Effects of Drugs and Alcohol To Seafarers

Disulfiram May Improve Abstinence Rates After Alcohol Rehab
By Tom Horvath, Ph.D. The year following inpatient alcohol rehab is a crucial period of time in which many patients relapse. Several factors may reduce the risk of relapse during this time, including therapy appointments, attendance at mutual help meetings such as Alcoholics Anonymous (AA) or SMART Recovery, aftercare group sessions, and the use of medications such as disulfiram (Antabuse), which produces a heightened sensitivity to alcohol by interfering with the body¶s metabolism of alcohol. Researchers in Portugal followed patients who completed an inpatient alcohol rehab program at the Lisbon Regional Alcohology Centre in an effort to delineate the features of aftercare treatment compliance, which predict outcome in aftercare (Neto et. al., 2007).

The researchers followed 74 patients for 6 months after discharge from the inpatient program. The study focused on the predictive value of aftercare therapies including attendance at AA meetings, attendance at aftercare groups, and attendance at outpatient sessions with a medical assistant. Disulfiram was prescribed to 83.3 percent of the patients. At the 6-month follow-up point, the patients and their significant others were interviewed via telephone. Results show that 39.2 percent of the patients had attained total abstinence at the follow-up point, and 71 percent of the relapses had occurred within the first 3 months of aftercare. The researchers found that the median number of days that patients took disulfiram was significantly related to the number of days of abstinence. However, outcome was not predicted by AA attendance, aftercare group attendance, outpatient appointment attendance, or demographic variables. The authors concluded that consistently taking disulfiram was associated with a good outcome. Previous studies have suggested that attendance at mutual help groups such as AA or SMART Recovery and aftercare group sessions are associated with positive outcomes following alcohol rehab. In this study, as the authors point out, there was low compliance with the aftercare plan, and this could explain the weak predictive value of group attendance. The finding that a longer period of disulfiram intake was associated with improved rates of abstinence could be a reflection of the patient¶s commitment to abstinence as well as the effect of the drug. Further, in this study, the success of disulfirm was likely due in part to the role of the patient¶s significant other or co-responsible person. Treatment providers stressed the importance of the significant other in the observation of disulfiram intake. Patients signed a contract that they would take disulfiram under the observation of their chosen co-responsible person. Perhaps the treatment providers should have also stressed the importance of co-responsibility in regard to meeting attendance and compliance with all aspects of the aftercare plan. In this study, 47.3 percent of patients did not attend outpatient meetings with the medical assistant, 20.3 percent did not attend aftercare groups, and 33.8 percent did not attend AA meetings.

Tom Horvath, Ph.D., is a California licensed and board certified (ABPP) clinical psychologist. He is the founder and president of Practical Recovery, a non 12-step self-empowering addiction treatment system in San Diego. He is past president of the American Psychological Association¶s Society of Addiction Psychology (Division 50), the world¶s largest organization of addiction psychologists. He is the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions (listed by the Association for Behavioral and Cognitive Therapies as a ³Self-Help Book of Merit´). Neto D, Lambaz R, Tavares JE. Compliance with aftercare treatment, including disulfiram, and effect on outcome in alcohol-dependent patients. Alcohol and Alcoholism. 2007; 42(6): 604-609.

Please Do Disturb: Creating Change in an Alcoholic Family
By Darren Haber, MFT The great Buddhist teacher and author Pema Chodron once suggested in a recorded talk that we hang a sign in our kitchen that says, ³Abandon hope´. At the time, I agreed with the listener who exclaimed, ³That¶s outrageous!´ Hope is of course essential to peaceful, purposeful lives. The lack of it can lead to despair or nihilism. Hope offers solace in stressful times, a balm for chafed nerves; it often marks the road forward. But there¶s a catch. Hope, like fear, is usually about the future. Fear says, ³Something bad is likely to happen´. Hope says, ³It won¶t be so bad, in fact it might not happen at all.´ Notice that both statements are about the future, rather than the now. Too much focus on the future can create a detachment or dissociation from the present, on one¶s current feelings, perceptions, or overall experience. But experience is our greatest teacher. If someone is mistreating us, it is our bad feelings which tell us so; if we¶re feeling loved, it is our emotional and psychic experience which tells us we¶re safe, cared for, and so on. We also learn from our present needs and desires which path to take, which roads on our personal ³map´ look promising. Passionate suffering, or positive relationships with others tell us whether we¶d like to stay where we are, or seek safer ground. I¶m not suggesting we wallow in emotionalism, but rather become attuned (or seek help in doing so) to our own emotional experience, to interpret the language of the heart and spirit. For it is our current experience which, with some discernment (since these things are often subtle), tells us what to do and where to go. This is one reason why we therapists and psychologists are always repeating that cliché, ³Get out of your head´. We can fantasize so much about better scenarios in the future that we fail to take action in the now. Living only for the future, or fearing that the future will only be a repetition of the past, creates paralysis, which in turn creates cynicism, self-loathing and bitterness. These things push away opportunities for growth and prosperity of all kinds, be it emotional, financial

or otherwise. I see this all the time with clients who love, and live with, people with addiction. Life in a house or relationship where addiction is present can be so painful that, sometimes, thinking of a better future is the only way to tolerate or survive. It¶s horrific now, but it will be better when«(fill in the blank). The only problem is that ³when´ may ± like Godot ± never show up. Thus, too much future-focus leads to present despair, which only creates obstacles for change. Cynicism, for example, gets us thinking, ³well, why bother doing anything at all«things will never change, life will always stink, guess I¶m screwed.´ Interestingly, this line of thinking parallels the rationalization of someone abusing substances ± i.e., ³it¶s a stupid, unfair world, so who cares, might as well get loaded.´ Why bother changing, if change is meaningless? May as well keep doing what you¶re doing, and getting what you¶re getting (i.e., misery). In spite of any bitterness, spite or rage you might be feeling, if you¶re living with an addicted person, the desire and need for a more unified, loving connection pulses somewhere beneath the surface. I¶ve never failed to find it, however faint, in anyone I¶ve been honored to work with in my practice, even folks who come in saying, ³I give up, it¶s hopeless.´ (I always congratulate them on their strength and courage in seeking help.) The bottom line is that something, or rather someone, needs to change, in a situation rife with stress and heartbreak. As the old adage goes, ³if you want something different, do something different.´ Usually the members of an alcoholic family freeze with anger or fear at this point, as if to say, ³Sure, we need change. You first!´ Why not you? Clinical observation in the mental profession has shown repeatedly that if one person changes, the entire family ³system´ changes. And addiction always adversely affects the system as a whole. The system becomes chaotic and volatile, yes, but patterns and routines ± or homeostasis ± emerge. The idea here is that something, no matter how small, must be done to shake up the system. But why should the non-using person take that step? Isn¶t that the responsibility of the one drinking or using? Partners or families of people with addiction are always shocked at how hard it is for them to adjust, when the partner gets sober. They report to me high levels of fear, sadness, anger, or other intensities ± because holy heck, their partner is actually listening! They, like the addicted one, are ³de-thawing´ from a traumatizing eco-sphere where feelings get ignored, rejected or stuffed. It¶s understandable, albeit naïve, to think that, if ³they´ get their act together, ³I´ will be much happier. Changing one atom affects the whole molecule, even when that change is positive. Sometimes families of addicted people say to me, ³I don¶t want to rock the boat´ by seeking help for themselves. I say, ³Yes, you do!´ Because if addiction is present, the boat is likely to hit the

iceberg anyway, with or without you. Why not increase the odds of positive change by doing some rocking, to see if you can wake the captain and crew from their slumber, and change course? It may sound a bit counterintuitive. In many areas, when we¶re unhappy with a situation, we change it from the outside. Don¶t like your grocery store or gym? Find a new one. Have a headache? Get aspirin. Don¶t like that show? Change the channel. But this is different. Not only because you can¶t trade your partner or family in for a new one (though there are moments you wish you could), but also because there are circumstances wherein the only thing you can change is yourself, your own thoughts, feelings, perceptions, to jar the overall ³system´ towards healthier functioning. To expose denial. To set healthier boundaries. To start telling your authentic emotional truth, without rage or fear. To say to yourself, ³No, I¶m not crazy, things are really messed up around here and I can trust my observations and feelings.´ To get some support for standing up for yourself, against the abusive patterns of addiction. It really is possible. Of that I¶m hopeful«

Drug and Alcohol Treatment for Employees
by Jeffrey Stuckert, M.D. If you currently know of or have known of an employee that needs drug and alcohol treatment, it is likely that you are frustrated. As an employer, you have a range of options available, but the action that many employers are likely to take is to fire the employee in question. Employers may think that is this the most practical and viable option. Dealing with employee drug or alcohol abuse seems troublesome, and hiring a new employee altogether seems as if it is the best choice for the company. But that choice may be wrong. There are numerous reasons why employers may want to consider sending their employees to a drug and alcohol treatment center. Some of the reasons are practical ± increased job satisfaction, or the use of less healthcare dollars ± but other reasons may actually impact the company's financial situation. The cost of finding and training new employees is not inexpensive, and it may actually cost less to send your employee to a drug and alcohol treatment program rather than to find someone new. The following include some, but not all, of the reasons to send an employee to a drug and alcohol treatment program.

Employee Drug or Alcohol Abuse: Reasons to Finance Employee Treatment

y Productivity. Employees who are sent to a drug and alcohol treatment program will experience a boost in productivity. Employee drug or alcohol abuse is detrimental to the company ± he/she may not be productive at work because they may be experiencing symptoms of withdrawal, or they may be trying to recover from the night before. Either way, employees lacking treatment cannot focus on their tasks at hand, short-changing the employer and the company. Treatment is essential to this employee. Afterward, he/she will be more responsive to their superiors, and in general, he/she will be a healthier employee ± physically and emotionally. y Job Satisfaction. If an employee suffering from drug or alcohol addiction is a supervisor in any regard, after treatment, the employees that they oversee will also experience increased job satisfaction. Employee drug abuse and alcohol addiction affects everyone in the workplace. It impacts many functional areas of the company, as the workplace is heavily impacted by negative attitudes. After treatment, the employee will be able to perform better at work, managing their workload and others more efficiently. y Company Loyalty. Employees who receive drug and alcohol treatment will be much less likely to injure the company in an inadvertent way, such as damaging the company's reputation. When employees are actively using, they are not good ambassadors for the company or the community. Interactions with clients and co-workers will suffer, and attendance may often be a problem. However, employees sent to get treatment will do and feel the opposite ± they may experience feelings of greater loyalty towards a company willing to provide them with assistance and help while they are dealing with their disease, and will "pay" the employer back with increased productivity, a boost in work performance, and company loyalty. y Recovery Time. Employee drug or alcohol abuse is a problem that can be treated within a reasonable amount of time. In residential recovery, employees who receive alcohol and drug treatment will be expected to attend a treatment facility for four weeks, and can begin work again in six to eight weeks. This recovery time is relatively short, especially in comparison to medical leave for lengthy operational procedures. The recovery time is not extraordinary, and the benefits, overall, are great. y Re-training and Re-hiring Costs. The cost to find middle to high management is substantial, and a missing employee puts a burden on additional employees to perform extra duties until that position is filled. Oftentimes, financing these costs can be more expensive than the cost it takes to send an employee to drug and alcohol treatment. There are several different costs that employers can expect to pay for when losing and attempting to replace an employee.
y y

y y

Separation Costs: These costs may be the costs paid for exit interviews, administrative duties, separation/severance pay and unemployment compensation. Vacancy Costs: These costs may include the costs paid to employees who work overtime to take over additional duties, or to find and hire a temporary employee to take over that specific employee's tasks. Replacement Costs: These costs may include the cost of attracting applicants, entrance interviews, testing, medical exams and acquiring and disseminating information. Training Costs: These costs may include formal or informal training costs, literature costs, technology costs, and time spent learning additional tasks.

y Moral Duty. Sending an employee with a serious health issue to find drug and alcohol treatment is the right thing to do. Legally, companies are not allowed to fire employees due to serious health issues, such as cancer or heart health, but employers are much more willing to let employees go because of substance abuse or alcohol addiction ± diseases which should be treated as physical and mental health issues that need to be addressed for the health of the employee.

Summary
Whether an employer chooses to send an employee to seek treatment is ultimately up to company, but there are numerous reasons ± both for the sake of the employee and for the sake of the company ± to send an employee to receive drug and alcohol treatment, rather than to wish them well and finance the costs of hiring someone new. About the Author As an American Board of Emergency Medicine (ABEM) certified physician, Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently serves as the CEO and Medical Director of The Ridge, a residential addiction treatment program and Northland, an outpatient treatment center near Cincinnati. He has personally attended to more than 70,000 emergency-room patients.

Drug & Alcohol Treatment: The Role of Addiction Assessment
by Steven Gifford, LICDC, LPC,

The Importance of Addiction Assessment ± How, When and Why it is Valuable for Drug and Alcohol Treatment
When you or your loved one decide to make the important step toward seeking drug or alcohol treatment, the next critical step in the recovery process is determining the level of appropriate care by receiving a professional addiction assessment. This is the first intake procedure to evaluate the extent of addiction as it determines the type and level of treatment a patient needs. A professional addiction assessment is critical to the recovery process as there are important distinctions between inpatient, outpatient, and ambulatory care, and it is essential to understand the best level of drug and alcohol treatment required to approach recovery.

Approaching the Addiction Assessment

It is important for patients and loved ones of an individual requiring drug and/or alcohol treatment to understand that family involvement is often a successful method of helping the patient seek treatment in the first place. Of all assessment calls received by outpatient and inpatient drug and alcohol treatment centers, about 50% are from patients, and 50% are from families. Assessments do not necessarily need to involve the patient the first time around, and can often help family members receive qualified and informative medical information about their loved one's addiction in order to make the next step toward an intervention. Often, family members struggle with the decision to even approach the issue of addiction, and do not know how to kick start the recovery process. By seeking a professional addiction assessment, the patient can be served with quality, professional medical information and attention, and family members can be educated about the medical components necessary for professional, effective care.

Assessing the Situation

Before the recovery process can begin, the patient's needs must be assessed. While the approach to drug and alcohol treatment is similar across recovery programs, the intensity and need for inpatient care vs. outpatient care is dependent upon a patient's circumstances, means, accessibility, and many other factors. An addiction assessment can determine what type of care is best for each patient. For example, individuals who have repeatedly enrolled in outpatient treatment programs with limited success (i.e., relapsing, not completing a program, not attending ongoing NA or AA meetings) may likely benefit from inpatient treatment. This type of residential drug and alcohol treatment is often ideal for drug and/or alcohol users who need to be isolated from accessibility and influence. Conversely, an individual who displays the desire and potential to complete an outpatient treatment program would not be an ideal candidate for an inpatient treatment program, as this type of program would be overkill, and more intrusive than necessary. An addiction assessment allows medical professionals to speak either with the patient or members of their family, and determine the most appropriate and necessary level of care to address the addiction treatment program. As a result, the patient receives the best level of care appropriate for their situation, and can work toward recovery in a manner best suited for their needs.

Determining the Level of Care

Like many things in life, starting slow and building up to a more complex solution is the ideal way to address a problem. By approaching drug and alcohol treatment from the bottom up, the patient and his or her family can receive professional medical assistance, while reducing the level of interference with their daily lives. A professional addiction assessment is the first step toward determining an appropriate level of care, and helps to ensure that the recovery process is just right for the patient's needs. If the patient has insurance, providers are most often willing to

pay for outpatient procedures before paying for inpatient procedures. While the inpatient drug and alcohol treatment recovery process can be highly beneficial for patients who need this type of treatment, it is most always more expensive than outpatient treatment, and does require a residential stay away from family or friends. An addiction assessment will determine whether the patient needs this type of in-depth treatment, or if he/she can be equally served in an outpatient setting. During an assessment, medical professionals will work to learn not only what the patient needs help with, but also who they are, and why drug and alcohol addiction is a destructive element in their life. Any other conditions that can perpetuate drug and alcohol abuse can be determined and logged, such as psychological factors, health problems, family involvement, spiritual needs, etc. At its root, drug and alcohol addiction is a disease, but there are multiple potential compliments to the disease that must be addressed during an addiction assessment to determine an appropriate level of care. For example, if a patient suffers from a psychological imbalance which requires medication, is an outpatient or inpatient facility equipped to serve that patient appropriately? If the patient is deeply religious, does the drug and alcohol treatment facility offer spiritual services or resources to help the patient through the recovery process? Overall, an addiction assessment is invaluable as the first step toward recovery, as they help patients, family members, and medical professionals understand the best approach toward treating an individual's addiction problem. They are a professional, discreet, and caring step toward overcoming addiction, and resuming a life free of drugs and alcohol.

About the Author

Since 1998, Steven Gifford, LICDC, LPC, has worked in the Licking Memorial Hospital -Shepherd Hill treatment center located in Newark, Ohio, and currently serves as Senior Counselor at The Ridge, a residential treatment center in Ohio.

Blood Alcohol Levels and Driving
by Reid K. Hester, Ph.D. A friend and I have a disagreement (and a bet on it) about drinking and driving. My friend, Dennis, says that as long as you keep your blood alcohol level under the legal limit that it's OK to drive. He has a chart that shows him how much he can drink over time and still stay under our legal limit of 0.8. I think he's nuts. I can feel the effects of 1-2 beers and wouldn't want to put myself and others at risk by driving after I've drunk anything. So who's right?

I have the pleasure of informing you that you are the winner of the bet with your friend. In a very narrow and legal sense, he is correct but that's about as far as it goes. Most states now have a 'per se' limit of 80mg% (also known as 0.8) blood alcohol concentration (BAC). This means that if a

driver is caught with a BAC at or above 80mg%, he or she is considered to be intoxicated regardless of whether they can pass a field sobriety test or not. A BAC of 80mg% will result in an arrest for driving while intoxicated (DWI) arrest. However, you can be arrested for DWI even if you have a BAC less than 80mg%. If you have any positive BAC and fail a field sobriety test you can be arrested for DWI. Some states also have very low BAC limits for underage drivers. But far more important than getting arrested is the risk you put yourself and others at if you drink and drive. Your judgment and reaction times don't just go down the tubes all of a sudden when your BAC gets to 70-80mg%. Rather, they decline as your BAC increases from 0mg%. As your BAC increases so does your risk for getting in an accident. There is no safe BAC for driving. So if you drink, don't drive. And if you drive, don't drink. If you're going out with your friends, designate a driver who won't drink. Or walk. Or take a taxi. Do what you have to so that you and your friends can get back home safely.
About the Author:

Reid K. Hester, Ph.D., Director, Research Division, Behavior Therapy Associates, 9426 Indian School Rd NE, Suite 1, Albuquerque, NM 87112. Phone: 505.345.6100. Dr. Hester is has developed an evidence-based, web application called ModerateDrinking.com to help heavy drinkers be successful in changing their drinking. A video demo of the program is available at www.behaviortherapy.com

How is Suboxone Treatment Different than Drug Abuse?
by Dr. Jeffrey Stuckert

How is Suboxone Treatment Different than Drug Abuse?
Physicians who treat opioid addiction also have the option of utilizing 'medication-assisted treatment', and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone). Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, "quitting cold turkey" has a poor success rate ± fewer than 25% of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.

Methadone

Methadone is an opioid and has been the standard form of medication-assisted treatment for opioid addiction and dependence for more than 30 years. Methadone for the treatment of opioid dependence is only available from federally-regulated clinics which are few in number and unappealing for most patients. In addition, studies show that participation in a methadone program improves both physical and mental health, and decreases mortality (deaths) from opioid addiction. Like Suboxone, when taken properly, medication-assisted treatment with methadone suppresses opioid withdrawal, blocks the effects of other problem opioids and reduces cravings.
Naltrexone

Naltrexone is an opioid blocker that is also useful in the treatment of opioid addiction. Naltrexone blocks the euphoric and pain-relieving effects of heroin and most other opioids. This type of medication-assisted treatment does not have addictive properties, does not produce physical dependence, and tolerance does not develop. Unlike methadone or Suboxone, it has several disadvantages. It does not suppress withdrawal or cravings. Therefore, many patients are not motivated enough to take it on a regular basis. It cannot be started until a patient is off of all opioids for at least two weeks, though many patients are unable to maintain abstinence during that waiting period. Also, once patients have started on naltrexone the risk of overdose death is increased if relapse does occur.
Buprenorphine / Subutex / Suboxone

In 2002, the FDA approved the use of the unique opioid buprenorphine (Subutex, Suboxone) for the treatment of opioid addiction in the U.S. Buprenorphine has numerous advantages over methadone and naltrexone. As a medication-assisted treatment, it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioid-dependent patient, and it blocks the effects of the other (problem) opioids for at least 24 hours. Success rates, as measured by retention in treatment and one-year sobriety, have been reported as high as 40-60% in some studies. Treatment does not require participation in a highly-regulated federal program such as a methadone clinic. Since buprenorphine does not cause euphoria in patients with opioid addiction, its abuse potential is substantially lower than methadone.

What is Medication-Assisted Treatment?
Medication-assisted treatment for opioid dependence can include the use of buprenorphine (Suboxone) to complement the education, counseling and other support measures that focus on the behavioral aspects of opioid addiction. This medication can allow one to regain a normal state of mind ± free of withdrawal, cravings and the drug-induced highs and lows of addiction. Medication-assisted treatment for opioid addiction and dependence is much like using medication to treat other chronic illnesses such as heart disease, asthma or diabetes. Taking medication for opioid addiction is NOT the same as substituting one addictive drug for another.

What is Suboxone and How Does it Work?

There are two medications combined in each dose of Suboxone. The most important ingredient is buprenorphine, which is classified as a 'partial opioid agonist', and the second is naloxone which is an 'opioid antagonist' or an opioid blocker.
What is a 'Partial Opioid Agonist'?

A 'partial opioid agonist' like buprenorphine is an opioid that produces less of an effect than a full opioid when it attaches to an opioid receptor in the brain. Oxycodone, hydrocodone, morphine, heroin and methadone are examples of 'full opioid agonists'. For the sake of simplicity from this point on we will refer to buprenorphine (Suboxone) as a 'partial opioid' and all the problem opioids like oxycodone and heroin as 'full opioids'. When a 'partial opioid' like Suboxone is taken, the person may feel a very slight pleasurable sensation, but most people report that they just feel "normal" or "more energized" during medication-assisted treatment. If they are having pain they will notice some partial pain relief. People who are opioid dependent do NOT get a euphoric effect or feel high when they take buprenorphine properly. Buprenorphine tricks the brain into thinking that a full opioid like oxycodone or heroin is in the lock, and this suppresses the withdrawal symptoms and cravings associated with that problem opioid. Buprenorphine is a long-acting form of medicated-assisted treatment, meaning that it gets 'stuck' in the brain's opiate receptors for about 24 hours. When buprenorphine is stuck in the receptor, the problem 'full opioids' can't get in. This gives the person with opioid addiction a 24-hour reprieve each time a dose of Suboxone is taken. If a full opioid is taken within 24 hours of Suboxone, then the patient will quickly discover that the full opioid is not working ± they will not get high and will not get pain relief (if pain was the reason it was taken). This 24-hour reprieve gives the patient time to reconsider the wisdom of relapsing with a problem opioid while undergoing medication-assisted treatment. Another benefit of buprenorphine in treating opioid addiction is something called the 'ceiling effect'. This means that taking more Suboxone than prescribed does not result in a full opioid effect. Taking extra Suboxone will not get the patient high. This is a distinct advantage over methadone. Patients can get high on methadone because it is a full opioid. The ceiling effect also helps if buprenorphine is taken in an overdose ± there is less suppression of breathing than that resulting from a full opioid.
What is an 'Opioid Antagonist' (Opioid Blocker) and Why is it Added to Suboxone?

An opioid antagonist like naloxone is a medication-assisted treatment option for opioid addiction that also fits perfectly into opioid receptors in the brain. Naloxone is not absorbed into the bloodstream to any significant degree when Suboxone is taken correctly by allowing it to dissolve under the tongue. However, if a Suboxone tablet is crushed and then snorted or injected the naloxone component will travel rapidly to the brain and knock opioids already sitting there

out of their receptors. This can trigger a rapid and quite severe withdrawal syndrome. Naloxone has been added to Suboxone for only one purpose ± to discourage people from trying to snort or inject Suboxone.
How is Suboxone Taken as a Form of Medication-Assisted Treatment?

Because it is long-acting (24 hours or more) Suboxone only needs to be taken one time per day. It should be allowed to completely dissolve under the tongue. It comes in both a 2 mg and 8 mg tablet, and a 2 mg or 8 mg filmstrip. The filmstrip is now the preferred preparation because it has less potential for abuse by people with opioid addiction (it cannot be crushed), serial numbers on the filmstrip packs help prevent diversion (trafficking), and the strip dissolves more rapidly than the tablet. Patients should not eat, drink or smoke for 30 minutes before their dose of Suboxone, or for 30 minutes after their dose of Suboxone. Food, beverages, and nicotine can block the absorption of Suboxone. Chewing or dipping tobacco can seriously impair the absorption of Suboxone and should be promptly discontinued by anybody going through medication-assisted treatment.
What is Recovery, and How Can Family and Loved Ones Help?

Put simply, recovery is restoring the life that was lost during active opioid addiction. As a complement to medication-assisted treatment, there are many ways that family and loved ones can help the person suffering from addiction. Family and significant other involvement is an important part of a recovery program. The following is a list of ten ways you can help:
y y y y y y y y y y

Learning about the disease the biology, psychology, and sociology of addiction. Understanding that addiction is not a problem of poor will-power or poor self-control. Understanding that this is a hereditary disease that results in long-term changes in the structure and function of the brain that lead to behaviors that are potentially fatal. Learning about the behaviors that occur during addiction, why they occur, and how they can be changed. Learning how living and social environments play a key role in triggers, cravings and relapse. Learning how easily family members can get drawn unwittingly into supporting their loved one's addiction (co-dependency). Encouraging and motivating your loved one to attend and complete treatment even when they don't feel like it. Understanding that you cannot make the addict get better, but you are not helpless. You can make changes that promote recovery for your loved one, and for you. Participating in support groups that help the family of the addict recover (such as Al-Anon or Nar-Anon). Attending the family education sessions with your loved one.

About the Author

As an American Board of Emergency Medicine (ABEM) certified physician, Dr. Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently

serves as the CEO and Medical Director of Northland, an outpatient drug and alcohol treatment center, and The Ridge, an inpatient treatment center near Cincinnati, and has personally attended to more than 70,000 emergency-room patients.

What is Opioid Addiction
by Dr. Jeffrey Stuckert

To first understand opioid addiction, you must first understand what opioids are. The term opioid refers to any drug or chemical that attaches (like a key fits into a lock) to sites in the brain called opioid receptors. The human body makes its own opioids (called endorphins) but the opioids we are concerned with when we talk about opioid addiction are those that are manufactured in a laboratory or made by plants. For instance, morphine and codeine are found in the extract (the opium) of seeds from the poppy plant, and this opium is processed into heroin. Most prescription painkillers like oxycodone, hydrocodone, and hydromorphone are synthesized in the laboratory. When a person becomes dependent upon these drugs, they need opioid addiction treatment.

What are Common Types of Opioids?
Opioids may be prescribed legally by doctors (for pain, cough suppression or opioid dependence) or they may be taken illegally for their mood-altering effects---euphoria, sedation, "to feel better", or for some, opioids are taken "just to feel normal". Not everyone who takes an opioid is at risk for dependence requiring opioid addiction treatment, but these drugs are commonly abused. Examples of prescribed medications that sometimes lead to opioid addiction, but that can also help patients battle other types of substance abuse include:
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Codeine--the opioid in Tylenol #3, Fiorinal or Fiorecet #3, and in some cough syrups. Hydrocodone--the opioid in Vicodin, Lortab, and Lorcet. Oxycodone--the opioid in Percodan, Percocet and OxyContin. Hydromorphone--the opioid in Dilaudid. Oxymorphone--the opioid in Opana. Meperidine--the opioid in Demerol. Morphine--the opioid in MS Contin, Kadian and MSIR. Fentanyl--the opioid in Duragesic. Tramadol--the opioid in Ultram. Methadone--the opioid in Dolophine. Buprenorphine--the opioid in Suboxone.

Although not entirely accurate, the terms opiate and narcotic are generally used interchangeably with the term opioid.

The great majority of illicitly used prescription opioids are not obtained from drug dealers. Family and friends are now the greatest source of illicit prescription opioids, and the majority of these opioids are obtained from one physician---not from "doctor shopping". More than 90% of the world's opium and heroin supply comes from Afghanistan and Southeast Asia. 'Black tar' heroin comes primarily from Mexico. Opioids are the most powerful known pain relievers, sometimes leading to opioid addiction requiring treatment. The use and abuse of opioids dates back to antiquity. The pain relieving and euphoric effects of opioids were known to Sumerians (4000 B.C.) and Egyptians (2000 B.C.).

What Happens When an Opioid is Taken?
When an opioid is taken into the body by any route (by mouth, nasally, smoking or injecting) it enters the blood stream and travels to the brain. When it attaches to an opioid receptor in the brain, our perception of pain is reduced (if we have pain) and we feel sedated. Most people also feel at least a mild pleasurable sensation, or a sense of well-being when opioid receptors are stimulated. Some report feeling more energized or motivated after taking opioids. A few experience unpleasant side effects such as nausea, vomiting or irritability. Unfortunately, those who are prone to develop an opioid addiction seem to experience an intense euphoric or pleasurable feeling when they take an opioid ± leading to prolonged dependence requiring opioid addiction treatment. An opioid seems to do something for their mood that it does not do for most people. Their experience with an opioid is quite different than it is for the person who is not prone to develop an opioid addiction. Drugs of abuse (like opioids, cocaine and alcohol) are addictive for the susceptible person because repeated use of those substances---in an effort to reproduce that intense euphoric feeling---results in long-term changes in the structure and the function of the brain. These changes in the brain start to drive their behavior, and when someone is suffering from opioid addiction, they want the drug even when the drug no longer provides pleasure. Opioids that can be snorted, inhaled or injected reach the brain in a high concentration rapidly and result in an even more intense high, or a "rush". As a result, drugs that can be abused by these routes are often more appealing to the person seeking euphoria, and are therefore more addictive for the susceptible person.

What is Opioid Dependence? Is it the Same as Opioid Addiction?
Yes ± opioid dependence and opioid addiction mean the same thing. Opioid dependence is a disease affecting the brain that involves both a physical and a psychological need for an opioid, and requires opioid addiction treatment. An individual is considered "dependent" or "addicted" when he or she exhibits this behavior---compulsive use despite obvious harm. The addicted person can't seem to stop using opioids even when it is obvious to himself or herself and others that he or she should stop. The two major signs of opioid addiction are cravings---an intense and overwhelming desire for a drug---and a loss of control---it becomes harder and harder to say no

to using a drug, or controlling the amount used, and thus use becomes compulsive. Behaviors which signal a need for opioid addiction treatment include:
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Denial that a problem exists, or minimizing the severity of the problem. Impaired control over use---using more than planned. A lot of time is spent obtaining, using or recovering from using opioids. Important obligations like school, work, or childcare are reduced for the sake of use. Multiple prior unsuccessful attempts to quit, or a persistent desire to quit. Continued use despite obvious harm to one's health, job, finances or family.

What is Physical Dependence?
A person is said to have "physical dependence" on opioids if they have high "tolerance", meaning more of the substance is needed to get the same effect, and they get withdrawal symptoms if the substance is stopped. Most patients who seek opioid addiction treatment also have some degree of physical dependence. However, physical dependence alone is not sufficient to make a diagnosis of addiction. A person can be physically dependent---such as a cancer patient might be who is prescribed opioids for severe pain---and not be addicted. Again, addiction refers to certain behaviors. Patients who are being treated for chronic pain can develop what we call "pseudo addiction". They may start to exhibit some of the same behaviors we see with addiction when they don't get adequate pain relief. When their pain is controlled, the behaviors that we associate with opioid addiction disappear. They do not need opioid addiction treatment. They need better pain management.
About the Author As an American Board of Emergency Medicine (ABEM) certified physician, Dr. Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently serves as the CEO and Medical Director of Northland, an outpatient drug and alcohol treatment center near Cincinnati, and has personally attended to more than 70,000 emergency-room patients.

Substance Abuse: What can a family do?
by Steven Gifford, LICDC, LPC,

The Importance of Family Involvement in Substance Abuse Treatment and Addiction Therapy

For family and friends of drug and/or alcohol addicted individuals, addressing addiction is one of the most difficult aspects of seeking substance abuse treatment. Often, drug and alcohol addiction has built a destructive cycle over a time to the point where daily family involvement actually enables the addicted individual. Family members frequently do not know how to bring up the issue of addiction therapy, and opt to ignore the problem for fear of pushing their loved one away during a confrontation or intervention. These are legitimate concerns, and while families should understand that approaching their loved one should be a gentle and supportive process, they also need to understand that most patients seek substance abuse treatment because of positive family involvement and intervention.

Prior to Substance Abuse Treatment / Intervention

Each family is different, and the way you should approach family involvement with addiction therapy will differ with every person. There are counselors in your area who are trained to work with drug and alcohol addicted patients and their families, and while they can be useful to mediate the intervention process, your family may decide to have a private, non-confrontational and honest talk with a family member or friend to implore them to seek substance abuse treatment. Whichever approach you take, it is important to understand that the family dynamic in drug and alcohol addiction is incredibly powerful, and that addressing an unhealthy imbalance in communication is your first step in moving your loved one toward inpatient / outpatient addiction therapy. This type of positive family involvement can also help lead the rest of your family toward a journey of recovery and self-discovery.

During a Patient's Substance Abuse Treatment Program

After an intervention, the best case scenario is that the individual suffering from drug or alcohol addiction will be compelled to enter either an inpatient or outpatient substance abuse treatment program. Each patient's needs and means are different, and outpatient and inpatient programs have varying benefits for patients and family. Involvement in an outpatient addiction therapy program means that patients are not separated from their families, they are able to attend classes in a facility close to their home, and patients can continue substance abuse treatment for an extended amount of time. In a residential (inpatient) program, patients travel to a facility where they undergo an intensive 28-30 day detoxification and recovery program. They are immersed in the recovery process and do not have the ability to leave the substance abuse treatment campus. However, family involvement is important, and inpatient addiction therapy programs often encourage frequent interaction with visiting family and friends. As previously mentioned, patients' needs vary, but inpatient substance abuse treatment has an obvious benefit of removing the drug and/or alcohol addicted individual from the toxic atmosphere that was enabling their addiction, and helping them through addiction therapy without distraction. This same benefit is transferred to the patient's friends and family, who are often able to gain a new perspective about their loved one's addiction and their own behaviors.

Family involvement, once the patient is in an off-site substance abuse treatment facility, is periodic and helps families step back and recognize patterns of negative behavior. For example, well-meaning family and friends often become trapped into a cycle of enabling and codependency with the patient prior to addiction therapy. Often, family members pretend like nothing is wrong, and unintentionally assist the patient's addiction by ignoring the problem. Conversely, family members might become distant, angry, and resentful by feeling that they cannot address the issue for fear of angering the patient or exacerbating their loved one's addiction. When the family members are able to take a break and assess their behaviors and environment while their loved one is undergoing addiction therapy, they often identify behaviors and traits that they adjust to break the cycle. This is not to say that residential substance abuse treatment programs isolate the patient from their friends and family ± quite the opposite. In a quality residential substance abuse treatment program, the focus is equally upon the patient's physical recovery from drug and alcohol addiction as much as it is on a mental recovery from the addictive disease. Addiction therapy is supported heavily by positive and frequent family involvement. The support that a family provides to a patient recovering from addiction is essential to that patient's success, and residential centers will often have not only visitation throughout the week or on weekends, but will also engage family into an educational substance abuse treatment program of their own, such as supportive and dynamic recovery workshops and sessions for family involvement. Outside of the residential substance abuse treatment facility, family and friends of patients are highly encouraged to attend Al Anon or Nar Anon meetings. These free programs are held around the nation and are dedicated to providing group support to family and friends of drug and alcohol addicted individuals. The meetings address things such as: helping an addict seek assistance for his or her own problem, addressing a loved one's drug or alcohol addiction, building family through the addiction therapy process, supporting yourself and your loved one through the recovery process, etc. These programs are essential for family involvement, as they support friends and family during and after the substance abuse treatment program.

After a Substance Abuse Treatment Program

With drug and alcohol addiction, there is truly no clear-cut "end" to the addiction therapy process. Families struggling with the effects of their loved one's drug and alcohol addiction should continually attend Al Anon or Nar Anon meetings (perhaps both) on a regular basis to continue a constructive program of support and ongoing education. Alcohol and drug addiction are both considered "family diseases", and family involvement with people combating drug and alcohol addiction requires continual attendance of these meetings during and after the formal inpatient or outpatient addiction therapy session. Additionally, while these meetings help individuals to understand the disease of drug and alcohol addiction to help and support someone they care about, they also assist friends and family with their own emotional support during what is most often an incredibly trying and stressful time. By continuing to attend Al Anon and Nar Anon meetings, friends and family of an addicted individual can continue to stay out of the

destructive cycle of enabling and codependency and fully realize the benefits of addiction therapy.

Is There Such A Thing as Adrenaline Addiction?
by Reid K. Hester, Ph.D.

I am curious as to whether there is such a thing as adrenalin addiction and if yes, how and why would someone get "addicted to adrenalin." I would like to know what physiological aspects of adrenalin make some people prone to becoming addicted to dangerous and life threatening activities. Some people call these activities "extreme" sports, but I call them crazy death wishes. If anybody can supply me with a possible explanation to this question, it would greatly be appreciated. The psychological and psychiatric manual (the Diagnostic and Statistic Manual of Mental Disorders, aka DSM) published by the American Psychiatric Association, Washington, DC, does not include a classification for adrenaline addiction or adrenaline 'junkie." Nonetheless, the terminology has been commonplace for decades now. Physiologically, adrenalin affects everybody in pretty much the same way. Your heart races, your blood pressure increases, you're more alert, and your body is in what biologists call the "fight or flight" mode. While the physiological experience is the same, how it is interpreted by different individuals varies tremendously. Some people interpret the "rush" you feel when adrenalin kicks in as positive and enjoyable. Others find it aversive. Your labeling "extreme sports" as 'death wishes' suggest you are in the latter camp. Taking varying degrees of calculated risks is a part of life and some people have a greater level of risk that they are comfortable with. And they have the opportunity to get an adrenaline "rush." Some research has also shown that babies who are deprived of oxygen at birth sometimes grow up to develop a higher need for stimulation. That is, they tend to be the high-risk-takers of the world. While our research strategies can't precisely say that the lack of oxygen at birth creates an adrenalin surge that the individual then continues to try and re-create, that is one theory that is being examined by some scientists. It might be that for these people, the surge was so intense that it threw off the infant's early development. Much more research has to be completed before we will know if this theory holds any truth, but it is fascinating to note that there is a correlation between the two groups of people: those deprived of oxygen at birth and those who are higher-than-average risk takers in adulthood.

Dizzy Spells after Drinking Alcohol
by Reid K. Hester, Ph.D.

I drink one bottle of chardonnay each night (or less) about 5 nights per week. One night this week, after having nothing to drink, I went to bed and awoke at about 6AM to a major dizzy spell. So major that I actually felt my eyes moving side to side as would be the case in REM sleep. The entire room was spinning. I didn't move for fear of falling down and it passed in about 45 to 60 seconds. Since then, I've have less severe spells nightly at about the same time of day (and after having some wine) and now today, 3 days after the initial spell, I'm having some slight dizziness during the course of the day. I do not drink at all during the day; only in the evenings. My normal blood pressure is about 100/70 or less sometimes. I am in otherwise good health. I'm 5'4" and about 145 pounds (size 14). Could this be the beginning of menopause? I see my ob/gyn yearly and always ask him about it but he says I'm too young. I saw him last about 4 months ago. I was especially afraid the first time it happened because I had not had any alcohol at all that night and because of the rapid eye movement involved. Contact your primary care physician immediately. You may be experiencing any one of a number of medical conditions. Please be frank and open about your pattern of drinking, which is heavy and may have either obscured a medical problem or exacerbated it.

Is Compulsive Shopping An Addiction?
by Reid K. Hester, Ph.D.

Is compulsive shopping an addiction? Why would a person become a compulsive shopper and how do you control it? Compulsive shopping is not really an addiction because addictions involve some degree of physical dependence. Rather it is a compulsive behavior with some aspects of a lack of impulse control. There is a multitude of ways that people can become compulsive shoppers and our society encourages people to spend, spend, spend. Look in nearly any medium today and you'll see messages like "Save $50!" (which, of course, means that you're only spending a little less but the bottom line is that money is flowing out of your pocket, not into it). If you personally are experiencing difficulties controlling your spending, ask yourself "What short-term reward or pleasure do I get from buying something?" Do you buy things to help you feel better about yourself? Do you feel like a 'nobody" unless you're wearing the latest fashion?

If yes, you may be shopping to cope with poor self esteem. Take a class or online workshop on building your self esteem and combine that with setting limits on yourself with your chopping. To help control your compulsive shopping, try some of these tactics: Control your available cash & credit. Leave credit cards, your check book, ATM cards, and most of your cash at home, taking only a limited amount of money, or access to it with you. If you see something you really would like to buy, hold off and think about it for a day or two. Do you really need it or are you buying it to feel good about yourself? If after considering it for a while, you decide you need it, consider whether you can afford it given your budget. Get a strong support group around yourself to help you weather the storms that will inevitably arise. Another option is to consider getting some counseling either with a credit counselor or with a professional counselor. Whichever option you choose, making a decision to control yourself is an important first step. And if at first you don't succeed, don't get discouraged. Continue trying different options until you find one (or a combination of tactics) that work for you. Good luck!

Father is More Emotional after He Drinks Alcohol
by Reid K. Hester, Ph.D.

My father is 60 years old and I am concerned about his emotional state. When I visit him he becomes very tearful when he thinks about my leaving. When we depart, the crying is worse and he can t control his tears. I made the observation, that he cries more, when he drank alcohol on the day before. (In general he is not drinking too much.) He has already seen a doctor, who gave him pills for calming down, to no avail. As you may know the attitude against psychology in Europe is not very good, and therefore my father in law is not willing to ask a psychologist. Any ideas how we could help? Encouraging him to not drink will be helpful but I doubt sufficient. Consider consulting with his doctor first. By your brief description, he doesn't sound anxious but significantly depressed. If the doctor prescribed anti-anxiety medications, they could be making matters worse. Antidepressant medications might be more appropriate. You may also need to find a physician with an interest in mood disorders for your father to see.

Health Benefits of Alcohol
by Reid K. Hester, Ph.D.

What are some benefits of drinking alcohol?

Moderate consumption of alcohol has health benefits of reducing the risk of heart attack and stroke. The hypothesized mechanism of action is to make red blood platelets less "sticky" and reducing their ability to clot together. There is also some evidence that the alcohol raises HDL cholesterol, the "good" cholesterol. By moderate we mean 1-2 5 oz. glasses of wine per day. The other good news in this area is evidence that drinking grape juice (without the alcohol) seems to have the same benefit. And you can raise your HDLs by increasing your level of muscle mass either through weight training or aerobic exercise. What this means is that, if you drink alcohol, doing so moderately can decrease your chances of having a stroke or heart attack. However, if you don't drink alcohol, you can achieve the same benefits with grape juice and exercise.

Duration of Alcohol in the Body
by Reid K. Hester, Ph.D.

What is the amount of time it takes for alcohol to fully leave the body or to become undetected by a random alcohol test? Alcohol is, on average, metabolized at the rate of 16 mg% (or .016 in more common terms) per hour. Some individuals process it more quickly and others more slowly. So if you have a peak blood alcohol concentration (BAC) of .16 your body would take about 10 hours to completely metabolize that amount of alcohol. However, how high your BAC gets is a function of your gender (females have higher BAC levels for a given body weight and percent body fat than do men), your weight and percent body fat (because alcohol isn't absorbed into fat), how much you drink, and how long you take to drink it. So this portion of the question is much more complex than how quickly a person metabolized alcohol.

Alcohol Effects on Psychological Health and Mood
by Reid K. Hester, Ph.D.

What are some of the psychological effects from alcohol abuse? There are more alcohol effects on psychology and mood than you can shake a stick at. If you head to your local bookstore and check out the "recovery" section you'll find shelves of books that address your question. So it really is impossible to answer your question in a brief, concise way.

Instead, let me give you a brief overview of alcohol and its effects on mood. Alcohol is a depressant. The more you drink the more it depresses your cognitive functions, your physical functions, and your mood. At high doses it can depress your central nervous system functions right into the grave. It is the most powerful drug available. Chronic heavy use puts people at risk for a variety of mood disorders including depression and anxiety, to name but two. Fortunately, we find that most, but not all, people's moods and psychological problems resolve or improve substantially when they stop drinking or drinking heavily. If you or someone you know are having problems with mood or other psychological consequences, consider a vacation from alcohol of 30-180 days. Give yourself time to figure out how you've come to depend on alcohol psychologically and time to develop alternative ways to deal with different situations and enhance your life. If you can't do it, for whatever reason (or excuse) you give yourself or others, you probably will need some form of professional help to stop successfully. Don't waste any more of your life. Go get the help you need, and the sooner the better. Alcohol has many negative effects It is one of the most serious causes of other health and relationship problems.

Why Do Teenagers Drink Alcohol?
Why do teenagers drink alcohol? And what do they find so good about it?

Teenagers, like adults, drink alcohol for many different reasons, although some of them are different for teens. Your question is on teens and so I'll restrict my answer to that population. Teens are more likely to start experimenting with drinking if they have parents who drink, if they have friends who are also drinking, and if their parents don't give them clear messages about not drinking outside the house (if they are allowed to drink some wine with dinner, for instance). Also, alcohol is a powerful drug and changes how you feel. Some of the initial sensations at lower blood alcohol levels are pleasant and it is this sensation that many teens, as well as adults, seek. Alcohol is a central nervous system depressant. So if you're tense or uptight, drinking some alcohol will, at least initially, reduce some of that tension and help you "chill out." There are many other reasons why teens drink but to answer in depth would take an entire book. If you're concerned about some of your friends' drinking, consider talking with an adult in whom you can confide. Also, if you yourself are a teen, consider talking with an adult you trust or a counselor. Drinking, especially heavy drinking (4 or more for women, 5 or more for men) can significantly increase your risk for alcohol-related problems and health problems. Yes, even at your age.

Whatever you do, don't drink anything and drive. The risk of being in a fatal crash is much higher at much lower blood alcohol concentrations (BACs) for drivers under 21 years of age. Here's a graph that shows the risk by age and BACs).

If you're a parent reading this, there's new data (May, 2010) on parental attitudes and teen drinking at http://tinyurl.com/2uggdle Rather than paraphrase their conclusions I've cut and pasted them here: Significant relationships were found between young people's drinking behaviours and perceptions of risk and protective factors in the family environment. Parental monitoring was strongly associated with family closeness and appeared to form one part of a parenting style of more general communication and regulation of children's behaviour. Findings support the need for alcohol misuse prevention interventions which address risk and protective factors within the family setting. Timing of such prevention work should be related both to the development of family relationships and the age at which young people begin drinking alcohol.

Alcohol and Depression: Bad Mix
by Reid K. Hester, Ph.D.

I have a concern about my sister. She is a heavy drinker, with mood disorders that are sometimes present even when she isn't drinking. The problem is I want to have a close relationship with her and we do, but she is so unhappy and stressed out all of the time, that I am beginning not to want anything to do with her at all, which is painful to me. What can I do to help my sister? As you have a close relationship with her right now you can have an influence on her sobriety. If you only want to be around her then she's sober, tell her so in a positive, caring way. Spend time together when she's sober and remove yourself when she's not. Her mood difficulties, however, may be a trigger for heavy drinking and she's at risk for returning to it until she learns

some additional strategies for managing her mood. There is a wealth of information here at the SelfhelpMagazine you and she could use. She might also benefit from a consultation and/or therapy from a professional. Alanon is a 12-step program, like AA, and has free meetings all over the world. Its focus is for friends and loved ones of alcoholics. You may want to go to at least a half dozen meetings and see how much you can learn about how to help your loved ones by loving yourself first. A colleague of mine, Robert J. "Bob" Meyers, wrote a book for concerned family members such as you. You might consider looking at a chapter 11 in a book by William R. Miller and Nick Heather, "Treating Addictive Behaviors" (second edition) by Plenum (1998).

Is God Required in Drug and Alcohol Treatment?
by Richard B. Patterson, Ph.D. Question: Does recovery from drug or alcohol problems require a belief in God or a higher power? If not, what other drug and alcohol treatment approaches exist?

What Gandhi said about religion certainly applies to recovery: "There are many roads to the same point." Although some in Alcoholics Anonymous might take issue, recovery from alcoholism and/or drug addiction does not require a belief in God or a "higher power." Clearly, there are persons who manage to quit drugs or alcohol through other means. Obviously, the approach of Alcoholics Anonymous has much to recommend itself, particularly the fact that it is an approach that has benefited millions. Some persons find the spiritual emphasis to be a major roadblock. Such persons would first do well to read the chapter "We Agnostics" in the book Alcoholics Anonymous. This chapter makes it clear that a belief in a personal God is not a requirement to recovery. Some persons define higher power to be simply the group consciousness of AA itself. One man I know found a workable concept of higher power through the writings of physicist Stephen Hawking. The point is to connect with a power larger than one's own ego. There is much flexibility. If, however, the spiritual approach remains an impediment, there is an approach known as Rational Recovery
Drug and Alcohol Treatment Options

Rational Recovery follows a plan of action similar to that of AA but without the spiritual emphasis. Many have benefited from this approach.

I'd say that a place to start would be to reflect on your hesitation with the AA approach. If it is based on a series of hurts connected with organized religion, then I believe you would find yourself not alone. On the other hand, if your hesitation is based on some genuine, strongly felt beliefs of your own, then certainly explore other approaches such as Rational Recovery. If a person really wants sobriety, there is always a path that can work. Drug and alcohol treatment approaches vary. You can find one that's right for you.

Bipolar Diagnosis Complicating Alcohol Recovery? Tie Bipolar Medication to New Path
by Richard B. Patterson, Ph.D.

Question: I am a recovering alcoholic and also have a diagnosis of bipolar disorder. I have trouble with taking my bipolar medication on a consistent basis. Can you offer any help? The problem of compliance with medication is not uncommon among persons suffering from bipolar disorder. Compliance can be a particular problem when a person is moving into a manic phase. The euphoria of early mania can convince a person that all is well and medication unnecessary. The noncompliance with the medication obviously encourages the progression of the illness. You did not say so in your question but let's assume for the moment that you participate in a 12Step program for the alcoholism. If that's correct, why not address the medication issue through the 12 Steps. In recovery, we learn how to care about ourselves in a healthy way. This includes developing a loving attitude toward our bodies. I often encourage persons in recovery to list themselves under persons to whom they need to make amends. This includes amends for the manner in which we have treated our bodies. Consider the consistent taking of your medication to be one way in which you are making amends to your body. If your recovery does not include 12 step work, nonetheless consider taking the bipolar medication to be an important facet of recovery from alcoholism. Link the two together.

Aging, Drinking, Alcohol Abuse and Alcoholism
By Emily Carton, LISW

Drinking and aging do not mix well. Anyone at any age can develop or resume a drinking problem. Great Uncle George may have always been a heavy drinker -- his family may find that as he gets older, the problem gets worse. Grandma Betty may have been a teetotaler all her life, just taking a drink "to help her get to sleep" after her husband died -- now she needs a couple of drinks to get through the day. These are common stories. Drinking problems in older people are often neglected by families, doctors, and the public.
Physical Effects of Aging and Drinking

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Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time, drinking increases the risk of falls and accidents Some research has shown that it takes less alcohol to affect older than younger people Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach Alcohol's effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack It also can cause forgetfulness and confusion, which can seem like Alzheimer's disease

Mixing Drugs

Alcohol, itself a drug, is often harmful when mixed with prescription or over-the-counter medicines. This is a special problem for people over 65, because they are often heavy users of prescription and over-the-counter medications. Mixing alcohol with other drugs such as tranquilizers, sleeping pills, painkillers, and antihistamines can be very dangerous, even fatal. For example, aspirin can cause bleeding in the stomach and intestines; when aspirin is combined with alcohol, the risk of bleeding is much higher. When alcohol is mixed with sleeping pills or barbiturates such as ativan, valium or librium, the combination can slow down the body's vital systems to the point of the person seemingly slips out of consciousness, but in reality, they have gone into cardiac or pulmonary arrest, and die. As people age, the body's ability to absorb and dispose of alcohol and other drugs changes. Anyone who drinks should check with a doctor or pharmacist about possible problems with drug and alcohol interactions.

Who Becomes a Problem Drinker?

There are two types of problem drinkers -- chronic and situational. Chronic abusers have been heavy drinkers for many years. Although many chronic abusers die by middle age, some live well into old age. Most older problem drinkers are in this group. Other people may develop a drinking problem late in life, often because of "situational" factors such as retirement, lowered income, failing health, loneliness, or the death of friends or loved ones. At first, having a drink brings relief, but later it can turn into a chronic companion or escape.
How to Recognize a Problem

Not everyone who drinks regularly has a drinking problem. Binge drinking, even just a few times a year, can be a signal that a problem exists. You might want to get help if you:

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Drink to calm your nerves, forget your worries, or reduce depression Lose interest in food Gulp your drinks down fast Lie or try to hide your drinking habits Drink alone more often Hurt yourself, or someone else, while drinking Are drunk more than three or four times last year Need more alcohol to get "high" Feel irritable, resentful, or unreasonable when you are not drinking Have medical, social, or financial problems caused by drinking

What is Binge Drinking?

Binge drinking is also referred to as 'heavy episodic drinking", has been defined in different ways at different times. Most people who binge drink are not alcohol dependent, or chronically alcoholic. It currently most often refers to heavy drinking over a short period of time, such as an evening. It often occurs with the intention of getting intoxicated, and is sometimes associated with social or physical harm. The National Institute of Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person¶s blood alcohol concentration (BAC) to 0.08 grams percent or higher. This typically happens when the average size American male consumes 5 or more drinks, and when an American female consumes 4 or more drinks, in about 2 hours. In older people, binge drinking can be associated with these health problems:

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Accidental injuries (e.g. vehicle crash, falling, burning, drowning)

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Intentional injuries (e.g. firearm injuries, sexual assault, domestic violence) Alcohol poisoning High blood pressure, stroke, and other cardiovascular diseases Neurological damage Sexual dysfunction or sexually transmitted disease Poor control of diabetes Liver disease

Getting Help

Older problem drinkers have a very good chance for recovery because once they decide to seek help, they usually stay with treatment programs. You can begin getting help by calling your family doctor or clergy member. Your local health department or social services agencies also can help.
Resources:

Alcoholics Anonymous (AA) is a voluntary fellowship of alcoholics who help themselves and each other get and stay sober. Check the phone book for a local chapter or write the national office at: 475 Riverside Drive, 11th Floor New York, NY 10115; or call (212) 870-3400. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides information on alcohol abuse and alcoholism. Contact: NIAAA 6000 Executive Boulevard Bethesda, MD 20892-7003 (301) 443-3860. The National Council on Alcoholism and Drug Dependence, Inc., can refer you to treatment services in your area. Contact: National Headquarters NCADD 12 West 21st Street 8th Floor New York, NY 10010 (800) NCA-CALL (800-622-2255). The National Institute on Aging offers a variety of resources on health and aging. Contact: NIA Information Center P.O. Box 8057

Gaithersburg, MD 20898-8057 (800) 222-2225, TTY (800) 222-4225.

Still Angry at Alcoholic Parent? You Can Find Peace
by Richard B. Patterson, Ph.D.

Question: I grew up in an alcoholic home but my father is sober thanks to AA. I believe I have forgiven him and, as a family, we have also sought outside help. I am having great difficulty with anger to the point where I have sometimes gotten physical. Some of this anger has been directed at my alcoholic parent. I try counting to ten, leaving the situation, etc, and am also seeing a therapist. Any suggestions? It's apparent that you are working hard on healing yourself. Be patient. Growing up around alcoholism can leave many scars, some of which don't start to emerge until we move into adult life. This is especially true if some of the experiences you had were traumatic in nature. In your efforts to find peace, I can offer the following thoughts:

1. Discuss with your therapist the possibility that you may be suffering from Post-traumatic Stress Disorder. Irritability is one of the symptoms of this syndrome. 2. If you haven't looked into Adult Children of Alcoholics (ACoA), consider it. This support group follows the twelve steps of AA in helping persons heal. 3. Often fear underlies anger. So, in examining incidents of anger, you might ask yourself "What am/was I afraid of?" This awareness can often diffuse anger. 4. There are good articles on anger control elsewhere in this magazine. Do a search with "anger" as the key word. Make the effort to take special care of yourself. Get out in nature if you can. Go for a walk. Find pleasant activities that will nurture you. Having an alcoholic parent can mean that you didn't receive guidance for a positive life.

Teens, Alcohol and Binge Drinking: Teens Drinking Hard Alcohol at a Younger Age
by Elisabeth Wilkins

It s Saturday night, and kids all over North America are hanging out at their friends houses, watching movies, going to parties. And children as young as 11 are taking their first drink of alcohol the average age when boys start drinking.

For girls, that age is now 13. More and more kids are drinking hard liquor, and an alarming number of those teens and pre-teens are binge drinking, which is defined as consuming 5 or more drinks of any alcohol in one setting for boys, and 4 or more drinks for girls. ³When I ask them if they drink to get drunk, they say, µDuh, that¶s why we do it,¶" says Dick Schaefer, an addiction counselor who has worked with chemically dependent teens for nearly thirty years. He is also the author of Choices and Consequences: What to Do When a Teenager Uses Alcohol/Drugs. ³Getting drunk is the thing to do, and they associate it with fun.´ Traditionally, in the upcoming season of graduation, prom and other kid rites of passage, the amount of alcohol young people drink soars. What's important, says Schaefer, is to keep the lines of communication open before an incident occurs²and know how to deal with your child if you do catch them drinking.

The fact is, kids are hitting the bottle in greater numbers these days, enough to cause the Surgeon General to issue a report last year warning parents about alcohol consumption among minors. According to the study, there are 11 million underage drinkers in the U.S., and 7.2 million of those teens and pre-teens are binge drinking. The reasons for the surge among teens and pre-teens in recent years are many: Kids are gravitating towards the newer, flavored hard liquors the alcohol industry is producing. And ³They¶re not sipping²they¶re gulping it down like soda,´ says Schaefer. ³The kids I see tell me they drink every weekend, at least four times a month. And they get drunk each time.´ He considers alcohol to be the number one risk for teens and pre-teens when it comes to substance abuse. The Surgeon General calls it ³The drug of choice for teens in America." Besides highway accidents and the increasing number of tragic fatalities caused by kids drinking to toxic levels, the dangers alcohol poses are many: recent studies have shown that binge drinking can lead to brain damage, obesity, memory loss, and impairment of other brain functions. The statistics are staggering: children who get drunk for the first time under the age of 15 are five times more likely to have alcohol-related problems later on in life. And if alcoholism is in your family, your child is four times more likely to become an alcoholic. It¶s been estimated that more

than three million teenagers are alcoholics in this country, and millions more are classified as having a serious drinking problem. In the last five years, some troubling new trends have emerged: There have been an increasing number of younger kids who are referred to the court as first time users²or kids who have been caught in the act of underage drinking. ³Now we¶re getting 12 and 13 year olds referred into the court system. And I¶ve seen kids who are 12 going to the ER as a result of over-drinking,´ says Schaefer. In addition, more girls are being referred to the courts than ever before. Misuse, Abuse and Addiction: Know the Difference As the director of the Touch Love Addiction Treatment Center in Fargo, North Dakota, Schaefer also works with the court system in his area to help kids who have been arrested for consuming alcohol. Frequently, treatment involves minors attending classes with their parents. He classifies their drinking at the following levels: Misuse: Any time a minor drinks. (Except for religious purposes or meals at home with parental approval.) Abuse: Any time a minor gets drunk or stoned, any time they have drugs on them, engage in binge drinking or have paraphernalia, and any time they get behind the wheel while intoxicated. As a parent, if you walk into your kid¶s room and find a bottle of alcohol, marijuana or paraphernalia, you should consider them to be at the abuse level. ³Kids at the misuse level won¶t bring it home, because they can take it or leave it and they don¶t want to get in trouble,´ says Schaefer. ³At the abuse level, they need the chemical high, so they¶ll take the chance. Once you equate having fun with getting high, that¶s abuse.´ Potential dependency: The primary relationship for addicts is the relationship with alcohol or drugs. This is when the relationship with the substance becomes more important than any other relationship. This is when a child will choose the chemical high over time with family or friends. ³Alcoholics and drug addicts are very lonely people,´ says Schaefer. ³You can¶t get close to someone while they¶re high. I tell the kids in my classes, µYou¶re lonely, and you¶re going to be lonely until you get straight.¶´ Giving Consequences: 4 Types of Contracts In his work as an addiction counselor, Schaefer developed a system of contracts parents can give their children in order to keep them alcohol and drug-free. Each new contract is adopted if the prior one has been broken. The Rules: What can parents do to set consequences in the home? Start out with rules. ³The rule in our house is no chemical use. Your curfew is 12:00 midnight on the weekends.´ This is a verbal agreement with your child. List the logical consequences for breaking the rules. ³We caught you drinking. You will have to forfeit the car keys for 1 month.´ Negotiate with your teen and agree to the consequences ahead of time. This takes the heat out of the moment. The Simple Contract: This is a rule written down with specific consequences, to be implemented if the verbal agreement is broken. The Simple Contract should be written down and signed at the misuse level. At the very least, your child should agree to three things: no chemical

use, no violence, and a curfew. Tell your teen that if they violate this contract, they will be sent to a chemical dependence evaluation. The Turf Contract: If the Simple Contract is broken, the next type of contract you can implement is the Turf Contract. This is a written agreement that includes all the points of the Simple Contract and outlines the behavior required for the teen to earn privileges at home, like use of the car or cell phone. In addition to stopping any alcohol or drug use, the behavior might include school attendance and performance, keeping a curfew, or doing chores at home. The consequence you can give for breaking this contract is the choice of chemical dependence treatment in either an in-patient or out-patient setting. Schaefer advises, ³Always give your child a choice²never put a kid in a corner without a way out.´ The Bottom-Line Contract: This is to be implemented if the Turf Contract is violated. The Bottom-Line Contract is a written agreement that outlines specific behaviors required for your child to retain the privileges of living at home or staying in school. It includes all the elements of the Simple and Turf Contracts. Consequences for breaking this contract by doing drugs or alcohol: Give the child the choice of two reputable and available inpatient treatment centers. ³You¶re saying, µYou¶re out of control, and we¶re going to agree to get you help,'" Schaefer explains. If You Suspect Your Child Has a Substance Abuse Problem: What You Can Do Now If you suspect your child might be drinking or taking drugs, talk to your child¶s school. Substance abuse almost always shows up in attendance, GPA, and truancy. ³If kids are getting drunk, they¶re not doing their work,´ says Schaefer. What happens in school is not confidential, and teachers are required to record observable behaviors of their students. Schools have checklists for teachers that parents can ask to see. (One of these is called the ³Student Assisted Programs Checklist,´ but names may vary from state to state.) The list includes questions about truancy, the students¶ attitudes and behaviors, and also alcohol and drug-related questions. "As a parent, you have the right to know what is being recorded about your child," says Schaefer. While parents do not have a right to hear what kids tell school counselors or psychologists² except in the case of suicidal or homicidal behaviors or vandalism²parents do have a right to see any checklist the school has on their child. You need to have some communication with your child about drinking and substance abuse. ³It should be just as easy to talk to them about drinking and marijuana as it is to talk about sex«and that¶s the problem,´ says Schaefer. ³We think we¶re so open but we¶re not. Talk about the drinking scene, talk to your kids about your concerns. Keep the lines of communication open.´ The good news is that not all kids are drinking. About 60 percent of kids in the U.S. and Canada drink, but 40 percent do not. Arm yourself with that information before you talk to your child, who might be under the impression that all his friends are doing it. ³That¶s the important message that I try to get across,´ says Schaefer. ³In my classes I say, µYou guys are among the 60 percent, you broke the law.¶ And that¶s good to tell kids. We¶ve got to break this idea that µeverybody drinks¶ because it¶s just not true.´

********************* At his court-mandated classes for kids who have been caught drinking, Dick Schaefer gives out this list of questions to parents who attend with their children. "I tell the kids, 'Parents are given this list of questions at the hospital when you're born. They have the right to ask you these questions²and get the answers from you²until you're 18." 5 Things Every Parent Has the Right to Know: Where are you going? What are you doing? Who will you be hanging out with? How will you get home? What time will you be home?

How to Succeed in Addiction Recovery
by Larry Tyler, M.Ed., LDAC

Most people attempting addiction recovery soon realize that such recovery is not as easy as they had imagined. It requires discipline and patience, often for months, and therein lies the problem with recovery A key aspect of addiction is it's immediate gratification, that is, its ability to make us feel good quickly. Being addicted means relying on immediate gratification and, as the pattern of addiction continues, our ability to delay gratification erodes. Recovery, on the other hand, asks us to forego the quick feel-good, often replace it with feeling ill for what might feel like an eternity to an addict. Recovery calls upon us to show a patience we have all but lost during our addiction.Recovery is a lesson in patience, a lesson we need to learn to be balanced and healthy human beings. While recovery requires a physical tenacity, to bear the strain of withdrawal, it also requires a mental tenacity. Hopelessness, fear, self-pity, and resentments conspire to wear down our resistance and draw us into relapse. Meditations, the slogans of Alcoholics Anonymous, affirmations, and psychotherapy's "self-talk" technique are designed to bolster our confidence when it falters. But, often we maintain a self-defeating philosophy of life that underlies our thoughts and actions. Like weeds with long roots below the ground, our defeatist thoughts keep reappearing because we have not challenged the philosophy behind the thoughts. Below, are twelve self-defeating messages commonly believed by people in the throes of addiction. Each message holds a certain level of truth, and all have been carried down through generations. But each is over-generalized. When we adopt these beliefs as truths for all occasions, we destroy the confidence, determination, and willingness to seek support we need to continue the day-to-day internal struggle to achieve sobriety.

y y y y y y y y y y y y

Ignore things and they will go away. People will hate you if you cause them any discomfort. You can do anything you want as long as it isn't hurting anyone else. People don't really care what happens to you. No matter how hard you try, you're never going to get ahead. If you want something done right, you have to do it yourself. If you want people to like you, you've got to keep a smile on your face. You can't teach an old dog new tricks. A promise to people should satisfy them. Life is supposed to be fair. You are not responsible for your behavior if you're sick. What you don't know won't hurt you.

As you identify these or any other self-defeating messages, the challenge you issue to refute the message can include an acknowledgment that the message may be sometimes true, or often feels true to you, but cannot and must not be true for you in your recovery. So, you convert the messages into a more helpful philosophy:

I cannot ignore things and expect them to go away; I cannot expect people to hate me if I cause them discomfort; I cannot do anything I want just because I believe it isn't hurting anyone else.... Meanwhile, the messages you use to replace these philosophies should emphasize a kindness and concern for yourself and those around you that will attract you back to life and away from addiction.Find a statement or series of statements that fit for one. One that an inspiring young woman taught me is this:

When I get on the other side of this, I will be more alive, think more clearly, and be able to handle any challenge that comes my way. My "self" if being forged in fires that will make me stronger, better and more successful than I have ever been. Those who help me are my friends. Those who tempt me and don't believe in me are to be avoided because they are not my true friends. By challenging the messages of defeat and cynicism you can weaken the power of the hidden enemy of your recovery: the thought processes that were cultivated during your addiction. Come up with your own powerful thoughts and chase those weakening thoughts away.

Moderate Drinking and Moderation Management
by Reid K. Hester, Ph.D.

Fifteen years ago I was diagnosed as an alcoholic and went through treatment. I was also diagnosed with clinical depression. After nine years of sobriety, I decided I wanted to feel good and began drinking in the evenings and only at home. It has worked pretty good. I am becoming more and more certain that my moods have to do with input of pure sugar. Is this possible or another form of denial? I have not seen any convincing empirical evidence that sugar plays a significant role in clinical depression or alcohol problems. Now I cannot tell whether you were appropriately diagnosed as alcoholic (alcohol dependent) and having a Major Depression. But if you've continued to have a depressed mood even with many years of sobriety, I would advise you to seek professional evaluation. There are many effective therapies for depressive disorders and it would be better to get appropriate treatment than to self-medicate with alcohol. I am also glad to hear that you are keeping your drinking at a moderate level. I'm assuming this means no more than two or three 5 oz. glasses of wine or 12 oz. beers over the course of an evening and not every evening. However, drinking to elevate your mood is risky business. You are going through a transition period in your life and if you've had problems with alcohol in the past, you are at some risk for developing alcohol problems now in this transition. However, if you decide to continue drinking I would strongly suggest you consider joining Moderation Management, a self-help group with a focus on moderate drinking. According to the NIAAA and many other independent researchers, there are four times as many problem drinkers as alcoholics in this country. Yet there are very few programs that specifically address the needs of beginning stage problem drinkers, while there are literally thousands of programs for the smaller population who are seriously alcohol dependent. This program helps people develop a moderation program. Their web site is http://www.moderation.org/. You can join the group from their site. Good luck!

Is This A Picture Of Marijuana Addiction?
by Reid K. Hester, Ph.D.

Question: I'm concerned that I have a marijuana addiction. It makes it easier for me to relax and talk to women at bars. Also, if I stop smoking it, I get bad dreams but resuming smoking stops them.

If you stop smoking marijuana and start having disturbing, bad dreams, that suggests to me that the dreams are part of your withdrawal picture. Whenever your brain gets used to having a mild altering substance in it and then you cut it off, you tend to get some physiological "rebound" effects. Because marijuana is a depressant, part of this rebound is to have more active dreams. I wouldn't worry about the content of the dreams themselves. They'll subside in time the longer you're off the pot. Also, I would look to know what the desired effects are from smoking (e.g., feeling more at ease meeting and talking with women). If the only way you have to achieve those desired effects is by smoking, then you're at great risk for relapsing. Ask yourself "What do I need to learn to do, without smoking?" Then find a non-drug alternative. There are many discussions of such good alternatives to be found right here in this zine. There are also online support groups to be found in the Links and Lists section. This may seem like hard advice, but it's sound. The hardest parts of stopping smoking are the first few steps. I think you'll thank yourself for stopping once you've been away from it for a few months. Good luck kicking the marijuana addiction!

Here's Where To Get Help For Internet Addiction
by Reid K. Hester, Ph.D.

Could you please give me an idea as to where one might find help for internet addiction? Also, could you please provide some information about it? Although many writers and researchers are starting to address the concept of Internet addiction, I would prefer to use the term compulsive behavior. Addiction technically implies a physical dependence on a substance (e.g., alcohol, tobacco, or other drugs). That said, it's becoming clear that some active computer users do develop compulsive behavior patterns involving the Internet. Fortunately, there are two excellent articles on Internet compulsive behaviors in our SelfhelpMagazine. I recommend that you first check out Computer and Cyberspace Addiction, then Internet Can Be As Addicting As Alcohol, Drugs And Gambling. The former also has several links for additional information. You might also enjoy seeing a slide show given by Dr. Marlene Maheu at several conferences in 2003 and 2004. And another by David Greenfield, Ph. D., L.MFT, CEAP, given in 1999: The Nature of Internet Addiction. More resources can be found by Dr. Greenfield at his website, Virtual Addiction.

If you're concerned that you're becoming compulsive about your use of the Internet I would recommend that you consult with a mental health professional with expertise in compulsive behaviors. Breaking free of compulsive behavioral patterns can be tough, but many people do just that. It requires some determination and perseverance though and that's where a professional can be helpful. This is in addition to his or her expertise in behavioral change. You can start today to modify your internet addiction, or compulsive use of the internet.

Gambling, Gamblers and Risk Takers
by Joanna Poppink, MFCC

During the last local earthquake, my house convulsed in the dark. I leaped from my bed to the hall doorway moments before a bookcase fell across the spot where I had been sleeping. Was my action one of gambling or taking a calculated risk? Was I lucky? When we buy stock, change jobs, buy more computer technology, get married or buy a lottery ticket are gamblers or simply calculated risk-takers? What's luck got to do with it? Chaos and change bring disruption and opportunity to almost every area of our lives. Job security, gender roles and viable opportunities are in continual change. To keep our balance, survive and thrive we need to be clear and focused in our actions. Every choice we make, including the choice to do nothing, involves some kind of risk. A gamble has a high probability of loss. A calculated risk has a much higher probability of a positive outcome. Knowing the difference is essential to our success. To make successful decisions and take positive action we must be in the realistic present. Emotional decision making can be lethal when governed by unexamined personal weaknesses and wounds from childhood. Finding and resolving old patterns of emotional highs and lows increases our ability to make a calculated risk. Even if old patterns are not resolved, acknowledging them and setting them aside during decision making can create better chances for being a winner. Here is a comparison check list of traits and tendencies for gamblers and calculated risk takers.
Gambler
y y y y y y

Looks for excitement and danger. Jumps in with the crowd momentum, not wanting to be left out or left behind. Blames others or luck for bad outcome. Lingers over losing choices and wins not taken. Is influenced by unacknowledged fantasies of what is possible. Will risk more than can afford to lose.

y y y y y y y y y y

Acts on impulsive decisions. Is unaware of unconscious motivations. Acts out of sense of superiority or magical thinking. Gets high and feels powerful on a win. Gets low and feels worthless and small on a loss. Lacks discipline and invests on wishful fantasy rather than recognizes reality. Hides losses and is secretive about taking chances. Procrastinates (building up excitement levels). Follows a favorite method no longer useful or relevant. When losing will take increasingly bigger risks to catch up. Looks for the one big win that will result in bliss.

Calculated Risk Taker
y y y y y y y y y y y y y y y y

Contains and manages emotions. Is aware of irrational factors swaying a crowd. Takes responsibility for results. Does not waste time with what might have been. Acknowledges personal fantasies and resolves them or disregards them. Risks a tiny fraction of equity on any individual choice (equity meaning time, money, relationship, self esteem, skill etc.). Concentrates on a realistic long-term strategy. Knows personal abilities and limitations. Is hardworking and open to new ideas. Stays emotionally even during wins and losses. Easily resists risks that do not fit within defined risk limitations. Is open about risk taking. Proceeds in a serious intellectual manner. Stays alert to present trends. Follows predetermined guidelines of safety. Analyzes situation, observes own reactions and makes realistic plans.

Being human, we will identify with some qualities on both lists. We will also lack some qualities on both lists. Our responses give us an indication of where we can congratulate ourselves and where we can apply effort. Calculated risk takers use as much energy analyzing themselves as analyzing opportunity. In this way the realist is able to appraise the specifics of possible choices rather than be carried away by glamorous promises, inflated feelings, the desire to win a competition or seek revenge. Actions taken on decisions made in the moment, like my leaping out of bed during the shake, may seem to be thoughtless impulsive acts. But what an action looks like is not a measure of its risk factor. Two people spend $1000 on the same stock. One buys because it's a hot tip that will be exciting to watch go up. The other buys because he's a trend watcher and is placing a planned percentage of his equity in what looks like an uptrend breakaway.

The first bought based on his emotions and will sell based on his emotions.The second had a purchase plan and knows in advance at what point he will sell. The initial purchasing action of both looks the same. Their background decision making is very different and will determine who is the lucky one. To be a reasonable risk taker we must address each tendency within us that propels us to gamble. Once we can create and follow our own reasonable guidelines we can take calculated risks. Then, like me under the doorjamb during the earthquake, we position ourselves for the best outcome possible and help make our own good luck.

What is the Best Way to Cut Down on My Drinking?
by Reid K. Hester, Ph.D.

I have started to wonder whether I should cut back on my drinking. I'll usually have somewhere between 4 to 6 beers 4 to 5 nights a week. I'm in my 30's now and am concerned whether my drinking might be increasing my risk for health problems. I don't consider myself an alcoholic and don't want to stop altogether. How can I learn how to cut down? I' ve got good news and bad news. The bad news is that your level of drinking increases your risk for health and other alcohol-related problems. The good news is that you can change your drinking if you decide to do it. Many people can and do cut down on their drinking while others find it easier to quit altogether. The first step is to look at your motivations. Moderating or quitting drinking to feel better and reduce your risk for health problems are good reasons. Consider others. What could you do with the money you saved if you cut back or stopped? Would you spend more time with your spouse and/or kids if you changed your drinking? Could you be more productive at home or work? If you decide to cut down, set a goal. The World Health Organization recommends a limit of no more than 3 beers per day and no more than 12 per week. If you're going to moderate, keep track of your drinking and drink more slowly. Reward yourself for progress in achieving your goals, but not with drinking! Look at situations where you drink over your limits and figure out new ways to deal with these situations. If you go over your limits, learn from your mistakes. If you want some help, you have several choices. First, there is a self-help group called Moderation Management. You can call their headquarters at 313-677-6007 and see if there's a group near you. Or there's a Moderation Management website that is worth consulting. They are to be found here: http://www.moderation.org/.

Depression and Alcohol
by Reid K. Hester, Ph.D.

I am curious about the relationship between depression and alcohol problems. I've had problems with depression all my life and I know many others with the same problems. I've done better with the depression since I put the booze away: drinking isn't a solution to anything. I quit drinking six years ago by going to a treatment centre and getting involved with AA for alcohol. I never could connect with its spirituality and although I never went to too many meetings, I quit altogether after two years. Living life sober got easier when I stopped worrying about trying to do everything the way others wanted me to do things. I haven't relapsed in six years and live a pretty good life. What can you tell me about depression and alcoholism? Congratulations on your six years of sobriety! Although many people stop drinking with the help of AA (Alcoholics Anonymous), it is not the only path to recovery. In the long run, people who have had significant alcohol-related problems stay sober by restructuring at least some aspects of their lives. Some do it with the help of AA. Others do it on their own. It sounds like you've done the latter. Keep up the good work! Now to your question about depression and drinking. People who have a history of clinical depression before they start drinking are at greater risk of developing a drinking problem. Drinking heavily also puts people at risk for developing depression for a number of reasons: it's a nervous system depressant and when people drink heavily they tend to restrict their lives and gradually exclude other activities that are pleasurable, etc. Continuing to experience symptoms of depression for as long as you have after you've stopped drinking is not good. It adversely affects your quality of life. I have two main suggestions for you:

1. Consider a professional evaluation by a clinical psychologist with expertise in affective disorders and substance abuse. 2. Look at the paperback book "Feeling Good: The New Mood Therapy" by David Burns, M.D. A psychologist can evaluate you and help determine the processes of your symptoms of depression. In other words, a professional can help you identify what keeps it going. He or she can then help you map out a strategy for better dealing with these symptoms.

If you do not have access to a psychologist, consider the Burns book. It is one of the best selfhelp manuals on the market for depression. It is based on an empirically supported, cognitive behavioral approach to dealing with depression. Whatever route you choose, I wish you the best of luck.

Codependence Explained in Psychological Terms
by Toru Sato, Ph.D.

The term "codependence" has been bantered about for decades, first in reference to being the unfortunate partner of an alcoholic or drug addict who displayed behaviors that supported the addiction. A revival of the term came about in the 1980's with the emergence of 12-Step Codependency (or CODA) Groups. At this point, the term was loosely used to refer to anyone who put another person's needs before their own, to the consistent detriment of themselves. Popular recovery authors made discussions of codependency more common-place, but succinct explanations that cite the early personality theorists are often lacking. This article is an attempt to integrate both camps: popular authors' personality theory and research to support similar concepts. These well-discussed and researched concepts have not received as much public acceptance, although they are steeped in decades of research that extend far beyond the 1980s. This article is an attempt to summarize this theory and research while discussing it in non-scientific language. According to many interpersonal theorists, the two most basic underlying motivations in forming and maintaining human relationships are intimacy and power. By presenting an exploration of the multiple ways in which we interact with others to experience power, this article outlines the various ways we are mutually addicted to one another. The objective of this article is to remind ourselves that even though we often strive to experience happiness by feeling a sense of power with others, an alternate path motivated by intimacy, trust, care, and love may be far more rewarding in the long run.
Co-Dependence as a Form of Addiction

Somewhere along the way in life, we can forget to love others for the sake of others. How does this happen?

y y y

We experience pain and hardships that make us afraid and defensive. We learn to associate with others for our own personal gain. We begin striving more and more to experience pleasure by becoming powerful and controlling.

Love Is Not the Only Drug

Dependencies are most commonly discussed in relation to substance abuse but dependencies can also occur between people. Interpersonal dependencies are commonly associated with love, romance, and friendships. We often think of interpersonal dependencies as a positive experience, a "feeling good habit" that develops when we experience togetherness with others. It is associated with a genuine sense of trust, and care for the well-being of others. The pleasure of togetherness however, can be experienced in two ways:

1. characterized by trust, care, and love with others and 2. by controlling and thus imposing our own will onto others.

Many relationship experts believe that people need both tenderness and power. In relationships, most people strive to achieve both to varying degrees. For example, we may focus on developing a sense of togetherness based on trust, care, and love with our family members, and we may try to control our family members, too. Though it is common to be dependent on togetherness with specific other individuals, dependency can also occur when we begin depending on specific others who consistently allow us to control and impose our own will onto them. For example, let's consider the following situation:

Every time Jane wants Jack to do some housework, she authoritatively demands it from him. As a result, Jack does the housework and Jane is rewarded for her demanding behavior. On the other hand, every time Jack wants something from Jane, Jack begins complaining. When Jack complains, Jane provides him with attention and Jack gets what he wants. Jack is rewarded for complaining.

Both Jane and Jack have specific interpersonal patterns developed from their past interactions with each other and with others in their lives, as far back as in their respective childhoods. These methods of interacting with others are commonly referred to as interpersonal patterns or interpersonal behavior patterns. Subtle ways of controlling others are used repeatedly with our friends and family since childhood. Thus as a child, if I repeatedly find that I am able to have my way when I cry, I may develop an interpersonal behavior pattern of crying based on a general belief system stating, "I can get what I want if I cry". John Bowlby, a well known scholar on human development, refers to these general belief systems as "working models". He has written extensively about how we use these working models to maximize our ability to get pleasure.

Specific Interpersonal Behavior Patterns

We all have specific behaviors designed to control others. Some of us may resort to being highly demanding or intimidating. Others may use more indirect methods such as using sarcasm or spreading rumors. Although we all have different interaction patterns, some of the more prevalent ones may be lumped into larger categories. Below are some of the patterns that we recognize most commonly in others. Of course, if we are very perceptive, we can also recognize them in ourselves.

1. One-upmanship. This is perhaps the most simple and obvious type of interpersonal pattern of controlling or at least imposing our own will onto someone When we find ourselves arguing about who is right or who is better, we are in essence trying to impose our own will onto others. Sometimes this is just a matter of simple boasting. In other cases this may manifest itself in heated arguments. 2. Criticism / high expectation. This behavior is characterized as being overly demanding of others. We expect others to be the way we want them to be, regardless of how they feel. We often criticize others, make sarcastic remarks, and make others feel inadequate. The underlying message of this behavior pattern is, "I demand that you to live up to my expectations and you are failing." 3. Intimidation / anger. This is the extreme version of criticism / high expectation. This behavior is characterized as frightening others through intimidation or expressing anger. The underlying message here is, "I will punish you (even more) if you are not the way I demand you to be." 4. Self-pity / guilt trip. This behavior involves making others feel sorry for one's self or making others feel guilty for not being compassionate. We sometimes demand that others wallow with us in our pity. At other times, we manipulate others to do things by making them feel guilty if they don't pay attention to us. The underlying message is, "You are making me suffer even more if you don't attend to my feelings." 5. Buttering-up. This is a common variation of self-pity / guilt trip. It involves convincing others to do things we don't want to do by telling them that we are not good at it and they are better at it. This type of behavior also tends to make others feel guilty for not being compassionate and helpful. 6. Aloofness and charisma. Though not easily identified, this is another very common interpersonal pattern. We try to generate interest in ourselves by withholding important information from others. The underlying message is, "I have something you want, but I won't give it to you." 7. Passive-aggressiveness. This interpersonal pattern is similar to aloofness / charisma. With passive aggression, we do subtle things to cause the other person to feel a negative emotion (e.g., concern, annoyance, anger). For instance, we may be late just to annoy someone. In extreme cases, we may actually begin feeling sick (not just pretending to feel sick) to make others more concerned about us. 8. Chainchatting. This involves speaking non-stop, and without listening to others. We sometimes demand attention incessantly without letting others have their turn. This is a mild form of imposing our will onto others: demanding that the other person to attend to our own needs while ignoring their needs. This type of behavior often makes others feel ignored and disrespected.

9. "Yes, but" This pattern, identified by Eric Berne, a well known expert in this area, involves confiding in someone about a problem, but when that person offers suggestions, we respond with "Yes, but." and dismiss their suggestions. This can continue until the other person gives up. This pattern is not used to get helpful suggestions, but rather, to get attention. Our Own Addictions: We Might As Well Face Them

Although we all engage in these types of behaviors to some degree, it is difficult to become aware of our own patterns because this type of information is most commonly processed out of our conscious awareness. Oftentimes, it takes a therapist or another perceptive person who is not afraid to inform us about our habits to realize that we actually use these negative patterns. Unless we experience complete ego-transcendence with nothing but the pure love for the wellbeing of others, dependencies are inevitable. These patterns are usually considered to be maladaptive when we consistently use these patterns with specific individuals, and we feel like we need them in order to maintain our sense of well-being. They are maladaptive when we begin relying on each other excessively to compensate for our insecurities. Strong mutual dependencies based on these deep insecurities are what we commonly characterize as codependence. We often develop this type of maladaptive dependency with our family members and close friends. These dependencies, however, usually work in both directions. As in the example of Jane and Jack illustrated earlier, the people we are dependent on are, in many cases, dependent on us as well. Despite the fact that the term "codependence" is commonly used when we excessively rely on others in this way, we could consider most of our relationships as mildly codependent. Although most of our relationships are not highly problematic, many of them can still be improved by making a conscious effort to recognize our own behavioral patterns. In fact, most interpersonal forms of therapy focus on helping us become more aware of our own interpersonal patterns and its long-term effects. The more we become aware of our own patterns, the more we are able to change the problematic ones, and free ourselves from our problematic codependences. The first step toward recovery is awareness. True recovery then leads to positive human growth. We gradually learn to experience pleasure by developing a sense of togetherness characterized by trust, care, and love with others rather than by controlling others. This is what makes the study of interpersonal dependencies so fascinating and meaningful. It helps us learn about ourselves and realize our true potential as human beings.
The Road of Life

Many of us have forgotten to love others for the sake of others. To varying extents, most of us have moments of fear, rigidity, and cynicism. To varying extents, we learn to associate with others for our own personal gain.

We learn to take pleasure in controlling and imposing our own will onto others. We forget more and more that the path through trust, care, and love may be even more rewarding. This loss of our "selves" and excessive dependence on others is the essence of human drama, of love stories and tales of friendships. We constantly tell each other stories to remind us of this truth, because we realize that even if we are reminded today, we will probably forget tomorrow.
Jumpstart Your Journey!

We have probably all used the interpersonal patterns listed in this article. Here are a few ideas to help you learn to overcome these very human tendencies:

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Examine each of your relationships and think about which patterns you might sometimes use. If you cannot think of any, show this list to a close friend or family member, and ask them for feedback about these patterns. Choose someone who knows you well, is kind, but not afraid to tell you the truth. Once you identify your own patterns, try to catch yourself in the act. There is no need to feel bad about it (everyone does it). Take pride in your growing ability to stop yourself from pursuing a hurtful pattern with someone you love. You can also engage in activities that make you feel powerful and confident without hurting others (e.g., writing how you feel in a journal, exercising, breathing deeply, expressing love and affection to others, etc.).

Alcohol Treatment Center Focuses on Marriage and Family
by Robert J. Rotunda, Ph.D. & Timothy J. O' Farrell, Ph.D.

The idea of treating alcoholism in the context of marriage and family has gained wider acceptance among psychotherapists and in the alcohol treatment center. A study supporting this approach was conducted at the Harvard Counseling for Alcoholics Marriages (CALM) Project. It is a four-phase alcohol treatment center for alcoholics and their spouses. Their overall purpose of this alcohol treatment program is to increase relationship stability, which in turn helps clients maintain sobriety. "We help couples reward abstinence from alcohol and refrain from punishing sobriety [by dredging up past behavior], increase positive feelings and activities and learn better communication skills. These skills help reduce family stress and the risk of relapse," explain the authors.

Project CALM's four phases include initial engagement of the identified patient and his or her partner, 10-12 weekly couple sessions, then 10 weekly couples group sessions and quarterly follow-up visits for another 24 months. The couples in the program agree to three commitments: (1) not to threaten divorce or separation during the course of therapy, even when in a heated argument, (2) to focus on the present and future, not the past drinking or negative events and (3) to dedicate themselves to completing whatever weekly homework assignments they agree to in session. CALM is action-oriented and focused on behavior change, the authors note. "Emphasis is placed on getting couples to renew their relationship in a more positive way by changing their behavior first and then assessing changes in feelings, rather than waiting to feel more positively toward each other before initiating changes in their own behavior." Outcome studies on Project CALM have shown it produces better sobriety rates and fewer marital separations than does individual alcohol counseling alone. When a relapse prevention component was added to the program, it had even better results, the authors say, particularly for alcoholics who had more severe alcohol and marital problems. In terms of cost effectiveness, the authors say Project CALM more than pays for itself by decreasing alcohol-related hospital and jail costs markedly. In fact, they note, "cost savings attributable to reduced hospitalizations after CALM are over five times greater than the cost of delivering CALM." The incidence of domestic violence after Project CALM also decreases significantly. "For CALM cases whose alcoholism is in remission, violence levels after treatment are similar to nonalcoholic couples," the authors say.

Understanding Addiction
by Phil Rich, Ed.D., MSW, DCSW

Addictions come in all shapes and forms. Difficult to define exactly, it has become popular to think of almost any behavior that has a compulsive quality as an "addiction." But for those who have an addiction, or for those affected by the addiction of a loved one or close friend, it's clear what an addiction means in "real" terms. A broad definition of addiction is that it is a dependency on a substance, an activity, or a relationship that become primary in the person's life. It's characterized by desires that consume people's thoughts and behaviors, and is acted out in habitual activities designed to get the desired thing or engage in the desired activity (addictive behaviors).

Unlike simple habits or consuming interests, addictions are "dependencies" with real life consequences that seriously impair, negatively affect, and damages relationships, health (physical and mental), and the capacity to function fully and most effectively. A more restrictive definition of addiction is that it is only applicable to substance dependence, and the user must show evidence of:

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habitual use (regular pattern of using); continued use despite evidence of related problems (physical, social or work related impairment) tolerance (increase need for more and more of the substance) withdrawal (physical need for substance to ward off physical withdrawal symptoms).

For purposes of this article, the first definition of addiction will be used. Using this definition, addicts are "dependent" on that thing which dominates their thoughts and desires and directs their behaviors, and the pursuit of that thing becomes the most important activity in their lives. In the advanced stages of addiction, the addiction dominates decision-making and nothing is as important as the addiction itself.
How Do People Become Addicted?

Some people see addiction as a disease in which addicts are afflicted and have little power over the cause or onset of addiction. Others see addictive behaviors as a choice, and addiction as the frequent outcome of this choice. Addiction is considered by some to be a pre-disposition (the "addictive personality"), where others believe it develops through exposure to the addictive behaviors of others (such as family members). In the case of "physical" addictions such as alcoholism or drug dependence, many believe that susceptibility to addiction is passed on genetically. Others believe that addiction is simply the result of repetitive behavior that, in some people, leads to a physical or psychological dependence. It is certainly true that although not all addictions are physical, (gambling for instance), they can be as destructive.
Understanding Addiction and Dependency

Defining exactly what is meant by addiction is not simple. People often associate addiction only with alcohol or drug abuse, but it's clear that addictive behaviors go far beyond. In fact, the key to "addiction" is an obsessive and compulsive need or dependence upon a substance, an object, a relationship, an activity, or a thing. Accordingly, it's both realistic and appropriate to say that someone can be addicted to almost anything. There are six clear indicators of an addiction:

1. An Object of Desire. There's always an object of desire. This is the substance, thing, activity, or relationship that drives the addiction, whether it be alcohol, food, sex, gambling, pornography, drugs, or anything else that sparks obsessive ideas and drives compulsive behavior. 2. Preoccupation. There's an obsession with the object of desire; a need for the thing that drives the addiction. 3. Driven Behaviors. There is a compulsion to reduce cravings and satisfy the obsession that drives the addict's behavior. 4. Lack of Control. Addiction always implies a lack of control over thoughts, feelings, ideas, or behaviors when it comes to the desired thing. Even when addicts try to stop or cut back on addictive behaviors, they fail. This is the hallmark and a central defining feature of addiction and dependence. 5. Dependence. There is a dependence on the object of desire, physical or psychological, so only that thing can satisfy the desire and fulfill (at least temporarily) the addict. 6. Negative Consequences. Addiction is always accompanied by harmful consequences. The Continuum of Addiction

Addicts don't become addicted overnight. There is progression as people first engage in the behaviors and experiences that may later become addictions, and a risk of creating an addiction over time. For most addictions "tolerance" is created through repeated use, in which more and more of the substance or activity is required to feel the emotional satisfaction that the addiction brings. Eventually the addict has to use (or engage in the activity) just to feel normal. This is what "dependence" truly means. Accordingly, there is a continuum of addiction, ranging from pre-addiction to the advanced stages of dependence. The progression from use into addiction can be measured in two ways:

1. The effect that addictive behaviors have on effective and healthy personal functioning. 2. The intensity of cravings for the substance, activity, relationship, or thing.

When taken together, these two measurements can help people who engage in addictive behaviors gauge their progression into addiction. Recovering from Addiction Whether physical or psychological, we know that addiction can be overcome. Millions of severely addicted people have either found or been helped into recovery, and many millions remain in recovery their entire lives.

Marijuana (Cannabis) and the Body
by Reid K. Hester, Ph.D.

What harm does marijuana do to the body? Is it worst for teens? We probably know more about the health effects of marijuana than those of any other drug, including alcohol, yet there are still unanswered questions and varying interpretations of what we do know. Those who wish a more in depth discussion than I can provide in a brief response may want to read "Cannabis and Health" by Reese T. Jones, in the 1983 Annual Review of Medicine or "Exposing Marijuana Myths" by Lynn Zimmer and John Morgan which is available here. The first reference tends to be biased toward finding harm while the latter is biased in the opposite direction, but both are responsible and stick to the facts. The Zimmer and Morgan analysis finds that the research "generally supported the idea that marijuana was a relatively safe drug -- not totally free from potential harm, but unlikely to create serious harm for most individual users or society." Laboratory and clinical studies have found a variety of potential harms related to marijuana, often occurring only at dosages vastly disproportionate to any real world levels of exposure. I draw my conclusions primarily from epidemiological investigations which have examined real populations of actual users. Most marijuana users are familiar with coughing and throat irritation as acute effects of marijuana smoking, so it was natural for many of us to expect marijuana to be associated with damage to the respiratory system. The evidence does show minor changes in large airway function which may increase susceptibility to bronchitis, but small airway changes such as those that are associated with lung cancer are not characteristic of marijuana use. Epidemiologic investigations indicate that marijuana use does not contribute to lung cancer, emphysema, or to diminished pulmonary function. Marijuana smoking, however, may be adding to the greater harm done by tobacco smoking in persons who smoke both marijuana and tobacco, the contribution of marijuana smoking might well be masked due to the smaller number of marijuana cigarettes a typical user will smoke per day. At one time, I predicted that marijuana would prove to be more damaging to the heart than tobacco smoking; I was wrong, there is no evidence of cardiovascular damage due to marijuana. It may, however, be dangerous for persons who suffer from severe hypertension or atherosclerosis. Reports of chromosome damage, damage to the reproductive system, breast enlargement in males, and suppressed immune function all have been discredited. Earlier reports of brain damage have likewise been discredited, but some new studies suggest that marijuana may produce very subtle lasting effects in the nervous system, these studies, however, seem to have serious methodological weaknesses and may also prove spurious.

Finally, it has been suggested that there may be a fetal marijuana syndrome similar to fetal alcohol syndrome. Evidence has shown that the effects of maternal marijuana smoking on the unborn child are, at most, about the same as those of maternal tobacco smoking, and diminish rapidly as the infant matures, disappearing entirely within a few years. There is a great deal of speculation, but little evidence, on the question of whether the harms are greater for teens than for adults. There is no particularly good reason to think that this would be so. The greater plasticity of neurological and other development during adolescence generally make youths less vulnerable to toxic exposures of most sorts. Most of our evidence is in fact drawn from populations in which the bulk of the exposure to marijuana was in middle to late adolescence, so my guess is that the answer will prove to be no -- but I have been wrong before.

Moderate Drinking? That's Not Drinking
by Reid K. Hester, Ph.D.

Many people do not drink heavily enough to be considered alcoholic, but they want or need help with moderating their drinking. What's moderate drinking?
First, we need to define what is meant by moderate drinking.

There is a consensus in the scientific community about what defines "moderate drinking." It's no more than 2 or 3 standard drinks per drinking episode, no more than 9 drinks per week for women and 12-14 for men. Also, moderate drinking means limiting how fast you drink and, as a result, keeping your blood alcohol concentration (BAC) below .045-.055 (.10 is the DWI limit in most states). A standard drink is the equivalent of a 12 oz beer with 5% alcohol (average for most U.S. beers). A 5 oz. glass of wine (12.5% alcohol) and 1.5 oz. of 80 proof liquor are also 1 standard drink each. This definition of moderate drinking prevents you from getting drunk. But then moderate drinkers don't get drunk. Now if your idea of moderate drinking is a 6 pack instead of a 12 pack, this would suggest that you drink with some pretty heavy drinkers. Drinking a 6 pack of beer is heavy drinking, period. Some heavy drinkers who've experienced problems from their drinking can learn how to moderate their drinking and maintain moderate drinking for years at a time. Others cannot.
So who's more likely to be successful at moderation?

Well, women tend to be more successful than men. Drinkers with a shorter history of problems and less severe problems also tend to be more successful with cutting back and maintaining it.

Drinkers who believe that alcoholism is a bad habit rather than a disease tend to do better with moderation.
If you're thinking about moderate drinking for yourself, there are a few things to think about.

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First, if you've had significant alcohol-related problems and are currently not drinking, trying moderate drinking may put you at risk again for alcohol-related problems. Second, if you're currently drinking more than the guidelines of moderation, you will reduce your risk for problems by cutting back. And third, there are a number of online resources you could use if you'd like some guidance and/or support in your efforts. Do an internet search for "moderation management" and see what's available for you.

13 Signs of Anger and How to Manage Them in Sobriety
by Thomas Hollander, Ph.D.

Angry feelings are one of the greatest challenges for recovering alcoholics and addicts. Relapse is often related to the inability to constructively handle anger. Mismanaged anger poses a threat to recovery for the newcomer and the old-timer. Sometimes the greatest threat is to relationships. In this article, we're going to identify anger signs, identify the causes, decide how to react, and also learn how to prevent and prepare for situations rather than get angry about them.
Identifying and Dealing with Anger Identify Your 13 Anger Signs:
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Head, stomach and back aches Rapid speech Yelling and screaming Sarcasm or cynicism Denial or rationalization about your behavior Revenge fantasies Thoughts about drinking or using drugs Arguing with others Becoming silent or withholding Avoiding Others Isolating

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Becoming Violent Compulsive eating, spending, cleaning, or sex

Recognize Angry Feelings:
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How does your anger show? Do you deny your anger and hide it? Do you acknowledge your anger and deal with it constructively?

Identify the Cause:
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What is the situation? Who is involved? Is this the first time, or is this a pattern? What other feelings are you experiencing? Are you too stressed? Tired? Hungry? Lonely? Scared?

Decide How to React:
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Reason with your angry self-talk. Change thoughts. From: "I'm angry at you because you..." To: "It's unfortunate this happened, but it's not worth the price I pay." Do physical activity. Engage in exercise that involves large muscle groups, like arms and legs to release pent-up energy that can fuel anger. Walk, jog swim, dance. Engage in physically demanding work. Chop wood. Clean the yard, garage, attic. Build something. Talk directly the person involved. o Use a calm and assertive voice tone. o Practice listening. o Don't interrupt. Be as polite as you would be to someone you didn't love. o If you're too angry, practice first with a third party. Talk to a friend, a relative, a therapist, or a religious leader. Use the internet to find discussion communities. Several communities online have members who will help you think through a situation and what you can say. Find communities that are well moderated by reading posts from other people before you join. Pick a community that is supportive and respectful, and which protects your identity by asking you to participate with another name, such as the one in this SelfhelpMagazine. Avoid behavior that will make the situation worse: o Artificial stimulants such as nicotine and caffeine. Remember that decongestants and stimulant drinks such as Red Bull can also give you a surge of energy that can be easily misplaced when angry o Ranting and raving. Unlike conventional wisdom dictates, it is often best NOT to say whatever is on your mind. While it is important to express yourself, taking the time to find respectful yet honest statements to represent your feelings. o Name-calling. This is simply childish and the result is likely to only be destructive. o Compulsive behavior with food, money or sex.

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Stomping out the door. If you need to leave, excuse yourself without blaming the other person, with statements such as "Please excuse me. I am afraid I will say something that I can regret later." Tell the other person when you will return, such as, "I'll go take a walk to calm myself down and we can talk when I come back in an hour, ok?" Be sure to get a response, and speak in a civil tone, or you may well return to someone is closed to you advances.

Prevention and Preparation:
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Meditation can help balance the nervous system, and contribute to less stressful anger management. Daily attention to diet and exercise will improve focus and concentration. Keep a log of your anger work, including triggers, behavior and future planning. Chart your progress and be generous with self-praise when you change your behavior.

Only you can decide on the best method to use at this time to handle your anger. Of the alternatives your have, which seem the best? What are the possible outcomes if you try a particular alternative? What will you do if this alternative doesn't work? Write in a journal. Discuss it with a friend or sponsor. Bring it to your recovery or therapy group. Seek professional help when needed. And remember, anger is NOT bad. It is a normal and healthy human response!

The Behaviors of Addiction
by Phil Rich, Ed.D., MSW, DCSW

Addiction treatment involves more than identifying addiction symptoms and handling withdrawal symptoms. Knowing and understanding the behaviors that are common to ALL addictions is one of the most important keys to preventing relapse, otherwise known as relapse prevention. This article will describe each of those symptoms and briefly describe some of the other issues that often surface along with addiction symptoms. There are a number of "side" behaviors that often accompany addiction which are not actually part of the addiction. It's simply that addiction is so inherently anti-social that many of these behaviors go hand-in-hand with it, required because they're needed to maintain the addiction.
The Side Behaviors
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Denial. Addicts often deny that there is an addiction. Denial is a way to ignore or dismiss the idea of addiction and avoid seeing a problem. Sometimes, addicts will acknowledge being addicted, but nevertheless dismiss the significance of the addiction. Cigarette smoking is a good example of an addiction that people readily acknowledge, but frequently do nothing about. They deny the reality of the addiction. Overcoming denial is always the first step in treatment of addictions.

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Selfishness. Addictions make people selfish and blind them. Nothing is more important than the addiction itself. Everything is geared towards getting the dependence met, and the deeper into addiction the greater the selfishness. Covert Behavior. Addictive behaviors eventually become a source of concern for others. Consequently, in order to meet the needs of the addiction, addicts often hide their behaviors from others. Addicts are often sneaky, running the gamut from hidden drug use and illicit sex, to drinkers who hide their alcohol, smokers who sneak cigarettes, and people who hide their eating. Irresponsible and Undependable. In the throes of addiction, addicts must pay far more attention to the needs of their addiction than the needs of anyone or anything else. Accordingly, addicts often become unable to meet social expectations and responsibilities, whether in school, work, relationships, or social roles. Illegal and Criminal Behaviors. Of course, many addictions are against the law in the first place. In addition, in the case of certain addictions the addict has to commit criminal acts in order to get the substance or engage in the activity. Much street, computer, and white collar crime is directed toward meeting the needs of addiction. Dangerous and Risky Behaviors. Because of the antisocial, and sometimes illegal, nature of many addictions, addicts often have to engage in dangerous behaviors to satisfy their needs. This may mean using a dirty needle, getting street drugs, going to an unsafe part of town, interacting with dangerous people, or engaging in some other activity that is inherently dangerous in order to support the addiction. And this also means using substances like nicotine which are carcinogenic and have a major impact on respiration and the cardiovascular system, and eating in a way that paves the way for, and directly causes, multiple physical problems. These too are dangerous and risky behaviors.

Paying the Price

Although these sort of behaviors or consequences often accompany addiction, they are neither always present or inevitable. Some addicts, in fact, are quite open about their addiction and are not in denial at all. Neither are they in denial about the possible consequences of their addiction. They have chosen to pay the price, although they may not realize what their use will really cost them or others. Perhaps more to the point, they don't care about the price. Perhaps this is a different form of denial.
Living with Addiction

In some cases, addicts learn to live with their addiction and find ways to met the needs of the addiction without having to give it up and enter treatment. Others form and live in a society composed of other addicts, and thus choose an entire life style that supports their addiction. It is also quite possible to be addicted and have access to the desired object without having to sneak around or engage in illegal or dangerous activities. It depends on the addiction itself and the circumstances of the addict. But addicts who successfully live with their dependency represent only a small percentage of addicts. For most addicts, the addiction eventually requires some form of underground behavior in which keeping the addiction secret is paramount, second in importance only to the addiction itself. Denial of the addiction is an important tool in the arsenal that keeps addiction alive.

Hiding Addiction

Some addictions can be hidden -- you'll find secret drinkers, heroin addicts with needle marks between their toes, and sex addicts who live in a secret world of lovers and prostitutes. In the case of addictions like these, many addicts try to have it both ways. They want to keep their addiction, but have everyone think they've quit. They think just because something is a well kept secret they won't have to pay a price. This is just another form of denial.
Beyond Denial

The first step in recovery is getting beyond denial -- recognizing that addiction makes life unmanageable for addicts, and keeps them powerless. It is not possible to overcome a problem unless one first acknowledges there is a problem!
References:

Ellis, A., McInerney, J. F., DiGuiseppe, R., & Yeager, R. J. (1988). "Rational-Emotive Therapy with Alcoholics and Substance Abusers." Needham Heights, MA: Allyn & Bacon. Carnes, P. (1992). "Don't Call It Love: Recovery from Sexual Addiction." New York, Bantam. Goldstein, A. (1994). "Addiction: From Biology to Drug Policy." New York, W. H. Freeman. Miller, W. R. Rollnick, S. (2002). "Motivational Interviewing. Second Edition: Preparing People to Change." The Guilford Press. Rich, P., & Copans, S. A. (2000). "The Healing Journey through Addiction: Your Journal for Recovery and Self Renewal." New York: John Wiley.

Anger Management in Sobriety
Thomas P. Hollander, Ph.D. Positive Steps in Dealing With Anger

Recognize Angry Feelings:
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How do you know when you are angry? How does your anger show? Do you deny your anger and hide it? Do you own your anger and go with it?

List Your Anger Signs:

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Head, stomach and back aches Rapid speech Yelling and screaming Sarcasm or cynicism Denial or rationalization about your behavior Revenge fantasies Thoughts about drinking or using drugs Arguing with others Becoming silent or withholding Avoiding Others Isolating Becoming Violent Compulsive eating, spending, cleaning, or sex

Identify The Cause:
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What is the situation? Who is involved? Is this the first time or is this a pattern? What other feelings are you experiencing? Are you too stressed? Tired? Hungry? Lonely? Scared?

Decide How To Behave:
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Reason with your angry self-talk. Change thoughts. From: "I'm angry at you because you..." To: "It's unfortunate this happened, but it's not worth the price I pay." Do physical activity. Walk or jog. Begin some physically demanding work. Talk directly the person involved. o Use a calm and asssertive tone. o Practice listening. o Don't interrupt. o If you're too angry, practice first with a third party. Avoid behavior that will make the situation worse: o Artificial stimulants like nicotine and caffeine. o Ranting and raving. o Name-calling. o Compulsive behavior with food, money or sex.

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Prevention and Preparation:
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Meditation can help balance the nervous system, and contribute to less stressful anger management.

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Daily attention to diet and exercise will improve focus and concentration. Keep a log of your anger work, including triggers, behavior and future planning. Chart your progress and be generous with self-praise when you change your behavior.

Only you can decide on the best method to use at this time to handle your anger. Of the alternatives your have, which seem the best? What are the possible outcomes if you try a particular alternative? What will you do if this alternative doesn't work? Write in a journal. Discuss it with a friend or spinsor. Bring it to your recovery or therapy group. Seek professional help when needed. And remember, anger is not a dirty word. It is a part of being human!

Recovering from Addiction: The Stages of Recovery
by Phil Rich, Ed.D., MSW, DCSW Recovery Work

Freedom from addiction is typically referred to as "recovery." Although there are many prescriptions for recovery and the treatment of addiction, there are essentially just two ways to overcome addiction and five stages of recovery. The most common and widely accepted way to overcome addiction is abstinence, or the complete stopping of the addictive behavior. In this case, the addict never again engages in the addictive activity. This applies mostly towards addictions involving alcohol, drugs, and gambling, because it's impossible in the case of a food addiction, for instance, to never again eat. This leads to the second model for overcoming addiction. Many addicts are unwilling to give up their addiction. Their goal is to continue their addiction moderately and get it under control, without letting it control them. For many, this is an unachievable goal and often wishful thinking. For many addicts, recovery requires complete and lifetime abstinence. But for others, moderation and control may be an appropriate and realistic goal. There may be addictive drinkers, marijuana smokers, and gamblers, for instance, who are able to moderate their use, and in some cases, moderation is the only realistic goal. Food addicts must eat, over spenders must shop, and sexual addicts must have relationships. In some cases, then, the addiction itself will dictate some key aspects of recovery. But in many other cases, it is the addict who will have to decide which route to take.
The Continuum of Recovery

Just as addiction doesn't develop overnight, neither do people recover from addiction in a single step. If successful, people enter recovery at one point and eventually undergo a major transformation, undergoing significant personal, emotional, and behavioral changes.

Although every addict's experience with recovery will be personal, there are five typical stages through which addicts pass on their way to lifetime recovery. These range from pre-recovery to the development of new ideas, behaviors, and lifestyle that maintain an addiction-free life.
The Five Stages of Recovery

Each stage has specific tasks which must be worked through completely before people can move on to successfully complete the tasks of the next stage.
Stage 1: Awareness and Early Acknowledgment

This is really a pre-recovery stage that paves the way for recovery, and begins with a growing awareness that there is a problem with addiction. During this stage people are still engaging in addictive behaviors and, in fact, are often pushed into the stage by the concerns of family or friends, or health, financial, work, or legal problems. The end of this stage is marked by an acknowledgment that action is needed to address issues. The tasks involve a shifting of perspective from outright denial to a willingness to consider the possibility of addiction.
Stage 2: Consideration and Incubation

This stage is still a precursor to actual recovery, but is the first concrete step towards recovery, characterized by a willingness to further explore ideas about addiction and recovery. The primary movement during this stage involves increasing knowledge about the realities of addiction and the impact it's having on the addict's own life and on the lives of others.
Stage 3: Exploring Recovery and Early Activity

This is the first clear stage of recovery. Beyond denial now, this stage unfolds with a clear resolution to quit the addiction. Tasks involve exploring ideas and activities of abstinence, moderation, treatment, and recovery; during this stage, people actively move towards stopping the addiction, and beginning treatment of some kind.
Stage 4: Early Recovery and Rehabituation

Recovery involves a change in perspective, attitude, values, and lifestyle. Stage 4 marks the entry into full, but early, recovery. Although still fragile, this is the stage which most solidifies recovery and during which a new life is built. During this stage, people learn the skills, develop the behaviors, adopt the habits, and build the relationships needed to maintain a lifetime of freedom from addiction.
Stage 5: Active Recovery and Maintenance

This is recovery proper. For many this is a stage without an end, for whom recovery is a lifetime process. It certainly is difficult to mark an end to the stage as it really "unfolds" into the life people will live for many years to come. By the time people enter Stage 5, they are actively

monitoring themselves, their feelings, thoughts, behaviors, activities, and relationships. Here, people are living out all they have learned as they ensure that each day is a day free of addiction.
The Journey to Recovery

Restoring and rebuilding life after addiction takes place only over time. How much time will depend on the commitment to recovery, and the personality, approach, and resilience of the recovering addict. And few people can go this route alone, without the support of family, friends, and the community of help that's easily available. For everyone though, recovery is possible.

Are You Aware of These Alternative Methods For Smart Recovery From Alcohol Abuse?
by Arthur T. Horvath, Ph.D., ABPP

Question: I have heard that in recent years alternatives to AA (Alcoholics Anonymous) have emerged, with approaches that are quite different from AA's. Can you tell me the names of these groups, how they are different, and where to contact them? I am particularly interested in an alternative smart recovery method for alcoholics. In the last two decades six alternative support groups for addictive behavior have emerged. These groups are: 1. Women for Sobriety (WFS), 2. Rational Recovery Systems (RR), 3. Moderation Management (MM), 4. Men for Sobriety (MFS) (same as Women for Sobriety), 5. Secular Organizations for Sobriety/Save Our Selves (SOS), and 6. S.M.A.R.T. Recovery (SMART). These six organizations are similar to AA in that they offer free groups (donations are requested) with the goal of helping members achieve abstinence (MM supports moderation). They are also quite different from AA. They neither encourage nor discourage belief in a higher power. None (except WFS/MFS) emphasizes the idea that substance problems are diseases. They focus instead on these problems as complex maladaptive behaviors. They use a small group discussion format, not a series of monologues. They do not use sponsors (a personal recovery coach you meet with between meetings). They do not encourage lifetime attendance.

Despite their similarities, there are also significant differences between these six groups. To mention just two: WFS is only for women with alcohol, or alcohol and other drug problems; SMART focuses on any addictive behavior. If you've had concerns about your drinking or other drug use, there's something here for you. Congratulations on looking for a road to smart recovery! Search for your local chapter of any of these groups by using any of the large search engines.

Treatment and Prevention of Problem Gambling
by Bryan Gibson, Ph.D., David M. Sanbonmatsu, Ph.D., and Steven S. Posavac, Ph.D.

Gambling has always been a big business. As more states adopt lotteries, permit casino gambling, and as Internet gambling or "gaming" websites proliferate, many people, including young college and university students betting on football and other games, are finding that compulsive or problem gambling is a big issue. But if gambling is, overall, a losing proposition for the gambler, why do so many people do it? Over the years, psychological researchers have identified several types or erroneous thinking contribute to problem gambling. These include:

y y y

biased evaluations of past gambling results (explaining away losses and viewing wins as evidence of gambling ability), the illusion of control (overestimating the influence one wields over outcomes and the probability of personal success) and the "gambler's fallacy" (the mistaken belief that over time, chance-determined outcomes will even out).

Researchers from Central Michigan University and the University of Utah have added add another cognitive process to that list:

y

considering only one possible outcome when making decisions (or what they call "selective hypothesis testing"). The researchers conducted a series of three experiments. The conditions for each experiment were:

1. participants were asked to estimate the probability that a specific National Basketball Association team (one of four) would win the NBA championship and explain how; 2. participants were also asked to estimate the probability that a specific NBA team beat the point spread in an earlier game; 3. participants were asked to estimate the probability that an NCAA basketball team (one of four) had won a computer-simulated playoff. In each experiment, participants were invited to place bets on the team they thought would win, had beaten the point spread or had won. In each experiment, when participants focused (as instructed) only on a single team (as opposed to estimating the probability of winning for all four teams), they consistently overestimated the probability of that team winning. These participants were also more likely to place bets and larger bets than those who were not focused on a single team. This overestimation of probability, the authors say, "could influence gambling decisions in any domain in which the potential gambler may focus on one possible outcome to the exclusion of others. Thus the blackjack player may be particularly interested in the likelihood of receiving a 10 after her or his first two cards sum to 11, the poker player may be particularly interested in the probability of making a straight on her or his next card, and the sports gambler may be particularly interested in the likelihood that the home team may win the league championship." Interestingly, when other participants were asked to estimate the probability of each of four teams winning a computer-simulated championship, they were less likely to gamble than those who had focused on only one team. In applying the meaning of their research to other gamblers in similar situations, these researchers concluded that, "By encouraging potential gamblers to consider a wide number of potential outcomes, the appeal of any specific outcome is lessened and the likelihood that a bet will be placed is reduced." Not only might this strategy be useful in the treatment of problem gamblers, the authors suggest it might be useful in preventing gambling problems from developing at all. The researchers in this study noted that training in abstract reasoning skills in high schools schools or college courses "could include a specific component that addresses the necessity of considering numerous potential outcomes when attempting to predict future events. This research suggests that such training could be relatively general in nature and still be readily applied by students to gambling and other risky choice situations."

Addictions and Addiction Treatment: Why Quit?
by Phil Rich, Ed.D., MSW, DCSW

Addiction separates people from everything around them. It makes invisible the damage it inflicts on the addict, those closest to the addict, and on the world at large. Addictions blind and desensitize the addict. There are many types of addictions and addiction treatment but why quit?
A Multitude of Addictions

There are many types of addictions, and many things to become addicted to. Some, such as drug addiction, involve illegal or socially unacceptable behaviors. Others, like alcoholism, involve behaviors that are legal most of the time, but have limits to their legal and social acceptability. Some addictions, once illegal and considered immoral, are big business nowadays although they can lead to tremendous personal and social destruction. Alcohol use and gambling, for instance, alre actively promoted and encouraged. They can easily get out of control and absolutely require a level of self-control and insight that many people don't have. And other addictions involve a distortion of normal and expected life functions such as eating, shopping, and sexual relationships.
The Price of Addiction

In some cases, the addiction itself destroys control and insight when under its influence. Alcohol and drugs are good examples (and alcohol can literally destroy parts of the brain in the long run). Some addictions, once considered entirely normal and even desirable, are now clearly seen as problematic and increasingly unacceptable. The most obvious example, of course, is cigarettes. Then there are those addictions that are currently acceptable and considered benign, such as coffee drinking. Even though caffeine is physically and emotionally addictive, the question remains as to what and how much damage it causes, and whether it will remain an acceptable addiction in the years to come. Addictions like this also beg the question of what threshold must be crossed, what damage must be caused, or what price paid before there is motivation for someone to quit the addiction. There are also the normal life functions and interactions, such as eating, shopping, and sexual relationships, that lead to patterns of addictive behaviors in some people.

Here the issues are more about self-control, regulation, and appropriate choice than quitting. In fact, abstinence in such cases produces a different kind of addiction that can be just as dangerous, or more so, such as anorexia.
Recognizing Addiction

The effects of addiction include behavioral, mind altering, mood altering, and physical change. Some of these changes are dangerous to others (for instance, drunk driving), and others dangerous only to the addict (overeating, for example). Some addictions produce immediate or rapid changes, and some changes appear only over extended and continuous addiction. In some cases, the results of addiction are almost unnoticeable. For instance, smokers and coffee drinkers don't usually behave differently after they use. In these types of addictions, it's the inability to engage in the addiction that produces noticeable change. In the case of all addictions, however, the absence of the addiction produces change. In fact, it's the emotional and often physical discomfort and anxiety that helps to maintain and drive addiction. This is one of those hallmarks by which addiction can be most clearly identified.
Addiction Treatment: Why Quit?

Just as remaining addicted is a personal choice, so too is quitting the addiction. But why quit? Why give up the thing that brings relief? The question is what personal price or damage to health, relationships, social functioning, financial freedom, independence, or the lives of others must be paid before the addict decides to quit. Some addictions have such a high price, it's obvious why someone should quit. Others, like caffeine use or addiction to chocolate, don't and quitting becomes more of a personal choice than a social, legal, or health imperative. But clearly, for some addicts, no price is too high and they die addicted, and often because of their addiction. In the end, addicts quit when they fully realize that the relief brought by addiction is temporary only, that there's a price to pay for that relief, and that the price is too high. It's the addict who gets beyond denial and into addiction treatment. They get to have their life back again.

It's True: A 12 Step Program Can Be Helpful In Bipolar Treatment Plan
by Reid K. Hester, Ph.D.

Question: I am a recovering alcoholic and also have a diagnosis of bipolar disorder. I have trouble with taking my medication on a consistent basis. Can you offer any help for bipolar treatment? The problem of compliance with medication is not uncommon among persons suffering from bipolar disorder. Compliance can be a particular problem when a person is moving into a manic phase. The euphoria of early mania can convince a person that all is well and medication unnecessary. The noncompliance with the medication obviously encourages the progression of the illness. You did not say so in your question but let's assume for the moment that you participate in a 12Step program for the alcoholism. If that's correct, why not address the medication issue through the 12 Steps? In recovery, we learn how to care about ourselves in a healthy way. This includes developing a loving attitude toward our bodies. I often encourage persons in recovery to list themselves under persons to whom they need to make amends. This includes amends for the manner in which we have treated our bodies. Consider the consistent taking of your medication to be one way in which you are making amends to your body. If your recovery does not include 12 step work, nonetheless consider taking the medication to be an important facet of recovery from alcoholism. Link your bipolar treatment with your alcohol recovery.

Over 10 DUI Arrests For Her Dad
by Reid K. Hester, Ph.D.

Question: My dad has just been convicted of his 10th DUI. How long will he go to jail? I can't even count how many DUI arrests he's had, without convictions. Penalties for DUIs vary by State so it is impossible to tell you what the range of jail time might be. However, given that he has now had 10 DUIs, he will probably receive a severe sentence.

Your father has a severe drinking problem, as you probably already know. If he has been in treatment at different times he has not benefited from it enough to avoid further alcohol-related problems. If this is the case and the courts take all of his DUI arrests into account, your father may be in for a long stay in prison, so there is time for him to learn whatever he still needs to learn, that is, if he gets into treatment. We can only hope the the court sees it appropriate to refer him for more intensive alcohol rehab while serving whatever time he has. Many people require multiple attempts at quitting, so take heart and do not give up hope. Meanwhile, your focus may be best directed toward avoiding your own co-dependency, which can not only harm you and your other loved ones, but also harm him. To learn about how you can best help yourself (and him), you might consider going to Alanon meetings or Codependency meetings, both of which are managed by Alcoholic's Anonymous (AA) group. They are all free and very consumer friendly. You can find the AA in the white pages of most phone books listed under 'Alcoholics Anonymous'. You might also try to find them online, where they have developed a very strong following.

Discover The Value Of An Alcohol Intervention
by Reid K. Hester, Ph.D.

Question: I have a concern about my sister. She is a heavy drinker, with mood disorders that are sometimes present even when she isn't drinking. The problem is I want to have a close relationship with her and we do, but she is so unhappy and stressed out all of the time, that I am beginning not to want anything to do with her at all, which is painful to me. I would like to try some type of alcohol intervention. What can I do to help my sister? As you have a close relationship with her right now you can have an influence on her sobriety. If you only want to be around her when she's sober, tell her so in a positive, caring way. Spend time together when she's sober and remove yourself when she's not. Her mood difficulties, however, may be a trigger for heavy drinking and she's at risk for returning to it until she learns some additional strategies for managing her mood. There is a wealth of information here at the zine she could use. She might also benefit from a consultation and/or therapy from a professional. Alanon is a 12-step program, like AA, and has free meetings all over the world. Its focus is for friends and loved ones of alcoholics.

A colleague of mine, Robert J. "Bob" Meyers, has written a book that might be helpful to you. It's called Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening There are different types of alcohol intervention strategies. You may want to consult with a professional to see if you can help your sister by using an intervention.

Would You Like To Understand Living With Chronic Hepatitis C?
by Reid K. Hester, Ph.D.

Question: I have chronic hepatitis C which is symptomatic. The lining of GI tract is all inflamed, as well as most other parts of my body. My first problem is that one of the side effects is constantly being tired and dizzy, with a lot of memory loss. If I try to help it by exercising, it makes my whole system very ill, and also I've been told many times that a lot of rest is indicated for chronic hepatitis. Also, I need to work to keep me sane. Yet, work is very strained with a lot of stress. Is there any solution? I hope that you are under the care of a physician. If not, you should be. My recommendation is that you comply with his/her directions. He or she should have the best judgment about your activity and work schedule. If you feel like you're bored out of your gourd because you shouldn't be working, or exercising, I suggest that you consult with a psychologist with a background in Behavioral Medicine. Ask your treating physician for a referral. If he or she is not aware of any, and you belong to a managed care organization, contact them. You could also call your state Psychological Association. They maintain directories of members with their areas of specialization. The important thing is that you don't want to cut off your nose to spite your face. If your doctor doesn't want you working or exercising, learn to deal with these restrictions and find other ways to satisfy your needs. You can do it, but you may need some professional help along the way to help you cope with your chronic hepatitis C. All the best.

Should You Look At Hypnosis For Alcohol And Drug Treatment?
by Reid K. Hester, Ph.D.

Question: Is there any known research or projects on using hypnosis in alcohol or drug treatment programs? There were four controlled clinical trials of hypnosis that were done in the late 1950's to late 1960's. None of them found hypnosis to have an impact on drinking behavior. However, I have not seen studies that assessed hypnosis for treating withdrawal. Most clinicians do not consider drug or alcohol withdrawal to be significantly aided by hypnosis. While hypnosis has been shown effective for a wide variety of specific problems, drug and alcohol treatment does not seem to be in that group. Perhaps more research will show it to be helpful in the future. Meanwhile, there are a number of effective withdrawal protocols for alcohol and drug treatment which are provided by treatment centers and professionals with expertise in these matters.

When Is Drinking And Driving Safe? Is It Ever Safe?
by Reid K. Hester, Ph.D.

Question: A friend and I have a disagreement (and a bet on it) about drinking and driving. My friend, Dennis, says that as long as you keep your blood alcohol level under the legal limit that it's OK to drive. He has a chart that shows him how much he can drink over time and still stay under our legal limit of 0.8. I think he's nuts. I can feel the effects of 1-2 beers and wouldn't want to put myself and others at risk by driving after I've drunk anything. So who's right? I have the pleasure of informing you that you are the winner of the bet with your friend. In a very narrow and legal sense, he is correct but that's about as far as it goes. Most states now have a per se limit of 80mg% (also known as 0.8) blood alcohol concentration (BAC). This means that if a driver is caught with a BAC at or above 80mg%, he or she is considered to be intoxicated regardless of whether they can pass a field sobriety test or not. A BAC of 80mg% will result in an arrest for driving while intoxicated (DWI) arrest. However, you can be arrested for DWI even if you have a BAC less than 80mg%. If you have any positive BAC and fail a field sobriety test you can be arrested for DWI. Some states also have very low BAC limits for underage drivers.

But far more important than getting arrested is the risk you put yourself and others at if you drink and drive. Your judgment and reaction times don't just go down the tubes all of a sudden when your BAC gets to 70-80mg%. Rather, they decline as your BAC increases from 0mg%. As your BAC increases so does your risk for getting in an accident. There is no safe BAC for driving. So if you drink, don't drive. And if you drive, don't drink. If you're going out with your friends, designate a driver who won't drink. Or walk. Or take a taxi. Do what you have to so that you and your friends can get back home safely. Drinking and driving don't mix.

Wife Abusing Alcoholic
by Reid K. Hester, Ph.D.

If someone is an alcoholic and a wife abuser, is it possible that overcoming the addiction can cause the abuse to stop? Abusive relationships often involve two people, that is both the abuser and the abused. Alcohol acts as a third party, but often is the first one that needs to be addressed. In other words, stopping drinking is necessary for spousal or relationship abuse to stop, but it is rarely enough by itself. In all probability the individual who is abusing a spouse also needs to learn anger management skills, communication and problem solving skills, and usually much more. All too frequently, the abused partner also needs help, not only to repair their self esteem, but also to learn a range of other skills, such as assertiveness training, and how to find and maintain a strong support system. Co-dependency training may also be in order for both partners at some point in the future. Such a couple may need to learn skills related to setting and maintain good interpersonal boundaries, how to identify their individual needs and negotiate them in a relationship. If children are involved, they may also need help. In summary, stopping the drinking and/or drug using is a necessary first step. Without it, I would not be optimistic about making any sustained progress with domestic violence or emotional abuse.

What are the Group Dynamics of Alcoholics Anonymous?
by Reid K. Hester, Ph.D.

What are the group dynamics in Alcoholics Anonymous? Although much has been written about Alcoholics Anonymous (AA), there is little empirical data about the dynamics of different groups. One study (Tonigan, et al., in press) found differences in group cohesiveness, independence, aggressiveness and expressiveness across three AA groups. There were also differences between groups on how frequently members discussed the 12 steps. What this suggests is that there are real differences between groups on different aspects of group dynamics and how much step discussion there is. This means you shouldn't conclude that all groups are alike. Clearly they are not. If you are considering attending AA, I suggest that you sample at least 10 different groups to find one you best fit in. Merely attending meetings is not likely to help you stay sober. Getting involved in an AA group can. (Montgomery et al., 1995). That means hanging around before and after the meeting to see what needs to be done to lend a hand (Setting up chairs, making coffee, putting pamphlets on tables, etc.) It also measn sticking around long enough to talk to people afterwards and perhaps even going out with people who are safe and going somewhere in a group. A lot of important interactions go on after a formal meeting in places like Denny's or Starbucks.

What are the DUI Laws?
by Reid K. Hester, Ph.D.

I am 18 and my Father has just been convicted of his 10th DWI. How long will he go to jail? Penalties for DWIs vary by State so it is impossible to tell you what the range of jail time might be. For the short term, he is probably considering whether to hire a DUI attorney, that is a lawyer who specializes in DUIs. In the longer term, given that he has now had 10 DWIs, he will probably receive a severe sentence. Your father has a severe drinking problem, as you probably already know. If he has been in treatment at different times he has not benefitted from it enough to avoid further alcoholrelated problems. If this is the case and the courts take this into account, your father may be in for a long stay in prison. An important question here is how are you doing with your father's condition and absence in your life? Have you found support for yourself anywhere? You might already know that there

are groups of kids that get together to discuss how to cope with their alcoholic parents. The group meetings are free and usually found in Alcoholics Anonymous clubhouse, called Alano Clubs. They are casual meetings and the kids are usually very open to new kids joining or showing up for thre first time. After all, they all walked in there alone at some point, and they know what it feels like to be in your shoes. If you feel like meeting other kids who have lived the same general kind of life you have, just look for An Alcoholic's Anonymous listing in the white pages of your phone book. Or find a club house in your neighborhood by looking them up online. Call then and ask if they have any Ala-teen groups. You might also try AA Central for your town, if you live in a relatively large city. They can tell you where all the Ala-teen meetings are in town. Go to a bunch of them, like 7-10 before you make up your mind about them, one way or another. You can just drop in to check them out and see if you want to go back at a later time. Some churches have them in their basements, too. You might want to look for them. They are called Ala-teen Groups. They are free.

Marijuana Resource Online
by Reid K. Hester, Ph.D.

How can I send information to a friend who smokes pot, is there a best site on-line? The best site I know for marijuana is http://www.nida.nih.gov. It is the web site of the National Institute on Drug Abuse of the National Institutes of Health. The main page has links to a great deal of information that represents some of the best scientific knowledge on marijuana.

Legal Highs?
by Reid K. Hester, Ph.D.

I recently came across some internet sites selling "Legal Highs". Are these drugs really harmless? Just because a drug comes from a natural source, it doesn't mean that it's safe. Opium comes from the opium poppy. Is it a safe drug because it's all natural? I don't think so. In a similar vein, it may be helpful to keep in mind that just because a drug has not yet been examined and found to be illegal, doesn't mean that it's safe. And usually the folks who are touting such a drug's safety are also trying to get you to buy it. Creative minds are always trying to figure out ways for people to alter their state of consciousness while at the same time drain your wallet. So the bottom line is to be very careful

what you put in your body in your quest to alter your state of consciousness and remember that the most powerful ways to alter your consciousness come from within.

Is It Wise to Stop Smoking and Drinking at the Same Time?
by Reid K. Hester, Ph.D.

Since Nicotine is now classified as addictive drug, do you think it better to detox nicotine at same time as alcohol and other drugs? Nicotine is perhaps the most powerfully addicting drug and although many addiction counselors advise against detoxing from it at the same time as from alcohol and other drugs, the research evidence suggests that quitting smoking at the same time as drinking lowers your chances of relapsing to drinking. So yes, I'd suggest you do them both at once for two reasons:

1. spare yourself another withdrawal episode later on, 2. and spare yourself probable continued cravings that can persist because you've continued to smoke.

How to Stop Alcohol Urges and Cravings
by Reid K. Hester, Ph.D.

I've been thinking about quitting drinking again and hope you can help me. I've tried quitting a couple times before and have made it for about two or three weeks. I haven't had problems with feeling bad when I stop drinking but after about a few days I start to get urges to have a drink. I've tried just biting the bullet and suffering through them but I think they've played a big part in my resuming drinking. Do you have any ideas about how to deal with these urges? It's not unusual to have urges and cravings to drink, especially in the early stages of not drinking. They're often set off by cues or triggers that have been associated with your drinking in the past. These triggers can be people, places, and events. They can also be internal things like feeling down, angry, anxious, or even happy and wanting to celebrate. Fortunately, there are a number of things you can do about it both on your own and with the help of others. An in-depth discussion is beyond the scope of an answer in this column. But within the space we have, allow me to offer some alternatives for your consideration.

If you are with family or friends you can confide in, tell them how you're feeling. Talk (or think if you're alone) about the negative consequences you've experienced from drinking. Consider the positive things that have happened to you since you stopped drinking. Delay making a decision about drinking and do something else. If you monitor the intensity of your urges over time, you'll notice that they fluctuate in intensity. Think about riding these waves of urges as you would waves in the ocean. Try to think about what cue might have triggered off your urge. What are your alternatives for dealing with the cue? Another option is to join a self-help group. Alcoholics Anonymous (AA) is certainly the most wide spread. This fellowship has help many an individual down the path of recovery. There are also other self-help groups including SMART, Rational Recovery, etc... Check the Resources section of our magazine for how to get in touch with these and other self-help groups. Yet another set of options involves professional help. Consider talking with your family doctor. He or she may be able to provide the extra support you need. Your doctor can also prescribe a medication called naltrexone to help with your urges and cravings. Naltrexone has been found in two controlled clinical trials to reduce cravings. When combined with professional help, they have also found that it significantly reduces relapses back to heavy drinking. The medication doesn't make you sick if you do drink while taking it. Rather, it seems to eliminate the euphoria you may associate with drinking. If this sounds interesting to you, you'll need to talk to your doctor about it because naltrexone is a prescription medication. There is a lot written about controlling urges online, look for articles with these keywords: "alcohol relapse prevention". That should get you several more good resources. Whichever course (or combination) you choose, don't give up! There are many alternatives for helping people quit drinking and helping you deal with urges to drink.

How Can I Keep My Friends and Stop Drinking?
by Reid K. Hester, Ph.D.

I drink 5-9 beers almost every night in a bar for socialization. How can I continue with the social aspect and not drink. Drinking that much "almost every night" suggests that it's become a very integrated part of your socialization. So not drinking and putting yourself in that particular bar to socialize may be difficult. Consider not drinking for a couple weeks and socializing in places other than the bar. This may be easier as you won't have as many cues to drink as in your favorite hangout. Then, when you're comfortable socializing and not drinking (which can take some time), consider returning to your old haunt. When you do, plan ahead. Think about what you'll order to drink. What you'll say to your old drinking buddies. Consider some activities that keep your hands busy. Play pool, shoot darts. And don't be surprised if some of your old drinking buddies aren't as friendly if you aren't

drinking with them. Your true friends will be glad to see you. People who are just drinking buddies may be threatened by your not drinking. This is one aspect that was recognized very early on in Alcoholics Anonymous. They developed what has become known as the "fellowship" which is a very strong and fast- forming social system that forms around a newly sober person to help them stabilize with a brand new circle of friends who are also sober. Many people attribute their sobriety to the AA "fellowship" even if they reject much of the remaining AA program. The easiest way to develop such a strong social system in AA is to go to about 8-10 meetings, and in one, stand up and identify yourself as a "Newcomer who needs the Fellowship". Stick around after each of those meetings for at least a half hour, even if you want to crawl out of your skin. Most often, someone will come up alongside you and ask you to join them for coffee at Denny's or Starbucks are some such public place. Ask who else will, be joining you. Never go alone, but if a group is going, talk to them and see if they feel like the kinds of people you'd like to get to know, or at the very least, that don't frighten you. If you feel safe with the person who invited you and the others who will be joining you, go with them and start to make new friends. These are the people who you'll be able to count on as you regain your sobriety. Once you get your 'land legs' with your sobriety, go back to your old haunts, and maybe bring one of your new sober buddies with you. See if you view your old friends with the same eyes. If yes, you've lost nothing. If not, you'll know to go elsewhere for your friendships, and you'll have a whole new set of people to choose from. One more thing. Very few people are completely successful in changing drinking behaviors perfectly. If you slip, learn something from your mistake, resume your non-drinking, and try something different. Keep trying. Persevere. If you still have difficulties, consider some professional help.

Depression and Alcoholism ± Are They Genetically Linked?
by Reid K. Hester, Ph.D.

Does it seem that it is common for bipolar disorder to run in families? I'm also curious as to whether or not losing a loved one can trigger symptoms to the disease. My last question is: what is the connection between bipolar and drug use, including cigarette smoking? I'm bipolar and my sister thinks that she might be bipolar too. Thank you for having this valuable resource available to readers of SelfhelpMagazine. The answers to your questions are yes, yes, and the connection exists. Individuals with bipolar disorder are at greater risk for developing addictive behaviors including alcohol, tobacco, other drugs, and gambling. Hopefully you are under the care of a psychiatrist, which is what I urge your sister to consider also. People dealing with such complicated issues often do much better

with the help of a reliable and well-trained professional who they can learn to know and trust over time.

Bipolar Depression and Alcoholism
by Reid K. Hester, Ph.D.

I am a recovering alcoholic and also have a diagnosis of bipolar disorder. I have trouble with taking my medication on a consistent basis. Can you offer any help? The problem of compliance with medication is not uncommon among persons suffering from bipolar disorder. Compliance can be a particular problem when a person is moving into a manic phase. The euphoria of early mania can convince a person that all is well and medication unnecessary. The noncompliance with the medication obviously encourages the progression of the illness. You did not say so in your question but let's assume for the moment that you participate in a 12Step program for the alcoholism. If that's correct, why not address the medication issue through the 12 Steps. In recovery, we learn how to care about ourselves in a healthy way. This includes developing a loving attitude toward our bodies. I often encourage persons in recovery to list themselves under persons to whom they need to make amends. This includes amends for the manner in which we have treated our bodies. Consider the consistent taking of your medication to be one way in which you are making amends to your body. If your recovery does not include 12-step work, nonetheless consider taking the medication to be an important facet of recovery from alcoholism. Link the two together.

How to Break through Someone's Denial about Alcohol?
by Brenda Wolfe, Ph.D.

How do you break someone out of a cycle of heavy drinking and denial of a problem? Everything I try seems to no avail. Any ideas? Helping a problem drinker to "see the light" so to speak is never easy. In fact, most concerned friends and family find that the harder they try to convince the drinker he or she has a problem, the more the drinker denies the problem. However, if you take a more positive approach, researchers at the University of New Mexico's CASAA have shown that you can improve the chances of getting your drinker to agree to treatment.

Their method is built on the idea that if you make it more enjoyable to be sober than drunk, your drinker will gradually come to value not-drinking. Thus, your objective is to make it clear (in a pleasant way) that you love your drinker and enjoy his or her company but only under sober conditions. For example, you might say to your husband who shows up drunk for dinner, "Honey, I really enjoy having dinner together but love you too much to enjoy seeing you drunk. If you come home sober tomorrow, I will prepare your favorite meal but if you come home drunk, I will go to my sister's for dinner." Then, of course, you must follow through and make sure that dinner is pleasant if he comes home sober and you really do leave for the evening if he comes home drunk.

Helping People You Care About with Their Substance Abuse Problems
by Ron Fagan, Ph.D.

Many of us have been in situations where we have friends or loved ones who we feel have drinking or other substance use problems. But despite our pleas, they are unwilling to even acknowledge the problem, let alone do something about it. The most commonly stated explanation is that they are "in denial" and they have to "hit bottom" before they will be willing to change. But there are things you can do to help people before they ruin their lives. Help-seeking is influenced by psychological, social, and economic incentives and barriers. Research shows that people trying to modify addictive behaviors typically move through a series of five stages from not feeling their substance use is a problem (pre-contemplation) to beginning to think about their problem (contemplation, preparation for change) to doing something to overcome their problem (action, change maintenance). Where they are in this cycle influences their willingness to change and how they will respond to different types of intervention. When confronted by loved ones, the courts, and/or employers about their use, most substance users are in one of the first two stages.
What can you do to help a friend or loved one who is at one of these early stages?

People in the first two stages, either truly do not feel they have a problem or, at best, they are ambivalent about their situation. Even people who are at the third stage, often are only saying things like "I cannot go on like this," but they have little idea what they need to do to address their problems. Rather than trying to "break through the resistance" by confrontational tactics (such as getting the person to admit they are an addict), I recommend using a style that some have called "rolling with the resistance" as you try to help the person move through the stages of change. Going through all five stages is critical to making meaningful change. I have found that one of the best early strategies is to discuss with the person any ambivalence they may be feeling about their use. Remember it is very difficult for most people to give up

something they know, no matter how distressing, to travel to an unknown place where they are being asked to give up some control and put their life in the hands of others. While you can give them feedback about the negative consequences of their use for you and the people around them, if you only focus on the negative aspects of their use, most substance abuser will be equally adamant about the positive benefits. When you say: "You are an addict and you must get help," the likely counter response is: "I am not an addict and I don't need your help." People are more likely to take action to change when they perceive they have personally chosen to do so, not when they are told they have no other choice. Too often people communicate a double message to the substance abuser. They say: "you need to change," but at the same time they communicate "but I am not very confident you can change." It is important for you to communicate to the person that you sincerely believe they can make meaningful changes in their lives and you will help them in any way you can to remove any barriers there may be to getting the help they need. Your goal should be to gradually help the person shift their primary focus from the perceived benefits of their use to more of the negative consequences of their continued use. I have found that a very effective strategy is to discuss with the person their life values and goals and how their substance use may be compromising some of these aspirations. Statements like: "On the one hand you say you do not have a problem in controlling your substance use, but on the other hand your use has had these negative consequences" may help the person begin this process. The person needs to get a consistent message that while you may need to do things to protect yourself and others from the negative consequences of their use, you care about them and these are the reasons you are concerned about their substance use. You are willing to help them in any way you can to see that they get the treatment they need, but ultimately it is their responsibility for deciding to make changes or not.

3 Types of Craving: How to Cope with Each Type
by Robert Westermeyer, Ph.D.

Changing an addictive habit usually means coping with sometimes relentless cravings. A craving often dominates thinking and interfere with the daily routine. Many people give up because they believe they can't function without their habit. Remember that urges, in and of themselves, are normal. We all experience craving in varying degrees every day. Because your habit has been important to you for a long time, it is unreasonable to expect urges to vanish completely. If they do, don't be surprised if they occur a month or two down the road. For the purpose of this article, craving and urges will be used synonymously.

The "three Ds" can be helpful in coping with urges and craving, whether these urges are related to alcohol or drug use, overeating, tobacco use or any habit you are attempting to change. The Ds stand for:

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Decatastrophizing, Disputing expectancies, and Distracting

Decatastrophizing

Especially early in your change efforts, cravings can seem excruciating. Everything you see can remind you of your habit. If you smoke, every room you enter may bring to mind the image of a cigarette and associated pleasure. The inability to satisfy the urge can lead to frustration and inner statements like, "I can't stand this!" or "There is no way I will be able to live without giving in. I'll just go crazy!" Statements like this can be overwhelming." Remember that urges are normal and typically decline in intensity as you continue changing. Avoid extreme adjectives like "horrible" or "unbearable." Belief in horrible extremes only makes you feel worse. Just how unbearable is your urge right now? To accurately answer, think of truly unbearable suffering. Is your current state as unbearable as getting punched repeatedly in the stomach? Bamboo shoots under your fingernails? Watching a loved one get hurt? What have you endured which was worse than your current urge? Did you survive? If so, does it follow that your urge is less than unbearable and perhaps only "very uncomfortable?"
Disputing Expectancies

Urges are, in essence, positive expectations. When we crave something, we expect it will create a pleasurable state, or reduce an unpleasant one. Urges are "myopic," they can only see advantages. You must shed some light on your craving to effectively control it. One good way to decrease the potency of an urge is to focus on its negative consequences. Ask yourself questions like:

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"How will I feel later if I give in to my urges?" "What consequences might I suffer if I give in?" "Will the negatives outweigh the positives in the long run if I give in?"

Another way to cope with urges is to imagine that someone very close to you is having the urge. How would you convince them to resist? Separating ourselves from urges is often required to respond to them objectively.

Distracting

Some urges are so relentless that talking back to them doesn't work. Good old-fashioned distraction is sometimes the only medicine that can pull your thoughts away. Distraction can be "cognitive," in the form of some mental exercises, or "behavioral," in the form of an alternate activity. Alternate activities are usually the most effective, in that urges tend to occur in environments similar to those the habit occurred in the past. If an urge feels overwhelming, remove self from the situation until it subsides. Cognitive distraction can be very powerful as well as convenient. You can use imagery to take your mind off particularly powerful urges. Conjuring a pleasant place like a beach, or a raft on a lake can help you take your mind off the urge and relax. Relaxing images are not helpful for everyone. Some even find that relaxation increases the strength of a craving. This makes sense. Many habits are associated with relaxation and pleasure. If this is true for you, find some mental task that will be very difficult to finish but is interesting and consuming. Think about developing Mental Tapes. Examples of helpful tapes are:

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Mentally writing the perfect epic novel or screenplay. Planning the perfect vacation. Creating the ideal money-making business. Interpreting a dream from the night before. Picking an acquaintance and trying to "figure them out."

What you choose will depend on your interests, but the key is to make it something easy, interesting, and fun to do. Here's what NOT to do: choosing to think about all the mistakes you've made this year; how you could have done things differently, what a failure you are ... These "tapes" won't be enjoyable. They may even increase your urges, especially if stress has precipitated your habit in the past. Though these techniques may feel awkward initially, with practice they can become almost automatic. Give them a try! What do you have to lose?

Fraternity and Sorority Drinking Patterns
by Kenneth J. Sher, Ph.D. and Bruce D. Bartholow, Ph.D.

Researchers have known for years that membership in a "Greek-letter social organization" is associated with heavy drinking among college students. Problems have ranged from those typically associated with alcohol intoxication to alcohol poisoning and death among sorority and fraternity members. These groups are being much more closely monitored on college and university campuses. For example, in September of 2008, San Diego Union Tribune reported on San Diego State University, "On the heels of Operation Sudden Fall, SDSU's largest drug bust in university history, fraternities and sororities will be banned from hosting parties with alcohol for five weeks starting tomorrow, about a week before the first day of classes Sept. 2. The ban coincides with a new, five-week period of university-sponsored, alcohol-free weekend night programming, including dances, movies and concerts for all students. "The highest number of alcohol incidents typically occur within the first few weeks of the semester," said Doug Case, an SDSU administrator in charge of Greek life. "Many students have freedoms they didn't have in the past. They do a lot of experimentation. We have a lot of issues with new students going to fraternity parties with underage drinking and even more serious situations such as alcohol poisoning." While authorities are finally curbing alcohol use in early college life, researchers have examined what happens with drinking behavior after graduation. In a study of Greek membership and postcollege drinking, researchers have found that heavy drinking among college Greeks does not generally lead to increased alcohol use later in life. Furthermore, it isn't necessarily membership in a Greek house that leads to excessive drinking during college but rather the perception among Greek members that such drinking is normal for their group, say researchers. College students will drink more alcohol when they are around friends who also drink a lot, whether in their fraternity house or at a resort town on spring break with 30 friends. Because these behaviors are situational and peer-driven, they don't usually continue after college, possibly because these young adults adopt more adult roles, such as full-time employment, marriage and parenthood. In their study of alcohol use during college and after, Drs. Sher and Bartholow surveyed 319 college students about their drinking habits every year during the college years and again three years after graduation. The students were also asked how their friends felt about drinking, how many of their friends drank and how often and what expectations they had concerning the positive effects of alcohol. The authors also assessed participants' academic ability and precollege achievement and major personality traits such as introversion/extroversion and novelty seeking. The study found that Greek members drank significantly more during the college years than students who did not belong to Greek houses. In addition, heavy drinking during junior and

senior years was associated with being a Greek member as a freshman. But after controlling for background academic and personality factors, Greek members were no more likely to drink excessively after college than those who didn't join a Greek house, said the authors. "Drinking patterns among Greeks and those not affiliated with a Greek house were clearly different during college, but by three years after college, levels of heavy drinking among Greek members had moderated significantly." Furthermore, the study found that heavy drinking is a result of students' perceptions that excessive alcohol use is normal in Greek houses, and perceptions that their peers encourage and support heavy drinking lifestyle during college, said the authors. "Once the students leave campus they are no longer immersed in a social environment that supports heavy drinking and their drinking decreases as a result." These findings are certainly consistent with norms-based, prevention approaches that seek to counter faulty beliefs about what constitutes typical drinking levels on campus. However, it is clear that effective prevention of excessive alcohol consumption on campus involves efforts with clear alcohol policies, consistent enforcement of those policies and coordination with prevention efforts in the larger community surrounding the campus. There also needs to be appropriate intervention services for those students manifesting signs and symptoms of alcohol dependence and methods for identifying and motivating them for treatment," said the authors.

Drinking Behavior Changes with Age
by Michel Bonin, B.A., Donald McCreary, Ph.D., and Stanley Sadava, Ph.D.

Depression, loneliness and coping (the way in which a person deals with a stressful event) are significantly related to problem drinking for both men and women. When researchers from examined data from the Niagara Young Adult Health Study, they examined at the interplay between coping, loneliness and depression and problem drinking behaviors in two groups of young adults. A younger group had men and women with a mean age of 21.93 years. An older group had men and women with a mean age of 30.69 years. The research team looked at the interplay between coping, loneliness and depression and problem drinking behaviors in both groups. Problem drinking behavior was defined as binge drinking, drink tossing and frequency of intoxication. Depression and coping style were found to be the strongest predictors of problem drinking behaviors. The association between coping, loneliness and depression and problem drinking tended to be the same for both genders with the single exception that in the group of younger study participants, lonely women tended to drink to intoxication more frequently than did lonely men.

While men and women were about equally likely to engage in problem drinking, differences were found in the patterns of problem drinking when comparing the younger study group to the older study group. In the younger group, higher levels of depression were significantly related to increases in the frequency of intoxication and binge drinking. Interestingly, using an avoidance coping style was predictive of drink tossing. In contrast, the older study participants did relatively little binge drinking. Rather, they coped by seeking support. Avoidance predicted increased frequency of intoxication. And contrary to the younger group, depression was associated with increased drink tossing, not avoidance. The authors suggest that their findings raise important questions for further research in these areas: Are the differences in predictors of problem drinking in younger versus older adults a result of different social contexts in which they live, or developmental differences between the age groups? They summed it up by stating, "Because our two samples were in different stages of their social development, adoption of social rules may have influenced their problem drinking behavior and the psychosocial factors that predicted it."

Alternative Support Programs (Non-AA)
by Tom Horvath, Ph.D., ABPP

Over the last few decades, several alternative support groups for addictive behavior have emerged. Their approaches that are typically quite different from that of the traditional Alcoholics Anonymous. These groups include, but are not limited to:

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Women for Sobriety (WFS) Rational Recovery Systems (RR) Moderation Management (MM) Men for Sobriety (MFS) (same as Women for Sobriety) Secular Organizations for Sobriety/Save Our Selves (SOS) and S.M.A.R.T. Recovery (SMART)

This brief article will introduce you to these six, but you are encouraged to recovery These six organizations are similar to AA in that they offer free groups (donations are requested) with the goal of helping members achieve abstinence (MM supports moderation). They are also quite different from AA. They neither encourage nor discourage belief in a higher power.

None (except WFS/MFS) emphasizes the idea that substance problems are diseases. They focus instead on these problems as complex maladaptive behaviors. They use a small group discussion format, not a series of monologues. They do not use sponsors (a personal recovery coach you meet with between meetings). They do not encourage lifetime attendance. Despite their similarities, there are also significant differences between these six groups. To mention just two: WFS is only for women with alcohol, or alcohol and other drug problems; SMART focuses on any addictive behavior. I've put the telephone numbers, addresses, and online addresses in the SelfhelpMagazine Outside Resource Links Department. Check 'em out! If you've had concerns about your drinking or other drug use, there's something here for you.