1 ALCOHOL RELATED ILLNESSESS IN ALCOHOLICS WITH LONG TERM SOBRIETY Overcoming Denial How Horses Help Children of Alcoholics Bill Wilson s Fourth Legacy RECOVERY AND CORE ISSUES SCRAMBLED EGGS AND BRAIN-FRIED CHICKENS Back to the BASICS OF RECOVERY STEP 4 (CONTINUED) Adolescent ADHD and Substance Abuse VIOLATION OF PROBATION IN FLORIDA
3 A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs, alcohol and petty theft in Palm Beach County. It is also distributed locally to the Palm Beach County High School Guidance offices, The Middle School Coordinators, Palm Beach County Drug Court, and other various locations. Many petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. Florida is one of the leading States. People come from all over to obtain pharmaceutical drugs from the pain clinics that have opened virtually everywhere. The availability of prescription narcotics is overwhelming, and as parents our hands are tied because it is legal. Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20 s and 30 s right up to the elderly in their 70 s, thus, creating a generation of addicts. Addiction is a disease but it is the most taboo of all diseases. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school, or even worse an overdose, that we realize the true extent of their addiction. I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved ones life. They are more apt to listen to you now then they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are Transport Services that will scoop up your resistant loved one (under 18 yrs old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean. Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment instead of jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself as well. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with any one outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-it MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the proper care. They need help. Please don t allow them to become a statistic. There is a website called the Brent Shapiro Foundation. Famed attorney Robert Shapiro started it in memory of his son. I urge each and every one of you to go to that website. They keep track on a daily basis of all the people that die due to drug overdoses. It will astound you. I hope you have found this magazine helpful. You may also visit us on the web at Sincerely, Patricia Publisher To Advertise, Call
4 4 IMPORTANT HELPLINE NUMBERS 211 PALM BEACH/TREASURE COAST 211 FOR THE TREASURE COAST FOR TEENAGERS AAHOTLINE-NORTH PALM BEACH AA HOTLINE- SOUTH COUNTY FLORIDA ABUSE HOTLINE AL-ANON- PALM BEACH COUNTY AL-ANON- NORTH PALM BEACH FAMILIES ANONYMOUS (USA) (Local) Center for Group Counseling CO-DEPENDENTS ANONYMOUS COCAINE ANONYMOUS COUNCIL ON COMPULSIVE GAMBLING CRIMESTOPPERS TIPS (8477) CRIME LINE TIPS (8477) DEPRESSION AND MANIC DEPRESSION FLORIDA DOMESTIC VIOLENCE HOTLINE FLORIDA HIV/AIDS HOTLINE 800-FLA-AIDS ( ) FLORIDA INJURY HELPLINE GAMBLERS ANONYMOUS and HEPATITUS B HOTLINE JEWISH FAMILY AND CHILD SERVICES LAWYER ASSISTANCE MARIJUANA ANONYMOUS NARC ANON FLORIDA REGION NARCOTICS ANONYMOUS-PALM BEACH NATIONAL RUNAWAY SWITCHBOARD 800-RUNAWAY ( ) NATIONAL SUICIDE HOTLINE SUICIDE ( ) ONLINE MEETING FOR MARIJUANA Ruth Rales Jewish Family Services MEETING HALLS Billy Bob Club central house 2170 W Atlantic Ave. SW Corner of Atlantic & Congress Club Oasis Crossroads EasY Does It The Meeting Place The Triangle Club Passionate Caring Truthful Prepared Miracles DO Happen HOPE. BELIEVE. RECOVER. A STRUCTURED, WOMEN--ONLY TRANSITIONAL HOUSING PROGRAM IN DELRAY BEACH, FLORIDA Millie Tennessee, Executive Director
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6 How Horses Help Children of Alcoholics By Lizabeth Olszewski Equine Therapy has been beneficial for many years in helping the physically disabled, autistic children, and even sufferers of PTSD. However, until recently our equine friends have not been introduced to help children of alcoholics until now. I am an adult child of an alcoholic, and in 2009 I started the first equine foundation specifically aimed at helping children of alcoholics (COA s) and addicts. Horses Healing Hearts uses horses to help COA s build selfconfidence and learn life-coping skills, and it was born here in Palm Beach County. HHH currently serves 30 children in PBC out of three sponsor barns in Boca Raton, Delray Beach and Wellington. Approximately one-fourth of our children have a parent absent due to jail, over-dose, suicide, or homicide. Why are Horses So Instrumental in Helping Children of Alcoholics? In the same way that dogs can smell fear, a horse can smell or sense stuffed or incongruent emotions. Because horses have been prey animals for over a million years, their survival instinct has required them to become acutely aware of their surroundings and the intentions of beings up to 100 feet around them. In fact, the limbic portion of their brain (responsible for sensing emotion) is abnormally large. You might wonder how does this translate to our needs? Let s say a participant just got in a fight with his brother on the way to our session. He s standing near the horse and showing a smile on his face, but inside he s still upset about the fight. The horse will be very uneasy because he senses this incongruence. The horse will show his own anxiety by pinning his ears or swishing his tail. We d ask the boy if there s anything he wants to talk about. And remind him about horses being feelings detectors; typically, he ll then know the horse gave him up somehow, and he will talk about the fight. You can physically watch the horse relax while he talks. This type of tool is invaluable with COA s because they are so adept at stuffing and hiding their emotions at home. Who We Are What we teach HHH is a 501c3 equine facilitated learning program. We are not a therapy program. Our first goal is to maintain the kids physical safety while allowing the kids and horses to work their healing magic together. To deal with parents addiction and behavior, participants learn a very important concept, the 7 C s: 1. We didn t Cause it 5. We can make healthy choices 2. We can t cure it 6. By communicating our feelings and 3. We can t control it 7. Celebrating ourselves 4. We can t change it How the Sessions Work: The children meet weekly at one of the three sponsor barns for a two hour session. We start with a 40 minute group session led by our child educator. The participants decompress and share highlights of their week. The educator briefly reviews some group rules. Next we discuss our subject for the week and start artwork (related to the subject). While doing this, our first three riders get their helmets on and go with a volunteer out to the arena to begin riding. The kids who are not riding stay with the educator to work on their art. The participants share different information while working on their art (possibly not comfortable discussing in a group setting.) We also make every effort to have siblings get time apart. Out in the riding arena, there are side walkers to assist riders and a lead instructor overseeing the riding portion. As the participants advance, they can go on the lunge line and then ride independently in the arena with instruction. Each child is given approximately a 15 minute private ride instruction appropriate to their skill level. Once all children have ridden, we close with a 15 minute circle time group session by talking about our rides or reading a meditation from the Al-A-Teen book. How A Horse Changed My Life At six I vaguely remember the fights between my mom and dad. After breaking my mom s nose twice, and her wrist once, they divorced; and we moved to Dayton, Ohio where she married another alcoholic. Ivan was a tall, well-educated pilot and engineer who lived on a farm. After we moved in, he decided we should have a celebratory bon fire with our toys because they had no place on a farm where you work hard. Surprisingly, he taught my two older brothers and me many valuable lessons, such as the value of hard work and excellent grammar. Then, a year later he shot our kittens in a drunken rage. When I turned 12, Ivan got sober, divorced our mom, and started to take me to AA meetings, where I learned about alcoholism. Then my life changed even more -- My first introduction to horses was indeed life changing. Ivan sent me for the summer to his sisters in Pennsylvania. Aunt Suzy was a Dressage rider and a concert pianist. She rescued a mustang named Jonathon, who was abused and tried to escape through a barbed wire fence. Grey-haired scars covered his brown coat. I identified with those scars, except mine were on 6 the inside. Jonathon had been rescued, and I wanted to be. He was shown great care, love and attention and went on to do great things. I knew I could do the same. I just needed the chance. That summer, being mentored by my aunt, was my first big shot. When I returned home to Ohio, I knew I wanted to work with horses the rest of my life. It was my dream. But for now, it was back to reality. Our housing conditions were not so good. Many times our heat or water was off due to non- payment, and my brothers and I had to use the restroom outside or go days without showers. One day my mother suffered an episode of bleeding esophageal varices (common from liver disease), and was rushed to the hospital. The doctors gave her only six months to live. The only parent I had ever known and my best friend was now given a death sentence. I loved her but hated her disease. My aunt Kay offered for me to live with her and my two cousins. I didn t really care where I lived. I just wanted my mom NOT to die. I couldn t understand why us three kids didn t mean enough to her to make her want to live and stop drinking. None of it made any sense! And I didn t realize it at the time, but the invitation to live with my Aunt was the next big opportunity I was given- a chance at normalcy. So I went from no heat, no toilet, and no shower to a normal house within three days. The transition to normalcy was not without its bumps but I did it. I went on to graduate high school and then considered college. My aunt filled out the loan applications, and my brothers helped to pay my tuition as they worked full time. I was the first in my family to graduate from college with a Bachelor s Degree. My mom lived another ten years, and died when I was 24 years old. She was 54 when she passed in a rest home alone. She never admitted she was an alcoholic. There are lots of heroes in my life, even one with four legs and fur!! Without each and every one of them in my life, I know I would have followed in my mother s footsteps. Before I moved in with my aunt, I was going to bars at 14 with my brothers and getting drunk. I was well on my way. I owe them all a huge debt of gratitude. Starting HHH is my way of paying it back or forward if you will, an organization where COA s have a shot at the same opportunity I had - a chance to be in the presence of horses and have their miracle spirit change lives the way it changed mine. To Contact HHH: Horse Healing Hearts is accepting new participants. Visit Use contact form to reach us. Or Lizabeth Olszewski is Director and Founder of Horses Healing Hearts, USA.
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8 Overcoming Denial By Anne Brown PhD, RNCS Let s keep it simple. A is an attempt to break through denial and B is keeping the denial in tact. Where do you fit in? Are you A or B? If you find yourself continuing to be B how about taking a different approach! A. That man did bad sexual things things to me. B. Oh No he couldn t, he has such a big heart. A. Dad, I am worried about my brother s drug use at college. B. Oh, everyone smokes pot at college. I smoked pot at college. A. Mom, Grandpa always makes me sit on his lap and he touches me in my private places. B. Don t you ever say that again! How could you say that? He loves you. A. We found your 20 year old son passed out on the side of the street at 3 am. B. Oh I am sure this is a one-time event. He probably didn t eat anything that day. A. Mommy, Daddy hit me last night when you were out. B. Oh you probably did something to upset him. A. I am worried about your wife, she smelled of alcohol when she came to pick up your kids. B. Oh, it was probably just her perfume. A. Why did you offer your wife wine just after she came home from the alcohol treatment center she went to for 28 days? B. Well, she should know how to drink responsibly with me now. A. Why did you bring your child pot while he was in drug treatment? B. Well he told us alcohol is his drug of choice and they wouldn t mind us bringing him pot. A. I believe your daughter is in trouble with alcohol. Her friends just left her unconscious at my house last night. B. Oh, all teens drink. These are responses that someone has said at some time. If you find yourself saying your version of the above/denial, it is wake up time. All that is necessary for the triumph of Evil is for good men to do nothing. (Edmund Burke) Addictions are evil and they need us to do something. Many people including professionals, families, friends, etc. do not want to acknowledge addictions because they don t know what to do when they find it. It doesn t have to be that hard. Helping someone you love requires caring, compassion, and courage to speak the truth, and a willingness to do something other than what you have been doing. As I have said so many times, no one has ever walked into my office, said Hi, my name is Harry, I am delighted to be here and I can t wait to give up drugs and alcohol. So, as long as you know that we are dealing with something I don t want to give up let s get started. Don t expect thanks on the first go round. When someone comes to you with a comment regarding an addiction about someone else, if you can do nothing else just listen and ask questions. Tell me more. Just those three little words can help overcome denial. After you get more information about the situation you can then start to research for answers about how to handle. Call a professional, go online, read, buy books about the concern and get all the information you need to assist you. I remember working with a man who really only knew how to say YES to everyone s request because he so wanted to please and be liked. Well I coached him to say, I don t know. When he got home he summoned up the courage to say No and it changed his life. Those three little words I don t know changed his life. I know if you can start to say Tell me more rather than shut down the opening sentence to break denial it will change your life. Start today! Tell me more. Anne Brown PhD, RNCS Author, Backbone Power the Science of Saying No 8
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10 Bill Wilson and Dr. Bob left us three remarkable legacies. Their first legacy was the 12 Steps. The 12 Steps have helped millions find freedom from their addiction to alcohol and other drugs. Their second legacy was the 12 Traditions. The 12 Traditions do for the fellowship of Alcoholics Anonymous what the 12 Steps do for the individual. We can think of the 12 Steps as a design for daily living that promotes emotional wellbeing and peace of mind, while the 12 Traditions provide guidelines for the healthy functioning of the AA fellowship as a whole. Their third legacy was the formation and structure of the General Service Office. These three legacies formed the foundation of Alcoholics Anonymous as we know it today. Recently I realized that there is another legacy that Bill Wilson left us- A legacy that has not been fully recognized for its value and role in recovery. Bill Wilson s fourth legacy was emotional sobriety. Bill originally wrote about emotional sobriety in a letter he sent to a depressed friend in I feel quite certain that this must have been something Bill shared about in meetings, but he didn t write about it until he wrote the letter. This letter was eventually published in The Grapevine in 1958 titled, Emotional Sobriety: The Next Frontier. I personally have found the contents of this letter very helpful. This is one of Bill s most important contributions to recovery. In it he unravels the source of his basic flaws and emotional deformities, issues necessary to understand and address, if he was going to finally tackle his depression and realize all the wonderful benefits of recovery. Bill Wilson s Fourth Legacy By Allen Berger, Ph.D. If you want to achieve emotional sobriety, then you need to get honest with yourself about your current level of emotional maturity. Your level of emotional maturity relates to your level of differentiation. The more mature you are, the more differentiated you are. But none of us are perfectly differentiated. We all exist somewhere along a spectrum of undifferentiated to differentiated. Emotional sobriety is the result of learning to soothe ourselves rather than manipulating other people to comfort us. Emotional sobriety is the movement away from manipulating others for validation towards supporting and validating ourselves. If we require other people to act and behave a certain way for us to feel safe then the world will never be a safe place. When I learn to stand on my own two feet and support and validate myself, then what others do or don t do becomes less important. Emotional sobriety means that we stop taking what other people do personally and we stop letting their limited perceptions define us. Emotional sobriety involves maintaining autonomy while maintaining togetherness. It means not losing ourselves in the relationship. As Dr. Erich Fromm stated, Mature love is union with the preservation of integrity. Emotional sobriety is what Stage II Recovery is all about. As it turns out, emotional sobriety is Bill Wilson s fourth legacy. In this letter Bill shared the insights he gained while understanding and unpacking the emotional causes of his depression. Bill worked hard on his recovery. He sought the truth about himself and about life. He was a great observer of himself and his emotional and behavioral patterns. Bill also received spiritual direction from some very prominent spiritual leaders of his time. He also received psychological help from Dr. Harry Tiebout, a psychiatrist who recognized the importance of AA, and befriended Bill and the fellowship. In fact Dr. Tiebout treated Marty Mann, the first female member of AA. The letter is a synthesis of what he had learned in his spiritual journey and in psychotherapy. Bill was working on what we now call Stage II Recovery. This second stage of recovery was appropriately labeled Stage II Recovery by Earnie Larsen. Stage II Recovery is concerned with healthy human relations. This is something that has eluded us throughout our lives because of our emotional immaturity. The 12 Steps help us grow up by identifying our emotional deformities and identify patterns in our human relations that help us see our basic flaws. So let s take a closer look at the issues Bill discovered. Do you ever find yourself overreacting to a comment someone important makes to you and then find yourself silently wondering, Why did I react so strongly? What makes their opinion of me more important than what I know to be true? This situation and others like it have much to teach us about our emotional deformities. Reflecting on what caused him to be upset and how he reacted when upset, helped Bill figure out some very important things about himself. In a way, we can say that he took an emotional inventory. As a result of the insights he gained from these selfreflections, Bill realized that his depression was a result of how he responded when things didn t go his way. Bill discovered that he imposed unenforceable rules on others and demanded that they accommodate his nonsense. When they didn t, he fought them and when they didn t cave in, he felt deflated and defeated. When he felt defeated he became depressed. But don t think for a minute that Bill is the only one of us that acts this way. I must confess that I do too. Less today after over 41 years of recovery, but it s definitely still a part of my reaction at times. I d bet if you are honest with yourself, you will see evidence of this kind of behavior in your reactions too. Bill realized that his emotional state was dependent on the outcome of his interaction with others, that he was emotionally dependent on how other people behaved towards him for his self-esteem and his emotional wellbeing. Bill described his epiphany this way: Suddenly I realized what the matter was. My basic flaw had always been dependence almost absolute dependence on people or circumstances to supply me with prestige, security and the like. Failing to get these things according to my perfectionistic specifications I had fought for them. And when defeat came so did my depression. I believe we are all emotionally dependent to one degree or another, and that s why we relate to Bill s struggle. Emotional dependency is the result of being emotionally undifferentiated. The more differentiated we are the less reactive we are to others and the better we can soothe ourselves. (You can read more about the concept of differentiation in my book 12 Smart Things to do When the Booze and Drugs are Gone). 10 Dr. Berger is an internationally recognized expert in the science of recovery. He is a popular recovery author and wrote Hazelden s popular recovery mainstay 12 Stupid Things that Mess Up Recovery (2008);12 Smart Things to do When the Booze and Drugs are Gone (2010) and 12 Hidden Rewards of Making Amends (In Press). He is widely known for his work on several areas of recovery that include: Integrating modern psychotherapy with the 12 Steps of Alcoholics Anonymous Emotional Sobriety Helping new patients understand the benefits of group therapy and helping them get the most out of it Helping families adjust to the challenges of recovery Training therapists and counselors in Gestalt Experiential Therapy You can learn more about Dr. Berger and his work at Need Help with Your Recovery? Pregnant or don t want to leave your children? Receive the help you need while keeping your children with you at The Susan B. Anthony Recovery Center. Our campus is a safe, nurturing residential program with 40 apartments, a state-ofthe-art child care center, group rooms, and more. We are ready to help. CALL NOW to begin the journey. TOLL FREE (866)
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14 As a clinical psychologist with a private practice in Woodland Hills, CA, for several decades, I have enjoyed developing several areas of specialization. A few of these are the treatment of adolescents and children, and I ve always had a special interest in the treatment of ADHD. Also, many teenagers consult me for substance abuse issues that most frequently involve alcohol, marijuana and tobacco. A certain percentage of these teenagers also suffer with ADHD. Their parents want to know: How do I know if my child has ADHD? Why is my son or daughter with ADHD self-medicating? How does ADHD develop? The research I reference here may be disturbing to the loved ones of individuals with ADHD, but I hasten to explain that timely interventions and skillful treatment can significantly reduce the detrimental impact of ADHD. Definition of ADHD ADHD is a biogenetic disorder and one of the most concise definition is given by Russell Barkley, Ph.D. (1991): ADHD consists of three primary problems in a person s ability to control behaviors: difficulty with sustained attention, increased distractibility, impulse control or inhibition, and excessive activity. In addition, there are two additional problems: difficulty following rules and instructions and excessive variability in response to situations, particularly during work. Research Findings Twin studies reveal that the majority of hyperactivity and impulsive behaviors seen in children (55% to 97%) is explained by heredity. The identical twin studies reveal that if one twin has ADHD, there is an approximately 80% chance that the other twin will have it. Other studies confirm that at least two genes may be related to ADHD, and that individuals with ADHD have reduced amounts of one or more brain chemicals such as dopamine. ADHD is the most commonly treated behavioral disorder in childhood. However, ADHD is often misdiagnosed and therefore may be treated inappropriately or missed entirely. It affects about 3-5% of young people. The good news is that 25% to 50% of children grow out of ADHD by the time they are adults. Up to one-half of children with ADHD also suffer from other disorders such as depression, anxiety, oppositional defiant disorder and conduct disorder. Association with Adolescents with ADHD and Substance Abuse Given the painful aspects of ADHD, it is not surprising that across the literature it is shown that children with ADHD have an increased risk of substance abuse. In a largely cited study, the Multimodal Treatment of ADHD study (MTA) reported that alcohol, tobacco and marijuana use were more likely to be initiated by early adolescence in youngsters with ADHD than for youngsters in that study that did not have ADHD (Molina, et al., 2007). There is also a strong association between childhood ADHD and cigarette smoking. For example, in one study, 40% of children with ADHD became more daily smokers by the age of 17 versus 27% of those without ADHD (Lambert & Hartsough, 1958). A high percentage of children with ADHD who smoke will also go on to become substance abusers. Also, one study revealed that children with ADHD are more likely to report heavy drinking in their teen years than non-adhd teens. The study stated that 14% of teens with ADHD reported a drinking problem. ADHD children with conduct disorder or bipolar disorder are more likely to have a substance abuse problem, usually associated with drinking, beginning at age 12. Symptoms associated with conduct disorder include aggression toward people, destruction of property, stealing and serious violations of rules, which can lead to anti-social personality disorder. Children who begin drinking earlier than age 15 are at a high risk for becoming alcohol dependent and marijuana users. According to Biederman, et al. (1995), marijuana is the most commonly abused agent. Family data indicate that abusers with parents with substance abuse disorder, anti-social personality disorder, and ADHD are at particular risk for developing substance abuse disorders. The Influence of Self-Medication Adolescents who suffer from ADHD often seek relief from feelings of restlessness, impulsivity, low self-esteem and difficulties focusing. They often have associated symptoms with anxiety and depression. These adolescents often view themselves as stupid and see themselves as undesirable with peers. They feel isolated. They do not understand why they struggle academically and compare themselves with their peer group. They become easily frustrated and irritable and often have great difficulties remaining motivated to perform in school. One 15-year-old high school student with ADHD comes to mind. He had used marijuana every day in order to relax and sleep, and he did not have friends nor was able to complete his assignments. He only felt relaxed when he was smoking or drinking. Another 15-year-old girl who had ADHD was ready to drop out of school 14 Adolescent ADHD and Substance Abuse By Donn Warshow Ph.D. because she could not sit still in class or complete her lessons, and found solace in her peer group that served as a surrogate family for her. She used drugs and alcohol. She displayed a concurrent conduct disorder and had been arrested. Her parents had a history of substance abuse and were emotionally abusive to her. These adolescents have attempted to compensate for their low self-esteem and emotional torment through self-medication. When adolescents realize that they suffer from ADHD and have a serious problem with substance abuse and are willing to engage in treatment, they can often ameliorate their maladaptive behavior patterns and enjoy positive results. Treatment Both substance abuse and ADHD should be treated concurrently and early, and parental participation is essential in all programs to facilitate progress. Substance abuse is the more dangerous condition, and depending on the severity of the substance abuse, such measures as inpatient hospitalization, residential treatment, day treatment, a 12-step program, meetings, individual and group therapy and intermittent urine testing can be effective interventions. Both adolescent and parental groups can be very useful. Many parents realize that their own substance abuse issues had been overlooked and that their adolescent may be modeling their own behaviors. Teenagers often respond well with an intervention from a teen who has a history of substance abuse and can serve as a peer group sponsor and participation in a 12- step program such as Alateen can be essential. Individual and family therapies are essential interventions. In my practice, I typically have family sessions at least once a month or perhaps every two weeks, as healthy family functioning is vital to therapeutic progress for the adolescent. These young people do not function in a vacuum, and there are always difficulties in the family system as well. Exploration of feelings is needed to build self-esteem and to help the adolescent become assertive. Many of the teenagers I ve treated with substance abuse and ADHD have benefited greatly from counseling, so family members have reason to remain hopeful. In middle school, adolescent support groups led by peers, the school psychologist or the school mental health practitioner can be a powerful adjunct to treatment. I strongly recommend them for high-risk teenagers who have ADHD and substance abuse difficulties. The parents can participate as needed. These groups are most useful when they occur on a weekly basis and as part of the counseling program. Contrary to popular belief, psycho-stimulant medication for ADHD does not increase the risk for further substance abuse in most cases. A small percentage of substance abusers with severe conduct disorder/impulse control problems will attempt to abuse these drugs. Medication can be a valuable adjunct to psychotherapy as prescribed by a pediatrician and/or psychiatrist who are involved in the treatment plan. Collaboration is the name of the game. The more professionals that are involved in the treatment program, the greater the chance for success. Often parents come in to my office in a state of confusion and feeling overwhelmed because they believe there is no one professional who is up to organizing the treatment. I have found it gratifying to be able to function as a manager for the treatment team to avoid lapses in communication and to offer the young person the best treatment possible. Parents often need to provide strict contracts with their adolescents including pay-offs and consequences for all behaviors. This provides the necessary structure that these adolescents desperately need and had previously lacked. The teenager should have input about which rewards would motivate them the most. I prefer a home/school reinforcement program, in which the school sends home a daily report so the parent and I can be aware of the progress that the adolescent is making. The adolescent understands that rewards and consequences will be determined on a daily basis based on this progress report. Intermittent urine testing, as already stated, is often useful as well. To sum up, ADHD and substance abuse can wreak havoc in the lives of youth and their families. However, treatment can break the grip of these disorders, especially when all parties contribute to a collaborative approach (i.e., the adolescent, parents, therapist, school, medical doctor and community organization offering a 12- step program). Early intervention enhances the likelihood of success. The two adolescents previously mentioned were able to turn their lives around as a result of intensive counseling, medication, family therapy, structured contracts, random urine testing and help from the school. I have often been inspired by the courage, commitment and accomplishments of these young people. Donn Warshow, PhD is a Licensed Clinical Psychologist with a private practice in Woodland Hills, California. He has over 30 years experience treating adolescents, children and adults with ADHD who also have substance abuse issues, depression or anxiety. Phone:
15 Recovery and Core Issues By Malissa Morrell LMFT, ATR-BC When considering treatment options for long-term recovery from addictive behaviors there are many things to consider. An important element of any treatment product is the quality of therapeutic resources available to reveal some of the drivers in the addictive process. Some therapists only address behaviors -- the choices and actions that can be seen and measured by others. Many therapists acknowledge a link between our behaviors and our emotions. Sometimes, though, understanding the way our strong emotions can influence our choices doesn t seem to be enough to truly make change. Core Issues are beliefs that we develop about ourselves which influence our emotions and lead us to behave in unhealthy ways. They re deeper than thoughts or feelings or behaviors. They often become a part of our identity. Common examples of core issue beliefs usually start with the words I am... and can include beliefs such as: I am unlovable. I am a failure. I am different, broken, or dirty. These beliefs can grow to be so strong that they influence our understanding of reality; core issues, over time, seem to be the truth. Once they gain enough power, we begin to measure our entire world against this truth. We begin to filter all of our life experiences through the lens of these core issues. This can make it very confusing for friends, family, and loved ones who are trying to support us. For instance, a person who believes, I am unlovable will not be able to accept it when someone says, I love you. Instead, they may twist this well-intended message to fit the truth as written by their core issue. So, I love you may be received as, What do you want from me? or You have to love me, because you re my mom. How can identifying and confronting your core issues help? Core issues can turn an everyday event into a trigger. Many young students are thrilled to receive a B on a quiz. However, a perfectionistic student with a core issue of I m not good enough could view a B as a tremendous failure! These feelings of failure can trigger destructive behaviors such as emotional meltdowns, unhealthy coping, addictive behaviors, etc. Learning to identify, confront, and rewrite the beliefs about yourself is the first step toward making profound, long-lasting change in behavior. Malissa Morrell LMFT, ATR-BC is Director of Expressive Arts, La Europa Academy To Advertise, Call
16 I m sure I m not the only one who immediately thinks about chickens and eggs almost every time they hear the word comorbidity. But the first time I found a hash pipe floating around with my daughters clothes in the washing machine, chickens and eggs were the furthest things from my mind. I grew up in a family who appeared quite normal on the outside and the inside. In the early 60s, watching your mother dress up for cocktail parties while easing down the final few puffs of her unfiltered Pall Mall was the norm. My father sitting with his after-work gin and tonic while he caught up with the national news was the norm. I didn t grow up exposed to blatant alcohol abuse or drug use of any kind. We were all June and Ward Cleaver. Really, we were. Even as a teenager of the 70s, drugs barely phased my world. Years later my husband and I continued the Cleaver tradition. Although I fell short of meeting him at the door in a pretty blue dress with my hair in a stylish flip, we raised our two girls in a very normal household. So when my two daughters suddenly turned from adorable little girls to unrecognizable teenage monsters with hash pipes and slips of paper decorated with curious, tiny, triangular squares in their pockets, we didn t know how to respond, who to blame (other than ourselves), who to turn to for help, or how to stop the rollercoaster, eggshell crushing few years we were heading toward. Nothing in either of our lives prepared us for what was coming. When my older daughter s behavior turned from that of a slightly difficult child to that of an unmanageable teenager, many hours of useless guilt bantering between me and my husband ensued: What did we do wrong? Do you think it s drugs? Why does she feel the need to do drugs? What could we have done differently? Am I a bad mom? And on and on. When she was ultimately diagnosed with bipolar disorder at the age of eighteen, we accepted this with a sigh of relief at least this was something tangible, something fixable. By the time her younger sister started getting in trouble at school, doing drugs, acting oddly, becoming paranoid, and hearing voices, I could almost handle the double punch. By then I had educated myself, I had become involved in the National Alliance on Mental Health (NAMI), and I had become an advocate. But it was still hell she was diagnosed with schizophrenia. So where s that chicken and where s that egg? Perhaps I should have been given a tiny ovum of foresight the first time our younger daughter woke us up in the middle of the night screaming in her little pink doll-baby pajamas with her moonlike eyes peering up at us without recognition and her face fixed in death-impending terror. But I was soothed by our doctor s reassuring words: Night terrors are very common. They are in no way related to future mental illness. I now know that he was incorrect. Perhaps my older daughter s contention that she had ADHD in spite of her exemplary school performance should have sent up red flags. Maybe if I had known what I know now, I wouldn t have placated her words: You have no idea what goes on in my head! But the fact is, other than a stubborn and sometimes difficult child at home, my older daughter was a perfectly charming, brilliant student who was well liked by her teachers and better liked by her friends. Then there were the things I never knew about until later. Like the fact that my younger daughter used to sit in her second grade class and say, Iron wall. Iron wall. Iron wall, over and over to herself as she tried to limit the external stimuli flooding her young brain. Then there was the time she was given steroids as a young child for a severe sinus infection and distinctly heard people talking to her. Mom, someone just said cleanup in aisle seven in my head! The moment the prednisone was decreased, the voices stopped. So as these early prodromal symptoms grew, so did my children, and so did their access to things like weed and alcohol and random pills pilfered from grandmas medicine cabinets, thus providing them something like relief. Yet my younger daughter did not become psychotic until after that bad LSD trip. My older daughter now admits that she was doing a lot of coke when she was most manic. Egg. Chicken. Egg. Egg. I think what we have here is the first and second hit. The first hit being the genetic propensity for these illnesses along with an increased sensitivity to certain medications and drugs. The second is environmental. Stress, drug use, hormones, a viral infection, and head trauma have all been theorized. I have no doubt that my children were vulnerable. I know now that both sides of our families are peppered with mental illness. The use of drugs to quell prodromal symptoms could have easily brought the predisposed mental illness to the forefront. Drug use absolutely made things worse. We were lucky. Thanks to the help of a great practitioner and people I met through NAMI, my kids were helped quickly. Proper treatment was 16 SCRAMBLED EGGS AND BRAIN-FRIED CHICKENS By Karen Winters Schwartz initiated and my children recovered before any sort of drug or alcohol addiction took hold. Regardless of the accuracy of their initial diagnoses, the word comorbid was never part of the equation. Twenty to twenty-five percent of adults in the US will struggle with mental illness at some point in their lives. Over half of these individuals have a coexisting addiction. What can be done to decrease these percentages? How can we decrease that drug-induced second hit? I believe early detection is the key flagging those children who are genetically vulnerable, screening each and every child as we screen for other serious illnesses. We need to step in and treat those early prodromal symptoms before drugs and alcohol can take hold. This can be achieved by education, by open and frank discussions on mental health, by making it okay to talk, by decreasing the learned fear, and by promoting what is needed for recovery. Screening should be done on every child by pediatricians and family doctors. Mental health should be stressed and taught in our schools, starting at lower grade school levels. We should be talking to our children about our own struggles or those of other family members. I could never talk to my children because no one ever talked to me. I was forced to learn everything I now know about these neurological brain diseases out of desperation, out of despair, and out of necessity. What we went through as a family was unconscionable. We should have been educated and supported by our medical and human community rather than made to feel ashamed, judged, and helpless. Blame it on poor genes if you must, but these are no-fault neurological conditions that are not due to poor parenting or weak constitutions. When it comes right down to it, eggs and chickens are not all that important. It really doesn t matter if the egg predated the chicken or the chicken predated the egg, or even if they both occurred at the exact same time. What s important is that we understand that both mental illness and addiction are often comingled. Both need to be acknowledged, understood, and treated. The cost of mental illness is huge; the cost of comorbidity is even larger not only financially, but emotionally and physically. I believe the mental healthcare system is beginning to understand this. Now we just need to get the rest of the world to understand. Karen Winters Schwartz, bestselling author of Where Are the Cocoa Puffs?: A Family s Journey Through Bipolar Disorder (Goodman Beck Publishing, 2010) and Reis s Pieces: Love, Loss, and Schizophrenia (Goodman Beck Publishing, 2012)
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18 VIOLATION OF PROBATION IN FLORIDA By Myles B. Schlam When a defendant is sentenced to Probation in Florida they are basically being granted a chance to stay out of jail or prison assuming that they adhere to the conditions of Probation. The defendant, by accepting the terms of Probation is basically signing a contract with the court stating that they can manage themselves without having to be rehabilitated in jail or prison. The consequences of violating Probation can be very serious, especially in Florida. In fact, it is my opinion that Probation can sometimes be a set-up for certain types of Probationers. Violations of probation can happen very easily, and can occur if your probation officer has any reasonable grounds to believe you violated the terms of your probation in any material way (Florida Statutes ). If there is suspicion you violated your probation, any law enforcement officer may then arrest you, or the judge can issue a warrant for your arrest. Community Control, as defined in Florida Statutes , is supervised custody in the community, home or another place that has specific rules and requirements. For example, licensed halfway houses are considered community control. Community control is daily supervision and surveillance by law enforcement officers, including weekends and holidays. Community control is stricter than probation, and is available to offenders who commit certain crimes that would not otherwise be available for probation. For example, those who commit serious felonies or felony offenders who have a criminal background may be eligible for community control, but would not be eligible for probation. However, violating terms of community control can result in the same penalties as probation violations. When one is accused of violating Probation (VOP), they are in a strange predicament because they were already sentenced for the original crime. The Probationer has less legal protection then if they were being charged with a new crime. Under Florida Statute , there is no right to a jury trial in a VOP hearing, which means that the Probationer is basically at the mercy of the Judge. There is no right to bond while awaiting a hearing for a VOP. This means that a person accused of murder may be able to bond out of jail, while someone who was on Probation and violates (with a dirty urine, for example) will have to sit in jail until the VOP hearing. There is also no Statute of Limitations on a VOP, which means that the Probationer cannot just stall or wait for things to blow over. Also, Hearsay is admissible against you in a VOP hearing, which means that whatever a Probation or Police Officer says you did can be admitted without any further proof. Also, under , Guilt does not have to be proven beyond a reasonable doubt. Basically that means that if you were over 50% more likely to have violated your probation in the opinion of the Judge, you may be charged. My advice to someone on Probation who may have relapsed on alcohol or drugs is to seek the advice of a professional before giving a confession to your Probation Officer. Similar to the police, anything you say to your Probation Officer can and will be used against you in a court of law. This is especially so in the case of a VOP, where Hearsay is admissible and the burden of proof is so low. Notwithstanding advice from friends in the fellowships to be honest in all your affairs, this is one of those cases where you want to proceed with caution. Probation Officers are NOT your friends. ASI has developed a working relationship with the Department of Corrections and has intervened in many potential VOP s before they are officially issued. How can Probation be violated and what are the consequences? Some of the ways in which individuals tend to violate probation can include, but are not limited to: Positive Drug or Alcohol tests; Failure to attend required treatment programs, courses or 12-step meetings; Failure to pay the fines and fees required as part of your probation terms; Not reporting to your probation officer on the correct date and/or time; Failing to report if you have changed addresses during the probationary period; Leaving the city, county, or state, without obtaining permission from the courts or probation officer; Contacting someone who has an order of protection against you; or Possession of firearms. In Florida, a Judge can make one of three decisions if you violate your Probation. They can either: 1) Reinstate your Probation, 2) Modify your Probation, or 3) Revoke your Probation. The best case scenario of course is to have Probation reinstated. If Probation is modified, this will usually mean an extension of time on Probation and perhaps additional requirements, such a community service hours, additional fines, or completion of a Drug Treatment program. At ASI, we have been very successful in persuading the court to reinstate Probation or modify it with completion of a Drug Treatment Program being one of the terms. This scenario however has been effective mostly for drug 18 offenders who have violated Probation with either a dirty urine or other substance abuse related violations. The worst case scenario is that the Judge can revoke Probation and sentence the defendant to the maximum penalty for the original charge. This is scary because someone who is on Probation for a Felony Drug Possession charge can technically be sentenced to five years in prison for a dirty urine. The way some judges see it, the defendant has already been given a break by getting Probation. Even with all the issues that arise for violating probation in Florida, you do have options that may put you in a more favorable position. A good advocate will know how to employ strategies to give you the best chance at succeeding. In some cases your attorney can argue the merits of the violation itself in an attempt to get the violation dismissed, or at least get Probation reinstated. However, a plan of action must be developed and proposed to the Court. In cases involving drug charges, it is recommended that you set up an evaluation with ASI, the Criminal Justice Addiction experts who can then testify in court on your behalf and propose a Treatment Plan as an alternative option to the Court. ASI coordinates Treatment Plans which may include Residential treatment, Intensive Outpatient Treatment (IOP), or a halfway house. We are licensed by the Florida Department of Children and Families for both Case Management and General Intervention. When it comes down to it, a probation violation is not something to be taken lightly. That is why ASI is affiliated with very experienced and knowledgeable criminal defense attorneys who understand Probation laws. ASI works together with our attorneys to achieve not only the best legal results, but also the best clinical outcomes for the clients. Clients eligible for our services include those charged with DUI s, Drug Possession, and other drug-related criminal charges. Myles B. Schlam, J.D.,CAP/CCJAP Advocare Solutions, Inc.- Executive Director (954) *Myles B. Schlam is a nationally recognized expert in Drug Addiction and the Criminal Justice System and an Internationally Certified Alcohol and Drug Counselor. He is one of 100+ Criminal Justice Addiction Professionals (CCJAP) in the State of Florida. Mr. Schlam graduated from the St. Thomas University School of Law in ASI is licensed by the Florida Department of Children and Families and operates in Palm Beach and Broward Counties.