Dec14 issue

THE HOLIDAYS: RESILIENCE OR ‘A BUMMER’ HOW TO HAVE A GREAT HOLIDAY: REFLECT ON BEST MOMENTS OF THE PAST

DOES BEING GAY ADD TO THE DIFFICULTY OF BEING AN ADDICT?

ALCOHOLICS ANONYMOUS: A SELFPSYCHOLOGICAL PERSPECTIVE

STRAIGHT LINE THINKING FROM ADDICTION TO ABSTINENCE

SINK OR SWIM: MEN, RELATIONSHIPS, AND RECOVERY “CONVEYOR BELT PSYCHIATRY....THE ASSEMBLY LINE OF MISDIAGNOSES AND TREATMENT IN MENTAL HEALTH AND ADDICTION ‘TIS THE SEASON

HOW DO EMERGENCY RESPONDERS COPE WITH ADDICTION? “RECOVERY RESIDENCES: FOUR DISTINCT SUPPORT LEVELS” CO-OCCURRING DISORDERS: DOUBLE TROUBLE AND INTEGRATION OF TREATMENT

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. The Sober World is an informative magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication in South Florida, as well as an online e-magazine reaching people globally in their search for information about Drug and Alcohol Abuse.

We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol in Palm Beach County as well as distributing locally to the schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more throughout Palm Beach and Broward County. We also directly mail to rehabs throughout the country and have a presence at conferences nationally.

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.

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.

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.

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.

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 provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under the age of 18 yrs. old) and bring them to the facility you have choTo Advertise, Call 561-910-1943

sen. 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.

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.

We are on Face Book at www.facebook.com/pages/The-SoberWorld/445857548800036 or Steven Sober-World, Twitter at www.twitter. com/thesoberworld, and LinkedIn at www.linkedin.com/pub/patriciarosen/51/210/955/.

I want to wish everyone a Happy Holidays.

Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com

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THE HOLIDAYS: RESILIENCE OR ‘A BUMMER’

By Fred Dyer, PhD., CADC

The holidays are upon us. Thanksgiving and Christmas are the most festive holidays. How well I recall growing up in Indiana with the sounds and smells of my mother cooking big dinners of ham and turkey and all the trimmings, me ordered, with my siblings, to clean the house so thoroughly you would have thought President Johnson was coming (that’s a 60s thing), snow on the ground, and Nat King Cole’s Christmas Carol playing on a 78 rpm album. On both holidays, the house filled with family and friends, and food was leftovers for days.

Fast forward from the holidays of our youth to the holidays of today. So much has happened to each of us—career changes, losses, maybe a few regrets; loved ones, friends, and possibly even colleagues have died. It is because Thanksgiving and Christmas have always personified family, emotional closeness, cohesiveness, and a term Alfred Adler coined, social interest (more about that later), that yes, those of us who are passionate about our work, who want to make a difference in the lives of others, young or old, who want to leave this world better than we found it, and who still believe in peace and love have moments— often tearful moments—of loneliness and sadness. The sadness can descend upon us anywhere, anytime, whether in a crowd or alone, in downtown Chicago or Minneapolis, on a December Saturday night when the snow is falling, engaged in what Shakespeare termed, communing with our thoughts.

As professionals, youth advocates, researchers, therapists, and trainers, the holidays can be a challenge, or as the youth I work with say, “a bummer” for us and for those for whom we provide services. In my interactions with colleagues and clients, I have observed that, for some, the holidays of Thanksgiving and Christmas can be the most anxiety-provoking, depressing times of the year. Going forward in therapy, we often have to say with adolescents or emerging adults, “Let’s stay in the here and now”, which consists of, “How do I get through these moments of loneliness, depression, sadness, and anxiety, which are normal for this time of year?”

It is equally important to remember a therapy principle utilized when working with adolescents, that of modeling what we are asking them to do. If we strip away the titles and positions, we too are everyday people with feelings and emotions who have to deal with our own holiday emotional challenges. The following is not written in stone nor is it from a psychological or behavioral journal but may be just common sense: • Avoid being socially isolated. Take care of yourself physically, emotionally, and spiritually. Make sure you connect with a colleague or friend, or attend a social event where the focus is not on you but on others, based on the principle that true happiness is related to social connectedness.

• Volunteer, be concerned about others or, as delineated in Adlerian theory, engage in social interest or Gemeinschaftsgefuhl, or a community feeling of oneness.

• If there is something you enjoy that promotes prosocial, emotional well-being, engage in that activity.

• Eat well. Try to stick to healthful foods. Yes, the holidays are a time when we tend to overindulge…

• Journal. Writing down one’s thoughts and feelings can be cathartic and an effective way to manage affect regulation.

• Attend an AA or NA meeting. While individual therapy is valuable, it may not be available during the holidays.

Fellowship groups such as AA and NA generate a feeling of camaraderie and a sense of belonging.

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• Be grateful. In Yalom’s Curative Factors for group, he lists “existential”, which I interpret as “What does it mean to be alive?” During the holiday season, one can remember to be grateful to be alive, for people to still call your name, to be a contributor, and to give back.

• Lastly, make the holidays work for you. They do not have to be “a bummer”. Moments of depression and sadness are all a part of living with which we must manage, regardless of the time of year. Maybe the folks in AA and NA are right, “We must be willing to deal with life on life’s terms.”

Happy holidays!

References provided upon request.

Fred Dyer, PhD., CADC, is an internationally recognized speaker, trainer, author and consultant who services juvenile justice/ detention/residential programs, child welfare/foster care agencies, child and adolescent residential facilities, mental health facilities and adolescent substance abuse prevention programs in the areas of implementation and utilization of evidence-based, gender-responsive, culturally competent, and developmentally and age appropriate practices. He can be reached at www.dyerconsulting.org

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HOW TO HAVE A GREAT HOLIDAY: REFLECT ON BEST MOMENTS OF THE PAST

By Ann W. Smith, LMFT

How often do we robotically immerse ourselves in the traditions of our families around the holidays without questioning whether those “must do’s” actually create the holiday joy we are seeking for ourselves and our families? Most of us want to feel closeness with those we love, to create moments we will remember with pleasure, to provide vivid sensory experiences that remind us of special holidays in childhood or that create new, more meaningful rituals that are more satisfying than any childhood experience we may have had.

I’ve done a little survey among family, friends and colleagues asking them what is most memorable and meaningful from recent and past holiday experiences. Most of us say similar things such as getting together with family; enjoying intimate gatherings with friends; giving heartfelt gifts; being near young children; spiritual practices; music and other sensory experiences.

When I asked about the gifts they received last year, many did not remember what they got. Some regret going overboard with trying to make everything perfect and mentioned that children really don’t notice the extra touches and seem happier with basic traditions like their favorite cookie, time with their cousins or the simple rituals when the family is together.

They also shared common feelings experienced when expectations have been set too high. For example, parents noticing that their children are not as happy or appreciative as they had hoped may sigh as the holiday comes to a close, feeling empty and exhausted asking “why did we do all that?” Another concern arises when a family has spent too much or created credit card debt in their efforts to please or simply spending extra in the holiday rush without enough time to do sensible shopping.

One reason some of us repeat the same mistake of doing too much year after year may be due to the memories and fantasies of the child within us who wants this year to be the BEST EVER! The phenomena of Euphoric Recall (remembering only the good stuff) tells us that this time it will be perfect; we will get great presents; others will love the gifts we give; the festivities will be super fun and everyone will be happy.

As portrayed comically in one of my family’s favorite holiday movies , “Christmas Vacation” with the Griswold family, it is just a few crazy days that do not quite live up to the hype and yet, we try again next year because in the end, it’s all about love.

If you would like to do better this year, these are a few tips to help you get there: • Reflect on past holiday seasons throughout your life and ask yourself and your family what worked and what was just a lot of trouble with little reward?

• Delegate - Instead of dreading December’s approach and obsessing about the to-do list, delegate tasks you don’t like or drop them off the list.

• Take care of yourself – Put your well-being first. Sleep well, eat healthy, energize with exercise and minimize sugar intake. By making yourself a priority, you’re also less likely to sabotage yourself and have regrets later.

• Make regular emotional deposits. Take a good look at how you are interacting with the people you love who matter most.

Is your exchange with a spouse or children always about the to-do list? Simple deposits – a smile, attentive listening, touch, validation and affirmation will help you feel the love and connection you really crave.

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• Focus on what matters most. During the holidays, we have a tendency to stress more about material items/gifts instead of focusing on what means the most to us – our relationships.

Take a moment to create a gratitude list of what you most appreciate and what you really need to feel fulfilled in life.

• Maintain healthy boundaries. It’s important to protect yourself from common invaders such as jobs, too much activity, intrusive family or friends, telephone, computer, TV etc. It’s ok to say no. You may need to reevaluate whether you’re trying to do too much.

• Take a moment after the season and write a “note-toself” on the new calendar listing the choices that came closest to what you value and also listing what needs to be left by the wayside.

• Live your truth. The holidays are a great time for families to think about a mission statement for the next year. Ask yourselves “Is this the life we want to be living?” Seek help if needed to make the changes you desire.

Ann Smith is the author of three books: Grandchildren of Alcoholics: Another Generation of Co-dependency, Overcoming Perfectionism: The Key to a Balanced Recovery and Overcoming Perfectionism: Finding the Key to Balance and Self Acceptance, second edition, which was released in March 2013. She also contributes to media including Dateline NBC, National Public Radio, Newsweek, Us Magazine, Redbook, U.S. News and World Report, Philadelphia Magazine, Washington Post, Forbes Women, Chicago Tribune, WebMD and Wall Street Journal.

Ann is the Executive Director of Breakthrough at Caron (www.

BreakthroughatCaron.org), a five day residential personal growth workshop designed to help adults shift destructive life patterns, improve relationships and strengthen self-esteem. For over 30 years, Ann’s focus has been on addiction, family systems and experiential therapy.

To learn more about Ann visit: www.BreakthroughAtCaron.org/ AnnSmith. Become a Fan on Facebook at www.facebook.com/ Caron

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‘TIS THE SEASON

By John Giordano DHL, MAC

Like so many others, I’m looking forward to spending time with friends and family over the holidays while giving praise to my higher power. There is nothing in this world that gives me greater joy than to share this special time with the ones I love and care about the most. I didn’t always feel this way. In fact, there were times I’d wished the holidays would just never happen or just end quickly. Unfortunately, too many addicts – both recovering addicts and those struggling with an active addiction – feel the same way.

As much fun and enjoyment as the holidays brings us, additional stress comes with it. Stress is a part of every day life. It’s a response to a perceived threat. When presented with a threat, our body automatically produces hormones that provide the energy and sharpness to deal with the danger. To maintain balance, our brain produces ‘feel good’ chemicals to keep the hormones in check.

The holiday’s amp-up this complex cycle and can extend it for longer periods of time than we’re accustom to. This often depletes ‘feel good’ chemicals that control our mood and behavior; thus taxing our coping mechanisms. Some of the more obvious stress induced behavioral changes include a change in eating patterns (over and/or under eating), aggression, angry outbursts, drug and/or alcohol abuse, excessive smoking and social withdrawal. It becomes more complicated for addicts in that they can experience all of the stressed behaviors plus strong cravings for drugs and/or alcohol.

Before I got help I displayed all of these behaviors and a few not mentioned. At the time I was married with two young children. I was also very involved with teaching and competing in Karate. For years I fought in tournaments in the biggest venues in the country including Madison Square Garden. I was on top of my game having won dozens of tournaments and enjoyed the widespread recognition that comes with the national titles I’d earned. Law enforcement and government officers sought me out for training like so many others who were serious about learning Karate. I thought I was living my dream. But in reality I was living two directly opposing lives – one of a respected family man and Sensei and the other of being an out of control drug addict living in the shadows of the night.

I thought I was invincible and abused drugs more and more each passing day. Eventually I began to withdraw. There were times I was no where to be found around the holidays, kids birthdays and anniversaries. I felt like these types of days just seemed to magnify my addiction and trigger a greater response. I tried to hide my addiction by just going away for a spell. I’d hole up in cheap motel rooms or sleep on the sofa in one of my addict friend’s apartments.

Thirty years ago this December my family gave me a Christmas present – although it didn’t seem like a present at the time – that forever changed and quite possibly saved my life. My friend invited me to his home for a holiday drink. I walked into a room filled with my friends – many of whom I’d abused drugs with – and family. It was an intervention. Immediately my cravings kicked in and my holiday cheer turned to anger. After a lot of talk in what seemed like forever, I accepted their challenge; but only because my mother swore she’d never speak to me again – and she meant it.

To this day I believe I was one of the worst addicts in rehab ever. I was completely uncooperative, belligerent and unruly. I threatened to beat-up therapists and counselors if I didn’t get my way. Thankfully my friends, who knew the doctors and counselors, assured them my threats were empty.

Then something clicked, I call it a spiritual awakening. It was Christmas Eve night and I was in a rage because the staff wouldn’t let me go home to be with my family. I tried to kneel, but couldn’t.

I forced my knees to bend and for the first time prayed for God’s

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will and not my own. Remarkably, my rage disappeared. I tried to summon my rage back but my heart would not let it in.

On Christmas day my wife and kids were allowed to visit with me for a couple of hours and I’ll never forget how I couldn’t look them in the eyes. I was angry with myself for allowing this to happen to me and for the shame I brought on myself and my family. I felt guilty and broken. As I look back I now know that my rage and illtempered behavior was nothing more than a mask hiding the raw emotions in the shell of the man I once was.

Thirty-years ago this January I walked out of rehab a changed man. I know that sounds cliché but its true. It wasn’t easy at first and I faced more than my share of trials and tribulations. I lost my marriage and my relationship with my kids. Financially I was broke and living in a rundown hotel. I couldn’t afford a car so I rode a bike. I had to go back to school to learn the skills I’d need to move forward. Nothing fazed me because I was so much better prepared to deal with life’s challenges. I used the coping skills that I once lacked instead of turning to drugs for answers. I learned how to turn my stress into a driving force that would ultimately lead to my growth and development as a person, husband, and father, and provided me with the motivation to raise the money to open my first treatment center, New Life. The reward I feel helping others overcome their addiction is far greater that I ever dreamed.

My holiday prayer for recovering addicts is that you continue winning your fight each and every moment. And for those still actively using I pray you get help. Millions of people have beaten their demons and you can too. Life has so much to offer that it is not worth one more day of using. I also pray for the families of addicts. I hope that you find the help that you need, the courage to guide your loved one in the right direction and the strength to see it thru. I know it is not easy for family members but sometimes you just have to put your foot down. I would probably be dead right now had my mother not drawn the line in the sand.

Addiction is truly a family affair. Remember, nothing is impossible and there is always hope.

Happy Holidays!

John Giordano DHL, MAC is a counselor, Founder and former owner of G & G Holistic Addiction Treatment Center, President and Founder of the National Institute for Holistic Addiction Studies, Laser Therapy Spa in Hallandale Beach and Chaplain of the North Miami Police Department. For the latest development in cuttingedge treatment check out his website: www.holisticaddictioninfo.com

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ALCOHOLICS ANONYMOUS: A SELF-PSYCHOLOGICAL PERSPECTIVE

By Noah Kass, LCSW

Self-psychology, developed by Heinz Kohut, is a psychoanalytic theory that views psychopathology as being the result of unmet or disrupted developmental needs. Essential to understanding selfpsychology is the concept of selfobjects. Selfobjects are persons or things physically existing outside the self, experienced as part of the self, and that function in service of the self (Kohut, 1984). Selfobjects fulfill mirroring, idealization and twinship needs.

The mirroring need allows the infant to confirm his own specialness and establishes excitement for existence. The infant craves appreciation and responsiveness from the caregiver. In an optimal caregiving environment, he will feel comfortable displaying his grandiose self, highlighting innate talents and potentialities.

Suppressing the child’s unrealistic fantasies and ambition would diminish development of productive energy and self-confidence .If the caregiver responds adequately to the mirroring need, the child gradually accepts the loss of infantile grandiosity and begins formulation of realistic goals.

The idealization need allows the child to draw strength from a caregiver’s power and calmness .Most noticeable between ages of four and six, this need focuses on the desire to be part of and protected by another .Kohut suggested children go through an evolution from idealizing their parent to viewing them as individuals with imperfections .Parallel to that process, the child evolves to recognize her own multi-dimensionality. If the idealization selfobject need is fulfilled, the individual can handle disappointment without impacting selfesteem .Having parents not attuned to this need or not worthy of idealization could result in narcissistic vulnerability, with the self being overly affected and distorted by the slightest discouragement or setback.

The twinship need helps individuals feel less isolated in the world by matching them up with another person like them .It becomes most relevant during the latency period (adolescence), a time when security in numbers is vital. Fulfillment of this need provides separation from the nuclear family, and formation of a consolidated sense of self .The goal is development of a person’s ability to form mutually gratifying relationships with others, and concepts of connection and belonging to the world.

Although these three selfobject needs have specific ages where they appear most relevant, they are consistently evolving and seeking gratification throughout the life cycle. In addition, the extent to which these selfobject needs are satisfactorily internalized in childhood becomes a strong predictor of overall mental health in adulthood.

Heinz Kohut’s self-psychological perspective supports participation in 12-step programs such as Alcoholics Anonymous (AA). Participation in AA often brings a sense of connectivity, safety, and support.

Membership in this community can provide an opportunity for an addict to acquire a substitute selfobject, filling an unmet need from infancy and childhood.

AA may serve as an “omnipotent transitional object”, an integral ingredient in helping make the transition from ingesting selfsoothing compensatory substances to sudden abstinence bearable. When AA members speak about their unwavering devotion to “working the program,” they may be speaking less about AA principles and more about finding an object (AA) strong enough to compete with their drug of choice.

The theory of self-psychology emphasizes the need for others to help maintain self-esteem, control anxiety, and provide self-soothing functions .Long-term AA membership combined with significant immersion in the fellowship may partially fulfill the idealization, mirroring, and twinship needs not properly internalized in addicts during childhood. Since it is difficult to fully meet needs that were unmet in childhood, many recovering addicts feel an almost “addictive” relationship with AA. Perhaps the more one attends, the more the needs of the tripolar structure (idealization, mirroring,

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twinship) will be fulfilled. Veterans of AA suggest newcomers attend 30 meetings in 30 days, supporting this hypothesis.

AA attempts to fulfill the addict’s mirroring need through admiration and validation. Designated time periods (30 days, 90 days, 180 days, 365 days, etc.) are constructed to acknowledge members have achieved significant abstinence from their drug or addictive behavior of choice. At these times, members explicitly reflect and voice recognition of the individual’s growth during the recovery process; a coin may be given representing the amount of sober days; and the individual may be given new membership responsibilities. The celebrated member is recognized, validated, and admired by peers.

In AA, the addict is given the time to freely share thoughts, feelings, and experiences without interruption. This promotes, rather than represses, a natural grandiosity often unacknowledged by the individual’s primary caregiver. It is a relief from the repression of emotions that often occur during active addiction.

The mirroring self is seen as the addict begins to recognize likeminded individuals inside the various AA rooms. Often he is surprised by the lack of judgment from fellow addicts. This experience may have a transformational impact. They have located others in the world who have shared experiences, and with that comes a unique sense of acceptance and familiarity. These like-minded individuals help lessen the shame associated with previous addictive behaviors.

Peers begin to see how voicing their own experiences can help each other. They become sponsors to newcomers, helping guide them through the AA traditions and principles. This continues an everlasting mirroring process, allowing the sponsor to continue having his own thoughts, feelings, and experiences, recognized and reflected back to him by the sponsee.

Alcoholics Anonymous attempts to fulfill the idealization need by providing an organization to admire and identify with. It serves as a re-parenting mechanism substituting for the original idealized parental imago. In the program’s principles and procedures, members recognize organization and productivity. In its focus on simplicity and consistency, members recognize calmness and rationality. These features were usually not seen in the addict’s relationship with his primary caregiver.

The hopefully productive sponsor/sponsee relationship makes vivid the often-problematic relationship of the caregiver/child. It is the hope that the sponsor, through example, can provide the addict with what the caregiver could not: the ability to be simultaneously productive and free from destructive anxiety. The prescriptive nature of AA, including working the steps, attending meetings regularly, getting a sponsor, and abstaining from drugs/alcohol, is reminiscent of a parental figure giving practical and compassionate advice to a child.

The focus on a higher power, sponsor, group members, and the entire collective could help mirror selfobject functions previously attempted by the isolated individual.

The power of the fellowship is recognized as existing beyond any individual room, extending across states and countries. Individuals are given a common language to communicate with a diverse population whose similarities bind them together. The addict feels less isolated in this world, the exact opposite of what she may have felt when in the cycle of active addiction.

References Provided Upon Request Noah Kass, LCSW, MA is a psychotherapist specializing in addiction treatment. He is a doctoral candidate at the University of Pennsylvania’s school of social policy and practice. Noah received an MSW in clinical social work and a master of arts in education from New York University. Noah has been Clinical Director at The Dunes East Hampton and Realization Center in New York City.

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13

SINK OR SWIM: MEN, RELATIONSHIPS, AND RECOVERY

By Dan Griffin, MA

As I have been looking at the intersection of masculinity, trauma, addiction, and recovery over the past two decades I have arrived at some interesting conclusions. In essence, something happens through the process of recovery in how men express themselves at the foundation of their identity – gender. This has a dramatic effect on our relationships. Many of us are unaware of this process simply because it happens in the context of our recovery – not our gender identity. That was certainly what I found interviewing men almost twenty years ago for my master’s research as well as the sixty-plus men I interviewed for both of my books. This phenomenon – this lack of awareness - is what I refer to as: The Water. “The Water” refers to the parable of the two fish who are at the bottom of the ocean when another fish swims up to them and says, “Howdy fellas, how is the water?” The fish smiles and then swims away.

The two fish look at one another and say, “What the hell is water?”

My experience is that is exactly how gender shows up for most of us: an invisible force that controls and impacts more of our lives than we could ever imagine. Mostly because we can’t see it.

Seeing the Water When I wrote my first book (and my master’s thesis) the most common responses from men to my question, “How have your ideas of being a man changed since getting into recovery?” was that they hadn’t. I was shocked by this. I thought it was obvious but I have come to realize that was primarily because I had the fairly unique experience of getting into recovery at the same time that I was “discovering” gender. So, when a man walked up to me and wanted to hug me at my first recovery meeting – I was taken aback to say the least. Then I heard men talking about being afraid and sad and sharing other information about their lives – their inner lives – that men are not supposed to share. I knew that men were expressing themselves differently than they did in larger society.

This is one of the core ideas behind my work: how the ideas that we have had forced upon us by various social agents (family, school, media, etc.), is what I have come to refer to as The Man Rules™, which are in almost complete contradiction to the principles of recovery. See the chart below The Man Rules™

The Principles of Recovery/ Therapeutic Change

• Always be in Control • Don’t Cry • Don’t ask for help • Don’t show emotion • Be a sexual superman • Don’t show weakness • Be a protector • Know everything • Be a provider

• Show vulnerability • Ask for help • Admit powerlessness • Let go of control • Be responsible • Be of service • Express emotion • Humility • Sobriety

Some of the key elements of the Man Rules™ are: • The anti-female typified through the “don’t be a girl” exhortation that is hidden in the admonitions to not be weak, not be vulnerable, not ask for help, etc. – all traits commonly associated with girls and women.

• The anti-relational through a focus on self-sufficiency, nonemotionality, hyper sexuality, and independence.

• The non-identity based upon the significant number of “don’ts” in the Rules that tell men who they are not rather than who they might be.

While not inherently bad or wrong or unhealthy, when taken to an extreme the Man Rules™ can be severely damaging to a man and his relationships. You can find a much more thorough discussion of the Man Rules™ in my latest book A Man’s Way through

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Relationships: Learning to Love and Be Loved in Chapter 1.

The tension between the two sets of expectations – the Man Rules and the Principles of Recovery - is obvious. However, this dichotomy is rarely acknowledged, let alone addressed, in men’s treatment or ongoing recovery. As a result many men do not have a lot of awareness about this tension or understand how it is affecting their relationships. And it is often affecting us and our relationships much more than you might think. This is an incredibly important part of “The Water” of men’s recovery. It deeply affects our ability to engage in intimate relationships.

The reason many men do not see the tension inherent in this dichotomy is because when they first get into recovery or are introduced to the concepts in treatment or in the recovery community they are adopting these new values for one reason: to save their lives. They are willing to go against any number of common behaviors or ideas if it will save their lives and offer them a glimmer of happiness and peace. The challenge is that when men do not completely see the Rules, those Rules tend to operate in a more insidious way – driving much more of men’s behavior, especially in their most intimate relationships, than they know. Look again at those Rules above – very few of them are behaviors or expectations that allow men to have healthy and successful relationships!

Let’s also think about why men follow the Rules. For one primary reason: safety. Contrary to popular opinion that men are trying to be assholes or act like cavemen when we act certain ways. We come by it naturally. It is how many of us were raised. Boys learn very quickly that they will not get made fun of, ostracized, beat up, or abused if they follow the Rules. All men follow them to varying degrees. Few men realize how much they have internalized the Rules. I firmly believe that almost all men simply want to love and be loved. The Rules make it hard. Really hard sometimes. The fact that the behaviors required for men to create intimate relationships are very similar to the recovery principle and also mainly goes against the Rules.

Navigating our relationships is difficult. So why is there so little conversation about men’s relationships that seeks to honor men and support us in finding meaningful connection? Why, until now, have there been zero books written just for men in creating healthy relationships in recovery – when all we have is relationships? Why has our attention to men’s trauma been such an epic failure? It is ALL part of the water. The question I have to ask you is very simple: Are you going to sink or swim?

Dan Griffin, MA, has worked in the mental health and addictions fields for over two decades. Griffin is the author of three groundbreaking trauma-informed resources for professionals working with men - A Man’s Way through the 12 Steps and A Man’s Way through Relationships: Learning to Love and Be Loved and co-author of Helping Men Recover with Dr. Stephanie Covington and Rick Dauer. Griffin travels internationally educating and training clinicians and other professionals about how to more effectively work with, intervene on and treat men. In early 2010, he started a consulting, training, and speaking business, Griffin Recovery Enterprises. He served as the state drug court coordinator for the Minnesota Drug Court Initiative from 2002 to 2010, and was also the judicial branch’s expert on addiction and recovery. He is a highly sought after speaker and trainer who has presented to thousands of people from around the world.

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17

“CONVEYOR BELT PSYCHIATRY....THE ASSEMBLY LINE OF MISDIAGNOSES AND TREATMENT IN MENTAL HEALTH AND ADDICTION.

By Ash Bhatt, MD

In the United States, a country of vast resources, there is an ironic existence of a healthcare system which cares for human beings’ physical and mental health, which in itself is in need of repair. Certain medical specialties are more vulnerable to the shortcomings of our current healthcare system and its’ limitations. Psychiatry, in my opinion, and the patients the field serves, is one of the specialties most affected. Each medical specialty possesses its’ own respective limitations, but also their strengths and resiliencies. I see more resilience when it comes to the more tangible, concrete specialties like surgery, internal medicine or radiology, where there has been an existence of more tangible, concrete tools to diagnose and treat patients. These specialties are able to exist, not optimally, but more effectively, within this broken system without significantly compromising diagnostic accuracy and treatment. Psychiatry is not as resilient. Unfortunately, the inherent building blocks of the field itself render psychiatry vulnerable as it depends much more on intangibles and it relies much more on time.

Those of us who treat patients with mental and emotional diseases are dealing with an abstract concept: The mind. We can’t palpate, auscultate, or obtain an MRI of the mind. We treat disorders of emotions, feelings, behaviors, perceptual disturbances, and thought.

Yes, there are advances in neuroimaging, measurement of biomarkers, and metabolic rates, but this is still a novel concept when it comes to its mainstream utilization. We do not have the luxury, if you can call it that, of physical examination, diagnostic imaging, laboratory results, or biopsies to assist us in diagnosing or treating.

Psychiatrists rely on an interview with patients who are often depressed, anxious, manic, psychotic, and in many circumstances incapacitated and unreliable. In any setting, from emergency rooms, to inpatient floors, to outpatient offices, we rely on a semi-structured diagnostic clinical interview to guide us to the most probable diagnoses and ultimate treatment. This requires time, and this is where the big problem lies. In my experience, when matched with this health care system, the creation of a giant mismatch has occurred. A field compromised both by the system and the individual practitioner. Our patients have often filtered down the socioeconomic ladder with poor support and have no means or the appropriate state of mind to hold the mental health practitioner accountable for their actions, question the treatment they receive, or demand for their deserved rights as a patient.

In any setting, from emergency rooms, to inpatient floors, to outpatient offices, I cannot count how many times I have heard from countless patients, “I’m Bipolar”, “I have Major Depression”, “I have ADHD”, or some other singular or combined diagnoses. Some start out requesting specific medications for these diagnoses which they have carried around for years. When I attempted to elicit criteria for such a diagnosis, past or present, they did not meet any such diagnoses.

Further history taking revealed that many were diagnosed by a physician or mental health practitioner who spent a reported 5 to 15 minutes going through a checklist of criteria or having them fill out a questionnaire without placing their symptoms and presentation in the appropriate context or considering the influence of illicit substances.

No collateral or corroborative information was obtained, or in the case of minors or incapacitated individuals, only a parent or guardian’s history was taken into consideration. Most of these individuals did have a true mental health disorder but sometimes not the one they believed they had, and were placed on years’ worth of ineffective trials of psychotropic medications leading to lack of improvement, exposures to unnecessary side effects, and frustration with the medical field and psychiatry as a specialty. Often these individuals were unable to accurately explain their symptoms, as they had difficulty discriminating their thoughts or emotional feelings from physical feelings, and needed help to articulate what was “The chief complaint” and “History of the present illness”. Over the years, many patients intoxicated with alcohol or cocaine made pit stops at emergency rooms and were

18

diagnosed with depression or bipolar disorder inaccurately and placed on psychotropic medications, only to carry them along adding medication and additional diagnoses by subsequent practitioners without addressing their true substance abuse diagnosis. The reverse has occurred, where the client on cocaine was diagnosed with cocaine intoxication and dependence but never had the possibility of a mood disorder thoroughly explored, diagnosed or treated.

Patients who were previously diagnosed ended up often being treated solely on their self-reported “past psychiatric history” without any attempt by the physician to explore and elicit the appropriate criteria warranting such a diagnosis and ultimate treatment, which only can be done by conducting a thorough diagnostic psychiatric interview. So essentially, they are stamped and labeled with their previous often self reported inaccurate diagnoses and then additional diagnoses are added on by various providers solely on the history of presenting symptoms or illness without “truly diagnosing them”. It is a conveyor belt of sorts, assembling a trail of misdiagnoses and inappropriate treatment.

Patients with emotional and mental illness need a thorough, sophisticated diagnostic evaluation. It incorporates appropriate history taking from birth to the present, considering biological, psychological and social influences as well as placing symptoms in the appropriate context and domains while seeking out any necessary collateral and corroborative histories. This is the minimum that needs to be done.

Again, this takes time. All aspects from the chief complaint, history of present illness, past psychiatric/suicide and substance abuse history and treatments, family psychiatric/suicide and substance abuse history, legal history, birth and developmental history, medical and surgical history, current and past medications history and trials, educational history, social history and a mental status examination needs to be conducted on all patients who are to receive a diagnosis by that practitioner. That practitioner has to elicit the diagnosis and be able to validate it. Necessary medical and lab work-ups should be done. I am pretty sure a neurologist is not going to make a diagnosis of right sided hemiplegia and left sided stroke and treat that patient for it without doing the appropriate diagnostic testing and physical examination, not solely based on a the patient’s self report of “past neurological history”. So why are so many people getting prescribed bipolar meds, depression meds, and ADHD medications, to name a few, without the appropriate workups and diagnostic evaluations?

Psychiatrists, and especially mental health practitioners, who make up the majority of those treating mental illness, have a duty to ensure the patient they are evaluating gets the appropriate evaluation, treatment and recommended follow up. This cannot be done in fifteen minutes or thirty minutes for that matter. Our field of psychiatry is too complex, one which we cannot compromise our time with our patients. We are doing them a disservice if we do it any other way.

Psychiatry is not a specialty suited for quantity but quality. Everyone deserves a first opinion, or at a minimum, an accurate second.

Ash Bhatt is Medical Director, The Recovery Place, Chief Medical Officer, EBH Florida Region, Diplomate, American Board of Addiction Medicine, Diplomate, American Board of Psychiatry and Neurology, Adult Psychiatry, Diplomate, American Board of Psychiatry and Neurology, Child and Adolescent Psychiatry

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19

DOES BEING GAY ADD TO THE DIFFICULTY OF BEING AN ADDICT?

By David Smallwood

I am gay and I am an addict. I have a great interest in understanding if there is a connection between the two. I believe very much that there is.

I don’t mean to argue that the gay community is special and different, but the large number of gay addicts seems to be out of proportion to the size of the gay population.

There have been a number of articles in this publication linking trauma (especially childhood trauma) and addiction.

From my perspective there is another factor that will influence the possible inception of an addictive process. That factor is emotional sensitivity. Eventually, this sensitivity will become distorted into great shame.

I believe that the root of addiction is that the addict (potential or actual) has a heightened sensitivity as a genetic predisposition. So we come into the world feeling scared from day one.

My understanding is that we arrive with little or no cognitive ability, but with a fully functional limbic brain that triggers our responses of fight, flight or freeze - although we mostly have only freeze available in our first months and years.

Anything that affects us adversely in our early childhood will therefore have more impact on us. It will stimulate the limbic system and will trigger a response that will remain in our limbic memory for use in the future.

Each time the memory is triggered we experience the same response as the original one. If we try to deal with this response by using a mood-altering behaviour or substance, then we have the basis for addiction.

Initially we will use a response such as tears (to gain connection) or maybe sugar. (It is only much later that we get into the real candy shop of mood altering nirvana.)

So let’s take sensitivity, limbic trauma and our early childhood experiences. How do they stack up for someone who is gay?

The first thing is that whilst I’ve met gay men who are mindless and oblivious to anything going on in the world, in my experience they are the exception. Most gay guys I meet are very sensitive, almost ‘painfully’ so.

Secondly, gay guys find coping mechanisms early on and use them very effectively. Who has not seen a gay man use his wit like a whiplash - always having the last word, using ‘camp’ as a defence, disarming any aggressor and avoiding any confrontation?

Also dressing and grooming ‘perfectly’ gets us approval and we hope acceptance.

In his book Velvet Rage, Alan Downs describes how a gay boy is by definition born into a heterosexual environment.

Parents can see that their little boy is not quite what they expected.

Whilst parents don’t always raise this as an issue and they still love their child, the boy will pick up the emotions around him and assume he has done something wrong.

You can see that the more sensitive we are, the more likely we are to be distressed by this. It immediately creates a ‘wound’ and starts a process of the child adapting itself to better fit what it perceives that the parents want (this process is described very well by Pia Mellody in her book ‘Facing Codependence’) If we (addicts) find a substance or process that helps to medicate or numb our anxiety, then we feel relaxed and much happier.

This process unfortunately kicks in the law of diminishing returns (another way to describe this effect is to call it tolerance).

I once read a book from Hazelden called ‘Denial is not a long river in Egypt.’ The quote that leapt off the page was ‘if one is ok, one in every colour must be better!!’

20

This then is the small ‘T’ trauma that can colour everything that we do. And I do mean everything. If we perceive that we are ‘not quite right’ then every action we take and every thought that we have, will have an element of defence and adaption.

We will make a comparison between what we might do or say and what we think other people will think is ‘right’. We then ‘act out’ off the back of those thoughts in the hope that we won’t be challenged about the validity of our words or actions.

For a gay boy this is a constant companion. We are ultra aware that we are different and somehow ‘wrong.’ We have a huge amount of ‘evidence’ to this effect. You have only to listen to news items about the pastor who says that natural disasters are punishment from God for our acceptance of homosexuality, or loony religious people praying outside hospitals for gay guys to die. Then there are the boys at school whose homophobia has been taught by their parents, just as their parents were taught it themselves, by their parents.

So we seek to not offend and instead we want to blend in, whilst at the same time we are angry that we are judged and reviled.

The effort required to facilitate this constant stress is huge and to some degree or other unsustainable. As I indicated above, we then start to adapt ourselves to suit society, which of course does not work.

The next very logical but ultimately destructive thing we do to seek something to relieve this stress is to find something powerful enough to medicate the feelings.

In my case, I ‘adapted’ by going to my doctor when I was 16 and I told him that I could not cope. Without looking up from his prescription pad, he wrote me a script for Ativan (lorazepam), which worked so well that I became immediately dependent upon it.

Despite current guidelines that say the drug is only for short-term use, I took it for 20 years!

It dissolved my fear and anxiety instantly. And I could cope with life again.

It did NOT however deal with the underlying issues, merely blotted them out.

This is a pattern that I see repeated again and again (both in gay and heterosexual clients) and it gets enhanced as time goes by. I know no better epithet to describe what gay guys end up doing than ‘sex, drugs, and rock and roll’.

Sounds cool and aspirational, but actually it’s a treadmill that is almost impossible to get off. If you ask the average young gay boy where he can meet other gay boys he will almost always say Continued on page 30

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HOW DO EMERGENCY RESPONDERS COPE WITH ADDICTION?

By Peggy Sweeney

No one intentionally chooses a path of self-destruction; an unhealthy behavior or addiction. These damaging tendencies may develop over a period of time, and are often the result of trying to cope with a physical and/or emotional trauma or multiple traumas: sexual abuse, depression, post-traumatic stress, job loss, debilitating injury, death of a loved one, to name a few. In this article, we will explore some of the reasons adults make the choices that they do as well as some of the struggles they must cope with during their recovery.

Several years ago, I served as a consultant for a local hospital.

During that time, I provided help for adult and adolescent/teen in-patients recovering from chemical dependency and emotional trauma by way of one-on-one conversations and group support meetings. The patients shared their personal stories of grief, abuse, and other misfortunes that had influenced their need to find a way to cope with these events. Flashbacks from childhood of sexual, physical, or emotional abuse were common themes as well as feelings of abandonment by a parent due to death, divorce, incarceration, or the unwillingness to care for their offspring. Some adults remembered the shame they felt as children or teenagers when classmates and neighborhood bullies belittled them because of their appearance, physical abnormalities, or social status.

Traumatic events that happened during childhood are not the only reason for choosing a path that leads to addictive behaviors.

Sometimes, a career choice can cause similar challenges that eventually lead to emotional chaos and nightmares. Take for example the response to life-threatening situations police officers often encounter. Or the day-to-day occurrences of human tragedy and suffering witnessed by firefighters and emergency service personnel.

Although they thrive on the adrenaline rush and the good feelings when an emergency call has a positive outcome, the opposite effect can result when the call is distressing. Multiple fatalities, the death of a child, or a line of duty death(s) can be unforgettable.

Some emergency responders are able to cope with these experiences. Many, unfortunately, cannot. As each new dangerous or traumatic event occurs, it becomes more difficult to cope with the anxiety, stress, nightmares, or the visions that play over and over again in their mind. They cannot sleep. They have difficulty communicating with others. They become fearful and anxious every time the tones go off announcing another potential stressor to add to their already overloaded mind and spirit.

To be able to cope with life in general, continue doing their job fairly well, and shut out the demons in their mind, they seek solace in what they believe will be a remedy or an answer to their prayers.

Their choice of coping mechanism may include alcohol, addictive drugs, self-mutilation, or gambling.

Addiction does not happen overnight, but rather over time. For instance, what may begin as a few beers to numb feelings and temporarily block out the horrific scenes that play over and over again in their mind, eventually becomes many beers in the same time period and slowly builds into an addiction. They have a strong need to suppress what is painful to remember. They want to erase from their memory all the unpleasantness in their life. Unhealthy habits or addictions become the outlet for overcoming the emotional, mental, and/or physical suffering they have endured or witnessed.

Before too long, they have added another element of struggle to their life. Now they must not only cope with the post-trauma issues, they must also cope with one more demon: the addiction or harmful behavior. This demon has the power to destroy their life and the lives of those they love. Their unhealthy remedy to heal their emotional wounds may become a financial burden in addition to a detriment to their health. In some cases, addiction can result in job loss, long-term disability, incarceration, or even death.

Once someone has acknowledged his or her addiction problem,

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recovery must follow. Recovery is not easy. It is not a sugar-coated cure for emotional trauma, but rather a lifelong commitment to coping with life – and profession – without the aid of alcohol, chemicals, or other addictive activities. Nonetheless, the benefits from recovery far outweigh the consequences of addiction.

As I stated previously, recovery from an addiction or unhealthy habit is never trouble-free. Case in point: Someone has acknowledged that they have an addiction to alcohol. They have begun their rehabilitation within the safe confines of a treatment facility. During this time, they have undergone the physical withdrawal from alcohol, and are participating in daily one-on-ones and group meetings with counselors and other inpatients as well as learning to rebuild relationships with family and friends once their time in treatment ends.

For now, the source of the addiction has been removed from their life. They are living in a “safe” environment. The patient is given advice and resources to help them address and come to terms with the stressors or events in their life that played a major role in the addiction process. As difficult and painful as it may be to talk about their memories and feelings, I believe this is a key factor to recovery.

At the conclusion of their in-patient stay, they must return to everyday life and deal with situations that challenge their abstinence.

Remember that his or her addiction is due to an unhealthy choice of coping with emotional trauma which developed over months or years. Staying addiction free is not a simple task. It will be their responsibility to make choices that will help them avoid a relapse.

For instance, they realize that certain places of entertainment that they once enjoyed must now be avoided at all costs. In some cases, it may mean a career change.

A major challenge facing people in recovery within the emergency response community is the recurring stressors and traumatic events that may have contributed to their addiction. It will be very important for them to receive encouragement and support from family members, co-workers, and friends as they re-invest in their new life. I recognize and accept that their choice for an addiction-free life is their responsibility, but no one can do it alone.

If someone you love is in need of your help, do not judge him or her by their addiction, but rather by the gifts and talents they possess.

With your help, their addiction can become a life-altering event of recovery and inner peace.

Peggy Sweeney is a retired mortician and bereavement educator.

She has developed and taught countless workshops for coping with grief and trauma, and is the editor of the Grieving Behind the Badge newsletter. Peggy is a member of the Comfort (TX) Volunteer Fire Department and a former EMT-B. Contact Peggy at peggy@ sweeneyalliance.org or visit grievingbehindthebadgeblog.net

It’s our

home.

Certifying safe and digniied recovery residences for individuals seeking peer-supportive shelter.

“Are you FARR Certiied?”

www.farronline.org

WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? Sunset House is currently classified as a level 4 transitional care house, according to the Department of Children and Families criteria regarding such programs. This includes providing 24 hour paid staff coverage seven days per week, requires counseling staff to never have a caseload of more than 15 participating clients. Sunset House maintains this licensure by conducting three group therapy sessions per week as well as one individual counseling session per week with qualified staff. Sunset House provides all of the above mentioned services for $300.00 per week. This also includes a bi-monthly psychiatric session with Dr. William Romanos for medication management. Sunset House continues to be a leader in affordable long term care and has been providing exemplary treatment in the Palm Beach County community for over 18 years.

As a Level 4 facility Sunset House is appropriate for persons who have completed other levels of residential treatment, particularly levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the world of work, education, and family life.

In conjunction with DCF, Sunset House also maintains The American Society of Addiction Medicine or ASAM criteria. This professional society aims to promote the appropriate role of a facility or physician in the care of patients with a substance use disorder. ASAM was created in 1988 and is an approved and accepted model by The American Medical Association and looks to monitor placement criteria so that patients are not placed in a level of care that does not meet the needs of their specific diagnosis, in essence protecting the patients with the sole ethical aim to do no harm.

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“RECOVERY RESIDENCES: FOUR DISTINCT SUPPORT LEVELS”

By John Lehman

FARR does not offer a rating scale that measures the efficacy or valuation of any individual Certified Residence. Our mission is to ensure the availability of housing that is: 1.

2.

3.

4.

safe and dignified alcohol and drug free a peer supportive environment a good neighbor and responsible citizen

FARR Standards and the FARR Code of Ethics serve as guides for how best to achieve these four goals and provide a basis for service provider accountability to an independent, non-profit organization dedicated to upholding the resident’s right to access high quality, recovery-oriented housing. Some support levels are more organically ‘peer-supportive’ than others and, when selecting a program, individual residents are ‘best’ served by first gaining a deeper appreciation of defining criteria for each level.

FARR recognizes four distinct support levels under the singular term Recovery Residence. One level is not better or more advanced than the others, but instead offers a unique service structure most appropriate for a particular resident. By way of example, Level 1 residences are perhaps best exemplified by the Oxford House model. This non-profit 501c (3) program operates nationwide, supports over 1,200 recovery homes that serve more than 24,000 residents annually. Highly regarded by clinicians, peer specialists and SAMHSA alike, the Oxford House program is documented by evidencedbased studies demonstrating consistently positive outcomes. Many people achieve sustainable recovery while residing in Level 1 residences. Visit www.oxfordhouse.org to learn more about this program.

During the first year of my recovery, I resided in a residence that excelled at the aforementioned core goals. The apartment I occupied was safe and modestly appointed, clean and adequate to my needs. I could rely on management to screen anyone whom they, or we residents, suspected was using and to immediately and responsibly remove active users from our community.

All my housemates were in recovery and once weekly we convened as a community for a 12 step meeting on property.

We were expected to attend meetings throughout the remainder of the week, work with our 12 step sponsor and take full ownership of our recovery program. This is a basic description of a FARR Level 2 residence. The Social Model might have been embraced more thoroughly to further empower that particular community.

However; an argument is just as easily made that the maintenance and development of future resident leadership is primarily the responsibility of the residents themselves.

Management was attentive to neighbor concerns regarding parking, noise and general resident behavior. Having established good relations, residents took pride in caring for the upkeep of the property. It was one of the nicest homes on the block, complete with the proverbial white picket fence. The home supported eleven residents in four attached units. While that community, like so many others, experienced the typical ebb and flow of casual, shorttimers who were uncommitted, I personally know of at least six housemates who remain clean and sober today. By my unscientific, outcome measurement, this rates a batting average above .500, which in this world, is a ‘hall of fame’ performance by most standards. Thousands of Floridians achieve long-term recovery while residing in Level 2 residences every year.

Level 1 & 2 residences require residents adhere to a published set of house rules and consequences, however; it is generally Level 3

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residences who offer 24/365 supervision, often by credentialed staff, such as behavioral techs, recovery coaches and/or peer specialists to ensure resident accountability. By design, Level 3 recovery residences are vested in delivery of only peer-support services. No clinical (medical) services are performed directly within or by a FARR Certified Level 3 residence. These services often includes life skill mentoring, assistance with crafting an individual resident’s recovery plan, communal meal preparation and dining, group transportation to self-help meetings and access to recovery coaches. This support is generally more appropriate for residents who require a structured environment during early recovery from addiction. Conversely; it is most likely inappropriate for a resident who has already achieved a solid footing and demonstrates a personal commitment to their recovery. Residents of a Level 3 residence often independently elect to participate in external clinical services such as attending an outpatient groups of their choice and/or engaging a private therapist for one-on-one counseling. “Independently elect” is a very important distinction. Many factors, including some that meet licensing thresholds, influence the distinction between a Level 3 and Level 4 recovery residence.

Level 4 residences incorporate the Medical Model (licensable clinical services) into the Social Model to varying degrees. In Florida, by virtue of state statute 65.397, Level 4 residences are required to obtain and maintain appropriate licensure from the Department of Children & Family Services - Substance Abuse (DCF).

“Florida Model” programs are defined as Partial Hospitalization Programs (PHP) with day/night community housing. In DCF licensing parlance, these are generally Residential 3 service providers. In turn, these programs fall under the FARR definition of a Level 4 residence. DCF Residential 4 & 5 programs also meet FARR Level 4 criteria. Each of these classifications offer varying degrees of clinical service, provided by credentialed staff, along with a recovery-oriented housing component. At first glance, the DCF licensing requirement coupled with FARR Certification may appear redundant. Nothing could be farther from the truth.

DCF is our state licensing authority. The Department is tasked with determining the successful completion of application documentation as it is submitted by substance abuse disorder treatment programs throughout the state. DCF does not have the funding, staff, infrastructure or appetite to measure service provider compliance to Standards established to promote highquality, recovery-oriented housing. This is not a job function the Department considers to be their their mandate nor is the Department prepared to take on this job at this time. Their report to the Florida Senate Appropriations Committee published October 2013 made this fact absolutely clear. To download a copy of this study, visit http://www.dcf.state.fl.us/programs/samh/docs/ SoberHomesPR/DCFProvisoRpt-SoberHomes.pdf As the Florida Affiliate of the National Alliance of Recovery Residences (NARR), FARR offers Level 4 Recovery Residences the opportunity to voluntarily submit for certification to our Standards and Code of Ethics. This opportunity directly addresses issues of import to the entire continuum of care. Persons seeking long-term, residential care and transitional support for themselves or a family member gain free, reliable access to a published list of programs Continued on page 30

To Untitled-4 Advertise, Call 561-910-1943 1

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10/7/14 3:28 PM

STRAIGHT LINE THINKING FROM ADDICTION TO ABSTINENCE

By Douglas Schooler, PhD Joe has been addicted to heroin. He wants to be cured of that addiction. But he soon learns that our culture and the rehab programs spawned by our culture see Joe as a perpetual “addict” who will always be in “recovery”. Cure? Forget about it. “You can’t get there from here.”

But Joe persists in his quest for a cure. He gets himself a coach.

His coach uses the principles of Straight Line Coaching. For the first time, Joe actually sees the possibility of cure.

Have you heard of Dusan Djukich? Djukich is a hard core guy. No BS here, he’s all about where the rubber meets the road. And that place is action, total commitment, doing what must be done. He gives stuff away for free, a lot of it, and I think it’s a must reading for anyone experiencing addiction or working with people trapped in an addictive process. He calls what he does Straight Line Coaching and his book is Straight Line Leadership. The coaching begins with straight line thinking. Here are just a few of the postulates Djukich puts out (from Dusan’s Apothegms I): • Motivation is to transformation as what cotton candy is to nutrition.

• It doesn’t matter what you “understand.” It’s a matter of what you do.

• You are either in the game or you are not.

• The people who are most confused are the ones with one personality.

• Reinvention isn’t changing “what is” but creating “what isn’t.”

• Relentless determination is a very sexy thing.

• “Results goals” will always trump “activity goals.”

• “Intention deficit disorder” is the main cause of low statistics.

• Discipline is actively creating what you want.

As you consider the above postulates you learn that the emphasis is on intention, commitment, determination and action. Let’s apply this approach to transformation of addiction into abstention.

In every area of achievement there are steps that must be taken to achieve success. Identifying these “Must Do’s” and then doing them is the key to accomplishing the goal.

Let’s say Bill wants to develop his body, build muscles, and lose fat. A number of things must be done to achieve that result. He has to eat a certain way, exercise a certain way, and get plenty of deep sleep, for example. A lot of stuff has to change for Bill to succeed. For Mary, success as a salesperson requires several Must Do’s. She must talk to people, learn about her products, do paperwork, and so on. However, for the addicted person the one Must Do is abstain from the substance. Any other Must Do’s are completely unique to the individual. If the addicted person can discover what are his Must Do’s, commit to doing them, and then actually do them, success is virtually assured.

Joe wants to break heroin addiction. Notice that the behavior actually required is not a long list. Just one item on the list is what must be done-abstain from heroin. That’s the only “must”. Journaling, yoga, group meetings, psychotherapy, exercise, massage, prayer, getting a sponsor, these tools, although maybe interesting, fun, and possibly useful, are not required. Avoid heroin, that’s it. How hard is that?

Probably as hard as one thinks it is and not one bit harder.

Question to the reader: How committed are you to not drinking a glass of bleach? Are you sure, even if its lemon flavored? Yes, you’re sure. You are so committed you don’t even have to decide not to. This is where we want our clients. Isn’t it?

With all the insurance money available for 30- 60 day residential

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stays, addiction treatment has evolved into entertainment. We put on a show for our clients often without any evidence (or negative evidence) that the elaborate programming actually works. But it sure does fill the time. So how long does it really take to cure addiction- 30 days, 60 days, or one powerful second where the client really gets what must be done and commits 100%? Some might say, wait a minute, the programming consists of tools to help people get the result of abstinence. Fine. So let’s get each client to know what tools they, as individuals, must use to stay sober. Let’s individualize this. For some, going for a jog every day may be the key. Others might need that 12 step meeting. Still others thrive on a daily yoga or tai chi session. And others may simply use the tool “I don’t use anymore. I do not and will not. I used to be an addict, now I’m an abstainer.”

Dr. Doug Schooler is a Licensed Psychologist and Certified Master Practitioner of Rapid Resolution Therapy. He maintains an independent practice of psychology, The Center for Rapid Resolution Therapy, in Boca Raton, providing treatment to all ages since 1985 (www.DouglasSchooler.com). Before coming to Florida he taught psychology at Eastern Michigan University. He graduated from Queens College in 1964 and received his PhD in psychology from the University of Rhode Island in 1976. Inneta Kantor is the founder of Energy Healing beyond Reiki which is based on her training in many energy balancing modalities including Reiki. She was born in Moscow, Russia and trained in classical piano and voice, performing as a soloist in Europe and the United States, arriving here in 1981. www.douglasschooler.com/energy _healing _beyond_reiki

To Advertise, Call 561-910-1943

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CO-OCCURRING DISORDERS: DOUBLE TROUBLE AND INTEGRATION OF TREATMENT

By Cristina Feliciano, PsyD, CPPS

Much has been debated about substance use, abuse, dependence, changes in the Diagnostic and Statistical Manual – and it’s several revisions – and if this is an issue of behavior or cognition, weak character, or a pervasive disease. And how to approach it when the substance use related problem is accompanied by another mental or physical health problem – that’s mayhem. Reclaiming normalcy in a person working his or her recovery there are important elements needed to succeed; support, self-help programs, adequate and accessible treatment, and understanding that dual diagnoses, now replaced by the term cooccurring disorders, are difficult and very common.

Double trouble by definition and numbers Co-occurring disorder (COD) describes the presence of both mental health issues and the addiction to drugs or alcohol, the impact on daily functioning, complications related to a problem left untreated, and the impact on others. Understanding co-occurring disorders also poses questions for both the professional and the patients on determining what came first, the chicken or the egg?

By definition, patients with co-occurring disorders (COD) have one or more disorders (substance use and mental or physical health related). A diagnosis of co-occurring disorders occurs when at least one of the recognized disorders exists independently and is not part of a cluster of symptoms.

Substance use and addiction can be a means to deal with mental health symptoms (self-medication), the reason why clinical issues worsen, or set the foundation for developing mental health disorders. Some of the most common mental health disorders found in chemically dependent people include mood- and anxiety disorders. An even higher percentage of people with severe mental illness also have co-occurring substance use disorders.

We already know there is a biological vulnerability as well as situational stressors – life challenges - that trigger the onset of symptoms. Many of the patients diagnosed with co-occurring disorders use alcohol and substances as a mean to cope with MH symptoms and facilitate social connections. More than fifty percent of the population with substance use related disorders are also suffering from mental health issues.

Approximately 8.9 million adults have co-occurring disorders; that is they have both a mental and substance use disorder. Only 7.4 percent of individuals receive treatment for both conditions with 55.8 percent receiving no treatment at all.

Approximately 22% of adults with serious mental health illness display alcohol or illicit drug dependence or abuse. Almost 50% of youth with mental health issues are also diagnosed with cooccurring disorders. Statistics show that 80% of patients diagnosed with COD report the onset of symptoms before age 20. Teenagers and females constitute the most rapidly growing population with COD in the USA and also the most admissions to primary care health services.

Double the consequences There are many consequences of undiagnosed, untreated, or poorly treated co-occurring disorders including higher probabilities of experiencing: (1) Homelessness, (2) Incarceration, (3) Physical health conditions, (4) suicide or self-injurious behaviors, and (5) early mortality. Other problems associated with co-occurring disorders is the access to adequate treatment and ensuring that the services are received for both disorders.

Best Practices – Integrated / Comprehensive Treatment Patients with COD many times go untreated due to the health care systems focus on only one of the extremes of the complex. Many people with co-occurring disorders end up receiving services through emergency rooms to avoid the stigma associated with formal treatment for substance abuse and mental health issues.

Fifty percent of the population with COD receive adequate

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treatment or even seek treatment. Providing resources beyond primary health care settings support successful outcomes.

The ideal continuum of care would include the identification and structured screening for COD, the collaboration and communication among clinical providers, and the integration of both mental health and substance abuse issues. Integrated treatment has shown to be more effective, featuring a client centered approach, assuring that only one provider works on a comprehensive treatment plan.

Patients with COD not only need clinical treatment but also an array of services from housing, employments, family psycho-education, to case management, among others.

Available research has made us aware of the urgent need for models and best practices for the treatment of co-occurring disorders.

Call for Research – Let’s Make it Happen The substance abuse and mental health fields of study have made great advances in addressing the treatment needs of people with COD (substance-related and mental). The focus is on having a common language and approach, what sets the foundation for improve treatment, communication, program development, clinical definitions, and ensure better outcomes.

Recent research papers encourages approaching existing programs that integrate SA and MH treatment to survey their patients and staff in order to clarify if patients are receiving the adequate services according to their needs.

Also, developing research on continuity of care research would focus on the transitional aftercare services, case management, and access to community resources that meet the multiple needs of patients with co-occurring disorders.

Research and program development will establish a working conceptual framework for providers across disciplines that will standardize terminology, concepts, and identify best practices and evidence based approached.

Positive steps The onset of mental illness is disrupting to the family, their cognitions, and social-emotional development. Combined with substance use problems, COD interferes with the patient’s ability Continued on page 30

A DV E R T I S I N G O P P O R T U N I T I E S

The Sober World is a free national online e-magazine as well as a printed publication. We use an educational and informative approach as an outreach to parents, families, groups and others who have loved ones struggling with addiction.

FOR ADVERTISING OPPORTUNITIES IN OUR MAGAZINE OR ON OUR WEBSITE, PLEASE CONTACT PATRICIA AT 561-910-1943.

We invite you to visit our website at www.thesoberworld.com You will find an abundance of helpful information from resources and services to important links, announcements, gifts, books and articles from contributors throughout the country.

For our e-magazine, send your request to patricia@thesoberworld.com.

If you would like to submit an article for publication, please contact patricia@thesoberworld.com for further information.

Please visit us on Face Book at The Sober World or Steven Sober-World Visit online Face Book at www.facebook.com/pages/The-SoberWorld/445857548800036 or Steven Sober-World Twitter at www.twitter.com/thesoberworld LinkedIn at www.linkedin.com/pub/patricia-rosen/51/210/955/

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DOES BEING GAY ADD TO THE DIFFICULTY OF BEING AN ADDICT?

By David Smallwood

Continued from page 20

Gaydar/ gayromeo /grindr (to get sex) or at a club (sex/ alcohol/ drugs) or a bar (alcohol / drugs). Furthermore, because he will feel judged and unhappy about being gay, he will turn to alcohol or drugs before he feels able to interact with other gay boys for love and sex.

Upon becoming sober again there is an inevitability about repeating this again and again (this repetition also happens among nonaddicts, but having an addictive nature makes it even worse).

If you can extract yourself from this merry-go-round, where are you left?

It is easy to see that there is a certain pathway here that can only end in one of two ways. If you are a non-addict and gay you have a chance of extracting yourself due to age and getting fed up with repeating the same process.

However, if you have the addictive problem it will be progressive and the need to fix is incessant. This can end with even more powerful substances and processes (i.e.: cocaine, crystal meth, group sex), which in turn generate more shame, risk, and stress.

This constant shame and fear drives the need to be cool and perfect and right. As a therapist I have lost count of the number

“RECOVERY RESIDENCES: FOUR DISTINCT SUPPORT LEVELS”

By John Lehman

Continued from page 24

who have voluntarily sought and secured certification. This voluntary approach appears to be provide a constructive and much needed path to establishing a mechanism for accountability without running afoul of FHAA and ADA protections. The current NIMBY climate that attempts to utilize municipal zoning as an alternative path amounts to an irresponsible waste of tax payer dollars, further dividing communities at a time when there is an ever-increasing need to foster local resources that effectively address what has now risen to the level of “An American Epidemic”.

FARR does not measure or evaluate the quality of clinical care.

This is outside of our mission and expertise. Instead, FARR measures accountability to standards designed to ensure the delivery of those four core goals referenced at the onset of this publication. Peer Support, provided through varying degrees of Social Model implementation within the residential component of a Level 4 residence is the guiding consideration. To learn more regarding the Social Model and how this structure is best embedded in recovery housing, please visit http://narronline.org/ wp-content/uploads/2014/09/Maximizing-Social-Model-Principlesin-Residential-Recovery-Settings.pdf The entire continuum of care recognizes an important truth: that the Acute Care model of “28 days treatment” followed by a graduation celebration and the abrupt return of the graduate to the same environment from which they originated has proven far less effective than has the long-term, transitional approach that gradually “steps the client up” towards assuming responsibility for their own chronic disease management. When framed positively, many refer to this achievement as ‘Recovery’. FARR Certified Residences receive our seal of approval.

The FARR certification process is rigorous and subsequent grievances related to non-compliance are taken very seriously. Our raison d’etre is to ensure residents have access to quality, peer-supportive, recoveryoriented housing to assist them along their journey to secure lasting freedom from the bondage of addiction.

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of gay men I have assessed who are in great pain and unable to function.

Despite this, they are unable to take on board any possible solution, instead saying ‘Thank you but I am going to do it a different way.’

They dismiss everything with a waft of the hand that only a gay guy can do. I know that they are just going to repeat the same behaviour until they are almost at death’s door. It is saddening and difficult to accept.

What then is the solution? It’s certainly not “gay pride” (this is just an opportunity one day a year to put down the fear, club together and give the world the finger). Instead we need to own our fear and shame and tell the world: ‘If I had the opportunity to become heterosexual I would not want that at all!’ That is not pride. It is acceptance.

I would ask only that anyone reading this may be able to open their hearts and minds to the needs of gay addicts. We do not need special treatment, just understanding.

David Smallwood is Treatment Director at Oned40 Ltd in Harley Street in London. He holds a Master’s degree in addiction counseling and a post graduate diploma in therapeutic counselling.

He helped to pioneer Mellody model trauma reduction workshops alongside non- cognitive therapeutic treatment.

David Smallwood is the author of Who Says I’m An Addict?

Published by Hay House at £12.99.

CO-OCCURRING DISORDERS: DOUBLE TROUBLE AND INTEGRATION OF TREATMENT

By Cristina Feliciano, PsyD, CPPS

Continued from page 28

to complete schooling, establish and maintain healthy relationships, find and maintain employment, and even live independently.

However, we have to be strong believers that change is possible and treatment is available.

Hitting bottom and the other negative consequences of cooccurring disorders can lead to death; providers and sources of support are key in the reduction of harmful consequences and taking steps into increasing motivation to change and work towards recovery. Targeting the patient’s motivation for recovery is a must, the process of engaging and persuading the person to actively participate in treatment and focus on relapse prevention.

Without the appropriate treatment both extremes of the disorders would lead to a loss of control over thinking and behaviors, causing a decreased ability of self-regulation and loss of will power to make the steps to change and work towards recovery.

Let’s get the job done! Patients with COD can overcome the despair and build a rewarding life, focusing on the strength and growth that comes from adhering to treatment and sources of support.

You must never give up, recovery can be a life-long journey, however unique and valuable.

Dr. Cristina Feliciano is a Clinical Psychologist for the Federal Bureau of Prisons in Texas. She has a specialization in drug use related disorders treatment. She has worked specialized programs in private hospitals, corrections, and the Department of Defense.

To Advertise, Call 561-910-1943

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P.O. BOX 880175 BOCA RATON, FLORIDA 33488-0175 www.thesoberworld.com

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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