THE IMPAIRED PROFESSIONAL, PART IV:
INSIDE BOOKS:
PHARMACISTS
YOU’RE TEARING US APART
SUDS:
Most Effective Treatments PATHWAYS TO BETTER OUTCOMES SBIRT & THE MENTORING ANGELS PLUS
EXTENDING THE BENEFITS OF ADDICTION TREATMENT
TWELVE STEP FACILITATION ASIAN SHAME & ADDICTION
Nov/Dec 2015
Vol. 1 No. 2
TREATMENT & RECOVERY
2016 Presiden tial Candidates Talk Addiction pg. 2
INDUSTRY INSIDER
Industry Tren ds: CEUs and Conferences pg. 4
FLIP OVER
Testing Mat ters
pg. 5
Using Data to Improve Outcomes pg. 6 CCAPP Cele brates Year of Firs ts pg. 14
Robert Wei ss: Sex Addi ction 101 & Ashley Madison
December 2015 Vol. 16 | No. 6, $6.95
Carol McDaid: Lobbying for Recovery pg. 15
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CONTENTS Letter from the Editor
32
By Gary Seidler Consulting Executive Editor
Most Common and Effective Treatment Practices for Substance Use Disorders
CCAPP
A Lesser Evil is Still Evil
9 10
By David Gust, LAADC, NCAC-II, CADC-II, & Philip Hodson, RADT-I
Presents information on common models of treatment, describes current treatment practices and their efficacy, and discusses cultural considerations for treatment.
NACOA
What’s Old is New Again
12
By Robert Denniston
By Samantha Sipple, MSW, Danielle Weiss, MSW, Alex Ramsey, PhD, Christina Drymon, MA, and David A. Patterson, PhD
Cultural Trends
Morrison’s Last Whiskey Bar, Part I
38 Outcomes: Developing Better Pathways to Quality Care Explains the value of outcomes, defines three different data combinations, and discusses abstinence-based versus medication-assisted treatment. By Bob Lynn, EdD
14
By Maxim W. Furek, MA, CADC, ICADC
Opinion
Asian Shame and Addiction
16
By Sam Louie, MA, LMHC
From Leo’s Desk
Recovery Needs Spirituality
18
By Rev. Leo Booth
Wellness
Aging and Wellness in Recovery, Part I
20
By John Newport, PhD
44 Beyond SBIRT: Incorporating Recovering Volunteers after the Intervention Describes SBIRT, outlines the Mentoring Angels volunteer program, and provides case studies showing how SBIRT and Mentoring Angels work together.
The Integrative Piece
The Importance of Leisure
22
By Sheri Laine, LAc, Dipl. Ac
Topics in Behavioral Health Care
23
Emotional Health and Well-Being in Recovery, Part I By Dennis C. Daley, PhD
By Jason Joy, MS, LMFT, Sara Bell, BS, and Carl Leukefeld, PhD www.counselormagazine.com
3
President & Publisher PETER VEGSO
A Health Communications, Inc. Publication 3201 SW 15th Street Deerfield Beach, FL 33442-8190 (954) 360-0909 • (800) 851-9100 Fax: (954) 360-0034
E-mail: editor@counselormagazine.com Website: www.counselormagazine.com Counselor (ISSN 1047 - 7314) is published bimonthly (six times a year) and copyrighted by Health Communications, Inc., all rights reserved. Permission must be granted by the publisher for any use or reproduction of the magazine or any part thereof. Statements of fact or opinion are the responsibility of the authors alone and do not represent the opinions, policies or position of Counselor or Health Communications, Inc. Health Communications, Inc., is located at 3201 SW 15th Street, Deerfield Beach, FL 33442 - 8190. Subscription rates in the United States are one year $41.70, two years $83.40. Canadian orders add $15 USD per year, other international orders add $31 USD per year payable with order. Florida residents, add 6 percent sales tax and applicable surtaxes. Periodical postage rate paid at Deerfield Beach, FL and additional offices. Postmaster: Send address changes to Counselor, PO Box 15009, North Hollywood, CA 91615 - 5009 © Copyright 2015, Health Communications, Inc.. Printed in the U.S.A.
Consulting Executive Editor GARY S. SEIDLER Managing Editor LEAH HONARBAKHSH Director of Editorial Communications STEPHEN COOKE Advertising Sales JAMES MOORHEAD Art Director DANE WESOLKO Production Manager GINA JOHNSON Director of Pre-Press Services LARISSA HISE HENOCH 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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Advertising Sales JAMES MOORHEAD Phone: (949) 706-0702 E-mail: jamesm@reneweveryday. com
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TIAN DAYTON, PHD
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
Advisory Board ROBERT J. ACKERMAN, PHD JOAN BORYSENKO, PHD
STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION (AS REQUIRED BY 39 USC 3685, USPS) 1. Publication Title: Counselor: The Magazine for Addiction Professionals 2. Publication Number: 1047-7314 3. Filing Date: 10/1/15 4. Issue Frequency: 6 issues per year 5. Number of Issues Published Annually: 6 6. Annual Subscription Price: $41.70 7. Complete Mailing Address of Known Office of Publication: 3201 SW 15th Street, Deerfield Beach, FL 33442 8. Complete Mailing Address of Headquarters of General Business Office of Publisher (Not Printer): 3201 SW 15th Street, Deerfield Beach, FL 33442 Contact Person: Leah Honarbakhsh; Telephone: 954-360-0909 x 211 9. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor: Publisher: Peter Vegso, 3201 SW 15th Street, Deerfield Beach, FL 33442 Editor: Leah Honarbakhsh, 3201 SW 15th Street, Deerfield Beach, FL 33442 10. Owner: Health Communications, Inc., 3201 SW 15th Street, Deerfield Beach, FL 33442 11. Known Bondholders, Mortgages, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages or other Securities: None 12. N/A 13. Publication Title: Counselor: The Magazine for Addiction Professionals
4
Counselor · December 2015
14. Issue Date for Circulation Data Below: December 2014–October 2015 15. Extent and Nature of Circulation Avg No. Copies No. Copies of During Preceding Single Issue 12 Mos Published Nearest to Filing Date a. Total Number of Copies (Net Press Run) 12,851 11,425 b. Paid and/or Requested Circulation 1. Paid/Requested Outside-County 8,965 7,657 2. Paid/Requested In-County 0 0 3. Sales Through Dealers and Carriers, and Counter Sales 2,292 420 4. Other Classes Mailed Through USPS 90 105 c. Total Paid and/or Requested Circulation 11,347 8,182 d. Free Distribution by Mail 1. Outside County 0 0 2. In-County 0 0 3. Free or Nominal Rate Copies Mailed 0 0 4. Free or Nominal Rate Distribution Outside Mail 966 2,705 e. Total Free or Nominal Rate 966 2,705 f. Total Distribution 12,313 10,887 g. Copies Not Distributed 538 538 h. Total 12,851 11,425 i. Percent Paid and/or Requested Circulation 92% 75% 16. Statement of Ownership will be published in the December 2012 issue of this publication. 17. Signed by Leah Honarbakhsh, Associate Editor, 10/1/205
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CONTENTS Research to Practice A Closer Look at fMRI Photographs
25
By Michael J. Taleff, PhD, CSAC
Counselor Concerns
Documenting Substance Use and Potential for Withdrawal
27
By Gerald Shulman, MA, MAC, FACATA
Substance Abuse in Teens Developing Empathy in Adolescents
50 Extending the Benefits of Addiction Treatment: An Interview with James R. McKay, PhD Presents Dr. McKay’s career history and describes his influence on continuing care studies.
29
By William L. White, MA
By Fred J. Dyer, MA, CADC
Ask the LifeQuake Doctor By Toni Galardi, PhD
Inside Books
You’re Tearing Us Apart: Twenty Ways We Wreck Our Relationships and Simple Ways to Repair Them By Pat Love, EdD, Eva Berlander, and Kathleen McFadden
30
From the Journal of Substance Abuse Treatment
72
Is Level of Exposure to Twelve Step Facilitation Associated with Treatment Outcome? Describes the STAGE-12 intervention, explains the various tools used to measure participant exposure and motivation, and presents an overview of study outcomes.
Reviewed by Leah Honarbakhsh
ALSO IN THIS ISSUE Ad Index Referral Directory CE Quiz
By Elizabeth A. Wells, PhD, Dennis M. Donovan, PhD, Suzanne Doyle, PhD, and Mary A. Hatch-Maillette, PhD
68 69 70
60 Treating the Addicted Pharmacist: Defining the Issues Assesses addiction education in pharmacy schools, lists addiction risk factors for pharmacists, and provides resources for counselors. By Wallace J. Cross, RPh, MHS, CADC, Jeffrey N. Baldwin, PharmD, RPh, FAPhA, FASHP, Brian E. Fingerson, BS Pharm, RPh, FAPhA, & Merrill Norton, PharmD, DPh, ICCDP-D
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Counselor · December 2015
54
The Impaired Professional, Part IV
LETTER FROM THE EDITOR
Lives to Remember As summer came to a close, and within a seventy-two-hour span, we lost three brilliant individuals who made extraordinary contributions to our understanding of the human condition. All of us interested in enlightenment and personal growth—which most often includes those of us in directly involved in mental health treatment and addiction recovery—owe our gratitude to: • Oliver Sacks (1933–2015) • Garrett O’Connor (1937–2015) • Wayne Dyer (1940–2015) Oliver Sacks, MD, was a great storyteller who spent his life bridging science and the human spirit. A renowned neurologist and writer, Dr. Sacks explored the mysteries of the human brain in a series of best-selling books including The Man Who Mistook His Wife for a Hat, Awakenings, and The Island of the Colorblind—all about unusual medical conditions. London-born, Dr. Sacks worked in recent years as professor of neurology at the NYU School of Medicine. The New York Times called him the “Poet Laureate of Medicine.” Garrett O’Connor, MD, a leading Irish psychiatrist, was in personal recovery from alcoholism for over thirty-five years and is widely known for using his own life story as a tool for teaching patients, medical students, and fellow physicians about recovery. Dr. O’Connor, former president and first CEO of The Betty Ford Institute, received a Lifetime Achievement Award in 2011 from the California Society of Alcoholism. The inscription read, “Garrett O’Connor, who speaks for the ‘invisible people’ and inspires us to do the same.” Dr. O’Connor’s expertise and background in addiction treatment and psychiatry are unparalleled. Wayne Dyer, a self-help pioneer and spiritual teacher, is known to millions of fans as the “Father of Motivation.” He
spent part of his childhood in orphanages and foster homes before serving in the US Navy and then earning his doctorate in educational counseling. His first book, Your Erroneous Zone, is one of the best selling books of all time. After publishing a string of best-selling books and ten PBS specials on the practical psychology of self-improvement, Dyer focused on the spiritual aspects of human experience. He said, My purpose is to help people look at themselves and begin to shift their concepts. Remember, we are not our country, our race or our religion. We are eternal spirits. Seeing ourselves as spiritual beings without label is a way to transform the world and reach a sacred place for all of humanity. This holiday season, as we spend time with friends and family, think about loved ones who have passed, and continue on our journey of helping those who suffer from addiction and behavioral health disorders, we remember these influential members of the field and share their messages of hope and service. Happy holidays.
Gary Seidler
Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication
www.counselormagazine.com
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CCAPP
A Lesser Evil is Still Evil David Gust, LAADC, NCAC-II, CADC-II, & Philip Hodson, RADT-I
W
ithin the chemical dependency treatment field, it is widely accepted that clients greatly improve their odds of remaining in recovery when they adhere to a strict policy of total abstinence. For instance, it is never advisable to suggest to a heroin addict that switching to alcohol is an acceptable path to recovery. By various neurochemical processes, all substances of abuse make it easier to either suppress or avoid unpleasant and distressing emotions, or to artificially alter one’s perceptual experience. Some clients prefer the feeling of intoxication from alcohol to that from methamphetamine or heroin. Furthermore, certain clients possess neurotransmitter dysregulations that predispose them to affinities for their respective drugs of choice. Regardless, real recovery from addiction of any sort cannot truly begin until all barriers between clients and reality have been removed. As we see it, the problem is that, although we are doing a better job of helping clients to move from active addiction to recovery, we still stand to lose over half of the clients who enter some form of chemical dependency treatment protocol to premature death. Why? It’s because we do not adequately address their concurrent addictions to tobacco (Richter, Ahluwalia, Mosier, Nazir, & Ahluwalia, 2002). Based on studies published in 1996 and 2002, persons with substance use disorders are three times more likely to smoke cigarettes than those with no substance use disorder (Richter et al., 2002); when they quit, smokers who are either alcoholic or drug-addicted quit at less than half the rate of the rest of the population; and, lastly, over half of the deaths recorded in the earlier, retrospective study were attributed to tobacco-related causes (50.9 percent). The next closest cause of premature death was attributable to alcohol at 34.1 percent (Hurt et al., 1996). Now, 10
Counselor · December 2015
this does not mean that there were no cases of successful recovery in this population, and we do not mean to say that participants’ lives did not improve, but with so many deaths attributed to preventable causes, how successful is treatment that does not address abstinence from tobacco products? According to the Centers for Disease Control and Prevention (CDC), cigarette smoking accounts for more than 480,000 deaths in the US each year, dwarfing the mortality figures for all drugs of abuse—legal and illegal— combined (2014). When viewed rationally, the case for quitting smoking is overwhelmingly plain, but the disease of addiction is anything but rational. Addicts and alcoholics are apt, during attempts to moderate or cease their use of one substance, to switch drugs of choice. They may figure, “I need something to help me with stress, but I can’t risk another DUI, so I’ll stop drinking and only smoke pot.” We believe that those with substance use disorders are
not so much addicted to one particular substance as they are addicted to intoxication: if they are not committed to total abstinence, then they will use whatever is available to change the way they perceive themselves and the world around them, and the fewer negative experiences they have had with a substance, the more likely they are to switch to it. Cigarettes—and tobacco products in general—do not possess the same intoxicating properties as other drugs of abuse; they do not break families apart; they do not contribute to job loss; they do not have the same capacity to exacerbate the symptoms of mental illnesses. In short, they do not create or perpetuate the kinds of negative consequences and problematic thinking and behavior that addicts and alcoholics in early recovery are most trying to avoid. Despite widely available data on the dangers of cigarette smoking, many treatment facilities continue to allow their clients to smoke, believing it more
CCAPP prudent to focus on one addiction at a time. While it is highly likely that a newly arrived client’s presenting alcohol or other substance use disorder constitutes a more immediate risk to that client’s physical and mental health, there is strong evidence to suggest that starting a smoking cessation plan or a regimen of nicotine replacement therapy in early recovery will, contrary to prevailing opinions, improve said client’s chances of long-term recovery. Writing for the National Institute on Drug Abuse (NIDA), Eric Sarlin, MEd, MA, citing a paper published in Psychological Medicine, states, “Smoking cessation appears unlikely to hinder and may even help recovery from substance use disorders and from mood and anxiety disorders (M/ADs)” (2014). He goes on to say that, of the study participants who quit smoking entirely, 69 percent “reported fewer continuing or recurrent DUDs (drug use disorders),” at follow-up. Similar reductions were noted by those suffering from alcohol use disorders (AUDs) and M/ADs (reductions of 36 percent and 30 percent, respectively). Because of several factors, the report stops short of saying whether there is a causal link between smoking cessation and better treatment outcomes, but the data bear out the fact that “smoking cessation is highly compatible with recovery from mental disorders” and “was still significantly associated with reduced risk for a new-onset DUD” (Sarlin, 2014). Based on these data, we now know that it is not just possible but prudent to engage in smoking cessation at a time concurrent to normal chemical dependency treatment. This does not, however, mean it will be easy. Approaching an irrational problem rationally rarely yields the results we might envision. Instead, we prefer to take a more conceptual view of the transition to and maintenance of recovery. When discussing substance abuse or, in the case of this article, cigarette smoking, we choose to focus on what clients stand to gain rather than on what they may have to give up. Cigarettes may appear to help clients with anxiety in the moment, but they do nothing to affect the cause of the anxiety. When we work with clients who are
still in active addiction, it is as though they are drowning: the desire to use can be as strong as the desire to take a breath. To try to draw breath underwater is to die, but they are powerless to do anything else. Should they deny this instinctual desire and manage to reach the surface, they are, at first, just happy to be alive. But after they have had a few moments to orient themselves to their surroundings, they are told to start swimming, lest they again risk drowning. Extending this metaphor to recovery, we would talk of the freedom clients might experience in the swim alone, or we might say that, upon reaching the distant shore, they will have the autonomy to plot their new lives’ courses. We discuss gratitude and humility. We remind them that knowing one’s limitations is honesty, not restriction. Just because something seems impossible doesn’t make it so. The decision to continue smoking cigarettes in recovery is a manifestation of clients’ desire to believe again that which they have already declared a fallacy: the idea that addiction is a continuum, that one addiction is better or worse than any other. We can no longer dismiss an addiction to tobacco as “less bad” than other addictions. If we do this, we are only helping clients to create an abbreviated, circumscribed version of recovery, cut short not by relapse but by death. c
David Gust, LAADC, NCAC-II, CADC-II, has been a member of the chemical dependency treatment field since 1978. He founded the New Directions Program, an outpatient counseling practice in Fair Oaks, CA, in 1981. He is a graduate of the Hazelden Foundation Chemical Dependency Counselor Training program. He works with adult male clients and their families. Philip Hodson, RADT-I, has been a member of the chemical dependency treatment field since 2013. He works in both inpatient and outpatient facilities and works with adolescent and young adult males at New Directions Program. In addition to his studies in the chemical dependency treatment field, Philip holds BAs in economics and French from Hamden-Sydney College.
References
Center for Disease Control and Prevention (CDC). (2014). Increases in heroin overdose deaths – twentyeight states, 2010 to 2012. Retrieved from http://www. cdc.gov/mmwr/preview/mmwrhtml/mm6339a1.htm Hurt, R. D., Offord, K. P., Croghan, I. T., GomezDhal, L., Kottke, T. E., Morse, R. M., & Melton, L. J. III. (1996). Mortality following inpatient addictions treatment. JAMA, 275(14), 1097–103. Richter, K. P., Ahluwalia, H. K., Mosier, M. C., Nazir, N., & Ahluwalia, J. S. (2002). A population-based study of cigarette smoking among illicit drug users in the United States. Addiction, 97(7), 861–9. Sarlin, E. (2014). Smoking cessation does not interfere with recovery from substance use. Retrieved from http://www. drugabuse.gov/news-events/nida-notes/2014/10/smoking-cessation-does-not-interfere-recovery-substance-use
www.counselormagazine.com
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NACOA
What’s Old is New Again Robert Denniston
T
wo drug-related issues have received a lot of public and media attention recently: the dramatic rise in deaths from opioids, and the growing legalization of marijuana in several states with expectations of more states still to come. While not trivializing those serious drug problems, we should recognize that alcohol remains the most harmful of drug problems, getting worse in some respects, even while there is some good news. As the fourth leading preventable cause of death, excessive drinking costs the US some $223.5 billion annually, which works out to about $1.90 per drink consumed as of 2006. With nearly ninety thousand deaths attributable to excessive drinking, more than 2.5 million years of potential life are lost annually (Stahre, Roeber, Kanny, Brewer, & Zhang, 2014). Most recently, Grant et al. (2015) reported that twelve-month and lifetime prevalence of alcohol use disorders (AUDs) were 13.9 percent and 29.1 percent, representing nearly 33 million people and 68 million people respectively, revealing a significant increase in AUDs over the past decade. Additionally, heavy drinking is a growing problem among young adults and “emerging adulthood is becoming an increasingly vulnerable period for AUD onset” as the authors report (Grant et al. 2015). But there is some good news! In its recent “Report to the Congress on the Prevention and Reduction of Underage Drinking,” SAMHSA (2013) reported a 26.7 percent decline in past-month alcohol use and a 35 percent drop in binge drinking among twelve- to seventeenyear-olds over the years 2004–2012. Yet the downside is that girls are catching up with boys, and 35 percent of twenty-year-olds binged at least once in the past month. In fact, an estimated 92 percent of all alcohol consumed by 12
Counselor · December 2015
youth is in the form of binge drinking. What do we make of these trends? It’s hard to know for sure, but we do know that adult drinking has an impact on youth drinking and other problems, and therefore we should expect over the long-term that adult drinking patterns will continue to harm youth, both directly and indirectly. For example, the Adverse Childhood Experiences (ACE) studies clearly established that certain parental behaviors—including child abuse and neglect, violence, separation and divorce, and alcohol problems—increase the likelihood that those children will develop a wide range of social and health problems, including early onset of drinking and, over time, alcohol dependence. The ACE studies have been widely cited to support increased efforts to reduce negative influences on children, especially in the mental health field. In a major study Anda and colleagues (2002) observed that growing up with alcohol-abusing parents substantially increased the risk of each adverse experience as well as the risk of multiple adverse experiences. They note: Our findings suggest that prevention of child abuse, domestic violence, and other forms of household dysfunction that are common in alcoholic families will depend on advances in identification and treatment of alcoholic parents . . . and on clinicians’ inquiring about parental alcohol abuse and the longterm effects of adverse childhood experiences, with which both alcohol abuse and depression are strongly associated (Anda et al., 2002). Yet despite the evidence that excessive parental alcohol use has a powerful negative influence on youth, there has been relatively little focus on problem drinking among adults in national
efforts to reduce underage drinking. The long view necessarily involves efforts to reduce childhood exposure to substance abuse, especially alcohol, to reduce adverse exposures to problem drinking per se as well as to the all too frequent consequences of problem drinking such as physical and verbal abuse, parental separation or divorce, and family dysfunction. Thus, the evidence suggests that reducing adult excessive drinking will have an impact on youth drinking, which in turn will have an influence on those youth when they become adults and, in turn, parents themselves. So how do we make progress? Traditionally, screening, treatment, and prevention are the tools we use to reduce problem drinking. Let’s review their practice and impact. Screening and brief intervention has been shown to be not only effective but cost-effective in reducing problem drinking among adults. In primary care settings, studies have shown that brief counseling for nondependent excessive drinkers reduces total alcohol consumption and binge drinking, reduces alcohol-related health outcomes, and is cost saving, according to a systematic review of the research literature (CDC, 2014b). How is screening working? Not so well, it appears. Several studies have shown that despite the evidence and the recommendations from authoritative medical and public health groups, screening and brief intervention are not widely put into practice. For example, a study published in Preventing Chronic Disease reported that relatively few problem drinkers are ever counseled about their drinking problems, even though most problem drinkers have health insurance and see a primary care professional routinely (Town, Naimi, Mokdad, & Brewer, 2006). But for those who are alcohol
NACOA dependent and who would benefit from treatment, how many are actually receiving treatment? Fewer than one might expect. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) and based on data from 2013, of 17.3 million people aged twelve or older with past-year alcohol dependence or abuse, only 6.3 percent actually received treatment, with another 3.1 percent who perceived a need for treatment but did not receive it (2014). So, more than nine of ten individuals with alcohol dependence or abuse did not perceive a need for or receive treatment for their problem drinking. Grant et al. (2015) notes that there are key barriers to getting problem drinkers into treatment, including attitudes about stigma, concern over effectiveness, and cost. Therefore, despite effectiveness of treatment with it increasingly being covered by insurance due to the Affordable Care Act, treatment is seriously underutilized, and until it gets to scale cannot make a major dent in our nation’s drinking problem by itself. So how about prevention? After decades of research, we now know that environmental approaches—that is, altering the physical, social, and economic environments related to alcohol—can reduce problem drinking. Many studies, and systematic reviews of those studies, have concluded that policies to increase the price of alcohol through taxation, reducing access to alcohol through decreasing alcohol outlet density, and cutting back hours and days of sales, dramshop liability, and overservice law enforcement initiatives, can have a major positive effect. Likewise, maintaining a minimum age twenty-one purchase age, together with effective enforcement strategies, can reduce underage drinking (CDC, 2014a). These policy approaches have been well researched and have been endorsed by a wide range of public health groups, and are included in the Surgeon General’s National Prevention Strategy, which includes specific targets as well as evidence-based interventions shown to be effective (US Department of Health and Human Services, 2011). Yet because changing alcohol policies
is a controversial issue, there has not been widespread adoption of the more powerful interventions. Clearly no single approach is going to be sufficient to reduce the consequences of excessive adult drinking on our nation’s youth. We have evidence-based approaches to prevention, intervention, and treatment, but they are not yet sufficiently to scale to make an appreciable difference. With more than 73 million youth ages zero to seventeen, and knowing that one in four children is, or will be, living in a family setting where alcohol is a serious problem, we have to do better. Indeed, what’s old is new again. Parental drinking does matter, and how frequently and how much they drink can influence the physical and mental health of their children for a lifetime. c Robert Denniston is the vice chair of NACoA’s Board of Directors.
References
Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R., & Williamson, D. F. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53(8), 1001–9.
Centers for Disease Prevention and Control (CDC). (2014b). Vital signs: Alcohol screening and counseling. Retrieved from http://www.cdc.gov/vitalsigns/alcohol-screening-counseling/index.html Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., . . . Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72(8), 757–66. Town, M., Naimi, T. S., Mokdad, A. H., & Brewer, R. D. (2006). Health care access among US adults who drink alcohol excessively: Missed opportunities for prevention. Preventing Chronic Disease: Public Health Research, Practice, and Policy. Retrieved from http:// www.cdc.gov/pcd/issues/2006/apr/05_0182.htm Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Report to the congress on the prevention and reduction of underage drinking, June 2015. Retrieved from https://www.stopalcoholabuse.gov/media/ReportToCongress/2014/ report_main/report_to_congress_2013.pdf Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Behavioral health barometer, United States, 2014. Retrieved from http:// www.samhsa.gov/data/sites/default/files/National_ BHBarometer_2014/National_BHBarometer_2014.pdf Stahre, M., Roeber, J., Kanny, D., Brewer, R. D., & Zhang, X. (2014). Contribution of excessive alcohol consumption and years of potential years life lost in the United States. Preventing Chronic Disease: Public Health Research, Practice, and Policy. Retrieved from http://www.cdc.gov/pcd/issues/2014/13_0293.htm US Department of Health and Human Services (2011). National prevention strategy. Retrieved from http://www.surgeongeneral.gov/priorities/prevention/strategy/index.html
Centers for Disease Prevention and Control (CDC). (2014a). Preventing excessive alcohol consumption. Retrieved from http://www.thecommunityguide.org/alcohol/index.html
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CULTURAL TRENDS peace and love formula that was an essential part of 1960s music. The Velvet Underground and The Doors are prime examples of this counterbalance. Lou Reed and the Velvet Underground sang about addiction, transvestism, sadism, sexual bondage, and human sufferings. The Doors explored Freudian themes of patricide and incest as Morrison provided intimate examples of lewdness and self-destruction (Furek, 2008). Often under the influence of alcohol or psychedelics, Morrison was difficult to understand and was difficult to live with. After the deaths of Jimi Hendrix and Janis Joplin, Morrison quipped to his Los Angeles companions, in a tongue of arrogance and bravado, “First Janis, now Jimi. You’re drinking with number three” (Jones, 2015).
Black Satan of Rock
Morrison’s Last Whiskey Bar, Part I Maxim W. Furek, MA, CADC, ICADC
J
ames Douglas Morrison was The Doors’ lead singer, sex symbol, and poet. Idolized by teenyboppers on one extreme and by intellectual rock critics on the other, he was also a contradiction, wrapped in fantastic delusions of self-invention and grandeur. He became “Mr. Mojo Risin’” and the leather-garbed “Lizard King.” Some believed he would be the next James Dean or Marlon Brando. Morrison, however, christened himself a shamanistic rock god and beckoned all to join in the “celebration.” Bringing to the stage a blend of theatrical drama, his avant-garde panache influenced the punk and new wave traditions. His frozen, detached stance at the microphone was a calculated performance with screams, yelps, and “accidental” falls. A typical Doors concert would include a song with verse, chorus, 14
Counselor · December 2015
and then an extended improvisation where instruments and Morrison’s lyrical creativity would erupt in spontaneous combustion, forcing the tune into new dimensions. Morrison had an adequate vocal delivery and ability to breath new life into classic blues such as Willie Dixon’s “Back Door Man.” When they performed that number, they owned it. Morrison’s live performances were unlike those of his English counterparts, who relied on classic stage tradition. Morrison drew upon the rich, more eclectic, and psychologically deeper Hollywood film culture. The Doors were theatrical, yes, but they were also provocative and sinister, dealing with themes running counter to the San Francisco love fest. There were only a handful of rock acts that provided a counterbalance to the psychedelic
The Doors’ lead singer was hailed and crucified as the “Black Satan of Rock,” and the cynical, swaggering former UCLA film student and precocious Doors frontman experienced a quick, albeit short-lived, ascendancy from the trendy Los Angeles club circuit to the top of rock stardom. Immediately there was a yearning disparity between screaming teens and caustic music critics. Morrison’s exploits and total disregard for others were detailed in No One Here Gets out Alive (Hopkins & Sugerman, 1995). The book follows his compulsive pathway of devastation. In this introspective look into the chaotic world of a rock superstar, a portrait of an ugly, unleashed dilettante emerges. He was spoiled, immature, and cruel. According to Hopkins and Sugerman, the authors of the book, “Incident followed incident: Morrison forcing a girl to drink his blood; Morrison passed out time and again in a deathlike trance induced by booze and drugs; Morrison dangling precipitously from balconies” (1995). Morrison was an angry, loud, and obnoxious drunk. Rock critic Lester Bangs observed that his life “could be written off as one of the more pathetic episodes in the star system or that offensive myth that we all persist in believing which holds that artists are a race
CULTURAL TRENDS apart and thus entitled . . . to generally do whatever they want” (Jones, 2015).
Beginning of Their Decent
From the late 1960s, Morrison experimented with substances. His drugs of choice were alcohol, cocaine, and LSD. The substance abuse predictably quickly took its toll: “From being the slender Adonis of early album covers, he became pasty-faced and bloated. He grew a beard and gained over twenty pounds, abandoning his former stage persona of the Lizard King” (“Jim Morrison,” 2015). After issuing their first album in 1967 and garnering intense media attention, their house of cards was about to collapse. The beginning of their decent was on March 1, 1969. The Doors were in Miami, FL, about to kick off a twentycity national tour. This was their largest tour to date. The band expected to pick up new fans and recognition across the country, but a drunken Morrison arrived late and refused to perform. Over one thousand ticket holders, packed into the hot, sweaty Dinner Key Auditorium, a converted and rundown seaplane hanger, overbooked the venue. On stage, Morrison began an angry rant titled “Rock is Dead.” Then, in a suggestive pose, he appeared to expose his genitalia to the audience. Miami was just another illustration of the Lizard King’s unraveling. He had been arrested for public obscenity at a concert in New Haven, CT in December 1967 and the next year Morrison was arrested on a flight to Phoenix for disorderly conduct. All of that was a mere prelude to what was about to unfold. Accordingly, the breaking point was reached after his March 1969 arrest in Miami “for exhibiting ‘lewd and lascivious behavior by exposing his private parts and by simulating masturbation and oral copulation’ onstage” (Pareles & Romanowski, 1983). “Morrison Slips” and “The Doors’ Appearance Touches off Near-Riot,” were headlines of the incident. Morrison was booked by the Dade County Police Department with threats of incarceration at Raiford Prison. The Doors were subsequently banned from all remaining cities on the tour. They became the pariahs and lepers of the music industry.
The Miami Obscenity Trial
The Miami obscenity trial framed another debate over free speech and celebrity responsibility. Parallels were quickly established connecting the previous trials of Henry Miller, Lenny Bruce, and D. H. Lawrence. As Morrison garnered incredible notoriety, his appeal sadly faded. An angry, bearded alcoholic stepped forward—the new face of Jim Morrison. An oblivious, dulled, intoxicated, and detached Morrison walked straight into the blades of a snarling buzz saw, smirking all the way. The charges were more serious then typical Morrison adolescent pranks and included both state and federal violations. Pertaining to The State of Florida vs. James Douglas Morrison, charges alleged, “The said defendant did stimulate masturbation upon himself and oral copulation upon another” (Manzarek, 1999). Even though the prosecution could produce neither eyewitnesses nor photos of Morrison performing the alleged lewd acts, court proceedings kept Morrison in Miami most of the year. The judgment on the bench docket read, It appearing unto this Court that you, James Morrison, have been regularly tried and convicted of Indecent Exposure and Open Profanity. It is therefore the judgment of the law that you are and stand convicted of the offenses as above set forth . . . It is further considered, ordered, and adjudged that you, James Morrison, be imprisoned by confinement at hard labor in the Dade County Jail for a term of six months and that you pay a fine of five hundred dollars (Manzarek, 1999). It was a grave matter. Ray Manzarek calculated that, Between Miami and Phoenix, Jim was facing a maximum of over thirteen years in prison. Three and a half in Raiford Penitentiary in the County of the Dead (Dade County), and ten in a federal hoosegow because ‘interference with a flight crew’ was an offense against the new skyjacking law (1999).
Charges were eventually dropped, but public furor, which inspired a shortlived Rally for Decency movement, concert promoters’ fear of similar incidents, and Morrison’s own mixed feelings about celebrity, resulted in erratic concert schedules thereafter. Miami verified just how impaired Morrison was and signaled what the band members had secretly feared: it was all about to end. Events transpired rapidly. The Doors immediately filed an appeal, buying them precious time. Morrison flew back to Los Angeles and bought a plane ticket to Paris. The specter of doing time in Raiford Penitentiary weighed heavily. It was 1971 and any cross-referencing computer systems were years from development. Morrison quickly left the country. For the moment, Morrison was a free man. Like Ernest Hemingway, Gertrude Stein, and James Baldwin, he breathed in the ether of literary inspiration and walked the cobblestoned streets as an American in Paris. c Maxim Furek, MA, CADC, ICADC, is the director of Garden Walk Recovery and a researcher of new drug trends. His book The Death Proclamation of Generation X: A Self Fulfilling Prophesy of Goth, Grunge, and Heroin is currently being used in classrooms at Penn State University and College Misericordia. His rich background includes aspects of psychology, mental health, addictions, and music journalism. His forthcoming book, Celebrity Blood Voyeurism, is a work in progress. He can be reached at jungle@epix.net.
References
Furek, M. (2008) The death proclamation of Generation X: A self-fulfilling prophesy of goth, grunge, and heroin. New York, NY: i-Universe. Hopkins, J., & Sugarman, D. (1995). No one here gets out alive. New York, NY: Warner Books. “Jim Morrison: Biography.” (2015). Retrieved from http:// www.lifetimetv.co.uk/biography/biography-jim-morrison Jones, D. (2015). Mr. Mojo: A biography of Jim Morrison. New York, NY: Bloomsbury. Manzarek, R. (1999). Light my fire: My life with the Doors. New York, NY: Berkley. Pareles, J., & Romanowski, P. (1983). Rolling Stone encyclopedia of rock & roll. New York, NY: Touchstone.
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OPINION
Asian Shame and Addiction Sam Louie, MA, LMHC
Saving Face
I
f you want to understand Asian addicts, you need to understand the principle of cultural shame and its underlying impact on those from Asian backgrounds. To clarify, the term “Asian” refers to those who are descendants from or who live in any part of Asia, which can include China, Japan, Korea, Taiwan, Vietnam, Thailand, Indonesia, and the Philippines, among others. Some Pacific Islanders—those from Hawaii, Samoa, Fiji, Guam, and Micronesia—might also have similar traits and patterns of relating based on that of a collective society (Tewari & Alvarez, 2008).
The Role of Shame in Society
Asian cultures are collectivist by nature. Unlike the US— which prides itself on the individual or “I” factor—Asian nations hold the “we” to an exalted status. As a result, Asian societies are often referred to as shame-based cultures where social order is maintained through the use of shame. When it comes to Asian people, our lives, families, and cultures revolve around some aspect of shame. Our identities are forged by trying to avoid any shame-producing feelings. Honor and upholding honor in our culture is paramount. As Asians, we learn early-on from our parents that everything we do is predicated on bringing honor to our families—our grades, our achievements, our careers, and our relationships. 16
Counselor · December 2015
Because of the Asian fixation on honor, we learn early to achieve as a means to “save face.” “Face” is the equivalent of how one is seen or judged by another. So when people talk about how Asian cultures are shame-based, they’re referring to the concern one has for what others think about them and their “face.” For example, Japanese mothers will teach their children not to do or say certain things or else people will laugh at them. This is the primary means of social control in order to maintain a good “face.” It should be noted the Chinese character or kanji for “face” is the same character for “mask.” If you follow this line of thinking, where your face is known as your mask, it’s no wonder why traditional Asian people will do whatever it takes to hide their emotions or their true “face” by putting on their “mask.” Since saving face is seen as bringing honor to oneself and one’s culture, then hiding one’s true feelings also carries a degree of honor. When we go through experiences that are not honorable or a source of pride for our families, what then? When you feel you’ve let down not only yourself, but also your family, your ancestors, and your entire culture, and can’t talk about them, it inevitably leads to toxic shame. This is a shame that seeps into the veins and courses through a person’s very being. This deep sense of rejection, humiliation, failure, and embarrassment penetrates our core and robs us of life. We come to view our entire self as flawed, defective, unworthy, and ultimately unlovable. You can see Asian shame in action when someone commits suicide. Unfortunately, suicide is still viewed by many Asians as an honorable way of atoning for public disgrace and an expression of one’s deep sense of shame. Suicide is
Areas to Consider When Helping Asian Clients Break the Stranglehold of Shame
• Explore their Asian support system. For example, do they have anyone of Asian descent whom they can confide in with their shame? • Since a large percentage of Asian-Americans adhere or are affiliated with some form of religion or spiritual practice, it is important to see if the church or someone from their religious background can be a source of healing.
OPINION Ways to Help from a Clinical Perspective
• Psychodynamic group therapy or issue-specific group therapy in addition to individual counseling • Therapeutic self-disclosure, when appropriate, to increase the alliance with your client • Active vs. passive engagement in therapy as Asian cultures adhere to hierarchy and see you as an authority figure. • Psychoeducation/coaching should be woven into your practice with Asian clients. It may not feel “therapeutic,” but I learned a lot more about my family and culture when my past therapist taught me about setting boundaries and guided me through that process. • Reflecting of feelings. Having an empathetic therapist who can not only validate your feelings but articulate them is invaluable. Some of my clients who can’t verbalize their feelings feel I get them when I give voice to what I think is occurring in their lives. For example, saying something like “So I’m not sure if this fits, but if I was in your situation I think I would feel ______. Does that seem right to you?”
often misunderstood in America because, for Asians deeply entrenched in a shame-based mentality, it is viewed as the ultimate means of taking responsibility for having brought shame to one’s family, group or country. This most personal act—while seen by the West as being selfish and not taking into account your friends and family’s concern for you—is considered in Asia as an act that expresses a supreme concern for what others think.
food, drugs, work, shopping or sex, the craving for competency, validation, and affirmation can be met through addiction. Addiction helps take away the pain of loneliness and the feelings of unworthiness, consequently serving as a way to cope with life. Many Asians would rather suffer in silence than break the cultural code of honor by acknowledging a problem and seeking help. As a therapist, I know how important it is to acknowledge that Asian culture—and many other ethnic cultures— view “self” much differently than in the Western world. Consequently, even shame is viewed differently since individuals from Asian countries will see themselves and their actions as interdependent upon those close to them. In other words, a traditional Westerner may experience shame as a result of something they did, whereas Asians entrenched in a shame-bound system or culture will experience shame not only individually but also collectively. Asians will also experience shame in response to something someone close to them has done. For example, if an Asian client experiences shame for being in a relationship with someone from another culture, even from a different Asian culture, this will also bring shame upon his network of close friends, family, and sometimes the larger ethnic culture as well. This shame can permeate to include a person’s grades, choice of career, relationship status, and especially addiction. c Sam Louie, MA, LMHC, is a psychotherapist and diversity cultural consultant focusing on multicultural issues and addictions. Sam spent more than twelve years as an Emmy Award-Winning broadcast news journalist. He is also the author of Asian Shame & Addiction: Suffering in Silence.
Addiction
When it comes to addiction, there is scant attention given to Asians. Part of the limited attention lies in the age-old Asian custom of secrecy, silence, and shame. This shame is so strong that when Asians struggle with life issues such as grief, depression, physical or sexual abuse, and anxiety, many never seek help. From an Asian addict’s perspective, it’s the ultimate blow of humiliation to be seen as weak. It’s the most difficult thing to admit to ourselves, our families, and our loved ones that we are weak and cannot solve our problems alone. For traditional Asians, this emotional repression is the fertile ground where the seeds of addiction are planted. Without a proper place to get their needs met, Asian addicts will turn to habits to meet that need. Whether it’s an addiction to
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FROM LEO’S DESK
Recovery Needs Spirituality Rev. Leo Booth
the choice not to drink. Why? Because they can. I recently heard an alcoholic in recovery share that for many years he was a pathetic and violent alcoholic, sentenced to many years in prison. Then he heard a simple message, from a recovery group, that changed his life: “You do not have to live like this anymore. You can change. You can stop doing what you are doing. Take responsibility for your disease and live a different life.” Here is a relevant excerpt from my book Spirituality and Recovery (2012):
W
hen we talk about the disease of alcoholism or drug addiction, we know that it is different from talking about cancer or ebola. It is not a virus that affects the organs; it cannot be treated by a series of operations or medications. Yes, it falls into the area of mental sickness, but it revolves around descriptions like allergy, obsession of the mind, and cravings, that are the result of an individual’s behavior around a substance. Discussions have often resulted in scientists talking about an “alcoholic gene” that separates alcoholics or drug addicts from other people; a difference in the brain that sets off a craving when alcoholics or drug addicts come in contact with mind-altering substances. More is being revealed, but the simple concept of alcoholism as a self-inflicted illness does not present the full picture. It’s not enough to say that alcoholics or drug addicts are crazy people who seem to willfully desire to destroy their lives. And yet, unlike ebola or cancer, the behavior of alcoholics concerning the substance alcohol is necessary. To become alcoholics or a drug addicts, individuals need to drink alcohol or take or inject the drug. Drunkenness or “being high” doesn’t just happen. You cannot think yourself into drunkenness, but you can think yourself into relapse. “Choice” is a powerful word. A person chooses to drink. Some make 18
Counselor · December 2015
We are able to live the good life when we know, on a spiritual level, that we make life come alive. Our decisions and choices determine success or tragedy. God doesn’t make anyone happy, sad, successful or loving . . . that’s our job (p. 59). Furthermore, The kind word can be said only if we choose to say it. That needed word of encouragement or forgiveness requires you. Others may say it, but that would not be you. It would not be you saying it. Remember, nobody can say it like you can. You are terrific. In your individuality is your uniqueness. In your individuality is your power. In your individuality is God expressed. Everything stems from how we choose to practice our spirituality. The word of encouragement or the silence of understanding: all are part of life. All are our responsibility. Even the negative and critical statements are ours. We choose to hurt. We choose to be cruel. We choose to destroy. The awareness of our imperfections can be the way back to our given spirituality (2012, p. 63). Notice that we are talking about spirituality, not religion. You do not need
to be religious to recover, but you do need to experience and demonstrate spirituality. What is spirituality? Well, in the way the word is being used for recovery from addiction, it means to “live the good life.” It means the opposite of drunkenness and the opposite of being irresponsibly “high” or “on a trip to nowhere.” Spirituality means living in the world of reality. The recovery program of addicts is based upon the simple but profound belief that human beings can change. I sometimes hear people say that the leopard cannot change its spots, but we are not leopards! And it’s not a physical description that is changing, but a spiritual, psychic change. A change occurred for me after a car crash and the magistrate took away my car keys. In my book Meditations for Compulsive People (1995), I wrote about this change: Spirituality will mean different things to different people, but for alcoholics or addicts it simply means a step into the good life—a life that emphasizes personal responsibility and the removal of any evident defects of character, and a life that is made stronger by knowing that there are some things that we can change . . . and we are prepared to do so. 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. (1995). Meditations for compulsive people. London: SCP Limited. Booth, L. (2012). Spirituality and recovery. Deerfield Beach, FL: Health Communications.
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