Today I was honored to present to the American Indian Section at the University of Utah’s School on Alcoholism and Other Drug Dependencies. This tract is planned for individuals who are involved with American Indians and alcoholic rehabilitation programs and those who are interested in expanding their knowledge in substance abuse, group counseling, program evaluation and community organization.

The primary objective of this section is to provide students with an understanding of the unique alcoholism and drug problems of American Indians with an accompanying knowledge of methods to treat their problems. Many of the participants of my presentation on Relapse Prevention reported that one of the troubling problems they experienced was a flood of chronic relapse clients.  Some of their clients had been through their programs two or three times and still relapsed.  Some of my objectives for my presentation were for the participants to better understand the progressive nature of relapse.

I endeavored to help the participants learn how to explain to their clients the concepts of relapse warning signs and high risk situations and how not recognizing and dealing with them can lead to relapse.  By the end of our session participants reported they felt better able to assist their clients in developing simple high risk situation and warning sign relapse prevention plans.

I explained that many programs took chronic relapse clients back into their programs and put them through an identical treatment protocol.  I explained that doing so was a waste of time, energy and money as well as keeping the client in a no-win position.  I then explained the several possible reasons for their problems with chronic relapse clients.

(1) Many of the people labeled as “chronic relapsers” did not relapse at all because in order to relapse someone must be fully engaged in recovery first.  I then explained that to be in recovery people need to meet four basic criteria:

(a) Admit and accept that they really do have an addictive disorder and be able to articulate this in no uncertain terms.

(b) Have hope and belief that not only is recovery possible for them but it is preferable/

(c) Be able to demonstrate recovery foot work biologically, psychologically, socially, and spiritually.

(d) Build a track record of at least 90-120 days of abstinence.  Many of the participants saw that many of their repeat clients probably didn’t meet theses prerequisites.   Many of them would need to have Denial Management Counseling treatment to help minimize treatment resistance and eliminate denial of their addictive disorder.

(2) Some of their clients did meet all of those four areas above but they ended up drinking and/or using other drugs do to hitting high risk situations involving trigger people, places, and things (situations) that led them to using again despite their honest commitment to be abstinent.  These people need Relapse Prevention Counseling which is designed to help clients identify and manage future high risk situation thus lowering significantly their risk of relapse.

(3) Another reason that some recovering people go back to alcohol and other drug use after coming out of denial and learning how to manage high risk situations is due to the presence of pre-existing core personality and life-style problems that usually pre-dated the addictive disorder.  These people need Relapse Prevention Therapy which is designed to help clients identify and manage the warning signs that eventually lead to high risk situation and alcohol and other drug use.

To learn more about relapse prevention and how to get training in the Gorski-CENAPS® Model of Relapse Prevention please go to the CENAPS consultation and training website. You can also go to our Addiction-Free Pain Management® website to see how I’ve adapted this model for people living with chronic pain and coexisting disorders.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page. You can also check out my article Managing Pain Medication in Recovery.

To check out my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

I’m spending this coming week in Salt Lake City presenting two Addiction-Free Pain Management® topics and helping Terence T. Gorski teacch the Relapse Prevention Counseling Track at the University of Utah’s School on Alcoholism and Other Drug Dependencies annual week long school. Last year I presented the Relapse Prevention Counseling Track myself and I am very honored to be asked back this year to present Managing Pain and Coexisting Disorders and Are We Managing Pain or Fueling Addiction.

The University of Utah’s School, which is recognized internationally, has continually expanded its scope to keep pace with increased awareness of the health and social problems of alcoholism and other drug dependencies and now I am bringing chronic pain and prescription drug abuse/addiction to the curicuulum.  All areas of these problems are presented in training sessions for professional and lay personnel.  The School provides students with the latest methods and techniques for working effectively in their respective disciplines.

COURSES OFFERED for substance abuse counselors, clinicians, physicians, dentists, pharmacists, nurses, medical personnel, rehabilitation counselors, public health administrators, educators, judges, lawyers, peace officers, county commissioners, industrial and community leaders, advisory council and board members, college and graduate students, families, treatment center personnel, and others desiring special instruction on alcoholism and other drug dependencies.

GENERAL SESSIONS for the entire student body will focus on current issues and trends in the field of substance abuse education, prevention and treatment.

GROUP SECTIONS provide specialized information and techniques for working effectively with substance abuse problems in various disciplines.  Specific groups are: American Indian; Criminal and Juvenile Justice; Dental; Drugs: Treatment and Rehabilitation; Education, Prevention and Youth Counseling; Employee Assistance and Human Resources; Mining Industry; Nursing; Pharmacy; Physicians; Professional Treatment; Recovery Support; Relapse Prevention Counseling; Substance Abuse Overview and Current Issues; Vocational Rehabilitation, Pain Management and Women’s Treatment.

I want to explain what I mean when I talk about denial and how it can sabotage chronic pain management. I believe that denial is a defense mechanism that helps us face painful reality when it is overwhelming or distressing. It’s an automatic and unconscious reaction that gets turned on when we have to think about or talk about our painful reality. There are both benefits and disadvantages to using denial. The benefits make us want to keep using denial in spite of the disadvantages that we tend to experience.

The Benefits of Denial

The major benefit of using denial is that it helps us to deal with unbearable pain and overwhelming problems. If you don’t believe it, talk to people who were near death as a result of a serious illness or injury and then survived. Ask them if at their worst moment they realized how sick and close to death they were. Most people will tell you that they didn’t. It was only as they began getting well that they realized how sick they really were. Why? Because at the moment of greatest illness, denial can be very strong and help us to keep hope alive by preventing us from seeing how hopeless the situation is.

You can also see the use of denial when talking with people who have a run a 26 mile marathon. Somewhere around 20 miles, most runners find that there body rebels and threatens to shut down. This is called hitting the wall. Experienced runners get through “the wall” by using denial. They try to ignore the real physical pain they are experiencing and focus upon getting through the wall and completing the race. Does it work? Sometimes it does. Don’t forget, however, that even the most experienced marathon runners have collapsed because the denial of their exhaustion caused them to push themselves beyond their physical endurance. In these cases the benefits that denial provides by helping deal with intense pain is outweighed by the disadvantages – the inability to accurately assess the truth of a given situation.

The Disadvantages of Denial

The major disadvantage of denial is that it prevents us from seeing what is wrong and taking appropriate action to handle the situation. As a result our problems can get worse in the long run because we refuse to recognize what is wrong and to do what is necessary to handle the problem.

When I was about 12 years old I injured myself playing sand lot football with my friends. I was rushed to the Emergency room and got shot up with Demerol. It sure stopped the pain. Then I was sent home with opiate pain medication that should have lasted 30 days if I took it as directed. First of all my parents should have held and dispensed this type of medication but they didn’t see why they should—total denial perhaps. Secondly, I ran out in about two weeks and used another type of denial—rationalization—to convince myself and my parents that the pain was worse and I really needed it. I continued this pattern off and on for the next fifteen years or so before I finally came out of denial and sought help.

At times denial was really a blessing for me because it not only helped with painful injuries and a chronic pain condition but it also allowed me to escape from some painful reality of an abusive school system and my father’s alcoholism. The problem was that as my tolerance built up so did my side effects or negative consequences.

For people living with chronic pain denial management is crucial for several reasons. One reason is sometimes people get into a problem with their medication management and just don’t see it. Another is sabotaging an effective pain management program by getting into automatic and unconscious self-defeating behaviors.

There are times when this defense mechanism called denial can help. Unfortunately, it can sometimes lead us to avoid looking at and dealing with a situation that is causing life-damaging consequences. There is also another interesting point about denial. If you are told “you’re in denial” you are now in a no-win position. If you are in denial you don’t know it, and if you’re not in denial you can’t prove it to the satisfaction of your accuser.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page. You can also check out my article Managing Pain Medication in Recovery.

To check out my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.