Types of Behavioral TherapyBlog

Types of Behavioral Therapy

Behavioral therapy, a commonly used evidenced-based practice in addictions treatment, was initially pioneered by Dr. Aaron Beck and Ivan Pavlov through a variety of experiments which were informed by an understanding of classical conditioning and automatic thoughts. Classical conditioning, founded by Pavlov, is a concept that resulted from the infamous experiment, “Pavlov’s Dogs”, which helped establish the behavioral connection between stimulus and reward. By conditioning the dogs to salivate (respond) after ringing a bell during feeding time, the behaviorist identified how learned responses are formed from unconditioned stimuli. Another form of learning, called operant conditioning, helps understand the developed connection between behavior and consequence, also known as positive and negative reinforcement and is similar to types of aversion therapy. Although addiction is not typically an intended outcome in substance use, conditioning as a concept aids in the development of addiction. That said, it can also be used to help gain an understanding of one’s behavioral learning style and work towards recovery from the addiction. 

In addiction, substance use becomes the conditioned response to multiple stimuli including uncomfortable emotions, a phase of life issues, conflict, and various other unpleasant situations. The development of a conditioned response is best described as: When I drink I feel good; I have a bad day so I drink to feel good again; therefore when I have a bad day, I am triggered to drink. Behavioral conditioning is important in understanding how addiction forms in each individual, which includes identifying triggers: what makes you want to use or drink. In treating addiction, behavioral therapy helps by changing the conditioned response to the stimuli through the development of healthier coping skills and possibly changing exposure to the stimuli. There are multiple types of behavioral therapy approaches that help address learned responses and conditioning such as cognitive behavioral therapy, systematic desensitization, aversion therapy, and flooding. 

Behavioral therapy is used to manage mental health symptoms and to treat addiction by changing behaviors which subsequently changes how you feel and think. This includes finding more positive and healthier activities to engage in, developing and utilizing your support system, and learning a more self-compassionate and positive language and automatic thoughts. At APEX Recovery, behavioral therapy approaches are utilized daily through behavior activation exercises, group therapy activities such as CBT, and recommended self-care interventions.

Cognitive behavior therapy (CBT) is a treatment intervention used to target unhealthy and irrational thoughts, behaviors, and feelings. Destructive behavioral patterns, such as substance abuse, have been linked to unhealthy thoughts and feelings about oneself, others, and the future. An example of this might be, “If I make a mistake at work and get a write-up, I believe I am a horrible person and should know better, I feel anger and shame, so I drink alcohol”. This example shows how unhealthy thoughts towards oneself result in uncomfortable emotions and subsequent unhealthy and destructive behavior patterns. By using CBT, you can identify cognitive distortions and extreme thinking patterns that can cause self-loathing and destructive behaviors, including substance use. Through changing the response or reward to stimuli to be healthier and constructive, you will able to build confidence, increase self-esteem and decrease the use of habits that help perpetuate substance use. 

Other forms of behavioral therapy, such as systematic desensitization and flooding, address fears and phobias which can often include anxiety and panic. Systematic desensitization is a form of exposure therapy that helps target irrational fears through gradual exposure. As with other forms of behavior therapy, systematic desensitization uses classical conditioning to counter-condition the response to fear or fearful situations. This form of therapy helps with social anxieties, panic, phobias, and other forms of anxiety disorders by helping the client develop relaxation and grounding skills through progressive muscle relaxation, deep breathing, and meditation and then gradually exposing the client to the stimuli. For example, if a client experiences anxiety about going swimming, the client would identify a small goal related to the task, such as putting on a swimsuit and engage their relaxation exercise during the task to help the mind associate the task to relaxation and safety as opposed to anxiety and fear. In this form of therapy, setting small goals for yourself is important and can be used as a way to mark progress and continued efforts.

In rehab programs, anxieties and fears are often co-occurring and can be a trigger for continued substance use. Some fears can include managing responsibilities of adulthood, parenting, social interactions, making new friends, etc., and can develop at a young age through traumatic experiences, unhealthy relationships, etc., making it difficult to build a healthy lifestyle for yourself. The innate purpose of fears and anxieties is to be a motivator and influencer in preparedness and precaution. However, if not addressed appropriately, they can be isolating and place limits or boundaries on a person that seem immovable and, in some cases, can become dangerous in addiction. In these cases, substance use can be seen as a way to cope with the isolating mental and physical strain that arise from those fears and anxieties. By using systematic desensitization, a client can gain the abilities to self-soothe when signs of anxiety begin the emerge. The use of classical conditioning in exposure therapy focuses mainly on pairing the conditioned stimuli to a healthier response, similar to Flooding.

Another efficient form of behavioral therapy, called “flooding”, can also be as effective and is known to be helpful for symptoms congruent with Post-Traumatic Stress Disorder. In this technique, the exposure is more immersive and less gradual. When using flooding in behavior therapy, the client learns grounding and relaxation techniques to help manage the anxiety and fear. There is also a component of cognitive therapy associated with flooding that is used to address cognitive distortions and irrational thought patterns; the CBT portion also helps process any trauma or unsettling experiences related to their anxiety. As a result, when the flooding experience occurs, the client is able to think more rationally and use grounding techniques to overcome the fear.

For example, a person who is triggered to drink alcohol due to social anxiety may be asked to attend a party, sober and alone, for a small and specified period of time. In this example, the individual is immersed in their feared experience, in a controlled environment, and is encouraged to apply their grounding techniques in the situation with the new knowledge they have gained. This subsequently re-conditions the brain to develop a more corrective experience. For clients who have a history of trauma and other fears that result in impairment or lifestyle disturbances, flooding can be very effective. As with any therapy, the coping skills learned and the knowledge gained during the course of therapy can be applied towards their recovery. By addressing the identified fears and traumas the individual will learn how to respond and react in situations and not feel that their fears and anxieties are hindering their progress towards recovery. It is of the utmost importance that these areas are addressed while completing recovery treatment in an effort to decrease the chance of relapse when encountering stimuli that were significant triggers for substance use initially. Through developing healthy coping skills to effectively manage such triggers, recovery is more attainable.

Lastly, an alternative behavior therapy approach that utilizes conditioning, called aversion therapy, has been proven effective in treating addiction through reinforcement and mild aversion techniques. Aversion therapy is a form of behavior therapy that uses conditioning to break certain behavioral habits. Different from systematic desensitization and flooding, instead of the client pairing the stimulus to a relaxation response, the stimulus is paired to something of discomfort in an effort to associate the behavior with an unpleasant response and therefore cease the behavior. This is sometimes used in substance use treatment in many different ways. For example, as a way to help a loved one abstain from substance use, a family member may decline continued support of the loved one. Another example would be the use of Antabuse for someone with a drinking problem, which is a medication that causes a person to experience symptoms of a severe and highly unpleasant physical sickness when alcohol is consumed. In substance use treatment, aversion therapy is used as a way to help the client abstain from substance use by associating continued substance use with something of mental or physical discomfort. That can include loss of financial support, declining health, and loss of familial support. 

In reality, recovery is challenging as it includes having to change behaviors, mindsets, and the overall lifestyle. It can also be difficult to obtain abstinence due to the quick and seemingly painless relief that substance use provides in the moment. However, the natural progression of substance abuse can often result in broken relationships, unprocessed trauma or emotions, health issues, and more hurt and anguish. For some, the inevitable damage substance abuse causes can be used as a form of aversion therapy to cease continued use and possibly seek treatment towards recovery. Just having the knowledge of the impairment that continued substance abuse has can reinforce continued abstinence. In many ways, aversion therapy is used at our facility by building the discrepancy between the want to use and the motivation to maintain sobriety. Recovery is a challenging feat which requires hard work and an understanding that cravings will occasionally re-emerge due to association and habit. It is the use of behavioral therapy approaches like aversion therapy that help break these patterns during the process of recovery.

Behavior therapy has been used for many years in a wide variety of therapeutic settings due to its universal techniques. Empirically based research studies have repeatedly shown it to be effective in targeting problems related to emotional regulation as well as unhealthy thoughts and behavioral patterns. In addiction it is common to see distorted patterns of thinking, irrational and unrealistic thought processes and abnormal behavioral patterns. By using behavioral therapy approaches in substance use treatment, the client is given the chance to not only achieve recovery but maintain their abstinence from substance use as well.

At APEX Recovery, relapse prevention is imperative to recovery and is addressed upon the start of treatment. It is therapeutic modalities such as CBT, exposure therapy, systematic desensitization, and flooding that help the client develop the tools and necessary coping skills towards relapse prevention. Clients are also taught how to continue implementing those interventions after treatment, as it is common to continue experiencing triggers, cravings, and other things that may prompt the want to drink or use. In substance use, there are always precipitating factors that exacerbate use and drive addiction and sometimes it can seem too overwhelming to deal with those factors. By addressing those precipitating factors, re-conditioning the mind and body to react in healthier ways, implementing new coping skills, and maintaining the motivation towards abstinence, recovery is possible.

Call APEX Recovery today to begin the process of working with our trained therapeutic staff using behavioral therapy techniques and the cognitive therapy approach to move towards living a life free from drug and alcohol abuse.


Cognitive Behavioral Therapy vs Psychotherapy

With so many different types of treatment for behavioral issues, choosing a therapist may feel like a difficult or even overwhelming task. Cognitive behavioral therapy and psychotherapy are behavioral treatment routes that many patients choose to take. Before selecting a therapist or treatment plan, it’s important to have a thorough understanding of each therapy as well as how they differ.

Defining the two therapeutic approaches and exploring their similarities and differences will help you understand the essence of each therapy and decide which will be the most helpful for your unique needs. Cognitive behavioral therapy is a type of psychotherapy. To define one, we must define the other. Keep reading to find out more about cognitive behavioral therapy and psychotherapy so you can make an informed choice about your treatment.

What is Psychotherapy?

Psychotherapy, sometimes referred to as talk therapy, consists of treatment methods that help people with a wide range of mental illnesses and emotional problems. Psychotherapy works to minimize or eliminate adverse behavioral symptoms allowing a person to heal psychologically and function better in all aspects of their life.

A variety of mental difficulties can be mended through psychotherapy including addiction, social phobias, childhood trauma, death of a loved one, insomnia, depression, and anxiety disorder. Psychotherapy can be administered through a variety of programs, each of which will work differently, depending on the individual and their specific cognitive issues. In addition, psychotherapy is often used in conjunction with other types of therapies or medications.

Psychotherapy may be short-term, consisting of just a few treatment sessions and dealing with immediate emotional issues. Conversely, it may be long-term, tackling more complex issues over the course of several months or years. The patient and therapist will work together to determine the length of treatment and specific goals for psychotherapy.

Types of Psychotherapy

Psychotherapy covers a wide range of cognitive treatment methods. As some patients respond better to certain types of treatment, psychotherapists will take a variety of factors into account in order to determine the best therapy program for each individual. The most effective type of psychotherapy will depend on a patient’s specific condition, unique circumstances, and personal preference. In addition to cognitive behavioral therapy, the following types of psychotherapy may be used to treat various mental conditions:

  • Interpersonal therapy
  • Dialectical behavior therapy
  • Eye movement desensitization and reprocessing therapy
  • Mentalization-based therapy
  • Psychodynamic psychotherapy
  • Supportive psychotherapy

Interpersonal Therapy

Interpersonal therapy focuses on a person’s relationships with others and aims to improve their interpersonal skills. During an interpersonal therapy session, a psychotherapist will help individuals assess their interactions with others and take note of negative patterns and behaviors such as social isolation or aggression. This will help the patient to strategize how to cultivate positive interactions with other people.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) was first developed to treat chronically suicidal patients with borderline personality disorder. This type of psychotherapy has developed over time and is currently used to treat people with a number of mental illnesses. However, most individuals treated with DBT have been previously diagnosed with borderline personality disorder.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is a type of psychotherapy most commonly used to treat post-traumatic stress disorder (PTSD). EMDR has been shown to reduce anxiety and emotional distress resulting from trauma.

Mentalization-Based Therapy

Mentalization-based therapy (MBT) is a form of psychotherapy that can result in long-term improvement among those with borderline personality disorder. MBT engages a skill called mentalizing in which people learn to separate their own automatic thoughts and feelings from those around them.  

Psychodynamic Psychotherapy

Psychodynamic psychotherapy is a clinical treatment method based on psychoanalytic principles. These theories are used to achieve self-actualization through a deepened insight into emotional conflicts causing cognitive difficulties.

Supportive Psychotherapy

The goal of supportive psychotherapy is to improve unfavorable mental symptoms and improve self-esteem and social skills. During a supportive psychotherapy session, a patient’s relationships will be examined as well as social patterns and emotional responses to various scenarios.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a newer form of psychotherapeutic practice. Although CBT cannot solve deeper issues and emotional trauma for some patients, it is considered to be an effective remedy for a long list of mental health conditions. This type of psychotherapy is generally short-term with a set number of sessions.

CBT combines theory and techniques behind both cognitive and behavioral therapies. The approach was created by examining the relationship between a person’s negative thoughts, fears, behaviors, and physical responses to various experiences. Cognitive behavioral therapy has shown to be effective in treating several different cognitive disorders including depression, anxiety, substance abuse, eating disorders, and severe mental illnesses.

Advances in cognitive behavioral therapy are based on extensive research and clinical practice. The approach has been backed by scientific evidence showing that it produces quantifiable changes in patients. Research shows that cognitive behavioral therapy leads to a significant improvement of mental wellness and overall quality of life in most patients. In fact, in many clinical studies, CBT has shown to be equally or sometimes more effective as medication and other forms of psychotherapy.

Types of Cognitive Behavioral Therapy

During cognitive behavioral therapy sessions, therapists work closely with their patients to figure out the best action plan for treatment for feelings such as depressive symptoms. This type of psychotherapy may consist of a few different approaches including exposure therapy, exposure and response prevention, and mindfulness-based stress reduction instead of relying on medications such as antidepressants.

Exposure Therapy

Exposure therapy is a type of CBT that is traditionally used to treat obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and certain phobias. During exposure therapy treatment, therapists will help their patients identify anxiety triggers and teach them how to avoid obsessive or anxious behaviors. Patients will then be exposed to their triggers and learn to confront them in a safe, controlled environment.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a type of exposure therapy in which a therapist helps patients confront their fears and learn to resist their compulsion to escape. ERP is often used to combat symptoms of OCD.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) is also known as mindfulness-based cognitive therapy and is a CBT method that uses highly-researched mindfulness techniques with consistent practice to accomplish certain behavioral outcomes.

Core Principles and Common Practices of Cognitive Behavioral Therapy

CBT is based on a number of core principles and common practices. Each cognitive behavioral therapy treatment program will be unique and will not use all of these strategies and principles. The therapist and patient will work collaboratively to gain an understanding of the psychological problem and develop an appropriate treatment plan.

CBT is based on several core principles including:

  1. The belief that psychological problems are based, in part, on unuseful thinking.
  2. Those who suffer from psychological issues can develop tools to cope which will relieve their symptoms and allow them to live more effective lives.
  3. CBT treatment usually involves efforts to change thinking patterns.

Common CBT practices include:

  • Learning how to recognize distorted thinking and reevaluate it logically
  • Developing a better understanding of the behavior of others
  • Using problem-solving skills for coping in difficult scenarios
  • Developing a sense of confidence
  • Facing fears instead of avoiding them
  • Learning to calm the mind and relax the body

In cognitive behavioral therapy, patients essentially learn to be their own therapist. By participating in exercises, developing tools, and learning coping skills, individuals are able to change their thinking patterns and prevent problematic feelings and behaviors for the long-term without extensive therapy.

Choosing the Best Type of Therapy for Your Needs

The effectiveness of different types of psychotherapy will depend mostly on patients finding a therapist they are comfortable working with as well as their willingness to put in the time and effort to make significant behavioral changes. The relationship between patient and therapist is the most important factor in successful therapy, so it’s a good idea to contact more than one psychologist before committing to a treatment plan.

If you’re ready to begin a psychological treatment plan, remember that the practice of psychotherapy encompasses a wide variety of therapy methods, including cognitive behavioral therapy and other forms of talk therapy.

The term psychotherapy refers any type of therapy related to the mind (psyche) that works to achieve mental wellness. Some forms of psychotherapy will involve extensive therapy sessions over the course of several months or years with the goal of working out deeper, underlying psychological issues or traumas. Conversely, cognitive behavioral therapy is a form of psychotherapy that is short-term and used with intent to correct and prevent future behavioral problems.

Choosing the right type of therapy approach can be difficult. While some types of psychotherapy work well in conjunction with one another, some forms work best on their own. Ultimately, this will depend on an individual’s specific situation, current condition, and treatment preference. It’s important to remember that patients have a say in the route they take for psychological therapy.

At APEX Recovery, a drug and alcohol rehab in San Diego, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery.  Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes. Call APEX today.


Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy (CBT) is a short-term psychotherapy approach. The intent of CBT is to help people refrain from undesirable behaviors by changing their thought patterns.

The idea behind this approach is that thought patterns and the way we process life events have a great influence on our behaviors and feelings. Cognitive behavioral therapy is an effective talk therapy approach that aims to teach coping skills and strategies for dealing with a variety of obstacles throughout life.

One of the major components behind the theory of CBT is that distorted thinking can lead to anxiety, depression, and problematic behaviors while thinking logically with a positive outlook can help people respond to life events more effectively. Research has shown that cognitive behavioral therapy is a powerful and useful technique for treating depression, anxiety, and panic and disorders, as well as addiction and other dysfunctional behaviors.  

On a fundamental level, cognitive behavioral therapy works. Successful application of CBT will consist of structured, collaborative therapy sessions between a counselor and patient. Sessions will involve clearly identifying the problem, goal setting, thorough and frequent communication, “homework” assignments, and feedback as well as the teaching of tools to help achieve behavioral changes and personal growth.   

History of Cognitive Behavioral Therapy

The practice of mindfulness dates back thousands of years to early Buddhism and Hinduism. Modern cognitive behavioral therapy is a relatively new psychotherapy method that was created in the 1960s for the treatment of depression. The Association for Behavioral Cognitive Therapies was founded in 1966 for CBT professionals and researchers. The 1979 book Cognitive Therapy and the Emotional Disorders by Aaron T. Beck was one of the first to explore cognitive behavioral therapy as a form of psychotherapy and was groundbreaking for its time. Today, CBT is modeled to treat a variety of behavioral disorders including anxiety, insomnia, social phobia, anger, addiction, and schizophrenia as well as panic, post-traumatic stress, bipolar, borderline personality, and eating disorders.  

How Effective is Cognitive Behavioral Therapy?

Research shows cognitive behavioral therapy can be more effective at treating behavioral problems than some medications and other forms of psychotherapy. It can be used to treat almost any dysfunctional behavior issue in which cognition plays a major role.

In clinical studies, CBT is known to be the most effective form of talk therapy. Unlike medication, cognitive behavioral therapy yields minimal side effects. After undergoing short-term CBT treatment sessions, many patients exhibit significant signs of improvement. Even when they discontinue therapy, most patients continue to improve because they are able to leverage the tools they learned in CBT and adjust their thinking styles and behaviors for the long-term.

In order for cognitive behavioral therapy to be truly effective, patients must commit to doing their “homework” between sessions with their cbt therapists. This means they use the skills they learned during therapy and apply them to real-life scenarios before their next visit. The process will also involve confronting various anxieties and fears, which can be difficult to do. With dedication, CBT is very effective in treating most behavioral problems.

However, cognitive behavioral therapy is not suited for every individual, and some will benefit from the treatment more than others. The therapy may not be effective for those with deeply-rooted mental health problems stemming from childhood or severe trauma. In these cases, longer-term psychotherapy can be more effective in treating behavioral issues.

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy focuses on changing certain thoughts and behaviors that prevent positive results. The psychotherapy technique can assist with working out numerous emotional, medical, and social problems. CBT is short-term and involves one-on-one treatment sessions. The therapy sessions are goal-oriented and intended to eliminate cognitive issues and prevent relapse of various behavioral disorders.

CBT is a one-on-one, short-term form of psychotherapy therapy that lasts anywhere from one to twenty sessions. It is problem-specific, goal-oriented, designed to achieve remission and prevent relapse of specific mental disorders.

Other forms of psychotherapy work by exploring a person’s past to gain insight into their emotions and behaviors. Conversely, CBT focuses on present beliefs and feelings. During cognitive behavioral therapy sessions, patients will develop skills to help them recognize problematic thinking, modify their thought patterns, and behave in more productive ways. Eventually, they will develop the tools to be able to act desirably in their ongoing life.

Cognitive behavioral therapy is based on the following core principles:

  1. Psychological behavioral issues are partially based on insufficient ways of thinking.
  2. Some psychological problems are a result of learned patterns of faulty behaviors.
  3. Individuals who suffer from psychological behavioral issues can learn better ways to cope in therapy which will relieve their symptoms and allow them to live less strained or destructive lives.

Cognitive misinterpretations can lead to adverse behaviors. When someone goes through a stressful experience, certain thoughts will automatically arise, leading to unfavorable emotions. Some individuals draw incorrect or illogical conclusions about the meaning of certain events and experiences based on this automatic thought process. When this occurs, they may fret, overreact, or shut down completely.

This flawed thinking will lead to negative behaviors unless interrupted or corrected through psychotherapy. For example, a person with social phobia is similar to social anxiety disorder, and a person may have feelings of fear attending a birthday party because they perceive that they will suffer from ridicule or trauma by being around groups of people. This fear may be triggered by an early childhood experience and can cause a person with social phobia to feel severe anxiety, experience sleep deprivation, and avoid a number of social scenarios. A cognitive behavioral therapist can help their patients realize how distorted thoughts directly affect moods and ignite fears and teach them how to change these thinking patterns. During CBT sessions, the patient and therapist will work together to develop a plan to overcome negative thoughts and irrational fears.

Common practices in cognitive behavioral therapy include:

  • Identifying problem areas
  • Practicing awareness of automatic thought patterns
  • Diminishing negative thinking
  • Learning to distinguish between rational and irrational emotions
  • Challenging underlying assumptions
  • Learning to view situations from various perspectives
  • Identifying what is realistic and what is illogical fear
  • Learning to stop catastrophizing
  • Testing perceptions against reality
  • Examining the validity of certain thoughts
  • Modifying distorted beliefs
  • Improving awareness of moods
  • Avoiding “all or nothing” thinking
  • Keeping a cognitive behavioral journal
  • Slowly increasing exposure to feared scenarios

During cognitive behavioral therapy, the therapist and patient will discuss different techniques and develop goals and practices that will be used throughout treatment as well as after CBT is completed. In order to see sufficient results with CBT, patients must be an active participant in their treatment.

How Cognitive Behavioral Therapy Modernizes Mindfulness

Cognitive behavioral therapy is typically very systematic and structured with frequent practice. This is part of what makes the treatment effective. For example, a person undergoing CBT to treat depression may be asked to write down their thoughts each time an upsetting event occurs. They will then work with their behavioral therapist to test how accurate and productive those thoughts are. Frequent and repeated practice is an essential piece of successful cognitive behavioral therapy.

CBT does not teach those with behavioral disorders what they didn’t already know. Instead, it works by reminding them of what they need to do. Cognitive behavioral therapy focuses less on conveying new information and more on building new habits. This form of psychotherapy helps patients by repeatedly exhibiting where flawed thinking can lead them astray and offers them better alternatives for moving forward.

What Happens During a Cognitive Behavioral Therapy Session?

Since cognitive behavioral therapy is a form of psychotherapy, early treatment will be similar to those in any initial therapy session. CBT Sessions will begin with a discussion of the patient’s background, expectations, and a general overview of the therapy. During the subsequent sessions, the patient will discuss their fears, struggles, and emotional setbacks. The therapist will work with them to develop the most effective responses to these emotional dilemmas.

CBT patients will prepare for behavior therapy sessions by thinking of emotional hurdles they’d like to overcome or stressful situations they fear. After presenting these items to the therapist, the two will work together to create an action plan. The goal of the plan will be to identify problematic thoughts and reactions and use strategies to change the adverse behaviors in between therapy sessions. Cognitive behavioral therapy action plans are sometimes referred to as “homework”.  

With relatively few therapy sessions and active application of goals and strategies, CBT has shown to be effective at reducing symptoms of behavioral problems. Cognitive behavioral homework may include keeping a journal of moods throughout the week, relaxation techniques, assigned reading, or seeking out opportunities to apply the refined approach to feared scenarios.

Cognitive behavioral therapy works by eliminating behavioral symptoms as soon as possible. This usually occurs within a few weeks or months of starting treatment. It’s important to keep in mind that results from CBT will depend on the number and severity of a person’s cognitive issues, but the approach is typically used for shorter periods of time than other forms of intensive psychotherapy.

Types of Cognitive Behavioral Therapy

Cognitive behavioral therapists work with their patients to determine the best course of action for treatment. CBT may consist of a variety of techniques including exposure therapy, mindfulness-based stress reduction, and exposure and response prevention.

Exposure Therapy

Exposure therapy works by encouraging patients to gradually face feared situations and repeat the process on a regular basis.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) is a cognitive behavioral therapy program that utilizes tested mindfulness techniques with consistent practice to achieve certain behavioral outcomes.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a form of exposure therapy that has patients confront their fears and resist their escape response. ERP is commonly used to combat obsessive-compulsive disorder (OCD).  

Cognitive behavioral therapy is an effective form of psychotherapy. Negative, distorted thoughts and emotions can lead to problematic behaviors and a dysfunctional lifestyle. CBT helps individuals recognize disordered thinking, understand cognitive distortions, modify their outlook, and practice facing situations with the right tools to help them cope.

At APEX, cognitive behavioral therapy is used as part of our approach to integrative treatment. Through CBT, we are able to help patients adjust their thinking and behavioral patterns and help them overcome addiction, mental illness, and depression. Our cognitive behavioral therapists work closely with patients to improve their outlook, behaviors, and general lifestyle. APEX administers cognitive behavioral therapy to combat a variety of conditions including addiction, depression, anxiety, and phobia. It’s a very hands-on approach that allows our cognitive behavioral therapists to work closely with each patient to improve his or her behavior and thought patterns through thought and behavior therapy.

For more information on cognitive behavioral therapy or other rehab programs we offer, contact us at APEX Recovery Center today! 


Dr. Matthew Bruhin Honored with Citizen of Courage Award

On April 10th, 2018 Dr. Matthew Bruhin was honored as a recipient of San Diego’s Citizen of Courage Award for 2018. The award was presented for to Dr. Bruhin for his work in saving a man’s life from certain suicide, when he encountered a man preparing to jump off Coronado Bridge in November of 2017. The man who was saved was a military veteran, a father, and hardworking native San Diegan. During the intervention, Dr. Bruhin and his wife were able to convince the man that they had resources to help house him. Get him clean and sober, and to move forward with his life in a better way. Finally, after intense negotiation, Juan chose to put his trust in the strangers and stepped back off the ledge and onto the bridge.  

Dr. Bruhin, a CEO of APEX Recovery and a licensed therapist, took him to treatment where he received a scholarship for three months. He was able to be treated for his depression and drug addiction. In addition, Dr. Bruhin’s wife, the City of Coronado, and many kind anonymous strangers donated money, clothing and well wishes to Juan. After discharge from APEX, Juan received help from the VA and received housing services. He remains sober to this day and maintains the experience not only saved his life but helped him enrich the lives of others. Dr. Bruhin received the award with his family, his business partner and co-founder of APEX Recovery, Fred Bowen, and nominator Dr. Ken Druck, a bestselling author and expert in the field. The highlight of the event was during Dr. Bruhin’s acceptance speech when he openly stated that the true man of courage was Juan, for trusting strangers to help him in the darkest of moments. The packed crowd then gave Juan a standing ovation for over two minutes. The story is nothing short of a miracle.

Side effects of heroinBlog

Side Effects of Heroin Abuse

A lingering danger during the country’s current opioid epidemic is heroin. Often, those who abuse opioid painkillers will eventually turn to heroin when they have run out of other options. The difference here is that heroin can only be acquired by illegal means, which adds another level of danger to this potent drug.

Just like its other opioid counterparts, heroin is highly addictive and can lead to a number of physical, mental, and social issues if a person uses the drug continuously for a period of time. In this post, we’ll go over the many potential side effects of heroin abuse.

What Is Heroin

Heroin is a modified version of morphine, that will typically be found in a white powder form. However, heroin can often be mixed with other substances, which will sometimes give the powder a yellow or brownish color. Sometimes, it may even be black (black tar heroin).

Heroin can be injected, smoked, or snorted, and will have a fast and dramatic effect on the user regardless of how it is taken. Because of how fast the drug acts, and how intense its effect on the body and mind can be, heroin is an extremely harmful and dangerous substance. Unfortunately, these factors are also what makes the drug so addictive.

How Harmful Is Heroin?

The level of harm heroin can cause a person will largely depend on their length and volume of usage. The prolonged abuse of heroin can cause serious physical and mental health issues, which may have some associated trickle-down side effects. Beyond its effects on a person’s mind and body, heroin abuse can also have several social and legal ramifications.

It should also be noted that heroin comes with an extremely high risk of overdose. Because heroin is a street drug, there is no standard process by which the drug is created. It can be mixed with other substances and will vary widely in potency. Anyone, no matter their history with heroin or tolerance, is at risk for overdose any time they use, simply because there is often no way to know what you are putting into your body and how it will react.

In fact, heroin is the main culprit when it comes to opioid deaths caused by overdose. Opioid abusers are often led to try heroin when they can no longer acquire their prescription drugs, or because they have built up such a high tolerance that they need something stronger to achieve the euphoric high opioids produce. Once heroin becomes their drug of choice, it will be difficult for them to go back to anything else that could compete with its intense high, paired with how readily available the substance has become, as well as the fact that heroin is relatively cheap to acquire. This all adds up to an extremely dangerous substance, that comes with the risk of death, as well as a host of other more minor side effects.

The Heroin High

Heroin is popular because of the intense, euphoric high it produces. The drug creates these feelings by binding to opioid receptors in the user’s body. This causes the affected nerve cells to release a neurotransmitter called dopamine, which regulates a person’s feelings of pleasure and reward.

When a person takes heroin, they get a rush of dopamine in their body, which is what gives them the intense feeling of euphoria. This is how addiction starts and grows because the user will want to repeat the behavior to achieve the same sensation. While the euphoric high is the first main effect of heroin use, there are some other short-term effects that often come with a dose of heroin.

Short-term effects will differ depending on how the person ingested the drug, but for the most part, they will feel warm and flushed during the dopamine rush an odd sensation of their extremities feeling heavy, as well as dry mouth. They may experience a few other pain-relieving and minor depressant effects. These may include a reduced sensation of pain, and a general drowsiness, sedation, and lethargy. The user may also “nod off” and rotate through being awake and asleep during their high.

Another reason heroin is so highly addictive is that the dopamine rush and its associated feelings will only last for a few minutes, while the sedative effects may last for up to a few hours. The duration of the effects will depend on their method of ingestion, as well as the purity and dose of the drug. Of course, there are some negative side effects associated with the use of heroin as well.

Short-term Side Effects of Heroin Abuse

Once the initial effects of euphoria wear off, the user will still feel drowsy for several hours. This period can come with some much less enjoyable side effects, from minor nuisances to more difficult to deal with, and even some serious health risks. These side effects occur when the body adapts to the heroin in its system, attempting to counterbalance its effects and restore the affected parts of the body to their normal functions.

These side effects may initially manifest as dry mouth, nausea, vomiting, and some severe itching. The person will feel groggy and be in a general haze, with slowed mental function putting them in a state of confusion. They are also likely to have constricted pupils that will make them extremely sensitive to light. Those are the easy/minor symptoms.

However, the short-term side effects of heroin can be much more serious. Heroin also causes the body to lose temperature and slows the user’s heart rate. Their breathing may slow enough to become life-threatening or lead to coma and permanent brain damage. And of course, there is the risk for overdose.

While death might not seem like a short-term effect, it is actually both. A heroin dose is impossible to measure because of the vast differences in purity, meaning it is never safe to use heroin. Long-time and first-time users alike overdose. It is certainly a substance best avoided altogether.

The short-term side effects can be compounded if the person is using other substances along with heroin, especially other depressants like alcohol or other opioids. When combined, the user is at a very high risk for overdose, as the other more dangerous side effects will be compounded. Using substances in addition to heroin will cause dangerously slow breathing, a lack of oxygen in the brain, and more serious heart problems.

Long-term Side Effects of Heroin Abuse

Prolonged abuse of heroin will come with a long list of potential harmful side effects, many of which can have lasting consequences.

Addiction & Withdrawal

As we’ve mentioned, heroin is a highly addictive substance because of the quick, intense high it produces, coupled with how quickly the drug wears off. When a user loses their high, some of the negative short-term side effects we listed above start to creep in, leading them to use again to feel better. As the cycle continues the user will develop an addiction.

Heroin is extremely addictive no matter how it is taken, but injection and smoking are the riskiest methods because of how quickly the drug reaches and affects the brain. Generally, once a person develops an addiction to heroin, it will take over their life — finding and using more of the drug will become their primary purpose, and all other responsibilities will be set aside.

As the person uses more heroin, they will quickly develop a tolerance to the drug, as well as a physical dependence. This will require them to get more of the drug and use it more often to achieve the same effects. Their body adapts to the presence of heroin and will attempt to compensate.

This is one of the most dangerous aspects of heroin abuse, especially because a user can become physically dependent in such a short period of time. Because their body has become so accustomed to having heroin in its system, they will feel nauseous and generally uncomfortable without it. When a person who has reached this level of abuse attempts to quit and suddenly stops taking heroin, they will encounter withdrawal.

Withdrawal and detox can be very difficult for a long-time heroin abuser, and may set in as quickly as a few hours after the last time they take the drug. The symptoms often closely mimic flu symptoms, but can be much more severe. The user may encounter withdrawal symptoms such as restlessness, discomfort, anxiety, insomnia, a pounding or racing heartbeat, muscle and bone aches and pains, cold flashes with goosebumps, uncontrollable shaking and body tremors, sweating, diarrhea, and vomiting. These symptoms will peak within 24 to 48 hours after the person’s last dose and should lessen and go away in about a week. However, some users may have persistent withdrawal symptoms for months.

Physical Side Effects of Long-term Heroin Abuse

The physical side effects a heroin abuser can expect to see will vary from person to person depending on their length of usage and abuse, the volume and potency of heroin they were taking, if they were taking any other substances at the same time, and their individual make-up. However, the severity of symptoms they experience is closely connected to how long they abused the drug. The longer the abuse — the worse the symptoms.

Those people who use heroin over an extended period of time can expect to see some changes to their physical appearance, as well as many ongoing harmful effects happening beneath the surface.

Heroin abusers often suffer from poor dental health as their usage worsens, including damaged teeth and swollen gums. This is in part directly to the chemicals in the drug, but also because personal grooming will no longer be a priority. Their heroin use may also give them a poor appetite and a malnourished appearance.  Long-term abuse will cause the user’s muscles to weaken and keep them in a general sedated state.

Because heroin can cause a user’s skin to itch, prolonged use can cause damaged skin due to excessive scratching. Pustules may also appear on the person’s skin, often on the face. Heroin abusers will often encounter insomnia as well as severe constipation, and will often experience sexual side effects, including impotence and the inability to achieve orgasm. The presence of heroin can also disrupt the female menstrual cycle.

Other physical side effects can be much more destructive to the body. A person who frequently injects the drug may cause their veins to collapse, which can then lead to infections in their blood vessels and heart valves. They may encounter arthritis and tuberculosis because of the poor condition of their body. Bacterial infections are also common, as well as skin disease and abscesses around injection sites.

Pregnant women are at high risk for miscarriage, as well as placing their child at risk for a communicable disease, in addition to being addicted to heroin from birth.

The list of potential major-risk side effects is long but includes:

  • Liver disease
  • Infections of the valves and lining of the heart
  • HIV or Hepatitis B and C
  • Chronic pneumonia
  • Blood clots, leading to stroke, pulmonary embolism, and heart attack
  • Kidney disease
  • Risks of contracting chronic illnesses
  • Risks for blood-borne pathogens
  • Septicemia
  • Respiratory depression
  • Seizures
  • Overdose
  • Death

Mental Health Concerns

The prolonged abuse of heroin will change the physical structure and physiology of the user’s brain. This can cause long-term imbalances in their nervous system that may not ever return all the way back to normal. Heroin can deteriorate the brain’s white matter, which can have an effect on the person’s decision-making abilities, behavior, and response to stressful situations.

Other mental health concerns include:  

  • Loss of memory and intellectual performance
  • Introversion
  • Depression
  • Anxiety

Co-occurring Disorders

A number of other mental illnesses and health conditions may co-occur with heroin abuse. These may include:

  • Bipolar disorder
  • Schizophrenia
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)
  • Personality disorders
  • Other substance addictions, including alcoholism

Since heroin users often share needles, they put themselves at risk for developing AIDS and other infections, such as liver disease.

Beyond health concerns, heroin abuse also causes side effects to the user’s personal life, including their finances, relationships with family and friends, trouble at school or their job, and of course, potential legal consequences from using the illegal drug.


This list barely scratches the surface of the many potentially damaging side effects of heroin abuse. It is a drug that wreaks absolute havoc on a person’s system, creating a ripple effect from their appearance to their physical and mental health, all the way down to their personal and professional lives. If you or a loved one is experiencing any side effects of heroin abuse or is suffering from a heroin addiction, seek treatment today.

Heroin detox timelineBlog

Heroin Detox Timeline

Heroin is an extremely dangerous substance that is a big part of the opioid epidemic that is currently ravaging America. According to the Centers for Disease Control and Prevention (CDC), in the past decade, heroin abuse has more than doubled among young adults aged 18 to 25 years old.

The alarming growth rate of heroin use has brought with it even more troublesome side effects: more and more people are overdosing and dying. The CDC also reports that overdose deaths related to heroin have more than quadrupled since 2010. The death rate increased by 20.6 percent from 2014 to 2015 alone.

Hopefully, these stats show what a truly dangerous drug heroin is and will inspire those currently using to quit. However, the process of kicking a heroin addiction is complicated and takes some time. Heroin is NOT a substance that you can quit overnight, especially if you have been a long-time user.

Those who try to quit heroin cold turkey put themselves at a high risk for some serious health concerns, as well as an elevated potential to relapse, overdose, and die. In order to safely stop using heroin, you will need to enter a professional detox facility, and taper off of the drug under close supervision. Depending on your level of abuse and addiction, this can be a very uncomfortable and trying time that will require some professional help.

While everyone’s long-term recovery experience will be different, there is a general heroin detox timeline that you can expect to follow. No matter what, this process begins with a person developing an addiction to heroin, so let’s start with how that happens.

Heroin Addiction

A synthetic opioid that comes from morphine, heroin is usually found in white powder form, although it can sometimes be yellow, brown, or black, given its content, purity, and whether or not it is mixed with any other substances. The powder can be “cooked” and injected, or smoked and even snorted. Regardless of how it is taken, heroin produces a profound effect on the user’s brain and acts quickly, producing euphoric effects.

This intense, euphoric high is what makes heroin so popular. Unfortunately, it is also part of why the substance is so addictive. Heroin produces its effects by binding to opioid receptors in the user’s brain, releasing a neurotransmitter called dopamine. Dopamine regulates the body’s feelings of pleasure and reward, and when a person takes heroin, the drug gives them a rush of dopamine, causing intense versions of these feelings.

The initial sense of euphoria will wear off rather quickly, sometimes in a matter of minutes. This will then be replaced by grogginess, lethargy, and some other, less-enjoyable symptoms. Rather than deal with the almost flu-like side-effects of coming down from a heroin high, the user will often be tempted to use again to go back to the happy feelings the drug produced.

Then the behavior is repeated, and the cycle continues until they have a full-blown addiction. Heroin becomes the only thing that can activate their pleasure-reward sensors, and the drug abuse will begin to consume all aspects of the user’s life. Once they are fully dependent on heroin to maintain their status quo, family and work responsibilities will become unimportant, relationships will suffer, their personal health and hygiene won’t even matter anymore — all they will care about is their next high.

This worsens as the user builds a tolerance to the drug. It’s very easy for someone abusing an opioid like heroin to develop a tolerance to the substance, which is another major reason it is so dangerous and addictive. At a certain point in their addiction, their current dosage will no longer be enough to achieve their desired effects, as the body rebounds to combat the substance. This leads the person to take a higher dose, or using heroin more often.

These alarming addictive behaviors will put the user at higher risk for overdose. It should be noted that absolutely anyone can overdose from heroin, whether they are a long-time user or trying it for the first time, because there is no regulation over the drug, and therefore you have no idea how potent the substance will be, or what it may be mixed with.

While drug addiction is very difficult in itself, the user may eventually decide, or be pushed by friends and family, to quit using. This will hopefully lead the person to enter a detox facility, to help them safely get clean from heroin. The initial stages of attempting to stop abusing heroin are so hard, because this is when withdrawal sets in.

Heroin Withdrawal Timeline

Withdrawal is the part of getting clean from a heroin addiction that will be most difficult to deal with, and heavily influences the timeline of heroin detox.

Withdrawal itself is rarely fatal, but is so unpleasant that it can trigger the person to relapse at a time when they are most vulnerable to overdose. This is why a supervised detoxification is the safest path to take for recovery.

The withdrawal process will be different for everyone, and depend on a number of factors. This mainly includes how long they abused heroin, and how dependent their brain and body are to the substance. Typically, the longer and higher volume their abuse, the more severe and longer-lasting their withdrawal will be. Those with a history of mental illness or addiction may have a more challenging withdrawal period as well as those who used other substances at the same time they were abusing heroin.

Those who haven’t used heroin for long may only experience minor withdrawal symptoms, which typically won’t last for much time. Withdrawal can begin as soon as six to 12 hours after the user’s last dose of heroin, and the symptoms will range in severity from mild to moderate, and in some cases, severe.

Mild Withdrawal Symptoms

Most short-term withdrawal symptoms are physical in nature and will start to pop up shortly after the user’s last dose of heroin. The mild withdrawal symptoms of heroin may include:

  • Minor nausea
  • Abdominal cramps
  • Dehydration
  • Runny nose
  • Excessive sweating
  • Chills
  • Uncontrollable yawning
  • Muscle and bone aches
  • Muscle spasms
  • An excessive secretion of tears
  • Restlessness
  • Insomnia
  • Mood swings
  • An inability to concentrate

Moderate Withdrawal Symptoms

As the person’s withdrawal progresses and their body continues to rebound and adjust to the lack of heroin in the system, the withdrawal symptoms will begin to intensify. Moderate withdrawal symptoms can include:

  • Vomiting
  • Diarrhea
  • Agitation
  • Restlessness
  • Tremors
  • Trouble concentrating
  • Goosebumps
  • Fatigue

Severe Withdrawal Symptoms

Those who have not abused heroin for long may not reach this level of withdrawal, however, long-time users can expect some intense effects. These may include:

  • Anxiety
  • Insomnia
  • Depression
  • Hypertension
  • Rapid heart rate
  • Frequent, severe muscle spasms
  • Impaired respiration
  • Difficulty feeling pleasure
  • Intense drug cravings

Quitting Heroin Cold Turkey

Because of how intense heroin withdrawal symptoms can be, it is not advised to try and quit heroin on your own, or all at once, also known as “cold turkey.” Withdrawal will undoubtedly be a part of the recovery process, and it will be safer and easier to deal with in a rehab facility, where medical professionals know how to deal with your withdrawal symptoms.

Suddenly stopping the use of heroin can cause its own dangerous symptoms such as convulsions, hallucinations, and seizures. Most detox facilities will help a person taper off of their addiction, with the aid of medications. This helps to reduce the severity of their withdrawal symptoms and help the person get clean in a safe, controlled environment.

The Heroin Detox Timeline

The heroin addiction recovery timeline is closely related to the timeline of heroin withdrawal symptoms. However, the process of heroin detox will vary in time and intensity based on a number of factors, including the user’s age, body composition, health and addiction history, length of usage, and dosage amounts.

Heroin withdrawal can last anywhere from a day for those who did not use heroin for long, to a week or a matter of months for long-time users. The first symptoms of withdrawal usually pop up within six to 12 hours, depending on how long the person has been using. Those with a longer relationship with the drug will not see withdrawal symptoms pop up until later because of how much heroin is built up in their body.  

Withdrawal symptoms typically peak at around 72 hours after the user’s last dose, and will gradually become less intense over the next few days. Some withdrawal symptoms may persist for much longer, and linger long after the person has become “clean.” This is why recovery is thought of as a lifelong process.  

The Heroin Detox Timeline Phase 1: Days 1-3

Withdrawal symptoms will begin within the first 24 hours of the person’s last dose, and will be uncomfortable, at minimum. In some cases, it can be extremely painful. Relapse is most likely during this period, as the symptoms may be too much for a person to deal with, leading them to take more heroin.

Symptoms of the first phase of withdrawal may include:

  • Headaches
  • Irritation
  • Muscle aches
  • Sweating
  • Nausea
  • Diarrhea
  • Insomnia
  • Anxiety
  • Loss of appetite
  • Panic attacks
  • Aggression

Because the first few days are so intense, this is perhaps the most important period of the heroin detox timeline.

The Heroin Detox Timeline Phase 2: Days 3-5

Past day 3, the most intense symptoms should begin to subside, and the person will likely experience some further muscle aches, stomach cramps, shivering, and general fatigue. Eating a healthy diet and drinking lots of fluids during this time is crucial to help boost the immune system.

The Heroin Detox Timeline Phase 3: Days 5-7

During this period, the symptoms should lessen further, and subside completely after a week. However, for others, some symptoms may lessen. Regardless of whether or not withdrawal symptoms have completely disappeared, reaching the one-week mark does not mean that the person is cured and their recovery is over.

Most people should continue going to therapy for months, years, or even the rest of their life after their heroin addiction treatment concludes. This helps the person avoid relapse and deal with any symptoms that may persist. Because of heroin’s profound effect on the brain, some may even have lingering withdrawal symptoms for the rest of their life, known as post-acute withdrawal symptoms (PAWS).

Detoxing From Heroin In A Rehab Facility

As we’ve mentioned, detoxing from heroin is safest in a professional rehab facility. This is the best option for a heroin addict’s physical and mental health, allowing them to recover from their addiction in a controlled environment. Medical professionals at rehab facilities are trained to treat intense withdrawal symptoms to make the process as comfortable as possible.

They will also help the person taper off of the drug rather than quitting cold turkey. This will involve taking some medication, typically another opioid, and safely reducing the dosage until it is safe to stop completely. In this way, the user can avoid the most severe symptoms of withdrawal and will have less risk of relapse.

After the initial treatment is complete, patients can transition to outpatient treatment, therapy, meetings, and other options, but it will be a lifelong process. A healthy diet should also be continued.


A heroin addiction is among one of the most difficult to detox from because of its intense long-term effects on the brain and difficult withdrawal symptoms. The detox timeline from heroin will vary, but generally lasts at least a week, depending on the person’s relationship with the drug.

If you or someone you know needs help to quit a heroin addiction, Apex Recovery treatment center can help you start the road toward healing.

treatments for heroinBlog

Treatments for Heroin Addiction

The National Center for Health Statistics reported that in 2016 more than 15,000 deaths in the United States were caused by heroin, which is a number that continues to grow at an alarming rate of 19% per year.  It is this statistic, as well as the deaths related to prescription opioids that has led to what is currently labeled as the “Opioid Epidemic” or the “Heroin Crisis”. While these terms have been used to help influence policy change and impact change at a macro-level, they do little for the individual and the family suffering through a heroin addiction or trying to navigate various treatment options for heroin addiction.

 As scary as the alarming death rate from heroin overdose are the news articles describing corrupt “sober homes” and fraud stemming from illegal practices in unlicensed facilities that have tainted understanding of treatment.  The alarming rates of overdose and reports of unethical treatment practices have caused seeking treatment to be a very difficult, overwhelming and scary time. At APEX Recovery, we can help you navigate the process.

Signs of Heroin Abuse

Even before seeking treatment, it is important to understand the signs of heroin abuse, whether you are concerned about yourself, a friend or a family member.  Unlike alcohol, and in some states marijuana, which you can buy and enjoy legally and that many individuals use in moderation, heroin is a drug that is not only illegal but also extremely addictive.  Despite the negative reputation associated with heroin as well as the high addiction and overdose risk, many individuals continue to be drawn to the substance due to the reported feelings of ecstasy and euphoria.  

Heroin users report immediate feelings of pleasure that are often described as a “rush”, an overwhelming feeling of calm, or an increased feeling of confidence and overall well-being.  While these are the reported feelings of users, there are signs and symptoms of abuse that will be present and are often based on the amount and frequency of use as well as the length of time of heroin abuse.

Immediate Symptoms

It can be helpful to understand the signs of heroin intoxication if you are attempting to understand if your loved one is using.  Short-term effects of heroin include flushing of the skin, dry mouth and a reported “heavy” feeling of arms and legs. Immediate symptoms may also include nausea, severe itching, and vomiting.  Following the immediate intoxication, or high, an individual will be drowsy for multiple hours, have slowed breathing and a slowed heart rate and display what can be thought of as a foggy mental state.  It is also common that a user will alternate between awake and asleep.

Long-Term Symptoms

As a person develops a tolerance to heroin, which occurs after initial use, their use becomes more frequent with greater amounts to experience the same feelings.  Because heroin affects the levels of dopamine in the brain, which helps us to feel good, long-term users begin to rely on the drug to feel normal. Once this develops, which is known as dependence, it becomes increasingly difficult to manage normal stress, emotions and experience, and engaging in normal daily life becomes increasingly difficult.  Users that have developed both tolerance and dependence often report finding difficulty meeting basic daily needs as they become consumed with finding, buying and using heroin.

When to Seek Help

Heroin use is a slippery slope, with most individuals developing a tolerance and dependence immediately, which indicates the need for treatment.  Furthermore, it is important to address the problem before it negatively impacts family relationships, work and school obligations and physical health.

Common signs that heroin addiction has impacted psychosocial functioning include changes in behavior, which can commonly be observed as changes to eating and sleeping schedule, changes in friends and neglect of work obligations.  

Social effects could include loss of interest in family relationships and friendships, loss of job, financial stress and legal issues.  It is highly likely that if you are concerned that you have a problem with heroin use, or you are concerned about a friend or family member’s use, that is already time to seek treatment.

Stages of Treatment


One of the largest barriers to getting off heroin includes withdrawing from the physical effects of heroin use.  These symptoms can be both physically and psychologically challenging, with the user often seeking to return to use to endure the physical withdrawal symptoms.  The physical withdrawal symptoms have been portrayed in Hollywood films including Traffic, Requiem For A Dream and Trainspotting, that while appear sensationalized depict a very accurate experience of this process.

During the withdrawal process, as the substance begins to leave the body, the user will often experience nausea, vomiting and diarrhea, cold sweats and hot flashes, extreme muscle and body aches, agitation, anxiety and restlessness and strong cravings to use.  It is recommended that detoxification occurs in a medically managed facility where not only support for physical symptoms can be provided, but also emotional support to prevent relapse in the midst of detox.

Following completion of heroin detox, success increases exponentially when transitioning to residential treatment to address the emotional, social and psychological aspects underlying substance use.

Medication Assisted Treatment

Medication assisted treatment helps provide treatment for individuals with opiate dependency through combining behavioral therapy and counseling with the use of medical intervention as prescribed by a physician or psychiatrist.  The prescribed medication can help relieve withdrawal symptoms and reduce the experience of cravings. Medication Assisted Treatment in conjunction with therapy and counseling can be an effective treatment option for heroin addiction.

There are multiple types of medications that can be utilized in this option.  Medication Assisted Treatment is thought of as a tool to slowly wean an individual off opiates and heroin to prevent the extreme symptoms related to “cold turkey” detox.

Methadone Treatment

Methadone can help individuals function at a normal level while maintaining socialization, engagement in school and work and rebuilding relationships.  Methadone does not provide the incapacitating side-effects associated with heroin use. Methadone can be used both as a maintenance program as well as helping taper individuals off heroin.  While methadone is safer than heroin use, it remains highly addictive when not closely monitored and can lead to addiction or abuse.

It should be noted that methadone is not a cure for heroin addiction and should be used as a short-term option for heroin addiction and will require a taper program when stopping to prevent withdrawal.  Methadone treatment is provided in highly structured clinics and works most effectively when addressing underlying issues contributing to substance use.

Buprenorphine Treatment

Buprenorphine is also used as part of a comprehensive treatment that includes behavioral therapy and counseling and is used to treat heroin addiction.  Unlike methadone which is dispensed in highly structured clinics, buprenorphine can be prescribed for home use. Buprenorphine works by lowering the physical dependency side effects associated with heroin and can ease withdrawal symptoms and cravings with lower risks of overdose.  

Additionally, buprenorphine can block the effects of heroin and is commonly referred to under the brand name Subutex and is often prescribed with naloxone under the brand name Suboxone.  Suboxone is usually recommended as a longer treatment for addiction. Both methadone and buprenorphine are harm reduction treatment options as they relieve cravings and withdrawal symptoms, however, have continued addictive properties with potential for abuse, especially when not used in combination with counseling and therapy.


Naltrexone is an additional medication that can be used to help individuals maintain abstinence in recovery and is highly effective when used in outpatient treatment.  Naltrexone can be used in both an oral pill form as well as in a long-acting injection that is given once a month and known by the brand name Vivitrol. Naltrexone in both forms stops the euphoric experience of heroin and opiates, which means that while a person is on the medication, they do not experience the high from heroin if they relapse.  

Additionally, Naltrexone can help manage cravings, with positive results in preventing relapse through multiple studies.  It is noted that Naltrexone is not considered a “magic pill” to cure addiction, and as with other medication assisted treatment options, requires a combination of intensive psychotherapy, skills training, and family and social support.


Psychotherapy, or more commonly referred to as talk therapy, includes addressing underlying emotional and behavioral aspects to identify ways to overcome challenges and live a more fulfilling lifestyle.  Psychotherapy as part of treatment for heroin addiction is the foundation of residential treatment and can be addressed in both individual and group settings. When engaged in psychotherapy, therapists will build relationships with clients based on support and positive regard and will work closely with each individual to improve insight regarding their substance use, build motivation for long-term changes and develop a skill set that assists with managing distressing emotions.  

Multiple modalities have been supported by research and are evidenced-based in supporting an individual in recovery. While the goal of therapy is always to improve well-being, it can be difficult to discuss and address emotions and trauma, however, our trained therapists will provide emotional support as you gain the skills to manage addiction.

Family Therapy

Substance abuse affects the entire family, not just the individual, and family inclusion is important during the initial stages of treatment.  Family therapy can lead to an opportunity to mend relationships, help family members develop an understanding of the addiction, and assist the family towards developing a plan that promotes sobriety.  

Research has shown that actively involving family members in treatment not only benefits the individual but allows a family to make a positive impact on sobriety and that when family is included, individuals are more likely to maintain abstinence.  Family therapy includes opportunities to communicate while learning relationship skills as well as conflict resolution and problem-solving techniques to create a family system that will support all individuals towards living a more fulfilling life.

Outpatient Therapy

Outpatient therapy for heroin treatment is a necessary step in maintaining sobriety.  The initial process of heroin treatment includes the physical withdrawal symptoms, with the second stage addressing immediate emotional regulation skills, however it is not until a person has reacclimated to their daily life that the biggest hurdles are presented.  Clients completing treatment will often reference the day they left residential treatment as the true start date to their sobriety.

This is because while in residential treatment, an individual in recovery is provided with daily structure as well as elevated levels of support and monitor, however as they begin to reintegrate to their daily lives, they often find themselves triggered by the same stressors, people, places and things that originally helped develop the addiction.  Because of this, long-term outpatient treatment becomes important.

At APEX, our outpatient programs incorporate daily group therapy, individual psychotherapy, drug, and alcohol counseling, and psychiatry or addiction medicine services. We utilize CBT, DBT, Motivational Interviewing, Coping Skills training and a variety of other didactic and process therapies to help individuals who have already finished a formal inpatient or residential treatment program, are currently sober, and need a continuation of care.

 In the initial stages of treatment and sobriety, having someone for guidance in the common life problems and challenges has an enormous impact on the positive outcome of the recovery process.  During outpatient treatment, the goal is to help individuals move through the stages of change and move from early recovery, into living a more productive life, while adhering to personal goals and needs in the recovery process.

Part of outpatient therapy includes a heavy focus on relapse prevention.  Developing a comprehensive understanding of warning signs, triggers, and new coping skills is required to build a new life that is more satisfying and promotes sobriety.  Developing long-term goals and identifying a value system that reflects new ways of managing stress, daily challenges, and struggles is all integral parts of the relapse prevention aspect.  

In the development of a relapse prevention plan, it includes incorporating new healthy habits, developing a new support system, changing unhealthy relationships and understanding when to ask for help.  These tools help contribute to the long-term success of individuals that have effectively managed heroin addiction.

Am I Addicted to HeroinBlog

Am I Addicted to Heroin? Signs to Look Out For

The young man sat down on my couch. He was twenty and already showed the telltale signs of heroin use. His eyes were myopic, meaning pupils were as tiny as pins. The young man’s weight was diminished, looking more like a POW than a college kid. I knew as a psychotherapist, I had a casualty of the growing epidemic in my office. “I’m not addicted” the young proudly announced. “I use heroin, but I never slam that stuff.” Slamming refers to the use of IV or “shooting up.” Many young people think that if they simply smoke or sometimes snort heroin, they are not at risk for dependence. Of course, after years in the field and hundreds of heroin addicts treated, I know better.

Heroin addiction is insidious at first, but then grasps hold like a rebel force that is intent of leaving no survivors. “How long have you used” I asked. The young man responded for the last year he would use over a weekend, then stop. He readily admitted that his use had increased and that is was starting to be more painful to stop, a sign of withdrawal. He minimized this fact and stated “listen doc, I understand that people get hooked. In fact, I have lost a friend to overdose. Thing is, I am smarter” he exclaimed. “Why is that” I asked? He went on to rattle of his philosophy of how by not using every day, giving his body some rest, and not shooting up, would allow him to dance with the devil.

It was no more than 6 months later this young man that was in my office, was living out of his car, shooting up heroin several times a day, and facing jail time from stealing from his family and ex-boss. Indeed, heroin addiction is real, very real. Then how come people struggle to realize this until it’s often too late? 

History of Heroin Addiction

Heroin use has been around for some time. In reality, heroin use originated with the opium industry that was thousands of years old. In the late 1800’s heroin was first synthesized and then peddled as an elixir that suitable for many uses. Indeed, heroin is a substance with great anxiety relieving properties and pain blockers.

This was popular for many people and it wasn’t until the 1920’s that the addictive nature of the drug led to the prohibition on the substance. As with many things, once it became illegal, organized crime began their sale and manufacture of the substance and the rest as they say, is history. 

During the 1960’s heroin addiction began to soar. This was in part with the popularity of the hippie movement and drug pervasive side culture, but also due to the fact that several wars including Vietnam had left many traumatized men open to the numbing effects and warm embrace of heroin. Drug addiction rates rose and the reality that heroin addiction could quickly slip in and take hold of emotionally and physically vulnerable users, was clinically evident.

In 1971, then President Nixon, began to make policy against the use and spread of heroin. It was at this point that US society realized that heroin was no longer a closeted drug that only touched the fringes of population, but that an epidemic of a difficult addictive substance was no permeating many homes across the US.

One of the most difficult components of this new addiction for society to deal with was the unbelievable and often fatal consequences of addiction to heroin that was not readily seen in many other drugs. Heroin addiction occurred so much faster than other substances and the body seemed to latch on and crave the substance like none other.

Symptoms of withdrawal basically made users prisoners in their own bodies, making daily life impossible to live without “the fix” that brought users back to baseline. All the while heroin users would slip further and further into a hole that often-included joblessness, declining physical and mental health, and eventual heroin overdose and death. All hallmarks of addiction.

So why do people start using a substance that is now known to be so addictive and deadly, and how do people know if they are addicted to heroin? First, it is nearly impossible to use heroin and not become addicted. The drug focuses on the dopamine system in such a way, that the unnatural release of dopamine and other neurotransmitters supply the brain with a calming, warm rush that is often 400% greater than sex, buying a new car, winning the lottery, basically anything that can be naturally pleasurable.

The brain is so greatly hijacked with heroin, that it is nearly impossible for a brain to not be re-wired to a craving state. Additionally, because heroin is so easily metabolized and utilized in the human body, dependence -or addiction- occurs quickly and with severe withdrawal symptoms. 

Heroin Addiction and Withdrawal

Withdrawal is often the telltale sign of heroin addiction. Addiction Specialists often state that is you are using heroin, you are addicted. This might not be 100% accurate, but the fact is that heroin use will within weeks, or sometimes days of use, turn into an addictive downward spiral. Dependence is felt when the body and mind are so intertwined in use, that the body goes through horrific cravings and withdrawal without use.

These withdrawals include flu-like symptoms, vomiting, and severe diarrhea. The user also feels anxiety that is debilitating, sleeplessness and restlessness like the worst case of panic one can imagine. The body shakes and cramps from loss of heroin. People often can’t sleep, but also can’t get out of bed. The skin becomes clammy, dark circles are around the eyes, and weight is lost at a rapid rate. All these physical symptoms can last a week in acute state, and often for months in sub-acute withdrawal. 

Perhaps the most troubling part of heroin addiction is that of neuroplastic changes to the brain. If you are addicted to heroin, your brain is literally inoperable. Motivation is impossible. Anxiety is paramount, and depression and suicidal thoughts are almost always present. When one is addicted to heroin they feel like a slave to a master, literally incapable of separating reality from the life on the drug. These neuroplastic changes are often to the longest lasting aspect of heroin addiction, and it is not uncommon to see people that are still struggling with work and motivation two years after their last use.

While the brain is creative in its ability to rewire, heroin addiction almost always leaves previous addicts with a mind that feels less interested, less motivated, and less happy than a brain that had never touched the substance. This altered state is often very depressing and frustrating for previous addicts and can create relapse triggers on their own. Many heroin addicts feel that they have damaged themselves so badly, that overdosing, and suicide are viable options. If they can’t be happy without the drug, can’t motivate or participate meaningfully with life due to damage, what is the point of trying?

Fortunately, while heroin addiction is real and very problematic, there are good outcomes that can be found. Particularly with MAT, or medication assisted treatment, brain function issues can be greatly helped. Additionally, with long term heroin addiction treatment and support, many addicts return to a high quality of life. This is of course if they survive. Heroin is deadly, and it happens so frequently because a compromised brain on heroin often forgets about safety and reality.

When one questions if they are even addicted and plays Russian roulette with their life, the outcome can often be poor. When anyone starts using heroin and thinks they will be an outlier, surviving occasional use and avoiding drug addiction, they are certain to lose. When one begins to use in any way, multiple times, surrounding themselves with like-minded users, it is only a short time until dependence creeps in.

Physical deficits will be slight at first, but the mind will have already created the necessary feedback loop to keep the horse coming back to the watering hole. So, in short, if you are using heroin, you should consider yourself altered mentally and in process of becoming addicted. Heroin use is serious and not something that can be used recreationally. The consequences are usually most severe possible. So, in short, if you are considering if you are addicted to heroin, get help, support, treatment, and be honest with yourself. If you are not, it will be a short window of time before life altering consequences set in. 


How to Avoid Alcohol Withdrawl

You might scoff at something like alcohol withdrawal while the opioid epidemic continues to wreak havoc on our country, but withdrawal from alcohol is very real and nearly as prevalent. Withdrawal from other drugs like benzodiazepines (benzos) and opioids have certainly taken hold of the public consciousness, and rightfully so, but alcohol withdrawal is just as dangerous, even deadly.

In this post, we’re going to discuss what exactly alcohol withdrawal is, how alcohol affects family members, its symptoms, the withdrawal timeline, and also dish out some advice on how to avoid alcohol withdrawal.

What Is Withdrawal?

Withdrawal will be a difficult part of the recovery process no matter what substance a person has become dependent upon, but alcohol withdrawal is actually more severe than most other drugs. Alcohol is one of the few substances that can cause death, along with opioids. Fortunately, alcohol withdrawal fatalities can be prevented as long as a person tapers off their alcohol use safely.

The Alcohol Withdrawal Timeline

Alcohol withdrawal occurs in three levels and comes with a wide range of alcohol withdrawal symptoms:

Stage 1: Minor Withdrawal – The symptoms of minor withdrawal may start to appear just six to 12 hours after an alcoholic stops drinking. They will include sweating, shaky hands, mild anxiety, nausea, insomnia, panic, twitching, and headaches.

Stage 2: Mid-level Withdrawal – Mid-level withdrawal symptoms will set in around 12 to 48 hours after the last drink. These can manifest as more intense versions of the symptoms listed above, as well as some visual and auditory hallucinations. The person usually will be aware that the hallucinations aren’t real, but they will still be difficult for them to deal with. Other symptoms may include an irregular heartbeat, elevated pulse, and even possible seizures.

Stage 3: Major Withdrawal – Setting in 48 to 72 hours after a person stops drinking, significant withdrawal symptoms will peak in around five days. These can include further hallucinations, during which the person won’t be able to distinguish their hallucination from reality. They may also endure withdrawal seizures, an irregular heart rate or racing heartbeat, profusely sweating, fever, high spikes to their blood pressure, rapid breathing, become easily agitated, intense tremors, or even death.

As you can see, major withdrawal is the one where the real danger lies. Minor and mid-level withdrawal can be dangerous as well if the person already has high blood pressure or a bad heart. And the longer a person has abused alcohol, the more severe their alcohol withdrawal symptoms will be.

Another common symptom of minor and mid-level withdrawal is shakiness, which people will often refer to as “DTs,” or delirium tremens, however, this is a bit of a mislabel, because actually DT is more associated with major withdrawal and can be severe and life-threatening. Shakiness from minor and mid-level withdrawal is not dangerous and should pass within a few days.

What Actually Causes Alcohol Withdrawal?

On the surface, the cause of alcohol withdrawal seems rather obvious: a person who was abusing alcohol stops drinking, and then alcohol withdrawal symptoms set in. But what actually occurs in the body?

When a person drinks, the dopamine levels in their brain become elevated, which results in pleasant feelings. Thus, the consumption of alcohol can elevate a person’s mood, low their inhibitions, and increase self-confidence. When the person stops drinking, the alcohol leaves their bloodstream and the dopamine levels and feelings that come along with it will dissipate.

When this behavior is repeated by the constant consumption of alcohol, the repeated altering of dopamine levels in the brain will cause it to expect alcohol to be present, and will discontinue its normal production without the presence of alcohol. This is how a person builds a tolerance to alcohol.

The more they drink, the more tolerant to alcohol their body becomes, and the more dependent their brain will be on its interference. When this has reached the level of dependence, the person may suffer withdrawal symptoms as the effects of alcohol wear off, symptoms that can range from mild to quite severe.

To be more scientific, it turns out alcohol withdrawal is actually caused by a neurotransmitter rebound within the brain in the GABA system. When a person consumes high levels of alcohol over an extended period, their neurotransmitters will adapt and work harder to try and perform their function despite the effects of alcohol. When the person removes alcohol from their system, the neurotransmitters won’t switch right back with them, they will actually continue to produce excess levels.

With alcohol no longer coming into their body to suppress the hyperactive neurotransmitters, the person will begin to see the symptoms we listed above in stages. The symptoms of withdrawal are actually quite the opposite of the symptoms caused by consuming alcohol. When alcohol is in a person’s system, it causes relaxation, sleep, and calm, while removal and alcohol withdrawal cause panic, insomnia, anxiety and others. Benzo and opioid withdrawal affect the body much in the same way.

How To Avoid Alcohol Withdrawal

Obviously, the easiest way to avoid alcohol withdrawal is to never drink at all, but if you do plan to consume alcohol, is it always best enjoyed, and safest, in moderation. Alcohol withdrawal will occur when your brain has been affected by alcohol over a long period of time.

Have Less Than Four Drinks Per Day

Therefore one way to avoid withdrawal is to not exceed four drinks per day if you are going to drink every day. This should limit the level of affect alcohol has on your brain. However, while you can generally consume low amounts of alcohol daily and avoid withdrawal, drinking that much every day is not recommended for your overall health.

Mix In Abstinence Days

If you can avoid drinking every day, you should. Another way to avoid alcohol withdrawal is to mix in abstinence days each week, and it’s best if you can take several days off from drinking at a time. Even if you do choose to get intoxicated some days, as long as you mix in some detox days in between, you should be able to avoid any withdrawal symptoms.

If you can manage to have several abstinence days each week it will give your neurotransmitter systems the chance to return back to their normal levels. This is because it takes a few days off each week for the alcohol to get completely out of your system. Since the body metabolizes roughly one standard drink per hour, limiting yourself to four drinks per day will give your neurotransmitter systems the time they need to  As long as your neurotransmitters have enough time to return to their normal levels, alcohol withdrawal will not set in.

If you go on a weekend bender, say for a bachelor party or any other big event, you may encounter some minor symptoms at the end, especially if your alcohol consumption was especially high, however it should be rather minor, and pass within a day. Yes, this is also known as the infamous “hangover.”

Don’t Mix Alcohol With Benzos & Opioids

Benzos like Valium and Klonopin and alcohol have similar effects on the GABA neurotransmitter system. If you were to mix the two, it would first increase the chances that a person can overdose on benzos, but also compound the withdrawal symptoms from each, making the process much worse when the person stops using one or both.

Who Is Most Likely To Have Alcohol Withdrawal Symptoms?

Alcohol withdrawal is a largely individual process that will depend on a lot of factors, including a person’s body composition and genetics, their history with alcohol, length of alcohol abuse, amount of alcohol consumed, and more. However, in general, some common factors would position a person to be more likely to encounter significant alcohol withdrawal symptoms.

This group mainly includes those people who have consumed alcohol to the point of getting drunk over any duration of time. Someone who has stayed drunk for several days in a row can expect to feel some minor withdrawal symptoms once they stop drinking. Those who drink during the day for over a month, or get drunk every night for a month or more are highly likely to have severe withdrawal symptoms. Those with a history of alcohol abuse, or have dealt with alcohol withdrawal symptoms in the past, will be highly likely to re-encounter them, most likely in a more intense form.

Those who drink in moderation or just get drunk every once in a while are unlikely to see any alcohol withdrawal symptoms. But those who abuse alcohol for a month or more can expect to experience both physical and mental health issues if they stop drinking.

Alcohol Withdrawal Treatment

If you do encounter lighter forms of alcohol withdrawal, it’s not an emergency situation, and you most likely won’t need any help or support to get you through it. Simply keep yourself in a quiet place with soft lighting and try to have limited contact with people, as you’ll probably be quite easily agitated. The best thing you can do to support your own system is to drink a lot of water or drinks with electrolytes as well as eating healthy food. In a couple days, the symptoms should pass.

For more severe cases of withdrawal, as in those who have a long history of alcohol use disorder and are in stage 3 of withdrawal, you should seek help to deal with your symptoms. Since alcohol withdrawal can be quite difficult and dangerous, it is in your best interest to not attempt to recover on your own. Enter yourself into a alcohol treatment center so you can safely taper off of your alcohol dependence.

Tapering Off Of Alcohol Withdrawal

Because the symptoms can be so severe, it is not recommended to stop drinking “cold turkey ” or detox from home. Someone who has abused alcohol for any duration of time should actually taper off of their drinking, instead of trying to completely stop drinking all at once. This helps keeps withdrawal symptoms moderate and allows the person to safely cut back on their drinking.

Essentially, if you or someone you know have been drinking consistently for a long period of time, visibly shake, sweat profusely, have a rapid pulse or heartbeat, or high blood pressure, then it will be much safer to taper off from drinking rather than quit cold turkey. Tapering off of alcohol actually means that you will continue to drink, just in smaller amounts incrementally until your body and mind become less dependent on alcohol, and it is safe to stop. Doctors can now even prescribe prescription medication to take along with a tapering plan, and tapering off of alcohol should be done under supervision, most likely in a rehab facility.

When tapering off of alcohol, it’s best to use beer because of its low alcohol content. The person dealing with withdrawal symptoms should only drink as much as they need to keep their sweats and shakes at bay. Depending on the person’s level of alcohol abuse, the process may only take a day, while for others it can take up to a week or more. While tapering, the person must also remember to stay hydrated. If the person is tapering in a rehab facility, they may be given an IV and vitamin shots, but if you’re trying to taper at home, Gatorade is a great pick because of its balanced electrolytes.

If a person chooses to taper off of alcohol, they will be most successful if they set up a tapering schedule. The schedule will depend upon how much the person has been drinking and the withdrawal symptoms they are already encountering. But essentially, the more they have been abusing alcohol, the slower the taper schedule will be, meaning the process will last longer. The person will have to pinpoint their average consumption, put it in terms of how many beers that amounts to, and slowly start to cut a couple beers out of the schedule each day.

If the person tries to taper too fast, their blood pressure and pulse will rise, and the shakes and sweats will return. No matter what, it’s important to remember during the process that the beer is being consumed as medicine, and not for pleasure. Tapering too quickly can be fatal, which is why it is best to detox in a professional rehab facility, where the patients can be properly supervised.

At APEX Recovery, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery.  We treat individual patients and their unique needs through a model that we recognize is not a “one size fits all”. Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes.  Call APEX today.


How Alcoholism Affects Families

Many American families find themselves dealing with what seems like an unstoppable force for destruction. Addiction plagues many families and significant others on a daily basis. Many families lack the knowledge or understanding of how addiction impacts a family unit. Often, once chaos, financial burden, and hardship plagues a family, due to a family member suffering from addiction the family is left wondering how, why and what contributed to their loved ones’ situation. Often, many family members and marriages are torn apart by the devastating and long-lasting impact that addiction leaves on a family. Families wonder what they could have done better and what they could have changed. This article will discuss why addiction is more than a mere individual issue and will help educate families about why and how they can make lasting changes in their loved one’s life, and for themselves.

The family unit is a system. The famed clinician, Dr. Murray Bowen, researched family dynamics and pioneered the treatment and model of Family Systems Theory. This approach is useful when trying to glean an understanding of addiction. In fact, Dr. Bowen’s first research into family systems focused in large part on analyzing alcoholism. Alcoholism is often a trait that is passed down both through heredity, and also due to systemic dynamics observed and practiced within a family system.

Looking at a family through a lens of a system is like looking at a car with all its interworking pieces. Without a steering wheel or tires, a car could not operate. Similarly, when a family system is broken or dysfunctional, such as in the case of a parent with an addictive disorder, it leaves the entire system out of balance, and sometimes inoperable. Additionally, when one part of a system is dysfunctional, other parts of the system often over-function in order to keep up. This can be called homeostasis and often poor coping mechanisms, poor communication, and faulty defense mechanisms begin to be the norm. This leads to repeated patterns of behavior that sometimes lasts generations.

Enabling Factors

Many families dealing with a family member with addiction have heard the term “enabling.” Enabling by definition is giving permission to another to do something. In most addiction cases, family members often knowingly or unknowingly “give permission” to a substance user within their family. Often the family outwardly says they want their loved one to change or stop their addictive behavior, but because of ingrained patterns or faulty systems behavior, and overcompensating, many family members indirectly support continued addictive patterns, despite their words and best intentions. This is what enabling is all about, and it can be often found in dysfunctional family systems.

The term enabling grew out of the Al-Anon peer support group, a 12-step group created for family members dealing with an addicted loved one. It also is referred to in more clinical models such as Family Systems Theory. Enabling has many keys factors, but the primary concept from a family systems perspective is that due to emotional stress or dysfunction, some key people in a family system begin making excuses or attempt to overcompensate for another member. This is usually the addicted family member. Often, fear that the addicted family member will die, get in legal trouble, or further hurt the function or reputation of the family, leads members to make repeated attempts to gain control of the faulty behavior. These attempts usually fail and fail again. The system becomes strained, there is yelling, crying, bargaining between family members and the one using. This leads to emotional fusion and a decrease in “differentiation” or healthy interdependent behavior within a family. Often it looks like grown adults trying to parent grown adults, which is never a pretty picture.

Genetic Factors

In addition to generational transmission, a process of behavioral teaching and practicing that lends itself to generations of addiction and dysfunctional behavior, families often must realize the underlying genetic factors can play a role in addiction within a family. Modern research has opened the door for understanding family addictive process on a broader level. While there is no specific gene that codes for addiction, it has been researched and found that many aspects of behavior associated with addiction are passed on. So, what does this look like? If both parents are alcohol dependent, the offspring will be significantly more likely to develop the same malady. This has also been shown with biological twins. The good news is that there are many children of substance abusers that do not end up addicted. While this may be true sometimes, system theory looks at historical and genealogical patterns to illuminate potential problems. Genetics plays a role, in impulse control, reward circuitry of the brains, as well as with depression and anxiety, a large factor for self- medicating and ending up with an addiction problem.

Genetics also plays a role in personality and how well stress is tolerated. In general, the less someone tolerates stress, the more prone they can be to fall into addictive patterns. This process of poor stress tolerance is one that is directly hinged on genetic factors. In short, if parents do not tolerate stress well, the children will be at risk for the same. Much in that same way that addiction to substances can come from genetic factors, so can controlling and enabling behavior. Personality, while hinged on both environmental and genetic factors, it is widely agreed that genetics often plays the primary role. Couple this with learned behavior, and it is no wonder why generations of dysfunctional alcoholic families can be seen and studied. If one wants to understand addiction within the family, doing a good look over the family tree can provide a good starting place. Often clinicians will use a genogram, which is a clinically developed “mapping” technique that looks at various components of family trees, such as addiction.

After looking at both systemic issues and genetic components to addiction within a family, it is crucial to look at treatment for the entire family. Attempting to treat an individual without treating a family unit will often lead to relapse or failure. This is because any system that does not require function of all parts, will inevitably return to the previous dysfunctional pattern that occurred before. This is why family treatment is such a crucial part of treating any one person with addiction issues. Only with simultaneous treatment of the family and couple system, will allow for a marked change with that system, allowing both the addicted patient and family to change to a more optimal behavior pattern.

So, what does the family treatment of addiction look like? It is really quite simple, any treatment or detox program for any addictive individual, should also offer some sort of family therapy program. These programs often differ from program to program. Traditionally 12-step programs would recommend that spouses, family members and children of addicts should attend Al-Anon or Alateen. This model should not be confused with actual family therapy or treatment.

While the 12-Steps can provide family members with needed support and some spiritual philosophy, it fails to do offer two critical components. One, it does not provide actual therapy, or a process of clinically trained individuals working to assist in the counseling of the family process. This is necessary for learning communication skills, as well as to work through hurt from both sides of the family.  Two, it does not allow for integration with the addicted patient, who has been diagnosed with addictive use disorder. So often during the course of experience for a family dealing with addictive illness, many emotional wounds, lack or trust, and failure to communicate has been at play for sometimes decades. It is crucial that families attend therapy together to repair and restore needed attachment bonds in a new healthy way to improve a family’s and individual’s outcome.

Family Therapy

Family therapy and specifically family systems therapy, allows both an addicted patient and their family to work through much of the dysfunction that preceded treatment. Family therapy also allows people to share their needs, ideas, and what works for them, getting away from the lopsided and over-functioning behavior that often allows addictive problems to continue and grow. Finally, it allows a needed conversation about what life will look like for the family and individual after treatment is finished. Families must understand that every member must learn new ways to function healthier and more productively if the system is to grow and change for the better.

It is also crucial for an addicted patient to understand what boundaries and expectations family members have of them moving forward. Conversely, it is crucial that family members understand that a person that has worked through substance use disorder has a new way of thinking. Often this is a struggle for family members. Even though they always dreamed and hoped for recovery and abstinence, dealing with a family member that used to hide out, be passive, not communicate is often very different and challenging from a healthier adult person who sets boundaries and requires family members to have respect for their new ways of handling their situation and recovery.

In summary, addiction affects the entire family. This maladaptive pattern can lead to years of systemic dysfunction. Often, despite best intentions, advice, and attempting to control an addictive family member, a family becomes disengaged, angry and hostile. All members are left in a state of stress that leads to further dysfunction. Reasons for this family behavior and addictive illness within families are multigenerational processed and encompass both learned behavior and genetic factors. These deeply ingrained traits that are inherited as well as repeated within families, lead to cycles where it is impossible for both individuals with addiction, as well as their family members to function without professional help.

While there have been traditionally 12-step peer support groups, they fail at targeting more important factors that are required to get a system functioning healthy again. This is why it is crucial for families to be treated in conjunction with any one specific family member that struggles with addiction. Furthermore, it is important that any family or individual seeking substance abuse treatment does not do so without making sure the family as a whole seeks out family therapy.

Family Systems Therapy is one such model that was created out of evidence-based research by Dr. Bowen, who studied alcoholism within families. Working on differentiation with family members, as well as supporting direct communication, leads to improved outcomes for both the family and the newly sober patient. Only with this type of help, will a system be able to avoid a return to the pitfalls of homeostasis or repeated addictive behavior.

At APEX Recovery, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery.  We treat individual patients and their unique needs through a model that we recognize is not a “one size fits all”. Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes.  Call APEX today.