Jan18 issue

JA N UA RY 2 018 | VO LUM E 7 | I SS U E 1

I N M E MO RY O F S T E V E N

A N AW A R D W I N N I N G N A T I O N A L M A G A Z I N E

DETHRONING THE REIGN OF OPIATES IN CHRONIC PAIN RECOVERY By Dr. James Flowers, Ph.D., LPC-S and Angela Harris, BS, MSW Candidate

A NEW YEAR, A NEW YOU

By Michael DeLeon

OUR EVOLVED UNIQUE “FEEL GOOD” CIRCUITS MAKES HUMANS DIFFERENT FROM APES

By Kenneth Blum, Ph.D., Edward J. Modestino, Ph.D., and Mark S. Gold, M.D.

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www.thesoberworld.com

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 as well as distributing to schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more .We directly mail to treatment centers, parent groups and different initiatives 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.

If you are experiencing any of the above, this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin.

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

There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under the age of 18 yrs. old) and bring them to the facility you have To Advertise, Call 561-910-1943

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 New Year.

We are on Face Book at www.facebook.com/pages/TheSober- 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.

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DIALECTICAL BEHAVIOR THERAPY IN RECOVERY

By Adam Friedman, Ph.D. and Adriane Schmitt, LMHC

Have you ever used your drug of choice (or been tempted to) because of overwhelming emotions or thoughts that were stuck in your mind - beating yourself up about things you did during your addiction or worries about the future? Have you experienced difficulties setting or maintaining boundaries in your relationships? Have you ever suffered a relapse because of unexpected setbacks (the loss of a friend, losing a job, illness)? Do you tend to make bad situations worse through your actions? If you answered yes to any of these questions, Dialectical Behavior Therapy (DBT) can help you greatly.

DBT was created by Dr Marsha Linehan in the 1980’s and was designed to help people better handle their emotions, thoughts, and relationships, in order to live a healthier and more fulfilling life. Dr Linehans research throughout the years has shown that DBT helps people understand and change the unhealthy coping behaviors that they use to deal with “the steam in the pipe”, the underlying problems that create the urge to use these behaviors (drug use, gambling, eating disorders, etc.). DBT replaces these behaviors with a set of specific and easily followed skills designed to handle the “steam” in a healthy way and to decrease our self-inflicted suffering.

The “dialectic” part of dialectical behavior therapy helps people dealing with addiction learn how to identify and correct their “all or nothing” thinking. Dialectical thinking is the understanding that two things that may seem opposite can be true at the same time. The example we use at drug and alcohol rehabs where we work is that while it is hard to be at the facility (leaving family, jobs, children, and working on sobriety), clients are also very fortunate to have the opportunity to come to treatment. Looking at things from a dialectical point of view helps us to get away from the one-sided thinking that can lead to the intense and overwhelming emotions which can lead to relapse and to understand that there is more than one way to view their circumstances.

DBT is divided into four modules, each with specific goals and skills. The first module is mindfulness. Mindfulness is the core of DBT and helps clients dealing with addiction learn how to handle the difficult emotions and thoughts that may have led to using their drug of choice in the past. Clients are taught step by step how to use an “anchor”, a thought or sensation used to help them control their attention when they are feeling overwhelmed.

Like all the skills in DBT, mindfulness, or the awareness of our thoughts and feelings, can create the difference between a difficult day and a relapse.

The second module is interpersonal effectiveness. This module deals with our relationships and creating healthy boundaries. In active addiction, people tend to be excellent at getting what they want but usually accomplish this through manipulation, lying, playing the victim, and any other means necessary. This tends to ruin relationships and hurt self- esteem. The skills of the interpersonal effectiveness module help clients learn different and better ways to ask for what they want, while maintaining the relationship and their self- esteem.

The third module is emotion regulation. In this module, clients learn to become aware of the little things that happen internally and externally when they are in an unhealthy place emotionally, or craving their drug of choice. This understanding is critical to stopping the cycle of using before the client gets to their “point of no return” The fourth module is distress tolerance, which is essentially DBT’s version of relapse prevention. In this module the client learns to plan for the unexpected. They create an “emergency exit plan”, a list of many things they can do to distract themselves when something upsetting happens out of the blue. The plan can

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range from using DBT skills learned in the past to reaching out to friends or family, or using activities to keep themselves from making a bad situation worse.

Clients find that DBT is a great component to add to their program of sobriety and goes hand in hand with 12 step programs. The most common feedback we get is that the skills are easy to use once they are taught and are very “common sense”. Clients often say that they wish DBT had been taught in grade school and if they had learned these skills at a younger age, they may have been able to avoid the pitfalls of addiction that they have suffered. Many clients go on to seek DBT skills groups and therapists in their hometowns once they leave in-patient treatment, and often get their families involved in learning the skills they have been taught. The responses we hear to DBT remind us that recovery isn’t simply about not using your drug of choice, but about creating a life worth living.

Adriane and I have been running skills groups specifically for the addiction community for over 5 years and the response we have received has been both humbling and rewarding.

Dr. Adam Friedman currently co-directs the Dialectical Behavior Therapy programs throughout Florida. He has had the privilege of being trained by DBT founder, Dr. Marsha Linehan. He attended Nova Southeastern University, where he received his Doctor of Philosophy (Ph.D.) in Psychology.

Dr. Friedman completed his doctoral dissertation on Anorexia Nervosa and self-mutilation. His work has been published in psychoanalytic journals and he has written a chapter on the analysis of dreams that has been published as part of a book. He is featured in HBO’s awardwinning documentary on eating disorder treatment, entitled, “Thin.” He has a private practice in Boca Raton, FL, but spends most of his time teaching, developing and supervising DBT programming both in the US and the United Kingdom.

Adriane Schmitt received her Masters of Science degree from Nova Southeastern University in Mental Health Counseling. She is an experienced psychotherapist with specific expertise in substance abuse, eating disorders, and dual diagnosis cases.

Ms. Schmitt has had the privilege of being trained under Dr. Marsha Linehan. She has an extensive background in facilitating Relapse Prevention Programs in other addiction programs, and has worked closely with families.

Adriane and Adam will be leading two 10 week DBT courses specifically for addiction in Boca Raton starting on Mondays from 2-4 beginning March 26th and Tuesday’s 6-8 beginning March 27th.

Call 561-699-3915 today for details.

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7

NEW ENERGY FOR BETTER RECOVERY OUTCOMES IN THE NEW YEAR

By John Giordano, Doctor of Humane Letters, MAC, CAP

Happy New Year! I hope everyone enjoyed their holidays as much as I did. The holidays are such a special time of the year; they seem to elevate nearly everyone’s mood and energy level. That is of course for everyone except for those who have a substance abuse disorder. For them the holidays are depressing and draining.

I can’t help but to wonder if all of this energy and mood shifting would occur if people were more aware of Mitochondria and how important it is to our health, especially someone in recovery.

Mitochondrion is our body’s biological powerhouse. They are found in multiple numbers in every cell in our body. It is our everything.

Mitochondria gives us the energy to move, breathe, pump our hearts, move blood through our veins, digest food, keep our brains functioning, and generally live life. Without it, we’d most likely cease to exist.

Here is a simplified version of how this process works. NAD (Nicotinamide adenine dinucleotide) is a metabolic coenzyme found in every cell, every organ and every tissue – and they need constant replenishment. It is an activated form of vitamin B3. When NAD is bound with hydrogen, it becomes NADH. NAD is also the carrier for reactive hydrogen as it becomes NADH. Once the NAD becomes ‘loaded with hydrogen (NADH) it enters the electron transport chain in the mitochondria. Down the line it is exposed to oxygen and as a result generates energy or, ATP (adenosine triphosphate), along with water. This is the energy source that powers the cells metabolic activities within the 100 trillion cells in our bodies. When NAD is compromised, serious disease can, and often does, ensue.

I know the process is a bit difficult to grasp. Regardless if you get it our not, it is imperative that you understand just how important mitochondria is to your overall health, especially, if you suffer from substance abuse disorder.

The chemicals necessary to produce NADH comes in trace amounts from the vitamins, minerals, complex carbohydrates, fats and proteins that we eat. Many of these essential components are lost through food processing and cooking. Energy production is diminished when any of these nutrients are low. Moreover, the enzymes needed to complete the energy producing process in the mitochondria are often inhibited or destroyed by chemical or physical toxins – such as opioids and other narcotic drugs – that create oxidative, or free radical damage. The primary site of free radical damage is on mitochondrial DNA (mDNA).

Low NADH can have a negative effect on their function and also trigger fatigue, depression, anxiety, sleep disorders and mood changes – all of these characteristics are commonly exhibited in addicts. Fatigue is often the first sign of NAD deprivation.

In over thirty years of treating addicts, I’ve seen literally thousands of people fresh out of detox. With only a handful of exceptions, they all showed signs of low energy and fatigue. Could impaired Mitochondria as a result of addiction to toxic illicit and pharmaceutical drugs be influencing these conditions? Absolutely.

I’m sure it comes as no surprise to anyone that addiction wreaks havoc on the body and the brain causing both long and short term detriment. Its damaging effects on Mitochondria are no exception. Studies published on the National Institutes of Health (NIH) website indicate that opiate addiction has been associated with mitochondrial abnormalities – none of which are good. In fact, in another study also published on the NIH site found that some addictive drugs alter mitochondrial and nuclear gene expression.

There is also another genetic component at play here.

Mitochondrial DNA is all received from the mother through the egg (no mitochondria are found in sperm). Therefore, genetic and chronic NAD Energy Deficiency (NED) is transferred from mother to child and is already present at the moment of conception. I’ve seen estimates as high as 10% of people suffer from an irreversible chronic NED. These people could never eat enough to elevate their

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NAD to normal levels.

NAD also plays a vitally important role in the addicted brain.

Studies have shown that it synthesizes dopamine (DA) as well as other neurotransmitters closely associated with addiction.

This is significant. Dopamine has a lot of responsibilities including being the primary neurotransmitter of reward and pleasure. It communicates calm and wellness to the rest of the brain. In April of 1990, Dr. Kenneth Blum and Ernest Noble, M.D., Ph.D. made global headlines with their seminal discovery of the ‘addiction gene’ published in the Journal of American Medical Association (JAMA).

What they found was that the dopamine receptor D2-A1 allele (DRD2-A1) had up to 40% fewer receptors.

This single discovery forever changed the way we view and treat addiction. What Doctors Blum and Noble found was that people with the DRD2-A1 genotype were not getting the complete ‘calm and wellness’ message leaving them feeling uneasy. Consequently, these people often seek out external stimuli such as drugs, alcohol, sex, gambling, gaming, sugary foods and other risky behavior that can elevate their dopamine function. NAD stimulates production of dopamine and serotonin, thereby improving brain function in addicts.

Is there a place for NAD in addiction recovery? From my own personal experiences, I’d say without a doubt. At my facility we use a product called SynaptaGenX™ that has been developed and formulized by Dr. Blum. SynaptaGenX™ has NADH in it. I take it daily and can tell you first hand I have more energy and better cognition. My clients tell me it eases their cravings.

By most standards Mitochondria and NAD are relatively new discoveries. It was Richard Altmann, a German cell and structure researcher, who discovered mitochondria in 1890 and Karl Benda, a German physician, who later gave them the name mitochondria.

It was not until the mid-1950s when a new approach to research was developed that the modern understanding of mitochondrial function was realized. NAD was discovered in 1906 by the British biochemists Arthur Harden and William John Young.

More recently, Mitochondria and NAD have been making headlines for their ‘anti-aging’ properties. David A. Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School, and his colleagues have seen great success in their studies and testing of Mitochondria’s influence on reversing aging.

Scan the Internet and you’ll find a plethora of information on Mitochondria and NAD. What is difficult to find is hard science on their effects on the addicted brain. There are a lot of things being said these days by a lot of people touting the benefits of healthy Mitochondria. However, there seems to be more information in advertisements and marketing materials than in peer reviewed scientific and medical journals. I’m not suggesting that the claims are untrue, but rather unsubstantiated by scientific tests Continued on page 30

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9

A NEW HOPE FOR DEPRESSION - PART 1 OF 2

By Raul J. Rodriguez MD, DABPN

Treatment resistant depression is one of the most crippling and emotionally devastating conditions known to man. The loss of hope in ever recovering from a disease that does not respond to conventional treatment and has hopelessness as one of its symptoms can lead to a deadly downward spiral. Many good medications have been developed to treat Major Depression over the years, but sometimes the disease can be too severe and the medicine does not work. Some intensive treatments, such as ECT (Electroconvulsive Therapy), are very effective but have severe side effects. This leaves many patients seeking a better solution. This dire need for a better solution led to the development of TMS. So what exactly is TMS? TMS is the acronym for Transcranial Magnetic Stimulation, which is a cutting edge treatment for depression that involves stimulation of brain tissue using electromagnetic pulses. This non-invasive procedure improves symptoms of depression by activating the parts of the brain associated with mood control and depression. TMS has grown in popularity due to the high degree of effectiveness while having very few side effects and absolutely no circulation of medication in the bloodstream. The process starts with the placement of an electromagnetic coil over the scalp near the forehead. The motor strip, the area of the brain responsible for movement of limbs and muscles, is then mapped out. This is necessary in order to subsequently determine the location of the lateral pre-frontal cortex. The actual procedure involves delivering a sequence of magnetic pulses to the left lateral pre-frontal cortex to induce stimulation. The magnetic pulses pass through the scalp and the skull to reach the target brain tissue. TMS activates the actual neurons by inducing an electrical current in the part of the brain cell called the axon. This current travels to the nerve cell body and then affects other connecting brain cells.

This stimulation ultimately creates the powerful antidepressant effect. TMS is indicated when conventional treatments for Major Depression have not worked. TMS is also an option for individuals who suffer from Major Depression and do not wish to take medications. TMS was approved by the FDA for the indication of treatment resistant depression in 2008. Deep TMS, possible with the newer generation of TMS technology, was approved by the FDA for the indication of treatment resistant depression in 2013.

Deep TMS, also known as dTMS, refers to a more deeply penetrating form of TMS now possible, using the newer generation of TMS technology produced by the Brainsway Corporation. Brainsway has engineered the H1 dTMS coil that was approved by the FDA for the indication of Treatment Resistant Depression. The H1 coil produces a magnetic pulse that stimulates a larger area than a traditional figure 8 coil. The stimulation also penetrates deeper, reaching 1.7cm into the cortex. The benefits of this have to do with both a more complete stimulation of the target area, as well as some stimulation of the neighboring areas of the brain that interconnect with the target area. The risk of dramatically losing efficacy from deviating even just 1mm from the target area is greatly diminished using a Brainsway device, as compared to a traditional figure 8 coil, due to the larger and deeper area of stimulation. The treatment session consists of up to 2,500 pulses delivered over a time span of approximately 20 minutes.

This all helps yield higher rates of both response and remission of Treatment Resistant Depression.

So we have seen what TMS can do as far as having very high response and remission rates in severe grades of depression.

What is TMS like though? The very first step is proper screening and evaluation. TMS has an FDA indication for Treatment Resistant Depression, although many practitioners have

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reported even better results in the non-resistant grades of Major Depression. Individuals do have the option of receiving TMS for a non-resistant grade of Major Depression, as an off-label usage of this medical technology. Insurances will only cover the FDA indication for Treatment Resistant Depression though.

Treatment Resistant Depression is most commonly defined as a Major Depressive condition that has not responded to at least four different antidepressants, including medications from more than one antidepressant category. Appropriate candidates would also have not responded to one or more “augmentation” strategies, which is when a secondary medication is added to boost the effect of the primary medication. Appropriate candidates commonly also would have failed a course of psychotherapy. Some may have also even failed ECT. A medication “failure” is defined as not achieving an adequate response after reaching the maximum dose for at least 4 to 6 weeks, or not being able to tolerate the medication at any point in the dosing range. A “response” is most commonly defined as a 50% reduction in symptom intensity based on depression rating scales. Most people will appropriately determine a medication non-response by simply recalling that it did not make them feel much better. An antidepressant that once worked but at some point stopped working, would also constitute a failure. Others, again, simply could not tolerate a medication due to side effects.

Some cannot tolerate a medication at all, at any dose. Some cannot tolerate a medication at the dose that it would take to get it to work. Either way, it is considered a medication failure.

After a patient has been determined to have actual Treatment Resistant Depression, the next step is to make sure there are no medical conditions that are TMS exclusions.

Please read part 2 in the February 2018 issue of The Sober World.

Dr Rodriguez is the founder and Medical Director of the Delray Center For Healing, the Delray Center for Brain Science, and the Delray Center For Addiction Medicine. He is board certified in both Adult Psychiatry and Addiction Medicine, with a clinical focus on Treatment Resistant Depression, Bipolar Disorder, Anxiety Disorders, Addiction and Eating Disorders. The Delray Center is a comprehensive outpatient treatment center that incorporates the most advanced psychotherapeutic and medical modalities, such as Dialectical Behavioral Therapy (DBT) and Transcranial Magnetic Stimulation (TMS), in the treatment of complex and dual-diagnosis cases. www.delraycenter.com, www.delraybrainscience.com, www.mydrugdetox.com

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11

DETHRONING THE REIGN OF OPIATES IN CHRONIC PAIN RECOVERY: UNHOOK FROM PRESCRIPTION CULTURE AND TAKE RECOVERY INTO YOUR OWN HANDS.

By Dr. James Flowers, Ph.D., LPC-S and Angela Harris, BS, MSW Candidate

Hopeless. Depressed. Anxious. Angry. These are just a few of the words an individual with chronic pain knows intimately, a condition experienced by many millions of Americans.

Chronic pain affects most Americans at some point in their lives, and many suffer without adequate care. A variety of factors serve as barriers to receiving care. Some of these include a lack of health insurance, living in an area isolated from a provider with the necessary specialty, financial limitations, and so on. However, even those who do receive care for their pain see providers who respond the best way they know how, with a prescription pad.

Americans crave instant gratification and western medicine views pain and illness through a fix-it framework. This framework and instant-gratification approach to healing leads providers to prescribing medications to “fix” the pain, often prescribing opiates. While medication plays a valid role in chronic pain recovery, patients often build a tolerance to prescriptions. As tolerance builds, the patient experiences an effect called hyperalgesia. Hyperalgesia refers to an increase in pain sensation and the need for a higher dosage to achieve the same effect… and then the tolerance builds again, leading to a higher dosage required to have the same effect… and the cycle continues, quickly leading to provider-prescribed addiction.

On top of that, emotions play a direct role in the presence and severity of pain. Approximately 70% of a person’s physical pain is an emotional response to the physical pain. The only way a person feels pain is with the brain. Anger, fear, frustration, anxiety, sleeplessness, fatigue, depression, grief, and trauma all activate the nervous system, which increases a person’s level of pain. When a person fights pain, pain increases. This means an attitude of acceptance must be developed in order to decrease the pain and therefore increase quality of life.

All of this points to the fact that chronic pain comprises of much more than physical symptoms. A holistic perspective comprehensively addresses all of the components of chronic pain, so a holistic remedy best serves patients for sustainable recovery.

A variety of other approaches provide the full and lasting healing every patient deserves. Opiates are not the answer. Painkillers do not address all of these other factors and leave a gap in treatment when only a prescription is used to treat the pain.

Additionally, these holistic approaches are found to be highly effective without the same risks associated with opiates. Some of these risks include addiction, complications with the kidney and liver, constipation, insomnia, and brain fog. These approaches also enable individuals living in isolated areas, without insurance, or with financial limitations to begin recovery without a huge (or any) out-ofpocket expense.

95% of all opiate prescriptions in the world are made in the U.S.

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Check out the list below to learn about alternative approaches for chronic pain recovery and why they are effective: • Yoga therapy incorporates stretching and movement of the body as well as mindfulness techniques to regain a connection between mind and body through light stretching.

• Qi Gong is a slow-moving and gentle physical practice that enhances balance, cleanses the body, and circulates chi.

• Exercise can be challenging for an individual with chronic pain, but is vital to regain motion and use of the full body. Starting with regular exercise that is tolerable from the patient’s pain perspective can lead to retraining the body and eventually increasing the exercise amount. Regular exercise also provides a steady stream of regular endorphins in the body, which enhance the emotions of an individual, therefore decreasing the level or

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severity of pain. Exercise has been found to increase strength and lower stress, which also contributes to a lessening of pain.

Acupuncture places small, sterilized needles along the pressure points, or energetic pathways, along the body to balance and increase flow of energy throughout the body.

Acupressure uses pressure of the fingertips on the same pressure points, or energetic pathways, along the body in order to achieve the same effects as acupuncture. Acupressure offers an alternative approach to acupuncture for individuals uncomfortable with or unable to use needles.

Nutritional and herbal remedies cause the body to boost its natural immunity, reduce pain-inducing inflammation, and decrease insomnia. Some of the herbal remedies include omega-3 fatty acids, ginger, turmeric, and MSM. Please ensure to consult your physician before changing your diet or adding herbal remedies.

Cognitive Behavioral Therapy (CBT) refers to a framework that considers the thoughts, behaviors, and emotions of an individual as directly related to each other. Chronic pain directly correlates with emotions, so the use of CBT teaches patients to change thought patterns in order to change emotions, therefore decreasing pain.

Meditation involves focusing on something specific (a word, phrase, or image) in order to quiet the mind.

Guided imagery involves imagining the body performing an activity in order to challenge one’s physical reality. This method enables the neurotransmitters in the brain to experience new pathways in response to experienced pain. Imagining the ability to perform these actions starts creating new pathways in the brain, telling the brain these actions can be done, even while pain is being experienced. Over time, the development of these new pathways becomes so strong that pain decreases due to the new thoughts and beliefs associated with the pathways.

Biofeedback uses a unique machine to become more alert to body processes and learning to control them. This enables the patient to become more in control of their body processes and therefore more in control of their pain.

Relaxation techniques address the underlying stress of chronic pain and the emotional detriments associated with pain. Using relaxation techniques enable the individual to relax themselves while experiencing the pain in order to relieve stress and negative emotions, which contribute to increased pain.

Massage incorporates the manipulation of tissue to reduce knots of muscle fiber, restore mobility, decrease blood pressure, Continued on page 30

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13

A NEW YEAR, A NEW YOU

By Michael DeLeon

There can’t be a New Year without a new you! I look at Recovery the exact same way – a new you. The New Year brings about a new beginning, just as recovery does. Recovery, like life, is commonly looked at as a day-by-day process. Each day is a new beginning, so taking on life-changing resolutions and embracing recovery is a daily acceptance of a new beginning.

Every year people spend the last few months going through their mental lists of promises they’re going to make to themselves on January 1st. They come up with these great, life-changing resolutions that barely make it through the first week of the New Year, much less the year itself. According to an often cited study by the University of Scranton, only 8% of people achieve their New Year’s resolutions. U.S. News says 80% of New Year’s resolutions fail by the second week of February. Those numbers are staggering. Yet, year after year, we commit ourselves to the same failed traditions. This is the year I’m going to lose weight, quit smoking, save money etc. We intend to do it, but we don’t often succeed.

Try going to a gym in January and look at the amount of people exercising. Then, go back in February and March. You will see a significant difference. How many times have we bought that elliptical or treadmill on Black Friday with the intention of getting into shape, only to turn the equipment into a coat rack by spring?

Often times, it’s because we perceive the resolution as an all-ornothing approach rather than a step-by-step process, or a gradual process of growth. We also kick the resolution off on January 1st – a specific, hard line date where it all must start. So that means, whatever we want to change must come to an end, and December 31st is that day. However, if that resolution fails, we become frustrated and give up. If the “change” was more about “growth” and less about “change”, maybe more people would succeed because even if they have a setback, they can continue trying without thinking they failed.

Much is the same with recovery, only not being able to quit can be deadly. Addiction now is like playing Russian Roulette with 5 bullets in the gun. It’s life or death. I believe we can learn more about recovery by looking at New Year’s Resolutions, and the underlying reasoning behind why people fail. What’s even more important about this perspective is to learn how people succeed. Maybe if we look at this process as constant growth, something that is consistently growing and improving, more people would succeed.

According to the National Institute on Drug Abuse, up to 60% of recovering drug addicts will relapse, and the relapse rate for heroin and opioids is as high as 80%. At this time of year, with the recovery rate at about 20%, the similarity to traditional New Year’s resolutions is eye-opening to me. It got me thinking, how can it get better? How can we solve this problem?

How can we improve our resolutions to help us recover from substance abuse, alcohol and negative life choices? Working out more often, getting in shape, quitting smoking, losing weight, studying harder, going back to Church or giving up a negative life choice like drugs or alcohol are all great goals. Finding recovery is a goal that can be life-changing. Enhancing our recovery through growth can also be life changing as well.

Successful growth happens when you are doing positive things rather than reflecting on the things you must stop. We shouldn’t deny our old person, rather work on our attributes and enhance them. We should think of the things that we can add to our lives which would produce the positive outcomes we desire. Getting off of drugs and alcohol is a change, but remaining off drugs and alcohol while enhancing and growing in life is long-term recovery. This enhances not only our life but the lives of those around us.

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Each year, I have watched this pandemic grow- from 1995 when Purdue Pharma convinced the FDA to approve oxycontin in order to treat chronic pain- to 2000, when Pharmaceutical advertisements began to permeate our television sets- to 2010 when the overdose death rate began to skyrocket throughout America- to today, when death from overdoses have become the leading cause of accidental deaths in America. I have wanted to change what is happening and become a solution in a world of problems. I set out to make a difference and every year I look closely at where we are. This year I couldn’t help but look at the New Year’s resolutions that people make and compare them to the goals of the addicted seeking recovery. Many people verbally state how they desire to get clean but don’t, and there are those who determine a future date when they will stop, and turn their lives around. Both of these demographics are growing, and the focus is often on them. But, there is also a group of people who are finding long-term sobriety without talking so much about it. I see an absence of people in recovery talking openly about their success. The population of those seeking recovery is growing, as is the publics recognition of it, and I believe that those finding long term recovery should be more vocal so people understand that long term recovery is not only possible but happens all the time.

So, as 2017 comes to a close, and we embrace a New Year full of promise and opportunities, I hope that those who have found recovery get even louder, and manifest more hope for those making promises to themselves and others, and that they can finally recover from their addiction. 2018 will be a year of increasing demise in this pandemic and we must make a resolution to that pandemic that recovery is stronger! Each day in recovery is a new day with a daily chance to grow. It’s a resolution that is not only possible, but achievable.

Michael DeLeon is the Director and Producer of the films” Kids Are Dying”, “An American Epidemic”, “MarijuanaX”, and “Road to Recovery”. His fifth documentary will be released in January, 2018 called, “Higher Power”. His memoir, “Chasing Detours will be released in January, 2018. Michael is the founder of Steered Straight Inc. a nationally-recognized educational program and a national advocacy organization called, “Recovery Army”. He is the National Recovery Advocate for Transformations Treatment Center in Delray Beach, Florida.

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WHAT NOW?

By Marcy Dorfman-Salenieks, LCSW Each time I get a call from a parent of a struggling teen, I’m all too familiar with the questions, concerns, and powerful emotions I encounter. And while there’s no way to adequately express a level of understanding of what it’s like to be in their shoes (I was such a parent), my goal is to come as close as possible.

As therapeutic educational consultants, we are approached by parents of teens in pain, immense pain. They are looking for options. It’s highly likely they have been passengers on a therapeutic journey that led nowhere. They have reached the end of the road, and literally don’t know where to turn.

Educational consultants have a broad and specific knowledge base of therapeutic and academic options throughout the country for teens and young adults. We provide safety and support by being “in the know.” Traveling across the country, assessing programs for their quality, expertise, services, staff, environment, and facilities, we provide assurance parents need that their children are in safe, professional hands.

Adolescents and young adults who are struggling, present with a wide range of behavioral, emotional, psychological, and academic issues. How does a parent gauge whether a decline in any one of these areas is cause for concern? What does a “crisis” look like?

Just as the situation is different for every teen and young adult, so too, is every parent’s threshold or limit to cope with it. Some of the useful questions we have found for parents to consider are these: • Has your child had a long treatment history and therapeutic involvement, with only marginal gains?

• Are you fearful of your child’s anger?

• Are your other children fearful, or being adversely affected by your teen or young adult’s behavior?

• Has your child had recent contact with the legal system?

• Is there a widening gap between your child’s development and that of his or her peers?

• Is your child associating with negative peers and viewing them as more influential than you?

• Is there an escalation of anxiety, depression, defiance, or substance abuse?

• Do you worry that your child will hurt himself or herself or others in some way by remaining on the current path?

• Is your child making decisions you don’t approve of?

• Is your child isolating from family and others?

• Have you lost parental control?

• Is your child running your home?

Parents who are overwhelmed are what I refer to as “near-sighted.”

Understandably, they are often too close to the situation to see what lies ahead. Therapists who work with families are often in a key position to have the “long-distance vision” that parents desperately need. There are several key questions therapists and parents can discuss together, when looking at a struggling teen or young adult’s current functioning: • What do you imagine life will be like for your child in ten years, if he/she remains on this course?

• What will your family life look like?

• Do you imagine your child being employable? Getting married?

• Does your child accept any responsibility for his/her actions?

• Does he/she have insight into thoughts and behaviors?

• Is your child close to age 18, with no improvement in sight?

• Are academics and a chance for college acceptance being affected?

If the answer is yes to any of these questions, it may be time to

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consider a more clinically intensive therapeutic setting. Therapeutic wilderness programs and therapeutic boarding schools are two of the most effective residential settings into which therapeutic educational consultants place teens and young adults. Each teen or young adult is matched with a school or program ideally suited for specific academic and psychological needs.

In addition, parents who are unclear about their child’s issues, root causes, and next steps needed for treatment can take advantage of short-term options such as clinical assessment programs that specialize in conducting comprehensive neuropsychological and psychoeducational testing. Results illuminate an accurate diagnostic picture of a child using a team of clinical experts.

This is often a helpful tool in more complex cases, when local testing still leaves a parent in a quandary, when there has been a significant change in the child’s functioning, or after a particularly unsettling event.

Parents need to feel that they have exhausted their local therapeutic resources before making the monumental leap to a residential setting. However, once that point has been reached, there are a plethora of schools and programs that specialize in accommodating specific student profiles. Issues such as substance abuse, disordered eating, anxiety, depression, oppositional defiance, mood swings, self-harm, adoption and attachment, trauma, school refusal, internet addiction, etc. are addressed by schools and programs with specific expertise. Their therapeutic approaches are varied, as are their levels of clinical sophistication, student populations, array of therapeutic services (i.e., traditional and experiential therapies), extracurricular activities, and location, to name a few. When working with an educational consultant, parents will visit schools and programs recommended by the consultant.

Ideally, outpatient therapy and or a change of school may make all the difference to provide what’s needed to get a teen or young adult back on track. But if outpatient therapy fails to achieve results, then knowing that these schools and programs exist is invaluable and comforting. Many parents struggle with the decision to pursue a residential setting for their child, because they simply don’t have the proper broad knowledge of top quality programs across the country.

A school or program recommended by an educational consultant is going to be clinically sophisticated, safe, nurturing, accredited, and a member of a national association which holds its members to the highest standards. Safety, clinical and academic programming, staff, facilities, and activities are all routinely evaluated by consultants, whose support and guidance is continuous throughout Continued on page 30

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THE IMAGINATION OF DREAM GLIDING

By Maxim W. Furek, MA, CADC, ICADC

“All the breaks you need in life wait within your imagination.

Imagination is the workshop of your mind, capable of turning mind energy into accomplishment and wealth.” ~ Napoleon Hill Napoleon Hill (1883-1970) was one of history’s most influential thinkers. His powerful and insightful words have been repeated and validated by countless others following in his path.

The incredible knowledge in Think and Grow Rich, among the top 10 self-help books of all time, was researched and compiled by Hill, who determined that imagination was key. Hill interviewed “40 millionaires” to discover the common thought processes, strategies and behaviors that led to their success. His work pre-dated Stephen R. Covey’s (1932-2012) The 7 Habits of Highly Successful People. Hill’s study of these “best practices” was revolutionary in a world where it was largely assumed that great wealth resulted from a combination of avarice and chance.

Hill disagreed. Intelligence, perseverance and good timing were essential elements of success, but as Hill declared in his bestselling book, a primary step towards that goal was imagination. The goal must be celebrated and savored, envisioned and designed. Hill believed that, “You will never have a definite purpose in life; you will never have self-confidence; you will never have initiative and leadership unless you first create these qualities in your imagination.”

Hill dramatically concluded, “Imagination is the most marvelous, miraculous, inconceivably powerful force the world has ever known.”

That profound statement, written long ago and in a different time, is still valid today. Others, including Albert Einstein (1879-1955), were in agreement with Hill’s observation. Einstein won the Nobel Prize in 1921 for his paper, submitted in 1905, explaining the photoelectric effect, the basis of electronics. His first paper on the Special Relativity Theory, also published in 1905, radically altered the world. “Imagination is more important than knowledge,” wrote Einstein. “For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.”

English writer and author of the classic high-fantasy works The Hobbit, and The Lord of the Rings, JRR Tolkien (1892-1973), immersed himself in glorious fantasy, noting that the adult mind has more need for fantasy that that of the child. Tolkien rightfully observed that, “Fantasy is escapist, and that is its glory.” He asserted that, “A single dream is more powerful than a thousand realities.”

Sigmund Freud (1856-1939), the founder of psychoanalysis, viewed this on an even deeper level. Freud found that the mere act of thinking (wishing and fantasizing) is itself gratifying. Fleetwood wrote, “What therapists and psychoanalysts commonly observe is that the fantasy is more mentally and physically stimulating and fulfilling than the actual, real life action the fantasy is organized around. Is it any wonder that reality doesn’t measure up to the intense, vivid fantasy? Freud’s observation that humans’ attempt to fantasize things into reality is today fully accepted by neuroscientists as the basis for imagination.

DREAM GLIDING Many have attempted to describe the powerful force that resides within our center. Hill’s “mind energy”, Tolkien’s “escapist glory”, and Einstein’s “all knowingness” have all examined this “soul-energy.”

When actualized, soul-energy, allows us to do incredible things.

The process of discovering our soul-energy and breathing life into our dreams is what this writer has labeled “Dream Gliding.”

The essential principle of Dream Gliding is, “if you can think it you can do it.” This universal principle has been identified by numer-

20

ous others. The words of American writer William Arthur Ward (1921-1994) have been widely quoted. Ward advocated, “If you can imagine it, you can achieve it. If you can dream it, you can become it.” In Stephen R. Covey’s The 7 Habits of Highly Successful People, the author and motivational speaker believed that all success begins with a single thought or idea. “Sow a thought, reap an action; sow an action, reap a habit; sow a habit, reap a character; sow a character, reap a destiny.”

By following their dreams, progressive visionaries have tapped into soul-energy and have literally changed the world. Although others may be unaware of soul-energy or unaware of how to use it, the possibilities are the same for everyone. You must see it, imagine it and believe in it. And then do it. Those are the initial steps in the process of Dream Gliding, of turning fantasies into reality.

We create our own reality. We have the ability to change behaviors and situations that we find unacceptable. Albert Ellis (1913-2007) spent his lifetime helping to empower others. Ellis developed rational emotive behavior therapy, teaching that we can either accept the way things are or change them. He challenged individuals to dispute notions that were holding them back from a complete and fulfilling life.

We have a choice. What we see through our mind’s eye is the result of our unique perceptive lens, our personal, all-important viewpoint. It defines who we are and dictates where we place our energies. This viewpoint can be a kaleidoscope of magical swirling colors or a world shrouded in a dark, repressive tapestry.

Dream Gliding is about self- confidence and self-actualization. It is about believing in ourselves and in our dreams. Dream Gliding transforms the fantasy and imagination of soul-energy into possibility.

That was the message that Juan Williams of NPR gave during his commencement speech at Whitman College. Williams implored the graduates to, “Go beyond what makes you comfortable. Open yourself to ideas, events, relationships that make you uncomfortable.

Travel places where you know no one. Learn another language.

Create art, even though you’re not an artist. Argue with people. Fall down. Get up. Read books, all sorts of books.” Williams was encouraging them to go beyond their comfort zone and to explore the far reaches of what they do not know. He encouraged them to embrace their life adventure, fearlessly and with passion. He implored them to allow themselves to imagine and to follow their dreams.

Imagination helps us break free from the chains that bind us, allowing us to explore other philosophies and themes. It lets us to venture into uncharted waters, arousing the creation of foreign shores and otherworldly landscapes. Imagination encourages us to celebrate the possible rather than condemning the failure of not reaching our goal.

Continued on page 30

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For the Families A SECRET NO MORE

By Lisa Hillman

When addiction crept into my household 11 years ago, I retreated to a journal. The clean, white pages offered me refuge to pour out my anguish, fear, confusion, and shame. It was a safe place to unveil my secret.

My story unfolds in the capital city of Maryland where my family is well-known. My husband is a former mayor and I was president of a large medical center foundation. We have two children, a girl and a boy, and – or so I thought at the time – we lived an idyllic life.

That all began to change one evening when a respected teacher at my son’s high school phoned at the beginning of Jacob’s senior year. The teacher asked, did I know Jacob was “smoking” and hanging out with a “different” crowd? MY first thought was he had the wrong kid. While the call upended my world, I tried to soothe my worry by believing, or hoping, that this was just a rite of passage, a normal stage in an adolescent’s maturation. Surely, Jacob soon would grow out of it.

Meanwhile, Jacob’s disease worsened. I began shielding his drug use from colleagues, friends, even close family. Unknown at the time, I was suffering the same feelings of fear, shame, isolation, anxiety and depression as my son. The stigma of addiction barred me from the consoling arms of colleagues at the medical center where I worked every day alongside premier physicians, addiction specialists and other healthcare professionals. Help was right in front of me, but I was loathing to reach out.

Until finally, I did. An astute counselor suggested I set boundaries with Jacob. It was a terrifying moment when I gave my son this ultimatum: continue to use, and you can’t live in our house; agree to inpatient treatment, Dad and I will pay for it.

Fortunately, he accepted treatment. While he wasn’t ready to give up drug use, he eventually entered a treatment center in South Florida and stayed for 100 days. When Jacob left Maryland for Florida, the counselor asked me: “Okay, your son will have his program. Now what are you going to do for yourself?”

Never a groupie, I soon found a 12-step program meant for families of addicts. Sharing my feelings of shame and isolation with others experiencing the same anguish as I was, gave me the courage to face addiction and how it was ravaging my life. Writing my memoir forced me to relive and understand the years of my son’s addiction, and my reaction to it, and to continue recovery.

It was a painful process of letting go of control and expectations, sharing my “secret” with colleagues and friends, finding strength in support groups, and giving back to the addiction community.

It is my hope that “Secret No More” will comfort families facing addiction in a loved one. This is the book I wish someone had given me when I needed it.

It’s humbling to visit South Florida, where the substance abuse and opioid addiction epidemic is painfully prevalent. If sharing my story with the South Florida Jewish community can help even one mom or dad, I will be truly glad. Jacob will, too.

About Ruth & Norman Rales Jewish Family Services (JFS) For over 35 years JFS has provided help, hope and humanity through a comprehensive range of programs and services for people of all ages and beliefs. With locations in Boca Raton and Delray Beach, JFS programs include food and financial assistance, counseling and mental health services, senior services, services for families and children, career and employment services, and many volunteer opportunities. To learn more visit our website www.ralesjfs.org or call (561) 852-3333.

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Secret No More Free Community Event

Ruth & Norman Rales Jewish Family Services (JFS) is committed to the timely and critical issues of substance abuse and opioid addiction. The organization will be hosting a free community event titled “Secret No More,” where Lisa and Jacob Hillman will share their personal story of a mother and a son facing addiction, learning about themselves and each other, and ultimately surviving. Lisa will talk about her journey with a focus on giving hope to parents and families struggling with a loved one suffering from addiction; Jacob also will participate. There will be a Q&A session, book sales and signing at the end.

DETAILS WHEN: Wednesday, January 16, 2018 from 7:00 to 8:30 PM WHERE: Zinman Hall, 9901 Donna Klein Blvd, Boca Raton, FL 33428 The event is free and open to the public. However, registration is required at www.ralesjfs.org/secretnomore

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IMPORTANT HELPLINE NUMBERS

A New PATH www.anewpath.org Addiction Haven www.addictionhaven.com Bryan’s Hope www.bryanshope.org CAN- Change Addiction Now www.addictionnow.org Changes www.changesaddictionsupport.org City of Angels www.cityofangelsnj.org FAN- Families Against Narcotics www.familiesagainstnarcotics.org Learn to Cope www.learn2cope.org The Long Island Council on Alcoholism and Drug Dependence www.licadd.org Magnolia New Beginnings www.magnolianewbeginnings.org Missouri Network for Opiate Reform and Recovery www.monetwork.org New Hope facebook.com/New-Hope-Family-Addiction-Support-1682693525326550/ Not One More www.notonemore.net/

ALCOHOLICS ANONYMOUS WWW.AA.ORG AL-ANON WWW.AL-ANON.ORG 888-425-2666 NAR-ANON WWW.NAR-ANON.ORG 800-477-6291 CO-DEPENDENTS ANONYMOUS WWW.CODA.ORG 602-277-7991 COCAINE ANONYMOUS WWW.CA.ORG 310-559-5833 MARIJUANA ANONYMOUS WWW.MARIJUANA-ANONYMOUS.ORG 800-766-6779 NARCOTICS ANONYMOUS WWW.NA.ORG

818-773-9999 EXT- 771 OVEREATERS ANONYMOUS WWW.OA.ORG 505-891-2664 NATIONAL COUNCIL ON PROBLEM GAMBLING WWW.NCPGAMBLING.ORG

800- 522-4700 GAMBLERS ANONYMOUS WWW.GAMBLERSANONYMOUS.ORG 626-960-3500 HOARDING WWW.HOARDINGCLEANUP.COM NATIONAL SUICIDE PREVENTION HOTLINE WWW.SUICIDEPREVENTIONLIFELINE.ORG 800-273-8255 NATIONAL RUNAWAY SAFELINE WWW.1800RUNAWAY.ORG

800- RUNAWAY (786-2929) CALL 2-1-1 WWW.211.ORG ASSOCIATION OF JEWISH FAMILY AND CHILDRENS AGENCIES WWW.AJFCA.ORG 410-843-7461 MENTAL HEALTH WWW.NAMI.ORG 800-950-6264 DOMESTIC VIOLENCE WWW.THEHOTLINE.ORG 800-799-7233 HIV HOTLINE WWW.PROJECTFORM.ORG 877-435-7443 CRIME STOPPERS USA WWW.CRIMESTOPPERSUSA.ORG

800-222-TIPS (8477) CRIME LINE WWW.CRIMELINE.ORG

800-423-TIPS (8477) LAWYER ASSISTANCE WWW.AMERICANBAR.ORG 312-988-5761 PALM BEACH COUNTY MEETING HALLS CLUB OASIS 561- 694-1949 CENTRAL HOUSE 561-276-4581 CROSSROADS WWW.THECROSSROADSCLUB.COM

561- 278-8004 EASY DOES IT 561- 433-9971 THE TRIANGLE CLUB WWW.TRIANGLECLUBPBC.ORG 561-832-1110 LAMBDA NORTH WWW.LAMBDANORTH.NET

PAL - Parents of Addicted Loved Ones www.palgroup.org/

BROWARD COUNTY MEETING HALLS

Parent Support Group New Jersey, Inc. www.psgnjhomestead.com

101 CLUB 954-573-0050 LAMBDA SOUTH CLUB 954-761-9072 WWW.LAMBDASOUTH.COM PRIDE CENTER WWW.PRIDECENTERFLORIDA.ORG

954- 463-9005 STIRLING ROOM 954- 430-3514 4TH DIMENSION CLUB WWW.4THDIMENSIONCLUB.COM 954-967-4722 THE BOTTOM LINE 954-735-7178

P.I.C.K Awareness www.pickawareness.com Roots to Addiction www.facebook.com/groups/rootstoaddiction/ Save a Star www.SAVEASTAR.org TAP- The Addicts Parents United www.tapunited.org

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OUR EVOLVED UNIQUE “FEEL GOOD” CIRCUITS MAKES HUMANS DIFFERENT FROM APES

By Kenneth Blum, Ph.D., Edward J. Modestino, Ph.D., and Mark S. Gold, M.D.

The brain regions circuitry tied to pleasure are difficult to accurately describe, partly, because of many different ways we can trigger enjoyment or “Feel Good.” Pleasure can result from engaging in sex, eating tasty food, watching a movie, accomplishments at school and athletics, consuming drugs, and noble efforts to help the community, the country, and the world.

It is noteworthy that research suggests that the later type of satisfaction, supporting the community, may result in the most substantial positive effects on our immune system, but these pathways are not understood. Similarly, one key to happiness involves a network of good friends. However, it is by no means clear how the higher forms of satisfaction and pleasure are related to an ice cream cone, or to your team winning a sporting event that may stem back to the old chariot days. Recent multidisciplinary research, using both humans and detailed invasive brain analysis of animals has discovered some critical ways that the brain processes pleasure.

Remarkably, there are pathways for ordinary liking and pleasure, which are limited in scope. However, there are many brain regions, often termed hot and cold spots, that significantly modulate (increase or decrease) our pleasure or even produce the opposite of pleasure— that is disgust and fear. More specifically, one particular region of the nucleus accumbens is organized like a computer keyboard, with specific stimulus triggers in rows— producing an increase and decrease of pleasure and disgust.

Moreover, the cortex has unique roles in the cognitive evaluation of our feelings of pleasure. Importantly, the interplay of these multiple triggers and the higher brain centers in the cortex are very complex and are just being discovered.

Desire and Reward Centers Surprisingly, many different sources of pleasure activate the same circuits between the mesocorticolimbic regions. Reward and desire are two aspects of pleasure induction and have a very widespread large circuit. Some part of this circuit distinguishes between desire and dread. The so-called pleasure circuitry called ‘REWARD” involves a well-known dopamine pathway in the mesolimbic system that can influence both pleasure and motivation.

In simplest terms, the well-established mesolimbic system is a dopamine circuit for reward. It starts in the ventral tegmental area (VTA) of the midbrain and travels to the nucleus accumbens. It is BRAIN REWARD CIRCUITRY

BRAIN REWARD CASCADE

the cornerstone target to all addictions. The VTA is encompassed with neurons using glutamate, GABA, and dopamine. The nucleus accumbens (NAc) is located within the ventral striatum and is divided into two sub-regions—the motor and limbic regions associated with core and shell respectively. The NAc has spiny neurons that receive dopamine from the VTA and glutamate (a dopamine driver) from the hippocampus, amygdala and medial prefrontal cortex. Subsequently, the NAc projects GABA signals to an area termed the ventral pallidum (VP). The region is a relay station in the limbic loop of the basal ganglia, critical for motivation, behavior, emotions and the “Feel Good” response.

This defined system of the brain is involved in all addictions – substance and non –substance that our laboratory in 1995 coined “Reward Deficiency Syndrome” (RDS).

Furthermore, ordinary “liking” of something, or pure pleasure, is represented by small regions mainly in the limbic system (old reptilian part of the brain). These may be part of larger neural circuits. In Latin, hedus is the term for “sweet”; and in Greek, hodone is the term for “pleasure.” Thus, the word Hedonic is now referring to various subcomponents of pleasure: some associated with purely sensory and others with more complex emotions involving morals, aesthetics, and social interactions. The capacity to have pleasure is part of being healthy and may even extend life especially if linked to optimism, a dopaminergic response.

Psychiatric illness often includes symptoms of an abnormal experience of pleasure referred to as anhedonia. A negative feeling state is called dysphoria, which can consist of many emotions such as pain, depression, anxiety, fear, and disgust.

Previously, many scientists used animal research to uncover the complex mechanisms of pleasure, liking, motivation and even emotions like panic and fear. However, as a significant amount of related research about the particular brain regions of pleasure/ reward circuitry has been derived from invasive studies of animals, these cannot be directly compared with subjective states as espoused in humans.

For the advanced reader, in an attempt to resolve the controversy regarding the causal contributions of mesolimbic dopamine systems to reward, we have previously evaluated the three main competing explanatory categories: “liking,” “learning,” and “wanting.” That is, dopamine may mediate (a) liking: the hedonic impact of reward, (b) learning: learned predictions about rewarding effects, or (c) wanting: the pursuit of rewards by attributing incentive salience to reward-related stimuli. We have evaluated these hypotheses, especially as they relate to the RDS, and we find that the incentive salience or “wanting” hypothesis of dopaminergic functioning is supported by a majority of the scientific evidence. Various neuroimaging studies have

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shown that anticipated behaviors such as sex and gaming, delicious foods and drugs of abuse all affect brain regions associated with reward networks, and may not be unidirectional.

Drugs of abuse enhance dopamine signaling which sensitizes mesolimbic brain mechanisms that apparently evolved specifically to attribute incentive salience to various rewards. Addictive substances are voluntarily self-administered, and they enhance (directly or indirectly) dopaminergic synaptic function in the NAc. This activation of the brain reward networks (producing the ecstatic “high” that users seek). Although these circuits were initially thought to encode a set point of hedonic tone, it is now being considered to be far more complicated in function, also encoding attention, reward expectancy, disconfirmation of reward expectancy, and incentive motivation. Elevated stress levels, together with polymorphisms (genetic variations) of various dopaminergic genes and the genes related to other neurotransmitters (and their genetic variants), may have an additive effect on vulnerability to various addictions. This Reward Deficiency Syndrome model of etiology holds very well for a variety of chemical and behavioral addictions.

Over many years, the controversy of dopamine involvement especially in “pleasure” has led to confusion in terms of trying to separate motivation from actual pleasure. We take the position that animal studies cannot provide real clinical information as described by self-reports in humans. On November 23rd, our concerns may have been highlighted. A brain system involved in everything from addiction to autism appears to have evolved differently in people than in great apes, a large team reported in the journal Science. In essence, although non-human primate brains are similar to our own, the disparity between other primates and those of human cognitive abilities tells us that surface similarity is not the whole story. Sousa et al. found various differentially expressed genes, to associate with pleasure related systems. Furthermore, the dopaminergic interneurons located in the human neocortex were absent from the neocortex of nonhuman African apes. Such differences in neuronal transcriptional programs may underlie a variety of neurodevelopmental disorders.

In simpler terms, the system controls the production of dopamine, a chemical messenger that plays a significant role in pleasure and rewards. The senior author, Dr. Nenad Sestan from Yale, stated: “Humans have evolved a dopamine system that is different than the one in chimpanzees.” This may explain why the behavior of humans is so unique from that of non-human primates, despite the fact that our brains are so surprisingly similar, Sestan said. It might also shed light on why people are vulnerable to mental disorders such as autism. Remarkably, this research finding emerged from an extensive, multicenter collaboration to compare the brains across several species. These researchers examined 247 specimens of neural tissue from six humans, five chimpanzees, and five macaque monkeys. These researchers analyzed which genes were turned on or off in 16 regions of the brain. It was observed, while the differences among species were subtle, there was a remarkable contrast in the neocortices, specifically in an area of the brain that is much more developed in humans than in chimpanzees. In fact, these researchers found that a gene called Tyrosine Hydroxylase (TH), an enzyme, which is involved in the production of dopamine, was expressed in the neocortex of humans, but not chimpanzees. The neurotransmitter dopamine is best known for its essential role within the brain’s reward system; the very system that responds to everything from sex, to gambling, to food, to addictive drugs. However, dopamine also assists in regulating emotional responses, memory, and movement. Notably, abnormal dopamine levels have been linked to disorders including Parkinson’s, schizophrenia, and spectrum disorders such as autism and addiction or Reward Deficiency Syndrome.

substantial role in humans’ ability to pursue various rewards that are perhaps months or even years away in the future.

This same idea has been suggested by Dr. Robert Sapolsky, a Professor of Biology and Neurology at Stanford University. Dr. Sapolsky cited evidence that dopamine levels rise dramatically in humans when we anticipate potential rewards that are uncertain and even far off in our futures, such as retirement or even the possible afterlife. This may explain what often motivates people to work for things that have no apparent short-term benefit, he says.

Moreover, the neocortex wasn’t the only area of the brain to show differences in gene expression among species. Sousa et al. also found differences in much older areas, including an ancient structure called the cerebellum. Accordingly, an ancient part of the human brain seems to have a very recent change. It will take years to understand more fully what all the changes mean, but this finding could eventually help divulge what makes the human brain unique, and even what goes wrong in a range of brain disease states. The role of dopamine in brain function has been well established throughout many decades of research and has merited the Nobel Prize in 2000, and continued work by one of us (KB) and Ernest P. Noble showing the role of dopamine genetics in severe alcoholism, and also by MSG and Charles Dackis with regard to the “dopamine depletion hypothesis” and cocaine. The new findings by Sousa et al., also calls for the importance of dopamine homeostasis through genetic addiction risk (GARS) testing and Pro-dopamine regulation (KB220PAM).

References provided upon request Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical College and graduated from Columbia University and New Jersey College of Medicine. He also received a doctor of humane letters from Saint Martin’s University Lacey, WA. Dr. Blum has authored over 600 medical articles, chapters, abstracts, journals, and sixteen professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox, and addiction treatment and psychiatric genetics.

Edward Justin Modestino, Ph.D., is a neuroscientist who focuses his research on various pathologies (i.e., ADHD, narcolepsy, PD and Reward Deficiency Syndrome) using both psychophysiological and neuroimaging techniques. He received his undergraduate education at Harvard in psychobiology; and his master’s degree in psychobiology and a post-master’s degree in cognitive neuroscience both from the University of Pennsylvania.

He completed a Ph.D. in complex systems and brain sciences at Florida Atlantic University. After this, he completed two postdoctoral fellowships in neuroimaging, the first in Psychiatry and Neurobehavioral Sciences at the University of Virginia Health System, and the second in Neurology at Boston University School of Medicine. Currently, he is an Associate Lecturer in Psychology at Curry College in Milton, MA. Mark S. Gold, MD, Chairman of the RiverMend Health Scientific Advisory Boards, is an award-winning expert on the effects of opiates, cocaine, food, and addiction on the brain. His work over the past 40 years has led to new treatments for addiction and obesity which are still in widespread use today. He has authored over 1000 medical articles, chapters, abstracts, journals, and twelve professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox, and addiction treatment practice guidelines.

Nora Volkow, the director of NIDA, pointed out that one alluring possibility is that the neurotransmitter dopamine plays a

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25

LIVING BEYOND

By Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S.

SUICIDE - SOMETIMES EVEN TO LIVE IS AN ACT OF COURAGE “Sometimes even to live is an act of courage”

~ Seneca

Suicide is the most unthinkable choice, but is it really a choice? In times past, suicide and suicidality were considered to be selfish choices made by an individual. Religion has even gone as far as teaching that you could be dammed for committing suicide.

In recent years, suicide has been researched and studied from a number of perspectives including: neurobiological, medical, and psychological, psychiatric, and psychopharmaceutical. The consensus is that the origination of suicidal thought may be related to a singular issue, a host of complex issues, and/or a bioorganic manifestation. Either way, what we do know and clearly understand is that suicidal thoughts are most commonly brought on by an upheaval of emotions that are sudden and overwhelming, feelings of withdrawal, despair, discomfort, hopelessness, and an inability to perceivably manage life. “Suicide can result if a mental illness--like major depression or bipolar disorder—goes untreated, in the same way that a patient can die from pneumonia if they go untreated.”

Although I have professional training as a clinical psychologist; I am always stunned by the sudden and tragic loss of an individual. Suicidal thoughts are not only a pervasive illness affecting the mind, body, and spirit; but the thoughts have this uncanny ability to permeate the very fabric of the human condition. The thoughts are like streaming media flooding the essence of the individual. For so many, the thoughts are as common place as the air with which we breathe. They may ponder, explore and even entertain the idea of suicide. Unlike the song composed by Johnny Mandel and Michael B. Altman; “suicide is painless,” you can rest assured “it brings on many changes...” For the family, friends and those associated with the individual; suicide leaves an imprint or scar that rarely completely heals.

There is no greater grief than when a parent losses a child to suicide. For a majority of parents, the loss of a child to suicide is simply unimaginable, unthinkable and unexplainable. Self-blame and guilt impregnate the very thoughts and mind of the loved ones left behind. For many, the thoughts go unanswered and the scars line the outer shell of the individual.

THE CATALYST OF SUICIDE THOUGHTS Suicide is neither selfish nor is it self-centered; but it is definitely a plea for help. Those who struggle with suicidal thoughts are rarely focused on the outcome, but are mostly interested in stopping the pain.

For those who struggle with suicidal ideology; the thoughts are like a slow drip pinging off a tap. The victim of suicidal thoughts hears every single drip, thump, and splash. For many suicidal thinkers, the thoughts have an obsessive quality. The thinker of suicidal thoughts may not only entertain the thoughts, but beg “God” for an out.

Early on in my career, I recall reading a report of a young lady that had taken her precious life. While the young lady was not my patient; I had an opportunity to read a review of this individual’s life. In the report, the young lady had expressed unto her therapist that she felt complete despair, helpless and abandoned by her parents. Why you may ask? The young lady had learned that she was pregnant. Not only was she pregnant, but she was impregnated by a fellow of a different ethnicity and religious background. For this young lady’s family, she had “disgraced” her family on many levels.

The details of the report indicated that the parents were the “pillars of their community.” Unfortunately, while the parents may have been the “model citizens;” they were neglectful in protecting their child.

Moreover, the parents were disinterested in speaking with the child’s father and had been making many threats upon his own life.

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The young lady’s heartache only intensified when her boyfriend was forced to join the military. The father had significant pull in his country and was capable of having his daughter’s lover be forcibly mandated to join the military.

Following the departure of this young lady’s boyfriend, the helpless young lady’s feelings only intensified. For several weeks, she would be emotionally tormented by her mother and perceivably rejected by her father. The family would make frequent statements concerning the perceived shame that she had brought unto the family.

Moreover, the family rejected the young man because of his ethnicity and cultural heritage. The family not only expressed their personal distain of the young man, but they expressed that the “bastard child” would never be welcomed in the family home.

In the end, the young lady would decide to take her precious life.

The catalyst was a family so ingrained in religious and cultural ideological perspectives that they overlooked the egregious pain that their own child was experiencing.

SIGNS AND SYMPTOMOLOGY • • • • • • • • • • • • •

Frequent conversations or statements involving death.

A preoccupation of death or the loss of life.

Increased alcohol, substance or prescription consumption.

Sudden withdrawal from family, friends, and others.

A dramatic change in behavior, attitudes, perceptions, and overall outlook on life.

Impulsive or reckless behaviors.

A sudden change in job and/or academic performance.

Complaints of increased lethargy, lack of energy, and enthusiasm.

Discussions involving wills or settling financial matters.

Chronic physiological or psychological pain.

Giving away his or her possessions.

Changes in eating or sleeping habits.

An individual focused on past guilt or shame.

RISK FACTORS FOR SUICIDE • Family history of suicide, suicidal thoughts and perceptions.

• A previous history of suicide attempts.

• A family history/personal history of mental health or substance abuse issues.

• Any known substance, alcohol or prescription drug use.

• Preoccupation with firearms or access to firearms.

• A family history of family violence and abuse.

• Chronic stress.

• Chronic financial challenges.

• A recent loss of a friend or family member to suicide.

• Recently being released from prison.

• A loss of a significant relationship.

• Recently being discharged from the military or suffering from PTSD. • The witness of a traumatic event.

• The unexpected loss of a job.

• Prolonged and chronic sleep deprivation.

MISPERCEPTIONS OF SUICIDE • Suicide is not a choice.

• Suicide is not cowardly.

• Suicide is not selfish or self-centered.

• Suicide is not going to send you to an eternal lake of fire.

• Suicide is not rare nor do all suicidal thinkers have a history of mental health issues.

• Suicide does not discriminate nor does it have an ally.

Continued on page 28

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LIVING BEYOND

By Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Continued from page 26

UNDERSTANDING SUICIDE

This poem was read to the staff of Wayside House (a nonprofit women’s treatment center who have been helping women for over 40 years) and I happened to be there that day for a holiday event. I was so moved by her words that I thought it was important to share with you how some people in recovery are feeling. She wanted to express her gratitude and it brought tears to many eyes. To all of you out there struggling with addiction, there is hope- Amanda has found it and so can you.

GOING IN CIRCLES

By Amanda W. 2017

Fight or flight I won’t, I might I’m home, I’m leaving I can’t, I’m believing in me.

For the first time I don’t want to pick up I want to be free I see the light Yet it’s so far away My demons wait close by They want me to come play Misery Is Company and madness is home to me Anxiety is familiar Happiness is a freaking trigger My brain is pure chaos My thoughts are Madness I’m lost ...

The wholehearted parenting manifesto The giving tree Every single group Encouraging me to see I’m surrounded by women Who not only succeed, but they believe in me...

In me?

That’s difficult to swallow, What is it that they see?

All I see is failure An addicted mother of three.

I threw my life away for addiction My mother swears a hopeful future is fiction.

Now I’m surrounded by complete strangers Who gently guide me to recovery.

They lovingly shut out all dangers to my sobriety.

I can breathe again...

God... Grant me the serenity...

Bless me with bravery This is where my heart will reside I’m grateful, no longer a failure But a recovering woman of Wayside!

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It is absolutely necessary that we recognize that suicidal thoughts may be caused or influenced by a number of physiological, neurological, biological, or psychological disorders; which eventually flood the mind of the individual. The thoughts may be subtle or they may be vivid messages producing powerful feelings and strong emotions. The thoughts may linger indefinitely waiting for the optimum time to be triggered.

Robert Gebbia, CEO for the American Foundation for Suicide Prevention, AFSP, states that “It’s especially important to be mindful of the way we discuss suicide because with mental illness, words matter. Telling a suicidal person that they are being selfish or cowardly does not inspire courage, it could even make them feel worse. It’s important to understand that people who are feeling suicidal do not choose to feel that way; their feelings are a symptom of their mental illness.”

Suicidal individuals frequently feel desperate, isolated and alone. It is not uncommon for someone feeling suicidal to express feelings of hopelessness and despair. “Research suggests that those who do attempt suicide are not thinking rationally. For example, one study found that lower levels of serotonin, a key factor in brain function related to behavioral control and decision-making, led to inability to make choices, impulsivity, and lack of flexibility.”

Suicide is not a selfish act nor is it a cowards way out.

THE HEALING PROCESS

“The bravest thing I ever did was continuing my life when I wanted to die”

~ Juliette Lewis

For many who have attempted suicide, there is a feeling of regret, shame, confusion, resentment, and possibly anger. It is essential that you ask for help.

The healing process is a process indeed. It is through a series of cautious steps that you will ultimately find your place of peace and sincerity. It is the healing process that will serve as your pathway to health and wellness. The journey of the healing process begins with: • • • • • • • • • • • • • • •

Allow yourself time to heal.

Be certain to establish a safety plan.

Be aware of your personal triggers.

Practice relaxation techniques such as breathing, journaling, and meditation.

Establish a list of preventive activities such as: walking, exercise, reading, listening to uplifting music, being artistic, being around others, and taking time for yourself.

Do not punish yourself for thinking certain thoughts.

Live your life daily and without regret, blame or shame.

Identify your positive network. Be willing to reach out to those closest to you.

Do not fear asking for compassion, understanding, comfort and support.

Be certain to find a clinician that you trust and identify with.

Allow yourself plenty of time to grieve, process and recover.

Avoid making any hasty or sudden changes, such as selling your home or quitting your job.

Consider taking time for yourself and making time for those who positively support you.

Always allow yourself the right to share your thoughts and emotions with those that are significant participants in your life.

Do not overwhelm yourself by taking on new tasks, assignments, or projects.

Always remember, that you are not alone. Learn to be your best advocate, ally and friend. There are others who are trained to offer support and guidance through the process of your struggles.

Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Website: www.asadonbrown.com References Provided Upon Request

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DETHRONING THE REIGN OF OPIATES IN CHRONIC PAIN RECOVERY: UNHOOK FROM PRESCRIPTION CULTURE AND TAKE RECOVERY INTO YOUR OWN HANDS.

By Dr. James Flowers PhD, LPC-S and Angela Harris, BS, MSW Candidate

• •

• •

alleviate stress, release chronic tension, and increase circulation.

Chiropractic realigns the vertebrae and joints to relieve stress.

Lifestyle changes make a huge difference in the life of an individual with chronic pain. Some of these include changing to a positive work environment, incorporating sleep hygiene habits, developing a positive relationship with pain, regular exercise, and regular sessions with providers to address the pain and find healthy and sustainable remedies.

Positive work environment involves having a comfortable working space and control over one’s own activities to develop a sense of mastery over one’s pain.

Healthy relationships serve as a support system to the patient living with chronic pain. These relationships encourage, support, and care for the individual in a healthy way. Unhealthy relationships cause stress on the patient, which can exacerbate pain.

These are remedies that can be incorporated in the home or DIY by using resources such as YouTube videos about these remedies and chronic pain.

Dr. James Flowers is an expert in chronic pain recovery and discusses holistic approaches to treatment of chronic pain without the use of opiates. He has occupied an expert leadership position in the pain recovery and addiction treatment field. He has dedicated his career to his passion, designing multidisciplinary addiction treatment programs and clinical protocols to help individuals

NEW ENERGY FOR BETTER RECOVERY OUTCOMES IN THE NEW YEAR

By John Giordano, Doctor of Humane Letters, MAC, CAP

suffering from addiction and chronic pain.

Continued from page 12

Angela Harris is an experienced writer, social media professional, and Master of Social Work student at Texas State University.

Angela is passionate about mental health and working with cooccurring addictive disorders. She has a variety of experience working in social service agencies, specifically those focusing on dual diagnosis treatment services.

WHAT NOW?

By Marcy Dorfman-Salenieks, LCSW Continued from page 18

a child’s placement. Finding the best therapeutic and academic program for a child is the mission; putting an end to the long journey to nowhere is the goal. The end result is a renewed sense of hope for a bright future.

Marcy Dorfman-Salenieks is a Licensed Clinical Social Worker and Therapeutic Educational Consultant who has worked with families for over 25 years. A therapist in private practice, she engaged with teens and young adults who struggled with a variety of issues.

When she encountered similar issues in one of her own sons, she entered the world of residential therapeutic schools and programs eventually leaving private practice to become a Therapeutic Educational Consultant. Today she is passionate about providing to parents resources for teens and young adults, guiding them through the therapeutic options with compassion and support. Marcy works with Judi Robinovitz Associates Educational Consulting, and can be reached at (954) 635-7161, Marcy@scoreatthetop.com.

Continued from page 8

and studies. That being said, I encourage scientists, doctors and researchers to study and analyze Mitochondria and NAD’s relationship with addiction and recovery so that we can all benefit from their life-giving properties.

From the limited amount of science that we do have right now, we know NADH can help people in recovery. The question remains to what degree. It is no secret that most people with substance use disorders suffer from nutrient deficiencies. Our body’s energy producing process depends on nutrients to function. Low nutrient intake equates to low energy production in the body that can exacerbate addiction and recovery.

Is NADH right for you in this New Year? You should always speak with your doctor or health care professional before you start any new regiment. My suggestion would be to find a doctor in your area proficient in Integrative Medicine. NAD Deficiency often goes undetected and/or undiagnosed and can lead to serious disease.

This is not something you can ignore. If you are in recovery, I strongly suggest that you take the step to find an Integrative Medicine Doctor and examine your options.

John Giordano is the founder of ‘Life Enhancement Aftercare & Chronic Relapse Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cuttingedge addiction treatment, check out his websites: www.PreventAddictionRelapse.com www.HolisticAddictionInfo.com

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THE IMAGINATION OF DREAM GLIDING

By Maxim W. Furek, MA, CADC, ICADC Continued from page 20

Whenever the power and human spirit of soul energy is unleashed, we are capable of attaining lofty goals. “Never underestimate the power of dreams and the influence of the human spirit. We are all the same in this notion: The potential for greatness lives within each of us,” was championed by track and field sprinter Wilma Rudolph (1940-1994).

British novelist and screenwriter J.K. Rowling, who wrote the highly successful Harry Potter fantasy series, acknowledges the power of imagination. She believes that, “We do not need magic to change the world, we carry all the power we need inside ourselves already: we have the power to imagine better.”

Imagination is one of the most liberating, all-encompassing and satisfying pursuits engaged by humans. It is at the essence of whom we are, a DNA-fueled, one-of-a-kind magic carpet ride that allows us to create new and wondrous worlds without end, without boundaries or borders, stretching limitlessly beyond the reaches of the cosmos. With Dream Gliding we have the power to become time travelers, shape shifters and intergalactic magicians. We can become the house of our dreams. And we can indeed have it all!

Maxim W. Furek, MA, CADC, ICADC has a rich background that includes aspects of psychology, addictions, mental health and music journalism. His book The Death Proclamation of Generation X: A Self-Fulfilling Prophesy of Goth, Grunge and Heroin explores the dark marriage between grunge music and the beginning of the opioid crisis. Learn more at shepptonmyth.com

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