A WAY OUT TREATMENT CENTER NEWSLETTER 02/13
AUGUST 2013
Addiction as a Disease This newsletter will focus on “Addiction as a Disease.” We look at The Disease Model, The New D.S.M.5 Criteria, 5 Myths that undermine Recovery and the “Great Lie”. We also have the first of two inserts where we meet the staff. . There are also one or two pages of fun stuff and a poem on addiction. Pleasant reading.
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Greetings in sobriety Welcome to the second edition of our exciting newsletter. In this edition we will be looking at addiction and exploring the research done around the disease of addiction. Each newsletter will have a specific theme, which will be dictated by the professional team at the treatment center. The theme will therefore maintain its relevance in terms of recovery, and will be a theme that is applicable, as dictated by their experiences in the treatment and/or recovery environment. I cannot emphasize enough the importance of your contributions and participation in order to help us to make these newsletters relevant and interesting to you. We sincerely hope that you enjoy the second newsletter, which focusses on the disease of addiction. I hope that you will find the articles compiled and included to be of interest, and even more so that you have a better understanding about the disease when you have read it. Lastly, please share this link with all your friends and family and on social media sites, such as twitter, Facebook, pinterest etc. etc. in an attempt to get the message out to as many people as possible. Hopefully the articles and extracts in this newsletter will be of use to both the addict and the family, and will assist in both parties gaining some sort of clarity as to the feelings and concerns of the other party. We look forward to receiving your suggestions for future articles, and would appreciate your constructive criticisms. Yours in sobriety
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FOR THOSE WHO MISSED OUR FIRST EDITION Kindly click on the link below should you have missed our first edition. In future, ALL past editions will be featured on this page.
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STAFF MEMBERS PROFILE At the risk of being called sexist, I have purposefully chosen only to include the “Baas of the Plaas” Hein, together with the, please forgive me Hein, the prettier support staff that are on Hein’s wonderful team of caring people. In Keeping with Woman’s Month we’ve only featured the ladies and the “baas”. Next month we’ll feature the other “uglies” who are renowned for their cooking skills, powerlessness and damages sessions, amongst other things.
All comments in purple are merely my own opinion.
Hein It is very rewarding facilitating groups and watching the growth of the clients as they take responsibility for themselves and take ownership of their lives. A Way Out is growing and it is a privilege to be part of that growth, our focus here is on helping people, we have a small group, this ensures us to build close relationships with them. When someone’s behavior deviates we can adjust it and get the client to rectify it, we believe in educating clients about how to live life. I believe people should come to A Way Out because we have a program that works, it’s not a theory but a program, clients that have applied themselves to the program stays drug free, it is a program that has kept me drug free for 12 years.
My counselor, when I was at A Way Out, and “Spiritual Guru” that showed me the way, by example. Also the one that gave me the hope that change is possible and more importantly that recovery is possible.
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Jolanda Admin Manager: Dealing with clients' and their families is my passion when that first call for help comes through. It is important that they don’t feel judged as the moral stigma to addiction is what keeps so many addicts bound to addiction as well as affecting their families and loved ones. Jolanda holds a VERY special place in my personal recovery. She was the one to take my call and did all the arranging to get me into the new life that I now lead. She along with the “ugly duckling” came to pick me up in a highly inebriated state from a small village on the West Coast to commence my journey in recovery. So bad in fact that I was kept in “isolation” from the rest for the first night. She also had to endure the wrath of a highly upset wife over the phone. A one in a million lady, in my opinion.
Belinda I am responsible for presenting craft classes as part of therapy. We teach our clients different crafts to help them ease the boredom as this is when they often relapse. Having to finish a project teaches them to strive to complete all tasks that they begin, i.e. work related tasks, house hold tasks. It is also a great sense of achievement for them and we encourage them to do projects at home that they can use as gifts for their loved ones. It is all part of the healing process of the family. As the professional nurse (Bcur Stellenbosch) at A Way Out. I also react to any medical emergency that might happen and filter the client to the appropriate destination, i.e. hospital, doctor or just applying simple emergency care. The “art lady” who had to endure my attempts at art. Initially my thoughts were W.T.F., but later strangely enough, started to enjoy the art therapy. One of the unluckier ones to encounter me on my first night at A Way Out, and the one who sent me to Mediclinic to get the scars of my “pavement kopstamp” stitched up.
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THE DISEASE MODEL OF ADDICTION “Those who do not have the power over their lives, the power to retell it, rethink it, deconstruct it … and change it at times, truly are powerless because they cannot think new thoughts.” Alcoholism and drug addiction affects the whole family –
Everyone that comes into contact with the addict is in one
One Wayof the fundamental concepts of recovery is that it is essential that the person suffering understands and realizes that they are afflicted with a disease. That being said let us add to it that the disease is, we believe, chronic and incurable. When a 1988 Gallup Survey asked members of the public if the thought that alcoholism was a disease, the following responses were received: • 78% responded that they strongly agree that it is a disease • 10% agreed somewhat • 6% disagreed somewhat • 5% disagreed strongly • 1% had no opinion •
The same poll illustrates clearly the misperceptions that the public in general have of addiction. When people were asked which of a selected set of feelings best described how they view alcoholism: • 60% said it’s a disease / illness • 31% said it’s a mental/psychological problem • 23% said it’s a lack of willpower • 16% said it’s a moral weakness • 6% were unsure The primary reason why people are confused about the disease of addiction is that it requires not only an understanding of scientific evidence, but also of ideas about moral judgment, free will and the stigma of addiction.
In order to more completely understand the disease model we will now proceed to look at the terms of addiction and disease. Following this we’ll take a look at the personal responsibility of the addict, as it applies to the disease. The disease concept dates back to the days of the early Greeks. Hippocrates, the “father of medicine” set down certain definitions for disease as early as the 5th century BC. He postulated that diseases were caused by an imbalance of the natural elements within in the human
body, particularly of earth, air, fire and water. Throughout history, there have been many people that have ascribed radically different causes for physical diseases than what they have ascribed for psychiatric disorders. Up to as late as the late 18th century certain diseases were still viewed as moral degeneracies. It was not until the late 18th century that a certain Dr. Benjamin Rush identified alcoholism as a disease in which: • Alcohol serves as the cause • Loss of control over drinking behavior is a characteristic symptom • Total abstinence is the only effective cure Alcoholism was only awarded the status of disease in the mid-20th century. It was officially declared as a disease in 1953 in a prominent medical journal. This statement signaled the official acceptance of alcoholism as a disease, however there are still many medical professionals that have profound difficulty in accepting and recognizing alcoholism as a disease.
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There are however simpler definitions, such as those of Dr, Silkworth. He stated that alcoholics suffer from a physical allergy to alcohol, existing only in those who are destined to become alcoholics, and not in temperate drinkers. He was also known as “the little doctor who loved alcoholics. Somewhat later Dr. Tiebout emphasized the significance of the defense mechanisms of denial, rationalization and minimization in alcoholism. In the 1960’s Jellenick concluded that the vast majority of evidence favors that alcoholism is a disease. Jellenick viewed alcoholism as an addiction, similar to any other drug addiction. He however furthermore predicted that this would not gain favor of alcoholics, as they would be adverse to the term addiction. Increasingly sophisticated studies of alcoholism have clearly established that alcoholism has important definitive characteristics of other diseases and provide substantial evidence that alcoholism is genetically transmitted. Many dictionaries simply define disease as an illness or sickness. The description of disease that in my opinion best fits the term addiction is Dorland’s Illustrated Medical Dictionary which defines disease as” any deviation from or interruption of the normal structure or function of any part, organ or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs, and whose etiology, pathology and prognosis may be known or unknown.” Alcoholism fits exactly into this definition. Now knowing that alcoholism is a disease we can accurately predict and describe an alcoholic’s behavior. The description and prediction of behavior is the basic aim of the scientific method, and the disease concept fulfills that aim. It is extremely important to realize that we call alcoholism a disease because it has been substantiated by such scientific studies of human biology. In order for science to recognize something as a disease in the 20th century, the condition must have a physical basis. The areas of science that provide insight into the physiology of alcoholism are biochemistry and genetics. Accepting alcoholism as a disease has further refined our approaches in treating the disease. A large body of this evidence comes from Alcoholics Anonymous, which has since inception, grown to have in excess of an estimated 73 000 groups in over a 114 countries. The millions of recovering alcoholics in A.A. implicitly endorse the concept that alcoholism is a disease. From the perspective of treatment, it is crucial to alcoholic’s acceptance of their loss of control over alcohol that they know that their alcoholism is a disease and not a lack of willpower or moral fortitude. In the treatment of alcoholism, there are numerous paradoxes, which weigh heavily on the recovering alcoholic. Possibly the biggest one encountered is that of lack of control. When the addict is still in active addiction it is often said that they have lost control over their using. However anyone wishing to find recovery will have to exercise some control – and that would be a commitment to abstinence from alcohol.
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It is however important that we realize that we realize that the alcoholic is powerless over alcohol but not alcoholism. It is often found that this notion of victimization is applied to alcoholism. The only way that this victimization can be overcome is by the alcoholic making a solid commitment to the 12-step program of alcoholics anonymous. Briefly, the 12-step program calls for the alcoholic to admit powerlessness over alcohol (not over alcoholism) and ask the addict to act to promote the recovery from alcoholism. In doing so, the steps strike a balance between loss of control and the addicts’ choice to reorient their lives – a balance that has guided recovery for millions of people. Hereunder is an extremely brief outline of the 12 steps of recovery: Step 1
Asks the addict to admit powerlessness over the use of the drug of choice and the associated consequences Step 2 Makes clear what is needed to refrain from continued use – “A Power Greater than ourselves or a Higher Power (H.P.) Step 3 Asks the addict to act on this realization Step 4 Asks the addict to make a moral self –inventory Step 5 Asks the addict to share this moral inventory with another person AND his H.P. Steps 6 & 7 Ask the addict for a willing ness to have their H.P. remove any sources of conflict Steps 8 & 9 Ask the addict to make a list of all persons they have harmed and where possible to make amends to these people Steps 10,11 and 12 Asks the addict to solidify the grounds made in the preceding steps and to continue to “carry the message. As can be seen from the above, it has, in my opinion, been clearly defined that alcoholism is a disease and is accepted as such by countless learned professionals in the Health and allied industries. With the continued and more advanced methods currently being applied to the field of addiction, it is my hope that this research will be improved upon, thus further eliminating the “doubting Thomas’s” from our midst’s in the quest to having final clarity on this issue. In the next section of the newsletter, we will briefly discuss the D.S.M. criteria for diagnosing the disease of chemical dependence.
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ADDICTION: THE GREAT LIE It is important for you to know how the psychology of chemical dependency gets going. During childhood, we come to believe in the great lie. This lie is at the core of chemical dependency. We do not hear this lie from our parents or from our friends. We don’t hear it from our teachers or from television. It is more powerful than that. We hear this lie inside of our own thinking, inside of that most personal part of ourselves. The lie is this: if we tell people the whole truth about ourselves, then they won’t like us. Once we hear this lie and believe this lie, we know that we never will be loved for who we are. Therefore, to get any of the good stuff out of life at all, we have to pretend to be someone that we are not. We try to be someone else. We watch those people who are popular, and we copy them. We are very careful about what kind of clothes we wear. We copy people’s mannerisms and their fine little gestures. We find ourselves cocking our heads in a certain way when we laugh or smile. We are hoping to fool the people. We hope that they cannot see our real selves. We want them to see our pretend selves. How the Great Lie Works At this, coping behavior occurs, it works. Some people do like us for the new selves we are trying to be. We become pleased to know that we are not going to be alone. The people we are fooling will love us. We begin to wear specific costumes and to play certain roles. We might wear the nice girl costume or the cowhand costume. We might wear the hippie costume or the yuppie costume. We know that it is a costume – we know it’s not us – but the people are fooled and the lie goes on. We Never Feel Accepted You must look carefully at what is happening. We have fooled people into liking us, but they don’t really like us. They don’t know us.
We are keeping who we are secret. As we keep doing this – making this effort to be loved – our emptiness grows and our pain increases. We try hard. We copy everyone who looks cool. We put on the best false front that we can, but in time we realize that it isn’t going to work. We feel more and more lonely and isolated. We have known all along that we weren’t going to be loved, not for the real us. No one was going to love us. The Promise of the Disease When we are lonely enough in this process, when we are isolated enough, and when we are hurting enough, the illness comes along and offers us a smorgasbord of answers to our pain. Sex, money, power, influence, drugs, gambling, and alcohol all are there, and more, and we begin to feed from this cafeteria of behavior. For a while, things get better. All of these things relieve the pain for a little while. We find ourselves irresistibly drawn to this table of wrongs. We spend more time doing it. We eat, drink, stuff, cram, push, and shove.
AUGUST 2013 We find that more and more of our lives center on the use of these things. We get up on the table and stuff ourselves. We begin to lose our morals and values. We eat, consume, vomit, and stuff ourselves even more. In time, there never is enough. There is not enough sex. There is not enough money. There is not enough power. There is not enough booze. Alcoholics Anonymous says that one drink is too much and that a thousand never is enough. Truth Finally, you begin to get sick from this cafeteria of wrongs. You realize an awful fact: The answer is not in these things. It is a terrible point of grief when you finally realize that the answer is not in your drug of choice. This is not a happy time, but by now you are addicted. You cannot stop. You might be addicted to sex, and you want to stop what you are doing, but you cannot stop. You might be addicted to money, and you want to stop chasing money, but you cannot stop. You want to stop drinking. You promise yourself that you will stop, but you cannot stop. You are addicted. Somehow, by the grace of God, you finally come to treatment. Maybe you are ready to surrender. I hope so, because if you are not, then you are in for a lot more misery. If you are ready to surrender, and if you are ready to try something new, then this program is for you. A Program of Rigorous Honesty One of the things that you must be willing to do is tell the truth all of the time. Nothing else will stop the great lie. The truth will set you free. You are enslaved to your addiction, but the truth will set you free of your chains. In treatment, probably for the first time in your life, you will have the opportunity to get honest. If you do not, and if you hold anything back, then you will return to chemicals. You don’t have to tell everyone the truth, but there is a psychological law at work. The law is this: The more you can share, the closer you can get; the closer you can get, the more you can share. As intimacy grows, you tell more of the truth.
VOLUME 1 ISSUE 2 In your Fifth Step, you will tell someone the whole truth at one time. You will tell that person exactly what happened. Time after time, we have had new comers decide to hold something back in their Fifth Step. They didn’t want to tell that one thing. Invariably, these people get drunk because they don’t prove to themselves that people will like them if they tell the whole truth. They keep the emptiness, loneliness, and isolation. The pain grows, and sooner or later they relapse. It is vitally important that you find out the truth about yourself. God created you in perfection. You are God’s masterpiece. You were created in the image of God. God loves you and wants you to be happy. For some of you, this will be difficult to hear and difficult to believe. How could God love you? Where was God when you needed God? If there is a God, then where is God? These are the questions that you will seek the answers to in this program.
“The journey of recovery has no destination – the destination is the journey”
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D.S.M. CRITERIA The Diagnostic Services Manual is published by the American Psychiatric Association is used worldwide in determining the criteria for the diagnosis of “mental illness”. Whether you like hearing, it or not addiction falls into the category of mental illness. In the past, the DSM 4 was used as the method of diagnosis, but since this in early 2013 the DSM 5 was released with a few changes evident when compared with its predecessor. This article will firstly focus on what the DSM 5 criteria are, the various groupings resulting from these and will finally highlight the differences between DSM 4 and DSM 5. The criteria applied for the DSM 5 are as follows: 1. A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period: 2. Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with 3. continued use of the same amount of alcohol
7. A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking 8. Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking. 9. No duration criterion separately specified, but several dependence criteria must occur repeatedly as specified by duration qualifiers associated with criteria (e.g., “persistent,” “continued”).
“Criteria are provided for substance use disorder, 4. The characteristic withdrawal syndrome for alcohol; or accompanied by criteria for intoxication, withdrawal, drinking (or using a closely related substance) to substance/medication-induced disorders, and relieve or avoid withdrawal symptoms unspecified substance-induced disorders, where relevant,” according to the APA. 5. Drinking in larger amounts or over a longer period than intended. Severity of the DSM-5 substance use disorders is based on the number of criteria endorsed: 6. Persistent desire or one or more unsuccessful efforts to cut down or control drinking 2–3 criteria indicate a mild disorder 7. Important social, occupational, or recreational activities 4–5 criteria, a moderate disorder given up or reduced because of drinking 6 or more, a severe disorder The DSM-5 removes the physiological subtype (not sure when this was ever used in the DSM-IV), as well as the diagnosis for “polysubstance dependence.”
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The D.S.M. criteria furthermore set down distinct guidelines for determining the psychiatric level of “recovery” and these are defined as : a) Early remission from a DSM-5 substance use disorder is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving), b) Sustained re-mission is defined as at least 12 months without criteria (except craving). c) Additional new DSM-5 specifiers include “in a controlled environment” and “on maintenance therapy” as the situation warrants.” “Recurrent legal problems” criterion for substance abuse has been deleted from DSM-5. A new criterion has been added: craving or a strong desire or urge to use a substance The threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria. This is a change from DSM-IV, where abuse required a threshold of one or more criteria be met, and three or more for DSM-IV substance dependence. It has often been thought that it was completely arbitrary that the DSM-IV made a distinction between someone struggling with substance “abuse” and “dependence.” To many clinicians — they appeared to be the same disorder but on a continuum of abuse. Finally, the DSM-5 comes around to the convention wisdom of therapists in the field. “Criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified substance-induced disorders, where relevant,” according to the APA.
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5 MYTHS ABOUT ADDICTION THAT UNDERMINE RECOVERY Honest, courageous and insightful are not words typically used to describe drug addicts. However, if given the chance, many addicts end up developing these qualities and contributing to society in a way they never imagined possible. These successes occur in spite of major obstacles, from the ever-present threat of relapse to the pervasive stereotypes addicts encounter along the way. Even with three decades of myth-busting research behind us, some of the most damaging beliefs about addiction remain: #1 Addicts are bad people who deserve to be punished. Man or woman, rich or poor, young or old, if a person develops an addiction, there’s a widespread assumption that they are bad, weak-willed or immoral. The hostility toward addicts takes a form unprecedented among other chronic illnesses, prompting harsh legal sanctions and judgments like, “Let them kill themselves, they asked for it.” It is true that many addicts do reprehensible things. Driven by changes in the brain brought on by prolonged drug use, they lie, cheat and steal to maintain their habit. But good people do bad things, and sick people need treatment – not punishment – to get better. #2 Addiction is a choice. Recovery isn’t as simple as exercising enough willpower. People do not choose to become addicted any more than they choose to have cancer. Genetics makes up about half the risk of addiction; environmental factors such as family life, upbringing and peer influences make up the other half. Brain imaging studies show that differences in the brain are both a cause and effect of addiction. Long before drugs enter the picture, there are neurobiological differences in people who become addicted compared to those who do not become
addicted. Once an individual starts using drugs, prolonged drug use changes the structure and function of the brain, making it difficult to control impulses, feel pleasure from natural rewards like sex or food, and focus on anything other than getting and using drugs. #3 People usually get addicted to one type of substance. At one time, we believed that most addicts had one drug of choice and stuck with it. Today, polysubstance abuse – the use of three or more classes of substances – is the norm, not the exception. Some people use multiple substances to create a more intense high (e.g., combining cocaine and heroin, or “speed-balling”) while others take certain drugs to counteract the undesirable effects of another drug (e.g, using alcohol to come down from stimulants). Some supplement their primary drug of choice with whatever is readily available (e.g., using prescription opiates and heroin interchangeably). Poly-substance abuse appears to be particularly common among males, those who begin using drugs at an early age, and adolescents and young adults. People who abuse multiple substances are more likely to struggle
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with mental illness, which when complicated by drug interactions and side effects, makes poly-substance abuse riskier and more difficult to treat than other types of drug abuse.
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Still, the media perpetuates the myth that there is a right way and a wrong way to recover, and that treatment that is luxurious or comfortable is inherently bad.
#4 People who get addicted to prescription A recent article in the Hollywood Reporter, for example, quotes Hollywood producers, former drugs are different from people who get actors, lawyers and other “experts” who believe addicted to illegal drugs. that high-end treatment centers do a disservice by offering upscale amenities and holistic therapies Despite the fact that prescription drug abuse has such as neuro-feedback and equine therapy. reached epidemic proportions in the past decade, the use of “legal” drugs to get high carries less stigma Despite a significant body of research showing than the use of illicit drugs. Because medications like that these therapies strengthen the relationship Vicodin, Xanax and Adderall can be prescribed by a between therapist and client, improve long-term doctor, are relatively safe when used as prescribed, abstinence rates and increase treatment retention, and are already sitting in most people’s medicine the media sends the message that addicts deserve cabinets, there is a widespread misconception that to suffer. they are safer than street drugs. They are not. When a person takes a prescription medication in a larger dose or more often than intended or for a condition they do not have, it affects the same areas of the brain as illicit drugs and poses the same risk of addiction. It’s not just curious, misinformed teens but also their parents who minimize the problem. According to a recent survey by The Partnership at Drugfree.org, only 14 percent of parents mention prescription drugs when they talk to their kids about drugs, and one in six parents said prescription drugs are safer than street drugs. #5 Treatment should put addicts in their place. Even though the leading authorities on addiction agree that addiction is a chronic disease similar to heart disease, diabetes and cancer, addicts are still treated as second-class citizens. Many treatment centers believe confrontational, shame-based methods are necessary to motivate addicts. Quite the contrary. In addition to contributing to the stigma of addiction and deterring people from seeking treatment, research shows that shame is a strong predictor of relapse.
The myths about addiction are damaging not only to addicts and their families but also to all of us. What if the many influential business leaders, inspirational artists, best-selling authors, and history-making politicians who join the ranks of recovering addicts were shamed into silence? By understanding addiction as a brain disease and allowing people to recover in the way that works best for them, we can make significant strides in addressing one of the nation’s leading public health problems.
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SOME FUN & FOOD FOR THOUGHT
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CONCLUSION This Editions Poem Sunshine After Rain One day when I was young I heard a knock at my door It sounded familiar, like I had heard it before I opened the door and to my surprise There stood a young lady with blond hair and brown eyes She said, I have the answers, are you ready to play? So I grabbed my money and I said ok There were the answers that I had always sought Liquids, pills, and powders, and I bought and bought
With a little belief in yourself that you can recover, a large part of the journey has already begun.
CONCLUSION What an honor and privilege to have been able to compile this second edition. If anyone had told me that this is what I would be doing about 18 months ago, I would have had him or her committed. ď Š I have learnt vast amounts from doing the research and have thoroughly enjoyed this issue, even more so than the first. My thanks to Hein and his team for checking through what I sometimes believe to be mindless babbling, and for pointing me down the right path in researching for the articles included. Until next time, let’s keep on One Day At A Time remembering that recovery is possible.
Then one day, my friend suddenly changed her face became ugly, calloused, and deranged She grabbed my hand and we tore through the town My loved ones and friends could only watch and frown She kept whispering something I could only guess It sounded like she was repeating "Yes, Yes, Yes" How quickly from fun to very near death How quickly from one beer, to smoking crystal meth I thought of my family, oh what a mess But all I heard was screaming "Yes, Yes, Yes" I had to find help I was at my wits end I had lost my child, my family and my friends I said "God are you there, can you help me please?" A sudden peace came over me and I fell to my knees God answered the riddle that so long I did guess Why my addiction kept screaming "Yes, Yes, Yes" It's because I kept asking night after night It's going to be different this time right? I said, "God I'm not worth it I feel like a jerk." He said, "Suit up and show up its time to go to work" Now it's been eight months since I had my last drink It's given me time to remember and think
A WAY OUT ADDICTION TREATMENT CENTRE
So I am here to tell you in this little rhyme Life keeps getting better "One day at a time'' So when you think you are going insane
There's always, ''Sunshine after the Rain."
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