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Treatment centers aren't helping patients nurture a sense of self

February 6, 2016
by Gary A. Enos, Editor
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Addiction treatment programs see high relapse rates in their patients because treatment tends to stop at the crisis and stabilization phases of the disorder and never gets to explore patients' personal growth, said the closing keynote speaker at this week's Addiction Professional Summit on continuing care in Anaheim, Calif.

Reef Karim, DO, director of The Control Center long-term behavioral treatment facility in Beverly Hills, outlined stages of treatment that begin with crisis intervention and ideally should proceed to identity formation and development of a core belief system. However, patients generally end treatment at the stage of achieving some lifestyle modification, without developing a self-concept that is essential to personal wellness, Karim said.

“I can say with full authority, 'People can change,'” said Karim, assistant clinical professor at the UCLA Semel Institute for Neuroscience. “But you have to have a sense of who you are in the world.”

He said in relation to treatment programs' typical reaction of blaming the patient who relapses, “Rarely do we talk about self-concept. Rarely do we talk about spiritual change.”

Clinicians should ask their patients a simple “Who are you?” question to probe their core values, although they may have to expect not much of an answer at first, Karim said. They might have to start with the basics, such as a person's political leanings or general interests. With some of his patients, he tries to address the difference between “the advertised version of you” (as portrayed on social media) and “the real version of you.”

In today's society, “We are more focused on capturing the moment than experiencing the moment,” Karim said. “We'd rather advertise than do, live! Our brains are suffering for it.”

He added, “We are more lonely than we were 10 years ago, and we're more bored than we were before.”

The Feb. 4-5 summit, “From Treatment to Recovery: Embracing a Continuing Care Model,” explored issues around treatment organizations becoming recovery-focused and supporting a system that moves away from episodic care. Topics included maximizing the power of treatment center alumni, using technological tools for recovery support, and integrating families and communities into the continuing care model. The event was produced by the publishers of Addiction Professional.

Changing the brain

Karim, whose online talk show “Reef Madness” explores a range of health and human behavior topics, used rich storytelling from his upbringing as the son of Indian immigrants to share messages about personal growth that should resonate with clinicians as much as patients.

He embraces the concept of “self-directed neuroplasticity,” which suggests that individuals can actively influence brain function in order to overcome limitations that have them stuck in life. Use of probiotics, or meditation, or yoga, can help achieve this. Medications may be helpful in the crisis phase of addiction treatment, he said, but mainly achieve symptom reduction.

“Medications certainly aren't going to give you self-concept,” Karim said, adding, “A good doctor knows when not to prescribe.”

Four S's—social connection, stress management, self expression and sense of purpose—hold the key to bringing about meaningful change, Karim said. “With these, you can make a shift in life,” he said.