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Articles, News and Blog

Alternatives When 12 Step Support Groups Cause Harm to a Member of the Fellowship

Journalist Darlena Cunha writes a fascinating article for The Guardian about mutual support groups, women's issues and addiction recovery.
 
At 23 years old, Asia Blackwood was the proud stay-at-home mother of three young children in a quaint Connecticut neighborhood. Day in and day out, she prepared snacks and watched with pride as her toddlers learned to share with each other while her husband worked. Life was picture perfect.

But just under the surface, Blackwood’s happy home was crumbling. She was often exhausted, and felt sad for no reason. This listlessness and unhappiness made her feel guilty, since she had nothing to complain about.

“I was given Percocet to deal with the pain after childbirth,” Blackwood recalls. “I realized immediately how good it made me feel. It lessened my depression and gave me more energy.”

Blackwood’s prescription ran out before she was ready so she started buying the pills online, using them in increasing amounts over the next year. During that time, she saw how unhappy her marriage was and divorced her husband.

She met John (not his real name), a recovering heroin addict, just weeks after her divorce and began dating him. Cut off from her husband’s credit cards, her stash of pills dwindled. John introduced her to a much cheaper alternative: heroin.

She soon lost custody of her children and became homeless for a while, still shocked that her life was now about finding her next fix instead of fixing her kids dinner.

After a very dark year, she decided to make a change, dropped John, and started going to Alcoholics Anonymous.

“What I did not expect was to be fresh meat when I walked into AA meetings,” she told me. “Men wanted my number and wanted to date me. I was newly sober, clueless and craving love.”

Blackwood said she began dating a man with nine months sobriety within her first weeks at AA, and later found out he was sleeping with dozens of other women in the same support group, many of whom she had considered friends.
That discovery was devastating.

“It never caused a relapse, but it did make me question the joy of sober life, and also consider suicide,” she said. “The world seems like a really mean place when you are surrounded by unhealthy people.”

Blackwood’s story of love in the time of drug abuse is not unique. Women trying to recover are falling into the trap of dating in which the goal is not love or mutual support, but a power play in which they are the losers.

The next AA? Welcome to Moderation Management, where abstinence from alcohol isn't the answer

Joella Striebel, a behavioral health specialist at Gundersen Health System in Wisconsin, says that women have a different pathway to addiction than men. To recover, they must believe they have control over their own lives and can make decisions for themselves, rather than admitting powerlessness – which is one of the main tenets of AA.

“Recovery from addiction is most successful when it is addressing not just the problematic substance-using behaviors, but the underlying issues and past trauma,” she said. “Many women who have been victimized engage unconsciously in repetition compulsions, seeking out archetypes and familiar situations, and through that they can be victimized.”

No one knows that better than Alex Hankel.

At 15 years old, Hankel (not her real last name) was already addicted to drugs. By 18, she was running Narcotics Anonymous meetings in her community in New Orleans. “Like I knew any damn thing,” she recalls. “The groups are so unstructured, basically anything goes.”

Hankel ended up pregnant by a man 15 years her senior while in rehab.
She said she tried to observe the “one year” guideline in place – that users have one year of sobriety before they start dating – but that as one of the only young women in her groups, she was a main target for sexual advances.

“I was too young to be navigating my sobriety around so many disturbed people,” Hankel said. “I needed a mental health doctor.”

Hankel said it was an expensive four-week rehabilitation center that finally helped her; a luxury most people suffering addictions cannot afford. She said many of the cheaper options focus on AA as their major recovery tool, and don’t address the underlying problems that may be causing destructive behaviors.

At her facility, she was set up with a personal therapist who paid attention to the specific issues beneath her addiction. If people in rehab programs only focus on their dependencies, they are only scraping the surface of the problem, painting over a broken-down foundation without fixing the splintering wood beneath, Hankel explained. Without delving down to the root of the problem, it becomes more likely to grow again.

According to New York psychotherapist Scott W Stern, when the general population thinks about recovery programs, there’s not a lot of distinction between treatment and support.

Treatment, such as rehabilitation and therapy, is run by professionals who start with their clients from where they are and work with them through a variety of medical and psychological means to build their autonomy, he said. In contrast, support groups like AA or NA provide merely a peer-to-peer network of individuals supposedly working toward the same goal.

Such groups are not equipped to address many of the complex issues that come along with addiction, since they’re run by people who are not trained as professionals. “These groups are places anyone can walk into, where anything could happen,” he said.

In essence, an environment that is touted as a safe space can be anything but. From easier access to substances to sexual harassment, abuse or even outright murder, these programs can inflict further damage.

On the other hand, “evidence-based groups are run by trained facilitators who, in theory, should be able to recognize predatory behavior and intervene”, Striebel said. “Many are gender-based, as well, which further mitigates the risk.”

While there are certain AA meetings that are women-only, the availability of these meetings is scarce at best. Hankel said she was frequently the only woman in a group of 15 or more men, because there was simply no other option in her area.

Leona Colón, who has been in and out of AA programs for decades, said south-east Georgia has just started providing one women-only AA meeting a week, compared with three men-only meetings. Before a couple years ago, she said, there were no women-only meeting at all.

Of course, AA and NA have helped many; it is one of the most popular recovery groups in the US. AA boasts over 1.3 million members as of 2013, but according to Stern only 5-8% actually recover longterm without relapse. This number originates from a retired psychiatry professor from Harvard Medical School, Lance Dodes, who compared AA’s retention rates with studies on sobriety and rates of active involvement in the group meetings.

Meanwhile, members are expected to move through the organization’s 12 steps and accept the doctrine put forth by AA. Some of the women I talked to called the groups cult-like, saying that members cling to the written word in the Big Book and exclude anyone who might question it, leaving them alone when they stumble across what is commonly known as “the 13th step” – that is, when someone makes sexual advances on someone new to recovery.

Being hit on at AA was a daily thing for me. In hindsight, I realize I was never really able to focus on my sobriety

Alexia Colon
Colón has been around 12-step programs since she was a child, and has experienced the 13th step dozen of times. At 14 she saw her mother go through “90 in 90”, which is when a person in recovery attends at least one meeting every day for three months.

“I didn’t lose my mother to alcohol, I lost her to AA,” Colón said. “Being a teenager with a cute mom in AA was not fun at all. No kid wants to see their parent dating, anyway, but the guys from AA bring it to a whole other level.”

Colón’s mother soon married a man she met through the group meetings, who had 15 years of sobriety to her mother’s one year, and the new couple forced Colón to go to meetings, too, even though she didn’t yet have a substance problem.

“They didn’t want me to be alone in the house all the time,” she said. “So I went to meetings and to sober dances. I was offered drugs there every single time.”

Eventually Colón did end up with a substance problem, and she has been to AA as an adult on and off throughout her life, taking what she needs from the program and leaving the rest. But the rest won’t leave her.

“I showed up to a meeting once in flip-flops and a black T-shirt,” she said. “Some guy yelled out, ‘You know what she’s looking for!’ I got in his face about it and shamed him. Then I was told I shouldn’t have said anything to him about it because he was new. But what about me? I should put up with that?”

Colón has been married for more than 25 years and knows how to handle herself around the group members, but she worries about her daughter, Alexia, who’s in her early 20s and trying to stay sober.

Alexia Colón suffers from depression, which she said she mitigated by self-medicating. When she turned 22, she decided to get help, and started going to AA and NA. Her first week there, she met a man who had four years sobriety and began dating him, only to find him isolating her from her friends and family, policing the way she dressed, and eventually hitting her.

“He was so jealous and kept me on a short leash,” she said, “always pretending it was about my sobriety and was what was best for me.”

Alexia broke it off and left AA, only to fall back into deep depression and substance dependency. When she tried again, months later, to recover, she found AA to be a dangerous place even without an abusive relationship tinging it.

“Being hit on at AA was a daily thing for me,” she said. “I relished in it, honestly. I loved that all eyes were on me all the time. In hindsight, I realize I was never really able to focus on my sobriety.”

She states that the type of attention paid to young women in the programs is detrimental in all ways. “Every single one of us is vulnerable going into those rooms. For the first time in your life, you think you’re learning to cope with your feelings. You’re not hiding behind substances anymore. And you’re speaking in front of people who hug you and tell you they love you. But they don’t. They’re in it for themselves.”

Leona Colón blames the current state of the legal system – in particular drug courts. She said the drug courts in south-east Georgia, where she and Alexia reside, mandate offenders to go to AA meetings. When she complained about this procedure, she was told they could go to any meeting and to find a different group.

“But there are no other meetings here that aren’t at least a half hour away,” Colón said. “Word got around about my complaint, and people started questioning Alexia about it, making the situation even worse for her.”

Stern said the problem is compounded when sex offenders go through the drug courts and are ordered to go to 12-step meetings, which he said is a fairly common occurrence.
“For people with criminal records, it’s not uncommon that they will argue they were under the influence of substances,” he said. “Ninety percent of treatment facilities in the US are 12-step-facilitated, too, which means no matter your crime, you’re most likely going to end up at AA or NA.”

Stern suggests the judicial system should be revamped. However, the National Association of Drug Court Professionals (NADCP) said the way they mandate recovery has already undergone vast changes in recent years.

While it’s still not perfect, Terrence Walton, the NADCP’s chief of standards, said the courts mandate professional treatment before recommending a peer support group to facilitate long-term recovery. He also said that drug courts no longer specify AA/NA as the support group that must be attended, as was the case a decade ago.

“We don’t recommend AA to unwilling participants anymore because if you force someone to go to AA or NA with people who are not being forced to go there, it can be a bad mix. You need to want to participate for those programs to work,” Walton said.

Rhonda Pence, who works in the NADCP’s public relations department, said it’s important to remember that their clientele are people too. “The goal is to help them put their lives back together and get them off drugs for good,” Pence said. “They deserve that chance to become a productive member of society again.”

But if drug courts mandate some form of peer-support group attendance for the betterment of their clients, and 90% of the peer-support groups out there are AA/NA 12-step programs, how can we avoid what Walton called a “bad mix” of people?

Walton, Stern and Striebel all highly recommend a new peer-support option called Smart Recovery. It is similar to AA and NA, but does not involve citing powerlessness as part of recovery, and does not insist on invoking a higher being to belong to the club.

More importantly, Smart Recovery has a 24-hour online option. This greatly helps women who don’t want to attend in-person meetings for fear of being the object of too much attention, as well as those who can’t drive, or live far away from meeting spaces.

The program encourages members to build their own motivation, find ways to cope with urges, manage behaviors and feelings, and start living a balanced life.

“Too many people equate the powerlessness in the AA program with helplessness,” Stern said. “Through that, they accidentally transfer their addiction to substances to an addiction to the support group or members within it. The only way to combat this that I have found is through empowerment.”

As for the four women who found their recovery marred and full of obstacles, they’re all faring well. Blackwood is about to go to court to win visitation privileges with her children again. She’s been sober for a year and a half. Hankel is raising a six-year-old girl by herself, while staying clear of drugs and alcohol. Leona Colón hasn’t personally needed the aid of a group in almost five years, and Alexia is leaning on her for support as she forages ahead in her own recovery.

It wasn’t through AA that Blackwood, Hankel and the Colóns were able to start their healthy paths to recovery. It was through truly learning to love themselves.

http://www.theguardian.com/society/2015/sep/22/alcoholics-anonymous-aa-women-dating-addition-rehab

"Is Ketamine Infusion a Safe, Effective Treatment Alternative to Combat Depression?"



At low, sustained dosage, Ketamine Infusion is said to be more effective for those who have been unsuccessful with more conventional anti-depressant medications.



"In New York City, Dr. Glen Brooks has been working with Ketamine Infusion Depression Treatment for many years and founded NY Ketamine Infusions.  According to Brooks, "Ketamine has a well established history as a general anesthetic agent. Recent advances have proven Ketamine to have additional benefits as a treatment for chronic pain and depression. Subanesthetic doses are often effective when other treatments have been less successful."

Located in downtown Manhattan, NY Ketamine Infusions, LLC is a private outpatient practice. We serve patients by appointment only. Please call anytime during office hours at 917-261-7370 to schedule an appointment, or for more information.

Glen Z. Brooks, MD. is a has dedicated himself to the treatment of depression and neuropathic pain syndromes with Ketamine Infusion Therapy. A Board Certified Anesthesiologist, he completed his residency and pain fellowship training at Harvard’s Peter Bent Brigham Hospital, Boston Hospital for Women and Boston Children’s Hospital. He has been a faculty member at Yale University School of Medicine, Chairman of Anesthesia at Cabrini Medical Center in Manhattan and is a member of The American Society of Anesthesiologists, The New York State Society of Anesthesiologists and The American Academy of Pain Medicine. If you or a loved one is suffering from disabling chronic pain or depression that has not been well controlled by other treatment, Dr. Brooks may be able to help."

http://nyketamine.com/pain/about-us/

At the Ketamine Treatment Centers of Princeton Dr. Steven Levine’s training is as a psychiatrist who is a therapist first, medicine prescriber second. However, he has expertise in pharmacology, particularly in the treatment of “tough-to-treat” mood disorders.


Dissatisfied with the options available that take a long time to work and cause unacceptable side effects, he was looking for a better option. As the research on ketamine for depression progressed, but was not available outside the research setting, he began to ask, “why aren’t we using this yet?”

According to Levine, major depression, the depressed phase of bipolar disorder (bipolar depression), anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), pain syndromes such as complex regional pain syndrome (CRPS, also known as reflex sympathetic dystrophy (RSD), and addiction.

Unsafe conditions to use Ketamine Infusion are uncontrolled blood pressure, unstable heart disease, untreated thyroid disease, active substance abuse, current manic phase of bipolar disorder, or active psychotic (hallucinations or delusions) symptoms.

Some may have heard that ketamine is used as a “party drug” and worry about addiction potential. Studies and clinical experience have found that in the very low doses used, medical setting, lack of access at home, and infrequent dosing, there is virtually no potential for addiction or abuse.

He reports the dose used for the treatment of mood and anxiety disorders is very low and safe. For a few minutes during the infusion itself, blood pressure and heart rate may increase. This is monitored to ensure safety.

Says Levine, "you will fill out depression and anxiety scales prior to the first treatment and approximately 24 hours later. This will help determine response. It is possible to notice effects as soon as 40 min after the infusion, most typically starting 2-4 hours later, but sometimes taking up to 24 hours. You should not expect to wake up feeling “perfect and overjoyed”, but rather there should be a noticeable difference in feeling more hopeful, less sad, decreased thoughts of suicide, increased calmness, 'weight' of depression lifted, or more inclined to engage with people. Further improvements are often seen over the course of treatment."


For MD's who administer Ketamine Infusions throughout the United States, you can access a directory at: 

"The Missing Link Between Attachment and Substance Use Disorders"

What is Personal Empowerment in Psychotherapy?

Personal empowerment is the process in which we 
gain the knowledge, skill-sets and attitude needed to cope 
with the changing world and circumstances.  
It is a process of transforming powerlessness and 
increasing individuals' control over their lives. 

Empowerment is a multi-dimensional, social process of increasing the capacity of individuals or groups to make choices and to transform those choices into desired actions and outcomes. This process creates the power to use these choices in his or her own life, community and society, with individuals acting on issues that they define as important.

The individual is never blamed for his or her problems but is responsible for generating a solution.

The process of empowerment is a process which enables one to gain power, authority and influence over themselves, institutions or society. Empowerment is probably the totality of the following or similar capabilities:

• Having decision-making power of one's own
• Having access to information and resources to make proper decisions
• Having a range of options from which you can make choices 
• Ability to exercise assertiveness in collective decision making
• Having positive thinking on the ability to make change
• Ability to learn skills for improving one's personal or group power.
• Ability to change others’ perceptions by democratic means.
• Involving in the growth process and changes that is never ending and self-initiated
• Increasing one's positive self-image and overcoming stigma
• Increasing one's ability in discreet thinking to sort out right and wrong
In short, empowerment is the process that allows one to gain the knowledge, skill-sets and attitude needed to cope with the changing world and the circumstances in which one live.
 



What are the Stages of Empowerment?


Pre-contemplation
In this initial stage, individuals may be outwardly unaware of their problems or be in denial. Either way, they definitely do not want to appear broken or damaged. As a general rule, "Pre-contemplators" often wish other people would change, as in: "How can I get my superior to quit bothering me about my poor people skills? That's just who I am." or "Things will change during the next quarter when I get through this especially tough assignment."
 
Contemplation
Contemplators are aware that they face problems and are seriously thinking about grappling with these problems sometime within the next six months.

Preparation
Individuals and organizations at this stage intend to take action within the next month. These individuals have taken personal responsibility for causing or contributing the need for change. In addition, these individuals have set a personalized measurable goal - a change that is under one's own control, rather than dependent on someone else's behavior.
 
Action
In this stage, individuals and organizations are taking concrete steps to change their behavior, experiences, or environment, in order to overcome their problems. Because action often brings up feelings of guilt, failure, coercion, and yearning to resume old familiar behaviors, individuals and organizations typically need a lot of support during this period. A sobering statistic: at any given time, only 10-15 percent of individuals or organizations in the process of change are engaged in the action stage.
 
Maintenance
During this stage, individuals and organizations work to consolidate their gains and prevent relapse. It is important that individuals and organizations remember that all merger experiences are different. Assuming a one-size-fits-all approach will not work! Instead, assess the group as individuals, to determine their stage of change.
 
Go slowly. Anticipate backsliding. While the term "stages of change" suggests that change marches forward in a step-by-step, linear fashion, it actually occurs in a spiral pattern, meaning change comes in both forward and backward movement. This is normal and to be expected. Good leaders should educate their staff and clients about the inevitable spiraling nature of change to help counteract doubt, shame, and frustration about regressing to earlier stage.



 
 

"Inpatient Rehab for Addictions: Is It Worth It and Does It Comply With the Affordable Care Act?"


Commentary By Scott W. Stern, Psychotherapist/Empowerment Professional:

Kudo's to to producers Greg Horvath and Adam Finberg for their brutally scathing documentary, "The Business of Recovery," and to colleague Gabrielle Glaser for her article about the inpatient rehab industry.

The film documents various perspectives about the billion dollar rehab business, unnecessary and expensive for most who can be treated more effectively in appropriate outpatient treatment therapy. (So much for reducing costs of health care!) It premiered at The Newport Film Festival in California on May 3rd.

Noteworthy are contributions of San Francisco's Dee Dee Stout who, like me, got sober in the rooms of AA without bias against evidence-based alternatives to Twelve Step Facilitation (TSF).

The film takes a scathing view of promises and guarantees made by inpatient rehabs (focused primarily in Southern California) via advertisements and literature."The filmmakers compare the services offered at Betty Ford (it has since merged with Hazelden), which costs $53,000 a month, to those of a nearby retirement home, which cost $4,005 a month. (One notable difference: at Betty Ford, you eat what’s being served that day. At the retirement home, you have your choice of a restaurant-style menu.)A spokeswoman for Hazelden said that they had not had the opportunity to see the film.

Other facility directors, including New Directions’ Rebecca Flood, did not return calls for comment."In fairness, I believe there is tremendous value to inpatient treatment for people with Severe Substance Use Disorders (i.e. extreme medical and legal consequences should they drink again). But this does not constitute the majority of people with substance use disorders who would greatly benefit from treatment alternatives.