Counselor Magazine - October 2015

THE IMPAIRED PROFESSIONAL, PART III UNDERSTANDING ADDICTED PHYSICIANS

BREAKING THE MOTHER-SON DYNAMIC

BY JOHN LEE

THERAPY in the DIGITAL AGE THE THERAPEUTIC ALLIANCE IN SUD TREATMENT

GROUP-BASED EXPERIENTIAL THERAPY BILL WHITE INTERVIEWS DR. SHEILA BLUME WISDOM RECOVERY, PART III

Sept/Oct 2015

Vol. 1 No. 1

FIRST ISSUE OF TREATMENT & RECOVERY

INDUSTRY INSIDER

UNITE: Ral ly for the Ages pg.

2

Recovery Hou sing— End of the Gold Rush pg.

12

FLIP OVER

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CARON Foc us on Elderly pg.

19

Claudia Bla Young Adultck Center Open s

A Technologi cal Pathway to Support Recovery pg.

20

LEADERSH

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CONTENTS

34

Letter from the Editor Wisdom Recovery, Part III

The Culture is the Competence: Evolving the Practice of Treatment and Recovery

By Gary Seidler Consulting Executive Editor

CCAPP

The 2015 CCAPP 2nd Annual Conference

NACOA

Landmark Study Ends Silence

Cultural Trends

42 Therapeutic Alliances in Substance Abuse Treatment Explains the current state of therapeutic alliances in the United States, provides insight into the efficacy of therapeutic alliances, and describes best practices.

By Kayde Claunch, MSW, Sarah Marlow, MSW, Alex Ramsey, PhD, Christina Drymon, MA, and David A. Patterson, PhD

Defines targets of experiential therapy, provides information on the Breakthrough program, and presents a case study.

By Erin Deneke, PhD, Ann Smith, MS, LPC, LMFT, Austin Houghtaling, PhD, Elizabeth Epstein, PhD, and Kevin Hallgren, PhD

12

By Sis Wenger

By Gordon Dveirin, EdD

The Value of Group-Based, Experiential, Personal Growth Therapy

10

By Pete Nielsen, CADC-II

Addresses the culture of addiction treatment, provides a historical context for the treatment of physical and mental illness, and describes an integrative model of recovery.

48

9

Music from the Heroin Songbook: Revisited

14

By Maxim W. Furek, MA, CADC, ICADC

Opinion

The Impaired Professional, Part III: Understanding Addicted Physicians

17

By Gregory E. Skipper, MD, FASAM

From Leo’s Desk

Spirituality vs. Religious Extremism, Part II

19

By Rev. Leo Booth

Wellness

Healing from Nature Deficit Disorder, Part II

22

By John Newport, PhD

The Integrative Piece Seeing With New Eyes

24

By Sheri Laine, LAc, Dipl. Ac

Topics in Behavioral Health Care

25

Financial Issues, Part II: Strategies for Those in Recovery

By Dennis C. Daley, PhD

www.counselormagazine.com

3

Introducing . . .

Counselor Magazine’s new Advisory Board Robert J. Ackerman, PhD Chair of Counselor’s Advisory Board A Health Communications, Inc. Publication

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Ralph Carson, PhD Nutritionist and exercise physiologist

Tian Dayton, PhD Author, expert, and consultant on psychodrama/trauma

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..

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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 2015, Health Communications, Inc.. Printed in the U.S.A.

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President & Publisher PETER VEGSO Consulting Executive Editor GARY S. SEIDLER

Don Meichenbaum, PhD Professor Emeritus, University of Waterloo, Ontario, Canada

Pete Nielsen, CADC-II Interim executive director, CCAPP

Managing Editor LEAH HONARBAKHSH Director of Editorial Communications STEPHEN COOKE Advertising Sales JAMES MOORHEAD Art Director DANE WESOLKO

Cardwell C Nuckols, PhD Addiction treatment and industry expert

Production Manager GINA JOHNSON Director Pre-Press Services LARISSA HISE HENOCH

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Founder and medical director of Haight-Ashbury Free Medical Clinic Counselor · October 2015

Director of Editorial Communications STEPHEN COOKE Phone: (800) 851-9100 ext. 222 E-mail: stephen.cooke@usjt.com Conferences & Continuing Education LORRIE KEIP Phone: (800) 851-9100 ext. 220 Fax: (954) 360-0034 E-mail: Lorriek@hcibooks.com Website: www.usjt.com Advisory Board ROBERT J. ACKERMAN, PHD JOAN BORYSENKO, PHD RALPH CARSON, PHD TIAN DAYTON, PHD BOBBY FERGUSON

Managing Editor LEAH HONARBAKHSH Phone: (800) 851-9100 ext. 211 or (954) 360-0909 ext. 211 Fax: (954) 570-8506 E-mail: leah.honarbakhsh@ counselormagazine.com

DAVID MEE-LEE. MD

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MARK SANDERS, LCSW DAVID E. SMITH, MD

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CONTENTS Research to Practice

A Tour of The Center on Alcoholism, Substance Abuse, and Addictions (CASAA)

28

By Michael J. Taleff, PhD, CSAC, MAC

Counselor Concerns Different Strokes for Different Folks

30

By Gerald Shulman, MA, MAC, FACATA

Substance Abuse in Teens Impulsivity and Gambling in Emerging Adulthood

32

54 Reflections of An Addiction Psychiatrist: An Interview with Sheila Blume, MD Discusses Dr. Blume’s career history in relation to addiction psychiatry, psychodrama, the Jewish community, children of alcoholics, and gambling addiction.

By William L. White, MA

By Fred J. Dyer, MA, CADC

Ask the LifeQuake Doctor

33

From the Journal of Substance Abuse Treatment

By Toni Galardi, PhD

Inside Books

Breaking the Mother-Son Dynamic: Redirecting the Pattern of a Man’s Life and Loves

By John Lee

Trauma-Informed Care: Consumer Perspectives

80

Describes the assessment of trauma, lists a variety of trauma-informed interventions, and assesses consumer satisfaction with treatment.

By Merith Cosden, PhD, and Ashley Sanford, MA

Reviewed by Leah Honarbakhsh

ALSO IN THIS ISSUE Ad Index

76

Referral Directory

77

CE Quiz

78

66 Is Your Therapy Practice Ready for the Digital Age? Presents issues faced by kids and adults online, describes the addictions that technology can engender, and provides advice for therapists unfamiliar with new technology.

By Robert Weiss, LCSW, CSAT-S

6

Counselor · October 2015

60

ARTICLE REPRINTS AVAILABLE. Educate your audience and reinforce your product message with an article reprint from Counselor.

Providing a valuable and appreciated take-home resource directly to your audience, reprints are an effective tool to get your message across and carried home from conferences, meetings or lecture halls.

Reprints can be produced as traight article reproductions or with a title page, magazine cover, and/or advertisement.

Reprints vary in cost depending on the number of pages and amount ordered.

Call (800) 851-9100 ext. 211 or e-mail leah.honarbakhsh@counselormagazine.com

LETTER FROM THE EDITOR

Progress, Not Perfection This feels surreal.

In October 1976, almost forty years ago, I welcomed readers to the first issue of The US Journal of Drug and Alcohol Dependence, a twenty-four-page newspaper which was the very first trade periodical that reported on research, findings, new treatment modalities, and educational advances in the then fledgling alcohol and drug abuse field.

Our field—along with our collective understanding that chemical and/or behavioral addiction affects us all—has grown beyond anyone’s imagination.

While there will always be dissenting voices, the vast majority of us understand that addiction is a serious illness, if not a disease, not a moral weakness that cries out for a punitive approach.

Rather, addiction is intrinsically linked to pain (most often emotional pain) with trauma most commonly related to family of origin issues.

Despite occasional critics of Twelve Step programs, most of us recognize that Alcoholics Anonymous (AA) in particular continues to be the most effective support system for addicts everywhere.

We have come to understand that addiction and mental illness rarely exist in isolation, so we recognize that much of the time we need to address co-occurring disorders. We have learned that treatment is most successful when an integrated approach is offered along with a continuum of treatment. We realize that prescription drugs are every bit as deadly as illicit drugs. We understand that there are costs, as well as benefits, to every legislative decision to decriminalize a drug, that the elderly need the same attention as adolescents, that gender-specific treatment works best, that family programs are an essential component of treatment, and that the newer process addictions—sex/love, gambling, food, Internet, shopping, and others—are all part of our new world.

To help keep us on track with important new science, clinical findings,

techniques, and educational initiatives, we proudly announce in this issue our new Advisory Board. These leaders in the field will help guide our editorial development.

Also in this issue, we present the first edition of Counselor’s Treatment and Recovery Industry Insider. As our industry grows, we face increasing challenges to ensure that we conduct ourselves ethically as well as cost-effectively. The Industry Insider will report on important developments and progressive initiatives. We also intend to shine a light on some of the more contentious issues that are causing loud rumbles (e.g., unfair practices by Internet marketing firms, improper billing for inflated urine lab tests, and the like).

Above all, we will adhere to our original and primary mission: to provide objective information to help counselors and other frontline workers do the best job possible.

Meanwhile, let us all take a deep meditative breath, celebrate our growth, and recognize that we are truly making a positive difference.

Gary Seidler

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

www.counselormagazine.com

9

CCAPP

The 2015 CCAPP 2nd Annual Conference Pete Nielsen, CADC-II

I

t’s hard to believe, but conference time is quickly approaching. It is amazing to consider the long list of accomplishments that have been made by this organization since CAARR and CAADAC consolidated to form CCAPP less than one year ago. Come and celebrate our success at this year’s conference at the Burbank Marriott, from October 1–4, 2015.

The terrific staff and management at CCAPP have created a fresh approach to substance use disorder (SUD) conferences that we think you will find extraordinary. We recognize that SUD staff have multiple needs for training, motivation, and inspiration. Why not recognize these needs all in one conference? Let us help you use your time and funds to attend SUD conferences in a better way. Instead of sending some of your staff to a conference 10

Counselor · October 2015

for marketing and admission, sending other staff members to a conference for administration and compliance, and sending yet another group for clinical staff training, our new concept, “the whole treatment conference,” allows everyone to attend the same conference while benefitting from specialized workshops and seminars unique to each need. CCAPP’s 2015 expanded conference offerings include tracks for: • Marketing and administration: Finding successful strategies for marketing and admissions in today’s crowded SUD market space.

• Sober living: Keys to navigating sober living regulation, management, and innovation.

• Executives and administrators: Created for executives,

administrators, and future leaders in addiction treatment organizations, the executive/ administrator track offers an array of intense business and clinical-care topics in the business of treatment and substance use disorders.

• Clinical supervision: Sharpening clinical supervision skills is the key to success in a coordinated treatment system.

This track updates professionals providing clinical supervision and gives them interesting insights on cultural competencies and special populations.

• Clinicians: Co-occurring disorders, aftercare, intervention, relapse prevention, enhancing motivation for change, intake and assessment, and approaches

CCAPP specific to cultural needs of the patient are just some examples of intended workshops.

• Intervention and referral: Disease model and recovery processes, information and referral, and detoxification and other treatment modalities will be covered in depth.

CONTINUING EDUCATION HOURS AVAILABLE FOR: PROVIDER NAME:

PROVIDER #:

NAADAC

189

I am confident that the 2015 conference will set the tone for conferences for years to come. The “whole treatment conference” concept addresses the need for knowledge and skill development through advanced training on key areas including the following:

NBCC

SP-689

CA BBS

PCE 680

NY: OASAS

0380

CA BRN

7482

• Cultural diversity • Criminal justice and DUI issues • Ethics • SUD prevention • Personal and professional wellness • Medication-assisted treatment • Changes in funding and billing • Implementation of the Affordable Care Act • Changes to regulation and law concerning programs and professionals

NASW

D-5098

CAADE

CP30 695 P0000

The CCAPP 2015 conference offers a unique opportunity for professional development, information exchange, and networking. As always, CCAPP’s networking opportunities are the best in the state due to our mixers and packed exhibit halls. In addition, the lineup for keynotes and presenters is phenomenal.

I am greatly looking forward to seeing everyone there. c

For more information, contact CCAPP at: 2400 Marconi Ave, Suite C Sacramento, CA 95821 Phone: 916.368.9412 | Fax: 916.368.9424 E-mail: counselors@caadac.org Website: www.ccapp.us

Pete Nielsen, CADC-II is the interim executive director for the California Association of Alcoholism and Drug Abuse (CAADAC), the California Certification Board of Alcohol and Drug Abuse Counselors (CCBADC), and the California Foundation for the Advancement of Addiction Professionals (CFAAP). Mr. Nielsen has worked in education as a campus director, academic dean, and an instructor. He has also worked in the substance use disorders field for seventeen years as an interventionist, family recovery specialist, counselor, and administrator.

www.counselormagazine.com

11

NACOA

Landmark Study Ends Silence Sis Wenger

“L

ook at this! They finally proved what we told them twenty years ago!” wrote psychiatrist Charles Whitfield, MD, ten years ago across the top of a recently published research report.

The article was reporting on lifetime health and mental health consequences of the chronic emotional stress that lurks in homes with parental addiction, and related adverse childhood experiences that create havoc and repeated trauma.

It was the beginning of a slow and often reluctant awakening to a major tenyear study with a cohort of seventeen thousand primarily middle class adults who had health care insurance with Kaiser Permanente. The original purpose of the study, which has generated over one hundred articles in peer-reviewed journals to date, was to identify potential new strategies to prevent, or to address earlier and more effectively, the chronic diseases among the burgeoning older population that were increasingly absorbing higher and higher percentages of the country’s health care resources.

The unexpected results that began to surface in interviews with research clients was a pattern of adverse childhood experiences creating traumatic events and/or chronic emotional stress from early childhood that could be identified as precursors to such chronic diseases as heart disease, strokes, diabetes, cancer, and obesity, as well as depression and other mental health disorders. Certain adverse experiences during the critical years of early childhood brain development began to be noticeable, including alcoholism or other drug addiction in the family, seeing 12

Counselor · October 2015

your mother get hit, having a parent in prison or a parent suffering with mental illness, and being physically or sexually abused as a child. From that growing awareness at the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, the cosponsors of this landmark research, came the study’s name: The Adverse Childhood Experiences (ACE) study.

What Dr. Whitfield, one of NACoA’s founders, was saying to us at NACoA was that the conditions in addicted families—and the often deleterious impact on children in those families—was obvious to the twenty-two NACoA founders who gathered in 1982 and again in early 1983 to share their individual work and what they had learned about children of alcoholics in their lives and their practices. At these gatherings, they determined that the silence that trapped these children—one in four from all socioeconomic and educational backgrounds—had to be broken.

They realized they needed to work collaboratively to break the silence, and they created NACoA to be a voice for the children.

Now, over thirty-three years later, there is an awakening of the impact of chronic emotional trauma on developing children, and a growing sense that this is proving too costly to our medical system, mental health system, school systems, and court systems, over and above the human cost to impacted children and families. As a result of this awareness, we now have a federal Health and Human Services Department (HHS) that has a growing focus on making all programs and most professional training trauma-informed as well as evidence-based.

“The ACE study provides populationbased clinical evidence that unrecognized adverse childhood experiences are a major, if not the major, determinant of who turns to psychoactive materials and becomes addicted,” noted Vincent

NACOA Felitti, MD, the Kaiser Permanente ACE study coprincipal investigator (2004).

As this becomes better understood by program designers, addiction treatment and prevention program directors, school systems, and those who fund them, we could imagine a world where all responsible adults would argue for child- and family-focused preventive interventions across our systems, including juvenile justice. Furthermore, in the next generation we could reap a historical drop in health care and mental health care costs among adolescent and adult populations, and an emotionally stable life for the one in four children who still suffer in silence in addicted families.

The ACE study researchers identified the most frequent adverse childhood experiences and developed an “ACE Score” to identify the most at-risk populations of children to whom public policy could direct more effective prevention and intervention strategies. They recognized that most ACEs did not exist in isolation in families. “Growing up with alcoholabusing parents is strongly related to the risk of experiencing other categories of ACEs,” stated Robert Anda, MD, a heart disease prevention researcher with CDC and coprincipal investigator of the ACE study with Dr. Felitti (2010).

The study has proven what we knew clinically and environmentally twenty years earlier.

As a result of the ACE study findings, childhood trauma is now called the nation’s number one public health problem. The relationship is difficult to miss between the NIAAA conclusions and the findings of the ACE study. The evidence continues to mount that compels the critical imperative for childhood to be a time of nurturing supportive environments and of developing healthy attachments to loving and supportive adults. Conversely, evidence mounts simultaneously that we must, as a matter of public policy and clinical practice, do all possible to ameliorate or halt the damage from chronic emotional stress in early childhood, with its lifetime of adverse consequences and shortened life span.

According to Rosemary Tisch, MA, and researcher Rivka Greenberg, PhD, there is ample evidence that prevention

programs which target the whole family can delay initiation of substance use, create healthier parent/child relationships and whole family healing that improves youth resistance to peer pressure to use alcohol, and reduces affiliation with antisocial peers and levels of problem behaviors (2015; UNODC, 2009). Family programs are found to be second only to in-home family support and nearly fifteen times more effective than programs working with youth only. In addition, the effect of family skills training programs is sustained over time (Cheng et al., 2007).

Family treatment courts (FTC) have offered successful treatment approaches for child abuse, neglect, family violence, and addiction “probably due to their focus on family-centered services,” said Ms. Tisch (2015). Reviews of FTCs show that “manualized, structured, evidence-based family treatments” are an essential component (Marlowe & Carey, 2012).

Family-centered services are critical for healing, yet few evidence-based family-focused programs exist; fewer still focus on addiction. NACoA is attempting to change that. With its updated and enhanced Children’s Program Kit to be rereleased this year, and its widely spreading and evidence-based whole family recovery program curriculum Celebrating Families!, NACoA is working to put the most effective evidence-based tools in the hands of those in prevention and treatment services.

These professionals are in a position to offer program services that are proven trauma-informed and age-appropriate preventive interventions to counteract the impact of ACEs on so many of America’s children. As ACE study research findings are published, there is a constant reminder of the need for enhanced, resilience-promoting interventions and program services. That family-centered treatment offers a solution to the intergenerational cycle of substance use and related consequences by helping families reduce substance use and improve child health and safety is clear to all who look (Werner, Young, Dennis, & Amatetti, 2007).

The ACE study has been a trigger for a critical awakening—the first step in the development and implementation

of effective programs that can foster resilience and a balanced life for all those hurt by its findings. For all of us, it is a powerful challenge from Drs. Anda and Felitti to remember that we already know what to do in each of our systems.

We need to get busy and do it for our nation’s children and for our nation’s mental and physical health. c Sis Wenger is NACoA’s president and CEO

References

Anda, R. (2010). The health and social impact of growing up with alcohol abuse and related adverse childhood experiences: The human and economic costs of the status quo. Retrieved from http://www. nacoa.org/pdfs/Anda%20NACoA%20Review_web.pdf Cheng, S., Kondo, N., Aoki, Y., Kitamura, Y., Takeda, Y., & Yamagata, Z. (2007). The effectiveness of early intervention and the factors related to child behavioral problems at age two: A randomized controlled trial. Early Human Development, 83(10), 683–91.

Felitti, V. J. (2004). The origins of addiction: Evidence from the adverse childhood experiences study. Retrieved from http://www.nijc.org/pdfs/ Subject%20Matter%20Articles/Drugs%20and%20 Alc/ACE%20Study%20-%20OriginsofAddiction.pdf 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.

Marlowe, D. B., and Carey, S. M. (2012). Research update on family drug courts. Retrieved from http://www.nadcp. org/sites/default/files/nadcp/Reseach%20Update%20 on%20Family%20Drug%20Courts%20-%20NADCP.pdf Tisch, R., & Greenberg, R. (2015). Addressing adverse childhood experiences (ACEs) through family-focused services for families dealing with substance use disorders.

Retrieved from http://www.acesconnection.com/ blog/addressing-adverse-childhood-experiences-acesthrough-family-focused-services-for-families-dealingwith-substance-use-disorders-by-rosemary-tisch-maand-rivka-greenburg-ph-d?reply=419293293307247851 United Nations Office of Drugs and Crime (UNODC).

(2009). Guide to implementing family skills training programmes for drug abuse prevention. Retrieved from https://www.unodc.org/documents/ prevention/family-guidelines-E.pdf Werner, D., Young, N. K., Dennis, K., & Amatetti, S. (2007). Family-centered treatment for women with substance use disorders – History, key elements and challenges. Retrieved from http://www.samhsa.gov/ sites/default/files/family_treatment_paper508v.pdf.

www.counselormagazine.com

13

CULTURAL TRENDS

Music from the Heroin Songbook: Revisited Maxim W. Furek, MA, CADC, ICADC

D

iacetylmorphine abuse has been widely discussed in literary forms, as well as in song. In the December 2014 issue of Counselor, the connection between musicians and this highly addictive substance was explored. In part two of this investigation, we once again examine how popular music attempts to define the destructive characteristics of heroin.

This powerful narcotic powder was first synthesized from morphine in 1847

by British chemist C. R. Alder Wright at St. Mary’s Hospital Medical School in London (“The heroin,” 2010). Heroin was used as a cold medication for children but was heavily promoted as being nonaddictive, and therefore an excellent treatment for morphine addiction. Bronchitis, tuberculosis, and other cough-inducing illnesses were also treated with heroin. In 1906, the 14

Counselor · October 2015

American Medical Association approved heroin for general use, and recommended that it be used in place of morphine (“Heroin history,” 2015).

Around 1913, there was an explosion of heroin-related admissions in east coast cities, especially New York City and Philadelphia, where a substantial population of recreational users was reported. Some of these users supported their habits by collecting and selling scrap metal, hence the name “junkie.” Prohibition seemed inevitable and the use of heroin without prescription was soon outlawed in the US (Askwith, 1998).

Heroin remains a huge problem and today we are in the midst of another tidal wave of heroin abuse. In February 2014, Attorney General Eric Holder called the prescription drug and heroin epidemic a “public health crisis”

(“Heroin overdoses,” 2014).

The escalation of the numbers is troubling. According to the National Survey on Drug Use and Health (NSDUH), in 2012 about 669,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. This trend appears to be driven largely by young adults, aged eighteen to twenty-five, among whom there have been the greatest increases. The number of people using heroin for the first time is unacceptably high, with 156,000 people starting heroin use in 2012, nearly double the number of people in 2006 (US Department of Health and Human Services, 2013). In contrast, heroin use has been declining among teens aged twelve to seventeen. Past-year heroin use among the nation’s eighth, tenth, and twelfth-graders is at its lowest levels in the history of the Monitoring

CULTURAL TRENDS the Future survey, at less than 1 percent of those surveyed in all three grades from 2005 to 2013 (NIDA, 2014).

Although countless everyday people become addicted, their stories often go unheard. No so with high profile celebrities such as rock superstars. Far too many contemporary musicians— including Eric Clapton, John Lennon, Lou Reed, Keith Richards, James Taylor, and Steven Tyler—have publicly acknowledged their heroin addictions.

These musicians are representative of the deadly relationship between heroin and the singular music community (Furek, 2008).

There were other musicians as well.

Art Pepper’s career as one of the leading jazz alto saxophonists was repeatedly interrupted by several prison stints stemming from his addiction to heroin, as detailed in his autobiography Straight Life (Pepper, 1994). Pepper rationalized that his love for heroin stemmed from a destructive self-hatred and violent, alcoholic parents. Still, he justified that, after getting high, “I looked in the mirror and I looked like an angel.

I looked at my pupils and they were pinpoints; they were tiny, little dots. It was like looking into a whole universe of joy and happiness and contentment” (Pepper, 1994). Pepper’s “joy and happiness” led to a life of misery and punishment. Pepper served several sentences in San Quentin prison. In the late 1960s he joined the controversial Synanon drug rehabilitation group, headed by Charles E. Dederich, and later began a musical comeback in the mid-1970s after successful methadone therapy.

Because of its severe physical withdrawal, heroin is a difficult addiction to treat via traditional interventions.

For many, the solution is to score one more time, search for a vein that hasn’t collapsed, and then inject. It is a shortterm fix that finds the addict dealing with the same pain after scant hours of numbing self-medication. It is the never-ending cycle of desperation, craving, and use.

The Songbook

The following songs, all depicting heroin addiction, do not convey Art Pepper’s “joy and happiness.” What they do present, however, is a common

theme of agony and despair. The songs, listed in chronological order, offer a historic perspective as well as a reminder that, while the problem persists, the song remains the same.

1967: “I’m Waiting for the Man”

Lou Reed’s driving heroin rock opera takes us “up to Lexington, 125” and even though he’s “feeling sick and dirty” continues “to a Brownstone, up three flights of stairs” where he is “just looking for a dear, dear friend.” Reed reveals in this Velvet Underground tune: “I’m just waiting for my man,” an obvious reference to the dope dealer who’s “never early, he’s always late.”

1968: “Cloud Nine”

In “Cloud Nine,” Motown’s in-house songwriters Barrett Strong and Norman Whitfield penned one of their strongest antidrug social messages. As observed in The Sounds of Social Change, “The Temptations could leave that smooth ‘middle-of-the-road’ Motown route, take off on ‘Cloud Nine,’ that junkie’s dream, and without even mentioning ‘drugs’ in the lyric, touch every nerve in the ghetto” (Denisoff & Peterson, 1972). Describing that addiction is nothing more than a wicked fantasy, the lyrics state, “Ain’t got no responsibility / Cloud nine / And every man / Every man is free / Cloud Nine / And you’re a million miles from reality.”

1970: “The Junkies’ Prayer”

This unusual and unexpected antidrug song from the country-pop group The Statler Brothers was penned by member Lew DeWitt. The song, included in their LP Bed of Roses, revisits the horrors of addiction: “For I soon must return to my gutter of thrills / Where joy is the needle or a bottle of pills / Where a man welcomes misery like an old friend from home / That he uses and abuses till the misery is gone.”

1971: “Dead Flowers”

The Rolling Stones’ countrified observation on “Little Suzie, Queen of the Underground” was ostensibly inspired

by Keith Richard’s continuing heroin addiction. Recorded on December 15, 1969, it wasn’t released until 1971 on the highly successful LP Sticky Fingers.

The song confesses, “Well when you’re sitting back in your rose pink Cadillac / Making bets on Kentucky Derby Day / Ah, I’ll be in my basement room with a needle and a spoon / And another girl can take my pain away.”

1972: “The Needle and the Damage Done”

Neil Young’s song from the LP Harvest addressed his personal loss after Danny Whitten, one of the original members of Crazy Horse, overdosed. As the story goes, Whitten came to rehearsal high on heroin and was fired by Young, who gave him a plane ticket back to Los

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CULTURAL TRENDS Angeles and $50 for rehab. Whitten spent the money on pure heroin, and, in death, became part of Young’s memorial: “I hit the city and I lost my band / I watched the needle take another man / Ohh, ohh, the damage done.”

1973: “The Devil is Dope”

Detroit’s Dramatics were a soul music group featuring lead singer William “Wee Gee” Howard. This was one of the first antidrug songs to identify the drug that plagued the inner city. The listener is warned, “He’ll make you a slave then / Put you in your grave / And close the door.” Scripted by songwriter Tony Hester, The Dramatics also recorded Hester’s “Beware of the Man with the Candy in his Hands.” Jason Elias’ All Music Guide noted that, “1973’s A Dramatic Experience seems to split the difference between a concept album dealing with the evils of drugs and polished, well-arranged ballads and dance tracks” (2015).

1987: “Mr. Brownstone”

In “Mr. Brownstone,” the oft angry and out-of-control Guns N’ Roses singer Axl Rose described the progression of heroin use, typically from casual use to social use to compulsive use and then full-blown addiction. Rose explained, “I used ta do a little, but a little wouldn’t do / So the little got more and more / I just keep tryin’ ta get a little better / Said a little better than before.” The song is included on their major label debut LP Appetite For Destruction.

1991: “Under the Bridge”

Singer Anthony Kiedis of the Red Hot Chili Peppers tells a sad tale of homelessness and despair brought about by his heroin addiction: “Under the bridge downtown / Is where I drew some blood.” The song, which propelled the group to stardom, was released on their LP Blood Sugar Sex Magik and the resulting video, directed by Gus Van Sant, won the group an MTV Video Music Award.

1992: “Junkhead”

Here Alice in Chains’ lead singer Layne Staley boasts of his heroin use, mocking those who do not. He said: “What’s my drug of choice? / Well, what have you 16

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got? / I don’t go broke and I do it a lot.”

Spin Magazine went even further and observed: “Alice In Chains’ videos are elegant little travelogues of junkie life.

Heroin addicts and struggling former addicts hear something in Layne’s gradeschool junkie poetry, a kind of siren” (Gilbert and Aledort, 2011). Staley died on April 5, 2002, ironically the same date as Kurt Cobain’s suicide death.

Staley’s body was not discovered until two weeks later. The autopsy report concluded that Staley died of an overdose of heroin and cocaine, the fabled “speedball.” “Junkhead” appeared on the CD Dirt along with “Godsmack” and “Angry Chair,” a failed attempt to find the music in addiction.

2002: “Hurt”

This Nine Inch Nails song was written

by Trent Reznor, but later reinterpreted by a somber Johnny Cash. It is one of the best literary representations of heroin addiction that is equally intelligent and immediate. Reznor’s lyrics reveal: “I hurt myself today / To see if I still feel / I focus on the pain / The only thing that’s real / The needle tears a hole / The old familiar sting.”

2005: “A Baltimore Love Thing”

Curtis James Jackson, aka 50 Cent, is recognized as one of the major proponents of early twenty-first-century gangster rap. His single mother worked as a drug dealer and was murdered when Jackson was only eight years old (“50 Cent,” 2015). He was raised by his grandparents and, after a life of crime, drugs, and violence, began a career as rapper 50 Cent. In “A Baltimore Love Thing” from the CD The Massacre, the rapper compares heroin addiction to a love affair, offering: “We got a love thing where you try to leave me / But you need me, can’t you see you’re addicted to me?” 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

“50 Cent biography.” (2015). A&E Television Networks. Retrieved from http://www. biography.com/people/50-cent-21330489 Askwith, R. (1998). How aspirin turned hero.

Sunday Times. Retrieved from http://www. opioids.com/heroin/heroinhistory.html Denisoff, R. S., & Peterson, R. A. (1972). The sounds of social change: Studies in popular culture. Chicago, IL: Rand McNally.

Elias, J. (2015). The Dramatics: A Dramatic Experience.

Retrieved from http://www.allmusic.com/ album/a-dramatic-experience-mw0000320316 Furek, M. (2008). The death proclamation of Generation X: A self-fulfilling prophesy of goth, grunge, and heroin. New York, NY: i-Universe.

Gilbert, J., & Aledort, A. (2011). 1996 Guitar World interview: Jerry Cantrell of Alice in Chains discusses songwriting and band’s new self-titled album. Guitar World. Retrieved from http://www. guitarworld.com/1996-guitar-world-interviewjerry-cantrell-alice-chains-discusses-songwritingand-bands-new-self-titled-album?page=0,0 “Heroin history: 1900s.” (2015). Retrieved from http://www.narconon.org/druginformation/heroin-history-1900s.html “Heroin overdoses pose ‘urgent public health crisis,’ US attorney general says.” (2014). Fox News. Retrieved from http://www.foxnews.com/ health/2014/03/10/heroin-overdoses-pose-urgentpublic-health-crisis-us-attorney-general-says/ National Institute on Drug Abuse (NIDA).

(2014). What is the scope of heroin use in the United States? Retrieved from http://www. drugabuse.gov/publications/research-reports/ heroin/scope-heroin-use-in-united-states Pepper, A., and L., (1994). Straight life: The story of Art Pepper (revised ed.). Cambridge, MA: Da Capo Press.

“The heroin drug history and heroin facts.” (2010).

Retrieved from http://heroininfo.org/heroin_facts.html US Department of Health and Human Services.

(2013). Results from the 2013 national survey on drug use and health: Summary of national findings.

Retrieved from http://www.samhsa.gov/data/ sites/default/files/NSDUHresultsPDFWHTML2013/ Web/NSDUHresults2013.pdf

OPINION

The Impaired Professional, Part III: Understanding Addicted Physicians Gregory E. Skipper, MD, FASAM

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nderstanding the historical and political issues surrounding the identification and management of addicted physicians is important to effectively work with them.

These issues in many ways reflect the continued ambivalence in our society regarding whether we regard addiction as an illness or a moral failing. Physicians hold a place of esteem in our society and the patient-physician relationship involves a transference necessary for patients to relinquish their privacy to get care. Patients tell their secrets, share their fears, face their mortality, expose their bodies to physicians, and follow the physician’s directions to undergo procedures and take medications only because of the special relationship and trust placed in them. This is why there is a cognitive dissonance associated with physicians having problems with substance abuse, and why it is newsworthy to hear about physicians admitting their addiction or being arrested for a drug problem. We have a morbid curiosity

about how this could happen.

Furthermore, the problem of addiction among physicians is common—studies show that about one in ten physicians become addicted during their lifetime (Flaherty & Richman, 1993).

Medical boards, whose members are usually appointed by the governor of each state, are assigned the responsibility to protect patients by assuring that practitioners are qualified and ethical. So it makes sense that medical boards would be concerned about addiction and other mental health issues among licensed physicians. Stories regarding addicted physicians are in the news and lawyers see the opportunity to capitalize on the anger of patients who feel betrayed.

These events garner negative publicity for the boards.

Most medical boards are funded through state budgets and they must continually demonstrate their need for funds.

Going after addicted physicians is relatively easy compared to seeking to discipline physicians who are greedy, overutilizing procedures or who have poor communication skills leading to medical errors. Medical boards are legal entities established through legislation; they are not designed for diagnosis and treatment of illnesses. Additionally, medical board investigators are essentially a police force—in fact, many board investigators are actually ex-police. The medical board process, like other legal processes, is slow. From the time of reporting a violation of a medical practice act to actual disciplinary action such as citation, fine, suspension or revocation can take years.

As an addiction professional there is nothing more bizarre and frustrating than to see a board pursuing an addicted physician. First there is a complaint, usually from a hospital or patient. The legal process of the board first www.counselormagazine.com

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OPINION involves a board investigator making a preliminary investigation to see if more in-depth investigations and interviews are needed. If so, the next step is usually to invite the physician for an informal interview. All this usually takes a few months, during which time the doctor may continue to use drugs or alcohol, except the doctor is now aware that the board is cognizant of the problem, which prompts the doctor to intensify his or her hiding. When the interview occurs, the doctor is essentially invited to come up with alternative explanations, which he or she will have had months to concoct. If the board decides to proceed, the investigators conduct interviews, gather data (such as DEA and pharmacy records) and eventually if there is enough evidence the physician is summoned for a formal hearing that resembles a trial. The physician usually brings his or her own attorney, one specializing in administrative law.

This “trial” can occur before the board itself or a proxy, such as an administrative law judge, usually hired by the board.

It’s obvious to any observer that this is not the best way to identify and obtain treatment for someone with an illness.

To rectify this bizarre situation, the concept of the physician health program (PHP) evolved over the past thirty years. The purpose of the PHP is to provide a “clinical arm” for the board. In its ideal form the PHP identifies physicians with addiction problems early, prior to overt impairment, and intervenes. Physicians are directed to proper evaluation and treatment and then, if they are deemed fit to return to practice, they are closely monitored for many years. The beauty of this approach is that it is not a legal, but a clinical process. If symptoms are identified, an intervention can be conducted and a thorough evaluation performed. There is no need for a police level investigation and there is no provision for “due process.” Thus, if physicians exhibit signs of addiction (e.g., showing up at work with alcohol on the breath), an intervention can be conducted immediately and the doctors can be asked to stop working and undergo prompt evaluation. The leverage to get physicians to cooperate is that if they fail to comply a report will then be sent to the medical board. Almost 100 percent of physicians comply because of the dread they appropriately have of dealing with the board.

The concept of the PHP is logical and effective; however, successful implementation has been mixed and continues to be controversial. The media sensationalize news of physician addiction and challenge the effectiveness of the medical boards. Questions continually arise, such as “Why is the addicted physician allowed to keep a medical license?” and “Shouldn’t patients have the right to know which doctors have an addiction history?” Organizations such as Public Citizen publicize the ranking of states regarding their per capita disciplinary actions. The assumption is that the boards with a higher disciplinary rate are doing a better job. Having an effective PHP decreases the number of disciplinary actions. This information is sent to state newspapers and leads to headlines, such as that in the MinnPost titled, “Minnesota ranked ‘worst in the country’ at disciplining physicians” (Perry, 2012).

Tension can then develop between the PHP and the 18

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medical board. Ambivalence regarding whether to treat or to punish addicted physicians varies year to year and state to state. The largest state for population of physicians, California, disbanded their PHP in 2008 following ongoing criticism regarding its effectiveness. Ironically, this has left the state of California now essentially prosecuting all addicted physicians and taking sometimes years to do so.

Sadly many physicians are prosecuted after they have been in good recovery for a year or more. So, states vary considerably regarding the way the PHP works in each with varying degrees of trust and functionality.

Points to Consider

• When working with addicted physicians it is important to investigate—in every state in which they are licensed—the status of the PHP regarding its functionality.

• All physicians will have to respond to license renewal questions. It’s important to help them decide how they will respond to questions such as, “Since your last license renewal have you undergone treatment for a substance use problem?” Failure to address this question in treatment can lead to the physician fraudulently answering the question, a far worse offense than being in recovery.

• Since physicians who are not involved with PHPs will eventually need to reveal their history of addiction, it is important that they be monitored in the interim with regular drug testing and other methods to document their recovery.

• When and how to advise a physician to self-report a history of addiction, which can often be the best tactic, must be carefully considered. Someone knowledgeable regarding the particular state medical board and PHP should be involved. c

Gregory E. Skipper, MD, FASAM, is head of the Alabama State Physician Health Program.

References

Flaherty, J. A., & Richman, J. A. (1993). Substance use and addiction among medical students, residents, and physicians.

Psychiatric Clinics of North America, 16(1), 189–95.

Perry, S. (2012). Minnesota ranked ‘worst in the country’ at disciplining doctors, Strib series recounts.

MinnPost. Retrieved from http://www.minnpost.com/second-opinion/2012/02/ minnesota-ranked-worst-country-disciplining-doctors-strib-series-recounts

FROM LEO’S DESK

Spirituality vs. Religious Extremism, Part II Rev. Leo Booth

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n my previous article I alluded to my book When God Becomes a Drug (1998), in which I placed religious extremism in the context of fanatical, addictive behavior. It was dangerous then, and with the rise of Al Qaeda and ISIS, it is far more dangerous now.

In the book I said, Religious addiction is built on absolute, unquestioning, uncritical acceptance of a set of teachings.

On this foundation abuses are committed in the name of God. The key ingredients are fear, shame, power, and control. No matter what the religion or belief system, fear and

shame are manipulated by those wanting power and control (Booth, 1998).

This is certainly true when we consider and analyze ISIS. It is a terrorist group that openly calls for violence, in the name of Islam, and seeks to justify its claims with sacred texts. This is theological terrorism; theological genocide. The victims include Muslims who do not agree with them, adulterers, homosexuals, and those who have rejected Islam.

What is happening today cannot be compared with the Christian crusades that happened in the 13th century. The

leaders of ISIS wish to take law and order back to the seventh century!

Consider the insanity of this proclamation. It is religious abuse and religious fanaticism (addiction) at its most extreme.

So what can be done?

I do not believe this ideology can be defeated on the battlefields of the Middle East. Only precise and interpretive theological education, alongside the battle of ideas, will defeat ISIS. A massive Islamic intervention is needed that challenges this toxic and destructive behavior and confronts the denial of the more moderate Muslims, who seem to be acting as if, over time, www.counselormagazine.com

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FROM LEO’S DESK this religious fanaticism will simply disappear.

In my earlier article I wrote about how Christianity, especially during the time of the crusades, had to experience a Reformation followed by an age of Enlightenment in order to move away from religious texts and teachings that promoted persecution, violence, and death. As President Obama said at the National Prayer Breakfast, “Remember that during the crusades and the inquisition people did terrible deeds in the name of Christ” (“Remarks by,” 2015).

Well, that was then. Such teachings and behaviors are no longer tolerated.

This same theological cleansing is now needed in Islam.

What Needs to Happen?

Firstly, the vast majority of Muslims throughout the world need to be involved in the battle of ideas to move the young and uneducated followers of ISIS away from toxic texts that only feed hate and persecution. The enlightened Mullahs who say publicly that they repudiate the insane and corrupt teachings of ISIS need to clearly explain why such teachings are anathema to Islam.

If ISIS is allowed to teach and preach

with only Western criticism, then we will be brushed aside as the protestations of “mere infidels.” This public repudiation needs to be done quickly, with a worldwide concerted effort—TV, newspapers, and informative videos.

Secondly, it is not enough to say that the Islamic religion has been “hijacked” by Muslim extremists. It’s not true that Islam has only peaceful, tolerant texts and teachings from the prophet Mohammed. As with Judaism and Christianity, which also has violent and death-threatening texts, a theological evolvement took place and such teachings are no longer emphasized or are placed in their historical context. Not everything that is written is true or acceptable. Islamic scholars need to clearly interpret, and in some cases repudiate, texts that encourage violence and persecution.

Muslims need to understand that the prophet Mohammed himself went through a process of change; from persecuting nonbelievers in his early mission in Mecca to political violence and death to the infidels in Medina.

The teachings of the Shahada that states “I witness that there is no God except Allah and that Muhammad is

a messenger of Allah” is dangerous if not interpreted. It cannot be as simple as “Submit or die!”

Lastly, as with the education of the public concerning alcoholism and other obsessive thinking, a similar process needs to take place with understanding religious extremism. Whenever religion seeks to limit or paralyze us, or is used to victimize and oppress others, then it is both dangerous and unhealthy.

It’s an aspect of addictive thinking and the “substance” being used is the concept of God.

Conclusion

We who write for and read Counselor magazine are familiar with compulsive and obsessive thinking that can often lead to violence and an excessive ego at the expense of others. But we have never allowed ourselves to become the prisoners of these problems; we always seek a healing solution. The “high” created by religious extremism appeals to the weak and uneducated—those who see themselves on the fringes of society with no hope for the future. This extremism thrives on victimhood. Fortunately this state of mind is not new to any of us and, as we have demonstrated with other addictions, we have the treatment, the solution, and the process for healing.

Let’s get the word out. c Leo Booth, a former Episcopal priest, is today a Unity minister. He is also a recovering alcoholic. For more information about Leo Booth and his speaking engagements, visit www. fatherleo.com or e-mail him at fatherleo@fatherleo.com. You can also connect with him on Facebook: Reverend Leo Booth.

References

Booth, L. (1998). When God becomes a drug: Understanding religious addiction and religious abuse. London: SCP Ltd. “Remarks by the president at the national prayer breakfast.” (2015). Retrieved from https://www. whitehouse.gov/the-press-office/2015/02/05/ remarks-president-national-prayer-breakfast

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