September 2017 - The Sober World

S E P T E M B E R 2 017

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VOLUME 6

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ISSUE 9

IN MEMORY OF STEVEN

THE

A N AWA R D W I N N I N G N AT I O N A L M A G A Z I N E

BACK TO SCHOOL

TIPS FOR PARENTS DURING AN OPIOID EPIDEMIC

By Jim Holsomback MA-ABT and Louise Stanger Ed.D, LCSW, CDWF, CIP

ISSUES YOU SHOULD KNOW ABOUT THE CURRENT MARIJUANA DISCUSSION

By Dr. Kevin Sabet

NEURO-NUTRIENT THERAPY-CLINICAL RAMIFICATIONS AND PITFALLS

By David Miller, Ph.D., Kenneth Blum,Ph.D., Merlene Miller, MA

OPIOID ADDICTION

A NEW UNDERSTANDING OF AN ANCIENT PROBLEM

By Mark S. Gold, MD

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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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OPIOID ADDICTION: A NEW UNDERSTANDING OF AN ANCIENT PROBLEM

By Mark S. Gold, MD

The current opioid crisis has produced shocking headlines, conflicting data, and far too much tumult and hyperbole by those who don’t understand the genetic and epigenetic influences that drive drug initiation, addiction and the mortality rate associated with opioids. As a result, there is plenty of finger pointing, but too few answers.

History Opioid addiction in epidemic proportions is nothing new. Opium, as it’s known in its most natural state, has negatively impacted individuals and entire cultures for thousands of years. The first known cultivation of opium poppies occurred in Mesopotamia, approximately 3400 BC by Sumerians who called the plant hul gil, the “joy plant”.

That milky fluid from the poppy plant contains a number of compounds including morphine, codeine and thebaine. Opium can be dissolved in alcohol creating a tincture called laudanum, which was popular in Europe and America in the late 19th century. At the same time, opium dens were scattered throughout the western frontier as a result of Chinese immigrants who came here to work on the railroads. Heroin, morphine and other opium derivatives remained unregulated and legal until 1920 when the US Congress recognized the danger and enacted the “Dangerous Drug Act.” which served to keep opium based narcotics out of the mainstream, which was highly successful until the mid 1960’s The Evolving Trend of America’s Drug Problem In the late 1960s and 70’s, the use of marijuana, LSD and other mind-altering drugs dominated the headlines. Returning soldiers from Viet Nam, who had barely reached their 20’s, were introduced to cheap Asian heroin on the battlefield and many returned addicted.

At the same time, Harvard psychiatrist, Dr. Timothy Leary told a generation of students to “drop out and turn on” referring to LSD, and many did just that. The devastation resulting from drug use, and the images of stoned teens at anti-war protests were indelibly etched on our national consciousness and drug use became a reality in the American mainstream that would never go away.

In the 1980s, the recreational use of cocaine by the young and affluent, snorted through rolled up 100 dollar bills was quickly usurped by the crack epidemic that decimated our inner cities and gave birth to a national anti-drug movement. The “Just Say No” mobilized millions of scared and angry parents whom pressured local authorities and successfully stigmatized drug use which resulted in the largest decline in adolescent drug use ever.

By the 1990s, amateur chemists produced dangerous analogues known as “designer drugs” such as ecstasy (MDMA). Before being outlawed by the FDA, legions of private psychotherapists were using MDMA in their clinical practice to assist their patients in quieting their neuroticism and ridding themselves of the guilt and shame that had tainted their “true selves”. By the mid 90’s a cheap, “smokeable” form methamphetamine became the newest scourge in our land.

Initially dubbed as “the poor man’s cocaine” rural America was hit particularly hard by the onslaught of meth and thousands died.

As the 21st century emerged, attitudes about drug use were changing and some thought it better to destigmatize drug use and just treat the overdoses, emergencies and serious addictions. The unprecedented use of heroin among celebrities and supermodels ensued, followed by young adults and middle and upper middleclass teenagers—was dubbed “Heroin Chic,” further blurring the line between the use of so-called “hard drugs” and so called “soft, recreational drugs,”. This radical change in the public’s perception and tolerance of drug use set the stage for the recent manifestation of the evolution of addiction in the US. That is, the non-medical abuse of prescription drugs, primarily opioids and benzodiazepines followed by heroin.

The lax prescribing practices and policies regarding opioids, resulted in thousands of drugs abusers and addicts whom simply added

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prescription opioids to their “menu” of intoxicants. For high school and college age kids, the use of prescription opioids as a party drug became increasingly popular. But when used while binge drinking, accidental death from respiratory failure occurred more frequently.

Changing Policies and Laws In the last 5 years, prescribing policies and laws have been tightened, which effectively shut down the major pill mills, making illicitly attained prescription opioids harder to attain and much more expensive. Consequently, many prescription opioid abusers found that heroin was both cheaper and easier to find. At the same time, the Mexican Cartel, which was losing millions from the legalization of cannabis in the US, began filling the demand for opioids by making fentanyl and adding it to cheap Mexican heroin. At the same time the manufacturing of look-a-like prescription pain pills that contained fentanyl hit the streets. This is what killed the music icon Prince.

Namely, because fentanyl is 50-100 times stronger than morphine.

Potentially addictive prescription medications used for the treatment of pain include: • Hydrocodone (Vicodin, Lortab, Norco, and their generics, Zohydro ER, a new long acting hydrocodone).

• Oxycodone (Percocet, Percodan, Roxicet, Roxycodone, Oxycontin and their generics) • Oxymorphone (Opana, Opana ER, and their generics.)

• Hydromorphone (Dilaudid, Exalgo ER, and their generics) • Demerol • Tramadol (Ultram, Ultram ER, Ultracet, and their generics) • Morphine (Avinza, Kadian, MS Contin, and their generics) • Fentanyl ( Actiq, Duragesic, Fentora, and their generics) Epidemic?

The word “epidemic” has been used to describe the current trend of opioid use, morbidity and mortality. First, and technically speaking, an epidemic is the rapid spread of infectious disease to a large number of people, in a given population, within a short period of time--usually a few weeks or less, with the major focus on the agent, e.g., measles, influenza or HIV. The other two factors of an epidemic are the host (the person who gets sick) and the environment in which the agent and host interact.

We know that drug addiction is not contagious but it is however, selective in the sense that in includes the interplay of genetics and external variables and stressors. Thus, environmental and cultural factors, as well as learned behavior and individual life experiences are relevant to the prevalence of substance use disorder (SUD) and mortality. Genetic and epigenetic factors which determine nearly half the risk of becoming addicted, combined with increased availability, Continued on page 32

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7 TIPS FOR A FULL RECOVERY

By John Giordano, Doctor of Humane Letters, MAC, CAP One of the first lessons I learned – and every addict is taught – in treatment is HALT, which are self-awareness cues critical to successful recoveries. HALT is like a flashing red light or an ‘early warning system’ alerting an addict in recovery that they are about to go off the rails. It is an acronym for: H – Hungry A – Angry L – Lonely T – Tired Any one of these left unaddressed can sabotage the recovery of even the most dedicated individual. Below you’ll find a brief description of each and tips that can enhance your recovery.

Tip #1 Hungry - Nutrition This could seem pretty straight forward but is a bit more complicated than you think. When our brains are starved of glucose our concentration becomes mitigated and we lose our self-control.

Our brain alerts us to low glucose levels by triggering the release of stress hormones. As a consequence we become ‘hangry’ (hangry is a portmanteau formed by the combination of the words ‘hungry’ and ‘angry’), a phenomenon that is actually a survival mechanism.

As you can imagine, nothing good can come from this, especially avoidable stress that can send an addict early in their recovery back to using.

Something as ubiquitous as a candy bar can temporarily reverse hangry, but adds nothing nutritionally in the long run. In fact, every candy bar that we eat to suppress hunger pangs pushes us further down the nutritional rabbit hole by replacing needed nutrition with a worthless workaround. Hunger is our body’s way of telling us we need nutrition, not candy bars. Too often it is perceived as a shortterm issue when in reality nutrition is a long-term proposition. We need certain vitamins, nutrients and amino acids at regular intervals to keep our bodies and brains healthy and balanced. There is a reason why they are called building blocks.

There is another nutritional reality that you need to take into consideration. The nutritional value of the food that we eat, especially processed foods, is in a steep decline. For example, for every apple eaten fifty years ago you would have to eat four today to get the same nutritional value.

That being said, we have little alternative but to look at supplements. I highly recommend seeking one out who can design a nutritional program based upon an addict’s medical condition and unique individual needs.

Tip #2 Hungry – Digestive System Most people don’t realize that we have two separate and distinct brains, one in our head and the other in our digestive system – it’s a fact. Moreover, everyday scientists and researchers are learning more about how our ‘gut brain’ influences our behavior. These studies have already lead to some interesting new treatments being trialed to reduce symptoms of migraine, Alzheimer’s, anxiety, tinnitus and depression to name a few.

However, what has consistently come out of these studies, which is changing the science of medicine as we know it, is the new found importance of gut and immune system health. Take for instance, leaky gut syndrome. When was the last time your doctor had a conversation with you about leaky gut? If you are like most people – probably never. But the reality is that stress, drug and/or alcohol abuse, diet, gluten, processed foods, sugar and a plethora of other things can cause the lining in your intestines to permeate and leak – in extreme cases flood – undigested food particles, toxic waste products and bacteria into the blood stream.

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Leaky gut affects the whole body including colon, adrenals, joints, sinuses, thyroid and a host of health issues. But more specific to this conversation is it can cause depression, anxiety and ADHD; which we all know can lead to addiction and/or relapse.

In most cases, leaky gut, or “intestinal permeability” as it is referred to at times, is easily repaired with simple dietary changes. Pre and pro biotics and enzymes will help keep your second brain in the digestive system in a healthy state. However, I always recommend seeing a doctor with Integrative Medicine credentials for cases like these.

Tip #3 - Anger Everyone experiences it and when controlled, anger is a normal, emotional response to a perceived provocation, hurt or threat.

Anger can also be a response to an attack on your emotional safety, self-image, or some part of your identity and used to mask fear, hurt or sadness. It’s the body’s fundamental physiological response that puts the fight into the primordial fight or flight response that triggers the release of chemicals such as adrenaline, noradrenaline and cortisol into the bloodstream. It also depletes Dopamine, the primary neurotransmitter of reward and pleasure that is linked to addiction. Rarely are we confronted with real lifethreatening situations, but our perceptions say otherwise. This causes avoidable stress which is the enemy of anyone in recovery.

Controlling anger can be challenging, depending on its degree, but doable. Some of the techniques I teach include breathing exercises that can change your mental state of mind. Repeated deep breathes from your diaphragm will cool the situation down.

Visualization and self-talk are also great tools to deescalate the situation. Once you recognize anger coming on, tell yourself to relax, be calm, and visualize a relaxing, fun or happy experience.

Exercise is also a useful tool.

These techniques need to be learned and practiced before anger strikes. If you wait until it’s coursing through your body, these techniques will not do you much good.

Tip #4 - Lonely Loneliness can happen to someone who is physically alone or to a person surrounded by people. It seems to occur among addicts more that most groups. It happens when we start to avoid interacting with people or groups; turning inward often out of fear or doubt thinking we are not understood. By itself, loneliness is not a mental health problem per se; however it is linked to a few. It can lead to stress, anxiety, and depression.

Overcoming loneliness takes a little courage. It is vital for you to reach out and communicate what you are feeling with someone who understands. It could be a family member, a close friend, a counselor, sponsor or speaking up at a group meeting. Take action.

Go for a walk in a crowded park or stroll through a grocery store and engage with people in some small way. All the time keeping in mind that you are not alone and help is right around the corner.

Continued on page 36

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ISSUES YOU SHOULD KNOW ABOUT THE CURRENT MARIJUANA DISCUSSION

By Dr. Kevin Sabet

There are many myths surrounding discussions about marijuana legalization. Americans often hear that states with legal marijuana are raking in millions in tax revenue and effectively regulating legal sales with public health and safety in mind. But new findings and landmark research tell a different story. Here are some important marijuana myths, debunked: Is marijuana really a “gateway” drug, or is that just a scare tactic?

Do most people who use marijuana go on to other drugs? No. But do most people who use other drugs start with marijuana? Most definitely.

A wide array of research has confirmed links between marijuana use and other drugs. While it is true most marijuana users won’t go on to use other drugs, research demonstrates that 99% of those addicted to other drugs started with alcohol and marijuana.

Marijuana users are also three times more likely than non-users to become addicted to heroin, and a 2017 National Academy of Sciences report found a statistical association between marijuana use and the development of substance dependence for other drugs like opioids and heroin.

But isn’t everything going fine in states like Colorado that already legalized marijuana?

Actually, beginning in the 1980s, scientists started uncovering a direct link between marijuana use and mental illness. Youth who begin smoking marijuana at an earlier age are more likely to have an impaired ability to experience normal emotional responses.

The link between marijuana use and mental health also extends beyond anxiety and depression. Marijuana users have a six times higher risk of schizophrenia and are significantly more likely to development other psychotic illnesses.

What is your biggest fear about marijuana legalization?

In Colorado, the first state to legalize recreational marijuana, pot is now involved in more than one of every five deaths on the road, and that number is rising.

The answer is simple: Big Pot. Already in Colorado, Washington and elsewhere, massive special interest groups and lobbies have emerged to protect the marijuana industry.

This immense increase in drugged driving fatalities isn’t the only failure of legalization.

The marijuana lobby already takes money directly from the tobacco industry. Just this year, the pro-legalization group Marijuana Policy Project solicited and received $150,000 in tobacco industry money.

Even more troubling is the fact that Colorado now leads the country in past-month marijuana use by youth. A 2017 study found that marijuana-related emergency room visits by kids in Colorado more than quadrupled since the state legalized marijuana, with most visits related to mental illness. The likely culprit: an aggressive industry pushing kidfriendly pot products, combined with a thriving black market.

Also troubling: significantly more African American and Hispanic youth are being arrested for marijuana-related offenses since Colorado legalized pot, whereas arrest rates for white kids have slightly declined. The Colorado pot lobby, now content with its thirty pieces of silver, couldn’t care less. The faux outrage over social justice issues went up in smoke as soon as legalization passed.

So far in Colorado, marijuana taxes have failed to shore up state budget shortfalls. The budget deficit there doubled in the last few years, despite claims that pot taxes could turn deficit into surplus.

Most Americans now favor legal marijuana, are you saying we should oppose the will of voters?

Science and evidence – not public opinion or ideology – should drive public health and policy in America.

The surprise results of the most recent presidential election demonstrate that anything can happen, and when it comes to controversial issues, public opinion can swing back and forth.

Moreover, in many places that voted for marijuana, we are now seeing evidence of “buyer’s remorse” after the proliferation of marijuana shops and advertising in communities.

Witness Colorado, where more than 70% of municipalities in the state have banned commercial marijuana operations, either by popular vote or board decisions. In Oregon, more than 75 cities have already banned recreational marijuana businesses.

Is marijuana use really linked with negative health outcomes?

Science has proven – and all major scientific and medical organizations agree – that marijuana is both addictive and harmful to the human brain, especially when used as an adolescent. One in every three marijuana users will become addicted.

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In the emerging marijuana industry, potent edibles in the form of colorfully packaged cookies, candies, sodas and brownies are being advertised on the Internet and in mainstream newspapers and magazines across the state. A relentless marijuana lobby insists that these products are not especially attractive to children, yet continues to block controls on advertising, labeling, shape and color. When Colorado Gov. John Hickenlooper wanted to limit access to marijuana magazines containing cartoon ads and coupons for one dollar joints by placing them behind the counter out of reach of children, the industry sued and won. That was the first of many victories for the marijuana lobby, whose case is buttressed by protections of commercial speech as free speech.

If this sounds familiar, it should. The tobacco and alcohol industries follow similar patterns while hawking their legal, addictive substances. And we know how that story ends: money-hungry industries, targeting the vulnerable, will stop at nothing to increase addiction and profit. Why would we want to repeat that debacle with marijuana?

How can I get involved?

You can visit our website at www.learnaboutsam.org to register for updates and learn more about our state affiliate program.

You can also text “SAM” to 797-979 to receive a link to install our mobile app, which will connect you to fellow advocates and allow you to contact your representatives about important marijuana legislation.

References Provided Upon Request Dr. Kevin Sabet is a former adviser to three U.S. administrations, and President and CEO of Smart Approaches to Marijuana, which he co-founded with former Congressman Patrick Kennedy and senior editor of The Atlantic David Frum in 2013. He worked in the Clinton (2000) and Bush (2002-2003) administrations, and in 2011 he stepped down after serving more than two years as the senior adviser to President Obama’s drug control director, having been the only drug policy staffer to ever serve as a political appointee in a Democrat and Republican administration. www.Learnaboutsam.org

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JUST SOME OF THE IMPLICATIONS OF LEGALIZED MARIJUANA PART 1 OF 3

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

The legalization of medicinal marijuana became official with the passing of amendment 22. This issue is real and has many farreaching implications. For decades people have argued over the chemical risks of cannabis and the primary active ingredient tetrahydrocannabinol (THC). There is more to marijuana than just THC though, which is what this 3 part series is intended to educate the community on.

The first aspect of understanding the complex marijuana issue is to understand that there are many different marijuana “communities”.

Cannabis is used by many different types of people in many different ways and for many different reasons. The first group I will describe is the one for which the legalization of marijuana is primarily intended. There are a number of serious medical conditions, such as glaucoma and certain types of epilepsy, for which cannabis provides a significant degree of symptom relief.

This group is motivated by feeling better and may have limited alternatives to do so. The next group includes those who would derive benefit from using cannabis to treat other legitimate conditions, but for which there may be equally effective or even better medical options already in existence. These conditions include many of the psychiatric disorders such as post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia. Even with effective medical options readily available, members of this group may prefer marijuana if given the choice. A third group exists that simply wants to get high on pot and does not want the legal hassle or inconvenience of having to go to a bad neighborhood to get it. They may fabricate or embellish symptoms in order to receive a prescription. This group is large and far outnumbers the previous two groups combined. This group is the source for many of the concerns. A fourth group consists of existing recreational cannabis users that have no interest in being “patients”. They don’t bother pretending and just do what they need to do to procure their supply.

The fifth group is comprised of the former marijuana users. They may have “outgrown” their usage or given it up for other reasons.

They all still have a prior experience with cannabis and will have a different perspective than someone who has never tried it (yes they do actually exist, even in 2017). The sixth group is those that are fully addicted or “cannabis dependent”. This population has extreme difficulty stopping despite rarely ever feeling good, even when using. They may fake or embellish symptoms to get a medical marijuana card to protect their access to cannabis. All of these groups can be further subdivided by age.

The perception and understanding of marijuana use may be very different to individuals from different age groups. Baby boomers often have much of their opinion of cannabis based on the weaker strains that predominated before the development of the more modern agricultural technologies and the stronger strains. The truth is that just based on the “dose effect”, marijuana was safer back then. Many of the complications seen in recent years are directly related to high concentrations of THC and other psychoactive chemicals in the “stronger” strains. Boomers also grew up in a time where drug use was not nearly as widespread and typically started at a later age. They had a healthy respect for the dangers of drugs in general and were reluctant to try harder drugs. They also grew up without the Internet and the rapid and far-reaching spread of information that came with that invention. Generation X was too young for Woodstock and the hippie movement, but otherwise was not that far off with their earlier drug experiences. This group did start to use the stronger cannabis strains while still in their 20’s and 30’s, but typically not yet during their earliest experiences. The Internet became widely accessible later in their use. Generation Y was much more likely to be exposed to stronger marijuana early on, as was generation Z. Availability of all other illicit drugs has continued to increase, especially affecting generations Y and Z.

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These 2 generations essentially grew up with the Internet and had unlimited information available to them. Early drug experimentation has been all but normalized for our youngest generation, placing them at the highest risk for the most negative outcomes among all of these groups.

The differences among these categories help explain the different perspectives that will be held by different groups. The psychological impact of legalized marijuana may be limited for the baby boomers but severe for generations Y and Z. The ratio of risks to benefits, as a whole, will be much better for the older generations and the worst for the youngest. In order to make a well-informed decision on this complex topic, the positives and negatives must be weighed out among all of the different groups, not just the group to which you belong. Even greater than the number of different perspectives on this matter is the number of different strains of marijuana that have been cultivated.

Please read part 2 of 3 in the October 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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DYING FOR A DRINK – REHABILITATING AN EXTREME ALCOHOLIC

By Candice Feinberg, Psy.D.

The tragedy of celebrity suicide is not new to the Los Angeles scene, and the recent deaths of two rock stars, shed light on the fragility of our mental health, reminding us that no one is immune.

It also highlighted the struggles of people suffering from chronic alcoholism and other addictions, as both celebrities had long term battles with substance abuse and both relapsed before their suicides. As experts in the field of recovery, we need to ask two questions. What hope do chronic or extreme alcoholics have, and how do we as professionals best treat them and help them obtain long term sobriety and mental well-being.

The answer to both questions is clearer and more promising than probably many assume. There are a large variety of treatment options available for chemical addiction and mental illness. Hope is alive, and help is available. As behavioral health clinicians, it is our job to be client-centered, identify one’s immediate needs, and assist our clients in getting the best care possible. Personal, individualized treatment is necessary for recovery and transforming mental suffering into mental wellness.

First Things First Excessive use of alcohol is dangerous and has proven to be life threatening yet no one is talking about it. In fact, the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health, is conducting a new $100 million study to identify the possible health benefits that can come from moderate drinking. Not surprising, this study is primarily funded by the alcohol industry. As experts in the field of treatment, we do not need to spend $100 million dollars to show how destructive alcohol can be. Let’s just look at the facts.

Damage done by chronic alcoholism can and will destroy the mind and the body. Cirrhosis of the liver from chronic alcoholism was ranked as the 12th leading cause of death in the U.S. This number does not include the deaths caused by accidents, drunk driving, and homicide/ suicide in which alcohol was involved. There is still the perception that because alcohol is “legal”, it is not as dangerous as other drugs. It is glamorized in the media and far too socially acceptable.

A commonly unknown fact is that detoxing from alcohol can be life threatening. In fact, it is more dangerous than detoxing from heroin.

Treatment needs to start with comprehensive medical evaluation for individuals with a long history of alcohol abuse including chronic relapse.

Supervised medical detox is often necessary for people suffering from an alcohol use disorder. While it is more common and necessary with longterm use, it is never something to attempt on your own.

Treatment Compliance vs. Treatment Acceptance For too long we have focused on whether or not a client is compliant with their treatment and doing “what they are told”.

Clients are still being labeled as treatment compliant in many places. This term is often heard during insurance reviews for medical necessity and plays a role in whether or not treatment will be authorized. It needs to stop. Think about an individual who has diabetes being denied treatment because they deviated from a diabetic diet. That would be unheard of. Treatment compliance puts the client in the position of being a passive player in their treatment and gives them no stake in its success or failure.

Treatment acceptance should be the goal to work towards with any client, but especially with people with a severe addiction to alcohol.

They need to be more involved in the process, be more motivated, and have a greater stake in the success of their treatment than anyone else. Working with them, creating goals for treatment together, and rolling with resistance will help increase the chances of successful long-term sobriety. To put it simply, clients need to buy into the fact they need help; they need to accept treatment and become an active member of their treatment team.

Client Centered Planning In treatment settings, client centered planning is imperative. The

14

concept is simple; the client should be empowered to be an active member of their treatment program, including setting goals and identifying how they will measure success. Ultimately, when a client is part of the solution, they are more apt to follow the plan.

Professionals have the best chance of treatment success when everyone is working together, including the client.

The Stages of Change Many people do not believe change is possible and it scares them.

Having worked in the field of psychology for over 15-years, there is no doubt in my mind that change is in-fact possible. Change nonethe-less is hard, and it holds true for individuals struggling with chronic alcoholism. Years of alcohol abuse can rob oneself from making healthy choices; such as seeking treatment or asking for help. But change is possible. Someone presenting at a treatment facility or asking for help from their provider is courageous and is the first step in the recovery process.

DiClemente and Prochaska presented a model for change that takes a person throughout the process of changing and maintaining new behavior. The Stages of Change are cyclical, nonlinear and seen as an ongoing process. It is important to note that once a new pattern of behavior becomes well practiced and routine, odds of relapse go down. Staying aware and mindful of potential to relapse has kept many in recovery from relapsing.

The stages include pre-contemplation, contemplation, preparation, action, maintenance, and possibly relapse. One stage blends into another as people begin to make the efforts to change, leading one on to a new stable pattern of behavior, and back to the beginning stage, repeating the cycle if necessary.

The model starts with a person being in pre-contemplation mode.

There is no awareness that there is a problem that necessitates change. The individual most likely has not suffered any significant consequences and is possibly even getting pleasure from the behavior. Most human behavior does not require change and often goes on for the course of a person’s life. However, some actions are unhelpful and unhealthy, and this moves the person toward the stage of change.

Contemplation is the next phase in the model. Here a person is aware that what they are doing is not helpful or healthy, and could be detrimental to their well-being. “This is an event, not a stage.

The person concludes that the negatives of the behavior outweigh the positives and chooses to change their behavior.”

Preparation comes next. Exploring options, finding resources, and making plans are part of this stage. Here we see a person marshaling their resources so that they can take whatever steps necessary to change what they are doing. Preparation can be quite easy and quick, or hard and arduous, depending on options and resources available.

Continued on page 38

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15

3 KEY BUILDING BLOCKS OF PROGRESS IN ADDICTION TREATMENT

By Anna Ciulla, LMHC, RD, LD

“Something is rotten in the state of Denmark,” muses one of Shakespeare’s characters in “Hamlet.” And after a round of bad press lately – the hard-hitting, June 26 exposé by “Sunday Night With Megyn Kelly” a case in point – it would be easy to size up all addiction treatment in similar terms, however misguided.

What such stories sadly overlook, and often at the expense of the millions of Americans whose lives hang in the balance because of substance abuse, is that treatment can be the best hope of recovery. We now know, for example, thanks to ongoing research in the field, that there is such a thing as “clinical excellence” in treating addiction. This article, as the first in a three-part series devoted to the theme, will explore three key building blocks of progress in addiction treatment that anyone in the world of recovery – be they a client needing treatment, a family member, clinician or referring professional – can benefit from knowing: 1. “Therapeutic Alliance” is the clinical term that is meant to describe the level of trust, working rapport and mutual connection between a client and their primary therapist. Research has revealed that the quality of this client-clinician relationship is of paramount importance – so much so, in fact, that the therapeutic alliance is reportedly the single biggest, clinician-influenced predictor of positive treatment outcomes.

Strikingly too, the therapeutic alliance proved to be an even bigger influence on positive treatment outcomes than the particular modality (or type of psychotherapy) itself. For example, cognitive behavioral therapy (CBT) and motivational interviewing (MI) are evidence-based therapies for substance use disorders (SUDs), meaning that in multiple clinical trials these two interventions have been associated with better treatment outcomes. Yet regardless of which of these two modalities was used, therapeutic alliance reportedly emerged as a bigger determinant of treatment progress.

If the strength of therapeutic alliance is such a vital component of successful addiction treatment, how, then, is it created for clients – and then measured and evaluated with a view to improving recovery outcomes in real time? The use of standardized measures of therapeutic alliance is one way; so are ongoing trainings for clinical staff in how to strengthen and evaluate therapeutic alliance; and finding the best fit of therapist for each incoming client is another way. (Upon admission to treatment, the use of certain evidencebased assessment tools can facilitate a good client-therapist match.)

But the regular evaluation of clinical staff according to measures of therapeutic alliance is also critically important. For more on this next building block of progress in addiction treatment, read on.

2. Clinical Supervision might seem like a no brainer – especially when treatment outcomes for substance abuse are necessarily a source of concern – but sadly; they are not yet the norm in the field of addiction treatment. A recent article in The Atlantic, titled “What Your Therapist Doesn’t Know,” draws attention to this current gap between, on the one hand, the recognition that the therapeutic relationship (a.k.a. “therapeutic alliance”) is vital to a client’s treatment progress, and, on the other, a lamentable scarcity of performance feedback that can cue therapists in to how they are doing with respect to the effectiveness of their interventions, including therapeutic alliance.

But it’s precisely this kind of performance feedback that is so critical to improving treatment outcomes, as the same article in The Atlantic, written by a practicing therapist, reiterates. The author, citing studies showing how feedback-informed treatment (FIT) is associated with better client outcomes, shares the story of two of his own clients: one, a heroin addict whom he calls “Grace,” progressed in therapy for a time only to relapse and tragically die from an overdose; but the other client, “June,” experienced a much happier outcome, one that the author attributes to performance feedback and metrics.

When metrics revealed June was not progressing in treatment,

16

the author (her therapist) sought out performance feedback from a seasoned therapist. Together they viewed a video of a recent therapy session, reflecting on what clinician-directed improvements could be made to better serve June’s needs. (And in this case, the counsel to her therapist was that he “get out of the authority role, approach June as an equal partner, and help her acknowledge her pain and anxiety...”) That approach is reportedly “what may have saved June’s life.”

Clinical supervision therefore works best when the following elements are in place: • “Feedback-informed treatment” that provides clinicians with performance feedback and the opportunity to adjust their interventions accordingly and in real time • The regular observation and evaluation of actual clinical sessions (via videotaped recordings) • The over-arching goal of delivering the very best cliniciandriven treatment outcome possible in each client’s case • A formal and disciplined working alliance between a clinician and a more experienced clinical supervisor 3. Outcomes Tracking is another critical but oft-overlooked building block of progress in addiction treatment – yet the data for recovery outcomes at treatment centers can often be sparse at best, for various reasons. Sometimes, the systems for collecting and evaluating this data are not in place, or a commitment to tracking outcomes isn’t there; sometimes marketing interests can get in the way of an impartial process of data collection. Whatever the reason, one direct consequence can be that the quality and effectiveness of treatment suffers.

Here, too, however, there are certain evidenced best practices for tracking and evaluating outcomes. For starters, investing in an independent third party that collects and analyzes data on client outcomes is one such practice. Another is employing evidence-based measurement tools for tracking and optimizing treatment outcomes. Any data retrieved by these efforts should then be the basis for future clinical research and efforts to improve treatment outcomes, providing a feedback loop that helps providers continually monitor and improve clients’ treatment experience and their prospects of long-term recovery.

In summary, therapeutic alliance, clinical supervision and outcomes tracking are three building blocks of progress in addiction treatment that, in the 21st century, define clinical excellence in treating addiction. While there is no iron-clad, one-size-fits-all guarantee of a successful recovery from drug and alcohol addiction—no matter how far research takes us, it’s hard to imagine a scenario in which this prospect could ever be real—these three findings from emerging science can be fresh footholds of hope for anyone suffering from addiction, and for all those who love and care for them.

Reference Provided Upon Request 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. https://www.beachhouserehabcenter.com

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NEURO-NUTRIENT THERAPY: CLINICAL RAMIFICATIONS AND PITFALLS

By David Miller, Ph.D., Kenneth Blum, Ph.D., Merlene Miller, MA

Addiction is the Product of Brain Reward Deficiency It is now known that individuals who seek treatment for chemical dependency have an impairment in the reward system of the brain that leads to low levels of the neurotransmitter dopamine which plays a significant role in feelings of pleasure and wellbeing. The impairment may be due to genetic or environmental factors. The sense of pleasure and satisfaction produced when adequate dopamine is released into the reward site (nucleus accumbens) are deficient when the reward system is impaired.

Impairment leads to craving and discomfort and other symptoms of what is referred to as Reward Deficiency Syndrome (RDS).

When RDS is present, an individual often uses addictive substances or behaviors to relieve the pleasure deficit caused by the impairment. Because the substance or behavior works to bring relief, the individual is likely to continue to use and is in high risk of becoming addicted.

Brain Reward Cascade (BRC) Evidenced-based medicine has revealed a well-defined interaction of certain neurotransmitters in the reward system of the brain that leads to normal dopamine release. This was first reported by Drs. Kenneth Blum and Gerald Kozlowski in 1989 and has been termed the “Brain Reward Cascade” (BRC). Any impairment, due to either genetics or environment, on this cascade will result in a reduced amount of dopamine release in the brain reward site and in symptoms such as cravings, anxiety, depression, and poor memory.

The following schematic describes the known interaction of the neurotransmitters showing how dopamine is released and regulated. Serotonin (by activating serotonin receptors in the hypothalamus) stimulates the release of enkephalins (opioid peptides). Then enkephalins (by activating mu receptors) influence the release of the inhibitory neurotransmitter GABA (in the Substantia Nigra). In turn, GABA inhibits the release of dopamine (at the Ventral Tegmental Area) via GABA receptors; and the correct amount of dopamine is released at the reward site of the brain to bring about a sense of well–being.

of these brain chemical messengers it is the net dopamine release that translates to well-being.

While it is would be beneficial to know exactly which neurotransmitter impairments are present, there is no known scientific methodology to date such as blood/urine analysis (neurotransmitter analysis) that could definitively identify or categorize neurotransmitter deficiencies. With this said, information related to drug of choice provides some basis for this categorization as well as the utilization of our “Neurotransmitter Questionnaire.”

The only way to accurately determine specific neurotransmitter deficits is through genotyping an individual for risk behavior. This genetic testing known as Genetic Addiction Risk Score (GARS) is under validation and will not be commercialized until 2017.

(Meanwhile, the present formula of neuro-nutrients, KB220Z, contains adequate amounts of neurotransmitter precursors and facilitators to optimize dopamine in the brain without the need to target a certain neurotransmitter.)

The GABA Paradox The above explanation as it relates to dopamine regulation strongly suggests that GABA control is tantamount to a happy brain. The paradox is that abstinent addicts have enormous amounts of stress.

Based on known pharmacological principles the benzodiazepineGABA complex combats anxiety. Thus, the use of benzodiazepines as tranquilizers to treat all kinds of stress is widespread and abused by big pharma. While there are benefits in the short term, especially for alcohol detoxification, it is not recommended for long-term use.

Based on the initial development by Blum and associates in 1984, clinicians adopted amino-acid therapy as a tool to treat addiction and other RDS conditions. However, a number of clinicians have inappropriately utilized the amino acid L-glutamine (a GABA precursor) in high amounts to mimic benzodiazepines to reduce stress and treat certain addictions. The take home message here is that too much GABA in the brain leads to too little dopamine.

Thus, even without any genetic deficits in the Brain Reward Cascade, the indiscriminate use of anything that will increase GABA, especially long–term, could compromise dopamine function, leading to anti-reward and a low dopamine state.

(We would note here that a number of respected clinicians have also erroneously prescribed the substance GABA to treat addiction which may be ineffective due to the fact that the blood-brain barrier prevents the penetration of GABA into brain).

A Natural Solution for Reward Deficiency: KB220Z

Happy Brain

Unhappy Brain

In the schematic, the happy brain (A) is illustrated showing the normal amount of dopamine being released as explained above. However, the schematic also shows the unhappy brain (B). It is noteworthy that GABA is in a higher amount, and as such, significantly reduces the amount of dopamine released.

This could be due to, for example, a genetic deficit of serotonin synthesis and or receptor function (including an increased serotonin transport resulting in not enough serotonin to stimulate the needed enkephalins to inhibit GABA). Certainly, other genetic deficits would also lead to less control of GABA. The regulation of dopamine is so important because too little leads to depression and too much leads to schizophrenia.

Neurotransmitters of the BRC include at least four known pathways: Serotonin, Opioid peptides, GABA, and dopamine. Impairments of specific neurotransmitters (serotonin, endorphins GABA, Dopamine) in the BRC can occur via genetics, stress and/or overconsumption of psychoactive substances like alcohol, drugs, nicotine, or glucose. However, due to the known interaction

22

Recovery from addiction requires healing the brain. It means balancing the Brain Reward Cascade to optimize the amount of dopamine to be released in the reward site in order to relieve the symptoms of RDS. How do we do that?

Utilizing precursor amino acids as building blocks for the synthesis of brain neurotransmitters has been known for many decades. Over the past 40 years, based on many studies and years of human trials it has been found that a combination of certain precursor amino acids and enkephalinase inhibitors promotes the release of dopamine at the reward site of the brain. Over the years, thousands of addicts have been able to get sober and stay sober using the patented KB220Z, developed with a combination of these ingredients.

The discovery of natural opioid peptides is relatively recent and occurred in 1975. Prior to this discovery, Pert and Snyder reported in Science on the first identification of the opiate receptor.

Interestingly, at about the same time Blum and associates working on rodent models discovered that an amino acid, D-phenylalanine (DPA) reduced alcohol craving in genetically craving high alcoholpreferring mice. The mechanism for such a finding resides in Continued on page 30

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THE RELATIONSHIP BETWEEN ADULT ADHD AND ADDICTION

By Allan N. Schwartz, Ph.D.

Jay, a 30-year-old man referred himself to me for depression, marijuana abuse and Adult ADHD, Inattentive Type. His marijuana abuse was acute because he used it daily and throughout the day.

While highly educated, he was socially isolated and unemployed.

According to Dr. Srini Pillay, MD: “More than 1 in 10 children in primary schools have attention deficit hyperactivity disorder (ADHD) and this number increases to more than 4 out of 10 adults between the ages of 18-24 years old.

Although the numbers decrease to 4 in 100 by adulthood, people who have ADHD at any age suffer in many ways. These include but are not limited to impulsivity, inattention, high distractibility, impulsive decision making, poor time management, difficulty following directions, working memory problems, excessive speeding while driving, difficulty engaging quietly in leisure activities, and poor follow-through.”

In my experience, ADHD can last throughout life as attested to by one patient who was diagnosed at age 70, medicated and referred to me for psychotherapy. For many other people with Adult ADHD, the hyperactivity diminishes but not the internal feelings of discomfort and disorganization.

What is so troubling about the statistics is the strong correlation between ADHD and drug and alcohol addiction.

Why does this Correlation Exist?

There are many explanations. For example, ADHD means that executive functioning is impaired. Executive function is the cognitive process that includes an individual’s ability to organize thoughts and activities, prioritize tasks, manage time efficiently, and make decisions.

1. Impulsivity People with ADHD tend to have problems with decision-making.

This is exemplified by the tendency to impulsiveness. Instead of thinking things out, they will take-action, never considering the consequences of that action. This is the type of situation that leads to drug experimentation and addiction. How does this work?

Those with ADHD experience a lot of anxiety and depression. The combination of ADHD and these emotions cause many to selfmedicate. During the high school years and even earlier, many youngsters experiment with drugs especially when there is a lot of peer pressure to do so. Those with ADHD are even more prone to that experimentation. The high that ADHD kids experience feels so good and such a relief from their symptoms that they continue to seek these drugs. By contrast, many other youngsters, though not all, will stop experimenting out of concern for their school work, religious upbringing, not wanting to disappointment parents and awareness of the importance of protecting their health.

2. School and Peers The symptoms of ADHD understandably interfere with a person’s ability to sit still in class and focus attention on learning in the classroom and, therefore, perform well in all academic areas. Many times, discipline becomes a major problem and the reason for parents being called to the school. It does not take very long for these youngsters to feel stigmatized. Feeling rejected by peers and alienated by teachers they find themselves seeking the attention and approval of those like themselves. When these alienated youngsters meet, they often get involved in drug abuse which can last well into adulthood. This is the type of scenario that leads youngsters to cut classes, get failing grades and drop out of school.

3. Self-Medication There are studies that show that those people who go undiagnosed and/or un-medicated are far more likely to abuse drugs than those who do not have ADHD as well as those who have it and are

24

medicated. The following is from Harvard Medical School: “In our study of young adults, only 30 percent said they used substances to get high,” says Timothy Wilens, M.D., associate professor of psychiatry at Harvard Medical School in Boston.

“Seventy percent are doing it to improve their mood, to sleep better, or for other reasons.” This kind of “self-medication” seems especially common among individuals whose ADHD remains undiagnosed, or who have been diagnosed but have never gotten treatment.

“When people with ADHD get older, the hyperactive component often diminishes,” says William Dodson, M.D., an ADHD specialist in Denver. “But inside, they’re just as hyper as ever. They need something to calm their brain enough to be productive.”

Several patients reported to me that while in college and undiagnosed with ADHD, drinking and using marijuana helped them feel better. Of course, how does one define feeling better? When asked, they reported the fact that they didn’t care whether they felt bored in class or whether they could concentrate.

4. The Myth of ADHD Medications and Addiction There is a commonly held misperception that use of stimulant medications for the treatment of ADHD causes addiction. What is so paradoxical about these medications is that those with ADHD feel relief from their symptoms because of the stimulants while others who do not have ADHD look for the high that they get from the same medicines.

In a private communication, one psychiatrist reported to me that while he worked in the prison system he saw a lot of inmates who had ADHD but undiagnosed and unmedicated. One must wonder whether these people never would have committed crimes or become involved in drugs if they had been recognized and treated while they were children in school? We can only speculate.

5. ADHD and the Drugs of Choice Several studies show that the two most commonly abused drugs by people with ADHD are alcohol and marijuana. While either drug can lead to addiction, there is some controversy surrounding the use of marijuana. There are many reports and articles stating that many of the symptoms of ADHD are relieved by marijuana. My clinical experience does not support the assertion that marijuana is helpful with ADHD. 6. ADHD and Depression According to some studies, depression is nearly three times more prevalent among adults with ADHD. According to the National Alliance on Mental Illness: Addiction is common in people with mental health problems.

Reports published in the Journal of the American Medical Association: • Roughly 50 percent of individuals with severe mental disorders are affected by substanc e abuse.

Continued on page 38

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Consequently, treating the substance abusing patient individually, apart from their significant relationships, is in most cases inadequate, ineffective and invariably results in relapse.

Couples in which one partner abuses drugs and/or alcohol invariably also experience relationship problems, (e.g., unhappiness, high conflict, resentment, and growing polarization). This relationship dysfunction in turn leads to increase substance abuse and post treatment relapse when relationship issues are not addressed.

Recognizing this destructive pattern, our behavioral couple’s therapy approach to treatment is designed to break and restructure this cycle by addressing three core areas: • eliminating abusive drinking and/or drug abusing behavior • engaging the family’s support for the patient’s effort to change and • restructuring couple and family interactional patterns in ways conducive to long term, stable abstinence Therapy sessions tend to be structured, goal directed, and collaborative.

Initially, the original focus of treatment is on decreasing the couple’s negative feelings and interactions about past and possible future substance abuse and to encourage positive behavioral exchange between partners/family members. Subsequent sessions focus on communication skills training, problem solving strategies, and negotiation of behavioral change agreements. Once stability in abstinence and relationship adjustment has been attained, the focus shifts to maintaining the gains achieved in therapy.

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EXPRESSING GRATITUDE OR --- SEALING THE DEAL

By Maxim W. Furek, MA, CADC, ICADC

It was beginning to be a very good day.

After a regular physical exam, with positive results, my physician told me, “God has granted you the gift of good health. Please do not squander it.”

That spontaneous affirmation and advice triggered a powerful response.

I immediately reviewed a mental list of good things in my life: exercise, clean living, intimate relationships, a loving wife and a satisfying career. I contemplated, too, that things could have easily been the opposite --- that my life could have been filled with struggle, hardship and poor health.

With those thoughts coursing through my mind, I took note of the wonderful things surrounding me. I gave thanks. And I expressed gratitude. Gratitude is a feeling of thankfulness or appreciation for the gifts and favors flowing into our lives, surrounding us and lifting us up and giving us a glimmer of happiness.

Inventor Fredrick Koenig (1774-1833) proffered: “We tend to forget that happiness doesn’t come as a result of getting something we don’t have, but rather of recognizing and appreciating what we do have.”

Although gratitude has aspects of acknowledgement, it is more like a spiritual business agreement. Our debt must be paid and the account settled. It is essentially a business transaction that comes full circle. Expressing gratitude is our way of saying thanks to what many have called our Creator, our Source or our Higher Power.

Gratitude becomes the tithe that offers our payment in full.

Psychology Today, citing the article “The Benefits of Gratitude” explains that “Gratitude is an emotion expressing appreciation for what one has—as opposed to, for example, a consumer-driven emphasis on what one wants. Gratitude is getting a great deal of attention as a facet of positive psychology: Studies show that we can deliberately cultivate gratitude, and can increase our well-being and happiness by doing so. In addition, gratefulness—and especially expression of it to others—is associated with increased energy, optimism, and empathy.”

Robert Emmons, called one of “The leading scientific experts on gratitude,” argues that gratitude has two key components, which he describes in a Greater Good essay, “Why Gratitude Is Good.”

“First,” he writes, “It’s an affirmation of goodness. We affirm that there are good things in the world, gifts and benefits we’ve received.”

In the second part of gratitude, he explains, “We recognize that the sources of this goodness are outside of ourselves. … We acknowledge that other people—or even higher powers, if you’re of a spiritual mindset—gave us many gifts, big and small, to help us achieve the goodness in our lives.”

Pay It Forward Gratitude encourages us to look outside our egocentric selves. This peripheral gaze forces us to recognize that many of the good things impacting on our lives come from external sources and other people.

We acknowledge these gifts by “paying them forward,” a concept popularized with the book Pay It Forward by Catherine Ryan Hyde, later made into a movie with the same title. Pay It Forward (2007) is Hyde’s second novel and, after 20 years in the making, is truly a labor of love.

The premise of the book: When a social studies teacher challenges students to develop an idea for world change, 12-year-old Trevor McKinney comes up with the concept of Paying Forward. His plan is fairly simple: Do something really good for three people who, instead of paying him back, will be asked to pay it forward by aiding three more.

Senior book reviewer Sharon Galligar Chance observed that, “Big things are expected of this book (there was already a movie deal in the works before its release), and with good reason. Pay It Forward is a delightfully uplifting, moving, and inspiring modern fable that has the power to change the world as we know it which would be a wonderful phenomenon indeed.”

Practicing the “pay it forward” principle will make you alert to unexpected kindness from strangers toward you, and you may find yourself becoming more grateful for everyday kindness and consideration from people you don’t even know.

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When we’re grateful for the good things happening around us, especially when we’re with those we love; expressing it helps the feelings of love and tenderness to blossom. It helps too to create a powerful social bonding, where we reciprocate by helping and supporting others. This is the spiritual center of tribes, communities and relationships, mutual help or, in the parlance of Georg Simmel, “the moral memory of mankind.”

Recognizing and appreciating the awesomeness within our lives is merely an initial step. There comes a time when we must express our appreciation for those blessings, a time when we acknowledge and communicate that gratitude in word, song and prayer. It is a purposeful and concrete expression of our appreciation and gratitude.

In As Bill Sees It… The A.A. Way of Life… selected writings of A.A.’s co-founder (1967) there are several notable references to our topic. “Gratitude should go forward, rather than backward” (#29); “When brimming with gratitude, one’s heartbeat must surely result in outgoing love, the finest emotion that we can ever know” (#37); and “Truly did a clergyman say to me, “Your misfortune has become your good fortune. You A.A.’s are a privileged people” (#133).

“Gratitude List” Many people suggest that we create a ‘Gratitude List” as a means of recording and identifying the good things in our lives. Creating a “Gratitude List” is like giving us a positive affirmation at the start of the day, promoting positivity, confidence and assurance.

We are nurtured with an abundance of blessings on a daily basis.

Some big, some small; but blessings just the same. Making a gratitude list helps us to underscore these blessings and keep our focus on the good things in our lives.

This is especially powerful for those in recovery as it maintains our focus on the positive and not on the drugs, alcohol, cravings and selfsabotage. Research has proven that people in recovery who focus on all that they have to be thankful for are less likely to relapse. It will also help you not take your recovery for granted over time and to “keep it green.”

Your gratitude list represents an essential tool in your relapse prevention toolbox. Commit to writing something every day. Look forward to it. Make this positive behavior a part of your daily routine.

Your list does not have to be extensive; you may only write a word or two. But do write and begin to reap the results.

Over time, the positive aspects of your life will become apparent as they multiply over and over again. Your list will provide you with an all-important focal point, one of positivity and empowerment. The physical documentation of these positive variables makes them even more tangible, not just on a mental plane, but on another palpable level as well. Your list will take on a new reality as you accept and savor this goodness as an intrinsic part of your life.

Value your “Gratitude List.” Keep it in a safe place, where you can re-read it time and again, as a means of keeping your thoughts positive and strong. Gratitude expressed a day at a time is the perfect mantra for those in recovery, but also for anyone striving towards self-actualization and love of self.

Maxim W. Furek, MA, CADC, ICADC is passionately researching the essence of happiness. His rich background 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 of grunge music and the beginning of the opioid crisis. Learn more at www.shepptonmyth.com

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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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DOING FOR OTHERS

IS ITS OWN REWARD.

Congratulations to Richard “Spike” Rothkopf as he marks his 26 year sobriety milestone. When asked about his achievement, Spike says, “My dedication is to help others in their communities achieve their sobriety and to share the importance of protecting families and their assets, which has always been a top priority for me.”

Richard “Spike” Rothkopf Financial Services Professional MassMutual South Florida 1000 Corporate Drive, Suite 700 Fort Lauderdale, FL 33334 954-817-6968 rrothkopf@financialguide.com www.southflorida.massmutual.com

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27

From The Hearts of Moms SEEKING JUSTICE FOR LIVES LOST TO OPIOID ADDICTION

By MaryBeth Cichocki

If planes were falling from the sky killing a large number of Americans on a daily basis, the Airline Industry would be held accountable. The FAA would be looking at data and investigating every inch of the industry. No one would be buying their way out of the nightmare and no one would be pointing fingers at the victims of the air disasters.

When life is lost due to the malfunctioning of an automobile, the National Highway Traffic Safety Administration (NHTSA) conducts an inquiry.

If they are found responsible, the Automotive Industry involved is held accountable and restitution is paid to the surviving family of the victims.

College fraternities are held accountable for drinking and drug use when harm or death occurs. Families are now being compensated for loss of life due to negligence and non-reporting of harmful behaviors practiced by the members.

As a Registered Nurse, I too would be held accountable if my conduct as a professional was responsible for patient harm, especially death.

My question is why should anything be different when we look at the Pharmaceutical Company responsible for the Opioid epidemic?

The Sackler’s and their family who own Purdue Pharma chose to cover up the highly addictive properties of their marketed opioids.

This false marketing of abuse resistant, time released poison led to more deaths than the Vietnam War, motor vehicle accidents, gun violence and the AIDS epidemic. In 2015, 44,000 Americans died from opioid overdoses. In 2016 the numbers jumped to over 50,000.

This deceptive marketing began in the 1990’s and continued for years. It is widely known that the addictive properties of OxyContin were hidden by the Sackler’s. How did they, and do they get away with not being responsible, or held accountable for this incredible loss of life that continues year after year? In 2007, Purdue Pharma paid $635 million in fines when found guilty of false marketing charges. Just a drop in the family fortune bucket when your company brings in revenues of $3 billion and your net worth is estimated to be $14 billion. So, I ask you- How does a company that was found guilty continue to mass produce and continue to falsely market their precious moneymaker- OxyContin?

You might wonder why this blows my mind. You might wonder why I even care. My youngest son Matt became one of the victims of the Sackler’s deception. Matt had everything to live for, but died at the age of 37 as a result of the misconception that OxyContin was safe for long term pain management. The Oxy’s were marketed as lasting for 12 hours, but only lasted 8 hours, setting Matt and so many others up to need more frequent dosing that led to addiction.

Matt was recovering from back surgery when he was prescribed OxyContin on a monthly basis by physicians who believed the claims that the drug was abuse resistant.

Matt became addicted and died from an accidental overdose along with 44,000 other loved ones in 2015.

My heart was broken after my son died and I wanted justice for him. I started doing research and was amazed to learn the power held by this industry. I found that Big Pharma spends millions on political contributions and even more on lobbying. According to the Center for Responsive Politics, Pharmaceutical companies contributed $51 million into

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the 2012 federal election and $32 million into the 2014 election.

Pharmaceutical companies also line the campaign pockets of both Republicans and Democrats. In other words, Big Pharma owns our government.

So how do those of us affected by the cover up make them pay?

How do mothers like me find a way to hold them responsible for the largest epidemic known to man? How can this industry continue to pump out poison pills and just go about their merry way? How many more lives must be sacrificed before our government puts human life over the mighty dollar?

I question how our government can continue to ignore the root cause of this horrific epidemic that is projected to continue to kill in massive numbers. There is not a state in this country that has not been profoundly affected by opioid addiction. In the 1890’s the Bayer Company commercialized both aspirin and heroin as cough, cold and pain remedies. They promoted it for children with coughs and colds.

When they realized people were becoming addicted, the FDA banned the use of it in 1924. So, I ask you- why did the FDA approve it all these years later for Purdue Pharma after knowing how addictive heroin is?

I’ve recently learned that a number of Attorney Generals from various states including Matt Denn in Delaware have filed suit against Big Pharma. Attorney Generals are known as the “People’s Lawyer” and the state’s chief legal officer. This courageous group of lawmakers has decided that enough is enough. Coming together to represent those who can no longer defend themselves against the corruption and greed that goes hand and hand with the Pharmaceutical industry is to be commended. I say Bravo. I pray that these few will be joined by every state and that in the end; Purdue Pharma will suffer tremendous losses, although nothing compares to the profound loss of your children. It’s time for restitution to be paid.

My son Matt lost his life at 37. He was robbed of many years due to the illegally misrepresented OxyContin that made the Sackler family billions of dollars while robbing thousands of mothers like me of their precious children. I wonder if they feel anything when they hear of all the overdoses… all the precious lives that have been lost…would they allow their own children or grandchildren to be prescribed this medication. I wonder.

The Sackler’s have an extensive philanthropic legacy, known for large gifts to both museums and universities. My hope is their true legacy will become known as being responsible for the largest epidemic known to mankind. Hopefully, with the help of the Attorney Generals, they will be held accountable for the massive destruction of thousands of lives, and their restitution will be building treatment centers in all 50 states.

References Provided Upon Request MaryBeth Cichocki is a registered nurse living in the state of Delaware. She lost her youngest son, Matt, to an overdose of prescription drugs.

After his death she was unable to return to her world of taking care of critically ill babies in the N.I.C.U. and now devotes her time to raising awareness and educating the community on the addictive nature of prescription drugs.

MaryBeth works with Delaware legislators and was involved in the creation and passing of 3 bills that became law in May of 2017.

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IMPORTANT HELPLINE NUMBERS

A New PATH www.anewpath.org Addiction Haven www.addictionhaven.com Bryan’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 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

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

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NEURO-NUTRIENT THERAPY: CLINICAL RAMIFICATIONS AND PITFALLS

By David Miller, Ph.D., Kenneth Blum, Ph.D., Merlene Miller, MA

Continued from page 22

the important innate property of D-amino acids to block the enzyme enkephalinase (responsible for the breakdown of opioid peptides including enkephalins) and as such significantly raise brain enkephalin levels. After a series of additional experiments, it was found that high drinking genetically bred mice had low levels of brain enkephalins. Subsequent experiments showed that the administration of direct brain injections of endorphins and or oral and IV injections of D-Phenylalanine resulted in significant reductions of alcohol drinking in these mice.

well. Certainly, if patients leave treatment they are unlikely to get into recovery. The importance here is that KB220Z reduces the need for benzodiazepines, reduces withdrawal tremors, reduces building up to drink scores (BUD), reduces the severity of reward deficiency symptoms, and increases recovery rates.

Many objective studies have verified what these recovering people have testified to. The most recent ingredients has been rigorously researched in 27 human clinical trials including double and triple randomized placebo controlled evaluation.

The evidence emerging utilizing neuroimaging tools such as qEEG and fMRI is that the highly researched patented KB220Z is indeed a pro-dopamine regulator. The exciting findings (utilizing qEEG) have now revealed that in both the intravenous and oral forms, this compound regulates the dysregulated brain waves in the cingulated gyrus in abstinent alcoholics and heroin and cocaine dependent patients. In fact, it (see figure 2) has been shown in one hour to bring about calming by increasing alpha brain waves along with increasing low beta waves.

This important effect, according to the past president of the American Society of Neurofeedback, would take up to 10-20 neurofeedback sessions.

Relapse Prevention Considering the high rates of relapse, it is clear that it is time for people leaving treatment to do something different. Sobriety is difficult because with abstinence the symptoms of low dopamine return in full force. Continuing to take KB220Z lowers the risk of relapse by reducing the severity of those symptoms. It reduces cravings, relieves stress and anxiety, lifts depression, and increases energy.

Evidence of the benefits of KB220Z for relapse prevention as reported in peer reviewed publications include: Moreover, utilizing fMRI in abstinent heroin addicts in China (see figure 3) one hour after administration of KB220Z compared to placebo showed profound activation of dopamine pathways of the caudate-accumbens region of the brain. This suggests that through this now known mechanism, craving behavior as well as stress will be reduced.

• It regulates the brain wave dysregulation at the Pre-frontal Cortex- Cingulate Gyrus by increasing alpha and low beta bands. By doing so this relapse site will be normalized and as such reduce relapse.

• It activates the caudate-accumbens-dopaminergic pathways inducing an attenuation of aberrant craving behavior.

• A major problem with addiction is that there are poor executive function abilities, which in part are due to genetic deficits and environmental elements leading to hypodopaminergic function and poor memory and focus. As reported in a published paper, KB220Z significantly increased focus after 30 days as measured by qEEG in healthy volunteers.

• Drug abuse counselors are very familiar with the importance of stress as a relapse factor in the recovering community. In a randomized–placebo–controlled study KB220Z significantly reduced stress as measured by skin conductance in patients attending a residential treatment facility.

Moreover, figure 4 also shows the KB220Z reduces the risk of leaving treatment against medical advice (AMA) as

30

• In recovery it is important to also boost immunity in aftercare patients because it is well-known that stress reduces brain endorphins with concomitant reduced immunity. Published papers show the importance of endorphins as a regulator of one’s immunity. One key ingredient in KB220Z raises brain endorphins and as such should boost immunity and needed brain flow.

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• Especially in the world of legal RX pain killers, patients that have detoxified from prescription opiates may still have pain.

Interestingly, dopaminergic tone is tantamount to pain control along with brain endorphins, our natural pain killer system.

KB220Z has a known analgesic effect.

• In support of relapse prevention, the following graph (X figure) represents a culmination of oral and IV studies showing very significant relapse reduction in alcoholics, heroin and cocaine dependent patients.

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Reward Deficiency Syndrome resulting in low dopamine makes sobriety uncomfortable and even painful for many. Comfortable sobriety requires healing of the brain. Neuro-nutrient therapy prevents relapse by enabling a comfortable sobriety. There are many tasks on the road to recovery. Reduced stress, clear thinking, and the ability to experience pleasure allow the recovering person to accomplish the tasks of recovery that lead to an enriched life.

David Miller is President of NuPathways, Inc. specializing in nutrients for addiction recovery. He has worked in the addiction field for 40 years as a therapist, an author, and an educator.

Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical College and graduated from Columbia University and New Jersey College of Medicine. He has published more than 550 abstracts; peerreviewed articles and 14-books.

Merlene Miller has authored numerous books on addiction and recovery, specializing in relapse prevention. She is an educator with 16 years’ experience as director of addiction studies at Park University and Graceland University.

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31

OPIOID ADDICTION: A NEW UNDERSTANDING OF AN ANCIENT PROBLEM

By Mark S. Gold, MD

Continued from page 6

decreased shame and stigma, plus increasingly lax attitudes regarding drug use, conspired to expose genetically vulnerable persons as never before. The consequences have been severe.

Since the dawn of the new millennia the number of overdose deaths involving prescription opioids quadrupled. For treatment professionals on the front lines, this trend towards opioid misuse and addiction among the middle and upper middle class, and the lengths that otherwise law-abiding citizens would go to attain their drugs was shocking at first. As prescription opioids became harder to attain, heroin became the alternative. This caught most of us by surprise due to widely held beliefs that most people would never risk the shame, danger and stigma associated with heroin, nor dare to cross the needle barrier. As I pointed out in my last article in The Sober World (July 2017), https://www.thesoberworld.com/july17_issue.pdf dangerous and often deadly adulterants such as back alley fentanyl, noxious chemicals used in drug processing, and bulking agents such as talc, also caused toxicity and death. Clearly there is much more going on here than just some unscrupulous doctors overprescribing, or big pharma peddling poison to pad their portfolios.

Here are the most recent facts regarding opioids and mortality From 2000 to 2015 more than half a million-people have died from drug overdoses. In 2015 alone, 90 people per day died (over 32,000 annually) as a result of an overdose involving opioids. In contrast, in 2010, 16,651, people died as a result of the misuse and overdose on prescription medications. Certainly, the increasing availability of prescription opioids has contributed to the mortality rate.

Figure 2. The use and abuse of prescription medications is now the second most abused drug among teens

But why have prescription opioids become more available?

There are 2 major reasons. First, in 1999, The Veterans Health Administration launched the “Pain as the 5th Vital Sign” initiative, requiring a pain intensity rating (0 to 10) during all clinical encounters. Endorsed by the Institute of Medicine (IOM), this became standard practice in all primary care in the US. Did it help?

Studying the outcome of this practice among Veterans, Mularski and colleagues reported. “Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management” Yet because of this change, more medications were prescribed by practitioners who lacked experience in pain management or addiction medicine.

The second reason is so obvious that we missed it. Last year the IOM reported that over 100 million Americans (one third of the

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population) currently suffer from legitimate chronic or intractable pain. To put this in better perspective, there are more people suffering from chronic pain than are inflicted with heart disease, cancer and diabetes combined. As the baby boom generation lives longer, they experience a plethora of physical wear and tear and injuries which often result in chronic pain. Yet the IOM reports that only 4 percent of Americans have EVER used an opioid that was not legally prescribed to them. Pain research is quite primitive and the research aimed at non-opioid or non-addicting therapeutics has lagged. In addition, few pain medicine or anesthesia pain experts are trained in addiction medicine and fewer yet are Board Certified in both specialties. The exception is my former fellow, colleague and friend Dr. William Jacobs who is Chief of Addiction Medicine at the Medical College of Georgia. His expertise is unsurpassed, and what we need to advance against this dreadful disease.

In spite of all the concern surrounding opioids and overdoses, the overwhelming majority of people who use prescription pain relievers for legitimate pain, do so as prescribed. We cannot forget, that for those who are crippled by chronic pain, these medications are life-giving. Having withdrawal signs and symptoms when they cut down or discontinue is normal physiological withdrawal—but it is not addiction. Many other non-opioid medications, produce tolerance and withdrawal upon cessation but this does mean they are addicted. Astute pain management professionals with expertise in addiction medicine are desperately needed to fill the gap and treat those with chronic pain.

The Accidental Addict The accidental addict can be a person of any age who has never abused drugs or alcohol, but as the result of an acute injury or illness are prescribed a pain medication, usually hydrocodone or oxycodone by a well-intentioned, urgent care physician, or by their primary care physician. The evidence shows that the overwhelming majority of people with acute pain usually do not finish their prescription and recover quickly. Yet for reasons not fully understood, some individuals have an intense euphoric response from the opioids, so much so, that they seek the drug long after their injury has healed and the pain subsided. This represents a very small percent of people with opioid use disorder, nevertheless the consequences of drug misuse and abuse, regardless of how one is initiated never turns out well. Only by understanding the biological, familial and social antecedents of addictive disease can we put the current opioid crisis in proper context and focus on improved prevention and better treatment.

Interpreting the Data As a researcher and addiction medicine doctor, I have seen first-hand how dangerous and addictive these medications are. As a scientist, my work is informed by the peer reviewed, scientific evidence—animated by years of experience and desire to continue as a translational researcher, fill the gaps in knowledge and educate others on addictive disease. Accordingly, I write summaries of the best available evidence each month. (www.addictionresearchyoucanuse.com) .Yet, interpreting the epidemiological data in regards to opioid mortality is difficult for two reasons. First, the landscape from which data is culled is dynamic and shifting constantly. Second, methodology for epidemiological research is often hampered by predetermined categories for drugs or outcomes, within a static timeframe. For example, if the research question is: To determine mortality related to opioid use, the methodology is to simply review post-mortem toxicology reports that are tabulated from a sample of those who died within a predetermined time frame. The problem is that toxicology screens are effective in detecting the presence of opioids but cannot tell a

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researcher anything about the deceased’s history or drug tolerance, or previous drug or alcohol use, or previous trauma, co-occurring illness and extenuating circumstances. They rarely report all the other drugs and adulterants in the overdose sample, and cannot determine whether the overdose was accidental, a form of “Russian Roulette”, or a passive suicide attempt accompanied by a wish to die.

For example, an individual develops a high tolerance for oxycodone and is taking 120 mg per day. But now she begins having sleep problems, so she goes to her primary care physician (PCP) with the complaint of insomnia and acute anxiety. But, as drugs addicts often do, she fails to mention the opioids. The PCP does not do a drug screen (because insurance won’t pay for it) and prescribes 0.5 mg of Alprazolam (Xanax) at bedtime, and 0.5 during the day as needed for anxiety. After a few days, the patient is still having trouble falling asleep, so on top of the 120 mg of oxycodone and 3 glasses of wine after dinner, she takes 2 mg of Alprazolam before she goes to bed. Unfortunately, she suffers respiratory distress, stops breathing and dies in her sleep. So, the question becomes, what killed her? Was it the Oxycodone? The Alprazolam? The wine? Her insurance company? Her doctor? Well, technical answer is the combination of Opioid, Alcohol and Alprazolam. The truth is … her Substance Use Disorder, killed her.

So, why do some people get addicted so quickly and others do not? Why do some people hate smoking marijuana or cocaine and others do not?

The quick answer is genetics, both genotype, which is our heritable genetic hard wiring, plus phenotype, which involves the environmental stressors that impact genetic expression, such as trauma or abuse, being a child of a drug user or addict, exposure in utero or in early life, and exposure to drugs during brain development. Epigenetics is the adaptation resulting from external forces that influence and potentially modify genetic expression during conception. Recent research suggest that these adaptations may be passed on to one’s children. Therefore, SUD is a poorly understood, genetically influenced, multifaceted brain disease that require multimodal and multidisciplinary expert treatment of adequate intensity and duration.

The Bad News Although the abuse of illicit prescription drugs is less prevalent than alcohol or marijuana use disorders among adults, the longterm trends cited in the recent Substance abuse and Mental Health Service Administration (SAMHSA) report indicate that in spite of the Herculean efforts to educate the public regarding the dangers of opioids and other illicit drugs, the impact in reducing the prevalence of Americans whom use, abuse, become addicted to, and die from using pain killers and sedative hypnotic drugs is negligible.

Clearly, we are spending far too much time and resources talking about a single class of drugs, and pointing fingers at bad doctors and “Big Pharma” as the cause. In reality cocaine production has increased due to demand, and accordingly smuggling drugs into the US has increased, prices are down, and deaths from overdose are common. Current drug prevention efforts are woefully underfunded but needed more than ever. Why? Because 8,000 young people will pick up and use an intoxicant for the very first time today, and another 8000 tomorrow, and another 8000 the day after tomorrow, and another 8000…You get the point? Do the math—it’s shocking and unsustainable.

What to do Recently the National Academies of Sciences, Engineering and Medicine convened to address the problem of illicit use of prescription opioids. They reported that. “Years of coordinated efforts will be required to contain and reverse the harmful societal effects of the country’s ongoing prescription and illicit opioid epidemic” I agree.

The committee’s specific recommendations include: • Changing the culture of prescribing, partially through enhancing

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education for physicians and the general public.

• Investing in treatment for the millions of individuals with opioiduse disorder and removing impediments to those treatments.

Also, improving health-care provider education for opioid-use disorder.

• Preventing overdose deaths, including access to naloxone (also known by its brand name Narcan) and safer injection equipment.

• Weighing societal impacts, not just an individual’s, regarding opioids, such as incorporating public health considerations into the FDA’s current framework for making regulatory decisions regarding opioids.

• Investing in basic research, particularly to better understand the nature of pain and the neurobiology of the intersection between pain and opioid-use disorders. In addition, increasing the investment in developing nonaddictive alternatives to opioids for pain management.

Medically Assisted Treatment A number of medications are now available to treat opioid use disorders. These medications can be used for both acute withdrawal and for long term recovery. Recent evidence shows that these medications have helped opioid-addicted persons become free from the mental anguish, preoccupation and craving for opioids.

There are 3 types of medication currently available for this purpose.

Drugs like Naloxone (Narcan) have been used to prevent death from overdose for several decades. A first cousin of naltrexone, Vivitrol, is now available in a long acting formula to prevent opioid relapse.

Medications for MAT include: 1. Full agonists: Methadone (Dolophine or Methadose), which activate opioid receptors.

2. Partial agonist, buprenorphine (Subutex, Suboxone, Zubsolve), which also activate opioid receptors but produce a muted euphoric response, and mediate craving.

3. Antagonists which are versions of naltrexone, which I helped develop in the 1980’s (Revia, Depade, Vivitrol). These medications block the opioid receptors and negate the rewarding and toxic effects of opioids.

Medically Assisted Therapy alone is generally not enough.

Continuous care, as would be provided for any chronic lifethreatening disease is essential. Effective treatment combines social support, psychological, and psychiatric treatment as needed, 12 Step Recovery (or similar programs), and continuous monitoring via drug testing--plus, aggressive treatment of co-occurring psychiatric or medical illness, such as depression or Hepatitis C. This model is the treatment approach most MDs choose for themselves, recommend for their colleagues, and known to be effective over the long haul. If outcome is measured in treatment retention and overdose prevention, MATs—especially methadone— are quite effective.

Until new therapeutics, vaccines and treatment modalities are tested and made available, those looking for treatment should only consider centers with the most experienced and credentialed clinicians, that offer multimodal, evidenced based treatment, and provide individualized care. These centers offer the best hope of those suffering from opioid addiction.

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. www.rivermendhealth.com

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BACK TO SCHOOL - TIPS FOR PARENTS DURING AN OPIOID EPIDEMIC

By Jim Holsomback MA-ABT and Louise Stanger Ed.D, LCSW, CDWF, CIP

Seeing those first ‘Back to School’ signs elicit a lot of different feelings for teens and parents. At its best, school can add structure, socialization and the promise of a successful year of learning. At its worst, school can prompt anxiety, conflict and trauma. While parents and teens try and balance socialization with stress, academics with anxiety, purpose and pressure, schools also wrestle with the ‘new norms’ of striking their own balance with the availability of phones, access to substances and a rising suicide rate amongst preteens and teens that is approaching epidemic numbers in the United States.

Without a ‘one size fits all’ instruction manual for teens, families often feel that they are in reaction mode, which often can feel unpredictable and driven by emotion rather than thought and logic.

Recommendations and support typically follow behavior that is concerning or scary and, even with the best of intentions; rules typically fade with time when they are born from anxiety or crisis around substance use. As important as structure, consistency and organization are, they can fade by mid-October in the same way New Year’s resolutions often do. So how can parents identify useful guidelines that can help create a smooth transition from the beginning of the school year through the academic term?

Parents often report feeling immense joy when the structure and stability of the first day of school arrives. The most successful families; however, start planning for school long before “First Day of School Eve”. In fact, setting an effective plan in place about 2 weeks prior to the beginning of school can help reduce anxiety and sleeplessness when the big day arrives. Families that start to RESET about 14 days before school begins help provide a smooth transition to school. What does RESET mean?

R-Recovery E-Eating S-Sleeping E-Exercising T-Telephone Recovery: Often summer can be a very risky time for teens to manage their recovery. Parties, holidays and fun often go hand in hand with substance use for adolescents. Without the structure of school, or fear of getting caught by more vigilant parents or the suspecting teacher, folks who specialize in recovery often look toward summer as a high-risk time to use. However, the stress of academics and seeing friends that often have found new experiences with substances during the summer can often create new and unexpected temptations to lapse in recovery, especially for those who use drugs to manage stress, anxiety or depression. Parents can use the beginning of the school year as a time to invite their teens into a conversation around recovery and substances and begin an ongoing dialogue around use. The more you speak about it, the more comfortable they will feel discussing it. Make recovery convos a part of weekly dialogue to open the door to proactive conversations.

Eating: For a lot of kids, hot dogs can become one of the major food groups during the summer. Meal times are often inconsistent and the meals themselves may not be as structured as they would be during the school year. Using the two weeks prior to school can be a great way to recalibrate eating, both in terms of the times families eat as well as what they are actually consuming during the meal. Eating balanced meals can have a profound effect on moods and mental health, so getting into the swing of a balanced meal and consistent time can help that transition back to school.

Sleep: This is another cornerstone mood regulator that can really shift in the summer. Between the longer days and not having to get up and prepare for school, the amount of sleep that children and adolescents get can vary during the summer. Getting kids and teens on a regular sleep schedule and ensuring that they are getting the recommended amount of sleep is an integral task before the school year begins.

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Exercise: For some kids, exercise is not a problem when the weather is nice and school doesn’t get in the way of play. For others, however, exercise can get lost in all the fun of sleepovers, barbeques and days at the beach. By getting exercise on board in a regimented fashion, children and teens can begin a routine that can last through the darker (and for some, colder) winter months.

Telephones: Have you forgotten what your child looks like because their face has been hidden behind a digital device all summer? Are you worried that your child’s school picture may feature a tablet instead of his/her head? Well, that may be because their head has been on their tablet for the better part of the summer. While all the conveniences of digital devices help kids stay connected, they can also become problematic when free time is replaced with homework.

Having your family set up a digital plan a couple of weeks prior to the school year can be a great way to remember what they look like without a tablet or cell phone and can actually promote better sleep.

The hardest part of having a difficult conversation is the beginning. As parents, we care deeply about our children. We often helicopter over them or scoot like a submarine underneath. How can parents effectively bring up their anxiety around tough teen topics such as substance use, suicide, sex, bullying and friends (The Big FIVE)? Here are some tips that can help parents ease their way into the conversation pool without feeling like it is too frightening to stay and chat…..

1. Own It! Most of the awkward conversations that happen (or don’t happen!) between parents and teens are elicited by mom and dad’s anxiety. Often, parents try and bury their anxiety in those conversations. Start the conversation by owning it. “This is just my ‘mom’ anxiety, and I want to talk about…..” can be a great conversation opener that helps teens understand that they may not have done anything wrong and they may actually be helpful in easing a parent’s anxiety (and teens, more than anyone, know that anxious parents do crazy things!)

2. Avoid Making The Conversation an Annual Event! While every difficult conversation around substance use, suicide, sex , bullying and friends may not go perfectly well, the more frequently parents and teens have the conversations, the more they will be integrated as topics that families discuss. It isn’t a secret that the difficult teen topics affect every adolescent; not treating it in a secretive manner can help make it easier to discuss.

3. We Are Opening an Amnesty Program! Teens often hate conversations around The Big FIVE because they are afraid of ‘getting caught’ or having parents snooping for information. As parents, we would be surprised if our 12-18 year old isn’t affected or worried about such topics. Adolescents are far more likely to have Continued on page 38

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Saturday, September 23, 2017 Location | Hyatt La Jolla at Aventine, 3777 La Jolla Village Drive, San Diego, CA 92122 10:00 | Boutique & Silent Auction 12:00 | Luncheon & Fashion show by Gretchen Productions Tickets | $85 per person or $1,300 for Topaz Runway Table of 10 RSVP | Call 619.670.1184 or visit www.anewpath.org Payment Options |

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FOR SOBRIETY!

Please join us in our efforts to make a difference in the lives of those who are in need of support and treatment for substance use disorders and addiction. This event benefits PATH’s efforts to reduce the stigma associated with addictive illness in order to increase access to quality drug addiction treatment services in lieu of incarceration.

Women Empowering Women in Recovery LLC, founded out of love. Amanda Marino experienced the loss of her childhood friend to the disease of addiction and was compelled to make Kim Kinkle’s unnecessary death serve a purpose.

Beginning with a passion for service, Amanda took her idea to Lisa Saunders and Heather Ann Adams, then approached Mo Maynor and Cynthia Weseman from Within Recovery Café to host her then, conceptual idea of a luncheon to inspire women and raise money to help other women in recovery. The idea has flourished into a powerful event, where women gather to listen, learn and empower one another while contributing to a scholarship fund established through the help of Palm Beach State College.

The mission of Women Empowering Women in Recovery LLC is to empower young women on their recovery journey by offering financial assistance towards education, allowing opportunities they would otherwise not have access to. WEW has grown over the past 1½ years as the direct result of God’s Divine Direction, and a group of strong, loving, dedicated and passionate women who believe not only in themselves, but the power of a tribe. We have formed an official non-profit organization with a Board of Directors. Amanda, Lisa, Heather Ann, Cynthia and Mo serve on the board.

So many people have helped along the way with time, money and gifts of empowerment, that we are happy to announce our first scholarship this fall.

On October 11th the presentation of a $3,000 scholarship, which is a semester and books for a full-time student at Palm Beach State College will be offered at the Hanley Center and presented by Kim Kinkle’s father. We are also thankful to announce that Dress for Success has graciously offered to wardrobe our recipient of this scholarship event.

We have opened this particular luncheon to men, and our goal is to exceed 200 people. To this purpose and magnitude, we are asking all empowered women and men to come help us celebrate the life of Kim Kinkle and show the community that recovery is real and strength in numbers works.

Tickets and sponsorship opportunities for this event are available on our Facebook page – Women Empowering Women or by calling Amanda @ 561.735.2590, Mo @ 561.309.5451 or Cynthia @ 561.360.6790. The Luncheon is at Hanley Center- 933 45th St WPB. October 11th, 2017 11:30 -2:00pm

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7 TIPS FOR A FULL RECOVERY

By John Giordano, Doctor of Humane Letters, MAC, CAP Tip #5 - Tiredness The reasons you feel tired are so many that I simply cannot go into detail in this short space. Just Google ‘why am I so tired’ and you’ll find over 33 million results. Just the energy and caffeine drinks alone burn out our adrenals and case tiredness. But what you need to know is its affect. Tiredness has a negative effect on our bodies, mind, and spirit. It affects our behavior and judgment. According to Wed MD, depression can stem from any sleep disorder that causes chronic fatigue and mood problems.

Tiredness is far too complex for you to analyze and solve on your own and is an area best left to the experts. Again I recommend seeking out a doctor with Integrative Medicine credentials.

Tip #6 - Exercise This is perhaps my biggest pet peeve. I cannot impress upon you just how important exercise is – regardless if you are an addict or not – for both your physical and mental health. Take a thirty to forty-five minute walk; go for a bike ride or a long swim. You will notice a change immediately. You’ll sleep better, feel lighter on your feet and be clearer minded.

Moreover, exercise reduces stress, depression, anxiety and improves cognitive function. It forces the body’s physiological systems — all of which are involved in the stress response — to communicate much more closely than usual. Exercise aids in the functioning of your brain’s ‘happy chemicals’ like endorphins and dopamine.

Tip #7 - Avoid Stressful Situations Until You Know How To Deal With Them More research on the subject needs to be performed, but recent studies have indicated that addicts tend to be highly sensitive people that can become easily overwhelmed. These characteristics when under stress can complicate anyone’s recovery.

Continued from page 8

stress combined with inadequate coping skills is one of the primary drivers of addiction and relapse. What is important to keep in mind here is that a stressful event or circumstance in itself is not harmful, but rather the meaning of the event or circumstance to an individual – how they perceive or interpret it – and how that person copes with it.

Coping mechanisms have proved to be invaluable in achieving a long and successful recovery. They can be taught. Addiction treatment centers do the best that they can but there are external forces such as insurance companies and our healthcare system that can tie their hands behind their backs. In my opinion, very few get the length of stay at a treatment facility necessary to learn these skills that will assure the best outcome. If nothing else, this situation is all the more reason to seek out a comprehensive aftercare program that can pick up where the treatment centers leave off in teaching these lifesaving coping skills that are integral to recovery.

It is the best way for any addict to gain the knowledge and coping skills they will need for a joyful and lasting 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

If there is a stressful situation on the horizon that you cannot avoid than prepare for it. Know that it is going to be stressful and take all the precautions you can think of. Talk to your therapist or sponsor because knowledge is power. If you find yourself spinning out of control during the stressful encounter than just calmly say so and walk away.

You probably noticed that stress pops up quite a bit in this article. It was not by design but rather an acknowledgement that stress is a wellknown risk factor in the development of addiction and relapse. In fact,

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RALLY FOR RECOVERY AND ADVOCACY DAY

September 29, 2017 Ohio Statehouse West Plaza Rally for Recovery – 10:00 am – 12:30 pm Advocacy Day – 12:00 pm – 3:00 pm THIS YEAR! Please donate a pair of shoes to line the Statehouse to represent

A COMMUNITY IN MOTION!

To donate a pair of gently used or new shoes, please send to: Ohio Citizen Advocates for Addiction Recovery 85 E. Gay Street, Suite 604 Columbus, Ohio 43215

Lunch will be provided to first 400!

For more information visit www.oca-ohio.org/rally-for-recovery

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DYING FOR A DRINK – REHABILITATING AN EXTREME ALCOHOLIC

By Candice Feinberg, Psy.D.

After laying all that groundwork, the action phase takes place.

This phase is where the behavior change begins, and the harder work takes place. Here an individual will take steps to implement the plans created in the preparation stage, utilize the resources found and needed, and do something different.

For some it will be entering a treatment facility, others it may be reaching out to a trusted advisor, or possibly attending a 12step meeting.

The action consists of reviewing what changes are being made, and access if they are working or not. Part of this step is considering if the new things that have been added are working, and if not, try another action to discover what will.

Maintenance is the next phase in the change process. Here the individual has changed their behavior and surroundings to ensure their life is becoming stable and routine. New practices, new supports, and additional resources are available and readily used, and the person is fully engaged in recovery.

The potential last phase of change is relapse. It is listed as both a reminder to be vigilant in change and recovery, as well as to acknowledge the difficulty of learning new behaviors and ways of being. Not all will relapse, but the model allows for room for transgressions, without having to start all over again. Prevention includes being mindful of warning signs, triggers, and what each need for self-care.

BACK TO SCHOOL - TIPS FOR PARENTS DURING AN OPIOID EPIDEMIC

Supports and Step Down Support increases the odds of long term sobriety for chronic alcoholics.

Ongoing support with a 12-step type program, or other models such as Smart Recovery, can help the client reach long-term sobriety. It provides better outcomes than having no support or aftercare, and increases the opportunities for social support and assistance for those struggling with their addiction. Having continuity of care during treatment and transitioning seamlessly from inpatient treatment to outpatient treatment, and aftercare is crucial in a comprehensive treatment plan.

It is difficult for individuals actively struggling with alcoholism to hold on to hope. There has been a lifetime of feeling hopeless for many.

We have repeatedly heard how they woke up every day for 10 or more years wanting to stop drinking and every night they drank again. Our job as addiction treatment specialists is to provide the client with the hope that they can change and know recovery is possible. Keeping them motivated, helping build rapport with them, letting them guide us, will go a long way to reach the end goal of a healthy and sober individual.

References Provided Upon Request Candice Feinberg is the Executive and Clinical Director at Avalon Malibu. She is an industry leader in developing innovative, evidencebased therapeutic programs for individuals suffering from mental health and addiction issues. Dr. Feinberg, a highly-respected authority in the field of mental health and addiction issues, has appeared on national television, and written articles published in Psychology Today.

THE RELATIONSHIP BETWEEN ADULT ADHD AND ADDICTION

By Allan N. Schwartz, Ph.D.

By Jim Holsomback MA-ABT and Louise Stanger Ed.D, LCSW, CDWF, CIP

Continued from page 34

open discussions about The Big FIVE if the hammer of discipline isn’t waiting for them at the end of a conversation.

4. Win, Lose or Draw! It can be easy to focus on winning a debate or conversation, catching a teen red handed like an episode of Law and Order or feeling like we know everything about our kiddo. The real ‘win’ is the conversation and the opportunity to have another. It is hard to feel effective as a parent when scary behaviors like substance use and self-injury go underground. The more parents can feel comfortable that their kids will be honest and approach them if scary behaviors affect them or their friends’ lives, the easier it is to parent.

5. Don’t Forget Sticker Charts and Other Strategies!

Remember when we relied on sticker charts to reward behavior?

They helped create pee in the potty, clean rooms and completed household chores. Why did they work? Behaviorism! We didn’t pull all the stickers off the chart at the first sign of a messy room, yet parents often fall into the trap of taking everything away when things aren’t going well and doing nothing when things are going good. If the reward of having ‘good teen behavior’ around The Big Five is just ‘not being punished’, behavioral principles won’t work.

6. Remember How Important things like Relationships, Trust, Feedback, Compassion and Time is to Our Teens? They are more powerful than stickers and work in very similar manners for eliciting the values and behavior we hope our adolescents exhibit.

Jim Holsomback (MA – ABT) is the Director of Clinical Outreach for Paradigm Malibu Adolescent Treatment and Program Director of Triad Adolescent Group Therapy Services.

Dr. Louise Stanger is a speaker, educator, clinician, and interventionist who uses an invitational intervention approach with complicated mental health, substance abuse, chronic pain and process addiction clients. http:/.www.allaboutinterventions.com

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Continued from page 14

Continued from page 24

• 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.

• Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

The correlation between ADHD, Depression, and Addiction is strong. So, when those with untreated ADHD become addicted, it is part of the attempt at self-medication for those awful feelings.

ADHD and Depression go together for two reasons. First is that there may be a biological cause of depression which runs in families and is inherited. In this case, depression would be present even in the absence of ADHD. Second, there are many people who become depressed in reaction to having ADHD. Difficulties with executive functioning, focusing attention and controlling impulses interfere with success in school, at work and at home in intimate relationships. A sense of low self-esteem with feelings of hopelessness set in leading directly to depression.

How to Cope It is very clear that to prevent drug addiction associated with ADHD that people be identified when they are in school and treated with medication, coaching, psychotherapy and the proper diet. Coaching helps clients learn specific techniques to counter the symptoms of ADHD. As part of this, it is also important to treat any depression that is present, whether it is caused by ADHD or not. Finally, exercise has been found to be very helpful with both ADHD and Depression.

It must be emphasized that this a dual diagnosis type of case and, as such, requires treatment of both the addiction as well as the ADHD. Dr. Schwartz is a Licensed Clinical Social Worker in Florida, Colorado, and New York. Currently, his psychotherapy practice is in Boulder Colorado. He can be reached through his e-mail at dransphd@aol.com and through his website at http://www.allanschwartztherapy.com

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Drug and alcohol detoxification is an intervention in the case of physical dependence to a drug or alcohol, the practice of various medical treatments for symptoms of withdrawal. Individuals who have been habitually using alcohol or drugs for a period of time will develop a chemical dependency, and it can be dangerous to try detox without medical assistance. The body and brain build up compensating measures when using certain drugs and alcohol, and simply stopping “cold turkey” can potentially cause seizure, respiratory depression and stroke.

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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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