YOUR TODAY INSPIRES HER TOMORROW A different way to treat people. A parents battle with addiction places their children’s future at risk. At Sober Living Outpatient, we strive to provide the highest quality treatment for each and every individual. Our clients are enabled to maintain long term sobriety and focus on what’s most important in their lives... their future.
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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. The Sober World is an informative award winning national magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication, as well as an online e-magazine reaching people globally in their search for information about Drug and Alcohol Abuse. We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol in Palm Beach County as well as distributing locally to the schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more throughout Palm Beach and Broward County. We also directly mail to treatment centers throughout the country and have a presence at conferences nationally. Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest manmade epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction. I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process,
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There are Transport Services that will scoop up your resistant loved one (under the age of 18 yrs. old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs, Extended Living and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean. Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help. Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com. We are on Face Book at www.facebook.com/pages/The-Sober- World/445857548800036 or www.facebook.com/steven.soberworld, Twitter at www.twitter.com/thesoberworld, and LinkedIn at www.linkedin.com/grp/home?gid=6694001 Sincerely,
Patricia
Publisher Patricia@TheSoberWorld.com
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ADDICTION—A DISASTROUS FAMILY HERITAGE By William G. Borchert
In this era of growing genetic research, scientists tell us that our genes are essentially the predictors of our biological future. They tend to lock us rather securely into our physical heritage through heredity So when it comes to addiction, these scientists tell us that if we have one parent who is an alcoholic or drug addict, we have a fifty percent chance of inheriting the same disease. If both our parents are addicts, we have a ninety percent chance of becoming similarly addicted to alcohol and/or drugs. Many who accept the premise of gene determination often try to change or delay its impact when it comes to such obvious lifethreatening maladies such as heart disease, cancer, diabetes and COPD. They exercise, lose weight, eat healthier and pay close attention to the advice and warnings they receive from their doctors and other health specialists. Few, however, who live in the danger zone of addiction, follow the same protocol. In fact, too many people biologically targeted by addiction even know or understand the warning signs of alcoholism or drug abuse. Instead they live blithely in denial until they begin to teeter on the edge of disaster or are already in its clutches. Even then, through some illogical mental quirks like pride, shame, ignorance and fear, many still believe they can handle things on their own and refuse to reach out for help. As I look back, that’s exactly what happened in my parents’ family as I was growing up and then later when I married, in my own family. Whether some want to believe it or not, I can tell you from firsthand experience that addiction to alcohol is a baffling, powerful and insidious disease. My father had five brothers. Three of them died of alcoholism. Both of my grandfathers also died of the alcoholism as well as my mother’s mother and one of her bothers. The disease was all around us. It ran rampant through the families yet everyone kept on drinking and denying and making excuses for their bad behavior and failure at life. And many of those I speak of were intelligent, talented and hard-working people until their struggles with addiction took them down. Growing up in an alcoholic home is a struggle in itself mainly because most of the time things just don’t make sense. And it’s not only having a drunken father who doesn’t teach you how to play ball or other sports like most fathers do. It’s also having a mother who gets enraged by her husband’s actions and has no one else to take that anger out on but her children. It’s the constant arguments, screaming and fighting that makes you hide under your bed with a pillow covering your ears to drown it all out, especially when there were things you don’t want to hear. For example, one night in the middle of a terrible argument that led to my mother pushing and slapping my drunken father, I heard her scream at him: “I should have never had these children! Then I wouldn’t have to put up with all of this! I could just leave here and be rid of you once and for all!” That was another night I went to sleep filled with fear and confusion. It also seemed like we were constantly moving from one rented place to another. While my father had a fairly decent paying
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job as a pressmen for a large daily newspaper, he would cash his paychecks at bars and bring home what little was left. As a result, he was always behind on the rent so we would have to move into smaller, less expensive apartments. But it wasn’t just these kinds of inconveniences along with the arguments and fights that tore into the hearts of those around my dad and his disease. It was all the shame, fear and broken promises that did the most damage. I can count on one hand the number of times my father took me fishing when he promised hundreds of times, or to a major league baseball game or to the carnival or to a movie. I’m sure deep down he meant to keep his promises but his drinking turned him into a liar. Each broken promise hurt that much more. And then there was the shame. I remember it was a warm, sunny Saturday morning and I was playing stickball in the streets of Brooklyn with my buddies. I was probably around eleven years old. I also recall there were a bunch of girls watching us which always made me feel uptight and selfconscious even though I was a pretty good player. Suddenly a taxicab pulled up nearby, close to where we lived. The passenger door opened and a man fell out into the street totally disheveled. He was obviously drunk and had saliva oozing down his chin. He was my father. The cab driver helped him to his feet and half dragged him into our building. Even though many of my friends recognized him, they couldn’t help but laugh at the shameful scene. The girls tried to hide their giggles. I felt humiliated. I didn’t know what to do. So I started to run. I didn’t know where I was going. I just needed to get away from all the laughter and giggles, away from all the shame. I ran and I ran until I couldn’t run anymore. Then I sat down on a large rock in a deserted field and wept. I remember how much I hated my father at that point and swore I would never be anything like him when I grew up. I not only became like my father. I became worse. Still, you would think that anyone with any sense, growing up in that kind of atmosphere, would be determined never, ever to have a drop of liquor even if they didn’t know they had the genes of an alcoholic raging inside. But that’s what makes the malady of addiction so baffling, powerful and insidious. The one thing I couldn’t understand was why my father continued to get drunk after creating so much havoc, hurting those he said he loved and losing so much materially including numerous opportunities for better jobs and advancement in life. It just didn’t make any sense. That’s because I didn’t understand at the time that alcoholism is a threefold disease. It affects one physically, mentally and spiritually. An alcoholic is constantly walking around with a drink on his mind. It’s called a mental obsession. Then once he or she picks up a drink, a physical compulsion takes over and they can’t stop. They become powerless over booze. One drink is too many and a thousand aren’t enough. And as they slide deeper and deeper into addiction and become willing to do almost anything for another drink, they become spiritually bankrupt. Continued on page 46
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WHEN BEING PREGNANT IS A CRIME By Hayley Keith
Imagine an emergency room full of patients waiting to be seen. Some of which are in pain, some in distress, and some show no signs of physical or mental ailment whatsoever. What goes unnoticed is the pregnant woman in the corner who hides under a blanket of shame and guilt. She is an addict and her addiction will soon destroy the life of her unborn child if help is not found. Every year in the U.S. over 30,000 babies are born physically dependent on drugs. This number may continue to increase if proper resources are not available to pregnant addicts. A sad reality in addiction is, using alcohol or drugs throughout a pregnancy exposes not only the mother, but also her developing child to the negative impact of such behavior. The long-term repercussions of drug use on exposed fetuses can be absolutely devastating. For this reason, seeking help is imperative for any pregnant woman who is addicted to any substance. Receiving professional assistance can often be a challenging endeavor. Pregnant clients are frequently turned away from drug rehabilitation centers and other facilities when their pregnancy is discovered. One can imagine the fear and anxiety brought on by social perceptions that label addicts as abusive parents and criminals. Legal Repercussions Pregnant addicts nationwide are afraid to seek help. Many believe that disclosing their addiction will have negative ramifications, such as judgement from their family and peers as well as legal repercussions. During the past few years, expectant mothers have been arrested and jailed in New Hampshire, North Dakota, Missouri, Georgia, Colorado, Alabama, Arizona, New Mexico, and South Carolina based on claims that drug use implies child abuse. Women arrested for failing drug tests during pregnancy are not on drugs with the intention of harming their unborn child. With proper resources in place, struggling addicts could be given the opportunity to recover. Upon hearing such news stories, we can only assume that many women are hiding their problem and trying to deal with it alone, instead of seeking help. Law enforcement agents and judges often justify their positions when arresting such individuals by stating they are helping to protect the children. It is obviously wise to remove a newborn baby from the custody of an addicted individual who cannot properly care for the child. Instead of criminally charging pregnant women, alternative options like rehabilitation should be made available to help erase the negative stigma surrounding mental illness and addiction. Doctor-Patient Trust Fear of judgment and confidentiality breaches can be a barrier to pregnant women seeking care from their healthcare provider. The Health Insurance Portability and Accountability Act (HIPAA) protects patients from having their medical records disclosed to anyone outside of the patient-provider relationship. However, health care providers are mandated reporters, and subsequently are required by law to report suspicions of abuse or neglect. Seeking drug rehab is not a crime, but may be reported if the provider recognizes that there are children at risk in the care of the addict. The reporting of this suspicion does not directly lead to legal consequences, but legal action may be taken upon delivery of the baby if withdrawal symptoms are present and drug testing is found positive. For those reasons alone, addicts may intentionally choose not to disclose their drug usage when seeing their healthcare provider. Opinion of Leading Organizations Many leading health organizations have addressed this issue, such as The American Medical Association, The American Congress of Obstetricians and Gynecologists, The American Academy of Pediatrics and nonprofit organizations such as the March of Dimes.
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All have concluded that the issue of drug and alcohol abuse among expectant mothers is a problem best addressed through appropriate rehabilitation therapy and education, rather than through the criminal justice system. If the threat of arrest is looming over a woman, she is much less likely to seek help and presumably envisions giving birth to a child in prison, a situation that is not uncommon. Medical knowledge about dependency and addiction also demonstrates that the threat of arrest or jail time does not give a person enough incentive to discontinue drug use. In other words, fear and negative consequences are not motivators that stop an addict from using. For this reason, the threat-based approach of putting expectant mothers into the criminal justice system is merely an exercise in futility. Anything that holds a person back from seeking help is not an effective approach. Stigma / Shame In addition to feeling fearful, pregnant addicts often experience pain, shame, and guilt for introducing their addiction to the unborn child. Modern society has an idea that motherhood should be exciting, challenging, and of course drug free. For an addict, the pregnancy dream immediately turns into a nightmare. Pregnant addicts struggle to forgive themselves, which causes depression, emotional turmoil, and feelings of embarrassment. The journey to sobriety can help these women immensely, as they are given tools to help cope with the stress of motherhood and difficulties during recovery. However, finding proper help for a pregnant addict can be difficult. Lack of In-House Facilities As of 2015, a mere 19 states offer in-house substance abuse programs specifically for pregnant women. There are many reasons for this, including the ambivalence of the medical community regarding the best withdrawal medications, and the lack of provisions specific to pregnant individuals. In some cases, rehab facilities do not want to take on the liability of caring for an expectant mother who is simultaneously dealing with a substance abuse problem. Many rehab facilities are lacking in resources and may not have qualified clinical staff necessary to provide appropriate care for pregnant patients. The sad fact is that few rehabilitation facilities offer programs for expectant mothers suffering from substance abuse. Fortunately, Continued on page 42
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WHAT FAMILY MEMBERS NEED TO KNOW ABOUT SUBSTANCE ABUSE AND SUICIDAL BEHAVIOR By Tony Salvatore, MA
Not all substance abusers manifest suicidal behavior, but too many do. A CDC toxicology study of suicide victims found over one-third positive for alcohol and just under one-fifth positive for opiates. These substances did not cause these suicides, but they likely added to the victims’ risk. Most family members of individuals who abuse alcohol and other substances are aware that this behavior can lead to suicide. They may become familiar with their thoughts and threats of suicide, and, in some cases, suicide attempts. Yet few may have much insight into how suicidal behavior is associated with substance abuse. What is suicidal behavior? Suicide is caused by a self-inflicted injurious act with intent to die. Suicide is a planned outcome of a desire to end one’s life. Explicit intent to die is what sets suicide apart from non-fatal self-injury (e.g., cutting) or intentional overdoses. Suicidal behaviors are activities related to suicide and include: • Suicidal Ideation – Thoughts of attempting or completing suicide. • Suicide Threat – An expression of intent to attempt or complete suicide. • Suicide Plan –When, where, and how an attempt will be made. • Suicide Attempt – An intentional effort to die by suicide that was not fatal, and which may not result in injury. Risk increases exponentially as an individual proceeds along this continuum. What about suicide threats? A suicide threat is a signal of potential suicide risk. It may be verbal or nonverbal. Threats may not necessarily be made. However, even when they are, suicide threats may not always reflect any thought of death. Consider these two threats: “I am going to kill myself tonight by [insert lethal means].” “I will kill myself tonight if you make me leave.” The first is an unconditional statement with a plan, timeframe, and means. The second is conditional and “sets the terms” under which “intent” may be acted on. Conditional suicide threats are probably the most common suicidal behavior experienced by family members. They tend to be heard when the substance abuser is losing control of an interpersonal situation or facing other adverse circumstances. Family members need to understand both types of suicide threats but leave it to mental health professionals to determine which is which and to respond appropriately. Suicide threats are a major danger sign and must never be ignored or minimized. Even the most apparently manipulative “suicidal” substance abuser has many risk factors and may constitute a potential danger to self or others even in the absence of suicide intent. Conditional threats are best discussed after the safety of all parties is assured. How does someone become suicidal? Thomas Joiner, PhD, a psychologist at Florida State University, developed a widely accepted model known as the “Interpersonal Psychological Theory of Suicide.” It proposes two prerequisites to a potentially lethal suicide attempt: (i) an extremely strong desire to die; and (ii) the capability for lethal self-harm. An intense desire for death arises in a strong belief that one is a burden
to others and/or the belief that one does not belong. The capability to try to take your life requires overcoming the instinct for self-preservation. This can occur through experiences that inure you to fear or pain. The lifestyle of most substance abusers offers many opportunities to meet Joiner’s prerequisites for a suicide attempt. The ability to fulfill personal responsibilities to others and meet even their minimal expectations is gradually lost and with it the support and meaning that interpersonal relationships provide. Most forms of substance abuse involve some degree of self-harm (e.g., IV drug use). Exposure to violence is a common. Suicidal ideation about intentional overdoses often plague substance abusers. Constantly thinking about such acts increases susceptibility to carrying them out. Some rehearse their suicide plan by holding a weapon, visiting a bridge, or walking by railroad tracks. This adds to capability. How does substance abuse drive suicide risk? Substance abuse is more than a risk factor. It is a facilitator of suicidal behavior. Alcohol and drug use worsen almost everything that should be minimized in a suicidal individual. They significantly enhance impulsivity, hopelessness, aggression, disinhibition, poor judgment, blunting of the senses, and pain tolerance. Problemsolving and coping skills are impaired as is understanding future consequences. All or nothing thinking tends to prevail. Most substance abusers already have multiple suicide risk factors such as male gender, serious legal issues, financial problems, unemployment, co-occurring mental illness, a history of trauma, and worsening physical health. Some of these may pre-date alcohol or drug use, but all are amplified by it. What are the signs of suicide risk? There is no standard presentation of emerging suicidality. Some early warning signs may include: • • • • • •
Talking about losing control or being trapped Withdrawal from family, friends, treatment, work, or school Anxiety, agitation, sleep problems Mood changes, anger, panic, pessimism Growing self-criticism Increasing use of alcohol or drugs
Some possible signs of rising risk are: • • • •
Escalating impulsivity, risky and negative behavior Indifference to favored activities or interests Being present-oriented and vague on future Giving away pets or valued possessions:
These are clearest indicators of possible imminent dangerousness: • Threats to severely injure or kill self • Looking for, acquiring, or having lethal means (e.g., gun, pills, poisons, etc.) • Voicing a specific suicide plan Family members should always opt to err on the side of caution when any signs are observed. What can family members do? Some preventive measures are supporting sobriety and recovery (the best buffers to suicidality), discarding or securing any Continued on page 46
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11/4/15 1:00 PM
Mal–FEE–Sance – BUYING POLITICAL INFLUENCE AND THE SECOND COMING OF THE AMERICAN OPIATE/OPIOID EPIDEMIC By John Giordano, DHL, MAC
David Jolly (U.S. Representative, Florida’s 13th congressional district) thought he was going to Washington to do the people’s work but quickly found out otherwise. He quickly learned that his highest priority as an elected official was to continue to get himself and others in his party elected. Upon arriving at the capital, Jolly was informed his job description changed to telemarketer. His responsibilities as such required him to spend 4 hours per day; 5 days a week along side other congressman calling small individual donors in a cramped, boiler room styled call-center filled with phones. That’s 20 hours a week, he and his colleagues spent dialing for dollars when they could have been writing bills and working on issues important to their constituencies. According to ‘The Hill’ Magazine, the 2016 presidential election could cost as much as $5 billion, more than double the 2012 campaign’s price tag. Some political pundits are predicting that the totals per presidential candidate might surpass $1.5 billion and go as high as $2 billion. By the end of 2015 the pharmaceutical industry ranked 15th as the most generous industry in terms of campaign contributions with no way of telling how much money PhRMA has given to the faceless super-pacs. Small individual donors are important to both parties, but getting over the hump is going to be difficult with only small contributions; leaving candidates with just one option – the flush pockets of big money donors such as the pharmaceutical industry and their super-pac dark money. The question of just how much influence powerful corporate interest money buys has been raised – but is yet to be answered. Self-funded Donald Trump claims he is the only Republican in the race not beholding to any special interest group. Senator Sanders has been attacking Secretary Clinton for what he infers as her indebtedness to big money supporters and ties to Wall Street. In their defense, Secretary Clinton along with the entire Republican field, sans Trump, all claim that money does not influence their vote. Should we, the addiction and its treatment community, be concerned about how much influence campaign contributions and political action committee (PAC) dark money buys? Perhaps a look at our recent history could give us an indication. It was in 1962 when President John F. Kennedy signed into law landmark legislation – Kefauver-Harris Amendments – that established the framework requiring drug manufacturers to prove scientifically that a medication was not only safe, but effective. The signing represented the culmination of years of political wrangling. This single piece of legislation gave the FDA the teeth they’d been sorely missing to effectively regulate drugs. But not everyone was happy with the legislation – especially the pharmaceutical industry. At about the same time of the Kefauver-Harris Amendments, a new trade group was formed: Pharmaceutical Research and Manufacturers of America (PhRMA). Their presence was felt at the FDA almost immediately. Dr. Herbert Leonard Ley, Jr. was a highly regarded physician and academic and appointed Commissioner of the Food and Drug Administration by President Lyndon B. Johnson on July 1, 1968. He served in that capacity for only a year and a half. Dr. Ley denied being fired, telling reporters he preferred the phrase “eased out.” In an interview with the New York Times after his resignation in December 1969, Dr. Ley warned the public about the FDA’s inability to safeguard Americans. He was critical of Congress, the Nixon Administration and the drug industry. Dr. Ley told the newspaper that the drug company lobbyists, combined with the politicians who worked on behalf of their patrons, could bring “tremendous pressure” to bear on him and his staff, to try preventing FDA restrictions on their drugs. Ley could not be any more concise than he was at the conclusion of his interview stating “the entire issue was about money, pure and simple.”
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The 70s brought even more scrutiny upon the fledging agency. Senator Ted Kennedy opened an investigation into charges by FDA employees which stated that “FDA was dominated by the pharmaceutical industry and was inadequately protecting the public against unsafe and ineffective new human and animal drugs.” After an internal investigation and an extensive probe by a review panel seated by the Department of Health, Education and Welfare (HEW) – renamed as the Department of Health and Human Services (HHS) – the allegations found to be unsubstantiated. Experts have said that the infusion of politics into the Commissionership is one reason for high turnover of FDA Commissioners in the 70s and 80s. In 1988 congress passed the Food and Drug Administration Act (1988 Act) and established the FDA as an agency of HHS. The FDA commissioner would be appointed by the President but was now required Senate confirmation. The 90s were summed up best by Sidney Wolfe, M.D. and Director of Public Citizen’s Health Research Group. In a FRONTLINE interview (2003) he stated: “The industry’s [pharmaceutical] influence has been allowed to grow considerably in the absence of congressional oversight. Up until 12 years ago [1991], whenever the FDA would make a mistake -- such as the series of mistakes they’ve made in the late 1990s -- there would be a congressional hearing. They would have to explain to the legislative branch of the government what went wrong. They would be -- properly, and in the best public health sense -- on the defensive to try and explain what went wrong. No one is there in the Congress [now]. There have been essentially one or two days of oversight hearings in 12 years, as opposed to maybe the previous 12 years with dozens and dozens of oversights. So they’re getting away with no congressional oversight.” Gene Haislip, the number three man at the DEA Office Of Diversion for seventeen years, made a similar disclosure after his retirement from the agency in 1997; “For a DEA official to put his or her neck on the line to block a company’s requested quota increase takes an awful lot of guts and a lot of hard work, particularly if that company is supporting members of Congress who have the power to block the agency’s funding.” It’s important to note that Dr. Wolfe’s and Mr. Haislip’s observations regarding the shift in congresses attitude towards the FDA – the lack of oversight – and the beginning of the FDA’s cozy relationship with PhRMA correlate chronologically with the The Prescription Continued on page 42
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WHAT DOES IT MEAN TO BE CODEPENDENT? By Riana Milne, MA
We have all heard the term “Codependency.” It can be simply defined as an excessive emotional or psychological reliance on a partner who requires support often due to an illness or addiction. It involves you making tons of sacrifices for your partner’s happiness, but not getting much back in return. One becomes dependent on approval from their partner for their identity and self-worth. You often feel as if you have “lost yourself” because your purpose and focus in life is on making sacrifices to satisfy your partner’s needs or difficult demands while at the same time, your energy and joy is zapped from your being. One or both partners depend on the other for their total fulfillment and usually one person is not self-sufficient. Some research suggests that those who were emotionally abused or neglected were more likely to become codependent because it became their norm to please and get love, attention and nurturing from a difficult parent. Codependent personalities are particularly vulnerable to the emotional manipulator and toxic personality types. Here are some warning signs that you may be in a toxic, codependent relationship: • You are aware of your partner’s toxic, unhealthy moodiness, poor choices or behaviors but still stay in the relationship. • You feel so frustrated; so you have an urge to control your partner when you see that their life, and then your own, has become unmanageable. • You feel if you can change your toxic partner to be a better person, the relationship would be fixed. • You over-do, over please, and indulge their needs beyond what is normal, often leading to you feeling burned-out or stressed and having little time for yourself. You have given up on your own goals and dreams. • You live in a constant, anxious state and have a desire for more independence but have trouble leaving your partner. • You avoid confronting any of their acting out behaviors like flirting or other disrespect, lateness, impulsive spending, or engaging in an addiction because you are just trying to keep the peace. • You have little life happiness or satisfaction outside of your partner. • You do all the work to maintain the relationship and prepare for dates/activities and feel unappreciated and resentful. • You get overly invested in your partner’s plans and goals and abandon or change your own to match theirs. • You blame, lecture or try to control your partner when you are disappointed or disagree with their choices. • You feel abandoned, unappreciated and angry when your partner leaves you unexpectedly. The dependent partner often rescues an addicted or acting out partner from responsibility by taking care of things. However, the ability to control is a delusion and you can’t love or do enough to make a toxic person want to change their destructive behaviors. They have to decide this for themselves. If, as a woman, you feel the need to “take care of your man,” and you become the strong, responsible “man of the family” or “a mother” to him, you will lose sexual attraction quickly. A codependent woman is overly attached to her “love object” and his problems. She worries excessively about him, feels emotionally dependent upon him, and focuses all her time and energy on him, leaving her physically, mentally and emotionally exhausted. This results in her loss of self-confidence and esteem, and her own power and purpose. Enabling is often a part of a codependent relationship and is a destructive form of helping. It is done to cover the actions of an addicted partner that helps them to avoid the responsibility and consequences of poor choices, and makes it easy for them to continue an addictive action. As you enable, you get angry
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over the lack of appreciation for your help and lack of time for yourself. Then your partner becomes angry at you for pointing out his incompetency. It is a horrendous, toxic cycle. You feel used, helpless, abused, depressed, anxious, neglected and outraged. It’s time to start focusing on yourself and get busy in your own life. Stop obsessing over what your partner thinks, feels or does. Remember, their actions don’t define who you are. And instead, do what you love that fulfills your passion in life. Call a Life and Relationship Coach who will help get “YOU” back, by increasing your confidence and self-esteem and launch you into a brand new way of thinking and being. Your new outgoing energy, confidence and enthusiasm in living a purpose-filled life you love will serve as your best attraction factor to finding the love you desire and deserve! Read more on this topic and others at www.RianaMilne.com and in her book, LOVE Beyond Your Dreams – Break Free of Toxic Relationships to Have the Love you Deserve. Riana Milne, MA, is a #1 Best Selling Author and Certified world-wide Relationship, Love & Life Coach, published author, motivational speaker, Licensed Mental Health Counselor and Cert Addictions Professional at Therapy by the Sea; Delray Beach, FL. Her free App: My Relationship Coach offers more articles and her books, LIVE Beyond Your Dreams – from Fear and Doubt to Personal Power, Purpose and Success, and LOVE Beyond Your Dreams – Break Free of Toxic Relationships to Have the Love You Deserve addresses relationships with yourself and others. To learn more about Riana’s Relationship, Life or Love Coaching programs or suggest a topic, go to Riana’s website, www.RianaMilne.com or email RianaMilne@gmail.com. Worldwide Coaching Phone: (201) 281-7887. Delray office: (561) 701-8277; Skype Coaching and FB: Coach Riana Milne.
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HEROIN EPIDEMIC IN AMERICA (Part 5) By Steven Kassels, M.D.
I hope you have enjoyed the first four articles in this five part series on who and what to blame for the heroin epidemic in America. More importantly, I hope that by better understanding how and why the opioid epidemic came to be, the solutions presented will be considered and assist in developing greater insight and activism to address this scourge to society. If you have missed any prior articles in the October – January editions of The Sober World Magazine, you can easily review them by going to www. thesoberworld.com and go under past issues. Mental Health Treatment or actually the lack thereof has contributed to the overall increase in illicit drug and alcohol use. It is well documented that patients with mental illness are still greatly underserved, and despite some positive movement to increase treatment funding and access, the drastic cuts from the distant and recent past have not been eliminated. NAMI, the National Alliance on Mental Illness, released the report “State Mental Health Cuts: A National Crisis” which documents the drastic cuts implemented by states between 2009 and 2011 for spending for children and adults living with serious mental illness. These cuts led to significant reductions in community and hospital based mental health services, with a direct effect also on access to psychiatric medications and crisis services. The Medicaid funding issue is a complex analysis, but there is no question that too many patients are left without viable treatment options. Also, in an article by the Pew Charitable Trusts, “Some States Retreat on Mental Health Funding”, Medicaid expansion “may also have persuaded some states to pull back funding for community mental health centers and other mental health initiatives, including school and substance abuse programs.” The lack of access is not limited to the Medicaid insured population, as many commercial insurers also do not cover mental health services in parity with medical and surgical illnesses. In addition to private insurance companies not abiding by parity laws, the federal and state governments, who are responsible for overseeing compliance, apparently are not doing a good job. Despite laws, mental health coverage often falls short. It was also reported that “NAMI found that patients seeking mental health services from private insurers were denied coverage at a rate double than those seeking medical services … [and] patients encountered more barriers in getting psychiatric and substance use medications.” Enough with the statistics! How does this lead to the heroin epidemic? Simply stated, patients with mental illness are no different than patients with a wide variety of complaints – they all want to feel better. However, when there are roadblocks related to funding and access to treatment and medication for psychiatric illnesses, patients look elsewhere to feel better. It is a well-known phenomenon that patients who cannot access care are more likely to self-medicate. So it should not surprise us that patients with depression, anxiety, bipolar illness and other psychiatric health issues reach for drugs that make them feel better: alcohol, stimulants such as cocaine, and opioids such as OxyContin or heroin are commonly used. So we have now exposed another cause leading to the heroin/opioid crisis; but let’s focus on another solution. Federal and State Governments must enforce parity laws and we must increase access and funding for mental illness. As they say in the Midas commercial,
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“You can pay now or you can pay later, but you are going to pay.” Inadequate mental health treatment leads to substance use, crime, dysfunctional family dynamics and an overall increase in financial costs to society. This now brings us to the final reason for the heroin/opioid epidemic - and what a way to end – by blaming our politicians and other public officials. Why? - Because if all our public officials showed the leadership and courage of Vermont Governor Shumlin, we would be further along in implementing solutions to curb the heroin epidemic. Governor Shumlin spent his entire State of the State address on the heroin/opioid crisis in bucolic Vermont and in doing so, risked his political career on exposing the issue for what it is - with no sugar coating, no minimizing, and no blaming – just good old fashioned straight talk! ! Here is a brief excerpt from Governor Shumlin’s 2014 State of the State Address: The crisis I am talking about is the rising tide of drug addiction and drug-related crime spreading across Vermont. In every corner of our state, heroin and opiate drug addiction threatens us. It threatens the safety that has always blessed our state. It is a crisis bubbling just beneath the surface that may be invisible to many, but is already highly visible to law enforcement, medical personnel, social service and addiction treatment providers, and too many Vermont families. It requires all of us to take action before the quality of life that we cherish so much is compromised. We must cut back on the demand to stand a chance of limiting the damage. Lives and dollars are at stake and it is time to lead the charge to educate through scientific fact and not out of fear. I commend Governor Shumlin for his call to attack the epidemic on the demand side (treatment); recognizing that putting more people in jail may make us feel safe on the short term, but does not solve the problem. Although Governor LePage of Maine has also addressed the issue of drug addiction as an economic issue, he unfortunately does not advocate for increased funding for treatment and access to care, but instead only for expanded law enforcement and judicial response. As the death of the likes of Philip Seymour Hoffman reinforces, drug addiction, including heroin dependency, is an equal opportunity disease affecting all socioeconomic strata; and knows no boundaries. This is not a problem of the welfare state or the poor or less fortunate. The disease is present in our impoverished neighborhoods as well as our wealthy suburban communities and in our resort towns and backwoods. Establishing treatment centers for addiction in one’s own locale should be worn as a badge of honor, no different than establishing a cancer treatment center or cardiac center; both of which are illnesses that may be related to the disease of addiction. NIMBY (Not in My Back Yard) no longer works! As I stated in an Op-Ed in the Boston Globe, “The Scourge of Heroin Addiction” There should be just as many public service announcements about addiction as there are Viagra and Cialis commercials. In addition, expansion of addiction treatment services in jails would help to mitigate much of the revolving door phenomenon. Furthermore, we should demand that our medical schools and hospitals improve addiction training of our physicians. While there is plenty of blame to go around, let’s focus on the solutions. The Continued on page 44
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THE SEARCH FOR CONNECTION: ADDICTION AND ADOPTION By Brennon Moore, MS, LPC, CTT, CADC-II
“The first and foremost instinct of humans is neither sex nor aggression. It is to connect (Johnson, 2013)”. Attachment is all about regulation. Many years ago John Bowlby recognized this groundbreaking truth in his theories on attachment, and now modern clinicians alike understand that for human beings, the easiest way to regulate ones mood is to turn to another person. I want you, the reader, to do a little exercise to illustrate this point first hand: Take a couple minutes to bring to mind the most distressing situation you’ve experienced in the last two weeks. Really allow a picture, or scene, to develop in your imagination. Notice the impact this has on your present state of being. Perhaps you feel a tightening in your chest, or a pit in your stomach just thinking about the situation? Now bring to mind someone you feel supported by- someone you feel safe with. Really see this person; perhaps a memory of this individual supporting you manifests in your minds-eye. What happens to that distress? For most who do this simple little exercise, the negative emotions associated with the distressful situation will either disappear or dissipate significantly (Please continue to utilize this tool!) However, for many individuals struggling with addiction, they never had a supportive person that made them feel safe, or they experienced such extreme betrayal as children that it simply became too dangerous to be vulnerable and trust. Furthermore, their addictive and self-destructive behaviors certainly did not facilitate the development of healthy and intimate attachments with self, or others. Thus, for many addicted men and women, alcohol, sex, self-injury, food, danger/adrenaline seeking, technology, and drugs become desperate substitutes for people, and for connection. What happens when an individual’s earliest memories are of them feeling like they just don’t quite fit in; that they don’t belong? These are often the feelings that many adopted clients I work with experience: That despite the quality of family that adopted them, they always felt like they were on the outside looking in. Like they were apart from, not a part of. I remember one poignant and very sad recollection a client shared with me, where upon looking up at his hand clasped by his different race, adopted parent, he was suddenly struck with the thought, “who am I?” At just 4-years old, he was hit by a deep sense of confusion and loss that fueled much of his addictive behaviors as he desperately searched for connection in all the wrong places. I have worked with numerous adopted addicts, and when I was asked to write an article on this subject I immediately recalled the following quote from a former client which demonstrates the dissonance so many adopted individuals face: “My parents are great- in fact I couldn’t have asked for two better people to have adopted me, but the thing about being adopted is that regardless of how you slice it, my story began with two people- my parentsgiving up on me... After looking into my bio-parents I know that it was for the best, intellectually at least... but it still really hurts.” This is a common sentiment expressed by many adopted clients I work with. Rarely are their adoptive families unhealthy, and usually they are adopted by parents who desperately wanted children, were well read on all the latest parenting books, and were provided loving homes. One of the struggles when working with adopted clients is that I cannot sit down and do a detailed family history and look for patterns of addiction and mental illness: In many cases I am going in blind. Therefore, I am not saying that adopted individuals inherently struggle, or that this is the case for all. However, what is a common theme with the adopted addicts I work with is that despite the quality of adoptive parents that entered into their lives, they still felt a deep hole within. They felt like they were missing a connection, missing a place in the world, and missing a tribe that not even the most motivated of adoptive parents could provide.
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In her amazing book (which I have all my adopted clients read), “The Primal Wound”, Nancy Verrier (2003) illustrates this point further: “An infant or child can certainly attach to another caregiver, but the quality of that attachment may be different from that with the first mother, and bonding may be difficult or, as many adoptees have told me, impossible (page 19).” My goal when working with adopted addicts is to help them rebuild attachment and connection. Family therapy is essential, as one of the issues was feeling like they didn’t belong. When I can help facilitate a shared experience in therapy, it can become the foundation for a new and beautiful connection. When I can get the family to engage not just in therapy, but their own recovery process in programs such as Al-Anon, it becomes a journey they walk alongside their loved one! It sends a message to the wounded little girl, or boy, that this family isn’t going anywhere. Additionally, one of the most beautiful aspects of recovery is that adopted individuals get to find that new tribe they have been looking for. They get to find a band of brothers and sisters that share similar stories. They begin to feel connection and love, and this experience is something they can take with them into every aspect of their lives. By leveraging this newfound connection with their family and recovery community, they begin to develop those intimate relationships that help them be strong. They begin to find meaning not in spite of their story, but because of it! That basic need to be seen and understood is realized, and they no longer need to seek it in their addiction. Brennon Moore has a master’s degree in Mental Health Counseling and is a Licensed Professional Counselor (LPC). Brennon is a Certified Alcohol and Drug Counselor (CADC-II), a Nationally Certified Trauma Therapist (CTT), and is trained in EMDR and Peter Levine’s Somatic Experiencing. Brennon joined the clinical team at The Refuge-A Healing Place in 2011 and shortly thereafter started a group specializing in childhood sexual trauma and addiction. Currently, Brennon leads groups, co-facilitates trauma intensives and trauma therapy trainings as well as speaking and educating on the topics of trauma, attachment and addiction all over the country, and has a book set to be released in the summer, 2016. He may be contacted at bmoore@therefuge-ahealingplace.com. References available Upon Request
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WHEN IT GOES BEYOND BEING TIRED… By Darlene Silvernail, Ph.D, LMHC, CAP
March is National Chronic Fatigue Awareness Month. As practitioners, it is important for us to be aware of the symptoms of chronic fatigue, as they may sometimes mirror symptoms of depression or other mental health disorders with low mood or affect. Additionally, many patients who suffer with chronic fatigue may have been told that their illness is psychosomatic or that they’re not feeling what they say they’re feeling. Unfortunately, chronic fatigue is still an illness that is not well understood. Chronic Fatigue Syndrome (CFS) is recognized as a medical illness. People that suffer with chronic fatigue experience symptoms of extreme fatigue that lasts longer than six months and often becomes worse after physical or mental exertion and which seems to have no other medical explanation. In order to meet diagnostic criteria for CFS, symptoms must significantly impact the individual’s ability to perform daily activities or work and they must also experience at least four of the following: • • • • • • • •
Post-exertion malaise lasting more than 24 hours Unrefreshing sleep Significant impairment of short-term memory or concentration Muscle pain Pain in the joints without swelling or redness Headaches of a new type, pattern, or severity Tender lymph nodes in the neck or armpit Frequently recurring sore throat
In addition to the diagnostic criteria listed above, according to the CDC, chronic fatigue patients often report a host of other symptoms, including irritable bowel, depression or other psychological illnesses, chills, night sweats, visual disturbances, brain fog, difficulty maintaining an upright position, dizziness,
balance problems, fainting, allergies or sensitivities to food, odors, chemicals, medications, or noise. While researchers still do not understand what causes CFS, they have found that it typically begins following some sort of trigger; this may be an infection, immune system dysfunction, hypotension, nutritional deficiency, or prolonged stress. There is also no specific treatment for CFS; practitioners currently take the approach of managing specific symptoms and treatment often fluctuates over time. As mental health workers we know that we often experience secondary trauma, that is, our bodies react to and store trauma messages we hear from clients. This is another reason it is so important to practice good self-care as a mental health worker. We must also recognize that failing to do so could result in burn out and fatigue. There are excellent resources on compassion fatigue at the Compassion Fatigue Awareness website www. compassionfatigue.org. If you are experiencing symptoms including preoccupation, difficulty concentrating, sadness, mental and physical malaise, chronic physical ailments, or poor self-care you may be experiencing compassion fatigue. It may be difficult to admit that we are experiencing compassion fatigue and difficult to ask for help, but recovery is possible and it begins with honest appraisal and loving self-care. So take care of you, and you will be the best practitioner that you can be. Darlene Silvernail is the Clinical Supervisor at Total Recovery Now in Lake Worth, Florida. She is also President of the FMHCA. References Provided Upon Request
THE MOUTH BODY CONNECTION For many years healthcare professionals (physicians and dentists) treated the mouth and the rest of the body as two separate entities. However, over the past 25 years endless science continues to surface proving that diseases and conditions of the mouth are directly linked to many of the medical conditions of the body. By seeing your Dentist/Hygienist at least twice a year for cleanings will help reduce plaque build-up along with the dangerous bacteria which depend on that plaque for survival. Bleeding gums, or gingivitis, is never normal, and allows the entry of bacteria into the bloodstream where they settle in various organs causing inflammation. Prolonged and repeated bouts of inflammation lead to diseases in these organs. Other diseases, such as Crohn’s disease, Anemia and HIV, can present initially with oral manifestations such as ulcers and swellings. Many times, systemic diseases are first identified by Dentists and confirmed after a recommended visit to the patient’s physician. Furthermore, chronic conditions are exacerbated by the inflammation caused by aggressive oral bacteria; making management of the condition difficult. For example, patients with diabetes and periodontal disease have a higher incidence of both uncontrolled blood sugar and complications associated with the diabetes. By successfully maintaining a healthy oral environment through professional dental maintenance and home care, you will reduce the bacteria in your mouth, therefore, reducing the adverse effects on the body. Here are just a few conditions that have studies proving a definitive oral-systemic connection: • Cardiovascular Disease - Heart Attacks and Stroke • Dementia • Erectile Dysfunction • Pancreatic Cancer • Diabetes • Autoimmune Diseases (e.g. Lupus, HIV) So remember, it’s more than just a “tooth cleaning.” A visit to the dentist can save your life.
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INTEGRATIVE SUBSTANCE ABUSE TREATMENT By Jay Faber, MD
Several months ago, I took one of my quarterly weekend vacations to relieve my level of stress. On this trip, I decided to stay at one of my favorite hotels in Los Angeles. While reading, I started hearing some bothersome buzzing noises from my 5th floor room. At first, I thought it may have been the air-conditioning misbehaving from another residence. However, the noise never went off and it sounded as if it was coming from outside. Subsequently, I decided to figure out what was making this obnoxious sound. I went to the window and wondered if I could find the source. While appreciating the Sunset Boulevard view, I suddenly saw a white fast moving object go right past my window. “What was that?” I thought. “Was it a bird? Was it a paper object that was blowing swiftly in the wind?” It was moving way too fast for my mind to logistically register. Suddenly, the fast moving object went by my window again. This time I pinpointed it and was able to label it. For the first time, I observed a 4-propeller drone flying at a very rapid pace between my hotel and another luxury residence across the street. As I hypnotically gazed at this fast moving machine, I was awestruck by the fact that it was flying up to levels at least 20 stories high. Wow! These machines were not even existing 2 years ago. No one could even get their hands on something like this. Now, all I had to do was go down to a local hobby store, pick one up and start flying. Over the last 10 years, our culture increasingly has become even more digitized with electronic machinery. Notably, our mobile phones have actually now become small portable computers. These nifty devices can quickly locate great restaurants, indicate memorable places to visit, and play our latest hit songs. Not only that, this micro circuitry takes portraits with greater clarity, brilliance, and speed than any camera 25 years ago. These cameras are just not in cellular phones! They have exponentially multiplied. Moreover, they are located everywhere. These small inexpensive devices are located on street lights, garages, hallways and elevators taking consistent video of how we behave, what we say, and how we appear. Never before in history has there been such an availability of constant real-time play back on what people are really doing. As a result of these changes, the world has become a more transparent and vulnerable place to live. Behaviors, actions, and utterances that were once thought to be more private have the possibility of becoming personalized public nuisances. As famed rock singer “Sting” so poignantly sings in “Every Breath You Take”: Every breath you take and every move you make Every bond you break, every step you take, I’ll be watching you Every single day and every word you say Every game you play, every night you stay, I’ll be watching you -Sting What was initially meant to be a romantic song about a passionate pursuer of his long desired love has now become a paranoid ballad of what can happen when people are watched, evaluated, and sadly judged by the cold sterile technocratic creations of the 21st century. For the substance abuser, this new world has become increasingly difficult. Those who have been connoisseurs of denial, rationalization, and minimization are no longer able to hide. In fact, they stick out…like a sore thumb. How so? Socially, significant others are more apt to find glaring inconsistencies in alleged alibis from accessible “selfies” about where one spent their time on Friday night. Legally, the entire world can discover charges including DUI’s, public intoxication, disorderly conduct, and other mischievous behaviors quickly on the Internet for approximately $25 per request. Occupationally, one’s ability to hide locations of leisure can quickly be deciphered by looking at the
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location finder on a cellular phone. Just as Kodak painfully discovered that the digitized world has no longer accepted traditional film pictures, so, too, has the substance abuser poignantly been exposed. It’s harder to fabricate. It is more difficult to deceive. It is more challenging to manipulate. In essence, the substance abuser’s ability to change the reality of stories just plain outright does not work. Although the substance abuser may not like this new reality, there are many opportunities that can be gleaned from our advancing technologized culture. Because anonymity has markedly eroded, we are now challenged to become more genuine, authentic, and credible. We are forced to make sure that the heart, our head, and behaviors are synchronously aligned. We are pulled to become greater people, with higher values, who strive for more noble causes. If he/she so chooses, the substance abuser now has an opportunity to take advantage of some other new exciting breakthrough advancements. These technologies give a better understanding of how the human brain functions and what can be done to genuinely optimize its function. Through these scientific developments, there is great hope to enhance the brain’s ability to think more clearly, feel happier, and behave more constructively. Given this reality, would it not make sense for the substance abuser to learn ways to optimize their brain function such that they are content the majority of the time without the use of artificial substances? Would it not make sense for those addicted to learn how to think more effectively such that they make wise choices that optimize their chances for success? Would it not next make sense for those painfully trapped to enhance brain physiology such that they can make great choices to avert future legal disasters? So what exactly are these cutting edge technologies? Currently, I utilize some of them at the Amen Clinic in Costa Mesa, Ca. At our clinic, we use SPECT Scans, that measure blood flow, and Quantitative EEGs, that measures cortical electricity, to better understand the brain’s overall functioning. These tools help us understand where the brain may be overworking, underworking, and functioning appropriately. With these tools, we scientifically assess regions of the brain frontal lobes, temporal lobes, thalamus, anterior cingulate cortex, and other neuro-anatomic areas. Through that assessment, we are able to get a unique profile on that individual’s brain and how it is working. Through this personalized approach, we are then able to have a collaborative discussion with the substance abuser about Continued on page 42
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11/2/15 11:21 AM
ADDICTION TREATMENT THE PAST, THE PRESENT AND THE FUTURE By Jacob Levenson
In 1935, two men, one a New York stockbroker, the other an Ohio surgeon, and both alcoholics, met and discussed their battles with addiction. From that meeting a spark was ignited and Alcoholics Anonymous (AA) began. That same year aversive conditioning sanatoriums opened to treat individuals suffering from addiction and the beginning of federal involvement in addiction research and addiction treatment began. As we consider the past, present and future of addiction treatment we can appreciate how far the field has come and understand how far it has to go. The Past America has a long history of treating addiction as a moral failing, believing it to be a weakness of character rather than an illness of the brain. Despite an early assertion in 1935 by Bill W. (the New York stockbroker and founder of AA), that addiction was a malady of mind, emotion and body, the collective response to treating addiction tended toward punitive measures as a method to correct bad behavior. As addiction began to be further understood and treated as an illness, the model of treatment mirrored other illness treatments with a standard vertical methodology – a one directional hierarchy of care that began with a diagnosis from a physician and a subsequent directive of treatment. Recovery support was a notion that meant attending support groups or abstinence-based meetings rather than a professionally structured system of care. The Present According to a recent Omnibus poll, 72% of Americans see addiction as a disease to be treated as a health issue and not with punishment or punitive measures. Well-respected organizations such as the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Service Administration (SAMHSA), define addiction as a chronic disease of the brain that requires treatment. It is understood by addiction treatment providers that a symptom of the disease of addiction is relapse, also known as a return to lifestyle, and behavioral issues are to be expected with the brain-altering illness. With the advancements in understanding as to how the disease affects the brain, the standard medical, or vertical, model of treatment is beginning to be replaced with the more progressive behavioral health, or horizontal, model of treatment. This horizontal approach is by definition, more inclusive and multi-directional in its scope. Rather than a general diagnosis resulting in the same treatment regimen, a diagnosis is met with an open dialog that considers the specific disease state, socio-economic status and a wide range of other factors effecting disease management. Post-treatment recovery support is no longer viewed as a pleasant notion for an addict to pursue but rather a substantiated professional service recognized and proven to be a significant element in successfully achieving and maintaining long-term recovery. While addiction treatment today is a vast improvement from its beginning, there is much progress to be made. When comparing the treatment of addiction to other chronic illnesses we see a marked difference. The relative lack of outcomes data is one pronounced difference. For example, when an individual is diagnosed with cancer, the patient and physician have empirical data (treatment success rates) to rely upon in order to determine the best treatment path. An individual diagnosed with addiction however, has not historically had similar outcomes data in which to base a treatment decision. This results in a tri-fold quagmire: (1) Patients and physicians do not have solid treatment success rates in which to base their decision as to the best-suited treatment for their illness, (2) Health insurance payers do not have the predictability of treatment success as they are accustomed in other forms of chronic disease management and, (3) addiction treatment providers experience an uncertainty in their revenue streams – when a provider is unable to demonstrate their
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success rates, they cannot distinguish themselves or their quality and effectiveness of treatment. The pendulum has begun to swing and increasingly the public, medical community and, in some cases, the correctional system, has accepted that addiction is a disease which results in sick individuals, not necessarily bad individuals. Interestingly, because our healthcare system has evolved to the expectations of demonstrated success rates, a new brand of addiction treatment has begun to elicit attention, resources and most recently, significant funding. Medical Assisted Treatment (MAT) is the provision of medical therapy (pharmaceuticals) in conjunction with behavioral therapy (counseling and recovery support) to individuals working to overcome addiction. This newly evolving form of treatment, despite its recent arrival to the field of behavioral health, has begun to demonstrate an advantage over traditional, abstinencebased treatments. MAT providers have, from the onset, measured and tracked their rates of treatment success which appeals to payers and consumers. While still in its relative infancy, this form of addiction treatment has recently gained the attention of the Obama Administration in the form of a $1.1 billion initiative to combat the addiction epidemic currently ravaging the nation. Clearly, the message from Washington is MAT is synonymous with effective treatment. The Future We will see MAT leave an impression on the field and it has yet to be discovered how successful this form of addiction treatment will be. What we know without question is that providers who collect long-term outcomes data to measure and demonstrate their rates of success will distinguish themselves in the field. In the future only those providers who embrace this practice will see their operations blossom into thriving, predictive models of care wherein payers reimburse for treatment, the standard in every other form of chronic disease management. Recovery support will evolve to a telehealth provision. This vital posttreatment support, by way of audio-visual technology, will be provided to every patient who completes treatment. Because telehealth is not limited to state lines or boundaries, providers will effectively maintain a connection with their discharged patients and be reimbursed for post-treatment services they provide. We will see addiction treatment facilities with telehealth divisions demonstrate their long-term recovery success rates and recidivism rates will decline. Consumers will make informed decisions as to the best suited treatment for their particular illness by relying on empirical data. The future will consist of addiction treatment based on a horizontal model of treatment, one which maximizes the continuum of care. Value-based, pay-for-performance contracting between provider and payer will be standard. Ultimately, due to the expansive and limitless capabilities of telehealth, providers will reach more individuals, the addiction epidemic will begin to decline and millions of Americans effected by this chronic disease will begin to see relief. Since the 1970’s, cancer survival rates in our country have doubled. The field of addiction treatment will begin to experience a similar phenomenon. For providers who embrace advancements in technology and outcomes data collection, the future will consist of the successful dismantling of addiction. And addiction? In the future, it will no longer be an epidemic. Jacob Levenson founded Austin-based MAP Health Management, LLC in 2011 and has served as Chief Executive Officer since its inception. MAP is a provider of comprehensive outcome data, aftercare programs and revenue cycle management to addiction treatment providers across the country. Levenson passionately architects and deploys data-based solutions and healthcare services that empower patients by mitigating potential relapse, increasing predictability for insurance payers and overall outcomes for treatment providers. For more information, visit www.ThisIsMap.com.
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ASI specializes in coordinating treatment alternatives to jail time for those facing alcohol or drug related charges in the court system. ASI is affiliated with a network of treatment centers and licensed attorneys who are qualified and experienced in defending alcohol and drug related charges. For those who are not covered by health insurance for Substance Abuse Treatment, we offer rehab alternatives at a rate substantially discounted from what the treatment centers will normally charge you. Call for a FREE consultation WE PROVIDE: Myles B. Schlam,J.D.,CAP/CCJAP • Interventions • Drug Evaluations CEO, Advocare Solutions,Inc • Drug Charges * • DUI’s * 954-804-6888 • Expert Testimony mschlam@drugtreatmentpro.com • Marchman Acts * www.drugtreatmentpro.com • Criminal Record Expungement *All clients with legal cases will be represented by one of ASI’s licensed network attorneys
WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? Sunset House is currently classified as a level 4 transitional care house, according to the Department of Children and Families criteria regarding such programs. This includes providing 24 hour paid staff coverage seven days per week, requires counseling staff to never have a caseload of more than 15 participating clients. Sunset House maintains this licensure by conducting three group therapy sessions per week as well as one individual counseling session per week with qualified staff. Sunset House provides all of the above mentioned services for $300.00 per week. This also includes a bi-monthly psychiatric session with Dr. William Romanos for medication management. Sunset House continues to be a leader in affordable long term care and has been providing exemplary treatment in the Palm Beach County community for over 18 years. As a Level 4 facility Sunset House is appropriate for persons who have completed other levels of residential treatment, particularly levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the world of work, education, and family life. In conjunction with DCF, Sunset House also maintains The American Society of Addiction Medicine or ASAM criteria. This professional society aims to promote the appropriate role of a facility or physician in the care of patients with a substance use disorder. ASAM was created in 1988 and is an approved and accepted model by The American Medical Association and looks to monitor placement criteria so that patients are not placed in a level of care that does not meet the needs of their specific diagnosis, in essence protecting the patients with the sole ethical aim to do no harm.
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DECORATE THE HALLWAY: MAKING THE MOST OF EACH MOMENT IN RECOVERY By Rabbi Jenny Skylark Kuvin, JD, RMT
They say, “When one door closes another one opens… but the hallway in between stinks.” It doesn’t have to. In fact, the hallway or the time in between major decisions and moments can be some of the most joyous and peaceful times of your recovery if you allow them to be. Most of us waste a lot of time obsessing and worrying about the future. If you spend all of your time waiting for the next big thing to happen you will miss the moment now. “This is the day the Lord has made rejoice and be glad.” Psalm 118:24 Each day is a gift. Use the time in between major moments to do things to nurture and love yourself. As everything is happening for you and not to you, these moments in between major shifts and changes are placed carefully and strategically to allow you to grow internally in strength and self-esteem. Here are a few suggestions of things you can do after one door closes and before another one opens while in the hallway: 1. Journal 2. Meditate 3. Spend time with people you love. 4. Spend time in nature 5. Learn to bake 6. Garden 7. Volunteer 8. De-clutter and Donate 9. Read 10. Rest
Maximizing these moments by exposing yourself to new experiences, new people, new ideas, and new sensations expands your mind, making you more ready for the open door when it appears. Perhaps a door you would not have recognized before. The door will open soon, as the universe is always bringing us new opportunities when we are ready. So for now, enjoy the hallway, decorate it, put some purple shag carpet, a lounge chair, and cool sounds on the headphones...chill...new doors will open soon, but this moment will never return again...so enjoy it...It is your gift! Rabbi jenny Skylark Kuvin is the host of The Rabbi Jenny Show on 1470am and iheart radio. She is the author and creator of AHAVATAR: Awakening the Divine Within, The Heroic, Visionary and Healer Therapeutic Model. She is also the Executive Director at Epiphany Resources Treatment Center www.rabbijenny.tv
SUNDAY MORNINGS, MY FAVORITE TIME OF THE WEEK By P.D. Alleva, MSW
Never, to not have control again! We have to be aware of the beast that is quietly doing pushups in a dark corner, waiting for that time of weakness to unscrew our skull caps and drop little daemons of anger and hate inside our minds. No food for the beast, surround myself with positives so unique they become real before your eyes and transform the minions running amok in the brain into guiding lights so bright the world has to take notice. Sunday Mornings, it’s where the heart has no end.
How I love my Sunday Mornings. The quiet feel of serenity fills the air with a calm excitement for a time of processing, collecting, and recollecting. Time to plan and quiet the mind in the company of true friendship, companionship and comradery. Time sinks deeper and deeper into something that becomes a part of who you are at a time where your confident in who you’ve become. Sunday Mornings are where I found my heart again. Unwinding from the chaos of our lives that unfolds like a ball of twine, bringing the mind to clarity as our gripes float away into the rising sun. I used to dread the coming of the dawn and hated watching sunlight appear through the window when I still could not fall asleep. Sunday mornings used to be horrific and chaotic, my mind racing like sandpaper scraped against the brain. I used to crawl into a hole trying to escape my thoughts.
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Taking a quiet moment to sit in the stillness of the morning it seems these are the times when worlds can be created and alliances towards a simple mission begins with the fury of passion to search and find peace of mind in a slow steady breath, in through the nose, out across the lips and understand that all is well, all is extraordinary, and know that the future is yours to make with no boundaries, neither physical nor metaphysical, to halt evolution. Everybody needs the light! Appreciative and grateful for those still sleeping not too far away, within reach of your arm, their breath so precious you feel how much the God truly loves you. So sorry for those who turn a blind eye to ‘just being,’ and fill the mind with junk and drama completely insignificant to the bigger picture, where opportunity seeks those yearning to be free of boundaries created with the intention of control. I chose to break free a long time ago, but why? Because there was more to me than was showing, so much more way down Continued on page 44
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STOP BEING TREATED LIKE A VICTIM. Epiphany Resources refuses to treat clients as victims, instead we help them to contextualize their addictive past. We train, teach and prepare our clients for their recovered future.
At Epiphany Resources, our program’s emphasis eliminates the “Victim Mindset” and replaces it with the “Hero Mentality.” Through the use of narrative exercises and creative exploration, we assist clients in re-visualizing their personal journeys in a positive framework, thus allowing them to move forward in control of their futures.
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LIVING BEYOND
A Monthly Column By Dr. Asa Don Brown
BULLYING MAYBE A CATALYST FOR ADDICTION
• Avoid jokes that are at the emotional expense of your child or others • Teach your children not to be a bystander. Encourage them to “Never be bullied into silence. Never allow yourself to be made a advocate for others. victim. Accept no one’s definition of your life, but define yourself.” ~ Harvey Fierstein • Prevent an atmosphere of bullying within your own home! (E.g. physical assaults or discipline, yelling, belittling, trivializing, minimizing, A victim of bullying never wakes up with a desire to be bullied; a downgrading, sneering, or running down your child or others). yearning to be disparaged; or a longing to be humiliated, belittled or trivialized. Recent research has shown that children who are bullied • Be certain to have conversations about bullying. • Schools and administrators should be encouraged to support have a greater probability of seeking out addictive substances, comprehensive bully prevention programs. alcohol, and a number of other addictive habits. Moreover, bullied • Be aware of children who may be bullied within their home. children have greater likelihood of at-risk behaviors, depressive Inform the proper authority. features, suicidal ideation, and delinquency. “(While) the specific • As a parent or caregiver, be a facilitator of kindness, acceptance, rate of bullying victimization and perpetration varies according to and respect. age, type of bullying, time period over which bullying behaviors are assessed, and by subgroup. Younger (middle school-aged) children • Always, always, always be a positive example, role model, and advocate of your child. are more likely to be involved in bullying than high school-aged children.” (Hertz, et. al., 2013) While there are a number of reasons and causations for the development of Bullying has a significant effect upon the physical and psychological addictive behaviors; preventing or curtailing bullying behaviors may prevent someone from becoming an addict. health and wellbeing of the individual. The longitudinal effects of bullying can last a lifetime. “A new study shows how our bodies May you begin living beyond. react in similar ways to the stress of bullying as they do to an Author: Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. infection.” The seriousness of bullying leaves an emotional and Website: www.asadonbrown.com psychological imprint upon the psyche of the individual. Thus, References Provided Upon Request leaving many children with feelings of hopelessness, despair, distrust, anguish and melancholy. The ramifications of bullying does not always occur face-to-face, nor does bullying only occur to those who are “fameless” or nameless. In 2014, Zelda Williams, the daughter of the late Robin William’s felt compelled to step away from social media because of cyber-social-bullying stemming from her father’s untimely departure. Fortunately, following her brief hiatus, Zelda returned to the social media scene with a desire to denounce the cyber-bullies. PARENTS’ AND CAREGIVERS ROLES IN BULLYING PREVENTION What can parents and caregivers do to help prevent or redirect the effects of bullying? As parents and caregivers, consider the following questions when discussing bullying with your children: • Have you taught your child the value of self-approval and selfacceptance? • As parents, we must teach our child to look at the overall purpose and intent of their precious lives? • Have you taught your child not to rely upon others for admiration, acceptance and approval? • Have you taught your child to have an ingrained attitude of approval, acceptance, and self-worth? • Have you taught your child to look beyond the projected words or deeds of others? “In the end, we will remember not the words of our enemies, but the silence of our friends” ~ Martin Luther King, Jr. PREVENTING BULLYING 101 • Be an informed parent or caregiver • Be an active participant of your child’s life (discuss school, peers, and activities). • Always make your familial environment a safe and inviting place. • Always allow for healthy and open communication • Actively listen, even if you disagree, promote healthy conversations
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NO MAN IS AN ISLAND By Maxim W. Furek, MA, CADC, ICADC
John Donne’s (1572-1631) quotation, “No Man is an island,” appeared in Devotions upon emergent occasions and seuerall steps in my sicknes - Meditation XVII, 1624. That verbally ponderous, yet sage, reference proclaimed: “All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; and every chapter must be so translated... As therefore the bell that rings to a sermon, calls not upon the preacher only, but upon the congregation to come: so this bell calls us all: but how much more me, who am brought so near the door by this sickness.... “No man is an island, entire of itself...any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” Although Donne was a practicing Christian, his concept of connection, that communion with fellow man, is shared by other religions, principally Buddhism. Connection is key. While people gathered in a group may provoke conflict, that same environment often provides valuable support systems and potential help. It offers a sense of connection, one of the most important of human needs. We are social creatures. It is as much a part of our DNA as survival and procreation. For the majority of us, true happiness and fulfillment result from being surrounded by friends, associates, family, or an extended family structure, individuals with whom one can socialize and communicate with. People need people. That belief is universally accepted and shared by others. It has become the gold standard. “People who need people, are the luckiest people in the world,” sang Barbara Streisand in 1964. The song, from the Broadway musical Funny Girl, resonated with a public who identified themselves as “the luckiest people in the world.” The song quickly became Streisand’s first major pop hit, peaking at #5, as it musically affirmed what many of us already knew. Everyone seems to have an opinion on the topic. H.A.L.T. is often articulated by Friends of Bill W. and those who frequent the rooms of Alcoholics Anonymous. H.A.L.T. is a self-help acronym that teaches, Don’t allow yourself to get too hungry, angry, lonely or tired. As the Grapevine publication instructs, “Don’t get too lonely. Nonalcoholic members of the psychiatric profession tend to equate loneliness with boredom, and we are inclined to agree. If there is any one thing that must be included in the alcoholic’s life before he can once again become a whole man it is worthwhile activity. This may be Twelfth Step work, his vocation, his avocation, or anything else. But we feel such activity must be present in order to fulfill his existence and eliminate loneliness. We must also consider the loneliness brought about because the newcomer lives alone. But this is easily rectified. It takes only a phone call or a visit to an AA-oriented social club. Or, for the AA Loner, or other members, the Big Book or a letter to an AA pen pal may suffice. Under any conditions, Loneliness is the mother of self-pity and the ultimate end is resentment and drinking. The rule of Thumb? Do something.” Loneliness is a curse. There are few who can live in solitude, alone and detached from fellow man. Human beings do better when they interact with one another. Those who are isolated and devoid of human interaction may stagnate and suffer from emotional insecurity and self-doubt; their existence a bleak and unfulfilled life. Marano points out that, “a lack of close friends and a dearth of broader social contact generally bring the emotional discomfort or distress known as loneliness. It begins with an awareness of a deficiency of relationships. This cognitive awareness plays through our brain with an emotional soundtrack. It makes us sad. We might feel emptiness. We may be
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filled with a longing for contact. We feel isolated, distanced from others and deprived. These feelings tear away at our emotional well-being.” There are exceptions to the rule. Consider the grouping of ascetics, monks, and holy men who chant, pray and meditate in silence. They converse only with their God, reaching exquisite states of ecstasy. St. Teresa of Ávila distinguished four stages of mystical prayer. St. Teresa described this Roman Catholic mystical experience in terms of three categories. “Ecstasy” appears gradually or quietly. “Rapture” is an experience of the same content when its onset is violent and sudden. Lastly, the “flight of the soul” is rapture with the specific content of an out-of-body experience. These alternate states or trance states are believed to be the result of repetitive prayer and meditation and aloneness. Happiness thrives in groups. Churchgoers are an illustration of a gathering that may be happier because they belong to an extended family with social interaction, community, and shared values. Individuals who have no family may reach out and embrace an extended community of like-minded persons, developing a strong, fraternal unit and infrastructure. Like Sly said, “It’s a family affair.” Addressing the importance of that connection, Harvard happiness expert Daniel Gilbert explained, “We are happy when we have family, we are happy when we have friends and almost all the other things we think make us happy are actually just ways of getting more family and friends.” In 1943, American psychologist Abraham Maslow (1908-1970) developed a template that outlined a strategy for human evolvement and evolution. His “hierarchy of needs,” and specifically his third level --- what he called “Belongingness and love needs” --recognized the importance of connection. Maslow reasoned, “As social beings, family, friendships and intimate connections get many people through the ups and downs of life. Numerous studies have shown that the healthiest, happiest people tend to be more involved in their communities. While there is debate on whether one causes the other is unclear, there is some sense that having wider social connections and relationships are an important part of being happy. Lack of emotional connection to others can produce detriments in the ability of the individual to connect with others. Friendship, intimacy and family are types of needs that categorize the third level.” But Maslow also imparted a warning. He said: “Lack of interactions, human relationships and the sense of belonging may result in depression or loneliness while an abundance of love and community often sustain people through difficult times.” References Provided Upon Request Maxim W. Furek is a competitive athlete and published author. His rich background includes aspects of psychology, addictions, mental health and music journalism. His latest book Sheppton: The Myth, Miracle & Music explores the psychological and spiritual trauma of being trapped alive and is available at Amazon.com
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BEYOND RECOVERY: CREATING A NEW FUTURE WITH A CAREER THAT EXPRESSES YOUR PASSION By Dr. Chaz Austin
To maintain a successful recovery, it’s vital that addicts in rehab plan - and create a structure - for a meaningful future in the workforce that ties in with their skills and talents. This article will explain how that’s done. Having fulfilling work is an important part of one’s recovery. A successful career choice allows us to express our passions - and is monetizeable (in other words, you can make a living at something you love to do). Working for one company for decades and then retiring with a pension, as past generations did, is history. Corporate loyalty is gone, replaced by a freelance marketplace in which everyone is always hustling for the next project or the next client. Today, when creating a career in any field, you want to find as many ways as you can to generate income. For example, let’s say you love to play the guitar. It’s what makes you happiest. If we broaden “guitar player” to “musician,” that creates more potential opportunities. Now picture a wagon wheel. The hub is your core brand or skill set. The spokes extending from the hub are the various ways you can derive income from your talents. So as a musician, you can make money as a: studio musician, touring musician, teacher (private lessons, clinics, K-12, after school programs, high school and college teaching), producer, audio engineer, arranger, manager of other artists, mixer, songwriter, booking agent, product endorsements, etc. I call this The Multiple Income Streams Approach to sharing you talents with the world. If you can’t find a way to earn a living with your passion, then what you love may just be a hobby. The Paradox You’re taking care of yourself by connecting with your passion in life and finding a way to monetize it - in order to be of service to others. You will want to shift your orientation to using your gifts as a contribution, so your self-marketing efforts are always about what others need. Don’t Worry About Finding “The Perfect Job” It’s likely that you will have many careers during your lifetime (members of the Millennial generation can expect to have six or seven), so focus on getting to work, expressing your gifts, learning, and making friends. And be open to having a different vocation in a few years. Reinvention is the new normal. And always remember the Cumulative Positive: everything you’ve done in the past will help make you better at what you’ll do next. Nothing is wasted. Critical Thinking This is the foundation for managing your career - but it’s only half the battle. Awareness is a necessary starting point, but you’ll also want to get into action. “It is important that you get clear for yourself that your only access to impacting life is action. The world does not care what you intend, how committed you are, how you feel or what you think, and certainly it has no interest in what you want and don’t want. Take a look at life as it is lived and see for yourself that the world only moves for you when you act.” (Werner Erhard) The Journal Get your goals and Action Plan out of your head and into digital or written form. For creating a career plan - or any project in your life - start at the end: what’s your goal? Be as specific as possible, and use as few words as you can. Then note all the steps you need to take to get you where you want to go. Include a list of
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deliverables - and a timeline. As you log your daily progress, pay attention to: what resources you utilized (including networking and collaboration), and what obstacles you had to overcome. You’ll begin to notice your behavior patterns - the things you do (or don’t do) - that keep getting in the way of turning your dreams into tangible results. This might include things like: overcommitting, procrastinating, feeling overwhelmed and then giving up. You probably can’t get rid of your bad habits, so learn to manage them. If you begin to recognize them when they appear, you can start to reduce their impact. For example: if you tend to procrastinate when you have a project, instead of worrying about it and not doing anything for two weeks, maybe you can train yourself to only spend a couple of hours being worried - and then get to work. Set Milestones And reward yourself in some way each time you hit one (for example, a good dinner or a movie). Instead of seeing your goal as a giant mountain you have to climb, break things down into small steps (hills). This will allow you to keep winning - until you finally reach the summit. Don’t Sin Against Your Talent When Lenny Bruce, the brilliant comedian and social critic, died of a heroin overdose at 40, someone said that he had “sinned against his talent.” You, too, were given unique talents. They are not to be wasted; they are to be nurtured, and used to help others. It’s a gift from the universe and you are merely the vessel for it. Any bad habit or addiction that interferes with sharing that gift is “a sin against your talent.” Treat your body like a temple, not an amusement park. Using critical thinking - and journaling your progress - will encourage you to avoid the childish drama by replacing it with tangible results. These results include: an ongoing sense of accomplishment, increased self-esteem, and lifelong healthy habits. Plus, work that is fulfilling and satisfying supports a positive identity and your recovery - and ties in with your passion. Welcome to responsible adulthood. And being proud of - and confident about the person you’ve become. Dr. Chaz Austin, Ed.D. (http://chazaustin.com) is a recognized authority in the field of Career Packaging and Marketing. His most recent book is 101 Ways to Find Work . . . and Keep Finding Work for the Rest of Your Career! Dr. Austin works with individual clients, and conducts weekly workshops at Chabad Regional Treatment Center, and Valley Recovery Center. A course he created, wrote and filmed for lynda.com, “Designing a Career Path,” will be published in February. He holds a Doctorate in Organizational Leadership from the Graduate School of Education and Psychology at Pepperdine University, and can be reached at chaz@chazaustin.com.
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FLORIDA’S FUTURE IS NOW By John Lehman, FARR President
The FARR brand is now comprised of two distinct organizations. Each has a unique mission and is served by an independent Board of Directors. The Florida Association of Recovery Residences (FARR, INC) has been selected by the Department of Children and Families to provide recovery-oriented housing operators an opportunity to achieve voluntary certification of compliance with National Alliance for Recovery Residences (NARR) Quality Standards, Code of Ethics and other criteria established by F.S. 397.487 and 397.4871. FARR certification, compliance, and field assessors are responsible to follow transparently published protocols for the assessment of provider compliance. Communities, neighbors, continuing care coordinators, families and consumers all benefit from uniform application of these protocols across all four recovery-oriented housing support levels. The new FARR Voluntary Application for Certification is now available under the navigation tab Certification when visiting www.farronline. org. Implementing criteria established by F.S. 397.487, programs must demonstrate Certified Recovery Residence Administrator (CRRA) staffing for every three locations. This credentialing process is overseen independently by the Florida Certification Board under contract with the Department of Children and Families. Included in the core competencies required for achieving this credential is a thorough working knowledge of NARR Quality Standards and Ethics as well as a practical appreciation of how to implement these standards as practices that produce a culture of recovery support within the residential community. As established by F.S 397.4871, applicants for Certified Recovery Residence Administrator must pass level 2 background checks. In turn, FARR requires all online applications for Voluntary Certification of Recovery Residence be completed by the CRRA . Newly introduced components of the FARR online application include execution of affirmative attestations, completion of a contact section identifying all recovery residence owners, managers and staff and a section that facilitates uploading documentation in support of attestation and standards. F.S. 397.487 establishes that recovery residence owner(s) and financial officers must also pass level 2 background checks. Further information regarding the application and certification process is available at www.farronline.org.
Enforcement To ensure the integrity of FARR Certification, all stakeholders possessing direct knowledge of provider non-compliance are encouraged to visit www.farronline.org to file a grievance. Together, concerned stakeholders and FARR staff are legislatively empowered to take action to protect consumers, families and neighbors against predatory opportunists who seek solely to profit from this vulnerable population. FARR has established relationships with external parties who possess authority to act upon certain credible allegations, including the Attorney General Office for Consumer Protection, local and state law enforcement agencies, DCF Substance Abuse Licensure and, when appropriate, local zoning departments. Academic Research Equally empowering; certification of provider compliance with NARR Quality Standards evidences a culture of recovery support is embedded in the fabric of the peer community. Federal protections afforded this population under the American with Disabilities and Fair
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Housing Acts which hinge on a key premise: that when individuals in recovery from addiction live together as “the functional equivalent of a family”, positive outcomes are greatly enhanced. Eleven core principles underpin 37 Quality Standards that are further delineated by 102 sub-standards. These standards represent promising practices comprising a “how-to manual” for creating and sustaining residential, peer communities that promote recovery capital. Promoting recovery capital is the primary mission of recovery residences. The new membership organization, Florida Alliance for Recovery Residences (FARR LLC), is honored to play an instrumental role in supporting academic research towards development of an assessment tool for measurement of recovery capital. Commencing April 2016, a research team led by Dr. David Best of Sheffield Hallam University will collaborate with FARR Certified Recovery Residences to implement the measurement platform that has been deployed by recovery-oriented housing providers in the United Kingdom. The first of several research projects involving FARR Members, assessment of recovery capital (ARC) is recognized worldwide as the gold standard for valuation of recovery outcomes. A strengths-based practice, ARC measures consumer progress towards achievement of self-directed, recovery goals and improvement in quality of life. Dr. David Best is recognized by the academic community and leaders in the substance use disorder treatment, recovery support and corrections service sectors as a leading subject matter expert. His pioneering work in this field is extensively published and peer reviewed. Provider reliance on this measurement instrument will help guide service delivery in both clinical and peer sectors. FARR Members are, at once, proud and humbled to participate in this ground-breaking project. The Florida Alliance for Recovery Residences (FARR, LLC) will assume ownership of all membership, academic research, advocacy and outreach activities. Providers electing to apply for voluntary certification are not required to join the membership organization. Membership in FARR, LLC has no impact on compliance assessments conducted by the credentialing entity. The membership organization is comprised of individuals and entities committed to the recognition and promotion of three components of the new recovery paradigm: recovery residences; recovery community organizations; and recovery-oriented systems of care. We are proud to announce Dr. Paul Ahr Ph.D., M.P.A. as Chair of this organization’s Board of Directors. Dr. Ahr’s education and experience, including having served as Director of Missouri Department of Mental Health and, most recently, a decade long commitment at the helm of Camillus House, a Dade county nonprofit engaged in a mission to end chronic homelessness, qualifies him to lead a member organization seeking to fulfill the promise of the new recovery paradigm. In 2014, Dr Ahr received the Sapphire Award: Excellence & Innovation in Community Health, from the Florida Blue Foundation. A House in Town, a level II recovery residence founded by Dr. Ahr and partners, is poised to launch in Lake Worth, Florida. Under his leadership, the membership platform will facilitate partnerships between recovery support and addiction treatment providers, resulting in a recovery-oriented continuum that effectively supports consumers as they transition to self-directed recovery. Membership categories include: Recovery Residences (Certified and Provisional), DCF Licensed Behavioral Health Care providers, vendors who support these service sectors, residents and family, academic researchers and students, government agencies and recovery community organizations. The Florida Alliance for Recovery Residences website will launch April 1, 2016 at www.farrmember.org. It’s not enough to simply rid our space of the imposters. Now is the time for all stakeholders to come together and maximize opportunities to deliver recovery-oriented systems that measurably alter the trajectory of lives.
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Mal–FEE–Sance – BUYING POLITICAL INFLUENCE AND THE SECOND COMING OF THE AMERICAN OPIATE/OPIOID EPIDEMIC By John Giordano, DHL, MAC
Drug User Fee Act becoming law. The timing also corresponds with the origins of America’s Second Opiate/Opioid Epidemic. The PDUFA is a law passed by the United States Congress in 1992 which allowed the FDA to charge fees from drug manufacturers for new drug approval applications. The money generated by PDUFA now accounts for nearly half of the FDA’s annual budget and many experts – myself included – believe the fees corrupted the agency. So just how much does it cost to influence our federal elected officials? Between April 1, 2009 and March 31, 2015 the pharmaceutical manufacturing industry gave a total of $7,869,406 in campaign contributions to 100 senators; and in the two years between Apr 1, 2013 and Mar 31, 2015 – $6,095,087 to 343 house lawmakers with key committee chairs in both house and the senate receiving the lions share. For all intent and purposes, nearly every lawmaker in Washington DC has accepted pharmaceutical manufacturing money. Is this enough money to influence a vote? But congress is a small player compared to the President of the United States. At the conclusion of 2015, the latest statics available showed the pharmaceutical manufacturing industry has already injected nearly $1,000,000.00 into the presidential race. Expect that number to grow substantially. In the last presidential election cycle (2012), the pharmaceutical and health products industry spent over $50.7 million in campaign contributions and nearly $32 million in the 2014 elections, according to the Center for Responsive Politics. This year’s top five recipients of PhRMA money are: Secretary Hillary Clinton with more than one-third of total contributions to both parties at $336,416.00 followed by Jeb Bush $152,350.00, Marco Rubio $133,638, Chris Christie $95,350.00 and Ted Cruz $87,364.00. Congressman Jolly recently proposed The Stop Act bill which
WHEN BEING PREGNANT IS A CRIME By Hayley Keith
Continued from page 8
federal aid is available to certain patients who are willing to temporarily relocate to areas where treatment is available. There are also resources, such as Pregnant Addiction Solutions, which have treatment programs specifically designed for pregnant addicts. Ultimately, it is not only in the woman’s best interest to seek help, but also beneficial for the unborn baby. If we educate the public on the issue of pregnancy and addiction, we can reduce the stigma and raise awareness. Pregnant addicts need help from the treatment industry, not the justice system. We must treat pregnant addicts to prevent babies born into addiction and ensure all mothers have a chance to raise their child. http://www.ncbi.nlm.nih.gov/pubmed/3504452 http://www.nih.gov/news-events/news-releases/buprenorphinetreatment-pregnancy-less-distress-babies http://www.advocatesforpregnantwomen.org/articles/ruddick.htm http://alcoholpolicy.niaaa.nih.gov/alcohol_and_pregnancy_priority_ treatment.html Hayley Keith is the outreach coordinator for Pregnant Addiction Solutions. In her capacity as a business development rep for a leading addiction treatment facility, Hayley saw that pregnant addicts were being turned away from treatment providers time and again with devastating consequences. She has helped pioneer treatment options for pregnant women that have achieved remarkable results. With continuous efforts she hopes to raise awareness, educate the public, erase the stigma, facilitate treatment for pregnant addicts, and change lives one day at a time.
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Continued from page 12
would make it illegal for any member of Congress to personally ask voters for money. I applaud his recognition of a small part of a much bigger problem. But I can’t help feeling that, unless his bill is incremental and leading to bigger campaign finance reform, he is missing the target. Average people make campaign contributions to candidates they like or feel best represent their ideas on governance. Big money donors will never be accused of being so altruistic. Corporations don’t shell out a single nickel without an expectation welded to it. As a society, we’ve seen the results of powerful big money interests creeping into our everyday lives. Did the pharmaceutical industry and their trade group’s campaign contributions and dark money influence the growth of America’s Second Opiate/Opioid Epidemic? Visit open secrets dot org and make your own informed decision. From what I’ve seen, it is long past time to review the influence money has in politics. John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: http://www. holisticaddictioninfo.com
INTEGRATIVE SUBSTANCE ABUSE TREATMENT By Jay Faber, MD
Continued from page 28
why it may have been so difficult to make more constructive, higher quality of life choices. Subsequently, we use this information to help optimize brain functioning. Our conversations are catered to help guide that individual to a lifestyle that is more likely to be filled with contentment, constructive behaviors, and sound choices. Treatment may potentially include medications. However, it often includes more holistic approaches using supplements, psychotherapies, and other advanced therapeutic technologies. Moreover, our clinic works closely with trained integrative medical physicians. The close alignment of these working professionals offers our clients the best of “Mind-Body” integration therapies. The medical community is learning a lot about how both the mind and body work together and our clinic is creating constructive treatments to help our clients experience beneficial emotional as well as physiological improvements of well-being. So in closing, if anyone else happens to see a drone flying high above their next vacation trip, I would hope that they might be able to take a different perspective than my initial impressions. Our world is changing. Our world is growing. Our world is expanding. The current tools of neuro-scientific advancements offer the substance abuser, as well as others, a chance to live healthy lifestyles filled with purpose, meaning, and significance. Does it not make sense to take advantage of this opportunity? John A. “Jay” Faber, MD is a clinical and forensic psychiatrist, child psychiatrist, and adult psychiatrist at Amen Clinics. In addition to his work at Amen Clinics, Dr. Faber is President of BrainSource, a corporation founded to teach adolescents how to build successful lives. Supporting the work at BrainSource, Dr. Faber is creating a series of programs to help guide teens to go from being good students to great leaders. The first of these programs, “Fortified Friendships” is a 3-part CD series for adolescents, teaching teens how to build successful relationship. www.amenclinics.com
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LIFE’S ONION®
Breakthrough Therapeutic Tool Produces Big Results for Clinics and Clients We all know the saying about what to do when life gives us lemons - make lemonade! But what do you do when life gives you onions? If you’re Mark Wetherbee, founder and creator of Life’s Onion, you make a therapeutic tool so innovative that it is awarded a patent. Life’s Onion is a handheld, onion-shaped device with 12 peels which transforms into a flower when opened. People in self-help and therapy record their goals and achievements on the actual peels, and peeling them back to flower petals as progress is made. It’s a simple tool, but its application is what makes it unique: while there are other methods of tracking improvement, Life’s Onion is the only product which marks people’s progress in a tangible, visual form and remains with them to reinforce their successes. One Life’s Onion user stated, “It will be a daily reminder of my journey through treatment, self-reflection, growth, and continued success in life.” It is not often that people have a visible reminder of their growth and achievements outside of the therapeutic environment, and this was clearly the creator’s goal. Life’s Onion incorporates elements of journaling, art therapy, Cognitive Behavior Therapy and Schema Therapy. The tool can be used by an individual or with any therapeutic modality or style. In addition to the tool itself, there is a full package of support materials designed to integrate Life’s Onion into existing programs. After more than 3 years of research, development and field trials, Life’s Onion is now being made available to the public. To find out more visit: www.lifesonion.com
The 7th Annual
West Coast Symposium on Addictive Disorders
June 2-5, 2016 La Quinta Resort & Club La Quinta, CA
Just when the thought the
was over
it became a
Earn up to of continuing education and choose from more than challenging workshops. Join us for the 7th anniversary of one of C4 Recovery Solutions’ premier addiction conferences — the West Coast Symposium on Addictive Disorders (WCSAD). WCSAD is dedicated to continuing education and networking in the field of addictions. In 2015, WCSAD hosted more than 1,000 attendees. Like its sister conference, the Cape Cod Symposium on Addictive Disorders (CCSAD), WCSAD combines workshops and seminars on timely industry topics with an unmatched showcase of the industry's products, services and facilities. We look forward to seeing you!
www.WCSAD.com Registration begins March 1 To Advertise, Call 561-910-1943
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HEROIN EPIDEMIC IN AMERICA (Part 5) By Steven Kassels, M.D.
scourge of addiction is in all of our yards. The solution is to decrease the demand with bold public initiatives and a change in attitude. It is both the humanitarian and fiscally responsible thing to do.
Continued from page 18
Chief Bergeron understood the apprehension of the townsfolk, that a drug treatment center in West Haven Harbor would label the town as a drug haven. The tourists would be frightened and stay away, the local economy would falter, and everyone would suffer. As a result, many in need of treatment never got it. It is time for attitudes to change!
We can make great strides to solve the scourge of heroin addiction, but we need to stop blaming and put words into action. As I have discussed in this five part series, there is plenty of blame to go around! Unfortunately, as illustrated in my book, Addiction on Trial, Police Chief Bergeron’s reflections are reflective of the unfortunate attitudes of many. Although Chief Bergeron had witnessed first-hand the increasing influx of drugs into not only his community but into all of Downeast Maine, Annette’s death and the likelihood it was drug connected posed challenges never before encountered. There had been a prolonged battle within the ranks of city government and among the citizens who irrationally opposed the siting of the treatment center, delaying its opening for years. Eventually, there was some acknowledgment that Downeast Maine, no different than innumerable regions and communities up and down the east coast, had a heroin and Oxycontin problem, but it was greatly minimized. The clinic was finally approved after much rancor, but treatment was initially limited to one hundred patients. Since no one ever wants to believe its municipality has a significant drug problem, it was decided that opening up one hundred outpatient slots would more than satisfy the need and help to quell the escalating controversy. The clinic filled all its patient slots within a month and droves of needy patients were placed on waiting lists. This struggle to establish treatment centers was not unique. There were similar controversial and heated discussions in many cities and towns … Lawsuits between municipalities against wellintentioned medical providers were not unusual. Paradoxically, at about the same time, a New England Governor’s Council Forum had convened … Presentations by illustrious speakers demonstrated the extent of the epidemic …What Bergeron remembers most from the conference was the statement by a prominent elected official that “these are telling times when elementary and middle school children are offered a bag of 70-80 percent pure heroin for the price of a double scoop ice cream cone.” The forum’s mantra was interdiction, education, and treatment. This battle cry was good in theory, but in practice it was a different story at the local level. NIMBY—“Not in My Back Yard”—was the rallying cry of most municipalities. No town would admit to having a significant drug issue; it was always the next town over that had the problem. The rationale was based on the fear that if a drug addiction center was established in one’s own town, which of course did not have a problem to begin with; all the addicts from the neighboring townships would spread the scourge as they migrated for treatment, thereby creating a drug problem that never before existed. Despite the documented epidemic of drug abuse across the nation, hardly any individual town, if you spoke to the locals, had much of a problem.
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Dr. Kassels has been Board Certified in both Addiction Medicine and Emergency Medicine. He serves as the Medical Director of Community Substance Abuse Centers. He is the author of “Addiction on Trial”, written as a murder mystery/legal thriller to reach and educate a wide range of readers. The book has recently been entered into medical school curriculum to help decrease physician bias. The book is available at: Amazon (http:// www.amazon.com/Addiction-Trial-Tragedy-Downeast-Maine/ dp/1491825316) and free author book club presentations and educational meetings (in person or using Skype) can be arranged at: http://addictionontrial.com/author-events/
SUNDAY MORNINGS, MY FAVORITE TIME OF THE WEEK
By P.D. Alleva, MSW Continued from page 32
there, deep within the depths of the soul, striving to come free with a barbaric YAAWWWWPPP! I Am All Things Peaceful! I want to send that across the universe, that feeling of pure uncorrupted love to shake the very foundation of the universe itself, to turn the tide on oppression and break the whole damn thing open so we can get on with it and live as we have been meant to live since the beginning, utopic and otherworldly. So my kids can live without the understanding of fear and look upon the human race like the vast expanse of ocean on a Sunday Morning, completely at ease. To tell stories with positive intention and results that can change things for the better, for them, in the name of the human heart. Sunday mornings, a time to make things right, to settle conflicts because they never truly mattered anyway, and to put away the movement of the week ,to stop for a minute to recognize and understand that we are all here together in one universal pod rocketing across the galaxy with a fierce pace towards the light. Inevitably being what they are, we can change them with a different mind. I bring only my heart! Sunday Mornings, my favorite time to meditate. Paul is the founding owner of Lifescape Solutions and Evolve Mental Health which he opened in December of 2011, based on a new model of healing and psychotherapy called Spiritual Growth Therapy. His newest book Let Your Soul Evolve: Spiritual Growth for the New Millennium 2nd edition describes the model.
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ADDICTION—A DISASTROUS FAMILY HERITAGE By William G. Borchert
I was actually able to avoid alcohol until I was nineteen and had just become a newspaper reporter for the largest daily paper in the world at that time headquartered in New York City. It was a tremendous opportunity afforded me in the heyday of journalism. I was rubbing shoulders with some of the greatest writers and columnists in the media universe. But the first night I showed up for work, I was invited into a saloon by some of my peers from other newspapers who were at least twenty five to thirty years older than I was at the time. They didn’t ask what I wanted to drink. They simply ordered for me what they were drinking themselves—a shot and a beer. There he was sitting on that mahogany bar-- John Barleycorn, my mortal enemy. But he was now presenting himself as my friend, as part of the happy celebrity surroundings, as part of the camaraderie. How could I say no, especially in the midst of my peers, men I admired, veteran newspaper reporters I could learn from. So I quickly downed the shot of rye. I almost choked from the burning sensation until the beer chaser put the fire out. Everyone laughed. They bought me another…and another…and another. They were having fun with the rookie. I didn’t get sick and I didn’t have a hangover. What I had was an experience I’ll never forget. I felt taller, older and handsomer. I felt like I was on top of the world, at peace with the world. I was a veteran newsman and the world was my oyster. It was an exhilarating experience that I continued chasing almost to the gates of Hell. When you’re young and healthy, you can handle the booze for a while. And God had blessed me with some talent to interview people, write their stories and create features that editors liked. I advanced rapidly, from a police reporter to covering general assignments to a by-line feature writer. I went on to write for wire services, news magazines and radio, creating new radio shows of my own. Everyone said I had a great future in the media world. But alcoholism is a progressive disease and it soon caught up to me. I was married now with four children and, like my father, spending more money on booze than I could afford. Between losing two lovely homes, having several serious automobile accidents, missing deadlines and then missing work, I got caught in the avalanche of alcoholism and my downward slide was precipitous. By the time I was twenty seven I was unemployable, living with my wife and children in my mother-in-law’s basement and pan-handling friends for the price of another drink. At one point I became convinced I was crazy or at least on the verge of insanity. I was doing things I didn’t want to do and doing them over and over again expecting a different result. So I wound up in a psychiatrist’s office and was told I was probably an alcoholic and should attend a twelve step recovery program. To me, an alcoholic was a Bowery derelict drinking cheap wine out of a brown paper bag. I revolted at the idea. So I continued drinking. I became convinced that I was a totally useless human being and that my wife and children would be better off without me. In fact, at the age of twenty eight I actually believed that I had no reason to live anymore and climbed out onto a hotel window ledge to jump. I know now that a God of my understanding had other plans for me. At that moment He made me realize that I didn’t really want to die. I just didn’t know how to live…and He was about to show me. The simplest way to put it is, I joined a twelve step recovery program, committed myself to its principles, turned my will and my life over to the care of a Higher Power and found a life beyond my wildest dreams. So did my wife and my children. And a short time later, believe it or not, my father found himself attracted to the same twelve step program. In sobriety I finally found the father I always wanted, he found a loving son and my mother found the husband she once loved.
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Continued from page 6
So while addiction can be a disastrous family inheritance, the miracle of recovery can overcome the power of our genes and give us the greatest gift anyone could possibly receive—sobriety. And it’s offered to anyone who truly wants it. William (Bill) G. Borchert is a multi-published author, national speaker and Emmy Award nominated screenwriter for the highly acclaimed Warner Brothers/Hallmark Hall of Fame movie, “My Name Is Bill W.” The film, based on the founding of Alcoholics Anonymous, stars James Garner, James Woods, JoBeth Williams and Gary Sinese. It won three Emmy Awards and has become the most watched television movie ever made. Bill won The Christopher Award, The Paul Newman Award, the Vince Lombardi Community Service Award and the Marty Mann Founders Award for the film. Bill also wrote the screenplay for the Entertainment One/Hallmark Hall of Fame movie, “When Love Is Not Enough” which was based on his book about Lois Wilson, the co-founder of the worldwide fellowship of Al-Anon. The movie stars Academy Award winner Winona Ryder as Lois Wilson and Golden Globe winner Barry Pepper as Bill Wilson, the co-founder of Alcoholics Anonymous. After working as a feature writer for national magazines and creating syndicated radio shows, Bill became a partner at Artists Entertainment Complex, an independent film production company that went on to produce a number of box office hits including “Kansas City Bomber” starring Raquel Welch, “Serpico” starring Al Pacino and “Dog Day Afternoon” also starring Al Pacino. Bill has written a number of books including “How I became My Father…A Drunk,” “The Skyline Is a Promise,” “50 Quiet Miracles That Changed Lives,” “When Love Is Not Enough,” “Sought Through Prayer and Meditation,” “When Two Loves Collide,” and “1,000 Years of Sobriety.”
WHAT FAMILY MEMBERS NEED TO KNOW ABOUT SUBSTANCE ABUSE AND SUICIDAL BEHAVIOR By Tony Salvatore, MA
Continued from page 10
prescription or OTC medications, and encouraging contact with a behavioral health provider at the earliest sign of suicidality. Be vigilant after a death in the family or of a peer, after a psychiatric hospitalization, and after a relapse. Prepare and share a family suicide prevention plan outlining any medical or behavioral health providers to call, other family members or friends who can help, local emergency service numbers, and include these actions if suicidal behavior is felt to be present: • • • • • • •
Directly ask about thoughts of suicide Ask if a suicide attempt is being considered Ask if anything has been done (if yes, 911) Say that you care and want to help Do not let the person leave or be alone Try to restrict access to lethal means (if this can be done safely) Urge contact with a hotline, crisis center, or emergency department • Call 911 if voluntary assistance is rejected • Do not hesitate to pursue an involuntary psychiatric evaluation Remember that suicidal behavior may abate but suicide risk endures and suicidality may resurface. Always maintain prevention mode. Tony Salvatore is on the staff of Montgomery County Emergency Service, a nonprofit crisis psychiatric service in Norristown, PA. He may be contacted at tsalvatore@mces.org.
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