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F E B RUA RY 2 018 | VO LUM E 7 | I SS U E 2






By Darlene Lancer, MFT



By Nancy Jarrell O’Donnell, MA, LPC, CSAT

By Terence T. Gorski


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 If you would like to receive an E-version monthly of the magazine, please send your e-mail address to 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 The Sober World wishes everyone a Happy Valentine’s Day. We are on Face Book at World/445857548800036 or soberworld,
Twitter at, and
LinkedIn at Sincerely,



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By Nancy Jarrell O’Donnell, MA, LPC, CSAT When presenting lectures on trauma to patients I often state, “there is no zip code that is immune from tragic experiences.” I work with patients who have suffered trauma and present with resulting symptoms of addictions, mood disorders, post traumatic stress disorder and more. I define trauma as an overwhelming emotional experience wherein one has a real or perceived threat to their life and safety and/or the life and safety of another. I further will explain how threat of life and safety is experienced differently across the developmental years; as what may seem life threatening to a 7-year-old may not to an adult. This however does not negate the 7-year-old child’s experience of being traumatized. In my professional life, I have listened to stories of traumatic experiences for decades and yet I never cease to marvel at the tenacity, courage, and resolve of so many who have suffered so much. In my personal life whether friends, family, colleagues or others- I have seen the scars of trauma. I too have experienced traumatic events over the course of my lifetime. The most disorienting and excruciating experience in my life though was losing a child. I lost my 16-year-old daughter in a car accident one July morning 11 years ago. It was sudden, it was instant, it was violent, and receiving the news from a sheriff while at work that morning was all of those and more. I remember just days before her death telling her “if something ever happened to you I would die.” Something did happen, and I didn’t die. There are some days I am still stunned that I am here. I was well into my career as an addiction and trauma specialist yet very little of my knowledge helped me in those early years of indescribable loss. Over the years, before and after this tragedy, I have researched complex trauma, betrayal trauma, traumatic grief, resilience, perseverance amidst adversity, PTSD, and other markers explaining why one individual develops PTSD symptoms and another does not. I have pondered the meaning of suffering in the context of religion, spirituality, existentialism, and questioned if human suffering is the only true catalyst for understanding our life’s’ purpose. I do not have all the answers by any stretch but continue to seek and share what I learn with others. The word “suffering” is derived from the Latin word “sufferentia” which is translated to mean endurance. The dictionary definition is “the bearing or undergoing of pain, distress, or injury.” Humanity experiences “pain, distress, and injury.” Suffering is part of the human condition. In our culture, suffering has a negative connotation, as in general, we seldom focus on the potential that spiritual and psychic growth suffering can provide us, but rather are compelled to find ways to avoid the experience and circumvent as much psychological and physical pain as possible. We know how this desire to numb can lead to addiction and other unhealthy compensatory behaviors to avoid the walk in the pain. Resistance to distress is a normal response to frightening and abnormal experiences. An initial seeking of relief is a normal response to traumatic exposure and although many will develop PTSD, there are many who experience unspeakable adversity who do not develop long term PTSD. The DSM V differentiates criteria for PTSD for children 6 years old and younger. In short, the manual defines PTSD based on exposure to a traumatic event, having one or more intrusive symptoms such as nightmares, flashbacks, hyper vigilance, and intrusive memories, avoidance of external reminders of the trauma, decreased ability to regulate mood and negative cognitions for at least one month in duration. We have known for decades that those who do not develop PTSD after experiencing trauma(s) have some ability to make sense out of what happened to them and did not feel complete and utter helplessness at the time of the event. These individuals generally live void of any negative self-cognitions relevant to the experience (s). Self-cognitions are beliefs we hold about ourselves as human beings. Individuals who tend to struggle more to move forward in health will often report negative selfcognitions such as “I am stupid, I am weak, I am a failure, I am


unlovable, I am a bad person, I am unworthy, I am incapable, I am untrustworthy” and so on. Many trauma survivors I have seen in treatment and private practice report these destructive beliefs, and despite years of distancing them from the event, there seems to be no erosion of the cognitions. For a parent who has lost a child, no matter the circumstances, most hold themselves responsible and carry guilt and/or shame. This can be further exacerbated by interpersonal factors if the parent is stigmatized or shunned, or has the belief this will happen. If the child’s death involved suicide, drugs and/or alcohol, or a car accident, many parents fear reaction from others who might judge our parenting. The traumatic shame that can develop after such a loss adds another layer of pernicious symptomology that does not simply go away over time. Time is a measure of moments passing. It is not a healer. An emerging area of research is the study of metacognition Metacognition refers to one’s own personal interpretation of one’s own thoughts. It is also defined as our self-awareness of our thoughts. An example of metacognition is while on a conference call as one speaker engages in monologue; another participant suddenly becomes aware of not having heard the last 5 minutes of the communication. The awareness can then assist this participant in trying to maintain concentration. In this instance, metacognition is helpful. What about our metacognition though after experiencing a traumatic event? Just as our self-cognitions can be damaging, so can our metacognitions. Metacognition differs from a self-cognition as the latter is a belief about one’s self as a human being, whereas metacognition is a resulting belief about what action is needed to feel better, be better, and ultimately to stay safe in the world. So, what kind of metacognitions can result following a traumatic event that might be maladaptive? Some examples include after losing a loved one isolating due to a belief that if I don’t get close to people, I won’t have to suffer like this again, or, after a physical accident or assault, believing I need to be hyper alert and worry more about my safety to keep this from ever happening again. This latter belief can result in a sustained over active amygdala if the trauma repair is to consciously attach to a PTSD symptom. To clarify, taking on the belief that constant worry and state of alert would result in keeping the brain and body in a state of perceived threat. This would exacerbate any PTSD symptoms. Using the PTSD symptom of hypervigilance in this case only serves to keep an individual in a constant state of stress. To further explain, an adult who is assaulted while walking in a dangerous neighborhood, despite having been harmed, may be able to make some sense of the experience due to the location and do so without self-blame. If this individual also was able to run away and fight the level of helplessness experienced at the time of the attack, it may not be significant. Someone else walking in the same neighborhood that lives there and knows the perpetrators and was unable to flee or fight will struggle to make sense of the assault and the degree of helplessness will be more profound. The second individual will more likely experience PTSD symptoms than the first.

Continued on page 28

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How chronic relapsers are getting swept under the carpet and what they can do to find sustainable recovery! Years ago a gentleman by the name of Todd (not his real name) enrolled in my program at the center I once owned in North Miami Beach. By all outward appearances, Todd exhibited a normal middle-class, married guy image. He wore a suit to work every day and even owned a successful business. What you could never have seen, or even imagined, is that behind his smooth veneer, Todd was a raging addict hooked on pharmaceutical painkillers. Although Todd experimented with cocaine in his late teens, he was by no means addicted to it. In his early twenties, Todd injured his knee in a pick-up basketball game. His doctor wrote a prescription for a commonly prescribed opiate painkiller, Percodan (Oxycodone). Todd was hooked immediately. Soon he found himself taking prescription opiate painkillers not necessarily to get high, but rather to get normal. The human body produces opiates naturally. When it becomes acclimated to opiates from external sources, the body ceases its own production. It also builds up a tolerance, constantly requiring more opiates each time to maintain levels and get the desired effect. The brain and body are being seriously damaged during this course. When the levels are not met, the addict’s body immediately goes into painful and debilitating withdrawal. Without opioids, Todd felt as though he was not able function. This was the genesis of a twenty-year prescription opiate addiction. Todd was the most purest definition of a chronic relapser that I can ever imagine. He was in and out of twenty-three addiction rehabilitation programs over twenty-years before I’d met him and helped him find sustainable recovery. I wish I could say that Todd’s experience is the exception, but it is not. According to the CDC in August 2017; “The supply of prescription opioids remains high in the U.S. An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.” Just like in Todd’s case, doctors in the privacy of their offices and clinics continue to prescribe deadly opioids at an alarmingly dangerous rate. Moreover, reliable scientific studies have shown that eight out of ten heroin addicts got their start with prescription opioids before transitioning to the less expensive and readily available heroin. Todd once told me he found doctors fall into one of two camps, being either naive or apathetic with very little in-between. “Some doctors just did not get it” Todd said. “They actually took the time to talk with me and try to get a handle on my phantom pain. Others simply didn’t care. They’d write a prescription as fast as they could and then it was off to the next patient. It was as if they had a daily quota to meet.” With that being said, does anyone still question why we’re still deeply entrenched in the worst opioid epidemic known to man? • According to a survey by the National Safety Council (NSC), 99 percent of doctors are prescribing highly addictive opioid medicines for longer than the recommended three-day period, and twentythree percent prescribe at least a month’s worth of opioids. • FDA approves Oxys for kids 11 – 16 years old (grooming the next generation of addicts?). • Although the DEA has cut the aggregate production quotas for a variety of Schedule I and II drugs in recent years, current levels of lethal opioid painkillers being produced and brought into the U.S. market are still many times higher than pre-epidemic levels.


• 1 out of 5 patients with non-cancer pain or pain-related diagnoses walk out of doctors’ offices with a prescription for opioids. • Opioid overdoses contributed to the decline of US life expectancy – the first time in decades. Despite all of this, doctors still wrote 240 million prescriptions for opioids in 2016 – roughly equivalent to one bottle full of poisonous opioid painkillers for every American adult. The U.S. government and our healthcare system’s answer for this deadly opioid epidemic is – believe it or not – more opioids. This is akin to putting out a fire with a torch! In their infinite wisdom, the people in government charged with keeping us safe, decided that the best treatment for an opioid addict is Suboxone, an FDA approved opioid whose research was financed by the U.S. government. If this wasn’t so serious, it would be comical. Is there any wonder why more opioid addicts relapse than those who find recovery after treatment?! A sane, rational and slightly intuitive person might think that we, as Americans, might have been better served by investing that money into promising new cutting edge ‘non- opioid’ evidenced-based therapies that have been slow rolled because of lack of funding. After all, most of our addiction treatment programs are based in a therapy developed in the 1930s with little or no conformance to the more recent scientifically-proven effective therapies discovered since. By far, most of today’s 30 day model programs are simply not designed for a drug with the intensity of opioids. The sad reality is, we have known for quite some time how to effectively treat opioid addiction. State medical boards began developing a program in the 60’s exclusively for their doctors who had succumbed to addiction. Today, the Physicians Heath Program (PHP) has a 79% success rate among doctors, dentists, veterinarians and pharmacists – meaning that 79% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring after treatment. One of the core principles and key drivers of the PHP’s success is a minimum requirement of 90 days residential treatment – that can often lead to 180 days – and comprehensive long term outpatient programs. This makes perfect sense to anyone who has been even remotely involved in ‘hands on’ addiction treatment – the 30 day treatment model is simply inefficient in treating the powerful effects of opioids. This is why comprehensive aftercare treatment programs are now more important to recovery than ever in the past. We know that opioid addiction requires longer treatment. It’s no secret. Any reputable addiction specialist will tell you the same. The barrier to effective treatment is cost. The vast majority of insurance policies that include addiction treatment Continued on page 30

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Transcranial Magnetic Stimulation (TMS) is a method that employs magnetism to stimulate small regions of the brain. TMS is a very safe and tolerable treatment with few medical exclusions although there are some conditions that are not compatible and these must be screened for. The first situation is the presence of any metal in or near the head or any implanted medical devices. Examples include cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, bullet fragments, jewelry and hair barrettes. Any metallic object within the magnetic field would be at risk for overheating or possibly moving. Implanted medical devices risk malfunctioning. Other exclusions include any history of aneurysms, seizures, stroke, brain surgery, neurologic disorders, and active substance abuse. Once a patient has been evaluated and screened to see if they are appropriate for TMS, they can start treatment. The first stage of treatment consists of mapping the brain to find the best treatment location. This is usually done on the very first session, which in total takes about an hour. Certain physical landmarks are identified on the head, specifically the nasion and the inion. The nasion is the distinctly depressed area directly between the eyes, just above the bridge of the nose. Inion is the bony prominence on the back of the skull. These landmarks and the nasion-inion distance are used to locate the starting point for locating the motor strip. The motor strip is the part of the brain responsible for controlling muscular movements. A significant portion of the motor strip represents the thumb and hand, which triggers thumb movement when stimulated at a specific location by a TMS machine. This location is used to determine how much energy is needed to elicit a muscular (in this case thumb) movement, which is the “motor threshold”. Treatment intensity is usually 120% of the motor threshold. This location also serves as the orientation point for the treatment location, which is 6cm towards the front of the brain. These measurements are all recorded on a fitted cap that is specific for each patient. Once the mapping and motor threshold determination phase is complete, treatment can begin. The first Deep TMS treatment session starts at 100% of the motor threshold to allow the patient to acclimate to the treatment before going to a higher dose. The 100% dose is generally easier to tolerate than the target 120% dose. If the dose is gradually increased from 100% to 120%, most patients will acclimate well. Patients often describe a tapping sensation on the scalp, in addition to the sound of the electromagnetic pulse generation. The sound is similar to that of an MRI machine and is managed well with earplugs. The tapping sensation is generally tolerable. Some people may also experience headaches in the earlier stages of treatment, which is typically resolved with either ibuprofen (Motrin) or acetaminophen (Tylenol). Many patients report a significant reduction in these side effects after even just the first TMS session. Seizures, the most severe potential complication of TMS treatment, are very rare. Most patients acclimate well to the early stage side effects and can proceed with treatment. A typical Deep TMS treatment course will consist of at least five days a week for four weeks, followed by two days a week for eight weeks. Another common treatment course starts with at least five days a week for six weeks, and then the frequency tapers down from there. The recommended minimum number of treatments is 36 while some TMS courses can have as many as 42 or more. Some patients will note an early response in the first three to four weeks, but many will take at least six weeks to really derive substantial benefits. Many of the patients that did not get a response within six weeks still derive a good response later in the treatment course, indicating the need to follow through with at least 36 treatments. After a successful course


with 36 to 42 treatments, some may not require any further treatment while others may need short booster courses of three to six treatments a few times a year. Overall the success rate is very high. In depression treatment, success is defined by rates of response and remission. It is important to note that in TMS studies, the patient population is a “treatment resistant depression” population that has failed four or more medications already. This population would be expected to have a significantly lower response rate to any type of therapeutic intervention than a conventional depression case. Even taking that factor into consideration, Deep TMS response rates after 30 sessions have reached 74% while full remission rates reach 49%. In comparison to other forms of depression treatment, these are extraordinarily high rates. Anecdotal reports suggest that response rates in non-treatment resistant depression patients are even higher. This supports the growing belief that TMS may one day become a first line treatment for Major Depression. Patients have increasingly asked for TMS to treat their depression before waiting to fail on four different medications. With the unequivocal results, an exceptional side effect profile, and the ability to produce long-standing brain changes through induction of neuroplasticity, this is no surprise. This is why Deep TMS has become the great new hope for treatment resistant depression. 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.,,

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Gaslighting is a malicious and hidden form of mental and emotional abuse designed to plant seeds of self-doubt and alter your perception of reality. Like all abuse, it’s based on the need for power, control, or concealment. Some people occasionally lie or use denial to avoid taking responsibility. They may forget or remember conversations and events differently than you, or they may have no recollection due to a blackout if they were drinking. These situations are sometimes called gaslighting, but the term actually refers to a deliberate pattern of manipulation calculated to make the victim doubt his or her own perceptions or sanity, similar to brainwashing. The term derives from the play and later film Gaslight with Ingrid Bergman and Charles Boyer. Bergman plays a sensitive, trusting wife struggling to preserve her identity in an abusive marriage to Boyer, who tries to convince her that she’s ill in order to keep her from learning the truth. Gaslighting Behavior As in the movie, the perpetrator often acts concerned and kind to dispel any suspicions. Someone capable of persistent lying and manipulation is also quite capable of being charming and seductive. Often, the relationship begins that way. When gaslighting starts, you might even feel guilty for doubting the person whom you’ve come to trust. To further play with your mind, an abuser might offer evidence to show that you’re wrong or question your memory or senses. More justifications and explanations, including expressions of love and flattery, are concocted to confuse you and reason away any discrepancies in the liar’s story. You get temporary reassurance, but increasingly, you doubt your own senses, ignore your gut, and become more confused. The person gaslighting might act hurt and indignant, or, play the victim when challenged or questioned. Covert manipulation can easily turn into overt abuse with accusations that you’re distrustful, ungrateful, unkind, overly sensitive, dishonest, stupid, insecure, crazy, or abusive. Abuse might escalate to anger and intimidation with punishment, threats, or bullying if you don’t accept the false version of reality. Gaslighting can take place in the workplace or in any relationship. Generally, it concerns control, infidelity, or money. A typical scenario is when an intimate partner lies to conceal a relationship with someone else. In other cases, it may be to conceal gambling debts or stock/ investment losses. The manipulator is often a narcissist, addict, or a sociopath, particularly if gaslighting is premeditated or used to cover up a crime. In one case, a sociopath was stealing from his girlfriend whose apartment he shared. She gave him money each month to pay the landlord, but he kept it. He hacked into her credit cards and bank accounts, but was so devious, that to induce her trust; he bought her gifts with her money and pretended to help her find the hacker. It was only when the landlord eventually informed her that she was way behind in the rent that she discovered her boyfriend’s treachery. When the motive is purely control, a spouse might use shame to undermine his or her partner’s confidence, loyalty, or intelligence. A wife might attack her husband’s manhood and manipulate him by calling him weak or spineless. A husband might undermine his wife’s self-esteem by criticizing her looks or competence professionally or as a mother. A typical tactic is to either claim that friends or relatives agree with the manipulator’s negative statements or to disparage them so that that they cannot be trusted in order to isolate the victim and gain greater control. A similar strategy is to undermine the partner’s relationships with friends and relatives by accusing him or her of disloyalty. Effects of Gaslighting Gaslighting can be very insidious the longer it occurs. Initially, you won’t realize you’re being affected by it, but gradually you lose trust in your own instincts and perceptions. It can be very damaging, particularly in a relationship built on trust and love. Love and attachment are strong incentives to believe the lies and


manipulation. We use denial because we would rather believe the lie than the truth, which might precipitate a painful breakup. Gaslighting can damage our self-confidence and self-esteem, trust in ourselves and reality, and our openness to love again. If it involves verbal abuse, we may believe the truth of the abuser’s criticisms and continue to blame and judge ourselves even after the relationship is over. Many abusers putdown and intimidate their partners to make them dependent so they won’t leave. Examples are: “You’ll never find anyone as good as me,” “The grass isn’t greener,” or “No one else would put up with you.” Recovery from a breakup or divorce can be more difficult when we’ve been in denial about problems in the relationship. Denial often continues even after the truth comes out. In the story described above, the woman got engaged to her boyfriend after she found out what he’d done. It takes time for us to reinterpret our experience in light of all the facts once they become known. It can be quite confusing, because we may love the charmer, but hate the abuser. This is especially true if all the bad behavior was out of sight, and memories of the relationship were mostly positive. We lose not only the relationship and person we loved and/or shared a life with, but also trust in ourselves and future relationships. Even if we don’t leave, the relationship is forever changed. In some cases when both partners are motivated to stay and work together in conjoint therapy, the relationship can be strengthened and the past forgiven. Recovery from Gaslighting Learn to identify the perpetrator’s behavior patterns. Realize that they’re due to his or her insecurity and shame, not yours. Get support. It’s critical that you have a strong support system to validate your reality in order to combat gaslighting. Isolation makes the problem worse and relinquishes your power to the abuser. Join Codependents Anonymous ( and seek counseling. Once you acknowledge what’s going on, you’re more able to detach and not believe or react to falsehoods, even though you may want to. You’ll also realize that the gaslighting is occurring due to your partner’s serious characterlogical problems. It does not reflect on you, nor can you change s omeone else. For an abuser to change, it takes willingness and effort by both partners. Sometimes, when one person changes, the other also changes in response. However, if he or she is an addict or has a personality disorder, change is difficult. To assess your relationship and effectively confront unwanted behavior, read Dealing with a Narcissist: 8 Steps to raise Self-Esteem and Set Boundaries with Difficult People. Once victims come out of denial, it’s common for them to mentally want to redo the past. They’re often self-critical for not having trusted themselves or stood up to the abuse. Don’t do this! Instead of perpetuating self-abuse, stop self-criticism and Raise Your Self-Esteem. You also need to learn How to Be Assertive and Set Boundaries to stop abuse. Darlene Lancer is a Licensed Marriage and Family Therapist, Author and expert on relationships and codependency. Find her on, Twitter @darlenelancer, and Facebook. You can contact her at ©Darlenelancer 2017

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Individuals struggling with addiction issues face many barriers and challenges that significantly impede upon the recovery process. Discrimination, access to treatment, health insurance, employment, and housing have long-been obstacles to building healthy and successful long-term recovery. Advocacy efforts and volunteerism, especially the service work of those in recovery themselves, have gone a long way in helping to change policies and educate the public on the needs, rights and struggles of those in recovery. Historically, South Florida has been a haven for those struggling with addiction. For decades, the community of Delray Beach has been considered a mecca for addiction recovery. With access to a multitude and variety of 12-Step meetings, and some of the best treatment centers in the country, Delray Beach and its surrounding communities have made a significant contribution to the field of addiction recovery and advocacy within the field. Not to mention, the countless lives that have been saved in the process. South Florida’s reputation as THE BEST place in the country, if not the world, to go for addiction treatment was not built overnight, and it did not happen by chance. It happened through the tireless and collective efforts of individuals in the recovery community and the field of human services. It happened through volunteerism. A volunteerism that advocates for the needs of those seeking effective and legitimate addiction treatment from qualified and caring professionals. A few of the early pioneers of this advocacy-based volunteer effort in South Florida were Jim Bryan, Peter Fairclough, and Phyllis Michelfedler. Jim Bryan, founder of the Beachcomber Family Center for Alcoholism and Addiction Recovery, one of the area’s oldest and most prominent treatment centers since 1976, was an area leader in the field of addiction treatment and advocacy. Peter Fairclough, another early pioneer, founded the Comprehensive Alcoholism Rehabilitation Programs, Inc. (CARP). CARP was one of the largest, most comprehensive substance abuse programs operating under a single administration in South Florida since its inception in 1967. Phyllis Michelfedler, one of the co-founders of the historic Wayside House, devoted her entire life to the rehabilitation of women with alcohol and drug problems. These pioneers are just a few of the early servant leaders in the field of addiction recovery who began as volunteers themselves. A volunteerism and servant leadership that is needed now more than ever as our industry and advocacy efforts have regressed in recent years. With the explosion of the nationwide opioid epidemic, even more discrimination, barriers to treatment, health insurance, and housing issues exist than ever before. The sober homes invasion, unscrupulous treatment operators, and patient brokering issues have made it that much harder for individuals and families to navigate the field of addiction treatment and recovery options. An issue that is not isolated to South Florida. This is a significant problem that is spreading all-across the country, tarnishing and fractioning the efforts of an entire industry. No area of the country is completely safe from predators seeking to take advantage of this vulnerable population. With the clean-up efforts in South Florida well under-way, many unscrupulous treatment operators and sober homes are moving out into other States, making it imperative that other States adopt similar policies and practices to South Florida. There are many organizations leading the charge in community cleanup and recovery efforts here in South Florida and should be considered model programs for other States. A few worth highlighting are the Sober Homes Task Force, the South County Recovery Residence Association (SCRRA), and the Palm Beach County Substance Awareness Coalition (PBCSAC). The Sober Homes Task Force is working with the State Attorney’s office to eliminate the illegitimate sober homes and treatment operators. The SCRRA is a local watchdog society of certified recovery residences that have joined together to raise the bar for recovery residences in Palm Beach County. SCRRA also provides education and disseminates information to the public and local government agencies. PBCSAC has been working to keep Palm Beach County communities


healthy, safe and drug-free since 1982. Although its’ overarching goal is recovery awareness, it has many task force initiatives addressing a vast array of community issues related to drug abuse. The Recovery Awareness Partnership (RAP) is one of the four PBCSAC task force initiatives, and works toward addressing emerging issues specific to the South Florida recovery community and general advocacy within the field. RAP’s 3-tiered approach, in partnership with treatment center alumni and staff, and community representatives, is to improve the recovery community through: 1. Sharing stories of successful addiction treatment in South Florida (of which there are thousands). 2. Educating and empowering individuals and families 3. Improving access to treatment. RAP’s efforts are both missioncritical and ground-breaking in the South Florida community recovery movement, and with it promotes a whole new era of advocacy-based volunteerism. Thanks to the efforts of these organizations, along with many other area organizations and the individuals who support them, South Florida is still one of THE BEST options for addiction recovery treatment in the country. Nonetheless, just like any other recovery effort, it requires a consistent effort through continued and collective action. There is not a single person in this country, at this point, that does not have a personal connection to this issue. The community recovery movement in Delray Beach and all over South Florida is not just a single community effort, it is a collective effort that needs to expand and become a national effort. A collective voice is an effective voice! With literally millions of lives at stake, more people must get involved. Not just here in South Florida, but across the nation. For those who are local to the South Florida area and looking for a way to get involved, the following RAP events are excellent opportunities for individuals, families, local businesses, and community leaders to come together in a collective effort to support the South Florida recovery community. Meet the Candidates - February 27, 2018 @ 7 pm, St. Paul’s Episcopal Church, Delray Beach. Find out what the Delray Beach Mayor and Commissioner Candidates think. This will be a moderated forum with questions and answers. Refreshments will be served. Reach Out for Recovery- March 10, 2018 @ 8 am, Old School Square, Delray Beach. For more information regarding these events and other opportunities to get involved, please contact the Palm Beach County Substance Awareness Coalition at 561-844-5952 or go to Karrol-Jo (KJ) Foster is a Licensed Mental Health Counselor, Certified Addiction Professional, and an Advanced Certified Relapse Prevention Specialist. KJ is also a PhD Candidate at FAU researching the impact of relapse risk, shame and wellbeing on addiction recovery.  In addition to her research, KJ recently authored a book chapter on 12-Step Spirituality and has lectured locally, nationally and internationally on the topics of shame, addiction recovery and spirituality.  KJ is a member of ACA, ASERVIC, FMHCA and Past-President of the Beta Rho Chi Chapter of Chi Sigma Iota Counseling Academic & Professional Honor Society International.


When you're in a jam...better call Schlam!

• Misdemeanors • Felonies • Marchman Acts* MYLES B. SCHLAM, Esq.

Attorney and Counselor at Law Certified Addictions Professional**

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Serving all counties in Florida* Based in Palm Beach county *by appointment only. subject to advance notice and approval. **Certification through the Florida Certification Board not the Florida Bar.

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Part of The Treatment Center Family

Monday Hope Starts Here (Open AA) 5:30pm Life Recovery 12-Step Group 7:00pm


Tuesday On Awakening (Open) 7:00am Candlelight Meditation (Open) 7:00pm

Back to Reality (Open AA) 12:00pm Recovery After Work (Open AA) 5:30pm Worthy of Love & Respect (Open AA) 7:00pm Caduceus (Closed AA) 7:30pm



Women in Sobriety (Open AA) 10:30am

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Al-Anon (Open) 12pm Open NA Meeting 7:00pm

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the big game Kickoff - February 4th 6:30pm Watch the Game at Within!


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Sober Residential Inpatient Treatment

Utilizing the newest techniques in addiction treatment, The Treatment Center’s in-house doctors and nurses is ready to provide you with a comfortable detox and ďŹ rm foundation for recovery.

Outpatient Care Our Intensive Outpatient Program and Partial Hospitalization Program is available after detox and stabilization for those who need support in our community. O U T P A T I E N T


Faith-based Options Road to Freedom is our faith-based inpatient program led by Pastors, therapists and medical professionals. Our program has in-house church and worship services and individualized groups. To Advertise, Call 561-910-1943

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Relapse-prone chemically dependent patients represent forty percent of all private sector patients and eighty to ninety percent of all public sector patients. These statistics drive home an important point. Every treatment center in the nation currently treats relapseprone patients. The question is whether they are going to do it well or poorly. The problem is, many treatment programs deal poorly with relapse-prone patients because they are not using specialized relapse prevention therapy methods and, as a result, many relapseprone patients fail to recover. This is unfortunate because it is no more expensive to treat patients using relapse prevention therapy than it is to use traditional recovery methods. And, the difference in improved outcomes with relapse-prone patients can radically increase recovery rates, while lowering the long-term costs of treatment. Every treatment program needs to be concerned about effectively treating the needs of relapse-prone patients, and developing a policy for dealing with relapse. An enlightened policy recognizes that: • Relapse is common in two-thirds of all patients attempting sobriety for the first time; • Relapse is not a self-inflicted condition, it is caused by a wide variety of problems that can be treated; • Relapse-prone patients deserve effective treatment with specialty methods designed to meet their needs, and • Relapse prone patient are not hopeless. Over 50% of all relapsers will achieve permanent abstinence with effective treatment, and many of the remaining 50% will significantly improve the quality of their lives, and lower their health care costs in spite of periodic relapses. Relapse prevention programs have two primary goals. The first is to prevent a patient from returning to alcohol and drug use after treatment. The second is to promptly intervene should a relapse occur. Prompt intervention assures that a patient who relapses gets back into recovery as quickly as possible. Prompt intervention usually results in a short-term, low consequence, and low cost relapse. The patient also has a greater chance at future recovery because the damage from the relapse is less than it would be without the intervention. Goals of Relapse Prevention Therapy: • To prevent a return to alcohol and drug use. • To stop relapse quickly should it occur. The best practice approach is to design a Standard Relapse Prevention Treatment Plan for relapse-prone patients. A Standard Relapse Prevention Treatment Plan guides a patient through the four-step process: 1- Assessment- carefully analyzes the past relapse history and looks for recurrent patterns that set the patient up to relapse. 2- Warning Sign Identification- a list of warning signs which describes the specific steps that a patient takes as he/she moves from recovery towards relapse. 3- Warning Sign Management- develops specific strategies for coping with each warning sign and the irrational thoughts, unmanageable feelings, and self-defeating behaviors that drive it. 4- Recovery Planning- modifies the recovery program to assure the patient has scheduled specific activities to help identify and manage warning signs as they occur. Experience indicates that it is far more effective to treat chronic relapsers in separate groups apart from patients who are in treatment for the first time. Chronic relapsers are often angry, and have serious doubts about the effectiveness of the treatment they have received. They are reluctant to be honest about these issues


when they are in groups with primary patients because they don’t want to hamper the new person’s ability to recover. By putting these patients in a separate group, and letting everyone know that they are all chronic relapsers, the level of honesty increases, and the willingness to talk about and resolve issues related to relapse becomes important. In order to integrate a relapse prevention track into a primary recovery program, it is helpful to conceptualize three components: • A stabilization and assessment program which screens and evaluates patients for appropriate placement in the proper track. • A primary recovery program for patients who are in treatment for the first time. • A relapse prevention program for patients who have attempted abstinence in the past, but have been unable to recover. The relapse prevention track should be structured to have a separate educational component, a separate group therapy component, and a separate individual therapy component. The primary thrust of therapy in a relapse prevention program is to identify the specific warning signs that lead the patient back to alcohol and drug use, and to develop management strategies so the patient can intervene upon these warning signs before he/ she uses alcohol and drugs. The third goal is to establish an early intervention plan that involves all significant others, so, if the patient does return to alcohol and drug use, an intervention is promptly initiated, which will remove support for the drinking and drug use behavior; and motivate the patient to get back into treatment. Effective relapse prevention therapy must be implemented in all programs. Relapse prevention programs cost no more to administer than primary recovery programs. The best way to reduce the cost of treatment for substance abusing patients is not only to get patients into recovery, but to keep them there through the implementation of relapse prevention programs. A viable national objective should be to establish a formal relapse prevention program in every treatment center in the nation, both public and private, within the year 2020. This would radically reduce the relapse rate, significantly reduce the cost of treatment, and reduce the overall risk of relapse. To learn effective relapse prevention strategies and techniques- Attend the Relapse Prevention Therapy Certification School April 16-20, 2018. Please call 352-596-8000 for more information or to register. Terence T. Gorski is an internationally recognized expert on relapse prevention, substance abuse, mental health, violence, and crime. He is a prolific author and has published numerous books and articles. Recovery books, tapes and resources authored by Terry Gorski are available through Herald House Independence Press, 1-800-767-8181 or

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In Florida, the Marchman Act is a very effective tool to get necessary help for those who are suffering from substance use disorders or impairment. Other states have laws which provide for a form of involuntary commitment for substance impaired individuals; however, Florida is alone in providing for involuntary commitment for a lengthy time. The good news is- if you do reside out of state, and desire to file a Marchman Act, the individual need not be a resident of Florida to be subject to the Marchman Act. It is enough that the individual is located, however temporarily, in Florida. Moreover, the family need not be Florida residents either. Many of our clients are out of state families who are able to suggest to their loved one that they visit Florida under the suggestion that they investigate treatment centers or just to enjoy our beaches and weather. Once the individual is in Florida for whatever reason, the family or friend can file the Marchman Act papers and the Court can enter an order.

The good news is- if you do reside out of state, and desire to file a Marchman Act, the individual need not be a resident of Florida to be subject to the Marchman Act. The Marchman Act has historically been underutilized by families and treatment professionals. There has been reluctance on the part of well-meaning treatment professionals and families to use the courts to compel a substance impaired person to go to treatment. There are two reasons for the reluctance to use this valuable tool. First, there is a lack of understanding of how the Marchman Act works. Second, many well intentioned individuals still cling to the mistaken notion that people only get clean and sober when they really want to do so. The reasoning then goes on to suggest that why should the family use vital resources in securing a court order for treatment if the individual doesn’t want help. I had this conversation with a very capable and compassionate doctor at a local hospital in the last month concerning whether a hospitalized patient who is a chronic alcohol abuser should be the subject of a Marchman Act. The doctor asked in good faith: “The Marchman Act does not really work, does it?” That thinking is simply incorrect according to several prominent studies done in the last two decades by well credentialed experts in the field of addiction. Those studies find that compulsory treatment including court ordered treatment is at least as effective, if not more effective, than voluntary treatment. See studies by UCLA and the National Institute of Mental Health in the 1990s and later studies which were published in the American Journal of Addictions (Use of Coercion in Addiction Treatment, January-February 2008). Please feel free to email my office for a copy of these studies. Former Surgeon General Vivek Murthy and countless mental health professionals tell us that addiction is a disease of the brain. The addict’s dopamine receptors are so highly and persistently stimulated by the use of substances that they stunt the executive decision making function of the prefrontal cortex (the part that tells the addict to stop using). It takes months to heal the brain. The Marchman Act allows family members or friends to obtain court orders which can keep the addicted loved one in a structured environment for up to nine (9) months. The objective is that while in a safe and caring treatment facility for a lengthy period of time, the former abuser can acquire enough skills coupled with good nutrition, rest, medical attention, to navigate life without returning to


substance abuse. This happens with time. The Marchman Act gives that time to the substance abuser. In my law practice, I see the effects of court ordered treatment upon individual substance abusers who wanted no part of treatment and had to be compelled to treatment by the court. In many instances, these people know their lives are a mess and they do not like what they are doing to themselves but they could not imagine life without substances - their best friend.

Those studies find that compulsory treatment including court ordered treatment is at least as effective, if not more effective, than voluntary treatment. So how does the Marchman Act work? The first step in triggering the Marchman Act is to request that the court order an assessment of the individual and to stabilize the individual. This is done by filing a petition with the court in the county where the substance abuser is located. It is not difficult to obtain such an assessment order. There has to be a “good faith” reason to believe the person is substance abuse impaired or has a co-occurring mental health disorder and because of the impairment or disorder: 1) The person lost the power of self-control with respect to substance abuse; and 2) a.) The person needs substance abuse services because his judgment has been so impaired that he is incapable of appreciating his need for such services and of making a rational decision about services; or b.) Without help, will the person likely suffer from neglect or refusal to care for himself which poses a real threat of substantial harm. For most people who have been abusing substances for any length of time, the above criteria are not that difficult to establish to the Court in order to obtain an order for the assessment and detox. The family or friend who files the petition (called the Petitioner) must locate a facility which can do the assessment and detox the individual, if needed. It is up to the family or the substance

impaired individual to pay for treatment services. There are many, very good facilities in South Florida available for these purposes which take insurance. Typically, the court orders a five day stay in the facility for the assessment although that time can be extended by the filing of the petition for involuntary services. The assessment has to be done by a “qualified professional” which is defined as a physician; a physician’s assistant; a professional licensed under Chapter 490 or 491 (i.e. a LHMC or LCSW); ARNP; or a person who is certified through a DCF recognized certification process for substance abuse treatment services and who holds at least a bachelor’s degree. The last category includes a CAP with a college degree in any area. The assessment report must be reviewed and signed off by a physician. The next step in the process is the Petitioner files a Petition for Involuntary Services (Treatment). The same criteria of the assessment proceeding must be met although now there is a higher burden of proof required to persuade the court to order involuntary services. The Petitioner must show the Court by clear and convincing evidence that the person needs treatment services. Services, by the way, are not limited to residential treatment but can include various modalities of services including intensive outpatient or outpatient treatment. At the involuntary services hearing, the Court will hear the testimony of the Petitioner, family or friends, and the qualified professional who performed the assessment. These witnesses will tell the court about what they have personally observed about the substance abuser including behavior, demeanor, hygiene, evidence of paraphernalia, arrests and past treatment history. Many times, the addict/alcoholic admits to the family at some point that she/he knows there is a substance abuse problem and cannot stop. This is very good evidence. The mental health professional/qualified professional will testify as to the recommendations for treatment. The testimony of the treatment professional is frequently given great weight by the Court and is mostly persuasive. Our firm is asked by treatment facilities who they should send to court to testify at Marchman Act proceedings or that they do not want their personnel to testify either due to a HIPPA concern or because the clinician has never testified in court and does not feel comfortable giving testimony. There is no issue that the testimony of the qualified professional who did the assessment is permitted by the Court as to the recommendation for treatment. Mental health professionals should have their concerns allayed by the fact that the qualified professional is the only expert in the courtroom and is the only expert who has assessed the individual. Sometimes families are concerned about the resulting anger from the substance abuser toward the Petitioner as a result of filing a Marchman Act case. It is important to remember that the family is trying to save the substance impaired individual’s life. I was very impressed by the comments of a client, the words of a father, who filed a case notwithstanding that his daughter would be very angry with him. He remarked to me: “I want to know that if her substance abuse kills her, I did everything possible for her to get her help.” Marchman Act proceedings are confidential by law and the contents of the filing are confidential and protected from disclosure both under HIPPA laws and the Marchman Act itself. Joe Considine has practiced law in South Florida since 1983. His practice is limited to family law and addiction related law including the Marchman Act. Joe works extensively with families whose loved ones have substance abuse and mental health problems as an attorney.

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By Hedy McDonald If I could give you one gift, if I could change one thing, if I could wish one thing for you it would be love That you would truly have love for yourself and believe you are lovable That you could leave your dark thoughts and destructive ways behind That you could believe in yourself, your talent and your inner and outer beauty That you could believe in your ability to represent and lead the way to greater things Second, I would take away your fear So that you would not run to the arms of numbing and into the blanket of chaos and distractions You would not be afraid of love for fear of rejection and you would realize your value. That you are feminine and beautiful inside and out and that you have the ability to help others, including your daughter Life needs you So take a hot bath, go for a long walk Read a good book and light some candles Stretch your body and pray to whomever made you and gave you this life For it is not in vain no matter how long or short you are gifted on this earth


For the Families THE PAL STORY

By Mike Speakman, LISAC While working with young people in treatment for alcohol and drug addiction, I witnessed first-hand how devastating the disease of addiction is to the entire family. Parents are faced with challenges they’ve never dealt with before. I saw how difficult it was for them to identify and work through these challenges. One of the biggest problems I saw for the parents was that due to the shame and guilt that accompanies addictive behavior, they isolated themselves and felt very alone. It was for this reason that I founded the self-help group- Parents of Addicted Loved Ones (PAL) in 2006 while working as a licensed substance abuse counselor at Calvary Healing Center in Phoenix, Arizona. PAL has grown from that one meeting in Arizona, to meetings being held in half the United States. Why do meetings like PAL work? Many expressed their relief when they first realized: “I don’t feel all alone with this problem anymore.” While in truth, they were going through what most parents go through when placed in the same situation. This is a founding principle of the PAL group curriculum. Parents helping other parents navigate new ways of parenting an adult child with addiction issues. PAL groups meet weekly at no charge- to educate, support and help each other with issues arising from having an adult child with an addiction. I realized that parents needed support and repetition to be able to make changes in the way they “parent,” their addicted adult children. The concept of parents helping parents is what makes this work. That is why the PAL group is facilitated by a parent with an addicted adult child. While the focus is on parents with an addicted child, we find that spouses also find the curriculum useful as they feel like they are sometimes “parenting” their spouse. Actually, all other sober, family members and friends can find help in support-group meetings, and it can lead to everyone getting on the same page in dealing with the person suffering from addiction. This can be important since most addicts when active in their addiction regress back to childhood coping skills to deal with life. For example, many will throw tantrums, sulk, completely disregard negative consequences, act irresponsibly, and demand immediate gratification. A person may experience the same immature behaviors with a spouse who is acting childish. Regardless of the familial relationship, once the addiction has surfaced, it’s hard for family members to know what to do, or what to expect. I urge parents not to blame themselves for not knowing how to best deal with an addicted loved one. This is new territory outside of the scope of “normal” parenting. The good news that groups like PAL offer is that there is a curriculum to addiction and recovery. If we learn it and are open to new ways of thinking and interacting with our loved one, there is HOPE. That hope comes from taking the spotlight off the addict and focusing it on ourselves as we become educated. When parents and other family members start working on their own education and health rather than changing the addicted loved one, the pressure is removed and healing is possible for the entire family. Just finding out for sure that a loved one is using drugs or alcohol can be an extremely difficult time. There can be a lot of deception and denial. Once you know what is going on, the next question is: What now? This is where groups like PAL can be helpful. At the meeting, you find there are others


who have walked before you, some walking along with you, and others right behind. But all are on the same path and no one is walking alone. Knowledge and new behavior doesn’t usually happen overnight. This journey is a marathon, not a sprint. We encourage parents to be patient with themselves as they learn new concepts in incremental stages over time. Some consider PAL to be an alternative or a supplement to Al-Anon, the 12-step program associated with Alcoholics Anonymous (AA). I founded PAL specifically for parents because of the unique relationship between parent and child. It can be very loving, yet problematic. As an old saying goes: “When it comes to our children, every parent is blind.” In order to help parents deal with the journey, I designed PAL in two parts: an educational component and a time for sharing. In addition, along with information about addiction and recovery, PAL uses stories and metaphors to help parents better understand addiction and recovery. For instance, a first-time parent might be asked to notice what age they picture their child in their mind. They are often surprised to find that they picture a 25-year-old son as a 15-yearold adolescent. This mental picture is important because it shapes how they decide to help which can turn into enabling a grown man who is acting like a boy. Once parents realize this, they gain a better understanding of the problem and more clarity on possible solutions. Treating an adult child as the adult they are, no matter what age they act, and stopping the enabling, allows a child to “step into adult life” and gain the self-esteem that comes from making decisions on their own. If you have an adolescent son or daughter with an addiction problem, you may still have some control over their actions. However, when your child turns 18 everything changes. Now you are dealing with an adult, who, due to delayed emotional growth, is acting like a child. You no longer have the element of control like you had when they were a minor child and it feels like you are losing ground when it comes to convincing them to change addictive behavior. I see many parents get angry at this point. They wonder why is this happening, how is this happening, and what can I do to change it? Solving this mystery is the essence of learning the curriculum of addiction. In addition, part of the curriculum is to help parents realize they did not cause their child’s addiction any more than they did a condition like asthma or diabetes. Once they realize their child suffers from an addiction, they can learn what to do just like with any other ailment. The PAL group facilitators strive to keep a relaxed atmosphere where education, support and encouragement are offered as members make positive changes. Not only does this help the parents, but, as parents change both themselves and how they interact with their child, the child is more inclined to acknowledge a problem and seek help. There is no guarantee in this realm of highrisk behavior, but there is hope. The guiding principles of PAL are confidentiality, respect, acceptance and support. Differences in opinion are common and accepted without judgment. Suggestions are offered if requested in lieu of advice. Members are encouraged to “take what you want Continued on page 28


A New PATH Addiction Haven Bryan’s Hope CAN- Change Addiction Now Changes City of Angels FAN- Families Against Narcotics Learn to Cope The Long Island Council on Alcoholism and Drug Dependence Magnolia New Beginnings Missouri Network for Opiate Reform and Recovery New Hope Not One More


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PAL - Parents of Addicted Loved Ones


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P.I.C.K Awareness Roots to Addiction Save a Star TAP- The Addicts Parents United

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According to the 2015 National Survey on Drug Use and Health, 20.8 million Americans aged 12 or older had a diagnosable substance use disorder (SUD) in the past year. This amounts to nearly 8 percent of the U.S. population, or 1 in 13 people. Addiction has recently gained widespread national attention, in part due to the escalating opioid crisis. Over 50,000 people in the U.S. died from drug overdoses alone in 2015, an increase of 11 percent from the previous year. The National Institute on Drug Abuse estimates that addiction and related problems cost our country $600 billion per year, not to mention the incalculable social and emotional impact on individuals, families, and communities. One positive effect of this grim situation is an increased focus on treatment effectiveness and availability. Last year, approximately 21.7 million people needed specialized substance use treatment, with 2.3 million actually receiving it. On March 31st, 2015, there were over one million people (1,305,647) on the census rolls of U.S. treatment centers, with over 15,000 treatment facilities in operation across the country to meet this need. This assortment of governmental, private non-profit, and for-profit organizations is maintained by a massive workforce of approximately 130,000 full time staff members. Fortunately and unfortunately, the demand for qualified professionals to work in the treatment industry is only growing. The Federal Bureau of Labor Statistics places the job growth rate for addictions counselors at 22 percent by 2024 – much faster than the national average. In addition to the growing need for services, factors like turnover and retirement have accelerated job growth in this area. According to Substance Abuse and Mental Health Services Administration reports, turnover rates for addiction services professionals range from 18 to 40 percent. While stress and burnout are certainly factors, many staff members also leave for better positions as they attain higher levels of training and education. The average age of someone in the addiction treatment workforce is in the mid-40s. For clinical directors, 60 percent are over the age of 50. As older professionals retire, new ones are needed to fill the vacancies as well as new positions created as the result of demand. In various surveys, program directors at addiction treatment agencies report difficulty hiring for these jobs. One reason for this is an insufficient number of applicants who have the requisite education and/or certifications. So, who then, is qualified to enter these positions and satisfy this increasing demand? Addiction treatment is unique among other behavioral healthcare fields. Unlike mental health counseling, where nearly all states require at least a master’s degree to practice, addiction counseling is regulated by a complex patchwork of state agencies and national credentialing organizations. Just 3 states require addiction counselors to have graduate degrees, while the vast majority require a bachelor’s degree or less. Owing in part to its origins in the mutual-aid/peer-support movement, addiction counseling operates according to an apprenticeship model. This means that more time is spent working in the field under supervision than is spent in the classroom. Shorter degree programs allow individuals to begin work sooner and experience hands-on learning in the “real world.” This focus on applied skills, local workforce needs, and job preparation is a cornerstone of the community college mission. A 2003 survey revealed that there were over 400 specialized Addiction Studies programs in the United States. Of these, 69 percent were at the associate’s degree (2 year) level. Community colleges have historically been the home for this discipline, with programs extending as far back as the 1970s. For many new students interested in the addiction treatment field, community colleges are a natural fit. First, these institutions are typically “open-enrollment,” which means that prospective students do


not have to meet eligibility criteria commonly seen in four-year universities like minimum GPA and test scores. Often, all that is required is an application and fee, though specific programs may have additional requirements. For many people who dream of becoming an addiction counselor, this comes as a welcomed relief. Those who are drawn to the addiction treatment field tend to have some personal experience with it; between 40 to 60 percent of professionals identify as being in recovery. Many students returning to college have had negative academic experiences as the result of their addiction. Others have no prior college experience at all or are beginning a new career in mid-life after initiating recovery. In all of these cases, community colleges are well equipped to meet students where they are and provide the support necessary for them to be successful – all while providing specialized knowledge that will prepare them for work in the field. Other benefits of community college addiction studies programs include accreditation and affordability. When students complete courses, they are issued college credit that may be transferred to other academic institutions, unlike the certificates issued by private training companies. This provides a foundation for students who want to eventually pursue advanced degrees and licensure in the future. Moreover, community college tuition is usually less expensive. A final benefit of community college addiction studies programs pertains to the field as a whole and the clients it serves. Presently, the addictions workforce is largely white, female, and middle-aged. However, trends in the demographic characteristics of people in treatment for substance use disorders point in the exact opposite direction: people of color, male, and young. If we want the diversity of our clients to mirror those who work with them, then community college programs provide an excellent, accessible resource that reflects the faces of the communities they serve. If you are interested in learning more, both the National Institute on Drug Abuse (NIDA) and the Addiction Technology Transfer Center Network (ATTC) have online national databases of addiction studies programs. * Citations are available upon request. Dr. Stoupas is associate professor of Human Services in the Addiction Studies program at Palm Beach State College in Lake Worth, Florida. PBSC’s program is designed to meet all of the educational training requirements for Florida state addiction counseling certification and prepares students for clinical work in the treatment industry. You may email him at

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By Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S.

THE POWER OF EMPATHY IN RECOVERY: AN ADDICTS GREATEST RESOURCE “I do not ask the wounded person how he feels, I myself become the wounded person.”

~ Walt Whitman

For many, unless you have been directly involved with an addictive family member, or you yourself have had an addiction; the concept of an addiction, or an addict, is foreign. Addiction itself is the process with which an individual becomes personally consumed with an object, a subject, a substance, or a particular activity. In general, it could be theorized (or hypothesized) that a vast majority of society today has the probability of becoming an addict. After all, an addict does not have to be consumed with a substance or have a substance abuse issue; to be clinically diagnosed as “an addict.” An addict may be addicted to gambling, technology, a career, academic pursuits, ideological or religious perspectives, sexuality, and a number of other possibilities. If you are human, you have the ability of becoming consumed with something in your life. In our society today, technology has become an essential part of our lives. It is easily understandable why technology could unintentionally become an addiction. Technology not only shapes the way we think, but the way we behave, interact, and communicate. In our society today, it is unimaginable for many to think of what the world would be like without it. The necessity of technology lends itself to becoming an addiction. Unlike alcohol, cigarettes, and other vices; technology knows no age limits. There are no restrictions or barriers for preventing someone from becoming an addict to a technological device. While we view technological addiction with a different set of lenses; technological addiction has the same makeup of other known addictions. Therefore, it is important to recognize that addiction has the probability of affecting you or a loved one. While the intent of this article is not to discuss the effects of technology or the probability of such an addiction; I simply wanted to clarify that addiction has an ability of affecting any person, at any time. What are the general warning signs of an addict? Interestingly enough, the warning signs of an addict abusing substances mirrors many other addictions. The general warning signs that someone may have an addiction are: • Increased aggression or irritability • Mood swings • Headaches • Weight gain or weight loss • Cravings, yearnings, and impulsive urges • Lethargy, lack of interest, or enthusiasm • Depression, severe despondency or dejection • Neglect of responsibilities or accountability: job, school, etc. • Significant changes in academic performance • Poor judgement or increased risk taking behaviors • Profound changes in an individual’s worldview or perceptions • Isolation or social withdrawal • Involvement in criminal activity and behaviors • Increased indebtedness or financial problems


For addicts of legal and illicit substances, this particular type of addiction is viewed with bleak optimism. Regrettably, society has a much skewed view of substance abuse and addictions. The perceptions have been fostered by the legal and judicial systems, the media, the movies, television and the internet. The legal and judicial system view substance use as a criminal matter; while the mental health system has been fighting for generations to change that particular perspective. “It is estimated that about one-half of State and Federal prisoners abuse or are addicted to drugs, but relatively few receive treatment while incarcerated.” Yet, the legal and judicial systems avoid addressing their responsibilities in the treatment of addicts. If our intent is to incarcerate those struggling with addiction, then we should be providing mental healthcare in the process of this individual’s rehabilitation. After all, if our judicial and legal system is going to proclaim substance abuse as a criminal matter, then they owe it to the individual and society at large to restore the individual to normality. The bleak optimism has skewed the overall views of our societal perspectives on substance abuse. Substance abuse users are considered weak and there is a general intolerance of those who have become vulnerable to substances. RETHINKING OUR PERSPECTIVES ON SUBSTANCE ABUSE AND ADDICTION

“And above all, we must reduce drug use for one great moral reason: Over time, drugs rob men, women, and children of their dignity, and of their character. Illegal (and legal) drugs are the enemies of ambition and hope. And when we fight against drugs, we fight for the souls of our fellow Americans.”

~ President George W. Bush

As a society, we must change our perspective on this most egregious epidemic. The power of empathy is essential in helping those who are societies most vulnerable. According to the United Nations Office on Drugs and Crime (UNODC) “the World Drug Report 2017: 29.5 million people globally suffer from drug use disorders, opioids the most harmful.” As a society, we must change our way of thinking and our perspectives on addiction. We can no longer view addicts as criminals and we must begin thinking of them as individuals suffering from a chronic disease. As a clinician, I have never met an addict without a psychological history. Whether the history is acute or chronic, there appears to always be some sort of history that lends the individual to seek out substances. The National Bureau of Economic Research (NBER) reports that there is a definite connection between mental illness and the use of addictive substances.” THE POWER OF EMPATHY The power of empathy in recovery can prove to be the greatest resource for an addict. If society were to treat addiction as any other disease; there would be no need for this article. As a society, we have no problem dispensing empathy for those suffering from chronic diseases such as cancer or diabetes, but mental health disorders and diseases lack a similar form of empathy. We must begin to recognize the importance of empathy and its role on Continued on page 30

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By Nancy Jarrell O’Donnell, MA, LPC, CSAT The second individual may develop the self-cognition of “I am stupid” or “I am weak.” A metacognition for this individual might be “I should never relax” or “I need to always be prepared for the worst.” From here a tendency towards catastrophizing the future could present. There are many recent studies on resilience. Resilience is defined as “the ability to rise above difficult situations”. Several studies conducted in Australia concluded that resilience comes from having been exposed to risk and adversity and successfully negotiating these events, thus, building self-reliance and confidence. Other studies demonstrated that having resilience modeled for us by a parent or other attachment figure strengthens our ability to access this survival trait. Studies have focused on psychological factors influencing resilience and most recently on physiological health. All provide valuable information about the connection between resilience and secure attachment. Those who experienced safety and consistent support in childhood are more prone to strong cognitive ability and problem solving strength, develop good social support systems, personality traits such as a sense of humor, healthy selfconcepts/cognitions, and ability to regulate emotional responses. The research on physiological health and resilience is pertinent today as longevity has increased and healthcare is becoming integrated. “Evidence of chronic health issues affecting mood, and the relationship between post-traumatic stress disorder, anxiety, and negative health outcomes, strengthen the hypothesis of a link between positive health and resilience. Current research is also examining the relationship between BDNF (brain-derived neurotropic factor) and resilience. BDNF is a protein in the brain’s nerve cells that support brain function by building brain cells and helping them to grow, as well as encouraging the growth of new neurons. BDNF improves neuron function and protects them against cell death. Studies are beginning to link low levels of BDNF with less propensity for emotional and mental resilience. This protein also promotes effective learning. It falls to reason therefore, if our levels are low, we may not quickly develop optimal coping abilities post trauma despite having resilience modeled for us. Scientists have determined that exercise can induce BDNF expression but the full physiological impact of this remains unclear and more detailed studies are required. We already know that exercise produces benefits that enhance learning and memory as well as reducing depressive symptoms. Research in 2013 demonstrated that individuals deemed resilient were better able to cope with serious health issues. It was also discovered that the individuals deemed resilient engaged in regular exercise, were nutritionally conscious, and reported sleeping well for a solid seven to nine hours a night. So how do we harness resilience, positive self-cognitions, and healthy metacognitions to provide our children and grandchildren with optimal knowledge and experiences to support them moving through adverse, stressful situations? Knowing that no one has immunity from traumatic events, I propose further challenging the stigma of mental health issues; which includes addiction, by incorporating our significant discoveries from neuroscience into school curriculums’, parenting classes, medical practices, hospitals and as responsible clinicians we go into our communities and teach and share what we know. When I lost my daughter, I had worked with a few bereaved parents that were patients in treatment, but I did not know anyone well who had experienced this with the exception of my mother, who lost my brother, and my grandmother who lost her son. Both of these women were deceased however when my child died. Despite their absence, I returned to memories of these two profoundly influential women in my life and also thought deeply of my deceased father and how he managed after my brother was killed in an accident. Within a year after my loss I came to know many bereaved parents and today I continue my journey providing support for newly bereaved


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mothers. I am not fixed or healed. I have not had an epiphany that provided a sudden insight into how losing my child made sense. My innate response from the beginning was to focus on why not me as opposed to why me, why her, why our family? What I did find was that I had the power to choose what I thought about me as a parent and as another hurting human on the earth. I had the power to choose my thoughts and develop beliefs that I consciously chose to not exacerbate my painful state. I knew we all have access to a buffet of thoughts we can choose from at any given moment. It only made sense to me therefore to select the least painful thought from the buffet to be able to keep on. This knowledge gave me a tiny bit of movement from feeling completely helpless. The tiniest bit of relief from indescribable emotional hurt and pain can actually be enormous as it breeds hope. I have hope today and that hope is that in at least some small way I have modeled some resilience for my son and future generations. I have hope for the amazing people that touch my life everyday with their strength and courage as they call upon me for help on their journeys of living despite indescribable pain. I am blessed and I am grateful. My hope for those of us working with addiction and trauma and other mental health issues is that we continue to unite in positivity and increase the sharing of our wealth of knowledge with our communities and each other for the better of not only our lives but those of future generations. As we continue to learn more about the way memory works and how our thoughts and beliefs and experiences influence our ability to rise above the trauma, my hope is that we begin to see a reduction in addiction and other mental health issues. Rising above does not mean we forget what happened or that we get over it. Expecting someone to “just forget about it” or “get over it” is irrational and unkind. Rising above means we engage our innate tools to help us maintain and thrive despite adversity. It means that we access the courage to feel the pain and allow it to be experienced fully in our bodies and then move forward in life as best we can as the way out of our pain is through. Nancy Jarrell O’Donnell specializes in addiction and trauma treatment. She has spent most of her 25-year career working in residential and in-patient facilities. Her experience ranges from Psychotherapist to Clinical Director to President of Clinical Services/Operations. She is a licensed therapist in Arizona currently in private practice. She developed The Sabino Model: Neuroscience Based Addiction and Trauma Treatment™ ©Nancy Jarrell O’Donnell


By Mike Speakman, LISAC Continued from page 22

and leave the rest.” Everyone experiences the journey at their own pace and is supported by the group regardless. PAL groups continue to spread as more parents seek better ways to help their addicted loved ones. For a full list of meetings, visit the PAL website at where you’ll also find helpful articles, videos and links. Mike Speakman is a Licensed Substance Abuse Counselor with an expertise in family education. He is presently on staff at Calvary Healing Center, a residential treatment center for substance abuse. In 2007, Mike founded PAL (Parents of Addicted Loved-ones), a no-cost, educational, self-help group for parents and spouses struggling with the problems of an addicted family member. In 2014, Mike’s book, The Four Seasons of recovery for parents of Alcoholics and Addicts, was published., 602.284.1411

HOPING 2018 IS A SPECIAL YEAR FOR YOU, AND WE LOOK FORWARD TO SEEING YOU SOON! To register or for more information, visit



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only cover up to 30 days of treatment – and even that can be iffy. It is far more profitable to just hand an opioid addict a month’s supply of Suboxone, and sweep him or her under the cover of ‘treatment’. Even with all of these unnecessary obstacles, opioid addicts are finding their way to sustainable recovery. For anyone with the financial wherewithal to afford aftercare recovery programs, I strongly encourage you to pursue it. I’m confident you’ll find they can significantly improve your recovery process. Below you’ll find six tips that can help anyone trying to find sustainable recovery. 1. Make The Commitment – As with everything in life, it starts with you. Nothing will ever come to fruition without someone committed to making it happen. You are the captain of your own ship. Others have done this before you; many are doing it now, and will do it after you. There is every reason in the world for you to believe you can succeed if you put the same amount of energy that you put into your addiction into your recovery. 2. Find A Strong And Supportive Sponsor – This is an important decision. Your sponsor is going to be your guiding light to recovery. You want to find someone who has the experience and the ability to keep you on the right track – someone you feel you can trust and be open with. It’s important that your sponsor has a sponsor and has been clean for at least three years and has worked the 12 steps. The 12 steps are the way of becoming the person you were meant to be and not the person you created. 3. Locate A Reputable Doctor Of Integrative Medicine – This is essential. Certainly opioids destroy the body and brain in ways no other poisonous toxins can. However, our changing environment also presents a broad spectrum of challenges that we are simply not physically capable of meeting. These physicians can help you navigate this treacherous terrain and help your body and brain find its natural state of homeostasis. When you do find a qualified physician, ask him or her about your second brain and gut health. For ages, scientists and doctors have been aware of our ‘second’ brain in our gut, but are just beginning to understand its full impact. They now believe that a lot of what makes us human including our moods depends on microbial activity in the gut. 4. Diet And Supplements – You are what you eat. We’ve become conditioned to consume what taste good rather than what is good for us. Everyone is unique and requires their own individual nutritional plan. Furthermore, we can no longer get our minimum daily requirements of nutrition from the food we eat. Integrative Medicine Physicians can develop a diet/supplement plan tailored to your biological needs. In the interim, avoid processed foods and sugars immediately. Besides having little to no nutritional value, processed foods and sugars cause changes in gut bacteria that seem to lead to an inability to think clearly. They also may accentuate and worsen the symptoms of mood disorders including depression and anxiety. Also, have them check you out for heavy metal toxicity. Heavy metals and other toxic chemicals can cause brain inflammation. If inflammation has already set in, your brain cells become even more vulnerable to toxins causing improper brain function including confusion, depression and other mood disorders. 5. 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. Additionally, 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. Physical activity will improve your health and sense of well-being from the second you start. 6. Work Your Plan – A plan is just that unless you put some wheels under it and push it down the street. Each step you take brings you closer to a happy and meaningful recovery. You’ll get out of it what you put into it. The sooner you get started, the better off you’ll be! I haven’t spoken with Todd in a while but last time I did he was high on life. One of the things Todd mentioned in our last conversation was that he felt that the holistic or all encompassing approach we used, which also treats the underlying or co-contributing factors of addiction, helped him the most in finding recovery. I’ve helped thousands of people like Todd using this approach and know it works if you let it. I strongly encourage you to take a look at holistic and consider it for your plan for 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: To reach John directly please call: 786-877-6389


By Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Continued from page 26

the treatment of those with substance abuse issues. “This is where the power of empathy works in recovery from addiction. Empathy is the ability to walk in the experiences of another, while recognizing that they are not that person.” Empathy transcends our preset perspectives and rises above those ideological viewpoints. It allows us to begin looking at the core of the individual, rather than the addiction. Furthermore, we must move beyond labeling the individual as an addict and begin treating their addiction. Not unlike a cancer, an addiction is a disease. An individual suffering from an addiction is neither their disease nor the psychological disorder that they are struggling to manage. Through empathy, we see an individual beyond their alignment, frailty and vulnerability. We begin to see the individual as worthy and deserving of our best. As a society, we practice empathy for those suffering from cancer and other grave diseases. Let’s start practicing empathy for those suffering from addiction and other psychological disorders. Dr. Asa Don Brown, Ph.D., C.C.C., D.N.C.C.M., F.A.A.E.T.S. Website: References Provided Upon Request


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