Counselor Magazine - February 2015 by HCI Books

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INTERVIEW: DR. JOSEPH WESTERMEYER

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2 Counselor 路 February 2015

contents Letter from the Editor

y Robert J. Ackerman, PhD B Editor

Wisdom Recovery, Part I: Organic Spirituality, Soul Consciousness, and Healing

CCAPP Ethics Standards through a Co-Occurring Lens

NACOA A Voice for Children

Cultural Trends

42 Utilizing Smartphone Technologies in Recovery Services Provides information on current smartphone applications for people in recovery, assesses current research into smartphone technology, and lists benefits and barriers to recovery. By Nicole Wisser, MSW, Starla Salazar, MSW, Alex Ramsey, PhD, Christina Drymon, MA, and David A. Patterson, PhD

Predicts how addiction treatment will evolve in the coming years and discusses such issues as where services will take place and what substance use trends will be seen. By Mark Sanders, LCSW, CADC

By Sis Wenger

By Mary Faulkner, MA

The Future of Addiction Treatment in America

By Mary Crocker Cook, DMin, LMFT, LAADC, CADC-II

Discusses the difference between religion and spirituality, explains the value of spirituality for therapists, and examines the future of society in a more circular, spiritual model.

The Painful Legacy of Rodney King

By Maxim W. Furek, MA, CADC, ICADC

Opinion Relapse and Prescription Medications: Advocating for Recovery

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

From Leoâ&#x20AC;&#x2122;s Desk Spirituality and Language

By Rev. Leo Booth

Wellness The High Cost of Anger, Part III

By John Newport, PhD

Reaching Out

Topics in Behavioral Health Care

The Integrative Piece By Sheri Laine, LAc, Dipl. Ac

Group Treatments in Behavioral Health Programs By Dennis C. Daley, PhD

www.counselormagazine.com 3

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contents Research to Practice Addiction Counselor Turnover: What’s up?

By Michael J. Taleff, PhD, CSAC, MAC

Counselor Concerns Where Are You Regarding Pharmacotherapy for Addictive Disorders?

Substance Abuse and Emerging Adulthood, Part I

Cross-Cultural Addiction Psychiatry: An Interview with Joseph Westermeyer, MD, PhD Presents an interview with Dr. Joseph Westermeyer about his career, the field of cultural psychiatry, and the evolution of addiction treatment.

By Gerald Shulman, MA, MAC, FACATA

Substance Abuse in Teens

By William L. White, MA

By Fred J. Dyer, MA, CADC

Ask the LifeQuake Doctor

From the Journal of Substance Abuse Treatment

By Toni Galardi, PhD

Inside Books Finding Freedom Through Illumination: Achieving Christ-Consciousness By Cardwell C. Nuckols, PhD

64 Calls for Help: Examining Scheduling Processes and Barriers in Addiction Treatment

Reviewed by Leah Honarbakhsh

Introduces the NIATx study, provides information about problematic scheduling issues facing treatment centers, and discusses best practices for minimizing barriers to effective addiction treatment.

Also in this issue

By Andrew Quanbeck, PhD

Ad Index

Referral Directory

CE Quiz

70 The Impaired Professional: An Overview Discusses professional wellbeing programs, provides historical background on professional drug and alcohol abuse, and describes elements of treatment.

On the Cover: Photo Credit Heather Muro http://instagram.com/murophoto

6 Counselor · February 2015

By David E. Smith, MD, FASAM, FAACT, and Leigh Dickerson Davidson, AB

Faculty Includes

Tina Payne Bryson, PhD

Rob Weiss, LCSW

Pat DeChello, PhD

Lisa Boesky, PhD

Robert Ackerman, PhD

Colin Ross, MD

www.counselormagazine.com 7

Letter from The editor

Resolutions

Do you remember the New Year’s resolutions you made about a month ago? I had to bring those up, didn’t I? How are you doing with them? It seems each year we make promises to ourselves to change our behaviors. Supposedly over 88 percent of us make at least one resolution at the beginning of the year. Fear not, however, because only 20 percent of us can maintain their resolutions. Good; eighty percent of us can’t be wrong! Who started this resolutions stuff anyway? It seems that the tradition is about five thousand years old and can be traced to the ancient Babylonians. Even though different societies varied in their opinions of exactly what was the first day of the year, they agreed it was a good time to begin something new. This way if you messed up early, you could wait almost another year to try again. Sounds like addictive thinking to me. However, the idea was to forget the past and look only to the future by making resolutions. How about we forget that they made these things in the first place? For the one in five of you who made a New Year’s resolution and is still sticking with it, 80 percent of us are proud of you and we will wait until the next New Year to join you. Before I go any further, I want to congratulate Mae Abraham, who recently celebrated her fiftieth anniversary. Mae is the cofounder of Father Martin’s Ashley along with Father Martin. I have been blessed to call her a friend for the past thirty-five years. She truly has been one of the outstanding women in America over the past fifty years. Congratulations and thank you, Mae. I also want to congratulate Dr. Claudia Black who was presented the 2014 Father Martin Award. Dr. Black’s contributions to the alcohol and drug community over the 8 Counselor · February 2015

past thirty years are outstanding and the award is richly deserved. As we begin another year I look forward to the continuing contributions of the Journal of Substance Abuse Treatment for 2015. I also look forward to our regular contributing columnists and to the excellent contributions of others. Some of the special features for this year include a series on impaired professionals that will focus on physicians and attorneys, among other populations. In this particular issue we look forward to an article on wisdom recovery by Mary Faulkner. Also, we are starting the year with a special California Edition featuring contributions from California authors and the support of many clinical professionals and organizations. Leading off this year is an article on smartphones used for recovery, which takes us as far into the future as Mark Sanders’s article titled “The Future of Addiction Treatment in America.” The first JSAT article of the year is by Andrew Quanbeck on scheduling processes in treatment centers. Finally, William L. White has an excellent interview with Dr. Joseph Westermeyer on his work in addiction psychiatry. I look forward to another exciting year with Counselor and to making another New Year’s resolution—next year.

Robert J. Ackerman, PhD

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

CCAPP

Ethics Standards through a Co-Occurring Lens Mary Crocker Cook, DMin, LMFT, LAADC, CADC-II

he new co-occurring disorder professional (CCDP) certificate announced by CCBAC in California prompted me to consider unique ethical issues that might be raised in working with this population. In fact, CCBAC has developed a separate co-occurring disorder Code of Ethics for new specializing professionals. This column

will briefly address two of the codes: nondiscrimination and professional standards.

Nondiscrimination The familiar n o n discrimination clause is so familiar to me that it was refreshing to review it again against the backdrop of mental illness as a specific disability that might

encounter discrimination and stigma in chemical dependency treatment settings. Co-occurring mental health conditions and substance abuse affect nearly 8.9 million people yearly, and when only 44 percent received appropriate treatment in the past year, I wonder about the role of stigma in a client’s reluctance to seek treatment (American

Psychological Association, 2014). I am particularly interested in the stigma mental illness may carry with counselors and treating professionals. To explore stigma in more depth, I would recommend an article from the Advances in Psychiatric Treatment journal titled “Stigma of Mental Illness and Ways of Diminishing it” by Peter Byrne (2000). www.counselormagazine.com 9

CCAPP Professional Standards B o t h m e n t a l h e a lt h counselors and chemical dependency counselors are often attracted to their specialties for personal reasons. We often have a kinship with the clients we treat, and the co-occurring specialty is no exception. It is our personal experience and success facing the co-occurring challenge that will often compel us to seek out specialized training and education, and when this is so we bring a wealth of intuitive wisdom to the process. We also bring to the process an imperative need for self-care. Much like the co-occurring clients we are treating, we have the dual focus of mental health and chemical dependency self-care tracks that can quickly be derailed in the face of unaddressed countertransference reactivity in the face of client denial, poor boundary setting with clients and colleagues, and overwork. Like most recovering people under

stress our first response is often to decrease our selfcare, hoping to use the time to rest. It rarely works out this way.

• If you are going through a medication change, let your supervisor know if you are having trouble with the side effects.

Self-care for the counselor with co-occurring issues is not a luxury; it is an ethical requirement. The service we deliver is a direct result of what we bring to the process as a person, and we could either be a wonderful role model of healthy dualdiagnosis recovery, or a terrible episode of “what not to do.”

• Take every single day off and vacation day you have coming to you. Try not to “bank them” because you feel guilty taking time off when the team is already stretched too thin. This is a management issue, not your issue. It is their responsibility to hire appropriately.

• Keep your regularly scheduled personal therapy and psychiatric appointments. Try not to reschedule, because appointments have a way of stretching out over time.

• Continue to attend your recovery support group, and consider adding Al-Anon. Working in treatment to support other people’s recovery is not the same as working your own program and getting the support you deserve.

• Stay on top of your medication refills. It is too common to lose track of time in our busy weeks, and time slips away. Write the call-in date on your calendar when you get your new refill as a reminder.

• Consider not sponsoring newcomers if you are working a Twelve Step program. You will have long days, and they will often be peppered with crises. You will need stress-free down time, and 2:00 am calls from

Tips to Keep in Mind

sponsees in trouble are not going to be best for you or the people you treat on your caseload. • Be realistic about your limits. Know your energy levels and plan your work day accordingly. If you need to take a cat nap on your lunch hour, do so. If you function better in the afternoon, try not to take an early morning shift. Play to your strengths instead of fighting your limitations. • Monitor your sense of humor—it will save you. It will be important to hold yourself and the people you work with lightly. Keeping things in perspective and using humor will provide the balance this challenging job requires. c Mary Crocker Cook, DMin, LMFT, LAADC, CADC-II, has been in practice with Connections Counseling Associates since 1993. She holds a doctorate in interfaith ministry. She developed and is currently the coordinator for the San Jose City College alcohol and drug studies program, and is an adjunct instructor with the John F. Kennedy Graduate School of Psychology in Campbell, CA. She is also the founder of the IC&RC International Alcohol and Drug Counselor Certification Trust for India.

References American Psychological Association. (2014). Data on behavioral health in the United States. Retrieved from http://www.apa.org/helpcenter/ data-behavioral-health.aspx Byrne, P. (2000) Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.

10 Counselor · February 2015

NACOA

A Voice for Children Sis Wenger

or the past thirty-two years, the National Association for Children of Alcoholics (NACoA) has been the voice for children and families impacted by the addiction of a loved one. Our mission is to eliminate the adverse impact of alcohol and drug use on children and families. We envision a world in which every child who suffers because of addiction in the family receives the right kind of support . . . a world in which children would grow up safe, happy, and healthy, without ever having to face the emotional anguish of family addiction. To help create such a world, NACoA partners with colleague organizations, with regional, national, and international affiliate organizations, and with profession-specific organizations to help imbue their memberships with the essential knowledge and skills to address the needs of those suffering from addiction, whose lives they touch in their everyday professional responsibilities. Through modern technology NACoA has added the capacity to reach directly to those impacted with messages, tools, and support that can enhance our effectiveness in creating a world that provides hope and support to those most in need—the children who have always been the first hurt and last helped when addiction enters a family.

New Website We invite you to visit our new website, which offers all the content and products you have expected to find there and much more. In addition to a new look, the updated site is offering more opportunities to become involved, an expanded education and training center with new and archived webinars, new online courses, a new comprehensive online seminary curriculum—Addiction and the Family—a blog featuring NACoA

leaders, daily encouraging thoughts for adult children of alcoholics (ACOAs) and daily messages for youth, an expanded affiliate section, monthly activity sheets and games for children and teens, FAQs, articles by renowned writers, including many who have contributed to Counselor, and introductions and linkages to our colleague organizations.

Current Programs and Projects NACoA is partnering with the American Association of Pastoral Counselors and with the Entertainment Industries Council to provide its 2015 series of free webinars featuring renowned national leaders, thanks to a contract with SAMHSA’s Center for Substance Abuse Treatment. The webinars are focused on helping the “people in the pews” who are suffering in silence and hopelessness and on helping the clergy and pastoral staff to understand the faith community’s critical role in educating and providing support to congregants who are waiting for guidance and messages of hope and recovery. Presenters, dates, times, and registration information can be found on www.nacoa.org. The recognition that whole family recovery programs can be strong catalysts for reducing relapse and recidivism in individuals who are in the drug court or dependency court systems has precipitated a substantial growth in Celebrating Families!™(CF!), NACoA’s evidence-based curriculum and training program. The number of young women in these court systems who are pregnant and/or have young children has created a demand for family recovery programs that also address the 0–3 population of babies and mothers.

The California-based CF! development team has met that challenge for a 0–3 curriculum component. It is being tested, with promising results, at sites in Oklahoma, Iowa, and California. NACoA will begin publishing and distributing this addition as part of the total CF! program in mid-2015. CF! had particularly strong growth in one state during 2014. NACoA provided extensive training and curriculum materials to local service providers throughout Oklahoma in collaboration with the state’s Office of Mental Health and Substance Abuse Services. NACoA also provided two trainings for trainers in Oklahoma last year in order to assist in establishing a sustainability system for this important recovery support effort directed at breaking the multigenerational cycle of addiction in the affected families. The state has also trained service providers in the Strengthening Families program, and families mandated to services through the courts are now routinely getting both programs, which complement each other. Initial research reports are showing even more remarkable results with this dual program approach. CF! is increasingly being recognized as a critical aftercare component to the continuing recovery support process following primary treatment. It is being offered through communitybased family service agencies as well as through drug courts and addiction support. NACoA hosts a separate website for CF! at www.celebratingfamilies.net.

COA Week Always celebrated nationally and internationally during the week in which Valentine’s Day falls, the annual Children of Alcoholics Week is February www.counselormagazine.com 11

NACOA

8–14. NACoA’s affiliate in Germany, NACoA Deutschland, celebrated the week last year in over eighty locations across the country. They hosted lectures, marches, recovery celebrations, and awareness activities and obtained proclamations to observe the week. They received NACoA’s Meritorious Service award for their extraordinary efforts. Stateside, the mayor of Boston proclaimed the week for the fourth consecutive year. Readers can visit the COA Week section of www.nacoa.org for tools and suggestions for COA Week 2015.

Still No Safe Level of Alcohol during Pregnancy “Responsible” alcohol use during pregnancy is finding some acceptance 12 Counselor · February 2015

once again in the popular press. At the same time, a newly published study finds that rates of fetal alcohol spectrum disorders (FASD) among children may be significantly higher than previous estimates. A research team headed by Philip A. May, PhD, studied more than 1,400 first graders in a Midwestern city. Their findings, published by Pediatrics in the November 2014 issue, identify cases along the entire FASD spectrum in this general school population. Specifically, the rate of fetal alcohol syndrome (FAS) was found to be six to nine cases per one thousand children studied, and the prevalence of partial FAS (pFAS) cases ranged from eleven to seventeen cases per one thousand. Total cases of any form of FASD ranged from twenty-four

to forty-eight cases per one thousand (May et al., 2014). NACoA urges pregnant women and those wishing to become pregnant to refrain from alcohol or other moodaltering drug use during the few short months of pregnancy to ensure the healthiest child possible. c Sis Wenger is NACoA’s President and CEO.

References May, P. A., Baete, A., Russo, J., Elliott, A. J., Blankenship, J., Kalberg, W. O., . . . Hoyme, H. E. (2014). Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/ early/2014/10/21/peds.2013-3319.abstract

Cultural Trends

The Painful Legacy of Rodney King Maxim W. Furek, MA, CADC, ICADC

odney King never wanted to become a celebrity, yet reluctantly and regrettably found himself in the glaring spotlight, a victim of police brutality and his own reckless behavior. Adding to this vortex of unbelievable circumstances was a drug King was suspected of using—a powerful substance alleged to have triggered the cluster of events leading to the Los Angeles riots. On the streets it was called “angel dust.”

George Holliday Videotape On March 3, 1991, Rodney Glen King III led California Highway Patrol officers on a high-speed chase through the north Los Angeles suburbs. King didn’t stop when signaled by a police car behind

him, but increased his speed. One estimate said that King drove at one hundred miles per hour for 7.8 miles. When police finally stopped the car, they delivered fifty-six baton blows and six kicks to King in a period of two minutes, producing eleven skull fractures, brain damage, and kidney damage (Delk, 1994). The Rodney King incident was broadcast on news outlets around the world after witness George Holliday videotaped the altercation. The overhead illumination of a police helicopter allowed the subsequent videotape that exposed four white officers brutally beating King, who seemed impervious to the blows.

“Can we all get along?” –Rodney Glen King III Police officers involved argued that King was on phencyclidine (PCP), which can make its users seemingly invulnerable to pain. Sergeant Stacey Koon suspected that King was “dusted”—that is, a user of PCP, the drug most feared by police departments. Koon concluded that King was probably an ex-con who developed his muscles working out on prison weights. During the trial, Koon stated that Rodney King was “an aggressive, combative suspect” and called King a “monster” with “Hulk-like strength” (Lepore, 2000). Koon also said his actions were based on his belief that King was on PCP. Although Koon’s suspicions about the PCP would later prove unfounded, he was right about King being an ex-con. Earlier that winter, King had been paroled after serving time for robbing a convenience store and assaulting the clerk. During the beating, Koon grew even more concerned after King successfully repelled a swarming maneuver by his officers and—more remarkably—managed to rise to his feet after being hit twice by a Taser (Linder, 2001).

Phencyclidine Koon surmised that King was under the influence of phencyclidine, described as a hallucinogen, dissociative anesthetic, psychotomimetic, and sedativehypnotic. PCP is a white, crystalline powder (contaminants may cause a tan to brown color), or a clear, yellowish liquid. As a recreational drug, it may be www.counselormagazine.com 13

Cultural Trends half-life and adverse side effects—such as hallucinations, mania, delirium, and disorientation—it was removed from the market in 1965. Patients often became agitated, delusional, and irrational while recovering from its anesthetic effects. PCP is no longer produced or used for medical purposes in the United States, but is used as a veterinary anesthetic or tranquilizer.

ingested, smoked, inhaled or injected. Even though PCP is known colloquially as “angel dust,” it is likewise referred to as “Ashy Larry,” “illy” or “wet.” The drug is often administered or mixed with other drugs such as crack cocaine, cocaine hydrochloride, and marijuana. Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy describes the varied effects of PCP: Taking PCP can produce a state similar to getting drunk, taking amphetamine, and taking a hallucinogen simultaneously. It is most frequently taken for the amphetamine-like euphoria and stimulation it produces. Many of PCP’s bad side effects also resemble those of amphetamine, such as increased blood pressure and body temperature. However, at the same time, it causes a “drunken” state characterized by poor coordination, slurred speech, and drowsiness. People under the influence of PCP are also less sensitive to pain. Finally, at higher doses it causes a dissociative state in which people seem very out of touch with their environment (Kuhn, Swartzwelder, & Wilson, 2003). PCP was first synthesized in 1926, and was developed by Parke-Davis in the 1950s as an intravenous surgical anesthetic. Because of its long 14 Counselor · February 2015

On January 25, 1978, PCP was transferred from Schedule III to Schedule II under the Controlled Substances Act of 1970 due to reported increases in abuse (NDIC, 2004). Schedule II drugs, which include cocaine and methamphetamine, all have a high potential for abuse that may lead to severe psychological or physical dependence. Once it became a recreational drug of choice in the 1970s, angel dust became the topic of Hollywood sensationalism and serious concern among law enforcement officers. Individuals using the drug were unpredictable and noted for their almost superhuman strength and aggressiveness. Still, not everyone believes that PCP is the killer drug that law enforcement fears. One report suggests that PCP never really became the drug of choice to most users because of its unpleasant side effects and it didn’t get much public attention until 1978 when Mike Wallace of 60 Minutes described PCP as the nation’s number one drug problem, reporting on bizarre incidents of brutal violence allegedly caused by the new “killer drug” (Narconon International, 2009). According to Narconon International, The connection of PCP with superman powers and a drug that provoked violence in humans was only press propaganda. A study with more than three hundred subjects taking PCP, under controlled conditions, reported no feelings of aggression or violence. Most of the stories related to violence were from individuals that had violent tendencies as a major part of their personal psychological makeup and not a side effect of PCP (2009).

Despite the supposed dangers associated with this substance, it remains popular and attracts a unique user population: PCP is predominantly abused by young adults and high school students. In 2010, there were an estimated 53,542 emergency department visits associated with PCP use, according to Drug Abuse Warning Network (New DAWN ED). This is a significant increase from an estimated 37,266 PCP-associated visits in 2008. The American Association of Poison Control Centers (AAPCC) National Poison Data System reports 747 PCP exposure case mentions and 350 single exposures in 2010. According to the 2011 National Survey on Drug Use and Health (NSDUH), 6.1 million (2.4 percent) individuals in the US, aged twelve and older, reported using PCP in their lifetime. The Monitoring the Future (MTF) survey indicates PCP use among 12th graders in the past year increased from 1.0 percent in 2010 to 1.3 percent in 2011 and then decreased to 0.9 percent in 2012 (DEA, 2013).

Los Angeles Riots The George Holliday video became a key piece of evidence leading to a criminal and civil trial against the officers. During the criminal trial of Sgt. Stacey C. Koon and officers Laurence M. Powell, Theodore J. Briseno, and Timothy E. Wind, both sides agree that King was intoxicated. The officers said they believed that King was also under the influence of PCP, but tests on King for PCP were negative, and the prosecution suggested the defendants falsified reports and concocted suspicions of PCP use to justify their actions. King’s attorney, Milton Grimes, disputed the police version, noting that no PCP or other illegal narcotics were found in King’s bloodstream (de Lama, 1993). Martha Esparza, a nurse at CountyUSC Medical jail ward, where King was admitted several hours after the beating, testified that he appeared “calm and cooperative” and showed no signs of having used PCP. Esparza said that, when she asked King how he felt, King said he “got beat up, and I agreed that

Cultural Trends he looked like he got beat up” (Cannon, 1993). Some felt that King’s problems with the law stemmed more from his heavy drinking than from any criminal bent. Tim Fowler, King’s parole officer, described Rodney as “basically a decent guy with borderline intelligence but [who] could function in society. His problem was alcoholism. He had been drinking from an early age.” Friends described King as usually friendly and gentle, but strong-willed and capable of blowing up after drinking (LawyerIntl, 2008).

four days rioters ran through the streets looting businesses, torching buildings, and attacking those who were in the wrong place at the wrong time. The violence was responsible for more than fifty deaths and $1 billion in property damage (CNN Wire, 2012). The acquittals subsequently led to the federal government obtaining grand jury indictments for violations of King’s civil rights. The trial of the four in a federal district court ended on April 16, 1993 (Preitauer, 2014). The jury found Officer Laurence Powell and Sergeant Stacey Koon guilty, and they were subsequently sentenced to thirty-two

law. He was convicted of spousal abuse in 1999 in San Bernardino County and was sentenced to ninety days in jail and four years’ probation. In October 2001, King pleaded no contest to three counts of being under the influence of PCP and one count of indecent exposure. A judge gave him a year in a drug treatment center even though a prosecutor argued King should spend a year in county jail. And again, on April 13, 2003, King was charged with three misdemeanor counts stemming from a car crash. Police said King was under the influence of PCP when he drove through a Rialto, California intersection at more than one hundred miles per hour, lost control of his sport utility vehicle, and slammed into a power pole. King was charged by San Bernardino County prosecutors with a single count each of driving under the influence, using PCP, and reckless driving. Toxicology tests showed “significant amounts” of PCP in King’s system after the crash (Associated Press, 2003). Rodney King was a frequent user of PCP and it came as no surprise that the drug would play a role in his untimely death.

The four officers were charged with assault with a deadly weapon and use of excessive force. Three were acquitted of all charges. The jury acquitted the fourth of assault with a deadly weapon, but failed to reach a verdict on the use of excessive force. The jury deadlocked at 8–4 in favor of acquittal at the state level. The acquittals are generally considered to have triggered the 1992 Los Angeles riots, which began as African-Americans in Los Angeles exploded in outrage. For

months in prison, while Timothy Wind and Theodore Briseno were acquitted of all charges.

Alta-Pazz Recording In 1994, King received a $3.8 million award in damages as a result of a civil suit filed against the City of Los Angeles. King used some of the money to start a rap label record business, AltaPazz Recording Company, but continued to abuse substances and run afoul of the

King was found at the bottom of the backyard pool at his Rialto home. King’s death at age forty-seven was listed as accidental drowning, but drugs were contributing factors. According to the death report, he was under the influence of cocaine, PCP, marijuana, and alcohol at the time of death. He was in a state of “drug- and alcohol-induced delirium at the time” and “either fell or jumped into the swimming pool,” according to the San Bernardino County coroner’s report (Miles, 2012). The drugs, combined with a heart condition, led to a cardiac arrhythmia and King was “thus incapacitated, and unable to save himself and drowned,” according to the report. King’s blood-alcohol level was 0.06 (Miles, 2012). The portrait of Rodney King is one painted in dark hues of sadness and misfortune. King was a petty criminal, alcoholic, and substance abuser. Even the brutal beating at the hands of rogue police officers did little to alter his tragic journey. At one point King said, “I realize I will always be the poster child www.counselormagazine.com 15

Cultural Trends for police brutality, but I can try to use that as a positive force for healing and restraint” (Medina, 2012). Those were sweet words from Rodney King, but only spoken in front of the pandering cameras and never acted upon. King uttered other quotes too; words that sought to explain his volatile existence. He said, “People look at me like I should have been like Malcolm X or Martin Luther King or Rosa Parks,” he told The Los Angeles Times, “I should have seen life like that and stay out of trouble, and don’t do this and don’t do that. But it’s hard to live up to some people’s expectations” (Medina, 2012). It was hard for King to live up to his own expectations. The habitual felon continued his egocentric path of selfdestruction that included robbery, domestic abuse charges, DUIs, and solicitation of a transvestite prostitute. He continued to use PCP, one of his favorite drugs of choice. Breaking the law and getting caught were risks he eagerly took. Consequences were of no concern. And no matter how large or small the infraction, the news media, paparazzi, and supermarket tabloids were always there to exploit King’s

16 Counselor · February 2015

celebrity and revisit his pain. His story should have had a better ending. c

Kuhn, C., Swartzwelder, S., & Wilson, W. (2003). Buzzed: The straight facts about the most used and abused drugs from alcohol to ecstasy. New York, NY: WW Norton & Company.

Maxim W. Furek, MA, CADC, ICADC, is 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 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.

LawyerIntl. (2008). Key figures in the LAPD officers’ (Rodney King beating) trial. Retrieved from http:// www.lawyerintl.com/law-articles/1402-Key%20 Figures%20in%20the%20LAPD%20Officers%27%20 (Rodney%20King%20Beating)%20Trial

References Associated Press. (2003). Rodney King charged with DUI, PCP use. Retrieved from http://www. freerepublic.com/focus/f-news/911899/posts Cannon, L. (1993). Prosecution rests case in Rodney King beating trial. The Tech. Retrieved from http://tech.mit.edu/V113/N14/king.14w.html CNN Wire. (2012). Rodney King dead at fortyseven. Retrieved from http://www.cnn. com/2012/06/17/us/obit-rodney-king/index.html Drug Enforcement Administration (DEA). (2013). Phencyclidine. Retrieved from http://www. deadiversion.usdoj.gov/drug_chem_info/pcp.pdf de Lama, G. (1993). Rodney King: I never tried to attack police. Chicago Tribune. Retrieved from http://articles.chicagotribune.com/1993-01-22/ news/9303171094_1_pcp-crazed-giant-officer-timothye-wind-officers-theodore-briseno Delk, J. D. (1994). Fires and furies: The LA riots. Palm Springs, CA: ETC Publications.

Lepore, M. (2000). Rodney King police brutality case and the 1991 Los Angeles riots. Retrieved from http://crimsonbird.com/history/rodneyking.htm Linder, D. O. (2001). Famous American trials: Los Angeles police officers’ (Rodney King beating) trials. Retrieved from http://law2.umkc.edu/ faculty/projects/ftrials/lapd/lapdaccount.html Medina, J. (2012). Rodney King dies at forty-seven; Police beating victim who asked ‘can we all get along?’ The New York Times. Retrieved from http://www.nytimes. com/2012/06/18/us/rodney-king-whose-beating-ledto-la-riots-dead-at-47.html?pagewanted=all&_r=0 Miles, K. (2012). Rodney King autopsy: PCP, cocaine, marijuana, and alcohol contributed to drowning. Huffington Post. Retrieved from http://www.huffingtonpost.com/2012/08/23/ rodney-king-autopsy-pcp-cocaine-marijuanaalcohol-drowning_n_1825263.html Narconon International. (2009). The history of drug abuse and addiction in America – Part 6 PCP. Retrieved from http://news.narconon. org/history-drug-addiction-pcp-america/ National Drug Intelligence Center (NDIC). (2004). PCP: Increasing availability and abuse. Retrieved from http://www.justice.gov/archive/ndic/pubs8/8180/ Preitauer, C. (2014). 1992 Rodney King police acquittal. Los Angeles Times. Retrieved from http:// blackhistorycollection.org/2014/09/02/1992rodney-king-police-acquittal-los-angeles-times/

Opinion

Relapse and Prescription Medications: Advocating for Recovery Roland Williams, MA, LAADC, NCAC–II, CADC–II, ACRPS, SAP

n my twenty-eight-year career, I have noticed that one of the biggest causes of relapse for people in recovery is the abuse of prescription medications. This is even the case for recovering people with decades of abstinence. It is critical that addicts and alcoholics are extremely careful when and if they are prescribed addictive and mood-altering medications because they can easily trigger a regression back to old addictive patterns. My philosophy is that we need to do more to teach the recovering person what to do when they have to take medications, not if they have to take medications, because sooner or later most of us are going to have some medical procedure for which medications will be prescribed. Remember, pain is just as much a threat to one’s recovery as pain medication, so we must help people get through these difficult situations and maintain their recovery. This article offers some concrete information and suggestions that counselors can use with clients to help avoid a relapse. Many addicts and alcoholics have relapsed following a “legitimate reason” for taking prescription medications. Some medications are harmless and do not necessarily pose a threat to one’s recovery—antidepressants, for example, are less likely to trigger cravings. However, once the recovering person takes an addictive, mood-altering medication such as pain medications, sleeping pills, anxiety medications, and/or muscle relaxants, there is great risk that the addictive disease will be awakened once more. Once awake, the disease will often demand more of the drug and a return to old addict behavior, such as lying and manipulating to stay high. The recovering person is often unaware or prepared for the risk. He or she may not know to ask for nonnarcotic pain medications. The addict may defer to the prescribing physician’s expertise, assuming that the doctor knows what to do. Unfortunately, many doctors have very little training in how to deal with addiction and may inadvertently prescribe medication that can start the disease process in motion. It is extremely important to know what medications your clients are taking, what the abuse potential is, and whether the drug is addictive and mood-altering. Just because a doctor prescribed it, doesn’t mean that it is okay. It is the responsibility of the recovering person to protect his or her recovery. Counselors should encourage their clients to ask questions, look the drug up online, get feedback, and be accountable before taking any prescribed medication. Even some over-the-counter medications contain substances that can be dangerous to the recovering person. Many cough

syrups and mouthwashes contain very high alcohol content, and some antihistamines contain stimulants, so advise clients to read the labels very carefully before they begin taking one of these seemingly harmless medications. The most commonly abused prescription medications are as follows: • Opioids—usually prescribed to treat pain • Central nervous system (CNS) depressants— used to treat anxiety and sleep disorders • Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD) Physicians are very quick to prescribe pain, sleep, and anxiety medications. Recovering people need to be extra cautious. Even in addiction treatment we are seeing enormous lobbying from pharmaceutical companies advocating for medicationassisted recovery as the first line of defense. Some managed care policies actually block attempts to place teenage opiate addicts into residential treatment, mandating that www.counselormagazine.com 17

Opinion these young people be seen instead by buprenorphineprescribing physicians in private practice. Hospitals have very strong policies regarding pain and are eager to prescribe pain medications to ensure that patients have little or no discomfort. This makes their jobs easier, but puts the patient at enormous risk for dependence. So here are some suggestions we as counselors can provide to our clients, so they may avoid a relapse: Before clients take medications: • Encourage them to find a doctor who is educated about addiction, preferably one that is ASAM certified. • Ask them to be very clear when they tell their doctor that they are a recovering addict or alcoholic and that they do not want any medications that can threaten their recovery. • Have them ask the doctor about the medication. Is it a narcotic? Is it addictive? Is there abuse potential? • Invite them to do their own research on the medication. They can research it and find out for themselves what it is and what it does. • Assure them that it’s okay to ask for nonnarcotic or other safe alternatives if they need medication. • Make sure they ask for a small amount of the medication with no refills. • Encourage them to contact their sponsor and other members of their support group and inform them that they will be taking medications. Clients can tell their peers what they have, how many they have, and what the recommended dose is.

• Have them ask if they can dose in the office rather than take meds home. • If clients have to take drugs home, they can ask for a three- to five-day prescription. When clients have to take medications: • Make sure they are taking medications only as prescribed. • Encourage them to stay in daily contact with several members of their support system and keep them current on the dosage and their reactions. • Ask them to consider giving the medication to a member of their support system who will be responsible to administer the medication to them every day. • Recommend that they talk about it at meetings and other support functions. • When the prescription says “Take as needed for pain or other symptoms,” they need to monitor their symptoms and contact their support system when they are not sure if they really need it. • Encourage them to stay in close contact with their doctor and comply with the doctor’s orders. • Remind them to be careful to not reinjure themselves so that they don’t have to take more medications for a longer period of time. • Suggest that they keep a journal and monitor their thoughts, feelings, cravings, and actions. • Propose that they report any concerning changes to members of their support system. Once the need for the medication is over: • Ask them to throw away any unused medications. They shouldn’t save them in case they “need them later.” • Have them inform their support system that they no longer need to take the medications. • Encourage them to share at meetings about what issues came up for them while on the medications and how they managed them. In summary, the key to avoiding relapse is to have your clients advocate for their own recovery; be honest and open about their thoughts, feelings, urges and behaviors; and most of all stay accountable. The biggest danger is for them to go underground and not let the key people in their support system know what’s going on. I have seen many addicts relapse, and some even die, because they were unwilling or unable to reach out and ask for help when they were struggling. c Roland Williams, MA, LAADC, NCACII, CADCII, ACRPS, SAP, the founder and CEO of Free Life Enterprises and VIP Recovery Coaching, is a world renowned addiction specialist, counselor, interventionist, lecturer, trainer, teacher, author, and consultant. He has been passionately working in substance abuse treatment since 1986.

18 Counselor · February 2015