Treatment Services Provided

People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.

These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance.

Over time people with addiction build up a tolerance, meaning they need larger amounts to feel the effects.

According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:

• To feel good — feeling of pleasure, “high”
• To feel better — e.g., relieve stress
• To do better — improve performance
• Curiosity and peer pressure

People with addictive disorders may be aware of their problem, but be unable to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.

Symptoms of substance use disorder are grouped into four categories:

• Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
• Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use
• Risky use: substance is used in risky settings; continued use despite known problems
• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)

Many people experience both mental illness and addiction. The mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse.

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The 12 Step Model of Recovery and Dr. Aiello’s approach 

When applicable, Dr. Aiello utilizes a rigorous study of the spirituality of the 12 steps while presenting each step as a compatible partner to various empirically evidenced cognitive behavioral, psychodynamic and mindfulness therapies, thus bridging the science of addiction with the 12-step model of recovery.  In accordance with the scientific steps of discovery ie; make an observation, ask a question, make a hypothesis, design an experiment and make a conclusion, is exactly the way Dr. Aiello approaches the 12 steps as a whole; breaking each step down into a palatable, rational, comprehensive approach to healing.  But this is not an overnight process.  It takes training, practice and “putting one foot in front of the other” to retrain the brain to accept a new way of living, and a permanent lifestyle change. 

Like insight-oriented therapy, the 12 steps are useful tools that may be used in the treatment of trauma with the addicted person.  For many recovering people, the 12 steps have been shown to be a useful and powerful adjunct that facilitates self-activation, spiritual growth and relationship healing. The addicted person learns how to live without the dominating obsessions of drugs or alcohol. 

While Dr. Aiello is not a sponsor, she willingly and patiently will take the appropriate patients through the 12 steps utilizing a workbook she has developed and owns to help with an understanding of the 12 step process and how this spiritual model can help the addicted person live free from the binds of drugs and alcohol to commence a life of purpose and joy.

Dovetailing of Alcoholics Anonymous and Scientific Discovery

The disease model recognizes biological forces beyond our will and has been evinced by AA for almost 75 years.  This model has been proven by scientific research over the last 15 years, which shows that the brain is trainable to alter neurotransmitter function at the cellular level.  You can change what you pay attention to.  Thus, being sober, one can learn to recognize one’s addictive thinking (obsessions, cravings, poor behavioral choices) along with their “give me a pill or a drink to alleviate my suffering” mantra, and approach (however haltingly at first), the fellowship of Alcoholics Anonymous and the recovery tools of the 12 steps to identify their self-destructive urges and poor impulse control and develop more positive, recovery focused thinking, keeping the goal of behavioral change as the new mindset.

Treatment in AA occurs as new behaviors are developed and habituated through the community participation, which of course is the fellowship.  Along the way, the structure and function of the brain changes as a result of a comprehensive, action-oriented engagement through the 12 steps.  The maintenance and continued practice of these positive brain changes, perceptual shifts and behavioral changes, is conducted through the actions of being of service to others.  Science and the 12-step model dovetail beautifully as a result of these integrated processes to help the recovery person learn how to “self-activate” and “individuate.” The mystery (concepts of God, for example) and a resistance to the 12 Steps, are removed and replaced with a logical acceptance and understanding of one’s own recovery.

Addiction as an Attachment Disorder

Dr. Aiello is an adherent to the theory that addiction is an attachment disorder. What does this mean?  Generally, people seeking treatment for addiction or mental illness come with a common problem: most of then have endured and suffered from a lack of adequate bonding or attachment with other human beings, especially in their early childhood with their primary caregivers. These ruptures in early attachments (or relationships) may cause what is known  as an Attachment Disorder.. During the first few years of life, a child raised in an adequate parenting environment receives what is referred to as unconditional positive regard, or acceptance and support of a person no matter what they do or say. For a brief time in our early lives, we need and require the experience of being loved just for existing.  Below is a primer on Attachment disorders and their relationship to Addiction. 

Lou Cozolino:  “We are not the survival of the fittest.  We are the survival of the nurtured.”

In addition to being a medical/disorder or “disease”, when looked at through a psychodynamic lens, ADDICTION :

• is an attempt at self-repair that fails
• may be a defense against shame, guilt, fear, self-loathing, emptiness

may be a disorder of self-regulation.  People who are addicted cannot regulate their emotions, self-care, self-esteem, self-activation and relationships.

Anxiety: Anxiety is about conflict. It’s a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention.

Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives. However, anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.

Women are more likely than men to experience anxiety disorders.

Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior.

Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

Anxiety disorders can cause people into try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

• Be out of proportion to the situation or age inappropriate
• Hinder your ability to function normally

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
• Feeling worthless or guilty
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

WHAT IS ATTACHMENT?

• John Bowlby is the founder of Attachment Theory. Attachment is about safety, protection and emotional regulation in the face of danger or perceived threat.
• The need for emotional regulation is what drives attachment behaviors
• 3 part motivational system of fear-attachment-exploration
  • fear triggers attachment behaviors
  • safe haven secures the fear (amygdala)
  • opens exploration

THE NEUROSCIENCE OF ATTACHMENT:

Donald Hebb: “Neurons that fire together, wire together.”

Strong neural connections become neural pathways and neural networks. This experience-triggered neural firing is how ALL neural pathways become patterns of response, and how all structures of the brain mature. This is how all patterns of attachment are laid down in the brain; it is also how they can change.

• Earliest relationships build brain structures we use for relating.
• The experience of these relationships are stored in implicit memory (subconscious) from 12 to 18 months of baby’s life.
• These patterns become the “rules”, templates, schemas for relating that operates lifelong relational interactions. The “known but not remembered”.   Implicit vs. explicit memory.  Explicit memory kicks in around 2.5 years of age when the child either begins to remember or for survival in the face of severely inadequate parenting skills, is stored in the unconscious.
• Less than optimal infant/childhood templates, “stick” and become increasingly difficult for us to learn, adapt, grow. They become “the tragic recursive patterns encased in neural cement.”  Flight, fright, freeze
• This becomes the groundwork for childhood trauma, which starts the journey towards personality disorders, maladaptive relational patterns and ADDICTION.
• Good news: Brain has capacity to grow new neural pathways, new connections to leave behind old thinking and maladaptive behaviors such as drinking and using.

AFFECT REGULATION IS THE ENGINE OF ATTACHMENT and what drives the pre-frontal cortex. 

• Affect regulation: The need to be seen, heard, understood.  Without these, baby has no way to self soothe.

ATTACHMENT STYLES:

Mary Ainsworth and Mary Main conducted intensive research studying babies and their primary caregivers to discover four types of attachment styles:  Watch the Strange Experiment to see these in action.  

• Secure
• Insecure Dismissive /Avoidant
• Insecure PREOCCUPIED/ Anxious/ambivalent
• Disorganized

SECURE PARENTING 

• Dysregulated infants are soothed by caregiver. This is what helps the brain to form its nervous system/regulatory capacities (ie:  self soothing in the future).
• Baby is taught through mirroring, (the “gaze”), attunement how to later respond to stress appropriate. Baby bonds through the chemical Oxytocin which is released through touch, calming talk, warmth, movement (such as breastfeeding) and orgasm.
• If parenting style is responsive, available, predictable, sensitive, emotionally and physically attuned to baby, holds and contends empathically with baby’s dysregulation.

SECURE CHILDREN 

• Feels a felt sense of reality
• Safe and protected
• Proactively seeks attention when needed
• Learns to self soothe
• SELF – OTHER world

SECURE ADULTS

• Comfortable with emotions, intimacy and interdepency
• Tolerates failure and frustration in healthy ways
• Relationships are longer lasting,

INSECURE DISMISSIVE/AVOIDANT

• PARENT: is indifferent, distant, neglectful, absent, rejecting, shaming, blaming, critical, judgmental, physically-emotionally unavailable, ineffective in regulating affect.

• CHILDREN BECOME INSECURE/AVOIDANT ATTACHMENT STYLE
  • the child withdraws from interactions, is seemingly indifferent to parent; the child doesn’t seek or expect comfort or soothing; there is a defensive exclusion of affects (numbing out); there is a focus on self or world, not other.

• INSECURE/AVOIDANT ADULTS ATTACHMENT STYLE
  • emotionally shut down; devaluing relationships and feelings; uncomfortable with intimacy, vulnerability, dependency. There is difficulty trusting; they can be aggressive or hostile.

INSECURE ANXIOUS-PREOCCUPIED

• PARENT is:
  • unpredictable; sometimes loving, sometimes harsh or punitive, inconsistent. Sometimes overly involved, other times off in their own world.

• THE CHILDREN’S ATTACHMENT STYLE:
  • become anxious about the reliability of the parent for safety-protection; they are not easily soothed; ambivalence: they are sometimes clingy and possessive, sometimes angry-defiant. There is an internalization of anxious mom. There is a focus on others, not on self.

• INSECURE ANXIOUS ADULTS STYLE BECOMES
  • subject to abandonment fears; there is chronic vigilance about attachment-separation, there is emotional dysregulation and anxiety, passivity and lack of coping; there can be a victim stance.

PARENTING STYLE DISORGANIZED

• PARENT is:
  • even temporarily, is fragmented, disorganized, dissociated; or is frightening, bizarre, abusive, traumatizing to the child.

• CHILD’s attachment style can become Disorganized:
  • the child can become, even temporarily, helpless, paralyzed, fragmented, chaotic dissociated; they cannot focus; they cannot soothe.

• ADULT ATTACHMENT STYLE :
  • Experiences of disorganized attachment can lead to an Unresolved/Disorganized adult: there are difficulties functioning; they are unable to regulate emotions; there are dissociative defenses.

CHILDREN who are not securely attached/bonded as infants are limited in their ability to connect as adults.  These relationship deficits or ruptures result in pain.  The person is more prone to seek a CHEMICAL solution for a human/relational one to help resolve, sooth, “numb out” negative feeling states.  We turn to:

• Drugs, alcohol, gambling, sex, shopping, food etc…
  • Pseudo secure attachments
  • Gives the illusion of control due to personal fragmentation
  • Helps with chronic dysregulation due to a lack of impulse control, inability to self soothe without the chemical intervention.
  • Provides a FALSE sense of grandiosity
  • Feeds a lost “hunger” for a relationship (ie: attachment)  that the person never had or once had and lost.
  • A Chemical Mythology/drugs being the surrogate ideal, a substitute value.

• Because of the ultimate destruction and havoc drugs and alcohol addiction can cause we ultimately end up repeating our childhood attachment ruptures. i.e: the addiction that once worked to soothe (the false attachment) becomes the insecure attachment we had as children.  HISTORY REPEATS ITSELF.

THE RELATIONAL IS TRANSFORMATIONAL

• Early sobriety/MOST IMPORTANT SKILLS:
  • Abstinence from all mind-altering substances
  • TOLERATE YOUR AFFECT SOBER 

• THE REAL PAIN-KILLERS
  • Fellowship, individual trauma therapy, group therapy

• Creating new neural pathways vis a vis:
  • Empathy
  • Learning to FEEL to HEAL (problems with alexithymia)
  • Relational skills
  • New attachments for old problems
  • Impulse control
  • Mentalization or reflective function
  • Mastery of interpersonal problems, social inadequacies
  • Healthy narcissism

Dr. Aiello uses empathy, bonding and reflection to regulate fear, anxiety, shame and to soothe the firing amygdala in order for the patient to learn to self-sooth without mind altering substances and to learn how to self-activate for a more purposeful and secure life.  Sometimes for the first time, the patient feels a felt sense of himself and learns to do these things for himself and to create relationships through trial and error without needing outside sources (drugs, alcohol etc.) to accomplish their goals.

What is your attachment style?   http://dianepooleheller.com/attachment-quiz/

Trauma is defined as a deeply distressing or overwhelming experience that is commonly followed by emotional and physical shock. If left unresolved or untreated, traumatic experiences can lead to short and long-term challenges.

There is acute Trauma which relates to the witnessing or involvement in a particular event such as

• Car crashes or severe accidents or attacks
• Military combat
• Physical or sexual assaults
• Sudden deaths
• Natural disasters
• war or battle, assaults, sudden deaths, natural disasters etc.

The term Complex Trauma describes exposure to multiple traumas. It also refers to the impacts of that exposure and can include interpersonal or physical trauma from family of origin neglect. It is usually described as “trauma on top of trauma” multiple attachment ruptures generally formed around childhood but may include partner emotional abuse perpetrated over time.

Intimate partner trauma occurs when someone we depend on for survival or are significantly attached to such as a spouse or live in partner, violates our trust in a critical way. It can be a singular event or a series of events or betrayals perpetrated over time. Examples may include:

• Spousal betrayal such as affairs or sexual addictions
• Continued emotional or physical abuse from family members (Complex trauma)
• Financial betrayal