Out with the Old....

The end of a year is always a time for reflection. a time to look back on the events of the previous year. Every where we look someone is making a list. Top moments, top songs, best movies, top news stories and of course the polar opposites of those top stories with the worst of all those areas as well.

From a personal standpoint the year end is a perfect time to reflect on the happenings of the previous 12 months. Some of those happenings we can be proud of and for those who are honest enough to admit it, many we would rather forget.

Don't forget them. Own them. Embrace them. Recognize them. Process them. And then put them behind you never to heard from again. Don't beat yourself up over them.

Accept full responsibility for them and learn from them but recognize that we often grow more from our mistakes than we do from our victories. If you allow those moments of defeat to dwell in our minds then we are destined to repeat them. Anyone who says that that have nothing to be ashamed for in the course of the previous year are simply being dishonest with themselves.

The Cost of Meds vs. The Cost of Rehab

Recovery does not come cheap. Financially, emotionally, and even physically there is a huge cost that must be paid in order to complete the transition from addiction to recovery. The financial burden is often one that is very difficult for the family and client to bare. Rehab is expense. Even an average program can cost up to a thousand dollars a day. Unfortunately cost does not in any way equate to quality. You don't always get what you pay for and I will save the discussion of how to pick the right program for another day. for now let it suffice to say that to pay for one treatment program is hard enough; to pay for more than one is almost impossible.

That being said it is imperative that any addict do whatever they can to prevent relapse. In many instances that means taking your meds!! Yet too often I hear that meds are expensive and patients can't afford to take them. the reality is that patient can't afford not to take them. In most instances between the cost of generic medications and generous patient assistance programs, drugs have never been more affordable. Every pharmaceutical company has very liberal patient assistance programs that provide free medication. But even with all that a monthly supply of medications can cost $200-$300. That is a lot of money. yet it is still cheaper than rehab. If you don't take your meds you are destined to relapse. It is not a possibility. It is a reality.

Rehab is expensive. Relapse is more expensive. Take your meds.

Whose Program is it Anyway?

WE see it all the time. Very often the addict shows up for his or hers 28 day treatment program not sure if they are ready for treatment. Not sure if they are committed to the process of moving toward recovery. the client is quiet and often withdrawn. Getting them to open up is often a challenge. Many still have the affects of the drug of choice still in their system and affecting their behavior. Sooner or later every addict who successfully completes a treatment program does open up however, and recovery becomes a real possibility.

The family however, is ready to go. They are ready to talk. They are anxious to tell their story; to vent to whoever will listen. They don't need any prodding or encouragement. Their therapy often begins with the first informational phone call.

Family members are desperate for therapy. Many of them may not even know it. They are just desperate to tell their story to someone. This cathartic behavior is often the most therapeutic process they have participated in for the past several years. for some that is all they need. They need to know that they are not alone. That there are other families out there who been in the same shoes and now it is time for some validation for what they are feeling and dealing with.

For many families it is far more than that they need. Remember that the genes don't fall far from the tree. Simply stated, many bipolar addicts are not the index case of bipolar disorder or some other psychiatric illness in the family. Many family members NEED therapy in order for their addict family member to get better. Family pathology and family dynamics must be addressed and every decent treatment program must have a family therapy as part of it's core curriculum.

So as a family member don't be afraid to jump into the treatment process with both feet. Family therapy is an important facet to an addicts recovery--and to your own.

To Hit Bottom or Not

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?

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.

“What Is The Difference between Enabling and Helping?’

First let me qualify myself as a gold medallist as an enabler. My personal life experiences in this area at least qualifies me to attempt to make the differentiation between these two behaviors. On first blush when discussing enabling as it relates to a behavior between two people. One currently under the influence of an addiction and the other a family member, friend and how they interact with support or lack of support of this person.

From my perspective enabling was an action in which I was the constant rescuer. Continuously taking care of issues and problems that my family member should have been taking care of themselves. Not allowing an individual to deal with the consequences of their actions is also enabling. Giving money to an individual that is capable of working and is not, is the purest form of enabling. Constantly making excuses for our family member’s inability to perform normally in our society is also enabling. I could go on and on with many examples of enabling, but I think you get the idea.

So what is appropriate help for an individual dealing with addiction. A rule of thumb our family finally adopted is, when our loved one was truly dedicated and serious about their addiction we would help with family support in the following ways. First and most important we told our family member that when they are doing the right things ie. treatment, working addressing their issues and accepting responsibility for their behaviors we would be there and form a reasonable support system to enhance the recovery process. When your loved one is actively involved with their addiction this can create a high degree of family stress and dysfunctional interaction affecting all family members. When this occurs I felt it was necessary for our family to develop the philosophy of “Let Go, Let God.”

Often times the difference between enabling and helping is difficult to distinguish. Using common sense and learning to say no, I feel can help one make the right decisions in terms of helping and not enabling. Remember, enabling is harmful and counterproductive. Whereas, helping can lead to positive situations.

Remember, enabling will never help the addict, but helping in the right way will.

Have you been a gold medalist enabler with your loved one? And if not how did you avoid this difficult behavior? Don’t forget the natural reaction for us is the help our loved ones, not abandon them.

Is One Lost Holiday really too Much to Pay?

What were you doing on Christmas Day in 1998? What was your favorite gift that day? Where did you spend Thanksgiving in 2001? In most instances an immediate response or a flashback memory does not come quickly to our minds. The warmth and joy that the holiday season brings us is not usually the result of one particular holiday. It is often not just Christmas day or Thanksgiving day by themselves that accounts for the emotion that surrounds the holidays but it is instead the totality of the season. Several weeks strung together when people may be a little bit happier, a little bit more friendly, and take a little bit more time to let the people around us know how we feel.The warmth we garner from the holiday season comes not from one particular holiday but rather from an amalgamation of many memories over several years grouped together to create nostalgia.

So what does it mean if you are missing this particular holiday season because you are in rehab? Is it ample cause to jeopardize your recovery by dropping out of your treatment program so you can be "home" for the holidays?

Addicts for the most part are very adept at putting road blocks up on their path to recovery. They can come with all sorts of reasons why this particular attempt at recovery is going to fail. Missing a holiday should never be one of them. If by missing one holiday this year you have a better chance of being sober for all future holidays then clearly the price is not too great. Family holiday celebrations can sometimes be trying even under the best of circumstances. Now add the drama created by both an addict and his/her family when there is a disparate need to enter a treatment program. The emotion in the room can shift 180 degrees when the addict skips the holiday for treatment rather showing up for dinner "using". Is the difference between hope and hopelessness.

Also keep in mind that for most addicts they have already "missed" many holidays even when they are home. As a result of using or drinking too much they have done everything but create an album of fond holiday memories for themselves or their family.

So here is your chance to start over. To get ready to start a new mental and emotional scrapbook of holidays to come by getting sober now. If the price for that to happen is one missed holiday then there couldn't be a better bargain around.

Cravings or Consequences : Who has more pull?

Unfortunately it is cravings. Hands down.

Over the weekend we admitted a new patient to our program who will not be spending Christmas with his 3 children for the first time ever. This is not his first treatment program. Hopefully it will be his last. His family has asked him to stop drinking on many occasions over the past 2 years. His job is suffering. His marriage is falling apart. Does he care? Of course he cares. The tears he had in his eyes as his family drove away were very real. the consequences to his actions are not sneaking up on him. They have all been laid out by his family. They are crystal clear. So why is he still drinking?

There is nothing unique about this story. His is not an exception to the rule. this is the norm. Every addict and alcoholic has a very similar one. So how do we shift the paradigm? How do we change the dynamic?

I don't know. Any suggestions?

Don't Pull the Trigger!

On several occasions in this blog I have made reference to the fact that in order to achieve long lasting and durable recovery an addict must answer the question "why do I use?". In most cases that answer is not so simple as to be only one item. the question is usually answered by several different contributors including psycho-social dual diagnosis and situations of time, place and content (or stressors) It is the time and place elements that I want to discuss today.

Ever hear the saying that "nothing good happens after midnight. How often do we hear that people we know or professional athletes get into trouble at 3 AM? NY Giants wide receiver Plaxico Burress did not suffer his self inflicted gun shot wound in a NY nightclub at 9 PM. Not only was his timing off but his choice of locations on the night before a game can be seriously questioned. Putting yourself in the wrong place at the wrong time has potentially devastating consequences.

Timing and place are even more important to an addict. Understanding that in the midst of a vulnerable period like the early stages of recovery an addict must avoid situations of time and place that jeopardize that recovery. Clearly in most in instances addicts have impaired decision making skills and that is why it is even more important to avoid obvious triggers to relapse.

When talking to a heroin addict yesterday about her plans after the completion of her treatment program she said, "One thing I know for sure; I am not going home". She has finally learned after many failed attempts at recovery that her home environment is one of her biggest triggers and she will not put herself in that situation again. Contrary to that one alcoholic who left treatment doing beautifully just 2 weeks ago relapse while in Vegas. Why was an alcoholic in Vegas with just 6 weeks of clean time.

Understand your weaknesses. Think before you act. Don't pull the trigger!

“Is Addiction a Family Disease?”

For those families that have not been affected by the disease of addiction the understanding of how this disease affects the total family would be difficult to comprehend. But, for those families that have been affected by this disease it becomes quickly apparent how this disease becomes a family disease. Addiction can be viewed as a family disease in two very distinct perspectives. First the question that begs to be asked is addiction a disease that has genetic links? When researching many clients it is very common to note that addiction in one form or another can be traced to other family members. Grandparents, parents, siblings etc. when doing a family history it becomes apparent that addiction has been in place in the family tree.

Often times when evaluating a person being treated for addiction issues, the review of the family dynamics brings one down two distinctive roads. One that often times finds the family member is a result of their environment. The family environment can be one of a highly dysfunctional family with a history of addiction within the family unit. So it is not unusual to see a family member with addiction issues usually coupled with other behavioral pathologies resulting in a dual diagnosis. So under this scenario one can easily state that addiction is a family disease.

The second road to be traveled to determine if addiction is a family disease can be presented as follows. The family member comes from a loving and caring family. One in which the family performs in a reasonably functional manner and yet a family member is now in the arms of addiction. The manner in which this disease affects all family members, one could certainly argue makes this a family disease. The interactions of the addicted member and their affect on the rest of the family would also certainly classify this as a family disease. The despair, concern, fear, helplessness and financial burden(for treatment & legal issues) and often times shame makes this truly a family disease. Many times those affected by addiction do not realize how their behaviors negatively impact the rest of the family unit. The strain on the rest of the family in dealing with all the issues surrounding the loved one with an active addiction can make the most functional families dysfunctional in a relatively short time.

So, I think we can say with a high degree of certainty that addiction truly is a family disease.

"I just like to get high"

I recently had a conversation with a family member of an addict and he related this story. His family member had been an addict for several years and over the course of that time had been in an out of several treatment programs at a cost of many thousands of dollars. Each treatment failure was an emotional and financial setback for the family but the addict seemed never to share their pain. Finally after another relapse the family member sat the addict down and asked him, "why after all these years are you still doing drugs despite all that we have done to try to help you?" The addict simply answered, "Because I just like to get high". the family member looked at him, shook his head and said, "If you just told me that to begin with I would have saved a lot of money!"

I like to exercise. I run, I bike, I play tennis and golf , and I do yoga. i like to read. I even like work.

An addict likes to get high. An alcoholic likes to drink.

Clearly there is a significant difference between my likes and theirs.

To say that you get are an addict simply because you like to get high is as simplistically immature and moronic as you can get. Every addict and alcoholic has a "real" answer to the question "why?". A legitimate answer to that question is ,or at least should be, the answer that every well designed, well run treatment program strives for. Until an addict is willing to look for that answer then every family that is willing to bear the cost of treatment is really just wasting their money like the family above. One of the unifying aspects of many addicts is that they lack insight. They also often lack maturity and an understanding of the consequences of their actions. Under those circumstances situations like the one described above are common place and a huge source frustration for the family. Consider this before you send a loved one to treatment and send them to a program that can help them find the answer to the question "why?" when they are ready.

Why are Substance Abuse Treatment programs 28 days.

I often have families ask me, “How long is my loved one going to need to be in treatment”? Families always want to know how long it will take their loved one to “get better”. The interesting thing is that despite the fact that most programs are 28 days, all the research shows that the ideal length of time is six to nine months. The idea is that during this time the client would transition into a less restrictive level of care as time progresses. So if that is what the research tells us than why are programs 28 days?

The answer is that the length of treatment was influenced by what the insurance companies were willing to pay or should I say not willing to pay. The average client that does have insurance coverage has approximately 28 days for the entire calendar year (if they are lucky). Many of them have only one inpatient stay a lifetime. This becomes very difficult considering the average rehab client has been in rehab more than once and often times it takes more than one try for them to really get into a recovery based lifestyle.

Many programs provide partial scholarships to assist families, but even with that many families still can’t afford treatment. I have often wondered if insurance companies covered longer periods of time in rehab if the need for repeat visits to rehab would be as common. Based on the research, it would make sense that longer stays in rehab would yield more positive outcomes.

Although, I have been focusing on the insurance companies that cover 28 days, there are many people with health insurance who have no substance abuse treatment coverage. I am not sure how this is the case considering it is a disease just like any other disease. I guess 28 days is better than nothing, but we still have a long way to go. Have you found yourself frustrated with the limitations of your substance abuse coverage? Did you feel like you were backed into a corner and that your hands were tied? Has anyone challenged the insurance company and won??

"A doctor told me I was bipolar once, but...."

"I didn't believe him and I didn't want to be bipolar, so I ignored him"

In the meantime this person continued to be an addict and many years later he is just starting his rehab. better late than never but imagine if he had just accepted the diagnosis years ago.

While I will be the first to admit that MANY doctors are often wrong about their diagnoses, especially when it comes to psychiatric diagnoses, but they are usually wrong when they MISS the diagnosis of bipolar disorder.

So, as a rule, if a doctor tells you that you are bipolar--then you probably ARE.

Approximately 80 percent of bipolar patients are chronic substance abusers and so it is never a walk too far out on a limb to suspect that an addict is bipolar. there is no harm in treating a patient who is presumed to be bipolar with medications that are indicated for this disorder. However the corollary is not true. Treating a patient who is indeed bipolar with medications indicated for patients who are not can be catastrophic. In that situation a patients risk of sucidality increases exponentially.

How do you know if you are Bipolar. It is actually quite simple. Look for these 5 simple signs. First, remember that your genes don't fall far from the tree. If you have a family member (parent, grandparent, sibling) with bipolar disorder or substance abuse then you are 10 times more likely to be bipolar. Second, if your symptoms of depression, anxiety or substance abuse start before the age of 21 or if your depression is seasonal or if you had postpartum depression then you are more likely to be bipolar. Third, if you took an antidepressant and it made you anxious or game you insomnia then you might be bipolar. Third, if you ever experienced mania then you are bipolar. Lastly, if you have what are know as associated symptoms then you are more likely bipolar. Associated symptoms are behaviors that people exhibit that make "normal' people nervous. Things like high risk behavior, multiple marriages, jobs, legal issues, etc.

Being bipolar is only a bad thing if it goes undiagnosed and untreated. Bipolar patients are patient who have trouble lives and live in disturbed worlds and that trickles over to the lives of those that they touch. Don't avoid treatment symply because of the condition. That won't make it go away. Face it head on. Get the right treatment. take your life back

Who can figure out procrastinators--Cont.

It was said by a therapist when commenting on last night's blog that the most common cause of procrastination is perfectionism.

I don't believe that. I do not believe that someone does not even start a task, let alone finish that task simply because they feel that they will not perform at a level of perfection. There may be some level of reluctance to initiate or complete a task because they don't feel that they can adequately perform, but I think that occurs even in the absence of perfectionism. I would need to see that this particular individual displays perfectionism in other aspects of their lives before I would concede the point. Even then it would only be on a case by case basis.

I believe that there are many other aspects that more commonly contribute to procrastination. I think most prominent is distractability. I believe that most people procrastinate because they are simply distracted and get side tracked by other tasks thereby letting the task at hang "get away from them". You will hear such things as "I didn't get a chance", I"ll get to it later because I got caught upo in another project", and "Where did the time go". Those who are focused and goal oriented are less likely to procrastinate and are more likely to complete tasks.

People who are distracted are also often overwhelmed. When one is overwhelmed they are less likely to initiate a task let alone complete that task. Together, distractability and being overwhelmed are often traits of those individuals who have ADD.

Procrastinators are often people who exhibit lassitude and a lack of caring. Pessimists are more like to be procrastinators--"why start or finish a project if the results just don't matter"

Clearly there are many contributing factors which lead to one becoming a procrastinator and these factors come in many colors and sizes and shapes. It is never one size fits all--but the end result is the same. that end result often leads to frustration; sometimes to the procrastinator and definitely to the family.
How many addicts procrastinate with regards to their treatment. Who has more inertia than an addict especially when it comes to ending their drug binge and starting a treatment program. Working with a program who understands this inertia and can create the appropriate counter forces is crucial.

Who can figure out Procrastinators

Procrastinators. What is it about them? Why do they do--or should I say not do, what it is they do? Why do they put off what needs to be done rather than just doing it?

I am not sure, but I am going to think about it and get back to you tomorrow.
Or maybe the next day....

"I am the best person I can be!"

But is that enough? In a recent episode of the Showtime series "Californication" the character "Cokey Smurf" is presented with her first temptation shortly after leaving rehab for cocaine addiction. At a party she is handed a cocktail and as she stares at it fighting the temptation to imbibe she says "I am the best person I can be". She then proceeds to pour the drink on the ground and the mini-crisis is averted.

But, again, is that enough? Is it good enough to simply be the best person we can be or do we have to do more? My feeling is that by saying we are already at a point where we are "the best that we can be" we are actually selling ourselves short. Particularly if it is shortly after exiting rehab. In a 4 week rehab program; and perhaps even ones of longer duration; our work is clearly not done. It is perhaps just beginning. certainly at that point an addict is in no way ready to pronounce that they are as "good as they can be". If, for instance, you are a believer in the 12 step program you certainly cannot work you steps that quickly. Even if you are participating in a more "holistic" program, regardless of the length of the program you are fall from the goal line and have a long way to go.

What would have happened if despite repeating her mantra, "Cokey Smurf" decided to take that drink. Would she simply say that "being the best person I can be" wasn't good enough. That may be true at that moment. That leaves you with two choices--give up because you will never be strong enough, or grow to be even stronger.

Personal growth is something that is vital to everyone. Addicts are not the only ones who must keep growing. Addicts and non-addicts alike should remain on a path of personal grow that has no limits. Lives that become stagnant and are absent of growth and development are ones that fail to experience all that life has to offer. All of us should squeeze all we can out of life and that requires a desire to move forward at all times ensuring that our own personal development remains limitless.

At any particular point in time as we take a snapshot of where we stand in our growth we should indeed be "the best person that we can be". But we should never be satisfied that we can stop there. Remember that "..life's like an hour glass glued to the table". It is never going to stop moving. We can't either. Keep moving forward.

An Alcoholic's Story--In his own words

I wound up at Synergy in West Palm Beach after basically giving up on almost all aspects of life. Job, wife, kids, and even the family dog; all given away. Now this didn’t develop in a matter of days or weeks. It developed over years of bad choices and decisions. I am an alcoholic, and have admitted it for some time, but I never really took action to treat my disease. Oh sure I went to AA, got a sponsor, and worked some of the steps. I even went to a treatment center in august of 2007. But it wasn’t until I gave away all the things in life that we cherish the most that it was clear I had to get sober for myself. If I don’t get better first nothing else will follow. This I am convinced. I need to get physically, mentally, and most importantly spiritually better so that I can reclaim my life that was at one time wonderful. I want to be a contributing member of society but nobody, and I mean nobody, wants a drunk for a father, husband, co-worker, or friend. It’s not that these people don’t care, but you have to want it and put effort in your recovery if you are going to get your life back and have it better than before.

I came down to Synergy not knowing what to expect and what I found was a great surprise and most importantly a huge relief. There was no pressure. Almost everything is taken care of for you and the staff here is top notch! As a person who likes being in control of all aspects of my life and is sometimes a “control freak” it was hard to let someone else “drive” for a while. At Synergy this was easy to do and for once I was able to really concentrate on myself and get ME better because if I don’t heal and get well no one in my life will. I’ve been told over and over you only have to give up 1 thing to get everything, and I believe it. I was also told at synergy to let go of those things I want back in life for now. They’ll come back if I do the work and get honest with myself. It’s not always easy on both sides of the therapy sessions, individual and group, but that’s a sign of progress.

Every day that I’ve been here my life has gotten a little bit better. Day by day, one day at a time, for all we have is today.

Now the question for me is “what to do next to progress in my recovery…”
I am sure Synergy will provide the guidance and support that is needed.

Anonymous

“Have a Very Merry Holiday Relapse?”

What’s up with relapse during the very merry holiday season? Do we see more relapse because those vulnerable to addiction feel lonely and left out even downright depressed during this very merry holiday season? Do we see more relapse because many are estranged from family during this very merry holiday season? Or do we see more relapse during this very merry holiday season because some people may just want to party one more time before the new year starts? Or do we see more relapse during this time of year for all of the above?

What can be done to help those in recovery not take that step towards relapse during this holiday season. First we can make sure that the person in recovery stays connected to all the positive things in their lives.

Staying close to sponsors, as well as family and friends that provide encouragement and support during the so called “very merry holiday season.”

Making sure the person is attending their NA or AA meetings consistently.

Observing behaviors and tell tale signs that relapse might be coming shortly. Relapse, as we know, starts weeks before someone actually picks up a drink or a drug.

Do not hesitate to tell your family member or friend what you are observing and engage in an open dialogue on what is going on.

Understanding that the very merry holiday season is not so merry for all. That people suffering from depression are more at risk for suicide during this time of year. Understanding that if someone is talking about suicide this behavior should not be taken lightly especially if the individual talking about suicide has actually thought out the manner in which to commit suicide. For those of us that have a loved one struggling with the disease of addiction we need to understand that depression, anxiety and other behavioral issues are very routinely present with addiction. Observing these behaviors can give us insight into prospective relapses especially during this season. Helping people get through this holiday season without relapse will certainly make for a truly “Very Merry Holiday Season” for them and their families and friends.

Those who can-- do; those who can do it better--Teach

Remember the saying,"those who can, do...those who can't, teach...and those who can't teach, teach gym".

It is not true. In fact it is rarely true. The truth is that those who teach are truly often the most intelligent and insightful. When looking for a doctor, for instance, look for one that is actively involved in academic medicine at the same time that they are maintaining a private practice. This is the balance that represents the best of both worlds. A physician who is best qualified to care for his patients is one who has blended the academic world with the real world.

We spoke on an earlier page in this blog about how addicts who are able to truly achieve recovery are those who can walk away from the world of addiction including meetings. However an addict who is able to revisit that world as a teach or a therapist often offers special gifts. They speak the voice of a survivor. They bring with them insights that a non-addict can never achieve or relate to. It may even be important to maintaining their own recovery. Every time one teaches--one learns. No matter who you are or what you are teaching. And so many addicts have the opportunity to maintain their own sobriety and keep learning every time you teach.

You don't have to be a therapist to teach. Sponsors teach. At least the good ones do. alumni teach. Never turn down the opportunity to give back to a program by going back as an alumnus and telling your story. there is a lot to be gained by the people in that program by hearing the story of someone who not only made it out, but made it all together.

A day of Rest

It's Sunday. A day of rest. Yeah right!

Addiction does not take a day off. It is relentless and tireless. It never keeps moving. It never gives you a break. It wears you down and it becomes increasingly more difficult to stop the momentum. Becoming an addict is never a conscious choice. The use of drugs is, but becoming an addict is not. There are those who do not believe this. They are typically the same ones who believe that homosexuality is a choice. It is not. Who would possibly choose such a devastating world as the world of addiction. Science tells us more and more that people who are addicts are often put on that course by their underlying disease state and it is that disease that we must address in order to change the course of their lives. What must, however, become a conscious choice is rehab.

It is a rare phenomenon that an addict can change their stars without help. Occasionally in the absence of underlying pathology an addict can turn their life around by themselves. That is the exception not the rule. The rule is that addicts must be treated like any one else with a chronic disease state. They need help. and they need help within the structure of a well constructed treatment program. One that deals with every aspect of their disease and every aspect of their family.

Addiction never takes a day off but you have the opportunity to change its course.

the perfect place when you're in a bad "place"

"Like a bridge over troubled water...". That's the way Simon and Garfunkel described it. It is the help that we can provide to those who are in need. When you are in the depths of addiction there is virtually no way to get out by yourself. crossing those trouble waters requires a helping hand. A hand that understands addiction in every way--Science, dynamics, family issues, personal and legal problems. A hand that will not be judgmental. A hand that has faced addiction and all that it has to throw at you.

At Synergy Group Services we are all those things. We are a physician owned and family run rehabilitation program in West Palm Beach, Florida. We have experienced addiction as a family and have dealt with every aspect of addiction on both sides of the fence. Now we live on the side of recovery as therapists, administrators, and physicians ready to give state of the art care not only to the addict but to their loved ones as well.

We believe that we have a unique approach to addiction therapy not only because of our background but because of our philosophy as well. We blend the elements of "12 step" with Holistic therapy to ensure that we give our clients every possible opportunity to succeed.

Call us and find our how we can help your family when someone you love is in a bad "place".

Why can't doctors get it right?

Data from as far back as 2002 tells us that one out of every three patients diagnosed with depression actually suffer from bipolar depression. The problem lies not so much in the misdiagnosis of these patients but in their mistreatment. When patients are treated with the wrong drug at the wrong time the consequences can be catastrophic. When patients who are bipolar are treated with drugs that are intended to be used in unipolar major depressive disorder because they are mistakenly diagnosed they are at significantly increased risk of suicide. Bipolar patients exposed to unipolar drugs often experience treatment emergent mania. This mania is characterized by symptoms which may include increased energy, increased anxiety, euphoria, poor judgment, insomnia, agitation, and thoughts of suicide. In the United States we have not significantly decreased the incidence of suicide in the past decade. There are approximately 60,000 suicides each year. The major risk factors for suicide include overwhelming hopelessness and the energy to commit the act. Therefore when we energize a hopeless patient by accelerating them into treatment emergent mania with the wrong drug at the wrong time it becomes very clear how we are putting our patients at risk.

A significant number of chronic substance abusers suffer form bipolar disorder. Unfortunately these patients largely go undiagnosed and mistreated. the average bipolar patient has symptoms for 10 years before an accurate diagnosis is made and along that journey they have seen on the average of 4 physicians before the proper diagnosis is made. Just today I such a patient. A young man who has suffered with drug addiction for 10 years. He has suffered the loss of his marriage, his job, and legal issues partly because he was mistreated for many of those years. If he had been properly diagnosed and treated for his bipolar disorder perhaps he would have gained control of his life years sooner.

We have an obligation as physicians to train ourselves to better recognize and treat bipolar patients. Given the information above our patients can't survive if we don't.

Hurry up and.....relapse

If there was one very significant and meaningful piece of advice that I could give every individual who is entering a treatment program it would be to SLOW DOWN. More so than any other obstacle to full recovery it is an addicts sense of urgency to rush the process that gets in their way. Addiction did not start over night. It did not last just a couple of days or even weeks. Yet, when every addict enters a treatment program the question that is paramount in their mind is "When is this program over?"

The simple truth is that you cannot rush the process. Recent science tells us that it takes a minimum of 90 days to change a behavior. Teaching an old dog new tricks takes time. It also takes a team of talented, committed people in a well structured treatment program. These people are handcuffed if an addict tries to rush the program. Keep in mind that someone (family, loved ones, insurance companies, charities, and the government) is paying a lot of money to get the ball rolling and put an addict in such a program. Yet invariably the addict will try to rush the process. The addict will insist that they are OK and on their way to recovery. But it takes time. Every addict needs to take a breath and slow down. It is the speed at which they want to run through the program that becomes their biggest enemy.

It is completely understandable. Good therapy is uncomfortable. It is difficult to face your demons. It is difficult to see where you have been and struggle to get where you need to be. Success will be enhanced significantly if you slow down. Your brain is not paint color on a wall--it will not change with a simple stoke of the brush. Addiction behavior is the manifestation of complex physiologic, hormonal, endocinolgical, and even anatomical changes within the brain and that process typically took years to take the shape that it has on the first day of treatment. To change that dynamic is one that takes time. In Orthodontics teeth move within hours of placing of the braces yet the braces stay in place for many months to ensure stability of the mouth. That analogy is appropraite for the brain as well. The wheels of motion of change are set in motion in the first couple of weeks but change takes months to become permanent.

Slow down. Take a breath. Recovery is a process that cannot be rushed.

Time to cut the cord.

What truly is the definition of recovery? Is it the absence of drug use? I think not. Addiction comes in all sizes and shapes. It looks differently in different people. Addiction doesn't just mean doing drugs or alcohol and recovery doesn't just mean staying clean. It is very common that an addict substitutes one addiction for another or fails to eliminate all their addictions at once. For instance, an addict substitutes suboxone for heroin, clearly a better choice but a controlled addiction is still an addiction. Or while an addict is no longer using alcohol they may be addicted to other destructive behaviors that impair their recovery.

So what does recovery really look like. To me recovery means getting as far away from the world of addiction as possible. Not just clean. Not just free from your drug of choice. It means joining the real world. It means having a job, having a bank account, a credit card, a cell phone, and most importantly gaining independence.

The process of recovery so often gets in the way of that. Addicts don't live in the real world even when they are clean. They live in halfway houses for months and months and they become addicted to meetings. At some point in order to be truly clean, to be truly in recovery, an addict must stop going to meetings. Meetings are the addicts umbilical cord. It is a cord that must be cut. In order to truly be in the real world as addict must get as far away from other addicts as possible. To put the addict world behind them as far as possible.

Join the real world. Cut the cord. Give up the meetings. Until you do you are not really in recovey.

“Is Relapse Part of Recovery?”

When talking about the issue of recovery from drugs and alcohol the discussion inevitably will include the high rates of relapse and the causes of failure. Within this discussion the phrase “relapse is part of recovery” is often referenced. What is this “relapse is part of recovery” theory? Are we saying that in order for someone to achieve sobriety they must first go thru a number of failures? And the obvious question that begs to be asked is why does one have to fail the first time, second time or multiple times before uncovering the key to a successful recovery?

Does drug or alochol addiction cause a person to loose their intellectual ability? Does drug and alcohol addiction cause a person the loss of will to succeed? Is it that the draw of addiction is just too strong to ever conquer? Or is it that as far as treatment strategies go we are just missing something? Or in the final analyses is it the person just doesn’t want to be in recovery and just loves their life so much they just don’t want to change?

Let’s discuss the last question and put this concept to rest. That people addicted to drugs and alcohol love their life so much they have no inclination of changing their life style. Well for one, I don’t buy this premise at all. I don’t thing too many people knowingly choose a life of drugs and alcohol that destroys all that is valuable and meaningful in ones life. A life that leaves people without family, friends and material possessions. A life that causes people to act in way that is contrary to all that is taught by families, schools and religious circles.

This leads me to the potential conclusion that maybe people are consistently relapsing because the process of recovery as we now know it and understand it just doesn’t get the job done. Repeating the same process time and time again with the same inevitable results of failure should at least get us thinking of some alternative modalities of treatment.

What changes or different types of treatments do you think we need to make to increase the success of treatment?

Step One--Let's pick a 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

How do I find a treatment program