JOURNAL TRANSCRIPT
11/26/2017
“Joe” from Kansas said:
Personal Medicine
“I think there’s a lot of other things that’s medication that’s maybe not considered medication. There’s things - things that you can do that does change what your body does and it may not be medicine . . . I still think one of the best mood stabilizers there is in life – maybe not for everyone – but for me, is math.”
Jerry Fouchey MA CADC Outpatient & Personal Medicine Therapist
[email protected] 1
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Recovery Defined
Recovery’s Four Dimensions I. Health – Managing or overcoming symptoms II. Home – Safe and stable environment
“A process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential.”
III. Purpose – Meaningful activities, independence, and resources for participation IV. Community – Supportive relationships
Substance Abuse and Mental Health Services Administration
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Guiding Principles of Recovery
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Guiding Principles of Recovery 5. Recovery is supported by Peers and Allies 6. Recovery is supported through Relationships and Social Networks 7. Recovery is Culturally Based and Influenced 8. Recovery is supported by Addressing Trauma
1. Recovery emerges from Hope 2. Recovery is Person-Driven 3. Recovery occurs via Many Pathways 4. Recovery is Holistic
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Guiding Principles of Recovery
Today’s Objectives
9. Recovery involves Individual, Family, and Community Strengths and Responsibility
1. Gain an understanding of the Personal Medicine concepts.
10. Recovery is based on Respect
3. Examine the specific use of Personal Medicine with SUD & co-occurring conditions.
2. Consider the use of Personal Medicine concepts with a variety of client populations.
4. Identify Personal Medicine strategies that may be personally useful. 7
Dawn Farm’s Rationale for Personal Medicine
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What is Personal Medicine? • Things we do that help us feel well and limit unwanted symptoms.
• Higher Percentage of clients presenting concerns beyond addiction alone
• Things we do that put a smile on our face and give life meaning and purpose.
• Early psych diagnoses are frequently inaccurate • Post Acute Withdrawal Syndrome
• Things we do to help us avoid unwanted outcomes like loss of work, homelessness, jail, hospitalizations, or loosing custody of our kids.
• Client safety in psych matters is our first concern • Chronic Pain and Sleep Disturbance are common • Dr. Patricia Deegan’s Personal Medicine Model offered hope 9
Personal Medicine Examples • Working out regularly • Joining a house of worship • Singing in the choir • Cognitive Rehearsal • Regular Fun Activities • Daily Meditation • Cooking for Family/Friends • Develop Social Supports
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Characteristics of Personal Medicine
Use Affirmations Fishing on Sundays Providing for my family Limit Caffeine & Nicotine Practice Self-Compassion Painting or writing poetry Go to an AA or NA meeting • Journaling Daily • • • • • • •
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• It’s what we DO to be well, not what we take. It’s active not passive. • It helps limit unwanted symptoms and maximize our enjoyment of life. • It’s something we do NOW, in the present. It is not a future goal. • It’s an ACTION we take, not a feeling or state of mind. 12
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Which of these is Personal Medicine? 1. I will use St. John’s Wort for depression. 2. I will play Frisbee with my dog after work to relieve stress. 3. I will release stress by swimming laps four days a week when I get out of the hospital. 4. I will use self-harm strategies to calm myself and to help manage my flashbacks. 5. I will use controlled breathing exercises when I get anxious.
Why is Personal Medicine Important to SUD Recovery? 1. Simply taking pharmaceutical medicine is not enough to make us well. 2. Meds can do a lot to manage symptoms, but we have to be proactive and build a worthwhile life. 3. Effective recovery often depends on finding the right balance between pharmaceutical and behavioral strategies. 4. Finding this balance maximizes our chances of identifying and creating the life we want.
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Cascading Effects of Combined Meds & Behaviors
Pat Deegan’s Experience At 17 years old, she received a diagnosis of schizophrenia. She was told that the most important thing she could do is to take her prescribed meds exactly as directed. So that’s what she did . . .
Lower med dosage -> More Energy
More Energy -> Exercise & Walking in Nature More Exercise -> Increased Self Esteem & Symptom Control More Self Esteem & Control -> Success in School 15
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Personal Medicine Worksheet “I will live my life, not my diagnosis. My dreams are the stars that guide my journey of recovery. I will pursue my goals today!” Dr. Patricia Deegan
Personal Medicine Example: Something I do to feel better
Walking in the Park
Active Ingredient
(How does it help?)
Top 3 to work on
Connects with Nature and improves my mood
Something I do to feel better is: Something I do that makes my life meaningful is: Something I do that helps me feel good about being me is: Something I enjoy doing on a daily basis is: Something I do that helps me when I feel bad is: The most important thing in my life is:
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Personal Medicine Worksheet
Personal Medicine is “Personal”
Personal Medicine
Personal Medicine Strategy
Active Ingredient – How it helps
Walking in the Park
Time to talk with my friend
Walking in the Park
Get out and avoid isolation
Walking in the Park
Connect with nature, get grounded, connect with my Higher Power
Walking in the Park
Example: Something I do to feel better
Feel connected to the people of the neighborhood
Walking in the Park
Active Ingredient
(How does it help?)
Top 3 to work on
Connects with Nature and improves my mood
Something I do to feel better is:
Go swimming for 30 minutes 4 times a week
Lifts my mood and makes me less angry
Something I do that makes my life meaningful is:
Feed and care for my dog
The caring/responsible relationship helps me stay sober.
Something I do that helps me feel good about being me is:
I don’t know
Something I enjoy doing on a daily basis is:
Pray & meditate for 5-10 minutes
Something I do that helps me when I feel bad is:
Call my brother
He makes me laugh
The most important thing in my life is:
Working a program of recovery – meetings, Steps and a sponsor.
Staying sober gives me hope for the future
Calms me down
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If you find yourself working with someone who doesn’t have any Personal Medicine . . .
If you find yourself working with someone who doesn’t have any Personal Medicine . . .
Generally everyone has something that brings them happiness or makes them feel better – not necessarily big things. If you’re having trouble identifying these, meet the client in a different environment and get to know the client in their world. Clients frequently demonstrate surprising strengths in their world.
Help the person cultivate their Personal Medicine. This can be done by using peer supports who can make suggestions or share some wisdom from their own experience, strength and hope. Also, the Personal Medicine Cards developed by Pat Deegan’s organization can be helpful in developing ideas.
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Personal Medicine Card Example
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Personal Medicine Card Example Personal Medicine: Depression
Personal Medicine: Depression
Special Instructions for My Personal Medicine
Talk with Friends
I will call ____________________________________________
Isolation can ,make our depression worse. If we call or visit friends, it breaks isolation and helps us feel connected and cared about. And we don’t always have to talk about our depression and ourselves! Sometimes talking with friends about a variety of subjects such as sports, hobbies, news and even TV shows can help heal our depression
The phone number is __________________________________ The phone number to the help line is _____________________ Did the Personal Medicine work? -> Use it again It didn’t work? - - - - - - - - - - - - - - -> Try another strategy 23
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Personal Medicine Fidelity Standards
Katy’s Personal Medicine Worksheet Personal Medicine
1. Helps me feel better and strengthens my recovery.
Example: Something I do to feel better
Walking in the Park
Active Ingredient
(How does it help?) Connects with Nature and improves my mood
2. Is something I do NOW in my life.
Something I do to feel better is:
Take St. John’s Wort
Lifts my mood
3. Is NOT a feeling or state-of-mind.
Something I do that makes my life meaningful is:
Going to my nursing school classes
Gives me hope for the future
Something I do that helps me feel good about being me is:
Paint my nails
Makes me feel worthy, like I deserve to feel pretty
Something I enjoy doing on a daily basis is:
Morning shower
Helps motivate me to get out of bed
Something I do that helps me when I feel bad is:
Call my friend
I unload my worries and she makes me laugh
The most important thing in my life is:
Becoming a nurse
I want to help others
4. Is NOT something I take like vitamins, herbal supplements, alcohol or recreational drugs. 5. It is personal and unique to me as an individual. No two people’s Personal Medicine will be exactly the same.
Top 3 to work on
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Katy’s Personal Medicine 1. Paint My Nails – it helps me feel worthy, like I deserve to feel pretty. 2. Morning Shower – Helps motivate me to get out of bed and start my day. 3. Going to Nursing School – I want to help others.
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Personal Medicine and pharmaceutical medicine are sometimes woven together when developing a plan for recovery from the co-occurrence of a substance use disorder AND conditions like mental illness, chronic pain, a mood disorder or sleep disturbance.
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There are two compelling statements which drive the application of Personal Medicine concepts with SUD Clients: “Skills Not Pills” “I am an Active Agent in my own Recovery” 29
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Dawn Farm Personal Medicine Goals: 1. To reduce client suffering, increase selfefficacy, and enhance recovery. 2. To provide a framework that engages clients in actively monitoring and managing their psychiatric/co-occurring conditions. 3. To provide an immediate response to psychiatric symptoms that does not interfere with our ability to determine the nature and course of their psychiatric symptoms. 30
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Dawn Farm Personal Medicine Goals:
Developed Topics for Groups
4. To increase global quality of life for clients dealing with psychiatric symptoms and chronic pain. 5. To establish Personal Medicine as part of Dawn Farm’s treatment culture—becoming fully integrated into our thought, language and practice.
Anxiety Depression Sleep Disturbance Tobacco Recovery Chronic Pain 31
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The P.L.E.A.S.E. Skills
Essential Elements of Dawn Farm Personal Medicine Groups
PHYSICAL CARE – Take care of your mind and mood by taking care of your body. Practice health promoting activities like good personal hygiene, dental care, safe sex and other behaviors.
1. Client identification 2. Client education on co-occurring condition and its relationship to alcoholism/addiction 3. Exploration of behavioral strategies associated with effective management of the co-occurring condition 4. Clients develop a weekly plan on a Diary Card, discuss the success or failure of the plan at the next group, and develop a new or revised plan
iLLNESS (Treat It) – If you are sick or injured, or have an ongoing medical, dental or psychological condition, get proper and timely treatment. Take prescribed medication as directed.
EATING EFFECTIVELY – Eat a healthy diet of balanced meals and snacks mindfully though out the day, and eat in moderation. Limit foods that can encourage you to feel overly emotional and irritable like caffeine and sugar.
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The P.L.E.A.S.E. Skills
Anxiety Strategies
AVOID ISOLATION, DRUG USE & ALCOHOL – Isolation can enhance anxiety
or depression. Alcohol, non-prescription medications and street drugs can make your mood unpredictable. Limiting nicotine also supports better sleep and a calm and even mood.
SLEEP IN A BALANCED WAY – Don’t sleep too much or too little.
Work to establish a regular bedtime routine and a schedule for sleep. Seven and a half to eight hours of sleep per night is recommended for the average adult.
EXERCISE REGULARLY – Get an effective amount of exercise, as this will
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The Relaxation Response Mindfulness Meditation Controlled Breathing Regular Exercise Cognitive Rehearsal
• Self-Soothing with the Senses • Just Noticeable Change (JNC) • Examine Thinking Patterns • Journaling
both improve your body image and release endorphins, making you happier. Building up to 20 minutes a day is a good goal. If you’re just getting started, brisk walking is good exercise or try Yoga! 35
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Depression Strategies • • • • • •
Meditation Regular Exercise Practice Gratitude Nurture Relationships Help Others Self-Compassion
Sleep Strategies
• Pursue Fun Activities • Behavioral Activation • Challenge Negative Thoughts • Affirmations • Cognitive Rehearsal
Limit Caffeine/Nicotine • Regular Exercise • Manage Sleep Space • Consistent Sleep Schedule • and Routine • Use Calming Strategies • • Plan for Worry Thoughts • • • •
Examine Negative Sleep Thoughts Soak Up Some Sun Journaling The Relaxation Response Mindfulness Meditation
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Basic Principles of Chronic Pain
Tobacco Recovery Strategies • • • • • • •
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Learn about Co-Addiction • Learn the long-run benefits • Identify your “Why?” • Know your Triggers • Plan for Triggers • Change your routines • Assess need for NRT
Develop a tapering schedule Develop social supports Set a “Quit Date” Meditation for Stress Reward yourself Cognitive Rehearsal • Affirmations
• All Pain Is Real – Pain Theory • Our Thoughts and Emotions about pain drive our experience of it • Opioids are ineffective for Chronic Pain • Focus on improving function, not reducing pain • Expectations Count
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Chronic Pain Strategies • • • •
Pain Monitoring Pain Coping Skills Progressive Relaxation Pain Cycle and Pacing
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For Further Information
• Managing Depression
• “Recovery, Rehabilitation and the Conspiracy of Hope” https://www.patdeegan.com/pat-deegan/lectures/conspiracy-ofhope
• Sleep & Exercise • Communication and Pain • Acceptance and Pain
• “Integrating Personal Medicine into Service Delivery: Empowering People in Recovery”http://psycnet.apa.org/record/2013-42745-005 • Personal Medicine & Recovery, Patricia E. Deegan, PhD • https://www.patdeegan.com/commonground
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