October 2017 - The Sober World

O C T O B E R 2 017 | VO LUM E 6 || I SS U E 10

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

PHYSICIAN’S HEALTH PROGRAM

ADDICTION TREATMENT THAT WORKS GROWING UP STONED -

THE IMPACT AND OUTCOMES OF CANNABIS ON ADOLESCENTS AND CHILDREN

By John Giordano, Doctor of Humane Letters, MAC, CAP

By Dr. Mark S. Gold and Dr. Drew W. Edwards

JUST SOME OF THE IMPLICATIONS OF LEGALIZED MARIJUANA

By Raul J. Rodriguez MD, DABPN, DABAM, MRO

WATER IS MEDICINE: ADVENTURE THERAPY IN RECOVERY

By Jonathan Rios, MA, LMHC and Jodi MacNeal

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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.

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 1)

By Dr. Mark S. Gold and Dr. Drew W. Edwards

Introduction

The Epidemiology of Cannabis Use in the US

Contrary to popular myth, marijuana is an addictive and debilitating drug, and currently at the center of much political, legal, medical and social controversy. The best available evidence reveals that 22.2 million Americans currently use marijuana, with more starting every day. In fact, marijuana use is increasing in nearly all demographic groups. It seems that everyone’s favorite drug of abuse is viewed as safe until proven dangerous. In spite of the evidence that, on average, 9 percent of those who use marijuana will become addicted to it—and for those who are initiated as children or adolescents, that percentage nearly doubles, to 17 percent, or 1 in 6.

Today, 8,000 Americans will use an addictive drug for the first time—most of whom are children and teens. Of these first timers, 65.6% will use marijuana.

“Marijuana use is associated with adverse health consequences, including damage to specific organs and tissues and impairments in behavioral and neurological functioning. Among these are acute impairments in the performance of complex tasks such as driving a motor vehicle. Marijuana-related crashes, deaths and injuries are currently a major highway safety threat in the United States.” ~ ASAM, 2013 In spite of these data, many people, including some physicians and healthcare professionals, believe that the use of cannabis is benign, or at least no more harmful than small amounts of alcohol.

In recent years the controversy has escalated, as several states have legalized the use of cannabis for either medical or recreational use, and some states have done both. As scientist’s we look to the peer reviewed literature for evidence regarding the nature and effects of psychoactive drugs, including their safety profile, as we are honor bound to “do no harm”. We have also witnessed, up close and personal, the tragic effects of marijuana in our patients, their families, as well as our friends, family members and colleagues.

We have seen far too to many promising medical and professional careers derailed because of marijuana. Depression, severe anxiety, psychosis and suicide are strongly correlated with high potency cannabis. Yet, if crude marijuana was assessed via scientific methodology, like all other proposed therapeutics, instead of at the ballot box, it would have been disapproved for lack of efficacy and numerous safety concerns. This is why pro legalizers reject FDA standards and scrutiny. They know what we know. If medical marijuana advocates were seeking FDA approval as a medicine to treat a specific medical condition, it would have to demonstrate, via double blind, placebo controlled clinical trials that it is equal to, or exceeds the safety and efficacy of medicines currently approved by the FDA for that specific condition. The medical marijuana advocates know that crude cannabis is not an effective medicine for the conditions they have claimed. If it were, those advocates would jump on the chance to own this patent. The truth is, there is NO empirically derived evidence to support FDA approval of crude marijuana for any medical problem. Conversely, there is a plethora of high quality evidence demonstrating the harmful effects of even moderate and occasional use, especially for children, teens and the unborn. This is not to say that there are no benefits associated with cannabis.

For example, the off-label use of smoking or vaping marijuana by patients with stage 4 cancers, receiving palliative care, to limit their nausea, pain and suffering is widely practiced and acceptable. We do not know of any physician opposed to this practice. And, as we will discuss in part two, there is some exciting new research investigating the therapeutic use of a novel constituent of cannabis, Cannabidiol (CBD), (which is not mood altering), for the treatment of spasms associated with Multiple Sclerosis, Lennox-Gastaut Syndrome (LGS), a rare seizure disorder, and as a preparation to treat anxiety.

But until any medication is proven safe and effective, it should not be approved by the FDA, or the ballot box.

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Figure 1: Breakdown by percentage of the drug of choice for first time users Pain Relievers 17% Marijuana 65.6%

Inhalants 6.3% Others: < 10% Tranquilizers Stimulants Hallucinogens Sedatives Cocaine Heroin

In truth, most teens will escape their adolescence relatively undamaged by drugs. But those who use marijuana early in life—are at greater risk for addiction. In addition, research bears out that these same early initiates often have other risk factors that make addiction more probable.

1. Parental addiction. Genetic factors now contribute at least 50% of risk for developing addictive disease.

2. Social and environmental risks include: Early life trauma, family dysfunction, concurrent medical or psychiatric disease (ADHD, depression or anxiety disorder), easy access to intoxicants, early maturation and looking older than age mates, etc.

3. Developmental transitions unique to the adolescent brain also influence the emergence and progression of substance abuse.

The adolescent brain simply lacks the hard wiring associated with inhibitory control. In males, the prefrontal cortex does not fully function until age 25 and in females, until age 18 or 19.

Thus, when intoxicants are consumed, the hedonic midbrain, through a complicated cascade of neurobiological events is energized, while the frontal areas, which serve to mediate and, when required, inhibit hedonically driven behavior that is potentially dangerous or contrary to one’s beliefs, goals and morality, fails to function. As a result, this drug induced state results in seeking quick rewards while minimizing or miscalculating the associated risks. It is not surprising that the number one cause of death for teenage males is alcohol and drug related trauma.

Monitoring the Future (MTF) 2016 MTF, in partnership with the University of Michigan, has been tracking adolescent drug use since 1975. It is gold standard of epidemiological data relevant to substance abuse among teens.

In 2016, 45,473 students from 372 public and private schools participated in the MTF survey.

According to the 2016 MTF annual survey, the prevalence of cannabis use among students from 6th to 12th grade reveals that trends in marijuana use have remained stable for several years.

Highlights 7 percent of high-school seniors report smoking marijuana daily.

Daily use of cannabis increases the risk of addiction by 4-7-fold, skyrocketing to somewhere between 25–50 percent. And because the MTF is a “snapshot” of current use, we can extrapolate these data, and see the dramatic increase between students in the 8th grade and those in the 12th grade. Thus, many young teens are well on their way to addiction, and all the consequences associated with growing up stoned.

Continued on page 32

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Hope For A Bright Future 7

PHYSICIAN’S HEALTH PROGRAM- ADDICTION TREATMENT THAT WORKS

By John Giordano, Doctor of Humane Letters, MAC, CAP

From all outward appearances, Dr. Peter Grinspoon looks to be the epitome of success. The Harvard trained physician has an accomplished wife, practices as a primary care physician at Massachusetts General Hospital’s Chelsea clinic and teaches medicine at his alma mater, Harvard Medical School. He spent five years as a Campaign Director at Greenpeace before med school. If you asked Dr. Grinspoon today what his greatest accomplishment is he might just answer that he is proudly ten years clean.

Dr. Grinspoon is not alone. In 2014, 21.5 million Americans over the age of 12 – or nearly 10% of the total U.S. population – battled some form of a substance use disorder according to the National Survey on Drug Use and Health (NSDUH). But only a fraction of those people, roughly 11% of the people with a substance use disorder, are being treated.

The rate of abuse rises to 15% when you focus strictly on physicians. That means that you have a one in seven chance of being treated by a doctor with a substance use disorder every time you visit a medical facility. This is not a surprising statistic when you consider that out of all practicing physicians in the U.S.; one out of twelve receives a payment involving an opioid according to the American Journal of Public Health.

Physicians like Grinspoon are inundated with opioids and it has been a problem for quite some time. It was in the late 50s when state medical boards began formulating plans to address physicians’ substance use disorders. However, it was in February 1973 when a seminal policy paper – prepared by the AMA Council on Mental Health and published in the Journal of the American Medical Association (JAMA) – forced the medical community to act. The landmark paper titled, “The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence” exposed the pervasiveness of substance use disorder among physicians.

Soon after “The Sick Physician” was in print, state medical boards with support from the American Medical Association, laid the foundation for the Physician’s Health Program (PHP) specifically designed to treat addicted physicians. Today there are comprehensive PHPs in all but four states: California, Georgia, Nebraska and Wisconsin.

Because every state oversees its own Physician’s Health Program, there are slight differences between them. However, the core principles they have in common are: • Physician’s Health Programs are all abstinence-based.

• Physicians must abstain from any alcohol and/ or drugs for a minimum of 5 years. There are frequent random tests conducted within that time frame.

• 90 days Residential treatment – this is key.

In most states, physicians are required to complete a minimum of 90 days of intense in house residential treatment; and in some instances up to 180 days.

• Treatment is based on the 12-step program and principles of Narcotics Anonymous.

• There is individual and group therapy, profession-specific peer support groups in addition to family counseling.

• Addiction education • Life skills training • Relapse prevention planning

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It is important to note that any deviation from the Physician’s Health Program by a doctor in the program can initiate the revocation process of his or her license to practice medicine.

Astonishingly, the Physician’s Health Program has a 79% success rate!

There are a lot of take-aways from the Physician’s Health Program that you should be aware of. First and foremost is the fact that all PHP’s are abstinence-based. To the best of my knowledge, there is no plan in any state permitting physicians to use MAT drugs such as methadone and/or Suboxone as part of their treatment or recovery. Medication-assisted addiction treatments (MAT) are not even part of the conversation.

The Physician’s Health Program plan incorporates a long term monitoring and support component with stricter guidelines than what you’ll find in most other treatment plans. In fact, some have argued that the success of the PHP lies in the leverage that a physician could lose their license if they fail a drug test. This brings to mind the old idiom ‘the carrot and the stick’ with an emphasis on stick. Is an individual motivated more by reward or pain? Everyone is unique which is why the theory certainly needs to be considered, but to what degree. The vast majority of addicts I’ve treated over thirty-plus years all want to slay their demons and get on with their drug-free lives. Are physicians any different?

Regardless of a person’s motivation, it is my belief that the long term monitoring and support helps people stay on track in their recovery.

Most, if not all, of the treatment involved in the Physician’s Health Program is what you will find in a reputable addiction treatment center. One of the key elements in PHPs that is missing in the treatment you or I receive is the long term or residential treatment, 90 – 180 days compared to 30.

This has been a pet peeve of mine for quite some time. The medical communities including addiction treatment all know that longer termed residential treatment in a quality treatment program plays an enormous role in successful recoveries. The successful Physician’s Health Programs prove it beyond any doubt. Yet here we are in the throes of the worst opioid epidemic known to mankind and the best most insurance companies are willing to cover is 30 days. Their reasoning has no basis in science or medicine – it’s literally an arbitrary number plucked out of thin air.

For all intent and purposes, the insurance industry is controlling your treatment. The profit they pay out to their board of directors and shareholders comes directly from what they do not pay for your treatment. They have their own case managers that are in contact with treatment centers daily looking for ways (medical necessity) to prematurely end a policyholder’s treatment. Their case managers have the power to over rule tenured and experienced addiction doctors and therapists. I have been told on multiple occasions by reputable treatment center owners that they have a hard enough time trying to keep someone in treatment for the full 30 days, much less 90, because of the insurance industries profit-driven policies.

If you want the best addiction treatment, than adopt the program your physicians choose for themselves and their loved ones. Unfortunately, the gold standard of addiction treatment is only available to a select few. This is a reality we are going to face for quite some time.

Continued on page 32

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THINGS THAT TREATMENT FACILITIES DON’T WANT TO TELL YOU – BUT YOU WANT TO KNOW

By Susan B. Ramsey, R.N., ESQ

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), it is approximated that at least 20 to 23 million Americans age 12 or older needed treatment for substance abuse and addiction. Unfortunately, only about 4 million out of those 23 million received it. It is also estimated that alcoholism causes 500 million lost work days a year.

Treatment centers for drug and alcohol abuse is a blossoming industry. While there are many exemplary facilities, there are also facilities that are ill equipped at best and dangerous at worse.

Moreover, with the advent of more recovery residences (sober homes) there are lots more questions to ask.

The National Institute on Drug Abuse (NIDA) created a brief guide containing these initial inquiries: 1. Does the program use treatment backed by scientific evidence? Ask the facility what the scientific rationale for their programs is. Do they utilize medical management, medications or other types of interventions? You will find that there are a number of different treatment modalities and each one needs to be analyzed separately and on its own.

commission, accreditation, health care, and certification) or CARF (Commission on Accreditation of Rehabilitation Facilities), you may want to check.

2. Where am I or my loved one actually going to be sleeping, eating, etc.? While the marketing brochures may look fabulous, reality may be quite a different thing. Ask to see the actual places- particularly with recovery residences (sober homes).

There have been fire code, health and sanitary concerns.

2. Does the program tailor treatment to the needs of each patient? Specifically, is the treatment “one size fits all”, or do they have different programs or tracks. Does the facility address the needs of patients with “dual diagnosis” or “co-occurring disorders”; such as, eating disorders, or hypertension, and other medical or psychiatric conditions.

3. Is there a safety plan? Is there a procedure for ensuring safety in the event of a hurricane, or other disaster? Will transportation be provided to safety? Who will determine this? What options would I or my love one have?

3. Does the program adapt treatment as the patient’s needs change? How does the treatment facility do these assessments and make these referrals. For example, if it becomes evident that a patient is in need of additional medical or psychiatric services, how do they ensure that happens in a timely and appropriate manner?

5. Ask what the “success rate” of their program is? According to the SAMHSA National Survey on Drug Use and Health estimates that relapse rates for addictive diseases usually range in the range of 50% to 90% and there are numbers of different factors relating to this. So you want to ask what this particular facilities follow-up studies are, follow-up information is and how they base it. If you are told some very high number for a “success” rate – ask them about the SAMSHA statistics.

4. Is the duration of the treatment sufficient? Specifically, different programs have different ideology regarding this issue. There are some programs that are many months in duration. Others are much more short term. This again will depend on the specific needs of the patient and needs to be discussed and addressed.

5. How do 12 step or other similar recovery programs fit into their substance abuse treatment? There are different programs that have different ideologies and philosophies as to what best works. Again, each individual needs to be evaluated for their suitability to a specific program.

6. How does the facility address a patient/client who is experiencing a recurrence of their substance abuse disorder (relapse)? The answer to this is critically important particularly for recovery residences (sober homes). Is there a documented plan that is reviewed with the patient/client and family members or emergency contacts at the time of admission? Consider having a loved one sign a Release of Information so there is absolutely no question as to who needs to be contacted if this unfortunate event occurs and have a plan.

These are general overview questions that will hopefully educate the prospective patient/client and/or family member. Once you have gotten to this point, if the facility is well run and above aboard, they will answer these questions without hesitation.

1. Has the facility had any complaints lodged against them?

In Florida, the State Agency that licenses Substance Abuse Facilities is the Department of Children & Families. If the facility is in another state, ask them who licenses them and whether there have been any complaints (and then check yourself). As to recovery residences – in Florida check with the Florida Association of Recovery Residences (farronline. org). Other states have associations as well (PennsylvaniaPARR, Arizona- AzRHA etc.…) If the facility tells you they have other types of accreditation, for example JCAHCO (joint

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4. Who are the patients/residents going to stay with? Meaning is the facility co-ed and how does the facility maintain boundaries.

6. Ask about the staff. How many professional licensed staff members are there versus non-professional? Specifically, who are the people that are going to be interacting with your loved one on an hour to hour - day to day basis? There are certifications and license requirements for para-professional and professional staff members who work in this field in most states. While 12 step programs encourage peer to peer support- utilizing other people in recovery as the main therapy model has a number of pitfalls.

7. More about the staff- Do not be afraid to ask the hard questions, what the backgrounds of these folks are, have any of these individuals had any complaints, felony charges, criminal complaints etc. It is not uncommon in this industry to have recovering substance abusers help those just beginning their own recovery, and some of these people have difficult pasts. These individual can be wonderful and truly help others but there are those who have no business working with vulnerable patients. Ask about the supervision of those caring for your loved ones or yourself.

Substance Abuse Treatment Facilities and Recovery Residences have enabled millions of people to get back to productive effective lives. It is our hope that if you or your loved one is in need of such treatment that you do the homework and investigate and find the right facility!

Ms. Ramsey’s professional experience began as a Registered Nurse at Yale New Haven Hospital. She graduated from CUNY Law School, and is admitted in several different state and federal bars. She is a Florida Licensed Health Care Risk Manager. Ms. Ramsey assists families whose loved ones suffer from the disease of substance use disorders. Ms. Ramsey actively litigates cases involving serious and catastrophic injuries on behalf of victims with Gary Roberts and Associates.

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JUST SOME OF THE IMPLICATIONS OF LEGALIZED MARIJUANA PART 2 OF 3

By Raul J. Rodriguez MD, DABPN, DABAM, MRO

Certain strains of marijuana do have certain actual medicinal benefits for certain conditions. The specific strain identified in the approved bill is called Charlotte’s Web, which has lower amounts of THC (tetrahydrocannabinol, the primary active and intoxicating agent) and higher amounts of CBD (cannabidiol, one of the more significant medicinal agents). Symptoms such as nausea, vomiting and pain related to cancer, AIDS, and multiple sclerosis, as well as from the side effects of some of the stronger medications prescribed to treat these conditions, can be relieved by marijuana.

Other conditions such as glaucoma and certain types of epilepsy are also treatable with marijuana. These are conditions regarded as severe, and with existing treatment options, are either not fully effective or can be difficult to tolerate due to side effects. Within the context of treating just these conditions, the safety profile and effectiveness of cannabis is favorable and forms the basis of the argument for legalization for medicinal purposes.

Common conditions such as post-traumatic stress disorder (PTSD), anxiety, depression, and insomnia can also be treated with marijuana, although the rationale here is debatable. PTSD is the only psychiatric condition listed in Amendment 22 and is the only one that could be legally treated in this manner; however, many habitual users will still attempt to self-medicate their anxiety, depression, and insomnia. Cannabis use will provide symptom relief for many of these cases, but may also worsen many other cases as well. Here is where the short-term benefits can be outweighed by the longerterm consequences. The feeling of depression and anxiety in many cases will be masked by marijuana use quickly, but not permanently.

The intermediate to longer-term effects of the many chemicals contained in the plant on the brain are such that depression and anxiety frequently worsen. A vicious cycle often ensues where the person smokes pot to relieve symptoms, symptoms temporarily improve and then worsen, and then the person is driven to smoke pot again to relieve the symptoms. This effect can be seen with many pharmaceutical grade medications as well, so the pattern is well-known. A key difference with marijuana is that dosing is not standardized in the way pharmaceutical grade medications are.

This leads to significantly higher degrees of over-consumption that perpetuates and intensifies the vicious cycle. This trend mitigates some of the potential medicinal benefits. Medicinal benefits were meant to be the primary focus of the legalization bill, yet other potential benefits drove the issue much more.

It is no mystery that the potential financial impact of legalization of cannabis in the state of Florida is huge. Many have witnessed the extraordinary profits earned in Colorado and other “legal” states. The same effect at the retail level is expected here. Many entrepreneurs and investment groups have already been contemplating opening up a dispensary when the time comes. It is understandable how so many people will be drawn to this. The potential tax revenue for the state and local municipalities also is a major driving force.

This is part of why the political support of this issue is actually bipartisan. One of the largest industries in Florida, agriculture, is also closely following this topic. Florida has many advantages over the many legal northern states when it comes to actually growing marijuana. Unlike Colorado for example, where indoor greenhouses are necessary, Florida has the ample land, sun, and water available for potential year-round growth. Legalization would be a huge boon for farmers who will have the opportunity to grow a very high profit crop. The other remaining farmers, who choose not to transition their farms into growing cannabis, will also likely see increased profits as they will have less local market competition for their existing crops.

Pretty much anyone else in the agriculture food chain, from fertilizer companies to farming equipment, will derive some significant financial benefit. It is without a doubt how major the financial impact legalization will have on the state of Florida, at least in the short term.

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The main concern with this entire matter is the long-term effects on the state and the population as a whole. All of these short-term benefits, even the financial ones, come with intermediate and longterm problems.

Cannabis is not without problems. Within the context of the legalization debate, the single greatest problem is how the younger generations will be affected. Much of the population, but especially the younger segments, have already concluded that pot has been legalized because it is safe and free of problems. I have seen this already, time and time again here in Florida, with teens generalizing the earlier legalization of cannabis in Colorado and California to include all cannabis everywhere. This has already led to heavier consumption and is starting at younger and often pre-teen ages.

This results in neurologically immature human brains being subjected to toxic doses of the many psychoactive substances found in marijuana. That exposure frequently has permanent neurologic consequences. This early use also has a psychological effect where the perceived safety of pot is generalized to other street drugs, leading to earlier and broader drug experimentation. This results in neurologically immature human brains being subjected to toxic doses of many psychoactive substances that are even more damaging and addictive than marijuana. The unavoidable result of this is proliferation of addiction to marijuana itself as well as addiction to the ever-growing list of illicit drugs that fuel the nation’s drug epidemic.

Please read part 3 of 3 in the November issue of Sober World 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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CLINICAL EXCELLENCE: 5 EVIDENCE-BASED PRACTICES

By Anna Ciulla, LMHC, RD, LD

What defines “clinical excellence” in addiction treatment?

This article is the second in a three-part series aimed at answering that question. In the September issue of Sober World, I laid out three key building blocks of progress in addiction treatment. Now we’ll turn our attention to nine “evidence-based” practices that define clinical excellence in addiction treatment.

Ideally, a quality treatment program will offer a diversity of clinical offerings, according to Dr. Jay Kuchera, M.D., an anesthesiologist with expertise in addiction medicine. In advising individuals and families regarding what to look for in quality addiction treatment, she said, “If there are five clinicians, you want to see the diversity of therapies offered and what the therapists are trained to do.”

On that note, whether you’re a client needing treatment, a family member, or referring professional, these five evidence-based behavioral therapies should be on your checklist for evaluating the clinical excellence of any drug or alcohol treatment program: 1. Cognitive Behavioral Therapy (CBT) – First pioneered by psychologist Dr. Aaron T. Beck at the University of Pennsylvania in the 1960’s, CBT began as a way to treat depression. Beck observed that his depressed clients experienced negative thought patterns that contributed to negative emotions and behaviors, and he surmised that if these same thoughts could be identified and replaced, clients would begin to feel and function better.

Since then, more than 1,000 clinical trials have reportedly demonstrated CBT’s efficacy in treating a wide variety of psychiatric disorders, including addiction. As a therapy for substance abuse, CBT focuses on identifying and replacing negative thoughts that feed the addiction cycle (by triggering drug-seeking behaviors) and impede recovery (by contributing to relapse).

A number of large-scale studies have been conducted to explore how cognitive-behavioral strategies can improve recovery outcomes for clients with substance abuse issues. For example, 34 randomized controlled trials reportedly found that CBT significantly improved recovery outcomes for marijuana, cocaine, and opiate abuse. In one study, 60 percent of recovering cocaine users who had been administered CBT were clean 52 weeks following treatment.

2. Mindfulness-Based Therapies are another evidence-based practice that has shown promise in treating drug and alcohol addiction. These therapies are rooted in mindfulness meditation, a derivation of Buddhist Vipassana meditation, which in the late 1970’s became the groundwork for Dr. Jon Kabat-Zinn’s “Mindfulness-Based Stress Reduction” (MBSR) program for managing pain and stress. Mindfulness meditation encourages non-judgmental awareness and acceptance of thoughts, emotions and sensations as they arise, based on the reality that they are temporary and will pass. Where mindfulnessbased therapies have proved especially therapeutic, then, is with respect to “experiential avoidance,” or an inability to face unpleasant thoughts and experiences that are common triggers for drug and alcohol abuse. Studies have shown that mindfulness meditation reduced experiential avoidance and may also help ameliorate cravings.

3. Motivational Interviewing (MI) – A “considerable body of research” has found MI to be effective for helping people initiate drug and alcohol treatment and reduce rates of drug and alcohol abuse, according to the National Institute on Drug Abuse. MI is a counseling style built on the premise that people can move towards positive self-actualization and self-empowerment through the choices they make. The goal of MI is therefore to encourage clients to move in this direction. Within the MI

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model, therapists take an empathetic, supportive and directive role, by helping clients better connect with their own values and motivations in order to make core changes that better align with these values and motivations.

MI has probably been most studied with respect to its effectiveness for alcohol recovery. At least 32 studies have linked MI to improved treatment outcomes for recovering alcoholics—specifically, increased retention in treatment andreduced rates of problem drinking.

4. Family Therapy – Research has shown that family therapy can prevent substance abuse, halt its progression, and increase drug and alcohol abstinence rates, by addressing dynamics within the family system that may be perpetuating the addiction cycle. Family therapy seeks to:

• repair these core family relationships

• build healthier interpersonal and communication skills

• strengthen emotional connection between family members

• improve coping and problem-solving skills

The end goal, in other words, is healthier family functioning, which is linked to better treatment outcomes for people in recovery. As one illustration among many, a 2015 study looked at the effects of family functioning on opiate treatment outcome, and found a clear, direct link between level of family support and function and treatment outcomes.

5. 12-Step Group Therapy – The 12-step, self-help approach combines the spiritual principles of the 12 steps with the practical support and help of group members who share the same problem. A large body of evidence has found that 12-step group participation correlates with better long-term recovery outcomes. For instance, one major randomized trial, “Project Matching Alcoholism Treatment to Client Heterogeneity (MATCH),” found that a 12-step program for alcohol abuse yielded outcomes similar to those for CBT and MI.

Research into the efficacy of 12-step groups for treating substance abuse has turned up the following key points: • Sustained 12-step group attendance predicts a higher likelihood of abstinence and better recovery outcomes.

• In contrast, “delayed participation and dropout” are associated with poorer recovery outcomes.

• 12-step groups may contribute to better recovery outcomes by providing “support, goal direction and structure; reward for substance-free activities; and a focus for building selfconfidence and coping skills.”

Continued on page 32

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WATER IS MEDICINE: ADVENTURE THERAPY IN RECOVERY

By Jonathan Rios, MA, LMHC, and Jodi MacNeal

In South Florida, we have access to powerful tools for healing – the sand, the sea and the sky. We’ve witnessed firsthand how adventure activities – especially water-related pursuits – play a profound role in long-term wellness and recovery from addiction.

Sea-based adventure therapy aims to connect clients to the water through a variety of activities: • • • • • •

Strategic team-building and group cohesion challenges Stand-up paddle boarding Kayaking Snorkeling local reefs with tropical fish, sea turtles and manatees Exploring secluded islands, remote beaches and mangroves Geocaching

Adventure therapy is far more than a day at the beach; it’s the prescriptive use of outdoor experiences under the supervision of a trained facilitator, and it’s designed to engage clients on many levels – physical, spiritual, emotional, and occupational.

These pursuits require movement, clear communication, attuned listening and teamwork. As a direct result, people find themselves fully in the moment as they experience resistance from limiting belief systems, currents, winds, and fatigue, experiences that help them develop resilience.

Swimming with marine animals or balancing on a paddleboard provokes mindfulness as clients engage in a foreign environment that requires focus, adaptability and the willingness to learn.

Addicted individuals often wrestle with tremendous stress, anxiety, trauma and depression. An hour or two on the water helps them break free from all of that, to become a child again and have fun.

We can’t stress the value of simple fun as a component of treatment. In a 2009 report, the National Institute for Play showed that play “increases coping skills, can foster empathy and a sense of belonging, and strengthen relationships.” We’ve seen all of those things happen in our time on the water. We think the life lessons tend to stick better, too; the Association for Experiential Education assures us that a person learns more effectively when all the senses are engaged and when he or she is directly involved in the learning process.

We’ve found that while many clients in recovery don’t engage in organized workouts on their own, they will try their hand at snorkeling, swimming and paddleboarding in the tropical waters of South Florida. That may serve them even better.

Why? Because we see tremendous therapeutic benefit from connection to the water. In his book Blue Mind, Wallace J. Nichols makes the case for the healing power of water on many levels, from the colors to the smell to the patterns of the waves. “In the motion of the water,” he writes, “we see patterns that never exactly repeat themselves, yet have a restful similarity to them.” Humans are hardwired to find the color blue calming, and associate it with feelings of joy and wellness.

Nichols believes that the rush produced by addiction and other atrisk behavior can be replaced with a more natural dopamine “high” from outdoor experiences. Water sports can satisfy the brain’s desire for stimulation, novelty and a neurochemical “rush,” while also getting clients out of their typical environment (a critical aspect of most recovery programs).

He recounts how a kayak expedition provides triple therapy: • Physical, by engaging the body • Occupational, by teaching new skills • Mental, by providing relaxation, renewal and wonder The kinds of interactions we experience on the water can also lead to a deeper client-therapist bond. Michael Gass, a leading researcher on adventure therapy, supports the belief that “change

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Photo courtesy of THRIIV

occurs when people are outside their comfort zone,” and that “the experience [and not the therapist] becomes the medium for orchestrating change.”

According to a paper in The Practical Scholar: Journal of Counseling and Professional Psychology, “novel or challenging experiences in treatment set the stage for a significant level of trust to develop throughout the therapeutic process.” We relate to one another differently on the water than we do in a therapy session, and that can be freeing when people otherwise have difficulty expressing themselves. Frequently, everyone lets their guard down and interacts in a spontaneous and genuine way – with the clinician and with each other.

We find that being on the water gets clients out of their heads and engages their senses through the smell of the air, the touch of the breeze, the sound of the waves. Studies of recovery rates have demonstrated that surgical patients with a view of nature recover more rapidly, require less painkillers and experienced fewer complications. How much better, then, to be on a paddleboard, gliding alongside a mother manatee and her pup, or in a sea kayak tasting the salt in the air?

In fact, science supports the physiological response to spending time in nature, and specifically, on the water: • The sound of waves alters brain wave patterns, producing a state of relaxation.

• Negatively charged ions in the sea air combat free radicals, improving alertness and concentration.

• Spending time in nature (as opposed to an urban environment) decreases obsessive and negative thoughts.

• Creative problem-solving can be dramatically improved by disconnecting from technology and reconnecting with nature.

• Being in or near the water can help lower levels of the stress hormone cortisol.

Researchers are beginning to study adventure therapy as it specifically pertains to people in treatment for drug and alcohol addiction. A 2012 study of adult women in substance abuse recovery showed that completing a challenge course “resulted in significant improvements in abstinence and self-efficacy, measured from intake to discharge.” When you stretch beyond your presumed limits, you discover strengths you didn’t realize you had.

Dan S., a lawyer, professor and former client, made this observation: “You actually forget that you are being ‘treated’ until you recognize just how much more at ease you are. Perhaps most importantly, you learn skills you can take with you beyond treatment, all while enjoying a great day on the water. For a spiritual and psychological therapy to be such a fun experience is really remarkable.”

Jonathan “Jonny” Rios is a psychotherapist with Desert Rose Palm Beach and the founder of THRIIV (thriiv.co), an adventure therapy company that helps connect participants to the healing power of the water.

Jodi MacNeal is Desert Rose’s communications and creative director. Learn more at DesertRoseRecovery.com or call for a free, confidential consultation: 561.459.8951.

References provided upon request

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REAL RECOVERY SERIES No. 1

“Why would someone come rescue me at 11 o’clock on a Friday night?”

“I was in a horrible situation. I knew I was going to relapse.

They took action right away, took me to a place of peace and kindness, and the next morning everything was different.

“I was safe. I was surrounded by love and acceptance and empathy. No one judged me for my mistakes. They just helped me learn how to quit making them.

“Why did someone come rescue me at 11 o’clock on a Friday night? They didn’t think I’d live ’til Monday.”

This is a true story as related by B.G., a Desert Rose graduate who has been clean and sober since September 2015

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ADDICTION, RECOVERY AND STUDENT SUCCESS

By Michael R. DeLeon

America is dealing with the worst public social health crisis she has ever seen- Addiction. One of the most afflicted populations is our youth and young adults. This population has always been disproportionally touched by addiction because of adolescent risky behavior. The real dilemma is that so many adolescents and young adults have been directly affected by a pharmaceutical induced opiate explosion. That, coupled with the legalization of this population’s most abused illicit drug, marijuana, we find ourselves in what is being called by many as a pandemic. This is one of the biggest hindrances to our population. In fact, I personally submit that it is the greatest threat to student success.

Every state in the nation is dealing with an addiction pandemic.

Every community is affected. Recent statistics show us that the problem is not getting better, it is getting worse. Some are predicting the crisis will grow unabated for the foreseeable future.

The CDC has stated that the number of opiate overdose deaths will not see decreases until after the turn of this decade. It’s beyond time for an all-hands-on-deck approach and as the epicenter of many counties and communities across this great country, community colleges must take a lead in the solution.

According to the Indiana College Survey (2009-2016), there has been a significant increase in drug use among college students. In 2009, it was reported that there was a “14.9% usage of marijuana within a one-month period. This number reflects combined reporting data with both males and females respectively. However, in a repeat study in 2016, the results of marijuana usage within a one-month period had increased to “23.6%” for males, and “17.3%” for females.

The findings within these studies shows a difference in usage between genders, but both have increased dramatically. Additionally, the studies reflect that males consistently have a higher rate of usage than females. I submit that even these documented statistics are grossly underreported. Addiction and drug use is vastly stigmatized in America. Generally, people won’t be honest when self-reporting drug use. The statistics do not coincide with national ones. They don’t paint a realistic picture of what’s happening.

the changes being made to this misunderstood drug. It will affect increasingly more people as use of the drug escalates. It will also increase other illicit drug use as higher-potent THC in marijuana will make the drug more of a gateway than it has ever been.

Education is one of the most important protective factors needed to prevent addiction and the most foundational component in recovery from addiction. Every study ever done on recidivism of jail and prison populations shows that increased education reduces recidivism.

Educating our population is critical. Supporting recovery is just as important. We must face this social issue in a systemic way.

Another finding is the variation between students attending twoyear and four-year colleges. According to the Indiana College Survey, those students attending two-year colleges consistently had higher reporting rates than those students who attended fouryear institutions. Thus, community colleges are particularly and uniquely affected and must become leaders in this fight. This is critically important for community colleges to understand. The students that we serve are a microcosm of society and society is in the middle of a pandemic. Society’s unpreparedness and naiveté about opiates and the growing overuse of those drugs brought us to where we are today. Studies show that young adults, ages 18 to 27 are one of the most prevalent populations affected by addiction.

We can’t as educators be as naïve about a systemic problem that affects the population we serve.

Four-year schools are doing a great deal with recovery housing which supports students in recovery with an all-around substancefree environment, but community colleges lack that component since students don’t live on campus. We must be more communityresourced and partner with students who need help or who are in recovery from addiction. Colleges need to set up core curriculum about addiction, not only in freshman orientation and seminars, but throughout all programs for all students. Staff must be aware of current drug trends and the importance of intervention when students present symptoms. Administrations need to inform students about community resources that are available and how students can access those programs. A campus-wide approach is necessary to overcome the stigma that fuels addiction. Not talking about this will not make this go away.

To lead, we need to understand the problem. Without systemic education among the college trustee boards, administration, staff and students, and a campus-wide plan to address the issue, it will continue to impact graduation and completion rates, enrollment, and student success. It is too late to be only proactive. We must address this issue differently and openly. It must be addressed on three fronts: Prevention, Intervention and Recovery Support. I call it the Tri-fecta approach to addressing our country’s growing addiction problem.

As secondary education becomes more important in American life, promoting recovery and student success to our population is more crucial than ever. Facing this American pandemic of addiction head on is vital. Our students will increasingly come to depend on our partnership in this issue for their success. Our success is only their success.

It is a national pandemic, and during this crisis, we are compounding this problem. Many states are moving to legalize commercial marijuana. This is being done without proactively considering the consequential effects on students. Marijuana is the most abused illicit drug in America. It is also the most abused illicit drug for adolescents and young adults. Most people do not realize

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Michael R. DeLeon is the Director and Producer of the films” Kids Are Dying”, “An American Epidemic”, “MarijuanaX” , and Road to Recovery” His fifth documentary, “Higher Power” will be released in September, 2017. Michael is the founder of Steered Straight Inc. He is the National Recovery Advocate for Transformations Treatment Center. Michael also is Trustee Board Member at Cumberland County College in Vineland, NJ.

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LIVING BEYOND

A Monthly Column By Dr. Asa Don Brown

OPIOID ADDICTION: A GLOBAL EPIDEMIC “No one is immune from addiction: it afflicts people of all ages, races, classes and professions.” ~ Patrick J. Kennedy Recently, I read a heart-wrenching article posted online by a father urging and begging those addicted to opioids to find help. The father’s sense of urgency stemmed from his recent loss of his only child. The father went on to describe how the loss of his only child had stripped him of his desire to live and find meaning in life. As he went on to discuss the implications of his son’s tragic loss; he also discussed how he had made a promise to his wife several years earlier that he would help their son beat this addiction.

“Canada is in the midst of an epidemic of opioid use and abuse - involving both prescription and illicit forms of the potent narcotics...” Truthfully, Canada and the United States are mere reflections of a global epidemic. According to the United Nations Office on Drugs and Crime’s, UNODC, World Drug Report approximately 29.5 million people are suffering globally from drug use disorders and specifically from opioids.

“Opioids were the most harmful drug type and accounted for 70 per cent of the negative health impact associated with drug use disorders worldwide...”

FACING THE CRISIS

As you read the article, you could sense that this father was feeling guilt, shame, and blame. As you read further into the article, you discover that the father had not only lost his son, but he had lost his wife of 30 years to ovarian cancer.

“There is much work to be done to confront the many harms inflicted by drugs to health, development, peace and security, in all regions of the world.” ~Yury Fedotov, UNODC Executive Director

As I reflected on this article, I realized that this father’s plea and sense of urgency is sadly and daily reflected throughout our global community. The father had not only lost his only child, but had lost himself in the process.

We must stop thinking of this crisis as a singular issue, and begin recognizing that it has become a systemic epidemic. There are no absolute remedies to solve this problem. It is an issue that is unprecedented and a new frontier with which we must face. Facing the crisis, we must begin with active discussions, communications and concrete solutions that will prove effective towards eliminating the problem.

As a father, I have personal angst raising my children, but I remain hopeful and optimistic about our future. While we are certainly facing more challenges, more uncertainties, and more temptations than any generation before; the truth is, we will not be defeated and will not be overcome by this global crisis. The good news is, while there are an unlimited number of challenges; there remains hope for tomorrow.

My heart breaks each time I learn of another tragic loss; it is certainly this generation’s “Black Death.” While the original “Black Death” may have been caused by an infection derived from a bacterium known as Yersinia pestis; this generation’s greatest nemesis will be that of illicit drugs. The opioid epidemic is not the sole causation of overdoses, nor will it be the last epidemic that we face derived from illicit and prescription drugs; but it is indeed one of the greatest challenges that we are facing UNDERSTANDING OPIOIDS According to the Department of Health and Human Services, HHS, opioids are the leading causation of overdoses in the United States.

Opioids are defined as being “a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others...

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused.”

The crisis is rapidly changing the landscape of legal and illegal substances. We must reconsider when, why, and how prescription opioids are dispensed and prescribed. We must consider actively training our professionals and those who are treating chronic / acute pain. Arguably, the judicial approach related to the criminal activity has been ineffective. It is clear that we must begin to relate to opioid abuse from a disease model. As clinicians, we must consider delaying prescriptions and only prescribing opioids when other approaches have proven ineffective. The crisis must be faced on a global scale made-up of varying perspectives, approaches and techniques. We must learn to work together as a global community and do all that we can to circumvent this unimaginable epidemic.

My hope is that no other parent will be faced with the untimely loss of a child due to opioids.

Author: Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Website: www.asadonbrown.com References Provided Upon Request

WHAT ARE WE DOING AS A GLOBAL COMMUNITY? On August 10th, 2017, President Donald Trump addressed the opioid crisis from his golf club in Bedminster, New Jersey. The President declared that “the opioid crisis is a national emergency.

We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.” While President Trump’s announcement might bring some comfort in knowing that the United States government is onboard to solve this most egregious issue; the truth is, the crisis goes well beyond the borders of the United States. The crisis has reached global proportions.

The Public Health Agency of Canada, PHAC, has reported a significant increase of opioid usage over the past 10 years.

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YES, YOU CAN BE MORE EFFECTIVE! What if it’s our own lack of knowledge that’s responsible for the poor treatment outcomes we are continuing to battle? We have all heard how genetics and biology play a role in chemical addictions, but do we really understand it? Do we really understand the significance of these findings?

And if so, what is being done about it? How do you apply it?

When I got into this field, I felt very uncomfortable and quite ill-prepared about treating an illness we know very little about. Addictions have been around for thousands of years, and although our attitudes towards those with addictions have improved tremendously, our approach to treating this illness has not really changed all that much. For the most part, we are still relying on our own, and very individualized, common sense.

Don’t get me wrong, our theories are wonderful, and they do make good sense, but don’t they all seek to unravel the truth behind why some people develop addictions and others don’t? Are they not a search for answers?

What if the answers we have been looking for, all these hundreds of years, can be found right here in the science we have now?

This book will challenge your beliefs and help you to bridge the gap between science and treatment. In doing so, it will arm you with the knowledge and confidence it takes to be more effective. There are no miraculous cures here, but science has provided the answers we need to take treatment to the next level and propel us into the future.

Science is changing how we view and address chemical addictions, so don’t be left behind. Visit my webpage at: www.theafflictionofaddiction.com and order your copy now. This is my gift to you. The time is ripe to reap the rewards of all our untapped knowledge. Change is in the air and the future is upon us! Welcome to the 21st Century!

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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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SAVORING THE CELEBRITY MELTDOWN

By Maxim W. Furek, MA, CADC, ICADC

The worst moment for a celebrity is that instance when things begin to go bad, when their star becomes tarnished and suddenly loses luster.

It could be an episode of uncontrolled drunken driving, a domestic dispute, a sordid sexual encounter or an encounter with drugs. It really doesn’t matter. The result is always the same: that tragic moment when the celebrity is called out, paraded onto the courtyard in today’s version of the stockades and made to suffer public condemnation.

There is no safe retreat, no solitude nor anonymity. There is no place to hide. Bright reflections of light cascade upon the celebrity in obscene luminescence. The result is a sad, much publicized, much analyzed, consequence. The public stares, mesmerized, at the photographed, videotaped and televised carnage, watching horrorstruck as the dirty laundry is publicly aired. Lusting for more, the public salivates at sensational news clips on The Insider, TMZ on TV, FOX TV, and Entertainment Tonight and at the graphic photographs from a relentless horde of paparazzi.

There is something inherently perverse about an American psyche that screams out for more celebrity blood and carnage.

It is pathological and it is predictable. And too, it demonstrates a troubling aspect about our character as a people, and as a nation.

Gone is celebrity respect, spinning full circle from adulation to castigation, replaced now with public shame and humiliation. It is a moment eagerly embraced by once adoring fans, bloated with lustful expectation of the bloody train wreck ahead.

privacy. Diana, who was married to Britain’s Prince Charles from 1981 to 1996, died from injuries sustained in a Paris car wreck on August 31, 1997. The car crash also claimed the lives of her companion Dodi Fayed and driver, Henri Paul.

The editors of the three biggest selling tabloid newspapers (The Sun, Daily Mirror and News of the World) admitted their own share of guilt over the accident that killed her. The editors conceded that they had helped create an atmosphere in which the paparazzi, who were chasing Diana when her car crashed in a Paris underpass, were out of control. Phil Hall, editor of the News of the World, said it was a circle of culpability involving the readers who demanded more photographs, the photographers who chased her and the newspapers that published the pictures.

“A big Diana story could add 150,000 sales. So we were all responsible,” he said. Hall, speaking on the ITV1 documentary Diana’s Last Summer, said: “I felt huge responsibility for what happened and I think everyone in the media did. “If the paparazzi hadn’t been following her the car wouldn’t have been speeding and, you know, the accident may never have happened.”

Prior to her death, Diana prophetically responded to a question about the relentless press, darkly anticipating that she was “a lamb to the slaughter.”

David Hasselhoff

The media, with blurred moral boundaries, are to blame for this celebrity exploitation. Like great whites, the media feeding frenzy enables and exploits instead of intervening and helping. They have been doing this for long time.

David Hasselhoff suffered this public degradation after a videotape showed him, shirtless and drunk, attempting to eat a cheeseburger.

Hasselhoff defensively claimed that the video was a deliberate plan, orchestrated to get him to stop drinking.

Princess Diana

The disgusting videotape, made in 2007 by Hasselhoff’s daughter, captured the recovering alcoholic falling off the wagon. The video, which aired on several syndicated entertainment shows including “The Insider,” “Entertainment Tonight” and “Extra,” depicted an apparently inebriated Hasselhoff, clad only in blue jeans, lying on the floor of a room

Many believe that the paparazzi madness started in the 1990s. The paparazzi stalked a vulnerable princess Diana, Princess of Wales, placing her private life on public display, ripping away any sense of

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and clumsily eating a hamburger. His 16-year-old daughter, Taylor-Ann, reprimands him about his drinking. The TV shows said the tape was made in Hasselhoff’s home in Las Vegas, where the former “Baywatch” star has been appearing in a stage version of “The Producers.”

“I am a recovering alcoholic,” Hasselhoff said in a statement.

“Despite that I have been going through a painful divorce and I have recently been separated from my children due to my work, I have been successfully dealing with my issue. Unfortunately, one evening I did have a brief relapse, but part of recovery is relapse.

Because of my honest and positive relationship with my daughters, who were concerned for my well-being, there was a tape made that night to show me what I was like. I have seen the tape. I have learned from it and I am back on my game.”

Anna Nicole Smith In a sensational trial investigating the February 8, 2007 death of actress Anna Nicole Smith, investigators listed a disturbing array of drugs that were prescribed to the one-time Playboy model and star of the 2002 “celebrity reality sitcom,” The Anna Nicole Show on the E! Entertainment cable network.

Dr. Joshua Perper, Broward County Medical Examiner and Forensic Pathologist, stated that Smith died of “combined drug intoxication” with the sleeping medication chloral hydrate being the “major component” in her death. No illegal drugs were identified but there were a total of seven prescription drugs, usually prescribed for anxiety, depression and insomnia, found in her bloodstream.

One of the more bizarre aspects of the trial occurred during the preliminary hearing and surrounded the so-called “Clown video.”

The video portrayed a multi-colored, face-painted Anna Nicole Smith, apparently in a drug-induced stupor. She slurs her words and seemed to be unable to concentrate. In the disturbing tape Smith is confused, mistaking a toy doll for her unborn child.

Prosecutors used the 45-minute-long “Clown video,” filmed by boyfriend Howard K. Stern, as evidence that Stern and two doctors, Dr. Khristine Eroshevotz, Smith’s personal psychiatrist and Los Angeles physician Sandeep Kapoor, conspired to keep the actress in a drug stupor in the two years before her death.

The sad and grotesque “Clown video” was another example of celebrity degradation disguised as entertainment. Smith’s drugged state was painfully exploited only to increase ratings.

humbling place called rehab. I truly hit rock bottom. Till this day I don’t think that it was alcohol or depression. I was like a bad kid running around with ADD.” In 2008, just days after losing a custody hearing, the singer locked herself in a room with one of her children in her Los Angeles home and refused to hand him over to ex-husband Kevin Federline. Police intervened and said the singer appeared to be “under the influence of an unknown substance.”

Spears was rushed to Cedars-Sinai Medical Center for evaluation.

The following day a court suspended her visitation rights and Federline was given sole custody of their children. Three weeks later Spears was committed to the psychiatric ward of Ronald Reagan UCLA Medical Center and placed on a 5150 involuntary psychiatric hold. Later that year, a judge granted the singer’s father a conservatorship giving him control of Britney’s finances and life decisions. The American public fixated on the Britney Spears soap-opera as she spun out of control, further down that hole of emotional darkness. Every facet of her life, every nuance and inference --- family, career, mental stability--- were televised for an audience lapping it up like a pack of rabid dogs.

Charlie Sheen In 2010, the talented Charlie Sheen was the highest paid actor on television. He earned $1.8 million per episode of Two and a Half Men. In 2011, the show went on hiatus while Sheen underwent a substance rehabilitation program, his third attempt in 12 months. Soon Sheen’s personal life began to unravel with reports of substance abuse, marital problems, and allegations of domestic violence. Sheen had a very public meltdown in 2011, recording a number of highly publicized videos claiming he was a “warlock” with “tiger blood” and “Adonis DNA” and that he was “winning.” CBS and Warner Brothers terminated his contract in March 2011. Sheen subsequently went on tour and later starred in the FX sitcom Anger Management.

In an Addictions Professional blog called “Charlie Sheen, the Art of Winning, and Recovery” Dan Griffin posted on March 1, 2011, “I feel as though I am part of the problem – watching the interviews and ogling over the incredibly devastating car wreck unfolding before us.

He doesn’t need people taking pictures of him in the car in flames, he needs help and few of the media exploits in the past week have been focused on that. Because our society sure loves its car wrecks!

His struggles with drug addiction, gambling, and other unhealthy behaviors are legendary. We have been watching an addict kill himself slowly for two decades. And the media and his employers (aka CBS and Warner Bros.) have been great enablers for years.”

Although there was much speculation about the cause of Sheen’s meltdown, much of his personal life revolved around chronic drug use and sexual romps with porn stars and call girls, individuals he called his “goddesses.” On November 17, 2015, Sheen publicly revealed that he was HIV positive, having been diagnosed about four years earlier. Sheen suffering a stroke in 1998 after overdosing on cocaine and trying to flee rehabilitation a few days later.

Britney Spears Britney Spears rapid decline was a much-watched and real-life reality show. In 2007, Spears entered a drug rehabilitation facility in Antigua. She stayed for less than a day. The next night, she shaved her head at a Los Angeles hair salon and then attacked a photographer’s car with an umbrella. It was an escalating drama, unfolding minute-by-minute through the eyes of the rapacious paparazzi, capturing every titillating and forbidden moment.

Weeks later, Spears entered herself into another treatment center, Promises, and finished a month-long program. After leaving Promises, she wrote on her website: “Recently, I was sent to a very

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Yes, there were attempts to rescue and rehabilitate the addicted Charlie Sheen, but there were also those who delighted, and profited from his frenetic, drug-fueled antics. He was nightly entertainment, with offerings of over-the-top, ramped up, super charged insanity.

Sheen was another train wreck about to happen. Many of us gaped in fascination as he rapidly fell further into the abyss. And, even though it was sick and perverse, many savored his celebrity meltdown.

Maxim W. Furek, MA, CADC, ICADC has a rich background that includes aspects of psychology, addictions, mental health and music journalism. His book The Death Proclamation of Generation X: A Self-Fulfilling Prophesy of Goth, Grunge and Heroin explores the dark marriage between grunge music and the beginning of the opioid crisis. Learn more at shepptonmyth.com

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From The Hearts of Moms UNCONDITIONAL LOVE--THE IMPACT ADDICTION HAS ON SIBLINGS

By Jodee Prouse

I love my brother. Forever. There is nothing he could ever do to change that.

lasting repercussions from what he “felt” about those Friday nights.

Growing up scared, fearful, lacking in confidence, and with anxiety.

Although my love for him was tested time and time again through appointments with doctors, therapists, psychologists, and psychiatrists, 911 calls, suicide attempts, lies, prostitution, debt, and destruction. My brother—a sweet, kind, soft-spoken, magnificent man—due to his illness eventually did things few could fathom and I was along for the ride. It was like I got on my first roller coaster at a carnival, and I was not quite sure what I was in for. It was full of twists and turns; I felt sick, scared; I was holding on for dear life and I just wanted it to stop. And it didn’t, for twelve years.

In early adulthood, I redefined my interpretation of “normal.” I loved my parents but I was going to do things differently. Better. My husband and I chose to have a sober home, to give our children a different life so that who or what they would become would not be based on alcohol.

No one taught me how to be a sister; I just became one. I entered the world in a particular birth order that I didn’t choose, but it defined the role I took on in this world. My brother would become an alcoholic and I the sister of an alcoholic. It is a job that came with a lifetime’s contract but no one gave me the skills to complete the assignment.

Once upon a time, over forty years ago, we were an average, everyday, normal family. A beautiful nurse mom. An oldest sister (me) who loved her family very much. A little boy, four years younger, with a round face and a huge heart. A baby girl, one year old with big piercing blue eyes, white blond hair, and still the most beautiful baby I have ever seen. And, an alcoholic daddy.

I was affected in different ways by different people. My dad’s drinking and the things I witnessed would change who I would be forever.

“Normal”? My daddy didn’t pick us kids up from the daycare when it was closed because he was with his friends at the bar.

Which in turn, left a two-year-old boy and his six-year-old sister feeling abandoned, forced to snuggle close together on the couch, watching Sonny & Cher until the little boy’s eyelids were too heavy to stay open. And our mommy would come and get us late in the night after she finished her job at the hospital.

I didn’t know that not all daddies kiss other women; I didn’t know that not all Daddies come home drunk every Friday night, yelling at mommy, crying, screaming, and fighting. I didn’t know that not all nine-year-old sisters would crawl down from the bunkbed above beside the brother that they love, to rub his short brown hair and whisper a lie in his ear, “It’s alright, everything is going to be alright” just so he would stop crying. I didn’t know that not all big sisters would have to find a coat in the middle of the night because we were leaving daddy. She led her frightened and wailing little brother out the front door; their Daddy stumbled in hot pursuit; mommy and the children sped away in mommy’s car.

These experiences would make me strong, stoic, confident, and able to take on the world. I know these things seem like great attributes to have, and certainly they have afforded me the ability to withstand and come out flourishing, happy, and healthy from many hardships in my life. But at times I am a little too rigid, trying to always do what is right, always being so damn scared that my life would turn out the wrong way.

I believe my little brother, although not able to really remember those events, was also affected, but in a different way. Knowing more now about some of the causes of addiction and mental illness, I believe he had

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So, I have no excuses; I am not making one. During my journey with my brother, I knew that I was hurting my own family. I knew that I was allowing my children to witness things that were unhealthy and could have an impact on who they would become. My own sons witnessed things, which from my perspective, were so much worse than I ever lived through as a child. I remember the hurt and heartbreak in my husband’s eyes when, after years of the struggles to help my brother, my husband asked me, “If it was me, would you have divorced me by now?”

I didn’t reply. But the silence was deafening. The answer was yes.

Addicts aren’t the only ones who feel ashamed, lost, broken, tired, sick, and alone.

My brother’s addiction took over my life; I sacrificed my health, my career, and my marriage. My brother was not responsible for that; I was. Every minute of every day, I was consumed by the same thought ringing loudly in my ear. “Someone I love is going to die.”

And that thought propelled me, fed my head and my heart false information. Just like my parents fed me false information when I was just a little girl.

My brother is etched deep in my soul. It took years of therapy and healing to come to terms with the most powerful truth that I have to live with. Why did I sacrifice the well-being of my own two young sons for that of my brother? I loved him like he was my own son.

Addiction affects all of us in different ways; which is why it is called a family disease.

If I could rewind things, I would do them differently. I would get help for myself first. Run. Get help. Stay aligned as a family.

Agree to disagree. I would not follow my heartstrings, whether it was my brother or my own son. I would listen to the advice of the professionals. But I can’t rewind; life is about moving forward.

My brother lost his brave battle with alcohol addiction on March 18th, 2012. Would I do this all over again for twelve years? Yes. But I would set myself a healthy boundary that I would work out through the help of the professionals in therapy. I would understand what is best for me, for my own family, and what ultimately is also best for the addict.

I love my brother unconditionally. Forever. There is nothing he could ever do to change that. Even though we had a much different interpretation of “normal”.

Jodee Prouse is a keynote speaker, blogger and author of the Amazon category best seller, The Sun is Gone: A Sister Lost in Secrets, Shame, and Addiction, and How I Broke Free. She is an outspoken advocate to eliminate the shame and stigma surrounding addiction and mental illness and empowering women through their journey of life and family crisis. Visit jodeeprouse.com to learn more.

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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

27

HEALING BY THE ART OF 8 LIMBS

By Alastair Mordey

In my view there are two states of being that are likely to bring about addictive behaviors in young adults; too much stress … and not enough stress. Often these two things combine, which may sound counter intuitive, in which case – please read on.

rats that are doing the proper rat things (like bonding and connecting) are almost completely immune to getting addicted to cocaine.

By ‘not enough stress’ I am not referring of course, to a blissful state of carefree happiness, but rather, to the stultifying lack of stimulation and mind crushing boredom which is so common in modern culture. Such unengaging environments are every bit as likely to produce an addiction in adolescence as one or more of the small ‘t’ trauma’s which are well known to result developmentally from adverse childhood experiences (ACE).

“mild stress can actually make male rats more social and cooperative than they are in an unstressed environment, much as humans come together after non-life-threatening events such as a national tragedy. After a mild stress, the rats showed increased brain levels of oxytocin and its receptor and huddled and touched more.”Muroy,, et al (2016)

Working with youths from predominantly middle ranging socio economic groups has led me to the conclusion that there are other factors at work in the causation of addiction than just the existence of household dysfunction, neglect and abuse. Oftentimes, both parents are highly involved in the intervention which is to get these young people into treatment, and while this strong parental involvement is not in itself a sign of familial health (or proof of the absence of ACE) it does suggest that these young people are loved, and so what exactly is the problem?

The problem is this – happiness, is over rated.

The Buddha told us this 2500 years ago, but in modern times we seem to have forgotten it. As the developmental psychologist Erik Erikson also noted; maladaptive traits are as likely to result from overly syntonic (ideal) environments, as they are from overly dystonic (disturbing) environments. For this reason ‘just good enough’ parenting has always insisted on making sure that there is a healthy dose of adaptive stress as well as protection from unnecessary suffering. Maybe, I thought to myself, we should be doing the same thing with our treatment models? And with this in mind, I set about building a program which would reflect these ideas.

Two years ago I began using Muay Thai boxing as a treatment method for young men who were mostly addicted to methamphetamines and opiates. Using a fighting sport to help heal the wounds of a condition which is partly caused by emotional and physical abuse might not seem on the face of it to be the best idea. But obviously, it’s not about the fighting. Initial phases of treatment do not include contact sparring and are heavy on grounding techniques which are mainly developed through Vipassana meditation which is led by local monks (because we are based in northern Thailand). In this way, the practice of Muay Thai (the movements only) becomes a type of somatic experience in itself. For many of our young men, proper ring fighting is not desirable, and only the few who are gifted will go on to compete at an amateur level locally in Chiang Mai, once they are in transitional living, or once they have graduated.

Most of our young men choose instead to enter our Triathlon track which, with its emphasis on long term endurance, is also a great analogy for recovery and an awesome way of improving brain function and mood (because it stimulates neurogenesis, improves dopamine tone and recruits manageable doses of endorphins, enkephalins, endocannabinoids and all the other good stuff).

This healing phenomenon is not just a neurochemical process, but also a social process. As Charles Darwin himself noted, humans are fundamentally no different to the other higher mammals in terms of their basic emotional platforms, which is why we find it easy to ‘make friends’ with cats, dogs, and horses, but rather more difficult to make friends with snakes. Addiction professionals who are familiar with the literature know that rats when isolated get addicted to cocaine whereas

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In 2016, a group of biologists noticed the following behavior in young male rats.

And this is exactly what we find with our young Muay Thai fighters and Triathletes. The fact is young people just aren’t going to get well by reading self-help books and learning to be more emotive. If the challenge is not daunting enough, it will not engage them and ameliorate their destructive tendencies quickly enough to stop them acting out again when they leave treatment, or even leave treatment prematurely.

To date, we have produced three Muay Thai fighters and more than a dozen triathletes. One of our graduates completed an Ironman triathlon in France, where he raised money for orphans affected by methamphetamine addiction in the hill tribe areas of the Golden Triangle (Thai/ Burma/Laos border). Next year (2018) will see five more of our graduates complete Ironman triathlons, accompanied by yours truly, because I believe in not asking my clients to do anything I wouldn’t do myself – whether that is sparring or running triathlons.

The more I learn about trauma, the more I realize that it is not a lack of individual durability which causes it - but a lack of cultural durability. We no longer have hyper meaningful relationships with others outside of our nuclear family units.

We have lost our belief systems which used to provide cogent answers to traumatic experiences.

In this vein, I have sought to reintroduce a potent sense of meaning into my work with addicted young men. We should realize that abstract ideas about what is meaningful are very difficult to impart to younger people who have a more visceral understanding of life. This is especially true of young men. I do not believe that asking them to be more quiet, sensitive and sedentary is very realistic. They learn to love these things too – only after they have embraced their destructive elements, harnessed them and walked through them. With addicted young men, any sense of belonging and meaning needs to be imparted via activity. In short, by odyssey and adventure with other men they respect and who embody the values they espouse. In this togetherness, they discover new depths to their own individuality. If the path forward is not challenging enough, it is impotent.

I have learned with the young men I work with – that there is almost no challenge which is too great for them to achieve. Perhaps we are not setting the bar high enough.

Alastair Mordey is the Program Director at The Cabin Addiction Services Group. He is a certified addiction counsellor for over 15 years. Alastair is the author of international rehab group The Cabin’s clinical method ‘Recovery Zones’. In 2016 Alastair pioneered The Edge, which was the first rehab in the world to treat addiction and trauma in young men (18-28) using Muay Thai boxing and triathlon training. Through The Cabin Foundation, Alastair and his graduates from The Edge, regularly embark on competitive triathlons to raise funds for poverty stricken, methamphetamine affected hill tribe villages in northern Thailand, where the Group is headquartered.

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29

HOW TO FIND HAPPINESS IN RECOVERY

By Louise Stanger Ed.D., LCSW, CDWF, CIP and Roger Porter

For the person in recovery, happiness can be a fleeting notion; happiness for anyone can be hard to claim. What does happiness even look like?

I define happiness as a feeling of contentment and peace about oneself. It’s the emotional response that the world is okay, there are better days ahead, and there’s room for possibility. Sure, anyone can have a bad mood, a bad day or even a bad date. True happiness lives in the moments when we feel good about our lives.

In recent years, behavioral healthcare scientists and researchers have looked at the science of happiness and have uncovered steadfast truths about how we live and interact in an increasingly hyper-connected world. These science-backed truths can help you find happiness, stay in recovery, and live your best life.

Business Insider reports that “40% of our happiness is under our control.” That’s a huge amount of control that we have over our own happiness! The other 60% is attributed to external factors such as the behaviors of others, unforeseen events and genetics. The key insight is that nearly half of what makes us happy through our daily activities, thoughts, and interactions with friends, family and coworkers gives us the power to harness happiness.

The following looks at these behaviors to unlock how we can live happier lives. In conjunction with Time Magazine’s Special Edition on The Science of Happiness, top-notch researchers from UC Berkeley to Harvard Business School and beyond, pulled together key findings related to behaviors that bring a spirit of happiness.

Finding Happiness For many of us, there’s an assumption that happiness only comes from life’s major milestones- weddings and birthdays, going to college and grad school, first cars and homes, vacations and kids.

This false narrative, coupled with the idea that we have to constantly move to accomplish our goals foregoing happiness, enduring stress and weathering negative feelings, may be why many Americans feel overworked and stressed out. Let’s break through these assumptions and take a look at the ways we can find lasting happiness: • Social Bonding. Human connection is in our DNA. According to The Harvard Study of Adult Development, which followed hundreds of men for over 70 years, the happiest were those who cultivated strong relationships where there was a bond of trust and commitment. Moreover, focusing your energy, time and money on social bonding rather than material goods maximizes pleasure and vitality. Why? Because developing cherished memories stay with us long after we experience them. Even “the anticipation of an experience can be as valuable a source of happiness as the experience itself,” says Michael Norton, an associate professor of business administration at Harvard Business School and the co-author of Happy Money: The Science of Smarter Spending. “And for months afterward, recalling the event continues to make you happy.”

• Empathy. Like Atticus Finch says in the classic children’s novel To Kill A Mockingbird, empathy is the ability to “climb into someone’s skin and walk around in it.” And research shows exercising empathy in the form of love and compassion toward others makes us happy.

According to Brene Brown’s article published in Psychology Today, who references nursing scholar Theresa Wiseman’s research on the four attributes of empathy, there’s a lot we have in our power to use empathy toward a happier well-being: • See the world as others see it (i.e. the Atticus Finch view).

• Leave your personal judgments at the door.

• Focus on understanding your own feelings in order to understand the feelings of your loved one.

• Communicate love and understanding as a way of showing support and validation for their feelings.

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• Focus. Psychologists at Harvard University studied 5,000 people and found that “adults spend only about 50% of their time in the present moment.” As such, we look for distractions through digital devices, media and escapist fare, which in turn only makes us more anxious and depressed. In fact, “the more people engaged in media multitasking (from word processing to text messaging and email), the higher their anxiety and depression levels tended to be.” One study cited in Time Magazine and published in the scientific journal PLOS One found “the more people spent time on Facebook, the more their life satisfaction levels declined.”

Building Resilience Researchers have come a long way in understanding how humans develop resilience and use it in their lives to weather life’s tough storms. In 1955, Emmy Werner, a developmental psychologist, formed a team from UC Berkeley to create the most important longitudinal study in the field of resilience research.

The 40-year project looked at nearly 700 children in Kauai, Hawaii, who had alcoholic parents. Turns out many of the children “adapted exceedingly well over time.” Werner and her research team found the following ways the children thrived when faced with adversity: • A tight-knit community • A stable role model • A strong belief in their ability to solve problems The key to building resilience? A stable support system. “Very few highly resilient people are strong in and by themselves. You need support,” says Steven Southwick of the Yale School of Medicine.

Moreover, these tenets for building strong resilience are the very things that 12-Step support groups use in recovery. Turns out, recovery and resilience go hand-in-hand!

What else can you do to build strong resilience? Here are expert tips: • Develop a set of your own personal values and stick to them.

• Look for meaning in stressful or traumatic life moments.

• Focus on the positives more than the negatives.

• Face the things that scare you the most. Dark shadows disappear when light shines on them.

• Learn something new every day.

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www.c4conferencing.org • Find an exercise regimen - yoga, Pilates, walking the park trail and stick to it.

• Let go of the past.

• Recognize your sources of strength and own them.

feelings in the form of being grateful for what matters. Here are ways to feel grateful for each and every day:

Feeling Grateful

• Journal your gratitude - a place where you can write down three things you are grateful for each morning before you start your day.

Gratitude in big and small ways scientifically helps us feel happier.

It’s true: “research suggests [a spirit of gratitude] is beneficial to our bodies and brains. People who are regularly grateful, who acknowledge the goodness in life and the sources of it, are generally healthier and happier.”

Like empathy, gratitude is developed through mindfulness.

What is mindfulness? In my studies and teachings on the topic, I’ve come to define mindfulness as the conscious awareness of the present moment and the people in it. Here’s what mindfulness can do for you: • Lower stress • Relieve pain • Build immunity so you’re sick less often • Help you through other medical issues • Mellow your kids (shout out to parents!)

The key to mindfulness is giving all your attention to what you are doing; to be present rather than dwell on the past or future.

It’s easy for our minds to drift “How do I make my mortgage payment next month?” to “Why did my sister get all the attention growing up?” so much so, that we’re distracted from the moment before us. Beginning with meditation, the touchstone of mindfulness says researchers- ten minutes a day can get you going toward being more present, So how do mindfulness and gratitude work in sync? Through mindfulness, a focus on the now, we’re present from the distractions in our lives. When we do that, look to the things that bring positive

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• Write notes - little reminders around the house that say you are grateful for all that makes your home warm and comfortable.

• Give thanks daily - to people on the street, family and friends, coworkers and bosses. When we give thanks to others, it shows that we care and truly value their contributions. Giving thanks helps us to remember the blessings that bring so much to our lives.

• Be specific about the things you are grateful and thankful for. For instance, if you share that you’re thankful when a friend organizes a group event, specifically thank them for this gesture and maybe it will lead to more.

In my many years as an interventionist and social worker, I’ve seen that happiness is a muscle that must be exercised and practiced with each passing day in recovery and beyond. With these new tools in your toolbox, you can flex happiness and embrace life’s challenges.

Louise Stanger received her bachelor’s degree in English Literature from the University of Pittsburgh, her Masters in Social Work from San Diego State College and her Doctorate in Educational Leadership from the University of San Diego. Her book Falling Up: A Memoir of Renewal is available on Amazon and Learn to ThriveAn Intervention Guidebook is available is on her website www.allaboutinterventions.com Roger Porter has two bachelor degrees, film and marketing, from the University of Texas at Austin. He works in the entertainment industry, writes screenplays and coverage, and tutors middle and high school students.

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GROWING UP STONED - THE IMPACT AND OUTCOMES OF CANNABIS ON ADOLESCENTS AND CHILDREN (PART 1)

By Dr. Mark S. Gold and Dr. Drew W. Edwards

Continued from page 6

In 2016, 9.4 percent of 8th graders reported marijuana use in the past year and 5.4 percent in the past month (current use). Among 10th graders, 23.9 percent had used marijuana in the past year and 14.0 percent in the past month. Rates of use among 12th graders were higher still: 35.6 percent had used marijuana during the year prior to the survey and 22.5 percent used in the past month; 6.0 percent said they used marijuana daily or near-daily.

For instance, adolescents who smoke marijuana once a week over a two-year period are likely to have lower scores on IQ tests, nearly six times more likely to drop out of school and over three times less likely to enter college.

Figure 2: Past-Year, Month & Daily Marijuana Use *Percentages are rounded to the nearest whole number

Part Two of this article will explore in depth the unique pharmacology and psychoactive effects of cannabis, including its potential for addiction, depression, low motivation, risky sexual behavior, and the potential for using other drugs. Lastly, the challenges of prevention, treatment and recovery unique to adolescence will be described as well as recommendations to improve treatment participation, adherence and outcomes.

Monitoring the Future: University of Michigan for NIDA, 2016 Data % Who Used in the Previous 12 Months

% Who Used in previous 30 Days

% of Daily Users

8th Grade

9.4%

5.4%

1%

10th Grade

23%

14%

3%

12th Grade

36%

22%

6%

Summary of Part One Marijuana is a poorly understood psychoactive substance. Recent epidemiological data reveal that the prevalence of marijuana use is increasing among nearly all demographic groups, but especially among those under age 18. This is cause for concern for many reasons, but none more so, than the deleterious effects of cannabis on the developing brain. Recent research has demonstrated the multiple harmful effects associated with the use of cannabis.

PHYSICIAN’S HEALTH PROGRAMADDICTION TREATMENT THAT WORKS

By John Giordano, Doctor of Humane Letters, MAC, CAP

Continued from page 8

That being said, a comprehensive aftercare program that is built on the principles of a quality treatment program is more important in a person’s recovery today than ever before. As evidenced by the success of the Physician’s Health Programs and a mountain of supporting medical and scientific studies, we know that the longer a person is in treatment the better the outcome. A good aftercare program will not only pickup where the treatment center left off but will also reinforce what has been accomplished in treatment. They provide the tools and a strong foundation for a sustained recovery.

They also teach the coping mechanisms that have proved to be invaluable in achieving a long and successful recovery.

The gold standard may not be available to you as a single package; however, adding a comprehensive aftercare program to a quality treatment program will go a long way in developing a sustainable and fulfilling recovery.

John Giordano 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 peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites: http://www.PreventAddictionRelapse.com http://www.HolisticAddictionInfo.com

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The life trajectory for those who begin using earliest in life is wrought with academic failure, psychopathology, underemployment, multiple failed relationships and decreased life expectancy.

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.

CLINICAL EXCELLENCE: 5 EVIDENCEBASED PRACTICES

By Anna Ciulla, LMHC, RD, LD

Continued from page 14

The five therapeutic practices I’ve just described have been evidenced to reduce rates of drug and alcohol abuse in substance abuse treatment populations. On this ground, they are “evidencebased,” having proven effective when administered on their own and/or in combination with one another.

What may be very effective for one person with a drug or alcohol addiction may not work as well for another person, however. The highly individualized nature of addiction—a disease caused by the complex interplay of biology, environment and individual life experiences—makes it hard to predict how a client will respond to one or more of these treatments. A prospective treatment program ideally should provide all or most of these clinical offerings, then, so that clients can maximize their prospects of a positive treatment outcome, thanks to a comprehensive, integrated, therapeutic approach.

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/

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JOURNALING

By Eileen Marin

Does the picture trigger a memory or two? Children of a certain age are consumed with having a small book with a lock on it- of course, to record what’s going on in their lives. The diary has been a rite of passage and incidents related to someone taking it or reading it has been the emphasis of many family focused television show episodes. Somewhere along the line, the diary is packed away or a parent tossed it in the trash with other childhood keepsakes that were outgrown. Maybe at some point the diary, or writing personal accounts of boy or girl friends, who wasn’t talking to who that day at school was resurrected, but most often, it fell by the wayside.

What many may not know is that writing in a diary or writing on paper with your hand on an implement, such as a pencil or crayon, produces definitive emotional benefits. It’s important to emphasize that using the hand to write or doodle is different than using technology; typing on a keyboard or using a stylus.

Extensive research testing has been done and measured to determine brain changes during writing occasions. Tracking brain waves using scans such as an MRI can’t be done. If a subject were to use their hand while in the machine it would be fine, but, because of magnetic fields in the machines, the subject couldn’t use a tablet or computer. All of the data gathered to date and documented in articles supports positive brain activity during the testing exercises.

There are people who use the term journal generically. They say they journal when they cut pictures out of a magazine and put it in a blank paged book using it as a “vision board or dream journal”.

Others may keep a log of daily events and consider it their journal.

Still others write what’s going on in their life topically while using correct grammar and punctuation. There are many ways to journal depending on the purpose of doing it. There are no rules or journal police to say you’re doing it right or wrong.

Perception is reality. What we believe becomes fact, our reality.

Some who are not familiar with journaling or its benefits, view those who do it in a certain way. They may think of the journaler as one who is also into voodoo or other practices they know nothing about. Of course that is an extreme exaggeration but you get the point.

Using a journal to pursue personal growth for physical, emotional, and spiritual healing is different than a “record of the day’s activity” writing.

How did “physical” make it into the list of three? What we think affects our physical body. It is no different than “perception becomes reality”.

When I introduce myself and begin to talk in a workshop, I stop mid-sentence asking the women to remove their blouse or top and the men to take their pants off. The room regardless of size becomes silent. I continue on after a few seconds with chuckles saying they participated in a firsthand experience of the mind and body connection. They all had a physical reaction hearing my directions. When you read the scenario, the words, did you?

Have you ever been driving the car, looked in the rear view mirror and spotted a police vehicle coming closer to you with its lights on? Did you feel anything in your body when you saw it and then again when it passed you by? Did you just continue on your way giving it no thought?

Most people experience a physical reaction to the scenarios; muscles tighten, the stomach may churn, there may be a little sweat happening.

causing headaches and backaches is one thing but over time, stress to the body causes disease.

You would have to live in a cave or under a rock to never hear about physical exercise being a great stress reliever. Some have a scheduled exercise program while others walk or do some form of movement periodically. And then there is the other group that chooses food, alcohol, drugs, spending money, gambling and even obsessive exercise to help them deal with stress. The problem with these last stress relievers is they are temporary, short acting and don’t touch the underlining issue. An easy explanation is to think about a festering cut. You can cover it with gauze or a band aid but until you clean it out, go through some pain, it won’t heal.

How does all this relate to keeping a physical, emotional, and spiritual journal? Writing by hand allows you to put feelings, the swirling, repetitive thoughts on your mind onto a piece of paper. Once writing begins, words may show on paper that even surprises the writer. Thoughts you wouldn’t necessarily share with a friend has a safe home on paper. It also enables the journaler to go back, read what was written and make plans for actions that can be taken.

It’s important to write using free flowing thoughts or words on paper without monitoring language, grammar and punctuation.

Another exercise if someone is working on issues that started as a child, is to use the writing implement in the non-dominant hand.

What appears on the paper at the end of the session usually looks like a child would have done it. That in itself brings up additional feelings of what was written or done that can be dealt with in the journal. There are many benefits to starting and staying with a regular program of journaling. Working out long buried feelings – feeling them rather than burying them isn’t easy but worth it.

Allowing the mind to help the body heal tight muscles and the ramifications of long time stress, are two great benefits.

Eileen Marin is “life credentialed” to share experiences on facing challenges of choice and those presented by the Universe. After living through three different cancer diagnoses, surgeries and treatments, she wrote the first published book, Chemotherapy Gives New Meaning to a Bad Hair Day ©, that addressed cancer with humor and inspiration. She has conducted workshops on visualization and meditation techniques and traveled the country as a speaker focusing on dealing with life on life’s terms with humor and how to keep an emotional, spiritual and healing journal. Her latest book, Color Outside The Lines©. She can be reached through the website www.liveyourdays.com

Our mind invites the body to participate with it when we are living life dealing with big or little everyday stressors. Tight muscles

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The contents of this book may not be reproduced either in whole or in part without consent of publisher. Every effort has been made to include accurate data, however the publisher cannot be held liable for material content or errors. This publication offers Therapeutic Services, Drug & Alcohol Rehabilitative services, and other related support systems. You should not rely on the information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health care professional because of something you may have read in this publication. The Sober World LLC and its publisher do not recommend nor endorse any advertisers in this magazine and accepts no responsibility for services advertised herein. Content published herein is submitted by advertisers with the sole purpose to aid and educate families that are faced with drug/alcohol and other addiction issues and to help families make informed decisions about preserving quality of life.

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