Treatment Modalities We Offer
Effective And Fully Proven
Whether it is medication or counseling, De Novo will only use addiction treatment modalities that are evidence-based and that have been fully proven effective. The following is a description of our treatment philosophy, some of our major counseling approaches, along with medications we can use to help reduce cravings and stave off withdrawals for opioids, nicotine, and alcohol, and our philosophy regarding the twelve step approach. At the end of this page is a form for you to submit any questions you may have for our addiction counselors in Salt Lake City, UT.
Stages of Change
The Stages of Change Model was originally developed in the late 1970's and early 1980's by James Prochaska and Carlo DiClemente at the University of Rhode Island when they were studying how smokers were able to give up their habits or addiction.
- Pre Contemplation: Where life is good and you see no need whatsoever to make any changes. Other people may not be happy with what you are doing, but that is their problem.
- Contemplation: You think you might have a problem and might need to make some changes, but you are torn. Your drugs or other addictions may still be doing some good things for you. Your daily routines may still be more comfortable for you than the unknown of making changes. What you have to give up in making changes – friendships, routines, emotional and physical pain relief, getting high, and so on – may still be more important than what you might gain by giving your addiction up. You are ambivalent. The help you want at this point is someone who doesn't have a particular agenda of their own who can help you decide what is truly best for you.
- Preparation for Action: You decide that you are "sick and tired" of being "sick and tired." You start seeking out help, whether it is self help groups, friends who have quit before you, family, or treatment. You begin making arrangements to get the help you need. The help you want at this stage is referrals and assistance hooking up with supports and treatment.
- Action: You are seriously involved in getting any help you need. You are reading resource materials and/or attending self help meetings and/or getting sponsors and/or getting treatment/counseling and/or develop relapse prevention plans and/or any combination of the above. At this point you want tools with which to make change and solidify changes in your life.
- Maintenance: You have done the work, but still need to be vigilant and maintain the changes and gains you have made. At this stage you may want ongoing support, but not full treatment.
- Relapse: It happens. Not always – it's not inevitable, but it is a natural part of the process and it's not the end. Not all gains are lost with a relapse. The key is to manage and limit the damage from the relapse and get back into an action stage.
These stages are not necessarily sequential. We can move back and forth between them. Some programs require that individuals be in an action stage when they come in for treatment. We find that we can be of most help if individuals will come in while they are in contemplation, before they have lost everything and before they have "hit bottom." You may also be in pre-contemplation regarding your marijuana use, in contemplation regarding your Oxycontin use, and in action regarding your cocaine use. This is fine. So long as any treatment we offer won't put you in danger we are happy to work with you at any stage (though you probably won't show up on our doorstep if you are in pre-contemplation). As implied above, our approaches and the treatments we offer will vary depending on the stage of change you are in.
Need For Treatment Or No Treatment
Research has shown that the majority of individuals who use opioids or drink alcohol will not become addicted. Of those who do become addicted most will be able to quit on their own or by participating in self help groups. A minority of those who become addicted will need formal counseling or professional treatment. Of these an even smaller number will require the assistance of maintenance medications such as methadone or Suboxone or medications that simply reduce cravings such as Campral for alcohol dependence. If formal treatment is not needed we will not push for it. Likewise, if short term counseling will be less expensive in the long run and stands a good chance of being effective we will not push for medication assisted treatment.
Similarly, some individuals will have such a horrific home environment, a critical need for medical monitoring, or concurrent psychiatric treatment that it won't be safe for us to attempt to treat them in an outpatient setting and they may need to at least temporarily participate in a higher level of care, either separately or concurrent with our treatment.
Our commitment is to carefully consult with and assess each individual who approaches us seeking help to insure that just the right type and intensity of treatment is provided. If we aren't in a position to provide this we will refer elsewhere. Our only agenda is to insure that everyone who comes to us gets the help they need. Again, we recognize that no formal treatment is a viable option for many and will support attempts at quitting on your own when it appears that this might be safe.
Group Vs. Individual Counseling
Both forms of counseling have very distinct and different advantages. Group therapy or counseling provides an opportunity for feedback from several individuals who have "been there" and yet have different perspectives to share. These individuals can also catch each other in their irrational thinking (bulls**t), which is also very helpful. In terms of resources this is also the most efficient form of counseling for clinics as one counselor or therapist can counsel with several individuals at once.
However, individual counseling also has its place. Some individuals have a fear of speaking up in groups. Many individuals have very private trauma (think sexual abuse) that they rightly won't divulge in a group setting. Often they won't divulge with an individual counselor until they have developed trust and a close therapeutic relationship over the course of several weeks to months. Again, this is appropriate: we recognize that we can't demand your trust just because we are professional counselors. We have to earn your trust. Once these traumatic events are shared therapy can move forward in leaps and bounds. If trauma is never shared counseling may never progress.
In consideration of the place that both group and individual counseling or therapy have, we are committed to provide a balanced blend of both for our patients.
Motivational interviewing (MI) refers to a counseling approach in part developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. We have found this approach to be particularly helpful for individuals who are in a contemplative stage. This treatment is non-confrontational and helps you explore future goals and dreams and whether your current lifestyle and behaviors are getting you closer to or further away from these goals and dreams. We explore obstacles to change, have you rate both your motivation for change on any particular issue and your belief in your ability to make changes. We also explore the benefits you may be experiencing from your drug use or other habits as well as any harmful consequences you believe you are experiencing. You can then explore what it would take to increase motivation or hope.
In the course of this you may decide you really aren't interested in making changes. Again, this if fine. It is your life and your decision. You may also decide that you are ready to move into an action stage. At this stage we will continue to use a motivational interviewing approach, but will also introduce more concrete tools.
Cognitive Behavioral/Rational Emotive Therapy
Everyone has their own unique view of the world. This may be influenced by culture, personal beliefs, and upbringing. This is fine and we support cultural and belief differences. However, sometimes our beliefs lead to emotions and behaviors that distract us from obtaining our goals or feeling the emotions we would like to. When this is the case our counselors can help explore and provide tools with which you can challenge some of these unhealthy beliefs.
For example, your belief that you must always be right may lead to more conflict than you would really like and interfere with your goal of stable employment. A more rational belief might be that it is OK to be wrong once in a while or that it is OK to change your mind based on new information and that it would be helpful to remain open to this new information. This approach was first pioneered by Albert Ellis.
Sometimes we go through life without paying much attention to our body's physical cues, our emotions, or even our routine actions. When this happens cravings can sneak up on us. We can find that we are driving past our old dealer's house without having given it a thought. Mindfulness training can help us tune in to our thoughts, feelings and physical sensation in such a way that we can take care of our needs in a healthy way before they sneak up on us and avoid old habitual patterns of behaving.
This approach is based on the observation that all repeated behavior, no matter how harmful it may appear to outside observers, performs a useful function for the person who is engaging in it. We help facilitate change when we respect and recognize the basic human needs that someone had been trying to meet through unhealthy means. In fact, it is often not fair to insist that someone make changes that will leave basic needs unmet. In helping individuals quit their drug use or other addictions we need to help identify what needs their addiction has been meeting and provide them with skills to meet these in healthier ways.
In broad terms, addictions generally either help you avoid unpleasant emotions or circumstances or bring people and events into your life that you find pleasurable that you would otherwise be lacking.
Although not comprehensive, some examples of unpleasant emotions addictions can help you avoid are: relief from boredom, relief from physical or emotional pain, and relief from stress. Addictions can also bring the following into your life: friends or associates, easy access to sex partners, a sense of identity, excitement, activities, rituals that help structure days, and if selling is involved they can bring in money and grant a sense of power.
When viewed from this perspective addiction is not deviant, but is rather an understandable attempt to meet healthy needs and we can assist you in learning and practicing healthy means of meeting these needs. When these needs are being met the pull of addiction is significantly weakened.
Many years ago a man by the name of Abraham Maslow developed a basic concept of a hierarchy of human needs. This means that it is not likely individuals will be able to work on higher level emotional needs such as overcoming an addiction when their basic physical and emotional survival needs aren't being met. Put another way, it is difficult to focus on counseling when you are hungry, don't have a place to live, or are thinking about going back to a cold, dark apartment with no heat and no water. This is compounded if you are responsible for meeting the basic needs of children or others.
Accordingly, a vital aspect of treatment is getting these basic needs met and we may spend a great deal of your initial counseling in what are called case management services, such as helping you apply for food stamps, rental assistance, energy assistance, Medicaid, legal assistance, job searches/approaches, or other resources that can help insure your survival. Once these are met you will be in a much better position to focus on counseling and recovery. Viewed from this perspective, case management is simply another aspect of effective counseling.
Over the years a great deal of research and study has been put into risk factors for relapses. This has led to effective methods for helping individuals identify triggers, or "persons, places, and things" that may help set off cravings. Our counselors can go from there to help you develop plans for avoiding these. Unfortunately, we can encounter several of these triggers at any time in spite of our best efforts. We run into an old drinking buddy at the grocery store, we see an ad in a magazine, or we come across someone's discarded works on the street. We then need skills that we have learned and practiced ahead of time for dealing with these triggers. Again, our counselors are skilled in developing relapse prevention plans and will work with you to tailor one to your individual circumstances.
Twelve Step Approaches And Other Groups
Based on the original Alcoholics Anonymous there are now virtually 12 step groups/ and meetings for every addiction – even a few that aren't yet formally recognized as such. These include, but are certainly not limited to Cocaine Anonymous, NA (Narcotics) Anonymous, Overeaters Anonymous, and Sex Addicts Anonymous.
There is no denying that these and other self help groups have helped millions recover from innumerable addictions. It is also clear that there are a good many individuals who do not relate and are not helped by this approach. Claiming that this latter group of individuals is simply not yet "ready for treatment" is not helpful.
Moreover, we believe that the twelve step approach, when it does work, does so best as it was originally designed, that is with "addicts helping addicts." When professionals attempt to co-opt this as part of their treatment we end up corrupting it. Finally, we believe that if you are paying us for professional treatment, we should provide something different than you can get in purer form for free on the streets.
Given the above, we support all of our patients who want to try a 12 step approach, but we don't force or require it of our patients. When our patients do want to attend twelve step meetings we will attempt to help them find healthy meetings that will fully support them in their recovery. Where feasible we will allow twelve step groups to use our facilities. We will also encourage and help patients who want to try other self help groups, such as SMART, Rational Recovery, and SOS. However, we will continue to restrict our core treatment to professional, evidence based practices.
As noted above, some individuals never become addicted; some become physically dependent on some drugs but never truly addicted; some become addicted, but quit with no help; some quit with outpatient counseling; some with intensive outpatient treatment; some with partial hospitalization, and some with residential treatment. A few don't seem to be able to quit their drug of choice with any combination of these treatments.
This is often not a matter of the quality of the treatment being offered and is never a matter of the willpower of the persons with the addiction. Rather, it seems to be a matter of their personal biology or how their body has adapted and bonded to the drug in question. In such cases, a medication adjunct or assist to treatment can be a godsend.
Suboxone/buprenorphine and methadone stave off opioid or narcotic withdrawals and eliminate cravings. They can also block the effects of opioids. Suboxone tends to be safer because it is a partial agonist and has a ceiling effect where it doesn't increase in it effect after a certain dose. However, this also means that it may not be effective in some cases.
Campral helps to restore brain functioning that has been altered by years of exposure of the brain to alcohol. It then alleviates the physical and emotional discomfort that many people feel in the weeks and months following a cessation of drinking, reducing the temptation to return to drinking. Naltrexone/ReVia can reduce cravings and block the buzz that accompanies drinking, thus preventing a lapse of one drink from turning into a full blown relapse where one drink leads to another.
Welbutrin or Zyban has been shown to dramatically reduce nicotine withdrawal symptoms. Chantix works in two ways. It targets nicotine receptors in the brain, attaches to them, and blocks nicotine from reaching them. It is believed that Chantix also activates these receptors, causing a reduced release of dopamine compared to nicotine.
Again, these medications aren't always necessary, and they are always and adjunct to therapy and counseling, but there are times when they can be a critical assist to a full recovery.
The staff at De Novo would be happy to provide you with a free consultation with our addiction counselors and if necessary, with our psychiatrist to see if treatment would be helpful for you or for someone you love, and if so, what form that treatment might take.
Whether you choose counseling only or medication assisted treatment, we will work toward the day when you will no longer need ongoing, regular treatment. Again, some individuals' biology may not allow a complete cessation of treatment and no one who is benefiting will ever be forced off. However, if the day comes that do no longer need regular treatment we don't want you to feel that a door has been forever closed behind you.
Unexpected events such as divorce, debilitating illness, or the death of a loved one can occur that can be devastating. Other times the routine stresses of life can just grind at us. Whatever the issues, we all need someone to talk with from time to time. We won't take the place of good friends or close family, but we want to be there just the same. Accordingly, we offer a lifetime of free aftercare counseling of up to two sessions or hours a month for our patients who quit treatment when both the patient and the counselor have agreed that the time was right to do so. Hopefully, this will prevent unnecessary relapses and re-admissions.
Book A Consultation
Please know that our door is always open for renewed formal treatment for our former patients. Use the form below if you have any additional questions about our addiction counselors and treatment modalities. Contact De Novo to schedule a free first-time consultation or to learn about our offered DUI courses.