DISEASE VS DISORDER

I am attending a major 'think tank' session today in Texas. The discussion revoles around whether to subscribe to the new definiton of addiction, set out by the American Society of Addiction Medicine. For Physicians and Pharmacists this is an easy sell. They call it a 'brain disease'. It is chronic and can be treated by medication. But the question still lingers as to why it occurs in the first place. If it is a disease than it just appears - we have no participation in it. If it is a disorder then maybe there is the implication that we have a part in the process. No one sits on our chests, puts a funnel in our mouths and pours alcohol down our throats. Likewise no one forces us to ingest or IV opiates. This 'disease' only shows up after we have participated in an action to make it happen. I would like to suggest that we have a disorder or even an illness, and we need help and support to get well. Wellness is our goal. Whether we use pharmacotherapy, or AA, or Mental Health/Substance Abuse Counseling, the goal is the same and we must be involved in the process somehow. Although ASAM decided to redefine addiction in a way that benefits physician practices and pharmaceutical companies, we must consider that stepping up on our own is a critical part of personal wellness.

RECOVERY IS A LIFE-LONG ENDEAVOR

Many people think a person in recovery needs to relapse to understand the numerous issues surrounding the addiction process. Those of us who have been in the field for a while realize that most folks relapse - not because it is a necessary step in the process, but more so because a person gets stuck in some phase of recovery and falls back on what is comfortable or what is known. Recovery is developmental and progressive in nature. For example: 1. The person needs to gain insight into his/her relationship with a substance or behavior. Most try willpower to stop and when this fails after 6 weeks they get stuck. 2.After some time being abstinent real life problems come alive. There is no chance to self-medicate and the person gets stuck again because they do not have tools necessary to manage their day with its complications. 3. In the early recovery stage we work on issues such as shame and guilt - many hard to handle. 4.Later recovery is when we repair damages. Rejection from others when we expect amends causes either a clash or a sticking point. 5. Maintenance is forever. It is critical to live life, not let boredom set in and think we are 'all better'. Then we regress to our old ways and we are really stuck with trying to put the pieces back together again. Recovery is a living part of life that must be kept healthy, active, nurtured, and sprinkled with daily spirituality if it going to thrive!

2010 TIME TO BEGIN AGAIN

Every New Year’s Eve folks deliberate on resolutions about how they want to live their lives differently. Lose weight, stop smoking, start exercising, go to church, work less, get a job, play more, give up drugs. Statistics report that most of these are broken or forgotten within the first thirty days of the New Year.
So why do we make resolutions? The definition of insanity is repeating the same behavior over and over and expecting a different outcome. Isn’t that what we are doing? We start the New Year behaving insanely and expect the next eleven months to get better. How about a different approach?
If we truly focus on the fact that the whole world is open to us and the only obstacles that keep getting in our way are those we construct ourselves, we could view life with a new perspective. Here are some ideas.

How about waking up each day and being grateful – that you are above ground!

Maybe we could enjoy the food we eat instead of inhaling what is on the plate, to get to dessert.

Instead of complaining about the snow – try playing in it.

Don’t wait to get to church to pray – talk to God in your car while the motor is heating up.

Since anger only grows- replace it with kindness and humor.

Rather than letting one thing ruin the entire day – let it go, and enjoy the next moment that has to be better.

Since yelling at the kids to behave doesn’t work- how about redirecting them to something fun for all of the family to do.

Live as if this is your last day and enjoy every minute of it. There are no tomorrows for parts of the world. There are no second chances for the majority. So if you are given one, hold it tight and use it in a positive way.
If you are not in prison – every day is a holiday. If someone, somewhere cares about you, you have love. If someone gives you a paycheck, you have security. If you can read this article, you have sight and education. And if you can talk about this with anyone at all, you have connectedness with society.

Let’s stop and count the blessings we have this year instead of wasting time trying to redesign our lives with silly resolutions. The whole world is open to us, so we need to begin living in it, in a positive, responsible, grateful way!

Be well, Dr. M

FEDERAL BILL HR 911

The US House has supported the Bill HR 911, which outlines a mechanism for oversight, monitoring and restricting programs/facilities which provide residential services for teens up to age 18. There are those who are not in favor of such a Bill because it is too restrictive and based largely on one person's experience with a program that took the life of his son. They view it as punishment to all service providers including foster parents. Human service professionals state that it will impede many houses/programs from being certified and placement for teens will get backlogged.
In my humble opinion, one child lost in a residential program is one child too many. Historically, we have been lax when it comes to oversight of out-of-home programs including wilderness experiences and group home foster care. As a country, we have broken the cardinal rule of parenting - to keep children safe and secure. It is sad that we need federal legislation to mandate us to pay attention to places where teens are housed/educated/detoxed/treated for mental illness. But if that is what it takes, so be it.

IS AA THERAPY?

I just returned from the Harvard University School for Addiction Study Annual Conference. One of the attendees posed two questions that have been circulating at AA meetings for sometime. The first is whether or not AA is therapy? The answer is 'no'. It is self-help. Although it is of therapeutic value to most folks who attend, it is run by others who have 'walked the walk' of dependence upon alcohol. Therapy is very different and conducted by professionals who have spent a great deal of time studying the addiction process as well as how to facilitate wellness. The second question is whether or not a person who is on prescribed medication is really in recovery. The answer is, that if a person needs certain medications to manage his/her life, and they are taking this medication as prescribed, while abstaining from their drug of choice, then 'yes' that person is in recovery.
There will always be folks who have drug-seeking behaviors and who doctor shop just to get medications that they can use recreationally. These people are not in recovery. They are people who have chosen to put their drug use ahead of family, work and friends. Hopefully they will choose both treatment and self-help when they decide to start walking on the road to recovery!

WHAT'S THE ISSUE

Many patients have asked me if I could tell them why so many people relapse. They often quote friends in AA who subscribe to the philosophy that relapse is part of addiction. After so many years in this field, I am reluctant to support that idea. My personal experience tells me that we can change external behaviors. We can encourage and support those who stop participating in negative actions. We can teach patients about triggers, urges and cravings and the journey towards relapse prevention. But the data demonstrates that most will relapse. Why?
My theory is that each person with an addiction has a core issue - usually emerging in childhood and unresolved. It could be abandonment, abuse of some sort, neglect, punishment, gender struggles or a host of other traumas that children are subjected to. Only the person him or herself can identify that issue. Until they recognize and acknowledge that issue and make a conscious effort to deal with it in some therapetic way, they will fall back on what they know - drinking, drugging, gambling or other addictive behaviors. We can put a bandaid on a deep cut and it will heal from the outside. Or we can debris the cut and then bandage it and it will heal from the inside out. Clean up the core issue and the healing will begin.

TEN TIPS FOR MANAGING THE HOLIDAYS

1. Eat Right and stay hydrated with water. Protein and fruits work well.
2. Sleep 8 hours and take two 5-minute rest breaks during the day. Breathe deeply and get centered.
3. Take a 5-minute walk or do some daily exercise. The 5 minutes is easier to fit in than 30 minutes every other day.
4. If you don't have a problem, drink socially, not alone. 2-3 drinks in an evening is fine. Just don't drive.
5. Don't smoke marijuana to get through stress. Also, take medications as prescribed.
6. Surround yourself with positive people. It is contagious!
7. You hav the power to make the day a good one. You can choose not to attend something if it is going to upset you.
8. Do something nice for someone else. Simple, but meaningful acts of kindness benefit the giver as well.
9. Find peace within yourself, at church, synagogue, the movies, the beach or with friends.
10. Be grateful to be above ground. It sure beats the alternative!

HAPPY HOLIDAYS TO ALL!