June issue by The Sober World,LLC

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs, alcohol and petty theft in Palm Beach County. It is also distributed locally as well as being mailed to rehabs through out the country. Many petty thefts are also drug related, as their need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. Florida is one of the leading states. People come from all over to obtain pharmaceutical drugs from the pain clinics that have opened virtually everywhere. The availability of prescription narcotics is overwhelming, and as parents our hands are tied because it is legal. Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20’s and 30’s right up to the elderly in their 70”s, thus, creating a generation of addicts. Addiction is a disease but it is the most taboo of all diseases. 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 an arrest, or even worse an overdose that we realize the true extent of their addiction. I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved ones life. They are more apt to listen to you now then 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 transport services that will scoop up your resistant loved one (under 18 yrs old) and bring them to the facility you have chosen, there are long term programs (sometimes a year and longer) as well as short term programs (30-90 days) there are Wilderness programs and there are sober living housing where they can

To Advertise, Call 561-910-1943

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 instead of 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 as well. 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. These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with any one outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction. 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 grades 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 had 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 proper care. They need help. Please don’t allow them to become a statistic. There is a website called the Brent Shapiro foundation. Famed attorney Robert Shapiro started it in memory of his son. I urge each and every one of you to go to that website. They keep track on a daily basis of all the people that die due to drug overdoses. It will astound you. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com. Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com

IMPORTANT HELPLINE NUMBERS 211 PALM BEACH/TREASURE COAST 211 www.211palmbeach.org FOR THE TREASURE COAST www.211treasurecoast.org FOR TEENAGERS www.teen211pbtc.org AAHOTLINE-NORTH PALM BEACH 561-655-5700 www.aa-palmbeachcounty.org AA HOTLINE- SOUTH COUNTY 561-276-4581 www.aainpalmbeach.org FLORIDA ABUSE HOTLINE 1-800-962-2873 www.dcf.state.fl.us/programs/abuse/ AL-ANON- PALM BEACH COUNTY 561-278-3481 www.southfloridaalanon.org AL-ANON- NORTH PALM BEACH 561-882-0308 www.palmbeachafg.org FAMILIES ANONYMOUS 847-294-5877 Billy Bob Club 561-459-7432 561-312-2611 Center for Group Counseling 561-483-5300 www.groupcounseling.org Club Oasis 561-694-1949 CO-DEPENDENTS ANONYMOUS 561-364-5205 www.pbcoda.com COCAINE ANONYMOUS 954-779-7272 www.fla-ca.org COUNCIL ON COMPULSIVE GAMBLING 800-426-7711 www.gamblinghelp.org CRIMESTOPPERS 800-458-TIPS (8477) www.crimestopperspbc.com CRIME LINE 800-423-TIPS (8477) www.crimeline.org Crossroads 561-278-8004 www.thecrossroadsclub.com DEPRESSION AND MANIC DEPRESSION 954-746-2055 www.mhabroward East Does It 561-433-9971 FLORIDA DOMESTIC VIOLENCE HOTLINE 800-500-1119 www.fcadv.org FLORIDA HIV/AIDS HOTLINE 800-FLA-AIDS (352-2437) FLORIDA INJURY HELPLINE 800-510-5553 GAMBLERS ANONYMOUS 800-891-1740 www.ga-sfl.org and www.ga-sfl.com HEPATITUS B HOTLINE 800-891-0707 JEWISH FAMILY AND CHILD SERVICES 561-684-1991 www.jfcsonline.com LAWYER ASSISTANCE 800-282-8981 MARIJUANA ANONYMOUS 800-766-6779 www.marijuana-anonymous.org The Meeting Place 561-255-9866 NARC ANON FLORIDA REGION 888-947-8885 www.naranonfl.org NARCOTICS ANONYMOUS-PALM BEACH 561-848-6262 www.palmcoastna.org NATIONAL RUNAWAY SWITCHBOARD 800-RUNAWAY (786-2929) www.1800runaway.org NATIONAL SUICIDE HOTLINE 1-800-SUICIDE (784-2433) www.suicidology.org ONLINE MEETING FOR MARIJUANA www.ma-online.org Ruth Rales Jewish Family Services 561-852-3333 www.ruthralesjfs.org The Triangle Club 561-832-1110 www.Thetriangleclubwpb.com

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Stressed, anxious, depressed, lonely? Are you concerned about your teenagers' behavior or perhaps you have conflict in your relationship with your spouse or other family members? Worried about your job, your health? We can help! We are a not-forprofit counseling center that provides individual, family and group counseling, and a variety of support groups for children, adults, and seniors. Our low cost services range from $5 to $45 per session. Call for an appointment. Mention Sober World and your comprehensive initial evaluation is only $25. Caring, confidential, professional support is just around the corner.

CENTER FOR GROUP COUNSELING 22455 Boca Rio Road, Boca Raton, FL 33433

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ASI and Alternative Sentencing By Myles B. Schlam, J.D., CAP / CCJAP

Incarceration is very expensive for society. In Florida, it costs the tax-payers an average of $135 per day for every inmate sitting in jail. The serious budgetary constraints have motivated Federal and State Governments to be open to suggestions for alternative approaches to traditional incarceration. While we who work in the field of Addiction know that it is a disease, many prosecutors and judges in the traditional court system just do not agree with the disease model of Addicition. This is the reason for the development of specialized courts such as Drug Court and Mental Health Court, where the staff, including the judges and prosecutors are specially trained to deal with such offenders. As the AMA and other organizations have given more credibility to the Disease concept of Addiction, the courts and criminal justice system have become more open to alternative sentencing in lieu of straight incarceration. It is not in anyone’s interest to resolve their case by simply doing time in jail or prison when there are other approaches which accomplish the same goals, meet society’s needs and where the ultimate sentence imposed by the Court can have a positive impact upon all parties concerned. So, ASI starts with the proposition that our Alternative Sentencing Program isn’t for everybody. It is reserved for those who have a substance abuse problem and are willing to commit to treatment for this problem. Treatment modality and duration will be determined by the Court, usually after a recommendation by the prosecutor. DUI’s can be problemsome, because when a person in florida gets his or her 2nd or 3rd DUI, there is usually a “minimum-mandatory” jail sentence. This means that the judge cannot deviate from the statutory sentence imposed by the legislature. For example, if a person pleas to two DUI’s within five years, there is a mandatory 10 day jail sentence. However, the courts are willing to consider certain treatment programs as a substitution to some if not all jail time. This not only helps people who need treatment to get this opportunity, but also takes the burden off the tax payers to keep them in jail. ASI is generally contacted by a criminal defense attorney who would ask us to perform an in-custody evaluation of their client, or the eval can be scheduled on the outside. We determine eligibility on a case-by-case basis, taking many factors into consideration during a 90 minute Assessment. We will then propose to the Prosecutor and the court an Alternative Sentence Proposal which may not avoid jail time entirely, but which may incorporate treatment and reduce jail time in some cases. Obviously the more serious the crime, the longer the duration of treatment would usually be. For example, a person charged with a 1st DUI, may only be ordered to a 30 day residential treatment program whereas a 2nd DUI may only be ordered to a 60-day treatment program. A person with a 3rd DUI may be ordered to a 90-day or even 180-day program. As an example, we had a case where the state sought to sentence a person to six months jail time for a 3rd DUI. We were able to convince the prosecutor to allow that person to complete our 90-day treatment program in conjunction with probation and other terms such as restitiution and community service hours in lieu of the 90 day jail sentence. There are many factors that are taken into consideration by the court in determining the appropriateness of such an alternative sentence. These would include: the number of prior offenses, the gravity of the crime, injuries to other parties, blood alcohol content (For DUI’s), and ammenability to treatment. In every case where a person is facing a sentence of incarceration, it is inevitable that one’s family members will be in a stressful situation. Every breadwinner’s incarceration means that a family will suffer from his or her absence. Every wife and child suffers from the loss of a loved one who is incarcerated. The point here, of course, is that such a circumstance, while unique to that particular offender and his immediate family at that moment in time, is not unique in criminal cases. Every time a person appears before a judge facing a term of incarceration, it is a given fact that the immediate family will be adversely impacted. This is neither special nor unique. Every son and daughter has a mother and father who will suffer because of the jail sentence imposed by a judge. Likewise, every child will pay a price for a parent’s incarceration. It is an unavoidable consequence of incarceration and usually doesn’t serve as a factor to leniency because this factor is present in practically every case; it is therefore neither unusual nor unique.

As more and more states, along with the Federal Government, use guidelines to determine an appropriate sentencing range for certain offenses, using complicated mathematical formulas to compute the amount of incarceration, these guidelines are now advisory only, meaning that Judges are free to fashion a sentence which accomplishes the goal of the guidelines, but in a unique manner utilizing treatment programs which we design and implement for a particular defendant. To be clear, a person whose guidelines call for substantial jail time should not expect that we can turn that inevitability into a slap on the wrist. That simply doesn’t happen. But we have been successful convincing Judges where some jail time is called for to utilize alternative approaches to punishment by substituting our treatment programs (sometimes in conjunction with community service and probation or house-arrest) designed specifically to meet the needs of a particular offender and his immediate family. Since we are intimately familiar with the impact of incarceration on immediate family members, we are able to be innovative in the creation and promotion of alternative approaches in sentencing a particular defendant utilizing methods and procedures tailored to the unique facts and circumstances of the case as an alternative or adjunct to straight incarceration. Defendants who have been charged with DUI, Drug Possession charges or other Drug-related crimes, should contact ASI directly or have their attorney call us to schedule an Assessment. In-custody evaluations must be set up by the Defendant’s Attorney a week in advance. ASI is licensed by the Department of Children and Families (DCF). Any questions or comments regarding this article can be addressed to: Myles B. Schlam, J.D., CAP / CCJAP Advocare Solutions, Inc.- Executive Director (954) 804-6888 • WWW.DRUGCOURTPRO.COM

CONFUSED ABOUT WHICH TREATMENT CENTER IS RIGHT FOR YOU? Choosing a treatment center is an important decision-one that you should not make alone! I can help you with: Placements • Consultation • Case Management Services • Client Advocacy • Court Liaison Services • Interventions • In-Custody Evaluations • Expert Testimony • Alternative Sentencing• Marchman Acts. Call me today for a free consultation.

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Myles B. Schlam J.D., CCJAP CLINICAL TREATMENT COORDINATOR

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This poem was submitted by Jordan- an addict in recovery.

BORN AGAIN

Born with a whole in my heart Born again with my soul ripped apart Lost in a lost land Trying to dig myself out of this big hole in the sand Don’t want to go back to that place Don’t want to have to hide in that space Oh boy, does it stink Oh boy, does it stink But it seems like I just lost all my luck I’m soul shattered, like a broken glass plate I’m soul shattered, can I have this much fate But I’m going to be the person I want to be I’m going to see, all the things I want to see I’ll be just like a bird. I will spread my wings and you will see me flying free

I’m going to be the person I want to be. I’m going to be that young man that everyone wants to see.

A ONE COACHING Helping you move your life forward

Laura KeLLey, CrSS Certified Recovery Support Specialist

Professional Life and Recovery Coach Is your life changing or troubled? Are you undecided which path to take? Do you need help determining the resources necessary to move forward? You need never again feel that you are alone in your decision making! I will help you find your own direction, set goals and move your life forward.

Call (561) 577-3083 www.aonecoaching.com aonecoaching@yahoo.com

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Treatment’s over...... Now what?

For many of us, we go to treatment and learn the facts and many facets of addiction. We are taught how to reach out, what to do next and how to reach long term sobriety. Treatment is a safe haven to help us clear our minds, detox safely and help us on the road to recovery. Whether this is your first treatment center or it has taken a few tries, now it's over and you’re feeling anxious about what to do next. Questions arise and soon feelings of anxiety hinder our chances of long term sobriety. Your therapist or treatment techs may have suggested you go to a sober house for extra support, but why is that so important? Why are our chances of achieving life-long sobriety so low without the extra support and structure of a sober living facility? Which sober house should I choose? How long should I stay? How can I afford that? Should I enroll in an Intensive Outpatient Program? Why do I feel so overwhelmed? These are only a few of the important questions we are faced with once treatment is over or when we decide to begin our sober journey. Halfway There has been providing a pet friendly residential living environment highly conducive to sustained recovery for over a decade now. Its high success rate is rooted in: A Strong Recovery Ethic; A Family-Oriented Setting; and Comprehensive Program Resources Halfway There is founded by recovering individuals, upon a holistic approach to the treatment of substance abuse. Halfway There offers a Comprehensive & Customized Program, with the full range of services necessary to both establish and sustain a healthy, recovering lifestyle. We offer transportation to meetings, job placement services, weekly community outings to the beach, arcades, movies etc. Weekly community meetings keep our residents informed and help to create a strong bond with the residents for added support through rough times. We help residents apply for Food Stamps, State Identification Needs, Health Insurance and Education Opportunities. As recovering individuals ourselves, the staff at Halfway There is dedicated to the well-being of our residents to make sure we help them have the strongest chance of long term sobriety. Come see what all the hype is about, schedule your tour today of our facility and learn how you can LOVE TO LIVE AGAIN!!

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What Are the Most Common Eating Disorders? By Carolyn Ross, MD, MPH

Eating disorders constitute a spectrum of disorders from anorexia to bulimia and binge eating disorder. Binge eating disorder is the most common eating disorder in the U.S., where an estimated 1 to 5 percent of the population has been affected, according to the National Eating Disorders Association. The National Institute of Mental Health estimates that 1.1 to 4.2 percent of women have bulimia in their lifetime. Anorexia affects 0.5 to 3.7 percent of women at some point in their lives, according to ANRED (Anorexia Nervosa and Related Eating Disorders). It is an artificial notion to see these as discrete disorders. Many patients begin with anorexia and food restricting but may begin purging and binging. Or binge eaters can become bulimic or anorexic. The underlying focus of all of these eating disorders is very similar in that their selfevaluation is dependent on body size and shape, there is a focus on the desire to be thin which drives the behaviors and emotions, and in the end they can take over the life of the person suffering from an eating disorder. Keeping this in mind, the definitions of the various diagnoses will help to determine where the person is on this spectrum: Anorexia Nervosa Anorexia nervosa is associated with one of the highest mortality of any psychiatric diagnosis. Onset of the disease can be as early as 7 years with a peak between 15 to 18 years of age. Behaviors include restriction of all foods, especially those higher in calories or fat and sometimes compulsive exercise. A subset engages in self-induced vomiting or purging and/or in laxative or diuretic abuse. The classical definition of anorexia is body weight 15% below age and sex norms, loss of menstrual cycles or delayed menarche, and the reversal or stunting of pubertal development. Anorexics often develop bizarre food rituals such as having to cut their food into tiny pieces or not being able to let one food come in contact with another on their plate. As the disease progresses, an individual suffering from anorexia may experience:

• Fatigue • Weakness • Loss of concentration and memory • Obsessive symptoms, including obsessive ruminations about food and obsessive body checking (e.g., pinching arms or thighs to look for body fat) Personality characteristics associated with anorexia include perfectionism, high harm avoidance, decreased novelty seeking, self-directedness and decreased ability to view themselves as part of society. These personality traits may be present before the onset of the disease and can persist after recovery. Interestingly, the proportion of boys who are diagnosed with anorexia is much higher for childhood anorexia (26-28%) compared with those diagnosed after puberty (4-6%). Bulimia Nervosa Bulimia nervosa is defined by the binge/purge cycle. Binges are defined as eating large quantities of food in a small period of time. Purging behaviors can include compulsive exercise, self-induced vomiting and the use of laxatives. As noted above, it is often difficult to define what constitutes a large enough amount of food to be a binge. Therefore, focusing on the loss of control over eating may be more useful. The onset of bulimia usually occurs after age 13 and its prevalence exceeds that of anorexia by the early adult years. Unlike anorexia, there is an increase in co-occurring substance use disorders in bulimics. The prevalence of lifetime substance use disorders in bulimics is 20 to 40 percent. Those with substance use disorders are also more likely to have social anxiety, antisocial behavior and other personality disorders, and to have a family history of substance abuse, anxiety, impulsivity and mood disorders. Personality traits associated with bulimia are increased novelty seeking, high harm avoidance, and low self-directedness and high impulsivity. Binge Eating Disorder and Eating Disorder Not Otherwise Specified Binge eating disorder is more common than anorexia and bulimia combined. Roughly 60 percent of binge eaters are women with an average age of onset in the 20s, according to the Binge Eating Disorder Association. Binge eating disorder is currently included in the DSM-IV under the diagnosis of Eating Disorder – not otherwise specified (EDNOS). This category includes those who may not strictly meet criteria for either anorexia or bulimia. Currently, EDNOS is the diagnosis with the highest prevalence, in part due to the need for revising the DSM-IV criteria to reflect, for example, that not all anorexics have amenorrhea or may have amenorrhea but have been put on the birth control pill and therefore, loss of menses cannot be documented. Proposed changes in the upcoming DSM-V, which will be released in May 2013, would categorize binge eating disorder as a separate condition. Binge eating disorder does have specific suggested criteria for diagnosis, including the eating of large quantities of food in a small period of time, loss of control over eating and the lack of a compensatory purge. There is often remorse or shame after eating, eating very rapidly, and eating when not hungry and past the point of fullness. The types of foods consumed by binge eaters tend to be those that are lower in protein and higher in simple carbohydrates, such as snack foods and desserts. The overall calorie content of foods consumed during loss of control eating is the same as those consumed during normal meals. Weight gain, therefore, may be a function of the type of food consumed rather than the caloric value. Accurate estimates of the number of people suffering from eating disorders are difficult to come by. As many as 10 million females and 1 million males have anorexia or bulimia, and millions more are struggling with binge eating disorder, according to the National Eating Disorders Association. Shame and stigma likely prevent many more from coming forward and asking for the help that could save their lives. Dr. Carolyn Ross is an internationally known physician, author and speaker on addictions, obesity and eating disorders. She serves as a consultant to The Ranch’s eating disorder treatment program in Tennessee, maintains a private practice in Denver, is the author of The Binge Eating and Compulsive Overeating Workbook: An Integrated Approach to Overcoming Disordered Eating as well as The Joy of Eating Well, and also hosts a weekly radio show, The Vital Life. www.recoveryranch.com • www.carolynrossmd.com

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SIX STYLES OF ENABLING I wanted to share this article that the Parents Support Group in New Jersey was kind enough to allow us to print in The Sober World. ________________________________________________________________ Enabling includes a superstructure of perspectives which many people relate to in terms offostering chemical dependency in one with whom one has a continuous relationship.No single definition is agreed upon by all professionals. The following is an attempt to pinpoint behaviors which are characteristic of different styles of enabling found among codependents. 1. Avoiding and shielding: any behavior by the codependent covering up for, or preventing the abuser, or self from experiencing the full impact or harmful consequences of chemical use. • I made up excuses to avoid social contact curing abusive period • I threw away, hid, or destroyed chemicals. • I threatened violence to get the person to quit. • I shielded the person from a crisis. • I helped the person keep appearances or covered—up. 2. Attempting to control any behavior by the codependent performed with the intent to take personal control over the significant other s chemical use • I brought things to divert the person from using • I stayed home to get the person to quit or to take care of • I reminded the person of his/her failure or consequences • I preached, screamed, yelled, swore, cried • I threatened to hurt myself • Stayed away from home • I threatened to leave. • I withheld affection. 3. Taking over responsibilities: any behavior by the codependent designed to take over the abuser’s personal responsibility, such as household chores or employment • I woke the person to be on time • I did his/her chores • I payed his/her bills. • I covered his/her debts/bad checks 4. Rationalizing and accepting any behavior by the codependent conveying a rationalization or acceptance of the significant other’s chemical use • I believed/communicated that the use of one chemical was better than another.e.g.better that you drink than use cocaine) • I rationalized that his/her use gave confidence • I enjoyed that his/her use kept him/her out of my way • I believed that his/her use made the person less depressed

• •

I believed that his/her use made the person more tolerate, sexual, energized, creative, tolerable,alert, fun, powerful, clearer thinker, open, confident, productive I provided aids to sooth the person after excessive use.

5. Cooperating and collaborating: any assistance or involvement by the codependent in thebuying, selling, adulterating, testing, preparing, or use of chemicals. • I helped the person take the chemical. • I helped the person prepare the chemical. • I helped the person get to the source to buy the chemical. • I supplied the person with the chemical. • I gave money to buy the chemical. 6. Rescuing and subserving: any behavior by the codependent over— protecting the abuser and subjugating himself or herself. • I cleaned up after. • I checked and measured to determine the amount used. • I encouraged ‘home use’ rather than go out. • I waited hand and foot. Review the history of the codependent’s relationship to pick out the basic pattern/ Style of enabling. Why do codependents enable? Genuine Concern: They see their behavior as helping. Self preservation: They fear the consequences of not helping Discount behavior: Not identified Not identified as harmful Identified as harmful, but temporary. Fantasize: Feel helpless, and wish it away. Esteem enabling becomes the source of self—esteem, enmeshed Necessity of concurrent treatment Metaphor of the Human Body and its movement toward equilibrium. Metaphor of Mobile art and its movement toward equilibrium. The codependent has learned adaptive behaviors directed toward survival and directed to counter the dependent person’s dysfunctional behavior. As the dependent person expands his/her competency, so too must the codependent expand his/her competency. to meet the new functional behaviors of the dependent person. Adapted from: Charles Nelson, Styles of Enabling in the Codependents of Cocaine Abusers, (San Diego: United States International University, 1984.).

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Back to the Basics of Recovery Overview and Step One By Wally P. As an A.A. archivist and historian, I have had open access to many of the A.A. archival collections throughout the United States and Canada. In addition, I have interviewed several hundred A.A. old-timers who found a solution to their drinking problem in the 1940’s and 1950’s. In this and subsequent articles, I will present the methodology the A.A. pioneers used to take newcomers through the Twelve Steps. The process was simple, straightforward, and very effective. It is my hope that you will find some of this material useful, whether you are a sponsor, sponsee, or someone interested in learning more about our Twelve Step program of recovery. Some of this material may contradict what you have personally experienced within the Twelve Step community. Although controversial, none of this information is meant to be confrontational. I commend anyone who is willing to guide a newcomer through the Steps. I am not here to critique or criticize anyone’s sponsorship style. I have written these articles with the sole intent of familiarizing you with some of the techniques the pioneers used during A.A.’s formative years. In the early days, the sponsor chose the newcomer and stayed with this person until he or she had taken all Twelve Steps and was able to demonstrate an ability to take others through the work or serve the A.A. community in some other way. How long did this take? In many instances the process was completed in a day or two, sometimes it took longer, but rarely did it take more than a month. Then the sponsor and sponsee moved on to work with others just coming into the program. Sometimes they worked together as co-sponsors until the sponsee became proficient with the recovery process. Taking the Steps quickly is described in the “Big Book” and other A.A. conference approved literature. For example, how long was Ebby T. sober when he sponsored Bill W.? Two months (A.A., 9:5). How long did it take Ebby to guide Bill through the Steps? One day (A.A., 13:1-4). How long was Bill sober when he started sponsoring newcomers? Approximately two weeks (A.A., 15:1 and Pass it On, p. 131). How long was Dr. Bob sober when he started sponsoring? Two days (A.A., 156:3 and Dr. Bob and the Good Oldtimers, pp. 81-83). How many newcomers did Dr. Bob take through the Steps? Five thousand over a ten-year period of time. This equates to more than one person a day. Did this process work? Absolutely. A.A.’s 50-75% recovery rate during the 1940’s and 1950’s certainly validates the process. Today I hear people say, “But that was then, and things are different now. People are coming in younger, they have a higher bottom, they have other issues, etc., etc., etc.” The only thing I find different is that there are a lot more people today who are unfamiliar with the simplicity of the original A.A. program of recovery. Over the years, people have added layer upon layer of complexity to the process, which has significantly reduced its effectiveness In the early days, most newcomers couldn’t afford a “Big Book” (it cost the equivalent of $95.00 today), so the sponsor would read the appropriate parts of the “Big Book” to him or her. Most of the A.A. pioneers used a few key paragraphs from the “Big Book” to take newcomers through the Steps. The rest of the book was left for a later time. Once the newcomers had recovered, they would then work the program in more detail. For a list of the paragraphs many of the A.A. old-timers used, please visit www. aabacktobasics.org. One of the key statements from the 1940’s was, “Put no block between the newcomer and Step 12. Get the newcomer through the process and working with others as quickly as possible.” In so doing, the sponsor helped alleviate the newcomer’s feelings of “remorse, horror and hopelessness”

(A.A., 6:1) and replaced these feelings with a “new sense of power and direction” (A.A., 46:2). In the early days, the Steps were summarized into four words, Surrender, (Steps 1, 2 and 3), Sharing (Steps 4, 5, 6 and 7), Amends (Steps 8 and 9), and Guidance (Steps 10, 11 and 12). Step One reads: We admitted we were powerless over alcohol–that our lives had become unmanageable. The “Big Book” authors devote 51 pages of the book to the first part of the surrender process, which is to admit we have a problem. Within these 51 pages, there are about nine crucial paragraphs. The authors begin by describing the physical and mental symptoms of alcoholism. Later they ask us to acknowledge that we are alcoholics. Before we can do this, we need to know what an alcoholic is. Explanatory Paragraphs: Physical Symptoms: pg. xxx: 5 (1-3, 5-8) (Phenomenon of craving) Physical Symptoms: pg. 44: 1 (4-7) (Lack of control) Mental Symptoms: pg. xxviii: 4 (1-6), xxix: 0 (1-3) (Inability to accept the truth about our condition) Mental Symptoms: pg 23:1 (3-10) +2 (2-9) (Problem starts in the mind) Mental Symptoms: pg 30: 1 (4-10) (Illusion that we don’t have a problem) Psychic Change: pg. xxix: 1 (1-5) (What it is going to take to recover) If you can identify with any of the physical or mental symptoms of alcoholism, you are ready to take the First Step. If you can’t identify or if you don’t think you are an alcoholic, you can take the First Step based on the second half of the Step, which refers to unmanageability. Unmanageability: pg. 52: 2 (3-8) (Trouble, misery, depression, uselessness, unhappiness) “(Are you) having trouble with personal relationships, control(ling) (y)our emotional natures, a prey to misery and depression, (having difficulty) mak(ing) a living, (do you) feel useless, (are you) full of fear, (are you) unhappy, ( does it) seem (you can’t be) of real help to other people?” If you can identify with either the first or any part of the second half of the First Step, you are ready to proceed to the First Step question. It is on page 30, paragraph 2. The First Step question reads: “Do you fully concede to your innermost self that you are an alcoholic?” or “Do you fully concede to your innermost self that you (have a problem)?” If you can answer in the affirmative, then you have taken Step One. According to the “Big Book” authors and the A.A. pioneers, nothing more is required. Now it is time to proceed to Step 2. In this Step we will describe the solution to our problem. Wally will be taking us through Step 2 in the July issue. About the Author Wally P. is an archivist, historian and author who, for more than twentythree years, has been studying the origins and growth of the Twelve-step movement. He is the caretaker for the personal archives of Dr. Bob and Anne Smith. Wally conducts history presentations and recovery workshops, including “Back to the Basics of Recovery” in which he takes attendees through all Twelve Steps in four, one-hour sessions. More than 500,000 have taken the Steps using this powerful, time-tested, and highly successful “original” program of action. THE

Back to Basics Basics--101 An introduction to the Twelve Steps of Recovery

During this seventy-five minute DVD, Wally Paton, noted archivist, historian and author, takes you through all Twelve Steps the way they were taken during the early days of the Twelve-Step movement. Experience the miracle of recovery as Wally demonstrates the sheer simplicity and workability of the process that has saved millions of lives throughout the past seventy years. Wally has taken more than 500,000 through the Twelve Steps in his Back to the Basics of Recovery seminars. He has made this “Introduction to the Twelve Steps” presentation hundreds of times at treatment centers, correctional facilities, and recovery workshops and conferences around the world. This is a DVD for newcomers and old-timers alike. You can watch it in its entirety or divide it into three segments: Surrender (Steps 1, 2 and 3); Sharing and Amends (Steps 4, 5, 6, 7, 8 and 9); and Guidance (Steps 10, 11 and 12). The accompanying CD contains twenty-four pages of PDF presentation materials for facilitators and handouts for participants. Here is everything you need to take or take others through the Twelve Steps “quickly and often.” Wally has modified the “Big Book” passages so they are gender neutral and applicable to all addictions and compulsive disorders. In keeping with the Twelve-Step community’s tradition of anonymity, he does not identify himself, or anyone else in this DVD, as a member of any Twelve-Step program. This DVD was recorded at the Public Broadcasting Service television studio in Tucson, AZ using high definition cameras, flat screen graphics, and PowerPoint overlays. It is a state-ofthe-art production that is both instructive and enlightening. “It works—it really does.”

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Chronic Pain and Addiction by Stephen Colameco Chronic pain complicated by addiction is a serious, undertreated and often poorly treated condition. In recent years, many individuals have become addicted to prescription drugs initially prescribed for the treatment of chronic pain. Also, research studies published in respected journals report that addicts are more likely to suffer from severe chronic pain than non-addicts. There a number of reasons why this is so. Chronic pain is now recognized as a complex disorder affected by the interaction of biological, social, environmental and emotional factors. Almost everyone has seen TV ads for Cymbalta (R) –an antidepressant approved for the treatment of chronic pain. Emotions, especially anxiety, depression, and post traumatic stress disorder play an important role in chronic pain, and these same conditions predispose to addiction. The use of opioids is another factor in the development of chronic pain, whether prescribed for pain or abused as a “street drug”. The fact that opioids may cause pain seems paradoxical because opioids effectively treat acute pain. But a growing number of pain experts believe that daily opioid exposure—whether prescribed or illicit—has direct, adverse biological effects on pain processing— actually making pain worse! When used on a daily basis, opioids can decrease the pain threshold and increase pain sensitivity—a condition known as opioidinduced hyperalgesia. That’s why many comprehensive pain programs routinely withdraw opioids as part of their treatment protocol. Opioids used on a daily basis also decrease hormone production in a dose-dependent manner—the higher the dose, the more hormone levels fall. This condition is called opioid-induced endocrinopathy. In men, this means lower testosterone levels with all the signs and symptoms described on the TV ads for testosterone supplements. Women with endocrinopathy may have lower than normal levels of adrenal sex hormones, decreased sex drive and abnormal menstrual cycles. Sex hormone deficiencies are thought to increase pain. Hepatitis C, a condition common among injection drug users, also causes chronic pain. For these and many other reasons, addicts

experience more pain than others, and pain can be a trigger for relapse. Although substance use disorders and chronic pain frequently co-exist, provider attitudes toward these two conditions are shaped by the prevailing medical model that views chronic pain as a medical problem and addiction as a psychological problem. When addiction is the primary diagnosis, patients are channeled into addiction treatment track that all too often neglects to recognize or manage addicts’ pain. Even worse, some programs refuse to accept addicts with complicated, painful medical conditions. Addicts suffering from chronic pain require specialized care in programs where they can receive addiction treatment combined with comprehensive pain treatment. Pain management typically includes non-opioid medications, painfocused cognitive behavioral therapy, and functional restoration through physical, occupational and other therapies. Interventional pain procedures (e.g. injections) may be used to provide temporary pain relief to facilitate therapy. There are a number of excellent programs providing comprehensive care for addicts, but the treatment need is far greater than available resources. Sometimes, addiction to opioids is too strong for successful “drug-free” recovery, in which case medication-assisted treatment with Suboxone TM may be needed while the recovering addicts learns new ways to cope with pain and addiction. Dr. Stephen Grinstead’s Addiction-Free Pain Management TM program’s web site is one of many excellent resources for more information about the connection between pain and addiction. Stephen Colameco, MD, M.Ed. FASAM is an addiction specialist and author of Chronic Pain: A Way Out as well as a number of articles published in the medical literature. He has no connection to Addiction-Free Pain Management. Information about Dr. Colameco and Chronic Pain: A Way Out available at his website: AddictionPain.com. THE

ADDICTION, SOBRIETY AND SPIRITUALITY By Tony Foster

The following is a two part article on the importance of spirituality in long term recovery. Since before the advent of Alcoholics Anonymous spirituality, religiosity, or some belief in a higher power has been thought to be one of the driving forces in someone attaining and maintaining sobriety from alcohol and/or drugs (Steiker & Pape, 2008 and Cheever, 2004). This article aims to shed light on the relationship between addiction, sobriety, and spirituality. Does spirituality play a major role in one’s ability to stay clean and sober? If so, what role does it play? How important is spirituality to maintain ones sobriety? What continuing effect does spirituality have on someone with a significant amount of time in recovery? And, what seems to be the never before asked question, does a lack of spirituality or a higher power lead to alcohol and drug abuse? Alcohol contributes to nearly 80,000 deaths annually (Center for Disease Control and Prevention (CDC), 2008), making it the third leading cause of preventable mortality in the United States after tobacco and diet/activity patterns (Mokdad, Marks, Stroup, & Gerberdin, 2004). In 2005 there were more than 1.6 million hospitalizations related to alcohol (Chen & Yi, 2007). Alcohol dependence and alcohol abuse cost the United States an estimated $220 billion in 2005 in healthcare and lost productivity. This dollar amount was more than the cost associated with cancer ($196 billion) and obesity ($133 billion) (TreatmentCenters.net, 2011). Approximately 14 million people in the United States, or 7.4 percent of the population, meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), criteria for alcohol abuse or alcoholism (American Psychiatric Association, 2000). Throughout the world, alcoholism accounts for 4% of the “global disease burden” (World Health Organization, 2002). In 2006, approximately 20.4 million people over the age of twelve were current users of an illicit drug, including marijuana, cocaine, heroin, hallucinogens, inhalants, and prescription-type psychotherapeutic drugs that were used non-

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medically. That amounts to 8.3% of the population (Substance Abuse and Mental Health Services Administration (SAMHSA), 2007). Additionally, in 2009 nearly 4.6 million emergency room visits were concerning the misuse or abuse of drugs, adverse reactions to drugs, or other drug-related consequences (Owens, Mutter, & Stocks, 2010; McCaig & Burt, 2005). Further, in the year 2000 approximately 17,000 deaths were attributed to the use of illicit drugs (Mokdad, et al, 2004). Finally, besides health and mortality issues, substance abuse is a tremendous drain on the economy. According to the National Institute on Drug Abuse, substance abuse and its related problems, including health, legal, and loss of productivity, cost the United States over $484 billion per year (NIDA, n.d.). While a great deal of research has been conducted on addiction, much less work has been done on recovery. Furthermore, there has been some research into what commonalities exist in long-term recovering people, but very little written about the individual characteristics of a recovering person and which of those characteristics are most important in someone staying clean and sober. Some researchers have isolated the effects of spirituality on sobriety through their studies aimed at finding the most common trait in a long-term sober person (Leigh, Bowen, & Marlatt, 2005; Warfield & Goldstein, 1996; and, Chapman, 1996) This paper attempts to analyze one common characteristic, spirituality; what role it plays in the recovery of the alcoholic and/or drug addict, and conversely, whether the lack of it is a leading root cause of alcoholism? The earliest known connection between spirituality and addiction or recovery came from the Oxford Group. The Oxford Group was a Christian-based organization that had its origins in Europe, China, Africa, Australia, and Scandinavia in the 1920s and 30s. It was begun in the United States by an American pastor, Frank Buchman. It was then known as “A First Century Christian (Continued on page 18

ADDICTION, SOBRIETY AND SPIRITUALITY

(Continued from page 17)

Fellowship” in 1921 and espoused complete surrender and sharing, bringing about true fellowship, faith and prayer. It was also, in large part, a temperance movement. By 1931, the pro-prohibition group had grown into The Oxford Group. The Group was religious in nature and somewhat radical in its thoughts. However, they had become enough a part of the mainstream that they claimed Henry Ford and Mae West as members. Ultimately they also attracted the likes of Harry Truman and Joe DiMaggio to their membership (Cheever, 2004). At that time a wealthy member of the Oxford Group named Roland Hazard from Rhode Island had reached such a level of hopelessness regarding his alcoholism that he went so far as to seek the help of the world famous psychiatrist, Carl Jung. Jung told him that he saw no hope in him that would come from the medical or psychiatric community and that his only hope was a religious conversion, or complete spiritual awakening. On his return to the United States he worked through the Oxford Group and was able to achieve sobriety. In 1934, Ebby Thatcher, a chronic alcoholic and childhood friend of Bill Wilson, the founder of Alcoholics Anonymous, was “saved” by members of the Oxford Group, including Roland Hazard. Ultimately he attempted to pass this sobriety to his friend, Bill Wilson. Together they attended Oxford Group meetings in the early 1930’s in hopes of getting Bill sober. While Bill Wilson found the tenets of the Oxford Group to be too stringent, he came to understand the need for a spiritual awakening. Accordingly, he used what he thought were the most important ideas, including the introduction of what would become 6 of the 12 steps of Alcoholics Anonymous. Therefore, Frank Buchman’s initial ideas on sobriety became the basis for Wilson’s development of Alcoholics Anonymous (Oxford Group, 2011) and the Steps and Traditions which are still the driving force of the fellowship (Alcoholics Anonymous, 1953). Following, Bill Wilson’s exposure to the Oxford Group he came to the realization that the only way he could remain sober was to have a spiritual awakening grounded in a power greater than himself. This was a revelation that at first he didn’t believe. Later though, Roland Hazard’s experience was confirmed for him through correspondence with Carl Jung, who informed him that, in fact, the only way to sobriety with any sort of permanence was a spiritual experience or higher spiritual education (Jung, 1961). When he was able to remain sober through his new-found belief in a higher power and subsequent spiritual awakening he began to help other alcoholics to become and remain sober. Initially he had no success with other alcoholics. He did however, stay sober himself. At that time Wilson traveled to Akron, Ohio on a business trip. There he met Dr. Robert Smith (Dr. Bob), another hopeless alcoholic. Wilson finally had success in helping another alcoholic, and together they began to look for others to help. Their meeting would be the genesis of Alcoholics Anonymous, both the book and the name of the group. Bill W. and Dr. Bob began meeting with other alcoholics in both Akron and New York. Over the next several years they grew in number until, at Bill W.’s urging, they wrote the book, Alcoholics Anonymous. It was published in 1939 and was written mostly by Bill Wilson, but in conjunction with the input of the first one hundred “recovered” alcoholics (Alcoholics Anonymous, 1939). Ultimately the book and the fellowship of Alcoholics Anonymous changed the way people dealt with alcoholism and addiction. As a spiritual and social movement, Alcoholics Anonymous was founded on the principle of one alcoholic helping another and the need for a spiritual awakening. All future 12-step programs followed suit and are based on AA’s 12 steps. In the original manuscript of the book Alcoholics Anonymous, Bill Wilson freely mentioned God’s impact on his sobriety. He was convinced by his co-writers that such a free use of the word “God” would be objected to by those newly sober. Wilson’s concessions on this point proved to be a smart decision, although the changes have not stopped naysayers from claiming that Alcoholics Anonymous is a cult and that its members are brainwashed. Ultimately, he changed the terminology to “power greater than ourselves”, replacing the word God in the twelve steps wherever he thought appropriate. Finally, the twelfth step states that “Having had a spiritual awakening as the result of these steps, we tried to carry this message to other alcoholics, and to practice these principles in all our affairs” (Alcoholics Anonymous, 1939). For AA this was the culmination of how one was to live their life after they’ve completed the twelve steps. Over the next seven decades

Alcoholics Anonymous became a world-wide phenomenon that was converted and adjusted to help those suffering from many other addictions, leading to Narcotics Anonymous, Cocaine Anonymous, Over-eaters Anonymous, Sex Addicts Anonymous and countless other 12-Step programs. All are rooted in the need for a spiritual awakening and individuals being grounded in the belief of a higher power. The perceived success and subsequent growth of Alcoholics Anonymous over the years led to researchers taking a closer look at spirituality (Kelly, Magill, & Stout, 2009; Korinek, 2007; Laudet, Magura, Cleland, Vogel, & Knight, 2003; and, Kaskutas, Bond, and Humphreys, 2002). Many studies link AA as a start, and some a focal point, to the idea that spirituality is critical to long-term sobriety (White, Montgomery, Wampler, and Fischer, 2009; Mason, Deane, Kelly, and Crowe, 2009). This has been particularly true as many have attained long term sobriety and attributed their spirituality as a major factor in being able to get, and stay, sober. Many articles and even dissertations have been written based on research and studies that have attempted to create a “how-to” of long-term sobriety (Strobbe, 2009). In one way or another, spirituality has consistently ranked among the top five factors in long-term sobriety (Pardini & Plante, 2000; Warfield & Goldstein, 1996 and Chapman, 1996). Beginning in 1939 with the publication of the “Big Book” of Alcoholics Anonymous spirituality was not only espoused as a factor in recovery, but the ultimate goal of someone attempting to gain sobriety. In Bill Wilson and A.A.’s view, the entire purpose of completing the first ten steps of the program is the ability to reach numbers eleven and twelve. In Step 11 he wrote that one has “sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out” (Alcoholics Anonymous, 1939). This step encourages having a relationship with a higher power that consists of daily contact, both speaking and listening. Step 11 is followed up with Step 12, which brings one to ultimate purpose of the 12 steps, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs” (Alcoholics Anonymous, 1955). It is interesting to note that in the first edition the spiritual awakening was characterized as a spiritual experience and subsequently changed for emphasis at the urging of those in the psychiatric community (Alcoholics Anonymous, 1939). The 12 steps of Alcoholics Anonymous build from the very basics of the first step or admitting powerlessness, through admitting one’s faults, making amends to those harmed, and finally, to the capstone of a spiritual awakening (Strobbe, 2009; and, Warfield & Goldstein, 1996). Alcoholics Anonymous claims to have helped many millions of people worldwide. It currently states that it has over 115,000 groups throughout the world and 2.1 million members (Alcoholics Anonymous, 2011). However, the organization has many detractors. Many people believe that members are “brainwashed” to believe things they wouldn’t normally believe (Walters, 2002). Others feel that the fact that they stress a belief in a higher power and that one must turn their will and their life over to God “as they understand him” (Alcoholics Anonymous, 1939) means that AA is a cult. Many newcomers blanch at the thought of putting a belief in a power that they feel got them into this predicament to begin with. Some in the recovery community believe that a lack of belief is the most significant problem leading to addiction. There appears to be very little research regarding this possibility and would serve for an interesting juxtaposition regarding spirituality. Finally, although there are no official statistics, it is thought that AA’s success rate is approximately 5%. It is very easy for cynics to see that as a 95% failure rate rather than the other way around (Petralli, 2004; and, Galanter, Egelko, & Edwards, 1993). Tony Foster is the Director of Therapy at the Beachcomber Outpatient Services treatment center located in Boynton Beach, Florida. The conclusion of this article will be in our July issue. It will discuss several studies that corroborate the importance of spirituality if someone wants long-term recovery.

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