By Lee Vorderer
The Director of the Bedford VA, Dr. Joan Clifford, defines the aim of the Medical Center as serving the whole person who comes to the VA for services. This means looking at the whole health picture, offering a wide range of traditional and non-traditional physical and mental health care therapies as needed, and doing it with the Veteran as part of the team. (Click this link to read about upcoming Introduction to Whole Health events.) It means providing comprehensive outpatient services, extensive mental health services, and wide-ranging and cutting-edge geriatric and extended care services. Research plays a vital role in the VA’s activities, too, and we’ll examine some of that work throughout the series.
Although the VA is perhaps most known for its primary care and long-term care, its mental health services offer an extensive range of options for both inpatient and outpatient care. Transitional services, substance abuse treatment and support, and supported employment and education are among these. One of these services is the treatment for behavioral addictions, and this article looks into the Behavioral Addiction Clinic.
Many behavioral addictions, defined as a compulsion to engage in rewarding, non-drug related behavior despite its negative consequences, are common experiences of Veterans with mental illness, PTSD, and substance abuse. The Bedford VA offers a new approach to these Veterans through the Behavioral Addictions Clinic. For Veterans who are experiencing gambling addiction, online gaming or shopping addictions, eating addiction, and sexual addictions like computer pornography site trolling, the Behavioral Addictions Clinic uses mindfulness and self-awareness training to help these Veterans take control of compulsions that can have serious negative consequences to a Veteran’s physical, mental, social, or financial well-being.
Editor’s Note: The second in Lee Vorderer’s series of articles about the Edith Nourse Rogers Memorial Veterans Hospital (the Bedford VA) for The Bedford Citizen. Each will focus on one of the ways the hospital’s mission becomes a reality for those who have gone to war. (Click this link to read the first story in the series)
The Behavioral Addictions Clinic
The foundation of the behavioral approach used in the Behavioral Addictions Clinic is mindfulness: the awareness of what your body and mind are telling you about yourself. It’s the practice of staying in the moment, noticing or being aware of your feelings, your thoughts.
Under the direction of Dr. Shane Kraus, the Behavioral Addictions Clinic is the only outpatient clinic that offers a mindfulness approach for treating addiction in the Veteran’s network. Dr. Kraus describes the Veterans who seek the Clinic’s services as often at high risk for suicide; they are people whose situations and addictions have taken over their lives.
Vets may self-refer to the clinic or be referred by other clinicians (both mental health and physical health clinicians) in the VA network. Some data from those who seek services: About 90% are men, about 50% have a gambling addiction; about 30% have some sort of pornography or other sexual addiction; about 15% have some kind of eating problem. The Behavioral Addictions Clinic offers short-term treatment, usually, about 10-12 sessions. Upon successful completion of the program, the Veteran is able to start other types of treatment for other issues that are driving his life.
Mindfulness and Veterans
Think of mindfulness as learning how to be aware in a more comprehensive way of what your own body and mind are telling you. At the Bedford VA, the program begins with three weeks of one-hour long orientation sessions, during which the Veteran begins to learn what mindfulness means and appreciate that he or she is not alone in having addictions or in seeking help. During orientation, each Veteran begins to formulate a treatment plan that he or she will follow. Here’s an example of a basic exercise that helps people be more in touch with how they feel. It’s called a body scan. During the three weeks of orientation, each Veteran learns to focus on the whole body, one part at a time, starting with his/her feet, to see what’s going on. The Veteran notices where everything feels fine, where there might be pain, or where there is tension. The Veteran learns that over time, he or she will learn to analyze the pain or tension, to understand where it comes from, and how to respond in new, healthier ways to the pressure, pain, or tension. The Veteran decides whether individual therapy or group therapy would be more comfortable, and then the series of eight to twelve outpatient sessions begin.
Throughout the sessions, the Veteran learns how to better listen to what the body is saying, to what the mind is saying, and how to build alternative behavioral responses to the compulsions that he or she experiences. Meditation is introduced to help the Veteran respond to cravings, and the Veteran begins to recognize the compulsions he or she feels that lead to engaging in a non-rewarding behavior; all the Veterans begin to learn alternative responses that are healthy. They learn how to “sit with things”, to not seek instant resolution to cravings; they learn to understand what drives the cravings. A way to think about learning mindfulness is to compare it to developing a muscle. Exercising the muscle makes it stronger; in the same way, practicing mindfulness and self-awareness makes it that much easier to be aware of yourself and how you feel about yourself.
As important as the mindfulness training is, the orientation group (and subsequent therapy groups) provides a Veteran with a non-judgmental forum where he or she can express thoughts and problems. Everyone in the group is a peer; everyone knows what being judged in a negative way feels like, and everyone wants to avoid doing that to one another. What happens in this non-judgmental setting is that Veterans learn to let go of the self-judging that is one of the components of their addictions. When they are not self-judging, it becomes easier to ask for help and to do something with the help available.
The Veteran is an important member of the treatment team. He or she is encouraged to be specific about the goals to be achieved during the treatment from the Behavioral Addictions Clinic; those goals become the reference points for the course of treatment. Here’s a story: a Veteran came to the Clinic with a powerful addiction to gambling; he’d lost his home, his family, and most of his other connections to society. His goal was to beat this addiction, and after several weeks of mindfulness training and practice, he told proudly this story. He had purchased a cup of Dunkin Donuts coffee, with a peel-off free offer on the cup. When he peeled off his sticker, he didn’t get a free offer, and he immediately felt himself become tense and experienced the urge to go find somewhere right away to buy a bunch of scratch tickets. But he thought about some of the exercises he’d been working on. He slowed down and examined what he was doing and recognized the beginning of the problem he was working on. He intervened in his own urge. He didn’t buy the scratch tickets; instead, he told his therapist about how he stopped himself from one instance of gambling. He recognized some of the signs that his body gave him about his addictions and he used those signs to set a new course for himself. It marked a new direction for him, this small event, as he found a new way to deal with the tension that used to drive him to gamble.
About the Clinic
The Behavioral Addictions Clinic has a research component that has been active for about three years. Dr. Kraus and his post-doctoral Fellow, Audrey Johnson, have published findings from various studies at the Clinic; they have made presentations about the workings of the clinic and its outcomes for Veterans to other Veteran’s Hospitals around the country. The goal is for this approach to behavioral addiction to be offered in other locations so that more Veterans can benefit from the practices that have evolved here in the Bedford VA.
The Behavioral Addictions Clinic is an example of what Dr. Clifford, Bedford’s VA Director, describes as Veteran-Centric care. The idea is not that the Veteran directs all the care that is available; rather, that he or she makes an investment in whatever care is needed by making choices, and that investment is demonstrated in the commitment made by the Veteran to his plan of care, to the components of the plan, and in the commitment of other members of the team to the Veteran ‘s essential role of full team member.
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