Are You Stuck With No Way Out?

What is it that is holding you back from being happy? What do you feel is the road block in your life that "if only" that particular thing was different then you could be happy? Have you ever consider that the real reason you remain stuck in this imagined hell isn't because of the outside circumstances but it's because of you?

 Oh I know, admitting that it's you is a hard pill to swallow and there are things that happen in our lives that basically suck, big time! But...it's up to you as to whether or not you rise above it or if you choose to let it consume you and suffer. It's called, resistance.

 Resisting "what is" is the quickest way to make yourself miserable. You wallow, worry, whine, wish things were different 24/7, and you waste your life away doing this. Ask yourself, "What is it that I can change about this situation?" And then take the steps to change it instead of crying about it.

 Sometimes you can't change anything about whatever it is your dealing with because you have no control over the situation or the other person who is inflicting this discomfort or pain in your life. In which case the only thing you can change is your attitude towards it. You can change how you view it, how you are going to approach it and how much time you give to dwelling on it negatively.

 There is a way out of this mental torture chamber that you've chosen to imprison yourself in and that is through how you choose to perceive it. You do this through your mind. You have the God given ability to choose what you think and no one can think for you. When you choose to change your thoughts; it will change how you experience anything.

 Replace the worrisome, painful thoughts that keep you entertained all day long to those of acceptance, of hope and of KNOWING that everything is going to work out for your higher good. Truly grasping and understanding this concept is when you will find the pathway out of your mental misery and begin to live the way you were meant to.

Take these 2 scenarios as examples. One person loses a one year relationship with someone she was in love with and who she thought was going to be her husband and she can't move beyond the pain. Another person was married for 20 years with 3 children and her husband left her for another women and she is picking up the pieces of her life with an inner strength and courage that so some would seem impossible. Some would argue that the latter's pain would or should be greater, but pain is pain.

 What is the difference between the two? It is 100% how they view their situations. How they feel is totally controlled by what they are telling themselves about it. Neither of them like it but one is telling herself that she is going to find the strength and move on and the other is saying that she can't move be on the pain and is devastated.

 People ask me how they can stop hurting, how they can move beyond the pain and how they can stop thinking about whatever it is they are going through. And, I say the same thing to everyone and some do it and some don't. Some understand it and some don't.

 It is all about what you say to yourself over and over and over again. When you learn to replace the thoughts that keep you stuck and hurting with those that will set your free; you will move on and live again.

 Let's say you want to lose weight because it is causing you to be unhappy. Every time you go to eat something would you chose healthy wholesome foods or choose to eat what you know is going to work against you? It's the same with wanting to lose your pain. Do you choose healthy, empowering thoughts or do you choose to eat a meal of sorrow, regrets and why's?

 There is a way out of your pain for everyone no matter what it is you are going through and it all begins with you. You have the power within you to allow thoughts in or push them out. It takes a little time and practice but it's worth the result in the end. Otherwise, don't expect anything to change when you keep on thinking what you're thinking.

 A great women once said, "You make your own good time or your own bad time." It's up to you to be happy or sad. It's your choice. And when you understand that, how can you not choose happiness!

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Susan Russo is fast becoming known as a miracle worker in transforming people's lives. She has the ability to turn negative circumstances into life changing opportunities. No matter where you are in life Susan knows how to help you achieve whatever you desire. To learn more about Susan's products and services go to: <a href="http://www.susanrusso.com">http://www.susanrusso.com</a> And, pick up a copy of her FREE ecourse too!

Outpatient Alcohol and Drug Detox and Treatment Programs

What all is involved with an effective quality alcohol and drug detox and addiction treatment program conducted in an outpatient setting? Well, I can tell you that there is a multitude of alcohol and drug treatment programs and models out there but the ones that are proven to be most effective for long-term success tend to follow the same design. For purposed here outpatient drug and alcohol detox and addiction treatment programs will be discussed, but what is the difference in design and purpose of residential treatment versus an outpatient alcohol and drug detox and/or addiction treatment program.

The difference between the two is really quite simple; one is conducted in a residential setting while the other is conducted in an outpatient setting. While they both have their purpose, combining the two is quite effective. In fact, residential treatment has a much lower success rate when not followed by an outpatient program. The reason for this is the process by which the pre-frontal cortex and limbic system recognize drug and alcohol use. The situations and stressors that cause a desire to use occur much more in the outpatient setting whereby the client must deal with them in a healthy manner. The idea is similar to learning cold weather survival during the summer in Florida versus learning during the winter in Maine.

So what does the continuum of care for alcohol and drug detox and addiction treatment in the outpatient setting look like? There are a number of aspects to treatment that are essential for effective improvement in quality of life, but one of the most key aspects is an ability for the program to shift along this continuum of care at a moment’s notice. For example, while detox is an initial phase of any addiction treatment program, relapse does occur and multiple detoxifications can be required. An inability to do this in a timely manner can devastate and cease progress.

The detox process for alcohol or drug addiction is similar. Basically the body has adapted to function with the chemical ingested by the client and so the detox process is a gradual change in homeostasis without the abused alcohol or drug. This process is often done using some type of chemical agonist that helps reduce withdrawal symptoms while simultaneously treating those symptoms to help maintain the maximum level of comfort for the patient until homeostasis can be maintained without the abused substance. This process varies in duration based on the programs design and the client’s response to treatment.

Psychiatric evaluations are an important aspect to treatment as well, especially with individuals that have co-occurring mental disorders. But here is an important note to make, while psychiatrists are used for evaluation and assessments, counselors, social workers, and therapists are the individuals that labor each day to benefit the client. Similar to an individual who injures their ankle, the physician diagnosis the problems but the physical therapists are the ones working to improve functioning. This is an important aspect as many cases have co-occurring disorders that need addressed.

Individual counseling is the aspect of the program that works off of what the psychiatrist has diagnosed to improve the clients quality of life. Counselors are often tasked with educating the client on the disease of addiction and providing knowledge, challenging the clients thinking, providing and helping to develop insights to the client about their particular situation, developing coping mechanisms for constant progress in treatment, and helping develop a strong and positive support system for the client within treatment and in all aspects of their lives. Individual counseling can be much more than this as well, such as helping the client improve in all aspects of their life.

Family therapy is an aspect of treatment often overlooked. Since the family system is many times the frontline and one of the most important support systems for the client, it is vital that this system be one that is healthy and strong. Often time families fall too far on either side of healthy support by being too enabling to the client or not supportive enough. This aspect of the program provides knowledge and insight for the family and often time strengthens this support network; but it also provides the family with much needed therapy as they often experience hardships because of their current situation.

Group therapy is an important aspect for alcohol and drug addiction treatment. This provides insight to new clients on situations and obstacles they might encounter, by individuals who have had to deal with them already, while also reminding clients farther along in treatment where they once were. Typically group therapy has an educational component while also allowing interaction and self-expression for the clients.

A quality program will have a tool in place to monitor progress and aid in quickly identifying trouble areas for clients. This tool is used periodically but frequently throughout the program to accomplish this task. While monitoring progress is important it is also vital that toxicology be checked frequently to identify relapse or usage of other substances as this often occurs.

A quality program is going to be one that is comprehensive and uses effective and evidence based protocols shown to produce positive responses and results. It will have the capability to rapidly adapt treatment along its continuum of care as needed. This program will be one that treats each client where they are at in their own recovery, both at the initiation of treatment and throughout the program.

www.MidwestInstituteforAddiction.org

Weighing the Consequences: One Last Drink

Here is the situation; a well-known businessman and entrepreneur approaches you and asks for a small amount of your time to propose a business proposition he thinks you might be interested in. The man explains that he has an investment whereby both of you could benefit. The investment is only $275,000.00, an amount that will require you to mortgage the home in which your family resides, and has the potential of a 100.1% return on your investment. So basically the man is asking that you risk your home in the hopes of making $275.00. That amount of money is definitely a benefit, it might even make life a little easier for a short amount of time; but can the benefit outweigh the risk involved. I think most individuals would decline such an advance. What’s my point…

Let’s look at the addict and alcoholic. Obviously individuals who have gone or are going through treatment for alcohol and/or drug addiction have had some negative motivators and experiences to get them there in the first place. I mean let’s face it, if I had a wash board stomach and extreme strength would I spend all my time and money in the gym? Probably not, negative motivators got me there and positive ones keep me going back. So there were definitely some negatives to get to treatment. Yet, still individuals often have the idea that using or drinking again would somehow benefit them. They desire the benefits that it once had for them. This is especially true during the holiday season when it seems many around us find solace in the joys of alcohol consumption.

Here is my point… You wonder if it’s ok to just have a drink one more time, or getting high again wouldn’t mean it would become a problem. Maybe prescription opiates were what got you to treatment in the first place so drinking is fine; perhaps the inverse of this. Ultimately, this is your decision and only you have control over it. But let me ask you this. What would you really, truly, gain from doing so? Think about that for a while. Can you even outline in an intelligent debate the benefits that are worth the risk involved? I have yet to hear someone do so… Would you risk all that you have or even a 1/8 of it just to have a “good” night; if that’s even what it would be. Not to mention all the negatives that definitely will ensue such as a hang-over.  Your choice; I for one cannot find the logic…

www.MidwestInstituteforAddiction.org

Simple Personal Development Ideas

Personal development relies on your efforts. If you set your goals within reasonable limits and allow yourself some flexibility, you'll be well on your way to creating a personal development plan that encourages organic growth. This article will outline several steps you can take to build a road to personal development, without the pot-holes.

Substitute positive surroundings for negative ones. Keep yourself busy and surrounded by people and things that have a positive influence on you. You'll be less likely to engage in bad habits like smoking or overeating,plus, you'll be more likely to use your time in a positive and more beneficial way.

Try using the free spaces under your stairs for extra storage. These can provide you with some decent sized drawers to keep more of your stuff in. These areas are nice and cool too so they make great storage for things that are sensitive to warm or hot temperatures.

A key to bettering yourself is to make sure you love yourself. Loving yourself is crucial because if you can not love yourself, then you truly can not love someone else. It is a prerequisite that comes before everything else. Therefore, work on you before you can work on anyone else.

It is very easy to both go overboard and also not to do enough. The right balance must be attained in order to achieve your goals. The planets and the stars know how to position themselves to achieve greatness so you must be able to do the same thing in life.

If you want to develop your personal self start doing more things for others, selflessness is a great trait. You can give up the needs of yourself to help someone else in need. It shows that you are humble and that you are a humanitarian. This can lead to great happiness.

If you find yourself at the point of a complete emotional meltdown, whether it is sadness, anger or what have you, stop and do not say a word. Sit down with a notebook or journal and write down the things that you want to say at that particular point. It will help you express your feelings without causing further conflict.

Personal development means spiritual development to many. But if this is your path, be sure you don't neglect physical well-being, for it provides the foundation on which you build. As a great ascetic saint used to tell his followers: "Make a friend of the body; it will help you on your path."

A great self help tip is to make sure your diet isn't making you depressed. If your diet consists of a lot of junk food then your mind might pay the price. Try eating healthier foods such as fresh fruits and vegetables. Eating healthier will make you feel much better.

As you can see, personal development requires discipline, self awareness, and knowledge. Perhaps by taking an NLP course, or having a liitle therapy may help you. Your efforts will pay off as often as you're willing to put in the work. The above tips have outlined several simple ways you can reorient your efforts to make your goals more tenable. With sound advice and a solid support system, anything is possible.

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If you are looking for an NLP Glasgow based course then <a href="http://www.nlpscotland.com">http://www.nlpscotland.com</a> can provide you with all the information you need.

Anger and Frustration as States of Mind

First of all, not having a support system that is on board with your goals is toxic and secondly, state of mind is a HUGE aspect of success.

Read this and then stop and imagine. The last time you got angry, really angry, why did you do it? What did it accomplish? What did it really accomplish, not just from that moment but did your anger aid you in becoming closer to your goals? My guess is NO. That is because you did not use your anger in the right way.

You see, anger is a state of mind. Belief, Certainty, Faith, Positivity and even Frustration are all states of mind. The only thing in this world that we have control over is our state of mind.

Anger

Do you know the actual reason we get angry? From an evolutionary standpoint we know that when we get angry the body dumps hormones into our system which allow us to be prepared to fight. Have you ever really fought anymore aside from the schoolhouse brawl you had 15 years ago in the 6th grade? Knowing the kind of person you are and that you are committed to success, I imagine that you are not quite the person who fights all that often. I did recently have a tenant actually get kicked out of his house by some guy. Mind you that was low income apartments and I was amazed at how barbaric that low income mentality really is. The guy literally got beat up and kicked out of his own house like a caveman taking another man's cave. That's not you though.

So why do you get angry? Well, evolution has not caught up to man as quickly as we would like. What is the key to anger? Well, realize that you are angry, then you can change it. Look at your situation right now, think about it. What do you hate about your situation? There is a reason you paid for this program and that has a small bit to do with you hating your current situation.

Now, channel that hate, channel that anger into something useful. Change it into determination to be successful.

Frustration

What is frustration anyways? Is it your way to throw a little pity party in your honor when things don't go your way. For me, I get frustrated when I am trying to do something and the people that it affects don't seem to understand when I know that it is something that needs to be done. The best example I can give you is in my building of the Freedom Fighter Army and building these systems for you. People seem to say that they want to be successful, but they don't. They want to be perceived as someone who is willing to try, but they aren't. That is something I had to understand and with my new understanding I was able to tailor the program to the few who actually want the change.

So, why would that frustrate me then? Well, the posers will say things to knock the products or my ways of doing things and simply not push forward. Do you know how I have to get past that? I have to think about the people who do want the help, the few that are focused and are ready to change their lives. They say that only 3% of the people are willing to make an actual change in their lives. Is that hard to believe? I am the kind of person that has read hundreds of self help books, engulfed myself in systems and learning about success and how to attain it. I can't even understand why these imposters would waste the time to look like they are trying when they simply are not.

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Dopamine: If It Feels Good, Do It Again

Dopamine (DA) is an important brain neurotransmitter; and especially significant in the process of addiction. Dopamine has been implicated in its involvement in motor functioning, cognitive functioning, as well as pleasure and reward systems. Its role in the reward system is integral and ultimately defines addiction. It does this in that much of the physical adaptations and psychosocial aspects are derived from the alteration in dopamine levels and their effect on dopaminergic neurons.

Substances associated with the disease of addiction often do so based on their effects on the dopaminergic system. Some chemicals act as dopamine agonists whereby they themselves act and bind as dopamine would in the body. Others are known for their ability to block the reuptake of dopamine and therefore produce higher concentrations than natural. Certain chemicals can also effect dopamine production and/or release that naturally occur within our systems. Regardless of the mechanism in which these chemicals use the end result is a higher amount of activation on the dopaminergic neurons.

Because dopamine plays an integral part in the brain’s reward system chemicals that have these effects can become highly addictive and produce other effects associated with increased dopamine levels such as hallucinations, delusions, and psychosis.

www.midwestinstituteforaddiction.org

5 Ways to Get Smarter

The brain is an amazing organ; the coordination centre of sensation and intellect. There used to be a misconception about our brains, our intelligence, and our IQ. We used to think that we were bound to live with the intelligence level we had at any given time. New research has shown that we can become more intelligent, smarter, and increase our IQ levels by taking some specific yet simple actions. These are the actions to take to become smarter and more intelligent:

 Action #1: Reshaping The Brain Lets start with our brains. Our brains have elasticity and plasticity. Over the course of your life, your brain has the ability to reshape connections when faced with new experiences. At any age, the brain can grow new neurons and the more mental stimulation you get, the more brain function is improved. By brain training exercises and games you can improve your attention, problem solving skills, memory, and processing speed.

Action #2: Learn a Foreign Language or Two New research suggests that learning a foreign language gives you a mental boost. It also protects you from age related mental decline and lowers the risk of developing problems of memory loss or mental decline. Those who speak several languages have a reduced risk of developing cognitive problems. Learning a foreign language provides the brain with a mental workout that fine tunes the brain and makes your brain more powerful.

Nowadays you can learn a foreign language in the comfort of your own surroundings and just by devoting about 20 minutes a day over a period, you can learn to speak a foreign language. Learning new languages contribute to make you "smarter". Let's face it, it makes you appear to be more sophisticated as well.

Action #3: Do Mind Mapping

Mind mapping is a visual thinking tool that helps you get information out, generate ideas, and analyze information. Mind mapping jogs your creativity and helps you think in a more lateral way. It helps with cognition and maximises the power of the brain. When you need to think and generate information which is something that we do very often, mind maps help you to make the most of it and really use the power of your brain. At work and at home, you can use mind mapping for your thinking and analysis of information.

Action #4: Diet and Exercise

There are certain types of foods that help to boost your brain power like blueberries, oily fish, whole grain foods, tomatoes, leafy green vegetables, brown rice, and broccoli. Talk to your doctor about your diet and about exercise so that you can get a diet and exercise plan that is scientific and really works for you.

Action #5: Increase Knowledge

Your brain has the ability to do more and you can stimulate the brain through brain training, brain games, and learning foreign languages. In addition to improving cognitive ability, you should also increase your knowledge while stimulating the brain. Read books and explore new areas of study. It helps to keep your brain sharp and makes you more knowledgeable while doing so.

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Jesse Ford is an author and a publisher at <a href="http://www.reachforhappy.com">http://www.reachforhappy.com</a> where he is focused on helping people create the life of their dreams. His interest and expertise is new thought, spirituality, personal development, and utilizing your inner power. Visit <a href="http://www.reachforhappy.com">http://www.reachforhappy.com</a> to get more information and resources that can guide and help you to create the life you really want to be living

4 and a Half Processes That Will Make Your 2013 Happy and Bright

2012 has been a great year, an interesting one full of surprises and just like every year, full of new things. 2013 is a new year and every new year brings possibilities. Rationalize it this way, a huge door opens up with unlimited possibilities and you can walk in and take what you want. That's a fact.

Every new year brings possibilities and opportunities that can change your life in a second. There is one thing you should know at this time and keep with you; it is that you are a co-creator with the Universe. You create the circumstances, experiences, and events that you experience. Assuming you have not been doing so purposely, but rather doing it unconsciously like most people, now is the time to tap into your personal power and create the life you want.

 There are four and a half processes that you should adopt and utilize which will make your 2013 happy and bright. That is what you want? Right.

 # 1 Process: Forgiveness
Now is the time to let go of hurts, pain, bitterness, disappointments, and regrets. Someone once said that forgiveness is giving up on the hope that the past could have been any different. That's powerful! Wrap up the past and declare that it is the only way it could have happened, no other way. Forgive and let it go. Forgive people who have wronged you so that you can be forgiven as well. Have peace in your heart towards the past, towards people, and towards the future.

# 2 Process: Creating Mental Images and Visualization
Create a list of the things you want in your life complete with details. Create a mental image of the things you want and put yourself in the picture. Visualize yourself in the picture with the things you want to have in your life. Believe you have received them . In your visualization, always dwell on the end result.

# 3 Process: Love - Loving Yourself and Loving Others
You have often heard that love is an action word. That is true. A powerful process to make your life happier and brighter in 2013 is love. Let's start with you. Love yourself, love everything about your life. Cherish your uniqueness, your vision, your goals, your mind, your body, everything. Come to terms with who you are as a person and truly love yourself. Then love others. Wish others well and let the emotions and actions of your heart towards others always be with love. It will powerfully create happiness and bring wonderful things into your life.

#4 Process: Gratitude
Gratitude can be defined as the quality of being thankful; readiness to show appreciation for and to return kindness. It is also known as thankfulness. When you are grateful, it opens the door for more to come into your life. When you are thankful for where you are now and for the good things you experience, it brings more good things into your life. When you have a heart of gratitude, it brings more into your life and more frequently as well.

It is recommended that you start a gratitude journal where you write down and keep track of things you are thankful for. Writing in your gratitude journal daily is highly recommend. Psychologists have traced and documented the benefits of gratitude in general and a gratitude journal in particular. Some of the benefits are: better sleep, fewer symptoms of disease, and more happiness. Do not forget to show gratitude to people as well.

#4 and a Half Process: Faith
Why I categorize faith as half of a process is because it is part of the process of creating mental images and visualization. You cannot get the things you want without faith. Remember what Jesus said? When you ask for things, believe that you have received them and you will have them. So for everything you want, ask for it, you create a mental image of it, believe you have received it and during your visualization, see it as already accomplished.

View it as already received and feel the emotion that comes with that - gratitude, joy, happiness. Really feel it. Make everyday from now a day of faith. Be a person of faith.

It would do you a lot of good to refer to this article now and throughout 2013, print it out and read it often. Use these processes and enjoy a happy and bright 2013.

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Jesse Ford is a developer, author, and publisher. His interest and expertise is new thought, spirituality, personal development, and utilizing your inner power. Visit <a href="http://www.reachforhappy.com">http://www.reachforhappy.com</a> to get more information, tools, and resources that can guide and help you to create a brighter, happier, and more fulfilling life.

The Number 1 Thing To Do To Be Happier

Regardless of how much we feel we know ourselves, it is always insightful to learn something about ourselves; be it our character, our personality and our drives. Happiness begins with knowing your personality well. A good personality test provides you with details of your strengths and weaknesses, and tells you what influenced your personality and which people suit you best.

Personality tests improve your relationships and increase your happiness. Without a doubt when you have a good relationship with yourself and then with others, your happiness is bound to increase. There are things we may or may not know about ourselves or maybe we may have had an inkling about; a personality test is a fun but scientific way to get valuable information about ourselves and pointers on how to advance our lives and be happier.

As you live you go through different life phases, a personality test has the benefit of showing you which goals and values currently guide you. That is useful because at every phase in your life, you want to know your goals and guiding principles and walk in the direction in which you will live your best life with happiness.

Having a happy relationship that is healthy is one of the core elements for a happy and fulfilled life. Most of the time though we know our partner or significant other, there are still underlying needs we need to know better. A personality test helps you understand your relationship needs and the relationship needs of your partner. It provides you with expert relationship advice to enable you experience happiness and fulfilment in your life and in relationships. Essentially personality tests provide you with tools and guides to improve your relationships and increase your happiness.

You also get to understand your needs better, and which environment and lifestyle suits you best. This is especially useful so that you live all aspects of your life true to yourself. For instance if an entrepreneurial lifestyle suits you better and you get to understand this from a personality test, presented with the option, you would go with the lifestyle that suits you better.

A personality test would also give you an understanding of what makes you happy and an understanding of your primary motivations so that you could start living and making conscious choices around what makes you happy. A personality test gives you the tools you need to live a more fulfilled life.

Career-wise you would gain information about what kind of career suits your personality and which interaction style you prefer. It is also always helpful to know your challenge areas so that you could work towards leveraging them to your advancement and your advantage. You get to understand your strengths and weaknesses that are not apparent and you are able to utilize your strengths knowingly and to leverage your weakness areas and also work on them.

This has implications for how you live the rest of your life starting from this moment. It will guide changes and inform what you pursue and how you do so. Personality tests help people direct their energies to live with authenticity, living their best lives.

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Jesse Ford is a developer, author, and publisher. His interest and expertise is new thought, spirituality, personal development, and utilizing your inner power. Visit <a href="http://www.reachforhappy.com">http://www.reachforhappy.com</a> to get more information, tools, and resources that can guide and help you to create a brighter, happier, and more fulfilling life.

The Superstition About The Abundance Code Revealed

Have you ever had an experience where something you put great thought into actually materialized and happened? Maybe you've even heard the quote "What we think, we become"? If so, you've been introduced to the world of visualization. You might have also heard it called The Abundance Code. No matter what you call it, visualization has been said to be the most powerful and efficient way to getting what we want out of life. No it isn't a physical product. There is nothing to buy. Everything you need is right inside of you. Let me share first what visualization is, and then I will share a powerful visualization technique you can start using today to get everything you desire out of life by using what's already inside of you.

Before I go any further, I should probably share my story. Five years ago my life was much different then it is right now. I had reached the limits of mental anxiety wondering how I was going to put food on my table, let alone pay the rent. I had been a part of a couple failed business attempts which had put me in the worse debt I had ever been in. I was at a mental low, and wasn't in a happy place overall. Seeking refuge in bookstores to pass the time, I began reading a lot of books in the self-help section. One such book talked about visualization. I devoured the pages, absorbing everything I could. I put the lessons into action each and every day. I began living a more positive rich life. Two months later I had found a job paying me three times what I had been making, allowing me to stop worrying about food on the table and a roof on my head. I did it with visualization.

Visualization is taking your cognitive thought and focusing it on your dreams and desires. This may sound crazy to you at first hearing it, but this simple method of thinking has changed thousands of lives. Visualization is based around the belief that if you focus on something for so long, it will manifest itself in some form and come true. If you think about it, it really makes sense. When we focus our thoughts on our desires, actually picture ourselves achieving or performing something, we tend to change our behavior to reflect the mood of those thoughts. It might be a baseball player picturing himself hitting the home run everyday, and then hitting one during the big game. Or it may be the intimidated driver constantly fretting over getting into a car accident, only to ultimately get into a car accident on his way home one day. The thing about visualization is it can work in a positive or negative way. There is one powerful strategy you can use to create a positive visualization  environment to guide your thoughts and your life.

If you want to effectively use visualization to change your life for the positive, I want you to do this one thing. Get yourself a visualization board. A visualization board is literally a whiteboard, bulletin board, or any sort of object you can hang on your wall that lists your top dreams and desires. Here is the deal, it needs to be very specific and it needs to be viewed everyday. When I say specific, I mean very specific. If you want to have a lot of money, write exactly how much money you want. If you want a new car, write down exactly which car. The more specific you are, the easier it is to visualize in your mind. When using visualization you want to see exactly what you want. This harnesses the full potential of visualization. Get the board on your bedroom wall so it's the first thing you see when you wake up. Put it next to the mirror in the bathroom. It doesn't matter where you put it, it just needs to be visible to you every day. A constant reminder of what you want to achieve in your life.

The beautiful thing about visualization is it is simple to implement, yet delivers powerful results. You can change your whole life by embracing visualization, and performing it each day. Use a visualization board to write down what you wish to possess, achieve, and perform. Place your visualization board in a location you can see it each day. Take in each item on your board. Then visualize yourself possessing those items, achieving those milestones, and performing those feats. Then be positive, and be patient. Good things will come, and then you will be ready for the next step.

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Visualization is one step on the path to living your most fulfilled life. If you haven't heard of it yet, Mike Evans has created the ultimate system of belief achievement called The Abundance Code. Visit <a href="http://www.mikeevanstheabundancecode.com">http://www.mikeevanstheabundancecode.com</a> for more strategies on achieving your life goals and gratitude.

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www.MidwestInstituteforAddiction.org

Tips on Looking for a Proficient Therapist

A competent therapist should have the proper academic background, extensive experience and commitment to patients. These days, it is not easy to find service providers who can provide you with 100 percent results. Hence, you have to be careful in your search. The most practical way in getting a highly capable therapist is through personal referrals. You have to consider not only aptitude but previous practice as well. Try to learn what other patients say about this counselor. These testimonials can help make your job in finding the qualified candidate easier.

You may opt for a professional referral agency or portal. There are professional organizations that maintain a directory of accredited and reputable therapists. It is one way of avoiding individuals who have an undesirable record or are not fit to perform this kind of work. Your family doctor can also be a reliable source. Prominent educational institutions are also good resources. Do not settle for only one applicant. There are prestigious counseling facilities that you can approach and solicit referrals. It is advisable to interview three prospects so you can have options to evaluate. Inquire about licenses and training since these are essential prerequisites. Know the government regulations about licensing so you are assure of getting the rightful provider.

Be careful to protect yourself. Just because someone says they are a therapist does not mean that they have had any training. People can call themselves a therapist, a psychotherapist, an analyst, a counselor, a marriage counselor, a hypnotherapist, or a sex therapist and not have had any formal training. Although very uncommon, it is nevertheless possible to practice as a psychiatrist in the United States without having obtained any specialized training more than a medical license. A psychologist should have the necessary license while a psychiatrist should have acquired a certification from the proper body.

It is important to develop rapport with your therapist. Choose someone with the same sex if you are quite choosy about gender. Inquire about professional fees so you can fix a budget for this service. Ask all the questions you like regarding treatment, schedules and the personal credentials of the therapist. When everything has been addressed, it is time to present your case and history. Be very candid with your counselor. Refrain from withholding any information prior to the preliminary session. Make it a point to attend all sessions promptly because these will ensure that you are successful with your therapy.

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To learn more on how to find clinical psychologists Melbourne, head over to <a href="http://www.vcps.com.au/about-us-a-our-staff">http://www.vcps.com.au/about-us-a-our-staff</a> or <a href="http://www.vcps.com.au/services/for-individuals-couples-a-families.">http://www.vcps.com.au/services/for-individuals-couples-a-families.</a>

St. Louis Alcohol and Drug Treatment Center

St. Louis Alcohol and Drug Treatment Center

Smoking Cessation and Nicotine Addiction

While research has shown that a comprehensive treatment program that combines medications, psychological, and behavioral care can increase a persons success at smoking cessation by 300% there are other tips and tricks that you should know about while starting your tobacco free lifestyle.

1. Make a public pledge

2. Track your progress on a calendar

3. Jump on the exercise bandwagon

4. Freshen your mouth with mint

5. Make a list of triggers and a plan for avoiding them

6. Chew gum -- any gum

7. Eat a psychedelic fruit salad

8. Stay well hydrated

9. Allow yourself every available treatment aid...

Our nicotine addiction treatment services offer our patients comprehensive solutions to overcome their addiction.
We proudly serve St. Louis, Metro West, Creve Coeur, Maryland Heights, Chesterfield, Town and Country, Ballwin,
Wildwood, Kirkwood, Webster Groves, Eureka, Jefferson County, St. Charles, and St. Peters, MO

www.MidwestInstituteforAddiction.org

Addiction Radio

Listen to our First Radio Addiction Show...still working out some of the technical kinks...

http://www.blogtalkradio.com/midwestaddiction/2012/12/19/addiction-treatment-options

with +Matthew Silva +Scott A Mckinney

Dealing With a Challenge

 The current financial crisis is rapidly spreading throughout the world. No one seems to have a answer. There are just too many variables, and very little clarity. Many people are feeling challenged or stuck in undesirable situations. This can be very frustrating and unsettling. A situation such as this often forces us to make lifestyle decisions.

 But every decision you make is not just a decision about what to do. It's also a decision about Who You Are. Once you understand this everything changes.

 The problem you might face in such a situation is this: How can you move forward when you feel unclear about the next step to take? Admittedly, this can cause some pretty extreme stress. Stress then adds more fuel to the fire, but you know deep inside that you need to DO something.

 What's the answer? To get your life on track you first have to get clear about your situation. If you fail to truthfully analyze your situation and possible courses of action, you'll find yourself stressed and confused. You already know this on a deep intuitive level.

 What are your options? One way to overcome indecision is to simply choose from among your possible solutions. Whether or not your choice is perfect, just take a small step in what seems the best direction.

 There is great power in action. Movement in any direction will break your mind free from the cement of indecision, and provide new information and experiences. Since life is so totally unpredictable, who knows how your situation will change once you take some action. Even if you make a wrong choice, at least you will break free of the painful, mind-numbing cement of indecision!

 What Can Happen! Years ago I worked with a couple who lost nearly everything in the 9/11 market crash. They lost their savings, their house and their nest egg. All they had left was a rundown shack of a cabin on a nearby lake. What did they do? They focused their energy on what they had left and moved into the lake house.

 Over the next year they repaired the house and turned their property into a "bring your own boat" little campground. Were they successful? Yes, and they now have a low stress fun lifestyle. They say "losing everything" was actually a blessing. The right attitude and realistic actions can make a huge difference! Want to deal better with afinancial challenge......
------------------------

Jill Ammon-Wexler is a Doctor of Psychology, best-selling author, and personal self mastery and mind power mentor to achievement-oriented individuals from around the world.

BUILD YOUR MIND HERE
http://www.buildmindpower.com">http://www.buildmindpower.com</a>

Effective alcohol treatment in St. Louis, Missouri

So you’re looking for effective alcohol treatment in St. Louis, Missouri. Well I can tell you, no matter what your demographic location, addiction strikes all the same. Understanding this attacker is really the first step in overcoming and effectively treating alcohol dependence or alcohol problems, and this attacker is one that is cunning, baffling, and powerful as some wise individuals often say. A good fighter is going to extensively study and understands their opponent; and so too must you understand what you are up against to maximize your potential for success. Many individuals do improve their quality of living but many also run through the gauntlet of treatment center to do so.

While it can be argued why individuals complete and/or attend multiple programs efficiency wins in all ways. Either it takes a series of trials to find the one program that works, or treatment is sometimes a slow process and many treatments occur within that time. Regardless, finding effective treatment will limit either of these processes. So what is effective treatment?

The program you are looking for should be evidenced based. There are many programs that might have you stare at goats with the hope of keeping you sober. While this might work for some, research has yet to validate this technique. Addiction is a complex disease; it fits the conceptual model for a disease, and so must be treated as such. Note that while this is a complex disease it is not an excuse; it is an individual’s choice to receive treatment for something such as diabetes and not doing so is simply irresponsible. Addiction is a disease of the brain. There are physiological adaptations to chemical abuse in various systems in the body but the brain is the focus of treatment while also treatment of symptoms to promote a return to homeostasis. In fact, looking at a line graph of medical versus therapeutic treatment you will see an emphasis on physiological treatment initially with a gradual decline and an increasing emphasis on psychological treatment with a growth of effectiveness due to pre-frontal cortex functioning.

This program should be one that is very malleable to the individual. No single treatment works for everyone and therefore a program should treat every client individually and use all known therapies which are proven effective. The program should not only adapt its treatment to the client initially but also throughout the duration of treatment. If a client is not having success with current treatment then only the same can be expected throughout the duration. The treatment needs to have a well-developed continuum of care with the ability to rapidly adapt and maneuver; treating the client where they are at in their recovery. For example, while detoxification is an initial stage relapse sometimes occurs and requires a rapid shift in this continuum.

Research has shown the effectiveness of treatment in directly proportionate to the amount of time in said treatment. Therefore a quality program will have tools in place to promote this duration of care. Many programs will offer aftercare programs and even lifetime counseling for the client and their families. This is a vital tool that should be sought and utilized by individuals in recovery. This is often differentiated from 12-step programs which, in this author’s opinion, should be utilized in conjunction if appropriate for the individual.

Medically assisted treatment has been shown to be very effective especially when combined with counseling and psychiatric care. A quality program recognizes this need and understands that while medications are an effective tool they are just that; a tool. Medications can make withdrawal a comfortable process and help the client transition into non-medicated state. Other medications can help limit cravings, block euphoria, and even prevent certain illicit drugs from having any effect on the client at all. A combination can be used to aid clients during the initial stages of treatment, as well as, promote brain healing and a return to homeostasis.

Overall a quality program is going to be one that maintains a comprehensive treatment atmosphere and is structured in such a way that the needs of the client are met at the beginning of treatment and throughout its duration by maintaining a rapidly dynamic model. When searching for treatments ask questions. A good program should be able to answer any of these concerns and explain to you exactly how their program addresses each one.

www.midwestinstituteforaddiction.org
 

Alcohol Treatment in St. Louis, Missouri: Finding Quality Treatment

So what are we dealing with? It is often the mindset of those who have problems with substance abuse that they are a minority and somehow alone. The fact is many people struggle with this same thing and many also overcome to live happy productive lives. You are not alone. Approximately 22.1 million Americans 12 years and older need specialized treatment for a substance abuse problem; that’s roughly 7.5% of the U.S. population. Of these Americans only 2.6 million or 11.2% actually receive treatment in one form or another. That leaves 19.5 million Americans in need of substance abuse treatment; some currently searching.

If we take a closer look at what these Americans are dealing with, it is found that 15 million (68%) are troubled by alcohol alone, 4.2 million (19%) by illicit drugs alone, and 2.9 million (13%) by both alcohol and drugs. This correlates into over 30% of Americans suffering from alcohol abuse. So you are looking for treatment; probably for yourself or someone very close to you. Either way I am sure you want to find something effective while also being logistically reasonable. Data from 2009 showed that only 47% of individuals that started treatment completed while 25% dropped out and 14% transferred to a different treatment median. This author believes that many of these cases are due to the lack of quality and individuality common to many programs.

The National Institute on Drug Abuse states that ideal treatment should reflect the following ideas; that a quality program understands addiction to be a disease; utilizes multiple avenue of treatment to include medical, psychiatric, and counseling; maintains a continuum of care that is adaptive to the needs of the individual both initially and throughout the duration of treatment; utilizes medications as a tool combined with other therapies shown to be effective; and provides some kind of continuing support as duration of treatment is directly related to benefits to the client.

So what would a quality program look like? A quality treatment program would include medication combined with counseling and psychiatric care. It would individualize the program so as not to "cookie cut" treatment. It would offer aftercare or some sort of support groups that the client could utilize even after the completion of their primary program. It would adapt to each client, not only upon the initiation of treatment, but also throughout the program; rapidly adapting to the needs of each client. It would constantly monitor toxicology as relapse is often a part of this process. And most importantly is would be genuine and caring to its clients.

It is this author’s beliefs that while searching for a quality program that will go the "extra distance" in providing effective treatment the ideas discussed here should be addressed. Of these ideas an ability to adapt to client’s needs both initially and throughout a program seems to be lost some of the time. Whether this is due to an organizations size or structure it is vital that this entity be malleable to one’s care. The idea that anyone is doing you a favor by "allowing" you into their program is a misconception; an idea that plagues the substance abuse treatment field. Most programs have an initial consultation; this is your chance to interview your provider. You deserve the best care possible but ultimately it is your responsibility to make the best choice. Ask questions and find out what programs are all about, you will be glad you did.

www.midwestinstituteforaddiction.org
 

Opiate Detoxification Program

What all is involved in opiate detoxification? Whether you are dealing with heroin or prescription opiates the process is often the same. It is very important to note that there is a distinct difference between medical stabilization of someone with opiate dependence and a complete detoxification. The definition of detoxify is; to remove a harmful substance (as a poison or toxin) or the effect of such from, let’s say the body. Now, this can be argued as to ones beliefs of a partial agonist like buprenorphine (the opiate agonist in Suboxone and Subutex) being a harmful substance and therefore the removal of it, et cetera. For purposes here we will consider detox to be the removal of all opiates, opioids, and opiate agonists to include; methadone and buprenorphine.

The process of detoxification is theoretically very simple. The body, having an increase in dopamine agonists (i.e. heroin, prescription opiates, buprenorphine, methadone, et cetera) has a physiological adaptation to this in a number of ways. There is an increase in receptor site density at dopamine receptors and other systems and chemicals as the body adapts to the increased dopamine and dopamine agonist levels. While usage continues the body functions normally, of course we should also consider the tolerance increases and need for higher amounts of these chemicals, but we will not go into great detail there. When the amount of dopamine and dopamine agonists decrease the body can no longer function normally and there is a compromise of homeostasis in a multitude of systems.

Because of the many changes, adaptation back to normal state is a gradual process but the withdrawal symptoms experienced most severely at the beginning can be stabilized. Many places use methadone, Subutex or Suboxone to accomplish this. Suboxone tends to be the most preferred method currently because of its added chemical naloxone which limits the threat of abuse. The duration of this process depends on the individuals responses to treatment in the outpatient setting but often follows a rigid timeline when done residentially. There is typically a stabilization period on the partial agonist used and then a gradual taper until the medication is completely removed from the treatment. Throughout this process other medications are often prescribed to treat any symptoms associated with the gradual taper and therefore minor withdrawal symptoms. Ideally this is done in conjunction with psychiatric care, individual therapy, group therapy, and family therapy. As each facility may vary in their detox protocol it is advisable that you inquire for information specific to the clinic. Detoxification alone has not shown to be very effective for long-term increases in quality of life or sobriety. It is advised that an individual combine this with other therapies for greater effectiveness.

www.midwestinstituteforaddiction.org

Alcohol Treatment in St. Louis, Missouri: Finding Quality Treatment

So what are we dealing with? It is often the mindset of those who have problems with substance abuse that they are a minority and somehow alone. The fact is many people struggle with this same thing and many also overcome to live happy productive lives. You are not alone. Approximately 22.1 million Americans 12 years and older need specialized treatment for a substance abuse problem; that’s roughly 7.5% of the U.S. population. Of these Americans only 2.6 million or 11.2% actually receive treatment in one form or another. That leaves 19.5 million Americans in need of substance abuse treatment; some currently searching.

If we take a closer look at what these Americans are dealing with, it is found that 15 million (68%) are troubled by alcohol alone, 4.2 million (19%) by illicit drugs alone, and 2.9 million (13%) by both alcohol and drugs. This correlates into over 30% of Americans suffering from alcohol abuse. So you are looking for treatment; probably for yourself or someone very close to you. Either way I am sure you want to find something effective while also being logistically reasonable. Data from 2009 showed that only 47% of individuals that started treatment completed while 25% dropped out and 14% transferred to a different treatment median. This author believes that many of these cases are due to the lack of quality and individuality common to many programs.

The National Institute on Drug Abuse states that ideal treatment should reflect the following ideas; that addiction is a complex but treatable disease that affects brain function and behavior, that no single treatment is appropriate for everyone, that treatment needs to be readily available, that effective treatment attends to multiple needs of the individual, that remaining in treatment for an adequate period of time is critical, that medications are an important element of treatment for many patients; especially when combined with counseling and other behavioral therapies, that an individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs, that many drug–addicted individuals also have other mental disorders, that medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse, that treatment does not need to be voluntary to be effective, and that drug use during treatment must be monitored continuously, as lapses during treatment do occur.

So what would a quality program look like? A quality treatment program would include medication and behavioral therapy, which when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. The program should include mechanisms to identify and address needed adaptations to treatment throughout the program. It should focus on easing withdrawal symptoms that can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes an individualized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a lifetime of sobriety
It is this author’s beliefs that while searching for a quality program that will go the "extra distance" in providing effective treatment the ideas discussed here should be addressed. Of these ideas an ability to adapt to client’s needs both initially and throughout a program seems to be lost some of the time. Whether this is due to an organizations size or structure it is vital that this entity be malleable to one’s care. The idea that anyone is doing you a favor by "allowing" you into their program is a misconception; an idea that plagues the substance abuse treatment field. Most programs have an initial consultation; this is your chance to interview your provider. You deserve the best care possible but ultimately it is your responsibility to make the best choice. Ask questions and find out what programs are all about, you will be glad you did.

www.MidwestInstituteforAddiction.org

Seeing Through the Fog: The Role of Mindfulness In The Management of Addiction

 

January 21^st, 2012

at

Midwest Institute for Addiction

Contact M.I.A. for more information

 

This professional workshop will provide an introduction to mindfulness-based interventions (MBIs) and their utility in addiction management. The discussion will include an overview of mindfulness theory and relevant neurological and psychological mechanisms. A survey of the current literature will provide attendees with an evidence-based understanding of MBIs. A discussion of strategies within behavioral medicine will highlight current and potential clinical implications and opportunities for the incorporation of MBIs. Finally, specific MBIs will be taught to attendees in a workshop setting to begin developing the skills necessary to include mindfulness therapy in addiction management.

 

www.MidwestInstituteforAddiction.org

 

James E. Eubanks, Jr. DC, MS

Dr. Eubanks completed his undergraduate education at Furman University in Greenville, SC, where he earned a BA in philosophy and pre-medical studies. During this time, he trained as a crisis intervention counselor through the Greenville Mental Health Association and performed volunteer work for Greenville County. He subsequently began formal training in mindfulness meditation under the late Ryugen C. Fisher, and David E. Shaner PhD. In 2005, he moved to St. Louis to attend Logan University, earning a BS and MS in sports science and rehabilitation, and a doctor of chiropractic (DC) degree. In 2006, Eubanks founded a 501(c)3 educational non-profit organization in St. Louis to offer instruction in mindfulness-based training for stress management.

After completing his education in St. Louis, Dr. Eubanks moved to Charlotte, NC in 2010 and joined an established practice as a non-surgical spine specialist, maintaining a specific interest in the psychosocial dimensions of chronic musculoskeletal pain. Mindfulness-based therapy and cognitive behavioral therapy (CBT) were incorporated into his "Applied Mindfulness Program" (AMP) for chronic pain patients. He is currently completing a three-year post-graduate training program in "Spine Diagnostics and Clinical Management" under the direction of Craig D. Brigham MD, senior spine surgeon at OrthoCarolina Spine Center and spine section chief of the Carolinas Medical Center (CMC) orthopaedic residency program.

In 2012, Dr. Eubanks joined the OrthoCarolina Research Institute (OCRI) as a consultant to a longterm partnership between OCRI and CareCore National; this effort involves a comprehensive evidence-based guideline development project for musculoskeletal medicine and pain management. He is a co-investigator in a clinical study examining the effects of framing and bias in the delivery of patient education by physicians, and its influence on patient decision-making.

 



Radio Special: Addiction treatment in St. Louis, Missouri

Midwest Institute for Addiction, being recognized as leading experts in addiction treatment, have partnered with Emmis Communications to offer a public radio program focusing on the issues of addiction for the entire first quarter of the 2013 calendar year. This series will be constructed in four 20 minute shows that will air on KSHE 95, KPNT 105.7 the Point, KHIT's 96.3, and KFTK 97.1 FM Talk each week throughout the months of January, February, March and April. More information can be found below or by visiting MIA on the web at www.midwestinstituteforaddiction.org 

 

 

 

 

Fighting the good fight; substance abuse prevention and treatment

It is one thing to treat individuals that deal with alcohol and drug addiction, but it is also our duty to help prevent individuals from having to deal with it in the first place. We all need only do our part or more to beat this growing epidemic.

Drug and Alcohol Addiction Treatment Options

At this very moment in many cities and towns across the United States individuals are compiling lists of numbers, making calls, leaving messages, and searching for the best possible care for themselves, a loved one, or friend. Unfortunately, what they will find a majority of the time is no one on the other line, a voice message system, or a referral to another number because the program is not what they need or what they are looking for. It has been this authors experience that the majority of individuals seeking alcohol or drug treatment for the first time, even those who have been in treatment before, do not entirely know what types of resources are available for their particular needs. The purpose of this article is to shed light on the differentiation in treatment and is merely opinion; is not meant to suggest one type over another or degrade any treatment option.

For purposes here I will break down treatment into two linear tiers. On the first level we have the option of residential versus outpatient treatment; note that there are grey areas such as recovery communities and transitional living but for now only a general overview is given. Tier two consists of state funded facilities, facilities that are insurance based and private facilities. It is important to understand the both tiers correlate in that a combination from either tier can be found dependent on geographic location.

Residential versus outpatient treatment; this is pretty self-explanatory as far as construct of these programs. Residential treatment requires that the client stay within the facility either by their own will or mandated by some other source of authority. These treatments can run from five days to six months; some even longer. The benefits of these types of treatment are control of the client and structure; treatment modalities and practices vary among each program. Outpatient programs are designed to allow the client to come and go as they receive treatment and are conducive to work, school, and family obligations in some settings. It has been shown that a treatment program is much more successful when finished in an outpatient setting; whether transition from a residential program occurs or not.

The second tier consists of programs, residential or outpatients, that receive state funding for their services, accept private and state insurance as a source of payment, or are privately funded by clients. State funded programs are able to offer free services to clients but are limited in doing so by the amount of funding they receive. There is often a wait list for treatment, something that can be detrimental when an individual finally realizes they need help. Many individuals in these programs are mandated by courts or other authorities to attend and often this affects the mean level of motivation throughout the program. They have less funding for overhead costs and this can be reflected in the quality of facilities, therapies, and even staff.

While insurance bases programs are higher in quality than that of the state funded they are often limited by what insurance will cover. Often residential treatment is cut short of ideal duration based on what insurance will cover. Because of the allotted amount paid per day in outpatient settings many programs require a minimum amount of therapy per week to off-set higher cost services such as doctors' visits which can interfere with client's outside obligations. Often in this setting it seems the patient's insurance is treated more than the patient.

Private programs can be a burden to individuals with limited funds but often are reasonably priced. Many of these programs are able to get clients reimbursed through their insurance and have financing available both internally and through third-party lenders. The benefits of private facilities are the level of care and investment into each client that occurs. They typically have the ability to provide comprehensive and cutting edge treatments and therapies and do so in a positive, motivated, and comfortable environment. These facilities tend to offer the highest level of care available.

Resources and needs are ultimately what drive the decision on treatment for anyone. And hopefully reading this article will at least help you categorize as you do your research and find the best treatment for yourself or a loved one. Just remember treatment for alcohol and drug addiction is not something to be taken lightly and investing in a life is no small matter.
Scott McKinney is the Vice President at Midwest Institute for Addiction; a state liscensed medically assisted treatment center in St. Louis, Missouri. MIA is committed to providing quality treatment and education in the area of chemical dependency and process addictions in our society. http://www.midwestinstituteforaddiction.org/

Nine Network Town Hall Meeting

Midwest Institute for Addiction recently attended a live town hall meeting on St. Louis's NineNetwork public television station. Along with being in the studio audience M.I.A. presented information about treatment options in the area to the public along with 5 other specifically selected treatment centeres. Check out the full show @

http://ourregionshealth.ninenet.org/category/heroin-response/

Living close to a bar increases chances of risky drinking...

http://www.medicalnewstoday.com/articles/252462.php

Battle of the Bottle: New Hope for Alcoholism Recovery

Check out this new book and share your comments here. We are very interested in seeing what the masses response to this piece of literature is. Click on the link below to go to Amazon.com and download a free ebook version for your Kindle.

http://amzn.to/QrOBar

Relapse: Uncommon aid is a common virtue.

A common trend among those that relapse from alcohol and/or drug addiction is a decrease or cessation of therapeutic groups and/or counseling. Whether listening to another’s story in a 12-step meeting or interfacing with individuals who have completed various treatment programs it is often heard that they quit working their program in one facet or another. While there are a wide variety of opinions as to why this occurs research has shown a correlation between treatment time and outcome.

This research has shown that the length a patient remains in treatment directly correlates to reduction in drug use and improved social functioning. (Walker, 2009). McKay & Weiss described longer periods of treatment as predictive of better outcomes for clients. One of the best analogies this author has heard is that of the “ex-lover” and “the resolutionist”. The first being about an individual who has terminated a relationship for a number of negative reasons, yet finds themself thinking of initiating contact again. They seem to have forgotten the negatives and focus only on some positive aspect of the past experience. It is important to remember the negative experiences as much as the positive.

What about the chronic New Year resolutionist? Here we have a person that desires to improve their appearance and every year that begin a fitness regimen only to “fall off the wagon” a few months later. The reason? Simple. They were driven to the gym by negative motivators. They got results and so the negatives subsided. Next year though the cycle repeats itself. What they should have done was what this author refers to as a motivational transition; changing from negative motivators (I’m overweight) to positive ones (boy, I do look good in this shirt). We also need to remember what those negative experiences where like, and why we don’t want to experience them again.

Many treatment programs offer ongoing therapy for their clients to address this issue. Programs like Midwest Institute for Addiction offer lifetime counseling for their clients and their client’s family. Other programs like Valley Hope Association offer continuing care. Both are excellent support services for continued improvement of quality of life and long-term sobriety.

Neurobiology of Addiction PPT

http://www.docstoc.com/docs/45630939/Neuro-of-Addiction-PPT--Neurobiology-of-Addictionppt

MBU Health Fair 2012

http://twicsy.com/i/gH6jsc

Addiction a Risk After Weight-loss Surgery

http://www.emedicinehealth.com/script/main/art.asp?articlekey=164010

UPS Health Fair 2012

Sometimes I feel I should wear an elephant costume to truly fit the part. What are your thoughts on the social attitudes toward addiction?

Information on Alcholism and Abuse

http://alcoholism101.com/

Matt Silva, MA, MBA, CRAADC

Matt will be speaking at Maryville University October 23rd, 2012 on current trends and treatment in addiction medicine. For more information visit: http://blogs.maryville.edu/rehabilitationcounseling/category/rehab-counseling-and-services-faculty/

Naltrexone or Vivitrol in the OutPatient Treatment Setting for Opiate Dependence?


About half of the individuals that come into our treatment center at M.I.A. are familiar with the pharmaceutical Naltrexone. Individuals that are not familiar with Naltrexone often confuse it with the Dopamine agonist Buprenorphine, the active ingredient in Subutex and Suboxone. I want to take this time to clarify a few points; and basically leave the reader with the information necessary to make an informed decision as to whether or not they think this could prove beneficial in their own recovery.

First, let's look at what opiates and opiodes do in our bodies. Opiates are agonists for the neurotransmitter dopamine; this means that they enter the body and can act in the same way as dopamine on post-synaptic neuron receptor sites to cause action potentials. With excessive amounts of dopamine agonists administered through chronic use, an increase in the density of post-synaptic neuron receptor sites occurs. While this has minimal effects during usage, the body is unable to function when dopamine or dopamine/agonist levels fall. When this occurs action potentials can not occur at optimal levels and we see both physical withdrawal symptoms, as well as a decrease in cognitive functioning.

To deal with the problem of excessive receptor site density Buprenorphine (also an agonist for Dopamine) is used to allow action potentials to occur. Buprenorphine does not activate the site as strongly as an opiate but enough to minimize withdrawal symptoms and allow for normal functioning. However, ceasing Buprenorphine use will also result in withdrawal as this too is considered addictive.

Naltrexone (the active ingredient in the Vivitrol (R) injection) acts as an antagonist for dopamine. This molecule acts the opposite of the neurotransmitter in that while it also binds to the receptor site it does not cause an action potential to occur. Naltrexone also has a higher affinity than that of the most commonly used opiates so that if both are in the system Naltrexone will bind before the latter. This does two things for the patient utilizing this pharmacological therapy. 1) Cravings associated with decreased amounts of available dopamine/agonists is controlled. 2) Dopamine agonists with lower affinities than that of Naltrexone cannot bind to receptor sites. This means that opiates commonly used by those struggling with addiction will not work while using Naltrexone, and because these sites are not being activated normal density will return; something that cannot occur on Buprenorphine or Methadone.

Simply stated, Naltrexone acts as a cast for our brains throughout the healing process...www.midwestinstituteforaddiction.org

Withdrawal Symptoms

I've noticed a trend in which individuals inquiring into our services don't really know what to do with someone going though withdrawal symptoms. Withdrawal can be dangerous and if there is any uncertainty take that person to an emergency room where they can receive appropriate medical care.

A Must Read: By Kevin T. McCauley, M.D.

Kevin T. McCauley, M.D.

1. Is addiction a disease? What are the arguments for and against this notion?

People often disagree with the idea of calling addiction a disease in the same way we call conditions like diabetes a disease. The behavior of addicts is frustrating, ugly - even criminal. How can driving drunk be a symptom of a disease?

The best argument against calling addiction a disease states that addicts make the choice to use drugs and that their inability to stop is simply immature and irresponsible behavior. Diabetics, for instance, do not have a choice about whether or not to have a high blood sugar. These arguments make sense, and are often embraced for their intuitive appeal alone.

When doctors use the Disease Model of Illness to think about a disease, they think of a specific physical defect in some organ or physiologic system of the body. That defect, once discovered, provides a causal explanation for the patient’s symptoms and points the way to treatment. With diseases like diabetes, the defect is easy to understand.

With

brain disorders however, it is not that simple.

Our understanding of brain disorders has not kept pace with our understanding of other diseases - like diabetes. A big part of our difficulty in calling addiction a "disease" stems from the fact that no one could ever find the defect in the brain that caused addiction. Without a physical brain defect to point to, addiction never earned the status of "disease" like diabetes did. The addict’s symptoms were assumed to be due to their intrinsic badness – their immaturity, their irresponsibility, or worse.

But guess what? In the last ten years we have learned a lot more about the brain. We know what the physical defect of addiction is and where in the brain it is. Addiction is a defect in the hedonic system, or the system that perceives pleasure, which is deep in the part of the brain that handles basic survival. Because of this defect, the addict unconsciously thinks of the drug as life itself. A beer is not just a beer anymore – the addict needs the beer to get through life and when the beer is unavailable they

crave it.

While it is true that the addict may have a choice in whether or not to use drugs, they do not have the choice over whether or not to crave. If craving gets bad enough, even the strongest-willed, most mature and most responsible person will return to using drugs. No brain can ignore that survival imperative. One of the big reasons we have difficulty calling addiction a disease is our inability to grasp the true nature of craving. Craving is a very real mental suffering the addict endures when they come to the point in their addiction when they are using drugs even when they do not want to.

If you are in medical school and you write, "addiction is not a disease" on one of your exams – you will flunk. In medicine, we now know that the addict’s brain really is different than normal brains, and from a physiologic standpoint we now know

how it is different. This explains a lot of the symptoms we see in full-blown addiction and helps us develop better, more effective treatments to help the addict recover. It also means that addiction fits the Disease Model of illness as well - if not better - than many other diseases.

Like say, diabetes.

2. How far have we come with regards to recognizing and treating addictions compared to years past?

Kevin T. McCauley, M.D.

For thirty years, research in neuroscience, psychology and pharmacology has been steadily building in the search for clues about addiction. Recently, this information has coalesced to the point that we now have a good working model of the physiology of addiction. Answers are starting to present themselves about the symptomology of addiction that in the past were perplexing. This more complete picture of addiction leads to better clinical tools to help addicts who in the past were branded as "unwilling" or "reluctant" to recover.

One crucial challenge remains: finding an objective test for the predisposition to develop addiction and for the presence of addiction already in progress. Currently, no such test exists to tell us who is an addict or who will become addicted, but the area of brain imaging holds some promising leads.

3. Is addiction a mental or physical disorder?

This is a truly loaded question. The

other big reason, besides the mystery of craving, that we have trouble calling addiction a disease, as we would a clearly physical disease like diabetes, is our reliance on terms like "mental" and "physical" (or "mind" and "body") and the assumption that the two are distinct entities without causal relation to one another.

This idea of a separation between the mental and the physical goes way back to the seventeenth century French philosopher Rene Descartes (1598-1650). In the Philosophy of the Mind, Descartes’ solution to the mind/body problem is that there is the mind (soul) and then there is the body (brain) – and never the twain shall meet, or causally affect one another. This solution is called Cartesian Dualism, and while dualism persists in our everyday thinking, made obvious by such terms as "mind" and "body", it is considered an unsatisfactory explanation. Dualism is obviously at odds with our experience. I think about raising my arm and then I raise it, or I get a brain tumor and my personality changes. Clearly, the mental influences the physical and vice versa. Nevertheless, Cartesian Dualism has crippled our understanding of the nature of consciousness. We are still unable to take "mental" disorders as seriously as we do "physical" diseases. We have no trouble accepting that a physical disorder of the pancreas causes diabetes, but the idea of a physical disorder in the brain causing the very unpleasant behavior of addiction is still tough for us to swallow. It is easier to simply write off addictive behaviors as caused by a weak character or simply moral turpitude.

The consequences of Cartesian Dualism have hit addicts especially hard. If you told me that your daughter has cancer, I can muster some comforting comments about courageous surgical techniques or life-saving chemotherapy that leads to good cure rates. Conversely, if you come to me and tell me that your daughter has a crystal meth addiction, my heart goes in my throat. I cannot promise you she will not die in prison. These are the very real consequences of our inability to reconcile the "mental" and the "physical."

The philosopher of the mind John R. Searle at U.C. Berkeley suggests a solution to the mind/body problem and thus a way out of Cartesian Dualism. Searle argues that consciousness is simply a feature of the physical organization of the brain. When we refer to the "mental," we are really just describing the "physical" at another level in the same way we refer to the "physical interaction between water molecules" as "wetness" or the Kevin T. McCauley, M.D.

"arrangement of tree cellulose in this desk" as "hardness." Thus, the mental and the physical are really just the same thing.

Once this solution is in place, the confusion about whether addiction is a "mental" disorder as opposed to a "physical" disorder clears up nicely, as does the skepticism of calling addiction a "disease". Addiction is simply a defect in the brain’s ability to perceive pleasure that so severely influences the addict’s conscious experience of drug use that they form a pathological attachment to the drug. On one level, we are talking about the defective response to increases in dopamine in the cellular structures of the midbrain, and on another level we are talking about relapse to meth despite a judge’s promise to send the addict to prison.

4. What part(s) of the body or brain plays the greatest role in addiction?

All drugs of abuse work in the reward centers of the limbic brain. This is the part of the brain that handles immediate survival – not long-term planning or anticipation of consequences. In addiction, a defect in the limbic brain changes the addict’s perception of the drug’s survival salience. This is the first part of the mechanism of addiction – the part that is unconscious. Then, that misperception of the drug experience is sent to the frontal cortex where an emotional connection is made to the drug based on the misinformation received about the drug’s salience. This is the second part of the mechanism of addiction – the drug takes on a conscious meaning to the addict. They love it when it is there. They miss it when it is gone. The drug hijacks the same parts of the brain that handle survival and love.

This will have major consequences for behavior.

5. What needs to happen physically or chemically within the body for addiction to occur?

The best descriptive model of addiction attributes the disorder to a dysregulation of the hedonic, or pleasure, system in the brain and a change in the "pleasure threshold" – or the brain’s ability to perceive pleasure. Dr. George Koob of the Scripps Neuroscience Institute in San Diego, CA developed this model. His idea is that closely spaced and intense drug use can cause the release of dysphoric chemicals and stress hormones in an effort to maintain balance in the hedonic system subsequent to drug use. This may cause the drug user to counteract the body’s attempt to maintain the "balance of pleasure" by using more and more of the drug, which will result in greater and greater release of dysphoric chemicals. In essence, when the drug pushes, the body pushes back.

If the body is no longer able to maintain the homeostatic balance due to ever-increasing drug levels, it will give up on

homeostasis and resort instead to allostasis in a compromise to maintain stability of the hedonic system. Whereas homeostasis is maintaining balance around a certain level, allostasis is an overall change in the entire level in order to keep the system stable overall. This is the point at which the "pleasure threshold" changes, and where the drug abuser crosses over into the diagnosis of substance dependance. Now the addict is not using the drug to feel good (positive reinforcement), rather he is using the drug just to feel normal (negative reinforcement). Kevin T. McCauley, M.D.

In thinking about Koob’s theory, it struck me that it might be possible to have the dysphoric stress chemicals already present prior to actual drug use – say from some chronic, unmanaged stress that has accumulated to the point that the brain interprets the stress on the survival level. This alone may change the "pleasure threshold" resulting in

anhedonia – a term in psychiatry that means the inability to derive pleasure from those things that used to be pleasurable. At this point, the old pleasures no longer work to make life worthwhile. The pre-addict may search for something to regain a normal feeling of pleasure. If at this point they should stumble across a drug, such as alcohol or crystal methamphetamine, the very high increase in dopamine concentration in the brain’s pleasure centers will cause that drug to be tagged with survival coping value. The pre-addict will seek out that drug – in fact, their entire behavioral repertoire may narrow around the attainment and use of the drug. The pre-addict is now a full addict, using the drug as their primary means of coping.

6. Does stress contribute to addictions? If so, how?

Koob’s theory, as discussed above, attributes the cause of hedonic dysregulation at the level of the drug use itself: stress hormones (Corticotropin Releasing Factor, Adrenocorticotropic Hormone) are dysphoric and the addict accelerates drug use to counteract that dysphoria, resulting in greater release of dysphoric stress hormones, resulting in greater drug use.

I agree with this, but would also add that drug use itself may not be necessary for these dysphoric stress hormones to be present. The presence of the stress hormones may be to motivate the individual to find coping mechanisms for stress. For example, stress of hunger results in search for food and eating results in relief of stress. As such, they may be released in varying amounts all the time, but in situations of

severe stress that are not promptly managed, these stress hormones may rise to levels that cause the hedonic system to dysregulate (war, emotional abandonment, physical illness, mental illness, sexual or physical assault, domestic violence). The individual is then motivated to seek relief of the stress. If the stress coping mechanism is healthy (church, friends, family, hobbies) then there will be no problem. If however, the stress coping mechanism is a drug, then addiction may form. The brain, subjected to chronic, severe, unmanaged stress is "fertile soil" for addiction. If a drug comes along at this time of severe stress, the effect and benefit that the drug has for continued survival, will not likely go unnoticed.

7. Tell me about the Hedonic threshold and its connection to addiction.

A big part of the brain’s job is to keep the various physiologic systems of the body in balance. This is easy to understand for systems such as blood glucose level and body temperature, but it is harder to grasp that the body has a system for regulating something like pleasure. Nevertheless, such a system exists – it is called the Hedonic System.

Normally, this balance, or "homeostasis," is maintained around a hedonic "set point," which could be considered a kind of "pleasure threshold." Addiction is an inability to maintain the "balance of pleasure," as it were.

When this hedonic set point is changed, such as in times of severe stress, the brain becomes

anhedonic: it is unable to derive pleasure from things that were formerly Kevin T. McCauley, M.D.

pleasurable. In essence, the brain is "deaf" to pleasure. The only pleasures it can now sense are VERY "LOUD" pleasures – or those pleasures that cause large fluctuations in dopamine in the limbic structures of the brain. Usually, the things that cause these fluctuations are drugs. If this happens, the limbic (survival) brain is likely to attribute special salience to these drugs as coping mechanisms. Behavior may reorient itself around the drug until the stress is gone.

This may seem like a strange and abstract concept, but the brain has another example of a temporarily changed "set point" in order to cope with one kind of stress: a fever. Under the stress of an infection, the brain may reset the body temperature set point from 98.6 degrees F to 102 degrees F. This is because at that raised temperature, the body’s immune system is much better at fighting infections. When the infection is gone, the body temperature set point returns to normal, and the fever is over.

In the case of addiction, the change in hedonic set point gets "stuck" and will stay that way until a

real coping mechanism (not a drug) is introduced to relieve the underlying stress.

8. Is there any connection between drug and/or alcohol addiction and eating disorders such as bulimia? If so, what is it?

When I read the research that revealed that all drugs of abuse cause the increase of dopamine concentration in the limbic reward structures of the brain, I wondered if

only drugs could cause such an increase. If dopamine is the currency of pleasure and reward in the brain, and addiction is a defect in dopamine processing, then shouldn’t anything that is pleasurable cause such an increase in dopamine – and potentially be addictive, too?

It turns out, that is correct and it was known long before I thought of it. We see close relationships between

chemicals that involve addiction and behaviors that involve addiction. This is especially true with eating disorders.

People with eating disorders value a high degree of control over their body weight. Major stimulants are excellent at helping them to do this – especially amphetamines. We see a high correlation between methamphetamine addiction and eating disorders like Bulimia Nervosa.

In the past, patients came to drug treatment and only their addiction to their drug of choice was addressed. Now we are realizing that we must address

both the drug addiction and the behavioral addiction to fully help the patient overcome the back-and-forth synergistic effect between the two.

9. How common is it for someone to have two separate addictions at the same time; in other words, they are addicted to both cocaine and sex?

It is common enough that once I know the patient’s drug of choice, I immediately start looking for the secondary drug of choice – or

behavior of choice – that might be paired with the core addiction and even contributing to it.

There are some drugs that I especially expect to be accompanied by a secondary addiction. I have a theory that

all (well, let’s say 99%) stimulant abuse, cocaine and methamphetamine, in men is about one thing: sex. And that sex is about one thing: anger. If I am only addressing the drug in treatment, without dealing with other two, then I am Kevin T. McCauley, M.D.

not fully treating the patient. It is entirely likely that the addict in treatment – while abstinent from their drug of choice – continues to use the secondary drug/behavior to cope in the absence of the primary drug. If this occurs, relapse once the person is discharged is highly likely because, in essence, the addict really never stopped using while they were in treatment. The secondary drug/behavior will lead the patient back to their primary drug if not dealt with. In addition, if a patient is experiencing particularly bad cravings it may be the use of the secondary drug/behavior that is perturbing the hedonic system into seeking the primary drug.

In stimulant addicts, especially men, I expect to see compulsive use of sexual behaviors (masturbation, pornography, inappropriate liaisons) as part of the early recovery process. This should not be a source of shame – it is part of the common clinical picture. Classically, stimulant drugs are used to enhance sexual experiences. Recovery from stimulant drugs will have to include a change in the use of sexual behaviors. I also expect that work on anger issues will ameliorate much of the preoccupation with the drug and with sex.

This is, by the way, a good reason to segregate the genders in drug treatment centers. Stimulant addicts tend to hook up in treatment – not because they are promiscuous, but because they are suffering severe discomfort as a result of the removal of their drug from their coping armamentarium, and because they have learned that sex can be used in a pinch to cope. These relationships in treatment are often terribly likely to result in relapse, and are particularly destructive to the woman’s recovery. For this reason, gender segregation will probably become the standard of practice in addiction treatment in the future. Men get sober with other men. Women get sober with other women. Only in the context of gender-specific treatment and twelve-step meetings are stimulant addicts likely to get to the more personal and loaded issues that drove their addiction.

10. Do you have any idea how common it is for doctors to develop addictions, whether we hear about it or not?

Most research indicates that doctors and other health care professionals do not have a higher prevalence of addiction than other professions. I think the cause for concern about addiction in healthcare professionals is the easy access to controlled medications along with the potential for disaster due to the high-risk nature of working on patients. State medical boards (led by a few pioneering physicians in addiction medicine) have been very successful in minimizing the risk of untoward outcomes for patient and physician alike by instituting diversion programs for impaired physicians. These programs have proven themselves to be so successful that other professions (aviation, legal, and managerial, for example) have duplicated them.

Professional organizations have found that they have a greater margin of safety if they have programs that allow the addict or alcoholic to self-refer themselves to treatment and ongoing monitoring of abstinence in the context of continued employment. Interestingly, these programs are based on those first developed by the U.S. military in the days prior to zero-tolerance. These programs allow for retention of personnel and training assets as well as providing a "vicarious learning" process for other individuals who may want to seek help for alcohol and drug problems. Professional programs for Kevin T. McCauley, M.D.

doctors, pharmacists, lawyers, dentists, nurses, pilots and others have enjoyed

astronomical success rates for long-term recovery.

I do not see why other workers, besides professionals, could not benefit equally from similar programs. I would like to see self-referral addiction treatment and monitoring policies in place for all employed individuals at various levels throughout the nation’s workforce. This would allow us to identify the patient’s addiction at its earliest stages, initiate appropriate treatment and arrest the addiction before it could progress to a point where intervention is more difficult. I think if we thought of addiction medicine in terms of occupational medicine, the morbidity and mortality caused by addiction would diminish dramatically in this country.

11. Does it help for someone to have been through addiction himself/herself in order to effectively treat it in another person?

I look at the issue of addicts in recovery entering the field addiction medicine in the same way I look at male doctors entering the field of gynecology: some patients do not want a male gynecologist, some don’t – but gender is not necessarily a bar to delivering competent, compassionate care. There are talented, helpful and sought out men working in gynecology in the same way there are talented, helpful and sought out non-addicts working in the field of addiction medicine for the simple reason that a past history of addiction is not a prerequisite for empathy for the addicted patient. So I would leave the choice up to the patient.

Interestingly, there is a strong current in addiction research that shows that the variable most predictive of treatment success is the interpersonal functioning of the professional delivering that treatment. Additionally, the act of

identification of the professional with the addict (sympathy) has been shown to be detrimental to long-term sobriety. This speaks to the fact that the treatment professional’s own experience (as well as the kind of treatment he or she delivers) has less influence on long-term sobriety than simply the degree of empathy shown toward the patient.

12. As someone at the forefront of addictions and treatment, can you tell me if you have seen any trends on either side?

Your question implies a division between trends in addictions and trends in addiction treatment. I will answer each in turn.

With regard to current and future trends in addictions themselves, there is still a strong emphasis these days on the use of M.D.M.A. ("ecstasy") and the controversy over whether or not the drug causes permanent damage to serotonogic neurons in the brain (possibly predisposing the user to Major Depression). I notice that most of the people I see presenting themselves for treatment for ecstasy addiction are sent by their parents or come due to a job or legal requirement. I do not see a lot of self-referral for ecstasy abuse or addiction, and I am not willing to speculate on what that means.

I am pleased to see a continuing emphasis on getting Oxycontin abusers and addicts into treatment. I think users of this narcotic preparation have a higher prognosis than the average heroin addict who presents to treatment (that is not to say that heroin addicts do not get sober all the time), so I am encouraged that Oxycontin users (and users Kevin T. McCauley, M.D.

of other prescription narcotic preparations) are seeking treatment prior to graduation to heroin.

Club drugs other than ecstasy (GHB, Rohypnol) get a tremendous amount of media attention but are a very small percentage of those coming to treatment.

Methamphetamine abuse and addiction continues to be strong in the western U.S. with increasing incidence in Rocky Mountain and Midwest states, although I hear that the quality of the meth has diminished markedly from the meth addicts coming to treatment. The usage of meth use has been moving eastward for some time, with the line currently about Ohio and Appalachia. There is concern that meth use will surge again as it reaches the eastern U.S. seaboard, especially since the current trendy drug there - cheap, high-grade heroin – may become scarce due to the war in Afghanistan.

With regard to trends in treatment, the shift away from "one size fits all" treatment continues in settings geared to middle class and upper-middle class patients. For low-income and fixed-income populations, access to treatment is still limited and the nature of the treatment that is available tends to be twelve-step, non-medical model and generally punitive. I continue to be optimistic that the general turn away from past punitive treatment tactics will continue as more medical/pharmacologic adjuncts become available such as buproprion and naltrexone treatments.

Lastly, the recognition of the needs of special populations (elderly, dual-diagnosis, battered women, gay and lesbian) who are entering addiction treatment is growing – a trend that I think will help patients who in the past were lost to treatment because of a lack of support groups for these patient populations.

13. What do you believe is the most effective method(s) for treating addiction?

Treatment should be tailored to the individual and his or her special needs. Some patients can go to outpatient treatment and get a good start at recovery. Other patients will need a higher level of care including inpatient treatment followed by a long-term sober living environment. Generally, the length of time spent in treatment correlates with long-term abstinence but the intensity of the treatment (inpatient vs. outpatient) may not be as crucial.

Of course, I have a strong personal prejudice against treatments that are more punitive, including behavior modification, therapeutic community model and social model treatment centers. Although there are patients who are appropriate for these modalities, and I would not want to deny them the opportunity, I do not believe these treatments should be the first line treatment choice

in any circumstance. I believe Medical Model/Minnesota Model treatment approaches are the best first line treatment choice.

For those patients who are not yet willing to consider abstinence, there is a growing body of addiction professionals who will consider treatment methods that do not insist on immediate abstinence as a requirement for initiation of therapy. Modalities such as Motivational Interviewing and the Matrix Model are being embraced, albeit slowly, by professionals as a means of helping patients who in the past were barred from addiction treatment.

My standard recommendation for any severe addiction remains: thirty day detox/inpatient treatment, immediate transition to an outpatient day treatment center with Kevin T. McCauley, M.D.

a sober living environment for three to six months, subsequent weekly random urine testing, weekly consultation with a licensed therapist or attendance of group therapy, and monthly consultation with a certified addictionologist for the first one to two years sober, preferably two years. All of this should of course occur in the context of regular A.A./N.A. attendance and a good, working twelve-step program. I have not yet seen any unfavorable outcomes in those who have followed this regimen. This is consistent with my experience treating pilots with addiction and my belief that if addressed fully and quickly the first time around, the addiction goes into remission quite nicely.

14. Must one suffer in order to obtain sobriety? How important is punishment in the treatment process?

If suffering and/or punishment worked to fix addiction, even a little, than the U.S. should have the highest treatment success rates of any country in the world. I am not sure why a treatment center would

ever consider it appropriate to use punishment in the treatment of any patient, but sadly I must confess to you - it happens. I am quite certain that punishment only serves to further cement the addiction into place. In fact, I spend a lot of my time trying to unscrew the mess a previous treatment professional has made by punishing the addict who now comes to me because the past punitive treatment did not work.

I think it comes down to whether or not the treatment professional believes that addiction is a disease or not. Unfortunately, sometimes everything that we

say about addiction being a disease is undermined by the fact that everything we do shows that we do not really believe it ourselves. If we do not show some integrity in our beliefs by demonstrating them in our actions, why should we demand that the patient show it?

If addiction really is a disease (it is), then that means that addicts are patients just like any other patient who seeks treatment. That means that addiction has parity with every other disease – and if you cannot punish a diabetic in order to get their blood glucose down, that means you cannot punish an addict either. Why should we think that the disease of addiction would respond to punishment when other diseases do not? By definition, diseases do not respond to punishment.

Not only that, when addiction fit the disease model there were BIG implications ethically – that meant that the biomedical ethical principles that apply to the diabetic now also apply to the addict, and the addict has the same right to quality, compassionate, and effective care as the diabetic.

Most treatment professionals do not see the ethical follow-through to the statement that, "Addiction is a disease." They believe that they

must aggressively confront and punish the addict to break through their defense mechanisms. This is simply rubbish. Anytime one group of patients is parsed out from other groups of patients for suspension of ethical treatment, then all patients are in danger. The addiction treatment professional that tells me that they cannot see patients without these punitive tactics is really telling me that they cannot see patients at all. Not only is this reasoning clinically unsound but the law has also not supported such utilitarian logic - to the point of awarding large malpractice judgments against treatment professionals who do not get it. This is a good thing, as it will serve to improve the integrity of the field of addiction medicine. Kevin T. McCauley, M.D.

My belief is that treatment fails in the U.S.

because it is punitive. Take out the punishment, and the treatment success rates will go through the roof. I draw support for this belief from the fact that diversion programs for doctors, dentists, lawyers and pilots – all of which are non-punitive – show extraordinarily high success rates. A fellow flight surgeon and I conservatively estimate that the U.S. Navy has a 97% return to flying status rate in its treated alcoholic pilots.

97%.

Not 3%, or 13% or whatever other dismal number most treatment centers give.

But 97%!

I want that 97% for

all addicts. There is nothing so male, or white, or college educated about those Navy pilots that gets them sober and back into the plane faster than other people. The variable at work is the fact that the Navy does not punish them. There is nothing that the Navy gives to their pilots that we could not give to every American.

All it takes is a little courage not to punish sick people.