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Inspiring Success on the Road to Recovery

Thursday, November 30, 2017

The Reality of Treating Pain with Opioids

By Mercy Care Plan/Mercy Maricopa Integrated Care staff

Most everyone has heard about the opioid epidemic — and the many lives lost to these highly addictive painkillers. The Arizona Department of Health Services released data on June 1, 2017 about opioid overdoses in the state. Those numbers showed that 790 Arizonans died from an opioid overdose; a 74 percent increase over the past four years. Statistics also show between June 15 and November 16, there were 564 suspected opioid-related deaths.

Easy access to opioids like Percocet, Vicodin, Morphine or Oxycodone contributes to this epidemic.
Think about a time you went to the doctor. Maybe you had a tooth pulled, twisted your ankle, hurt your back or had surgery. Were you prescribed a painkiller? You or someone in your family may have taken a prescription opioid without much thought as to what it was.

Did you know that prescription painkillers are cousins of heroin?
In fact, 80 percent of people who use heroin started with prescription pills. New information from the Centers for Disease Control and Prevention shows that it only takes four to five days to become hooked on pain medication.

Opioids act on the nervous system to relieve pain. And, treating pain with opioids is very common. So common that in 2013, there were enough opioid prescriptions written for every American adult to have their own bottle of pills . The highly addictive properties of opioids, coupled with physicians over prescribing their use, has led to an opioid epidemic. Across the U.S., more than 40 people die every day from overdoses involving prescription opioids.

But, an important question to ask is: Are opioids the best treatment for all pain?

“When we see a doctor for pain, we want relief. Does relief mean zero pain? No,” said Dr. Elisa Mashal, Medical Director for Mercy Care Plan and Mercy Maricopa Integrated Care. “Pain is our body’s way of telling us something is wrong. It’s important for your doctor to find out what the problem is and treat it so things don’t get worse. Not all pain is treated the same way. Just like you need different antibiotics for different kinds of infections, different medicines treat different kinds of pain.” It’s helpful to separate the myths from reality.

The myths vs the reality


  • MYTH: All pain is the same. Pain is pain.
  • REALITY: There are many different types of pain. Some of these are nerve pain, bone pain, muscle pain, pain after surgery, and pain after a dental procedure. Each type of pain is treated differently, and opioids are not proven to be the most effective treatment for any of them.
  • MYTH: If my doctor prescribes it, it must be okay. 
  • REALITY: Treating pain with opioids is much more common in the U.S. than anywhere else. Doctors were encouraged in the mid-90s to be more aggressive about treating pain, so prescriptions increased, and they haven’t stopped. People were given the impression opioids are the best way to treat anything other than the most minor pain. 
  • The U.S. accounts for only 5 percent of the world’s population, yet we use 99 percent of the hydrocodone (Vicodin) and 81 percent of the oxycodone (Percocet). Remember, 4 out of 5 people who use heroin started with prescription opioids and 35 percent of people on opioids for chronic pain develop a substance abuse disorder. 



  • MYTH: If I have anything more than minor pain, I need an opioid. 
  • REALITY: There is little or no evidence to show that opioids are the best treatment for pain (even after surgery). In comparisons, non-opioids work better than opioids for pain, even after surgery, yet hospitals rarely offer the choice. In fact, for chronic non-cancer pain, opioids are only a little bit better for pain, function and disability than sugar pills! 
  • “A combination of Ibuprofen (Motrin, Advil) and acetaminophen (Tylenol) has actually been proven to work much better for pain that just recently started,” Dr. Mashal said. “These over‑the‑counter pain relievers also work better than narcotic pain medicine for pain after minor surgery and kidney stones. For pain that has been going on a long time (chronic), your doctor can prescribe other medicines or treatments that work much better than opioids and will not cause addiction.”
  • When people use them after minor surgery, the risk of long-term opioid use goes up by 44 percent at one year after the surgery.



  • MYTH: If I’m in the hospital, I don’t have a choice about what pain medicine I get. I shouldn’t ask questions because the doctor knows what treatment would be best for me.
  • REALITY: It’s your body. Even in the hospital, ask your doctor about non-opioid options to treat your pain. Depending on the type of pain you’re having, you can ask for a non-narcotic anti-inflammatory medicine.
  • MYTH: If I still have pain, it means my medicine isn’t working. I should feel zero pain. 
  • REALITY: When someone is under anesthesia, they’re experiencing 100 percent pain relief. Otherwise, we should remember, instead of trying to cover up the pain, we should try to find the cause. When you’re getting treatment for your pain, your goal should be 30 to 55 percent pain relief and improvement in your function and quality of life. 

Debunking common misunderstandings is an important way to educate people about opioids. Understanding how they work is also important. 

How opioids work

Opioids bind to the same brain systems as heroin and morphine. They attach to the central and peripheral nervous system. These are called mu, delta and kappa receptors. These are receptors in the brain, stomach, intestines, spinal cord and other organs.
They suppress, or lower, your brain’s ability to sense when you aren’t breathing enough. That leads to heart rhythm problems. It can cause your heart to stop.
Opioids can also suppress your body’s natural “feel good” hormones, called endorphins. With repeated opioid use, you start to depend on the drugs for those “feel good” feelings.
It might not make sense, but opioids can even make you more sensitive to pain after you’ve used them for a while. What they don’t do is increase your ability to function in your daily life. They don’t help heal the cause of the pain. What are some other things you can do to help relieve your pain?

Exercise/physical therapy

There is great research to show exercise does help. It helps with everything from reducing pain to working as a treatment for depression. Exercise is especially helpful for low back pain, osteoarthritis and fibromyalgia. There’s also formal physical therapy. You can also try: Yoga, Pilates, Brisk walking, Swimming/water aerobics and Cycling

Weight loss/healthy eating

When someone is carrying a lot of extra weight on their bodies, that weight puts pressure on your spine and joints. That’s why it’s important to make weight loss a goal. There are many great books on healthy eating. You can work with a nutritionist at your local hospital. You can also join a weight loss group online, or in person for extra support. Always talk to your doctor about the best nutrition or exercise plan for you.

Cognitive Behavioral Therapy (CBT)

This is a fancy way of saying “talk therapy.” CBT helps you to change negative thoughts and behaviors. This, in turn, changes your awareness of pain and your ability to cope with it. There’s a lot of research to show this is one of the most effective treatments for chronic pain. It helps because so many people who suffer from pain also suffer from other trauma, like post-traumatic stress disorder (PTSD). You can do this in person with a therapist or get services online by teletherapy. Learn more at www.thepainproject.com.

Alternative medicine

Chinese medicine (e.g., herbs, nutrition, and exercise, like tai chi), acupuncture or osteopathic manipulation.
Acupuncture has become more widely known as an accepted alternative treatment for pain. The treatment involves stimulating specific point on the body with needles. It may help ease types of pain that are often chronic, for instance low-back pain, neck pain and osteoarthritis/knee pain.
If you decide to visit an acupuncturist, check his or her credentials. In Arizona, a license is required to practice acupuncture. You can see a list of licensed acupuncturists here: https://acupunctureboard.az.gov/.

Neurofeedback/biofeedback

This involves learning to regulate specific areas of your brain by feedback from your brain waves. This is done by psychologists, family therapists and counselors.

If you think you’re dependent or addicted to opioids
Opioid dependence is when your body starts to rely on the drug to feel normal. If you stop taking the drug too quickly or reduce your dose, you may have withdrawal symptoms. These can include:
Rapid heart rate • High blood pressure  • Runny nose and sneezing
Sweating  • Shaking • Confusion • Seizures
Seeing things that aren’t there (hallucinations)

“The good news is there are many places to go for help,” Dr. Mashal said. “It’s important to talk with your clinical team or provider about this.”

If you’re a member of Mercy Care Plan or Mercy Maricopa, you will find providers on our websites: www.mercycareplan.com or www.mercymaricopa.org. Click the “Find a Provider/Pharmacy” banner on the top right-hand corner of either website.  Call our Mercy Care Plan Member Services team from 7 a.m. to 6 p.m., Monday through Friday at 602-263-3000 or 1-800-624-3879 (TTY/TDD 711). Or, Mercy Maricopa Member Services team anytime, 24/7, at 602-586-1841 or 1-800-564-5465 (TTY/TDD 711). Check https://www.samhsa.gov/find-help and www.substanceabuse.az.gov/. If you think you may be dependent on opioids, talk to your doctor. Ask how to slowly reduce your dose safely to avoid withdrawal.

How you can help others

Dr. Mashal notes that it’s not uncommon for people to go through other people’s medicine cabinets looking for these types of medications.
“What if you do get opioids and have leftover medicine after your pain goes away?  Do you have teenagers in the house? Someone who comes to do home repairs?” she said. “It’s extremely important to dispose of any leftovers immediately.”

Visit www.acpa.net/arizona_drug_disposal_locations.aspx for a map of disposal sites all across Arizona. This will help ensure others won’t use your medications.


The Arizona Opioid Summit 2018

The Arizona Opioid Summit 2018

For more information and to register, visit www.arizonaopioidsummit.com. Visitors to the website can sign up for a complimentary e-newsletter on the opioid crisis in the region.


With the opioid crisis continuing to make headlines, those looking to make a difference will want to put the Arizona Opioid Summit on their calendars. The second annual conference will take place February 14-16, 2018 at the Tempe Mission Palms hotel near ASU.

On January 9 of this year more than 300 stakeholders met to discuss ways to engage treatment providers, law enforcement, and other groups to reduce overdoses and promote recovery. Advocates and professionals will reconvene in February to examine what progress has been made and explore what to do next.

“The second annual AZ Opioid Summit will be an ideal opportunity for stakeholders of all types to convene to share best and promising practices for tackling opioid abuse in our community,” said Doug Edwards, director of the Institute for the Advancement of Behavioral Healthcare, the conference organizer. “I hope people from many different disciplines and perspectives join us to explore ways in which we can make meaningful change and turn the tide of this public health emergency.”

The conference aims to bring together a wide range of attendees to offer a multi-disciplinary perspective. Those who should consider attending are private practice therapists, psychologists, clinicians, counselors, social workers, interventionists, pharmacists, advocates, families of people in recovery and those in recovery, public health and prevention officials, law enforcement, and federal, state, and local officials and lawmakers.

    The Arizona Opioid Summit 2018

With the opioid crisis continuing to make headlines, those looking to make a difference will want to put the Arizona Opioid Summit on their calendars. The second annual conference will take place February 14-16, 2018 at the Tempe Mission Palms hotel near ASU.
On January 9 of this year more than 300 stakeholders met to discuss ways to engage treatment providers, law enforcement, and other groups to reduce overdoses and promote recovery. Advocates and professionals will reconvene in February to examine what progress has been made and explore what to do next.
“The second annual AZ Opioid Summit will be an ideal opportunity for stakeholders of all types to convene to share best and promising practices for tackling opioid abuse in our community,” said Doug Edwards, director of the Institute for the Advancement of Behavioral Healthcare, the conference organizer. “I hope people from many different disciplines and perspectives join us to explore ways in which we can make meaningful change and turn the tide of this public health emergency.”
The conference aims to bring together a wide range of attendees to offer a multi-disciplinary perspective. Those who should consider attending are private practice therapists, psychologists, clinicians, counselors, social workers, interventionists, pharmacists, advocates, families of people in recovery and those in recovery, public health and prevention officials, law enforcement, and federal, state, and local officials and lawmakers.
Day one features presentations designed to educate and empower professionals and advocates to create meaningful change in their communities, which include:
Opioid Public Health Emergency – From Understanding to Action
Solving the Opioid Crisis Through Integration of Behavioral and Medical: The Trauma-Pain Connection
•Offering Choices for Treatment: An Examination of Medication Assisted Treatment Options and Personal Stories of Hope and Recovery
The Opioid Epidemic’s Impact on the Most Vulnerable 
Pharmacists, Prescribers, Hospitals, Healthcare Providers: New Advances in Working Together
How Kindness, Compassion, and One BIG Question Saved a Man’s Life
Turning up the HEAT – Heroin Enforcement Action Teams Make an Impact
Imposters on the Street – An Investigative Look at What’s Being Sold as Opioids and many more.

Speakers include Douglas W. Coleman of the U.S. Drug Enforcement Administration; Shana Malone of the Arizona Health Care Cost Containment System; and Haley Coles of Sonoran Prevention Works. Day one registration is limited to residents of Arizona for $45.
New in 2018, the conference is offering two additional days of educational sessions for clinical professionals for an additional fee. February 15 and 16 clinical experts will provide intermediate — to advanced-level training on treating opioid addiction and related disorders. An optional evening presentation will offer ethics training for clinical professionals.

Registration for the following days are open to everyone regardless of their state of residence, and continuing education credits are available.

Among the speakers will be internationally recognized author and trainer Claudia Black, PhD, who will explore Addiction and Trauma: How Clinicians Can Effectively Address Complex Cases Presenting in Young Adults. Mel Pohl, MD, DFASAM, will discuss Pain and Addiction: The Clinician’s Role in Treating Complex Co-Occurring Disorders. John Briere, PhD, will review Managing Countertransference: Key Strategies for Therapists During the Opioid Epidemic.

The conference is being organized by the Institute for the Advancement of Behavioral Healthcare, the largest media and events producer in the behavioral healthcare field. The Institute produces, among other events, the National Rx Drug Abuse & Heroin Summit.

The Institute’s educational advisors for the Arizona conference include the Arizona High Intensity Drug Trafficking Area (Arizona HIDTA), the U.S. Justice Department Drug Enforcement Administration, MATFORCE, Arizona Health Care Cost Containment System, Arizona Department of Health Services, Arizona Pharmacy Board, Community Medical Services, Sonoran Prevention Works, and U.S. Attorney's Office.

For more information and to register, visit www.arizonaopioidsummit.com. Visitors to the website can sign up for a complimentary e-newsletter on the opioid crisis in the region.

Don’t Quit Before the Miracle

All of us from Together AZ and the Art of Recovery Expo wish you a blessed and safe holiday season.

Being part of the ever growing community of addiction awareness, advocacy and prevention has given my life a very special purpose. When I made the commitment to see what this sobriety thing was all about, I had no idea how fulfilled my life would become. Through the years I have met hundreds and hundreds of people on the same journey, from the beginning through today — this family welcomes me with open hearts and arms.

While all our lives will have ups and downs, please stay on the path with us. Don’t give up, ask for help, and watch for the miracles. I’ve learned there is no other way to live. It took a lot of patience, fellowship, humility, and honesty to get to where I am at this very moment, sober and very very grateful.

To a Joyous Season and Beautiful New Year!

Scottsdale Recovery Center TRICARE Preferred Provider


Scottsdale Recovery Center is now a TRICARE Preferred Provider of substance use inpatient and outpatient services to active, inactive duty military members, veterans and their dependents of the TRICARE West, North and South Regions. As a TRICARE Provider, SRC is honored to provide behavioral health, substance abuse inpatient and outpatient services, with an emphasis on trauma, PTSD, and addictive disease disorders to active duty military members, retirees and dependents of the TRICARE West, North and South Regions.

Utilizing EMDR therapy as a primary treatment modality for trauma and PTSD, they employ the most experienced and accredited EMDR therapists the state has to offer. SRC is honored to help serve the health care and addiction needs of service members, veterans, and their families, and will help determine eligibility and benefits that can be utilized at Scottsdale Recovery Center. We are committed to helping military beneficiaries and partnering with all aspects of the TRICARE healthcare alliance.

Call us if your a TRICARE policy holder and need help getting sober, we are here for you America!  Call 1-888-NODRUGS and visit www.scottsdalerecovery.com

The Gifts of Pause

Tis the season to be jolly but the ho, ho, ho’s seems to be hiding. Today there is more holy cow than ho, ho, ho! To many of us, it feels as if we are waiting for the other shoe to drop and we are doing it while holding our breath. We haven’t had a lot of time to focus on what is good in our lives, what is sacred and fulfilling. So, what better time to pause and remember all the things that brings us joy.

The Holy Moments

For instance, those holy moments when something hits you just right with the perfect ah-ha and you get it, whatever it is. Or the holy moments when you are sitting with someone you love and the truth between you is electric. The holy moments when someone tells you how incredibly important to them and loved you are. Or those moments when you have wrestled with a problem, and suddenly step out of the box and have the answer.

How about that precious moment in the grocery store when some kid looks up at you when a grin the size of Milwaukee? What about the little successes when you didn’t forget your glasses or your pet insists on cuddling behind the bend in your knee, or rests her head there to watch TV with you?

Think about the times you have cracked up laughing with a friend or loved one in a movie or the food you ordered tastes as satisfying as the picture on the menu made it look. Or when you treated yourself to a dessert guilt free.

Think about when you wake up early and then remember you get to sleep in because it’s the weekend or when that outfit you love fits again.

What about the sheer joy of being a parent, grandparent or great grandparent! My munchkins start doing their dance the minute the music comes on and there is nothing sweeter than watching toddlers try to out dance each other.

If you are single how about having a singles holiday dinner with friends to celebrate your freedom and the fact that you all can keep shopping for the right partner and you’ve learned enough about yourself to have better boundaries and a well-trained “picker” this time.
I once wrote a poem.... “I sleep on my side of the bed as though there was still a your side. Will sleeping in the middle mean I am over you?”

Celebrate your singleness. Now, I love having the whole bed to myself.

Take a minute to be grateful for the people who get you. You know, the ones who never question your motives. The ones who understand the value of your character and spirit and celebrate that. And it could be time to celebrate your parents, even the ones who, were shall we say, screwed up. After all, they taught you everything you never want to do or be. That’s great gift.

There are also many gifts in aging. I understand more about life and the lessons we create for ourselves than ever. I am so glad to be past the challenges that brought me to my knees and so glad to be able to help my kids and grandkids create fewer of those for themselves. I am even glad to be near the last chapter of my life, because all these precious gifts and lessons are now the fabric of my soul. I embrace the sweet holy moments, the moments on my knees and the moments of enlightenment, kindness and new awareness’. We have so much for which to grateful. Take a moment this season to simply pause and be still — to reflect on the blessings in your life.

We who have the privilege of sharing our thoughts with you each month are incredibly grateful for you and Barbara for having this opportunity. You are the blessing in our lives, the people who help us fulfill our purpose and check our own integrity and level of vulnerability and honesty every month.
So, we all wish you every continued blessing. In the New Year, let’s all take a lesson from our canine friends. When they encounter poop in their lives, they simply kick some dirt over it and move on. Happy Holidays!

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

Reacting to Triggers

By Renee Sieradski, EA 

Recently I was reacquainted with an old friend, Betty. We hadn’t spent time in a decade. I knew her during my before and during my first year in recovery, back then I was a different person. A woman without  boundaries or clear sense of my reality, codependent, and learning how to grow up. 

As we were catching up, I was reminded of how verbally abusive she had been though I hadn’t thought of her as a major player I would have to recover from. But here she was, someone who didn’t know the real me today. Still, I found myself interacting with her as if I was a victim who accepted verbal abuse, a little child again. I regressed and was almost immediately triggered.

Oftentimes, my first reaction or feeling when I feel this way is frantic, or reaching for ice cream to stop my feelings of helplessness. I wish that wasn’t true, but it was especially after Betty made several indirect references to how much weight I had gained. 

I attend a 12 step meetings, but can find myself wailing in my car, having the desire to never see this person again, to run and hide from the perpetrator I am facing. When triggered I discount my reality based on old negative messages from my father. 

I would not have felt disempowered had I stood up for myself in the moment with her. But my inclination is to freeze and disassociate when verbally abused, especially when caught off guard, under stress, or over-tired. Betty literally showed up unannounced at my office, without warning. I was triggered for 36 hours after she appeared at my office. During her visit, I agreed to do some pro-bono legal work for her, and she will likely not be pleased with my work. 

After the encounter, I had to increase my attendance at meetings and find it comforting to tell myself it’s okay to be triggered. My sponsor has taught me the idea of radical acceptance. No matter where I am now, it will pass. Because of my severe PTSD, I’m prone to relapses when I encounter new situations. My therapist calls it a shame fever. He says fevers eventually break, naturally, once the body fights off the illness. My body will naturally handle this,  but in the meantime, I need to be gentle and kind to myself. I don’t have to decide right now whether to confront or not to confront her again. I must realize I am reacting because Betty’s words hit on tender wounds in my soul, and it isn’t all her fault. Actually, she gave me an opportunity to feel a deep raw wound and remember how I once was a vulnerable child who was mistreated. In turn I can practice extra good self-care and become a stronger woman.

Just because you’ve received a tax notice, you may not owe 

Here are some common tax notices you might see after submitting your return:
  • We’ve adjusted your return
  • We’ve made changes to your return
  • We have found problems with your return
For years, I’ve responded to tax notices from the IRS or states and 20% of the time, they are a result of errors on the part of the taxing authority. This means 80% of the time a taxpayer has forgotten to include interest income from a brokerage account or forgotten to include their 1099 income from that “small” side job.
Two out of 10 times, the IRS or State has:
  • mislaid a tax check
  • cashed a check and didn’t apply it to taxpayer’s account
  • charged a penalty and when taxpayer paid it, send a letter of a credit on account (Yes, really)
  • not credited taxes withheld by pass-thru entities
  • posted your taxes paid to the wrong year

In these cases, all it takes is a phone call, fax or a letter to the IRS/State explaining what took place and requesting your account be reviewed. Ask your tax advisor to send this letter for you and sometimes this may alleviate your stress just because they are used to doing dozens of letters a year and they will know how to word the letter in such a way to get the desired result.Don’t assume because you received a letter regarding your taxes, you owe the money, do some research.

Healing with Creativity

By A. Padilla


The creative process at Blue J Creative Healing is based on Jungian Psychology and much of what Joseph Campbell said in the above quote. Students work in different mediums from encaustic wax, resin, paint, watercolors, clay, to music. It’s not just the traditional art materials — there is much more. Scientific data is available documenting how creativity helps with anxiety, depression, addiction and self-esteem. During the creative process all parts of our brain are activated at one point or another. This is why the process is so healing when in conjunction with a person qualified like Jenny Preece Schomaker Padilla.

Who Can Benefit?

Blue J Creative Healing helps kids, teens, and adults in conjunction with Cognitive Behavioral Therapy throughout the Valley. Randi Gray, LPC said, “Jenny provides clients with an alternative, creative way to process, learn, discover and grow. I’ve seen the beneficial effects her work has on clients. It has been a positive experience having Jenny in my practice, offering this additional resource to clients.”

Her gifts lie in guiding us to understanding our bodies, minds, and how all of these are important in creating wholeness and unblocking past issues. She also focuses on nutrition and how it impacts the brain and body. Her grandmother and mother nurtured the importance of nutrition. Jenny doesn’t believe in dieting however, more of a balance and understanding how different foods and portions work with our brain and bodies.

Jenny graduated from Pacifica Graduate Institute in Santa Barbara where she obtained her Masters of Art in Creative Life, Humanities, and Depth Psychology. After being a internationally published photographer for 15 years, she was diagnosed during with Spasmodic Dysphonia. This impacted her voice, which was part of her identity for sometime. She was a DJ at her college radio station. After college she pursued marketing and sales management positions in the travel and tourism industry, which required daily public speaking assignments. After trying yoga, meditation, traditional therapy, she still needed more to understand not only what she was going through but understand things in another perspective. She felt called to go back to school as a single mom of three in her 30’s, no small task.

Being able to put the puzzle pieces together with her graduate program and other educational experience she was able to come up with an individualized program. The “Creative Life” is a way of life for humans, just like water is to fish. She uses creativity on a personal basis. “Each person has it within them, we have just forgotten how to use and access it” says Jenny. In a world becoming more and more electronic there is a need for balance.

Jenny is a guide, teacher, and coach helping people get back in touch with the part of them that may have been suppressed or traumatized. Tapping into the “inner child” specifically and subconscious to find those things that help build the person. Julia Cameron has said, “When we open ourselves to our creativity, we open ourselves to the creator’s creativity within us and our lives.”

If you or a loved one struggles   with anxiety, depression, addiction or low self esteem please visit www.bluejcreativehealing.org for more details.

Make a commitment! Three behaviors for parents

By Dave Cooke, 100 Pedals

Dave Cooke is a dad on a mission, to help parents get control of their lives over the powerful, destructive influences of a child's addiction. As the father of a son in a ten year heroin battle, Dave knows all to well the challenges parents and families face. He also knows there is a way to find peace in the chaos. Contact Dave at dave@100Pedals.com.

In a recent parent coaching session, we examined ways to interrupt triggering exchanges between a parent and addicted child. Many parents began to recognize patterns in their exchanges and the toxic impact they were having on both.

We get caught in a trap of repeated responses to the frustrating, challenging and difficult choices our addicted children make, losing our own perspective on the adverse reactions our responses can have. Instead of helping or healing, we actually make things worse, even if that seems implausible.

Altering or interrupting our patterns or habits of responding, requires the willingness to adapt, change or adjust our responses to these confounding choices. Here are three behaviors to focus on to help interrupt unhealthy patterns in our exchanges and interactions with our addicted children:

Eliminate criticism, judgement and condemnation from your dialogue: This is essential for healthy dialogue and healing. Even in the most chaotic situations, our children need to experience our unconditional love more than anything else. Sometimes giving our best is difficult — if not impossible.

It doesn’t mean in our anger or frustration they need to experience our worst. Listening, accepting, encouraging, and supporting are powerful, loving behaviors. When they share the news of a bad decision, it’s best not to challenge, criticize or express frustration. Offer a word of appreciation, ‘thanks for letting me know’, a word of encouragement, ‘I’m confident you know what you are doing’, an offer to support, ‘if you need my help, let me know’.  You may read this example and think, What? 

This is interrupting old behaviors with new ones, changing dialogue, bringing healing and love to a broken, strained relationship.

Focus on what you have authority over and responsibility for. It took me a long time to recognize the extent I would try to manage and influence behaviors which were beyond my authority. Even when I thought I had extricated myself from my son’s addiction/recovery, I realized I shifted away from much of it, though not all.

Everything changed when... where he’s living, what he’s doing to manage his recovery, legal obligations, finances, job, relationships, or his other ongoing recovery or addiction habits were not my responsibility or under my authority.

Anything I did to help or assist in managing his life, is my attempt to control. Today I chose to exert a healthier influence on my health, habits, relationships, communications and interactions with him. Being in a healthier, more balanced lifestyle, better equips me to love him and encourage him when he needs or asks.  Anything else is meddling, another form of control.
I will not engage in behaviors or activities which hurt me. There are “favors” my addicted son has asked which I knew were not a good idea. Each time they went against my instincts, causing causing personal and internal distress when I did. In the end, my instincts proved to be correct, the supportive action was B.S. and I ended up hurt, frustrated, or disappointed in the process. Today, I pay very close attention to my safe meter: gut instinct, the wisdom of experience, and common sense. 

Unconditional love is not demonstrated by engaging in an activity which is instinctively off. Only in active addiction did my son ask of me things that didn’t seem right or were hurtful.  In active recovery, he has demonstrated his independence and his interactions are devoid of strange and uniquely abnormal requests. Making a commitment to honor our warning signs may not be popular with an addicted child; but, they go a long way in protecting you from additional pain while helping you maintain the healthy boundaries.

There are many other behavioral commitments I would love to encourage you to focus on. Through my experiences, these were the most critical and proved to be the most influential and beneficial.  I will share more about these three on my upcoming podcast.  








Navigating the Holidays when Your Child is in Early Recovery

By Dr. John Dyben, DHSC, MCAP, CMHP – Clinical Fellow

Families can experience many emotions while navigating the holidays, whether in still waters or rough seas. Friends and families come together and we place at the forefront of our thoughts all of the joy of our connections we may forget in the day-to-day. In these special times, our gratitude for life and joy in all we share is so sharply focused that many describe these as “magical” times, bursting with wonder and delight.

The flipside to this is emotional pain and difficulties may also be magnified during these times. We miss lost loved ones. We remember and wish for simpler times. We feel the weight of difficult circumstances a bit heavier.

In few ways is this phenomena more realized than with families who have a loved one in very early recovery.

Strong emotions combine with a multitude of questions to create a feeling of constant pressure and walking on eggshells. Families want to know how they should act around their loved ones new to recovery. Should there be alcohol at gatherings, who should be invited to functions, or should participate in celebrations at all. They wonder if they should give gifts or hold back. They agonize over how to have a “normal” holiday, often having had so many where their loved one was actively using substances – or absent altogether.

As someone who has been in this position, I can share there are three important guiding principles to help families navigate these times.

1. The Principle of the Sail

In sailing, the seasoned mariner knows that no matter how exact he is in his rigging and tacking and moving all of the parts of the boat, he cannot control the wind. Knowing what we can and cannot control, and then practicing the art of accepting that which I cannot, is paramount in keeping sane during these times. I remember the first time

I went to an Al-Anon meeting and was told that I could have peace in my life even if my loved one was still drinking and using substances. I thought it was the craziest thing I had ever heard in my life. And yet, it is true.

At the end of the day, no matter what you do, you cannot control your loved one’s recovery. That is the wind to you. You can let go of that outcome. You must let go of that if you are to find peace. This is incredibly difficult to do alone. No matter how smart or strong you are, getting support from others who understand what you are going through is critical. Participation in groups like Al-Anon, Families Anonymous and other support groups for people who have family members struggling with substance use should be as important as getting gifts ready for the season.


2. The Principle of Waxing Strength

When a person has an allergic reaction to a food that causes them to nearly die from anaphylaxis, they may end up in the hospital for days. They may feel weak and be particularly vulnerable to that allergen. It would make perfect sense that in preparation for that person to come home from the hospital, we would clear the house of the allergen and encourage others not to bring it into the home.

Eventually, in time, as the person gains strength and learns how proximity to the allergen affects him, he may be fine with it next to him.

In the same way, it is a good principle to keep alcohol, medications that can be misused and any other substances out of the recovery environment of a person in early recovery. In time, a fully recovered person may be able to be around alcohol with no problem at all. For this first holiday season, though, it is usually better if it is not around.

3. The Principle of Falling Walls

This principle will cover so much more than one might imagine if it is bravely pursued. Family members have many questions about how to act and what to do around a loved one in early recovery.

Also, they have questions about how much should be shared with others in the family and circle of friends. A simple, though sometimes counterintuitive way to handle this is to ask direct questions — and ask permission to ask, too.

What might happen if you approached a loved one in early recovery and said, “Hey, I am new to this and I have some questions. Would it be okay if I asked you about your perspective on the holiday?” In my experience, I was able to get so many answers that I could never have figured out on my own even though I had been agonizing over them for weeks.

Ultimately, there is no magic formula to make things perfect for this holiday season. And I’m pretty sure there is no such thing as a “perfect” holiday season, anyway. In fact, it is often the bumps, hiccups and awkward moments that make for the most laughter and joy when we are accepting of the reality and beauty of our imperfections.

If you have a loved one in early recovery this holiday season, know that you can have joy and peace in your life and your home no matter what happens. Know that the actions you can take are like the mariner’s work on the sails — but remember that the wind is out of your control. So talk as openly as you can and push yourself beyond your comfort zone to open up even more. Reach out for help and remember that everyone deserves the gift of support, including you.
May peace find you and your family and may you all celebrate life this holiday season.

Powered by Origins Behavioral Healthcare

Monday, October 30, 2017

Update on a New Treatment for Major Depression

By H.J. Schulte, M.D., D.F.A.P.A.

Recall the worst you have ever felt with influenza — the headaches, the body aches, the joint muscle aches— everything hurts! Take away the nausea, vomiting or cough and that is what severe depression can feel like. It’s a whole body disease. 

Severe Major Depressive Disorder injures and pains our bio, psycho, social, spiritual beingness. It stops many from functioning at work and at home. It cripples one’s ability to love and to work and to enjoy life. I would like to review the symptoms of Major Depression, the findings of the STAR D study*(Sequenced Treatment Alternative to Relieve Depression Study), how often Major Depression occurs, its cost and highlight a new treatment called repetitive Transcranial Magnetic Stimulation for treatment resistant Major Depressive Disorder. 

Symptoms of Major Depression

The symptoms of Major Depression include the following: 

  • Depressed mood or apathy/loss of interest.
  • Four or more required: sleep disturbance, executive dysfunction, worthlessness/guilt, weight/appetite changes, psychomotor agitation or retardation, fatigue or suicidal ideation. 
  • It must significantly interfere with the functioning of the individual at work, at home or socially. Frequently, it affects all those areas. 

It is a little odd that someone can have Major Depressive Disorder but not have a depressed mood. I think we have all seen this can occur. We sometimes explain it as person who is out of touch with their emotions or may not know how to access them such as in alexithymia or perhaps it’s a macho football player. Nonetheless, it can occur if one meets the criteria instead of having depressed mood. Anhedonia is an important hallmark for Major Depressive Disorder. A person may present with apathy/loss of interest (anhedonia). 

In the future Major Depressive Disorder will likely consist of several different genetically defined illnesses. A patient may present with an extreme anxiety, insomnia, agitation, restlessness depressive symptom profile. Or a patient may be very lethargic, oversleep, complain of fatigue and be unmotivated to do anything they used to enjoy doing. Currently we are labeling them with the same name but the clinical presentations can be drastically different. 

In the STAR D study that was reported in American Journal of Psychiatry in 2005, 4,000 patients from 41 clinics were monitored and treated for one year. These were real life patients in medical and psychiatric clinics who also suffered from substance abuse, chronic pain and family issues. The study was a landmark because it looked at the treatment of depression in the clinical treatment settings. The study was designed so every three months if one did not go into remission from the first treatment, they were then put into the next level with different treatments. The goal of the treatment was remission which implied that the person was back to their normal functioning. Response, on the other hand, is a 50% improvement on the Hamilton Depression Scale. The reason remission is so important is that if the patient does not get fully into remission, they are much more likely to have increased relapsed rates of depression that can cause significant mortality and morbidity. There is also increased risk for suicide and increased risk for significant negative effects on the family, occupation and health of the individual.*

STAR D

In the STAR D study level one involved the three months treatment with Citalopram (Celexa). Those who did not respond went on to level two where they were randomly assigned to either Sertraline, (Zoloft), Bupropion- SR/ (Wellbutrin) or Venlafaxine-XR( Effexor). Bupropion was used both independently and as an add on to other medications. As in level one, those who became symptom free with level two could continue with treatment and in to the follow up. Participants could always switch to, or add on cognitive psychotherapy. Those who did not become symptom free would continue to level three. In level three, participants had the option of either switching to another medication or adding on to their existing medication. They were randomly assigned to Mirtazapine (Remeron) or Nortriptyline (Pamelor) a tricyclic antidepressant.

In level three, either Lithium or Thyroid was added to bolster the antidepressant action. In level four those who did not become symptom free where taken off of all their other antidepressants and were given a trial of a monoamine oxidase inhibitor antidepressant namely, Tranylcypromine (Parnate) or Venlafaxine XR with Mirtazapine. 

Measurement-based care was used to asset the patient’s progress at each level. 

In summary, about 70% of patients reached remission, however this left about 30% of patients who did not. The odds of beating the depression diminished with each additional treatment strategy that was needed. The drop-out rate also increased significantly with each progressive treatment level. Forty percent of the patients had side effects, some of them significant. 

If someone experienced one episode of Major Depression in their life, there is about a 50% chance of it reoccurring. If someone experienced two episodes of Major Depression, the risk of it reoccurring goes up to 70%. After three episodes of Major Depression, the likelihood of it reoccurring is 90%. By the second recurrent episode it recommended patients stay on medications ongoing to help prevent further relapses. MDD can be seen as a Chronic Medical Illness similar to Hypertension, Diabetes, Heart Disease or Autoimmune Diseases.

The risk of having major depression is about 17% for adults in their lifetime. The yearly risk for Major Depression is about 8%. The yearly risk for Anxiety Disorder is about 10%; Substance Abuse Disorder incidence is about 10%. The lifetime risk for both of those disorders is about 25%. 

How Common is Depression?

“Depression is a common mental disorder. Globally, more than 300 million people of all ages suffer from it. Depression is the leading cause of disability worldwide, and is a large contributor to the over global burden of disease,” “Annual costs related to MDD rose to $210.5 billion in 2010, according to the study published in the Journal of Clinical Psychiatry.” February 25, 2015.

Hope for Healing

Amazing advances have been made in brain chemistry. It is very exciting and hopeful to learn about neuroplasticity and how we can help our brain grow and heal. There is an explosion in neuroscience that brought with it many wonderful psychiatric medications which have been very helpful to help treat the symptoms of Major Depressive Disorder. 

Pills don’t teach skills. I have a strong belief that people with Major Depressive Disorder, as well as many other psychiatric disorder benefits from psychotherapy. There have been significant advances made in the psychotherapy world of new treatments, many which are very helpful. Allbeit the stigma and barriers to treatment for psychotherapy and psychiatric illnesses continue, there is also a great deal of progress in accepting psychotherapy and medication treatment for psychiatric illnesses. 
For treatment resistant depression the psychiatric profession employs Electroconvulsive Therapy (ECT). This is still one of the most powerful treatments for treatment resistant depression. However, it comes with significant drawbacks which involve having anesthesia for each treatment of which there about twenty over the course of a month. It is performed in such way that confusion and memory problems are less than they used to be.

TMS

Transcranial Magnetic Stimulation (rTMS) was FDA approved in 2008 for the treatment of severe treatment resistant Major Depressive Disorder. In 1985 the first TMS study was performed by Anthony Barker in Sheffield England. Some of his students reported the electromagnetic stimulation he was using to stimulate the brain caused them to feel less depressed. Over the years, there was a great deal of interest in how to apply electromagnetic stimulation for the treatment of depression. 

There were problems of where to do the treatment, how strong to make it and how to get back to the same site consistently. 

In the early 2000’s PET scans showed that in Major Depression Disorder, the left prefrontal cortex is low in metabolism. Other lower brain regions had increased metabolism. By applying electromagnetic stimulation to the prefrontal cortex of the brain over a period of time there was a decrease or severe symptoms in this treatment resistant group. In order to get FDA approval, rTMS was successful in getting about 50% of patients into response and about 30% of patients having a remission. 

These are similar results that prompted FDA approval of the early serotonin reuptake inhibitor antidepressants such as Prozac. You may recall remission is symptom free and response is greater than 50% decreased in symptoms on the Hamilton Depression rating scale. These findings were reported in a study of the first hundred patients treated in the first year after receiving FDA approval. Now, after nine years of experience our response rates are rates are around 70% and our remission rates are about 40%. The reason for this is we now leave patients on medications during treatment and the treatment is extended from four to six weeks. The treatment consists of daily 37 minutes treatment of rapid pulses of electromagnetic waves given to the left dorsolateral prefrontal cortex.

Electrical pulsing stimulation is directed towards a magnet and the magnet then sends off an electromagnetic wave that goes thru the scalp and into the brain about 3cm. This creates an electrical pulse inside of the brain causing neurons to depolarize and regenerate. This stimulation is to the left upper part of the prefrontal cortex, however, it also changes other areas of the brain, because the brain operates in tracts.

NeuroStar was the first company to invent the machine that successfully accomplished getting FDA approval. In the initial study the dropout rate was about 4% due to headaches. Most practitioners have very few dropouts from headaches because we tend to go lower and slower than they did in the study. FDA approval was obtained after the first 10,000 treatments in several studies. Between 10,000 and 100,000 treatments there were three episodes of grand mal seizures. This may have been due to drug abuse, changing medications and/or treatment error. 


The treatment error has been corrected by changing the algorithm on the machine. Now NeuroStar has had about 1.5 million treatments and no further episodes of seizures. There are about three to four other machines on the market providing similar treatment. Their seizure rate may be a little higher than the rate with NeuroStar. 

Currently there are about 400 providers across the country providing rTMS treatment in their office. It is also available in the top 10 medical schools outpatient departments. Cost has been a factor in terms of the slow growth of rTMS usage. Because of its success rate with a very ill patient population and its lower cost than ECT with less side effects, it is now being covered by most insurance companies. 

As you would imagine, insurance companies have strict criteria for treatment involving failing three to four antidepressants as well as failing add on treatments for depression. Psychotherapy treatment needs to be carefully documented with clinical based instruments such as the Beck Depressions Inventory scale or the Patient Health Questionnaire.

If you have clients or patients who are profoundly, severally depressed and are resistant to treatment you may consider rTMS as a treatment option for them.

Significant research applications of TMS for other illnesses are being done by Alvaro Pascual-Leone MD, PHD. For more information visit the TMS Clinical Society on line at https://clinicaltmssociety.org

*Trivedi MH, ET AL J Psychiatry 2006: 163: 28-40
*Zajecka JM. J Cline Psychiatry. 2003: 64 (Suppl 15): 7-12
*World Health Organization: DEPRESSION; fact sheet, updated February 2017
 

Interested in learning more?

Call Nancy, our TMS coordinator, if you have any further questions about rTMS treatment or insurance coverage at (480) 941-9004. The Schulte Institute, 7101 E. Indian School Road, Scottsdale, AZ 85251 and visit http://www.schulteinstitute.com

About Dr. Schulte
Dr. Schulte is a senior psychiatrist with a passion for providing excellent care to patients. His compassion, great sense of humor, and treating each patient with care and respect, has earned him the esteem of his peers and patients.

Dr. Schulte has been a Board Certified Addictionologist since 1998 and is Board Certified in Psychiatry. He is a distinguished life fellow of American Psychiatric Association.

Dr. Schulte has lectured for many pharmaceutical companies regarding, antidepressant, antipsychotic, and mood stabilizing medications. For many years, he lectured several times a month, to family practice doctors and other psychiatrists, regarding depression, anxiety, and Bipolar disorder and the use of medications. He continues in this capacity, educating other physicians about the use of these medications.

What if Your Teen Uses Drugs AND Has Anxiety, ADHD or Bipolar Disorder?



Many teens suffer from depression, anxiety, ADHD, bipolar disorder or some other mental illness. This puts them more at risk for developing a drug or alcohol problem.
Although not all teens with these disorders will develop a substance use problem, chances are higher when they have difficulty regulating their thoughts and emotions. Because of this, parents with children with psychiatric conditions should be vigilant about the possibility of their teen using drugs or alcohol.

Unfortunately, many teens with a mental health disorder turn to alcohol or other drugs to self-medicate. In fact, the majority of adolescents and young adults battling substance abuse and dependence may have an undiagnosed, untreated mental illness.

When a child gets diagnosed with a mental health disorder, in addition to alcohol or drug use and dependence, he or she has “co-occurring disorders,” also known as a “dual diagnosis.” When a child has co-occurring disorders, they should be treated for each of the diagnoses. Treating alcohol or other drug abuse and dependence/addiction alone does not help underlying mental disorders, and similarly, treating a depressive disorder alone will not treat addiction.

If your child has been diagnosed with co-occurring disorders, find a treatment program that specializes in treating dual disorders. Or find a treatment program that can make referrals to services to help treat your child’s mental disorder, while simultaneously getting treatment for alcohol or other drug use and dependence. Make sure to ask treatment providers whether their program is equipped to handle this.

(Partnership for Drug-Free Kids)

Surviving a Job Loss in Sobriety


Money is something that sustains us all. Some people are driven by it, hoping to collect as much as they can, while others scorn it, believing money to be the root of all that is wrong with society. It is something that many of us think about on a daily basis, as we check our bank account balance five times throughout the day, hoping it didn’t go down, and even more so — hoping that it magically went up. It is something that follows us into sleep, as we toss and turn worrying about how the bills will get paid, or how we don’t have as much as the person next to you, and for all that can be said, both good and bad about money, it is something that we need in order to live comfortably, but yet should not be something that masters us.

For the alcoholic or addict in recovery, we seek to be free from attachment to worldly things, or at least some of us do. We hope to transcend the issues of humanity through our spiritual practices and part of what that entails is not letting money rule our lives. In theory, this sounds wonderful, but in actual practice what most of us find is that when we have enough money, we are content, and when we don’t, we are preoccupied with how we can get enough money.

The reality is that there is nothing wrong with this, as it is part of being human and living in a society where money is a necessity. We innately understand that wealth or lack thereof is at least partially important in our daily lives, and because of this many of worry about job loss in sobriety.

We may work jobs we hate or we love, but at some point, we think about what would happen if job loss in sobriety occurred. Being alcoholic or addictively inclined, more than likely your mind goes to the worst case scenario and you think that if job loss in sobriety happened, you would instantly become homeless and wind up drinking or drugging yourself to death in an alley way somewhere. As realistic as this sounds in your mind, it will more than likely not occur, as it doesn’t occur to most people. If a  job loss in sobriety does occur, you hopefully will be given the opportunity to put to practice all you have learned in recovery and overcome this challenge. You will learn how to become a better person because of it; how to be a better employee, or you might finally get the courage to break out and pursue your dream path, rather than settling.

Facing the Loss

The reason why you were let go is not necessarily important, but what is important is finding a way to sustain yourself monetarily and also learning the lessons that you need to learn.
Just about everything that occurs in our lives can be looked at as an opportunity to grow. Without sounding too Tony Robbins-ish, it is the reality of life. Sometimes terrible things occur and we can either grow from them or let them destroy us. We can become consumed with hate, guilt, shame, and anger or we can take a look inside and see what chains still need to come off.

Now what

This is not an easy task to do, but often times when the worst-case scenario in our life occurs, i.e. experiencing a job loss in sobriety, we are broken open so that we can grow as a person. If you were at a job that you hate and have wanted to get out of, then possibly the job loss was a blessing in disguise. To this same thought, if the job you just lost was one that you loved then you may have another lesson to learn. This is not to say that life is teaching you a lesson because something is innately wrong with you, but rather that life presents us with challenges, that allow us to grow, and it is up to us what we do with that.

While none of that may sound like a way to not relapse after experiencing a job loss, it is, in fact, the only way to avoid a relapse when you experience something that is against your plans in recovery.

You have to maintain a perspective of perseverance and not fall into the thinking that just because you are sober everything should go your way. While it is okay to feel self-pity for a time being, if you wallow in these thoughts for too long, you can wind up becoming resentful at recovery and in turn wind up drinking.

Understand losing a job is not the end of the world. It is not the ideal, but since you are in recovery you are lucky because you are engaged in a widespread social circle, with hundreds, if not thousands of people who can help you find work. Reach out to others and ask for help and more than likely work will show up.

Through all of this, it is important to continue to go to meetings, talk to your friends, and pray. Believe me when I tell you, you will be able to survive a job loss in sobriety.

Freedom From Addiction
If you or a loved one is suffering from alcoholism or addiction, understand that you are not alone in your struggles! If you are ready to change your life and finally be free of your addiction, then Holistic Recovery Centers can help. We can give you the jump start you need in order to experience the recovery you have always wanted. Our holistic programs are unique in that they don’t just treat the addiction, but rather they treat the whole person, so if you are interested in finding out more information, please do not hesitate to give us a call 1-877-723-7117. https://holisticrecoverycenters.com/

The Word and the Womb

By Alan Cohen

How much should you tell other people about what is really important to you? Should you broadcast your dreams to everyone in hopes that others will honor your intentions and support you? Or would you be wiser to keep your visions to yourself and avoid debilitating criticism?

You have probably had the experience of sharing a fresh insight, experience, or project with someone, only to be met with an icy, insensitive response. “I tried that and it didn’t work.” “You will put yourself at risk.” “That would cost too much to produce and nobody would buy it.”

Nothing is more daunting than someone throwing cold water on your hot dreams. Then you walk away from the conversation feeling deflated and defeated.

I am amazed at how obtuse people can be when offered an opportunity to support someone. I visited a friend in the hospital who had a very minor surgery. A relative in the room said, “I know someone who died of what you have.” One of my coaching clients told her husband she wanted to take a yoga class. He laughed and told her she was on her way to Jonestown. When I self-published my first book using my mother’s life savings, the publisher’s agent told me, “They say you don’t make any money until your third book.” (The book went on to be a bestseller.)

Jesus was a master metaphysician who understood the power of thoughts and words. He instructed, “Cast not pearls before swine,” meaning to not offer sensitive, lofty ideas to people who will not understand, and gobble them up. After he performed a certain healing, he told the recipient, “Tell no man.” Jesus understood that if that man broadcast his experience publicly before the healing was solidified, negative observers would cast doubts and skepticism upon him so as to weaken or undo the healing. Better to wait until the healing was gelled in his subconscious; then the opinions of others could not unstitch his advancement.

A yogi told me, “When you plant a seedling in a field where cows are grazing, set a fence around the little plant to protect it from cows eating or trampling it. Later, when the seedling has grown large and sturdy, you can remove the fence, and the cows will have a magnificent tree they can rub up against and rest under its shade.”

Does the injunction to safeguard sensitive projects mean we should be neurotically secretive about what is important to us? No, it just means we should be discerning when choosing the people we share our visions with. If you know that someone loves and supports you, that would be a good person to include in your vision. Some people attend mastermind groups in which they meet weekly with a few positive friends to share exciting ideas and get behind each other for success. Cultivate and fertilize the soil in which you plant your valued seeds.

Let’s say you share a sensitive project at an early stage and someone throws a dagger of negation at it. Does that mean the project has been killed? Not at all. You can use the experience to make your project stronger. Use the criticism as motivation to go within and affirm the value, power, and potential of your project. In homeopathy and immunization, patients take small doses of viruses that would kill them in larger doses. The body then develops antibodies that prevent the disease from overcoming them should it return. “What does not kill me makes me stronger.”

No person, no matter how negative or virulent they are, has the power to thwart your project or remove your good. That power belongs only to you. If someone judges or attacks you, consider them an angel reflecting to you your own beliefs, doubts, or fears so you can recognize and heal them. If you get upset or cave in when someone criticizes you, you must agree with that person. If you didn’t, the criticism would not disturb you. Your issue is not with the other person. It is with yourself. Find the hidden self-doubt or judgment, confront it, hold it up to the light, and heal it with a greater truth.

Because light is more powerful than darkness, you must succeed.


As we enter the holiday season, you may have some juicy opportunities to discern who to share your sensitive truth with, and how to deal with people who judge or criticize you. Don’t shy away from these opportunities. Use each one to practice remembering your beauty, power, and worth, and that of your valued projects.

Motivational master Jim Rohn said, “If you really want something, you will find a way. If you don’t, you will find an excuse.” Don’t use fear or others’ negative opinions as an excuse to not move ahead. Don’t let people into your visions if they don’t match your intention. Love and support your visions like a pregnant woman would diligently protect and care for the soul in her womb. Then your progeny will grow into powerful, mature, successful adults.

Everyone is your teacher. Some teach through loving support, and others teach through challenge. Become a spiritual master by using the power of the word to your highest advantage.

Alan Cohen is the author of A Course in Miracles Made Easy; mastering the Journey from Fear to Love. Join Alan Hawaii, Feb 26 - March 2 for a rare retreat, Unplugged. Put your devices aside, liberate yourself from technology, and reconnect with yourself and your life. For more information about this program, Alan’s books and videos, free daily inspirational quotes, online courses, and weekly radio show, visit www.alancohen.com.


It Works for Me: EMDR

By Renee Sieradski, EA

Over the past 12 years I would guess I've had 150 sessions of EMDR (Eye Movement Desensitization and Reprogramming)with a favorable outcome. Generally the pain I'm experiencing before my session is lessened by having the treatment.

It works well and I get relief by this modality. In the early days, I would struggle and sob through each session and end up curled up in a ball — as I reprocessed early traumatic memories of physical and emotional abuse. I would go to therapy twice a week just to feel like I wasn’t going to split open into a million pieces and be reminded I was going to survive this inner turmoil of emotions.

Now I feel like an EMDR veteran. I can pinpoint exactly what I need to work on and begin the process of naming the distressing event, so when I get to therapy, we start right there. By the end of an hour session, it’s sorted out and I’m bouncing out the door.

But as we know, trauma is the gift that keeps on giving. Even after 12 years and 150 treatments, every once in a while trauma pops up in my subconscious. It reminds me of how miners used to find a small streak of precious metal and once they start digging what was exposed was hiding a deep cavern underneath.

When I strike gold, it requires more than one session of EMDR, and with therapy lasting an one hour, it can leave me in an uncomfortable place; a lump in my throat, nausea in my stomach and general unease knowing I have unfinished business. I want to delve deeper and at the same time I'm afraid.

But at my next session, I can pickup where I left off.  Maybe it is the moment I first felt responsible for caretaking my sister when I was four years old and saw her being neglected. That's my earliest memory of feeling responsible for others simply because I was more aware of my sisters needs than my mother or father. This has led to a lifetime of feeling responsible for everyone and every environment I find myself in. It’s profound to be able to recall the first moment I came to believe I was responsible for others and how it’s affected my life. What a powerful and amazing gift I have been given with this treatment to heal my soul.

On to Finances….

What Are the Penalties if I Don't Pay Payroll Taxes?


If you have employees, you absolutely must deduct and withhold various taxes from the paychecks of your employees. Since you are deducting money from the employee’s paycheck, you are handling their funds. This fact is very important to the IRS and it places great emphasis on any failure to forward these employment taxes swiftly to the IRS.

If you fail to pay employment taxes, you may be personally subjected to a 100 percent penalty. Yes, 100 percent! Known as the “trust fund recovery penalty”, the penalty is assessed against the person responsible for paying the taxes, not the entity. The person can be the owner, corporate officer, check signer, bookkeeper or other “responsible person.” In short, a business entity is not going to protect you from the wrath of the IRS.

Cash flow crunches are an inevitable event for practically every business. So, what happens if you make a late payment for employment taxes? Unless you can show a reasonable reason for the delay, the IRS is going to penalize you.

Late payment penalties range in amount depending on the delay. If the delay is less than six days, the penalty is two percent. Delay for six to 15 days and you are looking at five percent. More than 15 days in delay is going to push the penalty to 15 percent. If you delay this long, the IRS will be peppering you with penalty notices telling you where you stand.

Whatever you do, please make sure you deposit employment taxes with the IRS in a timely fashion.
If you are employed by a company that advises you to not pay the payroll taxes and you have a position of authority, you could be thrown under the bus later by the entity as the “responsible party”.

And you would be personally liable for the 100% penalty. So this job may not be one you consider keeping if you are privy to theft by the employer keeping payroll taxes to fund the business.

Take a moment to think about the worst thing you have ever heard done by the IRS. If you fail to pay employment taxes, the actions taken by the IRS will be ten times worse and you will be the one telling horror stories.

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



Crisis Text Line helps those in need 24/7


By Rev. Lucretia Howard, Lost Inside Ministry


Crisis Text Line is a free, 24/7 support line. At the time of this writing there were 51,628,392 messages exchanged since August 2013. These facts stated on the website www.crisistextline.org. “Our first priority is helping people move from a hot moment to cool and calm, guiding you to create a plan to stay safe and healthy.”

As a minister and addiction counselor in the South Bronx in NYC, having worked with the hard core employees of the NYC Transit Authority, I thought being a crisis counselor would be a great fit for me.

I thought it would come naturally and be easy. I believed since I was trained as a New Thought minister coming up with responses would flow as smoothly as water over river rocks. I was trained to reframe situations so recipients of my care would always anticipate a positive outcome. I felt confident I had the skills to provide instant solutions. I felt secure after training I would be capable of coming up with high quality, well thought out, sensitive caring answers. I was confident I could help those who text in the midst of a crisis.

What I came to understand was, being a good counselor would only happen if I consistently relied on the combination of leading-edge spectacularly well-planned training and the ability to take feedback from a highly skilled team of coaches and supervisors, as well as the patience — to second guess my initial responses.

Life and Death Situations

What I didn’t realize was how unprepared I would feel when dealing with life and death or self-harm situations. The physical sensations that would arise when I was dealing with children who were being harmed who wouldn’t give you their addresses was not what I planned for.

When I was interacting with live human beings waiting for a solution to be delivered within minutes, I was nervous and unconvinced of my abilities. I came to understand I had to trust God would give me the answers and I had to rely on the fact that this organization had a phenomenal system of training and support. They also provide self-care and debrief after each conversation. I began to see the training provided was first class and the support during the actual work was flawless.

The training to become a counselor consists of 34 hours of free online education provided through reading material, videos, tests and role play, all of which are carefully monitored.

From the outset I was impressed with the high quality training experience. Each counselor is assigned a coach before starting the training.  The coach outlines the processes and answers questions. Once the training begins your coach is always available to provide support via e-mail. Each time you sign on to the platform you are assigned a supervisor who watches everything you write for the first 100 conversations, and can give immediate feedback through chat. It was comforting to know someone was available to answer questions, make recommendations and give feedback. The response is instantaneous when you red flag a text from someone who is at imminent risk.

A vast amount of research has been accumulated to evaluate and quantify statistics, not only on what subjects are referred to the most at any given time, but what words to use that are appropriate and encouraging. I am consistently astonished at how much work is being done to make sure we as counselors know what phrases to use so we are giving non-judgmental, caring and sensitive responses. We are given support while we are working and in weekly e-mails we are directed to the statistics for the week on the most repeated subjects, the most appropriate answers, as well as being given feedback given from the texters for the week.

As a minister, I am always leading people towards answers I believe will result in their highest healing possible.
As a crisis counselor, I am not offering solutions. I am allowing the texters to come up with their own answers so they feel the empowerment of knowing they can help themselves again if in crisis. Most conversations last 20 minutes to 45 minutes at which time we are encouraged to recap the plans we have come up with for staying safe and calm.

Together we have plans to get through the next few hours until they can put in place more structured long term healing modalities. This has been a humbling and powerful experience. I have come to understand that God will give me the words when I am lost and that I can rely on this phenomenal system that has been put in place by the gifted conscientious creators of this platform.

“We want to be where you are. We want to make it as easy as possible for people who are in pain to get help.”— Nancy Lublin, Founder


You can learn more about the Crisis Text Line by visiting https://www.crisistextline.org.

For more on Lucretia Howard visit www.lostinsideministry.com.



The Magic of Being Fully Present

By Dr. Dina Evan

At age 75, every moment spent with my children, grandchildren and great grandchildren is a holy moment, not to be squandered. The other day, while going to the store, my granddaughter was on her cell phone texting. I said, “Sweetie you are important to me and every moment we have together now is precious. Do you think what you are doing now can wait?” She said, “Oh sorry grandma, every moment is really precious to me too, and this is just a stupid habit. Thanks for reminding me.” She put her phone away and we reconnected, creating the kind of conversations and connections we both love.

According to CNN and a 2014 Nielsen survey, the average American spends 11 hours on social media, and more than half of that is spent looking at smartphones or tablets. You can imagine what that figure is today with the addition of “selfies.” Our level of real intimacy has diminished with sexting, texting, porn sites and emails.

Some people keep messages from loved ones who have passed years after they have departed so they can remember the sound of their voice. Doing so may also keep the grieving process going on too long without healing, yet some might say, What better way of using technology? Hmmm...

How about love? It may sound simplistic, but actually, love is the most powerful energy known to man. It circles the earth in less time than sound or light and is considered the strongest healing energy on the planet. It is the only answer to our sense of isolation in the world, a world that is becoming increasingly more separated. Love will endure long after pictures have faded and messages are accidently erased.

Today we have to be careful 

We are all on sensory overload with what is going on in the world, in Washington and in our own homes with stressors of every kind.
It’s easy to want to check out, but the cost of that is devastating. My life is filled with amazing holy moments of connection, as I like to call them. The toughest ones were with my finest teachers, woven into the fabric of my soul. In these moments, I have been both teacher, student, adult, child, healer and healed...and I believe, these precious moments in relationships of every kind, are the real steps to enlightenment. The connections we have that are real, teach us who we are. They show us our need for sameness, our level of empathy, our ability to be present, our willingness to set and respect boundaries, our level of compassion, our willingness to forgive and our commitment to be truthful in all things. These holy moments reflect our character, values and our level of consciousness.

We live in a country that has an aversion to feelings. The amount of pain killers and antidepressants we take would attest to that. Could this need for our electronics simply be yet another way to avoid feeling our feelings? Now don’t get me wrong, I appreciate being able to write columns and share information on my website and Facebook. However, between people who keep their schedules so packed they don’t have time to deeply connect with anyone, and those who always have their noses in a cell phone or computer, I am afraid we are losing the incredible gift of going deeper with each other.

So, here is the point.... 

The next time you are with someone, put your cell phone on silent or put your computer away and get into the magic of being fully present. Think about some questions that you sincerely want an answer for or something you really want the other person to know about you. Ask meaningful questions, give truthful, meaningful answers and be genuinely interested in learning about yourself, your responses and the other person. In 35 years of counseling, I have never lost a client from a feeling. However, I have talked with many people at the end of their lives who felt they did not do what they came here to do which was find out who they were at a core level. Don’t let that be you. Dive back into real. The gifts are immense.

Grateful

By Barbara Nicholson-Brown

Before my recovery began grateful was never a word I used or thought of. My mind-set was ‘victim’; my view of the world was distorted through  my continuous usage of alcohol and drugs. I was a blamer. I blamed everyone and everything for the shame I felt. From feeling shame for being someone who could not handle how much they drank, shame for believing I was not as good as, shame for being who I was. Most of my problems were self-induced and what I asked for. With my focus being on the negative there wasn’t any room the positive. I’ve heard many times, that like attracts like, we are what we think.

Through the years of long term sobriety, while every day is not what I think it should be or how I want it, I feel and experience gratitude on levels I never knew existed before. And I have to remember that my plan is not the grand plan.
It was suggested in early recovery that I write a gratitude list to see if would change my perspective.

It seemed like a daunting task at first, but once the pen hit the paper, the gifts and blessings in my life just flowed.

I still need to write these lists whenever my thinking gets off track. And I can honestly tell you, the longer I am clean and sober the more I need to practice this simple exercise. For when I find myself wrapped in the world between my ears it still can be chaos and confusion. When all the blessings are right in front of my eyes I get grounded and humbled. Fear and Faith don’t mix and neither does Fear and Gratitude. I cant be in both places at once. For some reason, whether it be triggers from the past or fear of the future, when gratitude becomes stronger than any other emotion,  I get to be in the moment. Even for a moment.

During this time of thanksgiving and gratitude, take some “me time”, grab a note pad and jot down all the things you can think of that make you feel grateful.

Wednesday, October 4, 2017

The Power and Promise of Integrated Health Care

Terros Health inspires change for life by combining primary and behavioral health care


By DeEtte Person

Physical and mental health conditions used to be treated in silos. As a result, patients would see a doctor for one condition while another condition may have gone unnoticed. Today, that is beginning to change with organizations like Terros Health adopting behaviorally-led, integrated, whole health/whole person model of care.

The model is exactly what it implies – caring for the body and mind as one

The whole health/whole person model changes the paradigm of care by helping physicians and other clinicians uncover a patient’s source of pain and evaluate alternatives to prescription drugs like cognitive behavioral therapy and mindfulness-based stress reduction. Patients and physicians work in partnership to treat not just a single ailment, but toward overall better health, physically and mentally. If there are signs of mental health issues or addictions of any kind, those can be dealt with in the earliest stages before they take a greater toll on a person’s physical health. 

Behaviorally-led whole health/whole person care 

This was true for Nicole, her husband Martin and their children who receive primary and behavioral health services through Terros Health at 27th Avenue Integrated Care. Nicole, was the first family member to seek out Terros Health to address grief due to the death of her and Martin’s 3-year-old son. The counseling she received helped and she began to go to Terros Health for her primary health care, as well. 
Nicole encouraged Martin to give behaviorally-led integrated care a try. Today, the mental health care Martin receives has helped stabilize his depression and anxiety. He also receives excellent medical care for his diabetes. Their 20-year-old son Eric receives care from Terros Health’s behavioral health professionals. And, both Eric and 16-year-old daughter Mishelle are seeing primary care providers at Terros Health. Their older brother, Quinn, says he plans to reach out for his medical care. 
For Nicole, she values the convenience of having all aspects of the family’s health care managed from a single location, including prescription refills. Without Terros Health and its integrated approach, she feels her family wouldn’t be doing nearly as well. 
This success story is typical when integrated health care is implemented. By treating the whole person and weaving behavioral health into primary health care, even conditions such as diabetes and high blood pressure can have better outcomes. 

Terros Health primary integrated care services include same-day or ongoing medical services including physical exams, chronic disease management, nutritional coaching, immunizations, lab work and prescription pick-up, all in one centralized location.

Treating the mind, as well as the body

The “whole health” approach also provides support for body, mind and soul when there is a mental health issue. Terros Health treatment programs are designed to be culturally-responsive and to coordinate with your overall health care plan. The health care team will support you every step of the way as you make choices — positive changes — that will put you on the path to true health and wellness for life. This includes counseling, treatment groups, crises services, psychiatric evaluations and medication management. 

Karen experienced the whole health approach first-hand. As a child, Karen experienced sexual trauma in her family and again, at 19, when she was in the United States Naval Reserve (Women's Reserve). Since then, she has struggled with nightmares, anxiety and depression. Karen tried to reduce her painful symptoms of post-traumatic stress (PTS) with alcohol, a common way to try coping with PTS.

While working as an early childhood educator in Hong Kong from 2008 through 2012 — in that busy and crowded metropolis – Karen’s PTS symptoms became overwhelming. She was unable to continue working and returned home to Phoenix. But her symptoms didn’t lessen.

A Terros Health crisis counselor recognized Karen had a bi-polar disorder, in addition to the alcohol use and PTS. She was referred to the Terros Health McDowell LADDER (Life-Affirming Dual Diagnosis Education and Recovery) program, located at the McDowell Integrated Care center, which helps people with co-occurring serious mental illness and addiction challenges by providing therapeutic behavioral health treatment and counseling that focuses on symptom reduction and management. Karen credits her progress to the support and education she received that makes it possible to deal with two of her issues at the same time. Today, she’s looking forward to returning to a position in early childhood education or becoming a peer support counselor to help others with similar challenges.

Optimizing health by treating addictions

Part of whole person care is regaining wellness by reducing alcohol, tobacco and other drug use, as well as risky sexual behaviors. Change can come in many forms — embracing new ideas, hobbies and healthy habits. At Terros Health, this involves counseling, detoxification, treatment and recovery support. In addition, one of the keys to success is engaging in life-affirming enrichment programs, such as life skills trainings and arts and cultural activities for youth and adults. 

Robert knows well the success that can come from the support of integrated health care.
Robert stands well over six feet tall, and has the powerful physique of a body builder. Yet, inside his muscular body is a frightened little boy who experienced beatings no child should ever have to endure. When he was four years old his father, an alcoholic, drug user, biker and drug dealer, repeatedly beat him so severely he left permanent scars on Robert’s forehead. When his mother and father split up, things did not get any better for Robert. His mother’s new partner also was an alcoholic, and harshly disciplined Robert for things like not quickly memorizing multiplication tables in first grade. 

In high school, Robert was free to rebel and rebelled badly, skipping school and using alcohol and pot. He dropped out of school and became, by his own definition, a “lazy pothead.” In his early twenties, things got little better for Robert. He got married, had a good job in a mill and limited his drug and alcohol use to weekends. But after four or five years, the marriage broke up because Robert started “using” more than just on weekends. Finally, the law caught up to him and he was sentenced to seven years in prison.

Robert remarried after he got out of prison, but he still needed treatment. He made the decision to become part of Terros Health’s Maverick House. There, he confronted his alcohol and drug addiction. And perhaps most importantly – for the first time – he came to terms with the violence he experienced as a child.

The day Robert graduated from treatment at Maverick House was the day he also decided to keep his recovery going by living at Maverick House Sober Living. At Sober Living, he has a healthy environment of 27 caring men committed to supporting each other and living positive lives without alcohol or drugs. Robert’s wife lives nearby and they have a positive relationship. But, Robert’s home — for now — is Sober Living, because that is where he has the structure and the fellowship of men committed to supporting each other in recovery.

Integrated care can provide key to treating an epidemic

Integrated health care creates healthy communities by providing welcoming “one stop shops” for the needs of a person’s mind and body. In turn, this leads to what is known in health care circles as the Triple Aim – an excellent customer experience, quality care outcomes and controlled health care costs.

A patient’s integrated health care team will include a primary medical care provider and may include mental health care providers, community health workers, a case manager, wellness/prevention coach and counselors. All elements of care are coordinated across the broader health care system including specialty care, hospitals, home health care, community services and other supports. The team works together to anticipate patients’ needs, communicate findings and to ensure no aspect slips through the cracks.

A good example of how integrated health care can heal an individual, family and even community is when it comes to the opioid epidemic. This dangerous class of drugs includes prescription pain relievers such as oxycodone and hydrocodone. You might have been prescribed these after a surgery, even one as minor as wisdom teeth removal. But did you know this same class of drugs also includes heroin? On the street, heroin is cheaper – hence the revival of heroin addiction, overdose and death. 
Opioids are destroying lives in cities and states throughout the nation. Arizona is no exception. Sadly, two people in our state died every day from prescription opioid or heroin overdoses last year. All told, opioid overdoses claimed the lives of 790 Arizonans in 2016 – a 74 percent increase since 2012.

If you or anyone in your family has been prescribed these medications, talk to your physician about precautions to take. Following an integrated health model like that adopted by Terros Health can help doctors identify the signs of drug use and abuse in their early stages – signs such as drowsiness or sedation, slurred speech, uncharacteristic problems with attention and memory and constricted pupils. 

If you would like experience to experience the transformative power of integrated health care, or if you need mental health or addiction care services, please call Terros Health at 602-685-6000. www.terros.org

DeEtte Person is a freelance writer living in Scottsdale, Arizona