Counselor - June 2015 Issue Preview

BRAHMA KUMARIS LEADER OFFERS WORDS OF WISDOM

OPINION

E-CIGARETTES: A WOLF IN SHEEP’S CLOTHING?

THE IMPAIRED PROFESSIONAL: SPOTLIGHT ON ATTORNEYS AS CLIENTS SOCIAL PECULIARITY AN UPDATE:

SUBSTANCE USE DISORDERS vs MENTAL HEALTH DISORDERS

THE SCIENCE BEHIND MUTUAL AID GROUPS June 2015 Vol. 16 | No. 3, $6.95

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contents Letter from the Editor

36

y Robert J. Ackerman, PhD B Editor

Wisdom Recovery, Part II: Essential Questions about the Roots of Recovery and the Seeds of Addiction

CCAPP Coming out of the Closet and Stepping into Recovery: Working with LGBTQ Clients

8 9

By Kristina Padilla, MA, LAADC, ICAADC

Discusses the cultural drivers of addiction and stresses the importance of returning to nature in recovery.

NACOA

By Will Taegel, PhD, and Joan Borysenko, PhD

Culture and Family History Matter

11

By Sis Wenger

42 Social Peculiarity: A Primer for Counselors Explains what social peculiarity is, discusses prominent comorbidity with other psychiatric illnesses and conditions, and provides information on the DSM-5 as related to social peculiarity.

By Jerrold Pollak, PhD, ABPP, ABN

Cultural Trends Shake and Bake: A Recipe for Disaster

13

By Maxim W. Furek, MA, CADC, ICADC

Opinion Are E-Cigarettes a Wolf in Sheep’s Clothing?

17

By Thomas F. Hilton, PhD

From Leo’s Desk Twelve Steps into Spirituality, Part II

19

By Rev. Leo Booth

Wellness

48 Substance Use Disorders Compared to Other Mental Disorders: An Update Presents the differences and similarities between substance use disorders and mental disorders and examines best practices and treatments for both.

By Deanna McPherson, MSW, MPH, Chelsea Spencer, MSW, Austin Wilmot, MSW, Christina Drymon, MA, Alex Ramsey, PhD, and David A. Patterson, PhD

Optimism, Wellness, and Recovery, Part II

22

By John Newport, PhD

“Running to Be on the Run”

24

Topics in Behavioral Health Care

25

The Integrative Piece

By Sheri Laine, LAc, Dipl. Ac

The Impact of Substance Use Disorders on Parents, Part II

By Dennis Daley, PhD, and Joan Ward, MS

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contents Research to Practice The Memory Nodus

29

By Michael J. Taleff, PhD, CSAC, MAC

Counselor Concerns Recovery Support Groups and Continuing Care

31

By Gerald Shulman, MA, MAC, FACATA

Substance Abuse in Teens Therapeutic Alliance: The Glue That Makes Therapy Work

33 35

By Toni Galardi, PhD

Inside Books

Feeling Great: Creating a Life of Optimism, Enthusiasm, and Contentment

The Science of Mutual Aid Groups: An Interview with John F. Kelly, PhD Explores available information on addiction recovery research, discusses the role of language in addiction-related stigma, and describes the lack of scientific foundation in the alcohol industry.

By William L. White, MA

By Fred J. Dyer, MA, CADC

Ask the LifeQuake Doctor

54

From the Journal of Substance Abuse Treatment

62 Intensive Motivational Interviewing for Women with Alcohol Problems

80

By Dadi Janki & Peter Vegso

Discusses intensive motivational interviewing (IMI), presents an outline of the IMI manual, and explains study results.

Also in this issue

By Rachael A. Korcha, MA, Douglas L. Polcin, EdD, Kristy Evans, BA, Jason C. Bond, PhD, and Gantt P. Galloway, PharmD

Reviewed by Leah Honarbakhsh

Ad Index

76

Referral Directory

77

CE Quiz

78

70 Attorneys as Clients: Insights for Understanding an Especially Challenged and Challenging Population Presents factors that contribute to substance abuse in attorneys and examines barriers to treatment for this population.

On the Cover: Illustration by Dane Wesolko www.danewesolko.com

8 Counselor 路 June 2015

By Patrick R. Krill, MA, JD, LLM

The Impaired Professional, Part II

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Letter from The editor

Vacation Deprivation

Once again it is summertime. It begins this year on June 21, as it usually does.

This date has been recognized for thousands of years as the “summer solstice,” which means that sun is at its greatest intensity, standing still and creating the longest daylight of the year. The summer solstice has been celebrated by many cultures and is said to indicate a time for the celebration of life and a regeneration of our dreams.

In America, summertime has been celebrated with picnics, swimming pools, baseball, summer camps, amusement parks, and best of all family vacations. But wait! We don’t do vacations anymore, do we? As a matter of fact, I think we are suffering from vacation deprivation. The amount of time of American workers take off is now the lowest in forty years. We are rapidly devaluing vacation days. For example, in the year 2000, workers took an average of 20.3 days a year off and by 2013 it was down to sixteen days. We are taking only 77 percent of paid time off. Now, I realize that not everyone gets paid time off. For those working on the bottom of the pay scale, only 49 percent get any paid time off.

What’s wrong with this picture?

We need some time off! Research indicates that workers who use more vacation days have better performance reviews. Also, we are lagging behind other modern nations. Of the twenty richest nations, Austria leads with the highest number of required vacation days at thirty-eight. The United States is—you guessed it—in last place with zero number of required vacation days.

I think we need to go on vacation and visit those other countries!

10 Counselor · June 2015

The real point of all of this is we need to spend more time with our family and friends. We too need to celebrate life and regenerate ourselves. It is no secret that our lives are too stressful and that stress underlies many of the problems for which people seek counseling. Are we becoming “workaholics” along with our many other problems? Let’s see if we can take a vacation without taking our iPad, cell phones, laptops, and a stack of work documents. As a kid I thought summer was the best time of year and now I think it is a time to remember there might still be a kid in all of us.

For thousands of people the highlight of this summer will be the International Convention for Alcoholics Anonymous, July 2–5, at the Georgia Dome in Atlanta. AA will be celebrating its eightieth anniversary.

At least fifty thousand people are expected for the celebration and the theme will be “80 Years—Happy, Joyous, and Free.” Congratulations to Alcoholics Anonymous and all of its members. Thank you for the gift of sobriety and recovery for thousands of people, and especially for families.

I wish you all a good summer. Let’s all take a vacation!

Robert J. Ackerman, PhD

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

CCAPP

Coming out of the Closet and Stepping into Recovery: Working with LGBTQ Clients Kristina Padilla, MA, LAADC, ICAADC

W

hen counseling a client, it is important for a counselor to also understand general cultural differences, especially sexual minorities because they are of all nationalities, ethnicities, and socioeconomic classes.

Sexual minorities have been thrust into the national spotlight with several states passing the same sex marriage law. This group includes gay, lesbian, bisexual, transgender, and questioning (LGBTQ) people, who have had to fight oppression in addition to the attitudes of the majority.

When working with special populations such as the LGBTQ community, it is important to keep in mind that this population has been “in the closet,” so to speak, for a very long time. Many are just now getting the courage and strength to come “out of the closet.” When working with some LGBTQ clients, I have run into many different scenarios which I would like to share with you to help you effectively treat this population.

Many of the LGBTQ clients we have worked with have had to make up fake names for their partner or spouse so that they would be accepted by their families. They have had to introduce their girlfriend or boyfriend as a “friend,” when he or she is more than a friend. Think about it for a minute—put yourself in their

shoes. Imagine your uncle or aunt just told you that there is going to be a huge family reunion in two weeks and to bring your significant other.

However, your significant other is of the same sex. Now picture yourself going to the family reunion and having to come up with a name for your current same sex girlfriend or boyfriend that you have been dating for two or three years in fear that one of your family members might find out that you are gay or a lesbian and shun you from the whole family. Imagine yourself doing anything and

everything to hide it, to fit in and be accepted because of your fear of being cut off from your family and friends just because you have a different sexual orientation.

Now imagine getting kicked out of your house because your mother or father found out that you were gay or a lesbian. Imagine the feelings that you might have and think about how you would feel in that moment. A person that has taken care of you, nurtured you, loved you, and raised you, has now told you to get out and wants nothing

to do with you. It sounds pretty harsh when the son or daughter only wants to be loved and supported. These are some, but not all of the scenarios that the LGBTQ population has to face.

Sexual minorities are now coming together to change the values, attitudes, and laws of society that discriminate against them.

Many people who are sexual minorities do not identify themselves as such. Sexual minorities did not choose their sexual orientation, but their behavior relating to sex www.counselormagazine.com 11

CCAPP countertransference because they believe acceptance of this culture threatens their masculinity and their sexual orientation; this is one reason that some heterosexual males may lash out and act homophobic. It is important for counselors to work on their own personal issues of countertransference and biases before working with the sexual minority population. If a counselor is having difficulty working with this population, he or she should consult a clinical supervisor and seek supervision before supervision seeks them.

and lifestyle is a choice. The incidence of alcoholism and drug abuse is higher in the gay and lesbian community than it is in the general population. This is due largely in part to self-image, treatment by friends and family who may not approve, and fear of rejection.

Discrimination against sexual minorities should be addressed in the same manner as discrimination

against any other minority group. Counselors should avoid making sweeping generalizations about the behavior of sexual minorities, and should be aware of their own biases when working with this population. Many may feel threatened or overfascinated with this population. Male counselors may feel threatened when counseling someone who has a same sex orientation.

Male counselors may have

The LGBTQ community has struggled for years and the battle is only half over as there are men, women, and youth who are committing suicide every single day for not being accepted for who they are, in addition to being bullied because of their sexual orientation. This is where we as counselors come in to help this population that has turned to drugs, food, gambling, and alcohol to numb their hurt and pain. It is important as a counselor to push past our

bias—if we have any—while we are counseling the LGBTQ population and educate ourselves so that we can work with this population and not avoid them or refer them to other counselors or therapists because we do not know how to counsel them.

I challenge you to gain more knowledge and to increase your awareness to counsel this special population that has been struggling for a very long time. CCAPP would like to personally invite you to the CCAPP Summer Symposium in Santa Clara, CA on June 27–28, 2015 at the Hyatt Regency to gain more knowledge on the subject. The conference will be focusing on cultural competence and special populations. We will show you ways to work with LGBTQ clients as well as with American Indians, African Americans, Latinos, veterans, and many more groups.

Make sure to educate yourself on the LGBTQ population so you are able to reach many more people, make a change, and help heal someone’s life! c Kristina Padilla, MA, LAADC, ICAADC, works for CCAPP as the education manager that oversees the CCAPP education department.

Ms. Padilla is also the coordinator of events for the CCAPP annual conferences. She has a bachelor’s of science in criminal justice administration and a master’s degree in counseling psychology. Ms. Padilla also worked for CAADAC as the past offender mentor certification program director for three years in twelve of the in-prison programs. She worked closely with the California Department of Corrections and Rehabilitation (CDCR) in the California prisons.

12 Counselor · June 2015

NACOA

Culture and Family History Matter Sis Wenger

change, it is also critical that culture be blended with such programs in age-appropriate ways that can provide the path to healing and wellness so essential to recovery.

This insight brought the Wellbriety Movement to NACoA.

T

hrough a cooperative effort with NACoA (National Association for Children of Alcoholics) and the Wellbriety Movement, a new program has emerged and is designed to spread family healing and recovery across the country. The Wellbriety Movement is a national American Indian recovery and generational healing movement that addresses both addiction in the present and the generational trauma suffered at the hands of the government and the boarding schools of the past. This trauma has continued to pass through subsequent generations and fuels hopelessness, mental health problems, and addiction.

In addressing this generational pain and loss for American Indian individuals and families, the Wellbriety Movement and NACoA have established a partnership to strengthen the powerful recovery movement that is spreading through tribes across America, but has lacked the family healing needed to attain and sustain what Dr. Tian Dayton has called “emotional sobriety.” The Wellbriety Movement has recognized that while it is critical to use evidence-based programs to make and sustain healthy

C a l l e d We l l b r i e t y Celebrating Families!, the progr am uses Celebrating Families!, the NACoA, evidencebased, sixteen-week, whole family recovery program that has already demonstrated great success in populations being served by drug courts and dependency courts as well as posttreatment family aftercare and in programs treating and supporting young mothers and their children.

White Bison, Inc. and the Wellbriety Movement developed a comprehensive cultural enhancement for each module of the program. Group leader trainings are a three-day commitment with attendees agreeing to facilitate the program for four years, thus building program sustainability from the beginning at all locations. The enhanced facilitator implementation manual and training videos provide a framework of Wellbriety teachings that support the Celebrating Families! curriculum and provide insights into how the curriculum blends with American Indian cultural and family values. Throughout each lesson, this enhancement is bringing together culture and family—the two most important components to support recovery and healing for addicted individuals and impacted families— hurt often spanned over generations by addiction in the family.

Celebrating Families! is a cognitive behavioral support model written for families in which one or both parents has a serious substance use disorder and in which there is often a high risk for domestic violence, child abuse or neglect. It is listed on the National Registry of Effective Programs and Practices (NREPP) of the Substance Abuse and Mental Health Services Administration (SAMHSA) and works with every member of the family to strengthen recovery from alcohol or drug use problems, break the cycle of addiction, and increase the rate of reunification in families torn apart by the ravages of addiction. A 0–3 component is currently being developed and will be added to the full program in the next few months.

Wellbriety Celebrating Families! is designed to foster the development of safe, healthy, fulfilled, and addiction-free individuals and families by increasing resiliency factors and decreasing risk factors while incorporating addiction recovery concepts with healthy family living skills reflective of American Indian culture.

Applying evidence-based prevention and recovery support services that have blended in restorative culture brings great hope for a population that has suffered long enough. NACoA is extremely proud to be able to partner with the Wellbriety Movement to strengthen the heroic efforts of so many American Indian communities already inching toward healthy family recovery.

We anticipate that the movement will grow exponentially as the importance of helping parents, grandparents, and young children benefit from their own healing and recovery becomes apparent to all. www.counselormagazine.com 13

NACOA Why NACoA? Well, because COAs are still one in four.

Thirty-two years ago, there was a gathering in California of young clinicians—psychiatrists, psychologists, social workers, physicians, and teachers—brought together on the Kroc ranch in southern California at the invitation of Joan Kroc. Most had not met before, but all were working on their own, creating programs and trying to find solutions and provide therapy for children of alcoholic parents, both young and adult children. Of this extraordinary group, many remain top leaders in the fields of family therapy, addiction treatment, and children of alcoholic and drug-abusing parents.

In 1983, what these fresh, young, and new leaders in the addiction field had concluded was that the observations and shared knowledge from their collective anecdotal reports and from their practices made it clear that one in four children appeared to be living in households with one or more alcoholic persons and they were suffering from that experience. Too many children were suffering abuse, neglect, emotional and physical scarring, and a lack of supportive adults in their fragile lives.

They decided that something needed to be done collectively for maximum impact, so they created the National Association for Children of Alcoholics

and began a lifelong commitment to bringing awareness to those who could intervene and help these vulnerable children.

Twenty years ago, Lewis Eigen, EdD, and David W. Rowden, PhD, recognized that there was a sizeable number of children who were suffering in silence and being ignored in our public health policies and prevention programs. They did a comprehensive analysis of the number of children of alcoholics (COAs) in the country, breaking them into categories of when in their lifetimes they were exposed to alcoholism in their families.

In each category the number of COAs still averaged one in four. In 2000, this analysis was republished in NACoA’s publication, Children of Alcoholics Selected Readings.

Fifteen years ago, the American Journal of Public Health published a definitive report of a large epidemiology study by Bridget F. Grant, PhD, entitled “Estimates of the US Children Exposed to Alcohol Abuse and Dependence in the Family.”

The study sought to provide direct estimates of the number of US children younger than eighteen years who are exposed to alcohol abuse or alcohol dependence in the family. The findings were one in four. The first sentence in the report was, “Alcohol abuse and alcohol dependence are the two most prevalent and deleterious psychiatric disorders

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14 Counselor · June 2015

not only in the United States but in the world” (Grant, 2000). The report ends with, Children exposed through no fault of their own to alcohol abuse and dependence during their critical developmental years are thrust into families and environments that pose extraordinary risks to their immediate and future well-being . . . the potential cost to human services, health, education, social services, and correctional systems will quickly become overwhelming (Grant, 2000).

Ten years ago, the CDC and Kaiser Permanente began to publish the results of their joint Adverse Childhood Experiences (ACE) study, and one of NACoA’s founders, Dr. Charles Whitfield, a psychiatrist, sent one of the earliest published reports with a note written across the top. “Look at this!” it read.

“They finally proved what we told them twenty years ago!”

Yes, it is difficult to address such close-to-home issues as the pain, fear, confusion, and desperation millions of our children are feeling every day. None of us want to rock the boat, “interfere” or believe that since children remain silent, there is no opportunity to help. We can fool ourselves that they are somehow okay. Sometimes we do not want to think about the children of our clients and how they must be suffering; the client is difficult enough and no one pays for the children to get the help they need so they are not, one day, the client of a next generation counselor. And that is “Why NACoA?”—to continually remind those who could do something or say something to actually do it.

Readers of this esteemed magazine have great power to make a difference in the life of a hurting child. These children cannot wait another decade and they should not have to wait at all. c Sis Wenger is NACoA’s president and CEO.

References Grant, B. F. (2000). Estimates of US children exposed to alcohol abuse and dependence in the family.

American Journal of Public Health, 90(1), 112–5.

Cultural Trends

Shake and Bake: A Recipe for Disaster Maxim W. Furek, MA, CADC, ICADC euphoria. Meth provides a sense of power that promotes extended periods of energy as well as sexual endurance and prowess. Some use the drug to cope with feelings of depression, social anxiety, low self-esteem, loneliness, and boredom. Some use it to stay awake or to lose weight.

Potter had been using methamphetamine for about fourteen years. The drug is a central nervous system stimulant drug similar in structure to amphetamine.

Due to its high potential for abuse, methamphetamine is classified as a Schedule II drug and is available only through a prescription that cannot be refilled. Although methamphetamine can be prescribed by a doctor, its medical uses are limited, and the doses that are prescribed are much lower than those typically abused (NIDA, 2012).

T

he explosion came without warning.

The blast threw him against the wall. Dennis Potter felt the fireball sear into his flesh. He had never known pain like this before. Toxic chemical vapors burned lung tissue. Potter’s only mercy was the dark blanket that snuffed out his consciousness.

Potter, age twenty-nine, woke up in the burn unit of St. Louis’ Mercy Medical Center. There he spent the next five weeks, his body wrapped in restrictive sterile bandages. He underwent numerous skin graft operations (LaCapra, 2012). Potter was the victim of a horrible chemical explosion that took place in December 2009. The accident was triggered after Potter cooked methamphetamine using a dangerous process known as “shake and bake.”

The shake and bake procedure is the same for everyone. Combustible chemicals are emptied inside a plastic drink bottle. The next step is to shake, cool, and vent the mixture. If the procedure works as planned, several grams of meth are produced in less than an hour. But, if the concoction is not vented and cooled properly, an explosive fireball can result.

Potter had been teaching a friend the shake and bake method, an operation he claims to have completed thousands of times. But on this occasion, things turned ugly. The bottle took on an orange glow. Within seconds an explosion blew the walls off the room. Potter, looking into the face of death, was set on fire.

Individuals like Dennis Potter abuse meth because of the rush and resulting

Methamphetamine hydrochloride is used to treat attention deficit hyperactivity disorder, along with a psychological, educational, and social treatment plan. It may help increase the ability to pay attention, concentrate, and stop fidgeting. This medication is also used with a doctor-approved, reduced-calorie diet as an aid to help significantly overweight people lose weight. It should only be used for a few weeks in patients who have not lost enough weight with other treatments.

It may work by decreasing the appetite.

This medication should not be used to treat tiredness or to hold off sleep in people who do not have a sleep disorder (“Methamphetamine,” 2014).

With all of the perceived superhuman characteristics of the drug, there is an equally commanding addictive component. Meth is extremely addictive and has a high relapse rate among people who are able to quit, including individuals who receive treatment.

Meth changes the way a person’s brain functions and even after a person has www.counselormagazine.com 15

Cultural Trends stopped using meth, if they were a heavy long-term user, it may take a long time for the changes to reverse themselves— sometimes they don’t (“How easy,” 2012).

The Combat Meth Act of 2005 The government’s war on drugs has produced curious results. While Mexican drug cartels have flooded the American drug market, domestic super labs have been located and dismantled. The Methamphetamine Reduction Act of 2005 drastically cut down the number of domestic super labs. Known as the Combat Meth Act of 2005, the bill was a legislative attempt to control pseudoephedrine and ephedrine, now listed as Schedule V substances.

The bill requires a distributor or pharmacy that sells a pseudoephedrine substance to ensure that: 1. It is dispensed or sold at retail only by a practitioner, pharmacist or individual under the pharmacist’s supervision as permitted by the state 2. Any person purchasing, receiving or otherwise acquiring it, prior to taking possession, provides an approved federal or state-issued photo identification (or alternative form of identification authorized by the Attorney General) and signs or makes an entry in a written or electronic log documenting the transaction date, the name of the person, and the name and amount of the substance acquired 3. No person acquires more than 7.5 grams of such substance within any thirty-day period It also authorizes the Attorney General to exempt a product upon determining that it cannot be used in the illegal manufacture of methamphetamine or any other controlled dangerous substance; or upon the manufacturer’s application if the Attorney General determines that it has been formulated in such a way as to effectively prevent the conversion of the active ingredient into methamphetamine.

16 Counselor · June 2015

The Combat Meth Act of 2005 restricts the sale of large quantities of overthe-counter decongestants and cold and allergy medicines. Because of those restrictions, the total number of clandestine meth lab incidents reported to the DEA fell from almost 17,400 in 2003 to just 7,347 in 2006 (DEA, 2013).

Unfortunately, meth cookers have now switched to the easier, albeit more dangerous, “one pot” or “shake and bake” method, which has become a huge problem for law enforcement. A recent Internet search on “How to cook meth” resulted in a staggering 9,040,000 sites. Yet another search, “How to make shake and bake meth,” came up with 145,000 videos and instructional articles on how to manufacture the substance (Furek, 2015).

The problem is widespread and how-to information is easily obtained. By 2010, about 80 percent of labs busted by the federal DEA were using shake and bake recipes (Associated Press, 2012a).

Because it uses less pseudoephedrine and yields meth in minutes rather

than long arduous hours, the process has become popular. Meth cookers place chemicals such as drain cleaner, brake fluid, red phosphorous, lithium batteries, and other easy to purchase items in a two-liter bottle. The product is then shaken to create a chemical reaction that produces a crystalline powder that can be smoked, snorted or injected. Ingredients are mixed in the bottle and eventually poured through a coffee filter and dried (Ramirez, 2013).

The equation has rapidly changed.

Meth production is not centered in sophisticated domestic labs, capable of supplying numerous users, but in clandestine operations where cookers produce meth for their personal use.

The operation is easily concealed.

Meth cooks, like Dennis Potter, can transport all of the volatile ingredients in a backpack or in the back seat of a car and then cook the product on the run.

Even the manufacturing and distribution network has evolved into a more clannish grouping. According to

Cultural Trends Toxic Waste Methamphetamine production is dangerous. Simply being exposed to the toxic chemicals poses a variety of health risks, including intoxication, dizziness, nausea, disorientation, lack of coordination, pulmonary edema, serious respiratory problems, severe chemical burns, and damage to internal organs. Other problems include the following:

Inhalation

Inhaling chemical vapors and gases resulting from methamphetamine production causes shortness of breath, cough, and chest pain. Exposure to these vapors and gases may also cause intoxication, dizziness, nausea, disorientation, lack of coordination, pulmonary edema, chemical pneumonitis, and other serious respiratory problems when absorbed into the body through the lungs.

Skin Contact

The chemicals used to produce methamphetamine may cause serious burns if they come into contact with the skin.

Ingestion

Berwick, Pennsylvania Police Chief Ken Strish, the drug users have learned that it is easier to steal common household chemicals from retail stores and work in concert with others in the “smurfing process” to secure their drug rather than risk getting robbed by others in the drug trade. There is no need to go to the urban street corner to collect drugs. That is obviously dangerous.

Now they just work together and collect the necessary items needed to manufacture methamphetamine and once the synthetic drug is made it is shared with only those who helped create it (2014).

Potter confessed that he began using meth when he was sixteen years old.

Two years later he began to make his

own product. “It’s so easy,” he said.

“Any person can do it. You can go to Walgreens, Home Depot, and Wal-Mart, and they sell every bit of the ingredients” (LaCapra, 2012).

Methamphetamine lab seizures rose nationally again in 2011, further evidence the powerfully addictive and dangerous drug is maintaining a tight grip on the nation’s heartland, according to an Associated Press survey of the nation’s top meth-producing states (2012a). Missouri regained the top national spot for lab seizures in 2011 with 2,096, Tennessee was second with 1,687, followed by Indiana with 1,437, Kentucky with 1,188, and Oklahoma with 902 (Associated Press, 2012a).

Toxic chemicals can be ingested either by consuming contaminated food or beverages or by inadvertently consuming the chemicals directly.

Young children present at laboratory sites are at particular risk of ingesting chemicals. Ingesting toxic chemicals— or methamphetamine itself—may result in potentially fatal poisoning, internal chemical burns, damage to organ function, and harm to neurological and immunologic functioning.

In addition, methamphetamine production threatens the environment.

Shake and bake leaves behind discarded bottles containing toxic sludge. The abandoned materials are often strewn along highways and unpopulated rural roads throughout the country.

The average methamphetamine laboratory produces five to seven pounds of toxic waste for every pound of methamphetamine produced. Operators often dispose of this waste improperly, simply by dumping it near the laboratory. www.counselormagazine.com 17

Cultural Trends This can cause contamination of the soil and nearby water supplies (NDIC, 2006).

Burn Patients The shake and bake method has proven to be a major concern throughout the country. The easily obtained chemicals are extremely hazardous. Some are highly volatile and may ignite or explode if mixed or stored improperly.

Fire and explosion pose risks not only to the individuals producing the drug, but also to anyone in the surrounding area, including children, neighbors, and passersby.

An Associated Press survey of key hospitals in the nation’s most active meth states showed that up to a third of patients in some burn units were hurt while making meth, and most were uninsured. The average treatment costs $6,000 per day and the average meth patient’s hospital stay costs $130,000—60 percent more than other burn patients, according to a study by doctors at a burn center in Kalamazoo, Michigan (Salter, 2012).

Furthermore, burn units are closing due to the excessive cost of treating uninsured patients. At least seven burn units across the US have shut down over the past six years, partly due to consolidation, but also because of the cost of treating uninsured patients, many of whom are connected to

methamphetamine. Burn experts agree that the annual cost to taxpayers is well into the tens if not hundreds of millions of dollars, although it is impossible to determine a more accurate number because so many meth users lie about the cause of their burns to avoid arrest.

Larger meth labs have been bursting into flames for years, usually in basements, backyard sheds or other private spaces.

But those were fires that people could usually escape. Using the shake and bake method, drug-makers typically hold the flammable concoction up close, causing burns from the waist to the face (Smith, 2012).

Pain is not always a sage teacher.

Soon after leaving the burn center, Dennis Potter regrettably started making meth again. He told a reporter that he hates the drug, but still misses it every day. “I wish I had never learned how,” he said. “It haunts me daily because I do know how to do it” (LaCapra, 2012).

Dennis Potter provides an important, albeit unfortunate, lesson about the dangers of cooking meth. As he bartered for his fifteen-minutes of fame, he received instant gratification and notoriety from National Public Radio and other media outlets. And, in what may have been the harshest lesson of all, Potter traded away the anonymity and hope of a Twelve Step fellowship for

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his raw public confession. That mistake will haunt him the rest of his life. c 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.

References Associated Press. (2012a). Missouri leads spike in US meth lab busts. Retrieved from http://www.cbsnews. com/news/missouri-leads-spike-in-us-meth-lab-busts/ Associated Press. (2012b). ‘Shake-and-bake’ meth fills hospitals with uninsured burn patients, leading to closure of some burn units. Retrieved from http://www.nydailynews.com/life-style/health/ shake-and-bake-meth-fills-hospitals-uninsured-burnpatients-leading-closure-burn-units-article-1.1010381 Drug Enforcement Administration (DEA). (2013).

National drug threat assessment summary 2013.

Retrieved from http://www.dea.gov/resource-center/ DIR-017-13%20NDTA%20Summary%20final.pdf Furek, M. W. (2015). “How to make shake and bake meth.” Yahoo search results.

“How easy can one become addicted to meth?” (2012). Retrieved from http://www. crystalrecovery.com/meth/ask-michelle-questionsanswers-about-meth-addiction-and-recovery/ how-easy-can-one-become-addicted-to-meth.html LaCapra, V. (2012). ‘Shake-and-bake’ meth causes uptick in burn victims. NPR. Retrieved from http://www.npr.org/2012/02/07/146531937/ shake-and-bake-meth-causes-uptick-in-burn-victims “Methamphetamine hydrochloride - oral, Desoxyn.”

(2014). Retrieved from http://www.medicinenet.com/ methamphetamine_hydrochloride-oral/article.htm National Drug Intelligence Center (NDIC). (2006).

Methamphetamine laboratory identification and hazards. Retrieved from http://www.justice.gov/ archive/ndic/pubs7/7341/index.htm#hazards National Institute on Drug Abuse (NIDA). (2012).

Methamphetamine. Retrieved from http://www. drugabuse.gov/drugs-abuse/methamphetamine Ramirez, D. (2013). “Shake-and-bake” meth making has a dangerous side. Star-Telegram. Retrieved from http://www.mcclatchydc.com/2013/09/09/201554/ shake-and-bake-meth-making-has.html Salter, J. (2012). Methamphetamine accidents fill US hospitals with uninsured patients, strain burn units. Huffington Post. Retrieved from http://www.huffingtonpost.com/2012/01/23/ methamphetamine-burns_n_1222925.html Smith, G. (2012). Revealed: The extreme dangers of cheap but highly combustible ‘shake-and-bake’ method for making deadly crystal meth. Daily Mail.

Retrieved from http://www.dailymail.co.uk/news/ article-2090553/The-extreme-dangers-new-cheapshake-bake-method-making-deadly-crystal-meth.html Strish, K. (2014). Methamphetamine: Swallowing rural communities. Paper presented at a meeting of the Bloomsburg Theatre Ensemble/ Berwick Middle School Drama Club.

Opinion

Are E-Cigarettes a Wolf in Sheep’s Clothing?

Thomas F. Hilton, PhD

S

ince January 1, 2014, more than one study a week has been published that examines the ubiquitous e-cigarette for health effects—quite often for harmful effects. One health effect that should not be in debate is the effect of nicotine on addiction recovery. Hilton and White (2013) pointed out that nicotine, contrary to the “recovery crutch” hypothesis, poses a significant threat to self-sustainable addiction recovery.

That paper encouraged counselors and other addiction professionals to include nicotine addiction coincident with the treatment of alcohol and drug addiction. One new tool that might help some recovering addicts eliminate nicotine use might be e-cigarettes. But, are they safe? Are they effective?

Safety Issues One thing to keep in mind is that nicotine, however consumed, is a toxin. Although it might be argued that nicotine alone is harmless, such an assertion is factually wrong. Professor Edward Domino (1999), a pharmacologist at the University of Michigan, pointed out that a century ago nicotine was used as an insecticide. If it kills bugs (think DDT), what is it doing to people?

Unfortunately, both medical science and the media have stoked confusion regarding e-cigarette safety. Reports on the hazards of e-cigarettes are appearing almost daily in the popular press, often with alarmist headlines. Most of these headline-grabbing studies represent junk science. Either they are not done in the context of relative harm reduction for smokers or they sensationalize trivial or poorly-reasoned results.

Attempts have been made to systematically weed out junk science in an effort to examine e-cigarette safety. CallahanLyon (2014) conducted a meta-analysis of forty-four studies and concluded that e-cigarette safety could not be determined due mainly to weaknesses in many of the study research designs. A second meta-analysis sponsored in part by the World Health Organization (Grana, Benowitz, & Glantz, 2014) concluded that compared to tobacco cigarettes, e-cigarettes were often less toxic by an order of magnitude (i.e., ten times less). Most recently, a third meta-analysis by the prestigious Cochrane Collaborative (McRobbie, Bullen, Hartman-Boyce, & Hajek, 2014) looked at twenty-nine studies. They found no significant safety issues related to e-cigarette use. www.counselormagazine.com 19

Opinion Effectiveness Issues But, are e-cigarettes effective for use as quitting aids? The Cochrane Collaborative study (McRobbie et al., 2014) reported that e-cigarettes reduced tobacco smoking by 50 percent, that they were equal to or better than commonly used nicotine replacement therapy (NRT) like the nicotine patch, and were far superior to willpower alone. One of the most conclusive studies to date is a randomly controlled trial of over 5,800 smokers attempting to quit in England (Brown, Beard, Kotz, Michie, & West, 2014). The study compared reports of abstinence among people using over-the-counter NRT patches, e-cigarette users, and those relying upon willpower alone. A noteworthy observation by Brown et al. is that e-cigarette users achieved abstinence without any formal instruction on how to use the product for that purpose.

The answer to the question begged in my “sheep’s clothing” title is that it depends. Many things in life can be used for good or ill purposes, and e-cigarettes are no exception. The addictive properties of nicotine have for centuries ensured a market for tobacco products. The nicotine in e-cigarettes ensures a market for nontobacco alternatives to cigarettes.

Currently, e-cigarette producers leave dose potency to the customer, but research shows wide variability among products in dose delivered (see Goniewicz, Kuma, Gawron, Knysak, & Kosmider, 2013).

E-cigarettes are already showing signs of being more profitable than tobacco products. In addition, the lack of negative social stigma associated with produce use (Wieczner, 2013) should increase their appeal to many tobacco smokers. A looming concern among public health officials is that e-cigarettes might be, as Jan Wieczner (2013) at The Wall Street Journal put it, “Big tobacco in disguise.” It may be that the industry has found a way to legally sustain nicotine addiction, thereby ensuring market growth.

E-cigarettes appear to be evolving into a particular tool for kicking the smoking habit. Pulvers et al. (in press) report results from a national survey in which 40 percent of e-cigarette users report using the devices to reduce their tobacco smoking. Research mentioned in this paper suggests that many e-cigarette users have been successful in reducing tobacco use and in achieving nicotine abstinence. Used as a tool to reduce tobacco consumption, e-cigarettes do not represent a wolf in sheep’s clothing. Only time will tell.

Should Counselors Encourage Clients to Use E-Cigarettes?

Although the jury of scientific opinion remains cautious, mounting evidence suggests that e-cigarettes offer a relatively safe and effective path to reducing nicotine intake via tobacco smoking—perhaps eventually achieving self-sustainable abstinence. Should smoking clients recovering from addiction to drugs other than nicotine be encouraged to try e-cigarettes if previous quit attempts have failed? Generally, yes. Research reports in the past two years indicate that they are equally or more effective than competing methods. Should smoking clients be discouraged from using e-cigarettes? Definitely not.

However, they should be regularly encouraged to experiment with reduced dosage to help kick the smoking habit and thereby improve the odds of sustaining abstinence from alcohol and other drugs to which they are addicted. c Thomas F. Hilton, PhD, recently retired as program official for Recovery and Addiction Services Reengineering Research, National Institutes of Health, National Institute on Drug Abuse.

References Brown, J., Beard, E., Kotza, D., Michie, S., & West, R. (2014). Real-world effectiveness of e-cigarettes when used to aid smoking cessation: A cross-sectional population study. Addiction, 109(9), 1531–40.

Callahan-Lyon, P. (2014) Electronic cigarettes: Human health effects. Tobacco Control, 23, ii36–ii40.

Credibility Counts.

Gain professional credibility with the Distance Credentialed Counselor (DCC) credential.

Domino, E. F. (1999). Pharmacological significance of nicotine. In J. W. Gorrod & P. Jacob (Eds.), Analytical determination of nicotine and related compounds and their metabolites (pp. 1–11). Amsterdam: Elsevier Science.

Goniewicz, M. L., Kuma, T., Gawron, M., Knysak, J., & Kosmider, L. (2012). Nicotine levels in electronic cigarettes. Nicotine & Tobacco Research, 15(1), 158–66.

Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-Cigarettes: A scientific review.

Circulation, 129(19), 1972–86.

Hilton, T. F. & White, W. L. (2013). Why does the addiction treatment field continue to tolerate smoking instead of treating it? Counselor, 14(3), 34–7, 65.

McRobbie, H., Bullen, C., Hartman-Boyce, J., & Hajek, P. (2014). Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews 2012, Issue 11.

Pulvers, K., Hayes, R. B., Scheuermann, T. S., Romero, D. R., Emami, A. S., Resnicow, K., . . . Ahluwalia, J. S. (in press). Tobacco use, quitting behavior, and health characteristics among current electronic cigarette users in a national tri-ethnic adult stable smoker sample. Nicotine & Tobacco Research.

www.cce-global.org/dcc/credible

20 Counselor · June 2015

Wieczner, J. (2013). Ten things e-cigarettes won’t tell you. Wall Street Journal. Retrieved from http://www.wsj.com/articles/SB100014 24052702304448204579184052293918312