Last Door Recovery Society

Last Door Recovery Society, in British Columbia, Canada, has been providing addiction treatment for men and male youth for over 35 years. They offer youth and adult programs with substantial family support, and a “10 day intro to recovery” for individuals who may not be ready to commit to longer-term inpatient care but want to explore that option. More than just a rehab, Last Door is “an inclusive supportive addiction recovery community.” People come to Last Door to find recovery from drug and alcohol addiction, gambling addiction, video game addiction, internet addiction, and nicotine addiction. Last Door is located in New Westminster, a community that has become known as the Recovery Capital of Canada. Keystone, their 40-acre rural property one hour from Metro Vancouver, provides horticultural, wilderness, and recreational therapy.One of the things that sets Last Door apart is the level of participation from their alumni as mentors and volunteers. When invited to participate in a survey for the purpose of this review, more than 90 former residents responded, from recent graduates to alumni who completed the program more than 30 years ago. The bonds formed between residents and alumni have created an unbroken chain of mutual support spanning decades.Last Door alumni describe their fellow residents as coming from a wide range of economic backgrounds, “From homeless to professionals earning 6 or 7 figures,” with diverse histories. Some describe desperate circumstances that led them to Last Door: “I was thinking of doing an armed robbery at 7-11 to get high or go to jail.” A family member connected him with a Last Door alum and he ended up staying for seven months. Many people find their way to Last Door through referrals from former residents, who refer to themselves and others as “Door Boys.” Last Door is well established and connected to the local community, and many clients are also referred by detox facilities, other therapeutic communities, and courts. For this reason, Last Door is the first choice for many people who live in the area. For others it is quite literally the last door: “I was in deep addiction for 35 years, went through many other treatment centres with no luck.” Said another, “A friend told me about Last Door and the success they had with him. I saw the change in him and I wanted it.” His friend, like many alumni, not only referred him, but helped facilitate the transition. The gentleman went on to describe his time at Last Door as “An amazing experience.”Residents’ lengths of stay vary quite a bit, from a few months to a year or more. Some graduates go on to volunteer or become staff members. The youth program (13-18) is based on a “social model” which offers scaffolding in all areas to “improve overall functioning,” with the goal of improving self-esteem and decision-making skills. There is ongoing aftercare support for this group in the form of “Emerging Adult” alumni groups. One resident noted that their peers “were not excited to be in treatment at first” but after some time they became “invested in the other people there and made recovery look fun.” Another alum of the youth program reports that they “made great friends, and worked through problems with people I didn’t like.”Alumni were enthusiastic about the food at Last Door, describing “fresh home-cooked cuisine,” “comfort food,” and “Great variety of healthy, hearty and gourmet meals from day to day” with plenty of leftovers. While nutritious options are always available, one alum recalls that “Meals weren’t always healthy but were always delicious.” Another described “calorie dense” meals “centered on making opioid addicts gain weight.” Coffee, tea, and juices are always available, as well as snacks like fruit, trail mix, chips, and babybel cheese. “Dinners were what you'd get from a really good restaurant,” with a variety of proteins, including steak or ribs on Fridays, “everything carefully made by a trained Chef.” Residents also described “out of this world potlucks” and “amazing” weekend brunches. Least favorite items mentioned were “fish” and “curry.”Accommodations at Last Door are shared, sometimes with four people in one large room. “Relationship skills were gained,” said one alum. “I learned to get along with all kinds of people.” Chores are divided, but “everyone has a chore they must attend to twice daily, which can be anything from cleaning to helping make meals.” Daily life is structured and based around NA meetings in the mornings and evenings. There is group therapy and free time, spent “hanging out with each other,” going to the gym, and “going on outings.” As residents progress through the levels of treatment, they may transition into working an outside job.Most alumni felt that staff were fair when it came to infractions. Misbehavior such as “smoking, aggression, poor attitudes” or “leaving the property” (without permission or notice) was handled “swiftly and evenly. No grey areas.” Depending on the severity of the transgression, discipline could include completing “written exercises,” doing “extra chores," or having "restrictions on access to certain activities." In extreme cases, a resident could be discharged. Generally, “the punishment fit the crime and was usually pretty fair,” and infractions were treated “diligently, respectfully, and sternly.” A few alumni complained that some staff were “unprofessional” and exhibited “favoritism."Amenities at Last Door include a main gym and pool about a 20-minute walk away, weekly yoga and acupuncture, music therapy, martial arts, meditation, and more. Residents are encouraged to get involved with the greater recovery community and participate in NA dances and Recovery Day. Outdoor activities include “bowling, hiking, swimming, paintball,” volley-ball, and frisbee. Keystone, Last Door’s countryside retreat facility, was described as a “fantastic break from the centre while still continuing that fantastic fellowship and the recovery,” while another alum felt that “Keystone was definitely a good experience but not always accessible to everyone and not equally distributed.” Other off-site excursions are encouraged as long as they are approved by staff. Rules governing access to phones and the internet vary depending on the level of treatment. People in the early stages are not allowed to have their phones (or any personal money). After a set amount of time, phone use is allowed in non-group times as long as staff and other residents agree that there will be no misuse. Unsupervised emailing is not allowed, and internet access is only available at the library. TV is available on the weekends, and some alumni reported watching movies three times a week. While transitioning to working at a job, these rules are variable and determined in consultation with one’s caseworker.A doctor is on site at Last Door once a week (as well as on call 24 hours), and there is a clinic about ten minutes away. Alumni praised the doctors as being “very helpful and compassionate,” “extremely easy to be around,” and “extremely knowledgeable in dealing with addicts specifically.”According to the alumni who took our survey, Last Door is a 12-step- and social model-based program, and not centered around religion, although “anyone was free to practice whatever religion they believed in.” The treatment is “very strict in terms of having to follow the rules and participate” and “very much a 'tough-love' approach in that they did not coddle us or baby us." However, “the counsellors and staff were also very supportive, patient and empathetic.”Since leaving Last Door, the majority of the respondents who took our survey have remained clean, sober, and/or abstinent, with one “coming up on 30 years.” Some have relapsed and come back, crediting Last Door with providing “a deep recovery foundation.” Many have stuck around, volunteering at Last Door after finishing treatment. “You feel like you are part of a family,” one alum said, describing the “supportive camaraderie” that ensures “nobody gets left behind.” In fact, after completing treatment, you keep your facility key so “you can come and go as you like, if you want to drop by to have lunch, attend a group session or just visit and hang with the new guys.”When asked what Last Door could do better, most alumni felt that Last Door was already “the most effective treatment centre,” or that they should “add more beds.” Some respondents, however, felt there should be more “awareness on mental health” and a better “platform for mental illness treatment,” with “mental health evaluations when you enter treatment” and counselors with “better credentials.” Overwhelmingly, the alumni who took our survey had high praise for their entire experience at Last Door. Describing the group therapy sessions, one alum recalls “An incredible amount of recovery, healing, tears and growth took place during nearly every group session.” Another resident is grateful for forming “genuine connections with people. And learning to love myself.” One former resident describes “ feeling a sense of belonging and connection for the first time in so long. Having a strong recovery community of men who support each other was something I’ve never had before.” One alum echoed many others’ feelings with this final thought: “A part of me will always be there.. and for that I am forever grateful.” 

Doctors More Likely to Prescribe Opioids to Covid ‘Long Haulers,’ Raising Addiction Fears

Covid survivors are at risk from a separate epidemic of opioid addiction, given the high rate of painkillers being prescribed to these patients, health experts say.A new study in Nature found alarmingly high rates of opioid use among covid survivors with lingering symptoms at Veterans Health Administration facilities. About 10% of covid survivors develop “long covid,” struggling with often disabling health problems even six months or longer after a diagnosis.For every 1,000 long-covid patients, known as “long haulers,” who were treated at a Veterans Affairs facility, doctors wrote nine more prescriptions for opioids than they otherwise would have, along with 22 additional prescriptions for benzodiazepines, which include Xanax and other addictive pills used to treat anxiety.Although previous studies have found many covid survivors experience persistent health problems, the new article is the first to show they’re using more addictive medications, said Dr. Ziyad Al-Aly, the paper’s lead author.He’s concerned that even an apparently small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis, given the large number of covid survivors. More than 3 million of the 31 million Americans infected with covid develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety and memory problems known as “brain fog.”The new study also found many patients have significant muscle and bone pain.The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, chief of research and education service at the VA St. Louis Health Care System.“Physicians now are supposed to shy away from prescribing opioids,” said Al-Aly, who studied more than 73,000 patients in the VA system. When Al-Aly saw the number of opioids prescriptions, he said, he thought to himself, “Is this really happening all over again?”Doctors need to act now, before “it’s too late to do something,” Al-Aly said. “We must act now and ensure that people are getting the care they need. We do not want this to balloon into a suicide crisis or another opioid epidemic.”As more doctors became aware of their addictive potential, new opioid prescriptions fell, by more than half since 2012. But U.S. doctors still prescribe far more of the drugs — which include OxyContin, Vicodin and codeine — than physicians in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.Some patients who became addicted to prescription painkillers switched to heroin, either because it was cheaper or because they could no longer obtain opioids from their doctors. Overdose deaths surged in recent years as drug dealers began spiking heroin with a powerful synthetic opioid called fentanyl.More than 88,000 Americans died from overdoses during the 12 months ending in August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.The new study “suggests to me that many clinicians still don’t get it,” Kolodny said. “Many clinicians are under the false impression that opioids are appropriate for chronic pain patients.”Hospitalized covid patients often receive a lot of medication to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients placed on ventilators, for example, are often sedated to make them more comfortable.Martin said he’s concerned by the study’s findings, which suggest patients are unnecessarily continuing medications after leaving the hospital.“I worry that covid-19 patients, especially those who are severely and critically ill, receive a lot of medications during the hospitalization, and because they have persistent symptoms, the medications are continued after hospital discharge,” Martin said.While some covid patients are experiencing muscle and bone pain for the first time, others say the illness has intensified their preexisting pain.Rachael Sunshine Burnett has suffered from chronic pain in her back and feet for 20 years, ever since an accident at a warehouse where she once worked. But Burnett, who first was diagnosed with covid in April 2020, said the pain soon became 10 times worse and spread to the area between her shoulders and spine. Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which relieves pain immediately. She was reinfected with covid in December.“It’s been a horrible, horrible year,” said Burnett, 43, of Coxsackie, New York.Doctors should recognize that pain can be a part of long covid, Martin said. “We need to find the proper non-narcotic treatment for it, just like we do with other forms of chronic pain,” he said.The CDC recommends a number of alternatives to opioids — from physical therapy to biofeedback, over-the-counter anti-inflammatories, antidepressants and anti-seizure drugs that also relieve nerve pain.The country also needs an overall strategy to cope with the wave of post-covid complications, Al-Aly said“It’s better to be prepared than to be caught off guard years from now, when doctors realize … ‘Oh, we have a resurgence in opioids,’” Al-Aly said.Al-Aly noted that his study may not capture the full complexity of post-covid patient needs. Although women make up the majority of long-covid patients in most studies, most patients in the VA system are men.The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long covid,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”Al-Aly said covid survivors may need care for years.“That’s going to be a huge, significant burden on the health care system,” Al-Aly said. “Long covid will reverberate in the health system for years or even decades to come.” Subscribe to KHN's free Morning Briefing.

Punk Rock Powers My Recovery Every Day

I was a disheveled and bedraggled disaster of a person back in the winter of 2012. I lived for alcohol. If beer was the entrée, crack-cocaine was my digestif. But after an intervention and rehab, I’ve been sober nine years now. I never could’ve done it without music.Even though I had spent most of my career working in the music industry as a producer for MTV News, music wasn’t really a significant part of my life during the worst of my drinking days. But when I was a teen and again now, music has been of utmost importance. Now as an adult I realize music is better than sex. It’s better than drugs. And it’s better than alcohol. It’s a natural high. If given a choice between music and drugs, I choose music. Starting with punk.A Youth in Revolt“Where do you go now when you’re only 15?”Rancid, “Roots Radical,” off the 1994 album And Out Come the WolvesI’ve always felt like a bit of an outcast. As someone who struggles with the dual diagnosis of addiction and bipolar disorder, in a way, I am. But I’m proud to be an outcast, and my punk rock upbringing only reaffirmed that being different is cool.In the spring of 1995, March 9th to be exact — 26 years ago — I experienced my very first punk show. It was Rancid with the Lunachicks at the Metro in Chicago. I still have the ticket stub. I was 15. And in that crowd of about 1,000, I felt like I belonged. I had found my tribe. It was a moment that would transport me on a decades-long excursion, one that finds my punk rock heart still beating now and forever.I often think in retrospect that maybe there were signs and signals of my bipolar status as I grew up. I was in fact different from the others. And I was experiencing bouts of depression inside the halls and walls of high school. Freshman and sophomore years in particular I did not fit in. I was the quiet kid who had barely any friends. I didn’t belong to a social clique like everyone else. I was a rebel in disguise. Until I found punk rock. Then I let it all hang out."Once a punk, always a punk."Rock ‘n’ Roll High SchoolI am a Catholic school refugee. Punk was my escape from the horrific bullying I experienced in high school. Back then, the kids from the suburbs threw keggers. We city kids — I had three or four punk rock friends — were pretty much sober, save for smoking the occasional bowl of weed if we had any. We were definitely overwhelmingly the minority at school as there were probably only five or so of us in a school of 1,400. For the most part, though, we found our own fun at music venues like the Fireside Bowl and the Metro. We went to shows every weekend at the now-defunct Fireside – the CBGB or punk mecca of Chicago that used to host $5 punk and ska shows almost every night.The Fireside was dilapidated but charming. It was a rundown bowling alley in a rough neighborhood with a small stage in the corner. You couldn’t actually bowl there and the ceiling felt like it was going to cave in. It was a smoke-filled room with a beer-soaked carpet. Punks sported colorful mohawks, and silver-studded motorcycle jackets. Every show was $5.My few friends and I practically lived at the Fireside. We also drove to punk shows all over the city and suburbs of Chicago – from VFW Halls to church basements to punk houses.The Fireside has since been fixed up and has become a working bowling alley with no live music. A casualty of my youth. But it was a cathedral of music for me when it was still a working club. After every show, we would cruise Lake Shore Drive blasting The Clash or The Ramones. I felt so comfortable in my own skin during those halcyon days.Fat Mike of NOFX at Riot Fest in Chicago, 2012Punk Up the VolumePunk isn’t just a style of music, it’s a dynamic idea. It’s about grassroots activism and power to the people. It’s about sticking up for the little guy, empowering the youth, lifting up the poor, and welcoming the ostracized.Punk is inherently anti-establishment. Punk values celebrate that which is abnormal. It is also about pointing out hypocrisy in politics and standing up against politicians who wield too much power and influence, and are racist, homophobic, transphobic, and xenophobic.Everyone is welcome under the umbrella of punk rock. And if you are a musician, they say all you need to play punk is three chords and a bad attitude. Fast and loud is punk at its core.They say “once a punk, always a punk” and it’s true.Punk was and still is sacred and liturgical to me. The music mollified my depression and made me feel a sense of belonging. I went wherever punk rock took me. My ethos — developed through the lens of the punk aesthetic — still pulses through my punk rock veins. It is entrenched in every fiber of my being.Godfather of Punk Iggy Pop at Riot Fest in Chicago, 2015A New DayNow, whether it’s on Spotify on the subway or on vinyl at home, I listen to music intently two to three hours a day. Music is my TV. It’s not just on in the background; I give it my full, undivided attention.I started collecting vinyl about eight years ago right around the time I got sober and I have since amassed more than 100 record albums. There’s a reason why people in audiophile circles refer to vinyl as “black crack.” It’s addictive.I’m glad I’m addicted to something abstract, something that is not a substance. A music addiction is cheaper than alcohol and drugs. And not only that, it’s healthy, invigorating, fun, and liberating.And while my music taste continues to evolve, I’m still a punk rocker through and through. My love affair with punk may have started 26 years ago, but it soldiers on today, even though I mostly listen to indie rock and jazz these days. I recently started bleaching my hair again, platinum blonde as I had when I was a punker back in high school. It’s fun and it also hides the greys.Looking back on my musical self, I knew there was a reason why I can feel the music. Why tiny little flourishes of notes or guitar riffs or drumbeats can make my entire body tingle instantly. Why lyrics speak to me like the Bible and the sound of a needle dropping and popping on a record fills me with anticipationPunk is a movement that lives inside me. It surrounds me. It grounds me. Fifteen or 41 years-old, I’m a punk rocker for life. I’d rather be a punk rocker than an active alcoholic. I’m a proud music addict. I get my fix every day. Please enjoy and subscribe to this Spotify playlist I made of old-school punk anthems and new classics. It’s by no means comprehensive, but it’s pretty close.

The End

The last drink I have is a flute of champagne.It’s New Year’s Eve.My husband reserves a special room for us at a nearby hotel. He buys an imperial bottle of Moet, a misplaced purchase for this particular occasion. We’re making a last ditch effort at saving our marriage. A gala’s going on in the ballroom below, where we journey to join the revelers.Lights twinkle, streamers hang, and chandeliers glisten.I hardly notice.The band plays songs that were once my favorites.I hardly hear. Hoards of gleeful couples celebrate around us.We dance with them, pretending to have a good time.But I know the end is creeping near.My husband’s been having an affair with a woman half his age. He hasn't come clean yet, but my gut knows something’s going on. So I bleach my hair a sassier shade of blond, starve myself in hopes of losing the weight I know he hates, turn myself inside out to get him to notice me again.But mostly I drink.Because of my Catholic upbringing, I have a list of rules I follow.My commandments of drinking. I only have three. Ten is too many.1) No drinking before 5:00. I watch the clock tick away the minutes. It drives me crazy.2) No drinking on Tuesdays or Thursdays. I break this all the time. It’s impossible not to.3) No hard liquor. Only wine and beer. I feel safe drinking those.Anything else means, well, I’ve become my parents.Or even worse, his. I can't bear to go there.One night, when he takes off for a weekend conference, or so he says, I get so stinking drunk after tucking my daughter in for the night, I puke all over our pinewood floor. All over those rich amber boards I spent hours resurfacing with him, splattering my guts out next to our once sexually active and gleaming brass bed.Tarnished now from months of disuse.The following morning, my five-year-old daughter, with sleep encircling her concerned eyes, stands there staring at me, her bare feet immersed in clumps of yellow. The scrambled eggs I managed to whip up the night before are scattered across our bedroom floor, reeking so bad, I’m certain I’ll start retching again. I look down at the mess I made with little recollection of how it got there, then peer at my daughter, her eyes oozing the compassion of an old soul as she says, "Oh Mommy. Are you sick?" Shame grips every part of my trembling body. Its menacing hands, a vice around my pounding head. I can't bear to look in her eyes. The fear of not remembering how I’ve gotten here is palpable. Every morsel of its terror is strewn across my barf-laden tongue and I’m certain my daughter knows the secret I’ve kept from myself and others for years.You’re an alcoholic. You can't hide it anymore. Every last thread of that warm cloak of denial gets ripped away, and here I am, gazing into the eyes of my five-year old daughter who's come to yank me out of my misery.It takes me two more months to quit.Two months of dragging my body, heavy with remorse, out of that tarnished brass bed to send my daughter off to school. Then crawling back into it and staying there, succumbing to the disjointed sleep of depression. Until the bus drops her off hours later, as her little finger, filled with endless kindergarten stories, pokes me awake.Each poke like being smacked in the face with my failures as a mother.And then New Year’s Eve shows up and I dress in a slinky black outfit, a color fitting my descending mood, a dress I buy to win him back. The husband who twelve years before drives hundreds of miles to pursue this wayward woman, wooing me over a dinner I painstakingly prepare, as I allow myself to wonder if he in fact, may be the one. We dine on the roof of the 3rd floor apartment I rent on 23rd and Walnut, in the heart of Philadelphia where I work as a chef, and where I tell him over a bottle of crisp chardonnay that I might be an alcoholic. He laughs, and convinces me I’m not. He knows what alcoholics look like. Growing up with two of them, he assures me I am nothing at all like his parents.His mother, a sensuous woman with flaming hair and lips to match, passes out in the car on late afternoons after spending hours carousing with her best friend, a woman he’s grown to despise. Coming home from school, day after day, he finds her slumped on the bench seat of their black Buick sedan, dragging her into the house to make dinner for him and his little brother and sister, watching as she staggers around their kitchen. His father, a noted attorney in his early years, drinks until he can't see and rarely comes home for supper. He loses his prestigious position in the law firm he fought to get into, and gets half his jaw removed from the mouth cancer he contracts from his unrestrained drinking. He dies at 52, a lonely and miserable man.“I know what alcoholics look like,” he says. “You're not one of them.”I grab onto his reassurance and hold it tight.And with that we polish off the second bottle of chardonnay, crawl back through the kitchen window and slither onto the black and white checkered tile floor, in a haze of lust and booze, before we creep our way into my tousled and beckoning bed. It takes me another twelve years to hit bottom, to peek into the eyes of the only child I bring into this world, reflecting the shame I’ve carted around most of my life.So on New Year's Eve, we make our way up in the hotel elevator. After crooning Auld Lang Syne with the crowd of other booze-laden partiers still hanging on to the evening’s festivities, as the bitter taste of letting go of something so dear, so close to my heart, seeps into my psyche. A woman who totters next to me still sings the song, with red stilettos dangling from her fingers. Her drunken haze reflects in my eyes as she nearly slides down the elevator wall.At that moment, I see myself.The realization reluctantly stumbles down the hall with me, knowing that gleaming bottle of Moet waits with open arms in the silver bucket we crammed with ice before leaving the room. Ripping off the foil encasing the lip of the bottle, my husband quickly unfastens the wire cage and pops the cork that hits the ceiling of our fancy room. Surely an omen for what follows. He carefully pours the sparkling wine, usually a favorite of mine, into two leaded flutes huddling atop our nightstand, making sure to divide this liquid gold evenly into the tall, slim goblets that leave rings at night’s end. We lift our glasses and make a toast, to the New Year and to us, though our eyes quickly break the connection, telling a different story.As soon as the bubbles hit my lips, from the wine that always evokes such tangible joy and plasters my tongue with memories, I know the gig’s up. It tastes like poison. I force myself to drink more, a distinctly foreign concept, coercing a smile that squirms across my face. I nearly gag as I continue to shove the bubbly liquid down my throat, not wanting to hurt my husband’s feelings, who spent half a week's pay on this desperate celebration. But with each sip I take, my brain and body scream you freaking alcoholic, and I know at that moment I can no longer do this. When I put down that glass, on this fateful New Year's Eve, I know I’ll never bring another ounce of liquor to my lips.I’m done.There’s no turning back.And as we tuck ourselves into bed, I keep it to myself. Each kiss that night is loaded with self-loathing and disgust. Those twelve years of knowing squeezes tightly into a fist of shame.Little does my husband know, if he climbs on top of me,he'll be making love to death itself. Instead, I turn the other way and cry myself silently to sleep.Your days of drinking have finally come to an end. And you can’t help but wonder…will your marriage follow? Excerpted from STUMBLING HOME: Life Before and After That Last Drink by Carol Weis, now available on Amazon.

Recovery Through Music Therapy: An Interview with Tim Ringgold

Among the glowing testimonials from knowledgeable people on music therapist’s Tim Ringgold’s website, one woman mentions his “sheer kinetic energy,” and Joe Polish, founder of The Genius Network, says, “I work with some of the very best speakers in the world. There are very few people that can hold people’s attention better and inspire others more than Tim Ringgold.”Recently, I experienced that when I witnessed Tim give a Zoom public talk about his craft as a music therapist. Even so, as a former editor of The Fix, I found the content of his talk – using music therapy to treat emotional pain and addiction - even more compelling than his smile-inducing kinetic energy. I thought Fix readers would benefit from knowing about him and music therapy.A singer and classical musician before he was a music therapist, at 16 he sang solo to Pope John II in St. Peter’s Square before 13,000 Catholic pilgrims. In his twenties, he morphed into a rocker who played some of LA’s major clubs. In his thirties, reverting to classical music, he sang at the Hollywood Bowl and in some of the oldest and largest European cathedrals.Ringgold’s path to musical therapist was guided by pain, including struggles as a recording artist and with addiction, with added trauma from the early death of his father, the murder of his five best friends, and the life and death pain of his special-needs daughter. Recovery took him into the Landmark Forum where his exceptional natural gifts for teaching and empathy moved him up the ladder to Introduction Leader. Then, merging his music and counseling aptitudes, he studied music therapy. In 2008, with Landmark behind him, he was certified to practice by the certification board for music therapists (there are 8,000 nationwide, with a very small percentage working in addiction treatment).Tim began his practice working in oncology before he segued into the addiction recovery field, with a second career as an in-demand public motivational speaker. Now, apart from the sessions he leads for a multistate addiction recovery center, he manages a team of eight other music therapists across the country. Each music therapy session is one hour, once a week, and includes four to six clients, though some clients opt for one-on-one sessions.Since 2008, Tim has annually worked with 500 to more than a thousand recovery clients, primarily in groups. He also leads online workshops, a grief retreat, as well as hosts the Stress Elimination Summit and the podcast Reduce Your Stress with Tim Ringgold. Tim is also the author of Sonic Recovery: Harness the Power of Music to Stay Sober, and gave the first TEDx talk on music therapy in 2012.The Fix: What’s the relationship of music to addiction?Tim Ringgold: First, let me say that people who are in treatment for substance abuse and addiction are there because of underlying issues of trauma, depression, anxiety, high ADD, ADHD, PTSD, and/or traumatic brain injury. Addiction never occurs in isolation. The addiction is a solution to those problems. Problem is, it’s a crummy solution because it causes more problems than it solves. Most people think it is the problem itself, but it is really just a symptom - like a cough - of an underlying issue. So, the real game is to be addressing the underlying issues, which is what we want to get to with music therapy.What’s a story example or two?One day, I am leading a group, and we are doing active music making using rhythm instruments -  drums, percussions, shakers - and we’re improvising and just creating spontaneous music. The purpose is to explore the sounds of the instruments and connect with the beat.One of the clients is a teenage boy who doesn’t say much the whole session. We’ll call him Dave. Dave is playing a buffalo drum which is a Native American rhythmic instrument where you hold the drum with one hand and you have a mallet in the other hand and you play the drumhead with it.Throughout the improvisation, it is clear Dave is exploring this drum. There is a discovery happening, but he doesn’t verbalize anything. At the end of the session, there is a group note that all the clients have to fill out that asks things like:  “What was your greatest takeaway? What did you learn? Identify an emotion you feel.” Dave wrote: “I finally found the way to get the violence out of me.”One of things that was notable and remarkable about Dave were all the scars on both forearms, from his wrists on the outside of his forearms up and down his forearms. Dave had a history of cutting. Clearly, he had been trying to get the violence out of him. On this day he was introduced to a drum - and in his own words the drum was more effective than anything he’d tried up to that point.So, music therapy is about empowering and equipping clients and patients to use music as a tool for their own regulation, their own expression, in ways that talk therapy simply cannot access.Second story?Larry. It’s his first day at an adult residential drug abuse treatment program. In group, Larry says: “No offence, but I don’t trust anybody in this room and I certainly don’t trust any of the staff here,” myself [Tim] included. I said, “That’s okay, Larry. What’s one of your favorite bands?“ And he answers “The Eagles,” and I said “Cool, what song from the Eagles do you really connect with?” And he answers “Desperado.” Now this is one of those clinical moments you cannot make up. Because the lyrics from “Desperado” are so auto-biographical for so many men who find themselves in treatment. The song paints the picture of somebody who is tired and alone.And so it was no surprise that this guy - who said he doesn’t trust anybody - identifies with this song. It’s his story. So in one word he’s told me clinically more about himself by saying “Desperado” than if he had spent five minutes telling the narrative of what brought him to treatment.So, I say to Larry “Okay for the next week I don’t want you to trust anybody here but I do want you to trust the Eagles and I want you to trust “Desperado” and I want you to listen to the Eagles during the week.” Well, you should have seen the look on his face that I gave him permission to trust something that he felt safe with as opposed to something I felt safe with.People tend to trust the music they love because their music doesn’t scold them about how they feel, what they think, or what they do. So, they feel emotionally and psychologically safe around their music. That’s why someone can actually be feeling more safe and connected alone in their room with their headphones on than in a room full of people.PS: the next week in group Larry was fully invested - not just in group but in treatment overall. So that’s Larry’s story.What’s the age range of most clients?We mainly treat adolescents and young adults, which is very inspiring to me, because potentially they have so much future ahead and comparatively very little past. Because we imprint music on our psyche so deeply between the ages of 14 and 24, music is like our co-pilot in our journey of becoming our identity as an adult. To leverage music in such a personal and powerful way at such a time of crisis is so deeply rewarding.Even if they get sober, they are going to have a deeper relationship with music for the rest of their life - and it’s not going to be just entertainment. It’s going to be a vital tool in their ongoing recovery. Because music can trigger a craving, or it can relieve one. Showing clients the right way to reach for their music so their own music doesn’t undo all the work they are doing in treatment, is not only important but deeply satisfying.For me, to be a part of their treatment at this stage of their chronological journey holds great promise compared to when I worked in oncology with people at the end of their life and I was soothing their transition, which was deeply gratifying in a different way.How do you as a music therapist make it relevant to everyone in the room? What is the process? There are five clinical outcomes that we are addressing in any given group, and when combined they spell the acronym SOBER. It stands for Stay present, Open up, Be creative, Escape stressors, and Reconnect. The different types of groups that we lead are all focused on addressing one or more of those clinical outcomes - and those clinical outcomes are relative to everyone in the room. The session is tailored to address one or more of those outcomes. The interactions include active music making, song analysis, relaxation, creative arts, songwriting and song selection. The difference between song analysis and selection is that in song analysis the therapist chooses the music to address an underlying theme of treatment. In song selection, the clients choose the music that describes some part of where they have been, where they are, or where they want to go.Okay, so there are six clients in a room with you, and what is the flow? What do you start with, what happens after that, and how does it get individuated to six people?  Let's take an active music-making session, for example.Why do you even choose an active music-making session?Active music making is the most effective session because it addresses all five clinical outcomes simultaneously. It is efficient and effective - and empowering - because a lot of people have a story or belief that they are not musical, or not musicians, or couldn’t possibly play music, that they don’t have talent... some version of that belief. However, through our training, music therapists know how to get any human being making music in a matter of seconds.So, we are able to smash that belief - not by convincing but through a person’s successful engagement with the music. And the tools we use are rhythm-based instruments and voice because the human body runs on rhythm. Every cell, every organ, every system, literally every body – the fundamental organizing system of everything happening in the body is rhythm. For example, you walk in rhythm, talk in rhythm, chew in rhythm, sleep in rhythm, your heart beats in rhythm, you breathe in rhythm, you even scratch in perfect rhythm. As music therapists we just put instruments in the way of rhythms that the body already has experience with. That’s relevant because the person in treatment has that belief that music is hard, time consuming and relegated to those who have talent. But when we smash that belief in a matter of seconds by improvising with rhythm instruments, it opens the door to a conversation about what other limiting beliefs they have that aren’t serving them and are simply an illusion.Again, what is the step by step by step process?First thing we start with is teaching the acronym SOBER so they know why we are doing music and it is not for entertainment and is not for education, but as a tool for recovery. And then we introduce the instruments in the room and demonstrate them, showing how easy they are to play successfully. Then I will invite the participants to select an instrument that looks interesting. I play a bass drum and lay down a heartbeat on the bass drum and I simply say, “Explore the sounds on your instrument and then connect the sounds to the beat.” They only have two tasks: one Explore, two Connect.After we groove for a period of time I have them switch instruments and a new groove begins. After a period of time we switch instruments a third time. At this point, depending on how long we have been improvising together, I can take the group in one or two directions. The first is a discussion around what instruments they connected with and why?Now we begin the verbal process and look at how the tasks of “explore and connect” apply to all the other kinds of therapy groups they attend at the treatment center. We know they are not going to connect with every group, just like every one of us doesn’t connect with every type of exercise, but we all know exercise is vital in minting mental health. So, it is up to us in recovery to explore different types of exercises so we connect with one we enjoy.So, we use the music therapy experience as a metaphor and expand the conversation further out into their treatment. We might ask them to talk about what groups they have connected with in treatment, what staff have they connected with, which fellow client have they connected with, what family member do they feel connected with? The client begins to see the thread, the connection, as part of the road to recovery - and it all started with “just a shaker” or just a drum.At this stage of the group we will circle back to the SOBER acronym and ask them which one of the SOBER letters did we address in the group? And now they have to integrate their experience with the outcomes – it’s almost like a recap that cements the whole experience. It’s almost like “lecture, then lab, then lecture” - lecture and lab all in one. Its analytic and left brain and its experiential and right brain all in the same session.Say more about the instruments available.Usually there are more instruments than people. It’s like a buffet. They play three or four in the course of a session but there are 10 plus instruments at their disposal - mostly rhythmic percussion instruments – so drums, shakers, wood blocks. I used to run a group where they had to raid the kitchen and make instruments out of utensils, pots and pans. But the chefs didn’t like that.Are the one-on-one sessions much different?One-on-one mimes the others but we focus on guitar or ukulele lessons because learning guitar or uke is really useful as a recovery skill. That’s really hard to teach in a group setting but really easy to do one-on-one. But the main difference maker is client song selection where the client is the DJ for the hour and selects music that represents how they are feeling. What they are struggling with or, on the flip side, music that inspires them – there are lots of different prompts.The music creates a bridge between the client and the therapist because oftentimes an artist articulates emotion in the form of music and lyrics better than the clients with just words.So, you ask a client how are they? And they say, “I don’t know.” But if you ask them to play a song that might match how they are feeling, there is a whole world of emotion contained in the music and lyrics and it helps a client express those elusive feelings that they may not be able to put words to.Seems music therapy works best in concert with other therapies.In treatment there is no therapy that is a stand-alone therapy for addiction. Addiction treatment is a cluster or constellation of modalities. It is an inter-disciplinary approach because talk therapy alone doesn’t treat trauma, so you need multiple modalities that address the bio, psycho, social and spiritual aspects.Have you been doing this all on zoom this last year?During the pandemic we’ve been leading Zoom sessions most of the time and some of the time we lead in-person sessions wearing masks and social distancing. Learn more: Tim Ringgold.View Tim on YouTube. 

A Pandemic of Grief

COVID-19 has killed more than half a million Americans. That in and of itself is a jarring statistic, but there’s another grim number to be aware of: each of those deaths has left about nine bereaved people behind. That means that roughly 5 million Americans are grappling with grief and loss, which could put them at higher risk for opioid or other substance abuse. Pain — whether physical, mental or emotional — can cause people to seek out relief. Too often they find it by using or abusing opioids or other drugs.“Grief is a universal feeling that most of us will need to endure at one time or another,” says Clare Waismann, RAS/SUDCC, Waismann Method® and Domus Retreat founder. “Whether you are grieving the loss of a loved one, a job, or even a relationship, grief hurts. When the grief is the result of a death, the level of pain is substantially higher.”The pain of grief can be accentuated by the pandemic, which has disrupted the rituals that are meant to help us process grief. If you are unable to see a loved one before they die, travel to be with your family, or have a funeral, you’re more likely to suffer from complicated grief. Complicated grief is characterized by pain that is so overwhelming it can interfere with your ability to live your day-to-day life. Normally, complicated grief affects about 7% of bereaved people, but during the pandemic the prevalence is likely even higher.Many people with complicated grief turn to maladaptive coping strategies, including substance use and abuse. This is especially true for people who have a history of mental illness or drug dependence.“When the pain becomes overwhelming, the natural emotional response is to search for relief,” Waismann says. “Those with a history of mental health issues or addiction are more likely to fall into a pattern of substance abuse in order to cope.”Preventing substance abuse amid griefThere’s no prescriptive or expected way to move through grief, especially in the shadow of a global pandemic. Even the well-known Stages of Grief are often circular, rather than linear. Generally speaking, however, grief should become more manageable as time passes.“Most people experiencing grief can start the healing process after some time,” Waismann says. “While grief is a familiar and healthy feeling to experience, it is unpleasant and unresolved grief can significantly increase addiction-related issues.”If you feel entirely overwhelmed by grief, it’s important to reach out for professional help from a counselor before you try to self-medicate by using or abusing substances. These steps can also help you process grief:Talk to your loved ones about your feelings.Join a support group for people who are grieving. These are currently available online.Take care of your physical and mental health by exercising and meditating.Do activities that bring you joy, like reading or art.Staying ahead of griefIf you feel that your grief is more overwhelming than it should be, you should seek professional guidance. Remember, there’s no harm in reaching out, but doing so could make a world of difference.“You don’t have to wait until symptoms of grief persist to seek treatment,” Waismann says. “Remember, get ahead of your emotions. Don’t suffer more than you have to.”At Domus Retreat, Waismann provides support for relapse prevention. This can include for people who are experiencing grief, including the death of a loved one during the pandemic. The entire experience at Domus is designed to help people focus on their recovery and wellness.“There are no chores, no pre-set expectations, length of treatment or protocols. We will provide care based on your unique needs,” Waismann says. “We also offer services to support your overall physical and mental wellbeing including yoga, massage, drama therapy, tai chi, and individual psychotherapy.”Stepping back can be exactly what a person needs in order to process their grief and move forward in a healthy way.“We reach you where you are at and help you get where you need to be,” Waismann says.

Anxious about going out into the world? You’re not alone, but there’s help

It’s the moment we thought we were all waiting for…or is it? We were cautiously optimistic about the end of the pandemic in view of increasing vaccine availability and decreasing case numbers after the peak in January.Then, whether due to variants, pandemic fatigue or both, cases and case positivity began to increase again – throwing into question whether the end was as near as we thought. This is merely one of the most recent of the many reversals.I am a physician and associate professor of medicine at Michigan State University’s College of Human Medicine. In my role as the director of wellness, resiliency and vulnerable populations, I speak with staff and faculty members who may need a sympathetic ear or may be struggling.Amid the happiness and relief that people are feeling, I also see confusion and some fear. Some people are wary of going out again, and others are eager to throw a party. Some learned that they like being alone and do not want to stop nesting. I think this is all normal from a year of what I call the zigzag pandemic.Change after changeAwareness of the novel coronavirus for most of us rose between January – when the first cases in China were reported – and March 11, 2020, when the World Health Organization officially declared a pandemic. Since the declaration, daily uncertainty and contradictory information has been the norm.First, no masks were needed. Then you had to wear a mask. Hydroxychloroquine looked promising and got emergency use authorization, but that was revoked fairly quickly and officials said not only was there no benefit but there was some potential harm.We were transiently afraid of groceries, packages and surfaces. Then data emerged that surfaces were not as dangerous as previously thought.In the absence of a coordinated national policy, states began to fend for themselves, creating their own policies regarding shutdowns and masks. Even now, there is state-by-state variability in which businesses may be open and at what capacity and whether masks are required, suggested or neither.Both inevitable and avoidable factors played into the back-and-forth. Part of the whiplash is due to the “novel” part of the novel coronavirus, or SARS-CoV-2. This virus is new and many of its characteristics unknown, leading to policy revisions becoming necessary as more becomes known.Part of the zigzag is due to the nature of clinical trials and the nature of the way scientific knowledge emerges. Learning about a new pathogen requires time and the willingness to challenge initial assumptions. Part is due to the lack of a reliable source of information trusted to act in our collective best interests and a lack of preparedness.Given the reversals behind us and uncertainty ahead, we need to examine both individual and societal responses moving forward.Different experiencesThere is no question that all of our lives have changed. However, the ways in which they have changed has varied widely. The variation depends on our jobs – think of the differences for grocery store, tech and health care workers – our living situations, our underlying physical and mental health, our financial status and our personalities, just to begin with.For example, some introverts have been fortunate enough to work remotely in comfortable clothes with broadband internet and no children to educate, while their extroverted colleagues have longed for more social connection. Their colleagues with young children and jobs that could not be done remotely have been scrambling. Many have hit the wall and find themselves adrift and unmotivated, while others have seemingly thrived doing long-postponed projects.Nearly everyone has been affected in some way. A recent systematic review concluded that the pandemic is associated with highly significant levels of psychological distress, particularly in certain higher-risk groups.As individuals, what can help us get through this?What we can do for ourselvesFirst, we can begin by making a fearless assessment of our current reality – the state of now. Sometimes making an actual list of our needs and assets can help us to prioritize next steps. Steps may be visiting a community health center, a virtual therapist, a job fair or even something as simple as carrying a printable wallet card with stress reduction tips.What might work for you might not work for your spouse, partner or best friend. We need to be doing whatever is known to foster resilience in ourselves and our family members.This includes making human connections, moving our bodies and learning to regulate our emotions. Looking back at how we handled past difficulties may help us. Mental health concerns have become more common, and evidence on overall impact of the pandemic on mental health is still being collected.There has been increased public awareness about these issues, and telehealth has eased access for some seeking help. Our society – individuals as well as institutions – needs to continue to work to make it acceptable for people to get mental health care without worrying about stigma.Deciding which of your normal activities you wish to resume and which to let go of helps you to prepare for the future. So does noting which new activities you’d like to hold on to. These lists potentially include attending family or sporting events, traveling, going to the gym or live worship. You may choose to continue to cook at home or work from home if you have the choice. Of course, all of these choices should be made in accordance with CDC guidelines.And then there are things we may not want to do. That can include behaviors we learned about during the pandemic that don’t make us feel good or serve us well. That may include watching too much news, drinking too much alcohol and not getting enough sleep. And yes, maybe there are some relationships that need changing or reworking.Then, we need to to think about what we can do on a level larger than the individual.Societal and governmental changesFor many people, it feels futile to address individual resilience without addressing what feels like a rigged system.The pandemic hit at a particularly politically polarized time and a particularly unprepared time. This was unfortunate, because fighting a common adversary – such as polio or a world war – can unite a population.In contrast, the coronavirus was subject to multiple conflicting interpretations and even doubt about its severity. Rather than rallying together against the virus, our adherence to mandates became a surrogate for our political beliefs.[Get the best of The Conversation, every weekend. Sign up for our weekly newsletter.]Now that longstanding inequities have been highlighted by differential infection, hospitalization and mortality rates by race, political and public health officials can begin a careful analysis of the gaps in health care coverage by race.While examining how to effectively address longstanding disparities is crucial, so is being prepared for the next pandemic. A coordinated nonpartisan, science-based health infrastructure prepared to rapidly roll out emergency responses as well as consistent clear messaging would be vital. However, without a population willing to consider collective good ahead of individual freedom, we run the risk of repeating history.Claudia Finkelstein, Associate Professor of Medicine, Michigan State UniversityThis article is republished from The Conversation under a Creative Commons license. Read the original article.