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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 award winning national magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication, 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 treatment centers 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 manmade 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,
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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 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. 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. The Sober World wishes everyone a Happy and Healthy New Year. We are on Face Book at www.facebook.com/pages/The-Sober- World/445857548800036 or www.facebook.com/steven.soberworld, Twitter at www.twitter.com/thesoberworld, and LinkedIn at www.linkedin.com/grp/home?gid=6694001 Sincerely,
Patricia
Publisher Patricia@TheSoberWorld.com For Advertising opportunities in our magazine, on our website or to submit articles, please contact Patricia at 561-910-1943 or patricia@thesoberworld.com. 3
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CHANGES IN HEALTHCARE: YOUR GUIDE TO NAVIGATING THE COMPLEX WORLD OF HEALTH INSURANCE PLANS By Karen Pilley
Successfully getting from Point A to Point B has always required the ability to understand potential challenges and obstacles. Having a good foundation of knowledge in order to make an important decision is important which is precisely where we find ourselves today as we attempt to understand and navigate the complex world of health insurance plans.
• Do I fully understand the benefits available to me for the services I need?
According to a 2013 report by the Kaiser Family Foundation, premiums for the average American working family topped $16,000 for the first time in history. Employees paid, on average, more than $4,500 toward that cost which does not include co-pays and deductibles. In this fast-paced world of reimbursement change, those numbers are likely higher today. The sobering fact is that reimbursements from insurance companies are declining and we anticipate that they will continue to do so. Far too often we see consumers who have purchased a health insurance plan that in essence, provides catastrophic coverage and little else until high deductibles are met. When the time comes to rely on an insurance policy, consumers all too often realize that they have health insurance and cannot afford to use it.
• Validation of your benefit interpretation by the payer or employer is your best resource. Whenever possible, get this information in writing.
Health insurance plans change each year; services and treatments that were reimbursed one year doesn’t necessarily mean that they will be reimbursed for the same amount in the next. It is more important than ever for the consumer to become educated with regard to these changes. One example is the utilization of healthcare providers who are considered to be Out-of-Network. Health insurance payers have made it increasingly difficult for consumers to utilize healthcare providers who operate Out-of-Network. Health insurance companies (a.k.a. Payers) have realized that Out-of-Network usage can negatively impact their bottom lines and rather than absorbing that expense, the cost is passed along to the consumer, through higher co-pays and deductibles. The responsibility to understand what is being purchased (a specific health insurance plan) resides with the consumer and now, more than ever, the phrase ‘buyer beware’ is fitting. Ignorance is costly and the misconception that having insurance equates to having coverage can be shocking. In order to navigate this evolving world of reimbursement, consumers must learn to ask the right questions for their individual needs before making a commitment to any given plan. For consumers who have insurance through their employer, communicating with the Human Resources department can prove to be very valuable. Additionally, most (if not all) health insurance payers employ patient representatives who are available to answer questions and assist with explaining the nuances of the available plans. The critical part is learning what questions to pose and to whom. No one can predict the future therefore the consumer will always have to make an educated guess and it is important to place the emphasis on ‘educated’. By asking questions and taking advantage of available resources, educated consumers can successfully navigate this complex arena. If you want to learn how to best understand your health insurance plan and make educated decisions on, for example, finding an addiction treatment facility best suited for your loved one, there are steps you can take. Below are questions you can ask and resources to use that will help get you started.
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• What additional costs would I incur by using an Out-of-Network provider? Is using an In-network provider the better choice? • How informed is the treatment provider on my benefit plan?
• Comparative selection is key. Not all treatment providers are created equal and everyone has different needs. Ensure your selection is made using the most important criteria to you. Additionally, it is important to stay informed even after choosing a health insurance plan. Most health insurance companies mail newsletters and information guides throughout the year and it is helpful to read this material in order to stay abreast of the future of healthcare. One such message regards the migration toward two distinct areas: preventative medicine and telemedicine. With regard to prevention, consumers have the ability to be proactive in sustaining healthy life choices and payers are far more interested in working with consumers who are motivated to sustain their health and quality of living. Payers have begun to offer preventative ‘well-being’ services, such as annual physical exams. Consumers pay for these services and are wise to take advantage of them. Telemedicine, the provision of treatment for an illness by way of telecommunications technology, will soon prove its value to both payer and consumer. Telemedicine is the antidote to increased healthcare costs and is on the forefront of every segment of healthcare. For example, once having been treated for a disease such as addiction, we have learned that the provision of recovery support is a critical component for the patient to maintain sobriety and enter into long-term recovery. Telemedicine technology will be able to offer necessary recovery support which will result in a ‘win-win’ scenario. The patient who is striving to maintain sobriety will have the benefit of support and resources and the payer will have the benefit of consumers who are better-equipped to maintain sobriety therefore decreasing the odds of relapse and/or a return to inpatient treatment. Health insurance plans are complex and complicated. Consumers can no longer decide on a policy based on the insurance company – the level of benefit is determined at the plan level. The amount of healthcare dollars Americans are spending has dramatically outpaced both wage increases and the rate of inflation. We can expect reimbursement rates to continue to decline while Americans will continue to pay more for healthcare. When it comes to navigating the ever-changing field of health insurance policies, consumers need to educate themselves and take steps to ensure they are successfully navigating this changing environment. Karen Pilley is the Chief Operating Officer at MAP Health Management, LLC in Austin, TX. She has more than 30 years of experience in healthcare billing and collection, revenue cycle management, government and managed care payer regulation and compliance.
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Spiritual Growth Therapy (SGT) is a therapeutic way of living that incorporates spirituality into everyday life. Thinking and making decisions from a foundation of love and connection and with a future purpose that finds love and comes from the heart. Promoting individuality with a community driven connection that benefits and prospers all involved is the goal behind spiritual growth. Our devotion is to all individuals who need that extra help. We’ve created a spiritual paradigm to heal people suffering from substance abuse and mental health symptoms within our licensed treatment centers.
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ADDICTION, RECOVERY AND A PATH TO PREVENTION: STEMMING THE TIDE ON YOUTH SUBSTANCE USE By Stephen Gray Wallace, M.S. Ed.
Lawrence Steinberg, Ph.D., author Age of Opportunity – Lessons From the New Science of Adolescence, warns us that “When a country’s adolescents trail much of the world on school achievement, but are among the world leaders in violence, unwanted pregnancy, STDs, abortion, binge drinking, marijuana use, obesity, and unhappiness, it is time to admit there is something wrong with the way that country is raising its young people”. That country, he says, is the United States. While there is a lot of bad news contained in Dr. Steinberg’s assessment of modern-day adolescence, the note of binge drinking and marijuana use strikes a special chord for those of us working in the addiction, recovery and – maybe most important – prevention spaces. A case in point can be found in the story of Nic Sheff, as described by his father David in the New York Times bestseller Beautiful Boy – A Father’s Journey Through His Son’s Addiction. The book details Nic’s journey from alcohol addiction at age 16 to marijuana, ecstasy, LSD, mushrooms and crystal meth addiction by his late teens. In turn, that book inspired my September 2014 Camping Magazine article “Beautiful Boys,” which I co-authored with some of my former campers, each of whom had found his way to addiction during his teens. One of them told a tale similar to Nic’s: escalation from alcohol and marijuana to LSD, mescaline, cocaine, MDMA, and amphetamines. I knew “Michael” (not his real name) as a friendly, sensitive, somewhat rambunctious, rising 9th grader. What I would come to learn, years later, is that during his first year at boarding school, Michael got into a fight with an upperclassman, which resulted in a broken ankle. That scuffle, along with a questionable academic record, short-circuited his career there. He then bounced around from school to school and began drinking heavily and smoking marijuana – which led, as it so often does, to the abuse of a spate of other drugs. Michael revealed a highly dysfunctional relationship with an authoritarian dad whose expectations for him were wildly oversized. His relationship with his mother, while better, was distant as she was consumed with her career. He said he craved structure, order, guidance and direction but found very little. He turned away those who tried to help him because of his “conflict” in understanding, let alone accepting, unconditional love. Regardless, Michael was a resilient kid and found what he needed to make his way through six or seven years of addiction. He is in recovery to this day. As Nic and Michael’s stories reveal, adolescence represents a critical intersection of personal growth and personal behavior. Indeed, Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA), stated in Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide, “The adolescent years are a key window for both substance use and the development of substance use disorders. Brain systems governing emotion and reward-seeking are fully developed by this time, but circuits governing judgment and self-inhibition are still maturing, causing teenagers to act on impulse, seek new sensations, and be easily swayed by peers – all of which may draw them to take risks such as trying drugs of abuse”. Volkow goes on to explain that, given the fluid nature of adolescent brain development, substance use during this critical time may actually modify brain functioning, possibly making the development of a substance use disorder significantly more likely. Youth drug use can be hard to measure, though measure it we do. And as preventative strategies emerge from the data, we see almost cyclical drops in the popularity of certain types of drugs, only to see rises in use of others. As I illustrated in my book, Reality Gap: Alcohol, Drugs and Sex – What Parents Don’t Know and Teens Aren’t
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Telling, “In many ways, trends in negative behaviors act much like a balloon: Squeeze it smaller here, and it gets bigger over there.” What does that mean? That hyperfocus on lowering the impact of any particular drug at any given time, say heroin, may be successful but simultaneously other drugs may gain new users. A solution to that conundrum may lie in a new approach being promoted by the Institute for Behavior and Health. Its president, Robert L. DuPont, M.D., reflected on declining youth drug use in many areas and asserted, “This finding has the potential to reshape all prevention strategies away from substance-specific health-promoting campaigns to a single focus that promotes no use by adolescents of any addicting substances”. In “Beautiful Boys” I detailed Monitoring the Future (MTF) data from 2013. MTF is an ongoing study of the behaviors, attitudes and values of American secondary school students, college students and young adults conducted by researchers from University of Michigan and reported out by NIDA, among others. The data included the following.
• Five-year trends are showing significant increases in past-year and past-month marijuana use across three grades: 8th, 10th, and 12th. • The percentage of 12th graders reporting past-year nonmedical use of amphetamines rose from 6.8 percent in 2008 to 8.7 percent in 2013. • In 2013, perceived risk of harm of trying Vicodin occasionally declined in 8th graders, from 29.4 percent to 26.2 percent, and in 10th graders, from 40.3 percent to 36 percent in 2013. This drop in perception of risk might indicate that use could begin to rise again in future years. In the same article, I made connections from Vicodin use to heroin use and from use to addiction – something that seems to happen in a surprisingly, alarmingly short amount of time. By last year, predictably, the data had changed, with NIDA stating, “2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th graders continued to show encouraging news about youth drug use, including decreasing use of alcohol, cigarettes, and prescription pain relievers; no increase in use of marijuana; decreasing use of inhalants and synthetic drugs, including K2/Spice and bath salts; and a general decline over the last two decades in the use of illicit drugs. However, the survey highlighted growing concerns over the high rate of e-cigarette use and softening of attitudes around some types of drug use, particularly decreases in perceived harm and disapproval of marijuana use”. Despite the decreasing use of alcohol and a stagnant rate of marijuana use, the numbers remain depressingly real: 9 percent of Continued on page 52
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12/14/15 9:43 PM
THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS: DEA FLOODING AMERICA’S STREETS WITH NARCOTICS WHILE CONGRESS GIVES TACIT APPROVAL By John J. Giordano, DHL, MAC
Gene Haislip is probably one of the most successful and least known DEA high ranking officials in the history of the agency. By education he was an attorney, but his career path lead him to several government positions including Deputy Assistant Secretary for the Department of Health, Education and Welfare, Chief of Congressional Affairs for the DEA, legislative officer for the President’s Reorganization Project on Law Enforcement and Chief of Planning and Evaluation (DEA) and ended his career as the top official in the DEA’s Office of Diversion Control, a position he held for 17 years. Haislip was a sharp and principled man who often thought outside of the box when it became time to get the job done. He was considered an innovator for his approach to ending the Methaqualone epidemic that ravaged America in the 70’s and early 80’s. During an interview with the PBS documentary program Frontline, Haislip said: “We beat ‘em. By working with governments and manufacturers around the world, the DEA was able to halt production and eliminated the problem.” He used the same successful formula of negotiating with governments and pharmaceutical companies to severely curb Methamphetamine abuse in the 90’s. In 1997 Haislip retired from the DEA, leaving the agency with effective protocols that minimize the diversion of narcotics to street drugs and illegal use. In hind site, Haislip’s retirement came at a time when his expertise was needed the most. Many experts, including myself, believe that America’s second opiate/ opioid epidemic began in the late 90’s. Front groups sponsored by the pharmaceutical industry such as The American Pain Foundation were promoting wider use of narcotics for pain management; asserting the dangerous drugs to be safe and effective. Oddly, their claim is strikingly similar to the advertising slogans used over one-hundred years ago by the Bayer Pharmaceutical Company when they were promoting their product, heroin, as a safe, non-addictive cough suppressant, a painkiller for menstrual cramps and migraines and a cure for opium and morphine addiction. The late 90’s also coincides with the launch of OxyContin. The DEA was established on July 1, 1973. With congressional approval, President Nixon merged together the Bureau of Narcotics and Dangerous Drugs (BNDD), the Office of Drug Abuse Law Enforcement (ODALE); approximately 600 Special Agents of the Bureau of Customs, Customs Agency Service and other federal offices to form the DEA. The newly formed organization was designed to be both a regulatory agency and a law enforcement agency. The Administrator is appointed by the president and reports to the Attorney General through the Deputy Attorney General. The agency is also subject to congressional oversight. Controversy seems to have surrounded the agency from the moment of its inception. The DEA has been largely ineffective in its policing mission. After tens of billions of dollars spent, the DEA’s ‘War On Drugs’ is considered by most to be an abject failure; preventing less than 2% of the illicit drugs being smuggled into the U.S. from entering the country. However, with all of these widely reported failings; it’s what the press has overlooked or missed completely that many addiction experts consider the DEA’s most egregious miscarriage of the agency’s stated mission. Deep in the dark recesses of an innocuous modern glass building – Drug Enforcement Administration headquarters – is a little known department so small that it doesn’t even have its own wiki page. The Office of Diversion Control is the regulatory body of the agency. From the DEA’s website: ‘The mission of DEA’s Office of Diversion Control is to prevent, detect, and investigate the diversion of controlled pharmaceuticals and listed chemicals from legitimate sources while ensuring an adequate and uninterrupted
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supply for legitimate medical, commercial, and scientific needs’. The DEA’s Office of Diversion Control is the sole government agency with the responsibility of controlling the importation of narcotic raw material and the manufacturing of prescription opiates and opioids painkillers. It is this single office that sets annual aggregate production quotas for the pharmaceutical companies. With input from the FDA, the Office of Diversion Control reviews pharmaceutical company’s applications for opiate and opioid painkiller production for the forthcoming year and approves or adjusts production limits.
The Office of Diversion Control is the one and only spigot that has the responsibility and power to control the flow of pharmaceutical opiates and/or opioid painkillers into our communities. Today we’re in the throes of a full blown opiate/opioid epidemic fueled by prescription drugs – in two separate studies it was found that anywhere from 45% to 75% of heroin addicts surveyed said they were first addicted to pharmaceutical opiate/opioid painkillers then moved to heroin – and we repeatedly ask ourselves “how did we get here when the DEA once had such a successful track record in keeping pharmaceutical drugs off the streets”. In the 60s, amphetamine abuse became a national problem. The forerunner of the DEA, the Bureau of Narcotics and Dangerous Drugs (BNDD), responded to the crisis by reducing the domestic production of amphetamine. With FDA in agreement, BNDD set production levels for 1972 at one fifth of 1971 levels and at one tenth of reported medical production in 1969. Under the supply controls, amphetamines became relatively minor drugs of abuse by the late 1970s. In the early 1980s Gene Haislip eradicated Quaalude abuse by reducing the aggregate production quota of Methaqualone by nearly 75 percent while coordinating efforts to block illegal importation and smuggling of the drug into the United States. Haislip used this successful formula again in the 90s to stem-off Methamphetamine abuse before his retirement in 1997. But something happened to the DEA after Haislip’s retirement. It appears as though the agency has been rubber-stamping the pharmaceutical company’s annual aggregate production quotas since Haislip left the DEA. There has been much speculation as to how this came about, but many experts point to the power and clout the trillion dollar Pharmaceutical industry wields. Continued on page 48
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THE NATIONAL MARCH TOWARDS RECOVERY: A YEAR IN REVIEW By Jeffrey C. Lynne, Esq.
From a public media prospective, 2015 may be the year that the recovery industry and the greater recovery community had its “coming out party.” Social media campaigns, coupled with the growing face of the national opioid/heroin epidemic, have placed the discussion of addiction front and center on the minds of all Americans as the largest healthcare epidemic in our nation’s history. Persons from all walks of life have elected to forego the anonymity of their recovery to demand that our country collectively take definitive and decisive action towards eradicating opiate addiction and the effective legalized drug dealing perceived to be perpetuated by health care providers. This past October 2015, the nation experienced the first “National Addiction Rally” of sorts, as tens of thousands of persons from various backgrounds came to the National Mall in Washington, D.C. to demand a larger federal response to the national epidemic. What we experienced was a divergent group of persons from various socio-economic demographics converging around a single point of interest and demanding immediate and massive cultural change when it comes to how medicine and healthcare is practiced in our country. Concurrently, 2015 began significant discussions on the effectiveness of cost-control relating to the Affordable Care Act (i.e., “Obamacare”). While the Office of the President has publicly called the ACA a success, there appears to be continued concern from a cross-spectrum of Americans about how we pay for healthcare, accessibility, and the continued rising costs of premiums. By way of example, within the State of Florida, Cigna announced their election to leave the state due to what they claim to be overwhelming fraud within the Substance Use Disorder treatment field. At the opposite end, persons across the country continue to assert that the Mental Health Parity and Addiction Equity Act of 2008 still has not lived up to its hype, as readilyaccessible, full-continuum treatment for Substance Use Disorder remains a Rubik’s Cube depending upon state of domicile. Within 2015, we also saw the continued emergence of a cohesive force for change emanating from the Young People in Recovery (YPR) movement and the further establishment of collegiate recovery programs at universities and colleges in every state. National leaders in this space such as Andrew Burki of Life of Purpose Treatment continue to make inroads at college campuses across the nation. At the Congressional level, 2015 also saw significant discussion on legislative and policy direction that reaffirm the need for a comprehensive approach to Substance Use Disorder and the misuse (and over-prescription) of opioids. The proposed “Comprehensive Addiction and Recovery Act” (CARA) would enhance existing block grant programs to the tune of up to $5 million dollars to expand education and prevention; expand the availability of naloxone to law enforcement agencies and other first responders; expand resources to identify and treat incarcerated individuals suffering from addiction disorders; expand disposal sites for unwanted prescription medications; and strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion. CARA also underscores the continued strength and dominance of the discussion by the pharmaceutical industry, as medication assisted treatment (MAT) continued its upward trajectory as the primary source of initial treatment. Addiction professionals are being forced to reconsider prior policy positions about the role that MAT could or should play in long-term sobriety. On the Presidential campaign trail, America’s heroin crisis has risen to levels that are demanding attention going forward into 2016, as candidates from both sides of the aisle call for
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action, particularly in the first-in-the-nation primary state of New Hampshire where heroin overdoses have soared. From town hall forums to presidential debates, it seems the addiction crisis has taken the candidates by surprise, which may bode well for the short-term conversation about addiction, but remains part of the larger national discussion on social policy issues, which tend to get drowned out in the black hole that is Congress. Still, first primary states such as New Hampshire, which itself has an epidemic substance abuse problem, may be the testing ground for the national tolerance of discussing Substance Use Disorder consistently and openly. Looking forward to 2016, the topic of Recovery Residences (i.e., “Sober Homes”) will continue to be a hot topic, at least at the local level. Healthcare will begin to accept paying for “treatment” but continuing to deny that housing is an integral part of “recovery.” From an urban planning perspective, the place and placement of such homes, their concentration within communities, and their regulation will continue to be a point of great concern. Throughout 2016 and into 2017, our nation’s cultural values will likely see a seismic shift as marijuana usage becomes more acceptable, and treatment programs for high-potency grade misuse becomes more ubiquitous. A likely antagonism will surface between society, demanding that marijuana’s place in our communities is medicinal and not recreational; from growers and distributors who will experience high profit margins; and treatment centers, who themselves will be torn between patient care and profit margins. The year 2016 and beyond will surely see a paradigm shift in how Americans view our cultural norms about drugs, addiction, recovery, and housing. The discussion moving forward will be to determine at what point do we cross the line and allow the integrity of the “recovery movement” to be compromised by the need to be financially self-sustaining in light of the lack of public appetite to fund any social service. 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.
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11/4/15 1:01 PM
LETTER TO A CODEPENDENT FRIEND By Diane Jellen
Dear BFF: I’ve been meaning to email you but decided to send a letter instead. I know, this is old-fashioned of me, but I wanted to dwell in the past for a moment. Everything moves so fast now, even the language we use. There are new terms introduced every day, and the memes spread rapidly due to our social media culture. It’s hard to keep up. LOL, and that old standard TGIF, appear everywhere. I would have never predicted abbreviations could dominate our written conversations, would you? Who would have thought TBT (Throwback Thursday) would flood the internet with pictures from the past? TBT is so popular there is even a Throwback Thursday Etiquette Guide. When I looked a few weeks ago, Instagram’s #throwbackthursday page had 33,744,262 posts. Many of the photos are predictable: baby pictures, birthday celebrations, sporting events, graduations, weddings, and family reunions. Still, thirty-three million? OMG. I do enjoy seeing all my Facebook friends’ images from years past. For some, TBT may be an attempt to hold on to these happy moments. For others, it could be a futile effort to revisit yesterday in order to change today. In this gigahertz age of instant information, I think many of us would prefer to step back to a less demanding tempo of time. Because codependents are programmed to fix, please, and perform at the speed of light, slowing down is a challenging process. ICYMI (in case you missed it), we caregivers work at frenzied speeds because our poor self-image has conditioned us to meet the needs of others. Being a martyr strokes our self-approval. Not enough, however, for us to photograph this role we play. I would be thrilled to post pictures from the past but I worry someone would see this as a waste of precious time. Time when I should be proving my worth by being productive. OMG, my codependency is showing. Again. Besides, what would I post? My past is littered with reminders of my husband’s alcoholism and my enabling. I could never post the embarrassing pictures from our New Year’s Eve parties. Or the family vacation when my ex fell asleep at the picnic table while playing pinochle. We all laughed when I took the beer bottle out of his hand and led him to the chaise lounge to sleep it off. Over the years, however, those laughs turned to disappointment and tears. When I started attending Al-Anon meetings, I realized how I enabled his addictive behavior to continue. This is why my photos from the past are not TBT material. I would not want others to LOL at my dysfunctional family. No FBF (Flashback Fridays) for me either. Revisiting days gone by is just too painful. The upside of looking at the past, however, is that it can bring awareness. It allows us to look at our lack of boundaries and skewed activities. With a clearer understanding of our shortcomings, we can learn from the past and resolve to improve our future. We can start anew.
the first month of a fresh New Year and promises new beginnings, resolutions, and optimistic options to make our lives more manageable. Habitually, we codependents are left hoping the New Year will be different. No more addictive behavior from our loved ones, right? This time I really mean it. I promise I’ll stop drinking. I promise I won’t use anymore. LOL. If you are like me, you’ve fallen for this line over and over again. I propose a better way to bring in the New Year. Please join me in making 2016 the year you decide to respect yourself. Let’s start by taking a group selfie. Together, we can step out of the shadows of shame and into the light of selfunderstanding. Just as the addict struggles with the drug of choice, we must acknowledge that our obsession to control has blurred our vision of who we are. We need to admit we too have a problem: we are always trying to solve others’ problems while our own circle of life if spinning off the axle. Denials’ job is to keep us out of focus with the truth. Starting 2016 with NCAM means giving denial the boot. With self-deception exposed, we can uncover the real motive behind our actions. Be aware, denial will refuse to go away quietly. Seeking the truth about ourselves requires discipline. There will be days when we feel lazy and sabotage ourselves. We may slip back into old patterns of behavior, or not take the time to read a selfhelp book. It will take a dose of healthy self-respect to make the decision to go to a 12-step meeting. Giving notice and firing denial puts the burden of responsiveness on us. We have to walk and work the steps and embrace good judgment if we want to change our way of life. Unlike social media abbreviations, 12-step slogans are not cute or trendy. They are life-changing mantras that work. But it is up to each of us to put them into practice. There are thirty-one days in January. Let’s make each one of those days count. Use the NCAM calendar at www.dianejellen. com to focus on your needs ODAT (one day at a time). This is not a selfish goal—it is a survival method worthy of your efforts. Little by little, day by day, you can begin to change. You will see your own worth, and begin to like yourself. It’s a slog, to be honest. I know because I’ve been doing it for years now. But it’s worth the effort. Because I am worth it. And so are you. One, two, three, say cheese. It’s selfie time. This is us, working on ourselves. This is the photo everyone should see of us. Not just on TBT or FBF, but every day. Sincerely, Your BFF Diane Diane Jellen has worked at several treatment facilities in PA, FL, and the School District of Palm Beach County Alternative Education Department. Diane is the award-winning author of My Resurrected Heart: A Codependent’s Journey to Healing, available at www.dianejellen.com.
BTW, this is one of the reasons I designated January as National Codependency Awareness Month (NCAM). January is
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AN ADDICT’S JOURNEY FROM LONELINESS TO LIFE By Alan Charles
I heard the beeping of the heart monitor and felt the intense pain first before I opened my eyes and realized that I was hooked up to a bedside monitor in the ICU. I had no idea where I was or how I got there, let alone what brought me there. I looked around the room, completely dazed and thoroughly confused when a nurse walked in. I don’t think I have ever seen a nastier look on anyone’s face; it was filled with disdain and outright hatred. She finally spoke. “You piece of shit. You deserve to rot in jail.” I had no idea why she said that, but I knew deep down that my cocaine addiction was to blame. What I finally came to understand is that I had fallen asleep at the wheel of my car going 65 mph and slammed head on into a wall. I could have killed myself of course, but the nurse was reacting to the fact that I could have killed others. As the toxicology test had confirmed, I was loaded with cocaine and another narcotic and clearly a drug addict. Unbelievably my injuries, while severe, were not life threatening and even though they had to cut me out of the car, I basically walked away from the accident. After going to the state-run tow yard to collect some personal items from my trunk and hearing the guy on duty say “sorry for your loss”, I realized that he did not believe that anyone could have walked away from this accident given the state that the car was in. Once he found out that it was me, he would not let me see the car, saying “Um, no. You shouldn’t see the car.” I didn’t fight him; I just allowed him to retrieve my things and left him, looking pale as a ghost, as I had already called my dealer to let him know I was on the way to score more cocaine. It was 1998. The accident occurred following a failed marriage where my addiction had even caused me to miss our engagement party. The fact that the wedding went on as planned remains a mystery to this day. Even a stint at rehab didn’t work; in fact, I came out with the name and telephone number of a new dealer. My wife of one year left me without a backward glance. It was devastating. My level of addiction was so abysmal that neither a disastrous marriage nor a horrific, life-threatening accident could deter me. Cocaine had infiltrated my life, my brain and my consciousness, completely eradicating any sense of right and wrong. Cocaine eliminated the knot I had had in my stomach since the age of nine when my father died and my mother, devastated by his loss, lost her ability to be the loving parent she had always been. My younger brother also literally went off the deep end, wreaking havoc on the house, my mother and our entire lives. Alone, lonely and confused, I did everything I could to survive, but the knot remained. Somehow during the early years, I developed a mantra, “I can do this.” This simple four-word sentence took me through a terrible childhood, a wonderful baseball career where I played professionally in the Dominican Republic, a successful harness racing career and a prosperous sales vocation in a variety of industries. As an athlete drugs were off limits; in fact I didn’t even understand why anyone would use an artificial substance particularly when it could kill you. Finally after several failed relationships, work-related challenges and shocking revelations about family matters, a friend’s introduction to cocaine eliminated the knot completely and sent me spiraling downward into a 24-year affair with the white powder and a total loss of myself. My “I can do this mantra” somehow enabled me to support myself and my cocaine habit, fostered a further addiction to women and sex and even enabled me to marry again and start a family. I had momentary lapses in cocaine use, but not enough to sustain a healthy relationship or be a good father to my two daughters. I didn’t really know what a healthy relationship was; I knew that I loved my wife and my girls but I didn’t know how to share my fears or how to communicate any of my feelings whatsoever. This led to a lack of empathy and with the insidious disease of cocaine addiction driving my actions; my life was a disaster waiting to happen.
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In 2006, after five years of marriage, which I am surprised that it lasted as long as it did, my wife filed for divorce and petitioned the court for an order of protection. It should have been shattering to be told that you can no longer see your children and while it hurt immeasurably, the disease had control. The court ruled against me and ordered that I must be tested weekly with negative results for six months straight before the order could be lifted. I really tried. I made it to three months before relapsing. Finally after I destroyed a friend’s apartment during a drug-induced hysteria, I happened to hear a message left by my therapist the previous day. She said, “Alan, it’s time to come back. Please. You are going to die.” Somehow I “heard” it. I was as low as I could be; barred my seeing my daughters, without a wife, without a home, fired from my job; no one to care. I dug down as deep as I could and found my mantra; “I can do this.” I rejoined the Program on December 8, 2007 and with the help of my therapist, my sponsor and program members who believed in me, I am sober to this day. Some call this hitting bottom. I call it a miracle. When I look back I realize that I did not want to be like my father and leave my girls without their dad. And, although my mother officially “checked out” of my life when my father passed away, she had in my earlier years given me an incredible amount of love, a genuine feeling of being proud of who I was and who I might become and the feeling that I could do anything if I put my mind to it. She may have had her limitations in dealing with my father’s death, but she had already made her mark. I decided to write my memoir, Walking Out the Other Side, to help anyone who is either tempted by drugs or is already in the clutches of addiction, to see how insidious this disease can be and how determined you must be to avoid it or contain it. In addition, I believe that my story can help people who have loved ones who are crippled by their addiction by providing a window of insight into the addicts mind. If I can help even one person change their life, I will consider it a second miracle. Alan S. Charles has lived a remarkable, diverse, and full life. From playing professional baseball to being a professional harness racing driver and singing with Barry Manilow at Radio City Music Hall, he’s rarely known a dull moment. After his playing career, Alan was a successful businessman, quarterbacking multi-million dollar sales campaigns. The world seemed to be at his fingertips, but eventually, the pain of his dysfunctional upbringing caught up with him. Seeking relief from his lifelong feelings of anxiety and loneliness, he became addicted to cocaine, which ultimately caused him to lose it all. Then, after years of being in and out of rehab and battling his inner demons, Alan got clean and sober. Today, he is the doting father of two daughters as he takes life one day at a time. www.WalkingOutTheOtherSide.com
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Part of The Treatment Center Family
January Happy New Year!
2016
12-Step Medallions
Recovery Gifts
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ADDICTION AND PREGNANCY By Jan Gerber, MSc
Addiction is a challenging disorder for anybody, but for pregnant women, substance abuse and addiction present serious health risks for the mother and for the unborn child exposed to the substance through the placenta and umbilical cord. Substance abuse during pregnancy is widespread. According to a survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2013, 5.4 percent of pregnant women between the ages of 15 and 44 use illegal drugs and 9.4 percent reported drinking, with 2.3 percent of pregnant women admitting binge drinking. Use of alcohol and drugs tends to be higher in the first trimester than the final two trimesters. Problems can continue into adulthood, and intervention may be needed to address behavioral, social, developmental or academic challenges. Children of women who use drugs and alcohol during pregnancy are also more likely to become addicted as they grow into adolescence or adulthood. Alcohol - Many people assume that illegal drugs present the most risk during pregnancy, and it’s true that the consequences can be dire. However, alcohol presents tremendous risks for the developing fetus. Many addiction professionals recommend total abstinence, as researchers believe that there is no “safe” amount of alcohol, and even light drinking can adversely affect the unborn baby. Alcohol is one of the leading causes of birth defects and developmental problems, according to the National Abandoned Infants Assistance Resource Center at University of California Berkeley. Adverse effects of drinking during pregnancy can include delayed physical and mental development, learning disabilities, hyperactivity, poor coordination, central nervous system problems, and in some cases may result in spontaneous abortion. A serious condition known as Fetal Alcohol Syndrome can cause permanent mental developmental delay, severe facial deformities as well as heart, kidney and central nervous system problems. Opiates – Infants born to mothers who use opioid drugs such as Heroin, Morphine, and prescription drugs like Hydrocodone, Vicodin and Oxycodone may be born with low birth weight, respiratory and gastrointestinal problems. They may also display behavioral problems or developmental difficulties in childhood. Infants may have tremors and a high-pitched cry, and can actually experience seizures and other severe withdrawal symptoms at birth. The National Institute on Drug abuse (NIDA) stresses that stopping the use of the drug before the birth improves the chance of a positive outcome for the child (the sooner the better). Methamphetamine – Pregnant women who use Meth may deliver infants prematurely. Infants frequently have feeding problems, low birth weight and birth defects. As they grow, children born to mothers who used meth in pregnancy may have poor memory and learning disabilities. The problem is compounded if the mothers also use other drugs, including alcohol and tobacco. Cocaine – According to the National Institute of Health (NIH), pregnant women who use cocaine may have premature births or spontaneous abortions. Cocaine affects the developing fetus adversely and the infant may be lethargic or have a poor appetite that can lead to malnutrition. As the child develops, problems may include difficulties with language and attention span.
uses the drug late in the pregnancy. Infants may also experience sleep disturbances and high-pitched crying. They may be jittery or startle easily. By age three or four, children are often impulsive or hyperactive with poor motor skills. Pregnant women who stop using marijuana during the first trimester, however, have lower risks of negative outcomes. Benefits of Stopping For many women, pregnancy and concern for the unborn child provides a tremendous motivation to stop using. Getting clean, even later in the pregnancy, improves the chances of a healthy life for both mother and child. Unfortunately, many pregnant women never receive treatment for addiction, and treatment centers aren’t always equipped to deal with pregnant clients. Sometimes, women who use illegal drugs are afraid to seek treatment because they are afraid their children may be taken away from them. If you are pregnant and concerned about your use of drugs and alcohol, you can recover and improve the outcome for you and your unborn child. Talk to your health care provider or seek treatment as soon as possible. Be sure that the treatment provider has experience treating pregnant women and the right positive attitude to help you and your child. Jan Gerber, MSc, is founder and director of Switzerland-based Paracelsus Recovery, an addiction treatment provider providing 100% individually tailored treatment. Jan and his team’s approach to addiction and mental health is based on the philosophy and insights that there is no one-size-fits-all approach to mental health, but that each individual situation is different and warrants an individual approach. Jan Gerber is a contributor to various research projects on the subject of addictive disorders.
Benzodiazepines – “Benzos” are drugs that suppress the central nervous system, affecting mother and child much like exposure to alcohol. Marijuana – Many people think that marijuana is a safer drug, but using marijuana during pregnancy presents certain risks. For example, research indicates that infants born to women who use marijuana tend to have low birth weights, especially if the mother
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MAKING RECOVERY A LIFETIME OF ADVENTURE!
O
regon Trail Recovery combines clinical therapies with outdoor adventures that renew mind, body, and spirit.
Located in beautiful Clackamas County, Oregon, an incredible range of adventure environments lay within a couple hours in any direction—from ocean to mountain, forest to desert, city to countryside...
Our 3-9 month therapeutic and comprehensive Men’s and Women’s transition recovery programs include: • Individual therapy with a Licensed, Masters level therapist • Weekly groups facilitated by certified addictions counselors and a Master’s level therapist. • Spiritual group and guided meditation • Adventure Excursions that include camping, river and ocean fishing, hiking, biking, whitewater, snow trips and sporting events. • Job search and preparation, including resume building and interview skills • Upscale structured living homes provide a perfect environment to learn and grow in recovery. • Transportation and meals are provided. • Most insurance is accepted.
Oregon Trail Recovery provides clients with the resources and tools to address their core issues and behaviors to increase their ability for sustained recovery and mental and emotional well being.
Call 503.901.1836 or visit OregonTrailRecovery.com 1 0 6 0 0 S E M C L O U G H L I N B LV D . # 2 0 7
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M I LWA U K I E , O R 9 7 2 2 2
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THE HOLIDAYS ARE A GOOD TIME TO APPROACH THE “ELEPHANT” IN THE ROOM By Tony Bevacqua
The holidays are a good time to approach loved ones who may appear to have a drinking or drug problem. Families generally ignore the “elephant” in the room, opting instead to overlook obvious inappropriate behaviors. They think that bringing up such a contentious topic will ruin the occasion. However, since it may be one of the few times families actually have a chance to get together in a spirit of love and togetherness, it can also provide an opportunity to show someone how much we really care about them--a gift that might just save their lives. It’s not just concerns over impaired driving that we should be concerned about. It’s much easier to overdose when mixing drugs and alcohol, and today it seems like nearly everyone is taking some form of prescription drug. Everyone at one time or another, has experienced the “elephant” in the room. This is the friend, family member or relative that drinks too much, appears spaced out, exhibits mood swings, becomes agitated, and generally speaks and acts improperly at family functions. But, since it is the holidays, it gets tolerated. We know that opioid-based pain killing drugs have caused more overdoses than illegal drug use. These drugs are freely prescribed and many abusers do not fit a stereotypical profile. The “elephant” can be obvious like a son or daughter returning home from college and over imbibing on the libations, to Uncle Joe who makes tasteless comments, or to even grandma who is sipping a little too much wine with no regard for all the prescribed drugs she is taking which contributes to her failing memory, lethargy and depression. We are also familiar with the person that does and says something ill-suited or regretful when they are intoxicated and then blames it on the alcohol. Some people become very aggressive and meanspirited when they drink. But the reality is, booze doesn’t talk. What alcohol does is lower inhibitions which brings us closer to how we are really thinking and feeling about ourselves. In either case, if an individual is happy or mean-spirited when intoxicated, the alcohol did not put words and actions into their brains. Rather, it’s their own perception of reality based upon their self-talk. If they are experiencing genuine fulfillment, satisfaction and peace of mind, their relationship with drinking will be different than if they are constantly beating themselves up. This is what we are observing. There is a level of emotional immaturity which contributes to an individual who learns to choose certain uncontrollable behaviors as way to cope. They have formed a new “relationship” which helps numb their cognitive and emotional distress. The paradox is how the individual who may be abusing or becoming dependent on alcohol and/or drugs which can be correlated with their early childhood developmental experiences, trauma and family dysfunction, continue to seek love and approval from the very sources which contributed to their problems in the first place. Everyone needs love, approval and validation. The holidays have always been socially and culturally acceptable times to overindulge. Yet, for many, it is also a time of strained personal relationships, financial hardship, and an insufficient amount of rest. Consequently, this contributes toward an increase in stress, anxiety and depression. Chronic stress, anxiety and depression are preconditions for addictive behavior. Under the socially accepted guise of a festive occasion, some individuals will use this as a further opportunity to self-medicate. There are two things to consider if you are a parent, spouse or friend. First, understand that the behavior will never cease until it is addressed. But at the same time, confrontation, criticism and coercion are limited in their influence to affect the self-motivation necessary in order to seek and maintain ongoing help.
biological and genetic problem. For example, where drinking problems appear in families, there is also likely to be experiences of trauma, poor coping skills, and ineffective communication. This suggests the common coping strategies adopted by the family have been learned. You will also find parents who were either too authoritarian or too permissive in their parenting styles, which has a deceit-based effect on self-worth. Each individual has their own unique subjective experiences of reality directly influenced by social learning and the language they are using in their personal narration. Although some people believe that alcohol brings out the worst in them, the reality is that the good and bad traits expressed when intoxicated are a reflection of who they are. Our personalities are shaped and formed early on in life. We learned to mimic and conform to behaviors we saw from adults beginning with how our mothers and fathers solved problems and resolved conflicts. These experiences influenced our expectations and associations with drinking and/or drug use throughout our lives. We can attempt to disrupt these patterned behaviors by the way we speak to an individual which might have greater influence on their self-motivation. Since individuals preoccupied with drinking and/ or drug use have learned to use these behaviors as a way to cope with their life challenges and problems, their subjective experiences are filled with self-condemnation, negative self-talk and negative rumination. When friends and family express frustration, anger, judgment, criticism and freely use labels to reference and describe someone they care about, they are actually reinforcing the individual’s internalized narration and suffering. When we approach individuals in this way, they become selfprotective. This is why they learn to lie and manipulate, which further reinforces stigma and shame. We can’t remove the stigma without changing the language we use to better understand an individual’s subjective life. If we stop approaching the individual with disapproval, clichés, labels, and criticism, but rather engage them with more kindness, compassion, empathy, and nonjudgment, we can better determine if they might want to seek help if given options and the right kind of support for them…even during the holidays. Tony Bevacqua is an accomplished educator, corporate coach, social advocate and lecturer. He teaches college psychology courses, leads corporate wellness seminars and has a private practice in Los Angeles coaching people who have a desire to better understand their self-determining nature. He has contributed articles to the Journal of Humanistic Psychology and Addiction Professional Magazine. Tony’s first book (July 2015), Rethinking Excessive Habits and Addictive Behaviors (Rowman & Littlefield), outlines his belief system and encourages readers to see addictive behaviors differently. Be sure to follow Tony on Facebook
It’s also not useful to rationalize ill-timed behavior as simply a
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ADDICTION CAN HAPPEN TO ANYONE By Sandy Swenson
Before my son was an addict, he was a child. My child. But he could have been anyone’s child. He could have been — or might yet be — yours. Until the troubles started, I never thought my child would become an addict. It never crossed my mind. Until one day it did. Before my son was an addict, he liked to fish and camp; he was an Eagle Scout and a rescue diver; he built a playground for orphans in India, he wanted to be a marine biologist, and he was awarded scholarships from several colleges. He also sometimes lied and said things that were mean and sulked and was crabby; in other words, Joey was perfectly normal. There’s a widely held belief that addicts are bad people, but the truth is, addiction is not an issue for moral judgment. Addiction has nothing whatsoever to do with whether a person is nice, or the quality of their character, or the strength of their will. Addiction is a disease. Scientific research has proven this; the addicted brain exhibits measurable changes —this is fact. And, most addiction begins in adolescence, strongly enticed by popular culture.
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Addiction begins where dalliance —or doctors’ orders—becomes disease. It can happen to anyone who has taken a sip or puff or snort—or even a pill prescribed for pain. Even though my son has done some bad things while being an addict, my son is not a bad person. He’s a sick person. When addiction scooped up my child, it did so indiscriminately; Joey, at his core, is one of the least bad people I know. Before my son was an addict, I used to judge the dusty addict on the corner very harshly. But now I know that being an addict isn’t something anyone would choose. Now I know that the addict on the corner has been my sweet child — and could someday be yours. I wish I hadn’t waited for the worst to happen before I opened my eyes and heart. Before I looked beneath the addict’s dust to the person he was meant to be. To the person my child could just as easily have become — and did. Before my son was an addict, he was a child. Not a monster. Addiction can happen to anyone. Sandy Swenson is the mother of two sons—one of whom is an alcoholic and drug addict. ‘The Joey Song’ chronicles her journey through the place where love and addiction meet.
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“I DON’T’ KNOW”—THE THREE MOST COMMON WORDS SPOKEN IN THERAPY© By Clifton Mitchell, Ph.D.
“When struggling with a client, you often think you are missing some complex skill you have not learned; in actuality, you have somehow failed to apply a fundamental skill.” Scott D. Miller On any given day there are clients sitting in therapists’ offices throughout the country. Likely, the three most common words spoken by clients in all of these sessions are, “I don’t know.” Unfortunately, too many therapists are inadequately trained in the management of the “I don’t know” (IDK) response and incorrectly view the response as a form of resistance. Misperceiving the IDK response as resistance often leads to therapists’ responses that further fuel the stuckness of the client and the perceived resistance. This most frequently occurs in one of two ways. The first is that therapists push too hard to break through the momentary impasse. They too often assume that clients do know the answer to their question and are just refusing to speak it. This results in clients pushing back and digging into their position of not knowing. As a result, “resistance” that was not present initially is now created and amplified by therapists’ actions of too aggressively seeking or insisting on an answer. This is a poor technique likely fueled by a bit of countertransference. The second way therapists sometimes respond to the IDK answer is that they change the subject and move the conversation to a place that they think they will be able to get the answer or movement of some sort. Problems arise in this instance because, rather than staying with clients’ not-knowing state and respectfully exploring the meaning behind it, they have avoided addressing the IDK response at all. Both approaches are inadequate and thwart the therapeutic process. “I don’t know” responses are important, momentary junctures in the therapeutic dialogue and successful therapeutic outcomes are highly dependent on adequately processing through the internal struggles occurring within clients at these junctures. The IDK response is so common I am surprised that there is not more written about it and about how to respond in a manner that gently and deferentially moves clients through this point in the therapeutic conversation. I have studied, written, and lectured about the IDK response for more than 15 years. From my studies, I have come to a number of conclusions, many of which are contrary to common perceptions. To begin with, IDK is rarely an indication of resistance; rather, it is a genuine response to the current turmoil and internal state clients are experiencing. “I don’t know” is not typically a haphazard, flippant response to irritate therapists and such ideas only serve to create more perceived resistance. There is a reason clients respond with IDK. Once elicited, the therapist’s job is to explore and understand this reason. I have also learned that the management of the IDK response is rather easy once it is studied and understood, and therapists learn to be comfortable in its presence. Below are some ideas and techniques regarding the management of this ohso-common response. The first is that therapists must realize and take responsibility for their part in provoking the response from clients. Likewise, they must change their way of responding to lessen the possibility of eliciting the response. “I don’t know” responses only occur in the context of a conversation of which therapists are co-creators. Frequently, the IDK response is a result of a poorly worded question asked by therapists who employ question-laden dialogues that are of debatable therapeutic value. Thus, if you are tired of hearing IDK,
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limit the number of questions you ask. Instead, increase your use of empathy. If this sounds like a lesson out of your counseling 101 class, you’re right. Yet, we often forget the basics and wonder why we are struggling so with clients. The second is that, once prompted, the secret to responding to IDK is to respond to the meaning behind the response and not the surface response itself. I have learned that there are thousands of personal meanings encapsulated in IDK responses. Clients who have contradictory, conflicting internal answers to questions or who are attempting to avoid facing their internal struggles or pain from the past often respond with IDK. Similarly, a client may respond with IDK to defend the self or to avoid a truthful answer that will arouse controversy they prefer to avoid. There are thousands of personal meanings to the IDK response. Rather than press for answers to questions, therapists are advised to delve into and ferret out these meanings with clients. Once the meaning behind the IDK response is discovered and clarified, it is much easier to address the specific concerns disguised in the IDK. Therapy is the process of grasping, exploring, and processing these internal dynamics. While on the subject, the safest response to IDK is to respect and honor the “not knowing” state of the client and empathize with the difficulties clients are experiencing as they search for an answer. For example, you might respond with something like, “At this moment, you are a bit stumped as you search for an answer. This is a difficult situation to sort out.” Simple delivery of an empathic comment that moves to a position of understanding with what the client may be experiencing. Such therapist responses circumvent getting into a you-push-they-push-back, adversarial dialogue. In my experience, this approach moves as much as 60-70% of clients beyond the current IDK state toward a deeper exploration of struggles. Yet, this requires that therapists learn to be comfortable sitting with the client in a “not knowing” state for as long as is needed, an essential ingredient to managing IDK responses. The more comfortable therapists can be in the presence of the “not knowing” state, the easier it is for therapists to focus on the critical steps to managing it. Many times when asking questions, therapists can intuitively hear in their mind and anticipate that an IDK response will follow. Most therapists have had this experience. You are in the middle of the question and you just know the client is going to respond with an IDK. Such insights on the part of the therapist should be taken as a sign that the question being asked is not therapeutically appropriate at the moment. Your understanding of the client is telling you that the client is not at a place where he/she has a beneficial response. When this occurs, I suggest you immediately stop your questioning-in the middle of your sentence if necessary. It’s apparently not going to work; so, don’t do it! Instead, signal your client not to respond with some hand waving Continued on page 54
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IT’S ABOUT TIME: WHY TELEMEDICINE IS ON THE VERGE OF CHANGING ADDICTION TREATMENT FOREVER By Jacob Levenson
When it comes to blazing the healthcare trail with state-of-the art, cutting edge treatment and innovative modalities, the field of addiction treatment has lagged behind. Other healthcare specialties such as oncology have made tremendous advances in their respective fields. According to the latest research from the National Institutes of Health, cancer survival rates have more than doubled in the past thirty years. Meanwhile 125,000 Americans die of addiction every year, a number that progressively increases. The annual cost of addiction to our society is in the billions. The addiction treatment field’s slow embrace of technology has done nothing to advance treatment outcomes for individuals suffering from addiction. But today all that is changing. Long overdue advances in behavioral healthcare technology are revolutionizing the addiction treatment space. It’s about time. Of the 22 million Americans who meet the criteria for Substance Use Disorder (otherwise known as addiction), only 5 million receive any type of treatment in a given year. In the past ten years, the field has witnessed an explosion in the number of addiction treatment facilities. In one 2,000 square mile county in Florida, there are more than 500 addiction treatment facilities. This equates to an addiction treatment facility located every four miles, yet the need for treatment continues to go unmet for the majority of Americans. The demand for addiction treatment is the strongest it has ever been, yet the reality is providing treatment to those in need would cost an estimated half a trillion dollars! Despite the growth in addiction treatment facilities, there aren’t enough beds and there isn’t enough money to treat everyone in the traditional inpatient way. The fact that addiction is a chronic disease complicates the situation even further. As with other chronic diseases, treatment for addiction can be lengthy and may need to be repeated. We cannot expect an acute treatment model to effectively treat a chronic disease. Without taking a technological leap, the economics and infrastructure of addiction treatment cannot come close to meeting the demand. Telemedicine is the technological leap that the field of behavioral health is embarking upon. With its characteristics of scalability, data-driven precision medicine and resource efficiencies, telemedicine holds the promise for addiction treatment that chemotherapy held for cancer treatment thirty years ago. Prevention and maintenance are essential to successfully treating and keeping any chronic disease in remission. Twelve-step (and similar programs) have understood this premise for 80 years and health insurance payers have begun to catch on. Unconvinced of its efficacy (because addiction treatment providers have struggled to demonstrate its outcomes), health insurance payers have tired of paying for inpatient addiction treatment. When treating cancer everyone agrees that success equates to death of cancer cells and the field has been able to demonstrate this with empirical data. However, identifying successful outcomes in behavioral healthcare can be difficult. Payers, providers and patients have different concepts of success and there is little empirical data. Payers believe that successful treatment results in a reduction of costly repetitive inpatient episodes. Subsequently, treatment models are evolving and long, extensive stays in residential treatment facilities will diminish. Insurance companies and treatment providers will pivot toward a greater emphasis on disease maintenance and management in order to improve clinical and financial outcomes. Providers can expect to be required by payers to either offer aftercare support services to their discharged patients or coordinate with someone who will. It is common practice for most patients to travel outside of their geographical area for treatment. In essence, upon completion of treatment, payers will be asking providers to embrace telemedicine and value-based reimbursements.
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Last year there was a significant flow of capital and resources moving into the healthcare IT space. Companies such as Google Ventures and Salesforce have set their sights on healthcare technology as the next great territorial expanse of opportunity. Behavioral health will not go untouched by this influx of financial and technological attention. Google Ventures aims to take life science entrepreneurs and introduce them to technology that can be used to improve healthcare and access to health. Dr. Krishna Yeshnet, General Partner of Google Ventures, was quoted in an April 2015 MobiHealthNews article by saying, “I’m a firm believer that we are moving into a value based, capitated world…we can take a life sciences entrepreneur and expose them to the latest machine-learning technology and help them tie that in to their business…”. It is with this type of vision that telemedicine will make inroads in the field of addiction treatment. The first generation of behavioral health telemedicine has arrived. Payers are beginning to define pay-for-performance success measures and providers will soon be required to demonstrate treatment outcomes – a leap that Medicare and Medicaid took decades ago. Knowing the rates of treatment success of patients after they complete treatment will be more important than ever to the provider. In order to stay in the business of treating addiction and continue their revenue streams, treatment providers will use telemedicine to maintain contact, connection and provide on-going recovery support. Post-treatment support has been shown to dramatically increase a patient’s ability to maintain longterm recovery from addiction. Payers are motivated to work with providers who can successfully treat chronic disease states while minimizing the potential for relapse and recidivism. As we turn our focus to the immediate future, 2016 will be the year that telemedicine transforms the addiction treatment space forever. The outcome data derived from post-treatment patient encounters will illuminate treatment modalities that are clinically successful and those that are not. The vast majority of patients will receive longterm supportive care in order to successfully maintain their chronic disease. Within a few years, the majority of addiction treatment providers will have telemedicine divisions associated with their facilities to serve as new revenue centers which will quickly become an important part of their brand identity. The addiction treatment space has historically lagged behind in the utilization of empirical data and innovative technologies. The field will no longer lag behind. It’s about time. Jacob Levenson founded Austin-based MAP Health Management, LLC in 2011 and has served as Chief Executive Officer since its inception. MAP is a provider of comprehensive outcome data, aftercare programs and revenue cycle management to addiction treatment providers across the country. Levenson passionately architects and deploys data-based solutions and healthcare services that empower patients by mitigating potential relapse, increasing predictability for insurance payers and overall outcomes for treatment providers. For more information, visit www.ThisIsMap.com.
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SPIRITUAL CHOICES: SPIRITUAL GROWTH THERAPY ™ FOR THE TREATMENT OF TRAUMA AND ADDICTION By Paul D. Alleva, MSW
The treatment of trauma, PTSD, and addiction have a long standing history associated with cognitive functioning of the brain and the use of therapeutic interventions associated with behavior changing modalities that seem to be stuck in the dark ages of psychoanalysis and psychotherapy. Unfortunately, not much has changed in the psychotherapy field over the last thirty or more years. As a result, patients have been left to attend psychotherapy sessions and drug / alcohol recovery centers over and over again with no true basis of change or progress towards their ultimate goal of leading a sober life. The notion of getting sober is not the same that it was in the 1960’s; today’s addict requires intellectual stimulation with a proactive change within a purposefully driven goal that redefines the addicts identity of the self when they wake up in the morning and can actually look at themselves in the mirror. The disgrace that comes from living under the thumb of addiction and the stress of reliving trauma continues to hinder the progress of treatment to the extent that this associated stress, guilt and shame is a common thread among reasons to relapse. Spiritual Growth Therapy™ (SGT) is a philosophical concept that changes the way therapy is performed by the providing practitioner and a therapeutic modality that challenges the patient’s concept of themselves, redefines their identity, and drives them towards a life filled with purpose on a spiritual level. The SGT Therapist SGT is no longer a therapist with all the answers, informing the patient on what and how to act while passing judgement based on the clients pathology or newest and latest diagnosis. The SGT therapist is trained to meet the patient at eye level and to guide them through self-exploration, reprocessing, refinement of identity, and a spiritual awakening defined as a renewed purpose in life in spite of a diagnosis. SGT therapists collaborate with the patient, walking them through a set of intellectually stimulating and spiritually based practices that creates new neural pathways within the brain, opening and defining new ways of thinking and crafting new choices that are spiritually and morally sound. The ultimate goal of the SGT therapist is to guide the client to an understanding that they are able to perform the SGT tasks, practices and interventions on their own and throughout their lives. Clients will NOT have to seek the therapist’s couch every time something in their lives goes wrong. The SGT therapist MUST embody and be the perfect vehicle for Spirituality! They must engage in spiritual practices and lead by example. They must exhibit and exude peace, understanding and remain calm, cool, and collected. They must possess the ability to filter emotions from the body, both negative and positive to enhance their ability to think clearly, logically and rationally about themselves, their community and the world. They hold dear to their hearts and manifest the attitude that failure is not an option and that nothing, NOTHING, is going to hurt anyone; not on my watch! A Note on Research and Spirituality Unfortunately, addiction and trauma treatment has been highly dependent on research and so called best practices of therapeutic modalities to be used during treatment. Although these research studies take into account the dominant modalities being used in treatment centers across the country, they are limited in their scope as they do not take into consideration what is left of the client after these therapeutic interventions are used. Most of the research performed views the patient as a robotic system unable to think on their own and without emotion. These two elements discount the human component of treatment, leaving in its wake an army of dry drunks who continue to exhibit maladaptive addictive behaviors only without the drugs and alcohol. It is the purpose
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of SGT to redefine behavior towards a positive light and positive outcome. Current behaviors are to be driven by the mindset of a “wish and do no ill will towards the self or others”. The ultimate goal is manifesting a positive purpose into the patient’s life and turning the tide of behavior towards a ‘good will to men and women’ thought process that produces good human beings, with the light of hope, joy, happiness and a clear mind to make healthier choices and establish a better future for themselves and the people they interact with daily. Being a practitioner myself, it is not good enough to just help get people sober or overcome their trauma; we have a duty to create a better world. In all the research I have come across concerning spirituality and spiritual practices, the findings are the same; spiritual people live longer, have more productive and refined lives, are healthier human beings and are less likely to smoke, drink alcohol and use illicit drugs. According to the research, spiritual practices such as yoga and meditation reduce the neurochemicals in the brain associated with stress. As we in the recovery and trauma field know and understand, the inability to handle stress is a common thread leading to relapse and an inability to handle situations in real time. By reducing stress levels (of course without medications for which this country has become too dependent on) our patients’ abilities to think clearly under duress lead to better decision making and more proactive positive choices when presented with adversity. Most of the research defines a life of purpose and a strong connection with the self in an encouraging light as the reason that spiritual practices and spiritual people work. Spirituality redefines purpose; as written in our book Let Your Soul Evolve: Spiritual Growth for the New Millennium 2nd edition. Even addicts have a purpose: injecting heroin is a purpose on the negative scale if there ever was one. Initiating a positive purpose based on a spiritual connection redefines identity while creating new neural pathways in the brain towards a higher understanding of the self and a stronger connection to a higher purpose. Therefore, when a choice needs to be made based on the self, the patient exhibits a chain reaction leading to a choice based on a positive outcome. The sense of the self, the body, the mind, the heart, supersedes the want to create drama, chaos, and pain in one’s life. In conclusion, the driving force behind taking care of oneself alters the neural pathways in the brain to a point where doing things like drinking and smoking becomes superficial and a detriment to the goals the person is and has been accomplishing.
SGT and the Treatment of Addiction The American Society of Addiction Medicine (ASAM) has recently redefined the definition of addiction relating it to a Continued on page 50
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HEROIN EPIDEMIC IN AMERICA (Part 4) By Steven Kassels, M.D.
This is the fourth in a series of articles discussing the ten reasons for the current heroin epidemic, so if you have missed the prior editions of The Sober World Magazine, you can easily review them by going to www.thesoberworld.com This article will focus on the topics of Supply and Demand (“War on Drugs”) and Physician Training and Biases. Next month the series will close out with the final two reasons: Mental Health Treatment and the role of Public Officials. As the final four reasons for the heroin epidemic are reviewed, solutions within reach will also be emphasized. The issue of Supply and Demand directly relates to both the problem and the solution. Heroin production and distribution seems to be an unending saga; and unfortunately it has been compounded by the War in Afghanistan. No matter how many drug lords and kingpins we kill or arrest, there is always someone willing to fill the void. Money and power is the “addiction” that attracts people to the illicit drug world. Interdiction and attempting to close our borders to drugs is a losing battle; and increasing tax payers’ burden by growing law enforcement and judicial budgets has been unsuccessful. Yes, we can arrest and incarcerate all the current drug pushers, big and small, and we can continue to burn the fields of the countries that produce opium; but the profits of this organized industry of drug production and distribution is so great that there is a continuously replenishable supply of people who want to be the next kingpin or the next local drug pusher. Let’s look at this from a different perspective, using an economic analysis. If we cannot limit the supply, then we must look at the demand side of the equation. If there is decreasing demand, there will be decreasing profits and therefore decreasing production. I am not saying that we should abandon attempts to bring to justice those who are poisoning our communities with a constant flow of illicit drugs. What I am saying is we should attack the demand side of this problem with greater vigor. We spend $400 Billion Dollars annually dealing with the consequences of addiction in terms of crime, health care and lost worker productivity. This should be incentive enough to advocate for more preventive programs and more treatment centers to decrease demand. As I stated earlier in this series of articles, there is plenty of blame to go around. We must focus on the solutions. Last month’s article dealt with NIMBY (“Not in My Back Yard”) which is interconnected with the Supply and Demand. If our community leaders and citizens do not support local treatment centers in greater numbers, then curbing demand will remain an uphill battle. As you may recall from the article in the November edition, I casted some blame on doctors. I am further implicating the medical profession as a contributing factor, but now from the perspective of the educational process. To state it bluntly, sufficient addiction medicine training and emphasis on the complexity and interrelationship of addiction and underlying associated illnesses is lacking in our medical schools and residency programs. This not only leads to a lack of appreciation of the importance of screening patients for predisposition to and/or ongoing addiction, but also creates biases. In general, misconstruing or minimizing the complex societal and psychological issues reinforces preconceptions that are not based in fact. When this hypothesis is applied to physicians who are asked to treat the difficult and multifactorial aspects of addictive disease, bias can prevail. There are certain diseases
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that are more time consuming to manage than others, especially when the patient is either in denial and/or non-compliant. Examples may include diabetes, cardiac disease and lung disease. But physicians in general receive the appropriate training to deal with the demands of patients with these illnesses. That is not the case with addictive illnesses and bias is compounded by other societal factors that influence perceptions, such as jailing patients. Dr. Saul Tolson, in my novel Addiction on Trial, addresses this very issue: Pausing while attempting to make eye contact with each and every individual in the audience before proceeding, Dr. Tolson delivered his next few lines in a compassionate tone. “With no disrespect, but as a way to reinforce the point I am trying to make, I’d like to ask you to please tell me the difference between a nicotine or alcohol addict, who in some cases may even receive a heart or liver transplant, and someone addicted to heroin or cocaine? Why are those afflicted with the disease of addiction to certain drugs treated so differently than patients who suffer from nicotine or alcohol addiction or other chronic diseases like diabetes? Are they really any different?” Dr. Tolson never relinquished the podium without one last attempt to convert the naysayers. “Now for those of you who fail to agree with me, and I know you’re out there, let me appeal to your wallets. To incarcerate one addicted patient—that’s right, jailing patients—costs between $40,000 and $50,000 per year. A one-year stay for a patient in a halfway house costs society about $20,000 per year and this does not include any medical care. But to treat one heroin addict as an outpatient with regular individual and/or group counseling sessions, ongoing urine drug testing to monitor for illicit drug use, a complete admission physical exam including laboratory tests that screen for contagious diseases such as Hepatitis C and HIV, and the daily monitoring of medication administration costs approximately $5,000 per year! That’s right—only $5,000 per year or about one-tenth the cost of putting this patient in jail! Like they say in the Midas commercial, ‘you can pay now or you can pay later, but you’re gonna pay.’ However, inroads are being made to correct the deficiency in medical education. The organization, Coalition on Physician Education in Substance Use Disorders is making great inroads within the medical educational process, and I feel honored to have been chosen as a speaker at a recent event. I presented some facts such as:
• The changing face of addiction now includes aging baby boomers; • Heroin addiction is no longer just an inner city problem, as it has migrated to college campuses and to white suburban men and women in their late 20’s; • Physicians can make a tremendous difference by having a brief discussion and/ or implementing a form to rapidly identify patients at risk. The tool is called SBIRT (Screening, Brief Intervention and Referral for Treatment - http://www.integration.samhsa. gov/clinical-practice/SBIRT ; and most importantly • “Drug addiction is a brain disease that can be treated” (Nora D. Volkow, M.D., Director, National Institute on Drug Abuse) Physician bias is another roadblock to solving the heroin epidemic; biased doctors are less likely to treat patients with addiction. It is Continued on page 48
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ADDICTION – THE 3 FRONTAL ATTACK By Brent Burnmaster Spiritual The last attack of addiction is the spiritual issue. It’s the emptiness that the alcoholic or drug addict feels. In fact, most addiction, whether food, shopping, gambling, or sex is because of the void that exists in our spirit. We look for things from the outside (drugs, food, drink, shopping,) to make us feel good on the inside. I believe that this is an inside out job. So what do I mean by that? Inside out job is doing for others to make us feel good on the inside. We teach our residents to pray for 3 family members or friends who need prayers. They could be sick, lost a loved one or lost their job. This technique reminds me of the “Karate Kid” movie where Mr. Miyagi had the karate kid wax his car and paint his fence. Karate Kid did this for several days and did not realize that Mr. Miyagi was teaching him karate moves. We use the same habit technique which moves the alcoholic and addict away from thinking about their self to thinking about others. By thinking of others, the alcoholic and addict becomes less selfcentered. Soul’s Harbor stresses service work, chairing meetings and volunteering their time to help others. The alcoholic and addict feels much better about themselves after performing service work for others – thus filling the spiritual void from the inside out. So the 3 attacks of addiction – physical, mental and spiritual can be addressed through a long term holistic approach to recovery. Brent Burmaster is the Executive Director of Soul’s Harbor Treatment Center located in Dallas, Texas. Addiction is a 3 frontal attack – Physical, Mental and Spiritual. Physical The physical attack is the craving that follows the ingestion of the first drink, drug or pill. For most alcoholics and drug addicts, once the first drink or drug is consumed, there is no stopping until they black out, pass out, are locked up or have run out of money. For most drinkers and drug users that are not alcoholics or addicts, they will quit when they start losing control. Many alcoholics and drug addicts chase the delusion that they can either control their usage or can stop at will. These are one of the many lies of addiction. The 12 step program teaches us that the physical craving is an allergic reaction to the drink or drug. Instead of breaking out in rashes or hives, the allergic reaction is wanting the next drink or drug and then the next one and then the next one after that… So what is the solution? The solution is total abstinence from any mind altering substance. Another big addiction lie is that if I am a crack cocaine addict and have no problem with alcohol, I can drink once in a while. This kind of thinking will lead to one of two outcomes. One of the outcomes is that the crack cocaine addict switches their addiction to drinking. The other outcome, which is more common, is that after a couple of drinks, the addict will be steered to their drug of choice – in this case, crack cocaine. Mental The second attack is the mental obsession that tells the addict or alcoholic that they need the drink or drug. It is the notion that the alcoholic or drug addict cannot live without it. I heard that the mental obsession is like a 3 year old toddler who wants a Happy Meal at McDonalds. The toddler keeps yelling to his mom “I want a Happy Meal”. “Mom, I want a Happy Meal”, and then at the toddler’s loudest voice “Mom, I want a Happy Meal”… This is the thought process that is constantly repeated in the alcoholic / drug addict mind. Over time, the mental obsession is less and less- IF the alcoholic and drug addict stays sober and clean. You will never eliminate the mental obsession but after a couple of years of sobriety, the mental urge to drink or drug will become a fleeting thought. Certain events, emotions or memories may trigger the thought of drinking or drugging. We found that with 60 years of treating men with substance abuse, that the 12 step program is the most effective solution for the mental obsession along with completion of either a 6 month or a 12 month substance abuse program.
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At Soul’s Harbor, we have a very high success rate of long term sobriety for patients that have completed our 6 month or 12 month program and have followed our aftercare program. Brent has a Bachelor of Science from the University of Oklahoma. souls.harbor.dallas@gmail.com
Treating men with substance abuse issues since 1956 Offering 6 months and 12 months programs
You didn’t get addicted in 30 days and you should not expect to be cured in 30 days. Our 6 months “in patient” program is typically a lot less expensive than most 30 days programs. Call our Intake Coordinator for details 214-596-8225 www.soulsharbordallas.org
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The Benchmark Transitions® Program Benchmark Transitions is a comprehensive, multi-disciplinary approach to therapeutic transitional living for young men and women, ages 18-28.
ASI specializes in coordinating treatment alternatives to jail time for those facing alcohol or drug related charges in the court system. ASI is affiliated with a network of treatment centers and licensed attorneys who are qualified and experienced in defending alcohol and drug related charges. For those who are not covered by health insurance for Substance Abuse Treatment, we offer rehab alternatives at a rate substantially discounted from what the treatment centers will normally charge you. Call for a FREE consultation WE PROVIDE: Myles B. Schlam,J.D.,CAP/CCJAP • Interventions • Drug Evaluations CEO, Advocare Solutions,Inc • Drug Charges * • DUI’s * 954-804-6888 • Expert Testimony mschlam@drugtreatmentpro.com • Marchman Acts * www.drugtreatmentpro.com • Criminal Record Expungement *All clients with legal cases will be represented by one of ASI’s licensed network attorneys
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LIVING BEYOND
A Monthly Column By Dr. Asa Don Brown
NEW YEARS RESOLUTIONS “The object of a New Year is not that we should have a new year. It is that we should have a new soul and a new nose; new feet; a new backbone; new ears; and new eyes.” ~ T. S. Eliot At this time of the year, we are encouraged to develop our New Year’s Resolutions. The resolutions may serve as a renewing of our lives and a refreshing of our person. The resolutions may play upon our heartstrings, moral compasses, and ideological viewpoints. Resolutions are not only geared towards improvement of the individual, but as well as the improvement of societies’ moral and ethical compasses. The key to moving forward is establishing new pathways in life, which includes forgiveness. FORGIVENESS IS THE KEY TO MOVING FORWARD “Forgiveness is not an occasional act; it is a permanent attitude.” ~ Martin Luther King, Jr. A key to moving forward, is forgiving others, as well as yourself. Forgiveness is not only a state of mind, but it is a state of being. Forgiveness is a constant attitude occurring through a purposeful action. As humans, we are instinctively designed to forgive. It is only when we choose not to forgive that our minds, bodies, and spirits begin to experience disrepair. The lack of forgiveness is the catalyst for stress, anxiety, and depression. Forgiveness cleanses the body, ridding it of the decay of negativity, disappointment, and heartache. Forgiveness is the key to living life productively, thus by producing the desires and intended results with which we may choose to acquire. Forgiveness is a purposeful action filtered through a permanent attitude. WHAT IS A RESOLUTION? “For last year’s words belong to last year’s language and next year’s words await another voice, and to make an end is to make a beginning.” ~ T. S. Eliot The basic principle of a resolution is to be firm with one’s decisions, opinions, intentions, and expressions. It is through a resolution that we clarify our stance, becoming a decisive person. Being decisive is intent on settling an issue or a set of issues, by producing a definite result. MY PERSONAL NEW YEAR’S RESOLUTIONS “You are never too old to set another goal or to dream a new dream.” ~ C. S. Lewis When we set goals, we are seeking to achieve measurable, attainable, viable, and time oriented objectives. “Each January, roughly one in three Americans resolve to better themselves in some way. A much smaller percentage of people actually make good on those resolutions. While about 75% of people stick to their goals for at least a week, less than half (46%) are still on target six months later.” My goals have always involved the following: my personal (effecting myself); my professional (my employment, occupation or pursuit of a career); my academic (my pursuit of knowledge, instruction); my familial (promotion of family); and my overall life (global picture of my life). Consider the following questions: • Do I believe in myself and goal? • What is the purpose and intent of my goal? • Do I rely upon others for admiration, acceptance and approval? • Have I an ingrained attitude of approval, acceptance, and self-worth? Key Ingredients: Acceptance: the ability and willingness to unconditionally receive oneself. Admiration: the warmth and approval through a pleasurable contemplation. Approval: the direct action of completely and unconditionally accepting oneself or another. Attitude: a settled way of thinking or feeling about oneself and one’s
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life. Career: an occupation with which an individual commits to. Education: knowledge is the foundation of personal liberation. Expressive: Researchers have shown that the self-expression of art is one of the greatest tools towards developing one’s ability to think in the abstract. Family: a group of individuals that you have a biological or nonbiological connection to. Financial: financial stability leads to financial liberty. Physical: our physical body which is not including the mind or the psychology of the person. We may have physical aspirations to improve our health or to reach a particular physique. Pleasure: an ultimate feeling of bliss, happiness, satisfaction and enjoyment. Psychological: the psychology of the human condition is the study of the mind, interactions, and behaviors of an individual. Public Service: Serving improves your outlook on the world and encourages others to serve. KEY STEPS TO SETTING GOALS 1. Begin by identifying the goal. 2. Declare the intention of your goal. 3. Create a personal vision and quest. 4. Devise a plan and a course of action. 5. Allow yourself to make mistakes, because mistakes are key to growth. 6. Focus your time, energy and desires towards attaining your goal. 7. Believe in your person and ability. NEVER CAP YOUR CEILING Capping your ceiling gives an allowance for mediocracy. When we set goals, we should always be aware of potential ceilings. By eliminating our ceiling, we are essentially leaving room for the maximum opportunity for growth. Placing a cap upon your ceiling, may prevent you from reaching your greatest potential in life. HAVE FAITH IN YOURSELF AND YOUR PURSUITS “Faith is not the clinging to a shrine but an endless pilgrimage of the heart.” ~ Abraham Heschel The power of faith in oneself is a remarkable commodity. Faith is an ultimate player in goal setting. Faith is an empowerment in your desires. If you have the faith to believe, then you shall succeed at whatever your heart desires. The lack of faith in one-self is the greatest obstacle preventing someone from reaching ultimate success. What is it to have faith in one-self? Having faith in one-self is to deny room for negative communication. When you deny room for negative communication, you are preventing the infestation of negative language into your life. Words like: impossible, implausible, improbable, and no are not welcomed into your life. Faith in oneself is the key that grants the individual freedom from limitations and boundaries; allowing us to be the ultimate superhero. REACH FOR THE STARS OR THE MOON Do not allow anyone to deny your ability to reach for the heavens. My precious daughter Esperanza, at the whopping 3 1/2 years of age, informed my wife that her daddy created the moon for her. As a father, it is a humbling remark, but as a child, I am encouraged to see that she believes that we can accomplish anything in this life including creating the heavens and the earth. I beseech you to reach for your stars, create your moon, and to conquer the heavens. May you begin living beyond. Dr. Asa Don Brown Author: Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Website: www.asadonbrown.com Adapted from Dr. Brown’s article with Canadian Counselling and Psychotherapy Association.
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CHANGING OUR GENES By Kevin Wandler, MD
On Thursday Feb. 11 from 6 PM. to 9 PM. at the Delray Beach Center for the Art’s Crest Theater, the Delray Beach Task Force will host SUD (Substance Use Disorder) Talks. This event is modeled after the successful TED Talks and will include several talks from local, regional and national speakers. Among them are Dr. Kevin Wandler, Associate Chief Medical Officer, Advanced Recovery System; Dr.D.John Dyben, Director of Older Adult Treatment Services, Hanley Center; Marc Woods, Code Enforcement Officer, City of Delray Beach; and Dr. Elaine Rotenberg, Clinical Director at the Alpert Jewish Family and Children’s Services. The Visionary Speaker for the event will be Dr. Carl Hammerschlag, a master storyteller and internationally recognized author, physician, speaker and healer. He brings extensive knowledge regarding how communities can survive in rapidly changing cultures, the role community plays in healing and how a changed perspective is needed to gain ground in response to the swell of substance use disorder. The Presenting Visionary Sponsor for SUD Talks is Weiner Lynne & Thompson, P.A., Attorneys at Law. The effects of social media on a child or adolescent is in the infancy stages of being thoroughly examined. Preliminary research, and my 20 years of experience in treating adolescents for substance use disorders and eating disorders, shows that there is a significant cause and effect that is being exacerbated as the development of new media platforms is ever-growing and the level of intrusion into one’s personal life is constant. The media’s influence on a young person’s initiation of alcohol and drug use as well as self-esteem and body image can affect the young person’s psyche. Now more than ever we must hold social media channels accountable for their level of influence.
Early intervention and prevention is necessary to prevent long term damage and dependence. “Hijacking” of the brain occurs as a direct result of youth substance use. In those that become dependent, we are discovering epigenetic changes that affect how the brain responds and leads to increased use and drug dependence. Epigenetics occurs in addiction when there is a druginduced change in how the gene affects the reward receptors in the pleasure centers of the brain. Thus we see addicts relapse quickly because the brain wants to continue the drug-induced level of pleasure. Sadly, it takes time for the genes to adjust back to a drug free lifestyle. Research is now looking at medications that may reverse this craving quicker. The magnitude of influence cannot be underestimated with regard to body image and self esteem. A simple search on Pinterest returns millions of results to those looking for diet tips, “perfect” bodies and even suggestions on how to engage in unhealthy behaviors. “Thinspiration,” the online practice of sharing motivational images and text that encourage viewers and readers to lose weight and engage in disordered eating habits, much targeted to body image, has become extremely prevalent over the last several years and continues to grow in popularity as access to these resources is only a click away. Body image is learned and formed from many different sources, of which media is only one. Individual, familial, and social/cultural factors all are implicated in the development of body image, which is why mass media such as television can have differential effects. Children’s own weight status is a strong predictor of self-esteem and body satisfaction. Psychological characteristics such as self-esteem, the feeling of a lack of control, depression, anxiety, and troubled interpersonal relationships also have been linked to body-related perceptions and Continued on page 52
As adults, we are exposed to media at an exorbitant rate. Media messages are directly responsible for what we buy, how we “should” look, and for many how we feel about ourselves. The new normal for men is having a six pack abdomen and for women looking like the latest trend, always thin, athletic and “sexy” because the majority of models in commercials tend to be underweight or uber athletes. Surprisingly, it is estimated that teenagers spend nine hours a day using media—the majority being television and cell phones to access Facebook, Tumblr, Twitter, and Pinterest. Eighty percent of all teenagers use these social media websites. As a result, advertisers continue to increase their investments in social media advertising. It is a fact that adolescents use and abuse substances such as alcohol, tobacco and marijuana. Influences have been parents, peers and ever more so “super peers.” These would include celebrities in the music, television and internet, or as they are now known, “influencers.” In fact, there are talent agencies today that solely focus on employing individuals that have large social media followings because they have the ability to directly impact the brand awareness and sales of the clients that seek their services. Ninety-three percent of movies that adolescents watch portray the use of alcohol, and twenty-two percent reference illicit drugs. In music videos, alcohol use is portrayed every fourteen minutes and was associated with a thirty-one percent increased risk of use. (Pediatrics 2010). According to the journal Pediatrics 1998, an hour increase dose-response to television media lead to an elevated risk of starting to drink alcohol over the next eighteen months. The 2014 NIDA study recognized that the legalization of recreational marijuana in several states has made cannabis use even more accepted by youth because of the decreased perception of risk.
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South Florida is known globally for golf courses and addiction treatment resources. You would be amazed to know that the same strategies used in your golf game can help in addiction recovery, whether you are a scratch golfer or a beginner. Emotional mastery and composure, identifying things that you can manage, what you cannot control and being present in the moment are prime examples of techniques that can improve your game and life. Defining oneself not by performance, setting goals that are possible and believing in self can be learned. If the substance abuser is motivated internally to enter treatment instead of at the urging of loved ones, friends and colleagues, their chance of recovery is so much better. For that reason, addiction programs are dual purpose now. They are designed to engage potential people looking for recovery. Holistic amenities may attract woman, wilderness adventures for young adults or golf swing instruction and play for sports minded boomers and seniors. These added activities make addiction treatment more relevant. For instance, if one was able to improve their golf swing as well as learn to enjoy life sober, one may consider participating. Of course, solid medical and physiological services are still the basis of treatment. But to some, the addition of golf makes the process feel more like a positive experience than a punishment. Golf alone is not enough for successful long term recovery, but lessons learned during play can make a big difference in the course of life. Addiction Reach manages the practices of treatment providers that offer customized concierge addiction recovery services for individuals, couples, and families in all stages of recovery, including GOLF THERAPY. For a complimentary consultation call 561-427-1900 or visit www.addictionreach.com
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FREE ROOM AND BOARD: PATIENT BROKERING OR RECOVERY SUPPORT? By John Lehman
FARR recognizes discounted and/or “free” room and board in a recovery residence when exchanged for enrollment in a designated intensive outpatient program as an inducement. Individuals convicted of committing this crime may be subject to harsh punishment. F.S. 817.505 – Patient Brokering specifies such activity punishable as a third degree felony. No small matter. F.S. 817.505 – Patient Brokering leads off with the following: (1) It is unlawful for any person, including any health care provider or health care facility, to:
benefited from a month’s support when I started my journey. Thousands of Floridians will attest to how important external financial support was to their early recovery, whether provided by family, a charitable foundation, a non-profit recovery residence, or the Hot Team’s use of federal funds in provisioning a 30-day housing voucher. External financial support, even when provided by an IOP, is not in and of itself a deterrent to recovery. Transitional Support
The language above offers little room for creative interpretation. Therefore, it would be an easier, softer path for FARR to follow if we were to simply deny any provider application for Voluntary Certification of Compliance with NARR Quality Standards for Recovery Residences based on NARR Standard 02.02 that requires providers to comply with state and federal law. But easier, softer ways generally produce lousy results. Thus, we drill down to examine more deeply the issues raised by the statute’s language.
One of the challenges to establishing an ethical pathway through the mire of abuse relates to the longevity of the support. For how long is this practice truly in the consumer’s best interest? The primary purpose of a recovery residence is to promote the resident’s development of Recovery Capital. Transitional support includes mentoring each resident’s effort to develop their personal capacity to sustain recovery upon successful completion of the residential program. Efforts that might include having secured stable employment and enrollment in higher education. Science suggests that persons in recovery who achieved goals that promote self-esteem and fulfillment of purpose, progress towards establishing what has been termed Recovery Resilience. In other words, we are better prepared to handle the challenges of life on life’s terms without returning to active use. An IOP who utilizes “free rent” in exchange for continued enrollment in their clinical program participates in undermining their client’s recovery in favor of profits. Thus, returning us to the delineating question: intent to induce or intent to support. At FARR, we have fielded numerous grievances documenting provider abuse wherein the IOP client remained enrolled for extensive periods, often in excess of ninety days. The attendant expense is ultimately borne by the healthcare insurer while presenting a barrier to the resident’s development of recovery capital. The only true benefits of this practice are revealed on the bottom-line of the clinical service provider, the participating recovery residence and the affiliated drug urinalysis confirmation laboratory, often all owned by the same principals. Most frequently, the resident’s recovery is a casualty. We all know it, so what are we going to do about it?
Intent Matters
Open Call for Proposals
(a) Offer or pay any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of patients or patronage to or from a health care provider or health care facility; (b) Solicit or receive any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for referring patients or patronage to or from a health care provider or health care facility; (c) Solicit or receive any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for the acceptance or acknowledgment of treatment from a health care provider or health care facility; or (d) Aid, abet, advise, or otherwise participate in the conduct prohibited under paragraph (a), paragraph (b), or paragraph (c).
The statute clearly focuses on the intent of the transaction. Intent can quickly become a fuzzy area open to varied evaluation. Is the offer of free or discounted rent intended to induce the referral of a consumer or to induce the consumer’s choice to enroll in the benefactor’s behavioral healthcare program? Either intent is an activity the statute seeks to prevent; ultimately for the protection of consumers and healthcare insurers. How do we carve out a legal and ethical channel through which Intensive Outpatient providers might provision housing for clients whom they deem to have a need for standards-compliant, recovery residence services? Provided this channel is not abused as a marketing ploy or “closing” technique, all stakeholders benefit, including consumers, their families and the healthcare insurer. There exists a growing body of evidence to support the assertion that when clinical outpatient services and recovery-oriented housing services are delivered as a bundled offering, consumer outcomes are significantly enhanced. Family members frequently cover the costs associated with residency in certified recovery housing while their loved one is independently enrolled in a nearby IOP. In both of these scenarios, it is not the resident themselves who has assumed responsibility for their housing expense. While financial responsibility for housing will likely become a future goal of the resident’s recovery plan, there are many circumstances under which both clinical and peer professionals agree it is preferential to provide housing support to persons in early recovery. This was true in my own case. I
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FARR anxiously awaits submission of a proposal from a recovery residence, supported by an intensive outpatient provider, which successfully navigates these issues for the benefit of all stakeholders. The FARR Board remains highly supportive of a consumer-centric model that effectively documents provider intent to support the resident’s recovery as opposed to an intent to drive higher clinical enrollments. The effective blending of clinical behavioral healthcare services with standards-based, recovery-oriented housing offers a bright future for so many who seek freedom from the bondage of addiction. Florida is uniquely positioned to assume the leadership role in crafting an ethical relationship between these two distinct service modalities. The Department’s selection of FARR as the credentialing entity for voluntary certification of recovery residences positions us to work collaboratively with our state behavioral healthcare licensure authority. The time to fix this is now. The stakes are high and the willingness to drill down into this complex issue in a straightforward, open-minded and transparent manner appears to have emerged at long last. Please consider this article an open call for submission of well-crafted, written proposals. FARR is not a regulatory body and we do not seek to prescribe “the correct approach”. Instead, we seek mindful, constructive input from service provider groups to help guide our position as it regards these matters.
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THE ADDICTION RECOVERY NETWORK FOUNDATION CELEBRITY GOLF OUTING
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2
The Addiction Recovery Network Foundation held a 2 day celebrity filled golf outing November 15th and 16th. The event was held to celebrate Thomas “Hollywood” Henderson’s 32 years of sobriety. The goal of the event was to raise scholarships for 32 people seeking treatment. Adam Weil, founder of The ARN Foundation states, “I am honored to be celebrating Thomas’ 32 years of sobriety. He is a remarkable man who has made it his mission to help others suffering from this horrible disease. Thomas echoes the Foundation’s views on ensuring that treatment centers are providing quality, personalized care, with measurable outcomes. The celebration started with a VIP reception at the PGA National Resort and Spa. The silent auction included items from the likes of Michael Jordan, Charles Barkly, Lawrence Taylor, and Yoenis Cespedes. The highlight of the night was a special performance by Scott Stapp, the lead singer of Creed. The following day was a golf outing at Trump National Golf Course with a celebrity filled lineup of hall of fame athletes through to Former Vice Chairman of the Joint Chief of Staff, Admiral Winnefeld. For the first event, this was a major success, raising over $140,000. Be on the lookout for next year’s event which is expected to be a sober street festival and concert next year in Delray Beach! The Addiction Recovery Network Foundation is a non- profit 501c3 dedicated to improving recovery services for individuals suffering from addiction. The foundation recognizes that the “right” treatment works, and successful recovery from alcoholism and substance addiction must include four core components: Health, Family, Purpose, and Community. The Foundation works with those who have committed to a new life of recovery. The focus is primarily on post treatment, helping those in recovery get assimilated back into their family, workforce and community. The Foundation also assists with education, resources, and job placement.
3 1) Adam and Dawn Weil 2) Scott Stapp - Creed 3) Patricia ( Publisher, The Sober World) with Thomas Henderson
Celebrity Golfers included (right to left) Ed Too Tall Jones, Woody Bennett, Keith Byers, Yoenis Cespedes, Don Wright, Ron Harper, Charles Oakley, Beasley Reese, Thomas Henderson, Hugh Green, Michael Godman, Mark Duper
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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS: DEA FLOODING AMERICA’S STREETS WITH NARCOTICS WHILE CONGRESS GIVES TACIT APPROVAL By John J. Giordano, DHL, MAC
The Best Drug Policy Money Can Buy Pharmaceutical Research and Manufacturers of America (PhRMA, a/k/a Big Pharma) ranks sixth among the nation’s top lobbying spenders. According to the Tampa Bay Times, ‘PhRMA employs more lobbyists in Washington than there are members of Congress.’ In 2014, drug companies and their lobbying groups spent $229 million influencing lawmakers, legislation and politicians. A report published by Center for Responsive Politics (CRP), showed pharmaceutical and health product companies injected $51 million into the 2012 federal elections. The industry has already spent nearly $10 million on the 2016 elections and is expected to spend far more. Congress Turns a blind Eye In May 2012, U.S. Sen. Chuck Grassley (R-IA) initiated a GAO investigation into the DEA’s production limits on prescription drugs that contain controlled substance. Grassley, Chairman of U.S. Senate Caucus on International Narcotics Control, held a hearing on May 5, 2015 regarding the results of the study. In his opening statement the Chairman berated the DEA for what he claimed as, “Shortages of prescription drugs that contain controlled substances have increased sharply over the past decade.” He went on to claim that, “According to the Food and Drug Administration, these shortages can pose a significant threat to public health”. This is an astonishing statement coming from the Chairman of U.S. Senate Caucus on International Narcotics Control. With all due respect, it appears as though Senator Grassley is completely oblivious to the facts, especially when it comes to public health. According to the most current data available from the Centers for Disease Control and Prevention (CDC), more than half (1.4 million) of all emergency room visits in 2011 were related to prescription drugs, in 2013, 16,235 Americans died because of pharmaceutical opiate/opioid painkillers, and 6,973 deaths involved benzodiazepines. Since 1999, the amount of prescription painkillers prescribed and sold in the U.S. has nearly quadrupled (272%) to nearly 207 million in 2013; yet the CDC reports that there has not been an overall change in the amount of pain that Americans report in the same time frame. Surely Senator Grassley has access to these facts. In the May 24, 2011 testimony to the Senate Judiciary Committee, of which Senator Grassley was a member, and in response to the prescription drug epidemic: strategies for reducing abuse, misuse, diversion, and fraud: “The treatment of chronic pain, therapeutic opioid use and abuse, and the nonmedical use of prescription drugs have been topics of intense focus and debate. Due in some measure to the campaign of alleged under-treatment of pain, Americans, constituting only 4.6% of the world’s population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world’s illegal drugs.” In spite of this compelling evidence, the Chairman of U.S. Senate Caucus on International Narcotics Control, Senator Grassley believes there are not enough opiate/opioid painkillers being produced. The facts simply don’t fit in with Senator Grassley’s narrative. There was this in December 2003 from The Government Accounting Office (GAO), “In early 2000, reports began to surface about abuse and diversion for illicit use of OxyContin, which contains the opioid oxycodone. What GAO Found: Purdue conducted an extensive campaign to market and promote OxyContin using an expanded sales force to encourage physicians, including primary care specialists, to prescribe
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Continued from page 10
OxyContin not only for cancer pain but also as an initial opioid treatment for moderate-to-severe non-cancer pain.” Production of Pharmaceutical Opiate/Opioid Painkillers Have Skyrocketed Many drug policy experts believe OxyContin is a driving force in America’s second opiate/opioid epidemic. It’s impossible to deny its upward trend in production parallels that of overdose deaths. According to the Federal Register, the 2014 production quota for Oxycodone, the active ingredient in OxyContin, was 164.66 tons or 31.19 times more than 1995 (5.28 tons) when OxyContin was first rolled-out. As John Temple, author of the popular newly released book ‘American Pain’ puts it, “it’s the equivalent of turning two Buicks into four Boeing 737s.” This begs the rhetorical question, “are Americans really in 31 time more pain today than they were just 20 years ago – what could have possibly gone so wrong?!” Perhaps Gene Haislip left us a clue. In one of his last interviews before he passed in 2012, Haislip had this to say, “For a DEA official to put his or her neck on the line to block a company’s requested quota increase takes an awful lot of guts and a lot of hard work, particularly if that company is supporting members of Congress who have the power to block the agency’s funding.” To effectively end America’s second opiate/opioid epidemic we must first shut-off the spigot flooding our streets with deadly narcotics. It’s long past the time and well within public health interests for the DEA to reduce the production quotas for these deadly narcotics. Second we must end the pharmaceutical industry’s incessant massive campaigns to convince doctors that deadly and highly addictive narcotics are safe to prescribe and should be used as a first resort for patients with chronic pain. John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: www.holisticaddictioninfo.com
HEROIN EPIDEMIC IN AMERICA By Steven Kassels, M.D.
Continued from page 34
essential to attack this scourge to society by decreasing demand through treatment and education. We need more doctors willing to treat patients and also to be more involved in educating our citizens and public officials that treatment works. Our medical schools and residency programs need to do more. I hope my participation will further encourage these goals. I appreciate the opportunity to contribute to such an important advocacy magazine. Dr. Kassels has been Board Certified in both Addiction Medicine and Emergency Medicine. He serves as the Medical Director of Community Substance Abuse Centers. He is the author of “Addiction on Trial”, written as a murder mystery/legal thriller to reach and educate a wide range of readers. The book has recently been entered into medical school curriculum to help decrease physician bias. The book is available at: Amazon (www.amazon. com/Addiction-Trial-Tragedy-Downeast-Maine/dp/1491825316) and free author book club presentations and educational meetings (in person or using Skype) can be arranged at: www.addictionontrial.com/author-events/
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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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SPIRITUAL CHOICES: SPIRITUAL GROWTH THERAPY ™ FOR THE TREATMENT OF TRAUMA AND ADDICTION By Paul D. Alleva, MSW
brain based disease and not a behavioral disorder, meaning the causes of addiction, the behaviors associated with the addiction (sex, gambling, etc.) are an underlying result of the addiction disorder in the brain. The SGT therapist utilizes a skill set called Decompression to initiate and solidify new neural pathways in the brain which helps the patient to change the neural connectivity associated with addiction and addictive behaviors in order to redefine the concept of choice when faced with situations where normally the addicted person would view the circumstance as a reason for relapse or for the use of drugs and alcohol. They say that practice makes perfect and that perfect practice makes perfect results, the first step towards recovery is admitting there is a problem and then doing something about it. I tell my patients all the time that if they want to change they actually have to change everything there is about themselves; they have to redefine their identity and move towards a place in their hearts where purpose and passion live and breathe freely, so ultimately it becomes much more important to them than drugs and alcohol and there is no longer a choice. Their drive towards purpose supersedes the need for drugs and alcohol. However, first they have to get to the point in their lives where purpose and passion drive their choices, and self-love or self-preservation overrides the need to defile the self .Patients need time to reset neural pathways; this is why traditional thirty day programs have been a failure of biblical proportions. SGT redefines, defines, and redefines again the addict’s behaviors, causes of behaviors, and emotions that drive those behaviors on an everyday basis while receiving treatment in a safe environment. This time is spent in self-reflection where the SGT therapist utilizes the art of reframing to substantiate a positive response from a self-defeating thought process. The goal of the therapist is to guide the client to redefine themselves, their experiences and their present and future responses into a positive outcome and redefined behavior system, where, in time, the client is able to perform these tasks on their own through simple exercises utilized under SGT. The constant reframing, decompression, and again reframing while in a safe and caring environment are what drive behavior changes by creating new neural pathways. The attending result is the normal addictive response becomes a faded echo as the redefined neural pathway is heard loud and clear in real time. My suggestion is a minimum of sixty days in a safe environment with a gradual step down (recovery residences etc.) into society while maintaining contact with practitioners, recovery coaches and those who are all on the same page with the patient’s use of practices learned during the sixty days of treatment. SGT and the Treatment of Trauma/PTSD SGT views trauma/PTSD through the lens of a philosophical point of view of a karmic reaction that the soul has called in to overcome, conquer and spring board into a spiritual purpose. A person who has experienced a traumatic event, either be it a rape, combat threatening for soldiers, fear of death, or moral injury associated with leading a substance abuse lifestyle, becomes overwhelmed with the emotional content of the associated trauma, either by blocking out the traumatic experience and suppressing the emotional content of it, or being consumed with the emotion to the point where the emotion drives every action associated with pushing or blocking the emotion from the forefront of the brain. Having such overwhelming emotion blocks the brain from creating and forging new choices and relationships in the brain and fogs the brain from making new or better choices. This emotion is like poison to the body and the mind, often leading the patient to drown themselves in alcohol, drugs or other selfdefeating behaviors like self-injury or promiscuity; the goal being to defile and hurt the self. Keep in mind that the dominant word
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behind Post Traumatic Stress Disorder is STRESS. The stress the patient is experiencing is the blocked or stuck neural pathway formed during the traumatic event. In other words, the patient is locked in an endless cycle where the brain is convinced the traumatic event continues even until this day; however, the event is NOT happening and the brain seeks relief from the symptoms (i.e. drugs and alcohol) through learned behaviors. In a study performed by Segerstrom and Miller (2004) the experience of chronic stress was associated with suppression of cellular activity leading to compromised immune systems. The chronic emotional content associated with the traumatic event is like poison to the body. Traumatic events become stuck in the brain, disconnected from the processing of the event which is what allows the event to be stored into the subconscious mind as a lesson learned and to not be repeated. This process of ‘getting stuck’ often leads to self-deception where the brain is tricked into believing the event still continues to this day and the mind then reacts to triggers associated with the event, including emotions such as stress, anger, or fear that the body has used self-defeating behaviors as a means of coping with these emotions. But stress, anger and fear are normal emotions and are difficult, if not impossible to avoid. Life is a roller coaster ride with its severe ups and downs, twists and turns; the odds of experiencing such emotions are extremely high if not definite. The way SGT treats trauma is through practices associated with cleansing the energy body, or cellular activity while allowing the brain to process the experience(s) utilizing a host of techniques including hypnosis, bilateral stimulation and language. The SGT therapist is responsible for teaching and guiding the client through these processes reframing past events in a spiritual sense with an ultimate purpose of defining meaning to the events and choices of where and what the client wishes the outcome of these experiences to be; simply, redefining the process through spiritual means. The use of colors, scenes, spirit animals and symbols are utilized to convey the desired positive outcome for the patient. As with any required change, the patient is expected to practice therapeutic and spiritual techniques on their own to obtain the desired result as a self-healer with a strong positive purpose. Cleansing the negative emotion allows the body and mind to think clearly; thinking clearly allows the mind to process real time experiences logically and rationally without the strong emotional content associated with these events, therefore allowing the ability to make better choices. SGT for trauma is a six week program of study and therapeutic intervention that leads to the desired outcome of processing newly learned positive coping skills that can and should be practiced daily as a way of changing past behaviors and negative thought processes; the desired outcome being self-love and selfpreservation. Spiritual Growth Therapy™ is a collaboration between practitioner and patient that is not the therapist doing all the work and merely telling or dictating to the client what they want, need or have; but an alliance that dictates the patient will do the work necessary to change and the practitioner will guide the client through struggles and emotions as they arise to put into a positive context the experiences of the past, present, and future. References Provided Upon Request Paul D. Alleva is the founding owner of Lifescape Solutions and Evolve Mental Health which he opened in December of 2011, based on a new model of healing and psychotherapy called Spiritual Growth Therapy. His newest book Let Your Soul Evolve: Spiritual Growth for the New Millennium 2nd edition describes the model.
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ADDICTION, RECOVERY AND A PATH TO PREVENTION: STEMMING THE TIDE ON YOUTH SUBSTANCE USE By Stephen Gray Wallace, M.S. Ed.
8 graders, 23.5 percent of 10 graders, and 37.4 percent of 12 graders noted past-month use of alcohol. In terms of binge, or highrisk, drinking nearly 20 percent of seniors (19.4 percent) reported engaging in that behavior in 2014. th
th
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With marijuana use, there are also many reasons for concern. MTF notes “past month” use of marijuana among 6.5 percent of 8th graders, 16.6 percent of 10th graders and 21.2 of 12th graders. Perhaps more concerning, 6 percent of 12th graders reported using marijuana every day and a whopping 81 percent said that it is easy to get. While some young people and some adults may view alcohol and marijuana use among adolescents as “no big deal,” the truth is that both can be gateways to other, potentially more lethal drugs. Or they may become the addictions themselves. Indeed, according to a 2014 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol and marijuana accounted for the top two categories of treatment for those ages 12 and older during the past year. For his part, Ken, also a co-author of the Camping Magazine article, spoke of his alcohol addiction: “It was an experience of being divided against myself and distracted by feelings of inadequacy, resentment and despair. I felt alienated from others and overwhelmingly tired.” After he quit drinking, Ken said, he made amends to the people he had hurt and learned to deal with his feelings of fear, resentment and shame. He also revealed that with his recovery came a desire to connect to, love and be useful to others. Ken is now an ordained minister, and his congregation hosts addiction and recovery expos for those in or seeking recovery. Not everyone is so successful. Rates of illicit drug use are epidemic. So, too, is addiction. But what is driving young people into drug use in the first place? According to NIDA, the reasons include a desire to fit in, to feel good, to feel better, to do better and to experiment. No surprises there. Some good news for teens can also be found in the NIDA guide. It states, “Adolescents can benefit from a drug abuse intervention even
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if they are not addicted to a drug. Substance use disorders range from problematic use to addiction and can be treated successfully at any stage, and at any age. For young people, any drug use (even if it seems like only ‘experimentation’) is cause for concern, as it exposes them to dangers from the drug and associated risky behaviors and may lead to more drug use in the future. Parents and other adults should monitor young people and not underestimate the significance of what may appear as isolated instances of drug taking.” What does that intervention look like? According to NIDA, it can take many forms, including partial hospitalization, behavioral approaches, cognitive-behavioral therapy, motivational enhancement therapy and family-based work. Regardless of the mode of treatment, it is important to note that addiction can, in fact, end in sustained recovery – as we saw with Michael and Ken – which, on its own, lights a pathway to prevention. References provided upon Request Stephen Gray Wallace is President and Director of the Center for Adolescent Research and Education (CARE), a national collaborative of institutions and organizations committed to increasing positive youth outcomes and reducing negative risk behaviors. He has broad experience as a school psychologist and adolescent/family counselor and serves as senior advisor to SADD, director of counseling and counselor training at Cape Cod Sea Camps, a member of the professional development faculty at the American Academy of Family Physicians and American Camp Association, an expert partner at RANE (Risk Assistance Network & Exchange) and a parenting expert at kidsinthehouse.com and NBCUniversal’s parenttoolkit.com. He is also the author of the critically acclaimed book Reality Gap: Alcohol, Drugs and Sex – What Parents Don’t Know and Teens Aren’t Telling. For more information about Stephen’s work, please visit StephenGrayWallace.com. © Summit Communications Management Corporation 2015 All Rights Reserved.
CHANGING OUR GENES By Kevin Wandler, MD
behaviors, especially among children and teens who unfortunately develop eating disorders. Media messages about girls/women commonly emphasize the value of being young and beautiful — and especially, thin. Girls have been misrepresented in traditional media and with the impossibly unrealistic body proportions of Barbie. Male action figures that young boys tend to play with are even more unrealistic with dimensions exceeding those of the biggest bodybuilders. Another survey by the Today Show and AOL.com (2014) found that eighty percent of teen girls compare themselves to images they see of celebrities, and, within that group, almost half say the images make them feel dissatisfied with the way they look. Based on current research, we can only conclude that traditional media puts young adults at risk for developing an unhealthy body image, especially with genetic risk factors for low self-esteem, perfectionism, and anxiety. Just as we see in early substance abuse, starving, bingeing, purging and dieting can also lead to epigenetic changes that strongly reward individuals while they are engaging in such behaviors. Parents are critical to children’s healthy development. By limiting exposure to media to much less than nine hours a day, there
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is time for your child to complete homework and learn positive family messages. Parents must model a drug free lifestyle, i.e. not smoking, drinking or drugging. Families must discuss body image issues and monitor social media accounts. When young people start talking about dieting, parents must discuss what the meaning behind that is and the affects that it can have. Finally, always avoid fat talk, i.e. discussing how others look, and avoid the use of negative descriptors about others, especially in the family. Once the brain gets hijacked, the road to recovery can often be long and tumultuous. Kevin Wandler, MD, is the Chief Medical Officer of Advanced Recovery Systems. He is Board Certified in General Psychiatry with added Qualifications in Addiction Psychiatry by the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association. He is certified by the American Society of Addiction Medicine. He is the President of the Board of Directors of iaedp (2015-16)--The International Association of Eating Disorder Professionals. Dr. Wandler has been working in the Substance Abuse field for over 30 years and started his Eating Disorder career in 1995.
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“I DON’T’ KNOW”—THE THREE MOST COMMON WORDS SPOKEN IN THERAPY© By Clifton Mitchell, Ph.D.
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paralanguage. Then, assess and cultivate the empathic response you would ideally deliver had the client responded with IDK and say that in place of your question. From there you move the dialogue forward from your empathic response. There is no need to hide your struggle to adjust your response style. Your open display of your efforts to shift the dialogue style sends a signal to the client’s unconscious that you are working hard to move into a position of understanding and away from a position of opposition. I am convinced that clients appreciate experiencing your efforts to adjust and respond in an understanding manner. This particular technique is highly successful when practiced.
does not place the therapeutic tension between you and the client and it creates an environment where ideas are more readily expressed.
Another approach to eliciting answers after an IDK response has been given is to figuratively bring a third person into the room and ascertain what he/she may say regarding the unknown information. One way to do this is to inquire if the client has friends who are familiar with his or her situation. Many times clients do have such friends and these friends have opinions and may offer insights. If this is the case, you simply ask what the client hears his or her friends saying in response to your question. This technique often results in the client providing insights that he or she may feel reluctant to present were it coming directly from his or herself. Obviously, the use of this technique is predicated on what you know about clients, their situation, and their friends. Be aware that the friends’ responses may not be useful or worthy. A discussion of benefits and drawbacks may be needed.
I have spent many hours contemplating this linguistic creature. I now realize that when a human being says “I don’t know”, he/she is in one of the most human of all experiences. When you think about it, much of life is spent in a state of “not knowing.” As therapists, we must not allow ourselves to fall into the trap of conceptualizing one of most natural states of living as resistance.
By eliciting the response of a third party who is not present, any opposition can be framed as being against him/her and not the therapist. Thus, the therapeutic tension is between the client and an imaginary person in the room. The advantage of this approach is that it
ADV E RT I S I N G
The more I study the IDK response the more I am convinced that when it is fully understood, it will not be perceived as resistance. Rather, it is simply a reflection of the confusion and internal struggles the client is experiencing. In this sense, the IDK response should be thought of as a doorway into the very place the therapeutic conversation needs to move in order to be effective. Many foundational struggles clients face can be discovered by slowing the pace and discovering the meaning behind IDK responses.
Reference Provided Upon Request Clifton Mitchell, Ph.D., is an international clinical trainer, keynote speaker, and the author of Effective Techniques for Dealing with Highly Resistant Clients. For the past 15 years he has trained thousands of mental health professionals on methods of managing resistance in therapy. He also created The Legal and Ethical Game Show Challenge, the only legal and ethical training utilizing a game show format. He is currently an Emeritus Professor in counseling at East Tennessee State University where he received the teacher of the year award in 2002. cliftmitch@comcast.net www.cliftonmitchell.com.
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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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