Eating Recovery and the Holidays

gork0bacw2i-aaron-burdenMinimizing Fear and Anxiety

For individuals in eating recovery, the holiday season can stir up feelings of fear and anxiety. From Thanksgiving and Christmas feasts, to holiday parties and Chanukah traditions, this time of year is when memories are made around calorie-laden meals.

Often, fighting the urge to fall into old patterns and behaviors feels like an uphill battle for the struggling individual. At Sierra Tucson, our goal is to provide residents with healthy tools and continued support. Below are a few ideas that you can practice for a healthy holiday season – body, mind, and spirit.

  1. Create & Maintain Structure – We encourage you to put together a holiday food plan that includes regular meals and snacks, as well as healthy coping strategies that are unrelated to food.
  2. Eat Peacefully – Just like the mind needs time to unwind, the body craves stillness also. To help you avoid the temptation to binge at a holiday party, eat peacefully at home before the event – preferably with loved ones, if possible.
  3. Bring Along Support – There is strength in numbers, so the next time you are headed to a holiday gathering, bring a supportive friend.
  4. Tangible Reminders – No matter how much an individual plans ahead, unexpected triggers are inevitable. Keeping something small and tactile in your pocket or wearing a rubber wristband can serve as a gentle reminder to breathe and stay in the moment.
  5. Up the “Recovery” Ante – At Sierra Tucson, we recommend at least one recovery-related activity a day for residents who are completing treatment and returning home. We encourage you to boost your recovery routine with even more support during the holidays.

For more information on Sierra Tucson’s Eating Recovery Program, call our Admissions Coordinators today at (800) 842-4487.


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Scott Frazier, MSC, Program Manager for Sierra Tucson’s Eating Recovery Program, identifies healthy ways to approach the holidays while maintaining recovery from an eating disorder. Watch online now.

A Healthy Food Attitude

image003How long has it been since you’ve taken a look at your relationship with food or the parameters around which you eat? Does this relationship matter to you? Why or why not? The answer to these questions can create such an opportunity for you. In a world full of “eat this, not that,” “super food,” and a surplus of health claims, somewhere down the line there has been an attack upon our ability to feed ourselves. The messages that we receive in this process tell a story, and this story depicts a setting in which we develop the idea as to how and why we eat as a culture. This development is the creation of your food attitude (i.e., one’s relationship with food).

To generate a food attitude, one has to become familiar with the boundaries necessary to either create or absolutely destroy his or her relationship with food. So how can one develop a food attitude that is helpful? The answer lies within a person’s ability to recognize how boundaries reflect his or her relationship with self, but also with others. In doing so, one can then examine his or her relationship with food and establish safety in the process. This develops an intuitive process toward the progression of one’s food attitude. So why are boundaries important and what do they have to do with you?

Boundaries & Food

Boundaries contain physical, emotional, mental, and sexual parameters that are created by you. These parameters cooperate with your relationship to yourself and others. They develop an important and innate opportunity to take responsibility for what you think, how you feel, and what you do in response to your own or others’ behaviors and feelings. Think about it this way: Whether you agree with some of the traffic laws or not, one thing is certain—if there are no speed parameters or stopping measures, the roads upon which we travel become a dangerous environment that could lead to injury. The same is true for a person’s lifestyle. If there are no parameters or value systems by which to live, injury – physical or emotional – can also be a result. Parameters are boundaries, and boundaries create safety. So how can safety and food cohabitate?

We now live in a culture where food will either kill you or save you. A recent poll taken in Science Daily (2008) revealed that 65 percent of women in America endorsed unhealthy thoughts, feelings, or behaviors related to food and their bodies. Sixty-five percent! On top of this, newer research suggests that the ratio of men diagnosed with eating disorders is no longer 1 in 10, but 1 in 4 (Hudson J et al., 2007). Again, why is there an attack on food? This should direct us back to boundaries. If we initiate sole blame on others for how they think, feel, or behave, then where is the empowerment to be able to choose or decide how this can affect us? You wouldn’t blame a chair (an inanimate object) for stubbing your toe in the middle of the night, would you? Then why are we placing blame on the food that our culture consumes and why is this the sole cause of the obesity epidemic or the disordered eating trend? As a consumer and an individual, we are given choices. What we decide is up to us. In the same way that we choose to set boundaries, we can also choose the “how” and “why” we nourish ourselves.

1.    Build Awareness: Ask yourself on a daily basis, “What am I hungry for?” It could be acceptance; it could be knowledge; or maybe even hunger for a certain food item. Hunger is an innate feeling and it works together with a multitude of chemical reactions in the body. As stated by Adam Drewnowski, PhD, director of the Nutritional Sciences Program at the University of Washington, “The human body evolved an elaborate and powerful appetite system to ensure we eat—and eat well—when food is around, with fat being the most efficient way to obtain energy.” (Drewnoski A, 1997) This statement helps initiate the normalcy of hunger and how to get those needs met, as well as the importance of decision-making. So whether you are choosing a salad or a sandwich, your task is to become aware of the trend regarding your choosing. Start with tools that can you build upon:

  • Record your meals in a food journal.
  • Ask for help, whether from a registered dietitian or someone who can provide insight.
  • Read and ask questions – it is perfectly OK to learn about food.

2.    Be Intuitive: The whole idea of being intuitive and/or mindful starts with intention. Being intentional about your thoughts and behaviors helps you to regain what were once experiences in autopilot (e.g., taking the time to plan for lunch versus skipping or grazing throughout the day). If your behavior represents who you are and want to be, then this is something that can be helpful; if not, well, maybe change is in order. In short, it is about being present. (Robinson E., et al., 2013) Examples of tools for honing your intuition include:

  • Shop for groceries when you are well fed and have a list, to help you refrain from food waste and be mindful of your budget.
  • Take away the TV, electronic devices, and reading materials while eating. It takes 20 minutes for your stomach to signal fullness. Take at least 20 minutes to enjoy your food.
  • Eat with your non-dominant hand to help slow down the eating process. Gauge your fullness at the halfway mark.

3.    Be Objective: When developing your food attitude, please know that it will not be perfect. Progress will yield more results than chasing perfection. Too rigid of food boundaries can create guilt and shame about food consumption. But when a person is able to connect with his or her ability to learn what works, only then is the individual able to change his or her food attitude. Trust with one’s self is a cooperative effort between healthy behavior and time (e.g., taking the time to try new foods and learning how to cook and enjoy them). Here are some tools to begin this process:

  • Host a dinner party or cook for someone you love. Give yourself time to practice.
  • Plan to implement one new food item per week, which develops variety.
  • Keep track of the foods and new recipes you are trying and examine if they work or not. This helps you recognize your ability to provide things that are good and good for you

By this time, the hope is that you are aware of how your relationship with food affects not only you, but also the relationships around you. Take a strong look at your ability to choose and develop your food attitude to reflect an idea that brings awareness and a willingness to coach yourself –and allow yourself to be coached. Being intuitive about this process will not show up perfectly, but it will show progress. Above all else, remember that this type of attitude will provoke an invitation to receiving the message that eating can be flexible. It can change in response to your hunger, your busy schedule, and your ability to feed yourself as well as your feelings. If you are patient with yourself, then you can begin to take the power back from the all-too-easy scapegoat: food.

Article written by Dezi Abeyta

Works Cited:
Drewnowski, A. (1997). Taste preferences and food intake. Ann R Nutr (17): 237-253

Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358.

Robinson, E., et al. (2013) Eating attentively: a systematic review and meta-analysis of the effect of food intake memory and awareness on eating. Am J Clin Nutr, 97(4), 728-742

University of North Carolina at Chapel Hill. (2008). Three Out Of Four American Women Have Disordered Eating, Survey Suggests. ScienceDaily.

A Warm Welcome to the UK

Lila and horseSierra Tucson regularly invites professionals from all over the world to meet our caring staff and see our beautiful campus. We were fortunate to host several guests from the United Kingdom in September. Brent Clark, BA (Hons), MSC, a therapeutic director in London, shares highlights from his recent visit.

I first heard about Sierra Tucson eight years ago when studying for my master’s degree in addiction psychology and counselling. Max Cohen, Sierra Tucson’s treatment placement specialist (TPS) for the UK, gave a lecture on excellence in holistic care, and used Sierra Tucson as an example of how things could and should be. I remember being inspired by the breadth of vision in treating addiction and other disorders. I work with the homeless and marginalise at Spitalfields Crypt Trust (SCT), a local charity based in East London. We provide residential rehabilitation and continuing care for people who have been dealt a harsh deal in life economically, emotionally, and spiritually.

In the spring of this year, after heading up and developing our continuing care, I was given a new role as therapeutic director with the job of redesigning our residential rehab’s therapeutic delivery, which for many years had relied on basic 12 Step and Big Book delivery. Max is now my clinical supervisor and supporter of our charity, so being cheeky I asked if there was any chance of visiting Sierra Tucson and immersing myself in the programme. I was bowled over when Max informed me that Sierra Tucson would like to support SCT by inviting me to its Professionals Weekend so I could observe and have meetings with key staff for the week preceding.

The visit exceeded my expectations. At SCT, we pride ourselves on the relational and caring attitude we strive to uphold for our clients. Our resources may be limited, but we love much. I was concerned that Sierra Tucson might be excellent in terms of resources and sharp evidence-based delivery, but I wondered if it might be institutional and lacking in the recovery community focus we have developed at SCT. Furthermore, I was concerned I would be an imposition, another responsibility in a hectic schedule.

When I arrived, I was met with a huge screen welcoming me by name, a small touch, but one that typified the welcome I received from every staff member I met. I was often poached by staff members who wanted me to see their work or understand their approach. The passion was palpable and very affirming. In the week that I stayed in Tucson, I recognised what we are trying to do in East London: to make people feel cared for with kindness and grace, using the best interventions we can afford to help them overcome complex life issues. The integrative model was best typified for me in the staff meetings I observed, where all team members addressed each other with the kind of respect that reflected the appreciation that everyone’s work is part of the solution.

I am now in the position in London of trying to translate what I experienced at Sierra Tucson to our programme here. My week at Sierra Tucson was a personal and professional delight—one for which I am deeply grateful and will positively change the lives of the people we treat.

What Does “Quality” Mean at Sierra Tucson?

Susan MenzieBy Sue Menzie, BSN, MS
Director of Quality Improvement

Usually the terms quality improvement, quality management, and performance improvement evoke some very interesting emotions and responses in the health care industry. For most of my health care career, the Quality Improvement Department was also the “Gotcha” Department. Basically, the department that was always negative and condemning, representing a challenge to show “good numbers” so the organization didn’t end up on anyone’s radar.

Somewhere along the line, my point of view on “quality” changed, as I observed firsthand how compliance failure was actually a quality failure. Then I began to view the Quality Improvement Department as the “protectors” of the health care organization, whose function it was to find solutions so the organization could remain in good standing with regulatory agencies.

Thankfully neither of those two viewpoints describe my current viewpoint, as I came to realize that quality drives excellence and the Quality Improvement Department is really the department that leads the organization in the changes necessary to become a true organization of excellence.

Sierra Tucson has a long history of providing cutting-edge treatment that results in excellent patient and resident care. As health care has changed, it is not just the provision of that cutting-edge treatment, but it is also the documentation of the care that is given that showcases excellence in treatment.

Quality is described as the standard of something as measured against other things of a similar kind; its degree of excellence. Quality at Sierra Tucson is being able to quantify that excellence, measure it, and then inspire, nurture, and drive improvement to showcase it.

To that end, the Quality Improvement Department at Sierra Tucson, which includes quality, risk management, compliance, patient/resident advocacy, and medical records, has made a wide range of improvements that have proven to display the excellence that embodies the treatment at Sierra Tucson.

These improvements include everything from minor issues like chart dividers and permanent file folders (which improved access to documents within the charts), to major projects like audits and surveys. Here are a couple of these projects that highlight that drive to a higher level of excellence:

A multidisciplinary peer review system was implemented this past year, which has improved documentation and systems in each of the clinical departments. Typically peer review is limited to the Medical Department in a health care organization. We expanded peer review to include Nursing, Clinical, and Quality Improvement departments. We asked these divisions to create a quality review based on the areas they wanted to monitor or improve. From a quality improvement standpoint, the review is based on the overall quality of different perspectives of treatment, such as discharge plans. Discharge planning spans multiple departments, so the quality peer review looks at the discharge planning from a more global view.

In the peer review audit process, each department designates a staff member who is able to review the chart from that discipline’s perspective. Charts selected for the peer review process are 100 percent of the charts that comprise our atypical discharges, including AMAs (Against Medical Advice), administrative discharges, medical and psychiatric transfers, and re-admissions to the hospital level of care. Additionally, the chief executive officer, chief medical officer, chief operations officer, or the director of quality improvement can request a chart to be submitted for peer review due to complaints, process or system review, or other related concerns.

Data from the peer review audits is aggregated, analyzed, and reported to our Clinical Quality Committee, which is comprised of representatives of each of the clinical departments and the Quality Improvement Department. As the data is reviewed, the director of quality improvement then identifies trends and requests action plans to address those trends. The committee also discusses these trends in relationship to processes and systems that are in place and determines which improvements can be made to specific areas.

An example of a system-wide improvement that resulted from this process is the documentation of discharge plans. Often, residents would receive a discharge plan from their therapist or continuing care coach, but created their own plan for discharge. Since the discharge planning process spanned multiple departments and functions, the actual final discharge plan was not consistently documented in the chart. The medical team first identified the problem, and then created a form that helped them document their portion of the discharge process. The clinical team followed, using the medical team’s format, creating a discharge note that documented the process from the primary therapist perspective. After a few months, it was clear that the discharge plan/destination was not consistently documented by the nurse (usually one of the last staff members to have contact with a discharging resident), so the Nursing Department, using a combination of the formats from medical and clinical, developed a form that captured the discharge process from the nursing perspective.

Another value of the peer review process is that the reviewers have the opportunity to discuss the cases with each other, and identify cases that might benefit from a review by the medical director. So from the peer review process, we developed the Medical Director Review process, which is a review for practice and/or process and can be triggered by the peer review process or by complaints or concerns. These cases are then reviewed by the medical director of designee, usually a psychiatrist, who can review the case from a practice perspective. These reviews are kept confidential and are used to improve practice and training for staff.

Another project that the Quality Improvement Department has spearheaded is our Resident Satisfaction Survey process. Most health care organizations survey residents’ satisfaction at the end of their treatment experience. While these surveys are helpful as a retrospective review and can be used to drive improvement in the future, they are not effective for intervening in poor patient/resident experiences, nor do they give detailed information specific to departments or processes in individual organizations.

Sierra Tucson is fortunate to have a Quality Coordinator in our Quality Improvement Department, who has developed surveys designed to capture the resident experience. One such survey is the “Mid-Treatment” survey, conducted by our patient advocates, which allows us to keep up to date on the trends of satisfaction in real time. From this survey, other survey tools designed to assist the staff on keeping up with the pulse of resident satisfaction in more definitive areas are developed. This process has resulted in improvements in food service, programming, scheduling of individual sessions, and changes in activities.

Another project we implemented over the past year has been the “Golden Pen Awards,” which are given to clinical, medical, or nursing staff on a monthly basis. Too often we rely too heavily on the monitoring of what is wrong in documentation, forgetting that the rewards are a higher motivator. Each month the Quality Improvement, Risk Management and Utilization Review departments nominate staff members that demonstrate excellence in documentation. The awards include a nomination award or a “Golden Pen Award” certificate and a “gold pen.” While this monthly award system seems a bit simplistic, it has prompted staff to ask how they can improve their documentation and demonstrate excellence. Since May, there have been over 60 staff nominations for this award, resulting in some positive energy around the entire process.

The goal of the Quality Improvement Department at Sierra Tucson is to provide a foundation of quality upon which to build a resident’s experience. All of our individual efforts, combined with our team efforts, are focused on improving quality to drive excellence.

Psychodrama at Sierra Tucson

psychodrama experiential therapyBy Bill Coleman, LMSW, TEP
Resident Psychodramatist

Psychodrama at Sierra Tucson has a long history. It has been offered since the opening days in 1983 and long considered one of the most powerful forms of group therapy.

Not easy to describe, psychodrama can be classified as experiential therapy. It is essentially role-playing, where disturbing and inhibiting forces on the inside of an individual are manifested on the outside, in the form of roles. It works with any condition, including addiction, mood disorders, trauma, pain, and eating disorders.

The method was created by J. L. Moreno (1889 – 1974), a Romanian-born physician trained in Vienna, Austria. Moreno was intrigued with ancient Greek theater and the concept of catharsis; yet, he felt it was too rigid and scripted. Over a 10-year period, he combined what he called psychodrama with the fundamental dynamics of spontaneity and creativity. He brought the method to the United States in 1925 and continued to expand and refine the process. Shortly after his death in 1974, a formal regimen of training and certification was instituted by the American Board of Examiners in Psychodrama, Sociometry, and Group Psychotherapy. Full certification as a certified practitioner currently involves 780 hours of training, facilitating a group under supervision for a year, and a five-hour written essay exam, as well as being observed by certified trainers and maintaining a graduate degree in mental health or a related field.

Why It Works

Most therapies work from the top down. First, identify the dysfunction and then use a variety of cognitive, analytic, or symbolic therapies to modify the accompanying behaviors. These approaches are well established and thoroughly researched, and Sierra Tucson residents engage in many of them with considerable success.

Psychodrama, as practiced at Sierra Tucson, works from the bottom up. It incorporates current neuroscience discoveries and seeks to drill down to the most fundamental developmental structures that are driving the dysfunctional states, even into adulthood. All children, when victimized by intolerable stress, will create psychological defenses designed to explain and protect. Such defenses will be created from the child’s world and thus, seem irrational to an adult. Nonetheless, they are some of earliest neural pathways formed in the child’s nervous system. Also, the child’s brain (again, when subjected to intolerable stress), converts itself from being a learning system to becoming a survival system. The resultant fear-driven and shame-based neural pathways (roles) are carried through regardless of age and they remain irrational. Psychodrama seeks to ameliorate these fundamental primitive conditions by treating them as unwanted neural pathways and building new ones. This is done by presenting the unwanted pathways as roles, extracted from the mind and placed in an empty chair. From there, they can be interviewed and the resident begins to develop autonomy over the role.

How It Works

In a group setting, an individual sits in a chair – separated from the other group members – and is asked to become the very thing he or she wants to change. This is initially confusing, but with a series of simple questions from the Director, the person quickly assumes the role. An example of such questions might be:

Director: “Please tell us what you are.”
Resident: “I am Alicia’s shame.”
Director: “Are you a big thing in her life?”
Resident: “Immense.”
Director: “Did you get up with her this morning?”
Resident: “I’m always there.”
Director: “Did you go to breakfast with her?”

The interview progresses from there, with questions about what you, Alicia’s shame, do for her, how long you have been around, how you came into existence, etc. It is important to note that the interview is not designed to explore the resident’s past traumas, but rather, the outcome of his or her trauma (in this case, shame).

The Director then asks the group if they would like to ask Alicia’s shame a question. This serves to draw the group into the process. Finally, at the end of this section of the psychodrama, the resident selects a group member to sit in the “shame” chair. The Director re-interviews “shame,” having the group member repeat what was originally said by the resident.

But that is not enough. The resident must begin to create new neural pathways experientially. The resident, as herself (in this case, Alicia), moves through three positions or empty chairs, which resemble the Procashka Stages of Change. The objective is for the resident to complete three different statements that represent neural pathways. These statements are: (1) “I am not willing to give up my shame because ____________”; (2) “I might be willing to give up my shame if I ___________”; and (3) “I am now completely willing to give up my shame because ________________.” The resident asks group members to sit in these chairs, in the role of the resident herself, and repeat what was said while the resident listens.

There is a very critical end-piece. All the chairs are removed with the exception of the shame chair still occupied by a group member playing that role. The resident is asked to identify actual people in her life who truly “get it” and can be helpful in overcoming her shame (i.e., sponsor, therapist, family member, friend, Higher Power, etc.). These people, chosen from the group, form a line in front of the resident, blocking shame. The resident is asked to stand behind each group member and give a supportive statement, which the group member then repeats.

Finally, holding hands, the group forms a circle around the resident and repeats their unique statements while rotating the circle. The resident is asked if she wants shame inside her circle. The final action is to have the group “group hug” the resident.

As mentioned above, simply describing this process in a narrative may not make it easier to understand and cannot communicate the extraordinary power of the psychodrama experience. Of course, this is true in all therapies.

A Healing Place

There is no one single therapy that resolves life-long difficulties, which is why Sierra Tucson is centered on the idea of integration. Truth be told, we don’t know exactly what combination of therapies are going to work for any one individual. We are, however, confident that, when given a little willingness, our residents will find their own pathways to health and wholeness. Or, put in recovery terms, a place in which they are happy, joyous and free.*

*Alcoholics Anonymous (“The Big Book”), p. 133

Resident Satisfaction … And the Survey Says?

customer satisfaction surveyBy Richard M. Walko, PhD
Quality Management Coordinator

Surveys say a lot actually. Because of our strong commitment to resident satisfaction, Sierra Tucson conducts a lot of surveys. Years ago, each resident was offered one general satisfaction survey to fill out right before completing his or her stay. Today, with an eye toward knowing, in real time, how satisfied our residents are, we have implemented an additional survey.

At about two weeks into a resident’s stay, he or she is invited to complete a mid-term survey that is general, yet comprehensive. It consists of several items to be scored with a numerical rating on a scale ranging from poor to excellent, along with some open-ended, write-in items. Because the survey takes place in the middle of one’s stay, the feedback we receive allows us to be more responsive, and sometimes, right then and there, address an issue of dissatisfaction. In addition, we’re set up to conduct more detailed or “drill-down” surveys, if we need to know more specifically about an issue that is creating dissatisfaction.

Recently, we saw a decline in satisfaction among residents related generally to their daily schedules. To identify the specific issues, we quickly created and implemented a drill-down survey. The results were interesting. A while back, residents expressed the desire for additional therapies to be included in their treatment plans. As each resident’s program is individualized to best treat his or her specific issues, our therapists and medical providers worked with our care planners to determine ways of increasing the number of appointments and activities. Over time, we were able to fill residents’ schedules with many more services. But, as with many things in life, balance is critical. The responses we received in our more recent drill-down surveys were that residents wanted more free time. They felt like they had so much to do with all the individual meetings, group meetings, and activities, not to mention everyday responsibilities like eating and sleeping, that they didn’t have time to simply process it all. Many also indicated they wanted more time for exercise, and maybe a little more leisure time, too. We responded by lightening up their schedules in order to regain the balance.

At Sierra Tucson, we are always concerned with providing the best treatment for each resident, but that philosophy is all about treating the whole person. Balancing the various therapies and modalities with nutrition, sleep, relaxation, and individual and group processing, as well as taking into consideration the philosophical/spiritual needs of each resident, can be a challenge. The methods we have established for surveying are critical to finding that balance. The feedback we receive allows us to act quickly and adjust each individual’s schedule to combine the best therapeutic practices with relaxation and enjoyment. As a result, the resident satisfaction scores have increased significantly in all schedule-related areas.

The items on our mid-term survey are kept constant, so we can see long-term trends. Over time, we’ve seen a change in the dietary preferences of our residents. More and more residents now indicate a preference for vegetarian or gluten-free options. To meet that demand, Sierra Tucson’s kitchen staff has started to introduce new entrées and snacks, and even beverages. Ever tried a kale smoothie? OK, the verdict may still be out on that one, but we have received very positive feedback on one particular change that was made to the dining experience itself. Every Friday evening, instead of the usual dinner hours during which residents eat when they want, everyone gathers together for a delightful dinner served family-style. It changes the entire atmosphere of the dining experience and creates a tremendous sense of community.

It’s always nice to see positive responses and high scores. We love that. We routinely receive encouraging feedback about our facility and the beauty of the surrounding desert and mountains. We are also pleased to report that one of the top-scoring items is our residents’ feeling of safety. Nonetheless, we are most proud that their comments overwhelmingly state that the best thing about Sierra Tucson is the people. We believe that’s the way care should be … all about the people.

4 Tips for Managing Prescription Medicine in Recovery

Dr. Jerome Lerner, Director of Sierra Tucson's Pain Recovery Program

Are you anxious about undergoing a medical procedure while in addiction recovery? Are you hesitant to take prescription medications for fear of relapsing? These dilemmas pose unique sobriety challenges for those in both early and long-term recovery. With a little planning and a proactive approach to post-operative care, the following tips from Jerome Lerner, MD, director of Sierra Tucson’s Pain Recovery Program, can help lower the risk of relapse and guide recovering addicts into a successful healing process.

  1. Get Honest with Your Provider

Prior to surgery, talk to your health care provider and let him or her know you are in recovery. When treating a patient for pain, a doctor needs to look for potential risk factors of substance abuse. Having a conversation about your concerns of relapse will prompt your doctor to carefully assess your situation and select an anesthetic and/or medication that will be in the best interest of your recovery. When a situation warrants medication, it is not safe to under-medicate or over-medicate—the most effective route for managing pain is to consult your provider for post-operative recovery techniques and a tailored treatment plan.

  1. Ask for Help

If you are concerned about having medication in your home, ask someone else to monitor your follow-up treatment and dispense your medicine at the designated times. If that is not an option, a pharmacist can partially fill a prescription on a schedule.

  1. Take a Non-Narcotic Approach

Similar to tip #1, maintain regular conversations with your doctor after surgery and secure his or her permission to switch to non-narcotics as soon as possible. Examples of non-narcotics include Tylenol (chemical name: acetaminophen); non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Motrin or Advil (chemical name: ibuprofen), Aleve or Naprosyn (chemical name: naproxen sodium); and hot and cold packs, to name a few. This approach to pain management post-surgery may help expedite the healing process, thereby resulting in less pain, and reducing the risk of opioid dependence.

  1. Get Real with Your Recovery Network

Honesty and open-mindedness are essentials in addiction recovery. Don’t be afraid to seek counsel or talk with your sponsor or support system if you are experiencing cravings or feelings of withdrawal or despair. There is strength in numbers—realizing you are not alone and that intense feelings will pass can help you stay sober throughout the process.

Surgical pain is common and often expected, but each individual’s pain tolerance varies. If symptoms evolve into chronic pain that disrupt normal movement, functioning, and daily activities, adversely affecting your overall quality of life, seek professional help without delay. At Sierra Tucson, we understand how debilitating chronic pain can be. Our Pain Recovery Program is tailored to meet the needs of men and women who are struggling with complicated pain and the conditions that cause it.

Click here to learn more about Sierra Tucson’s Pain Recovery Program, or call (800) 842-4487. For more information about the safe and appropriate use of medicines in honor of “Talk About Your Medicines” month, visit



Identifying, Screening and Treating Depression

screening for depressionBy Valerie M. Kading, DNP, MSN
Director of Medical Operations, Sierra Tucson

October marks two days dedicated to highlighting depression and the potentially devastating effects of the loss of a pregnancy or child. National Depression Screening Day, on October 6, is devoted to educating the public on stigma reduction and improvement of access to treatment for individuals and families suffering from depression. Pregnancy and Infant Loss Remembrance Day, on October 15, is a day in which those who have suffered a miscarriage, stillbirth, ectopic pregnancy, or loss of an infant, can commemorate their babies.

Depression is a global health burden and leading cause of disability that affects over 350 million individuals worldwide. In the United States, over 15 million adults (or 6.7 percent) experience depression, which is the primary cause of disability for individuals ages 15 to 44. At any given time, more than 1 out of 20 Americans older than 12 years of age report current depressive symptoms. Approximately 42,700 individuals will die by suicide each year (CDC, 2016) and sadly, most suicides may have been prevented.

Depression takes a devastating toll on the individual and his or her loved ones. Depression can present throughout one’s life and can occur during childhood, adulthood, pregnancy, postpartum, and later years. Major depressive disorder (MDD) is diagnosed when a person experiences five or more or the following symptoms for at least two weeks: depressed mood, anhedonia, weight or appetite changes, psychomotor agitation, sleep disturbances, lack of energy, thoughts of death, or difficulty concentrating. These symptoms can cause significant impairment in a person’s relationships with others, work performance, and daily functioning. Depression is associated with trauma and/or significant life events such as divorce, loss of a loved one, medical impairments, and comorbid psychiatric conditions including anxiety, disordered eating, and substance use. Untreated depression is also associated with an increased risk of suicide and other causes of mortality, including heart disease.

Treatment options for depression include counseling, pharmacological interventions, naturopathic remedies, exercise, acupuncture, transcranial magnetic stimulation (TMS), psychoeducation, and integrative therapies. While various treatment modalities for depression exist, significant barriers delay or prohibit the treatment of depression. One barrier is stigma. Individuals often feel embarrassed or ashamed to seek help. Also, family members, loved ones, or health care providers may not support treatment based on negative societal views or personal beliefs about mental illness. Another barrier is a health care provider’s knowledge on how to identify, screen, or treat depression. He or she may not know how to comfortably engage in conversations and assess for depression, or may have time constraints that impact his or her ability to adequately identify and comprehensively treat depression.

Screening for depression is vital in the identification and treatment of depression. In September 2016, the U.S. Preventive Services Task Force (USPSTF) clearly articulated recommendations for screening the general adult population, including pregnant and postpartum women. The USPSTF also recommended that screening occur in the context of availability of adequate resources for diagnosis, treatment, and follow-up care. Several tools are available to screen for depression in adults, with the Patient Health Questionnaire (PHQ-9) being the most common. The PHQ-9 is a brief and validated self-administered tool that health care providers can give to patients and is easily accessible online. An appropriate screening tool for the elderly population is the Geriatric Depression Scale, while the Edinburgh Postnatal Depression Scale (EPDS) is the appropriate screening tool for pregnant and postpartum women.

Health care providers should routinely screen all patients for depression. It is especially vital to screen those who have a known family history of depression and/or suffered a recent loss or traumatic event. Once screening has been completed, treatment is warranted. Appropriate referral to a psychiatric provider or more intensive psychiatric care may be necessary if depressive symptoms are significantly impacting the person’s ability to function or remain safe.

Please call our Admissions Coordinators at (800) 842-4487 for more information about Sierra Tucson’s residential treatment for depression. There is hope.

Article by Alison Broderick

Alison Broderick became a part of Sierra Tucson’s Alumni Relations team in the fall of 2015. Her desire to help others discover the joy of recovery and stay connected is heartfelt. “Through my own experience in recovery, I have developed a passion for helping others find freedom,” she says. Prior to joining Sierra Tucson, Alison served as the Alumni Coordinator at MARR—a long-term drug and alcohol treatment center in Atlanta, Ga. Her commitment to our alumni, as well as recovery, helps the Alumni Relations team connect Sierra Tucson’s miracles from all over the world. Based in Atlanta, Alison focuses primarily on alumni outreach in the eastern region of the U.S. She says, “I believe in the quality treatment we offer. Recovery is a gift, and I am thankful for the opportunity to share that gift with our remarkable alumni community.” Telephone: (470) 955-4516 E-mail:

Individualized Treatment for Professionals

Struggling ProfessionalBy Michael Genovese, MD, JD
Chief Medical Officer, Sierra Tucson

At Sierra Tucson, we recognize that our residents share much in common, but that we must also be mindful of the stressors and circumstances facing each individual. Men and women who are in high-pressure professions may be the first to offer help to others but the last to recognize the need within themselves. Even if they do, many put off treatment because they feel it would take too much time away from work.

We have developed a curriculum at Sierra Tucson in which professionals can receive world-class, discreet treatment that includes mindfulness and stress-reduction practices, bodywork, offsite 12-Step meetings, and SMART Recovery. Psychiatrists and other providers deliver treatment based on the unique circumstances of professionals who are struggling with addictions and co-occurring disorders. We take the real world into account during treatment by offering accommodations such as “healthy electronics” time, which allows residents to address business needs in a structured, caring environment. We also cater Family Program work in a manner relevant to the professional and his or her loved ones.

Phil Mitchell, MA, MFT (CA), MAC, a primary therapist at Sierra Tucson who works closely with professionals, poses the following questions to this population:
  • Despite your successes, are there areas in your life that you feel are lacking or unfulfilled?
  • Is there an addictive behavior that takes the quality of life away from you and your loved ones?
  • Have you been moving so fast in your life that you’re losing touch with who you are and who you want to be?
  • Have others – friends, loved ones, colleagues, a professional board – noticed certain changes in your behavior and encouraged you to get help and support?
  • Are you open, interested, perhaps eager to regain a sense of quality and higher purpose in your life?

If the individual answers yes to any of these questions, Sierra Tucson can provide him or her with an opportunity to reset and recalibrate–mind, body, and spirit. We ensure confidentiality in a safe, structured environment that respects the privacy of each professional.

Each resident at Sierra Tucson receives a core team, which includes an experienced and skilled psychiatrist and psychotherapist, and many holistic specialty therapists and practitioners. Residents participate in educational lectures and workshops amid the breathtaking setting of the Santa Catalina Mountains; engage in mindfulness, meditation, yoga, equine and challenge course therapy, Somatic Experiencing®, and EMDR, to name a few; and take part in Family Week, which offers a powerful healing experience for the individual and his or her loved ones.

The End of Chronic Pain

painBy Jerome Lerner, MD

I understand that it’s a bold idea to declare the end of chronic pain. I have worked in the field of pain management for 30 years, most recently as the director of the Pain Recovery Program at Sierra Tucson. I have literally helped thousands of people suffering from seemingly endless pain to find relief. And yet, I dare to declare the end of chronic pain. Why? How?

Chronic pain is not a person, place, or thing. It is a concept – an idea or belief that some people are and will be stuck in suffering and misery forever. I simply do not have faith in this philosophy anymore.

What Is Chronic Pain?
The Merriam-Webster Dictionary defines the word chronic as “marked by long duration, by frequent recurrence over a long time, and often by progressing seriousness.”

According to the American Academy of Pain Medicine, pain is described as “an unpleasant sensation and emotional response to that sensation.”

Putting these two words together – chronic pain – inadvertently creates a phrase of implied hopelessness and powerlessness that, in my opinion, is unwarranted. It tells us nothing about why pain and suffering persist. It provides no insight or strategy into resolving or healing the situation.

Seeing Is Believing
As director of the Pain Recovery Program at Sierra Tucson, I guide my department with knowledge that is based on three decades of observation, experience, and an in-depth study of science and medicine:

We have directly observed that the vast majority of painful conditions resolve or recede to the background – within the 90-percent range.

We feel it is the birthright and natural condition of every person to expect that painful injuries and medical conditions can, will, and do get better with time and correct care.

We understand that when painful conditions fail to resolve or recede to the background, there must be some complicating factor or factors that are interfering with the natural process of healing.

We trust – and have frequently observed – that when these complicating factors are identified and addressed, the pain does indeed resolve or recede to the background.

We are committed to discovering what these complicating factors are and how to address them effectively. Often, we witness improvements in our residents whom others believed could not get better.

And that is why I believe and declare the end of chronic pain.

Chronic v. Complex
What I propose is that we replace the old language and conceptual model with a new one: “complex pain.”

When a painful condition gets better as expected, it is referred to as “simple pain.” When it does not, complicating factors are involved; and, is then identified as “complex pain.”

At Sierra Tucson, our residents experiencing complex pain may require additional medical and, rarely, surgical care to support healing. Yet in any case, simple or complex, I propose that pain as an experience can and does resolve or recede with time and good care when there are no complicated issues getting in the way.

The good news: almost anyone can understand the reasons that interfere with healing, and there are effective strategies to address them all. The tougher news: it takes a strong determination and perseverance to apply the strategies consistently over time to get the desired results. Because of the challenges along the way, residents often benefit from coaching or guidance to untangle the complicating factors and achieve their goals. When challenges are more severe or deeply imbedded, coordinated expert treatment directed at the complex issues is required.

The Four Factors
My studies and explorations have led me to identify four major complicating factors that interfere with the natural healing of painful conditions. All four factors must be addressed in a coordinated fashion to unlock a complex pain scenario.

1. Biomechanical Stressors – Alignment, stability, flexibility, and endurance challenges needed for the body to function
2. Hypersensitization – Primarily deals with the over-activity of the sympathetic nervous system and the changes to brain activity that occur over time with unresolved pain
3. Metabolic Inflammation – Chemical changes in the blood, which lead to increased tenderness to touch and movement
4. Inertia – The negative thoughts, beliefs, and judgments that keep people ‘stuck’

The Sierra Tucson Approach
Sierra Tucson’s Pain Recovery Program offers treatments and experiences that help individuals discover where and how they have become trapped in their pain. Residents learn a variety of ways to change the negative patterns that hold the pain, both physically and psychologically. The program places a strong emphasis on physical restoration, utilizing the benefits of physical therapy and personal training in individual and group activities. Massage, acupuncture, chiropractic, and other therapeutic bodywork are available to help relieve pain.

The Pain Recovery group at Sierra Tucson meets five days per week to discuss and explore pain-related issues. Pain education is strongly encouraged. Unresolved trauma – common in this population – is addressed with integrative therapies such as EMDR and Somatic Experiencing®. Medication and natural/herbal solutions are examined extensively among the resident’s multidisciplinary team of professionals, with an effort to minimize or eliminate addictive substances. Each resident receives individualized care. Our exceptional clinical team is committed to learning new strategies and applying evidence-based techniques to help resolve complex pain, and improve the quality of life for those who are suffering.