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OCD Treatment with CBT and ERP
Stellar Response to Integrative Harm Reduction Workshops at the Inaugural NASW Addictions Institute Conference in New York, New York
U.S. finally admits to research findings that prove cannabinoids kills cancer cells.
Smart Recovery, Charlie Sheen and CRAFT
Alternatives When 12 Step Support Groups Cause Harm to a Member of the Fellowship

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"It's time to stop trying to fit a square peg into a round hole in addiction treatment."
OCD Treatment with CBT and ERP
A New Trend: Smoking Alcohol
How PTSD Therapy Works
"Inpatient Rehab for Addictions: Is It Worth It and Does It Comply With the Affordable Care Act?"

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OCD Treatment with CBT and ERP

OCD Treatment with CBT and ERP

For clients with OCD, ERP (Exposure and Response Prevention) is a potentially traumatic and dangerous treatment approach --especially for those dealing with comorbidity. CBT is is safe and effective.

http://s3.amazonaws.com/academia.edu.documents/34561958/McLean_OCD_2001.pdf?
AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1491330251&Signature=Pmaow2Ft4D7YP7OqHRdtT%2Fu35Ps%3D&response-content-disposition=inline%3B%

http://onlinelibrary.wiley.com/doi/10.1002/jclp.20078/full

Stellar Response to Integrative Harm Reduction Workshops at the Inaugural NASW Addictions Institute Conference in New York, New York


Friend and colleague Andrew Tatarsky and I presented drawing from our personal and professional experiences in the field from the abstinence-only treatment model to Integrative Harm Reduction. We presented to well over 110 attendees. Even the Harm Reduction skeptics responded positively to treatment alternatives.

Andrew and I are considering giving the presentation again in additional settings.

"During our presentation yesterday at the NASW Addictions Institute Conference in NYC, Scott Stern and I shared our personal/professional journeys from the straight jacket of abstinence-only thinking to our integrative harm reduction perspectives in a way that was new vulnerable territory for me. 

We decided to bring 'treatment trauma' front and center into the conversation. I shared my experience of having been a surviver of 'treatment trauma' as a 15 year old member of a 'therapeutic community'.  

Scott shared his experience of having been a perpetrator of 'treatment trauma' when he worked as a clinician in an abstinence-only rehab early in his career. 

We explored the ways in which both the surviver and perpetrator are affected and how these experiences can be transformed into creative, passionate action for positive change, something Mark Epstein discusses movingly in his Trauma of Everyday Life. We felt that the audience was intensely engaged with our stories. 

I received an email last night from a woman who attended thanking us for sharing our stories and telling me that she had similar experiences in her life. She said she found our talks very affirming and personally helpful. 

Scott and I are considering giving this presentation in other places."

Addiction therapists who are oppressive to their clients create or re-create traumatic experiences for substance users. This was the old school training I received when I started working in the field 29 years ago. I've evolved in my commitment to empowerment and integrative harm reduction. So can the addiction treatment field as a whole.

U.S. finally admits to research findings that prove cannabinoids kills cancer cells.

“There is now promising research into the use of marijuana that could impact tens of thousands children and adults, including treatment for cancer, epilepsy and Alzheimer’s, to name a few. With regard to pain alone, marijuana could greatly reduce the demand for narcotics and simultaneously decrease the number of accidental painkiller overdoses, which are the greatest cause of preventable death in this country.”
 


That’s according to the US government, which has added a page on the use of cannabis and cannabinoids to their official cancer advice website.

The National Cancer Institute, part of the US Department of Health, now advises that ‘cannabinoids may be useful in treating the side effects of cancer and cancer treatment’ by smoking, eating it in baked products, drinking herbal teas or even spraying it under the tongue.

The site also lists other uses including: Anti-inflammatory activity, blocking cell growth, preventing the growth of blood vessels that supply tumors, antiviral activity and relieving muscle spasms caused by multiple sclerosis.

To do research on marijuana, scientists need approval from numerous federal departments and approval is extremely rare. Subsequently, this designation has prevented researchers from conducting clinical trials of cannabis as a treatment for cancer in humans.

The system is laid out in such a way that it creates a dynamic where physicians refuse to even consider cannabis, despite seeing evidence that it works. Without it being legitimized through clinical research and practice standards, doctors fear professional repercussions and potentially losing their license to practice medicine.

According to Dr. Gupta,

“There is now promising research into the use of marijuana that could impact tens of thousands children and adults, including treatment for cancer, epilepsy and Alzheimer’s, to name a few. With regard to pain alone, marijuana could greatly reduce the demand for narcotics and simultaneously decrease the number of accidental painkiller overdoses, which are the greatest cause of preventable death in this country.”
 
Currently, a bipartisan bill, authored by Rand Paul, R-Kentucky, Cory Booker, D-New Jersey, and Kirsten Gillibrand, D-New York — titled the Compassionate Access, Research Expansion, and Respect States Act of 2015, is in the Senate. This act would ease many of the current restrictions, simplifying the study of cannabis for research.

Dr. Gupta hits the nail on the head when he poignantly stated:

“We should legalize medical marijuana. We should do it nationally. And, we should do it now.”

The potential benefits from research into the medical uses for cannabis know no bounds. We could quite possibly be at the precipice of one of the greatest medical breakthroughs of our collective lives. If only the federal government would get out of the way and allow science to study this potential cure for cancer.

The time is now for us to make the changes we want to see happen; a medical revolution is taking place before our eyes. Please share this article with everyone you know to help awaken people to the potentially life-saving properties of cannabis and the cutting edge research that is proving it.

http://worldhealthsupport.com/u-s-just-admitted-that-cannabis-does-kill-cancer-cells/

 From 2013:

A scientist in the United Kingdom has found that compounds derived from marijuana can kill cancerous cells found in people with leukemia, a form of cancer that is expected to cause an estimated 24,000 deaths in the United States this year.

“Cannabinoids have a complex action; it hits a number of important processes that cancers need to survive,” study author Dr. Wai Liu, an oncologist at St. George’s University of London, told The Huffington Post. “For that reason, it has really good potential over other drugs that only have one function. I am impressed by its activity profile, and feel it has a great future, especially if used with standard chemotherapies.”
Liu’s study was recently published in the journal Anticancer Research. 

It was supported by funding from GW Pharmaceuticals, which already makes a cannabis-derived drug used to treat spasticity caused by multiple sclerosis.

The study looked at the effects of six different non-psychoactive cannabinoids — compounds derived from marijuana that do not cause the “high” associated with its THC ingredient — when applied alone, and in combination, to leukemia cells.

Cannabinoids displayed a “diverse range of therapeutic qualities” that “target and switch off” pathways that allow cancers to grow, Liu told U.S. News & World Report.

Liu stressed to HuffPost that his research was built around the testing of the six purified cannabinoid forms — not traditional cannabis oil, which Liu described as “crude” in comparison and generally containing 80-100 different cannabinoids. 

“We do not really know which are the ones that will be anticancer and those that may be harmful,” Liu said.

During the study, Liu and his team grew leukemia cells in a lab and cultured them with increasing doses of the six pure cannabinoids, both individually and in combination with each other. His study says the six cannabinoids were CBD (Cannabidiol), CBDA (Cannabidiolic acid), CBG (Cannbigerol), CBGA (Cannabigerolic acid), CBGV (Cannabigevarin) and CBGVA (Cannabigevaric acid). 

Liu and his team then assessed the viability of the leukemia cells and determined whether or not the cannabinoids destroyed the cells or stopped them from growing.

Although promising, Liu also said that it remains unclear if the cannabinoid treatment would work on the 200-plus existing types of cancer.

“Cancer is an umbrella term for a range of diseases that fundamentally differ in their cellular makeup, [and] which occur as a result of disturbances to growth controls,” Liu said. 

“Chemotherapy works by disrupting these dysfunctional growth signals. Therefore, any cancers that have these profiles should respond to the chemotherapy. It just so happens that a number of cannabinoids can target these very same mechanisms that make cancer what it is, and so any cancer that exhibits these faults should respond well to cannabinoids. The flip side is, of course, that other cancers may not have these same genetic faults and so cannabinoids may not work as well.”

According to the Centers for Disease Control, 7.6 million people die from various forms of cancer each year worldwide.

When asked if smoking marijuana has the same or similar effects as ingesting the pure cannabinoid compounds he studied, Liu said he thinks it’s unlikely.

“Smoking cannabis introduces a number of potential problems,” Liu said. “First, the complex makeup of cannabis that contains about 80 bioactive substances means that the desired anticancer effect may be lost because these compounds may interfere with each other. Second, we see that delivering the drug either by injection or by a tablet would ensure the most effective doses are given. 

Smoking would be variable, and indeed the heat of the burning may actually destroy the useful nature of the compounds.”

In 2012, researchers at the California Pacific Medical Center in San Francisco found that CBD (cannbidiol), a non-toxic, non-psychoactive chemical compound found in the cannabis plant, could stop metastasis in many kinds of aggressive cancer.

The National Cancer Institute has also funded some research into cannabis and cancer, including a 2012 study that looked at the effects cannabis compounds have on slowing the progression of breast cancer, spokesman Michael Miller told U.S. News and World Report. 

However NCI has not funded research on the effects of cannabinoids on leukemia.
Liu stressed that much work is still needed, and said that finding support for marijuana-derived medicines can be polarizing.

“Although there is much promise, I struggle to find enough support to drive this work on,” Liu said. “The mention of cannabinoids can polarize the public, who understandably link cannabis smoking with cannabis-derived drugs.”

Liu told the Seattle PI’s Pot Blog that he hopes to start clinical trials involving humans in 12 to 18 months.

http://www.huffingtonpost.com/2013/10/25/marijuana-cancer_n_4158865.html

http://www.whiteoutpress.com/articles/2014/q3/marijuana-destroys-cancer-tumors-says-nih-and-new-study/

Isn't it time to stop arresting people for marijuana use and to end cannabis prohibition? 

Smart Recovery, Charlie Sheen and CRAFT

"The end of hitting rock bottom"--An antiquated term in contemporary addiction treatment.

https://www.bostonglobe.com/ideas/2015/12/06/the-end-hitting-rock-bottom/nE4SAicvgaZ9KuIMypd3PL/story.html


Commentary by Scott W. Stern, Psychotherapist/Empowerment Professional


Smart Recovery, Charlie Sheen and CRAFT

"The end of hitting rock bottom"--An antiquated concept in contemporary addiction treatment. See commentary above the Boston Globe's article.

COMMENTARY: 

I remember when actor Charlie Sheen was everywhere in the press in 2011 and I was asked by a reporter, "do you think Charlie has hit his bottom, yet?" I responded that there is no way to tell, and no reason to assume that a "bottom" is the point when a substance abuser turns his life around and becomes abstinent. The "bottom" is an antiquated notion going back to the 1930's from Alcoholics Anonymous and carried over into many other 12 step meeting approaches (including Al-anon).

Sheen hated 12 step programs and had no desire to be abstinent. Recently, Sheen announced he is HIV positive to interviewer Matt Lauer. If asked again "has Charlie hit 'bottom,' who could know without a crystal ball? The only "bottom" I know of is death, because that is final without hope that addicted individuals can become empowered to overcome their condition. Similarly, it is the only point where families and friends can offer no supports to help facilitate change.

A colleague on FB responded to an article I wrote on Sheen, and referred to him as "non-compliant" and "not very receptive to treatment." But Sheen is not the exception--he is part of the 95% majority of substance abusers who do not respond well to abstinence and 12 step programs.

CRAFT offers a compassionate, harm reduction approach that can interrupt the cycle of destruction for the addicted, the chronic relapsers from abstinence programs, and the havoc families go through. The terms "tough love" and "keep the focus on yourself" often used in abstinence-based 12 step programs (i.e. Al-anon and A.A.)are obviously not terribly effective as Twelve Step Facilitation (TSF) and mutual support groups hold such poor outcomes (95% failure to remain abstinent of one year or longer while attending 12 step programs).

Instead, CRAFT offers an attractive recovery course with options and empowerment to all concerned. No treatment is infallible, but some are less fallible than others. CRAFT Intervention is designed to help a concerned significant other/family member (CSO) facilitate treatment entry/engagement for a treatment-refusing individual who is abusing drugs or alcohol (the family member).

Like Sheen, there are many addicted individuals who vie for control rather than relinquishing it. This is where the concept of empowerment trumps surrender to powerlessness as a more attractive course of treatment and saves lives.

CRAFT (Community Reinforcement and Family Training) is an excellent alternative highly regarded by SAMSHA, with a 64% success rate of positive outcomes (*positive outcomes have climbed since I collected this data in 2013) in which the addiction cycle is broken.

One can think of addiction more like a cyclone moving in an unpredictable, often destructive cyclical manner, rather than as a linear progression that will necessary lead to a "bottom" such as death. (Another antiquated concept going back to Jellinek's chart of the progression of addiction as a chronic disease.)

CRAFT is a more attractive method that provides harm reduction for individuals, families and the general public against the control and potential danger addictions hold.

I find that CRAFT is one of many paths down the road toward gaining control, rather than relinquishing it. In so many instances like the ones presented in the posted article, perhaps the remedy substance abusers and their families are truly in need of is empowerment.

https://www.bostonglobe.com/ideas/2015/12/06/the-end-hitting-rock bottom/nE4SAicvgaZ9KuIMypd3PL/story.html











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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No one knows that better than Alex Hankel.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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