In Praise of Tuesday’s 6pm Meeting, Free Coffee* and Knowing Smiles

Even before they get into recovery (and, hopefully, they do get there one day), alcoholics already know all about the idea of a “Higher Power” - the concept that there is an unseen, spiritual force above all of us in the great scheme of things, more powerful than our humble selves, and far more in control of everything than we are.In fact, you could say alcoholics, when they’re actively drinking, have been regularly worshipping one specific “higher power,” albeit straight from the neck of the bottle, on a daily basis for years and years, and sometimes even 24/7, on a particularly inspired day.As an AA acquaintance, after an especially freezing winter’s night meeting in Seattle, once said to me: “Let’s face it - they don’t call it spirituality for nothing, you know. S-p-i-r-i-t-uality. That’s so stupid, even old drunks like me can understand it.” Yes, she really did s-p-e-l-l it out like that. “F.E.A.R. = Face Everything And Recover”- Old Alcoholics Anonymous (AA) ProverbSo, here’s the thing.Regardless of what you may believe to be true of Alcoholics Anonymous, whether you think it’s just old and bearded, God-fearing guys getting together every week, and telling each other drinking war stories, or simply an exceptionally good example of how we can find real healing for ourselves and for each other within a supportive community network, there has always been one specific point that has always been vehemently debated.Everyone from the addiction experts, the medical clinicians, and the mainstream media, right down to a couple of die-hard drinkers arguing in a bar, the question remains the same, and so do the arguments for and against.The question is this: Does AA actually work? You may have missed it, as the following results came out during 2020 when the majority of our minds were rightly firmly focused elsewhere, but now there is proof - and clear, 100% proof, at that (and yes, pun intended). It’s official - well, as official as these things can be.Yes, AA really does work.AA Provides Powerful, Cost-Effective Addiction TreatmentHold the front page. What? Let’s repeat that… Alcoholics Anonymous really does work. Tuesday’s 6pm meeting, “free” coffee (pop your coins in the jar, please, newcomers), friendly faces, knowing smiles, even the old war stories that say, “It’s okay, brother, sisters, I’ve been in that hell you now find yourself in. I got out, and you can, too. You’re not alone,” and everything else - put it all together, it works.AA works. Now we know. Got that? OK, if that isn’t enough, now here’s the real bombshell - the “hold-the-front-page” headline:Active involvement in the AA’s 12-Step program is as good as any other form of addiction treatment.Based upon the clinical results of 27 peer-reviewed studies, representing over 10,000 participants, and in the very first analysis of its kind, supported by the U.S. National Institute of Alcohol Abuse and Alcoholism (NIAAA), active involvement in the AA’s 12-Step program performed as well as first-line clinical interventions at the end of treatment for keeping people abstinent from alcohol - and, therefore, sober.Clear-headed, 100% sober.Furthermore, in the majority of these 27 studies, which had to go through rigorous criteria to be included, full participation in AA even performed better over timed follow-ups - specifically at 6, 12, 24, and 36 monthly intervals - after the end of first-line clinical treatment for ensuring sobriety.That’s definitely worth repeating: Full and active participation in AA even performed better over time than first-line clinical treatments in keeping recovering alcoholics alcohol-free and in recovery.The proof comes from an ongoing review study, “Alcoholics Anonymous and Other 12-Step Programs for Alcohol Use Disorder,” which is being conducted through the esteemed Cochrane Library’s program of systematic clinical reviews, considered the gold standard in scientific rigor for medical research.This particular report, produced by the Recovery Research Institute, a leading nonprofit research institute of Massachusetts General Hospital (and an affiliate of Harvard Medical School), represents the most comprehensive and up-to-date review and analysis of the medical research community’s current and historical scientific literature on the effectiveness of Alcoholics Anonymous.More on the report, its evidential findings, and what it all means for the field of addiction treatment and recovery later in this article.Lockdowns, Locked Doors and Lost RecoveriesLet’s just remind ourselves of what the COVID-19 pandemic did to the absolutely huge number of AA meetings, here in the U.S.: When the stay-at-home orders came and the quarantine lockdowns began, every one of these meetings either had to move online or come to a temporary end.The once open doors of church halls, community centers, town halls and the like were now firmly closed, and the tough-looking padlock locking you out told you everything you needed to know about the fate of your usual 6pm Tuesday evening meeting. “F.E.A.R. = F*** Everything And Run”- Alternative AA version Knowing what we know now about exactly how effective these AA meetings are in keeping their regular attendees safely on the recovery wagon, it stands to reason that, when the lockdowns came, countless alcohol addiction recoveries simply fell by the wayside, lost to those who had previously relied on the camaraderie, the warm friendship, and the sense of real fellowship their local meetings provided to keep them focused, alcohol-free, and firmly in recovery.Fortunately, things are changing. According to the latest government figures, around 62% of U.S. adults have had at least one vaccination shot, and over 135 million are now fully vaccinated.Last month, the White House proudly declared the country was finally getting to grips with a virus that has taken over half a million lives across the nation to date, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recently stated, "We do need to start being more liberal, as we get more people vaccinated."Importantly for the usual participants of AA meetings, no doubt extremely fed up staring into a computer screen, very soon they will once again be meeting in-person - together again, with the free coffee* and the knowing smiles.Always on the Edge of Accepted Addiction TreatmentAlcoholics Anonymous, one of many 12-Step programs and similar mutual-aid programs around today, is easily the world’s most widely available and most used support group for recovering substance addicts. During its 85-year history, it has supported countless millions of alcoholics, spread all over the globe, to find a manageable and sustained recovery from their own personal version of this chronic disease.However, as we said earlier, AA’s efficacy has always had the clinical doubters and expert naysayers, and so, as viable addiction treatment, it has always been right out there on the edge of accepted treatment.Regardless, it does have its rightful place in the “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition),” published by the National Institute on Drug Abuse (NIDA), which states, “Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.”Hopefully, the editors at NIDA will now edit the sentence to read “does help maintain abstinence.” Who knows? On the basis of this article, they may even publish a Fourth Edition...Back to the doubters. The late 20th century saw clinical scientists and addiction experts begin (once again) to question and debate its actual effectiveness, often citing a lack of cohesive and reliable data for analysis. Fortunately, we now have that data - an additional 30 years' worth, both cohesive and reliable, to draw on for analysis.Not only that, the researchers have now:Developed highly sophisticated methods for evaluating AAThoroughly tested its clinical interventions, andDeveloped a rigid methodology to compare these interventions to other treatments, such as Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET).Twelve-Step Facilitation (TSF)In addition, their analysis included another recognised treatment strategy, directly allied to AA, and known as “Twelve-Step Facilitation” (or TSF, for short). TSF is an active engagement strategy included as standard in many professional treatment programs which directly links current program participants to 12-step mutual-aid organizations like AA, and encourages the active engagement and involvement of those people.Effectiveness and Cost Study of Alcoholics Anonymous (2020)So, sadly without a suitable fanfare, let’s provide a more detailed summary of the study’s findings, in terms of both the effectiveness and cost benefits of AA and TSF compared to other first-line clinical interventions, namely the standard therapies of CBT and MET:EffectivenessAlcoholics Anonymous and Twelve-Step Facilitation (AA/TSF) produced rates of alcohol abstinence, and subsequent alcohol use, comparable to first-line clinical interventions, and outperforms them over follow-up; for example:a 21% lower risk of a return to alcohol use among AA participants compared to those receiving other clinical interventions at 12-month follow-up.a 66% lower risk of a return to alcohol use among AA participants compared to those receiving other clinical interventions at 6-month follow-up.Specifically, AA/TSF was found to be better than other standard treatments (eg. CBT and MET) in achieving:Continuous abstinence, andSpecifically, AA/TSF was as effective as other standard treatments in reducing:The intensity of drinkingAlcohol-related consequences, andThe severity of AUD.Lastly, AA/TSF showed a higher percentage of days abstinent from alcohol use; for example:at the 24-month stage, an average improvement of 12.1% days, andat the 36-month stage, an average improvement of 6.6% days.CostIn addition to the overall effectiveness of AA/TSF as an addiction treatment in its own right, the Recovery Research Institute researchers took the opportunity to assess cost comparisons between the 12-Step program and the traditionally recognized therapies.In a 3-year follow up study of individuals with severe AUD, the researchers found that AA participants had alcohol-related outcomes comparable to outpatients receiving clinical addiction treatment, yet their alcohol-related health care costs associated with AA participation were considerably lower - 45% lower, in fact, representing a cost-saving of $2,856 per participant.What Does AA’s Proven Effectiveness Mean for Addiction Treatment?The report’s implications are undeniably extensive, affecting current and future recovering alcoholics, their families and loved ones, the field of addiction treatment and recovery, including both the medical researchers and addiction treatment businesses, and, particularly when you consider the cost-saving aspects, even right up to the policy makers in federal government.For example, if a recovering alcoholic is opposed to AA in some way, they really should consider alternative mutual-aid organizations, such as Self-Management and Recovery Training (SMART), LifeRing, Refuge Recovery, and Women for Sobriety, and then actively participate in the group of their choice.Certainly, far more research is needed around AA and other mutual-aid programs to discover what it is about the concepts and practicalities of each that drives these levels of engagement. With the additional benefit of significant cost-savings, hopefully, in the future, it will result in professional addiction treatment being far more accessible to more people who need it.Increased access to alcohol addiction treatment is certainly something that desperately needs to happen, and happen soon, especially when you consider the following recent statistics:Only 7.2% of people, aged 12 and older, who had AUD in 2019 received any treatment, andFurthermore, only 6.4% of adolescents, ages 12 to 17, who had AUD in 2019 received any treatment.*(Pop your coins in the jar - thanks) 

The Case Against Drug Decriminalization

Proponents of drug legalization argue that legalizing drugs would bring abuse from the darkness into the light, but Clare Waismann, RAS/SUDCC, founder of Waismann Method® and Domus Retreat, fears legalizing drugs would pour fuel on the fire of America's addiction and mental health crisis. "In the United States, we are currently lacking good, accessible and effective mental healthcare. Therefore, legalizing brain altering drugs is just putting gasoline on the fire." Waismann said on a recent episode of her podcast. The movement toward drug legalization or decriminalization might seem far-fetched, but the United States is rapidly moving toward decriminalization. In the past ten years, seventeen states have legalized marijuana for recreational use, and 43% of Americans now live in the seventeen states and Washington D.C., where recreational marijuana use is legal. States have recently started decriminalizing psychedelics as well. Although some see this as progress, Waismann believes it can be dangerous. A simple example is that marijuana users are more likely to drive while under the influence, putting themselves and others at risk. Additionally, they're dabbling with a drug with serious adverse effects on brain regions responsible for memory, learning, impulse control, and cognitive abilities. Likewise, psychedelics can impact the mind and perception of the world even after use. Studies have shown that psychedelic drugs can lead to severe long-term health conditions, including persistent paranoia and perception disorder.Marijuana might be considered a harmless substance that can be used safely and responsibly. However, widespread legalization means that any adult, regardless of their mental health history, has access to the intoxicant without any health care management. That's irresponsible, says Waismann, and could spell disaster down the line. Consistent marijuana use can diminish people's motivation, which can lead to depression and unproductivity."Sometimes individuals use marijuana to manage psychiatric disorders that are not being adequately treated by a professional. However, marijuana is not a treatment, but a way to self-medicate the emotional distress. Therefore, the condition may continue worsening because the person doesn't receive the help they truly need," Waismann says. According to recent studies, marijuana use can cause aggressive behavior, exacerbate psychosis, or even lead to paranoia.Furthermore, the currently available marijuana is far more potent in THC concentrations, the psychoactive component which results in a higher risk for paranoid ideation and psychosis. Consequently, paranoid behavior is directly associated with aggressive and violent behaviors.Legalizing drugs is currently a growing risk to American citizens’ well-being. The expansion of private pay studies, showing that marijuana provides minor threats to the public's health, is causing state and federal legislatures to change laws that will significantly expand the accessibility of marijuana. Consequently this puts people at risk.Of course, the harm of drugs exists on a continuum. Using marijuana is not the same as abusing opioids, for example. If someone can work with their doctor to medicate with cannabis rather than powerful prescription pills, that should be encouraged. Private industries have spread a tremendous amount of information that compares harmful drugs like opioids to marijuana. It's ludicrous that we have to choose one evil over another. Instead, we can choose to use our resources to focus and treat why someone is seeking to alter their feelings. If you just cover up a condition with a band aid, you may not see it, but the problem will keep growing. You can numb unwanted emotions with substances to a certain point, but eventually, the drug won't be enough to ease the pain anymore, leading to unpredictable, risky situations.People must address any physical or emotional pain that is driving them to seek relief through substances. By addressing the root cause of the pain — whether childhood trauma, untreated mental illness, or a physical condition — people can learn to live life without seeking mind-altering substances. Helping people find the best chance to a better quality of life is the goal of the Waismann Method and Domus Retreat team. Our mission is to better the lives of those impacted by substance use through proven medical care, using comprehensive and individualized solutions. Our work is strengthened and inspired by the respect and compassion we have for every person who comes to us for help. We genuinely believe that when people reclaim their health, they strengthen their abilities to cope with mental health issues.With millions of Americans dependent on substances, it's clear that we need to do something more. However, legalizing drugs, especially drugs that further cause damage to the nervous system, is not the answer. Instead, we must strengthen the strategies that people use to address their physical and mental pain, to keep them from seeking drugs in the first place. We need to focus on the crises of pain, isolation, and emotional health many Americans are grappling with. Legalizing drugs is not a solution but a profitable and damaging delay in providing one. 

4 Tips for Staying Strong as the World Reopens

A year ago, we were all reeling from the adjustments to pandemic life. Wearing masks felt confining and absurd; our tongues were still wrapping around new words like “social-distancing” and “quarantine.” And yet, over the past 12 months, pandemic life, with its social isolation, remote work and six-foot distances, has become our new normal. Now, as vaccines become more widespread and the world opens up, some people are finding that transition to be challenging and uncomfortable as well.This can be even more so the case for people who are newly in recovery. If you were newly sober before the pandemic, you might have found comfort in the fact that no one was out drinking and socializing — the world, for a year, hit pause, and that may have allowed you to focus on your recovery. Now, you might find yourself struggling to adapt to being sober during more normal times, or even concerned about relapse.If that’s the case, don’t worry. If you could stay sober during the pandemic, you’ll be able to maintain that during the reopening phase, even if your approach might need some adjustment. Here are some tips for staying strong and sober as the world reopens.Decide what stays and what goes. The past year has taught us that the world can keep turning even when we step away from our norms and routines. That was true as things shut down, and it will be the same as they reopen.Use that idea as a way to empower yourself. While there are some things we’re all eager to get back to (hello, restaurant dining) there are other changes during the pandemic that we’re loath to give up (like working from home). Take some time to decide what worked well for you during the past year, and what you might like to hang on to in the future.Set goals for the year. Sure, we probably all already set our New Year’s resolutions. But as things continue to open up, we’re facing another new beginning. Think about what you want to get out of this period of time, and set goals for it.Maybe you missed being of service, and are looking to utilize in-person volunteer opportunities. Perhaps you have enjoyed a particular online meeting and want to maintain your connection to that group. Write down your goals in order to stay focused on them through the transition.Recognize that change is tough. For months we’ve all been waiting for the end of the pandemic. But now that things are returning to normal, we’re also faced with the loss of the past year: the lives lost, the time apart from loved ones, and the milestones that we’ve missed.Because of that you might find yourself grieving, even during a time when you thought you would be celebrating. Recognize that this is a normal response — it’s understandable to be overwhelmed at a time when everything is changing, just when you’ve gotten used to the way things were. Practice self care to keep on track with your recovery even during this transition.Set the tone for the rest of your recovery. This year has hopefully been a once-in-a-lifetime experience. Right now you’re adjusting your recovery to post-pandemic life, but that will be the norm for the rest of your life in recovery. Right now is a great time to think about what you want your routine to look like long-term. Identify your priorities for your recovery, and begin implementing those in your life today. By doing that, you can guarantee that you have the recovery that you want.Getting through the past year with your sobriety intact is no small feat. If you’ve done that, congratulations. If you need support during this transition time, don’t be afraid to reach out to your rehab team, your recovery group or any friends and mentors that you have made in the community. Everyone is going through a transition right now, and by opening up to others you can surround yourself with the support that you need to make your recovery successful.Learn more about Oceanside Malibu at http://oceansidemalibu.com/. Reach Oceanside Malibu by phone at (866) 738-6550. Find Oceanside Malibu on Facebook.

5 Side Effects of Smoking That Might Come as a Shock to You

Cigarette smoking has catastrophic consequences as it changes just about every organ in your body, which leads to general deterioration of the smoker's life and health. The U.S. Centers for Disease Control and Prevention estimated that cigarette smoking is responsible for every 1 in 5 deaths across the U.S. It is deadlier on an annual basis than HIV/AIDS. Not only this, it also puts people at risk of heart disease and diabetes.Considering this array of diseases, it is necessary to seek proper medical help and sign up for an addiction treatment program as soon as you can.In case you’re not convinced that smoking is actually harmful to you, here are some side effects of lighting up that you might not be aware of:1. Risk of ALSA widely-held hypothesis that smoking causes ALS (Amyotrophic Lateral Sclerosis) has been confirmed by a study in 2009. ALS is a devitalizing neurological illness, a progressive nervous system disease that affects the nerves in the brain and spinal cord, causing you to lose muscle control. Research has found that people who are regular smokers put themselves at greater risk of developing ALS than non-smokers. In particular, people who have been smoking for around 33 years have a two-fold risk of developing ALS at a later age.2. COPD (Chronic Obstructive Pulmonary Disease)COPD, also known as chronic obstructive pulmonary disease, is an umbrella term used to describe complications in air flowing through your lungs. These diseases cause inflammation and affect the flexibility of alveoli; they also entirely destroy the walls between them. Symptoms include shortness of breath, wheezing, and coughing. Severe symptoms include a very high heart rate, weight loss, and discoloration of lips. There is no cure for COPD, only treatments that manage the progression of the disease.3. Pregnancy and Birth IssuesSmoking has been known to reduce fertility in women as well as men. It vastly affects the body’s ability to produce hormones, which makes it difficult to get pregnant, as well as damaging the eggs and sperm. For women who are able to conceive, smoking increases the probability of preterm labor, stillbirth, sudden death syndrome and low birth weight. One study found that smoking may put the baby at risk of contracting asthma. Moreover, women taking birth control pills while smoking are at a greater risk of developing blood clots. In men, smoking may cause issues with sperm quantity and motility.  4. Reduces Bone DensityIt's been 20 years since scientists first discovered that smoking puts one at risk of osteoporosis. In 2012, a study found that smoking also weakens the bones in general. Researchers discovered that smokers produce two types of proteins in massive amounts, which causes the production of osteoclasts and leading to the breakdown of old bone. In addition, the nicotine present in cigarettes destroys osteoblasts, the bone-making cells.5. Cognitive DeclineSmoking accelerates cognitive decline regardless of age; however, one study showed that older men who smoke experience a higher rate of cognitive decline. Researchers found that the decline was most evident in executive functions such as memory, problem solving, attention span, multi tasking, verbal reasoning, etc.The effects of smoking go far beyond the cancer scare we're all familiar with. Kicking the habit can save you from other life-long chronic illnesses and health complications. Although the effects are dire, you can take control of your health. Quit today and work on reversing the damage.

Love Without Martinis: Building Healthy Relationships in Recovery

Those who recover and prioritize sobriety almost always do so with the assistance of stories. The books of AA and Al-Anon, the literature given out at treatment centers, memoirs on addiction to alcohol or drugs, therapeutic workbooks, and even religious texts are used to guide both the newly sober and old-timer into a healthier and more stable version of their own sobriety. When it comes to romantic relationships in sobriety, the field is less crowded--there aren’t many guide books for two people who want to work on their relationship after the chaos of addiction.Love Without Martinis seeks to provide that valuable guidance through a collection of six stories of actual couples who found their way to a better place. As author Chantal Jauvin writes in the book’s opening, “Stories are a powerful medium for self-understanding. They help us find ourselves or remember who we are.”Jauvin and her husband Bill went through hell and back in their marriage as they struggled with Bill’s addiction to alcohol. Jauvin eventually worked with Dr. Jeremy Frank, PhD, CADC, a certified alcohol and drug counselor, and together they developed a framework for healing for couples in recovery called the ASCENT Approach. ASCENT includes a specific set of healthy practices that couples who successfully rebuild their relationships in recovery have in common; despite the many differences in couples’ stories--their sexuality, gender, socio-economic background--it is these powerful commonalities that ASCENT was built on, and Love Without Martinis was written to convey.After opening with a chapter outlining the specifics of the ASCENT Approach, the couples’ stories are told chapter by chapter in novelistic prose, instead of the seated in therapy and taking dictation-style of many self-help books. The narrative addresses the emotions, thoughts, and actions of each person in the couple as the addiction worsens, hits crisis, turns to recovery, and then the couple’s journey to heal the rifts between them.“When individuals suffering from substance use disorder get well, it changes the patterns of behavior and interaction in the couple.” writes Doug Tieman, President and CEO of Caron Treatment Center, in the foreword. “This new relationship is truly one of the “Promises of Recovery” and it does materialize if you invest yourself in reclaiming and rebuilding the healthy relationship.” The stories in Love Without Martinis trace the arc of the couples who do invest themselves.“The battle of an addicted person’s partner to either strong-arm a person they love into sobriety, or ignore them until they become sober, often draws a wedge between the partners and the world within us and around us,” the authors point out. It is this disconnect and dysfunctional coping mechanisms--as well as past hurt and anger--that these couples are addressing.Jauvin writes, “Here are the practices of The ASCENT Approach for couples in recovery: Assess your readiness to change. Structure your time. Create your community. Engage in your life. Nurture your spirituality. Treasure your partnership.” The couples' detailed stories are a living illustration of how each of these guide-points plays out.As a couple’s narrative is being driven forward, the changes to their thoughts and behaviors are illuminated to make clear the specific steps that each person must take to repair the relationship. Here is Larry, from the couple Larry and Sherri, moving through a negative thought pattern into a positive one:“Yes, he just needed to keep her in check. That thought was foul on so many levels, he admonished himself. First, it implied the game his psychiatrist warned him against. Larry might be the responsible one, keeping the family together, but he was also the “enabler.” He contributed to the family disease. That was a tall order for Larry to accept. For a long time, maybe even a few years, Larry had transferred the anger he felt towards Sherri onto the professionals whose help he sought. Of course, he tried to control his wife. He could not let her run wild with three young children in the house. Not to mention all the debt from rehab, therapists, and psychiatrists for the entire family. It was a miracle the dogs did not need therapy. Stop, he commanded himself. Control the silent introverted “awfulizing”—such a genius medical term—that is what Larry needed to do. Control himself, not Sherri. He’d accepted the expenses, written the checks, hired the housekeepers. He’d perhaps even played the martyr in the name of keeping the family together. Stop, he dictated to himself. Larry redirected his thoughts.”The work that these couples do individually and within their family can be life-changing for generations to come. Families can create a legacy of recovery with just one person deciding to work for and maintain sobriety; once one person has broken through, any other member of the family is more likely to get into treatment. Not only is the substance use disorder addressed, but years (perhaps generations) of dysfunctional interpersonal habits and thoughts can be changed, freeing the children of that family from those patterns. And those children are then more likely to seek partners of their own who have healthier relationship and coping skills. The legacy that a couple can leave for their family within the work of recovery is priceless.The stories in this book address many of the blocks that partners face in new recovery, but certainly cannot cover all of them. No one in these stories, for example, has severe mental illness, has been a violent abuser or abused, or is living in total poverty. The couples included here are not interchangeable: a gay couple with a partner suffering from Crohn’s disease, a young family with a baby whose father relapses, an executive who loses control once he retires, and the author’s battle with ovarian cancer and her husband’s messy divorce. However, the problems of co-occurring mental health issues are not specifically addressed.It’s obvious that Jauvin is a compassionate and knowledgeable guide from the way she writes and frames each couple’s story; the inner dialogue feels authentic, and raw struggles are portrayed with care to acknowledge the source of pain and the pathway out of it. Jauvin spent five years interviewing these couples--in addition to the work she did with Dr. Jeremy Frank to build the ASCENT guideposts--and that, combined with her own story of her husband Bill’s addiction to alcohol and recovery, makes her a trusted and worthy guide. She writes in the foreword: My favorite definition of recovery remains one written by Earnie Larsen, a pioneer in the field of recovery from addictive behaviors: “The core of recovery is becoming a person increasingly capable of functioning in a healthy relationship.” And now, Jauvin has contributed to that capability with Love Without Martinis.Love Without Martinis is a helpful touchstone and guide for couples seeking to stay together and heal in recovery, and would be a good book to take home on discharge for anyone in a relationship and leaving a rehabilitation center or sober living home to reenter life. Love Without Martinis is available at Amazon and elsewhere.

Apology to the Young Addict

The following is excerpted from a longer work.You post your picture on Facebook. It’s a close-up. Your long hair is dark brown. On one side you have strands of it curled behind your ear. Your eyes are dark brown, too, but they are also glossy and red. In your hand is a glass pipe, the bowl hot and alive, swirling with gray smoke. You’re holding it out to whoever is taking the picture, but it looks as if you’re offering it to me.You must be about twenty now. I lose track of time. In the beginning, as a child, you probably wonder why, when I come to see your father, he always asks you to go to your room and watch TV. After a while, though, and I don’t suppose it takes more than a few visits, you must catch on. By no means am I his only friend, if you can call his many visitors friends, because truthfully we are not. Sure, we laugh and joke and talk too long, like friends do, but we always leave looking and acting differently than when we arrived. Sometimes we move in slow motion. Sometimes we’re fidgety and nervous. It depends on the drug, whether it’s heroin or coke. Or meth. Or all three for an interesting little cocktail. Other times your father’s friends come and go so quickly you must wonder why they ever bothered to visit.Your mother, where is she?When did you last see her?I’m not familiar with this part of your story, knowing only that she’s not there for you at this point in your life. She’s an addict, too, this much I do know, and maybe she’s still using when your father is clean. Maybe that’s why she left. If this is the case, at least with your father you have a roof over your head and food in the refrigerator. At least you attend school instead of bouncing from one dope house to another, crashing on beat-up couches or dirty floors, and sometimes, when your mother wears out her welcome, having to sleep on the streets.To be fair, your father has seven years clean from heroin and cocaine before he receives his disability settlement for an injury he suffers working as a heavy equipment operator. He undergoes spinal fusion surgery but the procedure is hardly successful in relieving his pain. Still, for those seven years, he refuses the Vicodin and Oxycodone the doctors prescribe, knowing it will trigger his old cravings, and even though he walks slowly, wincing often, he nonetheless manages to take you fishing off the docks in Lake Arrowhead. You remember he’s good at it, and teaches you how to be good at it, too, so that you both catch plenty of trout. You also remember him taking you camping and how comforting, how calming, how secure and safe and loved you feel snuggling up to him in your sleeping bags in the tent he shows you how to pitch, because he can’t do much of the work himself. You like helping him. You like knowing he needs you, as you need him, and you think of you and your father as a little team.But money can be a trigger, weakening the addict’s resolve to stay clean. Why this is, I’m not sure, but I’ve seen it happen too often not to believe there’s truth in it -- addicts and alcoholics struggling to make ends meet, and then, when the burden is lifted, finding themselves drunk or strung out again. A seventy-five-thousand-dollar disability settlement is a windfall when you’ve been living month to month on paltry government disability checks.Ironically your father is my first sponsor, once a week taking me through the Big Book page by page, but after one too many slips I give up on myself and he gives up on me, too. I can’t blame him. We stop seeing each other until he calls out of the blue one day, asks if I’m clean, and when I tell him I’m not, that I’m drinking as we speak, he laughs and invites me over. He has it all. Heroin. Coke. Plenty of booze. From that night on we party hard and often, but your father is diligent, always cautious never to let you catch us in the act of getting high. He makes certain that his drugs and paraphernalia are always well hidden and never brought out until they’re needed. Syringes. An old leather belt with teeth marks on it. A couple spoons, the hollow part blackened, the handles bent for better control, easier balance.You aren’t supposed to be there.You are, instead, supposed to be spending the night with a friend. I don’t know the full story, if your friend gets sick or you have a fight and want to come home early, but I remember that you couldn’t have been more than eleven or twelve years old, and that we don’t hear you unlock the front door. We don’t hear your footsteps on the stairs leading to the living room where your father and I sit on the couch beside a coffee table scattered with syringes and booze and little baggies of heroin and coke. I’m already deep on the nod, melting into the couch. Your father has just tied off his arm, biting down on the leather belt with his teeth, searching for a vein. He slips the needle in and presses the plunger. Blood slides down his forearm, and you drop the backpack that’s hanging from your shoulder. It hits the floor and a pair of pajamas with little blue flowers on them tumble out. Your eyes meet with your father’s and I lower mine.“Baby,” he says. “I’m sorry. Come here.”He tries to get up from the couch but falls back. He tries again and succeeds this time, though he’s shaky on his feet. You run to your room, slam and lock the door. Your father weaves down the hallway, calling your name, and when I hear you crying, I pick up my cigarettes and leave. There is no excuse, accidental or otherwise, for an adult to use narcotics in front of a child, and my presence alone that night makes me complicit in your addiction today.I am and am not guilty.I am and am not responsible.Jump in time. Fast-forward a few years. Your father is pulled over for a broken taillight and ends up arrested for possession and distribution of narcotics. By no means is this his first run-in with the law. Once, traveling through Texas, he’s busted with two kilos of heroin and spends four years in the state prison in Huntsville. This time the judge sends him to Glen Helen in San Bernardino County. One day, in another life, I will find myself speaking to the convicts here about drug and alcohol abuse.In his mid-forties, he is, like myself, no longer a young man, and while serving the first of his two-year sentence he suffers a massive heart attack. The doctors save him with bypass surgery, and I’m sure they warn him that if he uses drugs again it will be his last heart attack. But when has the fear of death ever stopped an addict? Certainly it’s an answer to the end of the misery called addiction and all the shame and anguish and self-loathing that’s killing us anyway.Your father used to say, “You can always put more in but you can’t take it out,” which means the wise addict, if there is such a thing, is cautious. You know when you buy Jack Daniel’s that you’re getting eighty proof whiskey. On every bottle there’s a government seal stating exactly that, but there is no quality control when you buy dope. One day your dealer might sell you weak or bunk product. A week later it might be stellar, so the same amount you shot last time might kill you now. What happens, though, when you have a weak heart and any dose, even a small one, is enough to put you under? That’s the case with your father inside of a month after he’s released.Here’s the ugliest part.Here’s the scene where trauma gives you a choice. Break the cycle or join it. I can’t and won’t blame you, as I have no right, because I made the wrong decision, too, when I was young and lost my brother. My sister did the same and also found herself an early grave.That little team, just your father and you, it’s true. He had only you. All other family ties had been severed long ago, and so who do his so-called friends phone when they can’t revive him? Not the paramedics. Paramedics bring police and police make arrests. Take him to hospital? That’s also risky. Besides, by then, he’s probably stopped breathing. Instead, like good junkies concerned only for themselves, they phone you and then grab their dope and get out of whosever house or apartment they’re in. I’m told the message is brief.“Come get your father.”They give you an address and hang up. I have a hard time believing the caller would tell you he’s dead. I don’t suppose it’s fair to generalize, but junkies are notorious for being liars, cowards and thieves.So let me add it up.You’re just a kid the first time we meet and your father and I go on a run. Then he spends two years in prison while I begin the arduous struggle to get clean and sober. That should make you about seventeen or eighteen when you pull up to the house or apartment in your father’s old truck, the one he gave you after he lost his license and went to prison. Maybe you’re thinking that he’s passed out drunk. Possibly you detect the panic in the caller’s voice and already suspect the worst. I doubt it, though, and it has nothing to do with your youth. Old or young, clean or dirty, even the most jaded among us cling to hope where we know there is none.I understand you go there alone.I understand the door is left unlocked, so all you have to do is turn the knob and walk inside and this is how you find him, sprawled out on the couch in the living room, his face blue, his limbs already stiffening. I don’t know if you drew back in horror or kneeled by his side and cried and held him and kissed his cold skin. That’s as far as I let imagination invade this private and heartbreaking moment of your life.Under your picture on Facebook, in the reply box, I write that it doesn’t have to be this way, knowing full well my words mean nothing. I can hear you laughing. I can see you shaking your head and saying:“You motherfucker, of all people, slamming dope with my dad and now this shit. Fuck you. Of course it has to be this way. How could it be any other?”And maybe you’re right. Maybe this motherfucker might as well have snapped your picture. Fuck his laments, you think. Fuck his apologies. You hate the hypocrisy of reformed addicts telling you that the dope will stop working one day, that it always does, and in the end you’ll be left with nothing but misery. That you’ll do things you never imagined yourself capable of doing. Sell your body. Rip off friends and whatever family you might still have left.This is only the beginning.What the older recovering addict has to offer the younger, active addict is the hope and promise of change through example and really nothing more.Listen.I despise him, too, but at least for today he is as dead as your father, and hopefully he will remain dead, this old junkie staring into the photo of your glossy red eyes, who long ago might just as well have passed that glowing hot pipe to you. From Apology to the Young Addict by James Brown. Used with permission of Counterpoint Press. Copyright © 2020 by James Brown. 

Addiction in America: An Interview with Tom Coderre of SAMHSA

Tom Coderre is the first person in active recovery to hold the position of Acting Assistant Secretary for Mental Health and Substance Abuse at the Substance Abuse and Mental Health Services Agency (SAMHSA). Prior to this appointment, Tom was Senior Advisor to Rhode Island Governor Gina Raimondo from 2016-2019, where he helped to coordinate the state’s response to the opioid crisis. During the Obama administration, Tom led the team which produced “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” the first report from a U.S. Surgeon General dedicated to this public health crisis. And as the former National Field Director of Faces & Voices of Recovery, he was a key voice in “The Anonymous People” documentary and helped increase peer support services nationwide. The Fix is honored to have the opportunity to speak with him.The Fix: You are the first person in recovery from substance use disorder to lead SAMHSA. How is this significant? Do you think being in recovery will help you accomplish more?Tom Coderre: That’s a great question, John, but it’s important to point out that I am the acting assistant secretary for mental health and substance use. I am serving in an interim capacity until the Senate confirms Dr. Miriam Delphin-Rittmon. She was nominated by President Biden last week. I’ll serve until the U.S. Senate confirms her. I am currently leading SAMHSA, but I’m not going to be leading it too much more into the future. At the same time, I’ll continue to be a part of our leadership team here at the agency.Still, my acting appointment is significant because I count SAMHSA as partially responsible for me getting into recovery. SAMHSA block grant dollars funded the treatment that I received. Moreover, the recovery support services that I received post-treatment were funded by a SAMHSA discretionary grant program, the Recovery Community Services Program (RCSP). My experience speaks volumes about how the agency helps people.As the acting assistant secretary, being in recovery is the lens from which I view the world. I don’t know if it has helped me accomplish more or will help me moving forward, but it certainly has given me that lens of lived experience to bring to any policy conversation when we are talking about ways we can help more people find sustainable recovery.Has it been difficult to prioritize prevention, treatment, and recovery services for substance use disorder during the COVID-19 pandemic?To begin with, the Biden-Harris Administration obviously is remaining focused on the COVID-19 pandemic. At the same time, it also has prioritized the expansion of evidence-based treatment to get people with substance use disorders the help they need. Already, SAMHSA has received significant increases in funding from Congress and from the President to help address our country’s mental health and addiction crisis.As you know, John, it has only gotten worse during the pandemic. The latest CDC data points to ninety thousand overdose deaths in the twelve-month period that ended last September. It’s the largest increase on record, and that is why SAMHSA has been getting resources to the states and the people who need it the most. In addition to the state block grants, we have awarded a total of almost 700 million dollars to certified community health clinics (CCHPs) across the nation. We just gave a series of COVID Emergency Grants to address mental health disorders that arose during the pandemic. We have even made supplements to those grants with the new American Rescue Plan money.In terms of innovations, early on in the pandemic, we began the mission of expanding the regulatory definition of telehealth to help ensure that people who need medication-based treatment would access that critical support during the pandemic. We also provided free technical assistance and training for physicians who were unfamiliar with the use of telehealth. Out of necessity, telehealth has blown up during the pandemic, and we wanted to ensure that it was both accessible and well-executed. The free virtual trainings we provided were well-attended, and the response was positive. We knew that we could not focus only on COVID-19 because the parallel track of spikes in mental illness and substance use disorders could not be ignored. We had to ensure that people in crisis could access real help.Post-pandemic, what do you think will be the biggest challenges facing SAMHSA?That’s another really good question that we have been discussing at the agency. We know that multiple stressors during the pandemic like isolation, sickness, grief, job loss, food instability, loss of routines, and so many more have been devastating for many Americans. It has led to a series of unprecedented challenges for health providers across the nation.For example, the CDC also reported that American adults in June of 2020 reported elevated levels of adverse mental health conditions, including symptoms of anxiety and depression that were three to four times the levels of those reported in 2019. Going forward, this is a big challenge for us. Traditionally, SAMHSA’s Disaster Distress Help Line has been a low-volume hotline compared to our others that we operate like the National Suicide Prevention Lifeline. However, the call volume on the disaster distress hotline has increased significantly as people have become more aware of its services. We saw a 440% increase in the twelve months from March 2020 to February 2021. It tells us that people are reaching out and seeking help.One of the obstacles during the pandemic has been barriers to accessing services and the treatment that these people need. The challenge is that even people with mild or moderate symptoms who are looking for help cannot access it. They are unable to connect with a community mental health center or a treatment center. In response, SAMHSA is promoting the Disaster Distress Help Line and other similar resources because we want to know who needs help and where they are located. We want to be able to support them in the process of knowing where to go to get help.Another challenge to note is workforce readiness. Are people ready to make the full transition back to work? Mental health professionals have seen a significant increase in people seeking appointments to work past negative public attitudes. We need more trained professionals to help those folks successfully make that transition.President Biden recently dedicated $2.5 billion to prevention and treatment efforts. How do you see the pie chart of those funds being divided up?In the bill that Congress passed and the President signed, those resources are pretty prescriptive. SAMHSA does not really get to decide how to split them up. We have been directed to send that money to states and to territories and tribes. They have the flexibility to address those funds to address those various needs. The $2.5 billion in additional money that went to the different block grants for substance use disorder and mental health and those block grants allows states, territories, and tribes to tailor those grants to address the specific needs that they have identified.As part of the COVID Relief Package, we got $4.25 billion in December and an additional $3.56 billion in March as part of President Biden’s American Rescue Plan. Beyond the block grants targeted at front-line people on the ground, these new grants also help us expand the building out of the Certified Community Behavioral Health Clinics, which provide all sorts of wraparound services for people in the various communities. Each of the bills also dedicated funds to improve suicide prevention efforts and school-based mental health efforts. Also, the money for the National Child Traumatic Stress Initiative is an important step. We are really concerned with what has happened with youth during this pandemic, and we want to make sure they have access to needed resources.We are extremely grateful to President Biden and Congress for making these resources available. This capital is the largest investment in behavioral health in the history of our country. It’s a big step going from an overall budget of $6 billion to $13.8 billion. Thus, we’ve been tasked with a big, big job to get these funds awarded to states and, most importantly, working in local communities, thus reaching the people in need of this kind of help and support. Thank God for the SAMHSA staff because they have been working tirelessly to make this happen.In 2018, commenting on the rise in opioid use disorder (OUD) deaths, you told Fox News, “It took too long to get to where we are today. I think there was thought they could do this without declaring a national emergency, but people are dying.” Post-Covid, will we need to declare another national emergency to combat opioid use disorder and resulting overdose deaths?First of all, did I really say that? It sounds brilliant. Okay, I’m just joking, but I think I was referring to the public health emergency that was being declared at that time. Both SAMHSA and this Administration get the urgency of the current situation. We understand the concept of parity and the importance of delivering care to underserved communities. We understand that all of these statistics related to mental health disorders and substance use are tied to real people with loved ones and families. Suppose you look at the work done under the leadership of the Biden-Harris Administration. In that case, you see that SAMHSA’s funding and efforts are a crucial part of the White House’s tailored response to these challenges, including America’s mental health needs.An emergency is declared to increase access to funds and speed up the delivery of those funds to people in crisis. It’s precisely what is being done right now by this administration to address the opioid crisis, and the hard work at SAMHSA is making those directives happen. We are taking steps to expand access to evidence-based treatment like MAT [Medication-Assisted Treatment] and reduce the stigma that still exists. For example, we are working to reduce the medical stigma around integrating opioid use disorder treatment with primary care in office settings of doctors across the country. We also know that powerful synthetic opioids like fentanyl in the nation’s drug supply compound the overdose risk for Americans significantly. People with little or no opioid-related tolerance are being given this incredibly potent drug, and they are at a much greater risk of dying as a result from an overdose. This danger is one more reason we are grateful to work with the White House to connect more Americans to the treatment and care they truly need. Indeed, these communities need that support more than ever, and this is why it’s an all-hands-on-deck moment at SAMHSA.Under the last administration, there was a shift away from community-led, demographically-targeted interventions. Under the new administration, do you think there will be a renewed focus on evidence-based practices that address substance use disorder (SUD) and mental health from a holistic lens, including strategies to address current health disparities among various racial/ethnic groups?Of course, I do. Both President Biden and Vice President Harris have made diversity, equity, and inclusion a key part of their strategic plan for the nation. At SAMHSA, we have been doing behavioral health equity work for more than a decade. We recognize that there are disparities in treatment services that exist, particularly in Black, Indigenous, and people of color communities. We need to do more to identify those disparities in particular and root them out, do they can be eliminated.It is not okay to turn a blind eye anymore and expect somebody else to take care of these issues. We are making these efforts a strategic priority, and we are considering steps like disparity impact statements as an ongoing part of our grant programs. Also, although we think globally, we act locally. Although the White House or Xavier Becerra, the first Latino to serve as Secretary of Health and Human Services, can issue the policy, we are responsible for helping to make the change locally through our grant programs.We need to emphasize this issue regularly through our long-term relationships with states and local communities. Such essential progress in cultural competence and applying it effectively is now a priority on all levels of the federal government. For example, we need to do a lot more recruitment in the workforce at all levels, so the people providing the services look like the people they are serving. From our experience, the best people for helping local communities are people who came out of those communities and know firsthand the nature of the challenges. As you know, I came from the peer movement, and I believe the peer work that is being done around the country is an excellent example of this proposition working in practice.A perfect exemplification of this work is the success of recovery coaches that walk into emergency rooms. When they sit at the bedside of somebody who has just overdosed, and they can tell that person, “Not that long ago, I was exactly where you are now. I was lying in a bed in this hospital after a drug overdose. I was able to find out, and I am here today as a person in recovery to show you how I did it and how you can do it as well.” It’s so much more likely that such an encounter will lead to a person’s life being saved. We need to recruit a workforce that can walk that journey with people from their communities in need of such help. People who can give them the confidence to take that step, tell them about the pitfalls they’ll encounter along the way, and inspire them to start that journey of recovery.