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Families in the Addiction Cycle SUDs and the Child Welfare System Neonatal Abstinence Syndrome Partners of Sex Addicts The History of ASAM 〈 〈 〈 FLIP OVER
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Counselor | December 2017
A Health Communications, Inc. Publication 3201 S.W. 15th Street Deerfield Beach, FL 33442-8190 (954) 360-0909 • (800) 851-9100 Fax: (954) 360-0034 E-mail: editor@counselormagazine.com Website: www.counselormagazine.com Counselor (ISSN 1047 - 7314) is published bimonthly (six times a year) and copyrighted by Health Communications, Inc., all rights reserved. Permission must be granted by the publisher for any use or reproduction of the magazine or any part thereof. Statements of fact or opinion are the responsibility of the authors alone and do not represent the opinions, policies or position of COUNSELOR or Health Communications, Inc.. Health Communications, Inc., is located at 3201 S.W. 15th St., Deerfield Beach, FL 33442 - 8190. Subscription rates in the United States are one year $41.70, two years $83.40. Canadian orders add $15 U.S. per year, other international orders add $31 U.S. per year payable with order. Florida residents, add 6% sales tax and applicable surtaxes. Periodical postage rate paid at Deerfield Beach, FL, and additional offices. Postmaster: Send address changes to Counselor, P.O. Box 15009, North Hollywood, CA 91615 - 5009 © Copyright 2017, Health Communications, Inc.. Printed in the U.S.A.
President & Publisher PETER VEGSO Consulting Executive Editor GARY S. SEIDLER Managing Editor LEAH HONARBAKHSH Advertising Sales CHRISTIAN BLONSHINE Art Director JIM POLLARD Production Manager GINA JOHNSON Director Pre-Press Services LARISSA HISE HENOCH Managing Editor LEAH HONARBAKHSH Toll Free: (800) 851-9100 ext. 211 Phone: (954) 360-0909 ext. 211 Fax: (954) 570-8506 leah.honarbakhsh@ counselormagazine.com 3201 S.W. 15th Street Deerfield Beach, FL 33442-8190 Advertising Sales CHRISTIAN BLONSHINE Phone: (954) 360-0909 ext. 9232 Fax: (954) 360-0034 christian.blonshine@hcibooks.com www.hcibooks.com 3201 S.W. 15th Street Deerfield Beach, FL 33442-8190
Conferences & Continuing Education LORRIE KEIP Phone: (800) 851-9100 ext. 220 Fax: (954) 360-0034 Lorriek@hcibooks.com 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
24 The Relationship between SUDs and Child Welfare Services
CCAPP 6
The President’s Commission: Headed in the Right Direction?
By Natalie Burke, MSW, ASW, Kate McCalman, PLMSW, Duru Özbaş, MSW, and David A. Patterson Silver Wolf, PhD
By Andrew Kessler, JD
NACOA 8
Discusses child maltreatment in relation to substance use, presents characteristics of families in the Child Welfare System, and explains barriers to treatment.
What about Grandma and Grandpa? By Sis Wenger
Cultural Trends
28 Assessment and Treatment of Neonatal Abstinence Syndrome: A Review of the Literature By Taylor Decker, MSW, Melanie Kulick, MSW, Abigail Lyng, MSW, CMHP, Sarah Paletta, MSW, Sara BeelerStinn, LCSW, MPA, and David A. Patterson Silver Wolf, PhD Describes neonatal abstinence syndrome (NAS) and explains the usage of buprenorphine, methadone, and morphine in treating NAS.
35 The Scarlet Sisterhood: Treating Partners of Sex Addicts
5
Letter from the Editor By Gary Seidler Consulting Executive Editor
The Trials and Tribulations of Terry Gene Bollea
10
By Maxim W. Furek, MA, CADC, ICADC
Opinion 12
The Stigma of Addiction: Women and Children
By Rebecca J. Flood, MHS, LCADC, NCAC-II, BRI-II
From Leo’s Desk
Is Anybody There?
14
By Rev. Leo Booth
Wellness 16 Embracing the Quality of Patience, Part I
By John Newport, PhD
The Integrative Piece
18
Righting the Ship in Stormy Seas
By Sheri Laine, LAc, Dipl. Ac
By Crystal Rae Morrissey, CPC, CPLC, CCRC, CDRC Presents a personal and in-depth view of treating women who are partners of sex addicts and provides suggestions for counselors working with this population.
www.counselormagazine.com
3
CONTENTS Topics in Behavioral Health Care
Sober Holidays for Individuals and Families in Recovery
19
By Dennis C. Daley, PhD
21
Counselor Concerns
The Role of Abstinence
By Gerald Shulman, MA, MAC, FACATA
Ask the LifeQuake Doctor
23
By Toni Galardi, PhD
Inside Books
Why Buddha Never Had Alzheimer’s: A Holistic Treatment Approach through Meditation, Yoga, and the Arts By Shuvendu Sen, MD
42 The American Society of Addiction Medicine: A History By Andrea G. Barthwell, MD, DFASAM, & Megan Crants, BA Describes the history of the American Society of Addiction Medicine through interviews with those involved in the organization.
64
Reviewed by Leah Honarbakhsh
Evaluating a Competency-Based Supervision Approach for Motivational Interviewing
Also in this issue: Ad Index CE Quiz
59 62
By Manuel Paris Jr., PsyD, and Steve Martino, PhD Presents a study evaluating the effectiveness of the Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency supervision product.
53 A Test to Differentiate Between Organic Brain Disorder, Nonorganic Brain Disorder, and Schizophrenia, Part II By Norman E. Hoffman, PhD, EdD, LMHC, LMFT, & Wendy L. Rippon, MS Explains a study on the Hoffman Test for Organicity (HTO) designed to test its effectiveness.
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Counselor | December 2017
47
From the Journal of Substance Abuse Treatment
Special Series on Mental Health
LETTER FROM THE EDITOR
Notable Omissions in Surgeon General’s Report
L
ooking back over this year’s headlines on so many happenings in the world of addiction and behavioral health, it may be excusable to have given short shrift to one of this decade’s most important documents: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (HHS, 2017). By most accounts, the report is excellent in that it advances our understanding of addiction in over four hundred pages covering research, prevention, intervention, recovery, and a humanitarian vision for the future. The report goes a long way toward fulfilling its intention to articulate an approach to addiction that is science-based and compassionate at the same time. It represents the first attempt by any US Health and Human Services Administration (HHS) to approach substance use and addiction not as an ethical issue or a matter of criminality, but as a human experience to be understood and a dilemma calling for a humane response. “Once viewed largely as a moral failing or character flaw,” the report says, addictions are “now understood to be chronic illnesses characterized by clinically significant impairments in health, social function, and voluntary control over substance use” (HHS, 2017). The report sees addiction as a chronic illness, to be treated as other medical conditions. Where the report falls short is its omission of the plight facing children who grew up in an addicted household (i.e., children of alcoholism and other addictions). As pointed out by the National Association for Children of Alcoholics (NACoA)—now the National Association for Children of Addiction—there is not a word in the report about the one in four children exposed to alcohol addiction in the family (Denniston, 2017). More than twenty-eight million Americans are children of alcoholics, nearly eleven million under age eighteen. According to NACoA, Drinking is the primary factor in family conflict and disruption, and the home environment of children of alcoholics is typically characterized by a lack of parenting; poor home management; lack of family communication skills; emotional or physical violence; and increased family stress including work problems, illness, marital strain, and financial problems (Denniston, 2017). In the June 2017 issue of Counselor, Robert Denniston of NACoA’s board of directors points out that unless we break the cycle of addiction, these children will be at high risk of drug and alcohol disorders themselves, as well as many other health issues, from depression to heart disease to cancer. Where the Surgeon General’s report really misses the boat is in its almost complete omission of the role of trauma as the most prevalent and universal basis for addiction. We have
come to understand from teachers, most notably Canadian physician Dr. Gabor Maté, that childhood trauma—as in physical, sexual or emotional abuse, multigenerational family violence, parental addiction or mental illness, divorce or other loss—is the template for adult addiction. Dr. Maté points out that sometimes the trauma is less overt and takes more subtle forms that cause a sensitive child to experience pain, but it is always pain that underlies addiction and it is always pain, conscious or not, that the addiction is meant to help a person escape. “Not why the addiction, but why the pain?” is Dr. Maté’s mantra. Facing Addiction in America barely addresses pain—human pain, emotional pain, spiritual emptiness, and the loss of self. While the most progressive addiction treatment providers are becoming more trauma-informed to fully address the spectrum of addictive behaviors, so much more education and training is needed. The Surgeon General’s report could have been so much more powerful and effective if it had called for a trauma-based view of addiction and treatment, and for trauma education of health care professionals. If we continue to focus mostly on symptoms and behaviors, the underlying causes of addiction will remain mostly untouched. Progress, not perfection. c
Gary Seidler
Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication References Denniston, R. (2017). What’s missing in the Surgeon General’s report on alcohol, drugs, and health. Counselor, 18(3), 10–1. US Department of Health and Human Services. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Retrieved from https:// addiction.surgeongeneral.gov/surgeon-generals-report.pdf
www.counselormagazine.com
5
CCAPP
The President’s Commission: Headed in the Right Direction? Andrew Kessler, JD
T
he President’s Commission on Combating Drug Addiction and the Opioid Crisis has released its initial draft recommendations. A bipartisan commission of policy makers and scientists, this commission has been tasked with the development of a national plan of action to stem the opioid epidemic. While their recommendations are sensible, very little in the report is innovative or new to advocates in the arena. First and foremost, the Commission recommends that the president declare the opioid epidemic a national public health emergency, under either the Public Health Service Act or the Stafford Act. This would allow the federal government to draw upon the national Public Health Emergency Fund to address the problem. Unfortunately, the fund’s balance in mid-2016 was only $57,000 (Kodjak, 2016). The House of Representatives has requested $1.7 billion for a different, new fund for FY 2018, but even if the entire amount were spent on the opioid epidemic, it would not even be enough money for a single state to fully meet demand (HHS, 2017). Some in the advocacy community support the president taking such action, but there are drawbacks as well. Addiction is a chronic disease, and a problem that
will not go away in the short term. No one can deny that even if several billion dollars are poured into treatment, the problem will not be eradicated any time soon. Long-term solutions could be far more
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beneficial than an emergency declaration, which exists to handle short-term public health emergencies that can be dealt with through fast actions and reactions. Perhaps the most impressive recommendation is in regards to the IMD exclusion. In an effort to expand treatment capacity, the commission recommends that CMS grant waiver approvals for all fifty states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This would, according to the commission, “immediately open treatment to thousands of Americans in existing facilities in all fifty states” (Baker et al., 2017). While this is a worthwhile pursuit, the waiver application process is long and arduous, and the results may come in time, but certainly not “immediately.” The Commission stated that legislation would be necessary to repeal the exclusion in its entirety, which might be true, but legislation would not be needed to exempt substance use disorder (SUD) inpatient treatment facilities from the rule. That could be done independently by CMS. There is also a recommendation that could be considered controversial, pertaining to 42 CFR 2 and HIPAA regulations. The Commission believes it is possible to better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. The commission has branded 42 CFR 2 “a particular hindrance to comprehensive health care,” citing the difficulty providers have in sharing information, which leads to ill effects on patients in both physical and Continued on page 22
6
Counselor | December 2017
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NACOA
What about Grandma and Grandpa? Sis Wenger
“I
always looked forward to being a grandmother. I pictured myself holding a new baby, reading the books my children enjoyed to this child, and having a new life to love. I never imagined I would be so scared for a grandchild because his father is an addict” (Abbott, 2013).
Stephanie Abbott, counselor and author, began a commentary for NACoA’s newsletter a decade ago about grandparents and children of addiction with this quote. This grandmother was saying what so many grandparents faced then, a precursor to what countless thousands are facing today. Then, the primary drug addiction was alcoholism, and it ran from generation to generation in millions of families, leaving countless grandparents today who are yesterday’s children of alcoholics, and who never received help for the fear, confusion, and chronic emotional trauma that tormented them every day of their childhood. But many of today’s affected grandparents, stressed and afraid for both their child trapped in addiction and their grandchildren, are those children of yesteryear. They struggled to raise their own children with the parenting tools they were dealt, often without an understanding of the family transmission of both the addiction disease and the destructive behaviors and trauma it engenders and passes on to the next generation. Today they have their own health problems, some rooted in childhood. Even in the face of our growing understanding of the powerful connection between adverse childhood experiences, adolescent mental health, and adult mental and physical health, their own physicians are not taking the time to ask about their childhoods. How many have even bothered to review the massive amount of information generated by the Adverse Childhood Experiences (ACE) study that continues to demonstrate that traumatic childhoods lead to unhealthy adults who should be referred to therapists trained in adult children of alcoholics (ACoA) therapy? How many spiritual counselors ask about the childhood experiences of troubled congregants who are struggling with family issues, and then encourage participation in Al-Anon as the beginning of healing? Too many have survived their own childhood experiences only to be faced with their own children succumbing to the current epidemic. Just as they are bringing their grandchildren to live with them, they have much to grieve: the loss of their own childhood to parental alcohol addiction, the loss of their child to opioid or heroin addiction, and the loss of hope. Some have withdrawn from social contacts, frightened and ashamed, as the family disease traps them, adding to the grief. Foster care systems in every county in America are bursting at the seams with the additional children of opiate-addicted 8
Counselor | December 2017
parents who have died, who have been jailed for drug-related activities, who are in court-ordered treatment or who are still on the streets. In many cases these children have been removed by the courts, and the number of foster parents is inadequate to support the number of children who need homes and nurturing parents. And so grandpa and grandma step in—or too often just grandma—filled with confusion, shame, sadness, and fear that they are not physically, financially or emotionally able to support and raise children again. If they were licensed foster parents working with the foster care system, they would be given some financial support, and have a child care worker assisting them with their needs and with getting any services the children may need. This is not only unjust, but it also sets up too many loving grandparents for struggles for which they are ill-equipped.
Foster care workers and the general public are cheering the growing movement of grandparents and other family relatives taking responsibility for the children of their addicted family members. Many of those “stepping up” grandparents are personally on a path to recovery, and may even have substantial sobriety, have believed that their recovery is breaking the family cycle. Their recovery is an important gift to themselves and their children. However, a parent’s recovery does not alone protect children from following the family path to addiction. Anger, embarrassment, and shame resulting from their children slipping into addiction alienates them from their children, and these deeply felt feelings are supplanted by sadness and guilt when their children die from an overdose, and the grief deepens. Society sympathizes for a while, but moves on, leaving the grandparents, who are trying to put on a good face for the children, to wade into a world that they survived through their childhood without any orientation or support from the community. The community needs champions for these mostly silent, desperate
NACOA families. Any one of us could reach out to our faith communities or to our neighborhood schools. There are many actions that can make an enormous dent in the “abuse and neglect” of society’s grandparents. The faith Community can: n Establish and host weekly support groups for grandparents raising grandchildren n Develop a volunteer respite care team who can babysit while grandparents go shopping, to a movie, out for a meal or visit a friend n Train volunteers to help grandparents develop new skills that nurture and enhance the children’s ability to feel emotionally safe and to prevent later attachment disorders n Advocate with the foster care system to provide these grandparents all the same support licensed foster parents receive n Bring in an expert in the child and family impact and special needs to heal from addiction’s ravages, and invite the general congregation to attend (because what these grandparents need to know about caring for children of addicted parents should also be known by every caring adult in the congregation) n Provide equipment and clothing (e.g., diapers, formula, and baby bottles) to grandparents with minimal resources and encourage the older children to participate in the faith community’s youth programs (invite them personally and intentionally)
this school is a place where good things can happen going forward n Help children to get into an educational support group, like student assistance groups, where they can learn there are lots of kids in their school who are struggling with moms or dads who have this brain disease called addiction and that they are not alone and there are safe people who can help them n Guide children eleven years of age or older to Alateen n Provide regular education programs for staff about addiction, its impact on children, and what caring adults can do to provide support and hope n Be intentional in reaching out personally and with nurturing support Grandparents taking on the responsibility of raising their addicted child’s children need comfort, understanding, and support long before their child overdoses or is arrested. Al-Anon, Nar-Anon, and/or regular support groups just for them at a neighborhood church or senior center would be very beneficial. “The grandparent can be a haven of stability, predictability, and undemanding love, and they can help the child make sense of an unpredictable and irrational situation,” Stephanie Abbott stated (2013). But first they need to empower themselves
Sis Wenger is NACoA’s President and CEO.
References Abbott, S. (2013). The grandparents and the COA. Retrieved from https:// nacoa.org/wp-content/uploads/2017/07/grandparents-and-coa-SAbott-nacoa.pdf
GREATER CARE. Eight times a year, the JOURNAL OF SUBSTANCE ABUSE TREATMENT presents specific guidance tailored to a wide range of substance abuse problems, with an emphasis on techniques and treatments you can immediately apply to enhance the recovery of your patients.
n Provide a special welcome to grandparents, helping children understand that the school respects and want to partner with grandparents for their comfort
n Help children understand that they are very special and that if bad things have happened in the past,
About the Author
Offer your patients
The school can:
n Help grandparents understand that today’s educational ways may be different than they experienced, and guide them to support the children’s work appropriately
by learning about the nature of this disease, which hijacks the brain and insidiously changes the person’s capacity to utilize rational judgment. And then they need to learn the effects on children and what tools are available for them to download or purchase (e.g., the Kit for Parents from NACoA, a booklet that is requested by more grandparents than parents). Stephanie Abbott reminds us all that “Parents are forever a part of a child, so the wise grandparent helps the child to understand that addiction is an illness, and—if there are any healthy parts of the parental relationship—tries to build on them” (2013). Children want to love their parents, but sometimes they need to do it from afar in the arms and homes of their grandparents. How successful that life will be may depend greatly on the response of neighbors, churches, doctors, therapists, and schools, all of whom have a role in that success. We cannot wait for the foster care system to develop and provide the needed support for both our impacted children and their loving grandparents. The need is urgent. c
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CULTURAL TRENDS
The Trials and Tribulations of Terry Gene Bollea Maxim W. Furek, MA, CADC, ICADC
W
ith fierce body slams and an Atomic Leg Drop, Terry Gene Bollea (aka Hulk Hogan) wrestled his way to the top ranks of celebrity stardom and Hulkamania. Hulk Hogan dominated World Wrestling Federation (WWF) opponents André the Giant, The Iron Sheik, and The Undertaker. His bombastic persona enthralled hordes of faithful fans and followers. According to the Internet Movie Database (IMDB), “Hogan was soon seen everywhere—television, cartoons, movies, records, and lunch boxes—but he was a part of the steroid scandal in the WWF, and quietly left the organization” (2017). Despite sundry adventures and misadventures, the Hulkster had the ability to take a punch, shake it off, and somehow land squarely on his ponderous feet.
His most recent misadventure was a sordid sex scandal that threatened to further castigate a sullied career filled with the bitter and the sweet. In 2012, Gawker Media posted a nearly two-minute video of Hogan having sex with Heather Cole (Lombardo, 2016). Cole, who was married to radio shock jock Todd “Bubba the Love Sponge” Clem at the time, said, during a nearly two-hour deposition, that she had sex with the wrestling legend four times at the request of her husband. Neither Cole nor Hogan knew that Clem was recording their intimate behavior. Hogan filed suit against Gawker Media, maintaining that the site invaded his privacy. Hogan asked for $100 million in damages (Lombardo, 2016). Gawker maintained that the First Amendment protected its 2012 publication of the footage; due in part to how much Hogan has openly discussed his sex life with various media (Kludt, 2016). 10
Counselor | December 2017
Entertainment news website The Wrap wrote, After a ten-day trial, a jury in Florida found in favor of Hulk Hogan in his lawsuit against Gawker Media for $115 million in a case that has implications for media in the age of the Internet. Following six hours of deliberation on Friday, the jury found that Hogan suffered severe emotional distress over the publication of segments of a sex tape featuring him having sex with a friend’s wife, and that his privacy was invaded by publication of the footage (Kenneally, 2016).
“I fear no man, no beast or evil, brother.” – Hulk Hogan The Anti-Drug Abuse Act of 1988
Hogan’s career was always one of controversy and melodrama. In an earlier and relatively obscure courtroom drama in bucolic Harrisburg, Pennsylvania, Hogan was, once again, caught right in the middle. The trial, serving as a test case for a 1988 steroid law, was the beginning of the government’s attempt to control the use of performanceenhancing steroids. It immediately became a media sideshow with anticipated confrontation between steroid users and law enforcement (Furek, 1993). In the 1980s, “the sale of anabolic-androgenic steroids for nonmedical purposes became illegal under the AntiDrug Abuse Act” (“History of,” 2011). Futhermore, The Anabolic Steroid Control Act of 1990 added anabolic steroids to the federal schedule of controlled substances, thereby criminalizing their nonmedical use by those seeking muscle growth for athletic or
CULTURAL TRENDS cosmetic enhancement. It places steroids in the same legal class [Schedule III] as barbiturates, ketamine, and LSD precursors (Collins, 2005). The Anti-Drug Abuse Act rapidly assumed a central role in the WWF. In an emotionally charged trial, Assistant US Attorney Theodore Smith III argued that Dr. George Zahorian III, age fortythree, acted as a drug dealer and not a physician when he sold anabolic steroids and other controlled substances to professional wrestlers and weightlifters from the WWF (O’Sullivan, 2015; “Titangate,” 2012). Dr. Zahorian, a urologic surgeon who served as the Pennsylvania Athletic Commission’s physician at wrestling matches, was charged with eight counts of distributing steroids, one count of possession with intent to deliver steroids, four counts of delivering prescription painkillers and other controlled substances, and one count of possessing the substances with the intent to deliver (“Titangate,” 2012). A New York Times article about the trial stated, “The government tried to show that Vince McMahon’s Titan Sports Corporation had illicitly provided him with anabolic steroids,” charging that “Mr. McMahon provided steroids to his wrestlers to build up their physiques and thus make them more appealing to audiences” (“Hulk Hogan,” 1994). Dr. Zahorian confirmed the testimony of professional wrestlers Rick Martel, Roddy Piper, Brian Blair, and Dan Spivey, who admitted they purchased steroids from Dr. Zahorian after such sales became illegal in November 1988 (“Titangate,” 2012). All four wrestlers said that they ordered steroids over the phone, and then received them by Federal Express. None of the wrestlers were charged because steroid use was not illegal in the period covered by the indictment. Smith urged the jury to concentrate on the allegations against Dr. Zahorian, and not on the circus-like hoopla surrounding the high-profile wrestlers.
“John H. Doe”
WWF champion Hulk Hogan, the most successful and best-known figure in the game at the time, was testifying under immunity from prosecution. Prior to the trial beginning, he was designated as
“John H. Doe” (“Titangate,” 2012). The government was not going after him or his fellow wrestlers; the prosecution was betting the house against Dr. Zahorian and Vince McMahon. As the journalist Weldon T. Johnson noted, “Justice Department investigators would later uncover documentation indicating Zahorian ‘sold steroids and drugs to forty-three pro wrestlers, thirty-seven of whom were employed by McMahon’s WWF when deliveries were made,’ ” (Wilson & Johnson, 2003; O’Sullivan, 2015). According to the aforementioned New York Times article, Under questioning by prosecutor Sean O’Shea, Mr. Bollea . . . said that steroid use “was fairly common” among wrestlers working for the World Wrestling Federation in the 1980s. He said that while touring for the WWF, he would call Emily Feinberg, then Mr. McMahon’s executive secretary, “and ask her to place an order for me with Dr. Zahorian.” . . . Mr. Bollea . . . said that when the steroid orders arrived at Titan Sports headquarters in Stamford, Connecticut, he would “pick them up along with my paycheck, fan mail or whatever” (“Hulk Hogan,” 1994). Said Hogan in his book, My Life Outside the Ring: Dr. Zahorian was a real nice guy . . . He was the man who had whatever we
needed. He’d show up in the locker rooms with his two little black briefcases full of testosterone, Anavar, growth hormone, pain pills. He’d give us a hundred Valium in a little unmarked matchbook-type container if we needed them. You could always call ahead so he’d have what you needed whenever you blew through town (Hogan & Dagostino, 2009). The New York Times article about Hogan’s testimony stated, “Defense lawyers, in cross-examination, sought to show that Hogan had been using the steroids for nearly fourteen years and that it had been an entirely personal action” (“Hulk Hogan,” 1994). According to a biography of Hogan, Under oath, Hogan admitted he had been using steroids from 1975 to 1989, before they were outlawed. He denied, however, that McMahon had sold him steroids or injected him. Ultimately, both counts against McMahon of steroid distribution were dismissed, thanks in large part to Hogan’s testimony (“History,” 2009). Hogan later recollected, But at the time, every wrestler I knew was on steroids. . . . The most commonly prescribed steroids were testosterone, decadurabolin, and Dianabol. They were part of my generation. I’m not making Continued on page 15
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11
OPINION
The Stigma of Addiction: Women and Children Rebecca J. Flood, MHS, LCADC, NCAC-II, BRI-II
H
aving worked in addiction health care for nearly four decades, I have found the stigma behind substancerelated disorders to be one of the most crippling hindrances to widespread recovery. This stigma, exacerbated among pregnant women or women with children, forces many afflicted women to avoid seeking essential health care services.
The need for treatment and the desire to seek it out is clearly present, as documented from the very history of Alcoholics Anonymous (AA). The group was started between two men from Ohio trying to overcome their dependence to alcohol. The group spread to the UK in March 1947, when their first meeting was held at a classy London hotel. By 1949, there were regular meetings every Tuesday and Thursday in London, and membership exceeded one hundred attendees (Alcoholics Anonymous Great Britain, 1997). Currently, there are hundreds of AA meetings each week in London. Yet, substance use disorder (SUD) statistics continue to show a tremendous chasm between those who need treatment and those who are actually receiving it. According to the National Institute on Drug Abuse (NIDA), “In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, 12
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but only about 2.5 million people (0.9 percent) received treatment at a specialty facility” (2015). Across the pond in the UK, NHS statistics showed that “Deaths related to drug misuse are at their highest level since comparable records began in 1993” and in addition, “6 percent of eleven-year-olds said they had tried drugs at least once, compared with 24 percent of fifteen-year-olds” (NHS Digital, 2017). Furthermore, the Centers for Disease Control and Prevention (CDC) state that approximately 120,000 babies a year are born with birth defects (2015). CDC guidelines state that prenatal exposure to alcohol “is commonly cited as the leading preventable cause of birth defects and developmental disabilities” (Gerberding, Cordero, & Floyd, 2004). Despite this, there is still a failure to reach the millions of women who may need drug and alcohol addiction services. Helping a pregnant woman recover from drug addiction, or preventing her addiction, is a direct approach to combating addiction and its many other side-effects among all sectors of the population. Because of the intergenerational spread of this disease, treating women can be a direct method of preventing SUDs among both men and women in future generations, or at least diminishing the negative effects of addiction. I have found that when women recover, their family system also enters recovery. I always refer to a book called Men are from Mars, Women are from Venus (1992) by Dr. John Gray. One of the most longlasting truths I got out of this book is that women are gatherers; they collect information, they like to talk, and they nurture others in their family system. This, of course, affects the way we need to serve women in recovery. However, the Minnesota Model—one of the first forms of treatment—was developed by men for men. The Addiction Severity Index was developed by Dr. Tom McClellan to collect data and do assessments of military men (Samet, Waxman, Hatzenbuehler, & Hasin, 2007). So, much of the early instruments and models that we have were worked on by men and for men; they worked for a predominantly male population. It was not until 1994 that the greatest body of data was collected on five thousand women in the US through the Center for Substance Abuse Treatment (CSAT; Greenfield, Back, Lawson, & Brady, 2010). They funded demonstration projects throughout the US to collect data on best practices for women, pregnant women, and women with children in a residential setting. I was blessed to chair that cross-site evaluation when I worked at a program called Seabrook House in southern New Jersey. Data on these women were tracked against what services were provided and how well they did postdischarge. They were provided case management services on the back-end of treatment while integrating back into community. All of these women were either pregnant or parenting and brought their children to treatment
OPINION with them. They all received between six months and one year in residential care. These services were vastly different than anything that had existed in the research prior to 1994. They validated that services such as Seeking Safety (a research-based trauma curriculum), EMDR, EFT, mindfulness, and equine therapy are excellent tools in our toolboxes for treating women for their addiction and their trauma (Greenfield et al., 2010). A large part of the failure to reach women lies in the deep stigma associated with the disease. According to Livingston, Milne, Fang, and Amari, “Several studies have identified stigma as a significant barrier for accessing health care” (2012). Women with substance use problems are more likely than men to have experienced trauma and to have higher rates of concurrent psychiatric problems, as discussed in SAMHSA’s Trauma and Justice Strategic Initiative (SAMHSA, 2011). Not only are women exposed to the unique stigmas behind addiction during pregnancy, but they are also more likely to be facing additional mental health concerns and prior trauma. As health care professionals, we need our services to not only be more open and inviting to women who resist entering treatment, but to also understand the many layers of resistance and suffering they are going through. In general, women enter treatment with less education, and with less resources to pay for the care they need, however the intensity and duration of care they need is much more significant than men (Greenfield et al., 2010). This is known as “telescoping,” the phenomena of women presenting with a more severe clinical profile than men who use the same or more of the substance for an equivalent or longer length of time (Greenfield et al., 2010).
our peers to reduce the stigma that addiction sufferers go through in their search for recovery, and to encourage them to pursue treatment. The popularity of AA and other services speaks to the strong, universal desire that addiction sufferers have to attain recovery. We should seek to understand what is refraining so many others from participating in recovery services. Would a greater diversity of niche health care services—such as those specialized for women with children or specific racial and cultural communities—encourage more participation? For some, a broader or anonymous service might help them feel that their individual identity is less exposed, reducing feelings of stigmatization. Additionally, how does childcare play a part in meeting these individuals where they are? The goal should be to eventually lead recovery towards dedicated, in-house care so we can understand the people we serve more personally, and help them combat the lasting afflictions that resonate from a life of addiction, as well as prepare them for the many hardships they will overcome in a life after treatment. To get there though, we have to work together to help them take their first steps. c About the Author Rebecca J. Flood, MHS, LCADC, NCAC-II, BRI-II, is the CEO of New Directions for Women and has had nearly four decades of experience in the health care industry. Ms. Flood attended Johns Hopkins
References Alcoholics Anonymous Great Britain. (1997). Historical data: The birth of AA, its growth, and the start of AA in Great Britain. Retrieved from http:// www.alcoholics-anonymous.org.uk/About-AA/ Historical-Data Centers for Disease Control and Prevention (CDC). (2015). Facts about birth defects. Retrieved from https://www.cdc.gov/ncbddd/birthdefects/facts.html Gerberding, J. L., Cordero, J., & Floyd, R. L. (2004). Fetal alcohol syndrome: Guidelines for referral and diagnosis. Retrieved from https://www.cdc.gov/ncbddd/ fasd/documents/fas_guidelines_accessible.pdf Gray, J. (1992). Men are from Mars, women are from Venus. New York, NY: Harper Collins. Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. The Psychiatric Clinics of North America, 33(2), 339–55. Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. National Institute on Drug Abuse (NIDA). (2015). Nationwide trends. Retrieved from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends NHS Digital. (2017). Statistics on drugs misuse: England, 2017. Retrieved from http://www.content.digital.nhs.uk/catalogue/PUB23442 Samet, S., Waxman, R., Hatzenbuehler, M., & Hasin, D. S. (2007). Assessing addiction: Concepts and instruments. Addiction Science & Clinical Practice, 4(1), 19–31. Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Leading change: A plan for SAMHSA’s roles and actions 2011–2014. Retrieved from https://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf
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
Bridging the Gaps
Despite some cultural variations, the US and the UK share a common language and so much history. I recently spoke at the Recovery Plus addictions symposium in London and truly believe we can use our unique similarities to work together to understand this epidemic with better data and a broader range, and to identify the unique cultural aspects that could be preventing our women and families from seeking or receiving treatment. We need to share a discourse and spread it among
University and obtained her masters of human services from Lincoln University in Pennsylvania. She currently serves as a member of the National Association of Addiction Treatment Providers board and a member of the Seabrook House board. Effective January 1, 2018, Rebecca will assume the positions of President and CEO of Ashley Addiction Treatment.
We LIVE to Hope
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13
FROM LEO’S DESK
Is Anybody There? Rev. Leo Booth
W
This is not how I was raised. I was raised to believe that God hen I write articles, as I have been doing for is separate. That I had to go to Him, seek Him, and find Him. many years for Counselor magazine, the thought I do not believe this anymore. I am more inclined to the affiroccasionally enters my mind: Is anyone reading this mation “Whatever I am, God is, and all is well.” I do not ever want to miss me in the miracle of life. I am not a puppet, but column? Now, I do realize that there are many articles a creative human being (Booth, 2016). in each magazine and the reader is hardly expected to be glued to “From Leo’s Desk,” but it is rare that I ever Understanding God’s Grace Talking about God’s grace is a particular Christian insight get a response from anyone. that suggests that a spiritual power is emanating from God The thought occurred to me that my articles are so clear and logical that readers agree with my sentiments, indeed think the same way as I do, and therefore no response is necessary. Really? I do not think so. Also, my articles are really controversial, both religiously and from a recovery perspective, so why the silence? Then I realized that the information concerning how to contact me has been incorrect! My fault. My e-mail is leobooth46@gmail.com and I can be found on Facebook by searching for “Leo Booth.” That explains everything! You will note in my biography that the changes have been made.
Partnership
I believe that God is not controlling what happens in this world, through the direct action of God’s grace. On the contrary, my belief today is that we have free will and that means that the actions we take create the outcome, for good or bad. This is a markedly different position from Bill Wilson, and others, who believe that “God is doing for us what we cannot do for ourselves.” Such a belief is consoling, but (I believe) wrong. God does not get people sober from alcoholism and His job is not to keep people sober; that responsibility is ours. The emphasis I place, concerning our relationship with God, is on partnership or cooperation. God undeniably wants us sober, but we must also want it. The Big Book, the fellowship, a sponsor . . . all can play a supportive role, but we need to make the decision and stay, one day at a time, with that decision. In an issue of Counselor last year, I wrote the following: 14
Counselor | December 2017
that changes or encourages human actions or behavior. So, we hear frequently in recovery rooms: n “I am able to remain sober through the grace of God.” n “My life has been changed through the grace of God.” n “I could not stop drinking. But only because of the grace of God (or Jesus), I am now sober ten years.”
This I do not believe. Many people who utter these words often drink again. People who belong to a non-Christian religion and have never heard about God’s grace manage to stay sober for years. Atheists can also get and stay sober. This is what I believe today: What if grace is not something that descends upon us, but has been given to us at birth? God’s grace becomes akin to our reasoning powers, our ability to think and make choices, our ability to take responsibility for our lives and what is happening in our world. We utilize God’s grace when we see clearly the many disabilities that affect mankind and we use our brains to figure out ways to prevent sickness. God’s grace is working through doctors and scientists. We see God’s grace in the work of recovering alcoholics throughout the world who make the choice to stop drinking and then stay stopped. They begin to clear the wreckage of their past
FROM LEO’S DESK and embrace a spirituality that is both positive and creative. We see God’s grace at work in countries that are slowly working their way out of poverty and developing economic employment for their citizens. God’s grace is never favoritism, rather is it knowing and massaging a gift that has been given to every human being (Booth, 2017).
Change
We can only grow because we change; we never grow if we remain the same. My understanding of God has changed over the years. I did not realize it when I was a young man growing up in England, but the God of my youth brought along baggage: Hell, Heaven, sin, right, wrong, devils, angels, heretics, saints, and fear—a fear of God. It took me a long time to realize that “God” is not a name like Leo or Ann, rather it is a term and a description that seeks to explain the unexplainable. Religious dogma and rules messed me up and although love was mentioned it was never the center of my belief system; today it is. And this must include a love for Leo. Oh yes, the fear has gone. Today I am able to live with a spiritual agnosticism that refuses to place me in a box, and I am able to appreciate other religions and spiritual viewpoints. It is the journey that fascinates me today, not the destination. I am not wanting to be argumentative or controversial, rather I wish to be honest with readers. And when I sit with other recovering people, I am amazed to hear that they feel similar, they think the same, but are afraid to voice such ideas within the recovery community. Now that is scary. We become fake when we fear being honest. Cults maintain their power when individuals give up their freedom to think. Is anybody there? c About the Author Leo Booth, a former Episcopal priest, is today a Unity minister. He is also a recovering alcoholic. For more information, visit www.fatherleo.com or e-mail him at leobooth46@gmail. com. You can also connect with him on Facebook: Leo Booth.
References Booth, L. (2016). A spiritual revolution. Counselor, 17(3), 20–1. Booth, L. (2017). God’s grace: What is it? Counselor, 18(1), 18–9.
Cultural Trends Continued from page 6
excuses, but they were everywhere. And a lot of that had to do with what we knew about them, which obviously wasn’t enough . . . I never had a question about whether I would take them. It was part of my daily regimen. Did you take a shower? Yeah. Did you brush your teeth? Yeah. Did you take your steroids? Yeah. Okay, let’s go. That was the deal. It was how I lived (Hogan & Friedman, 2003).
All four wrestlers said that they ordered steroids over the phone, and then received them by Federal Express. Dr. Zahorian claimed he was unaware of the new steroid law, but his defense was rapidly falling apart: Prosecution testimony established that there was no medical examination before prescriptions were issued, or supervision during cycles, and according to the testimony of [wrestler] Billy Graham, [Zahorian] never gave any guidelines on dosage. It took a mere three hours for the jury to convict him. There was very little doubt. Zahorian was sentenced on December 27, 1991 to three years in prison and fined $12,700 (“Titangate,” 2012). Although the case of Dr. Zahorian investigated the crimes of one solitary man, it is obvious that he was a willing pawn of the WWF organization and a larger cadre of individuals, all interconnected by their use of steroids for nonmedical, cosmetic purposes. It was his courtroom trial that began the march against performance-enhancing drugs and a trial that, curiously, placed little guilt at the feet of the WWF’s Vince McMahon and his star wrestling champion, Hulk Hogan. c
About the Author Maxim W. Furek, MA, CADC, ICADC, is an avid researcher and lecturer on contemporary drug trends. His rich background includes aspects of psychology, addictions, mental health, and music journalism. His latest book, Sheppton: The Myth, Miracle, & Music, explores the psychological trauma of being trapped underground and is available at Amazon.com.
References Collins, R. (2005). The Anabolic Steroid Control Act: The wrong prescription. Retrieved from https:// thinksteroids.com/articles/anabolic-steroidcontrol-act-wrong-prescription/ Furek, M. W. (1993). The strange case of Dr. George Zahorian III. Steele Jungle Publications, 2(3). “History and biography of Hulk Hogan.” (2009). Retrieved from http://www.wrestlerbiographies. com/hulk-hogan/history-and-biography-ofhulk-hogan “History of steroid use.” (2011). Retrieved from http://www.intheknowzone.com/substance-abusetopics/steroids/history.html “Hulk Hogan, on witness stand, tells of steroid use in wrestling.” (1994). The New York Times. Retrieved from http://www.nytimes.com/1994/07/15/nyregion/hulk-hogan-on-witness-stand-tells-of-steroiduse-in-wrestling.html Hogan, H., & Dagostino, M. (2009). Hulk Hogan: My life outside the ring. New York, NY: St. Martin’s Press. Hogan, H., & Friedman, M. J. (2003). Hollywood Hulk Hogan. New York, NY: Simon & Schuster. Internet Movie Database (IMDB). (2017). Hulk Hogan: Biography. Retrieved from http://www.imdb. com/name/nm0001356/bio Kenneally, T. (2016). Hulk Hogan wins $115 million in Gawker sex tape lawsuit. Retrieved from http:// www.thewrap.com/hulk-hogan-wins-sex-tape-lawsuitagainst-gawker-media/ Kludt, T. (2016). Hulk Hogan’s partner on sex tape is emotional in taped testimony. Retrieved from http:// money.cnn.com/2016/03/16/media/hulk-hogangawker-tape-heather-cole/index.html Lombardo, K. (2016). The Hulk Hogan vs. Gawker legal saga, explained. Sports Illustrated. Retrieved from https://www.si.com/more-sports/hulk-hogangawker-sex-tape-lawsuit-racism-explained O’Sullivan, D. (2015). The forgotten steroid trial that almost brought down Vince McMahon. Retrieved from https://sports.vice.com/en_us/article/pg5n3z/ the-forgotten-steroid-trial-that-almost-broughtdown-vince-mcmahon “Titangate (part one): The true story behind the scandals that rocked the WWF between 1991 and 1992.” (2012). Retrieved from https://www.facebook. com/notes/piledriver-wrestling-net/ titangate-part-one-the-true-story-behind-the-scandals-that-rocked-the-wwf-betwee/464076513637661/ Wilson, J., & Johnson, W. T. (2003). Chokehold: Pro wrestling’s real mayhem outside the ring. Bloomington, IN: Xlibris.
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WELLNESS
Embracing the Quality of Patience, Part I John Newport, PhD
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his is the first installment in a two-column series fo- a high-strung gentleman, on his knees and praying to his cusing on embracing the quality of patience, with par- higher power, “Lord, grant me the quality of patience . . . and give it to me right now!” ticular reference to its relevance to enhancing both the In actuality, a much more effective approach to cultivating successfulness and overall quality of recovery from alco- patience is embodied in another old joke. A harried man jumps holism, drug addiction, and other addictive disorders. into a taxi in Manhattan and shouts to the driver, “How do I get to Carnegie Hall?!” The driver turns his head toward the This initial installment will expound on the quality of pa- passenger and calmly advises, “Practice, practice, practice!” tience and discuss ramifications of cultivating patience in promoting a more in-depth experience of recovery, to- The Importance of Patience in Recovery Many if not most practicing alcoholics and addicts have a gether with assisting clients in attaining higher levels of rather impatient side to their nature, demanding that everyphysical and mental-emotional health and well-being thing be the way they want it to be right now. Impatience is closely associated with a strong desire for instant gratificaalong with substantially improved quality of life. One of my favorite affirmation cards reads, “Embracing patience is the royal road to happiness, serenity, and true contentment.” Like many if not most people in recovery, trying to integrate patience into my life is truly a lifelong challenge. Reflecting on my tendency to get caught up in a whirlwind of activity, attempting to tackle what appears to be a million and one “urgent items” on my plate, I am reminded of an old joke you have undoubtedly heard before. It involves 16
Counselor | December 2017
tion, which at least at first is conveniently attained through ingesting their drug or drugs of choice. This, together with physical dependency, serves to keep alcoholics or addicts trapped in the inevitable downward spiral of addiction. As any addiction counselor is well aware, patience and persistence are key cornerstones of successful long-term recovery. Working the Steps is not an easy process, and the desire to move forward in recovery requires constant support and validation. Accordingly, I firmly believe that working the program
WELLNESS under the guidance and encouragement of sponsors who have walked the path before is essential to acquiring the patience and forbearance needed to successfully navigate the many obstacles and set-backs alcoholics or addicts inevitably encounter during the early and middle stages of recovery. As readers are well aware, attaining and maintaining true sobriety requires a deep commitment to recovery that goes far beyond maintaining abstinence, per se. As a staunch wellness advocate, I strongly encourage everyone in recovery to embrace a wellness-oriented lifestyle as an integral component of their recovery. As I describe in my book The Wellness-Recovery Connection (2004), in addition to dramatically enhancing one’s physical and mental-emotional health status, a lifelong commitment to pursuing wellness in recovery invariably opens the door to exciting new vistas in enhancing overall quality of life. Examples include manifesting the courage to find and follow your heartfelt dreams and fulfill your true sense of purpose in life; moving beyond surface ways of relating to developing deeply fulfilling relationships with others; nurturing the quality of personal integrity, together with a strong desire to help make this world a better place to live in; and greatly increasing the amount of joy you experience through making choices that enable you to spend more time doing whatever you truly enjoy doing. Returning now to the physical and mental-emotional dimensions, let us take a moment to consider how damaging chronic impatience can be to these important aspects of our health and wellbeing. When we are chronically impatient, we go through life being constantly “wired tight,” feeling overstressed and out of sorts most of the time. This manifests itself in the form of extreme irritability, resentment, despair, and withdrawal. Not surprisingly, this mindset wreaks havoc in both our lives and the lives of those around us—we push other people away and all too often end up feeling isolated and desperately lonely. Over the past several decades, a wealth of evidence has accumulated concerning the detrimental effects of the chronic stress overload on our physical health. A classic example is the
pioneering research of Friedman and Rosenman, who shared a cardiology practice in San Francisco. As reported in their landmark book, Type A Behavior and Your Heart (1974), their research documented a substantially higher incidence of serious heart disease among their high-strung, hyperaggressive, “Type A” subjects than was the case with their more relaxed, easy-going “Type B” counterparts. Voluminous subsequent research efforts have documented an association between chronic impatience and increased susceptibility to a wide range of health issues. Included among these are the common cold, hypertension, stomach ulcers, diverticulitis and other gastrointestinal problems, flareup of arthritis, chronic back trouble, migraine headaches, and debilitating asthma attacks, to name a few (Hafen, Karren, Frandsen, & Smith, 1995).
In addition to dramatically enhancing one’s physical and mentalemotional health status, a lifelong commitment to pursuing wellness in recovery invariably opens the door to exciting new vistas in enhancing overall quality of life.
and anxiety, together with subjects’ selfreported perceptions of experiencing increased peace and serenity, and reduced stress in their lives (Benson & Klipper, 1975; Caudill, Schnable, Zuttermeister, Benson, & Friedman, 1991; Fentress, Masek, Mehegan, & Benson, 1986; Mandle et al., 1990). Over the course of this column I have attempted to expound on the quality of patience and discuss in some detail ramifications of cultivating patience in promoting sustained recovery from alcoholism and drug addiction, while at the same time promoting enhanced health and well-being and substantially improved quality of life. In the next and final installment I will focus on identifying and discussing a variety of practical steps we can take to more fully integrate the quality of patience into our lives. In the meantime, I encourage you to reflect on what steps you might take to experience more patience, serenity, and true contentment in your own life. Until next time—to your health! 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
On the flip side, mounting evidence supports the efficacy of various interventions designed to induce a sustainable experience of increased calmness and reduced tendency to engage in highly impatient and aggressive behavior. These interventions have concurrently been associated with positive impact on subjects’ physical and mental-emotional health status. Many of these interventions constitute various forms of mindfulness practice including contemplative meditation, breathing exercises, yoga, devotional prayer, and insight-oriented journaling. A large number of studies have focused on meditation and in the main have documented a positive association between regular practice of meditation and reduced blood pressure, heart rate
Benson, H., & Klipper, M. Z. (1975). The relaxation response. New York, NY: HarperCollins. Caudill, M., Schnable, R., Zuttermeister, P., Benson, H., & Friedman, R. (1991). Decreased clinic utilization by chronic patients: Response to behavioral medicine intervention. Clinical Journal of Pain, 7(4), 305–10. Fentress, D. W., Masek, B. J., Mehegan, J. E., & Benson, H. (1986). Biofeedback and relaxation-response training in pediatric migraine. Developmental Medicine and Child Neurology, 28(2), 139–46. Friedman, M., & Rosenman, R. H. (1974). Type A behavior and your heart. New York, NY: Alfred A. Knopf. Hafen, B. Q., Karren, K. J., Frandsen, K. J., & Smith, N. L. (1995). Mind/body health: The effects of attitudes, emotions, and relationships. Needham Heights, MA: Allyn & Bacon. Mandle, C. L., Domar, A. D., Harrington, D. P., Leserman, J., Bozadjian, E. M., Friedman, R., & Benson, H. (1990). Relaxation response in femoral angiography. Radiology, 174(3 pt. 1), 737–9. Newport, J. (2004). The wellness-recovery connection: Charting your pathway to optimal health while recovering from alcoholism and drug addiction. Deerfield Beach, FL: Health Communications.
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THE INTEGRATIVE PIECE
Righting the Ship in Stormy Seas Sheri Laine, LAc, Dipl. Ac
A
s we move into the winter season, things can become hectic. Here are some tried and true tips for sustained happiness and health. n Pay attention to your wellness routine via sleep, diet, outdoor light, daily exercise, nutrition, and meditation. n Eat seasonal, fresh, and preferably organic vegetables and fruits, whole grains, eggs, nuts, and protein in the form of lean meats. n Limit sugar and sugar-infused drinks. Drink water throughout the day. n Moderate your coffee and caffeine consumption. n Give yourself time during the day to unwind and recharge. n Use natural bath and hygiene products. Check labels to rid yourself of additives and chemicals in your daily application of lotions and potions. n Include companionship and intimacy in your life. n Keep yourself sexually engaged—orgasms are important for ongoing “feel good” hormone production, mentally and physically. n Create friendships that empower your creativity, listening skills, laughter, positivity, and happiness. n Stay emotionally drama free and learn healthy behaviors and communication skills. n Limit your intake of alcohol and other mood-altering substances. n Maintain a monthly acupuncture, massage or chiropractic appointment. n Learn to check in with yourself, and if something does not feel right, honor your inner voice. n Maintain an attitude of gratitude. Say thank you, thank you, thank you for your life, the people you share it with, and your health every day. n Keep your home and office clean and clutter free. Surround yourself with your version of beautiful. n Remember that everything in life changes. n Dive into the now with open arms. 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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Counselor | December 2017
TOPICS IN BEHAVIORAL HEALTH CARE
Sober Holidays for Individuals and Families in Recovery Dennis C. Daley, PhD
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he holidays present challenges for some individuals in recovery from addiction, especially those who are new to the process. Following are ideas I have discussed with groups of individuals in treatment during the holidays to raise their awareness and get them thinking of how to make the holidays a time for sober celebration. After a discussion of sober holidays for individuals, I will share thoughts about recovery for family members during the holiday. S
Share the joy of the holidays with others you care about and who care about you. This can include family, peers in recovery, friends, coworkers, and others. Fostering positive relationships can lead to better connections with others, improved satisfaction with your life, and experiencing more positive emotions like love or joy. Do not focus on what you do not have or things not going well in your life, but what you do have and what is going well. Do not isolate from others, as you may be more prone to feeling lonely or depressed. If you have few sober or supportive people in your life, attend holiday dinners, meetings, and other events sponsored by mutual support programs like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), non-Twelve-Step programs, churches or other community organizations.
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Open your heart to the purpose of the holidays, which is to celebrate your faith and beliefs, spend time with loved ones, and give to others you care about or who are less fortunate than you. If formal religion is important to you, there are many celebrations during the holidays that can be uplifting. “Giving” to others can be of your time, attention, and love as well as simple gifts. Do not get caught up in gift giving that you cannot afford. Family members or important people in your life will appreciate your time and attention over the holidays, so be sure to balance the need for recovery and the need to stay connected and involved with others. Be generous to people like the homeless without judging them.
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Be vigilant about high-risk people and situations over the holidays. There is no need to socialize with people getting high or drunk who may pressure you to use substances. Holidays like New Year’s Eve are celebrated with excessive drinking by some, so avoid events where this may occur. As recovery programs suggest, “stick with the winners” over the holidays to reduce pressure to use substances and engage in meaningful activities.
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Enjoy the company of family, friends, and others in recovery over the holiday season. Go to events sponsored by AA and NA so you stay connected to your program and others who support you. Attend family or community gatherings as well. Some people new to recovery need time to learn to enjoy the simple pleasures of life or the company of others. If you feel bored with recovery, find new, enjoyable activities or connect with people to keep you focused on sober activities.
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Recovery continues over the holidays, so keep yours a high priority, no matter how busy you get. You can balance recovery and holiday celebrations with family and friends. If you are active in support programs and visit family out of town, attend local meetings or sober holiday events sponsored by these programs. www.counselormagazine.com
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TOPICS IN BEHAVIORAL HEALTH CARE H
Holidays are a time to reflect on your blessings and feel grateful for the “gifts” you have in your life. These gifts may be people important to you, your religious beliefs and faith, your health, your talents or abilities, your opportunities or your achievements. Express your gratitude towards others for what they give you or do for you.
joy or happiness, especially young children. If you have young children, grandchildren, nephews or nieces, take note of their enjoyment of the holidays and engage in discussions or activities with them. Play a game or a sport, build a puzzle or read a book together. Being with them is more important than what you do, although it is best to do things they enjoy.
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Offer to do for others. Focus less on yourself and more on your children, grandkids, parents, family, friends, peers in recovery or those in need. “Doing” for others means spending time with them, taking an interest in their lives or doing something concrete for them like taking them a meal or helping with a task. The less focus on self and the more focus on others, the better you may feel. Even if you are new in recovery and are advised to focus on self, you can do this as well as do things for others.
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Love is the most important part of the holidays. This includes the love of God, family, and friends. Love is shown in your actions such as praying or attending services, doing things for others, and reaching out to those unable to get out due to illness or disability. While love is best expressed in actions, you can also express it in what you say to others. You can send a personal note or card to loved ones sharing your feelings such as appreciation for them or love towards them. Fostering love and other positive emotions improves the quality of relationships in your life.
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Inventory-taking is a way to review your year, both in terms of what you have achieved as well as how you may have fallen short of your goals. Give yourself credit for reaching your goals or for the efforts put forth to reach these, even if you did not reach them all. Use this process to develop new goals for the upcoming year to improve yourself.
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Discover the joys of recovery during the holidays by paying attention to and appreciating the people and events around you. Look for what brings others 20
Counselor | December 2017
Aim for a sober and happy holiday in which you celebrate the season, continue to grow in recovery and stick with your program of change. Work hard and you will get benefits! You get nothing for nothing, so recovery has to be earned. There is a large community of people in recovery as well as family and friends who are willing to support and help you. Approach recovery as a “we” and not an “I” process.
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You can make it through the holidays—stay sober and enjoy this time of the year. Having the right attitude, sharing time with others, and keeping grounded in recovery will help. Be active in your program by attending meetings, connecting with others, and using your recovery tools.
If family members with addiction are doing poorly at this time, this can affect other family members, contribute to their anxiety or bring back bad memories or feelings. Families in Recovery
Some family members exposed to chaos during the holidays may struggle with bad memories, worry or anxiety. Even if this chaos occurred years ago, people can feel stuck in past heartache and heartbreak, which can affect how they feel at the present time. Or, if family members with addiction are doing poorly at this time, this can affect other family members, contribute to
their anxiety or bring back bad memories or feelings. I grew up in a family with a father who had severe alcoholism along with mental health problems. I cannot remember a single sober holiday until my dad got sober at age sixty-six, and most of my early holiday memories were negative ones. However, it has been decades since I have been bothered by these memories. I believe that the best antidote to exposure to this chaos and negativity growing up was to learn to live well in the present, focus on the positives in my life, and address and solve problems as soon as possible so they do not linger and pull me down. Trust me, I have had my share of problems and heartache in my life, but focusing on the present and future, along with getting love and support from others who understand what it is like to live in a family devastated by addiction, moved me towards recovery, healing, and growth. Focusing on my own family, raising children and working on my career enabled me to show resilience and grow from past experiences. I am now a grandparent, so I can focus on the many blessings young children bring to my life. I am still involved with families, some who are in recovery and some who are not. I see their pain and struggles with their addicted loved one and their own reactions over the holidays as well as other times during the year. They deserve our help and support. This requires patience and a willingness to see that addiction is not a problem affecting only the addicted individuals. I believe the focus on the current opioid epidemic has largely ignored the “other” opioid epidemic, which is addiction’s impact on families. The more we are aware of this, the more we can promote recovery. Clearly, sober holidays are for families, not just addicted individuals. c About the Author Dennis C. Daley, PhD, served for fourteen years as the chief of Addiction Medicine Services (AMS) at Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh School of Medicine. Dr. Daley has been with WPIC since 1986 and previously served as director of Family Studies and Social Work. He is currently involved in clinical care, teaching, and research.