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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.


I have been reluctant to write this but now need to. Our son died from a heroin overdose four years ago and it crushed us. I still don't sleep well. Last month we discovered that our daughter is now using methamphetamines and appears on the way to real trouble. We are beside ourselves. The fear and already sense of loss and confusion are terrible. It is more than double grief over both children. My husband is a mess as well and going between anger and sorrow. We just don't know what to do. A cousin suggested we have her arrested since she is not talking about recovery because there is supposedly a decent prison program. Any wisdom here would be greatly appreciated. -  Judith

Jay Westbrook:  It sounds as though you have been dealt more than your share of suffering, and I can’t imagine how painful the loss of your son and this situation with your daughter must be. I strongly urge you to contact the Grief Recovery Institute (800/334-7606800/334-7606) for assistance with the grief over the death of your son; their tools are among the most effective, accessible, and rapid in addressing grief.

I cannot tell, from your question, how old your daughter is, i.e., whether or not she is a minor. If she is a minor, you may well be able to place her in an adolescent treatment program, even if she doesn’t want to go. You can Google “Adolescent Treatment Programs” or you might contact either Visions Adolescent Treatment Center (866/889-3665866/889-3665) or Sovereign Health Adolescent Program (866/348-4818866/348-4818) and they should be able to help.

If your daughter is no longer a minor, your situation is made more difficult, as you cannot force her into a treatment program. The dynamics of her using may (or may not) have ties to her brother’s death, and therefore, a skilled interventionist could well be invaluable in helping move her to a willingness to enter treatment. Again, you can Google “interventionists” or, as I said in a previous article, “If the volume of the [Google] search results seems overwhelming, you might consider using either Stasie Kardashian or Ed Storti. There was a recent interview with Stasie (The Other Kardashian - Stasie, The Interventionist)  in this publication, and Ed Storti is spoken of in that article.  Whether you use them or not, you will probably find great value in reading everything on their websites.”

As for your cousin’s suggestion that you have your daughter arrested so she can access the prison [drug] program, there are multiple considerations. First, you have no way of assuring that she will actually be arrested, or convicted, or sentenced to a facility that has a drug program, or that she will enter that program. Second, there is always access to drugs behind bars, so an arrest brings no guarantees that she will become drug free. Third, prisons are violent, and if something were to happen to her, my guess is that you would blame yourself, in part. Fourth, you would alienate her from an important source of support – you.  And, finally, if her using is related to her brother’s death, she may be too fragile to do very well in prison, and would be unlikely to receive the comprehensive treatment she may require to really recover, treatment she is far more likely to receive in a non-prison treatment program. I hope this has helped, and please let us know the outcome.

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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.

 

I am pushing 50 and for a year have been clean and I think I am doing well except in one area. I want my three children, all adults in their twenties, to forgive me and they are still holding a lot of resentment. I don't have a therapist and not sure I am getting the best advice from my sponsor. I'd like to hear from one of your people. Thank you. - Arlene

Larissa Mooney:  Arlene, rebuilding trust in recovery can take a long time – perhaps longer than you would like. You have accomplished a great deal by achieving sobriety over the past year, and healing damaged relationships with friends and family may be one of the hardest challenges in recovery. 

Without knowing the details of your situation, I would encourage you to have open and honest conversations with your children about this process and the goals you are striving for in your relationships. I would reflect on what you have been through as a family and factors that may be making it difficult to move forward at this time.  I would also ask yourself whether you are consistently dependable, accountable, and responsible in your daily interactions with others. These are important steps to earn trust from those around you.  

Throughout this process, I would focus on changing things that are within your control, such as your reactions to others, choices, and activities, and accepting what may not be in your control. With consistency, patience and time, your relationships will strengthen and heal.

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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.

 

My wife is a recovering alcoholic who is obsessed with workshops for healing. She is almost compulsive about it, as if she is madly in search of herself and so goes to anything she hears about where someone is giving a workshop that promises your authentic self or great success in life or finding the meaning of your life etc. She has all these tapes and books around the house and is still emotionally unstable and unhappy and pretty drained of energy. It's like she replaced one addiction for another. She doesn't have much time for me, and so now I just bury myself in work. It's all taking a toll. So, my obvious questions is where do I turn? Where's the way out of this weirdness? My appreciation in advance. -  Jorel

Lance Dodes:  I think the answer to your question, Jorel, lies in your statement that your wife is unhappy and emotionally unstable.  It's likely that she has been dealing with her feelings with compulsive behaviors whose emotional purpose is to try to undo or reverse her feelings of being overwhelmed. Compulsions are not weird; in fact they're among the most common psychological symptoms. It is also common for them to shift direction, as your wife appears to have done by moving from compulsive drinking to compulsive book-buying etc. I suggest that you speak with her about seeing a good therapist to get to the issues behind her compulsive behaviors.

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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.

 

My daughter and I are both in recovery from being lushes. Me for eight years, she for two. I am 46 and she is 23.  Sometimes we go to the same AA meetings. She met a man in rooms three months ago who is 47 and they hooked up pretty quickly. I don’t really like or trust this man, this aside from their age difference. He has been sober for only three months and hasn’t done all the steps. I have the impression he is faking it and hanging in there because of her and sort of playing the game. I am not comfortable around him. My daughter is taken with him, though, and I am not sure how to handle this. Friends in the room give me mixed counsel – let her be, it is her challenge, to I really need to share my concerns. And other ideas. I’d like to get your opinion. Thank you. – Ruth 

Janice Dorn:  Dear Ruth, first of all, please accept my congratulations on your eight years of sobriety. It really does work if you work it, and you appear to be working it! Regarding the situation with your daughter, my heart goes out to you. This presents so many conflicts for you. It could turn out OK, or it might end very badly. I don’t know if she came on to him or he came on to her, but, in my opinion, it is not likely to end well.

This man is one year older than you are, i.e., old enough to be her father.The fact that they met and “hooked up pretty quickly” indicates to me that she is starved for male attention - possibly yearning for acknowledgement from her father or a male figure. I don’t know his motives, but it is entirely possible that they are each getting certain needs and wants filled. He has three months sobriety and this may not be his first time around the AA rooms. What do you know about him? Is he court-ordered to AA? Does he have a history of seeking out women at 12-step meetings? Does he have a criminal past? Is he a good guy? What other women has he been involved with and did he meet them at 12-Step meetings? Who else knows him and what do they say about him?  These are questions that are important to ask .

There are guys who go to AA meetings to meet vulnerable women. I am not blaming him, as I do not know the history, but it sounds as if your daughter was progressing pretty well before she met him. That can now change. The probability for her relapse is great at this point. Anyone who has been around the rooms for any time at all will tell you that.  

There is also the potential for real danger. You may find it of interest to read the story of Karla Brada Mendez and Eric Allen Earle entitled: "Twelve Steps To Danger: How Alcoholics Anonymous Can be a Playground for Violence-Prone Members." I don’t know if anything like this applies to your daughter, but it is a tragic story of two people who hooked up, attended AA meetings together and then went through a series of horrific events that culminated in Karla being murdered by Eric. 

There is a long history in AA of sexual and financial exploitation. It is believed that one of the founders of AA ( Bill W) was so sexually aggressive that the members feared that the organization would have to be disbanded.

That said, this is not a condemnation of AA or any 12-Step group. Many people have benefited enormously from participation in AA. This type of situation can happen anywhere or anytime that there are men and women gathered together. In your daughter’s case, it happened to be at an AA meeting. It is good to always be alert to the possibility for people to take advantage - sexual, financial or otherwise. Your daughter may know what she is doing, but it seems she is quite young and impressionable. Perhaps it is a truly loving relationship and they will live happily ever after. Nobody knows the future, so all we can do is go by the past instances of similar situations. What we do know for certain is that getting sober and into recovery requires an enormous commitment of mental, emotional, physical and spiritual energy. If her energy is now directed to this man and her life with him, there is real risk her recovery will suffer.

So what can you do? Sit down with her and have a serious conversation where you express your concerns. Don’t be angry or condemning. Remain calm and be loving but firm. If you have to, do this several times. She is young, but no longer a child. She is going to do what she wants to do and you won’t be able to stop her. Work on yourself and your sobriety and pray for her. Do not allow this situation to derail you from recovery. Speak your truth, and then release her with love to her higher power and her greater good.

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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.

 

How many times should I pay for help for my 24 year old son? He keeps relapsing, then keeps asking for help. Even though I have the money, it's me who needs the help at this point. The treatment centers of course want me to stay with it, but this is not working and I am not sure where to turn and would appreciate some perspective here. - Serena. 

Roland Williams:  First of all, thanks for the question and let me be honest and up front and say I myself am a big advocate of treatment. So, admittedly I may not be the most objective person to comment here. But let me tell you why I feel this way.I have been working full-time since December 1986 in the field of addiction treatment. I’ve worked as a counselor, a teacher, a program developer, a consultant and as the Director of a few addiction treatment centers, which is what I continue to this day. I know treatment works and I’ve seen so many people get their life back as a direct result of having gone to treatment. 

I also know what a terrible foe addiction is to those who fight it, I’ve seen the devastation and heartbreak as families struggle trying to make sense of the insanity and mayhem that goes with this disease. I have seen way too many people lose the fight against their addiction, good people, people with potential, and people with families and friends that love them. I know personally how hard it is to get clean and then stay clean. But I can tell you it can be done. 

Most people who try to get clean and sober do fail, that is a fact, but millions of addicts and alcoholics world-wide have found a solution to their addiction, and treatment is often but not always part of that process. I know that most people who are successful in their Recovery have been to multiple treatment centers before it all “clicks” in their head and they have that “moment of clarity.” A relapse does not mean a person failed; it means they need more tools, it is very possible that your son may not have found the right treatment program for him yet. I am encouraged that he “keeps asking for help.” I’d be really concerned when he “throws in the towel” and surrenders to his addiction permanently. Each time he goes to treatment, to 12 step meetings, to a therapy session, and even talks with you… seeds of Recovery are planted. It may take a while for those seeds to take root, but we should all continue to plant them. 

My opinion is as long as he keeps asking for help and you can afford it, I would suggest continue to offer him the option of a treatment program. It’s actually pretty remarkable that a 24-year-old, is repeatedly asking for help to get clean and sober. Now, you may need some help in selecting the most appropriate program for your son, and a good, objective addictions counselor should be able to assist you there. If you have trouble finding someone, give me a call. It helps for the counselor to know more about the specific issues your son struggles with, and what are the primary reasons he seems to relapse. Based on those findings it would be easier to select a program that might have the best chances for long term success. And the cost of the program is not necessarily a good indicator of the quality of the treatment so beware. 

As for the help that you need, I would recommend an individual therapist who understands addiction, and also Al-Anon and/or Nar-Anon, both great, (and free) programs for people in relationships with alcoholics/addicts. Most of all, don’t give up. If it happened for so many others, it can happen for him. I’m crossing my fingers that he finds his way and that you get some peace. Thanks.  - Roland

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Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans.    Full Bio.

 

I have been really conflicted for the past two years. I got into cocaine about 10 years ago. It started off fun and then progressed. Drinking has always accompanied my use. I indulge in anything that gives me momentary happiness. I've never really known how to moderate. Typically, I have to burn out in order to stop. I believe that's what happened two years ago when I entered an outpatient rehab. I was becoming increasingly paranoid and I was terrified. I was happy to discover that once I quit the drugs, the paranoia went away. Needing to give up the drugs was obvious; however, the idea that I could not drink socially left me very conflicted.

I stayed sober for a while and then started drinking again, only to end up doing coke on a regular basis and ending up putting myself in risky sexual situations. I scared myself enough to enter a 28 day rehab. I stayed sober for about 5 months. I got bored. I now drink moderately and I have slipped into doing coke every once in a while.  I've been completely sober for the past 10 days. I would like to have periods of sobriety and periods of social drinking.  Is this delusional of me to think that I can drink moderately?

A part of me feels that my actions were just apart of my young age. I feel like I have become much more responsible. I have a good job, I work out, I try and live a mostly healthy lifestyle, and I'm trying to develop healthy relationships with my family and friends. Having been in recovery and a treatment facility, I feel very guilty wanting to drink socially (not very often).  I do not know if I'm in denial. - Said.

Rita Milios:  You are certainly not alone in feeling resistant to the idea of having to remain completely abstinent from alcohol for the rest of your life. This kind of denial of a previously rewarding behavior sets up a competition between your logical, thinking brain and your inner subconscious mind. Your inner self is resistant to accepting the idea that deprivation will be your constant companion. You need to first re-train your inner mind that it is not really deprivation you are embracing, but rather a more balanced, healthy and life-enhancing (vs. self-destructive) mindset. If you can realign both your inner and outer mind parts so that they no longer feel in competition with regard to your intentions, you will be off to a good start.

You mention some positive new habits that you are working on establishing….a healthier lifestyle, healthy relationships. Continue reinforcing these and add more such positive habits; and with diligence, honesty (with yourself and others) and commitment, you may just be able to pull off what you desire…to obtain what is called “moderation management” in regards to drinking. (Note this method is for drinking only….not other drugs …so yes, you will need to give those up.)

Moderation Management is not for everyone. It requires that you monitor yourself and be responsible and dedicated about making sensible choices. According to the website, www.moderation.org, “ Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal. MM is run by lay members who came to the organization to resolve personal issues and stayed to help others.”

The MM website offers an online forum, online alcohol-drinking limit guidelines, and an online calendar where users can report their drinking. There is a book about MM that can be ordered from the website. Face-to-face meetings also take place in certain geographic areas; a listing of in-person meetings can be found on the website as well.

There is some research that suggests that MM is helpful for reducing both overall drinking behavior and problems associated with drinking. You can read about one such study, in Psychology Today’s online blog “All About Addiction” (March 9, 2011). You can also find information about MM at the government’s Substance Abuse and Mental Health Services Association (SAMHSA) website.

These are excellent resources for you, should you decide to go this route. But the bottom line is that you are the most relevant factor in determining your success or failure. If you take responsibility for your choices and use the tools that are available to you, you could attain your goal. But be aware of the slippery slope of habit and the risk of  “inch by inch” returning to old patterns. You must be diligent and determined in order to overcome these risks…yet it is possible.

Good luck. Feel free to report back regarding your results.

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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.

 

Two months ago I was diagnosed with diabetes, type 2, and my doctors put me on a disgusting strict diet. Why I look to you is I am a sugar freak - and yes, I am overweight and my booty is huge. I am down with sugary food and sweets big time and can't stop the craving for it. The doctors said I had to cut my carbs and eat a lot less sugar and I am trying but I have to say I am a mess and can't stop grabbing at the sweets. What do you offer that might get me out of this before it kills me? My doctors seem to just expect me to stop and I can't and they don't get it. I live in a small town and know about the Fix because my BF is in recovery and suggested I write you. He thinks I am addicted to sugar. - Dolores

Stacey Rosenfeld:  The jury's still out on the concept of sugar addiction, as there really isn't good evidence for this concept in humans. That said, you could certainly be used to a substantial amount of sugar, and cutting back can be difficult. Typically with food issues, we recommend intuitive eating - allowing yourself to eat what you crave - toward the goal of reducing the experience of deprivation (which can trigger increased cravings and overeating). In cases of medical illness, however, intuitive eating may need to be modified to allow for doctor's recommendations. 

How do you feel after you eat sugar? My guess is, because of your diabetes, not great. Is there any way you could try to change your intake based on this negative feeling, so that it doesn't feel like you're depriving yourself of sweets, but rather, listening to your body? I would also recommend consulting with a dietitian who specializes in diabetes - a professional can help you flesh out a meal plan so that you don't miss modifications as much. For instance, there may be a way to integrate certain types of diabetes-friendly carbohydrates in your diet, which can satisfy you and help ward off sugar cravings.

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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.

 

I want to get off my meds (Paxil) and frankly, just smoke marijuana when I get in a bad mood. Paxil scares me because I think I am dependent on it and I read about how hard it is to kick. I have been on it for only a year and want off even if I have to go through withdrawal as if I was on heroin. I think I can handle it. So what’s the best way to detox from it? What should I be taking as I cut back? I need to ask because my doctor is telling me not to do it and I don’t trust him. I am going to do this no matter what and I just want some guidance about it. - Jeremy 

Lance Dodes:  There are several reasons why your plan is not good for you, Jeremy. First, I assume there was some reason your doctor prescribed Paxil. Whatever that reason was, marijuana is not a treatment for it. Marijuana has important medical uses, including treatment of pain, nausea, and glaucoma, but none of these overlap with indications for Paxil. Second, it is always wise to discuss changes in treatment plans with your doctor. You may be feeling better and no longer need the medicine, but that would be part of the discussion, as well as reviewing your diagnosis and how your doctor understands the basis for your problem. Other questions would be whether there are other treatments, or treatment modalities (such as psychotherapy), that you should consider instead of, or in addition to, medication, and any risks of stopping.

Your doctor should answer any questions or concerns that you have, including a respectful conversation about your distrust of him or her. If, following this discussion, you believe that the advice you get is not based on adequate knowledge, then you owe it to yourself to obtain a second opinion from another doctor, rather than stopping on your own.

Lastly, your fear that you are "dependent" on Paxil is unrealistic. It's true there is a discontinuation syndrome, but it's not possible to be physically addicted to Paxil in the way people can become physically addicted to heroin. Narcotic physical addiction involves becoming tolerant to the effects of the drug. That's not seen with Paxil or the other SSRIs. Consequently, the SSRI withdrawal symptoms (irritability, flu-like feelings, etc.) are far less severe than narcotic withdrawal, and fear of withdrawal is not a sensible reason to stop taking them. If what you're describing is more an emotional sense of dependence, that's something to talk with your doctor or therapist about, rather than acting on it. Give yourself a chance to consider this decision with whatever doctors you choose, but not on your own.

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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.

 

I used to be an opium addict then became a heroin addict and used everything for almost 20 years. I started going to AA  + NA and could stop for a while and start again. Then my doctor prescribed me Suboxone 8mg/2mg and since that time (2004) I've been taking Suboxone. Well, I'm 59 years old and I asked my doctor when should I stop taking this Suboxone. He said as long as I have a sponsor and go to the meeting and am close to program, I have to take this. My question is should I stop taking Sub or just be on a maintenance program for the rest of my life? Thank you so much in advance. - David.  

Larissa Mooney:  David, you bring up an important question that almost all individuals on Suboxone have wondered at some point:  “How long will I have to take this medication?”  I recently answered a related question about the risks and benefits of Suboxone, which is a combination of buprenorphine and naloxone approved for opioid dependence treatment, so I encourage you to refer to last week’s September 2 post for more details.  

The length of time someone will remain on Suboxone will vary depending on his or her individual history of addiction and relapse and how well he or she is doing on the medication (as evidenced by abstinence from opioids, functioning in daily activities, etc.). I encourage you to discuss your questions about discontinuing Suboxone with your doctor, who has evaluated you over time. If you are stable, feeling well, and tolerating the medication, you may be advised to continue your current treatment plan since it is effective. Your history of prior relapses, both on and off medication, will be taken into consideration when deciding how best to proceed.  

We know from prior research that buprenorphine treatment lowers opioid relapse rates, and that longer-term treatment seems to be more effective than short-term. Though certain individuals are able to maintain abstinence off Suboxone, it is not always easy to predict who will be successful and the optimal duration of treatment.  Thus, if you have reasons why you wish to reduce your dose, it is best to do this only after a detailed discussion with your doctor and under close monitoring and guidance. For some individuals, we are able to find the lowest effective maintenance dose that still provides protection against cravings and withdrawal, which are common triggers for relapse. 

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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.

 

[EDITOR'S NOTE: Last week Jay Westbrook responded to reader Emily's email about an addicted cousin she cares about by recommending that the family consider an intervention. Here is Emily's reply and a further response from Jay Westbrook.]

I thank you for taking the time to write such a thoughtful and informative response. Unfortunately, the idea of an intervention was not well received by my family. One of the biggest reasons being that my aunt is in such deep denial, she won't/can't even admit that he is using drugs, let alone has a serious problem. (Complicated family dynamics also contribute). In the meantime, I plan to look into Nar-Anon (I've had some experience with Al-Anon), send him my letter and some info about treatment options, and hope for the best. Thank you again so much. - Emily 

Jay Westbrook:  Emily, I'm so proud of you, and your healthy approach. You know, Malcolm X once said, "If you see a man drinking from a glass of muddy water, do not tell him not to. Rather, place a glass of clean, clear water next to the muddy one, and step back; allow him to choose." From my perspective, the loving letter and treatment information you've sent, the kindness and concern you've visited, and the self-care you've role-modeled, are the glass of clean clear water. And he gets to choose it, or not. Move forward in your life, and I have little doubt that as you do, many will benefit from your kindness and compassion (including Emily).

As always, in love & service - Jay 

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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.

 

Three years ago I had a very bad experience with LSD and ended up on meds. They make me feel pretty numb much of the time. One way I found myself compensating is gambling for high stakes and watching a lot of violent movies to feel more. I am realizing this is not a life but feel trapped by the meds and my limited options. I am almost tempted to blow off the meds before I go broke and go back to psychedelics for the rush, though I know that's not real. So what would you advise? Thanks. - Merrill.

Rita Milios:  First of all Merrill, good for you for reaching out for help. Your letter indicates that you recognize, at least on some level, that “going back to psychedelics for the rush” is a bad idea, and essentially a dead end. Unfortunately, what you are experiencing is not uncommon - psychotropic meds can dull all feelings, not just the bad ones. But you are not trapped; there are options. Even though there may be no quick and easy way out, it is always worth the effort to work toward becoming whole and healed. Consider yourself lucky to have “dodged a bullet” with the LSD experience. You probably don’t want to take a chance on being lucky long-term… So focus on the wise, inner part of you that made the decision to seek help and listen to that voice more often.

The first thing you may want to do is to return to your doctor or psychiatrist and ask him/her to check your dosage. It is possible that it is too strong.

The other thing that you can do is to find a good therapist and address your issues through counseling. Meds often cannot do the job alone, and you don’t want to be dependent on meds long term. Working through your issues emotionally is a better way to address difficult or repressed feelings. Seeking out emotional intensity via gambling or violent movie viewing may just cause your feelings to become more repressed over time, as you habituate yourself to the intensity.

You may need to “try out” several different therapists in order to find one that you feel comfortable with and that you can really open up to. But it will be worth the effort. Finding emotional balance, inner peace and self-acceptance is possible. If you can refrain from high-intensity-seeking behavior long enough to give counseling a real chance, you can improve your life, not only in the immediate, short-term time frame, but long-term as well.

Your unfortunate experience could eventually prove to be a blessing, if it motivates you to address your emotional well-being in a serious and dedicated manner.

I will be sending positive vibes your way… please don’t waste them!

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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.

 

Last year I made $60,000 net and spent $23,000 of it on cocaine which I probably am addicted to. I mean I can't say I am not. I am a white collar addict. 32. I do web work at a straight company that doesn't do drug testing but got into the blow as a musician, my wished-for career that ain't working out. I'm having increased problems keeping my game going at work - I already burned out all my sick days for the year and have been telling people my doctors can't find my problem. When I am there I still get the job done but who knows how long that is going to last. I have no interest in NA or 12 steps and would like to be in a place where I can party now and then on coke but not be dependent on it. Does that exist? Are there measures I can take - more exercise, say, or some pills - that would allow me to maintain with going completely sober? - Roger

Roland Williams:  Hi Roger. First of all thanks for writing and I really appreciate your honesty. I know from working the last 28 years with people struggling with alcohol and drugs, that many of them really wish, like you, that they could figure out a way to continue to use “every now and then” without having all the problems. As a matter of fact many addicts spend years of their lives trying to moderate, control or cut back on their use. It’s common that they try to cut down, switch brands, avoid the hard stuff, limit the amount of money they spend, only use on certain days, avoid hanging out with certain people, staying away from different places, etc. 

And one of two things usually happens, they happily discover that they can manage their use, and get high like a “lady or a gentleman” or they discover as I did and many many others, that drugs and alcohol eventually kicks their ass…and not just once, but over and over again. After a while most people get tired of getting in the ring with “Mike Tyson,” as much as they tried to hang in there. The dope was just too big and too strong. 

So in reading your question it appears that you might want to be careful, I’m a bit worried about you, actually. You seem to be headed for trouble and I think you know it. If you think you’re “probably and addict” you are probably correct, and a white collar addict is still and addict. As you say, you are spending more than a third of your salary on cocaine, your “wished for” career isn’t happening, and your are jeopardizing your current job; you are lying to your employers and have wasted your “sick-time.” And even though you say while you are there at work you “still get the job done,” in actuality you are probably giving them about 70% of your capability.

Also every time you purchase, possess and use cocaine you are committing a felony. And I would suspect there are several other areas of your life that have been negatively impacted by your use, i.e your health, your relationships, your social life, your ambition, your mood, etc. I can tell you that most of the time, addiction’s negative consequences get progressively more severe. If you continue to use, things are most likely going  to get worse rather than get better. I think it’s time for a change.

One of the diagnostic criteria for addiction is the “loss of control.” That's an interesting concept which I’m sure you may understand. What it means is that 9 out of 10 times the addict/alcoholic can keep his word and use responsibly, however 1 out of 10 times a switch in the brain gets activated and even though s/he only intended to drink 2-3 or just use a little bit of blow, something goes crazy and they are off on a run, using way more than they intended, for longer periods of time with major consequences. The deal is, the addict cannot consistently predict,(key word “consistently”) the amount, effects, duration and consequences when they use. It’s actually like playing “Russian Roulette.” So that means your desire to “party every now and then” will probably eventually include some problems, and if you are willing to pay that price and take that risk, “Party On.”. 

However if I were working with you, I would respectfully invite you to get some “clean time”... i.e no drugs and no alcohol, clean and sober.Give it 6 months, and see how it feels, I would want you to have something to compare your current life to. And I’m not just suggesting abstinence, I’m talking Recovery. I would encourage you to really get healthy while you are abstaining. Develop a plan to take good care of your body, your mind, your emotions, your relationships and your Spirit. It’s fine that you don’t want to go to NA or work the 12 Steps, but I would encourage you to get around some people who understand addiction and could support you getting healthy. You will need someone you can talk to about everything, so maybe look for a good therapist, mentor, advisor, etc. 

Then after six months of really giving sobriety a shot, if you still want to “party,” at least you are making an educated decision. If you are unable or unwilling to get abstinent and things start to take a turn for the worse, I would strongly suggest you get yourself into treatment. And there are treatment centers that specialize in working with people who don’t want the 12 Steps. If you have any trouble finding one, shoot me an email at roland@rolandwilliamsconsulting.com.

I wish you all the best, and would love to hear how things go.  

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Roland Williams, MA, is an internationally recognized addiction interventionist, author, educator, trainer, counselor and consultant. He heads www.rolandwilliamsconsulting.com and is Director of Clinical Operations at DARA Thailand (www.dararehab.com) and Clinical Director at Lionrock Recovery’s (www.lionrockrecovery.com) Online Intensive Outpatient program. He has provided treatment and program development consultation to major institutions around the world. A popular keynote speaker, he authored Relapse Prevention Counseling for African Americans, Relapse Warning Signs for African Americans (with Terence T. Gorski), and the Relapse Prevention Workbook for African Americans.    Full Bio.

 

How do I know whether I am a sex/porn addict or if I just like porn a lot? I watch it all the time." - Seth 

Lance Dodes:  This question is part of a broader issue: If I do something a lot - or even if I do it too much for my own good - does that mean I have an addiction?  Fortunately, the answer is "No." That's because addictions aren't the only reason for doing things too much. We all take some actions because we like them, even if we know they're harmful in the long run.  Eating sugary food is an example. The immediate pleasure overrules our judgment. But this behavior will probably change depending on growth and circumstances. If the doctor tells you that you've developed Type 2 diabetes, you will probably cut out eating junk food, no matter how much you enjoyed it.

Another reason for overdoing is habit. We sometimes call addictions "habits" but true habits are very different - they are simply automatic actions we no longer need to think about. Putting your shoes in the same spot each night or checking your email first thing each morning are examples. If we had to think about all the actions we perform automatically we'd have little time for anything else. The important part of habits is that they have no deeper psychological meaning. They are not compelled activities, driven by emotional need or serving an emotional purpose. For that reason, they are pretty easy to stop, once you've made up your mind to do so.

But addictions are precisely the opposite. They are compelled actions, driven by emotional needs and serving an emotional purpose. For those reasons, they are very difficult to stop, even if you want to.

This brings us back to your question. Seth, you're wise to want to know the answer, and you can go a long way to figuring it out by running an experiment. You first need to make a firm decision to not watch pornography for a significant period of time, say, two weeks. If you have been watching just for pleasure, this will be a loss but you should be able to do it.  

The same applies to watching as a habit.  You might find yourself automatically linking to a favorite porn website, but you will be able to stop before you get there if this is just habit.

But, if you cannot keep to your decision, then you will have discovered that your behavior is driven by stronger factors. In that case, I recommend that you keep track of each occasion that you think of watching pornography, and focus on what just happened in your life, or what feeling you just had, prior to the pornography thought. If you have a true addiction, you will notice that there is always something that stressed you - made you feel frustrated or overwhelmed or helpless. I described a variety of examples of this in my second book, Breaking Addiction, and you might find it helpful to take a look at those. If you have a true addiction, you will also find that you are quite angry at being deprived of your behavior, even though you are the one depriving yourself. That anger arises because you are preventing not just the behavior, but the emotional solution which the behavior serves.  If you discover that you do have a true addiction, it would be wise for you to address it quickly.

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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.

 

My best friend is alcoholic and way overweight and I think he is going to die any day even though he is barely pushing 30. He's a writer, which makes it hard to tell him anything. He'll go out at night and end up lying in the street after the bars close in the Village. I live nearby so I get calls from his drinking buds or sometimes from him to come get him and help him get home (my job lets out just before the bars close) or I will go check myself on him. I've talked blue in the face to him. Nothing. So what's your best ideas on how to deal with this? Let him hit bottom, the AAers I know tell me. But really there must be an alternative to that somewhere. - Chad.

Rita Milios:  This is truly a terrible situation, Chad…for both you and your friend. I know it is painful for you to watch your best friend behave in such a self-destructive manner, and you are rightly concerned for his life. The advice of the “AA people” is hard to take, but it comes from first-hand and hard-won experience. Is there an alternative? Perhaps.

You can (1) accept the reality that your friend has self-determination (as everyone does), and therefore only he can decide what he is willing to do and then take action based on that decision. That is the AA “let him hit bottom” choice. (2) You can continue to be available for calls and late-night rescues. But that sort of enabling only gives your friend the idea that he has “back up” available and therefore he can afford to take more risks, which actually encourages the self-destructive behavior - not what you intend, I’m sure. (3) Another possible option is to try to stage an Intervention. Does your friend have family who would be willing to do this with you?

An Intervention requires a number of people who care about the addicted person (and who he cares about) all getting together at the same time with him and each one in turn expressing to the addict in specific terms how his addiction is impacting their lives. Each person also states firmly that they are no longer willing to accommodate or enable the addictive behavior, and they strongly encourage the addict to go into rehab or seek other professional help to come clean. If the addict has sufficient motivation, and/or he desires to relieve the pain of his loved ones, such an Intervention can be a catalyst for positive change.

Beyond the above options, there is little else you can do. You must reconcile yourself with the fact that this is a situation that you are not in charge of. Each of us has the right to self-determination, even if means we decide to destroy ourselves. You cannot make choices for your friend, so please try to avoid assuming responsibility for his choices, and any consequent outcomes. Inappropriate guilt is a sad and unnecessary burden that helps no one.

I wish all the best for both you and your friend. 

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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.

 

I am dealing with the pain of a broken relationship. I got past the suicide state and now in the medicating state, trying a number of things. I got hold of some Celexa and a friend gave me some Diluadid (not the whole dosage) which actually helps but I know they are both addictive. This is just the worst pain ever and I am not sure which way to turn. Its 24/7 pain without pills. I am looking for some other way. Thank you. – Gloria.

Janice Dorn:  Hi Gloria. There are few things that bite, sting and hurt like a broken relationship.It’s a feeling of being stunned, empty, helpless, angry, guilty, broken, useless, worthless and in so much internal anguish that it seems nothing can fix it.  You are absolutely right about the 24/7 pain! I felt this pain once in my life when I was in my 30’s and I remember it today (many years later) just as if happened yesterday. 

It’s important for you to understand that you have to grieve this loss. There are stages that you will go through. It’s a process. I will tell you more about the stages and give you some possible practical actions you may want to consider taking while you get over this breakup. 

I don’t know if your relationship was with a man or a woman, so I will use the masculine. I don’t know how long you were in this relationship with him, but it will take at least twice as long for you to get over it. Throughout this process, you will still feel pain and hurt. You may want to try to find out what he is doing, who he is seeing, plus calling, texting, looking at his social media pages, doing web searches or driving by his home or going to where he works. All of these are perfectly natural to think about but really counter-productive to getting over him and moving forward.

First, the good news: You got through being suicidal. That is a wonderful achievement and I congratulate you on getting through. Now, the bad news. You are receiving a highly addictive opiate (Dilaudid) from a friend ( I won’t even ask from where your friend is getting such a potent substance) and starting down a slippery slope. If this is not stopped and stopped immediately, a broken relationship is going to be the least of your problems. A true friend does not give you addicting drugs. A friend sits with you, listens to you, brings you food, goes shopping with you, and goes with you for a mani-pedi, massage, movie or road trip. A friend is there to help you recover, not to bring addicting drugs that take you further into depression. 

Now that we have covered that aspect, let’s look at the stages you will go through to recover from the loss. There is no pain that won’t heal one way or the other. You will recover from this, but you have to take active steps to do it. Start by removing every trace of this relationship from your life. Get rid of his stuff and things in your immediate environment that remind you of your time together. If necessary, change your mattress, get a new bed, remove all photos, voice and text messages and take his contact info out of your cell phone. There will be a tendency for you to want to know where he is, who he is with or what he is doing. You may find yourself doing online searches for him, calling him and hanging up, texting or driving by where he lives or works. None of these things is helpful except to keep you hooked on the relationship.

Recovery from loss takes place in three stages, and they may overlap. So, you might be experiencing them all at the same time, with one or more stages dominating. The stages are: (1) shock/denial, (2) anger/depression, and (3) acceptance/healing. It sounds like you are in the shock/denial state right now and attempting to medicate the pain. You may want to seek professional help to see if you could benefit from talking therapy to get you through this. There are many good licensed counselors who specialize in grief and loss. Since you got through the stage of being suicidal, there is a good possibility that you can move through the remaining stages fairly quickly. I think you are young enough that you can do this with the proper professional help. 

If you are unable to afford it, look for grief support groups.  Be active and move forward. Everyone has experienced some kind of loss. Lean on family, friends and groups to help get you through this. Don’t try to be a hero and think you can get through this alone or with some help from your pain killers. Reach out. You may be amazed at the number of people willing to listen and support you.

Don’t ever try to medicate or numb your feelings. Feel everything. Sit in the pain and keep sitting in it. It’s a big deal and you have been wounded. You may feel frightened by the feelings that come up, but they are your body’s way of helping you heal. 

To get over a bad breakup, there’s nothing much better than listening to or belting out the lyrics of a great breakup song. There are literally thousands of these songs. Songs about loss of love and yearning can make you cry a lot, or can motivate you to recover and move on. Find a few good songs you can identify with and evoke emotion from you-- and keep playing them. Some that come to mind immediately are:

Ce Lo Green:  “Forget You”

Fleetwood Mac:  “Go Your Own Way”

Gloria Gaynor:  “I will Survive”

Cher:  “Do you Believe in Life After Love”

Lea Michelle (Glee):  “What I Did For Love”

In time and with a good support system, you will recover your self-esteem, regain confidence and become stronger. Take care of yourself by getting enough sleep, exercise and healthy food. Stay away from the temptation to drown your sorrow in drugs or alcohol. Give your recovery time. It’s critical to remember that you really are so much more than an emotionally-wounded person. You are a real human being with wonderful qualities and you are a desirable woman who has become stronger as the result of going through this break-up. Not only will you survive, but you will prosper and become more alive and radiant from within. Open your heart and your mind to every possibility.  Life is a beautiful adventure with ups and downs and all-arounds. Hurt is a way of teaching us who we really are at the very core of our being. When all is said and done, you will look back and thank everyone for every lesson. You will be strong and stable and glowing in gratitude. 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 have a heroin problem (and getting worse) and live in a backward Red state. It's one of the states that won't implement Obamacare and which does not have much to speak of by way of rehabs, even if I could afford it, which I can't.  The medical people I started to see want me to take suboxone. I read about it, including on your website, and it looks to be as addictive as heroin and maybe even worse. What do you think? Is there a safe dosage or way of using it that the local clinic doctors here probably don't know about? Or maybe you've got something better in mind that I can use?  I am checking out NA here but it's not biting me and I need to do something fast.  Thanks. - Randell

Larissa Mooney:  Your dilemma is shared by many individuals who are faced with limited treatment options for their addiction, and then receive conflicting advice when it is time to make a decision.  Suboxone is a combination of buprenorphine/naloxone approved for maintenance treatment of opioid dependence. Like many other medications, there are a broad range of experiences reported with buprenorphine, and I would encourage you to work with your physician to make an informed decision about appropriate treatment options given your personal history with addiction and relapse.  What works for one individual may be very different than for another. 

I have treated many individuals who have successfully maintained abstinence from heroin while taking a daily dose of buprenorphine/naloxone. Buprenorphine acts on the same opioid receptor in the brain as heroin, but it is eliminated much more slowly. Therefore by alleviating cravings and withdrawal and the highs and lows of using, crashing, and recovering from heroin, individuals have the opportunity to  function more successfully in their daily lives, engage in therapy, and minimize overdose risk.  

With that said, buprenorphine is not a “cure” and it does not eliminate any risk of drug use. Like many other medications, buprenorphine may be misused or abused. There are longstanding patterns of behaviors and decisions that accompany the illness of addiction, and these issues must be addressed in any comprehensive treatment program whether or not buprenorphine is part of the treatment plan. However given that relapse rates are exceedingly high in heroin users, even with the best of intentions and support, buprenorphine may be a very useful recovery tool for some individuals. 

I do not agree that buprenorphine is “more addictive” than heroin; addiction is marked by loss of control and escalation of substance use over time. When taken as prescribed under the guidance of a physician, many individuals may be maintained on the same daily dose of buprenorphine, and often successfully lower their dose over time. However, similar to other opioids, abrupt discontinuation of buprenorphine will lead to withdrawal symptoms, and slower tapering of the dose may even cause discomfort in some individuals. In addition, when there have been unsuccessful attempts to discontinue buprenorphine, it may be perceived as “addictive”; it is unclear why some individuals successfully taper off the medication and are able to maintain sobriety, whereas others require longer-term maintenance treatment.   

So in summary, buprenorphine is not a “cure” for heroin addiction, and personal experiences with the medication vary widely. We know from research hat relapse rates to heroin are very high, and longer-term treatment with buprenorphine seems to be more successful than short-term in facilitating abstinence from opioids. For some individuals, buprenorphine may be a helpful tool to aid the process of recovery by minimizing cravings and withdrawal, which are common triggers for relapse. 

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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.

 

My cousin is deep in the throes of a heroin addiction. Most of the family has either written him off or are totally enabling him. Being a professional who is familiar with addiction, I know that the only way a person can get clean and stay clean is through internal motivation. External motivation can get you into treatment, but in the long term it won't last. My concern is he has neither. I'm so scared of losing him. I was going to write him a non-judgmental, non-confrontational letter and include information about local treatment options. My question is, what else can I do? I have very little support behind me, as most of the family doesn't understand the disease concept of addiction. Any thoughts or ideas would be extremely helpful.- Emily.

Jay Westbrook:  First things first – it sounds as though your cousin is very fortunate to have you, Emily, in his corner.  You are obviously caring and informed.

One approach to this situation is to simply wait for your cousin to “hit a bottom,” i.e., for things to get bad enough for him to find that “internal motivation” to which you referred. The problem with this approach is that with a drug like heroin, that “bottom” may very well be death. So let’s look at what else might be done.

Commencing with the family, it sounds as if your cousin has successfully manipulated the family into a triangulated posture. That means that half the family has “written him off” and the other half is “totally enabling him.” This allows a triangulation where each half of the family is focused on the other half of the family, judging them, and talking negatively about them amongst themselves. This suits the addict’s desire, for as long as they’re focused on one another, they are not focused on the addict and his life-threatening self-destructive behavior. Perhaps members of the family would be willing to go to either Alanon (www.alanon.org) or Nar-Anon (www.nar-anon.org) to acquire information, education, and support. These two groups have free meetings for the families of alcohol and narcotic abusers, where the attendees share their experience, strength and hope on how they’ve coped with a family member’s substance abuse, and in some cases, how they have moved them towards treatment.

Finally, it does not sound as though your cousin is willing to seek treatment based on internal motivation. Neither does it sound as though the family has the training and skills to transmit that motivation to him. My best advice to you would be to use the services of a trained interventionist to build consensus within the family and to bring your cousin to a willingness to seek help. 

Good interventionists are highly skilled at overcoming the myriad barriers to entering treatment, especially in difficult cases such as this one. You can just Google “interventionists,” and you will find many to sift through. If the volume of the search results seems overwhelming, you might consider using either Stasie Kardashian (www.LifeLineInterventions.net) or Ed Storti (www.StortiModel.com). There is a recent Fix interview with Stasie, and Ed Storti is spoken of in that article. Whether you use them or not, you will probably find great value in reading everything on their websites.

I hope this information helps you help your cousin find his way to treatment.

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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.

 

"I became addicted to oxycodone four years ago because of back problems and then finally kicked it by going through a local detox clinic. The follow-up therapists they recommended weren't very good, at least not for me. Most of them weren't sensitive enough to the fact that I didn't start out deliberately as an addict and so wasn't covering up trauma or medicating emotional issues. My trauma and emotional issues and life setbacks came because of the addiction - I didn't know how bad Oxy was and my doctor was a fool to over-prescribe. My question now is I need help and want to know what kind of therapy or coaching should I be seeking?  I live close enough to a big city to be willing to travel there. Are there specific therapy techniques or people with certain kinds of training I should look for? I also may now be asking all the right questions here so what should I be asking if I have not said it here?  Thanks. -- Daniel

Lance Dodes:  This question raises the distinction between physical addiction and psychological addiction. As we all know, certain drugs are physically addictive, so anyone who uses enough of them over enough time will become physically addicted. Physical addiction has, therefore, nothing to do with who you are. It is also easy to treat by detoxification, so if a person has only a physical addiction, once finishing detox, there is no need for any further treatment.

Psychological addictions produce the more serious problems we associate with addiction: repeated, compelled addictive behavior that cannot be stopped, even after detox when there is no physical component.  It is what makes addiction the major problem it is for individuals and society.  Appreciating that the most important aspect of addiction is a psychological symptom also allows us to finally understand why addictions are able to shift back and forth, from drug to non-drug addictions such as gambling, eating, or shopping. The addiction is the compulsive drive to repeat a behavior, and it doesn't necessarily have anything to do with drugs.

With this in mind, let me return to your question. You said you had a physical addiction to the physically addictive drug, oxycodone. If you became addicted simply because of overuse (due to overprescribing and concern about return of your back pain), then you had only a simple physical addiction. That would mean that detox is all the treatment you would need. But, you said that you still need help, so the situation must be more complex. If your use of oxycontin actually had an emotional purpose and drive (beyond your concerns about back pain or a fear of withdrawal symptoms), that would indicate it may have been  a true psychological addiction. In that case, it would be advisable to learn about the way the addiction mechanism works in you. You could learn the particular emotional themes that precipitate your addictive urges, how to anticipate them, and how to deal with them in a new way. You could learn this, in part, on your own (my book, Breaking Addiction describes this in detail), or with a good therapist who understands the psychological mechanism behind addiction.

That is also the key to answering your question about whom you should see.  It's a good idea to ask potential therapists how they understand the nature of addiction, before embarking on any addiction treatment. Therapists who think of addiction as somehow entirely different from other psychological  symptoms, or believe it should be treated apart from understanding the rest of you, should be avoided. The best therapists will work with you to understand both your addiction and yourself.

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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.

 

I think I am becoming a weed addict and don't want to go into any kind of program. I don't like how it feels not to be stoned but am starting not to like being stoned as much, and the comedowns are harder. My head is like non--working in the mornings so I am getting up earlier to exercise, a good thing, before I go to work (believe it or not I am an accountant and handle certain business affairs for a large company that does not drug test because it is in the entertainment industry).  Point is I am between a rock and hard place and if you just tell me to go to some program, it's not going to work.  What else you got for me?  -- Roger (not my real name)

Jay Westbrook:  You remind me of a friend who suffered with an intermittent toothache. He went to the dentist and said, “my tooth hurts, not all the time, but enough to interfere with my functioning and sleep.  I don’t want any x-rays or drilling; what can you do for me?” – to which the dentist replied, “not much.”

In the first sentence of your question, you said, “don’t want to go into any kind of program.” I’m really not sure what you mean by that, but I’m hoping you meant that you’re uninterested in a residential treatment program where you actually go to a facility and stay for 30 or more days to treat your substance abuse – whatever the actual substance might be, and the issues underlying it. 

If that’s what you meant, then there are alternatives to that kind of program. If, instead, you meant you’re unwilling to open to any kind of treatment, then we are probably at an impasse until your situation worsens, and your misery and/or desperation increase.

One of the options I would strongly suggest is a 12-Step Program called Marijuana Anonymous (MA) - https://www.marijuana-anonymous.org. It is modeled on Alcoholics Anonymous, but is specific for those who have a problem with marijuana. You can read a great deal about it at their website, and can also find meetings to attend, to see if this seems like a viable solution for you. It is suggested that you commit to trying six meetings, so that you can really get a feel for their Program and the people in it.

Of course, another option is to see a counselor or therapist to explore issues like 1) why you smoke weed, 2) why you don’t just stop if it’s causing you problems, 3) why you’re willing to jeopardize your career and happiness for the weed, and 4) how you might be able to quit (residential treatment program, Marijuana Anonymous, hypnosis, acupuncture, therapy, etc.).

It’s interesting, people who have a problem with peanuts (a peanut allergy, teeth that crack when they bite a hard peanut, choking on the peanuts, etc.) usually just stop eating them. The same seems to go for people who have a problem with strawberries, or shellfish. It might be well-worth exploring why you seem unwilling to completely stop the weed, now that it’s causing problems in your life. That insight might well be the key to you finding a way to stop. I hope this helps – let us know.

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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.

I’m 22 and have had anxiety issues for most of my life and my parents sent me to shrinks. When I was 17 I started using pot heavily, went off to college, didn’t do well, got into drinking a lot, dropped out. The one persistent thing since 17 has been shrinks, pot and alcohol, with occasional speed and ecstasy. The shrinks have been useless against both the anxiety and my tendency to medicate it. AA didn’t work as I couldn’t get into the higher power thing though I liked some of the people I met. I’ve tried some meds for anxiety but don’t like how they make me feel. I’m not a good meditator. I guess I am a hard case but I am willing to try other things and see what works. Please give me some suggestions – Doreen

Janice Dorn:  Hello, Doreen. Thanks for having the courage to reach out for help. You are not alone in suffering from anxiety and not being able to get help. There are at least 40 million adults in the U.S. who suffer from anxiety. Yet, only about a third of these people try to get help. Congratulations on being one of those who are attempting to get help.

The fact that you have had anxiety for most of your life and have not been able to get relief is of considerable concern. Nothing is working and you are using drugs that are going o end up making your anxiety a lot worse.

You may find it of great interest to read one of the best sagas of the search for anxiety relief that has been published in some time. It is written by the editor of The Atlantic magazine, Scott Stossel, and is called “My Age of Anxiety: Fear, Hope, Dread and The Search for Peace of Mind.” The author describes himself as “a living repository of all the pharmacological trends in anxiety treatment of the last half century.” In addition, he has undergone multiple types of talking therapy, including cognitive behavioral therapy, rational emotive therapy, eye movement desensitization plus biofeedback, hypnosis, acupuncture and a virtual panoply of treatments for anxiety.

My approach to treating you would be to first rule out that there is a true physical condition that is causing the anxiety. I would first do a complete physical examination as well as blood tests. There are a number of physical conditions that can manifest as anxiety, including thyroid disorders, migraine or other headaches, cardiovascular disease, respiratory conditions, endocrine abnormalities and some neurological conditions. It is critical for you to rule out any underlying physical condition that is causing or making your anxiety worse. If there is a physical basis for your anxiety, that should be treated.

If no physical basis can be found, then we must look to the possibility that your body has been under an enormous amount of stress for many years. Unable to find a healthy outlet for the stress, you are probably making unhealthy decisions about your lifestyle. By this I mean that you are most likely in a state of chronic inflammation (both of your brain and your body) that has been brought on by poor eating habits, lack of exercise, use of legal and illegal drugs, poor sleep habits and thoughts or worries that are causing you to be toxic. I would not be surprised to learn that you are having issues with digestion, food allergies, skin eruptions, headaches, joint pains, and that you feel tired a lot of the time with very low energy.

If you are unable to get an answer from a doctor who is trained in Western medicine (M.D., D.O.), you may possibly be helped by finding a really good naturopathic doctor who has extensive experience with nutritional healing and detoxification. If you decide to go this route, make sure you do your research and find someone who is board certified and has a good reputation. You are long overdue for relief and for finding someone who is willing to look at the entire Doreen from a holistic perspective. The goal would be to reduce your anxiety by 50%. I wish you much success with this and would love to hear back from you. 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 17 and found your website by google.  There’s a lot of drugs at my school and, because I like dancing, especially at all the dance parties and teen clubs. White lightening is very popular for example. I feel under a lot of pressure to take it but haven’t given in so far. But I feel myself slipping. I am not sure what the best response is how to tell people to back off, and I also have to deal with my own temptation to try it. How do I get through this? – Victoria

Rita Milios: First, let me commend you for having the wisdom and insight to do some investigation and to engage in some mindful deliberation before you make a possibly life-altering decision. I know it is difficult to stand up against peer pressure, but consider why peer pressure exists in the first place. Those who pressure others to join them in a risky proposition are really just attempting to validate their own choices by getting others to join in. If they were certain of their choices, they would not seek a “stamp of approval” via others’ joint participation.

Your choice so far shows that you are in touch with your “wise self,” your intuition, which always has your best interest at heart. You need to be your own best friend, and follow your inner guidance, rather than giving in to outside pressures from others who have their own agenda, not yours, as their motivation.

As far as the drug you mention, I am not sure if you are speaking of LSD or the “bath salt” named White Lightening, as the slang name can refer to either. Regardless, the biggest reason for avoiding either of these (or other drugs) is that you really can’t know for sure what effects these chemicals will have in your body. The White Lightening “bath salt” product is actually an insect repellant, and street-level LSD is known to be highly impure and significantly altered prior to distribution so that it is a mystery what you are actually taking. It is wise to seriously consider whether there is enough short-term gain to be found in taking any drug that could possibly be worth the risks….both immediately and in the future. Choosing to start experimenting with drugs is one of those decisions that can change the trajectory of your life, altering your future for years to come.

As far as how to resist:

1) For your own “temptation,” continue doing what you are doing…investigate. I’m sure that in reading some of the stories and articles on this website, you will see that many people who are recovering from drug addiction would give almost anything to be able to turn back time and make a different decision about going down that path. If you need support in gaining self-confidence and self-esteem so that you can speak honestly with your peers, please seek assistance from your school counselor or another counselor.

2) As far as what to say to others regarding their “pressure” to try to convince you to join them, create a simple, clear, concise message that you can deliver consistently, over and over, like a parrot (but in a kind, non-judgmental tone). Say something like, ”I have decided that this is not for me. I respect you in having made a different choice, and I expect that you will respect my choice as well.” If they continue to pressure you or taunt you, add: “Again, I have decided that this is not for me. I am not going to discuss it further.” Then smile and change the subject or walk away.

I wish you all the best.

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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.

 

I am in the process of trying to find a residential treatment facility for my 18-year-old daughter who is a heroin addict and 11 weeks pregnant. She went through treatment at Right Step in Euless, TX, discharged on 7-15, for less than the original plan of 30 days (because she had no desire to be there and thought she could do it on her own). It was definitely less than adequate, and she relapsed within two weeks. I have read through your ultimate guide but I can't find any info on accreditation. Several of the facilities have said JCAHO is the gold standard, and we should not consider a facility without that. Can you direct me to some info on that topic. Thank you! BP

Lance Dodes: Step one is that your daughter should be under the care of an obstetrician as well as another physician who will evaluate and monitor the current status of her drug use. If she is using heroin currently, she should be evaluated for maintenance on either buprenorphine or methadone. Both are safer alternatives to heroin during pregnancy. If she is not currently taking heroin, the fetus is best protected by her being placed in a facility away from all illicit drugs for the duration of the pregnancy. A JCAHO facility is required if she needs medical care during her pregnancy.

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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.

 

I am seeking some sort of recovery (I've done some meth, coke and occasionally smack - different highs, I know) and am just starting to explore what's available. I heard about something called Harm Reduction. What can you tell me about this and how might it apply to me. I don't need needle exchange but what I get from google is it has other elements.  What if any part of it might help me. -- Lloyd  

Tessie Castillo: Harm reduction programs offer many services in addition to needle exchange programs. Substance use specialists in harm reduction can work with you to help you manage, reduce or stop using drugs or alcohol, or to make safer health choices while you are still using. For example, harm reductionists teach their clients how to prevent or respond to drug overdose from opiates, like heroin, or how to avoid over-amping on stimulants such as methamphetamine or cocaine. They also provide education on how to prevent transmission of blood borne diseases such as hepatitis C or HIV whether drugs are injected, snorted, smoked. (For example through burnt or blistered lips from a hot pipe). 

Harm reductionists are trained to be nonjudgmental about drug and alcohol use and can work with you to create realistic goals based on where you are at in your drug use and where you want to be. You can google for specialists 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.

 

Hello, I am hoping that I can get some help (either from one of Experts, or a referral to another online forum) regarding codependency and enabling. My older (and only) brother is 34 and has been living at home with my parents for the past two years and hasn't worked in several years (for the years prior, he jumped around from girlfriend to girlfriend who would support him). He had numerous surgeries to fix his back-the result of being reckless and making poor decisions - and is now addicted to heroin (though he refuses to accept it). He has been using heroin for at least five years, and prior to that, was/is addicted to opiates.

Although my parents do not give him money, he steals valuables around the house, and recently, we found out that he sells drugs to support his addiction. Long story short, my parents are on different pages on how to deal with the situation. Although they have attended counseling appointments and NarAnon meetings, my father does not want to kick him out and wants to believe my brother when my brother says he is clean. My mother, on the other hand, is at her wit's end and feels that she can only care for herself and can't make my brother get better, especially when he refuses help. My dad, I believe, is codependent on my brother because he retired a few years ago and is filling a void in his life by being in the cycle with my brother.

My question is what to do when my parents are on two separate pages? I believe my mother is right; my brother needs to leave. My dad is enabling him by allowing him to stay at home, paying for his cell phone, and refilling his prescriptions. Having found out recently that he is selling drugs, and after recently damaging my father's car, I believe that things are escalating and getting worse quickly. I'd recall other past scenarios when I thought that things couldn't get worse, but you've heard them all in some iteration I'm sure. Thanks. - John

Rita Milios: I am so sorry, John, that your family is having such a difficult struggle. I know it is hard for you to stand by and watch your parents being in conflict because they differ in their opinions of how to help your brother. I know it is also hard to watch your brother sink deeper into addiction. There is no easy way to solve this dilemma.

Unfortunately, you are right in thinking that your dad is enabling your brother. You may be right in thinking that your dad is possibly trying to fill a void in his life by being codependent with his addicted son. But this way of demonstrating love and concern will only encourage, rather than discourage, further drug use. Your mother has the right idea, but unfortunately, she is outnumbered here. You cannot dictate to either your dad or your brother what actions they should take. But you can at least try to educate your dad by leaving information about codependency and enabling behavior around the house. (This may prove to be useless, as you say your dad has attended counseling and NarAnon meetings and still maintains his position.)

The other thing (and more important thing) you can do is to support your mother. She needs all the encouragement and stress relief that you can offer. Perhaps a drastic action may be called for on the part of your mother, to really bring home the point that she “can only take care of herself.” Discuss with your mom how she can follow through with specific actions to “take care of herself.” Does she need to be out of the house for a while? Could she visit a relative to distance herself from the chaos and get some stress relief? Perhaps a drastic move such as this would get the message through to your dad about how serious the issue is. At the very least, your mom should seek counseling for herself to help her deal with her own emotional turmoil. (It would not be a bad idea for you to consider the same.)

“Tough love” is hard for those who must implement it. But until your brother suffers enough as a consequence of his action, rather than being shielded from unpleasant consequences, he will have no incentive to change. You and your mom need to show a united front and take a stand, to indicate that the two of you will neither enable your brother’s addiction, nor will you allow yourselves to become collateral damage in its wake.

I wish you all the best.

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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.

 

I spent five months in jail for a minor marijuana bust.  I came out pretty fucked up by how depraved it was in the can, and irrelevant. I have trouble sleeping now but can’t go back to smoking (or selling) because of the follow-up drug tests I need to take for my parole officer. I’m thinking I need a whole new direction in life and am open to any suggestions before I  turn completely dark, which is creeping up on me with the sleeplessness. Don’t know which way to turn.  -- Oren

Stacey Rosenfeld: Trouble with sleep can be debilitating. The good news is, there are options for addressing insomnia that will allow you to continue to pass your drug tests. Getting into a good sleep routine is key - we call that sleep hygiene. That means establishing a nightly pattern of gradually cutting out stimuli as you get closer to sleep. Some behaviors, like eating and exercising, if done too close to bedtime, can, for many, interfere with good sleep. Are you drinking? Many people believe that alcohol helps them to sleep, but in reality, the opposite is true - drinking negatively impacts quality sleep. Near bedtime, you'll also want avoid arousing stimuli, such as television, gaming, reading, or conversations. Instead, opt to dim the lights and read something light or listen to calming music. 

If basic sleep hygiene techniques don't help you to sleep better, you may want to consult with a therapist to help you with your insomnia. Cognitive-behavioral therapy has been shown to be effective in the treatment of sleep concerns. Treatment may involve implementing some of the sleep hygiene techniques I discuss above, restructuring some of your thoughts about sleep, cutting out naps, learning relaxation exercises, monitoring your sleep, and scheduling it to make you a more efficient sleeper. In some cases, depending on the severity of your disturbance and your response to treatment, sleep medication might be indicated. 

You and your psychiatrist could discuss nonaddictive medications that won't put you at risk for any parole violations.

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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.

 

My partner has suddenly become very distant and secretive. I suspect something's up. Best way to confront? Should I suggest help? Give an ultimatum? – Chloe

Doreen Maller: Social withdrawal can be a sign of many things: depression, addiction, a change of heart…and it can be very confusing to partners and loved ones. When a person shuts down and resists connection, it may feel that all attempts to relate seem to drive the person farther away. Often the people closest are the first to detect shifts and changes. These can begin subtly and then move toward the situation you describe. Feeling distance in intimate relationships can be confusing and painful.

Using statements about yourself can start conversations that are less threatening and accusatory which can then lead to a deepening of connection. Therapists call these “I” statements, which means you are speaking from your own experience rather than stating your observations about someone else’s life. Saying, “I’m frightened and confused and concerned,” rather than “You have a problem” can cut through resistance and provide opportunities for dialogue. Asking your partner to join you for counseling or support can be a good first step. If addiction or abuse is contributing to the secrecy, early treatment and intervention can help connect your partner into a recovery model that works best for them. Getting your own support in the process can be helpful too. 

There are many opinions regarding the efficacy of confrontation and ultimatums. Some suggest that holding the person accountable to solve their own problems is the best approach. Others feel that doing everything in your power to move them toward recovery is a better choice. Ultimately, you will both may need support to move through your current situation. Asking your partner to join you in support and sharing the responsibility for education and a plan of action with a professional can reduce tension, and move both of you toward informed choices.

There are many resources online for guidance for these types of concerns. 

Try:

http://newsinhealth.nih.gov/2009/March/feature1.htm

You can contact rehabilitation centers in your area and ask for guidance or set up an appointment with a therapist to discuss your concerns. Mental health care providers can walk you and your partner through the first steps of relationship challenges and education toward recovery. Primary care physicians and clergy are also good resources who can refer you to programs and support. 

Shifts and changes in relationships can be isolating and frightening regardless of the cause. Asking for help and support in these times can help build coping skills as well as treatment plans to move both of you toward appropriate services.

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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.

 

I have been sober from opiates for 4 years. I have been really struggling lately. The problem I run into is I am constantly worried about relapse. I went to a rehab that taught addiction is a chronic, progressive, and fatal disease?  I was reluctant to believe this. They told me things like, "If you do not go to NA, you will eventually run out and get anything you can like a dog running through traffic not worrying about consequences.” So the last few years this has really been sinking in my head.

I wake up every day like this is the day I may relapse because I still refuse to go to NA. It’s like I obsess over it. I am even obsessed with drinking relapse now even though I never had a problem with alcohol. So I guess my question is that Is it definite addiction is a chronic and progressing disease. My counselor told me my thoughts will get so bad that I will eventually break down and relapse. So my head uses this against me or was he right maybe this is just how my addictive mind works. I think it is pretty horrible that they try to set people up for failure in rehabs like this.  Does this theory hold a lot of water? You would think after 4 years things would get better but not worse.  Please Help. - Trey

Lance Dodes: It is a myth that addiction is inevitably a "chronic, progressive, and fatal disease." The spontaneous remission rate (the rate at which people stop their addictive behavior without any treatment at all) is around 8% per year for alcoholism, for example.  Even people who are unable to abstain often have long periods of abstinence, and most do not die from their addiction. as we demonstrate in our new book The Sober Truth. We might forgive people for using scare tactics, such as what you were told, if it helped. But we have thousands of years of evidence that telling people they are going to die from their addiction does not make them stop. 

Instead of repeating this myth, we should be helping people to understand their compulsion to drink, take drugs, gamble, and so on, so they can be empowered over the addiction, rather than feel the addiction is a "disease" that controls them and will kill them.

It is also a myth that leaving 12-step meetings means that you are doomed. Far from being doomed if you drop out of programs that don't work for you, you are giving yourself the chance to try something that might help you. There are many non-12-step ways to approach addiction, including groups such as Smart Recovery, LifeRing, and the HAMS network. For people who tend to be introspective, I have found that understanding the way addictions work psychologically can be extremely helpful. (For more information, see the links below to The Heart of Addiction and Breaking Addiction).

The bottom line is that you are right that you are being set up for failure by 12-step people who tell you that you must do things their way or you will die. It just isn't so.

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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.

 

The news says Robin Williams suffered from Bi-Polar Depression­. What if anything is the difference between that and regular clinical depression? What are the signs to be aware of? Clearly it is not the same as just feeling depressed and moody for a while.

Rita Milios: Depression is more than just sadness.  It involves a major life-altering change in perception. You know you are depressed when life itself seems to have lost its zest and things that used to interest you or excite you now seem flat and void of emotional appeal. This deadening of emotion is the hallmark of “regular” depression. Depression also often manifests with self-defeating beliefs, such as a sense of personal worthlessness, or a feeling of helplessness.  Anxiety, irritability, fatigue and loss of concentration are other symptoms commonly experienced.

Bi-Polar Depression by contrast is the “down” cycle of bi-polar disorder, where a person’s moods cycle back and forth between two extremes­ – either a hyper-excited “high” or a depleted, depressed “low.” The swings of mood distinguish bi-polar depression from regular depression. To be diagnosed with bi-polar, one must have experienced at least one “manic” state, where increased energy, racing thoughts, decreased need for sleep and hyper-activity are experienced. There is often a sense of grandiosity and a hyper-awareness of emotions. In a manic state, sound judgment is often missing and irrational or destructive activities such as overspending and other high-risk activities may seem logical at the time.

Bi-polar cycling can occur with long intervals in between–several months or more. But some people with bi-polar cycle between high and low moods on a daily basis, or even many times in a single day. Sometimes the manic state can be channeled ­–into work, creativity or other positive outlets. Still, the “crash” after a manic state and the exhaustion­ – physically, mentally and emotionally– are a high price to pay.

Both regular depression and bi-polar depression place a person at greater risk for suicide, often because the strain of managing the overwhelming feelings becomes too great to bear.

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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 drove Robin Williams to hang himself? What makes depression so powerful in a bi-polar person?

Jay Westbrook: I can't imagine saying anything better than the late novelist David Foster Wallace's quote:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”

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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.

 

How does DA work? It doesn’t make any sense to me how the 12 steps apply to debt. - Joseph

Janice Dorn: Dear Joseph. Thank you for bringing the critical topic of debt to our readers. Debt is something that touches most Americans in one way or the other. We are a nation that is drowning in debt. It’s not just personal debt, but national debt. 

In terms of personal debt, it is estimated that each household with a credit card is carrying at least $15,000 in credit card debt. Total U.S. consumer debt is believed to be $11.4 trillion. This includes credit cards, mortgages and student debt. You are not alone in dealing with this challenge!

Yes, DA certainly can work to help a person get out of debt. Under the program you must take specific actions to decrease your debt. A person who is recovering from drugs or alcohol works the steps to get and stay sober. A person who is recovering from compulsive spending or who is in debt works the steps but must also make a specific action plan in terms of recovering from debt. Unlike the alcoholic or drug addict, the debt-addicted person can actually begin to see real changes in the way that his or her money is being handled. Figures don’t lie.   

The first step in DA is: “We admitted we were powerless over debt and that our lives had become unmanageable.” Step 1 is a great place to start. You must admit that you are powerless over debt and that your life has become unmanageable as a result of it.  Once you have done that, it’s time to get on with the business of getting out of debt.

Once you acknowledge the problem, your thinking may go something like this: 

OK, I have a real mess with debt. I got into this because I spent money I don’t have. I now believe there is a way out for me. I want to be able to control my spending, make a plan and slowly begin to get out of debt. My plan is this: I will set aside a certain number of hours a week just to deal with financial issues. I will go to DA meetings so that I can interact with others and be held accountable. I cannot do this alone. I have tried in the past and failed. If I keep doing the same thing over and over again and expecting different results, I will continue to be insane.

I will make a plan and stick to it. I will cut up all credit cards and use only debit cards. I will try to determine the difference between what I WANT and what I NEED. I will come to know myself in a completely different fashion as it regards my relationship to money. I will make small cutbacks at first just to get started. I will reach out to my fellow DA members for specific suggestions about how they have gotten out of debt. 

I will look for a really good website or two that speaks to the issue of being frugal or saving money or even being a “cheapskate.” I will ask everyone I know what they have done or are doing to get out of debt. I will continue to take inventory of everything I am doing, and add at least one new item a week. At the same time, I am working the steps of DA and taking a personal inventory.

The above is just a short introduction to how you might want to begin the process, but I think it’s a good start. 

DA can help in a number of ways. You can work the steps at the same time that you are actively taking measures to reduce your debt. In a way, this is the same as recovering from any addiction except you can see tangible changes in the real world as you make budgets, pay off bills, reduce spending and increase savings. 

As you do all the things that are required in order to reduce debt, you are likely to see how the other steps of DA can be applied. What defects of character caused you to get into debt in the first place? Who have you harmed or lied to or stolen from as a result of your addiction to debt?  Recognize these and correct them as you are learning how to respect yourself and respect money.

You can use every step of Debtors Anonymous to guide you through Debt Recovery. You are also very fortunate that there are a number of reputable financial advisors who can help you with the specific steps you need to take for getting out of debt. Using trusted people who have your best interests at heart, drawing on your DA group and your sponsor, and making and following a solid debt reduction plan will truly lead you to “a new freedom and a new happiness.” 

One strong caveat here: Do not be fooled by so-called Debt Recover, Debt Reduction or Credit Repair groups. Also stay away from anything to do with payday loans. A large number of these are scams that make robocalls or find you some other way. They know you are in debt and will prey upon you. They often insist on some payment from you up-front before they even do anything! The last thing you need when you are in debt is a so-called debt-reduction service that puts you into more debt! The same applies to bogus auto loan modifications and credit repairs. Beware of credit repair. If you have been or start receiving calls from any such groups, hang up immediately, ask they do not call again and put them on your “Do Not Call” list. If the pestering persists, report the call to the FTC through this link:  https://www.ftccomplaintassistant.gov/#crnt&panel1-1

I have really only scratched the surface of this (seemingly) simple question. A whole new world is about to open up for you once you make the decision to take action to get out of debt. There are few feelings as powerful and joyous as becoming debt free. Think of each step that you take toward this goal - no matter how small or insignificant it seems at the time - as one more load lifted from your shoulders. Imagine the beauty and glory of waking up one morning to the realization that the debt monster is gone completely and you are truly free. 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 lost it a few years ago to booze and coke and went down the usual tunnel and ended up broke and jobless. Then I got into Debtor's Anonymous, a really great program, and some not very good social services level rehab and have made my way back to being a reasonable functioning adult though I still have cravings (which I handle) and am certainly not getting rich. I get by and am much less on my own case than before. The issue now is I have fallen in love and am not really skilled in relationships and it is triggering very intense feeling and insecurities and fueling some craving. Clearly I need some help with this and can't yet afford a private therapist and DA and the steps don't seem to be the answer and, much as I dig the steps. AA I have found is not for me for some odd reason even though DA has been, and I can't see AA helping with relationships. So where do I turn? All help appreciated. Thank you. - Carl

Jay Westbrook: I’m so impressed with your willingness to admit that you need help with relationships, and that you’re willing to ask for that help. I’m also pleased you found someone you care about enough to look for tools. 

I was married for decades, to the love of my life. She died from cancer in 2012, and we both had over 23 years sober when she died.  We always loved one another, but the marriage was certainly better and more loving and harmonious after we got clean and sober. 

For both of us, the most important tool was to translate “loving feelings” into “consistent loving behavior.” That means we behaved in a way that was honoring, honorable, passionate, compassionate, playful, forgiving, supportive, kind, loving, unconditional, patient, tolerant, and imaginative.

We ran most of our decisions through the filter of Tradition 1 associated with the 12-step programs: does this strengthen or weaken the common welfare, and does this lead to unity or to separation. It’s amazing how powerful this one litmus test or filter can be in guiding us to behavior that strengthens the relationship. We also learned how to disagree without becoming disagreeable.

It’s also vital to let go of being a victim and to let go of score-keeping (remembering every bad thing they’ve done and every good thing we’ve done). Holding on to being a victim and practicing score-keeping are two of the most corrosive behaviors in which members of a couple can engage.

Because how we do anything is how we do everything, it also became important for me to look at my behavior outside of the relationship. If I cheat at sports and cheat on my taxes, it would not be surprising to cheat on my wife; so I don’t cheat, period. If I drive aggressively, disrespectfully, and with a sense of entitlement, I’m likely to bring those same postures into my home, and not leave them in the driveway; so I drive respectfully.

I don’t know if you attend a church or not, but many churches and temples offer classes for new couples, to provide them with tools to help address problems with communication, intimacy, money, fighting, decision-making, etc. These can be very valuable.

There is also a great annual workshop called the Couples Communication Workshop, held each June in Lake Arrowhead, CA.  It’s for couples that have at least one member in a 12-Step Program.  You can get more info at www.CouplesWorkshop.us. Nancy & I attended it every year for 23 years, and it was invaluable to our relationship. There’s no therapy or confrontation or professionals – just couples sharing their experience, strength, and hope on how they stay together, grow closer, have fun, and deal with the situations life throws at couples. I strongly recommend it.

Finally, there are a zillion books out there. As someone who cultivated a loving, happy, highly successful romantic relationship, the two I would most strongly suggest for you are: The Seven Principles for Making Marriage Work by John Gottman & Nan Silver, and Hold Me Tight by Sue Johnson. They are both relatively short, readable, and most importantly, useful.

I hope these help, and please let us know how things are progressing.

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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.

 

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