Counselor - August 2016 Issue Preview

THE SHRINKING SOUL: AN EXAMINATION OF THE EATING DISORDER ADDICT

INSIDE BOOKS: THE PERFECTION DECEPTION

JOHN BRADSHAW Remembered

EATING DISORDERS & FOOD ADDICTION YOGA THERAPY CANNABIS DEPENDENCE Vol. 2 No. 4

Jul/Aug 2016

CARA: Cautious Optimism pg. 2

The Meadows Joins

TREATMENT & RECOVERY

Forces with Sunspire Health pg. 3

Recovery: A LongTerm Journey pg.

4

Testing Matters pg.

very: The Rhythm of Reco hwell Dr. Andrea G. Bart Leads the Way pg. 6

10

Industry Trends pg.

11

The Legal Beat pg.

12

INDUSTRY INSIDER FLIP OVER

The Meadows Joins Forces with 3 Sunspire Health pg.

THERAPEUTIC BENEFITS OF COLORING pg. 48

August 2016 Vol. 17 | No. 4, $6.95

www.counselormagazine.com

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Caron.org/Proven-Treatment ©2016 Caron Treatment Centers

CONTENTS Letter from the Editor

30

By Gary Seidler Consulting Executive Editor Cover photo by Carl Studna

To Abstain or Not Abstain: What to Do When Eating is Out of Control

CCAPP

New CCAPP President Takes the Reigns in the “Wild West”

NACOA

Provides definitions for “food addiction” and “craving,” describes abstinence-based and moderation-based models, and discusses treatment options.

The Time for the Family Has Finally Arrived

36 Yoga Therapy for Eating Disordered Patients

By Sarahjoy Marsh Discusses the benefits of yoga therapy for clients with eating disorders, lists the foundations of yoga that help with mindfulness, and provides exercises for clinicians to use with clients.

Revisiting the Cannabis Debate

Addresses obesity and food addiction as related to addiction, presents an overview of eating disorders from the DSM-5, and describes treatment options.

14

By Maxim W. Furek, MA, CADC, ICADC

Opinion

The Shrinking Soul: An Examination of the Eating Disorder Addict

18

By Hillary Goldsher, MBA, PhD

From Leo’s Desk

Spiritual Principles, Part I

20

By Rev. Leo Booth

Wellness

By Kevin Wandler, MD, CEDS

12

By Sis Wenger

Cultural Trends

Food Everywhere and Not Enough to Eat: Food Addiction and Eating Disorders

10

By Sherry Daley

By Ralph E. Carson, LD, RD, PhD

44

8

The Obesity Epidemic Poses a Threat to Wellness in Recovery

21

By John Newport, PhD

The Integrative Piece Choosing Happiness

23

By Sheri Laine, LAc, Dipl. Ac

Topics in Behavioral Health Care

24

The Focus is on Synthetic and Opioid Drugs, but What About Drug X? Part I

By Dennis C. Daley, PhD

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3

ARTICLE REPRINTS AVAILABLE. Educate your audience and reinforce your product message with an article reprint from Counselor. Providing a valuable and appreciated take-home resource directly to your audience, reprints are an effective tool to get your message across and carried home from conferences, meetings or lecture halls.

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President & Publisher PETER VEGSO Consulting Executive Editor GARY S. SEIDLER Managing Editor LEAH HONARBAKHSH Director of Editorial Communications STEPHEN COOKE Advertising Sales JAMES MOORHEAD Art Director LARISSA HISE HENOCH Production Manager GINA JOHNSON Director Pre-Press Services BILLY NELSON Managing Editor LEAH HONARBAKHSH Phone: (800) 851-9100 ext. 211 or (954) 360-0909 ext. 211 Fax: (954) 570-8506 E-mail: leah.honarbakhsh@ counselormagazine.com

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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 Counselor Concerns Is Addiction Really a Disease?

26

By Gerald Shulman, MA, MAC, FACATA

Ask the LifeQuake Doctor

By Toni Galardi, PhD

Inside Books

The Perfection Deception

By Jane Bluestein, PhD

29

50 The Recovery School Movement: An Interview with Andrew Finch, PhD

By William L. White, MA

72

Reviewed by Leah Honarbakhsh

Discusses Dr. Finch’s early career, the history of recovery schools, and the importance of gathering research in the future.

ALSO IN THIS ISSUE Ad Index CE Quiz

69 70

From the Journal of Substance Abuse Treatment

56 Can Continued Check-Ups Following Treatment for Cannabis Dependence Improve Outcomes?

By Denise D. Walker, PhD, Claire E. Blevins, MS, Lauren Matthews, MSW, Kelsey E. Banes, MS, Sheri L. Towe, PhD, Robert S. Stephens, PhD, and Roger A. Roffman, DSW Describes a study on aftercare for weed-dependent patients.

62 Understanding and Treating Cannabinoid Addiction

By Cardwell C. Nuckols, PhD Examines the effects of cannabinoids on the brain, explains long-term effects of use, and provides information on how to treat cannabis addiction.

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Counselor · August 2016

LETTER FROM THE EDITOR

Remembering John Bradshaw “John was a very friendly man who wanted to share his life of recovery in order to help others. He did have his detractors who claimed that his theories were not sound and that his approaches to working with people were not evidence based.

True or not, he had a gift to touch people in a way that gave them hope and ways to improve their lives. It was a talent and he used it well. His contributions to the fields of addiction and behavioral and mental health will not soon be forgotten. I will miss seeing him.” —Robert J. Ackerman, PhD, author of Perfect Daughters, Silent Sons circuit and several joined our family of authors.

Suffice it to say that I had never experienced anything quite like being up close and personal with John Bradshaw.

He was on fire with an almost evangelical zeal. He was mesmerizing. Most compelling, and what I will remember most, was John’s humaneness and authenticity.

Although he had already

J

ohn Bradshaw wore many hats, and most of them fit quite well: theologian, scholar, selfhelp guru, evangelist, pop psychologist, best-selling author, orator, adult child, counselor, recovering addict, and my personal favorite, the pied piper of recovery.

I first met John in 1987 when I attended a talk he gave on toxic shame in a packed church auditorium in Fort Lauderdale, FL. Instantly, I knew we (i.e., Health Communications, Inc.) had found our next best-seller. It had been ten years since Peter Vegso and I started our publishing company and we had already been blessed with our first New York Times best-seller, Janet Woititz’s Adult Children of Alcoholics (1983).

During these early years, I was privy to hearing some wonderfully talented and skilled speakers on the conference 8

Counselor · August 2016

made his mark, most notably with his first PBS television series, Bradshaw On: The Family, he had not yet—fortunately for us—been snapped up by one of New York’s publishing giants. So, as a direct result of that first “Bradshaw sighting,” HCI published his first two mega-bestsellers: Bradshaw On: The Family (1988) and Healing the Shame That Binds You (1988). Together with Homecoming: Reclaiming and Championing Your Inner

Child (1992), these classics taught us that toxic shame is the fuel for all addictions; that until “adult children” of dysfunctional families healed their “inner child,” most would stumble through life, expressing their pain through self-destructive behaviors, and entering into unhappy love relationships with similarly damaged partners, each hoping to find in the other a loving, approving parent.

Bradshaw’s appeal stemmed in part from his own account of his life. He rose from poverty and a traumatic childhood with an abusive alcoholic father and a dysfunctional mother.

He had known addiction—to sex and alcohol—and broken family relationships. Everything he wrote about he struggled with himself.

He once said he regarded his role as similar to that of a priest. “If the priestly work is to bring hope and comfort to people, then in that sense I believe I am one. Everywhere I go people walk up to me and say, ‘You changed my life.’”

You changed my life, John Bradshaw. You will be missed but never forgotten.

Gary Seidler

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

REMEMBERING JOHN BRADSHAW

"One of the last Renaissance Men of the twenty-first century."

His son, John Jr., recalled, “Part of his charm was he was totally authentic. He revealed the worst and the best of himself.”

A gifted academic, Bradshaw had planned to join an order of Catholic priests known as the Basilian Fathers.

Instead, shortly before his ordination,

O

ur field lost a true giant with the passing of John Bradshaw on May 8, 2016.

John Bradshaw did not coin the terms “inner child” or “dysfunctional family,” but the motivational speaker and self-help icon of the 1970s and 1980s popularized them through his best-selling books and popular television programs.

On his own website, Bradshaw acknowledged being born in 1933 into a “troubled family” and abandoned by his alcoholic father. He later became an academic standout but had his own struggles with alcohol and drugs.

John Bradshaw is survived by his wife Karen Ann and his son John Elliot Bradshaw Jr., and daughter, Ariel Harper.

“John was an inspiration to us all and was one of the last Renaissance Men of the twenty-first century. He had a unique ability to synthesize complex psychological concepts and reframe them so we could understand and integrate them into our daily lives. John made the world a better place to live and we will really miss him.” —Jim Dredge, CEO of The Meadows

“Millions of people have had their lives profoundly impacted by John’s work.

His style of presentation both in his public speaking and his books spoke to people’s heart and soul and truly led to transformative changes. Having shared what we call the journey of “being on the road” and being a part of a social movement, it is still the personal time I will hold most dear.

The John I knew was a kind, incredibly bright, loving, verbose, and very funny man.

He was ‘one of a kind’ and the world is a better place because of him. RIP Johnny Bradshaw.” —Claudia Black, PhD, director of the Claudia Black Young Adult Center he returned to Houston and taught Sunday school there, used his education to practice as a therapist, and began speaking at Alcoholics Anonymous meetings.

In the mid-1970s, Bradshaw starred in a national PBS series called Bradshaw On: The Family.

He authored several bestsellers, including Healing the Shame That Binds You (1988) and Homecoming: Reclaiming and Championing Your Inner Child (1992), which explored the “child within.”

While the self-help craze eventually subsided, Bradshaw continued working—giving programs, speaking at conferences, and writing books on topics like post romantic stress disorder, a term he coined. For over twenty years, Bradshaw was affiliated with The Meadows in Wickenburg, Arizona as a senior fellow.

But he was also a lot of fun, his son recalled. “He would often come home and grab a carton of Blue Bell ice cream from the freezer. He’d just sit there and eat it. When you’re a kid and you have a dad who’s so unrestrained—almost childlike himself—it was often a lot of fun.”

“He was a big personality in everything he did.” c www.counselormagazine.com

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CCAPP

New CCAPP President Takes the Reigns in the “Wild West” Sherry Daley

I

t is a simple goal: make treatment better in California. Achieving that goal in the state with the nation’s largest and most diverse addiction treatment system is where it gets less simple.

Undaunted by the objective before her, Lori Newman, CADC-II, brings to her CCAPP presidency a defined set of objectives to move California forward on this mission. CCAPP’s nine-point plan, crafted by a strong executive committee and energetic board, sets the course for success during her presidency.

“Having a destination is key to arriving at one,” said Newman. “It gives us the ability to measure our progress at every step of the way and to stay on track in California’s sometimes chaotic environment,” she added.

Newman credits the consolidation of CAADAC and CAARR in 2014 for boosting the organization’s power in California. “We have been one organization for over a year now. Let’s take this opportunity to really reflect on what that means,” stated Newman.

She continued by saying, We now have one incredible voice that was only made possible by our efforts to come together. Our voice can be heard across California.

When we meet with legislators, we carry with us the entire treatment perspective; we speak with knowledge and with strength, but most importantly with experience— experience that can help policy makers make good decisions. It is our time to be proud of that knowledge and to share it wherever we can.

Newman is optimistic about the future of addiction treatment in the state and the potential for CCAPP members to affect change: 10

Counselor · August 2016

CCAPP Nine-Point Plan 1.

2.

3.

4.

5.

6.

7.

8.

9.

Residential fee rollback and PED issues Professionalize and lead peer support movement Lead and collaborate with insurance provider benefit assignment laws Improve Medi-Cal reimbursement/ODS Improve professional recognition via licensure and workforce development Influence legislative policy related to the prevention, education, and treatment of marijuana use Introduce legislation to support certification of small outpatient programs (SOPs) Collaborate with SLN on Sober Living (SLE) bill requiring registration Work with the state for new regulations

I know a lot of you and I’m not worried in the least that you won’t let your voices be heard. California has awakened to the need to expand and improve addiction treatment.

Legislators need to hear from you because you have the knowledge to help them in making the goals of more and better treatment come to fruition.

Furthermore, she sees strength in numbers for the organization as opportunity to reach goals that each organization had separately worked toward for years: As a united organization we can create legislation, like SB 1101, which will finally license alcohol and drug abuse counselors like they are in other states. As a united organization, we will see that any legislation that attempts to kick treatment out of neighborhoods or seeks to keep people from maintaining their recovery is killed.

She continued by stressing that, “We are the solution, not the problem. We

will continue to encourage this legislature and this administration to make the right choice when it comes to making treatment accessible, available, and on demand.”

In addition to expanding the quality and quantity of addiction treatment in California, Newman draws an impenetrable line in the sand when it comes to taxing substances that contribute to addiction: As a united organization, we will demand that the legalization of any new drug pays for its impacts on addiction. We fought and won the battle to earmark $650 million dollars of marijuana tax revenue to addiction treatment—without ever promising to support the initiative one way or the other. We are seeking to amend bills that call for the taxation of medical marijuana to make them pay their fair share as well. We are battling legislative budget subcommittee members to compel them to provide addiction treatment expansion monies to meet the growing demand for services created by the Affordable

CCAPP Care Act and California’s 1115 Waiver, and we are working tirelessly to raise reimbursement for treatment providers and raise wages for addiction counselors.

Newman’s chutzpah is backed by her board’s carefully constructed nine-point plan (see the previous page).

Newman sees great progress being made as CCAPP heads for its mid-year mark for 2016. Bills CCAPP supports are progressing and those it opposes are failing. CCAPP’s licensure bill, SB 1101 (Wieckowski) passed its first policy committee on a sixteen to zero vote with favorable support from the addiction treatment community. Four bills aimed at addressing unregulated sober living environments in California were introduced this year. AB 2772 (Chang) failed April 19 in the Assembly Committee on Public Safety, receiving only a few votes, and SB 1283 (Bates) failed in the Senate Committee on Health on April 27. Two bills remain active in the Legislature: AB 2403 (Bloom), which CCAPP opposes, and AB 2255 (Melendez), which CCAPP supports.

CCAPP is advocating for legislators to approve legislation that encourages voluntary certification of recovery residences over mandatory restrictions that have proven to be contrary to the Americans with Disabilities Act and federal fair housing laws. “We take pride in offering workable solutions to improving sober living standards, rather than pitting local governments against legitimate providers,” said Newman.

CCAPP is also actively pursuing state grant funding for treatment capacity expansion throughout the continuum of care. Two bills of particular interest are AB 2243 (Wood) which proposes to tax medical marijuana and distribute the revenue to various state agencies, and AB 1915 (Santiago) which would create grants or loans for residential treatment centers which are expanding services.

AB 1915 would establish the Residential Treatment Facility Expansion Fund, a continuously appropriated fund, and would transfer $120,000,000 from the general fund to residential treatment.

The bill was amended late and did not meet legislative deadlines for passage to the second house, but opportunities

for inclusion in other bills still exist.

“I am pleased with the depth and breadth of our legislative program in just our second year of operation,” said Newman. “We are making tremendous inroads in multiple areas that are important to our members,” she added.

In addition to a robust legislative program, Newman will be at the helm as the organization continues to increase its statewide presence. Plans for 2016 include: • District trainings in ethics and test prep • Executive roundtables in each district. This presents an opportunity for programs to meet and share recommendations and solutions; a place for CCAPP executives to turn ideas into action.

• M onthly teleconferences; the last Thursday of every month, CCAPP takes the pulse of its program members in an open conference call.

• CCAPP representation at events across the state and the nation.

CCAPP President Lori Newman, CADC-II, has twelve years of experience in the alcohol and other drug field. Ms. Newman is currently the executive director of a private nonprofit company that operates a men’s twenty-one-bed residential social model facility and a women and women/children fifty-bed residential social model facility. Her experience in social model programs range from being a resident herself, an alumni, and professionally has been as a volunteer, counselor, and program manager. Ms. Newman is currently a board member of the Merced County Alcohol/Drug Advisory Board, the California Association of Recovery Resources, and the Board for Certification of Addiction Specialists.

Ms. Newman’s dedication and willingness to serve makes her a dynamic advocate for social model recovery. c Sherry Daley is in charge of external affairs for counselors and marketing for the California Consortium of Addiction Programs and Professionals (CCAPP).

She is also a freelance writer from the Sacramento area.

With plans in hand and the support of her board, Newman says that success can only be achieved with the enthusiasm and excitement of the members.

“All of you give me tremendous faith . . . tremendous faith that 2016 is going to be our best year ever,” said Newman.

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NACOA

The Time for the Family Has Finally Arrived Sis Wenger

T

hroughout the year, every year, there are weeks and months dedicated to raising awareness about serious aspects of alcohol and drug use disorders. Why so many?

Advertising tells us that average people need to get the same information at least seven times—and from various sources—before it becomes engrained their psyches. It is also well known that the primary “educator” of young people about alcohol comes from the alcohol industry in the form of enticing advertising. Young people and their parents need to receive accurate and engaging education from credible sources in order to counter the very powerful social influence that the alcohol industry exercises over our young people and indeed over our society at large. This is why we have the need for special weeks and months to arm parents and other caring adults with the information and tools they need to protect the health, safety, and success of our youth.

that it is no longer acceptable to help only the addicted person to find recovery. The family members who have suffered in silence and sadness for too long deserve to recover as well!

September

October

September is National Recovery Month.

For the first time in twenty-six years of celebrating and strengthening public awareness about the transformational nature and breadth of recovery, this year’s theme is focused on family recovery. Finally, in legislation and in federal and state program policies, and in increasing numbers of treatment programs across the nation, wording demonstrating concern for those affected by another’s addiction is being added, such as “. . . and impacted family members, including the children.”

This September’s celebration of Recovery Month offers clinicians and advocates alike a public platform to remind clients and collaborating professionals 12

Counselor · August 2016

In October, early education about living a drug-free life through the Red Ribbon Campaign, which is sponsored by the National Family Partnership (NFP), begins the positive messaging children and youth need, from multiple credible sources, to help them make the decision not to use any alcohol, tobacco or other drugs. The impact of any drug use on the developing brains of children and teens can be damaging and put them at risk for a lifetime of negative consequences. This message is especially critical for children with a family history of alcohol or drug addiction who are at higher risk for lifetime problems from alcohol or drug use. Young people must be encouraged to say “no thanks”

until their brains are fully mature—that is, when they are at least twenty-one years of age—every time the opportunity presents itself.

The National Family Partnership organized the first Nationwide Red Ribbon Campaign in 1988. Since that time, the campaign has reached millions of US children and families encouraging them to participate in drug use prevention activities in their schools and communities each October.

February

The international celebration of CoA Awareness Week, which is always in the week in which Valentine’s Day falls, was featured in the February 2016 issue of Counselor. Its purpose was to help children and adults alike to understand two things: 1. T hat a child living in a family with a parent or other family member who is

NACOA alcoholic or drug addicted generally suffers in silence, trapped in a home where the people they depend on for their safety and support are the very people who are frightening them and setting them on a path to a life of sadness, pain, and loss 2. That it only takes one caring adult to help them understand that what is happening in their family is not their fault and gives them the information and emotional support they need to heal and to change their life trajectory

April

Each April since 1987, the National Council on Alcoholism and Drug Dependence (NCADD) has sponsored Alcohol Awareness Month to increase public awareness and understanding, reduce stigma, and encourage local communities to focus on alcoholism and alcohol-related issues. With this year’s theme—“Talk Early, Talk Often: Parents Can Make a Difference in Teen Alcohol Use”—April 2016 was filled with local, state, and national events aimed at educating the public about the treatment and prevention of alcoholism, particularly among our youth, and the important role that parents can play in giving kids a better understanding of the impact that alcohol can have on their lives.

NCADD stresses that alcohol use by young people is extremely dangerous— both to themselves and to society—and is directly associated with traffic fatalities, violence, suicide, educational failure, alcohol overdose, unsafe sex, and other problem behaviors, even for those who may never develop a dependence or addiction. In the nearly thirty years of this special month, local NCADD affiliates as well as schools, colleges, churches, and countless other community organizations have sponsored a broad array of activities each year that create awareness and encourage individuals and families to get help for alcohol-related problems.

April is also Child Abuse Awareness Month. When 80 percent of child abuse

cases are alcohol-abuse-related, the overlapping of these two critical, awareness-raising months seems appropriate.

As the now widely understood Adverse Childhood Experiences (ACE) study points out, alcohol or drug use disorders are prevalent in families where children are experiencing life-damaging trauma resulting from the chaos these disorders create or exacerbate.

Furthermore, National Drug Endangered Children Awareness Day, sponsored by the National Alliance for Drug Endangered Children, was held April 27, during which state DEC Alliances and law enforcement organizations sponsored educational events, worked to obtain proclamations from their governors, and reminded the public that children who live in families with drug abuse are suffering in often frightening and dangerous home environments.

May

National Children’s Mental Health Awareness Day was held May 5, 2016.

Communities across the country as well as national collaborating organizations and federal partners planned Awareness Day activities that took place throughout the month. To support their efforts, the Substance Abuse and Mental Health Services Administration (SAMHSA) hosted the national awareness event titled “Finding Help, Finding Hope” on May 5 in Washington, DC. The event explored how communities can increase access to behavioral health services and supports for children, youth, and young adults who experience mental or substance use disorders and their families.

NACoA urges early preventive education programs for children of parents with alcohol or drug use problems in order to prevent lifetime mental health problems resulting from living in the chaos such home environments tend to create and sustain.

In addition, National Prevention Week is also in May and is an annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. The overall theme for 2016 is “Strong as One. Stronger Together.”

The week had three primary goals:

1. T o involve communities in raising awareness of behavioral health issues and in implementing prevention strategies 2. To foster partnerships and collaboration with federal agencies and national organizations dedicated to behavioral and public health 3. To promote and disseminate quality behavioral health resources and publications National Prevention Week is an opportunity for all of us to continue all year long to promote children’s wellness, which includes staying away from alcohol or drug use to help ensure a present and future life without the pain and loss suffered by substance use disorders.

And finally, each May is also National Foster Care Month, which provides an opportunity for people all across the nation to focus attention on the yearround needs of American children and youth in foster care. This campaign raises awareness about foster care and encourages many more citizens to get involved in the lives of these youth, whether as foster parents, volunteers, mentors, employers or in other ways.

Conclusion

Participating in these special weeks and months throughout the year helps to keep a vigilant spotlight on prevention for our young people and their families to protect them from unhealthy involvement in alcohol or drug use that can wreck their lives and devastate their families. I have featured two more such campaigns than the seven the advertising world suggests is necessary, but then we need to get ahead of the damaging influence of alcohol advertising and, increasingly, the advertising of medical marijuana. c Sis Wenger is NACoA’s President and CEO.

References

Macdonald, D. I. (2014). A pediatrician’s blueprint: Raising happy, healthy, moral, and successful children. Petaluma, CA: Roundtree Press.

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CULTURAL TRENDS

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Counselor · August 2016

CULTURAL TRENDS

Revisiting the Cannabis Debate Maxim W. Furek, MA, CADC, ICADC

M

arijuana has long been demonized and implicated in the War on Drugs. Although listed in the Drug Enforcement Agency’s (DEA’s) Schedule I—along with MDMA, LSD, and heroin—some argue the scheduling is incorrect and advocate for marijuana’s medicinal and recreational use. With large amounts of money being raised to promote decriminalization and legalization, the marijuana issue has become part of the national discussion. Let’s attempt to update the marijuana debate in the following areas.

Legislation

Under federal law, marijuana is viewed as a controlled substance. Its possession, use, and distribution, even for medical purposes, are illegal under any circumstances. States that permit medical pot are in violation of federal law. Nevertheless, in October 2009, former US Attorney General Eric Holder announced that the Obama administration would not prosecute people who were using medical marijuana in compliance with state law (Stout & Moore, 2009). Note that tincture of cannabis was legal and officially listed in the US Pharmacopoeia until 1941.

Medical Marijuana

Marijuana comes from the plant cannabis sativa, with its active ingredient delta-9-tetrahydrocannabinol, better known as THC. Proposed medical uses include treatment for AIDS’ wasting syndrome, glaucoma, chronic pain, and nausea associated with chemotherapy.

Promising research has also been indicated in treatment for an assortment of illnesses including tremors and balance in multiple sclerosis patients, antiepileptic actions, spasticity in spinal

cord injury, neurological disorders, anxiety, Parkinsonian tremor, and aspects of Huntington’s disease.

On June 15, 2000, Hawaii became the first state to pass legislation approving medical marijuana (“Medical marijuana,” 2016). Although challenged by the Justice Department, voters in numerous states began approving the drug. In 1998 the case of Conant v. McCaffrey was decided in favor of Californian doctors being able to recommend, rather than prescribe, which would be illegal, cannabis to patients with criminal and civil sanctions. Today twenty-three states and the District of Columbia have legalized medical marijuana.

Recreational Marijuana

Although four states have approved recreational marijuana—Colorado, Alaska, Washington, and Oregon—several additional states are attempting the same thing. California, which has already legalized medical marijuana, has a proposal to legalize recreational marijuana, estimating it would generate about $1.4 billion in much-needed revenue. Officials argue this could help offset the California economic downturn and diminish the power of Mexican

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CULTURAL TRENDS drug cartels. In addition, the court systems overburdened by marijuana crimes would be freed up to deal with more serious drug issues.

Industrial Hemp

One of the world’s most durable fibers, industrial hemp, helped win World War II but is currently illegal in many states. That may soon change, as “the Industrial Hemp Farming Act would amend the Controlled Substances Act to exclude industrial hemp from the definition of marijuana and would allow for American farmers in any state to grow the crop” (Ferner, 2015).

Ironically, the US is the world’s largest consumer of hemp products, but is the only major, industrialized country that outlaws domestic hemp production. Hemp contains little to no THC, the psychoactive ingredient associated with marijuana’s high.

Butane Hash Oil

Also known as “dabs,” this trend started on the west coast and arrived on the east coast in December 2013. The butane method is popular because the solvent, combined with a heat source, extracts the THC from the marijuana, producing hash oil with 30 percent or higher THC content. Because of the Internet and YouTube videos, the recipe is available, relatively easy to make, and dangerous. Fires and explosions have occurred with novice chemists.

Shatter

Also known as “wax” or “710,” shatter is more potent and faster acting than standard hash oil. Shatter is a form of marijuana wax derived from butane hash oil. According to an article in The Washington Post, “. . . some forms of shatter have as much as 90 percent THC . . . about five times the potency of unrefined smoked cannabis and more powerful than standard hash oil. It is produced as a thin, hard, translucent layer similar to glass, which can shatter if dropped, and is typically heated and inhaled through a vaporizer rather than smoked” (Jackman, 2015).

Kosher Marijuana

Vireo Health of Albany, New York will market the world’s first certified kosher marijuana. The group announced that the Orthodox Union of New York had authenticated it as having met Jewish dietary laws and that the cannabis came from insect-free plants.

Organic Marijuana

Colorado lawmakers are debating whether the state should allow cannabis to be certified as organic. The state could be the first to regulate organic labels in its marijuana products.

According to an article by the Associated Press, “Consumer confusion over organic marijuana peaked in Colorado earlier in 2016, when Denver health authorities seized thousands of marijuana plants from growers suspected of using off-limits chemicals on their plants. Most of the plants were ultimately released, but some were sold with names that suggested the products were natural or organic” (Wyatt, 2016).

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Veterans

On July 22, 2010 the US Department of Veterans Affairs issued a long-awaited directive allowing its patients to use marijuana for medical reasons without jeopardizing their access to government-sponsored health care. VA patients who register for a medical marijuana card, demonstrating compliance in one of the states where use is legal, may use the natural painkiller.

Medical pot is being used by military veterans to treat aspects of PTSD, but Bonn-Miller and Rousseau warn that “. . . there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD” (2016).

Perception

Marijuana’s popularity waxes and wanes with the media’s antidrug message. Everything begins with perception, and with marijuana the news is troubling. The perception that smoking marijuana once or twice weekly is not dangerous has become a more prevalent attitude among American high school students. Research by the National Institute on Drug Abuse (NIDA) “found that when a teen’s sense of a substance’s perceived harm goes down, his/her rate of use of that substance goes up” (Steiner, 2015).

It has been sixteen years since Hawaii became the initial state to legalize medical marijuana. At this point, nearly half of the states have climbed aboard the cannabis bandwagon and, despite objections from drug and alcohol professionals, the wagon does not appear to be slowing down. c Maxim W. Furek, MA, CADC, ICADC, is an avid researcher and lecturer on contemporary drug trends. His rich background includes aspects of psychology, addictions, mental health, and music journalism. His latest book, Sheppton: The Myth, Miracle, & Music, explores the psychological trauma of being trapped underground and is available at Amazon.com.

References

Bonn-Miller, M. O., & Rousseau, G. S. (2016). Marijuana use and PTSD among veterans. Retrieved from http://www.ptsd.va.gov/professional/co-occurring/marijuana_use_ptsd_veterans.asp Ferner, M. (2015). Bill aims to end federal ban on US hemp production. Retrieved from http://www.huffingtonpost.com/2015/01/22/hemp-legalization_n_6525106.html Jackman, T. (2015). Shatter, a super-high-potency marijuana, is appearing on the east coast. Washington Post. Retrieved from https://www.washingtonpost. com/local/public-safety/shatter-super-high-potency-marijuana-now-appearingon-east-coast/2015/12/23/e09dfde4-a8fa-11e5-bff5-905b92f5f94b_story.html “Medical marijuana dispensaries opening soon; Hawaii legislature considering decriminalization and legislation bills.” (2016).

Retrieved from https://www.mpp.org/states/hawaii/ Steiner, A. (2015). ‘It’s just pot’: Does legalization of medical marijuana change teens’ attitudes about it? MinnPost. Retrieved from https://www.minnpost.com/mental-health-addiction/2015/11/ it-s-just-pot-does-legalization-medical-marijuana-change-teens-attit Stout, D., & Moore, S. (2009). US won’t prosecute in states that allow medical marijuana. The New York Times. Retrieved from http:// www.nytimes.com/2009/10/20/us/20cannabis.html?_r=0 Wyatt, K. (2016). Colorado debates organic labels for marijuana. Retrieved from http://bigstory.ap.org/article/3bb9c7b1670d402aa e029115f2822e7d/colorado-debates-organic-labels-marijuana

OPINION

The Shrinking Soul: An Examination of the Eating Disorder Addict Hillary Goldsher, MBA, PhD

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norexia nervosa is an eating disorder that affects many women and a small percentage of men in this country.

It is characterized by an acute reduction in weight, an intense fear of weight gain, and body image disturbances. Bulimia nervosa is characterized by recurrent and frequent episodes of binge eating (i.e., unusually large amounts of food consumed in a short time) and a feeling that one lacks control over eating.

Compensatory behavior such as purging, obsessive exercising or consuming diuretics to offset the potential weight gaining consequences of the food consumed typically follows the binge.

Much is known about the development and treatment of these conditions, but the way in which clinicians, health care workers, and well-intentioned loved ones conceptualize these complex diseases widely differs—meaning the purported cause of these conditions are as diverse as the available treatments. Thus, it would be useful to have a more stringent paradigm to conceptualize these intricate diagnoses.

This particular investigation of eating disorders seeks to borrow and utilize the concepts of addiction as a way to further elucidate what these conditions are, where they come from, and how to potentially treat and/or prevent the inception of these traumatic diseases.

Addiction is defined by tolerance, withdrawal, and craving. We recognize addiction by a heightened and habituated need for a particular substance; by the intense suffering that results from discontinuation of its use; and by a willingness to sacrifice all (to the point of self-destructiveness) in order to gain access to the coveted behavior. Typically we think of alcohol and/or drugs as the object of obsession in this scenario. The need to 18

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escape painful reality numbed by the blur and haze provided by one’s drug or drink of choice is how we regularly think of the unrelenting jaws of addiction. Meanwhile, we tend to struggle with how to think about and categorize eating disorders. We have certainly borrowed from the world of addiction when it comes to overeating; the existence of Overeaters Anonymous makes this very clear. Eating can be an obsession and an addiction. Eating can be an activity that placates, that numbs, that soothes, and that is a gateway to denial, escape, and disconnection.

Let’s consider using this same paradigm as a way to clarify the onset and prolongation of anorexia nervosa and bulimia nervosa. Are these individuals striving to adhere to the thin and fit ideal presented in various mediums and losing their way? Is this someone who came from a family that “fat shamed” or a family that overemphasized the value of the perfect exterior? Is this someone who came from a family environment that caused pain and uncertainty and now uses food to soothe or distract? Is this someone who feels pressure from peers to look a certain way and is using extreme measures to get there? Is this someone who has a particular brain chemistry that is more vulnerable to developing this type of disease? There is a case to be made that indeed some or all of the above dynamics influence the existence and continuance of an eating disorder.

But maybe there is a way to mobilize all of this information into a single archetype. Perhaps all of the above dynamics fit into the addiction paradigm.

If addiction is indeed defined by tolerance, withdrawal, and craving, how might these tenets of addiction help us understand eating disorders better?

Tolerance

This is the notion that over time, a tolerance is built for the desired substance and related activity. With eating disorders, like alcohol, this is consistently true. At first, anorexics have a low and inconsistent tolerance for self-starvation. They can skip dessert or maybe a second helping. But then it starts to feel good. They challenge themselves to endure more. They skip breakfast, now breakfast and lunch, now just a small bite for dinner. Eventually they reach total elimination or minimal consumption of food. The tolerance for the physical and emotional ramifications of starvation grows. In fact, it starts to feel good. Many anorexics report that achieving intense levels of starvation feels empowering, almost like a high— the ultimate control. Meanwhile, it’s making them sicker both physically and mentally, they are withdrawing more and more from friends and family, and they are obsessed with calorie counting, weight loss, and skipping meals.

Sounds a lot like what happens when individuals who use drugs and alcohol achieve higher and higher levels

OPINION of tolerance. Their lives, like the lives of anorexics, become dedicated to the substance. They spend all their time thinking about it, craving it, and figuring out how to get it at any cost.

Withdrawal

This brings us to the next tenet of addiction: withdrawal. Withdrawal alludes to the mental and physical symptoms experienced when the coveted substance is not ingested. With alcoholics and drug addicts, the withdrawal can be physical as well as mental. Individuals can experience physical illness, shakiness, and intense malaise during a respite from their drug of choice. They can also become gripped with unrelenting angst that can only be restored by consumption of the substance.

Anorexics and bulimics often have the same type of experience if they are unable to participate in their food rituals. If anorexics can’t starve (because they are at a mandatory social event during which they can’t escape eating or can’t restrain themselves from eating) or bulimics can’t binge and purge (because of lack of access or privacy), intense anxiety and discomfort ensues.

These individuals become consumed with when they can engage in the addiction again and they feel an invasive sense of upset and imbalance that can only be restored by resuming eating disorder type activities, just like addicts who don’t feel okay until they get a drink. The eating disorder withdrawal is painful and distracting and individuals often becomes highly irritable, anxiety-ridden or depressed in the wake of refraining from the targeted behavior. The behavior has come to serve as a way to provide order, calm, relief, and escape. All other coping mechanisms are dropped or underutilized or undeveloped.

These people are at the mercy of their eating disorder. How thin they are, how much control they have over their food intake, and how much food they are able to consume during a binge becomes paramount—akin to survival. Any interruption in this crucial sequence of disordered behavior causes extreme mental anguish. This dynamic only serves to renew the importance and dependence on the eating

disorder behaviors. These individuals start to invest in the narrative that, with the eating disorder behaviors firmly in place, they are contained and sometimes even strong, and without them they are lost or left yearning for the return of the activities. It is the very same terrifying dialogue that rules the mind of “typical” addicts.

Craving

Craving is a key component of addictive behavior and also plays a key role in the world of eating disordered individuals. Alcoholics are known for constantly craving the drink to feel calm, to escape pain, and to feel in an altered state. Anorexics and bulimics crave the same disconnect and achieve it through starvation or bingeing and purging behavior. In fact, there is a deep, all-encompassing craving to be thin and to engage in all activities that will achieve this state. However, note that it is not really about the thinness.

At a psychological level, it is not the state of thinness that soothes. It is the state of calm, disconnection, and escape that people achieve in the pursuit or achievement of thinness. All else is sacrificed in pursuit of altering the body; it becomes an obsession and a compulsion. No longer is the psychic pain that is actually at the root of despair accessible or known. It is too painful to keep at the surface. These individuals instead use the “drug” of

eating disorders to bury the pain deep inside. Their days, hours, minutes, and seconds are consumed with food and losing weight. There is no longer room for feelings of abandonment, vulnerability, worthlessness, and loneliness.

The food addiction, like drug and alcohol addiction, subvert the pain.

This analysis underscores the complex and dangerous nature of eating disorders. These conditions are not just about a desire to be trendy and trim; they are multilayered psychological disturbances that require comprehensive, collaborative treatment plans. Given the similarities between addiction to substances and addiction to eatingdisordered behavior, it seems reasonable that exploring the application of treatment protocols for substance addictions for eating disorders is paramount for an increased understanding and potentially enhanced treatment of these devastating diseases. c Hillary Goldsher, MBA, PhD, is a clinical psychologist that specializes in the treatment of eating disorders, couples/relationship therapy, trauma/grief, parenting, and forensic psychology. Dr. Goldsher also works with clients dealing with issues related to the business and/or corporate environment due to her extensive experience in the business world. She also works regularly with clients dealing with depression, anxiety, relationship/ family issues, work conflicts, and a desire for self-improvement or growth. Dr. Goldsher is presently working in her private practice located in Beverly Hills, CA.

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FROM LEO’S DESK

Spiritual Principles, Part I Rev. Leo Booth

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t is often said in AA groups that we need to honor principles before personalities. I think we all understand what the sentiment is behind this statement; in order to curb our egos we need to emphasize the spiritual goals of recovery rather than get caught up with the differing personalities that make up the variety of AA groups. Point taken! But I think it would be a tragic mistake to disregard the incredible personalities that are in recovery.

Sober characters are often a joy to behold.

I think there is a backdrop to this statement that pervades AA philosophy, or more importantly the mind-set of Bill Wilson. It seems to be his belief, especially during his early recovery, that without a belief in God or another higher power human beings stumble around in chaos and despair. They are like boats without sails and incapable of any real achievement.

This was a widespread belief in most Christian denominations and other religions, so it is not surprising that it influenced Bill W. It comes back to the saying that “God is doing for us what we cannot do for ourselves.” It touches on the very nature of grace, which many believe to be the idea that only because of God’s grace can human beings achieve anything.

So we can understand the dumbing down of personalities in order to celebrate a relatively abstract concept 20

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like principles. What are the principles anyway? Who decides what they are? Are there a set number like the Ten Commandments? And where do principles exist? Well, they exist right within the human being, within personalities!

Spiritual principles are the cognitive development of the human brain, and as the Big Book reminds us, “God gave us brains to use.” (Alcoholics Anonymous World Services, 2001, p. 86) It is anathema to me that we should dumb down the human being, or indeed the human spirit. Whatever it might mean to turn our lives in the direction of a higher power we understand him or her, it must never mean that we are not involved in the recovery process.

In some ways we have not come far away from the thinking of Augustine and his debate with the more radical Pelagius. Augustine won the debate, but I’ve always been inclined to Pelagius’s arguments. I wrote about how we are to understand the workings of God’s grace in my book The Happy Heretic (2012): Let’s take a moment to look at what is known about Pelagius. He was born around 354 AD in Wales, Britain. He was educated in both Greek and Latin, a monk but not a cleric; he was never an ordained priest. In his early years, he was

admired by no less a person than Augustine of Hippo, who called him “a saintly man.”

When he moved to Rome, he became concerned about the moral laxity in the city, believing it was partly the result of Augustine’s teachings concerning divine grace.

Pelagius was concerned about the emphasis that Augustine placed upon God’s grace—the idea that since the Fall of Adam, every good thought or action was dependent u p o n G o d . We co u l d do nothing on our own.

There was no teaching that affirmed the need for our response. There was little teaching concerning human responsibility; that we need to be accountable for our behavior. He was particularly disturbed by a famous quotation from Augustine, “Give me what you command and command what you will.”

Pelagius believed that this saying discounted free will, turning man into a mere automation.

He soon became a critic of Augustine, disagreeing w i t h h i m co n ce r n i n g original sin and the working of God’s grace in perfecting salvation.

Pelagius argued that if human beings could discipline themselves in the way exemplified by Jesus, then they could

remain perfect. He believed that grace needed to be connected with human choice. Pelagius’s personal discipline made him extremely puritanical, teaching a strict regimen to his disciples in order to ensure moral purity (2012, p. 7–8).

Interestingly, The church hierarchy ultimately supported the theological arguments of Augustine, and Pelagius was denounced as a heretic at the Council of Carthage in 418 AD. It is believed that Pelagius died of natural causes in Palestine around 420 AD (2012, p. 8).

In my next column we will continue this discussion and look more closely at the words of Bill W. c Leo Booth, a former Episcopal priest, is today a Unity minister. He is also a recovering alcoholic. For more information about Leo Booth and his speaking engagements, visit www.fatherleo.com or e-mail him at fatherleo@fatherleo. com. You can also connect with him on Facebook: Reverend Leo Booth.

References

Alcoholics Anonymous World Services. (2001). Alcoholics anonymous (4th ed.). New York, NY: Author.

Booth, L. (2012). The happy heretic: Seven spiritual insights for healing religious codependency. Deerfield Beach, FL: Health Communications, Inc.

WELLNESS

The Obesity Epidemic Poses a Threat to Wellness in Recovery John Newport, PhD

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s you are probably aware, our nation—and indeed the world—suffers from a growing epidemic of obesity.

A recent Los Angeles Times piece really drove home to me how serious the problem has become (Healy, 2016).

Over the past decade leading medical experts have pointed to data from the Centers for Disease Control and Prevention (CDC) that indicate that obesity is running neck and neck with smoking as our nation’s leading preventable cause of death (Flurry, 2009). Obesity Prevention Specialist Dr. David Ludwig is disturbed by the uptick in deaths from heart disease, stroke, diabetes, and chronic liver disease over the past year, underscored by a 19 percent rise in deaths from Alzheimer’s (Healy, 2016). Each of these causes of death has been linked to midlife obesity, which now impacts 35 percent of our adult population.

Indeed, over two-thirds of adult Americans are either clinically overweight or obese.

Equally frightening is a recent report by the World Health Organization (WHO) stating that worldwide cases of diabetes have increased nearly fourfold over the past twenty-five years, driven by excessive weight gain, obesity, aging, and population growth (Keaten, 2016).

Worldwide, WHO claims that diabetes and prediabetic high blood sugar levels together accounted for close to four million deaths in 2012.

Undoubtedly the majority of these deaths are attributable to Type 2 diabetes—formerly called adult-onset diabetes— in which the main culprits are obesity and sedentary lifestyles.

Let’s take a moment to explore why recovering alcoholics and addicts are at elevated risk in regard to obesity and its untoward consequences.

For one thing, many if not most people working in the field would probably agree that aside from genetic predisposition, a leading causative factor underlying addiction is a misguided effort to fill a perceived spiritual or existential void in addicts’ lives. Once they have weaned themselves from their primary drugs of choice, it is not particularly surprising that many of these people turn to food in an effort to fill the void. Indeed, eating disorders and food addiction emerge as fairly common substitute addictions among many people in recovery.

In my book The WellnessRecovery Connection (2004) I discuss in detail the propensity of many recovering alcoholics to gravitate toward high-sugar foods.

Unfortunately very few cells in the body are able to effectively utilize sugar. When we eat a lot of sugar, most of the

glucose or fructose gets metabolized by the liver, where it is turned into fat, which is secreted into the blood (Gunnars, 2013). In addition to the detrimental effects of sugar, many sugary foods such as ice cream and pastries contain substantial amounts of saturated fat.

If this wasn’t bad enough, many recovering alcoholics and addicts carry their addiction to nicotine over into their recovery, which dramatically increases their likelihood of succumbing to declining health and premature death.

Indeed, millions of people in recovery are unwittingly stacking the deck against themselves by subjecting themselves to the hazards associated with both food addiction and smoking.

Assessing Whether You Are At Risk

I encourage you to conduct a brief self-assessment of your own risk level in regard to www.counselormagazine.com

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WELLNESS obesity and its potentially devastating consequences.

Obvious “first cuts” include looking in the mirror, stepping on the scale, and trying on a pair of jeans or dress you bought several years ago.

In the fields of medicine, nutritional counseling, and fitness training, the gold standard for evaluating one’s current standing in regard to body weight is the body mass index (BMI). In a nutshell, BMI represents a ratio between a person’s weight and height, calculated by dividing one’s weight in kilograms by the square of one’s height in meters (CDC, 2015). Google either “body mass index” or “BMI” and you’ll come up with a wealth of information and a plethora of sites where you can easily calculate your BMI. Commonly accepted BMI ranges for adults aged twenty and older are • U nderweight: under 18.5 • N ormal weight: 18.5 to 25 • Overweight: 25 to 30 • Obese: over 30 The obese category is in turn divided into three subcategories: • M oderately obese: 30 to 35 • Severely obese: 35 to 40 • V ery severely obese: over 40 In interpreting ramifications concerning your own BMI, keep in mind that the BMI for a large-boned or very muscular person may be somewhat inflated in regard to actual health risk factors.

With that caveat in mind, if your BMI falls within the middle to upper range of the overweight category or within the obese category, 22

Counselor · August 2016

you are at substantially elevated risk of succumbing to heart disease or stroke, diabetes, liver disease, cancer, and/or a number of other potentially life-threatening diseases. I would urge that you consult with a health professional—ideally a physician in combination with a skilled nutritionist—concerning steps you should take to reduce your risk factor profile. This is especially true if you fall within either the severely obese or very seriously obese categories.

Reducing Your Risk

Generally speaking your best line of attack is to begin a medically supervised program of diet enhancement, weight reduction, and regular vigorous exercise, and stay with that program. Unless you have undergone a recent physical exam, schedule a thorough medical evaluation including a comprehensive blood panel. It is critically important that you bring your diet into balance concerning a more optimal mix in your nutritional intake. I personally favor the Mediterranean diet, sans the meat and wine, which I’m been practicing over the past several decades. You can find the Mediterranean diet pyramid in my book or download a copy online (“Mediterranean,” 2015).

If you fall within the BMI categories for overweight or moderate obesity, joining a group weight-loss program such as Weight Watchers, combined with consulting with a skilled nutritionist, should get you headed in the right direction. It’s important that you stick with your diet optimization and exercise program to fully integrate these healthy behaviors into your life.

If you fall within the severely or very severely obese categories you may want to discuss this with your doctor, together with the pros and cons of bariatric surgery.

Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold and/or restricting the absorption of nutrients (ASMBS, 2016). While bariatric surgery is a lifesaving procedure for many people that can dramatically improve their quality of life, the risks associated with this major surgery must be carefully considered. If your doctor believes you might benefit from this procedure, obtain a referral and schedule a consultation with a qualified bariatric surgeon. You may also want to seek out a second and even a third opinion to help you decide whether you want to undertake this major surgical procedure and, if so, which type of procedure appears best for you. Subsequent to the procedure you will need to follow a lifelong regimen of vitamins and minerals, together with a periodic battery of lab tests. It is also highly recommended that you bring your diet into balance and adopt a medically supervised exercise program.

The best way to protect yourself from unwittingly participating in our worldwide obesity epidemic is to fully integrate a wellness lifestyle into your recovery program. As the saying goes, an ounce of prevention is worth a pound of cure.

I hope this column may inspire you to initiate proactive action in your own life as well as with your clients to safeguard against unhealthy lifestyles that set the stage for obesity. As always, feel free to share this column with your

clients and others who may benefit from the message.

Until next time—to your health! c John Newport, PhD, is an addiction specialist, writer, and speaker living in Tucson, AZ. He is author of The WellnessRecovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction. You may visit his website www.wellnessandrecovery.com for information on wellness and recovery trainings, wellness coaching by telephone, and program consultation services that he is available to provide.

References

American Society for Metabolic and Bariatric Surgery (ASMBS). (2016).

Bariatric surgery procedures. Retrieved from http://asmbs.org/patients/ bariatric-surgery-procedures Centers for Disease Control and Prevention (CDC). (2015). Body mass index (BMI). Retrieved from http://www. cdc.gov/healthyweight/assessing/bmi/ Flurry, S. (2009). The most affordable health care there is. The Philadelphia Trumpet, 20(5). Retrieved from https:// www.thetrumpet.com/article/6074.24 Gunnars, K. (2013). Four ways sugar makes you fat. Retrieved from https://authoritynutrition. com/4-ways-sugar-makes-you-fat/ Healy, M. (2016). Will obesity reverse the life span gains made over decades of health triumphs? Los Angeles Times.

Retrieved from http://www.latimes.com/ science/sciencenow/la-sci-sn-obesitywill-reverse-lifespan-20160403-story.html Keaten, J. (2016). The World Health Organization says excessive weight, obesity, aging, and population growth were top factors behind a nearly four-fold increase in worldwide cases of diabetes over the last quarter-century, affecting some 422 million people in 2014. Retrieved from http://www.usnews.com/news/world/ articles/2016-04-06/who-diabetes-rises-fourfold-over-last-quarter-century “Mediterranean diet pyramid.” (2015).

Retrieved from http://oldwayspt. org/resources/heritage-pyramids/ mediterranean-pyramid/overview Newport, J. (2004). The wellness-recovery connection: Charting your pathway to optimal health while recovering from alcoholism and drug addiction. Deerfield Beach, FL: Health Communications.