The media is finally highlighting and doing a pretty good job in discussing the dangers of opiate dependence in relation to pain management. The Fine Line Between Pain Management And Opiate Addiction Those of use working in the chemical dependency field have been watching this snowball over the past decade. In the late 1990′s there were news articles about hilly billy heroin (otherwise known as OxyContin) overrunning rural counties in Maine and Kentucky. Celebrities have been dying from their dependence to prescription medications for years, i.e. Heath Ledger. The media and publicists refer to it as medication mismanagement or an unfortunate interaction with medications. One of my favorite surfers, Andy Irons, died in 2010 from a prescription drug overdose. At the time, and to this day, no one speaks of Irons as an addict. Just that he died of an overdose related to prescription medications.

As a therapist in this field I am witness to the struggle of hundreds of addicts as they fight for their recovery. Some come by the disease innocently, hooked by an open script from a dentist, multiple knee surgeries, and so forth. Others use the relationship with the doctor as a means to protect their disease. “I am not going to stop taking the xanax, my doctor ordered it” or “I still need one vicodin because my back is really damaged and the doctor says that is all that will help.” My personal approach to those responses is simple, please sign the release of information and let us call your doctor together. The disease informs the client that there is no way that Jamie is going to talk to my doctor. This becomes a wonderful opportunity to educate the client about the disease of addiction and how it continues to try to protect itself, even when the client knows that they want to get healthy.

So knowing that there continues to be an increase in prescription drug dependence were do we go from here. I believe that the chemical dependence field must take charge and become a leader in how we treat chronic pain. Our counselors should take an active role in the development and use of non-narcotic pain management programs. The author of this article does a nice job identifying some effective approaches to treating pain without the use of opiates. There needs to be additional programing using EMDR and the mindfulness based therapies. Our field must educate medical professionals and share our knowledge on chemical dependence. Our national groups like NAADAC  and ACA and government agencies like SAMSHA and NIDA need to fund campaigns educating the public and professionals to break away from the “pill a day” mentality that fuels our healthcare system. Change is possible but it will require groups of professionals to saying there is a different way to do this.

–Jamie Loffredo, MA LPC NCC CAADC
 

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A well written article identifying how repetitive traumas that occur at young age, mainly through perceiving an experience, can impact our development.  Tim Lott: Did we damage each other? The family experiences a series a traumas within a relatively short period of time; loss of a parent and a partner, isolation, stress related to a traumatic pregnancy, multiple medical procedures in the first months of life, and the list goes on.

Using the EMDR approach to treatment we would complete a thorough history of the client (in this case the family in the article). Narrowing in on that early phase we will work with tto how people process their life experiences there is a high probability that everyone in this family has experienced a significant amount of small “t” trauma. New experiences, especially interpersonal relationships with the core family, will be informed by these series of traumas.

In EMDR all new material is filtered through the Adaptive Information Processing Model. The family members will successfully process some of their experiences. However due to the sheer amount of negative experiences over the three month period it is unlikely that all the negative material will be processed appropriately and the experience will be “locked” in and block the flow of new material. As adults we can reasonably say, “oh it happened at two, he will get over it” or “He was just a newborn, he didn’t know what was happening.” We can tell ourselves that all day. However if it does not feel true, or as in this case, our developmental history follows a path of conflict, then it is likely that the AIP is compensating for the negative experiences.

Using the EMDR approach to therapy, the therapist works with the client to identify what is perceived as the most disturbing part of this experience. The client will identify how they view themselves in relation to the experience and if they are currently having any physical response while the trauma is being identified. From there, completing the eight phase approach and using the eye movements and/or other forms of bi-lateral stimulation, the experience is targeted and reprocessed. It is reported that some clients may successfully reprocess an experience in as little as one session.

–Jamie Loffredo, MA LPC NCC CAADC

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Many of my clients will report “feeling stuck.” The feeling keeps them from reaching their goals or engaging others authentically in their relationships. They are unable to trace these feelings back to any significant life event. They report symptoms of anxiety, inability to concentrate, restlessness, low self esteem, and other common mental health issues that are seen regularly in therapy practices. In talk therapy we may spend months, if not years, talking about the symptoms with minimal results. We may even identify a past experience that triggers the current feelings. However being able to identify the root may not be enough to relieve the current symptoms.

Using the EMDR approach in therapy we target the experience. Using the eight phase structure we reprocess the past experience to alleviate the current symptoms. The neural networks associated with the memory are “cleaned” and the appropriate, healthy associations are made.

Most of the literature on EMDR focuses on the impact of significant trauma or the resolution of post traumatic stress disorder. There is limited discussion on the benefits of the EMDR approach to resolve issues related to “lesser” traumas.

These small “insignificant” moments are the ones that in EMDR lingo we refer to as little “t” traumas. These are events that we tell ourselves are no big deal and that we should be able to let roll off our back. These events may include not being invited to a birthday party at age 8, not being asked to play during recess, messing up a classroom presentation, or a million miscues we experienced from our parents. When these events are not processed appropriately they becoming blocking events. In the addiction field we talk about how a client is delayed developmentally by the drugs that they abuse. The EMDR approach is very similar. The Adaptive Information Processing Model (AIP) indicates that when we are unable to process an experience appropriately it becomes locked in our neural networks in such a manner that it impacts the processing or flow of new material. Essentially we start collecting a lot of dust on our mind’s lens.

Using the 8 phase structure and the use of eye movements and other bi-lateral stimulation the material is reprocessed and the lens is cleaned. The effect is not just to the past material but generalizes to future events. Clients who enter therapy to work on these “stuck” moments are pleasantly surprised by the speed in which they feel better.

It should go without saying that for clients working a 12-Step program of recovery, EMDR is an adjunct, complimentary therapy and not a substitute. EMDR can help people get to the next level.

–Jamie Loffredo

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