical worldview. The therapist will act to help patients gain not only further expertise about themselves, but also to gain effective tools to live more fulfilling lives with more fulfilling relationships.
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