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CONTENTS
24 Healing the Invisible Wounds of Our Warriors: A Holistic, EvidenceBased Approach to Treating Combat Veterans
By Andrew Kessler, JD
8
NACOA
How Addiction Professionals and Prevention and Recovery Advocates Can Interface for Mutual Benefit
Presents information about the Strength in Support nonprofit, provides a background on issues experienced by combat veterans, and explains SIS’s three pillars of treatment.
By Sis Wenger
28 Ecotherapy: An Alternative Treatment Modality for Veterans By Miles Matise, PhD, NCC, LMHC, CAC-III, and Kate Price-Howard, PhD, CTRS Discusses various methods of ecotherapy treatment, provides research evidence to back its efficacy, and explains its benefits for veterans.
Cultural Trends
The Final Days of “The Rebel”
10
By Maxim W. Furek, MA, CADC, ICADC
Opinion
The Path Towards Successful Sobriety: Rethinking the Disease of Addiction
12
By Lilliam Rodriguez, PhD
From Leo’s Desk
What I Believe
14
By Rev. Leo Booth
Wellness
Cultivating the Quality of Contentment, Part II
Veterans and Insomnia: An Overview of Symptoms, Comorbidities, Treatment Approaches, and Access to Care Issues
6
CCAPP
National Legislative Update
By Jill Boultinghouse, MA, LMFT, and Evan Fewsmith, PsyD, LMFT
34
5
Letter from the Editor By Gary Seidler Consulting Executive Editor
16
By John Newport, PhD
The Integrative Piece Oftentimes We Teach What We Need to Learn
18
By Sheri Laine, LAc, Dipl. Ac
By Vishnupriya Samarendra, MD, and Adam D. Bramoweth, PhD Provides details about good and bad sleep, including diagnoses requirements for insomnia, and explains insomnia issues many veterans suffer from.
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3
CONTENTS Topics in Behavioral Health Care
Grief Has No Expiration Date, Part II: Coping with the Loss of Loved Ones to Addiction
19
By Dennis C. Daley, PhD
21
Counselor Concerns
Initial Engagement, Retention, and Continuation in Treatment
By Gerald Shulman, MA, MAC, FACATA
Ask the LifeQuake Doctor
23
By Toni Galardi, PhD
Inside Books
Weed, Inc.
41 An Overview of Challenges Facing the Addiction Field, As Told By Pioneers By Andrea G. Barthwell, MD, DFASAM, & Megan Crants, BA Presents a discussion of issues such as standardization of care, physician health programs, urine drug testing, and discrimination through interviews with pioneers in the field of addiction.
64
Increasing Use of Smoking Cessation Services among Women in Residential Addiction Treatment
Also in this issue: Ad Index CE Quiz
46
From the Journal of Substance Abuse Treatment
By Ben Cort Reviewed by Leah Honarbakhsh
59 62
By Joseph Guydish, PhD, Valerie A. Gruber, PhD, MPH, Thao Le, MPH, Shaina Zura, LCSW, Noah Gubner, PhD, and Janice Tsoh, PhD Describes a study involving a three-session smoking cessation group.
52 A Test to Differentiate Between Organic Brain Disorder, Nonorganic Brain Disorder, and Schizophrenia, Part I By Norman E. Hoffman, PhD, EdD, LMHC, LMFT, & Wendy L. Rippon, MS Presents a variety of different tests and scoring methods to determine the differences between brain disorders, and provides a literature review.
4
Counselor | October 2017
Special Series on Mental Health
LETTER FROM THE EDITOR
Stigma: From Addiction to Treatment
T
he news headlines continue unabated: unscrupulous addiction treatment facilities are uncovered; criminal charges are piling-up against individuals preying on vulnerable and at-risk individuals. Noteworthy in the discussion over corruption in the industry is a whitepaper—provided by Dreamscape Marketing— describing a shift of the “stigma” of addiction from “disease” to “treatment.” The whitepaper opens the discussion this way: The stigma around addiction treatment certainly has its roots in the stigma associated with addiction itself. People often don’t want others to know they’re addicted or that they have a family member struggling with addiction. Accompanying that thought, in most cases families and individuals also don’t want anyone to know that they had to seek treatment for it. The shame of addiction is a very real part of the disease and keeps too many people from seeking treatment sooner. This shame has, in recent times, been transferred to the treatment of the disease of addiction as well. Addiction treatment stigma, separate from the stigma surrounding addiction itself, is shaped by a number of factors. It would be appropriate for drug rehab centers to consider the following in order to communicate more effectively with potential patients and help create the best possible public perception of addiction treatmen t ser vices (Dreamscape Marketing, 2017). While there can be no question that the majority of treatment centers are operated by honorable individuals with integrity, there is also no doubt that some centers focus more on profit than on patient care by engaging in practices like patient brokering, unnecessary urine testing, and false digital advertising. The whitepaper concludes, Those who work in the drug rehab industry are acutely aware of the stigma around the disease of addiction. However, the stigma around addiction treatment itself must also be recognized
and addressed in marketing, admissions, operations, and clinical care. A shift to long-term operational considerations over short-term revenue must become a norm in order to fight this stigma and consumer doubts. Much like other medical care industries, if a standard is not adopted for clinical care and outcomes monitoring, regulation will follow stigma. The public is aware that there is not a universal cure for addiction, but they do want to see improved circumstances and long-term support for their loved ones as with the treatment of any medical condition. Without question, the greatest strength that drug rehab centers can have is to be perceived by the public as having integrity and possessing the ability to achieve positive results. Anything that interferes with these two perceptions must be eliminated to fight the stigma of addiction treatment (Dreamscape Marketing, 2017). In another key development, the National Association of Addiction Treatment Providers (NAATP) announced an initiative to address problematic business practices in the addiction treatment field. The guidebook will identify business practices that are inappropriate and also define those which are best practices. NAATP Director Marvin Ventrell says,
This is no small matter or undertaking. While the best providers operate by values and guidelines, the field as a whole lacks the necessary operational practice standards that are the hallmark of professional service industries. As our field has evolved, and more recently been infiltrated by unscrupulous profiteers, it is necessary for valuesbased and evidence-based providers to come together, reach consensus on practice standards, and separate the good from the bad (NAATP, 2017). Much needed, and the sooner the better. c
Gary Seidler
Consulting Executive Editor Counselor, The Magazine for Addiction & Behavioral Health Professionals, A Health Communications, Inc. Publication References Dreamscape Marketing. (2017). From disease to treatment: The shift of the stigma in addiction. Columbia, MD: Author. National Association of Addiction Treatment Providers (NAATP). (2017). NAATP to produce addiction treatment provider guidebook. Retrieved from https://www.naatp. org/resources/news/naatp-produce-addiction-treatment-provider-guidebook/aug-2-2017
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5
CCAPP
National Legislative Update Andrew Kessler, JD
O
n March 22, 2017, a Capitol Hill forum addressed the issue of recovery housing. Sponsored in part by CCAPP and hosted by Unite to Face Addiction, leaders from the community presented compelling evidence as to why Congress should pay attention to this important component of recovery. Several members of Congress spoke at the event, including the cosponsors of the landmark CARA legislation, Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) as well as Representative Brett Tonko (D-NY), who is cochair of the House Addiction and Recovery Caucus. Recovery housing has never received much attention on Capitol Hill, let alone been the subject of legislation. Yet with the industry growing, coupled with recent reports of criminal activity on behalf of those charged with the care of people in recovery, lawmakers are beginning to take interest.
Representative Darrell Issa (R-CA) once again introduced legislation that seeks to interfere with the growth and progress of sober living facilities. He introduced HR 472, the Safe Recovery and Community Empowerment Act (2016), late in the 114th Congress, where it died in committee. This bill seeks to amend the Fair Housing Act, to provide that nothing in federal law may prohibit a local, state or federal government body from “requiring a reasonable minimum distance between residential recovery facilities within a particular area zoned for residential housing, if such requirement is necessary to preserve the residential
It remains to be seen how long the issue of sober living can hold the interest of Congress. Most of the action taken to date by congress has been reactive, not proactive. character of the area” (Safe Recovery and Community Empowerment Act, 2016). It also requires that “such a facility obtain an operating license or
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use permit or satisfy a set of consumer protection standards, which may include a maximum capacity requirement” (Safe Recovery and Community Empowerment Act, 2016). A residential recovery facility is defined as “a residence that provides housing to individuals in recovery from drug or alcohol addiction with the promise of providing a clean and sober environment in return for direct or indirect payment to an owner, operator, or compensated staff person” (Safe Recovery and Community Empowerment Act, 2016). It goes on to declare that Facilities receiving payments from a federal health care program, or via private insurance purchased on a federal exchange or federally subsidized, for either housing, recovery services or testing or monitoring for drugs or alcohol must ensure that residents: (1) are provided a safe living environment completely free from illicit drugs, alcohol, firearms, harassment, abuse or harm and (2) live in a licensed or registered residence that has committed to following standards approved by states and localities (Safe Recovery and Community Empowerment Act, 2016). The language of the bill is quite vague, not defining “minimum distance” or “necessary to preserve the residential character of an area.” It also does not mention how purchasing “private insurance” is to be achieved. Continued on page 15
6
Counselor | October 2017
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NACOA
How Addiction Professionals and Prevention and Recovery Advocates Can Interface for Mutual Benefit Sis Wenger
M
utuality of need can bring positive collaboration and mutual benefits. The National Council on Alcoholism and Drug Dependence (NCADD) and the National Association for Children of Addiction (NACoA) have collectively about 120 affiliate organizations in the United States filled with intelligent, committed volunteers who supplement and support the work of professional staff. Many have been personally touched by or have found recovery from addiction or from the pain and losses experienced from parental addiction, and wish to help others find that recovery. Services provided by NCADD and NACoA affiliates vary widely, but include the following: n Early intervention and prevention programs for other nonprofit community organizations n Assessments and referrals to treatment n Prevention education services for staff and students in local school systems, often including staffing educational support groups as part of a student assistance program n Professional workshops that offer needed continuing education for many of the community’s clinicians All affiliates have volunteer boards of directors and office volunteers. Some have skilled presenters able to speak on a broad range of topics, who offer their training services as a way to give back or as a way to develop a wider range of clients for their own agency—both valid reasons for their volunteer services. Such relationships can be a win-win for the affiliate agency and for the professionals looking to broaden their reach into the community or simply willing to help make a difference on the seemingly intractable problem of substance use disorders (SUDs).
Recovery Community Organizations (RCOs)
Additionally, the powerful recovery movement, which has been building over the last decade, is resulting in an ever-increasing 8
Counselor | October 2017
number of recovery community organizations (RCOs), many of which are members of the Association of Recovery Community Organizations (ARCO) at Faces and Voices of Recovery. These are staffed mostly by deeply caring volunteers who share their own recovery stories and offer hope to all those who walk through the center’s doors. These rapidly growing support centers offer free help to struggling addicted people seeking support for a path to recovery. They also offer education and support for families, who find in these centers a hopeful and safe environment where they can explore, learn, and begin to heal. The support and sense of emotional safety found at a RCO positively reinforce lessons from counseling and treatment, and complement the guidance of Twelve Step sponsors during the risky periods of early recovery. Additionally, RCOs bring newly recovering individuals and families in contact with those who have been through the struggle, are now enjoying healthy and productive lives, and are ready to give back. Such new contacts offer hope and often turn into meaningful relationships for the whole family. NCADD, NACoA affiliates, and RCOs have agency staff and volunteers who could benefit from the knowledge and wisdom that experienced addiction professionals have to offer—as board members, volunteer educators, and reinforcements to those doing the heavy lifting advocating for prevention, treatment, and recovery supports in state legislatures and in county health departments. The personal benefits of doing meaningful service and advocacy work in an area about which we feel passionate are immeasurable and can often strengthen professional skills and insights as well. These remarkable, community-based centers are 501(c) (3) organizations that help to ensure that they stay true to their missions and can sustain themselves over time. They play an important role in facilitating prevention programs to reach vulnerable youth, offering them healthy and safe ways to grow up and prosper, even if their parents do not recover. They have been among the strongest advocates in the country’s state legislatures for policies that have created and sustained the establishment of recovery-oriented systems of care in their states, helping decision makers to understand that the goal is recovery and that treatment is a critical component in meeting that goal, but not the endgame.
NACOA RCOs and Legislation
Legislators and other decision makers are learning that recovery does not happen as a result of treatment alone or solely through faithful adherence to a Twelve Step program; it is a long, multidimensional healing process that needs the involvement of recovery support mechanisms, of which treatment—outpatient or inpatient—is a critical component. At the federal level in the past year, Congress passed the Comprehensive Addiction Recovery Act (CARA), which is the most critical piece of legislation in support of prevention, treatment, and recovery in several decades. It was the grassroots support across the country that stepped up to advocate for this logical and forward-thinking legislation to secure a full and balanced continuum of support over time, from prevention through to treatment and recovery. While there is still much to do, the action of such groups as the NCADD and NACoA affiliates and the RCOs organized under Faces and Voice of Recovery contributed greatly to the education of members that resulted in the bipartisan passage of CARA. Each of these community-serving organizations provides clinicians with an opportunity to be part of their work, whether as program leaders, presenters at seminars, advocates when education of legislators becomes critical or volunteers to help with calls on a helpline. At the same time, being a part of such an organization—one that is focused on ensuring that adequate and effective programs are developed and implemented for the good of individuals and families hurt by SUDs—can give added meaning to the therapeutic work of good clinicians and can offer insights into the policy world that often elude them, and yet profoundly impact their professional lives as well as the lives of most clients. There are a myriad of opportunities, from the boardroom to the receptionist desk, where a meaningful difference can be made by addiction counselors whose involvement can broaden the view of an entire staff and enrich their own lives by participating in the valuable work of a local community service organization. NCADD and NACoA affiliate organizations are frequently where both clinicians
seeking continuing education credits and updated information and people in recovery or living with those who need recovery will come for professional seminars. These workshops benefit both professionals and the community interested in expanding their understanding of addiction and its life-altering and lifethreatening effects on addicted people and their family members. The current climate focused on the serious addiction epidemic gripping so much of the country is causing more and more people to seek information and understanding. When clinicians and community members learn together, they gain additional insights into how addiction affects people and gain a deeper understanding of its complexity—another win-win. An opportunity to test this idea came with Recovery Month this September.
National Recovery Month: A Win-Win Opportunity
Recovery Month is celebrated across the country every September, honoring the millions of people who have conquered their SUDs and are living productive, contributing lives. It also honors the countless professionals who have carefully guided so many on their path to recovery. In recent years, Recovery Month has begun to broaden its focus to include the needs of the affected family members for their own recovery, paving the way for acknowledgement of the value to each
member when whole family recovery is made available to them. In 2016 the Recovery Month theme was “Join the Voices for Recovery: Our Families, Our Stories, Our Recovery!” This year it was “Join the Voices for Recovery: Strengthen Families and Communities.” The current theme highlighted the value of family and community support throughout the recovery journey and invited individuals in recovery and their family members to share personal stories and successes in order to encourage others to face the pain and losses suffered from addiction in the family and to begin to heal. Recovery Month offered multiple ways for SUD therapists to partner with and support the work of those providing complementary prevention and recovery advocacy support services for the betterment of the community and its families. Offering to participate in your community’s grassroots education and advocacy efforts by partnering on Recovery Month projects feels like a win-win for all. You can visit www.recoverymonth.gov to find all the tools needed for a broad variety of activities to honor Recovery Month and the millions of Americans celebrating their own recovery and that of their family members. c About the Author Sis Wenger is NACoA’s president and CEO.
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9
CULTURAL TRENDS
The Final Days of “The Rebel” Maxim W. Furek, MA, CADC, ICADC
O
n February 6, 1968, actor Nick Adams was found dead in his Coldwater Canyon home in Los Angeles, California. He had hitchhiked to Hollywood, boasting, “Some men bet on horses or dogs. I gambled on myself” (Donnelley, 2003). Adams was thirty-six years old at the time of his mysterious death.
Nick Adams as Johnny Yuma
His obituary, published in Variety, read, Death was attributed to an overdose of a drug used to treat nervous disorders and alcoholism, an autopsy established. “Immediate cause” of death, according to Dr. J. Wallace Graham, deputy county medical examiner, was “paraldehyde intoxication.” Drug was swallowed by Adams in liquid form. Coroner’s office reported no alcohol was found in actor’s bloodstream (“Nick Adams,” 1968). It was estimated that Adams “. . . had been dead an estimated twenty-four to thirty-six hours when found” (Fraiser, 2005). Crime Magazine writer Peter L. Winkler disclosed, His body, fully clothed, was found in a sitting position beside his bed by his attorney, Ervin “Tip” Roeder. There was no indication as to the cause of death. No weapons or sleeping pills were found. Adams’s lawyer told Det. Verne Jones he arrived at the $54,000, Cape-Cod-style home bordering Beverly Hills about 8 PM. When no one answered the doorbell, Roeder crawled through a window and discovered the body (2009). In the aftermath of his death, there remained many unanswered questions. Adams had reportedly taken an overdose of paraldehyde, a sleep-inducing drug that was once popular as a sedative. A second tranquilizer—promazine—was also found in the body. Paraldehyde was a drug commonly used to induce sleep in sufferers from alcohol withdrawal or delirium tremens (Winkler, 2009; “ ‘Rebel’ actor,” 2011). Pharmacologist Ken Dickinson immediately detected a recognizable pattern of abuse. He said, One could say paraldehyde is the granddaddy of propofol, a drug that many are currently familiar with when it comes to fatal overdoses and similar pharmaco-dynamics. Both have a small window between the therapeutic dose and the fatal dose. . . . Paraldehyde took the life of Nick Adams in a similar manner as propofol took the life of Michael Jackson fifty years later, most probably an accidental overdose with a highly toxic substance (personal communication, May 17, 2017). According to the blog “RIP Los Angeles,” During the autopsy, Dr. Thomas Noguchi found enough paraldehyde, sedatives, and other drugs in the body “to cause instant unconsciousness.” The death certificate lists 10
Counselor | October 2017
“paraldehyde and promazine intoxication” as the immediate cause of death along with the notation “accident; suicide; undetermined.” During the 1960s, drug interaction warnings were not so prominent as they later would be, and the American Medical Association (AMA) has subsequently warned these two types of drugs should never be taken together (“ ‘Rebel’ actor,” 2011). Promazine (sparine) is an older medication used to treat schizophrenia. Promazine has been described in medical literature as “an antipsychotic drug of low potency used in the treatment of disorganized and psychotic thinking. Also used to help treat false perceptions (e.g., hallucinations or delusions) with fewer movement side effects” (“Promazine,” 2015). Allyson Adams attempted to explain her father’s struggle with alcohol: My father was trying to stop drinking. The divorce [from actress Carol Nugent] and his career were very stressful. My father was someone who couldn’t drink, meaning he would have a few on an empty stomach and pass out. His drugs of choice were diet pills, and then I think he needed something
CULTURAL TRENDS to bring him down. He had a problem with his weight, being so short and all. He had a brother, Andrew Adamshock, a surgeon, who prescribed him drugs (personal communication, December 30, 2016).
Hollywood Renegade
Adams lived a fast life filled with struggle and hardship. Born Nicholas Aloysius Adamshock in Nanticoke, Pennsylvania, he hitchhiked to Hollywood in 1950 seeking a film career. He won a small part in Mister Roberts and as Andy Griffith’s sidekick in No Time for Sergeants (Winkler, 2009). Adams was known as a Hollywood renegade, especially after his talk show appearances. Many found him arrogant and rude. Adams associated with promising actors including Robert Conrad, James Dean, Elvis Presley, Robert Wagner, and Natalie Wood (Donnelley, 2010). In 1955, Adams attracted attention for his performance in Rebel without a Cause, director Nicholas Ray’s groundbreaking attempt to portray the moral decay of American youth. As a member of Hollywood’s “brat pack” (i.e., delinquents breaking rules at every turn), Adams was teamed up with cast members James Dean, Dennis Hopper, and Sal Mineo. Writing for The Orlando Sentinel, Crosby Day observed, “In retrospect, Rebel without a Cause had an aura of doom. Three other cast members died unnatural deaths” (2000). An obscure fact is that Adams had a close relationship with both James Dean and Elvis Presley. Dean and Adams were roommates. Dean, “the first rebel,” became the persona of the fifties’ Beat Generation, with Elvis claiming that throne after Dean’s death (Furek, 1989). James Dean became one of society’s first teen icons. Dead at age twentyfour, his legend grew larger and forever frozen in time—young, vulnerable, and filled with promise. After Dean’s death in 1955, Adams received countless requests for articles of clothing that Dean had worn, and for strips of wallpaper that he had touched.
ran successfully from October 4, 1959 until September 24, 1961 (Winkler, 2009; IMDB, 2017). The show was set in the post-Civil-War west and featured the exploits of an embittered young Confederate soldier who searched the west seeking self-identity. The short-lived Saints and Sinners followed, but without The Rebel’s popularity or success. Adams was nominated for an Academy Award in 1963 for Best Supporting Actor for his role in Twilight of Honor with Richard Chamberlain and Joey Heatherton (Winkler, 2009). He appeared in around thirty films, including Picnic, Pillow Talk, Young Dillinger, Our Miss Brooks, Strange Lady in Town, The FBI Story, and Fury at Showdown. His final motion picture was 1967’s Fever Heat. It was released on May 10, 1968, after his death, although it was shot the previous year. Today Fever Heat is an obscure piece of cinematic artwork, much like the life and times of Nick Adams. Although his personal life and movie career were languishing, we can only speculate on the reason for Adams’s overdose death. Allyson Adams believes her father’s death was suspicious: “Yes, I believe his death was made to look like a suicide. I don’t believe Tip Roeder’s [Attorney Ervin Roeder] alibi or how he found my dad” (personal communication, December 30, 2016). Nick Adams will always be remembered for his role in The Rebel, but his
most successful role may have been the “bad boy” image created by his Hollywood agents. Adams’s death also serves as a cautionary tale about the dangers of misusing potent medications, an unfortunate saga that never seems to go away. 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 Day, C. (2000). James Dean: Forever young, forever cool. The Orlando Sentinel. Retrieved from http://articles.orlandosentinel.com/2000-09-19/lifestyle/ 0009190018_1_james-dean-fairmount-dean-attended Donnelley, P. (2010). Fade to black: A book of movie obituaries (3rd ed.). London, UK: Omnibus Press. Frasier, D. K. (2005). Suicide in the entertainment industry: An encyclopedia of 840 twentieth-century cases. Jefferson, NC: McFarland. Furek, M. W. (1989). Adams rests in Berwick cemetery. Wilkes-Barre Sunday Independent. Internet Movie Database (IMDB). (2017). The Rebel. Retrieved from http://www.imdb.com/title/tt0052505/ “Nick Adams: Obituary.” (1968). Variety. “Promazine (sparine) data sheet.” (2015). Retrieved from http://www.psyweb.com/drughtm/jsp/sparine.jsp “ ‘Rebel’ actor Nick Adams found dead in Coldwater Canyon home 1968.” (2011). Retrieved from http://riplosangles.blogspot.com/2011/02/actor-nick-adamsfound-dead-in.html Winkler, P. L. (2009). Nick Adams: His Hollywood life and death. Retrieved from http://www.crimemagazine. com/nick-adams-his-hollywood-life-and-death
Johnny Yuma, “The Rebel”
The most important role that Nick Adams played was as Johnny Yuma. The Rebel was an ABC TV series that www.counselormagazine.com
11
OPINION
The Path Towards Successful Sobriety: Rethinking the Disease of Addiction Lilliam Rodriguez, PhD
F
or individuals struggling with addiction, their fami- well-being—anxiety, poor eating habits, depression, and others—then the only things being treated are the symptoms lies that are affected, and the doctors and thera- of addiction, not the disease itself. Critical criteria involved pists looking to treat this disease, it can be discourag- in treating other mental and medical diseases, such as hoing when a recovering addict relapses or struggles to listic approaches addressing the mind, body, and spirit, are lacking in today’s existing addiction treatment programs. maintain sobriety. In fact, 90 percent of alcoholics will experience one or more relapses during their first four Addiction is a Chronic Illness This is a tough concept to grasp for those who truly want to years of treatment, according to the National Institute get better or help their loved ones get better. However, in order on Alcohol Abuse and Alcoholism (2000). These sta- to move the addiction recovery movement forward, individuals, tistics are far from where they should be today. Of families, doctors, and therapists must accept that addiction course, finding the right treatment plan will always be recovery is a lifelong journey with trial-and-error processes. The goal of a basic diabetes treatment plan is to control a trial-and-error process, but how are doctors and blood sugar and glucose levels so as to prevent complications. therapists so clearly missing the mark? The disease really never goes away, it is simply maintained. The typical forty-five-day treatment plans that exist today follow the kind of thinking that once individuals become “clean,” then they are essentially “recovered” from addiction. Most doctors will note addicts are “clean” once they have successfully remained drug free for a certain amount of time, completed a type of Twelve Step program, and continuously attended community therapy. Yet, addiction is not a curable disease or an acute disorder treated in a single episode. This is where doctors and therapists are missing the mark. Addiction is a chronic illness of the brain that requires long-term care. People with addiction disorders will always have to protect and address their recovery, no matter how long they have remained sober. In order to improve the success rate of today’s addiction treatment programs and put people with addictions on the path towards successful sobriety, we must rethink the disease of addiction as a whole, restructure our approach to treating addiction, and reeducate society around this newfound understanding.
Redefining Addiction
In order for doctors, facility managers, and therapists to successfully treat addiction, they must first adopt its true medical definition. The American Society of Addiction Medicine defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry” (2011). When we adopt this definition, there are two areas that must be incorporated into today’s current understanding of addiction: addiction as a brain disease and addiction as a chronic illness.
Addiction is a Disease of the Brain
The brain is the organ that affects our physical and emotional well-being. As such, when addiction treatments fail to address the things in life that impact physical and emotional 12
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In the same way, the ultimate goal of all addiction treatment plans are to keep individuals from using and abusing drugs and alcohol. Yet, the actual disease will not disappear, and individuals will consistently address the disease their entire lives in order to manage it. If diabetics are considered “cured” after they’ve managed to keep their blood sugar low for a certain amount of time, does that mean they should stop taking medication and end treatments created to improve their health? Those dealing with an addiction will always have the addiction and need long-term care to keep it under control, not for just forty-five days or a few months.
Restructuring Research, Education, and Treatment
Redefining addiction as a chronic illness is the first step towards providing more successful treatment options, but it is not enough to simply understand that addiction needs long-term care. The medical field, doctors, therapists, and the insurance sector must restructure how they conduct research, provide coverage, and offer treatment to those living with this illness. The sad truth is that there is limited research and few programs that focus solely on today’s definition of addiction as a chronic illness. According to the Treatment Research Institute, less than 10 percent of medical schools in the US offer addiction courses (Cornish, 2016). This means very few are certified in modern addiction treatment practices. As we look to restructure our approach towards addiction, we must also not overlook the need to offer better treatment options than what is currently available. Most rehabilitation facilities today are run by recovering addicts who lack the proper training and expertise, implementing processes that are based on what they “feel” will help treat addiction instead of offering treatment programs backed by evidence.
OPINION simply unable maintain sobriety. Parents blame themselves, siblings blame one another or their parents, and the entire family dynamic is easily torn apart. As families begin to understand and accept that addiction is a chronic illness requiring long-term care, loved ones will have a greater understanding of the disease and can provide better support for the right kind of care.
The Way Forward
Group therapy and Twelve Step meetings are recommended as long-term solutions, yet neither of these options address the addiction symptoms of the brain. Treatment such as medication-assisted treatment (MAT), therapy that addresses co-occurring disorders, relapse prevention programs, yoga, equine and arts therapy, nutrition plans, and programs that address core issues must be incorporated into traditional rehabilitation programs to ensure long-term sobriety for clients.
Reeducating Society
Restructuring the education sector, existing rehabilitation programs, and postrehab therapy with treatments that offer long-term support for addicts is key to improving success rates. Yet, we must also look to reeducate society—our family members and friends—that addiction does not have a cure and is a lifelong journey for those who are diagnosed. Most individuals today look at addiction as a moral defect or criminal problem, and rightly so. When people are abusing drugs, they lie, steal, and promise they will do things they end up not doing. In fact, for hundreds of years, society understood addiction as a character disorder or flaw. A few misconceptions of addiction that exist today include: n “Only bad people use drugs.” n “If someone wanted to stop using drugs, they could.”
n “Individuals who use drugs use them because they do not know any better.” n “Addicts who are ‘clean’ and relapse do so because they really did not want to get ‘clean’ in the first place.” n “People who cannot stop using drugs just do not have enough willpower.” These common misconceptions play a major role in why addicts struggle to maintain sobriety or are afraid to speak up about their addiction to friends and family. One would never suggest that individuals struggling with diabetes should just lower their blood sugar, because “What’s wrong with you?” One would never assign blame to bad choices for someone diagnosed with arthritis. Yet, mainstream society believes that addiction is a choice and addicts can simply “just stop” using after detox. In order to create a supportive and encouraging community for those struggling with addiction, treatment centers, doctors, and the Al-Anon and Twelve Step program community must create greater awareness around the true definition of addiction. Helping society understand that addiction is a chronic illness will also improve family dynamics among those affected by addiction. It can be mentally, physically, and emotionally exhausting to support family members who are in and out of rehab, relapsing multiple times, and
Without question, what has been done in the past to treat addiction is lacking successful results. Doctors, therapists, case managers, and loved ones view addiction either as a moral defect or an acute illness with a cure, which is why current treatment programs have low success rates. In order to provide more effective treatment options and improve addiction as a whole, we must adopt the medical definition that addiction is a chronic mental illness that requires lifelong treatment. We must conduct more medical research around addiction as a chronic illness and restructure rehabilitation treatment programs and postrehab therapy around this understanding. The addiction recovery community and treatment centers must also help educate society that addiction is a lifelong journey. Then and only then, can we put individuals on the path towards a more successful life of sobriety. c About the Author Lilliam Rodriguez, PhD, is the clinical director at Holistic Recovery Centers in Miami, Florida. Dr. Rodriguez received a bachelor’s degree in psychology from the University of Puerto Rico and master’s and doctoral degrees in clinical psychology from the Carlos Albizu University. Dr. Rodriguez has proven success working with substance abuse, family dysfunction, co-occurring disorders, and trauma. Additionally, Dr. Rodriguez has taught undergraduate courses as adjunct faculty and conducted psychological evaluations in private practice. She is fluent in Spanish and English.
References American Society of Addiction Medicine (ASAM). Definition of addiction. Retrieved from https://www. asam.org/quality-practice/definition-of-addiction Cornish, A. (2016). Treating addiction as a chronic disease. Retrieved from http://www.npr.org/sections/ health-shots/2016/02/25/468085130/ treating-addiction-as-a-chronic-disease National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2000). Relapse and craving. Alcohol Alert. Retrieved from https://pubs.niaaa.nih.gov/publications/aa06.htm
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FROM LEO’S DESK
What I Believe Rev. Leo Booth
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ccasionally I get asked the question, “Leo, what do you believe?” If these people had read Counselor magazine the past few months, they’d know what I believe. In February of this year, I wrote concerning God’s grace: What if grace isn’t 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, and our ability to take responsibility for our lives and what’s 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 sober. They begin to clear the wreckage of their past and embrace a spirituality that’s 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 it’s knowing and massaging a gift that has been given to every human being. This understanding of grace makes more sense to me (2017a, p. 19).
Now it needs to be said clearly that what we believe is always evolving. What we believe today we may not believe tomorrow. Most of us, as we grow older, find that our understanding of God and how God relates to us in the world changes—rarely do we stay with the same beliefs we had as children. I also made a plea for religious agnosticism in the April issue of Counselor. To say that we do not know absolutely concerning our understanding of God seems most reasonable, especially when we observe the myriad of beliefs concerning God: I’ve been coming to the conclusion for many years that when we speak about God, His will for us or what He wants, we are invariably agnostic—“gnostic” means to know; “agnostic” means to not really know. Now, it’s important for me to stress that this is my opinion and probably the opinion of many other people who wouldn’t claim the title “atheist,” but they are consciously aware that when it comes to issues concerning God they don’t “know.” They have ideas, opinions, beliefs, insights, but they wouldn’t want to swear 14
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on the Bible that they actually know. Indeed, because I’m not a fundamentalist, I hold the view that what’s written in the Bible is a collection of ideas and opinions written by people at different times in history. It’s important to note that Jesus didn’t write a gospel; Matthew, Mark, Luke, and John wrote a biography of his life. And I’m agnostic about whether they actually quoted him correctly or wrote exactly about the events that took place (2017b, p. 18). I continued this challenging article with the following: I resist the idea that people know, actually know, what God wants from us or His will for us other than in the most general way: God wants us to be loving and kind. People have ideas about God, fine. People have opinions about how to live the spiritual life, fine. People have insights into the life of Jesus or other holy men and women, fine. But when they say that they “know,” I want to run for the hills. I particularly want to run for the hills when they say that they “know” what God wants for and from me (2017b, p. 19). The truth, for me, is that I’ve moved away from religious dogmas or teachings to more spiritual values. And the spiritual philosophies I’ve adopted to date are based upon the teachings of a man called Pelagius. This was the basis of my book The Happy Heretic (2012), in which I introduced Pelagius to readers in the following way: Let’s take a moment to look at what is known about Pelagius. He was born around 354 AD in Wales, Britain. He was educated in both Greek and Latin, a monk but not a cleric; he was never an ordained priest. In his early years, he was admired by no less a person than Augustine of Hippo, who called him “a saintly man.” When he moved to Rome, he became concerned about the moral laxity in the city, believing it was partly the result of Augustine’s teachings concerning divine grace. Pelagius was concerned about the emphasis that Augustine placed upon God’s grace—the idea that since the Fall of Adam, every good thought or action was dependent upon God. We could do nothing on our own. There was no teaching that affirmed the need for our response. There was little teaching concerning human responsibility; that we need to be accountable for our behavior. He was particularly disturbed by a famous quotation from Augustine, “Give me what you command and command what you will.” Pelagius believed that this saying discounted free will, turning man into a mere automation. He soon became a critic of Augustine, disagreeing with him concerning original sin and the working of God’s grace in perfecting salvation.
FROM LEO’S DESK Pelagius argued that if human beings could discipline themselves in the way exemplified by Jesus, then they could remain perfect. He believed that grace needed to be connected with human choice. Pelagius’s personal discipline made him extremely puritanical, teaching a strict regimen to his disciples in order to ensure moral purity (2012, p. 7–8). Simply put, I believe that God created us to create. Prayer should be a celebration of this divine gift. Again, I wrote in detail about this in Counselor magazine last year: For many years I’ve wrestled with the question: Does prayer work? As we’ve seen in this article, I’m uncomfortable with the traditional approach to prayer. Indeed, I think it makes no sense. However, I believe there’s another understanding of prayer that makes more sense. If the Kingdom of God (metaphorically speaking) is within, so is the window of prayer. When I pray, and I’m certainly not suggesting that God doesn’t hear my prayers, the essential ingredient is that I hear my prayers and focus on the action needed to make things happen. For example, if I’m praying for a good job, then I need to search out the necessary qualifications required . . . and fill in the application form! (2016, p. 19). So in the future when a person asks me, “Leo, what do you believe?” I’ll give them a copy of this article. Of course, when this article is published, I may have changed my thinking again! 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. (2012). The happy heretic: Seven spiritual insights for healing religious codependency. Deerfield Beach, FL: Health Communications, Inc. Booth, L. (2017a). God’s grace: What is it? Counselor, 18(1), 18–9. Booth, L. (2017b). What is religious agnosticism? Counselor, 18(2), 18–9. Booth, L. (2016). Prayer: What is it? Counselor, 17(6), 18–9.
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Rep. Issa drafted the bill after residents in his district demanded he act on the issue at a forum in his district last fall (Ritchie, 2016). The bill in its current form faces an uphill climb. Not only are several organizations representing the recovery community opposed to it, but in addition, an attempted amendment to the Fair Housing Act is almost certain to be met with fierce resistance. The Senate has not introduced any similar legislation, and is taking what appears to be a more measured approach. In June of 2016, Senators Marco Rubio (RFL), Elizabeth Warren (D-MA), and Orrin Hatch (R-UT) wrote a letter to the Government Accountability Office (GAO) asking them to conduct a review of federal and state oversight of sober living homes. Specifically, the Senators had four questions for GAO: 1. “How many sober living homes are there in the United States? How many individuals do they serve and what are the characteristics of this population?” 2. “How are sober living homes regulated at the federal, state, and local level? 3. “What is the range of services offered by sober living homes? Are sober living homes being used to expand the available resources to support recovery from substance use disorder? What is known about the effectiveness of services offered through sober living homes?” 4. “How do sober living homes and their patients interact with Medicaid and other federally funded health care programs? What impact does this have on Medicaid costs and on the effectiveness of Medicaid-funded drug and alcohol-abuse treatment programs?” The senators’ letter states,
Sober living homes can be an effective recovery service for those suffering from substance use disorder, but little is known about how this cottage industry functions overall. Additional information about the sober living homes will help us to provide proper oversight to ensure that individuals with substance abuse disorders are receiving the care they need (Warren, Hatch, & Rubio, 2016). Senator Rubio’s interest stems from incidents in South Florida, where in late 2016 six people were charged with fraud after allowing residents in sober living houses to use drugs, in addition to committing insurance fraud (Clary & Swisher, 2016). It remains to be seen how long the issue of sober living can hold the interest of Congress. Most of the action taken to date by congress has been reactive, not proactive. The federal government can have an impact on recovery residences via encouragement of best practices and continued research. Federal regulations, however, appear to be a very long way off. c About the Author Andrew Kessler, JD, is founder and principal of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy and federal policy liaison for IC&RC.
References Clary, M., & Swisher, S. (2016). Feds charge six in South Florida sober home fraud scheme. The Sun Sentinel. Retrieved from http://www.sun-sentinel. com/local/palm-beach/fl-fbi-sober-home-arrests20161221-story.html Ritchie, E. I. (2016). Sober-living homes forum attracts three hundred in San Clemente. The Orange County Register. Retrieved from http://www. ocregister.com/2016/09/03/sober-living-homes-forum-attracts-300in-san-clemente/ Safe Recovery and Community Empowerment Act, HR 472, 114th Cong. (2016). Warren, E., Hatch, O., & Rubio, M. (2016). Letter to Mr. Gene L. Dodaro, comptroller general of the United States. Retrieved from https://www.warren.senate. gov/files/documents/2016-6-2_Letter_to_GAO_on_ sober_living_homes.pdf
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WELLNESS
Cultivating the Quality of Contentment, Part II John Newport, PhD
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his is the second and final installment in a series focusing on cultivating the quality of deep-seated contentment, which constitutes an integral component in enhancing our recovery from alcoholism, drug addiction, other addictive disorders. This installment focuses on practical steps we can take to manifest the qualities of contentment and equanimity in our lives. As set forth in the preceding column, the quality of contentment is essentially synonymous with a profound sense of peace of mind and satisfaction, characterized by freedom from worry and the absence of craving for something that we perceive as lacking in our lives. Enduring contentment embodies a sense of deep-down, soul-satisfying contentment that infuses our lives with peace, serenity, and an abiding sense of fulfillment. As was the case with the first installment, many of the concepts presented are inspired by a profound book by Neil Clark Warren titled Finding Contentment: When Momentary Happiness Just Isn’t Enough (1997).
Steps for Manifesting Contentment in Our Lives
The following suggestions are presented to assist you and your clients in enhancing your lives with a deep sense of abiding contentment. As you read these suggestions, you may notice that many if not all of them run parallel to following a Twelve Step recovery program.
Authenticity
Warren believes that the deepest and richest form of contentment occurs when we make choices that guide us to a truly authentic existence. As the saying goes, “To thine own self be true.” Authenticity, in turn, entails intimately knowing ourselves and appreciating our unique gifts and abilities, coming to terms with our less desirable qualities, taking charge of our lives, and making moment by moment choices that demonstrate honor and respect for both ourselves and those affected by our actions. While taking charge of our lives and living a truly authentic existence may initially involve considerable sacrifice, it is definitely worth the price. Many people undertake mid-career changes driven by a desire to follow their own inner compass. Examples include a lawyer who opts to go back to school and experience an initial decline in income to follow his or her dream to become a psychotherapist, and an executive who takes an early retirement to pursue inner fulfillment as an artist or writer. While these choices may initially cause considerable disruption in our lives, they often prove to be both liberating and energizing, while ultimately yielding substantial rewards in terms of life satisfaction. As the saying goes, “The purpose of life is a life of purpose.” 16
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Gratitude
The older I get, the more convinced I am that the happiest people are those who infuse their lives with a profound sense of gratitude for what they have, rather than obsessing over what appears to be lacking in their lives. Pause for a moment, partially fill your drinking glass with water, and ask yourself, “Is my glass half empty or half full?” One of my neighbors is definitely one of the most positive people I have ever met. He lives by the mantra “Focus on the positive aspect of everything you experience!” A few examples from my own life come to mind as I ponder the powerful ramifications of my friend’s approach to life. Years ago back in California I worked as director of business development for a large medical group, a job that entailed a thirty-mile commute over crowded freeways. On a rainy day my drive would really get rough as things would slow down to a crawl. At those times I would focus on enjoying the music on my favorite jazz station, welcoming the additional sets I would get to listen to, while giving thanks for a tolerant boss who was okay with my arriving thirty to forty-five minutes late, provided that I stayed over to make up the time. A year and a half ago I had a rather painful fall that damaged my left arm and hand. Fortunately I was referred to an occupational therapist who put me through a rigorous exercise routine to regain my former agility. Painful though these
WELLNESS exercises were, I stuck with the program to avoid handicapping myself as a writer. I got to the point where I was proud of my weekly progress and even found myself enjoying the routine! Each morning I consciously focus on what I am grateful for by jotting down a brief, three- to five-item gratitude list. Two of my entries from this morning are: “I feel really good about the head start I made on my column for Counselor yesterday afternoon” and “I really enjoyed walking with Ann and Jack [our dog] in the park earlier this morning.”
Enjoy the Now
Live in the now and greet each day as an adventure presenting exciting challenges, learning experiences, and opportunities to fully embrace the sheer joy of living. Unfortunately, most of us live a good part of our lives outside the now moment, caught up in bemoaning our past mistakes and worrying about the future. We need to find what works best for grounding ourselves in the present moment. Two of my favorite grounding activities are hiking in nature and writing, where I become totally immersed in the creative flow (Csikszentmihalyi, 2008).
Humility
Recovering from a chronic lack of self-esteem during much of my younger years, at this point I generally feel pretty good about who I am and where I am going. In an effort to avoid letting a particularly gratifying accomplishment go to my head, each morning I ask my higher power to guide me to strive for a good balance and blend between pride, confidence, and humility.
Loving Service
Find and follow your true dreams, and strive to manifest a life of loving service and true fulfillment. A relatively recent shift in my life comes to mind as I write these words. About a year and a half ago my brother suffered a major stroke, followed by a hemorrhagic stroke fifteen months later. Fortunately we live in the same town, and I took it upon myself to serve as his patient advocate. At times this becomes a rather time-consuming and draining involvement. For example, I have fallen several months behind in my
current book project and have learned to recognize the need to set appropriate boundaries on my caregiving role. Despite the frustration accompanying that role, it constantly opens the door to new vistas of fulfillment. Again, I am reminded of my neighbor’s mantra: “Focus on the positive aspects of everything you experience!”
While taking charge of our lives and living a truly authentic existence may initially involve considerable sacrifice, it is definitely worth the price. Serenity
Practice the Serenity Prayer and view whatever setbacks you encounter as opportunities to learn and stretch beyond your previous self-imposed limitations. Through focusing on the acceptance part of this marvelous prayer, we cultivate the quality of equanimity by learning to accept those circumstances that are, at least for the moment, beyond our control. Focusing on the courage aspect, we become inspired to take calculated risks to achieve an outcome that may enhance our lives and the lives of those around us. As Emmett Miller says in his CD expounding on the Serenity Prayer, “A ship in the harbor is always safe, but that’s not what ships are made for” (2005). In my book The WellnessRecovery Connection (2004), I present a worksheet for applying the Serenity Prayer to your daily life.
The Gift of Life
Every day, give thanks for the precious gifts of life and health. One of my favorite affirmations is, “I am grateful, God, for your precious gifts of life and health. My body has served me superbly well for many years and I am grateful.” Especially when confronted with what may appear to be a devastating illness, it behooves us to give thanks for our precious gifts of life and health. About two years ago I was diagnosed
with mid-stage kidney disease, a fairly common condition among older people. While I was initially frightened, my doctor referred me to a nephrologist with a very positive orientation. Working with this specialist and utilizing the wealth of information I retrieved online on diet and related topics from the National Kidney Foundation, together with undertaking relatively modest lifestyle changes, has allowed me to be confident that I am on top of the situation.
Love and Forgiveness
Cultivate the qualities of love and forgiveness for both those around you and yourself, and “Beyond a wholesome disciple be gentle with yourself” (Ehrmann, 1952).
Higher Power
Constantly seek guidance from your higher power, while giving thanks for that power’s constant loving presence, guidance, inspiration, and grounded direction in your life.
Conclusion
Well, I could go on and on, but I am sure you get the picture. In fact, you are probably already coming up with some ideas of your own. As always, feel free to share this column with your clients and others who may benefit from the message. 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 Csikszentmihalyi, M. (2008). Flow: The psychology of optimal experience. New York, NY: Harper Perennial Modern Classics. Ehrmann, M. (1952). Desiderata. Retrieved from http:// mwkworks.com/desiderata.html Miller, E. (2005). Serenity prayer [CD]. Nevada City, CA: Dr. Miller Fulfillment Center. 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. Warren, N. C. (1997). Finding contentment: When momentary happiness just isn’t enough. Nashville, TN: Thomas Nelson.
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THE INTEGRATIVE PIECE
Oftentimes We Teach What We Need to Learn Sheri Laine, LAc, Dipl. Ac
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hile giving my patient Cynthia an acupuncture treatment the other day, she started sharing with me about her experiences dealing with several stressed-out clients.
Cynthia is a yoga teacher. She was telling me that many of her clients go through life mostly unconscious of the emotional state of others, and that most seemed quite unaware of their own emotional lives. Cynthia observed that many students in her class appeared to take more— more energy, more time, more space in the room—than they gave out, oblivious to the fact that when they walked into a room they took far more qi (i.e., energy) out than they ever gave back. Cynthia was clearly feeling very frustrated, and seemed somewhat burned out with her chosen, muchloved profession and the people with whom she worked. She also reported feeling low energy throughout the day, which was a rare experience for her. She said she was sleeping quite well, although I had my doubts about that. Together, we devised a plan for Cynthia, which included the usual healthy snacks several times during the day to fight low blood sugar spikes. I asked her to spend time every day outdoors in nature, rain or shine, ideally in a park, at the ocean or enjoying a long walk in the mountains. Most importantly, her new plan of action included checking in regularly with her emotional heart, asking what she needed and making sure she was feeling more nurtured from within. Some patients will often exhibit a bright red tongue tip. The tip of the tongue reflects the emotional body—the redder the color, the more activated the nervous system will be. The tongue is like a book; it tells the acupuncturist what exactly is going on within the inner eternal organs as well as how well one is eating, digesting food, sleeping, and living the results of their inner emotional lives. Cynthia’s tongue tip was bright red. Cynthia began to add intentional deep belly breathing to her daily routine, using long, slow languid breaths like she taught in her classes, especially when she was feeling a lack of empathy for others or feeling particularly frustrated with a certain conversation. This immediately helped her to relax. She then 18
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found it easier to focus on the other person, and to feel more understanding of what others were experiencing in their lives. It may seem a bit odd that a yoga teacher would need to be prompted to practice deep breathing. This is a reminder of the ancient wisdom that we have all heard before: oftentimes we teach what we most need to learn. With the acupuncture needles doing their work, Cynthia was able to relax further and reflect on what was going on in her life. She saw, clearly, the primary source of her unrest: her husband’s family was conflicted with decisions around estate matters and Cynthia frequently found herself at odds with their perspectives and behaviors. Consequently, she judged her husband’s family. That in turn caused stress in her marital relationship. As Cynthia was better able to understand the family dynamics and the pain her in-laws were experiencing—while taking herself and her husband out of the equation—she was able to let down her judgments about the whole lot of them. In a wave of epiphany, Cynthia understood they were trying to do their best while lacking the necessary emotional tools in what was a very stressful situation. Now that Cynthia was honestly doing her own awareness work, she began observing that when she replaced judgment with empathy, she received immediate payoffs, starting with the students in her class. Those who seemed to push her buttons so easily did not seem to bother her so badly. Additionally, she reported her quality of sleep was much improved. Cynthia is a much happier wife, yoga instructor, and person. She has looked at herself honestly and has learned to love with empathy, even when she does not agree with the decisions that are being made. In learning to let go of judgment, she is much more at peace with herself and others in her life. As we practice empathy, we can care for ourselves and allow others to feel the emotional kindness we all desire. 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.
TOPICS IN BEHAVIORAL HEALTH CARE
Grief Has No Expiration Date, Part II: Coping with the Loss of Loved Ones to Addiction Dennis C. Daley, PhD
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n part one of this column I discussed grief of family members who lost loved ones to addiction. I discussed how we lose our loved ones in many ways: n Active addiction, which takes center stage of the life of the addicted members, making them unable to fully function in a responsible manner in the family n Incarceration, which can take them away from us for years n Death from an overdose, accident, suicide or medical condition caused or worsened by the addiction This column discusses how family members cope with the intense pain and sorrow caused by the loss of their loved ones. Over time, many individuals show resilience and use their experiences to help others deal with losing their loved ones.
Coping with Loss and Grief
Following are strategies to cope with loss and grief (Daley & Douaihy, 2013).
Embrace it
We need to accept our loss and all our emotions, including anger or rage, confusion, anxiety, sadness, depression, emptiness or guilt. Healing over time involves feeling pain and suffering, not running away from them by getting involved in too many activities. We should avoid using food, alcohol, drugs or sex in unhealthy ways to escape our pain. There is no rushing the healing process, although some of us attempt to.
Share it
Recovery is a “we” and not an “I” process—we do not go through it alone. Telling our stories of loss allows us to release emotional tensions; get love, support, and compassion from others; and change how we think about our loved ones. Keep in mind that not everyone who hears our stories will fully understand what it is like to lose a loved one. Or, they may think that it is time for us to move beyond our grief.
Seek Support
Letting others into our inner world enables us to connect in ways that are emotionally and spiritually healthy. We should avoid the extremes of isolating from others or engaging in so much activity that we have little time to think and reflect on our loss. Some of us benefit from grief groups, many of which are specific to the loss of loved ones to addiction. One mother stated that getting and giving support to other grieving parents “was the only time I could pour my heart out without being judged. I didn’t have to worry how much I cried, how much I screamed, how many times I said I wish I were dead,
how much I hated my life.” The acceptance and understanding of others can be a powerful antidote to intense emotions.
Attend a Mutual Support Program
Programs like Al-Anon, Nar-Anon or others can connect us to others who have suffered in similar ways, but who are also healing. Members share hope and strength, and help each other learn to cope with loss. Some communities have family support programs that offer a range of educational and support services.
Seek Professional Help
Counseling or therapy can help with anxiety, depression, bitterness, rage or other struggles associated with our grief. Treatment can help us focus on our strengths and accomplishments, and less on our loss. Professional support can help us better understand addiction, forgive our loved ones, forgive ourselves, and live well in the present, which is the best way to deal with a difficult situation. Some people experience “complicated grief,” which persists over time. This involves a sense of disbelief regarding the death of loved ones; anger and bitterness over the loss; recurrent periods of painful emotions with intense yearning and longing for the lost loved ones; preoccupation with thoughts of the lost loved ones; and avoiding situations or activities that may www.counselormagazine.com
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TOPICS IN BEHAVIORAL HEALTH CARE be a reminder of the loss (Shear, Frank, Houck, & Reynolds III, 2005). Several therapies—including one developed specifically for complicated grief—may help. Some people benefit from medication if depressive symptoms persist and interfere with their ability to function.
Reflect
It is okay to feel anger, loneliness, depression or other emotions or moods after losing loved ones. As these emotions feel less intense or painful, we can reflect on experiences or memories that bring us joy or other positive emotions. We may experience positive feelings from looking at photos, videos or other items associated with our loved ones and our lives with them. We may feel good when we reflect on our loss, even if at times we feel sad and miss them terribly.
Practice Good Health Care
We need to get rest and sleep, eat properly, and exercise. Exercise actually helps release emotional energy. Good physical health habits can affect our moods or behaviors in positive ways. We also have to be careful about using alcohol or drugs to escape our pain.
Use Spirituality
Some of us are initially angry at God and wonder why our loved ones were taken away. Many of us find peace and comfort in prayer, religious services or our personal relationship with God or a higher power. Over time we accept and understand our loss, and find meaning in it.
Forgive the Addicted Family Member
Some of us harbor anger towards the people we lost. We may wonder how they could have allowed themselves to be controlled by addiction, or how could they have ignored or treated the family so poorly. As we understand how drugs can hold people’s brains captive to the need to feel euphoria, it may be easier to let go and forgive. Our addicted loved ones were sick, and their judgement and behaviors were influenced by their addiction. Recovery programs promote “making amends” so that addicted individuals can take steps to undo the damage caused to loved ones. This often enables those of us affected by our loved ones’ addiction to be more open to forgiveness, which is 20
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better than revenge or vindictiveness. NarAnon and Al-Anon also suggest making amends for family members in recovery.
Write
Some of us write about our experiences, thoughts, and emotions, and reflect upon the people we lost. When my wife of thirty years died of cancer years ago, I wrote in a journal, which gave me relief and sometimes gave me perspective on love, death, and grief. I have vivid memories of being wide awake at 2:00 AM, outside my wife’s hospital room, during the final days of her life. Writing made me think about how my life and that of my children was changing drastically. I used this to motivate myself to later write a grief journal so I could share my experiences with others.
Help Children with their Grief
Children and siblings are affected by losses and need to grieve and share their feelings and worries. Some kids who lose parents or siblings worry about losing another family member. We can encourage our children to share their grief and discuss their questions or worries. We can share memories of the people we’ve lost by looking at family photos or videos. We can pay respects with our children in a cemetery or mausoleum. We can talk before and after the trip with our children about their thoughts, feelings or questions.
Giving Back: Service to Others
I am impressed by the resilience, love, altruism, and kindness of many who have lost loved ones to addiction. Many give back to others through service in formal and informal ways. Sometimes they lend a compassionate ear to those new to grief and support them. They encourage them to share their stories, emotions, and thoughts about losing loved ones. They reach out and stay connected to those who may isolate themselves and avoid social interaction. They gently suggest ways to soothe themselves during periods of stress or internal struggles. Here are some ways these people have given back: n Starting or facilitating support or grief groups for other family members n Opening up treatment programs that include family services
n Sponsoring vigils in which family members acknowledge their losses n Speaking to groups about their experiences losing loved ones n Writing books about their losses and the journey of recovery Each person needs to find what works best for them. Many of us heal over time as we through work our grief and learn to live with our loss. c
Internet Resources n www.caringinfo.org n www.compassionatefriends.org n www.davidkessler.org n www.griefandrecovery.com n www.griefnet.org n www.journeyofhearts.org n www.webhealing.com
Suggested Readings n Harvard. (2010). Coping with grief and loss: A guide to healing when mourning the death of a loved one. Boston, MA: Harvard Health Publications. n Daley, D. C., & Douaihy, A. (2013). Grief journal: Living with the loss of a loved one. Murrysville, PA: Daley Publications. n Seligman, M. E. P. (2012). Flourish. New York, NY: Simon & Schuster. n Shear, K., Frank, E., Houck, P. R., & Reynolds III, C. F. (2005). Treatment of complicated grief: A randomized clinical trial. JAMA, 293(21), 2601–8. n Stroebe, M. S., Hansson, R. O., Schut, H., & Stroebe, W. (Eds.). (2008). Handbook of bereavement research and practice: Advances in theory and intervention. Washington, DC: American Psychological Association. 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.
References Shear, K., Frank, E., Houck, P. R., & Reynolds III, C. F. (2005). Treatment of complicated grief: A randomized clinical trial. JAMA, 293(21), 2601–8.