Dec13 issue

RELATIONSHIP BETWEEN CHILDHOOD TRAUMA AND ADDICTION FROM PRESCRIPTION DRUG ‘SAMPLES’ TO ADDICTION: ONE DOCTOR’S JOURNEY TO HELL AND BACK AS SICK AS OUR SECRETS HOW TO ENJOY THE HOLIDAYS WHEN YOU OR YOUR LOVED ONE HAS AN ADDICTION ALCOHOL: THE EFFECT ON MIND, BODY & SPIRIT ADDICTION: A NEUROBIOLOGICAL ILLNESS AND STRESS REGULATORY DISORDER INTERVENTIONS- THE FIRST STEP

THE DANGERS OF LAUNCHING WHILE INTOXICATED - LWI AND ARRESTED DEVELOPMENT SEASON’S GREETINGS FROM SUNCOAST REHABILITATION CENTER ADDICTION WITHOUT DRUGS-A GROWING MENACE! IS ADDICTION TREATMENT REALLY EFFECTIVE? RAISING BRADY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT FORCES SUBSTANCE ABUSE TREATMENT TO RETHINK BUSINESS MODELS

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs and alcohol in Palm Beach County. It is also distributed locally to all Palm Beach County High School Guidance Counselors, Middle School Coordinators, Palm Beach County Drug Court, Broward County School Substance Abuse Expulsion Program, Broward County Court Unified Family Division, Local Colleges and other various locations. We also directly mail to many rehabs throughout the state and country.

We are expanding our mission to assist families worldwide in their search for information about Drug and Alcohol Abuse.

Our monthly magazine is available for free on our website at www.thesoberworld.com.

If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest man-made epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns.

Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied.

Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20’s and 30’s right up to the elderly in their 70”s, thus, creating a generation of addicts.

Did you know that Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it?

Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction.

provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under 18 yrs. old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs, Extended Living and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean.

Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents.

These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with anyone outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction.

Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy.

He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him.

My son was 7 months clean when he relapsed and died of a drug overdose.

I hope this magazine helps you find the right treatment for your loved one.

They have a disease and like all diseases, you try to find the best care suited for their needs. They need help.

I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved one’s life.

They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin.

Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com.

I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from.

I want to wish everyone a Happy Hloiday.

There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that

To Advertise, Call 561-910-1943

We are also on Face Book at The Sober World and Sober-World Steven.

Sincerely,

Patricia Publisher

Patricia@TheSoberWorld.com

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The Sober World. is a FREE magazine for families and parents who have loved ones with addiction problems. We offer an E-version of the magazine monthly. If you are interested in having a copy e-mailed, please send your request to patricia@thesoberworld.com For Advertising opportunities in our magazine please contact Patricia at 561-910-1943.

In the new format, you will find our expanded list of resources and services, important links and announcements, gift, books and articles from contributors throughout the country.

As part of our effort to improve our magazines online presence, we now have included an interactive forum where we invite and encourage you to voice your opinion, share your thoughts and experiences.

We strongly encourage those in recovery and seeking recovery to join the forums as well.

Please note: Our forum allows you to leave comments anonymously.

Please visit us on Face Book at The Sober World or Sober-World Steven Again, I would like to thank all my advertisers that have made this magazine possible, and have given us the ability to reach people around the world that are affected by drug or alcohol abuse. I can’t tell you all the people that have reached out to thank us for providing this wonderful resource.

For more information contact Patricia at 561-910-1943 5

RELATIONSHIP BETWEEN CHILDHOOD TRAUMA AND ADDICTION

By Dr. Asa Don Brown, Ph.D., C.C.C., N.C.C.M.

The relationship between traumatic experiences in childhood and the later onset of addictive behaviors in adulthood is undeniable. A tremendous amount of research has shown a direct correlation between traumatic experiences per childhood and addictive behaviors later in life. While addictive behaviors are masking the real problem; the addiction itself becomes the forefront of the person’s persona.

Addictions come in an array of issues stemming from chemical and substance abuse, to pornography and sex addiction, to gambling and financial addictions, to a broad array of addictive attachments. Through our addictive attachments we are seeking to fill the voids, or perceived emptiness, within our lives.

The addictive attachment has been shown to fill the void of the human bond or attachment that was underdeveloped in childhood. The underdeveloped attachment is frequently caused by childhood abuse, traumatic experiences, neglect and maltreatment.

The Nature of Addiction A recent study found that “women who experienced severe physical or sexual abuse during childhood were much more likely to have a food addiction as adults than women who did not experience such abuse. The study’s findings provide valuable new information regarding potential causes and treatments for food addiction and obesity. Addiction recovery specialists have been addressing this link for years with their patients, and self-help groups have much experience with it.

Addiction issues are just as prevalent in males. It used to be thought that women were not as susceptible to addictive tendencies, characteristics, and/or vices. Therefore, many of the addictive models and treatments programs were intentionally created for the treatment of men.

Although research has shown that men are more likely to develop and maintain addictive issues; “...research also suggests that since the 1970s, this gender gap has been narrowing, as drinking by women has become more socially acceptable.” (Harvard Mental Health, 2010, Newsletter) THE MINDSET OF THE ADDICT...

The addict is not necessarily seeking the addictive vice; rather they are seeking to fill a void that has been plaguing them throughout their human evolution. While the addictive personalities do vary, one singular idea remains the same; the addict has an innate desire to feel, to experience, to be attached.

While what they are seeking to fulfill may vary; the very notion of feeling, experiencing, and being alive is true in a majority of cases.

The mind of the addict yearns for fulfillment. Although many of my counterparts may explain the mind of the addict as being chemically dependent upon the vice, the truth is, all addictive personalities have a very similar need; fulfillment.

While there is no doubt that a chemical imbalance, or need, is a common theme amongst many addicts; there is also a similar deprivation that stems from childhood traumatic experiences and an inability to properly attach.

As a clinician, I have yet to encounter an addict without an egregious history or a traumatic experience. It is not to say that there could not be an addict without an egregious past, but there appears to be a common theme of lacking of attachment amongst a majority of those who have addictive personalities. Now let’s clarify, not every person who has been traumatized has been incapable of properly attaching to a parental figure; however, in a majority of cases, attachment is made insecure when abuse is endured within the home. If, a child is incapable of feeling and experiencing an environment of safety within the home, the likelihood of becoming detached is greatly increased.

Early trauma also has consequences for how human beings respond to stress throughout their lives, and stress has everything to do with addiction.

Stress is a physiological response mounted by an organism when it is confronted with excessive demands on its coping mechanisms, whether biological or psychological. It is an attempt to maintain internal biological and chemical stability, or homeostasis, in the face of these excessive demands.

In relationship to childhood abuse and trauma, homeostasis is the ability to remain balanced in the face of imbalance or instability. It occurs when we are receiving the proper supports, validations, and reinforcements in spite of chaos that maybe occurring in our home or in our social environment.

The Repercussions of Childhood Traumatic Experiences According to clinical research, the odds of developing an addiction or psychological disorder are drastically increased when a child endures trauma or abuse per childhood. “In clinical practice, childhood trauma percentages may run close to one hundred percent. Not all addicts were subjected to

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childhood trauma, just as not all severely abused children grow up to be addicts. However, clinical experience has shown that a majority of hardcore injection users were subjected to childhood trauma.

Researchers have discovered that “trauma experienced in childhood often has profound effects upon the overall development of the individual.

Trauma experienced in childhood may be disguised or obscured by a child’s own temperament. Childhood traumatic experiences may be obscured or disguised by encouragement of one’s peers, the familial environment, academic influences, cultural dynamics, religious mores and ethos, medical and psychological constructs of the individual, and overall social constructs.

Apprehension of disclosing traumatic experiences and/or abuse may be manyfold. A child may be apprehensive with disclosing the traumatic experience, out of fear of possible repercussions or rejection. “Children may have fears about disclosing traumatic experiences—they may be dismissed as false allegations or tales, dependent upon the children’s age or intellectual quotient; and they may be sheltered from the parents or caregivers by the children themselves out of fear associated with their traumatic experience.

Unfortunately, not all parental caregivers are willing to recognize the probability of dire effects occurring per the child’s traumatic experience. Parental caregivers are often inclined to ignore, shelter, or dismiss the childhood accusation, disbelieving facts pertaining to the effect of the trauma, either because of the child’s age, intellectual quotient (IQ), and/or as an unconscious or conscious safeguard. Parents may also be dismissive if the traumatic experience occurs by the hands of their spouse, familial relation, close friend, and/or significant community leader (religious, academic, recreational).

Predicting Traumatic Experiences A difficulty in predicting childhood traumatic experiences and the outcomes of those experiences; stems from the variation of ... severity, frequency, longevity, and duration of the traumatic experience, as well as the temperament of the adult victim of childhood trauma. The variations may be in part due to the child’s own temperament, the child’s own coping skills, environmental and social conditioning, and the nature of care-giving received during childhood. Moreover, those involved directly and indirectly with the child may be unaware of the effect that the traumatic experiences has had on the life of the child, thus delaying the child’s ability to receive much needed care. The attention and immediacy of care is often the key to recovery for any person affected by trauma.

THE LINK BETWEEN TRAUMATIC EXPERIENCES AND ADDICTION A person’s environment includes many different influences, from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting can greatly influence the occurrence of drug abuse, escalation to addiction in a person’s life.” The link between traumatic experiences per childhood and addiction are not always clearly defined, but research has shown a correlation between childhood trauma and addiction.

Research has clarified that childhood traumatic experiences can have a profound affect on the psychological, biological and the physiological development of children. Children, who have experienced trauma, have an increased chance of developing physiological and psychological disorders such as: Irritable Bowel Syndrome, IBS; Posttraumatic Stress Disorder, PTSD; Reactive Attachment Disorder, RAD; Mood Disorders; Personality Disorders; and a host of chronic physical and psychological issues. Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease; early abuse may contribute to virtually all types of mental illness.”

Addictive Desire Addicts who have been traumatized are seeking to heal themselves, to bring forth pleasure and to feel fulfilled. The pleasure center (also known as the reward circuit) is responsible for engaging and reengaging acts that bring forth pleasure and satisfaction. The primary areas affected by pleasure are: amygdala (emotion regulation); nucleus accumbens (controls the release of dopamine); ventral tegmental area, VTA (technical center of release of dopamine); cerebellum (controls muscle function); and the pituitary gland (the region for releasing beta-endorphins, which is responsible for a reduction in pain); oxytocin (fortifies feelings of trust); and vasopressin (pituitary Continued on page 30

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FROM PRESCRIPTION DRUG ‘SAMPLES’ TO ADDICTION: ONE DOCTOR’S JOURNEY TO HELL AND BACK - AS SICK AS OUR SECRETS

by Steven H. Farber, MD

The painful truth: Physicians are not invincible when it comes to drug addiction. Approximately sixteen percent of the medical profession suffers from alcoholism or some form of substance abuse or addiction.

Doctors are human just like the rest of society. They are prone to physical illness and emotional distress. If anything, the often unbearable daily stress put on physicians, especially in training, leads to depression and early burnout, which, in turn, leads to the use of alcohol and other chemical substances. Unfortunately, people often believe that medical professionals are superhuman. Unfortunately, they can’t leap tall buildings in single bounds, and they shouldn’t be expected to do the impossible. Everyone in the medical field deals with the constant, unrelenting stress of dealing with acutely ill patients. Nurses are also prone to the same problems as physicians, sometimes even more so.

I was at the top of my career as a respected cardiologist when, suffering from professional burnout after twenty-five years of taking care of acutely ill patients, I discovered medicated bliss through prescription drug samples of Xanax that were constantly being brought to my office. This escape eventually turned my life upsidedown. After losing my medical license and experiencing the death of a friend from an overdose, I finally hit rock bottom. I threw away everything that I had worked hard for, while also alienating myself from my family.

Now imagine your worst nightmare … the doctor who is to perform your surgery is traveling on the same destructive path during the hours leading up to your operation. Make no mistake, it happens.

When you consider that doctors and nurses have very easy access to prescription drug samples, it’s not surprising that addiction is an epidemic that is rarely spoken of in medical communities.

In As Sick as Our Secrets, perhaps the most candid book ever written about addiction, I take you on a journey...my journey. My recollections of addiction’s darkest days are powerful, but the most powerful message of my book is one of hope....of freedom from addiction and the problems that cause it.

Addiction to prescription drugs is responsible for more deaths in our country than traffic accidents. Furthermore, half of all adults over eighteen have a friend or family member who is suffering from alcoholism or addiction to illicit or prescription drugs.

The numbers are astonishing. According to Sanjay Gupta, MD (CNN), “Every 19 minutes, a person dies from prescription drugs.” In addition, data from the Center for Disease Control (CDC) confirms that deaths from narcotics have quadrupled over the last decade.

The majority of people don’t understand that addiction is a complex problem rather than a curse or a moral judgment. It is a disease that affects the majority of us in one way or another. Most of us have an addiction to something, whether it is alcohol, sex, drugs, shopping, eating, gambling, smoking, or a variety of other things. It is an infirmity that cripples us physically, spiritually, and emotionally. The problem may be complicated, but the solutions are simple and straightforward.

Craving is a physiological process that involves neurotransmitters in the brain. When a person becomes an addict, they no longer have a “choice” about whether to pursue their addictions. That person becomes powerless over whatever satisfies their craving. Addiction is also a disease of the mind that involves a lack of proper perception about who we are and how we fit into the world around us. It is a symptom of a spiritual void which we try to fill with what turns out to be an illusion. We try to palliate a pain that is unrelenting and unreachable deep inside of us.

The first step in the solution to alcoholism and addiction is to admit that we are powerless over something that has taken control of our lives. I had to reach a point of desperation where I had no choice but to look at myself and my life and ask myself: Do I want to live or do I want to die? Am I sick and tired of being sick and tired? Here I was, a well-respected cardiologist in my community for twenty-five years, reduced to crawling on the floors of dingy hotel rooms looking for

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shards of crack cocaine at the age of fifty-five. After all of those years, I had everything, yet I had nothing.

I was in the darkest days of my life without a spiritual compass or a relationship with God. All of my material possessions were gone in a heartbeat. I was an absentee father, and when I was present, I was under the influence of drugs that changed my personality radically. I was no longer the understanding father, friend, or doctor.

People didn’t know who I was, and worst of all, I didn’t know who I had become either. I began to lead a Jekyll and Hyde life, hiding my addictions from the world, that is until they caught up with me, which they eventually will. It was as if an alien had come down from another planet and invaded my body. I was a different person. I had changed from being moral and responsible into someone who did things that I knew were wrong, unhealthy, and downright dangerous, not only to myself, but to those I loved. I exposed my own children to dangerous situations. That is the power of addiction.

As Sick as Our Secrets is the compelling description of my journey to hell and back. Some readers will see themselves reflected in its pages and identify with my feelings and experiences. This could be your story or the story of a friend or loved one.

This book is meant to hit the reader in the gut. It is important to understand the destructive forces of addiction and its deadly impact on our society. Addiction affects millions of people every day, and we must tackle it head-on and not sweep it under the rug until we read about the Michael Jackson’s and the Whitney Houston’s of this world.

“Addiction is the voice of desperation. It is a cry for help from millions of people who are being tormented by their demons. There is no end to suffering in the dark shadows of the cave if we isolate ourselves behind veils of secrecy. There are only false promises and the illusion of happiness. Yes, the temptation of darkness and its hidden secrets will always be there. It wages a war within our souls every moment of every day, and we must be vigilant in order to recognize its presence and resist its destructive nature. We should live as if every moment is our chance for happiness, while recognizing that every speck of time is precious, and life is short. My recovery has enabled me to take responsibility for my actions and has given me the opportunity to learn from my mistakes. My past has been a blessing because it allows me to see that isolation is not the answer to my pain and suffering and that I no longer have to fight the terrible battle against addiction by myself.

You see, all of us need the help of others who are struggling and they need our help as well. The battle against addiction can be fought only one day at a time and one moment at a time.”

-Excerpt from As Sick as our Secrets Read as Sick as our Secrets if you want to discover the solution to the epidemic that is destroying our society. Miracles happen every day around us and within us. We just have to learn how to change our perceptions, not only of ourselves, but of everything around us. In the process, we learn how to escape our darkest hours and find the light of love and forgiveness.

Steven H. Farber, MD, received his medical degree from Hahnemann Medical College and Hospital. He completed an internal medicine residency program and cardiology fellowship at the Baylor College of Medicine in Houston, Texas. He founded a non-profit organization called HEART of Montgomery County to improve access to affordable healthcare for the community’s indigent and uninsured population.

In 2003, Dr. Farber published Behind the White Coat, a personal memoir, and then co-authored Stepping Stones to Success with Deepak Chopra and Jack Canfield in 2011.

As Sick As Our Secrets is available at www.Amazon.com, www.BN.com and www.sickasoursecrets.com

To Advertise, Call 561-910-1943

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HOW TO ENJOY THE HOLIDAYS WHEN YOU OR YOUR LOVED ONE HAS AN ADDICTION

By Candace Plattor M.A, R.C.C Another year has gone by and “The Holidays” are fast approaching—although if you’re anything like me, you’re still wondering where September went!

The time has come when we are once again seeing commercials on TV and in magazines about how wonderful the Christmas season is, that it is better to give than to receive, and how warm and loving families are, especially at this time of year.

But the reality is that, for many of people, this is not a time of peace and joy...

However, because there is so much shame associated with not having positive holiday times, most people don’t talk openly about how difficult this time of year can be for them. This can lead to intense feelings of loneliness, disappointment, and even shame.

And when any form of addiction is thrown into the mix, this season of the year can be anything but jolly.

If you can relate to any of the following, then this article may give you some helpful tips for getting through the holidays.

1. IF YOU ARE STILL IN “ACTIVE ADDICTION” If you are still using your addictive behavior of choice, I want to congratulate you for reading this article, because it likely means that you are getting closer to reaching out for some help. Please know that all of us who have been in the throes of addiction have felt the same shame, guilt, hopelessness and despair that you are feeling right now. Every year, thousands of people all over the world are able to stop engaging in their addiction—and you can be one of them!

At this time of year, instead of spending time with your family, it may be wiser for you to sign yourself into a detox or a treatment center, or to call a professional Addictions Counselor. Although this may feel lonely, it may be easier than facing those same arguments and disappointments that you and your loved ones have experienced during past holidays.

Attending a support group such as Alcoholics Anonymous or Narcotics Anonymous truly understand you because they, too, have been where you are now.

If you are unsure of what to do, you might want to seek help from a trained professional to explore options and to make the best decision for yourself.

Don’t be afraid to openly address your loved one’s addiction BEFORE the family get-together. Otherwise, you may find yourself with “an elephant in the living room” that nobody acknowledges, and you will feel as if you have to walk on eggshells and continue your accommodating behaviors just to keep things under control.

For example, when dealing with family members who are alcoholic, you could let them know beforehand that you would love to have them there, as long as they understand that the expectation is that they will remain sober. If they choose to drink after being informed of this boundary, inform them that you will be asking them to leave.

If your loved one does not agree to this boundary beforehand, then it is best not to invite him or her to the gathering. Openly discussing these options with other family members and having their support when setting these boundaries can be crucial for the success of the gathering. Let them know your thoughts and feelings, and the specific help you need, whenever possible.

Please know that learning how to set these kinds of boundaries takes time and practice, but you can definitely do it! If you feel that you need help with this, get in touch with a professional counselor or therapist who can assist you. Many therapists work during the holiday season because they know that their clients need them at this time.

I hope these suggestions will help you have a happier holiday season than you may have had in the past. Deciding on whether to spend time with family over the holidays is not an easy decision. Remember to do the things that will help you achieve and maintain greater self-respect, and to let that be your guide during a potentially emotionally perilous time.

Candace Plattor graduated from the Adler School of Professional Psychology with a Masters degree (M.A.) in Counseling Psychology.

Candace’s award winning books Loving an Addict, Loving Yourself: The Top 10 Survival Tips for Loving Someone with an Addiction and Loving an Addict, Loving Yourself: The Workbooks are available in bookstores throughout Canada and the US. Please visit her website for more information: www.candaceplattor.com

2. IF YOU ARE IN “EARLY RECOVERY” I generally consider “early recovery” as anywhere between having one day to one year of not engaging in your addictive behavior of choice.

If you are in early recovery and involved in one of the popular self-help groups, there may be alternatives to “going home” for the holidays. These can include potluck dinners, dances, and other social activities, as well as extra meetings that have been scheduled for this time of year. If you’re involved in one of these groups online, there are often chats and meetings that you can join to discuss your feelings, where you can give and receive some extra support.

YOUR JOURNEY BEGINS HERE...

If you are not involved in a recovery program, spending time with friends who understand where you currently are in your life can be a wise alternative. These friends can provide loving support without the emotional triggers that often accompany your visits home.

M EDICA T ION A SS IST ED RE COV E RY

If you do decide to spend the holiday with family who live out of town, it is a good idea to have some support lined up for yourself. For example, before you leave, check out whether there are 12-Step or 16-Step meetings where you will be. You can also explore the online availability of these programs, either as your primary source of support or as backup.

STRUCTURED, SUPPORTIVE COMMUNITY COMFORTABLE, SINGLE OCCUPANCY UNITS STEPS TO THE OCEAN AND DOWNTOWN DELRAY BEACH

In addition, you can line up some people to support you where you currently live. Keep in touch with your friends, if they are either non-users or in recovery themselves. If you have a sponsor, checking in with that person daily, either by phone or online, would be a good idea. If your counselor or therapist offers phone counseling, book an appointment or two for the time you will be away.

There are also Crisis Centers in most urban areas that you can call. Some are open 24 hours a day, 7 days a week, while others have more limited hours of operation. Finding out when they are open and how to reach them is another wonderful way to be proactive and take care of yourself while you are away.

3. IF YOU ARE A “LOVED ONE” OF SOMEONE WITH AN ADDICTIVE BEHAVIOR If you are a loved one struggling with a family member’s addiction, you may find yourself tempted to over-function in order to reduce your anxieties and to make certain that everything goes well. But having an addicted person at your gatherings can make everything much more difficult.

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ALCOHOL- THE EFFECT ON MIND, BODY & SPIRIT

By Dr. Michael J De Vito

“Marley was dead, to begin with. There is no doubt whatever about that. ...Old Marley was as dead as a doornail.” These few words start the opening scene of one of the most recognized classics of the holiday season, A Christmas Carol, by Charles Dickens. This timeless short story has become a part of our December traditions and memories, along with Menorahs, Christmas lights, shopping, family gatherings, and year end celebrations. It is that time of year again, a time of joy and festivities for many, yet unfortunately a time of bad decisions, wrong turns and heart-ache for others. For that latter group alcohol is all too often the focus of predicable negative outcomes.

Alcohol use and production has been an integral part of our human history, festivities and culture since recorded time. It remains part of our culture today.

Every individual from adolescence on has a point of view regarding alcohol use. In other words we all have a relationship in some way with alcohol. That relationship can range full spectrum, from abstinence and intolerance, to acceptance and regular use, with all colors in between. That is part of our philosophy of life, our world view, how the mind perceives the use and abuse of alcohol. That world view is shaped daily by our culture, our social circle, our media indoctrination and our personal interactions. These factors create the collective consciousness of our human experience. All of our perceptions, thoughts, emotions, memories, beliefs and imaginations create our philosophy of life, The Mind, which includes our point of view regarding the use of alcohol.

The Mind can be controlled by our past, can affect our present, and can dictate our future. It is what leads the abuser and the alcoholic to be in denial, to justify use, to blame others, to live a life of deception, and to become more and more isolated over time. The Mind allows loved ones to be enablers. It permits them to willfully be distracted and minimize the truth of what is happening right before their eyes. It is the Mind that helps a child seek out a way to cope and survive in a surrounding family storm.

Everyone has a relationship with alcohol.

Our Mind and the minds of those we are teaching need to be nurtured and protected, not abused and polluted. Benjamin Franklin was quoted as saying, “A house is not a home unless it contains food and fire for the Mind as well as the Body”. Alcohol affects the Mind of everyone who uses it or is affected by it.

Alcohol is a simple compound, a by-product of the breakdown of simple sugars. And yet this simple two carbon molecule is physiologically perceived by the body, to be a poison. Additionally, highly toxic byproducts of the enzymatic breakdown of alcohol such as acetaldehyde are recognized as poisons also and must quickly be broken down further into harmless molecules to be excreted from the body. In some individuals with one of the genetic predispositions for alcoholism other by products such as THIQ are inadvertently produced. These unintended by-products increase the affinity for and the reactions of alcohol abuse. In the normally functioning individual toxic by-products, with the exception of THIQ, are broken down and eliminated by the liver, kidneys, lungs, digestive tract and skin As use, age and time go by the body functions less optimally and the effects of these toxins begin to take a toll. College students seem to bounce back in time for Monday morning classes. They have youth, health and less years of abuse in their favor, at least for a while. The greater the frequency or volume of alcohol use the greater this toxicity begins to overtake the target organs of the body. This social and often anti-social activity begins to take a toll on the brain, liver, heart, kidneys, esophagus, stomach, and other vital organs and systems.

Alcohol affects the brain. If we are a user socially or habitually of alcohol that is one of the reasons we left our abstinent relationship and continued with use. We liked the effect alcohol has on the brain. We liked the relaxation, the reduction of inhibition and the emotional change to a feeling of well-being, all of which are short lived. Other less desirable effects include slowed reactions, false confidence, bravado, slurred speech, short and long term memory loss, poor judgment, physical sickness and numerous other cognitive and physical impairments. We tend to remember the initial happy effects and forget the latter negative consequences. Each use has a lasting effect in the brain. Over time these effects become more obvious. Long term memory loss, brain chemistry deficiencies, lack of wellbeing, altered sleep patterns, separation from reality, psychotic events and much more physical destruction with predictable outcomes. The brain perceives alcohol as a poison.

Alcohol affects the liver. The liver has multiple functions in maintaining healthy homeostasis and physiology. It is the body’s filtration system, energy

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reservoir, participant in normal digestion and numerous other vital activities.

The introduction of alcohol and habitual use gives the liver an additional job, the detoxification of the toxic effects of alcohol on the body. Over time this begins to overwhelm the normal function of the liver and begins to destroy normal liver cells resulting in liver enlargement, fatty tissue and ultimate scarring of once normal liver cells, Cirrhosis. Liver enzymes become physiologically unbalanced leading to less efficiency in normal liver function and potential shutdown. The liver perceives alcohol as a poison.

Other common health conditions treated daily in our family physicians office that could naturally be eliminated or controlled by abstaining from alcohol are high blood pressure, erectile dysfunction, depression, anxiety, sleep disorders, upper and lower digestive problems, accidental injuries, (in and out of the home), Type 2 Diabetes, obesity and other numerous lifestyle conditions. How much better off would we be if we did not take the pharmaceuticals prescribed to treat these conditions in the first place?

Alcohol affects the Body in a negative way.

And now a gentle warning to any of the Secular Humanists who may have read this far, I am going to talk about the Spiritual aspect of alcohol use.

Yes, I may even mention God. Please discontinue reading now. I don’t want this article to be the cause of any insomnia, anxieties or indigestion you may experience over your version of the Holidays.

Let me be clear that I do not believe that for the non-abuser or non-alcoholic that the occasional social use of alcohol, the glass of wine with dinner, a beer with friends, or a toast at our daughter’s wedding is going to separate us from our spirituality, our health, or the personal connection we have with God. However, I do believe that the greater our willingness to tolerate alcohol use, the greater our devices to protect our drinking habits, the greater the risk becomes for negative consequences. That brings us back to The Mind and Body connection. Therefore, I believe the safer and wiser decision is the abstinence from alcohol to better protect a healthy Mind, Body and Spirit.

When the negative consequences of alcohol use begin, such as family dysfunction, academic and career disruptions, repetitive DUI’s, aggressive disruptive behaviors, isolation, constant lies and broken promises, the perception of who we are begins to change. That perception of ourselves that we develop over time is not a positive one. Self-confidence and selfesteem are lost or badly damaged. No personal connection has value or meaning. That includes any personal connection we may have had with God. That separation from ourselves, others, and God is spawned and maintained by us. We are sentient human beings with a spirit. We yearn for connection. However, as we progress in addiction we feel less and less worthy of acceptance. By our own self condemnation through the guilt and shame of our past actions we reject not only our physical connections; we reject our spiritual connections as well. We become our own source of isolation, and that isolation is harmful. Self-condemnation is overcome through the spiritual reconnection with God. Alcohol affects us spiritually.

The hallmark of all addictive and compulsive behavior including alcohol abuse and addiction is denial. Denial is that bolted door that every therapist, counselor, family member and physician must get past if we are going to have a chance of intervening and helping to change lives for the better.

The recognition of past and present events and the visions of the future outcomes must be seen and understood. That does not dramatically come when the “last stroke of twelve has ceased to vibrate” accompanied by ghostly apparitions. But it must be just as eye opening and profound for us to overcome denial and seek a new direction. As Ebenezer learned in the end of that Christmas classic we all have the capacity and strength to change.

Recovery is real and always available. Our past may be written but we still have pen in hand to write the new script for our present and future. Have a Happy Hanukkah, a Merry Christmas and a Healthy New Year.

Dr. Michael J. De Vito is a diplomate and is board certified in Addictionology. He has over 30 years of experience in successfully guiding patients and clients on the path of Recovery Consciousness.

He is the founder and program director of NewStart Treatment Center located in Henderson, Nevada. NewStart Treatment Center utilizes a drug free and natural approach to addiction treatment. www.4anewstart.com Dr. De Vito is the author of Addiction: The Master Keys to Recovery www.AddictionRecoveryKeys.com

We’ve been saving lives for the past 28 years WE HAVE ALL LEVELS OF CARE! • Detoxication Program • Partial Hospitalization Program (PHP) • Intensive Outpatient (IOP) • Outpatient Program (OP) • 24 hour staff in all programs

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THE DANGERS OF LAUNCHING WHILE INTOXICATEDLWI AND ARRESTED DEVELOPMENT

By Ronald B Cohen,MD

The stresses of helping to guide and facilitate our adolescent and young adult children’s journey to economic and emotional self-sufficiency are greatly compounded by misuse of both legal and illegal “mind altering substances”, as well as misappropriation of prescription medications. Alcoholism, substance abuse, and chemical dependence can be devastating to the individual and the family. Alcoholism is a systemic process that requires a systemic solution.

Alcoholism and chemical addictions affect the psychology of entire families.

While waiting for sobriety many families fall apart. Family therapy helps initiate change even when the alcoholic denies the problem and is unwilling to seek help. Engaging the entire family has multiple benefits in multiple domains including treatment outcomes, patient recovery, family recovery, long-term maintenance of sobriety and prevention of alcoholism in other family members.

The relational traumas of chemical dependence include: • A chaotic, unpredictable, and often unsafe home environment • Marital discord, infidelity, separation and divorce • Child, parental, and spousal abuse and/or neglect • Inappropriate hypersexuality and incest • Cutoffs and estrangement • Disruption of family life cycle stages Bowen Family Systems Therapy treats the individual with a chemical dependence as part of a family unit that has a multigenerational history that led to addictive behavior. Intergenerational patterns of power, loss and control (“overfunctioning” or “overresponsibility”), transmit poisonous attitudes from parent to child. If left unresolved, these problems often remain, even after sustained sobriety. Recovery from alcoholism and substance abuse involves healing the emotional relationships of all members of the family.

One of the paramount concerns for sober family members is being recognized as individuals in need of assistance. Family members must first learn to cope with their own problems before any beneficial effects can reach the individual with chemical dependence. Reducing the negative impact of chemical dependence is protective of future generations. The advantages of family involvement include: • Providing Cohesiveness and Support • Undermining Denial • Addressing cognitive distortions • Promoting abstinence and adherence to the treatment plan • Relapse Prevention Twelve step programs (AA, Al-Anon & Ala-Teen) are critically important parts of treatment for individuals with chemical dependence and their families.

During the crucial first year of sobriety, the family’s tasks include learning new behavioral skills for coping with stress and conflict in order to adjust to a change in lifestyle that supports both abstinence and a stable family system, thereby developing healthy interdependence and family reorganization.

modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. The goal is to solve problems in current relationships so as not to leave a damaging legacy for the next generation.

In their delineation of the six stages of the family life cycle, Betty Carter and Monica McGoldrick begin with a focus on the individual young adult. This Family Life Cycle transition, Becoming an Adult: Leaving Home and Staying Connected, begins with the adolescent’s struggle for identity and independence, and continues with the development of autonomy, healthy emotional interdependence, and self-differentiation during young adulthood. Developmental tasks include differentiation of self in relationship to the family one grew up in, development of intimate peer relationships, and establishment of financial responsibility and independence. Ideally one can stay meaningfully connected to significant others yet remain autonomous in one’s own emotional functioning.

Seen from the larger systemic family perspective of parenting adolescents and launching young adult children, key developmental changes in family structure, process and function include increased flexibility of family boundaries, expansion of the empathic envelope, and shifts of relationships from parentchild to co-equal adults. Taken together, the sum total is that “Launching” is a relational task, children have to launch and parents have to launch them.

A young adult’s tasks in this launching phase transition are primarily focused on the development of autonomy and healthy emotional interdependence. The parents’ tasks begin with facilitating the transition from the parent-child relationship to a more co-equal adult-to-adult relationship. In addition, parents must attend to other midlife developmental tasks including becoming a couple again and resolving issues with their parents, caring giving and adapting to their death.

Family members often fail one another in important and painful ways during this life cycle stage, yet they remain family forever and must find their way forward together.

Failure to launch results in both fusion and enmeshment, wherein the young adult does not “leave home”, or distance, cut offs and estrangement, where contact is kept to a minimum or not at all. Either way the members of the family remain highly reactive to each other, tied up in not being free to develop and grow.

Substance abuse and chemical dependence can have a devastating effect on the individual and the family during these life-cycle transitions. Family therapy can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another. Family conflicts, low family support, drug use among other family members and parenting stress have all been shown to contribute to relapse.

The goals of Family Therapy in the treatment of Chemical Dependence include: (1) “Utilize the support and leverage of the family to reduce the individual’s drug use and implement other important lifestyle changes” (2) “Alter problematic aspects of the family environment to maintain positive changes in the individual and other family members and promote long-term recovery”.

In their landmark book, The Responsibility Trap: A Blueprint for Treating the Alcoholic Family, Claudia Bepko and Jo Ann Krestan introduced three key constructs central to the understanding and treatment of addiction in family systems: (1) over- and under responsibility; (2) pride, shame, and power; and (3) the role of alcohol as a mediator of gender role construction. They also define the “co-alcoholic” as the overresponsible and overfunctioning non-drinking family member, be it parent, child or spouse, who is as nonresponsible as the underesponsible alcoholic. Both the non-drinking person and the one drinking alcoholically share a complementary process of abdicating responsibility for self.

Ultimately we are all responsible for our own emotional well-being. In the alcoholic family, as in all families, one is powerless over anyone else. Coercion, blaming and distancing are rarely productive. Rather work to promote a consideration of reasons for change, increase awareness of discrepancies and negative consequences of not changing behavior, and increase sense of self-efficacy.

Bepko and Krestan further delineate three stages in the family recovery process: (1) attainment of sobriety, (2) adjustment to sobriety (3) long-term maintenance of sobriety.

Family Systems Coaching or “family therapy with one person” focuses on understanding the rules and roles of one’s family of origin and developing the freedom to make one’s own decisions. The goal is self-differentiation, the process of changing one’s part in old, repetitive, dysfunctional emotional patterns so that one is able to speak one’s personal views calmly and nonreactively regardless of who is for or against them. What distinguishes Bowen Family Systems Coaching for Individuals is “Working with individuals to solve their problems with their families”

It is vital to prepare the family for the “crises of sobriety” which engenders bitterness, resentment, fear, rage and a sense of “unjust demotion” in the coalcoholic. This necessitates a re-organization of the family in order to establish healthy relationships, address other family issues, and help achieve desired level of intimacy. The adjustment to a more functional lifestyle that supports both abstinence and a stable family system requires family members to break out of the responsibility trap and adapt to new roles.

Children are molded by the alcoholic family to be over-responsible (calm, efficient but lonely and filled with self doubt) or under-responsible (filled with rage, demanding constant care and praise, but filled with violent resentment towards anyone that helps them). Conversely over- and under-functioning in families and relationships provides a welcome mat into people’s homes for alcohol and addictive chemicals. Therapeutic interventions are aimed at

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While the alcoholic is solely responsible for his/her sobriety, family behaviors can maintain an environment in which the task is much harder to achieve. However, change yourself and you change the relationship. Change the relationship and you give others in the system the best opportunity to do their own self-differentiation work.

The goal of Family Systems Coaching is to help individuals proactively define themselves in relationship to others in their families without emotionally cutting off or giving in. The process of change is built upon ownership of one’s emotional reactions to old triggers and interactions. Family Systems Coaching offers individuals a process for making change in their relationships even without the participation of other family members. It is family therapy from the individual’s point of view.

Continued on page 24

WOMEN’S ADDICTION NEEDS ARE DIFFERENT

By Marlene Passell Wayside House Communications Coordinator

Addiction is addiction – doesn’t matter whether you’re a man or a woman, right?

Wrong, very wrong.

Women are the fastest growing segment of substance abusers in the country.

Women who abuse alcohol and drugs endure greater stigma and isolation from family, friends, and outside connections than their male counterparts. Why? Because they are typically thought of as nurturers, caretakers, wives, mothers, daughters, and sexual partners. Social attitudes and double standards create a different set of expectations for a woman’s behavior.

And, there is much proof that women who abuse alcohol and other substances face greater risks to their health than men. Evidence shows that women become addicted faster and suffer the consequences and permanent damage of abuse-related illnesses earlier in the course of the disease than men. They are more likely to be sexually assaulted and more likely to have unplanned pregnancies. Their babies are more likely to have birth defects and are more likely to die from Sudden Infant Death Syndrome.

The good news is, Wayside House has always been a treatment program for women, by women. Wayside House clinicians understand that women suffer addiction differently than men. Until only a few years ago, very little research was done around the special needs of women seeking recovery. Research by the National Institute on Drug Abuse shows that women recovering in an environment created just for women remain in treatment longer, achieve better abstinence rates and are more than twice as likely to complete treatment. At Wayside House, there is a strong sense of safety in being in an environment of only women. Here women are free to express feelings about the guilt and shame of their behaviors of addiction.

This is particularly true for those women who are victims of trauma such as sexual abuse or domestic violence.

At Wayside House, the goal is to heal the whole woman – not only the symptoms of addiction but the physical and mental health issues as well. Within 30 days of admission, residential clients undergo a medical and psychiatric assessment, including screenings for pregnancy, tuberculosis, sexually transmitted diseases and HIV. A nursing assessment is administered by Wayside House’s medical case manager (a registered nurse) upon admission. The Well Woman Program at Wayside House ensures that Wayside House clients gain access to medical care.

Call for information or a tour (561) 278-0055. Visit our website at www.waysidehouse.net

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For women by women

waysidehouse.net 561-278-0055

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SEASON’S GREETINGS FROM SUNCOAST REHABILITATION CENTER The holidays are here! This can mean many warm, heart-felt moments and can also mean many opportunities for awkwardness and potential unhappiness. At Suncoast Rehabilitation Center we want to wish you all a safe and happy holiday season, with an emphasis on SAFE. Here are a few tips to help you to stay happy, healthy, safe and trigger-free over the holidays: 1. Do Try to Keep the Drinks Non-Alcoholic If you have a relative that is known to have one drink too many and make things rough for the rest of the party, then cook up some great nonalcoholic drinks that everyone will want to try.

There are some really good non-alcoholic egg-nog recipes, apple cider recipes, cranberry drink recipes, etc. Get creative. If time is short, you can also find some mixes at the store to add to water or juice.

2. Do Take the Time to Seek Out Friends Holidays are about love, friends, family, gratefulness, and appreciation for the good things we have. Let people know you are thinking of them. Find a person you haven’t spoken to in a long time and reach out to them. This can lift your spirits and lift the spirits of the other person. If you can, take the time to meet with them face to face.

3. Don’t Stress About Big Presents Sometimes buying the “perfect present” for friends and relatives can not only break the bank, but can also be depressing, add to stress and lead to yet another trigger.

If you step back for a moment, the holidays are truly not about who buys the most expensive presents. Despite all the advertisements on TV and the radio, most friends and relatives don’t really care about the cost or the size of the presents. “It’s the thought that counts” is what rings through the ages almost as much as “Happy Holidays.” So take a moment and see what the person may really need or want, or something that may remind them of you. It could be favorite coffee from that coffee shop back on the West Coast or a framed picture of you and them. Think out of the box and be creative. A friend told me one of the most meaningful gifts she ever received over the holidays was a collage of pictures of her and her best friend’s favorite moments throughout the year.

4. Do Something Different If getting a big ol’ Christmas tree and having that big ol’ holiday dinner

is a reminder of bad things past, then skip it. Do something else. Find a restaurant that will take holiday reservations; see if you can meet up with some friends that you haven’t seen for a long time. Some families rent a cabin around the holidays. With everyone pitching in, the cost becomes quite affordable. Maybe you can take that time off work and take that vacation you have always wanted to take. The point is, do something DIFFERENT that will get you into trigger-free circumstances over the holidays.

5. Don’t Wear Yourself Thin It’s easy to get sucked into saying “yes” to everyone and everything. In the end, though, this will likely turn you into a frazzled mess. Instead of adding extra stress to your life, gracefully bow out of any parties or gatherings that will make you uncomfortable or which cause too much of a time crunch.

Your time might be better served taking a nap, exercising, making up your card list, or getting organized for the holidays. You can always send a card to the host of a party you missed or see if you can catch up with them over coffee or lunch some other time when you are both less busy.

6. Do Pay Kindness Forward The holidays can be tough on others. There are still soldiers deployed overseas, young people may be struggling, or older people may not have anyone to spend time with. Think about all those moments of kindness that have helped you along in life and then pay it forward. You can pay off someone’s lay away items at your local store (this is becoming quite the newest thing), buy a coffee for a less fortunate person, pay for someone’s parking. There are so many ways to do this - try one out and see if it uplifts you!

The most important point about the holidays is that you make it through being safe and happy. It is our hope that these tips will assist you in doing just that!

The holidays are a time for celebration, a time to give thanks for those we love, those that love us, and all that we have in our lives that make holidays so special. Holidays can also be a time when people over-indulge in too much of that “holiday cheer,” which can turn any celebrated holiday into a time of family feuds, legal issues, court appearances, hospital stays or worse. So, whether you are celebrating Thanksgiving, Christmas, Chanukah, Kwanza or ringing in the New Year, remember to be responsible and ensure your loved ones do the same. A family together; happy, healthy and safe; are the best gifts we can give and receive for any holiday.

In Health and Happiness, All of us at Suncoast Rehabilitation Center

ADDICTION WITHOUT DRUGS-A GROWING MENACE!

By Mitchell E. Wallick Ph.D CAP CAGC

Most of us can picture that awful February morning when the charge bills arrive in the mail and we are faced with the results of our adrenaline endorphin charged Christmas Spirit bills. We all understand that feeling, and yet; how would it feel to have that feeling every day. How about just wanting to finish that last hand of solitaire on the computer, or maybe shoot down one more alien ship on the game boy? What if instead of just finishing that last game, every waking moment was spent on the computer? Twenty dollars in the slots of discretionary funds may equal fun, yet thousands of dollars (several years worth of play) equate to disaster. In fact all these process addictions will inevitably result in major life problems, and like all other addictions, result in insanity, institutions or death.

The simplest definition of a process addiction is “an activity or behavior that continues in spite of adverse consequences to the detriment of the individual” Examples include but are not limited to: compulsive gaming, compulsive shopping, and compulsive gambling. Finally after many years of research and debate, compulsive gambling has been recognized as a real addiction by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The remaining disorders are still classified as Obsessive Compulsive Disorders. Regardless of where they appear, they remain a significant problem for those who are suffering from them, as well as their families.

Recognition of these problems is sometimes extremely difficult. They are usually only recognized after the sufferer has progressed very far in their addiction. The reason for this is that most of us engage in these behaviors.

The difference is that persons suffering from the addiction do so to extreme excess.

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Consider this: The population of compulsive gamblers has the highest rate of suicides when compared to any other group of addicts. The reason for this is that this addiction is usually not detected till they have created major debt. The same applies to the other process addictions. Everyone shops, most play games etc. Process addictions, are realized only when the activity reaches such excess,(often to the exclusion of everything else) and is negatively affecting the addicts life.

The following case histories are just some examples of how process addictions can create havoc in people’s lives. (For obvious reasons names and localities have been changed to protect their privacy.

Dr. John, a well known and prominent neurologist, teaching fellow at an Ivy League university, entered treatment which had to be paid for by his ex wife. He was found in a casino hotel with a loaded pistol because he felt he had lost everything. After being discharged from a mental health hospital, he received his SSI check, lost it all and completed his suicide.

Gina, was a fifty nine year old grandmother. She entered treatment for her lottery and bingo addiction. Gina had a 75,000 dollar debt, and was facing legal issues because of the 100,000 dollars she had embezzled from her employer of twenty five years. After treatment Gina was placed on probation and is presently working on repaying her employer and her debts.

Michael used to be an A student in college. At the time his parents intervened, this 21 year old was playing computer games in excess of 48 Continued on page 30

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IS ADDICTION TREATMENT REALLY EFFECTIVE?

By Myles B. Schlam, JD, CAP/CCJAP/ICADC

Drug addiction is a complex medical problem with negative consequences that can affect almost every part of a patient’s life. To be successful, a drug addiction treatment program must be ready to address these issues by not only focusing on the patient’s addictive behavior, such as drug use, but also offering solutions to ancillary problems. Many programs now offer job skills training in order to help the patient become a productive member of both his family and society at large. This aspect of drug addiction treatment is an essential part of encouraging patients to stay sober by giving them something to be sober for.

Drug addiction treatment can be found in a variety of environments, using many different behavioral and pharmacological methods. There are over 10,000 drug addiction treatment facilities in the US that offer counseling, behavioral therapy, medication, and case management to those suffering with substance abuse.

In addition to formal drug addiction treatment centers, many drug addicts can get valuable assistance in doctor’s offices and medical clinics from doctors, nurses, counselors, psychiatrists, psychologists and social workers. Drug addiction treatment can be offered in outpatient, inpatient and residential settings and, although some treatment models are typically associated with a particular treatment environment, many effective methods are flexible enough to be offered anywhere.

Since drug addiction is such a major public health issue, much of the funding for drug treatment comes from local, state and federal government budgets.

Although private or employer-subsidized health insurance policies can provide coverage for addiction treatment and the resulting medical fallout, benefit caps have resulted in shorter stays or the total elimination of certain programs.

Although the US Congress recently passed a mental health parity law, it does not apply to all insurers and there are significant loopholes available for corporations to use in order to avoid having to pay out benefits.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free.

Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse. According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives.

People typically do more research when shopping for a new car than when seeking treatment for addiction. They search on the internet and see these beautiful resort-type facilities with beaches and palm trees promising to cure them or their loved ones of addiction. They call an 800 number and a “treatment consultant” tells them exactly what they want to hear. A recent Colombia University report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors actually suggested that such insufficient care could be considered “a form of medical malpractice”.

Contrary to the 30-day stint typical of inpatient rehab, people with serious substance abuse disorders commonly require care for months or even years.

The short term fix mentality partially explains why so many people go back to their old habits. Good Case Management, as I addressed in last month’s article is severely lacking. “You don’t treat a chronic illness for four weeks and then send the patient to a support group”, said Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism in an interview. “People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

While it is true that some people are helped by one intensive round of treatment, “the majority of addicts continue to need services” Dr. Willenbring said. He cites the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed. Strong and consistent Case Management is vital to ensure the continuum of care throughout the treatment process.

Before committing to a treatment program you should do your homework. The first step is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with any specific program. For any treatment center we consider placing a client in, we check on the credentials of the program’s personnel, who should have at least a master’s degree. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine. We also meet with the therapist

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who will treat you and ask what your treatment plan will be. It should be more than movies, lectures or three-hour classes three times a week. You should be treated by a licensed addiction counselor who will see you one-on-one.

Treatment should be individualized. One size does not fit all.

Our mission at ASI is to provide quality assurance to the clients before, during and after the actual treatment. We do the research for our clients to ensure that they are placed in a treatment facility that will treat the whole person and meet all their ancillary needs as well. It is important to have an independent professional who will oversee the entire treatment episode and facilitate appropriate aftercare. Oftentimes staff at a particular treatment facility are hesitant to question tactics employed at their facility for fear of “rocking the boat” or even losing their jobs. As independent Case Managers, we will say the things that need to be said and take action when necessary without these conflicts of interest. Our primary concern is for the client to receive the very best individualized treatment for their condition. Because no one treatment facility is the right fit for everyone, we work with a wide network of treatment facilities that have various sub-specialties. If a treatment center is not providing a high level of services to our clients, we will cease to refer clients to that facility.

Unfortunately insurance companies will rarely pay for the full extent of treatment that is recommended. That is where the necessity for thinking outside the box comes into play. Many of our treatment providers have agreed to discount their rates for our clients so that they may continue in treatment once insurance benefits are exhausted. When it is not feasible to keep the client in that facility, we will use one of our community-based facilities that are either free or on a sliding scale.

If you are in need of treatment for alcohol or drug abuse for yourself or a loved one, we are available for a free consultation. It is recommended that a full bio-psychosocial assessment be conducted for every client prior to selecting a treatment facility.

Assessments and In-custody evaluations are available by appointment only. *Myles B. Schlam is a nationally recognized expert in Drug Addiction and the Criminal Justice System and an Internationally Certified Alcohol and Drug Counselor (ICADC). He is one of approximately 100 Criminal Justice Addiction Professionals (CCJAP) in the State of Florida. Mr. Schlam is a graduate from St. Thomas University School of Law (Class of ’02) where he specialized in criminal law and interned with the Public Defender’s Office. ASI is licensed by the Florida Department of Children and Families and operates throughout the State of Florida.

All young people deserve an educational experience that leads to an

excepTIonAl lIfe. Allynwood Academy is an accredited, non-sectarian boarding school for students in grades 9–12, providing exceptional college preparatory education with individualized platforms of therapeutic support and independence. The Bridge is Allynwood’s premier college transition program.

It combines personal guidance with academic, therapeutic and recovery support to help students ages 17–20 successfully navigate the passage to college. www.allynwood.org

To Advertise, Call 561-910-1943

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RAISING BRADY

By Lynne R. Gassel

At the Philadelphia Airport, I was waiting with my husband and our five-year-old grandson for our flight back home to Los Angeles when my cell phone rang. I didn’t recognize the number and almost didn’t answer. It was a young woman’s voice. She said her name was Lindsay and that she was calling from the drug rehab where my daughter was being treated. Why was she calling me? Didn’t she know I hadn’t spoken to Jaime in months?

hospital, an autopsy would need to be performed to determine the cause of death.

Jaime’s incarceration, her stay in rehab and our taking over the parenting of her son threw me into a tailspin. The last thing I wanted was to talk about my daughter.

Trying to compose myself, I put the phone back up to my ear, thanked the nun and told her I needed to call my children and find my husband. “I’ll be all right,” I told her.

Our hands were full. Stu and I had been there to help parent Brady since his birth and took over full-time when Jaime began using, again. It was a constant struggle acting as parents while Jaime, no longer in our house, attempted to parent from afar whenever the impulse hit. Going to jail and then court-ordered rehab, she was forced to get sober. But after 10 years in and out of drug use, we had lost hope.

She said to please call her when we got home. I hung up and called my youngest son, Josh. He could hardly understand me through my hysteria.

Because of all of Stu’s heart issues, he logically thought something happened to his dad. Josh was in shock but I think he said he’d call his siblings, Tracy and Adam, or else I did. I can’t remember…

“I’m so sorry, Lindsay, I swiftly answered. “Right now I have very little to do with my daughter. If Jaime needs something, could you please call her sister, Tracy?”

She said she was aware we hadn’t had contact, but Jaime had an accident in the bathroom and she wanted to give me the number of a woman to call at the hospital.

“Oh, God,” I said under my breath. “What now?” Instead of feeling compassion for my adult daughter, all I felt was bitterness. What a burden she is—we’re at the airport, for God’s sake!

Jaime’s probably requesting I come see her or bring her a nightgown or some random personal item. Jaime certainly could have had the nurse call Tracy for those items but my daughter, famous for using the guilt card; most likely figured this was one way she might convince us to come see her.

I asked Stu to take Brady for a snack, that I needed to make a phone call and would fill him in later. After finding a quieter place to sit in the airport, I dialed the number I was given. The woman—I assumed was a hospital nurse—politely explained that Jaime had passed out in the shower, cut her chin and was brought to the hospital that morning by the paramedics.

“Please forgive me,” I interrupted, “but we’re on the east coast at the airport so there’s nothing I can help you with.”

I know I must have sounded hard and uncaring but I was so tired of all the years of addiction, manipulation and drama and was almost relieved we were out of town. I just wanted some peace.

“I must apologize,” the woman said. Then she paused. “Because you’re out of state, I have to tell you what has happened.”

Just as she was about to continue, a flurry of people entered the airport gate where I was sitting. The woman was very soft-spoken and it was getting noisy.

I asked her to hold on a moment while I moved to a different location so I could hear her better. Luckily, I found another gate where no one was sitting and got back on the phone. The woman resumed speaking.

“The paramedics informed me that after they picked your daughter up, she kept passing out in the ambulance.”

“It could be drugs,” I interjected. “My daughter’s been in a court-ordered rehab and she might have relapsed. I haven’t seen her in a long time.”

“I’ll make a note of that,” the woman responded. “Since you’re out of state, it’s my obligation to give you this information.”

There was an uneasy silence. I could barely make out what she was saying. Her words seemed muffled.

“We did everything we could,” the woman quietly said, “but we couldn’t revive her.”

What? What is she saying? I felt like my sense of hearing kept breaking up, as if I was going under water and out, again.

“She expired at eight thirty this morning,” the woman apologetically said.

I began to shake uncontrollably.

“What? What did you say? Are you saying she’s...gone?”

I could hardly speak through my trembling and my tears. People began trickling into the gate area where I was sitting so I cowered into a corner, cradling the phone tightly to my ear.

“How?” I managed to ask—my voice cracked.

She said she didn’t know. Because Jaime was alive when she arrived at the

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“I’m a nun,” she caringly said. “I’ll stay on the phone for as long as you need me.”

People in the airport were staring at me and I couldn’t stop crying. Holding the phone to my chest, I was trying to process all of this. “I can’t believe it, I can’t believe it!” I kept repeating out loud. “She can’t be gone…she’s gone?”

I worked my way to our gate where I found Stu and Brady. My husband took one look at me and knew something was very wrong. Brady was on the floor playing with his cars. Fortunately, I could pull Stu aside without Brady noticing. When I broke the news to him, Stu didn’t get emotional. He said he wasn’t shocked or surprised—just terribly sad.

How I sat on a plane for three thousand miles, I’ll never know.

Brady was looking at me, confused.

“Why are you crying, Mommy?” he asked.

Stu replied that Jaime was very sick and mom was upset.

We’d explain to Brady what really happened to Jaime when we got home.

I was numb.

But, now it was real. We were mommy and daddy in the truest sense— grandparents raising our grandchild.

Losing a child and raising a grandchild was never part of the plan and neither was addiction. Throughout our 10 years dealing with this baffling disease, we gained many life-altering lessons. We learned it wasn’t our fault, about tough love and about living our own lives even though chaos surrounded us. We discovered we were stronger than we ever imagined when we courageously asked our daughter to leave our house—that we’d care for her beautiful heartsick child. We became educated about play therapy and spirituality and building stability for this amazingly loving little boy.

I will always wish my daughter had been a healthy mother and was still alive.

There isn’t a day that goes by I don’t think about what if? Ironically, soon after her death, we found out Jaime had lied about remaining in rehab for her own good. She had planned to move into the same sober living home where she previously used without getting caught. It was also very close to our home and to Brady. When she passed, it was our belief God said “enough” and blessed us as Brady’s permanent parents.

This is my story, but it is typical of the tumult and tragedy that addiction brings to the addict and the addict’s family. Grandparents raising grandchildren is a growing phenomenon in our country mostly because of illegal drug use, alcohol abuse, unmarried teen mothers and our shifting economy. My husband and I have been cast into a shockingly large demographic. It is estimated that today there are close to 10 million grandparents raising grandchildren.

Our friends call us saints but we are just doing what needs to be done. Frankly, we are the lucky ones. We have each other and the resources to comfortably raise Brady. Not every grandparent is so fortunate. This includes having access to the right professional support to guide our way.

For example, Brady’s play therapist said for us to keep nothing secret and to make Brady’s history part of his life. That way, there would be no surprises and he’d grow up healthy. We’ve listened and it has paid off. Brady is a happy, well-adjusted little man.

One afternoon, 6-year old Brady came home from school. Apparently, his classmates were having a discussion about moms and dads because Brady took me aback with his question.

“So,” he said with his hands on his hips, “what are you, my stepmother or what?”

Clearly, his friends were throwing terms at him trying to figure out who I was.

“No, Brady, stepmothers aren’t related to the children; and you have my blood running through your veins.”

Continued on page 28

Destinations to Recovery is a dual-diagnosis residential rehabilitation and treatment center for teens (13-18 years old) affected by drug abuse and/or mental health disorders.

Our mission is to empower our residents to control their future and to build an open and healthy relationship with their families.

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To Advertise, Call 561-910-1943

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ADDICTION: A NEUROBIOLOGICAL ILLNESS AND STRESS REGULATORY DISORDER

By Michael Groat Ph.D.

Contemporary Views of Addiction: Psychological and Neurobiological Perspectives The field of addictions has come a long way in eradicating some of the misconceptions and myths around addiction. Once considered a moral failure, we now know that individuals do not become addicted because they lack integrity.

They become addicted as a habitual way to cope with pain and suffering—and to regulate stress. In fact, stress is one of the most important predictors of substance abuse. Some individuals are more susceptible to addiction due to genetic factors, family environment and poor coping skills, as well as other co-occurring forms of emotional distress like bipolar disorder, schizophrenia, post-traumatic stress disorder, depression or anxiety. Advances in the understanding and treatment of addictions make recovery, and healing, possible.

Addictive substances and behaviors activate the human neuronal reward system. Thus, individuals use substances because they serve a rewarding function. This function might include easing anxiety in a social situation, numbing physical pain, ridding boredom, increasing energy, or relieving feelings of emptiness. Achieving the hoped-for result leaves individuals prone to want to use the substance again under similar circumstances, or to repeat the behavior that evoked the desired emotion. With continued use, individuals’ brains and minds start adapting to the substance or behavior, and it becomes habitual. The problem is that uncontrollable desires for a substance or behavior stop rational thought. Individuals are then likely to act in out of control ways—the kinds of ways that often lead to suffering for them, their families, colleagues and friends.

Many individuals enter into treatment after suffering severe relationship problems, depression, anxiety, driving-under-the-influence charges, poor health (e.g., liver damage), or threats to their career. The negative consequences of use have led them or those around them to recognize a need for help. Many resist the need for help, however, believing that willpower or reason alone can prevail.

Addictions cannot simply be reasoned through. The power of the addicted brain can quickly overwhelm all rational arguments in favor of stopping the addiction.

This can generate profound feelings of helplessness, shame, and failure.

Recovery Occurs Best When Securely Attached to Others Left to themselves, most are not able to counter the incredible forces of cravings and urges, or escape the ravages of serious depression, alone. The reward system of the human brain reinforces behavior that our brain considers essential for survival—and for the individual with an addiction, using a substance or engaging in an addictive behavior can feel like a life and death matter.

Individuals’ best hope for recovery lies in learning to make use of others. Instead of turning to a substance to cope with pain and suffering, learning to turn to someone who offers an empathic, attuned and supportive response sets in motion a new pattern, and a new reward—but without many of the negative and devastating consequences of substance use. Consequently, the distress will become more bearable, the individual will feel more secure, and an optimal foundation for healing and recovery will be established.

Experimental research strongly supports that individuals regulate stress best when connected to others who provide emotional support. Going it alone when ill is going it the hard way. Psychologist Jim Coan, conducting neuroimaging research at the University of Virginia, found that merely holding a partner’s hand during a stressful laboratory situation significantly diminished brain activity associated with distress as well as brain activity associated with effortful regulation of distress (e.g., deep breathing, or, positive self-talk). Moreover, the mere contact with a partner was especially effective in decreasing the load on the brain when the relationship was felt to be highly supportive and trusting. To begin reversing the habits of addiction, individuals must gradually replace their deep attachments to a substance or a behavior with a secure attachment to others.

Many Discover Hope of Recovery Twelve-step recovery groups, like AA and NA, work not only because of the steps of change that are introduced, but because they offer individuals a routine place to feel accepted, known, and understood—even while feeling vulnerable. Peers can relate to the pain of addiction, offer solace, and provide hope, inspiration and encouragement. The experience of responsive emotional support lies at the heart of the relief provided, and a resource for the individual with an addiction to turn to time and time again.

Engaging in recovery helps the brain to begin forming new neural pathways, and recent evidence points to a 90-day period for this process to begin taking hold. In addition to modifying some of the neural networks involving

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addictions to a substance or a behavior, individuals can change their brains by forming deep attachments to people—instead of to substances or behavior. The possibility of forming secure, healthy attachments, and learning to turn to others for support and help in managing moments of distress, can help individuals stay on the road to recovery.

Many have taken the daring step of allowing their brain to heal from addiction, as well as replacing their attachment to an addictive substance or behavior with caring, responsive human connection. Twelve-step recovery, individual, couples and family counseling, new coping skills, medication, and addictions counseling can all serve to alter individuals’ brains—for good.

Michael Groat, PhD, is the Director of the Division of Adult Services at the Menninger Clinic, and assistant professor of psychiatry and behavioral sciences at the Baylor College of Medicine. He completed his internship in clinical psychology at the Albany Medical Center, a four-year postdoctoral fellowship at the Austen Riggs Center, research training at the Yale Child Study Center, and most recently trained at the Leadership Institute for Non-Profit Executive Management, Rice University. He has written and spoken nationally on attachment, addictions and treatment resistance, and has also published on the relationship between attachment style and recovery among individuals with dual-diagnosis disorders.

THE DANGERS OF LAUNCHING WHILE INTOXICATED LWI AND ARRESTED DEVELOPMENT

By Ronald B Cohen,MD

Continued from page 14

Family Systems Coaching teaches the possibility of dealing with differences without losing connection, which is one of the primary developmental tasks for a young adult. If you are tied up with all of the stuff and rules and roles of your family of origin, it is really hard to figure out whom you are and what you want to do with your life.

Family Systems Coaching promotes “differentiation in action,” guiding people through a process of changing their own participation in unsatisfying family relationship patterns. It is a conscientiously thought through approach to establishing a unique one-to-one relationship with every individual in the family system.

“All families can benefit from relational therapy. The good news is if one motivated family member changes in the context of relationship dynamics, the entire family’s functioning improves. The goal is to change your relationships with other members of your family of origin to improve your life and your family’s life regardless of what anybody else does. Taking responsibility for what you can take responsibility for and attending to your needs in the context of intimate relationships, opens the door to facilitating healing of the entire family.”

Working on self-differentiation in one’s family of origin is always available, is uniquely efficient and effective regardless of the situation, and cannot be sabotaged by anyone else. Family Systems Coaching helps parents and children become more self-directed, self-supporting and better able to make choices to change based on one’s internal beliefs, rather than slavishly conforming to or reflexively dismissing out of hand, the rules, roles, relationship requirements and rituals of one’s family of origin.

The good news is most families have successfully accomplished and completed this life cycle transition, thereby being well prepared for inevitable stressors of subsequent life cycle stages. For those stuck in pre-launch relationship patterns, consultation with a well trained Family Systems Coach can assist the family to expand its knowledge base and skill set, and help the entire family move forward in a positive direction.

Ronald B Cohen, MD is an Experienced Systemic Family Therapist and Board Certified Psychiatrist who specializes in Bowen Family Systems Coaching to help individuals, couples and families develop healthier, more satisfying relationships. The more responsible you can be to your own values and beliefs, the greater the likelihood of strong, resilient friendships and secure intimate partner relationships. Dr. Cohen trained in Bowen Family Systems Theory and Therapy at The Family Institute of Westchester, where he actively and planfully experienced the anxiety and avoidance, the emotional impasses and seemingly immovable triangles, and the negative reactivity and pushback of working on self-differentiation in the family he grew up in.

INTERVENTIONS- THE FIRST STEP

By Debbie Perkins

I am a Nationally Certified Interventionist. An Interventionist is the individual who helps to identify the appropriate people in the addicts life who will become an influential part of a recovery team. I was in active addiction for thirty five years due to sexual abuse as a child. I had an arrest count in the double digits and several prison terms. My substance abuse was contributed to my traumatic past which included my parent’s suicide, a rape, and death in general.

The reason I am so good at what I do is because of where I came from and where I am now in my life. Being an Interventionist is the gift I was blessed with to help other people who are struggling with addiction. I have been to several treatment centers, and I only work with a select few whose program models what it takes to get sober. A good interventionist will not only work with someone to get them into a good treatment center, but also help them all the way through their recovery. There are many elements in doing an intervention that have to be addressed in order for the person in active addiction to learn how to get sober. The family has to be on board and stop enabling and allow the treatment center to do their job.

I own a transition house for women and also work with men’s halfway houses.

These houses provide the structure that someone in early recovery needs.

They provide life skills, help with employment and coping skills, in order to become a productive member of society.

I did a lot of damage in my addiction and it took a lot of work for me to be able to stay sober. I had to learn how to forgive the person who abused me and ask for forgiveness from all of those who I had hurt. Early recovery is a painful process, but if the person really sets their mind to work on their drug use and the underlying issues, they then will have a chance to find peace and happiness in sobriety.

I tell my story often because it shows people in early recovery that if I can get sober, then anyone can. I will soon graduate with a bachelor’s degree; and I am on the Phi Theta Kappa presidents list and dean’s list. I own Acme Ranches Transition house for women and I am a certified life coach for family members with loved ones in active addiction or early recovery. I also co –authored a book called “Dare to be Authentic” which will be published early next year. My goal is to help anyone with addiction problems get the help they need, and to stay sober- one day at a time.

Please visit www.realintervention.com

To Advertise, Call 561-910-1943

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THE PATIENT PROTECTION AND AFFORDABLE CARE ACT FORCES SUBSTANCE ABUSE TREATMENT TO RETHINK BUSINESS MODELS

By Jeffrey C. Lynne, Esq.

The story of where we have been as a country in providing mental health care services is more relevant than ever as we are about to embark collectively on the next great American social experiment – the Patient Protection and Affordable Care Act. And this is particularly relevant to us because the history of American health insurance is a snapshot in time of our ever evolving cultural attitudes and generalizations towards substance abuse and mental health treatment, patients, and those who serve them.

Historically, most insurance plans have provided lower benefits for mental health and substance abuse treatment. Even today, treatment providers and billing companies fight with insurance companies to obtain reimbursement for multi-modal treatments such as acupuncture or massage or other evidence-based treatments. This stands in contrast to coverage for physical ailments and injuries utilizing the same treatment modalities, which treatment often has lower copayments and deductibles as compared to mental illness treatment. Mental health coverage typically is limited by insurance companies for fewer inpatient hospital stays and outpatient visits than their physical medicine counterparts.

With such obvious disparate treatment by insurance companies, why has the American public allowed this to go on for so long? Historically, it was first the state that bore the cost of mental health services, and did so in a low-cost, institutionalized setting reminiscent of many horror movies. After the Olmstead decision, which determined that perpetual institutionalization clearly violated the civil liberties of certain Americans, and as deinstitutionalization progressed towards community-based outpatient mental health services, private health insurance quickly realized these costs were staggering.

As compared to a broken bone or surgery to repair a torn rotator cuff, there is no standard by which we currently measure recovery in mental health and substance abuse. It remains more of an art than a science, though with the utilization of functional MRI’s, that too is changing. But until now, we were not ready to accept the bottomless pit of expenses that achieving true recovery would require. Add to this, the idea that mental illness and, more specifically, substance abuse addiction, was a failing of the patient him or herself, and the appetite to fund mental health care quickly waned.

Our culture of individual responsibility, coupled with our disdain for mental illness, allowed insurance companies to openly shift more and more of the costs of mental health and substance abuse treatment onto the patient, causing many to forego treatment altogether. But all of this was set to change starting in the 1990’s.

Our first modern attempt at health care reform that included mental health care services was actually borne out of the failure of Congress during the Clinton Administration to pass meaningful change. In its place, Congress did pass the Health Insurance Portability and Accountability Act of 1996 also known as HIPAA, the essential aim of which was to eliminate considerations of individual health status from decisions concerning the eligibility and specific coverage costs in the group health insurance market. HIPAA specifically prohibited insurers and employer-sponsored group health plans from considering health status, mental or physical health conditions, claims experience, the prior receipt of care, medical history, genetic information, evidence of insurability and disability in making eligibility and premium decisions in the group market.

But despite these reforms, the law still did not reach insurance plans that reduced the value of coverage for certain individuals such as the mentally impaired or those suffering through substance abuse. In response, Senate Democrats in Congress pushed through the Mental Health Parity Act of 1996. But as all compromise measures prove to be, it was a hollow victory for mental health advocates, as the law contained no mandate to provide mental health and substance abuse services themselves.

Thereafter, during the Bush years and the Republican majority in Congress through most of the 2000’s, public health dollars and private insurance reform was off the American agenda.

But in 2008, at the height of the Great Recession, and tucked inside the Wall Street bailout of that same year, was an enhanced version of the Mental Health Parity Act now named the Health Parity and Addiction Equity Act of 2008. Signed into law on October 3rd, this revised Parity Act required that any healthcare plan offering substance abuse treatment services must do so at the same level as other similar medical services. But still again, the mandate to provide substance abuse and mental health treatment

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coverage was lacking. In fact, even with the passage of the 2008 Parity Act, consumers continued to pay more for substance abuse hospital admissions than for mental health or medical/surgical admissions. Discrimination or not, our country failed to face the mental health and substance abuse epidemic Michael referred to.

This is where the 2010 Patient Protection and Affordable Care Act is so groundbreaking for the treatment industry. Under this new law, the parity gap between coverage for physical ailments and mental ailments, including substance abuse treatment, is expected to narrow and coverage for such treatments will be more comprehensive. More services will be available and there will be no preexisting condition denial, no treatment limitations and no financial caps that are more restrictive than for physical treatment services.

And how will we do that? By labeling mental health and substance abuse treatment services as an Essential Health Benefit. The “Essential Health Benefits” mandate are procedures and services that all insurance carriers must provide to consumers in all plans. Starting in 2014, all plans must cover these “essential health benefits” which include: • Ambulatory (outpatient) services; • Emergency Services; • Hospitalization; • Maternity and Newborn Care; • Rehabilitative Services; • Laboratory Services; • Preventative Care Services and Chronic Disease Management; • Pediatric Services; • Prescription Drugs; and • Mental Health and Substance Abuse Disorder Services.

Tie this together with the Parity Act of 2008, and you have the most comprehensive and extended mental health and substance abuse treatment coverage in our nation’s history, as a matter of law.

So, now the question you all have been waiting for is – how does it all actually work? Let me try to give you the “reader’s digest” version of the Patient Protection and Affordable Care Act; what it does and does not do; and how this new law may impact how you are expected to provide and get paid for.

In short the Affordable Care Act is intended to do the following: • It creates a health insurance marketplace called “Exchanges” where people and businesses can get health coverage at group benefit rates online.

• It requires everyone to obtain insurance or face a tax penalty, referred to as the “Insurance Mandate”.

• It requires insurance carriers to provide coverage of pre-existing health conditions.

• It makes the insurance marketplace more consumer-friendly by simplifying the description of coverage so consumers can make informed choices within the marketplace.

• It holds the line on premium rates by tying rate increases to actual costs and requiring refunds to consumers when premiums exceed a certain amount of healthcare costs.

• It prohibits health insurance companies from either dropping coverage or increasing rates due to making a claim.

• It requires insurance companies to allow parents to provide insurance for their children, up to age 26.

• It requires specific “preventative care” be covered without the need to pay co-pays or co-insurance.

• It creates a mechanism to appeal decisions to deny coverage; and • It eliminates lifetime and annual coverage limits on coverage for specific “essential health benefits.”

And how are we expected to pay for all of this? By January 1, 2014, the IRS will begin to impose a tax penalty on individuals who are considered to have access to affordable coverage as defined by the Act but who do not obtain it. For the poorest Americans, the Affordable Care Act expands state Medicaid programs.

People considered to be without access to affordable employer sponsored coverage would have access to the Health Insurance Exchanges. Individuals deemed qualified to purchase coverage through the exchanges would, depending on family income, be entitled to advance premium tax credits to try to bring the cost of coverage within the range considered “affordable” under the Act. Employers will be able to purchase coverage through the exchanges and Continued on page 28

To Advertise, Call 561-910-1943

27

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT FORCES SUBSTANCE ABUSE TREATMENT TO RETHINK BUSINESS MODELS

By Jeffrey C. Lynne, Esq.

Continued from page 26

would be entitled to tax subsidies. But larger employers offering no coverage or unaffordable coverage would pay a tax towards the exchange subsidy system.

astute providers who took the time to learn about the new law and positioned their business model accordingly.

So what’s the catch and all the brouhaha about? First, the Affordable Care Act has been “designed” under the assumption that the tax penalty applicable to individuals who do not buy affordable coverage will create the type of health insurance and risk pool essential to curbing discrimination against the sick. This is that “insurance mandate” issue that went before the U.S. Supreme Court and was upheld as a lawful tax, rather than a requirement to purchase services.

What we cannot foresee is how and whether the American cultural prejudice against people with mental health disorders or those in recovery from addictions will continue to drive people deeper into the shadows and avoid the care that we have finally made available to them. What we do know empirically is that, at least pre-Obamacare, it has been difficult to treat those with mental illnesses because they seldom seek treatment themselves due in large part to financial burdens and in some instances, that very fear of being labeled and stigmatized.

Second, the Affordable Care Act is anticipated to change the way health care providers get paid, and we all know no one likes change. Currently, American medicine is based mostly on the “fee of service” model, in which a fee is paid for services performed. More services performed, more fees get generated.

The Affordable Care Act envisions a world in which health care providers will be paid on outcome and shared saved expenses. By working together across disciplines, the Affordable Care Act’s drafters predict that the savings in health care expenses can then be shared with the physicians themselves. Stated otherwise, a physician or health care provider will make their money by not submitting patients to unnecessary examinations or tests, but by realizing the shared savings of avoiding unnecessary or duplicitous procedures. And in the field of mental health and substance abuse treatment, the focus will be on cooccurring disorders, and SAMHSA (the Substance Abuse and Mental Health Services Administration) appears to concur.

According to the SAMHSA’s calculations of treatment services in light of the Affordable Care Act, reimbursement models are going to demand treatment be provided in an integrated setting. In doing so, the Affordable Care Act effectively endorses the growing popularity of the data which acknowledges that mental illness often accompanies addiction and substance abuse. Many drug addicts and alcoholics enter drug and alcohol abuse treatment with depression, bi-polar disorder, or behaviors that mimic schizophrenia or other mental illness.

As such, and for at least the past 10 years, integrated care for dual diagnosis patients has become the preferred avenue of treatment, but up until now, only for those who could afford it. But with the Affordable Care Act, this theory is being effectively being adopted as policy, as it is perceived that, for the great majority of Americans, mental illness is the driver of addiction. Integrated drug and mental health treatment appears poised to become the norm as it allows an individual to undergo substance abuse treatment at the same time they are being treated for mental illness, or vice versa.

But this does beg the question – is there an actual existing mental health epidemic, or is the Affordable Care Act going to effectively create one?

It is also anticipated that drug and alcohol addiction will slowly shift from the 30 day inpatient model to an outpatient model. This does not mean residential style programs will go by the wayside. Instead, it is viewed as an opportunity for residential style programs to expand their outpatient offerings. The desired outcome is shorter stays in treatment and more aftercare under the theory this follow thru will not only be less expensive but will also lead to higher rates of recovery.

And what does bode for the current treatment model in Florida? As the Affordable Care Act begins to roll out in full in 2014, it would appear that collaboration will be the key to payment. Loosely organized health provider groups, referred to as ACO’s or Accountable Care Organizations, may become the 900 pound gorilla which captures the bulk of the detoxification, residential treatment, and outpatient treatment care, as they will be able to provide a continuum of care across all disciplines. These ACO’s may be best positioned to capture market share since they will be viewed as being able to more efficiently deliver a comprehensive set of health services.

Existing addiction treatment providers that can demonstrate they are part of an existing ACO-like health network will more than likely be integrated into the provider panels of health insurance plans and become the preferred provider of multiple levels of addiction and mental health treatment and concert with the physicians providing primary care access.

We believe this to be our future as the Affordable Care Act demands more comprehensive patient centered services; evidence based treatments; accountability for outcomes; effective use of health information technology; and fiscal agility to provide higher levels of treatment at lower cost. As such, the failure of unaffiliated treatment providers, at least those who rely primarily on insurance payments, to adequately prepare themselves to integrate into this new payment model will likely find themselves losing market share to more

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Ironically, perhaps, though the U.S. Supreme Court in the case of Olmstead v. ex rel Zimring shunned such institutional prejudice and demanded that mental health services be relocated out of institutions and into the communities, the Affordable Care Act would seem to favor the larger health care model that, inevitably, may drive service providers back into large institutional campus settings.

In closing, the future is not clear as it relates to the Affordable Care Act. The law is not a mandate as much as a grand social experiment to see if we can use the marketplace itself to shift our cultural beliefs about healthcare and what are essential health services. Much of what we said today is therefore only speculations, notwithstanding that others in the field agree.

What is not speculation however is that treatment providers who rely on insurance must reframe their business models and prepare for the new law; else they will find themselves unable to compete in the new paradigm of healthcare which includes mental health and substance abuse treatment services. Simply stated, it’s time to wake up and smell the coffee. The Affordable Care Act is here and it’s here to stay.

Likewise, we must remain mindful to avoid the commonly held belief that mental health and substance abuse disorders are a choice. They are real and significant health concerns that must be addressed and the Affordable Care Act boldly makes that pronouncement. And while we may have now overcome the financial barriers to that care, we must continue to remain vigilant to provide a safe space for people to come out from the shadows and actually seek the care and treatment that we have now made universally available.

Jeffrey C. Lynne, Esq., is the Managing Partner of Weiner, Lynne & Thompson, P.A., a Delray Beach, Florida, law firm specializing in land use & zoning, litigation, transactional real estate, and government regulatory law. Mr. Lynne and his firm represent a large number of substance abuse treatment providers and owners of sober living residences throughout the State of Florida.

RAISING BRADY

By Lynne R. Gassel

Continued from page 22

He looked confused.

“Brady, I’m your grandmother; and because I take care of you, I’m also your mom. You have two in one!”

“How about Dad?” he asked.

“The same thing,” I replied, waiting for his response.

He got a very serious look on his face.

“So, let me get this straight,” he self-assuredly re-capped. “In real life, if Jaime were still my mom, you’d be my grandmother. But because she took drugs and couldn’t do it, you’re my mom?”

“Yes,” I replied.

Brady stood there very pensive. Then a smile of recognition came on his face.

“God made a good decision.”

Lynne R. Gassel is a first-time writer, as well as an artist and singer. Her recently published book, “FIFTH CHILD –The Turbulent Path that Led to Parenting her Child’s Child” can be found on Amazon.com. The author lives in Southern California with her husband and 9-year-old adopted grandson, Brady, and can be reached at fifthchildblog.blogspot.com.

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RELATIONSHIP BETWEEN CHILDHOOD TRAUMA AND ADDICTION

By Dr. Asa Don Brown, Ph.D., C.C.C., N.C.C.M.

hormone that is responsible for the nature of bonding).

The fulfillment factor relies upon the brain’s pleasure center being engaged allowing for the brain, body and the mind to arrive to a state of satisfaction.

The pleasure center is responsible for alerting us to acts that are enjoyable and pleasurable. As children, if we have the privilege of experiencing laughter, then we will have experienced the ignition of our brain’s pleasure center.

Laughing stimulates the pleasure center which is responsible for reinforcing the act that brought forth the original stimuli.

Compulsive Behaviors Addictions are compulsive behaviors, and not unlike other compulsive behaviors, addictions are a means for aiding unfulfilled needs and desires, and bringing forth a perceived balance and a sense of control. Adult’s who were traumatized per childhood maybe seeking to fulfill a source of emptiness or even subtle void. As humans we will return to acts, deeds, performances, substances, foods, and other vices that stimulate the pleasure center.

If a child has been denied a proper attachment, they may have been denied the privilege of engaging their pleasure center. As a clinician, I have worked with young children that have been transferred home-to-home in the foster care system. I have met children who have lived in more than 20 homes by an early age. Such transfers can play havoc on the child’s ability to thrive, or from finding appropriate pleasures from relationships and social stimuli. For children who have been abandoned, placed in social care environments, etc; the likelihood of developing a balanced perspective on life is lessened. For a child who has experienced countless foster homes, the ability to feel secure may prompt a desire for personal control.

ACCEPTANCE AND RESPONSIBILITY Please understand acceptance does not mean adaptation. It doesn’t mean resignation to the sorry and miserable way things are. It doesn’t mean accepting or tolerating any sort of abuse... A person who is being abused will not make the decisions necessary to stop that abuse until he or she acknowledges the abuse. The person must then stop pretending the abuse will somehow magically end, stop pretending it doesn’t exist, or stop making excuses for its existence. Abused children have a likelihood of seeking out abusive relationships and destructive paths in adulthood. As abused children, they know and have full comprehension of the parameters of abuse. Victims of abuse can make the best detectives and investigators of abuse, because they recognize the signs, symptoms and symbols of abuse. Nevertheless, children of abuse frequently continue to walk down abusive and destructive pathways.

It is prudent that you never take ownership of the abuse. As a victim, you do not own the abuse, victimization, and/or traumatization endured in childhood.

However, as an adult, you owe it to yourself and those involved in your life, to end all forms of abuse. You owe it to yourself to take ownership of your life, moving beyond your victimization, and taking the control out of the clutches of the perpetrator. Even if, the perpetrator no longer lives, and/or the traumatization was singular in its effect; you owe it to yourself to move forward.

The masterminds of perpetration have an uncanny way of manipulating those beyond their control. Whether your traumatization occurred by the hands of another and/or natural forces; you need to take control of your life.

Personal responsibility is the willingness to completely accept choices that we have made throughout our life. It is the responsibility of you, the owner of your thoughts, deeds, and actions, to make choices that follow your own personal ethical and moral system of belief. Accepting personal responsibility is not a burden; it is a freedom, it is liberating, and it is necessary to live life abundantly... Personal responsibility is not based on blame, shame, or guilt. It has nothing to do with accepting responsibility for others’ choices.

Personal responsibility is about taking charge of your mind, body, and spirit. If you have become addicted to a vice, then you owe it to yourself to find help. We know that “drug addiction is a preventable disease. We also know that a majority of the addictive vices do not occur until we set them into motion. If you choose to reject the vice, rather than accept the vice into your life, then you have already won half the battle.

HEALING We know that children, even at birth, are not ‘blank slates’; they are born with certain neurological make-up and temperament. As children get older, these individual differences become greater as they are affected by their experiences and environment. We also are aware that children may have encountered vicarious traumatic experiences at the most primitive of age.

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Continued from page 6

Although the probability of experiencing a traumatic event has increased with the globalization of our planet, and technology has made access of traumatic experiences readily available; the benefits of globalization and technology have also benefitted the pathway of healing.

Healing the underlying causes of dependency is all about restoring your mind and body to their natural state of balance. One way or another, our bodies are always seeking to get back into balance. The healing process is the most essential aspect of moving forward. If you refuse to move beyond your past, you will limit your ability to heal. It is essential that if you want to live a healthy life and a life of abundance; that you learn to unconditionally accept, unconditionally approve, and unconditionally love your being. Through an unconditional state you will be capable of moving beyond your past and moving forward towards the future you.

Dr. Asa Don Brown is an author, professor, clinician, advocate, and an inspirational and motivational speaker. He currently serves as an Advisory Board Member at the Brain Technology & Neuroscience Research Centre, BTNRC and has served as the Bylaws and Ethics Director for the Washington Counseling Association, as well as having served as the Director of Promotions for The Society for the Arts in Dementia Care, and many others. In the summer of 2013, Dr. Brown was named a Global Presence Ambassador, which is the humanitarian community service arm of Parenting 2.0, and has been informed that his work will presented to the United Nations.

He is a prolific author having been published in a variety of professional and popular journals, magazines, and online columns, including: Healthy Directions, American Psychiatric, American Academy of Experts in Traumatic Stress, Inner Peace Parenting Magazine and many others. Dr. Brown has a bimonthly column with the Canadian Counselling & Psychotherapy Association and has published two books in recent years: Waiting to Live, 2010 and The Effects of Childhood Trauma on Adult Perception and Worldview, 2008. www.asadonbrown.com

ADDICTION WITHOUT DRUGSA GROWING MENACE!

By Mitchell E. Wallick Ph.D CAP CAGC

Continued from page 18

hours straight. So engrossed in the game was he, that he would wear a diaper so that he did not have to be interrupted in order to go to the bathroom. As of this writing, Michael is attending a sober college.

Jessie is a 33 year old single mother. She earns in the neighborhood of 75100,000 dollars per year. Her closets are full of shoes, overflowing with clothing and her jewelry is piled in 3 dresser drawers filled to the brim. Every imaginable product offered on the internet and/or TV was in her house. When entering treatment, she owed $90,000 in credit card debt. She is presently working two jobs while her mother watches her kids to repay the debt she has incurred.

Clearly, process addiction is as damaging to the individual and family as any other addiction. Treatment is required! In order to appropriately treat the process addiction, the therapist and the patient must address the underlying issues that the patient is seeking to escape. Just like drug addiction, the real world can be “put on hold” for a while, as the process addiction allows for temporary respite from problems. Not unlike losing one’s self in a movie and/or book, the process addiction narrows the focus of the mind and blocks out other issues which may be problematic. Further, the process addiction feeds the ego and builds false self esteem. Whether the medium is the comps offered by the casino or the imaginary life provided by the computer game, the addict is made to feel important and has the opportunity to escape from the less pleasant world in which he lives.

Based on my experiences at CARE, there is a clear need to develop programs which specialize in process addictions. After five years, our treatment team has learned to recognize the symptoms and underlying issues that drive the process addiction. We recognize the physiological, (i.e. the brain chemistry) as well as the psychological reasons for these addictions. The good news is that they can be effectively treated through the use of Cognitive Behavioral Therapy, in combination with both Allopathic and Eastern medicine such as acupuncture and aroma therapy.

In short, we recognize that the goal of the therapist is not to stop the addiction but to restore balance to a comfortable life.

Mitchell E. Wallick Ph.D.CAP CAGC is the Executive Director of CARE www.careflorida.com

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We treat underlying core issues Alcoholism Drug Addiction Trauma

Abuse Co-Dependency Sex & Love Addiction

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877.659.4555

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The contents of this book may not be reproduced either in whole or in part without consent of publisher. Every effort has been made to include accurate data, however the publisher cannot be held liable for material content or errors. This publication offers Therapeutic Services, Drug & Alcohol Rehabilitative services, and other related support systems. You should not rely on the information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health care professional because of something you may have read in this publication. The Sober World LLC and its publisher do not recommend nor endorse any advertisers in this magazine and accepts no responsibility for services advertised herein. Content published herein is submitted by advertisers with the sole purpose to aid and educate families that are faced with drug/alcohol and other addiction issues and to help families make informed decisions about preserving quality of life.

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