DR. MARC'S TREATMENT & PHILOSOPHY OF SERVICES

• Can you help me figure out the "Why I need to do it?" behind my present self-destructive behavior?   Do you think that if I figure out the "why?" - it will then be a lot easier for me to stop?
  
  

Over a period of time, an addiction develops a life of its own, independent of its original causes.    
I do not spend a lot of time going back into your past, or figuring out if you hated your mother or father. Usually, the original reasons you started ‘using or drinking’ or began engaging in any destructive behavior have no relevance now as to why you continued, and why you are involved with your addiction today.

Yes, I can.  An addiction doesn't stand alone. People with addictions always have associated problems that contribute to the phenomenon we call addictive behavior. I often assist clients to work on issues with Depression, Phobias, Anxiety, Panic Attacks, Marital Problems, Attention Deficit Disorder (A.D.D.), Early-Life Trauma, and many other feelings.  I can help you acquire practical, skill-building strategies, if you are socially shy, or are experiencing career concerns or money management problems.

As a Clinical Psychologist, I am trained in treating of a broad range of psychological disorders.

I can help you:

Take more control over your impulses - which can cause all types of unwanted repetitive behaviors, including problems with alcohol and drugs, smoking, problematic gambling/spending, eating disorders and hyper-sexual behaviors

Achieve a greater sense of self-confidence, trust, and emotional and ethical maturity

Resolve a myriad of underlying issues that can lead to addiction and it’s negative  consequences, and your role or responsibility in the involvement continuing to exist

Acquire a better understanding of your personal values, and your goal for life

Improve your ability to relate to others, and communicate your message appropriately

In what ways are you different from a traditionally-trained Psychotherapist or Marriage/Family/Child Counselor?

With you as my client, my mission is to facilitate a behavioral health-change experience that is individualized, rewarding and lasting. I do not take a passive role; but rather, I work proactively to give you as much information about a topic as possible. I do not spend months or years going over your past; instead, I teach you “Action Tools" to implement immediately, which will start helping you to manage your uncomfortable feelings and self-destructive behaviors more successfully.

Unlike other traditional therapists, I have extensive training and years of one-on-one experience in clinical psychology, but I specialize in addictions. I am not frightened by this topic, so I will not quickly dismiss you by sending you off to a 12-step meeting.  Nor will I judge or discharge you, if you should relapse or are unable to maintain abstinence.  I am very aware of the personal humiliation and public embarrassment, and sensitive to the ‘not-so-subtle issue of damaging your reputation’, as I felt similar concerns when I had an addiction problem. 

HOW MANY SESSIONS WITH YOU WILL IT TAKE BEORE I SEE ANY IMPROVEMEN? IF I FOLLOW YOUR STRATEGY, HOW LONG DOES IT TAKE FOR ME TO REALLY EXPERIENCE THE IMPROVEMENTS NEEDED FOR A SUCCESSFUL LONG-LASTING BEHAVIOR CHANGE?

In my work, I choose to use the term ‘syndrome’ over ‘disease’ - as described by Howard J. Shaffer, Ph.D., Director of the Division on Addictions at Harvard Medical School.  From his study, we know that some people are born with a biological propensity to become addicted, while others are not.

By calling an addiction a ‘syndrome’, it does not negate the existence of the neurological, genetic and biological components of the addiction; the term actually is inclusive of the ‘disease’ component of addiction, and it also acknowledges the scientifically-proven implications of the individual’s psychology and the influence of their environment.

Additionally, the word ‘disease’ has many associated negative implications in our society. I find it much too simplistic a word to address the complex phenomenon that we call addiction. It also implies that the addiction is solely a biological problem, and that a person has no responsibility for their behavior. I believe in the bio-psycho-social theory of addiction; therefore, I prefer the terms ‘syndrome’ or ‘disorder’ over the word ‘disease’.

Are addictions, like alcoholism or gambling, something that is inherited?

There have been no conclusive research studies which indicate that the excessive behaviors -  drinking alcohol nightly, or abusing prescription drugs, or continuing any other addiction -  are linked to being a 100% inherited trait.  However, there is general agreement that habituation to alcohol and other addictions do run in families; therefore, modern geneticists are continuing their research to potentially isolate a gene that may cause certain people to be more vulnerable to addictive behaviors, including alcohol dependency.

The range of genetic influence can vary between 40% and 60%.  Conversely, the impact of the psychological aspect - such as conditions of childhood, social factors, and environment must also range from 60% to 40%.

It is entirely possible for a person to come from a long line of heavy drinkers, and not drink any alcoholic beverages as an adult.  Conversely, a person growing up in an alcohol-free environment may develop a drinking problem later in life. There are many factors that weigh in when it comes to addiction  – including circumstances regarding poverty, health problems, personality traits, a tragic or unexpected loss, mental and emotional disorders, to name just a few potentially important variables.

DR. MARC'S HARM REDUCTION APPROACH

WHAT IS HARM REDUCTION ?

Harm Reduction is a modern or progressive way to deal with addictive behavior, as a practical, ground-breaking treatment approach for people who have problems with alcohol, drugs and other excessive behaviors.

When we talk about success in addiction treatment, we typically consider “life-time abstinence” as the only answer for every person’s problem. Think of it sorta like a light switch, and it is either ON or OFF.  While the Harm Reduction approach takes a more realistic perspective understanding that behavior changes usually happen in slow increments.  More like a dimmer light switch that can be adjusted to become brighter; Harm Reduction also includes and addresses the difficulty of achieving ‘total abstinence’ as an important factor.

Harm Reduction accepts the concept that each person develops a substance abuse problem due to their unique interplay of biological, psychological and social factors. It is based on the belief that since people develop bad habits gradually over time, then it will also take a gradual process to safely and successfully break those habits.

This new model development in drug and alcohol treatment in the United States is the most innovative and sophisticated approach used today for those high-functioning adults seeking help, where generally abstinence-only 12-step programs have been seen as the only way to deal with every addiction for decades. Ironically, it is a common practice in European countries and Australia for clinics to offer Harm Reduction as the first choice for substance abuse clients because they see that the approach works so well.

I HAVE A PROBLEM WITH COCAINE. MY FRIENDS ARE TELLING ME THAT IF I ALSO DON'T STOP DRINKING ALCOHOL, THEN I AM IN DENIAL. I FEEL AMBIVANLENT. WHAT SHOULD I DO?

This is a tricky one. The truth is, if alcohol is a stepping stone for you to engage in your drug of choice (such as cocaine), then you should seriously consider giving up alcohol as well.  It will be much easier for you to stay away from cocaine. If, on the other hand, you really believe that you can drink without returning to your drug(s) of choice, you probably will want to try a Harm Reduction approach first. This may actually be the only way for you to be convinced whether you can or cannot continue to drink.

As with eating or spending disorders, the reality of life mandates that you must moderate the activity or intake, not totally abstain from it . For that reason as well, I offer a Harm Reduction approach - which actually addresses all excessive behavioral problems. 

Remember, taking a Harm Reduction approach to your behavior can also be a stepping stone to finally considering abstinence. 

If you are interested in learning if you can keep drinking alcohol while stopping your cocaine, you can contact me at my office.  I can help you to evaluate your specific situation, and help you determine if it is a wise and viable goal for you.  If appropriate, I construct a short-term and long-term plan for you to attempt the moderation of alcohol while stopping other negative behaviors.  Then together, we evaluate the results to make the best decision for your future goal. 

Further, let me be your ‘Harm Reduction Addiction Coach’ because you will attain a much greater and faster possibility of success to reach your goal, and able to maintain it longer when you are guided properly. Harm Reduction is a goal that has its own set of techniques and science; it would be unwise to do it on your own, without the professional guidance that is available to you today. 

I UNDERSTAND THAT I HAVE A PROBLEM WITH ALCOHOL, BUT I DON'T WANT TO QUIT ENTIRELY. I REALLY DON'T BELIVE THAT I AM A 'TRUE ALCOHOLIC', BUT HOW CAN I CONVINCE MY FAMILY THT LIFE-LONG ABSTINENCE ISN'T THE ONLY WAY TO OVERCOME MY ADDICTION?

You are normal. I have never met anyone who really wants to stop drinking alcohol completely. They simply want the problems and the downside associated with their usage to disappear. Most people stop only because they have (or are forced) to stop.  But if you want to try moderation, there are certain "Harm Reduction" methodologies you can learn to follow and various resources that can help.

My ‘Harm Reduction Coaching’ sessions are designed to help you choose and learn to correctly apply the Harm Reduction techniques, and to acquire the varied tools that appeal to you most. So deliberately and methodically, you reduce your usage of alcohol (drugs or any other excessive behaviors) - gradually, over a period of time, and step-by-step - not immediately or overnight. This is a highly-customized treatment approach that is specifically molded to fit your personal situation, current lifestyle, and future goals.

Remember though, it is really hard to "Have your cake and eat it, too."   Even in the best of circumstances, the consensus is that once a person has a problem with any substance, it is easier for them to stop than to attempt to moderate. If you have had a long history of alcohol problems, it will be very hard for your family to trust that your moderate drinking will remain moderate.  If they had a parent or other relative who had a similar problem, it will be even more difficult for you because they are extremely sensitive to the potential for chronic relapses.

As a ‘Harm Reduction Coach’, you and I can discuss this method together with your family members directly, if you choose.   But ultimately, you will have to demonstrate your belief in moderation through your own actions of consistent ‘stable moderation’ behavior.  No amount of talking will convince them otherwise.

 

 

 

 

 

 

 

HOW DR. MARC COMPARES TO 12-STEP PROGRAMS

HOW EXACTLY DO YOU HELP ME TAKE CONTROL OF MY NEGATIVE HABITS AND TURN MY LIFE AROUND, IF YOU DON'T BELIEVE IN THE ALCOHOLICS ANONYMOUS APPROACH?

I begin by assuming that you are an intelligent person who has a right to determine the way you wish to live your own life.  My goal is to make you an educated consumer who understands the variety of treatment options available, whether your goal is abstinence, moderation, or an incremental reduction from your current level of involvement in your unhealthy repetitive behavior. Everything I do is based on scientific evidence and backed by solid research.

Before our first session, you trust me with only as much information about yourself as you are comfortable telling me. Then in our first session together, I go through a sequence of steps for your recovery, including the specific treatment tools that have proven to be successful at each stage. I talk to you about the array of medications that help with cravings or any other biological issues that can affect your recovery. Maybe you're not ready for the "abstinence only" answer, and want to know about the ‘Harm Reduction’ options along the way and the relative merit and success of each.  I carefully explain the differences and similarities, and the pros and cons, of each tool.

We first set short-term goals (i.e. How could you handle today? or What to do differently this weekend?).  Then we collaborate on a longer-range sequence and evaluate the relative importance of various issues.
Next it’s UP TO YOU to choose from among the Skill-building tools I've laid before you, and to select the ones to try that best fit for your present lifestyle, personality, and goals. You are always free to change your mind about those choices, if any of them are not successful for you. Remember, you are in charge, not me.

I educate you about why addictions are normal developments in every ones life -- whether it's the healthy habit of brushing your teeth or the unhealthy habit of working too hard. I inform, I suggest, but I don't insist. I don't mandate, shame, or blame you. I don't ask you to stop drinking, drugging or other habits, before we begin working together. I'm a firm believer that progress can be made even while you're actively still involved with your addiction.

My thirty-plus years of treating people with addictions and problem behaviors has taught me that you won't fit a slot that somebody else believes you should fit into. When we have our private sessions, you and I will constantly discuss and explore ideas, but you decide which tools, skills, and techniques you want to incorporate into your life.

But, I don't stop there; I put into words the mechanics and the meaning of your behavior.
I don't oversimplify your addictions by calling it a ‘disease’.  I don't use pseudo-science or unproven, unorthodox methods or attempt to convert you to my personal dogma.  Instead, I explain how biological, psychological and social forces have intertwined to bring about your present situation, and then together we collaborate to use this knowledge, and reverse the process to begin your recovery.

You can be confident that I will not push 12-step philosophy on you, although we know that it does work for many people. I am not anti-religious or anti-spiritual, but I don't bring that into our sessions. Naturally, you are free to pursue your personal spiritual and religious beliefs outside of our sessions, and I will be happy to combine them with the skills you acquire by working with me.

I'VE BEEN TO ALCOHOLICS ANONYMOUS AND OTHER 12-STEP PROGRAMS. I KNOW IT HAS WORKED FOR OTHER PEOPLE. WHY HASN'T IT WORKED FOR ME?

There is nothing wrong with you. You have not failed. Alcoholics Anonymous and the 12-step-based  approach was never meant to be a solution for everyone.  Even "Bill W." stated that in the AA "Big Book”.
Many individuals are also aware of the fact that the AA program has remained unchanged since it was established in 1935, despite the wealth of new scientific information discovered over the past 70 years.

Some of the most common reasons I hear why so many people drop out of 12-step groups - or simply refuse to attend them in the first place include:

• • Difficulty accepting the ‘higher power concept’
• • Not agreeing with the view that ‘addiction is a disease’
• • Not wanting to attend groups, particularly lifelong group attendance
• • Unable to identify with other members of the group
• • Not wanting to label oneself as an "alcoholic" or "addict" -and the fear of the stigma
• • The public exposure and recognition at support group meetings
• • Problems with the ‘powerlessness concept’ as they don't believe they are ‘powerless’
• • Tendency to feel shy and uncomfortable in large groups

There just isn't a simple and convenient "one size fits all" approach for everyone, as many people have been led to believe. So don't be discouraged. There are many other contemporary treatment options available to you that have nothing to do with the 12-step method.

IN WHAT WAYS ARE YOU DIFFERENT THAN OTHER 12-STEP PROGRAMS?

Difference  #1:
I firmly believe that progress can be made when you are still drinking or drugging.
Contrary to traditional 12-step-based and ‘disease-model’ therapists, I think that your treatment can begin and certain changes will be achieved and seen - even while you are still using your ‘elixir of choice’ or still involved in other excessive negative behaviors.  You do not have to be 100% abstinent to begin working with me, or be 100% ready to abstain immediately, even if that is ultimately needed. This evidenced-based approach is called "Behavior Management" or "Harm Reduction."

If your personal goal actually needs to be ‘complete abstinence’ as soon as possible, I help you to get there without the 12-step-based methodology.  A ‘reduction in the degree of harm being done’ can serve as your first step for the recovery, rather than beginning your journey with the shock of ‘cold turkey’. 

Difference  #2:
I will not push the 12-step approach on you.
My job as a Licensed Clinical Psychologist is to find the best, most effective methods for each individual client specifically, and then to explain the methods objectively, including the Pro's and Con's of each. No two clients in my private practice are doing the exact same thing to accomplish their distinctly different personal goals. I will always respect you, and approach your individual problem as a unique phenomenon that deserves the best treatment and techniques available today.

No one is forced into group participation, although I do offer several different small groups, which some of my clients find helpful to attend for additional support. I will not be asking you about what "step" you are working on, or if you have attended meetings since our last session. Traditional addiction therapists only seem to be familiar with the 12-step method.

Difference #3:
I take the role of a coach as well, not only a traditional psychologist.
I assist you to acquire techniques of self-management so that you will be able to play your best game of life, more successfully than ever.  I will consistently offer you new techniques and different strategies for change as we go along, but you are not obligated to do all of them, only pick the ones that seem right.  I will simply present them to you, which is why I am considered the "Voice of Choice"  regarding addiction treatment in the professional mental health care field

Difference #4:
I will strongly encourage you to take a “Pro-active Stance” on your reco Not a ‘powerless’ position.
The 12-step approach tells you that “Your best thinking got you here.”  - and you should listen to others now, rather than ‘think for yourself’.  My alternative treatment philosophy tells you to be pro-active, and actively stretch your thinking and behavior beyond what is familiar or comfortable to you. Historically, you were pro-active in areas that interested you. You would practice your sport when no one asked you to practice. You went out of your way to bake delicious cakes when no one asked you.

On the other side of the coin, you have been re-active about things that you were not interested in doing or  pursuing. For example, you did your homework only when your parents pushed you, or waited to practice the piano the night before the recital. More to the point, you are now searching the Internet for treatment ideas, only because  ”Your spouse threatened to leave you, if you didn't get help!”    And to be truthful, this is still being re-active.

I will ask you to become pro-active from this point forward. You must go beyond simply doing what I suggest that you do, and think for yourself. You need to push beyond the minimum to get through the rough time, and learn to accept that this must be your method of choice - now and in the future. I will be there, when you need support or additional help from me.

Difference #5
I will help you to develop and to continually foster your "Internal Locus of Control."
An "Internal Locus of Control" means that the ‘Source of Your ‘Emotional Control is Inside of You’. During these years that you have been doing drugs, drinking or other destructive behaviors, you have taken a position that the source or "locus" of your emotional control (or management) lies outside of you. Specifically, your "External Locus of Control" has been the alcohol you drink, the joint you smoke, or the cocaine you snort.

The traditional 12-step approach also fosters an “External Locus of Control”. When you feel like using a drug, they tell you to go to another meeting, or turn it over to a ‘higher power’.  Both the meetings and the higher power are forces outside of you.

Central to my approach and the psychological position I take is to assist you develop and understand the ‘where or how’ of the central control panel of your behavior that lies within you. Unlike the 12-step disease model, I do not believe the problem is in the addictive substance, but within you. I don't mean to imply that you are bad or weak or diseased, but simply that the reasons you have come to this point in life are inside of you. Your self-will and determination will make the most difference in the future.

Yes, there is a strong biological part to your addictive behavior, and you must acknowledge it and work within its facts. You must take back control of your emotions and your behavior and not allow other substances or people to control the life that lies before you.  “Haven't you always known this vantage point to work? Haven't you always known that there is nothing in the various elixirs or addictive behaviors themselves that really forces you to keep doing them?”

Once you decide to take full responsibility for your behavior, you will be in charge of your own life. I will show you the best, cutting-edge tools and practical techniques to help you manage bad moods, difficult news, and the constant daily stress - without reaching for your favorite elixir to ‘medicate or escape’.

By having an “Internal Locus of Control”,  you will know that you have the tools within yourself to deal with any issue wherever you are - on vacation, at your in-laws, or on a business trip. You won't begin to panic, or need to ‘find a meeting’ to get through the day. In the end, I will help you feel confident in yourself and your own judgement.

Difference  #6:
I will help you see the "Bigger Picture."
Traditional addiction therapists focus day after day exclusively on the drug or the addiction behavior.  “How much did you drink?  Did you relapse?  Did you go to your meetings?”

I step back and see your addiction problem from a much broader context. I will address the other complex, intertwining issues you are dealing with, such as marital problems, work obligations, depression, and anxiety. I will help you acquire new coping skills to deal with all aspects of your contemporary life that could be fostering and escalating your addiction.

Difference  #7:
I don't talk about addiction as a ‘disease’, but as a ‘syndrome’.
A syndrome addresses the biology, psychology and sociology components of your addiction (bio-pyscho-social factors) that have become intertwined, now trapping you "stuck" in your addiction. When considered as a syndrome, addiction can be approached not only from the biological level, but from the psychological and sociological levels, too. This broader interpretation automatically brings in many more tools, techniques, skills, strategies, insights and methods to your aid, than when treating just a biological “disease”.  For example, if addiction was truly a disease, why would relaxation techniques, such as biofeedback or meditation, be recommended to help make a positive improvement?