Rule number one...Everyone lies.

One of the biggest mistakes that we all make is forgetting rule number one. Rule number two...no one tells the truth all the time. Period. There are no exceptions. NO matter how honest someone is. No matter how well you know them. NO one tells the truth all the time. Everyone lies.

Now think about an addict. Someone with guilt, someone with a vested interest in protecting their addiction. Someone who will endure the most significant consequences. Someone who has been willing to alienate their family and friends; lose their job; subject themselves to legal proceedings; imagine their motivation to lie.

As people who consider ourselves reasonable and honest the majority of time we must never truly trust anyone with an addiction. They are the ultimate manipulators. They pull us in and at times make us believe that they are the victims. That their issues are not their fault. That everything will be OK if we just give them the money they want, or a prescription that they need for pain medication (in their mind that pain is real!). Don't do it. Don't make that mistake.

Addicts must start at a place where we trust nothing and believe even less. We must make them earn every drop of respect. If we do this we will go a long way in helping their recovery.

For every action...

...there is NOT always an equal but opposite reaction. As family members and friends of addicts we very often let them off the hook when their addiction negatively impacts on us. Along the way we learn from various support groups and therapists that we must practice "tough love" and we are torn between making the addict responsible for their behavior and not waning to create more friction in an already tense relationship. So which is correct. How do we best impact positively on an addict's behavior/disease and still feel good about ourselves. The answer is that there is no right answer.

If we truly believe that addiction is a disease then we must be careful not to hold an addict too accountable for a disease that he/she may have no control over at a given point in time. Particularly early in the course of their disease before they have had adequate treatment and their dual diagnosis has not been addressed. We do not punish someone when they develop diabetes or high blood pressure. We must be careful to not do the same to an addict under similar circumstances. Addicts deserve every opportunity to participate in treatment programs that "get it". Programs that understand the science of addiction, understand dual diagnosis, and treat the addict and their disease "Holistically".

That being said there does come a day when we as family members and friend s must hold addicts accountable. They don't get a free pass forever and they must learn that there are consequences for their behavior. When they have been given the righ tools for recovery and yet they ignore those tools and continue to let their addiction ruin their lives and the lives of those around them, then it is time to play the "tough love" card. Addicts must earn the right to be loved. to be a member of the family with all its privileges.

As strongly as I feel that addiction is a true disease, I also feel that once given the right treatment there comes a time when every addict has the ability to make a conscious decision to either use or stay straight. If they choose to use then we must hold them liable for that bad choice.

The Holiday Season is perhaps the time of year when families suffer the most because of a loved one's addiction. Making the "right" choice for us is always a difficult one. Perhaps this will help. Where do you stand? share your thoughts.

A Time for Thanks

I cannot be overstated. The importance should not be minimized. A day of thanks is surely not enough. But nonetheless this is what we have and it should not pass without giving those we share our lives with at least a simple thanks. Starting with those closest to us we must be thankful for what they give to us everyday by enhancing the quality of our lives. Large or small, the group of special people that we hold closest to us are in reality the bulk of the world we live in. The world gets very small when we count those that we care the most about and vice versa and it is this small sphere which accounts for the most joy and occasionally the most pain in our lives. But joy or pain this is what we call living and with them we simply would be alive but not living.

Beyond those who are closest to us there are those that we touch on a day to day basis and those who touch us. We cannot forget them. The check out girl at Publix, the cashier at Starbucks, the waiter at our favorite restaurant. These are the people who accent our life and the people who make our day with just a little smile. Even, or sometimes especially, if they are a stranger.

Now the trick is to not just be thankful on one day of the year but to find a way to be thankful on a daily basis. It is the concept of not wasting a day. Don't waste it by letting it get away without doing something to appreciate the world we live in and the people who share it with us. Have dinner with your family. Talk to your kids about school. Laugh.

"Just say No!"

During the Reagan years the so called war on drugs gained a lot of press when Nancy Reagan came out with the strategy of “Just Say No.” The Reagan administration appointed a drug Czar that would strategize and implement programs to reduce the abuse of drugs in our country. But what we saw on the tv routinely was Nancy Reagan discussing this issue and summarizing the strategy with “Just Say No.” So when my child started a life with drugs was I being naïve by saying “Just Say No?” When I would discuss this very private issue about my child with close friends they would say tell your child to “Just Say No”. Twenty years later I look back retrospectively and say to myself you got to kidding! “Just Say No” to teenagers when discussing substance abuse is like trying to kill an elephant with a sling shot.

I am a firm believer in open discussions with your children about the issue of drug abuse. Education is important and knowledge is power. And in some way we might be prudent and parenting appropriately when discussing drug usage with our children, but this process has limited ability to stop teenagers and their friends from experimenting drugs. Taking prudent parenting to the next level of adolescent drug usage prevention the following areas I feel are a necessity. Knowing where your child is at all times and with whom is a given. Discussing in an open fashion substance abuse is also prudent. But key is to educate yourself as to the tell tale signs and behaviors of teenagers when you are suspicious that something might be happening with your child experimenting with drugs. Following thru on with your parental instincts.
And I feel the most important rule of parenting is we do not have to be our child’s best friend, but rather parents first. Making the tough decisions that we know in our hearts is what is in their best interest. Parents first, best friends second.

“Just Say No” might have been a catchy phrase and sounds good, but as a strategy to prevent substance abuse with our adolescents, give me a break. When suspicious behavior raises your concern about substance abuse, be aggressive and proactive in finding out what is going on with your child as well as implementing swift and serious treatment. This might not sound catchy, but I believe is a much more appropriate way of dealing with your child when they are at risk for serious issues and consequences as a result of substance abuse.

Just saying no!..To the WRONG drugs

It seems so much easier. I never have any trouble try to get patients take antibiotics or medicine for their blood pressure or diabetes. Patients almost never turn down pain meds--especially addicts. Clearly addicts have the hardest time saying no when it comes to drugs that in any way resemble those chemicals which live in the same neighborhood as their substance of choice. But tell an addict that you are going to give them a drug to treat their anxiety or depression or bipolar disorder (unless of course it is a Benzo) and you have a whole new fight on your hands.

It is not just addicts that have an aversion to psychiatric or psychotropic medications. Everyday, not some days, everyday; I have a conversation with someone who is reluctant to take a medication to treat their psychiatric symptoms. People believe that they can control their own thoughts. That they have control over their emotions. That unlike their pancreas or kidney or liver they actually have control over their brains. That is simply not true.

As a patient imagine how many times you have woken up and said that this will be a day when you will not feel depressed or you will not have a panic attack. And yet it happens anyway. The centers of your brain responsible for emotion (depression, anxiety, fear, happiness, etc)lie in your limbic system; miles from from your prefrontal cortex. It is the prefrontal cortex that you do have control over. It is there that you can scratch your head or memorize a poem. It is a whole different world in the limbic system however, and you have no more control over that region of your brain than any other organ in your body. Medications allow us to change the dynamics of the limbic system in a way that we can't otherwise do consciously. And they can do it quickly. When combined with psychotherapy they can do it more thoroughly than any other treatment modality.

Perhaps most importantly, when you say no to medicine you may be guaranteeing that you will stay on a path or psychiatric illness with no hope of recovery. Recent studies show that when untreated, illnesses such as depression can cause irreversible anatomical, hormonal, endocrinological, and physiological changes to the brain and the adrenal gland. These changes not only attenuate recovery but also promote increased incidence of heart disease, diabetes, and stroke.

Today the United States leads the world in very few areas. One area where we are miles ahead of the rest of the world is psycho-social illness. The numerous reasons for this will be a topic for another day. One thing is clear. If we want to change this dubious distinction then we must stop saying "no" to the right drugs! Take your medicine!

How can families find peace?

As a therapist one of the most difficult things is to see family members in pain. the most frustrating thing of all for the families is that they have absolutely no control over the situation. I will have families worried sick about the whereabouts of their loved ones and the addict is out using and not the least bit concerned that the family is worried about whether they are dead or alive.

The truth is when the addict is using they are extremely selfish and self-absorbed. Once they resurface the family is so relieved that they are alright that they will give into the requests and demands of the addict (i.e. money, a place to stay, etc.).

This cycle of ups and downs is debilitating to the family. I will often hear how families become alienated from friends and family die to the number of times they canceled plans or make excuses as to why they cannot commit to plans. Families will say, "How can I possibly go out and enjoy myself under these circumstances?" The truth is that the more you life is changed and affected the more control and power the addict has over your life.

It is extremely important to go to Naranon. Get support and meet other families that can relate to what you are going through. At the same time, it is important to try and keep your life as normal as possible. It is important not to become too enmeshed with your loved one. Although it is extremely difficult it is important not to have the attitude that if they are not happy you can't be happy. You are not the addict and you should not be making poor choices just because they are. The more the addict controls your life the more resentful you will become.

I will often tell families that yo can be there for your loved one when they are doing the right thing, however, when they are not they are not welcome. When I say not welcome I mean not welcome to create chaos; the disruption and the pain that goes with having the addict in your life.

Are you a family that is trying to cope with having an addict in your life? What have you done to maintain your happiness and sanity?

Behind every door...

...you never know what to expect. I am sitting in my office waiting for a new client to arrive. At this point I know very little about him. I know he is a youn male from Texas with an addiction to oxycodone and that is it. I don't know how he is currently feeling or what he is thinking. Is he in detox? Is he feeling pain? Is that pain emotional or physical? Probably both. Is he regretting his decision to come to rehab? Did he even make that decision or did someone make it for him? Is he motivated to move forward to recovery or is he just wasting our time and someone's money? Time will tell.

This business is not glamorous. You have to leave your intentions to get rich at the door when you sit on the treatment side of this business. The failures will break your heart. The stories-by the clients and the families-are gut wrenching. But when someone gets it; when the light comes on and recovery is the only option; there is little in life as rewarding. To have the opportunity to significantly impact on the outcome of someone's life is a gift. It is a special opportunity that words don't justify. By directly influencing and guiding one's path from addiction to recovery literally serves to save their life. Few jobs compare.

So who is this young man about to arrive? Will I be able to help him. Does he want to be helped. I don't know yet. But he will get every morsel of my attention. Every drop of my ability to work with him and help him help himself. Because you never know who will survive.

" I like my glass of wine"

I heard it today. I hear it almost every day. A female in her mid 30's to late 40's and even older who everyday enjoys her glass of wine. What's the harm. It is the end of a long day--car pooling, working out in the gym, lunch with the girls, a quick trip into Nordstrom's, more car pooling, ballet class, dinner, homework. Who among us wouldn't need a glass of wine after a day like that?

Is a glass of wine really so bad? The medical answer is no. It has been very well documented that there are several health benefits to judicious use of wine. The definition to judicious wine consumption is 4-8 ounces of wine per day; preferably red.

So in the above scenario it is not so much the wine as the reason for the wine. What is hidden underneath this story is a lack of coping skills and the use of the glsss of wine as a "tranquillizer".

This is the secret addiction. White collar/Yuppie addiction. Cleaner and more civilized than a ball of heroin or a crack pipe. Yet there are thousands of house wives across America who are addicted to their glass of wine. they think they are much different from those who fill the ranks of addiction programs across the country but n reality they are not. Many of them become closet alcoholics who smolder for many years until the liver disease sets in. In reality they are luckiest when they get their second DUI (the first one is discounted) because then someone will do something about it before the irreversible illness sets in.

How many people do you know who can't go one day without a glass of wine. Who insist that it is just casual use--we know the truth. They usually do to. they just don't want to admit it.

What does "God" have to do with it?

So what is the answer? What does "God" have to do with it? Is it his fault that you became an addict? I think not. Then is it His responsibility to participate in your recovery? I think not. God did not have anything to do with picking up your first drink or ball of heroin. He did not hand you your first oxycodone or light your crack pipe. He did not misaligned the planets to create the set of circumstances which were so grave that you had no choice but to relapse. He cannot in any way be held accountable for your addiction. And so because of this you cannot ask "God" to hold your recovery in His hands. Like it or not, that is all on you!

Steps 2 and 3 of the the 12 Step Program bring "God" into recovery. First, in step 2, by saying that it is a higher power that will in essence set you free and then, in step 3, by saying that it is "God" specifically who will guide you on your path to recovery.

I am a Catholic. Raised in a traditional Catholic Italian small town family. I attended Catholic school from kindergarten through graduate school. I am not an addict, but I have "lived' in that world for the past 8 years and I can tell you one thing. "God" has nothing to do with your recovery.

Addicts often say that their recovery is in "God's" hands. That in the midst of their recovery they are "blessed". We are all blessed and the course of our lives is in our own hands. The higher power that will drive you to recovery lives in the power of your mind and spirit which creates the determination and drive that you need to change the course of your life. That to me is known as spirituality. It is not the spirit "above " us but rather the "spirit" within us. Every addict is responsible for their addiction and therefore they are responsible for their recovery. It is equally their responsibility to utilize the tools around them--therapists, doctors, family, programs, sponsors, and themselves--to assist in that recovery. But don't put it on "God's" shoulders. That just gives you someone else to blame if you relapse. Take control of your own life. Be the source of your own power.

A Parent's Perspective

As prospective parents we look forward with great joy and anticipation as we start our journey to parenthood. Even before the actual arrival of our child we are already thinking how we can be the best parents possible, provide all the essentials needed for a loving caring nurturing environment. As parents we don’t mind sacrificing so that our children can have all they need plus. We are gratified to see our children grow and develop and achieve their highest potentials so that life for them will be better for them that it has been for us. I guess you could say parents our very co-dependent on their children. When they are happy we are happy and when they are sad we are sad. We feel their joy and feel their pain.


Then a day comes in your life when joys and dreams of good things for your child come to a screeching halt. The day we find out that our child is “doing drugs.” It may be pot, cocaine, heroin, prescription drugs or alcohol or combinations of drugs, but regardless fear, anxiety takes over our bodies and minds. We try to find out all the circumstances surrounding what we have just found out. The extent of the abuse, what drugs, with who and whom are they getting these drugs from. The next step is to determine what kind of help we can offer our child. And as I went through this process anger and resentment and frustration entered into my life. As time progresses and the child we brought into this world so that they could enjoy success and happiness falls into a hole of drug use, deception and a life that most could not relate to or understand. Of course we send them to treatment, the best money can buy. But relapse after relapse fear and dismay heightens because as parents we do no see the light at the end of the tunnel. Then as a father the worst emotion of all surfaces, helplessness. After all I am a father and is it not my responsibility to make all right in the world for my family? With helplessness comes the next and final emotion as a father, failure. The acknowledgement that I cannot fix this problem for my child. That in the final analyses only the individual affected by this insidious disease can start and continue their own recovery. This acknowledgment took me many years to come to terms with. After much soul searching I came to the conclusion that I am only a parent. I can do only the best I can do. I also spent much time looking to blame someone for my child’s despair.

The disease of addiction affects the entire family tree, parents grandparents, other relatives and friends. Finally I came to the realization that addiction is truly a family disease for many reasons. As time marches on for many so does the disease of addiction gaining momentum in the most negative ways. Spiraling behaviors as a result of drug addiction bring other issues into the equation. Legal issues, family trust issues, resentment and family members dealing with their own psychological and physical fatigue of trying to keep up with all the negative behaviors of the addicted love one as their addiction spirals deeper and deeper.

I remember reading a book on the issue of kids and drugs many years ago when I discovered my child was involved in drugs. The title of the book is “Not My Kid.” I would suggest it be recommended reading for any family that first finds out that their child is abusing drugs. As parents we almost always retain hope that such a precious life we brought into this world will finally break away from the grasp of such a terrible disease. That the frown on the face of our child will turn to a smile and that they will achieve all the good things in life we planned for them before they ever entered this world.

An Addict's Story--In his own words

I am 23 years old and today I am sober and clean. Thank God. Today I feel peace and serenity witch I found in a place called “Synergy”. Witch is a beautiful place where you get amazing treatment and freedom. We get acupuncture to help detoxification. Also a great staff witch has helped me tremendously. We go to the gym to get physically in better health, also we get massage therapy so we get mentally and physically stronger everyday. It is truly a blessing and a wonderful place to be. The small groups is what helped me the most. I am so blessed and gratefull today that I got to come to this beautiful facility. Before I came to Synergy I was a mess beyound help. I had wreacked a truck, lascerated my liver, and had two DUI’s and continued to drink. That’s how sick I am from this disese. A week before I came hear I was in the hospital. I was throwing up blood from drinking 1.75 litters of vodka a day. I saw death looking over me wanting to take me away from the world. Then I got to Synergy and I have seen the light. Have you or anyone you know ever experienced this?

Anonymous Alcoholic

When is enough, enough

When is it time to say "I've had enough"? When is is OK to say "I've had enough"? Time to jump ship; to get off the merry-go-round. To say that I can no longer invest the emotional energy to stay on the band wagon because the "price" is too high. And that doesn't count the money spent. Every one of us who is in any way connected to an addict has asked these questions. The questions are easy. We ask them repeatedly. Every time there is another drama, another relapse, another excuse about why a program is not working; about why a job can't be held; about every "why it is just not my fault"; we ask them over and over. we ask them quietly to ourselves, to our closest friends and family, to our therapists, to any one we hope will have an answer. The reality is, however, that no one has the right answer to these incredibly difficult questions.

Is it the guilt that keeps us invested in each addicts life regardless of how much drama it brings us? Is it hope that eventually the light will go "on" and recovery will finally settle in? What ever it is, one thing is clear--The only answer to these questions are the ones you can live with. At the end of the day the right answers resides in that sweet spot where peace of mind lives. We must be prepared to live with the possibility that at the time we turn our back we will not be given the opportunity to have a "do over". The most serious and permanent end game may prevent us from reaching out to our loved one again.

Today in our program one parent decided that it was time to get out of the game. He had spent all he had. Emotionally and financially he told his sound that he had spent all he had and he was done. "Tell him I have nothing more to give". His son is forty and an alcoholic for as long as he can remember. He lost his job, his marriage, and his kids. He cannot talk to his kids for 1 year and his letters must be read before they are shared with his children. Clearly a bad situation. One that I just stepped into as his physician 4 weeks ago. Call me stupid but I really think that this time he really has a chance of making it and I only pray that the father didn't "jump" too soon. Time will tell.

“Can We Protect Our Borders From Illegal Drugs?’

What would the drug landscape of the United States be if illegal drugs where no longer available? Would all those addicted to these drugs be instantly cured with their addictions? I am referring to the following drugs cocaine, crack and pot specifically. Abuse of prescription drugs will not fall within the realm of this particular discussion. Can I make the assumption that because the lack of availability of these illegally smuggled drugs that those addicted would have no choice but to become clean and sober? What choice would these people have? They cannot abuse what is no longer available!

Now that I have put forth the basic premise concerning the potential of recovery because of no supply of product, can I put forth a valid argument for the ability of our country to effectively stop the smuggling of these drugs?
Does the United States have the capacity in terms of technology, manpower and the real willingness to once and for all eliminate this devastating issue?
Let’s first discuss manpower. The United States has put forth minimal manpower numbers in relation to the gravity of this issue. How many DEA agents do we now have as compared to years past and how many do we really need to appropriately deal with this issue. I know that within the past several years we have increased the number of these agents, but one could certainly argue we are still tremendously undermanned in this area. The government has increased numbers of border custom agents recently, but this is due in part to deal with the illegal immigration issue. The United States has a wonderful resource of the National Guard that could be utilized for border patrol and security that could go a long way in eliminating both of the above issues. But these resources are strained by fighting wars on two fronts in the Mid East. But if these troops were to return home I think we could easily redeploy appropriate numbers to have a dramatic impact on reducing the amounts of illegal drugs coming into our country. We must also develop a reasonable approach to the legal implications of supporting any of our personnel that protect and patrol our borders. Case in point the two custom agents that are now serving long prison terms for protecting us from drug traffickers. This issue was reviewed by higher courts and their guilty status and punishments have not been adjusted. In my humble opinion this is a gross injustice to those that are protecting and serving us.

Now lets discuss if this country has the technological ability to protect our land, air and sea borders effectively. I can summarize my view with the following point. Did we not put two men on the surface of the moon a number of years? Give me a break! If we really got serious about this with all the technology we have, we could develop and implement the needed technology within a short period of time. Many other countries with far less resources than the United States do a much better job than us.

This now leads me to my final question. Do we really have the will and stomach to do what we really need to do to finally abate this serious problem in our country? On first blush I must sadly say that it does appear that we have really placed a high enough priority on this issue nor have placed a high enough allocation of resources to effectively deal with the illegal importation of illicit drugs in this country.

What do you think we can do to stop the influx of these drugs into our country?

An Addict's Story

Before I ever tasted a drop of alcohol or inhaled a hit from a joint, I was an addict. I was addicted to chaos. From early childhood to present day, I've been addicted to chaos. I thrived on chaos; it was the only thing I knew. Chaos was normal. Chaos was my life. My life has been unpredictable, unstable, chock full of turmoil and unparalleled terror.

My mom's descent into alcoholism began for her at age 25. By the time I was born it was in full force. My earliest memories are of yelling, screaming, breaking glass, and sobbing. Mom would be kicked out or Dad would leave, or I would be sent off somewhere, confused and scared of my family.

At age 5, my uncle moved in with us to help out because my Mom was emotionally unavailable. My uncle began molesting me at that time and by age 7 I'd already been raped twice. this continued for years and I still suffer from silent screams that rage in my little soul.

I never knew safety. I desperately wanted to know safety. I never knew consistency. I desperately wanted to know that . too. But how would I find those? Thus, alcohol entered the picture.

I was 18 when I began drinking and it became the love of my life. Before alcohol I was terrified of the unknown; built into a nervous frenzy shell of a person. I loathed myself and I loathed my life. but with alcohol I felt nothing. With alcohol I felt good. With alcohol I could breathe. I was comfortable in my own skin and I felt like I found my miracle.

My descent into alcoholism was quick. Within months I got laid off from my job, was in a few car accidents; was transported to the ER for alcohol poisoning; detoxed numerous times; got arrested for DUI; etc. I drank alcohol around the clock almost every single day. It was at that time that I was first referred to rehab which I heavily protested. After I left i went to two other rehabs; neither of which kept me sober.

Weeks before I came to Synergy I was held at gun point in a stranger's apartment. I was raped and beaten for 5 hours. I thought I was going to die that night. It was terrifying, but relieving. I didn't know how I felt- I was scared to die, but I welcomed it.

I hit rock bottom after that. I swallowed a full bottle of Trazadone (65 pills) and 2 pints of vodka. I woke up days later in the ICU. I had been intubated and in a semi-coma. My heart rate was 38. I was closer to death than I's ever been.

Coming to Synergy has truly saved my life. Cliche as that sounds, it is the truth. The people who work here CARE. they don't pretend to know everything but they know how to treat and heal people. I feel at home when I'm at Synergy. They are a very caring and loving group. I have never in my life met people like them who are willing to go to any lengths to help someone.

I've never been so grateful in my life. Do you need to find a home? A treatment center to fell warm and welcomed?

“Should We Legalize Drugs?”

In the early 1900’s the government banned alcohol and prohibition ushered in the roaring twenties. Did prohibition really work or did it exacerbate the
whole social issue of alcohol consumption? Did prohibition eliminate the ills of alcoholism or did it add to the criminal behavior to illegally distribute and sell alcohol? In retrospect prohibition did nothing to eliminate the total consumption of alcohol. What prohibition did do was create an industry of criminal behavior in the forms of bootlegging and speakeasies and a gangster community that brought in the roaring twenties with a hug roar of illegal activities.

As we progressed into the realization that prohibition didn’t work and alcohol again was made legal the criminal activities associated with prohibition soon dissipated. Can we make the same argument for legalizing drugs in the twenty first century? If we where to legalize drugs would we eliminate all the illegal activities associated with drug usage? Looking at the distribution of drugs from the top down. From the drug cartels to street dealers to end users involving themselves in all types of criminal behaviors to support their drug habits. Can we put forth the hypothesis that with the legalization of drugs we would eliminate the drug cartels, the street dealers and for those needing to feed their addictions the criminal behaviors they enter to support their drug usage?

Would there be a huge cost savings to society because we could reduce huge amounts amount of money by reducing a huge strain on our judicial system that would not need to deal with all the criminal issues associated with illegal drug usage. Could we also achieve significant cost reductions in our law enforcement agencies throughout the country by legalizing drugs? We could also potentially achieve huge cost savings in our medical community by legalizing drugs. What is the annual cost of treating drug addictions? Literally billions of dollars annually is needed to treat this insidious disease. Monies coming not only from the private sector in terms of health care insurers and families paying out of pocket for treatment, but also federal, state and local budgets earmarked for the treatment of addictions.

I think society in general would be much better served by legalizing drugs because we could reduce the criminality at all levels by doing so. No more need for drug cartels, street dealers and the total elimination of criminal behavior for those addicted needing to generate money to support their drug addictions. One of the most compelling issues that has brought me to the conclusion for advocating for the legalization of drugs is due to the fact we have been unable in any significant measure to really deal with the illegal drug issue. So in summary my opinion is as follows. We can achieve more good for individuals and society by legalizing drugs as compared to staying the course we have been the last twenty-five years without making any real progress in terms of reducing availability of illegal drugs and thereby reducing the incidence of substance abuse in our country.

Who among you agree with me or disagree with me and for what reasons?

Trauma creates Drama, Drama inhibits Recovery

Trauma creates drama. It is unavoidable. In so many addicts when we peel back all the layers and finally get to the answer to the question "why" it is often related to trauma. The answer to the question "why" must always be found in order for recovery to occur but the answer is often a difficult one because that answer can cause so much pain. The trauma comes is all forms. Everything form family dynamics to sexual abuse to legal problems to psychiatric disorders. And so it is almost inevitable that unveiling that trauma will bring with it lots of drama.

Treatment success comes with keeping that drama to a minimum and not letting it interfere with the work that must really be done. In my time as a treating physician to those with a diagnosis of addiction I can absolutely tell you that the clients with the least amount of drama have the highest success rates. Two patients with the same circumstances surrounding their trauma may have completely levels of drama in their lives. I wish I could tell you what predisposes one patient to higher levels of drama than another but I cannot. It is occasionally a personality disorder. It is occasionally a psychiatric disorder. It is occasionally those "helicopter" parents--the ones who hover and coddle too much.

Today in the treatment center was a perfect example of how drama gets in the way of recovery. A patient who was doing so well for her first couple of weeks in the program let her drama disrupt not only her own program but the program of all those around her. The power of the mind is incredible and psychosomatic symptoms are over powering but it is really all just drama. Drama is more prevalent in the pessimistic personality--but how do you make a person optimistic?

I continue to look for the answers to the questions regarding the cure for drama. In the meantime keep the drama to a minimum and you will speed your recovery process.

Skip the Trip to Detox.

20 years ago hospitals were filled with patients. Patients would go to their Doctor and say they just needed to go into the hospital for a couple days of rest. Doctors would tell patients that they would be admitted to the hospital for a couple of days to "run some tests" Today hospitals are mostly empty. Illnesses that were once thought to be so serious that constant observation was surely needed in the hospital are now treated completely as outpatients.

Fast forward to the standard of care for detox in 2008 and you will find that there is no need for anyone to be admitted to a detox center. Thanks to a better understanding of the detox process and the medications needed to keep a patient comfortable and detox can be done either at home or right in a rehab treatment center skipping the need for inpatient detox. Perhaps the greatest vehicle used to facilitate outpatient detox is Suboxone. Often referred to as expensive Methadone, Suboxone is in a class by itself. Head and shoulders above Methadone. Suboxone allows you to take control of your addiction as early as day 1 and clearly by day 3 at the latest. Recent data confirms that long term Suboxone use is far superior to short term use with regards to overall treatment success (maintenance of sobriety). Inpatient detox centers who insists on coming off your Suboxone in 5 days could not be making a bigger mistake and are proving that they are in fact inferior to outpatient detox programs.

So do yourself a favor and skip a trip to detox--shop for a Suboxone doc instead.

Mr. President, we need Insurance reform!

When did we as patients and practitioners lose control of our health benefits? When did the balance of power shift from the consumer to the insurance companies. For many years patients complained that payer systems in which patients paid based on "fee for service" were unfair and excluded too many patients. Is our current system any better? A system in which insurance companies are in complete control and patients as well as practitioners are on the outside looking in. At least in the old "fee for service" system, in which patients and physicians were n control, money was spent to deliver quality health care. In the current system many of pay way too much money to insurance companies who then try their very hardest to not spend any of that money on our health care. Our system is currently one which excludes the best interest of the patient and eliminates any incentive for the practitioner to provide quality health care. the best interest of the patient is determined by a third party payer. the fundamental problem lies in the fact that the same third party payer making the health care decisions is at the same time try to protect their bottom line. It is counter intuitive to assume that a company can provide good health care at the same time that they are trying to make a profit. In order to provide good health care they must spend money--something that they are quite frankly not willing to do.

This weekend I experienced two separate incidents in which patients assumed they had health benefits for addiction therapy only to find out that they were being left out in the cold. Insurance companies do not want to pay for addiction therapy. It is often expense (although less so than diseases like rheumatoid arthritis, heart disease and any cancer you can think of) and the patient who need it are often the ones that no one wants to talk about ( unless of course you are a celeb). Even when you have insurance it takes an act of congress to find out exactly what those benefits are and when they will be paid out.

So now we need an act of congress to open up the health insurance industry to independent evaluation and review. It is time for government regulation to step into this industry. the solution to our health care crisis is not to force employers to pay for health care they can not afford. The answer is to make health care affordable by regulating. health insurance company. No family should go uninsured at the same time that insurance companies are making record earnings.

That's my plan Mr. President, what's yours?

Powerless vs. Powerful

Which is better? Powerless to your addiction or full of power to move forward and through it to a world of recovery? Out of control and letting your addiction take your wherever it wants to or in control of your life and choosing a path that takes you toward a world of independence? Independence from your addiction. Independent enough to say that " I want my life back". To say "I have left that person controlled by drugs behind and now I will enter the world the way people free from addiction know it".

Traditional 12 step programs ask us from the very beginning to admit that we have no power. That we are out of control. that the disease is a stringer entity than we are. Is that true. Is a person who decides to take his or her life back from an addiction really weak. Or do they possess the strongest of all powers.

At some point in the recovery process a conscious decision must be made that an addict will take his life back. That you will leave your addiction behind and never revisit those demons again. a decision must be made that life will be lived in the mainstream. A job will be held. A rent will be paid. A bank account will be opened and a family will be spared. Spared the emotional and financial turmoil which has been brought into their lives without invitation by the decisions of an addict.

When your ready to get clean it will be time to take your life back. Take control. Embrace the power of recovery and walk through the door that allows you to enter the real world.

“ Lock Em Up and Throw Away The Keys”

Today in the United States 85% of all people in jail are there for drug related crimes. There are different levels of drug crimes that have resulted in incarceration, ranging from possession charges to charges relating to criminal activities to generate money to buy drugs and then the upper tier behavior of distribution(drug dealers). Is society best served by grouping all these levels of violations of the law the same, in terms of locking em up and throwing away the keys? Or is society better served by providing appropriate treatment and rehabilitative programs for those suffering with disease of addiction? Let me be clear in stating I am not offering excuses for the actions of these people, but rather an explanation of some causative facts that are contributory to their behavior. Also this is in no way a deviation of my support for the rule of law. What I am attempting to do is make a personal differentiation between those suffering from the disease of addiction and enter in a life of inappropriate behavior to support their addictions as compared to those that prey on these people by dealing drugs and therefore benefiting dramatically by making large sums of money. I am certainly in agreement with the rule of law that the dealers of drugs be dealt with a much harsher hand of the law. Actually, my observations in the legal system is that this premise certainly legally holds true. Dealers of drugs certainly do receive harsher sentencing guidelines and therefore longer and harsher sentencing. Also let me qualify that I am not discussing those that have committed violent crimes such as assault with deadly weapons or have committed crimes that extend well beyond low level felonies or misdermeaners. I am discussing those thousands of inmates doing real jail time for multiple possession charges, petty thefts etc that have resulted in some serious jail time. Are we placing society more in jeopardy by imprisoning these people where their new mentors are long term hardened criminals that now can teach them all the new tricks of criminal life? Is this new mentoring system costing society more dollars in the long run by creating a new wave of hardened criminals that over time can cause an already overcrowded prison population to be even more overcrowded? What is the price in real dollars that society will pay for long term incarceration of these people? Would we all be better served by providing those with drug and alcohol addictions a venue for serious recovery and rehabilitation so that moving forward they can become productive citizens in our society and not a judicial and financial burden to society?

What are we really accomplishing by locking up people with a disease as significant as substance abuse. We must ask ourselves, besides short term protection of the citizens of our communities are we moving forward in attempting to deal with this disease and it’s consequential affects in a prudent and cost effective manner.

Does Recovery Mean "Drug Free"?

The short answer is a resounding "NO!"

But it is not that simple. If we are talking about illicit drugs then the answer for the most part is "yes". However even that is not an absolute. Old school recovery programs are firmly based in abstinence and clearly the literature continues to support the notion that once an addict is an addict then it is not the drug they are using that is so important but rather the disease of addiction that matters. To that end it is very easy for any addict to "switch" his or her addiction from one drug to another. The reality however is that even the process of recovery can be substituted as their new addiction. Care must be taken during the recovery process to not let this happen because extreme behavior of any kind is potentially destructive. There are those like myself who find fault with the "12 step" program because it often creates a process in which the program itself becomes the new addiction. In my opinion "Holistic" programs are more well rounded and are less likely to promote a "new" addiction to the program itself.

I firmly believe that as long as no significant psychiatric disorder exists (eg. bipolar disorder, schizo-affective disorders, personality disorders) it is very possible to recover from your addiction and still go on to experience healthy use of alcohol and nicotine. Addicts often discount nicotine as a drug and feel comfortable about their smoking. Do not be fooled. Nicotine is an abuseable drug. If there is room for the reasonable use of nicotine then there is room for the reasonable use of other substances as well.

In the presence or absence of psychiatric disorders there is always room for Suboxone therapy. In the recent past Detox centers have been very quick to pull the plug on Suboxone therapy in 3-10 days when a client is coming off opiates or heroin. Current literature does not support the quick removal of Suboxone therapy As recently as this week in the Journal of the American Medical Association data was published that supports long term Suboxone therapy over short term use. Adolescents who were maintained on maintained on Suboxone for an extended period of time had significantly higher treatment success than those who were. taken off Suboxone promptly.

Lastly, for those who have a significant Psychiatric diagnosis drug therapy, in my opinion, is not option but is instead mandatory. Recovery simply cannot be achieved without the appropriate and judicious use of prescription medications. Even prescription medicines like clonazepam and xanax have their place is a well designed and supervised treatment program. Given the co-morbidity that exists between substance abuse and psychiatric illnesses if those illnesses are not addressed then we are setting our clients up for failure rather than giving them the tools they need to achieve recovery. The only way to get the psychiatric clients on the same playing field as the non-psychiatric clients is to medicate those patient who require it. It is only then that the recovery process can begin.

So does recovery mean "drug free"? Almost never!

The Common Link of Addiction

The one thing that is heard over and over from people with an addiction is that beginning at a young age they never felt like they fit in. They describe it as "not feeling comfortable in one's own skin"

As a result of feeling like an outsider these individuals suffer from very low self-esteem. They begin to use alcohol and drugs as a way to cope with the fact that they do not feel good about themselves.

Many people admit to using drugs and alcohol at a young age to help them feel more comfortable in social situations. Many report that using drugs and alcohol in social situations can make them feel more confident. Some find themselves to be more outgoing and report that using substances allows them to be more assertive when it comes to approaching members of the opposite sex.

Increasing one's self-esteem is a key component in the recovery process. Individuals need to get to a place where they become comfortable with who they really are without the use of substances. Most addicts have many things during the course of their addiction that they are ashamed of. This shame and guilt does not help the negative self-image that they already have about themselves.

Can you relate to "not feeling comfortable in your own skin"? do you use drugs or alcohol to feel more comfortable in social situations? If so, tell use about it.

“To hit bottom or not that is the question”

As a family member of a loved one that has struggled with the disease of addiction I have spent twenty plus years researching treatment and program philosophies dealing with this issue of whether allowing your loved one to hit bottom or not. Many people in recovery relate their own experiences and what defining moment changed their lives to recovery. For many of these people the defining moment was hitting rock bottom. The realization that they have lost everything near and dear to them. They had no place to go and they had run out of options and therefore were accepting of a process that would lead them into a life of change and sobriety. In my opinion allowing someone to hit rock bottom is not without some serious potential incremental consequences. Leaving someone out on the street does expose them to serious consequences in the form of personal health issues, bodily injury from a criminal element as well as dealing with legal issues as a result of their own criminal behavior.

Is it better to rescue or “Let go, let God”? I could certainly make an argument that not allowing someone to hit rock bottom does make recovery and dealing with recovery issues much easier and simpler. Dealing with legal issues, health issues etc. can add to complexity of recovery. But as I previously stated many people believe that the concept of hitting bottom is necessary for many before recovery can start.

I have personally attended many Naranon meetings in which this very subject has been the focus of discussion. I can tell you personally there is no mandate for one course of action vs. the other. I will tell you the way any particular family may determine their actions in dealing with this situation often comes down to how they personally feel about leaving a loved one on the street or not is based on their philosophy of tough love or not. Will they have feelings of guilt if something untoward would happen to their loved one?
I have been in many Naranon meetings in which many members subscribed to the philosophy of getting their loved one off the street and getting them out of harms way and hope that they will be willing to go into treatment and start embracing a life of sobriety.

So in my humble opinion I’m not sure there really is a right or wrong answer to this question, but ultimately comes down to what the family is comfortable doing. What is your feeling on this subject? “Let go, let God” or rescue and hope your loved one is ready for recovery?

What defines a good treatment program?

Is it location? Is it the size of the program? Is it the experience of the therapists and administrators. Is it the ability to deal with the disease of addiction. Does the type of drug matter--oxy, heroin, hydrocodone, alcohol, etc.... Is group vs. individual therapy; or a combination of both? Is about Holistic vs. Traditional? Does Dual diagnosis matter?

The reality it is all the above. Plus one very important ingredient. You must be committed to your choice and comfortable with the notion that you will do whatever it takes to move past the disease of addiction and to the road where a new life begins. One without drugs. One where the person you will become will be unrecognizable from the person you are leaving behind.

What makes a good program is this. It starts with a program where the administrators care right from the first phone call. It begins and end with with individual attention on day one. Secondly size matters. Smaller more intimate programs are more likely to give you individual attention and design a program that most closely fits your needs. To that end, while group therapy is important, All groups pale in comparison to individual therapy. Small programs are more like to give you the individual attention you need to achieve the results you are looking for. In the midst of that individual therapy Dual Diagnosis is critical. Eighty percent of all bipolar patient have in some time abused something. Seventy percent of all chronic substance users are bipolar. One thing is clear. If the proper dual diagnosis is not made--you will not get better. Therefore any program you attend must have a physician available at all times to make the right diagnosis and help you with your recovery. As for Holistic vs. traditional; I believe in Holistic. You must not forget about your body and your soul as you heal you mind. Programs that address you in your entirety are more likely to be successful than those who do not.

So how do you define a good program? How does your family define it? Their needs must be addressed as well so you can all heal together