Tuesday, January 29, 2008

Mental Health Screening in Juvinile Justice System Needed

ScienceDaily (Jan. 29, 2008) — Kids who have been arrested and are depressed are more likely to use drugs and alcohol and engage in unsafe sexual activity that puts them at greater risk for HIV, according to new research from the Bradley Hasbro Children's Research Center.

Findings of the study, published in the January issue of the Journal of Studies on Alcohol and Drugs, suggest the need for depression screenings as part of the juvenile intake process in order to determine appropriate mental health, substance use and HIV risk behavior interventions.

"We know that symptoms of depression may be a factor that is linked to both drug and alcohol use and sexual risk-taking behaviors," said lead author Marina Tolou-Shams, Ph.D., of the Bradley Hasbro Children's Research Center and an assistant research professor of psychiatry at The Warren Alpert Medical School of Brown University. "However, juvenile offenders aren't routinely screened for emotional difficulties, such as depression or anxiety -- rather, everyone tends to focus more on their conduct or behavioral problems."

She said that understanding more about the association between depression and risky behaviors can help create protocols for appropriately screening, assessing and identifying the needs of juvenile offenders and lead to positive health outcomes.

The current study is one of the first to examine the link between substance use, mental health and sexual risk among high-risk youth who have an arrest history but may not have been detained or incarcerated. According to Tolou-Shams, these kids may be at similar risk to those detained but are often released back to the community without ever having their needs comprehensively identified.

Researchers assessed the depressive symptoms, sexual behavior, substance use, risk attitudes and mental health history of 835 sexually active adolescents and young adults, ages 15 to 21, from Providence and Atlanta who participated in a larger, multi-site HIV prevention program. A quarter of the study participants had an arrest history.

They found that juvenile offenders with significant symptoms of depression, such as feelings of loneliness or worthlessness, reported much greater drug and alcohol use. They were also more likely to use these substances during sex, used condoms less, and had more psychiatric hospitalizations and suicide attempts than arrestees without depressive symptoms.

The authors caution that the study's findings need to be replicated with a larger, more representative sample of kids with depressive symptoms. However, based on these findings, they say substance use and HIV prevention efforts within the juvenile justice system that include strategies to regulate mood may help juvenile offenders reduce emotional distress, thereby reducing the likelihood of risky behaviors.

"Models of juvenile correction that address mental health and physical health are crucial, because arrestees' contact with the legal system may represent one of few opportunities to address health issues," the authors said.

Study co-authors were Larry K. Brown, M.D.; Christopher Houck, Ph.D.; and Celia Lescano, Ph.D., all of the Bradley Hasbro Children's Research Center and Alpert Medical School, along with the Project SHIELD Study Group -- a federally-funded prevention/intervention program aimed at developing and testing ways to encourage and enable behavior change among two subgroups at high risk for HIV infection: adolescents/young adults and women.

Sunday, January 27, 2008

Methadone Crusader

Salisbury, N.H., police chief David L'Esperance is working to improve drug-related law enforcement and education for personal and professional reasons: his son, Christopher, 20, died last year of a methadone overdose.

The Boston Globe reported Jan. 12. that L'Esperance has helped focus attention on the dangers of methadone, an effective treatment for opiate addiction that also is increasingly being prescribed as a pain medication -- and being diverted for illicit use.

In Massachusetts, fatal methadone overdoses rose 400 percent between 2002 and 2005, and the story is similar in New Hampshire. Nationally, methadone overdoses rose 390 percent between 1999 and 2004.

Whereas methadone clinics administer the drug in liquid form to opiate addicts, the drug also is available in 5 or 10 milligram tablets or 40 milligram wafers as a painkiller. Due to the controversy over OxyContin, many doctors began prescribing methadone for pain. That had led to more availability of the drug on the streets.

"It's a very serious problem," said Michael Botticelli, director of substance-abuse services at the Massachusetts Department of Public Health. "What seems to be the case is that there are people who got it for a legitimate reason and then, for one reason or another, it gets diverted and used inappropriately by somebody else."

"People think it's safe, especially kids," said L'Esperance. "Because they see the ads on TV, they see it in the medicine chest. They're clean. They're not coming from some meth lab. It's not a crack pipe that somebody else is using or a dirty needle."

Methadone metabolizes slowly, staying in the body for longer than most users realize and raising the risk of overdose among novices and those who take the drug in combination with alcohol or other drugs.

Wednesday, January 23, 2008

Recovering a Healthy View of You

by Dale Wolery

What is my view of me, your view of you? Is the internal consensus I maintain about me accurate, or is it distorted? Is your view of you the element propelling your recovery forward? Or does the way you think and feel about yourself make it more difficult for you to move forward in recovery?

Every pilgrimage into self-discovery and growth is an excursion into the known and the unknown, the certain and the uncertain, the charted and the uncharted. But everyone who intentionally and seriously embraces this journey enjoys its reward. My experience is that grappling with our view of ourselves can be immeasurably rewarding. And yet it is often very challenging and sometimes frightening. It is like mining for gold; you sometimes have to dig through many layers of subterranean stone and dirt before you find the treasures capable of impacting the balance sheet of your life. And sometimes it feels like all those layers you have worked so hard to dig through might come tumbling back down on top of you.

I've met some disconcerting snares on my own self-discovery journey. Are they familiar to you?

The Knowledge Trap

One snare is the knowledge trap. Certainly there is a body of knowledge that it is important for us to acquire about the self. Truths like each "self" is uniquely designed by its Creator, each of us is always warmly accepted by our loving Acceptor, and none of us can out-sin Grace. These facts are essential to an empowering view of the self. But we all learn sooner or later that insight has its limits. Recovering a healthy view of ourselves will require more than just increasing our knowledge about what is true. In addition to learning the truth about ourselves we will need to learn ways to feel and experience these truths. Consistently feeling and experiencing these powerful truths personally in one's soul requires process, struggle, and time. Knowing is important. But by itself it is not powerful enough to make possible the changes that need to be made.

The Performance Trap

Performance isn't enough either. It also is a trap. We can't do anything well enough, fast enough, better-than-everyone-else enough to achieve a healthy view of self. Even if we are very successful at achieving, we—or someone to whom we have granted Higher Power status—can raise the standard. Suddenly, more is expected before we can finally feel okay about ourselves. In most cases even perfection is not really enough. Like a puzzle missing some of the pieces, performance always leaves gaping holes in the picture of the self. There is no way to perform well enough to feel good about ourselves.

A related trap is an overemphasis on appearance. We critique and measure the visible self, the external self, from hair to feet. We endlessly appraise and compare. Are they too little? Too big? Is it too loose? Does it stick out too far? Does it sag too much? Can I cut it, pad it, dress it, accessorize it or accent it so that I feel better about me? The answer, of course, is yes and no. Our bodies surely do impact our view of ourselves. But they are only one patch in the self-image quilt. No amount of external effort fills unattended internal voids. There is no way to look good enough to feel good about ourselves. It's just another version of the perfectionist's nightmare.

Recovering a Healthy Self

So what is essential for the journey toward a healthy view of ourselves? This issue of STEPS looks at this question from several perspectives. Allow me to emphasize three factors that seem particularly important to me.]

First, we must be willing to throw away any theology or teaching that causes us to feel like trash. It may be a cliché, but God does not make junk.

Second, it is important for us to connect with empowering, nurturing people. If, early in childhood, we were deprived of a sense of self that can be acquired only in the arms of nurturing and adoring parents, then we will not regain it without nurturing arms and warm hearts encircling us. Recovery groups and caring counselors are priceless in this process.

Third, recovering a healthy view of ourselves is and may always be a struggle. Like white-water rapids on a river journey, the essential experience that you and I need for sound views of the self are necessarily chaotic and turbulent. Knowing, really knowing, that we are uniquely created, specially suited and deeply loved won't just happen. It requires struggle.

I was recently reminded of the way that rough waters contribute to a landscape. While viewing a rushing stream from a high mountain pass I was struck by the beauty added by the struggle. I can't say that I enjoy the fear and the uncertainty that rapids can cause. But I am deeply grateful to God for the beauty that they can contribute to life.

May this issue of STEPS support and guide you through the white water of life to a more buoyant view of you. May you come to share the beautiful view of you that your Creator enjoys from above.

Tuesday, January 22, 2008

This is a call to arms for everyone who may someday be hospitalized, or who has a relative who may someday be hospitalized — which is to say everyone.

These days, to spend time in the hospital is to be at risk of contracting a hospital-acquired infection. Some of these infections can be life-threatening. But there is a simple way to make that hospital stay safer, devised by Dr. Peter J. Pronovost, a physician-researcher at Johns Hopkins.

The method — a five-item checklist to assure that proper precautions are taken to prevent infection — has been thoroughly tested, first at Johns Hopkins and later in 108 intensive-care units in Michigan, where it succeeded beyond anyone’s wildest dreams in saving lives and reducing costs for patients who received the major fluid tube called a central venous catheter.

According to Dr. Pronovost, whose findings in Michigan were published in The New England Journal of Medicine on Dec. 28, 2006, about half of intensive-care patients receive these catheters; about 80,000 a year become infected and 28,000 die, with an economic cost of $2.3 billion.

Five Simple Steps

Using the checklist, in 18 months the average I.C.U. at these diverse hospitals reduced its catheter-related infection rate to zero, from 4 percent. All told, the checklist saved more than 1,500 lives and nearly $200 million. The program itself cost only $500,000.

Dr. Pronovost, a professor of anesthesiology and critical care medicine, said in an interview that he distilled the five steps from a 64-page federal document on controlling hospital-acquired infections. When inserting a central venous catheter, doctors should do the following:

1. Wash their hands with soap.

2. Clean the patient’s skin with chlorhexidine antiseptic.

3. Put sterile drapes over the entire patient.

4. Wear a sterile mask, hat, gown and gloves.

5. Put a sterile dressing over the catheter site.

To someone on the outside, this list may seem like a no-brainer. But in the crush of crisis medicine, one or more of these steps is often neglected, sometimes with disastrous results. What made the program work in Michigan was continuous — and anonymous — collection of data. The hospitals were monitored on their use of the list, their rates of infection and their feedback to medical personnel to show what was working and where gaps remained in quality care.

The task now is to expand the checklist concept to other procedures and to get hospitals throughout the country to adopt it. New Jersey and Rhode Island are already planning to use it. And following a report on the checklist in the Dec. 10, 2007, issue of The New Yorker by Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston, Dr. Pronovost said he had been approached by health care authorities in California, Washington and Tennessee seeking the program for their states. Spain is adopting the program nationwide, and the World Health Organization is hoping to take it global.

As Dr. Pronovost explained, medical research must go beyond understanding the biology of disease and devising effective therapies.

“We have to assure that we deliver those therapies safely and effectively, but research examining 300 quality measures showed that patients receive adequate therapy only about half the time,” he said.

“My approach was to figure out what it takes to change behavior,” Dr. Pronovost said. “This represents the biggest opportunity to improve health — making sure that what we know works is delivered safely, effectively and efficiently.”

Coincidentally, a report in the Jan. 15 issue of Clinical Infectious Diseases by Dr. Sanjay Saint and colleagues at the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan stated that 1 percent of hospital patients fitted with a urinary catheter developed a urinary tract infection. Forty percent of all hospital-acquired infections are urinary.

Dr. Saint’s national study “found no strategy that appeared to be widely used to prevent hospital-acquired urinary tract infections.” Nearly half of hospitals had no system telling them which patients had a catheter, and three-fourths had no system to show how long the catheter was in place or whether it had been removed. Furthermore, fewer than 10 percent of hospitals used any system to remind doctors to check daily on whether a patient’s catheter was necessary; the longer one is in, the greater the likelihood of infection.

A nationally imposed checklist for safe urinary catheter insertion and removal could sharply reduce the risk to patients and the costs of hospital care.

But checklists need not be limited to reducing the risk of hospital-acquired infections. As Dr. Gawande and Dr. Pronovost explained, they could be used to enhance the safety of surgery and anesthesia, the treatment of patients with heart disease, diabetes, pulmonary diseases like asthma and a host of other conditions where certain approaches to care have been scientifically established as most effective but are still often neglected.

What You Can Do

The federal Office for Human Research Protections recently ruled that because this quality-control program constituted research on human subjects, every participating hospital must first get approval from its institutional review board. That ruling did not halt the use of checklists in the Michigan hospitals where they had become part of routine care. But it did stop the collection of data based on the lists, which Dr. Gawande described as “the driving force behind the effectiveness of the program,” until each hospital’s institutional review board approved it.

These boards meet monthly, bimonthly or quarterly. Sam Watson, executive director of the Michigan Hospital Association’s Keystone Center for Patient Safety and Quality, a sponsor of the Michigan checklist program, said the need for their approval could seriously delay the use of checklists for other aspects of medical care, like preventing hospital-acquired urinary infections — something his center has been working on with Dr. Saint.

Dr. Gawande suggested that consumers write to their members of Congress and the Department of Health and Human Services, asking that the ruling be reversed. Dr. Pronovost suggested that consumers let Congress know that checklist programs “could have a profound impact on their health,” ask local hospitals whether they are using checklists to reduce infections, and write to state hospital associations asking for a statewide effort to reduce infections.

In addition, Dr. Pronovost said, hospital patients should be their own advocates, armed with their own checklist and asking medical personnel whether they are using it “to help assure that I don’t get an infection” or asking, “Do I still need this catheter?”
Source: http://www.nytimes.com

Wednesday, January 16, 2008

Drink to Much?

IF YOU NEED HELP AND SUPPORT NOW PLEASE VISIT US AT The Sober Village or Sober Musicians where we care, understand and have been there!!

Here are practical suggestions for either cutting down or abstaining from alcohol along with tips for helping loved ones who have a drinking problem. Useful sources of help for alcohol and drinking abuse problems are also listed.
Some Questions

Could you or someone you care about drink too much? 1

* Do you drink alone when you feel angry or sad?
* Does your drinking ever make you late for school or work?
* Does your drinking worry your family or friends?
* Do you ever drink after telling yourself you won't?
* Do you ever forget what you did while you were drinking?
* Do you ever get headaches or have hangovers after drinking?
* Have you started hanging out with heavy drinking friends?
* Do your friends use less alcohol than you do?
* Have you ever been in trouble because of your drinking?
* Do you ever borrow money or go without things in order to buy alcohol?
* Is drinking hurting your reputation?
* Do you feel a sense of power when drinking?
* Do you ever drink until your supply is gone?
Set Goals

Write your drinking goal on a piece of paper and put it where you can see it, such as on your refrigerator or bathroom mirror.

I will start on this day ________.

I will not drink more than ________ drinks in 1 day.

I will not drink more than ______ drinks in 1 week.


I will stop drinking alcohol.
Have you ever lost friends because of your use of alcohol?
* Do you think you might have a drinking problem?

The more of these questions that apply, the greater the chance that you might have a problem with drinking. But having a drinking problem doesn't mean that you are alcoholic or that you have to abstain from alcohol. Most, people who experience problems from drinking choose to reduce their consumption to moderate levels rather than to abstain. You might consult with your doctor for advice.
How to Cut Back on Drinking

1. Write down your reasons for drinking less.

Why do you want to drink less? To protect your health, to get along better with your family or friends, to do better in school or to save your job? Make a list of the reasons you want to drink less.

2. Set a drinking goal.

Choose a limit for how much you will drink. A common guideline in the U.S. is no more than one drink per day for women and no more than two drinks a day for men. These daily drinks can't be "saved" and consumed later. For example, a man can't abstain all week and then consume all 14 drinks in one day.

Most countries define moderation at higher levels of consumption than does the US. For example, Australia, Italy and France consider anything from three to over four drinks per day for men to be moderate drinking. 2.1

3. Keep a "diary" of your drinking.

To help you reach your goal, keep a diary of your drinking. For example, write down every time you have a drink for three or four weeks. This will show you when, where, and how much you drink. How different is you goal from the amount you drink now?

e especially careful at home

Keep only a small amount of alcohol, or even no alcohol, at home. This will help reduce temptation.
Keep your blood alcohol content (BAC) low

When you drink, sip your drink slowly. Drink for taste rather than effect.

Don't drink on an empty stomach.

Consume no more than one drink per hour.

Eat food or "munchies" while drinking. High protein and high fat foods like cheese and nuts are especially good at keeping your blood alcohol content low.

Drink soda, water, or juice after a drink containing alcohol.
Learn to say "no" when you don't want a drink

You don't have to take a drink just because it's offered to you.

You can "lose" unwanted drinks that are given to you. For example, set them down and later walk away.

"A Consumer Guide to Recovery Options" provides excellent descriptions of both abstinence and non-abstinence recovery options. This useful guide is in Anne M. Fletcher's Sober for Good (NY: Houghton Mifflin, 2001), pp. 267-302.

Additional resources below.

You can drink non-alcoholic drinks that look like alcoholic ones. For example, tomato juice, lemonade, iced tea, water with ice cubes, club soda with orange juice, tonic water with a twist or wedge of lime, and either orange juice or 7-Up with grenadine.

Stay away from people who give you a hard time about not drinking as much as they do.

Saying "no" gets easier the more you do it. Practice refusing drinks politely. Say something clever. 3

I don't need any more hair on my chest

I'm performing neurosurgery in the morning

It sloshes too much when I jog

No thank you
Get support

Cutting down on your drinking can be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down; medications are available to help make it easier. Get whatever help you need to reach your goal.
Avoid temptations

Stay away from people who want you to drink more than you want to. Watch out for people, times, places or situations that encourage you to drink too much.
Don't give up!

If you don't reach your goal the first time you try, don't get discouraged. Try again. Remember, get support from people who care about you and want to help. Don't give up!

Some signs that may indicate a drinking problem in a loved one include:

* Changes in drinking patterns. The person drinks more, or more often, or drinks in the morning.
* Changes in appearance. The person frequently or usually smells of alcohol, has slurred speech, bloodshot eyes, unexplained bruises, or unkempt appearances.
* Changes in personality. The person suffers memory loss, sleep problems, mood swings, irritability, distrust, or lack in activities earlier enjoyed.
* Health problems. The person suffers from frequent hangovers, chronic digestive problems, fatigue, or shaky hands. 5

Helping a Loved One

Having a drinking problem does not mean that a person is alcoholic, or addicted to alcohol. The person may only need to cut down rather than abstain. Many find the idea of drinking in moderation more acceptable and achievable than abstaining entirely from alcohol.

The decision whether to reduce drinking to moderate levels or abstain entirely from alcohol is best made after consulting with a doctor.

Helping a person who drinks too much takes knowledge, compassion and patience. Some actions are helpful and others are not.

* Try to remain calm, unemotional and factually honest about how the person's drinking abuse hurts you and others.
* Discuss the problem with someone you trust - a friend, clergy person, social worker, or someone who has experienced alcohol abuse or alcoholism either personally or as a family member.
* Try to maintain a healthy, normal atmosphere in the home and try to include the alcoholic or problem drinker in family life.
* Encourage new interests and participate in leisure activities that the problem drinker enjoys and encourage the person to see old friends in non-drinking situations.
* Be patient and live one day at a time. Changing behavior is difficult, as dieters and those attempting to stop smoking know. Setbacks and relapses are to be expected. Try to accept them with calm understanding and don't become discouraged.


* Punish, threaten, bribe, preach, or try to be a martyr. Avoid emotional appeals that may only increase the problem drinker's feelings of guilt and compulsion to drink.
* Cover up or make excuses for an alcoholic or shield a person from the consequences of alcohol abuse.
* Take over the responsibilities of an abuser of alcohol.
* Hide or dump bottles of alcohol, or shelter a problem drinker from situations where alcohol is present.
* Argue with a person who is intoxicated.
* Drink with an alcohol abuser.
* Accept guilt for the behavior of a problem drinker.

Remember that changing behavior, especially becoming an abstainer, is very difficult. Be understanding and patient, but don't accept any responsibility or guilt for the behavior of another person. You are responsible only for your own behavior.

Tuesday, January 15, 2008

Breaking the cycle of drug addiction

If a community were a pond, then drug addiction would be a pebble big enough to cause ripples throughout, said Jim Gouveia, Benton County Drug Treatment Court program coordinator.

According to the U.S. Substance Abuse and Mental Health Administration, Oregon ranks No. 2 in the country for illegal drug use, and mid-valley communities are no exception.

“I can’t say the drug problem in Benton County has increased necessarily,” Gouveia said. “But we’re up there.”

Drug use isn’t an individual problem or even a family problem. It’s a community problem, said Jennifer Hogansen, a behavioral health specialist with the Corvallis Clinic.

“The effects on children and families, in particular, can be devastating,” Hogansen said.

The drug problem is a top priority for the criminal justice and social services systems, as well as educators, mental health experts and taxpayers.

Locally, a consistent approach of modifying drug users’ behavior to achieve lasting, life-changing results is being applied to public and private treatment programs. One of those programs is Benton County’s Drug Treatment Court.

There have been 70 or so graduates in its six years of existence, and officials say the program, which costs less than one-tenth as much as incarceration, is responsible for seeing some of the area’s most chronic criminal drug offenders become clean and sober, finish school, find jobs and become productive members of the community.

Cause for change

Figures from the Oregon Department of Human Services show that about 90 percent of children in foster care are there because of their parents’ drug use.

Hogansen previously worked as a clinical psychologist at Oregon Health & Science University and as a research assistant professor at Portland State University, where she studied the incidence of disabilities of children in Oregon’s foster care system. It’s believed than many of these children have a disability or experienced abuse, Hogansen said.

“When meth is involved, these rates skyrocket,” she said.

Drug addiction is a strategy that some people use for managing life, and parents who are using this strategy typically have limited parenting skills. For example, parents who are meth users often do not parent at all, meaning they neglect their children.

“This often results in an absence of basic needs like food, shelter and love,” Hogansen said.

Many of these children go on to have emotional or behavioral problems and developmental issues such as defiant behavior, communication problems, poor attention and impulse control, sensory difficulties and impaired emotional regulation, Hogansen said.

A flawed strategy

According to figures from the Benton County District Attorney’s office, 80 percent of the criminal cases are alcohol- or drug-related. Many of those crimes are thefts and burglaries committed by people who are trying to steal so they can pay for drugs. Most of these people make their way to the parole and probation system and get caught again for the same crimes.

The cycle is doomed to repeat, Gouveia explained.

“People can be compliant with treatment so long as there’s a hammer held over their head,” he said.

But compliance usually only lasts as long as drug users are supervised.

Turning things around

Benton County’s multidisciplinary drug treatment court incorporates the district attorney’s office, public defenders, psychologists and treatment providers, and law enforcement to work with drug users to internalize a behavior change.

“We work on getting them to see the benefit to them. If we motivate them to change, that will be lasting because it’s a choice they made, not a choice someone’s made for them,” Gouveia said.

Using a method known as motivational interviewing, treatment providers work with drug users to change their behavior. Through cognitive behavior therapy, people learn how to recognize and evaluate when they’re having thinking errors and to see how using drugs is not an effective way to deal with life.

Treatment involves intensive case management, as clients receive mental health care and housing assistance, and take GED, college or job-training courses. A majority of people in the program are parents, Gouveia said, and those with children are required to take parenting classes.

At a cost to the county of $9 a day, the drug treatment court program is a significant savings compared to the $150 a day the county pays to keep a person in jail. Benton County Drug Treatment Court Judge Janet Holcomb said the program is the best strategy she’s ever seen for dealing with criminal defendants.

“It’s cost effective,” Holcomb said. “It ties a lot of community partners together. I’m sold.”

Unlike in the regular criminal justice system, the consequences are immediate, as offenders can be whisked off to jail for failing a random drug test or lying to the judge at a mandatory weekly court appearance.

“The quickest way to get sent to jail in drug treatment court is to lie. We teach them to be honest in their recovery and provide close supervision and accountability,” Holcomb said.

Although drug treatment court is an accountability model, it’s also based on improving lives and strengthening and empowering people, Holcomb said. The change can be gradual to take hold.

“But people really do want to change their lives,” she said.

source: Albany Democrat Herald

Monday, January 14, 2008


CRAFT: An Alternative to Intervention

by Robert J. Meyers, Ph.D.


* The CRAFT method relies on nonconfrontational methods to encourage loved ones to enter addiction treatment.
* The method also can help family members improve the quality of their lives.
* CRAFT's effectiveness has been proven through scientific study.

Do you have a substance-using loved one who refuses treatment? The CRAFT program may help. CRAFT - Community Reinforcement and Family Training - teaches the use of healthy rewards to encourage positive behaviors. Plus, it focuses on helping both the substance user and the family.

The CRAFT goals are to teach you how to encourage your substance user to reduce use and enter treatment. The other goal is to help you enhance your own quality of life. This non-confrontational approach teaches you how to figure out the best times and strategies to make small but powerful changes. And it will show you how to do so in a fashion that reduces relationship conflict.

Experts have based CRAFT on solid science. People from many walks of life have used it successfully to help their loved ones and themselves. Whether you are the parent, spouse, romantic partner, adult child or friend of the substance user, research tells us that you too can succeed with this program. The methods are effective and easy to learn . CRAFT allows family members to feel good about their efforts on behalf of their loved ones.
When a CRAFT Program is Not Available in Your Community

CRAFT can easily be learned on your own. The 2004 book, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening by Robert J. Meyers and Brenda L. Wolfe, was written to bring CRAFT right into your home. It helps you change the way you think about your situation and teaches you how to help your loved one learn to enjoy a sober lifestyle. The authors also help you rethink your own lifestyle to make it safer and saner regardless of what your loved one does. If you are also working with a therapist, we recommend that you alert your counselor to the CRAFT manual for therapists, Motivating Substance Abusers to Enter Treatment: Working with Family Members.

1. CRAFT is a motivational model of help based on research that consistently finds motivational treatments to be superior to confrontational ones.

CRAFT shows you how to develop your loved one's motivation to change by helping you figure out how to appropriately reward healthy behavior. You learn how to make sober activities more attractive to your loved one, and drug- or alcohol-using activities less inviting. In this way, you minimize conflict and maximize cooperative relationship-enhancing interactions with your loved one.

2. More than two-thirds of family members who use CRAFT successfully engage their substance using loved ones in treatment.

This stands in sharp contrast to confrontational interventions that result in fewer than one-third of substance users entering treatment. The graph depicts one of the alcohol studies that contrasted CRAFT with both intervention and a modified approach supported by Al-Anon, a support group for family members of people with alcoholism.

3. Evidence suggests that substance users who are pushed into treatment by a traditional confrontational intervention are more likely to relapse than clients who are encouraged into treatment with less confrontational means.

4. Family members who use CRAFT experience greater improvements in their emotional and physical health than do those who use confrontational methods to try to help their loved ones.

5. People who use CRAFT are more likely to see the process through to success than those who use confrontational methods.

CRAFT programs have extremely low dropout rates, while over 75% of the people who try to use traditional interventions quit. The dropouts report that the confrontational techniques are too distressing and they worry about doing permanent damage to their relationship with the substance user.


1. CRAFT's system of offering and withdrawing "rewards" such as your affection and attention is just another way of enabling someone who is using substances. And enabling is bad.

Receiving affection and compliments for non-using behavior makes that behavior more enjoyable for your loved one. So, being nice when your loved one is engaged in sober activities makes it more likely that she or he continues those behaviors. One might say that you are "enabling" healthy behavior. Furthermore, CRAFT specifically teaches you how to withdraw rewards when the person is using - and this is the opposite of the traditional concept of enabling.

2. No one enters treatment until they "hit bottom" so using CRAFT while your loved one is still functioning is a waste of time.
People enter treatment when the reasons not to use outweigh the reasons to use. And as research has clearly shown, family members can help shift the balance so that the user develops enough reasons to stop. You can increase your loved one's reasons to not use by making sober time more enjoyable than using time. When she or he is not using, enjoy good times together. When she or he does use, withdraw yourself from the situation. The more pleasure your loved one experiences while sober, the less attractive getting drunk or high will be. So it is never too early to use the CRAFT alternative to nagging and threatening.

3. Most substance users overdo it all the time so it is impossible to do anything to lessen the severity of their use.
To the contrary, CRAFT teaches you how to map out your loved one's patterns to figure out the best ways to alter them. You learn two critical skills that allow you to do this. One is to identify the early triggers and signs of a drinking or drugging episode. The other is to determine which consequences you can influence or orchestrate yourself to begin to manage those episodes.

4. If you love someone, it is cruel to allow him or her to sleep in vomit or endure public humiliation when you have the power to fix those things.

Substance use creates messes. It causes missed work, embarrassing public behavior, vomit, wrecked relationships and worse. When it is your own loved one who gets into these messes, it is very difficult to just stand by and let him or her suffer. However, fixing the messes and protecting your loved one from his or her poor choices only makes it okay for those choices to be repeated. This may indeed be the most difficult lesson of CRAFT. With the exception of allowing truly dangerous behavior, let your loved deal with his or her own messes. These are called natural consequences and are powerful motivators to rethink one's behavior choices.

5. Once your loved one agrees to stop using or enter treatment, your job is done.

Between agreeing to enter treatment and making an appointment, a thousand things will change a substance user's mind. Your job, as a successful CRAFT practicer, is to select a therapist and be sure that he or she is ready to see your loved one within a day or two. From there, your support of treatment is invaluable. It can make the difference between your loved one dropping out of treatment or joining you in a happier, healthier life.

Saturday, January 12, 2008

I haven't killed anyone.. yet.

I've come to the conclusion over the years that most addicts are good people with a bad disease. In my conversations with many of them, they express a great deal of remorse for what they do and continue to do. Many become suicidal, not because they feel so sick, but because they cannot bear the thought of continuing to hurt those they love. To wake up day after day, not quite remembering what occurred the night before, then to see the look of disappointment and fear on the faces of the ones closest to you is a terrible thing - for everyone.

My arms are covered with light scarring - from practice cuts, "calls for help", and sometimes the pain inflicted would over-ride the confusion, fear and other emotional pain that was building inside me. They are a good reminder of the "dark days".........Death would have been an acceptable if not desirable effect of what I was doing.

There's a saying that goes "God looks after drunks and fools"....well, I can say from personal experience he (whoever he/she/it is) definitely does. When things got too much for me, I took a massive overdose and woke up 3 days later. Alone (no-one had found me), hallucinating, bright red through high blood pressure but, unfortunately, alive. I say unfortunately because that is how I felt at the time. I feared the future and what I may do next. I was so sure I was going to die from the overdose, I was at a total loss when I regained consciousness. So I did what any good addict would do in the situation - went and got blasted!

The years of accumulated destruction I had left behind me were really starting to wear me down. I could not see a time when I could walk down a street without looking over my shoulder. There were all the "yets" to think about:

I hadn't robbed a bank...yet
I hadn't killed anyone...yet
I didn't have irreversible brain damage...yet
There were still quite a few unspeakable things I hadn't done...yet.

If you are in the grip of a substance addiction....look back over the years...have things gotten better? What makes you think they will?

When you are an addict, you don't have control over a substance or a great deal of your behaviour while you are under the influence of that substance. As the disease progresses, your self-control declines. If you are an addict, it is very unwise to say "I would never do something like that" .... our jails are full of people who have uttered those damning words.

If you are close to an addict; whether you are their partner, family or friend there is also no way that you can state "He/She would never do that to me". Your false sense of security could cost you your life.

If you are living with someone who has a substance abuse problem and refuses to do anything about it, my advice to you is to pack your bags and leave... especially if you have children in your care. You may be saying to yourself "it's not that easy". It is. Think about the alternative - a life of continued fear and insecurity, or worse.

Have you ever heard of the "battered wife syndrome"? The victims are usually people who have been in an abusive relationship for so long, the person feels they can no longer leave, they have forgotten what "normal" is. Substance abuse is usually a feature in these relationships.

Read the papers.... "Father of four slays family"

Alcohol and other drugs greatly impair areas of the brain that deal with memory, reasoning, inhibition and aggression....the longer the abuse, the more the damage - the worse the behaviour.

So fellow addicts, what to do?

Suicide is an option if you don't wish to get help - but make it quick, the suicide through drug abuse is long and drawn out for everyone. Also, suicide is a bit harder than what people imagine. I have tasted the cold steel of a rifle barrel in my mouth - I didn't pull the trigger. I do know others that did. After all their years of drug abuse, they left one final gift for their family and friends - their corpses. How thoughtful. Another mess that others have to clean up on your behalf.

But there is another way, it's called recovery. A total stranger introduced it to me....

There are many strangers who can show you it too....

Pick up a telephone directory and look under "Drug and Alcohol". Almost everyone country in the world has a section for it. There you will find numbers for groups of people who have been to hell and back, who know just what you are going through. While I am aware that many countries in the world do not offer free detox services, these community based groups will assist you with detoxing and have "contacts" that can help you through the dangerous time of physical withdrawal.

Please, never try to withdraw on your own....

Life can be different for you - positive, energizing, peaceful

Or haven't you had enough of your addiction.....yet?

Michael Bloch

Friday, January 11, 2008

Anger Junkies

At the age of 3, Steven Stosny was rushed to a hospital emergency room with a roof shingle lodged in his skull. In a burst of angry rage, his father had thrown it at Stosny after the toddler poked a stick into wall plaster that was still damp. Along with a permanent hole in his head ("Do you want to feel it?" he asks), Stosny was left with a vivid experience of the deadly potential of uncontrolled anger. Today, the 55-year-old Stosny—a Ph.D. and clinical psychologist practicing in the Washington, D.C. area—has become a multimedia guru of anger. He has turned his intimate understanding of the emotion and its roots into an unconventional treatment method that's gaining both widespread popular attention and the notice of other psychologists. Most anger management programs are based on cognitive-behavioral therapy and the premise that our rational thoughts shape our emotional responses. If you can think before you explode and use relaxation techniques to calm your physiological response, the theory goes, you can control your anger and its potentially messy aftermath.

But research has shown that conventional anger management doesn't work very well. Domestic violence treatment is even less effective. These programs can help the highly motivated—but most people with problem anger don't think they have a problem and don't seek out treatment. Besides, merely controlling the impulse to lash out doesn't get to the root of long-term resentments. At the heart of problem anger, believes Stosny, are severe feelings of shame and guilt as well as a lack of empathy for self and others—or at least an inability to recognize and express it. Rather than merely teaching tactics to control anger, Stosny asks his clients to look at their emotional core and make a truly revolutionary shift: trade bullying for compassion. Instead of confronting angry people with their failures, he provides a way for them to adhere to their own internal values and meet their own best standards. Once that person recognizes his or her own best qualities, it becomes easier to substitute kindness and compassion for violence and hostility. "If you show people a way to change," says Stosny, "they do."

Anatomy Of Anger

Anger is not a popular subject of study. It's not fun to be around, and angry people are difficult to treat. Inevitably, studying anger also involves taking on the conundrum of domestic abuse, a sensitive subject dominated by what Raymond DiGiuseppe, a professor of psychology at St. John's University in New York City, calls a "politically correct view" focused on sexual inequality.

There is no consensus on anger's roots or definition, and academics debate whether persistent anger, which usually accompanies depression or anxiety, is an emotional disorder in its own right. Nor is there agreement on how to help people deal with anger. Many consider "anger management" an empty buzzword. "I hate the term," says DiGiuseppe. "It implies that we can keep anger under wraps. It doesn't imply therapy or treatment for a problem."

As a culture, we're ambivalent about anger. On one hand, there is a hip righteousness associated with flipping the bird at a driver who cuts you off; or, if you are a professional athlete, barreling into the stands to pummel the fan who has thrown a paper cup at your head. At the same time, we wring our hands in fear that anger is corroding civil society. But a moderate amount of anger, expressed under the right circumstances, plays an important role in healthy psychology. It saves us from predators, literal and figurative. Anger can motivate us to take on unpleasant tasks, like confronting a bully; it can maneuver others into attending to our needs. Besides, feeling anger doesn't always mean acting on it. Only 10 percent of anger is followed by aggression, points out Howard Kassinove, a psychology professor at Hofstra University in Hempstead, New York. "For a lot of us it's 'anger in,'" he says. "It's usually not shown."

Nonetheless, anger's provocations can be overwhelming and pervasive. More typical than physical aggression is the coworker seething with disappointment and resentment. Even everyday hassles like commuting or struggling with an automated phone system can cause anger that manifests as stress, hostility, depression or physical illness. Stosny's lesson is that once the root of anger is identified, a person can learn to be less responsive to these petty frustrations—and gain control over what seems to be an uncontrollable reaction.

How Anger Junkies Are Made

"Most people with real anger problems think that something outside of them controls what they think and feel," Stosny explains in an interview at A.M.E. Reid Temple in Prince George's County, Maryland, where he is preparing to teach a class. "They see themselves as just reacting to their environment. I want them to learn that there's something in them that regulates their emotions, regardless of what other people do."

This night is the third meeting of Stosny's 14-week workshop. It's a larger group than normal—his appearances on The Oprah Winfrey Show have brought many new clients. Stosny began his workshops in 1990 treating Maryland maximum security inmates, and since then, referrals from the criminal justice system have made up the bulk of his practice. Tonight's participants saunter into the fluorescent-lit basement classroom. About 25 of those present, mostly African-American men, have been ordered by a judge to attend, many on domestic violence charges. Few talk. There is little eye contact.

Stosny, dressed in pressed slacks, a blue collared shirt and black sweater, is a slight man with a low-key presence and a vestigial New Jersey accent. Initially, it is hard to imagine that this unimposing white guy, who appears not to have suffered an angry day in his life, could have much to offer this group.

Tonight's lesson: HEALS, Stosny's acronym for the five steps in a process that replaces feelings of anger with feelings of compassion. It will be learned through repetition—what Stosny calls "emotional conditioning"—to be practiced at least 12 times a day for the next 12 weeks.

His method has been shaped by John Bowlby's attachment theories and the teachings of Silvan Tomkins, who believed that all emotion is expressed physiologically. In his book Treating Attachment Abuse, Stosny explains that "a natural and healthy function" of shame or guilt is to help us maintain our attachment to loved ones: parent, lover, child. If we are threatened with loss of that relationship, guilt and shame motivate us to reestablish the bond, often through angry behavior. The problem is that anger is a turnoff, pushing the attachment figure further away, and making us angrier still.

"I've worked with more than 4,500 court-ordered DV offenders and child abusers, and I never met one who didn't feel like a powerless victim," he says— "No matter how victimizing they are, they see themselves retaliating against an unfair relationship or an unfair world." In this way, we learn from early relationships to blame our unpleasant feelings on others. So as adults, when we feel shamed or disregarded in situations that have nothing to do with loved ones—say, in the hierarchical workplace or in rush-hour traffic—our reaction is to get angry, targeting the person who made us feel that way. At the same time, we get a neurochemical rush from anger that relieves anxiety and provides a physiological boost. The nasty cycle turns many into what Stosny calls "anger junkies."

Psychology Today Magazine

Tuesday, January 8, 2008

Frustration Inc.

Frustration - for all of humanity it is an annoying, physically and mentally draining state of being that negatively affects our health.

For the recovering addict, chronic frustration is a one way ticket to "busting" and all the implications of it. "Busting" simply means using or drinking again. And the next bust may be the one we never recover from.

Frustration affects recovering addicts quite profoundly. Up until recovery we are used to dealing with frustration by turning to our substances of choice for relief. Suddenly it is no longer there to calm our thoughts and to numb the senses. We are left with random thoughts spinning in our minds until our brains feel as though they will escape our bodies via our eardrums.

So exactly what is frustration? It really is another word for stress. Stress is the feeling of a lack of control, but stress can also be a positive thing. There are two main types:

Distress - Anguish of body or mind. (Think of the word "DYSentery - A disease attended with inflammation and ulceration of the colon and rectum, and characterized by gripping pains and a constant desire to evacuate the bowels"). I think that describes it perfectly!!! ....in other words, things become a pain in the butt and situations give you the s....!

Eustress - The euphoric state induced by meeting a particularly challenging situation and emerging victorious.

Unfortunately, our modern lives seem to be plagued more with distress than eustress opportunities. But some of this frustration can be traced back to situations that we actually have control over. We just need to examine how we ended up in the position in the first place and learn not to repeat it. Any situation that we have appropriate control over decreases the chances of distress and increases the probability of eustress.

As addicts, we excel in getting ourselves into nasty situations. Our expertise falls down in getting out of them - this usually required the intervention of others. So while we are on the road to recovery, we need to take a serious look at our approaches to life situations. How are we dealing with them? If we are utilizing techniques from our dark days, such as sweeping things under the carpet or lying our way out, we are in trouble. Thought precedes action. I remember a cliché from my initial days of recovery that helped me out - "Stinkin' thinkin' leads to drinkin'. Okay, so it's Pollyanna rhetoric...but it worked for me; I used a mental library of these little quotes to help me through the tough days!

Being clean and sober is not just about abstaining from substances, but also changing our attitudes and defense mechanisms.

Dealing with frustration may mean that we need to learn to assert ourselves effectively, to allow people to know that they are "treading over the line" and giving them the opportunity to step back. There is a very fine line between assertion and aggression. Being assertive is to defend your rights and ideals without infringing on another's. Being aggressive is to attack another person. If we assert ourselves properly, there is less likelihood of being caught in situations we find frustrating.

Instead of allowing our frustration to build to a point that we lose control of our emotions, we need to recognize when events are piling up on us and take some affirmative action to clear our headspace.

We can get so bogged down in the day to day stuff of life, that we forget to nourish the person within. Recovered addicts have a tendency to be very hard workers, making up for lost time I guess. Hard work is good and rewarding, but can sometimes make us lose sight of the big picture. So we must take the time to "stop and smell the roses"....whatever the "rose" may be. And yes, mum and dad, if you are reading this I know exactly what you are thinking.... the term "hypocrite" springs to mind? ;-)

Also, it would seem by our very nature that we are easily frustrated people - it's written into us from the day we are born, part of the "Addictive Personality" (more on that in another article). We need to accept that things won't always move at the pace we wished, including our recovery, that the bus won't always be on time and people won't always see things our way....even when we are right.

When we had rid our bodies of the substance that had ruined our lives, we were left with the legacy of deeply ingrained inappropriate behavioral responses. They are the demons we must face at some stage of our recovery. There are many of these little demons tucked away in the corners of our minds and low frustration tolerance is but one. I'll examine more aspects of what I will term "Legion" in future articles. "Legion" relates back to a biblical story of a man who was possessed by demons. They were commanded to identify themselves. They replied "Legion, for we are many!". I am not a religious person, but that line always sent shivers down my spine. I see many parallels between addiction and the ancient concept of possession.

"Keep the demons down
And drag the skeletons out
I got a blind man following me in chains"

(Guns & Roses - Use Your Illusion Album).

Michael Bloch

Monday, January 7, 2008

Warning Symptoms

Like millions of Americans, you enjoy drinking. You drink often but can hold your liquor, although once in a while you have too much to drink.

Certainly, you believe you're not an alcoholic or in danger of becoming one. After all, you are not a skid row bum who has lost his family, job and self respect because of drinking.

Since you drink, there is always the danger of your becoming an alcoholic. Only three percent of the alcoholic population fits the stereotyped category of the skid row bum. The successful business person can be an alcoholic also even though few realize it.

As a predictable, progressive disease, alcoholism follows a sequence through certain stages from normal, social drinking to dependency, and from dependency to addiction and possible premature death. The day comes - usually but not necessarily after years of drinking - when some people drink not because they want to or enjoy it, but because they must. They have developed a physical addiction to alcohol.

There are early warning symptoms of alcoholism that every drinker should know:

* A history of alcoholism in you family which could genetically predispose you to become an alcoholic.
* A history of heavy drinking. You began drinking as an adolescent and usually have five to six drinks every night or every weekend. Any amount beyond two drinks when you imbibe could eventually lead to problems.
* Any problems caused by drinking - arrests, ill health, fights at home that become worse because you're drunk, complaints of friends, spouses or children, absenteeism at work - are all indications that drinking may have already become a problem for you.
* Inability to stop or cut back on your drinking when you've promised yourself or someone else you would.
* Loss of control. You planned to have only two drinks and wound up having too many. The bottom line question about alcohol is, Do you control it or does it control you?"
* Blackouts or an inability to remember events while drinking. This is one of the more serious symptoms of alcoholism.
* Denial that there is a drinking problem despite repeated confrontations by concerned others. This is another serious symptom of alcoholism. Your vigorous attempts to deny you have a drinking problem is, ironically, a good sign you do.

At this stage of the disease, alcohol has become increasingly important to you. Any criticism of your drinking represents a threat to something that has become central in your life. Your denial of a problem is your way to defend against this threat.

There are certain myths about alcoholism you may use to deny you have a drinking problem. You may try to convince yourself that since you only drink beer, or drink periodically, or can out drink most other people, you can't possibly be an alcoholic.

But these rationalizations do not hold up under the light of experience. Beer drinkers do become alcoholics; people do develop alcoholic behaviors even if they abstain for months; and an increased capacity for drinking is a symptom of the disease.

One of the most erroneous myths about alcoholism - one that is held by the family and friends of the alcoholic - is that he has to hit bottom and ask for help before he can stop drinking. To believe this myth is to do nothing but watch while the alcoholic's drinking becomes worse.

But this intervention requires considerable knowledge and skill, so it should be done in consultation with an alcoholism expert. The best thing family or friends can do for the alcoholic, and themselves, is contact an Al Anon group or alcoholism professional.

Friday, January 4, 2008

Drug Treatment Courts-Canada

Drug Treatment Courts

Drug Treatment Courts (DTCs) aim to reduce crime committed as a result of drug dependency through court-monitored treatment and community service support for offenders with drug addictions. They also aim to reduce the burden of substance abuse on the Canadian economy, which has been estimated at $9 billion annually for areas including law enforcement, prosecution and incarceration.

As part of their structured outpatient program, DTC participants attend both individual and group counselling sessions, receive appropriate medical attention (such as methadone treatment) and are subject to random drug tests.

Participants must also appear regularly in court, where a judge reviews their progress and can then either impose sanctions (ranging from verbal reprimands to expulsion from the program) or provide rewards (ranging from verbal commendations to a reduction in court appearances).

DTC staff work with community partners to address participants’ other needs, such as safe housing, stable employment and job training. Once a participant gains this social stability and can demonstrate control over the addiction, criminal charges are either stayed (meaning a judgement is suspended or postponed) or the offender receives a non-custodial sentence (meaning restrictions other than jail, including house arrest). If unsuccessful, an offender will be sentenced as part of the regular court process.

There are now 6 DTCs operating in Canada: Toronto (December 1998), Vancouver (December 2001), Edmonton (December 2005), Winnipeg (January 2006), Ottawa (March 2006), and Regina (October 2006).

Drug Treatment Court Funding Program

Funding is provided through the Drug Treatment Court Funding Program, managed by the Programs Branch of the Department of Justice, in partnership with the Drug Strategy and Controlled Substances Programme at the Department of Health.

The objectives of the DTC Funding Program are as follows:

* To promote and strengthen the use of alternatives to incarceration with a particular focus on youth, Aboriginal men and women and street prostitutes;
* To build knowledge and awareness among criminal justice, health and social service practitioners, and the general public about drug treatment courts; and
* To collect information and data on the effectiveness of DTCs in order to promote best practices and the continuing refinement of approaches.

For more information:

* Health Canada - Drug Strategy and Controlled Substances Programme
* Department of Justice – Programs Branch
* Toronto Drug Treatment Court
* Regina Drug Treatment Court
* Winnipeg Drug Treatment Court
Source: http://www.nationalantidrugstrategy.gc.ca/comm-coll/dtc-ttt.html