Counselor - February 2016 Issue Preview

OPINION: ANCIENT DESIRES AND MODERN DAY SYMPOSIUMS

BEYOND THE GOOD-GIRL JAIL

BY SANDRA FELT, LCSW

PREVENTION: A FAMILY-CENTERED APPROACH FAMILY SYSTEMS TREATMENT Jan/Feb 2016

COLLEGIATE RECOVERY PROGRAMS: WHAT YOU SHOULD KNOW

Vol. 2 No. 1

2016 Industry

TREATMENT & RECOVERY

Forecast pg.4

INDUSTRY INSIDER

NAATP Weighs in

on

Medication-Assisted Treatment pg. 6 The Broken System Exposed by The Addicts Mom pg. 7

FLIP OVER

16th Annual Caron Gala pg. 10

Dr. Oz Leads The National Night of Conversati on pg. 1

Panel Addresses Legal Marijuana Concerns pg. 12

Urine Drug Tests: Treatment Professionals Issue White Paper pg. 2

February 2016 Vol. 17 | No. 1, $6.95

www.counselormagazine.com

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CONTENTS Letter from the Editor

34

By Gary Seidler Consulting Executive Editor

A Family-Centered Approach as Prevention for Substance Abuse

CCAPP

By Shirley N. Sparks, PhD, and Rosemary S. Tisch, MA

By Roland Williams, MA, LAADC, NCAC-II, CADC-II, ACRPS, SAP

The ICD-10 and the DSM-5 Made Simple . . . Kind of, Part I

Discusses prevention strategies and research for substance use disorders, and examines risk and protective factors.

NACOA

CoA Awareness Week

9 12

15

By Sis Wenger

Cultural Trends

42

Morrison’s Last Whiskey Bar, Part II

By Maxim W. Furek, MA, CADC, ICADC

Dissolving Fear: Changing the Way We Engage and Treat Wounded Family Systems

Opinion

By Kenneth Perlmutter, PhD

From Leo’s Desk

Explains family of origin issues, presents an in-depth look at enabling family beliefs, and discusses family-oriented treatment.

Ancient Desires and Modern Day Symposiums

Peer Recovery Support by Prison Correspondence

By Scott Korpik Topal, MSW, Chris Budnick, MSW, LCSW, LCAS, CSS, and William L. White, MA Describes a peer support program for incarcerated persons with SUDs, provides examples of correspondence between peers and inmates, and presents implications for counselors.

19

By Margaret A. Fetting, PhD, LCSW

It’s about You

21

By Rev. Leo Booth

Wellness

Aging and Wellness in Recovery, Part II

48

17

23

By John Newport, PhD

The Integrative Piece Life Doesn’t Happen to You, it Happens for You

25

By Sheri Laine, LAc, Dipl. Ac

Topics in Behavioral Health Care

26

Emotional Health and Well-Being in Recovery, Part II

By Dennis Daley, PhD

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3201 S.W. 15th Street Deerfield Beach, FL 33442-8190 Advertising Sales JAMES MOORHEAD Phone: (949) 706-0702 E-mail: jamesm@counselormedia. com

Director of Editorial Communications STEPHEN COOKE Phone: (800) 851-9100 ext. 222 E-mail: stephen.cooke@usjt.com Conferences & Continuing Education LORRIE KEIP Phone: (800) 851-9100 ext. 220 Fax: (954) 360-0034 E-mail: Lorriek@hcibooks.com Website: www.usjt.com Advisory Board ROBERT J. ACKERMAN, PHD, CHAIRMAN JOAN BORYSENKO, PHD RALPH CARSON, PHD TIAN DAYTON, PHD BOBBY FERGUSON DAVID MEE-LEE. MD DON MEICHENBAUM, PHD PETE NIELSEN, CADC-II CARDWELL C. NUCKOLS, PHD MEL POHL, MD MARK SANDERS, LCSW DAVID E. SMITH, MD

CONTENTS Research to Practice

Introspection: It Has Some Problems

28

By Michael J. Taleff, PhD, CSAC

Counselor Concerns Length of Treatment and Outcome

30

By Gerald Shulman, MA, MAC, FACATA

Substance Abuse in Teens Adolescent Alcohol Use: Still Spilling the Wine

The Power of Families to Influence Addiction Recovery: An Interview with Robert J. Meyers, PhD

By William L. White, MA

32

By Fred J. Dyer, MA, CADC

Ask the LifeQuake Doctor

33

Inside Books

72

Discusses Dr. Meyers’s involvement with the CRAFT intervention, the early state of the addiction field, and the importance of family to those in recovery.

From the Journal of Substance Abuse Treatment

By Toni Galardi, PhD

Beyond the Good-Girl Jail: When You Dare to Live from Your True Self

By Sandra Felt, LCSW

52

Characteristics of Students Participating in Collegiate Recovery Programs: Implications for Clinicians

Reviewed by Leah Honarbakhsh

By Alexandre B. Laudet, PhD

ALSO IN THIS ISSUE Readership Survey

Describes collegiate recovery programs (CRPs), analyzes a study on CRPs in nineteen US states, and discusses the results.

11

Ad Index

68

CE Quiz

70

62 Recovery Counseling: A New Paradigm for Alcohol and Drug Counselors

By Allen Berger, PhD Introduces the “addict self” and the “recovery self,” explains the self-dialogue intervention, and provides help for counselors in successfully administering the intervention.

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Counselor · February 2016

58

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LETTER FROM THE EDITOR

New Highs and legalization.

• Legal prescription drugs become a growing problem among older adults, and at the same time, prescription drug abuse by adolescents is considered the biggest drug epidemic of all.

So, is there any positive news in all of this?

The answer is yes. As a society, we are realizing and accepting that mental health conditions and addiction touch the lives of millions of Americans, that we need to transform the way these illnesses are treated in our health care system, and that we need to ensure that everyone gets the treatment and services they need.

It is difficult to argue with those who state that drug addiction is the biggest single social problem of our times. It is undeniable that the threat of both legal and illegal drugs, most especially those facing our youth and our elderly, have reached unprecedented proportions.

Certainly, the scrutiny of network, cable, and social media attention— often spurred by proclamations from political candidates—capture our attention. Movies, documentaries, TV specials, feature articles in newspapers and national magazines, and the worldwide web bombard us 24/7.

Consider just a few of last year’s headlines: • “Heroin in the Heartland,” as portrayed in segment of 60 Minutes, traces the geographic shift of unprecedented opiate use by teens.

• Marijuana poses new treatment challenges as states move toward commercialization, decriminalization,

With the media, criminal justice system, 2016 presidential candidates, parents, and community groups focused on all aspects of substance abuse, addiction, mental health, and recovery, the discourse fills the air like never before.

In addition, there are more encouraging signs from Washington, DC, like the following remark from President Obama, speaking at a community forum late last year on the prescription drug abuse and heroin epidemic (The White House, 2015):

Over the last few decades, we have learned what does not work. The “War on Drugs” doesn’t work. “Just Say No” doesn’t work. Criminalizing addicts doesn’t work.

We have also come to understand that addiction is a brain disease that threatens us all, regardless of age, race, gender or socioeconomic status. We now know that addiction, much more often than not, stems from childhood trauma of one kind or another.

As we enter a new year, it is encouraging to observe that we are finally coming to the inevitable conclusion that a human condition requires a humane response.

Gary Seidler

Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication References

The White House. (2015). Remarks by the president at community forum at east end family resource center. Retrieved from https://www.whitehouse.gov/ the-press-office/2015/10/21/remarks-president-community-forum-east-end-family-resource-center

Let’s face it, there is still shame, and fear and stigma that too often surround substance abuse that often prevents people from seeking the help they deserve. When people loosely throw around words like “junkie,” nobody wants to be labeled in that way, and part of our goal here is to replace those words with words like “father” or “daughter” or “son,” or “friend” or “sister,” because then we can understand that there is a human element behind this, this can happen to any of us, to any of our families. www.counselormagazine.com

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CCAPP

The ICD-10 and the DSM-5 Made Simple . . .

Kind of, Part I Roland Williams, MA, LAADC, NCAC-II, CADC-II, ACRPS, SAP

I

’m guessing that by now you probably heard lots of talk about the new International Statistical Classification of Diseases and Related Health Problems (10th edition), or ICD-10, and hopefully you’ve attended a training or two.

Unfortunately, many counselors have very little understanding about what the ICD-10 is and how it is going to affect the work that we do. The little bit that we have been hearing is frightening

since there is so much emphasis on the fact that “something” went into effect on October 1, 2015.

You also have probably heard that the Diagnostic and Statistical Manual of Mental Disorders (4th edition), or DSM-IV was updated a couple of years ago and that there were several changes made to the newest addition, the DSM-5 (2013). You may or may not have begun to understand those changes or

implement them in your clinical work.

And many of us are not sure how the DSM-5 and ICD-10 are related and what, if anything, we as treatment providers need to do differently.

So, in this first column of a two-part series, I am going to give an overview of the DSM-5. In my column in the next issue of Counselor, I will go over the ICD-10. I want to explain how they are connected and what it means to addiction counselors. I hope these columns provide enough information to get you hungry for more!

A Little Background

Several months ago I was asked if I would be willing to do a training on the ICD-10 and the DSM-5. Being the seasoned educator that I am—and in addition to having an overblown sense of confidence in my abilities—I cavalierly said, “Sure, I can put something together!” Little did I know that I was embarking one of the biggest training commitments of my twenty-nine-year career.

I was not prepared for the hours and hours of studying, writing, and researching that was to come. Just when I thought, “Okay, I think I’ve got a handle on this,” I would learn something new, someone would ask a question I couldn’t answer or correct something I said during a presentation, and then it was back to the office to update my presentation. My first two trainings were a disaster! I realized that I really didn’t know enough about the subject matter to stand in front of 125 people and try to explain it. My ego wouldn’t let me go out like that, so I dug in deep, studied my butt off, and as a result each of the several subsequent trainings and consultations have been better, as I have become quite comfortable with the material.

I say this because many of us don’t bother to really learn new information unless we have a very strong desire to 12

Counselor · February 2016

CCAPP learn and stay current, or unless we have to, and even when we have to, many of us learn just enough to get by. You still have the option to learn the DSM-5 when you get around to it, unless your organization or payer is insisting that you use the most current diagnostic criteria, but you do not have the option to not learn and understand the ICD-10 because as of October 1, 2015, providers are not paid if they submit charges using the old ICD-9 codes.

So let me tell you what all that means in the simplest and easiest terms. Mind you, this is not to assume that the reader is “simple” and unable to understand complex ideas and concepts; it’s actually easier for me to write how I talk, which is, I’m happy to say, “plain and simple.”

So first I’m going to talk about the DSM-5 and the changes that are most significant, in my opinion, to addiction counselors. I will also point you to several resources that you might find useful if you want to learn more about this material.

The DSM-5

The DSM-5, written and published by the American Psychiatric Association (APA), came out in 2013. It contains several changes in language, philosophy, diagnostic criteria, and the addition and elimination of several diagnoses that counselors and mental health professionals have been using for years.

In the US the DSM serves as a universal authority for psychiatric diagnosis. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.

Although it may not be mandatory for you to use this new manual, I would strongly suggest that you do.

DSM-5 Diagnostic Criteria 1. S ubstance often taken in larger amounts or over a longer period of time than intended (impaired control) 2. A persistent desire or unsuccessful efforts to cut down or control use (impaired control) 3. A great deal of time spent in activities necessary to obtain the substance, use it or recover from its effects (impaired control) 4. Craving, or strong desire or urge to use (impaired control) 5. Recurrent use resulting in failure to fulfill major role obligations at work, school or home (social impairment) 6. Continued use despite having persistent or recurrent social/interpersonal problems caused or exacerbated by use (social impairment) 7. Important social, occupational or recreational activities given up or reduced because of use (social impairment) 8. Recurrent use in situations which are physically hazardous (risky use) 9. Use is continued despite knowledge of having a persistent or recurrent physical/psychological problem likely to have been caused or exacerbated by use (risky use) 10. Tolerance: the need for markedly increased amounts of substance to achieve intoxication or desired effect, or a markedly diminished effect with continued use of same amount (pharmacological) 11. Withdrawal: a characteristic syndrome or use to relieve or avoid withdrawal (pharmacological) Notice that criteria one through four relate to use, criteria five through eight relate to behavioral issues associated with use, and criteria nine through eleven relate to physical/ emotional issues. Furthermore, clients can be diagnosed as having a severe SUD without having tolerance or withdrawal.

History and Revisions

The first version of the DSM came out in 1952 and was 132 pages. It used diagnostic terms like “idiot,” “moron,” and “imbecile.” Most notably, homosexuality was listed as a “sociopathic personality disturbance,” and homosexuality was not declassified as a mental illness by the DSM until 1973. So you www.counselormagazine.com

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CCAPP can see how, fortunately, thinking and language has changed.

New versions of the DSM come out on an average of every fifteen years— DSM-I (1952), DSM-II (1968), DSM-III (1980), DSM-IV (1994), and DSM-5 (2013). This current version is the first version to use the number five instead of the Roman numeral “V.” The reason for this is the expectation that there will be multiple updates, as in the DSM-IV– TR, and those will be labeled DSM 5.1, DSM 5.2, and so on.

Some of the biggest concerns about the DSM are whether psychiatrists are trying to pathologize what could be considered in some cultures “normal” behavior, and in other cases normalize pathological behavior. This leads to the following question: Who gets to determine at what point a different and odd behavior becomes a mental disorder?

Important Changes

One of the biggest changes to this manual is the switch from a blackand-white method of diagnosing to introducing the idea that most disorders fall across a continuum. In other words, it’s not whether or not you are depressed, but how depressed you are and at what point does it become a disorder. We’ve moved from a categorical approach to a dimensional approach to diagnosing.

They also realized that many of the diagnoses in the previous editions were actually different manifestations of the same diagnosis, so they group many diagnoses together under twenty different clinical “umbrellas” or categories. This is particularly important for addiction counselors because there is no more “substance abuse” and “substance dependence”; those diagnoses are combined and replaced with the diagnosis of “substance use disorder” (SUD). The belief is that the only difference between substance abuse and substance dependence is the severity.

Here are some bullet points of major changes: • “Recurrent legal issues” was eliminated from the diagnostic criteria due to cultural influences and variances and “cravings” was added.

• In the DSM-IV-TR you only 14

Counselor · February 2016

needed one of the criteria for a diagnosis of substance abuse, now you need at least two for a SUD diagnosis.

• They have eliminated the Axes I–V and now want clinicians to list the diagnosis without the Axes in the order of severity, and/or what has caused the client to seek treatment.

• There is no more GAF score, but check out the alternative, Google WHODAS 2.0, which is a very cool tool and much better than the GAF. • Hoarding disorder, gambling disorder, binge eating disorder, and marijuana and caffeine withdrawal are all new to the DSM-5.

• They eliminated the “bereavement exclusion,” meaning that now a person can be diagnosed and treated for depression even though they experienced a loss of a loved one within the previous sixty days.

• The term “mental retardation” has been eliminated and replaced with “intellectual disability.”

• For those of you who used V codes, they have been eliminated and replaced with the much more descriptive Z codes.

• There is a whole section in the DSM-5 that addresses the variances attributed to culture.

This section includes a “cultural formulation interview,” which offers several assessment questionnaires that can be used with many different populations.

• They are proposing significant changes in the way personality disorders are assessed and treated, and offer some new and interesting perspectives.

Of the twenty categories of disorders listed in the DSM-5, I am only going to speak in this article on substance-related and addictive disorders in detail.

SUDs are divided into ten separate classes of drugs, and you will now need to list each drug the person uses and describe it as mild, moderate or severe.

For example, clients might have stimulants use disorder (severe), alcohol

use disorder (severe), and cannabis use disorder (moderate).

The ten drug classes are as follows: • Alcohol • Caffeine • Cannabis • Hallucinogens • Inhalants • Opioids • Sedatives, hypnotics, and anxiolytics • Stimulants • Tobacco • Other (or unknown) substances There are eleven diagnostic criteria (see the text box on the previous page), but some classes of substances have only ten criteria. Clients must have two or more within a twelve-month period and must include a pattern of use leading to clinically significant impairment or distress to be considered. To interpret the symptoms, note that two to three criteria indicate a mild specifier, three to five indicate moderate, and six or more indicate severe.

Conclusion

You will be blown away about how much information is available on this topic. In my next column, I will tackle the ICD-10 and explain how it is different from the DSM-5. c Roland Williams, MA, LAADC, NCAC-II, CADC-II, ACRPS, SAP, the founder and CEO of Free Life Enterprises and VIP Recovery Coaching, is a world renowned addiction specialist, counselor, interventionist, lecturer, trainer, teacher, author, and consultant. He has been passionately working in substance abuse treatment since 1986.

References

American Psychiatric Association (APA). (2013).

Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

NACOA

CoA Awareness Week Sis Wenger

P

atrick Kennedy spoke of the “conspiracy of silence” in alcoholic families and the pain and confusion such rigid silence causes family members.

His 60 Minutes interview on October 4, 2015—following the publication of his book, A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction—was a call to end the silence within affected families. Ending that silence is important so the children, who are the first hurt in addicted families and the last helped, can be offered the gift of recovery that is being treasured and celebrated today by over 20 million Americans.

The family recovery message is seen at the UNITE to Face Addiction rally in Washington, DC in October 2015. Photo courtesy of Faces and Voices of Recovery.

When is CoA Awareness Week and What Happens?

This awareness week (February 14–21) is always honored during the week in February in which Valentine’s Day falls. It has been officially declared by governors over the years and, in recent years, the week has been declared by the Mayor of Boston. It is the catalyst for multiple educational activities, including poster contests in schools and celebrations across this country and internationally by NACoA’s fortytwo affiliate organizations and by prevention programs, treatment centers, NCADD and many of its affiliates, and increasingly by recovery community support programs associated with Faces and Voices of Recovery. This year the Recovery Month theme will, for the first time, include a focus on family recovery.

There are social media campaigns, references in faith communities, and prayers for the silent young victims. In 2014, there were eighty-seven individual public awareness activities reported across Germany. In Great Britain, teenage CoAs sat at bus stops holding signs about the needs and solutions to help CoAs in their country. Each year, the Hazelden Betty Ford Center’s children’s program in Texas hosts a reunion day celebration on the Sunday that begins CoA Awareness Week. Children who

have gone through that supportive education recovery program in previous years, and their family members, often numbering five hundred to seven hundred, come together to celebrate that children can also recover and thrive.

It is a day of gratitude for the gifts of hope and recovery for children even as young as six or seven years of age.

Every awareness activity helps to break the silence and offers hope to the affected children and to the caregivers who are trying to help them.

Reasons Why We Have CoA Awareness Week One in four children lives in a family being torn apart by alcohol or drug abuse or active addiction.

Over thirty-five years ago, Claudia Black taught us the rules that still trap CoAs in their fear and painful silence: don’t talk, don’t trust, don’t feel. Treatises have been written about the ramifications of

these developmentally and psychologically damaging rules over the ensuing years. The chronic emotional trauma that too frequently grows from following those rules during a child’s life fosters mental health problems, increases the rate of adolescent depression and suicide, impairs intimate relationships in adulthood, and increases separation and divorce.

All of this puts our children at risk, yet they become such experts at keeping the family secrets believing that they are the only ones who live this way.

Caring adults can change the course of a child’s life.

Healthy ACoAs will often say, “There was my fifth grade teacher who believed in me and was always available for support,” or “It was the pastor who reached out and encouraged me and who provided a feeling of safety and love in the church,” or “It was my grandmother, throughout my entire www.counselormagazine.com

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NACOA growing-up years.” But most adults— from pediatricians to teachers to the neighbor next door—are still more comfortable following the “conspiracy of silence” which teaches young and teen CoAs that they are alone in their pain and that no one else will understand.

They keep their silence along with 25 percent of their classmates—all living in emotional isolation and fearful of what going home will bring.

Judges can take the first step to initiate dramatic change in countless addicts and their family members.

Drug courts and family dependency courts that refer drug-using and alcoholic offenders to programs of treatment and recovery support, with strong sanctions, see great reductions in relapse and recidivism. When they require whole-family educational recovery support, such as the evidence-based Celebrating Families!, rates of successful family reunification are doubled and the time of the children’s separation from their parents is halved. Too often the offenders and their partners are both “yesterday’s children” that no one helped when their parents were drinking, drugging, and involved in family violence. Courts are helping to break the generational transmission of addiction, and the silence that fosters it, helping to set the stage for the beginning of generational recovery in the family.

The science is clear.

Growing up in an addicted family creates varying levels of emotional and personal damage to developing children to such an extent that it was deemed the greatest public health problem in research published in the American Public Health Association Journal (Grant, 2000) and claimed again in the findings of the CDC/Kaiser Permanente Adverse Childhood Experiences (ACE) study in recent times (2014). To intervene in the cascade of assaults on defenseless children that alters their brain and psychic development should be a national imperative.

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Counselor · February 2016

Knowledge and validation of their reality begins the healing process for these children.

Program tool kits like the Children’s Program Kit, developed by NACoA for SAMHSA ten years ago and which has been updated and enhanced and will be introduced again this month, provide the activities and curriculum to break the family rules in safe and enjoyable learning activities. Such programs help affected children to understand that it is not their fault, that they are not alone, that they cannot stop their parents from drinking, and that they can learn how to have a good life even if their parents continue to use. They develop this understanding with others who are struggling with the same problems and feel validated. The Kit is designed for educational support groups to help the children of clients in addiction treatment and recovery support programs, for schools to offer age-appropriate educational groups in student assistance programs or for classroom use, and for camps that have offered such education and support groups.

Many people are unaware of how much alcohol is too much.

Parents who drink excessively often don’t realize that their children know, even if they think they are hiding it from them. They need to learn how much is harmful to them and to their children.

Sober parents need to become aware of the impact their spouse’s addiction has on their children.

Neighbors need to know that there are children next door who live in hidden chaos caused by parental drinking.

CoAs need to be invited to participate in the life of the neighborhood. They need neighbors who say something if they see something and who help the children to feel special and important.

CoAs should be welcomed to witness how healthy families interact.

Children need to know that there are people in school that they can trust with their secret.

However, they can’t know that unless there are posters, pamphlets, support programs, and clear school policies

and statements that there are people who can help.

Clergy need to know that young members of their congregation are suffering in silence.

They need education about addiction, about its destruction of spiritual life in the family members as well as the addict, and that they have the power to change the lives of many families in their congregations just by expressing concern. Clergy can support and encourage education programs for the congregation, beginning with CoA Awareness Week.

Aunts and uncles know that their brother or sister is alcohol dependent. They may not know how their nieces and nephews struggle each day to appear normal.

They should learn about appropriate interventions for their sibling and help support them. In addition, they can be the lifesaving adults for their nieces and nephews, helping them to name their truth and get the support they need from other meaningful adults. They can locate and provide transportation to Alateen meetings to facilitate recovery.

CoA Awareness Week is a gift that keeps on giving so long as those who care make sure that personal support is given, programs get established and are available, and adults learn that keeping the silence when the child does is harmful. Clarity and validation are powerful. When we help to break the silence, we can see these boys and girls go from children at risk to children of promise. They have an intrinsic right to that promise. c Sis Wenger is NACoA’s President and CEO.

References

Centers for Disease Control and Prevention (CDC). (2014).

ACE study: Major findings.

Retrieved from http://www. cdc.gov/violenceprevention/ acestudy/findings.html Grant, B. F. (2000). Estimates of US children exposed to alcohol abuse and dependence in the family.

American Journal of Public Health, 90(1), 112–26.

CULTURAL TRENDS

Morrison’s Last Whiskey Bar, Part II Maxim W. Furek, MA, CADC, ICADC

I

n my previous column in the December 2015 issue of Counselor magazine, I wrote about The Doors frontman Jim Morrison’s rise to fame, his growing alcoholism, and the obscenity trial that took place in Miami, FL. This is the second and final part of the twopart series on Morrison.

His Legacy

Fans and music critics sadly watched as a bloated and wild-eyed Jim Morrison continued on a path of self-destruction.

He had been one of the most charismatic performers of his time before the disease of alcoholism redefined what he had become. Now the singer was viewed in terms of sad, pathetic, and unfortunate.

In a way, none of the criticism mattered because his legacy endures.

Among the twelve Doors albums, ten are of either gold or platinum status, an indication of their musical prowess and popularity. An additional phase of the band’s evolution came when their song “The End” was included in the film Apocalypse Now (1979). Directed

by Francis Ford Coppola, Apocalypse Now was a popular Vietnam War epic adapted from Joseph Conrad’s novella Heart of Darkness. “The End” was the perfect soundtrack, ominous and foreboding, played against a chaotic background of napalm explosions and military gunships. The song was used in the opening sequence and during the killing of Colonel Kurtz. The 1979 film was nominated by the Academy Award for Best Picture and did much to resurrect the music of Morrison’s band, eight years after his death.

To their credit, Morrison’s lyrical delivery draped in the heady interplay of Ray Manzarek’s innovative keyboards and Robbie Krieger’s psychedelic guitar riffs worked magnificently. The unique sound blended into a musical style that is still revered and emulated by contemporary groups. Although Morrison’s theatrical, leather-clad persona was a

palpable attempt to reinvent himself, he couldn’t decide on a singular identity.

A conflicted Morrison anointed himself Lizard King, rock-poet, and shaman, assimilating many of the influences that drove his music and poetry. Those eclectic influences included writer Aldous Huxley. Morrison named his group after Huxley’s The Doors of Perception (1954), which investigated the mystical properties of mescaline. Here, Huxley borrowed from William Blake’s quotation, “If the doors of perception were cleansed, everything would appear to man as it is: infinite” (1954). Other themes appropriated by Morrison came from Carlos Castaneda and his revelations about Yaqui Indian sorcerer Don Juan; Freudian concepts of sex, death, and transcendence; and a musical delivery that coupled and intertwined with the progressive electric blues.

Morrison also borrowed from writerpoet Jack Kerouac, spokesperson for the Beat Generation and author of On the Road (1957). The Kerouac mythology

suggested that On the Road was written over a nonstop, three-week, benzadrine-fueled marathon—another dubious endorsement of the Beat’s drug culture. Kerouac referred to himself as a “religious wanderer” and a “Dharma bum,” but was later christened a “shamanistic visionary,” a term that Morrison later assumed (Lelyveld, 1969). Kerouac died at age forty-seven, hemorrhaging blood, the result of lifelong alcoholism and the disease that claimed both men.

The End of the Road

LA Woman (1971) was The Doors’ final LP for Elektra Records. On this album, rougher and less encumbered than previous studio efforts, the group demonstrated more artistic control, as a disenchanted Paul Rothchild had left and former engineer Bruce Botnick stepped in as producer. It would be the last hurrah as the band, having squandered their potential, watched a dejected Morrison self-destructing. www.counselormagazine.com

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CULTURAL TRENDS Ray Manzarek, who cofounded the band along with Morrison, witnessed the decline: Before LA Woman [Jim’s self-abuse] hadn’t yet affected his literary output or sense of songwriting. It had affected his health. We had a little confrontation at one point and told him he was drinking too much. He was like, ‘I know, man. I’m trying to quit.’ We were like, ‘Okay, just call us and let us know.’ But he didn’t quit.

Maybe he’d quit for a few days, but by the end of the week, it was like ‘Geez, I need a drink’ (Weiss, 2012).

Jim Morrison ran away from his band to Paris, where he believed his poetry would be better received. But inside his head, he might have heard the old AA saying: “No matter where I go, there I am.” It was true. Morrison began his Paris adventure right where he left off. According to his official biography, “Lunch started for Jim with two Bloody Marys, and then he ordered a bottle of Chivas Regal scotch. An hour later he was drunk and insulting a tableful of French businessmen in a language they blessedly did not understand” (Hopkins & Sugerman, 1995).

The singer’s end was a sad one.

Morrison never returned home to his bandmates. His cold body was discovered by girlfriend and common-law wife Pamela Courson in a bathtub in their apartment at 17 Rue Beautreillis. He died, it was initially stated, of an apparent heart attack on July 3, 1971. No autopsy was performed, thus leaving many doubts and questions regarding his death. News of his passing was not made public until after he was buried in Paris’ Pere Lachaise cemetery on July 7, 1971. It was a small ceremony without fanfare, newscasts or paparazzi.

Courson was one of only a few individuals who actually witnessed his corpse. She died of a heroin overdose three years later (Cherry, 2012).

Miami and Paris represented his inevitability. Miami was that “incident that wrenched his grip from whatever credibility he still clung to, and the exhausting obscenity trial . . . further sapped his flagging energies. Not long afterward—overweight, muddled, and 18

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dissolute—Morrison retreated to Paris to die a lonely death of heart failure in his hotel bathroom” (Seay & Neely, 1986).

Morrison’s death followed in the distressing wake of his personal idols and fellow luminaries—Elvis, Hendrix, Joplin, Kerouac. It was a funeral procession for too many of our greatest talents. At least one associate believed that the Lizard King simply lost his way, or lost sight of who he really was. The Doors’ lead guitarist Robby Krieger observed, “I think a really big superstar, who’s always in the public eye, always sort of on the edge, is really living for us all. He’s not living for himself anymore” (Mann, Smith, & Forbes, 1981).

Factual accounts of his death became a mystery of sorts. William Siddons, The Doors’ press manager, sidestepped the controversy and stated the death was not reported to the public “to avoid all the notoriety and circus-like atmosphere that so surrounded the deaths of Janis Joplin and Jimi Hendrix” (Fong-Torres, 1971). Some asserted that Morrison faked his death, and still lived. The Poet in Exile (2002), a novel by ex-Doors’ keyboardist Ray Manzarek, cryptically implied that the Lizard King had beaten his demons and was alive and well.

Provided the right circumstances and support, he could have been alive today.

The Doors’ drummer John Densmore believed in that truth. He wrote, I’ve been asked over and over again if Jim had lived in a time period like today, with our current knowledge of alcohol as a disease and so many substance abuse clinics and AA programs, would he have survived?

I always say, ‘No, he was a kamikaze.’

But with the advent of Eric Clapton and now Eminem becoming clean and sober, I can see that it might have been possible. After all, if a guy as angry (and talented) as Eminem can title his new CD Recovery, maybe Jim could’ve made it (2013).

Lyrically “The End” was the most important contribution that Morrison offered to the world and perhaps the exact words he muttered to his band mates as he walked away. “This is the end / My only friend / the end / Of our elaborate plans / the end / Of everything that

stands / the end / No safety or surprise / the end / I’ll never look into your eyes / Again my friend” (Morrison, Krieger, Manzarek, & Densmore, 1967). c Maxim Furek, MA, CADC, ICADC, is the director of Garden Walk Recovery and a researcher of new drug trends. His book The Death Proclamation of Generation X: A Self Fulfilling Prophesy of Goth, Grunge, and Heroin is currently being used in classrooms at Penn State University and College Misericordia. His rich background includes aspects of psychology, mental health, addictions, and music journalism. His forthcoming book, Celebrity Blood Voyeurism, is a work in progress. He can be reached at jungle@epix.net.

References

Cherry, J. (2012). Pam Courson dies April 25, 1974.

Retrieved from http://www.examiner.com/ article/pam-courson-dies-april-25-1974-1 Coppola, F. (Producer & Director). (1979). Apocalypse now [Motion picture]. San Francisco, CA: Omni Zoetrope.

Densmore, J. (2013). The Doors: Jim Morrison’s legacy on trial. Charleston, SC: CreateSpace.

The Doors. (1971). LA woman [LP].

Annapolis, MD: Elektra Records.

Fong-Torres, B. (1971). James Douglas Morrison, dead at twenty-seven. Rolling Stone. Retrieved from http://www.rollingstone.com/music/features/ james-douglas-morrison-poet-dead-at-27-19710805 Hopkins, J., & Sugarman, D. (1995). No one here gets out alive. New York, NY: Warner Books.

Huxley, A. (1954). The doors of perception.

London, England: Chatto & Windus.

Kerouac, J. (1957). On the road. New York, NY: Viking.

Lelyveld, J. (1969). Jack Kerouac, novelist, dead; Father of the Beat Generation. New York Times.

Retrieved from https://www.nytimes.com/ books/97/09/07/home/kerouac-obit.html Mann, R., Smith, L. (Producers), & Forbes, G. (Director).

(1981). Jim Morrison: No one gets out of here alive [Motion picture]. London, England: Eagle Rock Entertainment.

Manzarek, R. (2002). The poet in exile: A novel.

New York, NY: Thunder’s Mouth Press.

Morrison, J., Krieger, R., Manzarek, R., & Densmore, J. (1967). The end [Recorded by the Doors]. On The Doors [LP]. Annapolis, MD: Elektra Records.

Seay, D., & Neely, M. (1986). Stairway to heaven: The spiritual roots of rock ‘n’ roll. New York, NY: Ballantine.

Weiss, J. (2012). Surviving Doors members speak on Jim Morrison’s substance abuse. LAWeekly. Retrieved from http://www.laweekly.com/music/surviving-doors-members-speak-on-jim-morrisons-substance-abuse-2401843

OPINION

Ancient Desires and Modern Day Symposiums Margaret A. Fetting, PhD, LCSW

M

any of us like the experience of being intoxicated, and that desire creates enjoyment for most, problems for some, and devastation for a few. As a global citizen, I’ve become enriched by alternative attitudes of thinking about our relationship with alcohol and other drugs (AODs), our enjoyments, and our troubles.

Consequently, I have undergone an energetic evolution in my philosophical and clinical approach to substance use and its disorders since writing my first textbook, Perspectives on Addiction, six years ago. At that time, I began living and working in Europe, and this resulted in my developing a broader conceptualization of the place of drinking and drugging in our lives, including more flexible responses to problematic or excessive use.

The European approach to drinking piqued my curiosity, which led me to study the place of alcohol in ancient Greek culture. What I discovered was enlightening and seemed a particularly useful perspective for challenging some of the rigidity that exists in the field today. In the rough-andtumble of polemics and politics, we have lost an appreciation of the basic fact that human beings like to escape consciousness and reality with the help of AODs. This desire is neither sinister nor sinful, and its excesses are not necessarily pathological. Help or assistance with problems can be convivial and, at the same time, exact responsibility for our countenance.

Other forces influencing my evolution in thinking include the following developing perceptions: • That we have overvalued the prevalence of true addiction in this country and undervalued the universal desire to escape reality with AODs • That as a culture we seem to have compulsively adopted the disease model of thinking and are having a hard time accepting and integrating more wide-reaching, inclusive, and flexible approaches • That we have underappreciated the fact that people will naturally have problems managing something so pleasurable and have oversold the universal prescription of abstinence for all nature of problems Subscribe today • That we have neglected and save 20%! to integrate the thinking and experiences of other parts of the world that have decidedly different orientations

toward alcohol, drugs, pleasure, and excess • That we have not yet linked the rising rates of addiction with our individual and cultural attempt to self-medicate anxieties generated from the impact of our twenty-four-hour globalized world As long as I can remember, I have been passionately curious about our ancient desire for relief and relaxation, as well as escape from human discomfort with AODs. During the last two and a half decades of clinically practicing, teaching, and writing in the SUD field, I have become equally intrigued by our disregard of history, specifically our ancient civilizations’ appreciation of both the human necessity for a “spirited” release as well as the human necessity for education on the management of these potent pleasures. Reconnecting to our earliest appreciations and concerns about the elixirs may make room for a perspective that allows us to step away from our cultural obsession with searching for pathology in our AOD habits.

If we return to the ancient Greek days of the fifth and fourth centuries BCE, we find that Greek philosophers such as Socrates, Plato, and Aristotle laid the foundations for what would become Western culture, and that the young and inexperienced learned about the pleasures and disciplines of drinking in the convivial and educational environment called the “symposium.” This word means “drinking together,” but also implies a specific form of communal drinking that forges bonds around drinking’s shared pleasures and escapades, and allows neighbors to discover each other’s opinions on subjects from the serious to the banal

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OPINION (Lynch, 2007, p. 247). Plato said that the proper forum for young adults to learn to “tipple wisely” was in this symposium, a formal but hospitable drinking party with precise etiquette and an abundance of strict rules about the number of guests, the ration of water to wine, and how to set a limit on the quantity to be consumed (Gately, 2009, p. 14).

Drinking alcohol was seen as ordinary, natural, safer than water, and a right belonging to each individual. The Greeks considered wine to be a gift to humanity, having great potential powers including pleasure, chaos, and madness (Allhoff, 2007, p. 25). The symposium was considered the appropriate place for exploiting the pleasures of wine while minimizing the risks. Philosophers in the symposium led discussions designed for exploring people’s “felt sense” of their values, ethics, and responsibilities about their drinking patterns and habits. A major topic of Greek ethics was pleasure, and early Greeks were careful to separate enjoyment from indulgence (Gately, 2009, p. 15–25).

Let us take a stroll through more of the ancient vocabulary used in and around the symposiums. “Ordinary passions” were referred to as healthy devotions, habits or preoccupations that took place in ordinary societies, families or communities of people. The Greek word for the drinker, philopotes—literally, a “lover of drinking sessions”—bore no stigma. As drinking was an inherently pleasurable activity, it was understandable that people would want to indulge in it as much as possible, and those who succumbed too often did not do so out of dependency, but rather from an inability to resist an entirely natural impulse. They were considered weak, not wrong (Gately, 2009, p. 15).

Philopotes—or likely today’s conceptualization of misusing or problem drinkers—were encouraged to harness this natural power through gentle drinking, always mixing their nectar with water; taking a break or temporary temperance; adhering to the rules of moderation; using wine to facilitate one’s goals, not hinder them; and avoiding intoxication, particularly when suffering from yesterday’s hangover. The symposiums thought that the consumption of unmixed wine was not only uncivilized, but also perilous (Gately, 2009, p. 14–5).

Philosophers of the symposiums believed that the philosophical doctrine of temperance promoted healthy drinking habits. These ancient philosophers bequeath an important caveat to our contemporary treatment providers: “Deciding what constitutes temperate or moderate drinking for any particular individual, however, is a fact-intensive and individualized inquiry that depends on a number of complex factors” (Allhoff, 2007, p. 76–7). For Plato, temperance meant subordinating the desire for pleasure to the dictates of reason, using will and discipline to avoid overindulgence and indiscriminate drinking. The doctrine of temperance is closely related to the concept of balance. Balance occurs naturally when an individual is interested in other things besides intoxication. It is the stable state between the extremes of overindulgence and abstinence (Allhoff, 2007, p. 1–65). No wars were waged during these early drinking days—neither a war on drugs nor a war on human desire.

Socrates used the term “master passions” to describe 20

Counselor · February 2016

the very small minority of people who regularly and destructively use in excess. People under the tyranny of their passions are those who are consumed with wine and its abundance. The loss of dignity, respect, and love; the loss of work and income; and the loss of psychological and physical health are some of the devastating repercussions that follow. The life of a person ruled by a master passion is a life in ruins. These descriptions are likely similar to the Centers for Disease Control and Prevention study that found that 30 percent of the population were excessive drinkers, and approximately 3 percent of the population were truly dependent on alcohol (CDC, 2014).

People of master passions seemed unable to benefit from the ancient symposiums’ cautions, behavioral suggestions, and wisdoms. These lovers of drinking were not able to achieve temperance. Were they slaves of impulsivity, characterologically weak, captured by a lifestyle or devoted to sensual pleasures? Hippocrates, the father of Western medicine, decisively responded to this question: “Should a patient be suffering from an overpowering heaviness of the brain [mind], then ‘there must be total abstinence from wine’” (Gately, 2009, p. 13).

Hippocrates’s early and simple admonition for abstinence for the small number of heavy-minded drinkers has much to teach us today about the unique, distinctive, and highly idiosyncratic selection of abstinence as a way of life.

His words suggest that some of us may need abstinence not because of an uncontrollable disease or brain disorder, but because of unbearable, nameless suffering in a human mind that will never be satisfactorily soothed by drink. These individuals live with an unquenchable thirst in search of relief.

Just a handful of treatment centers currently exist across the country that embrace the philosophies, concepts, and Acknowledgements: This work is adapted from Perspectives on Substance Use, Disorders, and Addiction (SAGE, 2015). Reprinted by permission of Sage Publications, Inc., Los Angeles, California. All rights reserved.

Margaret A. Fetting, PhD, LCSW, creator of workshops certified by the California Board of Behavioral Sciences for prelicensure and continuing education credits, has presented to nearly 300 organizations on substance dependence and abuse, personality disorders, and adults molested as children.

Fetting has been teaching at the USC School of Social Work since 1989 and holds concurrent faculty positions at other institutions of higher learning around Southern California.

References

Allhoff, F. (2007). Wine and philosophy: A symposium on thinking and drinking. Hoboken, NJ: Wiley-Blackwell.

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author Centers for Disease Control and Prevention (CDC). (2014). Most people who drink excessively are not alcohol dependent. Retrieved from http:// www.cdc.gov/media/releases/2014/p1120-excessive-driniking.html Fetting, M. (2012). Perspectives on addiction: An integrative treatment model with clinical case studies. Thousand Oaks, CA: Sage.

Gately, I. (2009). Drink: A cultural history of alcohol. New York, NY: Gotham Books.

Lynch, K. M. (2007). More thoughts on the space of the symposium. The British School of Athens Studies, 15, 243–9.