fine tuning recovery
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Fine Tuning Recovery
Moving Toward a Wellness Model in the Treatment of AddictionsAddiction Studies Institute 2014
Steven J. Rendina, MTS, LICDC, LMT, ADS
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Presented by: Steven J. Rendina, MTS, LICDC, LMT ADSwho practices tuinaChinese medical
massage and teaches qigongfor healingto numerous recovery groups andclasses in the Columbus area.
He has been a counselor and educatorin the addictions field for over 20 years.
Clinical Developer for the House of Hope
Adjunct faculty at Columbus StateCommunity College and the University ofCincinnati
www.finetunehealthcare.com
http://www.finetunehealthcare.com/http://www.finetunehealthcare.com/ -
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Fine Tuning Recovery - Outline
Explore the growing use of holistic, naturopathic, andtraditional Chinese medical principles and theirtherapeutic application in the treatment of substance use
disorders.
A model for wellness - optimizing healthful living - will becompared with the generally accepted medical/diseasemodel.
Practical clinical applications and original research will bepresented.
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Recent studiestend to supportthe idea that
addiction is abrain disease
with markedchanges in thephysiologicalfunction of thebrainnotunlikephysiological
changes to theheart thatcan bemeasured inheart disease
patients.www.drugabuse.gov
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When compared to other chronic illnesses that involvesome type of behavioral management or self-care, relapseratesor a return to active symptomsare similar.
www.drugabuse.gov
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Premise
If addictions are diseaseprocesses at workcanthey not also be treatedas other chronic
diseaseswith basicchanges to improvehealth including propernutrition, adequateexercise, rest, sunlight,fresh air, plenty ofwater, and stressreduction techniques?
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What are some relevant principles of
Naturopathic Medicine? Naturopathic medicine is a distinct primary health
care profession, emphasizing prevention, treatment,and optimal health through the use of therapeutic
methods and substances that encourage individualsinherent self-healing process.
The practice of naturopathic medicine includesmodern and traditional, scientific, and empirical
methods.
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59
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What are some relevant principles of
Naturopathic Medicine?Treat the Whole Person:
Naturopathic practitioners treat each patient by takinginto account individual physical, mental, emotional,genetic, environmental, social, and other factors. Sincetotal health also includes spiritual health, naturopathicphysicians encourage individuals to pursue theirpersonal spiritual development.
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59 -
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Prevention:
Naturopathic practitioners emphasize the prevention ofdisease by assessing risk factors, heredityand susceptibility to disease, and by makingappropriate interventions in partnership with theirpatients to prevent illness.
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59
What are some relevant principles of
Naturopathic Medicine?
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59 -
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The Healing Power of Nature:
Naturopathic medicine recognizes an inherent self-healing process in people that is ordered andintelligent. Naturopathic physicians act to identify andremove obstacles to healing and recovery, and to
facilitate and augment this inherent self-healingprocess.
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59
What are some relevant principles of
Naturopathic Medicine?
http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59http://naturopathic.org/content.asp?pl=16&sl=59&contentid=59 -
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Whole Person
Holistic medicine is a form of healing that considers thewhole person -- body, mind, spirit, and emotions -- inthe quest for optimal health and wellness. According tothe holistic medicine philosophy, one can achieve
optimal health -- the primary goal of holistic medicinepractice -- by gaining proper balance in life.
What are some relevant principles of
Holistic Medicine?
http://www.webmd.com/balance/guide/what-is-holistic-medicine
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Interdependent/Balanced
Holistic medicine practitioners believe that the wholeperson is made up of interdependent parts and if onepart is not working properly, all the other parts will beaffected. In this way, if people have imbalances(physical, emotional, or spiritual) in their lives, it cannegatively affect their overall health.
What are some relevant principles of
Holistic Medicine?
http://www.webmd.com/balance/guide/what-is-holistic-medicine
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Naturopathy and Holistic Medicine
Natures Seven Doctors
Sunlight
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Naturopathy and Holistic Medicine
Natures Seven Doctors
Fresh Air
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Exercise
Naturopathy and Holistic Medicine
Natures Seven Doctors
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Rest
Naturopathy and Holistic Medicine
Natures Seven Doctors
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Clean Water
Naturopathy and Holistic Medicine
Natures Seven Doctors
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Whole Nutrition
Naturopathy and Holistic Medicine
Natures Seven Doctors
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Quiet/Relaxed
Mind
Naturopathy and Holistic Medicine
Natures Seven Doctors
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Chinese Medicineis a holistic
philosophy ofhealing and carethat looks at thehumanrelationship
within nature
What are the relevant principles of TCM?
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Qialso known aschi, ki, prana,universal lifeforce, vital
energy, ruachorspirit, breath oflifeit is the ein the formulae=mc2
What are the relevant principles of TCM?
The Chinese character for qi is the image of steamarising from a pot of rice cooking over an open fire
It is the invisible force that is present in all things
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Yin and Yang
The energy of qiis expressedin a dynamic ever-changinginteraction of thecomplementary forces of yinand yang. Some of theseyin/yang polarities include darkand light, cold and warm,
night and day, female andmale, lifting/sinking,
expanding/contracting, etc.
What are the relevant principles of TCM?
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Addiction from the perspective ofChinese medicine
Empty Fire
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Addiction from the perspective ofChinese medicine
Chinese medical theory is based on the conceptof yin and yang, which are dynamic andcomplementary opposites observed in all the
processes of nature.
In a healthy individual, yin and yang are inrelative balance. Addicts often suffer from adeficiency of yin.
Steve Phillips, L.Ac.
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Addiction from the perspective ofChinese medicine
Chinese medical theory, which comprehendsthe body metaphorically, relates yin tosubstance (being centered), quiescence (innerpeace), and the element of water (able to
flow).
Yang relates to function (sense of purpose),activity (doing as opposed to being), and the
element of fire (passionate intensity).Yinnourishes, and yang consumes.
Steve Phillips, L.Ac.
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Addiction from the perspective ofChinese medicine
When yin, or the water element, is deficient,fire is not held in check and rages out ofcontrol.
Since it is the product of a deficit, it is calledempty firebecause it has no substance tofuel it. On a psychological level, such an
imbalance creates feelings of emptiness anddesperation.
Steve Phillips, L.Ac.
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Addiction from the perspective ofChinese medicine
Physiologically, it manifests as frenetichyperactivity. The addict is driven to useand abuse, but the drug exacerbates the fire
and further depletes the yin; hence, thefeeling of power he or she gains isexaggerated and merely temporary, leading toeven more desperation.
Steve Phillips, L.Ac.
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Putting out the fire of addiction
The goal or intention of anapproach to addictiontreatment using ChineseMedicine is toput out thefire
Increasing the level of
inner calm, yin energy iscrucial to the effectivenessof this recovery process
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The Generally Accepted Medical Model
Medical proceduresinclude a diagnosis, atreatment plan, and aprognosis.
Drug therapy is the mostcommon treatmentapproach.
Medical model is criticizedfor labeling (diagnosing)and "imposing" treatmenton individuals.
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American Society of Addictive Medicine - ASAM
New Public Policy Statement: Definition of Addiction
Addiction is a primary, chronic disease of brain reward,motivation, memory and related circuitry.
Dysfunction in these circuits leads to characteristicbiological, psychological, social and spiritualmanifestations.
This is reflected in an individual pathologically pursuingreward and/or relief by substance use and otherbehaviors.
http://www.asam.org/DefinitionofAddiction-LongVersion.html
http://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.html -
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American Society of Addictive Medicine - ASAM
New Public Policy Statement: Definition of Addiction
Addiction is characterized by inability to consistentlyabstain, impairment in behavioral control, craving,diminished recognition of significant problems with onesbehaviors and interpersonal relationships, and adysfunctional emotional response.
Like other chronic diseases, addiction often involvescycles of relapse and remission.
Without treatment or engagement in recovery activities,addiction is progressive and can result in disability orpremature death.
http://www.asam.org/DefinitionofAddiction-LongVersion.html
http://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.htmlhttp://www.asam.org/DefinitionofAddiction-LongVersion.html -
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Harm Reduction and ReplacementTherapies
The medical model is moving in the direction ofHarm Reduction and Replacement Therapies
not unlike medical approaches to other types ofchronic illness
Suboxone, methadone, chantrix, etc
Needle exchanges, Moderation management
Patches, e-cigarettes
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New brain scan studies are showing that behavioraltreatments (i.e., psychotherapy) and medications worksimilarly in changing brain function. So addiction is a
brain disease that can be treated by changing brainfunction, through several types of treatments.
* Adapted from Myths of Addiction. Carlton K. Erickson, Ph.D., University of Texas Addiction Science
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Stop and Think!
The medical and replacement approachhas caused much controversyforexample: must we continue to give opiatereplacements on a long-term basis ratherthan as a short-term aid to detoxification?
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WellnessOptimizing Health
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WellnessDefined
Wellness is much more than simply an absenceof illness and/or disease. Wellness is a proactiveand preventativeapproach thats designed to
provide optimum levels of health, emotional andsocial functioning.
http://wellnessproposals.com/wellness-articles/definition-of-wellness/
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WellnessDefined
Wellness involves our recognition that we havepsychological, physical, spiritual and social needs
that are necessary for us to have higher levels offunctioning.
http://wellnessproposals.com/wellness-articles/definition-of-wellness/
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WellnessDefined
Wellness emphasizes the whole individual. Its
the integration of the spirit, body and the mind;and the understanding that everything we do,feel, think and believe has a direct impact onyour state of health.
http://wellnessproposals.com/wellness-articles/definition-of-wellness/
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The wellness model is moving in thedirection of prevention and holistic care
http://www.nationalwellness.org/?page=Six_Dimensions
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Why Wellness is Essential to Recovery
Repairing damage to mind and body
Safeguarding against relapse
Replacing negative behavior and anchoringclients in their recovery
Promoting quality sobrietyand helping clientsADD DECADES to their life expectancies!
Dr. John Newport http://www.wellnessandrecovery.com/
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How A Wellness Lifestyle Can HelpPrevent Relapse
Helps anchor clients in their recovery,reinforcing their commitment to clean and soberliving.
Helps safeguard against relapse during earlyrecoverywhen mind and body are mostvulnerable.
Fosters resiliency needed to deal with lifes upsand downs, without having to turn to drugs.
Dr. John Newport http://www.wellnessandrecovery.com/
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Alcoholism and Nicotine asCo-Addictions
Cigarette smoking is the LEADING CAUSE OFDEATH for people in recovery!
Between 80-95 percent of Alcoholics smoke cigarettesand 70 percent are heavy smokers
Many alcoholics/addicts carry their Nicotine Addiction
with them into recovery, although the majority reportthat they would like to quit!
Dr. John Newport http://www.wellnessandrecovery.com/
http://blog.kerrygaynormethod.com/3-of-the-most-common-excuses-for-smoking-debunked/
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http://blog.kerrygaynormethod.com/3 of the most common excuses for smoking debunked/
Many of the pioneers of twentieth century addiction treatment and
recovery mutual aid societies died of smoking-related disordersincluding the co-founders of AA
Bill W. (emphysema) Dr. Bob S. (cancer)
-White, W. (2011). Smoking and addiction recovery. For people in recovery. Posted at www.williamwhitepapers.org
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Perhaps we should see the continued acceptance of
tobacco use in drug and alcohol treatment for whatit isanother harm reduction/replacement therapy
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Your Clients Have a CHOICE
Addiction vs. Recovery
Quality of RecoveryCarrying a toxic lifestyleinto their recoveryOR Reaping the benefitsassociated with High Level Wellness(WellnessIllness Continuum)
Dr. John Newport http://www.wellnessandrecovery.com/
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Dean Ornisha model for otherchronic diseases
For more than 30 years,Dr. Dean Ornish hasdirected a series of
scientific research studiesshowing, for the first time,that the progression ofeven severe coronaryheart disease can often be
reversed by makingcomprehensive lifestylechanges.
http://www.pmri.org/lifestyle_program.html
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A very low-fat diet including predominantly fruits,vegetables, whole grains, legumes, and soy products intheir natural, unrefined forms
Moderate exercise such as walking, tai chi, qigong
various stress management techniques including yoga-based stretching, breathing, meditation, and imagery
enhanced love and social support, which may includesupport groups.
http://www.pmri.org/lifestyle_program.html
Dean Ornish - Program
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Dean Ornish - Program
These studies also documented that other chronicdiseases may be reversible simply by makingcomprehensive lifestyle changes.
These findings are giving millions of peopleworldwide new hope and new choices, options thatare more caring and compassionate that are also
more cost effective and competent.
http://www.pmri.org/lifestyle_program.html
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Lets apply a version of theDean Ornish program to recovery
http://www.mentalhealthmn.org/be-informed/mental-health-resources/wellness-and-recovery-resources
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Fine Tuning Recovery atthe House of Hopes Wellness Center
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What is Stress?
Life would be a daily grind of repetition, therewould be no ups or downs, no joy orsorrow, no excitement or vitality.
And ultimately, death is the occasion when allstress stops and we are flat lining. Noheartbeat, no respiration, no brain activity.
When we stress somethingit literally means to put an emphasis on it.
Without emphasis, for example speech patterns would be a boringmonotone.
Music would be without any dynamics, no tension or relief, it would
evoke no emotion or feeling.
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What is Stress?
We need stress in our lives to make them meaningful, enjoyable,challenging, and vital. Since stress is truly a part of life, our healthis dependent on our ability to manage stress, and to reduceunnecessary or excessive stressors.
Robert Sapolsky, in his highly acclaimed book Why Zebras Dont Get
Ulcers
describes a process in human life where the stress responsefight or flightbecomes a chronic condition rather than amomentary experience as experienced by wild animals.
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What is Stress?
It is this chronic excess that produces a physical and mental overloadwhich contributes to disease, depression, and destructive anddistorted patterns of coping.
Our stress management becomes crucial to whether we are healthy orsick.
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Managing Stress
When stressors build uppressuresfrom work, family, school, etc. -we need effective means tomanage those pressures. Astension builds, the weakest aspectsof ourselves are vulnerable andreach a breaking point. The samedynamics that work in the physicalnature of things can also beapplied to the psychologicalpressures that we feel.
In the linked video, the forces ofnature applied to the weakestpoints of this bridge cause it tocollapse.
http://www.youtube.com/watch?v=j-zczJXSxnw
http://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnwhttp://www.youtube.com/watch?v=j-zczJXSxnw -
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Relapse as a stress relief process
Relapse can often best be understood in the context of aninternal process, creating stress and tension,
which leads up to a need for resolution
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Managing Stress
Flexibility- the ability to bend without breaking becomes a critical
skill in learning about stress management.
If I have two sticks, one dry and the other green, when I applypressurethe dry one snaps while the green one bends withoutbreaking.
The dry wood is dead and breaks easily, the green wood is alive andflexible.
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Effective Stress Management
Many effective stress management techniques are thus focused on
increasing vitality and flexibility. Exercise systems such as yogaor tai chi and qi gong are excellent examples.
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Qigong as harmonizerbreath-body-mind
3 tunings: breath, body, mind Breathing Methodslow,
deep, smooth, even, fine,round, natural/relaxed
Postural Correctionfinepoints of standing, sinkingweight, lifting bones
Heart-Mind Intentcalm,empty, quiet, alert, aware,open, present, non-
judgmental
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What is Qigong?
Fluid Dynamics of Weight Shiftingtheocean within
Walking Dynamicsthe redwood tree andthe water strider
Three CsCircularity, Continuity,
Complementarity
Repetitionsnines
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What is Qigong?
70% ruletake it easy, build results slowly overtime (pain = no gain)
100 days to changeneuroscience confirms,neural networks grow
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Contraindications
It is best to avoid doing vigorous qigong exercise if one is feelingweak or ill. Breath work and use of meditation and healing soundswhile lying or sitting may be all one can do until strength returns.
It is possible to feel faint or weak after practice while one is buildingstrength and health. Nausea from exertion and holding posturestoo long for one's current level of vitality may also occur.
Muscles may become sore from being used in new ways. Take iteasy if need be. Avoid exercising in cold drafts or excess heat.Keep hydrated. It is best to avoid practice right after eating.
Practice is often best in the morning as a foundation for the day butmay be done at any time. Rarely, a person will develop obsessiveor compulsive desires to overdo it. If you have such tendencies, bereasonable.
It may be necessary to find a teacher who understands the 70%rule. Be aware of your own limitations. If you experience pain,modify or avoid the specific exercise. Stay in tune with yourself.
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Benefits of Qigong for Recovery
Negative, resentful, and self-critical thinking can get inthe way of recovery. Qigong practice can help theindividual cultivate a more positive, uplifted frame ofmind.
You may find that the early days of sobriety are like anemotional rollercoaster. Additionally, one of the mainobstacles to achieving long-term recovery is to developemotional stability. Qigong grounding and centeringexercises can help to manage volatile moods and buildself-control.
Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/
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Benefits of Qigong for Recovery
Anger and stress resolution as well as problem-solvingskill building each are enhanced through the mind-body-breath harmonies found in regular qigong practice.
Addicts tend to suffer from low self-esteem and feelingsof shame. Regular practice of the qigong principle ofmind-intent helps to develop a sense of mastery overones own body with the mind, bringing improvedconfidence and self-esteem.
Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/
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Benefits of Qigong for Recovery
One fairly common and unpleasant symptom for addictswho have stopped using is mental fog. Regular qigongpractice helps to improve mental clarity and focus.Practicing qigong exercises, breath-work, self-massage,and self-care routines can also help develop a normalsleeping pattern.
Triggers and cues to alcohol or drug use can bemanaged through the self-discipline of regular qigongpractice. Cravings can be reduced or re-directedthrough the principles of relaxation, sinking, and letting
go that are central to many of these qigong exercises.
Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/
U f t bl l t h i l t f
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Uncomfortable, unpleasant physical symptoms ofwithdrawal and issues of un-medicated physical andemotional pain can be eased through specific qigongpractices.
When people are active in addiction they typically havecaused significant damage to their health. Qigong helpsrestore physical vitality and promotes healing of thebody. Specific qigong exercises are directed towardpromoting healthy functioning of all internal organsincluding lungs, heart, liver, kidneys, and digestion.
Boredom can be a problem for people in early recovery,and it is a common reason for why certain peoplerelapse. Developing balance, patience, and self-disciplineadd to a meaningful life in sobriety helping the individualto keep things in perspective and avoid relapse.
Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/
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Benefits of Qigong for Recovery
Those who are newly sober will likely need to distancethemselves from drinking or drugging friends. Qigongpractice groups offer a good opportunity to socialize andmeet new people. Support networks themselves are
beneficial for strengthening and healing.
Following a spiritual path can provide one with apurpose in recovery. Qigong meditations and breathing
exercises can be good tools to strengthen the spiritualwarrior.
Revised from: http://alcoholrehab.com/alcohol-rehab/qigong-for-addiction-recovery/
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Original Research OutcomesPre-Session - UNIVERSAL PAIN ASSESSMENT TOOL
AlertSmiling
No HumorSerious / Flat
Furrowed BrowPursed Lips
Holding Breath
Wrinkled NoseRaised Upper LipRapid Breathing
Slow BlinkOpen Mouth
Eyes ClosedCrying
Moaning
No Pain Can Be Ignored Interferes WithTasks
Interferes WithConcentration
Interferes WithBasic Needs
Bed Rest Required
0 1 2 3 4 5 6 7 8 9 10
Circle the number that best fits your experience
E l R h O t P i
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Early Research Outcomes - Pain
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8 9 10 11 12 13 14
PainPre
PainPost
Pre Session Pain compared to Post Session Pain
290 total Pre 189 total Post
35% decrease in Perceived Pain
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Original Research OutcomesPre-Session PERCEIVED ANXIETY / STRESS
Calm / PeacefulAt Ease
Mild WorryConcern
Mild Stress
Tense / AnxiousNervousWorried
FrustratedPressuredRestless
Angry / UpsetEdgy
Losing Control
PanickyOverwhelmedOut of Control
No Anxiety or Stress Able to Relax Interferes WithThoughts
Interferes WithActions
Interferes WithHealthy Coping
Unmanageable
0 1 2 3 4 5 6 7 8 9 10
Circle the number that best fits your experience
E l R h O t A i t
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Early Research Outcomes - Anxiety
Pre Session Anxiety compared to Post Session Anxiety
325 total Pre 152 total Post
53% decrease in Perceived Anxiety/Stress
0
5
10
15
20
25
30
35
40
45
50
1 2 3 4 5 6 7 8 9 10 11 12 13 14
AnxietyPre
AnxietyPost
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Sample exercises and programming
Cravings and Urge Surfing Meditation
Self-Massage and Joint Mobilization forDrug-free Pain Management
Five Animals for Mood and Stress Management
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Cravings and Urge Surfing Meditation
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Cravings and Urge Surfing Meditation
Working through triggers and urges to usealcohol, drugs, or tobacco can be like riding awave.
Instead of fighting the urgelearn to ride it out.
Waves come and gothey rise to a crest thenbreakwhen they reach the shore, they losetheir energy and disappear.
If you can learn to ride out your cravings, theytoo will soon pass.
Qigong standing practice gives you a simplemethod to manage your energy, develop self-control, patience, and the confidence to defeataddictive craving and compulsion.
C i d U S fi M dit ti
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Cravings and Urge Surfing Meditation
Be Centered - The breath is
fundamental to our life process.When we are born, we must takeour first breath to stay alive. Ourfinal act before death is to take
our last breath. So breath is whatconnects us to life, and it is ourmost readily available tool to useto effectively change our mental,emotional, and even physicalstate. Use deep, slow, evenbreaths into your abdominal corea process that helps us to keepcentered.
C i d U S fi M dit ti
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Cravings and Urge Surfing Meditation
Be Grounded - Aligning ourposture so that our spine islengthened and the headlifted, while simultaneously
sinking the weight of thebody into the feet andground is a consciouspractice that helps us feelmore rooted, more solid, less
easily swayed by distractionsand the opinions of others.We become moregrounded.
C a ings and U ge S fing Meditation
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Cravings and Urge Surfing Meditation
Be Uplifted - keeping our mind
free of distractions,complications, and worryallows for the developmentof a more positive outlook
on life, we develop thefeeling of being uplifted.This is reflected in the waywe carry ourselves:confident, comfortable, andfully conscious of ourcapacity to be well. Feeluplifted.
Standing Practice
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Standing Practice
Find the balance!
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Practice, Practice, Practice
Be Prepared- by tuning the mind, breath, andbody - one becomes able to handle stressorsmore effectively. But this only works withpractice. Emergency responders, the firemenwho rush into a burning building practice theirdrills until the actions become a natural part of
them, in a crisis they can act without havingto think cautiously of each next move.
It is the same for you. Become a trained firemanwho can put out the fire of addiction. Onceyou have practiced these fundamentals forseveral months, it becomes second nature toyou. When a crisis or challenge hits, you don'thave to calm yourself, you remain calm,because that is where you live.
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Next time
Benefits of massage for recovery
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