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Inspiring Success on the Road to Recovery

Monday, August 6, 2018

Demystifying Detox

By Becky Kartagener, Executive Director Footprints to Recovery 


Nearly 21 million Americans struggle with addiction. To get a sense for the magnitude of this, that’s more than the number of people, who have all types of cancers combined. The epidemic of addiction to drugs and alcohol has overwhelmed our nation placing no discrimination on age, race, gender, education or income. In an effort to combat it and in some cases capitalize on it, there’s been an abundance of treatment approaches and options that have flood the market. It’s not uncommon for individuals, their loved ones and even professionals to be conflicted or confused about what is needed and where to start.

"Detoxification is the process of eliminating all traces of drugs and/or alcohol from the body, detox alone is NOT treatment."



For many individuals, the first step and perhaps the most crucial prior to addressing any underlying issues of alcohol and drug addiction is medical detoxification. Medical detoxification, often times referred to as medical detox, is the process of eliminating drugs and alcohol from the body while managing symptoms of withdrawal.

Physiological Affects

To shed light on the necessity of this, we must take a look at the physiological effects of chronic substance abuse. The continued use of drugs and alcohol can easily, and often does, lead to the building of tolerance and dependence. Tolerance can be defined as a reduced response to a substance due to repeated use. Essentially, the individual must take a higher dose of the substance in order to achieve the same feelings they initially felt. In the case of heroin and other opioids, tolerance develops rather quickly leading to the increase in doses. Following tolerance is typically dependence, the physical condition in which an individual’s body has adapted to the persistent presence of drugs or alcohol.

Our bodies are extremely adaptable; they’re constantly trying to reach a state of homeostasis or more simply put, regular functioning. When our bodies are exposed to drugs and alcohol for a continuous period of time they throw off the bodies regular functioning; therefore, our internal system adapts.

This can include modifying levels of neurotransmitters, hormones and other processes in the body to make room for the presence of the drug or alcohol.

With the development of tolerance and dependence the individual now needs a regular exposure to the substance in order for their system to maintain its new level of “regular functioning”. Any drop in exposure to the substance now results in the individuals system becoming unbalanced and the consequence is symptoms of withdrawal.

When an individual begins to experience withdrawal they are likely to exhibit flu-like symptoms such as; agitation, anxiety, confusion, depression, aching muscles, watery eyes, runny nose and difficulty sleeping. However, unlike the common flu, withdrawal symptoms can be extremely uncomfortable, painful and in some cases life threatening. This is even more so true in cases of addiction to alcohol, benzodiazepines and opioids where the withdrawal symptoms can include seizures, hallucinations and fatal delirium tremens. Drugs such as cocaine and amphetamines do not tend to cause fatality due to the withdrawal process; however, they can still present severe difficulties.

Going Cold-Turkey 

It has been found that many individuals who attempt to detox themselves by immediately stopping all drug or alcohol use, otherwise known as going ‘cold turkey’, are at the most risk of severe and fatal withdrawal symptoms.

For some, the withdrawal effects may last a few days or weeks, while others may struggle with lingering symptoms for months. The time frame for withdrawal may last even longer than anticipated without the presence of medical support. Furthermore, the severe intensity of symptoms often times lead individuals to quickly pick their substance of choice back up again. This is extremely dangerous, as the body has likely lost some of its tolerance for the substance; however, individuals tend to reintroduce the substance back into their body at their regular dose, putting the individual at a high risk for overdose. As we’ve been so frequently exposed to as of lately, it should come to no surprise that overdose is the most common cause of death amongst those addicted to drugs.

Medical Detox
It is for the reasons above that medical detox is often one of the most crucial, beneficial and lifesaving steps in an individual’s recovery from addiction. As previously stated, medical detox is the process of eliminating drugs and alcohol from the body, while managing withdrawal symptoms.

Withdrawal symptoms are often managed with medications and coupled with 24-hour supervision by licensed nurses, therapists and physicians. The staff is trained in helping clients cope with the effects of early drug or alcohol detox; therefore, they’re able to ensure withdrawal symptoms are comfortably taken care of and traces of the substance of abuse are effectively removed from the client’s body. Nutritional monitoring, individual and group psychotherapy are often available for clients during medical detox as well. As withdrawal symptoms are managed, the client’s risk of relapsing to avoid the painful symptoms is dramatically reduced. Furthermore, under the care of licensed medical staff the sometimes-fatal symptoms of withdrawal are essentially diminished.

Medicine Used 

During a medical detox, a physician oversees the entire withdrawal process. Typically, this involves medication regimens that allow the user to comfortably and safely remove drugs and alcohol from their system. The medication used to treat withdrawal are linked to the particular type of substance that was used, the length of time of abuse and the volume of use. The goal is to minimize risks of complication and maximize comfort levels.


How Long?

A common question posed is, “how long does someone need medical detox?” The short answer is, it varies for everyone. As we previously discussed, medical detox is the process of eliminating drugs and alcohol from the body while eliminating withdrawal symptoms; therefore, it’s typically seen as a period of stabilization.
Unlike other treatment programs there’s no set duration for medical detox, rather the length of time required is dependent upon the individual’s medical and addiction history. Factors that may influence the length of stay needed include; duration, frequency and the length of use, weight and age, and the presence of co-occurring mental health and medical issues. The average length of stay has been shown to be anywhere between three to ten days.

Where do you go?

There’s a variety of settings and locations where individuals can detox; however, individuals should be aware there are more benefits to some settings over others. The settings can be broken down into two categories: inpatient and outpatient. Inpatient detox includes; residential treatment facilities, hospitals, and standalone detox centers. Outpatient settings typically involve going into a facility daily to meet with a physician, receive medication and then returning to your home environment.

Compared to outpatient settings, studies have shown that inpatient settings tend to be the most effective treatment method.

Inpatient detox settings offer individuals with 24/7 support and treatment for other medical conditions. Furthermore, individuals are removed from their environments where they may face triggers and barriers that increase the risk of relapse.

What’s the process?

Medical detox is typically done in three steps: evaluation, stabilization, and transitioning.
The process begins with a thorough evaluation where key information is gathered in order to assist in the treatment planning process and to accurately assess the individual’s addiction. Treatment providers will gather information including: medical and substance use history, mental health history and family and social situations. In addition, a full physical is often completed.
The evaluation process is more than just gathering information; it also serves as a means to identify any underlying medical or psychological conditions that may be co-occurring along with an individual’s abuse. Upon completion of the evaluation, the client then moves into the stabilization period. The stabilization period encompasses the medical and psychosocial processes of helping an individual safely and effectively withdrawal from substances. Based on the evaluation, the individual’s treatment team creates a treatment plan and begins the administration of medications to help ease withdrawal symptoms.

Many medical detox centers also focus on proper diet and nutrition during this time as well. The treatment team is consistently monitoring the individual’s progress throughout this period and adjusting the treatment plan as needed. The process also includes education in regards to detoxification, treatment and recovery. Upon successful detox from substances the final stage of medical detox involves preparing the individual for transition into addiction treatment. Many programs will work with individuals to transition them to their own treatment programs or connect them with treatment programs in the community.

Aftercare

It is important to note that the completion of medical detox is largely for the physical dependence of addiction and is most effective when followed up with addiction treatment such as; residential, inpatient or outpatient treatment programs. Once the individual’s body is successfully detoxed it becomes less challenging for them to involve themselves in addiction treatment, where many of the underlying issues associated with their addiction are addressed. Treatment methods often include individual, group and family therapy.

Conclusion 

In conclusion, the importance of safely and effectively detoxing oneself from drugs and alcohol is stressed again, as it cannot only save a life, but decrease the risk of continued use and relapse due to withdrawal. If you, a loved one or a client of yours is considering addiction treatment there’s help available.

_________________________________________________
Footprints to Recovery, a nationwide addiction treatment provider, conveniently located in the Greater Phoenix area of Mesa, Arizona offers cutting edge medical, holistic and therapeutic approaches to medical detox. Board certified medical staff, as well as licensed and credentialed clinicians provide advanced, customized and comfortable drug and alcohol medical detoxification for young adults and adults.

Programming includes; complete history and physical medical exam, 24/7 medical care from the nation’s top physicians and clinicians, customized treatment planning, co-occurring and dual diagnosis care and individual and group therapy.

In addition to the best medical detox protocols for minimizing withdrawal symptoms and health risks, the facility will offer non-medical approaches to care including; yoga, meditation, acupuncture, massage therapy, chiropractic services, pet & equine therapy, spirituality groups, 12-step programming, 12-step programming alternatives, and writing workshops. With an emphasis on aftercare, the organization works with a variety of vetted treatment partners to ensure a seamless transition to the continued treatment of the clients’ choice.

Footprints to Recovery offers 24/7 - 7 day a week free and confidential consultations, as well as 24/7 transportation services. To learn more or take that next step towards recovery for yourself or another visit FootprintsToRecovery.com or call 855.628.2899. 

There are Better Days Ahead. 




Tuesday, July 31, 2018

Recovery Rising

Forging Connections in Recovery: 
A New Dialogue An Evening with Dr. Kevin McCauley



Hosted by ASU’s Collegiate Recovery Program 

Recovery Rising and The Meadows Behavioral Healthcare

Thursday, September 20 - 6-8:30pm
ASU’s Historic Old Main Auditorium


The Meadows and Recovery Rising bring Dr. Kevin McCauley to ASU for an evening filled with education and celebration. Dr. McCauley wrote and directed two films: “Memo to Self” about the concepts of recovery management, and “Pleasure Unwoven” about the neuroscience of addiction which won the 2010 Michael Q. Ford Award for Journalism from the National Association of Addiction Treatment Providers.  He will present on the ever changing dialogue surrounding recovery and substance use disorder.

Doors open at 6:00 PM, which will give attendees the opportunity to enjoy refreshments, learn about recovery resources at ASU and in the community. Dr. McCauley’s presentation will run from 7:00-8:30 PM, with questions and answers after.

Free and open to the public!  For more information and to RSVP:  recoveryrising@asu.edu


September is National Recovery Month, held annually to educate that substance use treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life. We know a strong community, sense of purpose, and leadership contributes to effective treatments that sustain recovery.

Desert Star Addiction Recovery Center and Starlight Recovery Housing

Each human being is a unique combination of strengths, experiences, preferences — and, unfortunately, afflictions. Many people who seek treatment for an addiction to a substance or for disordered eating also suffer from anxiety, depression, post-traumatic stress disorder, or other mental health concerns. Treating just one problem without addressing the others is like trying to row a boat with one oar: you’re likely to end up drifting in circles.

Desert Star Addiction Recovery Center believes in individualized treatment. They offer a menu of services including intensive outpatient programs, stand alone groups, individual therapy, and access to registered dieticians, psychologists, and psychiatric nurse practitioners. As a person stabilizes, they are able to transition into hybrid programs to address their full spectrum of problems.

Partial Hospitalization Programs

These behavioral health and addiction stabilization programs typically last one to two weeks and consist of 4-6 hours per day of therapeutic programming, five days per week, in addition to sessions with a therapist, medication management, and other treatment.

Intensive Outpatient Programs

Grace Program: 8-week intensive outpatient program for men. A  focus on life transitions, sexual /relationship addiction, healthy boundaries, masculinity, and more. 

Mariposa Program: 8-week intensive outpatient program for women 18 or older who struggle with unhealthy relationships, codependency, low self-esteem, addictive behaviors in relationships, or difficulties with commitment, sexuality, or emotional intimacy.

Mesquite Program: 12-week intensive outpatient program for men and women with disordered eating, including anorexia, bulimia and binge eating. It combines process and educational groups with supportive communal meals, nutritional sessions with a registered dietician, and individual therapy.

Oasis Program: 8-week intensive outpatient program for men and women with addictions to drugs or alcohol. The program incorporates groups, individual therapy, and medication management, and features both daytime and evening hours to better accommodate the schedules of busy adults.

Outpatient and Standalone Groups
The Men in Transition Group is a once-per-week, 10-week program for men who want to move beyond basic recovery to a more fulfilling, less lonely life, and experience deeper connections with safer, more satisfying relationships.

Food for Thought is a once-per week group for people who want to explore their relationship to food and/or related body image issues.

Healthy Intimacy meets once per week and is designed for women to explore their intimacy issues.
Desert Star recently opened Ocotillo Mood Program, a mental health intensive outpatient program for adults with mood, anxiety, and/or post-traumatic stress.

Starlight Recovery Housing

This structured sober living home is owned by Richard Poppy of Desert Star. A gender-specific men’s home, this well-appointed and serene house within walking distance of Desert Star provides a safe, stable, and structured place to recover from addictions to drugs or alcohol while attending a treatment program.

Getting Started

Call our office to schedule a free, introductory meet and greet appointment to see the facility and see if our programs are a fit for you. We will also be able to discuss financial information at that time, including payment plans and estimated insurance coverage.

Desert Star is an in-network, preferred provider with Aetna, Blue Cross/Blue Shield, Cigna, Healthnet/Ambetter/MHN, Humana, Tricare, Value Options, and United Healthcare/Optum/United Behavioral Health. www.desertstararc.com. 520-638-6000

The Whole Tooth and Nothing But the Tooth

By Dr. Dina Evan


“The more we create light and ethical, conscious energy on the planet, the faster it will change everything.”

A. J.Jacobs, wrote a story in 2007, in Esquire called, “I Think You’re Fat.” It was a story about radical honesty. But, mostly, it was a story about telling your truths with a sledge hammer, like the little girl depicted in the story who told the writer his teeth were yellow.

A study with 1000 participants reported the average number of lies told by each person every day is more than 100. It was published in the Journal of Basic and Applied Psychology. The experiment involved hundreds of people revealed the scientists found that 60 percent of all subjects lied within 10 minutes.

Let’s face it! 

We live in a world of liars, mostly led by liars. And now this disease which I believe is contagious and also deadly to our souls and spirit, and it has stolen our sense of safety.
Lying is not a simple matter of fudging a little something here or there or even telling a white lie now and then. This issue of what I call excruciating truth telling is a foundation piece of our character.
If you are not a person who tells the truth, how does one know when you really love a person, or the dish you just prepared? How does one know when you really love that thesis or column your daughter just wrote? How does one know that you really didn’t spend that extra hundred that is missing in the account, and on and on? And, then, it gets really serious. How do we know what our elected officials are doing behind our backs or what other countries are doing behind our backs, and now we are into some pretty important issues that affect the whole world. This is not a little issue!

How do we change it? 

The first thing we do is stop being concerned about going along with the crowd or being popular or even loved. If you are popular or loved because you always tell people what they want to hear, you are not love at all. You are just co-dependent and feeding someone’s ego.

Secondly, we need to stand up for what we believe. People will get angry with you but if you deliver your message with compassion and hear their belief with compassion and an intent to truly understand, that whole dynamic will change. We do not have to believe the same to love, or at the very least, respect each other.

You need to remember that you made the decision to come to this planet to find out who you are and do what you came here to do.

You will never be able to do that if you are afraid to stand in your truth, because telling your truth is exactly what you came here to do. You get to stand out from the crowd. That’s what you came here to do. You get to tell a truth that is different from the crowds. That’s what you came here to do and if you don’t do it — it doesn’t get done. And the biggest loss is that you missed the opportunity to fulfill your purpose and reason for being here.

Let’s face it. . .

This planet is the college of consciousness. It’s to up to you to choose and your choice is life changing. If you choose integrity, you not only fulfill your purpose in coming here, but, you also create a world event within...meaning there is another person in the world, living on purpose and in wisdom and light. Why do we care about that?

Well there are two reasons. The first one is that your entire life is a process of waking up. You leave this planet with the same level or frequency of awareness you have achieved while you are here. And you begin your next life at that same level or frequency, so you can continue to move forward evolving your soul toward enlightenment or you do have that other option of just continuing to mess around.

And the second reason is what Einstein proved, Like energy draws like energy. That means the more we create light and ethical, conscious energy on the planet, the faster it will change everything. Right now we are living exactly what we believe. At this moment we believe in division, greed and separation. We can change that, but the Divine wisdom in the process is that WE must change ourselves first. And when you get scared, just know there is an army of people out here doing the same thing with you.

And, watch the DrDinaEvan.com video series on our site very soon to talk about all this great information.

If you are not on our weekly message list to be informed about all the special new things that are happening, go sign up now at DrDinaEvan.com.

Stick with the Winners

Along with the guilt, shame and fear I felt when I finally surrendered to the truth about my addictions — I felt lost and alone.

Little did I know how everything in my life would evolve for the best. Maybe it was a combination of my innocence and ignorance — I knew absolutely nothing about recovery.

As I began to feel more comfortable, and a ‘part of’ — men and women with way more years sober than I ever thought possible, would tell me to “stick with the winners.” I thought it meant, look for those who had a better car, clothes or job than I did. I wanted those things, but that wasn’t the point.They meant, the winners were those who put their recovery first.

Sobriety was no guarantee I would have have more money or a better job. The guarantee was, if I was willing to do ‘the work’, follow suggestions, listen, and trust the process, the gifts of recovery would reveal themselves.

I’ve been blessed with more than I ever imagined, and I am not talking ‘stuff’. I’m talking about integrity, honesty and commitment. I’m talking about the men and women who ‘walk the talk’ and share their hope and experiences with me.

A few weeks ago, one of my Winners, a very dear friend passed away. He was sober over 37 years — someone I respected, admired and learned from. 

When my husband Bill died, he helped me during the difficult months that followed. He listened, shared his wisdom and checked in on my well-being often.

I am very saddened by his passing and extremely grateful for his friendship. These are the priceless relationships, the gifts; the kind I would have never known in the throes of my addiction.

Stick with the winners!

Barbara
aztogether@yahoo.com

Thursday, July 5, 2018

Covert Emotional Incest: The Hidden Sexual Abuse

By Adena Bank Lees, LCSW, LISAC, BCETS, CP

"Your dad doesn’t understand me the way you do.” “You’re such a good listener.” “I can’t talk to your mother like this.” “I always feel so much better when I talk to you."


  • Have you ever been hugged too tight or the hug was held too long?
  • Did you grow up feeling responsible to meet your parent(s) needs?
  • Have you ever felt you had to choose between your parent, your spouse or significant other?


If you said yes to any of the above, you may be a victim of Covert Emotional Incest.

What is Covert Emotional Incest (CEI)?

Covert Emotional Incest (CEI) is an elusive, emotional form of sexual abuse that occurs in the family system without there necessarily being direct genital contact. It is incestuous due to the undercurrent of sexual energy between a parent/caregiver and a child. It is characterized by the following: (1) triangulation (2) breach of the intergenerational boundary; (3) surrogate, substitute spouse or confidant role; (4) objectification. *

What do these concepts mean in plain English?

First, it is important to understand that the family operates as a system. This means each person in the family plays an interactive role and all impact one another. A metaphor often used to represent a family system is that of a child’s mobile hanging overhead. When the child reaches up and pulls on one of the parts, it causes the mobile to go out of balance. Stress in a family is like a child pulling on one of the pieces of the mobile; it too creates an imbalance. What we know about systems is that they strive for homeostasis, another word for balance. Marital problems, addiction, serious medical/mental health issues, and being a single parent, are just a few examples of these stressors. Without asking for outside help, the family relies on itself and adapts but its balance is precarious.

Healthy families have what is called an intergenerational boundary in place. This boundary is a flexible, invisible structure or energy field that defines the power differential between the parent/caregiver and child. This structure dictates the natural consequences of behaviors and deter-mines the appropriate interaction with the child on both spoken and unspoken levels. In essence, this means the parent is responsible to meet the child’s needs, not vice versa. The child has a voice in the family, yet does not have the final say regarding decisions that affect the family.

If the intergenerational boundary is rigid, the child has no say in the workings of the family.

If it is diffused or absent, it is often the case the child ends up meeting the parent’s needs as well as making adult decisions. In addition, the child can end up emotionally hijacking the household.

Part of constructing the intergenerational boundary is having parents or caregivers participate as a ‘unified executive committee’ to maintain the framework that ensures the child’s safety and wellbeing. One example is the child not being able to play one parent against the other. When there is only one parent, she/he ideally enlists assistance and support from external sources (peers and professionals) in order to sustain and enforce this boundary.

Triangulation

One adaptation to the imbalance in a family system is a dynamic called triangulation. This is a set up for CEI. Triangulation happens when major caregivers, not possessing the skills necessary to deal directly with each other, use their child as an intermediary and/or confidant. In CEI, this manifests as the child meeting the parent or caregiver’s individual emotional and/or romantic needs, namely, the surrogate spouse role. This role is a sexual role, communicating sexual energy whether there is physical sex happening or not.

It sexualizes the child, creating distorted beliefs and painful behavior in regards to sex and relationships. The system has therefore employed triangulation to ‘balance’ and function, incorporating destructive and abusive behavior patterns. The child often feels “special” and “privileged”, getting lots of attention and being trusted to keep secrets for the parent.

Objectification

Objectification is another component of CEI. The child is used, not having their feelings or needs considered. Using a person as an instrument for one’s own sexual pleasure (sexual objectification), may occur as well. Again, this may happen in a hug that is too tight or held for too long, bathing with or washing a child with mal intent and/or past the age of appropriateness, comments about the child’s body, voyeuring, watching pornography with the child, and so on.

A Few Client examples

Johnny is an eight-year-old boy who’s father just passed away. His mother calls him “my little man” and starts relying on him to soothe and comfort her. She encourages him to sleep in bed with her because she is lonely. Many adults attending the funeral approach Johnny, giving their condolences telling him, “You are the man of the house now, take care of your mother and your sisters.” Johnny was proud, yet overwhelmed and confused. As a 38 year-old married man, his wife keeps accusing him of “having an affair” with his mother. He finds himself torn between two women.

Who is he really married to? At eight, was he a man? Did he have what it takes to take care of his mother and siblings? What does “take care of mother” mean anyway? Johnny’s childhood was stolen from him. He was a husband long before he was an adult.

Ann is a seasoned professional who describes, “watching myself from the ceiling” while making love with her partner. She longs to be in her body so she can experience the sensations and feelings of connection with her beloved. Ann grew up in a family where her father made peep holes in every room of their house so he could watch his wife and daughters — whenever he wanted to. “But I wasn’t sexually abused by my father. He molested my two sisters, but he never touched me.”

As I was defining and explaining CEI, Ann began to cry, exclaiming, “Oh my goodness! This makes sense! I am not crazy! Being a victim of Covert Emotional Incest is enough for me to have this sexual problem!”

Elana, a 41 year-old woman with 10 years of sobriety and abstinence in 12-Step programs, tells the story of how she was covertly emotionally incested by both of her parents. Since she was a teenager, she felt like she was having an affair with her father. “When Dad and I were out by ourselves, people would come up to us and ask if I was his wife. We laughed. We thought that was cute and funny.”

Upon the return home, Elana experienced the jealousy of her mother. Mother was angry with her, and short and curt with her father. Elana also relayed her mother’s keen focus on her body, consistently commenting on her weight by telling her she would only get a boyfriend if she were thin; that her body was her way to lure a man. Elana received the message that in order for her to have power, worth and be loved, she needed to be sexually attractive to a man. And, of course, in order to do that, she needed to be, what her mother defined as thin. It was not a surprise that Elana had developed anorexia and bulimia and used substances to medicate painful feelings.

Core Symptoms

Those who are victims of CEI often have great difficulty in establishing and maintaining healthy relationships. They are often stuck in the caretaker, fixer, and mediator roles, which do not allow for meaningful intimacy (in-to-me-see) nor a productive sense of self.

Beliefs such as “Who I am and what I do is never enough”, and “I do not have the right to have needs,” combine with the codependent roles above, dictating interaction with others. Faulty boundaries, such as the struggle to say “no” and experiencing extreme guilt when saying “no”, create opportunity for violation and abuse. Sexual difficulties are common, often leading to compulsivity or shut down and denial of desire. Mental health issues such as depression, anxiety, and post traumatic stress symptoms develop, interfering in the ability to have self-esteem and practice good self care.

The abuse of alcohol and other drugs medicate painful feelings as well as foster a false sense of belonging and self-worth. If the only power you believe you have is in determining what goes in and out of your body, doesn’t it make sense that restricting, overeating and the binge-purge cycle take place? Being underweight or overweight are frequently attempts at protection from sexual attention/advances. Disorderd eating may also be means of expressing rage toward caregivers for feeling trapped in the CEI dynamic. Spiritual struggles abound, with emptiness and disconnection, as well as anger and conflict with or about God/Higher Power.


Key Elements of Healing

The most important element of healing is the awareness of Covert Emotional Incest and validation that it is real and hurtful. This includes being cognizant of negative consequences and the fact that it was not your fault. It is parallel to the first step of 12-Step programs; You have to have a name for what you are dealing with (e.g. alcoholism), know it is a legitimate concern (it is a disease), accept your powerlessness over it and the unmanageability it causes in your life (it is not your fault and you have had negative consequences because of it).

Asking for professional help is the next step. You cannot heal from CEI, or addiction for that matter, by yourself. You already know this. Help is out there and there is no shame in asking for it. Asking is actually a strength. Your best bet is the combination of professional and peer support. This is akin to the second and third steps of the program. “I can’t, HP can, I think I’ll let HP.”

The B Word — Boundaries 

Developing healthy boundaries is another key element of healing. What is a boundary? How do you set one? A boundary is a border or limit that is permeable and flexible. You, yourself, are responsible for setting and enforcing a boundary. This includes monitoring you own motives. The motive for a boundary MUST be self-care. Otherwise, it may be an attempt to threaten, control, get revenge, or manipulate the other person. It will thereby disrupt the relationship and cause more problems and pain. A healthy boundary says, “I choose me” versus allowing others to determine who you are and what you need. When beginning to set boundaries, you are at risk to be seen as the ‘bad guy’. Tolerating this role is a must. Get support. Guilt may arise when you set a boundary. Guilt is a withdrawal symptom from the surrogate-spouse, mediator, caretaker, and other codependent roles.

The formula for setting a boundary is as follows:

Tell the person how their behavior impacts you: “When you say/do this (specific thing in this specific way), I feel (emotions).” E.g., “When you complain to me about Dad, I feel angry and sad.”
“If you continue to do/say (specific behavior), I will (take an action), to take care of myself.” E.g., “If you continue to complain to me about Dad, I will hang up the phone and call you back within twenty-four hours.”

NOTE: A feeling is NOT, “I feel like ...” or “I feel that...” 
These are thoughts, not feelings. With a feeling, you say, “I feel angry, sad, hurt, etc.” 
For the best results, make your boundary SMART (Crapuchettes, 2005)
Specific: “I am going to take a time-out and hang up the phone.” 
Measurable: “I am going to hang up the phone for and get back to you within twenty-four hours. 
Attainable: The action is possible and you are willing to follow it through. 
Realistic: Can you do this exactly as you say? 
Timely: The response is as close to the even as possible.

Cultivating your spiritual life relieves you of a core emptiness caused by being objectified and identified with the surrogate spouse role. It allows you to fully experience yourself, as well as be in meaningful relationships with others.

I define forgiveness as “a process of letting go and understanding that is a gift to one’s self,” is the last key element to discuss here. It is necessary to dispel the myths about forgiveness. Forgiveness is NOT a one time event, condoning, forgetting, letting the perpetrator “off the hook”, absolving him/her of sin, nor superficially saying, “I forgive you”, without the emotional work indicated.

Forgiveness IS allowing yourself to feel feelings, acknowledge losses, make the decision to not languish in the past, and gain perspective that CEI has probably been multgenerational. In my view, forgiveness IS the grieving and healing process from CEI. It is a gift to yourself because you have a right to be free of the burdens of victimization.

For Parents in Recovery

Taking responsibility for your own behavior and needs is the best thing you can do for your children. Asking for and receiving the help you need from peers and professionals to stay sober, deal with “outside issues”, and be spiritually fit are essentials for effective parenting. Strive to meet your children’s needs by being aware of your own, checking your motives and listening to their very precious voices. Modeling is the most powerful form of learning. It is what you DO that matters, not so much what you say. Akin to early recovery, looking for those who “have what you want”, and “sticking with the winners”, your children need the same ideal so they can “have what they want” and be “a winner” in their own lives.

Knowing that Covert Emotional Incest is enough to have the struggles you have is of prime importance to your moving from the victim to survivor role and then into really living and enjoying your life. As you have probably heard before, you do not have to just survive any longer. You have the right to and can thrive! Thriving and living “happy, joyous and free” is there for the taking. May you be bold, go and reach for it!

Adena Bank Lees, LCSW, LISAC, BCETS, CP is an internationally recognized speaker, trainer and consultant, providing a fresh and important look at addiction treatment, traumatic stress and recovery. She is the author of the educational memoir, Covert Emotional Incest: The Hidden Sexual Abuse, A Story of Hope and Healing. For more information about CEI and Adena’s work, visit www.adenabanklees.com. Her book is available there and at www.amazon.com



* I have coined the term Covert Emotional Incest. This is an expanded view of Dr. Ken Adams’, term “Covert Incest”, Dr. Pat Love’s,“Emotional Incest,” and Pia Mellody’s “Emotional Sexual Abuse.” It takes into account that the child is treated as an object, their needs and feelings unacknowledged. It happens in many families, yet is relatively unnamed, rarely spoken about or recognized.










Is MAT the Bad Boy of Addiction Treatment?

By Tony Bratko, MSC, LPC, LISAC


“If we only address the physical part of the disorder, other areas
 will be overwhelmed and lead the addict to relapse.”

Is this Deja vu?
There was a time in our history when “Drug Replacement Therapy” was highly encouraged by our government under the guise of “Harm Reduction.” Methadone was supposed to be the answer for heroin addiction.

We were told if heroin addicts could legally get opiates from a clinic, they would stop using heroin and not share needles. This would stop the spread of communicable diseases, thus reducing harm to themselves and society. The only problem? Many addicts continued using heroin intravenously and diverted the methadone (to sell for heroin) or used heroin in addition to the methadone. Methadone only addresses opiates and not other illicit drugs that addicts use such as methamphetamine. This still exists today.

Drive by any methadone clinic at 6:00 a.m. and you’ll see lines of Uber and Lyft cars waiting to take addicts back home — all on the government’s dime and taxpayer’s money. Rarely are the addict’s clean from all illicit substances, yet they stay on methadone maintenance for years, even decades.

There is no incentive for the addict to get off methadone and definitely no incentive for the owners of the clinics to have patients free of methadone. The business is a cash cow for owners. If a patient wants to titrate off methadone, the clinics require it take up to two years, if you can’t pay or lose your Medicaid, they titrate you off in three days. It’s called “Fee-Toxing.”

So here we are again with the government encouraging the use of medication to stop addiction. I suppose they feel it’s the cheaper way than to provide addicts primary treatment in an effort to learn how to change their thoughts and behaviors. Remember, we have Doctors of Medicine dictating public policy and treatment, most of who are not educated or even have a basic understanding of addiction. Maybe it’ll be different this time — I think not. Similar to methadone maintenance programs, only one hour of counseling per month is required for a patient in a MAT program. As a licensed addiction professional, I know more is needed.

Positive Aspects of MAT
I believe there are positive aspects to a MAT program, especially for addicts who constantly relapse. It gives them the ability to stop using illicit substances and create a foundation of recovery. A distinction also needs to be made between maintenance, stabilization with the goal of titration, and eventual termination of use.

As we know, addiction is a physical, psychological, and spiritual disease and all three areas need to be addressed on a daily basis for any addict to be successful.

If we only address the physical part of the disorder, other areas will be overwhelmed and lead the addict to relapse.

Optimally, a MAT program would also consist of at least one hour of individual counseling, a two hour, CBT Based Relapse Prevention group session, and consistent 12-step support meetings. Eventually, the addict will be off the medication but if they are not taught coping skills for triggers and cravings, we are setting them up for failure.

Another consideration needing to be addressed is the misuse regarding Buprenorphine — a narcotic often abused by addicts to get high.

So I ask....

  • What systems will be in place to ensure that diversion is not taking place? 
  • What is the process and/or consequences for addict who consistently test positive for any illicit drugs while in the MAT Program? 

Should an addict who has never attempted primary treatment be admitted into the program or should they be encouraged or referred to a traditional substance use treatment center first?

These are all questions a successful and responsible MAT Program should have answered before a person in active addiction walks into their clinic.

In conclusion, I am an addict in long term-recovery as well as a professional in the substance use and mental health field. I was able to get clean by medical detox and participation in primary treatment. I also have experience working in a methadone clinic. The traditional methadone clinic concept does not work. I only had a few clients who were able to stay clean from opiates and other illicit substances, most tested positive. I had 95 clients I was required to see on a monthly basis for a one hour, individual, counseling session. Most never showed for their appointments and the ones who did were not interested in therapy. They were there to keep getting their drug. I hope our field doesn’t go down this road again.

Medication Assisted Treatment needs to be used as a tool — not the answer to addiction. As we know, the addict is always looking for the softer, gentler way out of their addiction and that is not always the best way. Doing the work required is what is needed for a successful and long-term recovery.


Tony Bratko, MSC, LPC, LISAC is Executive Director of Clinical Services, Continuum Recovery Center, tbratko@continuumrecoverycenter.com. 602-402-4474. 

www.continuumrecoverycenter.com