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Inspiring Success on the Road to Recovery

Sunday, July 30, 2017

Arizona Treatment Ethics Update: Better, Worse or the Same?

By Jim Kreitler, MS

Last year I wrote an article for this publication entitled “Are Arizona Addicts for Sale?” focusing on existing ethical issues in the field, in particular patient brokering. Now, 12 months later, are things better, worse or just the same?

Although a case could be made things have improved, Arizona is not nearly where it should be. If we look at the four areas of awareness, enforcement, current level of unethical activity, and the future of ethics in addiction treatment, it is clear that we are still in the process of solving this problem. 


Awareness 

We in Arizona have come a long way in recognizing these emerging ethical issues and dedicated professionals on all levels are getting involved in the discussion. The response to the ethics articles has been staggering. It has created vigorous, ongoing dialogue and a surprising number of people have reached out individually with offers to help, indicating that this issue is clearly not only my passion, but that of many others in the field. 

In the past year, several Arizona Addiction Advocacy Coalition luncheons focusing on ethical issues, organized by Arizona professionals Melissa Thornburg and Peter Thomas, have been held and were well attended. Numerous invitation-only Facebook groups dedicated to ethics in addiction treatment have emerged and are sparking important conversations. I also had the pleasure of participating in a panel discussion on ethics hosted by Behavioral Healthcare Magazine. 

On the national level, major associations like NAATP (The National Association of Addiction Treatment Providers, www.naatp.org) are on the cutting edge of discussion about what constitutes ethical treatment practices. These associations are moving beyond pledges to enforcement, but that only affects membership in the organization. Public awareness has increased, mainly from salacious news articles and stories. 

The troubling practices in south Florida have been the subject of almost weekly reports by the Palm Beach Post. Several major networks have broadcast stories that educated the public, but also put the entire industry in a bad light. NBC’s Sunday Night with Megyn Kelly aired “How to Find a Good Drug Treatment Program and Avoid the Bad Ones.” 

The show provided good information, and the video detailing the loss of life in Florida due to patient brokering and overdoses was heartbreaking. 

The bottom line is that, on all levels, discussion and awareness have significantly increased.

Enforcement

There is wide discrepancy in the enforcement of ethical practices across the country. We know of Florida as a hotbed of unethical and fraudulent activity, but to the state’s credit, that is also where most of the arrests and enforcement have taken place, and also where the strongest legislation was passed barring these practices. Unfortunately some of those unsavory programs now seem to have moved to sunny Arizona, where legislation and enforcement are lax.
MyPalmBeachPost.com reports that as of June 15, 27 people had been arrested by the Palm Beach 

County Sober Home Task Force for ethics violations. That includes Kenny Chatman, who was sentenced to 27 ½ years in prison in May for violations at Reflections Treatment Centers with charges including HealthCare fraud and money laundering. It seems as if there is an announcement weekly concerning new arrests in South Florida.

The FBI, which has been active in the Florida investigations, made a big splash in California by serving warrants to several programs operated by Sovereign Health. So far, no charges have been filed and Sovereign denies any illegal activity. 

Jeff Sessions and the DOJ announced that they are filing charges related to health care fraud against 412 individuals working in the prescription and distribution of opiates, as well as a treatment program in Palm Beach.

In Arizona, there seems to be almost no enforcement with regard to patient brokering. Effective enforcement requires strong laws, a motivated legal system, and a dedicated government to intervene. As of yet, efforts at legislation have been stymied. According to Angie Geren of the advocacy program Addiction Haven:

“In Arizona's 2017 Legislative season, HB2333 was introduced by Representative Campbell which would have banned patient brokering and made any offenses a felony. Unfortunately the bill was assigned to a committee chaired by Representative Farnsworth who was not in support of the bill and refused to hear it even upon the insisting of Maricopa County Attorney Bill Montgomery, Yavapai County Attorney Sheila Polk, and other high officials in government. While advocates were frustrated with the lack of progress this season it has not stopped them from continually educating legislators surrounding the need for a ban and that Representative Campbell will introduce this legislation again in 2018. Most recently 60 individuals and organizations signed onto a letter to Gov. Ducey and leaders asking for immediate action to ban patient brokering.”

On the hopeful side, an AZ state law was passed that grants cities the authority to regulate sober homes, which have been identified as part of the problem in Florida. Prescott is one city that took advantage of this new law. Since being enacted, the previously large concentration of sober homes in Prescott has been reduced by two thirds. But current efforts to increase regulation in Phoenix and Scottsdale are making well-run homes nervous, as this would reduce the availability of this critical component of the recovery process. Unfortunately, sometimes the pendulum swings too far the other way. 

Current Level of Unethical Behavior

It is expected that the new Florida law known as Practices of Substance Abuse Service Providers Act HB 807, which became effective July 1, 2017, will significantly reduce, if not eliminate, bad practices in the state; however, it will also likely reduce the number of people who get treatment there. As this Florida law may become a template for legislators who are working on laws for their own states, I am concerned that subsequent regulations may also go too far and prevent many patients from getting the help they need. Again with that pesky pendulum!

To examine things a bit closer, key provisions of this bill include:
  • Facilities cannot pay marketers directly or indirectly for referrals, including a bonus.
  • It is illegal to write off deductibles, co-pays, etc.
  • Facilities cannot pay for flights for patients to and from treatment.
  • Marketers can be charged for providing any benefit, even as little as buying a perspective patient a pack of cigarettes. 

This new law could have a chilling effect on business in Florida. Marketers who violate any of these provisions when sending a patient for treatment in Florida, even those based out of state, would risk being charged. They could not forgive co-pays and deductibles for active addicts who qualify for financial assistance. Even gestures such as buying a pack of cigarettes for an addict who has been on the streets would be disallowed. All this can seem pretty severe, but whenever an industry does not self-regulate and the government has to step in, the result often is over-reach.

I’d like to think that the amount of agreement among addiction professionals on ending unethical practices would have significantly reduced this activity in Arizona, but I am hearing otherwise. I do believe that some well-meaning people and programs have adjusted to new information about proper conduct, and I applaud those who have changed questionable practices and cleaned up, but others seem to have just gone deeper underground, and the reputations of many new programs, including plenty owned by Florida companies, are not good. 

The Future of Ethics in Addiction Treatment

While it is true that I currently have days when I don’t have the pride in our industry that I would like to, I remain optimistic that we can, and will, change and adapt. I see my patients change every day at the worst points in their lives, and I know our industry can meet this challenge. I remain hopeful. 

Addiction professionals are asking tough questions such as: 
How much sobriety time should be required of a former patient before they are hired? What are appropriate compensation structures for marketers working for one program or a family of programs? Can I accept a cup of coffee or a lunch from someone at another program? What assistance can we provide to eliminate barriers to treatment or to help an individual with no money, home or support? 
We have to, and we are, challenging familiar practices.

I admit that I occasionally buy, out of my own pocket, clothes or haircuts for patients that come in off the street and need those things. My wife understands that I take on these expenditures because I am uncertain how appropriate it is to ask my company to pay for them. The answers aren’t always clear, but we are working together and moving in the right direction.
In addition to professional dialogue, many sources are providing guidance to clients on how to find an ethical program. 

Jay Crosson, CEO at Cumberland Heights, a well-respected non-profit program in Tennessee, wrote a piece called 12 Questions to Ask Before You Choose an Addiction Treatment Program. 

Those questions are:

  • How long has the program been in operation? Providers in operation over 10 years typically aren’t seeking quick profits.
  • Is the program licensed by the state?
  • Is the program accredited by the Joint Commission, an independent nonprofit which certifies health care organizations and programs in the United States, or the Commission on Accreditation of Rehabilitation Facilities (CARF), an international nonprofit accreditor of health and human services?
  • Is the program a part of the national trade organization for addiction treatment? Is the program contributing to the community, including taking the NAATP ethics pledge which has been in place for five years?
  • Is the program In Network or Out of Network? For-profit or Nonprofit? While not all Out of Network or For-profit providers are bad it’s nearly impossible to be dishonest from a billing standpoint if you’re In Network with insurance payers.
  • How frequently does the program perform lab testing like urine drug screens? Does the program have financial ownership or receive incentives from the lab company?
  • Does the program have a family component or family participation? Is there an extra charge for this service?
  • What levels of care does the program provide?
  • Does the program have placement criteria? Do they refer patients to alternative facilities when they don’t fall into their area of expertise? What are those criteria?
  • Does the program offer airline tickets, free rent or other inducements? Offers of free rent or other benefits may be evidence of illegal patient brokering or in some states fraudulent inducement.
  • Does the program have a strong alumni base? Do they offer alumni services such as Aftercare?
  • If seeking a sober home, are referral fees paid to the sober home from a treatment center if residents enroll at that center? If so, it suggests the presence of an illegal kickback scheme.

I cannot emphasize enough that, “It is absolutely possible to recover from a life of addiction. I’m living proof. That’s why the information gathered while seeking treatment is the most important research done for the benefit of someone struggling with addiction. We see the miracle of recovery every day at Cumberland Heights, but it’s important to keep your eyes open and make certain you’re well informed when making decisions which will set the trajectory for your loved one’s life from this point forward.”

I want clients to be to be informed and to ask questions. And we need to be able to answer them. 

On Saturday, September 16th, 2017, at the Art of Recovery Expo, I will be moderating a panel of experts on ethics in addiction treatment, including Angie Geren of Addiction Haven, reporting on current legislation and advocacy efforts; Tom Heritage, LPC of Cigna, representing payers from a national perspective; and Peter Thomas of the National Association of Addiction Treatment Providers NAATP, providing an update on the efforts of his association. 

Please join us at the Art of Recovery Expo, ask the difficult questions, and join me in the important work of protecting the people we serve by continuous efforts to become the most ethical programs and professionals we can be. 

About the Author: JIM KREITLER (MS, LASAC), CEO

Jim earned his bachelor’s degree in psychology from the University of Dayton. He pursued a master’s in addiction counseling from Grand Canyon University and is a Licensed Associate Substance Abuse Counselor (LASAC) in the state of Arizona. In his spare time, he is working towards his doctorate at GCU.  Jim is CEO of Calvary Healing Center. Visit calvarycenter.com. For immediate help or questions call (866) 807-7412.
I remember the first time I could no longer tolerate what used to be acceptable. After watching a movie that showed a character being shot and throwing up, I felt nauseous. This was not long after I started on my spiritual path, meditating, doing yoga, and lightening my diet. Until that time I could watch any film with violence, war, or creepy monsters. I grew up in a New Jersey housing project, which effectively desensitized me to anything that would bother most people. In college I was in a party fraternity; nothing you could do could gross me out.

How I felt after that movie was at turning point. From then on, things that used to be fun or entertaining seemed heavy or pointless. My friends changed and I quit hanging out in conversations of complaint. The kinds of entertainment that appealed to me changed. All that letting go made space for new friends and more rewarding activities. I was going through a spiritual evolution. If you are reading this article, you know exactly what I am talking about.

Over the years that process has not stopped. It has accelerated. Now a lot of what used to seem like fun brings me down. I don’t engage in joke telling sessions. Malls seem like another planet. Television and the news are surreal. Dee and I peruse streaming movie service menus, and we are hard-pressed to find movies we value. We can sometimes ferret out something of interest, but only after extensive digging. We look at the offerings, scratch our heads, and wonder, “Who would pay to watch a movie like that?”

Part of my mind questions if I am being too picky or a snob. But I can’t make believe I can do stuff that leaves me feeling awful. I have to trust that my inner being is guiding me toward what serves me, and away from what is not in my best interest. Evolution makes certain activities obnoxious for a good reason, while it makes other endeavors very tasty.

Perhaps you, too, have questioned or judged yourself for being too sensitive or not feeling at home in the mainstream. When I ask my seminar audiences, “How many of you believe or have been told that you’re weird?” Almost everyone raises their hand.

I want to offer you a radical way of looking at your sensitivity and dissatisfaction with the mainstream: It’s not you that it weird. It is the world. A Course in Miracles tells us the world we have invented is the inverse of the way we are supposed to live. What is wrong seems right and what is right seems wrong. The world is like a photographic negative where black appears white and white appears black, and what you look at makes no sense. So accept your oddity as confirmation from Spirit that you are on the right track. As British playwright Tom Stoppard wrote, “It’s the best possible time to be alive, when almost everything you thought you knew is wrong!”

So now what? Do you just hide in a cave and wait for the world to change so you can fit into it? That will probably not happen anytime soon. In the meantime, here are some things you can know and do until the world catches up with sanity.

Be extremely honest about what empowers you and what debilitates you. Tell the truth about what is “It” for you and what is “Not It.” Let your preferences about where you find yourself propel you to where you want to be.

Trust you are being guided. You don’t need to apologize for your perfect evolution. If you believe in your intuition, you will be nurtured, sheltered, and directed. Don’t over think your promptings. Be open to clear knowing.

Act on your guidance. Say yes to what works and no to what doesn’t work. Most people can benefit from setting healthier boundaries. Remember that a “no” to what is Not It is a “yes” to what is It.

Don’t be afraid to let go of what you have outgrown. Many of my coaching clients report that they have old friends they don’t enjoy being with anymore. These friends want to continue a pattern of gossip and negativity, and my clients feel guilty about saying no to invitations to which they have traditionally said yes. If you can upgrade the relationship with loving communication, do so. If not, follow the river around the next bend.

Cultivate new connections, activities, and habits that match your evolution. When Dee and I can’t find a movie, we watch a spiritual seminar video, listen to music, play with the dogs, look at the stars, walk in nature, or talk about things important. I miss none of what I have left behind.

While I honor my own evolution, I also honor everyone’s choices. We are all on our perfect learning curve. If that curve takes you around a new bend, let it.

Alan Cohen is the author of The Grace Factor: Opening the Door to Infinite Love. Become a certified professional life coach though Alan’s transformational Life Coach Training beginning September 1. For more information about this program, his books and videos, free daily inspirational quotes, online courses, and weekly radio show, visit www.alancohen.com.

Hot Topics

Las Vegas Recovery Center Welcomes new Senior Vice President of Strategic Planning and Business Development 

Las Vegas Recovery Center (LVRC) announced the recent hire of Bill Ryan, CLC, CIP, BRI II as Senior Vice President of Strategic Planning and Business Development. Mr. Ryan will share the lead with current executive managem
ent in short— and long-term organizational planning and strategy. In addition to his new role at LVRC, he will maintain a similar position with Central Recovery, parent company to LVRC.  

Mr. Ryan brings  over 30 years of professional and personal experience in recovery. He is a Certified Intervention Professional (CIP), a Board Registered Interventionist and Addiction Specialist (BRI-II), and a Certified LIfe Coach (CLC).
“We are thrilled Bill has joined the team,” said LVRC, CEO John Seeland. “His background and experience in the field will be a tremendous asset."

Mr. Ryan's personal experience with successful recovery from substance use disorders coupled with his many years as a Fortune 300 senior executive in the corporate environment make him especially well-suited to address addiction and behavioral health needs in many situations.

Mr. Ryan maintains memberships with the American Counseling Association (ACA) and the National Association of Addiction Treatment Providers (NAATP) and he sits on the Board of Directors for Association of Intervention Specialists and the Foundation for Recovery.

“I have worked with Bill for many years and know his capabilities and passion for recovery. LVRC is truly blessed to have Mr. Ryan join our team,” stated LVRC CMO Dr. Mel Pohl. “Together, we can break new ground and implement more services to continue LVRC’s mission.”

 Las Vegas Recovery Center (LVRC), Central Recovery’s flagship inpatient treatment center, is world-renowned for its opioid-free, inpatient chronic pain treatment program and a complete continuum of addiction treatment programs. Since 2003, the experienced and compassionate staff at LVRC has helped thousands of individuals, families, and concerned others discover recovery through innovative and evidence-based treatments for addiction and chronic pain. www.lasvegasrecovery.com. (800) 790-0091.

Think your kid can’t be addicted? Think Again

By Maureen Birmingham My daughter, Victoria “Tori” Dail, wasn’t someone you would think was addicted to heroin. Tori lost her life to a heroin overdose on November 10, 2016. She was 22 years old.

She graduated in 2012 as an honor student at Nansemond Suffolk Academy. She was an athlete at NSA playing volleyball, softball, and basketball. She attended Virginia Wesleyan College and played volleyball. She stayed in a dorm at school and her grades were good. She appeared to be a happy college student.

Tori was fun loving, always wanting people to laugh and smile. You could hear her laugh before you saw her. She was competitive and outspoken. She was a wonderful daughter, sister, and friend.
She started using heroin shortly after she graduated from high school. She’d become addicted to oxycodone pain pills that were legally prescribed to her after she was in a car accident. The addiction moved from oxycodone to Roxy, and on to heroin.

Tori asked for help on December 3, 2014. I drove from New York to Virginia, picked her up, and drove back to New York the same day. We called several recovery centers during the drive and found out many were full or our insurance didn’t cover the facility. We finally found a place for detox. She stayed for six days. She then went to a drug rehab center for group meetings and weekly therapy. She was also prescribed suboxone. Around eight months later, she stopped taking the suboxone because she felt she didn’t need it anymore.

She was doing great and attended NA meetings weekly. She started coming to family get-togethers. She met new friends and she got a job. She started to act like her old self. She was happy and we were happy.

Tori wanted to enlist in the Navy. She scored high on the ASVAB test and was sworn in that October. She was headed to boot camp in March. Before she left, she wanted to go back to Virginia to visit her dad and friends.

She was staying with her grandfather. She quickly found a job. She was having fun with her best friend, who she hadn’t seen in a year. But something must have triggered her. Tori felt the urge to use. And so, she did.

Tori died of an heroin overdose on November 10, 2016. The autopsy said the heroin was mixed with fentanyl. Three days after Tori’s funeral, the Surgeon General issued a 428-page report titled Facing Addiction in America.

For the parents out there that think “my kid won’t use heroin,” I used to think the same thing. I would recommend educating parents of middle school kids about the dangers of heroin or other drugs. Speak to your kids before they use drugs. It can save their lives.I wish I would have learned more about addiction while she was alive. I wish I had her back. I love her. I miss her.

Join Facing Addiction. Visit https://www.facingaddiction.org for details. The Facing Addiction Action Network is a coalition of organizations that reaches diverse areas of interests across the spectrum of substance use and addiction issues.

No Quick Fix for the U.S. Opioid Epidemic

More than 2 million people in the U.S. are addicted to prescription painkillers, and almost 600,000 are hooked on heroin, according to the report.



Scientists who've developed a wide-ranging "action plan" to combat the U.S. opioid abuse epidemic warn there's no quick fix.

Needed measures include tighter prescription practices, greater access to treatment, physician-patient education and research into alternatives to addictive painkillers, according to a new report released from the National Academies of Sciences, Engineering, and Medicine.

The report's assessment "is a reassuring development, but long overdue," said Dr. Harshal Kirane, director of addiction services at Staten Island University Hospital, in New York City.
"While public awareness of the opioid epidemic is growing, the mobilization of an effective infrastructure to adequately address the burden of illness still lags far behind," Kirane said. This report provides a road map for future action from local agencies up to national leadership, he pointed out, but he wondered who will get on board.

The panel that penned the report acknowledged the solution could be a long time in coming.
The report authors "wanted to convey a clear message about the magnitude of the challenge. This epidemic took nearly two decades to develop, and will take years to unravel," said Richard Bonnie, chair of the committee that wrote the report.

"The report provides an action plan directed particularly at the health professions and government agencies responsible for regulating them," said Bonnie, director of the University of Virginia's Institute of Law, Psychiatry, and Public Policy.

Dr. Scott Krakower is assistant unit chief of psychiatry at Zucker Hillside Hospital, in Glen Oaks, N.Y. said, "It is important to address this epidemic 'head-on' by improving public awareness, educating more practitioners about this disorder and chronic pain, establishing more oversight of development of these medications, and building more resources for the public to get evidence-based treatment for these conditions."

Regulations intended to restrict illicit use of painkillers may have inadvertently boosted heroin use, it's cheaper and more obtainable than painkillers such as OxyContin (oxycodone) and Vicodin (hydrocodone). "Many people who otherwise would have been using prescription opioids have transitioned to heroin use," the report noted.

The plan calls expanded treatment for opioid use disorder. The U.S. Substance Abuse and Mental Health Services Administration and other federal agencies should help states provide "universal access" to proven treatment in places like hospitals, criminal justice settings and substance-use treatment centers. For more on the opioid crisis, visit www.drugabuse.gov.

Alive in the Midst of Dying

By Dr. Dina Evan

I am a writer, not a great writer, but a writer all the same. An authentic writer, writes about what is true for him or her and the truth for me is that I am dying.  I knew the time would come when I would write about this journey and since I have some time, now seems like the right time.
I am not embarrassed about it, after all, it’s something we all have in common, we’re all dying. However, I never expected to be so alive in the midst of dying, and for me that is a precious truth...a valuable lesson for my next life.
Other new awareness’ have arrived, such as I don’t need 20 pair of shoes or that outfit in my closet I haven’t worn in years just because I spoke to a thousand people in it.  And, don’t expect the people who have never been present in your life to be present just because you are dying.  Those who have always been present, are still profoundly here.

I have learned...If you take a deep breath when your daughter loses her breath at the thought of losing you, you are both able to breathe again. In the oddest way, this is a precious time. For me, this is a time of validating all the things I believe and taught for years...that communication is at the base of every precious connection; truth is not always comfortable but always healing, and the only thing we leave this planet with is that which we hold precious in our heart and soul. My heart and soul are full, in fact...as the song goes, I have embraced every challenge and "I’ve had the time of my life."

People hate talking about death
That’s because it scares us. I don’t feel scared because I believe there is no actual point at which we die into some kind of heaven or hell scenario where we are judged or, for that matter, given brownie points. I believe our souls just lovingly continue on to the next adventure and lesson and this experience is simply one more master teaching about what is important, what is true and who we have become.
There are things I do hate, like not having the energy or breath to take my grandkids on the same kind of adventures I took my kids on. However, clearly this is an exercise in acceptance — the acceptance of all of life, including death. From moment to moment, I remind myself to relax into the process and, being forever the conscious traveler, I peruse the people and issues with which I need closure. Fortunately, I have mostly been an ‘uppity woman’ who doesn’t hold back as issues arise. I am reminded of all the times one of my children would put their hand on my arm reminding me to stay in the appropriate lane so as not to embarrass them. No gasping loudly at the movies during the scary scenes. I may be out of the appropriate lane occasionally over the next several months as I share this journey with you.
So far, my priorities seem more to be about having those holy real moments with the people I love. It is in those moments, that I cry, with overwhelming gratitude, for their presence and their willingness to dance in my life.

With your permission. Over the next months, now and then, I will share some of the new realizations in my process. I do this because I think it’s important to make death a friend, not an enemy. It is such a gift to have this sweet slice of time, between birth and death, to find ourselves, to find each other and to allow our hearts to break open with the pain and joy-filled moments this divine experiment provides. I have been writing to you for more than 20 years, so although I have not met each of you individually, I still feel as if you are my spiritual family, a family of great diversity, enlightenment and love.
I won’t be writing about maudlin, gut wrenching issues some may expect about death, because I don’t expect to have those. However, if I do, I will be honest and tell you. All I ask of you, is you allow whatever feelings arise in you to be embraced as we share this journey. They will tell you things about yourself you want to know, in the same way my feelings are enlightening me. We are all, after all, all staying delightfully alive in the midst of dying.

Dr. Evan specializes in relationships, personal and professional empowerment, compassion and consciousness. 602-997-1200, 602 571-8228, DrDinaEvan@cox.net and www.DrDinaEvan.com.

Gaslighting and Infidelity

When Cheaters Flip the Script


By Robert Weiss LCSW, CSAT-S

Gaslighting is a form of psychological abuse where one partner persistently denies the reality of the other partner (via consistent lying, bullying, and obfuscating the facts), causing that person, over time, to doubt her (or his) perception of truth, facts, and reality. Some people may be familiar with this term thanks to Gaslight, the 1944 Oscar winning film starring Ingrid Bergman and Charles Boyer. In the story, a husband (Boyer) tries to convince his new wife (Bergman) she’s imagining things, in particular the occasional dimming of their home’s gas lights. (This is part of his plan to rob her of some very valuable jewelry.) Over time, the wife, who trusts her husband loves her and would never hurt her, starts to believe his lies and to question her perception of reality.
In the 21st century, the rather antiquated and convoluted plot of Gaslight seems a bit silly. Still, the psychological concept of gaslighting — insisting that another person’s perception of reality is wrong and/or false to the point where that person begins to question that perception — is well accepted, particularly in connection with sexual and romantic infidelity.

Gaslighting is similar to one of my favorite (if I’m allowed to have one) psychiatric syndromes, folie à deux, which literally translates to “madness in two.” Folie à deux is a delusional disorder in which delusional beliefs and/or hallucinations are transmitted from one individual to another due to their close proximity, emotional connection, and shared reality. In short, crazy for two. If you are in a close relationship with an actively psychotic person — for instance, a person who hears voices and is afraid of being watched — you might also start to hear voices and fear being watched. Such is the power of emotional connections and our desire to hold onto them. We can actually distort our own sense of reality.

The primary difference between folie à deux and gaslighting is with gaslighting, the person denying reality is perfectly aware of the fact they are lying, usually as a way to manipulate another person. But the effects are no less profound. Consider the following story, told to me by Alexandra, a female client who came to see me after learning about her long-term boyfriend’s infidelity.

Jack and I met at a party. I was 25, he was 30. We’ve been dating for six years now, living together for five, and he keeps promising me we’ll get married and start a family, but that never quite happens.
The last three or four years, even though we’re sharing an apartment, I almost never see him. He works in finance, and I know the hours are long, but sometimes I feel lonely and I try to call him but he doesn’t answer his phone, even when he’s gone all night. He doesn’t even respond to my texts, just to let me know he’s not dead. If I dare to ask him about using cocaine with his friends or sleeping with another woman, he calls me insecure and paranoid and all sorts of other things. Then he reminds me that his job is really demanding and I should cut him some slack. He tells me that if I truly want to get married and have kids with him then I need to stop acting crazy. Well, a couple of days ago I saw him at a café with another woman, kissing her across the table.

That night, after he was asleep, I went through his phone and found out he’s been having affairs with at least three other women. In the morning, when I confronted him, he told me that he wasn’t at the café where I saw him, and that I was misinterpreting all the texts I found. And I actually started to believe him! Now, instead of being mad, I feel crazy. I can’t eat, I can’t sleep, I can’t think straight, and I have absolutely no idea what is real and what isn’t.
________________________________________________________
Sadly, this story is not unusual. In cases of romantic and sexual infidelity, almost every betrayed partner experiences gaslighting to some degree. They sense something is wrong in the relationship, they confront their significant other, and then the cheater “flips the script,” adamantly denying infidelity and asserting the betrayed partner’s discomfort is based not in fact, but in paranoia and unfounded fear. Basically, cheaters insist they’re not keeping any secrets, that the lies they’ve been telling are actually true, and their partner is either delusional or making things up for some absurd reason.

The (typically unconscious) goal of gaslighting is to get away with bad behavior. Cheaters gaslight because they don’t want their spouse to know what they are doing, or to try and stop it. So they lie and keep secrets, and if/when their partner catches on and confronts them, they deny, make excuses, tell more lies, and do whatever else they can do to convince their partner that she (or he) is the issue, that her (or his) emotional and psychological reactions are the cause of rather than the result of problems in the relationship. Basically, the cheater wants the betrayed partner question her (or his) perception of reality and to accept blame for any problems.

At this point, you might be thinking you could never be a victim of gaslighting because you’re too smart and too emotionally stable. If so, you need to think again. Alexandra, in the example above, has a PhD in Economics from a world-class university, currently teaches at that same school, has wonderfully supportive parents and friends, and has zero history of emotional and psychological instability (beyond her partner’s cheating). Yet her boyfriend manipulated her perception of reality for the better part of six years, eventually causing her to question both her instincts and sanity, before she finally caught him red-handed. And then, instead of being angry with him, she was angry with herself and unsure of the truth.

The ability to fall for a cheating partner’s gaslighting is NOT a sign of low self-esteem or a form of weakness. In fact, it is based in a human strength — the perfectly natural tendency of loving people to trust the people we care about, and upon whom we are healthfully emotionally dependent. In short, we want (and even need) to believe the things that our loved ones tell us.

In large part, betrayed partners’ willingness to believe even the most outrageous lies (and to internalize blame for things that are clearly not their fault) stems from the fact that gaslighting starts slowly and builds gradually over time. It’s like placing a frog in a pot of warm water that is then set to boil. Because the temperature increases only slowly and incrementally, the innocent frog never even realizes it’s being cooked. Put another way, a cheater’s lies are usually plausible in the beginning. “I’m sorry I got home at midnight. I’m working on a very exciting project and I lost track of time.” An excuse like that sounds perfectly reasonable to a woman (or man) who both loves and trusts her (or his) partner, so it’s easily accepted. Then, as the cheating increases, so do the lies. Over time, as betrayed partners become habituated to increasing levels of deceit, even utterly ridiculous fabrications start to seem realistic. Instead of questioning the cheater, a betrayed and psychologically abused partner will simply question herself (or himself).

Sadly, gaslighting can result in what is known as a “stress pileup,” leading to anxiety disorders, depression, shame, toxic self-image, addictive behaviors, and more. As such, gaslighting behaviors are often more distressing over time than whatever it is that the betrayer is attempting to keep under wraps. With Alexandria, for instance, the most painful part of her boyfriend’s behavior wasn’t he was having sex with other women, it’s that he was never trustworthy and made her feel crazy for doubting his endless excuses.

For more information about gaslighting and its role in infidelity, plus useful advice on how to overcome this deep and horribly painful betrayal of trust, check out my recently published book, Out of the Doghouse: A Step-By-Step Relationship-Saving Guide for Men Caught Cheating.

Robert Weiss LCSW, CSAT-S is a digital-age intimacy and relationships expert specializing in infidelity and addictions—in particular sex, porn, and love addiction. Currently, he is Senior Vice President of National Clinical Development for Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities. For more information please visit his website, robertweissmsw.com, or follow him on Twitter, @RobWeissMSW.

Step 10 in Business

By Renee Sieradski


Recently I was reminded of how I need to strive to work Step 10 as a self-employed business owner.
Over the years, I've worked with numerous senior financial professionals who, rather than admit their wrongs, swept them under the rug and manipulated the numbers to make it seem like they came out with the same figures. I fear somehow, I might mimic their unethical behavior since they taught me so much of what I know about how to do my work. But one reason I struck out on my own was to start fresh, decide what my ethics were, and create a new style of company where honesty, kindness, and doing the right thing prevailed.

Since I made the decision to start my own tax firm, I’m continuously reminded of my initial goals as I keep meeting new business associates with similar values.

I referred my physical therapist to see a colleague of mine who is a mortgage broker, Stan. Stan has a great work ethic and rave reviews because of his character. I was reminded of this again when my physical therapist said, “Renee, thank you so much for the referral, Stan’s the man! He made a mistake on my numbers but he called and told me, “look I made a mistake, here's how I’m going to make it right. That's amazing, who does that?”

As I reflected on those words, a similar situation came to mind. I was searching for a new insurance broker and found Michele. Michele and I were in a networking group together and the quote she gave me was consistent with what I was paying. But she phoned and said, “I'm really sorry. I have to be honest: I made a mistake with the initial quote. I was quoting the wrong policy and it's going to cost more money and here's the correct number.” Immediately, I thought I don't care what the number is, I know she will always tell me the truth. After working with a 1-800 insurance company for the previous 19 years where I didn’t have personalized service, this was refreshing.

What could be more trustworthy than admitting a wrong? I continue to strive doing that in my recovery and in my business. It can be hard because sometimes my brain thinks I have to hide my mistakes, like when I was a kid, or else....

Transparency in business is what makes people trust you. These two fellow business owners Stan and Michele, have set such a fine example as to how to run an honest ethical business, even when numbers are we miscalculated. We're in the financial industry (mortgage broker, insurance agent, tax professional), we quote figures and sometimes we make inaccurate calculations.

I have faith the right kind of clients will come my way because they will value transparency and rather than yell at me when I make a mistake, they will trust me more for the candor.

Let’s Talk Auto Deduction for Business

Are you self-employed?
Do you drive your car to meet with clients, attend networking meetings, transport clients, or to drive from your home office to the work site?

The IRS allows you to deduct the greater of two types of expense: rate per mile driven OR actual expenses of depreciation, car loan interest, fuel, maintenance, etc.

Regardless of which method you use, you will still need to track your miles for the year. This means total miles driven; personal and business.

You can use a paper log book to track your driving record or a smartphone app, such as mileIQ. The great thing about these smartphone apps is they run in the background on GPS and at the end of the day, you can swipe left for personal or right for business. It saves a lot of time.
You will want to send this record to your tax preparer, and keep it in case of an audit to back up your auto deduction on your tax return. My sister and husband were audited and just used the “estimate” system (which isn’t an IRS authorized system). Now they owe the IRS $25,000 for not having kept mileage records.

You don’t have to send in the detailed mileage with your tax return, if you are audited, you will be so happy that you took the extra minute to track your mileage. It could save you a big tax bill!


Renee Sieradski is a Tax Specialist, visit www.tax-intervention.com or call 602-687-9768.