Addiction

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Traditional 12-Step Treatment

What to expect in this episode:

 

  1. Understanding the evolution of addiction rehab & recovery is important to understand where we are heading
  2. The 12-Step program is a spiritual program that evolved after psychotherapy failed to help
  3. This has become the foundation for most North American Treatment Programs, but the success rate could improve…

 

Traditional Addiction Rehab | The 12-Step Program

 

In terms of the future of recovery, I think we’re already in the midst of a rapid change in; let’s call it the recovery underground. To understand, first I think we need to understand traditional recovery and where that even comes from.

 

Traditional recovery is pretty much 12-step based in North America. Alcoholics Anonymous, Narcotics Anonymous everyone is familiar with that. The reason why traditional recovery developed in the first place is because the mental health and physical health systems that we’ve had historically weren’t helpful when it came to treating addiction.

 

So we knew very early on in 20s 30s 40s even before that, that Psychotherapy did not work with helping people to recover from addictions it’s a well-known historical fact. We’ve kind of forgotten that over time but it’s a well-known historical fact.  Alcoholics Anonymous came along as an interesting spiritual program with elements of therapy and morality and eventually community and literature that people started to get sober and people start to recover. That worked and works!

 

So traditional recovery in North America is 12-step and it was it was the dominant form of recovery for the… last eighty years let’s call it. The success rates that we see now, I think they’re controversial, to be honest with you, I think it’s a difficult question to ask, to talk about that, but let’s say the success rates are 15%. That might be generous that might be stingy,

 

it just isn’t good enough.

 

What are the Alternatives that are on the horizon for people in recovery?

 

 

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Marijuana Decriminalization | The Future of Addiction

What to expect in this episode:

  1. Exploring how marijuana fits in society
  2. Being Pro-decriminalization doesn’t mean there is no harm or side effects
  3. We’re in an interesting experiment to see what happens when we decriminalize a substance, the stigma goes away, & how that affects our society in general over time.

 

Marijuana Decriminalization | The Future of Addiction

 

I don’t think we really know over the long-term what it’s like to regulate self-medicating marijuana over 5 years 10 years 15 years 20 years and the impact that has on individuals and the impact that has on groups or productivity or our society as a whole.

 

So we’re in the midst of an interesting experiment to see what happens when we decriminalize a substance and the stigma goes away, which I think is a good thing, how does that affect our society in general over time.

 

So part of what will be understanding is what does society look like in relationship to mass consumption of marijuana over a long period of time.

 

Probably chill.

 

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Donald Trump & Addiction

What to expect in this episode:

  1. Donald Trump appears to suffer from Attention Deficit Disorder
  2. He has likely been prescribed methylphenidate, for decades
  3. Irritability, lack of sleep are side effects, so he likely has been taking benzos like Xanax to sleep, effectively putting him on a pharmaceutical cocktail long-term, locking in aspects of his personality as an addict would.

 

Donald Trump & Addiction

 

I have an interesting and controversial theory, I have no facts, this is just, shooting the breeze – I’m sure I’ll hear about it…

 

I look at Donald Trump, I look at his character structure, the little bit that we know about his history, and it’s clear that he suffers from some kind of attention deficit disorder.

 

He seems impulsive, not always so contemplative and thoughtful, and I imagine as a kid he was a lot to handle.

 

He also comes from a wealthy background, I’m assuming his parents probably had access to private doctors, psychiatrist, etc.

 

At some point in his development, his parents or whoever was in charge went, “this kid is pretty wild” and they put him on some kind of methylphenidate.

 

Something like a Ritalin or Adderall or something like that, and they used that to help him narrow his focus and be able to accomplish the task in front of him, school, etc.

 

I imagine him on this methylphenidate for 10, 20, 30 years – what happens if you consume methylphenidate, which is related to the class of drug that’s methamphetamine or speed, a stimulant, is… you begin to have side effects.

 

The side effects are irritation, lack of sleep, it stops working, you start to feel your focus starts to slip…

 

Usually what people do at that point if you’ve been on a methylphenidate for a long time, is you’ll take a benzodiazepine or sleeping pills and then you’ll begin to balance it out with different kinds of medication,

 

So my guess, when you look at Donald Trump, is that he’s been on a pharmaceutical cocktail for 40 years.

 

The reason why I think that is, most human beings in an interaction with the world would grow past some of the immature characteristics that we see in him.

 

The only way that somebody gets locked in that kind of way is either through extreme avoidance of yourself, which is hard to do or through some kind of addiction.

 

He also doesn’t drink and doesn’t get high. His brother was an addict and so he doesn’t medicate with those things.

 

So my guess is he actually got hooked on stimulants and then other drugs like benzos like Xanax and things like that to calm his nerves from the stimulants and it’s been locked in place for decades.

 

I think one day we’ll find that out.

 

 

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Suboxone Treatment | The Future of Addiction

What to expect in this episode:

  1. The immediate future of addiction is going to be dealing with the fallout of our current harm-reduction approach to the opiate crisis
  2. Suboxone or Subutex is currently subscribed widely to save lives but we don’t know what years of use will do
  3. It is widely known that suboxone is much harder to detox from than heroin, so what happens when all these people need or want to stop taking it?

The Immediate Future of Addiction | Suboxone and the Opiate Crisis

 

The most immediate thing I see on the horizon in terms of the near future of addiction is consequences of what we’re doing now with addiction.

 

The most immediate thing I see on the horizon in terms of the near future of addiction is consequences of what we're doing now with addiction. Click To Tweet

 

So, we have a gigantic opiate crisis in the United States, unprecedented really. One of the things that we’ve done to save people’s lives, understandably, is we’ve approached it from a governmental level and an Institutional level, and our approach has been harm reduction. Which means finding medications that reduce the amount of harm caused by heroin and oxy and these drugs and so the consequence of that is we are going to have a generation of young people or some percentage of this next generation that is on some sort of opiate blocker or opiate substitute the most common is called Suboxone most common is called a Suboxone or Subutex and the first crisis we’re going to deal with in terms of the future of addiction as we’re going to have hundreds of thousands or even millions of people who have been on Suboxone or Subutex for 3, 4, 5,10 years and we don’t really understand on that scale the effects of those drugs long-term on the individual.

 

We don’t know how that affects people’s development over the long-term you know, what happens when you put it on 18-year-old on Suboxone how does it affect the development when they are 24. Maybe it’s hardly at all, maybe it’s a really big deal, we don’t really know. But my guess is it’s something we’re going to have to deal with. As people start to have mental health problems years out of their development may be in relation to the Suboxone the questions going to be how do we get these people off of this drug? And, what I found in my own experience in treatment, is it’s actually harder to come off of suboxone than it is to come off of heroin – it’s actually well known. If you’ve been on Suboxone for a long time, you know, two, three, four, five years the detox is horrendous and often the depression is really heavy and lasts months if not years and so…

 

The immediate future of addiction looks like what are we going to do with this group of people who will put a bandaid on their situation that we had to do so they wouldn't die but they didn't completely heal Click To Tweet

 

The immediate future of addiction looks like what are we going to do with this group of people who will put a bandaid on their situation that we had to do so they wouldn’t die but they didn’t completely heal and they’re on this medication, maybe for life or maybe they want to get off and what do we do so that’s a new media crisis that we will be in the headlines in a couple of years.

 

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The Future of Addiction

What to expect in this episode:

 

  1. The drug and alcohol treatment industry tends to be very reactive
  2. How addiction works in relation to social phenomenon and social systems; increased anxiety and depression
  3. Prediction: Vaping, vaporizers & increasingly complex designer drugs.

 

The Future of Addiction

 

The question of what drug addiction looks like in the future is massively important. What I am experiencing working in drug and alcohol treatment is that we are very reactive. We’re in the midst of an opiate epidemic, methamphetamine use is also on the rise, and we’re so busy dealing with that we’re not looking at what’s coming down the pipeline, which I think is an important conversation to have.

 

I see addiction working in relation to social phenomenon and social systems, things that are happening in the world around us. I think the biggest thing that’s happening in the world around us, the biggest event of our time, is the rise of technology and the complexity of human urban life; and we don’t know how to deal with it. So we know how to engineer complex systems but we don’t know how to deal with our feelings. We’re not necessarily training our children to make their bed and do the laundry, even though they can be top scorer on Fortnite or whatever.

 

And so what I see is (this is already happening) I see massive growth in anxiety and depression which are internal disorders that come from coping with the difficulties of life. And so when I think about what’s happening in the future of addiction, I think of what’s happening in the future of mental health. My prediction is that there’s going to be more and more complex designer drugs.

 

Designer drugs are drugs where the molecular structure is modified usually from an existing drug for a specific application like Pharmaceuticals are designer drugs and what I see is a massive growth in designer drugs and their distribution online and so if you go online right now and you look up how many different kinds of drugs there are that list is growing more rapidly or drugs are coming out in the recipes are available and I think they’re going to be used for people to self medicate to treat feeling that they don’t know how to deal with a don’t know how to live into.

 

The other thing that’s happening is the way that drugs are being ingested is changing. There’s been maybe seven different routes of ingesting drugs for the last hundred years and when the vaporizer came on the scene I took notice. It was a new way to ingest a substance rapidly right that you can inhale and it’s also concealed you can flavor it however you want so the odor changes. We know that with marijuana THC and nicotine that you could… we have high schoolers that are running around vaping weed and nobody knows, nobody smells it so you can completely conceal it.

 

Now you can also Vape methamphetamine, you can also Vape dimethyltryptamine, in fact you can be anything that’s water soluble. So you can imagine the mix that you can see on the horizon as clever human beings all of these designer drugs all of these mental health problems and having a way to ingest them that’s hidden difficult for police officers and authorities to detect, parents, Etc.

 

So, I see a lot of complexity on the horizon and I see nobody talking about it. Interestingly I am not anti-drug. I think human beings have had relationships with two substances for all of history and it’s not a bad thing. The question is how we collectively deal with our relationship to drugs and alcohol, which is a really deep question.

 

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Interventionist Adam Mindel
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Interventions: A Series | Part 1 of 3

 

Interventions:  A Three-Part Series

by Adam Mindel and Ben Goodman

 

 

Intervention on account of its ubiquity is a term ingrained in the consciousness of modern culture

 

and has been for quite some time. Part of this has to do with the success of the reality TV show bearing the title, but more importantly, it reflects the prevalence of substance abuse permeating modern life.

 

Common familiarity with intervention has been honed to the point of parody. Recall the Sopranos, where Christopher’s intervention for heroin abuse ends with a stomping by Ralphie and Paulie and a trip to the emergency room.

 

The scenario contrasts starkly from the ideal’s intervention aims for which are a reckoning within the substance abuser and the emergence of a path towards recovery for all concerned, user, family, loved ones. Intervention is the medium through which light breaks on the horizon and life can resume.

 

“Intervention is the medium through which light breaks on the horizon and life can resume.” Click To Tweet

 

A long-held notion within traditional recovery circles has been the idea that a user had to “hit bottom” before becoming vulnerable enough to accept or seek help.

 

Such a bottom was typically preceded by a downward spiral, decades-long, and a wake of despair. The proliferation of Alcoholics Anonymous as a viable means of treating addiction resulted in a foreseeable alternative as the book 12 Steps and 12 Traditions stated, “It was obviously necessary to raise the bottom the rest of us had to hit to the point where it would hit them.”

When Vernon Johnson was developing the initial model of intervention in the late Sixties and early Seventies, preventing the addict’s death was his chief concern. Seeking out the best approach in doing this, Johnson studied 200 recovering alcoholics attempting to answer the question, “What made them want to quit drinking?”

What he found was that the decision to quit was more a result of the impact of alcoholic illness reflected by tensions within the family and other close relationships than a bottoming out per se. 

 

“What he found was that the decision to quit was more a result of the impact of alcoholic illness reflected by tensions within the family and other close relationships than a bottoming out per se.” Click To Tweet

 

Interventions have evolved over the years from Johnson Method to Invitational, Systemic, Engagement, and simply Collaborative models that work side by side with individuals and their families to harness family tensions and mobilize the power of love and attachment to create the essential willingness required for individuals to enter treatment. (next month’s blog will discuss different styles of intervention in depth)

The ensuing years, as it turns out, have seen intervention become the most promising means of raising the bottom for individuals suffering from the disease of addiction.  Adam Mindel, Program Director of Recover Integrity and Interventionist, is impassioned about raising the bottom. Adam states that with more than 72,000 overdose deaths including opiates and all drugs of abuse in 2017 we have no choice to but to “raise the bottom”. The old saying that each and every addict has to bottom out first is no longer relevant when there is such lethality.

According to The American Society of Addiction Medicine, Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

 

if addiction is brain disease as described above by the chronic pathological seeking of substances, does it make sense for us as families and society to expect our addicted loved ones magically to wake up one day and separate… Click To Tweet

 

 

Therefore, if addiction is brain disease as described above by the chronic pathological seeking of substances, does it make sense for us as families and society to expect our addicted loved ones magically to wake up one day and separate themselves from the disease of addiction. Furthermore, if addiction is characterized by neurochemical, personality, cognitive and mood disturbances, we must recognize that many individuals have lost the ability to separate themselves from chronic use.

Adam describes a series of cases involving intervention with clients drinking themselves to the point which each of them required hospitalization, who were pathologically defended in accepting treatment due to changes in their personality as a result of neurochemical changes in the brain caused by alcoholism. Each of these client’s neurochemistry was so affected that they lost a degree of insight to the severity of their alcoholism and were operating on a day to day basis in “limbic survival like responses” which were servicing their alcoholism in either seeking alcohol or protecting continued use.

With the stakes this high, the question becomes not whether to intervene, but how and when to intervene on an addicted person.

 

For further information please contact Adam Mindel directly at amindel@recoverintegrity.com, or 310-694-3552, or keep reading Interventions, Part 2, Understanding Change and Raising the Bottom

 

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Moment of Surrender

What to expect in this episode:

 

  1. Yeshaia Blakeney hit bottom on Pico in Los Angeles
  2.  He was pulled over an arrested for selling marijuana
  3. That was the moment of surrender for him, where he said ok. I give up. I lose. Show me the way out…

 

The Moment of Surrender

 

My bottom was on Pico in Los Angeles.  

 

I got pulled over.  I was selling marijuana.  

 

A police officer said, “Okay if I search your car?”

 

I said, “Why are you going to do that?”  He said, “Step out of the car sir” and searched my car.  

 

I knew I was going to get arrested and I knew I was in big trouble.

 

I remember sitting on the curb and I felt defeated, not just in that moment, but in my whole life.  I felt like I had been living one way and it wasn’t working anymore and that was the moment of surrender for me.  

 

Where I said, “Okay world, you win, I lose”.

 

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My Favorite Questions

What to expect in this episode:

 

  1. If you’re in a real situation that is making your life difficult I would say go inside of yourself and say, where are you stuck?
  2.  If there’s a favorite question, it’s those that the answers have a real impact on somebody’s life
  3. I’m trying to get off heroin, what do you think about Suboxone Maintenance? That’s a common question, but important question…

 

My Favorite Questions

If you’re in a real situation in real time in real life that is making your life difficult, whether that’s an act of addiction or you’re stuck in your sobriety or it’s somebody that you love and you’re stuck, I would say go inside of yourself and say, where are you stuck, what is it you don’t get, what is it you need at this moment, how would you frame that as a question?

 

So, if there’s a question, my favorite questions, are the questions that the answers have a real impact on somebody’s life.

 

It could be something technical, so it could be – I’m trying to get off heroin, what do you think about Suboxone Maintenance? Right. That’s a common question, but that’s an important question, right because that question is going to impact your life potentially for the next six months to the next year.

 

You know, so it could be a technical question around something like that or it could be a question about I keep letting my kid come back home and they keep relapsing. It’s been five times in two years, what should I do? Well, that’s a really deep question. Right. It’s easy to say, just lock them out and let them hit bottom.

 

It’s easy to say, just keep them and love them, you know what I mean? It’s hard to say you’re in a really difficult situation where any choice you make isn’t good – something bad could happen and that’s the first thing you have to acknowledge, that holding your kid in your house while they’re getting high, does not keep them safe and kicking them out doesn’t keep them safe.

 

So, my answer, for instance, to a question like that would be to tell your child that all you can support is their recovery right now and if they’re not being willing to engage in recovery than you can’t support them, because the only part of them you can support right now is recovery and that’s a hard thing to do, but at least it puts the ball in their court.

 

Where you’re saying “I’m not kicking you out, I’ll help you get somewhere, but I’m not just going to keep you here in your addiction either.”

 

And sometimes a little phrase, I know I had to say that.

 

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Moment of Grace

What to expect in this episode:

 

  1. When I first came into recovery it was like a giant mountain I didn’t know how to climb
  2. People were giving me info, love, encouragement, support, so I began The Climb
  3. You begin to plateau, but then you are granted a moment of grace – when all those burdens flip off your shoulders and become a foundation…

 

My Moment of Grace

When I first came into recovery, I just remember kind of walking into treatment and all this information that was given, and it was like a giant mountain and I was like “Whoa, how am I ever going to climb that thing?”

 

And there were people that were encouraging me and giving me information and giving me love and giving me care, and so I started to climb the mountain and I’m like “Whoa, this is – okay, I can do this”. And then it just felt like the progress was slow, it was like trying to climb a hill in roller skates, you know.

 

And everything felt so heavy, but there’s something that happens in that recovery journey. It’s not something that can be measured. It’s not scientific. It’s not in any manuals. It’s something close to grace and all of those things that are weighing you down, all of those burdens that are making you heavy and making you small and making you feel like you’ve never be able to stand up straight.

 

You’ll never be able to look yourself in the eyes. You’ll never be able to feel love, none of that. Something happens in an unmeasurable instant, at some point in that journey, where all of those rocks on top of you, all of those burdens, all of that weight, it just flips.

 

And suddenly, you have this new capacity, you have – you’re in touch with something different. I call it Hope, you can call it what you want and you’re able to travel up to the top of that hill. And once you get to the top of that hill and you’re standing on top of that mountain, once you’re there, there’s nothing to do but just dance, because you’re free and you’re dancing the dance of recovery.

 

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My Regrets

What to expect in this episode:

 

  1. My life turned out ok – do I have regrets about my path in addiction?
  2. I do not regret the path, but I regret every person I bumped into and harmed along the way.
  3. I didn’t have values, I was not a good dude. I regret that.

 

My Regrets

I was speaking to a group of high schoolers and somebody asked me the question, “well for you this all worked out, for your path, so do you regret it?” and I have the same answer now that I had with the high school kid:

 

I don’t regret that experience, I regret every person I bumped into along the way and influenced their lives poorly;  that I was not a person who made people’s lives around me better and so in that sense I actually really regret it and it wasn’t worth it for me in that sense – but now that I’m not going to beat myself up about that – but if that makes sense.

 

I think we underestimate the impact we have when we’re in our addictions let me know you know I’m here talking like a ‘made up’ dude but I was not a good dude I was not a good person and I didn’t have values.

 

I harmed people… I wasn’t evil but I wasn’t fun to have around either and so I have to acknowledge that, there’s a certain reality there…

 

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