1. Give respect to earn it. – The Christian saying, “Do unto others as you would have them do unto you,” could be modified to “Give respect to others if you would have them give respect to you.” Before you can expect to receive others’ respect, you must be worthy of respect. One way to begin this process of rebuilding your self-respect is to be respectful of others. It isn’t just your elders that you should respect – although many in the younger generation seem to have lost or never learned this lesson. Respect your parents, your spouse or partner, your children, boss and coworkers, and friends. Respect the cashier at the grocery store, the clerk at the gas station, the mailman, the FedEx driver, even passersby on the street or in the mall. This isn’t being a Pollyanna or goodie-two-shoes. It’s simply recognizing other people as human beings and according them the acknowledgement they’re due. In short, you offer them respect.

How do you give respect? It can be as simple as allowing someone to pass in front of you with a wave of the hand and a smile. You may hold the door for another person, allowing them to enter a building first. Listen, instead of interrupting, when someone speaks to you. Say thank you for any type of assistance you get – even if it is less than what you wanted or expected. Even if you disagree with the conclusions or statements of someone in charge – say, your boss or supervisor – afford that individual the respect their position deserves and moderate your responses accordingly.

Sometimes it’s difficult to be respectful, especially when others treat us with disrespect. In this case, you can kill them with kindness or, to use another Christian phrase, “Turn the other cheek.” No, you’re not asking to be a doormat. You’re deflecting negativity and turning it off with your own positive energy.

2. Start at home. – In early recovery, you’ll probably spend much of your time in the safety and security of your own home. This is a normal stage of getting used to being in your normal environment and that, in itself, takes some getting used to. But while you are at home, begin your process of winning back your self-respect by being respectful, kind, and considerate with your family members. After all, they’re the ones who know you the best. In the best-case scenario, they’ve been by your side throughout your addiction and treatment and are still supporting and encouraging you in recovery.

In the worst-case scenario, your family members haven’t done much to support your healing. Maybe they didn’t participate in family therapy or they have their own addictions. Are you destined to fail because of that? While it’s true that family support is a linchpin of an effective recovery, not everyone has a supportive family. Do the best you can, even to the extent that you find yourself a new support network elsewhere.

Other ways to help win back your self-respect is to practice doing what you’ve listed in your recovery plan. When you make a schedule for your daily activities, stick to it. Living according to a routine that you’ve set for yourself is an easy and painless way to mark accomplishments. Check completed tasks off your list. Give yourself credit for doing things ahead of time, better than expected, or when you’ve been able to tackle a challenging issue successfully. All of these can help you feel more at ease with your judgment and give you more confidence – which leads to increased self-respect.

3. Network with 12-Step Group Members. – Who knows better what it feels like to come back from no self-respect than someone who’s been in the same situation? Whether you received formal addiction treatment at a residential facility or got it as an outpatient or through private counseling – or even used self-readings and self-education to help overcome your addiction – you know or have been part of 12-step group meetings. These fellowships, such as Alcoholics Anonymous (A.A.) or any of the many 12-step groups that have been formed and operate on philosophy similar to that of A.A., are comprised of others just like you who have made a commitment to living clean and sober, and to helping others pursue the same goal. They are non-judgmental and anonymous. You don’t pay any fees or dues, and there are no other restrictions to participating other than the commitment to living life sober.

When you go to these meetings, the typical format is a sharing of personal stories (again, on an anonymous basis), recognition of members who have reached certain milestones – 30-, 60-, 90-day, and one-year sobriety achievement – and support and encouragement on a one-on-one basis. Often, newcomers to group meetings feel a little lost and confused, and the members with more longevity strive to help them feel more comfortable with the process and welcome them. Friendships may develop, but you don’t need to be friends with other 12-step group members to get valuable assistance from your participation in the meetings. In fact, you’ll learn something every time you go to a meeting – even if you don’t particular like the speaker. How can this be? In the words of some long-time members, it’s not the person – it’s the addiction recovery process.

Many 12-step groups will offer workshops or have lectures or other activities where certain topics are discussed. How to win back your self-respect and that of others may very well be one of those topics. If not, you can bring it up in discussion with a member with whom you’ve shared some conversation – and, hopefully, one who’s been in successful recovery for some time. The longer you are in recovery, the stronger, more self-confident, and more self-assured you will be. You will earn back your self-respect, and you will receive it from others as well.

4. Do what you can, but don’t over commit. – If you attempt to take on too much, you are bound to be disappointed that you either can’t fulfill your commitments or your productivity and quality suffer. This is true at work, at home, in social and other situations. If you’re not doing the job, what you said you’d do, or what you feel you should be doing to the best of your ability, it may be that you’re not ready to take on the level or number of commitments, or you’re subconsciously trying to rush back into a stressful and challenging situation.

Try to avoid promising too much. Don’t be the first one to ask for the tough assignments – at least, not in the first year of your recovery. Don’t stick around the office until late at night, bring home work, refuse to take vacations, as a means of getting back up to speed, trying to prove yourself to your boss, or make up for lost time. This will just serve to get you more frazzled, depressed, frustrated, and anxious. To make matters worse, others will notice. The cycle will repeat, and pretty soon, you may find your coping skills aren’t enough to overcome the cravings and urges that may surface.

This is not to suggest that you skirt your responsibilities – far from it. Recovery experts do recommend, however, that those in the early weeks and months of recovery tend to the basics: take care of your own needs first (nutrition, adequate rest and exercise), go to meetings and therapy, and spend time with your family. Limit your outside activities to those you can comfortably and reasonably manage, and don’t make any major life changes.

• You may find it helpful to make a daily schedule for all your work-related assignments and activities. This is similar to and often part of your daily schedule for recovery. Mark down the hours that you’ll be at work or working.

• Note any special projects, tasks, meetings, or assignments that are absolutely critical that you attend to.

• Anything that’s not mandatory, or that you’ve already committed to, leave out.

• If you need more time to complete an assignment, or find that you’re overextended and need to be excused from a meeting or ask for help, talk with your supervisor right away.

Another benefit of being mindful of your commitments so that you don’t overextend yourself is that others will recognize that you’re being responsible, diligent, resourceful, and a team player. They are more likely to give you more respect as a result – and this will also increase your own self-respect.

5. Live up to your word. – Loss of self-respect comes when we fail to live up to our word or when our words are regarded as useless because we have proven ourselves to be untrustworthy. In order to win back your self-respect and that of others, make it a practice to only say what you mean – and live up to your word. This is a little tricky to navigate, especially when you’ve been in the habit of fudging the truth, telling others what you think they want to hear, or engaging in self-deception about your true motives or intentions.

Try this for starters. When you feel like you’re about to say something, to make a promise or commitment to another: stop. Literally, stop yourself from talking. Before you allow the words to come out of your mouth, think about what it is that you are going to say. If you honestly feel that this is something that you will complete as promised, or that it is a reflection of genuine feeling (instead of flattery or an attempt to get on someone’s good side), then go ahead and say it. If, on the other hand, you recognize that your old need to use others to get what you want is trying to resurface, or what you’re about to say is without noble purpose, don’t say it. If you need to, excuse yourself, and go on to do something else.

6. Make your words mean something. – Another point about conversation is that people will respect your words if what you have to say means something. This isn’t about making a commitment. In this case, it’s all about talking about things that others consider worthwhile. In other words, if you can make a contribution to a conversation with an observation or point of interest or fact, others will recognize it as such. Depending on how, when, and where you deliver the comment – and these are other strategies to improving conversational skills that you should try to develop – others may begin to look at you in a new light.
Of course, don’t obsess over what, when, and where you engage in casual conversation, especially with long-time friends. Don’t attempt to over-analyze or engage in endless self-scrutiny before you say “Good morning” to your family, friends, coworkers, or passersby. Be aware that words have powerful impact. Choose your words wisely. Speak them in a welcoming and heartfelt manner. Others will react accordingly. Even if someone brusquely passes you by without an acknowledgement, you will have extended yourself and brought positive energy forth. Open yourself up to receive good things and you will send creative energy out in return.

Feeling good about yourself helps build your self-respect. Others can’t help but notice, and likely will begin to give you the respect that you increasingly deserve.

7. If you slip, learn something from it and move on. – What happens if you slip and have a relapse? Will your hard-won self-respect be lost forever? This is the fear of many in early recovery, when relapse is all too common. Addiction recovery experts, along with a great many old-timers who have been in successful recovery for years, say that a slip is often an opportunity in disguise. It doesn’t mean you are doomed to fall back into your old addictive behaviors. If, in having your slip, you’ve learned something – such as, if it’s slippery, don’t go to slippery places – then you’ve received a valuable lesson. You don’t need to start all over again. Just pick up from where you were and keep moving forward.

What if it’s a major relapse? In this case, you may need to go back into treatment or counseling. You will need to re-double your efforts at identifying and recognizing triggers, practice more effective coping strategies to deal with cravings and urges, and refine your recovery plan. Attend more 12-step meetings, limit extracurricular activities, and concentrate on healing. You can win back your self-respect – and that of others – but you have to be diligent and sincere in your recovery efforts. You may be able to fool others, but you can’t fool yourself. You will know if you’re only going through the motions and not really committing to the process of overcoming your addiction.

The good news about slips and relapses and self-respect is that, with genuine commitment, professional help, a sound support network, and loving family, those in recovery will find that self-respect can be not only won back, but also serve as a bedrock foundation to many more years of successful recovery.

8. Strive for a life of integrity. – Summing up the quest to win back self-respect and that of others, you can boil it down to this: strive to live a life of integrity. When you are honest with yourself and others, when you treat others as you want to be treated, make your words indicative of your commitment, and begin to believe in yourself, self-respect will naturally follow. It does take some doing. The path toward regaining self-respect may be more difficult for some than others. Those overcoming multiple addictions, substance abuse and mental health disorders, or those who have chronic addiction and associated physical/emotional/mental conditions may need longer to learn how to successfully navigate this journey. But it is possible – for all in recovery.

From this perspective, it doesn’t matter who you are, what your background is, how much money you make, where you live, whether you have a family history of addiction, abuse, or violence, or what type of addiction or addictions you’ve overcome, if you genuinely want to heal, do all you can to get the help you need, and make a sincere effort to live every day in integrity, you can have every hope that you will succeed. You will know – and others will, too – that you’ve given everything you have to living clean and sober. Living a life of integrity is a measure of the highest form of self-respect. You finally respect yourself – and others will acknowledge and do the same.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do, according to the National Association of Cognitive Behavioral Therapists (NACBT) (http://nacbt.org/whatiscbt.htm). The National Institute on Drug Abuse (NIDA) (http://archives.drugabuse.gov/txmanuals/CBT/CBT3.html) says CBT is a short term, focused approach to treatment that attempts to help patients recognize situations in which they are most likely to use drugs (or other substances or engage in other addictive behavior), avoid such situations when appropriate, and learn how to cope more effectively with a range of problems (and problematic behaviors) associated with substance abuse.

CBT doesn’t exist as a distinct therapeutic technique. Rather, according to the NACBT, CBT is a general term for a classification for a number of therapies with similarities. These include Rational Behavior Therapy, Cognitive Therapy, Rational Emotive Behavior Therapy, Rational Living Therapy, and Dialectic Behavior Therapy.

NIDA and the NACBT say that several important features of CBT make it appropriate for use in the treatment of particular types of drug abuse. NIDA publishes a manual where CBT is used for the treatment of cocaine abuse, but CBT has also been used to treat alcoholism and other forms of drug addiction, especially as part of an overall recovery program.

• Short-term – CBT is a relatively short-term (compared to other forms of treatment, including psychoanalysis, which can take years) approach, lasting from 12 to 16 weeks. CBT is time-limited in that the patient is instructed at the outset of the therapy that there will be a point where the formal therapy process will end. This ending date of formal therapy is a mutually-arrived upon decision between the therapist and the patient. Therefore, CBT is not a never-ending treatment approach.

• Evidence of CBT’s effectiveness in this short period of time makes it an attractive approach for clinicians to utilize – alone and in conjunction with other treatment modalities. CBT has been extensively evaluated in rigorous clinical trials and has solid empirical support as a treatment for cocaine abuse, for example. CBT has even proven effective for severely dependent cocaine abusers, according to NIDA data.

• CBT is structured and directive. Therapists have a specific agenda for each session and specific techniques or concepts are taught during each session. CBT is focused on the client’s goals, not what the therapist thinks those goals should be. It is therefore directive in that CBT therapists show clients how to think and behave in ways to obtain their stated goals. The CBT therapist doesn’t tell the patient what to do – they teach the patient how to do what it is they want to do (such as abstain from drug use).

• Flexibility is a key component of CBT. It can be readily adapted to a wide range of patients, settings that include inpatient or outpatient, and formats such as individual or group.

• CBT is a collaborative effort between the patient and the therapist. In order to be able to help the patient, the CBT therapist needs to learn what the patient wants out of life (his or her goals), and then help the patient achieve those goals. The CBT therapist listens, teaches, and encourages, while the role of the patient is expressing concerns, learning, and implementing.

• Speaking of the relationship between the CBT therapist and the client, a sound therapeutic relationship is necessary, but it isn’t the focus of the treatment. A good, trusting relationship is the foundation, but there also has to be more. CBT therapists believe that their clients change because they learn how to think and act differently as a result of their learning. CBT, therefore, focuses on teaching rational self-counseling skills.

• CBT is compatible with a range of other forms of treatment the patient may receive, including pharmacotherapy, self-help groups such as Alcoholics Anonymous and Cocaine Anonymous, family and couples therapy, vocational counseling, parenting skills, and so on.

• CBT is based on an educational model. The therapy is based on the assumption that most behavioral and emotional reactions are learned. The goal of CBT, then, is to help patients unlearn maladaptive behavior and learn a new way of reacting that is healthier. The educational benefits of CBT lead to long-term results. When patients understand how and why they are doing well, they know what they need to do to continue those good outcomes.

• Homework is a central feature of CBT. Patients need to complete reading assignments and practice what they’ve learned between sessions.

Key Components of CBT

There are two key components of CBT: functional analysis and skills training.

Functional Analysis: The patient and the CBT therapist work together to identify the feelings, thoughts, and circumstances of the patient before and after he or she drinks or uses drugs. This helps the patient to better understand the risks that will likely lead to a relapse. The functional analysis is critical, especially during the early treatment phase, for the patient and therapist to assess the high-risk situations that are likely to lead to drug use, as well as provide insights into why the patient may resort to using drugs. Some of the reasons may be coping with interpersonal difficulties, escaping from reality, or achieving euphoria not otherwise available in the patient’s life. Further on in treatment, the functional analysis of episodes of drug or alcohol use may identify situations or states during which the patient continues to have difficulty coping.

Skills Training: Think of skills training as a way for patients to unlearn old habits and learn new and healthier behaviors to replace them. Treatment professionals say that by the time a person’s drug habit is severe enough to warrant treatment, they have been using drugs as their primary means of coping with a wide range of interpersonal and intrapersonal problems. The reasons why include:

• They may never have learned effective strategies to deal with challenges in adult life. This is particularly true for those whose substance abuse began early in life (adolescence).

• Due to chronic involvement in a drug-using lifestyle, the individual may have forgotten effective strategies to deal with challenges and stresses. Constantly in drug-seeking, using, and recovering from the effects of drug use, the individual has repeatedly relied only on drug use as an effective coping mechanism.

• Although the individual may have learned effective strategies at one time, their ability to use them may be weakened by the presence of other problems, such as drug use and concurrent psychiatric disorder.

How CBT Works

When the patient (client) takes part in CBT, ideally, the session is just between the therapist and client. However, CBT can be modified to work in group sessions as well, as long as the session is structured to be long enough (at least 90 minutes, as compared to the normal 60 minute session length) so that each patient gets the opportunity to comment on their personal experience in trying out skills, give examples, and participate in role-playing.

The setting is typically an outpatient basis – although it is also effective in residential or inpatient settings. The outpatient setting, however, is preferred because it focuses on understanding what determines the patient’s substance use, and this is best done in the context of the patient’s day-to-day life. It’s important for the CBT therapist to know where and how the individual lives, and who they are, so that individualized functional analyses can be created. The outpatient setting is also more conducive to the patient’s practice of skills training learned during the sessions. They learn what does and doesn’t work for them and discuss new strategies with their CBT therapist.

During sessions, there are some essential interventions that must be part of the CBT in order to be effective. According to NIDA, these include:

• Functional analyses of the substance abuse

• Examining the patient’s cognitive processes relative to substance abuse

• Identification and debriefing of past and future high-risk situations

• Personalized training in recognizing and coping with craving, managing thoughts about substance abuse, solving problems, planning for emergencies, refusal skills (how to turn down invitations to use), and recognizing seemingly irrelevant decisions

• Practicing skills during sessions

• Encouraging and review of extra practice of skills between sessions

During the CBT session, the therapist may do the following, and it is recommended that they do, but these are not unique to CBT:

• Discuss, review, and reformulate with the patient the goals for treatment

• Monitor substance use (drug of choice) and craving

• Monitor use of other substances

• Monitor the patient’s general level of functioning

• Explore with the patient the positive and negative consequences of substance abuse

• Explore the relationship between affect and substance abuse

• Give feedback on the patient’s urinalysis results

• Set the next session’s agenda

• Comment on the process with the patient as warranted

• Discuss the advantages of a goal of abstinence

• Explore any ambivalence about abstinence on the part of the patient

• Use exploration and a problem solving approach to deal with patient resistance

• Support the efforts of the patient

• Assess the patient’s level of family support

• Explain how a slip and a relapse are different

• Include family members (or significant others) in at least two of the CBT sessions

Format of a Typical CBT Session

The flow of the CBT session (in a 60-minute session) may follow the 20-20-20 rule. Using this format, during the first 20 minutes the therapist focuses on the patient’s substance abuse, cravings, and high-risk situations since the last session. The therapist listens and tries to elicit the patient’s response, with the result that this portion of the session usually involves the patient doing most of the talking. In addition, the therapist seeks to find out how the practice of skills went in between the session (the patient’s homework, based on what he/she learned in the previous session). The therapist may ask if the practice session was harder than expected, if the patient had any difficulties performing the practice, if he or she came up with any new strategies, and what worked well or did not work as well?

The second 20 minutes is devoted to the introduction and discussion of the topic for the particular session. In this segment, the therapist does most of the talking, although it is important that the therapist relate the material back to the patient and ensure he/she understands what’s being introduced. A topic may be skills for refusing an offer of cocaine, or what to do in particularly high-risk situations. The therapist may ask if the patient understands the session material or how and why it relates to them, to describe the topic or skill in their own words, and role-play or practice the skill within the session.

Skill topics depend upon the substance abused (or addictive behavior) and are tailored to the patient’s individual needs. As an example, there are eight skill topics for CBT for cocaine abuse. These include:

• Coping with craving

• Shoring up motivation and a commitment to stop

• Refusal skills/assertiveness

• Seemingly irrelevant decisions

• An all-purpose coping plan

• Problem solving

• Case management

• HIV risk reduction

The final 20 minutes involves the patient and therapist having a discussion about the topic introduced. Together, they agree on a practice exercise for the next week, and review plans for the next week and anticipate any high-risk situations.

Here is an example of a practice exercise for cocaine abuse. The patient is asked to write down or record his or her answers (as many answers as apply) to the following questions:

• Trigger – What sets me up to use cocaine?

• Thoughts and Feelings – What was I thinking? What was I feeling?

• Behavior – What did I do then?

• Positive Consequences – What positive thing happened?

• Negative Consequences – What negative thing happened?

Unlearn Old – Learn New

In summary, CBT is an evidence-based form of psychotherapy that focuses on helping the patient to unlearn old drug-using or addictive behavior and learn to replace it with healthier behavior. CBT works for some individuals, but not for others. CBT works best when used in combination with other recovery efforts. While it may be adapted for group use, it is considered most effective when used in a one-on-one therapist/patient basis.

Where can you find CBT therapists? Go to the website of the National Association of Cognitive-Behavioral Therapists and use their search tool to find a mental health professional certified by NACBT in your area. Enter the country, state, age of the potential CBT client, and form of therapy sought (individual, couples, families, gay/lesbian/bisexual, or groups) and click “Submit.”

Also check with residential addiction treatment facilities and outpatient addiction treatment centers to find out if CBT is part of an overall treatment program.

Remember that CBT is a structured and time-limited therapy, usually lasting 12 to 16 weeks. There may be booster sessions, as appropriate, and a long-term (one-year) follow-up that’s part of the therapeutic process. As with other forms of therapy for drug abuse or addictive behavior, the motivation and determination of the patient to a life of abstinence in recovery is a crucial part of the process. By unlearning old behaviors and learning new ones, the road to recovery can be a lot easier to travel.

Don’t worry. These are tips and techniques that have worked for many individuals, but there’s nothing to say that you can’t come up with some equally effective ones on your own. And there’s no test you need to take, no one to answer to, and nothing to prove – except, maybe, to yourself in how much easier recovery can be when you put a little structure into it.

1. Simplify your daily schedule: Too many duties, chores, assignments, projects, or to-do lists that you endlessly draw up and fail to complete will only serve to leave you frustrated, disappointed, angry, or depressed. The best thing you can do in your first weeks and months of recovery is to simplify your life. Eliminate all but the essential activities or duties from your daily schedule – especially for the first 90 days. Why is that? Addiction recovery specialists say that the first three months are the most critical. It’s during this time that many well-intentioned persons in recovery slip, prone to falling back into pre-treatment routines that get them into trouble, or giving up under the pressure of cravings and urges that they’re ill-equipped (not sufficiently practiced) to cope with.

How can you go about simplifying your daily schedule? Ask yourself what is absolutely mandatory that you do today. If you’re unsure, you probably don’t need to do it, so scratch it off your list. If you can go either way or if, for example, your job doesn’t depend on you doing it, cross it off. If you wind up with only one or two things you simply must do, that’s a great start.

2. What to say to others: You might get some flak from others in your family, at work, or even friends, when you try to simplify your daily schedule or pay attention to what’s important for your recovery. That’s actually to be expected. Although they’re well-meaning individuals, no one except you really knows what it’s like to go through this sometimes difficult and confusing time. Well, no one except another person in recovery. And, even then, every person’s situation is unique. So, back to what do you say to others who wonder why you can’t spend time with them, take on this extra assignment, go for the long business trip, entertain clients at the bar, or some other form of subtle or not-so-subtle persuasion?

The answer is, frankly, that depends. If the person is someone who knows that you are in recovery, all you need to say is that you’re following the recommendations of your counselors or working your program. Tell them that you need time to work your recovery plan and that means taking a break from all unnecessary extracurricular activities, family pressures, or other demands on your time. If the person knows nothing about your situation, a polite “I’m sorry, I’m not available at this time” should be sufficient – or use words that you deem appropriate to the situation. Definitely don’t go into a long dissertation about overcoming your addiction, how hard or easy treatment was, or all the many worries and sleepless nights you may be going through lately. They not only don’t need to know, it will probably scare the daylights out of them. This is your business, your recovery. The person to tend to it is you.

3. Mind the basics: Of course, getting back to feeling in tip-top shape and maintaining your sobriety entails more than just streamlining your schedule and having rehearsed things to say to others. Part of your new and structured environment in early recovery involves taking care of your nutritional needs and getting adequate rest. As it often happens, when you’re in early recovery, you’re still recuperating somewhat from the residual effects or chronic conditions resulting from your addiction. You may be anemic, weak, have muscle atrophy, or have trouble warding off infection. Many who return home following treatment say they just want to hole up and sleep for a couple weeks straight. Many do just that, although they do make time to go to 12-step meetings and counseling in between sleeping sessions.

Begin by stocking up the refrigerator and pantry with wholesome foods, including fresh fruits and vegetables, lean meat, seafood, whole grain cereals, breads, and rice or pasta. If you’re not a cook, and have no one to cook for you, buy a good cookbook or research some recipes online and create menus filled with nutritious, easy-to-make meals. In fact, creating tasty dishes can be a form of therapy for you, besides being good for your overall health.

You’ll also want to ensure that you’re eating a solid three meals a day, beginning with breakfast. This is one meal you don’t want to skip. Forget about just a cup of coffee or a latte from Starbucks on your way to work. That’s no way to treat your body, especially in early recovery. You need the fuel from food to keep you going through the morning hours, and your brain functions better with the morning breakfast boost as well. Don’t think you can skip lunch or eat a candy bar at your desk, either. That’s just no fuel and empty calories, respectively. When you’re hungry (as you’re bound to be when you don’t eat), it’s too easy for cravings and urges to surface. You’re also more likely to become jittery, nervous, frustrated, stressed out and prone to making mistakes or rushing to faulty conclusions. For dinner, it can be a light meal, if you like, but be sure to allow enough time (2-3 hours) so that you’re not eating right before you go to bed.

Speaking of bed, you need a good 8 to 9 hours of sleep per night. Most adults do, and this is even truer for those in early recovery. You may even require more. If so, and your schedule permits, get more sleep. But don’t just languish the hours away in bed. There are many more things that need your attention for the early days of your recovery.

4. Make meetings a priority: While you were in treatment, you learned the value and necessity of attending 12-step group meetings such as Alcoholics Anonymous. These fellowships are comprised of others in recovery that are committed to being clean and sober and to helping fellow members do the same. Most addiction treatment specialists say that recovery is only as successful as the quality of the support network the recovering individual creates and maintains. The truth is that some people may be able to complete treatment and make it on their own for the first few months of recovery, but this is like Sisyphus attempting to carry the massive boulder uphill: sooner or later, everything will come crashing down. The burden is just too great. Why shoulder such self-imposed difficulty? It’s so much easier to go to meetings, listen to the stories and accounts of what worked for others who may have gone through similar (although each person’s recovery is unique) circumstances, and adapt what you hear to your own situation.

You may have heard that Alcoholics Anonymous has a semi-official rule about attending 90 meetings in 90 days. It’s even referred to as the “90-in-90 rule,” according to some written accounts of personal recovery. What it means is that the individual who is new to recovery should make it a practice to attend 90 meetings in the first 90 days. This can be one meeting each day for the full three months, or it can sometimes take the form of 2 to 3 meetings a day (morning, afternoon, and evening). Doubling or tripling up on meetings may even be a means of preserving your sanity during especially troubling times or when you feel a crisis coming on. However you do it, and whether or not you hear about the 90-in-90 rule, you should make attending your 12-step meetings a priority. This is one of the activities on your daily schedule that takes priority over everything else – especially in early recovery.

Finding the meeting location that feels most comfortable to you may take some doing. But there’s nothing that says you have to stick to one location. Vary your meeting locations, days, and times. Not only will you be keeping it fresh, you will also avoid becoming bored by seeing the same people and possibly hearing the same stories over and over again. When you do find a meeting location where you jell with the other members, this can become your home base meeting group, the one you return to at least once every week.

5. Learn structure from other 12-step members: Besides making attendance at 12-step group meetings a priority, do more than just sit there and listen. It’s not a job. It may be the most important thing you do for yourself in early recovery. Why is that? No matter what you hear during the meeting, there’s bound to be something that you can learn from the person speaking. You don’t have to like the speaker. AA, for example, and other 12-step groups as well, isn’t about the person. It’s about the process of learning how you can overcome addiction and live a full, productive, and sober life.

Many 12-step groups offer special programs, workshops, and seminars that deal with various aspects of recovery. Some deal with how to structure your life to avoid stress, how to prioritize decision-making, learning how to better cope with urges, or other particularly relevant topic. There are also alumni who return to give back to the 12-step group and volunteer their time in job fairs, practicing interviewing techniques and resume writing, training members in various skills, and offering their expertise in many other areas important to recovering individuals.

If you become close to several group members, use them as sounding boards or ask for their support as you try your hand at structuring your environment. While 12-step groups are nonjudgmental, and they aren’t a substitute for treatment, nor do they offer treatment, the support and encouragement you receive from participating in them can be the difference between feeling good about how you’re handing your day-to-day environment and feeling lost, confused about what to do and when to do it. So, make use of your friends and allies, including your 12-step sponsor, in helping to structure your environment.

6. Clear the clutter around you: Here’s a simple technique that can help you greatly in structuring your environment. No one likes a messy house, not even the person who’s become accustomed to it. When you return from treatment, you see the world in a different view. Use this new world-view to closely examine your home environment. This is where you spend the majority of your time, work notwithstanding. You owe it to yourself and your recovery to make it a clean, organized, and inviting place.
Start by clearing out the clutter from every room in the house. You could begin in the bedroom, since this is where you sleep and rest from the challenges (and opportunities) of the day. It should be a peaceful place, not one that’s piled with boxes and strewn with tossed-aside or dirty clothing, shoes, purses, wallets, and other accumulated items. Remove food detritus, leftover cartons and containers. Scrub, dust, launder, and vacuum everything to make it squeaky clean and fresh. This is a good start.
Next, go to the room where you spend another big chunk of time. That’s most likely the living or family room. Tackle this room the same way you did the bedroom. After that, move on to the kitchen, garage, other bedrooms, etc. What should you do with items that you have removed from a space and don’t know where to put them? Keep the three “Rs” in mind: reduce, reuse, and recycle. If you don’t absolutely need it, haven’t worn or used it in two years or longer, donate it, sell it, scrap it, or recycle it. If you’re not sure, put it in a pile you label “Maybe” and go back to it when you’ve finished the rest of your de-cluttering task. Never leave a maybe pile for longer than the time it takes for the donation truck to arrive. If you haven’t decided by then, donate the item.

Why all this concentration on having a clutter-free home? There is ample evidence that shows that a clean and well-organized environment is conducive to healing, well-being, and general peace of mind. You owe it to yourself to give yourself the best foot forward in your recovery. And making your home more inviting is an excellent way to do just that.

7. Tackle bills with the same sense of organization: Who doesn’t feel stressed and overwhelmed by a mountain of bills, many past-due, some of which are even threatening? This is often the case following treatment – which can be quite costly. What’s the typical response when faced with a pile of bills? If you’re just trying to get back on your feet, you may wind up tossing them in a corner, burying them in a drawer, or just ignoring them completely. As you know from your days in treatment, if you leave things untended long enough, they’ll only get worse. So, for the sake of structuring your environment in early recovery, it’s just as important that you make a serious effort at tackling your bill-paying responsibilities.

It’s very possible – even likely – that you can’t pay many of them. You may need the assistance of a financial counselor. Ask your 12-step sponsor or other group member for a recommendation for a financial guidance professional. Or call your creditors yourself and work out a repayment schedule. Even if you’re behind on your mortgage, lenders would much rather get something that you negotiate than have to go through with foreclosure on your property.

Keep in mind that walking away from your responsibilities, while it may be an option, carries some long-term consequences. Not the least of these is what it does to your credit. But perhaps even more important to you in recovery is the fact that abandoning your responsibilities goes against what you’ve learned about being in recovery. It isn’t your fault that you have an addiction, but you do need to accept responsibility for your actions. And your financial responsibilities are part of that equation. Of course, if your financial advisor recommends bankruptcy for your particular situation, you may wish to pursue that avenue. Just be aware that it will take a long time to rebuild your credit.

8. Ask for help from your spouse or loved ones: If you’re among the lucky ones who has a spouse or loved one to support and encourage you, ask for his or her help in structuring your environment in early recovery. This doesn’t mean that you want or expect him or her to do your work for you, but that together you create a structure that not only works for your recovery but also takes into account and respects the needs of the family.

At first, this may seem like a tall order. After all, you’ve just come out of treatment, more than likely, and all anyone in the family wants is for things to return to normal. But this is the new normal, and the family environment is also bound to undergo some restructuring. Be sure to discuss this with love and respect, and take it slow.

9. Make a list of goals: Your recovery journey is here and now, but it also includes having a focus on the future. To do that, you need to craft a list of goals, things that you would like to achieve in the next 1, 2, 5, 10, or 20 years. When you first start creating your goal list, it may be somewhat vague. Don’t worry. You will fill in the blanks as you progress toward them. That’s why it’s important to put down short- and long-term goals. While you’re working on achieving the short-term ones, such as achieving your 30- and 60-day sobriety milestones, you’ll come up with ideas and steps to getting closer to your long-term goals.

For now, just list goals as they come to you. If you think of interim steps or requirements to achieving those goals, mark them down as well. This may include a long-term goal of finishing or getting a degree, and short-term goals of applying to a college or university, securing financing, choosing courses, and attending classes.

10. Give thanks for each day: Sometimes we get so caught up in our day-to-day routines – whether in early recovery or years later – that we fail to give thanks for our successes, lessons learned, and accomplishments that day. It doesn’t matter if you are thanking and acknowledging yourself, or God, or higher power, or the power of the spirit. What does matter is that you do put your gratitude out there. This is a form of structure – prayer, self-meditation, call it what you like – that pays dividends far beyond the mere utterance or thinking the words.

Make it a daily practice to express your thanks for what you’ve received that day. Even the most stressful or frustrating day deserves acknowledgement. You’ve made it through the day and have succeeded in facing many diverse challenges and opportunities. You are that much better equipped to face tomorrow.

Structuring your environment in early recovery actually gets a lot easier in time. In fact, once your structure becomes second-nature to you, it will be possible for you to devote more of your focus on expanding your reach to include even broader horizons. Further along in recovery – say one year and beyond – you will have even greater self-confidence, self-esteem, and willingness to approach your future with hope, joy, and a sense of discovery.

Lead researcher Dr. Shelly F. Greenfield from McLean Hospital and Harvard Medical School in Massachusetts and her colleagues conducted a national, multi-site trial using the Combining Medications and Behavioral Interventions (COMBINE) for Alcohol Dependence database. The purpose of the study was to discover the presence of any differences between male and female patients after they received alcoholism treatment that involved behavioral therapy, medication, or a combination of both.

Previously, very little research had been conducted on gender differences among behavioral and pharmacological therapies in alcohol dependency treatment programs. Historically, more men suffer from alcohol use disorders than women by a large proportion, yet this gender gap has been narrowing during the past decade. Men were at once five times more likely to receive treatment for alcohol dependence than women; today, men are about twice as likely as women to seek treatment.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), females with substance abuse disorders experience more barriers that may discourage them from seeking treatment compared with their male counterparts, including stigmatization, childcare responsibilities, and lack of employment or health insurance. Female substance abusers are also more likely to have experienced traumatic events preceding their addictions, and are more vulnerable to the physiological effects of substance abuse. Because of these large disparities, female patients of recovery programs require more specialized treatment and services compared to male patients. Amid rising numbers of females seeking substance abuse treatment, the researchers sought to identify which pharmacological and behavioral treatment methods are gender-specific and which are effective for both men and women.

Between 2001 and 2004, researchers followed eight groups consisting of 848 male and 378 female patients of alcohol dependency treatment who were undergoing nine-session medical management intervention that focused on adherence to medication therapy and abstinence. The recently abstinent participants underwent 16 weeks of placebo, 100 mg of Naltrexone per day, 3 grams of Acamprosate per day, or a combination of all three while either receiving or not receiving combined behavioral intervention from a specialist. The researchers measured the overall outcome as well as gender-specific outcomes regarding the patients’ interactions with their treatment conditions.

The presence of gender disparities regarding alcohol use and treatment outreach was apparent among certain preliminary factors:

• Compared to male patients, female patients were more likely to report a later age of alcohol dependency onset by three years.
• Females were much less likely to have received previous treatment for their alcohol dependency than male patients.
• Female patients reported consuming fewer drinks per drinking day than men.

Besides these measures, male and female patients did not present any significant differences in their drinking patterns. For those who underwent COMBINE treatment, women showed the same pattern as men regarding their first heavy drinking day, number of heavy drinking days, number of days spent abstinent, and positive clinical response measures. Additionally, participants who received Naltrexone treatment reported lower craving than those who received placebo. Researchers state that these results demonstrate that Naltrexone is effective in treating both men and women.

Based on this clinical outcome, the researchers advise that clinicians should feel confident in prescribing Naltrexone to treat alcohol dependence in both their male and female patients. Furthermore, Naltrexone can be administered not just in specialty substance abuse treatment facilities but also in primary health care settings, which is where substance abusing women tend to seek treatment for their addictions more often. Despite where treatment is sought, Naltrexone in combination with medical management therapy demonstrates the same positive outcome for recovering alcohol dependent women as men. This effective method of treatment for women is pertinent for their recovery since the number of women with alcohol use disorders today is rising. Also, reaching women at such a moment of dependency is crucial to their recovery since women suffer from more health complications due to alcohol use and at a faster rate than men.

The researchers’ study was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and is available online or in the October 2010 print issue of Alcoholism: Clinical & Experimental Research.

Sources: Alcoholism: Clinical and Experimental Research, Gender Difference in Alcohol Treatment: An Analysis of Outcome from the COMBINE Study, July 20, 2010

Medical News Today, No Gender Difference In Response To Naltrexone As Treatment For Alcohol Dependence, July 21, 2010

In its true form, chemical dependency is referring to an individual who has become dependent upon a chemical and is unable to function without that chemical. Even in the face of serious health, economic, vocational, legal and social consequences, the individual dealing with chemical dependency will time and again choose the chemical.

Many in the scientific and health industries refer to chemical dependency as an illness or disease. While the condition can be progressive and chronic, it is treatable with the right methods and mindset. The problem is that often once chemical dependency sets in, the power of choice over using mood-altering chemicals is lost to the draw of the substance.

The individual who has a chemical dependency displays a number of continuous or periodic characteristics, including impaired control over their behavior when it comes to drinking or using drugs; a preoccupation with the mood-altering chemical; continued use of a substance in the face of adverse consequences; and distorted thinking, most notable denial that they even have a chemical dependency problem.

Denial often serves the purpose of a defense mechanism. The individual will go to great lengths to reduce awareness of the effect alcohol and drug use has on their lives. Many an individual with a chemical dependency believes that the substance solves problems instead of creating them, which makes it harder for that individual to come to terms with the fact that they have a substance abuse problem.

Helping a chemically dependent individual get past the point of denial is often a key initiative as it is a significant obstacle to recovery and plays a key role in relapse events. An individual in denial believes they do not have a problem and therefore they cannot become engaged in the recovery process. A problem cannot be fixed if the individual doesn’t believe it exists.

Chemical dependency requires more than just abstinence to overcome the problem. The disease presents a complexity that demands a constant focus on moving away from the addictive substances and removing environmental triggers that cause the individual to want to turn back to the substance that is hurting them.

Detox is often required in chemical dependent situations, but is rarely enough to eliminate the dependency. The individual must also learn to understand the causes of the dependency in the first place in order to move away from them, eliminating their power over their choices. Complete recovery demands interpersonal and lifestyle changes that take time and often also require help. The person willing to seek the help is more likely to gain back control over life.
 

1. They need more to get high than they once did
2. The effect is diminished over time; they continually chase that “original” high
3. Negative consequences are piling up due to marijuana use
4. They try to quit, but find themselves craving a joint – they rarely stay quit more than a few months at a time. Some can’t go more than a day or two.
5. They feel “bad” when they don’t smoke – they have become used to the effects of the drug and only feel “normal” when they have used it

Although marijuana is considered by many to be a “harmless” drug, it has dramatic effects on the brain and lungs. Marijuana is essentially an hallucinogen, altering for many the sense of time, sound, touch, and sight. Memory impairment is a common side effect of marijuana use. Long-term smokers may develop bronchitis or chronic chest colds, and can even develop emphysema.

Marijuana today is far more potent than the marijuana of the 60s and 70s. Regular use of marijuana can cause permanent brain damage, and some studies have linked marijuana use to Alzheimer’s disease.

The myth that marijuana is not addictive is belied by the fact that the number of people seeking treatment for marijuana addiction doubled during the 90s and continues to increase.

One of the biggest obstacles to getting someone into treatment who has a marijuana addiction is the denial that marijuana is addictive. Unfortunately, many people misunderstand the word “addiction” and use the wrong criteria to determine if they are indeed addicted.

If marijuana has undermined your success at work, your relationships, or simply your health, and yet you continue to abuse it, that is significant enough to merit treatment.

The approach to treating marijuana addiction is similar to the approach used to treat any addiction. Detoxification, cognitive behavioral therapy, and peer-support groups are critical to recovery. It is important to do a full psychiatric assessment to determine if there may be some underlying issues. Often, marijuana is a form of “self-medication” for anxiety or depression. However, marijuana is a poor treatment option for these disorders. Over time, its use can actually increase anxiety, even leading to paranoia. Marijuana can also exacerbate depression in some people.

Promises Treatment Centers has a highly effective treatment program that helps those addicted to marijuana develop the tools for a life free of this mind-altering drug.

Based on SAMHSA’s National Survey on Drug Use and Health (NSDUH), American Indian and Native Alaskan adult alcohol use had risen in their population alone in recent years. From 2004 to 2005, alcohol use among this group was at 42.8%, but had increased to 47.5% from 2007 to 2008. However, compared to the national average, past month alcohol use among American Indian and Native Alaskan adults was significantly lower than the national average. From 2004 to 2008, past month alcohol use was estimated at 43.9% among this group, whereas the national average stood at 55.2%. Although average alcohol consumption appeared to be lower than the general public, American Indian and Native Alaskan adults were shown to be engaging in more risky behavior such as binge drinking (30.6% vs. 24.5% national average) and illicit substance use (11.2% vs. 7.9% national average). Binge drinking and illicit substance use had slightly decreased among this group population alone between 2004 and 2008, but still remained higher than the national average.

When divided into age groups, the NSDUH showed that American Indians and Alaskan Natives of all ages were engaging in less alcohol consumption than the general public. The rate of past month alcohol use among individuals ages 18 to 25 within this group were 52.0% while the national average was at 61.1%; the rate of individuals between the ages of 26 to 49 was at 51.3% while the national average was at 60.5%; and the rate of individuals age 50 and older was at 31.0% compared to the national average of 46.9%. The occurrence of binge drinking among American Indians and Native Alaskans was relatively the same as the general public except among individuals ages 26 to 49. The rate of binge drinking among individuals of this age group was at 39.4% while the national average was much lower at 28.9%. Also, the rate of illicit substance abuse among this population was slightly higher than the general public, except among younger adults. For American Indians or Native Alaskans ages 18 to 25, the rate of illicit substance abuse was at 25.4%, while the national average was significantly lower at 19.7%.

When comparing health insurance statistics, SAMHSA found that uninsured American Indian and Native Alaskan adults were more likely than uninsured individuals from the general population to engage in binge drinking (44.4% vs. 33.1%). Similarly, American Indian and Native Alaskan adults living in poverty showed a higher rate of binge drinking than adults living in poverty among the general population (36.1% vs. 25.2%). The NSDUH showed that American Indians or Native Alaskans were much more likely to live in non-metropolitan areas than the general public (47.9% vs. 16.8%) and to be living in poverty (27.6% vs. 11.5%). The rate of individuals who are uninsured, however, was comparatively similar to that of the general public.

Most importantly, the study showed that 18.0% of American Indians and Native Alaskans (194,000 people) had a substance abuse problem during this time, which is twice more than the national average (9.6%). Currently, American Indians and Native Alaskans make up about 1% of the U.S. population (about 2 million people). However, American Indians or Native Alaskans and the general population had similar percentages of individuals with substance abuse disorders who sought treatment in the last year (12.6% and 10.4% respectively), or about one in eight individuals.

One of the nation’s top concerns regarding health care is eliminating disparity among diverse groups. Statistically, minorities are less likely to receive treatment for mental health or substance abuse disorders, have health insurance, and have higher rates of unemployment. Historically, outreach and prevention strategies have not adequately reached minority groups and have left many Americans underserved for treatment–putting them at higher risk of injury, illness, and premature mortality. By studying trends among certain minority groups, SAMHSA hopes to develop more effective methods of intervention and prevention to improve treatment rates and eradicate health problems that are overwhelming certain populations

A criminologist with 30 years of experience who works as a sentencing consultant in state and federal courts across the country, Sheila has been collaborating with Promises for many years, helping clients who may need guidance when faced with the consequences of breaking the law. Because simply sending addicts to prison doesn’t work—incarceration doesn’t address the complex underlying causes of drug addiction—Sheila is a strong advocate of providing her clients with comprehensive drug addiction treatment, first in a residential setting such as Promises and then in an outpatient program.

With a doctorate from UCLA in sociology and criminology, Sheila researched the field of crime for many years and taught at the college level. In 1980, she started her own practice, in which she identifies the human factors that are relevant to sentencing decisions. After investigating clients’ backgrounds, social histories, and offense conduct, Sheila specifies the particular issues that may have led to criminal conduct and presents an opportunity for treatment. Addiction is a common problem among her clients, so she is very familiar with the recovery process.

Sheila also strongly believes that being of service to the community is an important part of being in recovery. “Accountability is an essential part of redemption. People in recovery, even those in early recovery, can regain their sense of self-worth by giving back to the community,” she explained. “A person struggling with addiction doesn’t have a great deal of self-confidence, and one way to help them overcome that is to show them how valuable they can be to people who are struggling in other ways.”

At Promises, Sheila recently founded the “SHINE” program, which allows clients and alumni to volunteer as a group once a month as an introduction to being of service. Once clients graduate from residential treatment to the Outpatient Program or the alumni group, they can fill out an application online to participate on a regular basis. Many Promises clients are rewarded by seeing what these small gestures mean to people who don’t have much.

When placing clients with non-profit organizations in the community, Sheila looks at their strengths, talents, and interests in an attempt to find the best match. Often times, clients stay involved with the organization long after their court case or treatment is over because the experience is so fulfilling.

“We do our best to match clients with a non-profit program that fits their background, skills, and interests,” Sheila explains. “For example, we had some clients who had a creative background, so we sent them to a low-income housing facility where they helped mothers and children learn more about grooming, clothing, home decorating, and more. We had another group—under the wonderful direction of Tracey Simmons—help build a children’s library in a low-income housing area. Some people want to work with veterans or the homeless, and others prefer to work behind the scenes with administration or fundraising. We’re very interested in getting new ideas for ways to help.”

Sheila has steadily referred clients to Promises for many years. She says, “The staff at Promises really cares. They identify with clients while remaining very professional and providing a wonderful family environment and strong support network.”

To learn more about the SHINE program, visit http://www.promisesalumni.com/shine/.

Murray A. Mittleman, M.D., director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center in the Harvard Medical School in Boston, Massachusetts, led the study, in which 390 ischemic stroke patients were interviewed three days after their stroke. Ischemic strokes are caused by a blood clot in a brain vessel in or leading to the brain.

Fourteen patients drank alcohol within an hour of stroke onset. The researchers found that the risk of stroke after alcohol consumption was 2.3 higher in the first hour, 1.6 times higher in the second hour, and 30 percent lower after 24 hours. These patterns were the same for those who drank hard alcohol, beer, or wine. Only one patient had more than two drinks in the hour before the stroke, but removing that data didn’t change the pattern.

Immediately after drinking, the risk of clot formation increases because blood pressure rises and blood platelets become stickier. The researchers noted that their findings might not apply to those with severe stroke.

The American Heart Association recommends that if you drink alcohol, do so in moderation—no more than two drinks per day for men and one drink per day for women.

Source: The American Heart Association, Stroke risk temporarily increases for an hour after drinking alcohol, July 15, 2010

First, it is important to understand triggers. Triggers are things that tend to lead addicts back to their drug of choice. A trigger can be a person, a place, certain types of events, or unresolved psychiatric issues, such as depression or anxiety. When a person undergoes addiction treatment, their therapist will help them understand those things that could trigger them to relapse. The most common triggers are old friends who still abuse substances and significant stressors, such as job or relationship problems. For alcoholics, a trigger might be a bar they used to drink at. Some people in recovery will try to revisit their old haunts without the conscious intention of drinking or using drugs; they will claim they just miss their old friends. This is rarely a good idea in recovery.

Here are seven warning signs that you might be heading toward a relapse.

1. You Stop Doing What You Need to Do to Stay Abstinent

The most common thing is for the recovering addict or alcoholic to stop going to 12-step meetings. They will make excuses: they don’t like the fact people pray or everyone talks too much about their past substance abuse. Most people who stay in recovery maintain some sort of connection to the 12-step programs, even if it’s only a weekly meeting. This allows them to continually be reminded of who they are and what is at stake.

The recovering addict might stop therapy because they find it too uncomfortable. They might go against the advice of their doctor in treating a psychiatric disorder such as clinical depression or bipolar disorder.

2. You Start Romanticizing the Days When You Were Abusing Substances

This might take the form of remembering only the good times when you were drinking or experimenting with drugs. Most addicts had a time during which they had few consequences for substance abuse. They may even have had fun. However, those times were long gone by the time you got clean. At some point they became dependent on the drug and consequences piled up. If you find yourself smiling about the “good times,” and conveniently forgetting the misery of your later drug or alcohol use, this is a strong warning sign.

3. You Start Acting the Way You Did When Using: Selfish and Moody

Sometimes this is called a “dry drunk.” You act like you did when drinking, even without the drink. In recovery, addicts attempt to change their attitudes. They learn that they have a tendency to personalize things and overreact. They discover that they have a low tolerance for frustration, and can get rather ornery if they don’t get what they want, when they want it. They are the focus of everything. If someone doesn’t smile at them, they take it personally. If someone else gets a promotion, it says something bad about their work.

If you have been working on this behavior then start to see it reappear, this is a warning sign.

4. You start thinking that maybe just one drink or one pill wouldn’t hurt

It you find you are talking yourself into “just one,” this is one of the most obvious signs of an impending relapse. Those in recovery know full well the consequences of substance use, so the first step in using again is to somehow convince themselves that it wasn’t that bad, or that they have “changed” and won’t have the same issues this time around. The rule of thumb is that those who relapse pick up right where they left off. It might take a few days or weeks, but you will rapidly be in the same place you were when you last quit drinking or using drugs.

5. You begin seeking out old friends from your substance-abusing days

You might excuse this as just trying to find out how old friends are doing, but if you start seeking out old drinking buddies or people who shared your interest in using drugs, you are heading into dangerous territory.

6. You slowly but surely remove all those elements from your life that keep you anchored and balanced

Maybe you stop keeping your journal, stop calling healthy friends, and quit that daily walk that always helped you clear your head. You probably already stopped doing the things that are important for sobriety, but now you are removing things that keep you calm and centered. You might say you are getting lazy, and your life is likely getting more chaotic and stressful. You might also notice you are slipping back into old deceptive patterns; you might start lying to loved ones to keep them from challenging you.You are not taking care of your emotional, spiritual, and physical health.

7. You are extremely defensive when anyone brings up the changes in your behavior and attitude

This feeling will be familiar: it’s the same feeling you had when you first were encouraged to get sober and wanted everyone to mind their own business. It is denial crossed with an unhealthy self-righteous attitude. It’s very uncomfortable when others begin to notice our movement back toward a way of living that made us and most people around us miserable. Why? Because you are now in the place of moving with purpose back toward drinking and using, and the addict in you is determined to get that drink or drug. For some, this can be the ultimate point of no return: you either wake up and change direction, or end up taking that inevitable first drink or drug.

There is always a way back from this movement toward a drink. The important thing is to recognize it’s happening and be honest about your attitudes and behaviors. Many a time those in recovery have heard stories where someone says, “I don’t understand; I just suddenly heard myself ordering a drink.”  In truth, if that person looked back over the past few weeks and months, they would see this was the natural result of a progression toward relapse. The sooner you catch yourself slipping back into old behaviors, the better chance you have of not slipping.

The newly instated federal health care law requires that health insurance plans created on or after September 23, 2010, provide free preventive screenings and services without cost-sharing in an effort to guarantee important health care provisions that can help prevent or treat serious diseases and disorders.

Michelle Obama was accompanied by Vice President Joe Biden’s wife, Dr. Jill Biden, and Secretary of Health Human Services Kathleen Sebelius during her introduction of the healthcare reform bill at the GW Medical Faculty Associates.

Depending on age and type of health insurance plan, Americans will now have free access under the new health plans to counseling for alcohol abuse, tobacco cessation, depression, overeating, quitting smoking and drinking during pregnancy, and] child services including screening and counseling for behavioral or developmental disorders, depression, and obesity. Also included under the recommended preventive services are vaccines for common illnesses and screenings for chronic diseases like cancer, diabetes, hepatitis, heart disease, STDs, HIV/AIDS, and other conditions that can be exacerbated by drug and alcohol use.

The White House has recognized the lack of preventive services available to the American population that have the potential of preventing, reducing, or eradicating chronic conditions thanks to early detection and intervention. Because the cost of health care hinders many Americans from seeking treatment, almost half of the population does not receive the care they need to live productive lives and maintain a healthy lifestyle. When basic preventive services are denied, conditions can worsen or diagnoses can go undetected, exposing individuals to greater health risks and premature mortality. The leading causes of death among Americans are among the most preventable conditions, including heart disease and cancers, yet they still account for 7 out of 10 deaths in the U.S. and 75% of health care costs.

The Obama Administration predicts that the Affordable Care Act will immediately help about 40 million Americans to receive the health care they need, and around 88 million people by the year 2013. Under the new federal health care law, more individuals and their families in desperate need of counseling or inpatient treatment for substance abuse and mental health conditions will be lessened by the burden of costs and restrictions. To find out which health insurance plans will qualify for these changes taking effect in September, visit www.healthcare.gov.
 

Traditional methods of heroin use already pose a great risk to heroin abusers’ health and their chance of contracting HIV/AIDS, hepatitis, or other deadly diseases. Yet the new practice of flashblood creates a heightened threat of contracting AIDS and other viruses as heroin abusers can inject just under a teaspoon of another’s blood in one injection, which is more than enough to contract transmittable diseases.

Although the practice of flashblood is not common, reports from these areas are indicating that heroin addicts are resorting to this risky behavior to abet their addictions in the face of poverty. In Tanzania, heroin is used by both men and women, but female abusers are much more susceptible to HIV infection and are also more likely to engage in flashblood. Because female addicts are likely to be supporting themselves through prostitution, they have a higher risk of contracting HIV through sexual contact as well as drug-sharing practices like exchanging syringes. When the supply of heroin becomes scarce, or when prostitutes are unable to make enough profit from sex work to make drug purchases, some prostitutes who manage to score heroin will turn to flashblood as a favor to their friends to help alleviate withdrawal. Some heroin-addicted prostitutes can become too sick or old to find work and become vulnerable to their addictions, which some have admitted causes them to rely on flashblood to share a high with others.

In contrast, according to a 2006 study, flashblood is more common among male heroin abusers in Zanzibar. As reported in The African Journal of Drug and Alcohol Studies, 9.1% of substance abusers from this area who use injection as their method of consumption also engage in flashblood. Some accounts of East African addicts selling their blood has also surfaced, but researchers in the area have been unable to confirm the reports. Even though the practice of flashblood is quite unknown to the public and there is no concrete measure of its widespread use, medical researchers believe that the East African practice can proliferate into other nearby populations stricken with heroin abuse. More unconfirmed reports of flashblood-like drug practices have emerged in Pakistan and other countries where heroin is a common substance of abuse.

There is no scientific or medical proof that injecting small amounts of blood between drug users can actually create any such high. Some heroin users who have come forward to local doctors working in East Africa claim that they do experience a type of drug rush and even pass out during the experience. Some regional doctors believe that this alleged high is really the result of the placebo effect since such a tiny amount of blood might not significantly impact a human’s bloodstream which already contains an average of five quarts of blood. On the other hand, heroin abusers practicing flashblood may be experiencing a high from the traces of heroin still remaining on the shared syringe needle. Heroin abusers who inject the substance into their veins typically have to repeat the injection process three to four times as blood can be drawn into the syringe and some heroin may have been left out of the primary injection. Those who practice flashblood tend to share their needles after having injected just once, leaving a mix of their own blood and the substance within the syringe.

There was not much of a heroin market in these African cities until recently. Historically, drug smugglers from heroin-producing nations like Afghanistan or Asian countries would overlook African nations as a market because their citizens have always been too poor to make any valuable purchases. Within the last ten years, however, drug smugglers have been using these African maritime and transit cities as thoroughfares for their European drug trafficking. Local law enforcement and medical researchers have noticed the spread of heroin abuse within these regions, but distribution is difficult to combat due to corruption and a lack of manpower. Because less travel is required to import drugs into eastern and southern Africa, heroin prices have dramatically dropped on the streets.

Already plagued by the AIDS epidemic, flashblood creates another world of threat to vulnerable African drug addicts and their communities. Injecting fresh blood is the most guaranteed way of contracting life-threatening viruses; even though flashblood is only occurring within small groups of drug users, the transmission of viruses from these individuals can take off through multiple avenues. Dangerous practices like injecting, snorting, and sex work among flashblood users all have the ability of spreading HIV/AIDS throughout the population.

As of 2009, the CDC estimates that 19.5% of teenagers are current smokers, a percentage that has only slightly decreased since 2003, whereas the previous rate of decline from 1999 to 2003 was much more dramatic. As outlined in its Healthy People 2010 initiative, the United States has not met its ten-year goal of reducing teen smoking rates below 16 percent by the year 2010.

During the early 1990s, teenage smoking rates were on a progressive rise. In 1991, an estimated 27.5% of teenagers were current smokers, according to the YRBS. By 1997, this percentage jumped to 36.4%. However, beginning in 1999, statistics showed a drop in adolescent smokers and continued to steadily decline for 4 more years. By 2003, the percentage of adolescent smokers fell by 12.9%. Yet from 2003 to 2009, not much change in the rate of decline occurred. In 2003, 21.9% of teenagers were current smokers, a statistic that fell only by 2.4% within six years. When divided into demographics, age groups, and gender, the weak decline or plateau in smoking rates among teenagers was still apparent. The prevalence of teenage smokers has always remained highest among white males, and the amount of teenage smokers gradually increases with grade levels between ninth and twelfth grades. The prevalence of adolescent cigarette smoking has always remained the lowest among non-Hispanic black females.

Other adolescent smoking habits such as trying cigarette smoking for the first time and frequent smoking also demonstrate the plateau that smoking prevention efforts have had on teenagers. In 1991, the YRBS reported that 70.1% of teenagers had tried a cigarette, even just one or two puffs, in their lifetime. This statistic showed almost no change during the 1990s, resulting in 70.4% of teenagers by 1999. Within just two years, the percentage dropped to 63.9% in 2001, a 6.5% decrease. This statistic continued to decline during 2003 to 2009 but at a slower rate of only 4% during each interval.

In 1991, an estimated 12.7% of teenagers were considered frequent smokers (using 20 or more cigarettes within the past month). This percentage continued to incline during the 1990s, resulting in 16.8% of teenagers by 1999. By 2003, this percentage sharply dropped to 9.7%, a 7.1% decrease. Yet during the next six years, this percentage decreased only slightly, resulting in 7.9% by 2009.

The drastic decline in teenage smoking trends seen during the late 1990s proves the effectiveness of those counter-tobacco strategies geared towards young people that were installed during this time frame. By display of the slowed decrease in teenage smoking rates from 2003 to 2009, the CDC’s new study reaffirms the need to reinstate these effective strategies to combat cigarette use. These strategies include expanding tobacco-free environments, encouraging school programs that promote change in health policy, increasing state excise taxes for tobacco products, expanding counter-advertising mass media campaigns, and minimizing tobacco advertising, promotions, and availability of tobacco products aimed at attracting young people.

Although the majority of teenagers are not smoking, almost 90% of all adult smokers began their smoking habit during adolescence. Preventing teenage smoking creates a tremendous impact on adult smoking trends, and also prevents multiple public health risks including cancers attributed to direct and indirect cigarette use, psychological stressors caused by nicotine dependency, nicotine addiction and comorbid substance abuse, and likelihood of parents passing their cigarette smoking habits to their children. Cigarette smoking is still the leading preventable cause of death for both adolescents and adults.

The available support services nationwide may be insufficient in managing the needs of the public’s health when it comes to mental illness and substance abuse disorders, as evidenced by the disparity between MHSA emergency room admission rates and prevalence of mental conditions. Throughout the past decade, the rate of emergency room admissions for MHSA conditions has been steadily rising. Emergency room visits in 2007 associated to MHSA were also two and half times more likely to result in hospitalization than emergency department admissions attributed to non-MHSA conditions—around 41% of all MHSA admissions.

The majority of MHSA admissions to hospital emergency departments were caused by a mental health condition alone, or 63.7% of all MHSA admissions. Most mental health conditions seen in the emergency department occurred in women (65.4%), but the majority of both substance abuse disorders and comorbid MHSA conditions occurred in men. Adults ages 18–44 accounted for the majority of all MHSA visits regardless of what type (mental health conditions alone, substance abuse conditions alone, and comorbid MHSA disorders); the majority of admissions for this age group were related to comorbid disorders (58.8% of these admissions). Older adults ages 65 years and older were much more likely to be admitted for a mental health condition alone (25.9% of these admissions) than their admissions for substance abuse conditions (9.1%) and comorbid disorders (5.2%). Overall, the majority of all MHSA admissions were female (53.9%) and younger adults (ages 18–44 years).

The most common MHSA condition seen in emergency departments were mood disorders (42.7% of all admissions), followed by anxiety disorders (26.1%), and alcohol-caused conditions (22.9%). Other common MHSA conditions that resulted in emergency department visits for adults were drug-related conditions, schizophrenia/psychoses, and intentional self harm.

The majority of emergency department visits was billed to Medicare (30.1% of admissions), followed by private insurance (25.7%), uninsured incidents (20.6%), and Medicaid (19.8%). However, those emergency visits that were uninsured were disproportionately more likely to result in the discharge of the patient than those conditions that were billed to any insurance plan. Uninsured patients admitted to emergency departments accounted for the majority of substance abuse conditions treated (35.6% of these admissions), but they were least likely to remain hospitalized after admission. This may indicate that those individuals suffering from a MHSA condition and have no insurance coverage are the least likely to get the necessary treatment they require.

The rise of emergency department admissions for MHSA conditions has caused much alarm within the healthcare community and public at large. Mental health professionals are concerned that the people who are most in need of long-term treatment are not receiving treatment. Also, large surges in MHSA cases, such as prescription drug intoxication, have become a national health epidemic and create the need of more intervention and prevention policies. Secondly, medical professionals in emergency healthcare are becoming inundated by overcrowding along with a lack of manpower to meet this demand. Without proper admission of patients to emergency care, these medical professionals are more vulnerable to commit medical errors and thin out the amount of medical resources—all of which result in a reduced quality of care for MHSA patients and all other emergency department patients.

The report, Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007, is based off data gathered on 26 million emergency department records from across the nation, and is available online in AHRQ’s database at www.ahrq.gov.