Break the Chains
WOMEN AND ADDICTION
Host: Gwen Carden
Guests: Twyla Wilson
Gwen: How many American women do you think die each year of substance abuse related illnesses? I find the answer to that question quite astounding; 200,000. In addition to those deaths there are four million women in this country right now who are in need of treatment for their addiction. Those statistics are both startling and tragic.
Interestingly, although we’re talking about some pretty big numbers, only recently has it come to light that there are significant gender differences when it comes to addiction. These differences are biological, psychological and sociological. For decades, there has been kind of a one-size-fits-all to treating women based on what we’ve known about men. And in many pockets in America, ignorance about this persists.
On today’s show we’re going to pull the cover off some long held misconceptions about women addicts. Our goal is to shed light on the true and tragic reality that has for too long been swept under the rug. My guests today are Twyla Wilson and Linda Gingras.
Twyla is a licensed clinical social worker and psychotherapist in Durham, NC. She trains professionals on gender responsive, trauma informed treatment for women. And prior to being in private practice she was a faculty member at Duke University Medical Center in the Departments of Psychiatry and Social Work. At Duke she started a women’s addiction treatment program.
Linda Gingras is a licensed marriage and family therapist and a board certified alcohol and drug counselor. She serves as a Director of Addiction and Prevention Services at Jewish Family Service in Los Angeles where she coordinates and provides substance abuse services for chemically dependent clients and their families. She’s also President of the Women’s Association for Addiction Treatment, a national professional organization for women in the addiction field.
Welcome Twyla and Linda.
Linda: Thank you so much, glad to be here, Gwen.
Gwen: I’m really happy to have you both. I want to direct the first question to you, Twyla, but as our conversation progresses I really want to invite you two just to kind of chime in as you see fit.
Let me ask you, Twyla, let’s start with this question; are women more susceptible to addiction than men?
Twyla: Well our data on that has been a little unclear because as you referenced earlier, a lot of the research in this field has been done on men’s addiction. Women’s addiction really didn’t come to light in our society until the 1970’s. But we’re starting to get a body of knowledge that says, yes indeed, women’s addictions are different in a way that addiction impacts their physical self is different, as well as there are some physical things about women that impact how drugs and alcohol effect their bodies.
Gwen: What would some of those things be?
Twyla: Well we know that with shorter periods of use and less use of alcohol and other drugs, women tend to have more physical complications for that. In my work at Duke for example, I would see women in their early 30’s who were dying of cirrhosis of the liver after maybe only a decade of drinking. And I’d see men in their 60’s and 70’s who had been drinking heavily for several decades who still had impact livers, that’s one example.
Gwen: Linda, do you have anything to add?
Linda: I think the idea of being able to identify and acknowledge what addiction even is with women. The expectations of women and I think we’ll talk about this as we talk about the psychological and sociological issues as well. But to deal with the shame and the symptoms and to identify them as what they are and that when you’re looking at chemical dependency and the body’s changes in reaction to chemicals has been difficult for women to acknowledge when they address the shame piece, and I’m sure we’ll be talking more about that.
Gwen: Now is there any evidence that women become dependent on substances faster than men? I know that you said they certainly die more quickly in many cases, but are they dependent faster?
Linda: I don’t know the research on that, but I think because of the shame and stigma attached with the disease of addiction, that we often don’t find out about women’s addiction as early as we might with men.
Gwen: So in other words, it’s just not addressed as quickly or acknowledged as quickly and therefore it can go on longer.
Linda: It may be more serious by the time it’s actually begun to be addressed.
Twyla: So we know that several things like being a mom or being a woman carries a different level of stigma with it that prevents women from getting into treatment maybe as easily as men are identified and access treatment.
Gwen: And I do want to talk about that in a few minutes. But I’d like to ask just a little bit more about the physiological aspects of addiction. Do women get intoxicated more easily?
Twyla: Linda, do you want to take that?
Linda: I think often that is the case because women’s bodies are different. Often, and of course there are always exceptions that women’s bodies are usually smaller, so the amount of alcohol will affect them sooner. For example, the amount of a controlled substance can create intoxication on a smaller body sooner, their metabolisms are different. So often they will show the signs of physiological intoxication sooner than men, or with less intake.
Also because women have a higher fat content in their bodies, I’m not calling women, ‘fat’, we just have a greater content percentage wise than men do. The way that our body processes substances is more impactful.
Gwen: I remember years ago, 20/20 locked a group of men and women into a room and allowed them, or asked them to drink excessively. And it was obvious really quickly how much faster the women were becoming impaired than the men. And it had to do with I guess metabolism, smaller body size, smaller livers and that kind of thing. So I think the idea of a woman saying, ‘well I can drink and keep up with the best guy’ may be more than a boast than a reality in most cases. Do you agree?
Twyla: Yes, but there are also biological issues, heredity issues that impact how ones brain and ones liver are set up to process, alcohol in particular. And so if you have more aldehyde and alcohol dehydrogenated in your liver, even as a woman, you can usually drink large amounts of alcohol and not feel the effects of them as quickly as someone that didn’t have that biological predisposition.
Gwen: That’s interesting, I didn’t know about that. What were you saying; you have aldehydes in your liver?
Twyla: You have enzymes in your liver that break down the toxins and alcohol for example. And so if you have a lot of those enzymes you can drink and drink and drink and your liver goes to work overtime to break down the effects of the alcohol. So you can be physically impaired, but you don’t feel it as quickly.
So whereas the average American woman according to the AMA might have 1 ½ drinks and begin to feel the effects of that and just gradually lose interest in drinking any further. If your brain and your body hereditarily predispose you to not get the right messages, you can have 6 or 7 drinks and you’re going to feel fine. And in fact, you’ll want to continue to drink to get even more of a buzz, because it takes longer.
Gwen: Very interesting, that was something I had not read or learned about.
I also understand that there has been some research or some people taking a pretty serious look at the role of estrogen and addiction in women. Twyla, what can you tell us about that?
Twyla: Well we know that the chemicals in the brain of dopamine and serotonin impact our ability to feel pleasure and to feel calm and to feel a sense of wellbeing. And we know that estrogen really impacts both dopamine and serotonin levels in the brain. And so what we’re seeing is that craving and the desire to use to mitigate some of those hormonal shifts, such as higher emotionality, greater anxiety, greater irritability, more tendencies to depression that comes with the estrogen shift and the dopamine shift really impact women’s desire to use or their difficulty in staying abstinent.
Gwen: So again, that’s really a huge gender difference there that probably has not been really considered until recent years from what I’m gathering.
Twyla: Absolutely, and what we tend to do is we tend to dumb that down with psychotropics and treat the depression or the anxiety, rather than look at some basic physiological issues, such as thyroid, such as hormone fluctuations, which can also cause those symptoms, the psychotropic medications.
And I think so many women also can probably relate to that idea of having cravings during different times in their cycle; often we think of sugar cravings. But there’s a real connection between how sugar and alcohol for example, are metabolized in the body, there’s a desire to somehow address that craving through intake and self-soothing. And I think just that susceptibility to want to address cravings in a way that isn’t an unjust behavior creates kind of a ritual and that can lead to repeated behavior that has a reward attached to it. And then of course lead to dependent behavior.
And on a little bit of a tangent there, I think women are often more susceptible to chronic pain conditions that can be medicated and then create dependency. Like conditions like fibromyalgia for example, which has been largely looked at as something that’s maybe in a woman’s head, or we’re still starting to understand that it’s a real condition. And so it’s often treated with pain killers or antianxiety medication, or that kind of thing and again, creating that phenomenon of sort of accidental addiction.
Gwen: And I would think in many cases, women are more likely to go to the doctor and say, ‘I’m having this pain’ than men who are just going to suck it up and therefore they are more likely to get prescriptions, which can ultimately cause a problem for them if it’s not managed properly.
Twyla: Right and I think the percentages show nationally that women get prescribed more narcotics and psychotropics than men do. So there are a lot of cultural and physical issues that go into that.
Linda: It’s certainly not all medications create addiction and dependency, but when we look at the classes, like the narcotics and the psychotropics that can have addiction potential, it’s so interesting and I think there really is an intersection with psychological and sociological aspects here. Because when women do present for treatment in a doctor’s office, when they’re talking about issues like sleeplessness or chronic pain that may come from their lifestyles related to raising children, or working, or maybe even being victims of abuse. Anxiety medications, painkillers and sleeping medications just happen to be classes of drugs that certainly can create addictive potential.
Gwen: Twyla, before we move onto the psychology that’s different, I’d like to ask you one more question. Are we seeing changes in the treatments to address hormonal fluctuations in women?
Twyla: I think slowly but surely that’s starting. For example, I was just reading a piece that was written by someone at the Hanley Center in Florida who said that now on women who are admitted for residential treatment, they are doing hormonal shift assessments. And then setting up a treatment plan to address that, which is really a brilliant new endeavor I think to address this particular area, which has been an area of great oversight I think in this field.
I would also add, I mentioned that we thought that hereditarily that the predisposition for being addicted to alcohol ran more strongly through the male line. And then somebody pointed all that all the research has been done on men and so once we started researching women, we found that yes indeed; it runs as strongly through the female hereditary link as it does with men.
Gwen: So when you’re testing for hormonal fluctuations, is that some sort of a blood test or how do you test for that?
Twyla: I think you would have to have medical tests, such as a blood test. And then you would also be having a person track very carefully, a woman track over the course of a month mood swings and what’s going on with that. And then try to address a relapse prevention plan accordingly.
Gwen: So this is really a much more targeted way to help to treat someone struggling with addiction than just across the board, ‘do this, this and this’. Now its saying, well you know that these particular days of your monthly cycle you’re going to have more cravings. Therefore you’re going to be more susceptible to wanting to use, and therefore put into place some sort of plan to address that when it gets a little bit more challenging than it is other times of the month. Is that correct?
Twyla: Yes and I think it actually helps people when they understand that there’s a physiological component to it. When we talk about the brain and how that’s impacted with the disease of addiction, my experience has been that people always go, ‘Oh wow, there’s something I can hang onto there, it’s not just that I’m a bad person’ or ‘I’m not working my program as hard as I should be’. But there are other issues that impact that that we may not have been aware of and treating appropriately.
Gwen: Could this also be an opportunity for people to, I don’t know say women are once again the victims of their hormones; you hear that in things that are a little bit sexist anyway. Is there a danger here of maybe misusing this and it’s got to be presented in such a way that we are respectful of women’s differences and not critical of them?
Twyla: What a beautiful segway into the sociological issues that impact women in terms of addiction because absolutely, yes. And probably all three of us have cringed at some point when somebody said, ‘Oh wow, it must be that time of the month, that’s why she’s so cranky’. That comes sort of from a male-based society and I’m sorry, if anybody says that our society is gender neutral, I really don’t believe that’s true. I believe it still is male-based. And so that impacts how some of these issues for women are looked at.
Gwen: Let’s talk just a little bit about some psychological aspects of women and addiction. And then we have a lot because my biggest section of questions has to do with sociological things, which was kind of surprising when I started putting the list together and I realized how hugely differently society does look at that.
In many cases, are women’s motivations to use drugs or alcohol different from those of men?
Twyla: Linda, do you want to take that? I’m happy to but go ahead.
Linda: I think that there is a tendency for men to use to enhance a good feeling; to celebrate. Again, I know this is a sleeping generalization, but the idea of going out with the boys and having some beers to party and celebrate, where for women the use is often to self-soothe or self-medicate some sort of a condition to deal with stress at the end of the day, or to address depression, or to help self-soothe some other sort of discomfort.
And interestingly and we’re talking a lot about alcohol; alcohol has a unique effect of essentially taking whatever mood somebody is experiencing and intensifying it. So yes, when somebody starts drinking when they are happy and celebrating, they may feel less inhibited and looser.
However, when somebody starts drinking when they are angry, it’s a small step to getting very belligerent. When they start drinking when they are already depressed, even though the intent is to get to that numb, anesthetic kind of feeling, the end result is often an intensification of the depression and potentially even intense signs of suicidal behavior. Because the inhibitions are lowered and the mood is actually intensified, so the motivation to self-soothe or to anesthetize often kind of has an exactly opposite effect.
Twyla: And I think for women there are two particular issues that predispose their use; one is a history of trauma that has been unaddressed or untreated and the other issue is relational in context. Women are very relational in nature and they often use in response to the relationships in which they are involved. That’s not to blame a partner or a family member, but sometimes women will use alcohol or drugs to connect with somebody else, or to ease the pain of a disconnection or an abusive situation.
Gwen: And is this much more common in women than it is in men, this particular reason for using?
Twyla: Well statistically, yes we see that there are much higher levels of abuse in women’s lives than there are in men. However, we do suspect that there is some underreporting of that. However, when I teach what I talk about is the difference in abuse in the lives of women over their lifespan. For example, we know that both boys and girls are at risk for abuse in childhood; sexual abuse, emotional, physical abuse, with a spike at about age 5.
That changes in adolescence where we see that boys are more at risk for being hurt by people who don’t like them. For example, peers, rival gang members, police, people who take issue with their race or their sexual orientation. And we see that girls are most at risk for being hurt by those to whom they are saying, ‘I love you’.
And then that changes in adulthood and we see that men are most at risk for being assaulted or hurt as victims of crime or by going to war, being involved in combat. And we see that women are still most at risk for being hurt by those whom they are saying, ‘I love you’. And while any violence is important, at least there’s a congruent between, ‘if you don’t like me and you hurt me’ versus ‘if you are saying you love me and your hurt me’, that’s kind of crazy making. And I think that plays a role in why women use drugs and alcohol.
Linda: And also to sort of build on that, we talked about using alcohol to release inhibition. Sometimes in social situations, for men to go out and connect with women in either a physical way or some sort of flirtatious way, there’s kind of idea of making a conquest or being the man. Where often for women to participate maybe in a relationship physically in a way they’re not ready to, or to socialize effectively, there might be this sense of needing to somehow change their mind or their mood in order to participate in that to lower their inhibitions so that they can be sexually available to somebody, or dance better or flirt better.
Interestingly, something else to kind of comment on; we talked about the importance of relationships for women and I think there’s an interesting irony that for people that actually develop a chemical dependency, an addiction to a substance or behavior, if you talk to somebody who is dealing with that addiction, that actually becomes the relationship. You know women have such a craving for intimacy and the relationship to alcohol for example, I’ve talked with a lot of women who say, ‘alcohol is like my best friend’, or that ‘their cocaine is like their lover’ because it’s the one thing that’s always there and doesn’t talk back, it’s always available, it delivers a reliable effect, it doesn’t let them down.
So especially with these women who have maybe a background of abuse or a long history of being hurt, in an ironic sort of way even though its killing them, the alcohol or the drugs may have been the longest term and the most reliable relationship they’ve ever had in their lives.
Twyla: Absolutely, yes. And so that addiction or that relationship starts as a love relationship, but as addiction progresses, we all know things start to fall apart. And it eventually gets to be a love/hate or an abusive relationship as well. And we find that women often enter treatment less because there are external factors driving them to do that such as, problems with the law or problems with employers. But they come into treatment because they just can’t stand the way their lives are any longer.
Gwen: Is that different from why men would be seeking treatment?
Twyla: Often men seek treatment because some sort of happening has occurred and there’s pressure for them to go to treatment. Women more often go because they feel that they can no longer stand themselves and the chaos their life is in. It feels like anything could fall apart at any moment usually for women by the time they come in.
Linda: In treatment we talk about the difference between an external motivation and an internal motivation. You know a lot of times for men the external motivation is you’re going to lose a job, or you’re going to go to jail for the third time, or your wife is going to leave you. I mean whether it’s put to them as an ultimatum or not, there’s some sort of external consequence that is finally enough for them to say, ‘at least in this moment and time I don’t want to keep living this way’. Whereas for the women it’s often as Twyla said is internally motivated, ‘I can’t stand myself, the shame, the guilt, I can’t keep living this way, I can’t managing my life if I continue this way’.
Gwen: And I think it’s really interesting the points that you all have made about the relationships being such a key part of why women are medicating. It’s that the relationships are going well and they are hurting themselves I suppose if they don’t have the skills perhaps to make that better with their partner or their loved ones. They just turn it on themselves and they self-medicate and they hurt themselves.
Twyla: Yes, there’s a whole theoretical foundation for women’s psychological development that came out of the Stone Center, the scholars at the Stone Center at Wellesley College back in the ‘70’s. And maybe after the break we can talk about a little bit more of the relational nature of women.
Gwen: Yes, that would be a very interesting thing to do.
Gwen: I’d like to ask something about dual-diagnosis; this is a term that I have been hearing a lot more recently than I think we heard a few years ago. Linda, can you talk to us, what does that mean if somebody has a dual-diagnosis, how does that relate to substance abuse?
Linda: The term dual-diagnosis or another term essentially means the same thing is the idea of a, ‘co-occurring disorder’. This is a presentation where somebody presents with an addiction to a substance or a compulsive behavior, and at the same time some sort of mental health issue. Like something who is alcohol dependent and dealing with depression, or somebody who has an anxiety disorder and they’re using a narcotic for example.
And for a long time in treatment it was sort of addressed in a linear fashion; ‘let’s find out why you’re so depressed and we’ll deal with the depression and then if we figure out why you’re depressed, maybe you won’t have to drink so much’. Or traditional treatment programs or self-help groups often felt, ‘Well if you just get sober, your depression will go away’. And we have a much better understanding now that in treatment these issues are co-occurring, they are separate but interrelated and it is essential that they are treated together.
And the treatment programs that address dual-diagnosis issues are integrating the idea of addressing the mental health or the emotional condition, at the same time we’re building recovery skills. So that when the person has completed with the primary phase of treatment, they’ll be better equipped to deal with both conditions, rather than sort of dealing with the one first in a linear fashion, they really do need to be addressed together.
Twyla: Yes. We’re also understanding now that trauma plays such a great role in women’s addictions that I ask people who are treating women to use what Dr. Covington calls, ‘a trauma lens’, which means essentially, I assume that there’s trauma in a women’s history until hopefully I’m proven otherwise. And my goal in addiction treatment for women who have trauma histories is not recovery from addiction, but its recovery from trauma, because if you don’t treat and heal the trauma, someone is not going to be able to maintain sobriety and abstinence.
So that also makes me look at relapse a little bit different in women’s lives. We used to have this mantra in the substance abuse field that said, ‘when you’ve been sober for a year, then we’ll start working on your trauma, because if we start working on that too earlier, then you’re going to relapse and you won’t be able to stay sober’. So what would happen essentially is that women would come into treatment, the substances that they had been using to medicate the pain of PTSD, of disassociation, of flashbacks was all removed and they were flooded with trauma symptomology and may leave treatment.
And so we would say things pejoratively like, ‘well, I guess she’s not ready to do the hard work of treatment yet’ or ‘maybe she hasn’t just hit her bottom yet’. When instead we were really failing them as treatment providers, we needed to simultaneously be providing treatment for their mental health issues and their trauma symptomology, at the same time we were providing treatment for recovery from drug and alcohol addiction.
Gwen: Am I correct in my understanding that a lot of times the substance abuse is more a symptom of the underlying trauma? That it wasn’t just substance abuse for the sake of, ‘well she just had that gene’, although that’s also possible. But the fact that the trauma really underlies the substance abuse, which is an attempt to self-medicate. Am I following that?
Twyla: Yes, absolutely. And there’s a really important body of knowledge that comes out of something that’s called, ‘The Ace Study’, which is adverse childhood experiences. It’s a huge study; you can find a lot of information about it online. And what we have seen there is that bad things that happen to you in childhood predispose you to higher levels of addiction in adulthood, both for men and women. But sometimes up to seven times greater for women than for men.
Gwen: Why is it so much greater for women?
Twyla: Well because I think women still are at highest risk of sexual abuse, they are at higher risk than men are.
Gwen: Well I want to get into this whole sociological section of this conversation because it’s really significantly different for women than men. We’ve alluded to it a little bit in the course of our talk today. But what would you say and I’ll give you a chance; maybe, Twyla what you think is most important and maybe, Linda also on the top of the list; how is society treating women differently to the extent that it negatively impacts their sobriety?
Twyla: Wow, there’s so many ways to answer that, where to start. Let’s start with shame and stigma, I’ll give an example of a woman I worked with who had been pulled for a DUI one night in a parking lot of a grocery store. It was a small town and the cop who knew her asked her when she rolled down the window, ‘where are your children’? Now that is not a question that a man is probably going to get asked when he gets stopped for a DUI charge.
So we have a lot more stigma associated with women’s addiction because often women have the role of caring for children and so we think of active addiction as equaling being a bad mom. We also comment on women’s addictive behavior in terms of their sexual behavior; there’s lots of slanderous terms that can be used about a woman in terms of her sexuality when she’s actively addicted. And we don’t usually ever do that about men. So right there are two big issues that are different for women.
And research, Dr. Covington has done around the world shows that shame and stigma in all cultures are greater for women with addiction than the levels of shame and stigma for men.
Gwen: In all cultures, very interesting.
Twyla: All cultures, yes, across the world.
Gwen: Linda, what do you think are some of the sociological impacts that really make it tough for women?
Linda: I think that role of trying to be a woman and a mother, or a woman and a partner in society and then the shame and the stigma not only creates the emotional and psychological barrier to entering treatment, but also some real logistical issues. You know when a single mom is raising children, how can she go to residential treatment when she’s got children and there’s no partner support? There might actually be a real issue there.
A woman who is financially dependent on her husband for example, for resources and if he maybe even an abuser of some sort. And part of her aftercare for example, she needs to go to her self-help groups or she needs to go to her counseling appointments to meet the requirements of the court system, or to reinforce her recovery. And then he can pull the thread, ‘if you continue to do this then I can withhold your insurance, or I will not allow you transportation to get you where you’re going’.
Twyla: Or, ‘I’ll get custody of the kids if you go to treatment and I don’t want you to go to treatment’. It can be used against their mother role, exactly Linda.
Linda: And hearing that phrase, ‘I don’t want you to go to treatment’ sounds so counterintuitive, but when we think about the idea of active addiction essentially keeping a woman vulnerable and away from her resources, you sometimes in some abusive relationships there is some power in keeping the woman away from her resources. And so the man might actually not be invested in her recovery, in other words, in her developing health.
Twyla: Yes. And also I don’t know of any of the major treatment centers in the United States that would provide childcare for young children while women come to treatment. Because somebody has to take care of the kids and we don’t support that nationally as a society for working women, we certainly have not gotten to supporting that for women going in for treatment for addiction.
Gwen: So there is a lot of additional stresses and strains that men for the most part, are not going to experience. I suppose single dads would certainly have the same challenge when it would come to childcare. Are you saying that they are not experiencing quite the social stigma that the females do?
Twyla: Yes, we in many ways don’t want to think about women’s addiction because societally that’s something that feels not right. You know we want moms to be okay and when moms aren’t okay, because they’re supposed to sort of hold up the world and when they can’t do that, it’s very difficult for us to figure out how to help them.
Gwen: I read a statistic that said that 40% of alcoholics are female, but only 25% get treatment. That seemed like some of the things that we’ve been talking about could definitely be contributing to just making it a whole lot harder for women to even do it.
Twyla: And then the whole economic issue cannot be underplayed. I mean there’s just been a lot of information out in the last month about equal pay for women and we’re still at .79 cents on the $1.00. And for African American women, that’s .51 cents on the $1.00 compared to what a man would get for equal work. So that’s a huge economic barrier for getting childcare and going to treatment.
Gwen: And I think too often women are working part-time, they don’t have the benefit maybe of health insurance, maybe Obamacare is going to change some of that. They maybe not even have the coverage to do it because they have chosen to stay home and be with their children, so once again there’s a financial barrier for them.
Twyla: But interestingly what the studies show is that if women do get to treatment and if treatment is gender responsive, meaning it really addresses the realities of women’s lives, that women do better; they stay sober longer, they stay engaged longer and they become more functional in their roles.
Gwen: Linda, did you want to say something?
Linda: I absolutely agree with that, that when women get into treatment the possibility for fulfilling and driving recovery is great, but we’re talking about some of the actual logistical barriers to getting into treatment. But those logistical barriers can’t even be there until the person actually acknowledges that there is a need for treatment, and when we put it in that context that we’ve been discussing of the shame and the guilt and the needing to essentially deny the presence of the addiction, or to not recognize the addiction, that complicates thing.
I think in anybody that’s dealing with an addiction, in the beginning before they can even admit and acknowledge, there is a whole process of denying and rationalizing and minimizing. ‘How much do you drink?’ ‘Well I only had two drinks’, ‘yes, but they were each 40 ounces’. How are we reframing it; women have a lot of ways to kind of re-label, ‘Oh, I’m just drinking to relax at the end of the day’, ‘I’m taking my antianxiety medication to cope with the stress of the kids’, or ‘I’m frightened when my husband’s coming home at the end of the day, so I’m just doing that to cope’ and not really acknowledging the addictive relationship.
We often think about addicts just being liars and I would just throw out there that denial is a much more complicated piece than that, it’s not just lying to the world, ‘I know I have a problem, I’m going to tell you I don’t’. It’s actually convincing themselves and in fact they have a saying in AA that the word ‘denial’ stands for ‘don’t even know I am lying’.
Gwen: Before we went on break, Linda you were talking about denial and I think that was a really hot topic and I was sorry I had to interrupt you in the middle of it. But let’s continue, what were you saying about denial that you think is so key to women’s sobriety?
Linda: Well I think that obviously whenever we have a problem, we can’t really address the problem until we acknowledge that the problem exists. And to acknowledge that my relationship with substances has become such that it is creating a problem in my life is a huge admission. You know we look often at the person who is an addict as somebody who is weak or criminal or bad, or all the demoralizing that goes with it.
But when you think about that piece that is requiring somebody, anybody before they enter treatment to really acknowledge that, ‘my relationship with this substance has gotten to a point where I can’t manage my life anymore’, what a lot of courage that takes. And then to go into the treatment process and essentially as we were talking about that relationship, give up their ‘best friend’ and try to realign their life with new coping skills. What a challenge and what a lot of courage.
Twyla: Absolutely. Heroes are actually what I think, people who go into treatment and try to make this change. I’d like to add about denial; I loved what you said, Linda. We know that addiction is a disease; we know that the organ in the body that’s impacted is the brain and when we study the brain in people with active addiction. We see that their prefrontal cortex where all their executive functioning resides is completely cut out of the equation. And so that area where you can weigh the pros and the cons of decisions that you need to make, when you make decisions in your best interest all of that is cut off. So how can you at that point easily say, ‘Oh my gosh, I have this addiction and it’s causing trouble, I need help for it’.
And also society is still not saying it’s a disease, they’re saying its bad behavior. It looks like choice and the issues that come when someone’s actively addicted often can be horrific in terms of their impact to others. But it is not bad people, it is a bad brain.
Gwen: Well women have always been blamed for years for poor morals or whatever and this is still persisting as we were touching on earlier. That’s she’s just a bad person, she’s a loose woman, or whatever.
Twyla: Right, bad mom.
Gwen: Yes, so that adds to the same and guilt and also then the less likelihood to reach out because you’re too ashamed, you’re too guilty so you keep kind of in the same rut so that maybe not anymore people know what a bad person you have become.
Twyla: And I really encourage family members to take a loving, non-confrontational but consistent approach to dealing with the issue. And I know that’s very very difficult, but it does not get better without attention, it gets worse. And the higher somebody’s bottom there is, the less damage there is and the better the prognostic outcome.
Gwen: I want to bring up something that’s a little bit different, but I think it’s really worth noting that the female population in prisons from what I understand has a very high correlation with substance abuse. Can you speak to that, Twyla?
Twyla: Yes, thank you for asking that. We see that the number of women in prisons because of the drug law changes in the 1990’s, just skyrocketed the number of women getting admitted to prisons. It was 100’s of percentages more than it was for men. And they were being targeted for smaller, nonviolent crimes many times and getting very long punitive sentences; sometimes first felony offenses for possession resulting in 15 years. So a young woman who has got small children who gets imprisoned then has triple or quadruple jeopardy in her family because her children are unfairly impacted by that as well.
Gwen: What were the changes that caused this?
Twyla: Well the drug laws that came about really targeted the middle people and the smaller people in terms of those who were using and possessing and selling in small amounts and committing crimes to support their addiction, as opposed to the big players that were running the drug cartels. And so we got a lot of the little folks imprisoned and it’s just had a tragic effect on society I think.
Gwen: Why were more women getting put into prison when this changed?
Twyla: Because often they were caught in relation to relationships that they were involved in. And I think that there was a punitive judicial system that unfairly targeted them. And you know there’s no other disease that we imprison people for. It was be ludicrous to think of doing that for someone with diabetes or heart disease. And yet we have prisons full of people with the disease of addiction instead of sending them to treatment. And it’s much more expensive to house someone in a prison for a year than it is to send someone even for 3 months of residential treatment.
Gwen: Believe it or not, that is all we have time for today. I hope our discussion has been able to open your eyes to the unique challenges that are faced by women struggling with addiction.
I want to thank our guests, Twyla Wilson and Linda Gingras for taking time out of their busy days to be on “Break the Chains.” Twyla, would you like to tell people how they can contact you or learn a little bit more about you?
Twyla: Yes, I can be reached at my Gmail account, which is email@example.com">firstname.lastname@example.org for comments or questions. Also at www.therapist.psychologytoday.com and you can find a lot of information about what we’ve talked about on Dr. Stephanie Covington’s website, which is www.stephaniecovington.com at the Center for Gender Injustice and the Institute for Relational Development.
Gwen: And I might add that you spell Twyla, because that’s an unusual name.
Twyla: Thank you.
Gwen: Linda, what would you like people to know resource wise where you’re concerned?
Linda: I can be reached for questions or comments at my email account email@example.com">firstname.lastname@example.org, that’s for Jewish Family Service Los Angeles. Jewish Family Service is a large social service agency that provides a continuum of social services to people of any background. And we have offices throughout Los Angeles. And if anybody nationwide is interested in finding gender specific female resources that can assist them with addiction they can visit the Women’s Association for Addiction Treatment website at www.waat.us and that will take them to a website that has a lot of resources for women dealing with addiction.
Twyla: I would also like to add for a more modern twist that Stephanie Covington’s book of; “A Woman’s Way through the 12 Steps” is available as an app on your iPhone or your SmartPhone. So for women who are looking for resources and daily comfort and support in recovery, that’s available.
MYTHS ABOUT ADDICTION
Host: Gwen Carden
Guests: Adi Jaffe
Jerome R. Barry
Gwen: Which one of these statements is true; an addict has to want help in order to benefit from treatment, or it doesn’t matter if an addict wants help or not. He or she can be helped with the right intervention.
Well, if you’re like most people some of what you know about addiction might be conventional wisdom, but conventional wisdom isn’t always so wise.
Years ago it was believed that cigarette smoking was actually good for your health. You may have seen vintage ads stating that more doctors smoke Camel’s than any other cigarette. It seemed credible at the time, but now it’s hard to believe that any doctor would indorse smoking with the implication that it’s good for your health.
The same applies to addiction; what we think we know may not be the way it really is. On today’s show we’re going to talk about some of the most common misconceptions about addicts and addiction and why knowing the real truth can help you or your loved one see yourself and your addiction challenge in a more empowered and accurate light.
Our guests are Dr. Adi Jaffe and Jerome R. Barry. Dr. Jaffe is Executive Director of Alternatives; a Los Angeles based behavioral health company and an instructor at UCLA and California State University in Long Beach.
Mr. Barry is Director of the Independent Center and Director of Pastoral Care at Brian Medical Center in Lincoln, Nebraska. The Independent Center is the substance abuse and addictions services arm of Brian Medical Center.
Gwen: Welcome Dr. Jaffe and Jerome.
Both: Thanks for having us.
Gwen: We are just delighted to have you on the show today talking about and debunking some common myths. Jerome I’d like to begin with you. I posted a question at the top of the show so let’s start with that one. Does an addict have to want treatment before treatment can be successful?
Jerome: I think that’s a good place to start because that is a primary myth I think in our field. I would say I’ve worked in the field for 34 years and the clients that I’ve worked with over the years and many many areas of their lives are able to exhibit very good willpower. Not all of them, but most of the clients can get themselves up and go to work. Can get other daily tasks done that involve will power, but something odd happens in the area of addictions.
It seems like the more they try to kick in willpower and the want too to reduce their drinking, stop their smoking of marijuana, reduce their prescription pills. It seems like the more they want it, the further away it seems to get, so the same skill that they have using willpower in other areas of life doesn’t seem to work in the area of additions. It’s sort of an odd thing for them that they tried real hard and can’t seem to do it. So, we say in the addictions field is we try to help them get to the point where they say they give up trying to do with their own willpower and try to rely on someone else.
Gwen: Okay, Dr. Jaffe, an addict has to hit bottom to get better, is that a myth or is that the truth?
Dr. Jaffe: I think this myth is actually related to the one we started out with about wanting to change. I think the problem with this notion of having to hit bottom is that bottom is not really something that is well defined. So for some person bottom might be a fight with their wife or getting a talking to by their boss. For others, repeated visits to prison over a year are not a good enough bottom.
And so one of the problems is believing that you have to hit bottom or the thing we started with is that you have to really want treatment or you have to really want to stop to get better, I think stops a lot of people from getting the help that they need earlier in the process that makes them wait longer. You know, if I need to hit a bottom and I don’t feel I have yet, then maybe it’s not time for me to get help. Or, I sort of see that things are going wrong in my life, but I don’t exactly yet feel like I’m ready to quit then maybe I don’t need to get help.
I think part of what I really try to focus on when I work with people is I’m getting them to understand that you can stop this at any given point of time. Your bottom could be as high as you want it; you don’t have to really keep waiting for your life resolves.
Gwen: Do you find that some people might, and I think you sort of referred to it that hitting bottom might be an excuse to not go into treatment, because they say, well I know I haven’t hit my bottom yet, so let’s just not try yet?
Dr. Jaffe: You know I don’t call it an excuse, I call it a misconception, and unfortunately it’s a misconception that exists both in the potential client and their family members you know. So part of the work that we’ll do sometimes with the family is; you’ve heard about enabling obviously in the context of addiction, a lot of times we’ll work with family members and say look, you know, if you want a person to change and sometimes they have to be able to feel the consequences of what they are going through.
If it’s a student and they are getting to drunk or getting to high to be able to go to school, don’t sit there and cover for them every day because that’s not actually helping them. We’re animals that learn through experience the same ways as all other animals, so we stay away from activity that has negative consequences and we move toward activity that rewards us.
When somebody gets engaged in drug and alcohol use you really want to be able to let them feel the consequence of it, if there are no consequences they can keep going with the same pattern of use that they’ve had. But once consequences start showing up, if they do, you want them to be able to respond appropriately and not protect them from it.
Gwen: Very interesting. So, it doesn’t have to be, different people’s perception of bottom is going to be different as well.
Dr. Jaffe: Absolutely.
Jerome: I would also add that some, I smoked cigarettes for 30 years of my life and one of my favorite sayings was, ‘I’m not quite ready, I’ll quit when I’m ready’. So I agree with the doctor, I don’t call that an excuse, but to stop a habit that is so ingrained is scary at a certain level, its uncomfortable to consider. So putting that off until this moment when you think you’ll finally be ready really procrastinates any efforts or any action to change.
Dr. Jaffe: That’s a good point Jerome. I just want to bring up one other little thing and that is, when you are smoking when people use substances, oftentimes, it’s not always true, some people it’s just a habitual behavior, but oftentimes there’s a reason. There’s a role the substance is playing, for your smoking it might have been reducing your stress in specific instances. A lot of times we really have to figure out what role the substances are playing in a personal life so we can get in there and help them be able to find that sort of affect from something else in their lives.
Gwen: So in other words, what’s the payoff for continuing that behavior?
Dr. Jaffe: Yeah, you know, you said it, it’s hard to change a behavior that is ingrained and that is giving you something. And for us to ask somebody to do that is well and good, but were not the ones that have to give up our coping because of it, we have to offer them alternative ways of coping.
Jerome: Now when you give up addiction to the addict, it feels like someone’s taking something away from them. Someone is causing them to have to stop doing something they don’t want to stop doing and sometimes even internally an addict will self-talk to themselves, ‘why should I have to take this away when I’ve already given this up, this up, this up’. Addictions really do focus on that concept of, what am I giving myself, what do I really want, what’s the purpose when I take it away, what’s left? So I agree that we need to be focused on what is that purpose.
Gwen: Very interesting. Jerome, let me ask you this, people who get addicted to prescription drugs often feel like maybe they’re in a different category of addict than people who get addicted to illegal drugs. Is there a difference?
Jerome: You know, I think I’m going to start the answer with us sharing that people that come into treatment addicted to prescription drugs that they’ve may originally got for legitimate physical pain and now they find themselves addicted. They do view themselves coming in the door to treatment; almost all of them view themselves and think they’re different than the other people that they’re going to run into while they’re in treatment. And so a high percentage of those people do believe that. But, the same high percentage of the people when they leave treatment leave saying, ‘you know what, I wasn’t that different, there was a lot of similarities between my addiction and the alcoholic I sat beside or the combination poly-substance addict that I sat beside’.
So coming in, they view themselves a different way, going out, not so much. I would say too, that the onset of a prescription drug use has created a new wrinkle to our field. Because we are seeing folks that get involved in addictions from what is the onset is really innocent, its sometimes prescribed, sometimes very useful and needed, the prescription drug. But then it gets out of control and becomes harder to manage, it begins to serve a purpose as we just talked about. So even thought the onset maybe different, I think in the addiction itself there’s a whole lot more similarities.
Gwen: So the addicted person can easily say, ‘well it wasn’t my fault because the doctor prescribed it and of course it got out of hand but it didn’t start with me doing anything wrong’.
Jerome: Yeah, and it’s easy for someone who’s never used illegal drugs or used alcohol out of control. It’s really easy for that percentage of the population to look across the room at the illegal drug user and hold themselves out as different from them, because I wasn’t doing anything illegal, so it’s a way to separate myself. But like I said, in the end I think they see far more similarities.
Dr. Jaffe: Could I add something to this?
Dr. Jaffe: I think one thing that is important is that oftentimes when you talk about prescription drug abuse we are talking about opiates. And I think the important thing to understand here is, unlike alcohol, which takes a long time for something like this to happen. And for a lot of stimulants we don’t get this sort of affect, you know, cocaine, methamphetamine, things like that.
The physiological dependence that people can develop for opiates is massive and can happen relatively quickly. And in that sense people can find themselves in trouble much like addicts, or like the stereotypical addict I mean, relatively quickly just by following doctor’s orders. Now Jerome talked about one group of people I believe, which are the people who were prescribed opiates because of medical procedures and might find themselves in trouble. I went on a radio show here locally a while back and the host had actually run into one of these problems and it took him a long time to want to go into treatment because exactly as Jerome had pointed out, he didn’t really feel like he was the same as everybody else.
But there’s another group of people that become addicted to prescription meds that we’ve seen more of in the last I’d say five to ten years, and that is young adults who sort of sample prescription drugs from parents, from friends parents, etc., and they become addicted and for them it becomes a very different sort of addiction. And what I mean by that is unlike the adults who were given it by a doctor because their supply is limited, they are sort of using the drug illegally, they’re not getting it from a doctor. And these are the people who not all the time, but you’ve seen repeatedly move on to smoking opiates and eventually may be injecting heroin. And we’ve heard more and more about this nationally.
I think the reason I wanted to bring this up is, even when we talk about prescription drug abuse, were not always talking about the same group of people. It’s really important that we start really having the complex conversation of what sort of prescription drug addicts are we talking about? Are we talking about somebody who just went through major surgery, or are we talking about a kid who has been trying this step out and is now kind of strung out on opiates and needs to get a supply and not from a doctor.
Gwen: But the bottom line is that they are addicted regardless of how they came into it and that it isn’t necessarily, the end result isn’t that different, is that correct?
Dr. Jaffe: I think so, the people with medical procedures when we catch them early enough, and if we do the education on the front end saying to them, ‘look there’s going to be a physiological dependence for you’. That’s on doctors, that’s on physicians to have that education for their clients and not just give away strong strong addictive opiates as if it’ll take care of itself down the line.
Gwen: Let’s get right to our next myth. Dr. Jaffe, one of the myths is that addiction is a disease so there really isn’t much you can do about it; can you weigh in on that for us?
Dr. Jaffe: Sure, I love this one because I think it has two different elements that we need to talk about. First of all the fact the definition of addiction is a disease and the second one is that if addiction is a disease then individuals are sort of left what I’ll call handicapped and not really able to do much about it.
I want to address the first one first and that is I think there’s no doubt that for some people who meet addiction criteria the idea of a disease is an attractive way of looking at what they’re going through. You know, a disease and people often compare this to let’s say type 2 diabetes, or something along those lines, which means that there’s a biological component to why you get it. But your behavior changes, there’s a probability that you’ll have it, right you can be predisposed to type 2 diabetes because of your culture and your genetics. But then if you don’t eat foods that are high in fat and high in sugar and you don’t live a sedentary lifestyle where you don’t move a lot, you’re not going to develop type 2 diabetes. But once you develop type 2 diabetes, the idea is well now your diabetic and you know, you got to deal with it for the rest of your life.
First of all when you talk to diabetes experts, that’s not even true; people who develop diabetes can get in and out of it depending on their changes in diet and nutrition and things along those lines and exercise, etc.
Even for the addicts I think who seem to have a disease or a disorder, depending on how you want to call it, a lot of time we can see them moving in and out of having the disease, like almost you can talk about it like cancer and being in remission, right.
But the important thing for me in the DSM-IV, the new diagnostic statistical manual for the American Physiatric Association has moved away from considering all addicts as belonging to one group or another and looked at it more of a continuum. And I love that they finally done that because while I do believe that for some people the disease model fits in terms of giving us a good pretty good representation of what’s going on with them. I think that anybody would be really hard pressed to say that all individuals who struggle with addiction or struggles with substance abuse disorder meet those criteria.
And again, what I really urge people is to start being able to get a more complex understanding of is so they don’t feel that everybody has to fit this category or what else are we going to do.
Some people have a disease like set of symptoms and they need to be treated in a chronic way that lasts for the rest of their life. And for other people addiction might be more of a short term injury you know, like a very heavily twisted ankle where they need to pay attention to it for the next few months, maybe a few years and then things get better, especially early on in the process.
Gwen: So just across the board, it’s a disease, it’s hopeless, it’s really going to depend on the person and therefore the way you approach the treatment would be different.
Dr. Jaffe: Again, if you look at type 2 diabetes or something along those lines, you know if you catch somebody early on in the process, the treatment is completely different and the diagnosis and prognosis for their long term success are completely different.
Gwen: Jerome, yes.
Jerome: Yes, Gwen I’d like to mention too with most medical diseases there is the prescriber, the physician; the doctor will ask the patient to do things to manage their disease. And the general public is very quick to comply with taking the medication that the doctor says to take. Going to physical therapy that the doctor says you need to do. An interesting thing happens in the field of substance abuse treatment though, we often times will whether it’s a disease, viewed as a disease or not, I think isn’t as important as the person being willing to follow the recommendations that the therapist or doctor give s them for this condition that they suffer from.
And what we see so often in our field is people will leave treatment, leave a level of care that the doctor, the counselor, the therapist gives them prescriptions so to speak to do something more with their addictions and they don’t comply. And then they’ll come back to treatment and say it didn’t work, what went wrong. And usually lots of times, it has to do with complying with what they need to do to continue in recovery.
Gwen: So even if it is a disease, and I like Dr. Jaffe’s reference to diabetes, even if it is a disease there are ways to minimize the impact of that disease through lifestyle changes and compliance with other things. Or you can ignore it and it can get worse. So even if it is a disease, it doesn’t matter because you still have some control over how the outcome is going to be, is that correct?
Dr. Jaffe: Yeah, and actually when you look at diabetes and cancer, the chronic illnesses, the ones where people need to take care of themselves over long periods of time, adherence in addiction is actually relatively similar to like diabetes medicine adherence. The one difference is, and I don’t know Jerome, I run an outpatient treatment center so it’s a little bit different then residential but in many treatment centers for addiction, if you don’t comply you might actually get kicked out of treatment. And it would be sort of weird for you to think of a diabetes patient who doesn’t take their insulin one day or three days and has a blood glucose increase and their doctor says, ‘well I’m just not going to treat you anymore, I am kicking you out of treatment because you didn’t take your insulin’.
Jerome: Absolutely, I think the treatment of the past, I’m hoping this treatment of the past used to almost portray themselves as if someone had to put a halo over their head when they walked in and the very issue that they entered with would be gone. So I think current treatment is more friendly with the fact that they’re here to work on that very issue and we can’t kick them out just because it surfaces.
Gwen: Very good, well let’s move on. Jerome what about the myth that some alcoholics can learn to drink normally and can continue to drink with no ill effects as long as they limit the amount?
Jerome: You know, that’s a tough one because I think anyone, and most people that I’ve dealt with in treatment would love that to be true, that they will be able to return to a drinking pattern if we’re talking only about alcohol here. Most of them start out with, ‘I just want to be able to control it, and it would be great if I could use it like some of the other people I know in my life and give and take’.
The problem is that we very rarely recommend that in treatment because the percentage of the time where an addict is able to do that tends to be small. I ‘m not going to say it isn’t possible, I’ve seen that happen where people are able to reduce their level of drinking, things get better, reduce the volume and the amount and the frequency and things in their life getter better and I’ve seen people able to do that. But I would have to say that’s rare, so for us to recommend that sometimes is dangerous for those that won’t be able to do it.
Gwen: Like I say, it’s rare but it’s risky.
Jerome: Yeah, that’s what I was thinking
Dr. Jaffe: You know, I think my view point on this is maybe similar to Jerome in terms of one specific set of clients, but I think, there’s a couple of things. First of all Jerome said most people want it and I think that’s true. I would even argue that most people who entered treatment have already tried it many many times on their own and were unable to successfully reach moderation on their own and so they try to quit. In terms of the ability to recommend it, I would look at things a little bit differently and I would say it like this, ‘there is a saying in our field, meeting the client where they are at’.
I think and again, we do this specifically in our treatment program, but some people aren’t ready to quit, whether they need to or not is a separate question, but they’re not ready to quit. And one of the problems in my opinion is that we don’t offer them options that don’t include quitting in treatment. And the reason is then they try it on their own. And, you know, as we don’t think of drinking as something that we learn how to do, that’s not true, we did, we all learned how to drink at some point if we did drink alcohol.
I learned it from a bunch of 14 year olds at a camp. And let me just tell you, they didn’t know how to drink. What they knew is how too really get messed up and get incredibly drunk while away from their parents. So nobody, you know, then you go to college and nobody really “knows how to drink responsibly” there either. So we all learn how to drink we just learned how to drink from a bunch of people who didn’t know how to drink.
Gwen: I’ve never heard it put that way, I like that.
Dr. Jaffe: Well, to me that means that what would be nice is if more opportunities arose for us to teach people how to drink. There was a researcher called Allen Marlatt at the University of Washington who showed that if you teach college students how drunk they get based on a certain number of drinks they automatically reduce their drinking.
Now, that takes us to the next point that Jerome was making essentially which was about, who can do this and who can’t do this. I absolutely agree that there are people who cannot drink responsibly let’s say once they’ve developed a problem with it.
To me, and the reason I got into the clinical area of this, the treatment side of addiction was because I kept seeing research on that fact that 85% to 90% of the people that suffer with addiction problems never get help. And I think that part of the reason they don’t get help is, we know part of the reason is shame, part of the reason is cost. And I think one of the other reason is they’re not willing to take on this solution we’ve decided to give them and that is that they have to quit for the rest of their life.
So to me, sometimes it’s okay to offer somebody an option even if you don’t believe that they’re going to be able to follow through with it just for the fact that they will then engage you in treatment and be willing to talk to you about what alcohol is doing in their life. So we do offer one of these options, we offer people the option of not quitting. And I’ll tell you that half or more than half of the people who want to try out moderation or controlled drinking end up resorting to abstinence because moderation doesn’t work for them.
Gwen: We have a caller named Patchin; hi Patchin, do you have a question or a comment?
Patchin: Hi Gwen, good morning. Yes, I just wanted to call in and chat with you guys a little bit, I’ve been listening to this discussion. I’m an addict in recovery with two years and two months and I was just listening to the part about you know, trying to use in moderation once you know you have a problem with addiction. I spent many years trying to think that I can control it or going back to, well I’ll just do this because it’s not the substance I have a problem with. And it was always just a matter of time before I was right back where I started using the substance I had a problem with. I think that’s where, you know, the disease and choice today is huge in the recovery world and as an addict I think that’s where the disease part comes in, that I can’t use any substance in moderation, I’ll always will go back to you know the rock bottom.
But I think the choice part comes in where recovery is a choice. I have a choice now that I know it’s a problem, now that I know I suffer from addiction, that it’s my choice to get better you know. Now if I were to use now having clean time if I were to go out and use, that is a choice because I already know it’s a problem, I know I have an illness and it’s my responsibility now to treat it and do what’s necessary.
And I think that’s why you know, addicts are resistant to treatment sometimes is because addiction is the only disease that makes you think you don’t have it, you know, its constantly in your mind. You think you can control it, you think you don’t need to do, and you do feel like you’ve lost something. When you go to treatment, and as many times that I went I would always feel so overwhelmed when they would say, ‘you know, this is a lifelong thing’. And the feeling of, ‘oh my gosh, I’ll never be able to use again for the rest of my life’ is so overwhelming and you feel like you’ve lost your best friend. So that was really hard for me until I realized, you know, I mean it took many years but you have to be willing to want it. So I just wanted to throw that in there.
Gwen: Okay, Jerome, Dr. Jaffe; have any comments.
Dr. Jaffe: Yes, first of all congratulations on your two and a half years, that’s great. You know, there’s a piece here, I am going to use my own personal experience because I think it’s important to not always assume that people would go through the same extremes that we did; and my example, so I was a meth addict in my previous life and I drink moderately now. And so my experience is obviously different from the callers and I have been drinking moderately for eight to nine years. So when I first started this little experiment, peoples response was always, ‘we’ll save you a seat’, which kind of pissed me off to be perfectly honest because it was almost like they were aiming for my demise, nobody to wanted to see me succeed. I am now eight, nine years later and I am perfectly happy with where my life is.
But there are a couple of questions here which is, can anybody moderate if it is not their substance of choice? And can anybody moderate if it was their initial substance of choice? I think the important thing and researchers notice this repeatedly, by the way, when we look at research out of the University of New Mexico about what happens after relapse. People who relapse or people who use again after treatment don’t always go back to the same sort of use pattern they had before. But that doesn’t mean that you need to start recommending that everybody try this out.
But the caller said exactly what I had talked about before which is, she had tried to learn how to control her own use before. Nobody was willing to help her with that. Why, because the suggestion was that she must quit forever or else. And I think that’s how we send a lot of people to the bottom who maybe would have been able to get some help earlier on and resolve their issues much more successfully, so just because some people can’t moderate doesn’t mean that nobody can.
I think it is true that without professional help people kind of find themselves in this place where they stumble, they fall, they keep relapsing in relatively severe ways and they end up finding themselves maybe needing to quit for life.
Gwen: Very good, Jerome did you have any comment?
Jerome: Yeah, I appreciate the caller calling in and giving us her perspective. It seems to be very easy to discover, whether your one of those people that can moderately drink or not. It doesn’t seem to take very long, like I’ve said I’ve seen people that are able to do that. I think the doctor makes a good point though, is how well have we been at professionally trying to help people to be a person that can do that, who can drink moderately. I don’t think we’ve done that well in the field pursuing that avenue.
But with traditional treatment there’s a lot of people that leave and try to moderately drink and they find out very quickly whether they’re able to do that. If it doesn’t seem like an addict who returns to drinking, returns to a lesser level, they seem to very quickly go back to a very similar level that existed prior to treatment.
Gwen: Okay, well let’s move on to another myth; Dr. Jaffe is it a myth that most people can quit on their own if they really try?
Dr: Jaffe: This is actually really interesting, when you look at research from the NI Triple AAA, which is the National Institute on Alcoholism and Alcohol Abuse, they did a bunch of studies as early as the 80’s and actually found that, this is true for cigarettes smoking too by the way, that most people quit problematic drinking without any treatment. And by treatment they literally even mean going to AA meetings alone. So we actually end up finding that most of the people who quit by number, by raw numbers, actually do it without (inaudible audio).
Some of them take more than one try or one attempt to do it and others can do it relatively heatedly. But in terms of sheer numbers it’s actually true that most people quit on their own, I’ll give you one of the biggest examples I use a lot of times with my clients and that is we almost all know somebody in college, or maybe a whole slew of people in college who drank like alcoholics. And then they got out of college, they got a life and all of a sudden started drinking like normal people. That’s a group of people who “quit problematic drinking” on their own, they just never thought about it that way.
Gwen: So it is not a myth then that most people can quit on their own if they really try? Or is it just they are setting themselves up for a lot of frustration if they continue to try on their own and it doesn’t work?
Dr. Jaffe: Well again, so the question then becomes, how many attempts are you going to give on your own? It is true that for a lot of the people who quit on their own, it might take multiple attempts. But by the way, Jerome can back me up on this, even for people in treatment it often takes multiple times.
So you know my general stance on addiction and addicted people is this, anybody who is suffering consequences because of their substance use should be giving it a chance in terms of a way for them to move out of problematic substance abuse. Whether you do it on your own initially or whether you go right into treatment is up to you. They’re both viable options, I wouldn’t try the same method 10, 15, 20 times if they’re not successful, I would start looking for other options.
Gwen: Okay, very good; any other comments on that topic before we move on?
Jerome: I would say, you know, I’ll use tobacco for an example; people that smoke tobacco or quit tobacco use over and over and over. They quit for an hour until the next break, they quit till noon, they quit till the end of the day. They quit, so there’s some alcoholics that will quit for two weeks why they go on vacation with their wife so that they can come home and say, ‘see, I can quit’. So lots of times I think that’s the myth, I think the general population believes that alcoholics and addicts can’t quit. I think they can quit, it’s a matter of how they then work through the quitting and get better things going on in their life connected with that substance. So quitting isn’t always the issue, if that makes sense.
Dr. Jaffe: Mark Twain had that quote, “quitting smoking is easy, I’ve done it a million times.”
Gwen: So you could say the same about other challenges as well?
Dr. Jaffe: Yeah, I think Jerome brought up an important point and that is that’s not necessarily a failure. If you are able to quit multiple times for short periods of time then you know again, what I would ask is, how did you manage to stay away for those periods of time and let’s see if we can make it longer the next time.
Jerome: Yes, yes. And we need to remember too is and I think the doctor alluded to it is in a college setting, if you went into a college university and did a substance abuse evaluation, or substance use evaluation, you’re going to find some problematic usage going on in that college population. Two, three years later, four, five years later after college, a lot of those people have returned back to normal use.
Dr. Jaffe: Yeah, I wrote an article for “Physiology Today” called “Two Kinds of Alcoholism, the Chronic One and College.” And you see that all the time.
Gwen: That’s a great magazine and they have absolutely wonderful graphics in that magazine as well. I always look forward to what’s on the cover.
Gwen: Let’s move on to another myth and Jerome, I’m going to ask you this one; alcohol is not as bad for you as other drugs because if it were, it wouldn’t be legal. What do you have to say about that?
Jerome: Well, I don’t like the legal part of that question because I think that’s a nonissue, whether the substance is legal or not. I think the issue needs to be, what’s the impact being caused on one’s life connected with that substance? Lots of times when I’m referring to alcohol or drugs with clients I refer to them as products or substances, it’s something outside of myself that I decided to give myself in a habitual manor. So for me the focus needs to be not on whether its legal or not, even in Colorado or Washington or whatever else is going on with legalizing different substances or products, the issue needs to be, how’s that working for me?
My use of it, am I concerned, is it causing problems, am I able to move forward with my goals and my ambitions in my life connected with this substance? As we’ve talked it seems like some people are able to do that. There’s a certain percentage of the population that are able to drink responsibly. Use alcohol legally, when they’re of age and seem to not have problems, but there’s a certain percentage of the people that can’t do that. So again, my thing isn’t about whether it’s legal, it’s about problems it may be causing.
Dr. Jaffe: You know, I really love hearing that, the legality of substance is not always determined by their safety. When you stop and think about it for a second, yes, alcohol is legal, but not only is it legal it’s actually one of the declassified drugs. So that means it’s not on the FDA’s classification of drugs in, you know, based on prescription, whether physicians need to be the gatekeepers for it, etc.
But when you start looking at some of those rules, you start questioning a little bit about motivation behind some of those ratings. You know, marijuana is in the same class as heroin for instance and things of that nature. And I completely agree with Jerome, not only is it not about the legality, it’s not even always about the specific substances. We talked about prescription drugs before and opiates, some people take opiates and have absolutely no problem with it and while other people take them and get into a world of hurt. We need to stop looking for the bad drugs or the bad people and start understanding that it’s all about the intersection of those (inaudible) and start looking at who suffers with what substance. Because alcohol use over a long period of time can cause some of the most devastating physiological effects.
Gwen: And yet people do say over and over again, I think, it’s just like they would say the same thing with prescription drugs, ‘well I got the prescription from my doctor’. Or you know, in this case, the alcohol, how bad could it be if you can find it on every street corner and you don’t get arrested for using it. So to me there is a little bit of a naiveté among certain people who separate alcohol out and then find themselves in the same boat as people who have gotten addicted to other substances and kind of shaking their heads and wondering, how in the heck did that happen?
Dr. Jaffe: Absolutely.
Jerome: It’s not uncommon to hear someone who is using alcohol to talk about the fact that well, at least I don’t use drugs or at least I, even alcoholics who don’t drink hard stuff, well I’m only drinking beer. Again, that’s not the issue, it’s not the issue of what they are using, its how’s that working for you? How many DUI’s do you have? Are you able to maintain relationships in your marriage? How’s life going connected with that substance you’re using?
Dr. Jaffe: Absolutely.
Gwen: Okay, let’s move on to another myth. Because the prisons are filled with people who have drug addictions and many of them are there because they were drug addicted and they were possibly selling to feed their habit or to get enough money to be able to continue their addiction.
Addicts should be punished rather than treated for drug abuse; that does seem to be a philosophy in certain corners of this country. Dr. Jaffe, what’s your thought on that?
Dr. Jaffe: You know it’s funny, I have a complex view on this. First of all, as a policy it’s obviously something that has failed us over decades. I mean we’ve been doing this since the 50’s and 60’s and drug use and addiction rates have not gone down, they’ve stayed they’ve same, depending on the substances you’re talking about, have gone up. So as a policy I think there’s something a little misguided there.
Then we get into the next piece, which is my own personal experience. And to be perfectly honest you know, going to jail was one of those things that made get out and say, ‘whatever I need to do to not end up back in this place I am happy to do, just show me the way. But while I was in jail I met many many people who had had multiple stints in jail and prison and that didn’t really work for them as a stop-gap measure.
I think what we need to start doing is again, developing a more complete understanding of the problem we are dealing with. Understand that even when you show somebody that there’s something wrong about their behavior that does not necessarily mean that they’re going to be able to auto correct immediately just because you feel like they need too.
The criminal justice system is not necessarily a place for rehabilitation. I can tell you the officers who I came into frequent contact with in jail cared nothing for what the rest of my life would look like. They wanted to keep order in the place and that’s really all they cared about.
And so, if we’re going to talk about this problem as something that is based on biology, is based on environmental influences and based on personal experience, we need to have an approach much like we stated talking about over the last five years. A public health approach for what do we do with this?
Gwen: You want to weigh in Jerome?
Jerome: Yeah, I would. I think if our society decides to continue to punish folks who use illegal drugs or prescription drugs that’s obtained illegally, they need to realize that that’s all that is, that that’s all it is, is punishment. It’s not rehab, it’s not treatment and like the doctor shared, it has no focus on future life post-imprisonment.
You know in treatment programs we put almost all, 80% to 90% of our focus on what’s going to happen after treatment, what’s going to go on next? That’s not the way the prison system is set up; it’s set up to maintain control during that time period.
Gwen: Do you agree though that a lot of judges do just sent addicts right to prison or jail? Or are we seeing a trend of having them be more lenient and send them to treatment instead?
Jerome: I hope we’re seeing that trend, I hope we are, that we are having a little more compassion for the issues rather than punishing. I think we’re seeing that a little bit.
Dr. Jaffe: Yeah, I think we’re seeing it as a top-down approach. I know in California when I was doing research at UCLA, a lot of the research was on Prop 36 or other state sponsored laws that gave addicts the option to get treatment.
I am going to back up again and get us back to this place where well, what sort of treatment are we offering them and are we doing it a disservice by limiting the sort of treatment options that they have? And therefore we kind of back them into a corner and say, ‘okay well, you either get this treatment you don’t want or you go to jail that you really don’t want.
Gwen: I find this hard to believe but that is actually all that we have time for today. It’s been a fascinating discussion and I hope that you’ve learned something you didn’t know and maybe something you can use. I want to thank our guests Dr. Adi Jaffe and Jerome Barry for taking time out of their busy days to be on Break the Chains.
WHAT IS NEUROFEEDBACK?
Host: Gwen Carden
Guests: Bill Scott
Gwen: What if I told you that there is something available to people with drug and alcohol addiction that eliminates or significantly reduces cravings? What if that same thing could also eliminate the high that addicts feel? What if I told you that I’m not referring to a medication, but instead to a revolutionary technology available around the United States and often with permanent results? What I’m talking about is neurofeedback, it’s also known as EEG biofeedback, or biofeedback for the brain.
When an addict abuses substances fundamental changes occur in the architecture of the brain. It simply doesn’t look or behave like it once did. This damage produces cravings, anxiety, sleep problems, judgment lapses, inappropriate emotions, depression, loss of motivation and a whole bunch of other things that aren’t too fun to live with. And it happens that feeling normal pleasure is just nearly impossible for the addicts.
However, studies show that when neurofeedback is added to conventional treatment modalities like therapy, AA and NA, that addicts get better and they get better faster. They have fewer cravings and they see improvements in all aspects of their lives. And all of this is without medication.
So what is this thing called, ‘neurofeedback’ and why haven’t you heard about it? After all it has been around for about 60 years. So today’s guests are going to answer those questions and others over the course of the coming hour.
Our first guest today is Ray McGarty, who has worked in the behavioral health field since 1976 and he is the former clinical administrator of the Betty Ford Center. He is currently in private practice in Dover, New Hampshire and has a large patient population of addicts who receive neurofeedback, along with conventional therapy.
We have another guest, Bill Scott, who if we hear from him shortly I will tell you a bit more about him but we’ll wait on that. And later in the show we’re also going to speak to someone who was finally able to get sober and stay that way with the help of neurofeedback after many, many unsuccessful and frustrating tries.
Oh, we have Bill on the line, hi Bill.
Bill: Good Morning, Gwen.
Gwen: Hi, Bill Scott is CEO of BrainPaint and BrainPaint is a neurofeedback program that’s been shown to be particularly effective in helping addicts remain abstinent long after they’ve left treatment. And BrainPaint has been featured on the History Channel, The Doctors, and Discovery Science.
A recovering addict himself Bill’s program is being actively researched at several universities, including Harvard and UCLA and within the U.S. Military.
So I’m glad to have both of you here and I’m going to ask you both to kind of chime in as you see fit. But Ray, let’s start with you; how does drug and alcohol abuse damage the brain?
Ray: Well to keep it as simple as possible, the limbic system or the mesolimbic system, which is a system that really mediates drives like fight/flight and hunger and so on, seems to be hijacked by addictive process, it becomes highly sensitive to substances. And produces all of the kinds of things that you talked about; cravings, urges, loss of control and leads people to have tremendous difficulty controlling their emotions, or regulating emotional states.
Along with that we see a lot of difficulty with the frontal lobes and prefrontal lobes, which control or immediate the executive functions of the brain; ability to sing, attention, focus. And also the ability to not act on urges. Those two central areas of the brain; one seems underactive, that’s the frontal areas, and the other is overactive. Substances make that worse, there seems to be certainly a hereditary predisposition, in other words, some of these brains were not really as functional as need be from birth. Those differences seem to be consistent across children of alcoholics and so on.
Gwen: So when you’re talking about the two centers that are most frequently damaged, one controls or relates to how a person thinks and perceives, and the other is more how they feel about things. How does this exhibit itself in things like poor judgment, but maybe being too emotional, what do those two areas look like when one is under aroused and the other is over aroused?
Ray: A person who seems to have trouble controlling their behavior. They are driven by urges, cravings, preoccupations, which lead to self-destructive behavior, there seems to be no stop. As I talk with my clients, I use an analogy of an automobile and there an automobile that has a gas pedal that could drive in the Daytona 500, but they had a breaking system that would suit a Model-T.
Gwen: I like that analogy, that’s a good one. Bill, did you have something to say?
Bill: I would agree in my observations in particular looking at pre and post-neurofeedback testing, I concur with that. There’s a psychological test called the MMPI that showed precisely what the doctor is referring to with regard to the kind of multitude of problems; anxiety, relationship issues, depressions, obsessionality, over concern with what others are thinking about them, hypersensitivity. In addition to cognitive deficits, as well with the majority of the subjects who underwent some continuous performance testing also prior to the neurofeedback had some significant issues that we are able to correct in the experimental group with neurofeedback. But not in the control group who didn’t do neurofeedback in a study with 121 subjects.
Gwen: Well that leads me to a question because when I talk to people about neurofeedback and I tell them a little bit about what’s happened to their brain, they get really scared and worried that this damage is permanent. So is it permanent? Is it reversible? Or can it just simply be palliated in some way?
Bill: Yeah, it definitely appears to be quite reversible; in the 2005 UCLA study, the experimental group did seem to normalize a lot of the behaviors pre and post training and the cognition as well, the ability to think also improved pretty significantly. But even without neurofeedback, those who comply with the ongoing program of recovery after a few years tend to improve a lot of emotional regulation. And also even some cognitive deficits appear to improve as well just from time away from the substances, but combined with an active recovery program.
It seems a lot of things do improve; they don’t seem to improve quite as well as they do with people who have done neurofeedback though.
Gwen: So it’s not hopeless the brain does get better, but if they return to using, that’s going to reset it and get it back where it was before it got better. And with the neurofeedback it is going to make it improve more quickly. And perhaps if you do have a relapse, does it have an impact on the severity of the relapse if you’ve done neurofeedback?
Ray: That’s been my experience. People tend to have shorter periods of relapse, they tend to actually in an interesting way deteriorate a little more quickly and get back to health.
I wanted to just say one other thing in response to the previous question and that is that this sensitization of the brain systems that drive the urges and cravings; so it’s sensitized to drugs of all kinds that we use to get high, it’s also sensitized to stress. And levels of stress can increase urges, cravings. And we know that if you raise stress levels, there have been many studies for instance in laboratory animals, that they’re addicted and then found what would provoke relapse the quickest; raising levels of stress provokes relapse the quickest.
And the other very powerful thing about neurofeedback is how it begins to really recondition the autonomic nervous system, which is about the sympathetic, parasympathetic; sympathetic is the fight/flight system, parasympathetic is the healing or calming system of the brain. And it really increases the parasympathetic, the brains ability to calm itself in a cores common body.
Gwen: So when that is not working well then that leads people to use to try feel better.
Ray: It leads them to use, it leads them to get involved in all kinds of other compulsive behaviors. And that’s what we commonly see, they’ll put down the drink or the drug but then they’ll pick up other kinds of compulsions, whether it’s sexual compulsions, gambling, food problems. They are in a state of having these unbearable kinds of internal states that they seem to not be able to regulate. And the neurofeedback if for me has been the single most powerful tool to quickly start to regulate that.
Gwen: So it kind of breaks this cycle, ‘if we give up this addiction, now we’ve got that one, now we give that one up, we have another one’. So it kind of puts the breaks on that cycle, is that what I’m hearing you say?
Ray: To a great extent, yes.
Gwen: We have just a couple minutes before we’re going to go to break, but Bill could you just give us a real basic explanation on what neurofeedback is? Exactly what’s happening when people are getting it?
Bill: Good question. Ultimately, neurofeedback teaches our brain, teaches us how to feel better and how to think better is the easiest way to think of it. There are brainwaves, like we have heart waves, when you put a sensor on your heart, you can see how your heart is working. We have brainwaves as well when we put similar sensors on our scalp, we can see how our brain is working. And when you can show us how our brain is working with brainwaves that are related to how we’re thinking and how we’re feeling, our brain can self-regulate. It can learn to exercise the underlying brain state for the (inaudible) of those brainwaves. And the problems that are associated with them can reduce significantly.
Gwen: So it uses a computer program and sensors go on the persons head and that’s how the brainwaves are looked at. But people are always saying, ‘oh my gosh is something going into my brain’? You want to make sure people understand that it’s like a stethoscope where you’re reading the brainwaves but you’re not putting anything into the brain.
Bill: Yes, not directly through the sensors. But the brain when it can see, let’s say for example there’s a brainwave that some people have what I call, ‘daymares’ where during idle moments their brain goes into these kind of negative states where they start illuminating on things and worrying about things needlessly and things like that. Well there’s a sleeplike brainwave that gets too large while they’re awake and when that starts happening, their brain just goes into these negative thoughts and they’ll usually have nightmares at night as well.
If you have a lot of nightmares at night, virtually always have what I call daymares during the day. And for that when they’re looking at a screen, there’s an indicator for what is and what isn’t, and there’s auditory sound that are happening more rapidly when their brain is more awake. And when they start to get a little more sleepy, the sounds get higher in pitch and they begin to stop and this graph of what isn’t starts ratcheting up and then they can learn to control that sleeplike brainwave.
And then the underlying brainwaves that are related to it, the brain sort of waking up more end up regulating and they start waking up more. Like during the sessions though, it’s a lot of work for the brain initially, they might get really sleepy because it’s like a brain workout. But after the sessions, the first thing that starts to improve usually is their sleep wake cycle, that their nightmares usually in a handful of sessions the nightmares go away and then we’ll usually see afterwards they use what I call, ‘daymares’ improving as well.
Gwen: Before the break we were talking a little bit about what neurofeedback is and a little bit about how it works. Bill, would you like to continue that just a little bit of what you were saying before the break?
Bill: So what a session would look like is the clients come in, they’ll be asked some questions about the previous session and what’s happened since the session.
What’s most valuable is sort of the day following the session because a lot of people the day of the session might feel kind of tired for a bit during the day and we actually ask clients not take naps on the day that they’ve done their neurofeedback. And when they come in for a session after we’ve asked those questions, they sit down in a chair, we place anywhere from three to five sensors on their head in a particular location; two ear clips, one on their scalp and we make sure we have a good enough connection with the equipment, it will tell us when that’s the case.
And we start what’s called, ‘a protocol’; usually there are two or three different protocols that will happen in the session. That’s just where we put the sensors and what brainwaves we’ll be training and for how many minutes is all a protocol is.
So once they’re looking at the screen, the computer will be making sounds; when brainwaves are moving more in the right direction, there will be sort of more sounds happening. Almost all neurofeedback systems have an auditory component because all the research has had auditory feedback in it as well.
And then there’s also visual feedback in that they would be seeing some indicator of when they’re getting into the right states or maybe into some of the wrong states. And with their particular equipment BrainPaint, they would be indicators as well when the person is physically tensing up; it will say, ‘your tension is increasing’. And when they relax a little bit more it will say, ‘your tension is decreasing’. And if they’re moving around, if they’re talking during the session, it will give you these break periods that would say, ‘looks like you were talking too much in that session’, you’ll need to not do that next time.
Gwen: Let me just interrupt you here because what we’re trying to do, at least the way I understand it is, let’s say a person has a lot of anxiety, we’re trying to train the brain to be a little more calm. If the person has a lot of depression, depression and anxiety are two factors that can cause people to abuse drugs. So if they’re depressed, then you maybe want to help help the brain operate on a little bit higher frequency when appropriate.
Is that kind of the end goal here, is just to get the brain to be firing at the proper rate, at the proper time, as opposed to being anxious when you should be calm, or being depressed when you should be alert?
Bill: Absolutely, yes absolutely.
Gwen: Ray, did you want to say something?
Ray: I think that’s a good summation. A lot of these issues are about arousal regulation, whether a person is experiencing dramatic under arousal or over arousal. A lot of the brains that we’re dealing with rapidly shift states and put people in these unbearable kinds of places emotionally like in deep depression, or intense anxiety, or hyper arousal, or send them into migraine. Or the brain is up regulating when they’re going to bed at night when it really should be down regulating.
And the bottom line is that we’re helping the brain optimize its function, so that whatever its task is in front of it, whether that’s to slow down or speed up, it does it in an effective way. And if you give the brain significant feedback about its own functioning, as Bill said in terms of sound for instance and some visuals, the brain responds. The brain wants to be in an optimal state, the organism wants to be in an optimal state. So it’s a conditioning paradigm, the sounds begin to teach the brain and body what it’s like to be for instance, in a more relaxed state or in a state of more focused attention. Depending on what specific issues you are working on as Bill said, what the protocol is and what brain areas you’re trying to impact.
Gwen: So you’re really teaching the brain through feedback to shift into the appropriate gear at the appropriate time. Is that an oversimplification?
Ray: Not at all, it’s a wonderful simplification.
Bill: That’s precisely all we’re doing.
Gwen: Bill, just very briefly, could you give us the history of neurofeedback? Because as I said at the top of the show, it’s been around for 60 years but interestingly, most people have not heard of it. So just very briefly the history of it and then let us know why it’s not as well-known as it should be?
Bill: Good question. In the mid-60’s a man by the name of Joe Kamiya, in their laboratory they were teaching animals, rabbits to warm up one ear turning it red through heat biofeedback. And one of his graduate students said, ‘why don’t we try seeing if we can teach people to control their brainwaves’, because they were learning how to control their heartbeat and other biologic systems.
And so Joe had looked up meditators and research with EEG and found that some advance meditators would produce this very high alpha, so he thought, ‘what if we taught people to increase this alpha brainwave’? And his very first subject he found, he put the sensors on his head and over the course of the first session, this particular meditator was a person who didn’t know how to meditate, could actually increase his alpha across a session. And then across multiple sessions his alpha kept getting higher and higher and he thought, ‘wow, this is wonderful’.
And he said that since then in all the years of his research he never found anyone who could control their alpha like that again. But being that he found this one subject who could raise their alpha that much, he started to investigate the phenomenon. So he is really thought of as sort of the father of the field of neurofeedback.
But someone who really took it to the next level I would say would be Barry Sterman in 1969 did a study with cats initially where they were looking at some of Joe Kamyia’s earlier work. And he thought, ‘what would happen if we trained cats to increase this brainwave that’s involved with muscle control and to see what might happen with them’? It’s a brainwave that when they’re sitting in a state getting ready to jump on a mouse and their tail is twitching and they are being very still, they produce large amounts of (inaudible) if we can teach them to do it.
Sure enough, they were able to increase that brainwave. And then NASA needed a bunch of cats for some experiments to find out why astronauts were having these hallucinations. They thought maybe the gas was causing some seizure like activity and so they got this batch of cats from UCLA and when they exposed them to the cats, the cats that had done the neurofeedback were immune to the toxic effects of the gas, it stopped their seizure activity. And when Barry got word about that he thought, ‘wow, that’s remarkable, there must be some kind of self-regulation that’s happening with these cats’.
So he replicated that research where he trained their brains with this sensory motor rhythm, ‘training brainwaves’ he calls it. And then he exposed them to this gas and found that they were also immune. From there he did it with people who had seizure problems and it reduced their seizures by 67%. And that was where the field really began.
And from there, there have been other replications of seizure studies, but most of the work that people have looked at, well brainwaves with people who have attentional problem also have too many of these sleep like brainwaves when they’re trying to be awake. And others since have been training people with attentional problems with EEG biofeedback. As of last year, the American Academy of Pediatrics finally ranked neurofeedback as being a best practice for ADHD, equal with medications.
Gwen: So what they’ve said is that this can be as effective as medications. And what we know about neurofeedback is that post your medication when you stop taking it the effects go away. However, when you train neurofeedback and you’ve trained your brainwaves to operate more optimally, that doesn’t tend to go away. Is that correct, is that what we find?
Bill: Exactly. The long term studies, like some are as much as 10 years, like Eugene (inaudible) in his first addiction study, he did follow-up for 10 years and found the same success rate had happened. Joe Lubar did a 10 year follow-up with people with ADHD found that they didn’t. In the UCLA study we were able to contact everyone in the entire study, the 121 subjects, everyone except for three subjects and collateral contact, others who would verify that the people were still abstinent, that was an accumulation of a year-and-a-half after treatment; so the effects are permanent.
There’s also some FMRI studies with ADHD also that showed the problem went away in the experimental group who were on medication and doing neurofeedback. And then when they were retested six months and a year after the neurofeedback training, that those who did the neurofeedback, that part of their brain that was too sleepy had actually remained woken up.
For those who remained on the medication, their brains quickly reverted back to the state who didn’t do the training, their brains (inaudible). So yeah this is like an exercise just like when you learn to balance on a bike your brain develops some new neuro networks for that. And that’s permanent, that’s what we are teaching the brain with neurofeedback, to balance the brain state, that is how well we’re thinking and how well we’re feeling. And so when it develops new abilities, it never loses that. The brain speaks for how we feel and think or for riding a bike or playing a piano.
Gwen: So the application to addicts is that once they’ve done the neurofeedback training and their brain is more balanced, let’s say if they were doing that in a rehab environment or even on an outpatient basis, once they’re not doing it anymore there have been significant changes. To the point that they are likely not to continue to have the underlying things, such as anxiety or depression that they had which got them into the problem in the first place?
That’s a really convoluted question, but I guess what I’m trying to say, is opposed to the medication, when you get off the medication the effects are gone. When you’ve done neurofeedback the new neuro pathways have grown. The current links and connections are stronger and chances are they’re not going to return to the state that they were in.
Ray: And I might say that all medications, the kind we’re talking about have significant side effects and long term effects. You don’t get that with neurofeedback.
Gwen: Well that is a good thing and I think that I want to ask about that so hang onto that thought, Ray, I want to talk about side effects versus not. But we’re going to have to take a break right now and when we come back we will continue our discussion about neurofeedback.
Gwen: Before the break, Ray we were talking about side effects of medication versus neurofeedback. So are there side effects to neurofeedback and how do they compare to any side effects for conventional medications?
Ray: Side effects to neurofeedback for the most part seem to be limited to a session. So a person might go away and they might be a little too activated or a little under activated.
Gwen: What does that mean?
Ray: They go away kind of sleepy or they go away feeling a little bit of anxiety. They might have trouble sleeping that evening. That usually wears off within the first 24 hours and it’s a good indicator for us then to make adjustments in the kind of protocols we’re using. So side effects are minimal and they are far from long lasting. Whereas, we all know that most of the psychiatric medications have some pretty powerful side effects, not to mention that many of them are addicting in and of themselves. So they’re not good choices for our clients.
The underlying kind of issues that is most important for us to help people with is this whole issue of emotion regulation. I mean if you look at the DSM, which is the bible of behavioral disorders, over half the diagnostic categories are categories that have to do with a person’s inability to regulate their emotional states. When somebody puts down a drug like alcohol or cocaine or whatever, they are dramatically impaired in that ability. And they further impair themselves by using substances. So all of this stuff begins to arise, whether its anxiety, depression, rapid shifts in mood.
And the power I find with neurofeedback, particularly some specific types of neurofeedback is that you can quickly start to regulate their emotional states, which emotions are what drive us. And they’re driven by some pretty unbearable states, so you can go directly at that with very little side effect.
Gwen: Is neurofeedback helpful for everybody? Like some medications, like an antidepressant works better on this person than another kind. Is neurofeedback that way or can everybody be responsive to it?
Ray: I’ve only been doing neurofeedback for about the past four years. And I found a tiny subset of people that seem to not have a response. I’m talking about less than 1%. Most people seem to be able to respond. There are different types of neurofeedback and when one approach isn’t working, you have a number of options. We’re being told now that the brain is plastic, meaning it changes and it changes with experience and this is a learning experience. As long as the person is conscious and neurons are talking to one another, they can be impacted by this type of training.
Gwen: So really anything that we do in life is changing our brains, so there’s nothing magical about it, it’s just that we are changing our brain in a way that’s more directed, that’s more direct I should say, with a goal in mind. I mean I think if you sit and watch a great movie, you form a memory in your brain and so your brain has changed from watching that movie. And in this case we’re changing the brain but with the end result of looking toward where the brain is not responding and functioning in an optimal way.
Ray: Exactly right, we’re moving them toward optimal functioning. And there’s a whole branch of neurofeedback that those with peak performance with athletes and so on. And it has good effect and has been studied, so again, can increase the brains capacity to perform in an optimal fashion.
Gwen: And there’s something really interesting in neurofeedback called, ‘the Peniston effect’, Bill could you tell us a little bit about that?
Bill: Right, I think you’re referring to as what’s known as, ‘The Peniston Flu’, where people have done neurofeedback when they have an addiction and they start to use again. Ray touched on this a little bit also already, how we find that when people relapse, how we find that in similar to the research that I’ve been involved with Peniston and the UCLA study as well that within 4 weeks they’re going to stop using again.
A significant number of people who do attempt to use will find that they don’t get the relief they use to get from the substances prior to the neurofeedback. A lot of people will go right into almost the withdrawal state that they’re abusing sedatives or opiates and things of that nature where ordinarily they would get high for a longer period of time and to kind of enjoy it after they have not used after a period of time. They don’t get anywhere near the relief they used to when they’ve done neurofeedback; about 25% of them actually with the polysubstance abusers, those who use lots of other drugs. And it’s about 50% of the population of alcoholics; when they would attempt to use, about half of them would get sick right away.
Gwen: So it ruins the high. Does it do kind of like what Antabuse does?
Bill: They don’t seem to get that sick like Antabuse does. It’s just that they don’t feel so good, rather than kind of getting sort of easy going from alcohol for example, they’ll just get kind of sad and depressed from it and really sleepy, rather than getting kind of elated and euphoric.
Ray: I don’t think it’s directly comparable to Antabuse, which makes you very sick. I think what happens is that again; the brain is functioning at a better level. So you put a toxin in the brain and it’s going to have a more powerful response, a negative response, it doesn’t want the toxin.
We see the same thing when people come in, or I see the same thing and others do on medication. They may be on an antidepressant medication like an SSRI, they start training with neurofeedback and they weren’t having side effects on their medication, all of a sudden now they’re starting to have mild side effects and the medication needs to be decreased. Because the brain is now functioning at a better level, it doesn’t need what we’re putting into it artificially, if that makes sense.
Gwen: I see where I work that people who come in and are not sleeping well and they put them on something to help them sleep and after a few neurofeedback sessions, they’re falling asleep before they even take their sleep medication at night. So it does definitely help with sleep for sure.
Do people have to be careful if they’re on other medications? Is there any danger to doing neurofeedback when someone is on say an antidepressant or antianxiety medication?
Ray: The only danger is that they might not need the medication much over time. And I said that with tongue in cheek. No, they’re not going to have an adverse effect, but before they might not have been experiencing any side effects on the dose that they’re on, they might start to feel some mild side effects and will have to cut the dose down. That’s the more common thing that I see, I don’t know what, Bill sees.
Bill: Yeah exactly, I see a very similar thing. It can be like classic symptoms of over medication, if somebody is taking too much of an antidepressant for example, they’ll tend to lose their sex drive or they won’t get as excited about things as they were. One thing about neurofeedback is that a good protocol for someone doesn’t become bad, but when they’re on a medication and they start getting this kind of flat affect after like 8 to 12 sessions and not experiencing as much joy, you do what you do with everyone else, you refer them to a prescribing physician. The client seems to be overmedicated and what are your thoughts? And then always what the doctors suggest and then they can adjust the medications. But my experience, over half of the clients that I work with who are on medications usually get off of them. And I’ve not seen any negative side effects either from any particular drugs, there’s no kind of contra indications I would say with any of the prescribed psychiatric medications and neurofeedback.
Gwen: So one side effect is that you may not need your medications anymore?
Ray: And actually like a subset of people, right now with this whole narcotic epidemic that’s going on, I have some clients who have been maintained on Suboxone and are now having side effects and want to come off it. And I’m working with them with neurofeedback to bring them off of Suboxone and we’re having very good success, so there’s that piece too.
Gwen: We’ve only got about two minutes until break; I was wondering if one of you could talk to listeners about why this is so wonderful, you know it’s not everywhere, people often haven’t heard of it.
Bill: The biggest reason is and I used to be a little more paranoid I think about it, you know big pharma and things like that, but what it really seems to boil down to is paradigm paralysis. Meaning that people tend to want to do what they are used to doing. And so for hundreds of years there are three routes of change; you can cut something out with a surgical procedure, you can put something in with a pill, and you can talk about it. This is a new thing where talk therapy says, ‘talk about it and you’ll feel better’, this is a very different paradigm, which is to teach you how to feel better so then you can talk about it.
And so it’s a very different paradigm that people are getting used to, there’s more research with this than most other forms of therapy and medications and things like that. It sort of doesn’t fit in with the three kind of archetypes. And things tend to take about 40 to 60 years to really take hold, if they stay around long enough that is to be more accepted.
But in the addiction space, it is really starting to take off. A lot of people are beginning to look toward evidence based treatments and they are finding that neurofeedback as really standing out above a lot of the others. So in the addiction space it’s really beginning to take hold.
But also, it’s not a panacea for addiction in my experience when it’s not combined with an already effective treatment approach for addiction. It doesn’t do very much.
Gwen: So you can’t just do neurofeedback and not do anything else is what you’re saying?
Bill: Right, with addiction there are certain things like PTSD and ADHD where it does seem to have a big effect regardless of whatever else they do. But when it comes to addiction of any kind that is, when its combined with an already effective treatment approach than it significantly reduces that resistance to that treatment, so you get the compliance that’s necessary for the long term recovery.
Ray: I agree very much with that. From the addiction perspective, people need a recovery program of some sort and recovery supports. Let me also say that I’m primarily a psychotherapist and what I find is that this often prepares people to actually do some psychotherapeutic work that they wouldn’t typically be capable of doing. They come to me now for their neurofeedback, they don’t want therapy and then about two months into the neurofeedback they say, ‘you know I’ve got this stuff coming up, I really want to start to work on it now’. And they seem to have the regulatory capacity, the ability to deal with the emotion. So it really enhances the psychotherapeutic work.
Gwen: I would now like to bring someone on the show who has actually benefited from neurofeedback with his addiction. I have Michael on the line and he’s a 46 year old retired firefighter from the northeast. He’s been sober since October, which is the longest period of sobriety that he has had in six years. He says that he owes being sober in large part to finally discovering and undergoing neurofeedback sessions.
Michael’s quitting odyssey began about six years ago when he came home too drunk one night to even untie his shoes. So his wife insisted that he do something and he did. He got a sponsor and he started regularly attending AA meetings. But he only had brief periods of sobriety, like a week or a month, or maybe a couple of months.
Ironically, he was functioning so well at work that nobody even knew that he was an alcoholic but at home it was a far different story. And he describes himself as being really ‘checked out’ from the family. He was there, but he wasn’t present for his wife or his three kids and his wife had to carry all the domestic duties on her shoulders. And every birthday and holiday ended really badly with Michael passed out drunk and everybody kind of just trying to pick up the pieces.
And Michael’s wife told him twice to leave and twice he did. And both times he swore that he would quit and both times he didn’t, at least not for long. At the core of Michaels challenge was that he had PTSD that was stemming from unresolved childhood sexual abuse and he had also seen a lot of grizzly stuff at work in his life as a firefighter. He was unable to go to sleep easily, he couldn’t stay asleep, he had horrifying nightmares. And when he drank he would pass out and those would kind of keep the nightmares at bay, but of course that was no way to live.
And last August when Michael was banished to his mother’s house, he got drunk and he was driving to his sponsor’s home and he hit a parked car and didn’t even know it. Not until about three hours later when a police officer that he worked with on his job came to the door and handcuffed and arrested him and carted him off to jail. He was really humiliated and embarrassed.
So Michael entered a 28-day residential program and when he came out he started doing neurofeedback once a week, along with doing counseling and AA. So welcome to the show, Michael, I’m glad you’re here with us.
Michael: Good Morning!
Gwen: Hi, I wanted to ask you, how quickly once you started doing neurofeedback did you notice benefits from it?
Michael: I would say within the first few weeks I noticed a difference. You know, I basically woke up one morning and realized I actually slept the night and I didn’t have a nightmare.
Gwen: What was that like for you to have slept a night and not have had a nightmare?
Michael: Well I’m 46 today and I don’t believe my whole adult life I actually slept a night all the way through. Before this radio show this morning, I was thinking about it and like last night, I slept all night like a baby.
Gwen: And what is the benefit when you’re struggling to stay sober, what is the benefit of simply having a good night sleep and not having nightmares?
Michael: Well I was at the point where I would wake up as my nightmares were so bad that I would wake up and I would actually be like scared in the morning, I was like afraid to go to sleep at night because I didn’t want to wake up terrified every day.
Gwen: And when you have a good night’s rest and that’s been consistent since you started doing neurofeedback that the nightmares have gone and you’re getting a good sleep most nights, is that correct?
Michael: Yes, every night.
Gwen: And by being well rested and the nightmares are being gone, how does that impact your desire to use or any types of skills or things that you’ve learned about that you need to apply to help stay sober?
Michael: For one I’m actually productive, I can do stuff, where I spent a good majority of my time just kind of in a fog for years. I just couldn’t you know, go from A to B; I would get distracted easily and I couldn’t remember things. Say I had tasks to do at home, I knew what the tasks were but I’d start to walk to do a task and before I got to it, I couldn’t remember what I was supposed to do. I think it’s due to mental and physical exhaustion I would imagine.
Gwen: Well and you also made a lot of attempts to be sober before neurofeedback came into your life, but you always backslid because something was not working for you then that’s working for you now. What do you think that is that’s giving you that edge so that you’ve been sober since October and before if you had quit in October you would have been drinking again by Christmas?
Michael: Right, I would assume the neurofeedback has clearly removed my nightmares. It clearly has allowed me to get rest, you know like a quasi-normal person I can sleep at night. And I just feel different, much different than I’ve felt my whole adult life.
Gwen: So you’re not self-medicating to sleep, you’re not self-medicating to get rid of the nightmares, so those components are not driving you the way that they were.
We don’t have too much longer here but I would love for you to tell the listeners the story about the day you went out on the boat.
Michael: I was working on a commercial lobster boat and it was the kids last day on the boat and he’d work on the boat for a few years and he pulled out his backpack and pulled out some beers. And he went to hand me a beer and I said, ‘no, thank you’ and I left that at that. But I didn’t have no craving, no mouthwatering urge; my desire to drink is gone. There’s no urge, that overwhelming urge where my mouth would be watering, I would get that phenom of craving, it’s completely gone, it’s been removed.
Gwen: That is amazing. Well believe it or not that’s all we have time for today and I hope you now know what neurofeedback is and why it can be so powerful in helping addicts remain sober.
I want to thank our guests, Ray McGarty, Bill Scott and Michael for taking time out of their busy day to be on, “Break the Chains”. You can learn more about our two expert guests on my talk zone show page under ‘guest listings’.
Ray, would you also like to tell listeners how they can reach you?
Ray: Yes, www.mcgartyassociates.com
Gwen: How about you, Bill?
Bill: Yes, at www.brainpaint.com or if you’re looking for a neurotherapist you can Google search, ‘find neurotherapist’ and you can find a lot of providers we have in every major city as well.
EVERYTHING YOU NEED TO KNOW ABOUT INTERVENTIONS
Host: Gwen Carden
Guests: Burr Cook
Gwen: If you’ve seen the A&E’s series, “Intervention”, you know that doing an intervention isn’t easy on anyone. It’s not easy on the addict and it’s not easy on those affected by the addict’s behavior. But what you probably don’t know is that there’s more than one kind of intervention; for example, they’re not all ambushes like you see on the TV show. Interventions conducted professionally have a huge amount of preparation behind them that helps ensure the addicts safety and also increases the chance that the intervention will succeed.
During the course of this hour we’re going to learn a lot about this sometimes controversial practice and later on we’ll speak with someone who was in fact the subject of an intervention. I want to begin by introducing my expert guest, Burr Cook; Burr is a Board Certified Interventionist in New Port Beach, California and he has conducted hundreds of interventions over the past several decades. He’s also a Certified Alcohol and other Drug Recovery Specialist too, a Nationally Certified Addiction Counselor and a Registered Nurse.
Burr is trained and experienced in three intervention models and teaches intervention techniques to students around the U.S. Welcome to the show, Burr.
Burr: Hi Gwen, thanks for having me on.
Gwen: I’m just delighted; Burr, I would like to start our discussion today with a history, just a brief history about interventions. Because I was really surprised when you and I did the pre-interview at what a long history interventions have. We think of it maybe of something just modern, but that’s not the case at all.
Burr: Sure, well professional interventions are fairly modern, going on within the last almost 60 years. But interventions for alcohol and drug abuse have really been around for as long as there has been alcohol and drug abuse. They were just pretty primitive efforts and for the most part it involved some sort of banishment where people just wouldn’t tolerate the behavior and people were banished from homes and towns and villages and so forth.
But in the early 1960’s, interventions took on a more professional, more organized, more prepared approach and there’s been an evolution in intervention models and the practice of interventions from that time.
Gwen: What exactly is an intervention?
Burr: An intervention is simply applying solutions to problems with respect to alcohol and drug abuse or other types of harmful behaviors. The intervention as we think of it today is a professionally organized and prepared meeting or a series of meetings between a family and somebody who is the subject of the unwanted behavior. Oftentimes it can be not just the families but with businesses as well; businesses oftentimes will conduct interventions on employees.
Gwen: I know there’s a lot of variations and types of interventions, but are there two or three that are considered pretty much the gold standard type of interventions, or the ones with the most history and experience?
Burr: The classic interventions that most people think about and the one that has been portrayed on television shows is the Johnson Model Intervention or a variation of a Johnson Model in which it is a surprise meeting with somebody who has got an alcohol or a drug problem or a behavioral health problem. And the intervention is somewhat conspiratorial; people portray it as an ambush and even though we try to do what we can to ameliorate that ambush feel to it, it is a surprise.
There are also a couple models that are Invitational Models, in other words a person is invited to either a meeting or a series of meetings and that’s the Family Systemic Intervention Model, or the ARISE Model of intervention.
Gwen: And what is an Invitational Model?
Burr: An Invitational Model is there’s been an assessment done, there’s been preparation and planning for the meeting. But the person often called, ‘the identified patient’, or the ‘IP’ is invited to the meeting. And typically in the case of the Family Systemic Invitational Model, the IP or the person of concern is the entire family. So the intervention is not just on the person with an addiction problem, it’s on the family and the family dynamics that exist. So it’s not so much about the addict, it’s more about how addiction is impacting the family.
Gwen: And we do know from certainly modern psychology that it’s not just, ‘fix this person in my family, they’re all messed up’, usually it’s been a whole system that has contributed to the end result of the person having an addiction.
Burr: That’s absolutely right and that’s why the evolution has been more to take care of the entire family system. Actually the process starts before we ever have the meeting; but it’s about shifting the family system, providing them with the education and preparing the entire family for treatment and recovery as a long term solution to addiction and we get better outcomes when we do that.
Gwen: So the identified patient knows about this at all times or are they brought in part way into the process where you’ve already been working with the family?
Burr: Generally the process starts with the family members that are concerned with the assessment, but sometime prior to that meeting and the invitation is extended to the family member that everyone is concerned about to attend a family meeting. And oftentimes we don’t use the word, ‘intervention’, we may call it a, ‘family meeting’, we may call it a ‘workshop’.
A Systemic Family intervention is typically a one to two day, sometimes it might go into two-and-a-half days. Let’s say it’s a two day meeting, whether its education provided, there’s also some experiential work opportunity for process. But it’s really about taking a look at addiction, defining what addiction is and defining how it’s affected this family specifically. And educating them about their recovery options and treatment options and so forth and preparing them for the next step, which is treatment and then onto recovery. So it’s conducted in a very open, transparent, non-judgmental, non-shaming fashion to really get everyone to take an honest and open look at how addiction is impacting the family.
Gwen: Is the Invitational, does that typically have better results or does it really just depend on the specific situation?
Burr: Well there are lots of factors; it depends on their family and their willingness and motivation to submit to the process, not only of the workshop but of treatment and recovery. Obviously the skill and expertise of the interventionist that’s involved can play a factor. But what we find is that the more people in a family that are for recovery for themselves, and with the understanding there’s often more than one person that has a substance abuse problem in a family. We run into that quite often. So while somebody may have called about one specific individual, oftentimes there are other individuals that have their own issues. And the more people in that family we can get into recovery, we do see better outcomes.
Gwen: So how do you decide that it’s time to have an intervention?
Burr: Well when you’ve first of all you have somebody that’s engaging in a harmful behavior, it doesn’t have to be addiction, it can be gambling, it doesn’t have to be a chemical addiction. It can be gambling, a sex addiction, it could be codependency, eating disorders, whatever the harmful behavior is, somebody who is resistant to getting help and a family wanting to really raise the bottom for that person and prevent what the inevitable consequence is of continued unhealthy behavior. So it’s unhealthy behavior resistance to that, then it’s time to do an intervention.
Gwen: Now does an intervention always need to be conducted by a professional to be successful?
Burr: Well not always and the families that are able to do an intervention on their own and they’re not only incredibly resilient and they have a lot of recovery capital, there are families that tend to intervene quickly when the problems first start arising. And many families do.
I’ve heard many stories of families that have tried to do their own and then they end up calling a professional. So it really is dependent on how long this has been going on; what are the specific circumstances that a family is dealing with and what are the benefits of hiring an interventionist? Because an interventionist does far more than just help somebody get into treatment, they provide a lot of education that’s needed for the family, they provide a lot of support and guidance through this recovery continuum. I like to think that it’s always better to have a professional because they’re going to help you with the bumps, the inevitable bumps that are going to be in the road.
Gwen: What are some examples of things that can crop up that if someone without professional training is not there that could really get out of hand and maybe have a poor result?
Burr: Well families dealing with addiction are struggling in many different ways, at many different times to try to get somebody into treatment. And they have a history of how they interact with each other and it’s one that the addict is generally pretty skilled at doing an end run around their efforts. So really if you look at what is the family dynamic? What’s going on in this family? Are they stuck? Are they able to move forward? Are they making any headway in this person getting help is really the defining thing. If what they’re doing has been working as far as moving forward in getting into either some help or healthier behaviors, well that’s great, the question is, is what they’re doing working? And if it hasn’t been working it might be time to seek professional help.
Gwen: And by not working it could also mean further distancing the addict from the family, or plunging the addict into a little bit more despair and perhaps even more complicated behaviors. So that would be something that I would think would be, you would want to be very careful if you’re going to do this that that could happen if the person doing it doesn’t know what they’re doing.
Burr: Oh yeah, absolutely. These are highly charged emotional atmospheres with people where the entire system is fairly defensive; there’s a lot of blame passed around, there’s a lot of different avoidance and denial going on in the family. And things can escalate without somebody who is not emotionally attached to this situation that the families generally can’t deescalate, they have a pattern of interacting in which things are emotionally charged and tend to deteriorate. Particularly when it’s really just a series of confrontations, those are rarely helpful.
Gwen: So if its confrontational, as I say sometimes you do see that on the “Intervention” TV show, it looks very confrontational and people often just fly out the door and get lost. I would assume that would be one of the main goals that you would have, to minimize the confrontation and have everybody be as calm and receptive to it as possible.
Burr: Sure and that really is a great deal is the fact (inaudible 14:36) interventionist, how do they work with the family? Are they keeping this at worst carefrontational, but do they have an atmosphere of non-judgment, non-shaming. We really want to bring love into this. And are they skilled at controlling the family and deescalating? This is one of the reasons preparation is so important because oftentimes you will have family members that are angry, they’ve been abused, they’ve been through the wringer and there’s a lot of emotions involved and you want to deal with those before you sit down for your meeting. You want to help create an atmosphere of one of love and really about a family getting together to deal with a problem and not villainizing somebody.
Gwen: Burr, before the break we were talking a little bit about the process of interventions and I wonder if you would like to elaborate a little bit on some of the details of that?
Burr: Sure, the process of intervention starts with an assessment. Not only an assessment of the individual that people are concerned about and what their behaviors have been, but a further assessment into what is their history been? What is the history of the consequences that they have experienced? What sort of case of chemical addiction? What drugs have they been using? What patterns have we seen in changing? What are the behaviors that we’re concerned about? What sort of history is there of psychiatric or mental health problems? What sort of history is there with regard to self-harm or harming others? Who is this individual?
And we want to get an assessment about the family dynamic, everybody else in the family and what their relationship is to that person and what sort of dynamic exists. Is there a history of enabling behaviors? Is there a tremendous amount of animosity between one person or another? We want to look at this entire family dynamic.
Gwen: What do you do with the information once you’ve gathered that? How does that apply to the intervention?
Burr: Well it really tells you what the educational needs of the family is going to be. And also might throw up some red flags of who needs some help with being able to put this whole process and the experience they’re having with addiction into a context of where we’re looking at somebody that’s sick and needs help. You know sometimes there are family members that say, ‘this guys a liar, he’s a cheat, he’s a thief and I want him out of here’. Well that may help them to get them out of there but it doesn’t do much to help the addict.
So sometimes it’s really about finding out what the educational needs of the family are and how we can get everybody on the same page. These family dynamics are often complicated. Again, they’re very defensive systems; this disease really ties entire families up in knots. So it’s really about who is the family I’m working with? What are the dynamics that I need to be aware of? And where can we make some shifts in this family dynamic to a healthier dynamic before the intervention, so all that information is important.
Other information that’s important for the interventionist is what is going to be the best clinical fit for this person in treatment? In other words, what are going to be appropriate treatment scenarios and also appropriate treatment scenarios for families? We may want to send a family member to treatment for codependency for instance, and so that information is going to be very important in the referring that we’re going to do for treatment and also for the ongoing aftercare and recovery recommendations for the entire family.
Gwen: So there is really a lot that goes into being a professional interventionist and a lot of bumps in the road for someone who thinks that they could just come in and make some decisions and be authoritarian and send somebody away. I can see how that definitely could have a very dangerous outcome.
Burr: Absolutely, in fact we try not to be authoritarian, we try to be collaborative; we are guiding, we are directing the process. The family actually plays a big role in what happens, it’s not like this miracle worker comes in and drags somebody off to treatment, that’s not how it works.
Gwen: What sort of expectations should a family have or not have where an intervention is concerned?
Burr: Well families should have an expectation that they are going to be educated about the disease of addiction and about recovery so that they can make healthier decisions through the course of a person’s illnesses. They can expect to be surprised at outcomes because oftentimes my experience is that families have been defeated for so long in trying to deal with addiction that they tend to be very much focused on outcomes, and they’ve been losing hope for a long time. So they can expect to get education, guidance and support that is going to help them prepare and deal with whatever the outcome is.
Gwen: So the expectation is to be prepared for whatever the outcome, but not to expect, ‘this is going to happen, this is going to work, my loved one is going to go to treatment and there’s just going to be flowers and roses and rainbows from here on out’.
Burr: Sure, families have their own denial and really they have their own misunderstanding if oftentimes it’s all about getting somebody into treatment. Well the reality is is what somebody does after treatment is what’s going to be the most important thing. And so families do need to be prepared for this. And we’re talking about people with chronic illnesses and their recoveries are chronic as well, they happen over a long period of time. So somebody gets intro treatment right, families tend to immediately worry about what’s going to happen when they come out of treatment. And then somebody gets out of treatment, they’re going to worry about what the next step is.
So one of the things that families can expect with a good interventionist is to be supported for whatever is happening. Oftentimes there may be relapses, there may be families falling back themselves into old behaviors, families relapsing into self-defeating behaviors. And so families that hire a good interventionist that’s going to be there for long haul can expect to be supported and expect to get good guidance throughout the process. Even families where everybody, everybody is doing everything right, it’s a bumpy ride, recovery. Recovery is often traumatic for families. What families shouldn’t expect are quick fixes.
Gwen: And they can expect to have what it sounds like kind of almost a long term relationship with the interventionist that starts before the intervention actually occurs and afterwards and helping as you said, to guide the families to get the identified patient into the right treatment environment. And then to guide them once they get out, it’s like a relationship with a therapist almost it sounds like.
Burr: Right, we’re not doing therapy, although we may oftentimes refer various family members to therapy, not every interventionist works that way. That’s how I work at, Family Intervention Now, my company, that’s how we work. We look at this as a process and a process that is chronic that takes place over an extended period of time. So we want to be there for the support of families and to help guide them and support them through the process. We get better outcomes when we do that.
There are interventionists that however that see this as only a front-end piece, their job is solely to get somebody into treatment and that’s just their business model and that’s how they work and then they leave the rest up to the families and the different supporting professionals that they’re working with afterwards and all that. I like to have my hand in it a little bit; again, it’s a collaborative process. If families trust you and rely on you we should be able to give them the guidance and support they need for as long as they need it. I always work towards doing what’s necessary to get you so that you don’t need somebody like me.
Gwen: So an interventionist that kind of comes in and does the intervention and leaves is not necessarily a bad thing as long as you have supports on both sides of that, the before and the after?
Burr: Well sure, families need the support. It’s not necessarily a bad thing as long as everybody knows what to expect from that interventionist. As you’re getting hired as an interventionist, you need to tell families what the scope of your services entail. I don’t put a time limit on how long I work with families as long as everyone is taking direction. Because oftentimes this is a long process; for me to say that I’m going to be with you for the intervention and four weeks afterwards, that doesn’t work for me and I don’t think it works for families.
Now a different interventionist, they may have the case management piece, the ongoing piece as a separate part of their contract. Some interventionists do it inclusively where everything is inclusive. And some interventionists frankly just are only there to get somebody into treatment. So it’s about business practices and it’s about what that interventionist does as part of their business, and how they see themselves in their own role of interventionist for a family.
I talk to families that I worked with years ago that may call up with a specific question or identify a problem, perhaps there’s been a relapse or they just have a question of, ‘this is what’s going on in my family now, do you have any suggestions’? And I want to be there to support the families, so I think it’s important.
Gwen: I would like to move into the cost, because Burr what you were describing earlier, especially the way that someone like you does it, sounds like its requiring a high level of professionalism and a fairly significant amount of time on the parts of the family, as well as on the interventionist. So what can people expect an intervention to cost?
Burr: You know I think the average is between $4,000 and $8,000; the interventions that I do are typically $5,000 to $6,000, depending on the model and the circumstances of the family. I know interventionists that do interventions as little as $2,000 and those are interventions where the part of the interventionist is fairly limited within the process. There are other basis models that some interventionists have where they charge separately for the intervention and then have a case management piece being with the family from anywhere up to a year or so after the interventionist where they will charge a separate fee for that. And the cost for that varies, but generally between $4,000 and $7,500 from most of the interventionists that I know, that’s the price range.
Gwen: And I think some people might say, ‘oh wow, that’s a lot of money’, but if they stop and think of what they may have been spending enabling the addict or on legal fees or medical bills and that kind of thing, it’s not necessarily that expensive when you look at it in that context.
Burr: No there’s lots of savings involved, again we’re raising the bottom in preventing future medical issues, legal issues, and financial issues for a family. The families have spent a lot of money on this individual, typically before they call an interventionist and this is really about money well spent. And oftentimes when you are working with an interventionist, treatment centers will take that into consideration and might discount the family on the cost of their treatment. That happens fairly often; treatment centers are happy to work with interventionists and occasionally they will provide partial scholarships for families. It’s never a guarantee but it does happen. So there’s savings there for families as well when they’re working with an interventionist.
Gwen: That’s good to know. Now are there any states that require interventionists to be licensed?
Burr: No, and it’s an unregulated industry; literally one can hang a shingle and call themselves an interventionist.
Gwen: Okay and that always raises a red flag when you’ve got kind of a Wild West situation. Let me ask you this; if you are considering hiring an interventionist, what are some of the most important questions that you need to get answers to before you write a check?
Burr: Sure, one question would be, how long have you been doing interventions? What sort of training and supervision did you receive to become an interventionist? What sort of models do you work in with interventions? Is there a contract that people are going to sign?
Gwen: Is that a good thing? You should always have a contract?
Burr: I think you should have a contract; it’s an agreement to work together. I think that within that contract families should know who they are hiring and what their responsibilities are going to be, what it covers and what it doesn’t. I think that it’s important to find out is the person you’re working with, are they licensed, are they certified? What are those licenses and certifications, do they actually mean something?
People with licenses and certifications have codes of conduct and ethical expectations for themselves, so you’re more likely to get somebody that’s ethical if they’re licensed and certified. And it’s also a testament to some of the training and experience they have. They want to know what the service is; it’s important to find out what services are you buying. What are the obligations and responsibilities of the interventionist? I would want to know if somebody carried malpractice insurance. Are they actually a professional?
Another important question, a very important question is, is the interventionist independent of a treatment facility? In other words, are they working for a specific treatment center? And you can’t always get this information from the interventionist but it is important for the interventionist to be independent of the treatment center, unless the family knows that they’re working for a specific treatment center.
Gwen: Why is that so important?
Burr: Well sometimes treatment centers will pay an interventionist; they might put them on a monthly stipend to bring people into their treatment center. Well that shouldn’t be what guides an interventionist in making a referral, an interventionist wants to refer a client to a treatment center that’s clinically, financially, geographically appropriate for that person. They don’t want that to have the influence of, ‘I’m going to send your loved one to this treatment center because this treatment center gives me so much money for each person I put into a bed’. Or, ‘they give me so much money a month to put people into their beds’. That’s highly unethical; it’s a conflict of interest. But there are interventionists that do engage in that practice and there are treatment centers that engage in that practice. So I think it’s very important that it be established prior to hiring an interventionist, that they are independent of treatment centers.
Gwen: Okay, that’s a very good point. What are some other good questions to get answers to?
Burr: A good question would be what is the scope of your responsibility? Are you just there for the intervention? Will you be helping my loved one get into treatment? Will you be taking care of the logistics and the transportation? How long will you work with us afterwards? I think those are all very important questions.
Gwen: But because as you said earlier, not all interventionists do the exact same thing. So you need to know if this is someone who does the process from A to Z, or who just comes in and does the intervention and then has people on the other side who take over. You wouldn’t want to be surprised to find that out.
Burr: Sure, are there going to be additional costs? For instance, if I was doing an intervention on a woman and there was going to be transportation to a treatment center, in other words there’s an expectation that we’re going to get on a plane and fly to Acme Treatment Center across the country, families need to know in that case that if they don’t have a family member traveling with us, that we’re going to need a female escort to go alone with. I wouldn’t escort a female patient alone just as a matter of safety and just good practice. The people that we are working with are highly compromised and so you want to be safe and you want to be appropriate. So that might be an additional cost.
Gwen: Now is it usual for an interventionist to do the transportation or again, is that one of those things that might be in place or might not be in place?
Burr: Sometimes family members will travel with the individual. Sometimes an individual really doesn’t need anyone to go with them and it’s up to the interventionist in collaboration with the family to make those determinations. These are judgment calls.
But frequently people go to treatment by themselves, particularly at Invitational Interventions where the process is very open and very transparent. Oftentimes we’ll have people that will travel on their own, it’s just really about the circumstances and really about their specific circumstances. You know are people so compromised? Are they dangerous? By dangerous I mean, can they be trusted to get on a plane and go through an airport or two without going to the bar. So what kind of support they need is really a judgment call that the interventionist and family will make together.
Sometimes a person going to treatment wants a family member or a friend to travel with them and that’s fine. I like to travel with individuals because I see my part that I play in their life as being an advocate, for not only their treatment but for recovery. So the better I can get to know them and better establish a relationship, I think that works towards a better outcome in the relationship.
Gwen: Would you ever accompany someone to a treatment center who has either said, ‘no, I don’t want to go’ or has said, ‘yes’ but they were just saying that in the moment to get the heat off of them?
Burr: Well I think that happens from time to time. Generally if somebody is going to pack a bag and go to the airport, they’re going to treatment. But it doesn’t mean that ambivalence won’t step in and fear and things like that. Maybe they’re starting to experience withdrawals; it doesn’t mean they won’t have second thoughts. This is why preparation is so important; we need to know what this person is going to be experiencing from leaving the intervention and going to treatment so that we can be prepared for it.
For instance, if I was doing an intervention on an opiate addict and I frequently do, to expect them to not use and go through withdrawals and travel across the country to a treatment center is really an unrealistic expectation. They’re probably going to either want to have some sort of detox medication on board, or they’re going to want to get high before they go to the airport, otherwise they simply won’t go. So you’ve got to take all of these things into consideration about what’s going to happen in that transport period.
Gwen: And very quickly we’re going to have to go to break but I know one of the important questions would be to find out what the persons fee structure is, like if it’s a flat fee, or hourly, or a sliding scale. What other things pertain to the fee would be important? So the fee structure, you want to establish that upfront and that’s probably going to be in that contract you say everybody needs to have.
Burr: Sure you want to know. And different interventionists have different fee structures and they have different payment structures. Some interventionists do work hourly; it’s just a matter of what is their particular business practice. But it is important that families know upfront what their expenses are going to be and what they can expect as far as expenses. There’s nothing worse than finding out in the middle of a process that things aren’t what you thought they were.
Gwen: Yeah, this is hard enough without having an unpleasant surprise coming in the form of a bill.
Burr: And another thing prior to hiring an interventionist, Gwen that I think is important is that families need to know what can they expect as far as cost for treatment? Is there going to be a cost for detox? Is their medical insurance going to help them? What sort of treatment center is going to be financially appropriate?
I think it’s important for families to know that hiring an interventionist is one thing, but there is a cost of treatment. And so they generally need some guidance and support and a lot of education about what types of treatment centers are out there and what the cost of their services are. And we try to give that to the family that we’re working with.
Gwen: We’ve been speaking with an interventionist and it’s time to talk to someone who has seen interventions from the other side. Our guest, Sami is 24 years old and she knows what it’s like to have an intervention because she was the subject of one about ten months ago.
Her odyssey into drug abuse started when she was 15 and she was involved in a horrendous snowboarding accident in Colorado. She had six major surgeries and a hip replacement by the time she was 17 years old and along the way she became addicted to prescription Vicodin and she also began drinking heavily. When she was about 20, her doctor got wise to her pill addiction and he cut her off but that didn’t stop her. She turned to the streets, she bought pills, she started smoking methamphetamine and before long she was shooting heroin into her veins several times a day.
Her parents were of course, terrified for her life and they sent her into treatment. By 2013 she had been in two inpatient rehabs, plus a combination of 12 detoxes, outpatient treatment programs and sober houses. Finally, Sami was living on the streets. She did keep her belongings in a sober house but she really didn’t stay there, she would just come back every now and then to get something that she needed.
She was malnourished and strung out and she was really in grave danger of dying until one day about ten months ago she walked into the sober house where her belongings were living and she saw an interventionist named, Chris Bennett sitting there. On the table there was a laptop computer opened to Skype and on the screen she could see the pained faces of her distraught parents that were looking into the room. Her mom was weeping and her dad was stoic; Sami frankly just avoided the camera because she was really too ashamed for the pain that she had caused her parents.
Ironically she knew, Chris because he had staged her brother’s intervention a few months earlier. Anyway, Sami why don’t you take it from here and tell us just what that moment was like when you walked in and saw Chris.
Sami: Oh gosh, that moment was pretty terrifying. I knew exactly what it was. I still at that point was still trying to manipulate the situation and pretend that I wasn’t getting high. A lot of cursing and things were thrown; I put the computer down so I didn’t have to see their faces. At that point Chris offered me a couple options and I was pretty hesitant to going anywhere so I packed my bags. And then at that point he threatened to call the cops and he said that he already had the license plate number on the car out front, which I had no idea he knew. And I was very sick, sweating profusely and at that point real desperate to get high.
So about a half hour into it he mentioned a detox and I had a couple terms I wanted to get by; basically the first one was that I wanted to be in medical detox, I was way too dope sick to have any other kind and he offered me a place in Ventura County. After about 30 minutes of some very not nice words and going back and forth, I decided to go. And I had called the person I was dating at the time who was waiting in the car basically that I decided to go and that I had no other choice, they were going to call the cops on both of us. So that was devastating; she was crying and I was crying. And then she drove away and then I got in the car with Chris.
Gwen: And what did that feel like getting in the car with Chris, packing your bags and knowing you were going once again to detox and rehab?
Sami: Oh God, hopeless, very depressing. I felt pretty humiliated once again, not really knowing like what was going to happen, where I was going to go. It was more just like it wasn’t going to work, I had done it so many times that I was pretty down in the dumps at that point and still had no hope of sobriety or living a sober life as I do now. It’s still very surreal; I mean without that moment I don’t think I would have made it this far to be honest with you. As painful as it was, I’m very grateful to that situation.
Gwen: And were you really angry at your parents that they had staged an intervention?
Sami: Oh yeah, I was again, I’m a very selfish addict and in my eyes I felt very ambushed. And again, I didn’t want their help and they intervened without me knowing; it was the first time that they came in without my knowledge. So yeah, I definitely felt ambushed and I was angry and resentful towards both Chris and my family.
Gwen: Now your brother as you mentioned, had already had an intervention. Did he play any part in this and perhaps helping you to see that it was the best thing? Or were you angry with him as well?
Sami: You know, at this point my brother was in the program and he was in a rehab in Utah. He played a part, but I had no resentment against him.
Gwen: Did you speak with your parents when you were on the way to rehab or did it take you awhile before you could even speak to them?
Sami: No, it took me awhile. I think when I started working the steps of Alcoholics Anonymous and really surrendering to my addiction, I kind of reached out to them. I think it took me awhile, I had to like let all my resentments die down before I could involve them in my life again.
Gwen: Because they were taking away from you the thing that you thought you most loved.
Sami: Oh yeah, I mean I had nothing besides my drugs.
Gwen: Had you become estranged from your family?
Sami: Yes, I hadn’t spoken to my parents in a long time. At this point I really didn’t know if my brother had relapsed or not, I didn’t really care at that point.
Gwen: Do you feel, Sami like the intervention saved your life?
Sami: Most definitely. As much as I hated Chris, we’re actually really good friends now, but it was a pretty pivotal part of my recovery.
Gwen: Very quickly why don’t you tell listeners how your life is now, 10 months later, what are you up to these days?
Sami: I currently live in Ocala and I have an apartment, I’m in the process of getting my real estate license. I have an amazing boyfriend and a cat and I pay my bills. It’s crazy; I’m like a member of society, a respectable member of society.
Gwen: Well and that feels pretty good doesn’t it?
Sami: Oh yeah, I have a great relationship with my family as well.
Gwen: Well we are all rooting for you and I know that you’ve been through an awful lot, as has your family. Thank goodness the intervention had a good outcome and you were open to it. Life is looking pretty good for you.
Sami: Yeah, thank you.
Gwen: That’s all we have time for today. It’s been a fascinating discussion and I really hope that our listeners today learned something about the intervention process that maybe would be useful.
I want to thank our guest, Burr Cook and Sami for taking time out of their busy day to be on the show. Burr would you like to tell listeners how they can find out more about you or get in touch with you if they want to?
Burr: Sure, my name is Burr Cook; the name of my business is “Family Intervention Now.” You can just type into your browser, Burr Cook at Family Intervention Now or
www.family-intervenion-now.com and my website will come up. Or you can call me directly at 949-903-3008 and I’ll be happy to talk with you and answer any questions I can about the intervention process.