Summer House

Individuals, who engage in substance abuse use, are often facing more than one issue. Research literature has shown, time and time again, that there is a stereotypical personality that accompanies the addict, rightly named, the ‘addictive personality’. Some characteristics that accompany said individual are as follows:
 

* Impulsivity
* Difficulty in delaying gratification, sensation seeking
* Nonconformity combined with a weak commitment to the goals for achievement valued by the society.
* Social alienation and a general tolerance for deviance.
* Poor tolerance for stress, increased sensation of distress
 

This is being outlined, to assist the lay person in understanding why addicts cannot just stop using drugs. Substance use is not just an action it is in effect a lifestyle. This implies that in order for an individual to stop utilizing drugs, he or she must not only actually stop using but must change aspects of personality that may lead him or her in that unhealthy direction. Once this has been outlined and agreed, the individual next needs to decide a plan of action. It is unadvisable for an individual to attempt to stop using drugs on his or her own. Breaking such habits is difficult for anyone with the assistance of others let alone as a solitary mission.
 

So, now the question comes, inpatient or outpatient?
 

Research conducted over the last few decades indicates that longer treatment periods are associated with more positive outcomes. On average, a treatment period of three months was correlated with more positive results. In the case of substance abuse treatment, this is to mean less incidence of relapse. Patients expressed more positive feelings towards more intense treatment plans. So, those individuals who were in residential treatment and received one on one consistent attention were more likely to indicate a better sense of overall satisfaction in regards to treatment. However, there is little statistically significant difference between outpatient and inpatient long term treatment recidivism. Meaning, long term effects of staying clean do not differ.
 

In order to understand the above findings, one must integrate the information previously presented. In order for substance use to cease permanently, an individual must totally change his or her behavior and surroundings. Going into a residential facility assists in removing one from his or her life. This cuts out locations and individuals that probably assisted in facilitating drug use. One is also in the presence of others with a similar goal. All of these factors are positive and if one can integrate them into his or her psyche, inpatient treatment can longitudinally provide the basis for healthy living. The one factor that proves to sabotage all this is properly presented in one question often asked by residents of treatment programs:
 

What Happens When I Get Out?
 

It is a valid question. In a controlled environment anything is possible. If temptation is outlawed, the individual does not have to utilize his or her decision making skills because in effect, the decisions are made for them. Substance users in this context can be thought of as a child. As children, our parents monitor our behaviors and our actions often giving us the proverbial slap on the wrist if we reach too close to the fire. As adults, we must utilize our decision making skills or else we have the potential to be severely burned. For this reason, substance abuse recovery must take place in small steps with much reinforcement utilized.
 

The main variable shown to influence whether treatment programs work or not is continued monitoring. One study that analyzed outcomes of parolees who participated in treatment communities (TC), either outpatient or inpatient, found that the outcome variable: return to prison, was correlated with longer participation in ‘aftercare’ treatment programs. Thus, those individuals who left prison and had some level of reinforcement, was more likely to stay clean and not return to incarceration.
 

McLellan (2004), a researcher out of the University of Pennsylvania, compares substance abuse treatment to treatment for any other chronic illness. Mclellan point out, that what will make treatment effective is the three following variables noted:
 

* Making treatment options attractive
* Offer options/alternatives
* Constant and continued monitoring of the individual
 

It is no shocker that most people are more inclined to do something they view as positive or attractive. So, first things first, treatment options should be something that the individual in fact beckons to the individuals tastes. Varying options in the form of treatment (i.e group versus individual therapy for instance) keep treatment ‘entertaining’ if you will, thereby making continued treatment as an option. Finally, when an individual leaves treatment he or she needs to continue with what we will call ‘stabilization’. Whether that means switching from residential to outpatient treatment or joining a group like alcoholics anonymous or narcotics anonymous after intense treatment depends on the individual and the program from which he or she graduated.
 

No one program will fit every individual as every person is different. Residential treatment may very well be the best option for some and not for others. It is up to the individual to decide what will suit him or her better. Having said that, when considering substance abuse treatment one must remember that treatment consists of a plan that must unfold longitudinally. Changing one’s behaviors and in effect, one’s personality is a long process which, with proper guidance and support can occur. Like any task worth undertaking it takes time, perseverance and most importantly assistance from those who can help to attain a life free of drug use.

Drug and Alcohol addictions continue to effect people from all walks of life. Many people believe that all drug and alcohol abusers are criminals or are morally weak. But, that simply is not the case. Whether one is a doctor, stay-at-home mom, lawyer, teacher, preacher, mill worker, teenager or even a child, drug and alcohol addictions respect no one. Addiction is a physiological dependence on something, meaning it is both physical and psychological in nature. Therefore, when one is addicted one literally needs whatever it is that feeds that addiction.
 

Education remains a key factor in fighting drug and alcohol dependencies. When people understand drug and alcohol abuse prevention becomes visible and effective. The National Institute on Drug Abuse (NIDA) notes, a tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data NIDA has amassed. NIDA further states that overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" - the gap between the public perception of drug abuse and addiction and the scientific facts.
 

In the mean time, it is necessary to facilitate assistance for the current drug and alcohol abusers. There are diverse options in treatment and rehabilitation programs. Those options include: 12-step programs; 12-step alternatives; programs, wilderness camps and schools for troubled teens with addictions; inpatient residential; day treatment; outpatient treatment; faith-based facilities; and holistic treatment.
 

The 12-step program, one of the most popular rehabilitation programs, originated for Alcoholics Anonymous, but later versions were adapted for other addictions. The synopsis of the 12-step programs consists of: 1) Admit that we are powerless over drugs or alcohol and that our lives have become unmanageable. 2) Come to believe that a Power greater than ourselves can restore us to sanity. 3) Turn our will and our lives over to the care of a Higher Power. 4) Make a searching and fearless moral inventory of ourselves. 5) Admit to a Higher Power, to ourselves and to another human being the exact nature of our wrongs. 6) Be entirely ready to have a Higher Power remove all these defects of character. 7) Humbly ask a Higher Power to remove our shortcomings. Make a list of all persons we have harmed, and be willing to make amends to them all.
9) Make direct amends to such people wherever possible, except when to do so would injure them or others. 10) Continue to take personal inventory and when we are wrong promptly admit it. 11) Seek through prayer and meditation to improve our conscious contact with a Higher Power, praying only for knowledge of the Higher Power’s will for us, and the power to carry that out. 12) Having had a spiritual awakening as the result of these steps, try to carry this message to other drug addicts or alcoholics, and to practice these principles in all of our affairs.
 

The Comeback Treatment Center of California states several facts regarding drug and alcohol rehabilitation: drug addiction and alcoholism is a highly treatable disease (continued suffering is optional); no drug addict really likes the way he or she has to use drugs and alcohol; drug addiction can be outgrown in an honest, responsible, character-building environment; personal growth feels better and lasts longer than any drug; the hardest part about drug rehab recovery is getting started, the rest is reward, once earned, sobriety becomes a precious gift of spirit and mind that overcomes negative emotions and mental blocks that could keep one from continuing in a responsible direction towards self-fulfillment.
 

In conclusion, drug and alcohol abuse will be around as long as there are people, drugs and alcohol. One must make a proactive choice to educate and understand these addictions so that early intervention can be made as soon as abusers are identified. Ideally, education and training would decline the statistics on addictive behavior, but personal pleasure and the masking of personal problems through addiction remain prevalent today.

Miami Herald — Most everybody in this neighborhood coffee haunt has been hooked on something. The high school dropout with beauty-pageant looks has been fending off a heroin habit for two decades. The former football player says he is clean now after years of popping pain pills. Santa Claus succumbed to alcohol.

Nineteen of the fallen are here tonight for therapy and healing, for a second — or a third or fourth — chance, hoping to reclaim a piece of their lives. They form a circle in the pebble garden behind KoffeeOkee, which is owned by Harold and Dawn Jonas, former users who now help others kick drug and alcohol habits and answer the question: What now?

A resort on the Atlantic in Palm Beach County, Delray Beach has another, less obvious civic profile: Florida’s sobriety capital. Like Hazelden in Minnesota and Utah’s Cirque Lodge and the communities that surround them, it is a place to dry out, clean up. Its recovery community is spirited and multilayered, a dense mesh of dozens of treatment facilities, counseling centers and residential housing that gives addicts a wide-reaching chance for recovery and permanent lifestyle change.

This is where people start over. And sometimes stay.

”You want to be here if you are struggling with an addiction,” says Anna O’Connell, 43, who has been in and out of detox for crack cocaine, heroin and alcohol over the past 20 years and attends therapy sessions at KoffeeOkee. “This is the closest thing to family; this is where you feel safe.”

Treatment for addictions that the medical community now accepts as chronic diseases ranges from private $10,000-a-month treatment centers to free coffee, counseling and karaoke at java houses such as this one, which hosts formal therapy sessions twice a week and informal gatherings even more often.

MANY, FROM ALL OVER

The size of South Florida’s recovery community is difficult to estimate because only one layer — facilities with residential treatment beds — is licensed by the state. Delray Beach alone offers more than 1,200 beds in transitional houses — a second layer — according to the South County Recovery Residence Association in Delray, which monitors halfway residences.

Every week in Delray, about 5,000 addicts attend 12-step meetings that stretch from 7 a.m. to 11 p.m. At Crossroads Club, a squat stucco complex off Lake Ida Road, about 700 people walk through the doors every day to attend 120 meetings aimed at a swath of needs, from treatment for cocaine addiction to obsessive cluttering, says Susan Miller, executive director, a recovering alcoholic.

Addicts arrive from as far away as Oregon and Rhode Island and from as nearby as South Beach. They face daunting odds: Relapse rates range from 40 to 90 percent, depending on the client’s dedication and will power, sustained treatment, and follow-up care, according to the National Institute on Drug Abuse.

”My parents sent me here to try to turn my life around,” Rani Canosa, 21, a pretty, petite college dropout offers one Monday night at KoffeeOkee. “Alcohol made me feel good. I would be really, really happy, then really, really sad, then just miserable.”

Canosa, from a Baltimore suburb, started drinking seriously as an 18-year-old freshman in college. Soon she could consume a 12-pack of beer and a half-bottle of vodka in a two-hour stretch.

She had tried treatment centers in Maryland and Pennsylvania but returned home only to relapse once she was back among friends and familiar haunts.

Canosa has been in Delray Beach since Aug. 29, out of treatment at the Wellness Resource Center in nearby Boca Raton since Feb. 5. She lives in a halfway house and works as a barista at KoffeeOkee.

”The truth is, if I was home, I would be drunk or looking to get drunk,” she says softly, never making eye contact. “I actually want to be here.”

COLLECTIVE STRUGGLE

But what distinguishes this vibrant recovery community from similar places elsewhere, is a growing sober social infrastructure, an informal network of places for people to mingle without the colossal temptations of drugs and alcohol.

”Delray Beach is a microcosm of the various layers of the recovery process,” says Howard Lerner, clinical director of the Addiction Treatment Program at South Miami Hospital. “Those struggling belong to a fraternity.”

Here, even in the midst of fighting for sobriety, addicts can go dancing at popular clubs that hold sober nights, sing karaoke at a sober coffee house, listen to live music at a sober juke joint, call in to recovery radio shows, roar into the sunset with a sober motorcycle club and pray at a Bible study just for them.

”The struggle with an addiction can be forever,” says Harold Jonas, a mental health counselor. “So all we really want is for people to be healthy and to laugh and have hope and be part of the world, not just the recovery community.”

The collective sobriety struggle here is no longer anonymous. Recovering addicts live among ”normies” and often work on Atlantic Avenue, the city’s glittering ribbon of sidewalk cafes and boutiques and galleries.

”When you are on this journey, it’s incredibly important to feel like you are not alone, to see and be around people just like you,” says nattily-dressed Jonah Yolman, now 22 months on the clean side of a wicked crack-cocaine addiction.

Yolman, 29, sitting in a Starbucks on Atlantic Avenue, quietly acknowledges two people ordering coffee who are in one of the dozens of 12-step anonymous programs. He talks casually about the familiar identifying signs of people in recovery: the relentless smoking and coffee drinking, the trails of cigarette butts and empty coffee cups and candy wrappers. And the most obvious sign: people tightly clutching books with dark covers, their 12-step guides.

”We are everywhere, living and working in this city,” says Yolman, a counselor at a local treatment facility who promotes two sober nights at area clubs. He and a partner are also launching a similar sober club night in August at a South Beach club (sobernightlife.com).

“People come here and enjoy the weather, the beaches, low-key atmosphere and try to start over.”

NATIONAL REPUTATION

In some ways, Delray’s recovery community draws its inspiration from a small, rural town in Minnesota that over the years became a magnet for recovering addicts, from marquee rock stars like Eric Clapton to the anonymous souls who came looking for peace and order.

Since 1949, addicts have famously flocked to Hazelden, which started as a farmhouse retreat in Center City for men working their way through programs based on the 12-step principles.

Over the years, teams of doctors, counselors and chaplains developed a holistic approach to rehab now emulated worldwide.

More than three decades ago, Delray’s first sober houses opened for people making the transition from residential care to independent living. The houses — a yellow clapboard with a sweeping porch on one street, a peach bungalow with a white-picket fence on another — are sprinkled within neighborhoods, around public squares, near churches.

Rents range from $125 to $175 weekly for a room and access to kitchens and family areas. Most landlords require random drug tests, and some perform bed checks or monitor whether their clients have reported to work.

Two years ago, Crossroads Centre in Antigua, a drug-treatment program founded by Eric Clapton, opened in the city. And in February, Lecreshia Hall, a Boca Raton psychiatrist, started Hallway of Life Recovery Center, a faith-based, 28-bed transitional facility for women, on a quiet residential street near downtown.

”When I did the research to find the best place to open, Delray Beach kept coming up,” says Hall, who leads Bible study on Tuesdays. “The idea of our center is to teach our clients how they can use the Bible to help in recovery.”

But Delray Beach’s national reputation as a recovery community has been unsettling for some residents.

”We don’t mind taking care of the people living here, but we don’t particularly like people coming from all over the country or the world to recover,” says City Manager David Harden. “But it’s a fact of life, and so we have tried to be supportive of the community.”

Harden says Delray Beach gives money each year to the Drug Abuse Foundation of Palm Beach County, the county’s oldest chemical-dependency treatment and prevention center. The Commission also sold city property to Crossroads Club several years ago, allowing the center to expand.

Over the years, residents have complained to city officials about the lack of security and control at some sober houses. Owners need only a landlord permit to run them, a reality that makes strict regulation difficult.

Jonas, who heads the South County association and runs the coffee shop, says problems stem mostly from unscrupulous landlords who hope to turn quick profits at the expense of fragile tenants and the surrounding neighborhood.

”You got some of these operators who don’t manage the property or the tenants, then they put the people out and leave them homeless,” Jonas says. “There are some operators we would all be better off without.”

FINDING SOLACE

Jonas came to Florida 20 years ago full of reasons to give up. But with the help of his father, who put him in a West Palm Beach treatment center, he cleaned up and stayed put.

A slight guy with a thick mustache and a thicker Philadelphia accent, Jonas sits in the lounge of his coffee shop one afternoon rattling off his story with sobriety’s detachment and confidence.

Pot by 13. Then acid and speed and cocaine. Graduation to alcohol. Bottomed out in the injection world of cocaine and heroin.

Jonas entered rehab in 1987. He married Dawn, a recovering cocaine addict (they met in a 12-step group), and went back to school, earning an online master’s degree in counseling psychology from Antioch University and a doctorate in addiction studies from International University in St. Kitts.

”You come out of a situation like that broken and with very little to hold on to,” Jonas says. ‘You come out of treatment and you say, `Now what?’ ”

So Jonas and his wife — who recently celebrated her 22nd clean year — began working to answer this huge question, working to help define what life after treatment really means.

In 2000, they launched sober.com, a Web clearinghouse for 30,000 recovery programs nationwide. And for 10 years, he operated a recovery residence in Delray Beach. She runs a home for women in recovery.

Two years ago, they opened KoffeeOkee, in many ways ground zero for the recovery community. Inside is a cozy mix of velvet wingback chairs and bistro tables and a small cafe offering every coffee, tea and juice imaginable but absolutely no alcohol. The walls are covered with bulletin boards offering testimonials, treatment and housing ads, and calendars outlining the month’s sober activities.

A piano sits in the corner with a dried white rose on top, a delicate memorial to Valerie, a drug counselor who died a year ago.

Of an overdose.

InfoPackets.com — Major recovery organizations have been using the Internet to help individuals recovering from drug and alcohol addiction. An increasing number of support groups are springing up all over the web with one goal: to provide online, 24/7 assistance to people recovering from some form of substance abuse.

According to the U.S. Department of Health and Human Services, almost 2 million people this year will find themselves entering some kind of rehabilitation for abuse of various drugs or alcohol. In the past 70 years or so, these alcoholics and addicts would have left various rehabilitation institutions to then begin a lifetime of meetings in church basements with fellow addicts or alcoholics, there to find the support and encouragement to continue their life clean and sober.

Typically, the online venues focus on the 12-step recovery approach — the recovery program outlined by Bill Wilson and Bob Smith, founders of Alcoholics Anonymous. It’s a popular program and, it seems, there is now a 12-step program tied to every possible substance abuse or behavior, including Nicotine Anonymous. Instead of holding daily or weekly meetings however, more and more of these 12-step groups are turning their attention to providing online chat, web forum, and list server-based recovery groups. The Internet is being used to connect similarly afflicted individuals and groups from all over the world. Over the world wide web, recovery meetings are no longer of an hour’s duration in a church basement, groups now meet for 24 hours a day with members checking in and out at will or as needed.

Alcoholics Anonymous the oldest of the recovery groups, now offers meetings using email list servers, VoIP, and chat. AA provides online meetings in 33 different countries and hosts them in more than 10 different languages!

Narcotics Anonymous has more than 20 internationally accessible email meetings and Cocaine Anonymous offers 6 internationally accessible email meetings.

Of course, for every benefit of online meetings, there are also some risks. The use of chat protocols, for example, opens up a portal to the user’s PC that may expose them to risk of being hacked. Email-based list servers also pose the problem of how to remain anonymous when the entire virtual room can see your email address.

There are also hazards from various unscrupulous recovery organizations that prey on individuals in early recovery or their families. Over the Internet, they seem like legitimate organizations, but they are not always. As with most Internet-based activities, various fraud, email harvesting, and identity theft schemes abound. But even in those cases, Internet-based solutions emerge. One organization, All Addictions Anonymous Watch, for example, focuses on keeping a watchful eye on some of the less scrupulous efforts to exploit recovering individuals.

Exploiting Internet technology may prove to be a great boon to people trying to shake addictions. It has truly become Addiction Recovery 2.0. Nonetheless, family members and recovering individuals would be wise to stick to the best known recovery organizations (e.g AA, NA, CA) and, if they choose to participate online, they should get a Yahoo!, Gmail, or Hotmail mailbox using a pseudonym to keep themselves truly anonymous.

Utah — “Methamphetamine addiction has the worst long-range organic effect on the brain of any drug,” said Glen Hanson, University of Utah Addiction Center director.

Hanson’s blunt comment defines extent of the the public health problem in meth-damage control in Utah.

He was speaking at an all-day meth workshop before 30 participants; family members, caregivers and health care professionals in Roosevelt on June 21.

Addiction of any kind is a learned repetitive behavior, but meth is the worst, ” explained Hanson, “It alters the brain biology in ways similar to Alzheimer’s or Parkinson’s disease.”

Why would anyone choose to damage their brain to such a degree? The answer, because “it feels good,” may be the best an addict can offer after treatment.

Simplistic as it sounds, it is not wrong. Meth over-stimulates the “feel-good” portion of the brain and can severely damage a person’s cognitive abilities.

“The brain is a network of 100 billion cells that transmit information by making 2,000 connections individually,” Hanson said, telling the group why an addict’s ability to communicate has been compromised.

“Stimulated brain cells respond by releasing dopamine to anything that feels good” he continued. “Over-stimulated brains release too much dopamine. Then the free radicals that are chemically abundant in dopamine will eventually destroy portions of the brain.”

Meth stimulates the release of dopamine in excess. The more an addict uses the more they crave. It affects the cognition system in the brain by “turning-off” the prefrontal cortex.

As a consequence, meth addicts loose inhibitory control, tending to act on impulse rather than reason. They overreact to situations, tending toward rage.

This is partly due part to the “damage to the orbitofrontal cortex which ultimately inhibits saliency,” said Hanson. “The addict becomes motivated most by getting and using meth over anything else.”

It fouls up the meth addict’s ability to appreciate consequences like taking care of their children, themselves or being cognizant of others.

“Meth addicts may steal from or abuse their family members with little conscience,” the researcher explains. “All they think of is the drug, because the reward portion of their brain is on all the time.”

Hanson referred to the amygdala reward-region of the brain, which processes memory and emotional control. Damage to the region and the adjacent hippocampus region leaves the addict agitated and often aggressive.

Once these areas are damaged the memory portion of the addict’s brain often fails to recover even with treatment.

“Rehabilitating cognitive systems requires exercise,” explained the researcher. “Sometimes that means establishing new pathways in the brain around damaged portions that will never return.”

“Treatment is lengthy,” he continued, “requiring five to seven months for brain function to stabilize and restore saliency. It’s hardest for meth addicts because their familial support systems are often irreparably damaged. They’ve hurt the very people they need most.”

In the end, there are successful treatments to re-develop cognitive skills through mental exercise. One way, Hanson explained is through literacy education, which seems to help re-establish cognitive functions.

So, why with all this wreckage would anyone choose to use meth? Hanson’s research suggests that there is a strong sociocultural component contributing to the meth scourge in Utah.

“Meth abuse demographics indicate that it is the primary drug of choice among women,” he explained. “Thirty-seven percent of all women in treatment are addicted to meth. Men use it too, but represent fewer addicts in treatment than women.”

Some women are attracted to meth as it is readily available, cheap and long-lasting in effect. Others discover more energy, weight loss or help with social inhibitions through meth abuse.

“In Utah, there’s a sociocultural tendency of women toward perfection,” said Paul Smith, eastern Regional Director of the Division of Child and Family Services. “Perfect wife. Perfect mother. Perfect beauty. Too much pressure toward perfection drives the social component of meth abuse.”

“Whatever the cause, abuse is only part of addiction,” Hanson said. “Only 15 percent of users become severely addicted, which means 85 percent of users are out there managing their drug use.”

Why people become addicted may, in part, be genetic. For example, researchers found that many women in treatment suffer from other repetitive disorders like smoking or alcoholism.

The most interesting connection was re-occurrence of attention deficient-hyperactivity disorder. The familial connection of ADHD or alcoholism may include a predisposition toward drug addiction among family members.

There’s also the social aspect of addiction. Meth tends to stay in the family. A documentary shown at Saturday’s seminar showed women frankly admitting that, “My daughter introduced me to meth and then I gave it to my sister, and so on.”

Hanson notes that addictions like alcoholism re-occurs in families, but there is hope. Children removed from addictive families show no greater addiction rates than children from non-drug abuse families.

However, children left in addictive families are almost certainly going to experiment with drugs. Addictions, particularly those with long-term treatment requirements like meth are a burden on Utah society.

“Forty-seven percent of women in treatment for meth addiction have children,” Hanson continued. “Worse still, 45 percent of female meth addicts end up in prison. Incarcerated women cost the state $30,000 each and an additional $33,000 for each child placed in foster care. All totaled, jailed addicts cost the state about $100,000 a year.”

Treatment, on the other hand, costs the state about $15,000 per person. More recently, the treatment alternative has become policy in the criminal justice system of Utah. The effort is to stop the revolving door of prison addicts.

“New strategies for treatment are highly successful, but the addict must remain in rehabilitation,” said Hanson. “Judges are learning that success requires mandated, long-term compulsory treatment. I guess they figured that success means more taxpaying Utahns.”

Sun Sentinel — South Florida is tops in all the wrong things again, this time in prescription drug overdose deaths, with Palm Beach County leading the state in fatal methadone overdoses last year, and Broward ranking second in deaths involving the anti-anxiety drug Xanax and third in oxycodone fatalities.

No one knows why South Florida owns this tragic distinction, but one thing is clear: It proves why crackdowns on doctor shopping and unscrupulously run "pill mills" are so essential. And why they deserve an even higher ranking on the law enforcement priority list.

Drug addiction is not a victimless problem. Even if it’s not your loved one who’s hopelessly hooked, your safety may be affected because addicts often turn to crimes like burglary or robbery to feed their habit.

So combating addiction, and reducing the incidence of overdoses, is a societal, not just a personal, responsibility.