Click here to contact Mou and/or see her GoodTherapy.org Profile

At the very core of our lives is sexuality. Though as a society we are not quite exactly trained to talk openly and honestly about sex, nonetheless we grow up recognizing and knowing intrinsically the need we as human beings have for sex and the roles it plays at the very core of humanity, with of course it’s one of it’s main functions being procreation. And, what is the other function of sex? Well, pleasure, of course.

If only pleasure were such an easy thing for us to comprehend. As a society not only are were discouraged from talking about the pleasure that sex brings us, we are also led to recognize the detriments of deriving too much pleasure. The very lack of our society’s ability to openly acknowledge the things, which bring us pleasure, may also in turn cause us to abuse the things that bring us pleasure. It is known as hedonistic to throw oneself into pleasure all the way, to be unable to find a happy medium, middle ground or balance, and when all the other things in life begin to become neglected: work, family, friends, finances, and so on. We have come to call this phenomenon as Addiction. And, when someone comes to the end of the rope with Addiction they often recognize that the only way to undo the damage is to go into what we call sobriety of recovery.

When an alcoholic or addict goes through recovery from a chemical dependency, too often sex is at the core but is one topic that often also gets neglected. Much of recovery is spent addressing the relationships, which affected and were affected by the addiction, coming to terms with our addictions and understanding ourselves in relation to and in connection to our higher spirit. All of these are indeed all very important things on the road of recovery. However, it is not every day that the role sex plays in an addiction is explored.

One of the first things to mention is that drug and drinking problems are often sexual problems in disguise. Sex plays a major role for too many individuals who become chemically dependent. And to break down its walls it’s necessary to understand its effects.

Sexuality is often the one of the most fragile areas of a recovering individual’s torn self-image and esteem. Many of the issues of love and relationships that come up for addicts in recovery from alcoholism and other forms of chemical dependency have much to do with sexuality once the walls broken down.
Sexual fears and insecurities may often be the force that drives a user to drinking or drug use in the first place. For example, many professionals point to early sexual abuse as the place where some anxieties begin. It has been recognized that childhood sexual abuse is a risk factor in drug dependence. Research indicates that of all the patients in treatment about half have been raped or abused, while a third are victims of incest. So, as practitioners we have to recognize that sexual abuse may be damaging to feelings of self-worth, which in and of itself is a risk factor for drug use and abuse.

Not only is sexual abuse is a major contributor to addiction. Sexual and gender stereotypes are another. Some of the tried and true gender roles still hold true in our society, even though we are seeing progress and change. Many women are still the primary home caregivers, putting the needs of men and children ahead of their own, neglecting their own need for support and intimacy. And, men are often still expected to be the initiators, the aggressors, and the breadwinners forgetting to express their emotions and feelings. Ignoring our needs and feelings are risk factors for addiction.

In treatment we learn that preserving sobriety involves more than merely reshaping the habits of drug or chemical use, it also requires throwing away stereotypes and reshaping the old attitudes that have been hammered in over the years. In treatment the addict learns to start taking care of his/her own needs. The addict learns to address feelings, and to address emotions for recovery depends on it. The individual in recovery must talk about things like sexual abuse, sexual gender roles and stereotypes. And, likewise must also talk openly talk about his/her sex life.

The key is to deal with sex after sobriety. Avoiding sex may leave one poorly prepared to cultivate relationships that don’t revolve around for example, singles bars and drinking, causing an addict to lose that hard-earned sobriety within months, if not weeks. Unless treatment addresses both the dependency and sexuality, recovering addicts risk relapse with every close romantic encounter. Most treatment programs do recognize that it takes two to repair a relationship strained by years of chemical abuse, and will incorporate the partner of the addict.

And even though many addicts may feel like doing so in recovery, running away from sex is not realistic, so it’s better to put sex in the context of feelings and factors that make up the whole person. Here are some things for the addict to remember when it comes to sex:

1. Talk about sexual feelings of guilt and anger in order to heal. Addicts need to learn to recognize the patterns of feelings, sexual or otherwise, that drive them to drink or abuse substances. Only then are they ready for new relationships, or of rekindling that old relationship.

2. A recovering addict also needs to move slowly whether in a new or old relationship or if single. Concentrate on building self-confidence first and self-image before building up the sex life. For many it is even a good idea to wait, six months even a year before beginning a new sexual relationship. Couples should focus first on sharing time and feelings together before jumping back into bed and into their old, unstable, erratic sex life, and sex therapy is a good starting point.

3. Start over by focusing on really learning about our own bodies and feelings. The goal here is to help ease fears that sexual feelings are abnormal or strange. It is important to take the time to really learn (or re-learn) what one likes sexually. Couples should focus on sensuality and should take the pressure off of sex and orgasm for a while and instead do things like take bubble baths, sensual massage, and mutual masturbation, and openly communicate with each other about sex. It is important to recognize that just like there’s more to alcoholism recovery than not drinking, there’s more to sexuality than just sex.

An addict will very likely need to rewire his/her ideas about sex. Taking the time and talking openly about sex are the keys. And the addict who discovers that sex can be a bridge to intimacy, satisfaction, and a strong self-image is likely to find deeper, more honest and satisfying relationships – sexual and otherwise – at the other end.

©Copyright 2010 by Mou Wilson, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mou and/or see her GoodTherapy.org Profile

Click here to contact Lynn and/or see her GoodTherapy.org Profile

Susie could tell right away when her father had been drinking – he had extra sparkling eyes, he smiled a lot, he breathed heavy, and he talked non-stop for endless hours. She was supposed to listen to every word, agree real fast and with enthusiasm, and then tell her dad what a great man he was.

This got boring, but when her father was on a jag she was expected to stay right with him every minute; she was not allowed to go to bed just because it was a school night or because it was 2:00 AM and she was tired. Her dad poked her in the ribs if he thought she was nodding off.

Susie learned to hit the sack real early, before her father had time to tie one on. She didn’t want to get caught in her father’s endless web of stories, tales of daring, of fights and beating people up, of how mean people are, how sick the universe is, how nothing matters, and nothing is any good; everybody is out for themselves, and anybody who says different is a phony. In Susie’s family, life was a war.

Susie wanted to kill herself, if she had to live in that kind of world, so she had to prove to herself that the world was different.

When she grew up she adapted. She had a decent job – she was a social worker in a foster care agency, helping kids survive their families. She didn’t make much money, but it was enough.

She lived on her own now, she could sleep when she wanted, she didn’t have to hide in bed any more, but she couldn’t stop. It was her pattern to go to bed early and stay there as long as she could, then get up and run fast to work, no breakfast. Or else stay up all night and sleep at her desk when no one was looking.

She had a boyfriend. He was glamorous, sexy, handsome—but he ran around with other women. He liked to get high, and he told her she was selfish when she didn’t lend him money.

“I promise to pay you right back, payday after next.”

“Sure, right.”

Susie was miserable. She still thought about killing herself. Or maybe she would just get run over by a bus sometime, or catch a fatal disease or something. She was always imagining her own sudden death.

She knew she wasn’t normal – every time she got in the subway she was scared some guy would push her in front of an oncoming train, so she went to therapy, where she complained long and loud about her boyfriend. After a while she began to see that he was treating her as she expected, which was terrible. She tried to break up with him, but she kept going back, over and over. Her therapist told her she was a masochist. Susie knew what that meant – she knew her therapist was right. She got mad. And she slowly got better.

Underneath it all, she had always been furious. Who wouldn’t be? She talked a lot in therapy about her father.

Her therapist, Caroline, asked Susie, “Where was your mother? Didn’t your mother protect you?”

“Mom didn’t protect me, no. She hid behind me. She used me to hide from Dad.”

Susie had been taught to be an instrument belonging to someone else, and not belonging to herself. She had been taught to live for others- as her father’s own personal cheer leading squad, as her mother’s defensive armor.

Caroline was outraged on Susie’s behalf. That helped a lot. And Susie was in charge of how far, how deep to dive in therapy; Caroline always checked, asking, “Where do you want to go with this? You OK?” Susie could rely on Caroline to protect her.

A lot of times Susie wanted to quit therapy because it was hard, it was expensive–even though Caroline gave her a break on the fee–and it took up a lot of time; but she knew she was worth something, and her time was better spent in therapy than wasted on some guy who didn’t really care about her anyway. She wanted to learn how to have her own life, and then maybe share it with someone worthwhile.

Therapy rules were clear and fair. Caroline had faith that Susie’s life could be better. Susie worked hard to understand herself, to clear her vision, to look around and see that the world wasn’t only harsh as her father made it.

She called for a truce inside herself, and outside too.

©Copyright 2010 by Lynn Somerstein, PhD, RYT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lynn and/or see her GoodTherapy.org Profile

Click here to contact Michael and/or see his GoodTherapy.org Profile

In Switzerland, Carl Jung told a young American man suffering with alcoholism that as far as medicine and psychiatry were concerned, there was no hope for him. That was in 1931, and this still remains true in 2010. The single alternative left was a religious or spiritual experience — what Jung referred to as “a genuine conversion.” Jung had heard of such experiences helping alcoholics get sober, but admitted that such cases were “comparatively rare.”

In 1934, William D. Silkworth, a prominent physician specializing in alcoholism and drug addiction had a similar slant on the problem. He proclaimed that only a message of “depth and weight” could hold the interest of the addicted person. “In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to re-create their lives.” Silkworth further stated that, “Unless this person can experience an entire psychic change there is very little hope of his recovery.” Anyone presently familiar with addictions knows that it was out of these messages that the entire Twelve-Step recovery movement was born. Addressing the relief from out-of-control obsessive desires (alcohol, drugs and other addictions) and the need to create substantive lives, the Twelve Steps have helped millions of people throughout the world. It is also clear that while this movement continues its profound and rapid growth, at its core are controversy and mutations of the experience. A 1994 issue of Common Boundary magazine states, “On the eve of the 60th birthday of Alcoholics Anonymous critics are charging that the Twelve Steps are outdated and irrelevant. Others claim they’re the doorway to new forms of spirituality and social action.

Far from outdated and irrelevant I would say the Twelve Steps are dated. For many they are a doorway to new forms of spirituality and social action, but they need to be built upon with all that had been learned in the last seventy-six years. We need to acknowledge the limitations of these steps. Building on my own experience, I am hoping to create a larger view of addictions recovery. I want to build on AA’s original intent to be inclusive and transforming, while integrating with newer, more expanded wisdom on spirituality, diversity and psychology. In doing so, I continue to proclaim our societal needs for the Twelve Steps with nothing less than my respect and loyalty, as the program continues to support so many in a profound, meaningful way.

The purpose of this article is to explain the sense of spirituality that one must bring to the staged model of addictions recovery, as illustrated in the Tree Diagram at the end of this article. My extensive work in this integrative model is fleshed out in my book The Journey Toward Complete Recovery: Reclaiming Your Emotional, Spiritual & Sexual Wholeness. The National Institutes on Health (NIH/NIDA) and The National Association of Addiction Professionals honored the study for Outstanding Leadership in Research in the year 2000. At the awards banquet a NIH senior researcher congratulated me, along with a caveat: Don’t get your hopes up too high. As valid as this research is, it might take a minimum of twenty years before it could reach mainstream acceptance. I was disappointed in hearing that then, but now, ten years later, I understand what I was being prepared for.

To have the capacity for however one defines God, love, or the great, or universal spirit, one must come out of their self-sustaining, ego-driven fear and isolation or conditioned thinking. (Attachment to outmoded, self-harming conditioning is an addiction in itself; all the same healing techniques apply.) One must also admit that they cannot successfully confront their addiction without the help of others. In so doing, the ego, one’s conditioned thinking and its enforcing armor begin to relax, allowing the opportunity for a spiritual conversation. This is the threshold to Stage One recovery. If the person is earnest in their desire for help, and if empathetic help is available, this spiritual, energetic and experiential conversion will begin to take place. The words energetic and experiential are important because this conversion is beyond words, and can take place without any reference to God or spirituality. It does so in groups like AA for Agnostics all the time. It is done through the compassion and understanding of others who allow a person to be just as they are — even when that includes not believing in God or spirituality. The experience is felt as an opening, however slight, to the energy flow within the person and how they’re connecting with the energy in those sharing their recovery process.

When a recovering person has sufficient time adjusting to a life that is not ruled by their primary addiction, a second stage of the process begins. The timing for this emergence varies for each individual. This Stage Two requires a deeper, spiritual experience of the sense of self that is created as part of the process. It is this phase that empowers a deeper realization of self through a merger of Analytic Theory, Humanistic, Transpersonal, Existential, and Somatic Psychologies. Often called the remembering and resolution stage, this is a time when one awakens their unconscious, with the help and support of others, to dissolve existing barriers to fuller self-expression and joy. Similar to addressing the primary addiction, there is often great resistance to this deeper self-discovery. Again, it will be the reaching out for help, and letting go of the self-sustaining ego that will allow one to lean into this work.

Similarly, the empathetic nature of one’s help will significantly impact the process. At this point in the process, many will wonder: Why should I spend time and energy probing my depths? I want to just get on with my life. That is understandable, as it takes courage to confront one’s own barriers of getting needs met, to gradually move further into the remembering and resolution. Once one makes this movement, they will be able to open to new energy and information. AA’s founder, Bill Wilson, wrote, “Sobriety is only a bare beginning; it is only the first gift of the first awakening. If more gifts are to be received, our awakening must go on.” Taking the leap into this kind of work has its rewards, as attested to by many of my clients; some of their remarks follow:

I discovered Stage Two work after my recovery from crystal meth addiction and sexual compulsion. Focalizing in Stage Two was especially effective in healing the traumas and blocks that kept me from living the life I desired. These techniques were graceful, occurring naturally with ease.

Having previously been in therapy, as well as successfully working on my sobriety for over a decade, I thought that I was fairly self-aware, able to work out problems on my own. I had little idea then of the life-changing journey I was about to embark on in Focalizing Stage Two.

Today my life has changed beyond what I thought was possible.

Of the thousands of highly motivated women and men that I have worked with in addictions recovery, they have all expressed the same longings. They want to connect more meaningfully with others. They want consistent loving relationships, and a sustainable loving, sexual relationship. They want to feel less awkward in their presentation of self. They want to have a sense of purpose to separate from obsessive drives. They want to know who they are. Stage Two was developed to begin the process of fulfilling these deep, inner desires.

In my own recovery and struggles to define God, I eventually distilled a technique of personal observation and experience. From this refinement of many years of searching, I was left with two concepts that I continue to juggle with through all the work I presently do. The first is love; the feeling of kindness, compassion and understanding toward others. Many ancient philosophical and religious writings espouse that “God is love,” but it took my own rigorous study to breathe life into those words. The second is that an experience of transcendent energy, spirit or force inspires the disentanglement of my unconscious. As I learned to bring compassion and understanding into my own repressed traumas, conflicts, defenses and secrets, I experienced a deeper well within from which I am able to share an energetic connection.

At one point in my search, M. Scoff Peck became my hero when he wrote in The Road Less Traveled, “If you desire wisdom greater than your own, you can find it inside you. The interface between God and man is at least in part the interface between our unconscious and our conscious. To put it plainly, our unconscious is God.”

Although I have used the word God in my own discoveries, it is important to remember when working with recovering people, that word must often be abandoned for another more practical and meaningful to the individual. For many, having experienced childhoods that were inconsistent, abusive or neglectful, there is a deep sense of having been deserted or betrayed by the concept of God. Assisting people in discovering this deeper sense of self can be best accomplished with words and phrases that describe a feeling. Ones that I have used with a high degree of success are: energy, spirit, the Great Spirit, the universal spirit, connection with self and others, or letting go of willfulness and ego.

These realizations are the spiritual grounding for the self awareness that is required to do this work. Eva Pierrakos, founder of the Pathwork, said, “If you make your commitment to yourself to fully accept everything you now are and to proceed to get to know yourself where you do not yet know yourself, you will find it is the most exciting, significant, and meaningful journey into your own depth. You will have all the help you can possibly need, for no one can undertake this journey alone. The help will be given to you; it will come to you.”

The abstract concept of Serendipity, a motivating goal in the staged model of recovery, is rooted in these ideas. Webster’s defines serendipity as “the gift of finding valuable or agreeable things not sought for.” Carl Jung referred to this phenomenon as synchronicity, while M. Scott Peck called it “being touched by grace.” Eva Pierrakos takes it further. “When your spiritual center begins to manifest, your ego consciousness integrates with it and you begin to be lived through, as it were, by the spirit.”

However one describes serendipity, people in recovery who have reached out of their self-sustaining ego for empathetic help report these occurrences regularly. They will often say “miracles happen,” or “there is no such thing as coincidence.” Simply stated, the minimum spirituality that a person must bring to the staged model of addictions recovery is the willingness to be open and reach out for help. It is in this humility that the determined, willful ego of the addicted person begins to relax and integrate with their energetic, core center. Focalizing and other somatic healing practices bring grace to the Stage Two recovery process by gently introducing our central nervous systems and neurobiology to the experience of wholeness. Another of my clients remarked:

We started out using Focalizing techniques to calm the physical trauma to my central nervous system. The effect was subtle, but clear. I soon began to easily take positive actions that I had previously been too paralyzed to even think of.

As recovery continues, this willingness, humility or surrender will become elusive at times, particularly in Stage Two. When deeper issues, traumas and conflicts get exposed, one must then integrate the determined aspects of the ego defenses with the deeper desire for connection, and continue to open up for help and clarification. This continued reaching out for the wisdom and experience of others will provide necessary spiritual support for working through this staged model. It will deepen one’s sense of self, slowly evaporating the invisible shame that ensconces it, and making it possible to share this deeper self with others.

Through Focalizing and other visualization techniques, I find myself able to finally let go of the mental debris that prevented me from building a more solid foundation. I am now able to make positive, transformative changes to become more of my authentic self.

What truly inspires me to continue this journey is another quote from M. Scott Peck. “I think of addiction as the sacred disease…Very probably, God created alcoholism in order to create AA, and thereby spearhead the community movement which is going to be the salvation not only of alcoholics and addicts, but of us all.”

(Note: Although the above Tree Diagram is a linear presentation it is in fact non-linear, fluid and organic progression. Particularly in Stage Two, where whatever needs to be healed next presents itself in a natural process of resolution.)

©Copyright 2010 by Michael Picucci, PhD, MAC, SEP. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Michael and/or see his GoodTherapy.org Profile

Click here to contact Darren and/or see his GoodTherapy.org Profile

First I want to thank those of you who took time to comment on my last article. I love getting feedback, so keep it coming.

Last time I discussed what happens when members of alcoholic families, who are alcoholic themselves, get sober. The members of these families tend to fall into certain behavioral patterns, or “roles”, which classically include: the hero, the scapegoat (or identified patient), the mascot, the “lost child” and the caretaker. I wanted to explore further the patterns I have observed in my clinical experience with literally hundreds of clients and their families, both in my private practice and at Promises Treatment Center, where I am a therapist in their 30-day residential program.

What’s interesting to observe is how the entire family dynamic changes once their loved one gets sober. I never cease to wonder at how the client’s stabilization in treatment leads inevitably to an increase in their family’s anxiety. Thus, as soon as the client completes detox and starts showing signs of improvement, the parent or sibling or spouse of the client will call the staff in a more anxious state than ever. This, of course, is a sign that the family’s homeostasis is changing, which is terrifying to a dysfunctional system (which tends to reject change) – another reminder that, to paraphrase James Masterson, clients often come to therapy or treatment to feel better, not necessarily to get better (Masterson & Lieberman, 2004).

What happens when a family “mascot” enters the treatment process for alcoholism or addiction? The mascot is someone who lessens family anxiety by providing distraction and deflection, often via humor and comic relief. Here is the “class clown” who can break tension by cracking wise at precisely the right time.

Keep in mind that family members may play more than one role simultaneously; for instance, I once had a client who was a recovering alcoholic – and a stand-up comedian. Quite a good one, in fact. Fortunately, he was able to provide insight and painful emotional truth, along with the laughs. The good news with such a person is that humor is often a filter for truth, so if he/she can step out of the spotlight and get in touch with the pain of addiction, without deflecting it with humor – or to enhance rather than distract from truth – then recovery can begin.

The problem is when the person tries to re-enter the family system. Family members are inevitably going to find themselves unsettled, antsy, perhaps even critical of the clown who sheds the mask. Very often you will hear people say of a recovering mascot, “She used to be so funny, now she’s kind of boring” or “He’s so serious now that he’s sober, what happened to the exciting guy I used to know?” What often happens when a mascot (or any such family member) gets sober, is that the other members (or even close friends and co-workers, etc) are now left with an absence of deflection, or distraction, which creates a void – filled, inevitably, with each persons’ unexamined problems. Now the sibling, parent or spouse of the mascot no longer has the luxury of distraction, and that anxiety must be contained and processed by a system that is inherently uncomfortable with “owning” or processing anxiety healthily.

Thus the mascot may be left with feelings of guilt, shame, self-criticism – the usual feelings that come with early sobriety, magnified by a dysfunctional family system which gives lip service to sobriety but, in fact, isn’t exactly sure how to deal with it. This person may feel they are “causing” the anxiety in a family, when it’s been there all along: in subterranean form. This speaks again to the importance of viewing alcoholism as a “family disease” in which each person is required to look at his/her “stuff” without passing the buck any longer (i.e. shaming/blaming, etc). For each member, this process will at first feel very uncomfortable. But getting better does not guarantee, at least in the beginning, feeling better. Paradoxically, the constant laughter and tension-breaking shenanigans of the mascot, within an actively-addicted family system, has drowned the pain that must now be dealt with head on, if the system is to truly have a shot at health.

This, sadly, did not happen with the sober comedian I mentioned earlier. With sobriety came anger on the part of his spouse, much of which was justified, given the destructive way he behaved in his addiction. However, she refused to acknowledge the fresh start his sobriety provided, declined to get help via al-anon or counseling; in turn, he blamed her for his feelings of guilt, shame and (eventually) rage. Neither took responsibility, or found healthy support, and word has it that he is now drinking and using with abandon while his wife is hurt, angry, and seeking divorce.

References:

1) Masterson, J. & Lieberman, A. (2004), A Therapist’s Guide To The Personality Disorders. Phoenix, AZ: Zeig, Tucker & Theisen.

©Copyright 2010 by Darren Haber, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Darren and/or see his GoodTherapy.org Profile

While statistics on drug use in the United States have been gathered in many different forms and are available in diverse formats, the Substance Abuse and Mental Health Administration has recently announced that it will begin an extensive survey of US households to gather critical information about current practices and concerns. The administration has noted that the survey will take around an hour to complete, and that participants will be compensated for their time. The results will likely help mental health professionals gain a clearer picture of modern drug use issues.

Click here to contact Darren and/or see his GoodTherapy.org Profile

Sometimes the hardest thing about getting sober is…getting sober – or rather, what “sober” means to the person in regard to their family. This is especially true for members of alcoholic or addictive families, where maintaining the status quo may require members to operate according to prescribed “roles”. Getting sober means surrendering this role, eventually, in order to become more authentic or real.

This is not easy, to say the least, within a family where roles are required to keep the (dysfunctional) system going. The recovery slogan, “The only thing that has to change is everything,” points to the enormity of the change required. Sure, change happens slowly, a day at a time, but addicts are not stupid and understand that their way of handling life and relationships is now subject to change, especially when it comes to the roles they have implicitly been assigned – and accepted. Sobriety can be threatening to both person and family, since alcoholic families have weak coping skills and difficulty adapting to the new. The status quo, or “homeostasis” of such a family, is resistant to change.

Take, for instance, a child or adult child of an alcoholic family who assumes a “hero” role: here is the overachiever who excels at academics, sports, college, and so forth. (These roles most often apply to the children or adult children of such families.) This person feels that they are loved not so much for who they are but what they achieve. When such a person turns out to be an alcoholic, the injury to his/her self-esteem is severe; not only are they letting themselves down (since failure to control drugs or alcohol is often seen initially as a “weakness”), but they’re letting their whole families down by removing their hero-mask and getting real. In the big picture, they are now authentically heroic by having the courage to face their problems. In the short run, however, family members can no longer say, “Well as screwed up as we are, at least we have one high achiever in our midst!” The hero can no longer be celebrated as the “pride and joy” of a struggling family, carried on the shoulders of jubilant parents – and above the heads of their siblings. Now the hero must abandon the mask, come down to their siblings’ level, and risk being seen as a “loser” (or scapegoat), someone who brings stress to the family by challenging homeostasis.

This is enormously difficult terrain to navigate – not only for the sober person but also the family, who may even subtly indicate that maybe their beloved is not really an addict or alcoholic. Very often the messages, conscious or not, sent to the newly sober person are, Please don’t change or Don’t make us change (or look at ourselves honestly). The family may (unintentionally, most of the time) undermine the hero’s sobriety, because of the threat to the status quo. They may pile on a stack of requirements impossible to fulfill; they may create distraction, sabotage therapy, or refuse to support treatment. Siblings may minimize the person’s drinking or using, lest they have to look at their own issues. One rule of thumb you can almost always count on is, Once the alcoholic stabilizes, their family will become more anxious and agitated. Sobriety causes undue stress and agitation within such a system. Thus many heroes feel guilt or remorse, not so much for their own suffering but how they’ve caused their families to suffer, or “make” them suffer by threatening homeostasis.

They may end up trying to be a (false) hero in sobriety by trying to speed their recovery as quickly as possible. Look ma, all better! This rarely works over time, for obvious reasons. Often heroes are surprised at the tepid or lukewarm responses they receive from some family members, responses that may leave them feeling like a scapegoat.

This brings us to role number two. The scapegoat, of course, is the “cause” of most if not all the family’s woes. Their new sobriety, by default, pushes not only the alcoholic but also his family members to begin looking at themselves and “their part” rather than continue to blame. Scapegoats may end up receiving a lot of mixed messages; i.e., we’re glad you’re sober, but you’re still messed up in these ways over here. They may, hopefully, begin to finally receive positive support, which can be an awkward adjustment. A longstanding pattern of negative attention conditions a scapegoat to feel that negative attention and blame is all they will ever get, or even deserve. They often sense, consciously or not, that they are doing a service to the family by distracting or diverting everyone from their own accountability (while continuing to numb their own conscience with alcohol and drugs). Getting sober, in this instance, is often felt by them to be a kind of “betrayal” because now the skeletons will have to be dragged from the closet if he/she wants to truly clean house and drop false pretenses. Many of those skeletons involve family members’ culpability in sins of the past, and some of the old family myths (that it’s all the addict’s fault) are now threatened. Why did our kid get sober again?

Most families, of course, are frightened to face this kind of change, and may cling to the old patterns for dear life. Change is often frightening, even when necessary. The scapegoat may feel some isolation and disorientation as they take the heroic, honest journey of sobriety – stepping out of their role, and away from the family (at least temporarily). This can be a lonely place to be at the beginning, since it’s not at all certain that the family will follow them on their new path.

So it is that the newly sober person – and this applies to both roles described above – is risking abandonment, which is the worst fear an alcoholic family member often has (especially a child or adult child of an alcoholic). Add this to the fact that getting sober is very difficult under any circumstances, and you start to get an idea of the level of commitment required to stay sober. This is why “it takes a village” to help, via recovery (peer support, sponsorship), therapy or counseling, psychiatry and hopefully family counseling as well, to help everyone make the difficult transition to sanity.

Next: In Part II I will discuss what happens when a Mascot or Lost Child gets sober…

©Copyright 2010 by Darren Haber, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Darren and/or see his GoodTherapy.org Profile

Though mental health difficulties are able to affect a wide number of people of many different types of lifestyles, a significant number of people facing mental health challenges are also confronted by issues of alcoholism, and their friends and family members may be unsure about how or where to obtain help. The National Institute for Alcohol Recovery recently announced that its popular “Restore” program will now be launched in a digital format suitable for mobile devices, providing instant, on-the-go support for people concerned about someone with specific needs for alcoholism-related psychotherapy, medical treatment, or other services.

Click here to contact Darren and/or see his GoodTherapy.org Profile

So your child or romantic partner (or close friend, sibling, etc) has finally agreed to go to rehab for his/her drinking or drug problem. Now what?

There are some important things you can start doing right away, and approximately none of them have to do with the addict/alcoholic. They are, however, related to the person you’ve likely been ignoring for a while now, if in fact you’ve been living with, helping, or “enabling” the addict.

That’s right, I’m talking about you.

But wait, you’re thinking, I’m not the one with the problem…it’s him (or her), not me!

Well, yes and no. No, you may not be addicted to a “substance” per se, but addiction is a family disease, wrecking nearly everyone and everything in its merciless path. It may take some time to become aware of the emotional and psychological damage on a family level.

Some of you may already be aware that something was severely “off” about the situation, even where your own emotions and strength were concerned. You wondered why you couldn’t just walk away…or hold the boundaries you so earnestly tried to keep…or kick him or her out of your life once and for all, to end the suffering and chaos that was making you crazy. It was so hard to detach, to shut the door on the person once and for all. If he/she wants to throw their life away, then so be it, but I’m getting off this insane merry go round.

And then you discovered, to your horror, that you can’t.

Then, finally, the addict gets to rehab. And yet the “edge” is still there, that worry, that undertow of anxiety. Perhaps the internal “tape loop” would sound something like this:

Sure, they’re safe in rehab now…but what about when they get out? Then what? What if they return to their same old shtick? If they do, yours truly isn’t going to stand for it! Those rehab people better know what they’re doing! But does rehab really work? Are there any real statistics? What if they’re lying to me about how “good” they’re doing? What if their counselor is believing the same old b.s.? And how come I haven’t heard from them…and why I am obsessing about this all over again?

There’s a name for this phenomenon, which some call “co-dependence”, others “enabling”, though for my purposes here I’ll use the term “co-addiction”.

The fact is, addiction is an emotionally-charged way of life that, like a black hole, exerts a darkly magnetic pull on all those in its orbit: spouses, family members, children, siblings: all get pulled in. Those who come from alcoholic families are especially vulnerable. Alcoholics are notoriously adept at sending out S.O.S. signals and then rejecting help when it arrives. Co-addicts are expert at “rescuing” addicts from consequences – and turning a blind eye or minimizing (denial) the wreckage piling up around them, since they often feel “responsible” for “saving” the alcoholic. Though they mean well (we’re talking about family after all), this “rescuing” impulse goes into overdrive, resulting in the insanity of endless failed attempts (to get the person to stop), stifling anger, self-righteousness, existential despair, etc. When the alcoholic finally does get help (thank goodness), the “co” may be left with a huge pile of unresolved emotional and, just as likely, financial wreckage to sift through. Because alcoholism and addiction are so difficult to understand, families often need help and relief as much as the addict.

* * *

If you’re a true co-addict (and this is true if you’re also an addict, even a sober one, who has a friend or family member in recovery or needing treatment), you can’t just “walk away”. Perhaps the professionals have urged you to let go, “trust the process”, but you can’t. There’s a knot in your stomach that just won’t abate, a lump of hot coal burning away… if that “burning” could talk, it might sound something like: Sure, they’re safe and sound in rehab now, but what about me? How come no one’s asked me about all the heartbreak I’ve been through, the time and money and energy wasted… oh sure, he gave lip service to me about the “trouble he caused”, but I’m sure he didn’t mean it…he’s sitting pretty now with three square meals and a cushy bed… who’s to say he won’t get out of that place and start up again… do those rehab people really understand what it’s like living with a dopehead, all the late-night calls and worrying… they probably don’t have a clue… what with the lawyers and police… I’m tired of bailing him out…no more, I say, never again! But hold on, I’m getting worked up again, they told me to stay calm, take it “a day at a time”, whatever that means, I just wish someone would tell me what’s going on or what to do.

If this little “monologue”, or something like it, sounds at all familiar, you’re a prime candidate for al-anon and, possibly, individual or family counseling.

Co-addiction is a curious thing; in many ways it parallels alcoholism. Just as the alcoholic believes that “next time it’ll be different” (i.e., they’ll be able to get a handle on drinking), the co-addict often believes that “next time they’ll be different” (i.e., buying into the addict’s denial, in spite of massive evidence to the contrary). This is sometimes referred to as “ignoring the elephant in the room”. Thus the parallel process of addiction and co-addiction, wherein those close to the addict start to believe the same lies and rationalizations: a way of warding off hopelessness and despair. But the tough, hard-nosed acceptance of the reality of the situation, dire as it may seem, is often the spark that leads at long last to change. And if you, the co-addict, can begin to honestly (and often painfully) accept the ways you bought into the addict’s denial/coping system (i.e., insanity), you can begin to feel some of the same relief the addict receives simply by being sober and stopping the self-destructive cycle.

Another way of putting it is, the addict/alcoholic makes a “higher power” out of the drug or the drink; the co-addict makes – often in very subtle ways – the addict the higher power…meaning that until they’re safe, you’re not. In other words, the addict wants to control the drug, the co-addict wants to control the addict. It’s a variation on that old self-help book, “I’m Ok/You’re Ok”; the co-addict’s version is, “I’m Ok if You’re Ok” or “I’m ok if I’m convinced You’re Ok”.

Truthfully, after all the havoc wreaked by the addict, he/she will never be ok enough to convince you to relax and find true peace of mind. You’re going to need some healing of your own to find the inner balance and serenity you crave – and deserve. Because there are no guarantees, period, and it’s “a day at a time” for everyone, including you. Learning to walk that path often requires a little help, and there’s no shame in that. In fact, asking for help (rather than “toughing it” on your own) is the true way of courage. Paradoxically, knowing where you’re weak (and taking action accordingly) is often a sign of strength.

Both addicts and co-addicts need abstinence – mostly from addictive thinking (i.e., denial, a need for external “fixes” to internal problems, etc). That involves programs for all family members, specifically designed for either the addict or co-addict, that will introduce new ideas and behaviors that may seem radical, at first, but eventually become more comfortable and, even more crucially, effective.

It may sound like bad news, but the truth is, pursuing your own recovery as the co-addict may be the best thing you can do for your loved one in recovery. Curiously enough, surrendering the concept of controlling them and finding your own healing may be the best way to help. Once those close to you sense real change occurring, they will (hopefully) be inspired to pursue change of your own. Once the old lies and rationalizations stop working, the newly-sober addict or alcoholic will have to try something new. She just may feel safe enough, with your new foundation emerging, to try something just plain crazy: tell the truth, warts and all. And being a safe place for your loved one to tell the truth, no matter what, is one of the greatest gifts you can ever give.

©Copyright 2009 by Darren Haber, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Darren and/or see his GoodTherapy.org Profile

The search for effective tools to help people quit smoking has been underway for many decades, with scores of mental health professionals devoting some or all of their careers to assisting clients curb the habit. A study aiming at addressing smoking with the help of virtual reality has recently concluded, with positive findings that may make the technological technique popular for cessation programs. Participants who crushed virtual cigarettes as part of a smoking cessation program showed significantly greater rates of abstinence and lowered nicotine addiction at the end of the treatment and at a six-month follow up than participants who squeezed a virtual ball. As virtual reality technology advances, so too may addiction treatment programs.

Substance abuse disorders, including difficulties with the regulation of alcohol intake and retaled behaviors, affect many people at different stages of life, though a significant portion of those who grapple with these issues are in their mid to late years. It may seem inconsistent, then, that a study supported by the University of Pittsburgh School of Medicine has searched for signs of substance abuse risks in children, but the gathered data may serve the primary purpose of helping to identify children who may benefit from additional education and training to prevent substance abuse issues later in life. Risk factors considering both environment and neurobiological factors were studied.

Smoking cessation programs are frequently cited for the difficulties involved in getting smokers to volunteer, as well as to help those with addiction problems overcome the urge to start smoking again. These issues are especially prevalent when working with teenage smokers, so the industry has suggested –and reason would seem to support–. But this may not actually be the case, says a new trial cessation program targeted at high school students.

With an admirably large recruitment group at over two thousand teenagers, the trial set out to test the efficacy of a structured smoking cessation support program, using a number of special checks and a control group to ensure that collected data was as reliable as possible. The trial involved the administration of up to nine personalized and confidential telephone counseling sessions aimed at providing moral and emotional support during the process of quitting. The high school students were recruited during their junior year and were given the telephone treatment over the course of their final year in high school.

The trial enjoyed a remarkable success rate of over twenty one percent in terms of students who had successfully quit over the course of six months, and a fair percentage –about fifty– completed their entire course of telephone counseling regardless of whether they reported six-month cessation or not. The researchers and organizers involved with the study note that the often-referenced difficulty of successfully working with smoking cessation within this age group served as a major impetus for trying the telephone treatment trial. Rather than proving difficult to reach or to recruit, however, the high school students were remarkably receptive of the offer of help. Now that results have showed great potential, further trials will likely be forthcoming.

Efforts to advocate smoking cessation nation-wide and around the world have been accelerating in recent years as the understanding of the negative aspects of smoking improves. One program, called CHOICES, has won a Silver Achievement Award for its work with smoking cessation among those with mental health difficulties. As a significant number of smokers are faced with mental health issues, the program, which provides community support and logistics for people hoping to quite smoking, has delivered a valuable service to global efforts to ease addiction, and to serve as a source of caring and resources for people struggling to improve their mental health.

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

The “Bucket of Crabs” is one of our favorite analogies. Pulling crabs out of traps on Kodiak Island, we’d just toss them into a big bucket – no need to put a lid on the bucket.

Why not?

Because as soon as one crab would start to climb out, the other crabs would drag him, or her, right back down into the bottom of the bucket. There’s no escape to life back in the ocean. And that keeps happening until all of the crabs end up in the steamer.

The point?

Pick your support group with care. Most so-called alcohol support groups are, in fact, merely a bucket of crabs who will keep dragging you back down to their level. Try and escape and you’ll be warned that it’s too dangerous to get a life, or to mingle with “normies,” or grow up. It’s too dangerous to stop building your life around alcohol.

So you stay in the alcohol bucket, drinking or not, or complaining about your spouse, or parents, or children, or……

And what’s the point of all of this?

Obviously the point is to avoid actually making any real change. That’s what groups like AA and Alanon and Alateen do best, they help you maintain the “security of familiar miseries” – as we termed it 25 years ago – instead of fixing your life.

But why would you want to trade the illusory security of the crab bucket for an actual life out in the real world?
Remember, despite all of the con men and hucksters, alcohol abuse is a choice and you are free – not powerless – to make a different choice at any time. If you’re the spouse, parent, or child of an alcohol abuser, you are also free to make choices, including the choice to get a life of your own. Not a life focused around another’s alcohol abuse.

You can always choose to be recovered, not in crippling, life-denying, “recovery.” You can choose to be an ex-drinker just as many of us are ex-smokers. You can also choose to be someone who used to waste you life on a drinker but got a grip, got over him or her, and got a life of your own.

Please, alcohol abuse is a choice, not a disease, and you can escape the AA/Alanon Bucket of Crabs. Don’t let the doomed continue to drag you back to share their misery and their fate.

©Copyright 2009 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

A large percentage of those who commit suicide each year do so while experiencing the effects of alcohol dependence, a mental health and behavioral concern which can engender great feelings of powerlessness and have a negative impact on many areas of life. Recently, a study conducted by the Prevention Research Center and Texas A & M University has sought to investigate any links between the density of bars and other alcohol “outlets” and suicide rates. While there was some correlation between these factors, researchers found that rural areas had higher rates of alcohol-related suicide. The study may prove useful in efforts to combat alcohol dependence and suicide.

Click here to contact Arthur and/or see his GoodTherapy.org Profile

In this first article here I will describe what Dyadic Developmental Psychotherapy is. Dyadic Developmental Psychotherapy began as a family-therapy approach, grounded in attachment theory, for the treatment of children with disorders of attachment. It has developed over the past decade into a broader approach for treatment and has been found to be an evidence-based, effective, and empirically validated treatment.

Dyadic Developmental Psychotherapy has as its central therapeutic mechanism the maintenance of a contingent, collaborative, sensitive, reflective and affectively attuned relationship between therapist and child, between caregiver and child, and between therapist and caregiver. Dyadic Developmental Psychotherapy focuses on and relies upon the intersubjective sharing and joint development and organization of emotional experience. Intersubjectivity refers to shared emotion (also called attunement), shared attention, and shared intention.

A few basic principles of Dyadic Developmental Psychotherapy:

1. Confidence that both the caregivers’ and therapists’ own attachment strategies are organized and resolved must be present before involving the child in the therapy. Previous research (Tyrell et al. 1999; Dozier et al. 2001) has shown the importance of the caregivers and therapists state of mind for the success of interventions.

2. The therapist and caregiver provide intersubjective experiences for the child that are positive, concordant, and healing. These intersubjective experiences are characterized by shared affect (attunement), joint focus of awareness and attention, and complementary intentions. Intrafamilial trauma will significantly disrupt the development of intersubjectivity and increase the risk that the child will be unable to create a coherent meaning for many events and especially traumatic ones.

3. Use of PACE and PLACE. These acronyms describe the ‘attitude’ of the therapist and caregiver. PACE refers to the therapist setting a healing pace to therapy by being playful, accepting, curious and generate and regulate through empathy (and playfulness when appropriate), the emerging affect that is associated with events being explored. The therapist is also able to facilitate an open, reflective attitude to reorganizing the experience of these events through her accepting and curious stance. PLACE refers to the parent creating a healing environment by being playful, loving, accepting, curious and empathic. These ideas are described more fully in Becker-Weidman & Shell (2005) and Hughes (2006, 2007).

4. The inevitable misattunements and conflicts that arise in interpersonal relationships are directly addressed and then repaired through the ongoing qualities of the relationship (PACE). The need for interactive repair is especially important as the themes often being explored are often characterized by shame and fear. Repair helps with both affect regulation and directly addresses the child’s convictions that he must face stressful events alone, or that any conflict will lead to abandonment. The attachment figures – parent and therapist – are responsible for the initiation of repair, rather than the child.

In my next article, I will describe some of the interventions and methods of this treatment. Your comments and questions are welcome.

References

Becker-Weidman, A., (2004) “Dyadic Developmental Psychotherapy,” in Attachment Disorder Resource Book, As Simple As That Foundation, August 2004.

Becker-Weidman, A., (2005) “Dyadic Developmental Psychotherapy: A multi-year follow-up…Preliminary Summary Findings,” Connections, June 2005.

Becker-Weidman, A., & Shell, D., (Eds.) (2005, Reprinted 2008) Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders. Woods N Barnes publishing, Oklahoma City, OK, 2005.

Becker-Weidman, A., (2006) “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, pp 147-171.

Becker-Weidman, A., (2006) Dyadic Developmental Psychotherapy: A multi-year Follow-up, in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43-60.

Becker-Weidman, A., (2006) Principles of Attachment Parenting, 3 DVD set.

Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf

Becker-Weidman, A., (2008) “Treatment for Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy” Child and Adolescent Mental Health Volume 13, No. 1, 2008, pp. 52-60.

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Family Social Work, 13, pp.329-337.

Becker-Weidman, A., & Shell, D., (in press), Attachment Parenting: Developing Connections and Healing Children.

Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.

Hughes, D. (2004) An attachment-based treatment of maltreated children and young people. Attachment and Human Development,6, 263–278.

Hughes, D. (2005) The development of Dyadic Developmental Psychotherapy. In: Creating Capacity for Attachment (eds A.Becker-Weidman & D. Shell), pp. vii–xvii, Wood N Barnes, Oklahoma City, OK.

Hughes, D. (2006) Building the Bonds of Attachment, 2nd edn. Jason Aronson, Lanham, MD.

Hughes, D. (2007) Attachment-Focused Family Therapy. W.W. Norton, NewYork.

Hughes, D., (2008) Attachment-Focused Parenting. Norton, NY.

©Copyright 2009 by Arthur Becker-Weidman, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Arthur and/or see his GoodTherapy.org Profile

Click here to contact Sherry and/or see her GoodTherapy.org Profile

Viewers cannot turn on the television today without a story depicting pop icon Michael Jackson and his un-timely death. It has brought to the forefront of everyone’s mind a reminder of the dangers of abusing prescription drugs. What parents may not realize is although overall teen drug use is down nationwide; prescription drug abuse is on the rise, as one of the fastest growing addictions amongst teenagers today. Since 1992, the number of teenager’s ages 12 to 17 years old abusing controlled prescription drugs has tripled and nearly one in five teens reported that they are able to get prescription drugs such as Vicodin or OxyContin in one hour. In fact, nearly all poison deaths in the country are attributed to prescription drugs. In the last ten years, the number of teens going into treatment for addiction to prescription pain relievers has increased by more than 300 percent. In fact, most of the clients I see today are struggling with prescription drug abuse, specifically pain medications. Although it is understood heroin is dangerous and that overdoses are common, what parents don’t understand is that narcotic painkillers mimic the same effects of heroin on their bodies and can be just as lethal. Teens turning away from street drugs and moving towards prescription drugs is rampant and the myth that these drugs are safe because they are legal must be squashed or this trend will continue to grow.

One of the reasons for this increase is that the state of the economy today is causing more teens to not only sell drugs to support their habit, but to also make money. With the high un-employment rate, many of the clients and young adults I am seeing are having a very difficult time finding work. This is causing an influx of teenagers and young adults on the streets bored and without money to pay their bills. Dr. Charles Sophy, Medical Director of the LA County Department of children and Family Services says “In this time of economic stress on families and parents inability to cope, their children, especially adolescents, drift to their own devices.” Boredom reeks havoc with today’s young adults and teenagers.

Another problem is adolescents and young adults are part of a generation that is used to instant gratification through video games, texts, cell phones, instant messaging, and other technology. They want what they want and they want it now and are not willing to wait. The pain they are trying to anesthetize coupled with their lack of impulse control makes the internet and access to controlled substances a viable option for any teen needing a fix. Sophie agrees, “Adolescent substance abuse is a growing problem and having our adolescents so easily connected to technology, allows easy accessibility.” With easy internet access, teenagers can buy all the drugs they could ever want with one press of a button.

Another issue is Doctor shopping. In fact, the Center for Addiction and Substance Abuse report over 40 percent of American Doctors don’t even inquire about their client’s previous prescription drug use or if they have an addiction, and over 30 percent don’t even gather a history of their patient’s previous medical records. In fact, investigators are presently investigating the records of multiple Doctors who might have prescribed medications to Michael Jackson, which might have contributed to his death. Joanne Barron, CADC, M.A. and National Outreach Director of Insight Treatment Program for adolescents says, “The availability of these drugs and the widespread use not only helps to make them available to teens, but promotes the false idea that they must not be that bad if doctors are prescribing them.” The attitudes amongst teens is packed with all sorts of denial that if prescription painkillers are not considered street drugs, and since technically a doctor’s prescription is needed, they are thought to be okay. “Once use is established, addressing the denial system by the adolescent and at times by the parents becomes a significant treatment focus. It’s not like I am smoking crack or shooting heroin, the pills were prescribed by a doctor……..my mom takes them for back pain is a rationalization as well as a symptom of the thought process that keeps the adolescent stuck in their abuse,” explains
Stephen Mardell, a Marriage and Family therapist who works with Adolescents and their families.

Another problem is how easy it is to steal prescription drugs right from their parents or grandparents medicine cabinets. Pain killers are rapidly increasing in the adult population which models acceptability in their teen’s eyes. “While teens recognize certain type of drugs like heroin or cocaine as being dangerous, often they do not recognize the dangers associated with prescription drugs because of their legal status”, says Barron. Many adults rely on sleep aids, pain medication, and anti-depressants, making these drugs easily accessible to teens wanting to numb out or fit in. Barron explains, “Parental attitudes trickle down, so that the more adults use prescribed pain killers, the more accepted they become.” Teens report how easy it is to gain access to their parents prescribed medications or even from their friend’s parents. Dr. David Lewis, MD and Medical Director of Visions Teen Treatment Program in Malibu, California reported on their blog parents should throw out outdated prescriptions and hide current ones, carefully monitoring the amounts. He continues to say, “Dumping an intensely psychoactive drug into a teenager’s developing brain is like a chemistry experiment and the damage can be devastating.” Another issue parent’s need to be aware of is pain medication can be difficult to spot especially with adolescents as many of the symptoms associated with pain medication mimic other developmentally “on-target” behaviors. “Some of these behaviors include, defiance, mood swings, irritability, withdrawal from parents, are among many symptoms that could be missed and viewed as age appropriate,” says Mardell.

Most teens feel immortal and immune to the destructive nature of drug addiction. Some teens will experiment but many will become dependent and the earlier they start using, the more likely they are to develop a serious addiction. Due to the rapid development of tolerance, there is a strong possibility that teens will progress to needing larger doses of medicine for the same effect which in turn increases the potential for overdoses and serious medical consequences. These same teens will also have difficulties with their attempts to get clean and sober and will continue to relapse. Allen Cardoza, President of West Shield Adolescent Services and host of LA Talk radio’s Answers 4 the Family, attributes the increase in addiction to prescription painkillers in teens to the three A’s: “accessibility, apathy, and acceptance.” He says emphatically, “These three situations are a recipe for disaster for teens and adults alike because by the time anyone knows there is a problem, most are deep into their addiction both psychologically, as well as chemically.”

Females become addicted more often than males. Getting high becomes an easy way to hide from uncomfortable feelings such as break-ups, un-popularity, school pressures, and all the other typical teenage woes. Among 12 to 17 year olds, girls are more likely than boys to have abused prescription drugs such as pain relievers, tranquilizers, and stimulants in the past year. (SAMHSA,2006). In fact, females will more often mix pain meds with alcohol for a stronger buzz without having to ingest more calories from more alcohol. This dangerous combination is called a “Diet Cocktail” amongst the Generation RX club scene. This plays right into today’s teenage girl’s struggles with eating disorders and their need to be a part of what society deems beautiful. Tara Schroeter, a Marriage and Family Therapist, who facilitiates teen and young women’s groups says, “Often young girls feel the need to fit in because of the pressures of society and what is considered beautiful, such as being thin. Often that image is not even truly who they really are.” Sophie agrees, “Often times these devices are influenced by peers and often times by anyone or anything that will make them feel accepted.”

An article in USA Today exposed another concern called “Pharm Parties.” This consists of groups of teenagers getting together encouraging each other to take multiple doses of unknown pills. Some professionals who work in the addiction field believe these gatherings have been over exaggerated, however, I have seen numerous teenagers in my own practice reporting on similar events. Regardless, the mixing of different prescription and illegal drugs can be deadly. “For teens, the possible lethal affects of mixing alcohol or marijuana with these drugs, the addiction potential and the possibility of overdoes must be addressed,” says Barron. She believes the community at large must become better educated about the growing trend in misuse of prescription drugs.

There are several warning signs to look for if parents believe their teenager is developing a dangerous addiction to prescription drugs. They include:

1. Signs and symptoms of anxiety, depression, irritability, agitation, and mood swings.
2. Low self esteem and an inability to express their feelings openly and honestly.
3. Social isolation and not feeling like they fit in with their peers.
4. Lethargy and difficulty sleeping.
5. Difficulty getting along with authority figures.
6. An overwhelming sense of responsibility and co-dependency towards others.
7. Weight loss.

Communication between parents and teens is vital in combating prescription drug addiction. Parents can take advantage of teachable moments to express the dangers of pain meds. An example of a teachable moment could be while watching television programs such as “Intervention” or “Celebrity Rehab” which depicts the ravages of drug addiction and what drug addicts have to go through to get clean and sober. It is often said in professional circles that addiction is a family disease; therefore, including parents in the treatment plan is absolutely necessary to help address family patterns that may cause stress, enable substance use, and damage the parent/child attachment. “My belief is that while the adolescent substance abuse is the overt reason for psychotherapy, family harmony and strong parent/child attachments are also primary therapeutic goals,” insists Mardell.

Other ways parents can prevent drug abuse include:

1. Keep prescription drugs hidden and out of reach from teenagers.
2. Adequate parental supervision by knowing who and where their teens are at all times.
3. Controlling their teenager’s med regimen by monitoring the dosages and refills if they are on other prescription meds.
4. Keeping teens busy with healthy extracurricular activities.
5. Explaining the dangerous effects of mixing drugs with alcohol as well as the dangers of mixing prescription meds.
6. Random drug testing.

References:
The 2005 National Survey on Drug Use and health, Substance Abuse and Mental health Services Administration (SAMHSA), 2006.

CASA’s National Center for Addiction and Substance Abuse at Columbia University 2009: national Survey of American Attitudes on Substance Abuse XIV: Teens and Parents.

Teens and Prescription Drugs: An Analysis of Recent Trends on the Emerging Drug Threat: Office of national Drug Control Policy Executive Office of the President, February 2007.

©Copyright 2009 by Sherry Gaba, LCSW and Life Coach. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Sherry and/or see her GoodTherapy.org Profile

Though a growing number of people are making the choice to quit smoking for a variety of reasons, physical health complications from the habit continue to be a problem of serious concern both for those who smoke and their loved ones as well as for taxpayers left with large bills to foot for associated medical issues. Most general practice doctors advise their clients to cease or significantly reduce their tobacco use, but one smoking cessation advocate notes that when it comes to those who exhibit signs of mental health concerns, many doctors shy away from suggesting that their clients should quit. Brian Hitsman of Northwestern University argues that while thirty eight percent of people visiting their medical physician receive treatment to quit smoking, a mere twelve percent of those with mental health difficulties receive the same treatment.

The discrepancy, suggests Hitsman, is the result of a false belief that tobacco use is somehow necessary or helpful for those with feelings of depression, anxiety, or any other mental health concerns. Unfortunately, this reluctance to persuade clients to quit smoking may have profound effects; on average, a far greater number of those with mental health issues smoke than those without symptoms.

Hitsman points out that people experiencing mental health difficulties may experience an increased challenge when attempting to quit smoking, but also notes that the cessation of tobacco use has not been shown to have any adverse effect on the symptoms of mental difficulties themselves. Rather, exhibiting the strength, determination, and commitment to overcome smoking may work wonders for those experiencing self-esteem issues or grappling with feelings of dependency. Far from something that should be swept under the rug, Hitsman proclaims that tobacco use among those with mental health concerns should be highlighted, addressed, and ultimately, resolved.

Often, an inability to access or receive meaningful mental health services can lead those experiencing debilitating symptoms to rely on pharmaceuticals and other substances in an effort to self-medicate. Such instances carry great risks, not only for physical and mental health, but for the development of deep addictions, engendering further negative consequences. This situation has been clearly observed recently in Kashmir, where long-term violence and social disorder have led to a growing number of women developing symptoms of mental health difficulties. The creation of accessible mental health care as well as treatment for addiction and substance abuse is needed to help the region recover from its deep-rooted turmoil.

Most people are well aware that some percentage of the population grapples with a substance abuse issue, and that trends in the precise substances used may change from time to time, but difficulties that arise as a result remain largely the same. Problems at work, within social lives, and at home can easily arise in the presence of substance abuse issues, and there are many factors that can compound the negative potential of drinking or drug use. But many people are not clear about the fact that experiencing mental health difficulties in conjunction with a substance abuse issue can be a great indication of serious risks to personal health and safety, a lack of understanding that may contribute to further suffering, such as in the case of one young adult with dual diagnoses who recently committed suicide.

The young man’s story may sound exotic –multiple trips in and out of mental health facilities, rehabilitations and relapses with substance abuse, and extreme difficulty finding treatment to collaboratively address both issues– yet his situation is likely shared by many who struggle with substance abuse and mental health concerns at the same time. The man’s parents express their remorse over their inability to find treatment capable of addressing both concerns in a meaningful way, an inability that they believe ultimately led to their son’s death.

Seeking new ways of identifying and treating substance abuse problems in those with mental health difficulties as well as screening addicts for symptoms of poor mental health and following up with comprehensive care are crucial in the effort to help all people, no matter how complex their situations, find their path to living with prosperity, happiness, and a sense of self-empowerment.

Internet addiction may seem like a slippery slope to many who use the internet for working and engaging in social interactions, but some people may experience a strong tendency to crave internet and computer use to a debilitating degree. To address this issue, an internet addiction clinic has been opened recently in Washington state, with hopes of helping addicts return to a prosperous and balanced life. The program runs for the course of forty five days and is not covered by insurance, but is intent on providing quality services to those who enter its doors.