Dance and Psychotherapy
by Suzanne Silberstein, LMFTi
The dance of medicine man, priest or shaman belongs to the oldest form of medicine and psychotherapy in which the common exaltation and release of tensions was able to change man's physical and mental suffering into a new option on health. We may say that at the dawn of civilization dancing, religion, music and medicine were inseparable.
--The Dance, Joost A. M. Meerloo, 1960
As a practitioner of talk therapy, I have dedicated my career to the value of meaningful conversation. However, I also am aware of the connection between mind and body, and the various ways healing can occur.
I have, at times, offered a "prescription" - play. On the surface that may seem flippant, but play is a forgotten art, or sometimes, one that was never learned. When we see a child play - dance to music, paint without judgment, talk to their stuffed animal, or get better from a kiss, there is magic there that holds the power to heal.
Trauma, depression, anxiety, addiction, and other problems can separate us from the person we want to be, and interfere with our relationships. Talk therapy can be augmented by creative expression. That is to say, having fun-dancing, making art, playing music, writing-enhances your therapy.
The theory behind dance movement therapy explains why dance is healing:
Dance movement therapy is rooted in the idea that the body and mind are inseparable. Its basic premise is that body movement reflects inner emotional states, and that changes in movement can lead to changes in the psyche, promoting health and growth. Helping people regain a sense of wholeness by experiencing the unity of body, mind, and spirit is the ultimate goal of dance movement therapy.
-Dance Movement Therapy: a healing art, Fran Levy, 1988
So turn up the volume and start dancing like no one's watching...
Suzanne Silberstein is a Marriage & Family Therapist Registered Intern #55952, supervised by Sinéad Smyth, LMFT. MFC # 36400
The Biochemistry of Addiction
by Teena Scovis-Weston, Ph.D.
The quality of your life is dependent upon the quality of the life of your cells. If the bloodstream is filled with waste products, the resulting environment does not promote a strong, vibrant, healthy cell life-nor a biochemistry capable of creating a balanced emotional life for an individual.
--Anthony Robbins
The biochemistry of addiction must be recognized and addressed in treatment for successful and sustained recovery. Drug addiction is a bio-psycho-social disease. Addiction incorporates a matrix of etiology that considers the following: 1) the physical disorder or chemical dependency that needs to be treated, 2) damaged personality and/or emotional disharmony affecting self-image and social skills, and 3) subsequent impact on relationships with significant other people and society at large.
The biochemical underpinnings of addiction are largely ignored in the recovery community, leading to increased risk of relapse, recidivism, and overall organic conflict within the counseling/recovery process. The bio-psycho-social model of counseling does not exclude the traditional psychological aspects of behavior, but it predicts that ignorance or disregard of the biological aspect of behavior is doomed to affect treatment failure. Similarly, clinical nutrition without psychological intervention often fails because practitioners overlook the effects that a long history of a metabolic disorder has on personality development. Generally, a whole new range of social skills needs to be relearned.
The biochemical features of addiction and recovery overlap each other. The following are only some of fundamental factors of biochemical consideration when treating or in receipt of recovery:
- Drug addiction is a lifestyle disease characterized by poor nutritional status. Use of addictive drugs undermines appetite, affects food habits, and often leads those struggling with addiction to crave empty-energy, or potentially nutrient-deficient foods.
- Drug addiction induces immunonutritional deficiency. Drugs are themselves immunosuppressive. Addictions to alcohol, chemical substances and certain foods virtually drain the body of essential nutrients, and eventually of life itself.
- Recovery needs to be augmented by formalized nutritional counseling and immunonutrition, or supplementary amino acids and fatty acids that amend immune deficiency. Use of illicit drugs produces multiple nutrient deficiencies or malnutrition, which is the most common cause of immunodeficiency. A nutritional recovery plan can help both detoxification and ongoing recovery. Diets consisting mainly of meat, milk and refined flours (including sugar) have a high acidity and should be avoided, whereas diets rich in fruits and vegetables increase alkalinity, which fosters healthy detoxification. Clients in recovery should avoid all foods containing sugar, such as sweets, soda pop, ice cream, artificial juices, maple syrup, honey, soda, or artificially sweetened juice drinks.
- Contrary to popular belief, people don't choose their addiction, it chooses them, according to Michael Culp, MA, ND. Instead of a "drug of choice," it's closer to "the drug that chose you." Most substance abuse problems result from biochemical imbalances in the brain that impair normal function and alter normal behavioral and emotional responses. Culp asserts that recovery needs to involve the reestablishment of normal brain chemistry. In the case of many patients, when we establish normal brain chemistry for the first time in their lives. Human beings consciously or unconsciously will seek out what they need to achieve a greater balance. For instance, we seek out food when our blood sugar levels drop and we feel hungry. Substance abuse is often a response to a biochemical imbalance that renders a person depressed, irritable, unable to focus, or anxious. The specific substance one becomes addicted to (alcohol, pain killers, tobacco, etc.) is the one that imparts to the person the best sense of well-being and balance, however temporary. In this sense, addiction is a natural response, albeit a misguided one. This is why we say, people don't choose their drug of choice; it chooses them. Recovery does not depend on which substance you are abusing, but on re-balancing the out-of-balance neurotransmitters that lead to the need for the abusive substance in the first place.
- Other research supports the above claim, demonstrating that addictive diseases are the result and/or can affect or exacerbate deficiencies or imbalances in brain biochemistry. Much of this biochemistry can be altered by nutrition. The structure and function of brain cells have been altered, and that it may take a long time to allow the brain to recover from the toxic effects of drugs. The most difficult biochemical stage in the treatment of drug addiction is withdrawing from drugs. Not only is withdrawing difficult, but the temptation to return to drugs after withdrawal may be even more difficult because most drugs alter the receptors for natural neurotransmitters in the brain such as dopamine and serotonin. For example, cocaine blocks the re-uptake of dopamine (a neurotransmitter that sends messages of pleasure), thereby increasing dopamine levels. Such increased levels are responsible for the experience of the "highs" and which cause addiction. The brain adjusts by reducing the number of dopamine receptor sites at target cells; this is called down-regulation. Thus, more of the drug is needed to experience the same feeling of pleasure. Normally, the dopamine cells are regulated by another set of neurons - cells secreting gamma-amino-butyric-acid or GABA. One of the nutritional forerunner of GABA is glutamine, a non-essential amino acid, but which requires vitamin B6 (pyridoxine) for its conversion to GABA. This is one reason to consider the nutritional aspects of detoxification. A toxic person is usually low in vitamin B6. Thus some nutrients or neurotransmitter precursors, such as phenylalanine, tyrosine, glutamine and tryptophan may help detoxification.
- There is a subsequent neurological readjustment in recovery which paradoxically increases the chance of harm or death if there is a relapse. Once withdrawn from the addictive drugs, the brain needs time to readjust to the naturally produced neurotransmitters in the brain. Fresh receptor sites need to be created (up-regulation) to respond to indigenous neurotransmitter now synthesized in the body. This is a critical time, for although free from drugs the person will experience strong cravings as a result of low levels of dopamine relative to reduced receptor sites. If you were to relapse in this stage, you are vulnerable to overdose as a result of reduced tolerance with often fatal consequences.
- Positive reinforcement in addiction has a biochemical component. People will tend to repeat an action that brings pleasure or reward. Certain behaviors, especially those associated with survival needs, are linked to biochemical processes within the brain that cause powerful biological reinforcement for these behaviors. This biological reinforcement is related to the release of specific brain chemicals when the behavior is performed. These brain chemicals produce a sense of pleasure or reward. Evidence suggests that Alcohol and Other Drugs of Abuse (AOD's) produce chemicals that are surrogates of these naturally occurring brain chemicals that produce biological reinforcement. As a result the use of AOD's cause a rewarding mental state (euphoria) that functions as a positive reinforcement of the initial use of AOD's. This rewarding mental state is defined as euphoria. As a result, individuals who receive positive reinforcement for AOD use as a result of the production of these brain chemicals are more likely to engage in drug seeking behavior and to use drugs regularly and heavily. The biochemical reinforcement that results from alcohol and drug use is more powerful and persistently reinforcing than the biomedical reinforcement provided by other survival related actions.
There is a social impact to considering the biochemistry of addiction. The above points are only some bio-psycho-social considerations. But the science of addiction has demystified the belief that sheer willpower is a cure for addictions. Understanding of the molecular mechanisms underlying drug addiction could lead to new approaches for interrupting addictive behavior and have lasting impacts on how society copes with this public health problem.
Family responses to addiction
by Elizabeth Dandenell, LMFT
"The family. We were a strange little band of characters trudging through life sharing diseases and toothpaste, coveting one another's desserts, hiding shampoo, borrowing money, locking each other out of our rooms, inflicting pain and kissing to heal it in the same instant, loving, laughing, defending, and trying to figure out the common thread that bound us all together. " ~Erma Bombeck
September is National Recovery Month.
Ever since my days working as a counselor in the Haight-Ashbury Free Clinic in San Francisco, I've heard many statistical statements about the effects of alcohol, tobacco and other drug dependencies. One that seems to come up often is "1 out of every 10 people struggles with alcohol or other drug problems."
I thought about this while I was in the theater this weekend with my family viewing Ponyo. So when you're sitting in a movie theater with a couple hundred people, does that mean that 20 people have alcohol or drug problems? Is it the person sitting in front of you who keeps up a non-stop commentary. Right? Or what about the person sitting next to you, who you really can't see in the dark? Oh, god, what are they on?
Then I added another statistic from CAMFT (California Association of Marriage & Family Therapists). For every substance abuser, there are friends, co-workers or family members who are often deeply affected by their interactions with alcoholic and other drug-using behavior. Approximately four to seven of people who have regular interactions with a substance abuser experience depression, anxiety, and other stress problems themselves.
Let's go back to our theater. If you have 20 people with an addition, then there at least 80 (4 X 20) more people with related stress problems. Adding those together gives us 100. Is it possible, then, that out of the two hundred people sitting in theater with you, half are touched in someway by substance abuse and dependency for themselves or others?
These numbers certainly vary. One thing is certain, however; no matter the numbers, family members are significantly affected by the identified alcoholic and or drug addict. And how a family manages the situation makes a profound difference on their mood.
When a distraught family walks into my office because a loved one is using for the first time or using again, they are often wondering: Why did this happen to them and when is it going away?
Understandably, they just want it all to be better. One mother recently asked me "Haven't they made a pill for this disease yet? There are all kind of pills out there: isn't there a sober, anti-drug taking pill out there? A pill to make it all go away. I just need a break, give my daughter a pill, please". My response is often, "Recovery is a process; it not an event, and there is no pill that will make it all go away. The struggles of your daughter and all those affected are more often chronic, not acute."
When they hear something like this, many family members just look at me with confusion and disbelief. Some understand, and others wonder. Some family members get angry while others cry. But most continue with the conversation, as did this mother, with something like this: "If Peggy just would just get better, if she would go to more meetings and come to therapy with us... If she would just stop being so angry at me when I am trying to help... If she would stop, then I would feel better and the family would be happier." The family usually nod their heads in desperate agreement.
I reassured her and the rest of the family. "You can feel better, but I don't know if wishing the person would get better is the most effective way. It is a place to start, but it's not a solution. Have you ever been on a plane?"
They said yes.
"When you get on a plane," I said, "the flight attendants explain the emergency procedures. There's one thing they always say about the oxygen masks - 'If you are with a child or a dependent adult put your oxygen mask on first; then put the mask on your child or dependent adult.'" Then I sent them home to make a list of no fewer then 25 ways they could give themselves oxygen first.
The following week they came back with their lists and discussed how they could help each other and themselves keep their oxygen going. The mother was more relaxed and the family was laughing. Interestingly, this week no one was talking about Peggy; the focus was on them. In the last five minutes of the session of the dad said, "We haven't heard from her in a week. It hurts to know she might be out using again . But my wife, son and I did something different this time. We got our oxygen this past weekend and took a long hike among the Redwoods. We had so much fun, talking, telling jokes, and just being together. That night Peggy didn't come home for dinner. We all knew the reason she probably wasn't sitting at the dinner table., Sure it hurt, but it was manageable because we had our hike about and the day we spend together to talk about at the dinner table. Somehow it helped. It still hurts, but our family time helped the hurt."
Family recovery is a process. There are few effective shortcuts and no magic cures. It takes commitment to rediscover and explore what has meaning to you and the family. The focus often needs to shift from getting the person sober (or just riding out another binge) to how you are managing the thoughts and feelings that arise from your interactions with the active user or the person in recovery. What are you doing in your life that helps you feel good? Are you doing things in your life that feel good or help you feel good?
One way might be discovering what is meaningful and important about your relationships. What you are doing about creating meaning and importance? This family spent an afternoon together on a hike. It helped them relax, have fun and gave them more to talk about then their ongoing problems with Peggy. The more fulfilling the family relationship or friendship you develop, the easier it can be to manage the hard times.
Recovery from substance dependency for the family involves:
- Becoming educated about the alcoholism and drug addiction.
- Adjusting to the sobriety or relapse (lifestyle and behavior changes) of the substance-dependent family member.
- Managing the negative effects of substance dependency that you experienced. Learning how to take care of yourself when times are difficult. How will you respond to a relapse in behavior or mood?
- Developing new, healthy thoughts and behaviors that create more of a balanced relationship. This means shifting your focus from what doesn't work to what does.
When you shift the focus from the worry and angst of the relationship with the substance-dependent person to creating and sharing meaningful important moments with them and other family members. Recovery can be a valuable and often gratifying process for everyone involved.
More information about addiction
Self-screening for drug addition
Other things you may want to know:
Information about social psychology and depression
Important to play with your kids outside