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

N OV E M B E R 2 017 | VO LUM E 6 | I SS U E 11

I N M E MO RY O F S T E V E N

A N AW A R D W I N N I N G N A T I O N A L M A G A Z I N E

GROWING UP STONED - PART 2

THANKSGIVING, FOOTBALL AND RECOVERY By John Giordano, Doctor of Humane Letters, MAC, CAP

By Mark S. Gold, M.D. and Dr. Drew W. Edwards, EdD, MS

WHY FAMILY THERAPY IS CRITICAL TO RECOVERY

By Anna Ciulla, LMHC, RD, LD

FREQUENTLY ASKED QUESTIONS FROM FAMILIES ABOUT THE MARCHMAN ACT By Joe Considine, Esq.

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

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

Patricia

Publisher Patricia@TheSoberWorld.com

For Advertising opportunities in our magazine, on our website or to submit articles, please contact Patricia at 561-910-1943 or patricia@thesoberworld.com.

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GROWING UP STONED - THE IMPACT AND OUTCOMES OF CANNABIS ON ADOLESCENTS AND CHILDREN (PART 2) By Mark S. Gold, M.D. and Dr. Drew W. Edwards, EdD, MS

In part one, we culled the scientific literature and presented the best available research to bring forth the facts amid the current controversy. Framing the issue of cannabis use in terms of prevalence among children and teens, the neuroadaptive changes unique to adolescent brain development, and the long term cognitive and emotional deficits observed in those who are initiated early in life. [link to part one] The unprecedented correlation between cannabis use and mental illness, particularly depression, suicidality and psychosis and schizophrenia is cause for alarm and the reason the FDA requires all medicine to meet rigid safety standards.

Figure 1 (NIDA)

“The consequences associated with frequent use of marijuana (as is the case for most teens and young adults) now include severe depressive state, suicidality, anxiety and psychosis that requires acute medical or psychiatric intervention.” The research is clear, the life trajectory for children and teens who use cannabis is wrought with academic failure, psychopathology, underemployment, multiple failed relationships and decreased life expectancy. In part two, we will delve deeper into the neurobiology of cannabis use, and explain the unique pharmacodynamics and pharmacokinetics of cannabis, in order to explain “WHY” cannabis has such unique, and deleterious effects. Part two will conclude with the challenges scientists face in understanding the endocannabinoid system and how to better educate parents and the public of the dangers unique to children and adolescence who live in a time, and in a society, that is, at best, ambivalent about this drug. The neurobiology of cannabis In 1964, the psychoactive ingredient of Cannabis sativa, Δ(9) tetrahydrocannabinol (THC), was isolated. In the late 1980’s and early 90’s researchers at Johns Hopkins discovered the endogenous counterpart of THC, collectively termed endocannabinoids and began to isolate them to understand their function. Anandamide is a naturally occurring, lipid endocannabinoid (endogenous cannabinoid) that functions as a neurotransmitter. Its natural receptors are found throughout the brain and body. Over the past 3 decades endocannabinoids have been recognized as key mediators of numerous aspects of human pathophysiology and thus have emerged as among the most widespread and versatile signaling molecules ever discovered. Most medications are mediated, to some degree through this system. Specific functions of endocannabinoids mediate reward / pleasure, cognition (memory, executive function, focus, problem solving, concentration), movement, coordination, perception, and our sensation of time and space. Usurping the Endocannabinoid System Because THC is chemically similar to Anandamide, it can easily attach to cannabinoid receptors in the brain. But because it is a counterfeit to the anandamide, it corrupts the signal, and thus, the important functions of the endocannabinoid system throughout the brain and body.

Impaired Memory and Focus Of particular interest is the effect of THC on the developing brain. For instance, THC binds to receptors on the hippocampus, which is designed to function much like the Random-AccessMemory (RAM) in a computer. The hippocampus, like a computer’s RAM, is responsible for coding, storing and retrieving memories. When impaired by THC, it fails to function properly. This was first observed in lab rats, while under the influence of THC and failed to navigate their way through a simple maze to find food and water, or escape. In contrast, the “sober” rats were able to learn, remember, store, and recall the information needed to find their way through the maze with relative ease. Human observational studies reveal much the same thing. Regular cannabis users struggle to recall previously learned information including common words used during a simple conversation. They often forget what they are saying, while they are saying it. So, they pause in mid-sentence and ask, “what was I saying”. Once “cued up” and reminded, they continue until the next time. Marijuana also inhibits the normal function of the Orbitofrontal Cortex (OFC), an area directly behind the eyes, which serves to sustain and to shift our attention, and to create icons for new learning. The Pre-Frontal Cortex (PFC) houses our highest level or reasoning, problem solving and serves to mediate and inhibit hedonic signals from the midbrain. As a result of using marijuana, dopamine signals to the midbrain are enhanced while dopamine signals to the PFC are muted by marijuana. The result: Impaired cognitive function that interferes with the user’s ability to learn and perform complicated tasks, and apply sound reasoning in making important decisions in a timely manner. The bottom line is clear. Adolescence who use marijuana regularly are at great risk for incurring detrimental and perhaps permanent neuroadaptations that can drastically alter the trajectory of their lives—while impairing their potential and capacity to be the very best version of themselves. Perhaps the most shocking evidence, is the quantitative drop in IQ among those who are initiated in their early or mid-teen years. These data explain the high level of school dropout, multiple failed relationships, and increased prevalence of dose dependent mental health problems. THC also binds to the cerebellum and Continued on page 30

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THANKSGIVING, FOOTBALL AND RECOVERY By John Giordano, Doctor of Humane Letters, MAC, CAP

Without question, Thanksgiving is one of my favorite days of the year. It is a uniquely American tradition where families put their differences aside and draw close to each other to enjoy a wonderful meal and give thanks for all of their blessings. Even with all the controversy surrounding the NFL as of late, many families will be tuning into the football games as part of their Thanksgiving tradition. With nearly all the attention squarely focused on who is standing or kneeling during the national anthem, very few people will be aware of what is happening to the players behind the locker room’s closed doors where film crews are not allowed. Hours before kickoff, many if not most of the football players will get onboard with what has become known as the “T - Train.’ The ‘T’ in ‘T - Train’ is an acronym for Toradol, the brand name for the powerful painkiller ketorolac tromethamine. It is a non-steroidal anti-inflammatory drug (NSAID) used for short-term management of moderate to severe pain. Toradol is in the same class of painkillers as Advil and Aleve but far more powerful. When it was approved by the FDA and released to the medical community, the drug was indicated specifically for the relief of severe post-operative pain. Although it’s not a narcotic, Toradol’s effects are often compared to morphine by scientists and researchers – it is that powerful and can last for a couple of days. As I’m sure you are aware, professional sports are very competitive. Football players call lining up on the T - Train just another part of staying on the field. It helps them feel less pain when they step on the field and during the game. It amazes me how the pharmaceutical industry has taken over college and professional sports. I am a tenth degree black belt. In my youth, I competed for years in national and international Karate tournaments. We’d train and spar for hours upon hours for days on end to prepare for the competitions. Our bodies were savagely beaten. The kicks and punches took a heavy toll on everyone involved. We relied on Tylenol for pain relief. Anything more would have masked serious injury. And that is exactly what is happening in the NFL today. Players are so doped up on game day that their injuries can take a day or two to surface. The NFL’s answer to this issue, like so many other sports franchises and many of our doctors here in America, is opioids. As a former professional athlete, this is what I find so incredulous about professional sports today. The people at the top are so fixated on revenue and brand image that they completely overlook the athlete’s health. For example, an NFL player can be suspended for a minimum of four games for taking banned performance enhancement drugs (PED). However, that same player can take as many opioids as he wants leading up to and including game day and be a starter. It’s been said that team doctors hand out opioids in the back of the training room with complete disregard for addiction. The NFL’s hypocrisy is palpable. According to future Hall Of Famer Calvin Johnson, addictive opioids were, until recently, handed out “like candy.” In an interview with ESPN’s “E: 60” Johnson said, “If you were hurting, then you could get them. It was nothing. I mean, if you needed Vicodin, call out, ‘My ankle hurt,’ you know. ‘I need, I need it. I can’t, I can’t play without it,’ or something like that. It was simple. That’s how easy it was to get them. So if you were dependent on them, they were readily available.” Former San Diego Chargers offensive tackle Shane Olivea took a different route. His opioid addiction became so strong that he ended up bypassing the team doctor and secured opioids from his own outside sources – even one in Mexico. Olivea told The Columbus Dispatch that he

was high every day following his rookie year with the San Diego Chargers. “At my height on Vicodin, I would take 125 a day.” He said doctors told him he was lucky to be alive. I find it so difficult to believe that a professional athlete could be high day in and day out, around hundreds of team mates, coaches, doctors, trainers and other football personal, for months at a time, with not one person noticing. It sounds more like ‘turning a blind eye’ to me. However, this phenomenon does explain why retired professional football players are four times more likely to become addicted to opioids than the average person. Chronic pain is a serious matter for far more people than just professional athletes. Millions of people suffer everyday from the disabling affects of chronic pain. There are many people who just cannot get relief from their devastating pain without opioids. For years I’ve said we’ve become a pill society – one that has been led to believe there is a pharmaceutical fix for everything that ails us. However, it is just prudent that we challenge big Pharma’s ethos and examine several safer courses of action that can be taken before we flood our vital organs with these toxic and often deadly opioid painkillers. There are two alternative medicine therapies that have been proven effective in relieving pain and have entered into the mainstream of modern medicine. Acupuncture has been successfully practiced for literally thousands of years. Some experts believe it originated around 100 BC in China while others suggest it could have been practiced earlier. It has always had a following in China, but more recently became popular in the US, Europe and Australia. In Europe, acupuncture is one of the most common alternative medicine practices. Acupuncture is used to treat a wide range of conditions and is commonly used domestically for pain relief. Acceptance of Acupuncture in the U.S. became official in 1992 when Congress created the Office of Alternative Medicine. The National Institutes of Health (NIH) declared support for acupuncture for some conditions in November 1997. More than 14 million Americans reported in the early 2010s that they have used acupuncture as part of their health care. In the last few years, academic medical centers – such as those located at Harvard University, Stanford University, Johns Hopkins University, UCLA and others – now offer acupuncture mostly through CAM centers or anesthesia and pain management services. The National Institutes of Health (NIH) has this to say regarding the efficacy of acupuncture; “Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider.” Another alternative medicine steadily gaining popularity in the U.S. is chiropractics. Compared to acupuncture, chiropractics is a much newer therapy. It was founded in 1895 by Daniel David (D.D.) Palmer in Davenport, Iowa. He opened the Palmer School of Chiropractic in 1898. His son, Bartlett Joshua (B.J.) Palmer, took over the Palmer School in 1906, and rapidly expanded its enrollment. By the 1930s chiropractics was the largest alternative healing profession in the U.S. Although it was a tremulous journey, chiropractics has gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States in the last few decades. According to the National Institutes of Health (NIH), a 2007 National Health Interview Survey (NHIS), which included Continued on page 34

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WORKING THROUGH LOSS AND GRIEF IN RECOVERY By Murphy Vestute, MS, RMHC, CGRS, and Jodi MacNeal

Losses are more than just deaths. People in active addiction lose far too many friends to drug overdoses. We would never let that painful fact go unacknowledged. But for so many people entering treatment for addiction, grief from a lifelong string of losses fueled the need to drink or use in the first place. People in recovery face subtle, unrecognized losses every day: • Loss of the drug itself • Loss of the rituals around getting and using the drug • Loss of the people you drank or used with, and loss of sober friends and family • Unresolved losses from the past Adding grief therapy to the treatment plan addresses what Mark Sanders, LCSW, CADC, calls a “long, unwritten legacy in the field of addiction treatment, which suggests that clients should leave all other problems at the door until they have dealt with their addiction first. As the field matures, we are discovering that many clients cannot recover unless we are able to address a number of their problems simultaneously. Grief is often one of those problems, as acute pain around losses seems to resurface as soon as clients stop using.” It’s frightening and uncomfortable to confront loss and grief while in treatment without the numbing effect of drugs or alcohol. In many cases, it’s the first time in years – maybe the first time ever – a recovering addict examines a life’s worth of losses and the accompanying emotions. It’s brave and courageous work. And while you don’t have to do grief work to get better or to stay clean or sober, those who’ve done the work often come back later and report that it helped. In grief recovery work, we’re trying to say goodbye to the pain related to the loss, so the wounds don’t keep reopening. Success means resilience, and the ability to navigate new losses as they occur. Loss of the drug In her book, Addiction and Grief, Barb Rogers writes: “My friend is gone – the friend who got me through all the bad times, who was there for me whenever I needed help. Tears run down my face. Great sobs wrack my body… Can I really be grieving a bottle of whiskey?” You can. Even though you’ve willingly walked away from that bottle, or that needle, or those pills, it’s still a loss. You still feel the pain of that grief, and you still mourn. The substance has been the constant. It’s been there to provide escape or pleasure. It’s been like a lover, preoccupying your thoughts and filling your days and nights. Its absence leaves a profound sense of loss and grief, including the realization that you no longer have that escape to look forward to. One young therapist had each person in her small group write a goodbye letter to their drug. “It was so moving,” she said. “It felt like they were letters to people. One person wrote, ‘I needed you. It felt good, and comfortable. You made me feel like everything was OK, but I didn’t realize how much damage you were doing. Now I have fatty liver and I’m dying, and I realize how much you hurt me, inside and out.’ “ Loss of rituals People in active addiction spend hours every day acquiring and using their drugs. For some, it means planning ahead so they can shoot up before getting out of bed. For others, it means getting through the day at work by looking forward to getting drunk at night. Once in recovery, those rituals have ended and they’re faced with this daunting question: “How am I going to fill my time?” Part of the loss of rituals involves the loss of freedom, the freedom to do whatever they want with whomever they want, whenever

they want. This can feel stifling for a person who’s become unaccustomed to having little or no responsibility. Grief work helps that person see that freedom is available in other healthier ways. Loss of people People are powerful triggers. Very often, the only way to escape relapse is to avoid contact with the friends you drank or used with or the boyfriend or girlfriend who got you hooked. As once-addicted people step away from the drug community, it’s natural to mourn the relationships that must end if the person is to remain sober. Often, we meet people who have experienced family losses – through death or estrangement. Even the pain of romantic breakups can linger, causing the person to get stuck in their grief and turn to drugs or alcohol to numb the pain. As they complete their loss inventories, clients often are astounded at the number of personal losses they’ve experienced. One young man’s list was so long, he laid it out on the floor endto-end and looked up in disbelief. “This explains so much,” he said. “No wonder I’m using.” Losses from the past Why revisit old losses – like sexual trauma, abandonment, and abuse – in grief work? Rebecca Williams and Julie Kraft address the question in their book, The Mindfulness Workbook for Addiction: “Loss compounds loss… It’s as if those old wounds are simply covered over with a thin layer of scarring, only to reopen as soon as another loss hits, and then they begin throbbing and bleeding all over again. Lasting recovery requires healing at the source.” Grief is a normal and natural reaction to loss. It is not a pathological condition. It is not a personality defect. Grief comes to us all. As a culture, we’re given so little education about how to handle loss. Time does not heal – only what you do with that time does. That’s a powerful message for people in recovery to hear. Murphy Vestute, MS, RMHC, is a Certified Grief Recovery Specialist, a primary therapist at Desert Rose Palm Beach, and owner of A Place to Heal Counseling, LLC (www.aplacetohealcounseling.com). Jodi MacNeal is creative director at Desert Rose, a gender-specific, long-term outpatient treatment center in Palm Beach Gardens, Florida. Soul-Centered Treatment™ at Desert Rose addresses past hurts and losses. Learn more at www.DesertRoseRecovery.com or call 561.459.8951.

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REAL RECOVERY SERIES No. 2

Every time she’d start treatment, she had one thought: “Let me out.” “Finally I realized it wasn’t me that wanted to run. It was my addiction that wanted me to run. That was my ﬁrst breakthrough.” And so she found the courage to stay at Desert Rose, not just for a few days, but for 6 months. She got clean and stayed clean. Then she started sharing her story at treatment centers. During one talk, she noticed a girl sitting in the back of the room, crying. “Later I found out it was her ﬁrst day. She was like, ‘I wanted to leave so bad, but seeing your hope and your strength, seeing how you pulled through? It makes me want to stay.’ “ This is a true story as related by L.W., a recent Desert Rose graduate who has moved home and is rebuilding her life.

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JUST SOME OF THE IMPLICATIONS OF LEGALIZED MARIJUANA PART 3 OF 3 By Raul J. Rodriguez, MD, DABPN, DABAM, MRO

As defined by the CDC, an epidemic is the occurrence of more cases of disease than would normally be expected in a specific place or group of people over a given period of time. Drug addiction in the United States has reached epidemic proportions and continues to grow. Certain things have been shown to make drug addiction epidemics worse, especially substance availability and perceptions of safety. The recent pain pill crisis is a good example to illustrate both. Many people who would otherwise never have gotten into opioid addiction did so because a clean looking little blue pill with a precisely measured dose is far less scary that a baggie of mysterious powder that seems to have different colors depending on the grade or where you buy it. Heroin has been around for ages but opiate addiction really took off when the pill mills were selling oxycodone like if it was the newest version of the iPhone. The combination of perceived safety and availability quickly resulted in the pain pill epidemic. Once addiction develops it is treatable but not curable. A second epidemic developed when the pill mills were shut down and the supply of heroin continued to increase. Because they were already addicted to one opioid drug, a transfer to the increasingly abundant heroin was very easy. Most of the northeast coast is still trying to figure out what to do about their heroin epidemic. The pain pill and heroin epidemics are actually good predictors of some of the expected trends with legalized marijuana. We already discussed perceptions of safety. Availability of cannabis would surge, and to a greater degree than in Colorado and other states. Florida, especially South Florida, is very entrepreneurial and is very quick to jump on the next big cash cow. Remember when every strip mall in Broward and Palm Beach counties had a pain clinic? It would be less than 2-3 years before we saw equally if not even more marijuana dispensaries. Colorado is already having great difficulty even attempting to regulate the dispensaries in their state. A similar problem would be seen here, as was the difficulty and delay in regulating the pill mills in Florida being the prime example of how it would look. So why are pain pills and marijuana so difficult to manage? This difficulty has to do with the principle of “legalized vice”. Humans really like vice. They go out of their way to break laws and spend large amounts of money to get vice. So what happens when you legalize it? In the human mind, it is still a vice and has the allure of vice but now just easier to get. Pain pills were actually not widely considered vice until one of them came out that could be easily crushed and snorted or used intravenously. Marijuana has always been a vice. Legalizing it will not change this conscious, if not at least subconscious perception. Like other vices, cannabis is typically not consumed in small or precise quantities. It is most often consumed to excess, to a point of intoxication. It is a fundamental part of the marijuana culture. Medications are taken in small and precise quantities. Good luck breaking that habit with medicinal marijuana. This behavioral propensity would be even worse in someone who had reached the point of Cannabis Dependence or was in recovery from other drugs. The effect of legalized marijuana on the recovery population is potentially catastrophic. The last thing someone in recovery needs is to be inundated with hype regarding overstated medicinal benefits of a legalized vice. Some may become psychologically enabled by a diagnosis of PTSD that could give them a license to consume THC. It is very difficult to change the mind of someone who believes you are trying to take away a part of their “treatment” and thus hurting them. In reality the recommendation against Cannabis as a treatment option would be no different than a recommendation against Xanax, another legal but problematic “medication”. Xanax has “legally” been around for years and it is no better now for someone in recovery than it was when it first came out. Those that are strong in their recovery can look past this, but those that are more vulnerable, are at risk of being

seduced. This effect has already been seen with all of the Kratom dependence problems and precipitated drug relapses caused by the Kava bars. Many Kratom users argue that their use is “medicinal” and that they are treating themselves in a way that bypasses the greed of Big Pharma. They are often ferocious in the defense of their Kratom use despite stunted personal growth and a progressive decline in their global functioning. Attempts at banning Kratom have come close but have been sabotaged by political interference from special interest groups (Kratom users and Kava bar owners). The impact from medicinal marijuana stands to be worse due to the greater cultural following of cannabis and the much greater degree of media exposure. Medicinal marijuana is not without some potential benefits but it is also not without serious far-reaching problems. On its best day, it is a problematic and controversial medication. It may help some people with certain specific conditions but unfortunately will hurt far more due to the human vulnerability to vice and problems with the culture we all live in. It will be especially damaging to individuals with active drug use or early in recovery. In light of the escalating addiction crisis, the legalization of the quintessential “gateway” drug really adds fuel to the fire. The overall risks of legalized cannabis to a large segment of the population far outweigh the potential benefits to a very small segment. It was legalized due mostly to the shortsighted financial benefits and unfortunately the aforementioned problems will ultimately manifest. The best hope to contain the problems is a massive drug education campaign directed at the entire population, but especially the segments that are most vulnerable such as our youth and those in recovery. Dr. Rodriguez is the founder and Medical Director of the Delray Center For Healing, the Delray Center for Brain Science, and the Delray Center For Addiction Medicine. He is board certified in both Adult Psychiatry and Addiction Medicine, with a clinical focus on Treatment Resistant Depression, Bipolar Disorder, Anxiety Disorders, Addiction and Eating Disorders. The Delray Center is a comprehensive outpatient treatment center that incorporates the most advanced psychotherapeutic and medical modalities, such as Dialectical Behavioral Therapy (DBT) and Transcranial Magnetic Stimulation (TMS), in the treatment of complex and dual-diagnosis cases. www.delraycenter.com, www.delraybrainscience.com, www.mydrugdetox.com

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WHY FAMILY THERAPY IS CRITICAL TO RECOVERY By Anna Ciulla, LMHC, RD, LD

The case for family therapy during recovery is a strong one, based on decades of research into how the intervention improves drug and alcohol treatment outcomes. As a clinician in the field, I’ve also seen firsthand how family therapy can effectively address the systemic dynamics of substance abuse. In this third and final installation of a series devoted to “clinical excellence,” I’ll share that experience, along with findings from leading experts in the field. The aim will be to show why family therapy is critical to recovery. How Addiction Is a Family Disease An October 1 NBC Nightly News report told the heartbreaking story of 9-year-old Stetson and his three younger siblings— each an innocent victim of the devastating fallout of their mother and stepfather’s addiction to heroin. They were now in the care of other family members, who had also been impacted by the enormous strain of heroin abuse. Sadly, such stories abound in this country. They help to illustrate the physical, emotional and financial toll that addiction takes on families, and why we clinicians have come to treat addiction as a “family disease.” The reality is that one person’s substance use disorder (SUD) impacts the entire family system— but especially the parents, spouses and children of that loved one. If left untreated, these family dynamics can pose a serious obstacle to successful long-term recovery. Family Dynamics of Addiction What are the family dynamics of addiction, then, and how does family therapy help to heal and redress them? Research has revealed the following commonly occurring patterns of dysfunction in SUD-affected families: • Impaired parent-child attachment and a higher rate of attachment disorders • Unmet developmental needs • Higher rates of domestic violence and abuse • Parent-child role reversals • Disrupted family rituals and routines

Family Therapy for Codependency Another reality is that the family dynamics of addiction can be hard to address without the help of a licensed therapist. Take the commonly occurring dynamic of “codependency,” for example. Codependency is characterized by an unhealthy need to please others. Those who suffer from it are constantly seeking self-validation by putting themselves out in order to rescue the person with the SUD. At its root, though, codependency stems from an inability to set healthy emotional boundaries. And what I’ve found (from working with SUD-affected families) is that family therapy is one of the most direct and effective ways to help families establish these healthier boundaries. (12-step recovery groups like Co-dependents Anonymous can also be supportive in this pursuit, but to a more limited extent because they focus almost exclusively on the codependent person.) My own experience has been that when clients and their families start practicing these healthier boundaries with the help of a family therapist, they really can begin to heal from codependency and other dysfunctional dynamics that feed addiction. How Family Therapy Improves Treatment Outcomes

• Impaired communication

Additionally, there is now a large body of evidence that testifies to how family therapy improves treatment outcomes for SUDs, by:

• Financial problems

• halting the progression of substance abuse

• Emotional chaos, fear, and a high-stress family environment characterized by shame and secrecy, loss and conflict

• preventing relapse

• Higher propensity for addiction and other risky behaviors in children of parents with a SUD

• and boosting motivation for recovery

If left untreated, these dynamics don’t just disable the recovery of the loved one with the SUD. They can also leave a devastating long-term impact that compromises the health and well-being of future generations, according to studies. The Essential Benefits to Working with a Licensed Family Therapist The destructive and potentially long-term impact of substance abuse on the family is only one reason why family therapy is critical to recovery. Another has to do with the therapeutic benefits unique to working with a licensed family therapist. From my experience, these include: • A trained and emotionally neutral observer who is better able to identify unhealthy family dynamics and ways of relating • An emotionally safe and accepting environment in which to air needs and feelings • Improved communication and mutual understanding

• increasing abstinence rates Still, other research has turned up the following outcomesrelated findings: • As an intervention for teen substance abuse … family therapy significantly decreased teen drug use, improved family functioning, and reduced conflict, strengthening family cohesion, according to findings in the Journal of Family Therapy. In another study at the University of Miami, family therapy boosted adolescent engagement in recovery, leading the researchers to conclude “family-based models for therapy” are “among the most effective approaches for treating both adults and adolescents with drug problems.” • As an intervention for alcoholism … the participation in therapy of just one “supportive significant other” (a spouse or other close family member) reportedly improved both retention in treatment and treatment outcome. Another study found that alcoholics who received communication skills training with family participation (a form of family therapy) drank significantly less alcohol per day during a six-month follow-up. They also exhibited better communication skills and lower levels of anxiety— measures that correlated closely with treatment outcomes. Continued on page 34

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FACING ADDICTION BY FACING YOURSELF By Michael DeLeon

“A True Friend will tell you the truth, even at the cost of the Friendship” The #1 reason why people don’t become who they want to be is because they’ve grown too attached to who they’ve been. Change is a mountain sometimes. Change amid and from addiction is a mountain without a map. But change is necessary if one is to rise above the state of substance use disorder. We are in the midst of the worst public social health crisis America has ever seen; and with more people being affected by addiction than ever before, one has to wonder where we go from here. How do we overcome this pandemic? How will we avoid losing an entire generation of people? When will we have a system of care and an evidence-based approach that is void of profit-focused care, absent the fraud and lacking the siloed, splintered remedies that permeate the treatment world? When will we stop telling people that “Relapse is part of Recovery”? When will America treat this issue with the attention it deserves? When will we stop looking for a chemical solution to a spiritual problem? When will we stop looking for the answer in more drugs when the answer is in connection, coping skills and self-fulfillment? These are all great questions. But, at times I wonder if they are rhetorical. I wonder if the questions even have answers. I wonder if the questions aren’t answers themselves. And with so many people asking these questions, are there more contradictory answers than shared answers? Is perception and interpretation getting in the way of what will work for most? I often hear now that there are many pathways to recovery; that people find recovery on different journeys. I often hear recovery defined in so many ways now that it puzzles me. How can “Recovery” be a matter of interpretation? A recent “Recovery Coach” trainer stated that, “Someone is in ‘recovery’ when they SAY they are in recovery.” WHAT??? How can we accept that an addict, whom we accept is incapable of rational thought, define their own recovery? How can we define it so differently for different people? When did it change from becoming completely free of all mind altering and mood-altering substances?

longer deny it. I learned this recently both from self-reflection and by giving the advice to someone I mentor in early recovery. The lesson came from both sides, and learning it both ways doubled its impact on me. I want to solve this addiction pandemic more than ever, and I ask myself how it can be done. The point I make at this juncture is that none of these questions can be asked by themselves without consideration of the other. No group in society is going to come up with the same answer for each and every question. That doesn’t mean that we cannot have the same shared goals, but, without collaboration rising from antagonism, without partnerships over dissociation, without unity in our shared goals, I just don’t see the end of this. Do we want to become a society free from addiction? Is that even possible? We are at a point in our history where life expectancy is actually decreasing faster than at any time on record. And it is preventable. “Despair deaths” – alcoholism, drugs and suicide – are a big part of the problem, and so is obesity, poverty and social isolation. It is absolutely NOT just about opiates and heroin. They are merely the flavor of the day. The headlines mislead America; and the groups that pop up titled, “Fight Heroin” or “Stop Opiates” are missing the forest for the trees. If we are to answer the many questions I pose, if we are to cease this preventable decline in the decrease in mortality, if we are to become a nation that does not destroy itself from within, I imagine we must face not only the problems, but face ourselves. We must ask ourselves not only some of these questions, but all of them. The real question is- can we face the answers? DeLeon is the director and producer of the films” Kids Are Dying”, “An American Epidemic”, “MarijuanaX”, and “Road to Recovery”. His fifth documentary will be released in January, 2018 called, “Higher Power”. His memoir, “Chasing Detours will be released in January, 2018. Michael is the founder of Steered Straight Inc. a nationally-recognized educational program and a national advocacy organization called, “Recovery Army”. He is the National Recovery Advocate for Transformations Treatment Center in Delray Beach, Florida.

The “Disease of Addiction” - I think that’s one of the most controversial social topics we’ve ever come up with. We try to change societal perception of addiction. We try to educate society about this being a brain illness and set out to smash the proverbial stigma. We try to convince people that addiction is not a choice, that it is a disease from which there is no known cure. To many, that sounds like addicts are victims, and I don’t know if that is the right approach. The disease concept became divisive in the solution and it’s more misunderstood than ever. I want to believe that we are making more progress than ever, but, the increasing number of people affected does not support my hope. The escalation of social rhetoric in the comment sections of newspapers on articles about addiction, continue to fuel the division. Victim stance is the most damaging and devastating self-defeating mindset in our country. For those caught up in addiction, and often as a result, the criminal justice system, it is more commonplace to simply blame the world. “My parents got divorced when I was very young”, “I was abused”, “I grew up poor”, or, my drug-dealing sibling turned me on to it” … I’ve heard them all. I have used many of them myself. It was when someone told me that I was inviting more problems into my life that I started to change. He told me to “Cancel My Membership to the Woe Is Me Club.” It was some of the best advice I had ever received. I don’t know that this mindset can really change everything for everyone, but, so many people I see caught up in addiction don’t see their way out of it through their own power. What you don’t want to hear is more than likely what you need to face. The truth is already in you. The validation just forces you to no

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“DOPAMINE HOMEOSTASIS” REQUIRES BALANCED POLY-PHARMACY: WE CAUTION AGAINST THE RISK-LADEN USE OF DESTRUCTIVE POWERFUL DOPAMINE AGENTS TO COMBAT AMERICA’S DRUG EPIDEMIC. Kenneth Blum, Ph.D., DHL, B. William Downs, B. Sc., David Siwicki, MD, John Giordano, MAC, DHL, Thomas McLaughlin, MD, Ph.D., Jennifer Neary, Ph.D.

In 1908, President Theodore (Teddy) Roosevelt worried that the national crisis of opiate addiction was weakening America and diminishing its greatness. So, he appointed an Ohio doctor, Hamilton Wright, to be the nation’s first Opium Commissioner. In the decades after the Civil War, the United States developed a deadly narcotics habit. Suffering veterans were hooked on morphine while genteel “society ladies” dosed up with Laudanum — a tincture of alcohol and opium. The wonder drug was used widely as a cough suppressant, and it proved very effective in treating diarrhea in children. In fact, in 1911, Wright told the NY Times- “Our prisons and our hospitals are full of victims of it, it has robbed ten thousand businessmen of moral sense and made them beasts who prey upon their fellows … it has become one of the most fertile causes of unhappiness and sin in the United States.” Remarkably, more than a century later, America has relapsed. The current opioid crisis is more lethal, with record numbers of fatal overdoses, public health professionals expose. However, it is not the first time in U.S. history that the lax commercialization of legal opioids led to a national epidemic. Faced with a late 19thcentury dope scourge, federal law enforcement officials, doctors, and pharmacists, eventually managed to contain the country’s first addiction epidemic. The authors, who have numerous scientific publications on this issue, believe that FDA approved Medication Assisted Treatments (MATS), such as the acute administration of Buprenorphine, are helpful in inducing short-term dopamine release. Chronic use, however, induces a significant reduction in dopamine release at the reward site of the brain, causing an unwanted anti-reward state (see figure 1). Figure 1

For more than 50 years, our research has provided a significant dossier of peer-reviewed and published evidence in scientific journals showing that balancing Dopamine dynamics in the brain reward circuitry is a far more desirable and useful strategy than blocking its normal physiologically required function. Fundamentally, dogmatic protocols used routinely in addiction treatment are an attempt to medicate people with substance dependence back to health. To put it more simply, we are trying to force health rather than nourish the body’s ability to repair and rebalance via optimal gene expression. This focus on medicating abstinence seems counterintuitive. Health can only be nourished not forced; this is more easily said than done. In this multi-billion-dollar market, Big Pharma’ opted for simplicity, combating the global drug epidemic by blocking dopamine function with Naltrexone (via mu receptor antagonism) or with, for example, Acamprosate via antagonizing the NMDA– glutaminergic drive to release dopamine at the reward site (Nucleus Accumbens). Mark Gold and associates in their “dopamine depletion hypothesis” suggested that the powerful dopamine two receptor (DRD2) agonist

Bromocryptine could be used for the treatment of cocaine addiction. Fortunately, neuroscientists realized that chronic administration caused a severe reduction in the number of dopamine receptors (down-regulation). The reason for this unwanted side effect is that Bromocriptine or other powerful D2 agonists like L-Dopa overwhelm the neuro-pathways of the brain, especially the pleasure centers, and the biologically intelligent neurochemical adaptive mechanisms react to prevent too much dopamine function (hyper-dopaminergia) and possibly schizophrenic–like behaviors. Blum and associates have been developing by trial and error a neuro adaptogen, KB220 and many variants since 1968. One recent innovation is the KB220ZBR variation. To date, 37 published clinical studies have validated this nutrient technology based on gene mapping research. This patented technology is comprised of an extraordinary list of ingredients intended to optimize gene expression and the synthesis, transport, reception, and disposal of neurotransmitters. This optimization of gene expression affects the entire brain reward cascade, from serotonin down to dopamine, achieving the functional ‘symphony of neurochemistry’ and the induction of “dopamine homeostasis.” The first ever confirmed psychiatric genetic discovery by the Blum and Noble’s group; the association of the Dopamine D2 Receptor (DRD2) gene and severe alcoholism, was published in JAMA in 1990. The association in genetic studies of the DRD2 gene with many addictions such as alcohol, drugs, food, sex, nicotine, and other excessive reward seeking or selfmedicating behaviors led to the idea of “Reward Deficiency Syndrome” (RDS), first coined by Kenneth Blum in 1995. Reward Deficiency Syndrome is now considered to be an established abnormal psychological disorder listed in the SAGE Encyclopedia of Abnormal Psychology (2017) and refers to a deficiency of reward; disrupted neurological dopamine function. This dysregulation of dopamine is the cause of all addictive, compulsive and impulsive behaviors. To highlight the importance of the RDS concept, in 2013, B. William Downs and Kenneth Blum, published a paper entitled “Have We Hatched the Addiction Egg: Reward Deﬁciency Syndrome Solution System” dedicated to all the people who have lost loved ones to substance-abuse and “reward deficiency syndrome” related tragedies. Why are we failing at reducing the incidence of RDS behaviors? Are we aiming at the wrong treatment targets? At that time, we proposed a paradigm shift; the “Reward Deficiency Solution System,” and provided evidence for its adoption. The Reward Deﬁciency Syndrome Solution System” included: 1) A psychological RDS questionnaire (RDSQ); 2) Genetic Addiction Risk Score (GARS) and 3) A Pro-Dopamine Regulator (KB220ZBR). While the RDSQ and GARS are in development and should be launched in 2018, KB220 variants, with a variety of different ingredients, have been studied in both animal (see figure 2) and human research (see figure 3). At the time of this writing, research on KB220ZBR is progressing. After 50 years of study, we now have fMRI evidence that KB220 variants can enhance resting state functional connectivity and volume (recruit neuron firing in the reward center of the brain) and balance the brain reward circuitry, especially in abstinent heroin-dependent people. Continued on page 32

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DON’T WORRY, BE HAPPY!

By Deborah Rasso, LMHC, LPC, NCC, CAP, ICADC, CH, QS Anxiety, worry, stress, concern, apprehension, nervousness. It doesn’t matter what name you give it. It’s a horrible feeling. Anxiety comes when our minds focus on something in the future that feels like a threat. The body will respond as if it is in danger. The autonomic arousal system (our primitive fight, flight, freeze response) kicks in, causing surges in hormones and brain chemicals that prepare us to survive a life threatening attack. The baffling thing about anxiety is that we can be sitting in a chair in the safety of our home and suddenly our mind perceives that we are under attack. What the mind perceives, the body responds to. The heart may pound, thoughts may start racing, the body may sweat or shake, muscles may tense, the stomach may start to churn, all this in response to a perceived threat. Anxiety disorders are on the rise. According to the National Institute on Mental Health in 2002, 18.1% of the US population suffered from an anxiety disorder. The lifetime prevalence was close to 23% of the population. Though the statistics have not been updated since 2002, those percentages have likely increased. There have been many anxiety-provoking changes since 2002, including the recession in 2007, which caused a marked increase in individuals experiencing anxiety. The Diagnostic and Statistical Manual of Mental Disorders (DSM -5) identifies at least eleven different types of anxiety disorders. Amongst those are Generalized Anxiety Disorder, Social Anxiety Disorder, Specific Phobias, and Panic Disorders. Often, anxiety disorders begin in childhood and if untreated can persist over time. A person can even suffer from several different types of anxiety disorders at the same time. It is often difficult to give one simple diagnosis. When you are suffering from this condition, you don’t really care what they call it. You just want to make the feelings stop. Your loved ones may say, “Don’t worry about that” or “Don’t think about that right now”. You may even hear “don’t act so crazy”. If only it were that simple! If you are in full panic mode, you may not be able to take your next breath. What you really need to hear is “you are safe, you are not alone, and you are loved.” When the worry and stress of life gets too hard to handle, you should seek professional help. However, it’s important to go to the right care giver. You may walk out of the office with a prescription for a dangerous, addictive medication. Many doctors freely prescribe benzodiazepines (i.e., Xanax, Ativan, or Klonopin) to treat anxiety. If you tell them you have trouble sleeping, you may walk out of the office with hypnotic medications (i.e., Ambien, Restoril). These types of drugs can be highly addictive. If you stop taking them abruptly, you may have serious side effects. The best way to begin your treatment is with a mental health professional like a counselor, psychologist or a psychiatrist. You will most likely be referred to a primary care physician for a full check up to rule out any medical cause for your symptoms. Once a medical cause is ruled out, you should begin working with your counselor to identify possible causes for the anxiety and to develop coping skills for the symptoms. Most of the worries we have in our head are just an example of “catastrophizing” (thinking the worst will happen). Since anxiety begins with thoughts, that is the best place to begin treatment. The most common therapeutic modality for anxiety is called Cognitive Behavioral Therapy (aka CBT). CBT is based on the theory that your irrational thoughts cause your emotional reaction, which then changes your behavior. If you look more closely at the original thought and see that it is irrational (not true or proven), you will be able to change your reaction to the thought, which in turn changes your feelings. So in therapy, you are encouraged to identify the thoughts that are causing you to worry, for example “What if I fail the test and can’t graduate”. Once you have identified the thoughts

that are causing you to worry, you will look at how realistic the thought is. For example, “Have I ever failed a test? Have I prepared for the test? Will one test really keep me from graduating”. When you ask yourself the right questions, you will more than likely feel that your worries are unfounded and your anxiety will fade. Mindfulness and meditation are quickly becoming a popular tool to fight anxiety. Mindfulness has its roots in Buddhist meditation practice. Simply put, mindfulness is about being focused in the present moment. There are countless websites and app’s that can help with mindfulness practice. The beauty about practicing mindfulness is that it changes your brain over time. Mindfulness helps to develop the pre-frontal cortex of the brain. That part of the brain works diligently to calm the limbic system which is where the brain responds to perceived threats. The more you practice “staying in the moment” the easier it will be to calm yourself down when you become anxious. When you begin to address your anxiety disorder, you may work with your counselor to determine when and why you became anxious. Once the root cause is identified, you may be a candidate for other therapeutic techniques. If you experienced a trauma and are diagnosed with Post-Traumatic Stress Disorder, your counselor may suggest EMDR (Eye Movement Desensitization and Reprocessing) as an alternative. This method has proven effective in reducing the long lasting effects of a traumatic incident. Depending on the complexity of the trauma, it can be a short treatment or a long process. Another popular way to reduce anxiety is through hypnotherapy. Hypnotherapy is performed by a clinician trained in Hypnosis. This method is used to create a change in behaviors, attitudes and thoughts through the subconscious mind. The therapist may teach you “self-hypnosis” to calm yourself down when you are becoming anxious. There are many other ways to address anxiety, stress and worry. Exercise, self-care, diet, support groups are among them. Take that first step towards change. Anxiety does not have to control your life any longer. Deborah Rasso is a Licensed Mental Health Counselor and Certified Addiction Professional. She is also trained in both EMDR and Hypnosis. She is currently a Primary Therapist at The Palm Beach Institute where she combines her background in music, communications and counseling to create a unique blend of expressive, experiential, and motivational tools to help clients make the necessary life changes for long term recovery. www.delphihealthgroup.com

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

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FREQUENTLY ASKED QUESTIONS FROM FAMILIES ABOUT THE MARCHMAN ACT By Joe Considine, Esq.

In our law practice, we are often asked by families and friends of a substance impaired individual about certain matters with regard to the Marchman Act. These questions arise more than several times and I wanted to address them here. 1. Question: If I file a Marchman Act proceeding with the Court, can I terminate it if I change my mind or my loved one agrees to stay in treatment? Do I have any say in bringing the case to a close? Answer: The family member(s) or friend who files the Marchman Act petition is called the Petitioner. The Petitioner, with some exceptions, controls the action from the perspective that the Petitioner can dismiss the case at almost any time he or she chooses. If there is an outstanding order for treatment or assessment, the court needs to be apprised that the Petitioner wants the case to be terminated which is usually done by the Petitioner filing a pleading entitled a Notice of Voluntary Dismissal. Moreover, the way that the Marchman Act action is enforced is usually by some affirmative action of the Petitioner in requesting that the Court do something. The Petitioner can simply refrain from asking the court to take any action. So, the answer is generally that, yes, once an action is started it can be terminated by the Petitioner. If there is an outstanding order, the Petitioner should appear in Court and explain the reason for wanting to terminate the case. 2. Question: Does the Marchman Act work? I have heard people in recovery programs remark that people do not get clean and sober until they really want to. What’s the deal? Answer: It used to be the conventional wisdom that no one gets help until they want it. But that’s become an old wives’ tale; it is simply not true. There are numerous studies done by highly credentialed experts from prestigious institutions which indicate that court ordered treatment is at least as effective if not more effective than voluntary treatment. We call it a “nudge from the judge”. When there is enough skin on the line, there is a small amount of willingness to listen and the survival instinct kicks in to stay in treatment. We know from numerous studies of the brain that when the pleasure centers of the brain (dopamine receptors) stop receiving their feel good (cocaine, alcohol, pot, etc.…) chemicals, the executive decision making part of the brain – the part that says do not touch the hot stove - starts to regain some functioning and can listen to the good information being provided in treatment. We know that when someone with a professional license (doctors, nurses, airline pilots) is forced into treatment in order to keep their license, they have a high degree of success. The Marchman Act increases the skin in the game of the substance abuser. Go to treatment or go to jail. 3. Question: As a parent, I am concerned about a future employer, a college or professional board finding out that my child has been ordered to treatment under the Marchman Act. Is my fear well-founded? Answer: With the end of the most recent legislative session and the signing of the legislation into law by the governor, the confidentiality of the Marchman Act process is no longer in doubt. The new amendment is Marchman Act, Section 397.6760, which makes it very clear that Marchman Act court records are confidential. All petitions for involuntary assessment and stabilization and all court orders and pleadings are confidential and exempt from the Public Records Act. The public is not allowed access to Marchman Act records or pleadings. Personal identifying information may not be published by the Clerk on a court docket or in a publicly accessible file. There is disclosure permitted but only to limited classes including the parties, their attorneys, guardians of the impaired individual, and the individual’s treating health care providers. A person or entity other

than the classes of people mentioned above may gain access to Marchman Act records only upon a showing of “good cause”, which is a very difficult standard for someone seeking information to meet. In my opinion, it will be exceedingly difficult for a nonparty to demonstrate “good cause” to a court so as to allow any of these records to be released. Disclosure of information about treatment and records of treatment is strongly disfavored as a matter of public policy by the courts generally. So I tell my families to rest assured that no one can find out about their loved one being in treatment. 4. Question: Does the Court make the arrangements for my loved one to go to treatment or do I have to do that? How do I do that? Answer: It is up to the family or the friend who files the Marchman Act petition to locate a facility to do the assessment and treatment. Notwithstanding the bad press of treatment in South Florida, we have many excellent, ethical treatment facilities which accept insurance or are private pay facilities. Sadly, there are few publicly funded or assisted facilities. In Palm Beach County, there is Drug Abuse Foundation in Delray Beach. In Broward County, there is Broward Addiction Recovery Center (BARC) but only for Broward residents. 5. Question: If either I or my loved one with a problem live outside of Florida, can I get my loved one help using the Marchman Act? Answer: The answer is yes. Neither you nor the impaired individual needs to be a legal resident of the State of Florida to utilize the Marchman Act. As long as your loved one who has a problem is physically present however brief a time in Florida, the Marchman Act can apply. Many times we file Marchman Act cases on a substance impaired individual who is a resident of another state but who is visiting friends or family or is temporarily present in Florida. Because the Marchman Act allows a family to get long term help for a loved one and most states have no similar law, many interventionists and treatment centers urge families to find a way to get their loved one to Florida whether on a vacation or to visit, and once the impaired individual is physically present in the State of Florida, the Court has jurisdiction over that individual and can order the person into treatment. Again, there is no legal requirement that the impaired individual be a resident of Florida for the Marchman Act to apply.

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6. Question: How would I get my loved one who is not a resident of Florida subject to the Marchman Act? Answer: Hereâ&#x20AC;&#x2122;s a brief case history to show how it can be done. I represented a family of a young man from North Carolina, an accountant, who was abusing drugs and alcohol. His parents were extremely worried about him. They contacted an intervention specialist who was aware of the Marchman Act and who put them in touch with me. The interventionist helped them locate a Florida treatment center. The parents suggested that their son visit his ailing grandmother in Florida which he agreed to do. The parents provided me with the necessary information ahead of time when their son will be arriving in Florida; the pleadings were prepared and ready to be filed. Once their son landed in Florida, the Marchman Act pleadings were filed, an emergency order was entered, and the son was picked up and taken to treatment where he stayed for sixty (60) days. In another case, the family convinced their out-of-state daughter to vacation for a week in South Beach. Once she was in Miami, she was served with Marchman Act papers and went to treatment. 7. Question: What happens if my loved one leaves treatment even while under a court order? Answer: The treatment facility will notify the Court which will then schedule a hearing on an Order To Show Cause. Sometimes the facility will notify the family or the attorney for the family and the family can file a Motion For Indirect Civil Contempt. In either event there will be a hearing at which time the person leaving treatment will be called to task for leaving contrary to the Court order. Usually, the individual will be given the option of being allowed to return to treatment after a scolding by the Court or to go to jail. Almost everyone in my experience chooses to go back to treatment. This is the leverage of the Marchman Act and one of the reasons it works. Most people do not want to violate a Court order and risk going to jail. But sometimes, it is just the thing that needs to happen, to get their attention that they are killing themselves; and they need help. 8. Question: What is the type of evidence that I need to be prepared with to present to the Court to show that my loved one needs help? Answer: The best evidence includes when the loved one has admitted to you or other family members that they know there is a problem and the need to stop using substances. Many times a substance abuser will be remorseful after a bad run and will admit to family members or friends that they really need to stop. Testimony by the person to whom such a statement was made is admissible. Other types of evidence includes eyewitness testimony of seeing the loved one under the influence; DUIs; arrests for possession or other substance related offenses; hospitalizations for overdoses; testimony by the family member or friend who has seen evidence of usage such as empty bottles, needles, drug residue and the like. 9. Question: If my loved one is in a treatment facility pursuant to a treatment order, can the patient change treatment facilities? Answer: If the family and the patient are working collaboratively and want to change the facility, the answer is usually yes. Generally, the court wants the impaired individual to â&#x20AC;&#x153;buy intoâ&#x20AC;? the treatment process. Unless there is some compelling reason not to change facilities, the court generally approves a change in facilities. If you have questions, feel free to send them to me at our email address: joe@joeconsidinelaw.com. Joe Considine has practiced law in South Florida since 1983. His practice is limited to family law and addiction related law including the Marchman Act. Joe works extensively with families whose loved ones have substance abuse and mental health problems as an attorney. www.joeconsidinelaw.com

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For the Families LIVING THE AMENDS By Craig Schmell

I’d been sober seven months by then. As a recovering alcoholic, I knew how important it was that I made amends to the people I had harmed when I was drinking. God knows, there was a long list of them. But I had to start somewhere, and I decided my father should be at the top of the list. He had tried so hard, loved me so much, given me so many second, third and fourth chances—well, there was no one I had disappointed more than my dad. It’s not easy figuring out exactly what to say to someone you love dearly and have also hurt badly. But now that my thinking was clearing up, I really wanted to find the right words to make amends to this man who had meant so much to me. I prepared for two solid weeks, trying to capture just the right words to express what I was feeling. I sat down, and I wrote up a whole speech. I had so much I wanted to say. My journey to the bottom had been a long and destructive one: years of lying, cheating and manipulating as I drained my father’s faith in me and also his checkbook. I was committed to getting this right. I called him and said I wanted to come see him. He said sure. I went to his house and joined him at the kitchen table, which in our family was always where important conversations occurred. He looked at me without saying anything, just letting me begin. I took a deep breath and opened my carefully crafted speech. “I want to tell you how sor--,” I began.

array of alcohol-fueled adventures I can hardly believe I lived through: Sneaking into the Grammys at Radio City Music Hall, then singing on stage with Whitney Houston and Michael Jackson. Driving in President Reagan’s motorcade. Getting stoned inside the Kremlin and marching in Moscow’s May Day parade. Hanging backstage with major rock stars at Live Aid and the MTV Music Awards. I wasn’t a celebrity or a VIP–just a booze-fueled jerk with a knack for smooth-talking my way into places I did not belong. I thought those hijinks made me feel good about myself. Really, they proved only that I could drown my low selfesteem in gallons and gallons of cocktails, wine and beer. It was only when my mother and father burst into my apartment one Saturday morning—their apartment since they were paying the rent— that I finally began my long road to becoming an honest and decent man. With the help of a brilliant shrink and the beautiful support of daily meetings with other brave souls on the same difficult path, I am proud to say I am twenty-six years sober now and feeling better all the time. That’s twenty-six years of acting—not just saying—my amends. Earlier this year, as I was finishing work on the book, I wanted to do something special for my father, who is now eighty-three years old. I had spent a lot of time thinking about our relationship while I was writing the book. Since I’ve gotten sober, we really had grown extremely close. But I felt like there was still some unfinished business between us. I still had never said to him exactly how I felt or just how thankful I was for everything he had done for me.

“Stop talking,” he said.

I called him on a Thursday morning, and this time I didn’t give him a chance to cut me off. I told him how much I loved him and what a wonderful father he is now and has always been. I told him I wanted to take him on a two-week trip to Israel. I’d pay for everything, I said. I wanted us to have that time together, just him and me.

I was momentarily startled.

As my words sunk in, my father started to cry on the phone.

“Just stop talking,” he said.

Overcome with emotion, it took a moment for him to say anything.

“I don’t want to hear what you have to say,” my father continued. “Your apologies mean nothing to me. Absolutely nothing. Nothing you say means much to me because you are a liar and a cheat.”

Then, he answered that he would love to join me in Israel. He said he really looked forward to spending that time together and taking this special trip with me.

How should I answer this? The thoughts were racing through my head. Should I argue? Should I plead? Should I just stop? Before I could settle on a strategy, my father continued.

“For the last twenty six years,” my father said, “you have made me the proudest father in the world. You did what you said you would. You have lived the right way. You have become a man of honor, dignity and commitment. I told you, ‘Live it. Don’t say it.’ You have lived it, and I have watched everything.”

But halfway through the word sorry, before I could even complete a single sentence, my father cut me off.

“I want desperately to be judged by my intentions,” he said. “But the world continues to judge me only by one thing, and that is my actions.” My father is a lawyer. He has spent his whole adult life representing clients. He is used to making arguments in court. But I never remember him speaking so firmly to me in such a deep, insistent voice. “Don’t tell me what you are going to do,” he said. “Just do it. Just live it. I will know when you are living the right way. You won’t have to tell me. I will know. Great men never have to tell anybody how great they are. People know.” And that, right there, ended my first, halting attempt to make amends to my father and to the rest of my family, as well. I have just written a new book about my wild ride to sobriety and the life-changing lessons I learned as I pulled my careening life back from the abyss. “The Uninvited,” the book is called. “How I Crashed My Way into Finding Myself.” The book, which is being published November 14 by Post Hill Press (Simon & Schuster), recounts an

My father and I had a wonderful trip to Israel. We walked together through the old city of Jerusalem and marveled, like millions of visitors before us, how the world’s three major religions all grew up there. How all these centuries later, the holiest sites of Christianity, Judaism and Islam, are just a short stroll apart. What a shame it is, we agreed, that these three great faiths can’t find full peace and acceptance with each other. “They can’t just say it,” my father reminded me. “That’s not good enough.” “They have to live it,” I agreed.’ CRAIG SCHMELL is a 25-year veteran of Wall Street and a successful business owner in the fitness and food-service fields. He is a popular public speaker and advocate on addiction issues and a dedicated peer counselor. A graduate of Syracuse University and Touro Law Center, he lives in Rumson, New Jersey, with his two teenage daughters.

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IMPORTANT HELPLINE NUMBERS

A New PATH www.anewpath.org Addiction Haven www.addictionhaven.com Bryanâ&#x20AC;&#x2122;s Hope www.bryanshope.org CAN- Change Addiction Now www.addictionnow.org Changes www.changesaddictionsupport.org City of Angels www.cityofangelsnj.org FAN- Families Against Narcotics www.familiesagainstnarcotics.org Learn to Cope www.learn2cope.org The Long Island Council on Alcoholism and Drug Dependence www.licadd.org Magnolia New Beginnings www.magnolianewbeginnings.org Missouri Network for Opiate Reform and Recovery www.monetwork.org New Hope facebook.com/New-Hope-Family-Addiction-Support-1682693525326550/ Parent Support Group New Jersey, Inc. www.psgnjhomestead.com Not One More www.notonemore.net/ P.I.C.K Awareness www.pickawareness.com Roots to Addiction www.facebook.com/groups/rootstoaddiction/ Save a Star www.SAVEASTAR.org TAP- The Addicts Parents United www.tapunited.org

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

ADDICTION & CODEPENDENCY IN THE MIDST OF A NATIONAL CRISIS By Louise A. Stanger Ed.D, LCSW, CDWF, CIP and Roger Porter

We are a nation in crisis. There is hardly a family that has not been affected by addiction. The statistics on the matter of opioids, alcohol and marijuana are alarming - 105 American lives are lost each day to an opioid-related overdose, 1 in 8 Americans experience an alcohol addiction, and a recent Gallup poll finds that 1 in 8 smoke marijuana as legalization rolls out across the states. I am a fierce advocate for systemic change on the micro (individual), mezzo (family) and macro (community) levels. In the wake of our national drug crisis, action must be taken to help loved ones and their families achieve health and wellness. Let’s begin with unpacking the definition of addiction. Per the American Society of Addiction Medicine (March 2011), addiction is a chronic disease of brain reward, motivation, memory and related circuitry. Like diabetes and heart disease it is chronic, progressive and if left untreated- fatal. The individual pursues relief by substance abuse and other behaviors. Addiction is typically characterized by: • An inability to abstain • Impairment in behavioral control • Craving or hunger for substances or rewarding experiences • Diminished recognition of problems with one’s behavior and interpersonal relationships • A dysfunctional emotional response to experiences and circumstances Addiction takes on many forms- from alcohol and other drugs to process disorders: shopping, sex, love, gambling, spending, disordered eating, and even digital addiction. These addictions often overlap together with co-occurring (mental health) disorders. As a clinician/interventionist, when working with families and their loved ones it is important for me to unpack and address the complex nature of these issues. When folks think of addiction, they typically believe it’s an individualistic disease affecting only the one caught in its grip. In truth, addiction creates a volcano effect. Like a volcano that slowly and steadily builds pressure, steam and corrosive lava, addiction erupts with a powerful force and disrupts families and friends, colleagues and associates, business partners and co-workers. Like the unstoppable lava that flows in the streets, addiction disrupts everything in its path. And because one form of addiction bleeds into another - cooccurring mental health disorders such as depression, anxiety, personality disorders, juxtaposed with medical problems such as chronic pain, legal or school issues - many family members feel like they are constantly caught in a spin cycle of destruction and despair. They struggle to find a quick fix with the next bail out for a loved one or for an employer. Moreover, there are over 133 million people in the US that experience chronic pain - pain which is persistent and lasts more than 3 months. Digressing, we know that our bodies are designed to heal within 90 days and after that – it is our emotions that fuel our pain and become the culprit making us believe we need more opioids. This is another piece of the pie that fuels addiction for it often starts with a simple prescription and is confusing to many family members as they believe their loved one’s problems have a firm medical rationale. The findings from the University of Arkansas in 2016 on opioid use are alarming. With a 10-day supply of opioids, 1 in 5 become long term users. Like the deadly volcano effect, addiction and codependency become soul mates holding each other hostage. Codependency is defined as excessive emotional or psychological reliance on a partner, typically a partner who requires attention due to an illness or an addiction. I call this the ultimate bail-out because in effect, a codependent relationship causes the loved one of the person

experiencing addiction to make excuses for their behavior. Here are signs to look for when experiencing a dose of the bail out syndrome, otherwise known as codependency: • Always saying yes to whatever is asked of you • Difficulty setting limits or boundaries. “No” is not part of your vocabulary • Feeling responsible as if it is your fault for your loved one’s problems-hypervigilant • Feeling trapped or held hostage in your relationship • Making excuses, apologizing for your loved one’s behavior, calling work, school, rearranging appointments etc. • Giving money or not realizing money is missing from your wallet • Difficulties showing intimacy • Confabulating the truth, making up stories about why your loved one is the way he /she is • Being secretive, lying to the person so as to hide the truth • Feeling anxious and fearful about being abandoned or rejected • Needing to be in control, looking good to the outside world. Keeping addiction a secret. • Not recognizing how attached you are to your loved one and how your behavior has become part of the problem If you or a loved one is experiencing an excessive relationship with an individual who has substance abuse or a mental health disorder, here are common behaviors you might be taking on: • Being a martyr, (Look what I do for him/ her) • Being a victim (look what he/she has done to me and our family – poor little me) • Being a perpetrator – blaming your loved one who has an addiction for everything that’s not right with your life • Feeling angry and resentful about someone’s behaviors and still bailing them out. (You wrecked that car and got a DUI and you still pay for the car to get out of impound) • Refusing or denying there is a problem – “It’s just this way.” • Challenging to share, know or express feelings - “Everything is alright” • Putting the addicted loved one’s needs first • Making excuses for the loved one • Blaming situations or other people instead of the addicted loved one - “He has such a tough boss” or “She has a mean teacher” • Ignoring the addicted individual’s negative or dangerous behaviors (i.e. stealing, lying, fighting, legal trouble, etc.) • Feeling angry with righteous indignation towards the person • Not being able to label one’s feelings beyond mad, sad, angry • Finishing one’s sentencing for them • Using excessive “we” terms; rarely saying “I” or “me” • Being unable to distinguish the difference between yourself and your loved one’s problems Despite the destructive and painful reality of addiction and its grip

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on circles of families, friends and business associates, change is possible. There are several parts to this. The first is to learn about substance abuse, process disorders, mental health and chronic pain.

articulates what they are willing to do to support their loved one in recovery, as well as ways in which family members are going to take care of themselves.

The second is that you need not be part of the problem - be part the solution! In doing so let the 7 C’s be a guidepost for your new way of being.

The key notion is that healthy boundaries are critical for personal health and happiness. Once a loved one experiencing addiction seeks treatment, all family members, friends and colleagues and business associates must take a hard look at their own behaviors and re-draw these boundary lines to find change.

1. You did not Cause your loved one’s addiction, 2. You alone cannot Cure the addiction 3. You alone cannot Control your loved one’s addiction 4. You can take better Care of yourself 5. You can learn to Communicate your feelings 6. You can make healthier Choices 7. And you can Celebrate yourself and your growth The third aspect of change is creating healthy boundaries for you and your family members and the loved one with addiction. Here are questions that need to be asked related to building honest and healthy boundaries: • What is okay behavior and what is not okay? • What was okay before treatment and how has that changed? • What was NOT okay before treatment and how can you make it better this time? • What gets confusing? I always tell the families I work with that they must be able to wake up each morning, look themselves in the mirror and know that they are worthy and that they can stick to the boundaries they have set and their own personal recovery map. To assist in this process, clients and families in collaboration often develop Change Agreements to help guide the way Change Agreements are a written document in which one clearly

Fourth, it is of paramount importance for the co-dependent to begin to take care of themselves physically and emotionally and to turn to one’s personal values to find strength. Al-anon, other support groups, meditation, mindfulness, exercise and social bonding aid in the healing process. Lastly, movement starts with a willingness to change, sprinkled with fierce love and commitment to family and loved ones, coupled with the tools necessary to change. When those are in place, family members (i.e. you) no longer have to travel down a pity path that leads to cajoling and bargaining. No longer will you mortgage your homes or blame others in an effort to have your loved one stop using. You can finally, unequivocally, tell the truth without shame, guilt, fear, humiliation, fear of recriminatio n and a lifetime sentence that you are the eternally bad sister, mother, father, brother, husband, wife, etc. Because now you know you do not have to have all the actions and now you can Take Positive Action! Be the Warrior! Be Strong! Be Vulnerable and Be the Non CoDependent YOU! Dr. Louise Stanger is a speaker, educator, clinician, and interventionist. www.allaboutinterventions.com Roger Porter has marketing and filmmaking degrees from the University of Texas at Austin.

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GROWING UP STONED - THE IMPACT AND OUTCOMES OF CANNABIS ON ADOLESCENTS AND CHILDREN (PART 2) By Mark S. Gold, M.D. and Dr. Drew W. Edwards, EdD, MS

Continued from page 6

the basal ganglia and thus, impairs balance and coordination, reaction time, and perceptions of time and space.

association between cannabis and a higher risk for depression was noted across different age groups.

Yet, for those who regularly use marijuana to get high, these side effects are dismissed as inconsequential because THC’s effect on the reward system in the midbrain is the brass ring, so to speak, because this is where the rewarding psychoactive effects, of the “high” occur.

After adjusting for co variates and using regression analysis, the research revealed that both early and frequent cannabis use is “robustly associated” with depression as well as suicidal thoughts and behaviors, with adjusted ORs ranging from 1.28 to 2.38. These significant associations persist, even when the researchers excluded lifetime never-users of cannabis from the analysis. Frequent users were twice as likely to report suicidal ideation and attempt than were lifetime but less-frequent users.

Figure 2.

Why Crude Phytocannabinoid should never be a “medicine? Unlike drugs approved by the Food and Drug Administration, “dispensary marijuana” has no quality control, no standardized composition or recommended dosage for specific medical conditions. It has no prescribing information or no high-quality studies of effectiveness or safety. The FDA is not opposed to approving cannabinoids as medicines, as it has already approved two cannabinoid medications and is poised to approve a CBD based anti-seizure medication shortly. Specifically, R=researchers at Nationwide Children’s Hospital and the Ohio State University College of Medicine in Columbus have demonstrated that CBD may provide tremendous benefits for children suffering from a severe form of epilepsy called LennoxGastaut Syndrome (LGS). The researchers noted “CBD looks like an important molecule for reducing seizures among children and adults with epilepsy possibly other medical conditions”. Areas of the brain and function impaired by THC High Octane Weed Higher Potency Marijuana is particularly harmful to the developing brain. But it’s not just the potency, it’s also the ratio between THC and CBD. For example, street marijuana in the 1980’s contained approximated 50% THC and 50% CBD. We now understand that CBD is the healthy and protective constituent of cannabis. In contrast, today’s street marijuana is 90% THC and 10 % CBD, which produces an intense high, but also does more damage to the functionality of the brain, e.g., the neurotransmission of anandamide is corrupted by THC, thus inhibiting the role of anandamide in numerous somatic systems. To put it bluntly, CBD has numerous protective and beneficial effects, whereas THC simply gets you high. The only medicinal benefit of smoking THC is to reduce nausea and some neurogenic pain associated with late stage cancer and the effects of chemotherapy. Yet, it very well may be that the CBD is responsible for the positive effects observed in palliative care. Even if THC may temporarily mediate some forms of pain, the damage done, especially to the young and relatively healthy users far outweighs any known benefit of smoking a psychoactive substance associated with addiction, depression, cognitive decline, suicidality, anxiety, multiple failed relationships, and psychosis. Marijuana use and Depression and Suicidality The single most controversial question is the effect of cannabis use on mental health. Lev-Ran and colleagues evaluated 14 studies with a total of 76,058 participants in a meta-analysis. The odds ratio (OR) for depression among cannabis users’ vs nonusers was 1.17 (95% confidence interval [CI], 1.05-1.30). There was also evidence of a dose-response effect between marijuana use and the risk for depression. Heavy cannabis users had a higher OR for depression of 1.62 (95% CI, 1.21-2.16) compared with nonusers. The positive

Knowing that the science does not support the claims that THC is a harmless drug with multiple medicinal value, the pro cannabis lobby set their sights on the ballot box. Backed by millions of Madison Avenue marketing dollars, they have prevailed in several states and are targeting many more. As scientists, we are excited about the potential of cannabis derived medicines, especially from CBD, which has no psychoactive effects. This is important because the best available research informs that THC is associated with numerous deficits including cognitive impairment, lower IQ, neuroadaptation, passed in utero to an unborn child, depression, suicidality, anxiety disorder, psychosis, schizophrenia and a shorter life expectancy. Marijuana is a dangerous and addictive drug. Additional cannabinoids and constituents of cannabis may be approved for humans in the near future, but only after rigorous scrutiny by the FDA for a specific disease, with a specific dosing and high safety parameters. References provided Upon Request Mark S. Gold, MD, Chairman of the RiverMend Health Scientific Advisory Boards, is an award-winning expert on the effects of opiates, cocaine, food and addiction on the brain. His work over the past 40 years has led to new treatments for addiction and obesity which are still in widespread use today. He has authored over 1000 medical articles, chapters, abstracts, journals, and twelve professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox and addiction treatment practice guidelines. Dr. Drew Edwards is a behavioral medicine / addictive disease researcher, clinician, author, medical writer, and clinical consultant. He has published over 250 peer-reviewed and popular articles on behavioral medicine obesity, addictive disease, parenting and youth culture, as well books on childhood depression, and instilling selfesteem in children. He is a graduate of the University of Minnesota, received his Master of Science from the University of No. Florida and earned his doctorate at Nova Southeastern University.

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OXYGEN 8 ADDICTION - USING HYPERBARIC OXYGEN AS AN ADJUNCTIVE THERAPY FOR ADDICTION RECOVERY By Mark Jackson and Thomas J. Foster

“It’s not your fault”, are the famous words that Robin Williams repeatedly spoke to Matt Damon in the nine time nominated Academy Award film Good Will Hunting, and may very well ring true in the quest for freedom from substance abuse. “Often times there’s a direct correlation between addiction and brain damage”, says Thomas Foster, Co-Founder of Oxygen 8 Addiction. Foster bases his claims on personal experience as well as research from Paul Harch, M.D., Author of The Oxygen Revolution. Dr. Harch has been treating Traumatic Brain Injury (TBI) with Hyperbaric Oxygen Therapy for three decades in Louisiana with notable success. Within the last decade he discovered that it reduces suicidal ideation with PTSD patients. He uses SPECT brain imaging to find oxygen deficient areas. Post therapy scans typically show substantial metabolic increases in brain function. Videos of patient progress taken before and after treatments have gained national attention. The latest of many amazing recoveries was recently aired all across the nation October 6, 2017 on the Today Show. Toddler Eden Carlson almost died from drowning. She suffered a near-drowning and reportedly did not have a heartbeat for two hours before being resuscitated. The three year old had severe brain damage and her recovery with HBOT has been described by many as “miraculous”. Foster’s passion for helping families recover from substance abuse comes at a price and hits close to home. “I lost a daughter in 2010 and made her an oath to help her generation with addiction recovery”, Foster stated. His personal traumatic brain injuries led to his discovery of HBOT and when he met Mark Jackson last December, the seed of his promise sprouted. “It was like throwing gas on a fire”, Jackson expressed as he described their passion to ameliorate addiction issues and aid in successful long term recovery using HBOT and thus, the journey began for Oxygen 8 Addiction. HBOT is FDA approved and most insurance companies will cover approximately 15 conditions. Many neurological conditions such as Dementia, Alzheimer’s, PTSD and TBI are also being treated but paid for out of pocket as American allopathic medicine is slow in supporting the “off-label” use of HBOT. Some HBOT advocates suggest it is a financial political issue. Oxygen is a necessity of life. No oxygen means no life. HBOT delivers oxygen under pressure and acts as a drug. It is non-invasive and has virtually no side effects with proper dosing. The process saturates the body with 700-1,200 times more oxygen than normal breathing. Rehabilitation centers can easily incorporate HBOT as an adjunctive therapy to their current programs. Under appropriate protocols it can detoxify the body and regenerate and repair damaged tissuesincluding brain tissue and liver. “I don’t even use the word ‘Addict’ in my vocabulary”, Jackson says, “I ask therapists to give me their toughest cases, the ones that are continually relapsing. Most have experienced some form of mild brain injuries ranging from contact sports to falling off a swing at the playground to emotional trauma.” Jackson adds, “This is not a weak-willed or morally flawed problem. HBOT needs to be implemented immediately and it’s simple to do. It can be relieving from the guilt and shame they carry when they experience the benefits”. Covenant Hyperbarics in Searcy, Arkansas works with recovery professionals to implement HBOT. This issue has garnered national attention, especially with the current Opioid crisis that has escalated in the last couple of years. “After 40 years and a trillion dollars, the nation has little to show for its war on drugs”, sites Former Director of National Drug Control Policy Michael Botticelli in a 60 Minutes Interview aired December 13, 2015. “We’ve learned addiction is a brain disease. This is not a moral failing. This is not about bad people who are choosing to continue to use drugs because they lack willpower. You know, we don’t expect people with cancer just to stop having cancer”, says Botticelli. “The hallmark of addiction is that it changes your

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Paul G. Harch, MD

brain chemistry. It actually affects that part of your brain that’s responsible for judgment”, he continued. Foster and Jackson met with Ohio Attorney General, Mike DeWine on July 3, 2017 about the addiction epidemic Ohio is facing as they lead the nation in death by addiction. When DeWine was asked what has helped the “death by addiction” epidemic his frustrated response was a swift “Nothing”. The state of Ohio has filed a lawsuit against certain Pharmaceutical companies as a counter to the “Tsunami” of drug deaths. Foster has hopes to join forces with drug companies to implement HBOT as a reformative approach to recovery. Foster knows the trauma of dealing with the fog of Post-Concussion Syndrome. After his first HBOT treatment he cited, “I felt more alert and mentally sharper using HBOT”. Colorado resident Jay Roller had brain surgery 6 years ago and experienced a concussion 2 years ago. He describes his progress as, “the light switch was flipped on” in his brain following his HBOT treatments, “I was on everything (prescription drugs) for anti-anxiety and depression. HBOT improved my sleep and changed my life”. He is currently planning a HBOT facility in the Boulder area. In 2009, Dr. Mehmet Oz, from the Dr. Oz Show described his first HBOT treatment as feeling “more alert and jazzed up”. “It gets those cells moving along so it goes out to heal areas. In some parts of the body, like the brain, where you don’t always have a lot of oxygen in the tissues, it might improve memory. It might play a role in making those cells which have energy factories function more efficiently”, he adds. Our hero Veterans know all too well the relationship between addiction and brain injuries. In April, the State General Assembly of Indiana appropriated $1 million for an initial pilot program to treat Veterans with TBI and PTSD using HBOT due to the efforts of advocates like Brigadier General James L. Bauerle, USA, (Ret). He says using HBOT for addiction will, “definitely work because it is used successfully in other countries like Russia, India, China, and the United Kingdom and the cost is very minimal”. General Bauerle emphasizes, “The significant scourge of drug addiction we are experiencing in America needs every possible solution acted upon NOW! Delay will lead to more deaths, more tragedy, more broken homes, more grieving parents, more orphaned children, more addicted new-born babies, and unrecoverable damage to our society.” www.oxygen8america.com Mark Jackson owns Covenant Hyperbarics in Searcy, Arkansas. He is the Co-Founder of Oxygen 8 Addiction and offers consultation, sales, installation, and training for all aspects of Hyperbaric Oxygen Therapy. Thomas J Foster is the Co-Founder of Oxygen 8 Addiction. He specializes in the consultation and implementation of Hyperbaric Oxygen Therapy into Addiction Recovery Facilities.

“DOPAMINE HOMEOSTASIS” REQUIRES BALANCED POLY-PHARMACY: WE CAUTION AGAINST THE RISK-LADEN USE OF DESTRUCTIVE POWERFUL DOPAMINE AGENTS TO COMBAT AMERICA’S DRUG EPIDEMIC. Kenneth Blum, Ph.D., DHL, B. William Downs, B.Sc., David Siwicki, MD, John Giordano, MAC, DHL, Thomas McLaughlin, MD, Ph.D., Jennifer Neary, Ph.D.

Continued from page 20

Figure 2.

and optimal health. Pharmacological impositions can have a shortterm benefit, but chronic administration of drugs like SSRIs (or any ‘reuptake inhibitor’) prolongs neurotransmitter presence in the synapse and blunt or inhibit the synthesis and reception of serotonin or other neurotransmitters using this pharmacological tactic. There is evidence that chronic administration of L-Dopa increases pre-frontal cortex dopamine and serum corticosterone (the stress-related hormone). There is also evidence of a profound serotonin-dopamine imbalance following L-Dopa treatment. Some manufacturers despite FDA limitations have produced plant-based L-Dopa in the form of Velvet Bean and studies have linked this to both psychosis and homicidal behavior.

Figure 3.

Unfortunately, the success of a useful product technology incentivizes the entrance of opportunistic knock-off marketers. After all these years, it has come to our attention that an unnamed company is attempting to copy KB220 technology and commercialize what could be a very harmful product. While the product contains some of the same ingredients as found in KB220 variants, the inclusion of the drug L-Dopa, an amino-acid precursor of dopamine approved by the FDA for Parkinsonism, with well documented side effects, is of concern. Of even more concern, is the potential of this product to cause more harmful effects, with the daily use, common to products identified as ‘dietary supplements.’ A possible harmful offense notwithstanding, this ingredient disrupts the neurochemical balance, especially of dopamine, and can induce unwanted hyperdopaminergia and dyskinesia, instead of much-needed balance. It has the same effects as bromocriptine leading to dopamine D2 receptor down-regulation and even possible heightened schizophrenia-like behaviors. The body maintains the ideal environment to optimize health via an elaborate system of ‘checks and balances’; i.e. a highly complex feed-back system to achieve homeostatic equilibrium. Examples include body temperature, pH, insulin, thyroid, and other hormone functions, neurotransmitter function and much more. So, to protect against excesses or deficiencies of such bio-substances, feed-back regulatory signals maintain balance

Over 100 million people in the United States carry the D2 receptor gene A1 allele, which is responsible for lower D2 receptor formation, present in Parkinson disease, and may be a precursor to the development of Drug-Induced Dyskinesia. Therefore, persons presenting for chemical dependency treatment should be warned about using any product containing L-Dopa. Moreover, low Dopamine function can be problematic especially in carriers of the Valine allele (replacement of Methionine) that causes reduced dopamine function due to the high activity of synaptic dopamine break down. This high activity could subsequently produce an unwanted potent neurotoxin metabolite from L-Dopa in the form of 3-O-methyldopa. Another associated problem with L-Dopa administration is that it is known to cause a decrease in concentrations of S-adenosyl Methionine (SAMe) in cerebrospinal fluid with an increase in 3-methoxytyrosine, especially in children. The small molecule (SAMe) is involved in a process known as methyl donation, seen as an intermediate in one pathway to epigenetic cellular maintenance. Known side effects of the chronic administration of L-Dopa for Parkinson patients include mania, dyskinesia (rigidity in extremities, face, mouth, and tongue) and abnormal involuntary movements (AIMs). Also, psychosis, auditory hallucinations, homicidality, hypersexuality, confusion, delusions, orthostatic hypotension, sleep disruption, age-related mental disturbances, impaired gait, cognitive decline and kaliuresis (renal dysfunction; the induction of unwanted excretion of potassium) are side effects. Based on ignoring many studies, the use of L-Dopa is still considered Recognized As Safe (GRAS) but the FDA has provided limitations on the over-thecounter use of L-Dopa and even the plant extract. Certain combinations that evoke significant caution include threonine, a GRAS listed amino acid precursor, in combination with L-Dopa, are present in products that claim benefit for anti-cravings. L-theanine increases neurotransmitter production, one of which is dopamine. Green tea has lots of threonines, although it can also be taken as a supplement. Along these lines, Acetyl-l-tyrosine (a potential supplement) is a production-ready form of tyrosine, which will make it easier for your brain to create dopamine. It is easy to understand that this combination is unwanted especially in any nutraceutical supplement with the potential to impact the over-production of dopamine both within the central nervous system and peripherally. Summary The well-researched pro-dopamine regulator KB220ZBR and prior variants, show increased functional connectivity, in both animal and human neuroimaging studies. Prolonged neuroplasticity (brain cell repair) has been observed in rodents. Moreover, studies have been published showing that KB220Z increased Continued on page 34

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“DOPAMINE HOMEOSTASIS” REQUIRES BALANCED POLY-PHARMACY: WE CAUTION AGAINST THE RISK-LADEN USE OF DESTRUCTIVE POWERFUL DOPAMINE AGENTS TO COMBAT AMERICA’S DRUG EPIDEMIC. Kenneth Blum, Ph.D., DHL, B. William Downs, B.Sc., David Siwicki, MD, John Giordano, MAC, DHL, Thomas McLaughlin, MD, Ph.D., Jennifer Neary, Ph.D.

Continued from page 32

connectivity volume, enhances neuronal dopamine firing, and has eliminated lucid dreams in humans over a prolonged period. An unprecedented number of clinical studies validating the success of a patented nutrigenomic technology (KB220ZBR and prior variants) to re-balance brain chemistry and optimize dopamine sensitivity and function have been published. On another note, it is sad that unsuspecting consumers could be duped and endangered by false promises of knock-off marketers with look-and-soundalike products. Moreover, unscrupulous marketers sell products containing ingredients having potential dangers (i.e., combinations of potent D2 agonists including L-Dopa and L-Theanine) which threaten the credibility and reputation of validated, authentic, and ethical products. We encourage clinicians and neuroscientists to continue to embrace the concept of “dopamine homeostasis” and search for safe, effective, validated and authentic means to achieve a lifetime of recovery, instead of reverting to anti-dopaminergic agents disrupting feed-back sequela or promoting powerful D2 agonists compromising needed balance that are doomed to fail in the war against this devastating drug epidemic. Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical College and graduated from Columbia University and New Jersey College of Medicine. He also received a doctor of humane letters from Saint Martin’s University Lacey, WA.

WHY FAMILY THERAPY IS CRITICAL TO RECOVERY By Anna Ciulla, LMHC, RD, LD

Continued from page 14

• As a treatment for co-occurring disorders (CODs) … CODs like anxiety, depression and schizophrenia (among other mental disorders) often coexist with drug or alcohol addiction, but family therapy has been a promising intervention for many of these disorders. As one example among many, in findings published in the journal, Advances in Psychiatric Treatment, depressed clients who received couple’s therapy “did significantly better” than those who received an antidepressant alone. Similarly, a 2010 study found that schizophrenic clients with relatives receiving family intervention were more likely to comply with their medication regimen and had lower rates of relapse. In summary, family therapy is critical to recovery from drug and alcohol addiction. The family dynamics of addiction are one reason. These dynamics are hard to address without the help of a family therapist— another reason. Then there are the essential therapeutic benefits that only a licensed family therapist can provide, based on my experience working with clients and families (a third reason). The overwhelming evidence that family therapy improves treatment outcomes is a fourth and final reason. Together, these four factors help to fill in the contours of what constitutes “clinical excellence” in treating addiction, by revealing how family therapy is a gold standard in substance abuse care. Anna Ciulla has been passionately helping clients with substance use and co-occurring disorders to heal, using solution-focused, strengths based care, for nearly twenty years. In her role of directing client care services at Beach House Center for Recovery, she uses a spiritual perspective and strongly believes in the power of a culture of connection for both clients and staff. In addition to addiction and mental health disorders, Anna has expertise in the area of eating disorders and women’s issues, both as a Licensed Mental Health Counselor and Registered and Licensed Dietitian. https://www.beachhouserehabcenter.com/

Bill Downs is a nutritional biochemist. In 2008, Downs was cofounder and CEO of LifeGen, Inc., a nutrigenomic company In 2013, Downs founded Victory Nutrition International, Inc. to research, develop and market evidence-based proprietary, patented and patent-pending nutraceutical products direct to consumers. Jennifer Neary MS, PhD serves as Chief Scientific Officer for Avagen Health in San Antonio, Texas. Dr. McLaughlin is the Medical Director of the Center for Psychiatric Medicine in Lawrence Mass. Dr. Siwicki is a Co-Founder of Dominion Diagnostics and served as President and a Director of Dominion since its founding in 1997. He continues to serve on Dominion’s Board of Directors and Addictions Advisory Board.

THANKSGIVING, FOOTBALL AND RECOVERY

By John Giordano, Doctor of Humane Letters, MAC, CAP Continued from page 8

a comprehensive survey of the use of complementary health approaches by Americans, found that more than 18 million adults and nearly 3 percent of children (more than 2 million) had received chiropractic or osteopathic manipulation in the past 12 months. Patients are finding relief from pain through chiropractics. On the NIH website I found an analysis of the use of complementary health approaches for back pain, based on data from the 2002 NHIS. The study revealed that chiropractic was by far the most commonly used therapy. Among survey respondents who had complementary health approach therapies for their back pain, 74 percent (approximately 4 million Americans) had used chiropractic. Among those who had used chiropractic for back pain, 66 percent perceived “great benefit” from their treatments. Like dealing with any professional, your results can vary by practitioner. When seeking out an acupuncturist or chiropractor it is always a good practice to ask them about their education and license. Also ask for references from people in the medical profession, friends and relatives. There are sites online that you may find helpful as well. I seriously doubt we’ll see professional sports adapt alternative medicine anytime in the near future. Although alternative medicine is effective at treating the core of the pain, opioids can mask it and get the player on the field faster. But sports franchises have concerns – revenue and image – that you do not. I think you’ll find the effort you put into examining alternative medicine well worth the time. In closing, I would like to wish you, your family and friends a warm and blessed Thanksgiving. John Giordano, Doctor of Humane Letters, MAC, CAP, is the founder of ‘Life Enhancement Aftercare Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peerreviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites: www.PreventAddictionRelapse.com www.HolisticAddictionInfo.com

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Take the first step towards recovery. Learn more about our detox services. Drug and alcohol detoxification is an intervention in the case of physical dependence to a drug or alcohol, the practice of various medical treatments for symptoms of withdrawal. Individuals who have been habitually using alcohol or drugs for a period of time will develop a chemical dependency, and it can be dangerous to try detox without medical assistance. The body and brain build up compensating measures when using certain drugs and alcohol, and simply stopping “cold turkey” can potentially cause seizure, respiratory depression and stroke. A thorough drug and alcohol detox center program preceding a drug or alcohol rehabilitation program ensures the process of recovering from addiction will have a lasting and significant effect. 1st Step’s drug detox center safely helps a substance abuser through the experience of withdrawal from habitual use of drugs and alcohol. The drug detox process often includes medication to manage dangerous and unpleasant withdrawal symptoms, making the transition safer and more tolerable. Drug detox medications can be administered both on inpatient and outpatient basis, through medical supervision. 1st Step offers a comprehensive recovery plan and treatment available to transition individuals who complete detox into the next phase necessary to ensure their ability to remain drug free. Call today for information and availability of our detox and drug and alcohol rehabilitation services.

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