Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. 

Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses may provide support and information but their assistance is limited to office visits or hospitalizations. Until recently, there has been an unmet need in the healthcare system for a provider who works with patients in the days and weeks between appointments or post inpatient treatment. But now there is a new breed of healthcare para-professionals, called among other things recovery support specialists who are filling that gap.

Recovery support specialists are trained to help people change their lifestyles using a tailored approach and the tools of compassion, motivation and self-efficacy building. One does not have to be trained in medicine to be a recovery support specialist. Timothy Harrington, Chief Empowerment Officer of Sustainable Recovery, stresses that it takes a large skill set to be effective, and for people transitioning from other medical disciplines it requires a deprogramming from the role of expert advisor to that of health facilitator. While physicians serve as advisors, defining agendas, and treating disease, recovery support specialists serve as partners, eliciting patient’s agendas and co-discovering solutions. One is helpful for treating illness, the other for changing habits.

There are numerous examples in the literature of recovery support specialists achieving good outcomes in programs for smoking cessation, weight loss and diabetes management. Corporate America is also catching on, with some of the nations biggest employers such as Johnson & Johnson hiring health coaches for their workforce to cut down on medical expenses and lost productivity.

Despite these gains, the practice hasn’t quite hit the mainstream and in most cases it is not covered by health insurance. One reason for this is that field is still highly fragmented in terms of certification and education. Unlike seeing a board certified physician, when you work with a recovery support specialist you don’t always know what you are going to get. Educational programs differ in intensity, some may be the equivalent of a master’s degree and others just a scant two-week certification course.

In order to standardize the emerging field of recovery support specialists, Timothy Harrington, is hopeful that soon their will be, at a national level, uniform educational standards, core competencies and more research demonstrating cost savings.

“There is a huge lack of understanding from within most conventional healthcare clinicians as to what a recovery support specialists is and how it is different from case management, disease management, nurse education and health navigators. Part of the need is for us to come up with a cohesive definition and clarification of credentials to be able to hold our own in this ground where there is a lot of confusion,” commented Timothy Harrington regarding the immersion of recovery support specialists into mainstream medicine.

When asked if health coaching was an outsider movement, Timothy Harrington asserted that in the future recovery support specialists will have a place in the conventional primary care system, especially if there is an overhaul of the pay per service reimbursement model.

Who will fix healthcare? The answer to this is still unclear, but recovery support specialists are certainly priming themselves to be an important part of the solution.

It has become fashionable by commentators in the addictions arena to point to research studies confirming three linked findings:  1) the course of alcohol and other drug (AOD) problems are highly variable rather than inevitably progressive, 2) the majority of people experiencing substance use disorders and broader patterns of AOD-related problems resolve these challenges without specialized professional care or mutual aid assistance, and 3) the majority of such resolutions occur through deceleration of the frequency and intensity of use rather than through complete and sustained abstinence.  Those findings, drawn from studies of community populations, have been used to buttress attacks on addiction treatment, Alcoholics Anonymous and other abstinence-based mutual aid organizations, the conceptualization of addiction as a disease, and the characterization of addiction as a "chronic" disorder.  There is within these critiques an implied underlying tone of moral indictment:  "If such large numbers of people resolve AOD problems without the need for abstinence and professional assistance, then why can't you?"  The tone of moral superiority in which this question is posed suggests that such problems could be resolved if one would just "Suck it up and deal with it!"

The idea that some people can resolve alcohol problems on their own via an exertion of will is not a new one and is outlined clearly in the basic text of A.A.--authored before most contemporary critics were born.  Such self-will and moderated approaches had not worked for early AA members, but AA made no effort to deny that option to others.  In fact, AA took quite the opposite position. 

             Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to di a few years before his time. If a sufficiently strong reason-ill health, falling in love, change of environment, or the warning of a doctor-becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention.  (Alcoholics Anonymous, 1939, p. 31)

             If anyone, who is showing inability to control his drinking, can do the right-about-face and drink like a gentleman, our hats are off to him. Heaven knows we have tried hard enough and long enough to drink like other people!  (Alcoholics Anonymous, 1939, p. 42)

AA literature makes no claim that the collective experience of AA members constitutes a universal truth applicable to the broader universe of all alcohol problems. By distinguishing themselves ("real alcoholics") from problem drinkers, early AA members defined their own recoveries in terms of abstinence and mutual support because that is what had been successful in their experience. 

So if there are potentially two worlds of AOD problems reflected in the divergent conclusions of epidemiologists and clinicians, what separates those who naturally mature out of AOD problems without professional or peer support and those for whom AOD problems become prolonged, life-threatening medical disorders?  Having closely observed both patterns for nearly half a century, I believe there exists a "clinical cluster" that predictively distinguishes those whose AOD problems are most likely to become the most severe, complex and enduring and that are less amenable to natural recovery and moderated resolution.  This cluster includes the following elements:

* Family history of AOD-related problems

* Early age of onset of AOD use

* Euphoric recall of first AOD use

* Atypically high or low drug tolerance from onset of use

* Historical or developmental trauma:  cumulative adverse experiences with traumagenic factors (e.g., early onset, long duration, multiple perpetrators, perpetrators from within family or social network, disbelief or blame following disclosure)--without neutralizing healing opportunities

* Adjustment problems in adolescence that contribute to adult transition problems, e.g., instability in education, employment, housing, and intimate and social       relationships 

* Multiple drug use

* High risk methods of drug ingestion (e.g., injection)

* Co-occurring physical/psychiatric challenges

* Enmeshment in excessive AOD-using family and social environments, and

* Low levels of recovery capital (internal and external assets that can be mobilized to initiate and sustain recovery).

Each of these factors constitutes a risk factor for the development of severe and prolonged AOD problems, but such risks are dramatically amplified when combined.  Not everyone sharing such risk factors will develop severe and chronic addiction, and some lacking such factors will still experience prolonged addictions.  Some in the former group will also resolve their AOD-related problems without professional or formal peer assistance.  But addiction is a disorder of odds, and one's odds of escaping addiction and achieving recovery without help from others decline in tandem with the accumulation of risk factors and the absence of factors that protect and promote resiliency. 

In my professional experience, the prospects of natural recovery and problem resolution via moderation decline in tandem with the increased number and intensity of the above factors.  The "apples and oranges" comparison problems can be minimized, if not transcended, if we realize that findings from studies of the resolution of AOD problems among persons without these risk factors cannot be indiscriminately applied to those who possess such characteristics, and vice versa! 


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Coping Skills Help Make Behavior Change Last
~Carrie Wilkens, Ph.D., Center for Motivation and Change

Making a change in your life is a pretty big deal. If you’ve moved into the action stage of change, we’d first like to first offer you a huge congratulations! This is a bold move, and one that deserves a lot of praise! Next we’d like to offer you some helpful tips to help make this change a little bit easier, and hopefully a lot more permanent!

Learn a few coping skills

You may have heard this term, coping skills, before and you may not really know what it means. Coping skills are things that you can do to help tolerate a difficult time by using constructive and positive strategies. More specifically, coping skills are what you need to tolerate the difficult moments that come along with making a significant change in your life (like giving up an unhealthy habit, learning a healthy behavior, not giving into impulses, etc.).

When we talk about coping skills, we can break them up into two categories, internal (things that happen in your own head, no one can necessarily tell that you’re doing them) and external (things that happen outside your own head, more active and visible to others).

You already have a ton of coping skills that you use daily (even hourly!) without realizing it. The goal is to start to recognize what you do to manage different life situations and apply those skills to the changes you are trying to make, in a more “conscious” manner. This way, when you feel a little shaky or insecure about achieving your new behavioral changes, you can apply some of the skills that already come naturally to you. As you try to change a habit however, you may realize you are lacking some skills and that you need to learn a few more!

What is the best way to learn new coping skills? Involve other people! When you are making a change, whether it is eating healthier, or trying to exercise more regularly, or stopping/changing your use of substances, support from other people can be hugely helpful. Studies have found that we often make similar changes as our peer group. In other words, behavior change (both healthy and unhealthy) is contagious and we learn to make changes from watching other people make them. By listening to and watching other people you will speed up your own learning process as you figure out new coping skills to make the changes you are working towards. If you surround yourself with good role models, you will learn a lot. It can also be helpful to find a therapist or mentor who can teach you some of the skills you might be lacking as you face new changes.

Spending time with other people who are trying to make changes, or who have already been successful at making them can also be especially helpful in those moments when your motivation to keep up those changes has waned. Organizations like AA, NA, SMART Recovery, Weight Watchers, and others use the idea and power of a supportive community to help their members maintain difficult changes. Why does this work? There are many reasons, but one of the more powerful ones is that they can cheerlead us when we need a little extra help. You may feel like rolling your eyes at the thought of having/needing a cheerleader in your corner, but give it a chance! Cheerleaders can help pump you up in times when your energy level is low, and help keep you going even when you don’t want to. Sports teams have cheerleaders for this very reason, and you should have some, too.

Another new coping skill? Remembering to reward yourself. You’ve made a bold decision to make a change in your life. Big decisions like this come along with a certain amount of angst, and a certain amount of effort to actually implement the change. At the end of all of this, you deserve a reward. Even if this change is something that you feel you’re “supposed” to be doing, like eating healthier, or stopping using drugs, at this point in your life, it is a change and something that deserves an extra little something. Also, if you know you have a reward coming, it might help you through those tough moments.

What constitutes a reward? Well, that’s different for each person. Whatever you find rewarding (and holds with your stated goals and personal values) can be a reward. Maybe it’s a nice meal (if your goal isn’t food related), or it’s that new outfit you’ve been thinking about buying yourself. Try and pick something that’s immediate, and not too big (you don’t want to use your biggest guns just yet!). You may also want to identify some rewards that are farther away (like a concert that you want to see) which can help you to maintain motivation moving forward.

Starting to make a major change is both exciting and a bit scary. Asking for help and surrounding yourself with good role models or teachers can really help. And rewarding yourself for your efforts and for tolerating all the ups and downs of behavioral change can keep you motivated long enough to really make lasting change.

Dr. Wilkens is a Clinical Director of the Center for Motivation and Change in NYC which she co-founded with Dr. Jeffrey Foote. She specializes in motivational treatments and group psychotherapy, and has worked with traumatized populations in both individual and group modalities.

It’s part of building a healthy relationship, or rather a friendship, with yourself. 

As Eleanor Roosevelt said, “Friendship with oneself is all important, because without it one cannot be friends with anyone else in the world.” 

Here are 30 prompts, questions and ideas to explore in your journal to get to know yourself better. 

1. My favorite way to spend the day is… 
2. If I could talk to my teenage self, the one thing I would say is… 
3. The two moments I’ll never forget in my life are… Describe them in great detail, and what makes them so unforgettable. 
4. Make a list of 30 things that make you smile. 
5. “Write about a moment experienced through your body. Making love, making breakfast, going to a party, having a fight, an experience you’ve had or you imagine for your character. Leave out thought and emotion, and let all information be conveyed through the body and senses.” (A prompt from Barbara Abercrombie ’s creative book  Kicking In The Wall: A Year of Writing Exercises, Prompts and Quotes To Help You Break Through Your Blocks And Reach Your Writing Goals. )
6. The words I’d like to live by are… 
7. I couldn’t imagine living without… 
8. When I’m in pain — physical or emotional — the kindest thing I can do for myself is… 
9. Make a list of the people in your life who genuinely support you, and who you can genuinely trust. (Then make time to hang out with them.) 
10. What does unconditional love look like for you? 
11. What would you do if you loved yourself unconditionally? How can you act on these things whether you do or don’t? 
12. I really wish others knew this about me… 
13. Name what is  enough for you. 
14. If my body could talk, it would say… 
15. Name a compassionate way you’ve supported a friend recently. Then write down how you can do the same for yourself. 
16. What do you love about life? 
17. What always brings tears to your eyes? (As Paulo Coelho has said, “Tears are words that need to be written.”) 
18. “Write about a time when work felt real to you, necessary and satisfying. Paid or unpaid, professional or domestic, physical or mental.” (Also a prompt from Abercrombie’s  Kicking in the Wall .)
19. Write about your first love — whether a person, place or thing. 
20. Using 10 words, describe yourself. 
21. What’s surprised you the most about your life or life in general? 
22. What can you learn from your biggest mistakes? 
23. I feel most energized when… 
24. “Write a list of questions to which you urgently need answers.” (This is probably my favorite prompt from Abercrombie’s book.) 
25. Make a list of everything that inspires you — from books to websites to quotes to people to paintings to stores to the stars. 
26. What’s one topic you need to learn more about to help you live a more fulfilling life? (Then learn about it.) 
27. I feel happiest in my skin when… 
28. Make a list of everything you’d like to  say no to. 
29. Make a list of everything you’d like to  say yes to. 
30. Write the words you need to hear. 

Journaling helps us figure out who we are, what we need and what we want. It can help us make better decisions, and focus on the very things that support us in taking compassionate care of ourselves and others. 

- See more at: http://spiritualityhealth.com/articles/30-journaling-prompts-self-discovery#sthash.1mH4pOD7.dpuf

We all experience resistance everyday when we’re trying to do something that matters. Whether you want to sit and meditate, work on a new project, get out and exercise, whatever it is that is in the direction of growth, resistance comes alive. In my next bookUncovering Happiness (can’t wait to share it with you – January, 2015), I explore some of the neuroscience behind what keeps us stuck in a depressive loop and how to get unstuck and even find our natural anti-depressants and thrive.  While resistance lies within a depressive spiral, you don’t have to have had experienced depression in the past to know resistance, it’s a universal daily experience for all of us.

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In the words of the renowned Katie, “I didn’t quit drinking; I did "The Work," and drinking, drugs, compulsive eating, smoking, anger, depression, sorrow, fear, all quit me.”

In 1986, Byron Katie found herself at the bottom of a ten-year spiral into depression, rage, and self-loathing, until one day she woke up to a state of constant joy that has stayed with her ever since. She realized that when she believed her stressful thoughts, she suffered, but that when she questioned them, she didn’t suffer. The simple yet powerful process of inquiry that was born from this experience is what Katie calls The Work.

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It’s safe to say that alternative treatments for addiction are no longer, actually, alternative in the “outside of the mainstream” sense. These days, many treatment facilities and therapists offer an array of these types of "supplemental" therapies, including acupuncture, equine (horse) therapy, neurofeedback, biochemical restoration, hypnotherapy, yoga, watsu (water therapy), meditation, ropes courses, sound therapy, and many more. Additionally, researchers are proving that experimental treatment with psychedelic drugs—though still illegal in the U.S.—can have profound effects on reducing cravings and preventing relapse. 

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