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CIS London


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Collective Intervention Strategies

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CIS London

  1. 1. Welcome To World Drug Day London , 2018
  2. 2. About Dr. Louise Stanger • Clinician-Educator • Interventionist • Author-Falling Up A Memoir of Renewal- Amazon • The Clinicians Guide to Addiction Interventions-In press Routhledge • Widow, Wife, Mother, Grandmother • Soul Cycler adventurer • Honored Participant World Drug Day
  3. 3. Collective Intervention Strategies The Definitive Guide to Addiction Interventions: Collective Strategies (in press Routhledge)
  4. 4. How Did You Arrive Today
  5. 5. Objectives • Identify, Describe and Demonstrate CIS • Define & Describe & Identifyh how shame, trauma, addiction, mental & physical health effect families • Demonstrate the power of family mapping & science of portraiture in CIS • Share invitational vocabulary
  6. 6. Demonstrate CIS -Case Studies Clinical & Reverse Interventions Change Agreements
  7. 7. Create Possibility Aspiration that a better life is possible
  8. 8. Substance Abuse- Addiction Mental Health- Depression/Anxiety Chronic Pain-Physical Maladies Relationship failures - Legal But-how do our clients arrive?
  9. 9. ASAM March, 2011 A Primary Chronic Disease of the brain reward, motivation, memory and related circusy Dysfunction leads to Biological, psychological, social and spiritual manifestations Individual pathologically pursing reward or relief thru substances
  10. 10. Problematic Behaviors Substance Abuse- Mental Health Chronic Pain & Codependency & Process Disorders -Sex, Gambling,Work, Debiting, Spending, Shopping ,Religiosity, Disordered Eating, Digital etc.
  11. 11. Chronic Pain 133 million People Experience Chronic Pain 1 in 5 globally (more women then men ) 65% of all people experience chronic pain once in their life 75 % of all heroin users started with a prescription Annual cost of $365 billion , $154 For young people 151 people die daily (CDC)
  12. 12. Mental Health Issues Anxiety Depression Narcissism PTSD Bi-Polar Personality Psychosis Phobias
  13. 13. Shame Shame is that intensely painful feeling of believing we are flawed and therefore unworthy of love and belonging. I am not good enough Brene Brown
  14. 14. Trauma
  15. 15. Definitions of TraumaOverwhelming experiencing that cannot be integrated and elicit animal defensive mechanisms and dysregulated arousal “A stress that causes physical or emotional harm that you cannot remove yourself from” Larke Huang , Director of Health Care Equity at SAMSHA
  16. 16. Trauma is objective What happened ( I was date raped , humiliated , I fell of a ladder, had a concussion, was in a terrible accident etc
  17. 17. Trauma is subjective : How do I perceive the situation ? Relationship to early child- hood experiences - and Alcoholism Adverse Childhood Experience- 17,000 patients -Kaiser- effects of trauma are cumulative and one of most destructive forms is recurrent calling and humiliation
  18. 18. What do your Clients Say about Trauma ???? Verbal abuse Physical abuse Witnessing a tragedy Not being told about something Accidents Divorce Death
  19. 19. Addiction -Attachment Disorder Values are lost as we attach to substances and other unhealthy behaviors
  20. 20. Dr. Louise A. Stanger “An Intervention is an invitation to seek and accept care “
  21. 21. Professional Interventionists are Called when Families are Fearful ,Angry &Confused Attached to the Problem Cognitively and emotionally Dis- regulated Attempts have failed
  22. 22. Collective Intervention Strategies Louise Stanger Ed.D, LCSW, CDWF, CIP
  23. 23. Why CIS? • Collective - In that to be successful there must be a team of Families, Friend, Collegues, Associates, business partners , managers or co-workers assembled to bring about change • Intervention- In that we seek to move (i.e/ motivate a person to a place of change) • Strategy, in that nothing is set in stone ; we may adapt the process as needed
  24. 24. • Strength Based • Solution Focused • People are Teachable • Change is Possible • The Present is Important • We can rise to our best possible self Philosophical Underpinnings
  25. 25. Theoretical Underpinnings Salvador Minuchin Virginia Satir. TFT Bowen , Family Systems Bowlby, Attachment Monica McGoldrick- Family Systems Therapy
  26. 26. Theoretical Strategies • Motivational Interviewing • Cognitive Behavioral • Acceptance & Commitment • Values Clarification • Solution Focused • 12 Step or other Self help • Mindfulness • Breathing
  27. 27. Counseling Skills Used • Listening- Empathy • Genuine • Unconditional Positive Regard • Concreteness • Reflecting- Echoing Key words • Body Language • Open Ended Questions • Paraphrasing- Summarizing • Counselor Self Disclosure • To Do Not Harm
  28. 28. Collaborator I am the mirror who reflects back their pain, their fears their voices. I am the inquirer who asks difficult questions, who searches for evidence and patterns. I am the companion on the journey bringing my own story to the encounter, making possible an interpretive collaboration, I am the audience who listens , laughs , weeps an applauds. I am the spider women spinning their tales.. I am the therapist who offers cathaersis support and challenge… I am also the stage manager coordinating the intersection of three plays-the story teller, the narrator and the readers inviting your voice to the drama” Sara Lawrence Lightfoot
  29. 29. Interventions Include a Village of Potential Change Agents Participants are experts Value Driven Solution Focused Evidenced Based Interventionists job is to bring people together for the common good and to identify SA, MH and other issues
  30. 30. Families are taught • The nature of substance abuse process and mental health disorders. If appropriate about chronic pain syndrome or other medical legal problems • The way an intervention is conducted • The active and instrumental part they have in moving someone to change
  31. 31. Clinician Interventionsist Must Be able to : • Develop a Team • Do a Family Map that engages everyone • Do a Retrospective -bio-psycho-social • Develop case strategy • Create Treatment Plan & Placement • Case Management • Follow with Aftercare • Facilitate Family Engagement in the healing process • Have Concierge Capabilities • ETHICS are Paramount
  32. 32. Ethics? Beliefs an individual or group makes about what constitutes proper behavior Standard of Conduct Make sure you know
  33. 33. Dr. Louise Stanger “An Intervention requires Crucial Conversations”
  34. 34. Collective Perspectives Bringing Folks Together For The Common Good
  35. 35. War of The Roses Case Study
  36. 36. Clinical & Reverse Interventions
  37. 37. Reverse Intervention
  38. 38. Clinical Intervention
  39. 39. Basic Anatomy • Intervention Agreement & Initiative • Education, Information Gathering & Assessment • Implement , Review, Followup
  40. 40. Start where your Client is !
  41. 41. Family Mapping A Way into Story
  42. 42. Folks have unconsciously colluded with the problem
  43. 43. Dr. Louise Stanger “A Successful Intervention has the Potential To Transform not just the Identified Client but the Entire Family”
  44. 44. Families Learn • Their History • Their Ways of Communicating • To take Care of Themselves • To Discover Curiosity • To Discover Joy • To try Out New Ways of Relating
  45. 45. Families Learn • Chronic Pain , Addiction , Mental Health are all Diseases • Boundary Setting-Responding Not Reacting • Caretaking is not always helpful • Chronic Pain is 80% Emotion • Attachment Disorders • Join in the Solution
  46. 46. Meet Jack and his family 54 yo old retired executive lives with 29 yo son Two previous treatment episodes 3 children 19, 22, 29 Wife in process of divorce- Being asked to leave treatment center as wrong placement Had to get him from A -B
  47. 47. Families Readiness to Change In 2 months 3 out of 5 family members were ready to change In 7 months 4 out of 5 family members had engaged in treatment which lasted more then 60 days. 1 family member went for a 2 week intensive, 2 Private therapists 1 family member refused treatment
  48. 48. Meet Sam Family hx of SA SA- MH -Body Dysmorphia In and Out of Programs Since 7 th grade Failed to Launch Attachment to women
  49. 49. Meet Christine 32 yo music executive Opioids and disorder eating Depression, Anxiety Mother and Father Brother Cooper
  50. 50. What Stands out?
  51. 51. High Wealth Clients
  52. 52. Meet Josh- Age 52 Money Manager • A=Age 14 Played Pocker- family trips to Vegas • B Divorce pending 2 14 year old boys • C-Highstrugh -anxiety-poss- Mania - Cocaine- Alcohol-Pills • Dx-Hx of religiosity, Trauma workaholism, MH , holocaust survivors 3 generations
  53. 53. Meet Sylvia-62 Hoarder- Depression- Substance Misuse • A-Valium from Mom • B= Suicide adopted son, two daughters, Husband had affairs • Stole money from dying mother, collects, collects, collects little trinkets • C-Cognition Problems, MH/SA/RO Early Dementia
  54. 54. Celebrities
  55. 55. Meet Ed Two Families Celebrity Personal Cervical Pain Opioids Alcohol Marijuana
  56. 56. Celebrity Management Business, Personal, PR, Hairdresser, Stylist, Lawyer, Entourage, Security Etc Etc
  57. 57. Meet Jake • International Soccer Player • Back and knee • Family- Mother- Father, brother, subsequent child of infant death • Family Hx of Depression, Trauma, Codepedency • Religious orientations different • Secrets
  58. 58. Meet Rock Refered by Producer 37 foster homes legal problems sexually assaulted Gang leader Chronic Relapser Multiple marriages and children Poet
  59. 59. Sometimes the First Story is SFD Great Treatment center CorrectFamily Map Wrong Placement How did I react ?
  60. 60. Rock is Raquelle
  61. 61. Rock is one of the Most Courageous Gentleman Walked Into His Story Got Curious Felt Safe to End the SFD - Confabulations And asked for Help And After I got Over being Uncomfortable, I was of service
  62. 62. Chronic Pain
  63. 63. 100 Million- One in Ten Americans - 1.5 Billion Globally
  64. 64. Concussions Facial pain Neck Pain Accidents -Driving, Texting Exercising, Weekend Warrior Tasks Hips, Knees , Shoulders
  65. 65. Low back pain Osteoarthritis Rheumatoid Arthritis Migraines Fibromyalgia Pelvic Pain Carpel Tunnel Syndrome
  66. 66. Common Types of Chronic Pain • 28% Low Back Pain • 15% Migrane or Headache • 15 % Neck Pain • 4 % Facial Pain • #1 Cause of long term disability
  67. 67. Impact of Chronic Pain on Families • Person with Pain • - Pain that does not show • -Fluctuating Activity Levels • -Isolation in home and income • -Unpredictable Mood Swing • Doubt about reality of Pain • Loss of friends, job, productivity • Loss of plans , hope for the future • Family Members • -Inability to see or feel pain • Increased responsibility for maintaining home and income • Loss of personal support system • Emotional Outbursts of person with pain’Added Daily stress • Loss of plans and hope for the future
  68. 68. Meet Maddi 10 operations - 6 treatment centers
  69. 69. First major accident age 14 Family History of SA , MH and Molestation Pain Body, Sexual Assault Trainer For past 9 years has been in and out of treatment centers Walking on crutches or not walking at all
  70. 70. Maddi gains trust with primary clinician Maddi gains trust with exercises Maddi Starts to talk to therapist Family is confronted with their substance abuse and their need to detach Maddi experiences a difference in family Maddi experiences a Community Integration Approach Maddi could be your next client
  71. 71. Accepted to premed
  72. 72. Meet Helen - 62 y.o FemaleHip replacement Knee replacement’ Shoulder Constant pain-anxiety Cancer survivor Tried to commit suicide Angry Husband & Family Addicted
  73. 73. IN THE BEGINNING Not able to take breaths - use of Heart Math Self Esteem was missing Smile was gone Only memories of what once was
  74. 74. I Have Lost Relationships Money Self Esteem Ability to Walk Smile
  75. 75. Strategies 15 day detox- Pain still 20% due to Hyperalgesia Education Cognitive Behavioral Therapy Mindfulness Mediation Yoga etc - Canoeing- walking Peer Support
  76. 76. Strategies 15 day detox- Pain still 20% due to Hyperalgesia Education Cognitive Behavioral Therapy Mindfulness Mediation Yoga etc - Canoeing- walking Peer Support
  77. 77. Who would of ever thought Canoeing
  78. 78. Meet Doug
  79. 79. Back Pain Severe-Not able to lift young children- possible candidate spine surgery Mother Dying -house full of edibles and pills Previous treatment for substance abuse Unemployed Stealing from wife and mother Isolating Lying Family History- Alcohol and Pills Anxiety , Depression About Doug
  80. 80. What’s working!
  81. 81. High Ropes Course
  82. 82. Showing Up
  83. 83. Mental Health , Substance Abuse & Young Adults
  84. 84. Meet Sally Mental Health- Sucicidality- Disordered Eating -Substance Abuse
  85. 85. About Sally • Mother -Father South American, Jewish descent • Father Hx of Depression • Family has 4 children- Sally is the Subsequent child of an infant death - Brother died of brain tumor at 9 months, older brother age 5 dx with autism- PTS • Bullying, Isolation , No Friends • Trauma Riding , at School Sexual Assault • 4 Suicide Attempts-Disorded Eating- • Pills & Marijuana • No Formal Inpatient Treatment
  86. 86. Meet Erik 20 years old Only son of high wealth family 92 sisters) Legal issues Substance Abuse Anxiety & Depression ADHD
  87. 87. Eriks Family Sisters-Bullying and Depression Mom -Family History of SA Mom in Recovery Dad Family History of SA and then Mom said I have something to share ……
  88. 88. ABOUT DR. LOUISE ▸Clinician-Interventionist- Award Winner ▸Educator- Speaker- Trainer ▸Author, Falling Up!A Memoir of Renewal, Amazon Press ▸Author- The Definitive Guide to Addiction Intervention-Routledge in Press ▸Widow-Wife-Mother-Grandmother ▸SoulCycler-Adventurer ▸email ▸ ▸619-507-1699
  89. 89. Resources Stanger, L & Weber, L. 2018. The Definitive Guide to Addiction Interventions- Collective Strategies . NY . Routhledge. Stanger, L. 2016. Falling Up-A memoir of Renewal. Ca. WZY Press. available on Amazon Stanger, L 2016. Learn to Thrive : An Intervention Guidebook (available at Stanger, L & Roger P. 2016-present Huffington Post, Thrive Global, The Sober World, Renew, Recovery View, DB Resources, Counselor Magazine etc. Stanger, L .& Flowers, J. 2016-present. Huffington Post, Thrive Global,The Sober World. Stanger, L & Holsomback, J. 2016-present. Huffington Post, Thrive Global, The Sober World. Stanger, L.
  90. 90. Resources Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY Brown, Brene, DaringGreatly. Gothom Books 2012 Lawrence Lightfoot,Sarah & Hoffman Jessica .The Art and Science of Portraiture. Joey Bass. 1997 LawrenceLightfoot, S. Respect , 1998. Press Books, Mass. Lawrence, Lightfoot,S. I’ve Known Rivers , Penguin Publishing. Ny 1995 Lawrence, Lightfoot, S Growing Each Other Up, University of Chicago Press. 2016
  91. 91. Resources Kopp, Sheldon- If You Meet The Buddah on the Road , Kill Him, 1982. Penguin House Random House, NY, NY Stanger, Louise. Falling Up- A Memoir of Renewal 2015, WZY Press Stanger, addiction-you_us_592f0f7ee4b0d80e3a8a329e Stanger differences-between-trauma- addiction_us_58f4e7aee4b048372700da27
  92. 92. Resources Stanger articles management-and-opioid- addiction/ Stanger, Porter, Flowers Huffington Post-Trauma and Addiction addiction-whats-the- difference_us_58d14912e4b0e0d348b347f3 Flowers Articles, james-s-flowers-phd-lpc-s-and-angela-harris-msw-candidate Stanger, news/
  93. 93. Resources Stanger Systemic Model Arise Jays Lamm Seeley
  94. 94. Resources Stanger Systemic Model Arise Jays Lamm Seeley
  95. 95. Resources Mintz www.reallifeis Tap 35 www.motivational
  96. 96. Resources- Chronic Pain R, L. Nahim, Estimates of pain prevalence and severity in adults, 2012, “j Pain, vol.16, no 8 pp789-80 A. May, “Structural Brain Imaging. A Window into Chronic Pain", The Neuroscientist,vol17,No 2,pp.2019-220, 2011 Napadow& R.E. Harris ,”what has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of centralized pain ? Arthritis Research and Therapy .vol 16 Ingemanson, Morgan PHD , “Chronic Pain Lives in the Brin, April 17, 2017 Vox Brain Map brain/
  97. 97. Resources-Chronic Pain Nahin, R. ,Boineau, R, Partap. S. K., Stussman, Weber, N.D. Evidence -Based Evaluation of Complementary Health Approaches for Pain Management in the Inited States , Sept. 2016 Why Goldilocks is my Rehab Heroine goldilocks-is-my-rehab-heroine
  98. 98. Resources-Chronic Pain Driftwood Recovery sees-spike-in-heroin-overdoses-876423747884 Achenbach, Joel.The Washington Post, Dec.23, 2016. An opioid epidemic is what happens when only treated with pills. Gebelhoff, R. The opioid epidemic can turn into a pandemic if we are not careful. The Washington Post .Feb. 9, 2017 theory/wp/2017/02/09/the-opioid-epidemic-could-turn-into-a- pandemic-if-were-not-careful/?utm_term=.d7f5c8218e3c
  99. 99. ResourcesTrauma- Addiction-Chronic PainStanger articles management-and-opioid- addiction/ Stanger, Porter, Flowers Huffington Post-Trauma and Addiction addiction-whats-the- difference_us_58d14912e4b0e0d348b347f3 Flowers Articles, james-s-flowers-phd-lpc-s-and-angela-harris-msw-candidate Stanger, news/
  100. 100. Brief History Lesson • Surprise • Invitational • Action Intervention “Models”
  101. 101. Traditional Surprise Vern Johnson-I’ll Quit Tomorrow Frank Pickard- Family Intervention Ken Seeley-Face It Fix It John Southworth- Intervention Show
  102. 102. Traditional Made Modern The Storti Model Est. 1973 Heart to Heart: The Honorable Approach to Motivational Intervention, 1995
  103. 103. Jeff and Debra Jay Love First , A Families Guide to Intervention 2000 Aging & Addiction , Colleran and Jay 2010 It Takes A Family, 2014
  104. 104. Action Intervention Model Jean Campell LCSW, Dr. Jim Tracey and Bill Maher Psychodrama , sociometry and other action oriented strategies for families
  105. 105. Thought Leaders in Invitational Models Spaere & Raitner - Systemic Arise -Garret and Landau Breakfree- Lamm
  106. 106. Interventions are an Invitational Process An 11 step process for a 12 step solution Stanger 2016 on line