By Kambria Kennedy-Dominguez

Getting Sober

What "sobering up" means to you depends on your situation. Sometimes it means decreasing the frequency or quantity of use. Called "harm reduction" in treatment terms, many people naturally do this when they notice a problem with drugs and alcohol but are unsure of its severity. For example, if you find that you binge drink (more than 4 drinks at a time for women and more than 5 for men) when you're out with friends at bars, you might decide to ask your friends to meet you at a movie instead of a bar. Shifting the environment in which problematic behaviors occur is a way to reduce harm. Likewise, you may try to limit the amount you are drinking or using, or you may make deals with yourself not to use at certain times of day or in certain places. All of these methods of control are common once a problematic pattern is recognized. Whether these methods of control work or not depends on your individual circumstances. Here's a guideline for the safe consumption of alcohol, by the way. Great graphic from the CDC. 

Harm reduction is controversial, because many treatment professionals and many of those in recovery believe complete abstinence is the only way to sobriety. They might say that attempting to reduce harm only keeps you in the dangerous cycle of addiction, as you try to negotiate the problem away. There are reasonable arguments in favor of abstinence as the best strategy and it does indeed seem to work best for many. Taking a harm reduction versus abstinence approach is a very personal decision, one that I help clients make based on their own experiences.

Depending on the severity of the addiction and on the substances or substance combinations being used, withdrawal may with abstinence. Withdrawal symptoms range from mild to severe and vary depending on the drug. The process of withdrawal under medical supervision is called detoxification, and is the safest way to discontinue use of a drug when withdrawal is present, particularly with alcohol, opiates (heroin or prescription pain killers) and anti-anxiety drugs (like Xanax and Klonopin). After detox, many continue to residential treatment for 30 days or more, and some choose to move into sober living environments after residential care. These are each options along the way to sobriety, and most everyone's journey looks different depending on what they need. 

Once a more sober life is established, you have entered "recovery." Below is the three part plan that I use with counseling clients to help sustain recovery.

Using coping skills that work

A critical part of therapy for anyone, whether addiction is present or not, is learning to identify and use coping skills that work. What do you do when you feel stressed out at the end of a busy day? What do you do when you fight with your spouse? What do you do when you come up short on your monthly bills? What do you do when your boss yells at you? These are just some examples of possible triggers (see above) that may lead to cravings to use if there are not more adaptive coping skills in place. Some examples of coping skills are exercise, art, reading, talking to trusted friends, 12 step groups like AA, support groups, meditation, spending time with pets, making music, listening to music, walking, drinking tea, taking a warm bath, having a massage, giving yourself a massage, learning a new skill, taking up a new hobby....the list is limitless really. The question to ask yourself is how can I soothe myself in a way that doesn't create harm? 

Recovery is possible and it's happening for many people every single day. There are a ton of resources available to help and lots of evidence that positive change is within reach. If you are struggling with addiction or wanting to know more, please don't hesitate to reach out.

by Megan Kennedy

Bipolar disorder is a serious mental illness and permanent condition. When left untreated, it’s highs and lows can be erratic and the disorder can be overwhelming. The cyclical manic and depressive phases that distinguish bipolar disorder can cause poor performance at work or school, fragmented relationships, and sometimes suicide. However, with treatment, people with bipolar disorder can lead very full lives.

Bipolar symptoms can be severe and they are different than the normal highs and lows everyone occasionally experiences. The manic episodes present with bipolar disorders are characterized by an elevated, expansive, or irritable mood in combination with symptoms such as:

• Inflated self esteem or grandiosity
• Decreased need for sleep
• Racing thoughts, talking fast, jumping from one idea to the next
• Distractibility
• Having unrealistic beliefs about your abilities
• Restlessness  
• Increase in activities/ beginning multiple new projects
• Excessive involvement in high-risk, pleasurable activities

Some individuals with bipolar disorder experience hypomania, which is less severe. During a hypomanic phase, you may be extremely productive, feel great and function very well. While you may not feel like anything is wrong, others may suspect bipolar disorder as a possibility. People with hypomania are at an increased risk of developing mania if not treated.  
During the depressive phase, you may find it difficult to complete everyday responsibilities. Bipolar depression is characterized by:

• Feelings of guilt, worthlessness, or hopelessness 
• Losing interest in activities once enjoyed
• Fatigue or loss of energy
• Changes in sleeping and eating habits
• Difficulty concentrating, thinking or making decisions
• Thoughts of death or suicide

Both manic/ hypomanic and depressive episodes can last for days, weeks or months. However, in classic cases of bipolar disorder, people experience three or less mood episodes each year. A typical illustration includes one month of mania/hypomania, three months of depression while the remainder of the year is spent in a normal mood.   Untreated manic episodes can last up to three to six months, while untreated depressive episodes can last up to six to twelve months. Rapid cycling occurs when people cycle (move from one mood to another) more than three times per year. People with rapid cycling bipolar disorder usually experience longer durations of manic and depressive episodes and the symptoms tend to be greater.
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Effective treatment of bipolar disorder is dependent on a number of factors, and medication unaided usually isn’t sufficient. For the most effective treatment, you should learn about the illness, talk openly with your doctors and therapist, develop a reliable support system, live a healthy lifestyle, and commit to a treatment plan. The goal of a comprehensive treatment plan is to ease symptoms, restore your ability to function, repair problems that bipolar disorder has caused in various areas of your life, and lessen the possibility of recurrence. Comprehensive treatment plans usually include:

1. Medication – Mood stabilizers are used to reduce the ups and downs of bipolar disorder and control symptoms. Common mood stabilizers used include Lithium, Lamictal, Depakote, Tegretol, Trileptal and Topamax.  
2. Education: Symptom management and the avoidance of complications starts with an in-depth understanding of the disorder. The more knowledge you have about your illness, the more you’ll be able to avoid complications and deal with obstacles.
3. Therapy: Therapy is critical for managing bipolar disorder and the problems it can cause in your life. Therapists can help you learn how to handle difficult feelings and emotions, patch-up relationships, cope with stress, and control your mood.
4. Healthy lifestyle management: By purposefully adjusting your lifestyle and developing a schedule, you can manage your symptoms and keep the highs and lows to a minimum. You’ll need a consistent sleep pattern, to avoid drugs and alcohol, exercise consistently and learn healthy ways to cope with stress.
5. Support from others: Living with bipolar disorder is often difficult, so having a support system is important. Support from family, friends and support groups can be very helpful.

Learning to successfully manage bipolar disorder isn’t immediate and treatment has its peaks and valleys. Finding the best treatments for you takes time and obstacles will be present but with a commitment to recovering, you can control your symptoms and live a full and productive life.
To learn more about bipolar disorder or find local support groups visit: http://www.dbsadallas.org/