Oct issue

ALCOHOL RELATED ILLNESSESS IN ALCOHOLICS WITH LONG TERM SOBRIETY THE RIGHT DETOX RECOVERING FROM CO-DEPEPENDENCY: THE TRUTH ABOUT PEOPLE PLEASING

DRUG CRIMES:FEDERAL AND STATE ADDICTED FAMILIES AND FRIENDS BEWARE OF TRADING YOUR ADDICTION WALLY P - STEP 4-THE ASSETS AND LIABILITIES CHECKLIST AFFECTIVE MINDFUL PRESENCE

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs, alcohol and petty theft in Palm Beach County. It is also distributed locally to the Palm Beach County High School Guidance offices, The Middle School Coordinators, Palm Beach County Drug Court, and other various locations.

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.

Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. Florida is one of the leading States. People come from all over to obtain pharmaceutical drugs from the pain clinics that have opened virtually everywhere.

The availability of prescription narcotics is overwhelming, and as parents our hands are tied because it is legal.

Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20’s and 30’s right up to the elderly in their 70”s, thus, creating a generation of addicts.

Addiction is a disease but it is the most taboo of all diseases. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school, or even worse an overdose, that we realize the true extent of their addiction.

I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved ones life. They are more apt to listen to you now then they were before, when whatever you said may have fallen on deaf ears.

This is the point where you know your loved one needs help, but you don’t know where to begin.

I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from.

There are Psychologists and Psychiatrists that specialize in treating people with addictions.

There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are Transport Services that will scoop up your resistant loved one (under 18 yrs old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes To Advertise, Call 561-910-1943

a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs 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 instead of jail.

I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself as well. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents.

These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with any one outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction.

Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top 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 proper care.

They need help. Please don’t allow them to become a statistic.

There is a website called the Brent Shapiro Foundation. Famed attorney Robert Shapiro started it in memory of his son. I urge each and every one of you to go to that website. They keep track on a daily basis of all the people that die due to drug overdoses. It will astound you.

I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com.

Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com 3

SunsetHouse Ad_Layout 1 8/17/12 10:31 AM Page 1

IMPORTANT HELPLINE NUMBERS 211 PALM BEACH/TREASURE COAST 211

www.211palmbeach.org FOR THE TREASURE COAST www.211treasurecoast.org FOR TEENAGERS www.teen211pbtc.org AAHOTLINE-NORTH PALM BEACH 561-655-5700

www.aa-palmbeachcounty.org AA HOTLINE- SOUTH COUNTY 561-276-4581

www.aainpalmbeach.org FLORIDA ABUSE HOTLINE 1-800-962-2873

www.dcf.state.fl.us/programs/abuse/ AL-ANON- PALM BEACH COUNTY 561-278-3481

www.southfloridaalanon.org AL-ANON- NORTH PALM BEACH 561-882-0308

www.palmbeachafg.org FAMILIES ANONYMOUS 847-294-5877

(USA) 800-736-9805

(Local) 561-236-8183 Center for Group Counseling 561-483-5300

www.groupcounseling.org CO-DEPENDENTS ANONYMOUS 561-364-5205

www.pbcoda.com COCAINE ANONYMOUS 954-779-7272

www.fla-ca.org COUNCIL ON COMPULSIVE GAMBLING 800-426-7711

www.gamblinghelp.org CRIMESTOPPERS 800-458-TIPS (8477)

www.crimestopperspbc.com CRIME LINE 800-423-TIPS (8477)

www.crimeline.org DEPRESSION AND MANIC DEPRESSION 954-746-2055

www.mhabroward FLORIDA DOMESTIC VIOLENCE HOTLINE 800-500-1119

www.fcadv.org FLORIDA HIV/AIDS HOTLINE 800-FLA-AIDS (352-2437) FLORIDA INJURY HELPLINE 800-510-5553 GAMBLERS ANONYMOUS 800-891-1740

www.ga-sfl.org and www.ga-sfl.com HEPATITUS B HOTLINE 800-891-0707 JEWISH FAMILY AND CHILD SERVICES 561-684-1991

www.jfcsonline.com LAWYER ASSISTANCE 800-282-8981 MARIJUANA ANONYMOUS 800-766-6779

www.marijuana-anonymous.org NARC ANON FLORIDA REGION 888-947-8885

www.naranonfl.org NARCOTICS ANONYMOUS-PALM BEACH 561-848-6262

www.palmcoastna.org NATIONAL RUNAWAY SWITCHBOARD 800-RUNAWAY (786-2929)

www.1800runaway.org NATIONAL SUICIDE HOTLINE 1-800-SUICIDE (784-2433)

www.suicidology.org ONLINE MEETING FOR MARIJUANA www.ma-online.org Ruth Rales Jewish Family Services 561-852-3333

www.ruthralesjfs.org MEETING HALLS Billy Bob Club 561-459-7432

561-312-2611 central house 2170 W Atlantic Ave.

SW Corner of Atlantic & Congress Club Oasis 561-694-1949 Crossroads 561-278-8004 www.thecrossroadsclub.com EasY Does It 561-433-9971 The Meeting Place 561-255-9866 The Triangle Club 561-832-1110 www.Thetriangleclubwpb.com

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Sunset House is a licensed, residential treatment program for men struggling with chemical dependency. We are committed to helping our men develop the skills necessary to lead sober and productive lives. Our goals are to safely and effectively transition our residents back into their communities with all of the tools necessary to maintain long-term, meaningful sobriety. Our clients are men looking for an affordable alternative to intensive inpatient treatment.

Early recovery can be a difficult experience; our program is intended to aid residents in body, mind and spirit at every step of the way.

If you or someone you love is struggling with addiction, call Sunset House today at 561.627.9701 or email us at darthur@sunsetrecovery.org. www.SunsetRecovery.org

Miracles DO Happen HOPE. BELIEVE. RECOVER.

A STRUCTURED, WOMEN--ONLY TRANSITIONAL HOUSING PROGRAM IN DELRAY BEACH, FLORIDA Millie Tennessee, Executive Director 561-302-9584 Lisa May, Director of Admissions 606-362-6989 lisa.miraclesdohappen@gmail.com

www.miracles-do-happen.net

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Addicted Families and Friends

By Mitchell E. Wallick Ph.D. CAP CAGC FABFCE, Executive Director at C.A.R.E. Addiction Recovery Addicts are addicted to their drug or activity of choice. Families and friends are more often than not addicted to controlling the behavior of the addict. Because we do not wish to see our loved ones hurt or go to jail, we often will take extraordinary steps to keep them from using and getting them out of trouble.

I would share with you the story of a wife, a very respectable, generally tea totaling lady who was arrested for a DUI. At a party, her alcoholic husband was as usual drinking far too much. In order to slow the amount he was drinking, she finished each of his drinks. Since in spite of her efforts, he was passed out on the back seat of the car she was driving home-- and you can figure out the rest of the story.

In my discussion I must begin with two unalterable truths. They are:

The family in turn now feels like they are the victim. They respond with pleas like: 1. How can you do this to us?

2. We have given you everything?

3. Weren’t we good parents?

4. We put you through school, how could you do this to us.

5. You are killing your mother, father, grandmother etc.

6. We love you so much. Please stop for our sake.

1. People must recover for themselves. Like going to the bathroom, the actual act of recovery must be performed by the addict. No one is able to do it for them. If that were the case there would be no addicts, as families and therapists would have gladly done it for them.

The addict then will feel guilty. They will now have to rescue those around them. The only way to perform this rescue is to agree to do what the family is asking, i.e. stop using. This is not what the addict wants so they again become the victim and the vicious cycle begins again.

2. People get better “when the pain of their illness becomes less than their fear of changing.” To recover, one must decide that the benefits of using are far less and more painful than a sober life.

For this reason it is extremely important that the well meaning family/friends break the cycle of their own addiction. In order to do this they must learn and accept the fact that giving the addict what they want instead of what they need is neither helpful nor loving. In fact while it is easier to give in, than to give the addict what they need.

Facing the anger and displeasure of someone we care about is definitely not a pleasant task. None the less, if the addict is to get better, this will have to be done.

Think of it this way. Is it not far better to have the addict angry at you for a few days, (or even weeks or years) than be angry with yourself because the addict has died of an overdose or ended up in jail?

When as well meaning family members and friends we seek to protect the addict from the consequences of their actions, we are actually encouraging their disease.

Think of it this way, a young child begins to climb a fifty foot ladder. Each time he climbs we laugh and say cute it is. We stand behind him and make sure he does not fall. A few days later you are not around. He climbs to the top of the ladder and falls.

How much better would it have been if we stopped him from climbing by giving him a consequence? (Either natural falling off the ladder, or a time out etc.)

I repeat, addicts get better when the pain of their disease becomes less than their fear of changing. When we bail the addict out, we are allowing climbing that ladder higher and ensuring that consequences of their addiction will be that much greater.

Remember the consequences of addiction uninterrupted are always resulting in institutions, insanity or death.

Let us look at the dynamics that posed by the Addict Dysfunctional Family Relationship.

Most families are rescuers. They try in every way that they can to protect the addict from the inevitable consequences of the addict’s addiction. They will bail the addict out, make excuses for the addictive behavior etc. Their fallacious belief is that they can make the addict change by protecting him or her. They in turn, recognize the illogic of the addict’s behavior attempt to institute controls. They in practice become jailers. They take what they believe are appropriate steps to ensure that the addict will stop using. These might include but are not limited to: 1. Attempting to baby-sit the addict.

2. Making sure that the addict is attending meetings.

3. Setting up all types of questions about the addicts activities 4. Following the addict around.

5. Checking his/her cell phone calls 6. Insisting on curfews.

7. Confining the addict to the house 8. Making sure the addict has no money 9. Making idle threats 10.Taking away the addicts car etc.

At the same time the addict sees him/herself as a victim. In active addiction, the addicts never view themselves as being at fault. Because of their ability to rationalize and justify their behavior, they feel put upon and the recipient of unfair treatment.

After all they are different from other people. They minimize their disease. The crack addict will say, “Well at least I don’t use a needle like those heroin addicts” The heroin addicts will rationalize, “well at least I am not using heroin.” It is important to remember throughout this process that the addict is not ready to give up drugs and/ or stop using. In fact, the more controls that are placed on the addict, the more likely he/she is to attempt to use more drugs. Let’s face it, that is an addict’s response to all uncomfortable situations. When pressure is placed on the addict to control their behavior it results in two things. The addict will: 1. Use more 2. Become very angry When this occurs the addict usually becomes very angry. The addict will yell, scream and argue. He/she will say things like: 1. You can’t tell me what to do. I am an adult.

2. If it were not for you, I would not be an addict.

3. You know, I might just as well kill myself.

4. You don’t understand how sick I will get if I don’t have my drugs.

5. If you don’t give me the money to pay the dealer, he will kill me.

6. What will the family say if they find out that you are not helping me.

7. If you don’t do this for me, I might lose my job and then how will you live.

8. If you had the job I do, you would use also.

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9. If you had to live the way I do, you would use also.

10.The Dr. is giving me these medications. Who are you to tell me to stop?

11. So you want me to hurt.

Try to think of it this way. The person you love has a physical illness. There is an operation that succeeds one in one hundred times. Ninety nine times the patient dies. On the other hand if they receive no treatment they will die a horrible death one hundred percent of the time. Placed in this situation would you not then drag that person to the table kicking and screaming? I expect that you would do whatever it takes to give them that chance. The same applies to the addiction. Being tough with the addict is the only way that they can be saved.

I am often asked how to be tough. The following is the technique that I recommend for intervening.

1. Gather together everyone who is concerned about the addict.

2. Decide on those things that you can do to encourage the person to go to treatment. This might include withholding financial support, divorce, loss of job, inability to see relatives. (The list will be different for everyone, however; if it will hurt, it will contribute to making the pain of the disease greater than the fear of changing. It is for the addicts own good.

3. Choose a treatment center to make sure they have a bed.

4. Choose a date for the intervention.

5. Have everyone write a letter to the addict. a. Tell them how much you love them. b. State specific instances of behaviors that you are worried about. E.g. On Friday September 7, you ran over our son’s bicycle in the driveway. You have killed him. I am afraid to have our friends over the house and/or go to parties where alcohol is being served because I never know how you will act.

Then ask the person to accept the gift of treatment. If they agree, leave for treatment immediately. If they resist, go to step c. c. Tell the person what will happen if they do not go. See step 2 above. Again ask them to accept the gift of treatment. d. If the addict still refuses implement the consequences. It is essential that you hold firm. When the addict calls ask, ‘are you ready to go to treatment?” If the answer is yes, go. If the answer is no, with no further discussion say, “call when you are ready and hang up.” This is tough, but you need to remember that you are saving the person’s life. e. Repeat step d till the addict agrees to go to treatment.

In some cases you may wish to consider a professional interventionist. These are therapists and individuals who specialize in helping families encourage their loved ones to seek treatment.

Finally having decided to take these steps you will probably need support. Alanon, Naranon and Gammanon are places for the families of addicts to go and share their hopes, strengths and experiences in dealing with their own family members and friends who are addicted. It is a place where those that are there will usually understand where you are coming from and give you the great support that can only come from those who have walked the same path as you are.

It is also a good idea to seek professional therapy for yourself and other family members. We often feel that the problem is the addict’s and fixing them will make everything ok. Unfortunately we to have been damaged by their behaviors and it is very important that we heal as well.

Understand the road to recovery is not only for the addict, but for all those with whom the addict interacts. Remember the damage that they have done is not only to them.

Like the addict, you are a good person with a bad disease.

To Advertise, Call 561-910-1943

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The Right Detox

By Gary D.

Making the decision to separate ourselves from whatever addictive substance has been driving us is a remarkably courageous decision—and a very difficult, even dangerous one. No one should minimize the process of withdrawal nor the commitment required to re-construct a life. The new spat of on-line and brick-andmortar “pop-ups” offering safe, home detox seem an easier, softer way. We imagine ourselves too busy, too important, too well to need residential detox. Often we’re being offered fool’s gold—shiny and bright but worthless. As one medical doctor with years of experience treating addicts and alcoholics put it, “I would no more prescribe a home detox than I would a home appendectomy.”

Withdrawal symptoms from alcohol, pain killers and opiates include hot/cold sweats, heart palpitations, vomiting, diarrhea, dehydration, tremors and seizures–not to mention the hysterical acts of violence done to our furniture, to ourselves, and to our loved ones. Many suffer heart attacks; some die.

Believing we’re able to handle our own detox is as tempting and as mindless as believing that we could handle the drugs or alcohol to begin with. Given the particular mental twist of the alcoholic/addict, detoxing on our own is not only dangerous but usually ineffective. Addicts who insist on controlling the process of their recovery just set themselves up for another attempt at controlling the substance. Few are those who can withstand the discomfort of withdrawal for long before returning to those behaviors which bring them temporary relief and long-term despair. The chemical doses offered for home detox often arouse more cravings than they satiate. The home or clinic doses soon produce the same effect as the methadone clinics of the 70’s and 80’s.: the doses get the users stable enough to search for more, more of whatever they can get.

Genuine and effective detox requires help.

Twenty-four hour medical supervision keeps us safe, and not just from the symptoms of withdrawal. Often the alcohol and chemicals mask other symptoms or illnesses which surface only as our bodies detoxify. More pointedly, no two bodies react exactly the same, and even those who have been through detox before may now face new medical concerns. At the same time, the better the pain of withdrawal is managed the more likely it is to be successful. Residential detox can offer a painmanaged taper yet assure a complete detox—when clients leave The Right Place, a residential detox facility in Pompano Beach, for example, they do so with blood checked and bodies completely free of the chemicals that had been enslaving them.

By its nature, residential detox is indicative of a much greater degree of surrender, a

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greater acknowledgment of the need for help. Yet the alcoholic or addict is a master of self-delusion and denial. For that reason, there is usually a very short window during which the addict/alcoholic is truly open to help.

Family members of alcoholics and addicts, like those of us who work with that population, know the drill only too well. It starts with another late night phone call or a knock on the door and a Sunday evening confession. “I’ve had it,” he or she cries, “Please, I just can’t go on like this.” If we’re lucky, the caller is safe but worn, tired and in pain, but facing no immediate threat. If we’re less lucky, the call comes from a police station, jail, a hospital. “Please, help me! I’ll do anything, anything, I just can’t do this anymore. Please help!” The cries continue as the caller becomes incoherent and breaks into sobs.

Cold compresses, re-assuring whispers, perhaps one short drink or low-dose valium and a combination of falling asleep and passing out somehow gets us through the night. The next morning, we get the coffee ready, prepare a small breakfast we know will go uneaten, straighten up, make frantic phone call after frantic phone call to find an answer, someone, anyone who will offer a solution. Much of the day passes while we wait for our loved one to stir awake. We offer coffee, a smile, and proudly announce that we found someone who can help. The response is more angry than grateful: “Help?! Let’s not over-react; it was one bad night.” And they are off on another run.

According to a 2006 National Survey on Drug Use and Health (NSDUH) study, of the 940,000 people who said they needed treatment in a drug or alcohol facility, only 314,000 made any effort to get such help. That means, on average, two out of three addicts/alcoholics recognize they need help but fail to get the sort of help they need.

They want to change without making changes.

Residential detox assures that when the addict/alcoholic wavers, the peer and professional support needed to forward his decision to seek help is not just available, but inescapable. In separating users from their normal lives, facilities such as The Right Place secure them a safe, medically supervised environment in which to begin their recovery.

Recovery begins with the decision to separate ourselves from the substances and behaviors that are now destroying us. It is a big and difficult decision, and we need help to follow through. One of the techs at The Right Place describes the facility as “a very comfortable place to face discomfort.” Restoring a life is a holy but difficult quest. Get all the help you can.

To Advertise, Call 561-910-1943

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Recovering from Codependency: The Truth About People-Pleasing

By Candace Plattor The term “codependency” can mean different things to different people. Over the years, a number of authors have offered a variety of definitions for this difficult dynamic that seems to affect more people than we can imagine.

My definition is a very simple one: “codependency” occurs when we put other people’s needs ahead of our own on a fairly consistent basis. In truth, when we are codependent, we are also people-pleasers who will go to virtually any lengths to avoid unpleasant conflict with others.

DOES THIS SOUND LIKE YOU? You are tired of giving and giving to other people, without getting much in return.

You are concerned about the pain and /or abuse that you are experiencing in your relationships.

You feel sorry for yourself, baffled about why this is happening to you but not knowing what to do about it.

You try to convince yourself that the problems you are experiencing aren’t really that bad.

“BUT I’M SUCH A NICE PERSON!” Because codependents consistently put others’ needs ahead of their own, they often believe that they are “nice” people.

“I’m doing what everybody wants me to do,” you tell yourself, “so why do I get mistreated so much of the time?” Indeed, this will be a real dilemma for you as a people-pleaser. If you are codependent, it probably doesn’t make sense to you that you are being treated abusively by the very people you are trying so hard to accommodate!

But the truth may be that you are not really as “nice” as you would like to believe you are, because you are not saying yes to everyone else just to be kind to them.

Nor do you do more than your fair share of tasks because you truly want to be of service over and over without any kind of reciprocal arrangement.

When you say yes (especially when you really want to say NO), you are actually protecting yourself from having to face the potentially painful consequences that can result when someone is angry or disappointed with you for not agreeing to do what they want you to do.

Even though you are really trying to look out for yourself by side-stepping these negative outcomes, which could be seen as a self-caring intention, it is unfortunately not a healthy form of self-care when it is done out of resistance to unpleasantness.

WE TEACH OTHER PEOPLE HOW TO TREAT US In order for codependence to be part of any relationship, two things have to happen ~ the people-pleaser has to say yes a lot more often than no, and the other person has to not only accept this but also begin to expect it in the relationship. Once that dynamic is in place, it is difficult to break the cycle.

When you say yes consistently to another person, and when you accept any form of abuse as part of any of your relationships, you are essentially teaching the other people that it is all right for them to treat you that way. Although you might not be aware of it, you actually do have as much power and control as the other person does, because all of us can really only control ourselves.

It is only when you choose to give your power and control to another person that you begin to feel the sting of codependency, because the truth is that no one can disrespect you without your permission.

SHIFTING OUT OF PEOPLE-PLEASING INTO HEALTHY ASSERTIVENESS ~ HOW TO BEGIN If you are experiencing codependency and people-pleasing in any of your significant relationships (which can include those with parents, children, siblings, spouses, partners, friends, bosses or co-workers), then there has likely been a cycle established in which you have been reacting in a “passive” manner while the other person has been acting “aggressively” toward you.

The healthy balance is one of “assertiveness.” This occurs when both people speak and behave toward each other in respectful ways, taking full responsibility for themselves and their own choices without resorting to blaming, shaming or threatening each other in any way.

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But change always has to start with oneself. If you are in relationships that are already entrenched in codependent dynamics, you will need to make some important changes within yourself before you can expect to see any change in the behaviour of those around you.

You can begin by deciding that it is time to learn new ways of being in relationship with yourself, such as treating yourself more respectfully and saying yes to yourself more often. You will also need to become willing to learn how to deal with the negative reactions you might encounter when you stop being so accommodating and available to the others in your life. This will prevent you from reacting from a place of fear in your relationships.

When you are starting the journey away from people-pleasing and seeking a new level of emotional health, you may find that self-help books about codependency can be a great aid. You may also want to check out some self-help groups such as Codependents Anonymous or 16 Steps for Discovery and Empowerment, to find others who are on the same journey as you are. As well, you might want to reach out to a skilled counsellor for help, as you begin to test out new boundaries and healthier ways of relating to others.

THE GIFT OF ASSERTIVENESS Becoming more real and genuine in your relationships is a gift you give to both yourself and to the others in your life. Learning how to tell people the truth about how you feel, as well as about what you are (and aren’t) willing to do for them is an act of love, honesty and personal integrity.

As you learn how to deal with potentially unpleasant reactions from others, you can begin to change your people-pleasing patterns. This is the key to unlocking a whole new world of being a self-respecting, authentic and genuine person in your relationships.

Candace Plattor, M.A., R.C.C., is a therapist in private practice, specializing in addictive behaviors such as Substance Misuse, Eating Disorders, Internet Addiction, Smoking, Gambling, Compulsive Over-Spending, and Relationship Addiction.

Candace offers individual, couple, and family counseling in her Vancouver, BC office and by telephone worldwide. She also counsels family and friends whose loved ones are struggling with addiction, and provides Clinical Supervision for therapists working with addicts and their loved ones.

To Advertise, Call 561-910-1943

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To Advertise, Call 561-910-1943

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DRUG CRIMES: FEDERAL AND STATE

By Myles B. Schlam, J.D., CAP / CCJAP

Drug laws and drug crimes have gotten lots of attention in the past decade. Laws in every state and at the federal level prohibit the possession, manufacture, and sale of certain controlled substances -- including drugs like marijuana, methamphetamine, ecstasy, cocaine, and heroin.

Putting aside political arguments over the so-called “war on drugs,” it isn’t hard to see why controlled substances are the focus of so much attention from legislators and law enforcement. It’s estimated that drug and alcohol abuse costs society over $110 billion a year -- through accidental death and injuries, health care, dependency treatment, criminal behavior, and more.

Illegal Drugs vs. Legal Drugs The legality of a drug often depends on how it is being used -- or what it is being used for. For example, amphetamines are used to treat attention deficit disorder, barbiturates help treat anxiety, and marijuana can help alleviate cancer-induced nausea. But unprescribed and unsupervised use of these substances (and many others) is thought to present a danger to individuals and to society in general. So, for decades, lawmakers have stepped in to regulate the use, abuse, manufacture, and sale of illegal drugs. People who suffer from Addictive Disorders or those who are Dually Diagnosed with mental health disorders should not be prescribed any of these drugs for obvious reasons.

Federal, State, and Local Drug Laws Though there is a longstanding federal strategy in place to combat the abuse and distribution of controlled substances, each state also has its own set of drug laws. One key difference between the two is that while the majority of federal drug convictions are obtained for trafficking, the majority of local and state arrests are made on charges of possession. Another difference between federal and state drug laws is the severity of consequences after a conviction. Federal drug charges generally carry harsher punishments and longer sentences. State arrests for simple possession (i.e. possession without intent to distribute the drug) can be charged as Misdemeanors or Felonies. In Florida, if it is Marijuana under the quantity of 20 grams, it is usually charged as a Misdemeanor. Marijuana over 20 grams is usually charged as a Felony. Possession of Cocaine is always charged as a Felony in Florida, which includes a crack pipe that field tests Positive for Cocaine. Opiates and Anabolic Steroids without a legitimate Rx are also charged as Felonies in Florida, regardless of the quantity.

The consequences of a conviction for distribution and trafficking vary significantly depending on: • the type and amount of the controlled substances(s) involved • the location where the defendant was apprehended (for example, bringing an illegal substance into the country carries higher penalties, as does distributing drugs near a school or college), and • the defendant’s criminal history.

Sentences for distribution and trafficking generally range from 3 years and a significant fine to life in prison -- with trafficking carrying higher sentences.

Manufacturing Under federal and state drug laws, the government can charge a person for playing a part in the cultivation or manufacture of a controlled substance. Cultivation includes growing, possessing, or producing naturally occurring elements in order to make illegal controlled substances. These elements include cannabis seeds, marijuana plants, etc. A person can also be charged for producing or creating illegal controlled substances through chemical processes or in a laboratory. Substances created this way include LSD, cocaine, methamphetamine, etc.

Possession The most common drug charge -- especially in arrests made under state drug laws -- involves possession of a controlled substance. Generally, for a possession conviction, the government (usually in the form of a district attorney) must prove that the accused person: • knowingly and intentionally possessed a controlled substance • without a valid prescription, and • in a quantity sufficient for personal use or sale.

Drug Crimes: Charges and Terminology

A possession charge can be based on actual or “constructive” possession of a controlled substance. Constructive possession means that even if the defendant doesn’t actually have the drugs on their person (in a pocket, for example), a possession charge is still possible if the defendant had access to and control over the place where the drugs were found (a locker, for example). This is important to note because, unlike DUI/DWI laws, the government does not have to actually prove that someone is using a controlled substance in order to charge them with possession. The theory of constructive possession is often used when illegal drugs are found in a car during a traffic stop.

In both the federal and state criminal justice systems, most of the cases stem from charges of possession, manufacturing, or trafficking of controlled substances. Below you’ll find a brief overview of these offenses, as well as an explanation of some key terms related to drug crimes.

It is also usually illegal to possess paraphernalia associated with drug use, such as syringes, cocaine pipes, scales, etc. In fact, being found in possession of these objects -- without any actual drugs -- may be enough for a person to be charged with a misdemeanor or felony.

Controlled Substance

Drug charges often start with possession, but then overlap with other offenses. For example, if the police find marijuana plants in X’s storage room, X can be charged with possession of the marijuana and of cultivation equipment. If the amount of the plants is large enough, X can also face distribution, trafficking, or manufacturing charges.

When a federal or state government classifies a certain substance as “controlled,” it generally means that the use and distribution of the substance is governed by law.

Controlled substances are often classified at different levels or “schedules” under federal and state statutes.

Drugs listed in schedule I have no currently accepted medical use in treatment in the United States and, The drugs and other substances that are considered controlled substances under the CSA are divided into five schedules. A listing of the substances and their schedules is found in the DEA regulations, 21 C.F.R. Sections 1308.11 through 1308.15.

A controlled substance is placed in its respective schedule based on whether it has a currently accepted medical use in treatment in the United States and, therefore, may not be prescribed, administered, or dispensed for medical use. Schedule I substances have no accepted medical value and therefore cannot be prescribed by a doctor. In contrast, drugs listed in schedules II-V have some accepted medical use and may be prescribed, administered, or dispensed for medical use. There is relative abuse potential in II-V, and it has the likelihood of causing dependence. Some examples of controlled substances in each schedule are outlined below: Schedule I: Heroin, LSD, Marijuana, Methaqualone Schedule II: Morphine, PCP, Cocaine Schedule III: Anabolic Steroids, Codeine, Hydrocodone, and some Barbiturates.

Schedule IV: Most Benzodiazepines such as Valium and Xanax.

Schedule V: Over the counter cough meds with Codeine.

Distribution and Trafficking As a drug charge, “distribution” usually means that a person is accused of selling, delivering, or providing controlled substances illegally. This charge is often used if someone tries to sell drugs to an undercover officer. Trafficking generally refers to the illegal sale and/or distribution of a controlled substance. Despite the name, trafficking has less to do with whether the drugs cross state lines, and more to do with the amount of drugs involved.

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Charges for simple possession are often less serious than charges for possession with an intent to distribute. The difference here does not necessarily turn on an actual intent to distribute, but on the amount of the substance found in the defendant’s possession (i.e. smaller amounts are usually charged as misdemeanors, while larger amounts can be used to suggest felony possession with intent to distribute).

Diversion: Many states allow diversion for first-time offenders charged with simple possession of illegal drugs. Drug Court is such a Diversion program. Diversion allows offenders to maintain a clean criminal record by pleading guilty and then completing a prescribed substance abuse program and not committing additional offenses. At the conclusion of the diversionary period (12 months is common) the guilty pleas is vacated, the case is dismissed, and the offender will be eligible to get his or her criminal record expunged.

“Search and Seizure” Laws The most common defense to a drug charge -- especially drug possession charges -- is a claim that a police officer overstepped search and seizure laws in detaining a person and obtaining evidence. If a defendant in a criminal case (usually through a criminal defense attorney) can prove that the police violated the defendant’s Fourth Amendment rights in finding and seizing drug evidence, that evidence may not be admissible in a criminal case against the defendant.

Increased Prison Sentences in Florida for Drug Crimes Prison sentences for non-violent drug crimes, like drug possession, drug sales and drug manufacturing, have substantially increased in the last19 years. A new study from the Pew Center on the States analyzed sentencing trends for violent crimes and non-violent crimes across the states and found that the amount of time prisoners spend behind bars has increased by 36 percent since 1990.

In Florida, the increase is even more substantial and, by far, the highest in the nation. In 2009, Florida Drug Offenders spent 194 percent more time behind bars than they did in 1990. In 1990, Florida drug offenders served an average sentence of 9 months - in 2009, that sentence had increased to an average of 2.3 years in prison.

The sharp increase in prison sentences can be attributed to a prison overcrowding problem that Florida was facing in early 1990s. The state responded to the overcrowding by granting prisoners parole after serving an average of 30 percent of their sentences. When the parole program caused problems with re-offenders, the legislature reacted by passing a law that required prisoners to serve at least 85 percent of their sentences. The aggressive legislation increased overall prison sentences by 166 percent; and increased prison costs by $1.4 billion annually.

Longer Prison Sentences Do Not Reduce Crime The recent Pew Study has determined that longer prison sentences for non-violent drug offenders do not necessarily keep our streets safe. The study analyzed the relationship between time served and its impact on public safety. The study compared crime rates in states that lengthened prison sentences and those that significantly reduced them.

The study found that the states that reduced incarceration times for non-violent offenders experienced dramatic reductions in crime. The results of the study reveal that for non-violent offenders incarceration isn’t the only answer. Treatment and rehabilitation programs may be better tools to reduce crime and protect the public.

Even though harsher penalties for non-violent drug crimes are probably not the answer for safer streets, that doesn’t mean being charged with an offense isn’t a serious matter, with serious consequences. If you or a loved one have been arrested and charged with a drug crime like Possession of a Controlled Substance, there are steps you can take now to understand the situation and protect your legal rights. To learn how to navigate and survive the criminal justice system, contact ASI for a consultation.

Myles B. Schlam, J.D.,CAP/CCJAP Advocare Solutions, Inc.- Executive Director (954) 804-6888 www.drugcourtpro.com *Myles B. Schlam is a nationally recognized expert in Drug Addiction and the Criminal Justice System and an Internationally Certified Alcohol and Drug Counselor. He is one of 100+ Criminal Justice Addiction Professionals (CCJAP) in the State of Florida. Mr. Schlam graduated from the St. Thomas University School of Law in 2002. ASI is licensed by the Florida Department of Children and Families and operates in Palm Beach and Broward Counties.

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15

Back to the Basics of Recovery Step Four–The Assets and Liabilities Checklist

By Wally P.

For those of you who are reading The Sober World for the first time, Wally P is taking us through the steps each month (excluding September due to travel commitments).For those of you who would like to read Steps 1, 2, and 3, please go to www.thesoberworld.com and you may read them online. _____________________________________________________ Made a searching and fearless moral inventory of ourselves.

In the past three articles, we have been through the Surrender process as practiced by the A.A. pioneers during the 1940’s. The sponsor read a few key passages either from the “Big Book” or from a typed sheet of these passages, and together the sponsor and the newcomer took the first three Steps.

The sponsor read the “Big Book” passages to the newcomer because, in most cases, the newcomer didn’t have a book. The “Big Book” cost the equivalent of $95.00 today; so the book was not only big, it was expensive.

Many groups had to pass the basket for weeks and sometimes months, to come up with enough money to buy one book. Key passages from this book were typed up, mimeographed, and distributed to home group members. They used these carefully selected passages when working with newcomers. Please keep this in mind as we proceed through the Steps as they were taken during A.A.’s early days.

We are now ready to start the Sharing process (Steps 4, 5, 6 and 7) by taking the Fourth Step. Many people today are unfamiliar with the assets and liabilities checklist used by the A.A. pioneers to take newcomers through this step. This “commercial inventory” is described on page 64 of the “Big Book” and consists of Resentment, Fear, Selfishness, Dishonesty, Inconsideration, Jealousy, Suspicion, and Bitterness. These liabilities are found on pages 64, 68 and 69 of our “basic text.”

Why assets and liabilities? Many early A.A.’s were business people and they readily identified with the “commercial inventory” represented by the equation for double-entry bookkeeping: Assets = Liabilities + Owner Equity.

Why didn’t the pioneers use the example on page 65? They didn’t know how to. The “three-column inventory” didn’t come into general use until the 1970’s when several writers published inventory guides based on the columns.

Where did the assets and liabilities checklist come from? It came from the Oxford Group, the organization from which A.A. evolved. Oxford Group members (including Bill W. and Dr. Bob) used it to take people through the Steps before the “Big Book” was written. The assets they used were Honesty, Purity, Unselfishness and Love and the liabilities were Dishonesty, Resentment, Selfishness, and Fear. These same four liabilities are part of the “commercial inventory” in the “Big Book.”

In June 1946, The A.A. Grapevine published a list of assets and liabilities.

The “Little Red Book,” released in the fall of 1946, used an assets and liabilities checklist, as did the step guide titled, “Highroad to Happiness” which was circulated throughout A.A. in the 1950’s.

When the “Twelve and Twelve” was published in 1952, the authors made no reference to a three-column inventory during their description of the Fourth Step. They did refer to, in great detail, the assets and liabilities checklist.

On page 42, they state: “. . . Nearly every serious emotional problem can be seen as a case of misdirected instinct. When that happens, our great natural ASSETS, the instincts, have turned into physical and mental LIABILITIES.” “Step Four is our vigorous and painstaking effort to discover what these LIABILITIES in each of us have been, and are.”

On page 49 of the “Twelve and Twelve,” the authors present the seven deadly sins plus fear as the liabilities to inventory. These eight liabilities are quite similar to the ones found in our “basic text.”

In the “Big Book,” the introduction to the Fourth Step starts at the bottom of page 63: “Next we launched out on a course of vigorous action, the first step of which is a personal housecleaning, which many of us had never attempted. Though our decision was a vital and crucial step, it could have little permanent effect unless at once followed by a strenuous effort to face, and to be rid of, the things in ourselves which had been blocking us.”

This is a very important paragraph. The “Big Book” authors tell us we are to take the Fourth Step immediately after the Third Step prayer. There is no waiting period between the Surrender and Sharing Steps.

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In the first paragraph on page 64, the authors describe the assets and liabilities checklist.

“Therefore, we started upon a personal inventory. This was Step Four.

A business which takes no regular inventory usually goes broke. Taking a commercial inventory is a fact-finding and fact-facing process. It is an effort to discover the truth about the stock-in-trade. One object is to disclose damaged or unsalable goods, to get rid of them promptly and without regret.”

Whether you use the assets and liabilities checklist on page 64 or the threecolumn example on page 65, please sit down with the newcomer and fill out the inventory sheet or sheets together. This is how it was done in the early days. The A.A. pioneers knew this was a very stressful and uncertain time for the newcomer and they didn’t want him or her to relapse over this “fact finding and fact facing process.” That’s why the sponsor and the newcomer worked the Fourth Step as “partners.” In subsequent articles, I will show how the sponsor and the newcomer made amends together, practiced twoway prayer together, and worked with the next newcomer together.

About the Author Wally P. is an archivist, historian and author who, for more than twentythree years, has been studying the origins and growth of the Twelve-step movement. He is the caretaker for the personal archives of Dr. Bob and Anne Smith.

Wally conducts history presentations and recovery workshops, including “Back to the Basics of Recovery” in which he takes attendees through all Twelve Steps in four, one-hour sessions. More than 500,000 have taken the Steps using this powerful, time-tested, and highly successful “original” program of action.

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

During this seventy-five minute DVD, Wally Paton, noted archivist, historian and author, takes you through all Twelve Steps the way they were taken during the early days of the Twelve-Step movement. Experience the miracle of recovery as Wally demonstrates the sheer simplicity and workability of the process that has saved millions of lives throughout the past seventy years.

Wally has taken more than 500,000 through the Twelve Steps in his Back to the Basics of Recovery seminars. He has made this “Introduction to the Twelve Steps” presentation hundreds of times at treatment centers, correctional facilities, and recovery workshops and conferences around the world.

This is a DVD for newcomers and old-timers alike. You can watch it in its entirety or divide it into three segments: Surrender (Steps 1, 2 and 3); Sharing and Amends (Steps 4, 5, 6, 7, 8 and 9); and Guidance (Steps 10, 11 and 12).

The accompanying CD contains twenty-four pages of PDF presentation materials for facilitators and handouts for participants.

Here is everything you need to take or take others through the Twelve Steps “quickly and often.”

Wally has modified the “Big Book” passages so they are gender neutral and applicable to all addictions and compulsive disorders. In keeping with the Twelve-Step community’s tradition of anonymity, he does not identify himself, or anyone else in this DVD, as a member of any Twelve-Step program.

This DVD was recorded at the Public Broadcasting Service television studio in Tucson, AZ using high definition cameras, flat screen graphics, and PowerPoint overlays. It is a state-ofthe-art production that is both instructive and enlightening. “It works—it really does.”

To order this DVD plus CD, please contact: Faith With Works Publishing Company P. O. Box 91648 ~ Tucson, AZ 85752 520-297-9348 ~ www.aabacktobasics.org DVD+CD Price: $79.95 + $11.05 (priority s/h) Total Price: $91.00

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17

TRADING YOUR ADDICTION

By Michael Burke

This is a letter of warning to all people in recovery from alcoholism and drug addiction or to those who know someone in recovery.

Do not gamble.

Do not buy lottery tickets.

Do not gamble on the horses.

Do not go to casinos.

Stay away from the poker rooms.

Stop sports betting.

I travel around the United States warning people in recovery about the dangers of trading one addiction for another. It has been over 34 years since I have consumed any alcohol. I did those things that we are taught to do to protect our sobriety.

In 1978 I attended and completed a 30 day inpatient program to deal with alcoholism. One of the lectures dealt with the dangers of trading addictions. One of the addictions we were warned about was gambling. Back then there was very little gambling to be worried about. I chose to ignore that particular warning. As a result, I spent my 24th, 25th, and 26th years of sobriety in prison. I lost my license to practice law after 25 years as an attorney.

My family was devastated. They had no idea of the depth of my gambling.. It all started when I began frequenting a casino that had opened less than 60 miles from where I lived. In the beginning it was just fun. I only gambled during the daytime hours when I was supposed to be at work.

Gambling is very easy to hide from those who care about you. It is often referred to as the “hidden addiction.” Unlike substance abuse, there are no outward manifestations of a problem. No slurred speech, no stumbling, no smell of intoxicants. The first signs a problem exists can be a loss of a job, a bankruptcy, foreclosure notice, a divorce, criminal charges being filed, or suicide. Families are torn apart by the sense of betrayal they suffer at the hands of the gambler. This betrayal can go on for many years before it is discovered. It will make a spouse question all aspects of the relationship. If the gambler has been lying about this behavior for years, what else has he been lying about? It can take years to re-establish the trust that was once taken for granted.

Gambling did everything for me that my drinking had done. It was the perfect substitute for alcohol. My first three or four years could be described as social gambling. I would take a predetermined amount of money to the casino and would rarely exceed my limit. I excused my behavior by convincing myself that my trips over to the casino were not hurting anyone. This was just how I chose to relax.

However, the foundation of every addiction is built upon lies. Every time I went to the casino I was adding a new brick to the foundation of my compulsive gambling addiction. Finally the day came when I crossed the line into compulsive gambling. There was no return. The devastation was total.

The numbers of problem gamblers are only going to increase. Today, some form of gambling is available in all but two states. It is legal, socially acceptable, and morally appropriate. Churches,

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charities, and non-profit organizations routinely sponsor Bingo, Vegas Nights and Texas Poker Rooms to raise money for the good works that they do. When questioned about the appropriateness of sponsoring events that contribute to addiction, the response I hear is, “Yes, I understand that gambling is considered an addiction, but look at the amount of money we receive.”

Many states have Native American and commercial casinos. Most states are attempting to fill holes in their budgets by relying on state lotteries. One state has found that state ownership of casinos is even better than taxing casinos.

Within months, internet gambling is going to be legalized in most states. These states are making a conscious decision to increase gambling in their states regardless of the social costs.

They need the money and are unwilling to raise taxes on the general population. They will instead create a “regressive tax” on the gamblers in their communities. There has been no talk by these states about treatment for those they know will develop a gambling problem because of their new tax policy.

Studies show that a majority of people who will develop a gambling problem come from a substance abuse background. They either have a substance abuse problem themselves or it can be discovered somewhere in their family history. Many of them will simply trade one addiction for another. Most never see a problem coming. Many alcoholics have openly discussed their gambling patterns with me. They say that they take a certain amount of money with which to gamble and do not exceed that amount. They tell me they are able to control their gambling. The wonder if they should be concerned. I explain it is just like their drinking.

Abstinence is the only guaranteed answer. If you don’t gamble, you will never develop a gambling problem.

If you have a spouse, a significant other, a loved one, or a friend in recovery who is gambling, you must warn that person not to gamble. Most compulsive gamblers I have met in the last seven years were in recovery for substance abuse and in a good twelve step program. If you can convince that person to stop before he/she crosses the line into compulsive gambling, that person has a chance.

Most of the compulsive gamblers I have worked with who have crossed that line have suffered total devastation. Many of the people in recovery I have talked with who have not started to gamble have told me they never will gamble. This is the group we must educate. They are the ones who will never have to endure the pain of compulsive gambling. If you care about them, discuss this issue with them. The chains of addiction are too weak to be felt until they are too strong to be broken.

Michael Burke lives in Howell, Michigan where he practiced law for 25 years. His book “Never Enough: One Lawyer’s True Story of How He Gambled His Career Away” has been published by the American Bar Association. Proceeds from the book go to his victims. He travels the country speaking to groups on the topic of trading addictions and compulsive gambling. Michael can be reached at burkemichaelj@yahoo.com.

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ALCOHOL RELATED ILLNESSES IN ALCOHOLICS WITH LONG TERM SOBRIETY A PILOT STUDY

By Anthony G. Foster - Florida Atlantic University

This is Part 1 of a Two part Pilot Study. The Result, Part two, will appear in the November issue _________________________________________________ Introduction This pilot study was conducted to examine whether alcoholics in longterm sobriety continue to suffer from alcohol-related illnesses even after twenty or more years of continuous sobriety. Little has been written about the health outcomes of recovered alcoholics many years after they stopped drinking, particularly as it relates to academic research.

Anecdotally, it has long been thought that once an alcoholic becomes abstinent that he will recover from his physical ailments brought on by the disease if he has not abused his body to having cirrhosis of the liver, chronic pancreatitis, or Korsakoff’s Syndrome to his brain, among other ailments. In recent years there has been some evidence that alcoholics may develop symptoms from previously undiscovered and/or dormant ailments which suddenly appear more than twenty years after their last drink. This study aims to ascertain whether the subject matter warrants a more in-depth investigation through a dissertation. Therefore, the primary question for this study is: “Do alcoholics with long-term sobriety continue to be afflicted with alcohol-related ailments more than twenty years after their last drink?” A secondary question is “what should the direction of future research be?”

Definitions Addiction, drug or alcohol – Repeated use of a psychoactive substance or substances, to the extent that the user, or addict, is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying the substance used, and exhibits determination to obtain psychoactive substances by almost any means. Tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted (World Health Organization (WHO), 1994). Addiction is often chronic with relapse always a possibility, even after years of sobriety or abstinence. There are various areas that can be affected by addiction, but for this study it will relate primarily to alcohol.

Alcoholism – E. M. Jellinek, a physiologist and researcher, who consulted with the World Health Organization and the American Medical Association in the establishment of alcoholism as a disease, defines it as “the use of any alcoholic beverages that causes any damage to the individual, society, or both” (Jellinek, 1960). In 1992, to establish a more precise and current definition of the term alcoholism, a 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine conducted a two year study of the definition of alcoholism. The goal of the committee was to create a revised definition that is scientifically valid, clinically useful, and understandable to the general public. Therefore, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, especially the phenomenon of denial. The symptoms may be continuous or periodic (Morse & Flavin, 1992).

Abstinence – Refraining from drinking alcoholic beverages, whether as a matter of principle or for other reasons. The term “current abstainer”, often used in population surveys, is usually defined as a person who has not drunk an alcoholic beverage in the preceding 12 months; this definition does not necessarily coincide with a respondent’s selfdescription as an abstainer (WHO, 1994). Also, the absence of use of mood altering drugs or alcohol excluding caffeine, nicotine, and those that are prescribed by a physician for a legitimate physical or psychological complaint. For this study abstinence and sobriety will be used synonymously.

Long-term sobriety – For this study long-term sobriety will mean the abstinence from drinking alcohol or using any other mind-altering drug for twenty consecutive years or more.

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Relapse – A return to drinking or other drug use after a period of abstinence, often accompanied by reinstatement of dependence symptoms (WHO, 1994). Also, the return of signs and symptoms of a disease after a patient has had a period of abstinence. It usually occurs prior to the actual consumption of the alcohol or drugs from which the patient is recovering, but is assuredly followed by it. Relapse is very common in the recovering community.

Literature Review Alcohol contributes to nearly 80,000 deaths annually (Center for Disease Control and Prevention (CDC), 2008), making it the third leading cause of preventable mortality in the United States after tobacco and diet/activity patterns (Mokdad, Marks, Stroup, & Gerberdin, 2004). In 2005 there were more than 1.6 million hospitalizations due to alcohol (Chen & Yi, 2007). Alcohol dependence and alcohol abuse cost the United States an estimated $220 billion in 2005 in healthcare and lost productivity. This dollar amount was more than the cost associated with cancer ($196 billion) and obesity ($133 billion) (Treatment-Centers.net, 2011). Approximately 14 million people in the United States, or 7.4 percent of the population, meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), (American Psychiatric Association, 2000) criteria for alcohol abuse or alcoholism. Throughout the world, alcoholism accounts for 4% of the “global disease burden” (World Health Organization, 2002).

According to the Centers for Disease Control and Prevention (CDC), the disease of alcoholism creates many long-term and chronic health risks. Some of these include neurological problems, including dementia, stroke and neuropathy. Chronic alcoholics also live with the prospects of developing cardiovascular problems, psychiatric issues, higher risks of various forms of cancer, in addition to social problems (Centers for Disease Control and Prevention, 2011). These are all in addition to the commonly-known diseases which are normally attributable to alcoholism such as cirrhosis of the liver, alcoholic hepatitis, pancreatitis, gastritis, and other liver diseases (Xu, Kochanek, Murphy, & Tejada-Vera, 2010; Lesher & Lee, 1989 and Kelly, Kaufman, Koff, Laszlo, Wilholm, & Shapiro, 1995). Cirhossis of the liver is currently the 12th leading cause of death in the United States (Szabo & Mandrekar, 2010).

While a great deal of research has been conducted on alcoholism and drug addiction, much less has been done on the physical ailments of those with long-term sobriety. There has been a significant amount of research into what commonalities exist in long-term recovering people, however, the question of physical infirmities connected to their prior alcohol problem has been, for the most part, left alone. This pilot study attempts to analyze whether there are any common lingering physical effects for those with more than twenty years of sobriety and if so, do the results warrant a dissertation.

It has long been anecdotally thought that an alcoholic in recovery can completely restore his or her physical and mental health through longterm abstinence if their self abuse had not crossed the line of permanent damage. The potential damage that has caused the most concern was that done to the liver, pancreas, brain, and esophagus. We will primarily look at the liver, pancreas and the brain in this study, although it is known that for those alcoholics who smoke, cancers of the throat, especially the esophagus and the larynx, are very common (Edwards, 2004; Anderson, Chhabra, Nerurkar, Souliotis, and Kyrtopoulos, 1995).

Alcoholic liver disease (ALD) is one of the most common causes of chronic disease in the world. The severity of the damage related to alcohol varies within different individuals and even within the same individuals at different times. While laboratory tests have long been used to distinguish among the the various stages of alcohol-related liver damage, liver biopsies have been found to be the most accurate method of distinguishing among the stages and finding more covert evidence of damage (Diehl, 2002) Continued on page 22

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21

ALCOHOL RELATED ILLNESSES IN ALCOHOLICS WITH LONG TERM SOBRIETY A PILOT STUDY

By Anthony G. Foster - Florida Atlantic University

Alcoholic liver disease runs a spectrum of various levels of how much damage the alcoholic has done to his liver. At the less severe end of the spectrum is the condition of a fatty liver, known as steatosis. Steatosis is reversible with abstinence or a significant drop in consumption (Diehl, 2002; and, Mann, Smart, and Govoni, 2003). If the alcoholic continues to drink his liver issues will become more severe, leading to steatohepatitis, or alcoholic hepatitis, and further inflammation leading to fibrosis. These illnesses may or may not improve with abstinence.

Research shows that 40% to 50% of patients with chronic alcoholinduced steatohepatitis develop cirrhosis within five years (Galambos, 1972). Further drinking will bring the alcoholic towards the most severe end of the spectrum, cirrhosis, and finally, end-stage liver disease. Both of these conditions are irreversible and create a poor prognosis for the alcoholic (Szabo & Mandrekar, 2010). The progression of ALD is caused by the continued consumption of alcohol creating a chain of events in which inflammation plays the key role. The continued inflammation will cause the alcoholic to progress from a fatty liver to liver cell death, inflammation, regenerating nodules, scar tissue (fibrosis), and finally cirrhosis (Diehl, 2001 & Tilg, Jalan, Kaser, Davies, Offner, et al, 2003).

It is important to note that alcohol-induced cirrhosis may be present in individuals who have very few symptoms or signs of liver disease.

However, 25% to 30% of patients will develop more clinical symptoms per decade, meaning that within twenty years more than half of the people who are diagnosed with cirrhosis will have had it in a dormant form. Diehl’s study did not address whether those in dormant form were abstaining from alcohol or continued to drink alcoholically (Diehl, 2002).

When a patient has reached the level of having cirrhosis of the liver it often creates the need for a liver transplant. This has become a controversial issue when the patient is an alcoholic (Esquivel & Keefe, 1993; Boren, 1994; and, Light, 1994). There are several reasons for the controversy. They are as follows: a) questions as to whether the alcoholic will return to drinking, recidivism; b) the possible postoperative noncompliance of the patient regarding lifestyle and diet regimens, resulting in the new liver’s failure; and, c) although alcoholism is designated as a disease, many still view alcoholism with moral overtones, therefore, the feeling exists that the need for the liver transplant is the patient’s own fault (Boren, 1994 and Light, 1994). Since an alcoholic in need of a new liver has generally shown a disregard for their own life, many have thought that a new liver would be a license to continue drinking (Esquivel and Keefe, 1993). Studies have shown this not to be the case (Berlakovich, Steininger, Herbst, Barlan, Mittblock, and Muhlbacher, 1994). A University of Michigan study went so far as to develop an “alcoholism prognosis scale” to decide which alcoholics would be accepted for a transplant. Acceptance was based on a variety of factors such as acceptance by the alcoholic and his family that he was, in fact, an alcoholic, social functioning and stability, changes in life-style with substitute activities, hope and self esteem. Fewer than 50% of those who applied were accepted based on those qualifications.

The researchers found that the alcoholic’s survival rate was no different than the non-alcoholic, approximately 80%. Additionally, only a small number, 10% to 12%, returned to drinking after the transplant. Most of these did not drink alcoholically, and some only drank once. (McMillen, 1995 and Lucey, Merion, & Henley, et al, 1992 and updates).

abuse has a very negative effect on the pancreas, not only limited to pancreatitis, but also pancreatic cancer.

Nearly 38,000 people will die in 2011 from pancreatic cancer in the according to the American Cancer Society. Of all forms of cancer this ranks as third in number, even surpassing more commonly known cancers as leukemia and lymphoma. In fact, the only forms of cancer that kill more are breast and colon cancers (American Cancer Society, 2011) A third problem for alcoholics is the function of their brain after years of abusing it with alcohol. While some studies have shown the brain to recover from the effects of alcohol with long-term sobriety, others have not (Cardenas, Studholme, Gadzinski, Durazzo, & Meyerhoff, 2007 and Gadzinski, Durazzo, & Meyerhoff, 2005). Cardenas, et al found that brain tissue volume recovers with a significant period of abstinence.

Interestingly, Cardenas’ study found that drinking severity was not significantly related to the brain’s structural changes as much as length of time drinking. The results of this study are tempered by the fact that it had a relatively small sample size, limiting its prediction of how much recovery of the brain would exist (Cardenas, et al, 2007). Studies that don’t show improvement on the part of the recovering alcoholic appear to be the result, in part, to the combination of many years of alcohol abuse and the advancing age of the alcoholic (Rosenbloom, and Pfefferbaum, 2008). Specifically, abstinent older alcoholics tend to suffer from brain atrophy producing memory loss and impairments in their visual-spatial motor skills that may be a combination of the aging process and the effects of years of alcohol abuse (DiScalfani, Ezekial, Meyerhoff, Dillon, Weiner, and Fein, 2006).

In a twist of what this study is trying to ascertain, a 1992 study looked at the mortality rate of alcoholics who stayed abstinent compared to those who relapsed over an eleven year period. While those that relapsed died at a rate five times higher than those who stayed sober, it is interesting to note that the sober group’s mortality rate was similar to a non-alcoholic control group. The researchers concluded that alcoholic men who achieved “long-term” sobriety experienced the same mortality rate of the general male population (Bullock, Grant, & Reed, 1992).

Tony Foster is the director of therapy at the Beachcomber Outpatient Services Treatment Center located in Boynton Beach, Florida.

SUNCOAST REHABILITATION CENTER HOLDS CHARITY GOLF TOURNAMENT FOR DRUG REHAB SCHOLARSHIP

Liver cancer is also a significant concern for alcoholics. Many studies have shown in both humans and laboratory animals that large quantities of alcohol may produce as high as a fivefold increase in the incidence of liver cancer (Anderson, et al, 1995; Naccarato & Farinat, 1991; and, Anundi and Lindros, 1992). In 2011 it is estimated that nearly 20,000 people will die from liver cancer in the United States (American Cancer Society, 2011).

A second common problem for alcoholics is the function of the pancreas.

Pancreatitis, an inflammation of the pancreas, is very common in severe alcoholics. Pancreatitis is life threatening because of its effect on the efficiency of the operation of the pancreas. The pancreas is a gland located behind the stomach. It releases the hormones insulin and glucagon, as well as digestive enzymes that help you digest and absorb food (National Center for Biotechnology Information, 2010). Alcohol

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To Advertise, Call 561-910-1943

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