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I N M E MO RY O F S T E V E N

GAMBLING:

THE HIDDEN ADDICTION

By Arnie Wexler, ICGC and Sheila Wexler, LCADC, ICGC

THE RELATIONSHIP BETWEEN PAIN AND ADDICTION

By Allan N. Schwartz, Ph.D., LCSW

ARE PHARMACEUTICAL COMPANIES INTENTIONALLY MARKETING TO YOUR CHILDREN?

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

SELF MOTIVATION 101 By Gary Greenberg


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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. The Sober World is an informative award winning national magazine that’s designed to help parents and families who have loved ones struggling with addiction. We are a FREE printed publication, as well as an online e-magazine reaching people globally in their search for information about Drug and Alcohol Abuse.

(under the age of 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.

We directly mail our printed magazine each month to whoever has been arrested for drugs or alcohol as well as distributing to schools, colleges, drug court, coffee houses, meeting halls, doctor offices and more .We directly mail to treatment centers, parent groups and different initiatives throughout the country and have a presence at conferences nationally.

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.

Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest manmade epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction. If you are experiencing any of the above, this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is
the point where you know your loved one needs help, but you don’t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved
one

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Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help. Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com. The Sober World wishes every father a Happy Fathers Day! We are on Face Book at
www.facebook.com/pages/TheSober- World/445857548800036 or www.facebook.com/steven. soberworld,
Twitter at www.twitter.com/thesoberworld, and
LinkedIn at www.linkedin.com/grp/home?gid=6694001 Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com

For Advertising opportunities in our magazine, on our website or to submit articles, please contact Patricia at 561-910-1943 or patricia@thesoberworld.com.

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THE RELATIONSHIP BETWEEN PAIN AND ADDICTION By Allan N. Schwartz, Ph.D., LCSW

It is important to understand what we are talking about when we refer to addiction. The American Psychiatric Association states that “addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life.” Those with chronic pain tend to be vulnerable to opioid addiction. Opioid drugs are used to ameliorate the effects of pain on patients. Typically, the type of pain that seems to lend itself to addiction are those of the lower back. Patients complain that it’s difficult to sit, stand or lie down because of lower back injuries. Patients with chronic back pain could try such alternative therapies as tai chi, yoga, acupuncture, and mindful meditation before being prescribed opioid painkilling drugs, according to new guidelines from the nation’s largest specialty physicians group. A recent commentary from the American College of Physicians is the latest in a continuing flow of recommendations that seek to change how patients and doctors think regarding prescription painkilling drugs, blamed for the national addiction crisis. Still, the information hasn’t gotten to many people. “I think most patients want medications as a fast fix,” said Anita Gupta, vice chair of Drexel University College of Medicine’s division of pain medicine. “What patients understand is often far from what the evidence tells us to do. Dr. Gupta stated that her practice at Hahnemann University Hospital gets patients’ “family and friends involved in care, and often includes psychotherapy because pain can cause isolation and depression.” People living with chronic lower back pain are more likely to use illicit drugs, including marijuana, cocaine, heroin, and methamphetamine, compared to those without back pain, reports a study in Spine, published by Wolters Kluwer. According to the report, all four specific drugs were more commonly used by patients with lower back pain. “Rates of lifetime use were about 46.5 versus 42 percent for marijuana, 22 versus 14 percent for cocaine, nine versus five percent for methamphetamine, and five versus two percent for heroin. After adjustment for other factors, participants with lower back pain were more than twice as likely to report methamphetamine and heroin use. Many other studies show that prescription opioids are widely used by patients with lower back pain, raising worries about addiction, misuse, and accidental overdose. Older studies found that people with a history of illicit drug use are more likely to misuse prescription opioids. In a recent scholarly article published in the New England Journal of Medicine, it said “addressed the problem of opioid misuse in the context of chronic pain, a big part of the problem of prescription opioid addiction. They pointed out that chronic pain and its accompanying disability are huge problems and opioid analgesics are now the most commonly prescribed class of medications in the United States. They further noted that opioid analgesics are widely diverted and improperly used, resulting in a national epidemic of addiction, opioid overdose and death, and that the major source of misused and diverted opioids is prescription by physicians.” During my years of psychotherapy practice, I have seen a sharp increase in the number of clients addicted to opioids because of lower back pain. These are people of all ages from young to old. Even though they suffer from the pain, they unfortunately become drug seekers, going from one pain clinic or MD to another to fill more prescriptions. By the time they get to me, they are not functioning. Their marriages are in trouble and they are no longer able to work. Many of them are trying to make cases for disability

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and are often denied. Finally, they feel depressed and hopeless. Many of these clients had no history of drug abuse despite the finding that was cited in this article. However, once they became addicted, denial set in and they justified the use of the drugs. Always having pain was their justification for the continued use of the drugs. There is one major observation of mine that is notable. Even though there was no history of drug abuse, these clients all had personality disorders. What are Personality Disorders? The American Psychiatric Association states: “Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” These problems functioning are chronic and repetitive. They are behaviors learned during childhood and clients are often unaware that they have a personality disorder except for the fact that they know they are having problems. Chronic pain also leads to feelings of depression and hopelessness. Opioid medications exacerbate those feelings. That is why psychotherapy, as well as alternative self-help techniques, are recommended and listed below. What is the solution? As the beginning of the article stated, there are some alternative methods for patients to use to find relief. Among these are tai chi, yoga, acupuncture, and mindful meditation. Research has found that all or any of these are effective in reducing pain, stress and anxiety. In addition, there is psychotherapy that can be useful. There is Cognitive Behavioral Therapy, better known as CBT that helps people restructure their thinking- yes, there is the sensation of pain but then there is how we think about it. Many times, our thinking worsens the situation. Then, there are the other psychotherapies such as psychoanalysis, psychodynamic therapy, group therapy and marriage counseling. After all, the spouse and Continued on page 30

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THE CHANGING POINTE AT CENTERPOINTE HOSPITAL Addiction to alcohol and other mood-altering substances has affected individuals, families and societies throughout recorded history. Research on genetics and the brain demonstrates that 10% of our population is at risk for addiction to mood altering drugs. That physiological risk, combined with environmental events and situations, combined with the use of mood-altering substances, can lead to addiction.

disorders such as schizophrenia and schizoaffective disorder, PTSD associated with traumas and chronic pain conditions.

Addiction to alcohol and other drugs is a chronic, progressive and sometimes fatal disease. It causes emotional, physical, financial, employment and social problems that can destroy relationships and ruin lives. Addiction does not discriminate – it affects men and women of all ages, intellects and income levels.

Medication-assisted treatment can stop the cravings for drugs and alcohol, allowing the individual to stay focused on their recovery plan.

The good news is that addiction is treatable. With an opportunity to learn about addiction, develop coping skills and establish alternate behaviors, many individuals addicted to alcohol and other drugs can manage their addictions and live lives of recovery. Treatment provides the opportunity to stop the progression of the addiction disease and offers hope for individuals and families. For more than a decade, the Changing Pointe at CenterPointe Hospital has provided private addiction and substance use treatment services. The Changing Pointe provides a full range of treatment services, including detoxification, 4 weeks of residential treatment, outpatient treatment and medicationassisted treatment. Families groups and meetings with spouses, parents and siblings offer weekly support for family members and significant others The Changing Pointe is based on the philosophy that addiction is a disease with identifiable, diagnosable symptoms. The Changing Pointe also believes that addiction can be effectively treated in a medically monitored, multi-disciplinary environment utilizing proven therapeutic techniques. C

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Life-long sobriety can be maintained by utilizing effective coping and relapse prevention skills with the support of a 12step recovery model, which is the core of curriculum at The Changing Pointe. The Changing Pointe curriculum is designed to initiate the recovery process and promote a substance-free lifestyle. Patients learn about addiction as a disease, the ways it affects their lives and the lives of their families. MY

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Untreated symptoms of mental illness may repeatedly trigger relapse to substance use. Relapse indicates a return to prior, old behavior. Relapse is often part of a learning curve for individuals who are trying to learn new, healthier behaviors and skills, to take care of themselves differently and maintain sobriety.

CenterPointe Hospital is a private 150-bed psychiatric hospital located in the scenic rolling hills of St. Charles, Missouri just outside of St. Louis. The Changing Pointe Addiction Treatment centerpointe_changingpt_soberwrld_18_print.pdf 1 2/1/18 4:45 Center located on the campus of CenterPointe Hospital, providing affordable and quality addiction treatment in the St. Louis area.

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It’s not uncommon to find that people suffering with substance addictions also often have other mental health problems. It’s not always clear which came first, both need to be treated, in order to provide the best scenario for recovery. This is called dual disorder treatment, providing treatment for both addiction and mental health issues. Common mental health disorders coupled with substance use disorders include anxiety disorders, depressive symptoms, bipolar spectrum disorders, attention-deficit disorder, psychotic

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SELF MOTIVATION 101 By Gary Greenberg

All of us have goals we hope to accomplish. Those in recovery, who are trying hard to stay sober, need all the self-motivation they can muster to achieve their goals. Unlike motivation offered by others, self-motivation comes from within. Instead of external motivation which is temporary and will dissolve in a few hours or a few days, self-motivation is a developed skill that can be practiced daily until one day, you have become master of your own life. My new book, No One Is Coming (Find Your Power In SelfMotivation) is designed to help readers rekindle that inner motivation and discover a clear path to who they want to become. This book is based on a unique, understandable and useful philosophy that recognizes we can achieve whatever we want if we just understand and apply these basic principles of self-motivation. The book lists 10 STEPS – each a Chapter – that every reader can use to help realize his or her goals and dreams. Chapter 1 - Read, Read, Read Inspiration can help you find self-motivation and one of the best ways to get inspired is to read. For self-motivation, it is often good to read stories about the success of others, anyone who has overcome adversity to reach selected goals. Reading and learning from examples set by others can help you become energized toward achieving your goals. Chapter 2 - Rethink The Way You Think There are times when we think with our emotions rather than our intellect, and when we are guided by our feelings instead of our thoughts, which may lead us into trouble. Rather than let our emotions take control, we need to never lose sight of our goals and think like a strategic warrior– a real-world Jedi, who keeps his or her ultimate goals in mind. Then we are able to make better decisions crucial to our success. Chapter 3 - Find Your Passion and Purpose Passion helps us achieve our goals. Its energy is also a selfmotivator, helping us hang in there so we can improve our skills, overcome adversity and find meaning in what we are hoping to achieve. If you are passionate about overcoming your challenges, and you believe in what you’re doing and the impact it will have on your future, you’ll be much happier and find greater fulfillment in life. Chapter 4 - Be Persistent and Persevere Perseverance can often make the difference between success and failure. We have all showed persistence and perseverance many times throughout our lifetime, whether it’s learning to walk, ride a bike, drive a car, etc. But when it comes to our goals, we’re notas good as we should be about just hanging in there. This is where self-motivation is critical, where a focus on the light at the end of the tunnel and what we are hoping to achieve is so important. Chapter 5 - Discover the Power of Patience It is not always easy to be patient. There are things we all want to achieve and sometimes we just can’t wait. Patience, however, can be a most powerful tool. Patiencewill help you make better decisions and can also reduce stress and frustration in your life. If you understand that reaching your goal is a process -an evolution rather than a revolution - you are less likely to be distracted and give up. Learning to harness the power of patience is an important step in self-motivation. Chapter 6 - Making Friends With Your Fears Fear is one of the greatest obstacles to self-motivation. For many of us, the fear of the unknown tops the list of things that get in the way. For others, our biggest fear is change, which draws us out of the safe cocoon we wrap ourselves in, but change is how we grow.

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A proper mastery of yourself over your fears - a friendship if you will - is what drives us to overcome fear and achieve our goals. As you push forward, remember the words of Franklin D. Roosevelt who said “The only thing to fear is fear itself.” Chapter 7 - Be Bold and Courageous Achieving your goals take drive, dedication, determination, decisiveness and direction. Often, it also includes taking a risk. There are times when mustering up your courage and taking a step into uncertainty is the only way to achieve your goal. By unlocking that vault of inner strength, you open up the treasure chest of your future where all things are possible. Taking a risk often gives you the opportunity to move forward with confidence. Chapter 8 - Hitting the Curveball We all face situations or circumstances in our lives that are unexpected. These situations are often feared, misunderstood and avoided because, like a child afraid of the dark, we constantly seek a nightlight to illuminate what we don’t know. You must understand that life is not so much about how you fall, but more about how you get back up. Chapter 9 - Take the Strategic Approach All of us face battles in our daily lives. That is the reality for all creatures in their struggle to survive. The greatest battle of all- is with yourself. Remember Pogo’s famous line “We have met the enemy and he is us.” Most of us think tactically. We see the task at hand and we either do it or we don’t. When we look at that task as a step in a master plan – a battle within the war – then we will have greater reason to move forward. By thinking strategically, you can learn to take steps that will best help you meet your goal. Chapter 10 - Carpe Diem, Seize the Day Action is the fire which ignites our dreams, our plans and our goals into a living force. Ghandi may have given the best advice when he said “The future depends on what you do today.” The idea of seizing the day is a simple one, but doing it, is far from easy. There are many forces that can get in your way, but once you have mastered your day and accomplished all you set out to do, you will discover that you are proud of what you have achieved. By seizing the day, you will find it easier to keep moving forward to accomplish your goals and dreams - because they often can come true! Gary Greenberg, founder of Self-Motivation, Inc. is an author and self-motivational speaker. An entrepreneur who has started several successful businesses, Gary is fast becoming well known for his expertise in the field of self-motivation, having appeared on radio and television. Like so many others in our nation today, Gary’s family has been touched by tragedy with the loss of his brother to substance abuse. He firmly believes this book and the techniques it offers can help those in recovery achieve their goals. www.garymotivates.com, garyg114@aol.com

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WHEN DONOVAN MOVED ON By Maxim W. Furek, MA, CADC, ICADC

“Sorry seems to be the saddest word,” ~ Elton John Donovan was adept at saying “I’m sorry.” After receiving his third DUI, he apologized to his wife, Mary Anne, and again after he crashed their new Acura and, once again, after he forgot to pick up their daughter, Chelsea, at an evening school event. There were other occasions too, when Donovan’s drinking got him into trouble, always followed by apologies and requests for forgiveness. Donovan’s apologies were strong, emotional and seemingly heartfelt. He was a Shakespearean actor, reciting his lines, stage center. Sometimes he would cry, his eyes wide and frightened. Mary Ann really wanted to believe that he was going to stop drinking. She kept the fires of hope alive. It was 8 p.m. when the ah ha moment struck, bringing about a profound clarity for both Donovan and Mary Anne. It happened as he fell down the basement steps. He broke several ribs, punctured his spleen and suffered a severe concussion. There was blood, strands of hair and pieces of broken teeth on the steps. On that night, Donovan, reeking of alcohol, almost died. Mary Ann dialed 911. She screamed at Chelsea to go to her room. The EMT’s used a stretcher to transport the battered, bloody body up the stairs and into the awaiting ambulance, revolving lights pulsating across the neighborhood. The neighbors all watched and, along with her emotional roller coaster, Mary Ann suffered the embarrassment of public humiliation and castigation. It was a small town and everyone knew about Donovan’s court dates, his DUI’s and the time he passed out in the front yard. He was viewed with pity, perhaps contempt. None of his neighbors reached out and offered help. Donovan was shut off and ostracized from what could have been his most valuable resource. Still, he was strangely remorseful. He seemed different. He pledged to Mary Ann that he was sorry, that he would stop drinking. It was an old story she had heard many times before. She had had enough. Donovan’s cousin said it best, angrily proclaiming that, “It was the straw that broke the camel’s back.” Some quip that pain is a great teacher. Donovan was sick and tired of being sick and tired. Looking back at his lifetime of past transgressions, he was consumed with remorse. He cursed his life, an ever-escalating pattern of legal and social issues, a neverending dance of drama and unresolved conflict. The accident was his moment of truth, his final bottom. Donovan had hit the end of the line. There were no more options, no more crossroads or alleyways diverting around his alcoholism. There was nowhere else to go. All roads had been cut off. It was do or die as Donovan heard the incessant inner mantra that if he continued to drink, the final end would be “jails, institutions or death.” For the first time in his life, he was scared, scared that he was going to die a painful death. He couldn’t live like this anymore. Donovan begged forgiveness, vowed to stop drinking, offered to make things right. He made frantic phone calls and began to attend AA and NA meetings. Donovan knew about hitting bottom. He spent hours searching the Internet. There seemed to be some insane cosmic law stating, “Before things got better, they had to get worse.” It was crazy talk. It didn’t make sense to him, didn’t seem to apply to him, but he could admit that maybe he did have a problem with alcohol, maybe his life had become unmanageable, and maybe it wasn’t about his former boss or his wife’s nagging, or anything else. Maybe this was where the rubber hit the road.

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Mary Ann also discovered that she had a bottom, a point where she simply could not take it anymore. Mary Anne moved out, filed for divorce, and joined a fitness club. She lost 14 pounds and quickly began a relationship with a toned fitness trainer, several years younger. She hated Donovan for squandering what could have been their wonderful life, hated the years spent cleaning up after his messes, lying for him, acting that everything was all right. Consumed with anger and resentment, she loathed herself for being the enabler, caught in a spell of something that she couldn’t understand or control. Mary Ann refused to accept Donovan’s amends. She had heard it before. Now was her time to say “no.” Mary Ann was familiar with his lies. The false promises were repeated again and again, like a beautiful song, but these words, perhaps meant to be sincere on some cerebral level, rang hollow. The repetitive “I’m sorry” and “I’ll never do that again” eventually lost all credibility. These were apologies, not from the heart, but lies and distortions, festering scum like, at the bottom of the bottle. Living Amends Donovan had destroyed his marriage and his family and needed to make amends. Alcoholics Anonymous provides a strategy for restitution. Two specific AA steps include Step Eight, which reads, “Make a list of all persons we had harmed, and became willing to make amends to them all.” And Step Nine, “Make direct amends to such people wherever possible, except when to do so would injure them or others.” Donovan found these to be difficult and painful steps. Amends need to be more than mere words of an apology. They need to signal a genuine change in behavior and that takes the passage of time, and the blessings of forgiveness and restitution. After years of hurt and betrayal, his amends fell short. Mary Ann refused to accept his apologies. She said that “maybe,” in time, she could forgive him, but not now. His only option was to make indirect amends, such as volunteer work, becoming an organ donor, donating blood or working towards the betterment of his community. Donovan could also make symbolic or “living amends.” Donovan would dedicate his life to staying sober a day at a time, practicing an ongoing process of kindness, brotherhood and altruism. He would strive to be the best person he could, impacting on everyone in his life as a positive influence. Only after making amends could Donovan, straddling the line between fear and anxiety, walk proudly into the daylight with renewed confidence. It could take days and weeks and months. It could take years, but he was becoming stronger every day, living in the moment, conquering the dread of his past and facing the fears of his yesterdays. He was changing, evolving, arriving. Donovan had moved on. He no longer needed to say, “I’m sorry.” Maxim W. Furek has a rich background that includes aspects of psychology, addictions, mental health and music journalism. His book Sheppton: The Myth, Miracle & Music blends facets of the miraculous and supernatural into a psychological profile of survival. Learn more at shepptonmyth.com

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MARCHMAN ACT SUCCESS STORIES By Joe Considine, Esq.

Families of individuals with substance use disorders (SUD’s) always are concerned about and want to know whether the Marchman Act really produces benefits. They sometimes quote the old adage that no one gets help until they have hit their own bottom and really want help. In previous articles we have discussed the authoritative studies which have been conducted by prominent and well credentialed researchers which indicate that involuntary commitment to treatment is at least as effective, if not more effective, than voluntary treatment. We also know that to be the case at least anecdotally through the several hundreds of Marchman Act cases we have filed. The answer is that the Act really provides great help to people with SUDs. And the evidence clearly is that you do not have to sit by and watch your loved one get sicker and sicker waiting for them to hit a bottom which will drive them into treatment. The following are stories of cases where the Marchman Act was used to good end. The results are promising. Facts, which could identify the individuals below, have been altered for privacy but the paths taken, the court proceedings and the results reflect those of real cases which we have handled. A woman in her mid-thirties with a history of trauma continued to abuse substances even after several treatment episodes. As disappointing as it was to her family, that should not necessarily come as a surprise to anyone in the treatment field. A Marchman Act case was filed and the Court was asked to initially order the woman to a treatment facility which dealt with her substance use disorder for sixty days, and then, successfully asked the Court to extend the Marchman Act treatment order for another ninety days for treatment of the underlying trauma and co-occurring mental health issues which included an eating disorder at a facility which specialized in helping women who are trauma survivors. This woman is over one year clean and sober and she is on the right path with much greater insight and tools for recovery. A young man who was enrolled in a local college with a history of abusing various substances had been arrested for possession of marijuana. He was emotionally troubled and was self-medicating with various substances. He failed his courses and had to leave school, as is so often the case with SUDs. This young man also has some co-occurring mental health issues, and struggles with his parents who try to provide guidance. His parents filed a Marchman Act and he was brought to a local treatment center where he completed residential and outpatient treatment totaling ninety days. This young man was really unhappy that he was being ordered to treatment. He lived in a sober living facility and attended outpatient treatment under a Marchman Act order for another ninety days. He is no longer the pale, depressed, shrunken young man we saw in court two years ago. He had added weight and was training in the weight room. He seems confident in his recovery and is grateful to his parents for filing the Marchman Act. Obviously, it is up to this young man to stay connected with recovery and work on his mental health and substance use disorder on an ongoing basis. A mother called us a few months ago to let us know that her daughter (in her early 20s) who had been addicted to opiates and lived on the streets was now clean and sober one year. She had a job and her own apartment. She was going to recovery meetings and taking care of herself. It was not an easy road however. This young woman left treatment even while under a Marchman Act order and the mother had to ask the Court to have her daughter held in contempt of court and almost incarcerated in order to get the daughter to comply with treatment. She did and there is a good ending to this story as of this writing. A middle aged woman was quite literally drinking herself to death. Her liver is cirrhotic and she needs a liver transplant. Of course, she does not qualify to be on the liver transplant list until she has

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six months clean and sober. Her family filed a Marchman Act proceeding. She was picked up by law enforcement and taken to a treatment facility. She was extremely angry with her family. She has now completed sixty days of residential treatment and will go to an outpatient program. She has some insight into her condition and now wants to stay sober so she can qualify for a liver transplant. An elderly gentleman was abusing substances and his wife was very concerned. She filed a Marchman Act proceeding. He was court ordered into treatment. Needless to say, as is often the case, he was very angry with his wife. The therapists at the treatment facility did a very good job with re-directing him and having him look at his anger. He is clean and sober six months now. The director of the facility called me to tell me that the man looked nothing like the very angry and troubled fellow who had been brought there by law enforcement under a Marchman Act pick up order. Not all involuntary treatment cases under the Marchman Act turn out well nor do all voluntary treatment cases turn out well. The point here is that the old idea that people with substance use disorders cannot be helped until they hit their own bottom and really want to get help on their own is a fallacy. Too many people have died while their loved ones have waited for them to hit a bottom which would cause the individual to want to get help. We do not need to do that any longer. The Marchman Act is an effective tool to get the substance use disordered individual, who says he or she does not want help, into treatment. Joe Considine has practiced law in South Florida since 1983. His practice is limited to family law and addiction related law including the Marchman Act. Joe works extensively with families whose loved ones have substance abuse and mental health problems as an attorney. www.joeconsidinelaw.com

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GAMBLING: THE HIDDEN ADDICTION By Arnie Wexler, ICGC and Sheila Wexler, LCADC, ICGC

Compulsive gambling is a progressive disease, much like an addiction to alcohol or drugs. In many cases, the gambling addiction is hidden until the gambler becomes unable to function without gambling, and he or she begins to exclude all other activities from their lives. The inability to stop gambling often results in financial devastation, broken homes, employment problems, criminal acts and suicide attempts. The gambler is eventually able to remove himself/herself from reality, to the point of being totally obsessed with gambling. Eventually, they will do anything and everything to get the money they need so they can stay in the “action”. They will spend all their time and energy developing schemes in order to get money to continue their gambling. Lying becomes a way of life for the gambler. They will try to convince others and themselves that their lies are actually truths and they will eventually believe their own lies. Some people will hit their bottom, and when they do, they know they will need to get help to stop their gambling. At this point, they want to stop, but they can’t do it alone. Many will keep gambling. Some will end up in jail, some will attempt suicide, and some will die from their addiction because they haven’t taken care of their health. For some, the stress can kill them. And then, there is a small group of addicted gamblers who will seek and find help. There are Gamblers Anonymous groups that can help the gambler find recovery- real recovery, not just abstinence. www.gamblersanonymous.org/ga/ By the time the gambler comes for help they have broken brains (meaning, their brains don’t work like they used to when they were not in their addiction). To get real recovery, the gambler needs to work on himself/herself one day at a time and get someone who has been in recovery for a significant amount of time (a sponsor), who can help them learn how to think normally again. After some time in recovery, their brains will begin to go back to normal and they will once again become productive at their job and go back to being the father, mother, wife, or husband, son or daughter that they were before gambling took over. Recovery is a process and it takes a lot of work on one’s self, as well as making a moral and financial inventory. But, people can and do recover. Family involvement is crucial, and will enhance the treatment process. Family members need to understand that bailouts are detrimental to the gamblers recovery. They also need to take care of themselves and find their own road to recovery. There is a group called Gam-Anon with meetings throughout the United States. Their website is: www.gam-anon.org . Gam-Anon can help them understand the financial and emotional effects of living with a gambler.

leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling. 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. After losing money gambling, often returns another day to get even (“chasing” one’s losses). 7. Lies to conceal the extent of involvement with gambling. 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

Compulsive Gamblers and family members can find recovery from this devastating addiction, but it is a process that takes time and effort. During, and after treatment, the gambler needs to continue attendance at GA meetings, get a sponsor, have a pressure relief meeting to aid in financial recovery, and continue to learn and live the 12 steps of recovery.

A personal example from my own history while gambling is as follows:

Many people who go into treatment for drugs or drinking also have a gambling problem but it is rarely addressed in treatment. In most cases, treatment centers don’t have someone on staff that understands gambling addiction. When the client goes home and starts to gamble again, many of the old behaviors return. Hopefully, if the treatment center has someone on staff that understands gambling, the client can be assessed for a gambling addiction as well, and will be able to be treated for all addictions.

Sheila: I kept thinking it would get better, but married life just got worse. The refrigerator was empty, the furniture was threadbare and the scruffy apartment was even more dismal than you can imagine.

Symptoms of Gambling Disorder The DSM-5 indicates that the symptoms of Gambling Disorder are: A. Persistent and recurrent problematic gambling behavior

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Arnie: My gambling started at age 7 and lasted until I was 30. I placed my last bet on April 10, 1968. My wife Sheila can tell you a little of what went on in our home in the first seven years of our marriage before I got into recovery.

I was trying to get pregnant and thought having a child would pull us together. The doctor told me that the stress I was living with made getting pregnant more difficult, and I certainly was living with a lot stress. Eventually, I did become pregnant and those were happy times for me, even if it was one sided. I ignored what was going on in our lives together. I told myself everything was going to be wonderful and for a while, being pregnant was my delight and I was Continued on page 30

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HANLEY FOUNDATION’S PROJECT C4OPE (CONNECT FOR OVERDOSE PREVENTION AND EDUCATION): A FORUM SERIES FOR FAMILIES IN THE OPIOID CRISIS PROVIDES SUPPORT AND RESOURCES By Barbara Shafer, Director of Education, Hanley Foundation

When my 21-year-old daughter, Alison, passed away from opioid addiction-related causes three years ago, I quickly learned that the kind of assistance I truly needed at that time – a safe place to connect and share resources with other families who had gone through the same experience I had – was not easy to find. At the time, I was working in publishing, and had many local connections with caring people who expressed heartfelt support. I also found solace at the beach, where I could draw in nature’s positive energy. As a member of U.S. Masters Swimming and having trained for many triathlons, I could enter the ocean and find a measure of peace in the water, or I could go for a long, cathartic run or bike ride. But at the same time, I felt like there was a stigma surrounding a loss from overdose, an overall sense that society views those who struggle with addiction as having moral failure, rather than being in the grip of a terrible disease they cannot control. As a mother, all you want to do is care for your children and not see them suffer. Trying to help somebody who doesn’t want help is a hard reality I had to learn to live with. The science of addiction is something I learned along the way, too, but I also had to learn it was OK to continue to love my child. No matter the age or the issues, our children need that unconditional love. So, I never gave up on her, and kept trying to connect her with outside help hoping someday, somehow, somebody might say something that she would connect with, and she would win her battle with heroin. While there are many groups that provide excellent support to those grieving a loss – and I still attend these valuable meetings - the kind of connection I longed for after Alison’s death was with people who shared the unique emotions and challenges related to losing someone to addiction. Today, I am proud to say that while the loss of my daughter is no easier, I have found an empowering new path for myself that I hope will also help others along their own journey. As the Director of Education for Hanley Foundation, a statewide leader in substance use disorder prevention, education, advocacy and access to quality treatment, I am excited to announce the launch of Project C4OPE, a free forum series I will be facilitating that is designed to connect families who share the experience of a loved one who has died of opioid overdose, survived an overdose, or are at high risk for overdose. Palm Beach County leads the state in opioid-related overdose deaths, with more than 600 recorded in 2017 alone and more than 5,000 total opioid overdoses recorded in 2016. In the United States, overdose is the leading cause of death for people age 50 and younger. I am so grateful to be able to welcome families in the opioid crisis from across Palm Beach County to connect via Project C4OPE on Thursdays from 6-8:30 p.m. at four regional locations throughout the county through September:

which is funded through a grant from Palm Beach County and the Southeast Florida Behavioral Health Network: “We understand that the individual who has experienced an overdose is not the only one who has endured a traumatic event. Family members often feel judged or inadequate because they could not prevent their loved one’s overdose. It is important for the community and families to work together to obtain support following an overdose, or education on preventing a future overdose.” Topics to be discussed at the Project C4OPE forums include:

• • • • • •

Strengthening our understanding of the opioid epidemic Non-addictive strategies to manage chronic pain Raising the level of opioid prescriber education Medication-assisted treatment (MAT) Overdose-reversing medications Other topics identified as important by the family members

My philosophy is, whatever we can do to break the silence and talk about the opioid epidemic will help others like me. The more we talk, the more educated people become, and with education comes empowerment to change. I will always believe there is hope, and I welcome you to join me for one of the next Project C4OPE forums in your area. To register to attend one of the free sessions, please call 561-268-2355 or visit http://bit.ly/c4ope. I also encourage you to learn more about the mission of Hanley Foundation by visiting hanleyfoundation.org. About Hanley Foundation Hanley Foundation, established more than 30 years ago by Mary Jane and Jack Hanley, is a charitable 501(c)(3) organization with a mission to give hope to individuals, families and communities affected by substance use disorders. The Foundation provides programming and grant support throughout Florida for advocacy, prevention, education and access to quality addiction treatment. The organization’s prevention programming is available to schools, churches and community groups through grant funding provided by the Florida Department of Children and Families, office of Substance Abuse and Mental Health. Barbara Shafer came to Palm Beach County in 2000 from the northeast while advancing her marketing/publishing career. She received her Bachelor of Arts degree in Communications from the University of Dayton. Barbara has participated in numerous local community organizations as well as volunteering her time to philanthropic efforts for students through the Alliance of Women Executives (AWE) and is an ambassador for ALwayS for ALS, Inc. Barbara participated in the HGTC Addiction Lecture Series in Myrtle Beach, South Carolina in 2016 and has now made it her mission to bring hope to those families and individuals who have been affected by addiction and/or have lost children to addiction.

• NORTH COUNTY: 1st Thursday of each month (May 3, June 7, July 5, Aug. 2, Sept. 6) - Beach House Center for Recovery 13321 U.S. Hwy. 1, Juno Beach

• GLADES REGION: 2nd Thursday of each month (May 10, June

14, July 12, Aug. 9, Sept. 13) - Lakeside Medical Center, 39200 Hooker Hwy., Belle Glade • SOUTH COUNTY: 3rd Thursday of each month (May 17, June 21, July 19, Aug. 16, Sept. 20) - Guardian Recovery Network - 3333 S. Congress Ave #402, Delray Beach • CENTRAL COUNTY: 4th Thursday of each month (May 24, June 28, July 26, Aug. 23, Sept. 27) - Hanley Center at Origins - 933 45th Street, West Palm Beach Jan Cairnes, CEO of Hanley Foundation, explains why our nonprofit Foundation believes so strongly in the mission of Project C4OPE,

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Connect 4 Overdose Prevention and Education A Forum Series for Families in the Opioid Crisis Join us Thursdays through September from 6:30 pm – 8 pm. Meetings are free and open to the public with advance reservations at http://bit.ly/c4ope.

Meeting Schedule: • 1st Thursday of each month at Beach House Center for Recovery, 13321 US Hwy 1, Juno Beach • 2nd Thursday of each month at Lakeside Medical Center 39200 Hooker Hwy, Belle Glade • 3rd Thursday of each month at Guardian Recovery Network, 3333 S. Congress Ave #402, Delray Beach • 4th Thursday of each month at Hanley Center at Origins, 933 45th Street, West Palm Beach For more information visit hanleyfoundation.org or call 561-268-2357.

HANLEY

FOUNDATION

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LIVING BEYOND

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

ARE PHARMACEUTICAL COMPANIES INTENTIONALLY MARKETING TO YOUR CHILDREN? PHARMACEUTICAL AWARENESS AND THE CRAVING The pharmaceutical industry has been the unintentional catalyst for many addicts. It begins innocently: a patient sees his or her doctor for a major chronic issue, or they have a major surgical procedure. The patient is prescribed a narcotic for pain management, but in time, the narcotic is no longer enough or the prescription expires. The patient is then left with a craving for the relief that the narcotic provided. There have been countless examples in the media of prescription abuse and addiction. The list is equally as long as those who have lost their precious lives. The treatment should not end with the expiration of the pharmaceutical. Moreover, it may be advisable to help patients being weaned off of narcotics by working with a mental health professional.

In recent years, the manufactures of a variety of pharmaceuticals have been intentionally marketing to children. The pharmaceutical companies are not alone in this marketing strategy to reach children, but they have devised a way to reach them through a strategy that employs some ethically questionable tactics. A number of the pharmaceutical companies have not only marketed through traditional platforms, but have now become players in technological applications. According to a recent article in Business Insider, “Medical companies are bankrolling classroom lesson plans and comic books, hosting events with costumed characters, and promoting smartphone apps.” What is wrong with pharmaceutical companies creating awareness in the classroom? “Companies frame their efforts as a service to kids. But they also bring benefits to the company: Children might ask their parents for a certain medicine just as they would a cereal brand. And kids are valuable customers. The percentage of American children and teens taking prescription drugs has stayed fairly steady over the past two decades, but insurance companies are forking over more money for their pills.” Unfortunately, the pharmaceutical companies have recognized that children are a guaranteed consumer. If you convert them when they are young; they will remain loyal users and supporters of your company. Name brand and recognition of a product guarantees consumer loyalty, just ask the pharmaceutical company BandAid. How does consumer loyalty to pharmaceuticals relate to addictions? Pharmaceuticals would have you believe that they are the be-all and the end-all. Regrettably, pharmaceuticals are not always the answer nor will they cure all. The pharmaceutical companies would have you believe that they are capable of preventing or alleviating a majority of psychological and physical health related conditions, but what we have learned is that such conditions are more complex and they take a layered approach to treatment. Please understand that I do not intend on bashing pharmaceuticals, nor is it my objective to promote a particular psychological slant, but rather to bring awareness to the probability of a child developing an unintentional desire or addiction for pharmaceuticals or other substances. Moreover, we have witnessed an increase in a variety of pharmaceutical medications and their illegal counterparts. According to Dr. Donald W. Light of Princeton University, “few people realize that prescription drugs have become a leading cause of death, disease, and disability. Adverse reactions to widely used drugs, such as psychotropics and birth control pills, as well as biologicals, result in FDA warnings against adverse reactions.” The issues of addiction and an increased tolerance are a footnote in the advertisements.

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INTENTIONAL ADVERTISEMENT The marketing gurus of pharmaceutical companies are psychologically savvy. They intentionally market to children through a number of avenues. They target children by marketing to the child’s parents or caregivers, pediatricians, dentists, health specialists, teachers, mental health professionals, etc. While there are an infinite number of examples, the following are blatant acts of marketing to young children: Spriva (tiotropium bromide) asthma treatment features a gentle bear hugging a man throughout his day. It includes a clip of the man playing miniature golf where you see a supersized honeycomb. https://www.youtube.com/watch?v=J9LwjpBInEs Abilify (aripiprazole) anti-depressant treatment has targeted children through a variety of cartoon like characters including the letter “A.” The “A” character resembles an afternoon special or a Sesame Street Character. https://www.youtube.com/watch?v=tGymr78FtbU. How is the intentional marketing of pharmaceutical products any different than the previously banned tobacco or alcohol ads that targeted children? Do you remember the Joe Camel ad for Camel cigarettes, a product of the R.J. Reynolds Tobacco Company? “Do adults really need cartoons to understand what a drug can do? Or is there a more sinister plot afoot?” The pharmaceutical companies appear to be mimicking the past marketing strategies of big tobacco and the liquor industries. For many generations, youth and children of all ages were indirectly and directly marketed to. The Federal Trade Commission was “… successful in appealing to many children and adolescents under 18, induced many young people to begin smoking or to continue smoking cigarettes and as a result caused significant injury to their health and safety… the percentage of kids who smoked Camels became larger than the percentage of adults who smoked Camels.” Advertisements are not isolated to pharmaceutical companies, but have spread throughout a variety of school related products. According to an article in the American Academy of Pediatrics, “Ads are now appearing on school buses, in gymnasiums, on book covers, and even in bathroom stalls. More than 200 school districts nationwide have signed exclusive contracts with soft drink companies. These agreements specify the number and placement of soda-vending machines, which is ironic given that schools risk losing federal subsidies for their free breakfast and lunch programs if they serve soda in their cafeterias. In addition, there are more than 4500 Pizza Hut chains and 3000 Taco Bell chains in school cafeterias around the country.” Continued on page 30

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ADDICTION-WHERE WERE THE PARENTS?! By Katie Donovan

I see the comment so often when it comes to addiction. “Where were the parents?”. That REALLY infuriates me. It adds to the stigma that is already present and a big reason why so many families keep the struggle to themselves. We feel judged, people cast downward glances, unsure of what to say. Where was I? When you were born, I stayed up all night long, feeding you, changing your diaper, reading the latest books on parenting. I rocked you to sleep singing lullabies, holding your little body close to me. Where was I? When you were 5, I helped you learn how to ride your bike without training wheels. Memories are flooding in of running down the driveway, holding on to the seat of your bike, while you laughed like crazy with joy. Where was I? When you were in the 2nd grade, I taught your catechism class and watched with pride while you made your 1st Holy Communion, surrounded by the love of family and friends. Where was I? When you lost your teeth, I was the tooth fairy, sneaking money under your pillow while you slept, and ran into your bedroom in the morning, as I couldn’t wait to see the smile on your face when you discovered it. Where was I? When the thunderstorms came, you were scared and we snuggled under the covers, while I rubbed your back to ease your fear. Where was I? When you were involved in sports, I came to every game, cheering for you at the top of my lungs and going out for the celebratory ice cream after. Where was I? When you were 16, we had a code word “Bible” that you could text me at any time, if you were in a situation you were

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uncomfortable with, and I would pick you up, no questions asked. Where was I? When you were 17, I rushed to the ER when I got a call that you had flipped your truck, with a very high level of xanax in your system. I didn’t understand how this happened and we got you into therapy right away, hoping we could “nip this in the bud”. Where was I? Frantically driving around the streets of Detroit, trying to find you, with tears streaming down my face, fear in my stomach, yet determination in my heart. Where was I? When you came to me in tears, that you had become addicted to heroin and didn’t know how to stop. We cried together, me rocking you in my arms again, promising you that we will get through this together. Where was I? When we searched for rehabs together, my head whirling that this was even reality, my sole focus was on saving you, as you were in the bathroom vomiting from withdrawals. Where was I? For the next 10 years, I was by my daughter’s side, never giving up on her, riding the roller coaster of addiction that practically tore our family apart. 20 rehabs, detoxes, psych stays, 4 different states, countless overdoses, sleepless nights, jail stays, etc. As a parent, when your child is sick with a disease, you never give up. That’s where I was. Go ahead. Judge me. Katie Donovan is a writer, family recovery coach, EVP of Families Against Narcotics and Co- Founder of Hope Not Handcuffs. katie@amothersaddictionjourney.com www.amothersaddictionjourney.com

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WHAT TO EXPECT FROM NEW OPIOID DRUG POLICY (PART 2 OF 2) By John Giordano, Doctor of Humane Letters, MAC, CAP

This is the second installment of this article. In Part 1, I examined the first two prongs of the administration’s proposed three prong approach to ending the opioid epidemic. I showed how building a wall on our Southern border would do little to slow the import of illicit drugs, as they are coming into this country at every port, with fentanyl increasingly coming from our northern border and from China through mail carriers. I also demonstrated how revitalizing the “Just Say No” campaign would be an effort in futility as it was an abject failure in the 80’s. Perhaps what is most astounding about the third prong of the new policy is the intent of the President and Attorney General to execute drug dealers. If I am to be completely honest here, I must admit upon hearing this policy, I wondered if opioid Pharmaceutical company’s CEOs, opioid distributer CEOs, pharmacists who knowingly fill opioid prescriptions for addicts and doctors who over prescribe opioids would fall into the “drug dealer’ category and be subject to the death penalty considering that 8 out of 10 opioid addicts got started with prescription opioid painkillers. What most people don’t realize is that many addicts sell drugs to finance their own habit. Additionally, executing them, as good as it might make some people feel, will have no effect on curbing illicit drugs coming into our country. The threat of capital punishment means nothing to drug dealers. The reality is these people face the death penalty every morning when they wake up. The vast majority of street drug dealers are poorly educated individuals from economically depressed areas; they have no skills or hope for a better life whatsoever. When you take one of them off the street another pops right back up in his or her place. Its economics 101: as long as there is a demand for a product or service there will be a supply. The Philippines provides the best insight into the efficacy of capital punishment as a deterrent to drug trafficking and abuse. It’s been nearly two years since President Duterte declared a War on Drugs. Estimates range between 7,000 and 12,000, mostly poor addicts and low level drug dealers, were killed in that time frame. The success or failure of this egregious and large-scale violation of human rights as a policy intended to deter drug trafficking and abuse is a bit murky.

punishment – the Philippine’s experiment has proven this to be true. If we are to have an honest conversation about ending our epidemic we must first get past the white noise so that we can embrace a forward thinking strategy founded upon evidenced-based and scientifically-proven effective modalities. The first area I would recommend we look at is mental health. We simply do not have enough resources dedicated towards treating people with mental health conditions. In 1955 there were 166 million people living in the U.S. and 560,000 state psychiatric beds. In 2016, we have twice the population (325 Million) and only 37,679 state psychiatric beds – less than 7% of the number of beds in 1955. In 1955, there were about 340 beds per 100,000 population; today it is closer to 11. Experts estimate that between 40 to 60 public psychiatric beds per 100,000 population is the absolute minimum necessary to treat today’s Americans with mental health issues.

When Elephants fight only the ants are killed.

There have been advancements in the treatment of mental health, but certainly not nearly enough to justify the egregious loss of psychiatric beds. This has far more to do with money and budgetcutting than treatment.

The president and his loyalists are claiming a resounding victory in their “War on Drugs” policy; nevertheless, their own Philippine Drug Enforcement Agency’s data suggests illicit drugs have become even more available and cheaper in Manila. It appears as though the upper echelon drug dealers and drug lords have come out of this mass homicide unscathed and are importing more drugs than ever before to compensate for the drug labs lost in the war; supply meeting demand. There is no reliable information even remotely suggesting that drug abuse has abated in the Philippines due to the “War on Drugs” policy.

What could possibly go wrong? So what happens to the most vulnerable of all Americans; the ones with mental health conditions who are in dire need of treatment? Doctors prescribe them opioids. Every morning when you walk out your front door to face the world, you are surrounded by people with mental health issues using or abusing legal opioid painkillers prescribed by their family doctor. They may be driving the car behind you at the stop light, or it might be the crossing guard helping your children through a busy intersection. You just don’t know.

Moreover, this policy will catch addicts in the dragnet. It’s already happening right here in states with laws on the books similar to what the president is proposing. I read about a young woman, not too long ago, who was arrested for murder when the person she was with died from an overdose. The state charged her as a dealer even though the woman pooled her money with her friend’s so that they could get a better deal on the heroin. A lot of addicts will do that – pool their money with people they’ve just met. However, this case made state headlines and I’m sure it gave everyday citizens that heard about it a sense of relief and satisfaction that their state was ‘getting tough on dealers’ and doing something to fight this epidemic. But that is about the extent of the usefulness of these types of laws – to grab newspaper headlines and TV lead story lines that give a false sense of safety and security to an unsuspecting populace because it does absolutely zilch in stemming the tide of illicit drug sales and abuse.

People with mental health conditions receive more than half of the total opioid prescriptions distributed in the United States each year. In a study published by the Journal of the American Board of Family Medicine (July 6, 2017), researchers found that more than 7 million adults with mental disorders are prescribed opioids each year – what could possibly go wrong?

The simple reality is that we are not going to change the tide of our raging opioid epidemic through banal policies and capital

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This is particularly concerning because mental illness is also a prominent risk factor for overdose and other adverse opioid-related outcomes. Moreover, opioids may temporarily improve symptoms of some mental illnesses leading to patients who experience this to ask for more and/or stronger opioids. Does it come as a great big surprise to anyone that people with mental health issues who are prescribed and taking powerful opioid painkillers might behave in a way outside of the norm and the law?! Continued on page 29

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UNDERSTANDING ADDICTION IS NOT ENOUGH- AFFIRMING YOUR LGBTQI CHILD MAY SAVE THEIR LIFE By Alicja Majer, MSW Intern, BSW, CRRA

As a parent or family member who has dealt with addiction in the family, or more specifically, if you have dealt with your child’s addiction, you might ask yourself, isn’t understanding my kid’s addiction enough? The answer is no. When thinking about the complexity of addiction and how it affects all areas of a person’s life, we sometimes forget to recognize key components, such as, freedom to be your authentic self and comfortability with feeling accepted by your community, family, and loved ones. When we look at the Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex (LGBTQI+)* community, that authenticity and comfortability stems from a freedom of gender identity, sexual orientation and expression. All these pieces are important, especially, when in conjunction with addiction, and many times- a mental health diagnosis. Gender Identity When we look at gender identity we are talking about the ways we define and categorize our genders. That could be through the binary lens of male or female, a combination of both or neither one. Dictionary definition: A person’s perception of having a particular gender, which may or may not correspond with their birth sex Sexual Identity/Orientation When we say sexual orientation or even sexual identity we are referring to the way we categorize and define who we are attracted to romantically, sexually, emotionally or sometimes- not attracted at all. Can be defined as: A person’s sexual identity in relation to the gender to which they are attracted; some examples are heterosexual, homosexual, or bisexual. For someone on the outside, it’s tough to conceptualize the struggle of the LGBTQI+ population. It’s often when someone close to them or they themselves have an opportunity for such certain experience that it brings them closer to a sense of understanding. Often, they are left feeling uncertain, uncomfortable, and unable to see differently due to their inability to step outside of the engrained understanding of the world around them. This is especially true for parents of LGBTQI+ children, and it is not uncommon. What is common are the research based facts from the Human Rights Campaign that outline the set back of the community showing that 25% of LGBTQ people abuse alcohol compared to 5-10% of the general population, 41% of transgender and gender nonconforming people have attempted suicide, whereas 1.6% of all people have tried to take their own lives. And what does this mean to us? Well, according to The Center for American Progress “The stress that comes from daily battles with discrimination and stigma is a principal driver of these higher rates of substance use, as gay and transgender people turn to tobacco, alcohol and other substances as a way to cope with these challenges.” All these statistics are just an overview. When we add suicidality, depression and anxiety, as well as addiction- the suicide rates rise to more than 41%. When we look at homophobia (dislike of or prejudice against homosexual people) and transphobia (intense dislike of or prejudice against transgender people) engraved in some societal perspectives, we see a common denominator behind the feelings of shame, rejection, hopelessness, and fear. Both phobias can be defined as prejudice, discrimination or violence against an LGBTQI+ identified person. This systemic oppression is not just external but can often become an internal struggle in the form of internalized oppression, both just as harmful to an LGBTQI+ person. This oppression can be easily seen in a survey by Human Rights Campaign that states “roughly 50 percent of LGBTQ Americans live in states where they’re at risk of being fired, denied housing, or refused service because of who they are.” To access the disadvantages based on gender identity

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and sexual orientation represented by each state, go to: www.lgbtmap.org and click on equality maps. We ask ourselves, what does inclusion; recognition and an affirming response do for the LGBTQI+ person? These three actions produce less suicidality, less depression, less anxiety, and less dysphoria, which means stronger mental health which is the most important thing- for anyone. Stronger mental health means having the tools for a more successful recovery from addiction. Social cohesion and increased sense of security are a direct result of inclusion, especially inclusion offered by the family system. On the flip side, social exclusion and abuse only result in poor mental health, suicidality, self- harm, addiction, and feelings of not being safe, as pointed out by The National LGBTQI Health Alliance. Despite the influx of information regarding the challenges and risks for lesbian, gay, and bisexual (LGB) individuals, as well as rising information on trans individuals, we know far less about their strengths and resiliency, including the strength of families in supporting their children’s health and well-being. According to Family Acceptance Project at San Francisco State University this scarcity in reflection of strengths also affects the family. “There is a lack of information about how family involvement, especially parental and caregiver reaction directly contribute to reducing risk and evolving the LGBT person’s well-being.” “Victimization has long-term consequences for health and development, and impacts families as well as the targeted individuals. Early intervention can help families and caregivers build on strengths and use evidence-based materials to understand the impact of acceptance and rejection on their child’s well-being.” According to PFLAG, United States’ largest organization uniting families and allies with LGBTQ people, “LGBTQ youth who reported higher levels of family rejection during adolescence are three times more likely to use illegal drugs.” The bottom line is we have to recognize how rejection and acceptance can have an enormous impact on a LGBQI+ person’s well-being. How can we increase family support? For families that are not ready or are having difficulty accepting their loved ones, seeking help in the form of individual support, a support group, individual counseling or even family therapy could be a good start. Practitioners should try to meet the parents “where they are” in their process to help support and build an alliance with their LBGQI+ child. According to research by SAMHSA “few parents and caregivers have had opportunity to talk about their concerns and hopes for their LGBT child with a supportive, nonjudgmental professional.” Jaki Neering, who is a primary therapist working with LGBTQI+ Continued on page 29

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TRAUMA THEN AND NOW (PART 2 OF 3) By Nancy Jarrell O’Donnell, MA, LPC, CSAT

In Part 1- May 2018 we discussed what trauma is and the history of trauma. To read this article, please go to www.thesoberworld.com and enter the title name. Underlying Causes of Trauma What happens in the brain - The limbic system is a set of brain structures located in the middle area of the brain. The limbic system is responsible for our survival instincts and reflexes. It manages body temperature, hydration, sexual arousal, the stress reaction, motivation, memory, emotional processes, and olfaction. Within the limbic system is the amygdala, a small almond shaped nucleus. The amygdala, in short, is the area of the brain that alerts us to danger and initiates autonomic responses to insure our safety. It is responsible for evaluating the emotional meaning of incoming sensory information to the brain. The amygdala is fully developed by the 8th month of gestation. The amygdala further apprises for danger and threat. The hippocampus is also a structure within the limbic system and processes data to make sense of an experience and places the information in a timeline. The hippocampus also interprets the safety of the environment. If not able to function properly, we may demonstrate impairment in discerning the signals in our environment. It also plays a role in consolidation of both short term and long term memory. When trauma occurs, the memory can be stored both in implicit memory (sub-conscious) and/or explicit memory (factual memory). Implicit memories may present as somatic symptoms in the body with no attached content for the individual. When trauma occurs our natural biological processes are activated. Epinephrine is one neurotransmitter that is secreted during terror and acts to cement memory. Continued terror can result in too great a secretion of epinephrine, which can overwhelm the system and impair memory. Trauma memory is not linear. It becomes fragmented and disorganized. Trauma memory becomes stored in physical sensations, sounds, smells, images and other emotional and sensory traces. For this reason, anything can trigger a trauma memory. A trigger can be a scent, a location, a sound, a body position, a color, and more. Someone can be triggered into a trauma memory when a current internal state replicates an internal state from a previous event and time. It is worth noting that the Olfactory Bulb (sense of smell) is within the limbic system and many childhood events are only remembered through our sense of smell. It is not surprising that many trauma memories may lack linear, visual detail but will be robust with the scents present at the time of the trauma. Scent memory is continuing to be tested but some recent research has demonstrated that not only does scent have effects on the body but that it does not require a great deal of odor to make this impact. When under stress our bodies release a hormone called cortisol. Cortisol is critical for our survival in the short term as it fuels our body when the fight or flight response is needed. Too much cortisol however can essentially flood the hippocampus, and results in impairment of the hippocampus and consequently impaired memory and problems with new learning. The excessive release of cortisol can also impair the amygdala’s performance of regulating our emotions, specifically fear, in the case of trauma. The result is an impaired ability to exhibit the appropriate amount of fear in the context of what is happening around us. Anyone consistently exposed to severe stress will become wired to operate from survival instincts of fight, flight and freeze, even when it is not necessary to do so. Attachment Theory and Trauma Trauma is often about unmet needs. All humans require a wiser and

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more advanced human to attach to in early life to ensure their survival. The one they attach to becomes their model from which they learn behaviors and how to interact with others to ensure they are fed, safe, nurtured and consistently cared for and provided for. If the attachment figure is inadequate, the system of healthy human connection is damaged. Infants react to a primary caregiver’s (usually Mother) emotional state. They personalize the mother’s emotional state. If, for any reason, the infant does not experience the mother as consistently safe and attentive or as frightening, neglectful or even rageful, the infant will not be able to connect to the mother in a way that supports optimal emotional, mental and behavioral health. We know that the first three years of human life is the period when the brain grows most rapidly. Attachment failure can occur during this time when the child is completely dependent on others for her survival. For the brain to wire and develop in the most optimum way for mental and emotional health, safety must be present in childhood. Disruption of the attachment system is trauma. The early life relationship dynamic we have with our caregiver is imprinted in the brain providing a template of how we engage in relationships in the future. Historically, children were able to have their needs met by attaching to a culture or a community. A village did raise a child and thus attachment failure was not as prolific. If attachment needs are not met; a child will find another way to connect. Examples today are through the Internet, Facebook, social media, texting etc. A great deal of critical learning involving selfsoothing does not occur when there is not eye contact and physical touch from the primary caregiver in early life. Not everyone with symptoms from trauma has had attachment failure. Our culture places high expectations on us to manage ourselves in the face of disaster, to “get over it”, to move on etc. and these are unrealistic and harmful expectations. These messages can result in a need to medicate the emotional pain in some way. Trauma Sub-Types The following sub-types of trauma are not found in the DSM. They are not coded diagnoses yet are very real and warrant the attention of any good clinician. Complex Trauma or Developmental Trauma – Complex trauma results from exposure to repeated traumatic experiences over time. Developmental Trauma occurs when this repeated exposure specifically occurs across the developmental years. The impact on a developing child suffering repeated abuse, neglect, and more is profound and results in changes in the brain that affects the development of healthy neural pathway formation. Children who grow up in an environment of frequent terror, in which they need to stay vigilant for personal safety, can develop a brain state of chronic hyper-arousal. This state of hyper vigilance interferes with an individual’s ability to focus and retain information due to a need of maintaining high alert status for safety. Over the years, I have worked with many patients admitting to treatment with diagnoses of ADD, Bi-Polar Disorder, Borderline Personality Disorder to name a few… that I have questioned as mis-diagnoses, as their behaviors seem more accurately to be the result of attempts to self-regulate after debilitating complex trauma. Traumatic Shame – This can be considered another sub-type of Developmental Trauma. A child who is repeatedly subjected to criticism, shaming, and devaluing comments over the developmental years will struggle with having healthy esteem, a sense of place in the world, and safety in the world. Children who are repeatedly shamed verbally, emotionally, physically and/or intellectually will develop traumatic shame. This shame can lead to behaviors, which have negative consequences such as addictions or other mental health conditions. A child subjected to emotional shaming will develop negative self-cognitions such as “I am unworthy”, “I am unlovable,” “I am

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attachment theory. Traumatic grief is misunderstood in our culture and many myths exist as to how symptoms should progress and just disappear over time. This does not happen. Individuals may develop shame over long-term grief over a loss. Traumatic grief and the long-term symptoms are normal reactions to horrific loss and in some instances extreme separation anxiety. The continued need to be in close proximity to the deceased lends to the separation being traumatic. Some symptoms include a preoccupation with the deceased that results in longing and searching, an example being scanning the environment for cues of the loved one. In addition, shock, disbelief, purposelessness, difficulty imagining a fulfilling life without the loved one, numbness, detachment, distortions of time and memory and more. As a bereaved parent, I relate at a deep personal level to this diagnosis.

a mistake,” etc. Examples of the emotional shaming messages that as they accumulate become traumatic are comments such as “You are stupid, who asked for your opinion? “I wish you were never born, you don’t have anything smart to say, you are a disappointment, what is wrong with you, what makes you think you know anything?” As a child becomes increasingly distressed finding no comfort or emotional safety from those responsible, a cascade of brain changes occur that end up compromising the function of the amygdala, over sensitizing it, and also impairing the hippocampus. When these two areas of the brain are sabotaged, the result can be memory distortion, and skewed intense emotional responses to seemingly minor stimuli. When an infant or child pre-language age is exposed to repeated negative experiences, the emotions and experiences are stored in implicit memory and body memory as the child had no capability for language at the time of the traumatic occurrences. Implicit Memory – Implicit memory is critical to better understanding the impact of trauma. Implicit memory is subconscious and is stored in the brain’s frontal lobes. It is responsible for storing procedural information relevant to learning tasks, skill performance and emotional associations. An example of implicit memory is learning to ride a bicycle. Perhaps I don’t ride a bike for many years, but my procedural memory allows me to get back on the bike and ride effortlessly years later. Implicit memory in general is memory that I don’t have grasp of but it has associations paired with a specific event. In terms of emotional associations, imagine a toddler is learning to walk and as her parents sit facing her with looks of joy and pride, she begins her first steps towards them. In an instant, the family dog jumps up and knocks the toddler over. Just as the parents see the dog moving towards the toddler their faces change to looks of fear and anger. The toddler takes in a snap shot of their faces just as she falls. She begins to cry. Perhaps the child begins to associate achievement with pain. She does not remember the incident but the event could be important in understanding a pattern she develops of self-sabotage over time, fearing success and not knowing why. This is how implicit memory can play a critical role in shaping patterns of behavior. In 2008, I attended a conference in Phoenix on Trauma and Bereaved Parents. Dr. Robert Scaer was the Keynote Speaker and stated “PTSD is a complication of memory.” He further described how individuals with PTSD might have images, behavioral impulses, and body sensations but no understanding of why and may lack any context to connect these two. Traumatic Grief – Despite a strong movement by psychiatry, this disorder did not make it into the DSM V. The diagnosis is characterized by a sudden, unexpected, and perhaps untimely death that includes both violent death and non-violent death that result in traumatic separation. An adult form of separation anxiety that is severe is at the root of traumatic grief and is connected to

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Betrayal Trauma – This diagnosis is frequently used to describe the resulting symptoms of a spouse or significant other after discovering their partner has engaged in secretive, sexual behaviors and/or gone outside of the relationship emotionally as well. If repetitive deception occurs, the resulting emotional and psychological pain for the partner can be staggering, as the neurochemicals in the brain are released preparing the betrayed for the next possible unseen threat or danger. Emotional trauma can result in the brain staying in a state of high alert with resulting hyper vigilant behaviors to protect the self. These behaviors can be seen in the betrayed partner’s seeking safety by spying, snooping, and seeking more evidence of improprieties as the need to know becomes obsessive and all consuming. Betrayal and resulting trauma can occur in a variety of contexts besides an intimate partnership. Work environments in which employees are in constant competition for maintaining a position, promotion, or the good graces of their supervisor are rich with betrayal. Fear based organizations may have shareholders and board members whose employees perceive as strangers and disconnected from the day to day operations of a facility. We all have an innate need to be recognized. If one believes their employer sees them solely as a dollar number, not an individual, the fear spreads and creates an environment ripe for betrayal. Nepotism continues to be rampant across the business world and trust in leadership can be nil if employees view a leader as unskilled and in the position solely due to familial relationship. Sudden job termination with no explanation after long-term commitment, high performance, and loyalty to a company can be devastating and experienced as a trauma. Betrayal comes in many forms as seen in cases involving incest, religious abuse, terrorizing to control, seduction, and abuse of power. Multi-generational trauma – Much has been written about the unspeakable long lasting day after day horror experienced by victims of the Holocaust. Research has revealed that the emotional and psychological scars suffered by the victims are still reflected in the behaviors of descendants. Physical adaptations such as changes in the body to better tolerate starvation are found in later generations of Holocaust survivors, despite not needing that adaptation in their current environment. In Part 3, we will discuss the Treatment for Trauma. Nancy Jarrell O’Donnell specializes in addiction and trauma treatment. She has spent most of her 25-year career working in residential and in-patient facilities. Her experience ranges from Psychotherapist to Clinical Director to President of Clinical Services/Operations. She is a licensed therapist in Arizona currently in private practice. She developed The Sabino Model: Neuroscience Based Addiction and Trauma Treatment™ www.nancyjarrellodonnell.com ©Nancy Jarrell O’Donnell 08/31/2017

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For the Families THE CALL NO PARENT WANTS TO GET By Liz Pires

On March 30, 2018, my husband and I were out of town when we got the call no parent ever wants to get. After not hearing back from my 19-year-old daughter all morning, we asked my son in Texas to ask his friend in California to check on her. She was found nonresponsive, and the paramedics could not revive her. An hour after the initial call, my son called to inform us she had passed, and the police would be calling us to confirm our worst fears. My heart sank, and I got the biggest pit in my stomach. We were traumatized and devastated. Almost two years prior, in March 2016, she had opened up to me and her step-dad, who loved her as if she was his own daughter. She told us she had a problem with drugs and asked for help. It took courage for her to trust us enough to admit she had a problem for which she had no control over. We had no idea she was an addict. Initially, we thought we were dealing with typical teenage defiance. In hindsight, we came to realize we were in denial that something far worse was wrong. However, we were greatly relieved she had found the strength to ask for help. The deep, dark world of addiction is not one we ever expected to be in. We knew nothing about it and quickly took a crash course to find out what we were supposed to do to help her. We read extensively, sought out counseling and attended support groups to learn from the experts. It was like learning another language with its own acronyms and words we had never heard before. This is when we learned about using an Education Consultant (EC). We did considerable research to find an EC whom we felt could best help her. After several interviews with her and family members, the EC recommended we send her to a wilderness program. We were taken aback because we thought the EC was going to recommend a school she should attend to finish high school in a safe, drug-free environment. In addition, we were totally unfamiliar with wilderness programs. The EC said education was a secondary priority at this point and insisted my daughter needed an “intensive” intervention, another term we were not familiar with. In a state of shock and disbelief, we tried to wrap our heads around all this new information. My daughter had an opiate addiction, specifically heroin, which we came to learn was quite serious and extremely hard to break. After the thought of sending my only daughter into the wild in another state sunk in, the EC narrowed down our choices. We chose one, and she agreed to go. So, we quickly began figuring out all the logistics. In the process, we learned it is rare for an addict to come forward on their own and ask for help. Because of her willingness to go, she would not require professional transport, or “being gooned” as the kids term it. This was the beginning of our treacherous journey down the road of addiction that is full of hope, heartbreak and financial despair. She spent seventy-seven days in the wilderness program, immediately followed by an additional forty-five days in a residential treatment center (RTC). This allowed her to gradually reintegrate back into the “front world.” The RTC program included individual, group and family counseling, as well as school and meetings. She was doing very well, which “they do until they don’t.” In October 2017, I received a phone call from her; she was crying hysterically. She had been in an accident. Fortunately, she was alive, only shaken up. No one was hurt, but she had hit at least four parked cars and flipped her car, totaling it.

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When we arrived at the scene of the accident, we thought she was lucky to be alive. There were several police cars, one lane closed, and tons of onlookers. She had relapsed after a fight with her boyfriend and ended up in jail. She had been sober for seven months. Part of ensuring accountability was a family contract which she had agreed to and signed. Per our family contract, if a relapse occurred, she would immediately go into detox and start treatment again. Once again, I began contacting resources to find a place for detox and rehab. To her surprise, we picked her up from jail and drove her straight to detox. After completing detox, she transitioned into a ninety-day treatment program which she completed successfully. Then, she stepped down to an intensive outpatient program (IOP), followed by an outpatient program (OP). She was also taking high school classes. Only a few chapters were left in her last class. This put her on track to finish by April 13, 2018, the week after spring break. She had picked out her graduation gift, a trip to South Africa to volunteer at a monkey and wildlife rehabilitation center. But, instead of planning an exciting celebration for her graduation, we were forced to plan her funeral. For some time, my daughter had wondered if she was bipolar because she felt like she had two different personalities. As part of our addiction education, we learned that addiction is a brain disease and that her addict self is like a separate personality. The goal in recovery is to suppress her addict self and keep her sober self in control because only the sober personality can reason and think logically. Addiction is truly a family disease because it affects the entire family. Parents of a child who is an addict feel the stigma of shame and guilt. We found ourselves putting our lives on hold, not doing our usual activities or going on trips because we always wondered in the back of our mind if something would happen. And, just as we started to move on and live our lives normally, tragedy did happen. My daughter had been doing so well. She was sober five-and-onehalf months, about to graduate high school, had just gone to her outpatient group, had a clean drug test and was dead three days later. She had a bad day and her addict self reared its ugly head, took control and made a deadly decision. She chose the wrong way to cope instead of using the skills she learned in therapy. She was beautiful and had her whole life ahead of her. This final relapse was not only the end of her recovery, but, tragically, the end of her life. Liz Pires is an average American, middle-class family, mom, wife, daughter, sister, aunt, corporate executive.

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IMPORTANT HELPLINE NUMBERS

A New PATH www.anewpath.org Addiction Haven www.addictionhaven.com Bryan’s Hope www.bryanshope.org CAN- Change Addiction Now www.addictionnow.org Changes www.changesaddictionsupport.org City of Angels www.cityofangelsnj.org FAN- Families Against Narcotics www.familiesagainstnarcotics.org Learn to Cope www.learn2cope.org The Long Island Council on Alcoholism and Drug Dependence www.licadd.org Magnolia New Beginnings www.magnolianewbeginnings.org Missouri Network for Opiate Reform and Recovery www.monetwork.org New Hope facebook.com/New-Hope-Family-Addiction-Support-1682693525326550/ Not One More www.notonemore.net/

ALCOHOLICS ANONYMOUS WWW.AA.ORG AL-ANON WWW.AL-ANON.ORG 888-425-2666 NAR-ANON WWW.NAR-ANON.ORG 800-477-6291 CO-DEPENDENTS ANONYMOUS WWW.CODA.ORG 602-277-7991 COCAINE ANONYMOUS WWW.CA.ORG 310-559-5833 MARIJUANA ANONYMOUS WWW.MARIJUANA-ANONYMOUS.ORG 800-766-6779 NARCOTICS ANONYMOUS WWW.NA.ORG 818-773-9999 EXT- 771 OVEREATERS ANONYMOUS WWW.OA.ORG 505-891-2664 NATIONAL COUNCIL ON PROBLEM GAMBLING WWW.NCPGAMBLING.ORG 800- 522-4700 GAMBLERS ANONYMOUS WWW.GAMBLERSANONYMOUS.ORG 626-960-3500 HOARDING WWW.HOARDINGCLEANUP.COM NATIONAL SUICIDE PREVENTION HOTLINE WWW.SUICIDEPREVENTIONLIFELINE.ORG 800-273-8255 NATIONAL RUNAWAY SAFELINE WWW.1800RUNAWAY.ORG 800- RUNAWAY (786-2929) CALL 2-1-1 WWW.211.ORG ASSOCIATION OF JEWISH FAMILY AND CHILDRENS AGENCIES WWW.AJFCA.ORG 410-843-7461 MENTAL HEALTH WWW.NAMI.ORG 800-950-6264 DOMESTIC VIOLENCE WWW.THEHOTLINE.ORG 800-799-7233 HIV HOTLINE WWW.PROJECTFORM.ORG 877-435-7443 CRIME STOPPERS USA WWW.CRIMESTOPPERSUSA.ORG 800-222-TIPS (8477) CRIME LINE WWW.CRIMELINE.ORG 800-423-TIPS (8477) LAWYER ASSISTANCE WWW.AMERICANBAR.ORG 312-988-5761 PALM BEACH COUNTY MEETING HALLS CLUB OASIS 561- 694-1949 CENTRAL HOUSE 561-276-4581 CROSSROADS WWW.THECROSSROADSCLUB.COM 561- 278-8004 EASY DOES IT 561- 433-9971 THE TRIANGLE CLUB WWW.TRIANGLECLUBPBC.ORG 561-832-1110 LAMBDA NORTH WWW.LAMBDANORTH.NET

PAL - Parents of Addicted Loved Ones www.palgroup.org/

BROWARD COUNTY MEETING HALLS

Parent Support Group New Jersey, Inc. www.psgnjhomestead.com

101 CLUB 954-573-0050 LAMBDA SOUTH CLUB 954-761-9072 WWW.LAMBDASOUTH.COM PRIDE CENTER WWW.PRIDECENTERFLORIDA.ORG 954- 463-9005 STIRLING ROOM 954- 430-3514 4TH DIMENSION CLUB WWW.4THDIMENSIONCLUB.COM 954-967-4722 THE BOTTOM LINE 954-735-7178

P.I.C.K Awareness www.pickawareness.com Roots to Addiction www.facebook.com/groups/rootstoaddiction/ Save a Star www.SAVEASTAR.org TAP- The Addicts Parents United www.tapunited.org

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WORDS AND PHRASES WE NEED TO ERADICATE FROM OUR TREATMENT LANGUAGE By Jim Holsomback, MA

Language is important. For those that were raised to believe the adage “It’s not what you say, but how you say it”, it was a lesson learned early in life. From childhood, we are taught that using manners, speaking kindly to others and avoiding words that we may later regret are integral lessons in communication that are important to adopt. In the clinical and addiction field, we often find kinder, gentler tones to describe disorders, behaviors and interactions because semantics are important and we strive to have relationships with patients that keep them engaged in treatment and feeling heard, respected and understood. In the treatment community, we have also worked to ensure that words are behaviorally defined and absent of stigma which can contribute to experiences of feeling marginalized as a patient, or unequal in the patient/practitioner relationship. The lay community has certainly noticed as well, and words like ‘crazy’ and ‘druggie’ are viewed as the ignorant and inconsiderate words that they are. As we continue as a treatment community and society to better define our language, and thus, diagnoses, symptoms and behaviors; we have also reached a time to strike a few other antiquated terms from our clinical language that would continue to destigmatize the important clinical work we provide. Here are some proposed words and phrases that have hit their expiration date… “Client” – The word ‘patient’ is used to describe someone receiving treatment for a pathology that needs clinical care. Formally, patient is defined as ‘a person receiving or registered to receive medical treatment’. A client is defined as ‘a person or organization using the services of a lawyer or other professional person or company’. So, how did the psychiatric and addiction community begin using the word ‘client’ to describe a person seeking medical treatment? The short answer? Stigma. The medical community describes their patients as just that. A person seeking treatment for leukemia is not a ‘cancer client’ nor is a transplant patient a ‘client receiving a new heart’. They are patients because of their pathology and their willingness and strength to engage in treatment which is celebrated by their status as a patient receiving care for their pathology. We should not denigrate our patients by hiding behind euphuisms such as ‘client’ or ‘individual’ and communicate shame in their mental health or addictive disorder. “Enabling/Enabler” – Again, if we were to rely on the actual definition, we would be casting blame on the ‘enabler’ as giving the patient the authority to engage in an unwanted behavior. It simultaneously takes the control for changing an unwanted behavior away from the patient and gives an inflated sense of power (and implied control) over the behavior to another person. If that were true, once an ‘enabling’ person stopped contributing to another person’s behavior, then the behavior would stop. It is full of pretense, a perceived control, and judgment. Let’s work toward behaviorally defining what is happening and avoid harsh judgment around the intention. Most behavior that is defined as ‘enabling’ should be defined as the desire for someone to reinforce behavior with negative consequences with really good intentions and a lack of awareness. Practitioners often see people in families and relationships working in a diligent manner to help a family member or friend and often, they have been reinforced to do so without bad consequences. As a behavior becomes more acute and pathological, family members continue to find themselves reinforcing the same behavior in spite of it becoming problematic. Rather than casting blame and hoping that someone can bring awareness to their unintended reinforcement, let’s work toward defining the behavior and helping them understand how to find a more effective role as a support in a patient’s recovery.

endorse this phrase as a useful treatment term. Unfortunately, as we all know, what is ‘rock bottom’ one day can often be ‘topped’ (or bottomed?) the following week with behavior or symptomatology that is more concerning and acute. When we are treating patients that are implicitly at risk for relapse, the utility of labeling a behavior or situation as ‘incapable of getting any worse’ seems counterintuitive. A lot of people have another relapse left- but unfortunately, everyone doesn’t have another recovery. That may be the only accurate usage of the ‘rock bottom’ verbiage. Using a disorder to describe a person – Again, when we think of traditional medicine, patients are not labeled as an ‘insuliner’ or ‘melanoma-ey’. Yet, when we are working in psychiatric and addiction circles, we hear patients described as “so borderline”, “addict” or a “cutter” and more. Let’s put some space between the person and their disorder or behavior in the same way we would with any other diagnoses because everyone is, first and foremost, a person who is receiving treatment for or suffering with the diagnosis for which treaters can provide compassionate treatment…..and language. Jim Holsomback is the Director of Clinical Outreach for McLean Hospital and Program Director for Triad Adolescent Services. www.mcleanhospital.org www.triadadolescentservices.com

“Rock Bottom” – If ‘rock bottom’ would announce itself as a certainty that things would never, ever get any worse, we could

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WHAT TO EXPECT FROM NEW OPIOID DRUG POLICY (PART 2 OF 2) By John Giordano, Doctor of Humane Letters, MAC, CAP Another catastrophic unforeseen result of our total inability to treat mental illness is the ever growing prison population. With less than 5 percent of the total global population, the U.S. has 25 percent of the world’s jailed population – meaning that 1 in 4 of all prisoners in the world are right here in the U.S. But even more concerning is that Americans are being put in jail for substance abuse issues or mental health issues at an unprecedented rate. According to the non-profit Treatment Advocacy Center during 2014 in the United States, there was nearly 10 times the number of people with severe psychiatric disease locked up behind bars as opposed to the number of patients remaining in the nation’s state hospitals. This is partially due to the “Get Tough on Crime” policies from the 80’s that was based in political optics intended to grab newspaper headlines and TV lead story lines rather than scientific rationale. A National Research Council report in 2014 revealed that; “Mental illness among today’s inmates is also pervasive, with 64 percent of jail inmates, 54 percent of state prisoners and 45 percent of federal prisoners reporting mental health concerns.” To the best of my knowledge, we are the only modern country that puts the weakest, the most vulnerable members of our communities and society behind bars – an environment dreadfully ill suited to address – much less provide – the complex treatment needed by people with mental health issues. For all intent and purposes, we’re simply warehousing our mentally ill in jails and prisons. The president acknowledged as much just a few weeks into his administration when he stated; “Prisons should not be a substitute for treatment. We will fight to increase access to life-saving treatment to battle the addiction to drugs, which is afflicting our nation like never ever before — ever.” However, the president’s sentiments do not square with those of his Attorney General Jeff Sessions who just a few months later reversed Obama era drug sentencing reforms, calling a harsher approach ‘moral and just.’ Now, both agree capital punishment for certain drug traffickers will somehow, someway curb an opioid epidemic raging out of control. As I mentioned earlier, policies built around projecting political optics are more effective at getting headlines and TV lead stories and tend to make some people feel good, rather than having a positive effect on the issue they’re intending to resolve. This is one of them. Executing drug traffickers will make some people feel good, but will do absolutely nothing to help the millions of addicts and people with mental health issues who are in such desperate need of treatment. The Philippine’s “War on Drugs” experiment, if nothing else, has proven this to be fact. Much has been accomplished in recent years in addressing the opioid epidemic with effective policy. It has been just a little more than two years since the CDC released it’s ‘Guideline for Prescribing Opioids for Chronic Pain’ that seems to be making inroads into one of the primary drivers of this epidemic, over prescribing. In fact, many doctors have stopped prescribing opioids all together. It was also in 2016 that congress passed the Comprehensive Justice and Mental Health Act. This bill reauthorizes millions of dollars for state and local efforts to reduce the number of imprisoned mentally ill people. Recently, there have been national pharmacies with locations across the country that have taken it upon themselves to limit opioid prescriptions to one week. All of these policies will have a positive outcome over time. Yet, even with all these accomplishments, there is still much more to be done. More than half of all the opioid prescriptions are written for people with mental health issues and that has to stop. Dr. Brian Sites, of Dartmouth-Hitchcock Medical Center and the senior author of the study: ‘Prescription Opioid Use Among Adults With Mental Health Disorders In The United States’ said, “We’re handing

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this stuff out like candy. “Adults with mental health disorders were more than twice as likely to receive an opioid prescription.” We are doing a disservice to America’s weakest and most vulnerable by continuing to prescribe them strong opioid painkillers and think their lives are going to improve. In reality, they’re given a one way ticket to addiction and quite possibly jail. Doctors engaged in this practice need to consider non-opioid pain medicine and alternative therapies scientifically proven effective in managing pain such as acupuncture and massage therapy. There is far more to this story, but you are going to have to wait until the next issue of Sober World Magazine is published where I go into over medicating, its negative and deadly effects and what can be done about it. John Giordano is the founder of ‘Life Enhancement Aftercare Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites: www.PreventAddictionRelapse.com www.HolisticAddictionInfo.com

UNDERSTANDING ADDICTION IS NOT ENOUGH- AFFIRMING YOUR LGBTQI CHILD MAY SAVE THEIR LIFE By Alicja Majer, MSW Intern, BSW, CRRA

Continued from page 23

population in recovery describes when an individual experiences unconditional love, encouragement, and complete acceptance from family members, their sense of self may be more aligned with their highest good. On the other hand, when a person lacks support from family, and feels abandoned by their loved ones, feelings of guilt and shame tend to take over and shape their experiences. Sometimes, support will come from a healing community that is experiencing a similar journey before it comes from a family member. Just remember, when you or a family member needs support or education, just search online, call a professional, or another parent to start your process. It is important to remember that your healing process can help implement a supportive and affirming environment for your LGBTQI+ child or family member. Alicja Majer is the Director of Operations at Inspire Recovery since 2015, an LGBTQIA+ specific substance abuse treatment facility. Alicja’s focus in on LGBTQIA+ Advocacy, Addiction Recovery, LGBTQIA+ rights and education as well serving as a board member on TranspireHELP http://transpirehelp.org (not- for-profit dedicated to raise funds for the LGBTQIA+ community in recovery). Alicja is a co-founder of Rise2Love a brand that supports the LGBTQIA+ community and all people, empowering all to rise 2 love ALL beings. https://inspirerecovery.com/ https://rise2love.com *Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex (LGBTQI+) is an expansive acronym. The LGBTQI+ letters do not represent the whole community as a whole, as gender identity, expression, and sexual orientation are represented across a wide spectrum. For more information on terminology and more details regarding the community visit: www.itspronouncedmetrosexual.com

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LIVING BEYOND

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

ARE PHARMACEUTICAL COMPANIES INTENTIONALLY MARKETING TO YOUR CHILDREN? Continued from page 20

ACADEMIA AND PHARMACEUTICALS Pharmaceutical companies are big business and like any big business they have no place in academia. There are reports that pharmaceutical companies are not only directly and indirectly marketing to children, but are now directly influencing academia. In fact, while there are a number of reasons and rationales behind the pharmaceutical developed worksheets, instructional manuals, and coloring books; the truth is, these large corporations are directly advertising to our children by placing logos and advertisements on the materials. Why does this matter? “By first grade, most American children have learned 200 logos, and research shows they are much more likely to stick with those brands throughout their lifetime. That’s why companies are eager to expose their logos to as many youngsters as possible, stamping corporate logos all over children’s toys and hanging their banners at children’s events like the circus or ice-skating programs.”

UNINTENDED CONSEQUENCES Are we conditioning our children to be addicts? Should medication have an attractive smell, odor or taste? What is the probability of a child becoming more enticed by medications when they are attractive?

While I am hopeful that the intentions of the pharmaceutical companies is altruistic in respect to academia; I am deeply concerned by their logos being plastered all over my children’s materials.

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

THE RELATIONSHIP BETWEEN PAIN AND ADDICTION By Allan N. Schwartz, Ph.D., LCSW

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family are also affected by what the patient is experiencing. Success is being reported with the use of CBT to help refocus thoughts on things other than pain: “CBT consists of teaching patient’s cognitive (reframing maladaptive thoughts) and behavioral coping skills (e.g., relaxation strategies). The technique was shown to improve pain and function in patients with several pain modalities, including back pain and pain associated with arthritis and fibromyalgia.  Finally, attitude is very important. For example, several of my friends have gone through rotator cuff surgery. The pain is intense after the surgery. Physical therapy is also extremely painful. Added to this is the necessity of having to sleep in an upright position because the shoulder must remain in a sling, rendering one feeling very awkward. The friends’ I am referring to refused opioid pain medications despite the recommendations of the physicians. They toughed it out mostly using aspirin until the worst of the pain was over. These friends of mine are just ordinary people. So how is it that they tolerated pain while others can’t seem to do so? In an article about Dr. John Sarno, MD, one of the foremost experts on back pain- much of it is all in your head. Dr. Schwartz has been a psychotherapist for forty years. He has a Ph.D. in Educational Psychology, an MSW in Clinical Social Work and certification in Psychoanalysis from NPAP, a New York Psychoanalytic Institute. Dr. Schwartz has appeared in a variety of radio and television shows around the country and has written for Mentalhelp.net, one of the finest mental health websites on the internet. www.allanschwartztherapy.com

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“Making children’s medicines tasty makes the experience of being sick less stressful for kids, and helps doctors and parents get kids to take them peacefully. But there is also the danger, if they are too tasty, that kids will consume them in secret, and overdose.” When medications provide a state of euphoria, it creates a relationship between medication and happiness. The realization that the medications are drugs is lost in the taste. Are we allowing the alteration of medications to create a subtle appeal to the unconscious and conscious minds of our children? The alteration of medications and vitamins create a longstanding appeal for children. While pharmaceuticals have their place, we must refrain from allowing them to become an intricate part of our children’s lives.

GAMBLING: THE HIDDEN ADDICTION

By Arnie Wexler, ICGC and Sheila Wexler, LCADC, ICGC Continued from page 14

very forgiving and less critical of Arnie. But, I was fooling myself. I will never forget when my pregnancy was close to term, I phoned Arnie at work and asked him what I should do if I went into labor. Before that, when I had a doctor’s appointment, he would send me with his brother. Now, he told me to call my father to take me to the hospital because he was busy. He had left work that day and went to the race track! Arnie: This is a typical scenario of a relationship when someone is in the throes of their gambling addiction. It was another three years before I went for help. Arnie and Sheila Wexler are the authors of “All Bets Are Off”, a book on gambling addiction and recovery. Arnie and Sheila have presented at educational workshops nationally and internationally, and have trained treatment centers opening up gambling treatment programs. They also have provided expert witness testimony. They have trained over 40,000 casino employees and executives and have worked with gaming companies to help formulate Responsible Gaming Programs. In addition, Arnie has done training for Fortune 500 corporations, legislative bodies and on college campuses. He has also done trainings’ for the National Football League (NFL)and the National Basketball League (NBA). They provide extensive training on Compulsive Gambling. www.aswexler.com aswexler@aol.com 954-501-5270

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

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