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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.

Hot Topics

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

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

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

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

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

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

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

Think your kid can’t be addicted? Think Again

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

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

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

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

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

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

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

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

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

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

No Quick Fix for the U.S. Opioid Epidemic

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

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

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

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

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

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

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

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

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

Alive in the Midst of Dying

By Dr. Dina Evan

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

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

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

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

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

Gaslighting and Infidelity

When Cheaters Flip the Script

By Robert Weiss LCSW, CSAT-S

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

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

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

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

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

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

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

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

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

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

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

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

Step 10 in Business

By Renee Sieradski

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

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

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

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

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

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

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

Let’s Talk Auto Deduction for Business

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

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

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

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

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

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

The Business of Recovery Treatment

by Barbara Nicholson Brown

For the unsavory, the business of recovery treatment and sober living is just that — business. Yet on the other side of the coin there are so many professionals in this field whose only goal is to help people, not hurt them, heal, not hinder, and why I’m honored to call them my colleagues and friends.

Recovery treatment has a shadow that is being uncovered and why I asked Jim Kreitler, CEO of Calvary Healing Centers to explain this growing problem, and steps being taken to expose those in this field for the wrong reason. People are dying because of it.

In January of this year addiction treatment, Interventionist Heather Hayes told 3TV, ‘patient brokering is equivalent to human trafficking.’

In our November 2016 issue, Interventionist, Carey Davidson’s article, Navigating the Maze of Addiction Treatment said, “If a person who is recommending a treatment center can’t give clear criteria as to why they are recommending a particular center, find out more. Ask if anyone receives any kind of financial compensation or incentives for referrals and/or placement. Just because someone calls themselves a “professional addiction whatever,” does not mean their decisions are not financially incentivized.” (www.togetheraz.com/previous issues November 2016). In short, Beware.
Treatment industry insiders in Phoenix say the city became flooded with body brokering because it’s unregulated and remains legal. State Representative Noel Campbell entered a bill into the state health committee, which would make patient brokering and kick-backs illegal. Without patient care in mind, without the person’s health, well-being, and safety coming first, there is no room for success for anyone seeking help.

Don’t let the unethical practice of patient brokering ruin your view of addiction treatment or rehab facilities. There are hundreds of high quality treatment facilities all around the country, and many recognizable names in our state committed to getting addicts and alcoholics the professional help they need.

I invite you to learn more about Ethics and Treatment in Arizona at the Art of Recovery Expo this September. Jim Kreitler and a panel of professionals will discuss these challenges and more at 10:30 a.m. Bring your questions and become informed with the tools necessary to make the right choice. (see  page 9)

Saturday, July 1, 2017

Healing, Recovery, and Emotional Growth

By Georgia Fourlas, DSW, MSW, LCSW, LISAC, CSAT-S, 
Clinical Director of Workshops, Rio Retreat Center at The Meadows

For those who are looking to overcome negative behaviors, or even simply identify the source of some of their emotional suffering, intensive workshops can be a springboard to recovery and renewal.

Workshops are brief and often intense sessions designed to address an area of concern or personal struggle. They are transformative programs that help individuals identify negative patterns and break the cycle of maladaptive behaviors that may be holding them back. Workshops often last three to five days but can last up to two weeks. 

Workshop participants work on sensitive issues in a concentrated format. This allows them to gain insight into unhealthy, embroiled patterns of behavior, and to practice new relational skills within a safe environment. Workshops are a great option for people who do not need inpatient treatment but want to participate in a program that can bring them more immediate results than they are able to accomplish in weekly individual therapy sessions. 

What Can You Expect? 

Participants can expect to be in programming all day and often continue into the evening with group activities and ancillary services. Workshops typically contain a lot of psycho-education with therapeutic activities designed to break through barriers and strengthen recovery.
Workshop providers often have therapists who are dedicated solely to facilitating workshops. This means the therapists are specifically trained in conducting a particular workshop and have extensive expertise in the subject matter. For example, you will often find specialized trauma therapists, certified sex addiction therapists and licensed marriage and family therapists running workshops related to their areas of expertise. Other providers may have therapists who work in their inpatient treatment center rotate into facilitating workshops occasionally when they are offered. 

In addition, some private practitioners who function as long-term, ongoing therapists may also provide workshops to their clients. These may occur over a weekend or another block of time that the therapist chooses. Workshops provided by a private therapist may or may not occur in a group environment.

Many workshop providers offer on-site accommodations which allow participants to stay cocooned into the treatment process, offering a supportive environment even outside of group sessions. It is possible to stay in your own home for some workshops if you are able to find a provider within driving distance of your home, but this is not ideal. If on-site accommodations are available, participants can maximize their experience by staying on site. 

Intense work is most effective if participants are able to “check out” of the regular daily stresses of everyday life and just focus on the healing. Work duties, family responsibilities, world news events, and technological devices can distract a person from focusing on themselves and their personal healing. 

Who Benefits the Most? 

There are a number of different types of people who can benefit from workshops. Anyone who wants to begin an emotional healing process, take an emotional healing journey already in progress to the next level, or who need a little recovery renewal, could benefit greatly from a workshop. 

Those Who Are Beginning a Healing or Recovery Journey

Some participants may want to start a journey of healing and recovery but need to build a solid foundation first through some intensive, focused work. Others may not have any addictions or mental health conditions, but feel they need some help with a particular issue. People who do not have a history of addictions or other mental health issues still struggle with the same life issues as those who are addicted or mentally ill. They may pursue a workshop to address those needs. 

Maybe it is a mother who cannot stop enabling her addicted child. A child abuse survivor who never really got a chance to address the trauma they experienced. Possibly it is a person who continues to find themselves in destructive and abusive relationships. A student who is gifted and has always had success in high school but finds that in the freedom of college, they get stuck for hours watching online pornography and fail to complete course assignments. It could be someone who just lost their beloved spouse and feels overwhelmed and stuck in grief. Or even someone who just wants to learn more about mindfulness practice. These are only a few examples.

Sometimes participants may have considered inpatient or outpatient treatment and have determined — maybe with the help of their therapist—that they do not qualify for that level of treatment. The therapist may recommend workshops as a viable alternative. 

Those Who Need a Recovery Refresher

Workshops can provide a refresher or a source of renewal for those in recovery or those who have already completed an inpatient treatment program, an intensive outpatient program, or both and are active in a 12 step recovery program. 

People who are already in recovery from substance use disorders or intimacy disorders often find in their recovery process that other issues pop up that need to be addressed. Sometimes we call this “Whack-a-Mole,” referring to the carnival game where the player is challenged to continue to hit “moles” as they pop up out of a game board, with the “moles” popping up faster and faster in an endless cycle that makes it very difficult for the player to keep up — as they hit one down, another pops up. Addiction and other mental health issues can be much like this. 

As an example, a person might stop drinking only to find their online porn use starts taking over more and more time than they used to spend in the bar. Or a person may find some healing with depression only to discover they are having increasing issues within their relationships. Workshops are designed to help these people address arising issues and navigate their way through the obstacles they are facing on their journeys. 

Who Should NOT Attend a Workshop?

Most workshop providers will not accept someone who is in active addiction with drugs or alcohol and may also exclude those active in sexual addictions. Typically, there is a minimum requirement of 30 days of abstinence prior to attending a workshop. Individuals who are a danger to themselves or others are not a good fit until after they are safe. Individuals who are psychiatrically unstable are also not a good fit for workshops. This is not an exhaustive list of who would not be appropriate but this covers the main exclusions. Participants can expect to enter a screening process to determine their eligibility for workshops at the specific facility and for the specific workshop in which they are attempting to enroll. Each facility and each workshop have unique criteria for admission that they will consider. Their intake departments can guide participants and help determine eligibility.

Types of Workshops

There are many different types of workshops available, so people seeking help should have very little difficulty in finding one that suits their own particular needs or issues. 
There are workshops designed to help people to generally break through obstacles with no specific focus on the type of issues to be addressed. There are workshops that are specific to the issue or obstacle that a person may be attempting to overcome. There are workshops that use a specific treatment modality or type of therapy. There are also workshops that are based on a specific popular book or on the work of someone who is highly respected in the addictions or behavioral health field. 

Trauma Workshops

Trauma workshops are very popular and offered by a number of providers. Trauma workshops may address general traumatic events or may specialize in a certain type of trauma. There are workshops geared towards childhood, sexual and military trauma. These workshops are designed to address the residual effects of traumatic events, to reduce reactivity to past trauma, and minimize the strength of triggers from past trauma that can lead people back to addictive or other maladaptive behaviors. 

Rio Retreat at The Meadows has two trauma workshops that were both designed under the guidance of Pia Mellody. They follow the Overview of Developmental Immaturity Model outlined in her book Facing Codependence. These workshops are called the Survivors Workshops and are focus solely on childhood trauma. Survivors I is run every week of the year. It is a vital component of inpatient treatment at The Meadows, and it is also offered for individuals who want to deal with childhood trauma but do not need inpatient treatment. Survivors II is a continuation of Survivors I and can deal with a wider array of traumatic events that range from childhood to adulthood. 

Relationships and Intimacy Workshops

Intimacy disorders represent another topic commonly addressed in workshops. It should be noted that depending on the severity of the intimacy disorder, inpatient treatment is sometimes necessary. However, many people find that a workshop sufficiently addresses their challenging intimacy patterns. Sexual compulsivity, love addiction, partners or sex addicts, and those who consistently find themselves in destructive, abusive or exploitive relationships may find a workshop to fit their needs. 

Intimacy Disorder workshops are designed to help individuals cope with the obsessive and compulsive nature of the sexual or intimate behaviors. Addressing intimacy issues in a workshop can go a long way in reducing shame and empowering people into recovery.

Rio Retreat at The Meadows offers a Men’s Sexual Recovery Workshop and a Women’s Sexual Recovery workshop. Both of these workshops were designed using Dr. Patrick Carnes’ 30 Task model. The workshop for partners of sex addicts, Healing Intimate Treason, is designed by Dr. Claudia Black who frequently stops by the workshop to meet the participants. The Love Addiction/Love Avoidance Workshop is based on Pia Mellody’s book Facing Love Addiction — Pia often drops in to meet the participants of this workshop. 

Grief and Loss

Grief and loss workshops are extremely effective in helping individuals who are grieving, and particularly those people who feel they may be stuck in grief. While it is common to think of death and dying as the reason to come to a grief workshop, there are actually many more reasons people attend. Some people may have lost a marriage, career or their health. It can be a relief to just be in a group with other grieving people who would like to honor their grief while also moving forward in their lives. Healing Heartache is the name of the grief workshop at Rio Retreat Center.

Couples and Family Workshops

Individual work is not the only type of work that can be accomplished in a workshop. Couples and family workshops are also popular. 

Couples workshops can include general couples work or can be specialized for couples who are dealing with specific issues, such as sexual addiction. Couples workshops usually involve more than one couple per workshop. Rio Retreat Center has Couples Bootcamp which is for couples who want to improve communication and renegotiate boundaries with one another. Discovery to Recovery is a series of couples’ workshops that help promote recovery for couples who have had issues with sex addiction that have impacted their partnership. 

Family workshops are a bit different since they are often limited to one family and can be customized to the specific needs of that family. Family workshops are great for families that have difficulty getting everyone to commit to long-term therapy or for families that live in different geographical locations. Family Matters is a customized workshop for families that want to heal from any number of issues.

Specialty Workshops

Specialty workshops include specific therapeutic modalities or the work of specific experts in the field. Rio Retreat Center offers a mindfulness workshop and an equine therapy workshop. Many other facilities offer divorce workshops, workshops that address money and work disorders, eating disorder workshops, workshops based on the work of Brené Brown and more. All it takes is a simple Google search to find a workshop that might fit whatever issue you need to address.

Why Should You Attend a Workshop? 

Workshops are known for giving people “more bang for their buck.” They can offer a cost effective way to address a wide variety or people with a wide array of presenting issues. The ability to delve deeply into sensitive issues while having the safe container of the workshop structure and support of the group environment enable participants to get to a level of healing beyond what they thought could ever be possible in such a short time period. Participants are frequently amazed at how much progress and relief they were able to experience in only a few days. 

Workshops cannot replace the value of long-term, on-going therapy; but, they can enhance an individual’s ability to clear an obstacle they may be encountering in their on-going work or build a stronger foundation in recovery as they delve deeper into the roots of the problems that fed their addictions or other mental health issues. Therapists who send their clients to workshops often report that the clients come back to them with resolutions to issues that have been long-term struggles and with a renewed commitment to healing.

Workshop participants often describe their workshop experience as “life-changing,”“life-altering,” and “transformative.” Recovery beyond their wildest dreams is how some people have described the relief they have gotten from workshop participation. Groups are large enough for participants to benefit from the energy of the shared experience with others and small enough to allow for personal and intimate sharing and support. Participants are able to achieve a higher level of emotional health and are able to make substantial progress on their healing journeys.

The common goal of most workshops is to help people improve their emotional health. Individuals who are emotionally healthy are able to regulate and manage their own emotions and behaviors. They are able to manage life’s challenges, build strong relationships, and recover from setbacks. Workshops are designed to provide participants with the tools they need to participate in life to the fullest extent possible through productive and meaningful interactions with others. Workshops can help you find the path to emotional health. Even with the help of workshops, life is never going to be perfect, but it can be more manageable, breathtakingly beautiful, and profoundly joyful. 

Dr. Georgia Fourlas is the Clinical Director of Workshops at Rio Retreat Center at The Meadows. Dr. Fourlas has been working in the field of behavioral health for more than 20 years. Dr. Fourlas has extensive experience working as a crisis counselor, a trauma therapist, and as addictions therapist. More than ten years of her experience has been working with patients in an inpatient setting with both state funded and privately funded agencies and patient populations. Learn more about the workshops offered at Rio Retreat Center at The Meadows by visiting www.rioretreatcenter.com/ 

Arizona’s Opioid Epidemic

Q & A with Dr. Shapiro & Dr. Jackson of Sierra Tucson

Teresa Jackson, MD, is the Director of the Addictions / Co-occurring Disorders Program at Sierra Tucson. Dr. Jackson is board certified in Addiction Medicine.

Dr. Shapiro is board certified by both the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a member of the American Society of Addiction Medicine and the California Society of Addiction Medicine.

If you or someone you know needs help contact Sierra Tucson (855) 693-7208 and visit http://www.sierratucson.com 

Q: Governor Doug Ducey declared a state of emergency regarding the opioid epidemic in our state; what are your thoughts?
Dr. Jackson: The Center for Disease Control and the Surgeon General’s report on addiction have both declared an opioid epidemic in the United States. Recently, opioid overdose statistics for 2016 were released. 59,000 American died from a drug overdose in 2016. Drug overdose is now the leading cause of death for people under the age of 50. 
Allocating funds in the state of Arizona is progress in the right direction.

Q: Why do you think opiates are so prevalent in Arizona?
Dr. Shapiro: Prescription medication misuse is a nationwide problem and Arizona is not an exception.

Q: What factors have contributed to the severity of the current prescription drug abuse problem? 
Dr. Shapiro: Beginning in the 1990’s, there occurred significant societal and political pressure on the medical community to treat pain as the so-called “5th vital sign” (in addition to pulse, blood pressure, respiratory rate, and temperature). There was a perception in the community that medical providers were not doing enough to address patient complaints of pain. 

Opioid analgesics have long been used as ineffective and appropriate treatment for acute pain, but have generally been shown to be less effective for chronic pain syndromes and possibly more dangerous. The pendulum is now swinging back in the other direction, given the current opioid misuse epidemic. I believe that other factors include increased advertising by pharmaceutical manufacturers including television ads for prescription medications, and the ready availability on the internet of medical information that makes the public feel more enlightened, but is often incomplete and frequently read out of context.

Q: Education is a critical component to curb the abuse of prescription medications; do you think most doctors are now more aware of what they are prescribing? 
Dr. Jackson: The tides are turning. Medical students and residents now learn improved opiate prescribing and the risk of opiate addiction. The DEA and Arizona Medical Board require education on opiate prescribing as well. Arizona Board of Pharmacy has a monitoring program that physician can use to monitor both patients’ opioid prescriptions and their own prescribing trends. 
More physicians are learning about addiction and learning to screen for signs and symptoms of addiction. 

Q: What are some other options for pain management other than prescribed drugs? 
Dr. Shapiro: That depends on the type of pain, but in general the following: physical therapy, chiropractic, bio neuro feedback, acupuncture, acupressure, deep tissue massage, craniosacral therapy, transcutaneous electrical nerve stimulation techniques, radiofrequency nerve ablation, naturopathic remedies (holistic approach). All the above techniques represent management of pain, and not necessarily elimination or even reduction of pain, and patient's need to understand these differences and the limits of our current state of the art for pain management; and this requires patient education.

Q: As parents, neighbors, community members, what can we do collectively to bring more education and awareness to this crisis? 
Dr. Jackson: 1. Remove all controlled prescription medication from the home when not using 2. Keep controlled medication locked 3. Don’t be afraid to start asking about drug use early (age 10 to 12) 4. Intervene early when children have behavioral changes 5. Confirm, but verify with a drug screen 6. Involved physician, school counselors, and church. 

Q: What if any responsibility should the pharmaceutical companies take on this crisis? 
Dr. Shapiro: Significant responsibility, but not all. The pharmaceutical industry responds to the demand from society, but I also believe that it is the FDA’s responsibility to provide some check on the pharmaceutical industry, and that has sometimes been lacking when it comes to the proliferation of more and more formulations of opioid analgesics.

Q: What age group do you see as the most vulnerable? 
Dr. Shapiro: All age groups are vulnerable and we are seeing the epidemic of the opioid use disorder cross all demographic boundaries, not just age boundaries but traditional socioeconomic lines. In my opinion, the younger age groups, teens and adolescents, are at more risk because, in general, younger patients have less developed coping skills to avoid the pitfalls and temptation of using substances to address situational stressors and peer group pressures.

Dr. Jackson: Junior high and high school age children most commonly begin using opiates from family members or friends. The first exposure is normally an opiate pill from a friend or family member’s medicine cabinet. 

the R word

by Dr. Dina Evan

What’s the world coming to? It seems no one is willing to take personal responsibility for any decisions about anything, especially in Washington. However, that’s not the only place. We see this in families when couples blame each other, when kids argue and blame each other  and in business when medicines, toys, cars or any other product fails or is faulty.
Somehow, we got the message that taking responsibility is a bad thing, it makes us feel like a failure.

Actually, just the opposite is true. Taking responsibility for our actions is a sign of integrity, strength and courage. It makes you self-aware and honorable in a healthy way, both of which may seem unfamiliar and new to you. Careful though, one pitfall to avoid is that of beating yourself up for making human mistakes — because that is self-abuse. The truth is that people who either never make mistakes, or never admit to them, are standing still in their own ego.

Making mistakes is part of life

Finding out what doesn’t work is required for creating what does. Leave the past in the past and don’t drag it into your now. It’s not helpful or relevant.
A major part of being responsible is also about setting heathy boundaries. In the beginning of your process, you may have a tendency to take too much responsibility for what others think, what they may be feeling or how they react. You are not responsible for anyone else’s feelings or responses. You are only responsible for your own.

When you take responsibility, everyone wins because your relationships are more honest and authentic. Unfortunately, you can’t avoid the reality that others may feel pain simply because you choose to be who you are.

An example may be that you are dead tired and your best friend needs you to sit up all night commiserating over her broken relationship. If you say you take responsibility and say you are exhausted and need to be with your family that night, she is going to feel pain and it is not your job to fix that.

What you can do is set a time that is better for both of you during which you can give her what she needs. If you treat yourself as if your needs are important, worthy of being respected, most people will respect that as well and if they can’t...it’s not about you and it’s not your problem.

We all come here with only one assignment and that is to be fully who we are. We can get side tracked or delayed, but, sooner or later, we have to get back to this one basic assignment. It is that of taking full responsibility for every action, every word we speak and everything that happens in our life. That is what being fully empowered means. Here’s a little something you can hang on your wall in case you need a reminder about what your responsibilities are or are not supposed to be.
It is never your responsibility to: 

  • Give what you don’t want to give, for that is a violation of your own boundaries 
  • Sacrifice your integrity to anyone for that grieves your spirit 
  • Drain your strength for others because that discounts your own needs
  •  Listen to unwise counsel for that ignores your inner wisdom 
  • Maintain an unfair relationship because that devalues your worth.
  • Be anyone other than who you are because that robs the world of your unique gift 
  •  Conform to unreasonable demands for that creates resentment 
  •  Be 100% perfect because we are all still works in process 
  • Follow the crowd because there is no value in sameness 
  • Please unpleasant people because that is self-induced abuse 
  • Bear the burden of an other’s misbehavior because accepting consequences are a precious part of each person’s own path 
  • Feel guilty for your own inner desires for those are Divinely inspired
  • Endure your own negative thoughts because that is a refusal to heal
  •  Meekly let life pass you by for that is a waste of your choice to be born.

Missing Money

By By Renee Sieradski, EA

As I write this column, I am struggling with a depressive episode. My SSRI that has worked for over four years at the same dose, has slowly stopped working over the last two months. After bargaining for a few weeks with the reality of the situation and getting some feedback from my husband, we decided I most likely need an increase in my dosage. He did some research online and found the average dose is 40mg per day. I’m on 20 mg, therefore, I’m headed to the doctor’s office and will most likely bump up to 30 mg.

I’ve been down this road before so I know once I start the higher dose, it will take about two weeks before I feel better. Waiting isn’t fun when you don’t feel well. But on the other hand, two weeks isn’t a long time considering it took me 10 years to find this particular medication that lifted my depression.

I also have some random musings rattling around in my brain such as, “Doesn’t it seem strange to have a depressive episode in summer?” Of course, I know Serotonin is not solely produced by the sun’s vitamin D. Also, “If I gained 40 pounds when I went on 20 milligrams, will I gain 20 more pounds if I increase to 30 mg’s?” (as an accountant, I have to break everything down by the math.)

Not Internalizing Other People’s Reactions

When we become self-aware and begin to have self-love, only then can we extend it to others. If we are talking to someone and they become defensive, we've hit a shame button. This would be a shift from internalizing their defensiveness and feel shame ourselves asking ourselves “What did I do wrong to deserve that reaction?”

This takes time and a lot of failed attempts. I can attest to this being a continual work in progress. But it's easier if we can take a step back and realize this person has their own shame and their reaction of defense may have absolutely nothing to do with us.

They could be experiencing shame over fear, anger over shame, or insecurity. It’s an invisible button inside another. It helps us not take a swan-dive into chaos, responsibility for another person’s reaction. We’re okay and hopefully someday they will experience their own self-awareness.

On to Finances

One exciting thing I like to share with my clients is a website maintained by the NAUPA (National Association of Unclaimed Property Administrators). They keep a record of funds the government is holding in trust until owners are located. It's surprising how many people, due to moving have missing money owed to them because a check didn't get forwarded.

I encourage you to check it out at www.missingmoney.com. You'll put in your first and last name, and the state you're living in (if you've moved leave this one blank and do a national search). If you have missing money, it will show up and tell you which government agency is holding the funds.

Usually, it's the unclaimed funds department of the state that you lived in when the funds were mailed to you and returned to the sender. If you find missing money for your friends, you'll be their hero. If you find missing money for yourself, it's pretty exciting. The search will inform you if the value is under $100 because then it might not be worth your time to fill out the paperwork or go down to the state office to claim less than $100.

If the site does return a search stating you have unclaimed funds, it won't tell you the dollar amount but will tell you if it's less than $100. You can assume if it doesn't say "less than $100", then it's over. Last year, I received $500 from finding my husband’s name on www.missingmoney.com. It was from a car accident in 2005 where we had to pre-pay our insurance deductible for the car repairs to the auto-body shop and then after the case was settled, the insurance company reimbursed us.  We forgot about the expected reimbursement, moved in 2005, and it was returned to the unclaimed funds department where it stayed for 11 years until I discovered it on missingmoney.com.

My husband and I printed out the Arizona Unclaimed Funds form, filled it out, and had his signature notarized. We took it downtown to the Arizona Department of Revenue and after about 10 minutes, we had a check in our hands for $500. Not bad at all!


The Thrill of Victory

By Coach Carl Hargrave

"Integrity and character are the cornerstone to our success. This opens the door to meet our objective, to build an excitement and understanding about living and growing in sobriety. Here we experience the joy and confidence that comes as we unearth and demonstrate those positive character traits that so easily escaped us."

It is a pleasure to have the opportunity to impart into the minds and hearts of the many who are mired in the agony of addiction, that they know Victory is imminent when "Recovery" becomes a intricate part of who we are.

I liken it to the playing field. Having been a significant participant in guiding and mentoring numerous individuals on the football field, I now coach people in the game of life. When I say "Life" that’s exactly what I mean.

The fight or game of addiction is about life. We must be cognizant in the reality of winning this game. It's for keeps, the stakes are high, and we must play to win and understand with addiction — looms death.

To insure we align ourselves with the quest of the end goal, I present the "X & O's of Sobriety," the playbook of champions. Here we will bring to life the game plan in attacking the opponent.
You will see the importance of a positive attitude as step one, gaining and launching an assault against the strong but not so worthy opponents drugs and alcohol ravaging our society.

We must understand we are digging out of a situation that calls for intention and singleness of purpose, and it is imperative we identify our expectations and commitment. What are our expectations and what is the commitment to meet them? What do you want to achieve, and what are you willing to do to achieve your goal? This must be defined prior to kick off.

Point of Launch

 Commitment is the stuff character is made of; the power to change the face of things. We must be committed to the process. Challenges are only challenges until you accept them, once you do they become opportunities. We have a great opportunity to change our lives forever, a day at a time.
Integrity and character are the cornerstone to our success. This opens the door to meet our objective, to build an excitement and understanding about living and growing in sobriety. Here we experience the joy and confidence that comes as we unearth and demonstrate those positive character traits that so easily escaped us. What I have found in the initial preparation phase, is the importance of encouragement, be it from family or friends. Encouragement is a key element to our success in the game.

The Winning Game Plan

From a football analogy, taking a radical approach gives us the best chance of beating our opponent. Launching an offensive assault coupled with a staunch defensive front becomes the task at hand as we set our goals on both sides.

In the Pass (I will pass up that drink or drug) 
Top 3 in the Rush ( a. I will do it now. b.Take the action immediately. c. Rush to get it accomplished.) 

The Rush (I don't need the rush, avoiding the triggers, great avoidance technique)
TOP 3 vs. PASS (a. Don't Pass It To Me, (b. I will break up the pass, c. I will sack the QB. "the dealer" 
# 1 in Turnovers ( I turn it over to my Higher Power) 

The offensive philosophy is one of "Attack, Attack, Attack, wanting to strike fast and often. We want to take the game to the opponent. Take the initiative (show up) I can't stress enough the importance to GET UP and GET GOING. Don't lay around feeling sorry for oneself, and expect anything to change.

The champion dictates the game. It is imperative we keep the opponent off balance. Remember  "Enthusiasm " is contagious. Talk about it; (Share your story) Be about it; (Service) this allows you to be unselfish.

I encourage you to put your huddle together and surround yourself with those you trust. The Huddle is the most sacred place on the field, where you can gain the support of those who love you. Your Huddle may consist of family, friends, and sponsor,and therapists. They are in the game with you, inherently committed as you are, if not kick them out of your circle.

The defensive philosophy must be one of tenacity as you SWARM the opponent. Gang tackle the disease: (attend meetings, there is power in numbers.) Force turnovers: (turn it over to your higher power, work the steps) Dictate the game: (be large and in charge of your mind. Call your sponsor).

The Recovery community will overtake the addiction community as we become less anonymous, less frightful and less self consumed. We will one day see more people in active recovery than active addiction. Stand strong! It truly takes more than a village, it takes a society.

Coach Carl and Fit Four Recovery will be presenting at the 12th Art of Recovery Expo on Saturday, September 16, Phoenix Convention Center, Hall F. artofrecoveryexpo.com

Living with/out Fear: The Power of Being a Rational Optimist

By Jason Powers M.D. 

Much has been written on the subject of fear and how it impedes success. Go to the self-help section of any bookstore and you’ll find thousands of pages dedicated to the idea that if you “throw your fears aside you will shine like a burning star and achieve your goals.” According to popular literature, fear tells us “wait a minute you can’t do that, it’s never been done” or “you’re not good enough” or “you don’t have the resources” or “now is not the time.” 

Author Samuel Johnson said, “Nothing will ever be attempted if all possible objections must first be overcome.” Fear will drown your passion and halt your momentum before any dream has a chance to become reality.  

Even love is letting go of fear (there’s a book by that title). You can achieve power, success, a financial windfall and love if you just put fear aside — at least that's what you'll find in the self-help section and in blogs — but here is a little different view on fear and passion and life.

Living a Passionate Life, Devoid of Fear

Truth be told, I started out intending to write a similar blog post. I interviewed CEOs and COOs, executive vice presidents, regional vice presidents and professional athletes. I talked with two clients I coach on personal development, a practice that focuses largely on escaping the clutches of fear and entering “the zone,” where one can achieve optimal performance. I also interviewed a close friend who to me is an exemplar of living a passionate life, seemingly devoid of fear.

When I was younger, I was fortunate enough to be part of a tightly knit group of best friends. There were five of us and we would dream about what our futures would be like. All but one of us wanted to change the world in our own way, to make it better than the way we found it, to help people and not least of all to be wealthy and successful professionally. But my friend Stan didn't participate in that type of future planning. He said he hoped he had a modest house and had “enough,” and we would laugh at him. 

So I asked Stan recently what he is passionate about and how he handles fear and stress. Although he appears to be devoid of the types of fear-induced neuroses, let's call them, that afflict so many of us, he says he does feel stress related to the things that are important to him. It’s just that his passion isn’t about attaining great wealth and prestige and the accoutrements of success. To him, achievement is measured differently. “I don’t want to be successful the way other people are professionally and I am not jealous of them in any way,” he tells me. “I worry about the people I love being healthy and happy.”

That is his passion — achieving happiness, not striving for the next promotion, because that just brings with it the stress of climbing up the next rung on the ladder, or the fear of falling off, because the higher you climb the more painful the tumble.
I asked, so what exactly do you do with fear — do you just push it aside? “Absolutely not,” he replied. “I put everything in a box and I look at it. I can’t push it aside or it’s going to take on a life of its own. I decide I'm going to do something about it rather than give it more energy than I’m giving myself.” 

In short, what he talked about was not an unrealistic and overwhelming delusion about the harsh realities in the world, but rather a realistic, rational optimism. 

Mindless Optimism vs. Rational Optimism

On the flip side of rational optimism is irrational or mindless optimism. Irrational optimists see the world through rose-tinted glasses, believing that negative experiences are what happen to other people. For example, research has shown that people are irrationally optimistic about an array of health concerns. Smokers underestimate their risk of developing lung cancer compared to other smokers and even nonsmokers. Most of us believe we are less likely than other people to have a heart attack or be involved in a car accident. Such irrational optimism, or what psychologists call the “optimism bias,” can also be found in the problem gambler who is irrationally optimistic about winning. 

Buoyed by mindless optimism, the smoker forgoes medical research and never tries to quit. The career-changer gets his real estate license at the top of the bubble (home prices will never fall!) without doing his homework on market indicators. These people hope for the best and close their eyes to potential threats. And therein lies the danger. Just believing things will get better will not cause them to get better and can prevent us from taking preventive action that might curb the inherent risks. 

Martin Seligman, one of the foremost experts on optimism and the father of positive psychology, implores the need for optimism to be checked by reality testing in these words: “What we want is not blind optimism but flexible optimism — optimism with its eyes open. We must be able to use pessimism’s keen sense of reality when we need it, but without having to dwell in its dark shadows. 

Flexible optimism accounts for risk, rather than a Pollyannaish belief that everything will turn out just fine.”

Becoming a Rational Optimist

Being realistic and at the same time positive helps us move forward. We shouldn’t worry about or fear the future, but rather have a plan to deal with things should they not turn out like we hope. And if Plan A doesn’t work, we’ll have Plan B and Plan C at the ready. 
In short, rather than being paralyzed by fear or, on the other end of the spectrum, unwisely pushing  forward while ignoring danger signs, channel my friend Stan, the rational optimist. Combine a positive attitude with an honest appraisal of risk. Don’t simply put fear aside. Look at it, consider its validity, then put it in a box. Think of two or three actions you can take to make things better. Plans A, B and C. In the words of William Arthur Ward: “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.”

I think Stan is dealing with fear optimally, the way we all should no matter what we are striving to achieve. I also believe that Stan stresses about the right things. Health and happiness are what he is passionate about and what he’s focusing on.
And, by the way, others might come to the same conclusion that Stan reached at such an early age about what to concern ourselves with if they knew what Aristotle said about happiness — that it is an end in itself, that all virtue and action aim to happiness: 

“Honor, pleasure, reason, and all other virtues, though chosen partly for themselves are chosen for the sake of the happiness that they will bring us. Happiness, on the other hand, is never chosen for the sake of these, nor indeed as a means to anything else at all.”

Jason Powers, MD, is chief medical officer at Promises Austin drug rehab and The Right Step recovery programs in Texas. He is the pioneer of Positive Recovery, an approach to addiction treatment that helps people discover meaning and purpose in recovery.

Claim Your Inheritance

by Alan Cohen

When my coaching client Lana was a small baby, her parents divorced and she never saw her father again. For much of her life, she felt sad because she was fatherless. As an adult, Lana became a life coach and wanted to set up a studio and business, but she did not have the funds. Then she received a surprise letter informing her that her father had died and left her a substantial inheritance—enough to start her coaching business and a lot more.

Like Lana, you may feel fatherless—not so much for a physical father, but for a source of support, abundance, and well-being to live the life you would choose. You may feel in some way deprived or outside the circle of enoughness. Meanwhile the universe has ingenious ways and means to take care of you.    

The spiritual teacher Bashar defines abundance as “the ability to do what you need to do when you need to do it.”

This definition says nothing about a particular amount of money in your bank account or a specified way your support should come. There are an infinite number of ways you can be taken care of.

Money is just one of them.

I sat on an airplane next to a woman who told me that she and her husband wanted to live amidst lush nature on the island of Kauai, but the couple did not have money to make such a purchase. Then they met someone from a family that had just inherited an 1,100-acre estate in one of the most beautiful areas of that island. The family lived far away and needed caretakers for the estate. They didn’t have to ask this woman twice. Now she and her husband live there full time, enjoy all the amenities as if they owned the property, and the owners hardly ever visit. This entire transaction occurred without the couple having to pay even a penny.

Don’t get stuck on how your supply should show up. You may have your idea that it should come through a particular person, job, sale, or investment, but it could come in any one of a thousand ways. The universe is clever and creative when it comes to manifestation. Affirm, “I am open and willing to have the universe support me in the easiest and most efficient way possible,” and you will set in motion the positive dynamics necessary to work on your behalf.

In my book Handle with Prayer, I designate several different identities or positions from which most people pray.

One is that of a beggar, in which you see yourself as unworthy and outside the kingdom and you must scratch and plead to get your prayers answered. The next identity is the servant, in which you see yourself as a worker on God’s payroll and you live in the kingdom because you have a job at which you are earning your good. The next level is that of Child of God, meaning that you deserve the kingdom not because of anything you have done, but simply because you are heir to the estate established by your infinitely wealthy Source. While all the positions of prayer work if you are sincere, the identity in which you deserve the kingdom by virtue of who you are is the closest to the truth and the most rewarding to exercise.    

Someone gave me a pamphlet titled, Are You Letting Life Love You?

That pamphlet sat on my coffee table for years, and every time I looked at the title I had to do an honest introspection. We spend lots of time trying to make life love us, through people and things and events, but less time noticing how life is already loving us. You have been taken care of very nicely thus far.

The hand of Grace that has provided for your needs will not stop now. The ego wants us to believe that the current challenge is an exception to the presence of love, but it is not. The universe has not let you down so far, and it will not let you down now or ever. You are valuable and you are loved. This is God’s vision of you, calling for you to join it.  

You are not fatherless, abandoned, or unsupported. Those thoughts are tricks of the mind fooled by current appearances. But appearances cannot override the truth that you have an infinite, eternal, loving Source that will give you exactly what you need when you need it. If you discovered that you have a winning lottery ticket, all you need to do is go to the lottery office, show your ticket, and claim your winnings. You don’t have to beg, plead, argue, explain, or convince the bank of good to give you what you deserve. The number you are holding gives you all the entrée you need.

You were born with the winning ticket; everyone was.

But only a few are willing to show it with confidence. Ask and it is given, but claim and it is done.  

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.