TERENCE T. GORSKI
WHAT PEOPLE WANT FROM ALCOHOL AND OTHER DRUGS? MENDI BARON
FLAKKA: PARENTS NEED TO KNOW ABOUT THE RISING POPULARITY OF THE LATEST DESIGNER DRUG AMONG TEENS JOHN GIORDANO
INSURANCE COMPANIES PLAY DOCTOR
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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. The Sober World is an informative award winning national magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication, as well as an online e-magazine reaching people globally in their search for information about Drug and Alcohol Abuse. We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol in Palm Beach County as well as distributing locally to the schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more throughout Palm Beach and Broward County. We also directly mail to Treatment Centers throughout the country and have a presence at conferences nationally. Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest manmade epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction. I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process,
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There are Transport Services that will scoop up your resistant loved one (under the age of 18 yrs. old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs, Extended Living and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean. Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help. Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com. Wishing everyone a Happy Independence Day. We are on Face Book at www.facebook.com/pages/The-Sober- World/445857548800036 or www.facebook.com/steven.soberworld, Twitter at www.twitter.com/thesoberworld, and LinkedIn at www.linkedin.com/pub/patricia-rosen/51/210/955/. Sincerely,
Patricia
Publisher Patricia@TheSoberWorld.com
For Advertising opportunities in our magazine, on our website or to submit articles, please contact Patricia at 561-910-1943 or patricia@thesoberworld.com. 3
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FROM DRUGGIE TO SCIENTIST: HOW I FINALLY MADE SENSE OF ADDICTION By Marc Lewis, Ph.D.
I’ve been asked to write an autobiographical sketch, and I suppose my life has been unusual enough to make it something you might want to read, especially if addiction has ripped a hole in your own life. I went from screwed-up teenager to addicted young man - and I recovered. Or, rather, I kept developing, got straight, got a Ph.D. and got a job as a professor. And lately I’ve gone back to addiction, but this time as a science writer. Here’s the story. I was a typical middle-class kid, living in Toronto, scraping my way through adolescent awkwardness and surviving. And then, at the age of fifteen, my parents sent me to boarding school in Massachusetts. I now find myself shuffling from the dining hall to early morning assembly with four hundred other boys through cold, rainy mist, seven hundred miles from home. And I’m miserable. My room-mate is a pathetic slave to the bully in the room next-door. They both make my life hellish with taunts and practical jokes, but not as much as the guy across the hall who can’t resist noticing that I’m Jewish every time I walk by. Within a year, depression had become a way of life. I had to endure one more year at that place and then the family plan was to move to California. That was a sweet thought. But enduring wasn’t easy. Isolation and anxiety were daily companions. So when a couple of guys espoused the glories of cough medicine, I was ready. And when the first joints got passed around, I wanted all I could get. This phenomenon of changing reality - changing how it felt to be me - was a miracle. My family did indeed move to California. It was the summer of 1968 and I was seventeen when I arrived at U Cal Berkeley. It seemed like
the Pearly Gates had opened. There were drugs everywhere. My friends would take LSD now and then. I took it three times a week. Pot or hash daily. Mescaline, uppers, downers...I tried them all. And I liked them all--because the depression had not gone away. It just went underground. I still felt inexplicably lonely, empty and anxious whenever I wasn’t with other people, and often even when I was- except when I was stoned. Having that switch to flip, I felt I could control my moods for a few hours-- or until whatever it was wore off. My first shot of heroin was no big deal, but by the time I’d taken it half a dozen times, I was infatuated. Within a few months, I only really cared for opiates. Other drugs were a diversion. By my last year at Berkeley, I would study many hours each day, then snort coke for a couple hours and study that much harder, then snort heroin and land in that familiar world of soft edges and dreams. I left Berkeley to get married to a Toronto girl. You’d think that would have straightened me out but my marriage got more and more difficult. Issues of immaturity and interlocking needs made both our lives miserable. By now I was a psychology student: late nights in the rat labs for my thesis research, but lonely and anxious, anticipating more arguments, more confusion, once I got home. Then I found morphine in the lab fridge. Someone had used it in their rat research and left the leftovers. It didn’t take long for me to start injecting again. Next I found jars of morphine in a closet down the hall. It was a huge amount which I continued to pilfer several days a week for over a year. And when I couldn’t get my hands on that I was ready to try anything. I started breaking into medical offices. I know that sounds like a massive dive from being a struggling kid to a hardnosed criminal, but somehow it wasn’t sudden at all. I attempted my first break-in after a terrible fight with my wife. I was stunned by helplessness and hopelessness. I was barely aware of what I was doing, and I climbed through an unlocked window. It got easier and easier after that. I figured out how to cut a strip of plastic into the perfect tool for opening doors. I would plant myself in the lobby of a medical building-- I still looked respectable enough to get away with it and then, when the medical staff went home, I would “visit” one office after another. I had learned by now to put aside my guilt, just like I put aside my depression and anxiety-- with drugs, always with drugs. By the age of 27, I had been arrested several times but never convicted, my wife and I were in the throes of separation, and staying off drugs took too much effort. Despite my best intentions, I would fail again and again. Even after weeks of abstinence, when the day darkened and the depression came on, I would tell myself: go ahead; it’s not the first time. I was now in graduate school in clinical psychology. I had worked hard to get there, and I was proud of my accomplishments- but I couldn’t stop. Despite many bouts of withdrawal symptoms, I was not “physically addicted” in any continuous way.Rather, I was psychologically addicted. And that’s far worse. Then came my first serious arrest. I was working as a summer intern in a mental hospital in a small city in Canada. I would grit my teeth day after day, fighting off the urges, the loneliness, and then finally give up. After several break-ins, I was caught with an armload of drugs, climbing out the window of a large medical complex. The cops were almost gentle as they relieved me of my burden and then cuffed me. We all knew it was game over, and a part of me was deeply relieved. My lawyer told me that I must get “character Continued on page 44
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SUBSTANCE ABUSE TREATMENT TODAY: A CRASH COURSE ON THE 12 STEPS. WHY IS THIS NOT THE SOLUTION FOR TREATMENT? By David Kolker, JD, LCSW
Roughly 3-5 percent of individuals completing inpatient treatment remain sober for 12 months or more. Is a 95% failure rate acceptable in any other business? Why has the treatment industry been doing the same thing for 50 plus years and somehow expecting a different outcome, absent substantial change? History supports treatment as an adjunct The approach to substance abuse treatment for the past 50 years has been a crash course on the 12 steps. There is no doubt that the 12 steps provided a much needed solution to issues related to alcoholism; however, Bill Wilson’s stated intention was not to discount or deny the importance of treating the entire person as an adjunct to the 12 steps. Moreover, Alcoholics Anonymous was to be forever non-professional, with the stated primary purpose “ to stay sober and help other alcoholics to achieve sobriety.” Bill Wilson, in a talk presented to the New York City Medical Society on Alcoholism, April 28, 1958, stated: When our combined understanding and knowledge have been fully massed and applied, we of A.A. know that we shall find our friends of medicine in the very front rank – just where so many of you are already standing today. When such an array of benign and cooperative action is in full readiness, it can, and will, surely be a great tomorrow for that vast host of men who suffer from alcoholism and from all its dark and baleful consequences. Thus, Bill Wilson clearly was in favor of: 1. Keeping AA non-professional; 2. Accepting outside help as part of the goal to treat the alcoholic; and 3. Understanding that the alcoholic, in many cases, needs help from professionals in conjunction with AA The treatment approach for the past 50 years The vast majority of the treatment industry has been teaching the 12 steps as the primary approach to 28-day treatment for a better part of the past 50 years. Treatment consists of working the first three steps, learning about the disease concept, defining powerlessness and acceptance, assistance with attainment of an AA/NA sponsor, internal and external triggers and relapse prevention. Why is teaching the 12 steps the focus of treatment when AA does a superb job of handling this responsibility and providing this service for free? The second issue is whether it is ethical to charge for a service that is seemingly free. A new approach: Addressing core issues in treatment As an illustration, let’s assume that an addict who has been drinking and using drugs for 15 years enters treatment at age 30. Additionally, let’s assume that this individual grew up in a family system whereby the father worked 90 hours a week, and the mother was a stay-athome mom, alcoholic and a participant in multiple affairs. Mom was lonely and used the patient as a surrogate spouse and confidant; thus, stressing the importance of maintaining her secrets. Moreover, the patient was a victim of sexual abuse by a neighbor from ages 7-10 and has never disclosed this abuse to anybody. This patient will enter treatment and AA, with warped definitions of the principles espoused in AA. Additionally, if this individual begins to work steps with their prior definition of concepts such as honesty, faith, courage, willingness and humility, the work they complete will be severely diminished. If the individual’s definitions have been defined via their family of origin, as is the case with most individuals including alcoholics and addicts, how can they be expected to have a foundation for healthy definitions of the aforementioned definitions? The answer, it is impossible! Unless this individual identifies the dysfunctional definitions they have been taught, as
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well as how these definitions have negatively impacted their lives and thereafter has assistance re-defining these concepts, physical and emotional sobriety will be tenuous. Re-examining the illustration above, it is likely this individual suffers from issues related to abandonment, trust, lack of healthy attachments, anger and severely warped definitions of love and intimacy; thus, arguably, a host of issues related to the need to numb via alcohol and drug addiction. A question posed by this writer is whether providing an education and teaching this patient about the disease concept and the intricacies of the 12 steps is a valuable first step in treating the patient as opposed to processing the patient’s trauma and abuse (core issues) for the purpose of identification and re-defining dysfunctional and destructive definitions of life. The first approach seems to put the cart before the horse and quite possibly has been a root cause of poor treatment outcomes of treating substance dependence. Additionally, this approach creates a revolving door of repeat business-beneficial to the industry and potentially life threatening to the patient. The latter approach, that of defining dysfunctional core issues, re-defining these issues/ definitions and thereafter or simultaneously incorporating the 12 steps seems to provide a much more comprehensive approach; thus, providing more successful outcomes. Opposition to treating Core Issues This writer was recently involved with a peer-peer review with a large insurance company seeking additional days of treatment for a patient. The patient is an 18-year-old female that has a history of suicide attempts, self-harm behavior, sexual abuse from the ages of 8-10 and Opioid dependence. Additionally, she completed 60 days of inpatient treatment without addressing issues related to trust, abuse, self-love, vulnerability or abandonment; however, she did work the first three steps of Alcoholics Anonymous, obtained a sponsor and began writing her fourth step. Thereafter, (within two days of departing inpatient treatment) she was injecting Heroin. This writer was discussing the patient with the physician from the insurance company who stated, “We don’t suggest that you take the patient that deep, she is only in partial hospitalization and intensive outpatient treatment for the purpose of acute stabilization!” The physician continued “If the patient’s family believes that she needs additional psychiatric assistance, it would be appropriate for you to discharge her from your program and have them place her in a psychiatric facility, although, they would probably need to pay out of pocket.” The lack of connection between core issues as a root cause of substance dependence creates a fallacy that treating substance dependence is as simple as removing the substance (acute stabilization). If this were a reality, it would only be necessary to place the patient in detoxification and that should be the end of the problem. Good luck with that approach! Another argument against treating core issues as a root cause of substance dependence is “the patient isn’t emotionally ready to Continued on page 10
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DRUG TREATMENT AND THE EVOLUTION OF THE SOUL By Philip Diaz MSW
You are not who you think you are. Most of us identify with our ego, the self that is attached to everything around us. The self that takes offense to others negative comments about us and identifies when we have been harmed in word or deed. The self that experiences the world on a personal level. This self-attaches to everything in relation to your ego, positive or negative. The world at this level is ego based and never neutral. Things are either good or bad. But there is another self who is on a higher plane than the small I. This other ego is called the observing self. Have you ever had the experience of watching yourself, being outside of an experience you are having? This often happens when you are either having a wonderful experience in which you experience happiness or a horrible experience which is causing you pain. In the first case, this observing self-moves above the joy but validates it and in the second case, watches the pain, but helps you to remove yourself from it. When people have out of body experiences, it is the observing self that is traveling outside the body. This observing self is attached to everything and nothing in particular. It has a quality of connection and universality. It is the core of spiritual experience, the point of meditation and prayer- the connection to all that exists. Anyone who has had this experience is aware of seeing themselves in body while experiencing themselves in spirit. According to many religious traditions, it is believed that after death, this is the part of ourselves that moves on. Often people abuse drugs as an attempt to reach this higher spiritual plane and seek to have egoless experiences, but instead, get trapped in the lower small I ego because instead of removing oneself from self, drugs increase the sense of ego experience and the small I in the experience is even more intensified. Drugs trap the spirit, they do not liberate. In my experience after thirty years in the drug treatment field, the current approach to treatment only intensifies the sense of the small I while ignoring the person’s real reason for using drugs to remove them from the prison of ego. This is especially true for people who abuse drugs. Drugs like opiates, alcohol and cocaine all intensify the sense of ego. We call this ego on a personal level as the small I. The impulse to use drugs is often positive but misguided. As we say, drug users are looking for God in all the wrong places. While AA is a spiritual program that I can attest for after 41 years sober in AA, treatment has an overwhelming psychological focus on the mental state of the client which traps the therapist and client in the ego, which is not the answer the client is seeking. The therapist is trying to alleviate mental distress by helping the patient become more logical and rational in their life and to help them become more effective in their decision making. They try to create an intellectual answer for a spiritual problem. In order for real treatment to take place, everything about treatment must change. We have created Spiritual Growth Therapy to answer the real issues for drug addicts. Most therapists try for mental change- we try for spiritual change. They look for education for the mind while Spiritual Growth Therapy looks for the evolution of the soul and a greater connection to the observing self. When drug addicts experience the connection to the source, the need for drugs dissipates and will stay dormant as long as the addict stays spiritually fit. By meditation, self-examination and dedication to service of others, the addict will stay connected to his higher self and evolve. As he evolves and comes closer to the source, the small ego becomes less important and drugs become irrelevant. Treatment for drugs and mental health issues is evolving. Spiritual Growth Therapy is the beginning of that evolution. At Evolve Mental Health and Lifescape Solutions we teach the soul, not just the mind, using meditation, acupuncture, transpersonal teachers, hypnosis, gestalt therapy, vibrational healing and many
10
other ancient tools to cross over to a new way of healing that connects us to the source of all that is. We are starting a new change process at the level of soul- healing that has as its goal, transformation to a whole new level of experience reminding us of the spiritual beings we are and have always been. Phil Diaz has over thirty years’ experience in the field of addiction and mental health. He is an internationally known trainer and coauthor of six books on trauma, addiction and spirituality. Phil has formerly worked in the White House Drug Czar’s office in charge of drug prevention policy in the United States. He is also a partner at Lifescape Solutions and Evolve Mental Health.
SUBSTANCE ABUSE TREATMENT TODAY By David Kolker, JD, LCSW
Continued from page 8
handle these issues, let’s get them sober first.” If the direct cause of a person engaging in addictive behavior (alcohol, drugs, sex, relationships, gambling etc.) is to avoid pain and dealing with abuse and trauma from their past, how can you “get them sober” absent addressing the direct cause of the problem. Alcohol, drugs, sex, relationships etc. are the solution to the problem, not the problem. The theory that an individual should deal with one addictive issue at a time has proven to be a dismal failure. If all of the substances (drugs, alcohol, sex, relationships etc.) are a means of avoiding the pain of the core issues, how will the person ever get well merely dealing with the faulty solutions, one at a time, as a means of solving the problem, given that the patient will substitute one addictive behavior for another as a means of avoiding the problem. Conclusion In summary, the present approach to substance dependence is a failure. The absence of a true multi-disciplinary approach that addresses biological, social and psychological issues, coupled with a twelve-step approach, is a set-up for a revolving door into present day treatment and the ultimate failure of the patient to get well. It is time that professionals in the industry stop accepting failure as the only means of treating an individual suffering from substance dependence. David Kolker is a Licensed Clinical Social Worker and a Juris Doctor. He is the Clinical Director/CEO and primary therapist at Sober Living Outpatient. He thrives on working closely with clients and watching them grow as individuals. David is published in the area of evidenced-based therapy and specializes in family dynamics and relationships as they relate to recovery. www.soberlivingoutpatient.com
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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS INSURANCE COMPANIES PLAY DOCTOR PART IV: MEDICAL NECESSITY 2.0 By: John Giordano DHL, MAC
“The very definition of insanity is placing your health in the hands of an industry – whose mere existence depends solely on not paying healthcare claims – and expecting a good outcome.” ~ John J. Giordano By all accounts, Salvatore Marchese was a lovable guy who was kind, sensitive, moral and embarrassed by his disease. He struggled with addiction through his high school years. Sal wanted desperately to get off of drugs and lead a normal life. He reached out asking for help; but help arrived in the form of insurance claim denials. Marchese was in and out of rehab facilities, but never for more than eleven days at a time. It was a constant struggle for Sal and his family to get insurance companies’ approval for the treatment he so direly needed. In the end, the insurance company won, saving thousands of dollars on life-saving treatment they determined to be not ‘medically necessary’ for Sal. Marchese is survived by his son, Salvatore W. II, who was eighteenmonths old at the time of his father’s death. Sadly, stories like Sal’s are becoming too frequent. In 2010, the year Sal died, 38,329 people perished from fatal drug overdoses in the United States, more than double the 16,849 fatal overdoses observed in 1999. Fatal overdoses from prescription opiate medications such as oxycodone, hydrocodone, and methadone have quadrupled in the same time frame. Americans, who represent less than 5% of the global population, consume over 80% of the world’s production of opiate pain killers – and 99 percent of the world’s hydrocodone – every year. There are ten times more people suffering with addiction than people who receive life-saving treatment – and that ratio continues to grow. We came to a point long ago where there was no denying we have a full-blown, non-discriminating deadly addiction epidemic here in America. The question that still remains today is what are we, as a society, going to do about it? Politicians told us the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA) of 2010 would right the ship. It has been seven and five years respectively since each piece of legislation has been signed into law. In that time over 200,000 Americans have died preventable deaths. The intent of the legislation looks good on paper, but its impact on turning the corner on this deadly epidemic has been negligible. In fact, many believe the legislation has been a boon for the insurance industry and a bust for addicts trying so desperately to get off drugs. Neither bill appears to have the teeth to rein in the insurance industry’s ramped and indiscriminate wielding of ‘medical necessity’ that is causing ineffective treatment and avoidable deaths – all for the sake of bigger profits. The insurance industries never-ending quest to grow their profits at the expense of their policyholders continues to erode addiction treatment best practices. Their policies are a sure recipe for more preventable deaths. I was talking to a friend of mine, Ira Levy, who was instrumental in the growth of Sunrise Detox. Facilities like Sunrise play an important role in not only detoxifying a patient, but also preparing them for the next level of care by providing therapy and a professional medical team for support and counsel. Ira mentioned to me that some insurance companies are toying with the idea of not paying for detoxifying opiate addicts. Their reasoning is this: the chances are an addict will not die if they don’t receive detox – therefore detox is not ‘medically necessary.’ Everyone should be concerned should the insurance industry decide to expand on this logic. This policy is tantamount to a person having his appendix removed without anesthesia. Apparently, the insurance industry is floating another detox protocol – out-patient detox. Considering no detox at all, this option almost seems humane. However, at its core, the concept of out-patient detox is as
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absurd as asking an addict to arrange his own intervention. The simple reality is that if addicts could detox on their own, they would have done it a long time ago. Neither of these options are based in science or reality. The insurance industry’s dictation of patients’ care protocols is centered solely in their opinion of what is medically necessary and on the strong objection of nearly every doctor, therapist and professional specializing in addiction treatment. Best practices and what is clinically appropriate are simply not part of the equation. I’ve also heard from reputable sources that addicts are being denied detox because they were incarcerated for a couple of days or more prior to treatment. This practice is becoming more and more common. Apparently the insurance industry, based on the supposition that drugs are not available in our correctional facilities, has determined detox is not medically necessary for opiate addicts who are assumed to have not used for a couple of days. If nothing else, this policy is certainly a fine example of your insurance company making medical decisions for you without consulting with your doctor. Unfortunately in making their decision, the insurance industry does not take into account the much needed therapy and twenty-four hour medical support an addict receives at reputable detox centers. Nor are they willing to accept science that has proven beyond any reasonable doubt that the time necessary to detox an opiate addict is directly proportional to the years said individual used, the amount used in the 30 days prior to detox, whether the patient is a quick or slow metabolizer, their liver and physical condition. Obviously the detoxifying process is far more complicated than the insurance industry wants to acknowledge. Anyone who is remotely associated with addiction treatment knows that one of opiate addict’s biggest deterrents to treatment is the pain associated with detox. Detoxifying the body of drugs can be so painful that many addicts view suicide as a realistic option – they’d rather die than go through the painful process. If you build a barrier between people wanting to get off drugs and detox, you are guaranteeing fewer individuals will seek treatment. Is it possible this new policy could be a diabolical plot to keep people from seeking effective treatment? Is the insurance industry herding addicts into the chute that leads to the lesser expensive Methadone/Suboxone clinic pens, or is this new policy just a coincidence? I’ll have more on this topic later. The duplicity, regretfully, doesn’t end there. The insurance industry has invested quite a bit of time and money in developing a sequence of skewed questions for case managers to ask doctors. The directed questions are carefully framed in such a way that a response can only lead to one answer – the one the insurance Continued on page 42
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THE ABCs OF RECOVERY By Ira Levy
In this industry everyone is always looking for the next best thing, the easy fix, the quick fix, new medication, holistic approaches, vitamins and therapies- those are all well and good, and it is important to move forward with treatments as we progress and learn more. What they seem to be missing is the core of what recovery was years ago, the basics. That’s where the ABCs of Recovery come into play. They are Acceptance, Believe, and Change. Acceptance It all starts with acceptance. Many addicts say “I am an addict.” They admit it, but it’s only lip service. They don’t really accept it down in their soul. They don’t accept it wholeheartedly, and so somewhere down the road there will be doubt, a moment when they think “I can do just one hit” or “I can have just one drink.” The problem is, they never really accepted that they can’t do just one. They think, “I’m a drug addict so I can have alcohol and smoke some weed,” but it leads them to the same place they were before. I know, because I’ve been there. Just because you’re a drug addict doesn’t mean you can drink, and vice versa- if you substitute your drug of choice for another, all you are really doing is switching seats on the Titanic. The key is to accept who you are, and what your limits are. Look at how you use and compare it to “normal” people- you will notice a difference. Be honest with yourself too. The goal is to be sober and clean, while living a happy and productive life, but that can’t happen until you can be honest with yourself. That leads right into the next step, and that is to believe. Believe Be honest, look at your life while using, something is lacking, right? It could your job, relationships, or happiness in general. You need to have the genuine belief that life can and will get better or else it will never happen. It’s less of a religious idea and more of a spiritual one. Believing in a power greater than one’s self, and knowing things can get better.
could happen and I know how I feel. I know where this road leads. If I change, I won’t know anything.” Change Change is hard, although some may seem easy. If you’re addicted to crack, stay out of crack houses. If you’re an alcoholic, stay out of bars, and so on and so forth. But there are other things that need to change that aren’t so simple. What if you live in a house with an active addict? Or if you have a job that enables you? For example, if you are addicted to pain pills, you can’t be a pharmacist. It would be like giving a five year old the keys to Toys-R-Us. Opening up to new things is scary, but it’s needed to really heal and change. Once you go out and do the “new” things though, they aren’t new anymore and it becomes easier. Doing new things can be uncomfortable because they are new but it’s something that is needed. In recovery they basically take away your best friend. Your needle, your drug- that was your best friend. Now you have to find something else to fill the void deep inside you, the void in your soul. Once you accomplish this you have a chance to become who you want to be. You are on a good plain, in a good place, and your life becomes more than your next hit. Ira Levy is the National Marketing Director for Sunrise Detox in Florida. He previously was admission coordinator for the National Recovery Institute. In 1996 he became the National Marketing Director for Focus Healthcare overseeing four hospitals throughout the country. After leaving Focus in 2001 he worked as a consultant for various treatment centers. In 2004 he joined Sunrise Detox where he is today. They have multiple locations throughout the country. He has worked with numerous treatment centers all over the country, and has become a resource for many treatment providers and employee assistance professionals. He began his career in 1992 working as a mental health tech.
The number one argument for this step is “if I can’t see it, how can I know it’s real?” Well, you may not be able to physically see it, but you can see the results. Just like the wind, you can’t see it blowing but you can see the trees move when it does. Think about the times when you were using, when things were out of your control. Think about how someone can overdose once and die and others can overdose multiple times and live. There is a higher power or a power greater than one’s self. There are levels to addiction. You will hear people say things like “functioning addicts,” but is that the way you want to live? Functioning. Every level of addiction eventually gets worse. Addiction is like an elevator, you can get on at any floor. You might be at the top floor, with a family, a good job, and a successful life. You could also be at the bottom with nothing, or anywhere in between. It’s not until people lose something that they realize they have a problem. You need to believe that there is a better way to live. Once you accept your problem and believe that there is a better way to live, the final step is to make the necessary changes to obtain that better life. This is by far the hardest to accomplish. Humans by nature are creatures of habit, and that’s the case even more so for addicts. Changing is not only a lot of work, it is also a trip into the unknown. Sometimes it’s just the fear of the unknown that keeps addicts using. It’s common to think along the lines of, “Yes I have an addiction, and yes it is bad, but this is a bad that I know. I know what
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THE DO’S AND DON’TS FOR THE NEWLY SOBER WITH PTSD By Jerry A. Boriskin, Ph.D., C.A.S.
Early sobriety is difficult enough, but for those with co-occurring PTSD it can feel overwhelming. Without your substance of choicetypically used for self-medication - symptoms can be raw, powerful and intrusive. Do not despair; you can and will get better with proper guidance, lifestyle changes and professional care. I am often asked, “How do you deal with the PTSD?” I have distilled the essence of early treatment to a basic three S’s - sleep, safety, and sobriety. You cannot move forward without being sober, in a relatively safe setting and without getting uninterrupted quality sleep. Here are a few do’s and don’ts that might provide a basic framework for you and prove useful. Things to Do: 1. Do attend recovery support meetings and stick with your treatment plan. 2. Do find meetings that you are comfortable with; LifeRing, if available in your area, is sometimes a desired alternative to traditional meetings. 3. Do work with a psychiatrist familiar with both conditions and be assertive if the medications are too potent or insufficient. There are safe anti-craving medicines that may help you stay sober during those fragile first 90 days. 4. Do get quality sleep! I cannot emphasize how vital that is. There are non-addictive medicines that facilitate sleep- Doxepin or Mirtazapine, for example, as well as medicines that block nightmares. A little known secret is an old anti-hypertension medicine, Prazosin, which is remarkably helpful in easing night sweats and nightmares. The VA has been using this for years with excellent results. 5. Do develop regular sleep patterns in a darkened, quiet room with no distractions. Don’t watch the news or violent movies or play intense video games just prior to sleeping. 6. Do rule out sleep apnea; your sleep quality and health may be harmed if your breathing patterns during sleep are poor. The evaluations are simple and affordable. 7. Do get moving! Daily aerobic movement will help with depression, anxiety and anger. Break a sweat- safely, of course - once daily for at least 20 minutes. It will help in more ways than I can explain in a brief article; the positive evidence is overwhelming. 8. Do learn and practice yoga breathing. Knowing that you can calm down with a few paced, fully exhaled breaths can be a lifesaver. I also highly recommend a mindfulness discipline. Many forms of Yoga, Tai Chi, meditation and Chi Quong are invaluable to many. 9. Do clean up your diet. I strongly recommend the healthy diet of your preference- not for weight loss necessarily - but for mood management. Surges of insulin can set off anxiety or panic. If possible consult with a nutritionist and/or use a fitness diet app. Stay away from Rockstar and similar ‘energy’ drinks. 10. Do consider a canine adjunct- service dogs can enhance your recovery and perceived safety. 11. Do find a qualified psychotherapist. A psychologist, social worker or other specially-trained allied professionals can help you deal with PTSD. Be certain your provider is licensed. Look for trusted recommendations but remember to be assertive and insist on a provider who makes you feel safe. There are many approaches and techniques with many confusing acronyms and promises. If the clinician promises a ‘cure’ or insists on their own agenda, technique or pacing, find another provider. The key is quality of relationship; your perceived safety is paramount. Don’t 1. Don’t avoid or deny PTSD: Dealing with denial is not limited to addiction; trauma survivors want to avoid remembering or acknowledging they were overwhelmed by events. Remember,
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PTSD is not indicative of ‘insanity’ or ‘weakness’; at its core it is A NORMAL REACTION TO ABNORMAL EVENTS. 2. Don’t procrastinate: Those who begin working on trauma issues within the first six months of sobriety are much more likely to stay sober. 3. Don’t ruminate: “I just need to figure things out.”- occurs most often alone, and at night. PTSD is not ‘solved’ by thinking; in fact it gets worse when you overthink it. 4. Don’t isolate: “I don’t trust anybody and nobody can understand me”. This is simply not true. You are not alone and you should not remain alone, isolated, silent and miserable. 5. Don’t be discouraged with setbacks or relapse; relapse can be part of your emotional recovery. Do not become discouraged. Getting flooded happens. Your job is to learn to prevent those triggers from controlling your life. 6. Don’t hesitate to utilize higher levels of care, if needed. If you relapse in both the addiction and emotional domain you might need higher levels of structure, support and care. Finding the right setting or system can be difficult but you must persist and insist. These conditions, while not ‘curable’ are very treatable and your quality of life will improve. 7. Don’t grab on to newly-hyped treatments: hallucinogens, exorcisms, surgeries or supplements may do far more harm than good. Look for credible evidence, even if the technique claims it is evidence based. Medical marijuana, for example, has testimonial support but the evidence is not yet solid, and it poses a risk for dependence, relapse and mood disruption. 8. Don’t continue with techniques, methods or groups that cause emotional ‘flooding’. Recovery is not an epiphany with Hollywood drama and a flood of tears. It is a process. 9. Don’t lose hope. Never give up. Whereas many addiction treatment models place emphasis on ‘surrender’, the goal of your PTSD recovery is finding your voice and your power- safety, articulation and empowerment, not control is the goal. Dealing with the aftermath of trauma in concert with an addictive disorder can be perplexing to you as well as your providers. Never lose faith in your own resilience, learn to derive a narrative and remember that PTSD recovery is a process, not an absolute. Your symptoms can become strengths in terms of wisdom and supporting others who struggle. Work on acceptance as well as forgiveness - it will get better! Jerry Boriskin, Ph.D., C.A.S. has more than thirty-five years of experience as a licensed clinical psychologist, PTSD specialist, certified addiction specialist, and program consultant. He worked in South Florida for 17 years and developed residential programs for co-occurring PTSD and addictions. He is currently working with VA Northern California returning to his roots as a clinician treating combat veterans with complex PTSD. www.jerryboriskin.com/blogs
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WHY THE ROAD TO RELATIONSHIPS IN EARLY RECOVERY IS OFTEN ROCKY AND NOT RECOMMENDED By: Heather Coll, LMHC
As a substance abuse therapist, there are certain things I dread hearing from a client in early recovery. One of those being, “so, I hooked up with someone I met on tinder.” Any clinicians reading this will be able to resonate with the immediate and internal distress that comes up for a clinician in that moment. If you are in early recovery yourself, you may be wondering what the big deal is. Possibly, this suggestion was also made to some of you reading this article, but you also quickly dismissed it. For this reason, I would like to expound upon this matter and explain why clinicians and sponsors discourage such a decision. And no, it’s not because we are mean ogres who don’t want to see you happy. In fact, it’s because we do want to see you happy. Why Relationships In Early Recovery Can Be Rocky • Distracting Substitution: Addicts look outside of themselves to soothe themselves internally. When the substances are removed, the recovery person may look to other things outside of themselves to regulate their feelings and increase self-esteem. Relationships can be used in this way in early recovery. For this reason, relationships in early recovery can become consuming, can pose as a distraction to working one’s program thoroughly, and therefore can result in relapse. • Low Self-Esteem: One’s choice in partners is often a reflection of one’s self-esteem and in early recovery, it’s often deficient. For this reason, the recovering individual will often choose an unhealthy partner that they may not have chosen at a later stage in their recovery. In addiction, because relationships can be utilized to mask issues of low self-esteem, the recovering person may become unaware of their feelings of inadequacy until a problem occurs in the relationship. When that happens, not only do they lack the skills necessary for coping with feelings of inadequacy, but they must also manage the pain associated with the relationship issues. With limited coping strategies, the combination may be enough to result in a relapse. Unless a recovering individual has insight into their low self-esteem and negative core beliefs, they can’t be addressed therapeutically.
• Enabling: Because persons in early recovery have not yet resolved their own issues of low self-esteem, trauma, and/or abandonment, they are likely to choose unhealthy partners that are co-dependent and enabling. • Fear of Being Vulnerable and Intimate: People in early recovery are often uncomfortable being vulnerable and often avoid intimacy, which is necessary for a relationship to be healthy and to flourish. How Long Should I Refrain From Dating? When my clients ask me how long they should refrain from getting into a relationship, I let them know that the usual recommendation is for them to refrain for at least a year or until they have completed the 12 steps. Then I let them know my recommendation, which is not contingent on a time frame, but on a state of mind. Specifically, I encourage my clients to refrain until they are confident that they are healthy enough to choose a healthy partner and be a healthy partner. For each recovering individual, the goals and time frame associated with this will vary and should be developed collaboratively with their therapist. Recognizing My Powerlessness Although I dissuade my clients from getting involved in romantic relationships in early recovery and provide education on how it may adversely impact their recovery, I also recognize my true powerlessness to the decisions that they make. Once the decision has been made and my client is adamant that they will continue to pursue the relationship, I choose to take the approach of supporting their decision and helping them to navigate the relationship as best as possible in order to minimize the potential harm to their recovery. Specifically, I try to take a proactive role and educate them on the warning signs of unhealthy relationships, Continued on page 42
• Re-enactment of Prior Relationships and/or Trauma: Until a recovering person has therapeutically addressed and resolved their history of trauma, they are at risk for reenacting their history of trauma by choosing an unhealthy partner. When one’s trauma is reenacted, it reinforces one’s negative core beliefs, which can result in a relapse. • Lack of Identity: Many recovery persons struggle with their identity in early recovery. If one is unsure as to who they are, what they want in life, and what their preferences are, how can a person make a wise decision regarding a romantic partner? • Programs Diverge: If your partner is also in early recovery, it is possible that you and your partner will be growing in different ways during your recovery journey. Even if you and your partner are working strong, parallel programs, each partner may progress at a different pace and each may grow in different ways. • Abandonment Issues: Many people in early recovery have abandonment issues. Relationship issues, particularly a break-up can trigger issues of abandonment and can result in a relapse. • Poor Boundaries: The boundaries of the recovering person are often poor in early recovery, which may make a person prone to being taken advantage of or being mistreated by their significant other. If this happens, one’s self-esteem may worsen further predisposing a person to a relapse. Other individuals may present as controlling and intrusive of others’ boundaries, which may harm their partner and therefore, their relationship. • Sabotage: Your significant other may be invested in keeping you sick if you’re getting healthy threatens them. They may actively attempt to sabotage your recovery and keep you sick.
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FLAKKA: PARENTS NEED TO KNOW ABOUT THE RISING POPULARITY OF THE LATEST DESIGNER DRUG AMONG TEENS By Mendi Baron, LCSW
Running naked across a major intersection, attempting to kick down the doors of a local police precinct, and shouting from a rooftop while naked and wielding a gun; these are just three examples of bizarre behavior that have been linked to flakka, the newest designer drug on the streets. Known by some as “gravel” because it comes in crystalline rock form and deemed “the insanity drug,” by the media, because it causes such crazy behavior, its’ popularity among teens is surging because it is cheap. For just $5, flakka is far too affordable and accessible for adolescents who fail to understand the drug’s serious risks. While the turbulent years of adolescence present parents with more challenges, conflict, and stress, parents need to remember that they still have a strong influence on the decision-making of their teens. More likely than not, the fact is your teen has already been to at least one party where alcohol and drugs, including flakka, are readily available. When it comes to talking to your teen about critical issues like drug use and abuse, it is important that you keep the lines of communication open. In fact, studies show that the more frequent the antidrug messages are at home, the less likely a teen is to become a user. To start that conversation about this new and deadly designer drug, parents first need to learn as much as they can about flakka; so let me fill you in. Flakka is addictive, dangerous, and potentially deadly. It resembles a white or pink crystal, a cross between crack cocaine and meth, with a distinctive foul smell. Flakka comes from the same designer drug family as bath salts, which caused a similar string of bizarre behaviors in 2012. Both bath salts and flakka are cathinones, a class of synthetic drugs that produce short and long-term effects that are similar to crystal meth and cocaine. The effects of the drug can last as few as 3-4 hours, but can also linger for several days. Flakka floods the brain with dopamine and then blocks the brain’s natural dopamine re-uptake process. It also causes a surge in norepinephrine, increasing heart rate, blood pressure and feelings of alertness. It is a highly addictive drug, both from a physical as well as a psychological perspective. When eaten, snorted, injected or vaporized in an e-cigarette device, flakka creates a feeling of euphoria, “excited delirium,” an abundance of manic energy, and hyper-stimulation. It can also cause excessive sweating, seemingly superhuman strength, paranoia, and hallucinations that can lead to violent aggression, self-injury, and even psychosis. Flakka is most commonly vaporized using an e-cigarette, which quickly sends the drug into the bloodstream and increases the likelihood for an overdose. Some flakka users continue to take more of the drug while high, a practice known as “snacking. Or they combine flakka with other drugs, causing serious health complications and drug-induced delirium. The main ingredient (a chemical compound called alpha-PVP) is not federally regulated, which means the drug is technically legal in any state that doesn’t specifically ban it. Again, because it is so inexpensive, flakka abuse is on the rise and it’s sweeping through Florida as well as popping up in Texas, Oklahoma, and Ohio. Paramedics who have driven teens high on flakka to emergency rooms, say, “this drug is scary.” The emergency calls come in describing trouble breathing, chest pains, and patients who seem mentally unstable. In addition, when the body enters a state of psychosis from flakka abuse, internal body temperatures can exceed 105 degrees accompanied by a rapid heart rate. Excessive internal temperature can lead to kidney damage, muscle breakdown, or kidney failure. Flakka has been linked to deaths by suicide as well as heart attack.
effective when it comes as part of a greater conversation. While your words carry weight, no one wants to be lectured, especially teens. Your teen may already know about flakka, so don’t be surprised if they roll their eyes when you broach the subject. Talking about drugs will not tempt your teen to try drugs. A conversation with your teen about drugs is a two-way dialogue: a give and take that builds trust and respect. If you are confident that you have built a trusting relationship with your teen, then your teen will most likely feel comfortable and confident enough to say “no” to drugs and will not succumb to peer pressure as a “cool” way to fit in. Having this conversation with your adolescent may save their life! Mendi Baron, LCSW, is the founder and CEO of Evolve Treatment Centers based in Southern California. A passionate advocate for teens in the field of mental health and addiction, Mendi is the go-to expert to start the conversation on critical issues that impact teens and their families. For more information, please go to www.evolvetreatmentcenters.com or call 1800-665-GROW
Talking about drug and alcohol use with your teen is always most
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THE BIOLOGY OF ADDICTION By Dr. Eduardo Pena, MD
Some in the addictions field have suggested that addiction is a medical condition like diabetes. Yet, many find the medical view antithetical to a psychological and spiritual view of addiction. Fundamental beliefs about choice and self-determination seem challenged. Although the mind cannot be reduced to neural activity, it is worth taking a look at the biology of addiction and understanding the medical view. Substance abuse typically begins with experimentation in the early teen years. Experimentation results from the developmental inclination of adolescents to try out adult experiences. Unfortunately, the risk of developing an addiction increases the earlier experimentation begins. With persistent use, there is a change of friends and interests. As abuse progresses into addiction, a fundamental change occurs in the user. What began as a social activity undertaken by choice, becomes a solitary activity undertaken by compulsion. Broken relationships, academic failures, job losses, and arrests fail to deter the addicted user. This end stage of substance abuse is stereotypic. The behavior of a heroin addicted person is similar to the behavior of an alcohol addicted person. The behavioral impairment is milder with tobacco and marijuana, but the overarching pattern is similar – compulsive use. The addicted person no longer feels normal when they are not high. Even the highs have changed. They obtain diminishing pleasure from their substance , increase the doses, combine drugs, and move to more potent delivery methods like intravenous injection. The addicted person begins to hate their drug, yet the addiction becomes increasingly compulsive. Let’s look at what is happening to the brain in this process. The human brain is comprised of about 100 billion neurons (brain cells), each functioning like a switching station. A spray of neurotransmitter from one neuron reaches across a microscopic gap to bind with the receptors at the receiving branches of the next neuron – the dendrite. This sets off an electro-chemical wave known as an action potential that spreads over the receiving neuron. Depending on the set point of that neuron, that action potential is either stopped in its tracks or propagated down the axons – the firing branches of the neuron. When an action potential does reach the end of an axon, it releases neurotransmitters to other neurons. Neurons arrayed in systems serve specific functions. The limbic system manages memory, mood, and motivation. Within it, the mesolimbic-mesocortical subsystem manages motivation and pleasure. Simplifying, there are three major areas involved in this subsystem when it comes to addiction: the ventral-tegmental area, the nucleus accumbens and the prefrontal cortex. Imagine you were laboring through your income tax return. After a few hours, fatigue and distress set in. You go to the refrigerator for some refreshments. At first, you only find mundane items: milk, bread, mayonnaise. Then you spy a bakery box! The ventral tegmental area, which responds to stimuli with potentially greater than routine reward, begins delivering dopamine to the nucleus accumbens - the pleasure center. You open the bakery box and find a moist chocolate cake inside. It’s pleasure just looking at it. Dopamine starts to surge in the nucleus accumbens. Now the signal is passed on to the pre-frontal cortex which, as the brain’s executive, has to make some decisions: How many calories can I afford? How much time do I have for this? You judiciously cut out a slice as the pre-frontal cortex closes the loop with feedback to the ventral tegmental area bringing your desire into balance. Your pleasure center (nucleus accumbens) is then stimulated with dopamine with each chocolaty bite. Take note that the circuit was transversed before the first bite. That is because this circuitry is about desire and motivation and not just about pleasure itself. So what do drugs do to warp this subsystem? Well, imagine that the white powder baked into that moist chocolate cake was cocaine instead of sugar. Cocaine has ten times the potency of sugar in
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the nucleus accumbens. That pleasure would be hard to resist and with repeated consumption, the nucleus accumbens undergoes a homeostatic down regulation of its dopamine receptors. It reduces the number of dopamine receptors, in an attempt to normalize the dopamine activity. Over time, there is decreasing sensitivity to things that ordinarily would stimulate and motivate. Only drugs of abuse suffice now. The rest of the limbic system adapts through neuroplastic changes to the new priorities. Neuronal connections (via dendrites and axons) instrumental to addiction related behaviors strengthen and those that are irrelevant start to die off. The pre-frontal cortex becomes less active in managing behavior and requires less blood flow and fuel. In distinction to other rewards, like sugar, the attraction to substances does not stabilize in priority but continues to rise in importance. This is why addicts will even risk their safety in pursuit of drugs once their addiction has become severe. Teens are at greater risk for addiction because their brains are under development. In adolescence, it undergoes a major remodeling wave from the back of the brain to the front. As this wave passes over the limbic system, the nucleus accumbens becomes robust while the pre-frontal cortex is still under construction. The result is an excitable, curious teen without the benefit of a pre-frontal cortex in full control. Mother Nature seems to have created a dicey situation for teens (and their poor parents) but this situation is actually adaptive because adolescence is about independence. Teens would not launch if they did not get excited over their own interests, their own mates, and branch out to create their own lives. The problem is that the developing brain is particularly vulnerable to substances that stimulate the nucleus accumbens. If substances of abuse affects everyone’s brain in a similar way, why are there such great differences in the propensity to addiction? Well, young people can inherit different risk factors for addiction. Young people who are impulsive, irritable, have trouble with delay gratification, have ADHD or bipolar disorder, are at risk to develop addiction. These conditions reflect an imbalance in the same areas of the brain as is affected in addiction, and make it harder for that person to be satisfied with the ordinary range of stimulation. A child with a predisposition does not inevitably become addicted but under environmental stress like a dysfunctional family or trauma, addiction becomes harder to avoid. We as recovery professionals can only benefit our clients and their families by offering as full an understanding of addiction as possible, including the biological side of the story. Dr. Eduardo Pena specializes in Addiction Medicine and Addiction Psychiatry and is the medical director at the VA Substance Abuse Department, Recovery Associates and is a Clinical Assistant Professor for NOVA SE University.
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3/27/15 10:37 AM
LIFE’S ONION®
Breakthrough Therapeutic Tool Produces Big Results for Clinics and Clients We all know the saying about what to do when life gives us lemons - make lemonade! But what do you do when life gives you onions? If you’re Mark Wetherbee, founder and creator of Life’s Onion, you make a therapeutic tool so innovative that it is awarded a patent. Life’s Onion is a handheld, onion-shaped device with 12 peels which transforms into a flower when opened. People in self-help and therapy record their goals and achievements on the actual peels, and peeling them back to flower petals as progress is made. It’s a simple tool, but its application is what makes it unique: while there are other methods of tracking improvement, Life’s Onion is the only product which marks people’s progress in a tangible, visual form and remains with them to reinforce their successes. One Life’s Onion user stated, “It will be a daily reminder of my journey through treatment, self-reflection, growth, and continued success in life.” It is not often that people have a visible reminder of their growth and achievements outside of the therapeutic environment, and this was clearly the creator’s goal. Life’s Onion incorporates elements of journaling, art therapy, Cognitive Behavior Therapy and Schema Therapy. The tool can be used by an individual or with any therapeutic modality or style. In addition to the tool itself, there is a full package of support materials designed to integrate Life’s Onion into existing programs. After more than 3 years of research, development and field trials, Life’s Onion is now being made available to the public. To find out more visit: www.lifesonion.com
WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? Sunset House is currently classified as a level 4 transitional care house, according to the Department of Children and Families criteria regarding such programs. This includes providing 24 hour paid staff coverage seven days per week, requires counseling staff to never have a caseload of more than 15 participating clients. Sunset House maintains this licensure by conducting three group therapy sessions per week as well as one individual counseling session per week with qualified staff. Sunset House provides all of the above mentioned services for $300.00 per week. This also includes a bi-monthly psychiatric session with Dr. William Romanos for medication management. Sunset House continues to be a leader in affordable long term care and has been providing exemplary treatment in the Palm Beach County community for over 18 years. As a Level 4 facility Sunset House is appropriate for persons who have completed other levels of residential treatment, particularly levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the world of work, education, and family life. In conjunction with DCF, Sunset House also maintains The American Society of Addiction Medicine or ASAM criteria. This professional society aims to promote the appropriate role of a facility or physician in the care of patients with a substance use disorder. ASAM was created in 1988 and is an approved and accepted model by The American Medical Association and looks to monitor placement criteria so that patients are not placed in a level of care that does not meet the needs of their specific diagnosis, in essence protecting the patients with the sole ethical aim to do no harm.
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The Benchmark Transitions® Program Benchmark Transitions is a comprehensive, multi-disciplinary approach to therapeutic transitional living for young men and women, ages 18-28. Our dual-diagnosis model combines clinical treatment, behavioral health therapy, addiction recovery & aftercare, educational & vocational opportunities, job training and life skills in a structured and nurturing environment that fosters self-discovery and autonomy. Benchmark Transitions offers day treatment, IOP and structured transitional living in a sober environment. Minimum length of program is six months with extended care options available. Benchmark is designed to be a step-down transition program for participants coming out of other primary treatment programs, such as Detox, Residential Treatment Centers, Wilderness Therapeutic Programs, hospitalization/stabilization units, and for adolescents aging-out of Therapeutic Boarding Schools. Benchmark is also an ideal option for young adults who are “stuck” at home with failure to launch issues.
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WHAT PEOPLE WANT FROM ALCOHOL AND OTHER DRUGS? By Terence T. Gorski
Why are so many people drawn toward using alcohol and other drugs? What do they want the alcohol and other drugs to do for them that they are unable to do while clean and sober? Over the course of my career, I’ve asked hundreds of people this question and I was surprised to find that almost everyone gave me one of the following seven answers. WHAT PEOPLE WANT FROM USING DRUGS 1. To Get High (To feel the pleasant state of drug-induced euphoria) 2. To Relax 3. To Be More Social 4. To Manage Feelings 5. To Get More Energy 6. To Block Out Pain 7. To Be More Spiritual 8. To Have Better Sex Let’s look at each of these in more detail. TO GET HIGH … Some people use alcohol and drugs to get high: If they have a genetic predisposition toward addiction, they experience an intensely pleasurable feeling called euphoria when they use their drug of choice. They do not feel “drunk” or “stoned” in the usual sense of those words. They feel a unique sense of well-being. Everything seems right. They feel normal, competent, functional, and relaxed. They feel like they can handle anything. They love that feeling and keep using in order to get it. Most people find they can’t get that euphoric feeling in any other way. Euphoria The Feeling That Addicts Want To Have. The Feeling They Eventually Need to Have! TO RELAX … Some people use alcohol and drugs to relax. They feel constant stress and pressure and mind altering substances help to: turn the stress off, relieve pressure, help them to calm down and feel mellow. These people usually use alcohol, sedatives, or tranquilizers to help them relax. Once they depend upon the drugs to relax, there’s no need to learn how to relax using other methods. Relaxation Is Just a Swallow Away TO BE MORE SOCIAL … Some people use alcohol and drugs to be more social. They want to make it easier to get along with other people, take the rough edges off of their personality. Many people find that they feel better about themselves when they are drinking and drugging. As result, it is easier for them to deal with other people. This newfound social ease is caused in part by the euphoric effect of the drug. Another big part is psychological. When under the influence of alcohol and drugs, many people can give themselves permission to do things that they would never be able to do sober. Most of us learn to be who we believe we are early in childhood before we even have the power to use language. We learn our sense of self intuitively, by watching and copying the behaviors of others and noticing how people react when we do or don’t do certain things. Without words, we discover a basic sense of ourselves as being ok (meaning that I believe I can belong in the world and succeed by doing what is expected of me) or being Not ok (meaning that I believe that no matter what I do or how hard I try I can never really belong in the world because I am incapable of doing what other people and the world expects of me). Remember, this learning is done in the first eighteen months of life by intuitive observing how other people behave, what works and doesn’t work for them, and how people treat me when I do or don’t do certain things. This basic belief about self, others, and the world becomes a
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basic template for our personality. Once established it is difficult to change – unless we have a magic drug (our drug of choice) that allows us to step out of the comfort zone of our early childhood learning, feel good about ourselves, and do the things we need to do to belong and succeed. As people find their drug of choice and begin to regularly use, many develop a social persona based upon our self-image as a drinker and drug user. Once developed, if we were to stop using alcohol and other drugs, we wouldn’t be sure of whom we really were, how people viewed us, and how we could fit into the world. To MANAGE FEELINGS … Some people use alcohol and drugs to manage feelings: They may want to get rid of “bad” or uncomfortable feelings. The problem is this - when people manage their feelings with alcohol and drugs, they have no need to develop or use other emotional management tools. As a result, they need to use alcohol or other drugs in order to cope with their emotions. People who start using alcohol or other drugs on a regular basis during their teenage years never learn these emotional management skills. Why work hard at learning how to manage feelings when a quick dose of alcohol and drugs makes it easy? As a result, most addicted people find it very difficult to manage feelings and emotions when they try to get into recovery. If You Are Addicted and Do Not Like The Way You Feel, Relief Is Just a Swallow Away. TO GET MORE ENERGY … Some people use alcohol and drugs to get more energy and feel more alive. They want to get stimulated, feel excited, and be powerful. The drugs that are most likely to produce these energizing effects are the uppers, such as amphetamines, cocaine, and crack. The problem here is that this drug-induced sense of power is a false sense of power. This Drug-Induced Sense of Power Is A False Sense of Power! You Are No Stronger, Tougher, Or Competent Than You Were Before. You Just Feel Like You Are! You feel down on yourself, lonely, and weak. Then you take an amphetamine pill, snort a line of cocaine, smoke some meth or shoot up some amphetamines and all of a sudden, you feel like superman or superwoman. Are you really that powerful? Of course not! You are the same person you were before you took the drug with one very important exception – the drug is distorting your judgment and making you feel like something you’re not. You are no stronger, tougher, or competent than you were before taking the drug. You just feel like you are. If you are dumb enough to put this drug-induced delusion of strength to the test, you will probably end up falling flat on you face. TO BLOCK OUT PAIN … Some people use alcohol and drugs to block out pain. They want to get rid of unpleasant thoughts, feelings, and memories. The narcotic drugs, like heroin, morphine, oxycodone or Vicodin are most likely to produce this effect. These drugs manage both physical and emotional pain To Be More Spiritual … Some people use alcohol and drugs to be more spiritual. They want to alter their consciousness and have mystical feelings. They want to find and share an experience of God that can give their life meaning and purpose. They want to feel spiritually connected and learn to transcend themselves by connecting with some higher power, higher vision, or higher set of values. They also want to feel closer and more deeply connected with other people. The Mind Benders, like LSD, and Ecstasy are most likely to produce this effect. Continued on page 44
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GOVERNOR SCOTT SIGNS “SOBER HOME” BILL (HB 21) INTO LAW Wednesday, June 10, 2015, the “Florida Sober Home Bill” (HB 21) crossed the last hurdle by achieving Governor Scott’s signature on its way to become state law, effective July 1, 2015. For FARR, this voyage began in 2012 and charted us through some very challenging waters. We encountered hostile elements and, at various moments, feared our little ship would capsize. Fortunately; the mast held and along our journey we’ve been graced with tremendous support from many sources. Without all of you; there would be nothing to celebrate. Congratulations to all! There are far too many contributors to name them all here. You know who you aware. You are agency leaders, substance use treatment facilities, charitable foundations, lobbyists, legislators, legislative aides, committee chairs, clinicians, recovery coaches, community leaders, private citizens, certified residences and affiliate supporters whose investment of time, experience, knowledge and financial support empowered FARR to suit up, show up and hoist the sails yet another day. We salute you. This is unquestionably your win! In the still water; please allow us a moment to acknowledge just one agency specifically. We want all you to be aware of our deep and profound gratitude to this particular partner. The Florida Alcohol & Drug Abuse Association (FADAA) essentially adopted FARR without fanfare or ceremony. This well-respected, non-profit organization headquartered in Tallahassee voluntarily assumed responsibility to support FARR in our mission to promote recovery residence standards. It is through their leadership, mentoring and ongoing commitment that we celebrate this day together. There is simply no way to overstate the contribution FADAA makes to ensure consumers of recovery support services, including those offered by recovery residences, are standards-based and deliver on their promise to place consumer wellness ahead of other considerations. We are humbled and honored by FADAA’s continuing contribution to the FARR Mission.
CAPRSS Accredited Recovery Community Organizations (RCOs) will address “Building Recovery Ready Communities”. Surrounding these keynotes will be presentations regarding NARR Support Levels, recovery residence certification to the NARR Standard and the plan Floridians for Recovery (FFR) will reveal to assume a leadership role in promoting the New Recovery Advocacy Movement throughout Florida. YPR will present an overview of Recovery Messaging and a video booth will be available for those who wish to record their personal recovery story for publication on the FFR website (edited to approximately 3 minutes in length). During the breaks, several musicians will provide entertainment. Seating is expected to sell out and we hope you’ll join us for this celebratory event! This legislative initiative, now passed into law, positions us to effectively advocate for quality recovery support services in Florida. We’ve arrived in safe harbor for a time to provision our ships for the next leg of this voyage. Join us in Orlando and participate in navigating our way towards a Florida that embraces all paths to Recovery, placing consumer and family wellness ahead of provider profit. The two objectives can coexist nicely together only when the former leads the way. We recommend early registration for those who have a genuine interest in the keynote topics, as well as those vested in learning more about the impact this new law has on substance use treatment and recovery support service providers. The same holds true for potential sponsors and exhibitors. Opportunities to participate in the 2015 FARR Summit are limited and at the time of this publication, over half are taken. In fairness to all, both event registration and sponsorship opportunities are offered on a first-come, first-serve basis. Hope to see you in Orlando and we thank our supporters, including Affiliates, Friends of FARR, and Certified Residences for making this historic moment a reality! Together, we will build a model for Recovery Support worthy of replication throughout our nation.
So, how and where will we celebrate together? Join us at the Orlando Omni ChampionsGate Hotel for the FARR Golf Tournament & Awards Dinner followed the next day by the 2015 FARR Summit. Tee off is at noon on August 3rd followed by the awards dinner on property at 7:00pm. The 2015 FARR Summit conference room doors open at 7:30am for coffee and continental breakfast followed by a full day of informative presentations beginning at 8:30am and running through 5:30pm. A complimentary lunch buffet is included. Remain at the Omni ChampionsGate for Florida’s Premier Behavioral Health Annual Conference August 5-7th hosted jointly by FADAA/FCCMH. FADAA has added a “Recovery Track” to the annual conference that promises to provide informative content. The Orlando Omni Champions Gate Hotel is a beautiful venue and the Summit seats 300 for morning and afternoon keynote presentations by nationally acclaimed speakers. Dr. Ijeoma Achara discusses “Recovery Capital” as the underlying mission of recovery residences. Mr. John Shinholser, co-founder of the McShin Foundation, one of only five
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THE PROMISE OF LGBT PRIDE AND RECOVERY By Thomas Mondragon, LMFT
Currently we see an ever-growing support for substance abuse recovery through effective treatment strategies, residential and outpatient programs and medical inroads. Yet, there is still a great deal of misunderstanding, stigma and bias when it comes to addiction. Equally wonderful is the growing acceptance of gay men, lesbians, bisexuals and transgender (LGBT) individuals. But the current cultural and political climate also shows there is still a long way to go towards full LGBT acceptance and civil rights. During June, there were Pride celebrations taking place in cities small and large. Initially started to memorialize the 1969 Stonewall Rebellion in New York City, the event was seen as the birth of the gay liberation movement. Gay Pride celebrations honor this pivotal stance against homophobic violence and discrimination too long unchallenged in our culture. The Stonewall Rebellion also represents a beginning emergence out of shame and homophobia, biphobia, and transphobia tragically imposed on all LGBT people. Starting the process of saying no to homophobic oppression is rooted in an innate but often buried personal pride in being LGBT, yearning to be uncovered. Coming out, whether you’re a 14 year old lesbian, or a 50 year old gay man, is an initial proclamation of self-worth, a choice to begin breaking the shackles of the insidiousness of heterosexism, and an opening up to having LGBT identities explored and cherished. Similarly, saying “I am an addict” means getting honest and real about the power and soul-destroying effects addiction has had, while making different choices to support a new life of healthier self-valuing. Both represent confronting different aspects of deeply sourced shame and often trauma. Being LGBT and an addict brings particular challenges, dynamics and possibilities for healing. But some would question the connection between being LGBT and substance abuse. After all, young people come out earlier and earlier, right? Same sex marriage is legal in 37 states. Glee, Empire, Orange is the New Black, How to Get Away with Murder – all have prominent visible LGBT characters. Doesn’t this say we don’t have the same kind of oppression plaguing us anymore? When gay men are abusing drugs at much higher rates than their heterosexual counterparts, does this really have something to do with being gay? Study after study alarmingly shows significantly higher rates of substance abuse among LGBT individuals. This includes studies among college LGBT young adults – the segment of the LGBT community that supposedly has an easier time coming out now. College campuses can be intimidating for any student. Many campuses have created Safe Space programs because of overt and/or implicit homophobic rejection and other real oppressions LGBT students still experience while in the process of finding themselves, how they want to express themselves, and who they want to form relationships and community with. Children have a powerful need for necessary reinforcement from parents and the adults in their lives so that a child’s healthy wonderment of an emerging sense of self is to be felt as good and lovable in each person’s unique individual expression. For example, imagine the positive feelings a young gay boy would experience when a parent non-shamingly understands that his crushes on his father or a male school mate are normal developmental steps towards a healthy gay identity, just like his heterosexual brother “wanting to marry mommy when he grows up” is understood and not ignored. Instead of silence, imagine the positive effects on this young gay boy if the bedtime stories he was read included the same sex themed myths of ancient Greece, or if he was taught in history class that there have always been significant influential same sex loving persons throughout time such as Socrates, Walt Whitman, and the homosexual artists of the Renaissance.
even when he comes out at 15 years old to parents who declare they love him for who he is, and yet his being gay doesn’t get talked about within the home, with extended family, at school or church. Even with a Gay/Straight Alliance club at school, imagine hearing “that’s so gay” as a powerful slur and putdown, day after day. Or imagine getting the message that gay sex is disgusting when as a young teen and adult he is also longing for love and sexual exploration with another young man. Imagine what the psychological spiritual impact might be on him. Now imagine this young gay man meets someone he wants to experience an intimate relationship with or have sex with. He should just know how to do it right? What’s the big deal, it’s just sex? However, “just sex” for many gay men – young and older – still carries the weight of profoundly instilled homophobic messaging that brings shame, fear, anxiety and distress. It makes sense then that he carries all this with him when he comes to that deeply intimate moment with another man. We can understand that he might think that a few drinks, a drug or a combination of drugs, would make it easier and less intimidating. Imagine how this too easily becomes a pattern if the initial source of shame and wounding around his desire for gay love and expression is not dealt with head on. What can be most transformative is to recognize that the longing he feels when he meets that young man that gets his heart racing is also more than a desire for love and relationship with another man. A reparative and imaginative gay-affirmative perspective, sees this other hot man as a symbolic friend in his psyche – soulfully inviting him to go inside himself with curiosity and courage to foster an experiential understanding of the psychological, emotional and spiritual value and meaning of being homosexual. Recovery is often seen as a spiritual program. We can likewise envision that an ongoing developing gay identity has a similar possibility. To have the fullest feeling of pride would mean to explore what prevents this gay man from having more authentically felt feelings of worth and value. If we consider the ongoing development of a valued gay self as a hero’s journey, then we can imagine that part of recovery for a gay man involves an honest non-judgmental self-appraisal of how homophobia and heterosexism has stood in the way of experiencing himself as lovable because he is gay, but how unprocessed dark feelings of shame and feeling unlovable would be connected to abusing substances or other self-destructive behaviors. In this example of a revelatory journey, Pride then brings the promise of greater potential, well-being, and vision for all LGBT individuals on unique paths of healing and recovery. Thomas Mondragon, LMFT, is a West Hollywood, California psychotherapist and professor at Antioch University Los Angeles’ LGBT Specialization in Clinical Psychology, providing his clients with LGBT affirmative counseling and expertise. He can be reached at 310-779-3113 or at thomasmondragontherapy.com.
But also imagine the confusion and shame that gets created
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LIVING BEYOND
A Monthly Column By Dr. Asa Don Brown
THE ATTRACTION OF ADDICTIVE HABITS “I guess we always find excuses to keep on with our bad habits, don’t we?” ~ Stephen King The habits we are attracted to bring us a sense of comfort, reassurance and confidence. The addictive mind is enamored with habits that bring reprieve from the undesirable and the unpleasant aspects of life. Addictions rarely start off as an intentional escape, rather through the use of the chosen addictive habit; the addict finds a path with which to escape aspects of his or her life. Addictions are not always about escaping either; rather sometimes they are about a pleasurable act that ignites into an addictive habit. What is an addiction? An addiction is anything that negatively consumes a person. An addiction can be any substance (legal or illegal), activity, or possession that provides a continuous escape from reality. While our intent may not always be to give over to an addiction, the addiction’s charm creates an impenetrable wall with which we are incapable of breaching. Moreover, addictions may even start off as a positive pursuit, but through time and usage, we find ourselves negatively attached to the addictive habit. THE NATURE OF THE ADDICTION “Every form of addiction is bad, no matter whether the narcotic be alcohol, morphine, or idealism.” ~ Carl Gustav Jung The moment that we can no longer refuse, deny, or give-up a habit, then we will find ourselves consumed by an addiction. A majority of addicts make plausible excuses why they cannot give up the habit. While research has shown that there is evidence of a biological and chemical relationship to addictions; there is also the psychological component to the addictive habit. What is the stimulus? The argument remains: is the addictive habit itself the source of the problem; or are there psychological triggers that awaken the need for the habit; or is there a biological or chemical need that is being met by the addiction? According to Indiana University’s website, “Individuals with addictive behaviors often have low self-esteem, feel anxious if they do not have control over their environment, and come from psychologically or physically abusive families.” The addiction may be fulfilling a void, or a subconscious issue from the past or the present, and/or an underlying psychological problem. The nature of addiction from a neurobiological perspective could be further explained through a reward system. The reward system is based on the concept that the neural structures generate a need to be met and reinforced. If the appetitive stimulus is a particular behavior, act, or thought, and it is met, then the person has received his or her reinforcement. Reinforcement does not always have to be a positive reward, rather it is any form of reinforcement, whether negative or positive, that provides the individual encouragement and an increase sense of self.
Gradually there is a shift from conscious motivated seeking of drugs (addiction) to a stimulus response driven drug (addictive) habit.” Thus, the addiction becomes a more natural or unconscious response, than a purposeful action or conscious decision. It has been said that if you continuously and repetitively perform a task that in time that habit becomes a regular and unconscious routine. As a clinician, I have used repetitive acts to create positive habits. For instance, I have often used breathing and meditation in my therapeutic practice. Furthermore, I have found tremendous benefit from using breathing and meditation in my own life. Likewise, I have found that if a patient purposefully and consciously uses breathing and meditation on a daily basis that in time this task becomes an unconscious behavior. As a society we seldom think of addictive habits as being a positive source, but I have found that if we purposefully and consciously seek positive habits then we can transform our way of thinking. CREATING POSITIVE HABITS “Cultivate only the habits that you are willing should master you.” ~ Elbert Hubbard Creating positive habits begins by making a conscious decision to change some aspect of your life. It is through purposeful action that we will create positive habits. If you have been struggling with an unhealthy eating habit, the choice not to eat unhealthy foods will need to be initiated by our conscious mind. In time, the conscious choices that we make will become and form unconscious behaviors. “The habits of highly successful people allow them to consistently perform behaviors that breed success. Everything from eating well to responsible spending to task completion and beyond requires habits that make such behaviors part of our daily life.” While I have been discussing two distinctly different types of habits, the truth is the formation of negative habits affect positive habits and vice versa. Moreover, while the creation of a number of negative habitual acts may be influenced by biological and chemical presets, there always remains the psychological component. We must recognize that we are ultimately in charge of our own physical being. Likewise, if even the treatment of the addiction uses a medication or medical regiment, the individual who is addicted must desire to find health, happiness, and peace. Otherwise, all of the treatment in the world will remain void. Ultimately, the treatment of any addiction must begin with a desire of the person being treated. May you begin living beyond.
Dr. Asa Don Brown Author: Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Website: www.asadonbrown.com
“The reward system is a highly complex system and is composed of sub components and several distinguishable neurobiological mechanisms. Reward often manifests as hedonic pleasure and motivation to seek out that pleasure as well as to avoid displeasure.
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JOURNEY OF RECOVERY By Carol Bettino, MA, LPC
Your past may have influenced where you are today, but where you want to be tomorrow is up to you. No matter when, how, or why you started using or abusing drugs, at one point it became a learned behavior. You may have learned about drugs in your own family. For some, a family member may have turned you on or used with you. For others, you may have tried to escape feelings or memories that brought you to a place you didn’t want to be and selfmedicating became easier. Even with the innocence of having fun with friends, it still can become a bad habit that leads to addiction that could destroy your life. Most importantly, anyone can change bad habits; because anything learned can be unlearned. While bad habits may be hard to break, good choices are not as difficult as we sometimes make them. Imagine a dog accidently trapped in the trunk of a car. No matter how short the trip was, the dog, if given a choice, would never want to go in a car again. There would be no denial it was a bad experience; one he would not want to relive again. Yet, even if you had a bad experience or a major consequence at any time during your use, why would you ever use again? The “Boiled Frog Syndrome” may shed some light. If a frog was placed in boiling hot water, it would leap out immediately. Intellectually, the frog knows he is in a bad place. He does not want to feel the pain. He is aware of the consequences of staying. However, if the frog doesn’t jump, it will acclimate to the temperature. As the temperature continues to rise, it adjusts to the heat no matter how painful. Eventually the frog boils to death. This is similar to addiction. Regardless of the consequences, staying builds tolerance. The more you tolerate, the more you use, and the longer you stay. Denial keeps you trapped. You ignore the warning signs and problems that come with continuing to engage in drug use. Ultimately, it’s too late. Many describe this as their “rock bottom.” In order to change a behavior, you must first change your attitude toward it. You must acknowledge that you have the problem and how it has impacted your life. In my book, “Directions: Your Roadmap to Happiness”, I discuss the ABCs of Life. • A is Attitude (Your thoughts, feelings, perceptions, and interpretations) • B is Behavior (Your reactions, responses and behaviors) • C are choices (Decisions you make and the consequences of those choices) If your perception is you are not addicted, you will continue to use in spite of the problems your using causes. Your faulty thoughts, feelings and interpretations will keep you stuck in denial. Conversely, if you hit rock bottom and are not in denial, you’ll seek help. Changing your attitude will help you change your behavior and the quality of your life. Your attitude can ultimately lead you to addiction or recovery. When you are in denial, your thoughts, feelings, perceptions and interpretations are distorted. The longer you engage in self-defeating behaviors, the more you train your brain that your chemical use is a viable option in your life. In reality, if you are addicted, you are not choosing any options. The drug has control. You may be powerless over your chemical addiction, but you are not powerless over the choice to use or not to use. Your brain works like a computer. It stores memory and connects links together. When you continue to use, everything you do while using becomes connected and natural. Not using creates anxiety and overwhelming feelings. The brain looks for normalcy. Unfortunately, for the addict, normalcy keeps you trapped in your addiction. Recovery is possible but you must be willing to change the way you perceive your life and the choices you make. Before you can successfully stop the behavior you must retrain your brain to think, feel, interpret and perceive things and situations differently. I recommend the following simple steps to stop those self-defeating behaviors: • First, “Recognize you have a problem and decide what to do about it.” Just like the first step of Alcoholics
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•
•
• •
Anonymous, you must admit you are powerless over a chemical and your life is unmanageable. Now that you acknowledge you have a problem, take responsibility to do something about it. Make sobriety your number one priority. Abstain from all chemicals. Remember one drink/drug is too much, because one is never enough. Second, “Own your behavior” Be honest with yourself. Be aware that denial is a road to relapse. Admit you can’t do it alone. Don’t blame anyone or anything for the choices you have made. Third, “Take responsibility for the behavior.” Make a conscious choice to stay sober. Seek professional help, attend AA meetings and find a sponsor. Look up and read about addiction. Reprogram your brain by avoiding old hangouts and old friends who use. Find healthy alternatives to deal with the urges of using. Fourth, “Try to understand your feelings.” Talk to others who struggle with addiction. Journal your thoughts, feelings and behaviors. Make an appointment with a therapist. Fifth, “Stop the behavior immediately.” By now, you should have already begun to reprogram your brain that you have alternatives. Stop all use. No excuses. There will never be a good reason to use. Nothing is worth losing your sobriety over. Don’t give in to urges. Get rid of all paraphernalia.
Chemical addiction is a disease. You may not have caused it, but you are responsible to find a way to treat it. Abstinence is the first step. You may be powerless over chemicals, but remember you are not powerless over making the choice to use or not to use. If you struggle with problems from your past, you do not have to let them have power over you in the present. Do not let anyone dictate the direction your life will move in the future. There was a banner in church that I found quite profound. It simply said: “God’s gift to you is life. Your gift to Him is how you live it. Stay sober and live a happier and healthier life. Carol Bettino is in private practice in Prescott Valley, Arizona. She is the author of “Better Choices, Better Life” and “Directions: Your Roadmap to Happiness”. She is an Adjunct Faculty Instructor at Northern Arizona University-Yavapai and Yavapai Community College. Follow her blog: directionsaroadmaptohappiness.blogspot.com
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WHEN SOCIETY LOSES CONTROL: A NEW CHALLENGE TO HEALTHY RECOVERY By Stephanie Brown, Ph.D.
Ever since the beginnings of my own recovery, I’ve been asking the question “what happens to people after they stop drinking?” I’ve been exploring the terrain of recovery and outlining theories about just what happens for over 40 years. I’ve defined recovery as a process, not an event, which occurs developmentally over a lifetime following abstinence from alcohol or other substances and addictions. Over the years, it’s become a broader question: what happens to people who have lost control and come to face it? The idea of “recovery” is not new. Something happens after abstinence. But understanding just what happens is still a challenge. For decades lay and professionals alike believed that abstinence was the goal and the end point of treatment. Abstinence would be a static state of wonderful. Then we came to understand there’s more. The idea of “family recovery” is still new. We learned in The Family Recovery Research Project during the 1990s that recovery is, and can be, bigger than the individual addict. Help has been available for family members, but it’s still hard to comprehend what is “normal” in a long-term process of change for the family as a whole. We used to believe that active addiction was bad and recovery was good. Simple. Abstinence would be the “fix” that makes everyone well and everyone happy. It turns out recovery is not so simple. It is good, but it is also hard in ways that nobody expected. Recovery is a process of radical change and growth, with highs and lows and massive uncertainty, all leading to a much healthier self and relationships eventually. We learned that it was helpful for families in treatment and new recovery to have a “map” that would help them normalize the rough and rugged road ahead. Teaching families to expect radical disruption as normal, and to give them tools to cope with this turmoil, provided reassurance and support to navigate the anxieties of massive change that recovery would bring. We learned that the process of recovery is counterintuitive: what is normal goes against what is logical. Instead of “happy ever after” with no problems, the family in recovery embarks on a tumultuous process of change which can throw everyone into high anxiety, panic and often a greater sense of danger than during active addiction. “At least then, we knew what to expect even if it was awful,“ said a baffled family member. “Now, nobody knows what’s happening. “ We came to call new abstinence the trauma of recovery for the family. This was shocking news: the normal processes of individual and family recovery are destabilizing, creating chaos that makes no sense, unless you know it’s normal. With all this disruption, people reach out for support in order to maintain their focus on their addiction and recovery so they can create and maintain a quiet-enough calm to help them keep their focus on the tasks of recovery growth. Individuals and families rely on “holding people and environments” outside the family, such as continuing care in treatment programs, 12-step groups and people, and other community resources to provide essential support in weathering the long, often chaotic and stressful process of change for the family. We used to think of society as a “holding environment,” a “normal” place of stability, providing structure and healthy social mores when the family collapsed in the throes of addiction and the stresses of new recovery. People anticipated a “reintegration” into normal life. But now society is out of control, addicted to a faster and faster pace of life. Society no longer operates as a safe haven for wobbly individuals and families new to their recoveries. For many, society is now the major threat, a bigger version of their own “alcoholic family”. New Threats To The Stability Of Recovery Before the 21st century, many challenges could threaten the stability of recovery – the ups and downs of normal life such as illness, work stresses, financial gains and losses, even a family member’s active relapse. Families in recovery learned to cope with life’s challenges without losing their recovery perspective and stability.
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Now we’ve got a cultural bandwagon that does threaten to destabilize all recovering individuals and their families. I have called this societal threat SPEED, our addiction to going faster and faster in a grandiose, unlimited pursuit of progress and success. People embarking on new recovery are finding it difficult to maintain a focus on the realities of their addiction, including the new learning necessary to establish and maintain recovery. They reach outside the family for safe supports, but these people and structures are gone, lost in a cultural addiction to speed. Society has lost control, exactly like the addict and family lose control in the downward spiral of active addiction. Society is caught in the same out-of-control behavior, distorted, illogical thinking, including denial and rationalization, and the intense, internal pressure to score – to stay on-line, to keep plugged in, to never stop – the same emotional state of the addict on a run with the terrified family helpless to stop it. We are seeing families in recovery thrown backwards into loss of control and a dangerous new addiction, this time to technology and the pursuit of “more, better, Faster.” The emotional experience of being addicted to technology can also trigger a relapse to the first, core addiction. The alcoholic in recovery chases a fast pace and begins to rely on sleep medications, for example. The natural body rhythms and the development of self-regulation that grow with time in recovery are quickly lost to the high of success. The dry drunk common to new abstinence becomes the normal state. People may remain in abstinence from alcohol, other drugs, food or gambling, but they are no longer calm, no longer able to focus, to listen to others and reflect. Chasing after SPEED, the family is on a dry drunk that threatens to derail all of family recovery. SPEED is society’s new addiction that calls us all to get on board. The lure of wild success promotes a gambling state – go baby go, blow on the dice – faster, faster, spend; spend as if there’s no bottom. The cultural mandate to never slow down, never accept limits, threatens every individual, couple and family in recovery. Individuals in recovery have accepted loss of control. Families in recovery have learned the same core truth: we all have limits. The path of recovery is grounded on this acceptance. Yet, society is now waving the lure that we can once again have it all. Just like the recovering addict can be drawn back to have “just one,” new SPEED addicts vow to take time, to slow down, but often lose their way. The will to get on board society’s new gold rush is overwhelming many people in recovery. It doesn’t take long to lose the calm, the center, and your deep knowledge of limits. It doesn’t take long to be off and running. Treatment centers, 12-Step programs and recovering communities must become aware of the new addiction. It will take careful, constant attention to the principles of recovery to withstand the pull to give it up in the service of finding a new high. Stephanie Brown, Ph.D. is an internationally recognized authority on the trauma and treatment of alcoholics, all addicts, and their families. She directs The Addictions Institute, an outpatient clinic in Menlo Park, California. She is especially well known for her work on the theory and treatment of adult children of alcoholics. Dr. Brown’s many contributions to the field include research, teaching, clinical work, and publishing, including her books on ACOAs and The Family Recovery Research Project. In her latest book, SPEED: Facing Our Addiction to Fast and Faster and Overcoming Our Fear of Slowing Down -Berkley( Penguin)2014, she applies her theories of addiction and recovery to a culture that has lost control. www.stephaniebrownphd.com.
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GOING INSIDE THE ADDICT’S BRAIN WITH NEUROIMAGING By Courtney Lopresti
Once upon a time, it was illegal to dissect a human body. In classrooms, students did not look upon plastic skeletons or crosssections of the human face; instead they looked at illustrations that combined animal organs with human heads, crude approximations of what was “probably” in there. The more dedicated anatomists sneaked outside the city walls and cut down criminals from the gallows to study. One anatomist in particular, Andreas Vesalius, would hide the bodies under his clothing and carry them back home to his bedroom where he kept them for weeks at a time – in various states of disassembly, of course. Medical knowledge has come a long way since the early days of modern anatomy. The ability to open up the human body and look inside of it has preceded the understanding of the human muscular system, the human stomach, the human heart. Opening up the human body has allowed experts to investigate –and ultimately treat – various diseases ranging from smallpox to tonsillitis. And now opening up the human body has the potential to revolutionize researchers’ understanding of the mind when it comes to drug addiction. What happens to the brain after a single use of cocaine? Which neural structure can help doctors predict who will become an addict and who won’t? Which of the brain’s regions is smaller – or larger – in drug addicts? All of these are questions that can be answered by taking a look inside a living person’s brain with various neuroimaging techniques, helping scientists stay on the cusp of addiction research. Functional MRI In the 1990s, scientists developed the ability to peek inside the human brain and see how it responds to the world. Functional magnetic resonance imaging – or fMRI – is a brain imaging technique that uses changes in regional blood oxygen to determine which brain areas are active and when. Articles about functional MRI often talk about specific brain regions “lightning up,” painting a biological picture of various cognitive processes from reading a book to pining over a loved one. Functional MRI has also been used to inspect the brain during various disease states in order to figure out how these diseases tick. One of these disease states is addiction. The functional MRI has provided considerable insight into how the addicted brain functions. For instance, the images reveal that chronic cocaine users have low levels of activity in midline areas of the anterior cingulate, a region responsible for behavioral and cognitive control. Functional MRIs have also linked the pleasurable experience of intoxication in a wide variety of drug classes to activity within the subcortical striatum. A full list of addiction related discoveries attributed to functional MRI is too exhaustive for this article, but the procedure is today’s most commonly used neuroimaging method. There are some downsides to using functional MRI in order to better understand drug addiction. Functional MRI does not offer very good temporal resolution, meaning that it is difficult to trace the exact timeline of brain activation. Most studies with functional MRI only take snapshots of the brain every two or three seconds – practically a lifetime when considering that neurons send over a billion signals per second. Another issue with functional MRI is that it does not directly measure neuronal activity – it only measures blood oxygen levels. Scientists, however, are reasonably confident that oxygen levels correlate with neuronal activity. Structural MRI Like functional MRI, structural MRI allows scientists to look inside the brain of a living person. Unlike functional MRI, however, scientists cannot see what the brain is doing. The main advantage of structural MRI is its ability to produce high resolution images of the human brain. Scientists can use these images to pinpoint the location of a wide variety of structures. By measuring the amount of
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gray and white matter in these structures, scientists can determine whether or not they are abnormally large or small compared with the overall population. Structural MRI has revealed that chronic drug use can enlarge or shrink various structures in the brain. For instance, multiple studies using structural MRI have found that gray matter within the prefrontal cortex shrinks as a result of drug use. The prefrontal cortex is an area associated with impulse control, decision-making and logic. A smaller than average frontal cortex could be one reason why people with chemical dependence find it difficult to stop using even when drug use begins to negatively impact their lives. Scientists have also found that chronic users of cocaine and meth have larger than average basal ganglia, suggesting a heightened amount of the neurotransmitter dopamine and therefore, inflated reward processing. PET Positron emission tomography, or PET, was the precursor to functional MRI and was once the typical way in which scientists measured brain activity during cognitive tasks. PET, however, is considerably more invasive and less safe than fMRI. In order to see areas in the brain to “light up” during PET, scientists must first inject their subjects with a radioactive tracer. This radioactive tracer travels through the brain, hitching a ride in the bloodstream and reflecting the ebb and flow of activity throughout the task. Luckily, the amount of radiation is low, but it still makes PET an unattractive way to measure brain function. Scientists succeeded at attaching radioactive tracers to various illicit drugs. This allows scientists to study the precise ways in which drugs interact with the central nervous system. Scientists can literally see the drug enter the brain. They can then evaluate where it binds, how long it sticks around, and the various other ways in which it influences cell-to-cell communication. Research using PET is responsible for linking both dopamine and the reward system with drugs of abuse. These three neuroimaging techniques are only some of the ways in which scientists are investigating the causes and effects of drug abuse on the human brain. Researchers and clinicians continue to strive to create new forms of neuroimaging as well as improve the techniques that already exist. Every year, the image of the human brain will grow just a bit clearer – and the cure for drug addiction will get a little closer. Courtney Lopresti is a Medical Writer for Sovereign Health Group. To learn more about Sovereign’s addiction treatment program, read more of Courtney’s work and to read patient reviews, visit www.sovhealth.com.
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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS INSURANCE COMPANIES PLAY DOCTOR PART IV: MEDICAL NECESSITY 2.0 By: John Giordano DHL, MAC
company wants. These meticulously constructed questions were not born out of science or medicine; nor are the doctor’s forced responses a true measure of a patient’s progress in treatment. These questions – developed with interlacing self-serving bias – were never intended for that purpose; but rather to further blur the fine line between ‘clinically appropriate’ and ‘medical necessity’. Once again this conscious and deliberate effort by the insurance industry to increase profits and pad their bottom line severely undermines their policyholder’s health and could lead to their death. Doctors and therapists fear talking to case managers – and their trepidations are not unwarranted. Their job requires they talk with case managers regularly. Over time, the addiction experts have become aware of the case managers’ trick questions and learned through their experiences that they are looking for any little thing they can possibly find that might lead to a lower level of treatment – or no treatment at all – resulting in cost savings for the insurance company. Something as innocuous as a patient saying he or she is feeling a little better – which can change from day to day – is enough to influence case managers’ opinion and change the course of treatment. Doctors and therapists will at times down play a patient’s progress knowing full well the case manager will use the information in demanding the patient be relegated to a lower treatment level before they’re ready or ending treatment all together. It’s a constant, never ending tug of war between what is best for the patient and the insurance company’s cash outlays. My good friend and colleague Dr. Ken Blum, co-discoverer of the reward gene – a.k.a. the addiction gene – is very disheartened by the lack in progress in addiction treatment over the last 25 years when he first announced his discovery of the addiction gene. He holds the insurance industry partially the blame. According to Dr. Blum; “It certainly takes more than thirty-days for an addict’s brain chemistry to normalize and potentially ninety days or more. Moreover, a person with a genetic predisposition to addiction has inherently lower dopamine function. Dopamine is the brain chemical associated with addiction function. Lower dopamine function is the key issue – one of the single most important treatment issues – that is not being discussed much less addressed in the vast majority of treatment programs available today. In addition, the oppressive policies instituted by the insurance industry have stymied the implementation of new evidenced-based and scientifically-proven treatment that can help every addict, especially people with chronic addiction issues. Imagine where we could be today if all the brain power and energies exerted over the last twenty-five years trying to determine what is medically necessary were instead focused on developing new and innovative addiction treatment protocols.” I’ll have more on this in my next segment. Addiction is a chronic, incurable, life-threatening illness that can be managed. The ranks of people suffering with addiction grow every day. Yet the insurance industry continues to either deny or cut short life-saving treatment to people – ravaged by their disease and hanging on to life by a thread – based on their own set of complicated self-serving guidelines. Their matrix is more opinion than science; more managing profits as apposed to managed healthcare. Their motives are aligned with the board of directors while flying in the face of the medical board. The insurance industry has given no indication they intend to follow the spirit of the Affordable Care Act and the Mental Health Parity Act; in fact just the opposite. They are standing like an impenetrable road block between you and your doctor. There are some who say the insurance industry’s position and power to have the final say in what is medically necessary for you constitutes a death panel. The only action that could possibly change the course is a public outcry. For those of us fortunate enough to have gone through
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rehab we know we didn’t do it on our own. We relied on each other to produce a positive outcome. If we are to effect positive changes in the healthcare industry, we need to band together one more time. All I ask is that you contact your congressman and senator and ask them what they are doing to prevent the insurance industry from dictating addiction treatment protocols. If you can’t do it for yourself, please do it for the person behind you who needs life-saving treatment but is being blocked by the many barriers put up by the insurance industry. This is our battle and this is our time to shine! “There are in fact two things, science and opinion; the former begets knowledge, the later ignorance.” ~ Hippocrates John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cuttingedge treatment check out his website: www.holisticaddictioninfo.com
THE ROAD TO RELATIONSHIPS By: Heather Coll, LMHC
Continued from page 18
their rights in romantic relationships, and coach them on issues pertaining to assertiveness, communication, and boundaries. Suggestions For Those Who Have Decided to Pursue A Relationship While In Early Recovery If you are like many of my clients who are adamant that they want to pursue a relationship despite being recommended otherwise, I hope you will keep reading. First, I suggest that you disclose honestly to your therapist and sponsor about the relationship. You might not like the initial reaction, but if you refrain from disclosing this information, your support system in navigating the relationship may be limited and inadequate. Sure, your buddies may be able to offer some support and advice when things get rough, but your therapist and sponsor are important members of your treatment team and are the best equipped to help support and guide you. In the early portion of the relationship, you may feel that things are unfolding perfectly and you may not be able to imagine that the two of you could possibly encounter any difficulties. Although I would love for that to persist indefinitely, that is not realistic. Eventually, there will be a conflict, differences in communication, and even a potential break-up. If your therapist and sponsor are already aware of the relationship, you will most likely be apt to contact them for support. But, if they don’t know about the relationship, it’s more likely that you will not go to them for support and will be left without professional help. I’m sure my clients are initially apprehensive about telling me about their relationship, but they often express gratitude that they did when they start to need support around relationship issues. I recognize that for the reader in early recovery, this information may not be met with the most enthusiasm. So, if this article fails to adequately challenge the recovering persons’ view on relationships in early recovery, I hope at the very least it has convinced them to share the status of their relationship with their therapist and sponsor. Heather Coll is a licensed Mental Health Counselor in the Sate of Florida. Heather has a private practice in Delray Beach and specializes in the treatment of substance abuse, depressive disorders, anxiety disorders, PTSD and trauma resolution, selfesteem issues, and perfectionism. Heather also facilitates an outpatient substance abuse group Monday evenings from 7:00-8:30 pm. Heather Coll can be contacted via telephone @ 561.843.8917 or via email: hcoll@rocketmail.com.
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FROM DRUGGIE TO SCIENTIST: HOW I FINALLY MADE SENSE OF ADDICTION By Marc Lewis, Ph.D.
references” from everyone who knew me if I wanted to stay out of jail, and all I could think of were my professors. So I got a year’s probation rather than jail time, but now everyone knew. I was promptly kicked out of school. My dreams of becoming a psychologist were shattered. Back in Toronto, washing windows, painting houses, working finally at group homes for troubled kids, I still couldn’t seem to stay abstinent. I’d remain sober for weeks, even months, and then dive back in. The whole thing became deeply intolerable. My girlfriend left me, my friends became distant, and I hated my life, hated what I was doing to myself and began to hate the drug itself. I forced myself to meditate every day. I knew that meditation was powerful stuff. Then there was one final binge which left me weeping with self-disgust. And the next morning, something was different. I wrote the word “No” on a piece of cardboard and stuck it to the wall of my apartment. I told myself over and over that I could say that word whenever I had to. I could keep saying it to myself for an hour, which meant I could keep saying it for a day, a week, even a year. And maybe because I was old enough, maybe because I was ready, maybe because the attraction to the drug was so tainted with revulsion, this time it stuck. After roughly two hundred failed attempts, this one worked. I was thirty years old and I was done with drugs. About a year later I applied to half a dozen graduate schools in psychology. I was so sure I’d be rejected by all of them that I made back-up plans for my back-up plans. I even applied to undergrad programs in other fields. Whatever it took, I was going to do it. And then, to my amazement, I got asked for an interview at the University of Toronto and I met the man who would soon be my supervisor. He listened to me recount my life as an addict - there was no way to hide my record - and he appreciated that the person was much more than the addiction. He saw that there was more to me, and I showed him that he was right. I got a Master’s and then a Ph.D. in Developmental Psychology at the University of Toronto. By the time I graduated in 1989, I had published enough of my own research to be competitive for a university job. I did not attempt to hide my criminal record, and I got a couple of rejections, but I was offered a professorship at my own department. They knew me and they liked me. And I was good at what I did. Then I got a license to practice Clinical Psychology, and I started seeing clients when I could. Students, clients, grants, publications, a large endowment to build a lab, a shift in my research from psychology to neuroscience... Life was very busy, and very satisfying. Only now, at the age of 64, I’m starting to slow down a bit. I’m able to reflect, to look back, but also to look forward. My present family and I live in the Netherlands, where my wife is the professor and I’ve become what I’ve always wanted to be: a writer. I’m a science writer, and I write about addiction. Around 2006, I began to review and synthesize the literature on the neurobiology of addiction. As a neuroscientist myself, I was able to analyze it. As a writer, I was able to put it into accessible language and interpret it for ordinary people. And as a former addict, I was able to blend the science of addiction with the experience of addiction. I began to see that this blend was exactly what was needed to make real progress in the field. We could start to understand how addiction works in the mind, in the body, and in the lives of those it affects, all at the same time. It’s my goal to continue to work at this juncture for the rest of my career. My first book, released in 2012, is called Memoirs of an Addicted Brain, and it combines my life story with a low-tech account of how drugs affect the brain and how alterations in brain function help explain addiction. My new book, to be released in July, is The Biology of Desire: Why Addiction is Not a Disease. Here I argue that the scientific
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Continued from page 6
facts don’t support the disease model of addiction. But rather than say more, I’ll leave you with this description from the back cover: Through the vivid, true stories of five people who journeyed into and out of addiction, a renowned neuroscientist explains why the “disease model” of addiction is wrong and illuminates the path to recovery. The psychiatric establishment and rehab industry in the Western world have branded addiction a brain disease, based on evidence that brains change with drug use. But...Marc Lewis makes a convincing case that addiction is not a disease, and shows why the disease model has become an obstacle to healing. Lewis reveals addiction as an unintended consequence of the brain doing what it’s supposed to do—seek pleasure and relief—in a world that’s not cooperating. Brains are designed to restructure themselves with normal learning and development, but this process is accelerated in addiction when highly attractive rewards are pursued repeatedly. Lewis shows why treatment based on the disease model so often fails, and how treatment can be retooled to achieve lasting recovery, given the realities of brain plasticity. Combining intimate human stories with clearly rendered scientific explanation, The Biology of Desire is enlightening and optimistic reading for anyone who has wrestled with addiction either personally or professionally. This book brings it all together and shows how a change in our thinking can initiate crucial changes in the policies and treatment options that govern the lives of addicts. www.memoirsofanaddictedbrain.com/buy-it/ www.memoirsofanaddictedbrain.com/buy-biology-of-desire/
WHAT PEOPLE WANT FROM ALCOHOL AND OTHER DRUGS? By Terence T. Gorski
Continued from page 28
Once again, there is a problem. Most drug induced spiritual experiences are not genuine. They are merely the effect of the drug disrupting your brain chemistry in a way that creates a sense of euphoria in a social setting suggestive of spirituality. The same is true of intimacy. Most Drug Induced Spiritual Experiences Are Not Genuine. ENHANCE THEIR SEXUAL EXPERIENCES … The eighth and final reason that many people use alcohol and other drugs is to enhance their sexual experiences. This may work for a while but eventually being passionate sexually must be built on a solid foundation of interpersonal intimacy. This means that the quality of sexuality shared by a couple increases with three things: the quality of the non-sexual intimate connection, the level of trust shared with their partner, and their ability to put their partner’s intimate and sexual gratification on par with their own. Again, a pill will never fix these things. Having a hard and long-lasting erection is of little value in the absence of a willing and eager sexual partner who wants to share the experience with you. Terence T. Gorski is the Founder and President of The CENAPS Corporation. He is an internationally recognized expert on substance abuse, mental health, violence, and crime. He is best known for his contributions to relapse prevention, managing chemically dependent offenders and developing community-based teams for managing the problems of alcohol, drugs, violence, and crime. He is a prolific author and has published numerous books and articles. He is the Director of Relapse Services at the Beachcomber and is Director of The National Certification School for Relapse Prevention Specialists.
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Florida’s Premier Behavioral Health Annual Conference 2015
If you are... • Treating patients with addiction and mental health conditions (from intervention to long-term recovery planning) • Running your own practice (dealing with ethics, compliance and regulations) • Focusing on the best treatment modalities (advances in behavioral health, strategies and new research) • Looking to improve your company’s performance, operations and outcomes (mergers and acquisitions, leadership, third party reimbursement and more) MOMENTS OF CHANGE is exactly what you need to take your patients’ recovery and your ability to treat them to the next level. REGISTER ONLINE AT FOUNDATIONSEVENTS.COM.
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r Ea n up 18 to Us CE
Las Vegas, Nevada | Bellagio | October 5–7, 2015 Intervening on Process Addictions at Home and In the Workplace
Who should attend?
Don’t miss keynote speaker
Our audience is made up of a wide variety of industry professionals
Dr. Patrick Carnes!
• Professional Counselors • Nutritionists • Interventionists
• Clinicians
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• Addiction Counselors
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• Social Workers
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• Case Managers
“Addictions more than coexist; they interact, reinforce, and become part of one another. They become packages. The different types of addiction interaction will be discussed and presented with appropriate treatment strategies for each emphasizing effective diagnosis, assessment, and treatment for addiction interaction.”
• Marriage & Family Therapists
• Psychologists
– Dr. Patrick Carnes
• Students
• Dietitians • Holistic Specialists
This year’s conference will focus on cross addiction as it relates to these four tracks: Advanced Intervention
Love, Sex & Relationships
Employee Assistance
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The contents of this book may not be reproduced either in whole or in part without consent of publisher. Every effort has been made to include accurate data, however the publisher cannot be held liable for material content or errors. This publication offers Therapeutic Services, Drug & Alcohol Rehabilitative services, and other related support systems. You should not rely on the information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health care professional because of something you may have read in this publication. The Sober World LLC and its publisher do not recommend nor endorse any advertisers in this magazine and accepts no responsibility for services advertised herein. Content published herein is submitted by advertisers with the sole purpose to aid and educate families that are faced with drug/alcohol and other addiction issues and to help families make informed decisions about preserving quality of life.
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