Counselor - October 2016 Issue Preview

CONGRESS 60 IN IRAN: A RECOVERY COMMUNITY

INSIDE BOOKS: THE ESSENCE OF RESILIENCE

BY WILLIAM L. WHITE, MA

BY TANYA LAUER AND KATHLEEN PARRISH

The Foundations of Resilient Recovery RESISTANCE MANAGEMENT BEHAVIOR CHANGE IN ALCOHOL USE DISORDER TREATMENT HOMELESS YOUTH WITH SUDS

TREATMENT & RECOVERY

INDUSTRY INSIDER FLIP OVER

Sept/Oct 2016 Vol. 2 No. 5

Dr. Gabor Maté on Trauma pg. 2

NAATP Faces “Critical Times” pg.

4 Responding to First Responders pg. 7

CCAPP National Advocacy Update pg. 9 Recovery and the Community Health System pg. 11

Mark Gold Heads Scientific Advisory Board at RiverMend Hea lth pg. 5

October 2016 Vol. 17 | No. 5, $6.95

Cottonwood Tucson and The Essence of Resilience pg. 8

www.counselormagazine.com

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CONTENTS

28

Letter from the Editor

7

CCAPP

8

By Gary Seidler Consulting Executive Editor

Self-Regulation and Stress Coping at the Foundation of Resilient Recovery

Addicts Don’t “Hit Bottom” Until the System Around Them “Hits Bottom”

By Jon Daily, LCSW, CADC-II

By Stephen Sideroff, PhD Discusses the development of addiction vulnerability, provides information on relapse susceptibility, and describes a model for fostering resilience.

NACOA

Voices Needed: Yours, Mine, and Ours

10

By Sis Wenger

Cultural Trends

36 Fundamentals of Resistance Management

By Clifton Mitchell, PhD Explains the ways in which counselors promote resistance, describes the “Yes, but” response, and provides suggestions for counselors on how to deal with resistant clients.

Uncharted Waters: Navigating the Madness of Designer Drugs, Part I

13

By Maxim W. Furek, MA, CADC, ICADC

Opinion

Reliable Identification of Borderline Intellectual Functioning

16

By Jerrold Pollak, PhD

From Leo’s Desk

Spiritual Principles, Part II

18

By Rev. Leo Booth

Wellness

41 Mechanisms for Behavior Change in Alcohol Use Disorder Treatment

By Sarah Adair, RASAC-II, MSW, Erin Church, MSW, Kaitlin Peterson, MSW, Madeline Seim, MSW, and David A. Patterson Silver Wolf, PhD Presents information on current therapies for alcohol use disorder, provides a literature review, and gives recommendations for therapists and counselors.

Wellness in Recovery from Eating Disorders

19

By John Newport, PhD

The Integrative Piece Smoker No More

21

By Sheri Laine, LAc, Dipl. Ac

Topics in Behavioral Health Care

22

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

By Dennis C. Daley, PhD

www.counselormagazine.com

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Counselor · October 2016

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

ADVERTORIAL

Healing and Recovery: It’s a Matter of the Heart

“Healing is less about ‘saving’ or ‘fixing’ and more about ‘allowing’ ourselves to ease into the remembering that there’s a wholeness that has been there all along.”

–Emmanuel Dagher After years working in the treatment field, we’ve come to believe that clients benefit from a program that helps them “remember that there’s a wholeness that has been there all along.” This means creating a healing environment grounded in respect and empowerment; where clients begin to make their own decisions and choices again, and are encouraged to believe in themselves as whole rather than damaged or defective.

The Healing Environment

The word healing comes from the AngloSaxon word haelen, which means to make whole. A healing environment cannot be created through fear, working from a “one up” or expert position or control and manipulation. It can only be created through respectful practices such as nonjudgment, kindness, compassion, healthy boundaries, and mutual respect. We cannot demand respect, we must earn it. We cannot empower others, we can only create an environment that supports clients to believe in and empower themselves to risk trying something new. We must respect where clients are in terms of their readiness to change, and remember that they are usually afraid, wounded, stuck, sad, and angry.

In treatment, clients often act out these emotions and are labeled “resistant,” “noncompliant,” and “not caring.” We don’t want to view clients through this lens and instead see

them as human beings who are suffering, not as addictions, eating disorders or depression.

We may suffer from those things, but they do not define what we ARE. Labels tend to inhibit the creation of a healing environment. In contrast, “holding space” (being fully present with others without judgment) for clients invites them to settle in and feel safe enough to let go of these adaptive behaviors. Holding space allows clients to have their own experience without someone else trying to “fix it” or affect a specific outcome, which enables clients to gain confidence in themselves as they work out their struggles themselves with the support of the group community.

This provides the foundation for them to begin to believe that they are good enough and can live a great life.

Structure vs. Control

“Fear focuses on what you don’t want; love focuses on what you do want. Fear controls, love structures. Fear judges, and love notices.”

–Becky Bailey Author of Easy to Love, Difficult to Discipline Intrinsic motivation does not rely on external pressure like fear, rewards/approval or punishment/disapproval from peers or health professionals. It exists within the individual, and is driven by interest or enjoyment in the task itself. This is the basis of self-determination theory. Contrary to rewards and incentives, research supports the idea that intrinsic motivation is stable and lasting as the individual is making changes based on what is

enjoyable or compatible with their “sense of self,” core values, and life goals.

Establishing an environment that supports choice over control and promotes intrinsic motivation has been a cornerstone for us at ILC. People need to feel a sense of choice and responsibility for their actions, to feel capable of achieving their goals and also understood, cared for, and valued by others. Our staff understand this and help guide clients along a path of change of their choice. We offer opportunities for them to learn by living life and being accountable (Real World, Real Life, Real Recovery). They are supported in recovering faith in self instead of looking to others for approval. We do not view the self as a bad thing or something to be avoided or shunned and believe that until we are in alignment with our self we cannot be in alignment in life. What we ARE and what we DO are not the same.

What we ARE are human beings; reflections of our creator. What we DO is largely inherited when we are born into this world. By supporting clients in recovering faith in and reclaiming their authentic selves, life (recovery) becomes interesting again and clients become intrinsically motivated for change.

Our commitment is to support those who walk through our doors in their journey by providing a healing environment, the highest quality care and holding a space of re spect for them until they can reclaim that for themselves. That’s how we roll. One day at a time.

— Holly Cook, executive director & Lee McCormick, CEO 877-334-6958 www.integrativelifecenter.com

CONTENTS Counselor Concerns

Smoking for Behavioral Health Patients

24

By Gerald Shulman, MA, MAC, FACATA

Ask the LifeQuake Doctor

By Toni Galardi, PhD

Inside Books

The Essence of Resilience: Stories of Triumph over Trauma

27

46 Congress 60: A Recovery Community in the Islamic Republic of Iran

By William L. White, MA

68

Provides information on recovery communities in Iran and focuses on the elements of the Congress 60 recovery community in a photographic essay format.

By Tanya Lauer and Kathleen Parrish Reviewed by Leah Honarbakhsh

ALSO IN THIS ISSUE Ad Index CE Quiz

63 66

From the Journal of Substance Abuse Treatment

52 A Comparison of Three Interventions for Homeless Youth with SUDs

By Natasha Slesnick, PhD, Xiamei Guo, PhD, Brittany Brackenhoff, MS, & Denitza Bantchevska, PhD Describes a study comparing treatment outcomes for homeless youth and presents information on study methods, participants, and limitations.

58 How Compatible are the DSM-5 SUD Diagnoses and their Corresponding ICD-10 Billing Codes?

By Stephen L. Proctor, PhD Explains HIPAA compliance laws in relation to claims, compares ICD-10 codes with DSM-5 diagnoses, and presents implications for clinical practice.

6

Counselor ¡ October 2016

LETTER FROM THE EDITOR

Believe it or Not

J

ust when I thought I had heard it all . . .

Earlier this summer, California’s Coalinga City Council voted to sell the city’s dormant prison to a company looking to cultivate commercial marijuana within city limits.

This was a $4.1 million sale; cha-ching! In one foul swoop, the city was out of debt. Claremont Custody Center is now owned by Ocean Grown Extracts, which will transform the former prison into a medical cannabis oil extraction facility.

Surely, this is not what is meant by advocates of criminal justice reform!

Chances are that the State of California will vote this November to legalize possession of marijuana for recreational use, thus joining Colorado, Washington, and Oregon.

Many feel legalization is inevitable and has been since more and more states voted first to decriminalize and then allow medical marijuana. And, regardless of mounting new research that points to the dangers of today’s far more potent marijuana and the increasing public health concerns voiced by frontline clinicians, let’s face it—there’s just too much money on the line.

One particular study by the Rand Corporation should give us pause.

The study found that while use of both marijuana and alcohol in middle and high school increased the likelihood of poor academic performance and mental health issues at the high school level, marijuana use was associated with greater problems in more areas of functioning than alcohol use, including mental health and delinquency (D’Amico, Tucker, Miles, Ewing, Shih, & Pedersen, 2016).

The Rand study points out that many youth tend to think that alcohol use has more consequences than marijuana use and therefore view marijuana use as safer than drinking. However, the study concludes, youth need to better understand the harms of marijuana use, such as the potential effect on their developing brain and how it can

affect performance in both adolescence and adulthood (D’Amico et al., 2016).

Californians would do well to monitor closely the experience of Colorado and Washington who voted to legalize marijuana is 2012.

In an “Open Letter to Anyone Who Will Listen,” Ben Cort, director of professional relations at the Center for Addiction Recovery and Rehabilitation (CeDAR) in Colorado and a board member of Smart Approaches to Marijuana, is making waves from coastto-coast with a bucketful of information that leads to only one conclusion: “The grass isn’t greener on this side.”

The federal government, Cort says, initially announced it would take a hands-off approach, promising to track nine consequences of legalization and determine action later. So far, Cort adds, no effective or robust public tracking system by federal or state authorities has been implemented and, in Colorado and Washington especially, some fret that “Big Marijuana” has been allowed to run wild.

Cort predicts that as we see the next generation grow up in a place where pervasive THC use is accepted, and even encouraged, we will see the harmful effects of marijuana on the brain and body play out much faster because they will be using much stronger stuff, more often, and at earlier ages.

Cort sounds the alarm on the Colorado “experiment” which he insists “is not going to end well,” and counsels us all to “Learn from the mistakes made and let the damage done in my home state be a warning to yours.”

One thing is for sure; increased consumption of the “new marijuana” by young people will result in more and more health consequences and the treatment field will be challenged to respond.

The biggest single concern has got to be marijuana use by adolescents. Previously, we did not appreciate the long-term effects of marijuana on the brain.

Fortunately, with the California vote around the corner, the leadership of

California’s Consortium of Addiction Programs and Professionals, understands this all too well. CCAPP is calling for legislators in the state to include significant dollars earmarked for all addiction treatment, not just marijuana, as they debate legalization. Unlike Colorado, Washington, and Oregon, CCAPP is asking legislators to set aside 45 percent of tax revenue for treatment.

Sounds like a good place to start.

Gary Seidler

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

D’Amico, E. J., Tucker, J. S., Miles, J. N. V., Ewing, B., Shih, R. A., & Pedersen, E. R. (2016). Alcohol and marijuana use trajectories in a diverse longitudinal sample of adolescents: Examining use patterns from age eleven to seventeen years. Addiction, doi:10.1111/add.13442.

www.counselormagazine.com

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CCAPP

Addicts Don’t “Hit Bottom” Until the System Around Them “Hits Bottom” Jon Daily, LCSW, CADC-II

2

016 is the year of the heroin epidemic in the media. We have witnessed it in President Obama’s State of The Union Address as well as on the current presidential campaign trail with both parties spending hours of their campaign time discussing heroin. They have talked about lives that have been lost and the need for medication-assisted treatment (MAT) such as buprenorphine. It has been debated whether or not naloxone, the overdose antidote, should be available for staff on high school campuses in case a student has an overdose. The media has covered synthetic, fentanyl-laced pills sold as Vicodin on the streets which have killed many this year. As I write, there have also been suspicions and allegations that the music artist Prince’s death was from an opiate overdose.

Political and media coverage may have many thinking that the source of the problem comes from the doctors who are overprescribing these painkillers; this can certainly be the case with the elderly, as well as many chronic pain management patients. However, when I look at the many teens, young adults, and adults with opiate abuse issues and addiction, I see the cause of this problem differently.

In my over twenty years working with teen and young adult addicts it has been easier to get opiate addicts clean versus marijuana addicts. Why is that?

It is because addicts don’t hit bottom until the system around them does. We see a surge of intervention practices to help opiate addicts, but little to none for marijuana addicts. Further, many enable marijuana addicts with statements like, “Kids will be kids,” “Boys will be boys,” “It’s a phase of life” or “It’s a rite of passage.” Sadly, I have seen many marijuana addicts suffer various consequences related to sports, school, family, romantic attachments, 8

Counselor · October 2016

the law, employment, and their health and mental health. Currently, with the more potent strains of THC and other concentrates, I am seeing panic attacks, psychosis, and $50,000 to $100,000 spent privately by families to intervene when years have gone by before they decide it is a problem.

We are more effective dealing with the heroin epidemic when we understand that the name of the drug addicts are using is irrelevant. Addicts are not hooked on marijuana, alcohol or heroin, they are hooked on intoxication. Our own bias that one drug is worse than another significantly impairs our effectiveness when it comes to identifying and helping teens and young adults in slowing or reversing the addiction progression.

To illustrate the point that the real issue is that addicts are hooked on a pathological relationship to intoxication, and are not hooked on specific substances such as marijuana, alcohol or heroin, please read the following case and help me to understand which drug my new client is using.

Case Example

Yesterday I met with a young lady named Tamara. Since Tamara started using she has lied to her family about her use and has taken money from her family to pay for her use. Her siblings have expressed concern to her about her use. Her family has talked to her about it and has set limits in the home by implementing restrictions. Tamara has also had girlfriends and boyfriends express concern to her about her using by explaining to her how her use has affected their relationship and how they see it affecting her directly. With regard to school, Tamara has increasingly started to lose focus on homework, has skipped classes, and her grades have been declining. Finally,

she is getting a reputation on campus as being a person who uses. Moreover, she has had close calls with the law and doesn’t care about sports or music instruction anymore.

So, what substance is Tamara using?

Is it marijuana, alcohol, molly, opiates, meth, stimulants, cocaine, 2CB, 2CI, wax, dabs, budder, LSD, mushrooms, heroin?

When I ask this question to a large room filled with seasoned clinicians, they struggle to answer it correctly. The correct answer is, “It could be any of the drugs.” What I have laid out in the previous vignette are the symptoms of late stage substance abuse and stages within addiction. The symptoms are the same across the board 95 percent of the time from one drug to the next.

We are too caught up in the 5 percent biological differences. This case and question help people to see that the symptoms of substance abuse and addiction are the same from one drug to the next, so the name of the drug is irrelevant; what needs to be understood is that addiction is simply a pathological relationship to intoxication. It is intoxication that is driving Tamara to use despite the symptoms of negative consequences occurring in her life.

Drug Bias

One factor getting in the way for members of our society who want to help is their own drug bias. It is actually this bias that gives people pause on my question posed with the vignette you just read. To further illuminate the bias, I ask this question to many therapists when I am speaking at trainings and conferences: I want you to take a quiet moment and think about your own son or daughter. In this very moment I want you to connect to your gut. Now I

CCAPP want you to hold that connection and connect to what it feels like for you right now when you get a call from the police and they say your child has just been busted at the park with alcohol.

What does that feel like? How driven do you feel in the moment to mobilize and take action? Stay connected.

All right, now you get the same call, but the officer says your child has been busted with ecstasy. What is the reaction now? What about if your child has been busted with heroin?

What is your reaction now?

It is easy to see and feel the visceral difference with each substance. This is the drug bias that has to be removed. A huge paradigm shift is needed so that we are able to see all drugs as harmful. Once a person forms a pathological relationship to intoxication, the symptoms and progression will all play out the same. Certainly, there are differences, but not enough to identify which drug Tamara was using in the vignette.

To bring home the truth that addicts are not just hooked on a particular drug, but rather that they are hooked on intoxication, what happens when addicts’ drug of choice is removed? Do they stop using? Are they sober? When marijuana users are being drug tested by family or the legal system, do they stop seeking intoxication? Of course not. The reason for this is that they were never hooked on marijuana, they were hooked on intoxication. Marijuana was just their favorite flavor. You know, and they will admit, they will just shift to a different source of intoxication like K2spice, alcohol, opiate pills, and even heroin. This is the reality. We have to lose the bias and recognize this issue in a deeper and more serious way in order to help addicts sooner and more effectively.

The System

One caveat that goes with my point is that drug users don’t hit bottom until the system around them hits bottom.

These systems include the parents, teachers, coaches, friends, and employers. It also includes MDs, therapists, legislators, and legislation. When the system recognizes that intoxication in any form is not okay, that there should

be no more of this substance use, and when the system can see clearly where this is headed, it is then that the system finally reacts and begins the necessary support for the user.

Sadly, today’s systems are still holding drug of choice biases and making the same statements of “It’s only alcohol,” “It’s only marijuana” or “It’s the teenage years, just a phase.”

Certainly this fails to recognize that THC users are using over 73 percent potency THC compared to 5 percent in the 1980s and 10 to 20 percent in the 1990s. Furthermore, most teen deaths are related to alcohol. This ignorance supports addiction and allows it to progress. This is a system which has hit bottom due to ignorance about the illness of addiction. This is a system that might hold the car keys while a group of teens gets drunk at their house after a Friday night football game. However, systems react differently when teens use OxyContin or when they shift to using heroin. It is then that the system recognizes a problem and is more motivated to do something about it, which in turn makes users face the issue of their drug use.

Personally, I am frustrated that communities and politicians are outraged today about the heroin epidemic we are in with teens, young adults, and adults. Where is the outrage concerning

the growing drug problem which has been unfolding for a long time with alcohol and marijuana? People are subscribing to the idea that heroin is the problem, and missing the other drugs the opiate addicts were addicted to first, and the illness as a whole. In my long career, as well as in my program that sees over one hundred people per week, 90 percent of the opiate addicts were hooked on marijuana long before they got into opiates. Sadly, today the state of California and other states are looking to pass an initiative to make recreational marijuana use legal for those aged twenty-one and older. It is insultingly harmful, and the upside potential to the downside risk does not balance out. We have to be a part of the solution and speak out about marijuana addiction. We also must strive to intervene earlier and as soon as we know substance use has begun. c Jon Daily, LCSW, CADC-II, is the founder and clinical program director for Recovery Happens Counseling Services. He also instructs a graduate school course on chemical dependency for the University of San Francisco and has been an instructor for University of California-Davis and Sacramento County Probation. He has given numerous local and televised presentations on substance use issues and is the author of Adolescent and Young Adult Addiction: The Pathological Relationship to Intoxication and the Interpersonal Neurobiology Underpinnings.

CCAPP is unifying the addiction field 2400 Marconi Avenue P.O. Box 214127 Sacramento, CA 95821

Education “CCAPP is educating addiction counselors by supplying quality options for schools and providers”

Membership “CCAPP is supporting and advocating for programs and professionals in the addiction field.”

Recovery Residences “CCAPP recognizes quality sober living by registering recovery residences.”

T (916) 338-9460 F (916) 338-9468 www.ccapp.us

Credentialing “CCAPP is the largest, most respected SUD counselor and prevention specialist certifying organization in California.”

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9

NACOA

Voices Needed: Yours, Mine, and Ours Sis Wenger

A

t the recommendation of her high school guidance counselor, Mary Beth was invited to join a group where teenagers could talk about the troubles at home because a parent was abusing alcohol or drugs. While nervous, she was curious to see if other students from her school would even care about her problems, let alone help. She almost froze when she entered the room, finding a star player from the football team, a goofy classmate who made all of the teachers laugh, and a fellow field hockey teammate. She was confused because these teens had “perfect lives” that she often envied. She sat down and realized she had never noticed the solemn looks hanging on their faces until just then. As each spoke, she heard her own family’s problems being described by these other kids. While there were some in living situations that might be a bit different, she was amazed to learn that they basically had lives like hers. Some even much worse.

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Counselor · October 2016

It was a life-altering discovery that she was not alone and that there were other teens like her who were coping and finding supportive help. She was inspired; if these kids could come, talk about their problems, and be okay, so could she. So she stayed in the group, learned about how alcoholism was wreaking havoc in her family, learned that she had choices, and was able to make sense of her life and move forward. In later years she joined Al-Anon and continued her recovery from the painful impact of her growing-up years. Today she mentors newly aware adult children who didn’t receive the blessing of a student assistance program in an enlightened school system when they were growing up.

At one level Mary Beth is still confused. She wonders why the schools allowed student assistance to fall off when the Department of Education— which didn’t manage the program and didn’t see how much it served educational goals of helping students to learn and succeed—arbitrarily pushed for

ending the state’s portion of the drugfree schools monies so that it could be used for programs designed by the Department. This is a small amount of money to every school that provided the basic support for such locally supported programs to be sustained, and save thousands of children and youth like Mary Beth. After three years of trying to retrieve the funds working so well at the school system level, the money was finally zeroed out at the insistence of the Department in favor of a few large programs created by the Department to help a few at-risk school systems.

The Power of a Letter or Visit from You

As counselors whose work is funded through federal, state or local county agencies, you have a vested interest in strong legislative action and reasonable financial support for addressing addiction in your clients and helping your family members recover as well.

The slogan “No Money, No Mission”

NACOA is very clear. Unless there are taxes paid and funds distributed for quality programs for the betterment of society, there is no opportunity to follow your passion to support individuals who need help. There is power in one letter to your representatives in state and federal legislatures, and you have the knowledge that can help foster the wisdom you want to see in your locally elected and appointed officials who manage your court systems and your health departments. A well-presented argument in a private meeting with one or more of them—along with an offer to assist them in any way possible as they do their research and craft their decisions that impact your paycheck— make it possible for you to be the professional you were trained to be.

Elected officials and competent appointed administrators relish the knowledge, wisdom, and collaboration of wise, experienced, and caring members of the electorate. Becoming a trusted vessel of information on critical issues that impact the people you serve, as well as your career, is an important goal. But the first step is becoming known and being steeped in the issues that you can support with credibility, and the legislation and public policy production can follow.

This year, the Comprehensive Addiction and Recovery Act (CARA) has moved steadily through Congress against all odds, strengthening prevention, addiction treatment, and recovery support programs. Countless concerned citizens and responsible national organizations became trusted experts, collaborated at all levels, and never lost sight of the goals: overdose deaths must be stopped; people must have access to effective treatment and recovery support for the duration and at the level needed to recover; and the criminal justice system must change its paradigm from punishing a person because of a debilitating illness to promoting rehabilitation from the illness in all appropriate ways. We must prevent the disease from capturing our youth and our families, and it starts with each of us. It will save money, save lives, save marriages, and save whole families.

If we do not develop our power to affect change, how can we fault others for not fixing all that is broken in our critical social systems?

The Story Remains Remarkably the Same

An “epidemic” explodes; once it hits the families and neighbors of the “empowered” there is a seemingly rapid series of expensive and politically driven quick fixes, many of which can provide urgent help, but too often real prevention slips down under the stampede, helping to set the stage for the next epidemic. Where can we find the voices to send a collective message to those who make decisions everyday about children and families? The message to look for the at-risk child, to ask about addiction in the family, and to respond with knowledge, wisdom, and support?

The prevention of opioid abuse and addiction begins before birth, not in middle school, and is age-appropriate at each stage, but the message struggles to get above the din.

Recently the Massachusetts legislature passed a law to provide help to the children of opioid abusers (Quinn, 2016). While the intent is laudable, it will help a small percentage of the one in four Massachusetts children of addicted parents being harmed every day by the hostile environment created by addiction in a parent. The CDC’s Adverse Childhood Experiences (ACE) study has made abundantly clear what clinicians in the field have always known: growing up in a house with

addiction and the related conditions that flow from it creates such chronic emotional stress as to dramatically affect the emotional and brain development of the child, too often fostering a lifetime of mental and physical illnesses (CDC, 2016).

As more states consider legislation similar to Massachusetts, a compelling argument from a knowledgeable professional about the need to broaden the vision to include all children who are at risk could be made. Imagine the drop in juvenile justice cases, the increase in graduation rates, the lessening of theft for drug money, the drop in opiate overdose cases, the drop in domestic violence, the savings to the medical system, the jails and prisons that could be closed, and even the savings to the health insurance companies followed by premiums being lowered!

Just imagine! Our united voices can write such a future, and make even more happen! c Sis Wenger is NACoA’s President and CEO.

References

Centers for Disease Control and Prevention (CDC). (2016).

About the CDC-Kaiser ACE study.

Retrieved from https://www. cdc.gov/violenceprevention/acestudy/about.html Quinn, G. (2016). Everything you need to know about the new Massachusetts opioid law. Boston.

Retrieved from http://www.bostonmagazine.com/ news/blog/2016/03/14/massachusetts-opioid-law/

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CULTURAL TRENDS

Uncharted Waters:

Navigating the Madness

of Designer Drugs, Part I Maxim W. Furek, MA, CADC, ICADC

T

hey seemed to emerge out of nowhere; strange products labeled “not for human consumption� with names like Tranquility, Hurricane Charley, Spice, and K2.

Suddenly bath salts and synthetic cannabinoids appeared on shelves of gas stations and convenience stores throughout the country. They had previously been sold over the Internet through a clandestine network known mainly to drug experimenters. Now they had arrived in suburbia.

In parts one and two of this column I will present a list of ten substances.

They fall into the categories of substituted cathinones, synthetic cannabinoids, synthetic opioids, piperazines, and phenylethylamines. These are designer drugs, substances that attempt to mimic known illegal drugs including hallucinogens and opioids. All reside in www.counselormagazine.com

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CULTURAL TRENDS the aforementioned “uncharted waters” and present a clear and present danger.

Benzo Fury (5-APB or 6-APB)

Benzo Fury is in a class of drugs called piperazines, which include TFMPP, mCPP, and BZP. Benzo Fury acts like both amphetamines and hallucinogens (“New legal,” 2013). The party drug is available over the Internet, at music festivals, and in clubs. It sells for about $15 per pill and this “legal high” is believed (by users) to be safer than other similar illegal substances.

Benzo Fury came on to the UK club scene in 2010. It has since been banned for a twelve-month period while it is being “assessed.” Piperazines and especially BZP have been used as additives to ecstasy when high-quality MDMA was not available.

The substance effects brain receptors of the hormone serotonin, structurally similar to MDMA but more powerful.

That may lead to dangerous high blood pressure by causing constriction of the blood vessels. Other problems include jitteriness, hyperthermia, and seizures.

Dragonfly (Bromo-benzodifuranyl-isopropylamine)

According to Joseph Lee, MD, ABAM, the director of the Hazelden Betty Ford Foundation Youth Continuum, “Bromo Dragonfly is one of the dozens of designer hallucinogens with an increased presence in our communities. There are many cousins of Dragonfly, most famously the ‘2C’ drugs, such as 2C-B and 2C-E. All of these chemicals work on serotonin, and change the way we feel and experience the world through our thoughts and senses” (Lee, 2011). The drug is typically sold either as a powder or spotted on blotter paper.

According to Drug-Rehabs.org, Synthesis of the drug was first achieved in 1998 in the United States, in the laboratory of the prominent pharmacologist, David E. Nichols. The first chemist to synthesize the drug was Matthew Parker. Its name followed on from a number of compounds in the previously synthesized dihydrofuran series, which had been given the informal name of FLY. However, Dragonfly was found to be considerably more potent than any of these earlier drugs (“Dragonfly,” 2016).

Dragonfly is a drug with mind-altering effects similar to that of LSD. The drug causes hallucinations and users are usually incoherent and exhibit severe muscle breakdown. The drug remains in the system for days.

Flakka ( -Pyrrolidinopentiophenone, O-2387, alpha-PVP)

Also referred to as “gravel,” this stimulant compound, the newest member of the bath salt family, is more potent than current cathinones. The route of administration is usually intranasal, but the drug can be vaped, smoked or taken orally.

Alpha-PVP was developed in the 1960s and related to pyrovalerone, a novel designer drug. Its primary component, alphaPVP, is often used in combination with other drugs. Seizures of the drug have identified the adulterants methamphetamine, 14

Counselor · October 2016

Klonopin, and bath salts. The drug is believed to be manufactured in China. According to The Washington Post, Chinese chemists continue to have a growing influence on the kinds of drugs entering the US and “In 2015, China banned 116 different synthetic drugs, according to reports, including fentanyl and the deadly flakka, a drug that put South Florida in crisis mode.

Since then, flakka has all but disappeared” (Mettler, 2016).

Alpha-PVP improves productivity, wakefulness, motivation, locomotion, and endurance. Negative effects have included delusions, hallucinations, and erratic behaviors. The drug is highly addictive.

Krokodil (Desomorphine)

Known as the “Zombie Drug,” Krokodil is a synthetic opioid producing a high similar to heroin, but much cheaper in cost.

Krokodil is highly addictive and physically destructive. The krokodil high lasts approximately 1.5 hours.

Krokodil is related to the drug desomorphine, introduced in 1932 as a less addictive form of morphine. Krokodil was first observed around 2002 in Siberia and the Russian Far East where it is extremely popular. Desomorphine is roughly one-tenth the cost of heroin and made from codeine tablets combined with substances like gasoline, paint thinner or lighter fluid (“Krokodil,” 2013). The manufacturing of this drug is dangerous and, like methamphetamine, leaves several pounds of hazardous waste. It can be made with ordinary ingredients including iodine, hydrochloric acid, lighter fluid, and red phosphorus.

Consequences of using the drug include destruction of internal organs and susceptibility to infections including HIV, hepatitis C, and other blood-borne diseases. Compromised immune systems are highly likely to occur with intravenous krokodil abuse. The drug ruptures blood vessels and rots the flesh around the injection site—human flesh turns grey, green, and scaly, hence the “krokodil” nickname. The life expectancy of a regular krokodil user is under two years (“Krokodil,” 2013).

In my next column I will provide an overview of the next five designer drugs in the list. 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

“Dragonfly.” (2016). Retrieved from http://www.drug-rehabs.org/research/dragonfly.htm “Krokodil, the flesh-eating street drug that rots skin from insideout, expands to Illinois.” (2013). Retrieved from http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html Lee, J. (2011). Dragonfly: What this deadly new drug means for your family. Retrieved from http://www.doctoroz.com/article/ dragonfly-what-deadly-new-drug-means-your-family Mettler, K. (2016). This new street drug is 10,000 times more potent than morphine, and now it’s showing up in Canada and the US. The Washington Post. Retrieved from https://www.washingtonpost.com/news/morning-mix/wp/2016/04/27/this-new-street-drug-is-10000-times-more-toxic-than-morphine-and-now-its-showing-up-in-canada-and-the-u-s/ “New legal drug ‘Benzo Fury’ may harbor addiction risk.” (2013).

Retrieved from http://www.foxnews.com/health/2013/04/09/new-legal-drug-benzo-fury-may-harbor-addiction-risk.html

OPINION

Reliable Identification of Borderline Intellectual Functioning Jerrold Pollak, PhD

B

orderline intellectual functioning is included in the DSM-5 as one of many V codes, or “other conditions that may be the focus of clinical attention” (APA, 2013). In the DSM-IV this condition was defined as having an IQ falling within the range of seventyone to eighty-four. The DSM-5 does not specify an IQ range, but states that it is important to differentiate borderline 16

Counselor · October 2016

intellectual functioning from mild intellectual developmental disorder based on “careful assessment of intellectual and adaptive functioning and their discrepancies” (APA, 2013).

Below average cognition—that is, cognition falling within the range warranting the designation of borderline intellectual functioning—is relatively common among clients with a broad

range of difficulties seen by counselors (Koenen et al., 2009). Despite its fairly high prevalence in clinical practice, it can be difficult to reliably identify borderline intellectual functioning particularly among adults who may “age out” of some of the more obvious manifestations of this condition and/or appear to possess adequate verbal and social interaction skills. Such a clinical presentation

OPINION frequently results in an overestimation of the general level of cognitive/intellectual and adaptive functioning.

Individuals with borderline intellectual functioning have early-onset problems with academic learning and many have associated difficulties with attention, concentration, social interaction, and effective coping. Consequently, this condition is frequently confused with neurodevelopmental disorders, in particular attention deficit disorder, autism spectrum disorder (mild severity), and specific learning disorder.

The DSM-5 diagnosis of specific learning disorder does not require the results of IQ testing, although criterion B stipulates confirmation of this diagnosis by formal psychoeducational assessment.

This type of evaluation often, but not always, involves completion of a standardized test of intelligence. Yet, many persons diagnosed with specific learning disorder—especially those at the moderate and severe levels of impairment as defined in the DSM-5—have IQs that fall within the range warranting the designation of borderline intellectual functioning.

Additionally, lower general intellectual functioning is a significant risk factor for the development of psychiatric disorders (Wieland, Kapitein-de Haan, & Zitman, 2014). Borderline intellectual functioning is also a significant risk factor for treatment noncompliance and poor treatment outcome due to persistent problems with attention, concentration, memory, comprehension, reasoning, and problem solving. As well, it is a good predictor of adverse psychosocial consequences, notably limited academic and vocational achievement, chronically low self-esteem, personality difficulties, and recurrent adjustment problems (Peltopuro, Ahonen, Kaartinen, Seppälä, & Närhi, 2014; Wieland, Van Den Brink, & Zitman, 2015).

Individuals with borderline intellectual functioning are also vulnerable to diagnostic overshadowing. This is a common error in clinical judgment whereby established medical and/ or mental health diagnoses serve to obscure other important aspects of a client’s clinical status, including significant difficulties with cognitive/information processing that can contribute

to the development and persistence of psychiatric symptoms.

For all of these reasons, it is important to reliably identify this condition to facilitate optimal intervention. The following indicators strongly raise the index of suspicion for borderline intellectual functioning: • “Across the board” difficulties with the acquisition of academic skills evident by the early elementary school years • History of psychoeducational assessment and/or special education for presumptive attentional, learning, and/ or other neurodevelopmental difficulties • Deficits in social competence and/or judgment • Limited formal schooling and vocational attainment which are not well explained by sociocultural factors, a trauma history, one or more neurodevelopmental disorders, and/or major mental illness Review of educational and psychoeducational records and a client’s mental health history, together with updated psychological and neuropsychological testing is the most reliable way to determine if a client warrants the designation of borderline intellectual functioning.

Testing should involve administration

of a gold standard test of global cognitive/intellectual functioning— Wechsler Adult Intelligence Scale-IV (WAIS-IV), the Stanford-Binet-5 or the WoodcockJohnson Test of Cognitive Abilities-IV—as well as a gold standard measure of adaptive functioning such as the Adaptive Behavior Assessment System-3 or the Vineland Adaptive Behavior Scales-II. c Jerrold Pollak, PhD, is a clinical and neuropsychologist for the program in medical and forsensic neuropsychology at Seacoast Mental Health Center in Portsmouth, New Hampshire. He is also is a member of the Emergency Services Department at Seacoast.

References

American Psychiatric Association (APA). (2013).

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

Koenen, K. C., Moffitt, T. E., Roberts, A. L., Martin, L. T., Kubzansky, L., Harrington, H., . . . Caspi, A. (2009). Childhood IQ and adult mental disorders: A test of the cognitive reserve hypothesis.

American Journal of Psychiatry, 166(1), 50–7.

Peltopuro, M., Ahonen, T., Kaartinen, J., Seppälä, H., & Närhi, V. (2014). Borderline intellectual functioning: A systematic literature review. Intellectual and Developmental Disabilities, 52(6), 419–43.

Wieland, J., Kapitein-de Haan, S., & Zitman, F. G. (2014). Psychiatric disorders in outpatients with borderline intellectual functioning: Comparison with both outpatients from regular mental health care and outpatients with mild intellectual disabilities. Canadian Journal of Psychiatry, 59(4), 213–9.

Wieland, J., Van Den Brink, A., & Zitman, F. G. (2015).

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities. Nordic Journal of Psychiatry, 69(8), 599–604.

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17

FROM LEO’S DESK

Spiritual Principles, Part II Rev. Leo Booth

my failure to grow up, emotionally and spiritually. My God, how painful it is to keep demanding the impossible, and how very painful to discover finally, that all along we have had the cart before the horse! Then comes the final agony of seeing how awfully wrong we have been, but still finding ourselves unable to get off the emotional merrygo-round (1958).

I

n my last column I introduced Pelagius and described his relationship to Augustine of Hippo in relation to their spiritual principles. Let’s continue this discussion.

Here is an excerpt from a powerful letter that Pelagius wrote in Defense of Freedom of Will: That we are able to do good is of God, but that we actually do it is of ourselves. That we are able to make a good use of speech comes from God; but that we do actually make this good use of speech proceeds from ourselves. That we are able to think a good thought comes from God, but that we actually think a good thought proceeds from ourselves (Booth, 2012, p. 51).

I love the AA fellowship. This group of men and women invites me to share my ideas and opinions concerning God, recovery, and spirituality. It is not a cult that restricts thinking or the sharing of ideas.

Having said this, there are undoubtedly some who think in order to defend the “purity” of AA—and I’m always suspicious of people who want to defend the “purity” of a cause—we need to resist all 18

Counselor · October 2016

change. Such people are the real obstacles of spirituality and recovery.

Bill W., the architect of the AA fellowship, realized the need to change in order to grow. He did not want the fellowship to become rigid. He also came to understand his personal shortcomings and his need to grow up.

In an article in AA Grapevine he wrote: I think that many oldsters who have put our AA “booze cure” to severe but successful tests still find they often lack emotional sobriety. Perhaps they will be the spearhead for the next major development in AA—the development of much more real maturity and balance (which is to say, humility) in our relations with ourselves, with our fellows, and with God. Those adolescent urges that so many of us have for top approval, perfect security, and perfect romance—urges quite appropriate to age seventeen— prove to be an impossible way of life when we are at age forty-seven or fifty-seven.

Since AA began, I’ve taken immense wallops in all these areas because of

What are the spiritual principles?

Well, for me they must involve a willingness to change. Not change for the sake of change, but change when I was clearly wrong or had misspoke.

Possibly prior to this willingness to change comes courage—to have the basic self-confidence to confront myself and others if I feel we are going in the wrong direction or missing a vital ingredient of recovery.

Today I have the awareness of moving beyond being a “mere” human being to being a vital and creative one infused with the spirit of God, with a spark of the divine.

Lastly, I celebrate the principle of imagination that enables me, in sobriety, to see beyond the words into the essence of spirituality. This important principle enables the personality to become a point of attraction, enabling the newcomer to say, “I want what you have.” 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

Booth, L. (2012). The happy heretic: Seven spiritual insights for healing religious codependency.

Deerfield Beach, FL: Health Communications, Inc. Wilson, B. (1958). The next frontier: Emotional sobriety. Retrieved from http://silkworth. net/aahistory/emotionalsobriety.html

WELLNESS

Wellness in Recovery from Eating Disorders John Newport, PhD

E

ating disorders represent a complicated cluster of conditions within the realm of addiction that often occur within the context of a prior history of alcoholism and/or drug addiction. In this column I will initially highlight commonalities and differences pertaining to treating both classes of disorders. I will then discuss the application of basic wellness principles in treating eating disorders and promoting sustained recovery.

Commonalities and Contrasts

Clearly both eating disorders and substance abuse are devastating, life-threatening diseases in which peoples’ lives become unmanageable unless successful intervention is brought to bear. Both classes of disorders entail either compulsive use of a drug of choice or compulsive repetition of a highly dysfunctional pattern of behavior.

In addition, a growing body of evidence points to a genetic predisposition to both types of disorders (Costin & Grabb, 2011).

Personal observation leads me to believe that people suffering from both classes of addiction tend to exhibit extremely compulsive patterns of behavior. Whereas in chemical dependency the obsession centers primarily on maintaining a supply of drugs and pursuing the next high, in the realm of eating disorders we find that many if not most anorexics exhibit heightened, compulsive, perfectionistic tendencies as integral components of their personalities.

For obvious reasons the abstinence model employed in most approaches to treating chemical dependency does not apply to treating eating disorders.

As we must eat in order to live, in treating eating disorders the emphasis is on helping clients attain a proper and balanced perspective regarding the role of food in their lives.

In addition, as Costin and Grabb point out, application of the Twelve Step, abstinence-based treatment model often entails a “black or white,” “all or nothing” mode of thinking (2011). In contrast, eating disorder treatment specialists are inclined to view their role as helping clients become more

comfortable in dealing with the gray areas of life.

Another distinction pertains to the ultimate goal of recovery. While the abstinence-based model views recovery as an ongoing, lifelong process, eating disorders specialists tend to view the ultimate goal of treatment as enabling clients to completely eliminate the eating disorder from their lives, at which point clients are deemed to be fully recovered (Costin & Grabb, 2011).

Eating Disorder Interventions

The following is a brief recounting of two eating disorder interventions I instigated over the course of working in the addictions field for a number of years.

Working in an acute psychiatric hospital setting in the early 1990s I led a weekly wellness in recovery group. One of the patients was a very pleasant young woman in treatment for anorexia. Her compulsive perfectionistic nature came forth full force one afternoon as she vociferously complained about an “obnoxious” painting of a barn hanging on the wall. She remarked that her father was an artist who loved to paint pictures of barns, exclaiming that he would never tolerate such a disgraceful work of art!

Intrigued by her strident criticism of the painting, I asked if she had ever noticed any perfectionistic tendencies in herself. She readily admitted to this and I responded, “Carolyn (not her real name), I’m giving you a homework assignment. The next time you attend occupational therapy, I want you to spend the entire session sketching the most crazy, off-the-wall pictures of barns you can imagine.” She proceeded with the assignment, and later told me that through conducting this exercise she experienced a real breakthrough in directly confronting her perfectionism.

Years later I was lecturing on Gorski’s postacute withdrawal syndrome to a substance abuse counseling class at a local community college. During my talk a student commented that she was extremely frustrated with her weight gain ever since she quit her addiction to speed. Seeing before me an attractive young woman who appeared to have no weight problem whatsoever, I responded, “Tara (not her real name), I would like to try an experiment.

I will present two questions to the class: ‘How many of you www.counselormagazine.com

19

WELLNESS believe Tara is overweight?’ and ‘How many of you believe she looks pretty damn good just the way she is?’” The greater majority of students, especially the guys, responded affirmatively to the second question. I then told Tara, “You know, I am here as a teacher, not a clinician. As such it is not my role to engage in diagnostic assessment. You may, however, consider reflecting on whether you might be experiencing some symptoms of an eating disorder.” She approached me after class and thanked me for my observation. She added that she had a history of anorexia and realized that she evidently had some more work to do in that area.

Wellness Applications in Recovery from Eating Disorders

In my book The Wellness-Recovery Connection (2004) I discuss the application of basic wellness principles in recovery from addiction. These include nutritional restructuring, exercise, stress management, meditation, building a strong support system in recovery, and imbuing one’s life with a robust sense of purpose.

. . . eating disorders and substance abuse are devastating, life-threatening diseases in which peoples’ lives become unmanageable unless successful intervention is brought to bear.

Enlightened treatment professionals in both the substance abuse and eating disorders fields agree to the importance of pursuing balance in our nutritional intake. If I were counseling a recovering alcoholic who aspired to follow a vegetarian diet, I would probably encourage my client to move in that direction and consider adopting the Mediterranean diet as an intermediate step (“Mediterranean,” 2015). In recognition of the fact that most eating disorder patients have locked themselves into an extremely rigid set of selfimposed rules regarding their food choices, most eating disorders specialists advocate adherence to common sense “conscious eating guidelines” as distinct from attempting to follow any particular dietary regimen (Costin & Grabb, 2011).

Likewise, for a variety of reasons I strongly recommend regular physical exercise as an integral component of recovery from alcoholism and drug addiction. Eating disorder specialists, however, must confront the reality that many of their clients risk sabotaging their recovery through exercise addiction. Compulsive exercise often manifests itself in these patients as either a compensatory measure to counteract bingeing or, in the case of many anorexics, as part and parcel of their overriding obsession with avoiding weight gain at all costs. While we may differ regarding the particulars, we are in full agreement concerning the importance of a balanced approach to exercise in recovery.

A seasoned psychotherapist often reminds me that “under 20

Counselor · October 2016

stress we regress.” Hence, acquiring the skills needed to effectively manage day-to-day stresses is an important component in recovery from both substance abuse and eating disorders. Particularly effective modalities for taking the edge off stressors in our lives include both contemplative and active forms of meditation—such as yoga or tai chi— and cultivating the practice of mindfulness (Fields, 2008; Marlatt & Gordon, 2005).

As many counselors believe that addiction is often a manifestation of loneliness combined with a perceived lack of meaning in one’s life, experts in both the substance abuse and eating disorder fields endorse the importance of nurturing a healthy support system in recovery, together with cultivating and embracing a strong sense of purpose in life. In The Wellness-Recovery Connection I devote a chapter to “Cultivating Your Central Purpose, Spirituality, and Life Satisfaction” (2004).

A Final Note for Counselors

Due to the high degree of overlap between addiction to alcohol and other drugs and the presence of an eating disorder, substance abuse counselors need to be on the lookout for possible signs of eating disorders and make appropriate referrals for evaluation. This is particularly true during the continuing case phase of treatment, when “substitute addictions” often emerge.

In summary, while treatment of both substance abuse and eating disorders incorporate a number of parallel principles and approaches, the complexities entailed in the etiology and treatment of eating disorders may mitigate significant departure from generally accepted models of substance abuse treatment. Both treatment models, however, promote a balanced approach to sustained recovery from devastating, lifethreatening addictions. They also embrace the basic tenets of wellness and recovery in laying a firm foundation for sustained recovery, with particular emphasis on promoting dramatically improved quality of life in recovery. As always, feel free to share this column with 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 Wellness-Recovery 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

Costin, C., & Grabb, G. S. (2011). Eight keys to recovery from an eating disorder: Effective strategies from therapeutic practice and personal experience. New York, NY: WW Norton & Company.

Fields, R. (2008). Awakening to mindfulness: Ten steps for positive change. Deerfield Beach, FL: Health Communications.

Marlatt, G. A., & Gordon, J. R. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York, NY: Guilford Press.

“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.

THE INTEGRATIVE PIECE

Smoker No More Sheri Laine, LAc, Dipl. Ac

M

ark is a sixty-nine-year-old family man who is still gainfully employed as a machinist. He was also a lifelong smoker and had no intention to quit, even though he knew it was not in his best interest.

Then came his moment of truth.

Mark received a very scary report from his family doctor following a routine physical: a lung x-ray revealed a specious spot on his lung. Then and there Mark made a decision to stop smoking once and for all.

Mark’s wife, a patient of mine, had been begging her husband to quit for years. She wasted no time bringing him to my clinic.

In truth, Mark was quite easy to treat since he had already made a firm decision to quit, no matter what.

Most long-time smokers have trouble sticking with their plans to stop “cold turkey” even when they have made up their minds to do so. The psychological—and in the case of nicotine, the physical—cravings often result in initial failure, which is why many smokers report several attempts to quit before finding success.

This is where acupuncture and other natural therapies including exercise, hypnotherapy, and mindfulness practices can really help break the addiction cycle.

During his acupuncture treatments, Mark shared with me that since he made his decision to quit smoking, he felt more in control of his life than he had for many years. Together, we developed a plan of action so Mark could achieve his goal to remain a nonsmoker.

Mark began each day by getting up and immediately going to his backyard patio for his first cup of coffee and his first cigarette of the day while he checked his e-mails. We broke this habit by having Mark get dressed and out of the house as quickly as possible and start the day with a brisk walk around his block. On his return, he would then have his cup of coffee and check his computer.

Needless to say, Mark was more relaxed after moving his body and releasing the “feel-good” hormones in his brain.

By moving his qi, he found a sense of peace and calmness.

With increased exercise, Mark found it easier to keep his cravings at bay.

In addition, I taught Mark a little trick. I told him to take a cooking clove—the kind you use on a ham—and place it in the back of his mouth toward his last molar. Gently, as he pressed down on the clove with his tongue, the oily taste would be released into his mouth. This helps to alter the craving for the taste of nicotine.

We also discussed ways for Mark to rearrange his patio so it became a place of relaxation—more like a retreat area to read, listen to music, and visit with friends and family and less like a smoke stop. This meant renovating with paint,

furniture, and plants.

In observing smokers over the years, I’ve noticed they use cigarette breaks as a way of taking a relaxing deep breath.

Consider; by taking a drag of a cigarette, smokers are breathing in to inhale and breathing out to exhale smoke.

I taught Mark another trick by suggesting he cut down a regular drinking straw to the size of a cigarette and use it as a new inhale and exhale tool. This helped him with the tactile sensation of holding a cigarette between his fingers, which is also a part of the smoking ritual. Substituting a straw for a cigarette can help the initial transition. By week three, Mark was able to lose the straw completely.

Studies show that it takes three weeks to form new habits in the basal ganglia, which is the part of the brain that creates action, thus playing an important role in planning actions that are required to achieve a particular goal. Most nicotine addicts report that the initial three weeks are the most difficult in which to overcome their cravings. Once you cross this time barrier, success is far more attainable.

Immediately, acupuncture was an enormous help to Mark.

The twice-a-week treatments kept him relaxed through his acute stages of withdrawal from nicotine. In addition, I sent him home with ear pellets, which remain in the ear, stimulating the twelfth vagus nerve, which passes through to the brain releasing calming hormones. Whenever he needed a stronger stimulus for relaxation, he could press down on the pellets with his fingertips.

Acupuncture is a viable, evidence-based solution to smoking cessation. What makes the smoking cessation treatment unique is the fact that the needling can be done in a group setting or one-on-one. In a group setting, the acupuncture needles are placed on the inside of both of one’s ears and the patients are seated in a comfortable chair. In a more private setting, patients lay on a table with needles in one or both ears and on the body as well.

Mark is no longer a smoker. He is a regular exercise enthusiast, has lost twenty-five pounds, and has come to appreciate the benefits of a healthy lifestyle, which includes meditation and deep belly breathing. He is no longer dependent on a source outside of himself for calmness and relaxation.

Mark reports a sense of freedom emotionally. He told me recently that quitting smoking was the second best decision of his life; the first being the decision to marry his wife. c Sheri Laine, LAc, Dipl. Ac., author of Living the EnerQi Connection, is a California-state and nationally certified acupuncturist/herbologist licensed in Oriental Medicine. She has been in private clinical practice in Southern California for twenty-five years.

In addition to teaching, Sheri speaks throughout the country about the benefits of integrative living and how to achieve a balanced lifestyle. Please visit her at www.balancedenerqi.com.

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