Author Archives: Stacy Overby

Life with the Wright Family

This is a great activity for working on active listening skills with teenagers. It was originally found on the CDC’s website.

Materials:

  • The Wright Family Story found here.
  • One playing card, paper clip, pen, or other small item for each person in the group.

Activity Instructions:

  1. Have the entire group stand in a circle, shoulder to shoulder.
  2. Give each person in the circle the small item that can easily be passed from hand to hand.
  3. Explain you will read them a story. Every time they hear any word that sounds like right, they are to pass their object to the person on their right. And, every time they hear the word left, they are to pass the object to the person on their left.
  4. Start reading the story slowly to give clients a chance to follow what you want them to do. After a few passes of the objects, stop and check in with the clients. Make sure they all have an item in their hands as it is normal for some clients to have several items and others to have none.
  5. Redistribute the items as needed and continue with the story. Speed up your reading a little as you go. Pay attention to how the clients are doing. Stop, check in, and redistribute items as needed throughout the rest of the story.
  6. After the story is done, collect the items and process the experience with the clients. Follow up questions can include:
    1. What does this activity tell us about communication?
    2. What does this activity tell us about teamwork?
    3. What does this activity tell us about listening skills in particular?
    4. What was your experience participating in this activity?
    5. How much of the story can you remember?

When A Loved One Relapses

This is part one of a series on how to support loved ones through the ups and downs of recovery.

Relapse. It’s a scary word. Scary for people using, but just as bad for family and friends. So, as a parent, what do you do if it’s your child? After all, parents are supposed to help and protect their kids. But what do you do when you have to protect your child from him or herself? 

No Easy Answer

 Let me start by saying there’s no easy answer. Sure, there’s the canned answers of “tough love” and “they made a bad choice, so they have to live with it”. These answers aren’t helpful though. Remember, the definition of an addiction is a compulsive behavior you cannot stop. Yes, choice plays a small role in that a person makes a choice to use that first time, but even that isn’t as clear cut as it seems. Way back when someone first used, choice existed. Once the person learned to cope by using, the role of choice becomes minimized. The person cannot unlearn that getting high takes away the problems they have. At least for a while. It’s guaranteed to make you feel better quickly. So, when things get rough, the compulsion to use overrides the good sense of choice. 

They Do Care

Another thing to remember is that “users don’t care about anything or anyone but using” is not true. They care. And they care quite a bit. In reality, that is a big part of the problem. See, the loved one using knows just how much they’re hurting everyone around them by their actions. So, on top of the struggles with depression, anxiety, anger, self-hatred, and more, they’re adding large amounts of shame. It becomes more of an issue of the person using feeling too much, caring too much, not being apathetic despite what they may say. 

Another Way to Look at Addiction

But what should a parent or other caregiver do? Remember first, another way of looking at addiction. Addiction is isolating. People leave. Addiction ruins relationships, loses jobs, until no one is left but the person using. Not an ideal situation for someone battling depression, anxiety, anger, shame, self-hatred, and more. 

So, if the opposite of addiction is recovery, then recovery means connections. As hard as it is, finding a balance between setting boundaries while also not abandoning the person using is important. Encourage the person to take their medications as prescribed if they have them, to see a therapist or counselor, to attend community sober support meetings. Anything you can think of to help connect the using person to positive sober supports. 

Now, I know setting boundaries with a loved one, particularly your child, can be challenging. When minors are involved, there’s a whole different set of legal obligations to think about on top of healthy limits within the family. We will discuss setting healthy boundaries next week, so please stop back. In the meantime, please call or email us with questions or concerns. We are happy to help.


Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.  

Islands of Personality Activity

Purpose:

To explore how the ways in which we define ourselves influence our choices and behaviors.

Materials:

The Disney film Inside Out (or follow the link below for a clip of the relevant segment of the movie), large sheets of blank paper, markers, paints, pencils, and other art supplies

Directions:

  1. Watch the movie Inside Out, directing clients to pay attention to Riley’s Islands of Personality. If you don’t have access to the full movie, follow this link for a clip of the relevant segment of the movie. I recommend watching the whole movie as there are many great treatment tie-ins throughout the movie.
  2. After the movie is over, hand out the large sheets of paper and art supplies.
  3. Instruct clients to illustrate their own islands of personality. Remind clients that the drawings must stay appropriate. If clients so choose to include substance use and/or mental health issues in their drawings, ask them to consider how they should include it as these are not part of our core personalities.
  4. After everyone is done, discuss the drawings. Discussion questions could include the following:
    1. Why did you choose the things you did for your islands?
    1. How has substance use affected your islands?
    1. What did you learn about the islands of personality from the movie?
    1. What would you want to change about your islands of personality?
    1. What would you hope never changes about your islands of personality?

What’s Most Important

Purpose: To become aware of values and priorities.

Materials: One copy for each participant of the handout, “What’s Most Important” handout; scissors; tape or glue; one piece of blank paper for each participant; one business envelope for each participant; whiteboard and markers or chalkboard and chalk

Time: 40-50 minutes

Planning Notes:

  • Read the handout and add values statements of your own, if you wish, before duplicating the handout.
  • Cut the individual handouts into strips. Place each set of strips in an envelope, creating a packet for each participant.
  • Create a poster of prioritized values for Step 3, one for each value statement. The priorities should read from MOST IMPORTANT to SECOND MOST IMPORTANT and so on, down to LEAST IMPORTANT.

Procedure:

  1. Review the concept of values. Talk about choosing from a series of coins/bills and how the largest value is the one we pick first and so on.
  2. Explain that for, this activity, the participants will choose among several intangible items, rating which they value most, second most, all the way to which they value least.
  3. Go over instructions for the activity
    1. I will give each of you an envelope containing 20 strips of paper. Each strip has the name of something intangible written on it. Arrange these strips so that what is of most value to you is on top and what is of least value is on the bottom. (Display the illustration you have drawn.)
    1. Move the strips around until the ranking matches how you really value them. Then tape or glue your strips in the correct order to the piece of blank paper I will also give you.
    1. This may be somewhat frustrating because you can have only one top priority. Sometimes, we have conflicting priorities. You must just do the best you can.
  4. Distribute one envelope and one piece of blank paper to each participant. Ask participants to begin. Circulate, offering help if anyone who is having trouble understanding what it is you asked. Caution the adolescents to work slowly and think carefully about each item.
  5. When all or most of the participants are finished, call time. Conclude the activity using the discussion points below.

Discussion Points:

  1. What were your top three or four values?
  2. Was it easier to choose the things you value the most or the least? Why?
  3. Were there items on the list that that you had never really thought about before? Which ones?
  4. Were you surprised by your completed list of values? Why or why not?
  5. How do you think your ranking of values would compare to your parents’ ranking?
  6. How might you stand up for your top three values?

What Is Treatment?

Treatment. It’s a loaded word when talking about substance abuse and recovery services. There are many misconceptions about substance use disorder treatment around. This leads to misunderstandings from potential clients about what happens, which can be significant barriers to seeking needed help. With this confusion, what is treatment about?

Treatment is Not Shaming

First, let’s talk about what treatment is not about. First, treatment is not about shaming people. I know, there’s an old school treatment concept that still exists which includes shaming tactics under the guise of helping the client. Treatment programs built this method around the concept that addiction is a moral failing and people continue using despite negative consequences they’ve experienced. This is not true.

Let me say it again—addiction is not a moral failing. Research has proven this in a variety of ways under many circumstances. Addiction is a brain disease. This means the concept of choice plays an insignificant role in substance use disorders. Yes, technically people have a choice to use. However, there are multiple things influencing that choice which are beyond a person’s control. And, the bigger part of the equation to use is that once the person picks up, any subsequent use is beyond their control. Period. No ifs, ands, or buts about it. Therefore, shaming tactics are ineffective and, most times, much more harmful than helpful. Treatment should never be about shaming. Any treatment tactic that includes a shaming component will inherently be problematic.

Treatment is Not About a Cure

Treatment is also not about “curing” people. Think about it a minute. Can you forget, truly forget, how to ride a bicycle? Outside of other influences that affect memory and the brain, it isn’t possible, is it? This principle also applies to substance use. A person who has turned to substances as a coping skill has learned, for a short time, substances provide relief from their distress. That’s impossible to forget. And, the problem is, these underlying pieces are generally not “curable” pieces. For example, we cannot yet “cure” the discriminatory behaviors ingrained in our society. Thus, the distressing and traumatic personal experiences with this discrimination are still incurable for an individual. Which means the temptation to return to substance use as a way to cope will never completely go away either.

Treatment is Not About Not Using

Finally, treatment is not about not using. You read that right. Treatment is not about not using. Yes, there is that piece in there. However, the bulk of treatment is about other issues. The not using part is only a small piece of a much larger puzzle. The larger puzzle is more what treatment focuses on instead. Why is the person using? What barriers exist to sobriety for the person? What can treatment staff do to address the reasons for use and the barriers to recovery? What supports does the person need to continue in recovery? These are some examples of what treatment is about.

Treatment is About Resources

Treatment is about finding resources for people. It is about rebuilding connections people have to their families, friends, jobs, and communities. It is about helping them address underlying trauma issues, underlying mental health concerns, financial problems, social problems, and more. Because we live in a society that criminalizes addiction, it is about helping people navigate and address legal involvement. For adolescents, it’s about addressing school needs and parental conflict.

Treatment Is about Respect and Dignity

Most importantly, treatment is about helping people find dignity and respect for themselves again. See, part of what addiction and substance use problems do is rob people of their own sense of self-worth, compassion for themselves, and their sense of well-being. People who struggle with use and the negative behaviors associated with it are acutely aware of how these behaviors have affected loved ones in their lives. The shame and self-loathing they experience is as bad, if not worse, than anything anyone else can evoke in them. Therefore, treatment is about building people back up again. About helping people through these dark periods in their lives when they can’t find the light for themselves. Treatment becomes that light.

Yes, treatment is a loaded word when we look at substance abuse treatment. But it doesn’t have to be scary. Understanding what treatment is, and what treatment is not, is a key piece of removing the stigma and fear around seeking help. Treatment is about humanizing people. It’s about understanding.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

Recovery Dice Group Activity

Goals: 

  • Teach the participants the importance of Coping Skills and Sober Resources, by utilizing their creativity.   
  • Assist participants in identifying various coping skills and community resources they have available to them to assist them in improving their relapse prevention skills and knowledge.  
  • Encourage creativity in this hands on recovery activity.  

Materials:  

  • 12 Sided Dice Template (2 for each client) linked below
  • Scissors 
  • Markers/Writing Utensils
  • Clear Tape 

Introduction: Start at discussion with participants regarding what they should do when experiencing cravings or triggers.  Encourage them to brainstorm various options including different coping skills and community resources.  Assist and provide additional examples if needed. 

Procedure:

Explain to participants that they will be creating their own Recovery Dice.  The idea for the dice is to have as a resource when struggling with finding the right coping skill or resource to use in a particular situation.  They will each create one Coping Skill Dice, and one Resource Dice. They may not repeat any resources or coping skills on their recovery dice.   

Discussion: 

  • Have participants share their finished projects, explaining which coping skills and resources they put on their Recovery Dice.  
  • Have the participants come up with various situations or triggers in which a coping skill or resource would be necessary.   
  • Each individual will take turns using their recovery dice for the scenarios discussed as a group.  
  • Closing: Discuss/reiterate the importance of effective coping skills and knowledge of community resources in and effective relapse prevention plan.  Assist clients in identifying additional resources they may not have come up with on their own.  

The Doorway Into Treatment

Treatment centers regularly get phone calls. Someone is calling looking for some help. Sometimes it’s for themselves. Other times, in fact most often with adolescents, it’s someone else looking for help for a loved one. But the caller is lost. He or she may not understand where to get help, regardless of who it is for. Or they think because they’re looking for help, they can check themselves in to a program as the first step. However, there is a critical first step to finding help for a substance use concern. It’s the comprehensive assessment.

What Is the Comprehensive Assessment?

While they can go by other names, such as a Rule 25 assessment here in Minnesota, the comprehensive assessment is about getting a global view of the client’s life. Therefore, any decision to seek treatment for a substance use disorder for someone of any age should start here. See, the comprehensive assessment will review substance use patterns and the consequences of using for a person. It will also evaluate other factors in the client’s life—things like jobs, transportation, community supports, and more. It’s these factors that have just as much influence on the level of treatment recommended as the use itself does.

Understanding Substance Use Patterns

First, and foremost, the assessment will examine what substances the client uses and how the client uses those substances. This is about how much they use of a substance, how they use it, and how often they are using overall. Understanding this pattern of use helps LADCs assess the risk in the way a client is using. For example, adolescents have a riskier pattern of use than adults in general. This is because adolescents tend to experiment with more substances, mix substances, and use in binge patterns. Adolescents use like this because often they are uncertain when they will get to use again so they’re “going to make it count”. They also don’t always understand why they’re not feeling the effects of a substance right away, so they use more thinking it will help. Then, by the time the substance takes effect, the adolescent has pushed it to where they’re risking an overdose.

The route, or way, someone is using also influences the level of care recommendation. People who are using intravenously run significantly higher risks of overdosing and of having serious secondary health problems. The intravenous use can be more difficult to reduce and eliminate due to how fast the substance takes effect in the brain. Oral only use, while still perilous, does not carry quite as much weight. Substances ingested orally take 30 minutes or more to affect brain function. This means there’s a greater window to address an overdose. It should be noted, though, that this effect is also what contributes to adolescent binge use patterns and can place adolescents in particular at a higher risk of overdose. Now, these are just a couple examples of how counselors consider a person’s patterns of substance use. Each person’s situation is unique and cannot be fully explored here. Questions regarding a specific person’s situation should be directed to a treatment provider for more information.

Reasons for Substance Use

Once the counselor assessing a person understands the patterns of use and potential risk factors associated with this aspect of the assessment, the counselor will explore other areas of the client’s life. Physical health issues can contribute to a person’s substance use. This is one significant factor that can lead to opioid addictions. Mental health is another area in which there are several risk factors that contribute to substance use. For example, those who have experienced traumatic events have a much higher rate of substance use disorders than the general population. This is because of how the trauma influences and distorts the relationship between one’s mind and body. As you can see, the goal here is for the counselor to find and understand potential areas that are feeding into the ongoing substance use. It’s these areas that treatment must address so a person can decrease and stop using substances in harmful ways.

Barriers to Treatment

After exploring potential underlying reasons for substance use, the counselor will look at potential barriers to treatment. For adults, these barriers could be job concerns, child care issues, housing issues, other relationship issues, and more. For adolescents, these barriers include school, jobs, sports, and trying to explain to parents what is happening. The recommendations will not be helpful to a client if a counselor does not consider these factors. After all, why would a client be expected to follow recommendations for treatment if the cost they pay includes things like a place to live, no way of taking care of children, or not being able to graduate from school? The counselor involved can help address these barriers when they come to light. Therefore, the counselor will ask questions about these seemingly unrelated areas.

Assessing Strengths

Finally, throughout the assessment, the counselor will look for strengths in the client. This is a critical piece of an assessment. After all, no person is without some strengths. Those strengths become the foundation on which everything that happens in treatment is built. A person’s strengths are what counselors use to see people through treatment and to help people develop ways to build up limitations and overcome barriers. For example, someone using in part as a response to trauma has the strength of being a survivor. That simple fact—a person survived a traumatic event—becomes the start of a new chapter in their narrative where they survive the aftermath of that trauma and the subsequent substance use. e 4 Accent

Finally, the Recommendations

Once the assessment is done, the counselor will weigh out all the strengths, barriers, and risks a client presents with to the assessment. And, the ones discussed here aren’t even everything a counselor will explore during the assessment. They are just a sampling of the things under consideration. They weigh each recommendation in the context of each person’s life. Because there are so many unique combinations of things going on for people, this assessment becomes a critical tool in determining what the recommendations for helping a client should be.

And it’s not a case of substance use treatment or not. Often there can be recommendations such as mental health therapy, a medication management evaluation, family or relationship therapy, connecting with sober support groups, a physical health evaluation, referrals to state or county resources, and more. Many people make the mistake of thinking the assessment is about using and if someone goes to treatment or not. The assessment, and treatment itself, is so much more than that. It’s about how to help support a whole person in every aspect of their lives so they can get to a place of health and happiness.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

Parenting Teenagers 101

I’ve worked as a substance abuse counselor for over eight years now. Most all of that time has been with adolescents, and one of the things I hear frequently from parents and guardians of teenagers is they struggle to engage their teen in meaningful conversation. How do you parent when they won’t talk to you?

Parenting Means Listening

I talk and talk and talk to them but they just won’t listen. While the words vary, I’ve heard many parents and guardians say things like this. The problem with this style of parenting is it relies on the spirit of “do as I say and not as I do” mentality. Teenagers are good at spotting those seemingly hypocritical behaviors and using them as a reason not to “do as I say”. While it can be so difficult to do, turning that pattern around tends to improve the relationships and overall parenting process. Let the teen do more of the talking and listen. Listen not just to what they say, but what they don’t say. Look at what their body language and facial expressions are saying. Teens often struggle to put their thoughts and feelings into words, so these non-verbal cues are a good tool to help them learn how to do that.

Parenting Means Admitting When You’re Wrong

Admitting you’re wrong. That is something so many people struggle to do. We’ve come to equate this admission to somehow being less than or not as good as others. Yet every single person on this planet has been wrong. And more than once. Yes, sometimes teenagers try to hold it against adults when adults are wrong. However, rather than letting the focus turn to who’s wrong and who’s right, deflate their argument by admitting it. Two things will start to happen when we admit we are wrong to teenagers. First, it will boost our teenagers’ self-esteem by hearing they are right at times. Second, it is an excellent way to work on building mutual respect. By acknowledging we are wrong, it tells teenagers we are listening to what they have to say.

Parenting Means Admitting We Don’t Have All the Answers

Another thing I’ve seen is when parents and guardians struggle to admit they don’t know something. It gets easy to pretend you have an answer to try to get them to do what we want them to do. However, when we pretend we have all of the answers, we also teach teenagers to pretend the same thing. This, in turn, sets up situations where teenagers get in over their heads pretty quickly. Instead, learn to admit when you don’t have the answer. Then work with your teenager to learn the answer together. It teaches your teenager the skills to find answers to things they don’t know and it helps them learn to admit they don’t know everything.

More Parenting Resources

Eowyn Gatlin-Nygaard, a therapist from Headway Emotional Health, wrote a great article with additional insight into decoding teens for Minnesota Parent. You can find it here.

Mayo Clinic also has some good insight here.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

A Centering Exercise

Often clients come into sessions agitated and unable to focus. Sometimes it’s walking into a group setting that can trigger this. Centering exercises are designed to calm the mind of racing thoughts and relax the body. While there are many options out there, here’s an easy one to try.

Have the clients sit comfortably in a chair, with their feet on the floor. Instruct them to close their eyes and breathe slowly in through the nose, hold the breath for a moment, then breathe out through the mouth until their lungs are empty. Ask them to notice any thoughts that come into their mind. Remind them, all they need to do is acknowledge and then let go of the thoughts that come to mind. Have them continue breathing in the same pattern for several minutes, just observing the thoughts coming and going. Then, when they are ready, have the clients open their eyes. Ask the clients if anyone wants to volunteer their observations on the thoughts they noticed, but don’t require it of clients when completing a centering exercise. Allow time to discuss any thoughts or observations should clients choose to do so.

And there you have it. A quick and easy centering exercise. Remember the main goal of this exercise–peace and calm. Dealing with those thoughts and feelings are for another time.