Tag: Hazelden Betty Ford Foundation

Find the Switch — 3

Jean Strobel introduced me to the the “dry drunk syndrome” years ago and it has guideded my work ever since. A well-known pamphlet on the subject states, “Being dry is not the same as contented sobriety.”1 Bev Lemaniak, another important mentor, said it best: There’s more to recovery than sobriety.”

Dick Solberg, the pamphlet’s author, notes:

Dry drunk refers to attitudes and actions that poison our well-being. We keep acting "drunk," even when we're "dry." What's more, these attitudes and actions often show up after we've been sober for a while. They're a sure sign that we're experiencing discomfort in our lives.2

I’d argue that the attitudes and actions are generally present before struggles with alcohol and other drugs develop. They represent the driver or “switch” (and here) for addiction.

Solberg explored some “obvious traits” of those with substance use disorders including grandiosity, judgmentalism, intolerance and impulsivity.3 Some in recovery refer to these are “character defects.”4 From a clinical standpoint, we think in terms of attachment patterns, personality structure, irrational beliefs,5 and so forth. Treatment involves targeting these underlying issues. ✸

  1. R.J. Solberg. The Dry Drunk Syndrome, Revised Edition. Center City, MN: Hazelden, 1993, p. i
  2. Ibid., pp. 1–2; emphasis in the original
  3. Ibid., pp. 3–8
  4. Alcoholics Anonymous, 4th ed. New York: Alcoholics Anonymous World Services, 2001, pp. 58–71, 72–88 (Step 6)
  5. Irrational beliefs, or iBs, are a core feature of rational emotive behavior therapy (REBT), a form of cognitive behavioral therapy. Those with substance use disorders often address awfulizing, frustration intolerance and self-downing by “chemical coping”

Endnote. According to Hazelden, Solberg’s pamphlet was initially published in 1970. It was revised in 1983 and 1993. There have been many different covers over the years and pamphlets are often undated. The copy that Jean Strobel gave to me appears to be a later printing of the first edition (publishing mark: dry drunk is hyphenated).

Solberg also authored The Dry Drunk Revisited, which was published in 1980 and is now out of print.

Many thanks to Chuck B. for helping me understand the publication history.

Series Installments
Find the Switch
Find the Switch — 2
Find the Switch — 3
Find the Switch — 4

Remembering Wes Thomsen

News of Wes Thomsen’s sudden passing reached me Saturday afternoon at a wedding. I found myself struggling with the juxtaposition of beginnings and endings, joy and sadness — and, ultimately, future versus finality.

I’m going to remember Wes in innumerable ways: his ready smile; his unhurried manner; his palpable sense of contentment; his vision and creativity; his deft leadership skills; his deep desire to help those touched by addiction; his amazing portfolio of work at Hazelden Publishing (example here); and so forth.

Wes Thomsen (left) on set at Westminster Presbyterian Church in Minneapolis, Minn., on August 3rd, 2021.

But I will mainly remember Wes as a friend surrounded by lights and cameras who blessed me with amazing conversations. ✸

Kate Gillette created a GoFundMe campaign to benefit Andrea and Margot. Please give generously.

P.S. A lovely memorial service occurred on October 1st. I appreciated the photographs of Wes, hearing the various recollections and tributes, and the remarkable closing song by Pegtop. A recording of the livestream captures most of this. I’m currently trying to find a stream of “I Believe in You,” a track on Just Us.

The Books Before the Big Book

About 20 years ago, I ran across this in an essay by C.S. Lewis:

Every age has its own outlook. It is specially good at seeing certain truths and specially liable to make certain mistakes. We all, therefore, need the books that will correct the characteristic mistakes of our own period. And that means the old books.*

Photo Credit: PBA Galleries

Lewis argued, “I do not wish the ordinary reader to read no modern books. But if he must read only the new or only the old, I would advise him to read the old.” He also offered this suggestion: “It is a good rule, after reading a new book, never to allow yourself another new one till you have read an old one in between.”

My reading habits immediately changed. I started reading old books—in many cases, very old books.

And so it is that we will be considering Richard R. Peabody’s The Common Sense of Drinking, which was published in 1931, at an upcoming residential recovery retreat at Hazelden Betty Ford’s Dan Anderson Renewal Center. The book contains ideas and phrases that were later popularized by Alcoholics Anonymous such as “once a drunkard always a drunkard” and “halfway measures are of no avail.”†

Many thanks to Kim Albers and Peg Schroeder for inviting me back!

* C.S. Lewis. Undeceptions. London: Geoffrey Bles, 1971, p. 161–166.
† The first edition of the Big Book appeared in 1939.

This Is Water

Last weekend, I lead a residential wellbeing retreat at the Dan Anderson Renewal Center on the Center City, Minn., campus of the Hazelden Betty Ford Foundation. We examined the origin and nature of suffering, and some potential solutions.

We used David Foster Wallace’s This Is Water as our core text. Here are my PowerPoints that explore some related ideas:

Many thanks to Paul Anderson for inviting me to lead the retreat. And a huge thanks to Peg Schroeder for assistance with planning and onsite support.

Based on positive evaluations, it seems likely that we will offer the retreat again to all comers (not just health professionals). ✸

Adjust Your Own Mask

No, not *that* kind of mask! I’m thinking about the airline safety announcement. It’s a great metaphor for health professionals—it’s hard to help others when we’re struggling ourselves.

Please join me for a weekend retreat at Hazelden Betty Ford Foundation’s aptly named Renewal Center, located on its beautiful Center City, Minn., campus. I’ll be bringing together a decade of work on burnout, resilience and wellbeing, with a big emphasis on acquiring new self-care skills.

Anyone working in healthcare welcome. And, yes, Hazelden Betty Foundation is known for addiction treatment—but you don’t need to have a personal history of addiction to attend the retreat. ✸

_____
Postscript. The retreat’s title—This Is Water—is a riff on a small but profound book by David Foster Wallace.

SIMS Season — 2022

I’m privileged to serve as faculty for another season of Hazelden Betty Ford Foundation’s Summer Institute for Medical Students (SIMS). This page contains links to my teaching materials and some additional resources.


Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program! ✸

PowerPoints
Screening, Brief Intervention & Referral to Treatment (v. 05/11/2022)
Motivational Interviewing Skills Session (v. 11/09/2022)

Key Readings [Mindy & Kari will provide copies]
Alcohol Use Disorder (textbook chapter)
Taboo Topics in Addiction Treatment: An Empirical Review of Clinical Folklore (J Subst Abuse Treat 1993;10(3):303-16. PMID: 8315704)
The 10 Most Important Things Known About Addiction (Addiction 2010;105(1):6-13. PMID: 19712126)

Patient Assessment
The ASAM Criteria Assessment Interview Guideline (Adult)
Tailoring Treatment (transtheoretical model)

Patient Resources
DBT Skills Training Handouts and Worksheets (see: Chain Analysis of Problem Behavior, p. 31)
Motivational Interviewing Workbook
REBT Pocket Companion for Clients
Rethinking Drinking (consumer health website)
Tips for Cutting Down on Drinking

I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Summer Institute for Medical Students

I’m privileged to serve as faculty for another year of Hazelden Betty Ford’s Summer Institute for Medical Students (SIMS). Here are my PowerPoints and some additional resources.

Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program! ✸

—
Postscript [07/30/2021]. I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

SBIRT — Updated

Just a quick post with my updated SBIRT slide deck. I mess with it a few times per year, generally when new research or policy developments appear.

Slide 39 now contains the current screening recommendations from the United States Preventative Services Task Force (USPSTF) concerning alcohol and illicit drugs. Both are B recommendations, although the latter is still is the draft stage (but is likely to become final).

Continuing thanks to Kari Caldwell and the Hazelden Betty Ford Foundation for including me in its Professionals in Residence (PIR) program. PIR remains a tremendous source of personal and professional satisfaction that has only increased with time.