Treating Chemical Dependency and Co-Occuring Disorders

Our integrated treatment system addresses dual diagnosis (co-occuring substance abuse and mental health diagnosis) disorders simultaneously. Individualized treatment planning with certified, experienced counselors incorporates short and long-term goals to ensure that clients special needs are met. At the same time, continuing care planning assists the client in developing healthy strategies for maintaining sobriety after treatment.

Each dual diagnosis client consults with our staff physician to focus on adjusting treatment to fit their particular needs. In order to be effective, medications must be taken consistently. Often, addicts still "in the disease" have difficulties following through with medication schedules. At Support Systems Homes' treatment centers, when clients are prescribed medication, staff assist clients in developing a regular, consistent schedule that has the maximum potential of providing benefits.

Support Systems Homes recognizes the importance of coordinating services for clients with co-occurring disorders. Our treatment center staff provide transportation to outside appointments, work with the client's mental health team, help the client access the necessary resources, and encourage family involvement in the process of recovery.

We provide the following CARF-accredited services for those with co-occuring chemical dependency and mental health diagnoses: Detoxification, Residential Treatment, Day Treatment, and Outpatient services. Sober living environments that provide social and recovery support are available as well. Dual diagnosis clients are also encouraged to participate in free lifetime aftercare and Alumni activities after treatment.

Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services are often not well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them.

While the picture regarding dual diagnosis has not been very positive in the past, there are signs that the problem is being recognized and there is an increasing number of programs trying to address it. It is now generally agreed that as much as 50 percent of the mentally ill population also has a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs such as tranquilizers and sleeping medicines may also be abused. The incidence of abuse is greater among males and those in the aged 18 to 44. People with mental illnesses may abuse drugs covertly without their families knowing it. It is now reported that both families of mentally ill relatives and mental health professionals underestimate the amount of drug dependency among people in their care. There may be several reasons for this. It may be difficult to separate the behaviors due to mental illness from those due to drugs. There may be a degree of denial of the problem because we have had so little to offer people with the combined illnesses. Caregivers might prefer not to acknowledge such a frightening problem when so little hope has been offered.

Substance abuse complicates almost every aspect of care for the person with mental illness. First, these individuals are very difficult to engage in treatment. Diagnosis is difficult because it takes time to unravel the interacting effects of substance abuse and the mental illness. They may have difficulty being accommodated at home and may not be tolerated in community residences of rehabilitation programs. They lose their support systems and suffer frequent relapses and hospitalizations. Violence is more prevalent among the dually diagnosed population. Both domestic violence and suicide attempts are more common, and of the mentally ill who wind up in jails and prisons, there is a high percentage of drug abusers.

Given severe consequences of drug abuse for the mentally ill, it is reasonable to ask: "Why do they do it?" Some of them may begin to use drugs or alcohol for recreational use, the same as many other people do. Various factors may account for their continued use. Probably many people continue their use as a misguided attempt to treat symptoms of the illness or the side effects of their medications. By "self-medicating," they find that they can reduce the level of anxiety or depression -- at least for the short term. Some professionals speculate that there may be some underlying vulnerability of the individual that precipitates both mental illness and substance abuse. They believe that these individuals may be at risk with even mild drug use.

Social factors may also play a part in continued use. People with mental illnesses suffer from what has been called "downward drift." This means that as a consequence of their illness they may find themselves living in marginal neighborhoods where drug use prevails. Having great difficulty developing social relationships, some people find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.

This overview of the problem of drugs and mental illness may not be a very positive one. However, there are some encouraging signs that better understanding of the problem and potential treatments are on the way. Just as consumers and families have faced other very troublesome problems in the past and developed adequate responses to them, they can also learn to deal with this one in a way that their lives become less troubled and better treatment is received.

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Treatment Programs For Those with Dual Diagnoses As many have probably discovered, service systems have not been well designed with this population in mind. Typically a community has treatment services for people with mental illness in one agency and treatment for substance abuse in another. Clients are referred back and forth between them in what some have called "ping-pong" therapy. What are needed are "hybrid" programs that address both illnesses together. Development of these programs locally requires considerable advocacy efforts.

Limitations Of Traditional Drug Treatment Programs Treatment programs designed for people whose problems are primarily substance abuse are generally not recommended for people who also have a mental illness. These programs tend to be confrontive and coercive and most people with severe mental illnesses are too fragile to benefit from them. Heavy confrontation, intense emotional jolting, and discouragement of the use of medications tend to be detrimental. These treatments may produce levels of stress that exacerbate symptoms or cause relapse.

Characteristics Of Appropriate Programs

Desirable programs for this population should take a more gradual approach. Staff should recognize that denial is an inherent part of the problem. Patients often do not have insight as to the seriousness and scope of the problem. Abstinence may be a goal of the program but should not be a precondition for entering treatment. If dually diagnosed clients do not fit into local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups, special peer groups based on AA principles might be developed.

Clients with a dual diagnosis have to proceed at their own pace in treatment. An illness model of the problem should be used rather than a moralistic one. Staff need to convey understanding of how hard it is to end an addiction problem and give credit for any accomplishments. Attention should be given to social networks that can serve as important reinforcers. Clients should be given opportunities to socialize, have access to recreational activities, and develop peer relationships. Their families should be offered support and education.

Advocacy For Effective Treatment

If no appropriate programs exist in the community, families of dually diagnosed persons may need to advocate for them. References listed below describe a number of experimental programs that can serve as sources of information. Advocacy should also be directed at research and training. One program (Sciacca,1987) uses an educational approach and recognizes the tendency for dually diagnosed individuals to deny their problem. The client does not have to recognize or publicly acknowledge that he or she has a problem. Clients meet in a group and talk about the issue of substance abuse, view videotapes and involve themselves in helping others. Only later do members get around to talking about their problem and the potential for treatment. A non-confrontational style is maintained throughout. Rather than send participants to AA or NA, members of these groups are invited to visit the agency. Eventually some of Sciacca's groups do go to AA and NA.

Recognizing The Problem

As mentioned, many families do not recognize that their mentally ill member also has a substance abuse problem. This is not surprising because many of the behavioral changes that lead to suspicion of drug problems in other people already exist in persons with mental illness. Therefore, such behaviors as being rebellious, argumentative, or "spacey" may be less reliable clues in this group. Observation of some of the following behaviors, however, may put families on the alert:

Suddenly having money problems Appearance of new friends Valuables disappearing from the house Drug paraphernalia in the house Long periods of time in the bathroom Dilated or pinpointed eyes Needle marks

Of course, there are also those individuals who react strongly to drugs and alcohol and whose unusually chaotic behaviors leave little doubt regarding the use of drugs.

Addressing The Problem

This may or may not involve confronting the individual. It is usually best not to immediately and directly accuse the individual of using drugs because denial is a likely response. Unless one has irrefutable evidence, the person is entitled to be presumed innocent. What one can object to are behaviors, whether or not they are known to be influenced by drugs, which are interfering with family life.

These behaviors may take any number of forms: apathy, irritability, neglect of personal hygiene, belligerence, argumentativeness, and so forth. Since the problem of drug use is a very serious and complicated matter, it should be addressed in a careful deliberate manner. It is best not to try to deal with the individual when he or she appears to be under the influence of drugs or alcohol, nor when family members are feeling most emotionally upset about the situation. Avoid making dire threats such as calling the police, resorting to hospitalization, or exclusion from the home unless you really mean to do it. There is a risk that you may say things under the stress of the situation that you don't mean. It is important that your relative knows where he or she stands with you and that you mean what you say.

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Developing A Plan Of Action

Since it is likely to be difficult at best, select a time when things are relatively calm to decide what to do. Involve as many members of the family as possible and develop an approach all can agree upon.

Then the family must follow through. This works better if alternate housing can be arranged ahead of time so that the streets do not become the only option. Families often ask if the family should insist on total abstinence from all drug use. While authorities in the field point out that abstinence is by far the safest option, some families may find that tolerance of occasional use or agreement to cut back may get reasonable cooperation whereas insistence on total abstinence will result in denial and inability to communicate further on the subject. Recreational drugs and alcohol and prescribed medications might have serious interactive effects. Clients and families need to be fully informed about these possibilities.

Support And Self-Care For The Rest Of The Family

Coming to terms with chemical dependency of a mentally ill relative does not come easily. For a time, it may just feel too painful, too bewildering, too overwhelming to face. The family may feel terribly angry at the ill person and blame him or her for seeming so stupid, so weak-willed as to add problems of substance abuse to an already highly disturbed life. Feelings of anger and rejection, unfortunately, do not help the situation and can delay rational thinking about how to approach the situation. Parents and siblings may be hurt because the addicted person blames others for his or her problems and breaks trust by lying and stealing, and in general, by creating chaos throughout the household. A great deal of fear and uncertainty may prevail as behavior becomes more irrational and violence or threats of violence increase. Members of the family may feel guilty because they feel their relative's substance abuse is in some way their fault.

First, it is important to realize that substance abuse is a disease. The person who is truly addicted is no more able to take control of this problem without help than he or she is able to take control of their mental illness. Thinking of this problem as a disease may reduce the sense of anger and blame. Family members may learn to take negative behaviors less personally and feel less hurt. People may cease blaming themselves and each other for a disorder that no one could have caused or prevented. Coming to terms with substance abuse in someone you love will take time. It will be easier if the family can close ranks, avoid blaming each other, agree on a plan of action, and provide support to each other.

It is also important to seek support from other families who are dealing with similar problems. This subset of families in the local NAMI affiliate may find it beneficial to meet separately at times to provide support in a way best done by other people who also have the problem. Families may want to investigate their local Al-Anon and/or Narcotics Anonymous (NA) groups. These support groups have proven to be immensely helpful to some families.

Finally, families should realize they cannot stop their relative's substance abuse. They can, however, avoid covering it up or doing things that make it easy for the person to continue the denial. Families can learn what they can do about the problem, but they must be realistic that much of it is out of their hands. With great effort, some of the painful emotions will subside, members will feel more serene, and life can be worthwhile again.

For the most comprehensive information about Depression, visit our Depression Community Center here, at HealthyPlace.com.

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Health Care Providers Should Be Prepared

People who have major mental illnesses often have co-occurring substance abuse disorders

Conversely, individuals with substance abuse disorders often have co-occurring psychiatric disorders. But are the substance abuse problems of patients with major mental illnesses less severe than those of patients in substance abuse treatment? Are the psychiatric disorders of patients receiving substance abuse treatment less severe than those of psychiatric patients? Scientists at the University of California-San Francisco conducted a study that addressed these questions. They compared, at treatment entry, 120 substance abuse patients who had co-occurring psychiatric disorders with 106 psychiatric patients who had co-occurring substance abuse disorders. Both patient groups were in public, acute-crisis, residential treatment programs, within either the mental health or substance abuse treatment systems.

The researchers speculated that the relative absence of differences between the two patient groups would suggest that the prevalent practice of specialized treatments in separate systems of care for comorbid patients was not clinically indicated.

Dr. Barbara Havassy and her colleagues determined patients' DSM-IV (the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychiatric and substance abuse diagnoses and assessed severity of drug abuse and psychiatric symptoms. Few differences between the comorbid groups emerged. There were no diagnostic differences except for those with schizophrenia spectrum disorders.

These disorders were slightly more common among psychiatric than substance abuse patients; nevertheless, nearly one-third of substance abuse patients were diagnosed with this disorder. Furthermore, although more substance abuse than psychiatric patients reported recent drug abuse, the average days of drug abuse, among those in each group who reported drug abuse, was not different.

Health care providers should recognize the associative nature of drug abuse and mental illness. Substance abuse treatment providers should be prepared to treat patients with severe mental illness. Likewise, mental health treatment providers should be prepared for patients with severe drug problems and long histories of abuse.

Other providers and programs, independent of the treatment system, should be aware of the potential for co-occurring disorders and be prepared to offer interventions to their patients.

The researchers published this study in the January 2004 issue of the American Journal of Psychiatry.

For the most comprehensive information about Depression, visit our Depression Community Center here, at HealthyPlace.com.

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Bipolar disorder and alcoholism commonly co-occur. Multiple explanations for the relationship between these conditions have been proposed, but this relationship remains poorly understood. Some evidence suggests a genetic link. This comorbidity also has implications for diagnosis and treatment. Alcohol use may worsen the clinical course of bipolar disorder, making it harder to treat. There has been little research on the appropriate treatment for comorbid patients. Some studies have evaluated the effects of valproate, lithium, and naltrexone, as well as psychosocial interventions, in treating alcoholic bipolar patients, but further research is needed.

Bipolar disorder and alcoholism co-occur at higher than expected rates. That is, they co-occur more often than would be expected by chance and they co-occur more often than do alcoholism and unipolar depression. This article will explore the relationship between these disorders, focusing on the prevalence of this comorbidity, potential theoretical explanations for the high rates of comorbidity, effects of comorbid alcoholism on the course and features of bipolar disorder, diagnostic issues, and treatment of comorbid patients.

Bipolar disorder, often called manic depression, is a mood disorder that is characterized by extreme fluctuations in mood from euphoria to severe depression, (symptoms of bipolar disorder) interspersed with periods of normal mood (i.e., euthymia). Bipolar disorder represents a significant public health problem, which often goes undiagnosed and untreated for lengthy periods. In a survey of 500 bipolar patients, 48 percent consulted 5 or more health care professionals before finally receiving a diagnosis of bipolar disorder, and 35 percent spent an average of 10 years between the onset of illness and diagnosis and treatment (Lish et al. 1994). Bipolar disorder affects approximately 1 to 2 percent of the population and often starts in early adulthood.

There are a number of disorders in the bipolar spectrum, including Bipolar I disorder, bipolar II disorder, and cyclothymia. Bipolar I disorder is the most severe; it is characterized by manic episodes that last for at least a week and depressive episodes that last for at least 2 weeks. Patients who are fully manic often require hospitalization to decrease the risk of harming themselves or others. People can also have symptoms of both depression and mania at the same time. This mixed mania, as it is called, appears to be accompanied by a greater risk of suicide and is more difficult to treat. Patients with 4 or more mood episodes within the same 12 months are considered to have rapid cycling bipolar disorder, which is a predictor of poor response to some medications.

Bipolar II disorder is characterized by episodes of hypomania, a less severe form of mania, which lasts for at least 4 days in a row and is not severe enough to require hospitalization. Hypomania is interspersed with depressive episodes that last at least 14 days. People with bipolar II disorder often enjoy being hypomanic (due to elevated mood and inflated self-esteem) and are more likely to seek treatment during a depressive episode than a manic episode. Cyclothymia is a disorder in the bipolar spectrum that is characterized by frequent low-level mood fluctuations that range from hypomania to low-level depression, with symptoms existing for at least 2 years (American Psychiatric Association [APA] 1994).

Alcohol dependence, also known as alcoholism, is characterized by a craving for alcohol, possible physical dependence on alcohol, an inability to control one's drinking on any given occasion, and an increasing tolerance to alcohol's effects (APA 1994). Approximately 14 percent of people experience alcohol dependence at some time during their lives (Kessler et al. 1997). It often starts in early adulthood. Criteria for a diagnosis of alcohol abuse, on the other hand, do not include the craving and lack of control over drinking that are characteristic of alcoholism. Rather, alcohol abuse is defined as a pattern of drinking that results in the failure to fulfill responsibilities at work, school, or home; drinking in dangerous situations; and having recurring alcohol-related legal problems and relationship problems that are caused or worsened by drinking (APA 1994). The lifetime prevalence of alcohol abuse is approximately 10 percent (Kessler et al. 1997). Alcohol abuse often occurs in early adulthood and is usually a precursor to alcohol dependence (APA 1994).

Susan C. Sonne, PharmD, and Kathleen T. Brady, M.D., Ph.D.
Susan C. Sonne, PharmD, is a research assistant professor of psychiatry and behavioral sciences and clinical assistant professor of pharmacy practice, and Kathleen T. Brady, M.D., Ph.D., is a professor of psychiatry and behavioral sciences, both at the Medical University of South Carolina, Center for Drug and Alcohol Programs, Charleston, South Carolina.

For the most comprehensive information about Depression, visit our Depression Community Center and about Bipolar, visit our Bipolar Community Center, here, at HealthyPlace.com.

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Joseph Volpicelli M.D., Ph.D., our guest, pioneered the use of therapy combined with medications to treat alcoholism. In his new book, "Recovery Options:The Complete Guide , Dr. Volpicelli explains all the options to treat alcoholism. (find here the basics of alcohol abuse treatment)

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Medical Treatment of Alcoholism". Our guest is Joseph Volpicelli M.D., Ph.D. Dr. Volpicelli is an Associate Professor of Psychiatry at the University of Pennsylvania and Senior Scientist at the Pennsylvania VA Center for Research on Addictive Disorders.

During the past quarter century, he has pioneered the integration of medications with psychotherapy support to treat addictions. His research on the use of Naltrexone led to the first new medication to be approved by the FDA for alcohol treatment in nearly 50 years. Dr. Volpicelli is also the author of the book: "Recovery Options: The Complete Guide".

Good Evening, Dr. Volpicelli, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Have we arrived at the point yet where there are medications available that will stop, or greatly reduce, the alcoholic's craving for alcohol? (How much is too much alcohol?)

Dr. Volpicelli: Thanks for the introduction, David, and its a pleasure to be here. To answer your question, I believe that we now have effective medications that can greatly aid in recovery from alcoholism. Medications such as Naltrexone can very effectively reduce the craving for alcohol and reduce the chance of a relapse.

David: What medications are available today to help alcoholics and what do they do?

Dr. Volpicelli: The two medications that are approved in the United States are Antabuse, a medication that when combined with alcohol can make you feel ill. And in 1994, a new medication was approved by the FDA, Naltrexone. This is a new class of medication, that can actually reduce the desire to drink and the "high" one gets from drinking. People may have heard of several newer medications that are being tested such as Acamprosate (Campral) and Ondansetron. These medications may be helpful for certain types of alcoholics.

David: Is there any conclusive research out yet, that indicates a physiological reason why a particular person becomes addicted to alcohol?

Dr. Volpicelli: There are several studies that clearly point to a genetic basis for why some people become addicted to alcohol. We have conducted studies that show the release of endogenous opioids (endorphins) is higher in people at risk of becoming an alcoholic. Also, some people may be protected from abusing alcohol because they are very sensitive to the sedative effects of alcohol. They fall asleep before they experience the alcohol "high".

David: What, would you say is the most effective long-term treatment for alcohol addiction?

Dr. Volpicelli: I believe that alcoholism is a biopsychosocial disorder and the best long-term approach to treatment is to combine a biopsychosocial approach. This includes the use of medications such as Naltrexone, and also psychosocial support to help people learn to cope with life without alcohol. Often people have damaged their social relationships from their alcohol addiction, so recovery includes reconnecting with family and friends. For some people, support groups like Alcoholics Anonymous (AA) are helpful, especially in reducing the shame associated with having an alcohol problem. In general, the best approach is individualized to meet the needs of the patient.

David: The relapse rates among alcoholics are very high. Some 50% relapse within three months of starting treatment and 75% within the first year. Can we say that therapy alone, whether it be a 12-step program like Alcoholics Anonymous (AA) or a residential treatment program or individual therapy just isn't that effective for most alcoholics?

Dr. Volpicelli: I would say the glass is half full. Psychosocial treatments are effective for some people, and even among people who relapse, one can often get them back into treatment. Of course, if we can combine medications and reduce the relapse rates further, as appears to be the case, then it is wise to use every available tool to aid in recovery from alcoholism.

David: Here are some audience questions, Dr. Volpicelli:

mwolff: What are the major side-effects of Naltrexone?

Dr. Volpicelli: Most people taking Naltrexone do not report significant side-effects. However, when side-effects are reported, they are often mild and disappear in a few days. These side-effects include nausea in about 10% of people, and for some, tiredness, headaches, or irritability. We can often manage the side-effects by giving Naltrexone at night or with food. On those rare occasions when side-effects persist, Pepto-Bismol can help.

jeffgrzy: How can medication get rid of a craving for alcohol, when cravings are beyond the physical, such as selfishness, resentments, fears, and ego?

Dr. Volpicelli: There are now several studies that show how emotions can affect brain chemistry. So for example, feelings such as anger or fear, cause biochemical changes in the brain and can increase the craving for alcohol. The use of medications can help block craving for alcohol caused by unpleasant moods or even reminder cues for using alcohol.

aurora23: How do you know if you are an alcoholic or just a social drinker?

Dr. Volpicelli: The best way to decide is to ask yourself: how well can you control your drinking once you start? For alcoholics, it is said in Alcoholics Anonymous (AA) that one drink is too many and 100 drinks not enough. This points out that for the alcoholic, one drink increases the desire to have the next drink creating a vicious cycle of alcohol addiction. This addictive cycle typically leads to problems with physical, psychological, or social health. The social drinker, on the other hand, is able to limit their drinking once they start.

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David: One of the other medications I've seen mentioned recently is Ondansetron, an anti-nausea drug used for cancer patients. Is that similar to the effects of Antabuse?

Dr. Volpicelli: Ondansetron is a medication that blocks certain serotonin receptors. It appears to be helpful in a group of alcoholics who have an early onset of alcoholism, like those under twenty-five years of age. It may be that for certain types of alcoholics, medications such as Ondansetron can help reduce the desire to drink and the amount of drinking that occurs once a drinking episode begins. It does not work like Antabuse by making you sick. Rather, we are still trying to learn how it may work.

Spiced: What distinguishes the reaction of an alcoholic's brain to alcohol from that of a non-alcoholic's?

Dr. Volpicelli: The excitement or high that one obtains from alcohol, often differentiates alcoholics from social drinkers. I have had some patients tell me, that the first time they drank, they experienced a wonderful euphoria, unlike anything they had experienced before. This pleasure seems to be related to changes in brain neurotransmitters such as endorphins or dopamine that cause the "high" from alcohol. There may be a day, when we can predict who is likely to abuse alcohol, based on the brain's response to alcohol.

ammat: How do you reassure a prospective patient that treating one addiction with a drug won't lead to another addiction (e.g. taking pills)?

Dr. Volpicelli: Excellent question. Many people fear that medications such as Naltrexone are a crutch, or worse yet, can lead to addiction themselves. However, naltrexone is not addictive, and does not have psychoactive effects on its own, rather it blocks the psychoactive effects of other drugs.

As we learn more about the brain chemistry of addiction, we will find that alcoholism is not that different from other chronic medical disorders, such as diabetes or hypertension. While we can often control these other chronic diseases with diet and exercise, for some people, medications offer the best hope for treatment and to avoid future complications. That is why it is fortunate that medications are now an option for the treatment of alcoholism.

Manyhats: Would Naltrexone help someone who wants to moderate their drinking?

Dr. Volpicelli: Naltrexone has been suggested by some people as a way to moderate drinking. My own bias is that Naltrexone, while it can limit drinking episodes to just a few drinks, is best used with a program that promotes abstinence. Having said this, I do have some patients who choose to have a drink now and again, and find that Naltrexone is an excellent aid in limiting their drinking.

ALL4UBABY: Do you think that it doesn't matter what medication you take to get rid of the main problem? Will this lead to cause another problem? Is this true, and if so, what is the point in taking medication?

Dr. Volpicelli: I have treated hundreds of patients with Naltrexone, or other medications, as part of a whole biopsychosocial approach to treatment. Naltrexone does not make all of one's life's problems to go away. Rather it is a tool to help people remain sober and to help people not experience the intense craving for alcohol, so that they can learn to cope with issues that may have contributed to their drinking.

For example, several patients have told me that without Naltrexone, they had to "white knuckle" their first several months of sobriety and all they could concentrate on was not drinking. On Naltrexone, they felt less obsessive desire to drink and could focus on the main issues.

David: Correct me if I'm wrong Dr. Volpicielli, but what you are saying is: the medications help control the physical craving for alcohol, but that doesn't mean the psychological issues have gone away. And for that, you need therapy.

Dr. Volpicelli: That is exactly right, David. No medication can solve your problems with your spouse or boss. However, drinking alcohol certainly does not help one solve any problems. So, if you can control the drinking, then you have a much better chance to cope with psychological issues.

Spiced: Can you enlighten us briefly, on what is behind a craving for alcohol?

Dr. Volpicelli: There are several theories, but one biological theory is that when you think of alcohol, or see something that reminds you of drinking alcohol, the brain releases chemicals that "prime" the body for alcohol. These chemicals stimulate the desire to drink and can be associated with real physiological changes such as salvation. It is like an itch that needs to be scratched. Now if one can distract oneself long enough, the craving may go away. But for some people, the craving for alcohol is so strong that they decide they need a drink to reduce the craving.

mwolff: My biggest problem without alcohol is insomnia!! Any suggestions?

Dr. Volpicelli: Yes, often insomnia is present in the early stages of recovery from alcoholism, as the body adjusts to not having alcohol. For people with chronic insomnia, there are behavioral strategies such as getting into a daily routine of going to bed. For some people, the use of medications such as Trazodone may help initiate sleep.

David: Are any of the medications we've talked about tonight effective for binge drinkers? (What is binge drinking and binge drinking stats here.)

Dr. Volpicelli: There have been a couple of studies that show that Naltrexone is effective for binge drinkers. Naltrexone reduces the binge from over five drinks per drinking episode, to just a couple of drinks. Also, newer medications such as the SSRI's may help reduce the number of binges, but more research is needed.

David: Besides the medications, are there any medical techniques that reduce the desire to drink or is therapy the only thing left?

Dr. Volpicelli: At Penn, we have developed new behavioral treatments to help alcoholics stay in treatment longer, and adhere to taking their medications. We call this new approach the BRENDA approach because it stands for:

• Conducting a thorough Biopsychosocial evaluation
• Giving people a Report of how their drinking is causing problems
• Using Empathy to help people feel understood by the therapist
• Understanding the person's Need for wanting to recover
• Offering Direct advice
• Followed by Assessing the response to direct advice

We finish that, by maintaining a non-confrontational, non-judgmental approach to treatment and giving people options. Most people will stay in treatment and recover. With the BRENDA approach and the use of medications, we have observed about an 80% success rate in helping people recover.

David: You can purchase Dr. Joseph Volpicelli's book: "Recovery Options: The Complete Guide" by clicking here.

Thank you, Dr. Volpicelli, for coming tonight and sharing this information with us. We appreciate it. And thank you to the audience for coming and participating. I hope you found it helpful.

Dr. Volpicelli: Thank you for inviting me.

David: Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Stanton Peele, Ph.D. , our guest, is a psychologist, author, lecturer and lawyer. We discussed addiction and recovery, his beliefs about why people become addicted and the addiction treatment process including the AA (Alcoholics Anonymous) 12-step approach to treatment for addictions.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "An Alternative View of Addiction and Recovery." Our guest is a psychologist, author, lecturer and lawyer, Stanton Peele, Ph.D. Dr. Peele has some strong and non-mainstream beliefs about addictions and the addiction treatment process.

Good evening, Dr. Peele and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Much of the mainstream medical world believes that addictions have some sort of genetic and/or biological component. You have a different viewpoint on why people become addicted to substances and destructive behaviors. I'd like to start off with having you explain that. (Extensive information on different types of addictions and addictions treatment in our Addictions Community Center.)

Dr. Peele: Even those engaged in genetic research recognize that claims commonly made on behalf of genetics -- e.g., that people inherit loss of control -- simply cannot be true. That is, the most optimistic claims are that people have some sensitivity to alcohol which influences the overall equation of addiction.

David: What, then, is your theory behind why people become addicted to certain substances and behaviors?

Dr. Peele: People utilize the effects of alcohol like they utilize other experiences: for the purposes of satisfying internal and environmental demands with which they are otherwise unable to cope.

The best example was the Vietnam experience, where soldiers took narcotics but largely desisted at home -- in other words, they used drugs as a way of adapting to an uncomfortable experience, but they rectified that in other circumstances.

David: To clarify then, what you're saying is that people become addicted to things because they can't cope with their environment any other way.

Dr. Peele: Yes, and they often shift in their reliance on drugs, alcohol, et al. depending upon shifts in their environments or as they develop the resources with which to cope.

One of the things most wrong -- and wrongheaded -- about disease theories of addiction is that they predict a one-way trip downhill. In fact, all data shows that the majority of people reverse addictions over time, even without treatment.

David: What are your thoughts about treatment for addictions?

Dr. Peele: Pretty dismal. We allow virtually only one type of treatment -- 12 step treatment -- which has been shown to be highly limited in its applicability. That is, we face this great contradiction -- people claim we have an unmatched and successful way of coping with addiction -- only, despite its popularity and imposition on so many people, we have increasing levels of addiction and alcoholism.

David: And what do you feel is wrong about the 12-step approach?

Dr. Peele: Other than this clear evidence that it has a limited positive impact on our society, I personally feel its model of human behavior is limited for most people ( especially the young) in its emphasis on powerlessness and self-sacrifice. I feel that for most people in most situations -- a belief in self and emphasis on enhanced skills and opportunity are the best keys to positive outcomes.

David: So for someone who is addicted to alcohol or cocaine, for instance, what would you suggest to them to help them overcome their addiction?

Dr. Peele: I don't think this is the best way to approach the problem -- to suggest to people what they might do.

People are struggling to improve their lives and to combat addiction all the time. I seek to help them develop the resources with which they may succeed. You know, people try to quit addictions -- like smoking -- for years. Ultimately, many succeed, and it's not because I gave them a great philosophy or treatment for addictions.

David: So are you essentially saying: "if you have an addiction problem, figure out what works best for you and do it? Eventually, you'll find the answer."

Dr. Peele: Often, this works. Of course, people seek help from me and others when they are discouraged, or we see recalcitrant individuals. In these cases, my job is like an interior explorer, to help examine their motivations, skills, opportunities, and deficiencies with them in order to develop a path out of the thicket.

Again, I am a helper -- people escape their own addictions. But I have seen how people summon their resources to do so, and I have some idea of which resources and ways of coping -- with stress, for example -- often accompany remission.

David: What about the idea that eventually, at some point in a person's life, they will outgrow their addiction?

Dr. Peele: This occurs remarkably often. In one colossal survey by the government of 45,000 people who had ever been alcohol dependent, and three quarters of whom had never sought treatment or AA (Alcoholics Anonymous), about two-thirds of the untreated were no longer dependent.

Obviously, many people do seek treatment, and of course many might not escape addiction without formal help. But when I perform such assistance, I see it as aiding the natural curative process, which is in itself so strong.

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David: We have some audience questions, Dr. Peele, so let's get to those:

Biancabo1: As an addiction counselor, often I have clients who have concurrent disorders. The latest research emphasizes treating both the substance problem and the mental health issue simultaneously. Do you agree?

Dr. Peele: I can't speak as an expert to dual diagnosis problems. I can say that I see the development of coping with one's environment to be critical to both. I also know that, in all emotional-behavioral disorders, people with added difficulties, one on the other, face greater difficulties in remission. I say this not to be pessimistic, but to express sympathy for the depth of the problem. At the same time, I am not at all discouraged that these individuals will be able to improve their lives as well. One last point -- we can't set impossible goals. One other thing wrong with our treatment is our insistence that remission means being perfectly good all of the time. A more incremental approach, embodied in harm reduction, will benefit more human beings.

David: Do you feel that a person with an addiction needs some sort of therapy, even if it's not a 12-step approach, to learn how to better cope with his/her environment?

Dr. Peele: No, not at all. What about the 45 million Americans who quit smoking? I do think that facilitative environments -- involving human support of one form or another, among other things, enable more people to succeed, but formal therapy is not a necessity.

Xgrouper: I still have a lot of anger about treatment. If I had known the first time, I would have never gone in due to the nature of the 12 step treatment they used. I went back a second time under pressure from my work and family but was miserable. If they would have told me upfront that there was a religious aspect to that program, I never would have gone in. I do not trust the recovery movement one little bit. I have a lot of anger towards addictions treatment centers and the 12 step community. What are your thoughts?

Dr. Peele: Well, now you are in my pipeline (I just published a book, "Resisting 12-Step Coercion.") There is no excuse for the amount of coercion in our system and the almost total absence of what is recognized as the necessity of informed consent in other areas of therapy.

Why are people so afraid to outline and accept alternative approaches, and to allow people to sample or try different approaches? So much of success is due to the conformance of the approach to the person's values and beliefs, this would indubitably improve outcomes.

David: Is there any value then, in your opinion, in "spirituality" in a person's recovery?

Dr. Peele: Spirituality as a requirement, among other things, violates American religious freedom. Of course, if a person is oriented that way -- just as if religion is a strong force in their life -- then this may be a valuable resource. I also believe in the value of having goals that go beyond one's own individual concerns. I come from a very community-oriented and political background.

The task becomes to seek out which values are most motivating and supportive to the particular individual. I often speak of my uncle Oscar, whose opposition to GE and capitalism caused him to quit smoking -- so he wouldn't be a sucker to the tobacco companies, but that doesn't "prove" that communism is the cure for cigarette addiction.

David: Here's the next question:

Annie1973: My husband has been fighting an addiction (crack cocaine, to be specific) for years now and is slowly getting better. His problem seems to be aggravated by success. He is a very intelligent, talented man. He has just learned of an upcoming promotion, and due to his past behavior, we are both a little worried this will bring on a relapse. Is there anything I can do or suggest to him to get through this without fail?

Dr. Peele: Forewarned is forearmed. An important ingredient in relapse prevention is:
(a) anticipating rough spots where relapse is likely; and
(b) imagining these moments and planning alternatives and resources to avoid relapse.

I would, as a therapist, ask your husband to imagine just when and why he will relapse, understand those dynamics, and then do a hell of a lot of planning for alternative outcomes at those key moments of challenge.

David: What are your thoughts about using medications, like Antabuse, to treat substance abuse?

Dr. Peele: I have lately become somewhat involved with some specialists, like Joe Volpicelli, (read Medical Treatment of Alcoholism Online Conference Transcript with Joe Volpicelli) who rely on naltrexone, which has shown some success. However, I would never rely on a medication by itself, or even primarily. I see it (like antidepressants) as clearing the space for building a substantial basis for sobriety. You need to be alert to plan, develop resources, create a supportive environment. But once engaged in these activities, I see them as being the substance and structure of improvement and non-addiction.

freakboy: I am not a religious person in any way, but find the 12 steps program very helpful. Are you familiar with the term "dry drunk," meaning to abstain but not necessarily being a happy person, or recovered, for that matter. Without some amount, some level of spirituality, one might just be living a false recovery. How do you deal with this type of issue in your approach?

Dr. Peele: Dry drunk seems to me to be a pejorative term employed at will by 12-step supporters. For example, I have seen it used when people quit without AA (Alcoholics Anonymous), or quit AA. Alternately, it can be used to excuse flimsy outcomes within AA. In other words, a person struggles to quit drinking but fails to attend to substantial life issues. This, for me, is a testimony to the limitations of AA.

But AA members can use this obvious -- if not failure, then at least less than fully adequate outcome -- as a way almost to justify their failure. They say, "he just didn't fully get it." I find this kind of recrimination against people who do not take well to, or succeed at the 12 steps, to be commonplace. In my approach, I follow people's leads. I take what they say is important to them and work in terms of that, not by imposing my views, values, and judgments on them.

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David: The 12-step approach is: an addict is an addict for life. If you stop ingesting the substance, you can't ever have it again or you will become addicted again. Do you believe that's true?

Dr. Peele: No. This kind of thinking is, in most cases, harmful and self-defeating. Not that there are not many people who should not avoid certain behaviors, certainly in the near-term. But virtually all alcoholics drink again -- the question is only how they view that drinking, how they cope with it, and where they proceed from taking that next drink.

David: So you're saying, "if you can handle it, fine. If not, then don't do it." Am I correct?

Dr. Peele: Not exactly, but good try. I say, "How are you going to make progress over the way you may previously have handled it." Remember, at any given moment, a microscopic number of people are quitting any addiction entirely. For the rest, we start at the worst outcomes -- how are you going to avoid killing yourself or others (as Audrey Kishline did)? This may involve turning your keys over to others, drinking in your basement, etc. I then turn towards the goal or minimizing all-out relapse, by getting people to cut off their binges, or returning to their goal of abstinence --meanwhile increasing the time between negative outcomes and the severity of these outcomes. In this larger picture, some people will quit altogether, and some will actually succeed at being controlled users, but if we limited our successes to just these people, we could not justify virtually any therapeutic effort.

You know, the government (through the NIAAA) just spent the largest amount of money ever on a clinical trial of psychotherapy. This was project MATCH, where 12-step, coping skill, and motivation enhancement therapists developed manuals, supervised training, and scrutinized therapy with a selected group of skilled therapists.

The ultimate result was declared a success by Enoch Gordis, director of the NIAAA. However, in order to do so, he was forced to rely on the fact that, overall, these alcoholics reduced their drinking from 25 to six days a month, and from 15 to 3 drinks per occasion of drinking. Gordis hates controlled drinking and often puts it down, but with this large, alcoholic population, improvement is the only way to see any progress -- the amount of absolute abstinence is bound to be minimal and discouraging.

sheka2000: What happened to admitting you have a problem, taking responsibility for that problem, and working on that problem.

Dr. Peele: I'm for that. But there are actually therapeutic techniques for assisting that process, called motivational enhancement. In brief, this involves exploring the individual's values, calling attention to conflicts between what that person him or herself considers important and their behavior, and then assisting them to channel this unpleasant realization in the direction of ameliorating the problem behaviors in which they are engaged.

sheka2000: That still comes from personal admission to a shortcoming, correct?

Dr. Peele: No, I wouldn't call it a shortcoming. I would call it a deficiency in the realization of one's goals and values. Perhaps this sounds like semantics, but I don't find people do best when others emphasize their weaknesses. Have you ever watched a daytime talk show where they bring in children who are acting out and then assign them to boot camp instructors who shout at and demean the kids? I don't believe people are best ready to change when they are assaulted like that. Rather, they do best when they feel the best about themselves.

joslynnn: In my experience, there is no sanity and no control once an addiction is in action. Do you consider this an extreme case?

Dr. Peele: Yes, and even in the most extreme cases -- of insanity as well as addiction--people frequently have moments of cogency and control. I think much is justified by claiming people have no control or ability to be aware of themselves. But this is rarely the case with most people, and never the case all the time with even the worst addicts.

scottdav: Would quitting of alcohol altogether, without some kind of taper in the amount being drunk beforehand, not be dangerous since the body has developed a physical need for the alcohol?

Dr. Peele: If you are looking for reasons why people might want to abstain, there are many. However, when someone has been drinking for years and decades, the idea that all of a sudden they must totally abstain seems alarmist, even when they are doing themselves considerable harm. Rather, we can avoid panic and try different approaches when we can realize that we cannot gain in several weeks what a person has failed to demonstrate for many years or several decades. Nonetheless, it may well be best for this person to aim for abstinence, or virtual abstinence, for their best health outcomes. But let me also remind you that, believe it or not, overall drinkers outlive abstainers. Of course, there are some drinkers who bring that average way down. But, and here is the strange contradictoriness of human existence, abstinence is a mortality risk factor.

David: Here are a few audience comments on what's been said tonight, then we'll take a few more questions:

Biancabo1: I have been involved in counseling people with substance abuse problems for the past 7 years, and I still find the most difficult aspect is letting go and trusting in the process, especially as it applies to the family members.

Xgrouper: Thanks for being here tonight. I am a big fan and visit your website for accurate and up-to-date information on today's issues. Keep it up, you are doing great things.

sheka2000: The 12-step approach has saved many lives, and created direction for many. My thought is if it works, why fix it? As a recovering addict, I gotta say that I disagree that there are moments of cognitive choices in the midst of addiction.

David: Here's the next question:

Steve1: Why is alcohol such an issue? So many other drugs are thrown at us to help us, but if you drink a beer--it's bad?

Dr. Peele: You may be a little different in your experience from most participants at this site. They are people involved, either personally or professionally, with alcoholic excess. Given that, we do not minimize the damage that many people suffer from alcohol. I did just say that much drinking is not only not harmful, but, ironically, has substantial benefits. I just published a massive research paper (in the current issue of Drug and Alcohol Dependence) finding that in a number of key areas of psychological functioning, including mental health and cognitive acuity, moderate drinkers are in better shape than abstainers, even lifelong abstainers (that is, not people who quit drinking).

scottdav: Would it not be more likely that the person would achieve better results by breaking down, giving up alcohol in steps, rather than aiming for the goal of giving up completely?

Dr. Peele: Often, yes, but not always, and it is hard to dictate that sort of thing. Of course, I might ask you, do you think most people do best by quitting smoking altogether, or by trying to cut down. The conventional wisdom is quitting altogether is necessary. I think this is overstated, even with tobacco, but it certainly seems to be pertinent for many people.

David: I know it's getting late. Thank you, Dr. Peele, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

Please feel free to stay and chat in any of the other rooms on the site. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com/. Thank you again, Dr. Peele, for being our guest tonight.

Dr. Peele: I welcome and appreciate this opportunity. People seemed to feel free to speak with a range of viewpoints. I hope they benefited from my views, and I know I enjoyed and benefited from theirs. Please do not hesitate to call on me again.

David: Good night, everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Perpetual Powerlessness and Never-Ending Recovery

Anne Wayman, author of the book Powerfully Recovered, joined us to discuss her view of 12 step programs, recovery, and powerlessness as these issues relate to substance abuse and addictions.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Addictions Treatment: Perpetual Powerlessness and Never-Ending Recovery."

Our guest tonight is Anne Wayman, author of the book Powerfully Recovered. Anne maintains that all the talk in 12-step programs, like Alcoholics Anonymous (AA), about perpetual powerlessness and never-ending recovery are simply false myths that are doing real damage to both 12 Steppers and to many who need recovery but refuse it.

Good evening, Anne, and welcome to HealthyPlace.com. Thank you for joining us tonight. Can you please tell us a bit more about yourself, who you are today, and also give us a feeling of your previous relationship with various substances?"

Wayman: Hello David and everyone! I'm glad to be here.

I'm a firm believer in the 12 Steps - recovered alcoholic and addict, currently living in San Diego - I'm a writer, a grandmother, a potter, etc.

David: How long were you dealing with substance abuse?

Wayman: Let's see, I first started getting drunk in college, but my father was in AA and I had been at AA meetings, so I knew how to change my pattern of drinking. I controlled, more or less (mostly less as time went on), my drinking until I had a car accident at 32 which sent me to the Program. I also claim addiction because I discovered I was abusing prescription drugs.

David: And this went on for how long?

Wayman: How long is... say... 18 to 32? I'm not good at numbers.

David: And then you started with your recovery. What did you to do recover from alcohol and drug addiction and how long did it take you?

Wayman: I came to my first AA (Alcoholics Anonymous) meeting at 32 and stayed sober from then on... not easily or gracefully, but I didn't slip... more by the grace of God than of my own efforts. It took about 5 years, give or take, to really settle in and start to feel like my skin fit.

David: So the audience knows, Anne has been clean and sober for 25 years. As I mentioned at the beginning, Anne has a different concept of what 12 step programs should be.

One thing I want to make clear, Anne. For years, you participated in Alcoholics Anonymous (A.A.), Narcotics Anonymous (N.A.), Debtors Anonymous (D.A.) and other 12-step programs and you learned a lot from them. They helped you in your recovery. Am I correct in saying that?

Wayman: Oh yes, and I still participate, but not as intensely. The 12 Steps act as my foundation. I also draw from all sorts of other things, spiritual, self-help, and my own intuition now.

David: Anne, we may have people here tonight who may not have a complete understanding of 12 step programs. So, for them, could you please briefly explain the concept of "powerlessness" and "recovery" from the 12-step program viewpoint?

Wayman: David, the first step says, "We admitted we were powerless..." and I've come to see that it means, before the steps, we are totally and utterly powerless over our addiction. But after we've worked through the steps well, and settled down, we needn't fear our addiction any more (not cured). What I hear so often around the tables is statements like "I'm powerless over everything in my life." Do you follow?

David: I do, and I want to explore that more in a few minutes. Could you also explain, from the 12 step point of view, the idea of "recovery."

Wayman: Hmmm, as we often hear it around the 12 step tables, recovery is the ongoing process of letting go of our addiction and the emotional problems that contributed to it. I believe, however, that we can become recovered - like it says in the forward to the first edition of the Big Book - recovered in the sense that we can get fully back to life, free of our addiction.

David: And when you use the term "Powerfully Recovered" (the title of your book), what do you mean by that?

Wayman: That the goal of any 12 Step Program is real freedom from addiction, that we can become 'recovered' in the sense of not being sick, and that we can take powerful action in our lives on our own behalf.

David: The two things I want to emphasize tonight is the idea of "powerlessness" over one's addiction and behaviors and secondly, that recovery is an ongoing process. Everyone who enters A.A., for example, is told that recovery is an on-going thing. However, after years of meetings, you found that less involvement in recovery and engaging more in the outside world and other activities was really helpful to you. How so?

Wayman: Recovery is ongoing in the sense that we grow up. When I started exploring the world, my first venture was to a folk music club. I found just not being at an AA meeting every night meant my life expanded. I've done all sorts of things, from new age to psychology studies.

I also discovered that when I came back to a meeting after, say, a night at the folk music club, I was fresher and freer and had more to say that made sense at the meetings.

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David: I guess what you are saying is your life had/has become more than AA meetings.

Wayman: Yes, much more, and I believe that's what the Program - the 12 Steps - is actually designed to do - let us go back to the world that we rejected because of practicing our addiction.

David: You don't believe that people are powerless over their addictions/behaviors, do you?

Wayman: Let me put it this way: My alcoholism and drug addiction is no longer a major issue. The promises on pp 84-86 have come true for me fully. And yes, I have a great deal I can do about my behaviors; always, however, with the foundation of the 12 Steps. The steps are simply a spiritual discipline. I'm not sick and getting well anymore.

David: Anne Wayman's website is here: http://www.powerfullyrecovered.com

Anne's book is: Powerfully Recovered: A Confirmed 12-Stepper Challenges The Movement." It can be purchased by clicking on this link.

I want to get to a couple of audience questions before we continue our conversation. Here's the first one, Anne:

TexasCounselor: Why do you think the statement "we are powerless" can do harm?

Wayman: Texas, when we say we are powerless over everything, we limit ourselves. I'm also convinced that telling someone in a ghetto, for instance, that they must always be powerless makes it extra hard for them to come... and I don't think that's what the program means.

MiracleMeGPC: Why do you think it is harmful to turn 'everything' over to God?

Wayman: Miracle, I don't think that's harmful. I pray a lot, but I also believe that I am a co-creator with the Source or the Higher Power. It's a question, I think, of attitude. Does that make sense or answer your question?

David: You have several major philosophical disagreements with the 12-step programs. I'll put them up one at a time, and I'd like you to comment on them.

1. Members get stuck.

Wayman: Yes, and by stuck I mean afraid of life beyond the 12 Step rooms; stuck in life because they feel they are different than others. Not everyone does this, but quite a few.

David: 2. Many never even attempt recovery because of the idea that "you'll never completely recover."

Wayman: I've spent some time in inner cities and I think to tell people there they must remain powerless leads them to say "no way." Many of those people have a whole different view of powerlessness, and to tell someone they have to stay sick is not very attractive.

David: Are you saying that the idea of "ongoing recovery," never being completely free of your addiction, leads people to say "then, what's the point of even trying?"

Wayman: David, I think there's some real confusion over recovered and cured. Cured would mean we could drink (or whatever) again. I'm certainly not saying that! Recovered, however, is a stronger position for self-worth and ability to take action. Besides, the Big Book uses the word recovered at least 11 times and recovering only once.

David: 3. Long time members of 12-step programs don't stay around long after their recovery.

Wayman: That's a more iffy proposition - a few do, but I've been surprised at how many I've met who no longer attend meetings. When I ask why it seems to be around these very issues. By the way, I believe the Program, as it's written, is just fine. It's the stuff we tend to tell each other that takes on the tone of gospel. That's where we get in trouble.

David: You're saying these people have recovered and moved on with their lives. That their addiction isn't the primary thing in their lives any longer?

Wayman: Yes, exactly, and the tone, if you will, of perpetual powerless that shows up in so many meetings is a bit discouraging. It's almost as if we become afraid to claim we are recovered.

David: Here's an audience comment on just that point:

ddoubelD: I'm thinking about joining a twelve step program but I also hedge cause it sounds like you never graduate.

Wayman: double - that saying, 'you never graduate' isn't in the Big Book. It's a saying that's grown up over time. The Big Book says we can become recovered.

David: 4. Alcoholism, drug addictions, spending problems are "diseases" that people suffer from.

Wayman: I also think there's an overemphasis on the disease theory. I'm no longer sick.

David: Do you believe that addictions are diseases?

Wayman: Not in the sense you can catch them, and not even like diabetes which requires an outside solution. Recovery is an inside job. If you use the word disease like dis-ease, then I think it fits better.

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David: Here are a couple of more audience comments, then I'll post some audience questions for Anne.

bcain2001: Alcoholism is a self-inflicted disease.

ddoubelD: I don't believe these are diseases in the classical term. They are character flaws and weaknesses.

bcain2001: My father attended the 12 -step program twice and went inpatient. He drank until the day he committed suicide last year and I know several more like him. I don't believe the 12-step program even works in today's society.

TexasCounselor: Applause for you! I did my clinicals working with a drug and alcohol counseling group and saw too many use that as an excuse and never really take responsibility for their actions.

David: Here's the next question, Anne.

MiracleMeGPC: Can you be 'recovered' and still in 'recovery' at the same time? Do we have to go to 12-step meetings for the rest of our life, until the day we die, in order to stay clean and sober?

Wayman: Miracle, I'm recovered and I'm still growing all the time. And I don't think you have to go to meetings forever - not at all - not to stay clean and sober.

David: I think one thing that's important to mention here, Anne, is that you consider yourself recovered. You have been clean and sober for 25 years. Do you feel in danger of a relapse at any moment or down the road if you don't go to 12 step meetings, etc.?

Wayman: No, that's the point. The Big Book promises we no longer need to be afraid. Could I relapse? Sure, but it's my spiritual life that keeps me sober/clean now. The meetings and working the 12 steps set the stage. Now I'm back in life and others can be too. There is no need for the fear.

David: And maybe one of the most important things you speak of is the concept of "recovery." Many of the guests we've had here talk about recovery as being some illusive thing. As long as you do this or that, you'll be okay. But, they say, relapse is just around the corner. What do you say to that?

Wayman: I say that if we do a good and honest and complete job with the steps, recovery is not illusive at all. Why should it be illusive?

David: One thing I thought was interesting in your book is that by identifying addictions as a disease, people start over-identifying themselves with the "disease." They are their addiction or dysfunction, rather than seeing themselves as being parents, computer programmers, etc. with an addiction.

Wayman: Yes, we are so very much more than our addictions. We are whole beings, discovering how to be the best beings we can be. My alcoholism is important but not as my ground of being. It's only a part of who I am.

David: Just a couple of site notes here and then we'll continue:

Here's the link to the HealthyPlace.com Addictions Community. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Here's a good question, Anne:

MiracleMeGPC: So the 12-step meetings are more for getting ourselves back on the right track? Do you still go to 12-step meetings?

Wayman: That's certainly one way to frame it, Miracle. I go occasionally, but not very often. You'll more often find me on online meetings - great for touching base.

David: And from your perspective, the reason for going to AA or other 12-step meetings is what?

Wayman: Now? To give back but sometimes that's really hard when the meeting is more focused on powerlessness, etc.

David: And what about in the beginning?

Wayman: I went to some 400 meetings my first year, and needed every one... but... if there had been more talk about becoming recovered, my recovery would have been quicker. David, I want the fellowship to shape up.

David: We've talked about some of the things that are wrong with 12-step programs. Why should someone participate in one or do you feel they shouldn't? Should they seek an alternative treatment program?

Wayman: I know people get sober in other ways, but my experience is in 12 Step groups. I'm all for them. I think the quality of recovery or becoming recovered is better or more likely because the 12 Steps are a spiritual discipline. Yes, send them all to 12 Steps, but let's quit pretending recovery is never-ending.

David: You also maintain that 12-steppers have lost their sense of what "normal" really means. That it's not normal to practice an addiction and it turns people into "victims" to keep thinking that way.

Wayman: David, there's a huge difference between the program and fellowship. Yes, I refuse to consider myself or anyone else abnormal because they don't drink/use etc. It's the addiction, practicing the addiction that's abnormal.

David: So, to clarify for everyone here tonight, you believe 12-step programs have a lot to offer. It's some of the people who run the programs and participate in them that makes it difficult to fully recover and believe in the concept of a full and complete recovery.

Wayman: Yes, but not deliberately. Myths have grown up in the fellowship over time.

David: Thank you, Anne, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Wayman: My pleasure David and everyone else.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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back to: Addictions Conference Transcripts
~ Other Conferences Index
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Dr. Kimberly Young,has been touted as the world's leading "Cyberpsychologist". She has taken her expertise in computers and human behavior to become a pioneer in the study of Internet addiction, cybersexual addictions, and deviant online behavior.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic is "Internet Addiction". Our guest is Kimberly Young, Ph.D. (What is Internet addiction (online addiction)?)

Dr. Young is a licensed psychologist and author of the book, "Caught In The Net," which addresses internet addiction recovery. You can view and purchase the book by clicking on the link.

Dr. Young started her career working in the information systems field and then entered the field of clinical psychology. She has taken her expertise in computers and human behavior to become a pioneer in the study of Internet addiction, cybersexual addictions, and deviant online behavior. She is internationally known for her work and is a frequent speaker on how technology impacts human behavior. If you're wondering if you have an internet addiction, you can take the online internet addiction test.

Good evening, Dr. Young and welcome to HealthyPlace.com. We appreciate you being our guest tonight. What is it about the internet that makes it so difficult for some to break away from it?

Dr. Young: Well, it varies from person to person. The interactive features and availability online can be addictive. Then, stock trading and eBay auctions attract people and can be addictive too.

David: Can you define internet addiction for us?

Dr. Young: Sure, it's the same criteria defined for substance abuse. You look for people that lie and become preoccupied with the internet and who jeopardize their career and other aspects of their life, despite the consequences.

David: Considering then, that it's similar to other types of addictions, like substance abuse, is the treatment of internet addiction similar?

Dr. Young: Yes, traditional recovery programs are generally used to treat Internet Addiction (IA).

David: So, are we talking about 12 step programs and that sort of thing?

Dr. Young: Yes, 12 step programs, rational recovery, cognitive behavioral techniques, etc.

David: Now, I can understand people becoming addicted to online gambling, even online stock trading and ebay auctions. What other types of things create an addictive environment over the computer?

Dr. Young: Generally such things as, chats, games and pornography.

David: Here's an audience question/comment, Dr. Young:

GreenYellow4Ever: Isn't it a little ironic to have support groups for internet addictions ONLINE?

Dr. Young: Yes, I've heard of groups like that and for some, it is a comfort to know that you are not alone. In many instances, the support is used to empower people. They seem to be useful from what others have told me.

David: On your site, you use the term cyber widows, significant others or spouses of internet addicts. How are they impacted?

Dr. Young: Well, with spouses, it is very difficult if their significant other is having an affair on the net and can often lead to separation and divorce.

David: Are their key personality traits in an individual that can lead to internet addiction and that can be used to identify them as a potential internet addict?

Dr. Young: Yes, studies show that key personality traits that make a person more vulnerable to develop addiction are:

• shyness
• introversion
• dominance
• open-mindedness
• intellectual ability

David: So, how can one tell if they are spending too much time online?

Dr. Young: You have to look at the characteristics and symptoms. There is no time cut-off. That is like trying to define alcoholism by counting the number of drinks the person consumes. The characteristics and symptoms I previously mentioned can also reveal if you are spending too much time online.

Keatherwood: I just took the "internet addiction test" on your site and got an 87. I spend lots of time in chatrooms, both as a moderator and a member. As someone that deals with trust issues from abuse, is it necessarily bad to make most your friends online? My husband does complain, but I really think I give him enough attention :).

Dr. Young: That's a difficult question to answer. Obviously, it is easier to make friends online, but it is difficult to make a diagnosis. Is it bad though for a person to make most of their friends online? I don't think it should be judged in terms of bad or good. Online friendship offers a unique opportunity. I know of some people that have met and married online and I don't think it's a bad thing.

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vetmed00: Both of my relationships have been online relationships and they are the healthiest relationships that I have been in.

David: But what if most of your relationships are solely virtual vs. face-to-face? Would you consider that healthy?

Dr. Young: Again, it's not for me to judge the quality that online relationships can offer to an individual. I suppose though it can be unhealthy if there is no contact with other human beings.

GreenYellow4Ever: Is the allure of online pornography because of anonymity, availability, or just the addictive behavior a person has and this is, frankly, the cheapest way to feed the addiction?

Dr. Young: Yes, typically it's the anonymity and the availability of online pornography that makes it enticing.

David: Given that many families today have family members who have faced addiction, and there is very easy availability of all these addictive features, i.e. gambling, stock trading, pornography, how do other family members help the internet addict control their behavior?

Dr. Young: Understanding what the internet has to offer can help families control the addictive features that the internet offers. My programs for parents focus on these issues.

David: Can you elaborate on that please?

Dr. Young: Reading my book, Caught in the Net, can help educate parents on the pitfalls of the internet but also reading other material about the internet. The main point is awareness, especially the careful monitoring of computer use in the home. Let me add, that my programs for parents focus on awareness, which I believe is important for controlling their behavior.

David: Can you give us a few examples of how someone would control the addictive features of the internet?

Dr. Young: If you are looking at an individual, try and set goals. This is because people lose track of time. Presetting an alarm to help you monitor a person's use of the internet might be a possible solution.

David: In a home where there is an alcoholic, family members won't stock the liquor cabinet. What do you do in a home where there is a computer? Would you lock it up? Throw it out?

Dr. Young: No, I base everything on moderation and controlled use. The metaphor I use is food addiction. You must make healthy balanced choices.

Phyllis: How about setting up a schedule for family members?

Dr. Young: Yes, that's an excellent idea, Phyllis.

David: What advice would you give to an internet addict who has a job which requires them to be online a good part of the day, but they can't stay away from something like eBay, stock trading, etc.?

Dr. Young: Typically that's the case and many times they can install filtering software. Some companies might have policies that can have a person fired for continued internet use and that can be a deterrent.

David: Isn't that sort of like having an alcoholic and locking up the liquor cabinet and handing him the keys and saying "now don't have anything to drink." I mean, if you have to set up your own filtering software, I'm assuming that if the allure is strong enough, you'll change the filter? Would you suggest that person find a different line of work?

Dr. Young: Honestly, that has happened before where a person has to go through detox. They would have to change professions.

GreenYellow4Ever: My husband is ADD and can literally sit for hours until the wee hours of the morning just dinking on the computer. He says he is not addicted, just forgets about time. Would you say this is a valid reason for him being on so long?

Dr. Young: Yes, often that is the case. People lose track of time. Unlike TV, there are no commercial breaks. Interestingly, children with ADD can sit on the computer for hours and hours as well.

David: I'm wondering if you think the internet itself is addictive, or whether people who are addicts, or who have an addictive nature, are being drawn to the internet because of the easy availability of the things they crave?

Dr. Young: The reason could be both. My studies show that people who have a prior history of compulsivity, certainly multiple addictions, are quite common. However, there are some people that have had no prior addictions, which is a new clinical development.

David: And I'm assuming that's one of the reasons why it's so important for parents to monitor their children's internet use?

Dr. Young: Yes, that is one of the reasons.

David: Since internet addiction is fairly new, are there many therapists out there who know how to treat it?

Dr. Young: The actual field of therapists dealing with IA has grown since I started in this field in 1994 and there is an emerging number of therapists who are interested in this field. I, myself, provide workshops for therapists who are interested.

Phyllis: What would be your suggestion then to overcome internet addition?

Dr. Young: Getting involved in treatment programs that focus on time management, and also understanding the underlying issues of his or her internet addiction. A formal evaluation is necessary to develop the best treatment plans.

David: Can a person end their internet addiction on their own or do you feel they would need professional treatment for internet addiction?

Dr. Young: Sometimes self-control is possible, just like smoking addiction.

David: In the hierarchy of addictions, would you consider internet addiction a less or more serious addiction than others?

Dr. Young: Well certainly it does not pose the same health risks as alcoholism and drug addictions. However, it still creates the same level of emotional and family problems. In that way, it's at the same level of alcohol and drug addictions.

vetmed00: Is one to believe they have an addiction to the net if they would rather talk to people here, than to the "real life" people around them?

Dr. Young: No, that's not the definition of addiction. You need to look at the basic criteria. Is it compulsive, etc.? Those factors have a role in defining the addiction.

GreenYellow4Ever: What is your program for parents?

Dr. Young: I developed a program based on speaking with parent groups, that I will be launching in a few months. The focus is on child safety and understanding the digital generation a bit better.

David: Thank you, Dr. Young, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. For more information, you can visit Dr. Young's website here.

We have a growing addictions community here at HealthyPlace.com.

Dr. Young: Thank you and goodnight.

David: Good night, everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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~ Other Conferences Index
~ all addictions articles

Dr. Thomas Schear, is a Certified Alcohol and Drug Counselor with about 20 years experience in the field. The discussion centered around alcoholism and drug addiction and dual diagnosis, along with self-medicating.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Addictions and Dual Diagnosis" and our guest is Dr. Thomas Schear. We'll be discussing addictions treatment and the topic of dual diagnosis - having a psychiatric disorder and an addiction at the same time.

Dr. Thomas Schear is a licensed marriage and family therapist and a Certified Alcohol and Drug Counselor. He has over 15 years of experience working with clients who deal with substance abuse problems and dual diagnosis. Just so everyone is clear on the term dual diagnosis, it means someone who has a mental illness, psychiatric disorder and an addiction. Sometimes that involves self-medicating behaviors. Tonight, we will be talking about addictions issues AND also dual diagnosis.

Good evening Dr. Schear and welcome to HealthyPlace.com. Thank you for being our guest tonight. Why is it so difficult to kick addiction?

Dr. Schear: I am glad to be here. I have been looking forward to this.

There are a lot of reasons why it is so hard to kick an addiction habit. Part of the reason is that it becomes part of a lifestyle that begins to set the person up to behave in certain ways and expect certain outcomes.

For some, the reality is too hard to handle in some ways. It seems that the addict is someone who feels pain more readily than the rest of us. They salve the pain by using alcohol or drugs. Then, we counselors try to convince them they don't need it.

David: So, would you say that some people are "more susceptible" to developing an addiction habit than others?

Dr. Schear: Perhaps. To some extent, addictive behaviors are a lifestyle choice. To another extent, people see how a parent, or other adults, deal with life's challenges by using a substance so they try it. For most of us, using alcohol is no big deal, but for the person who may be more susceptible, their first drink is a sensation and clearly the solution to their problems. It is when the person's usage is more of a problem than a solution, that they are faced with a dilemma.

David: At this time, I want to give our audience the link to the HealthyPlace.com Addictions Community. Here, you will find lots of information related to the issues we are talking about tonight. Also, you can sign up for the mail list on the side of the page so you can keep up with events like this.

Dr. Shear, when it comes to treatment for addictions, when is it time to say "I need help"?

Dr. Schear: Frequently, the user has to experience the consequences of their usage and resultant behaviors before they decide it is time to get help. Generally, family, friends, and others, enable the user by paying fines, making excuses, tolerating the intolerable behavior. These people need to withdraw their enabling behaviors, so the user begins to experience the pain associated with their use. Usually, it is the pain that leads to seeking help. The pain of recovery is seen as less than the pain of continuing addictive behaviors.

David: And before we get to some audience questions, I have one more question: there's self-help, seeing a therapist, getting outpatient treatment and inpatient treatment. How does one figure out which treatment for addictions to choose? And, in your experience, what works best in initially treating an addiction habit?

Dr. Schear: In recent years, Client Placement Criteria have been established by ASAM to better determine what level of care is appropriate for the addictive client. Everyone is measured on several continuums having to do with withdrawal symptoms: how much of a support system does the person have, if they also have medical problems, psychological problems that need additional support, etc. Depending on how "healthy" a person is, will determine where they ought to go for treatment. The person who has no withdrawal symptoms, who has the support of clean and sober family and friends, has a job, no psychiatric or medical problems and maybe a couple of drunk driving charges, may be appropriate for an outpatient setting. However, the person with no support system, who has experienced withdrawal symptoms in the past, has medical and maybe psychiatric problems will need more intensive and long-term care. The level, or intensity of care, really depends on a lot of these factors. It appears that the introduction of managed care and funding issues seems to drive some of this, but it does better utilize the resources too.

David: Here are some audience questions, Dr. Schear:

squeaker: I have been sober for nine months now. My doctor says I am not an alcoholic, it is solely due to my bipolar disorder. That I am self-medicating. People close to me disagree. What is your opinion?

Dr. Schear: The concern I have when someone has a psychiatric diagnosis and drinks is that the combination of medication with alcohol can negate the effects of the medication. The result, then, is that a bipolar condition is not being properly treated because the client is also using alcohol. It is less of a question of whether you are alcoholic or not than it is a question of properly treating the psychiatric condition. By the same token, if a person wants to drink so badly that they will interfere with their treatment for a bipolar condition, maybe alcohol use is a problem. The main concern should be properly treating the psychiatric condition.

GiddyUpGirl: I was wondering if you know anything about SSI (Social Security Insurance) and if one could be terminated if they were found to be a substance abuser. I really need treatment and I am close to signing myself into a psych ward for depression and need to know if I should tell them about my addiction?

Dr. Schear: I don't know much about SSI except that a few years ago there was the push to get addicts and alcoholics off SSI. Too often the checks were going to the alcoholic's bartender.

Yes, you must tell the people at the psychiatric ward about your addiction. They cannot properly diagnose or treat the psychiatric problem if they do not know about that. Your use of substances is likely contributing significantly to the depression, and the depression may lead you back to substance use. Both need treatment or you likely won't recover from either.

Chesslovr: I have been clean and sober for 18 years but have been given Valium by my doctor for medical problems. Is it safe?

Dr. Schear: Valium is a drug and all drugs have their effects. Does your doctor know about your recovery? Is the valium a temporary solution or a more or less permanent thing? Keep clear with your doctor and yourself what the is for. Remember that it is a mood-altering drug. Keep clear on your relapse pattern and symptoms, so you don't lose your sobriety.

David: Earlier, I mentioned the term "dual diagnosis," having a mental illness and an addiction? Of the addiction population, how many people, would you guess, fall into that category (percentage-wise)?

Dr. Schear: That is hard to say. One question that always comes up with this topic is "which came first?" Did the person have mental health problems before they began to use, or did their using cause a mental health problem? You don't really know until the person has been clean and sober for a while. If psychiatric symptoms persist, there is apparently a co-existing problem that needs treatment. Much more frequently though, for the vast majority of addicts, once they stop using, much of the psychiatric problems go away. They may still feel guilty, angry, depressed, but much of that may be the result of the things they did while using, rather than a psychiatric condition. A period of being clean and sober and a thorough assessment, are essential to sort this all out.

msflamingo: Are the signs of drug use, specifically of cocaine, always obvious? Or are there body indicators to tell if drugs have been used? In other words, change of skin tone or such, to indicate "closet" use? My question is based on the recent discovery of my husband having used drugs for many years while on the road. I was not aware of it until he was home for an extended period. Before that, he managed to hide it really well. People have told me the skin tone and color change, as well as other indicators from the body, are signals to the use.

Dr. Schear: People who use get good at hiding, covering up, and otherwise distracting people away from their alcohol and/or drug use. Sometimes a person has used so much for so long, that no one knows how they are when they are clean and sober. The user person becomes the way everyone knows them. Each drug has its own way of showing itself, whether by slurred speech, flushed face, or whatever. Mostly, the challenge for family members is to notice things like missing time, missing money, missed appointments, unfulfilled obligations, etc. Vague explanations usually indicate that there is something going on that they want to hide and anger is a way to distract you from finding out what's really going on. The fact he got away with it for years, suggests that he was particularly well-practiced in hiding it from you. There may have been suggestions that there was something going on, but you may have not known what you were looking for and accepted an explanation that made things seem okay.

imahoot: I used alcohol and drugs as a numbing behavior, which in reality caused more chaos, depression, anxiety, and break down of the physical, psychological and spiritual systems. Do you feel that a person should work on their addiction first, then their internal issues, or visa versa, or both simultaneously?

Dr. Schear: Generally, the person should get clean and sober first. Substance use does nothing but contribute to the chaos. Abstinence is the first thing you need to do. You cannot deal with the problems of depression, anxiety, etc. while you are bathing your brain with any number of drugs. Besides, once you get clean and sober, you may find that many of the emotional, spiritual, physical problems may get resolved. Those that don't, can then be treated. But until you are clean and sober, I, for one, would know where to start.

David: Here's the link to the HealthyPlace.com Addictions Community. Also, here's the link to Dr. Shear's web site.

Here is another audience question:

annie1973: My husband has been trying to kick his crack addiction for 2 years and just relapsed a week ago after being clean for 5 months. He seemed fine to me, but things are pretty stressful around here. Are there any warning signs I could spot, so I can intervene? Or shouldn't I try to intervene at all?

Dr. Schear: You should intervene ASAP. The fact that you have let him go this long without intervening, conveys the message that him staying clean and sober is not a priority for you so why should it be a priority for him. The fact that things are "stressful" means that things aren't okay. The fact that he relapsed means that he did not do all the things he needed to do, to stay clean and sober. That should not be rewarded by skirting the issue. Besides, crack use may be only what you know about. Think about the other things he was up to in the past when he was using. Likely, he is up to the same things again. Intervene As Soon As Possible.

rooster48: Is Dr. Schear familiar with the use of SMART (Self management and Recovery Training) or REBT (Rational Emotive Behavior Therapy?) Has he had any experience with using cognitive therapy as an alternative to 12 Step programs? Cognitive therapy came about in the late '50s with REBT by Dr. Albert Ellis.

Dr. Schear: Yes, I am. In fact, most of my work is using the cognitive approach. I do know that AA, NA, etc. is not for everybody. I find that, for many, the religious tones of the 12 step programs turn some people off, while the cognitive approach works in recovery. We are dealing with powerful drugs that can really bend a person's view of reality and interfere with a person's ability to think rationally for quite some time.

just_another_addict: I was wondering what to do when you have like a craving or an attack where you really want to drink? How do you handle that?

Dr. Schear: There are a variety of techniques you can use, such as distracting yourself by doing something else, call someone, talk, read, whatever. But more importantly, find a relapse prevention program at an agency in your community. They can teach you how to look at your relapse pattern, how to handle high-risk situations, techniques for dealing with the cravings, thoughts of using, etc. It is largely a matter of you paying attention to what precedes the cravings, and then doing and thinking something different to avoid it in the future. But a full fledge relapse prevention program based on the information of Dennis Daley and Terry Gorski will go a long way toward helping, as you deal more effectively with cravings.

Funny Face1: If the alcohol addiction is combined with bipolar, how do we, the family, get him to understand how badly he needs to get help?

Dr. Schear: It depends on how functional they are to start with. It may depend on the laws of your state. If they are at all functional, you may be able to do an intervention with the help of someone who is trained in doing that sort of thing. If they are a potential harm to themselves or others, in some states the courts can get involved. With patients rights and whatever, some states have gotten away from commitments to hospitals. You need to take care of what they can't take care of themselves, and that is to get help. There may come a point though, where you even have to step back from that stance if your best efforts are rejected by the family member.

shylight: Is it possible for a recovering addict who also has DID (Dissociative Identity Disorder) and depression, to stay clean and sober without medication?

Dr. Schear: Unlikely. The combination suggests that medication is being prescribed to control the depression and the DID, but taking medication and staying clean and sober is a small price to pay for being able to live a reasonably normal life.

Phhantom: Given the power of self-help, people seem to get through their days better using it. What is your opinion on the "why's" people choose not to employ these tools? And how effective do you think they are in dealing with an addiction?

Dr. Schear: The reason why some people don't use the self-help groups are as varied as people themselves. What is really important to me, when doing counseling, is for the person to find what works for them in staying clean and sober and enjoying life. Self-help groups provide the support and give the user the sense that they are not alone in either their pain or in their recovery. Not everyone needs that if they have other support in their family, church, or whatever. Support is where you find it. I am pragmatic about this. I don't insist on self-help groups, I insist that the client do the things that promote health.

David: I know it's getting late. I want to thank Dr. Schear for being our guest tonight and sharing his knowledge and expertise with us. Dr. Schear's website address is http://www.ccmsinc.net.

I also want to thank everyone in the audience who came tonight and participated. I hope you found this conference helpful.

Our next conference is about OCD (Obsessive Compulsive Disorder) with Dr. Alan Peck, who has been treating OCD patients for 20 years. He calls OCD "one of the most emotionally painful psychological problems that exist." 

Dr. Schear: Good night.

David: Thanks everyone and good night.

Glenn C., a member of Alcoholics Anonymous for ten years, joined us to discuss the twelve steps and their effectiveness. He discussed hitting bottom and how the twelve steps can help everyone cope with an addiction, whether they suffer from alcoholism, their family members are alcoholics, or they suffer from an addiction which is not alcoholism.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I'm glad you had the opportunity to join us and I hope your day went well. Our topic tonight is "The 12-Steps For Addictions Recovery." Our guest is Glenn C., from Alcoholics Anonymous.

Our topic tonight is "The 12-Steps For Addictions Recovery." Our guest is Glenn C., from Alcoholics Anonymous.

Glenn is 55 years old. He has been in A.A. for over 10 years, not only as a practicing member but he now also serves as the Public Information Officer for the San Antonio, Texas branch of Alcoholics Anonymous. Glenn is a retired city government employee and now has several business projects that he works on.

Good evening, Glenn, and welcome to HealthyPlace.com. So our audience can get to know a little bit more about you, how did you first become involved with Alcoholics Anonymous and can you share some of the personal details of how alcohol had affected your life? (Read the negative and long-term effects of drinking alcohol.)

GlennC: Good evening. To start out, I could see that alcohol was affecting my life and the lives about me well before I came into the program, but I refused to address it as I thought that the only person I was harming was myself. It is said that alcoholism is one of denial on that basis.

David: What drew you into AA?

GlennC: It is what is called "Hitting Bottom." Today I personally define that in this manner: It is when a person sees that they no longer have control over the thing that they value the most - as to whether they can keep it or lose it. The other thing was that after I moved into an apartment by myself, I found that it was not other people, family members, or even the job which was causing me to continue to drink. I just could not leave it alone and kept getting drunk.

David: Millions of men and women have heard or read about the unique Fellowship called Alcoholics Anonymous since its founding in 1935. Of these, more than 2,000,000 now call themselves members. People who drink too much alcohol, finally acknowledged that they could not handle alcohol, and now live a new way of life without it. Why is that particular program so successful in helping so many?

GlennC: What has been found is that because AA is an "experience shared" and spiritually oriented program - it works. It is like as if a person were lost in the Grand Canyon in a blinding snowstorm and along came an Indian guide who worked for the Park Service who knew the way out. One alcoholic can relate to another in a manner that no one else seems to be able to do.

David: The "shared experience" you refer to, is it like going to a support group where people talk about how, whatever it is, has impacted their lives?

GlennC: I guess it could be viewed that way, but our book puts it like those who share a lifeboat together.

David: And, I guess from your statement above, that you are saying "you have to have been there to really understand where another alcoholic is coming from."

GlennC: That is exactly it. Doctors can look at it from the outside, and they do an excellent job, but if I were wanting to find out about racing cars I would go and talk to the drivers instead of the owners or mechanics.

David: For those in the audience who have never been to an AA or 12-step meeting, can you describe what goes on there for us?

GlennC: There is a lot. We have various kinds of meetings where people come to share their "experience" when drinking, their "strength" as they found it through working through the 12 steps, and their "hope" that it will continue to work for them, and for others. There are Open meetings where anyone can attend. Closed meetings are for alcoholics only. Discussion meetings are where open discussions are held, speaker meetings are where one person shares their story, and Study meetings are where the book, Alcoholics Anonymous, or the 12 Steps are studied in depth. There is also a lot of friendly fellowship.

David: I'm assuming that by sharing experiences, it lets others in the group know that they are not alone in what they've experienced in their lives because of alcohol - that they aren't the only one who has gone through this.

GlennC:Right, and it also reveals the true causes behind the disease.

David: Here's the link to the HealthyPlace.com Addictions Community. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Glenn, you were talking about the purpose of people sharing their stories at AA meetings. Please continue.

GlennC:Let me give those who might not know the official contact points for AA:

ALCOHOLICS ANONYMOUS WORLD SERVICES, INC.
Box 459, Grand Central Station
New York, NY 10163
http://www.alcoholics-anonymous.org/

From the shared experiences and stories people can identify and possibly see that they, too, are alcoholics, as we do not tell them that they are. This is left to the individual.

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David: We have some audience questions I want to get to and then we'll continue with more about the 12-steps. Here's the first question, Glenn:

forgetful_me!:I am not an alcoholic but most of my father's family members are addicted; I am addicted to smoking weed. I am not sure if it makes it okay in my head or not, but can the 12 step program help me with both issues? I am using now and not taking my medication that I need for my disorders; can this 12 step program help me?

GlennC: A 12 step program certainly would not hurt and would most likely help. Again, another factor that comes into play is whether or not a person is really ready to become rigorously honest with themselves and to take the actions necessary.

In a chapter of our book, "How it works," it is said, "If you want what we have, and are willing to go to any lengths to get it, then you are ready to take certain steps." All I can say is that it does work.

AA also produces another book. It is called "The Twelve Steps and Twelve Traditions." It goes into more depth as to the steps.

David: One of the basic premises of the 12-steps is admitting that we were powerless over alcohol - that our lives had become unmanageable. How difficult is that to do? And do a lot of people have trouble with that UNTIL they hit bottom?

GlennC: Yes. Step One - "We admitted we were powerless over alcohol -- that our lives had become unmanageable." Who cares to admit complete defeat? Admission of powerlessness is the first step in liberation. Relation of humility to sobriety. Mental obsession plus physical allergy. Why must every AA hit bottom? These are the subtitle listings out of the 12&12.

What it really addresses is a matter of "control." My sponsor had me look up the definitions of "power" and "manage," and they both have to do with control. What I found was that I lost control, or the power of choice when it came to alcohol, once I took that first drink. For once I did, it set up an allergic reaction which set up a deeper craving for more, but what started out the whole set of events was an obsession to drink in the first place. A line in the book says, "Alcoholics drink essentially for the effect." And when I read that I said, "RIGHT." And so I kept chasing that effect, but could never quite get the total effect that I wanted, so I drank more and more in an attempt to get there.

David: Here's the next audience question:

Ida Jeanne: My 36-year-old daughter just entered a 12 step recovery program. How do I bring up reality during group? She has lived in her own world of reality for 23 years and we could never get her to see the truth as it really is. I want to be supportive but not an enabler. I'm already raising her two children.

GlennC: My suggestion to you would be to seek out another 12 step program called ALANON. It is for friends and families of those in the program. From those in that program you will find the tools to help not only her but also yourself and the children.

Ida Jeanne: Should I attend it along with the family group with her?

GlennC: I would suggest that you go for yourself, without her. All I can say is that this program also works, as I am also a member of this fellowship. I had to do it for me as my son was an active alcoholic, and the disease killed him.

David: I'm sorry to hear that. Here's an audience comment, then another question:

forgetful_me!: I am a 29-year-old wife and mother of a 10-year-old. I am ready, just not really sure how in the world I have made it this far. I feel that my addiction is the only thing I have control over. My husband has found out about my addiction and is aware of my family's addictions to alcohol and because he does not truly understand he is not sure how to help. I am afraid that I will be put into a rehab center - the one place I say I do not need. When I do drink I am very obsessed with getting drunk. I cannot just drink socially and I am aware that I am a potential alcoholic.

David: Here's the next question:

julesaldrich: Do you think that this step - approach - can be helpful with any kind of addiction? I have an eating disorder. It was suggested by my therapist that I find out more about this. Just as an alcoholic, I have claimed to have control over this only to have "fallen off" several times.

David: And Glenn, I'll mention that many of the people who visit HealthyPlace.com are dealing with "dual diagnosis," coexisting conditions.

GlennC: Right, the 12 steps were first brought forward by AA and today they have been adopted by many other 12 step programs. Overeaters Anonymous is one of them, and from what I hear it works. What we have found through experience is that these separate programs work to address these separate issues. I guess what I am saying is that I would not go to AA to address a gambling issue as there is really not a shared experience base.

David: You mentioned earlier that AA members discuss in detail what the disease (addiction) is all about. Does having a better understanding of alcohol abuse and it's consequences or any other addictive substance for that matter, help one recover from it?

GlennC: That depends on what you are saying. When I could see the reason(s) why I could not stop after I took the first drink and the reason(s) why I just could not seem to muster enough control to leave it alone completely, this did not solve the problem. It just identified the causes and conditions that started it. What it took to solve the problem as a whole was to completely and thoroughly work through the 12 steps with someone who had already done them. As strange as it may seem to some, alcohol was not my problem, it was my solution to the problem. Through the 12 steps, I was able to help the real problem, which was me. I found that this could be done only through the help of a power greater than me.

David: I'm wondering, is a program like Alcoholics Anonymous considered a substitute for professional therapy or does it supplement therapy?

GlennC: We do NOT claim to be a substitute for professional therapy. In the present position that I serve in, Cooperation with the Professional Community, I have found it a privilege to cooperate with many therapists and treatment facilities. We cooperate with them but are not affiliated with them. This has been the case with AA since its beginning.

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David: Regarding face to face AA and other 12 step meetings, you can usually find them listed in your Sunday newspaper, and you can contact the appropriate organizations. They are listed in the phone book.

Thank you, Glenn, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Glenn for being our guest tonight.

GlennC: In many cities, AA is listed in the telephone book.

David: Before we sign off, Glenn wanted to post some additional material. Go ahead Glenn.

GlennC: ALCOHOLICS ANONYMOUS® is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution; AA does not wish to engage in any controversy; AA neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

This information is both for people who may have a drinking problem and for those in contact with people who have or are suspected of having a problem. Most of the information is available in more detail in literature published by AA World Services, Inc. This tells what to expect from Alcoholics Anonymous. It describes what AA is, what AA does, and what AA does not do.

WHAT IS AA?

Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, nondenominational, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about his or her drinking problem.

WHAT DOES AA DO?

• AA members share their experience with anyone seeking help with a drinking problem; they give person-to-person service or sponsorship to the alcoholic coming to AA from any source.
• The AA program, set forth in our Twelve Steps, offers the alcoholic a way to develop a satisfying life without alcohol.
• This program is discussed at AA group meetings.
  • Open speaker meetings open to alcoholics and nonalcoholics. (Attendance at an open AA meeting is the best way to learn what AA is, what it does, and what it does not do.) At speaker meetings, AA members tell their stories. They describe their experiences with alcohol, how they came to AA, and how their lives have changed as a result of AA
  • Open discussion meetings one member speaks briefly about his or her drinking experience, and then leads a discussion on AA recovery or any drinking-related problem anyone brings up.
  • Closed discussion meetings conducted just as open discussions are, but for alcoholics or prospective A.A.s only.
  • Step meetings (usually closed) discussion of one of the Twelve Steps.
  • AA members also take meetings into correctional and treatment facilities.
  • AA members may be asked to conduct the informational meetings about AA as a part of A.S.A.P. (Alcohol Safety Action Project) and D.W.I. (Driving While Intoxicated) programs. These meetings about AA are not regular AA group meetings.

MEMBERS FROM COURT PROGRAMS AND TREATMENT FACILITIES

In the last years, AA groups have welcomed many new members from court programs and treatment facilities. Some have come to AA voluntarily; others, under a degree of pressure. In our pamphlet How AA Members Cooperate, the following appears:

We cannot discriminate against any prospective AA member, even if he or she comes to us under pressure from a court, an employer, or any other agency.

Although the strength of our program lies in the voluntary nature of membership in AA, many of us first attended meetings because we were forced to, either by someone else or by inner discomfort. But continual exposure to AA educated us to the true nature of the illness... Who made the referral to AA is not what AA is interested in. It is the problem drinker who is our concern... We cannot predict who will recover, nor have we the authority to decide how recovery should be sought by an

PROOF OF ATTENDANCE AT MEETINGS

Sometimes, courts ask for proof of attendance at AA meetings.

Some groups, with the consent of the prospective member, have the AA group secretary sign or initial a slip that has been furnished by the court together with a self-addressed court envelope. The referred person supplies identification and mails the slip back to the court as proof of attendance.

Other groups cooperate in different ways. There is no set procedure. The nature and extent of any group's involvement in this process is entirely up to the individual group.

This proof of attendance at meetings is not part of A.A.'s procedure. Each group is autonomous and has the right to choose whether or not to sign court slips. In some areas, the attendees report on themselves, at the request of the referring agency, and thus alleviate breaking AA members' anonymity.

SINGLENESS OF PURPOSE AND PROBLEMS OTHER THAN ALCOHOL

Alcoholism and drug addiction are often referred to as substance abuse or chemical dependency. Alcoholics and nonalcoholics are, therefore, sometimes introduced to AA and encouraged to attend AA meetings. Anyone may attend open AA meetings. But only those with a drinking problem may attend closed meetings or become AA members. People with problems other than alcoholism are eligible for AA membership only if they have a drinking problem.

Dr. Vincent Dole, a pioneer in methadone treatment for heroin addicts and for several years a trustee on the General Service Board of AA, made the following statement: The source of strength in AA is its single-mindedness. The mission of AA is to help alcoholics. AA limits what it is demanding of itself and its associates and its success lies in its limited target. To believe that the process that is successful in one line guarantees success for another would be a very serious mistake.

CONCLUSION

The primary purpose of AA is to carry our message of recovery to the alcoholic seeking help. Almost every alcoholism treatment tries to help the alcoholic maintain sobriety. Regardless of the road we follow, we all head for the same destination, recovery of the alcoholic person. Together, we can do what none of us could accomplish alone.

GlennC: Nice to have been with you all tonight.

David: Thanks Glenn. Good night everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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~ all addictions articles

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5. Psychiatric Medications
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6. Rage: Overcoming Explosive Anger - Online Conference Transcript
   Guest: Dr. Ronald Potter-Efron

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