Equine-Assisted Psychotherapy: Healing Through Horses

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Liz Dampsey, PhD, SEP

By Liz Dampsey, PhD, SEP
Clinical Psychology Postdoctoral Fellowship Program

The field of equine-assisted psychotherapy (EAP) has seen rapid growth over the last decade. Research in the field has been increasing substantially in terms of qualitative and quantitative studies that point to its therapeutic efficacy. Evidence suggests that EAP can improve self-awareness, self-efficacy (the belief in one’s own abilities to achieve goals and influence outcomes), and emotion regulation, while decreasing depression, anxiety, negative affect, and maladaptive behaviors.

The potential for experiencing these benefits is directly related to the inherent nature of horses, which involves their biological makeup. Their prey nature makes them highly attuned to their environment in order to ensure their safety, which is what makes them intuitive and emotionally sensitive to the slightest gesture, body posture or tension, tone of voice, or glance that we humans may unknowingly communicate. They respond to our non-verbal behaviors and feelings through their body language, which can be subtle (i.e., the direction of their ears, overall muscle tone, licking of their lips) or quite overt (i.e., walking away from an approaching human). They have the potential to teach us how we impact those around us.

The size and power of horses require a certain level of attentiveness in the moment to safety, which increases awareness of oneself and the environment. Their size can trigger fear and an opportunity to overcome that fear, while increasing self-confidence and self-efficacy through the successful completion of horse-handling tasks. The issue of boundaries also arises when dealing with the horse’s size and power. Horses have clear boundaries, which they assert freely with each other and with us. Learning to attune to a horse’s subtle and sometimes not so subtle boundary cues has the potential to further increase awareness of one’s own physical and emotional boundaries.

Furthermore, learning to communicate with horses involves awareness of our thoughts, intentions/feelings, and the body language we use to convey what we are asking. The ability to clearly and congruently communicate with a horse can be quite empowering for many people dealing with mental health issues, as well as cultivate a sense of self-efficacy in other areas of one’s life.

Horses are instinctively social and focused on inclusion in their herd. They willingly allow humans to join their herd once safety is established. They often provide opportunities for learning about relationships, including mutual trust and respect. Those who have difficulty trusting humans may find it easier to trust a 1,000-pound animal that is unconditional and non-judgmental. Connecting with a horse can act as a bridge to connecting with people.

Studies suggest that EAP has been effective with at-risk youth, particularly those with maladaptive social, emotional, and behavioral problems; those who experienced intra-family violence; and those in foster care. Results of these studies found that EAP increases in self-awareness, trust, general life satisfaction, self-esteem, self-efficacy, social functioning, and emotion regulation.

In addition, studies with adults have indicated that EAP has been effective for women addressing eating disorders, adult female victims of interpersonal violence, adult trauma survivors, and adults from the general population. Results from these studies showed a reduction in psychological distress, improved self-efficacy and impulse dysregulation, increased emotion regulation, and a reduction in depressive and anxiety symptoms.

The effects of EAP on emotion regulation is a fairly new area of study, and may be examined through the research on affective neuroscience including self-regulation of the autonomic nervous system (ANS), particularly the sympathetic and parasympathetic responses to one’s environment. More specifically, there is a correlation between the development of the ANS and the ability to emotionally regulate, which includes regulating both body and behavior states, and also engaging socially with others in effective and affirming ways. Self-regulation can also be explained through attachment theory, which proposes that poor attunement from caregivers early in life leads to maladaptive attachment patterns, the inability to emotionally regulate, and lack of healthy social engagement later in life.

When horses are successfully raised, they instinctively know how to self-regulate. The fear response to a potential threat will activate a horse’s sympathetic nervous system, much like a human. However, once the horse perceives there is no real threat, their parasympathetic nervous system will activate, leading to a physiological discharge of the sympathetic activation, and they will readily return to a relaxed state. This is not always the case for humans because our instinctive impulses to discharge and deactivate may be overridden by our rational brains that get confused by our physiological signals. Furthermore, since horses are emotionally attuned and focused on connection/relationship, the horse-human bond provides an opportunity for social engagement/attachment that can potentiate an interactive, neurobiological attachment transaction.

The sparse research in the area of EAP and emotion regulation includes a few empirical studies that show attachment transactions, as well as positive changes in physiological measures such as cortisol levels and heart rate variability (HRV) levels during human-horse interactions. Findings from these studies suggest increased emotion regulation capacities as a result of: 1) lower cortisol levels; 2) increased HRV levels; and 3) emotional attunement from an attachment relationship with a horse.

A recent study, conducted at Sierra Tucson, an inpatient psychiatric/behavioral health treatment facility for adults, examined the effects of EAP on emotion regulation, with self-efficacy and self-awareness as potential mediators. The hypothesis predicted that the effects of EAP would increase measures of self-efficacy and self-awareness, which would in turn contribute to improved emotional self-regulation as measured by HRV. In order to substantiate the potential relationship between EAP and emotion regulation, positive and negative affect were also examined as outcomes.

Participants included 95 consenting residents who were in the Addiction Recovery Program, Mood & Anxiety Program, and Trauma Recovery Program. Residents in these programs received EAP group sessions as part of their regular programming. However, some received more sessions than others due to the program’s commitment to individualized care, which sometimes involved prioritizing other treatment modalities. Emotion regulation was assessed before and after each EAP group session using HRV, which is a non-invasive, physiological measure of autonomic nervous system activation that involves the beat-to-beat heart rate pattern. Participants were given a portable HRV recorder, which estimated the interactions of parasympathetic and sympathetic control of the heart. It is the rapid modulation of cardiac activity by the parasympathetic system that allows for physiological and emotional regulation to occur in response to changing environmental demands. In essence, higher HRV, or more variability between heartbeats, is an indicator of self-regulatory capacity.

Participants also completed three self-report measures twice during their stay, as part of the admission process (baseline), and at the end of their final EAP session. Measures included the General Self-Efficacy Scale (GSE), the Mindfulness Attention Awareness Scale (MAAS) measuring self-awareness, and the Positive and Negative Affect Schedule (PANAS).

Due to the limitations inherent in field research versus laboratory research where many confounding conditions can be controlled, the findings were unable to suggest any effects of causality. However, correlations among the variables indicated several noteworthy relationships. Self-report measures showed a positive and statistically significant change between pre- and post-test, suggesting that EAP sessions may have contributed to an increase in self-efficacy, self-awareness, and positive affect. As for negative affect, scores were negatively correlated such that negative affect was seen to decrease between pre- and post-test. Results also suggest that an increase in HRV/emotion regulation is associated with an increase in the number of EAP sessions. Additionally, HRV/emotion regulation was also noted to increase from baseline (upon admission) to the last EAP session.

The number of research studies on the therapeutic benefits of EAP has significantly increased over the past decade. Studies suggest positive changes in self-efficacy, self-awareness, self-esteem, and social functioning, as well as a decrease in depression and anxiety as a result of engagement in EAP. Evidence also suggests that the inherent nature of horses can help facilitate attachment transactions, corrective emotional experiences, and nervous system self-regulation among humans.

 

References

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Bachi, K. (2013). Application of attachment theory to equine-facilitated psychotherapy. Journal of Contemporary Psychotherapy, 43, 187-196.

Bachi, K., Terkel, J., & Teichman, M. (2011). Equine-facilitated psychotherapy for at-risk adolescents: The influence on self-image, self-control and trust. Clinical Child Psychology and Psychiatry, 17(2), 298-312.

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Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. New York, NY: Basic Books.

Burgon, H. L. (2011). ‘Queen of the world’: Experiences of ‘at-risk’ young people participating in equine-assisted learning/therapy. Journal of Social Work Practice, 25(2), 165-183.

Burgon, H. L. (2013). Horses, mindfulness and the natural environment: Observations from a qualitative study with at-risk young people participating in therapeutic horsemanship. International Journal of Psychosocial Rehabilitation, 17(2), 51-67.

Chardonnens, E. (2011). The use of animals as co-therapists on a farm: The child-horse bond in person-centered equine-assisted psychotherapy. Person-Centered and Experiential Psychotherapies, 8(4), 319-332.

Cumella, E. J., & Lutter, C. B. (2014). Equine therapy in the treatment of female eating disorder. SOP Transactions on Psychology, 1(1), 13-21.

Ewing, C. A., MacDonald, P. M., Taylor, M., & Bowers, M. J. (2007). Equine-facilitated learning for youths with severe emotional disorders: A quantitative and qualitative study. Child and Youth Care Forum, 36, 59-72. doi: 10.1007/s10566-006-9031-x.

Frewin, K. & Gardiner, B. (2005). New age or old sage? A review of equine assisted psychotherapy. Journal of Counseling Psychology, 6, 13-17.

Geisler, F. C. M., Vennewald, N., Kubiak, T., & Weber, H. (2010). The impact of heart rate variability on subjective well-being is mediated by emotion regulation. Personality and Individual Differences, 49, 723-728.

Hallberg, L. (2008). Walking the way of the horse: Exploring the power of the horse-human relationship. Bloomington, IN: iUniverse.

Hamilton, A. J. (2011). Zen mind, zen horse: The science and spirituality of working with horses. North Adams, MA: Storey.

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Kemeny, M. E., Foltz, C., Cavanagh, J. F., Cullen, M., Giese-Davis, J., Jennings, P., . . . Ekman, P. (2012). Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses. Emotion, 12(2), 338-350.

Kemp, K., Signal, T., Botros, H., Taylor, N., & Prentice, K. (2014). Equine facilitated therapy with children and adolescents who have been sexually abused: A program evaluation study. Journal of Child & Family Studies, 23, 558-566.

Klontz, B. T., Bivens, A., Leinart, D., & Klontz, T. (2007). The effectiveness of equine-assisted experiential therapy: Results of an open clinical trial. Society and Animals, 15, 257-267.

Lavender, D. (2006). Equine-utilised psychotherapy: Dance with those that run with laughter. London, UK: Mrunalini Press.

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Levine, P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.

Meinersmann, K. M., Bradberry, J., & Roberts, F. B. (2008). Equine-facilitated psychotherapy with adult female survivors of abuse. Journal of Psychosocial Nursing & Mental Health Services, 46(12), 36-42.

Pendry P., & Roeter, S. M. (2013). Experimental trial demonstrates positive effects of equine facilitated learning on child social competence. Human-Animal Interaction Bulletin, 1(1), 1-19.

Pendry, P., Smith, A. N., & Roeter, S. M. (2014). Randomized trial examines effects of equine facilitated learning on adolescents’ basal cortisol levels. Human-Animal Interaction Bulletin, 2(1), 80-95.

Peters, S., & Black, M. (2012). Evidence-based horsemanship. Shelbyville, KY: Wasteland Press.

Porges, S. W. (2005). The role of social engagement in attachment and bonding: A phylogenetic perspective. In S. W. Porges (Ed.), Attachment and bonding: A new synthesis (pp. 33-54). Cambridge, MA: MIT Press.

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Schultz, P. N., Remick-Barlow, G. A., & Robbins, L. (2007). Equine-assisted psychotherapy: A mental health promotion/intervention modality for children who have experienced intra-family violence. Health and Social Care in the Community, 15(3), 265-271.

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Shambo, L., Young, D., & Madera, C. (2013). The listening heart: The limbic path beyond office therapy. Chehalis, WA: Human-Equine Alliances for Learning.

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Siporin, S. (2012). Talking horses: Equine psychotherapy and intersubjectivity. Psychodynamic Practice: Individuals, Groups and Organisations, 18(4), 457-464.

Trotter, K. S., Chandler, C. K., Goodwin-Bond, D., & Casey, J. (2008). A comparative study of the efficacy of group equine assisted counseling with at-risk children and adolescents. Journal of Creativity in Mental Health, 3(3), 254-284.

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Whittlesey-Jerome, W. K. (2014). Adding equine-assisted psychotherapy to conventional treatments: A pilot study exploring ways to increase adult female self-efficacy among victims of interpersonal violence. The Journal of Counseling and Professional Psychology, 3, 82-101.

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The Importance of Nutritional Therapy for Addiction Recovery


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Rachel Reid, RD

By Rachel Reid, RD

Seventy four percent of individuals with substance use disorder also suffer from nutritional deficiencies or malnutrition.1 Adequate nutrition and hydration are vital to substance use treatment for restoring physical well-being and mental health and for promoting long-term recovery. Individualized nutrition education and counseling provided by a registered dietitian during substance use treatment has been found to significantly improve sobriety success rates.2

It is well known that substance abuse can significantly impair one’s ability to consume a balanced diet. Substance use also depletes many essential vitamins and minerals in the body, which can exacerbate irritability, sleep disturbance, poor digestion, and a compromised nervous system. It is important to start vitamin and mineral supplementation early in the recovery process.

Moderate amounts of lean proteins are essential for liver regeneration and neurotransmitter production. Lean cuts of pork are a great source of thiamin, which is often severely depleted with alcohol use. Thiamin depletion can cause serious neurological deficits as well as metabolic abnormalities. Mindful portions of healthy fats are beneficial for mood and brain function. Complex carbohydrates are imperative for adequate energy levels, B vitamins, blood sugar control, and gut health. Ample amounts of fruits and vegetables are necessary for a balanced diet, healthy digestion, and nutritional restoration.

During treatment, it is important to manage sugar and caffeine cravings that may arise. Residents at Sierra Tucson sometimes report that highly palatable foods, caffeine and/or nicotine are the only pleasurable substances they have left. Sugar and caffeine may provide a temporary rush, lasting only short term; however, when this feeling wears off, individuals may feel worse. These dietary choices are also not nutrient-dense enough to repair brain, liver, and other tissues that were negatively affected by substance use. Often nicotine use increases during treatment, which can damage taste buds, interfere with hunger/fullness cues, and worsen vitamin deficiencies and dehydration.

Extreme weight changes are common with substance use disorder. These weight changes can heighten depression and can worsen body image issues. Food can also become a cross-addiction, leading to binge eating disorder (BED) or bulimia nervosa. It is common for old eating disorder behaviors to resurface in the absence of substances. Overindulgence of food or food restriction can serve as a distraction or a maladaptive coping mechanism for dealing with unwanted emotions and discomfort during and after substance use treatment. It is important that substance use treatment centers have at least a general knowledge of eating disorder behaviors.

Irritability, anxiety, and decreased mood caused by an unbalanced diet, low blood sugar, dehydration, or excess caffeine can be triggers for cravings, which can cause relapse.3 Individuals should be educated on the importance of nutrition to the recovery process and should be counseled on continuing nutritional supplementation, given it can take 3-12 months for nutritional deficiencies to resolve.4 Meal planning, grocery shopping, and cooking are skills that benefit lasting recovery.

Unfortunately, not all treatment centers include nutritional therapy by a registered dietitian. The substance use model, which has been around for many years, did not previously emphasize the importance of nutrition on rehabilitation. We now know that registered dietitians can provide a powerful impact on the treatment process and help support an enduring recovery.

References:
1. Nazrul Islam S, Hossain K, Ahmed A, Ahsan M. Nutritional status of drug addicts undergoing detoxification: Prevalence of malnutrition and influence of illicit drugs and lifestyle. British Journal of Nutrition. 2002;88(5):507-513.
2. Grant L, Haughton B, Sachan D. Nutrition education is positively associated with substance abuse treatment program outcomes. Journal of the Academy of Nutrition and Dietetics. 2004;104(4):604-610.
3. Salz A. Substance Abuse and Nutrition. Today’s Dietitian. 2014;16(12):44.
4. Dekker T, Nutrition & Recovery: A Professional Resource for Healthy Eating during Recovery from Substance Abuse. Toronto, ON: Centre for Addiction and Mental Health; 2000:1-14.

Celebrating Every Body: The Body Positive Movement in Action

Rachel Reid, RD

Rachel Reid, RD

In today’s world of Instagram, Snapchat, Facebook, and Pinterest, photos of near-perfect bodies and flawless faces flood the social media scene. While many celebs and citizens alike are promoting a new approach to beauty known as the body positive movement, it’s easy to fall into the toxic trap of comparing ourselves to others. The good news is we’re making progress toward positivity and a healthy lifestyle. Rachel Reid, RD, a dietitian at Sierra Tucson, offers insight for men and women who are struggling with disordered eating patterns and poor body image.

Q: What are some ways in which individuals can celebrate their bodies?
RR: Daily positive affirmations are key. Give yourself compliments daily. Create a list of all the wonderful activities your body is capable of doing, and then read this list on a daily basis and add to it often. Those struggling with disordered eating can celebrate their bodies simply by giving themselves permission to eat foods they love and add a dose of fun to each day.

Q: How can we shift our focus from body hatred to being grateful for a healthy body?
RR: Give up the scales and the calorie-counting apps. You can honor your hunger by choosing foods that make you feel good. Focus on the flavors, textures, colors, and aromas of your food to promote a mindful eating experience. Celebrate your body by choosing exercises that bring you joy and pleasure. Remind yourself daily that your body is much more than its physical appearance, but an instrument to experience life’s adventures and a shell to your soul.

Q: How does Sierra Tucson promote body acceptance while staying mindful of a healthy meal plan and lifestyle?
RR: At Sierra Tucson, we do our best to avoid focusing on weight and numbers. We encourage our residents to focus on how their body feels, how much energy they have, and how well they are able to accomplish their daily tasks with adequate nutrition. We have a number of opportunities for residents to use their bodies in new and challenging ways such as our ropes course, rock climbing wall, equine therapy, yoga, and other practices that support body acceptance. Mindful movement is a therapeutic way to maintain a healthy lifestyle as well as improve mood and body image.

Q: What changes do you hope will transpire from the body positive movement?
RR: I hope the body positive movement will begin to counter the notion that our bodies are not good enough. I hope people begin to realize how beautiful and extraordinary their bodies really are. I hope we can disconnect our focus on appearance and turn our attention to health.

About Our Eating Recovery Services

Sierra Tucson’s Eating Recovery Services provide comprehensive treatment for individuals (18 years and over) struggling with disordered eating as a co-occurring condition. Residents benefit from our wide range of medical and clinical services that address disordered eating and simultaneously treat primary diagnoses such as depression, anxiety, trauma, chronic pain, or substance use disorder.

For information, please call our Admissions Coordinators at (800) 842-4487.

Empowering Residents to Find (and Speak) Their Truth

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Sierra Tucson Patient Advocates John Flagle and Jan York

The Patient Advocates help foster healthy recovery behaviors

At Sierra Tucson, the Patient Advocates serve as the liaison between residents and staff. Patient Advocates communicate resident concerns to appropriate staff members. The team, consisting of one male and one female Patient Advocate, is open seven days a week to reinforce an environment that is focused on resident-centered care.

What Is a Patient Advocate?

  1. Self-Advocacy – A Patient Advocate supports residents by empowering them to become effective self-advocates. At Sierra Tucson, our job is not to rescue residents from despair; our job is to teach residents essential life skills in recovery. We want each individual to learn how to become his or her own spokesperson, then practice speaking his or her truth during treatment. Self-advocacy allows residents to “flex” their recovery muscles, and the Patient Advocate serves as a trusted staff member with whom they can be transparent.
  2. Cultural Sensitivity – Patient Advocates help to support cross-cultural beliefs and practices by listening and responding to residents’ religious, spiritual, and cultural needs throughout the year. For instance, residents may receive visits by members of the clergy, or the Patient Advocate may coordinate a trip to a nearby synagogue, temple, or church. Special dietary modifications are also organized through the Patient Advocate Office, and certain religious items such as Bibles, prayer books, kiddush cups, and Shabbat candles are provided upon request.
  3. Communication, Collaboration & Confidentiality – Information that is shared between a resident and Patient Advocate is confidential. Although our Patient Advocates are an extension of Sierra Tucson, they want residents to feel safe and comfortable when disclosing information that is often personal to them. They maintain their trust and confidence with integrity. When appropriate and/or necessary, they collaborate with other staff members to ensure residents’ needs are met in a timely manner.
  4. Assessment – The Patient Advocates are responsible for conducting mid-term surveys with our residents. These surveys disclose how the resident feels about his or her treatment experience two weeks after admission. Once the survey is completed, it is reviewed by the Patient Advocates, who address any concerns the resident may be having with the resident. The mid-term survey is then disseminated to Sierra Tucson’s Quality Manager for further investigation and clinical outcomes studies.
  5. Community – The Patient Advocates at Sierra Tucson work hard to establish a sense of community among our residents. From weekly all-community meetings to resident traditions, to outings and fun events on campus, they are committed to creating a feeling of togetherness. Before coming to Sierra Tucson, many of our residents were deep in the throes of their disease – often isolated from the outside world. Patient Advocates help to break down those barriers of isolation by reconnecting residents with others and self. Ultimately, it is their goal to foster healthy recovery skills early on, making the transition from treatment to the “real world” as seamless as possible.

“Residents tell us that we provide a safe environment for them to express their needs and concerns, and that they feel heard.”
-Jan York, Patient Advocate at Sierra Tucson

Revealing the Reality of Perinatal Women and Substance Use

Perinatal Woman and Substance Use

Valerie M. Kading, DNP, PMHNP-BC

By Valerie M. Kading, DNP, PMHNP-BC
Chief Medical Operations Officer

Women of childbearing years represent approximately 1 out of every 4 individuals globally. In 2015, 1.6 billion women aged 15 to 44 years represented approximately 45% of the total female population (U.S. Census Bureau, 2015). The number of women of childbearing years has been projected to increase by over 0.4 billion between 2002 and 2050 (U.S. Census Bureau, 2015). In 2012, there were nearly 63 million women in the United States aged 15 to 44. Of these women of childbearing years, 6% became pregnant, resulting in 3.9 million births (U.S. Census Bureau, 2012). The total population of women aged 15 to 44 in the United Kingdom in 2014 was 22.5 million with a total of 695,000 births (Office for National Statistics, 2014). Women of childbearing years who represent a significant portion of the population and pregnancy, both intended and unintended, should be considered when addressing the health of this population.

Substance use and overdose-related deaths are a public health crisis and women represent a significant portion of this population. An alarming 30% of individuals addicted to substances are women of childbearing years aged 15 to 44. The National Survey on Drug Use and Health (NSDUH) from 2015 shows that approximately 5% of pregnant women in the United States report using illicit substances within the past month, compared to 10% of non-pregnant women (SAMHSA, 2015). Alcohol use among pregnant women was 16.4% compared to 53.2% of non-pregnant women. These results, while promising, may be conservative due to stigma and fear of reporting, and may not have included women who did not know they were pregnant. NSDUH data also suggests that substance use decreases during pregnancy but resumes after pregnancy and beyond.

Perinatal and Substance Use_VKVarious risk factors exist for illicit substance use, including family history of drug addiction, history of addiction to any drug (including tobacco), history of psychiatric or psychological illness, and history of childhood trauma (SAMHSA, 2015). Research suggests that 55% to 99% of women who abused substances had a significant trauma history (Najavits et al., 1997). Other risk factors include involvement in an intimate relationship with a partner who abuses substances. Protective factors include marriage and partner support.

Women are more likely than men to experience co-occurring substance use and mental health disorders. It is estimated that 72% of women diagnosed with alcohol use disorder (AUD) have a co-occurring psychiatric illness, and 86% diagnosed with alcohol dependence have a co-occurring psychiatric illness (Kessler et al., 1997). Anxiety disorders, depression, PTSD, and eating disorders are the most common co-occurring psychiatric illnesses among women (Agrawal et al., 2005). Individualized treatment targeting co-occurring illnesses is critical to addressing the health of the woman during the perinatal period.

Management of a pregnancy in a substance-abusing woman can be complex and involve psychosocial, medical, and addiction considerations. The perinatal period is a critical transitional time in a woman’s life where healthcare providers must address concerns about substance use and mental health issues. Perinatal depression is estimated to affect approximately 10% to 15% of women worldwide and is considered the most significant risk factor for postpartum depression (Agency for Healthcare Research & Quality, 2015; Melville, Gavin, Guo, Fan & Katon, 2010; WHO, 2012b). A systematic review revealed that postpartum depression symptoms were present in 19.7% to 46% of postpartum women who abused substances and those with a history of substance use (Chapman & Wu, 2013). In a sample of 125 women, one-third of opiate-addicted mothers screened positive for major depression, and almost half experienced postpartum depression 6 weeks post-delivery (Holbrook & Kaltenbach, 2012). Perinatal women experiencing depression may be at a higher risk for substance use as a means to self-medicate. Addressing substance use and co-occurring mental health concerns is imperative for a positive outcome for the mother, unborn child, and family.

Substance use during pregnancy has been associated with negative outcomes for the woman and baby, including increased morbidity and mortality for the woman and her child. Pregnant women abusing substances are less likely to obtain consistent obstetric care and have poor medical follow up. Obstetric complications associated with opiate dependence include miscarriage, preterm labor and postpartum hemorrhage. Adverse outcomes for the fetus include stillbirth, prematurity, intrauterine growth retardation (IUGR), and neonatal abstinence syndrome. In a sample of 247 subjects, cocaine and heroin use were both positively associated with IUGR, preterm delivery, and low birth weight (Pinto et al., 2010).

Perinatal and Substance Use imgHealth care providers are at an optimal position to screen for substance use among perinatal women. Women with histories of psychiatric or substance use should raise concern and trigger focused assessment on substance use. Screening for the use of substances should occur routinely in obstetric/gynecology, primary care, and psychiatric practices to immediately capture substance use among perinatal women and result in referral for treatment. Evidence-based substance use screening tools for perinatal women include ASSIST, CRAFFT, Substance Use Risk Profile-Pregnancy Scale, T-ACE, TICS and TWEAK (Goodman & Wolff, 2013). These screening tools range in sensitivity from 50% to 91% and are validated for prenatal and pregnant women (Goodman & Wolff, 2013).

Valerie M. Kading, DNP, PMHNP-BC, serves as the chief medical operations officer at Sierra Tucson, focusing on enhancing medical system operations and management to facilitate exceptional patient care. Prior to joining Sierra Tucson, Dr. Kading practiced as a board-certified psychiatric mental health nurse practitioner for10 years in a community mental health clinic, working with patients with various mood disorders and co-occurring substance use diagnoses. Dr. Kading specializes in working with perinatal women experiencing psychiatric illness, and continues to be clinically involved with this special population through the Tucson Postpartum Depression Coalition. She is a member of Phi Kappa Phi, Arizona Nurses Association, American Nurses Association, and the American Academy of Nurse Practitioners. Dr. Kading is passionate about her roles at Sierra Tucson, as a psychiatric nurse practitioner and an administrator, and provides compassionate attention to the wellbeing and positive outcomes of residents and their families.

A Physical Approach to Pain Treatment

Anthony Henderson, DPT

Anthony Henderson, DPT

By Anthony Henderson, DPT
Doctor of Physical Therapy

Physical therapy is designed not only to treat physical limitations, but also to ensure improved pain over a longer period of time, overall functional mobility with a high success rate for treatment, and a 72-percent reduction in the medical cost of treatment within the first year. However, physical therapy can be one of the most challenging methods for treating pain due to the rigorous work required, as compared to other treatments which may involve a more passive, quick-fix approach that can seem appealing for immediate pain relief. Due to this rigorous physical demand, patients often struggle to comply with a home exercise program and attend physical therapy appointments. At Sierra Tucson, physical therapy conveniently takes place on site and thus, vastly improves compliance.

Another challenge people often experience with physical therapy is a lack of one-on-one time with the physical therapist. Instead, more time is spent “handing off” the patient to physical therapy assistants and physical therapy technicians. Consequently, the individual may feel undervalued and unheard. At Sierra Tucson, each patient is granted 60 minutes during each visit with the same physical therapist. The treatment plan may be modified by the attending physical therapist to ensure treatment appropriateness, and adjustments are made as needed.

A Patient-Centered Approach

We use a pain-directed, interdisciplinary, professional team approach. Our Pain Recovery Program includes health care providers who work directly with each individual, offering a variety of interventions and strategies for self-management. Our comprehensive treatment focuses on a thorough assessment, communication within disciplines, education, and follow-up. We believe pain should never be the only focus assessed – it is important to take a holistic approach when shaping one’s overall treatment.

The Treatment Team

Patient
Physician Assistants
Nurse Practitioners
Nurses
Psychologists
Physical Therapists
Nutritionists/Dieticians
Recreational Therapists
Pharmacists
Support Staff
Volunteers
Significant Others (family, friends, neighbors)

In a typical healthcare environment, there may be a primary care provider, a physical therapist, a counselor, and other specialists on staff. While they communicate occasionally, they seldom meet face-to-face as a team to discuss the well-being of every patient. Sierra Tucson’s interdisciplinary treatment team for the Pain Recovery Program meets regularly to review each individual’s treatment and care. We assess goals that have been set, the progress that has been made, difficulties and challenges, and next steps. Based on the patient’s progress, we are able to determine which team members may need to alter their approach and other areas that might require additional attention, as well as personally communicate with the patient.

Our goal at Sierra Tucson is to provide individuals with a well-balanced approach to treatment. Each team member complements the team as a whole. The patient is our priority – we respect his or her values and needs, coordinate and integrate appropriate care, provide emotional support, and involve his or her family and loved ones. We empower patients to take an active role in their recovery.

Physical therapy is designed to treat physical limitations and ensure improved pain. We believe in a well-balanced, holistic approach to treatment. Call today.

The Opioid Epidemic: Prevention, Recognition & Treatment

Teresa Jackson, MD, Director of Sierra Tucson's Addictions / Co-occurring Disorders Program

Teresa L. Jackson, MD

By Teresa L. Jackson, MD
Director of Addiction Recovery Program

Prince, Michael Jackson, Heath Ledger, Whitney Houston, Amy Winehouse, Philip Seymour Hoffman, John Belushi, River Phoenix, Janis Joplin…the list goes on and on. It’s shocking to hear when a famous rock star or actor has died of a drug overdose.

What’s more disturbing…

  • 91 people die each day in the United States from an opioid overdose.
  • 33,000 people died from an opioid overdose in 2015. Half of these deaths were from prescription opioids.
  • Drug overdoses are the leading cause of accidental death in the United States, ahead of motor vehicle deaths and firearms (deaths).

In the last 15 years, the number of prescriptions for opioid pain medications has quadrupled. Prescription opiates like methadone, oxycodone (Percocet), and hydrocodone (Norco and Vicodin) are the leading cause of prescription opioid deaths. The United States uses 99 percent of the world’s hydrocdone. The majority of people that use heroin started with an opiate pill. Sadly, heroin is readily available and less expensive. We are in the midst of an opioid addiction and overdose epidemic in the United States.

The best way to prevent opioid overdose deaths is to improve opioid prescribing, reduce exposure to opioids, prevent abuse, and stop addiction. Prescribing physicians must carefully regulate opiate prescriptions. Preventing abuse of prescription opiates is a combined effort between physician, pharmacies, patients, and family members. It is very important to keep all controlled substances in a secure location. Never share your prescription and always destroy the medication when it is no longer needed. Pharmacies often accept medications. In addition, they can be discarded in cat litter or coffee grounds.

Early recognition and treatment of addiction to opiates can save lives. Medication-assisted treatment (MAT) combines the use of medication with counseling and behavioral therapies. Unfortunately, behavioral interventions alone have a poor success rate in opioid addiction, with a relapse rate that is greater than 80 percent. The addition of medication to behavioral intervention greatly increases the outcomes. FDA-approved medication such as buprenorphine (Suboxone, Subutex), methadone, and naltrexone improve the success rate and decrease the associated risks of opiate addiction, including HIV, Hepatitis C, and overdose. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function.

Often, patients express concern about seemingly trading one drug for another. Abstinence is always an option; however, MAT allows the brain to heal from opiate dependence. The patient can concentrate on recovery without ongoing withdrawal symptoms and cravings. The brain gradually heals from opiate dependence and the medication can be slowly tapered. One of the most common fears for patients is withdrawal. The Surgeon General and government are responding to this epidemic by increasing funding for the treatment of addiction, including MAT. In addition, life-saving medications that can reverse an opioid overdose are now available to patients who are prescribed opiates and for the loved ones of patients addicted to opiates. Naloxone (Narcan) can reverse an opiate overdose. The nasal spray is easy to use and more readily available now.

Early treatment for opioid addiction saves lives. If you are concerned about a loved one’s use of prescribed opiate pain medication or use of illicit opiates such as heroin, please seek professional help. The combined use of medication, counseling, and behavioral therapies may save his or her life.

MAT: A Case Study

Jane is a 34-year-old woman addicted to heroin. She started using oxycodone in college on the weekends. She began working after college and married a man that also used oxycodone. After a miscarriage and the death of her father, Jane’s use escalated to daily use of up to 600 milligrams of oxycodone. She was spending $600 daily on oxycodone. Her drug dealer introduced her to heroin. Her use of heroin escalated to 2 grams per day. She tried stopping on her own and could not. She tried two detox programs and immediately returned to using. She was overwhelmed with anxiety and cravings without heroin. Upon admission, she was prescribed Suboxone® to help with withdrawal symptoms. Within 24 hours of her admission, her withdrawal symptoms were gone and she was feeling well and participating in groups and activities. Because Jane had been using for many years and relapsed several times after trying to stop on her own and detox, she is candidate for MAT. She was discharged on Suboxone maintenance therapy for at least six months. Suboxone®, in addition to Intensive Outpatient Treatment (IOP) and relapse prevention meetings, is the reason Jane is drug-free today and enjoying life.

Ready for Change: How the Admissions Team Supports Referring Professionals

Blake Master

Blake Master

By Blake Master
Director of Admissions

With direct efforts from behavioral health professionals who refer to Sierra Tucson, over 1,600 lives were touched in 2017. That’s 1,600 people making a change in order to feel better, improve, and thrive for years to come. It is not only these individuals who are taking a leap of faith when seeking treatment, but also their referring doctors, therapists, and counselors who are joining them on their journey. Having professionals feel prepared for this process is as important as having the residents feel comfortable and ready to begin. Sierra Tucson has refined the admissions process for healthcare professionals who reach out directly to our facility.

If you are a referring professional who is making a phone call to Sierra Tucson, you will be greeted by an admissions coordinator. He or she will gather clinical information regarding your client and walk you through our simple, two-step admission process. That’s it. In less than 90 minutes, your client will be ready to begin individualized treatment at Sierra Tucson.

Now, what happens while your client is in treatment? To ensure fluidity of care, Sierra Tucson will update you, the referring professional, weekly while your client is in treatment at our facility. We understand and respect that professionals have a history with the individual whom they referred, and the clinical information they  provide helps us deliver precise care. This weekly contact will continually happen until discharge. Sierra Tucson also understands that the upcoming change of treatment environment can be stressful for the individual and all parties involved. As your client’s treatment experience comes closer to completion, we make this process as smooth as possible for all involved.

Sierra Tucson has a three-pronged approach to its continuum of care. First, we communicate with the resident’s treatment team to assist with the individualized continuing care plan, which may include stepping down to a lower level of care (i.e., PHP, IOP, extended care, sober living, or continuing care with the referring professional). Second, the resident will be enrolled in Connect365, our year-long continuing care service offered at no additional cost; the individual will engage in weekly communication with his or her recovery coach for one year post-discharge to help with the transition from treatment to life in recovery. Finally, the resident will have all of the offerings that come with being a Sierra Tucson alum, including support groups offered throughout the country, workshops, social activities, and the annual Alumni Retreat.

Our primary goal is client success. Pending the appropriate releases, we believe that communication and working collaboratively with treatment professionals help create a supportive environment that aids in the resident’s healing journey.

“The intake department at Sierra Tucson is extremely effective and efficient. I can usually expect an email response to our inquiries within 90 seconds from two separate intake specialists. They are quick to run verification of benefits, and great on the phone with our clients and their family members. If we ever want something done quickly, we know that Sierra Tucson is the first place to call.”
– From an outpatient professional group in Newport, CA

 

Alumna Shares Her Gratitude

Thank you so much to everyone at Sierra Tucson, especially my counselor, Phil Mitchell.

Since completing treatment, I have finished both of my masters’ degrees (MSW and MPH), have a job as a study coordinator and smoking cessation counselor, and have started yoga teacher training.

Let the journey continue – it truly is a miracle!

With unending gratitude,

Jessica W.
Philadelphia, PA

Miracles All Around

Jaime Vinck, MC, LPC, NCC, CEIP

Jaime Vinck, MC, LPC, NCC, CEIP

By Jaime Vinck, MC, LPC, NCC, CEIP
Chief Executive Officer

Happy New Year from beautiful and sunny Tucson, Arizona! As I reflect on the past 365 days, it is humbling to consider that we have helped more than 1,600 individuals find hope and healing. Prior to Sierra Tucson, each of those individuals were cared for by at least three people, conservatively speaking, who likely breathed a huge sigh of relief when their loved one agreed to treatment. In that case, another 4,800 lives were positively impacted by the work of our talented team of professionals in 2017.

Every day when we read or listen to the news about the world around us, we are overwhelmed with abhorrent behavior, drug epidemics, tragic overdoses, and suicides of public and not-so-public figures, to name a few. Unfortunately, the good news is often overshadowed by the negative, more scandalous news.

For me, it is helpful to think about the many miracles taking place right here at Sierra Tucson. In 2018, I choose to focus on the positive and affirm those I care about. I am going to be gentle with myself; celebrate the grace that has been given to me without even asking; and embrace the wisdom that has emanated from my pain. No marathons, no diets, no other punishing behaviors—a simple celebration of daily gratitude is my only resolution.

In the next year, Sierra Tucson will continue to be a thought leader in the treatment of substance use and mood disorders. We will celebrate with our residents as they begin their healing journey, and we will support them in the 365 days following treatment via Connect365 – our signature continuing care service. Thanks to Sierra Tucson Alumni Relations, the support continues for a lifetime.

Here’s some good news we can savor in 2018: Sierra Tucson is committed to clinical excellence and compassionate care – yesterday, today, and tomorrow. May you enjoy a happy and healthy New Year!

For information about our residential treatment programs, please call our Admissions Coordinators at (800) 842-4487.

Residential Therapists: Providing Comfort and Care During the Holidays

Residential Therapists keep residents safe

Gabrielle Shoun, MS, LASAC

By Gabrielle Shoun, MS, LASAC
Manager of Residential Therapists at Sierra Tucson

Taking that first step through the doors of a treatment center is often one of the most overwhelming experiences a person can endure, particularly during the holiday season. So many unknowns consume the minds of all those involved. “What kind of support will I have?” “How will I cope with being away from home?” “What will my loved one be doing all day?”

Sierra Tucson is proud to offer an exceptionally unique team of 19 masters-level therapists whose role is to address concerns like these and assist in comforting residents, which, in turn, provides comfort to their loved ones.

The residential therapists, or RTs, work from 7 a.m.–midnight, seven days a week, and are responsible for the coordination and facilitation of didactic lectures, psycho-educational groups, and individual sessions. These activities help in keeping residents engaged throughout the day and provide an opportunity for them to develop and hone their recovery skills from the moment they wake up until the time they go to bed. RTs utilize this time to establish a rapport so the residents always have a familiar face to seek out should they require additional care and support or need to process information they gathered in their groups.

Residential therapists assist in crisis management, for instance, if a resident receives difficult news, is contemplating leaving treatment against medical advice (AMA), or experienced a particularly intense session. RTs utilize evidence-based practices such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), and incorporate various grounding skills to meet residents’ needs. The treatment team may request to have an RT check on an individual at night as well. From the beginning of treatment until completion, residents know their needs are of the utmost importance, even after their primary therapist leaves for the day.

The unwavering and continuous support of Sierra Tucson’s residential therapists provides a strong structure in which residents can foster healthy connections and process any feelings and emotions that arise, no matter the time of day.

Throughout the holiday season, families can rest assured that their loved ones will be surrounded by a skilled team of clinicians who provide additional support during the treatment process and guide residents on the path of recovery.

Gabrielle Shoun, MS, LASAC, manager of residential therapists (RTs) at Sierra Tucson, explains the important role Sierra Tucson’s RTs play in providing residents with the comfort and care they need. Watch now.

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