In doing counseling with clients who have substance abuse concerns and disorders, I
often draw from the world of 12-Step recovery. One of the concepts that comes out of
the wisdom of AA is the idea of People, Places, and Things. In order for someone who
abuses substances or things like food or sex to change their behavior and maintain their
progress, it is usually necessary to change the people with whom they associate, the
places they frequent, and items with which they regularly come in contact. The world
that someone in that situation has created is often filled with other people who abuse
substances, places the person goes to use those substances, and items that are
components of their use pattern.

The comedian Bill Hicks once said that the only things a man needs in order to be come
someone who has an alcohol use disorder are, “the right bar, the right girl, and the right
friends.” I have always liked that quote because it acknowledges that anyone can
become someone who abuses something or other given a few circumstances. While I
appreciate the wisdom of the disease model of addiction and also see people who
abuse substances as having a likely chemical imbalance and a genetic predisposition to
addictive behavior, there is also a role that habit, modeling, and circumstances play in
substance abuse and life in general.

I have always felt that in the “nature versus nurture” debate, the answer is both. As
such, people who abuse substances tend to think in such a way as to maintain the
addiction and the circumstances that give rise to it. Changing people may be the
hardest of the three. It may mean cutting off contact with family or close friends
temporarily or indefinitely. Sometimes new ways of interacting with them can be
negotiated, but sometimes not. When I quit smoking cigarettes many years ago, having
a romantic partner who believed I could and should do and did not smoke herself was a
huge factor in the longevity of my ability to cease and desist from using tobacco. If
someone has a problem with methamphetamine and chooses to stay with their partner
who abuses meth also, one can imagine all of the temptation and other challenges that
will continue to bring into their life while they try to pretend that they are quitting in a
vacuum.

I have seen some of the places people should consider avoiding be the route to the
liquor store they normally go to, places that are trauma triggers that may make them
want to use to self-medicate, childhood homes, their drug dealer’s house and so forth.
Sometimes if avoiding those things is not suggested by a peer or professional, it does
not occur to the user. I have seen numerous people with alcohol problems believe they
can/should work in a bar and have encouraged them to consider other options. There
are countless rituals and routines around using that the person will benefit from
breaking or at least interrupting.

“Things,” can be paraphernalia, numbers in ones phone, the actual substance they use.
I have seen people hold onto a stash of tobacco, drugs, or alcohol because they say
they feel more comfortable still having it if they need it. While this may work as a form
of harm-reduction at first, it is likely not sustainable long-term. Initially keeping alcohol
around with hopes to one day drink in moderation also seems premature in my
experience. In short, every person who abuses substances or struggles with other
compulsive behavior has a list of people, places and things that they need to evaluate
and possibly partially or completely liquidate in order to best prevent relapses into old
behavior. These are always unique to each person.
​
Once someone is far enough along the stages of change to take action, they are more
likely to take this recommendation or see that this work needs to be done without
guidance. Sponsorship within AA/NA, counseling, or just some serious conversations
with concerned loved ones can also wake a substance abuser up to a lot of their
patterns of behavior and once they have this solid information, it is up to them to
personalize it and choose to take it from there.

Avoidance can cause prolonged grief, traumatic reactions and the like and, as such,
therapists typically advise clients to face their fears, explore underlying emotional
responses and the like. By contrast, avoiding people, places, and things is an adaptive
tool for people to use in recovery because they have likely already identified the
underlying emotion, have no sound reason to be around their substance of choice given
the corresponding cravings that may ensue, and are or will become aware that trying to
master regularly being tempted just isn’t worth it.

Author: Chris Scarberry, LPC
Chris is Therapist and CO-founder of Healing Reflections Therapy and is available to see clients in recovery.

It’s February, which means Valentine’s Day is quickly approaching.
Whether this is a meaningless holiday to you, or your favorite holiday…you can’t forget to show
a little love to yourself!

Small ways to show yourself a little extra love:

 Treat yourself to a special meal
 Have an at-home spa day
 Buy yourself flowers
 Read a book
 Make up a bubble bath
 Practice positive affirmations
 Make a sweet treat (chocolate dipped strawberries are a holiday favorite!)

Valentine’s Day does not have to be about romantic love. Valentine’s Day can also be showing
love for family members or friends or your favorite fur baby!

So, you can get creative during this holiday of love and show a little more love and gratitude for
yourself and all that you are!

Author: Anne Marie Mathews, MS, SMFT

Anne Marie is Currently Accepting New Clients. If loneliness and feelings of isolation are triggered by this time of year, reach out today.

Related to my recent post, Huffington Post just published an article on survivors speaking out on how they were impacted by the election and how it mirrored their trauma experience. Worth a read.

http://www.huffingtonpost.com/entry/7-survivors-on-what-it-means-to-have-a-man-accused-of-sexual-assault-in-the-white-house_us_583c7163e4b01ba68ac5732a

Given all the talk about sexual assault and trauma survivors coming forward about past allegations of abuse, the presidential election has shown a spotlight once again onto sexual abuse and the ill treatment of survivors. 

Although there is a benefit to  increasing the national conversation  on  sexual assault towards the goal of improving  treatment for survivors and reducing overall victimization rates,  there is a profound impact on trauma survivors who find their PTSD  symptoms retriggered.  

In the weeks leading up to the election  there was  increased reports of trauma survivors  calling crisis lines like RAINN  and  therapists who treat trauma survivors were reporting  high levels of distress and increased PTSD  symptoms among clients who were previously doing better. Survivors reported experiencing an increase in flashbacks, resurgence in nightmares, recalling aspects of the trauma at unwanted times in intrusive ways, heightened levels of fear, discomfort with leaving the house, and reminders of shame/guilt/and inappropriate self-blame prompted by victim blaming talk in the media.

There was even discussion of how the election was triggering perpetrators as well, resulting in the possibility of people being retraumatized.  

Whether evidence truly supports the connection between the election and victimization rates or symptom rates, it is clear to people on the ground level that the election and post-election  has sent a wave of aftershocks through the sexual trauma world and women in general. Since 43% of women experience sexual abuse or assault at some time in their life according to the Office for Victims of Crime and CDC, then it is imperative that the public be aware of how trauma survivors across the world may be impacted by, sometimes unknowingly by current events.

​Author: Megan Garza, MA, LMFT