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July/August 2012

This is Your Brain in L ve

Inside

Science takes us deeper into the world of attraction, sex and romance – and it’s still a mystery Jeffrey C. Friedman

Be Your Own Person.........17 Does Booze Make You More Creative?....................3 God's Whispers................... 9 The Movie in Your Head..............................8

The “Miracle” of Recovery........................ 18

But, lately, the waters of love have been washing onto the dry and ordered shores of neuroscience, a place where all emotions, even love, have their distinct and measurable neurobiological substrates. Thanks in part to a new generation of neuroimaging technology, science can now offer new insight into the limbic pathways that govern attraction, sex and romantic attachment. Few would have guessed that it would be white-coated researchers, rather than the world’s artists and poets, to whom love would relinquish its final secrets, revealing truths that may help us fully sound love’s hidden depths. The Oxford English Dictionary defines love as “an intense feeling of deep attraction or fondness for a person or a thing – a sexual passion or sexual relations.” It is a definition that is both accurate and dense, though a bit of resonance is felt when the dictionary also tells us that the word “love” shares common etymological roots with the words “desire” and “libido.”

“The meeting of two personalities is like the contact of two chemical substances: If there is any reaction, both are transformed.” – Carl Jung

ung was right. No experience in life is more transformative than falling in love. Love has a remarkable ability to open our hearts and, if tenderly nurtured, bind them to the hearts of others. No single emotion has as much power to enrich lives, even heal nations. But then love is less a single emotion than a patchwork of many. Its boundaries are vast and deep and encompass an ever-evolving medley of the most diverse feelings. And love is a force so enigmatic that, for millennia, its investigation has been primarily the domain of philosophers, artists and poets. Over many centuries, those whose craft is to define the indefinable have labored to chart love’s unfathomable waters, from its balmy, placid promises, through the stinging chop of its sudden squalls and down into the sightless depths of its bitter sorrows.

(Continued on page 14)

The Cure is Worse Than the Pain The abuse of prescription pain medicine is epidemic, especially among adolescents. Dr. Mel Pohl, medical director of the Las Vegas Recovery Center, and one of the nation’s leaders in studying prescription abuse, has successfully treated patients and his own chronic pain without dangerous meds. We need to rethink how we approach pain, he says. By Suzanne Riss Together: Pain is the primary reason we go to see a doctor. Is the real problem that the most common treatment is medication? Dr. Pohl: There’s an underlying cultural problem here: We don’t want to feel pain or anxiety. So we take a pill or we go on the Internet or we text or we gamble. As a society, we’re oriented away from the present moment, and we try to take away any unpleasant feelings. The reality is that the world is filled with unpleasantness. We can’t medicate it away. It’s impossible. We can temporarily numb the brain with a drug. But the drug wears off, and then we need to do it again. I think as a culture we need to learn how to deal with reality. And as a corollary, a lot of people are medicating emotional pain that they perceive as physical pain. They feel anxious, and their back starts

to hurt, so they take a Vicodin. They’re not making it up. Anxiety causes you to hurt more. Using pain medications to treat emotional pain is called “chemical coping,” and it’s a common phenomenon among people who get in trouble with these meds. Do most people become addicted to prescription pain meds by accident — they underestimate how addictive the meds are? What’s the typical scenario? There are three basic scenarios. The first involves people who will become addicted to anything that alters their mood, like drugs that hit the reward system of their brain. These are people who have an underlying addictive disorder, and they’re at risk for problems with any drug. They may have used marijuana, alcohol, sleeping pills, cocaine. Then they find an opiate at some point. If they develop a painful condition, they then get into trouble with that drug.

The second group has never had a problem with addiction. They drink socially. They might have experimented with marijuana or even cocaine recreationally. But when they’re exposed to opioids to treat pain, they become addicted. These folks take more than they’re prescribed and they chew or snort their oxycodone and Roxicet (Roxy’s), which is the newest popular drug being abused. Those are signs they’re out of control. They have become addicted although they never were before. The third group doesn’t

(Continued on page 10)

EDITOR'S•DESK

Happy Birthday To Us

e enter our third year of publishing with an indepth look at a problem that is ensnaring people far removed from the “drug scene,” who would never think of using drugs recreationally. For a lot of reasons the abuse of prescription drugs – in particular painkillers – has become epidemic. The high profile cases distract from the thousands of ordinary people who, following doctors’ orders, become addicted. Then, inevitably, their teenagers find these drugs in the home and take them for fun, not understanding the deadly risks. A year ago Congresswoman Mary Bono Mack of California advocated in our pages for stronger controls on these drugs. She told the story of a pharmacy holdup on Long Island, N.Y., in which four people were killed – all for pills to feed an addiction. This month we report the conclusion of a grand jury investigation into that case, in which we found the chilling story of “Mary,” the name we gave to “Defendant B,” a nurse practitioner who got caught in the hall of mirrors of pain relief and drugs. Her frightening story shows how even someone in the healthcare profession can get into trouble.

s an issue of Together takes shape it’s interesting to see the unintentional connections among articles. In our page one interview with Dr. Mel Pohl, a leader in prescription drug abuse, he says that 80 percent of chronic pain is emotional and that quitting opioids can actually decrease pain. This was the case with “Mary,” described in the grand jury report as suffering hyperalgesia, in which patients experience worse pain than they experienced without opioids. It’s interesting, as well, that Dr. Pohl suffers chronic pain and

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deals with it without medicine. “I know that if I stretch, meditate, take a walk or listen to music, I’ll feel better,” he says. And then he adds: “Something that works and that is free is your breath. If we can learn to work with our breath, we can settle our nervous system down without medication. If each of us could perfect that technique, we’d have less war, fewer car accidents and less of a dependence on drugs.” I don’t make those claims in the article (page six) that I wrote on breathing, but it does make sense. Our general lack of physical exercise, coupled with almost constant stress from the complexities of everyday living, make us one tense society. I often imagine the farmer who tilled the land where I now live. No fast, loud automobiles, no phones, no TV, no electric light. I doubt he needed to reach for pills.

Contact Together:

e would like to thank those who have supported us with your advertising and editorial contributions in our first two years. We appreciate your faith in us. We invite the rest of you to join us, too, in this third year. Help us, and yourself, by taking out a subscription, which you can do on our website. If it is appropriate, ask your company to buy an ad to help us help others. Send us articles or quotes you find particularly helpful. Pass your issue along to someone who might need it. Let us know what you like and don’t like. And let us know when we’ve been helpful to you or others. It has been good to have you as part of the team.

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Terry A. Kirkpatrick

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www.together.us.com | July / August 2012

GUEST•COLUMNIST

Does Booze Make You More Creative? Don’t believe everything you read

By Joe Nowinski

n April 11, 2012, the New York Daily News published an article titled “Beer Makes Men Smarter,” which got a lot of attention. Is that really true? Let’s take a closer look. Here’s how it got started. The March 2012 online edition of the journal Consciousness and Cognition included an article coauthored by Jennifer Wiley, a psychologist at the University of Illinois, along with two graduate students, titled “Uncorking the Muse: Alcohol Intoxication Facilitates Creative Problem Solving.” Here is what these researchers did: Beginning with a group of 40 men, none of whom were identified as alcoholics or problem drinkers, half were given a mix of vodka and cranberry juice, enough to bring their blood alcohol level to 0.75, or just shy of the legal limit of .08. The other half did not drink anything. Both groups were then given two tests, one that involves memorizing words and one involving “word association,” which asks people to think of a word that “goes with” a series of words, such as “apple, banana, _________.”

What does it prove? What did they find? They found that the intoxicated group did better on the word association test, but worse on the memory test. So, does that prove that drinking makes men smarter? Well, that depends in part of what your idea of “smarter” is. For example, what role does memory play in intelligence (and creativity)? And how exactly does word association relate to creative success? The relative performance of these two groups was measured in a highly controlled setting. We have no way of knowing what the results would be if we compared a group of six-beers-a-day men to a group of men who drank two beers two or three days a week. In commenting on the implications of her research on creativity, Dr. Wiley was fairly circumspect, saying, “Sometimes the really creative stuff comes when you’re having a glass of wine over dinner, or when you’re

I pity the man who is struggling with writing (or any other creative activity) who concludes that drinking is the pathway to creative success and who seeks a solution through drinking. taking a shower.” But the writer of the Daily News piece went much further, stating of the results: “It may also help to explain why raving drunks like Ernest Hemingway, John Cheever, and Charles Bukowski were able to write their books.”

A Reality Check Could it be true that famous authors, such as Ernest Hemingway, may have been successful in part to the fact that they were notoriously heavy drinkers? Let’s look at a few examples: • Both Ernest Hemingway and a famous contemporary, F. Scott Fitzgerald, produced their best work early in their careers, before they became alcoholics. • Fitzgerald died in his early 40s of a heart condition caused by his alcoholism. Sadly, in his later years, as he struggled to write, Fitzgerald referred to alcohol as a “stimulant,” whereas it is actually a depressant. His struggle continued, and his later works are generally considered inferior to his earlier books such as The Great Gatsby and This Side of Paradise. • Hemingway committed suicide after succumbing to flagrant alcoholism. It is widely recognized that, like Fitzgerald, he hit his literary prime early, not later. He wrote For Whom The Bell Tolls when he was 40; he shot himself at the age of 62. • Then there is Truman Capote. He also became an alcoholic and died an early death, at age 59, in 1984. Capote, too, produced his

best work prior to being ravaged by alcoholism. Breakfast at Tiffany’s was published in 1958, In Cold Blood in 1966. So it would appear that drinking might not facilitate creativity after all, at least not in the long run, as much as we might be tempted to believe so. The above authors all drank to excess, but not to facilitate their creativity; rather, they likely drank to quell their inner demons, whatever they may have been. Writing a book, like any other creative endeavor, requires complex cognitive skills. These include not only the ability to think conceptu-

ally but also the ability to organize and articulate one’s thoughts. It also helps to be able to remember what you wrote two chapters ago. In other words, it’s a long stretch from “apple, banana, _______” to any of the above literary masterpieces. To be sure, sharing a beer or two with friends can be an enjoyable experience. I have male friends and we enjoy these times together. (We, of course, do not have problems with alcohol.) However, I pity the man who is struggling with writing (or any other creative activity) who concludes that drinking is the pathway to creative success and who seeks a solution through drinking. Footnote: As women were not included in this study we do not know if intoxication can also facilitate their creativity. That leaves open the question of whether Jane Austen could have done even better had she been an alcoholic. Dr. Joseph Nowinski is an internationally recognized clinical psychologist. He is coauthor with Robert Doyle, MD, of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? He lives in Tolland, Connecticut. This article originally appeared in The Huffington Post.

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IN•THE•NEWS

Headliners • • • • • •

ade h - Thomas Kink

Heather's Hutc

The Painter of Light After a drunken night popping Valium, Thomas Kinkade, the “Painter of Light,” died in his bed, the San Jose Mercury News reported. Smudges of green paint still stuck to his fingernails. An eight-page autopsy report plus police documents obtained by the Mercury News added more troubling details to the final months and hours of the world-famous artist known for his peaceful, pastoral images. Kinkade was 54 when he died the morning of April 6. His girlfriend, Amy Pinto-Walsh, found him unresponsive and told authorities

he had been drinking all night. For the past two years, he had been legally separated from his wife, Nanette. Kinkade, who donated to numerous local causes, had become a fixture in the Los Gatos bar scene over the past couple of years. He was often accompanied by his private bodyguard, who doubled as a driver ever since Kinkade was arrested for drunken driving in Carmel in 2010. The autopsy revealed “a lethal level” of alcohol, combined with benzodiazepine, the anti-anxiety medication known as Valium. In an interview with the Mercury News, Kinkade’s brother, Patrick Kinkade, said the artist had sobered up the past few months and had been “in his studio painting religiously,” but relapsed just before his death.

A campaign for Cameron Douglas A group of prominent addiction doctors has mounted a quiet legal campaign on behalf of Cameron Douglas, the troubled son of the actor Michael Douglas, in hopes of finding a sympathetic ear for their view that drug addiction is best handled with more treatment, not more prison time, the New York Times has reported. In December, Mr. Douglas, 33, was already serving a five-year federal sentence for drug distribution and heroin possession. He was sentenced to an additional four and a half years after being caught behind bars with heroin and Suboxone, a prescription medication used to blunt the pull of opioid addiction. That sentence, believed to be one of the

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harshest ever handed down by a federal judge for drug possession for an incarcerated prisoner, prompted about two dozen addiction doctors and groups to file a brief on behalf of Mr. Douglas, whose case is under review by a panel from the United States Court of Appeals for the Second Circuit. Their argument is that Mr. Douglas, who began injecting heroin daily in his mid-20s, is a textbook example “of someone suffering from untreated opioid dependence” and that more prison time would do nothing to solve his underlying problems.

Mary Kennedy, RIP Mary Kennedy, the estranged wife of Robert F. Kennedy Jr., was found dead in Bedford, New York, the small town north of New York City where she lived. She died of asphyxiation due to hanging, the Westchester County medical examiner said. A private memorial service was held Saturday at St. Patrick’s Roman Catholic Church in Bedford. Among those attending were Glenn Close, Chevy Chase, Susan Sarandon and Larry David. She was in the midst of an excruciatingly ugly divorce from Robert F. Kennedy Jr., the second son of Robert and Ethel Skakel Kennedy. She was drinking heavily, and her behavior became so erratic that court authorities would only allow her to see her four children during visits supervised by the family housekeeper, according to The Daily Beast. “I saw her in the kitchen, like with her head down, and I was like, Oh, golly, she’s talking on the phone and crying,” says the housekeeper, who had lived with the couple throughout their entire marriage. “But then I get close to her, and she was passed out. The plate of food was old, and her face was on top of the plate. And that day, she was drinking a lot.” She’d already been arrested twice for DUIs since Bobby had filed for divorce in May 2010.

Our Children • • • • • •

The difficult “drug talk” Legions of American parents finding the “drug talk” increasingly problematic as more states allow medical marijuana or decriminalize its use, The Associated Press reports. Colorado and Washington State have measures on their Nov. 6 ballots that would go a further step and legalize recreational use of marijuana for adults. Parent-child conversations about pot “have become extraordinarily complicated,” said Stephen Pasierb, president of the Partnership at Drugfree.org, which provides resources for parents concerned about youth drug use. Legalization and medical use of marijuana have “created a perception among kids that this is no big deal,” Pasierb said. “You need a calm, rational conversation, not yelling and screaming, and you need the discipline to listen to your child.”

A father’s challenge Five years ago, Leo McCarthy lost his 14-year-old daughter, Mariah, when a drunken driver hit her and two of her friends as they walked down a sidewalk near her home. But

he refused to let her tragic death become just another statistic, CNN reports. Knowing that the driver was 20 years old — not even old enough to drink legally — McCarthy made an unusual promise to the teenagers attending Mariah’s memorial service in Butte, Montana. “If you stick with me for four years,” he said during her eulogy, “don’t use alcohol, don’t use illicit drugs but give back to your community, work with your parents and talk to your parents, I’ll be there with a bunch of other people to give you money.” McCarthy has lived up to his end of the bargain. Along with Jimm Kilmer and Chad Okrusch, the fathers of Mariah’s two friends who survived the accident, McCarthy has given $1,000 scholarships to more than 140 high-school graduates who have taken Mariah’s Challenge.

Black out drinking National survey studies suggest that roughly one in four college students who drink will experience a blackout in a given year, making blackouts a surprisingly common outcome of excessive drinking, The Partnership at Drugfree.org reports. Blackouts are very different from passing out, when a person falls asleep or is rendered unconscious from drinking too much. During blackouts, people can participate in events ranging from the mundane, like eating food, to the emotionally charged, like fights or intercourse, with little or no recall. A 2009 study of 4,500 students about to enter their freshman year of college found that 12 percent of males and females who drank in the previous two weeks experienced a blackout during that time. Another study observed that college students who black out are more likely to experience alcohol-related injuries than those who do not. Those reporting a history of six or more blackouts at the beginning of the study were more than 2.5 times more likely to be injured in an alcohol-related event over the next two years. The second study estimated that emergency department costs due to injuries sustained during blackouts could total $500,000 or more per year on large campuses.

Prescription drugs and depression A new study finds college students who use prescription drugs for non-medical purposes are at increased risk of depression and thoughts of suicide, The Partnership at Drugfree.org reports. Researchers analyzed the answers of 26,600 college students who participated in a survey by the American College Health Association. They were asked about their non-medical prescription drug use, including painkillers, antidepressants, sedatives and stimulants, as well as their mental health symptoms in the past year. About 13 percent of students reported nonmedical prescription drug use, Science Daily reports. Those who reported feeling sad, hopeless, depressed or considered suicide were significantly more likely to report non-medical use of any prescription drug. The link between these feelings and prescription drug abuse was more pronounced in females, the researchers report in Addictive Behaviors. The researchers conclude that students may be inappropriately self-medicating psychological distress with prescription medications.

www.together.us.com | July / August 2012

IN•THE•NEWS To

Your Health • • • • • •

Meds for alcoholism?

As part of the larger Study of Addiction: Genetics and Environment (SAGE), Rice and his colleagues interviewed 3,829 adult participants (1,761 males, 2,068 females) using the SemiStructured Assessment for the Genetics of Alcoholism; subsequently, 2,610 non-Hispanic, European-American individuals (1,144 males, 1,466 females) were genotyped using the Illumina Human 1M array, and CNV analysis was conducted. “We found two CNVs (genetic variations called common copy number variations) on chromosomes 5q13.2 and 6q14.1 that were associated with alcohol dependence,” said Rice said. “For both CNVs, dependence cases tended to have more duplications than controls without dependence. These two CNVs are statistically significant but the effect on risk is modest. The region identified on chromosome 5 contains several genes that have been implicated in rare neurological disorders and play a role in the nervous system. It will be a challenge to understand what gene(s) are causing this association and how they work to increase one’s risk for alcohol dependence.” “CNVs can be inherited or be a genetic mutation that neither parent possessed nor transmitted,” Rice said. “In addition, CNVs have been reported to influence diseases such as autism and schizophrenia.” “This is a carefully done study and results are conservatively interpreted,” Goldman said. “The association to the 5q13.2 region is highly significant statistically, but further it is compelling that the region they have found is one that plays a role in other neurologic disorders. The chromosome 6 findings are statistically more highly significant but more difficult to pursue because the region involved is a gene desert.” “It is important to note that the associations are modest,” Rice said, “so these findings cannot be used to predict who will become an alcoholic. The results open up a new line of investigation, but it can take many years before we have a true understanding.” “These findings are indicative of the increasing pace of genetic and genomic research on alcoholism,” added Goldman. “However, the findings are at least several years removed from clinical impact, except in the sense of showing that alcoholism is a biomedical disease whose genetic influences are beginning to be understood.”

Many people struggling with alcohol dependence who could benefit from medication are not receiving it, according to an expert who spoke at the recent American Psychiatric Association Annual Meeting, The Partnership at Drugfree.org reports. “Antidepressant prescribing is 100 to 200 times as great as prescriptions for medications approved to treat alcohol dependence, despite the fact that the prevalence of disorders for which antidepressants are prescribed — major and minor depression and anxiety disorders — is only two to three times that of alcohol dependence,” says Henry Kranzler, MD, Professor of Psychiatry at the Treatment Research Center at the University of Pennsylvania and the Philadelphia VA Medical Center. The reasons why medications to treat alcoholism are not more widely prescribed are complex, he says. A main factor is that pharmaceutical companies and physicians have been afraid to deal with alcohol-dependent patients because they are concerned about liability, for example, if a patient under treatment drives under the influence and has an accident, he says. Some doctors, as well as patients and their family members, also believe that alcoholism is not a suitable target for medication because, in their view, it only substitutes dependence on one substance for another. Medication also may not be offered to many people with alcohol dependence because they are treated exclusively by non-medical personnel, such as counselors, Dr. Kranzler added. Three drugs are approved by the FDA to treat alcoholism: disulfiram (Antabuse), naltrexone (ReVia and Vivitrol) and acamprosate (Campral). “These drugs all exert modest effects,” notes Dr. Kranzler. Another drug that is prescribed off-label for alcoholism is topiramate (Topamax), which is approved to treat certain types of seizures and to prevent migraines. Topamax appears to correct a chemical imbalance in the brain caused by chronic drinking. Unlike treatments currently approved for alcoholism, it has been shown to be effective in people who are still drinking. However, it can cause side A large-scale study has found that nearly a effects such as memory and thinking problems, quarter of U.S. suicide victims are legally inas well as sedation. toxicated when they die, Fox News reports. These victims are also much more likely than their sober counterparts to commit suicide by violent A new study has examined links between al- means such as using a firearm, hanging themcohol dependence and genetic variations, finding selves or falling to their deaths. Researchers at Portland State University a significant association, Medical News Today analyzed the blood-alcohol levels in nearly has reported. “Twin and adoption studies have estimated 58,000 suicide cases across 16 states and found the heritability of alcohol dependence — the that 22 percent of victims were drunk when they proportion of variability in risk that is due to died. Twenty-four percent of men and 17 percent genetic factors — to be to be about 50 percent,” of women who committed suicide had bloodsaid John P. Rice, a professor of mathematics in alcohol levels of at least 0.08 g/dL, the legal psychiatry at Washington University and cor- standard for intoxication. In the current study, Kaplan and his team responding author for the study. “Alcoholism’s pervasive impact on public found than less than half of the victims had a health and its heritability make searches for genes problem with alcohol dependence or alcoholism influencing vulnerability a priority,” said David or a history of prior suicide-related behaviors, Goldman, chief of the lab of neurogenetics at the such as attempts or ideation – though 76 percent National Institute on Alcohol Abuse and Alcohol- did show prior evidence of mental health probism. “Although only a few genes influencing al- lems. “One hypothesis is these were individuals coholism risk have been discovered so far, we can expect this picture to change rapidly as more responding to major life stressors or crises, who powerful genomic tools, including genotyping engaged in drinking with a firearm present arrays and next-generation sequencing, are ap- within a few hours of taking their lives and beplied, and as geneticists become ever more am- came disinhibited by the alcohol,” Kaplan bitious in the size and phenotypic depth of the said. “They were drinking excessively in order to make it possible to die by suicide.” populations they study.”

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significant life events and how these events impact on their lives in the present. Viewing That’s it. Nothing totimelines, it. Told you it was easy. And a lot is Breathing is critical to yoga, as my instructor, Tricia Keane, By Terry A. Kirkpatrick these I often observed thatyet directly has beenissaid thatremindthe only guarantees going on behind the when youofbreathe that way.in these who teaches in Northern WestchestertCounty, forever afterscenes the occurrence tragic life losses death and taxes. “When you exhale completely, you keepthat a natural balance of was lying on my back on a purple mat on a black floor ing us. In fact, yoga has its own wordin forlife it:are “pranayama,” whichThis applies patients’ lives, it appeared their substance to everyone whether they are in recovery in a dance studio with my fingers resting on my belly, means control or lengthening of breath. Tricia will set us up in oxygen and carbon dioxide,” Tricia says. “When you breathe use spiked — sometimes dramatically. In some or not. Various aspects of the grieving when my yoga teacher said, “Now I’m going to teach you some pose and then quietly say, “Breathe.” Or may favorite: through your nostrils you release nitric oxide, which relaxes you. cases the loss triggered a downward spiral of process, however, hold special challenges the ultimate way to relax.” “Don’t forget to breathe.” As though I have a choice. When you breathe deeply through your nostrils your diaphragm using and and depression that ultimately resulted It’s deceptively simple, although there are a thousand goes all the way down your ribs expand. Your belly organs for recovering alcoholics and addicts. in admission into treatment. I was drawn to getpast squished years of Eastern tradition and perhaps as many Western scienEveryone grieves uniquely. In the it was around – massaged. Proper posture while breathlearning more about how grief, addiction and ing deeply can be beneficial to people with scoliosis, who can tific studies to give it credence. thought that there are predictable stages that affect how couldspinal help tend to favor onerecovery lung over the each otherother as a and result of Itheir You don’t have to practice or even like yoga to do this, and grievers must go through to achieve accepnewly sober people negotiate their grief more curvature.” you don’t have to lie on the floor. You can do it in your chair – if tance of the loss. Twenty-three years of peryou sit up straight and stop slumping over the way I do, espeadaptively. I came to believe that if life losses sonal and professional experience tells me that, cially at the computer. You need to open up your airways, because were not adequately addressed in treatment, when it comes to the process of grieving, one this little secret is about breathing. the neglect of this would be a contributing facsize does not fit all. In my private practice and Most of us Westerners don’t breathe correctly, although we I ran all this bytor some other friends who breathin potential relapse. Myhave ownstudied experience of also at Cottonwood Tucson whereing. I work as a Mincer of Ridgefield, Conn., a yoga instructor for reveal at least a subconscious appreciation of its importance in Deanne loss also reinforced my emerging viewpoint. griefand counselor, I have conducted grief therapy the way we speak: “in the same breath,” “save your breath,” “take “Actually people hold their breath don’t even realize it,” 25 years who studied the Himalayan Institute, notesa that Myatfather died in February of 1986, timewe with newly clean and sober clients, and found, exerting – to do these yoga your breath away,” “as I live and breathe,” “breathe a sigh of she says. “When they’re focusing or breathe 18,000 to 20,000 times a day. “There are a lot of funcwhen, sadly, I was not yet sober. My response timeofand again, that they to their poses is exertion — people just kind automatically feel respond they tions relief,” and “breathe easy.” of our bodies that are not within our control,” she says, that I used more of the subhave to hold their breath. Anxiety alsodifferently. makes you holddiscovered your “but breathing is.toIfthat we loss can was control our breathing it gives us a losses I have that, in stances I was then addicted Throughout the breath. Breath is the best barometer for how you’re doing in lot of power.” When we breathe deeply we’re to. oxygenating blood working with clients like these, the treatment initial mourning rituals of my religion, I was your yoga practice. If you find while you’re practicing that sud- atapproach. the bottom of the lungs, where most of the blood is, she says. of grief requires an individualized physicallyshallowly present but emotionally checked out “When we’re breathing we’re under the influence Our breathing is typically shallow – the air goes into our up- denly you’re breathing rapidly or shallowly or holding your andnervous unavailable. something you shouldn’t or of our sympathetic system. We’re keeping the fight or per lungs, our chest, and then comes back out. We breathe this breath, it’s a sign that you’re doingGRIEF, ADDICTION AND RECOVERY In November of 1987on I hit bottom andactiflight response active. Deep breathing, themy other hand, way especially when we’re nervous. If we’d watch a sleeping that you’re straining.” In 1997 I had been working at Cottonwood I’d say that’s true of life in general. vates the parasympathetic nervous system, the relaxing part of baby or a dog we’d see how it should be done. Therapeutic began a new journey of recovery and hope. years. One of the assignments that paHere is the technique she taughtfor us.two Breathe in through your the autonomic breathing, drawing air deep down into the lungs with our belnervous breathe in the chest As my system. body andPeople mind who healed, an interesting tients that time presented in primary groupare keeping the flight/fight response active.” twoat counts, then exhale to lies moving out and down, actually relaxes us – if we remember nose as you count to six, pause for all the time phenomena occurred when I had about three was timeline in which the patient You depicted the count of eight, and pause again fora two counts. to do it. want that if you’re driving down the highway and see

An TonE

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months ing my normal One n City sub exceptio person’s as I spo ing in re person was shi As I s corner p up. It w him. He had rec looked in his tw — the p said, “D dead!” H you to k going to I wok my face his grav his tom about m feeling been lif Over my pur entered therapi at the a bedside day dea recover from ne Florida there to last mo My m as an al was abl when I every st be there This wa lost my

Together www.together.us.com | July / August 2012

BODY•MIND•SPIRIT another car coming straight at you. The problem is that there’s not an oncoming car, but rather that our minds are working on a fear of losing our jobs, or worrying that we don’t have enough money. The way to get out of this thinking is to breathe deeply. “As soon as you know you’re thinking that way you want to move your breathing to your belly,” Deanne says. “Once you do, you tell you’re body that, ‘I’m safe, I’m no longer under stress.’ The only thing you can control voluntarily is how you breathe; you can’t control your blood pressure directly. But if you’re in deep breathing mode your mind will clear.” As a sort of proof of this, when she’s at the doctor’s office, Tricia Keane has her blood pressure taken routinely. Then, when the nurse leaves the room, she begins breathing deeply. When the nurse returns, Tricia asks to have her blood pressure read again. It’s often lower. Deep breathing, Deanne Mincer says, actually “tricks the body into thinking it’s safe. As soon as the breathing changes everything else calms down. You can get to the point where you don’t breathe in the chest unless there’s a bear chasing you. In fact you’ve probably never been chased by a bear, but you don’t realize it because you’re so used to being stressed.”

Deep breathing actually tricks the body into thinking it’s safe. As soon as the breathing changes everything else calms down.

Focused energy I recently began studying tai chi under Richard Dandanell at the Georgetown, Conn., Martial Arts Center, and, as with yoga, breathing is integral to the movements of this graceful martial art. “We are concerned with relaxing the body, relaxing the muscles, relaxing the heart rate,” Rich says. “This allows us to concentrate and focus our energy and to direct it in a concentrated fashion.” In the dojo, Rich says, “If I were to throw a punch I would project my arm forward but do that with the intention in my mind of driving my chi to that point. When I exhale it gives me more energy to do the motion. You may recognize that from lifting weights or from the kiai – loud exhalation – in a martial arts strike.”

But he also applies deep breathing in his car, when the tensions of everyday life and crazy drivers start building. “We all spend a lot of time in the car,” he says, “so you can start there and learn to reverse your anxiety by changing the way you breathe.” The last stop on my breathing education tour was Dr. Thomas Knox, a psychiatrist in Mt. Kisco, N.Y., who helped me stop smoking last year. Of the many things he taught me was that resisting an urge to smoke by breathing deeply was my first line of defense – when I remembered to do it. “It’s a good thing to do to help with an urge or anxiety or rac-

ing thoughts because it helps us to focus away from them,” Dr. Knox says. “It helps us to feel in control, which is the opposite of feeling anxious. And it calms us down physiologically, because when we breathe slowly and deeply it’s like breathing into a paper bag: it increases the carbon dioxide in our blood stream, which in fact calms the brain. “It’s calming and focusing. We can only think of one thing at a time. So you’re not thinking about the urge to smoke or a worry if you’re focused on the air moving in and out of your nostrils. You’re focusing away from the urge, and you’re in control.” There are many forms of diaphragmatic breathing, he says, and you can choose one that works best for you. “The more you practice it when you don’t need it, the more powerful a tool it’s going to be against anxiety when you do need it. The most important part of all deep breathing is posture,” Dr. Knox says. “Sitting in a very erect way, opening up the chest cavity and creating a pelvic tilt. Sitting like a marine or a ballerina in and of itself is calming.” The form Knox teaches starts with posture, then focuses on hearing the air moving in and out through the nostrils. “That’s usually the easiest thing to concentrate on. I suggest that people take a two-phased inhalation through their nostrils, first filling their bellies, which should move out and down diagonally, then filling and expanding the rib cage, the chest wall. Then exhaling and just experiencing that it takes no effort at all. Another thing I teach is slowing down exhalation. That activates the parasympathetic nervous system, which is calming. It happens on very slow exhalation. “We become focused on bodies by focusing on breathing,” Knox says. “And our bodies exist in the present, not the past or the future, where regrets and worries live.” All fine and good – and you don’t have to buy expensive uniforms or equipment. You just have to remember to do it. I suspect, though, that Tricia will for a long time be reminding me: “Don’t forget to breathe.” Terry A. Kirkpatrick is Editor in Chief of Together.

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Which Movie Are You Watching? You can’t control events, but you can control how you look at them

By Alan Cohen

itting on an airplane in flight, I was listening to an inspiring audio seminar on my iPod. Then the in-flight movie came on. Since I was in a bulkhead seat and the projection screen was just a few feet from me at eye level, it was almost impossible not to watch the movie. So I kept listening to the audio seminar with my ears and my mind, while the movie paraded before my eyes. The film, a predictable teenage romantic comedy, was easy to figure out even without sound. So while I was primarily focused on the lecture, a lesser part of my attention was tracking the film. Halfway through the movie I realized I was participating in a seminar that transcended the one I was listening to. I was learning how to remain established in a higher consciousness even while the drama of the world unfolded before me — the formula spiritual masters prescribe for a successful life. We live in a multi-dimensional universe in which an infinite number of parallel realities exist simultaneously. Some of the realities are wonderful, others horrible; some exhilarating,

If you are fixated on what is, you cannot discover what could be.

others annoying; some fascinating, others boring. The reality you live in is determined by what you give your attention to. On one dimension a mindless movie drags on, while on another dimension impeccable wisdom is broadcasting. You get to choose which story you will participate in.

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Attention is the most powerful currency at your disposal. Where you place your attention today is a coming attraction of what you will receive tomorrow. You may not be able to control the events that present themselves to you, but you have total control over the vision you use to see them. In that way you gain mastery over your experience. Perspective makes all the difference. Where we live in the country, sometimes rodents show up. When our little visitors increased in numbers, we got a cat to keep the population down. One morning I woke up and enjoyed an empowering meditation, tapping into a pool of deep inner peace that established the frequency for a great day. Then I walked into the living room and found a dead rat on the rug. After an initial “Arrrgh,” I got a shovel and scooped up the remains. As I headed outside, my partner Dee commented, “I am so grateful the cat is doing her job!” Ah, another way of looking at the situation. We hired the cat for a reason. Why should I complain when she fulfilled her role? Two realities presented themselves as an offering for my choice: a disgusting sight or a job well done. I decided the second option felt better, and the apparent problem gave way to a sense of gratitude. Metaphorically speaking, we all have dead rats on our living room floor and we all have agents doing their job to keep things running efficiently. The more you complain about the dead rats, the more you find. The more you thank the cat, the more you find to be grateful for. The facts of events are neutral. Your interpretation creates their meaning and subsequently your experience. It’s all about frequency and attunement. The spectrum of visible light we see, as well as audible sound, comprises a tiny, tiny slice

of the full spectrum of light and sound. If you think that the only light in the universe is what your eyes can see, or the only sound what your ears can hear, you will not have access to extremely helpful dimensions beyond the obvious. Radio, microwave, and x-rays are just a few of the many unseen realms that enhance our life. The movie of the five senses, rich and amazing as it is, is just one channel among an infinite number available. All healing and world progress comes through visionaries, people who see a brighter, higher, broader, freer movie than the masses are watching. If you are fixated on what is, you cannot discover what could be. To improve the world, beginning with your own life, you must look up. In Genesis 13:14 God told Abram (later Abraham), “Lift up your eyes from where you are and look north and south, east and west.” The instruction was more metaphorical than literal. God was telling Abraham to broaden his vision; to not be stuck in the narrow-sighted vision that keeps most of humanity embroiled in sorrow and suffering. To discover a new land, Abraham had to use a new way of seeing. You and I are being called to a new way of seeing. As old forms and institutions fall away, we must lift up our eyes to more fulfilling movies with story lines that take us where we want to go. If we continue to use the kind of vision that has shown us the old world, the old world will continue. If we use the kind of vision that shows us a new world, the new world will begin. Even if a silly movie is being projected right before your eyes, you can switch your focus to the inspirational lecture downloading. That lecture will guide you precisely as to how to understand the movie of the world, master it, and go beyond it. “In my father’s house there are many mansions.” One airplane, many movies. Alan Cohen is the author of many inspirational books, including the new popular Enough Already: The Power of Radical Contentment. For more information about Alan’s Hawaii retreats, Life Coach Training, free daily inspirational quotes via email, and other books and programs, visit www.alancohen.com, or email info@alancohen.com.

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Teenagers and Treatment

BODYâ&#x20AC;˘MINDâ&#x20AC;˘SPIRIT

A Whisper from God

on happiness, relationships, fun, pursuit of passions and helping others. It was obvious that their positive energy is infectious. (Continued from page 12) Recovery is a powerful thing to witness. These miracles are happening every day one time had very little hope of a successfor young people, and so much of it starts ful adult life were truly happy, exchanging with something so simple and often given sober war stories, laughing and having a I did. The last obstacle of the day involved climbing up a teleBy D. John Dyben the stateand andrecovery: was on his way to Miami for business. too little priorityacross in treatment great time with long-term friends they had When I arrived at the chapel, he was kneeling in a corner phone pole, standing at the very top, and then jumping off with FUN! â&#x153;ş sobered up his with. They had been is one of those times.there It is afor dark night of the soul. It praying silently. I walked in and I sat down and I waited for him. only an angled rope held by your peers to make you fall away one anotheristhroughout a piling of tootheir manylives. things to mention and a temporary I did not recognize him from behind. But when he stood and from the pole and to keep you from hitting the ground. All of the Joshmoment Azevedo, II,almost is the glowing Owner face looked at me, I realized that peers on the ground cheer the climber on and encourage him to sense of hopelessness that there to LISAC, turned CAC and his How wonderful it is that having dealtis any better come, ever. was S., aatman chaplain I had been when he was in trust. It is a leap of faith. Literally. and Program itDirector Thewhoâ&#x20AC;&#x2122;s Pathway with their alcohol and drug use early on night their I lay in bed awake hour, wait- chemical dependency treatment nearly three years earlier. He S. continued. â&#x20AC;&#x153;I had finally climbed to the top of that telephone Program. they were ableLast to focus young lives hour after ing for a sun I was almost sure would never rise. In these moments looked amazing. I immediately remembered that he spent many, pole, and I was standing on top, and there were all of those guys there is so totally nothing to be done and it feels like the muscle, many hours in my office and walking the outdoor track, and we yelling for me to jump and trust the harness and saying that I bones and sinew are pushing to blast free from the skin and there would be okay. And over it all, I only heard your quiet voice is NOTHING to do about it. speaking calmly and almost under your breath: â&#x20AC;&#x2DC;You are not So I began to pray. I am not a complicated prayer. But nights alone.â&#x20AC;&#x2122; I was all the way up on the pole and you were all the way like last night cause me to wane in even my own typical nondown on the ground in the middle of a bunch of other loud complexity. voices. There is no way I should have heard you, but that was all I simply prayed, (exact quoteâ&#x20AC;Śno embellishment here) â&#x20AC;&#x153;God, I could hear at all, your voice saying to me, â&#x20AC;&#x2DC;Youâ&#x20AC;&#x2122;re not alone.â&#x20AC;&#x2122; I please just let me know that I am not alone.â&#x20AC;? That was it. Over know that it was really God speaking through you to me to tell and over and over again. Maybe for an hour, maybe more. It was me that I am not alone. I am never alone.â&#x20AC;? almost trance-like at times. I had not seen this man in three years. There was no practical Eventually, I was too exhausted to even speak, and the sun did or logical reason for this encounter today. He told me he had rise, and the new day did begin. I made my coffee, went to work made this drive many times, but this time he simply felt compelled and began the hectic schedule that is my every dayin as the clinical to come by here to see me. the Hamptons I must believe that I have been whispered to by God Himself. director of a substance abuse treatment center. Then about half had talked about grief and sorrow and prayer and forgiveness Substance Abuse Treatment and finding Godâ&#x20AC;&#x2122;s love and so many other things. But today he May His whisper be all that I can hear. way through a clinicalAlcohol supervision&session, my assistant knocked on my door and said, â&#x20AC;&#x153;John, Carol needs to call her right wanted to tell me something very specific. Where theyou healing begins..... â&#x20AC;&#x153;I think about you a lot, John, and I carry many things in my John Dyben, a board certified mental health and addictions away. She says there is a patient you need to see.â&#x20AC;? Carol, a former

clinical director, was spending time with me at the center and heart still,â&#x20AC;? he said. â&#x20AC;&#x153;But, of all the things I remember about our professional, is clinical director at the Hanley Center in West Adults - Adolescents - Family - Men & Women times together, the most important is the thing that happened Palm Beach, Florida. He supervises all residential and outpatient acting as a mentor for me. My assistant would not have interrupted me if it were not on the ropes course. This was a full day obstacle course that in- treatment, as well as Spiritual Care and Wellness programs. John 1-800-448-4808 important, so I called Carol and she informed me that a former volved many challenges, including climbing vertical walls and joined Hanley Center in 2004 as chaplain. He spent his first patient had come to see me completely unexpectedly and he was navigating high in the treetops on narrow rope bridges. professional years as a pastor in a traditional church setting, Together Q pg CH 10/27/11 4:20 PM Page 1 â&#x20AC;&#x153;Do you remember what happened with me that day, John?â&#x20AC;? with a focus on teaching and pastoral counseling.Â waiting for me in the chapel. He apparently had driven in from

Why did this man I hadnâ&#x20AC;&#x2122;t seen in three years pick this day to show up?

There is no way I should have heard you, but that was all I could hear at all, your voice saying to me, â&#x20AC;&#x2DC;Youâ&#x20AC;&#x2122;re not alone.â&#x20AC;&#x2122;

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SPECIAL•FOCUS

Prescription Abuse (Continued from page 11)

they think are safe, but they are not, and they stop breathing. Do we have misconceptions about the safety of prescription meds because a doctor prescribed them, so they seem safe to take under any circumstances, such as while driving? There is a new crisis with drugged driving. It’s a challenge for the legal system because the person can say, “I have a prescription.” How many people are taking prescription pain meds and driving? What’s their efficiency level? When you take opioids, your concentration and sleep and memory are disturbed. Airline pilots can’t fly on these meds. People are getting started with prescription drug abuse at an earlier age — NIDA says 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin. How are they getting a hold of prescription narcotics? Use among high school seniors has been on the rise the past five years. About 70% of 12th graders get prescription meds from their parents’ medicine cabinets. The lesson for parents is to keep your prescription meds with you – don’t keep them in the medicine cabinet. Teenagers are also getting the drugs

from friends. Teens attend “pharm parties” where they get all the pills they can and them dump them in a bowl. Everyone reaches in and takes anything and everything. Their attitude is that these prescription meds are safer. We know that kids’ attitudes about prescription drugs impact their use. The perception of safety causes an increase of use. What advice do you have for a parent trying to help their teenager who appears to be abusing prescription meds? Unfortunately, the effects of prescription drugs aren’t always apparent. It’s not like with alcohol where parents can see their kid slur words or with marijuana where there’s a smell and other evidence to suggest intoxication. Pupil size shrinks when on opioids, but that can be difficult for parents to see. Any big change from the norm – in grades, mood, functioning – can be a sign. Parents need to raise the threshold of suspicion. At least one out of 10 high school seniors is doing this drug – this could be happening in your house. So have the conversation proactively. At what age should parents have this conversation? It should start really early, before age 10, because that’s when kids formulate their attitudes about medications. So you want to have a courageous conversation about life and pain and emotions and the dangers of drugs. You want to have weekly talks about drugs and have zero tolerance for using these drugs in your household.

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What does treatment for addiction to pain meds typically involve? People shouldn’t simply stop taking these meds cold turkey. There’s an element of physical dependence. The best way to stop is under a doctor’s supervision. If the doctor says you can’t come off the pain meds, get another doc. Here at the Las Vegas Recovery Center, patients go through detox, typically for 5 to 10 days, but it can be as long as 3 weeks. We give them meds to help block the symptoms of withdrawal. The alternative is to cut down gradually as an outpatient under the supervision of a medical practitioner. It’s a weaning down process, but as the dose of meds goes down, the pain can go up, so it can be a daunting task. How do patients manage their pain once they’re off pain meds? For some people, when they’re off opioids, their pain goes down. They have less pain, but their pain isn’t gone completely. They’re usually left with some discomfort. We created a program that lasts four weeks. We look at life balance. We look at physical, mental, and cognitive thought processes. We explore how you think and feel about pain. It’s also a spiritual approach to pain. The most important thing you can do with a person who is in chronic pain is to get the person moving. Inactivity causes muscles to almost freeze up. Yoga, stretching, chi gong or physical therapy are all good – we do all of these here. Movement is critical: walk, swim and get your muscles lubricated. We also do massage, chiropractic work and acupuncture. How much do our emotions impact our pain? If you sum up a description of chronic pain, 20 percent is sensory and the rest — a full 80 percent — is emotional. People have anxiety about pain, and about their loss of their sense of identity. Fear, anger and frustration drive their experience of pain much more than the physical/sensory part. This doesn’t make the pain any less real. A person with chronic pain may be sedentary because they’re afraid they’ll have an even worse injury if they stretch or exercise. Or they’re angry with the person driving the other car that injured them, or with the doctor that messed them up. Or they feel guilty they’re not at their kid’s soccer game, again. The pain gets worse with all of these phenomena, pointing to the fact that emotions drive chronic pain. What does your center’s spiritual approach to treating chronic pain involve? This may have nothing to do with religion. It’s just the idea that it’s about something other than me. That’s where we start. And that’s the basis of addiction recovery: Yes, I’m in pain and you are, too. What’s important to me? What do I want to do with my painful body? How do I want to live? There are ther-

apies that attend to that, including mindfulness practice and meditation, which is being in this moment without judgment. Do you suffer from any chronic pain? I have chronic back pain: My left lower back hurts. The process for me is to notice it but not to say, “Ah, that pain. I hate this. Gosh, darn, my back hurts.” I just observe a strong sensation in my back, without judgment. There’s nothing I have to do, just be there. The pain doesn’t stay. It might be back again later. From breath to breath, it changes. So I will notice that my back bugs me, but I know that if I stretch, meditate, take a walk or listen to music, I’ll feel better. Our approach at the center is to work around the edges of pain, not straight at it. It may be less satisfying that popping a pill because it’s not instant and it’s not mind numbing. But I’ve never taken a prescription medicine for my chronic back pain, which I’ve had for 12 years. I do light stretches, yoga, and meditate regularly. Do you think more research needs to be put into developing pain medications with diminished abuse potential, such as those that bypass the reward system of the brain? I do think the goal is to have medicines that don’t cause problems or at least do more good than harm. We can’t fix the state of being with a pill; that’s absurd. I have seen people make so many changes with their minds, by harnessing the power of their minds. I think there’s a lot more we can do with our minds. The answers to these problems lie in the powers of our own minds. What have you found to be the most effective approach to treating pain that doesn’t involve pills? A principle of pain treatment is that some things work for some people some of the time. It’s reasonable to explore acupuncture, yoga, chiropractic approaches, and physical therapy, and many other treatments. There are many options. I’d say there isn’t one approach that works best for everyone. But something that works and that is free is your breath. If we can learn to work with our breath, we can settle our nervous system down without medication. If each of us could perfect that technique, we’d have less war, fewer car accidents and less of a dependence on drugs. Dr. Mel Pohl, M.D., a Board Certified Family Practitioner, has been named one of the 2011-2012 Best Doctors in America. He is the Medical Director and the Vice President of Medical Affairs at the Las Vegas Recovery Center. He is a Fellow of the American Society of Addiction Medicine (ASAM) and co-chaired ASAM’s Third, Fourth, and Fifth National Forums on AIDS and chemical dependency. He is a Fellow of the American Academy of Family Practice and a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. He is the author of A Day without Pain.

SPECIAL•FOCUS

“I felt like I just wanted to die.” "Mary" was a mother, wife and nurse practitioner who inadvertently found herself entangled in a frightening web of prescription drug abuse. Her story comes directly from the Suffolk County, N.Y., grand jury report, in which she is described simply as “Defendant B.” We have given her the pseudonym “Mary” to humanize her amazing ordeal.

ary resides in Suffolk County, and is a New York State licensed Adult Nurse Practitioner, wife and mother. At the time of her arrest for three counts of Criminal Possession of a Forged Prescription in the 1st degree, she was employed by a local hospital. The charges involved the forgery of prescriptions for opioid pain medications. Although her case is still pending, Mary voluntarily testified during this proceeding and related her story of opioid diversion and addiction, and how it damaged her life, her family, and her career. Upon reflection, Mary recognizes that she made a series of bad decisions indicative of the aberrant behavior commonly associated with addiction. (Though not excusing legal culpability, one expert who testified before this Grand Jury indicated that opioid use affects the orbital frontal cortex of the brain, which is the decision-making center; continued use can cause impairment of judgment and greater harm.) Mary’s most tragic behavior was an attempted suicide, which resulted in a short stay at a local psychiatric hospital and detoxification unit. Her opioid use began approximately five years ago with a lawfully issued prescription for 5 mgs of Percocet. Post-child birth muscle spasms, along with emotional and physical stress, prompted a visit to her primary care physician for diagnosis and treatment. Initially he prescribed physical therapy, chiropractic care, and non-narcotic medication to provide pain relief. When these methods offered minimal results, and she proved to be intolerant of the commonly prescribed Soma, a muscle relaxer, she began an extended course of opioid treatment therapy. At no time in her medical exam or self-reporting did she indicate there was a family history of opioid addiction. Reporting this would not necessarily have prevented the doctor from prescribing the medication. “Originally, I would just start at night,” Mary said. “And then the pain was so significant I would have to take it during the day. Three times a day maybe. But unfortunately I would need more and more just to get relief.”

Signs of dependency Within two months of ingesting her first Percocet, she recognized that a tolerance had developed. She continued receiving chiropractic care and physical therapy but still felt pain. Six months into treatment, her primary care physician referred Mary to a pain management specialist. The specialist recommended a course of treatment that included lidocaine injections 1-2 times each week, and 10 milligrams of Norco 3-4 times a day. Her use quickly escalated to 6-7 times a day. At this time she recognized the signs of drug dependency. “I started to realize I could not be without it when I tried to stop, like if there was a day that went by, I would have withdrawal symptoms. And it scared me to death. And I also realized I was taking it sometimes when I was not in a significant amount of pain, where probably

other alternatives would have worked, but I found myself taking them anyway.” She called her pain management specialist who recommended a long-acting morphine. Instead, with the help of a family member also employed in the medical field, she visited another physician who diagnosed her as an addict and put her on a course of treatment using Suboxone, which prevents opiate withdrawal symptoms. Approximately 4-6 months after starting Suboxone, she experienced a decrease in pain symptoms. Within months she was able to start a new job. Although her new employer conducted a drug test, she did not indicate at the time that she was on Suboxone, and this drug would not show up in commonly used tests. Soon after she learned that she was pregnant, her physician advised her to either switch to Subutex or stop the Suboxone therapy completely. Instead, fearful of experiencing the pain of withdrawal, she decided to return to illegally obtained oxycodone, which she continued using in slowly decreasing amounts until approximately three weeks before she delivered her child. Mary started taking approximately ten 15 mg tablets of oxycodone daily and weaned herself down to no pills shortly before giving birth.

pro for depression. Within two weeks, she voluntarily surrendered her DEA license, thereby no longer having privileges to lawfully prescribe controlled substances. Yet, despite the now obvious harm done to her life, she soon wrote another unlawful prescription for opioids. She took the prescription to one of the very same pharmacies she had used on many prior occasions. And it was filled, despite her having surrendered her DEA privileges weeks earlier. The regulatory system clearly had its faults: “At first I thought that I would go there and they would tell me I‘m sorry we cannot fill this prescription, you do not have a DEA number. But for me, again, I made so many bad decisions, that I just felt like my life was in ruins, I‘ll just try, knowing that the ramifications would be really bad … and surprisingly enough, my number was still in the system … it was still there … nothing in the computer system saying that my DEA number was voluntarily surrendered. So they filled it.” Approximately two weeks later she returned to the same pharmacy with another unlawful

opioid prescription. This time she was told that a DEA representative had been there and advised the pharmacist that her number had been surrendered and she no longer had privileges. The pharmacist kept this prescription and days later she was under arrest.

No one ever said a word

Mary said that within a two-year period, she filled unlawfully issued-prescriptions at four different pharmacies. She explained that — 95% of the time — she went to the same pharmacy, sometimes close in time, always issued the prescription with a family member as a patient. Her name was listed as prescriber, they knew who she was, and for two years no one ever came to pick up a filled prescription besides her. “And no one ever said a word. I don’t know if they trusted me or just didn’t care.” As she reflects on her experience, she believes that dependency and addiction are interchangeable. Though often used to distinguish certain behaviors, in her experience they are effectively the same thing. Irony of ironies, she said that when she was taking opioids for an extended time she felt more intense pain than if she had never taken them. This is called hyperalgesia, whereby patients experience worse pain sensation than they previously experienced. It is a condition recognized by medical experts as a side effect of continued opioid use.

Extreme despair In an ironic twist, after giving birth to a healthy child, her physician prescribed opioids post-delivery, first through an intravenous tube, then orally. She was given a prescription for 5 mg oxycodone tablets to be taken as needed, not to exceed one every four hours. Although she filled the prescription and began taking it as directed, within two days she increased her intake in excess of the prescribed dose. When she quickly ran out of her lawfully prescribed supply, she used her own DEA license to write unlawful prescriptions to feed her own addiction. It is illegal in New York State for a prescriber to issue to herself, so she engaged in a criminal scheme of fraud and deceit, using the names of family members to acquire the pills. “I already have a prescription pad with the hospital name on it, and a stamper with my license (DEA) number, so basically I would just write the prescription under somebody else‘s name and then I would bring it to the pharmacy and fill it.” This continued for approximately one year, until her husband found her stash of pills. Though he had been aware of her past addiction, she testified that he did not know that she returned to opioids after the birth of their child. Combined with what she explained as pre-existing depression, this revelation triggered extreme despair and an attempted suicide. “Basically I felt like I just wanted to die,” she said. During her one-week stay at a psychiatric hospital she was treated with methadone, a commonly prescribed treatment for drug abusers. Upon her release, she was prescribed Lexa-

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COVER•STORY

Love

(Continued from page 1) But then desire and libido are among the emotional states that, recently, have been subjected to neuroscientific investigation. And what has emerged from that investigation is this: That, viewed through a neurobiological prism, love is a complex chemical alchemy brewed in pleasure and reward pathways deep in the brain — the very same pathways that drive instincts that most powerfully motivate and steer our behavior. And the neurological pathways of love are there

because love serves the highest and most crucial of biological goals: it is only because of love that the human race thrives and survives.

Hot or not “There is always some madness in love. But there is also some reason in madness. — Friedrich Nietzsche Romance typically starts with attraction, a pleasant feeling carrying the twin promises of passionate adventure and the happy hope of finding an ideal mate. In the attraction stage of romance, lovers often focus on the

emotional, rather than sexual, expression of their attraction. Biological anthropologists now have uncovered evidence that indicates romantic attraction evolved as a necessary foundation for attachment, and that our survival as a species depends on our being biologically wired for both. While simple lust drives us to seek a variety of sexual partners, attraction persuades us to narrow this drive to the pursuit of a specific mate. The selection of a single partner must happen before a couple stands any chance of forming attachments strong enough to keep them together during the time their children are dependent on their parental care. But sexual or otherwise, attraction is a feel-

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ing that arises in pleasure and reward pathways in the amygdale — a double-globed structure in the neocortex that assigns emotional resonance to people, things and occurrences in our environment. In infancy, it was our amygdale that had us cooing contentedly when we recognized our mother’s face. The amygdale is a part of the brain that has no ability to reason and can’t access language or spatial awareness. It is a brain structure that functions solely on an emotional level. The amygdale decides what we like and what we don’t – what we are drawn to and what we fear. In regard to attraction, it is the amygdale that decides who is “hot” and who is not. And, not surprisingly, the amygdale is involved in sexual arousal too. In fact, stimulating their amygdale in just the right way can induce ovulation in women and produce an erection in men. Sexual desire often accompanies attraction because the same cortical regions activated in sexual arousal can also be triggered by an attractive face, form or personality. It is a well-known maxim in advertising that sex sells. But whether this is true or not, it is a biological fact that beauty sells sex. Once our amygdale has pronounced a person desirable, that assessment is sent on to the brain’s frontal cortex (a part of the brain that organizes behavior toward specific goals) where feelings of attraction can be translated into the behavior of pursuit. And love’s sales pitch can also have the dual effect of influencing our environment while distorting our subjective reality. As is known in other species, loving attraction in humans may trigger the release of pheromones – hormones capable of acting outside the body and which can generate social responses in others. And just viewing the face of our beloved can disable a part of our brain that is involved in critical assessment. This effect may account for our tendency to overestimate our lover's virtues while, at the same time, overlooking their imperfections. It is a neuroscientific fact that, while love may not be blind, its vision is often far from perfect. But we all know romantic attraction can be stressful too. Everyone who has ever been in love knows that falling in love involves the element of risk. What if our tender feelings are not reciprocated? What if our loving advances are rejected? Neuroscientists now believe that stress related to the emotional vulnerability characteristic of the attraction stage of love may lay a biological foundation needed for the subsequent life task of forming strong romantic ties with our partner. Mercifully, the brain responds to the stress of initiating a romantic relationship by mobilizing neurotransmitters capable of calming anxiety and minimizing stress-related avoidance.

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The desire for sex is a powerful, instinctive drive coded in the deepest part of the human brain. Our sex drive is more than just simply adaptive; it, too, is a force critical for the survival of our species. The desire for sex occurs in the right hemisphere of our brain — the one primarily involved in lust and sexual pleasure. This finding at first surprised researchers who knew that the left hemisphere is the brain region usually activated

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COVER•STORY by pleasurable activities. The right side of the brain also has been found to be especially active in patients who suffer from hypersexuality and sexual addiction. And sex can be as addictive as the most powerful of drugs because, just like a drug, sex mobilizes a laundry list of feel-good neurotransmitters, including dopamine, adrenalin, endorphins, and vasopressin – chemicals known to promote feelings of arousal, pleasure, connectedness, calm and well-being. Vasopressin and oxytocin, the so-called “cuddle hormones,” also released during sex, help to create feelings of attachment and trust in sexual partners. Even a loving caress can make for emotional bonding. Recently identified sensory-emotive neural pathways have been shown to actually transform the pleasant sensation of a tender touch into feelings of attachment and affection. And at sexual climax, orgasm lets loose a riot of dopamine, endorphins, serotonin and oxytocin throughout the brain, toppling lovers into a happy state of ecstatic abandon. During the bliss of orgasm, the boundaries of sexual partners’ bodies seem to dissolve and lovers can experience a sense of melding together. And orgasm can also trip a brain circuit called the mesolimbic dopamine pathway — a powerful reward network well known to all who work in the field of addiction. The mesolimbic dopamine pathway is a brain circuit key to the reward and reinforcement of drug use, and is a neural pathway now implicated in several biological theories of addiction. In that spell of happy, exhausted repose as an orgasm resolves, serotonergic activity (promoting satiety) increases to supplant the orgasm’s initial dopaminergic energy (facilitating pleasure). Vasopressin and oxytocin also released during orgasm reinforce feelings of trust and emotional bonding between sexual partners. In fact, the amounts of oxytocin and vasopressin mobilized during orgasm actually increase as lovers’ emotional attachment deepens. Lovers who fire together, it appears, wire together.

circuits that govern romance evolved as a necessary adjunct to our biological system of attraction. Now it is known that romance, too, has its own distinct neurobiological underpinnings. Though its expression can vary from culture to culture, romantic attachment seems to be practically universal. A 1992 survey of 166 societies by biological anthropologists Jankowiak and Fisher found compelling evidence of romantic love in all but 19. And there seems to be a good biological reason why romance is pan-cultural. Romantic attachment, too, helps assure the survival of our species by making emotional bonds that keep partners together for the benefit of their dependent children. And, though sex and attachment can be related, they are not really the same thing. Though sex and attachment often occur coincidentally, either can occur independently. Our brains allow sex and attachment to arise singly or jointly by mediating sex and romantic attachment in overlapping parts of the limbic brain. Because romance can be so intensely pleasurable, researchers were not surprised to find that the nerve bundles governing romance are those circuits rich in the pleasure neurotransmitter dopamine, a common ingredient in all the brain’s love potions. Being in love can feel like having one’s dopamine pump turned full on. Interestingly, the dopaminergic pathways activated when lovers are together are the very same pleasure and exhilaration circuits energized by psychostimulant drugs like cocaine and methamphetamine. The stimulant-like neurochemical response triggered by romance explains why our hearts pound and our palms sweat when we unexpectedly encounter our beloved. Understanding the dominant role exerted by dopamine in romantic love, some therapists are now advising couples who fear their love is growing stale to make lifestyle changes aimed at optimizing their brains’ production of dopamine, activities like trying novel things together, engaging in regular aerobic exercise and eating freshly prepared, nutritious food. The exhilaration of love is made even more enjoyable because its passion is sweetened and mellowed by oxytocin and vasopressin, calming neurotransmitters also activated by romantic attachment. And as their love matures, partners’ romance-inducing dopaminergic activity is gradually displaced by the mobilization of trust and attachment promoting oxytocin. The discovery that oxytocin is so tied up with attachment has led some researchers to suspect that autism spectrum disorders – developmental disorders marked by difficulties in forming meaningful attachments – may be related to an imbalance of oxytocin. Infusing autism patients with oxytocin often results in a marked reduction of the disorder’s characteristic repetitive behaviors.

The dopaminergic pathways activated when lovers are together are the very same pleasure and exhilaration circuits energized by psychostimulant drugs like cocaine and methamphetamine.

The biology of romance Love is the blossom where there blows Every thing that lives and grows — Giles Fletcher Romance is the heady spice of love, the ingredient that gives love its varied, appetizing, flavors. Romance combines a delightful sense of drama with the reward inherent in forming a deep emotional attachment. For years historians, and even some psychologists, have thought romance to be a man-made notion — created in the last thousand years as a component of the medieval ideal of chivalry. But from a neurobiological perspective, romantic attachment is less something we created and more likely something that created us. There is now strong evidence that romance is an eons-old bio-emotional potential, a drive that appears to be hardwired in the oldest part of the limbic brain. Evolutionary biologists now believe that the neural

miserable – like coming down with a sudden and severe case of obsessive-compulsive disorder. We do things we normally wouldn’t, we ruminate about our lover, replaying past conversations over and over, wondering where he or she is. No matter how hard we try, we just can’t get our lover out of our mind. The sweetest of romances can become fouled by the bitterness of obsession and jealousy. Defying every sane and rational notion, obsessive jealousy can kill our partner’s love just by trying to keep it alive. The temporary madness of love’s obsession has its own neurobiological roots. Those under love’s spell tend to have less available serotonin than those not in love. Serotonin

is a neurotransmitter that helps to moderate mood and mediate the ability to quell impulse and compulsive thought. Serotonin levels in lovers can become dysregulated to the point where these levels approach the neurochemical profile of a patient who suffers from obsessive-compulsive disorder. And, in a few people, falling in love can create a dysregulation of serotonin sufficient to trigger an impulse control disorder like sexual addiction. But it appears that we might need to be a little bit crazy for love to happen at all. The intense feelings and happy impulsivity resulting from a slight depletion of serotonin might

(Continued on page 16)

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Madly in love But love can be the source of immense hurt too. As pleasurable as it can be, love can feel

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Love

(Continued from page 15)

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be the neurochemical formula most conducive for feelings of romantic attachment. Medications that help to regulate serotonin (drugs like Prozac® and Paxil®) have been shown to impair some people’s ability to have romantic feelings. And the long-term attachment that can grow out of romance may also be helped by the leveling effect being in love can exert on the hormonal differences between men and women. Women in love tend to have higher levels of testosterone while the testosterone levels of men in love appear to decline. So, in brief, and according to the most recent science, the neurobiological metric of love seems composed of equal parts chemistry, physiology, and evolution – and is more a province of the limbic brain than of the heart. And while the field of brain science has done well in explaining the neurophysiological processes that give love its power to exhilarate and motivate us, it has done little to rob love of its sweet mystery. But this is a mystery neuroscience will continue to try to solve. In coming years, new generations of electrophysiological recording devices – instruments which will allow scientists to collect data from many parts of the brain simultaneously – will likely yield new and more detailed data and perhaps a more nuanced understanding of the neurobiological bases of attraction, sex and romantic attachment. But whatever information future research turns up, the world’s poets, artists and philosophers might ultimately find it to be, at once, too much and too little. These gifted

few are apt to conclude that, like two bodies toiling in the passion of love, all this science makes for a little heat but no real light. And when all the experiments are done and the data are finally tabulated and analyzed, those whose art is to describe the many waters of love will likely find a neurobiological explanation of love every bit as dry as its dictionary definition. For these are people whose passion it is to plumb the mysteries of human experience, people who are willing to plunge deeply into the unknowable waters of love. And when they finally surface, they come to us with truths about love that researchers will never be able to provide. For love is not a science, but a sea of soundless depths and unknown boundaries, a sea of uncertain and varied weathers, a sea filled with waters that can buoy us up or draw us under, a sea that is by turns placid and stormy — a mystic sea in which scientists can only tread water but one in which artists and poets happily swim. But maybe that’s too cold. Scientists fall in love too. Jeffrey C. Friedman, MHS, LISAC is a primary therapist at Cottonwood Tucson, a 48-bed inpatient behavioral health treatment center located in Tucson, Arizona. He is a summa cum laude graduate of The School of Human Services of Lincoln University. Jeff ’s work at Cottonwood includes treating chemically dependent and disordered gambling patients, lecturing on the neurobiology of addictive and mood disorders, and presenting workshops on a range of behavioral health issues at counseling conferences throughout the Unites States, Europe and Asia. His articles have appeared in Counselor Magazine, Addiction Professional and Together AZ. Jeff can be reached by email at jfriedman@cottonwoodtucson.com.

Romance in Early Recovery

arly recovery is a time when we are still a little awkward in our practice of new, more adaptive ways of managing reawakened emotions. Feelings of lust and romantic attraction, long subdued by drugs and alcohol, may arise for newly sober men and women at a time when they still might have some difficulty distinguishing between sex and intimacy, and before they have had a chance to fully crystallize personal values and boundaries about sex and romance. For as long as 12-step recovery has been around, newcomers have been cautioned to stay out of romantic relationships for their first year of sobriety. Sadly, this advice is routinely debated or ignored by many to whom it is offered. And, though some might call it prudish 12-step dogma, there is a good scientific rationale for abstaining from romantic attachments in the first year of recovery. Perhaps the most important neurobiological challenge for the newly recovering alcoholic/addict is re-regulating their brain’s reward circuitry while dismantling a neural channel called the mesolimbic dopamine pathway. This is the brain circuit responsible for the reward and reinforcement, and subsequent loss of control, of drug and alcohol use and a neural pathway now implicated in several biological theories of addiction. As we develop better distress tolerance and learn healthier ways of being present with our emotional pain, we weaken the mesolimbic pathway. Any activity that nourishes our mesolimbic dopamine pathway can undermine this

process and empower our addiction. Sex and romance, because they are among the behaviors that mobilize dopamine in our brains, can strengthen the mesolimbic dopamine pathway in a way similar to drugs and alcohol. In fact, any of the common early recovery fall-back feeling fixers – behaviors like smoking, overeating, romance, sex, spending, and gambling — can energize dopamine in our mesolimbic pathway. In those with a predisposition to lose control over highly reinforcing behaviors, these feeling-fixers can turn into substitute addictions. And, even when they don’t, these behaviors can keep our potential to relapse to the use of alcohol or other drugs dangerously high. And there’s more. An early recovery romance gone wrong (go figure) can leave us feeling hurt, used and desperate to escape our emotional pain. As is often said in AA, “many a slip has been found beneath a skirt.” Another example of a dysfunctional recovery romance is “thirteenth-stepping,” a practice where newcomers are targeted by experienced recovery group members who selfishly satisfy their own sexual desires by using their presumed status to prey on the emotional vulnerabilities of women and men in early recovery. Though there are no reliable statistics on newcomers relapsing as a result of a broken, early recovery romance, any experienced AA or NA sponsor will tell you that this is something that happens far too often. — Jeffrey Friedman

www.together.us.com | July / August 2012

INFORMED•OPINION

Breaking From The Pack Kids at two or three eat their shoes and talk to their bananas. They are independent thinkers

By Dina Evan

on’t you love that word? Independence! It has a nice ring to it and such a strong energy and essence that you nearly expect a flag at the end of it instead of some passive punctuation. Normally, when we use this word we are talking about those who have fought in war and we celebrate them with sincere appreciation, firecrackers, noisemakers and flags. However, we live in a new era today and we are fighting a very different kind of war. Today, we are fighting for our very survival, and the weapon of this war is consciousness. Today our planet, and our survival, depends upon you becoming an independent thinker, and that is not popular, albeit priceless. People who stay in the pack with what is popular conventional thinking keep us trapped in the status quo, or take us backward. You don’t have to be a brainiac to be an independent thinker. Kids at two or three eat their shoes and talk to their bananas. They are independent thinkers. Somewhere along the way, after being stirred with a bit of parental, or societal pressure, we loose that creative imagination, and that skill. How do we get back to this desperately needed quality of character? First, we pull up our big girl and boy pants and rediscover our courage. We need to stop listening to the media, who seldom if ever tell the truth about anything anymore and we begin to listen to the wise voice inside us that really has all the answers. Perhaps, it’s time to give up our adoration for mindless entertainment and go back to perceiving the world and everyone in it from the foundation of acceptance. Let’s kick separation and animosity to the curb. It doesn’t seem to be working for us. Secondly, let’s deliberately seek out information and experiences that debunk our old ways of thinking and challenge us to move to the fertile ground of curiosity. You can find that rich soil in a new neighborhood, a volunteer position with persons who are homeless, or who have AIDS, a foreign country, a good book or a kickass master teacher that asks you to think. Tom O’Leary, an Australian Alien living in Japan says, we should begin to “practice disbelief.” I believe he means instead will-less acceptance.

the more you understand what is truly important and what is not and the freer you become to stand in and voice what the wisdom inside you knows to be true.

Proving your integrity

You can’t be independent if you let others tell you what your values ought to be. After all, the right use of will is to push the edges of our current limited awareness with compassion.

What really matters? Third, start asking your self what really matters. Is it the quality of your character and soul or is it being right and or part of the in-crowd? Being still from time to time to ask that question, has a humbling affect and tends to put

things back into the right perspective and priority. In addition, watching ourselves from a distance can be very entertaining. “It’s never too late to change the programming imprinted in childhood, carried in our genes or derived from previous lives; the solution is mindfulness in the present moment,” Peter Shepherd has said. One of the most important aspects of independence is integrity. Inherently, we are free and independent, but only in equal degree to the level of our awareness. The more you know,

Integrity is very real and tangible. Integrity is measurable and embodies such traits as: taking personal responsibility, keeping your word and being faithful in the little things. It’s about being honest, standing your ground for what is right, maintaining your honor and sense of virtue, being morally upright (however that looks to you personally), making right choices and doing what you say you will do. Integrity, like love, is something you cannot pretend to have. You either have it or you don’t, and the majority of life’s circumstances will ask that you prove that you have it. If your core belief is one of integrity, your decisions will bear that out. If not, that too will become obvious. The more you stand in your integrity, the more independent you become. You are less guided by outside influences than you are by your own center of wisdom. Ralph Waldo Emerson said, “I pack my trunk, embrace my friends, embark on the sea, and at last wake up in Naples, and there beside me is the stern fact, the sad self, the unrelenting identical (person) that I fled from.” Real independence takes courage. It’s not for sissies. Nevertheless, the truth is, that as long as you keep seeking your good feelings and applause from outside yourself, you are clearly not yet independent. You can’t be independent if you let others tell you what your values ought to be. So, this July 4th, take a moment to remember in awe, respect and gratitude those who have valiantly fought for our freedom. Then decide to fight for yours. Dina Bachelor Evan has a Ph.D. in psychology and one in holistic health and more than 20 years of counseling and coaching experience. She has written several books and created meditation CDs. She is a licensed marriage, family, and child Therapist in the State of California and has offices in Phoenix, AZ, and Los Angeles, For more information email drdbe@attglobal. net or visit www.DrDinaEvan.com.

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FINAL•WORD By Lauren McHugh

y name is Lauren and I am an alcoholic and an addict. I have not found it necessary to take a drink or a drug since October 6, 1982. I got sober when I was 35, and I recently celebrated my 65th birthday, so I have been at this sobriety business for almost 30 years, over 10,000 consecutive days without a drink. Over these past three decades, the AA program of recovery, the Twelve Steps, has provided the foundation of the life that I have learned and am still learning to live. Recovery from addiction may feel like a miracle for those who have been trapped in the horror of the disease and is often described that way by those who have found a way to break the addiction cycle. When I hear someone describe their recovery as a miracle, I always feel there is an element of magical thinking involved, that somehow something unfathomable has happened to them. I believe, however, that the recovery process is not at all mysterious, that it is in fact very practical and easily comprehended. Recovery from addiction is rarely easy, but it is always simple. The bottom line is that the way to stay clean and sober is to not use or drink, period. The difficulty is making this daily commitment to total abstinence, followed by developing, and using, the “tools” to support that commitment. Since the beginning of AA, there has been endless speculation about “how it works.” I feel it is disrespectful to this very difficult process to dismiss it with platitudes like “just fine.” Someone once said at a meeting, ”It works if you work it, and it works even if you don’t, just not for you.” Which I think is a perfect short hand for the truth about AA. AA is a program of recovery, not some mysterious miracle cure.

It’s very practical Every addict has dysfunctional physical, emotional and spiritual thought patterns and resulting behaviors that need to be discarded and replaced with functional ones. This is a large part of the “how” to establish and maintain sobriety. It’s all very practical. It’s essentially a matter of replacing the habit of substance use and abuse with the habit of sobriety by following a set of explicit directions about how to think and act. That said, I did not arrive at my first meeting shouting, “I’m home!” and never drink again. Nor did many others I have known over the years I have been attending meetings. I have heard people who have begun their re-

covery in exactly this way, but this was absolutely not my experience. I attended my first meeting of AA on May 31, 1980, and had my last drink on October 6, 1982. In the intervening months, I attended many meetings and occasionally maintained brief periods of abstinence, but I was unwilling to do the work necessary to remain clean and sober. I choose my words carefully. I could not stay sober because I was unwilling — not because I was unable. I have come to believe that it is essential to be very mindful of the words recovering people use to describe their recovery process and their state of mind, since an addict will seize on anything that provides an excuse to continue using. To say I was unable to remain sober suggests that there were forces outside of my control that dictated my actions. This is a classic excuse used by the addict to explain and rationalize relapse. To say that I was unwilling puts the responsibility where it belongs.

The “Miracle” ?

Can’t or Won’t? A very wise person once said to me, “It’s not about can’t, it’s about won’t.” The rollercoaster of abstinence, relapse and increasingly painful consequences that characterized my first years in recovery were, with the clarity of hindsight, a perfect example of my unwillingness to accept responsibility for my actions. Every time I picked up a drink or some other substance it was because an external situation made me uncomfortable, something was not going my way and I felt angry or anxious. Or perhaps my feelings were injured because someone was not appropriately appreciative of the sacrifice I was making by not abusing alcohol. As an active addict it seemed logical to be outraged because I was not getting credit for acting the way an adult would normally be expected to behave! And yet, on October 6, 1982, all of that changed. I found myself yet again hospitalized for the disease of addiction. This time, with the help of his Al-Anon friends, my husband finally found the courage to throw me out of the house and take charge of our children. He very clearly told me he was no longer willing to watch me kill myself, and unless I stopped drinking and using, I could forget about coming home. At the time I had no idea this day would mark my bottom. I had had many so-called bottoms over the past 29 months since my first meeting. So what was different this time? It is my opinion that the alcoholic and addict in recovery does the newcomer a disservice by continuing to describe what has happened in their lives as a miracle. As defined in the dictionary, a miracle is:

1. an effect or extraordinary event in the physical world that surpasses all known human or natural powers and is ascribed to a supernatural cause. 2. such an effect or event manifesting or considered as a work of God. 3. wonder; marvel I agree that when the struggle to not drink one day or even one hour at a time is no longer the constant preoccupying thought in the alcoholic’s mind and is replaced by the peace of mind that comes with surrender to the recovery process, it absolutely feels miraculous. I not only agree, I also know how it feels. However, my experience was that the conversations at meetings about miracles encouraged me to develop the expectation that if I just “kept coming” this miracle cure would somehow wash over me and I would be “restored to sanity” and essentially struck sober. That’s not in fact at all how it worked for me. Like all people, those with addictions like to feel they are somehow special or even unique. If the recovering person can stake a claim to having had a miraculous event occur in their life, this finally sets them apart in a positive way. However, it also relieves that person of the need to take ultimate responsibility for their recovery. If, as some people state at meetings, “my life is none of my business” and “I owe my recovery to my Higher Power,” then perhaps it is not a stretch for them to also believe that relapse is equally out of their control. At meetings, the members frequently talk about “hitting bottom,” about that “moment of truth” when something shifted in their minds and hearts and they “knew” they could no longer go on drinking. But there are as many AA members who also share that what they had assumed was their bottom in fact had a trap door through which they fell back into active addiction because they were no longer vigilant about doing the work that recovery requires.

Making a commitment I believe what happened in my life on October 6, 1982, was that I was finally able to make a decision to find a way to take responsibility

for my recovery. I was finally able to contemplate the possibility of making a commitment to do the work required to stay away from a drink one day at a time rather than put all my energy into trying to find a way to drink with impunity. I was finally willing to acknowledge that the disease was the winner. I understood there was no way for me to continue to drink and drug without experiencing consequences that had become unacceptable. And I recognized the ultimate result of trying to find a quick fix for my inability to deal with the emotional and psychological challenges of my life (which in truth were not that monumental!) was not only not working but was in fact creating problems far worse that the ones I was running from. So I made a decision to follow the suggestions offered by the medical staff at the hospital and my AA sponsor, to do what I was told whether I wanted to or not. Was this shift motivated by an intense desire to get and stay sober or simply by a desire to get back into my house? Was it motivated by the image I had of my life devolving to the point where I would spend the rest of my days alone in a room with a bottle? Honestly, most likely the latter. But whatever the motivation, I made the decision. The question is, was this shift in fact a miracle? Perhaps it would be more useful to describe what happens when someone like me crosses that divide between active addiction and recovery as a psychological shift. There are definitely recovering people who believe that they experience a spiritual awakening. There are those who have a personal spiritual higher power and those whose higher power is of a more secular nature, for example the AA group. What I believe all recovering, sober addicts have in common is that they have made a psychologically useful shift that enables them to put aside the terror of relinquishing what they have come to rely on as their solution to every negative emotion and challenging event in their lives. In place of that fear they are finally able to substitute a belief that help is available and change is possible. It is this shift from “defiance to reliance” that makes it possible to postpone taking that next drink or next fix when the emotional triggers

www.together.us.com | July / August 2012

FINAL•WORD

of Recovery The conversations at meetings about miracles encouraged me to expect that if I just “kept coming” this miracle cure would wash over me and I would be “restored to sanity” and essentially struck sober. That’s not in fact at all how it worked for me. begin to fire. Whether the recovering person has decided to ask for help by substituting a prayer to a spiritual higher power or making a phone call to an AA sponsor or sober friend to talk through the challenging situation, the fact is that the thought pattern and behavior has changed. This is a “wonder and a marvel.” This change is the result of a conscious decision the person has made to break an old habit of thought and behavior. It is a decision to trust that by thinking and behaving differently the result will be different, the outcome more positive. If this is in fact a miracle, it is at least one in which the addict has chosen to participate rather than one that is simply happening to him or her. I can tell you, as can most people in recovery, the first time this shift happened, the first time I honestly asked for help and then took responsibility for following suggestions. I was sitting in my hospital room having been literally dragged off to detox by paramedics early in the morning of October 6, 1982, after a night of lying in bed drinking vodka, smoking pot and snorting coke while listening to Bette Middler sing “The Rose” over and over again on my walkman (this was after all 1982!) My long -suffering sponsor, Ann, came to see me. I had been “rehab shopping,” deciding where I would be most comfortable spending the next month or so since my husband, having joined Al-Anon, finally had the wherewith all to tell me I could forget about coming home until I stopped using. I was in search of some place with the appropriate amenities, comfortable private rooms, enough activities to keep me amused. This was my third hospitalization that year and I had spent six weeks in rehab earlier that year as well but my primary concern was that I would move on to some facility that met my standards.

So without any expectations, I did what she told me to do, which in and of itself was a dramatic change. What happened might in fact have been a kind of spiritual awakening. I didn’t see any flashing lights, but I did feel a definite emotional and psychological shift. It was as though something within me, perhaps my spirit, was awakened to the possibility that I could choose health over self-destruction, literally life over death. I finally made that third step decision, if not to turn my life and will over to the care of God, at least to turn it over to the care of Ann and the professionals at the hospital. What followed was a series of opportunities to say “yes” rather than “yes, but” which had always been my pattern, opportunities to overcome my resistance to following directions and do what I was told whether I wanted to or not. And to make a very long story very short, I have not found it necessary to pick up a drink or a drug since that day. This first experience provided what is often called “a sober reference.” This sober reference becomes a mental touch stone that can be triggered the next time a similar situation comes up, which it inevitably will, in the same way, and as a substitute for, the trigger to drink or drug. It serves as evidence that change is possible if not easy. And it reinforces that psychological shift. The recovering person experiences the positive results of believing that they are not alone and the positive outcomes of acting on that belief. They understand that help is available and that it is possible to learn how to deal with life’s challenges without using.

Following directions Ann pointed out that since I was in fact now homeless, perhaps my priorities were a bit skewed! She said to me, “Maybe now you will be ready to get down on your knees and beg this God that you say you don’t believe in, and clearly don’t understand, for the willingness to be willing to follow directions!” She was done with subtleties, no more of “this is only a suggestion.” She was now clearly going to tell me what to do. Ann made it clear that in her opinion my life depended on my cooperation. This was now the time to “act as if ” and no matter what my reservations, behave as though I was willing to do whatever it took to get and stay sober.

In practical terms, and in my experience, the decision stated in AA’s third step to turn one’s life and will over to the care of God as we understand Him is in essence a decision to believe and then act as if one is in fact being taken care of even in those life moments when one does not feel taken care of. It is a commitment to use the strength that comes from that belief. It is a commitment to resist relying on habitual thought patterns and the resultant self-destructive behavior.

Picking up the phone In my case, this decision made it possible for me to try something different. To choose, for example, not to pick up a drink but rather to pick up the phone. It was a decision to trust those who had gone before. This decision to learn how to live life one day at a time without impulsively giving in to the compulsion to pick up a drink or a drug was in fact amazing. I suddenly became willing to believe that those recovering in AA had fact found a solution that worked and most importantly that that solution was available to anyone, even me. All that was required was to ask for help and then commit to follow the program of AA, to doing the work as outlined in the steps. The essential thing for anyone seeking recovery is to find a way to not to pick up that first drink or drug one day at a time. The beauty of the AA program is that within the framework outlined in the steps and the suggestions put forth by those who have gone before, there is much room for personal interpretation and the

development of personal recovery practice to help the addict “stay stopped.” What works for one recovering person does not necessarily work for another. If believing there has been a miracle provides that way “up and out,” who am I to argue? I would only urge that the absence of experiencing a miracle does not serve as an excuse to continue to self-destruct. Or that the addict who has that “white light” moment, should ever take that miracle for granted and stop doing the work necessary to staying sober. The psychological shift from “defiance to reliance,” the behavioral shift from self-destruction to selfcare, must be carefully protected. I have witnessed the trap door of addiction open and watched recovering addicts who seemed to have it all together plummet back into the horror of active addiction after days, weeks, months, years and even decades of continuous abstinence. No one of us is immune. but we are all capable of continuing, one day at a time, to do the work necessary to participate in this miracle of recovery. Lauren Hughes received her BA from Brown University in 1968 and her MSW from Columbia University in 1970. She is a Licensed Clinical Social Worker in the State of Connecticut and a Licensed Masters in Social Work in New York State. She is a certified as a Master Social Work Addictions Counselor. She has a private therapy practice in Ridgefield, CT, and works for the Wilton Department of Social Services in Wilton, CT. Lauren can be reached at 203-6132903.

Do You Need Help? Resources & Links

Together’s mission is to serve the extended community of individuals and families seeking information about relief from addiction-related issues to lead healthier and happier lives. Here is a partial list of referrals with a more comprehensive list on together.us.com. Together is not affiliated with any 12-step program or organization, although we do support them all. One essential of recovery is knowing you don’t have to walk alone.

12-step organizations

Adult Children of Alcoholics Al-Anon & Alateen Family Groups Alcoholics Anonymous Chapter 9 | Couples in Recovery Cocaine Anonymous Codependents Anonymous Crystal Meth Anonymous Debtors Anonymous Food Addicts in Recovery Anonymous Gam-Anon Gamblers Anonymous Marijuana Anonymous Narcotics Anonymous Overeaters Anonymous Sex & Love Addicts Anonymous Nicotine Anonymous

Telephone

562-595-7831 212-941-0094 212-647-1680 888-799-6463 212-262-2463 646-289-9954 212-642-5029 212-969-8111 781-932-6300 718-352-1671 888-424-3577 212-459-4423 212-929-6262 212-946-4599 212-946-5298 212-824-2526

National and institutional organizations Call Us Today! 888-44-DETOX www.SunriseDetox.com

Call Us Today! 888-44-DETOX

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Center for Alcohol and Substance Abuse Center for Substance Abuse Treatment National Association of Addiction Treatment Providers National Clearinghouse of Alcohol and Drug Information National Council on Alcoholism and Drug Dependence, Inc. National Eating Disorders Association National Institute on Drug Abuse National Institute on Alcohol Abuse and Alcoholism Partnership at DrugFree.org

Website

adultchildren.org nycalanon.org nyintergroup.org chapter9couplesinrecovery.org canewyork.org codependentsnyc.org nycma.org danyc.org foodaddicts.org gam-anon.org gamblersanonymous.org ma-newyork.org newyorkna.org oanyc.org slaany.org nicotine-anonymous.org

casacolumbia.org csat.samhsa.gov naatp.org health.org ncadd.org nationaleatingdisorders.org drugabuse.gov niaaa.nih.gov drugfree.org

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