June 2017 - The Sober World by The Sober World,LLC

J U N E 2 017

VOLUME 6

ISSUE 6

IN MEMORY OF STEVEN

THE

A N AWA R D W I N N I N G N AT I O N A L M A G A Z I N E

WORKPLACE LEADERS AND

DEPRESSION By Dr. Mel Whitehurst

POWERFUL CLUB DRUG “KETAMINE” AKA SPECIAL K, PROVIDES RAPID RELIEF FOR

TREATMENT RESISTANT DEPRESSION AND SUICIDALITY By Mark S. Gold, MD

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. The Sober World is an informative award winning national magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication, as well as an online e-magazine reaching people globally in their search for information about Drug and Alcohol Abuse. We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol as well as distributing to schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more .We directly mail to treatment centers, parent groups and different initiatives throughout the country and have a presence at conferences nationally. Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest manmade epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction. If you are experiencing any of the above, this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under the age of 18 yrs. old) and bring them to the facility you have To Advertise, Call 561-910-1943

chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs, Extended Living and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean. Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help. Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com. To all you Dads - Happy Fathers Day. We are on Face Book at www.facebook.com/pages/TheSober- World/445857548800036 or www.facebook.com/steven. soberworld, Twitter at www.twitter.com/thesoberworld, and LinkedIn at www.linkedin.com/grp/home?gid=6694001 Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com

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WORKPLACE LEADERS AND DEPRESSION By Dr. Mel Whitehurst

Researchers rank depression and anxiety among workers as two of the most destructive workplace problems faced by employers. Research indicates that most workers suffering from clinical depression remain in the workforce each day functioning at a reduced capacity. Unfortunately, work environments often worsen depression in workers. It is not the responsibility of workplace leaders to diagnose clinical depression or to become therapists for troubled workers. Leave that to mental health workers outside the workplace. However, what leaders can do is construct work environments that lessen the destructive impact of depression on worker efficiency through some very specific leadership tactics that uniquely enhance efficiency of these workers. Depressed clients in my private practice told me depression was like a shadowy cloud hovering over them with constant feelings of impending doom. Things were meaningless; nothing seemed to really matter. Intense feelings of sadness and unhappiness stayed with them always. They went through the motions of working each day, returning home at night in a foggy state. What makes this even more perplexing is that workers infrequently recognized this as depression, typically feeling, for some vague reason, they were “bad” persons or that others are “making” them depressed. These feelings can lead to observable performance problems. Here are a few questions a leader can ask about observable performance behaviors that may suggest depression. 1. Has the worker’s behavior changed from generally positive to negative? Does the worker complain about lack of support to do the job? Depressed individuals often “feel alone” and unsupported, and tend to focus negative feelings on something external. Self-isolation is common. 2. Has the worker’s energy level dropped from full of energy to withdrawal from others and to producing less? Does the worker show a diminished interest in work? Work productivity often slowly drops as a person descends into depression.

depression.” Instead, stay with clearly observed performance behaviors - “You appear downcast” or, “you seem less energetic lately.” • The negative emotions of depression have a narrowing effect on thinking and problem-solving. Positive emotions broaden and build a repertoire of thoughts and actions. I help clients to be more positive so they are open to new things, get more involved, and put effort into solving problems. I adopt the attitude that things can change and can be improved. I consistently encourage hope for a better day. Even in darkest times there is always a better way. I stay positive, point out the client’s strong points when possible and provide encouragement. Depressed workers need this kind of positivity. • Make a list of positive words. Then, use as many as you can appropriately in talking with a worker who has performance problems that appears to be the result of depression. Depressed workers need more positive words. You can never use too many.

3. Does the worker start hedging time, coming to work late, asking to leave early, missing deadlines, taking longer to perform routine activities and forgetting details? Depressed workers start avoiding work, especially the more complex aspects of work.

• The identification of the real causes of any underperformance problem may never be conclusively determined. You can only make speculations from observations. Do not suggest that a problem will be totally resolved or ideal goals completely attained. Instead, propose that circumstances can be significantly improved, and meaningful progress toward performance improvement can be made. Then work with them on how they can improve for now and the future.

4. Is there an increased edginess? Is the worker more easily annoyed or irritated? Has the worker become a chronic complainer with frequent displays of temper? Depressed persons can take on an agitated, short-fused state.

• Remain outcome-oriented and solution-focused. What and how are used instead of why. Focus on what and how to improve performance instead of identifying the underlying causes by asking why.

5. Has the worker become more uncooperative? Depressed workers become less cooperative and will attempt to “block out” responding to new information.

• Help the worker see what things would be like if the performance problem was resolved. Ask the question often asked by psychologists to their clients: “Suppose you go to sleep tonight and in the middle of the night a miracle happens and all your work problems are solved. What would have happened?” I work to get the worker looking to a more positive future.

6. Does the worker have a downcast appearance? Depressed persons lose their expressions of positivity. They may appear to be “plodding” along in a rote manner, just going through the motions with no enthusiasm, barely performing at the minimum level and sometimes below the minimum. 7. Does the worker show increased difficulty in organizing tasks and activities? Does the worker have trouble planning and thinking ahead? Depressed workers are ineffective in thinking ahead. When you see these performance problems, you need to act. In my private practice, I frequently helped clients who suffered from these performance problems resulting from depression using a solution-focused approach. Here are some suggestions for workplace leaders. • When talking with a worker never imply that you know exactly what is going on in their mind. Only the worker knows. Don’t say, “You are depressed.” or “You are experiencing too much

• Correspondingly, help the worker see the ultimate results of a problem if the problem does not get resolved. Ask, “If the problem does not get fixed what will happen?” • Change takes place gradually over time. Big problems do not always require big solutions. Reducing problems to the lowest common denominator is essential. Work for the smallest change. Small change leads to big change. A worker who can be persuaded to agree to a small suggestion is more likely to agree later to a larger request. • People often agonize for long periods of time about particular performance problems, but spend little time analyzing why something is working so well. I try to find those things the worker is doing well in their job and get them to do more of them. Continued on page 32

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POWERFUL CLUB DRUG “KETAMINE” AKA SPECIAL K, PROVIDES RAPID RELIEF FOR TREATMENT RESISTANT DEPRESSION AND SUICIDALITY By Mark S. Gold, MD

“I could watch the sunset over the ocean, or notice a rainbow after a warm summer rain, but never feel moved or awed by its beauty or wonder. Drinking or getting high is the only thing that allows me to feel anything good anymore—but only lasts a short while. So most nights I go to bed hoping that I won’t wake up in the morning.”

~Sarah, 33, San Diego, Ca.

Introduction Like addiction, Major Depressive Disorder (MDD) is a life threatening brain disease characterized by persistent depressed mood with overwhelming sadness, loss of pleasure (anhedonia), isolation, despair and hopelessness (DSM V, 2013). MDD is not having a bad day or week or feeling blue for a few days, like most of us will experience for brief periods during our lives. Rather, depressed persons feel as if they have sunk into a deep, dark hole with no way out —and with little belief that things will ever improve. Like addictive disease, MDD is not well understood and difficult to treat. Persons with these disorders are prone to relapse and without optimal treatment of adequate intensity and duration, these disorders can result in premature death or disability. Treatment Resistant Depression (TRD) Treatment resistant depression is diagnosed when a patient fails to respond to at least two courses of traditional antidepressant therapy, usually coupled with individual psychotherapy. At present, the most commonly prescribed antidepressant medications are Selective Serotonin Re-Uptake Inhibitors (SSRI’s) and their first cousins, Selective Serotonin Norepinephrine Re-Uptake Inhibitors (SSRNI’s). While effective in many patients, SSRI’s), such as Zoloft, Prozac, Paxil,…and SSNRI’s such as Effexor and Cymbalta, can take up to 6 weeks to be effective. As a result, adherence to these medications, especially among young depressed persons is very low. Whether they were addicted and now depressed or just depressed, they want to feel normal now—and many know how to do so by using illicit intoxicants or alcohol. Self-medication with powerful addictive substances can provide immediate, but temporary relief that wears off quickly, and over time, actually makes depression worse. To be sure, SSRI’s and SSNRI’s have been life savers for millions of people suffering from MDD, largely because of their impressive safety profile, limited side effects and documented efficacy. Although many patients respond to SSRI’s or SSNRI’s, many have only a partial response and never return to their pre morbid state. For those with TRD, waiting weeks or months for relief can seem like an eternity. Often they can’t stand feeling empty, losing hope and wondering if life is worth living. Who can blame them? These non-responders often suffer through numerous trial and error with different medications, doctors, combinations of SSRI’s / SSRNI’s, sometimes combined with mood stabilizers and antiseizure medications. To make matters worse, psychiatrists have no way, other than trial and error and their clinical experience to predict which medications might work and which will not. This is not surprising as most of the currently available medications are based on a circa 1960’s, catecholaminergic view of depression, anxiety and addiction. Yet, those with TRD remain treatment resistant, often desperately going from doctor to doctor seeking relief until they either give up, drop out of treatment, start self-medicating or start thinking of suicide. These data confirm what I first wrote about in the 80’s. Namely that we are far away from understanding the genesis of major depression. Moreover, our current arsenal of medications, may in fact be working on secondary brain systems rather than the root neurobiological cause.

What is Ketamine? Ketamine is an N-Methyl D-Aspartame (NMDA) receptor antagonist with dissociative properties. NMDA receptors (NMDARs) possess high calcium permeability which allows Ketamine to pass through the blood brain barrier and reach its target very quickly. Illicitly, Ketamine is still a drug of abuse in the US, but it is primarily used in Asia, especially in Hong Kong where it is commonly abused as a “club drug”. Ketamine has been FDA approved in the US as an anesthetic for nearly 50 years. It is used safely, primarily by anesthesiologists, in both hospital and surgical settings. Recently several small but well-controlled studies have found that Ketamine can dramatically relieve and even eliminate depressive states and suicidality in a matter of hours, even among the most severely depressed persons and non-responders, when administered intravenously, in sub anesthetic doses. These small studies have been replicated by researchers at the National Institute of Mental Health (NIMH), Yale University, Mt Sinai, Washington University, and at Stanford. Because Ketamine also reverses suicidal thinking, it may ultimately provide ED physicians a way to quickly stabilize suicidal patients and facilitate referral to the appropriate psychiatric or dual disorders provider. Researchers, like me, view Ketamine as a major advance in our understanding of the etiology of depression, primarily due to the nearly immediate effectiveness and short duration of Ketamine. These data suggests to me, and others, that we are on the verge of a new and novel understanding of depression and the development of a new class of antidepressant treatment. Ketamine unlocks a key in the brain that clearly provides immediate relief to some TRD patients. There is no reason to settle for the “wait 4-6 weeks and see” approach used today in treating TRD. Some physicians have already begun to offer Ketamine, as an “off label” treatment for severely depressed, non-responders, who exhibit symptoms of suicidality (JAMA Psychiatry. March 2017). Why We Can’t Wait for a Cure Today, Major Depressive Disorder (MDD) also called unipolar depression, affects more than 14 million Americans annually. Depression is now the leading cause of disability in US, and the mortality rate (suicide) for adults with untreated or under-treated depression is between 15-20%. Recent surveys by the CDC and others indicate that as many as 1 in 5 high school students in the US have seriously considered, or attempted suicide. The American Academy of Child & Adolescent Psychiatry (2013) reports that suicide is now the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to14-year-olds—and growing. No, it’s not a typo, 5 year old children are committing suicide. It’s absolutely shocking to realize that with the elimination of the diseases that shortened lives of young Continued on page 30

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WHEN PEOPLE VISUALIZE DRUG AND ALCOHOL ADDICTION IN AMERICA TODAY By Matt Polacheck, PsyD, MA

When people visualize drug and alcohol addiction in America today, the images they see are a young adult with a needle in their arm, a bum with an empty bottle of rum sitting next to him, or college students with bongs smoking marijuana. In fact, research confirms our society’s problems with addiction. In one specific population, deaths due to alcohol abuse have doubled since 1999. That statistic may not surprise you given the amount of media attention drug and alcohol abuse has gotten recently. However, what might surprise you is the population where deaths have doubled since 1999 - white women ages 35-54. Yes, that’s right; our perception of the people dying from drugs and alcohol might be different than the reality. As wives and mothers grab their keys and a bottle of wine to rush off to their book club, I am reminded that addiction does not discriminate. In fact, later onset alcoholism research confirms that women are much more likely than men to become addicted to alcohol later in life. For years, we have known that addiction has a symbiotic relationship with genes and genetics playing a key role. But compounding the situation of later onset alcoholism is the more surprising and perplexing etiology of societal influence. Yes, those 35-54 year old white women who are having a drink after a PTO meeting, a long day at the office, or at a book club are at risk because of the culture around them and the company they keep. Unfortunately, as we get older our bodies aren’t doing us any favors. In fact, older onset alcoholics have increased serious threats to consider. First, as we age we have less liver enzymes which means it takes us longer to metabolize alcohol. Our bodies gain fat and lose lean muscle as we age causing a reduction in our blood water levels leading to higher levels of blood alcohol content. Recent studies (Krenzler 2012) have found that serotonergic levels that correlate with early onset alcoholics does not correlate with older onset. Meaning, the traditional risk factors such as depression and other biological factors have less influence on later addiction. This further confirms that our environment is playing a more pivotal role. Media and social outlets have always advertised alcohol consumption as a way to “relax” or take a break from the stresses of everyday life. However, never have we seen this more normalized with women’s lives than today, from Face Book posts showing mommies having a “time out” drinking to “Real Housewives” in every city routinely shown drinking and having a good time. In fact, the television show The Bachelor portrays women drinking every single evening during the “rose ceremony”. Women having fun and relaxing is centered around alcohol consumption. Drinking has become the vehicle or way for women to relax, have a good time and for coping with the stress of everyday life. These women are portrayed as selfsufficient, powerful, smart and beautiful, and the drink is part of their everyday life and a measure of success. But there are shadows and shades of gray that develop and cloud their parenting, work and relationships. The relaxation and good times fade away. The trickiest part is most mommies are utilizing “mommy juice” as a coping mechanism. They live busy lives, and alcohol becomes a quick and easy numbing solution. Most of our mommies have busy schedules and don’t have the time to go to the gym, a spa, or find other self-care or coping skills. Their busy lives and increased responsibilities minimize their chances and opportunities to explore treatment options. There are additional issues preventing women from getting the treatment they need. First, there is still a larger stigma for women to admit they have a problem with alcohol. Women also may feel pressure and shame for having to leave their family for an extended period of time to get help. Finally, even in today’s society, women have more limited financial resources than men to get the help they need. Their shades of gray do not provide them easy or healthy alternatives only more reason to live in the shadow of alcohol.

So what is the answer? Are we as adults still victims to peer pressure? The research world says yes! One study showed that adults find it harder to turn down drinks in social situations than younger people, reflecting that heavy drinking remains the norm in middle age. In fact, adults report having to come up with excuses for not drinking in social situations (dieting, New Year’s resolution etc.). Within that, we have to accept the well-known social principle that birds of a feather stick together. Studies show we most likely pick friends that are similar to us in values, morals, and even physical appearance. So take time to consider who you are hanging out with and if they are the types of people you align with. Aside from the groups we choose to spend time with, we all have to be responsible for our own actions and behaviors. It is important to shift our focus away from getting validation from others. A helpful tip is to focus on how we want to be remembered. If you are curious if your drinking is on the level of an addiction this might require a professional assessment. Remember, later onset addiction is less connected to genetics, so assessment might be more difficult to determine. The key to getting assessed is to rely on professionals with a specialty in addiction. Most general medical doctors and therapists are not thoroughly trained in addiction and going to a specialist is highly recommended. There are tons of resources available that are free including AA meetings, and most local programs offer free evaluations and workshops. The good news is that addiction is becoming less and less stigmatized and there are an abundance of programs out there. But it takes courage to reach out for help. Regardless, the studies are showing us that this is a serious and growing threat and must be addressed. Matthew Polacheck, PsyD, MA, is a nationally recognized expert spokesperson on mental health and substance use disorder issues, and utilizes his wide breadth of experience and expertise to lead the Betty Ford Center’s Outpatient Services as its Director. Dr. Polacheck has had numerous leadership roles during his 15 years as a clinician, in several settings. Most recently, he was Director of Mental Health for the Center for Discovery. Dr. Polacheck also served as Program Director for multiple adolescent residential facilities, where he worked with an ethnically diverse range of patients using a variety of clinical interventions, and he was instrumental in opening and running a mental health I.O.P. Program. Dr. Polacheck earned a Master of Arts degree in Counseling Psychology and a Doctor of Psychology from The Wright Institute, and he holds an undergraduate degree from the University of Arizona. He is also a certified trauma therapist and substance abuse counselor, and is a frequent guest on local TV and radio shows on the subject of addiction and recovery. License CA 22442

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HELPING AN INDUSTRY HELP PEOPLE By Michael DeLeon

“The changing dynamics of an industry under siege” We are in the midst of the worst public social health crisis America has ever seen. We are losing more people to addiction than at any time in our history. According to US Surgeon General Vivek Murthy, nearly 21 million Americans were directly affected by drug or alcohol addiction last year — a number similar to those suffering from diabetes. This is a huge social and medical problem; there is hardly anyone in America today who is not directly or indirectly affected, and the problem continues to worsen. Our opiate and heroin pandemic is escalating in an out-of-control synthetic storm. Prescription medication sales are on the rise. At this rate, the problem will only get worse in the years to come. The need for addiction treatment is greater than ever before. Thanks to the Mental Health Parity and Addiction Equity Act passed by Congress, mental health and substance use disorders (SUDs) must be treated like any other medical condition. When working with people seeking treatment for SUDs, I have found it tremendously difficult finding long-term treatment for them. It has become even more difficult finding sufficient recovery support services for those completing primary treatment. Such services hardly exist across America; they’re not supported. Incredible as it may seem, the US lacks a uniform system of care for addiction. We lack a long-term approach to treating an illness that people commonly accept as a lifelong condition. Treatment is needed more than ever, but is becoming more difficult for the industry to provide. Present-day substance abuse treatment is both reviled and required for solutions. From my view over the past five years of finding and securing treatment for thousands of people, the treatment industry is rarely loved and often hated. However, this is a service many people are frantically searching for: “More beds! We need more beds!” In reality, the problem is not necessarily the amount of beds, it’s the amount of empty beds due to lack of funding. What we also need are more long-term treatment beds with a continuum of care and recovery support services. In my opinion, the addiction pandemic will worsen over the next few years as more prescription medications are prescribed, poisonous synthetic opioids made in China flood the United States, and catastrophic consequences begin to unfold from the legalization of commercialized and industrialized THC massmarketed as marijuana. The client’s needs have become more complex as the need to do more with less has manifested itself and the insurance companies will hinder the treatment industry in accomplishing its mission. There is a burgeoning population of people in need of therapy and counseling, yet the insurance companies are making it more and more difficult to provide these services. We want addiction treated as a disease, yet we don’t have a standardized system of care to treat it, and the industry charged with treating it is being hindered by the industry that is charged to fund it – Insurance. Reimbursements to treatment centers are getting lower while the need for further, more extensive treatment increases. There are treatment centers closing down across this country, as insurance companies which have previously approved services; are now denying payments. How does an insurance company approve a service and a treatment, then months later, deny the payment? It’s immoral and unethical and should be illegal. It’s what the treatment industry fears – being unable to save lives due to insufficient funding to operate. In addition, relapse from the disease of addiction is typical. Treating the disease of addiction also means treating the continued recovery from that disease. Many people return to treatment over and over

again. All evidence proves that longer term treatment is necessary especially when dealing with opioids, yet clients are receiving less and less time. When someone relapses instead of providing more time than previously, they are approving less time. Why are we providing less support to people that need more. Compounding this fear is the realization that the current treatment standards will be further developed and will require additional medical education and licensing, thus costing more. Addiction will be perceived as a “spectrum” disorder and the current “1 size fits all” programs will no longer apply to some individuals seeking treatment. Further education and regulation will be developed and implemented thus changing substance abuse and mental health treatment as we know it. The more evidence based science that is released, the more we know that not all addictions should be treated in the same manner. Just as ovarian cancer is not treated with the same chemotherapy as prostate cancer; the opioid addicted brain should not be treated with an alcohol addicted brain program. The protocol must be different. Individualized treatment is paramount to those with addictions. Socrates said centuries ago that individualized medicine would save the human race. We haven’t learned that yet. The treatment industry has for far too long been trying to put square pegs into round holes coupled with the very troubling lack of documented outcome data. In most cases of addiction, there is a personal history of trauma or an untreated mental health disorder that must be addressed. Thus, here again, this calls for additional licensed professionals and more complicated treatment. If these medical conditions are not treated medically - the client fails, the industry fails and we all fail. If the treatment industry is hindered from providing these services because the insurance industry is more focused on shareholder profit than funding the solutions, we will be unable to solve the addiction pandemic. We must not allow the insurance industry to prevent us from treating a disease that is absolutely treatable. The American Health Care Act (AHCA), if passed, provides even greater risk for the reduction in treatment services due to restrictions for pre-existing conditions and rollbacks of Obamacare policies to mandate Substance Use Disorder coverage. This would benefit the healthiest and wealthiest, but not the common individual in need of treatment services. Stay informed. Get involved. Visit www.recoveryarmy.com for a more detailed explanation and proposed solutions. Learn how to get in touch and stay in touch with your federal, state and local elected leaders. Write to your State’s Insurance Commissioner. Details about personal and local impact are very effective in getting our message across. We have to speak up. Silence kills, and we can’t stay silent any longer. Michael is the founder of Steered Straight Inc. a nationallyrecognized educational program and he has just founded a national advocacy organization called, “Recovery Army”

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TREATMENT TRANSPARENCY 12 QUESTIONS TO ASK WHEN SEEKING TREATMENT By Leigh Kolodny-Kraft, MA, LCADC, CSAT-C, CCTP, CCGC, SAP, ICADC

With addiction on the rise in the United States, we need a cultural shift in the way we view and treat it. According to a report from the Attorney General’s office, 27.1 million Americans suffer with addiction and only 1 in 10 seek treatment. The reasons are plenty: managed care, individuals not knowing their options, providers polarizing treatment with a one-size-fits-all approach, and unfortunately the system is not an honest one. I have been in the field of addiction for 20 years. We teach patients how to be honest about their addictions and the causes behind them. If we expect honesty from our patients, then we need to run our industry with transparency and truthfulness. The addiction industry has always been on the fringe; ever since hedge fund companies learned that it’s a $35 billion industry. They started buying out treatment centers with little to no knowledge of the business. Heads in beds has replaced quality care. Since money has become the main goal, there has been an increasing amount of deaths, kickbacks, overcharging, fraud, and patient brokering, which is when rehabs and sober living homes pay kickbacks to one another or to therapists referring clients to them without regard for whether or not a facility or provider is appropriate for the patient. One of my clients, a mother seeking treatment for her bipolar 25-year-old son who suffers from heroin, marijuana, alcohol, and cocaine abuse, has put her son through treatment eight times in three years. Along the way, she—like many others—ran into dishonest marketers claiming their programs were dual diagnosis and trauma focused when they were not. Her son spent between five and ten minutes with a part time psychiatrist; she was promised he’d receive a minimum of two individual sessions a week and on-going group therapy. She reported that most of the programs did not deliver and many had hidden fees. This is a common problem.

An LSW (Licensed Social Worker) and LAC (Licensed Associate Counselor) are social workers or professional counselors who have met the educational criteria and passed the first licensing exam, but have not met all of their clinical hours so they need to work under the supervision of a fully licensed counselor or social worker. 3. Is the program centered on evidence-based practices and how do they measure how effective their services are? 4. How much will this cost? Ask about hidden fees. Get everything in writing. 5. What is the patient to counselor ratio in all of their programs? How many private and group sessions will you receive each week? 6. Is the program gender specific? If not, is there access to gender specific programs? 7. What is the treatment center like? Does the program treat a full range of your needs, including medical and psychological? Is it spiritual? Does it address family issues? You may have to visit in order to see for yourself. 8. How tailored are the programs to your needs? Will they work with your individual needs and history?

My client became so depressed due to her son’s addictions and the lack of honesty in these facilities that she started self -medicating. When we discussed getting her treatment, she said she no longer had the energy to sift through all the scams and hassles.

9. What types of services are available to families? Can they visit or call? Can you contact them during your stay? Will they educate your family on how to work with you once you return home? Are there private family counseling services available?

Eventually, she agreed to attend a family owned dually licensed treatment center that provided a warm and nurturing environment. She was put in touch with the medical director so she could ask the questions that needed answering.

10. Is there a medically managed detoxification program provided on site as part of the inpatient program and if not, will they transport you from detox to the facility? What types of medical stabilization are provided? Are medications provided, and if so, which ones?

Upon admission, she was given a complete physical. She saw the psychiatrist every day, had individual and group sessions, too. Not once did she feel like a number. As her therapist, I received weekly progress reports. I’m happy to report she’s doing well.

11. What about aftercare? A 28-30 day stay in an inpatient facility is not enough to maintain recovery. How will this program support you after you leave? Does the program actively participate in assisting clients to obtain quality care treatment close to home? Do they help set up appointments with medical, psychological, and all other out patients’ needs?

So what can you do to protect yourself or a loved one seeking treatment? Ask these questions: 1. What type of accreditation or licensing does your program have? You need to know about their national accreditation because licensing laws and regulations vary from state to state. The Joint Commission and the National Committee for Quality Assurance are two national accreditation programs. You also want to know if the facility has a primary mental health license and a primary addictions license. If it is a true dual diagnosis program there should be a full time psychiatrist and medical director on staff. 2. What level of education, training, and licenses does the program’s clinical staff possess? Look for a minimum of a master’s degree of education for all clinicians. The different licenses for clinical staff are: LCADC (Licensed Clinical Drug and Alcohol Counselor) LCSW (Licensed Clinical Social Worker) LPC (Licensed Professional Counselor)

12. Will the program provide a Vivitrol injection prior to discharge and arrange for the patient to have their next appointment already set? Vivitrol injection is used in some treatment programs for drug or alcohol dependence. As a patient or a family member it’s your right to ask questions. If your questions go unanswered, trust your gut and move on. Leigh Kolodny-Kraft, MA, LCADC, CSAT-C, CCTP, CCGC, SAP, ICADC, is the founder and executive director of The Kraft Group, Inc., a mental health therapy center for children, adolescents, and adults. Based in Florham Park, NJ, Kolodny-Kraft and her team of mental health professionals emphasize the need to customize therapy sessions, whether it’s for individuals or groups. Her work covers a broad spectrum from helping people overcome addiction to social anxiety, trauma, depression, and other mental health disorders. Kolodny-Kraft received the 2014 Lora Roe Alcoholism and Drug Addiction Counselor of the Year award from the National Association for Addiction Professionals.

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NEW HEALTH CARE BILL’S DEVASTATING IMPACT ON THE MENTALLY ILL, ADDICTS AND TREATMENT By John Giordano, Doctor of Humane Letters, MAC, CAP

It was a typical spring day when Olympic Gold Medalists Allison Schmitt and Michael Phelps received special recognition awards from the Substance Abuse and Mental Health Services Administration (SAMHSA). During the ceremony held at George Washington University both Schmitt and Phelps spoke openly about their personal battles with depression. The awards were presented by Health and Human Services Secretary Tom Price, M.D. “Mental illness and drug addiction, along with childhood obesity, are some of the most urgent challenges facing America today,” said Secretary Price. “As Secretary of HHS, promoting the behavioral health of all Americans and reducing the impact of substance abuse and mental illness on our communities are among my top priorities. This was SAMHSA’s annual event to recognize National Children’s Mental Health Awareness Day 2017 “Partnering for Help and Hope” which focuses on the importance of addressing physical, mental, emotional, and behavioral health needs when providing services and supports for children, youth, and young adults. There has been a notable increase in overall rates of major depressive episodes among all adolescents. There was another celebration going on at the same time in Washington D.C. no more than a mile away from the “Partnering for Help and Hope” event. In the White House Rose Garden, President Trump and a group of House Representatives bestowed each other with adulations and pats on the back for the narrow passage of a piece of legislation that – if passed by the Senate –will effectively strips millions of Americans of addiction and mental healthcare coverage. “We’ve taken a historic first step to repeal and replace Obamacare and finally give the American people the kind of health care they deserve,” Vice President Mike Pence stated, prompting a thunderous applause. The cruel irony was completely lost on the lawmakers as they joyfully toasted each other and sipped on their chilled bubbly refreshments in the comfortable surroundings of the Rose Garden. However, the celebration seems a bit premature as they’re normally reserved for a bill signed into law. There are many who have suggested that the passage of the American Health Care Act (AHCA) in the House is an example of Trump making good on his campaign promise to repeal and replace the The Patient Protection and Affordable Care Act (ACA). But attached to that promise was a better healthcare program than the existing ACA with lower premiums, lower co-pays and better coverage for all Americans. Those promises remain unkept leaving many to wonder how the new healthcare program will affect them. The answer to that question varies from person to person, unless of course you’re an addict or have mental health issues in which case the answer is devastating. The core of The Patient Protection and Affordable Care Act (ACA) is the requirement of participating insurance companies to cover the “Essential Health Benefits” as outlined in the bill. Included in the benefits is mental health and addiction treatment. This one element of the ACA dragged mental health and addiction out of the stoneage and placed the diseases squarely in the twenty-first century. It is the first time in American history that mental health and addiction were rightly identified as diseases that warrant insurance coverage like any other disease. It’s my opinion that the ACA did more to remove the stigma attached to poor mental health and addiction than any law before it. The ACA went further by making sure middle and lower income Americans have access to treatment. It gave states the option to expand their Medicaid programs to cover all people by increasing eligibility levels for individuals and families with a household income below a certain level. Thirty-one states and the District of

Columbia adopted the plan and it’s working. Specific data is hard to come by, but reputable sources estimate that as many as tenmillion Americans now have access to healthcare – some for the first time – from this one provision in the ACA. Moreover, the ACA provides Premium Tax Credits (PTC) on Marketplace insurance plans for individuals and families who don’t qualify for Medicaid but still cannot afford health insurance. In all, the ACA has provided more than twenty-million Americans with access to healthcare that previously had none. But more to the point, the Affordable Care Act provided the first opportunity for millions of low and middle income Americans to get mental health and addiction treatment. In addition, the federal government has committed billions of dollars to help addicts find recovery and turn the tide on America’s opioid epidemic. And the program is working. As flawed as the Affordable Care Act may be, it did set the tone and move the direction of mental health and addiction treatment forward. Its possible replacement, The American Health Care Act, is about to change all of that and more. If passed in its current form by senate and signed into law by the President, mental health and addiction treatment will become severely compromised. This new measure will effectively send addiction and mental health treatment back to the stone-age with less coverage and higher premiums and co-pays – exactly one-hundred and eighty degrees opposite of the politician’s promises. Below are the five key areas where the American Health Care Act will eviscerate treatment for people with addictions and mental health issues. Medicaid Cuts Medicaid is a federal program established over fifty-years ago and adopted by all fifty states and the District of Columbia. It provides matching funds to participating states for the expressed purpose of providing medical assistance to residents who meet certain eligibility requirements such as low income adults, their children, people with disabilities, pregnancy or being a woman with children. Each state administers its own Medicaid program. Under the bill passed in the House, federal spending on Medicaid would be slash by $880 billion over ten-years. Medicaid expansion, the program responsible for insurance coverage for up to ten-million Americans, will be phased out by 2020. In addition, the funding of Medicaid will be changed from its current federal/state partnership each paying their share person by person, to a block grant from the federal government. This is an optimal option for the feds but leaves states with less money for treatment. Many Continued on page 34

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WHAT IS LIFESPAN RECOVERY MANAGEMENT? By Michael Weiner, Ph.D., MCAP

In 2011, an article written by Dr. John Kelly and William White was published in a volume titled “Addiction Recovery Management”. The title of the article was also a question: Recovery Management: What if we Really Believed that Addiction was a Chronic Disorder?” The answer may be that we would be providing care for our patients over the course of a lifetime. Hopefully, there would be long periods of stability that would require only monitoring. However, symptoms of a chronic disease tend to recur. At those times, interventions could be rapid and the intensity of the intervention would depend upon the severity of the symptoms and the level of risk. For clarity, as I refer to “symptoms” and “risk” I’m referring to those for a substance use disorder (sud) as stated in the 2013 ASAM Criteria and in the DSM-5. What we have been doing is treating a series of episodic occurrences as though one episode was totally unrelated to the other. I frequently hear people in the process of recovery say something like “I’ve been to treatment three times.” That perception is understandable. If a person has been admitted on multiple occasions to residential treatment for substance use disorders (suds) each treatment was likely to look the same, e.g. another 1st step, another story, etc. There’s an assumption that a person needs to start from scratch. Every time this happens shame accumulates. Lifespan Recovery Management, on the other hand, treats a chronic substance use disorder over the course of time. The intensity of care would always match the severity of symptoms and the level of risk. The critical factor is that even when symptoms are inactive, the disorder is monitored. The lowest level of care would be an annual recovery check-up (White, 2014). Sounds a lot like any other chronic disorder, doesn’t it? No shame. Initially, residential care is likely to make sense. As a culture we tend not to recognize the severity of suds until the symptoms become severe. If the disorder is caught early, a lower level of care, such as intensive outpatient, may be recommended. Again, symptoms and risk dictate the level of care. The length of stay in any level of care needs to depend upon how quickly or slowly symptoms can be treated, e.g. withdrawal from one drug may take longer than from another, age, history and body weight are also factors. Let’s forget about a 28 day program. We do treatment, we don’t do time (David Mee-Lee, M.D.). As a matter of fact, lifespan recovery management means that we don’t make time frame recommendations. We make recommendations based upon symptoms and risk. A person can be discharged from the residential level of care when the objectives for that level have been met. This is likely to mean that the patient can now function at a lower level of care with a minimal risk of a recurrence. What happens next is critically important. The term “aftercare” is a relic. It has to go. It should have gone twenty years ago. What happens next is not an “afterthought.” Research continues to show that people who are committed to and follow at least a five year plan are highly likely to remain abstinent. What happens next also depends upon the unique needs of each patient. It’s logical that an intense level of outpatient care would follow the completion of residential objectives. It’s the same as for a person leaving a hospital after being treated for diabetes. Initially after leaving the hospital, outpatient care is frequent.

an Addiction Specialist (www.abam.net) on their medical team. Getting through the medical and emotional upheavals of life is not always easy. Staying motivated to follow a program of recovery does not remain consistent. There are geographical changes, career changes, and probably much more. One might ask “how does anyone remain abstinent through all of that?” The answer is that not many do. Recurrences happen. However, recurrences do not have to be shameful nor do they have to be a disaster. They can be short lived. A person perceiving themselves to be in treatment over the course of a lifetime will have an Addiction Specialist to reach out to in a manner similar to the diabetic reaching out to an Endocrinologist. Diabetics and people with Hypertension have always had a safety net, a place to land. People with suds need one too. A New Paradigm Requires a New Language Earlier this year the White House’s Office of National Drug Control Policy (ONDCP) made recommendations regarding the language we use on a daily basis in the field of substance use disorder treatment and recovery. The recommendations reflect a movement away from language that has been judgmental and toward one that is consistent with health care. One recommendation is that the term “relapse prevention” be replaced with “recovery management.” I would suggest going a step further. “Recovery management” can also replace “primary care,” and “aftercare”. It is recommended that “relapse,” a word that elicits shame, be replaced with “recurrence.” The changes recommended by ONDCP force us to change our thinking. Botticelli, M. (2017) How the words we use can support people on the path to recovery. Retrieved from: https://t.e2ma.net/webview/pa dpk/4b84fef410d1207a1a98a1b7badef2ed

Current Terminology

Alternative Terminology

Treatment is the goal; Treatment is the only way into Recovery

Treatment is an opportunity for initiation into recovery (one of multiple pathways into recovery)

Untreated Addict/Alcoholic

Individual ndividual not yet in Recovery

Substance Abuse

Substance Use Disorder/Addiction/ Substance Misuse

Drug of Choice / Abuse

Drug of Use

Denial

Ambivalence

Relapse Prevention

Recovery Management

Pathology Based Assessment

Strength / Asset Based Assessment

Focus is on total abstinence from all illicit and non-prescribed substances the CLINICIAN identifies

Focus on the drug CLIENT feels is creating the problems Each illicit substance has unique interactions with the brain; medication if available is appropriate.

A Drug is a Drug is a Drug Relapse Relapse is part of Recovery Clean / Sober

Recurrence/Return to Use Recurrence/Return to Use may occur as part of the disease Drug Free / Free from illicit and non non-prescribed non-prescribed medications

Self Help Group

Mutual Aid Group

Drug Overdose

Drug Poisoning

Graduate from Treatment

Commence Recovery

Michael Weiner, Ph.D., MCAP is the Director of Alumni Services at Behavioral Health of the Palm Beaches/Seaside. He has been a Director, Trainer, and Researcher for Behavioral Health of the Palm Beaches since 1999. Dr. Weiner has regularly published in professional journals and presented at professional conferences.

The patient with diabetes will be monitored for a lifetime. People with suds need the same. A person with a sud would always have

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Revised 7/16 cfd

YES, YOU CAN BE MORE EFFECTIVE! What if it’s our own lack of knowledge that’s responsible for the poor treatment outcomes we are continuing to battle? We have all heard how genetics and biology play a role in chemical addictions, but do we really understand it? Do we really understand the significance of these findings? And if so, what is being done about it? How do you apply it? When I got into this field, I felt very uncomfortable and quite ill-prepared about treating an illness we know very little about. Addictions have been around for thousands of years, and although our attitudes towards those with addictions have improved tremendously, our approach to treating this illness has not really changed all that much. For the most part, we are still relying on our own, and very individualized, common sense. Don’t get me wrong, our theories are wonderful, and they do make good sense, but don’t they all seek to unravel the truth behind why some people develop addictions and others don’t? Are they not a search for answers? What if the answers we have been looking for, all these hundreds of years, can be found right here in the science we have now? This book will challenge your beliefs and help you to bridge the gap between science and treatment. In doing so, it will arm you with the knowledge and confidence it takes to be more effective. There are no miraculous cures here, but science has provided the answers we need to take treatment to the next level and propel us into the future. Science is changing how we view and address chemical addictions, so don’t be left behind. Visit my webpage at: www.theafflictionofaddiction.com and order your copy now. This is my gift to you. The time is ripe to reap the rewards of all our untapped knowledge. Change is in the air and the future is upon us! Welcome to the 21st Century!

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THE SINGLE SOURCE OF ALL ADDICTION By Amy Johnson, Ph.D.

Beneath the perceived complexity of addiction—beneath layers of chemical dependency, psychological and emotional instability, complicated relationships, fear and trauma—lie some incredibly simple truths. These simple, universal truths apply to every human on earth, no exceptions. They are that universal and that true. These truths apply to you regardless of the nature of your habit and regardless of how long you’ve been suffering. They don’t care who you are or what you’ve done in your life. They have nothing to do with your physical or mental capacity; your age, sex, or religion; or how many people you’ve helped or hurt. They are true beyond your diagnosis, prognosis, or how many steps you’ve completed. Realizing these truths begins with seeing that you are made of health and resilience, now and always. Innate health and infinite resilience is who you are. It is the default backdrop that never changes. Your capacity for, and inclination toward, thriving is stable and always present. Think of who you deeply are—your healthy, default nature—as the sky. The sky is always blue. Weather moves through the sky masking its clear blueness, but the sky is still blue whether it appears that way or not. The sky is unaffected by the weather. Weather moves through, creates some temporary commotion, and then moves out, naturally and on its own, without exception. The same is true of you and your human experience. You are healthy, clear and wise, just like the blue sky. And your addiction is like the weather. Your addiction is made of impermanent, passingthrough thoughts and feelings, urges and cravings. Those passingthrough feelings are not fundamental to who you are and so your addiction isn’t either. Like the weather, your human experience is always changing. Even when the sky looks grey and overcast for a long time, there is movement. The clouds are moving, the air is moving, and particles in the atmosphere are constantly in a state of flux. Your “human weather” is the same. Regardless of how stuck you feel and how long you’ve felt that way, there is unending movement. It may be subtle, but it is happening. Your moods, feelings, cravings, sensations and memories are moving and evolving. There is great momentum—a force of nature, in fact—ensuring that your experience passes through you seamlessly and naturally, like weather. We all have just one addiction: addiction to our own experience. We become addicted to our internal weather; our impermanent, safe thoughts and feelings.

our gaze to the blue sky backdrop that is within us all. Not denying or suppressing, but acknowledging and respecting what is real, true and stable, and giving less weight to what is not. Life was incredibly simple before we became addicted to our thoughts and feelings. The good news is that you have not actually lost your health and common sense so it is much easier to “recover” it than it may seem. Look toward the supportive nature of life itself and the amazing resourcefulness that is alive and well within you right now. These simple truths allowed me to walk away from an 8-year struggle with food addiction and binge eating and I’ve seen the realization of them help countless people begin to experience true freedom. All humans have the same basic design, and it is an unbelievably forgiving one. There is limitless hope for us all. Dr. Amy Johnson is a psychologist and coach who helps people find freedom from habits and addiction through a common sense understanding of how our human experience really works. Her bestselling book, The Little Book of Big Change: The No-Willpower Approach to Breaking Any Habit, has helped thousands of people move beyond abstinence and sobriety, toward complete freedom. For free resources, please sign up at www.DrAmyJohnson.com. The Little School of Big Change is an upcoming online community devoted to sharing and spreading these simple truths about human life. Learn more at www.TheLittleSchoolofBigChange.com.

We take our thoughts, feelings, urges and cravings very seriously. We get caught up in them. We misunderstand them, mistakenly believing that because we feel the urge to do something, we must do it. We innocently miss the fact that our experience isn’t “us” or “ours”. It’s simply human weather passing through. We believe that we need to do something to end the discomfort, but everything we do to fix or change our experience tends to make things worse. We buy our own stories, get caught up in our own painful lies, and fear our own safe, temporary emotions. We’re addicted to staring at the weather, imbuing it with meaning and importance it doesn’t actually deserve. Recovery is about recovering the common sense way of naturally being that we knew as children. The way we lived in the world, letting our common sense and innate wisdom guide us through life. Recovery is about recovering our innate health and resilience. That means paying less attention to the weather and returning

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WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? Sunset House is currently classified as a level 4 transitional care house, according to the Department of Children and Families criteria regarding such programs. This includes providing 24 hour paid staff coverage seven days per week, requires counseling staff to never have a caseload of more than 15 participating clients. Sunset House maintains this licensure by conducting three group therapy sessions per week as well as one individual counseling session per week with qualified staff. Sunset House provides all of the above mentioned services for $300.00 per week. This also includes a bi-monthly psychiatric session with Dr. William Romanos for medication management. Sunset House continues to be a leader in affordable long term care and has been providing exemplary treatment in the Palm Beach County community for over 18 years. As a Level 4 facility Sunset House is appropriate for persons who have completed other levels of residential treatment, particularly levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the world of work, education, and family life. In conjunction with DCF, Sunset House also maintains The American Society of Addiction Medicine or ASAM criteria. This professional society aims to promote the appropriate role of a facility or physician in the care of patients with a substance use disorder. ASAM was created in 1988 and is an approved and accepted model by The American Medical Association and looks to monitor placement criteria so that patients are not placed in a level of care that does not meet the needs of their specific diagnosis, in essence protecting the patients with the sole ethical aim to do no harm.

Seacrest Resource Center is full service Behavioral Health Care Consulting Firm, which provides results and not promises. Our services include assisting organizations in seeking initial State Licensure/Certification, The Joint Commission Accreditation, and CMS Certification in any state in the U.S. Linda Potere, CEO, President, MBA, CAP, LHRM, CHCQM, CAS, NCACII, CMHC has over 30 years experience licensing and accrediting organizations and has obtained state licensure and TJC accreditation for over 200 organizations with stellar results.

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TAMING THE MONKEY MIND By Maxim W. Furek, MA, CADC, ICADC

One of the most difficult tasks that humans undertake is listening to the chatter of our inner voice. It is that nagging voice in our head telling us things we do not like to hear; a voice that castigates and demeans us, making life miserable or, at times, intolerable. This secret voice tells us we are not good enough and not worthy enough. It compels us to create a “to do” list, prioritize the list and then compulsively repeat the process again and again. It pits us against others in a senseless no-win competition. It is the noise that threatens to drive us insane with its nonstop chatter and damaging thoughts. The incessant babble and cerebral bickering are part and parcel of what has been called “monkey brain,” “monkey mind,” “gremlin voice” and “egoic mind.” Mind monkey or monkey mind, is a Buddhist term meaning “unsettled; restless; capricious; whimsical; fanciful; inconstant; confused; indecisive; uncontrollable”. It is all of that and more. The Buddha believed that the human mind is filled with drunken monkeys flinging themselves from tree branches, jumping around, and chattering nonstop. He meant that our minds are in constant motion, always thinking, comparing, and judging. We are intrinsically wired to believe that the monkey mind is the voice of truth. It is not. The monkey mind bombards us with the language of torment, voices that constantly pummel and distract. If not tamed, the monkey mind can significantly upset our quality of life, separate us from others and prevent us from attaining our goals. Gina Lake, observed, “When we stop and examine what this mental voice is saying, we discover a lot of contradictory advice, misinformation, prejudices, judgments, and other negativity. This mental voice is often unkind, belittling, fearful, self-doubting, judgmental, complaining, confused, and unhelpful. “…This voice, in fact, is the cause of human suffering. It fights life, rails against it, and is discontent and afraid. It is the voice of the false self--the ego--not the true self. Without these thoughts, we would live in peace within ourselves and in harmony with others,” Lake concluded. The “voice in our head” Eckhart Tolle referred to it as the “voice in our head”. He wrote, “Once you can be aware of certain thoughts in your head, then you can observe them. This creates two dimensions in your mind: the thoughts and the awareness. The person who is totally in the grip of ego is so identified with the thoughts that there is no awareness. That is the state that generates conflict, violence and all the enormous amounts of suffering that human beings create for themselves and others.” The monkey mind is a repository of negative thoughts and mental anguish. It cannot exist in the present moment but resides in the dark reaches of the past and future. It conjures up messages that promote fear and uncertainty. Ann Pizer describes the monkey mind as the part of our brain that “dreads something that may occur in the future or fixates on something that happened in the past. It jumps around, resting briefly on one of the many thoughts that pop up before moving on to something else.” As Eckhart Tolle infers, awareness of the problem is a step towards resolution. By discovering ways to quell the monkey brain, we can reduce the noise and lessen the chatter. The keys to calming the mind are widely known and discussed. Motivational speakers often used these strategies as a focal point in their lectures. Numerous books have focused on strategies to relax and decompress. Michael Neill noted that, “One of the things that most people are striving for in one way or another is a quiet mind. Books, audios, and courses abound promising to teach techniques for achieving inner peace, reduced stress, less worry, and peace of mind. Yet, curiously, many of these programs seem to add to the number of shoulds, ought tos,

musts, and have tos that fill our already-noisy brains.” Still, for some, the quest for mental tranquility can be found in an impressive collection of self-help books. An example and possible resource is the book Calm: Calm the Mind. Change the World by Michael Acton Smith. This book has been called “a practical and pleasurable guide to twenty-first century mindfulness.” Smith invites us to, “Join the calm revolution: inspiration and activities showing how absolutely everyone can achieve calm in everyday life.” Smith contends that his book “contains the simple tools, tricks and habits that will change the rest your life.” Achieving the calm Because we are so involved in the frenetic pace of our work and daily lives, we often neglect to nurture ourselves and discover our inner stillness. Unless we take action, we will remain imprisoned by the thoughts and words of the monkey mind. Achieving the calm, as mentioned by author Smith, is something to consider. Positive thoughts of affirmation can help replace the negative chattering. Another effective strategy is to stay in the present and live in the moment, and to “be here now.” Some believe that prayer and meditation may be useful. Meditation, including chanting, walking and other physical exercises, can have a relaxing effect and help to calm the mind. According to Deepak Chopra, “In meditation, any attempt to quiet the mind using force won’t work. The everyday mind is full of thoughts, feelings, sensations, worries, daydreams and fantasies. But at a deeper level, the mind begins in silence. Finding that level deeper than thought is the essence of meditation.” Global teacher, speaker, and author, Max Strom provides a most appropriate epilogue. In his book titled A Life Worth Breathing is the following passage: “It is the storm in your mind-the mental stress, negativity, and endless inner monologue – that causes so much of your emotional suffering and ill health. It is by teaching your intellect to become quiet, and learning to be still, that you can become happier, healthier, and more emotionally stable. Constant lurching into the future or dwelling on past events robs you of your present. True joy is experienced only in the present, so you have to be present to experience it.” The exciting news is that with practice, patience and resolve, it is possible to calm the monkey mind. We can turn off the noise in our head, and find that precious space between the words and thoughts, where our silence and calm reside. That stillness is the center of our creativity and the essence of who we are. Maxim W. Furek, MA, CADC, ICADC is passionately researching the essence of happiness. His rich background includes aspects of psychology, addictions, mental health and music journalism. His book Sheppton: The Myth, Miracle & Music explores the miraculous and supernatural events experienced by two entombed miners. Learn more at shepptonmyth.com

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CERTIFIED RESIDENCES

How can a parent searching for a legitimate service provider choose a quality program Certifying safe and for their son or daughter to reside? State digniďŹ ed recovery of Florida relies on FARR certification as confirmation that the program, staff and residences for property comply with nationally recognized individuals standards. FARR regularlyseeking audits compliance and provides a path for residents, families peer-supportive housing. and community members to file a complaint if warranted, ensuring that operators remain compliant with standards. FARR ( 561-2990405) is the oversight agent for sober homes. Please check with NARR ( 855-355-6277) Join Volunteer Support to gain information in your state who is certifying sober homes.

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From The Hearts of Moms FROM POT TO HEROIN: IS YOUR CHILD AN ADDICT? HOW DO YOU KNOW? By Suzanne Wachtel, LCSW

How does smoking marijuana segway into other drugs? Many people may have or still do smoke pot recreationally and that’s where it ends. Marijuana use is becoming legalized, accepted by peers, seems pretty harmless and is socially acceptable in many circles. So that being said, how does pot start the chain to hard drugs? Addiction starts slowly, quietly creeping in like an unknown stranger hiding in the shadows. How do we not notice, not clearly see when our child is not just smoking pot occasionally, but instead is getting carried away. From smoking pot with friends, to smoking all day long, to pills, and eventually turning into a hard core drug user with no turning back. How does this happen to our children, sometimes under our very noses? How do you prevent your child from becoming a statistic of drug related deaths plaguing our nation? How do we know if our child will be the one to experiment with drugs and not become an addict? Is there a guide? A certain formula we can follow…? Not really, but we need to talk about it! From the moment we become parents, we plan how we will be the “best” parents possible. From the best stroller to the right schools, we worry about every step of our children’s’ lives. We try with every good intention to help them grow into happy, productive people with good values and all of the tools to live independent, full lives. We struggle to make the “perfect” parenting choices. Death by drugs was not in that plan! How can we help other parents coming up in the ranks, figure out a formula to prevent their children from turning into hard core addicts? We need to end this epidemic, now! I’m not saying that every person who tries drugs will be an addict, but if addiction is in your history or you try opiates, your odds of becoming an addict are very strong. I am a licensed clinical social worker with a private practice in Boca Raton, Florida and I run two groups weekly at a rehab in Coral Springs. My question to the group each week is “How did you go from smoking pot at 14/15, to shooting heroin? What happened? How did your parents miss the signs? How did they not notice that their child was using life threatening drugs?”

I had no idea that my son had ever tried heroin, and then he died from an overdose at age 27. Crazy! What I have learned since his death is that the majority of addicts stem from opiate users. Yes, the medicine that our trusted doctors give out like candy for injuries or wisdom teeth extractions may have been their first introduction to the deadly opiate family! We need to talk openly about drugs and not hide behind the shame attached to the subject or the stigma that “If your child becomes an addict, it is your fault”, and due to a lack of your involvement or awareness etc…. All I can say is… my son died, I’m an educated, aware parent, and until he died from a heroin overdose, I was clueless to addiction and the signs and dangers! If I can prevent one death… from overdose that will be worth it! Please pay attention when and if your kids start using marijuana. Not that anyone has died from a marijuana overdose … but if they get into pot, have an addiction gene…. That could be your clue, that there could be possible danger in the future. If marijuana is the first clue, that there may be a future problem… don’t look away, don’t over react, but be aware that addiction issues may be a topic that needs to be addressed… before it’s too late and know that you are not alone. Suzanne Wachtel, LCSW is a no nonsense, seasoned psychotherapist. She has a private practice in Boca Raton, Florida and devotes much of her time to helping those struggling with addicted loved ones and the loss of family members to drugs. She arms us with tools to cope and strategies to handle the pain that goes hand in hand with loving an addict. She is kind, insightful and very wise. Suzanne lost her own son to a heroin overdose 3 years ago. Her goal is to not let it identify her but instead, to take the experience and use it to teach and help others. Life is not what happens to us … It’s how we handle it that matters. Through individual and groups, she helps us heal. Suzanne can be reached at www.therapy-boca.com

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IMPORTANT HELPLINE NUMBERS

A New Path www.newpath.org Addiction Haven www.addictionhaven.com Bryanâ&#x20AC;&#x2122;s Hope www.bryanshope.org CAN- Change Addiction Now www.addictionnow.org Changes www.changesaddictionsupport.org City of Angels www.cityofangelsnj.org FAN- Families Against Narcotics www.familiesagainstnarcotics.org Learn to Cope www.learn2cope.org The Long Island Council on Alcoholism and Drug Dependence www.licadd.org Magnolia New Beginnings www.magnolianewbeginnings.org Missouri Network for Opiate Reform and Recovery www.monetwork.org New Hope facebook.com/New-Hope-Family-Addiction-Support-1682693525326550/ Parent Support Group New Jersey, Inc. www.psgnjhomestead.com P.I.C.K Awareness www.pickawareness.com Roots to Addiction www.facebook.com/groups/rootstoaddiction/ Save a Star www.SAVEASTAR.org TAP- The Addicts Parents United www.tapunited.org

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ALCOHOLICS ANONYMOUS WWW.AA.ORG AL-ANON WWW.AL-ANON.ORG 888-425-2666 NAR-ANON WWW.NAR-ANON.ORG 800-477-6291 CO-DEPENDENTS ANONYMOUS WWW.CODA.ORG 602-277-7991 COCAINE ANONYMOUS WWW.CA.ORG 310-559-5833 MARIJUANA ANONYMOUS WWW.MARIJUANA-ANONYMOUS.ORG 800-766-6779 NARCOTICS ANONYMOUS WWW.NA.ORG 818-773-9999 EXT- 771 OVEREATERS ANONYMOUS WWW.OA.ORG 505-891-2664 NATIONAL COUNCIL ON PROBLEM GAMBLING WWW.NCPGAMBLING.ORG 800- 522-4700 GAMBLERS ANONYMOUS WWW.GAMBLERSANONYMOUS.ORG 626-960-3500 HOARDING WWW.HOARDINGCLEANUP.COM NATIONAL SUICIDE PREVENTION HOTLINE WWW.SUICIDEPREVENTIONLIFELINE.ORG 800-273-8255 NATIONAL RUNAWAY SAFELINE WWW.1800RUNAWAY.ORG 800- RUNAWAY (786-2929) CALL 2-1-1 WWW.211.ORG ASSOCIATION OF JEWISH FAMILY AND CHILDRENS AGENCIES WWW.AJFCA.ORG 410-843-7461 MENTAL HEALTH WWW.NAMI.ORG 800-950-6264 DOMESTIC VIOLENCE WWW.THEHOTLINE.ORG 800-799-7233 HIV HOTLINE WWW.PROJECTFORM.ORG 877-435-7443 CRIME STOPPERS USA WWW.CRIMESTOPPERSUSA.ORG 800-222-TIPS (8477) CRIME LINE WWW.CRIMELINE.ORG 800-423-TIPS (8477) LAWYER ASSISTANCE WWW.AMERICANBAR.ORG 312-988-5761 PALM BEACH COUNTY MEETING HALLS CLUB OASIS 561- 694-1949 CENTRAL HOUSE 561-276-4581 CROSSROADS WWW.THECROSSROADSCLUB.COM 561- 278-8004 EASY DOES IT 561- 433-9971 THE TRIANGLE CLUB WWW.TRIANGLECLUBPBC.ORG 561-832-1110 LAMBDA NORTH WWW.LAMBDANORTH.NET BROWARD COUNTY MEETING HALLS 101 CLUB 954-573-0050 LAMBDA SOUTH CLUB 954-761-9072 WWW.LAMBDASOUTH.COM PRIDE CENTER WWW.PRIDECENTERFLORIDA.ORG 954- 463-9005 STIRLING ROOM 954- 430-3514 4TH DIMENSION CLUB WWW.4THDIMENSIONCLUB.COM 954-967-4722 THE BOTTOM LINE 954-735-7178

FINDING HAPPINESS AND ACTIVATING DOPAMINE THE NEUREKA! NEUROFEEDBACK WAY: CAN WE RETURN TO NEVERLAND? By Jonathan Cowan, Ph.D. and Kenneth Blum, Ph.D.

Happiness and other positive feelings are the rewards we feel when dopamine acts appropriately in the “normal” brain. These feelings are actually rewards for paying attention and learning something new—part of nature’s plan for insuring our survival. For many people dependent on drugs and even addictive behaviors, this proper brain activity is “Neverland”, something they have not ever experienced, or at least in a long time. Wouldn’t it be wonderful if their brains could be trained to shift the “set point” of their happiness system upwards! Following the discovery of the first association between the dopamine D2 receptor gene polymorphism and severe alcoholism, there has been an explosion of research reports in psychiatric and behavioral addiction literature and neurogenetics. Since 1996, our (Blum’s) laboratory has coined the umbrella term “Reward Deficiency Syndrome” (RDS) [now a recognized disorder SAGE Encyclopedia of Abnormal Psychology 2017] to explain the common neurochemical and genetic mechanisms involved with both substance and non-substance, addictive behaviors. Our ongoing proposal is that the real phenotype is RDS, not any specific drug of abuse or addictive behavior, and impairments in the brain’s reward processing system, either genetically or environmentally (epigenetically) induces its influence on both substance and non-substance, addictive behaviors. Understanding shared common mechanisms will ultimately lead to better diagnosis, treatment and prevention of relapse. While at this juncture, we cannot as yet state that we have “hatched the behavioral addiction egg”; we are just beginning to ask the correct questions and through an intense global effort will hopefully find a way of “redeeming joy” and permitting homo sapiens to live a life, free of addiction and pain. Along these lines we are proposing a Reward Deficiency Solution System (RDSS) that includes: Genetic Addiction Risk Score (GARS); Comprehensive Analysis of Reported Drugs (CARD); and a glutaminergic-dopaminergic optimization complex (Kb220Z). We are now hereby adding Neureka! Neurofeedback, to this comprehensive approach. It is potentially a missing piece in the puzzle to prevent relapse and help balance brain dopamine function.

All of the subjects used very positive words to describe what it felt like to be at higher Neureka! Levels. There were some fascinating descriptions, all but one very positive. They used words such as: love, compassion and joy.

In the next part of the study, a researcher read words aloud to the subjects and they asked the subjects to create the feeling or idea inside themselves and watch the screen on the Peak BrainHappiness Trainer. Then, they rated how the measured levels of Neureka! they saw on the screen compared to the intensity of what they felt. They reported remarkably strong relationships to happiness, love, gratitude, satisfaction, awareness and other experiences. Study 2: Create the Feelings In this study, researchers read words related to positive emotions to subjects who were asked to feel that way for just 6 seconds. The researchers used the Peak BrainHappiness Trainer neurofeedback system to measure and record the levels of the Neureka! for the subjects as they felt these emotions. With all of the positive words, the test subjects showed a significant increase above the baseline levels in their Neureka! output. The highest increases in Neureka! values were for the words “happy” and “joy”. The brain produced more Neureka! when the subject felt positive emotions. Study 3: Positive vs. Negative Feelings

We’ll review some of the studies that show the effects of raising Neureka! Then, we’ll summarize some lines of evidence which indicate that Neureka! may act by raising dopamine activity. Training Happiness With Neurofeedback The brain produces brainwaves for everything it does. Research shows when we feel good feelings, such as happiness and love, the brain produces brainwaves around 40 cycles per second. These can be measured by the Peak BrainHappiness Trainer Pro and processed to create Neureka! A special protocol in the Trainer reads the raw brainwave information from the sensors on the person’s head and shows the level of Neureka! on a PC screen. New studies show a person can learn to increase the amount of the Neureka! produced by the brain. The more Neureka! they produce, the more good feelings, like happy, loving and grateful, they feel. There are also improvements in memory and attention from this training. Study 1: What Does Neureka! Feel Like? In this study, researchers asked the subjects to raise their level of Neureka! using neurofeedback with the Peak BrainHappiness Trainer for 15 minutes. Then, the researcher asked the subjects to describe what it felt like, in their own words, when they were able to see that the level of their brainwave output had changed.

In this study, subjects created internal states related to the positive, negative or neutral words read to them. The Neureka! associated with positive emotions was significantly higher than the Neureka! during negative or neutral emotions. In one of the test cycles, the researchers said “unhappy” after testing “happy”. That pair showed the greatest difference in Neureka! output levels from the subjects.

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Continued from page 28

This chart shows how the levels of Neureka! relate to several positive feelings. Study 4: Enhancing Happiness, Thinking, and Memory The 4th study we are reporting showed that people who used Neureka! neurofeedback training with the Peak BrainHappiness Trainer had positive results in 3 main areas. In just 5 hours of training--25 minutes for each session--the subjects showed positive changes. They reported being happier, having better brain function, and feeling less depressed. Dr. Estate Sokhadze and Robert Daniels carried out this study, which was published in Adolescent Psychiatry. Half of the subjects were referred from Court for involvement with drugs as a diversion. In the first part, the subjects watch ed DVD’s with beautiful scenes from the BBC series- Planet Earth, during their training sessions. When they raised their Neureka! values, the size of the DVD picture on the PC screen grew at the same time. The researchers asked the subjects to make the picture grow as much as possible. All of the subjects learned to raise their Neureka! values. Enhancing Happiness The study used a question to rate happiness, which was used in an earlier study done in Australia, called HILDA [Household Income and Labour Dynamics in Australia survey]. In that study, they asked the subjects to rate how happy they were from 1 to 6 - (6) all of the time, (5) most of the time, (4) a good bit of the time, (3) some of the time, (2) a little of the time, and (1) none of the time.

In this study, there was an overall increase in happiness of about 33%. The subjects in the lower happiness ranges rated their happiness 50% higher as a group after Neureka! training with the Peak BrainHappiness Trainer. Their enhanced happiness lasted at least four months!

Feeling Less Depressed The study included another test called the Beck Depression Inventory, a very well- known and accepted measure of depression. The subjects improved their scores by an average of 35%, showing that they felt better. This effect did not persist until the four month follow up. This is not about the serious condition called clinical depression, which has to be diagnosed by a professional, which was not done here. Better Brain Function When the subjects had finished all the training sessions, the researchers rechecked them with a short computerized test called the MicroCog. The MicroCog was developed at Harvard to look for difficulties in thinking and general brain function. The results seem to show the subjects improved in two main areas: General Cognitive Functioning and Memory. This indicates a very selective improvement in brain function, particularly centered around memory accuracy. Another set of tests showed major improvements in attention after they were trained. Improvements in Happiness Lead to Better Health and Success There are over 150 studies which show that current happiness leads to better health in the future. The Australian study on happiness, HILDA, showed this relationship between happiness and health in nearly 10,000 people. In 2001, they asked the subjects to rate how happy they were. Three years later, in 2004, the researchers asked the same subjects to rate their health, with the question: “In general, would you say your health is excellent, very good, good, fair, or poor?” The people who rated themselves in the upper ranges of happiness in 2001 were much healthier in 2004. Those happier ones had more than 50% odds to be in better overall health in 2004 than the others who had reported they were less happy in 2001. The results of this study may also indicate that Neureka! training with the Peak BrainHappiness Trainer can improve long-term health. We used the same question about happiness that they did in the HILDA study, and they showed major improvements, which persisted for four months. Health and happiness seem to be connected. For example, there are studies connecting heart disease and immune system function to the level of happiness. This could mean that people who become happier may also become healthier. There are also a number of studies which indicate that happiness leads to future success. The Neverland of Happiness due to Proper Dopamine Function Overall, this study showed that people can learn to raise their Neureka! level using neurofeedback with the Peak BrainHappiness Trainer. When they do, they report they are happier, and tests show their brains work better and they feel less depressed. They also Continued on page 32

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POWERFUL CLUB DRUG “KETAMINE” AKA SPECIAL K, PROVIDES RAPID RELIEF FOR TREATMENT RESISTANT DEPRESSION AND SUICIDALITY By Mark S. Gold, MD

Continued from page 8

people 100 years ago, depression and drugs have slowly and steadily moved up to become number one public health concerns. Depression in any age is crippling. But young children can feel so overwhelmed, sad, or lonely that the only solution they can think of is to end their life. I suspect that prenatal and early life exposure to alcohol, drugs, second and third hand smoke play a role. Academics may argue over the chicken or the egg, but SUDs cause depression which can last long after detox, when the chemicals have cleared from the body.

for this new Psychiatry, Yale University has recently started a new one year training program for Psychiatrists in an exciting new field called “Interventional Psychiatry.”

The Conundrum of Addiction and Depression

Because Ketamine is a powerful anesthetic which can be associated with dissociative symptoms, cardiovascular, respiratory and other medical emergencies, a thorough pre-anesthesia like work up prior to infusion is indicated. Such a work up provides valuable information regarding medical risks, dosage and treatment frequency in order to maximize response and minimize adverse events. Patients undergoing ketamine infusion require monitoring of their respiratory function, CO2 levels, along with vital signs. Accordingly, an anesthesiologist and/or specially trained interventional psychiatrist with advanced life support training are recommended.

Fact: Addicts are depressed Fact: Depressed people often become addicts Why? Addiction and depression share common neurocircuitry in striatum and forebrain. Thus, the concordance rate of addiction and depression is between 45-60%. Clearly they are related. Moreover, this relationship is bi-directional, meaning that one doesn’t necessarily cause the other. In other words, they simply “co-occur” and should be treated as such. If a child had strep throat and severe diarrhea, we would treat both aggressively and wouldn’t waste a second arguing about which came first. The same principle applies to addiction and depression. It doesn’t matter which came first, they must both be treated. Why? Because the cost of failure is very high. The best addiction treatment centers know this, have Psychiatrists, counselors, and addiction experts so that they can aggressively address depression and other co-occurring disorders. The Neurobiology All drugs of abuse initially produce euphoria, but over time, what goes up, must come down, and soon depression, anhedonia and boredom become reasons for continued and harmful drug use, which is addiction. In the 80s, we showed that cocaine did this by increasing dopamine to cause pleasure and then using up the dopamine and causing depression even while cocaine use continued. The cocaine crash looks and feels like major depression. The pathophysiology of addictive disease usurps the brain’s reward center, via numerous mechanisms that cause disruption of the dopamine circuitry making it nearly impossible for the addicted individual to experience good feelings without intoxicants. Other important neurotransmitters are also involved in the neurobiological “cascade” that produces and sustains both depression and addiction. Like alcohol, Ketamine inhibits the release GABA, a neurotransmitter which hinders the release of dopamine (which results in increased stratal dopamine) and glutamate, an abundant and vitally important neurotransmitter that is linked to the pathophysiology of numerous disorders including depression and addiction. By inhibiting GABA, ketamine increases dopamine and releases a bolus dose of glutamate causing neurogenesis and synaptic rebuilding in the brain’s reward system. The Good News: Ketamine The effects of Ketamine on TRD is an exciting finding because of its potential to change the way we think about depression and its treatment. It could become the mother of novel and powerful new therapies—which are desperately needed. At present, Electro Convulsive Therapy (ECT) and most recently Transcranial Magnetic Stimulation (TMS), have been the only other FDA approved treatments for severe and treatment resistant, life threatening depression and acute suicidality. Both are effective, but neither is convenient. Ketamine may successfully treat different types of patients than either ECT or TMS. Time will tell. Understanding more about how Ketamine effects mood will change our understanding of the pathophysiology of depression and addictive disease, as well as our approach to relapse and suicidal thinking. To prepare graduates

Treating Depression with Ketamine At present, Ketamine is delivered as a low dose intravenous infusion of 0.5mg/kg over forty minutes. The early results indicate more than 70 percent of patients with TRD have experienced significant relief with ketamine infusion therapy.

As reports have spread from the research and medical literature to the lay press, some Psychiatrists and physicians have started ketamine infusion centers. For this reason, The American Psychiatric Association (APA) has recently issued guidelines for clinicians who wish to use ketamine as an off label treatment for TRD and suicidality. APA Guidelines for Ketamine Use 1. A comprehensive diagnostic assessment should be completed to establish current diagnosis and evaluate history of substance use and psychotic disorders. 2. Assessment of baseline symptom severity should be completed to allow later assessments of clinical change with treatment. 3. A thorough history of antidepressant treatment should be collected and documented to confirm previous adequate trials of antidepressant treatments. 4. A thorough review of systems should be performed to evaluate potential risk factors associated with ketamine treatment. 5. Decisions on the specific physical examination and laboratory screening assessments should be made according to established guidelines and advisories issued by the American College of Cardiology Foundation/American Heart Association and the American Society of Anesthesiologists and should be based on a patient’s individual clinical characteristics. 6. A careful review of past medical and psychiatric records and/ or corroboration of the past history by family members are strongly encouraged; all current medications and allergies should be reviewed, including histories of opiate and benzodiazepine use; the use of a baseline urine toxicology screen is strongly encouraged to ensure the accuracy of the reported substance use and medication record. 7. An informed consent process, including discussion of the risks associated with the treatment, the limits of the available information pertaining to the potential benefits of the treatment, the fact that this is an off-label use of ketamine, and a discussion of alternative treatment options should be completed; this discussion should be complemented with written materials, and the patient should provide written informed consent before initiating treatment. As I previously mentioned, a number of Addiction Medicine Continued on page 32

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POWERFUL CLUB DRUG “KETAMINE” AKA SPECIAL K, PROVIDES RAPID RELIEF FOR TREATMENT RESISTANT DEPRESSION AND SUICIDALITY By Mark S. Gold, MD

physicians are also Board Certified in Anesthesiology and have administered ketamine to countless patients. Many addiction medicine doctors and addiction psychiatrists have also worked in pain medicine. For licensed medical professionals the APA guidelines are a good reference if Ketamine is being considered. Certainly more studies are needed and professionals will require new skills with specific training in Psychiatry, Addiction Medicine, TRD, TMS and Ketamine therapy, especially when treating patients with co-occurring depression and addictive disease. Final Thoughts It is not surprising that a drug of abuse, like Ketamine, can play an important role in medicine—not unlike opioids, that are both FDA approved medications— and also drugs of abuse. Similarly, coca leaves (cocaine) are consumed like we drink coffee, by those who live in the Andes Mountain regions of South America, while pure cocaine hydrochloride is still used by ENT doctors as a local anesthetic during nasal surgery. So, is Ketamine a panacea for depression? Unlikely, or maybe it’s just too early to know for sure. At present, the IV delivery system for Ketamine therapy is neither convenient, simple, or without risk. Although the remarkable and fast acting effects of Ketamine is short lived, the fact that it works at all and exerts its effect via the NMDA system is a potential game-changer. Further, this research may shed some light on why a disproportionally high percent of motivated and treatment adherent recovering people struggle with debilitating depression long-after they have stopped using intoxicants. Although they remain sober, many struggle with sleep problems, anhedonia, boredom, and mood swings, all of which are well documented risk factors for relapse. Our research and work with impaired health professionals have found that 12-Step programs, Caduceus Fellowship, continuous drug and alcohol testing, ongoing professional and peer support have produced unprecedented success, e.g., Over 80% of MD’s in these programs: • Have never tested positive for drugs or alcohol during 5 years of monitoring. • Nearly all returned to work in their chosen field without restrictions. • Nearly all report having a high quality of life. We know and accept that many of our addicted patients experience co-occurring depression. Accordingly, recovery counseling, tailored psychotherapy modalities, and, when needed, antidepressant therapy can help. If not, TMS, ECT and now, perhaps Ketamine may provide relief and prevent relapse, overdose, loss of hope, and even suicide. In summary, addictive drugs change the brain. These changes

WORKPLACE LEADERS AND DEPRESSION By Dr. Mel Whitehurst

Continued from page 6

• Instead of asking the worker to change, ask them to do something different. You can never completely change things by fighting the existing reality. To change something, build a new model or a new way of doing things can energize the depressed person. • When problems are identified and solutions constructed, the worker should make a verbal commitment to comply. References Provided Upon Request

Continued from page 30

include depression and may persist for months and even years into recovery. Yet we continue seeking to improve because the cost of failure for TRD and addictive disease is simply too high. So we will keep an eye open, and an open mind regarding Ketamine and the research that will certainly follow. References Provided Upon Request Mark S. Gold, MD, Chairman of the RiverMend Health Scientific Advisory Boards, is an award-winning expert on the effects of opiates, cocaine, food and addiction on the brain. His work over the past 40 years has led to new treatments for addiction and obesity which are still in widespread use today. He has authored over 1000 medical articles, chapters, abstracts, journals, and twelve professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox and addiction treatment practice guidelines.

FINDING HAPPINESS AND ACTIVATING DOPAMINE THE NEUREKA! NEUROFEEDBACK WAY: CAN WE RETURN TO NEVERLAND? By Jonathan Cowan, Ph.D. and Kenneth Blum, Ph.D.

Continued from page 29

appeared to raise their long-term “set-point” of happiness, as they stayed at the same level of happiness for 4 months. Could this help addicts return to Neverland? There are other reasons to suggest the idea that this happiness increase is due to balanced dopamine function. The location where the Trainer measures from is right over the largest concentration of dopaminergic neurons in the cortex, an extension of the midbrain dopamine system we call the “Prefrontal Pleasure Center”. Dopamine is well-known to enhance memory and attention as the training study showed. Putting it altogether, the Neureka! rhythm and the dopamine system are part of the brain’s system for processing new learning, and rewarding us for making the effort to explore and discover by creating positive feelings. Continued investigation of this novel strategy may lead to a bettertargeted approach in the long-term, enhancing dopamine regulation by balancing the glutaminergic-dopaminergic pathways. This may potentially change the landscape of treating all addictions, helping many people to return to “Neverland”. Jonathan Cowan, Ph.D., studied with the discoverer of brainwave biofeedback while doing his Ph.D. dissertation at the Univ. of California, San Francisco, and then was one of the first researchers to publish about the joyless moods of narcotic addicts, while on the staff at the National Institute on Drug Abuse Addiction Research Center. Over the next 40 years he has combined these interests by designing and marketing neurofeedback systems that use unique methods to train Focus, Alertness, Neureka!, and the Mood Elevator—the Peak Achievement Trainer and the Peak BrainHappiness Trainer Pro. Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical College and graduated from Columbia University and New Jersey College of Medicine. He also received a doctor of humane letters from Saint Martin’s University Lacey, WA. He has published more than 550 abstracts; peer-reviewed articles and 14-books.

Dr. Mel Whitehurst is a semi-retired psychologist. He has been a practicing psychologist for over forty years, most of which was in independent private practice.

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NEW HEALTH CARE BILL’S DEVASTATING IMPACT ON THE MENTALLY ILL, ADDICTS AND TREATMENT By John Giordano, Doctor of Humane Letters, MAC, CAP

Continued from page 16

healthcare experts have stated the block grant will force Medicaid to revert back to being a program for just a fraction of the poor. Subsidies Under the Affordable Trade Act, subsidies are given to the insurance companies or tax credits to low or middle income beneficiaries to make insurance affordable. The proposed healthcare bill will eliminate these subsidies leaving these Americans without healthcare coverage. Essential Health Benefits The American Health Care Act that was approved by the House in May 2017 eliminates the federal requirement stipulating that insurance companies provide coverage for the health issues identified within the Essential Health Benefits of the ACA – including mental health and addiction. That authority to require what insurance companies cover is being passed down to state level. Altruistically, I’m sure most states would want coverage for their citizens with addiction and mental health issues. But, with limited financial resources and shrinking dollars coming from the federal government, something has to go. State officials are going to be forced to make very difficult decisions if the American Health Care Act becomes law. Pre-existing Conditions Under the current Affordable Care Act, insurance companies are required to insure people with pre-existing conditions. The law also prohibits insurance companies from charging people with preexisting conditions higher premiums. The new bill passed in the House would eliminate these protections and allow states to waive them as well. According to the Kaiser Family Foundation, a nonprofit focusing on health care research, these are just a few of the conditions universally used to deny people coverage: • Alcohol or drug abuse with recent treatment • Alzheimer’s/dementia • Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia) There are a lot more – in fact, so many that the list is too long to print here but you can find it online. High Risk Pools If you are an addict or have mental health issues, chances are you’ll end up in a state run, federally funded high-risk pool. In theory, these pools are made available to people with medical histories, such as addiction and mental health issues, to get coverage at standard prices. But what politicians are reluctant to tell you is that the pools are grossly underfunded – so much so that Ohio’s Governor, John Kasich, laughed at how little the federal government budgeted for the program stating that” It’s ridiculous; and the fact is, states are not going to opt for that.” If you think you’re safe because you get your health insurance through your employer, you’re not! The Brookings Institute found a last-minute amendment that they claim by “allowing states to define “essential health benefits” could weaken Affordable Care Act’s protections against catastrophic costs for people with employer coverage nationwide.” With the exception of politicians whose healthcare is unaffected by this bill, everyone, regardless of how or where you get your health coverage, will be exposed to some negative affect from this legislation if it becomes law.

It just seems counter intuitive to me to take away the very resources that have been effective in treating addiction and saving lives in the middle of the worst opioid epidemic this country has ever seen. Does any of this reality live up to the rhetoric? One politician has gone so far as to say, “Nobody dies because they don’t have access to health care.” This contradicts a 2009 Harvard study (most recent data on the subject available) that revealed some 45,000 Americans die annually due to their lack of health insurance. After exhaustive research on the proposed healthcare plan, I find calling this bill the “American Healthcare Act” disingenuous – there is nothing American about it. If politicians were to be intellectually honest with us they’d call this bill the “You’re Going to Pay More and Get Less Healthcare – Draconian Act.” None of the political rhetoric lives up to the reality of what this bill does. The reality of the American Healthcare Act is your premiums and co-pays are going to go up for insurance coverage that goes down while tens of millions of Americans are left without insurance and tens of thousands die avoidable deaths every year from a new disease about to spread across this great country of ours called “inaccessible healthcare.” That is the unfiltered, raw unvarnished reality of the American Healthcare Act and none of us, unless you’re a politician, come out of this unscathed. What I find truly astonishing is the politicians’ statements regarding this bill. I’m hearing them talk about slashing budgets, tax credits, tax rollbacks, high-risk pools and block grants. But nowhere do I hear them say how many more Americans will be covered, how outcomes will improve, new protections for people and how many lives will be saved by the American Healthcare Act. Isn’t that the whole purpose of healthcare – to keep us and our children healthy and alive?! You’d think that after the trillions of dollars we give in taxes every year, the very least our senators and congress men and women could do is provide us with a robust healthcare system at a reasonable price. Ask yourself “does this bill help me or hurt me?” “Am I willing to entrust my most valuable personal asset, my health, to a politician intent on cutting healthcare budgets?” “Is this the kind of health care I deserve?” “Is my congress man or woman or senator working for me or against me?” “Do they expect me to accept less than what I currently have?” Everyone has something to lose if the American Healthcare Act is passed in the senate. No one gets to ride the pine and sit this one out. Now, more than ever, it is imperative you call your senator and tell them to vote “no” on the American Healthcare Act. Social media is good but the simple fact of the matter is that phone calls carry the most clout. If you’re not sure who your senator is or what number to call, you can find a list of all senators and their numbers on my site www.preventaddictionrelapse.com John Giordano, Doctor of Humane Letters, MAC, CAP, is the founder of ‘Life Enhancement Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment check out his website: www.holisticaddictioninfo.com

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