Ask an Expert: Previous Questions and Answers

By The Fix staff 07/01/14

 

NOTE TO READERS: Your anonymous questions to the expert panel can be sent to [email protected]  Click here for full bios of our Experts.


My mother was a meth addict when she was young. Then she did a lot of ecstasy and, for a while, heroin. Now she smokes pot every day. My issue is she is extremely abusive and controlling even if also loving. I know it makes no sense. I have been on my own for years now -  I am 24 and doing well on my job and did very well in college  -  and I find myself having to avoid her because she won't stop the abusiveness and still tries to control me. I am not sure how to handle this as I want a good relationship with her. She did one round of recovery and won't do another, by the way. What do you think I should do?  -  Glenna

Rita Milios: Glenna: I know it seems like a no-win situation, when you have your mother behaving the way she is and you still desire to have a positive relationship with her. However, there is an aspect of this situation that you have perhaps not considered. A relationship is a two-way street; you cannot create a positive relationship with anyone (relative or otherwise) if they do not do their part. So, as it stands, you have pretty much zero chance of making the mother-daughter relationship you desire happen. And this is not your fault. So please do not become overly sensitive about your mom’s current choices regarding her interactions with you. She is making choices based on her agenda, not yours, and these choices have little to do with your worthiness as a daughter. Perhaps she feels that you are judging her and she is reacting to this. But whatever her reason, it is not about you…it is about her.

The best thing you can do, actually, is what you are doing–avoid her until or unless she behaves more appropriately toward you. If someone does not treat your gift of friendship/companionship with respect and appreciation, you do not have to continue to give that gift. If you do, you are actually contributing to the problem in several ways:

First of all, you teach people how to treat you. In allowing and accepting her abuse, you are teaching your mom that her abuse is something that you are willing to tolerate, and she therefore has no incentive to stop offering it up. 

Secondly, your acceptance further serves your mom’s purpose because it validates this kind of behavior in her eyes (If you accept it, you must agree that you deserve it, so therefore it is okay that she abuses you). 

Finally, because you are, in effect, validating her abusive behavior, you are contributing to your mom’s development of bad character. You are teaching her that being an abuser works for her and serves her agenda (to not accept responsibility for her bad behavior, but to blame it on you). Neither of these attitudes is helpful to your mom. 

So, in the end, only by taking a stand for your own right to be treated well, can you ever hope to achieve your goal of having a positive relationship with your mom. At this time, she likely does not have a positive relationship with herself, so it is highly unlikely that she can maintain one with you. If, however, you teach her that her bad behavior has consequences, and that you will not tolerate abuse, you can possibly help her learn a better way to deal with you and other people in her life. It is not a guarantee, but it is the only thing you can do to help. The rest is up to her; so do not take ownership of it. Even though it is painful, it is often better to remove yourself from a toxic relationship, rather than allow it to poison your life as well as the one who is generating the toxins.

I hope this helps, and that in time, your mom will become whole and healed.

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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 will keep this brief. I am 19 years old and in my second year in college. My dad who I lived with the last three years takes care of this cost. My mother is a functioning heroin addict (for four years) who has finally gone on methadone maintenance and who always begs me to visit her, though between her rages and her stonenedness, I haven’t been willing to see her for 3.5 years. Now she says she is clean and is begging me to visit her or to come visit me in school. My father says I should make her wait. I am torn. I found your website and decided to see what you had to say either about exactly what I should do or how to get the information I need to make the decision. Thank you. - Kathy 

Janice Dorn: Hi Kathy,

This is just a totally awful conflict for you.  You have to choose between your mother and your father. No person should have to do that. Not in this day and age when—perhaps more than at any times in history—children need both parents. OK.  Maybe you are not exactly a child. You are a young woman. Nineteen years old.  However, you are dependent on your Dad for money to pay for your college education and room and board. This is a good thing to do, and you are fortunate that you have him. I hope you get through college and do something wonderful and productive with your life.  

That said, you know about money and control. The person that has the money almost always has the control. So, your Dad is in charge right now. He is sacrificing so that you can do to college. You don’t want to upset him in any way. He wants you to “wait” to see your mother.

I am not exactly sure what “wait” means, but, perhaps, this would be a good place to start.  If you really want to see your mother, you must first talk to your father. Ask him exactly what he means by “wait.” How long? Days, months, weeks, never? This is a critical thing to know.  

Whatever he tells you is what you should abide by until you are out of college and on your way to a career. I don’t usually talk like this to young people because I believe in their (your) autonomy and ability to make decent decisions. However—in your case, the most important thing for you is to finish your education and begin your career.  Once you are independent financially, everything will change for you.

So- what is the bottom line: 

You have two options in terms of seeing your mother—Either you see her or you don’t. Right now, I suggest you don’t. Why? Because your Dad doesn’t want you to, your Dad is supporting you and you really need to finish college, get on your own and build a life and a career for yourself.

Perhaps the best thing would be to tell your Mom that you would love to see her but you really cannot take the chance to do it right now. You need your Dad to support you and get you through your education. Talk to your Dad. Run everything by him. Approach him with totally rigorous honesty and don’t hedge or pretend. If you are talking with your mother, tell him everything. Ask him if he would have any issues with your speaking to your Mom on the phone, SKYPE or texting her. If he says “No”—then the answer is “No.” Tell your mother that you would like to see her but have to wait until you are finished with college and on your own. See if you can work out something so that you can continue communication with her while you finish your college work.

I think it’s possible that if you have a totally honest conversation with your Dad, he may agree to let you at least SKYPE or text with her. Your Dad is in charge right now and it’s important that you respect that. Your Mom is pretty much an unknown in terms of her degree of sobriety or recovery. In the final analysis, I think it’s critical that you choose yourself. Finish your education, get a good job, and become independent so that you don’t need anyone to support you. Then, you can make the decision if you want to continue the relationships with your Mom and Dad—and at what level.

Sometimes in life, it becomes important to put you first. In fact, you may find something quite magical happens when you put “YOU” first. Everything falls into place. Things that you never thought would or could happen actually do happen.  People begin to respect you for the woman you are and the woman you are becoming.  

There is a wonderful wisdom-filled poem called “After A While” by Veronica A. Shoffstall. Google it. If I were your age, I would memorize it and print it out and keep it with me all the time. 

I send warmest wishes and much strength to you. I hope that you will come to understand that there is a time and a place for everyone and everything. Right now, it’s YOUR time. Go for it; stand in your truth and your integrity. Get your education and find something to do that you truly love. Once you do that, you will truly know a new freedom and a new happiness. Decisions that  once seemed so difficult will no longer be that way. You will be free to choose and find what is right for 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.

 

We are a Persian family in this country for 20 years.  I came here when I was 11 and  so mostly grew up with an American sensibility and have studied some psychology, though that is not my profession (I am a sales person).  Most of the immigrant Persian families I know are very tightly knit and keep this going partially by being very judgmental, blaming and emotionally controlling of each other. They all the speak the “you should” language. This is not unique by any means to Persians, and I recognize it was a survival system in the old country. The issue now is that the full weight of this way of relating is being slammed at my cousin, who we recently learned is addicted to methamphetamines. I don’t know how to get through to most of the family that he needs our support and not blame and condemnation, with almost everyone in the extended family defending themselves that they did nothing to create the situation for him.  I am pretty lost about what to do here to turn this around and asking for any guidance you can give. – Adar

Doreen Maller: Thank you so much for this question, I think issues of blame, shame and stigma arise in many families regardless of cultural background as you mentioned, and are very typical responses that tend to bubble up in families during times of crisis.  I appreciate your concern for your cousin and your desire to connect with your family to move beyond their initial response of blame and defense toward a more generative response of support and education.

Methamphetamine has its own culture.  Its use, abuse and addiction can be devastating to individuals and families and its culture of use can distance family members through concern, fear and secrecy.  Recovery from a meth addiction takes time and care; your cousin has a journey ahead, which will include physical and emotional recoveries.  As noted in your question, there are aspects of recovery that impact the family as well.   Here is a link to some information about methamphetamine.

Family therapy which can be a component of many recovery models provides support for the family toward education regarding drug use, abuse and addiction in general and for this substance in particular and also can provide support as the family comes to terms with their own healing.  Compassion for each other and an understanding of recovery as a process can be helpful.

One of the tools that I have found particularly useful is the Prochaska & Diclemente Model of Change.  This model illustrates the nuanced stages a person passes through as they incorporate change into their lives.  From a family systems point of view, all family members are in need of aspects of recovery.  This model breaks down that journey into the following steps:

Pre-contemplation:  The individual is not even contemplating changing behaviors and has no plan

Contemplation: The individual is considering making changes in their lives

Preparation:  The individual is pulling together the team, tools or considerations necessary for change to occur

Action:  The individual is actively working on change and incorporating elements of change in their lives

Maintenance:  Change has been incorporated into a person’s life and while support might still be necessary, a new way of being is somewhat dependable.

There is a caveat to this model that notes that relapse is possible at every step.

As a family therapist I use this model in numerous ways, not the least of which is to remind myself that change takes time, has many elements and that there are quite a few steps necessary before “Action,” also, that relapse may be part of the process and should be considered as possible rather than a surprise if it occurs. The goal at each stage (including relapse) is to remember that this is a generative model that moves forward with possibilities of hope and sustainable change.

From a family-systems perspective, when one member enters recovery it is important to remember that everyone in the family is in a cycle of change.  From that point of view, I find it helpful to introduce the “Wheel of Change” and take an inventory on where each family member may be on his or her own change process.  Often family members will find themselves to be in very different places; one may be assuming “Action” while another may still be in “Contemplation.”  Understanding that we all are paced differently and that we have individual journeys as well as collective journeys can yield ripe conversation and deepen a family’s understanding of themselves as individuals and their collective relationships.  Therapists believe that this kind of insight can deepen family trust, support and relationships and that accepting differences can lead toward realistic support and healing through the recovery process.

You can find an in depth free power-point of this model here.

I hope your cousin finds a program that works for them and that your family finds the support it needs at this time.  A quick Google search can yield results in many communities for Family and Individual support for families in recovery.

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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 am curious about substituting one drug for another milder one. I had a bout with cocaine, won it, then did a round with meth and was lucky to just about escape it by going for an early detox. I have a friend who got clean of an early heroin habit (snorting) and now swears that his salvation is pot. He seems to function pretty well. I have another friend who my take is he is addicted to pot and he doesn't function that well at all but that may be him and not the pot. I have still another friend who did coke a lot and now medicates with porn. A woman I know went from smack to ecstasy. (We're all mostly in a music circle, by the way, so drugs are all around us.) I've read about moderation management and it could be that this is their form of moderation management. Me, I think a couple of beers and a toke or so are helpful to me as I no longer seem to crave the heavier stuff. Most of us are now in our mid thirties and have a sense that our habits won't get worse and may taper off with age. So, are we deluding ourselves? Am I deluding myself, or are we on some natural moderation management path and shouldn't worry about it? I am making a living and am functional myself and am not doing any programs. - Ted

John C. Norcross: Dear Curious Ted, here’s what we can say with clinical and scientific certainty: Some folks can successfully moderate their addictions, and some folks cannot, requiring abstinence. Some folks can replace a serious substance addiction with a milder substance and function well, but many others cannot. Most substance addictions do taper off with age, but many addicts never make it to later years because of early deaths and the health ravages of their addictions.

You beautifully capture the dilemma of every substance abuser and treatment professional: In this particular case, is this safe moderation or is this massive rationalization? A natural course of recovery or delusional denial? 

Four guidelines can help you differentiate between the two. 

1. Level of functioning: Glad to hear that you are making a living and functioning well. Would you function substantially better without those few beers and an occasional toke? For those functioning well, moderation may be the sensible path. But for those who try to moderate and continue to struggle, abstinence is the preferred route. 

2. Others’ observations: Addiction robs us of clear thinking and accurate self-awareness, so our appraisals need to be strengthened with observations from other, unbiased people. What would good friends, mental health professionals, and coworkers (not heavily involved in drugs themselves) say about your current use and functioning? Please do not rely entirely on your own analysis; obtain some feedback from trustworthy sources. 

3. Intensity of craving and use: This is an obvious defining point. If you hanker constantly for the substance and your life revolves around it, then moderation, at least at this point, is contraindicated. But if the beers are indeed occasional and unnecessary, then moderation is indeed possible. 

4. Defensiveness: A cardinal feature of active addiction is defensiveness about the topic, the substances, and their consequences. How openly and honestly one can discuss these topics marks a line between those caught in denial and minimization, on the one hand, and those aware of various healing paths, on the other. I am impressed that you are asking these important questions about addiction and recovery; that’s a favorable sign for moderation management, as long as it does not deteriorate into an intellectual defense. 

So, Ted, take a fearless inventory of your functioning, request that trustworthy people offer their observations, gauge the intensity of your cravings, and determine your level of openness. Those answers will assist you in determining whether moderation management can work for you.

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

 

I went through rehab four years ago and have been doing pretty well. Recently my mother who is a very difficult person got sick and I took a leave of absence from my job to take care of her. It is oh my God stressful, with lots of nasty comments from her that bring up my childhood issues. I am resisting medicating (I was a downer person and drank). I live in the Bay area and there are two therapists here my friends rave about and go to who take their patients on guided journeys with Ecstasy (they say it is very good MDMA). Both my friends have made a lot of progress with therapy on E and both say I should go and one says I should take my mother. I'd like to get the thoughts of one of your experts who knows a lot about pharmacology as well as therapy. Thank you. - Melissa

Larissa Mooney: Melissa, there has been considerable interest in the use of MDMA to facilitate psychotherapy; recent research has focused on the potential utility of MDMA to augment therapy for post-traumatic stress disorder (PSTD) and anxiety disorders. However, though your friends have had a positive experience with MDMA-guided therapy, MDMA is not approved for this purpose and we do not have sufficient data or regulations to recommend this approach. My initial suggestion is to schedule a clinical evaluation with an addiction psychiatrist to thoroughly evaluate your symptoms and treatment options. There may be other treatments available to help you that pose less risk. I would caution against basing personal decisions on anecdotal reports from friends or loved ones, because individuals may vary widely in their responses to any treatment.  We do not yet know the range of experiences or risks to individuals who participate in MDMA-assisted psychotherapy.

MDMA has serotonergic effects that cause a sense of euphoria, alertness, empathy, and pro-social feelings and behaviors (e.g. friendliness, openness, confidence, and closeness) after use.  MDMA use may also initially improve feelings of trust and dampen fear. In combination, these psychological effects may have clinical benefit in therapy, and preliminary evidence has been demonstrated for MDMA in the treatment of PTSD. However, negative effects of MDMA include jaw clenching and other medical consequences as well as feelings of sadness and distrust several days after use, consistent with effects of serotonin depletion. More research including larger trials would be necessary to delineate the range of potential benefits and consequences of MDMA-assisted therapy.

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

 

I have been in recovery (from cocaine and booze) for 12 years with just one six-months relapse after a breakup eight years ago. Now I am just beginning with another breakup and while I am stronger, I am on the shit end of this one again and feeling very bad. I am not a 12-stepper and didn't relate when I tried it. I'm concerned about how bad the pain will get and whether I will relapse. Any thoughts on how best to fortify my sobriety? I can get some small amount of counseling via my health insurance, but not much, and I am not sure counseling is the answer anyway.- Carlton

Jay Westbrook: I applaud you for recognizing the magnitude of your feelings, and the behaviors in which you might engage to avoid feeling them, and for reaching out for help.  

Break-ups are never easy, even when they are the best choice. We may realize, intellectually, that the relationship is not providing joy for either partner. We may also be aware that the only way to find another person with whom we can share joy is to end the joyless relationship. That being said, we will still experience grief (the normal and natural reaction to loss), hurt, loss of identity, a wounded ego, and possibly anger, bitterness, or regret. None of these are easy to deal with, and they are made more difficult when we are alone.

The first thing I would do, if I found myself in your situation, would be to reach out to my friends in recovery and tell them that I really want to stay clean and sober through this difficult time. I would then ask for their help – hang out with me, keep a watchful eye on me, call me on any BS thinking or behavior you observe in me, and don’t offer me any mind-altering substances.

You stated that you were not a 12-stepper, but that you were in recovery. I’m not sure what that means. Are you clean and sober on your own, or are you part of a non-12-step program?  If you are part of a program, tell them what’s going on and that you’re worried about your recovery being at risk. If not, you may want to go, temporarily, to some 12-step meetings (either Cocaine Anonymous or Alcoholics Anonymous), stand up and ask if anyone in the room has experience with staying clean and sober through a romantic breakup. I’m sure those that do will share their experience with you.

As long as you have insurance, why not see a counselor for whatever number of visits the insurance covers? Tell the counselor you want to explore coping strategies for staying clean and sober through a romantic breakup, and make that the focus of your sessions together. I can’t imagine anything bad coming out of that.

Finally, I was taught two important things about recovery: 1) there is no situation so good, that it can’t be destroyed by getting loaded, and 2) there is no situation so bad, that it can’t be made worse by getting loaded. You will get through this much faster if you’re clean and sober, and you are far more likely to find a new partner with whom you can build a joyful relationship if you are clean and sober. I wish you well Carlton.

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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 [email protected].    Full Bio.

 

I am in the process of kicking opioid pain meds I was taking for my back. I am actually also in a pain management program. So far so good on that front though it is slower than I would want and harder than I would like to readjust. Not so good on the home front where my wife is in turmoil over my mood swings. She almost would prefer I stayed on the meds.

The pain management people say we should do therapy together. She doesn’t want to. Yes, she is being selfish but telling her that puts her in fits. I am thinking about moving out until I am somewhat normalized even though I would hate it and it would really impact my finances and small savings. I thought someone in our group might have some guidance or out of the box ideas here. Any fresh thinking would be appreciated.  - Dean 

Janice Dorn: Hello Dean and thanks for submitting this question. I congratulate you for being in the process of “kicking” the opiates. Also, I think it’s great that you are in a pain management program.

I would like to know a little more about how you are going about getting off the opiates. Is this part of your pain management program? Is it separate and you are under the care of another medical professional for the opiate tapering process? I would also like to know if you have had challenges in your marriage previously related to your mood swings or other issues.   

It’s important to know the answers to these questions before I am able to help you with the issues you are facing with your wife. So, I am going to make the assumption that you are trying to get off the opiates under the direction of a pain management program - not separately. I am also going to assume that this is not the first time you have had issues with mood swings

I think it’s important for you to get a thorough work-up from an Addiction Psychiatrist. I am being quite specific about this in terms of Addiction Psychiatry for several reasons. A good Addiction Psychiatrist will be able to know if the mood swings you are having are the result of opiate withdrawal/discontinuation, or are part of a separate mood condition (such as bipolar disorder or depression). The psychiatrist would also likely have specific  suggestions for you in terms of certain medications that can be used to stabilize your mood. 

In terms of your marriage, it is pretty clear that there are real issues and that they are not going to go away easily. The fact that you say your wife is selfish because she won’t go to therapy with you is not helping at all. This is your issue and you need to fix it. If she is willing to stand by and go through it with you, she is to be congratulated, not made to feel foolish or responsible for a situation that is not of her making. Your sobriety is not the responsibility of your wife. It is yours and you have to own it and stop making it seem as if she (or the two of you as a couple) go for therapy, it will fix everything. It won’t.  In fact, it may make everything worse.

I suggest you focus on you and get the true high-level professional help you need from a seasoned Addiction Psychiatrist who is familiar with all aspects of mood swings and opiate withdrawal. Also, it would seem that time is of the essence for you right now. I would do this as soon as possible. It’s not too late.  You can recover from addiction and your marriage can be saved, but it is going to take action and work. I wish you the best. 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 2 DUI's and the judge assigned me to a treatment program. It is pretty basic and uninteresting. I really need to be driving and can't get another DUI but this program is not going to do much. AA didn't do much and was boring. I don't drink every night but when I do I have a hard time stopping. What other programs are out there that I might get more out of?  Thanks.  - Richard

Tessie Castillo: Dear Richard: If group programs aren’t meeting your needs, then you might consider individual therapy. Substance abuse counselors can work one-on-one with you to create a plan to manage your drinking based on what your personal goals are and what behavioral changes are realistic for you. If your goal is total abstinence, there are counselors who can help you create a plan to achieve that. If your goal is to drink less, you might consider seeing a counselor who specializes in harm reduction or moderation management. Under these methods of treatment, the idea is to work toward any positive behavioral change based on a treatment plan that fits your needs and objectives.

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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.

 

Are there differences in detox?  My wife has been in and out of treatment for serious alcoholism for several years and then relapses very badly every two or three years. Her physical craving seems to become overwhelming. Over and above insurance I have spent a fortune on this. Also, I am sorry to say, I don't help the situation sometimes by showing my frustration. Recently I have been reading there are a number of forms of detox. I am looking for recommendations about the most effective, maybe something even out of the box, so we can compare it to past detox experiences she has had which have not stopped the physical craving in its tracks. Yes, she is in therapy as well.- Arthur.

Lance Dodes: Arthur, you stated your question as if it is about detox, not rehabilitation facilities, which makes a big difference.  Detoxification from drugs on an inpatient basis is a medical procedure which is basically the same everywhere.  It is not related to the relapses you describe, since once the detoxification is completed (usually no more than a matter of days), there is no more physical addiction. For that reason, your wife's relapses much later are not due to "physical craving." Relapse urges are driven by emotional factors for which drug use is an attempted solution.  The appropriate treatment is to figure out the factors that repeatedly precipitate these urges (I describe this in detail in my book, Breaking Addiction).

If what you are asking about is not detoxification itself, but inpatient rehabilitation programs, then you should understand that the rehab industry is unregulated, so rehabs may offer any kind of unproven treatments and claim any wonderful results they want, without evidence. There is also no reason to think that paying more will get you better treatment. Indeed, the most expensive and well-known facilities charge for such irrelevant "treatments" as horse therapy, "ocean therapy" (a trip on a yacht), aerobic exercise, and more. If you are considering an inpatient rehabilitation stay, 

I would look for a shorter (no more than 2 weeks) and less expensive facility that offers zero horses and does not insist that everyone buy into whatever is their standard program. Ask if most treatment is done in groups or whether there is truly individual therapy, and ask about the academic qualifications of the "therapists." Avoid places that are "12-step-based" unless your wife is in the 5-10% who do well with that approach. Finally, if your wife has had extensive periods of abstinence and not benefitted from longer hospitalization beyond physical detoxification, I would obtain a careful review of her situation before embarking on another inpatient stay.

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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 a recovering alcoholic and have been sober for 3 years, 3 months and 8 days. I am also a mum, a wife and a professional. Because of my life and responsibilities I have done much of the work to get sober from home: online (your website is an enormous help to me) and through reading at the library. I have wanted to attend AA but I have small children so it's not possible. My reason for writing today is that in November I have a girls weekend away in another city from where I live. It will be the first time I am away from my children, or my husband for that matter, in sobriety and I am terrified of relapse. It is with friends from childhood, and yes old drinking buddies. Everyone knows I no longer drink but I'm so scared that my brain will just tell me 'go for it' and I'll drink. I truly believe that if I drink again, it will kill me. This situation feels life and death for me and it's making me not want to go on the trip. What advice can you give me on how to handle myself on the trip. I have OCD (the self medication of which led to my addiction) so I'm starting to obsess and all this thinking about drinking is difficult also. 

Your help is greatly appreciated. Kind regards - Barbara

Roland Williams: Hi Barbara. Thanks for your question. t’s a tough one actually, so much comes up for me when I read and re-read your email. You seem to have a lot going on and I don’t want to minimize any of these very important issues in my response. So I think it would be easiest for me to break it down into what I am getting from you. 

  • You are sober and obviously proud of that accomplishment
  • You did most of the work to get sober from home, online and reading at the library
  • You want to attend AA but it’s not possible
  • You have not been away from your children in a long time
  • Your first trip away will be with old friends that drink away from your home 
  • You are afraid that your disease will take over and you might possibly drink
  • You believe that if you drink again it will kill you
  • You are obsessing about thinking about drinking

 

When you look at it like this, it looks overwhelming, doesn’t it? In one short paragraph you outlined a series of very complicated issues, each one could be a separate therapy session. So here’s what I think, in order of how you presented it all. 

First and foremost, protect your 3 years, 3 months and 8+ days of sobriety, at all costs. I’m sure that your ability to be a mum, a wife and a professional are all contingent on you staying sober. If you drink, your ability to be either and all of those becomes compromised. So your Recovery has to be your number one priority - you need it to do all that other good stuff. 

I think it’s great that you were able to get and stay sober primarily from home. However, from your email I can’t determine exactly what your Recovery program looks like in practice. It’s very difficult to achieve Recovery in a vacuum. It’s usually not enough to just stop drinking, because abstinence is not the same as Recovery; it’s a prerequisite for Recovery. It gives you the clarity to do the work you need to do to heal, and I can’t tell what that “Recovery Work” looks like in your life. 

I know Recovery is a fluid process and it changes as we change…. we get older, acquire responsibilities etc. and we have to do whatever we can to keep our Recovery program fresh, current, and applicable to our issues. A lot of people are finding themselves challenged by a working a program that was appropriate in year one, but not so appropriate in year five. 

The fact that you “want” to do AA is encouraging, and if that’s the case, then I would challenge whether it is truly “not possible.” I believe if you wanted to go, you could make it happen, and that might be one of the updates you need in your Recovery program at this time in your life. 

I know a lot of people who don’t want to go to AA. They have many reasons, from philosophical differences, to conflicting schedules, bad experiences, new responsibilities, etc. And certainly a lot of people actually stay sober without AA, but the fact is if you are an alcoholic/addict seeking Recovery and are not going to 12-step meetings, you actually have to work twice as hard to achieve Recovery. AA provides a fellowship, a social network, accountability, a mentor, a set of guidelines for living your life, a sounding board, a routine, a laugh or two and a constant reminder of what to do and what “not to do”… all for free. Without AA a person has to try replicate as many of these things as possible in their lives, and that's not as easy as it sounds. 

The fact that you have not been away from your children in I’m not sure how long implies that your life could use a little balance, some mum time, some wife time, some professional time and some Barbara time. It doesn’t seem as if  you are getting enough Barbara time. So now you are tempted to go away from the city you live in for a “girls weekend” with women you used to drink with, In Relapse Prevention Therapy, we would refer to that as a “High Risk Situation” and the first rule in dealing with a HRS is to ask yourself “do I have to go?” You see we treat any person, place or thing that poses a threat to our Recovery, the same way Superman would treat Kryptonite. 

By your own admission you are afraid that your alcoholic brain will tell you to "go for it," so it sounds risky. I’m not telling you whether or not you should go, that’s your choice, but I wish you were connected to some women in Recovery who you could go and hang out with. It sounds as if you need a break, but I’m not sure if this is the best way for you to get one, I wish you had healthier and safer options. 

If you decide to take such a gamble with your Recovery, and I only say this based on the thoughts you are having about going, I think you need a real solid Relapse Prevention Plan, i.e. have your own transportation, call someone everyday and check in, have a drink in your hand at all times, (Coke, soda water, etc). Have a person there that you can tell if things get uncomfortable for you; have your own living area so you can get away from the drinking if you need to, etc.

Don’t underestimate the seriousness of this situation. By your own admission you believe if you drink again it could kill you. So again I challenge you to consider the stakes as you weigh the pros and cons of putting yourself in such a situation, and ask yourself is there a better, safer way for you to have a good time. In the first sentence of your email you describe yourself as a “Recovering” alcoholic, so now is the time to use your Recovery tools. 

Finally if your OCD is kicking in and your are obsessing about this… pay attention to your intuition. Listen to that voice inside - it might save your life. I wish you all the best and I would love to hear what you decide to do.

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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 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.

 

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 may both 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.

 

My husband had an affair for several months with someone he met in rehab. Now he says it's over and he wants to go on like nothing happened. I'm glad he got sober and is now back in AA but I wonder how this could get by his sponsors and whether these character defects are just never going to get fixed in an addict. I am not trusting him and can't forgive him for the infidelity, though I do care about him. I clearly need some guidance here and an overall plan. Do you think this is fixable or should I just move on, given how he has revealed himself. - Laurel

Stacey Rosenfeld: This sounds like a difficult situation, but the good news is, you have a say in how things proceed. I'd conceptualize this as less an addiction issue and more a marital concern at this point. We might debate whether or not someone can recover from a character defect, but what seems more useful is determining if your marriage can recover from this affair. 

Does the relationship seem salvageable? Is your husband willing to acknowledge the pain he's caused? Does he seem committed to working on the marriage? What is keeping you in the relationship at this point? What could your husband do, if anything, to earn back your trust over time? These are some questions to consider. A course of couple's counseling might help you and your husband determine whether the relationship is fixable and, if so, guide you through the process. Individual therapy could provide you with support and a place to process your feelings and develop a plan that feels right for you.

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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 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 (800/334-7606) 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 (866-889-3665) or Sovereign Health Adolescent Program (866-348-4818) 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 [email protected].    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 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 [email protected].    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 [email protected]

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 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 [email protected].    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 [email protected].    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 [email protected].    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 [email protected].    Full Bio.

 

My 17-year-old daughter is showing signs of anorexia. For more than a year she has been obsessed about gaining weight and claiming she is too fat when she actually is pretty thin. Some months ago I caught her trying to throw up and don't have any idea of whether she is still doing it behind my back. We can't afford a shrink and the doctor I insisted she go to wanted to give her stress pills that when I looked them up, are highly addictive. So that didn't work. Any help on how I can help her move through this would be appreciated.  I am a single mother by the way - Roslyn

Stacey Rosenfeld: Eating disorders are serious mental illnesses that have high mortality rates. If you think your daughter is showing signs of an eating disorder, I would recommend her getting evaluated as soon as possible. A professional can help you understand the severity of the symptoms and different treatment options. If she is diagnosed with an eating disorder, the sooner she gets treatment, the better her chance for recovery. You may be able to do some of the treatment yourself, under a model called family-based treatment (FBT) but you'll still need the guidance of an eating-disorder specialist. 

Unfortunately, many medical doctors aren't sufficiently trained in how to address eating disorders.

Treatment can be a pricey endeavor, but there are some lower cost options. Many therapists will offer sliding scale fees. For help on finding those who do, you may want to put in a call to the counseling center at your local college/university. They often have a list of providers who are willing to work for a lower fee. Also, many therapist training programs will offer treatment at a lower cost - look into local graduate programs for psychology, social work, and counseling. Many of these are affiliated with clinics with low-fee treatment. You'll still want to make sure that the therapist has a background in treating eating disorders. 

Some organizations - Project Heal, for example - offer grants for eating disorder treatment for those who need help but cannot afford to pay. The National Eating Disorder Association's Helpline may be a useful resource for you - they offer free help and support at 1-800-931-2237. Also, the organization's treatment finder allows you to search for therapists who offer a sliding scale fee: http://www.nationaleatingdisorders.org/find-treatment

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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.

 

Do antidepressants interact with opiates or other street drugs, which I would guess they do, but I need to know what to look out for here specifically.  What are the particular bad mixes? I don't necessarily trust pill pushing shrinks to know the story here. - Bruce

Larissa Mooney: Antidepressants may interact with street drugs, but the risks are often difficult to quantify or predict. For example, antidepressants may increase the potential for seizure, and stimulant drugs such as cocaine and methamphetamine carry a similar risk. Therefore when stimulants and antidepressants are taken together, seizure risk may be further increased, particularly in the presence of more “stimulating” antidepressants such as bupropion or tricyclics. Other factors may also contribute to seizure risk, including medical conditions, electrolyte imbalances, and brain injuries. Therefore it is very important to discuss all drug use, medication use, and health conditions with your doctor so that risks and benefits may be weighed when making treatment decisions. 

Elevations in blood pressure may occur when amphetamines are combined with antidepressants that enhance noradrenergic activity, such as tricyclics, venlafaxine, or MAOIs (monoamine oxidase inhibitors). Certain antidepressants, such as fluoxetine and paroxetine, may also increase the concentration of amphetamines in the blood by inhibiting liver enzymes; this effect may also increase the potential for toxicity.  

It is difficult to determine the frequency of adverse interactions, and though amphetamines are not prescribed in combination with MAOIs due to the potential for severe events, many stimulant users take other antidepressants without consequences. 

Another medical condition associated with serotonergic antidepressants is serotonin syndrome, which is marked by symptoms including muscle twitching, rigidity, sweating, fever, rapid heart rate, agitation, and confusion. The risk of serotonin syndrome is increased when antidepressants are used in combination with other drugs that increase serotonin or activate serotonin receptors.  

MDMA/ecstasy is one example of a drug that may be involved in this interaction; certain opioid medications such as tramadol and meperidine also have serotonergic properties and may increase the risk of serotonin syndrome when combined with SSRIs (selective serotonin reuptake inhibitors) and other antidepressants. 

In general, medications with sedating properties enhance the risk of oversedation and of suppression of breathing when combined with other sedating drugs, such as heroin and other opioids. And while sleeping medications, alcohol, and tranquilizers are well known to enhance the potential for overdose when combined with opioids, this risk may be exacerbated in the presence other medications with sedating properties, such as mirtazipine and tricyclic antidepressants.  

Medications and street drugs may also have additive effects, and risks are amplified when more than one substance and medication are combined. 

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

 

I am 24 years old and like alcohol a lot and the problem is I get nasty when I get drunk, which happens pretty easily. All this anger comes out of me. I don't want to stop drinking because I like it and would feel excluded from going out after work with other employees and also with friends. I have heard of something called moderation management programs and would like to know if any of your experts endorse them and can give me some guidance about them. I read what they have to say at moderation.org but would appreciate some independent guidance here.  - Wendy

Tessie Castillo: Since you aren't ready to stop drinking, it might be good for you to look into moderation management programs (MM). These are harm reduction programs that work with you to create personalized goals to manage your drinking, whether it be abstinence or a reduction in drinking. If you get nasty when you get drunk, perhaps a worthwhile goal for you would be to control your drinking enough so that you don't develop those mood swings. 

MM programs have been shown to have fairly good success rates in helping motivated people to bring their drinking down to manageable levels or to stop altogether. Members of MM are also more likely to be female (49%), under 35 (24%) and employed (81%) than members of abstinence-only groups. 

Keep in mind that MM is for people who want to manage their drinking but are not dependent on alcohol. If you experience signs of withdrawal when you don’t drink such as anxiety, shakiness, sweating, nausea or insomnia, then you may be alcohol dependent and should consider an abstinence-based program. 

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

 

My dear friend's 18 year old son is currently in a court-mandated treatment program (outpatient) as well as suboxone treatment. (First arrest was couple weeks ago for possession) He is addicted to snorting oxycodone. He has been using since 2012. Began Suboxone 2 months ago. Mother doubts he is fully compliant...but the random court drug testing will provide answers. He plans to begin college in the fall, located about an hour from home. He believes he will be safe from using because his suppliers will not be around. However, the school he plans to attend has a very bad heroin problem...our fear is that he will begin using heroin....

It defies logic to send him to this environment. My instincts, as well as others close to him, are to remove him from his current life and place him in a program like Intercept offered by Outward Bound. I have been doing research to determine the success rate of programs like this....do they work? The idea of 60 days removed from mainstream society, living in the wilderness, developing survival skills, and expanding the mind to break through dysfunctional thinking would be a powerful treatment.

Does anyone have any feedback on the effectiveness of these programs? We are working hard to find the best treatment option for him?

Rita Milios: There are both some real successes and some worrisome failures regarding wilderness programs. A 16-year-old Outward Bound wilderness program participant died in 2006 while participating in one of this organization’s programs in Colorado. According to a National Geographic report, she was the program’s first fatality in ten years, but their 24th fatality overall (in 46 years of running such programs).

On the other hand, a study by the Outdoor Behavioral Healthcare Council (OBH -- an organization formed in 1996 by a group of wilderness treatment program organizations to conduct research and collaborate on best practices) states that 81% of wilderness program graduates interviewed for a 2004 study reported their behavioral treatment as being “successful,” and their goals having been sustained for one year.

However, in your specific question, I detect some red flags. First, the potential program attendee is 18 years old, and for many programs this is the age where parents cannot force participation. It does not sound like this particular 18- year-old has sufficient motivation - you say his mom doubts his compliance with his current treatment. Most of these wilderness programs, as well as other recovery programs, stress that success is mainly determined by the motivation of the participant. So without sufficient motivation on the son’s part, this or any other treatment could be wasted.

My suggestion would be for the parents simply to reduce their co-dependent interactions with their son and require more personal responsibility and commitment from him before they shell out money for a recovery program or college. Realistically, he is probably not ready to go away to college right now, if doing so would put him at risk for continued (or even greater) addiction. And the parents certainly do not have to pay for college under these circumstances. They could simply tell their son that until he is completely drug-free and demonstrates a commitment to maintaining this status, they will not pay to send him to college.

The parents could suggest any number of different treatment programs to their son. But ultimately, it is up to him to decide if he is motivated and wants to be free from addiction. Perhaps giving him a wake-up call by withholding college funds could help him consider his options. (To view studies by the OBH Council, go to https://obhcouncil.com)

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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've been sober in a 12 step program for 3 years and some change. Presently, I do a lot of service. I have 6 commitments that take at least an hour a week, usually more like 2-3 hours, plus several sponsees. I keep being asked to do more, and I keep saying yes. We're supposed to say yes, right? My sponsor and network say I'll figure out how much is too much by taking too much, and I understand that, but I don't even know how to say no to it. - Brady

Janice Dorn: Thank you so much for bringing this issue to the attention of our readers.  It’s a powerful one that touches so many lives and has implications that are far-reaching and often complex. You may not like what I have to say to you, but I am saying this out of enormous compassion, concern and my own personal experience.

You have been sober for three years, so congratulations are in order. If you continue to do what you are doing at present, everything positive about your recovery is at high risk for reversal.

Let’s start with the fact that you are on overload. In addition to your job, you are spending maybe up to 18 hours in “service” plus sponsoring some people. I suspect you are relatively young and trying to hold down a job to support you and possibly another person. You are saying “Yes” - and you assume that “we’re supposed to say yes, right?”  Wrong. What you are doing is putting your recovery in jeopardy by saying “Yes.” In your words,” I don’t even know how to say no to it.”

Let me attempt to scratch the surface of this issue. You have many characteristics of what is sometimes called “people-pleasing.” As such, you have learned, likely from childhood, that you will be loved and accepted by your parents, siblings, friends or peers, if you go along and do things that people ask you to do. Don’t rock the boat.  Don’t be stubborn or act out. Go along to get along. Just say “Yes” to any and all requests or demands and you will avoid conflict, confrontation and be liked by everyone. 

In the process of doing this, you give up one of the most important aspects of self-growth - finding out who you really are. You wear a mask that says you are cheerful, pleasant, supportive, helpful, hard-working and ready to help with anything. Underneath this mask is fear and resentment. You are afraid that, if you say “No” people won’t like you, will abandon you, or speak badly of you. As a result, you find yourself worn out and feel like you are being taken for granted and not appreciated.  

You state “My sponsor and network say I'll figure out how much is too much by taking too much, and I understand that.” Yes. You understand that on an intellectual level, but you are not self-actualized (don’t know how to calm yourself or care for yourself or manifest your self-esteem) enough to truly understand that, in fact, you are taking on too much. Even if you do understand it (as is clear from your comments), you do not know how to stop. Why? Because you never learned how to stop. You are continuing to act out the script of your childhood drama - this time substituting your sponsor and network for other authority figures you have had in your life. In the process, you are becoming increasingly unsettled and frustrated. In other words, you are at high risk for burnout and relapse.

What can you do? The most important thing is to start taking care of you first. As much as you may hear the opposite, there is a true virtue to being selfish. If you are selfish enough to take radical self-care, to rest and restore and recharge, you then have more and more energy to give to others. If you do not do this, you are like a battery that has run out of charge. You are drained and will continue to be drained until you re-charge. Your stress levels are high and will get higher if you don’t take action to change your behavior.

The tasks ahead of you are not easy and will take time. You must begin slowly to break the pattern of being addicted to pleasing people. What follows are a few suggestions to get you started. They are not the be all and end all. This will be a gradual process for you, so please be gentle with yourself: 

-Become aware of what you are saying or doing to please people. Be aware of that feeling you get inside of you, that little twinge or actually physical sensation in your stomach or pain in your neck, that tells you that you are doing something that you really don’t have time or energy to do. Acknowledge that your brain will trick you, but your body doesn’t lie to you. Use these bodily sensations to guide you to hold back on accepting anything else or agreeing to do something. This is the beginning of learning to say “No.”

-Make a vow to yourself that you will stop saying or doing things just to please others.  Don’t be afraid to say or do what is really in your heart. Stop apologizing or feeling guilty. You are not perfect and not a superman. You simply cannot be all things to all people. Start slowly and practice gently with assertive words and gestures. Watch and learn from others who have learned to be assertive with grace and integrity. It’s absolutely OK to say “No” if you learn how to say it. Practice doing this until it begins to feel comfortable and natural to you. It will take time, but the rewards are worth the effort.

-Think about what you are saying “Yes” to when you say “No.”  Things like more time to spend on your own recovery, quality time to enrich precious relationships with friends or family, time for radical self-care so that you have energy and enthusiasm for outside tasks and can approach them with vitality and vigor.

-It may become necessary for you to have some therapy to heal whatever childhood wounds you are carrying with you. In the process, you will begin to develop a true sense of who you really are. Your self-esteem will increase, you will be much more comfortable around people, body aches and pains will diminish. You will begin to develop clear boundaries between where you end and others begin.  You will begin to feel real and natural in your own skin.

All of this is a process. It’s a discovery of the true you. It takes time to learn to be as gentle and loving and giving to yourself as you are with others. The risk is great for you, and probably a little scary right now, but I assure you that the rewards are magnificent.  I wish you every happiness and success in finding the true you that wants and deserves to be loved for exactly who you are. Perhaps the great leader Mahatma Gandhi said it best:  A 'No' uttered from the deepest conviction is better than a 'Yes' merely uttered to please, or worse, to avoid trouble.

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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.

 

What does the word recovered mean? I though it was still recovering after doing rehab but wonder what the benchmark is for simply being recovered? - Tess

Lance Dodes: Many words in the addiction field have been tossed around for years without being clearly defined or even being meaningful.  "Recovered," "recovery" and "being in recovery" are examples. In most of life, "being in recovery" means a person is making progress even though s/he isn't "cured." Sometimes it is used as a synonym for "being in remission" - indicating relapse is a clear possibility (as with being "in recovery" from cancer). Other times it means "on the path to a definite cure" - as in being in recovery after surgery. Neither of these usages is problematic, so long as we all understand what is meant. But in the addiction field, the term has been used in a third way in 12-step programs. 

There, it is traditional for people to refer to themselves as "in recovery," no matter how long they have been abstinent from their addictive behavior and no matter how well they are doing in life. Partly, this is the same as saying they are "in remission," based on the idea they can always suffer a relapse. But too often, being "in recovery" has come to mean something different: that they are on what they declare is the right path. When used this way, folks are condemned as not "in recovery" if they drop out of 12-step programs or are thought to not be "working the program" adequately. When "recovery" is used this way, it is more a political statement than a factual or medical one. 

Tess's question sounds like it has roots in this "recovery community" definition of addiction and its treatment. I hope that Tess would ignore the agendas of anyone attempting to define whether she is "recovering" or "recovered." Instead, I suggest that she think of her addiction as a repetitive behavior that arises with great force at key moments when she feels overwhelmingly helpless. These moments can be predicted and avoided once she knows just what her emotional vulnerabilities are. 

However, there will always be some risk of becoming overwhelmed, and responding with the old behavior. To this extent, it is true that she would never be "cured." But we are all at risk of repeating old behaviors (in my field it's called "regressing"), whether these old behaviors are addictions or anything else that used to be part of our solution to life. That's not a specific feature of addictions, it's just the way humans are. It makes no more sense to label oneself as "recovering" forever from an addiction, than it does for a person who used to be depressed to forever be "recovering" from depression, or a person who has been cancer-free for 15 years to still define herself as a cancer patient. It certainly makes no sense to define "recovering" in terms of whether you are in one treatment approach or another. 

Addiction is a terrible symptom, but it is not who you are, and once you understand how it works emotionally in you so it doesn't sneak up on you, there is no reason to dwell on what words you use.

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

 

I am a 43 year old woman who has been struggling financially and gotten into debt as my industry is going through transformations. I am drinking a lot more now to help with the anxiety. I don’t seem to relate well to AA though I have a spiritual side to me. I am thinking of some anxiety and sleep meds but I know I am an addictive personality and am afraid to go on one of those. I read about the horrors of Ambien, for example. What kind of help you would suggest? - Natalie

Janice Dorn: Thank you so much for reaching out to us for help. You have shown great courage in doing this, as well as some excellent insight. It may or may not be of comfort for you to know that you are not alone in your worries about financial issues. It is estimated that 75% of the American population lists money worries as Number 1 on the list of situations that are causing them stress. Number 2 on the list of stressors - coming in at about 70% of the population - is concern about work. You have a double dose, since you are struggling with both financial and work issues.

You are under a huge amount of stress. This is manifested as anxiety and you are drinking to try to calm the anxiety. To the best of my knowledge there is not a definitive study on the incidence of alcoholism resulting from stress, or on the relationship between drinking behavior under stress and the development of alcoholism in human beings. However, the fact that you admit that you have an “addictive personality” puts you at high risk for development of alcoholism and other addictions. Perhaps you have some family history of alcohol or substance abuse that adds further risk factors? I don’t know this from your question, but I suspect this may be the case.

I have written and spoken a lot about what stress is doing to our society. I have labeled this the Dorn Dart Board. Take a medical book with just about every illness known to human beings and put all of the illnesses on a dart board. Now throw a dart. That dart will land on an illness that is either: 

(1) Caused by stress

(2) Made worse by stress

(3) If you get it, you are going to have stress

In my opinion, stress and the inflammation associated with stress are intimately related to the majority of illnesses of our time. You have stress that may well be causing or manifesting as anxiety and insomnia. The first thing to do is to go to a really good Family Practitioner and have a complete physical workup to rule out that the anxiety and insomnia are not secondary to another illness such as a thyroid, diabetes or a cardiac condition. If any physical cause is ruled out, the physician is like to recommend an anti-anxiety medication (such as a benzodiazepine) or a sleeping pill (such as Ambien).

At that point, just say “No” and ask the doctor if he or she can recommend any complementary or alternative treatments for your anxiety and insomnia. If the physician says “No” or “Nothing like that really works,” I suggest you politely thank him or her and leave (quickly!) before you are given a prescription for an additive drug.  Taking prescription drugs for anxiety or insomnia is the worst thing you can do in your present situation. You may want to seek out a homeopathic or naturopathic physician who can possibly offer you more natural and non-addictive alternatives to classical (allopathic) remedies.

In terms of support, get as much as you can. I don’t know anything about your life, but I suspect you may be presently unmarried and have no children or a child who may not be completely supportive to you. You are intelligent and resourceful enough to research your current challenge. If you have a trusted friend who is not an addict, reach out to him or her. Join a support group. There are many alternatives to 12-Step Programs. You can find these out by doing a search in your area for addiction recovery that is not 12-Step. Depending on where you live, you should also be able to find a therapist who treats addiction without the use of the 12-Steps. You will likely be well-served by exploring more deeply the spiritual side of you, as this may lead you to stress-reducing activities such as meditation, yoga, or Chi-gong (Qigong)

In terms of your financial issues, the most important thing is to begin to get out of debt. There are a number of ways to do this that are beyond the scope of this answer. You may want to start by making an appointment with a certified financial adviser (CFA). Make sure the person is licensed and reputable. If you pick the right one (many will give you a free initial consultation), you will be helped greatly. You will have to make some significant changes in the way you look at money and the way you spend money. A good financial adviser can be a great help to you in getting started. I caution you about employing so called debt counseling agencies or services. There are some that are reputable, but, as a general rule, you have to be very careful with these. There are few life situations that are as burdensome and troubling as being in debt. Having a plan to get out of debt is likely to reduce your anxiety and allow you to get some decent sleep. 

I really would like to hear back from you about what I have suggested.   Your question is a great one that affects so many people. I have really only scratched the surface in terms of an attempt to help you. If you wish to write more, please do so.

There is hope!

-------

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’m just leaving rehab and considering half -way house options or a therapeutic community. Which would be better for me? -  Carl

Rita Milios: The real question here is not so much whether a half-way house or therapeutic community is the better option overall, but which is a better option for you, as an individual, with your specific goals and needs. And this question can only be answered by you, after some investigation and personal research about what is available in your community.

Over time, the distinctions between “half-way houses” (or sober living houses) and “therapeutic communities” have blurred. Many facilities now market themselves as “therapeutic community style” half-way houses. Originally, the term half-way house referred to residences set up to house people who were leaving jail or prison. They were designed to offer these individuals a safe place to learn how to re-integrate into society. In recent years, many half-way houses have changed their focus, and they now serve people in recovery who are seeking sober living options within a structured, supportive environment. They are no longer intended to appeal only to people leaving incarceration, but to anyone seeking such assistance.

There are still a few conceptual and theoretical differences between half-way/sober living houses and therapeutic communities. Half-way/sober living houses often still retain their main mission of reintegration into society for the resident, where the resident re-enters society as both a law-abiding and productive citizen. To this end, half-way houses tend to offer more help with things like job coaching, job search assistance, transportation to/from work and education regarding money management and coping skills that emphasize the needs of daily living. 

Therapeutic communities developed with a focus toward mental/emotional growth and personality development as their central theme.

Therapeutic communities may incorporate more types of counseling and psychotherapy techniques to achieve these goals, such as Cognitive Behavioral Therapy, Motivational Enhancement Therapy and Dialectical Behavioral Therapy. These therapies emphasize individual responsibility for changing thinking and behavior and learning about one’s self at a deeper level. These communities may also incorporate a more holistic approach to overall development of the individual vs. a solely sober living focus.

Still, every facility - half-way house or therapeutic community – sets up its own environment and treatment structure, so they will vary greatly, and concepts and techniques from one may be adopted by the other. 

That is why it is important that you visit several different facilities and discover for yourself which environment and lifestyle arrangement is best for you. Ask a lot of questions, both of the residents and of the staff, to determine which specific living environment would be the best fit for your needs and goals.

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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.

 

My brother is 26 and has been in a non-luxury recovery facility for heroin abuse and has been asking for me to visit him. I have always had issues with him and been reactive to him and I know that's not good for him, especially now. He's often been so difficult and selfish and self-absorbed that I don't trust him. He's very manipulative. I'd like to forgive him but it's hard to trust him. This is his second go-round. Is it best if I don't visit him? And if not, what advice would you give me as to how to best handle the visit?  I am two years older than he is, by the way.

Jay Westbrook: You sound like a very caring sibling, and I applaud you for seeking greater perspective before making a decision about visiting your brother.  Here are several points for your consideration:

1)  1) You are under no obligation to visit your brother, period. If you do decide to visit him, it would be very useful to know why you are making the visit. What is the purpose of seeing him? Would the visit be to support him, to shame him, to check up on him, to catch up with him, to guilt-trip him, to offer encouragement, etc. – the list could go on and on. Please make sure your motives are clean.

2)  Since you’ve always had issues with him, what steps are you going to take to protect yourself, to avoid becoming reactive, and to assure that you are not manipulated? Perhaps placing a call to his counselor at the treatment center, and asking that he or she be present during the visit, or even arranging a structured visit with that counselor could create a safer and more productive visit.

3)  You said, “I’d like to forgive him, but it’s hard to trust him.” The similarity between forgiveness and trust is that they are simply decisions on your part. The difference between them is that forgiveness is for you, so that you no longer sit in anger and resentment. It does not mean that you condone or excuse his past behavior, does not require that you trust him, and does not even require that you allow him back into your life. You forgive so that you can be free of corrosive thoughts and feelings. Trust, on the other hand, is also just a decision, but a decision you base on his behavioral change over time. If you don’t observe consistent behavioral change, you would be wise to maintain an untrusting posture and vigilance around your brother. You might also work with your brother’s treatment center counselor to identify and communicate the behavioral changes you would want to see before being willing to consider offering your trust again.

I hope these suggestions helped, and please let us know your decision and 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 [email protected] or 818-773-3700.Full Bio.

 

I am a 43 year old woman who has been struggling financially and gotten into debt as my industry is going through transformations. I am drinking a lot more now to help with the anxiety. I don’t seem to relate well to AA though I have a spiritual side to me. I am thinking of some anxiety and sleep meds but I know I am an addictive personality and am afraid to go on one of those. I read about the horrors of Ambien, for example. What kind of help you would suggest? - Natalie

Janice Dorn: Thank you so much for reaching out to us for help. You have shown great courage in doing this, as well as some excellent insight. It may or may not be of comfort for you to know that you are not alone in your worries about financial issues. It is estimated that 75% of the American population lists money worries as Number 1 on the list of situations that are causing them stress. Number 2 on the list of stressors - coming in at about 70% of the population - is concern about work. You have a double dose, since you are struggling with both financial and work issues.

You are under a huge amount of stress. This is manifested as anxiety and you are drinking to try to calm the anxiety. To the best of my knowledge there is not a definitive study on the incidence of alcoholism resulting from stress, or on the relationship between drinking behavior under stress and the development of alcoholism in human beings. However, the fact that you admit that you have an “addictive personality” puts you at high risk for development of alcoholism and other addictions. Perhaps you have some family history of alcohol or substance abuse that adds further risk factors? I don’t know this from your question, but I suspect this may be the case.

I have written and spoken a lot about what stress is doing to our society. I have labeled this the Dorn Dart Board. Take a medical book with just about every illness known to human beings and put all of the illnesses on a dart board. Now throw a dart. That dart will land on an illness that is either: 

(1) Caused by stress

(2) Made worse by stress

(3) If you get it, you are going to have stress

In my opinion, stress and the inflammation associated with stress are intimately related to the majority of illnesses of our time. You have stress that may well be causing or manifesting as anxiety and insomnia. The first thing to do is to go to a really good Family Practitioner and have a complete physical workup to rule out that the anxiety and insomnia are not secondary to another illness such as a thyroid, diabetes or a cardiac condition. If any physical cause is ruled out, the physician is like to recommend an anti-anxiety medication (such as a benzodiazepine) or a sleeping pill (such as Ambien).

At that point, just say “No” and ask the doctor if he or she can recommend any complementary or alternative treatments for your anxiety and insomnia. If the physician says “No” or “Nothing like that really works,” I suggest you politely thank him or her and leave (quickly!) before you are given a prescription for an additive drug.  Taking prescription drugs for anxiety or insomnia is the worst thing you can do in your present situation. You may want to seek out a homeopathic or naturopathic physician who can possibly offer you more natural and non-addictive alternatives to classical (allopathic) remedies.

In terms of support, get as much as you can. I don’t know anything about your life, but I suspect you may be presently unmarried and have no children or a child who may not be completely supportive to you. You are intelligent and resourceful enough to research your current challenge. If you have a trusted friend who is not an addict, reach out to him or her. Join a support group. There are many alternatives to 12-Step Programs. You can find these out by doing a search in your area for addiction recovery that is not 12-Step. Depending on where you live, you should also be able to find a therapist who treats addiction without the use of the 12-Steps. You will likely be well-served by exploring more deeply the spiritual side of you, as this may lead you to stress-reducing activities such as meditation, yoga, or Chi-gong (Qigong)

In terms of your financial issues, the most important thing is to begin to get out of debt. There are a number of ways to do this that are beyond the scope of this answer. You may want to start by making an appointment with a certified financial adviser (CFA). Make sure the person is licensed and reputable. If you pick the right one (many will give you a free initial consultation), you will be helped greatly. You will have to make some significant changes in the way you look at money and the way you spend money. A good financial adviser can be a great help to you in getting started. I caution you about employing so called debt counseling agencies or services. There are some that are reputable, but, as a general rule, you have to be very careful with these. There are few life situations that are as burdensome and troubling as being in debt. Having a plan to get out of debt is likely to reduce your anxiety and allow you to get some decent sleep. 

I really would like to hear back from you about what I have suggested.   Your question is a great one that affects so many people. I have really only scratched the surface in terms of an attempt to help you. If you wish to write more, please do so.

There is hope!

-------

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.

 

So I'm in a bad situation. I have been heroin addict for 10 years but have been doing very well the past year, especially past 6 months. but something from my past 2 years ago came up and now I have to go to jail on the 16th of this month, for 6 months. I have also been enrolled in a methadone program for 7 months and been doing great. So the jail I'm going to doesn't give methadone at all, so I had to taper from 95 mg's to 0 in less than 2 weeks. Today is my first day at 0. I was fine with all the drops, felt no withdrawal even coming down 10 mg a day. Started feeling it around 10 mg. So now that I'm at zero i am obviously sick but by question is, how sick will I get? Because the taper went so well until the end, does that mean the hard part is over, or are the nasty withdrawals going to hit me all at once because i tapered so fast. Now that I'm on 0, what can I expect withdrawal wise? - Larry”

Larissa Mooney: Unfortunately it is often difficult to predict an individual’s course and severity of opioid withdrawal. We know that methadone withdrawal often mimics that of other opioids, but it may start later and last for a longer period of time because it takes a longer time for methadone to leave the body compared to heroin or other short-acting prescription opioids. Withdrawal symptoms may include muscle ache, nausea, vomiting, diarrhea, sweating, anxiety, insomnia, runny nose, and goosebumps. 

Tapering off slowly tends to minimize the onset and severity of withdrawal symptoms, whereas abrupt cessation of opioids or very rapid tapers may be associated with more uncomfortable withdrawal. Medical supervision and use of ancillary medications for gastrointestinal discomfort, pain, and other symptoms may also ease withdrawal symptoms. Since methadone is long-acting, symptoms may persist for more than two weeks. 

From anecdotal and clinical experience, an individual’s anxiety about opioid dose reductions may worsen his or her subjective experience of withdrawal. Thus in certain clinical situations, patients may agree to a “blind” opioid taper, during which they are not informed of their specific dose amount or dates of dose reduction. This may help to minimize the experience of anticipatory anxiety about stopping the medication and the severity of associated withdrawal.

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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.

 

Hello, I am a recent mother of a teenage addict to marijuana and alcohol. My son will be going to a treatment facility for six months out of state. He was a sophomore in high school, but didn’t pass his sophomore year. I'd appreciate any suggestions about how to work with him when he returns home. I know its going to be a tough road ahead but I will do what I can to help him. I would greatly appreciate any suggestions or insight you may have to help prepare for his return home.”

Doreen Maller: As with any and all issues, my general responses here do not replace individual support and should not be considered medical management for any individual or family. Any answers here are for informational purposes only. Personal treatment, interventions and case management are between you and your medical care providers.

That said, as a general rule, treatment is best considered as a family issue and not just rehabilitation for the child. Most programs include various aspects of family sessions, family training and psychological education, family support, and peer-to-peer counsel. This might include face-to-face forums, on-line chat and support forums.

Outside of programmatic support, personal support is helpful, including personal therapy, peer support, co-dependency support groups and groups such as NAMI (the National Alliance on Mental Illness), which supports families dealing with the co-occurring disorders of mental illness and substance abuse. 

As your family begins its relationship with recovery, it is important to remember that each person and each family navigates recovery differently. The intention of residential treatment is to return positive control back to the client, teach behavioral and coping skills and create positive alternatives for stress management, addictive behaviors, as well as identify and address underlying emotional issues.  It is helpful that family members use the time apart for their own healing, learning and recovery. Find restorative time and rest for yourself, carve out time for positive experiences with other family members, and obtain professional support for yourself if you have not already. Engage in your son’s program, learn about addiction, co-occurring disorders and cross addiction, and fight isolation by participating in peer to peer support.

It is hard to predict re-entry needs this early in your son’s recovery but, in general, moving from a residential program back home is a process that will require additional support.  Lining up services for yourself and your child in anticipation of his return can provide a system-of-care safety net.

Residential treatment provides structure 24/7; returning to a less structured environment can be a challenge to all. Setting clear ground rules and expectations should be part of your son’s exit from rehab and of your re-entry protocols, and these should inform your dialogue with your child upon his return. Establishing a clear sense of routine and expectation is important. Some families utilize a step-down process where children return into an intensive outpatient program or a sober living environment before their full return back home. Typically, inpatient programs will provide guidance in these transitions.

Re-entry into the family and home environment can be a particularly triggering time so making sure services are in place for yourself, other family members and your son to cushion the stressors of return.

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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 was talking with a friend the other day about the lack of options especially women ( I feel ) face today in recovery.  I have written a lot on my “getting sober.”  I have written poetry that may or may not get published but helped me get my thoughts from being a tornado in my brain.  I am extremely frustrated by AA and all its suggestions albeit rules. I am just as frustrated that there is nowhere else to go so to speak. I happened upon your site after I told my sponsor that maybe AA isn't for me. 

Who is me?  I am a divorced 49 yr old college educated working professional that drank her way out of an unhappy marriage. Once divorced I tried social drinking only to find all the AA jargon was swirling through my brain and the guilt overpowered me. Once my anxiety kicked in, for added measure, I was back to drinking to stay calm. That doesn't work, it just increases the need of alcohol to keep the anxiety from overpowering my brain for a short while, too short, so I think you can imagine how I ended up. 

Being an eternal optimist I tried several times over the past few years to “social” drink only to have that whole thing happen each time. Today I am 6 months sober and trying desperately to fit in somewhere. I have no idea why I am telling you all of this but I do hope that reading your newly found website can be a tool in helping me find me or at least where I fit in.  - Eileen

Rita Milios: I am so sorry that you have been feeling overwhelmed and frustrated, but I also congratulate you on remaining sober even despite these trying circumstances. Yes, I can understand that AA might not be right for you -  many people report similar experiences as yours, where AA may feel too “regimented “ or that the slogans, intended to be motivating, can be “guilt-inducing” instead.

Please do not give up! As the saying goes, “Sometimes you have to kiss a lot of frogs before you find the prince”…in other words, you may have to try out a number of alternatives before you find the source of support that you feel “fits” you.  And actually, it is a good thing that you have recognized that the dilemma is with “fit” and not with you or your ability to make the changes you desire in your life. Many people give up after trying AA and failing; then they feel that they are without hope and their goals are unachievable. That, however, is certainly not the case.

Below are several of the most promising “alternatives” to AA, with a brief description of each. Perhaps one of these support systems might be a better fit for you. Also, please do not discount the value of individual counseling. Issues such as you describe (unhappiness, anxiety, and frustration with life circumstances) are indeed triggers for drinking, but they do not exist in a vacuum. Unresolved anger, self-doubt and fears are often “residuals” of a failed marriage and lost dreams. Resolving these underlying issues via therapy might be a good option to consider as well.

I wish you all the best! 

Alternatives to AA:

SMART Recovery is recognized by the American Academy of Family Physicians, the Center for Health Care Evaluation, The National Institute on Drug Abuse (NIDA), U.S. Department of Health and Human Services, and the American Society of Addiction Medicine. It offers free face-to-face and online mutual help groups, as well as an online message board.

Women For Sobriety, Inc. is a non-profit organization dedicated to helping women overcome alcoholism and other addictions. It is the first national self-help program specifically for women alcoholics. It does advocate total abstinence.

The Recovery International Method uses cognitive behavioral techniques and psycho-education to teach people to control self-destructive behaviors and change self-defeating attitudes. The Method advocates that learning to change thoughts and behaviors leads to positive changes in attitude…and from there, changes in beliefs follow, resulting in long-term positive change

Rational Recovery provides counseling, guidance, and direct instruction on self-recovery from addiction to alcohol and other drugs through planned, permanent abstinence. The group believes that individuals are on their own in staying sober, so there are no meetings or treatment centers as part of the approach. The website provides information about the method (Addictive Voice Recognition Technique® (AVRT®), frequently asked questions, and other free information.

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.

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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 a binge eater. Every two or three months or so I go into a panic and can't stop eating. Therapy hasn't helped yet.  I read the medical literature and know this is dangerous and that there are millions of us who have the same problem.  What's your suggestions about what I should do?

Stacey Rosenfeld: There are a few ways to address binge eating. Therapy isn't an overnight solution, so while I understand your impatience, I'd encourage you to give it some time. That said, I'd make sure you and your therapist are working from an evidence-based model - using techniques from cognitive-behavior therapy and perhaps some skills from dialectical behavior therapy - to help get you on your way.

Have you noticed what seems to lead to your binges? One helpful technique is keeping a log of the episodes. This allows your to keep track of some of the patterns that might occur around them. If you binge, try not to beat yourself up for the behavior. Instead, use it as a data collection experience. Make careful notes on what was going on prior to the binge episode. Do you tend to binge when overly hungry, when you didn't get enough sleep, when stressed at work, after you've had an argument? What seems to precede the panic you mention? 

Looking for some of the precursors to the episodes might help you address them over time. Speaking of hunger, we know that a common trigger for overeating is under-eating. Are you dieting or otherwise restricting your food? If so, I'd discourage this and encourage you to flesh out your intake so that you're eating three meals a day and likely 1-3 snacks. People who binge often skip meals - make sure that you're keeping yourself fueled throughout the day. If you need help with meal ideas, I might consult with a dietitian who specializes in eating disorders. In any case, make sure you aren't ignoring hunger - again, this can be a big trigger for a binge. 

Are there certain foods that tend to trigger your binges? I wouldn't eliminate these foods from your diet - this only tends to result in an experience of deprivation that can further trigger binge eating. However, I might be mindful of how you interact with these trigger foods. For instance, if you tend to binge on bread, you can practice eating bread in moderate amounts (e.g., ordering a sandwich at a restaurant), but you might decide that keeping a loaf of bread in the house might be too difficult at this point in your treatment.

Do you find your binge episodes are a way to cope with difficult emotions? If so, you might want to work with your therapist on alternate ways of experiencing and expressing these emotions. Sometime people will experience the urge to binge as a wave, which ultimately will die down if they sufficiently distract themselves and engage in an alternately soothing or tension-relieving behavior. Again, none of this will work if you're trying to restrict your food - the binges can be your body's way of keeping you nourished. 

Finally, many people who suffer from binge eating are concerned about the weight implications of their behavior. Most of us who treat eating disorders have found that successful recovery efforts typically involve putting weight-loss or weight-maintenance as a goal aside and instead focusing on developing a healthy relationship with food as the primary goal.

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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.

 

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

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

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

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

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

 

Is marijuana addictive?

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

Write us about the results of your experiment.

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

 

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

Here are some great kid’s books:

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

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

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

Visiting Day by Jacqueline Woodson and James Ransome

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

 

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

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

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

Here’s my answer:

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

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

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

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

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

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

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

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

There is hope!

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

 

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

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

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

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

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

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

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

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

 

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

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

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

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

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

 

What Spiritual Practices May Best Support Recovery?

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

 

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

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

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

1.  Your boyfriend's life.

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

2.  Your values.

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

3.  Your sobriety.

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

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

With good wishes for you and your recovery.

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

 

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

Harold Owens: Hi GF???

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

 

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

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

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

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

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

 


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

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

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

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

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

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

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

 

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

Self-Help Books

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

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

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

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

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

Autobiographies

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

Online Self-Help

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

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

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

 

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

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

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

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

 

How should I respond to an opioid overdose?

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

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

 What to do:

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

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

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

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

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

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

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

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


Our panel of experts. Click for full bios. 

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

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

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

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

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. 
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