Working with professionals to bring families back together.

Transcription

1 HOW SUBSTANCE USE AND DEPRESSION DEVELOP IN ADOLESCENT GIRLS THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS EDUCATION IS PARAMOUNT NEUROSCIENCE DISCOVERIES AND THEIR IMPACT OPIOID DEPENDENCE NO EVIDENCE FOR BRIEF DETOX THE HARMFUL IMPACT OF ROMANTICIZING MARIJUANA DEATH OF SOBER HOME LEGISLATION HIGHLIGHTS NEED FOR ACTION BETTER PARENTING THE MOST PAINFUL PART OF RECOVERY INTERVIEW WITH MARK LUNDHOLM SHARING THE GIFT OF RECOVERY WITH CHILDREN GETTING UNSTUCK: BREAK FREE FROM ADDICTIVE PATTERNS THE COMMUNITY REINFORCEMENT AND FAMILY TRAINING (CRAFT) A PROVEN METHOD TO GUIDE YOUR LOVED ONE INTO TREATMENT

2 Working with professionals to bring families back together. Hundreds of referral partners from around the country rely on American Addiction Centers to provide the perfect combination of evidence-based treatment programs and settings in order for their patients to receive the best care possible. With coast-to-coast facilities and caring, highly-seasoned professionals, American Addiction Centers is your ideal treatment partner. To learn more, please call Consultants available 24/7 AmericanAddictionCenters.com 2

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 and alcohol in Palm Beach County. It is also distributed locally to all Palm Beach County High School Guidance Counselors, Middle School Coordinators, Palm Beach County Drug Court, Broward County School Substance Abuse Expulsion Program, Broward County Court Unified Family Division, Local Colleges and other various locations. We also directly mail to many rehabs throughout the state and country. We are expanding our mission to assist families worldwide in their search for information about Drug and Alcohol Abuse. Our monthly magazine is available for free on our website at If you would like to receive an E-version monthly of the magazine, please send your address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as the biggest man-made epidemic in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. 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. Did you know that Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction. 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 one s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don t know where to begin. I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from. There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (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, Extended Living 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 as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. 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 anyone 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 best care suited for their needs. They need help. Deaths from prescription drug overdose have been called the silent epidemic for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at We are also on Face Book at The Sober World and Steven Sober-World. I want to wish all the dads a Happy Father s Day. Sincerely, Patricia Publisher Patricia@TheSoberWorld.com To Advertise, Call

4 IMPORTANT HELPLINE NUMBERS 211 PALM BEACH/TREASURE COAST 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 OVEREATERS ANONYMOUS- BROWARD COUNTY OVEREATERS ANONYMOUS- PALM BEACH COUNTY RUTH RALES JEWISH FAMILY SERVICES WOMEN IN DISTRESS PALM BEACH COUNTY MEETING HALLS CENTRAL HOUSE 2170 W ATLANTIC AVE. SW CORNER OF ATLANTIC & CONGRESS CLUB OASIS CROSSROADS EASY DOES IT LAMBDA NORTH CLUBHOUSE THE MEETING PLACE THE TRIANGLE CLUB BROWARD COUNTY MEETING HALLS 12 STEP HOUSE SW 23RD STREET 101 CLUB 700 SW 10TH DRIVE & DIXIE HWY LAMBDA SOUTH CLUB POMPANO BEACH GROUP SW CORNER OF SE 2ND & FEDERAL HWY PRIDE CENTER WEST BROWARD CLUB COMPREHENSIVE AND INDIVIDUALIZED DETOX AND OUTPATIENT TREATMENT A1 BEHAVIORAL HEALTH, LLC Substance Use Recovery and Education (SURE) Outpatient Detox Services Relapse Prevention Groups Day/Night Treatment Program Parental & Family Support Groups Intensive Outpatient Program Individual, Couples & Family Counseling Struggling with addiction? CALL US TODAY! Toll Free: Admissions: WHAT WE OFFER Clinical Evaluations & Drug Screening DUI & Addiction Awareness Programs Housing/Placement Services Case Management Services Court Appointed Treatment Programs Ofrecemos ayuda en Español West Dixie Hwy, Aventura, FL DCF license #1113AD At the Serenity House Detox we pride ourselves on taking care of our clients like our family. We are a small private medical detox offering a peaceful and compassionate environment. Our clients will have the opportunity to take the first step in the journey to recovery in a safe environment. info@serenityhousedetox.com

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6 Clinicians, therapists, substance abuse counselors, mental health workers, and criminal justice workers are encountering and working with adolescent girls who present with co-morbid disorders, in addition to substance abuse disorders. There are several issues that need to be addressed to ensure that adolescent girls with comorbid disorders will achieve success in treatment. The etiology of substance abuse varies by gender and ethnicity, and there is a growing recognition that the meaning of substance use in adolescents may also vary. Teenage girls appear more willing to talk out their feelings and experiences with others. This tendency is a strength that allows for the possibility of helpful feedback or support from others, which enables girls to nurture and connect with other girls. Donovan (1996), for example, states that whereas boys tend to use alcohol for recreation and the known effect of the drug, girls have been found to use alcohol as a means of connecting to others. When faced with a drug-using group, some girls may use substances in order to not make the others feel uncomfortable by their lack of participation. Depression has been identified as a factor strongly associated with substance abuse by adolescent girls. If drug use is understood as a mechanism to cope with emotional pain, it is not difficult to comprehend this connection. Several studies have supported the prevalence of significant co-morbidity of depression and other psychiatric disorders. Depression is one of the most common comorbidities that accompany substance use for adolescent girls. Demographic Differences Although depression can be found among children of all ages, it is more prevalent among adolescents. Rates of depressed mood tend to increase during early adolescence (ages 13 to 15), peaking at ages 17 or 18, before declining to adult levels. Although rates of major depressive disorder are equal for boys and girls during childhood, gender differences emerge during adolescence with rates among girls becoming double that of boys, similar to the female-male ratio found in adults. Co-morbidity - Many adolescent girls who present for treatment meet criteria for two or more diagnoses, a phenomenon referred to as co-morbidity. In principle, an adolescent girl could meet criteria for any two or more disorders; in practice, some combinations of disorders are much more likely to occur in girls than in boys. Disorders that frequently coexist are substance dependence, depression and anxiety disorders. Why some combinations of disorders are more prevalent than others, whether there are common features or simply definitional overlap and ambiguities of various disorders, and how co-morbidity disorders emerge, are just some of the questions research raises about girls with co-morbidity. Co-morbidity is significant in providing treatment. Many adolescent girls may suffer significant impairment in multiple domains and areas of functioning. It is important in determining co-morbidity in adolescent girls to formulate a differential diagnosis that is, simply finding out what is going on with her. This is accomplished by 1) looking at presenting symptoms; 2) looking at her history (some clinicians make the mistake of looking only at present symptoms); 3) looking at stressors in her life that exacerbate symptoms, i.e., family, environmental, developmental. Etiology of Depression in Adolescent Girls Models to account for behaviors in adolescent girls have been posited in most areas of psychological functioning, psychopathology, and psychobiological development. Depression in adolescent girls is no exception. Research indicates several risk factors for depression for adolescent girls. Risk factors for depression in adolescent girls can emanate from multiple sources, including loss of the primary object or parent through death or abandonment and thusly, anger turned inward, which, from this psychodynamic perspective, defines depression. 6 HOW SUBSTANCE USE AND DEPRESSION DEVELOP IN ADOLESCENT GIRLS By Fred Dyer, Ph.D, CADC This loss produces unsatisfied affection needs and diminished selfesteem. Cognitively, depression is associated with an adolescent girl s thinking or thought distortions. Seligman (1975) introduced the concept of learned helplessness, which basically posits the belief that I do not have any control over my situation, and there is nothing I can do about it, so I surrender, acquiesce, because I can t do anything about the situation. This can or often produces depression. Learned helplessness definitely has implications for domestic violence prevention. Learned self-helpfulness vs. learned helplessness are both cognitive constructs that can be learned and unlearned. Cognitive distortions can affect an adolescent s judgment about the social environment and the world, for example, I must be thin in order to be successful, or If I am not in a relationship with a boy, then I must be inadequate. In the cognitive approach to depression, there are three types of negative thinking, according to Beck (1979) negative views of the self, of the world, and of the future. These views can eventuate/produce depression in adolescent girls. The whole point of learned helplessness is I give in and I am helpless. Behavioral formulations of depression are based on the notion that depressive symptoms are learned through interactions with the environment. Social skills deficits, as well as other skill deficiencies, may be a function of reinforcement histories. In other words, an adolescent girl, according to the behavioral theory, may become depressed because of lack of environmental reinforcement, and depressive symptoms in adolescent girls may also occur because of a lack of reinforcers in the environment. An example of depression caused by behavior reinforcement is, If I drink with the other girls, I ll be more acceptable to boys, because all the girls I know drink and also have boyfriends, so I drink, and I now have a boyfriend. An example of depression as a result of poor or lack of reinforcement is, I go out of my way to please everyone, and people still do not like me. Life stressors/social environment Research demonstrates that stressful life events are more frequently reported by depressed adolescent girls and the occurrence and number of stressors appears to be positively related to depression in children. It is crucial for those working with adolescent girls to understand the nature, importance, and implications of this point and to see how the role of abuse and violence and other gender-specific losses have not been addressed, i.e., physical or sexual abuse or witnessing the abusive acts which makes the adolescent girl a covictim. The stress over losses may also cause depression losses such as: loss of self-esteem, self-worth; loss of educational and vocational opportunities; loss of health; loss of childhood; loss of control over their bodies; loss of home and sense of permanence; loss of belief, trust, faith, hope; and loss of credibility once labeled. It is apparent that, for adolescent girls, multiple losses or one that is salient or acute can very often eventuate into depression. Genetics Research has demonstrated that genetics can influence the occurrence of depressive disorders in adolescent girls. Strober (1984) was able to demonstrate that the cases of depressed adolescents and 35% of parents and 20% of second-degree relatives were depressed, and an even larger percentage was depressed when adolescents were bipolar by diagnosis. Article References are Available upon Request Fred Dyer, PhD., CADC, is an internationally recognized speaker, trainer, author and consultant who services juvenile justice/ detention/residential programs, child welfare/foster care agencies, child and adolescent residential facilities, mental health facilities and adolescent substance abuse prevention programs in the areas of implementation and utilization of evidence-based, genderresponsive, culturally competent, and developmentally and age appropriate practices. He can be reached at dyertrains@aol.com and

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8 THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS EDUCATION IS PARAMOUNT By: John Giordano DHL, MAC Timothy Sutton is not unlike any other young career-minded professional trying to make a name for himself. He worked long hours and seemed to be handling the pressures of his profession quite well. That is until the 32-year-old doctor was found laying unconscious on a bathroom floor in cardiac arrest with an empty syringe and an antiseptic wipe in his hand. Sutton injected himself with Fentanyl, an opioid that has a rapid onset and short duration of action. The drug is approximately times more potent than morphine on a dose-by-dose basis. What makes Sutton s story unique is that he is an anesthesiologist resident at the Cardiovascular Center of the University of Michigan Hospitals. Dr. Sutton received his medical degree from Johns Hopkins University School of Medicine one of the finest medical schools in the world. Sutton is obviously one of the best and brightest. What could possibly make a distinguished doctor of Sutton s caliber with such an extensive knowledge of drugs and their effects inject himself in the neck time and again with prescription drugs meant for his patients? How could anyone so bright jeopardize their promising future? Addiction is ubiquitous. In my thirty plus years of addiction treatment I ve been saying all along that no one just woke up one morning and said to themselves: today, I think I ll become an addict. Drugs hijack a person s brain. Not even a well educated anesthesiologist with a vast knowledge of drugs and their effects is immune. In fact, it s quite the opposite. It s hard not to think of doctors as being the pinnacle of health. After all, when all is said and done they ve spent nearly ten years studying and training in the medical profession. Yet with all of these educational requirements, you d be hard pressed to find a primary care doctor or anyone in the field of health for that matter who has studied addiction. It is simply not required by most medical schools. A recent comprehensive report by the National Center on Addiction and Substance Abuse (CASA) discovered that: of the 985,375 practicing physicians in the United States, only about 1,200 are trained in addiction medicine. As you can see, not even health specialists possess the skills to identify addiction in their patients much less themselves. They struggle with drug and alcohol addictions at similar or higher rates as the general population. According to a paper published in the Western Journal of Emergency Medicine, The University of California, Irvine, up to 14% of physicians, nurses and/or other health professionals have a drug and/or alcohol addiction. That translates into tens of thousands of doctors and hundreds of thousands of nurses are showing up to work everyday impaired by drugs and/or alcohol. This begs the question, with so many of our best and brightest minds including our doctors, nurses and medical professionals succumbing to addiction, why is there not more taught about the subject in medical schools? It is required of licensed physicians to complete one-hour of addiction continued education per year. Just one hour! What is even more concerning is that the pharmaceutical companies who net billions of dollars annually from the sale of prescription painkillers that were involved in over sixteen-thousand preventable deaths last year provide the required education. The CASA study found that addiction is linked to more than 70 diseases or conditions. How can a physician effectively treat a person with one of these addiction linked diseases if he doesn t have the training or skills necessary to address addiction? In addition, addiction accounts for one-third of inpatient hospital costs. Over thirty-thousand preventable deaths occur right here in America every year because of addiction. Drug abuse 8 cost the United States economy over five-hundred and sixtybillion dollars in increased health care costs, crime, and lost productivity last year and that number is on the rise. Addiction is an epidemic affecting ten to fifteen percent of our population and less than one in ten get treatment; yet only about 1,200 doctors or.1% of the practicing physicians are trained in addiction medicine? I fail to see the logic. It s well established that addiction is a treatable brain disease. My good friend and colleague Dr. Kenneth Blum wrote a paper that was published in the peer-reviewed Journal of the American Medical Association (JAMA) identifying the genetic link to addiction. The paper was published twenty-five years ago. Since that time literally tens of thousands of papers on the neurobiological processes that influence addiction have been published in peer-review medical and scientific papers. With so much that has been discovered in the last thirty-years, why is there not more taught about the subject in our medical schools? These discoveries pulled back the curtain that once hid the true roots of addiction. From the science, we were able to develop new evidenced-based modalities that were proven to be effective in the treatment of addiction. Even though many of the newer holistic protocols struggle for acceptance in mainstream medicine, they have been shown to be effective. A great example is nutraceuticals. Drug abuse is very disruptive to brain chemistry. With this in mind, I began formulating my own brand of amino acid supplements intended to address this issue. Nutra Clarity is the result of over twenty years of formulation. It has become very popular among addicts in rehab and recovery as well as health minded individuals. The results have been overwhelming. People taking Nutra Clarity claim they feel an overall lift both mentally and physically. Yet with all the successes, it s a daily struggle getting acceptance in the mainstream of medicine. Fortunately for Dr. Sutton and other doctors, recovery is not so far away. Recently I contributed to a paper with Dr Kenneth Blum discoverer of the addiction gene where we researched education levels of addicts in recovery. What we found was that people with higher educations had much greater success in their recovery than those with less education. Dr. Sutton is also fortunate in another way he survived. Less than four hours before he overdosed, Carla DelVecchio, a nurse at the same center, perished from an overdose of a deadly mixture of fentanyl and the benzodiazepine midazolam. She, too, was locked in a bathroom with hospital-issued sedation medication and a syringe. For anyone paying attention, addiction has a new face. It s that of a younger person with a promising future that looks very much like 32-year-old Dr. Sutton and 29-year-old Carla DelVecchio. If anything good is to come from Carla s death, and others like her, it would be the acceptance of addiction for what it is a non-discriminate, treatable brain disease and provide the catalyst for the requirement of addiction education at our medical colleges. There is a mountain of research and studies idly collecting dust on the shelf just waiting to be shaped into a comprehensive curriculum. How many more young promising lives have to be lost before we start educating our best and brightest? John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies, Laser Therapy Spa in Hallandale Beach and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: holisticaddictioninfo.com

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10 NEUROSCIENCE DISCOVERIES AND THEIR IMPACT By Michael J Kuhar Ph.D There have been many important discoveries in the neuroscience of drug abuse. These have had a big impact on how we treat and understand drug abuse, and I would like to address some of these. My views could be arguable, but they are reasonable and based on many years of study. We have always known that drug abuse is a highly relapsing disorder. This makes it seem like drug abuse is inevitable and unending. But this is not so. Brain imaging studies have shown that it is not always unending; it just takes a long time for the brain to heal. When the levels of an important brain chemical called the dopamine D2 receptor (D2R) are measured in the brains of users who are at various stages of abstinence, we find that the newly abstinent users have lower levels of D2Rs. But this changes. The longer the user is without drugs, the more the levels of D2Rs return to normal. This receptor in the brain is there for the chemical dopamine, an important substance that modulates feeling good or reward. But the hitch is that the return to normal takes a very long time - months or years. There is evidence that the rate of return varies with the individual. So, we have to cope with the fact that healing takes a longer period of time than most can spend in rehab. Instead, we need to develop ways, approaches, or techniques that allow some form of treatment to extend for a long time. It s more like a lifestyle change. The particulars of this are left up to the user and his or her treatment professionals. Getting everyone onboard with this duration issue has to happen before we can realistically address the problem. Does extended drug use change the brain forever? Is it that once you are a user, you are always a user? Some researchers might think so, and others think no. I m one of those who do not think so because the brain imaging data do show a return towards normalcy as was mentioned previously. Also, there are many long term users who give up certain drugs forever or for a very long time. In those cases, if the brain was changed forever by drugs, the change was not very impactful. However, because of individual variations, there may be some users who are changed forever. But, we don t have any evidence that proves this one way or another for everyone, at least not right now. We already know that some users may require help and guidance for a long time. Overall, studies show that treatment works, and the longer treatment is given, the better. Let s move on to another issue. Why does addiction occur? Why hasn t evolution weeded addiction out of the human race? After all, by definition, addiction has negative consequences on our lives. A set of advances in many areas can help us look at these questions. First, we need to look at the brain as a survival organ. Whether we realize it or not, the brain guides or at least nudges us to carry out behaviors that are good for our health and survival. It guides us by making us feel good after activities such as eating when hungry, drinking when thirsty, or mating to have offspring. These feel good responses of the brain are crucial, because without them, our survival as an individual or species might be seriously threatened. A key thing here is that this is also how drugs work. They turn on our feel good systems in the brain. The brain becomes an unwitting co-conspirator in the addiction process because it can t combat drugs in the brain very effectively. Feeling good every time we take drugs is a powerful reinforcer of our behavior. Reinforcing means that it causes us to want to do it again. Drug taking, for these reasons, is very powerful. In this view, the brain reinforces drug taking because it is interpreted as something important for survival. Before we can get the big picture, we need to realize that people are different. While we are all people with 46 chromosomes, we are all different in sometimes significant ways. Some have higher IQs than others. We all look different. Some are tall and others not so tall. This is, in part, because our genes are slightly different. We all have the genes needed to be a human, but, because of mutations and environmental influences; the power or effectiveness of each of our genes can vary. Just as some of us are prone to cardiovascular disease or asthma or diabetes, some of us are more prone to having problems with drugs. So where does this leave us? We have a brain that, because of the way it functions to reward survival based activities, allows drug abuse and addiction. The brain can repair itself (return to normal) when we stop taking drugs, but this takes months or years. We all have a slightly unique gene pool and slightly unique environmental experiences that leave us all with different vulnerabilities to take drugs. It seems complex. Can we make sense of this? Well, perhaps we can. We need to accept that some of us end up in trouble with drugs. If somebody is already an addict, then they know what to do. They need to find a way to get off drugs and/or minimize the damage they cause. To do that, they likely need the help of a professional. It can be a long battle. If you are worried that you or someone you know or are related to may become or is becoming an addict, then you need to assess your vulnerabilities. Are you worried about a genetic load or predisposition to drug use? Are you in a difficult environment where drugs are freely available? These vulnerabilities need to be assessed, perhaps with a professional, so that your behavior can be adjusted to keep you safe. Drug abuse can be as complex, long lasting and as complicated to treat as cardiovascular disease, asthma or late onset diabetes; treatment can encompass a number of activities that include behavioral and life style changes as well as taking medications. None of these diseases are easy to deal with and the vulnerability to get sick may always be there. They require awareness, vigilance and a persistent effort. Michael J Kuhar PhD, Yerkes National Primate Research Center of Emory University, Candler Professor of Neuropharmacology, School of Medicine, Georgia Research Alliance Scholar and Senior Fellow, Center for Ethics, Emory University. 954 Gatewood Rd NE, Atlanta GA Tel: Author of The Addicted Brain: why we abuse drugs,alcohol and nicotine. 10

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12 OPIOID DEPENDENCE NO EVIDENCE FOR BRIEF DETOX By Dr. Robert A. Moran M.D., F.A.P.A. Maintenance medication-assisted therapy is more effective than any other type of treatment for opioid dependence.there is no longer any medical indication for the use of short-term detoxification from opioids for the vast majority of people who have become dependent. Most studies have shown extremely high relapse rates in those who undergo short-term detox. The World Health Organization has stated that of the treatment options examined, opioid agonist maintenance treatment, combined with psychosocial assistance, was found to be the most effective. According to Gavin Bart, MD FACP FASAM, Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world. Treatment cannot be accomplished in a short 30 day program for the vast majority of people. Studies have shown that behavioral interventions alone have poor outcomes, with, as Bart points out more than 80% returning to drug use. In the study completed by Smyth et al, follow-up interviews were completed with 109 opiate-dependent patients admitted to a residential addiction treatment program for detoxification using methadone during the first 10 days, followed by lofexidine (an antihypertensive similar to clonidine) for 7 days. After discharge, 99 (91%) reported a relapse. In 64 (59%), relapse occurred in 1 week. There have been many studies that have replicated these results, showing high relapse rates after short-term detoxification typically 90% relapse rate during taper. What drives these high relapse rates? The persistent desire to get high? Probably not. Once the individual has developed addiction, science has shown us that the brain has changed. Those circuits in the brain which subserve the functions of motivation/reward, behavioral inhibition, mood regulation, and drive have been changed. In opioid dependence, the natural opioid system, the endogenous opioids endorphins, enkephalins, dynophins, have all been imbalanced by the chronic presence of the exogenous (the illicit) opioid. The opioid system in the brain is directly or indirectly involved in many different functions including pain regulation, mood regulation, respiration, heart rate, and cognitive function, such as planning, decision-making, and the capacity for delayed gratification. When an individual abruptly ceases to use illicit opiates/opioids, e.g. upon initiation of detoxification, all of these functions are naturally affected. The degree and rapidity to which they normalize will differ from person to person. It is naïve to think this will happen at the same rate (for example, in 7-10 days) and to the same degree (for example, completely) in every opiate/opioiddependent individual who undergoes detoxification. The protracted withdrawal may continue for many months; that is, the changes that were induced in the brain as a result of the months or years of illicit opiate/opioid use, and it is this that continues to maintain the high risk of relapse. It is very difficult to resist this. Add to this either stress or cues (people, places, or things) which will flood the brain with memories directly stimulating the part of the brain which has hitherto been stimulated by the drug itself and it is only a very small minority who will be able to maintain abstinence. Methadone, buprenorphine, and naltrexone have been approved by the FDA for the treatment of opioid dependence. Methadone is a full opioid agonist at the mu receptor, acting much like all the other opioids and requires the individual to attend the clinic on a daily basis for the dosage of medicine. Naltrexone is an antagonist which helps by blocking the effect of any ingested/injected opioid and therefore decreasing any positive reinforcement. Buprenorphine is unique in that it is a partial agonist at the mu 12 receptor and also an antagonist at the kappa receptor. These properties of buprenorphine confer extremely important differences upon it. Most individuals do not experience euphoria. The kappa receptor is responsible for anxiety and dysphoric mood; therefore, by blocking this receptor, buprenorphine helps to treat these symptoms. There is also evidence that buprenorphine helps to normalize the stress-response system (repairing the brain) which has been damaged by the illicit opiates/opioids. It was everyone s hope in 2000 when the Drug Addiction Treatment Act paved the way for physicians in 2002 to obtain a special waiver to prescribe buprenorphine for opioid dependence that finally we had a medicine available that would enable the opioid-dependent individual to be detoxified comfortably and effectively in a short period of time, and then move on to rehabilitation to learn the appropriate relapse prevention skills and coping mechanisms enabling the individual to live a productive drug-free life. Unfortunately, our experience began to teach us that it was not so easy. What we in addiction psychiatry quickly began to learn was what the above-mentioned studies revealed, that is, that the vast majority of people who underwent rapid detoxification from buprenorphine relapsed, no matter how motivated they were to remain abstinent. One patient described his experience this way: I have tried every way possible to get clean. Over the past year alone, I have been in and out of six treatment centers. I ve never been able to successfully complete a program because my urge to use, combined with the withdrawals were to [sic] great to bare. So how long should someone who initially is prescribed buprenorphine remain on buprenorphine? The answer given on a recent board-certification examination was as long as it seems to be helping. The fact is, the research is still being done in an attempt to answer this question. Studies have been done looking at increasing lengths of time on buprenorphine leading to retaining individuals in treatment at their most vulnerable time. The longer people remain in treatment, the more likely they are to be successful in recovery. And, of course, further time in treatment is giving the brain more time to heal. If buprenorphine is helping the brain to heal, then those circuits responsible for impulse control, judgment, decision-making, anxiety, tolerance, and mood regulation will improve over time in its presence. Why would we want to prematurely deprive the individual of a medicine that might enhance the repair of these processes? Once we see evidence that the brain is functioning well in these areas that is, the individual is maintaining sobriety, attending 12-step meetings, working a strong program, establishing healthy relationships, coping well with life s daily stressors, then perhaps that is truly the ideal time to begin a very slow tapering off of buprenorphine. Ultimately, only further scientific study will tell us for sure. Article References are Available upon Request Dr. Robert A Moran is the CEO and Medical Director, Wellington Retreat, Inc., Diplomate, American Board of Psychiatry and Neurology, Certified in General Psychiatry and Addiction Psychiatry, Diplomate, American Board of Addiction Medicine, Certified in Addiction Medicine, Clinical Instructor in Psychiatry, Weill Cornell Medical College, Voluntary Assistant Professor of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Affiliate Clinical Assistant Professor, Charles E. Schmidt College of Biomedical Science at Florida Atlantic University and Adjunct Clinical Assistant Professor of Psychiatry and Neurology, Lake Erie College of Osteopathic Medicine

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14 THE HARMFUL IMPACT OF ROMANTICIZING MARIJUANA By Noel Neu, MS, LMHC Lately I have been reading how marijuana is safe and wonderful, and how it will change your life for the better. All over social media, there is a buzz on how this wonder-drug will benefit your life. One recent posting with a background of cannabis paraphernalia stated the following: When I first started smoking marijuana I planned on saving it only for special days, little did I know that every day would become a special day. Another posting s headline read 12 ways how marijuana can improve your life. Not that pro-cannabis rallying and extolling is anything new, as it has been part of anti-government backlash hyperbole for at least the past 50 years. However, at this time the grand romanticizing of cannabis has become more commonplace and accepted with the legalization of it in two states and growing. Currently I am neither for nor against the legalization of marijuana in our society. As I see it, legalizing it can lead to regulation of the drug so that more accurate statistics and concrete research can be made to its ill-effects as well as any perceived benefits. What I do want to make claim to is the antiromanticizing of marijuana as it does have powerfully harmful results when used chronically in a family setting. The following is my experience, strength, and hope both personally and professionally over the past twenty five years. Marijuana is a central nervous system suppressant. This means it lowers the reaction time of nervous system processes. This includes impairment physically, mentally, and yes, emotionally. The result is a disconnection from what is really happening in life, and the creation of an illusion. I discovered that once living in this illusion the only way I could maintain stasis (feeling ok) is to continuously inhale marijuana into my system on a daily basis. My own romanticizing of marijuana began while I was in college. I became truly successful as I committed to doing well in school for the first time after I got to college, which is around the same time that I discovered this wonderful high of being stoned which resulted in a contrived sense of being free. I became convinced that I had figured it all out. I could be successful in school and smoke all I want as long as I did not mix the two. Which I did not do ever, thus, feeling in control. I did want the illusion of feeling free to last as long as I could make it. Around ten years later I hit a bottom spiritually, mentally, emotionally, and yes, physically in a career that I could not stand, with a life that I did not want, and a belief that I needed to continue smoking marijuana to feel anything. This is called addiction and marijuana is a drug that you can become addicted to. Marijuana is a-motivational, isolating, and distracting to any sense of what is really important in life. It creates what I call the legend in my own mind syndrome. This means that no real connection with self, with a power greater than self, nor with any real support system is ever genuinely made. Just a series of if-only scenarios that occur one after another that leave the chronic marijuana smoker with the belief that they are a victim of his/her time or of any perceived or actual societal factors. This victim belief is carried over in dealings with family, neighbors, work peers, and friendships. Most friendships to a chronic (daily) marijuana smoker are steeped in the procuring, smoking, and pontificating of marijuana and all that it cures. This leads to a life unfulfilled unless filled with the drug that is believed to be so very good for you. In my first year of early recovery I bumped up against another difficulty, in that marijuana was perceived as not being a real problem compared to crack cocaine or heroin. Fortunately for me I had a major support that helped me to see that marijuana recovery is more challenging. Since it has been downplayed 14 and minimized, the result often ends up with an enabling of the problem. Honestly, nobody celebrates crack or heroin addiction, but the celebration of smoking marijuana to heal your problems has become increasingly stronger and louder. In my 16 years since my last use of marijuana, I have learned about who I am as a person. My strengths, weaknesses, my hopes, goals, and dreams. I have learned that this plant that I was ingesting was not the cause of my problems, however, it contributed to me not being able to get to the cause which was actually my faulty belief that I needed a drug to enter my system to feel free and alive. Professionally over the past 12 years, I have had the privilege to work with many young men and women, as well as adolescent boys and girls, experiencing the spectrum of marijuana use, from abuse to dependence. Romanticizing marijuana from them makes sense, since they have been unsure of themselves as well as the difficult challenges that life has put in front of them. Unfortunately for them the result has been the stunting of their growth as human beings in their abilities to communicate and effectively connect with their families and themselves. This is the essence to my desire of anti-romanticizing marijuana. It is my hope that with the continued legalization of marijuana, a device to detect marijuana levels similar to breath devices for blood-alcohol levels will be developed to further analyze the impairments marijuana causes while driving. In addition, with marijuana being freely admitted to being smoked, better analysis of lung diseases can be researched to determine correlation to marijuana intake much like the research being completed on cigarette smoking. Any argument that marijuana is better for you than alcohol or cigarettes is counterproductive. More than often, this argument is made by people very determined to smoke marijuana on a daily basis because they need to. The confusion with being under the influence of cannabis is that it has the user believe that they want to use it rather than need to use it. This keeps the illusion that all is under control, and smoking marijuana to reduce stress on a daily basis is the solution. This is the same argument made by functional alcoholics who do not believe they have a problem. Let s not romanticize it. If we are going to legalize it, let s put it into the category that suits it, with alcohol and cigarettes, where it can truly be regulated and thoroughly researched. Then we can help those addicted to marijuana to get the help they need and not be told it s just marijuana. I believe this is the true path to freedom Believe in Yourself and Follow Your Truth. No wonder drug is necessary. Noel Neu, MS, LMHC is the CEO and clinical director of Empathic Recovery ( Mr. Neu has been a clinician in private practice for over ten years and has developed programs for Assertive Awareness training, Living your Truth to build self-esteem, and helping families with addictions heal.

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16 2014 Way of Life Conference Fri., June 13th Sun., June 15th 9th Annual Way of Life Conference AA / Al-Anon / ACA Palm Beach Gardens Marriott, 4000 RCA Blvd. 4 Circuit Speakers from AA, Al -Anon, and ACA over three days Over 50 AA, Al-Anon, and ACA meetings Karaoke / DJ Dance Party Friday Night Back to the Basics - 12 Step of AA in Five Sessions Banquet and Talent Show Saturday Night Long Timers Meeting Five Workshops done in the Three Fellowships To register: For information call Hotel reservations: or before 6/5 and mention WAY OF LIFE CONFERENCE for rate of $95 SAVE THE DATE Every patient presents a new challenge. Each person has specific needs, requiring a unique approach and effective care. For the patients who are even more challenging than the rest, treatment professionals need to be equipped with the most innovative methods that the industry has to offer. Moments of Change is designed to supply professionals with the information, skills and resources to address the growing needs of an ever-diversifying patient base. INNOVATIONS IN INTEGRATED TREATMENT CONFERENCE SEPTEMBER 29 - OCTOBER 2, 2014 THE BREAKERS, PALM BEACH, FL CONFERENCE TRACKS INCLUDE: Advances in behavioral health Specialty populations Mental health disorders Interventions Process addictions Psychological trauma Contact Jordan Young for more information (877)

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18 DEATH OF SOBER HOME LEGISLATION HIGHLIGHTS NEED FOR ACTION By John Lehman Once again, this year s Sober Home legislative initiative failed to make its way to the Governor for signature. But, unlike previous years, it was a close race right up to the wire. Though Senate Bill 582 & House Bill 479 entered their respective chambers as identical legislation, HB 479 was entirely rewritten by the time it made its way out of Representative Gail Harrell s Healthy Families Subcommittee. The bill was transformed from requiring mandatory registration of all sober home transitional living programs, their owners and locations into a voluntary, self-regulatory approach consistent with that suggested by the Florida Association of Recovery Residences (FARR). Under the revised version, HB 479 called for DCF to outsource certification to an independent, nonprofit organization that holds Recovery Residences accountable to a nationally recognized set of standards. This version was passed by the House and sent to the Senate where, unfortunately, its companion bill 582, died in appropriations before an opportunity to reconcile these two legislative initiatives could be negotiated. Despite their many differences, one notable similarity present in both bills was a date specific for when it would become a first degree misdemeanor for a licensed Florida treatment provider to make a referral to a non-certified residence. While FARR recognizes that there are those who believe government regulation is necessary to compel compliance with consumer protections, it has long been our position that the substance abuse treatment community is already sufficiently motivated. The vast majority already agree that case managers, therapists and discharge planners should restrict referrals to certified residences. Do we need the threat of a misdemeanor violation to compel us to do what is in the best interest of the client and the industry as a whole? The real challenge centers on the number of certified beds. It s a chicken versus egg dilemma. The availability of certified beds must increase to match the demand before treatment providers can fully embrace this practice. Caron Renaissance, and a handful of others, have actively encouraged recovery residences to seek FARR Certification for some time now. Their message has been consistent: Get organized and hold yourselves accountable to these standards or the state is going to do it for you. To be clear; if at the time we enter the next legislative session, FARR does not represent the majority of Florida transitional housing programs, our argument in favor of voluntary self-regulation will fall on deaf ears. The community needs to begin asking those who market themselves to treatment providers Are your FARR Certified? and to set a date specific for when FARR Certification will be a requirement for future referrals. FARR recommends the adoption of July 1, This is the date that was proposed by HB 479. Provided residence operators act now and do not procrastinate further, mid provides sufficient time to achieve this task and demonstrate to lawmakers that our industry is motivated to clean house without further threat of punitive action. The FARR Partner in Excellence program centers on this imperative as well as the need for the treatment community to help finance our mission. The integrity of FARR Certification requires we conduct impromptu, unscheduled audit inspections, in addition to our initial and annual visits. The annual budget for these audits exceeds $50,000; funds that must be sourced from outside the recovery residence community. Having travelled extensively throughout the state to meet with hundreds of owner/operators, it is my personal assessment that most housing providers want to do the right thing. Many of these have requested education and training to help them better achieve that goal. Best Practices content, designed specifically for this sector and mindful of the four levels of support as defined by FARR, must be developed and made available to all who wish to take advantage of this training. This too requires funding from outside the recovery residence sector. The substance abuse treatment community can help fund this vision by simply joining FARR as a Partner in Excellence. Frankly, this should be a relatively easy sell. All Partner in Excellence members receive a listing on the FARR site that includes a link to their website as well as a 300 word bio on the merits of their program. While we encourage a higher level of participation matching that of Archstone Recovery Center (Silver), Caron-Hanley Treatment Centers (Platinum), Delray Recovery Center and Wellington Retreat (Silver), if all the licensed treatment providers located in Palm Beach County alone were to join FARR as Partners in Excellence at the entry level for just $ annually, FARR would have sufficient funds to carry out its mission for the next twelve months without financial constraint. At every conference I attend, treatment professionals approach me and commend FARR for taking on this much needed, long over-due task of organizing and certifying the transitional housing sector to these standards. Frequently, they make the statement: Please let us know if there s anything we can do to help. We really believe in what you re doing. Please allow me to answer this by replying: Join FARR now as a Partner in Excellence: - Bronze - $500 - Silver - $1,000 - Gold - $2,500 - Platinum - $5,000 Continued on page 30 It s our home. Certifying safe and digniied recovery residences for individuals seeking peer-supportive shelter. Are you FARR Certiied? 18

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20 BETTER PARENTING THE MOST PAINFUL PART OF RECOVERY By Marlene Passell, Communications Coordinator Wayside House Rhonda Fritzhall is a parent educator on a special mission helping addicted mothers become better parents - even while they are in treatment for their addictions. They often are angry, sad and feeling guilty they tell me that dealing with their parenting issues is the most difficult part of recovery, said Ms. Fritzhall, who teaches parenting to the growing number of women at Wayside House in Delray Beach, FL, who are mothers. More and more national research is honing in on the benefits of including parenting training in addiction treatment. And the number of mothers needing such help is staggering. Children of Addicts Substance abuse among women is a serious problem for parenting and represents considerable human and financial burden to society. Estimates suggest that 50-80% of child welfare cases involve a parent who abuses alcohol or other drugs and mothers make up the majority of substance-abusing parents in the child welfare system, according to the Harm Reduction Journal. In the United States, up to 70% of women in substance abuse treatment have children. Rates of substance abuse in women have been increasing and substance abuse in women also is associated with a greater and unique set of risk factors and needs than men, greater prevalence of mental health problems, histories of physical or sexual abuse, serious medical problems, poor nutrition, relationship problems including domestic violence, and lack of social support. The unique risk factors and needs of women have resulted in the development of women-specific comprehensive treatment models. However, in addition to having gender-specific needs, women with substance abuse issues also have unique needs as mothers. Research has shown that women who abuse substances may have difficulties providing stable, nurturing environments for their children compounded by challenging life circumstances, including severe economic and social problems, such as lack of affordable housing and homelessness. Their children are at greater risk for impaired physical growth, development, and health, poor cognitive functioning and school performance, emotional and behavioral problems, psychiatric disorders, and substance use themselves. Despite their best intentions, women with substance abuse issues are at risk for a wide range of parenting deficits. Parenting among mothers with substance abuse issues is often impaired by mothers focus on satisfying their addiction over the welfare of themselves and their children. Also, women with substance abuse issues often have high levels of co-occurring psychological and personality problems which can impair their emotional ability to be a good parent. Parenting and Recovery As maternal substance abuse is a growing problem, there is an urgent need to identify effective interventions. Treatment for mothers with substance abuse issues and their children may represent an important opportunity for breaking the intergenerational cycle of addiction and dysfunction and improving parenting. However, women with substance abuse issues report difficulties using conventional systems of care (for reasons including fear of losing custody of children, guilt, stigma, and lack of transportation), and request comprehensive services provided in a caring, one-stop setting. Given the barriers, risks, and outcome implications, researchers, clinicians, and policy makers recommend that substance abuse treatment programs address women s needs as well as their children s needs through comprehensive, integrated services in centralized settings for both women and children. This recognition has resulted in the development of numerous integrated treatment programs (those that include parenting- or child-related services with addiction services), both residential and outpatient. Parenting is an important outcome of intervention because it impacts child outcomes. Studies of parenting interventions with other atrisk populations have shown that improving parenting can improve outcomes for children. If intervention for mothers with substance abuse issues is successful in improving parenting outcomes, it may reduce costs (in terms of foster care placement, emergency room visits, medical and psychiatric admissions, child treatment, crime, 20 etc.) and enhance healthcare and social service delivery. Overcoming Parenting Challenges Ms. Fritzhall, who teaches a nationally recognized parenting curriculum called S.T.E.P., as well as an international evidencebased program called Triple P, said there are additional challenges in trying to change parent-child relationships among addicted women. Before we can focus on different approaches to discipline and bonding and talk about child development, addicted women must deal with the guilt, shame and sadness they feel, that may even be affecting their ability to battle their addictions, she said. She provides the parenting education program once per week for 90 minutes as part of the variety of therapies women in residential treatment at Wayside House undergo. What they want, what we all want for them, is to put families back together. The parenting portion of treatment is crucial to that, Ms. Fritzhall added. As with all mothers, addicted mothers have parented the way they were parented, and, for many, that was not a positive experience. They have to learn new skills, new ways to bond with their children who have already been negatively affected by their mothers addiction. They have to learn child development so they understand that not all their children s behavior is tied to their addiction some is just related to a specific stage of a child s development. Lisa McWhorter, clinical director of Wayside House, said parenting education has been added because of the growing number of their residential clients who are mothers. We re asking them to face all their demons in order to end their addictions their relationships with their children are a huge part of that for many of them, she said. [Research for this article is from the Harm Reduction Journal] Marlene Passell is the marketing and communications director for Wayside House in Delray Beach, FL