Counselor - August 2017 Issue Preview

OPINION: UNCOVERING THE INTERSECTIONALITY OF MEN, TRAUMA, AND ADDICTION

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BY DAVE BRAUN & TROY AMDAHL, WITH JANET SWITZER

FIND BALANCE IN AN UNBALANCED WORLD

Men & Anger Healthy Anger: A Mind and Body Approach The Myth of Anger Management Celebrity Theft Addiction Interview: Women of Color in Alcoholics Anonymous

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CONTENTS

25

Letter from the Editor

6

By Gary Seidler Consulting Executive Editor

Healthy Anger: A Mind and Body Approach

CCAPP

National Perspective

By Bernard Golden, PhD

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By Andrew Kessler, JD

Discusses the neurology of anger, defines healthy anger, and provides examples of successful techniques used to manage anger.

NACOA

A Name Changed, a Stronger Voice

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By Sis Wenger

Cultural Trends

31 Men and Our Anger: How to Make it Work for Good

By William G. DeFoore, PhD Presents information on the evolution of anger and how men have used it in the past, and explains how to heal toxic and dysfunctional anger.

Bill Cosby: America’s Dad

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By Maxim W. Furek, MA, CADC, ICADC

Opinion

Uncovering the Intersectionality of Men, Trauma, and Addiction

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By Devon Hawes, BS

From Leo’s Desk

What is God? Part II

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By Rev. Leo Booth

Wellness

Cultivating the Quality of Contentment, Part I

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By John Newport, PhD

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The Integrative Piece

A New Doorway

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By Sheri Laine, LAc, Dipl. Ac

The Myth of Anger Management

By Dan Griffin, MA Clarifies that trauma is the root of problematic anger for men, defines the “Man Rules,” and discusses how counselors can help men understand and tame their anger.

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C

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

CONTENTS

43

Topics in Behavioral Health Care

Grief Has No Expiration Date, Part I: Losing a Loved One to Addiction

Women of Color in Alcoholics Anonymous

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By Dennis C. Daley, PhD

By Andrea G. Barthwell, MD, DFASAM, & Megan Crants, BA

Counselor Concerns

Shares stories of various women of color with over fifty years of sobriety and imparts their advice to those seeking recovery.

Reconfiguring Diagnosis

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By Gerald Shulman, MA, MAC, FACATA

Ask the LifeQuake Doctor

24

By Toni Galardi, PhD

Inside Books

From the Journal of Substance Abuse Treatment

49 The Link between Quality Measures and Mortality in Individuals in Co-Occurring Issues

By Katherine E. Watkins, MD, MSHS, Teresa J. Hudson, PhD, PharmD, and Corey Hayes, PharmD, MPH

Oola for Women: Find Balance in an Unbalanced World

64

By Dave Braun & Troy Amdahl, with Janet Switzer Reviewed by Leah Honarbakhsh

Also in this issue: Ad Index CE Quiz

59 62

Describes a study on veterans with mental health issues and comorbid SUDs to determine if higher quality care improved mortality rates, and presents implications for health care systems and counselors.

53 Celebrity Theft: Unmasking Addictive Criminal Intent

By John C. Brady II, PhD, DCrim Discusses the cases of three men jailed for theft, explains how theft can be a behavioral addiction, and presents the stages of this kind of addiction.

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LETTER FROM THE EDITOR

Unsavory Practices in the Addiction Treatment Industry

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ince Counselor’s primary objective is to provide our readership with tools to be more effective addiction and mental health counselors and therapists, we rarely venture into today’s most pertinent issues affecting all of us who work in this industry. This is an exception.

We are compelled to comment on the volatility in our field, specifically addiction treatment. As we go forth each day, doing the best we can for our clients and patients, it is nearly impossible not to be affected by the strife reflected in today’s alarming news headlines: n “FBI Agents Raid California Health Care Company” n “Rehab Centers: A Get-Rich Quick Scheme” n “ South Florida: Multiple Arrests for Fraud, Patient Brokering” n “Pharmaceutical Industry Investigated for Prolonging Opiate Epidemic” With the enormous growth of the treatment industry—now estimated by Forbes magazine at $35 billion dollars per year (Munro, 2017)—a myriad of financial abuses have been uncovered.

Like any “gold rush,” the greedy and the cunning have been attracted and are in full force.

We are not talking “fake news” here.

The various financial opportunities presented by addiction treatment can be problematic. A MarketAlert brief for investors described financial risk in the recovery business this way: It’s not all kittens and rainbows. As we have seen countless times in other frenzied health care sectors, when the money flows in, so do the ne’er-do-wells, which can bring the sector the kind of attention it doesn’t want. Markets in hyperdrive are extremely fragile. And sometimes all it takes to bring a highflying sector crashing to the ground are a few, high-profile cases of chicanery that paints the entire industry with a broad brush of suspicion (The Braff Group, 2014).

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With overdose deaths quadrupled since 1999 (Sforza, 2017) and mandated addiction treatment coverage under the Affordable Care Act (ACA), many have recognized that there is money to be made.

An investigative report in the highly-regarded Orange County Register provides an eye-opening overview of recent trends: Investors are attracted because the business of addiction treatment is so fragmented and ripe for modernization; in the world of health care, size matters . . . more sophisticated operations can allow for investment in technology and data-mining that may better manage health and financial outcomes. . . . consolidating addiction treatment companies are reaping the benefits of “vertical integration,” what happens when websites, call centers, rehab facilities, drug-testing labs, and soberliving homes are all gathered under one corporate roof, capturing all that spending for the same corporate family. . . . There’s a great deal of uncertainty around Obamacare’s survival.

Insurance companies are pressuring addiction treatment providers come in-network, which costs insurers less and may decrease revenue growth for providers (Sforza, 2017).

There have been lawsuits and investigations which could impact the business, and the market itself has been volatile.

Mark Mishek, president and CEO at the Hazelden Betty Ford Foundation, stated, “The black-hat marketing techniques, an incredible amount of fraudulent billing, payment for patient referrals, self-referrals, fraudulent work in drug testing— it’s all there and it’s terrible. If you ever did that in the real world of health care, you’d go to jail. It’s fraud” (Sforza, 2017).

The Register also reports on The Southern California News Group’s recent investigation, which found the industry “peppered with financial abuses that bleed untold millions from public and private pockets, can upend neighborhoods, and often fails to set addicts on a path to sobriety” (Sforza, 2017).

Then there is “the role that pharmaceutical companies played in creating and

prolonging the opioid epidemic” (Lurie, 2017). An investigation, led by AG offices in Washington, DC and Tennessee, “will focus on whether the marketing and sale of prescription painkillers was unlawful” (Lurie, 2017). Twenty-one states and Washington, DC are participating in the investigation.

Rebecca Flood, long-time executive director and CEO of New Directions for Women, adds a strong voice to the discussion. She reminds us, “There are many good people in our field, including addiction treatment providers that have been around for decades, are reputable and accredited, and remain driven by the mission of helping to save lives” (Flood, 2017).

We all need to remember that not everyone is a culprit. The heart of the industry is equitable, fair, and compassionate.

Gary Seidler

Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication References The Braff Group. (2014). A peek inside American Addiction Centers’ initial public offering: Implications for the industry. Retrieved from http://www.thebraffgroup. com/Articles/articlespdfs/MarketALERT/MA_BHSS_ Fall2014.pdf Flood, R. (2017). Coming together the get rehab industry back on track. The Orange County Register. Retrieved from http://www.ocregister.com/2017/06/16/ coming-together-to-get-rehab-industry-back-on-track/ Lurie, J. (2017). A giant coalition of states is investigating opioid manufacturers. Retrieved from http://www.motherjones.com/ politics/2017/06/a-giant-coalition-of-states-is-investigating-opioid-manufacturers/ Munro, D. (2017). Inside the $35 billion addiction treatment industry. Forbes. Retrieved from https://www. forbes.com/sites/danmunro/2015/04/27/ inside-the-35-billion-addiction-treatmentindustry/#591d313117dc Sforza, T. (2017). Addiction treatment: The new gold rush. ‘It’s almost chic.’ The Orange County Register.

Retrieved from http://www.ocregister.com/2017/06/16/ addiction-treatment-the-new-gold-rush-its-almost-chic/

CCAPP

National Perspective Andrew Kessler, JD

O

ver the past few years, the federal government has made a noticeable investment in fighting opioid abuse. Traditionally this subject was the purview of federal agencies such as the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) or even the Veteran’s Administration (VA). Yet recently, the Centers for Disease Control and Prevention (CDC) has emerged as an agency committed to this issue, with the funding to match. According to the CDC, there are a variety of ways to help reduce exposure to opioids and prevent abuse, which include prescription drug monitoring programs, enhancing state prescription drug laws, quality improvement programs in health care systems to increase implementation of recommended prescribing practices, and youth substance abuse prevention.

It is the CDC’s goal to improve prescribing of opioids, expand treatment of addiction, and reduce access to illegal opioids. They wish to expand access to evidence-based substance abuse treatment, such as medication-assisted treatment (MAT), for people already struggling with opioid addiction. Another goal is to expand access and use of naloxone. They also wish to promote the use of state prescription drug monitoring programs (PDMPs), which give health care providers information to improve patient safety and prevent abuse, and implement and strengthen state strategies that help prevent high-risk prescribing and prevent opioid overdose.

Most of the new funding has gone to the National Center for Injury and Control. Two years ago, their budget for opioid overdose was just over $20 million. In fiscal year 2016, that jumped to $70 million. Another increase of $20 million was recommended for 2017, but due to no appropriations bills being passed, it remains at $70 million under a continuing resolution. In fiscal year 2016, California received $9.5 million in Injury Prevention and Control funding (CDC, 2016a).

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CCAPP One of the key programs managed by this center is funding that goes to states to enhance prevention, especially in the form of PDMPs. California is one of sixteen states that is funded through this program, having submitted a successful application (CDC, 2016c). The purpose of the Prevention for States program is to provide state health departments with resources and support needed to advance interventions for preventing prescription drug overdoses. Through 2019, the CDC plans to give selected states annual awards between $750,000 and $1 million to advance prevention in four key areas (CDC, 2016c).

Awarded states are collaborating with key partners to maximize efforts and address issues that impact prescribing and drug overdoses. In addition to funding PDMPs, states are encouraged to undertake policy evaluations and develop raid response techniques.

The CDC’s foray into the complications of addiction is not new, however.

For decades they have been funding research and grants aimed at fetal alcohol spectrum disorders (FASDs), led by their National Center on Birth Defects and Developmental Disabilities (NCBDDD).

They monitor patterns of alcohol use across the country, especially amongst women of child-bearing age. They seek to reduce alcohol use and alcohol-exposed pregnancies through community-level

guided self-change, which tend to be of low intensity as compared with traditional treatments, targeted toward the community at large, and focused on problem drinkers as opposed to severely alcoholdependent drinkers (CDC, 2016b). The goal of these programs is to attract and assist motivated individuals in the early stages of alcohol abuse to take part in an

The purpose of the Prevention for States program is to provide state health departments with resources and support needed to advance interventions for preventing prescription drug overdoses. intervention aimed at facilitating a clientdriven, self-change process of alcohol reduction or abstinence. In the last several fiscal years, California has received millions of dollars’ worth of grants to work on this issue, including FASD Regional Training and Practice Centers ($275,000) and FASD Practice and Implementation Center High-Impact Projects for Practice ($151,200; CDC, 2017a).

Perhaps the effort that has gained the most recognition in the last year is the CDC’s “Guideline for Prescribing Opioids for Chronic Pain” to provide

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recommendations for the prescribing of opioid pain medication for patients aged eighteen and older in primary care settings (CDC, 2017b). Recommendations focus on the use of opioids in treating chronic pain—that is, pain lasting longer than three months or past the time of normal tissue healing—outside of active cancer treatment, palliative care, and end-of-life care.

This guideline addresses when to prescribe opioid treatment for chronic pain, as well as opioid selection, dosage, duration, follow-up, and discontinuation. It also covers assessment of risk and addressing harms of opioid use. For the guideline, the CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee (CDC, 2017b). This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.

The CDC is critical to our nation’s collective health. Its contributions to fighting addiction are no exception, and we will continue to support their initiatives throughout the budget process. c About the Author Andrew Kessler, JD, is founder and principal of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy and federal policy liaison for IC&RC.

References Centers for Disease Control and Prevention (CDC).

(2016a). Centers for Disease Control and Prevention fiscal year 2016 grants summary profile report for California.

Retrieved from https://wwwn.cdc.gov/ FundingProfilesApp/Report_Docs/PDFDocs/Rpt2016/ California-2016-CDC-Grants-Profile-Report.pdf Centers for Disease Control and Prevention (CDC).

(2016b). Fetal alcohol spectrum disorders (FASDs): About us. Retrieved from https://www.cdc.gov/ncbddd/fasd/ about.html Centers for Disease Control and Prevention (CDC).

(2016c). Opioid overdose: Prevention for states. Retrieved from https://www.cdc.gov/drugoverdose/states/state_ prevention.html Centers for Disease Control and Prevention (CDC).

(2017a). Fetal alcohol spectrum disorders (FASDs): Training and education. Retrieved from https://www.cdc. gov/ncbddd/fasd/training.html Centers for Disease Control and Prevention (CDC).

(2017b). Opioid overdose: CDC Guideline for prescribing opioids for chronic pain. Retrieved from https://www.cdc. gov/drugoverdose/prescribing/guideline.html

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Counselor | August 2017

NACOA

A Name Changed, a Stronger Voice Sis Wenger

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ifteen years ago, I could not envision a time when leaders of major national medical organizations would gather at the White House, as they did last September, to discuss initiatives developed by NACoA. Fifteen years ago, I dared not hope that NACoA would one day be the vigorous voice for children that we are today. . . . No, fifteen years ago I was just praying that someone, somewhere, would notice, listen, and maybe print a little article about our new organization. I hoped maybe someone might think children of alcoholics were an important population.” – Cathleen Brooks Weiss, a NACoA founder, on the occasion of NACoA’s fifteenth anniversary in 1998

The National Association for Children of Addiction (NACoA), which until this month was called the National Association for Children of Alcoholics (NACoA), came into existence in February of 1983, and has been the continuous voice for the children across the addiction treatment and recovery fields, faith communities, the medical and mental health fields, and the fields of social work and education since its inception. It has never deviated from its focus of bringing hope and healing to the millions of children suffering from the effects of parental addiction. It has done this through partnering with its over forty affiliate organizations that provide myriad services to foster and support addiction prevention and recovery in their communities.

The organization has also been known for years as “NACoA: Voice for the Children” and will continue to be. It has been that continuous and strong voice for the millions of children hurt everyday by the chaos and confusion of living with alcoholism or other drug addictions in the family, with a particular emphasis on the affected children.

Recognized in the early 1980s by the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Centers for Substance Abuse Prevention and Substance Abuse Treatment as having the top experts in age-appropriate prevention and supportive interventions for this population, NACoA partnered with these federal agencies to provide critical expertise so that the most effective prevention and recovery support materials and training could be developed, healing children of addiction while they were still young and vulnerable. NACoA has always known that these children could benefit from educational support that could foster and build their resiliency.

Beyond the work of NACoA’s affiliates and its partnership with federal agencies, NACoA has partnered with leaders in

medical education, providers in children and family medical practices, social work education specialists, educators, practicing clergy, and the institutions that train them to develop profession-specific core competencies and educational tools for those who work in systems that touch children’s lives every day. The goals of these competency development projects—and the educational programs and tools that follow— are to help foster awareness of the silent suffering children experience to these critical influencers who provide services to them and too often miss the underlying and primary issues, and to instill in these influencers a willingness and ability to address the needs of these children. The ultimate goal is to make it commonplace for these professional systems to educate their colleagues to understand that children of addiction who are troubled or in trouble, need—possibly first and foremost—recognition of their silent struggle and the healing they need to recover from their home environment of chronic emotional stress. NACoA’s reach continues to grow, and this goal is now part of the work of our international affiliates in Canada, Great Britain, Germany, New Zealand, Poland, and Slovenia.

In the first decade of NACoA’s work, it held regional and national conferences, many in partnership with U.S. Journal Training, Inc (USJT). Those conferences, which awakened many thousands of people to understand their www.counselormagazine.com

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NACOA own childhood and their adulthood-related consequences, awakened others to hope for personal recovery. They also taught many thousands of mental health and substance use disorder clinicians about their clients. USJT went on to host NACoA’s twenty-fifth and thirtieth anniversary conferences in Orlando, Florida and Las Vegas, Nevada, respectively. Throughout the 1980s and early 1990s, the programs of each of these conferences always included training about the effects of alcohol and other drug use and about the solutions for helping the children and families to recover and to change the trajectory of their lives.

NACoA: A Voice for the Children

In 2018, NACoA will celebrate its thirty-fifth year as the “Voice for the Children” with a new name: The National Association for Children of Addiction.

We have changed one word to further clarify what the organization’s mission, programs, and advocacy work is now and has been throughout its history.

Today, in the face of yet another growing drug epidemic that has captured the public’s attention and the media’s storytelling, NACoA is marshalling its resources and partnering with the leadership of other major organizations in the field of addiction recovery, as it did during the meth, cocaine, and

crack epidemics. NACoA continues to acknowledge that the drug epidemic still kills the most people, devastates the most families, and creates chronic emotional stress in the lives of the most children over more years, changing their brain development and potentially their lives.

We are working with our existing partners to strengthen the impact of our program materials, trainings, and advocacy efforts to bring more attention and healing support to all the children of addiction so that they too can be included in the recovery support legislation and funding that is on the table in our federal and state legislatures. As evidence of the importance of recovery for family members comes slowly to the forefront again, we are reminded of Robert Denniston’s column in this space in December 2015.

Mr. Denniston, NACoA’s board vice chair, titled his column in that issue, “What’s Old is New Again.” NACoA could do so much more with help from Counselor readers if we all did a piece of the advocating and helped to spread knowledge rather than having to repeat what has been known for decades.

Recently, a major report was issued by the Surgeon General on alcohol, drugs, and health—a report discussed by Mr. Denniston in this space in the June 2017 issue. While the report was historical and extraordinary, it missed the greater majority of Americans whose mental and

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physical health are challenged every day by their attempts to survive in a household with an addicted parent, and who research has made clear will suffer expensive, lifetime mental and physical distress as a direct result of the adversity they face every day unless help and support comes from caring and responsible adults within their environments.

Their unrecognized and unaddressed adversity today will swamp the physical and mental health systems of tomorrow, and facilitate their being trapped in the generational transmission of addiction in their young adult years. This is a public health problem at the highest level. Imagine what could happen if we all did what we could to make both the plight of and the hope for children of addiction understood by just two colleagues, sufficiently motivating them to step up to the challenge. Imagine what could happen if each of those colleagues helped two more to reach that level of understanding and commitment.

When will we take a good look at the pain of these children? When will we acknowledge the data that clearly shows when the family members (including the children) receive recovery services, there is more and healthier recovery for the addicted people, less family violence and disintegration, more family reunification, and lower health care costs for all members of the family? America has a major opioid and heroin epidemic; it also has a major societal neglect problem—both within the addiction field and society. “Our children are our future” is a slogan often mouthed in America, but who is marching for those most at risk—in the broader society and in the recovering community—so that they can have the future a civilized society should be willing to provide? There are many ways Counselor readers can join this “march.”

We invite you to visit www.nacoa.org, sign up to receive our monthly e-newsletter, and review the opportunities to help. NACoA welcomes all those who would like to help strengthen NACoA’s “Voice for the Children” until the children can find their own. c About the Author Sis Wenger is NACoA’s President and CEO.

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Counselor | August 2017

CULTURAL TRENDS

Bill Cosby: America’s Dad Maxim W. Furek, MA, CADC, ICADC

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n his popular comedy television sitcom, The Cosby Show (1984–1992), Bill Cosby came across as a successful professional and a compassionate family man (IMDb, 2017). The much-loved and respected Cosby was recognized as the fictitious Dr. Heathcliff Huxtable and as “America’s Dad.” But it was no laughing matter for Cosby after he became the target of ugly accusations stemming from his past. It started when another comedian accused Cosby of rape. The comedian, Hannibal Buress, spoke the language of stand-up: irreverent, disrespectful, without boundaries (Anderson, 2015).

His skit went viral and quickly began to resonate. “Bill Cosby rape” became a popular Facebook trending topic. One by one, women who had crossed paths with “America’s Dad” accused him of drugging and then sexually assaulting them.

The patterns were all similar in theme; only the names and times were different.

On August 7, 2016, The Washington Post reported that two more women had come forward with accusations against the star. With their allegations, the number of women claiming abuse by Cosby rose to sixty (Goldstein, 2016).

“Luding Out”

Although Cosby denied all claims from each woman, he had settled a civil lawsuit filed by Andrea Constand in 2005 (Goldstein, 2016). The women’s basketball team at Temple University, Cosby’s alma mater, employed Constand. She claimed that she was assaulted after visiting Cosby at his Montgomery County, Pennsylvania home in 2004. Like other alleged victims who came forward after her, she claimed the comedian gave her medication that made her feel “. . . shaky, weak, and dizzy” and then sexually assaulted her (Engel & Fuchs, 2015).

That “medication” is believed to have been methaqualone, a controlled substance commonly known as “Quaaludes.”

According to an article by PBS, “Bill Cosby testified during a 2005 civil lawsuit that he acquired Quaaludes ‘with the intent of giving them to young women to have sex with’ and admitted to giving the sedative to at least one woman, the Associated Press reported” (Epatko, 2015).

Quaaludes are banned in the United States, but were, at one time, a popular drug of abuse. Quaaludes were first synthesized in India in the 1950s as a nonaddictive sleeping pill also used to treat malaria (“Methaqualone timeline,” 2001).

Quaaludes act upon the central nervous system as a depressant; the drug can release inhibitions, raise the pain threshold, www.counselormagazine.com

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CULTURAL TRENDS and produce feelings of euphoria and well-being (“Quaaludes,” 2015).

According to PBS, “The drug was manufactured in the United States under the name ‘Quaalude’ with the number 714 stamped on the tablet” (Epatko, 2015).

Methaqualone was introduced to treat anxiety in 1965. Experience showed, however, that their addiction liability and the severity of withdrawal symptoms were similar to those of barbiturates. The Physician’s Desk Reference described the drug as a “sedative hypnotic” and incorrectly pronounced the drug as being “nonaddictive” (Furek, 1973).

In 1972, Quaaludes were one of the most prescribed sedatives in United States (“Quaaludes,” 2015) and “became popular for recreational use in the late 1960s and 1970s in discos—where they were known as ‘disco biscuits’” (Epatko, 2015). Even though the United States and Britain tightened control around their use and dispensing, methaqualone’s euphoric effects promoted its widespread recreational use. The abuse potential of Quaaludes soon became apparent. By 1972, “luding out”—that is, taking methaqualone with wine—was a popular college pastime that resulted in a “drunken, sleepy high” (“The Quaalude,” 2006).

Excessive use of Quaaludes “leads to tolerance, dependence, and withdrawal symptoms similar to those of barbiturates” (“Methaqualone (Quaalude),” 2015). Overuse could lead to respiratory arrest, delirium, kidney or liver damage, coma, and death. Overdose effects include drowsiness and reduced heart rate and respiration. According to Drugs.com, “. . . in 1973 methaqualone was placed in Schedule II, making it difficult to prescribe and illegal to possess without a prescription” (“Quaaludes,” 2015).

Much of the Quaaludes “came from legitimately manufactured pills diverted into the illegal drug trade and from counterfeit pills coming from South America and illegal labs within the United States” (“The Quaalude,” 2006). Furthermore, Frontline attests that By 1981, the DEA ranked Quaalude use second only to marijuana and estimated that 80 to 90 percent of world production went into the illegal drug trade. Stress clinics, where customers paid about $100 cash for a Quaalude 12

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prescription from a licensed physician, became popular in urban areas. The DEA estimated that the twenty million pills on the street in 1980 would double in just a year and match heroin’s popularity.

And yet, within just a few years, the DEA got the problem of Quaalude abuse under control. By 1984, Quaaludes had all but disappeared from the US marketplace.

Gene Haislip, the DEA’s number three man at the time, was the idea man behind shutting down Quaaludes. He came up with the solution to go after Quaaludes at their source: the chemical manufacturers of methaqualone powder in West Germany, Austria, Hungary, and China. . . . Finally, Congress banned domestic production and sales of the prescription version of Quaalude, which was made by just one company, and President Reagan signed the legislation into law in 1984 (“The Quaalude,” 2006).

Methaqualone was moved to Schedule I in that same year, “making it illegal to buy, sell or possess” (“Methaqualone timeline,” 2001).

Sworn Depositions

Although Quaaludes are not legally available in the United States, Cosby was able to obtain them. Court records and sworn depositions were made public on July 6, 2015, “after the Associated Press went to court to compel their release” (Yan, McLaughlin, & Ford, 2015).

Andrea Constand’s attorney, Delores Troiani, asked Cosby directly, “When you got the Quaaludes, was it in your mind that you were going to use these Quaaludes for young women that you wanted to have sex with?” (Yan et al., 2015). Cosby answered in the affirmative, but when Troiani asked, “Did you ever give any of those young women the Quaaludes without their knowledge?”

Cosby’s attorney objected and instructed him to not answer the question (Yan et al., 2015).

Cosby admitted under oath “that he acquired seven prescriptions of Quaaludes with the intent to give the sedatives to young women he wanted to have sex with,” but did not admit that he actually

drugged any of his many accusers (Yan et al., 2015).

Reporters Engel and Fuchs provided a stark overview: “The accusations have common threads, painting a picture of a man who allegedly used his power and influence in the entertainment industry to seek out vulnerable young women and lure them in with the promise of mentorship” (2015).

That was only the beginning. Cosby’s career of comedy rapidly morphed into a house of horrors. Reruns of The Cosby Show were cancelled by at least two networks and Disney took down a statue of the comedian at Hollywood Studios (Engel & Fuchs, 2015). Cosby agreed to step down as an honorary cochairman of the University of Massachusetts-Amherst’s $300 million fundraising campaign. He also resigned from Temple’s board of trustees, a post he had held for thirtytwo years (Yan et al., 2015).

The attacks were relentless. One by one his supporters turned their backs on him. A coalition of black civil rights activists called on the Hollywood Chamber of Commerce to remove Cosby’s star from the Hollywood Walk of Fame in Los Angeles. The Chicagobased Promoting Awareness, Victim Empowerment (PAVE) petitioned the White House to revoke a Presidential Medal of Freedom the comedian received in 2002 (Fantz, 2015).

During a news conference, Former President Obama, asked if that honor should be revoked, “said there is no precedent for revoking a medal,” according to an article on MarketWatch: “We don’t have that mechanism, and as you know, I tend to make it a policy not to comment on the specifics of cases where there might still be if not criminal, then civil, issues involved,” Obama said. But he continued: “I’ll say this: if you give a woman—or a man, for that matter—without his or knowledge, a drug, and then have sex with that person without consent, that’s rape. I think this country, any civilized country, should have no tolerance for rape” (Schroeder, 2015).

“Most Prolific Serial Rapist”

One victim, Barbara Bowman, was an eighteen-year-old, blonde, aspiring

Continued on page 21

OPINION

Uncovering the Intersectionality of Men, Trauma, and Addiction Devon Hawes, BS

R

esearchers and treatment professionals have explored the intersection between trauma and substance abuse for years, as the majority of clients entering addiction treatment have experienced some form of trauma in their lives.

But what is often overlooked is how trauma manifests differently and specifically in men and women.

Traumatic events can lead to a change in the sensitized nervous system in the brain, making individuals more likely to isolate, dissociate, and express depression and anxiety symptoms (Bremner, Elzinga, Schmahl, & Vermetten, 2008).

In turn, this can lead to the development and progression of self-destructive behaviors, including substance abuse disorders, eating disorders, self-harm, and suicide. When the trauma-associated emotions of anger, fear, sadness, shame or guilt surface, it can be all the more difficult for people to seek help due to reactive or impulsive behaviors in response to these emotions.

Further, as a result of societal norms and messages conveyed in the media—like “boys do not cry” or “man-up”—men’s trauma is often discounted or not acknowledged. The seeds of this are planted at an early age. For example, if a young boy and girl are running through a playground and both fall, we as a society are more likely approach the girl and say, “Are you okay? What can we do to help? Tell me what is going on.” We

are, because of our own gender biases, more likely to tell the boy, “You will be fine” and to pick himself up and keep going.

Years of social conditioning has led many men to repress emotions stemming from traumatic events, and can prevent them from feeling comfortable expressing themselves due to fear of appearing weak or out of control. In the context of counseling, this means that men are often less willing to acknowledge or bring up past trauma when in treatment. Women, on the other hand, are usually more willing to enter a safe, therapeutic space where they can express vulnerability, and are sometimes more comfortable discussing their emotions relating to a traumatic experience.

As treatment professionals, it is essential to continue to share the message that everyone has the potential to experience trauma and the emotional struggles related to trauma, regardless of gender. We must help people feel safe and comfortable receiving the help they need, for any emotion that might be causing them discomfort or problems, by communicating that asking for help is natural, common, and in many situations critically important.

Treating Trauma and Addiction

As previously discussed, men suffering from trauma can use drugs and alcohol as a means of coping. It is essential that these men enter treatment—not just to help them recover from addiction, but to get to the root of the trauma that is www.counselormagazine.com

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OPINION manifesting in such a destructive way. If that trauma is not properly addressed, the dangerous behaviors will just perpetuate. But getting individuals into treatment, especially those reluctant to expose their vulnerability and open up that sensitive part of themselves, can be a serious challenge. Professionals should start by communicating to those considering treatment that healthy recovery is possible, and that through therapy and rehabilitation they can simultaneously treat substance abuse and past trauma.

Once in treatment, it is also important to understand what is happening in addition to the trauma. While both men and women may have experienced past traumas such as physical abuse, verbal or emotional abuse, neglect during childhood, exposure to violent incidents or natural disasters, men may process that trauma differently than women. In addition to identifying the impact of past trauma, it is also important to gain insight into other potential influencing factors. Are there chemical imbalances in the brain, either naturally occurring or substance induced, that are resulting in symptoms of anxiety, depression, and other mental health issues? Have they recently experienced loss of social support or connections?

Psychologically, how are they processing emotion? Are they having a difficult time with certain emotions such as anger, guilt or shame? Socially, what is their home environment like? Most importantly, how can we, as treatment professionals, take a full-picture approach towards finding solutions to those factors so clients can help themselves not only embrace sobriety, but also begin building a recovery focused on overall wellness? This approach needs to focus on healthy changes towards physical, emotional, and mental health, developing a strong support network and social environment, and may include a spiritual component.

I have found that clients see better results when clinicians focus on clients’ strengths and how to embrace those strengths to solve their existing problems.

This can be leveraged using solutionfocused brief therapy, which has been proven to be successful with those who are attempting to reprocess their shame and guilt into hope and empowerment (Berg & Miller, 1992; Winbolt, 2010). This approach to psychotherapy emphasizes 14

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the “solution,” rather than the “problem.”

While it is important to acknowledge that certain issues or experiences in life can create “problems”—whether those are negative effects from trauma, substance use disorders, mental health issues, and so forth—it is critical to come to an understanding, and very importantly an acceptance, that all those factors and “problems” may have led them to this point in their lives, but do not define their ability to currently live healthy and happy lives. By shifting the focus from the “problems” to the “solutions,” we can assist clients in identifying healthy things that have worked in the past and also how to utilize their current strengths through action to achieve personal goals for treatment and recovery.

Leveraging Individualized and Client-First Strategies

So, how might clinicians approach male patients suffering from trauma and other behavioral issues? Consider the following three tactics when meeting with these clients for the first time.

Meet Them at Eye Level

Understand where they are coming from and pivot your strategy to provide tailored counsel. It is important to clearly ask if your clients have experienced trauma, but very often they might not yet be willing to disclose that information. That may affect your ability to help them in understanding the role their trauma may have played in other issues.

Acknowledging trauma will be essential in eventually working on reprocessing the emotional response towards the trauma, but it must be done on clients’ terms. One of the most important things to remember is to respect their sensitivity to their trauma and not push them to discuss something they may not yet be comfortable discussing. In the meantime, focus on the strengths they possess, which will be needed in moving forward with their treatment, recovery, and hopefully at some point, healing from their trauma.

Never Judge

It is fairly self-explanatory, but clinicians and therapists must establish a safe, open, and therapeutic bond with clients so they feel comfortable in sharing what can potentially be the most intimate aspects of their pasts and their lives. Put

extra care and effort into creating that trusting space. It may take some time to develop that trust, but being nonjudgmental is vital to successful treatment.

Empower Them by Focusing on Their Strengths

It is easy for patients who are entering treatment to feel beat down or at the lowest point of their lives. Often, those beginning conversations with clients focus on what has gotten them to this point and the resulting guilt, shame, anxiety, and fear they are now experiencing. Let them open up, but remember to focus more on how to get clients to where they want to be by focusing on what they are good at, what healthy things make them feel good, and how you can apply those factors in every facet of their daily lives.

Conclusion

Despite the stigma and societal norms that continue to persist for men who are struggling with their emotions, it is important that we work together, as health care providers and as a community, to challenge those gendered assumptions and erode the stigma men feel by opening up conversations, sharing stories, and examining our own judgements. Every man who is brave enough to admit he is coping with trauma and wants to change his behaviors and life should be treated with respect and dignity, and know that his emotions are valid and accepted. C About the Author Devon Hawes, BS, received a bachelor’s in psychology from Sacred Heart University and is currently preparing to test for his certified addiction cotreatment specialist. Working for Mountainside Treatment Center, Hawes partners with their medical team to develop effective, solution-focused treatment, minimize withdrawal symptoms, and overcome early recovery hurdles. His training also includes the Helping Men Recover curriculum as well as the the trauma substance abuse and men’s trauma recovery empowerment model (SA·M-TREM), which enables him to evaluate and address male gender issues.

References Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-oriented approach. New York, NY: Norton.

Bremner, J. D., Elzinga, B., Schmahl, C., & Vermetten, E. (2008). Structural and functional plasticity of the human brain in posttraumatic stress disorder. Progress in Brain Research, 167, 171–86.

Winbolt, B. (2010). Solution-focused therapy for the helping professions (pp. 206). London: Jessica Kingsley.

FROM LEO’S DESK

What is God? Part II Rev. Leo Booth

W

hen theologians and philosophers postulate the Objectification Throughout history we have had people declare concept of God, it is important to understand that God has spoken to them, has appeared that God is not writing about Himself; he is not explic- in spirit form, has taken them on a miracuitly saying, “This is how I created the world” or “This is lous journey, and has told them to declare how I interact with the world.” God is not clearly or certain insights to the world. All the religions of the world have men and women demonstrably declaring Himself. This must be under- telling stories of how and what God said stood. What has happened and is still happening is to them. While they are interesting and that we—that is, human beings—are speaking about fascinating stories, that in itself does not make them true.

God, describing the qualities of God or telling others Let us agree for the sake of argument how God relates and makes things happen. Human that God is really speaking to the men and beings have postulated the notion of God and then women in this world. Okay, so He is saying different things, creating different creation stories, sought to explain Him. And the “we” in each religion and different prophecies? This is just an objective observation of the religious world and its history. throughout the world has done the same.

Background

In my last column, “What is God? Part I,” I gave the following examples: n In Judaism people have said that God is ultimately unknowable, created everything, and interacts with creation. It is interesting that He is “unknowable” and yet we know this information. n Christianity suggests that God is made up of the Father (creator), Son (redeemer), and Holy Spirit (sustainer). n Islam proclaims that God begetteth not, nor is He begotten. n Buddhism teaches that the spiritual life seeks to alleviate any pain or distress. n Hinduism is complex and seeks to incorporate all the above.

Just because a person says something, does not make it a fact. Just because something is written down, does not make it a fact. Just because people believe certain things, does not make them true.

What we really have concerning God are many ideas and opinions concerning who God is and how He relates and interacts with the world. They may be good and interesting ideas, but that does not make them true. People do and say anything they want, but that in itself does not make for facts.

It may be that what is said about a supreme being, and what is expressed concerning how the supreme being expects us to behave as human beings, can have a positive effect on any given society. For example, do not kill, steal or tell lies— these edicts may make for a more humane society, but that, in themselves, does not make them true.

Need to Believe

People sometimes say to me, “Everyone needs to believe in something.” Okay, but that does not in itself make these beliefs true. Some people believe that a snake in the Garden of Eden spoke to Adam and Eve. Some believe that the world was created in six days. Some believe that the Blessed Virgin Mary did not die, but was assumed into Heaven (which in Roman Catholicism is called the Feast of the Assumption). Some believe that Mohammed is the last prophet.

The reader knows from his or her personal experience that people believe all manner of things, but that does not mean they are facts or true.

“Yes, Leo, but look how many people believe in Jesus, or in Mohammed, or follow the teachings of Buddha. Are you saying they are all wrong?”

No! I am not saying they are all wrong, but I am not saying they are right. Numbers are no substitute for facts!

Religion: Good or Bad?

Religion being good or bad is not the real issue for me. I am not questioning what religions are saying. I know what many religions say and what their followers believe.

My question is this: Is it true? The question for me is not whether or not religion exists, because I know religion exists. I see them and I know what they say and believe. My question is: Do we know, Continued on page 17

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WELLNESS

Cultivating the Quality of Contentment, Part I John Newport, PhD

A

Warren is concerned with the search for enduring contents shall be demonstrated in this series, cultivating ment, which he defines as embodying a sense of deep-down, the quality of deep-seated contentment constisoul-satisfying contentment that infuses our lives with peace, tutes a key cornerstone in integrating a wellness mind- serenity, and an abiding sense of fulfillment. He goes on to state set and lifestyle into recovery from alcoholism, drug that the deepest and richest form of contentment is the natural addiction, and other addictive disorders. This column is result of a truly authentic existence (Warren, 1997). Authenticity, in turn, entails knowing ourselves intimately, appreciating our the first installment in a two-column series focusing on unique gifts and abilities—while coming to terms with our less the importance of contentment in living a truly authen- desirable qualities—and making moment by moment choices that tic and fulfilling life, while deepening a commitment to demonstrate honor and respect for ourselves and those around us. recovery. This series is largely inspired by one of my The Distinction between Contentment and favorite books, Finding Contentment: When Momentary the Compulsive Pursuit of Happiness While Warren is fine with pursuing and fully enjoying Happiness Isn’t Enough (1997), by Neil Clark Warren.

This first installment will focus on defining and elaborating on the quality of contentment, as distinct from the compulsive pursuit of profound yet fleeting experiences of momentary happiness. We will also examine the significant degree of overlap between chemical dependency and the obsessive pursuit of happiness, together with the relevance of these concepts to both addictive disorders and recovery from addiction.

Contentment Defined

The dictionary defines “contentment” as being essentially synonymous with peace of mind, satisfaction, and “freedom from both worry and restlessness” (Merriam-Webster, 2017).

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life’s precious moments of sheer joy and ecstasy, he is very concerned with our becoming obsessed with these moments, which he defines as “happiness highs” (1997). In his words, “Happiness (as distinct from contentment) is usually more superficial and is usually contingent on something (or someone) external to you” (Warren, 1997). He contends that at the center of our inner being, we all yearn for a quiet sense of satisfaction and fulfillment. However, as many if not most of us fail to attain a deep sense of contentment in our lives, we are vulnerable to becoming consumed by a frantic search for “happiness surges.”

We live in a culture which heavily exposes us to societal influences, reinforced by peer pressures that feed into our compulsive pursuit of the biggest and best of everything! The media and the

WELLNESS advertising industry thrive on constantly bombarding us with supposedly foolproof promises of how to find happiness—be it in the form of a new car with all the latest gizmos, the right sex partner, a bigger house in a better neighborhood, wearing elegant clothes and jewelry or rising to the top of the ladder in our careers. As Warren points out, this headlong pursuit of instantaneous happiness is designed to distract us from an inner sense of emptiness, and to numb ourselves to the deeply felt pain of lack of meaning in our lives and our gnawing sense of futility. In his words, “This addiction requires daily, sometimes hourly, fixes so there is little time or energy left to pursue healthier, more permanent (and more meaningful) solutions to our dilemmas” (1997).

Let us now take a look at the striking similarities between addiction to drugs and alcohol, and the addictive pursuit of happiness.

Addiction and the Pursuit of Happiness

Just as chemically dependent people are (often subconsciously) obsessed with escaping from the seemingly intolerable experience of deeply felt pain, misery, and lack of meaning in their own lives, the lives of those caught up in the obsessive pursuit of happiness is likewise consumed with a frenetic search to fill a deep-seated sense of void while momentarily escaping from the pain, drudgery, and lack of meaning in their lives.

Indeed, there is a great deal of overlap and striking similarity between these two basic manifestations of addiction.

Consequently, I believe that “former addicts” who are abstaining from alcohol and drugs while not following a structured recovery program are highly vulnerable to transforming their former primary addiction into a highly addictive pursuit of superficial “happiness highs.”

As is the case with dependency on chemical substances, this incessant craving for happiness will never be satisfied.

This circle includes the millions of “career singles” who are constantly looking for love in all the wrong places while always finding fault with their current partners; together with the legions of men and women who obsessively pursue the pinnacle of career success to the detriment of their relationships with family and friends

and their ability to find true contentment in their lives, together with the overall destruction of their health, well-being, and intrinsic sense of worth. These are just two of the more prominent manifestations of this truly devastating addiction.

To summarize, in this installment we have focused on the distinction between the attainment of a deeply ingrained sense of true contentment, as contrasted with the addictive pursuit of superficial “happiness highs.” We have also examined the commonalities between addiction to substances of abuse and the obsessive pursuit of fleeting and often superficial moments of happiness. The next and final installment will discuss measures that both we and our clients can undertake to cultivate the qualities of contentment and equanimity in our lives. C About the Author John Newport, PhD, is an addiction specialist, writer, and speaker living in Tucson, AZ. He is author of The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction. You may visit his website www.wellnessandrecovery.com for information on wellness and recovery trainings, wellness coaching by telephone, and program consultation services that he is available to provide.

References Merriam-Webster. (2017). Contentment. Retrieved from https://www.merriam-webster.com/dictionary/ contentment Warren, N. C. (1997). Finding contentment: When momentary happiness is just not enough. Nashville, TN: Thomas Nelson.

Leo’s Desk Continued from page 15

with any certainty, as a fact, that God exists? Do we know, with any certainty, as a fact, how He wants us to live? Is it possible that what all the different religions say and believe concerning God, can they all be true? Are there indeed “alternative facts”? I do not think so.

Conclusion

Maybe we need to separate a person’s beliefs from facts? A person’s faith from truth? Maybe the concept of God being “unknowable” is true, and we will never know God? Maybe religious agnosticism is the best that we can hope for in this life? Maybe what people believe in says more about them than it does about God? “I am who I am” is the most we will ever know, and even that is questionable! C About the Author 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.

Serving the Inland Empire for over 25 years, we provide multi-level care in the following areas: • Chronic pain and medication dependency • Eating disorders • Chemical dependency services • Adolescent self injury • Mental health services unique to youth, adults and seniors

We LIVE to Hope

For more information or to make a referral, please call 909-558-9275 or visit us on the web at llubmc.org.

MANY STRENGTHS. ONE MISSION.

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THE INTEGRATIVE PIECE

A New Doorway Sheri Laine, LAc, Dipl. Ac

C

hange is rarely easy. In fact, it is often a messy business. While great benefits oftentimes result from the altering of our lives or paths, change can be difficult while it is happening.

Kevin was in the middle of his own big, messy, wonderful change when he came to see me, complaining of constipation and anxiety.

In a long-term relationship with the love of his life, he had been living alone in his house by the ocean’s edge. It was now time to make the switch to “family-life” with his girlfriend and her three teenage sons from a prior relationship. They were in the process of buying a large home, remodeling, and moving in together.

Kevin was excited about the transition, but also nervous.

He was accustomed to coming and going from his girlfriend’s home with all the trappings of a big family, to his own quiet,

tidy, and hip bachelor pad. He knew he loved being with her and the family, yet he also felt quite comfortable and content when in his own space.

Anxiety was keeping him awake at night, and while never “regular,” he was finding it more and more difficult to eliminate most mornings.

When working with healthy men like Kevin, I find it most helpful to encourage them to take a step back and focus on the things that make them feel their best in the current moment.

In Kevin’s case, he enjoyed music, exercise, a healthy lifestyle, and the love he shared with his extended family and friends.

First, I treated his heart center or shen (the Chinese termfor the spirit) with acupuncture to help him to calm down his mental and all-around physical inflammation, which was manifesting into untold thoughts and fears. I also prescribed an herbal combination to moisten his stool and help with his inflammation and anxiety. We talked in depth about how positivity can change how we perceive life, and how it can enhance our overall well-being.

In the process, Kevin became a meditator and was happily able to envision life with his extended family filled with love and mutual admiration. He felt love coming to him in ways that enhanced his life, rather than making him feel pulled into fragmented directions.

With dietary enhancements of increased fruits, nuts, grains, and vegetables, along with the important addition of more room temperature water on a daily basis, his elimination challenges were less frequent.

Kevin’s anxiety lessened as he developed a positive mindset and accepted his new and changing lifestyle. Most importantly, he was able to calm his mind, which was helped by weekly acupuncture sessions and stepping-up his stretching and exercise routine.

Following an acupuncture treatment one day in my clinic, I asked Kevin if he might consider keeping his bachelor pad for awhile, in addition to moving into the new family home. He loved the idea and it turned out his partner concurred.

It was a win-win. He found his way through by taking a step back, having the courage to change, and considering new ideas. By staying in the moment, letting the universe present new ideas, and developing skills to manage his own well-being, Kevin was happier than he could have imagined. His life continues to unfold. C About the Author Sheri Laine, LAc, Dipl. Ac., author of Living the EnerQi Connection, is a California-state and nationally certified acupuncturist and herbologist licensed in Eastern medicine. She has been in private clinical practice in Southern California for twenty-five years. In addition to teaching, Sheri speaks throughout the country about the benefits of integrative living and how to achieve a balanced lifestyle. Please visit her at www.balancedenerqi.com.

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