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HOT TOPICS: Alcoholism  Addiction  AA  Cocaine  Heroin

Ask an Expert: Previous Questions and Answers

By The Fix staff

07/01/14

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NOTE TO READERS: Your anonymous questions to the expert panel can be sent to editor@thefix.com.  Click here for full bios of our Experts.


When my grandmother was dying, I only showed up once, and I stole her pain meds. Now I'm sober, and on Step 9; how do you make amends to someone who's dead?

Jay Westbrook: Great question - I believe this is a situation that calls for both a living amends and a direct amends.

For the living amends, as you go forward in life, simply do two things. First, show up whenever someone in your family (however you define “family”) is sick or dying, and show up with both the attitude and behaviors of service. Second, stop stealing, and not just pain meds or money or stuff. Stop stealing people’s trust, time, emotions, joy, and peace of mind.

For the direct amends, write out a formal amends to your grandmother, saying everything you would say if you were making that amends to her face-to-face. Then, you can do one of several things. You can go to her gravesite, and read the letter to her. Or, you could take the letter outside at dusk, burn it, and watch the smoke drift up towards the sky. Or you could do both – read the letter at her grave, and then burn it, setting an intention that she receive the message.

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G Jay Westbrook, M.S-Gerontology., R.N, is a multiple award-winning clinician (Nurse of the Year), Visiting Faculty Scholar at Harvard Medical School, speaker and author who specializes in both substance abuse recovery and End-of-Life care and is an expert in Grief Recovery©. He has both consulted to and served as a clinician in multiple treatment centers and hospitals, guiding clients through their grief, and working with them and their families on healing broken relationships. His lectures to physicians and nurses include trainings in When Your Patient is a Substance Abuser: Currently or Historically. He can be reached at CompassionateJourney@hotmail.com. Full Bio.

 

Is marijuana addictive?

Tessie Castillo: Whether marijuana is considered addictive depends on how addiction is defined. A person with a physical addiction to a drug will experience physiological symptoms if he stops using. For example, withdrawal from alcohol, opioids or benzodiazepines may cause symptoms such as high blood pressure, increased pulse, discomfort, seizures or even death. If a chronic but not heavy marijuana user stops using, the symptoms, if any, are milder by comparison: anxiety, irritability or slightly increased pulse. As for "heavy users" who go through withdrawal, a 2012 study by National Institute on Drug Abuse researcher David Gorelick, PhD, MD, found that among the 100 heavy users in the study, 42% experienced withdrawal symptoms, such as cravings, irritability, anxiety and sleep disturbance. 78% of this heavy user group returned to pot use to reduce or avoid their withdrawal symptoms.

Thus, while marijuana is not generally considered physically addictive, the physiological symptoms experienced by heavy users suggest that for some people it may well be addictive, even if less so than opioids. However, anything can be psychologically addictive if a person experiences a strong and harmful need for it. Though most people use marijuana in moderation, there are some who develop such a strong need for it that marijuana use begins to negatively affect other areas of their lives. Those people may be considered addicted to marijuana. Anything can cause psychological addiction if used in excess: gambling, sex, food, video games, even exercise.

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Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform organization in the Southern United States. She is an expert on harm reduction, overdose prevention and response, naloxone, the drug war, and policy reform. Full Bio.

 

My name is Frank & I feel that I am at a crossroads in my recovery. I have been clean & sober through AA/NA for just a hair over 4 & 1/2 years. I have worked the steps twice, I have had the same sponsor the entire time and I have sponsored others. The ways that my life has changed have truly been immeasurable and I don't want to be wasted again. 

I used alcohol destructively and I had a strong bout of troubles with all other drugs, except hallucinogenics, which I always found to be helpful. The last 3 years of my "using", I was physically addicted to heroin. It went from smoking to snorting and in the final year before I got clean I was injecting it. It was hell to get clean. I was medically detoxed and relapsed immediately for 6 months then I got clean on my own using suboxone. I have been 100% drug free since my clean date including from suboxone. I have battled with smoking cigarettes on & off since then and have happily drunk coffee daily. 

The crossroads part has been very recent. I have never loved meetings & honestly have never attended regularly. I am also not convinced that addiction is a disease and hate thinking of myself as having a disease. I am also unsure if I am truly powerless since I found so much power in stopping. I don't think (I am open to many things so this is an open ended subject for me) I believe in a higher power & I am a non-theist. I do believe in the subconscious. These things rub  me the wrong way in AA/NA & I am at the point today of speaking with my sponsor about it. 

The most surprising thing that I learned about myself getting clean was recognizing & admitting how much pain & how hurt & damaged I felt from my abusive childhood. I've done some ACA as well and really like it, although, again, I dislike the disease-model idea but that work is valuable enough for me to want to at least work the steps once in ACA. It's hard for me to believe that my relationships with drugs & alcohol isn't different now that I'm so different. Just the fact that I'm looking at it in this way versus "relapsing" is really an answer I think. 

I am thinking of experimenting with drinking and some drugs to see where I'm at with them. I don't want to be wasted but if I could drink socially and use marijuana and hallucinogenics successfully, I couldn't imagine why I wouldn't. Have you encountered someone that was a hard-core drug user that can then successfully use anything? l'm not running out & using but I'm very curious. There is nothing that could make me give up the strength & clarity I've found & I want to remain sober in the sense of staying true, clear, and on a path I'm proud of. Thank you for your time.

Stanton Peele: Let me answer your question about becoming a moderate drinker and marijuana user in five parts, if I may:

(1) I never tell anyone they can or cannot use substances moderately.  I cannot make that determination for you, or for anyone.

(2) Having said that, I respect your desire to try to moderate your substance use. People do it all the time, and your logic that you feel differently about yourself and your life are good grounds for contemplating this choice.

(3) Obviously, you are thinking about the milder end of your substance use panoply - the alcohol/marijuana/hallucinogenic part, as opposed to the heroin part. But you haven't made clear rules and limits about what you are prepared to use, how often, and how much. You should think these parameters through and write them down and share them with friends and family.  You might then review them regularly (starting with weekly) with a therapist, friend, or family member, in order to be objectively clear whether you are working within these parameters or not.

(4)  If you are serious with yourself, with me, and with heaven above (whoops, that's not your bag) you WILL be sensitive to your success and failure at sticking to your plan. I don't accept denial, and - before you start this experiment - make clear to yourself and others that you don't either. The fact that you weren't explicit in your definition of moderation IS a counter-indicator of success, since you are not anchoring your change to clearly defined standards. Are you serious about this business, or are you crapping around?  I don't like it when people crap around with me.

(5)  An experiment is an experiment, and it implies that you can simply revert to abstinence should your experimentation fail. And you can - NOTHING stops you from doing this. Please make this clear to yourself, to those you discuss your plan with, and to anyone reading your question and my answer. Repeat after me: "I can, and will, revert to abstinence should I fail to meet the limits I have set for myself, so help me Stanton."  If you don't succeed, that you recognize and amend your plan is a sign of integrity and honor, and not something to be ashamed of.

You've respected me enough to ask me this sensitive question. Please respect me - and yourself - enough to be honor bound and committed to measuring your progress, involving others in assessing this progress, and acting with authenticity and integrity in responding to this objective feedback.

Write us about the results of your experiment.

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Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers. See www.peele.net and his Facebook and Twitter.    Full Bio.

 

I am having issues with a family member around drug usage and what I now believe is addiction. Is "tough love" going to help or hurt?

Lance Dodes: If addiction were viewed as a kind of bad habit, or a sign of laziness or immorality, then it might make sense to be "tough" on the person who has the problem. Indeed, people have been trying to deal with addicts by punishing them, withdrawing from them, and condemning them for much of human history, without helping the problem at all.  It makes sense that these approaches fail, since addiction is neither a bad habit nor a sign of laziness or immorality. 

Far from it, addiction is a very understandable psychological symptom, one that is essentially identical in its mechanism and function as other compulsive behaviors such as having to compulsively clean your house or exercise. Of course, addictions are more dangerous but their inner emotional workings are the same. And nobody would suggest that we deal with compulsive house cleaners by withdrawing from them, or would believe that they will stop cleaning if only we discipline them. So why do people think it makes sense for addiction?

When people engage in compulsive activities like excessively cleaning their houses, they generally don’t cause much harm or pain to those around them. It is easy to empathize with them, to see their suffering and to be drawn toward them to help, rather than feel like beating sense into them. But when people’s behavior is harmful or painful to those around them, they are often consciously or unconsciously viewed as self-centered, thoughtless, and immoral. Once this thought has set in, it’s very difficult to maintain a rational perspective toward either the person or the problem from which he or she suffers. It begins to seem reasonable and fair to treat the person as though she is bad, or stupid, or lazy. 

It's a short step from there to believe that it makes sense to be "tough" on her. Certainly, living with an addict is very often frustrating, enraging and depressing. But these reactions, understandable as they are, are not a good basis for deciding how to deal with loved ones, or with the problem they are facing.

The first step in dealing with someone suffering with addiction is to understand for yourself how addiction works as a psychological symptom (my first two books - The Heart of Addiction, and Breaking Addiction - are devoted to this). Having this knowledge can help you avoid the extra pain of believing that a family member's addiction means that person no longer cares about you, or is intentionally trying to hurt you. It also opens up a way to talk with the addicted person, and to help that person understand his own behavior in a new way. At the point you both appreciate that addiction is something comprehensible and, therefore, potentially solvable, the possibility opens up of restoring the damage that has been done to your relationship.

A spouse or friend can never fix another person's addiction, but there is a much better chance of helping both yourself and your addicted friend if you approach the problem by understanding it better, rather than attempting to control it through discipline or withdrawal.  Said another way, you may have to withdraw for self-protection, or simply to move on with your life. But that is very different from the false idea that you can affect addiction by punishing the person suffering with it.

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Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking AddictionA 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.   Full Bio.

 

How do I talk to my young child about his father's drug addiction?

Doreen Maller: While every family’s addiction journey is different, in general kids do well when someone is able to listen to their needs and curiosity, and relate information back to them in an age-appropriate way. Depending on the level of drug use and its impact on the family, there is a handful of ways that conversation can be initiated.

If there are safety concerns, all efforts should be made to keep the child safe, including leaving the home. In issues regarding safety you can say, “When Daddy is using drugs we aren’t safe around him, we need to go away until he is safer to be with.” Sometimes the child’s own behaviors are impacted by the tension in the home. Children are often confused by erratic adult behaviors and can feel frightened or unsafe when they witness family tension and drama. As a child and family therapist, my goal is to help the child integrate what he or she has seen and heard into something that makes sense from a child’s perspective so that they can return to the behaviors and tasks necessary in their own lives (like school, exercise and sleep). 

Children often miss the absent parent. Being able to talk about the person, separate from their behaviors, can help a child feel more grounded, “When my Daddy drinks I get scared, but I miss him anyway…” Therapy can provide an opportunity for the child to explore their curiosity or strong feelings with a neutral party.

If a family is comfortable with a medical model for intervention, an addiction can be characterized as an ailment - “Daddy has an allergy to alcohol.” Or if the addiction began as pain management, “Daddy hurt his leg and now he has a problem with his leg and his medicine too.” 

There are studies that show that people who can control their impulses and postpone pleasure for a greater reward have more success in life. With that in mind, addiction can be discussed as an impulsive action, “Mommy has a hard time stopping when she starts drinking. Do you ever have a hard time stopping something? How do you stop something once you start it?” 

If incarceration is part of the process, “Mommy had such a hard time with her addiction that she got in so much trouble and has to go away for a while.”  Hospitalization may require another type of explanation, “Daddy was having a hard time and needs some extra help feeling better and getting better. Sometimes you have to go someplace else to do that.”  

Truth telling, though difficult, can help set clear expectations. A child may be concerned and ask "Will Mommy come home soon?" A response might be “We sure hope so, getting better is difficult and takes a lot of work, for now, we want to be sure you are OK and doing all the things a kid needs to be doing, and that Mommy is safe and doing what she needs to do and can come home when she is ready…”

Asking the child how he or she feels can be helpful; “Mommy is having a hard day today, how are you doing?” Young children can find adult behaviors confusing, or they may want to provide comfort, or they may get angry. Helping the child express their feelings: “I know you get angry when Daddy is out of control. I do too. And I think Daddy maybe too." "We need to be sure you’re OK even when Daddy isn’t.” Or: “We need to go be with Grandma to be safe until Mommy can be safer to be around” is a good place to start. The goal is to create a safe place for the child to talk about and process her or his feelings, rather than internalize or deny them. 

As a therapist I often rely on therapeutic children’s books to help combat the natural isolation some kids feel when dealing with issues in their family. I have a collection of books that discuss what jail is like, and how to act on visiting day. I have books that explore trauma though a child’s eyes and help explain how they may act out as a result. Some of the books even help introduce kids to working with and talking to a therapist. Knowing that there are other kids out there experiencing similar issues can give a child a sense of comfort. 

Working with families to provide structure, clear expectations, extra support, pro-social activities (exercise, good nutrition, time outdoors) during particularly stressful times can be very helpful for families working though issues, experiencing loss or adjusting to change.  Allowing the child to share their thoughts and feelings in a calm non-judgmental way can help relieve some internal tensions.

Here are some great kid’s books:

Overview of Kids and Trauma: A Terrible Thing Happened by Margaret M. Holmes, Sasha J. Mudlaff, Cary Pillo

Family in Divorce Transition: Dinosaur’s Divorce by Marc Brown and Laurie Krasny Brown

Incarceration: My Daddy Is in Jail by Janet M. Bender

Visiting Day by Jacqueline Woodson and James Ransome

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Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See  www.doreenmaller.com    Full Bio.

 

he has 16 months, i have 100 days. he suggests we keep our recovery first. i totally agree. my sponsor says wait a year. he says he would wait 12 months for me. perfect guy, right? he suggested i call him and we could go to meetings together. i get all cheesy in front of him and i'm a little school girl again. i can't stop thinking about him. my mind just thinks SEX he's SEXY and SEX. while i don't have any intentions of having sex with him (because of my step 4 sex inventory convictions), i am confused if i should even talk to him because I’m so deeply in lust. should i practice being friends like we agreed upon or stay away from him?

Janice Dorn: Dear Deeply in Lust: Thank you so much for reaching out for help. You may not like what I have to say, but I assure it’s from many years of recovery and treating others in recovery.  With 100 days of sobriety, you are very vulnerable. I suspect you have been where you are now a number of times in the past. I also suspect it has not worked out so well for you. How many times before do you think you have come across the “perfect man?” How many times were you wrong about this?

He says he will wait 12 months for you and you say that he’s the perfect man. What does this mean? Wait for what? Does this mean he will wait 12 months and then have sex with you? Does this mean that he will go ahead and see other women and then, at the end of 12 months, be all ready to give himself fully to you? Do you seriously think that something like this is even possible?

Here’s my answer:

NO. He is not the perfect man for even suggesting this to you and leading you on and giving you some kind of hope for the future. He is much better served by focusing on his sobriety, and you on your sobriety.

He asked you to call him to go to meetings together. My answer to you is two words: Don’t call. If you must, let him call you. If he calls, tell him that you would prefer to go to meetings alone or with your sponsor.  Who is this man?  He has more sobriety than you do. Is he for real? Is he a predator who is trying to do a 13th step on you? How many other women has he asked to call him? Do you have reason to believe that you are the only one?   

I don’t know the answer to any of the questions. I suspect he would not tell you, even in his state of “rigorous honesty.” 

You are in lust. You are thinking of SEX, SEXY, SEX (all in your caps). Do you understand that you are hijacking your recovery by thinking of him constantly and being in “lust?” How is that lust working for you, and how did it work when you were in your addiction?  How about when you were not in your addiction?

One major reason that people relapse is over relationships. You think it will be wonderful, that the sex is great and nothing can ever go wrong. It can and it will. Relationships are the most difficult thing we do. The rush of “love chemicals” is every bit as powerful as the high from drugs or alcohol. And then something happens. You try to get the high and keep getting the high and maybe its good sex or maybe it isn’t. In any case, once you have sex with someone everything changes. There is a huge difference between sex and love. Lust alone is not love. Sex alone is not love. Love is love, and it is built over years, time and shared experiences.

We don’t get sick because we use. We use because we are sick. Now is the time for you to get well. Now is the time for you to fall in love with YOU. Once you do that, everything will change. This is a beautiful time for you to truly get to know who you are - clean and sober. This is a remarkable opportunity for you to become the person you truly are - your authentic self. This is the time to let go of shame, guilt and fear without using drugs or alcohol. Once you do that, you will attract men who truly love you for you.

At this point in your recovery, I do not think it’s a good idea to have this man as friend. It is a slippery slope because of your present emotional state. I also think that there is a real possibility that you are at great risk for substituting one addiction for another. You are working the steps. Keep working them. Keep in close touch with your sponsor. Start to become aware of any person, place or thing that might derail your recovery. There will be many - sometimes in the most surprising ways.

Stay strong, stay safe, keep working the steps and don’t get into a relationship now. It’s too early. You need time to heal and time to learn that you are truly becoming the woman you really are meant to be.  

There is hope!

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Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall.    Full Bio.

 

I am having problems in my marriage and it is added to because of weight gain which turns my husband off.  I am consuming much more sweets than I know I should, ice cream especially, and can't seem to stop.  My husband says I have become addicted. Any help that works would be more than appreciated.

Stacey Rosenfeld: We know that eating can sometimes be emotional and during times of stress or discord, this can intensity. While the research doesn't offer convincing support for the idea that food itself is inherently addictive, we know that food can be used in an addictive way. Many people get trapped in what we call the diet-binge cycle, restricting foods at some times and then overdoing them when feelings of deprivation kick in and rigid control over intake breaks down. Eating disorder specialists will often note that the diet-binge cycle is, itself, addictive.

I wonder if you typically limit the foods you mention and that now that you're going through a rough time, you're seeking comfort in them - they have too much value because they're typically forbidden (the lure of "the forbidden fruit")? The idea is to equalize all foods so that there are no "good" or "bad" foods. When this occurs, people develop a more neutral approach to eating and tend to reduce overeating of previously restricted items. 

Toward this goal, I'd allow yourself access to sweets - if you want dessert every day, have it. You'll likely notice that the amounts will come down naturally over time as you trust your permission to eat these foods. In my practice, I've also found that patients who binge on sweets are typically denying themselves carbohydrates - a diet trend these days. Once they add back sufficient carbohydrates into their diets, sugar cravings seem to subside.

At the same time, I'd work on recognizing when you're hungry and full (and trying to honor both). Intuitive eating involves eating when you're hungry and stopping when you're full. If you find yourself eating when you aren't hungry or eating past fullness often, you might want to figure out what feelings are triggering these behaviors. If no obvious emotion preceded the overeating episode, go back a bit in you day. Were you sad? Lonely? Anxious? Did you have an argument with your husband? What might be some other options for coping with these emotions rather than turning to food? 

The goal is to use food to nourish (and to experience some pleasure in eating) but not as medication. Take a look at the consequences of overeating, too. How do you feel after? (physically? emotionally?) You say that your husband is less attracted to you - is there a possibility you might, in some ways, be trying to push him away? If you have trouble coping with emotional triggers for overeating, or sorting through the consequences of the behavior, it might be time to turn to a therapist who can help you sort some of this out. A course of couples counseling might also be indicated so that you and your husband can work through your concerns in a productive manner.

EDITOR'S NOTE: "Ask An Expert" is guidance for the general public and is not to be construed as a doctor/patient relationships, which requires private and extensive consultation.

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Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com   Full Bio.

 

Because my head is so often cloudy from drinking and other stuff I use, I am looking for a way to guide myself and the decisions I have to make. Someone mentioned the I Ching.  Anyone on your panel have any ideas about this?

Brian Donohue: Once you do away with the silliness about the ancient Chinese oracle’s ability to “tell the future,” the I Ching becomes an extraordinary support to recovery and self-insight. The future, after all, is most likely a vast illusion; and if it isn’t, it certainly is not a script of pre-determination, but a quantum field of possibility. 

A resource like the I Ching exists to help us achieve a self-determined future that harmonizes with our moment, our circumstances, personality, relationships – the complex set of dynamics that makes up what the Chinese called, at a microcosmic level, one’s tao. 

I have used the I Ching in my personal counseling practice, and the benefits have been consistently gratifying. As Jung recognized and recorded in his original Foreword to the famous Wilhelm translation of the oracle, the I Ching is a superbly clear mirror of the living psyche. For those wishing to undertake a complete study of the oracle, I would recommend the seminars and publications of the I Ching Institute, which is led by two of my own teachers, Carol Anthony and Hanna Moog. It is obviously best by far that you encounter this resource in a personal setting; but I can be reached via my contact page to discuss remote sessions.

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Brian Donohue has an MA degree from Long Island University in clinical psychology, and has worked in private practice as a therapist with a loosely Jungian perspective and as a meditation teacher. He has worked with depressed people, anxious people, and people undergoing major life changes, challenges, and crises. See briandonohue.org.   Full Bio.

 

What Spiritual Practices May Best Support Recovery?

Brian Donohue: A client once came to my counseling practice with an extraordinary story: he had just come back from a business trip where he had nearly lost his job after missing an assignment due to his drinking. He was now on final probation at work and staring the firing squad in the face. But he wasn’t concerned about that; he wanted to understand the meaning of something else that had happened on that business trip.

After he’d missed his appointment and been caught AWOL once again, he had wandered the streets for hours, and finally stumbled into an empty church. He approached the altar and fell prostate before it, asking desperately for help from God or whatever, even if that help came in the form of his death. Then it happened: he saw Jesus walk out from behind the altar and sit beside him. Christ helped him up and told him: “I can’t do this for you but I can be there with you. Go home now, and stay sober. I will go with you.”

Whether, like my client, we stumble into a spiritual encounter or seek it out (as in most 12-step programs), the fundamental danger is the same: expectation. It can be positive (God will bring me healing) or negative (nothing can make me free; I’ll always be a slave and nothing can change that). In every case I’ve encountered, it’s a chaotic combination of both. So the work of true spiritual practice is not to dispel devils or false gods, or to erase sin, but to strip away the shroud of claim from the still-living body of your true self. The following is a brief list of spiritual or spiritually-inspired practices worth examining for their potential in your own healing.

Mindfulness Meditation: The most effective, well-researched, and time-tested of Western adaptations of Zen and other Buddhist practices can be represented generically by this term, “mindfulness meditation.” Since Dr. Herbert Benson first published “The Relaxation Response” nearly 40 years ago, meditation as “mind-body medicine” has achieved pockets of recognition in professional circles beyond the arc of the “new age” community.

One of the leaders in research, treatment, and advocacy of mindfulness meditation as a support for standard medical treatments and therapies has been Dr. Jon Kabat-Zinn of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. The best introduction to this approach to healing is in any of Kabat-Zinn’s excellent books. I would personally recommend Full Catastrophe Living and Wherever You Go, There You Are. If you are in the Boston area, there are continuous research projects being developed and implemented in mindfulness meditation’s efficacy across many areas of medical and psychological study.

Transcendental Meditation: There have been many claims made about the efficacy of TM for addiction recovery, and some research has tended to support these claims. If you believe it’s worth a try, I wouldn’t discourage you. I think TM has great potential; but it’s not for everyone. The cost of more than $1,000 for a single introductory program, along with the ideological baggage it tends to carry with it, can be prohibitive to many.

Yoga. There is evidence – mostly anecdotal and experiential – that hathayoga (the familiar stretches and poses known to most Westerners) has beneficial effects as a support to traditional recovery interventions. There is also a strong vein of advocacy for kundalini yoga, both as support and replacement for traditional therapies. It could well be worth looking into, but one warning: kundalini must be taught by experts who are thoroughly versed in its potential dangers. In the wrong hands or as a DIY undertaking, kundalini can be as perilous a practice as the addiction it is meant to undermine.

Prayer: There have been many claims made for propitiatory prayer, both within and beyond the 12-step universe. Personally, I don’t buy any of it. I believe in propitiatory prayer about as much as I believe in genies. And after all, I have found that the greatest and deepest blessings we receive are those for which we never ask. If there is a single God, It certainly doesn’t need my steerage or suggestion-box input. The only prayer that works is an opening rather than a plea: receive and then share. As the old saying goes, pay it forward. That’s effective prayer.

So a meaningful practice of prayer may have far less to do with what happens between you and God and more to do with what occurs purely within yourself. If you’re seeking a specific outcome or the fulfillment of an expectation, then you’re just making deals with a silent universe. But if you ask from the core, from the heart, for some understanding in bringing your life back into resonance with the cosmic harmonic, then you are engaging and activating energies that are not separate from your essence. I think asking for that kind of help in that frame of mind is both healthy and potentially transformational, for it begins with a single, heartfelt admission: I can’t do it all by myself. This is not about affirming your need for help from people, programs, institutions, and teachings. It is about suspending disbelief in the invisible and saying, “I may not understand who or what I’m trying to connect with, but I’m ready to feel them now. I’m ready to stop being alone, even if no one is with me.”

I often wonder if that admission is itself the foundation of all healing.

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Brian Donohue has an MA degree from Long Island University in clinical psychology, and has worked in private practice as a therapist with a loosely Jungian perspective and as a meditation teacher. He has worked with depressed people, anxious people, and people undergoing major life changes, challenges, and crises. See briandonohue.org.   Full Bio.

 

What exactly are the options for opiate/heroin detox? I have heard of: methadone, Suboxone, Subutex, Naltrexone - orally and by injection – Ibogaine (in mexico only?). Which types of populations work the best for each option? i.e., is naltrexone an option for the poor/poverty populations on state funded “insurance?” What do the rich people do? What is typically given to people with no money?

Larissa Mooney: Opioid withdrawal causes significant physical discomfort and increased relapse risk. Medications may be used to alleviate symptoms, including muscle aches, abdominal cramping, nausea, vomiting, diarrhea, anxiety, restlessness, sweating, yawning, and elevated blood pressure and pulse. There are several options for opioid “detoxification” involving either long-acting opioids, including methadone or buprenorphine, or non-opioid medications, such as clonidine in combination with other supportive medications. Clonidine is an antihypertensive that reduces the severity of acute withdrawal symptoms.

Detox typically occurs in medically supervised settings and lasts at least several days; the goal is to minimize withdrawal symptoms and facilitate transition to abstinence-based treatment. 

It is true that the choice of treatment is often influenced by insurance coverage and other financial considerations. Facilities may have a preferred approach shaped by clinician experience, local policies and state laws. Non-opioid detox approaches typically include the use of additional supportive medications that are often given in combination with clonidine. These include anti-inflammatories for muscle aches, antinausea medications, antidiarrheals, and sleep medications.

Methadone, a long-acting opioid prescribed for both chronic pain and opioid maintenance therapy, may be used for outpatient opioid detoxification within federally licensed treatment programs.  Buprenorphine, a long-acting partial opioid, may also be prescribed within outpatient or inpatient settings and by individual practitioners. The duration of the detox may be relatively short (i.e. within one week) or longer, depending on patient and clinician preference.

Depending on financial issues and clinical factors, both methadone and buprenorphine may also be prescribed for longer term opioid maintenance treatment. Relapse rates to illicit opioid use are very high after “taper,” the term used for gradual reduction of medications. Recently detoxified patients may also be transitioned to the opioid blocker, naltrexone which is available as a daily pill or monthly injection.  Ideally, comprehensive treatment planning after detox incorporates psychosocial therapy and support to optimize long-term success.

Ibogaine is a psychoactive plant-based compound that has been used in the treatment of drug addiction outside of conventional medical settings. It has been reported to reduce opioid withdrawal and cravings, and some individuals have reported longer term abstinence from opioids following treatment. Largely due to medical safety concerns (including cardiac risk and reports of sudden death) and to a lack of research data supporting its use, ibogaine treatment and possession is illegal in the U.S. It is available for treatment and use in Mexico, Canada and some European countries. 

A wide variety of factors determine which treatments are available for wealthier vs. less wealthy individuals. In general, methadone and non-opioid-based detox options are less expensive and more widely covered by insurance plans (including Medicaid-based coverage). Buprenorphine is more costly, and availability may be limited by insurance formularies and out-of-pocket expenses.

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Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA. www.LarissaMooneyMD.com   Full Bio.

 

I have been clean off drugs and alcohol for over three years. I have been dating someone very seriously for almost a year who is a social drinker. He will go out with friends and all they do is drink and that is the only thing he does. When he goes out I am sometimes invited and when I go. I get the want to drink because I feel left out of what they're doing. 

When I do not include myself with the group because of that, I feel like I'm missing a huge portion of his life. I don't  know what to do or what to tell him because when I say I feel left out, he stops going out because he feels bad. I have the feeling sometimes I shouldn't be with him because of these feelings. Please help.

Stanton Peele: May I ask you about your situation, you values, your sobriety?

1.  Your boyfriend's life.

You have a boyfriend who, when he goes out with friends, "all they do is drink and that is the only thing he does." From your description, this isn't a very interesting man. He has no other recreation with friends other than drinking?  They never go to ball games, the movies, go to the beach, throw a frisbee in the park, do any political, charitable, or community work?  Does your boyfriend have family?  Does he do anything with his family besides drink with them? Is he involved in his work? What's he do at home?  What do the two of you do when you go out, or stay home?  Do you share interests and activities and enjoy talking and your time together?  

2.  Your values.

You don't describe anything positive about this man or about being with him, only that you are serious about him. What do you like about this man?  What do you find interesting about him? What do you admire about him?  Why have you become involved with him?  Does he represent a real life choice you have made?

3.  Your sobriety.

What is going on in your life? Do you have work, friends, activities? Do you exercise and look to your heath?  Do your care about others and yourself?  Do you have some purpose? I wonder if your sobriety is rooted in a substantial and meaningful enough life to allow you to make a serious personal commitment to a relationship. 

Sobriety is about more than steering clear of drugs and booze, as I describe in my accompanying blogpost, "The New Recovery."  It is built on four pillars: health, home, purpose, and community. So if you are feeling vulnerable, if you have chosen a man ultimately not likely to support your changed life, or to be good for you, it may be due the lack of substance to your life. Do you feel up to this? Because your choice of a lifemate can only be built on this foundation, just as your sobriety must be built on it. My book, "Recover!" is about how recovery can only be achieved in this way.

With good wishes for you and your recovery.

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Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers. See www.peele.net and his Facebook and Twitter.  Full Bio.

 

What can an individual like myself do. My bf was arrested for the 3rd time for robbery to buy drugs. He's a good man sentenced to 17 yrs. Never recd proper care or after care. I am a recovering addict.....4 yrs clean. What can I do if anything to change the justice system, any support groups, new law????? Thanks for your time.

Harold Owens: Hi GF???

I’m pretty confident that your boyfriend’s drug use preceded his entry into the criminal justice system. Because so many of the jailed population are there because of addiction, the enormous amount of money spent on drug related incarceration has forced lawmakers to re-assess their decades-old policy of harsh and long mandatory sentencing guidelines for non- violent drug related crime. 

Unfortunately, your boyfriend was also convicted of two prior drug related crimes for robbery. What if he had instead received the opportunity to enter a substance abuse treatment program with a long aftercare component early on before he got in trouble again? Your boyfriend with three past drug related crimes should have been the kind of high-risk offender that the criminal justice system would intervene with,  before he was sentenced to a lifetime of jails.

For the past 10 years, I have been involved with the National Association of Drug Court Professionals (NADCP). The group was started in 1994 by a group of judges from around the country. Their vision and mission is to reduce the negative social impact of substance abuse, crime, and recidivism by advocating for the growth and funding of Drug Courts throughout the country. 

What’s important here is that there is an organization out there composed of judges, Congressional and community leaders who actually get it. They understand the necessity of creating a vision of a reformed justice system by impacting new public policy and legislation models. West Huddleston is the CEO of NADCP and a dear friend. He introduced me to national political and judicial leaders whom I never would have imagined would have the same passion as I do to help addicts get sober and really change their lives. 

If you are looking to get involved in making a change in the criminal justice system, please look up this organization online: www.nadcp.org as well as other local drug court programs in your area. There are many ways to help, including introducing yourself to someone who is struggling with not only their sobriety but their freedom and a  possible lifetime of incarceration or death.

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Harold Owens is Senior Director of the MusiCares/MAP FUND, the charity arm of the National Academy of Recording Arts & Sciences (the GRAMMY organization). He is responsible for the implementation of all aspects of the MusiCares addiction recovery program for artists. Earlier, for three years, he was Program Director of The Exodus Recovery Center. He can be reached at harold@grammy.com  Full Bio.

 

What does it mean when they say that having five years sober is when you get your marbles back?

Janice Dorn: Thanks for this question, which reminds us of how many of these bromides or common sayings there are in recovery programs, especially in 12-step programs. Actually, the complete saying is: “After five years, you get your marbles back. After ten, you know how to use them.”

From my point of view, this is pretty much nonsense. It might be helpful as a kind of “goal” for addicts in recovery in the sense of thinking that, if they can make it for five years, then they have a chance to make it for ten. As a general rule, it may be better to focus on one day at a time, instead of five years. For many addicts in early recovery, five years is simply not in the picture for them as they are struggling to get through the next hour!

Is there a biological basis to this saying? I believe there is, but more studies are needed. Current studies on brain function in patients suffering with alcoholism show that there are structural and functional changes in the brain that result in disorders of cognition. Such studies include that of three investigators from the University of Łódź, Poland, Katarzyna Nowakowska, Karolina Jabłkowska and Alina Borkowska. Their “Cognitive Functions in Patients with Alcohol Dependence,” Archives of Psychiatry and Psychotherapy, 2008, reported disturbances of working memory and brain executive function in both short-term and long-term abstinent alcoholics.

There is a need for more definitive studies using current brain-imaging techniques (PET, fMRI) to provide more definitive information about the brain of active and recovering addicts.

It is my opinion that recovery is a lifelong process and that addiction is a biopsychosociospiritual illness that is treatable, but not curable. The good news is that addicts can recover and stay sober. It takes a lifetime to recover and it’s one day at a time…and sometimes (even with long-term sobriety of more than 20 years), it’s one minute at a time.  

Recovery is a deeply personal process, and no two individuals approach it or manage it the same way. So much depends on the individual personality, family and group support and the motivation to get sober. If addicts stay clean and sober for five years, they will most likely feel a lot better than they did five years previously. In that sense, maybe there is something to the five year marble business. There is hope!

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Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall.  Full Bio.

 

 

If you are in recovery for four years and your family still treats you like an alien, what can you do?

Doreen Maller: The road to recovery begins with a personal journey, but re-integrating into a family is inter-relational. It is important to remember that each family member had his or her own unique experience of the "using years," and therefore trust will need to be established or re-established with each family member in their own way.

It may help to re-enter a period of brief therapy to move beyond some of the relational patterns that may have been necessary at an earlier point in time but have not evolved to include your current recovery status. With the help of a facilitator, a dialogue can begin where family members can share what they may need in order to move forward. Just like you take a car in for a periodic tune-up, these sessions can be seen as a family relational tune-up - a chance to consider where you are right now, provide an opportunity to move beyond the challenges of the past, and create a co-authored map toward your future together.

Therapists sometimes call this the re-contracting period; you are establishing new rules of engagement for the family. Families are encouraged to hear-out the fears of others and engage in collective problem solving. In this process of dialogue, awareness and forward momentum, new experiences are made and tracked. Acknowledging and building on successes leads to a “new normal” for your family.One where you are less alien to them and they to you.

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Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See www.doreenmaller.com  Full Bio.

 

Do you think there is an over-diagnostic component to our culture, so that being needy means I’m codependent, eating cake means I’m an over eater, etc? Can’t we relax a little bit on all these recent labels?

Rita Milios: I believe our culture currently over-uses labels in general, and that includes the use of diagnostic labels in mental health and addictions medicine. So, yes, I think it would be a good idea for everyone to “relax a little bit on all these recent labels,” and on mental health labels as a whole.

In some ways, labeling is helpful. If addiction disorders were not included in the “medical model” approach, their treatment would not be paid for by insurance. However, these diagnostic mental health labels have long been the focus of controversy. Many critics, including the National Institute of Mental Health, argue that descriptions presented in the DSM (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, and used extensively by mental health clinicians to codify mental health issues for insurance purposes) are not backed by sufficient scientific research and they rely too heavily on subjective, clinical opinion.

It is important to remember that a diagnosis is really just a snapshot of a person’s symptoms at a particular time, and DSM coding is just one model (although it is currently the prevailing one). There are many other models, including strengths-based and positive psychology models. Such alternative models might view substance use as a learned coping mechanism, which early on can provide some relief from mental health-related distress symptoms. Substances are often used for such self-medication purposes. However, substances can easily become over-used and move from a problem-solving tool to a self-destructive habit/addiction. As a therapist, I encourage clients to resist “leaning into” a particular diagnosis and over-identifying themselves with it. The more important issue is not what you call a problem, but how you go about solving it. If a heavy-handed mental health label deters some people from seeking help, then there is something wrong with the labeling system. Stigmatization does not further the goals of either the patient/client or the mental health field as a whole.

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Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training." RitaMilios.linktoexpert.com  Full Bio.

 


What are the best drug and alcohol addiction blockers on the market?

Larissa Mooney: It depends on what your goals are and what substance you are struggling with. Naltrexone is a true “blocker” – it acts on receptors in the brain to block the activity of opioids, including heroin and prescription opioid painkillers. It is available as a daily oral pill or as a monthly injection (as Vivitrol®).  Several studies presented to the FDA indicated that monthly injections of Naltrexone were more effective in maintaining abstinence than the pill form as it reduces the problem of medication compliance.

Nalrexone is approved for the treatment of alcohol and opioid addiction and has been shown to reduce cravings for both substances. If an individual uses opioids while on naltrexone, he or she will not experience the effects, and feelings from drinking alcohol may be less pleasurable (due to blockade of “natural” opioids including endorphins).  

Buprenorphine, a medication with partial opioid activity approved for maintenance treatment of opioid dependence, also blocks the effects of other opioids because it binds strongly to opioid receptors in the brain. Buprenorphine is absorbed under the tongue and may be taken once a day, relieving the highs and lows associated with intoxication and withdrawal from short-acting opioids, respectively. 

Other FDA approved medications for addictive disorders do not act as “blockers” in the traditional sense, though they may be useful in reducing substance use or cravings. Disulfiram (known as Antabuse) inhibits the metabolism of alcohol, causing an aversive reaction when alcohol is consumed.  Acamprosate may facilitate abstinence from alcohol by stabilizing chemicals that are dysregulated after chronic alcohol use, including GABA and glutamate.  Methadone, a long-acting opioid, is approved for maintenance treatment of opioid dependence. 

There are a number of medications approved for nicotine addiction treatment.  Nicotine replacement therapies, including the patch, gum, and lozenge, are available over the counter and may be used to reduce nicotine cravings and withdrawal after a quit attempt (others, such as the nicotine inhaler, are only available with a prescription).  Extended-release bupropion, an antidepressant that is also approved for smoking cessation, may reduce cravings, improve quit rates, and facilitate abstinence from cigarettes. Varenicline, a medication with partial activity at nicotine receptors in the brain, may also reduce cravings and pleasurable effects of cigarette smoking.

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Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA. www.LarissaMooneyMD.com  Full Bio.

 

Can you please explain what Motivational Enhancement therapy consists of and is it any good for addiction?

Stanton Peele: Motivational enhancement (or interviewing, MI) is my go-to therapy for addiction.  It also expresses my philosophy of what causes addiction and how it is overcome.

Motivational interviewing sees addiction as an expression of self-directed will. The solution is not to deny or denigrate this will, but to assist the person to find healthier outlets for it.  The therapist works collaboratively with clients to express their own motivation to pursue new goals—ones that rule out and replace the addiction. 

MI rejects the disease approach’s view that the person is powerless over their addiction. Instead, it invests in their self-efficacy - their belief in their own inner power.  It is a nondirective, client-centered therapy.  The helper doesn't dictate or decide anything for the client.  From the start, MI doesn’t define people’s problems for them (“you are an alcoholic”).  It has no sequence of steps for them to follow.  MI believes that people have the ability to direct themselves out of addiction.

MI uses questions to explore people's values (like family, health, religion, community, self-respect, achievement, etc.) and their discontent with their failure to honor these.  It is by finding these inconsistencies themselves, not by being confronted by others, that clients develop their motivation to change. All of this is based on straightforward, well-known psychological principles that the disease model ignores or violates.   You can learn more about MI in my book, Recover! Stop Thinking Like an Addict.

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Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers.  Full Bio.

 

Why is treatment in rehab so expensive? Is there any way to get results without mortgaging my home?

Lance Dodes: To begin, it's important to understand that the rehabilitation industry in this country is basically unregulated, so facilities can staff themselves any way they like and claim fabulous results without having to produce any proof. Indeed, rehabs are mostly staffed by counselors with negligible training that would not qualify them to be therapists in a more professional setting. 

Hazelden Treatment Center (one of the most famous rehabs) for example, advertises that you can become an addiction counselor in just a year, while training to be a social worker, psychologist or psychiatrist requires from three to eight years plus more years of practical experience in the field. 

Even saving the cost of better therapists, these programs charge from $30,000 to $90,000/month. 

Many justify these charges by adding expensive "extras" that have no relevance to addiction such as equine therapy (spending time with a horse), "ocean therapy" (taking a ride on a yacht), educational lectures, fitness training, aquatic aerobics, work assignments, leisure skills group, and others. In my new book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, I published the complete daily schedules from the Betty Ford Center and Hazelden which list many of these irrelevant and unproven "treatments." 

The most famous and expensive rehabs compete with each other to offer beautiful settings with spacious rooms and gourmet cuisine, none of which has anything to do with treating addiction. In many if not most, there is a specific de-emphasis on individual sessions, making these programs unable to address the specific issues within each person. There are, instead, multiple groups but unlike true group therapy, these are lectures and discussions about assigned topics.

Is it possible to find less expensive and better alternatives? Look for programs that do not have a rigidly fixed length of stay. There is absolutely no medical or psychological justification for staying in a facility for exactly 30 days. Length of treatment for addiction should be individualized just as it is for every other medical or psychological hospitalization. There are programs that average shorter, two-week stays, and are able to charge less because they are not as long and don't have horses or yachts or ocean views. 

Besides emphasizing individual treatment with well-trained counselors, a competent rehab must offer a variety of modalities without insisting you fit into their favorite one.  A program may offer 12-step meetings, for example, but to be adequate it must offer non-12-step approaches for those who cannot benefit from a 12-step approach. A rehab must never be a boot camp to whip you into accepting their belief system.

Mortgaging your home is not actually the worst consequence of bad treatment. The worst is spending all that money thinking that these incredibly expensive facilities will live up to their promise of changing your life, then suffering a sense of failure and despair if the treatment fails you. Save yourself the heartache and financial loss and make a careful search for rehabs that offer professional, individual treatment without trying to push you into one particular approach, and without costly and useless frills.

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Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and  The Sober Truth, have been described as revolutionary advances in understanding how addictions work. Full Bio.

 

What can you say about cognitive therapy?  Hard to see how it is supposed to help with drug addiction.

Rita Milios: Cognitive Therapy, and Cognitive Behavioral Therapy (CBT) is based on the idea that what we think (cognition), what we feel (emotion) and what we do (behavior) are intrinsically linked together. Faulty thinking, often based on deeply held but erroneous subconscious beliefs, may cause us to believe that we are less adequate, less loveable or less capable than we really are. Some people attempt to deny or dampen these uncomfortable feelings though the use of addictive substances.

Along with limiting or refraining from the use of addictive substances, it is a good idea to address the underlying uncomfortable emotions that often are at the root of substance abuse. Cognitive errors are often so ingrained in a person’s thinking style that they are unaware that they have “stinkin’ thinkin.” CBT helps bring conscious awareness to cognitive distortions, such as “I am incapable of having a positive future because of my past,” or “No one will love me as I am.”

CBT (most often used because behaviors as well as ideas must be addressed), focuses on helping a client discover and challenge Irrational Beliefs that hold them back from reaching their goals. In the 1950’s, Albert Ellis, PhD., created an ABC method to demonstrate this. Ellis said that it is not the activating event (A) itself that causes negative emotions and behaviors/consequences. Rather, it is that a person’s unrealistic interpretation of the event feeds a deeply held irrational belief system (B) that leads to painful consequences (C). For instance, Stan experiences an Activating Event, A, in that he made a mistake at work. Stan’s Irrational Belief, B, is that he must always do well or he is worthless. The Consequence, C, is that Stan feels depressed and down on himself (and he is more likely to self-medicate with a substance if he happens to be a substance user).

CBT is a great tool for re-programming thinking errors. Common irrational thinking errors that can be re-programmed with cognitive behavioral therapy or CBT include, but are not limited to: selective attention (for instance, the tendency to see the negative in one’s self and ignore the positive), magnification (“making a mountain out of a molehill” when viewing one’s own mistakes), and overgeneralization (one misstep and you believe “It always goes wrong” or "I’ll never get it right.”)

For more on subconsciously-programmed erroneous beliefs, see the author’s Fix article, “Oh, Grow Up!”

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Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training." RitaMilios.linktoexpert.com  Full Bio.

 

What do you recommend to someone who is addicted to gambling and cocaine?  Does this call for separate treatments or is there one kind of treatment format that would help me?

Janice Dorn: This is a timely question since researchers at the University of Granada in Spain published a study in March showing differences in the brain functions of people with either gambling or cocaine addiction. They demonstrated that gambling addicts have trouble with decision making, and cocaine addicts have impulse control issues.

As if this isn’t enough, there is a pretty high incidence of psychiatric disorders (depression, anxiety, or personality disorders) in patients with two addictions. This is called COD (Co-Occurring Disorder) and requires a higher level of care. Treatment can be done at one of a number of facilities that specialize in COD, but there will be differences in the way that the gambling and cocaine issues are addressed. In addition to treatment for the addictions, the patient would be seen by an addiction psychiatrist to determine the best way to manage the psychiatric condition. This could be with medications, counseling, support groups or a combination.

It’s a lot for the addict and the treatment team to deal with: two separate addictions (cocaine and gambling) plus a mental disorder. As a consequence, many persons with COD tend to have higher relapse rates, so they should be prepared to re-enter a treatment facility immediately upon relapse.

Taken separately, the best treatment for gambling addiction is a combination of therapies:  individual, group and family. It is important to focus on and strengthen the ability of the addict to make good decisions and engage in self-care. There is some evidence that medication management with anticonvulsants, antidepressants or opiate antagonists may be of help in gambling addiction but they are best used (if at all), in combination with talk therapies. For certain patients, Gambler’s Anonymous may be a benefit and the family may find some comfort and support with Gam-Anon. I am a strong proponent of exercise, diet and meditation/relaxation techniques as part of a recovery program for gambling addiction.

The best treatment for cocaine addiction alone is a combination of structured talking therapies, including group therapy.  Cocaine Anonymous or some non-12 step group may be appropriate, depending on the individual. There are certain medications that may be helpful, but the primary focus is on working with disorders of impulse control that are association with cocaine addiction. As a general rule, I am not an advocate of using a medication to treat a substance disorder unless the patient has  a dual diagnosis or COD (Co-Occurring Disorder).  That said, there are some promising studies on compounds that block the effects of cocaine on brain receptors.  Exercise, diet and relaxation techniques should be part of an integrated treatment program for cocaine addiction. 

Despite the heavy burden of COD, many people can and do recover, remain clean and sober and have fulfilling lives.  There is hope.

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Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself.  Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fallFull Bio.

 

What can you tell me about various self-help methods because I can't afford rehab?

John Norcross: You are not alone, friend. The dismal state of healthcare insurance in this country has left millions unable to afford rehabilitation and aftercare for addictive disorders. It’s a national disgrace.

At the same time, let’s focus on what you (and others in your circumstances) can do. First off, don’t rule out rehab until you have investigated all of the options. Most private rehab programs offer scholarships to select patients who can demonstrate financial need. Many public rehab programs provide free care as well. So call around to public and private facilities.

Self-help for addictions is the de facto healthcare system in this country and, fortunately, it works for many.  The research shows that regular AA attendance, for instance, is nearly as effective as formal counseling for alcohol dependence. Of course, self-help groups plus professional treatment typically works better than either alone, but do not discount the power of self-help. 

For the past 20 years, colleagues and I have been identifying effective self-help books, autobiographies, films, online programs, support groups, and Internet sites. The ambitious goal of our book Self-Help that Works (Oxford University Press) is to guide folks in selecting effective self-help resources; we hope to separate the chaff from the wheat among the tens of thousands of self-help books, groups, and websites.

Your question does not indicate your self-help preferences (book vs. groups vs. apps) nor your particular addiction(s), so we will need to go broader than usual with self-help suggestions. Here’s the consensus from our national surveys and research reviews on self-help that works for addictions:

Self-Help Books

· On Alcoholics Anonymous and recovery: Alcoholics Anonymous by Alcoholics Anonymous and Twelve Steps and Twelve Traditions by Alcoholics Anonymous.

· On maintaining sobriety with or without AA: The Addiction Workbook by Patrick Fanning and John O’Neill;  Controlling Your Drinking by William R. Miller and Ricardo Munoz; When AA Doesn’t Work for You by Albert Ellis and Emmett Velton.

· On adult children of alcoholics: A Time to Heal by Timmen Cermak and It Will Never Happen to Me by Claudia Black.

· On women, couples, and drinking: A Woman’s Addiction Workbook by Lisa Najavits and Overcoming Alcohol Problems by Barbara S. McCrady and Elizabeth E. Epstein.

· On sexual and internet addiction:  Out of the Shadows by Patrick Carnes and In the Shadows of the Net by Patrick Carnes and associates.

Autobiographies

There are dozens of excellent memoirs on addiction and recovery as well. These include A Drinking Life by Pete Hamill and Getting Better by Nan Robertson on alcohol, Go Ask Alice by Anonymous and Beautiful Boy by David Sheff on polydrug abuse, Born to Lose by Bill Lee on gambling addiction, and Love Sick by Sue William Silverman on sexual addiction.

Online Self-Help

Much of free self-help is moving online. For evaluation and feedback on gambling:  Check Your Gambling.  For self-assessment and guided treatment of alcohol abuse: Moderate Drinking at and Drinker’s Check-up. For self-assessment and guided treatment of marijuana abuse: Check Your Cannabis and Marijuana 101. 

Final point: It’s not either self-help or professional treatment. Instead, it’s about getting all of the assistance and fellowship that will lead you to sobriety.

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John C. Norcross, PhD, is the author of the critically acclaimed book Changeology as well as co-writer or editor of 19 other books. He is Distinguished Professor of Psychology at the University of Scranton and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His ideas have been incorporated into addiction treatment by many therapists. Full Bio.

 

  My band is on the road a lot and we mess around a bit with pot, coke and sometimes meth. Hard to stay clean in the enviro but I can't afford to give up the gigs or disrupt the group, so how can I or any of us get help on the road?

Harold Owens: Addiction is an occupational related hazard when you are a traveling musician and certainly not a conducive environment in which to stay sober. I don't know if you are an addict or not, but if any or all of you are considering getting sober, the first thing you need to do is to get help. I recognize that if the ship has sailed, the decision would affect the livelihood of everyone involved with the band. It is a decision based on whether or not you can keep it together and to what degree your life is unmanageable. If you're out there screwing up, don't jeopardize your career. Cancel the tour and get help. 

If you are considering finishing the tour you need to create a healthy environment when you are out there. The first is to stop using, if you can. The next thing is to structure your day with activities that are healthy including: finding a 12-step meeting in every city you visit and calling someone you know in recovery and calling them every day. Don't hang out at the venue either before or after the show. Ask for support from your band mates. The MusiCares Foundation is a resource for all of the above, including treatment. Call me directly at 310-382-4398310-382-4398 and I can help. Remember, there are many musicians out there staying clean and you are not alone.

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Harold Owens is Senior Director of the MusiCares/MAP FUND, the charity arm of the National Academy of Recording Arts & Sciences (the GRAMMY organization). He is responsible for the implementation of all aspects of MusiCares addiction recovery program for artists. Earlier, for three years, he was Program Director of The Exodus Recovery Center, at one time the largest behavioral health and chemical dependency treatment program on the West Coast. He can be reached at harold@grammy.com.  Full Bio.

 

How should I respond to an opioid overdose?

Tessie Castillo Drug overdose is now the leading cause of accidental death in the U.S. Most deaths are caused by opioids: methadone, heroin or prescription pain relievers. Opioid overdose causes a person to stop breathing, which can result in brain damage or death.

Signs of an opioid overdose: The person does not respond when called or shaken and has slow breathing or no breathing. Some people turn blue around the lips or fingernails and make a snoring or gargling sound.

 What to do:

 1.   If you do not have naloxone available (see below), do a sternum rub: If the person does not respond to being called or gently shaken, rub your knuckles hard along the sternum (the chest bone). If the person doesn't wake up, call 911. 

2.   Call 911: Many states now have laws that protect people who report an overdose from arrest or prosecution if police find some drugs or paraphernalia as a result of the call. Check here to see if your state has these laws, but even if it doesn’t, it is important to get medical help for anyone experiencing an overdose.

3.   Do rescue breathing: Tilt the person’s head back, clear out his mouth, pinch his nose shut, seal your lips over his and breathe once every five seconds. If he starts to breathe on his own, lay him on his left side. Do NOT put the person in a cold shower, place ice on his genitals, or inject him with salt water, milk, or any other drug. 

4.   Administer naloxone (or Narcan): Naloxone is a medication that reverses opioid overdose. It is safe to use and very effective. Absolutely everyone who lives with someone using drugs or even on pain pills should have naloxone at home. It's an emergency medication like the epipen for allergies. 

If using intramuscular naloxone: Inject 1cc of naloxone into the muscle of the arm, butt or thigh. If using intranasal naloxone: Spray half the vial up one nostril and half up the other.

Administer one dose of naloxone and continue with rescue breathing. If the person does not respond after three minutes, give a second dose. Even if you have naloxone, it is still important to call 911 because naloxone wears off after 30-90 minutes.

You can get naloxone at pharmacies with a prescription. Also, many states have programs that distribute naloxone in the community. Check here to see if there is one in your area.

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Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform organization in the Southern United States. She is an expert on harm reduction, overdose prevention and response, naloxone, the drug war, and policy reform. Full Bio.


Our panel of experts. Click for full bios. 

Patrick J. Carnes, PhD, CAS, is the best-known sexual addiction expert in the country. An expert in all addictions, he is the founder of the therapist-training International Institute for Trauma and Addiction Professionals (IITAP) in Arizona, of Gentle Path Press and of the 12-step based Twelve Principles Online Recovery program. He also created the Gentle Path Program, a residential treatment program for sexual addiction. 
Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition, a leading public health and drug policy reform organization in the Southern United States. She is an expert on harm reduction, overdose prevention and response, naloxone, the drug war, and policy reform.  
Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of AddictionBreaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.
Brian Donohue has an MA degree from Long Island University in clinical psychology, and has worked in private practice as a therapist with a loosely Jungian perspective and as a meditation teacher. He has worked with depressed people, anxious people, and people undergoing major life changes, challenges, and crises. See briandonohue.org.
Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall. 
Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See  www.doreenmaller.com
Rita Milios, LCSW, is a psychotherapist in private practice, author of more than 30 books, and frequent professional lecturer and on-camera expert. She also facilitates workshops and training for clinicians, therapists, writers, holistic practitioners, businesses and associations. She is known as "The Mind Mentor" because of her unique approach to “mind tools training.”  RitaMilios.linktoexpert.com
Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA. www.LarissaMooneyMD.com 
John C. Norcross, PhD, is the author of the critically acclaimed book Changeology  as well as co-writer or editor of 19 other books. He is Distinguished Professor of Psychology at the University of Scranton and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His ideas have been incorporated into addiction treatment by many therapists. 
Harold Owens is Senior Director of the MusiCares/MAP FUND, the charity arm of the National Academy of Recording Arts & Sciences (the GRAMMY organization). He is responsible for the implementation of all aspects of the MusiCares addiction recovery program for artists. Earlier, for three years, he was Program Director of The Exodus Recovery Center. He can be reached at harold@grammy.com.

Stanton Peele, PhD and attorney, is an innovator in the field of addiction, beginning with his breakthrough 1975 book, Love and Addiction (written with Archie Brodsky) and followed by 11 others, most recently Recover! Stop Thinking Like an Addict. He has created his own rehab program (The Life Process Program) for individual substance abusers. See www.peele.net and his Facebook and Twitter.

Stacey Rosenfeld, PhD, is a clinical psychologist who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly- praised Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight, she is often interviewed by media outlets as an expert in the field. www.staceyrosenfeld.com

G Jay Westbrook, M.S-Gerontology., R.N, is a multiple award-winning clinician (Nurse of the Year), Visiting Faculty Scholar at Harvard Medical School, speaker and author who specializes in both substance abuse recovery and End-of-Life care and is an expert in Grief Recovery©. He has both consulted to and served as a clinician in multiple treatment centers and hospitals, guiding clients through their grief, and working with them and their families on healing broken relationships. His lectures to physicians and nurses include trainings in When Your Patient is a Substance Abuser: Currently or Historically. He can be reached at CompassionateJourney@hotmail.com or 818-773-3700.

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