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Inspiring Success on the Road to Recovery

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

Recovery Month and Unknown Soldiers

By Tracy Smith

This recovery month was a bit strange for me. You see last year my calendar was full of events and rallies that I often traveled to and attended. This year I took a backseat and instead, in a different role of advocacy, I worked long hours with clients and organizations to place speakers throughout the country to inspire change.

I missed the PRO-ACT walk and the SAMHSA Press Club and Luncheon, and other key events that I would have really liked to attend— but the conversations, emails and voice mails I received reminded me there are all different positions in a marching army of advocacy. I realized from listening to these calls and messages — that the impact of my new role — to sit quietly and put new captains out front — was not only the right strategy — it was exactly as all was meant to be and incredibly satisfying. 

Yes, I realized, I'm exactly where I'm supposed to be.

It also made me reflect and realize advocacy can be done in so many different ways. There are individuals quietly writing letters and making phone calls who you never see on social media but they're out there and they care. There are socially responsible businesses that donate and support important causes and host speakers to educate their audiences. There are individuals writing and developing new training to assist those in recovery. In a remote part of the country, in a quiet community there are meetings around a kitchen table discussing better supports and programs for individuals. There are counselors who go late into the night motivating another on a call they chose to answer. So many quiet foot soldiers we may never ever see or hear are doing amazing work along side loud captains who are very visible.

To our army marching along, loud or quiet, known or unknown — I want to thank you all for your efforts to promote recovery and understanding! Remember, we are all in this together — to inspire change!

Tracy Smith is a Public Speaker. She is the Founder and Owner of a national speaker bureau dedicated to inspiring change. Her agency, Speakers for Change, offers a roster of social responsibility. If you would like to hear more about solutions to the current opioid and prescription drug epidemic from impactful speakers who understand the power of their words and want to inspire change, please contact tracy@speakersforchange.org

Drug-sniffing dog helps families learn if loved ones are using drugs

Amy Halm believes the road to recovery starts with discovery.

Halm is a K-9 handler by trade.

She started Desert Drug Dog roughly 8 years ago in Chandler after adopting a retired narcotics police dog. It’s a unique business that offers sniffing snouts in a private and discrete manner.
"I would love to lose this job because there's no need, but there is a big need," Halm said. 

We put Amy and handler Hannah Arendall to the test.
Cottons balls soaked with the scent of drugs across an 800 square foot apartment were hidden. Amy then took Caela, a Belgian Malinois, across the apartment. In 20 minutes, all three drug scents were found.
“People actually get so creative that they take apart machines," said Arendall.

Halm brings dogs like Caela to homes, shelters, schools and recovery centers.

Both Scottsdale Recovery and Community Bridges utilize Halm’s business. Unfortunately, Halm is also going to homes where the users are often teens.
She had the following advice for parents: "Help them learn coping skills because what I see are people are using drugs because they don't know how else to cope with things in their life."
She also recommended that parents visit online and in-person resources to seek out help. (source ABC 15 Arizona, Chris Gros)

About Desert Drug Dog

A confidential drug detection service working with schools, treatment centers, businesses, and families throughout Arizona.

Their professionally trained teams work with schools, treatment centers, businesses and private parties throughout the state of Arizona, providing you with one more tool in your toolbox to prevent, detect and deter the use and abuse of drugs. 

To learn more about how Desert Drug Dog can support your current efforts to maintain a drug-free environment call 602-908-2042 and visit http://desertdrugdog.com/

Valley Hospital's New Freedom Care Outpatient Program

Freedom Care offers comprehensive, evidence-based treatment for those experiencing substance use, abuse or dependence, depression, military sexual trauma, combat-induced PTSD/trauma, military-related chronic pain or co-occurring mental health and substance abuse disorders.

These programs include PHP and IOP Program for First Responders, Active Duty Service Members, Retirees and Veterans

The PHP is daily, Monday-Friday from 9:00 a.m.-2:00 p.m. and IOP is offered thee days a week from 9:00 a.m. until noon. Additional Adult Programs are available. To learn more call or text Kenny Flack (Freedom Care Community Liaison) at 602-292-6757 for any questions on how to enroll.

Valley Hospital is built on three core principles: outstanding care, compassionate people and unparalleled service. Valley Hospital is located in Phoenix at 3550 E. Pinchot Ave. www.valleyhospital-phoenix.com.

6 Things to Do Before Your Kid Comes Home from Treatment

By Mary Ann Badenoch

The day has finally arrived to welcome your child is back from residential treatment. You may be cautiously optimistic for the homecoming — or worried how it will go. You may not feel ready for your child to come home yet, remembering those feelings of walking on eggshells when they were last home struggling with their addiction. These feelings are completely normal and you may even be experiencing them simultaneously.
You and your child are about to enter a new phase in a long process of recovery. It will involve sacrifice for the family, and it’s best to talk about what this will mean for everyone and plan for it. While you cannot control what will happen (your child is ultimately responsible for their own recovery), you can be proactive and better prepared to be supportive in your child’s recovery.

1. Time for a housecleaning.
Take all substances and paraphernalia out of your home. Secure all alcohol or remove it completely. Lock the medicine cabinet and dispose of any old or unused prescriptions. Search your child’s room for drugs, alcohol and paraphernalia — and then search it again.

2. Naloxone as a prevention measure.
If your child’s substance use included opioids (heroin and pain medications like Vicodin, OxyContin and Percocet), have you obtained a Naloxone kit? Naloxone (brand name Narcan) can reverse an overdose, potentially saving a life. It’s never the wrong choice to be safe. In many states, chain drugstores, as well as some independent drugstores, are providing naloxone through their pharmacies without requiring a prescription. Is the kit easily accessible in your home? Have you learned how to use the Naloxone kit?

3. Make the aftercare plan a priority.
The first step is to fully understand what the treatment facility is recommending for the next steps and clarify anything that is unclear or concerning to you. Hopefully, you and your family were part of developing this “aftercare,” “discharge,” “continuing care” or “stepdown” plan — the plan for those next steps after treatment.
Aftercare plans may include the following:

  • Family counseling
  • An outpatient program
  • Recovery support groups
  • Psychiatric appointments
  • Ongoing psychiatric medications, and/or medication-assisted treatment

Things to consider

Is your child going to need a ride to and from an outpatient program, counseling or support groups? Since this is vital to their recovery, if transportation is needed, make arrangements ahead of time with your employer or hire someone to drive them to appointments, programs or meetings. You may need to make plans to take time off from work to attend family meetings which are a part of your child’s aftercare program. Continued involvement matters.

Your child may need help in finding healthy friends and activities, given many of their friends are likely still using substances.

If your child is living in sober housing, an Intensive Outpatient Program (IOP) or whatever the step down plan is, become familiar with the requirements and rules for this type of living community.

Even though your son or daughter is the one receiving treatment, the rest of the family will greatly benefit from regular counseling and support groups of their own. This can be a difficult time of transition and it’s critical everyone is supported, has help coping and addressing any issues that come up.

4. Try CRAFT skills to improve communications in your family.
Community Reinforcement and Family Training, or CRAFT, is a scientifically proven approach to help parents with skills to stay involved in their child’s recovery in a positive, ongoing way. CRAFT provides families with tools to better understand your child’s reasons for substance use, ways to improve communication and to reward non-using behaviors while discouraging substance use. Equally important are the tools around self-care to handle negative emotions like anger, guilt, depression, and to address feelings of isolation.

5. Develop a contract and recovery plan
You’ll want to establish some boundaries and rules with your child. Some families find it helpful to develop a contract including both positive reinforcement or rewards for good behavior and consequences when they push boundaries or break the rules.
In addition to a contract that simply states what is expected, create a Recovery Plan. A Recovery Plan is for both you and child to put down in writing what you both agree to do (or not do) to help support and maintain continued recovery and personal growth.
Plan to sit down during a calm time soon after they get home to develop a plan as a family. Here are some questions to ask your child as you develop your plan:
How can I be helpful?
What would be stressful or unhelpful for you?
Can we agree on what will be discussed and what won’t?
Can we talk about how we will communicate with each other in both easy and difficult situations?
Would you prefer to keep your treatment and recovery private from others outside our family?
If you are willing to talk about it, with whom and how much information will you provide?

Are there upcoming family gatherings where alcohol will be served that might be too difficult or be triggers? Decide as a family if you will decline an invite or attend with a plan in mind to protect your child’s recovery first. Can you think of fun activities to do together as a family? After all, your son or daughter may need to stay away from the friends they were hanging around before they went to treatment.

6. Take it one day — perhaps one minute — at a time.
The first few weeks and months of recovery will probably be the hardest. Your son or daughter will most likely go through periods of emotional ups and downs. They may be angry at times (at him/herself, at you, at others, or just angry), sad at other times, or even may seem manipulative or distant.

Other times they may be grateful and more like the person you used to know — savor those moments! Be sure to point out any and all positives, and offer hope and compassion. There isn’t a “one size fits all” road map to recovery.

Never give up. There is hope.

Stigma within a Stigma

 By Renee Sieradski, EA

My husband was diagnosed with bipolar disorder after we had been married for 8 years. When I told others I found their reactions unsettling. Most had a deer in headlights look. Why the surprised and embarrassed response?
"The stigma of mental illness" is what I read online.

The dictionary defines stigma as "bad reputation, shameful, mark of disgrace." But I would reason, “My husband became ill, he didn't choose to have the disorder, so I couldn't understand why my friends didn't want me to talk about it. His father and brother had the same diagnosis. It would seem it was in his genes. So why would he be in disgrace?

Soon after his diagnosis, we found that medications weren’t working. The psychiatrists tried every medication on the list. Nothing fixed his suffering. He was given a special term, refractory bipolar, meaning he didn't respond to conventional methods. Then, something I had never heard of was suggested to us- ECT shock treatment

We went ahead with the treatment.  When I told my friends their jaws dropped in horror, with comments such as, "I didn't know they did that anymore". I discovered here was another stigma for receiving this treatment.

Since the initial course of shock treatment in 2010, he has had 4 series of maintenance ECT treatments. As I write this article, he is currently undergoing a series of ECT's. So, I am again reminded of the surprised reactions I received years ago.

We are stigmatized for talking about having mental illnesses and stigmatized for receiving the necessary treatment for these illnesses.

I've decided if someone asks where he is, why he's missing from church or social events, I will simply say he is having therapy to help with depression. Unfortunately saying the words depression or the blues is easier for society to handle.

What exactly does “pennies on the dollar” refer to? 

Pennies on the dollar is a reference to the IRS Offer in Compromise program. It allows eligible tax debtors to pay the IRS an amount of money that is less than what they owe in order to wipe out the entire tax liability.

In advertising, you’ll hear companies talk about settling for 20%, 10%, or even less. These ads, and the sales people you talk to on the phone, are trying to sell you an Offer in Compromise service package. Many of their web sites even have interactive calculators where you type in how much you owe the IRS, and it’ll spit out a, “You may only have to pay $xxx” message.

The phrase “pennies on the dollar” was actually determined several years ago by the IRS to be a form of deceptive advertising. They explicitly instruct licensed practitioners the use of this phrase is a violation of ethics. However, since the IRS doesn’t have jurisdiction over firms market these services, it comes into the FTC’s purview to look out for these deceptive marketing practices.

Sales people are trying to convince taxpayers that what you settle for is some fixed percentage of your tax debt. However, this is blatantly incorrect. There is absolutely no provision in the tax code for allowing a taxpayer to pay a set percentage of their tax liability and calling it good. It has never existed, and most likely never will.

Instead, the amount of your Offer in Compromise settlement is calculated using a very, very strict formula…and the formula is NOT a secret — it’s available on a worksheet in IRS publication 656B.
Based on this formula, if you have equity in assets that exceeds your tax debt, you simply don’t qualify. Period. End of story. For most individuals, the common thing is going to be equity in a homee or rental properties, equity in a collection of classic cars, stamps, coins, guns, art, etc. If the value of ANY of those assets is greater than your tax debt, you do not qualify for the Offer in Compromise program and cannot settle for “pennies on the dollar” – there is no way around this.
In the same vein, if you are a high-income earner, it’s also highly unlikely you will qualify for the Offer in Compromise program. The reason for this is the IRS only allows certain amounts of money every month as “eligible expenses” for housing, cars, food, etc. If your lifestyle exceeds these amounts, the IRS doesn’t care — they will only allow you to claim the National Standard expenses.

Any monthly income over those amounts goes into your offer amount.
In these circumstances, you may qualify for a period of up to 12 months to make a “lifestyle adjustment” and reduce your living expenses to come into line with IRS standards. This will often involve selling luxury homes and getting rid of toys such as cars or boats. Keep in mind these items are all covered by your tax lien, so any proceeds from the sale of these items technically is owned by the IRS, and should be paid to them. A good tax representative, such as a Federally Licensed EA, can assist you with structuring these sales so both you and the IRS get something out of it.

Beware of anybody promising your tax debt can be settled for some fixed percentage of the debt. That’s not the way it works, and it never has. Anybody trying to sell you on that idea is selling you swampland in Florida, and you should seek assistance elsewhere.

Renee Sieradski is a Tax Specialist, for information and to set up a consultation visit www.tax-intervention.com or call 602-687-9768.

Two Days Ago

By Barbara Nicholson-Brown

I was going to begin this piece about the magic of recovery month we celebrated just a few weeks ago. And suddenly life as we knew it drastically changed— again. We learned of the mass shooting in Las Vegas just two days ago.

For all of us it is a most horrific and incomprehensible act. I can’t even imagine how undeniably painful this time is for the victims, their friends and families.

May our prayers and hearts filled with compassion reach each and every one who has been shattered and affected. I am, like all of us, at a loss for words.

Thank You to the first responder's, doctors, nurses, paramedics, concert-goers who helped each other, the unknown heroes who may have saved lives

And it is difficult to seque into another topic, but I will do my best.

Recovery Month

As founder of the Art of Recovery Expo, I want to thank each and every supporter of this year’s event. The recovery community came out strong and proud.

As I look back to 2005, when Bill and I thought a public event was needed, and to see how it has grown, locally and nationally, is powerful.

We have witnessed tremendous growth in awareness and advocacy, reduction in stigma and more people are seeking help.

While looking for addiction treatment might appear easier with the click of a mouse, the Expo continues to be a unique avenue where people can meet the professionals face to face. And that in itself is something that I am proud of. There were many serendipitous moments on September 16th.

A special note of gratitude to our leading sponsors, CBI., Inc., Terros, Calvary Healing Center, Mercy Maricopa Integrated Care, Mercy Care Plan and Holistic Recovery Center.

Our Bronze Sponsors, Decision Point Center, Dr. Phil Path to Recovery, The River Source, Intensive Treatment Systems, Crossroads, Inc., KFNX News Talk Radio, NCADD, PCS- Psychological Counseling Services, Scottsdale Recovery Center and Teen Challenge of Arizona.

And for making this event the success it was, my gratitude to Austin Eubanks, Stephanie Siete, Jim Kreitler, Gary Hees, David Seymour, Angie Geren, Gwen Henderson, SAMSHA and many many more.

My heart is full.

Continue to be safe! Stay on this wonderful road of recovery with us.

Calling All Heroes & Heroines

By Dina Evan, Ph.D

Most of us are holding on by the seat of our pants today, waiting for the next feud, flood or failure of our government to return to compassion and humanity. This is a difficult time, but what do we do besides wait for someone else to fix it?  What if something bigger than that is going on here? What if you knew this time is a reminder the only way things change is through us? What if the whole time we were saying let’s leave it up to God, God was saying, Okay, but how about a little help from you!
I think this is a great time! Because it’s fun or easy? No! But because it is calling each of us to step into our personal hero or heroine and change something. Don’t gasp. You don’t have to start a march or craft an amendment. However, what we each of us has to do is become the hero or heroine we are within.

Jim Weiss reminds us in his 2015 article on the nature of a hero... “Rosa Parks is such a hero. She did not change the laws in the USA, but she began the process one day on a bus ride home. Confronted by the demand to give up her seat-something she knew was wrong — she firmly said, "No." That one syllable, spoken quietly, was more powerful than the angry shouts of today's talk show hosts, more long-lasting than damage done by bombs and bullets, more inspiring than demagogues' easy answers. Rosa Parks was one of us.” She was a heroine!
What are the internal values or principles necessary for the making of a hero? Let’s look.

  • A hero doesn’t finesse the truth for personal protection or political gain. He or she tells the truth exactly as it is.
  • A hero is never silent in the face of abuse or prejudice to anyone. They do not stay silent in the face of oppression of any kind.
  • A hero looks beyond what is, to what can be different.
  • Heroes ask for help and find the strength to overcome challenges and difficult conditions without becoming a victim. They face the smallest and largest of fears with unbridled determination, even while they are afraid.
  • Heroes and heroines make decisions, both small and large that cause us to stand in mute applause and awe, just like Rosa Parks. Those decisions are based solely on what is right and principled, rather than personally advantageous.
  • Heroes use compassion and integrity as the motivation and base for having a positive effect on every personal, professional and political issues.

Heroes and heroines don’t necessarily have great degrees, certificates of accomplishments, hefty stock portfolios or grand achievements. They are everyday people just like you and me. In fact, if you stop a minute, you will be able to identify a regular everyday person in your life who was a hero to you, one who changed your life or ideas dramatically.

For instance, one of my heroines is my spinster (lovingly interpreted to be independent warrior) fourth grade, teacher Ms. Franklin, who wore long skirts and old fashion laced up heels, but who braved the dirt playground to come and ask me — after I had sort of given up — whether even though things were pretty bad at home, “Do you think it could be time to stop acting like you are not smart, because I know better?” Or, my 80 year old, spiritual sister who braved the California Topanga Canyon Mountain Trails with me to teach spiritual truths to people who sometimes came to the door nude. To my amazement she talked a growling, frothing at the mouth dog down one time by reaching in her pocket and offering him the nuts she used to keep her energy up after telling me, “We are all God’s creatures Dina, settle down.”

I am proof, that just one hero or heroine can change a life. This time is not about what other people are doing or not doing or what is God doing for us. It’s about who we are being or not being. Get your cape and the next time you have a chance, be the hero or heroine you already are. Who knows what great things might happen!

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.

Getting Sober

By Alan Cohen

I recently learned of the death of a musician I admire. Ruud was a trombonist in André Rieu’s orchestra. Besides being a talented musician, he was something of a comic spark plug, performing clever antics in skits the orchestra wove into their performances. I enjoyed watching him on YouTube for years. He died suddenly at a relatively young age.

I was surprised at how moved I was at the news of Ruud’s passing. I found the incident sobering. We usually use the word “sober” as the antithesis of being drunk. When an event sobers us, it dashes cold water on our face to extricate us from the drunkenness of the meaningless activities we often engage in. We are awakened from the addictive behaviors we use to distract ourselves from our pain. The list of our addictions, hard and soft, is substantial: Drinking, drugging, email, Internet, smartphone, gaming, anxious eating, overworking, compulsive shopping, disconnected sex, neurotic cleaning, mindless babbling, arguing, continual drama, on and on — all tricks we play on ourselves to stay hypnotized by emptiness. We each have our preferred escape.

Then something happens that forces us to face ourselves and our lives. A death, divorce, accident, business setback, health issue, legal problem, or weather disaster. Some crisis or emergency. Then we have to think about what is really important and what our priorities are. While such challenges are painful, they are also liberating. They jolt us to dig into our soul rather than hang out at the shallow surface of our lives. When we go through such difficulties, we resist and curse them. After we graduate from the lessons they bring us, we find deep gratitude.

None of us knows how long we or our loved ones will be here. It could be a very long time or a short time. Some people disappear quickly, without notice. For that reason we must appreciate the people and gifts in our lives while we have them. Don’t take anyone or any situation for granted. Bless it while you have it. Tell your close ones that you love them. Thank them for the good they bring you. Imagine that you might not see each person after this encounter. What would you say if you knew this would be your last meeting?

Hopefully you will have lots more time with these people. Just don’t wait until they are gone or almost gone to express your heart to them. Likewise, don’t wait until you find your soulmate, lose 20 pounds, get your ideal job, make your first million, or attain nirvana before you appreciate who you are. Now is your big moment to fall in love with yourself. Right where you are. As you are.

In Arthur Miller’s play After the Fall, a character says, “I dreamed I had a child, and even in the dream I saw that it was my life, and it was an idiot, and I ran away. But it always crept into my lap again, clutched at my clothes. Until I thought, if I could kiss it, whatever in it was my own, perhaps I could sleep. And I bent over the broken face, and it was horrible. . .  but I kissed it. I think that one must finally take one's life into one's arms.”

We all have traits in ourselves, our relationships, and our lives that we believe are unlovable. But if we can find beauty and goodness in ourselves and others, even with those traits, we find release that does not come as long as we use judgment to separate ourselves from healing.

We are now heading toward the holiday season, which brings unique joys and challenges. Family issues arise and unhealed relationships get in our face. Perhaps you had a loss or a relationship end during the past year. The season conjures countless distractions—shopping, parties, social obligations, travel, lavish food, financial issues, and many other temptations to stay foggy. Yet we also have many opportunities to get sober, to get clear on our values and the kind of relationships and activities that are truly meaningful to us.

In my town during the holidays the police set up roadblocks to check for drunk drivers. Likewise, it might not be a bad idea for each of us to check in with ourselves occasionally to see if we are staying sober, remembering what is real in the face of illusions to the contrary. A Course in Miracles tells us we have set up the world as a place to hide from ourselves, each other, and love. The Course also tells us we have many invitations each day to cross the border between illusion and truth, connect, and live in ways befitting the noble, magnificent spiritual beings we are.

When André Rieu learned that his beloved trombonist of 22 years had died in the midst of the orchestra’s tour, he cancelled the remainder of the tour—a bold move when many thousands of fans were waiting and millions of dollars were on the table. But André decided it was more important to honor the orchestra’s fallen brother and be there for Ruud’s family. He reminds us that every moment of life is an invitation to get sober.

Alan Cohen is the author of A Course in Miracles Made Easy: Mastering the Journey from Fear to Love.  Join Alan and friends in Hawaii, Feb 26- March 2 for a rare retreat, Unplugged. For more information about this program, books and videos, free daily inspirational quotes, online courses, and weekly radio show, visit www.alancohen.com.

Wednesday, September 6, 2017

From Tragedy to Triumph

Columbine Shooting Survivor shares his journey at Recovery Expo 

Do you remember where you were on April 20, 1999? Art of Recovery Expo, Keynote Speaker, Austin Eubanks personally experienced the mass shooting at Columbine High School that day. He survived his injuries, and among the many lost who their life was his best friend, Cory DePooter. 

After a long and painful struggle with an opiate addiction that began soon after that horrific day, Austin has devoted his career to helping others who have journeyed into addiction by way of trauma. 

Austin will speak on the problems with over-prescribing medication, the importance of the continuum of care, the benefits of treatment and overcoming trauma as it pertains to addiction. 

You won’t want to miss his compelling story from Tragedy to Triumph on Saturday, September 16, 2017 at the Phoenix Convention Center. Austin takes the stage at 1:15 p.m. 

I encourage you to attend this free event with family and friends. Together we inspire success on the road to recovery.— Barbara Nicholson-Brown 

Was your introduction to pain medication a direct result from your injuries sustained that tragic day at Columbine? 

My first experience with them was immediately following Columbine, after being shot. When I left the hospital I was given a 30 day supply of pain medication. At a follow up appointment with my primary care physician, I was given another 30 day supply.  Before those pills ran out — I was already taking them off label, and in the early stages of a decade long addiction. My addiction snuck up on me fairly quickly. Before the shooting, I had never drank a beer, or smoked weed. I didn’t realize I was taking those medications for emotional as well as physical pain. 

While my physical wounds were healing, the emotional ones like survivor’s guilt, remained wide open and raw. Taking pain meds made me feel better, so, I kept taking them. 

At the time I had no clue about how addiction works. I had never been spoken to about it. That’s why I think in the work I do today, education on substances is so important.  Maybe if I had prior knowledge I might have had a different outcome.

Were you worried that you would become addicted?
No, because professionals were prescribing them for my injury, they were intended to make me feel better and they were absolutely working. That was all I knew — feeling better. It wasn’t until years later I started to explore the idea I might be an addict. 
The first time I went into withdrawal I thought I had the flu. I went out of town and simply forgot to bring them. Two days later I was on the bathroom floor in the worst pain of my life. I remember Googling, “what is withdrawal?” That’s how little I knew about what was happening to me. 

That nightmare of a day affected so many young lives, their families, how did your  family cope?
It was incredibly tragic. My best friend Cory was like a brother to me and very close to my family. It was a loss, a very long period of grief and heartache.

What finally led you to seek help for your addiction?
I went to treatment on three different occasions. At first through the urging of my family, and it didn’t stick because I didn’t go for the right reason, I didn’t go for me. 

Each time I entered treatment I learned a little bit more. With relapses, I became tired of the ups and down and realized as my tolerance to drugs increased, my behaviors worsened. If I didn’t change I was going to be dead or in prison. 

When I entered the last treatment center I finally had a willingness. If someone would have told me to stand on my head for six hours a day to stay clean I was willing to do it — anything not go back that life of an addict. 

I was done fighting. I stayed in a continuum of care for 14 consecutive months, consisting of in-patient for seven and transitional living for seven. That long term continuum of care was pivotal for my recovery because of all the stumbling points my first year of sobriety.  Having accountability allowed me to stay sober. When I was back in independent living at a year and a half of sober I was able to respond to triggers in a responsible way and not use any substances.

What signs should parents watch out for that may indicate their children are on drugs?
Extreme changes in a child’s behaviors are a good indicator. I became rebellious, stayed out all night, and did things I would not have normally done. When this happens you should definitely be on alert. My behaviors were like night and day, before and after Columbine. 

What can parents do once they realize there are signs pointing towards addiction?
Like with any other disease, early intervention has the greatest outcome, especially if someone can get an understanding early on. I don’t believe you have to wait until someone is at rock bottom. We can help people earlier than that. The sooner you can intervene and get someone in an educational curriculum the better, often at an out-patient level, this is incredibly important.

Pressure Points – Everyone Has Them

By Samuel Burba, Interim Director of the Governor’s Office of Youth, Faith and Family

Several years ago, I read a statistic that will always stick with me in my profession and as a parent.

Seventy three percent of youth say that school stress is the primary reason they use drugs while only seven percent of parents believe their child would use drugs to cope with stress. The disconnect between parents and youth on this point is sobering. If we as parents can help our children understand healthy levels of stress and healthy coping strategies, we will go a long way in helping them avoid negative and risky behaviors such as the early onset of substance use.

Just like adults, youth face different levels and types of stress at different points in life. For youth, a significant amount of stress may come at high-risk periods in their life. These key risk periods often occur during major transitions which may include moving to a different school, facing new social and academic challenges or changes in a family dynamic. To complicate the issue of stress, our children hear a myriad of ways to self-medicate stress, many of which end up causing more stress.

Underage drinking, marijuana, and prescription drug use are significant issues for Arizona youth and for parents who are struggling to communicate with them about the potential dangers. In fact, the average age youth first try alcohol and drugs is 12 to 13.

Knowing our youth are at a vulnerable point in their life, it’s important for us, as their role models, to help them develop proper coping strategies and keep them from turning to unhealthy coping mechanisms such as substance use.

Here are some simple ways parents can work with their children to develop healthy coping strategies:

Communicate —Youth need ongoing positive communication with their parents or guardians. It is estimated that having ongoing talks with children about drugs and alcohol can reduce the risk of youth drug use by 50 percent. Yet in Arizona, only 51 percent of youth report ever having these conversations. Every talk does not need to be about drugs and other risky behavior, but we want to create a consistent expectation of having open and honest dialogue with our children.

One strategy that helps in setting this expectation is having tech-free time every night. While it may be uncomfortable at first, this intentional time naturally leads to conversation. Consider using conversation starters over a family dinner and ask open-ended questions about each person’s day. If a conversation ever becomes too intense, it is actually healthy to take a break and set a time to come back and finish the conversation after everyone has had time to cool down. By modeling healthy communication, we are teaching our children one of the most important coping strategies and life skills.

Be intentional about spending time with your children — By spending intentional, uninterrupted time, we are communicating we love, care about and want an ongoing relationship with our children. Consider spending 15 minutes a day, an hour a week and one to two uninterrupted days a year with each child. This time spent together helps build a positive relationship between parent and child and allows for trust to be established. Never underestimate how important it is for your child to know you are in their corner and enjoy their company. Parents can find a list of low to no-cost activities to do with their child on OvercomeAwkward.org.

Create time for your child to de-stress and relax — While it is important for youth to be involved in school, extra-curricular activities and spending time socializing, it is equally important for parents to create a safe place and time for children to disconnect. Many children become overloaded with all the activities and social pressure throughout the day. Having a time and place to safely de-stress is critical for youth in a day-and-age when they are always “plugged-in.” Activities can be as simple as journaling, playing music, reading a book, healthy exercise or exploring a new hobby. The key is they can spend intentional time just being themselves.

Establish consistent, obtainable family expectations — It is stressful for anyone, let alone youth, when we do not know what is expected of us. Imagine working in an environment in which you never knew what was expected of you or if you are doing a good job. In a similar way, families need consistent and clearly stated values and expectations. One of the best ways to form this consistent foundation for your family is by developing a family prevention plan.

Consider taking time with the leaders of the household (adults) to clearly articulate and write out the core family values and develop strategies for upholding those values on a consistent basis. The purpose is never to entrap anyone or to make expectations on the family or child that are unobtainable.

Review the plan as a family, listening to each family members thoughts and input. Post or place the plan where everyone can see it to serve as a constant reminder. Remember, a prevention plan is an ongoing, living document for the family, so revisit the plan every six to twelve months to see if it needs to be modified.

You can find a family prevention plan template at OvercomeAwkward.org

Recognize signs of stress — When is the last time you asked your child what stresses them out and actually listened? Youth will tell us what their stress is, but we usually don’t ask them and listen without trying to solve their problems or becoming defensive. The truth is, as parents, our role has never been to eliminate stress from our child’s life. Our role is to understand their stress, intervene in negative behaviors and help them identify healthy coping strategies. With that said, there are times that youth will not be able to healthily cope with stress and we, as parents, will need to intervene. For example, bullying, negative peer influence, risky behaviors, substance use, etc. The more we seek to understand or child’s stress the more equipped we will be to know when it is time to intervene.

Warning signs in kids often look like normal adolescent development: withdrawal from family and friends, drop in grades, pushing against family rules or unwillingness to talk. The sooner you identify signs of stress or other negative behaviors, the sooner you can come alongside and better support your child.

Identify community support systems – The beautiful thing about community is that it means families are never truly alone. It is good for our youth to have monitored and positive relationships with adult role models and mentors such as coaches, school teachers or pastors. Ideally, these people will help reinforce family values and give youth perspective on difficult situations. The more the family can be active in a healthy community, the more our youth are protected and likely to grow into the individuals they want to be rather than having their future radically altered because of a series of negative choices.

Samuel Burba is the Interim Director of the Governor’s Office of Youth, Faith and Family. The Governor’s Office of Youth, Faith and Family aims to create a brighter future for youth and families by providing Arizona with programming, resources, and expertise.

A Glance and a Smile

By Renee Sieradski, EA

As I was mowing the lawn one Sunday morning, a neighbor and her son passed by. The mom was looking at her cell phone and her son was on his tricycle in front of her. As they passed, I glanced at her in hopes of greeting her with a smile. She briefly looked up  and smiled back. In my peripheral view, it occurred to me the little boy was grinning at me from ear to ear, yet I had never met his gaze. I wondered if this was a normal thing we adults do; overlook the little ones. Did this happen to me as a child? I definitely felt unseen as a kid. There wasn’t much of a connection between me and my extended family, and I don’t recall a real conversation with any of them.
So I’ve discovered a way to boost my self-esteem — go on a well-traveled hiking trail and greet and make eye contact with every one on the path. They respond with a friendly hello, and it helps me feel seen. It’s therapeutic and as bonus it’s a positive way to take care of my inner child and body at the same time.

On to Taxes

Many people wonder why they owe taxes. As an employee, the main reason may be you didn't have your paycheck tax withholdings correct.

When starting a new job, we are required to fill out tax paperwork, including a W-4 form to choose dependents. You can claim one dependent exemption for yourself and one for any children. If married, make sure your spouse doesn’t double up on the kids. If you're married with two children, each of you could claim yourself plus one child. The more dependents you claim, the less taxes are taken out of your paycheck, but this may result in owing the IRS at tax time.

Shouldn’t I always get a refund?

The IRS revealed that 80% of tax returns are refunds. If you receive one, you're having more than what you need withheld each paycheck and giving it to the IRS interest-free. There are two schools of thought on this:

If you're not a good saver, then it's not a bad strategy to put away a little extra and get a refund in April and use the IRS as your “piggybank.” When filing your return, you'll get a refund to use for things like paying real estate taxes, going on a vacation, or paying down debt.

If you are a good saver, then you should have a goal of breaking even with taxes at the end of the year. This means claiming the exact number of dependents in your household on your W-4. You will have more money hitting your pocket every paycheck. You could put some of that money into an interest-bearing savings account. At the end of year, you will not get a big refund.

If self-employed; the IRS prefers you pay your tax in the year you earn it, rather than wait until tax returns are due. You can pay online at IRS.gov and use a direct pay feature. IRS prefers payments every quarter on the 15th of April, June, September and January. To calculate yours take last year’s income, divide it by four, and pay in equal amounts each quarter. This saves on interest and penalties.

If you can’t pay quarterly, when you file your return the following April, you'll owe tax plus interest and penalties for not prepaying. Think of it like this: Just as a W-2 wage earner’s boss withholds taxes every paycheck and submits it to the IRS, the IRS wants you as a self-employed person to send in your taxes in real time, while you make the money during that year.

I owe and can’t pay, do I still file?

Many people I have worked with who owed taxes, felt if they did not file their tax return, somehow the IRS wouldn’t come after them to pay.

The truth is — eventually it catches up and you will have to pay. The IRS can collect on your unpaid tax return for up to 10 years after you file. If you don’t file, the 10 years gets extended until you do.

This makes it important to file on time.

You can always work out a payment plan at IRS.gov. Another option is to hire an accountant to do that for you to negotiate a payment plan.

If you always owe the IRS, you can solve this by adjusting your W-2 withholdings, paying in quarterly if self-employed, or filing your taxes timely.

www.tax-intervention.com or call 602-687-9768.

Renee Sieradski | EA, CTR
Renee Sieradski, EA has received extensive training in the field of IRS Representation, with over 18 years of experience as a practicing Tax Professional, and specializing in Multi-State Taxation and the Real Estate Industry. Her expertise is in resolving tax debt, with a focus on 1040 tax liens. She is also a Federally Authorized Enrolled Agent. 

You Break it, You Own It!

By Dr. Dina Evan

Someone once said. "The face of the devil is our own." That is true in this moment. We have tolerated bigotry, dishonesty, racism and prejudice and now it has come home to roost. We are responsible! So, how shall we respond to what we have created?  First, we have to move out of our heads, fear and ego and back into our hearts in order to live the truth we know, no matter what the cost. And, we do know the truth. In the deepest recesses of our hearts we know, that we are complicit, even if it’s because of our apathy. Just breathe. We created this...We can change it.

Nothing is ever created that does not first exist in our own consciousness, good or bad. The era we are in and the principle players are master teachers for us. They are asking us to search our souls and realize we have been asleep. Even in the smallest circle of our personal lives, we have seldom taken responsibility for broken relationships, financial challenges, health issues, lost jobs and almost everything that happens to us daily. We don’t even take responsibility for the good things, we credit those to good luck. I even sat in a New Thought Church recently and had to tape my mouth shut as the minister said things like, if you want something you must ask God for it, God has your answers, everything is God’s will not yours. I nearly wet my pants. I wanted to jump up and say, “Who in the world taught you God’s job is to work for us not through us? Where is our responsibility in creating our reality?”

We have gotten so lazy that we now expect our politicians, our ministers and even God to do it for us. We have abdicated our power as a way to avoid responsibility for our lives. Our power is returned the moment we own that we are a part of God or Spirit in the same way my hand is part of my body. As long as we believe in separation, we don’t have to take responsibility for anything. That’s convenient, albeit a lie. We are responsible for everything in our lives and the moment we accept that realty we wake up and start creating the lives we want. We can feel the joy of being part of a Divine Spirit that empowers us to change the things that need changing, to find the answers that are aligned with love, honesty, truth and compassion and to act in that alignment powerfully.

This is not the time to beat ourselves up, it is not helpful. Once a child understands why he or she should not run in the street there is no need to keep spanking.  Beating ourselves up past the point of understanding is self-abuse. So how do we start to empower ourselves and return to a sense of unity with our spiritual power?

First, we need to learn to greet everything in our lives and every person in our lives as a gift to our spiritual growth. The first question to ask when a horses patoot screws around with your life is, “What am I supposed to learn from this experience?” The first time you have to claim a bankruptcy, lose a dear friend, say something that was hurtful or end up with a government that is dysfunctional is, “What am I supposed to learn from this?”  The minute your relationship hits some stormy patches ask yourself, “What am I supposed to learn from this?” This planet is a grand school in which we can push our souls forward toward enlightenment but we have been skipping classes! It’s clear from everything that is happening today, if we don’t graduate with honors from this school we may not have many more chances. We are creating more of what we don’t want than what we say we do.
Time to wake up.

You have no idea how amazing and loved you are. Nothing you have done in the past changes that. We are all free to be our greatest selves and do what we came here to do to fulfill our purpose. The first step is owning our responsibility, together with owning our power. Go for it. You are safe. The Universe has your back now and always.

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.

Who is Minding Your Meds?

Two-thirds of teens who report abuse of prescription medicine are getting it from friends, family and acquaintances. Make sure the teens in your life don’t have access to your medicine. Follow these three steps to find out how to monitor, secure and properly dispose of unused and expired prescription and over-the-counter cough medicine in your home.

Step 1: Monitor

Parents are in an influential position to immediately help reduce teen access to prescription medicine because medicine is commonly found in the home. But how aware are you of the quantities that are currently in your home? Think about this: Would you know if some of your pills were missing? From this day forward, make sure you can honestly answer yes.

Start by taking note of how many pills are in each of your prescription bottles or pill packets, and keep track of refills. This goes for your own medicine, as well as for your teens and other members of the household. If you find you need to refill your medicine more often than expected, that could indicate a problem.

If your teen has been prescribed a medicine, be sure you control the medicine, and monitor dosages and refills. You need to be especially vigilant with medicines that are known to be addictive and commonly abused by teens, such as opioids, benzodiazepines and stimulants.

Make sure your friends, parents of your teen’s friends, neighbors and relatives — especially grandparents — are also aware of the risks. Encourage them to regularly monitor their own medicines in their own homes.

Step 2: Secure

Approach securing your prescriptions the same way you would other valuables in your home, like jewelry or cash. There’s no shame in helping protect those items, and the same holds true for your medicine.

Take prescription medicine out of the medicine cabinet and secure them in a place only you know about. As mentioned previously, if your teen has been prescribed a medicine, be sure you control the medicine and monitor dosages.

If possible, keep all medicines, both prescription and over-the-counter, in a safe place, such as a locked cabinet your teen cannot access. Spread the word to other households that teens may have access to, and encourage them to secure their prescriptions as well.

Step 3: Dispose

Safely disposing of expired or unused medicine is a critical step in helping to protect your teens, your family and home, and decrease the opportunity for your teens or their friends to abuse your medicine.

Pain Management/ Opioid Use with Veterans and Service Members

Military service brings a risk for serious injury, and with it, the possibility of severe or chronic pain. Such pain may be treated with prescription medication —sometimes opioids, which carry a risk for overuse or misuse. SAMHSA has been working with the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) to enhance informed prescribing practices and prevent misuse that can result in overdose or even death.

Controlling Pain

Injuries incurred during military service can be complex and the management of chronic pain requires attention. According to Friedhelm Sandbrink, M.D., VA’s Acting National Program Director for Pain Management, up to 75 percent of older veterans experience chronic pain.
Prevalence of severe pain is strikingly more common in veterans than in the general population, particularly in younger veterans and in veterans who served during recent conflicts. Complicating matters are co-occurring disorders experienced by veterans, such as posttraumatic stress and traumatic brain injury, for which additional psychotropic medications may be prescribed. Medication interaction is an important consideration.

“The challenge for those prescribing medications in the military and in the VA is to find the right balance to get the pain under control and to keep the patient safe,” said Dr. Sandbrink. “We want to ensure that patients are finding relief and taking medications as prescribed, and that we are aware of other sedating medications or alcohol use that could increase the risk of overdose.”

He added, “in order to find the right balance, we nowadays rely less on medication and make much greater use of other approaches, including behavioral therapies, physical therapy and integrative health modalities, and emphasize physical and mental function.”

Providers outside the military systems and VA are accessed by more than half of those who serve, so they need to be aware of population-specific guidance for veterans and service members. This is particularly true for members of the National Guard and Reserve, whose home communities may not include military supports.

The High Risk Of Relapse 

For individuals in recovery from a substance use disorder who relapse, the risk of overdose is greatest. Tolerance of a drug during sobriety decreases, so if a person resumes at the same dosage as before recovery, that use can be lethal. It is extremely important to educate family members on the possibilities of misuse and how to respond.

The DoD currently has a pilot project called Building Healthy Military Communities that addresses the unique needs of geographically dispersed service members and their families that may affect readiness, resiliency, and wellbeing. SAMHSA supports this work to address the mental health needs of service members and their families in communities throughout the U.S.

Interagency Task Force

The DoD, VA, and HHS participate in the Interagency Task Force on Military and Veterans Mental Health, created in 2013 to ensure veterans, service members, and their families can access the services and supports that they need. SAMHSA represents the U.S. Department of Health and Human Services on this Task Force. Through this partnership, SAMHSA provides a number of resources to DoD and VA providers.

SAMHSA and Veterans Affairs in Action

Dr. Karen Drexler, M.D., the National Mental Health Program Director for Substance Use Disorders in the VA, explained that, “SAMHSA resources and trainings are excellent. We are currently using many SAMHSA resources to educate Veterans, their families and clinicians about the best approaches to care.”

“SAMHSA’s contribution on the Task Force has led to some specific advancements that support military service members, veterans, and their families,” said Cicely Burrows-McElwain, SAMHSA’s Military and Veteran Affairs Liaison. “In addition to reviewing the clinical practice guidelines, SAMHSA also worked with the other agencies to relay and report prescription drug information to Prescription Drug Monitoring Programs which helps to prevent over prescribing and overmedicating.”

The VA also worked to eliminate the co-pay on drugs like naloxone that are used if someone overdoses, making it much more accessible to patients and their families.
Although advancements have been made to better equip treatment providers with information and training to prevent circumstances that could lead to addiction, opioid misuse continues to be a serious public health concern. Providers in the DoD and VA continue their efforts to address pain and limit opioid use, while discussing potential associated risks with military service members, veterans, and their families. SAMHSA’s work with the Task Force, and work done to support states across the country through the SMVF TA Center,  will ensure that the support, resources, and training to improve care and prevent substance use disorders is accessible no matter where military service members and veterans go for care.

Substance Abuse and Mental Health Services Administration | 1-877-SAMHSA-7 (1-877-726-4727) | http://www.samhsa.gov. SAMHSA is a public health agency within the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Resign as Your Own Teacher

While traveling in Europe to attend an André Rieu concert, my laptop wouldn’t boot. If you ever had this happen, you know it can be, well, disconcerting. I Googled computer repair technicians in the small Holland city where I was staying, and found two technicians with good reviews. One of them seemed really attractive, with lots of great comments. I decided he was the guy for me, and phoned him. It was Saturday, and although Google said his shop was open, it wasn’t.

I didn’t have much choice but to phone the second tech, fingers crossed. Harry answered immediately and came to my hotel to pick up the laptop. In a foreign country, I had to really trust to let the machine go. Yet to my happy surprise, Harry returned a few hours later, the hard drive perfectly restored. In spite of my misgivings, he was the perfect guy for the job.

Often what I believe is my true guidance, isn’t. It’s quite humbling not to know it all. A Course in Miracles underscores our inability to make healthy decisions when we depend on our intellect only. A Course Workbook lesson asks us to remember, “I do not perceive my own best interests. The text bluntly advises us, “Resign as your own teacher.” The Course explains, “You cannot be your own guide to miracles because it was you who made them necessary.”

The way we have been taught to make decisions, through intellect and emotion, is ultimately not our answer. If we can’t trust our thoughts and feelings, then, what can we trust? Are we bereft of guidance, impotent to know what is right for us?

To the contrary, we have impeccable guidance. We have an inner teacher to whom we can turn with perfect confidence. Call this teacher Higher Power, Holy Spirit, Divine Guidance, or whatever you like, there is a voice of deep knowing within us that will show us exactly what to do.
We must turn challenging situations over to this Higher Power. Say, “I do not know what to do here. I am not seeing clearly. I now release my attempts to figure this out, and I place this situation in the hands of Greater Wisdom. I ask and trust that right action be revealed to me, and this situation be resolved in the best interests of everyone concerned.”

Now that’s a prayer that will work—if you pray it sincerely.
In the case of my laptop repair, I didn’t see my true guidance because I had made up my mind about how events should go. But when I turned it over and trusted the process, everything worked out perfectly.

The Course advises us to ask at the beginning of each day, “What would You have me do? Where would You have me go? What would You have me say, and to whom?” Instead of depending on ego, the mode from which we usually operate, we are asking for guidance from Spirit.
Many of us make up our mind about an answer before we ask the question. We decide that someone is our soulmate, or a particular job or house should be ours, and then we ask for guidance. Real asking is open-ended. “Send me the right partner, job, or house,” allows that the partner, job, or house may be the one you think it should be, or another. End all prayers with “this or better.”

Einstein explained that you cannot solve a problem with the same mind that created it. The problem is moving you to rise to a higher level of consciousness so you can see the issue from a broader dimension and resolve it from the Big Picture. Don’t be so sure you know what to do. If you think you know what to do, head in that direction. Then watch for signs. Is your solution flowing and attracting people and events that foster resolution? Or are you hitting walls, having conflicts, and getting frustrated? If the latter, try another approach. The walls you are hitting are redirecting you to move in another direction. Great Spirit is very generous with signs as to whether or not we are on the right track. But we must be keen to observe and act on those signs.

The spiritual path is not about gaining sophistication. It is about gaining simplicity. We must become like a little child and be open to be shown. Don Marquis summed it up: “The most pleasant and useful persons are those who leave some of the problems of the universe for God to worry about.”

Alan Cohen is the author of A Course in Miracles Made Easy; mastering the Journey from Fear to Love. Become a certified professional life coach though Alan’s transformational Life Coach Training beginning January 1. For more information about this program, his books and videos, free daily inspirational quotes, online courses, and weekly radio show, visit www.alancohen.com.

Sunday, July 30, 2017

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

By Jim Kreitler, MS

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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

Current Level of Unethical Behavior

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

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

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

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

The Future of Ethics in Addiction Treatment

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

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

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

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

Those questions are:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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