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Find the latest news regarding addiction and mental health treatment from Behavioral Health of the Palm Beaches.

photo of a closeup of person's eyes and forehead covered in many different color paints

The Myth of Drugs and Creativity: Mental Illness’ Role in the Using Artist

Drugs and CreativityThe writer sits at his table, a drink in hand and ready for the downing. The painter stands at her canvas, having recently smoked a bliff, and contemplates the pigments on the surface of her latest work. The musician runs on stage, revved up on coke and ready to wow the crowd.

Whether touted as an emblem of counter-cultural freedom from the restrictive thinking of mainstream society or reputed to stimulate the imagination, drugs and alcohol have been linked with the artistic process for some time now. Both celebrated and aspiring creatives often dabble in drugs at one point or another in their lives. Though emerging from different walks of life, many artists fall into a tradition that began well before the 20th century and that has been maintained by legends like Pablo Picasso, The Beatles, and most recently Prince. Cocaine, methamphetamines, marijuana, alcohol – these are all part of the artist’s toolkit, right?

Not exactly.

A Myth That Enables Addiction

This common trope of drugs as elixirs of creativity is misleading and, when taken too far, irrevocably harmful. America’s favorite horror author Stephen King, who famously struggled with alcoholism and a number of drug addictions throughout his life, has no patience for those who claim that drugs inspire creativity.[1] As he states in On Writing: A Memoir of the Craft, “The idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.” The mystique that drugs hold in society is just that — an illusion.

the idea that the creative endeavor and mind-altering substances are entwined is one of the great pop-intellectual myths of our time.

When it comes down to it, King goes on to argue, artists who claim to use illicit substances to stir their creative juices are more-or-less trying to justify their inclination toward such self-destructive behavior. “But I need it to write!” or “I can’t express myself artistically without it” are not valid excuses but are instead symptomatic of a larger problem at hand: abuse and/or addiction. Drugs don’t make artists — they break them.

Stress and its Many Sources

Connection between drugs, alcohol and creativityThough those who abuse and become addicted to drugs are not one in the same and range in socioeconomic status, race, gender and other qualities, what they often do share is stress. Unstable households, physical pain or the pressures from school or work are stressors that can drive individuals to self-medicate through available drugs.

However, mental illness is one of the most prominent sources of stress that pulls people toward abusing substances in attempt to relieve or cope with their conditions. In fact, approximately a third of all individuals who experience a mental illness and about half of people living with severe mental illnesses also have substance abuse issues, according to the National Alliance on Mental Illness (NAMI).[2]

For reasons not yet fully understood, rates of mental illness are also high among artists, and understanding this link may help explain why so many artists are drawn toward drugs.

Mentally Ill or Creatively Inclined? The Two Often Go Hand-in-Hand

bipolar disorder and creativityWhile the belief that creativity is dependent on drugs is, as King put it, just a “pop-intellectual myth,” the stereotype of the tortured artist does have some credence (though is certainly not all-defining). A body of research suggests that there is a strong link between mental illness and creativity. In 2012, Sweden’s Karolinska Institute found that, “People in creative professions are treated more often for mental illness than the general population.” [3]

In one of the most comprehensive studies conducted in this field, the researchers used a registry of psychiatric patients listed for over the past 40 years, containing data on nearly 1.2 million Swedes and their relatives. Analyzing patients with a variety of diagnoses, ranging from schizophrenia and depression to ADHD and anxiety syndromes, they saw that bipolar disorder was the most prevalent among people with artistic and scientific professions, including dancers, researchers, photographers and authors.

The creative figure of the author, however, seemed to be especially burdened by mental disorders more-so than other individuals, artistic or otherwise. The study stated that ‘authors suffered from schizophrenia and bipolar disorder more than twice as often as the general population.’ [4] They were also more likely to be diagnosed with depression and anxiety disorders, and they also had a greater tendency to commit suicide.

Abusing Drugs to Cope with Mental Illness

emotional pain and artSo, we know the facts: a considerable number of artists experience mental illness. Since those who are mentally ill often abuse substances or have substance use disorders, according to the NAMI statistics, it stands to reason that many artists also have drug problems. Though some try to convince themselves that their lingering, preoccupying desire for another hit is a testament to their creative genius, the real story is that many artists cling to substances for a false sense of stability. They want to relieve the distress of their mental disorder left untreated, and too often they turn to drugs as a way of coping. But this only harms them in the long run.

What starts out as a casual experiment can quickly turn into abuse when an illicit substance temporarily dulls emotional pain or provokes euphoric feelings of delight in the user. Eventually, the body and mind can become so dependent on the drug that the user continues to abuse it in order just to function. This is when addiction sets in.

Case Study: Eminem’s Descent into Drug Addiction and His Sober Awakening

Take Eminem, one of the most versatile and provocative artists of the rap and hip-hop world. Though only revealed later in his career in 2008 that he has been grappling with bi-polar disorder for most of his life, his feelings of raw anger and emotional instability were exceedingly clear in his lyrics.[5] He also suffered from prescription pill addiction and even nearly died from an overdose at one point, according to MTV News.[6]

“It’s no secret I had a drug problem,” he was quoted admitting. “If I was to give you a number of Vicodin I would actually take in a day? Anywhere between 10 to 20. Valium, Ambien, the numbers got so high I don’t even know what I was taking.”

Eminem drug addictionAnd how did he get so hooked? Through the psychological and physical relief that the substances instilled in him, countering the near-constant emotional instability that he experienced from his mental illness. “When I took my first Vicodin, it was like this feeling of ‘Ahh.’ Like everything was not only mellow, but [I] didn’t feel any pain,” Eminem says in the documentary How To Make Money Selling Drugs, quoted by MTV News.[7]

“I don’t know at what point exactly it started to be a problem. I just remember liking it more and more. People tried to tell me that I had a problem. I would say, “Get that f____g person outta here. I can’t believe they said that sh_t to me.”

As Eminem’s addiction worsened, his motivation, physical health, and even his ability to string words together deteriorated. MTV News writes that at his lowest the drugs shut off his brain and made him so lazy he preferred watching TV to making new tracks.[8]

After seeking treatment and remaining sober for a year, Eminem came back to the recording studio. In 2009, he released Relapse: an album that openly discussed his struggle with addiction. But he comments that during Recovery, an album released a year later, is when he really began to repair the damage that the drugs took on him despite how impossible it felt at times.

“I had to learn to write and rap again, and I had to do it sober and 100 percent clean,” Eminem told MTV News. “That didn’t feel good at first. I mean it in the literal sense. I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them. I was relearning basic motor skills. I couldn’t control my hand shakes. I’d get in the [recording] booth and tried to rap, and none of it was clever, none was witty and I wasn’t saying it right.”

Yet he did it, creating an award-winning album that stands as a testament to how only sobriety can unlock the true potential of an artist.

Let Our Treatment Help You Find Your Creative Flow Again

Eminem\’s Recovery is dedicated, “Anyone who’s in a dark place tryin’ to 2 get out. Keep your head up… It does get better!”[9] We couldn’t have said it better ourselves.

I actually had to learn how to say my lyrics again; how to phrase them, make them flow, how to use force so they sounded like I meant them.

Though the confusion, frustration and emotional agony that can come along with an untreated mental illness and drug addiction can seem insurmountable, there is a way out. Behavioral Health of the Palm Beaches’ dual diagnosis program is sensitive to the hardships unique to both mental health and substance use disorders, and our professionals are experienced in treating both conditions simultaneously.

At our facilities, artists can also continue creatively expressing themselves as a way of working through their conditions. We offer art therapy, music therapy, and expressive writing therapy for those who want to discover what it means to be creative while sober.

Don’t let drug addiction get in the way of what’s important in your life. Contact us at 888-432-2467 to learn more about our addiction help and mental health treatment options and how we can help you or a loved one find the courage to recover.

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photo of a group of baby boomers sitting together at an outdoor party drinking alcohol

Substance Abuse on the Rise with Baby Boomers

Overlooking a Growing Dilemma

Substance abuse, particularly of alcohol and prescription drugs, among baby boomers is one of the fastest growing health issues facing our country. Yet, even as the number of older adults suffering from these disorders increases, the situation remains relatively hidden from the public’s eye. While substance abuse among the young is surveyed, categorized and analyzed, addiction problems of the parents and grandparents of these youths are virtually ignored.

Addiction problems of the parents and grandparents of these youths are virtually ignored.

The reasons for this oversight can be due to a lack of knowledge, limited available research statistics or even hurried doctor visits that overlook symptoms or attribute them to other health issues. As people age, medical issues, such as high-blood pressure, diabetes, dementia and others, can present symptoms that mirror the ones associated with addiction.  However, a better assessment of the problems associated with substance abuse among baby boomers is needed.

The Numbers are Rising

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol use among individuals aged 50+ is sustainably higher than illicit drug use. [1] The 2014 and 2015 SAMHSA’s Behavioral Health Barometer, which provides overviews of behavioral health in the United States, reported the following information on baby boomers: [2]

The use of illegal substances by older adults is on the rise. The generation who grew up in the “Age of Sex, Drugs and Rock & Roll” often see drugs as a way to combat loneliness and depression. Long-term recreational drug users, such as marijuana smokers, may now be facing increasing physiological problems associated with aging and drug use. Extended periods of isolation from retirement, “empty nest” or reduced interpersonal interactions tend to escalate substance use. Individuals who are hard-core drug users are at an even higher risks of serious physical decline, possibly leading to an early death. In 2013, more than 12,000 boomers died from accidental drug overdose. [3]Elements that contribute to higher alcohol use among older adults include significant changes in life, such as retirement, loss of family and friends and a decline in mental or physical health. Additional factors that make older individuals more vulnerable to inappropriate alcohol use include insomnia, family history of substance abuse, and having a psychiatric illness, such as depression or anxiety.

Misperceptions and Addiction

According to the American Society of Addiction Medicine (ASAM), addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is characterized by biological, psychological, social and spiritual symptoms. [4] Addiction, like Alzheimer’s disease, is a disorder of the brain that can affect both young and old. The lack of attention to this problem in older individuals may stem from the false beliefs that addiction results from a lack of willpower. So, this could result in a “shame” associated with substance abuse, which then leads to a reluctance to seek professional help and attempting to handle the issue privately and discretely. Their relatives, especially adult children, are often embarrassed by the problem and purposely choose to ignore it.

Ageism can also contribute to the silence associated with substance abuse in baby boomers. Young people often assign a different set of standards to older individuals. However, it is the belief that substance abuse can be overlooked in older individuals because of far-fetched reasons, such as: “It doesn”t make a difference since they are near the end of their lives anyway,” or “Grandma needs her ‘Happy Juice’ because she is so much easier to manage after she has it.” These attitudes are not only callous, they rely on false perceptions. Somehow, it becomes acceptable to ignore addiction problems with baby boomers. The same disorder that would have a family rallying around and staging an intervention for a teenager does not illicit the same sense of urgency for a grandparent.

Small Amounts, Big Effects

The reality is that the misuse and abuse of alcohol and drugs takes a greater toll on baby boomers than younger individuals. As people age, the way that their bodies metabolize alcohol and other substances slows. According to the National Institutes of Health (NIH), as the body goes through aging changes, alcohol and drugs cannot be broken down and eliminated from the body as easily.  Thus, they remain in the body longer and even a small amount can have a strong effect. [5] Some of the risks include increased number of falls, greater levels of confusion and higher potential to interactions with other medications.

Telling Mom and Dad That They Need Help

It is a difficult situation when a child has to tell Mom or Dad that they need help for a substance problem.

Increased mood swings, difficulties making decisions, disorientation and just not seeming like themselves can be symptoms of a substance abuse problem and not just general characteristics of the aging process. However, it is a difficult situation when a child who has always relied on his or her parents to make wise choices, now has to tell Mom or Dad that they need help for a substance problem.

Unfortunately, our society does not fully recognize the seriousness and extent of substance misuse in older adults. As the number of older individuals with addiction problems grows, better methods for early identification of the signs are needed. In an article in Today’s Geriatric Medicine, some of the steps are:

  • Improving quality of care, including training and broadening dissemination of effective practices;
  • Integrating substance abuse, health, mental health and aging services to provide comprehensive care tailored to the needs of the individual consumer who presents with co-occurring, multiple needs;
  • Building a clinically and culturally competent workforce through education and training of providers, increasing the supply of competent providers, especially those who are bilingual and culturally competent and using older adults in peer-to-peer service roles more extensively;
  • Increasing support for family caregivers, including education about medication management and signs of alcohol and drug abuse;
  • Providing public education to address ageism, stigma, ignorance and fears about treatment and its effectiveness;
  • Improving research on effective prevention, intervention and recovery support strategies
  • Developing governmental and private sector readiness including leadership, planning and program development. [6]

Too Much Time On Your Hands

The generation that grew up in an era that romanticized drug use and rebellion is now preparing to retire. Uninhibited by work responsibilities and parental duties, many of the baby boomers are using the extra time to relive their youth and return to a favorite pastime. If you are concerned about an older friend or family member, Behavioral Health of the Palm Beaches is ready to help. With nearly 20 years of experience, our doctors and other medical professionals can develop a treatment program that encompasses baby boomers’ needs. When you are ready to get back those good feelings without misusing alcohol and drugs, call us at (888) 432-2467.

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photo of bartender pouring alcohol into a row of shot glasses

Alcohol Still One of The Nation’s Deadliest Drugs

While much of the national discussion about substance abuse and addiction has been focused on the rising death tolls surrounding prescription opioids and heroin use, alcohol-induced deaths remain perched near the top.

New data from the Centers for Disease Control and Prevention (CDC) showed that the alcohol-induced death rate has increased nearly 23 percent since 1999. It also revealed that almost 31,000 people died as a result of alcohol abuse in 2014, surpassing the death toll from opioid overdoses. When accounting for deaths from drunk driving, other accidents and homicides committed under the influence of alcohol, the death toll spiked to 88,000 in 2014, making alcohol the second deadliest drug in America, only behind tobacco. [1]

Why Americans Are Drinking More and More

Given the various factors that lead an individual to alcohol consumption and abuse, pinpointing an exact reason why alcohol-related deaths have increased is extremely difficult, if not impossible. But one of the simplest reasons is that Americans are drinking more. The number of Americans who reported having a drink in the previous month has increased along with the rising death toll. [2]

The most significant increase is in the female demographic, who reported more drinking and binge drinking than in the past. In 2006, 45.2 percent of women reported drinking within the past month, and 15.2 percent admitted to binge drinking (five or more drinks in one occasion). In 2014, those numbers climbed to 48.4 percent and 16.4 percent, respectively.

Another factor is that alcohol is more affordable than it has been in six decades, according to a study published in the American Journal of Preventive Medicine. The study attributed this to rising incomes and stagnant alcohol taxes. [3]

What’s Leading to More Deaths?

A rise in alcohol consumption does not necessarily lead to an increase in alcohol-related deaths. In fact, while more and more people are drinking alcohol, binge-drinking and heavy alcohol use have not increased population-wide, according to the National Survey on Drug Abuse. Many industry experts have pointed to the opioid painkiller and heroin epidemic as a reason why.

It’s extremely dangerous to mix prescription painkillers and alcohol. When taken together, opioids and alcohol intensify the effects of the other drug. Additionally, approximately one-third of opioid deaths now involve benzodiazepines, such as Xanax. Benzodiazepines can enhance the effects of alcohol, which may explain why death rates from alcohol have risen at the same time as death rates from prescription drugs.

What Can Be Done?

Leading researchers are pointing to the need for legislative action. It is impossible to completely eliminate all substance use and abuse, as was shown during the nation’s failed attempt at prohibition in the 1920s. But just because alcohol abuse and the resulting deaths can’t be eliminated doesn’t mean that they can’t be reduced. Many leading researchers are pointing to the need for legislative action and federal policy changes.

One of the loudest calls is for an increase on alcohol tax, as written by David Roodman, senior adviser for the Open Philanthropy Project: [4]

“Higher prices do correlate with less drinking and lower incidence of problems such as cirrhosis deaths. And I see little reason to doubt the obvious explanation: higher prices cause less drinking. A rough rule of thumb is that each 1 percent increase in alcohol price reduces drinking by 0.5 percent. Extrapolating from some of the most powerful studies, I estimate an even larger impact on the death rate from alcohol-caused diseases: 1-3 percent within months. By extension, a 10 percent price increase would cut the death rate 9-25 percent. For the US in 2010, this represents 2,000-6,000 averted deaths/year.”

A 10 percent increase, put in context, amounts to only a few extra cents and dollars on a bottle of wine, spirits or on a six-pack of beer, but could save thousands of lives.

Parents Must Set Better Examples

One of the greatest predictors of a person’s future drinking habits is their parents’ patterns. It has been shown that children of alcoholics are approximately four times more likely to develop alcohol abuse problems than the rest of the population. [5] It has also been shown that children may mirror their parents’ drinking habits when they become adults. [6]

Even further than parents directing the future substance abuse habits of their children, they are also often the easiest place for kids to acquire alcohol. According to a study published in the Journal of Studies on Alcohol and Drugs, children who had sipped alcohol by the time they were in sixth grade were about five times more likely to have a full drink by high school and four times more likely to binge and get drunk. [7]

Quite obviously, the most likely place for an underage person to get alcohol is from his or her parents:

  • Nearly half of kids between ages 12 and 14 who drink got their alcohol for free from a family member or at home. [8]
  • Approximately 709,000 U.S. kids between ages 12-14 have had at least one alcoholic beverage in the last month. [9]
  • Of this group, 93.4 percent said they got their alcohol for free last time they drank.
  • 44.8 percent of kids who got free alcohol said it was from a parent or in their home.
  • 19.6 percent got alcohol from another underage person
  • 13.5 percent from an unrelated adult
  • 6.8 percent from someone else’s home.
  • 8.7 percent got alcohol from other miscellaneous source
  • 6.6 percent paid for their alcohol
  • People who begin drinking alcohol before age 15 are six times more likely to develop alcohol problems than those who wait till they are 21. [10]

By working to reshape the thoughts and attitudes children have about alcohol use and abuse, parents can sow the seeds for a better future with fewer alcohol-induced deaths. This begins with parents setting examples with their actions as well as their words.

Start Setting a Better Example by Seeking Help

No matter how long you’ve been abusing alcohol or to what extent alcoholism has taken hold, it’s never too late to ask for help. If you’ve allowed alcohol and drug abuse to take over your life and dominate your habits, set an example your kids won’t soon forget by admitting you have a problem, acknowledging the need for treatment, completing rehab and turning around your life.

Behavioral Health of the Palm Beaches will guide you through each step of the process, from a medically administered alcohol detox all the way to a year’s worth of aftercare services. Contact us today at 888-432-2467 to learn more about our treatments, family-themed therapies and nationally recognized facilities.

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photo of former Florida Governor Jeb Bush at recent republican debate talking about the problem of addiction in the U.S.

Jeb Bush: Daughter Noelle Bush’s Drug Addiction Leads to a Father’s Strategy

Jeb Bush’s Daughter on Drugs

With a lineage that consists of two U. S. presidents, a U.S. senator, two governors, president of major industrial manufacturer and several successful businessmen, one would not expect to find a drug addict on any branch of the respected Bush family tree. However, Noelle Bush is an addict. As the only daughter of Republican Presidential candidate John Ellis “Jeb” Bush, Noelle has endured a long and trying struggle with drug addiction.  In today’s society, substance abuse knows no boundaries. Regardless of gender, race and socio-economic status, the allure of illicit substances continues to have a strong magnetic pull over a significant portion of the population.

Jeb Bush recently addressed the challenges that he and his family have encountered while dealing with his daughter’s disease. As the potential holder of the highest U. S. governmental office, he has outlined steps to fight the drug epidemic in this country. He recognizes that this is a long-term dilemma that needs a long-term solution. According to Bush, “It will take real leadership that makes solving the problem a top priority.”

Noelle Bush on Drugs: An Uncontrollable Spiral

Noelle did not wake up one morning and decide to use heroin. However, she did become a statistic in the opiate crisis that is overwhelming this country. In 2012, 259 million prescriptions for opioid pain medication were written, which is enough for every American to have a bottle of pills.1

Opioid abuse serves as a key to unlocking dormant compulsions within a person’s brain. The resulting addiction is defined as a chronic, relapsing disease that alternates the brain’s mechanisms due to sustained drug use. Some of its symptoms are:

  • Persistent desire or unsuccessful effort to stop or reduce the use of substance
  • Lack of behavioral control, i.e. overwhelming cravings, taking undue risks, etc.
  • Inability to recognize significant behavior and relationship problems
  • Inappropriate emotional responses

Without a proper Florida opioid detox program like ours, addiction often involves spiraling between relapse and remission. This never-ending cycle places an enormous amount of stress on a family. But, when your family is in the public eye, the additional pressures are unimaginable. With Noelle Bush on drugs, her struggle serves as an eye-opening experience for the man who was once a presidential hopeful.

A Slippery Slope

Transitioning From Prescription Medicine to Addiction

The transition from a prescription for OxyContin to heroin is not a difficult one. According to the Journal of American Medical Association, approximately 75 percent of patients addicted to opioids will switch to heroin as a cheaper substitution.2

The ease-of-access and lower costs were cited as the two major reasons for the conversion.  This also introduces even greater dangers. Because heroin is illegal and unregulated, it can be laced with anything. Users are virtually unaware of exactly what they are putting in their bodies. They can quickly become addicted and before they realize it, they will need a professional heroin medically-monitored detox treatment in order to get themselves to stop.

One Vision For Drug Changes

In 1989, a group of concerned professionals came together to address the drug epidemic by forming the first drug court. The idea was simple;  to stop treating substance abusers as criminals and to recognize that they were facing a disease that requires more help than just jail time.

The concept of combining medical professionals with the judiciary system to create a treatment program that could break the continual recovery-relapse loop was revolutionary. While drug courts have proven to be very effective, the exponential growth of substance abuse in the U. S. requires additional methods of combat.

Jeb Bush’s Strategy: Tackling the Addiction Problem

With Noelle Bush on drugs for a lot of her life, the next step was for her to receive professional treatment. Noelle is an addict, but she is also currently in recovery after successfully graduating from the drug court system. In a recent post, Jeb Bush not only addressed Noelle’s substance problems, but he also identified tactics for dealing with the drug epidemic in this country. His versatile strategies included:

  • Preventing drug abuse and addiction before it starts
  • Strengthening criminal justice
  • Securing the border to stop the flow of illicit drugs
  • Improving drug abuse treatment and recovery programs.

1. Prevention Programs

With drug addiction starting at younger ages, the best time for discussion is during early childhood. Before Noelle Bush was on drugs, there was a missed opportunity for prevention. Children need to develop strong coping mechanisms so that drugs don’t appear as the only viable option for handling pressure. The National Institute on Drug Abuse (NIDA) developed a list of the 16 principles for developing a prevention program. Some of the key factors are:

  • Enhance protective factors and reverse or reduce risk factors
  • Address all forms of drug abuse
  • Deal with the drug abuse in the local community
  • Tailor program to address risks specific to population or audience characteristics
  • Enhance family bonding and relationships
  • Design the package to intervene as early as preschool
  • Target improving academic and social-emotional learning to address risk factors for drug abuse (Elementary school students)
  • Increase academic and social competence in various areas (Middle/High school students)
  • Aim initiatives at general populations and key transition points, such as the transition to middle school
  • Combine two or more effective programs, such as family-based and school-based programs
  • Present consistent, community-wide message in multiple settings, including schools, clubs, faith-based organization and the media
  • Retain the core elements (Structure, Content and Delivery) when adapted to meet the needs of the community
  • Should be long-term with repeated interventions
  • Include teacher training on good classroom management
  • Employ interactive techniques
  • Should be cost-effective 3

2. Adding Support to the Justice System

The justice system is littered with addicts and the mentally ill. Many statistics reveal the overall ineffectiveness of incarceration. Recently, a report revealed that over half of the federal prisoners are serving time for drug crimes.4

While drug courts are helping, other options for dealing with addiction in the judicial system are needed.

Drug courts provide an additional mechanism for dealing with the effects of addiction. Since their initial introduction in 1989, they have expanded to include courts dedicated to families, adults, veterans, DWI-related and juveniles. Courts have also been established to deal with parolees’ reentries into the community after incarceration. These specific courts help with jobs, housing and any other services that will keep the individuals drug-free. As of June 2015, over 3,000 drug courts are in operation in the United States.5 While drug courts are helping, other options for dealing with addiction in the judicial system are needed.

3. Drug Seizures

Drug seizures at the U. S. borders are constantly making headlines. While there are many governmental departments that handle drug interdiction, Bush suggests that direct intervention from the highest offices would have the most impact on improving border control.

He affirms that the establishment of better relationships with the nations responsible for the majority of illicit substances will lessen the drug flow. Whether it’s better border patrol, guidelines or coordination, stopping drugs before they enter this country is one of the best ways to reduce drug abuse.

4. Better Drug Recovery Program

With his daughter, Noelle Bush, on drugs and in treatment, the last part of Bush’s strategy called for improvement in residential addiction treatment programs and recovery programs for drug addiction. At Behavioral Health of the Palm Beaches (BHOPB), we offer a comprehensive program designed to deal with the addiction disease. In a warm and welcoming environment, we empower our patients with the tools that they need to manage and overcome their affliction.

With intervention, detox, and holistic approaches, we can design a strategy that will help you become a better you. Noelle was on drugs, but she has started recovery, and so can you. For more information about a drug rehabilitation plan for you, call our Florida drug treatment center at 888-280-4763.

Sources:

  1. Centers for Disease Control and Prevention – Opioid Painkiller Prescribing
  2. JAMA Network – The Changing Face of Heroin Use in the United States-A Retrospective Analysis of the Past 50 Years
  3. National Institute on Drug Abuse – Preventing Drug Use among Children and Adolescents (In Brief)
  4. U.S. Department of Justice – Prisoners in 2012
  5. National Institute of Justice – Drug Courts
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Pills and Marijuana

To Legalize or Not to Legalize: That Is the Question

There’s an argument, often made by libertarians, that all drugs should be legal. A person’s body is their own domain so what they do to it should be beyond government control. By and large, that sounds like a sound argument, I might agree. In this case, however, we have the opportunity to reflect on a time in our country’s past when all drugs were legal.

Why ignore history?

Around the turn of the 19th century, all drugs in the United Stated were legal. It’s not like anyone made a law stating that all drugs should be legal. There was never an opportunity to vote on whether or not we were going to have marijuana available for medical purposes. Drugs of all kinds were available because no one ever thought about controlling them.

I wonder how many people reading this remember the old western movies, even those of Gene Autry, Hopalong Cassidy and Roy Rogers. Some of those movies depicted medicine-shows or wagons selling “Feel Good Tonic” and even medications or “elixirs” for weight loss.

What was being sold seems to have been effective. “Feel Good Tonic” did make you feel good, as well it should have. It likely contained alcohol, cocaine, and probably an opiate like laudanum. The weight loss drugs probably worked too: ingesting a capsule containing the head of a tapeworm will make anyone lose weight, after all.

A Look into the Past

It may be helpful to look at where we were as a culture as 1899 turned to 1900. It was not too long after the end of the civil war. It has been estimated that somewhere between 600,000 and 650,000 soldiers lost their lives in that conflict. How many severe injuries were there? I don’t know. I do think painful injuries probably surpassed the number of deaths and that wartime injuries were often treated with morphine. I don’t know how many people became addicted to morphine, nor do I know how many people who were afflicted with “morphinism” passed the addiction on–it must have been a lot.

The preferred method of ingesting an opiate, other than morphine, became “opium eating.” The primary opiate of the day was Laudanum. It would have been more appropriate to call it “opium drinking” because Laudanum was actually a liquid. I don’t know who initially thought that cocaine would cure morphinism but Sigmund Freud wanting to “write a song of praise to this magical substance” probably didn’t help. 

Opium Comes to America

As Freud and the psychoanalysts of the era were arriving at Clark University on our East Coast, something else was influencing us on our West Coast. A lot of Chinese workers were building America’s railroads. Smoking opium was as much a part of that culture for them as watching a football game with a Budweiser in hand is for Americans.

As smoking opium began to pass from Chinese workers to American middle-class culture, an emotional reaction was triggered in the halls of Congress and gave brith to the the Pure Food and Drug Act passed in 1906 (at least Congress was doing something back then). The Pure Food and Drug Act really didn’t change much of what was going on. It just said that whoever was producing “Feel Good Tonic” had to put a label on it. It’s likely that triggered even more sales because customers could pick and choose their poison.

A lot of people were abusing drugs, including alcohol, cocaine, and opiates around 1900. Many were addicted (e.g. Annie Myers, Eight Years in Cocaine Hell, 1902). It’s likely that many families and livelihoods were affected. How come everyone doesn’t know this? What impact did addiction have on our country around 1900?

Things were not the same. The Wright brothers didn’t take off from Kitty Hawk until 1903 and America’s first car didn’t hit the road until 1908. There were no 300-passenger jet planes flying between New York and California; there were no Ferraris or SUVs driving along interstates at 70-80 mph. I doubt that farmers were using tractors that could be lethal or that there was as much machinery around that could seriously injure and kill people. A lot more people stayed at home and were able to keep their problems a secret.

Also, the American population at that time was around 78,000,000. Now it’s 330,000,000. What would the 1900 culture be like with a population of 330,000,000? Well, it would be like, as they say in Persia, “the fit hitting the Shan.”  

The Harrison Act Changes Everything

There were also clinics available, mostly in cities, with doctors who would provide maintenance medication to people who were addicted to morphine or laudanum. Everything came to a screeching halt with the passage of the Harrison Act in 1914. Clinics that were providing maintenance medications to addicts were swiftly closed. Physicians who defied the Harrison Act and continued to provide maintenance medications to addicts were jailed. The day after the passage of the Harrison Act, the price of drugs on the street became 50 times more expensive than it was the day before.

The Harrison Act criminalized addiction, prior to passage there was no connection between addiction and criminality like there is today.

Few things have impacted the culture of addiction more than the Harrison Act.

  • The most significant effect of the Harrison Act was that it criminalized addiction. Prior to passage there was no connection between addiction and criminality. There is today.
  • “Narcotic” came to mean all illegal drugs (not just those that derive from opium).
  • Heroin and marijuana were deemed to be equally as dangerous and both remain federal schedule 1 drugs today. Schedule 1 drugs are the perceived to have the most abuse potential and are the most highly regulated.

The Harrison Act has shaped thinking and behaviors for more than 100 years, for example a lot of people still think that all illegal drugs are “narcotic” drugs . Our prisons are overflowing with people convicted of drug-related crimes. The number of people in U.S. prisons is embarrassing. A rallying cry that could solve this problem has been a campaign to make all drugs legal. That would be another emotional response creating a policy that has already been made nonsensical by emotional responses.

But the question of whether or not drugs should be legal is not that simple. It’s not black or white. Legalization does not necessarily mean that crack cocaine and heroin should be available on every street corner. It does seem to me that an evolution is taking place rather than a revolution. In general, evolutions work better.

So Where are We and Where Will We Go?

  1. We could return to the times when every drug conceivable was readily available to everyone in any quantity, quality, and location. We could return to the days of local apothecaries. Personally, I don’t think that would be a good idea.
  2. The only drugs that I know of that are readily available to everyone in any quantity, quality, and location are alcohol and nicotine. How’s that working?
  3. As of April 2014 twenty states have approved marijuana’s use for certain medical conditions. The term “medical marijuana” is generally used to refer to the whole, unprocessed marijuana plant or its crude extracts, which are not approved as medicine by the FDA. Two of the chemicals contained in the marijuana plant that receive frequent attention are THC and CBD. THC gets you high, CBD doesn’t. Selective planting can yield plants high in CBD and low in THC and vice versa. THC is effective in treating the nausea caused by chemotherapy and the severe weight loss experienced by AIDS patients. CBD is effective for reducing the frequency of seizures. Two medications containing THC are FDA approved in the U.S. Two containing CBD are in process. Marijuana for recreational purposes is available in four states. For a full discussion of medical marijuana see the 2015 NIDA publication listed below.
  4. We do have clinics where people who have an addictive disease can get maintenance drugs. We provide methadone, buprenorphine and buprenorphine/naltrexone. These are not necessarily drugs of choice for people with addictive diseases and they can be abused. Medication-Assisted Treatment (MAT) is a controversial topic among addiction professionals. Before anyone rejects what is going on now, I think that we need to look at how we can use MAT on a large scale better than we do today. On a small scale, one that limits access, it works well.
  5. Researchers continue to work on safe medications to replace stimulant drugs such as cocaine.

Perhaps the question that we’re left with is whether or not we will make more recreational drugs that will cause impairment, drugs such as cocaine and heroin, legally available to the public? Where will they be available and under what conditions? We already allow for the use of alcohol and marijuana both of which can cause impairment. The inappropriate use of methadone and buprenorphine will also cause impairment.

We, as a culture, seem to have made the decision to tolerate a certain level of impairment despite the risks involved. We can go back to the libertarians and say a person’s body is their domain. However, the drugs we’re talking about effect us all.  A person may say “I will never drink and drive,” but alcohol is mind altering. When our minds are altered we make bad decisions. Sometimes those decisions lead to the next DUI or worse. Under the influence no one should bet on what they will do. The bottom line is that drug use will have an impact on us all . . . legal or illegal.

My best guess is that we will have to continue to assess the results of what we have only recently begun to do, e.g. medical and recreational use of marijuana. We’ll see what works and then decide what risks we are willing to take. Keeping things as they are today certainly involves risk; but evolution works.

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Old Baseball on Wood

Treating Seniors for Addictive Diseases: It’s a Whole New Ballgame

In 2013 the American Society of Addiction Medicine (ASAM) designated “seniors” to be a special population. Since that happened a number of quality treatment programs have attempted to enhance the services they provide to senior patients. In my professional experience I have found that there is a lot to be considered when treating seniors for addictive diseases. To properly treat seniors for addiction, it takes a lot more than making a few adjustments to a rehab’s existing treatment program that is already being used to treat their younger patients.

Behavioral Health of the Palm Beaches (BHOPB) is one of the leading addiction treatment providers in the country today. We are proud to offer patients several paths to recovery, including gender-specific and highly individualized care. Seaside Palm Beach is the luxury rehab facility at Beahvioral Health of the Palm Beaches. I’ve been fortunate to be directly part of Seaside Palm Beach since its opening back in 2009, and I know that it was not specifically designed to provide senior care when we first opened.

However, highly individualized care is expensive, so it may not be surprising that Seaside has attracted an older population than most of BHOPB’s other facilities. Honestly, this was not anticipated when the doors were opened in 2009. Highly individualized care is very good care. It so happens that Seaside has been affordable to a more senior, successful and entrepreneurial group of people.

We didn’t anticipate the downside of achieving success. Successful people have been fairly good at avoiding consequences and are less likely to experience confrontation from colleagues, family and peers than their less successful counterparts. Seniors in need of addiction care generally have a longer history of substance abuse. It is not uncommon for us to treat patients who are baby boomers and have been using alcohol, benzodiazepines, and/or opiates for twenty to forty years.

Who is a Senior?

Our country’s population of seniors is growing significantly because of our baby boomer generation. There are 50 million people over age 65 in the United States, and people over 70 are the fastest-growing group in the nation (Vimont, 2015). Would this entire population meet the admission criteria for senior specific care? It’s unlikely. Age needs to be a factor, but far from the only factor. Other things need to be considered: substance use history, medical/neurological impact, and psychosocial factors.

It may sound reasonable to say that a person who is fifty-five years old would meet the admission criteria. However, there may be some fifty-five year old people who have used substances for a very short period of time. There may be forty-eight year old people who started using at the age of fifteen. The forty-eight year old may meet the criteria. The fifty-five year old may not. There are numerous factors that would need to be considered.

Withdrawal Management:

It would not take long to realize that traditional withdrawal management protocols are not likely to be effective when managing the withdrawal of a senior with a forty-year use history. In these cases withdrawal management protocols should be extended.

Perhaps that’s one of the reasons why ASAM designated seniors to be a special population. Traditional protocols need to change.

ASAM (2013) has described five levels of withdrawal management:

  1. 4.0 Medically Managed Inpatient
  2. 3.7 Medically Monitored Inpatient
  3. 3.2 Clinically  Managed Residential
  4. 2.0 Ambulatory extended on site monitoring
  5. 1.0 Ambulatory without extended on site monitoring

All five levels need to be considered when treating seniors.

Medical/Neurological Concerns:

With longer histories of substance abuse come more substance-related physical ailments. Seniors will bring more instances of chronic hypertension, diabetes, liver and pancreas damage and other ailments often associated with chronic substance use disorders. A treatment program for seniors will need to have the ability to provide or access a higher level of medical care than has been provided for younger populations.

Long histories of substance abuse may cause extensive brain damage. I’ve seen men and women arrive at Seaside who can be ambulatory only with the help of a wheelchair or walker. More senior women have fit this description than men. It is likely that chronic substance abuse has impacted their motor cortex. The only upside is that the motor cortex begins to heal quickly. Three to four weeks into recovery they get around just fine.

Other areas of the brain that have been damaged seem to take longer to heal.

Long histories of substance abuse can also cause severe memory loss, cognitive impairment (Korsakoff’s psychosis, Wernicke’s syndrome), and accelerated dementia. I have worked professionally with people having addictive diseases for almost thirty years;  it’s only been in the past five that I’ve encountered two senior gentlemen who could not be treated in the setting that I’m familiar with. In the afternoon they could not recall what took place in the morning.

Seniors may experience the worst consequences of addiction. It is truly sad to see people who have been bright, hard-working, successful and creative, and who have raised families and often made significant contributions to our culture be reduced so much in their later years.

I’ve witnessed cases of alcoholism that have been different from what I’ve seen before. I’m talking about a few people between the ages of fifty-eight and seventy-seven whom I believe truly could not stop drinking alcohol outside of a structured setting.

I have a patient who is ninety-two years old who is functioning well, which is another good argument for individualized care.

Length of Stay:

Sometimes our senior patients have unrealistic expectations about how long it will take them to get well. These estimates are likely to formed from observing younger people who are also in recovery. 

I think that families and patients who meet the criteria for admissions into any seniors’ program need to accept the reality that a longer stay will usuaully be needed then the average stay for younger patients.

Other Things to Consider:

Helping our senior patients maintain their dignity is of the utmost importance to us. Let’s not forget that seniors have not been enlightened to the fact that an addiction is a disease; even many younger people still have a hard time accepting it. So the time-honored technique of “confrontation” should be avoided (ASAM, 2013), especially if it going to be coming from a therapist half their age.

As much as possible, staff should be mature and experienced. Staff needs to be able to relate to senior issues such as isolation, changing role in the community, mortality and many other speicialized considerations.

Family treatment also needs to be different. It too needs to be provided by age-appropriate staff that is more likely to be dealing with adult children than spouses.

The whole point of this article is to say “give a lot of thought to the needs of seniors” before installing a program, It’s not a matter of a few adjustments, it’s a whole new ballgame.

A lot of of what we know about treating addictive diseases is based on people in their early to middle years—from the Baby Boomers generation when they were young. Those who have survived wars in Korea and Vietnam, as well as those who attended Woodstock are showing up on our doorsteps today for treatment as seniors. As addiction treatment professionals we need to do the right thing for them and by them.

 

 

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Calendar Pages and Dates

If Addiction is a Chronic Disease, We Need a Chronic Care Model to Treat It

I have this friend of mine who has a chronic disease: type 1 diabetes. He’s doing OK now, but he’s been hospitalized on two occasions in the twenty-five years that I’ve known him. After being hospitalized, he had a lot of outpatient appointments with his endocrinologist. He had frequent check-ups. While the frequency of the appointments seems to have slowed down, he still checks his blood sugar daily. My friend knows that he has to follow a daily plan to treat his disease. If he doesn’t, he could wind up in a hospital again or have to see his endocrinologist more often. In fact, this has happened on a few occasions since I’ve known him.

My friend used to live in New York. He moved to Florida a few years ago. When he moved to Florida, he searched for and found another endocrinologist. He has regular check-ups with his new physician. All seems to be going well.

My wife suffers from a different chronic disease: hypertension. Her treatment routine is very similar to that of my friend with diabetes. She has frequent check-ups. She was hospitalized on one occasion. After we moved she found another physician to monitor her hypertension. All is well today.

Historically, patients going through residential care are being told that they have a chronic disease, but the disease has been treated like an acute occurrence; this is in the process of changing.

I have a chronic addictive disease. However, the course of my treatment has been much different. I was treated for 28 days in 1983 which was followed by fifteen weekly group counseling sessions. I haven’t seen a physician since nor has seeing a specialist of any kind been recommended.

When a person leaves the hospital after developing chronic heart disease, they have an appointment scheduled to see a cardiologist. That person will have a cardiologist on their medical team forever. How come I don’t have an addictionologist?

I know someone who had their appendix removed some time ago. His appendix was diseased, it was removed. It was over. This person has not seen an appendix specialist since nor has he had any further difficulties. It was an acute occurrence and was treated as such. It seems that addictive diseases have been treated more like an appendectomy, an acute occurrence, than like chronic diseases such as diabetes or hypertension.

 

We Need to Change How we Think, How we Talk and What we Do:

Patients Do Not “Complete” Treatment

It’s up to us to stop giving patients the impression that they’ve “completed” treatment after they’ve met the objectives of inpatient or residential care. Remaining abstinent from substance use while in a safe, secure environment is hardly completing treatment for a chronic disease. Yet, we’ve given that impression.

We’ve Had “Coin-Out” Ceremonies or “Graduations”

Perhaps something like a “commitment to recovery” celebration would work better. It would recognize that hard work has been done, but that their work is hardly complete. It’s only the beginning of a lifetime of recovery during which there will be many celebrations.

Let’s Stop Asking Patients: “How many times have you been in treatment?”

It’s like asking them: “How many acute episodes have you had?” It also conveys: “How many times have you failed?” No one has ever asked my diabetic friend: “How many times have you been in treatment?” No one asks because diabetes is recognized as a chronic disease. My friend wouldn’t even understand the question.

We Still Treat Patients Who Need a Higher Level of Care Like they Have No Experience with Recovery

People enter recovery when first diagnosed. It’s likely that coming back to a higher level of care was preceded by a period of not treating their chronic disease, but even that was an experience that a first-time patient is lacking. We tell patients that doing the same thing over and over and expecting different results is a good definition of insanity. Why do we do the same thing? It demeans us as professionals.

Discharge Planning Has Not Received the Attention It Deserves

A close friend remarked that “The single most important thing that we do in treatment (residential or inpatient) is discharge planning and we give it the least amount of attention.” Maybe it’s not the “least amount of attention,” but it isn’t given the attention it deserves.

There’s being in treatment, and then there’s the rest of your life. Which is more important?

A discharge plan is essentially an assessment of the patient’s performance in treatment: which treatment objectives were met, which ones were deferred, which ones need more work, which new issues, if any, have come up in treatment? The plan needs to address medical, emotional, motivational, relapse and recovery environment issues. The discharge plan needs to be the next provider’s starting point. It is also the document that gives the next professional their first impression of the treatment provider. First impressions are hard to change.

It is also a legal document. It has to make sense.

The next provider (next level of care) needs to be carefully determined.  Continued care recommendations vary. For the most part, they are individualized, but it’s hard to tell what criteria were used for the patient’s next placement. Actually, little clinical information is provided. In particular, there is very little discussed about a patient’s motivational level or recovery environment.

Discharge planners/case managers need more training and more involvement with the clinical team.  There is a need for a discharge summary that looks more like an assessment.

What Treatment Needs to Look Like

It’s actually quite simple: it needs to look like how we treat any other chronic disease. The intensity of care should always match the severity of symptoms. When I say that people in recovery need to be in treatment “forever” I clearly do not mean a continuously high level of care.

Personally, I see my dermatologist every three months, whether I feel like I need to or not. I have skin check-ups. There have been times when I developed a basil cell skin cancer. The intensity of treatment increased. As I got better the frequency of my check-ups came down.

What about “recovery check-ups?” (White, 2014) How about at least semi-annual addiction check-ups?

Who would do them? How about an Addictionologist? What’s that? It’s a physician who has been certified by the American Board of Addiction Medicine (ABAM). Before actually sitting for the exam offered by ABAM, the physician would have completed a residency in Addiction Medicine. There are approximately 3000 board certified Addictionologists in the U.S. The numbers are growing. If you are in recovery, find one! Let\’s call this “Medically Monitored Recovery.”

If we treat addiction like we treat any other chronic disease, this all begins to make sense. Anyone who is fortunate enough to have achieved long-term recovery will have experienced illnesses, prescribed medications, surgeries, anxiety, depression, pain, sleep disorders, loss, changes in recovery environment, etc.  How do people get through all of that and remain drug free? The answer is that many don’t. Recovery monitored by an ABAM/ASAM primary care physician could help many more people achieve long-term recovery.  

The faster we change how we talk, what we think and what we do, the faster shame will disappear from the treatment of addictive diseases.

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Clock

The Times They Are a-Changin’

The culture of recovery is changing. If you haven’t heard anybody say something like “My name is Michael and I’m in long-term recovery,” you will soon. If you haven’t been fortunate enough to see the documentary Anonymous People (Williams, 2012), see it soon. I first became aware of it when the American Society of Addiction Medicine (ASAM) gave it their 2014 Media Award. You can view it on Netflix or purchase it from Amazon. It’s only one of the things that points to a cultural change.

As far as I can tell, several very important things are happening at the same time.

Right here in Florida, I have seen tremendous changes since I came to work for Behavioral Health of the Palm Beaches (BHOPB) in 1999. At that time the “Florida Model” seemed like a great idea. By separating the place where patients were treated from where they resided it was possible to provide higher levels of care for longer lengths of stay. It worked well for everyone.

As we moved forward, several things began to change the culture of recovery for the better.

Seaside Palm Beach opened in 2009. The demographics of the patient population were very different. Highly individualized treatment required skilled case management. Transporting residents was taking away from the treatment day.

Four years later ASAM published the third edition of their Criteria for placing patients in appropriate levels of care (Mee-Lee, Shulman, Fishman, Gastfriend, & Miller, 2013). There were now very distinct differences in the criteria for residential care as compared to other levels of care.

Sometime later, Florida’s Department of Children and Families (DCF) began to encourage organizations providing a residential level of care to provide treatment at the same location. At the present time, almost all people being treated at BHOPB’s four centers, including Seaside Palm Beach, are treated and reside at the same dignified location. Guess what? It works really well.

There are more than twenty-three million people in long-term recovery.

Here in Florida, and nationally, one of the things that our culture is beginning to accept is that there are more than twenty-three million people in long-term recovery and that we come from all walks of life. We can have an impact on local and national politics and economies. People are actually beginning to sell us stuff.

I’ve been around long enough to know that companies selling any type of insurance used to run from us like we had the plague. More recently, some people have figured out that twenty-three million people are a market that no one wants to ignore. I’ve always thought it to be ironic that as long as drugs were flowing into my body everyone was willing to sell me insurance.

Have you seen Renew magazine? I was impressed because it’s about time that a magazine for people in recovery is as nice as any magazine on the bookstore shelf. It’s as well done as magazines about cooking, mechanics, cars, etc. It\’s not hidden, not kept under the counter. I feel good about knowing that we’re twenty-three million strong and we do buy nice magazines. People are not just talking about recovery, they’re bragging about it!

We can also be a force for change. Do you suppose that the health care system has treated us differently because we let them? What would the voice of twenty-three million people sound like? We vote! We have an impact on the economy.What would the voice of twenty-three million people sound like?

Did you know that September was National Recovery Month? By going to the Faces and Voices of Recovery website you can see that there are many activities celebrating recovery all over Florida. Since many people from outside of Florida get well here, you can also find activities celebrating recovery all over the United States and beyond.

Now that Faces and Voices has announced its intent to merge with Young People in Recovery (YPR), the impact will be multiplied.

Twelve Step recovery is very strong in Florida. There are more than 350 meetings listed in Palm Beach County alone. Twelve Step recovery keeps us on track. Faces and Voices and similar movements make us proud. I’m just beginning to realize that there is a difference between “anonymous” and “secret.” I respect the Twelve Step tradition, but I’m fine with telling anyone that I’m in recovery. It is a little different than how I’ve been introducing myself at meetings, but it is working and it doesn’t seem to define my entire being.

I was recently talking with a friend at a local clubhouse. He doesn’t really like the way many other people think and feel about people in recovery. My thought is that what the rest of the world thinks will take some time to change, but the way we think and talk about ourselves can change very quickly.

I’ve recently become a lot more aware of the language I use. In the past, I’ve asked many people “How many times have you been in treatment?” Did I mean “How many times have you failed?” When I’ve asked, “Are you clean?” have I implied that they’ve been dirty? It really bothers me that a person like me, who has worked in the treatment field for a long time, may have been contributing to the problem. It’s time for us to change too.

Our country is beginning to truly treat addiction as a chronic disease.

Culturally, in Florida and as a nation, we are really just coming out of an era in which addiction has been criminalized. It’s been treated as bad behavior – immoral and punishable. Our prisons are full. So maybe we have to take another look at whether or not we’e gotten away from treating a chronic disease. Come to think of it, the question, “How many times have you been in treatment?” is never asked of a person with any other chronic disease. My friend, who has diabetes, has always been in treatment; it’s been continuous. A person who is diabetic has an endocrinologist, and a person with heart disease has a cardiologist.

An addictionologist is a physician who is certified by the American Board of Addiction Medicine (ABAM). Most addictionologists are members of ASAM or physicians who are ASAM members likely to be moving toward certification. In any case, ASAM members are likely to be well schooled in addictions medicine.

How come a person in long-term recovery doesn’t have an addictionologist? How come a person in long-term recovery doesn’t have an addictionologist? Currently, whenever possible, we are referring people who are leaving Seaside Palm Beach to addictionologists. It is making a difference. There are many board-certified addictionologists in Florida and elsewhere. They can be found at www.abam.net. ASAM members and information regarding membership can be found at www.asam.org.

Perhaps the most important thing that those of us who work professionally in the treatment field need to change is our expectation regarding addiction treatment being effective. I’ve been asking many professionals the question “Who relapses more frequently, addicts or diabetics?” and the only person who immediately got it right was a nurse who works with diabetics.

When a plan for recovery is followed addicts get well at an amazingly high rate (Baxter, 2012; DuPont, McLellan, White, Merlo, & Gold, 2009; McLellan, Lewis, O’Brien, & Kleber, 2000; McLellan, 2002). Studies published in professional journals indicate that 75 to 80 percent of people treated for an addictive disease, who follow every step of their plan for recovery, are stable after one year. If this is news to the people reading this article, what expectations are we passing on?

Changing how we treat and feel about addictive diseases isn’t going to happen overnight; not in Florida, not nationally. We’re not Fed-Ex. But we have a right to be proud of who we are and what we have overcome. We are fighters and survivors. We are also people who keep it by giving it away. Our pride in how we live our lives will influence others. It’s time to let go of whatever shame there may be and stop keeping what we have a secret.

Share the secret! Give it away! Be proud!

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