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Inspiring Success on the Road to Recovery

Monday, October 30, 2017

Update on a New Treatment for Major Depression

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

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

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

Symptoms of Major Depression

The symptoms of Major Depression include the following: 

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

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

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

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

STAR D

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

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

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

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

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

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

How Common is Depression?

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

Hope for Healing

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

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

TMS

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

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

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

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

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

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


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

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

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

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

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

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

Interested in learning more?

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

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

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

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

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



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

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

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

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

(Partnership for Drug-Free Kids)

Surviving a Job Loss in Sobriety


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

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

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

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

Facing the Loss

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

Now what

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

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

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

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

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

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

The Word and the Womb

By Alan Cohen

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

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

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

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

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

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

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

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

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

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


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

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

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

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


It Works for Me: EMDR

By Renee Sieradski, EA

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

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

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

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

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

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

On to Finances….

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


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

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

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

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

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

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

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

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



Crisis Text Line helps those in need 24/7


By Rev. Lucretia Howard, Lost Inside Ministry


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

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

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

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

Life and Death Situations

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

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

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

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

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

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

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

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


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

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



The Magic of Being Fully Present

By Dr. Dina Evan

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

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

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

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

Today we have to be careful 

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

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

So, here is the point.... 

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

Grateful

By Barbara Nicholson-Brown

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

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

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

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

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

Wednesday, October 4, 2017

The Power and Promise of Integrated Health Care

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


By DeEtte Person

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

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

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

Behaviorally-led whole health/whole person care 

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

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

Treating the mind, as well as the body

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

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

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

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

Optimizing health by treating addictions

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

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

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

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

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

Integrated care can provide key to treating an epidemic

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

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

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

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

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

DeEtte Person is a freelance writer living in Scottsdale, Arizona

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.