THE NEW DRUG DEALER IN TOWN TOWARD A BRAIN HEALTHY LIFE “WE SHALL OVERCOME…” TRANSCENDING TRAUMA AND THRIVING THROUGH GROUP PSYCHOTHERAPY A NEW YEAR: A NEW CHANCE FOR RECOVERY ADDICTION AND MAKING YOUR NEW YEAR’S RESOLUTIONS BLESSINGS A NEW YEAR WITH THE SAME OLD BROKEN HEART
ADDICTION – A GAME THE WHOLE FAMILY CAN PLAY. DETACHMENT. HOW CAN I? TRAUMA AND ADDICTION: A TRAUMA INFORMED PERSPECTIVE. NEW YEAR’S RESOLUTIONS VERSUS COMMITMENT FOR LIFE ADOLESCENTS AND CHEMICAL DEPENDENCY HOW CAN I CONNECT WITH YOU WHEN I BARELY KNOW ME? EQUINE FACILITATED PSYCHOTHERAPY REPAIRS THE SELF
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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs and alcohol in Palm Beach County. It is also distributed locally to all Palm Beach County High School Guidance Counselors, Middle School Coordinators, Palm Beach County Drug Court, Broward County School Substance Abuse Expulsion Program, Broward County Court Unified Family Division, Local Colleges and other various locations. We also directly mail to many rehabs throughout the state and country. We are expanding our mission to assist families worldwide in their search for information about Drug and Alcohol Abuse. Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to email@example.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest man-made 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. Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20’s and 30’s right up to the elderly in their 70”s, thus, creating a generation of addicts. Did you know that 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.
provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under 18 yrs. old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes 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. These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with anyone outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help.
I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved 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.
Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com.
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.
I want to wish everyone a Happy and Healthy New Year.
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
We are also on Face Book at The Sober World and Sober-World Steven.
Patricia@TheSoberWorld.com To Advertise, Call 561-910-1943
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ADV E RT I S I N G O P P O RTU N I T I E S
The Sober World is a FREE magazine for families and parents who have loved ones with addiction problems. We offer an E-version of the magazine monthly. If you are interested in having a copy e-mailed, please send your request to For Advertising opportunities in our magazine or on our website, please contact Patricia at 561-910-1943. We invite you to visit our newly redesigned website at www.thesoberworld.com In the new format, you will ﬁnd our expanded list of resources and services, important links and announcements, gift, books and articles from contributors throughout the country. As part of our effort to improve our magazines online presence, we now have included an interactive forum where we invite and encourage you to voice your opinion, share your thoughts and experiences. We strongly encourage those in recovery and seeking recovery to join the forums as well. Please note: Our forum allows you to leave comments anonymously. Please visit us on Face Book at The Sober World or Sober-World Steven Again, I would like to thank all my advertisers that have made this magazine possible, and have given us the ability to reach people around the world that are affected by drug or alcohol abuse. I can’t tell you all the people that have reached out to thank us for providing this wonderful resource.
For more information contact Patricia at 561-910-1943
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THE NEW DRUG DEALER IN TOWN By John Giordano DHL, MAC
I want to tell you about the new drug dealer in town. You won’t recognize him because he’s cleaned up his appearance. The new guy traded-in his hoodie and sneakers for an expensive Italian suit and loafers. This sharply dressed dealer is responsible for more deaths than any other drug dealer, yet he’s immune to our laws. He’s on every street corner in what has become the greatest drug distribution network ever devised. He’s cooking his poison right here in the U.S. and there seems to be absolutely nothing you and I can do about it. The criminal I’m referring to is the pharmaceutical companies, or more specifically, the people who make highly addictive pain killers – legal heroin – and aggressively market their products through our health care system. Please don’t misunderstand my position on modern eastern medicine. I firmly support the development of drugs for disease and even pain management. There are many drugs available today that improve and expand our quality of life. However I would like to see alternatives be examined and – if feasible – be implemented before some of these harsh toxic medications are prescribed. We’ve become a pill society; there’s a pill for everything. Unfortunately the ensuing result is only the symptom gets treated and not the disease or injury. I can’t tell you how many stories I’ve heard from people who had experienced some type of injury – car accident, sports injury, back, job related injury, a slip or fall etc. – were told they needed a procedure, but for whatever reason didn’t get it. They were given a handful of highly addictive opiate pain killers and sent home. It even happened to me once. After a rigorous workout I felt chest pain and stopped at the ER to have it checked. The first thing the nurse did was hand me a pill and told me to take it. Come to find out it was morphine. I told the nurse what I do and asked why she was handing out these highly addictive pills like candy canes at Christmas. Her response: “it’s policy.” These are just a couple of a plethora of examples of how regular law abiding everyday people are unwittingly get hooked on prescription drugs through no action or “desire to get high” of their own. One might think that a doctor would at least explain to the patient just how addictive these pills really are. The simple truth of the situation is that physicians are in the dark…they really don’t know. Doctors are only required to have one hour of addiction education per year. One hour per year! Even more concerning is that the pharmaceutical companies are responsible for educating the doctors. Nearly three years ago our national drug czar, Gil Kerlikowske, stated that doctors lack necessary addiction education and training, yet nothing has been done to correct it. Not long ago I saw a statistic that hit me like a blow to the stomach. Of all the prescription painkillers made in the world Americans consume eight out of ten of its opioids and 99 percent of the world’s hydrocodone. This is astounding! The U.S. has less than fivepercent of the global population but yet Americans are prescribed eighty-percent of all the opiate painkillers in the world, and all of the hydrocodone. Is there any wonder why we have a drug abuse problem right here in our own home towns when over 600,000 doctors freely write prescriptions for legal heroin that experts say are mostly unnecessary? Katherine Eban, contributor to CNN Money and Fortune, wrote this regarding her interview with Alan Must from Purdue Pharma – makers of OxyContin – VP for state government and public affairs: Must says, “The idea that our business model is based on getting patients addicted and dependent is absurd,” though he acknowledges it’s “not unusual for patients to become physically dependent.” In the company’s view, Americans have long suffered from an epidemic of pain, and Purdue provides profound relief.” An epidemic of pain; I can appreciate Mr. Must’s business acumen and marketing views. It’s what you’d expect from an upper management position in today’s business world. They all want to be dominating in their respective industries. But they’re not selling cell phones and video games – this is about grossly overly prescribed
legal heroin that is killing people. However the business side of the opiate painkiller industry does not recognize the difference. Like any good business their sole concern is increased sales and profits mostly by increasing the price, expanding their market share and capitalizing on emerging markets. In that they have achieved. Results from new research conducted by the University of Michigan revealed that one in ten teenagers receiving emergency medical treatment admitted to abusing prescription painkillers and sedatives like Oxycontin and Valium within the last year (2013). A recent report by Trust for America’s Health says deaths due primarily to prescription painkillers have quadrupled between 1999 and 2010. The number of people addicted to opiate painkillers increases every year and now prescription drugs are killing far more people than illegal drugs. This is what expanding markets and growing market shares look like in the legal heroin business – Pharmageddon. From USA Today: ”Nationwide, pharmacies received and ultimately dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which statistics are available. That’s enough to give 40 5-mg Percocet’s and 24 5-mg Vicodin’s to every person in the United States.” In an interview with ABC News in 2011, Drug Czar Kerlikowske said the current culture of writing narcotic prescriptions for moderate pain, which began about a decade ago, needs to be changed and doctors need to be retrained - yet nothing has changed. Doctors continue to write prescriptions for deadly pain killers at an alarming pace. According to CNN, sales of prescription painkillers since 1999 have more than tripled. To fully grasp what is transpiring, it’s important to keep in mind that your health has become a huge business – the biggest in fact. Healthcare in the U.S. is 18% of our gross domestic product – nearly twice that of most modern countries – and double what it was in 1980. Why has our healthcare costs doubled while other modern countries have only seen marginal gains with a near consistent percentage of GDP while they provide better outcomes? There are a lot of opinions but the facts remain. Healthcare costs are on tract to reach twentypercent of our GDP within the next seven years. Literally trillions of dollars goes to healthcare every single year yet the outcomes haven’t improved. With so much money at stake it’s not surprising that there is a lot of competition for those dollars. And when the competition heats up, marketers get creative. The healthcare industry is no different. Arthur Sackler, a psychiatrist, earned his way into Medical Advertising Hall of Fame by being the first to market drugs directly to doctors by lavishing them with fancy junkets, expensive dinners, and lucrative speaking fees. The plan was so successful that it is used today – in full or part – by nearly every pharmaceutical company in the country. So just how much money is going into the local doctor’s pocket? In a recently reported survey of only fifteen drug makers that represents forty-seven percent of the market; over $2.1 Billion Dollars has been given to doctors and/or researches between 2009 and 2012. Could the real figure be closer to $4 Billion Dollars with all drug companies reporting their cash disbursements to doctors? Has a moral and/or ethical line been crossed? I suppose it depends on which side of the line your standing. In an interview with reporter Linda Hurtado of ABC Action News in Tampa, Dr. James Orlowski, Head of Pediatrics at Florida Hospital, says doctors taking money from the pharmaceutical companies is on the rise. “Doctors are feeling the crunch because the government is cutting back on reimbursement and they’re looking for ways to supplement their income. And pharmaceutical companies are looking for more ways to get more use of their drugs so they can make more profit. So, the Continued on page 30
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TOWARD A BRAIN HEALTHY LIFE
By David E. Smith, MD, FASAM, FAACT and Leigh Dickerson Davidson, AD Last November, those of a certain age were sadly reminded of the death of President John F. Kennedy fifty years ago in 1963. While we’re now learning of his flaws, in the early 1960s many of us saw in Kennedy’s relative youth and energy the start of a new era. Shortly before his death, President Kennedy signed a bill authorizing funding for mental health programs. It was never fully funded. Some have said that President Kennedy’s assassination launched the notion of “Question Authority” so popular in the years that followed and the beginnings of the lack of trust in our government.
In 2008, President George W. Bush signed the Wellstone-Domenici Mental Health Parity and Addiction Equity Act, requiring that mental illness be granted care on a par with physical illness. In 2010, President Barack Obama signed the Affordable Care Act, further establishing parity for mental health treatment, among a host of other regulations. How this legislation will play out remains to be seen, but various scenarios are possible and we may see a process of trial and error as new systems of care are developed for substance use disorders.
Later in San Francisco in the ‘60s, we saw those concepts blossom. As the media spread the word of the marijuana/LSD/sex/rock ’n rollinfused Haight Ashbury neighborhood, the City decided that if it simply ignored the needs of the young people coming its way – they would turn around and leave. Recognizing a looming public health crisis, the lead author rallied colleagues at the University of California San Francisco, the San Francisco Medical Society and others to open the Haight Ashbury Free Medical Clinic in June of 1967 with the philosophy “Health care is a right, not a privilege.” We were immediately inundated with young people who needed treatment for an assortment of ills, including infections, fractures, lacerations, burns, scabies/crabs/ lice infestations, dental issues, sexually transmitted diseases, and malnutrition, as well as pregnancies, and saw about 250 patients in the first 24 hours. To our surprise, we also became a haven for those facing the terrible dark side of the drugs they’d ingested – too much pot, too much acid, too much amphetamine, too much heroin. The narcs watched us from across the street, but decided we really weren’t selling or encouraging the use of drugs, and left us alone (we had a big sign at the top of the stairs to the Clinic – “No Dealing, No Holding, No Using”).
More primary care clinicians will be trained to screen for and identify substance misuse and/or addiction, resulting in an increased demand for treatment. Existing treatment facilities will expand and consolidate with others to develop cost efficiencies. Addiction treatment centers will incorporate medical facilities into their programs to better address the physical issues their patients bring with them. We’re seeing the start of many new facilities using evidence-based medicine in their treatment, funded by investors expecting solid returns. These are not “Malibu-style” luxury detox centers, but more mid-priced ventures, and they’re establishing relationships with insurers, expecting that the new parity regulations will once again require insurers to cover substance abuse treatment on a parallel with their coverage of physical ailments. We will likely see more of a range of facilities, ranging from front-line inpatient detox through residential treatment through “halfway house” to sober living residences, where individuals share a living situation and provide informal mutual support, while holding jobs to pay the rent and other expenses (the organization or entity operating the house usually has a paid part-time staff member to ensure rent collection and payment of utilities, taxes, insurance, etc.).
Rock ‘n’ roll kept the Clinic alive. Rock impresario Bill Graham organized benefit concerts to fund the Clinic, headlining such then-local acts as the Grateful Dead, Janis Joplin, and Creedence Clearwater Revival – and even rock royalty George Harrison of the Beatles. Our Rock Medicine program provided medical and crisis intervention services at small venues like the Fillmore Auditorium and large stadiums like the Oakland Coliseum, building on and refining the Clinic’s pioneering of the art of talkdown with LSD trippers. In the early 1970s, somewhat astonishingly to the anti-Vietnam War generation, President Richard Nixon set up a White House office for drug education and treatment, in part because so many soldiers were coming back from Southeast Asia addicted to heroin. The Clinic received a large grant for treatment and education, which allowed us to continue to develop our outpatient treatment of addicts, which at the time was illegal in California. Increasingly, the bulk of those funds have gone to the war on drugs, with education and treatment now allocated a relative pittance. In the late 1970s, we borrowed a page from Alcoholics Anonymous, which at the time wasn’t too welcoming of drug addicts to its meetings, and started the first Narcotics Anonymous groups patterned on AA’s philosophy and structure at the Clinic’s Drug Detoxification, Treatment and Aftercare program. NA spread primarily on the West Coast and expanded across the country. We have seen some progress. Drug addiction is losing some of its stigma and criminalization and becoming increasingly recognized as a brain disease. The American Society of Addiction Medicine (asam.org) has recently formulated a definition that states in part: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
It’s unknown at present how the core peer staff of many existing treatment programs will be recognized as caregiver/clinicians by this new influx of funds. Will the first-hand experience of having gone through the addiction and sobering process receive the same acknowledgement of value it does now? Will insurers demand additional credentials and licensing? While the overall concept of parity will bring much-needed mental health services to many, the questions of actual implementation are many. The criminal justice system will (hopefully) increasingly realize that every dollar spent on treatment saves about seven dollars in social costs such as jails, prisons, parole and probation officers, attorneys, et al. As addiction is increasingly recognized as a brain disease and mental health issue, its treatment is becoming increasingly medicalized. While methadone counters the effects of heroin, newer medications such as buprenorphine (with or without naloxone), depot injectable naltrexone, and others can moderate the uptake of opioids by the brain. Other medications are being developed for other classes of illicit drugs. While medications, treatment facilities, counselor credentials, and peer groups provide necessary support for regaining freedom from misused drug and/or alcohol, one of the most important steps in recovery is to maintain a healthy brain. The simple acronym HALT reduces this to the basics: Avoid HUNGER. Avoid ANGER. Avoid LONELINESS. Avoid getting TIRED. These stressors break down our defenses and make us more likely to look to alcohol and other drugs to relieve the tension and make us feel better. As we’ve all learned, “feeling better” is only transitory and only serves to remind the brain that it once needed those mind-altering substances, leading to craving and the undoing of one’s hard-earned sobriety. There’s a lot to be said for natural highs – and we’re not talking about banana peels and poppy seeds. Exercise releases endorphins, which activate the pleasure and reward centers of the brain in ways similar to opiates. A healthy diet that minimizes sugars, fats and meat, while emphasizing fruit, vegetables and grains, feeds the brain as well as the body. Developing closer relationships with spouses, children, families and friends provides a support system to counter the temptation to return to the “old ways.” Continued on page 30
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“WE SHALL OVERCOME…” TRANSCENDING TRAUMA AND THRIVING THROUGH GROUP PSYCHOTHERAPY By Marcia Nickow, Psy.D, CADC, CGP When I was a rookie addictions counselor, I had repeated run-ins with clinical supervisors. The conflicts centered around the abuse histories of men and women at the treatment centers where I worked. My bosses were fearful of delving into trauma. They’d say things like, “No, don’t talk to them about trauma. Don’t open any wounds. We aren’t equipped to close those wounds. Teach them about AA. If they need therapy, put it in their aftercare plans. Don’t dredge up any ghosts.” Trauma wasn’t new to me. Raised by parents who survived the Holocaust, I grew up listening to heroic escape odysseys and horrific encounters with violence and death. Also, before becoming a clinician, I had been a journalist. As a police reporter, I chronicled the dark side of human experience by interviewing numerous police officers, victims and offenders about traumatic events that took place in the communities I covered. Later, in my clinical internships, I conducted detailed psychosocial assessments, exploring themes of trauma, abandonment, and loss. Since narrating one’s story is a critical part of early recovery, I couldn’t understand when I began my work as a counselor how I was supposed to avoid asking about clients’ traumatic pasts. I began to explore and treat trauma “undercover,” utilizing astute and insightful senior colleagues outside of my work settings for informal supervision. Today, the addiction field has finally embraced the notion that underlying trauma must be addressed for a person to recover. I am privileged to be asked frequently to present on trauma around the country. I share clinical vignettes to illuminate the link between trauma and addiction and illustrate pathways to healing. As part of my presentations, I facilitate demonstration psychotherapy groups, called “fishbowl groups,” offering clinicians attending the conferences a rare opportunity to experience the healing power of group. I invite nine people to participate in the groups, while other attendees observe. I encourage members of the demo groups to self-disclose about the familyof-origin dynamics and transgenerational themes that commonly lead to countertransference reactions in their work with patients. Very often, clinicians will make speakable in these groups traumas heretofore unprocessed. In one powerful demo group, an African American female counselor courageously and tearfully shared about a tortuous memory of being raped and left stranded. Barely a teen at the time, the woman recalled that a police officer remarked to her that how dare she select a holiday on which to be raped, burdening police with her needs. The young girl was turned away from the police station. She carried the secret of the assault and the brutal encounter with police until her demo group experience. The group, and other attendees later, offered her overwhelming support. Many cried with her. In my private practice, I lead 15 psychotherapy groups per week—women’s, men’s and mixed-gender. I am privileged to watch group member’s work through trust and attachment issues and let go of daunting, haunting past memories. Group therapy is an effective modality for treating eating disorders, chemical dependency, and “process addictions,” such as sex, gambling and internet addictions. It also is a treatment of choice for psychological trauma. Acutely painful psychological states related to feelings of being trapped, disconnected, socially isolated, and alienated have been clinically observed in addicted, eating-disordered and traumatized populations. Many people with eating disorders, chemical dependency histories and process addictions are, in fact, trauma survivors seeking relief, escape, or pleasure through addictive behavior. Unprocessed, untreated trauma contributes to both the development of an addiction or eating disorder or to relapse once a recovery process has begun. Tian Dayton, a clinician and researcher specializing in treatment trauma, refers to trauma as “unmetabolized pain that sits within the self, leaking out in all the wrong places.” Trauma survivors often self-medicate with alcohol, drugs, food, sex, gambling, the Internet, shopping, spending, work, frenetic activity, or other “excessive behaviors,” she reports. They engage in addictive behavior to ease the emotional pain caused by trauma and then to numb themselves from the trauma created by addiction. Often, by the time they present for help, they have long buried their feelings, avoided sharing their feelings, or pretended their feelings don’t exist. “Trauma, by its very nature, renders us emotionally illiterate,” notes Dayton
Trauma creates what Dayton describes as “a cauldron of pain that eventually boils over…. (The) pain feels overwhelming. The person in pain reaches not toward people, whom he or she has learned to distrust, but toward a substance…. Addicts may initially feel they have found a solution, but the solution becomes a primary problem…. The longer traumatized people rely on external substances to regulate their internal worlds, the weaker those inner worlds become…. Emotional muscles atrophy…. Personality development is truncated or goes off track. Thinking becomes increasingly distorted and secretive as addicts strive daily to justify to themselves and others a clandestine life. Authentic, honest connection slowly erodes as relationships turn from sources of support to targets of deception and means of enabling.” Damaged “survival bonds” are the major trauma underlying addiction, says Dayton, referring to relationships with primary caregivers. And subsequent traumas add on layers of complexity and severity. “…Ruptures in early parent/child bonds are some of the most traumatic because our dependency and risk for survival are at their highest in infancy and childhood…. If someone has experienced a rupture in a ‘survival bond,’ subsequent bonds may be harder to form and subsequent ruptures may be more devastating because they return us to the pain of the original one.” Group therapy provides a therapeutic context in which to conquer the shame, secrecy and stigma that frequently silence and marginalize traumatized and addicted individuals. Groups offer a rare opportunity for people to overcome, in a safe setting, impairments in attachment and relational capacities, develop trust, and achieve a sense of intimacy and belonging. Group members find commonalities with others whose traumatic experiences may be both similar and dissimilar in terms of the particulars. They build their own resilience and self-esteem by observing and recognizing others’ strengths and resiliencies and by sharing their coping skills with others. They learn to value themselves when they feel accepted and affirmed by valued others. The concept is reminiscent of a phrase often shared in 12-step fellowships: “Let us love you until you learn to love yourself.” Members tend to develop a sense of pride as they contribute to others’ healing. And the experience of connection in the group often empowers people to seek out affirming relationships in 12-step fellowships and in the outside world. Group therapy therefore functions as a bridge to new community. The term, “trauma,” may be broadly applied. It includes personal trauma and community catastrophes. Atrocities include many things—sexual and domestic violence, combat violence, state-sponsored violence, political terror…. Judith Herman, in her book Trauma and Recovery refers to commonalities “between rape survivors and combat veterans, between battered women and political prisoners, between the survivors of vast concentration camps created by tyrants who rule nations and the survivors of small, hidden concentration camps created by tyrants who rule their homes.” Traumatic events involve threats to life or bodily integrity, or a close personal encounter with violence or death. The fundamental stages of recovery identified by trauma theorist Judith Herman are all amenable to the group format. The three stages are establishing safety, constructing the story, and restoring connections with family and community. With some therapy groups, there is mutual member support outside the group along the way as members make contact by phone or in person and engage socially or may, for example, attend 12-step meetings together. Co-existing PTSD symptoms are common in addictive populations, and group therapy can offer support. There are three main clusters of such symptoms: intrusion, or re-experiencing; constriction, or avoidance; and hyperarousal. • Intrusion – Long after the danger is gone, traumatized people may relive the event as if it were recurring in the present. They may try to return to a normal life, but the trauma repeatedly interrupts. This can happen both as flashbacks during waking states and as traumatic nightmares during sleep. • Constriction – Since reliving a traumatic experience evokes intense emotional distress, traumatized people may go to any length to avoid it. Herman explains, “The effort to ward off intrusive symptoms, though self-protective in intent, further aggravates the posttraumatic syndrome, Continued on page 12
A NEW YEAR: A NEW CHANCE FOR RECOVERY By Marlene Passell Communications Manager for Wayside House Delray Beach
The holidays are behind us and we know that they presented a very difficult time for those with addictions. If you relapsed or turned to your alcohol or drug addiction to help you through, make this your year for change. Recovery is the greatest gift you can give to yourself and your loved ones. Make it your New Year’s resolution that the next holiday season will be a joyous time for you – that you will be sober and celebrating your new life. Turn the pain you felt during the holidays into determination that this year will be better. The help you need is right around the corner here at Wayside House. Our 90day program gives women ages 18 and over an opportunity to learn the skills you need to get sober and stay sober. We’ve been doing this for 40 years and make this the most meaningful experience of your life. You won’t face full days of counseling and therapy, but rather a full range of services and programs that put you in touch with yourself again – body, mind and spirit. You’ll learn your triggers and re-discover your strengths through equine and horticulture therapies; you’ll understand how to de-stress through meditation, yoga and exercise; and you’ll be able to express yourself through art therapy. Most importantly, you’ll meet and bond with other women who face the same issues that you do and realize you’re not alone.
For women by women
Our thorough assessment by our outstanding staff ensures that together we design services to meet your individual needs. Your reasons for addiction are yours alone. We recognize that every woman is different and how we help you recover should be based solely on your needs – that’s what leads to success. At Wayside House, there is a strong sense of safety in being in an environment of only women. Here women are free to express feelings about the guilt and shame of their behaviors of addiction. This is particularly true for those women who are victims of trauma such as sexual abuse or domestic violence. So, don’t wait another minute – make your health and well-being your priority – do it for yourself and your family. Vow now that this will be your year for change – a return to health and happiness – a second chance. Contact Wayside House at 561.278-0055 to visit or receive an assessment. To see our full range of services, costs, and activities, visit our website at www.waysidehouse.net
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ADDICTION AND MAKING YOUR NEW YEAR’S RESOLUTIONS By Suncoast Rehab Center res·o·lu·tion (rezə-lo-oSHən) /noun 1. A firm decision to do or not to do something. With the ringing in of the New Year, the holidays have said their good byes until the next time around. It’s now the time to look ahead into 2014 and one of the best ways to do that is with the age-old tradition of “New Year’s Resolutions”. Whether those resolutions are, “Man, I’ll never do that again” or they are along the lines of, “I resolve to do something just spectacular,” the desire overall seems to be, “How can I improve myself and others?” Goals are important. Resolutions are important. Life becomes much more enjoyable when you have things for which you are striving. Happiness comes from setting goals and then making progress towards their accomplishment. People do have different ways of approaching/attacking their resolutions. You may already have yours laid out. If you already have your resolutions and plans set, good on ya mate! And all the power to you to bring them all to fruition! If you need a little help, read the tips below and maybe some of them will help you make and start on your plan for a spectacular new year. Tips on Making New Year’s Resolutions: First! Don’t limit yourself to just 1 or 2 things to be resolved to do or accomplish. This is LIFE! Write down as many things as you can that you want to do, want to accomplish, have resolved to do. That is a major first step! One person I know has as part of her a New Year’s Tradition to make little boats out of this and that, write the New Year’s Resolutions on paper, and “launch” them on the boat. One year a friend wrote a small novel to launch into the future. When questioned about it she said, “I am going do a LOT this year!” Whether you are the planning type and schedule out how to accomplish them, or you are more laid back and simply glance at them throughout the year, write them down! You may be pleasantly surprised with yourself: If you were to ONLY take a piece of lined paper and fill out every single line with something you wanted to accomplish this year, then neatly tucked it away in your sock drawer, then pulled it out 1 year from today, you would probably find that over ½ of those items were accomplished and you didn’t even know you were doing it. All because you thought of it, resolved to do it and wrote it down. Second! Don’t be shy about sharing them. Tell your trusted friends, a supportive family member, your child or your spouse what you resolve to do this year. There may be private resolutions you don’t want to share – and that’s fine – but share things that you might need help with so they can participate and help you accomplish your goals. For example, you may not want to share with your child that you want to pay your bills on time – but you can always share that you’d like to write and illustrate a children’s picture book or that you want to get a promotion at work. Also, when you do share some of your resolutions, you can get the help of those friends and family that may have wanted to do the same thing. Instant support group! Third! Put your resolutions somewhere that you can refer back to them whenever you want. Imagine how much you could accomplish if you were to have a resolution list in a visible place to refer back to it often? Make some goals. Then work to make them happen. And just remember: You • Are • Powerful! You can use that power towards negative actions or towards positive ones. Use your power towards positive results for yourself, your family, and your community. It all starts with a decision. You truly have within your power to make resolutions and make them stick.
For those you know who are addicted to drugs or alcohol, you CAN make the resolution to get through rehab and live a drug free life. You CAN get to the bottom of your demons and rise above. The life you will lead after you have become drug free is completely under your control – and is within your reach at this moment, right now! And for all you friends and relatives, help that person who you know needs help make it to rehab this year. Their success in life may be dependent upon you – and your happy new year may count on their ability to succeed in achieving a drug free life. At our center, our resolutions this year are big and bold – as they are every year. And every year we help more and more people free themselves from the chains of addiction. With your help, together we can help more people and achieve our goals. Give us a call today. Women’s Articles – New Section on Our Website! We have a new series of articles available. What is the main stressor for American women? Why are so many women taking drugs for sleep problems, pain, and anxiety? What does nutrition have to do with health and stress? Find out in our new series of articles. You can find them here: www.suncoastrehabcenter.com/womens-articles/.
“WE SHALL OVERCOME…” TRANSCENDING TRAUMA AND THRIVING THROUGH GROUP PSYCHOTHERAPY By Marcia Nickow, Psy.D, CADC, CGP Continued from page 10
because the attempt to avoid reliving the trauma too often results in a narrowing of consciousness, a withdrawal from engagement with others, and an impoverished life. It is like going into a state of surrender. There are alterations of consciousness, which are at the heart of constriction or numbing.” There may be amnesia for important aspects of the trauma; diminished interest in significant activities; feelings of detachment from others; a limited range of affect; and feelings of a foreshortened future. • Hyperarousal – After a traumatic experience, the human system of selfpreservation seemingly goes onto permanent alert, as if the danger might be back at any moment. Included in the hyperarousal cluster are sleep difficulties, irritability, trouble concentrating, hypervigilance, and a heightened startle response. Lillian Rubin authored a book, The Transcendent Child: Tales of Triumph over the Past, based on life-history interviews with four men and four women with heart-wrenching childhood stories. Rubin found that children who “transcend” painful pasts typically “disidentified” with their family and their family’s way of life. They became adept at “finding and engaging alternative sources of support.” At any point in the lifespan, therapy groups can be powerful sources of support. “Creating a protected space where survivors can speak the truth is an act of liberation,” declared Herman. Marcia Nickow, Psy.D, CADC, CGP, is a clinical psychologist and group psychotherapist in private practice at Working Sobriety, Chicago. A specialist in the treatment of trauma, chemical dependency, sex and relationship addiction, and eating disorders. Dr. Nickow presents at conferences nationwide on addiction, eating disorders, transgenerational trauma, and addicted family systems, she is co-author of a manual on group psychotherapy for the treatment of process addictions, to be published in 2014 by the American Group Psychotherapy Association (AGPA). As adjunct faculty at The Chicago School of Professional Psychology, Dr. Nickow teaches in the Psy.D. Clinical Psychology and the Forensic Psychology programs. Dr. Nickow presents annually at AGPA’s experiential group psychotherapy conference. She is past board member of both the Illinois Group Psychotherapy Association and the Chicago Center for the Study of Groups and Organizations.
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BLESSINGS By Jerry Moe, MA
Stella has scratched and clawed her way to eleven years of being clean and sober. It has been both a remarkable and difficult journey as she encountered multiple challenges along the way. This bright and attractive forty-year-old let go of a circle of friends who inadvertently supported her disease, but not her recovery. Stella had been stuck in a marriage that was irretrievably broken. In early sobriety she was flooded by painful memories of early childhood trauma. She refused to let any of this knock her off course. She was really good at following directions – she went to 1-2 12 step meetings daily, found a good sponsor, read the book and worked the steps with much enthusiasm and fervor. Individual counseling gave her added insight, clarity, and healing. I have such deep respect and admiration for adults who bring their children or grandchildren to a kids’ program. It takes both courage and strength to not only admit that one’s children have been affected by the family disease of addiction but also to take them for education and support. It’s an unbridled expression of love to allow youngsters a path of healing at such a tender age. Stella called the children’s program to learn more about it. As she inquired about the program and talked about her son Malcolm, you couldn’t miss the reluctance and trepidation in her voice. Towards the end of the conversation Stella admitted that she was calling at the strong urging of her sponsor. Once again she was simply following directions. Even though her nine-year-old had only known a sober Mom, Stella had never told him about her disease or her recovery. Like many recovering parents in similar circumstances, she related that she could never find the right words to even broach this subject. Stella agreed to another phone conversation once she had digested all the information and emotion from this initial call. The Children’s Program The Children’s Program serves a diverse group of families impacted by addiction in a variety of ways. Some kids end up at the Center because their parent is in treatment here. Others come because their parent or adolescent sibling has just completed treatment in another program. Many children come here because their loved one is still trapped by addiction, so they are brought by the non-addicted parent or grandparent. We also serve boys and girls whose parent has been clean and sober for their entire lives. The latter is quite challenging as it’s a balancing act to provide age-appropriate education, skill building, and support without exposing youngsters like Malcolm to tough problems and situations he has never had to deal with in his life. The children’s program would never want to harm, confuse, or overwhelm a child in the name of helping him or her. Stella had much more clarity and insight during that second telephone call. Sponsors certainly have a unique way of guiding their charges at times. She was now adamant about wanting Malcolm to participate in the four day prevention program. She spoke at length about her family’s long and pervasive history of alcoholism and other drug addiction. Stella also needed an avenue to teach Malcolm and help him understand the importance of the recovery lifestyle she wholeheartedly embraced. She now desperately wanted her son to get the education and support she never received when she was a child. We agreed to take things a day at a time in the kids’ program to make sure it was working for him. Malcolm is one of those kids that are simply easy to be around. He took to the program immediately and quickly made friends. He actively participated in all activities and listened most intently to the thoughts, worries, problems, and feelings of his peers. He had a huge heart as he would tear up when others shared their pain, reach out a hand to anyone who needed it, and gave astounding feedback with a wisdom and conviction that belied his years. Mom had prepared him well the night before the program started by briefly and concretely telling him about her recovery.
The culminating event at the end of day two is for the children to write a story or draw a set of pictures about how addiction has hurt their family. Many important steps have taken place to arrive at this moment. One key ingredient is teaching children how to separate the person they love from the disease that has consumed them. Children might feel guilt or shame in talking about their loved one, but will usually tell on addiction which has wreaked havoc and chaos on the entire family. It takes two full days to build trust, develop rapport, and deepen bonding to reach this critical point. The true magic of the process is creating a safe place for children to be with other kids who have experienced similar issues, challenges, and difficulties. Many understand for the first time in their young lives that they are not alone – others have gone through the same thing. Such a newfound connection runs powerfully and deeply. At first, Malcolm struggled with this. He didn’t have many stories to tell. He had never been embarrassed by Mom’s drinking or using in front of friends. He hadn’t been disappointed by broken promises or driven with an intoxicated parent. Malcolm squirmed in his chair, fiddled with his pencil, and struggled more as everyone else was writing away. I slowly approached his table, knelt down to be at his level, and whispered, “Just write down what you’ve learned here so far.” He nodded his head, grinned, and started to write. The Sharing Group The next morning staff prepared the kids and adults in separate groups for the children’s sharing. The grown-ups feel a full range of emotions when they learn that the children are going to talk to them about the family disease – fear, hurt, shame, joy, gratitude, and sadness are typically shared. Stella, even though clean and sober for Malcolm’s entire life, was consumed by a boatload of guilt. “I think it’s time to leave,” she privately confided to me before the start of the family group. Upon inquiring in a gentle way, Stella shared, “I’m scared. I’m afraid my son will say he doesn’t love me. I work so hard at staying clean and sober that I know I haven’t’ spent as much time with him as he deserves. I’m afraid he’ll tell me that I love my meetings more than him.” Even though she was trembling, tearing up and wanting to run, Stella agreed to stay and walk through her fear. They were last. Malcolm sat across from his Mom in the middle of the circle. He politely declined to read his few sentences in favor of just talking to her. He started to cry before he could find the right words to begin. “I’ve made many new friends and learned an important thing here. God blessed me when he made you my Mom. Thanks for being in recovery my whole life.” Almost everyone in the group was in tears. Malcolm continued, “I promise I won’t get mad when you go to your meetings. That’s what keeps addiction away. Now I understand.” They hugged and held each other for a few minutes. What a gift her son had given her. What a gift she had given her son. Much of Stella’s guilt was drifting away. Malcolm and Stella served as a powerful reminder that the gifts of recovery can be bountiful in many, many ways. Jerry Moe, MA. is the National Director of Children’s Programs at the Betty Ford Center. An Advisory Board Member of the National Association for Children of Alcoholics (NACoA), he is the author of many books. Jerry has lectured, trained, and consulted around the world. The Betty Ford Children’s Program is for 7 through 12 year-olds who come from families hurt by alcoholism and other drug addiction. With locations in Southern California, the Dallas/Fort Worth Metroplex, and Denver, Colorado, no child is ever turned away due to an inability to pay. For more information go to www.bettyfordcenter.org
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A NEW YEAR WITH THE SAME OLD BROKEN HEART By Sheryl Letzgus McGinnis “The hardest thing I’ve ever had to hear was that my child died.
people felt like!
The hardest thing that I’ve ever done is to live every day since that moment.” Anonymous
What a blow that was to us, to think that our handsome, talented, popular son didn’t feel normal. Just like so many addicted people, he suffered from low self-esteem. He hid it with bravado that some thought to be arrogance but was instead a mask hiding his true self.
As I sit in my chair pondering what 2014 might bring, the Burt Bacharach and Hal David song, “A House Is Not a Home” begins playing its mournful melody in my head. I hear it being sung as if just to me though by Chris Colfer of “Glee” fame. This young man’s voice is so beautiful that it allows me to focus on the sheer beauty of it, and let the words flow over me knowing I am not alone in this journey of grief. How did they know what was in my head when they wrote that song? How could they have known the depth of despair that I’ve felt since 2002 when our youngest son, then 31 years old, died of a drug overdose? I could not have put my feelings into words as masterfully as they wrote them, nor could anyone ever soothe my soul as gently as Colfer’s dulcet tones washing over me. “A chair is still a chair Even when there’s no one sitting there A room is still a room Even when there’s nothing there but gloom A house is not a home when the two of us are far apart and One of us has a broken heart” There are so many of us out there who feel the same as I do – from mothers, fathers, grandparents, siblings, spouses to friends and everyone who has known and loved an addicted person. I try not to use the term “addict” because it is so limiting, so defining when in reality addicted people are so much more than their disease. They’re humans with many facets to them. We run the gamut and I don’t like to put just one label on someone. My son was a Paramedic and an RN and a handsome, loving, kind young man who rescued helpless animals, who was a wonderful son, extremely musically talented with a brilliant, keen mind but he also suffered from the disease of addiction. So why does society want to label him as just an addict? The word describes the worst part of him, the disease that took over his life. And yet the good that was him was still there battling what I call “The Addiction Monster,” struggling to stay on top so people could see the real person and not the disease. But all the world could see was the Monster so they forgot all his endearing, charming, kind qualities and instead focused on the one thing that was not him. It was a disease. Would we describe a person with diabetes as just a diabetic? “Hello, there’s Mr. X, he’s a diabetic.” No one would think of taking a single descriptor of a person’s life and defining them as such. Not so with a person who has an equally deadly disease – addiction. Instead it seems that is the only thing most people can focus on. He is no longer anything but an addict. Some people say that the addicted person chose addiction therefore his disease is not worthy of sympathy or even understanding. The person who suffers from diabetes or heart disease due to an injudicious diet and lack of exercise is deemed more worthy in society’s eyes. Yes, addicted people chose to do drugs…in the beginning. When they took that first line of cocaine or snort of heroin or Oxy they had no idea of the hell they were sliding into and the rapidity of the descent. All they knew was how good the drugs made them feel. As my son told me, speaking about the first time he did cocaine when he was a child of 17 and knew it all, that it made him feel like what he thought normal
Ours was an extremely close, tight-knit family, who could talk openly about anything. Our two sons knew we were always there for them and they knew how much they were loved and adored. Our oldest son was not cursed with the addiction gene and he has a normal, healthy sense of self. Perhaps as more light is shed on the disease of addiction, more answers will surface along with better treatment and hopefully one day, a cure. In the meantime we must speak out – loudly – about this scourge and shatter the stigma. In the meantime addicted people will continue to fight an uphill battle, fighting their brains every day, doing their best to slay the monster and suffering from unwarranted guilt and shame. Some will succeed. There is hope and my hope is that one day all of them will win this battle and no one else will feel the sting of “A House Is Still a Home…” “Now and then I call your name and suddenly your face appears But it’s just a crazy game and when it ends, it ends in tears.” Sheryl has written 4 books on addiction and drugs. Her best-selling book “The Addiction Monster and the Square Cat” is aimed at children ages ten and up. For more information on the author and her books please visit her website at www.sherylletzgusmcginnis.com
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ADDICTION – A GAME THE WHOLE FAMILY CAN PLAY. By Lorelie Rozzano
It recently occurred to me I wear many hats when it comes to addiction. I’m the daughter of an alcoholic. I learned early to walk on egg shells and feel overly responsible for you. Your bad mood was somehow my fault. I was eager to please, having no well defined boundaries. In my early teens I switched roles moving from the care-taker to the scapegoat. If I wasn’t going to get any positive attention, I was willing to settle for negative, and I got plenty of it. This is right about the time I took my first drink, found my first love, and thought it a good idea to be a child, raising a child. So now, not only am I the daughter of an alcoholic, I’m well on my way to being one. Wishful thinking became a way of life, living in and creating chaos was as easy. I manipulated others and topping it all off, I was a teen parent who knew absolutely nothing about parenting. By now, not only am I the daughter of an alcoholic, and well on the way to being one, I’m also a poor excuse of a mother. One who doesn’t feel very good about herself and medicates with anything she can get her hands on. You’d think it was drinking and drugging which were my problems, but they weren’t. They were my solution and that in itself was the real problem. Years pass, as they do and it became apparent I wasn’t just the daughter of an alcoholic, and by this time one myself, but I was the mother of one also. My child very early on, developed a relationship with marijuana and shortly after, hard drugs. I reacted to all of this very poorly. I had developed great survival skills. You know the fight or flight response. Weird when I think back. I really thought I could change him, when the truth was, I couldn’t even change me. Life was interesting, to say the least. Each moment was rich with tension, blame, resentment, or anger. We chose sides and drew lines in the sand. There were times it wore us all out. Then we’d give in or get out, or take another drink, or find some other way to avoid the reality of what was happening in our home. Thing is, when you develop the ability to avoid reality, you also develop the ability to deny, minimize, rationalize, justify, deflect, make excuses for and become tolerant of, intolerable behavior. Not just yours, but others as well. Now we have a real problem. For not only am I the daughter of an alcoholic, the mother of an alcoholic and one myself. I’m also a co-dependent too. Dear Lord! Can it get any worse? The short answer? Yes! It’s really easy when you’re involved with addiction, to want everyone else to change. If only they could just get their act together. Wouldn’t your life be so much better? Uh, huh. See it doesn’t work that way. Whether you’re the daughter of an alcoholic, or the parent of one, or one yourself, it’s you who has to change. Not anybody else. You can’t make people change. All you ever get for trying is sicker than you already are. Yes I said it, sicker than you already are. For isn’t that what we become, when we’re involved in addiction? We learn to adjust, and then re-adjust,
and finally mal-adjust. Some of us spend our entire lifetimes, waiting for someone else to change. I worked with a woman once, who refused to do anything that would give her pleasure while her son struggled with addiction. She told me as long as he was unwell, she couldn’t feel good either. She gave up the simple things. You know, like her smile, other relationships, and finances. She rarely left the house in case he called needing her. She was just one case, but there are millions and I get it. None us knows how sick we become, when consumed by addiction. Sometimes I really believe the addict, or alcoholic, is the least impaired of the bunch. Nothing with addiction is as it seems. When one person makes the necessary changes, this change affects the dynamics and outcome of the whole system. This is how we move forward. Not by waiting for others to change, but by doing it ourselves. Nothing says things are changing in this family more, than when I stop talking and start doing. If you love someone affected by this illness, you must get an education, get support, and learn what role you play. Instead of asking them to go to meetings, get up and go yourself. If you’re unwilling, then you are part of the problem. Don’t ask others to do, what you won’t do. If you have the disease of addiction, good luck. You can’t stay sick without an enabling system. The most loving and caring thing anyone could do for you, is to stop helping you kill yourself. Believe it or not, there will come a day when you give thanks for the family and friends who loved you enough, not to co-sign your illness. Who knows? Perhaps someone reading this article just might do it different. You really only have to do one thing. Pick up the phone, reach out, and say it out loud. ‘I need help.’ You can’t change, what you won’t acknowledge. Yes, addiction is a game the whole family can play, but recovery is too. Somebody has to start it. Will you? Lorelie Rozzano is a recovering addict. She currently works as a family counselor for Edgewood Treatment Centre in Nanaimo, BC. She works a program of recovery herself, and really understands, first-hand, the benefits of healthy families. She began working at Edgewood in 1998 and has had the privilege of working with both patients and their families. In the past few years, Lorelie has written two fiction books: Gracie’s Secret and Jagged Little Edges. Jagged Little Edges was recently published by Rebel Ink Press. Her third book Jagged Little Lies is currently being published. Her books are available at www.jaggedlittleedges.com or find her on face book at www.facebook. com/pages/Lorelie-Rozzano/506483446066023
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DETACHMENT. HOW CAN I? By Joe Herzanek
When life becomes one crisis after another, when emotional pain and endless drama become “the norm” what am I supposed to do? Over the past few decades I’ve received this question a lot. Recently it has become the #1 question. Why is that? What do I suggest to families who have arrived at this place? How about this: My suggestion is to do NOTHING! Stop “doing.” Quit “doing.” No longer “DO” anything. Let’s talk about letting go and what that looks like (sometimes referred to as detachment). So there—I’ve said it; The “D” word, The Ultimatum, The Nuclear Option. When to use it Let’s start with “when to use it.” Detachment is usually the last resort—although it doesn’t have to be. This is most effective in the life of an “adult” loved-one who has demonstrated that they no longer have any ability to control or stop substance use on their own. This person has a boatload of extremely negative consequences piling up all around them, but they continue to drink and/or drug. Often this pattern has gone on for years and gets progressively worse. Perhaps there were a few “okay” periods of time, but they didn’t last. Sooner or later everyone sits down to a banquet of consequences. ~Robert Louis Stevenson This person may or may not have a job (approximately 77% of all substance dependent men and women get up and go to work most days). They may function well enough on the job to be able to keep it. Many will even point to this fact as proof that they are not addicted. In reality most perform poorly on the job, miss work, and generally have a negative attitude about almost everything. This in turn, leads to “pour me another drink.” Others move from job to job and eventually become unemployable. Some will tend to isolate and spend most or all of their time with their first love, AOD (alcohol and other drugs). Family life, parenting, being the father, mother, spouse or sibling they once were no longer is a priority. In fact, it’s probably not on the radar screen at all. Borrowing money, promising to quit, burning bridges, causing heartache to anyone who comes close to them is the “new norm.” When small children become part of this picture it gets uglier. This is not sad; this is pathetic. If not now—when? When do the family members say, “We’ve had enough?”
Everyone’s situation will be unique, and obviously I can’t tackle each one here. Having said that, I suggest, at a minimum, that you jot down some bullet points you want to cover when you share your concerns with your loved-one. Even writing out what you want to say, word for word, is perfectly fine. Anticipate what the person will say or object to beforehand. Keep in mind that detachment is rarely forever. In fact, when you confront the person you have decided to detach from, put a timeframe on it (let them know how long it’ll be till you are willing to regain communication). Once you have reached this point, you need to remember that it’s too late for another broken promise or a few days of abstinence to mean anything. So, here we go. You’ve prepared—both mentally, and you have a plan on paper–and you are ready to have a firm, but loving discussion with this person. A time to confront/talk with the person has been set and agreed to. You’ve asked this person to let you share your concerns and you simply read what you want to say or speak to them based on your written bullet points. My suggestion is to determine a minimum period of total abstinence you are requiring from your addict or alcoholic—before you are willing to talk or see them again (thirty or sixty days should be the minimum). Begin by emphasizing to them that you love them very much and that it breaks your heart to see them continue with their substance abuse. Let them know that you (and all family members involved) have made this decision. You can list possible living options for them on their copy of your letter. Tell he or she–that they must decide which relationship is the most important—the one they currently have with their alcohol or drug use, or their own family. You must make it crystal clear that they have to choose–because they can’t have both. There is so much more I could write on this topic—especially when I think of all the different scenarios possible. Please do your homework before attempting this, seek wise counsel, read all you can and get a second opinion. When it’s all “said and done” this tough love approach often works when nothing else will. Addiction, left alone will only get worse over time. What I remind people about in my book and in counseling is that “recovery is a process—not en event.” This is why I sometimes suggest that you “do nothing.” The phrase “let go and let God” applies to the family members and friends–as well as the person seeking recovery. Detachment is one of the most difficult things that a person (especially a mom) may ever need to do.
This, dear reader, is the time to detach. This is the time to “do nothing.”
Stay strong, seek support and know with confidence that no matter what happens—you have “done” everything you know to do.
I also like to remind people of The Three C’s of Al-Anon which are: “you didn’t cause it, you can’t cure it, and you can’t control it.” What you can do is help the person to “want to” quit. If the “want to” is there, anyone can have recovery.
Joe Herzanek (Chaplain Weld County Jail, Greeley, CO) has spent over twenty years working in the criminal justice system counseling and ministering to inmates and is an expert on recovery from drug and alcohol addiction. He also is a Certified Family Addiction Counselor, author of the award-winning book “Why Don’t They Just Quit? What families and friends need to know about addiction and recovery.” and founder of “Changing Lives Foundation.”
What does detachment look like? How do I do it? Before I explain how it works, I need to add one caveat. I was recently in San Antonio conducting a workshop for The Palmer Drug Abuse Program (PDAP). The Program Director of this wonderful facility, a woman named Trish, reminded me of something important I sometimes tend to overlook. She said the family needs to be totally prepared for this step (intellectually and emotionally) and that for this to be effective, all family members need to be “on board.” Having emotional support and guidance regarding the necessity for such action, what to expect and being prepared is critical to the success of this step. This is not going to be a “walk in the park” and having good support is crucial. So, how does one begin to do this? My first suggestion is to get a pen and paper and write out a plan.
A recovering person himself, his passion is for helping families struggling with addiction. Joe specializes in “crisis counseling” for those situations that seem hopeless or impossible. He’s especially gifted at helping families find their way “out” and partnering with them to formulate a plan. Email email@example.com or call Joe at (303) 775.6493 for more info. www.whydonttheyjustquit.com/index, www. drug-addiction-help-now.org/
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NEW YEAR’S RESOLUTIONS VERSUS COMMITMENT FOR LIFE By Ann Smith, LMFT
Years ago I had a pattern of joining a gym a few weeks before Christmas. Frustrated with my excess weight, I would sign up and pay for a year’s membership just before I started baking my favorite sugar cookies. Once relieved from the guilt by that decision, I then proceeded to eat whatever I wanted to until January 2nd (the 1st just didn’t work for me with the pork and sauerkraut) knowing that for sure, this time, I was going to follow through with healthy eating and regular exercise. I actually felt thinner just thinking about it. New Year’s resolutions are so freeing before January 1st. After the midnight festivities we go back to reality in a hurry. In my case, I would follow through for a week or two but one excuse after another came up and before I knew it, I had wasted another $200 on a gym membership I would never use. Eventually I learned that commitment has to involve action, not just thinking and promising. I made a vow to never join a gym again unless I could first put on my walking shoes and go out my front door on a daily basis for two consecutive months. I now enjoy walking but haven’t thought about going to a gym since 2005. I accept who I am and try not to make the same mistakes repeatedly. Why do we make promises and then break them? In part we do this because we like how we feel when we say things like “Next year I’m going to . . .” or “From now on . . .” It gives us a sense of accomplishment. In reality we haven’t done anything. It’s a game we play with ourselves to put off the work of changing. Perfectionists, whether the overt type (looks very put together on the outside) or the covert (self critical, feels “never enough” but can’t quite live up to the expectation they hold in their minds), have a terrible time keeping promises they make at New Years. Perfectionists are all or nothing thinkers. If they mess up a little, they quit, thinking “I just can’t do it right.” Their goals and standards are usually higher than most humans can accomplish without making mistakes or slip-ups. They start out with exuberance and crash when they don’t succeed immediately or when those around them are doing better than they are. Whether your resolution is to control spending, read more, be kinder to
others, quit smoking or lose weight, there is a better way. Here are a few suggestions: 1. Make a commitment to something more meaningful than getting into a smaller dress. For example: self esteem, health, flexibility, strength, prosperity or accomplishing a goal. 2. Start it today; no planning for future change. Do something now. 3. Do it every day – possibly for the rest of your life, in small increments, one change at a time. Walk around the block, eat a salad every day, pull out your exercise CD or wear a pedometer and start counting your steps. 4. Make it simple and easy to do. It’s best if it doesn’t cost anything, is close to home, fits in a hole in your schedule but doesn’t change your schedule, has something rewarding or pleasurable involved in it like enjoying audio books, time with a friend on a regular basis, eating real foods you love or feeling better emotionally. 5. Start a daily journal of only your successes, focusing on what you are doing each day, not on the outcomes. Be proud of your small actions and don’t worry about the result. It will pay off in the end.
Remember that the real goal is to change something for the better for the rest of your life. HAPPY NEW YEAR! ONE DAY AT A TIME
Ann Smith is the author of three books: Grandchildren of Alcoholics: Another Generation of Co-dependency, Overcoming Perfectionism: The Key to a Balanced Recovery and Overcoming Perfectionism: Finding the Key to Balance and Self Acceptance, second edition, which was released in March 2013. Ann is the Executive Director of Breakthrough at Caron (www. BreakthroughatCaron.org), a five day residential personal growth workshop designed to help adults shift destructive life patterns, improve relationships and strengthen self-esteem. Visit: www.BreakthroughAtCaron.org/AnnSmith. Become a Fan on Facebook at www.facebook.com/CaronBreakthrough
ADOLESCENTS AND CHEMICAL DEPENDENCY Karen R Rapaport, Ph.D, ABPP
Adolescents, by nature, struggle with many internal conflicts and often act impulsively, at least in one area of their lives. Their central conflict is their attachment to their parents versus their loyalty to peer-group codes. As a group, they are particularly vulnerable to group mores, yet usually unaware of their own high state of suggestibility. Some teens indulge much more than peers in risk-taking, flouting safety and health care and, often, legal regulations. These are the lead-teens, and they typically have followers who are even more highly suggestible than the lead-teens tend to be. It is essential to define two central factors in understanding adolescents and addiction: 1) Abuse of drugs, which is an isolated event(s) of drug use, vs. drug dependence, which is characterized by continued abuse of a drug or alcohol, despite development of cognitive, behavioral, and physiological signs and symptoms. The dependence pattern leads to increased tolerance for the drug, withdrawals, and compulsive drug taking. 2) Psychological dependence: The motives of adolescents who begin to use drugs are typically: a) To cope with anxiety, b) Ease social interactions c) Join networks of teens and adults where they can obtain alcohol and drugs. Encountering the life-long struggle with the authority problem, adolescents tend to be especially vulnerable to the contagion of belief that other teens are expressing. Apathy and \ sometimes outright combative antipathy are typical stances toward adults. Within this context, it is not uncommon for adolescent chemical dependency to develop. Most teens have some incidents of chemical abuse, e.g. alcohol, or pills, yet the teens that develop chemical dependency begin to experience hallmark signs of chemical tolerance and withdrawal symptoms.
It is helpful for parents to view their teen’s chemical dependency within the context of adolescence, a developmental period characterized by identity diffusion. Teens, under the best circumstances, have a wavering sense of self and some difficulties with relying on their own strengths. Thus, they are particularly vulnerable to substance abuse or addiction. Like its adult counterpart, teen addiction is a progressive disorder which distorts and destroys healthy development of the adolescent and his/her family. As adolescents tend to recover from acute toxic insults following ingestion of alcohol and/or drugs, they are much less aware of complications that may result from such intoxication, including physical, e.g. pancreatitis and other medical disorders, and psychological disorders, e.g. depression. Parents must be aware that many teens also engage in poly-substance abuse. Thus, it becomes more difficult to predict the course of the problem. However, most addicted teens lean on a “drug of choice.” In recent years, teen abuse and dependence on prescription drugs has risen, while use of marijuana, related to daily consumption, has not. Trends over recent decades reflect that 18-25 year-olds are still the target group for the highest use rates of drugs. It is also estimated that 10-15% of teens under 18 years old have a definable problem with at least one incident of drug/alcohol abuse. Yet, less than 1% are “chemically dependent.” Also, over the decades, there has been an increase for young female adolescents to begin using drugs, and to develop drug dependence. Teens still tend to fall into groups of those who are drug “experimenters,” vs. those who are exhibiting transitionmarking behavior, e.g. potential dependence on drugs. Continued on page 26
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TRAUMA AND ADDICTION: A TRAUMA INFORMED PERSPECTIVE. By Herb Cohen
When I do an intake on someone seeing me for therapy, I always take history from birth to present. I create a timeline of traumatic events and mark the onset of maladaptive coping in response. For example: age 14, I was raped and that year I started cutting and getting high. When life is presented this way it is easy to connect the dots between negative events and maladaptive behaviors. They suddenly make sense. Something bad happened to me and I needed to deal with that, usually by avoiding behaviors. It is NORMAL to want to avoid pain. Avoidant behaviors may work for a while, and help us survive but in time may be trouble by themselves. Avoidant behaviors not only get stuck, but carry shame and that is problematic. Traumatic memory is stored differently than other types of memory. It is important that it is stored in a way that we can easily recall, yet not delete it as we may need to reference it to light up a fight- flight response to protect ourselves in the future. Encoded within those permanently stored memories are negative beliefs about ourselves along with body sensations, smells, pictures, sounds etc. of the event as if it just happened. They are stored as fragments with core memory in the right frontal cortex and other fragments in the respective sensory cortexes. At the moment of recall, all the parts come together to paint a picture though not entirely accurate. These negative ideas are always irrational and generalizable to other aspects of our life. Some examples are: I was sexually abused as a child but because it was done in a loving manner and my body responded pleasurably, I must have wanted it and caused it to happen. It was my fault, becomes –everything that goes wrong is my fault. Or I felt dirty thus I do not deserve as I am not worthy. I am not lovable, thus I am not capable of receiving or giving love. These negative beliefs are shame based and painful. Ironically we often choose behaviors that help us avoid them that are also shame based. If I drink until I cannot think, I will feel shame afterwards especially if I do something I would regret if sober. Now I have the intrinsic shame of my traumatic memory driving drinking which brings on more shame. That’s shame upon shame. I cannot cope with so much shame so I need to avoid that too. Shame is stressful. Stress causes dopamine cells to fire. Dopamine is a common brain chemical that seeks more of whatever gives us pleasure. Dopamine cells do not have any judgment of what is good bad, safe etc. They just want more. Stress is pain and so dopamine cells say “let’s avoid” and remember that moment we felt relief when we first cut, drank, ate or smoked etc. A memory can be triggered by anything that reminds us of it or the negative idea we have associated to it. Both light up, triggering a need to avoid. Dopamine elicits a memory of what worked in the past and that creates a craving. If we do not give in to the craving-more stress builds until it is intolerable and we must give in. Cravings are 90% memory. So let’s take a look at this memory that is lighting up dopamine. Dr. Robert Miller has hypothesized addiction and compulsive behaviors as being created by “Positive Feeling States” or PFS. A PFS is created when a positive condition ( in response to a negative condition, like those fixed negative beliefs attached to trauma memories) develops in combination with a highly desirable outcome combined with the dopaminergic surge from getting high, etc. and if it is illegal or bad we may get an adrenaline rush from that excitement. These states synergize into a fixed state that becomes frozen just like our trauma memories. An example would be someone who has been the black sheep of his family who feels unaccepted and unloved. As a teen he is confronted by a group of older teens who call him over and offer him a cigarette. He tries it even though he has never smoked before. He coughs, the others laugh but one puts his arms around him as if to say” it’s OK, you’re one of us now”. He gets a little buzz from smoking, he knows he should not be doing this and that causes excitement and the feeling of being accepted. All the physical and emotional details synergize together into a fixed PFS. His cravings going forward all reference this PFS. There can also be other Positive Feeling States created in regard to his smoking, fostering compulsive smoking behavior. Dr. Millers says that when these Positive Feeling States are identified and delinked, followed by processing the negative conditions corresponding to the desired state, i.e. not accepted, the compulsion
then dissolves. This means processing the trauma associated with the negative idea. Processing in this case means using EMDR, Eye Movement Desensitization and Reprocessing. EMDR is a special therapy used to treat trauma and addiction. It works on memory and can release fixed memories such as trauma to be processed into neutral states with no charged negative associations. As memories become neutral, the desire to avoid no longer has any reason for being. Adaptive responses stop. Addiction using PFS Protocols may take a few weeks to extinguish verses years of trying to manage addictive behaviors. For those with no access to EMDR, do a timeline, identify Positive Feeling States and see if you can remove shame from your reactions to events. Shame is a big motivator so removing shame is big. Add coping skills like breath-work, grounding and stress management to manage stress. If you can manage stress that will help diminish cravings and dopamine triggers. Herb is a Registered, Board Certified, and Licensed Creative Art Therapist. He is trained in EMDR and is a Certified Level II practitioner. Herb is the Director of Stepping Stones PROS Program in Huntington, LI for Family Service League and also manages a part time private psychotherapy practice. Herb Co-Chairs the Long Island Committee on Sexual Abuse and Family Violence. He is the Regional Co-Chair for EMDR for the Long Island region. Herb is a tireless advocate for advancing and integrating trauma informed care and EMDR in government and community based agencies and institutions. Herb has studied Eastern healing arts and not only teaches Tai Chi, Chi Kung and Meditation, but integrates those methods into his practice. Herb has also studied Gestalt and Sensorimotor therapy approaches as well has a strong neurobiological foundation.
ADOLESCENTS AND CHEMICAL DEPENDENCY Karen R Rapaport, PhD, ABPP
Continued from page 24
Risk- factors for teen drug abuse dependence are genetic predisposition for depression, the style of parenting in the family-oforigin, behavioral patterns of the family, which may reinforce “family myths,” peer relationship problems, physical/medical disorders, school and legal problems. Families who suspect drug abuse/dependence in their teens will benefit most by psychotherapy, if not for the entire family, then for parents alone and teen separately, if they will attend sessions. Often, teens may require treatment in a treatment recovery facility, if the problem cannot be handled well on an outpatient basis. In daily family experience, parents will benefit from developing skills in: reframing the adolescents behavior/drug abuse problem, developing an action plan, seeking support of other parents, maintaining and communicating positive expectations of the addicted teen, assertiveness with teens, and understanding the problems with coaddiction. Teens who are using alcohol or drugs often present themselves to adults as free of problems or as falsely accused, yet truly blameless. Individual and/or group psychotherapy is warranted, outpatient or inpatient, in addition to work with parent(s). The orientation of treatment needs to be addictionology/traumatology, as there are patterns of addictive behavior that the clinician must be able to predict. They also need access to meeting lists of Alateen, AA, NA, and Al-Anon. Finally, within any therapeutic context, teens need to learn interoceptive awareness, or consciousness of a spectrum of internal sensory and affective states that may precipitate slips or relapse. Karen R. Rapaport, Ph.D, ABPP is a Fellow of the Academy of Clinical Psychology (FACLINP), and Board Certified in Clinical Psychology, American Board of Professional Psychology. She has been in private practice in Palm Beach County at CME Psychology Consultants for over 25 years, specializing in Psychotherapy and EMDR for the treatment of trauma, addiction and mood/anxiety disorder.
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HOW CAN I CONNECT WITH YOU WHEN I BARELY KNOW ME? EQUINE FACILITATED PSYCHOTHERAPY REPAIRS THE SELF By Gail Hromadko
The isolation resulting from substance dependence is deeply damaging. 12 Step programs acknowledge the importance of connection in fellowship and the Steps. Yet social connection remains difficult for many recovering people. Adding a history of alcoholism in the original family and this task become more challenging. This article will explore how equine facilitated psychotherapy (EFP) is a uniquely helpful treatment for these challenges.
touch with effective containment and boundaries. Further, a client who is in contact with a horse may also feel needed by the horse. As the horse indicates a desire to be touched, clients are awakened to their ability to give. For newly recovering addicts and alcoholics, this might be the first time in years that they have the experience of having something to offer. The process awakens compassion.
Research shows that attachment to original caregivers--parents, foster parents, or guardians -- is critical to many developmental tasks including: selfregulation, homeostasis, brain development, developing sense of self, and forming relationships between self and the world .The caregiver bond provides the skills and practice needed to manage all of these tasks until the infant brain develops enough to accomplish these skills on its own. That is the bad news for people who have had ruptures in the original caregiving relationship like those with alcoholic parents or those who have been placed in unstable foster care situations. The good news is that the brain is “plastic,” that is, it has the ability to regenerate significantly given the right circumstances even in adulthood. There are certain qualities within a therapeutic relationship that enhance this healing which are uniquely present in EFP.
3. Laughter: Animal research describes seven ingrained emotional systems of the mammalian brain: SEEKING, FEAR, RAGE, LUST, CARE, PANIC and PLAY. Each of these systems occurs from the instinctual action programs of the brain. There is a recent theory that addictions and alcoholism may result from a thwarted SEEKING instinct -- a natural instinct gone awry. The PLAY instinct is also hard wired into all mammals. Recent research shows that addiction damages this instinct. For example, psychostimulants like methamphetamine reduce playfulness. In addition, substances of addiction actually get wired into the reward pathway in the deep brain causing the addict to lose the ability to feel joy. When an addict uses a substance of abuse, there is a huge release of dopamine in the reward pathway then a deep depletion. For those addicts who have lost the sense of joy, re-engaging in natural play can be of help. Movement is fundamental in reprogramming the pleasure pathway. The movement of play combined with laughter is even more effective in evoking the emotions which emerge from play -- joy, glee, happiness and playfulness itself. Horses play naturally among themselves for no other “purpose” than to play. They recognize a playful intention and will join in the game. In EFP we can dance with horses, run with horses, dress them up, paint with them, make games with each other, and laugh. Even a very “unserious” EFP session offers healing of the joy pathway.
1. Nonverbal Intuitively Felt Communication: Infancy is a time of nonverbal knowing. Wordlessly, a parent knows his or her child’s state of being, needs and wants. Wordlessly, a child relates his distress and/or comfort. Wordlessly, a lifetime bond develops. These silent communications occur so rapidly that words would actually slow down the process. Horse therapists are uniquely suited to assist in healing a broken nonverbal bond. Horses have a smaller cortex -- the part in humans that gives us language skills among other things -- and an expanded intuition. They operate from the right brain, the home of instinct and intuition. In making contact with a horse, we shift from our usual left brain state of being into the right brain instinctive/intuitive mode. This more closely mimics the original state of being with caregivers than the traditional verbal relationship between therapist and client. The transition to right brain experiencing can be difficult initially as clients try to interpret what the horse is doing from their left brain mode. When a client “interprets” what the horse is doing, they are most often projecting their own rich material onto the horse. Often people will say “he doesn’t like me,” or “she is afraid of me.” Because horses take their environment at face value and respond solely on what will facilitate survival, they lack the subjective judgmentalism we are so good at. As we evaluate the horses’ physical cues, we can interpret their state of being with some accuracy. This allows the client to see themselves. This feedback loop would be impossible in talk therapy. Here the client is allowed to hear their own projected story and then focus on their feelings, their needs, and their wants in light of that story. This is often the missing piece from the original caregiving relationship -- the luxury of focusing on ones’ own experience. Human therapists will feel a need to respond verbally at some point and certainly cannot contain their own judgments perfectly even with years of experience. 2. Social Touch: Recent research shows that humans are biologically predisposed to seek out and sustain physical contact and emotional connection with certain “others” upon whom they come to rely. This touch in the first few months of life actually establishes the neurological connections which will develop into an ability to manage emotions later in life. Animal research suggests that the urge to touch animals is biological and may trace back to human-wolf relationships .This “seeking” of touch is hard wired in us and in other mammals as well--think of your pet coming to you for contact. It has been discovered that the body’s endogenous opioid system drives this need. When we are socially isolated, our levels of endogenous opioids fall which triggers the need to seek social contact. For addicts, the natural ebb and flow of endogenous opioids is interrupted. In making contact with animals, that urge for connection is rekindled. Therapeutic interaction with a horse inevitably involves touch. Even people who are deeply afraid of horses will work hard on their fears in order to be in contact. When asked what they might want from an equine interaction people will often report “I want to be able to touch him.” Or “I want to be close to her.” Certainly this tool is infrequently used in traditional talk therapy settings as it should be. One of the advantages of having the horses available for this touch seeking is that there is no illusion that the horse will play another role such as parent, enabler, or spouse. While all of these emotions may be visited, it is clear to participants that the horse will stay behind and be a horse. This allows the richness of
4. Sense of SELF: Panskepp (2002) defines SELF as a “neuro-symbolic homunculus, grounded in action urges, from which a variety of core emotional states of being could emerge. This means that emotion and motor action are essential for a sense of self to develop. We only recognize changes in our own states of being based in bodily sensation and movement. There is a map of the bodily state in the right brain which facilitates this process. Moving in the world helps us know who we are because we can have our own felt sense of what is occurring within us. This gives us an inner felt sense of what is going on with others. Without this sense of self and understanding of other, social bonding would be impossible. Horses’ entire understanding of their world comes from an intuitive and instinctual perception which is gained through their body and senses. When engaged in EFP we move toward that way of metabolizing the world. We watch the horses and begin to have a sense of what they are feeling, what they are demonstrating, what their intention is. The equine work wakes up this bodily sensing which drugs and alcohol have so effectively numbed. Additionally, because we are outdoors and engaged in movement, the information we are receiving through our senses is quite different than in alcoholic isolation or drug related activities which are often too stimulating or violent or totally numbing. We have an opportunity to see nature and the beautiful horses, feel the breeze or the softness of a horse muzzle, hear the trees rustling, the horse nickering, the birds singing, our heart pounding, feel energy in our arms and legs and smell the horsey smells of leather, manure and hay. Each of these experiences offers a possibility for reprogramming the addicted brain and awakening the sensitive heart and soul -- the Self -- of the alcoholic/addict. The gifts that the horses give go beyond brain healing. In our interactions we discover an honest and nonjudgmental possibility of relationship. We interact and are effected but also effect the other. This profound place of tenderness is a healing matrix that is similar to meditation or tai chi. The difference, however, is that the healing occurs in relationship and within the container of the human therapist and group. These connections, while fleeting, offer a real felt experience of self and other, of compassion, of affection and bonding, and of trust which are carried into life. Gail Hromadko is a Marriage & Family Therapist and Certified Equine Interaction Professional-Mental Health with 30+ years’ experience in treating alcoholism/addictions. She has a private practice in Palm Springs and Morongo Valley, CA. Her facility, Five Hearts Healing Arts, focuses on equine facilitated psychotherapy and other alternative healing modalities. She can be reached at 760-323-2524 or via the website: www.5Hearts.org.
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THE NEW DRUG DEALER IN TOWN By John Giordano DHL, MAC
two are obviously coming together here and fulfilling each other’s needs.” Has your healthcare been compromised by this some what ethically questionable financial union between the drug companies and the medical profession? Is your doctor making money from Big Pharma? There is an easy way to find out. The Federal Government is forcing drug companies to disclose the money it’s paying to doctors and their reason for paying them. ProPublica has been tasked with gathering the information on these financial relationships and making a database available to the public. I’ve been on the site and it is very user friendly. See for yourself by visiting: www.projects.propublica. org/docdollars/ I’m a firm believer in personal responsibility; the duty of making the right choices for ourselves and the people closest to us. Yet the more I see of the emerging world we live in, the more I realize how our choices can be undermined. Perfectly normal and productive people who experienced some sort of injury are handed little innocent looking pills. They’re told by their trusted physician to take one every so many hours for pain. Within weeks many of these unsuspecting souls find themselves craving more painkillers and their live beginning to unravel. Prescription drug abuse is a raging epidemic that no one wants to talk about. Although it might be great for the economy, legal heroin is killing Americans in droves across this great country of ours. According to the CDC, prescription drugs killed more than 37,000 Americans in 2009 alone! That is triple the death rate since 1990. Its more fatalities than from heroin and cocaine combined. More people are dying from prescription drugs than car accidents. Certainly there are people with chronic pain who would not have relief without prescription painkillers. That being said, I’m not advocating for the elimination of all opiate painkillers. However, when less than five percent of the global population consumes over eighty percent of the world’s production of opiate painkillers, it becomes perfectly clear that Americans are being grossly over prescribed. Legal heroin starts at the point after those with chronic pain who could not experience relief without pain medication. It’s that area where people are prescribed thirty days worth of painkillers when four or five day worth will do or when eighty milligrams are prescribed as apposed to ten. How many lives have to be ruined or ended before we accept the fact that most prescription painkillers are nothing more than legal heroin and that grossly over prescribing opiate painkillers is nothing more than distribution of this deadly product? If we as a society are to be honest in our “War on Drugs” efforts, we must take the blinders off and get legal heroin off our streets while instituting new standards requiring more continued addiction recognition and prevention education for physicians. Much of the pain, suffering and malevolence associated with addiction could be avoid with very little effort. An efficient early detection and treatment program would go along way in reducing drug and alcohol abuse in America today. It would require an on going comprehensive addiction educational program for all physicians, nurse practitioners and nurses. One hour per year is not enough time to grasp even the simplest of concepts much less understand the complexities of addiction. Another effective method for the early detection and treatment of addiction would be a screening process. My close friend and colleague Dr. Kenneth Blum – discoverer of the addiction gene – has a system of determining a person’s genetic predisposition to addiction. A simple swab could easily be done in any doctor’s office. This DNA test in combination with an open dialog between doctors and their patients would be a very efficient way to prevent the progression of this deadly disease. Being realistic, the ‘War on Drugs’ will continue to stall without addressing the makers’ marketing programs. This will not be easy. Asking a painkiller company with annual sales in the billions of dollars to reduce his sales is going to be as challenging as asking his clients
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nicely to stop taking the pills. But leaving it up to the industry to police its self is like asking an addict to arrange his own intervention. It’s time to start calling our state and federal representatives and ask what they are doing to get legal heroin off the streets. And when you get them on the phone, be sure to also ask them what they’re doing to promote an early addiction detection program and continued addiction education for physicians. John Giordano is the Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. Giordano has contributed to over 65 papers published in peer-reviewed scientific and medical journals. He is the proud recipient of a Doctor of Human Letters from Sinai University in Jerusalem. Mr. Giordano is a recovering addict with thirty years of sobriety to his credit. He is a therapist, Certified Addiction Professional (CAP), a Master Addictions Counselor (MAC), Certified Eye Movement Desensitization and Reprocessing (EMDR) Specialist, Trauma Relief Specialist (TRT), certified Hypnotist and a Certified Criminal Justice Specialist (CCJS). Mr. Giordano also earned a Masters Certification in Neurolinguistics Programming (NLP). He is a professional expert witness for the state and federal government. John is a Karate Grand Master 10 th degree black belt and is in the Karate Hall Of Fame. John Giordano’s website: www.holisticdrugrehab.com (Holistic Drug Rehab)
TOWARD A BRAIN HEALTHY LIFE David E. Smith, MD, FASAM, FAACT
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Get enough sleep. Think positive. None of these is rocket science, but when you remember that addiction is influenced in large part by genetics, you realize that you have to stack the deck as much in your favor as possible. One of my colleagues has suggested that use of particular drugs runs in approximately six-year cycles and we’re currently approaching the waning of the prescription drug epidemic. Currently, we seem to be facing increased Ecstasy and bath salts use. In the 1980s, we introduced the concept of clinicians who were Dated, Disabled, Dishonest and/or Duped in their drug prescribing. The Haight Ashbury Free Clinic developed training and education programs for impaired physicians, nurses and other clinicians that were adopted by what is now the California Society of Addiction Medicine and “exported” across the U.S. One of the most interesting addiction-related advances in our increasingly technological age is the development of apps for supporting recovery. Downloadable to a smartphone, these constant companions can remind you of the benefits of staying clean and sober. Some provide interactive access to a counselor, while others offer affirmations, daily check-ins, virtual meetings, and other options. Of course, the importance of one’s sponsor, family and friends in living a sober life can never be overemphasized. These are the folks who’ll be with you, no matter what. Treat them right. David E. Smith is board-certified in addiction medicine and a certified Medical Review Officer. He founded the Haight Ashbury Free Medical Clinic in 1967 and has taught that addiction is a brain disease for over 45 years. Leigh Dickerson Davidson volunteered with Rock Medicine and other Haight Ashbury Free Clinics programs for many years and published books on women’s health and related issues for over 25 years.
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