INTERVIEW WITH
THOMAS HENDERSON
FROM SUPER BOWL XII TO HAPPY AND SOBER
NEUROSCIENTIST DR. MARC LEWIS PH.D
DR. JEKYLL AND MR. ADDICT 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.
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.
We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol in Palm Beach County as well as distributing locally to the schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more throughout Palm Beach and Broward County. We also directly mail to rehabs throughout the country and have a presence at conferences nationally.
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.
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, There are Transport Services that will scoop up your resistant loved To Advertise, Call 561-910-1943
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 all Fathers a Happy Father’s 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.
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INTERVIEW WITH THOMAS HENDERSON By Patricia Rosen
Thomas “Hollywood” Henderson is a former National Football League Linebacker. He was drafted in the first round by the Dallas Cowboys in 1975, 18th pick overall. He was in the NFL from 19751982. He helped lead the Cowboys to three Super Bowls, and won Super Bowl Xll. He played 5 seasons with the Dallas Cowboys and was waived in 1979 following on camera antics against the Washington Redskins. He was playing with the Miami Dolphins when he suffered a career-ending neck injury. He was also the first football player to publicly admit to a drug problem. Today he has 31 years clean.
Thomas: My flamboyant lifestyle, limousines, hanging out at the Playboy mansion with Richard Pryor, Bill Cosby, Marvin Gaye and more.
Patricia: Thank you for sitting down with me for this interview. I am so impressed, 3 Super Bowls- not many players can say that.
Patricia: What kind of drugs?
Thomas: No, not many at all. Patricia: I would like to hear all about the Super Bowls but first I would like you to tell me what your childhood was like. Thomas: My parents were both drinkers. I grew up in a very violent home and witnessed my mother shooting my stepfather. Patricia: How did that affect you? Thomas: I don’t know if you really know how it affects you when your 8 or 9 years old. I know I was traumatized. I had witnessed a lot of violence between them and the gun was just an escalation of that. Patricia: Were you doing drugs at this time? Thomas: No, I was just a kid. I would take a sip of my mother’s beer, or I remember drinking some scotch but the drug use didn’t begin until I was around 12. Patricia: What drugs did you take? Thomas: Hashish, marijuana and psychedelics- I loved marijuana. I was unlucky to be a teenager in the late 60’s. Patricia: How did this affect your schooling? Thomas: Well, that’s funny you should ask. I loved school and loved learning. I started school at 3 at the Montessori school because my mother worked there. I loved knowledge and I loved learning unlike most of the friends I had. I moved to Oklahoma in my junior year of high school to live with my grandmother and have a more stable environment. Patricia: Did that help? Was your Grandmother stable? Thomas: Yes, she was a holy roller, bible fearing woman. Patricia: So, that must have kept you somewhat grounded. Thomas: She adored me. I did everything I could to do well in school. Then came the Vietnam War, and I was afraid I would be drafted. Patricia: I heard you joined the Air Force, but quit before being sworn in. Thomas: That’s true. I didn’t want to go to Viet Nam so I enlisted in the Air Force. I wanted to fly planes but then found out there was a Geometry and Biology class I needed to take in order to finish high school, and they couldn’t draft you into the army if you were still in high school. So I took the classes and never ended up signing on the dotted line. I was then accepted into Langston University playing football. I was the first team all-America for two straight years. I was a great player; I ran the 100 yard dash in 9.5 seconds and the 40 yard dash in 4.3 seconds. They never saw anything like it and in 1975 I was drafted to the Dallas Cowboys. And guess what? My biological father who I never saw, never spoke to, never had a hug from decided to call me! Patricia: How did you get the name “Hollywood” Henderson?
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Patricia: What was your drug use like at this point? Thomas: It was escalating. I had money to buy drugs; I was partying out in California. Thomas: I was smoking marijuana every morning and every night but then I was introduced to Cocaine and that’s when I began to spiral. Patricia: Were you using drugs while playing football? Thomas: I never did coke while playing, but sometimes amphetamines and marijuana. Patricia: Did this affect your game? Thomas: No, but it affected my personality, my behavior and my respect to my boss. It got in the way of a lot of things. My playing was always good. I had a lot of pride in my game. I gave a 100% every down. Patricia: Amazing. So were you thrown off the team for using drugs? Thomas: No, I was hamming it up in front of the camera with a handkerchief with the Dallas Cowboy logo on it and my coach, Tom Landry was so angered by that display, he fired me. In reality, he did give me plenty of warnings. Patricia: I find it so fascinating how the personality of someone on drugs changes 360 degrees. It’s so incredible. So, you went to the 49ers, Houston Oilers and then the Miami Dolphins in 1981 where you suffered a career-ending neck injury. What happened then? Thomas: No, I went for treatment before I went to the Dolphins. A Dallas Cowboy employee approached me and said “we all know you are doing a lot of cocaine, you need help”. I announced to the world that I had a problem and I checked myself into a Psychiatric hospital for 12 weeks. They really didn’t address the addiction and I felt like I was in the movie “One flew over the Cuckoo’s Nest”. When I got out of there, I went right back to the drugs. I thought I could just smoke marijuana and take a drink; I thought my only problem was the cocaine. Next thing you know, I am falling down drunk. This eventually led me back to the cocaine. For 2 years it was crack houses, hookers and more crack houses. Patricia: What happened in 1983? Thomas: I was arrested for smoking crack in a crack house. I was charged with one count of sexual misconduct. I pleaded no contest to those charges and was sentenced to 28 months in prison. This was clearly my bottom. In crack houses and crystal meth dens this happens every day. “Hollywood” Henderson died on Nov 8, 1983. That allegation, that charge, shamed me so bad; I was suicidal for a while. The thought that I was accused of this and the effect it had on my family and friends were devastating to me. Patricia: How did you handle it? Thomas: I was out on bond and the lawyer representing me dropped me off at rehab. I was there for 2 months and a sober living house for 5 months before I had to go to prison. I remember something Roger Staubach said to me that really changed my life. He said “Thomas, you’re a good guy- get away from those drugs. Continued on page 42
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DR. JEKYLL AND MR. ADDICT By Marc Lewis, PhD
This will be a 3 part series by Dr. Marc Lewis, a neuroscientist and professor of developmental psychology, recently at the University of Toronto, where he taught and conducted research from 1989 to 2010, and presently at Radboud University in the Netherlands. He is the author or co-author of over 50 journal publications in psychology and neuroscience, but he now focuses exclusively on drug addiction -- what it’s like to be an addict and what’s going on in the addicted brain. His recent book, Memoirs of an Addicted Brain, blends the telling of his own years of drug addiction with an accessible account of how drugs affect the brain and how changes in brain function help explain addiction. His upcoming book is entitled The Biology of Desire: Why Addiction is Not a Disease. It combines scientific findings with intimate biographies of addicts who recovered, and shows how addiction can be overcome, through self-directed change and empowerment.
PART ONE: TWO “YOU’S” – A DISCONNECT IN MIND AND BRAIN In our attempts to understand addiction, it’s particularly important to integrate what we know of the psychology and subjective experience of addiction with findings from neuroscience. The subtleties of our thoughts and the cellular activities of our brain might seem like different planets, impossible to gaze at simultaneously. Yet both are going on at exactly the same time in exactly the same person. In this brief series of articles, I combine brain facts with mind facts to try to arrive at a clearer picture of addiction and a more realistic sense of the obstacles to recovery. Addiction is usually characterized by two psychological states: craving and loss of control. But when we look very closely at the flow of time leading to each occasion of drug using (or drinking, or whatever it is), there seems to be a blurring of the two. Craving is a well-worn gateway to losing control. So what if we view craving and surrendering not as two processes but as one? Just a single time-line, a building momentum, leading from a state of determined abstinence to a headlong plunge? Easy enough to do, but that leaves us with an even more puzzling conundrum -- one that sits right at the center of addiction and our failed attempts to understand it: why and how do addicts manage to lose control of their desire to get high, repeatedly, consistently, in the face of their own strong incentives not to cave? Why is it so difficult to “just say no?” Imagine that you can be two different people. That’s not such an absurd idea. It’s been around in psychoanalysis for a century, and even the cognitive science of the last three decades finds it reasonable. Not multiple personalities, but something subtler. The you that screams for vengeance when your favorite player gets tripped from behind and the you that turns off the TV and tucks your kid into bed can easily be seen as two distinct you’s. So let’s imagine that the you who anticipates how wonderful it will feel to get high is simply a different you than the one that knows that’s insanely stupid. Of course this isn’t an original idea in addiction studies. Twelvestep fellowships continue to broadcast warnings that your addiction is waiting to get you, doing push-ups in the parking lot, and even the more contemporary cognitive-motivational tactics of SMART Recovery might counsel you to ignore the addict voice -- as though it weren’t your own voice at all. So let’s think about the two you’s differently. Let’s connect the psychological states of wanting and abstaining to each of two distinct brain activation patterns. When getting high feels terribly attractive and we anticipate it with excitement, the striatum, which is the part of the brain that initiates goal pursuit and powers it with desire, is strongly connected to the orbitofrontal cortex (OFC), a region of the prefrontal cortex on the border of the limbic system that
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encodes the value of things -- good things like a friend’s smile and bad things like sour milk. The striatum and OFC are quickly linked (by activation of the synaptic pathways between them) in anticipation of a valued outcome. This linkage creates a “motivational furnace” that radiates its message to the rest of the brain. And when that furnace is activated, you feel and perhaps act like a child, yearning, anticipating, and falling forward into the treasure trove at your feet. But what happened to self-control? A much smarter part of the brain – called the dorsolateral prefrontal cortex -- often oversees the impulses generated by the motivational furnace, the orbito-striatal alliance. The dorsolateral PFC is where judgments are formed by comparing possible outcomes and making conscious decisions. We can call the dorsolateral PFC the “bridge of the ship.” Its job is to steer. A fair amount of research shows that addiction (in the long run) and impulsive acts (in the short run) give rise to a “loss in functional connectivity” between the orbitostriatal alliance and the bridge of the neural ship. A loss of connectivity simply means that activity (measured by an fMRI brain scan) in one region becomes less correlated with activity in the other region. This disconnect is exactly what we observe in the addict’s behavior. When pictures of drug paraphernalia are flashed on a screen, addicts show a surge of activity in the orbitostriatal furnace and reduced activity in the dorsolateral bridge of the ship. Some studies show this disconnect to become more severe with the length of the addiction. Other studies show the same disconnect when “normal” people surrender to tempting (but dumb) impulses. The disconnect is real (though it’s temporary). And when it happens, you become the unfettered, unconstrained child. Craving is simply desiring what feels attractive, and surrender is the natural order of things when desire is unconstrained. So you get high, you start drinking, you click on a tried-and-true porn site or you call that forbidden phone number. An hour later you are bored and you know you didn’t get what you wanted. Two hours later the regrets pile up like unanswered mail. Three hours later (if it takes that long) the child’s excitement is replaced by self-reproach, recrimination, and perhaps a determined commitment to never do it again. You are no longer thinking or feeling the way you were a short time ago; your values have locked in again. And your brain is no longer functioning the way it was functioning a short time ago. The orbitofrontal cortex (preoccupied now with something like sour milk) is reconnected with the dorsolateral PFC, its overseer. Desire is now just a memory, an empty husk. With desire slaked, no matter how unsatisfactorily, your brain changes back again. It’s just the way brains work. Let’s say you’d been abstinent for weeks, maybe months. How could you have done something so stupid? Again?! The answer is simple: it was a different you. For blog posts and commentaries, please visit his website: www.memoirsofanaddictedbrain.com
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EGO
By P.D. Alleva, MSW How often are we confronted with challenges throughout our lives? Challenges related to work, career, family, friends; personal challenges that reach into the very heart of our convictions, passions, and ideals. They are paramount over the course of our lives. Every challenge that manifests itself in front of our faces looks to be resolved in order for us to grow, to evolve, and to learn. Some religions and faiths believe that we ourselves call in these challenges. Somewhere deep inside our hearts, subconscious thinking and our souls, we are striving to overcome these challenges in order for the soul to move forward and evolve in a positive thinking karmic manner. We achieve new awareness with every situation and every challenge we overcome. Whether that thinking turns into a positive power or into a negative resentment clawing at our heals from our past to reach into the present and drag us back into despair, depends heavily on our ego. Freud was correct on a thing or two, ego being one of them. Our cognitive behavior, our thought processes, largely depends on whether or not our ego is in check, inflated, or deflated. Like the difference between arrogance and confidence, a common misconception is arrogance is often a result of low self-esteem or poor personal self-worth. An inflated or deflated ego can result in catastrophic results for the individual and those most closely affected by it. Whereas an ego that is in check understands all sides of a situation and seeks to resolve the conflict peacefully and with the best intentions of all involved, a master of their own conviction and passion if you will. Letting our ego down is one of the most difficult tasks for human beings to do. How many of us truly allow ourselves to admit when we are wrong? To admit our wrongdoings with the understanding that those around us will look on us in a different light, as if we’ve lost the respect our hearts have long desired. How many of our actions have led to such results, shaming ourselves for our failures as human beings to do the right thing and live the right way, in accordance with societal norms of course. How often have you been down on your luck, taking stabs at your heart with daggers that seem to come out of nowhere and are hell bent on keeping you down on your knees until you just can’t get up any longer? Until you just don’t want to get up any longer. How long do you keep up this fight and at what cost? When do we let go and let the situation manifest itself as it wishes, were we ever truly in control anyhow? In these situations, are we able to turn to positive thinking to help us through it? Are we able to take a shot at our ego so that someone else can take that spotlight just this once? How and where then, will our awareness of ourselves turn? Will doing the right thing- the selfless act for someone else, come around to help us evolve and enrich our souls, strengthening our core foundation of love and innocence to the extent where we can be inspired once again and move in a different direction? The right direction for where our heart of hearts wishes to lead us. Can we trust our instincts or do we become consumed with automatic behaviors and responses that lead us to fulfill nothing more than a self-indulgent life style? Our cognitive behavior, the actions manifested by our thought processes, has a large part of play inside our ego. For example, let’s talk about addiction for a moment. No one when they are younger dreams of becoming an addict. I haven’t met one person yet who’s told me otherwise. Either you grow up with it, hate it, and because that’s all you know it comes and slaps you in the face. Or you came from a good family with good values and no addiction but one day you take the wrong pill at a party, or are influenced greatly by others and the next thing you know your shooting heroin in a flop house, stealing money and robbing houses to keep up with your addiction. Either way, no one had dreamed of becoming an addict, meaning, it wasn’t a conscious choice. Most people seek treatment to help overcome their addiction and once they
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make this conscious choice to change their lives, their journey into a new world begins. Unfortunately relapse does happen, but why does it happen? What are the reasons behind the relapse? At this juncture, I’d lecture my clients on how they were afraid of the light. Sinking back into the darkness of addiction is comfortable and familiar and the easy way to go, much easier than pushing through with strength, conviction and positive thinking when the chips fall beneath their feet. They put too much importance on trying to pick up what slipped through their fingers. Most often these circumstances are related to their ego. They lost their job, they lost their spouse, or they lost something that held importance to them (more than likely as a result of their addictive behavior) and they have difficulty seeing the light that awaits them on the other end of this challenge. Their ego took a shot they hadn’t expected, especially since they’ve been feeling so good about themselves and being sober. Ego is one of the biggest causes of relapse in the addiction field; they just can’t get over the fact that their self-worth had been compromised by an outside force beyond their control. They couldn’t control the situation which in turn made them feel powerless. This is a common cognitive behavior of an addict. So often our ego becomes inflated. We ride high on current circumstances when things are really going good and in our favor. Often our ego becomes deflated, exhibiting actions that go against our moral fiber contributing to a low self-worth depending on where we are in our life today. Sooner or later we become challenged by life as situations arise that surround a challenge we hadn’t thought of and depending on the state of our ego, we see this challenge as either debilitating or insignificant, therefore choosing our course of actions to resolve the problem. The result of our choices can come back to slap us in the face should we have not chosen to view this challenge in the correct light. At this moment we can either raise our confidence or even out our ego. I hope that when this happens to you, and it will, you will be able to see and be aware of why this challenge had been called in. Perhaps your confidence has been low and you need to rise to this challenge or risk being brought down further, or your success has turned to arrogance and your soul is calling you to begin to be humble in your endeavors. Please see to the heart of each matter and challenge, doing so will lead you to a path of enrichment. Paul is the founding owner of Lifescape Solutions and Evolve Mental Health which he opened in December of 2011, based on a new model of healing and psychotherapy called Spiritual Growth Therapy. His newest book Let Your Soul Evolve: Spiritual Growth for the New Millennium 2nd edition describes the model.
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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS INSURANCE COMPANIES PLAY DOCTOR PART III: MEDICAL NECESSITY 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 Not long ago I was speaking with a therapist friend of mine who told me this story of how a patient of hers – a female opiate addict – came to be discharged long before her treatment was completed. The patient had gone through a shorter than needed detox and struggled to complete her second week of intense therapy. She was responding as well as could be expected considering the patient was still experiencing detoxing effects. Then my therapist friend got a call in the early afternoon from the insurance company’s case manager instructing her to discharge the patient before the end of the day. The case manager told the therapist that if she wanted to keep the patient longer it was her choice, but the insurance company was not going to pay for it. There was one other option. Under the Affordable Care Act (ACA) a patient can appeal an insurance company benefit denial; however, it can take some time before the process is complete – try explaining that to an addict fresh out of detox. According to my friend, the patient responded by saying; “I’ve never felt like using (drugs) more than I do right now.” This is not a unique story – in fact it has become the archetype of the cost-driven addiction treatment model being imposed by the insurance industry on treatment facilities across the country. Your insurance company is the one who, through purse strings, controls your healthcare – and their subordinates have become charter members of death panels who are standing like a roadblock between you and your doctor. They are capitalizing on trusting and unassuming policyholders. People are dying because someone with little or no addiction treatment expertise is sitting comfortably in a cubical somewhere making autonomous health decisions under the guise of ‘medical necessity’ for people they never even met, much less understand their condition. The passage of the Mental Health Parity Act in 2009 gave a lot of hope to the addiction treatment community. It was the first piece of federal legislation requiring insurance companies to cover mental health treatment just as they would any other physical ailment. We rejoiced in exuberant cheer at its passage thinking our government has heard our collective voice. Finally, we thought, at the height of America’s opiate epidemic, we would be empowered to change the rising tide of addiction. We envisioned every addict having access to the critical treatment they needed to stay clean, sober and not become an overdose statistic. We saw our universe expanding. But something happened on the way to implementing the law. The new bill had the opposite effect from what we were expecting. A seemingly innocuous term, “medical necessity” written into the bill has grown to become the hinge on an ‘Exit Only’ backdoor that continues to block addicts from receiving the life-saving treatment they so desperately need. “The term, medical necessity,” predates the ACA. Yet, from the people in the field I talked with, it seems to be used with increasing frequency in recent years to manipulate treatment and deny benefits to policyholders. That is certainly the observation from my vantage point in addiction treatment. What is most concerning is that the definition of “medical necessity” varies depending on who you talk to. Just do a quick Google search and see for yourself; you’ll find dozens of competing definitions. Every major insurance company has their own version. The U.S. court system has varying opinions on what
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“medical necessity” is and is not. As you’d expect when big stacks of money are sitting on the table with no clear definition of the rules, interpretations quickly become bias. Conversations today between insurance company case managers and treatment facility’s doctors and therapists look more like a Mixed Martial Arts (MMA) rumble than a civil conversation between two professionals discussing the best care for a patient. It’s pure unadulterated chaos. The American Society of Addiction Medicine (ASAM) – a physician society with a focus on addiction and its treatment – came into prominence nearly forty-years ago during an earlier era of medical/insurance dysfunction in our country’s history. It was in the late 70’s and early 80’s that ‘managed healthcare’ was taking hold. A time when medical practices, procedures, terminology, medical coding and just about all other things medical came under great scrutiny. The American Society of Addiction Medicine stepped up and developed the ASAM criteria, also known as the ASAM patient placement criteria. It was the result of a collaboration that began in the 1980s to define one national set of criteria for providing outcome-orientated and results-based care in the treatment of addiction. ASAM criteria grew to become the most widely accepted guideline of recommended addiction treatment in the country. As principled, respected and well intended as ASAM patient placement criteria is, the sad reality is that ASAM is not immune to manipulation. To help you understand, I’m going to use this very simple example of what goes on behind the scenes at a treatment facility and how ASAM criteria is being manipulated. A patient comes in after detox and is subject to several tests to determine the level Continued on page 38
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THE USE OF BUPRENORPHINE FOR OPIATE DEPENDENCE DURING PREGNANCY By Joseph Troncale, MD
The opiate addiction epidemic affects a lot of young people – many of whom are sexually active women. It’s not uncommon for pregnancy to occur in the midst of active opiate addiction, and consequently a rehabilitation center such as ours often sees opiate-dependent mothers enter into treatment. In recent years, buprenorphine has been legalized for the treatment of opiate dependence – yet there remains an active controversy surrounding whether or not it’s appropriate for use during pregnancy. For years prior to the advent of buprenorphine, opiate-dependent mothers were treated with methadone; it was considered the gold standard in treating opiate-addicts during pregnancy. From the time I first began treating opiate-dependent mothers, methadone – when available – was always used to maintain both the patient and the fetus for the duration of the pregnancy. In a recent study published in the Journal of Addiction Medicine in April, 2015, Marjorie Meyer compared cases of pregnant addicts who were maintained on methadone, versus a group maintained on buprenorphine. The study revealed that mothers treated with buprenorphine were more likely to start medication earlier in pregnancy, have longer gestation, and give birth to larger infants. Additionally, it was found that newborns born to mothers maintained on buprenorphine presented fewer symptoms of Neonatal Abstinence Syndrome. This study is important as there remains controversy in some medical circles concerning whether or not buprenorphine during pregnancy is safe. We consistently employ buprenorphine as the choice treatment for pregnant, opiate-dependent women, and our results have been altogether favorable. While Meyer’s study reveals no appreciable harm in the use of methadone, it does illustrate
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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that buprenorphine (Subutex), is safe and effective for use during pregnancy – and that its use produces favorable outcomes for both the mother and the fetus. This is good news for both patients and providers, as buprenorphine is generally a much more accessible treatment. Methadone use is mired in regulations, making it far more difficult in terms of storage, guidelines, and paperwork. The Meyer study showed that only 2% of the individuals who had commenced the use of buprenorphine wanted to switch to methadone. Individuals treated with Subutex were reasonably satisfied from both the treatment itself, as well as its outcomes. We are happy to see this study validate what we have believed to be safe and efficacious care for mothers and fetuses suffering from opiate dependence. We plan to follow similar studies to see what future data shows and will hopefully continue to shed light on this most imperative subject. Joseph Troncale, MD is Retreat’s Medical Director. Over the past 35 years Dr. Troncale has established himself as one of the premier physicians working in the field of addiction. He is both a fellow and a member of the American Society of Addiction Medicine (ASAM) and was named Outstanding Clinician by Addiction Magazine in 2010. He has publications in journals such as The Journal of Addictive Diseases and other peer-reviewed journals.
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CHANGING HEARTS AND MINDS By Steven Kassels, M.D.
As a physician who spent my earlier years practicing Emergency Medicine, it became clear that many, and at times a majority of patients presenting to the emergency department had illnesses related to the disease of addiction. There were patients who were intoxicated and been battered in altercations or involved in automobile accidents; and patients having PCP induced psychosis or a hypertensive crisis; or a heart problem from cocaine; the opiate-dependent individuals feigning kidney stones or other medical conditions to get pain pills, or … well you get the picture. But when you add the children with asthma due to secondhand smoking; the unwanted teenage pregnancies from poor choices while intoxicated; cardiac arrhythmias (“irregular heartbeats”) or infarctions (“heart attacks”) or cerebral vascular accidents (“strokes”) due to nicotine; diabetes or other complications of obesity from food addiction; and panic attacks from living with family members with addictive behaviors, one begins to understand the true magnitude of the relationship between medical, psychiatric and surgical illnesses and underlying addiction. Because of these causal relationships I morphed my medical practice to include Addiction Medicine. As time marched on, I devoted more time to treating patients with the disease of addiction, but what became increasingly clear was the lack of understanding of the disease of addiction by politicians, public health officials, physicians and the general population. To change attitudes, I gave lectures, presentations and round table discussions to police, civic groups, medical students and to just about anyone who would listen. But, there was a problem – who came to listen? It was like preaching to the choir! So nothing really changed – NIMBYism (“Not in My Back Yard”) continued and I was not making a difference. That was then and this is now; and all of us who have been touched by this scourge to society and lost loved ones, or are part of the treatment community, or desire to be part of the solution, the time has come to ramp up our commitment and to advocate loudly and clearly. We are so fortunate to have such politicians like Governor Shumlin of Vermont who dedicated his entire January, 2014 State of the State address to the issue of opiate addiction. In every corner of our state, heroin and opiate drug addiction threatens us. It threatens the safety that has always blessed our state. It is a crisis bubbling just beneath the surface that may be invisible to many, but is already highly visible to law enforcement, medical personnel, social service and addiction treatment providers, and too many Vermont families. It requires all of us to take action before the quality of life that we cherish so much is compromised….Nearly 80% of our incarcerated population are either addicted or in prison because of their addiction. And listen to this math: a week in prison in Vermont costs about $1,120.00 but $123 will buy a week of treatment for a heroin addict at a state-funded center. Today, our state government spends more to imprison Vermonters than we do to support our colleges and universities, and our prison spending has doubled in the last nine years. You do not have to be a math major to realize that we can’t afford our current path. We have to figure out how to spend taxpayer money more wisely, while we treat the disease more effectively. And on March 4, 2014 the Worcester, MA District Attorney announced the formation of a Task Force that brings together law enforcement, government leaders, health-care professionals and experts in the field of substance abuse to combat the rise of opiate abuse and overdose deaths. You can’t arrest your way out of the problem …You can’t prosecute your way out of this problem. And yet there are still too many “naysayers” who think we can arrest our way out of this dilemma. Governor LePage of Maine is a perfect example:
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While other governors have called for hefty increases in funding for treatment, LePage called for $2 million to hire 14 drug agents, four judges, and four prosecutors to target a drug trade … But it is important not to alienate those we are attempting to educate, and we must Carpe Diem! Momentum is on our side to keep the rising deaths of our children and our neighbors front and center – but this will take novel approaches to reach out and convert the naysayers. One way is to emphasize the economics of the issue that it is much less costly to treat than to ignore the problem or to incarcerate. We must stress the societal costs in terms of damage to family structure, to the fabric of our society, to the secondary health care costs in terms of illnesses to the substance user as well as the spreading of disease as a public health crisis. And we must emphasize that the disease of addiction is an equal opportunity illness that has no socioeconomic barriers. In fact, a recent study demonstrated that the demographic composition of heroin users has shifted from an inner-city, minority-centered problem to one now involving primarily suburban white men and women in their late twenties. And when people still do not want to listen to the scientific facts, when they are convinced that addiction is simply mind over matter, when they are unwilling to acknowledge the biological, psychological and sociological aspects, there is still one approach that appeals to everyone – make it an issue of money and taxes – make it an issue of their wallets - then they will listen! We need novel approaches to educate and to expand support for prevention and education; we all need to find creative ways to get the message across – that treatment saves lives and money. I recently had an Op-ed published by Boston Globe and concluded it as follows: There should be just as many public service announcements about addiction as there are Viagra and Cialis commercials. In addition, expansion of addiction treatment services in jails would help to mitigate much of the revolving door phenomenon. Furthermore, we should demand that our medical schools and hospitals improve addiction training of our physicians. While there is plenty of blame to go around, let’s focus on the solutions. The scourge of addiction is in all of our yards. The solution is to decrease the demand with bold public initiatives and a change in attitude. It is both the humanitarian and fiscally responsible thing to do. I have created my “Novel” approach through the book Addiction on Trial in an attempt to reach a much broader audience to destigmatize the disease of addiction, to put faces on the illness and to change hearts and minds through the back door. Skype meetings allow me to educate in a relaxed manner, and in doing so, to convert the naysayers; but we all need to do our part. Remember – Carpe Diem Steven Kassels, MD has been Board Certified in Addiction Medicine and Emergency Medicine. He currently serves as Medical Director of Community Substance Abuse Centers and has authored the book, “Addiction on Trial: Tragedy in Downeast Maine”. The book is available at Amazon, iBooks and Barnes & Noble online.
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ARE ALCOHOLICS ANONYMOUS AND THE 12 STEPS REALLY IRRATIONAL, UNSCIENTIFIC & OUTMODED OR ARE THEY ACTUALLY VINDICATED BY PIONEERING NEUROSCIENCE? By Alastair Mordey
Spates of recent articles in the press have denounced 12 Step programs as unscientific and irrational but this is based in a lack of understanding of what creates and maintains healthy neuro-adaptation in humans. You might think comparing Alcoholics Anonymous with more scientifically proven treatments for addiction is a bit like comparing apples and oranges. How can an eighty year old, quasi-religious movement of non-professionals possibly stand up against mainstream psychology and medicine? A recent article in the The Atlantic (April issue) asked exactly that, “The Irrationality of Alcoholics Anonymous” by Gabrielle Glaser. In her piece Glaser slams both AA and the 12 Step treatment industry as ineffective in dealing with the nation’s alcohol problems, citing medications such as Naltrexone and Antabuse as being more effective because they reduce cravings and create aversion to alcohol, rendering AA’s abstinence philosophy redundant. However, advances in the understanding of addiction are showing us that there may well be sound scientific principles at work within the social processes of AA and other 12 Step groups. Science cannot prove AA ‘works’ any more than it can prove that the love of family is a good thing. What it can help us to understand is the underlying principle of why things like familial love and 12 step fellowship are healthy and therapeutic for human beings. Scientific principles help us to understand why something might work, when it appears to work, but we do not really, fully know how it works. 12 Step programs work primarily as a social support mechanism and whilst this may seem somewhat inconsequential to the uninitiated, to reduce the importance of social support in the treatment of addiction as Glaser does, is to make a profound mistake in understanding the illness. To explain this we will need to look at some of the exciting research taking place in the addiction field today as well as the scientific principles that govern the workings of the brain. Many people are probably familiar now with the role that dopamine plays in addiction. Dopamine is popularly known as the brain’s reward and pleasure chemical. All drugs of abuse including alcohol strongly increase dopamine transmission in the brain’s reward system. Pioneering neuroscientists like Kenneth Blum, Mark Gold and The National Institute on Drug Abuse’s charismatic director Nora Volkow, have all contributed significantly to our understanding of dopamine’s role in addiction. A plethora of research over the last five years has isolated the DRD2 (dopamine) receptor gene, and problems associated with poor dopamine function, as a likely cause of addiction. Blum and his colleagues have even termed this disease of damaged dopamine receptors, ‘Reward Deficiency Syndrome’. However, this is not a purely biological or genetic problem. Trauma and stress are also thought to impair dopamine function and create reward deficiency. The implications of this are enormous. It turns a lot of what we think we know about addiction on its head. For most addicts, their addiction is probably not caused by using lots of drugs and alcohol. It is more likely to be the other way around whereby reward deficit (created by genes or environment) pre-exists addiction, and in fact causes it. The symptoms caused by dopamine deficiency are clearly observable; restlessness, irritability, discontentedness, massive boredom, blunted pleasure, low stress tolerance and lack of meaning and purpose. In other words, the same symptoms that have been described voluminously in 12 Step literature for the last eighty years. But it is the last two symptoms that hold the key to a correct understanding of how dopamine really functions, and why AA works. Dopamine is not really a pleasure and reward chemical per se. Dopamine makes us want something more than it makes us like it. Essentially dopamine helps us understand the meaning or purpose of a reward. Because reward deficient people don’t register
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ordinary rewards as being meaningful in the way that most people do, they look for bigger dopamine hits that their disabled pleasure senses will actually be able to feel. Drugs, alcohol, gambling and novel sexual or eating behaviors all create much larger surges of dopamine than normal rewarding activities do and help a reward deficient person to feel, well…..normal! When this happens a process called neuro-adaptation takes over. Neuro-adaptation is a learning process that re-wires the brain. This process is underpinned by the principle of brain plasticity, or the brain’s capacity to change itself. The addicted person is learning and remembering that the drug is important and meaningful for them in alleviating their reward deficiency and this process helps them to prioritize drug use more and more – and make sensible decisions to stop, less and less. The reward deficient brain is adapting and trying to find balance. For the type of addicts and alcoholics who end up in treatment, there are few vestiges of their former personality left after this process of brain change. The only thing that has meaning for them is their drug. But this impairment can be reversed during recovery by the same principles of neuro-adaptation that formed the disease in the first place. Recovery programs like AA re-train the brain with activities which are intensely rewarding, but at the same time safe. The ‘spiritual’ aspects of 12 Step programs provide an almost religious or tribal identification which deliver potent and cogent social meaning and purpose. When somebody identifies with a 12 Step group it kicks off a process of neuro-adaptation in which the individual learns what to do to keep themselves sober and rewarded instead of high and rewarded. 12 Step program participation effectively drills down new brain pathways particularly in the areas of the forebrain which construct and control personality and sound decision making. Eventually these new brain pathways become so well-trodden they become robust and lasting. 12 Step programs are a form of behavioral modification for addicts that provide the key to good neurochemistry and a map out of their maze of meaninglessness. Regardless of whether ‘spiritual’ activities are rational or not, they are effective in healing addiction on a biological, neurological level because they recruit natural rewards via the meaning and purpose inherent in social activity like fellowship, belonging, identity and altruism. Behavioral modification is a vital constituent of treating many chronic illnesses including diabetes and addiction. No one is suggesting that diabetics or addicts should go without medical supervision. Positive thought doesn’t cure cancer and we do not detoxify alcoholics using holy Continued on page 40
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THIS SOBER DAY (A SHORT LOOK BACK) By Jim Anders
This sober day, this here and now, was a long time coming. Over the course of thirty years and more than 50,000 drinks, my blackouts went from being periodic to nearly daily. Slowly but surely, my drinking went from being a simple form of pleasure to the anticipation of pleasure to no pleasure whatsoever. I could not have understood this. I would not have believed this. If I was not insane before my very first drink, then I would certainly become a victim of this chemically induced insanity called addiction by the end of this long, downhill disaster. I could not have predicted that hospitals, detoxes and rehabs would become the norm. It did not have to be that way. But it was that way. Today. Today. Today. What a clean and sober elixir today is. Clean and sober is this day. Hopscotch, Butterscotch. Scotch, Scotch, Scotch. Do children become alcoholics because they inherited particular genes from their parents or because they simply emulate their parents? This double-helix, rung by rung I climbed, upward and outward, past and future, intertwined. Maybe my childhood seemed so great because it preceded the onset of my alcoholic catastrophes. When I was a child, I was sober. The excitement of the chase, the uncertainty and vulnerability, peer group pressure – all these and more formed the collage of my experience. I skipped from the childhood world of the playground to the underworld of adulthood addiction to alcohol. There was no looking back. How the Addiction Balls Bounced A family disease, a cultural phenomenon, a world in crisis. Addiction is everywhere.
degrees of diminishment. So much of my perceived pleasure in drinking, smoking and adding other addictive substances to the mix was actually the anxiety preceding picking up and the relief of getting my fix. Give me my drugs and my anxiety and stress were reduced. ‘Pleasure’ is the name I gave to that. This must be pleasure, mustn’t it? Unknowingly, I lived to satisfy my level of addiction. This is how I lived and what I lived for. Hitting the Tarmac The lights outside the hospital emergency room were like the lights on the landing strip of an airport and I was a helicopter hovering, hovering, hovering. I stood on the street outside the emergency room of the Atlantic City Hospital. I had been in a blackout and I did not know how I got there. Finally, a paramedic came over to me, after 5 or 20 minutes. An hour? I don’t know. “Do you need help?”
In my particular instance, my younger sister’s addictions came on harder, faster and stronger than mine. A certain frailty and susceptibility took over Betty sooner than it took over me. Our common genetic predisposition could have led to my death instead of her suicide, but that’s not the way the addiction balls bounced. We had become too distant, too detached. Our addictions kept us apart. I dissolved into mine. She dissolved into hers. It was not the distance between Pennsylvania and New Jersey that kept us apart. It was the distance of disease, if you please. The distance of disease if you don’t please.
I answered, “This is not working. This is not working. The alcohol is not working. I cannot do what this is now, not working….”
How Smart I Felt
A Long Look Back
Alcohol almost immediately took over my young adult life and I truly didn’t know it. I had learned more and more about scotch and wine, beer and cocktail recipes and this glass, that glass, boilermakers, hot toddies and which garnish goes with which drink and on and on. More and more knowledge about alcohol and no real knowledge of alcoholism. Generally speaking, as I got more and more entrenched in alcoholic behavior, the more I felt sophisticated, the less sophisticated I must have appeared. Who could see the forest? All I saw were trees. A rebellious nature became my habit. A habit caused by drinking… problems caused me to drink more and drinking caused more problems. “The man I was will drink again…” Knowledge may not keep you sober, but ignorance most certainly helped keep me drunk. The Chaos Crowd Fun nights of drinking slowly evolved into drinking binges, blackouts and chaos. Addiction to alcohol, wanting more despite any and all negative consequences, marked my every action. Any potential I may have had was slowly being eaten away. Now sober, this leads me to ask “How good was it, how high was I, really?” Being powerless to stop could not justifiably be called a high. ”How low was I?” would be the more correct question. In any real sense, every ‘high’ could more accurately be measured in
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I collapsed on the street like a sandcastle knocked over by a wave. My sand spread out onto the sidewalk. That was my first hospitalization. Many more would follow. And detoxes and rehabs and on and on. I could have been called the Relapse King. Eight years in and out of recovery. Which bring us now to today, where I have 10+ years of continuous sobriety (6+ years to write my book). Today. This sober day. According to statistics, life expectancy in 1900 was around 46 years. I first got sober in 1996 at the age of 46. Had I lived in an earlier time, I would have died before ever getting sober that very first time. When I finally got sober, the momentum of the chase, the momentum of addiction, continued long after the substances were cleansed from my body. Serenity was a foreign subject in my early sobriety. Part of me preferred the familiar pain more than the prospects of change. Anxiety reigned. Today, the chaos crowd within my clouded head has been dispersed. Today, serene, this sober day. All Drinking Aside: The Destruction, Deconstruction and Reconstruction of An Alcoholic Animal is a 90-piece orchestration of autobiographical flashbacks in which the author describes his descent into alcoholism while three fictional flies-on-the-wall (unnoticed by him) discuss his prospects for recovery. 286 pages, it is available on Amazon.com in both print and Kindle editions. Jim Anders is a former advertising copywriter and graduate of Moravian College in Bethlehem, Pennsylvania. He currently resides in Atlantic City, New Jersey and is an active member in NCADDNJ. www.alldrinkingaside.com alldrinkingaside@yahoo.com
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3/27/15 10:37 AM
A KEY FOR EARLY RECOVERY - STICK WITH THE WINNERS By Alison Smela
Prior to uncovering the layers of obsessive thoughts and unhealthy behaviors that defined my life, I wasn’t aware I had this uncanny ability to “hear” words differently than what was actually said.
stopped living a life directed toward having more. They found the true meaning of success was being at peace with what they had; a life free from the obsessions associated with addiction.
Somewhere between my ears and my brain a converter of sorts would take words spoken to me and turn them into something entirely different.
Gradually I began to process what I was hearing and this redefined manner of living. I thank God for those role models and examples of winning. They helped me stay focused and get on the right track. I know today if I ever feel off-balance I can look to them for support and encouragement. I can’t imagine where I’d be if I didn’t stick with them.
In early recovery, when people kept telling me to stick with the winners and look for the people who have what I wanted, I took those suggestions to mean I should hang around people who appeared to be winning at life based on the material things that they had and what I wanted. I thought I was being told to connect with people I observed to be perfectly put together; those who had a good job, nice car, great shoes, happy family, etc. At that time, my idea of “winning” in life was based solely on how they appeared from the outside. When it comes to overcoming an addiction, I was sorely mistaken. Before I raised my hand to recovery, the people I considered “winners” were those who lived the type of lifestyle supporting my addictions. I wanted to hang out with people who wouldn’t harass me for the way I was living my life. As a matter of fact, if I came to find they actually didn’t partner with me on my unhealthy lifestyle, I’d push them away. As far as I was concerned, how I was living was the way to go. In my mind, as long as I was in control, I was a winner at the game of life. Yet life isn’t a game, it’s a gift. Recovery taught me that. Early on I was incapable of recognizing I wasn’t winning at anything other than self-destruction. I had grown into adulthood with a false sense of what winning meant. I believed I was a success by what was reflected on my paycheck, the title on my business card or the house I lived in. I had never once imagined that success was more a matter of who I was on the inside rather than what I was on the outside. There were countless stories I listened intently to, amazed at the miraculous transformations people had made in their lives by shifting how they purposed their lives. They weren’t going away to far off lands to build homes for the homeless (although some did). They weren’t spending all their time feeding the poor (although many did). Most people were telling how they had come to live differently. Based on their own experience, they explained how they
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A Moment to Breathe Who are the people you spend the majority of your time with? Are they living the kind of life you envision for yourself? Do they have the kind of outlook, attitude and sense of peace you desire? Take a slow deep breath and allow yourself to be honest. Are they truly reflecting the life you hope to one day lead or are they enabling the life you’re leading now? Alison Smela is in long-term recovery from alcoholism and a lifethreatening eating disorder. In addition to sponsoring/mentoring women who seek the same freedom from addiction, Alison speaks to groups around the country encouraging mid-life recovery offering her recovery story of healing as an example of hope. She’s a participating resource for educational webinars, conferences and teleconferences and a contributing writer for several online communities. Her recovery story was featured in several articles about mid-life recovery for publications such as the Chicago Sun-times, Vogue, Parenting and Renew magazine and online with Forbes.com, ABC News, and HealthDay News. Alison sits on the Board of Directors for a global 501(c) (3) nonprofit online eating disorders recovery mentoring community and held a board member seat for the 12-Step fellowship club where she continues to attend meetings on a regular basis. She was a contributing guest for HuffPost Live and the featured speaker for the 2013 Chicago National Eating Disorders Association Walk fundraising event. Currently Alison is working with a publisher to complete her book, Slow Deep Breaths: How to Find Freedom from Addiction in Midlife One Day, One Moment, One Breath at a Time. The book offers practical experience about recovery later in life and how to navigate everyday challenges with recovery-based solutions. Learn more at www.alisonsmela.com
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LIVING BEYOND
A Monthly Column By Dr. Asa Don Brown
ACCEPTING RESPONSIBILITY “Most people do not really want freedom, because freedom involves responsibility, and most people are frightened of responsibility.” ~ Sigmund Freud For so many, having the courage of being honest with oneself is challenging. For being honest with thyself, is a part of the process of accepting responsibility. While responsibility is an acceptance of the role in a situation, circumstance or within an event; it should never be the measure of an individual’s self-worth or value. There should never be shame or blame associated with responsibility. For the only way to move beyond the past is to be separated from shame and blame. Therefore, allowing for the individual to take ownership of his or her responsibilities. Shame’s intention causes a feeling of humiliation, anxiety, and undue sorrow. While blame reassigns the responsibility of an event, situation, or circumstance unto another, Blame is self-serving. Responsibility is a personal decree accepting the fault, the wrong or a mistake associated with an event, situation, or circumstance. When we are responsible, we are agreeing to be accountable. Accountability is the willingness to accept ownership or leadership over a person, place, or thing. As individuals, we should always be willing to accept the responsibility over the good and the bad associated with our lives. While we are accepting responsibility, we must always remember that our deeds and acts are not a mirror or reflection of our personhood.
“Victory has a hundred fathers and defeat is an orphan.” ~ John Fitzgerald Kennedy Responsibility is the willingness to accept the good with the bad. Responsibility casts out any relationship to shame and blame, rather it sees the good and bad as opportunities for growth and maturation. For who I am is much more than the good and bad associated with my life. For I am a person worthy of acceptance, approval, and love. While I may be capable of speaking of the good and bad associated with my life, I understand that my personal worth and value should never be associated with my achievements or failures. For if I associate my worth and value with my successes, then I must associate them with my failures too. I am no more a failure when I fail, than I am a complete person when I succeed. For failure and successes are simply mile markers in this journey we call life. 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 price of greatness is responsibility.” ~ Winston S. Churchill For so many, accepting responsibility is directly and indirectly linked to one’s self-worth, self-esteem, and self-image. Accepting responsibility should never be a frightening experience. All too often, we hear of individuals who intentionally shift the responsibility around an event, situation, or circumstance. When we intentionally shift responsibility, then we are laying blame and shame at the feet of another. Whereas, if we accept the responsibility of an event that we are not accountable for, then we are accepting the blame and shame associated with the event. Moreover, authentic responsibility never seeks to place shame or blame upon oneself or another. How would you react, or how have your reacted when someone has accepted the responsibility for an error in life? Responsibility is not a one-way street, rather it goes both ways. For the person admitting the wrong, the failure and the mistake is accepting his or her responsibility; the person hearing the conveyance of repentance is also responsible for acknowledging and forgiving those who are responsible for the errors. For acknowledgement and forgiveness opens the pathway to healing.
866-951-5357 SMART Recovery, a Volunteer-Driven 501(c)3
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RECOVERY RESIDENCE -VS- BOARDING HOUSE By John Lehman
The persistent public debate over the rights of persons in recovery to live together as a family unit rages on in communities throughout our nation. The vast majority who attend town hall meetings express resentful objections to FHAA and ADA protections of this disabled class. Discriminatory statements fly into the record, one right after the other, sometimes for hours at a time. The “sober home” applicant who seeks reasonable accommodation to expand local zoning restrictions regarding the number of unrelated adults permitted to occupy a residential dwelling, a right provisioned by FHAA, often feels threatened in this hostile environment. In the face of this community hostility, it is easy to overlook legitimate concerns expressed by neighbors. One legitimate concern that both sides of this debate might embrace, were we to engage in civil public dialog, is that over-saturation of recovery residences in neighborhoods may undermine a key objective of community based, recovery housing. Recovery Residences are not boarding houses. The term Recovery Residence was promulgated by the National Alliance for Recovery Residences (NARR) and refers only to standards-based recovery housing. FARR is the NARR Florida affiliate and, as such, certifies provider compliance with the NARR Standard. This Standard is constructed atop the Social Model of Recovery Philosophy (SMRP) which emerged in California seventy (70) years ago, attracted science-based, academic researchers fifty (50) years ago and continues to be aggressively studied today. Evidenced-based measurement of positive consumer outcomes delivered by recovery-oriented support systems that implement the SMRP to varying degrees and at a drastically reduced expense to taxpayers and private pay citizens, has generated a resurgence of federal and state interest. Twenty-nine (29) SMRP scale considerations are organized and evaluated under six (6) domains: Social Model of Recovery Philosophy Scale Domains Physical Environment
To what degree does it feel like a home
Staff Role
To what degree are staff respected peers vs. distant superiors
Authority Basis
To what degree is authority based on experience
Paradigm
To what degree is it recoveryoriented
Governance
To what degree does accountability involve peers
Community Orientation
To what degree is the community viewed as a resource
The sixth domain, Community Orientation, includes consideration of both the surrounding recovery community and the broader community in which the Recovery Residence is situated. One hallmark of recovery oriented support systems is to foster community engagement and responsible citizenship. By necessity this objective requires access to a two way street, does it not? Residents who are encouraged by Recovery Residence operators to give back to their community must be welcomed to do so by that community. Volunteers willing to suit up and show up to participate in service projects with other citizens should be made to feel welcome as equal members of that community. They’re not seeking charity. They’re proving charitable contributions of their time and energy for the betterment of their community, just like every other citizen who showed up to volunteer. The short FARR film “Community Partnerships” (14:15-directed by filmmaker Michael DeLeon; Kids are Dying and An American Epidemic) addresses the need for community and provider group collaboration to end the addiction healthcare crisis at the local level.
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We encourage individuals within each group to invest a quarter hour of their time to view this documentary. It provides a balanced perspective and suggests specific ways in which we might come together over issues upon which we are in agreement. To view this film and read more about the SMRP, please visit www.farronline.org/community. Addiction is an isolating disease. Over its course, the afflicted person generally experiences a profound disconnect from all social networks including family, friends and community. This article does not seek to explore the root cause(s) of this isolation, but to simply acknowledge that a key value proposition for community-based recovery housing (for which a preponderance of evidence is recognized by FHAA) is to reintegrate persons in recovery within their surrounding community. Both stakeholders benefit from the successful implementation of this strategy. Siting a dozen recovery residences on a block of thirty homes may, in fact, minimize the effectiveness of this strategy. The point is: we don’t really know, do we? No studies have been funded to arrive at evidence based conclusions. FARR suggests that both stakeholders, community and provider groups, have a vested interest in determining definitive answers to this question. While we will likely continue to debate the many issues that divide us, certainly we can begin to stand common ground and seek funding solutions to conduct fair, unbiased research to inform and guide our collective resolution to this challenging dilemma. John Lehman is the president of FARR. Over the last two years, he has helped to develop the organizational infrastructure and continues to support initiatives to enhance the rights of residents who seek to enjoy alcohol-drug free housing that is safe, clean, and peer supportive. John is also the managing partner of Cashbox Solutions, a payment system developer that designs fi nancial and management cloud-hosted software solutions for the recovery industry.
Certifying safe and dignified recovery residences for individuals seeking peer-supportive housing.
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EXCITED DELIRIUM: IT’S NOTHING TO BE EXCITED ABOUT By Heather Coll
If you watched the video of the man who was recently recorded running naked through the streets of Ft. Lauderdale, you might have found yourself chuckling. But excited delirium is no laughing matter. Neither for those afflicted with excited delirium or for the law enforcement dispatched to confine these individuals. Since January, there have been at least five incidents where individuals have displayed bizarre and sometimes dangerous behavior. For instance, in February, a paranoid man while high on Flakka attempted to kick in the door of the Ft. Lauderdale police department. He later disclosed that he believed that he was being chased down by a group of men who wanted to harm him. Unfortunately, excited delirium is not a new phenomenon although the emergence of Flakka is creating a rash of recent incidents. Some of you may also recall the 2012 story of the man who partially ate off the face of a homeless man while high on Bath Salts. The cannibalistic behavior of the man was also the result of excited delirium. What is Excited Delirium? Excited Delirium impairs a person’s emotions, cognition, perception, and neurophysiology that result in disorganized thought patterns, dangerous physiological responses and bizarre behavior that can be potentially lethal. The symptoms of excited delirium consists of motor and mental excitement, extreme anxiety, rapid pulse, hypertension, elevated body temperature, high agitation, aggressive behavior, profuse perspiration, disorganized speech and behavior, disorientation, paranoia, hallucinations, delusions, super human strength, and diminished sense of pain. When excited, delirium is present. Body temperatures may rise as high as 105-106 degrees, potentially resulting in kidney damage and failure. Some individuals with excited delirium were later discovered to have died due to cardiac arrest. Bath Salts Bath Salts contain two synthetic chemicals that are responsible for the excessive release of dopamine and the subsequent psychosis and excited delirium that follows. One of those chemicals, Mephedrone is responsible for the excessive release of dopamine in the brain and the second chemical, MDPV, prevents the dopamine from being reabsorbed back into the neurons. According to the American Association of Poison Control Centers data, there were approximately 6,136 calls to poison control centers in 2011 pertaining to adverse effects of Bath Salts, which consisted of increased heart rate and blood pressure, agitation, hallucinations, extreme paranoia, and delusions. Risks of Bath Salts: Variance in Production, Purity, and Potency: There are no standardized production methods established for bath salts; therefore, the ingredients included in bath salts will vary across batches. Because some manufacturers use fillers to augment the quality of the batch, a user cannot have confidence in the consistency of ingredients and are at risk of being exposed to potentially toxic chemicals. Because the chemical compounds are not consistent across batches, some batches may be more potent and therefore, more lethal than others. The Louisiana Poison Control Center performed a laboratory test in 2010 discovering that one batch contacted 17 mg of MDPV, but another batch contained 2,000 mg. What is Flakka? Unfortunately, there is little available literature regarding Flakka, but what is known is that it’s a synthetic drug that has a stimulating and hallucinogenic effect. Flakka comes in a crystalline rock formulation, is chemically produced from alpha-PVP (a synthetic cathinone), and can be swallowed, snorted, injected, or inhaled through an e-cigarette or vapor. Detection of Synthetic Drugs Although early detection of designer drug abuse would be advantageous for treatment centers and halfway houses, it doesn’t
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exist as there is no “stick” test that allows for immediate testing of either Bath Salts or Flakka. In order to confirm the use of either of these drugs, a urine sample must be sent out to a laboratory. For clients who may want to use and avoid detection, they are often aware of this systemic deficiency and are able to use successfully or use for a considerable amount of time before the use is detected. Given the serious medical complications associated with the abuse of synthetic drugs, this poses a serious danger to the treatment community. Another barrier in synthetic drug abuse detection is the constant modification of the chemical compound structures in the production of these chemicals. In order to avoid detection by the authorities and in order to circumvent legal restrictions on the distribution of these drugs, the chemical compound structures are constantly being altered. If the ingredient list and compound structures are not consistent over time, it makes it arduous for scientists, laboratories, and law enforcement to keep up. Given the possible medical consequences associated with Bath Salt abuse, early detection is imperative for the treatment community and law enforcement. Hopefully, the recent emerging media attention being given to Flakka and excited delirium syndrome (ExDS) will be enough to prompt additional research. References Provided Upon Request Heather Coll is a licensed mental health counselor in the state 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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HOW BULLYING CHANGES YOUR LIFE’S COURSE, ESPECIALLY IF YOU’RE LGBTQ By Richard Taite
Far too often, bullying is disregarded as kids being kids. Yet bullying is pervasive in our communities and is a leading factor that can contribute to the development of addiction. This happens across the board in many different socio-economic groups, but it is particularly pronounced among those who identify as gay, lesbian, transgendered, queer or bisexual (LGBTQ). There is now a great deal of evidence that bullying in subtle and not-so-subtle ways, changes the trajectory of people’s lives. According to a government anti-bullying website: Bullying is defined as unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Studies suggest that this type of peer victimization is a pervasive issue — 28% of children and youth reported being bullied at school during the 2011 school year. Research since the 1990s shows that children who are bullied are more likely than their peers to develop mental and physical health problems. Now, new neurobiological research shows the negative effects of bullying on the physical health, mental health, and overall well-being of children and youth. At the addiction treatment center I founded and operate, we see the results of bullying on a daily basis. Individuals who are picked on suffer from lower levels of self-esteem than others. Again, the relationship between bullying of LGBTQ individuals and substance abuse/addiction is very strong. The CDC reports:
Studies have shown that, when compared with the general population, gay and bisexual men, lesbian, and transgender individuals are more likely to: • • • •
Use alcohol and drugs Have higher rates of substance abuse Are less likely to abstain from alcohol and drug use Are more likely to continue heavy drinking into later life
Alcohol and drug use among some men who have sex with men (MSM) can be a reaction to homophobia, discrimination, or violence they experienced due to their sexual orientation and can contribute to other mental health problems. In order to overcome the mistreatment experienced and the addiction problems that very often result, LGBTQ individuals are encouraged to seek out specialized treatment. Treatment from professionals who are sensitive to the particular needs of LGBTQ addicts provide the most favorable outcomes. Richard Taite is the CEO and founder of the Cliffside Malibu Treatment Center in Malibu, California, He has developed a successful treatment protocol that includes specific evidence-based interventions reflecting the Stages of Change behavioral model. At Cliffside Malibu, Richard is dedicated to helping addicts overcome their addictions so they can lead their best lives. As a hands-on CEO overseeing daily operations, he practices what he preaches with regard to addiction recovery—a rigorous schedule of exercise, yoga, meditation, therapy, acupuncture, and self-reflection to maintain his sobriety. Richard is co-author of the award-winning Amazon bestseller Ending Addiction for Good. www.cliffsidemalibu.com
RECOVERY COACHING By Mark Crawford
Coaching is a unique approach to the process of Recovery. Coaching is based on the idea that a person has all the answers they need inside of them. The coach serves to draw those answers out through evocative questions designed to serve the agenda decided upon by the client. These questions lead the client on a journey of self-discovery and intuitive insights arise that guide the client to solutions. Rather than seeking to teach, analyze or fix the client, coaching serves to get the client to open the door to their own understanding. When a person arrives at the answers themselves rather than being told what to do, the results have staying power that other approaches do not. On this journey of discovery also lies the question of “Okay now that I know this, what do I do?” Coaching helps remove the barriers to successful implementation of new strategies. Through the process of insight the client will see his own obstacles to success and begin to plan, along with the coach, ways to get through them to be successful. Through the co-creative process great long lasting results can be achieved in their lives, careers, businesses and relationships while advancing their recovery from addiction. Recovery Coaching is an ongoing professional relationship that helps people who are in or are considering recovery from addiction. Through the process of coaching the clients’ deepen their learning, improve their performance and enhance their quality of life. Coaching accelerates the clients’ progress in recovery by providing greater focus and awareness of choices, actions and responsibility. The focus is on the now and what they are willing to do to enjoy a better tomorrow. The coaching process recognizes that results are a matter of the clients’ intentions, choices and actions taken toward building a strong foundation and creating a life worth staying healthy for, supported by the coach’s efforts and application of the coaching process. While therapy focuses on the past, coaching is focused on the present and creating and sustaining a meaningful life.
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Sponsorship focuses on 12 step programs while coaching seeks to get the client to uncover their own strategies for success. Both are great avenues and can be used in conjunction with a coaching program. Coaching is not meant to replace these programs and does not seek to treat or diagnose addiction. Although studies are limited, research does point to a superior success rate for those who incorporate a program of coaching into their recovery process. Evidence also points to greater success with relapse rates and length of recovery. Without a coach three out of four people relapse within a year. With a Recovery Coach three out of four people remain in recovery. People who use coaches make better decisions and spend less time struggling through the recovery process. Whether a client is thinking about going into recovery or is in recovery, a coaching program can help. Coaches can guide a client through the options available to them albeit without endorsing any particular program. They are the guides and mentors for people seeking or already in recovery. Coaches are committed to supporting their clients in developing successful strategies that work for them. Recovery Coaches work with their clients to come up with their own solutions, to make their own choices and they support their clients to stay on track and take the actions that bring about transformation. Wherever the client is in their stage of recovery the process can be overwhelming. Coaches support their clients as they face the challenges before them. Coaches can help clients find their way in a new different life. It is a wise investment that prevents relapse. Mark Crawford is a Recovery Coach with a practice in the West Palm Beach, Florida area. Please visit my websitewww.redirections.biz or feel free to contact me at 845-467-8853 for further information or details.
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ADOLESCENT SUBSTANCE USE, LOSS, AND BEREAVEMENT By Fred Dyer, Ph.D., CADC
If you recall in the December issue of Sober World, I mentioned the statement that you frequently hear around the AA and NA rooms, “You must be willing to deal with life on life’s terms”, meaning that there are some things in life that are non-negotiable and some things in life about which, as Walter Cronkite (excuse my return to the 60s) said, “And that’s the way it is.” It is necessary when working with adolescents, to assist them, as difficult as it can be, to understand that loss is both a common and unique component of human existence. It is common in that all human beings go through separation and loss of significant relationships throughout the course of their lives and share a collective need to learn ways of coping with the impact and aftermath of serious losses. Loss is unique in that each individual has a distinct life history with loss and develops a particular set of beliefs about loss which reflects that life experience. When I was an adolescent I faced significant losses just as today’s adolescent does, and the losses faced by the adolescent are significant because they affect the adolescent’s ability to cope with, and adapt to, subsequent and major losses, such as the death of a pet, death of a friend, or death of a parent. Interestingly, adolescents, like adults, may try to manage the bereavement from the loss through alcohol and drugs. Research reminds us that the use of alcohol and drugs has a coping motive; rather than attend grief counseling groups or meet with his or her counselor, the adolescent becomes more comfortable smoking weed or tossing down a forty-ounce. In providing services for adolescents who have experienced loss and grief and who are now using substances, it is important to differentiate between grief counseling and grief therapy. Grief counseling is defined in the literature as the appropriate treatment for uncomplicated grief. The goal is to help the survivor complete any unfinished business with the deceased and to say a final good-bye. Conversely, the goal of grief therapy is related to complicated grief in that to identify and resolve the conflicts of separation which preclude the completion of mourning tasks in persons whose grief is absent, delayed, excessive, or prolonged. In substance abuse treatment, grief issues for the adolescent are often addressed through the substance abuse group modality, when in actuality those adolescents who have experienced loss could more than likely benefit from a grief and loss group. One must be clear: giving up alcohol and drug use can itself be another loss in the life of the adolescent, because for some adolescents, alcohol and drugs become the center of their lives, more important than family, friends, boyfriends and girlfriends, or once-favorite activities. Techniques used in working with adolescents who have delayed, masked, or inhibited grief reactions must be utilized by a therapist with knowledge of grief counseling, therapeutic dynamics, or as is often stated in the literature, to be able to put a person back together and make him or her whole. This practitioner will need knowledge about substance use and be able to interface that knowledge in grief therapy. Some interventions used in working with adolescents include guided imaginary for reliving, reviving, and revisiting scenes of the loss; for example, the funeral. Other interventions helpful in assisting the adolescent to acknowledge the pain of the loss are direct questioning regarding the circumstances of the loss and encouraging him or her to relive past experiences, and to express memories, thoughts, and feelings regarding the loss. It is necessary that regardless of the multiple techniques used, the practitioner must him- or herself be competent and capable to deal with the flood of emotions, i.e., pain, fear, anger, and rage from the adolescent about the fact that someone important to him or her is gone. It is also necessary to augment the aforementioned techniques with family therapy, because the adolescent’s loss impacts the entire family. For some adolescents there is a certain romanticism to death: for
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instance, an adolescent girl who loses her boyfriend might want to die herself in order to join him. The challenge for the practitioner is: 1) To help the adolescent develop emotional acceptance that the person is no longer here. 2) To help him or her work through the pain of the loss. 3) To help him or her work through the pain without alcohol and drugs. 4) To help him or her be able to say good-bye and move on with life. 5) For the practitioner to have worked through and resolved their unfinished loss and grief business. References provided upon request. Fred Dyer, PhD., CADC, is an internationally recognized speaker, trainer, author and consultant who services juvenile justice/detention/ residential programs, child welfare/foster care agencies, child and adolescent residential facilities, mental health facilities and adolescent substance abuse prevention programs in the areas of implementation and utilization of evidence-based, genderresponsive, culturally competent, and developmentally and age appropriate practices. He can be reached at www.dyerconsulting.org
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FROM COMPULSIVE CONTROLLING CODEPENDENT TO COUNTER-CODEPENDENT By Diane Jellen
A quarter of a century since the divorce? And in all this time you’ve only had four dates? What is wrong with you? These are questions I often ask myself. I’m not a show-stopping beauty, but I’m not unattractive either. I can be pleasant and carry on an intelligent conversation. I’m humorous, and I’m able to engage in discussions on current events. And thanks to my 12-step work, I have learned to be a good listener. My first suitor after my alcoholic husband and I split up was Hank. Hank had a great smile, and his eyes danced whenever we were together. We enjoyed intimate dinners and off-Broadway shows at the community playhouse. Four weeks had gone by when I sensed Hank wanted more than just a good night kiss. That was my cue to say goodbye. My dream was to move to Florida and I would not let a serious relationship derail my plans. My first date after moving south was perfect. I met John at the library. He was a retired college professor with an added bonus— he looked like Michael Caine, the actor. John loved steel drum music, and we spent our first and last date at an oceanfront restaurant listening to calypso melodies. The ambiance transported me to an island where lightheartedness reigned. John had a lot going for him. Notably he only had one glass of wine. The music and evening ended at my front door with a soft kiss goodnight. When John called for a second date, fear of intimacy answered, “No.” They say the third time is a charm. Frank, my third suitor, was a coworker who had recently lost his wife to cancer. He confessed his loneliness, and asked to visit me. His request sounded innocent. After all, it was only for dinner. So I said yes. Perhaps the bright moonlight and intoxicating fragrance of the tropical flowers prompted his impulsive, unexpected marriage proposal. The warmth of the evening did not thaw my resolve. I could not get involved in a relationship with someone so needy. After decades of feeling sorry for others, I had to stick to the healthy boundaries I had set for myself. I declined Frank’s offer. This time there was no goodnight kiss. A gentle hug and Frank was gone. My forth date occurred recently. My friend had a friend whose wife had succumbed to cancer. It seems cancer is not the only life-threatening disease. The loneliness it inflicts on the surviving husbands is unmistakable. The retired New York executive and I met at a local coffee shop. Mel was nice, but it didn’t take long for me to realize this depressed man, who looked too much like my ex-father-in-law, was emotionally bleeding to death. My codependent tendencies wanted to soothe the kind of pain only he could work through. He pulled out his cell phone and showed me pictures of his deceased wife. “She’s lovely,” I told him. I placed my hand on his and, in a sympathetic voice, I counseled him. “I think you need more time to heal. In the meantime, I’ll be praying you meet someone just right for you.”
thought I knew all about the dynamics of codependency. As I studied the characteristics of a counter-codependent, I decided it was time to re-examine my co-addictive behaviors. The self-evaluation chart revealed that, along with being a fixer, I also wore a hard hat with “Avoidance” stenciled across it. Perplexed, I needed to know how I had gone from being a busybody to an isolationist. For example, I loved getting involved and helping others. I would put myself last in order to assist others, helping to the point of playing martyr. I still have trouble setting boundaries, and my offers to help continue to overload my schedule. However, I no longer act like the victim. Without waiting for pity strokes, I do what I have to and move on. I wondered whether it was fear of rejection that was now making me shy away. Was this a bad thing or a protective mechanism? Lately, I have chosen to retreat from involvement. My motto has been the Polish proverb, Not my circus, not my monkeys. But was this a smart strategy? After taking my own inventory, I had realized my overly opinioned personality needed to change. Now I live in the inner peace moment that comes from avoiding conflict and family addiction drama. I am willing to Let Go and Let God, and that is a great thing. Before, if anyone needed a go-to organizer, I was that person. Regardless of the hard work involved, my grandiose flair egged me on. Afterwards I would tell myself, “You did it, Diane. Once again, you’ve proven your worth and managed to complete the project.” Now when I accomplish something, I’m uncomfortable with fanfare. I’d much rather slink away unnoticed. I used to be the people pleaser party planner. I had that outgoing, everyone’s welcome mentality. Now, not so much. When I do attend parties, I’m usually the first to leave. I know this carryover is from the times my hard-drinking husband was the life of the party, while I was suffering humiliation’s slow death. It still feels safer to leave before there is an embarrassing scene. Or am I avoiding others because I don’t want to get drawn into a personal relationship? What about you? Do you put up walls and refuse invitations? Are you happy being alone or are counter-codependent behaviors exiling you to a lonely place? There is a difference, you know. Below are established traits that may fit your classical conditioning. Look and see what you think. Codependent or Counter-dependent? Codependent Traits
Counter-Dependent Traits
Focuses on fixing others
Focuses on improving oneself
Projects false confidence
Projects semi-secure self-image
Feels weak and unappreciated People pleaser
Displays inner strength Detached from people – less hassle
Addicted to changing the addict Addicted to self-help projects
With sad, puppy dog eyes he confessed, “I thought I had. You.”
Wallows in shame and blame
Gulp! After two cups of black coffee and a bagel, he thought we were on our way to being a couple.
Reduces blame and shame by avoidance
Clingy need to be affirmed
Erects a “do not touch” zone
The fact that I didn’t fall for his clingy line told me I must have been getting better. Not even his forlorn response made me feel guilty enough to stay and fix him. Yes, I was definitely getting better. Or was I? Recently I came across the term counter-codependent. I had
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Diane Jellen has worked at several treatment facilities in PA, FL, and the School District of Palm Beach County Alternative Education Department. Diane is the award-winning author of My Resurrected Heart: A Codependent’s Journey to Healing, available at www.dianejellen.com.
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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS INSURANCE COMPANIES PLAY DOCTOR PART III: MEDICAL NECESSITY By: John Giordano DHL, MAC
of treatment they’ll need. Their brain chemistry hasn’t normalized yet so their foggy brain for the first couple of weeks is making it difficult to accomplish much more than planting the seeds. In the mean time, the insurance company’s case manager is in daily contact with the facility, often the doctor and/or therapist, overseeing the patient’s progress. The case manager uses the ASAM patient placement criteria like a check box form. They’ll check off things like the number of days in the program, levels of accomplishment in treatment, hours of therapy and so on. It has been my experience, and the experiences of a number of people in the field that I’ve talked to, that you just never know when the insurance company’s case manager will demand that you move the patient to a lower level of treatment because, in their opinion, the current level is no longer ‘medically necessary.’ As I mentioned, it takes a couple of weeks before therapy can really take root. Case managers are shuffling patients into lower treatment levels before doctors and therapists have the chance to do their most important work. When the case manager has enough boxes checked off, it tells them it’s time to lower the level of treatment. I don’t recall a situation where a patient who experienced a lapse being approved by a case manager to go back to a higher level of treatment – ever. Case manager’s decisions have little if anything to do with how the patient is responding, if there have been any regressions, and are nearly always met with the vehement disapproval of the doctor and/or therapist on site treating the patient. Their decisions are simply based on how many boxes are checked off. The box check off policy makes sense if we’re talking about a broken finger – but we’re not. Mental health treatment is not linear – it doesn’t follow a straight line. It makes more twists and turns than a Disneyworld rollercoaster. The check box approach – a.k.a. assembly line treatment – may serve the insurance industry well, but it simply doesn’t work for the patient in addiction treatment – unless of course you can uncheck boxes which doctors and therapists cannot. Once a box is checked off, it becomes permanent. From the perspective of treatment facilities – and the patients’ doctors and therapists – the term ‘medical necessity’ has become nothing more than the oil that keeps the gears in the insurance industry’s money machine turning smoothly to produce the greatest amount of profit. It’s the hinge on an ‘Exit Only’ backdoor that is continuing to block addicts from receiving the life-saving treatment they so desperately need and paid for. There is one option for a person who has been denied benefits. They can have their doctor/therapist appeal a case manager’s decision with a doctor who represents and is paid by the insurance company. As you can imagine the rate of denials is high. The insurance industry refuses to publish the denial rate, claiming the information is proprietary. From what I’ve been told, the denial rate is easily well above 50%, some have suggested it’s as high as 90%. It’s no wonder the relapse rate is as high as it is. I have nothing but respect for ASAM and the exceptional work they do. What I find unnerving is the way the insurance industry hijacked ASAM patient placement criteria and turned it into a check box system while using ASAM’s upstanding reputation for their own gain. The patient placement criteria was designed to be – and currently still is – a guideline for recommended addiction treatment. The two operatives here are ‘guideline’ and ‘recommended.’ ASAM criteria was never intended to be used as the ‘absolute’ rule to addiction treatment the way that it is being used today by the insurance industry; nor was it ever intended to usurp a doctor or therapist’s authority and/or role in treatment.
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Continued from page 12
To the contrary, it was designed to enhance addiction treatment professionals’ role in the care of an addict. I spoke with an ASAM representative for this article and was told that ASAM is patient-centric and based on the constant adjustment to the patients’ needs. It was never intended to be converted into a check box form used for advancing addicts expeditiously through treatment – and any use as such is not in the spirit of ASAM. Scientific research has borne out that addiction treatment can be very effective. This is not opinion, but fact. The best example of effective treatment is the Physicians Heath Program’s 90 day intense level one residential treatment followed up with long term comprehensive aftercare. The program has proven itself time after time. We know it works. Every professional in the addiction field knows it is the most effective treatment available including the executives in the insurance industry. Even with this knowledge, the insurance industry continues to jeopardize peoples’ lives everyday by putting up barriers to life-saving therapy. Today we find ourselves in a growing opiate epidemic and faced with an ‘either’ ‘or’ decision. It’s either the financial health of the insurance industry or your health. The insurance industry is standing squarely between you and your doctor; managing their profits rather than your healthcare. They hold your money (premium payments) and the associated power that goes along with it. The insurance industry has, and continues to, invest that money wisely – local, state and national political campaign contributions and lobbying firms – to assure their continued financial success; while we, on the other hand, have a collective voice. It is time to use that voice for the health of it. Too many people are dying avoidable deaths because of the cognizant and intentional gross misuse of ‘medical necessity,’ one of the many walls to effective treatment erected by the insurance industry. These walls must come down. The only action that could possibly change the course is a public outcry. For those of us fortunate enough to have gone through 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! John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: www.holisticaddictioninfo.com
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
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ARE ALCOHOLICS ANONYMOUS AND THE 12 STEPS REALLY IRRATIONAL, UNSCIENTIFIC & OUTMODED OR ARE THEY ACTUALLY VINDICATED BY PIONEERING NEUROSCIENCE? By Alastair Mordey
water, but to do without behavioral modification would be equally disastrous. Lifestyle changes must occur for full recovery from addiction. As they say in AA, “it works if you work it”. If you don’t work it, the self-directed neuro-plasticity doesn’t happen and there are no new brain pathways for you to utilize in getting safer forms of reward and meaning regardless of how well the doctor is medicating you to reduce your cravings. Human psycho-social development is teeming with examples of how words and actions change the structure of our brains. As infants we did not require medicating to learn our mother language. Via the principle of brain plasticity, our mother’s words floated through the air into our eardrums – and neural fibers in the language centers of our brain started to fuse and connect, forming brain circuits which ultimately enabled us to speak. We have to understand, that for a wide range of illnesses, particularly those with large psychological components, learning to think and behave differently can have a profound impact on the structure of the brain, and it is therefore valid and rational to use anything which achieves this as a treatment method. 12 Steps is nothing more than a program that teaches people how to think and behave differently, regardless of the fact that it may be clumsily applied by some. Glaser’s sources seemed happy enough to validate Cognitive Behavioral Therapy (presumably because it doesn’t contain untrendy religious connotations or outmoded Edwardian English) but the similarities between CBT and 12 Steps as behavioral change tools which occur via a change in thinking are widely observed. Mindfulness meditation (another non-medical approach used in addiction treatment) also takes a drubbing from one of Glaser’s sources for being ‘unscientific’. But the fact is, Mindfulness was pioneered by the University of Massachusetts medical school for use in the treatment of depression and anxiety and is heavily evidence based. It is also used in the UK’s National Health Service. Most of the scholarly written articles on the subject (not newspaper articles) agree on one point; addiction is a bio-pyscho-social disease which requires treatment which reflects that. Physicians attend to the physiological aspects of the disease, psychologists and counselors to the psychological aspects and 12 Step groups help to reduce the social symptoms by mutual self-help. If you are in any doubt (as Glaser appears to be) that addiction is actually a disease then I will save you hours of wading through hundreds of studies by referring you to the official position of two leading medical and research bodies, The American Society of Addiction Medicine (ASAM) and The National Institute on Drug Abuse (NIDA). Whilst Glaser denies that addiction is a disease and supports her argument with a quote from 1982, back in the twenty first century ASAM have defined addiction as a “primary chronic and progressive brain disease” and NIDA also define addiction as a chronic disease. A chronic disease is incurable. Both bodies are broadly supportive of 12 Step programs because they understand that the illness produces symptoms for life unless it’s treated regularly and 12 Step programs are widely available and free. So whilst it may be the prerogative of journalists to investigate alternative views, the prerogative of addiction practitioners is to follow the mainstream of science and research. One of Glaser’s alternative views is to promote medicines like Naltrexone and Antabuse as far more effective treatments than AA in treating alcoholism or problem drinking, but yet again this misunderstands the fundamental nature of the illness and the multi-disciplinary way it needs to be tackled. These drugs are not the silver bullets that Glaser and her sources suggest. They are frequently ineffective without psychological and social support, in the same way that 12 Steps would be ineffective without appropriate
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Continued from page 18
medical intervention. During my ten years of working with alcoholics and problem drinkers in North London (from street alcoholics to high flyers) I came to learn that it took a brave doctor to prescribe Antabuse. Drinkers who were prescribed Antabuse with no psychosocial recovery solutions frequently drank on top of the medication making themselves profoundly sick despite knowing full well that it would happen. The late George Best, Britain’s most infamous soccer player of the post war era was a very good high profile example of the limitations of Antabuse treatment. He failed to stop drinking through Antabuse treatment and even with a liver transplant he continued to drink until he died of his disease to the absolute horror of the general public. Likewise, people with naltrexone implants have been known to literally gouge them out of their own skin, such is their determination to relieve their need for reward and meaning, regardless of whether their cravings have been reduced by the medicine. Addiction is a disease like no other. It is a biologically driven existential crisis. Medicines that provide meaning should continue to be explored, but in the meantime AA is doing a pretty good job for a group of very ordinary people supporting each other in a very ordinary human way. Alastair Mordey is programme director of The Cabin Addiction Services Group, a provider of inpatient and outpatient addiction treatment across Asia and Australia. He has also worked in all four tiers of the UK’s treatment services for over a decade, including as an advisor to the National Treatment Agency on matters of drug and alcohol treatment provision. His forte is developing therapeutic group work models for both inpatient and outpatient settings.
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INTERVIEW WITH THOMAS HENDERSON By Patricia Rosen
You are a good guy. Nobody ever told me I was a good guy before. There was also this doctor that helped me when I got out of detoxDr.Joseph Pursch; he worked with Buzz Aldrin, Betty Ford and many others. He said to me, “Thomas, anything is possible for you if you stay sober. Nothing is possible if you ever drink again. Patricia: That’s so true for everyone struggling with addiction. Thomas: So, 31 one years later, the words from Roger Staubach, rehab, the quote from Dr. Pursch and 12 step programs has saved my life. Patricia: Why did you go public with your drug use? Thomas: I wanted parents to know the perils of addiction. I wanted them to know the things that go on when their child is addicted to drugs. They do things and get involved in situations that are not so healthy but in the drug world when you’re an addict you will do anything for your drugs. This is happening and it’s very real. I want parents to be aware of what their children are doing. Ignoring it won’t make it go away. It will just get worse. They will be asked to do things; anything goes in the drug world. Patricia: I think if more people come forward and speak about it, such as yourself, we would see a lot more people trying to get help. There is such a stigma attached to addiction but hopefully as people come forward, more lives will be saved. What was prison like? Thomas: It was a time to reflect on my life. The 3 year old boy who loved to learn came back. I devoured books and knew I was headed for a different future. Patricia: So, for all the young people reading this, prison is not where they want to be. Thomas: no, no, no- I had people start fights with me, it’s not a place they want to go. I want parents out there to know, if your daughter or son is doing opiates, crystal meth or cocaine, be assured they are doing things that are not so nice in order to get their drugs. You don’t want them to learn the way I had to learn. Patricia: Well, it’s interesting you say that because there was an article in my magazine last month on PTSD by Jim Snow. He wrote about men presenting with PTSD which many times happen from the things they did while in their addiction. Thomas: Yes, men and women. Patricia: What happened when you were released? Thomas: I was a different human being. I was clean and sober. I had gone from patient to pupil and my life and my outlook had changed. I was a whole different character.
Continued from page 6
Thomas: lol- Yes, winning the lottery. Patricia: You won 28 million! I heard you started a charity called East Side Youth Services and Street Outreach. Thomas: Yes, Our web page is www.hollywoodhenderson.com Our purpose is to provide a successful athletic facility to the underserved in the Austin community, and to contribute activities that share a similar mission of youth development through sports and drug free health. My philosophy on giving back is not holding hands. I was going to start a scholarship but then I said no, I went to school, I went to the ball fields; I did the work so I wanted to lay the groundwork and give them an opportunity. Patricia: You gave them the tools. Thomas: Yes, and the facilities, but the rest is up to them. As a matter of fact, we are going to be raising money again to redo the track. It’s worn out which is a good thing. It means people have been using it. Patricia: Will you be fasting again? Thomas: No, I will be out there selling my newest book “In Control” 14 hours a day. And guess what? If people have a drug issue and don’t have $10.00, I will sign it and give it to them anyway. Patricia: Speaking of Books, You have written two, am I correct? Thomas: Yes, “Out of Control: Confessions of an NFL Casualty” and “In Control: The Rebirth of an NFL Legend.” Patricia: I have also heard you are very active in raising awareness about addiction. You have been doing this for over 25 years. Tell us a little about that. Thomas: I speak to patients, do interventions and consulting. I made films for schools and jails and even spoke at a Sober Home a few weeks ago for only 6-7 clients! I worked at Sierra Tucson, Father Martins Ashley and The Hanley Center. I am now very excited to be the Brand Ambassador for the Addiction Recovery Network. Our mission is to connect people struggling with addictions to the treatment center best qualified to serve them. Patricia: It sounds like you have been a very busy man these last 25 years. My last question- I heard you lost your Super Bowl ring to the IRS and a friend got it back for you. You said it was less important to you than the more than (at the time) 16 years you have been playing every day in the “Sober Bowl”. How do you like living in the “Sober Bowl”?
Patricia: How do you stay clean?
Thomas: It’s better than all the Super Bowls, even the one we won, better than everything. Someone once told me “Behave Boy, because you may be the only book that someone reads”.
Thomas: I have been a faithful worker and follower of the 12 step programs.
Patricia: That’s so true. I want to thank you again for all you do to educate people.
Patricia: Did you ever bump into old friends that wanted to get high with you?
Thomas: It’s my pleasure. I wanted to tell you that your Publishers page in your magazine is a bundle of information and right on target. Thank you for all you are doing.
Thomas: No, I was enmeshed in a whole other community. I never looked for it. I did lots of public service; motivational speaking and I have produced motivational films since 1988 that are currently distributed by www.FMSProduction.com In 1992 I built a football stadium for the kids in Austin, Texas. In 1999 we needed a track around it but we couldn’t afford it. I called a press conference and told the good citizens of Austin, Texas that I wasn’t going to eat or go home until we raised $300,000 to build the track. I was there in a tent for 7 days drinking only water when on the 7th day we had $300,000. Patricia: It’s nice to see how you turned your life completely around. Maybe what happened to you in 2000 was Karma then.
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Patricia: Thanks.
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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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