Family and Relapse

July 30, 2014
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Families Recover Together

By Terence T. Gorski
Author and Trainer

This Article is excerpted from: “Staying Sober- A Guide To Relapse Prevention By: Terence T. Gorski

In many cases the addict is the first family member to seek treatment. Other family members become involved in order to help the alcoholic get sober. Many family members refuse to consider the fact that they also have a problem that requires specialized treatment. These family members tend to deny their role in their addicted family and scapegoat personal and family problems upon the addicted person. They develop unrealistic expectations of how family life will improve with their loved one getting abstinent. When these expectations are not met, they blame the addict for the failure, even though he or she may be successfully following a recovery program. Their attitudes and behaviors can become such complicating factors in the addict’s recovery that they can contribute to the process of relapse and even “set-up” the addict’s next “episode of use.”

On the other hand family members can be powerful allies in helping the addict prevent fully engaging the relapse process. Relapse Prevention Planning utilizes the family’s motivation to get the addict sober. As family members become involved in relapse prevention planning, a strong focus is placed upon co-addiction and its role in the family relapse process. Family members are helped to recognize their own co-addiction and become actively involved in their own treatment. Addiction is a family disease that affects all family members, requiring everyone to get involved in treatment. The addict needs treatment for addiction. Other family members need treatment for co-addiction.

The term “co-addiction” is sometimes used to refer only to the spouse of an addict and other terms are used to refer to other family members. We are using the term “co-addict” to refer to ANYONE WHOSE LIFE HAS BECOME UNMANAGEABLE AS A RESULT OF LIVING IN A COMMITTED RELATIONSHIP WITH AN ADDICTED PERSON.

Co-addiction is a definable syndrome that is chronic and follows a predictable progression. When persons in a committed relationship with an addicted person attempt to control drinking, drug use, or addictive behavior (over which they are powerless), they lose control over their own behavior (over which they can have power) and their lives become unmanageable.

When you try to control
What you are powerless over
You lose control
Over what you can manage.

The person suffering from co-addiction develops physical, psychological, and social symptoms as a result of attempting to adapt to and compensate for the debilitating effects of the stress of living with someone who is addicted. As the co-addiction progresses, the stress-related symptoms become habitual. The symptoms also become self-reinforcing; that is, the presence of one symptom of co-addiction will automatically trigger other co-addiction symptoms. The co-addiction eventually becomes independent of the addiction that originally caused it. The symptoms of co-addiction will continue even if the addicted person in the family becomes sober or joins AA/NA, or the co-addict ends the relationship.

The condition of co-addiction manifests itself in three stages of progression.

Early Stage: Normal Problem Solving and Attempts to Adjust

The normal reaction within any family to pain, to crisis, and to the dysfunction of one member of the family is to do what they can to reduce the pain, ease the crisis, and to assist the dysfunctional member however possible in order to protect the family. These responses do not make things better when the problem is addiction, because these measures deprive the addicted person of the painful learning experiences that bring an awareness that his/her addiction is creating problems. At this stage, co-addiction is simply a reaction to the symptoms of addictive disease. It is a normal response to an abnormal situation.

Middle Stage: Habitual Self-Defeating Responses

When the culturally prescribed responses to stress and crisis do no bring relief from the pain created by the addiction in the family, the family members TRY HARDER. They do the same things, only more often, more intensely, mores desperately. They try to be more supportive, more helpful, more protective. They take on the responsibilities of the addicted person, not realizing that this causes the addict to become more irresponsible.

Things get worse instead of better and the sense of failure intensifies the response. Family members experience frustration, anxiety, and guilt. There is growing self-blame, lowering of self-concept, and self-defeating behaviors. They become isolated. They focus on the addict’s addictive behavior and their attempt to control it. They have little time to focus on anything else. As a result they often lose touch with the normal world outside of their family.

Chronic Stage: Family Collapse and Stress Degeneration

The continued habitual response to addiction in the family results in specific repetitive, circular patterns of self-defeating behavior. These behavior patterns are independent and self-reinforcing and will persist even in the absence of the symptoms of addictive disease.

The things the family members have done in a sincere effort to help have failed. The resulting despair and guilt bring about confusion and chaos and the inability to interrupt dysfunctional behavior even when they are aware that what they are doing is not helping. The thinking and behavior of the co-addict is OUT OF CONTROL, and these thinking and behavior patterns will continue independent of the addiction.

Co-addict degeneration is bio-psycho-social. The ineffective attempts to control drinking and drugging behavior elevate chronic stress to the point of producing stress-related physical illnesses such as migraine headaches, ulcers, and hypertension. This chronic stress may also result in a nervous breakdown or other emotional illnesses. Out-of-control behavior itself is an addiction-centered lifestyle that pervades all life activity, even that which seems unrelated to the addiction. Social degeneration occurs as the addiction focus interferes with relationships and social activity. Spiritual degeneration results, as the focus on the problem becomes so pervasive that there is no interest in anything beyond it, particularly concerns and need related to a higher meaning of life.

Recovery from co-addiction means learning to accept and detach from the symptoms of addiction. It means learning to manage and control the symptoms of co-addiction. It means learning to focus on personal needs and personal growth, learning to respect and like oneself. It means learning to choose appropriate behavior. It means learning to be in control of one’s own life.

Because it is a chronic condition, co-addiction, like addiction, is subject to relapse. But a condition of co-addict relapse may be more difficult to identify. Without an ongoing recovery program and proper care of oneself, old feelings and behaviors thought to be under control may surface and become out of control. Life again becomes unmanageable; the co-addict is in relapse mode.

RELAPSE WARNING SIGNS FOR CO-ADDICTION

From the observation of counselors who have worked with recovering family members, relapse warning signs for the co-addicted significant other have emerged. The following list has been compiled from these observations.

1. Situational Loss of Daily Structure. The family member’s daily routine is interrupted by a temporary situation such as illness, the children’s schedule, the holidays, vacation, etc. After the event or illness, the significant other does not return to all of the activities of his or her recovery program.

2. Lack of Personal Care. The significant other becomes careless about personal appearance and may stop doing and enjoying small things that are “just for own personal enjoyment.” The person returns to taking care of others first and self second or third.

3. Inability to Effectively Set and Maintain Limits. The significant other begins to experience behavioral problems with the children or roommates. Limits that are being set tend to be too lenient or too rigid and result in more discipline problems.

4. Loss of Constructive Planning. The significant other begins to feel confused and overwhelmed by personal responsibilities. Instead of deciding what is most important and doing that, he or she begins to react by doing the first thing that presents itself, while more important jobs go undone.

5. Indecision. The significant other becomes more and more unable to make decisions related to daily life.

6. Compulsive Behavior. The significant other experiences episodes during which he or she feels driven to do more. Whatever has already been done does not seem to be enough.

7. Fatigue or Lack of Rest. He or she becomes unable to sleep the number of hours necessary to feel rested. When sleep does occur, it is fitful.

8. Return of Unreasonable Resentments. The significant other finds himself or herself mentally reviewing persons or events that have hurt, angered, or been generally upsetting. As these are reviewed, the significant other relives the old emotions and feels resentments about them.

9. Return of the Tendency to Control People, Situations, and Things. As the co-addicted significant other feels less control over life, he or she begins openly to try to control and manipulate other people or situations. The addicted person may be the prime target, but does not necessarily have to be.

10. Defensiveness. The co-addicted person may not totally approve of some of his or her own actions, but when challenged about them will openly justify the actions in a sharp or angry way.

11. Self-Pity. The co-addict begins to dwell on problems from the present or the past and in turn begins to magnify them. The significant other person may ask, “Why does everything always happen to me?”

12. Overspending/Worrying about Money. The significant other may be very concerned about the family finances, yet impulsively spends money in order to “feel better.” He or she becomes convinced that what was purchased was deserved, but ends up feeling guilty and even more trapped.

13. Eating Disorder. The significant other “loses” his or her appetite to the point that even favorite foods are not appealing. Or the significant other may begin to overeat, regardless of appetite, in order to feel better. The overeating satisfies for only a very short time, or not at all.

14. Scapegoating. There is an increasing tendency to place the blame on other people, places, and things. The co-addict looks outside of self for the reasons why he or she is feeling bad.

15. Return of Fear and General Anxiety. The significant other begins to experience periods of time when he or she is nervous. Situations that previously did not cause fear or anxiety are now causing those emotions. The significant other may not even know the source of the nervousness.

16. Loss of Belief in a Higher Power. The significant other begins to lose belief in a higher power, whatever it may be. There is a tendency to rely more on self-alone, or to turn to the addict for strength and the solutions.

17. Attendance at Al-Anon Becomes Sporadic. The significant other changes the pattern of Al-Anon meeting attendance. He or she may go to fewer meetings, thinking there isn’t time, the meetings aren’t helping, or are not needed.

18. Mind Racing. The significant other feels as though he or she is on a treadmill that is going too fast. In spite of attempts to slow down, the mind continues to race with the many things that are undone or the problems that are unsolved.

19. Inability to Construct a Logical Chain of Thought. The significant other tries to solve problems and gets stuck on something that would normally be simple. It seems that his or her mind does not work anymore, that it is impossible to figure out the world. As a result, he or she feels powerless and frustrated with life.

20. Confusion. The significant other knows they are feeling out-of-sorts, but don’t know what is actually wrong.

21. Sleep Disturbance. Sleeplessness or fitful nights become more regular. The more the person tries to sleep, the less he or she is able to. Sleep may come, but it is not restful. The significant other looks tired in the morning instead of rested.

22. Artificial Emotion. The co-addict significant other begins to exhibit feelings without a conscious knowledge of why. He or she may become emotional for no reason at all.

23. Behavioral Loss of Control. The co-addict begins to lose control of his or her temper especially around the addict and/or the children or roommates. Loss of behavioral control is exhibited in such ways as over-punishing the children, hitting and yelling at the addict, or throwing things and tantrums.

24. Uncontrollable Mood Swings. Changes in the co-addict’s moods happen without any warning. The shifts are dramatic. He or she no longer feels somewhat down or somewhat happy, but instead goes from feeling extremely happy to extremely low.

25. Failure to Maintain Interpersonal (Informal) Support Systems. The co-addict stops reaching out to friends and family. This may happen very gradually. He or she turns down invitations for coffee, misses’ family gatherings, and no longer makes or returns phone calls.

26. Feelings of Loneliness and Isolation. The co-addict begins to spend more time alone. He or she usually rationalizes this behavior – too busy, the children, school, job, etc. Instead of dealing with the loneliness, the co-addict becomes more compulsive and impulsive. The isolation may be justified by convincing him or herself that no one understands or really cares.

27. Tunnel Vision. No matter what the issue or situation might be, the co-addict focuses in on his or her opinion or decision and is unable to see other points of view. He or she may become close-minded.

28. Return of Periods of Free Floating Anxiety and/or Panic Attacks. The co-addict may begin to re-experience, or experience for the first time, waves of anxiety that seem to occur for no specific reason. He or she may feel afraid and not know why. These uncontrollable feelings may snowball to the point that he or she is living in fear of fear.

29. Health Problems. Physical problems begin to occur such as headaches, migraines, stomach aches, chest pains, rashes, or allergies.

30. Use of Medication or Alcohol as a Means to Cope. Desperate to gain some kind of relief from the physical and/or emotional pain, the co-addict may begin to drink, use drugs, or take prescription medications. The alcohol or drug use provides temporary relief from the growing problems.

31. Total Abandonment of Support Meetings and Therapy Sessions. Due to a variety of reasons (belief that he or she no longer needs the meetings, immobilizing fear, resentment, etc.), the co-addict completely stops going to support meetings or to therapy or both.

32. Inability to change self-defeating behaviors. While there is recognition by the co-addict that what is being done is not good for himself or herself, there is still the compulsion to continue the behavior in spite of that knowledge.

33. Development of an “I Don’t Care” Attitude. It is easier to believe that “I don’t care” than it is to believe that “I am out of control.” In order to defend self-esteem, the co-addict rationalizes, “I don’t care.” As a result, a shift in value system occurs. Things that were once important now seem to be ignored.

34. Complete Loss of Daily Structure. The co-addict loses the belief that an orderly life is possible. He or she begins missing (forgetting) appointments or meetings, is unable to have scheduled meals, to go to bed or get up on time. The co-addict is unable to perform simple acts of daily function.

35. Despair and Suicidal Ideation. The co-addict begins to believe that the situation is hopeless. He or she feels that options are reduced to two or three choices: going insane, committing suicide, or numbing out with medication, and/or alcohol, drugs or maladaptive, perhaps compulsive behavior.

36. Major Physical Collapse. The physical symptoms become so severe that medical attention is required. These can be any of a number of symptoms that become so severe that they render the co-addict dysfunctional (e.g., an ulcer, migraines, heart pains, or heart palpitations).

37. Major Emotional Collapse. Having seemingly tried everything to cope, the co-addict can conceive no way to deal with his or her unmanageable life. At this point the co-addict may be so depressed, hostile, or anxious that he or she is completely out of control.

RELAPSE PREVENTION FOR THE FAMILY

While each family member is responsible for his or her own recovery and no one can recover for another, the symptoms of addiction and co-addiction each impact upon the relapse potential of the other. Even if the alcoholic/addict is no longer drinking or using and no longer experiencing the alcohol/drug-related symptoms of the disease, the post acute withdrawal symptoms affect and are affected by co-addiction. Both the symptoms of post acute withdrawal and the symptoms of co-addiction are stress sensitive. Stress intensifies the symptoms and the symptoms intensify stress. As a result, the recovering addict and the co-addict can become a stress-generating team that unknowingly and unconsciously complicates each other’s recovery and create a high risk of relapse.
What can family members do to reduce the risk of their own relapse and the risk of relapse in the recovering addict? They can become informed about the addictive disease, recovery, and the symptoms that accompany recovery. They must recognize that the symptoms of post acute withdrawal are sobriety-based symptoms of addiction rather than character defects, emotional disturbances, or mental illness. At the same time they must accept and recognize the symptoms of co-addiction and become involved in Al-Anon and/or personal therapy as they develop plans for their own recovery.
Clinical experience with relapse prevention planning in a variety of treatment programs has indicated that the family can be a powerful ally in preventing relapse in the addict. In 1980, relapse prevention planning was modified to include the involvement of significant others including family members. This significantly increased effectiveness. With further clinical experience, however, other problems became apparent. Many family members refused to participate in relapse prevention planning. Other family members participated in a manner that was counterproductive.

In 1983 relapse prevention planning was expanded to include relapse prevention in both the addicted person and the co-addict. The newly designed relapse prevention planning protocol utilizes the family’s motivation to get the addict sober. As family members become involved in relapse prevention planning, a strong focus is placed upon co-addiction and its role in family relapse.

Family members are helped to recognize their own co-addiction and become actively involved in their own treatment. Addiction is presented as a family disease that affects all family members requiring them to get treatment.

All members of an addicted family are prone to return to self-defeating behaviors that can cause them to become out of control. An acute relapse episode can occur with an addict or a co-addict family member.

Like addicts who develop serious problems even though they never use alcohol or drugs, the co-addict often becomes dysfunctional even though the addict is sober and working an active recovery program.

It is important to protect the family from the stress that may be generated by the symptoms of post acute withdrawal experiences by the recovering person and to cooperate in plans to protect the recovering person from stress created by symptoms of co-addiction.

Remember that none of you became ill overnight. Recovery will, likewise, take place over a long period of time. Develop a plan to prevent personal relapse and support relapse prevention plans for the recovering addict.

Family Relapse Prevention Planning is intended to help prevent acute relapse episodes in the recovering addict, to prevent crisis in the co-addict, to develop a relapse prevention plan for both the addict and co-addict and to develop an early intervention plan to interrupt acute relapse episodes in both the recovering addict and the co-addict. For the addict this involves interrupting problems that are caused both by Post Acute Withdrawal (PAW) Syndrome in the sober addict and by alcohol or drug use in the addict who has returned to drinking or using. For the co-addict this involves interrupting the co-addiction crisis.

The family needs to work with a counselor to establish a formal relapse prevention plan that will allow them to support each other’s recovery and to help intervene if the relapse warning symptoms get out of control.

The family relapse prevention planning protocol consists of twelve basic procedures. These are:

1. Stabilization: The first step in relapse prevention planning is to stabilize both the addict and the co-addict. The addict is stabilized through the process of detoxification or treatment of post-acute withdrawal symptoms. The spouse is stabilized by treating the co-addict crisis, through detachment from the addicts crisis, by regaining a reality-based perspective, and the development of some basic personal strengths. This often requires attendance at Al-Anon and professional counseling.

2. Assessment: Prior to developing a relapse prevention plan it is necessary to evaluate the addict, the co-addicts, and the family system. The evaluation should assess the current problems of each family member, their willingness and ability to initiate a personal recovery program, and their willingness to become involved in a program of family recovery.

3. Education about Alcoholism, Co-addiction, and Relapse: Accurate information is the most powerful of all recovery tools. The addict and the family must learn about the disease of addiction, the condition of co-addiction, treatment, and relapse prevention planning. This education is best provided to the family as a unit in multiple family classes. It is helpful if separate group therapy programs accompany the education for each family member. The addict should enter an addict group, the adult co-addict should enter a spouse’s group, and the co-addict children should enter a children’s group. It is in these group treatment sessions that individual recovery of all family members is initiated.

4. Warning Sign Identification: Both the addict and the co-addict need to identify the personal warning signs that indicate that they are becoming dysfunctional. Again, this is best done in a group setting. The addict is better able to identify relapse-warning signs when working with other addicts. Co-addicts are best able to initially identify relapse-warning signs when working with other co-addicts. Relapse warning sign lists for addiction and co-addiction are useful guides for personal warning sign identification.

5. Family Validation of Warning Signs: After each family member has developed a personal list of warning signs and reviewed these in his or her group, a series of family sessions is scheduled. During these sessions all family members present their personal lists of warning signs and ask for feedback. Other family members discuss the warning signs, help assess fi they are specific and observable. New warning signs may be added to the list based upon the feedback of others. Since each family member has a list of warning signs that precede acute relapse episodes there is no identified patient. All participate from a position of equality. They essentially say to each other, “We have all been equally affected, in various ways, by addictive disease.”

6. The Family Relapse Prevention Plan: Family members discuss each of their warning signs, how the family has dealt with those warning signs in the past, and what strategies could be effectively used in the future. Future situations in which the warning signs are likely to be encountered are identified. Strategies for more effective management of the warning signs for each family member are discussed. During this process a great deal of role playing and problem solving occurs. Problems are often identified that are taken back to the separate therapy groups for further work.

7. Inventory Training: All member of the family receive training in how to complete a morning planning inventory and an evening review inventory. These focus heavily upon time structuring, realistic goal setting, and problem solving.

8. Communication Training: The family members must learn to communicate effectively in order for a Relapse Prevention Plan to work. The family is trained in the process of giving and receiving feedback in a constructive and caring manner.

9. Review of the Recovery Program: All family members will report to the family the recovery program that they have established for themselves. This focus here is, “How will you and I know that I am doing well in my recovery?”
All are invited to express their recovery needs and point out their progress in treatment.

10. Denial Interruption Plan: Both addiction and co-addiction are diseases of denial. Most of the denial is unconscious. Neither the addict nor the co-addict realizes that they are in denial when it is happening. It is important to take the reality of denial into account early. Each family member should be asked the question, “What are other people in your family supposed to do if they give you feedback about concrete warning signs and you deny it, ignore the feedback, or become angry and upset?” Each family member should recommend specific plans for dealing with their own denial. This open discussion sets the stage for intervention should denial become a problem in the future.

11. The Relapse Early Intervention Plan: Addiction and co-addiction are prone to relapse. Relapse means becoming dysfunctional in recovery. For the recovering addict relapse may ultimately lead to alcohol and drug use, or it may simply mean that the person becomes so depressed, anxious, angry, or upset that he is dysfunctional in sobriety. For the co-addict relapse means the return to a state of co-addict crisis that interferes with normal functioning. Once family members enter an acute relapse episode they are out of control of their thoughts, emotions, judgements, and behavior. They often need the direct help of other family members to interrupt the crisis. Many times they resist this help. They act as if they do not want help even though they desperately need it. The family is instructed in the process of intervention. Intervention is a method of helping people who refuse to be helped. This intervention training has resulted in a radical decrease in the duration and severity of relapse episodes in family members.

12. Follow-up and Reinforcement: Addiction and co-addiction are life-long conditions. The symptoms can go into remission but they never totally disappear. They rest quietly, waiting for a lapse in the recovery program to become active again. It is important that the family maintain an ongoing recovery program including AA/NA, Al-Anon, and periodic relapse prevention checkups with a professional addiction counselor.

This Article is excerpted from: “Staying Sober- A Guide To Relapse Prevention By: Terence T. Gorski

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Drug War Policy and The Prison Industrial Complex

July 29, 2014

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By Lisa M. Hammond and Terence T. Gorski
GORSKI BOOKS

The war around the War on Drugs is a battle between public health and criminal justice. It’s a battle between conservatives calling for imprisonment and progressives calling for public health solutions. It’s the legacy of Barry Goldwater, Richard Nixon, Nelson Rockefeller, and others, who used the fear of crime to build campaigns around law and order. While these conservative politicians were pounding the bully pulpit and demanding that every drug offender is punished, Congress was eliminating mandatory minimum sentences and mainstream public opinion considered drug addiction to be a public health problem, not an issue for the criminal courts.

The battle between public health and criminal justice began to move right with the graphic depiction of drug addicts as immoral and dangerous criminals. Rockefeller demonstrated his commitment to law and order when he crushed the Attica prison uprising, and took the lead in the War on Drugs by proposing the harshest drug laws in the country. The War on Drugs rhetoric and Rockefeller drug laws were arguing a correlation between crime and drug abuse. To further fuel the debate, the economic recession of 1973-75, saw escalating crime and the proliferation of criminal drug activity as economic alternatives. Americans wanted to solve the crime problem and believed that the enemy was drugs and all who used them. What started out as a policy to reduce drug abuse has resulted in the mass incarceration of drug addicted individuals. Public health lost the battle to treat drug abuse in 1986, with the passage of the Anti-Drug Abuse Act, and the criminalization of drug addiction.

For the past 25 years, the U.S. has pursued a drug policy based on prohibition and the application of severe criminal sanctions for the use and sale of illicit substances. Over this 25-year period, the rate at which criminal penalties have been imposed has steadily increased resulting in the United States imprisoning more of its citizens than any other industrialized nation. Furthermore, the enforcement of drug laws has not always been applied equally to all groups, despite comparable rates of drug use. African Americans are disproportionately represented among imprisoned drug offenders. The War on Drugs policy has criminalized drug addiction and resulted in mass incarceration for disadvantaged populations.

As of June 30, 1998, more than 1.8 million people were locked up in the immense network of federal, state, and local prisons and jails.(1) In total, more than 5.5 million people ‑‑ including those on probation and parole ‑‑ were directly under the surveillance of the criminal justice system.(2) Additionally, more than 60 percent of the imprisoned population are people of color.(3)

Since 1994, the disparity between white and non white prisoners as a percentage of the total prison population has widened dramatically. State prison incarceration rates for African Americans for drug law violations are almost 20 times those of whites and more than double those of Hispanics.(4) Although whites account for 69% of drug offense arrestee’s and blacks 29%, blacks are disproportionately convicted and comprise 48% of the U.S. prison population, while they are only 12.5% of the general population.(5) From 1990 to 1994, incarceration for drug offenses accounted for 60% of the increase in the black population in state prisons and 91% of the increase in Federal prisons. (6) By 1995, 35% of all African American males ages 25-34 were under the control of the criminal justice system–behind bars, on probation, or on parole. (7) In 1998, 3% of all black men were in prison on any given day.(8) And one out of three Black men aged 20 -29 were under some form of criminal justice control, which are more black men than were in college.(9) Additionally, one out of every four Black men will go to prison in his lifetime. (10)

Much of the disparity in incarceration rates can be attributed to the insidious inequality of the Mandatory Minimum Sentences (MMS) passed by Congress in 1986. Federal Mandatory Minimum Sentences are determined solely by the weight of the drug, or the presence of a firearm during a felony offense. The prisoner must serve 85% of this sentence, and there is no parole available. A judge must impose the sentence, regardless of the defendant’s role in the offense, his likelihood of rehabilitation or any other mitigating factors. Possession of 5.01 grams of crack is subject to a mandatory minimum of five years, while it takes 100 times more cocaine in powder form to receive the same MMS, despite the fact that the two drugs are similar in chemistry and physiological effects. As it happens, crack is predominately used by blacks, while powder is often used by whites.

The drug addict, who has been demonized by conservatives, is now seen as the source of many of our social ills. With the perceived escalation of crime, the War on Drugs incarceration policy has come to dominate the nation’s political agenda. However, mass incarceration is not a solution to social problems. The 1.8 million people behind bars are not the only ones affected. Many prisoners leave families, friends, employers, and communities struggling to cope with the consequences of incarceration. Furthermore, incarceration can be a self-fulfilling prophecy, resulting in a future generation of potential criminals. Children subjected to parental incarceration, financial insecurity, and a hereditary predisposition to drug abuse are far more likely to engage in criminality than others.(11) Unfortunately, the great majority of people believe imprisonment works and it is the key to winning the War on Drugs. Hence, the focus of state’s policy having shifted from social welfare to social control is endorsed by the American public.

The punitive impact of the War on Drugs policy can also be seen in the Welfare Reform Act, Section 115, where legislation has placed a lifetime ban on Temporary Aid to Needy Families (TANF) and Food Stamp benefits for all convicted drug felons. Coincidentally, the Coalition for Federal Sentencing Reform found that more than 80% of the female prisoner population are mothers, and 70% of these are single parents. Since 1990 the annual rate of growth of the female inmate population has averaged 8.8%, higher than the 6.9% average increase in the number of male inmates.(12) By year end 1997 women accounted for 6.4% of all prisoners’ nationwide, up from 5.7% in 1990.(13)

Female incarceration rates, though substantially lower than male incarceration rates, reveal similar racial and ethnic disparities. Black females (with an incarceration rate of 188 per 100,000) were more than twice as likely as Hispanic females (78 per 100,000) and eight times more likely than white females (23 per 100,000) to be in prison in 1996. (14) Inmates at year end 1990 and 1996 reveal differences in the sources of growth between male and female inmates. During this period the number of female inmates serving time for drug offenses doubled, while the number of male inmates in for drug offenses rose 55%.(15) The number serving time for violent offenses, however, rose at about the same pace (up 57% for men and 58% for women).(16) Denying TANF benefits and food stamps to convicted drug felons imposes grave hardship on the children of these individuals and creates additional barriers to success after imprisonment. A former felon without readily marketable skills will not be able to seek immediate employment upon release. Hence, without a social safety net, this individual will have no choice but to engage in behaviors that may lead to recidivism. Women with children and inadequate means of financial support will resort to prostitution and drug dealing to provide for family essentials.

The National Institute on Drug Abuse estimates the economic cost from alcohol and drug abuse was $276 billion in 1995.(17) Since that time there have been significant increases in expenditures to incarcerate, but not solve the social ills that lead to drug abuse. Billions of dollars are lost in productivity, tax revenues, wages, social security contributions, and lost life because our public policy leaders fail to recognize alcoholism and addiction for what they are, chronic diseases. The prevalence of drug abuse has created a public health and social community crisis. Responding with incarceration does not treat the problem, it only compounds it. The 1994 California Drug and Alcohol Treatment Assessment, General Report, found that every dollar spent on addiction treatment saves taxpayers more than $7 in medical and social costs.(18) However, we continue to pursue an extraordinarily expensive policy of criminal justice at the expense of alternative social solutions.

Drug enforcement activities cost more than $20 billion per year in state and local law enforcement and constitute 68% of the $17 billion Federal drug budget, compared with the $5.5 billion in treatment, prevention and research. (19) The cost of drug enforcement is 50% larger than the entire federal welfare budget of $16.6 billion, which provides income supports for 8.5 million people.(20) And represents six times what the federal government will spend on child care for 1.25 million children.

The most visible part of the War on Drugs is the development of the Prison Industrial Complex. Short of war, mass incarceration has been one of the most thoroughly implemented social programs of our time. The dramatic increase in funding for prison expansion and criminal justice has come at the expense of education. From 1987 to 1995, general fund expenditures for prisons throughout the country increased by 30% while general fund expenditures for universities decreased by 18%. (21) In 1995, the National Crime Bill was passed, resulting in the construction of 150 new prisons and the expansion of 171 existing prisons.(22) States around the country spent more building prisons than colleges and there was nearly a dollar for dollar tradeoff between corrections and higher education, with university construction funds decreasing to 2.5 billion while corrections funding increased to 2.6 billion.(23)

Since 1984 more than 20 new prisons have opened in California, while only one new campus was added to the California State University system and none to the University of California system.(24) For the first time in California’s state history the 1995 budget allocated more money for prisons than education. Today, California plans to add six new prisons to its existing 32, and it is estimated that an additional 11 will be required over the next five years just to maintain the current level of overcrowding.(25) According to the California Department of Corrections, it currently costs $22,000 to imprison one inmate for one year. With an annual average cost of $4,022 in tuition fees for attendance at the University of California, the housing of one inmate precludes five students from obtaining higher education. The minimum period of incarceration for inmates sentenced to 25 to life under California’s “Three Strikes” law is 21.75 years (85% of the minimum sentence). This means that, in 1998 dollars, a defendant sentenced to life will cost a minimum of $467,500. The current population of California inmates serving life under “Three Strikes” is 4,318 at a cost of $95 million for one year.(26) The state could send a number of students to UC or California State University for that same amount and quite possible find alternative solutions to our various social ills.

Interestingly, prisons and universities have the same target audience, young adults. Though unlike universities, 70% of prisoners nationwide have not completed high school, and more than 50% are illiterate. (27) At present, five times as many black men are presently in prison as in four‑year colleges and universities. The War on Drugs promotion of incarceration has not only affected funding for education, but has inadvertently created a population in grave need of learning and skill development. The War on Drugs and resultant prison industrial system has devoured the social wealth needed to address the very problems that have led to spiraling numbers of prisoners. As prisons take up more and more resources, other government programs that have previously sought to respond to social needs ‑‑ such as Temporary Assistance to Needy Families ‑‑ are being squeezed out of existence. The deterioration of public education is directly related to the prison “solution.”

Drug abuse is a problem with many social ramifications. There are 26 million Americans who abuse or are addicted to drugs and alcohol.(28) There are 10.5 million victims of drug related crimes each year.(29) There are 700,000 infants exposed in utero to illicit drugs each year.(30) There are 132,000 premature deaths as a consequence of drug and alcohol problems.(31) Drug abuse is a problem. Addiction is a disease with bio-psycho-social causes(32), whose prevalence has created a social crisis. However, the solution is not to lock them up and throw away the key.

People who support incarceration, vote for new prison bonds and give their tacit assent to a proliferating network of prisons and jails. But prisons do not solve social problems. Without addressing the underlying social issue, a burgeoning penal infrastructure will continue to grow in order to accommodate an exponentially increasing population of caged people. However, the economics of the private prison industry are in many respects similar to those of the lodging industry. An inmate at a private prison is like a guest at a hotel and the economic incentive is to book every available room and encourage every guest to stay as long as possible. (33)

Prisons are becoming increasingly important to the U.S. economy. Prison privatization is the most obvious example of opportunistic capitalism in the current development of the prison industry. Prison Realty Trust (PZN), the largest private prison company in the U.S., builds and manages prisons in Australia, Puerto Rico, the U.K., and the U.S. It owns 50 prisons, 49 in the U.S., and it manages more than 70,000 prison beds in more than 80 facilities. The company recently identified California as its “new frontier.”(34) Wackenhut Corrections Corporation (WHC), the second largest developer and operator of private prisons in the U.S., has contracts to manage more than 40 facilities in the U.S., the U.K., and Australia. It boasts more than 30,000 beds as well as contracts for prisoner healthcare services, transportation and security.(35) Currently, the stocks of both PZN and WHC publicly trade on the New York Stock Exchange and are doing extremely well. Between 1996 and 1998, PZN’s revenues increased by 126 percent, from $293 million to $662 million. WHC raised its revenues from $138 million in 1996 to $313 million in 1998. Unlike public correctional facilities, the vast profits of these private facilities rely, in part, on the employment of prison labor. But PZN and WHC are not alone in exploiting the burgeoning new industry of prison privatization. When an offender enters a California prison, he is surveyed for more than 50 skills and placed in a facility with targeted skill needs according to his ability. Corporations ranging from J.C. Penny and Victoria’s Secret to IBM and Toys R Us utilize prison labor to cut costs and increase profits.

Private prison companies are only the most visible component of the increasing corporatization of punishment. Government contracts to build prisons have bolstered the construction industry. The architectural community has identified prison design as a major new niche. Technology developed for the military, such as “Night Enforcer” goggles and “Hot Wire” fencing, by companies like Westinghouse are being marketed for use in law enforcement and punishment. Moreover, corporations that appear to be far removed from the business of punishment are intimately involved in the expansion of the prison industrial complex. Prison construction bonds are one of the many sources of profitable investment for leading financiers such as Merrill Lynch. MCI charges prisoners and their families outrageous prices for telephone calls by adding a $3.00 surcharge to every call.(36) A pay phone at a prison can generate as much as $15,000 per year.(37) The business is so lucrative that MCI installed its inmate phone system, Maximum Security, throughout the California prison system at no charge. (38) As part of the deal MCI provides the California Department of Corrections a 32% share of all revenues from inmates’ phone calls.(39)

Financiers and high‑tech industries are not the only ones reaping profits from incarceration. Nordstrom’s department stores sell jeans that are marketed as “Prison Blues,” as well as T‑shirts and jackets made in Oregon prisons. The advertising slogan for these clothes is “made on the inside to be worn on the outside.” Maryland prisoners inspect glass bottles and jars used by Revlon and Pierre Cardin, and schools throughout the world buy graduation caps and gowns made for Jostens by South Carolina prisoners.(40)

“For private business,” writes Eve Goldberg and Linda Evans “prison labor is like a pot of gold. No strikes. No union organizing. No health benefits, unemployment insurance, or workers’ compensation to pay. No language barriers, as in foreign countries. Prisoners do data entry for Chevron, make telephone reservations for TWA, raise hogs, shovel manure, make circuit boards, limousines, waterbeds and lingerie for Victoria’s Secret ‑‑ all at a fraction of the cost of ‘free labor.’ ” (41)

Although prison labor is quite profitable for the private companies that use it, incarceration does not produce wealth for the public sector. On the contrary, it devours wealth that could be used for education, drug rehabilitation, programs to combat HIV, child care, housing, and job creation for the unemployed.

The Prison Industrial Complex is an interweaving of private business and government interests. Private capital has become enmeshed in the punishment industry. Although the primary purpose of prisons is social control and the public rationale is the fight against crime, the results are clearly profit on the backs of disadvantaged populations

Reframing the War on Drugs policy to a national public health policy on substance abuse treatment would not only reduce costs and improve national health, but also make our communities safer, lower taxes, improve workplace productivity and reduce health care costs. Addiction is a disease, not a moral failing. Addiction is primarily a health care problem with criminal justice implications. It is not primarily a criminal justice problem with healthcare implications. We need to get the relationship straight. Treatment is the most effective way to reduce drug and alcohol addiction, and dramatically reduce drug and alcohol related crime and health care costs. Treatment cuts health care costs. Treatment improves economic welfare. Treatment is cheaper than enforcement, prosecution and incarceration.

Three decades after the War on Drugs began, we have developed a prison industrial complex, with seemingly unstoppable momentum. The line between public interest and private interest has blurred. The crackdown on drugs has not stopped drug use, but it has taken thousands of unemployed and potentially angry young men and women off of the streets and has created a growing prison population and new industrial complex. Our failure to spend on relatively inexpensive measures, such as drug treatment and probation, has forced us to increase spending on prisons. However, as criminal justice increasingly devours social resources it does not add to social wealth. Building more prisons to address drug abuse is like building more graveyards to deal with a fatal disease.

We need to treat the cause of drug abuse through public health and reinstate social resources to combat the risk factors leading to abuse. The goal is simple, to reduce drug abuse and the constellation of associated problems and costs. We can achieve this goal through a continuum of health care services orchestrated by a Public Health Addictions Policy.

GORSKI BOOKS

Endnotes
1. Dept. Of Justice, Bureau of Justice Statistics. Prison and Jail Inmates at Mid Year 1998. Prepared by Bureau of Justice Statistics (Rockville, MD, 3/99): NCJ 173414; available from http:// http://www.ojp.usdoj.gov/bjs/pub/ascii/pjim98.txt; Internet.
2. Dept. Of Justice, Bureau of Justice Statistics. Correctional Populations in the United States, 1998. Prepared by the Bureau of Justice Statistics (Rockville, MD, 4/99) NCJ 170013; available from http://www.ojp.usdoj.gov/bjs/abstract/cpius96.htm ; Internet.

3. Dept. Of Justice, Bureau of Justice Statistics. Prison and Jail Inmates at Mid Year 1998. Prepared by Bureau of Justice Statistics (Rockville, MD, 3/99): NCJ 173414; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/pjim98.txt ; Internet.
4. Dept. Of Justice, Bureau of Justice Statistics. Federal Pretrial Release and Detention, 1996. Prepared by the Bureau of Justice Statistics (Rockville, MD, 2/99): NCJ 168635; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/fprd96.txt ; Internet.

5. Ibid.

6. Dept. Of Justice, Bureau of Justice Statistics. Drug and Crime Facts, 1994. Prepared by the Bureau of Justice Statistics (Rockville, MD,): NCJ 154043; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/dcfacts.txt ; Internet.

7. Ibid.

8. Dept. Of Justice, Bureau of Justice Statistics. Prison and Jail Inmates at Mid Year 1998. Prepared by Bureau of Justice Statistics (Rockville, MD, 3/99): NCJ 173414; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/pjim98.txt ; Internet.

9. Mauer, Marc. Young Black Men In the Criminal Justice System. [article online] The Sentencing Project, 1995. (Washington, DC); available from http://www.sentencingproject.org ; Internet

10. Ibid.

11. Johnson, Denise, M.D. Report No. 13: Effects of Parental Incarceration. Prepared by The Center of Incarcerated Parents (Pasadena, CA, 6/96) p. 24

12. Dept. Of Justice, Bureau of Justice Statistics. Correctional Populations in the United States, 1998. Prepared by the Bureau of Justice Statistics (Rockville, MD, 4/99) NCJ 170013; available from http://www.ojp.usdoj.gov/bjs/abstract/cpius96.htm ; Internet.

13. Dept. Of Justice, Bureau of Justice Statistics. Prison and Jail Inmates at Mid Year 1998. Prepared by Bureau of Justice Statistics (Rockville, MD, 3/99): NCJ 173414; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/pjim98.txt ; Internet.

14. Ibid.

15. Ibid.

16. Ibid.

17. Dept. Of Health and Human Services, National Institute of Drug Abuse. Economic Costs of Substance Abuse 1995. National Institute of Health Publication Number 98-4327 (Rockville, MD, 9/98); available from http://www.nida.nih.gov/EconomicCosts/Chapter1.html#1.1 ; Internet

18. California Dept. Of Alcohol and Drug Programs. Evaluating Recovery Services: The California Drug & Alcohol Treatment Assessment, General Report, 1994.; available from http://aspe.os.dhhs.gov/HSP/Caldrug/costs.htm#Table5.1 ; Internet

19. Office of National Drug Control Policy, National Drug Control Strategy. Fact Sheet: Drug Data Summary 1998. (Washington, DC, 1999): available from http://www.whitehousedrugpolicy.gov

20. Ibid.

21. Macallair D., Taqi-Eddin K., Schiraldi V. Class Dismissed: Higher Education vs. Corrections Durng the Wilson Years. [article online]; (San Francisco, CA: Justice Policy Institute) ; available from http://www.cjcj.org/jpi/classdis.html ; Internet.

22. Wisely, Willie, California Expanding Prison Industrial Complex. [article online]; (Berkeley, CA, Prison Activist Resource Center); available from http://www.prisonactivist.org ; Internet.

23. Macallair D., Taqi-Eddin K., Schiraldi V. Class Dismissed: Higher Education vs. Corrections Durng the Wilson Years. [article online]; (San Francisco, CA: Justice Policy Institute) ; available from http://www.cjcj.org/jpi/classdis.html ; Internet

24. Wisely, Willie, California Expanding Prison Industrial Complex. [article online]; (Berkeley, CA, Prison Activist Resource Center); available from http://www.prisonactivist.org ; Internet.

25. Schlosser, Eric. The Prison Industrial Complex. The Atlantic Monthly. December 1998; p.63; available from http://www.theatlantic.com

26. Macallair D., Taqi-Eddin K., Schiraldi V. Class Dismissed: Higher Education vs. Corrections Durng the Wilson Years. [article online]; (San Francisco, CA: Justice Policy Institute) ; available from http://www.cjcj.org/jpi/classdis.htm l; Internet.

27. Worth, Robert. A Model Prison. [article online]; The Atlantic Monthly: Nov 1995.; available from http:www.atlanticmonthly.com ; Internet .

28. Dept. Of Health and Human Services, National Institute of Drug Abuse. Economic Costs of Substance Abuse 1992. National Institute of Health Publication Number 98-4327 (Rockville, MD, 9/98); Section 1.4

29. Ibid. Section 5.1

30. Ibid. Section 4.4.2.2

31. Ibid. Section 1.3

32. Gorski, Terence. Relapse Prevention Therapy with Chemically Dependent Criminal Offenders, Part Two. (Independence, MO, Herald House/Independence Press, 1994) p. 24

33. Schlosser, Eric. The Prison Industrial Complex. The Atlantic Monthly. December 1998; p.64

33. Davis, Angela. Reflections on the Prison Industrial Complex [article online]; (Weschester County Weekly: New Mass. Media, Inc. 1998); available from http://www.westchesterweekly.com/articles/prisondavis.html; Internet.

35. Lotke, Eric. New Growth Industries: The Prison Industrial Complex. [article online]; (Washington, DC: Multinational Monitor); Nov. 1996 Vol. 17 No. 11 available from http:www.essential.org/monitor/hyper.mm1196.06.html; Internet

36. Schlosser, Eric. The Prison Industrial Complex. The Atlantic Monthly. December 1998; p.63; Available from http://www.theatlantic.com

37. Ibid.

38. Ibid.

39. Ibid.

40. Davis, Angela. Reflections on the Prison Industrial Complex [article online]; (Weschester County Weekly: New Mass. Media, Inc. 1998); available from http://www.westchesterweekly.com/articles/prisondavis.html ; Internet.

41. Goldberg, E., Evans L. The Prison Industrial Complex and the Global Economy. [article online]; (Berkeley, CA, Prison Activist Resource Center); available from http://www.prisonactivist.org

GORSKI BOOKS

Bibliography

Browne, Julie. The Labor of Doing Time. [article online]; (Berkeley, CA: Prison Activist Resource Center 1995); available from http://www.prisonactivist.org ; Internet.

California Dept. Of Alcohol and Drug Programs. Evaluating Recovery Services: The California Drug & Alcohol Treatment Assessment, General Report, 1994.; available from http://aspe.os.dhhs.gov/HSP/Caldrug/costs.htm#Table5.1 ; Internet

Davis, Angela. Reflections on the Prison Industrial Complex [article online]; (Weschester County Weekly: New Mass. Media, Inc. 1998); available from http://www.westchesterweekly.com/articles/prisondavis.html ; Internet.

Goldberg, E., Evans L. The Prison Industrial Complex and the Global Economy. [article online]; (Berkeley, CA, Prison Activist Resource Center); available from http://www.prisonactivist.org

Gorski, Terence. Relapse Prevention Therapy with Chemically Dependent Criminal Offenders, Part Two. (Independence, MO, Herald House/Independence Press, 1994) p. 24; Available from: http://www.relapse.org

Gorski, Terence. Public Health Addiction Policy – an alternative To The War On Drugs, available on the internet http://www.tgorski.com

Dept. Of Health and Human Services, National Institute of Drug Abuse. Economic Costs of Substance Abuse 1995. National Institute of Health Publication Number 98-4327 (Rockville, MD, 9/98); available from http://www.nida.nih.gov/EconomicCosts/Index.html ;Internet

Johnson, Denise, M.D. Report No. 13: Effects of Parental Incarceration. Prepared by The Center of Incarcerated Parents (Pasadena, CA, 6/96) p. 2-24

Dept. Of Justice, Bureau of Justice Statistics. Correctional Populations in the United States, 1998. Prepared by the Bureau of Justice Statistics (Rockville, MD, 4/99) NCJ 170013; available from http://www.ojp.usdoj.gov/bjs/abstract/cpius96.htm ; Internet.

Dept. Of Justice, Bureau of Justice Statistics. Drug and Crime Facts, 1994. Prepared by the Bureau of Justice Statistics (Rockville, MD,): NCJ 154043; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/dcfacts.txt ; Internet.

Dept. Of Justice, Bureau of Justice Statistics. Federal Pretrial Release and Detention, 1996. Prepared by the Bureau of Justice Statistics (Rockville, MD, 2/99): NCJ 168635; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/fprd96.txt ; Internet.

Dept. Of Justice, Bureau of Justice Statistics. Prison and Jail Inmates at Mid Year 1998. Prepared by Bureau of Justice Statistics (Rockville, MD, 3/99): NCJ 173414; available from http://www.ojp.usdoj.gov/bjs/pub/ascii/pjim98.txt ; Internet.

Lotke, Eric. New Growth Industries: The Prison Industrial Complex. [article online]; (Washington, DC: Multinational Monitor); Nov. 1996 Vol. 17 No. 11; available from http:www.essential.org/monitor/hyper/mm1196.06.html ; Internet

Macallair D., Taqi-Eddin K., Schiraldi V. Class Dismissed: Higher Education vs. Corrections During the Wilson Years. [article online]; (Berkeley, CA: Justice Policy Institute) ; available from http://www.cjcj.org/jpi/classdis.html ;Internet.

Mauer, Marc. Young Black Men In the Criminal Justice System. [article online] The Sentencing Project, 1995. (Washington, DC); available from http://www.sentencingproject.org ; Internet

Office of National Drug Control Policy, National Drug Control Strategy. Fact Sheet: Drug Data Summary 1998. (Washington, DC, 1999): available from http://www.whitehousedrugpolicy.gov

Schlosser, Eric. The Prison Industrial Complex. The Atlantic Monthly: Dec 1998; p.51-77; available from http://www.theatlantic.com

Wisely, Willie, California Expanding Prison Industrial Complex. [article online]; (Berkeley, CA, Prison Activist Resource Center); available from http://www.prisonactivist.org ; Internet.

Worth, Robert, A Model Prison. [article online]; The Atlantic Monthly: Nov 1995.; available from http://www.atlanticmonthly.com ; Internet .

GORSKI BOOKS


Depression and Relapse: A Guide To Recovery

July 29, 2014

thBy Terence T Gorski
Author, Gorski Books
Excerpted from the Book: Depression and Relapse by Terence T. Gorski

Depression and Addiction

Depression is a significant complicating factor in recovery from substance use disorders. Nearly all substance abusers show significant depression in the first several weeks of recovery. In most cases, the depression quickly subsides. Others, however, suffer from serious bouts of depression throughout their recovery.

The Continuum of Depression

Depression is a state of central nervous system inhibition that operates on a continuum between severe depression (i.e. severe central nervous system inhibition) and severe mania (i.e. severe central nervous system stimulation). When a depressed mood becomes so severe that it interferes with normal daily routines necessary to maintain interpersonal relationships, work activities or the maintenance tasks of life, it is identified as a mental disorder called depression.

Normal Mood States Related To Depression

It is normal and natural for healthy people to swing between mild and moderate states of stimulation and depression. We have good days and bad, we feel high and low. It is also common for people to experience an extreme mood state in response to severe psychosocial stressors such as the loss of a loved one, the loss of a job, serious financial setbacks, or other extreme life changes.

Normally, however, there are protective factors that prevent us from getting locked or trapped in extremely depressed or agitated states. These protective factors also keep us from rapidly cycling between the agitation and depression.   Unfortunately, there are also risk factors that make us more likely to suffer from episodes of depression.

Risk and Protective Factors

It’s helpful to think in terms of protective factors and risk factors. Protective factors are ways of thinking, feeling, acting, and living our lives that protect us from depression. Once these protective skills have become a habitual part of our life, we find that it takes more stress and pressure to trigger our depression and that the episodes of depression become shorter and less severe.

Risk factors are ways thinking, feeling, acting, and living our lives that make us more vulnerable to depression. If these risk factors have become a habitual part of our life, we find that it takes much less stress and pressure to trigger our depression and that the episodes of depression become longer and more severe.

The good news is that we can learn to identify these risk and protective factors and make choices to learn and practice protective skills while eliminating or minimizing the use of risk factors.

Symptoms of Depression

The following list can be used to identify the symptoms of depression.

  1. Feeling sad, anxious, or “empty” mood
  2. Feeling pessimistic about yourself or your life
  3. Feeling helpless or hopeless
  4. Loss of interest in hobbies and activities that you once enjoyed
  5. Decreased interest in physical affection and sexual experiences.
  6. Unable to experience pleasure as a result of physical affection and sexual experiences
  7. Decreased energy, increased fatigue, or a sense of being sluggish or “slowed down”
  8. Difficulty concentrating or remembering things
  9. Difficulty making decisions
  10. Trouble sleeping restfully. This may include the inability to sleep, waking up many times during the night awakening early in the-morning, oversleep, or waking up without feeling rested
  11. Increase or decrease in appetite
  12. Overeating and weight gain?
  13. Poor appetite and weight loss
  14. Agitation, restlessness, or irritability?
  15. Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
  16. Believing that life isn’t worth living that you would be better off dead, Thinking about, having a plan, or actually trying to kill yourself.

The Biopsychosocial Model of Depression

It is helpful to think about depression as a complex cluster of biological, psychological, and social responses that occur when a stressful event activates specific thoughts and feelings, and behaviors. In other words, depression is a biopsychosocial disorder. The biological factors in depression make a person more likely to experience serious depression in response to external situations and the thoughts and feelings they experience in reaction to those situations.

Biological depression results from an inhibited response of the brain and nervous system to internal and external events. Some people may be genetically predisposed to experience depression. Other people may be born with normal brain chemistry systems but experience high levels of debilitating stress or use alcohol, drugs, or other substances that interfere with or damage the normal brain chemistry systems and create physiological tendencies toward depression.

Antidepressant medications can be a helpful adjunct to treatment for people suffering from forms of depression that have a strong biological basis. From a biopsychosocial perspective, however, it becomes clear that purely physiological interventions for depression are not and cannot be the total answer for depression.

When medication is used in isolation from treatment designed to identify and change the psychological and social processes that are linked to the depression, the relief is often temporary. The brain chemistry is temporarily adjusted while the psychological and social processes that drive the depression continue. As a result there is often an escalating need for more or different antidepressant medications to keep the depressed mood in remission.

The most effective use of antidepressant medication in the treatment of depression that coexists with chemical dependency is as an adjunct to a structured recovery program that also includes cognitive behavioral therapy and involvement in structured self-help groups such as Twelve Step Groups.

Psychological Factors In Depression

Psychological depression is associated with specific ways of thinking (T), managing feelings (F), and acting (A). These TFA’s are usually activated by a trigger event that causes stress. The stress then activates depressive brain chemistry that is linked through long-term stimulus response conditioning to the depressive thoughts, feelings, and actions.

There is a link between what we think and the tendency to feel depressed. This process can be called depressive thinking and is generally based upon depressive thinking errors that lead a person to believe that they are powerless, helpless, and have little ability to impact or change themselves or their lives.

These depressive thoughts do not occur in isolation. They are linked with depressive images of past events or depressive fantasies of future outcomes that reinforce the thinking errors. The process goes like this: Something happens that activates a depressive thinking error, the imagery system responds to this error in thinking by providing vivid sensory images of past experiences and projected future occurrences that support the thinking error.

The affective system responds to the imagery by creating brain chemistry changes (such as lower Serotonin levels) that depress the mood. The feeling of depression is used as further evidence and the emotional confirmation that the depressive thinking errors are in fact correct. The process is called emotional reasoning and is based upon the mistaken belief “if I feel this way it must be true.” The depression creates an urge to stop trying and withdraw from the situations or relationships that are the focus of the depressive thinking. If these urges are acted upon the person reduces stimulation through social withdrawal which reinforces the brain chemistry state associated with depression. The resultant boredom and lack of social interaction and reality testing that result from the isolation further reinforces the depressive physiology and the depression continues to intensify as a result of progressive cycle.

In some cases the depression begins with physiological factors that depress the nervous system and result in a diminished ability to respond. In other cases the depression results from the habitual use of ways of thinking and behaving that are based in a fundamental assumption of helplessness, frustration, and powerlessness to make a change or to impact the world or life. In still other cases people are caught up in legitimately stressful and often catastrophic events which lead to stress degeneration and then to depression. For most patients two or more of these causative factors are linked together to create the depression.

Patterns of Depression & Addiction

In addicted people, depression often presents itself in one of four common patterns: Substance Induced Depression, Depression Induced Substance Abuse, Situational Depression in Sobriety, and Co-occurring Addiction and Depression. To avoid relapse it is critical to recognize these four types of depression and to match patients to appropriate treatment strategies.

Chemical Dependence and Depression:  Common Patterns

  1. Substance Induced Depression
  2. Depression Induced Substance Abuse
  3. Situational Depression in Sobriety
  4. Co-occurring Addiction and Depression

Substance-Induced Depressions are caused by the use, abuse and addiction to alcohol and other drugs and the depression quickly remits in early recovery without special treatment. Depression Induced Substance Abuse occurs when patients suffering from depressive illness start using alcohol or other drugs to medicate or manage the symptoms of depression and then becomes dependent upon those substances.

Situational Depression in Sobriety occurs in some chemically dependent patients who experience extreme stressors in recovery. The depression is clearly linked to the mismanagement of specific problems in sobriety. The depression is relieved when these problems are identified and effectively managed.

Co-occurring Depressive Illness occurs when patients are suffering from both chemical dependency and an independent depressive illness. These patients typically have a family history of substance abuse and addiction, a family history of depression or other mood disorders. The history reveals that the symptoms of the depression predated the chemical abuse and that as the addiction progressed so did the severity of the depression. There is often a vacillating symptom pattern. The depression temporarily goes into remission when the patient is drinking or drugging only to return in a severe form when the patient attempts abstinence. With co-occurring depressive illness both the chemical dependence and the depression need to be treated simultaneously.

Treatment and Recovery

Whenever depression becomes severe enough to interfere with ongoing addiction recovery it is serious enough to seek specific help for managing the symptoms.

Although it is possible to recover from depression, there is no one correct way to do it. Different people use different recovery tools. What works well for one person may not work very well for another. Yet there are general principles and basic tools that are effective for a large number of people.

This means that putting together a recovery program from addiction and depression will require learning about the choices that are available. It means being willing to put together an initial recovery plan and being open to adjust the details of that plan in order to make it work more effectively. In recovery we seek progress not perfection. We take small steps that make us feel a little bit better. We learn from those steps, and then take other small steps

Fortunately the recovery plans for addiction and depression are closely related. Many of the things that help people stay comfortably sober also help them to manage their depression. This means that a recovery plan that meets the needs of both addiction and depression can be developed. If you’re already in recovery from addiction this is good news. You already know and have practiced many of the recovery skills needed to manage depression. All you will need to do is to learn a few additional techniques. Here are some ideas that you can use as a check-list.

  1. Recognize the presence of chemical dependency and depression by evaluating all chemically dependent clients for depression and all depressed clients for chemical dependency.
  2. Stabilize the client from severe symptoms of acute withdrawal, post acute withdrawal, and depression using an adequately controlled environment and appropriate medications. Evaluate and implement appropriate suicide precautions during stabilization. Caution should be taken not to prescribe antidepressants for transient states of substance-induced depression or for complaints about normal depressed states associated with early recovery or normal life stressors.
  3. Educate the client about both chemical dependency, depression, and the reciprocal relapse process.
  4. Develop and monitor involvement in a structured recovery program consisting of psychoeducation, group and individual therapy, and self-help group involvement which needs to be initiated and maintained.
  5. Develop a plan with the patient and significant others in the patients life for what actions will be taken should they relapse to either alcohol and drug use or should depression occur. Prepare an early intervention strategy that will be used if relapse does occur.
  6. Help the client to identify their unique profile of problems related to the chemical dependency and the depression. Both addictive thoughts and behaviors that activate an urge to use alcohol and drugs and depressive thoughts that activate feelings of depression need to be identified and managed.
  7. Develop a personalized list of relapse warning signs that can lead from stable sobriety and normal mood to chemical dependency and depression. The high risk situations that activate these warning signs need to be identified and management strategies developed.
  8. Develop management strategies for each warning signs that includes challenging irrational thoughts, managing unmanageable feelings, and changing self-defeating behaviors related to the warning signs.
  9. Reduce the frequency of treatment sessions as the client becomes involved in self-help groups.
  10. Schedule regular follow-up sessions to monitor for relapse warning signs. By doing so the door is left open for the client to access frequent help at the earliest sign of problems.

Depression and Relapse – The Book

Terry Gorski’s book on Depression and Relapse will be published by Herald House Independence Press: : Depression and Relapse by Terence T. Gorski

 


Transcendence

July 27, 2014
20140727-175925-64765356.jpg

The Moon, Earth, International Space Station, and Rising Sun

By Terence T. Gorski
Author
GORSKI BOOKS

We don’t have to fight it. We can transcend it. We can take it in, understand and learn from it. We can mix it with what we already know and move beyond the limits of our previous knowledge, point of view, or frame of reference.

We transcend something when we go beyond, rise above, cut across, or surpass some previous limit or boundary.

The word transcend comes from
Old French transcendre or Latin transcendere, from trans- ‘across’ + scandere ‘climb.’ The origin of the word therefor implies the idea of climbing or moving across something, especially a limitation or an obstacle.

Transcendence takes us beyond the limits of a previous paradigm, belief, or way of thinking. Transcendence in a spiritual sense, transcendence involves moving beyond the limits of ordinary human consciousness usually in an experiential and nonverbal way.

The idea of transcendence implies moving to a higher level or expanding to a wider and more all-encompassing frame of reference.

Transcendence usually results from an active process that unfolds in stages:

Stage 1: Identifying a personally important problem or area of new knowledge or skill. The key seems to be the initial desire or motivation that becomes harnessed in stage 2.

Stage 2: Total absorption in solving the problem, learning the skill, or figuring out how to achieve a desires state of consciousness. This involves reading, studying, discussing, and mentally wrestling with the problem.

Stage 3: Persistent Intense Effort: This process leading to transcendence is usually so intense that it leads to exhaustion and the inability to continue to hold related ideas in consciousness. This results in the person feeling a need to let go and stop trying.

Stage 4: Sudden and Unexpected Insight: The exhaustion is followed by a period of fitful rest. During this period of rest the unconscious mind or higher self integrates the previous disconnected ideas and presents the conscious mind with a spontaneous insight which is often called “The Aha” experience.

Stage 5: Documentation: The insight is often fragile and quickly forgotten unless written down or concretely expressed. In this way the idea of transcendence and creativity are similar because they both emerge from the same process.

Transcendence is an important idea in recovery from addiction, psychotherapy, spiritual development and personal growth. The process of transcendence that leads to a bigger and more useful frame of reference and a different and more useful point of view is essential to all of these processes. Most people find that as they mature they learn how to transcend or use above pain and problems in life in order to find meaning and purpose.

“We don’t have to fight it. We can transcend it.” ~ Transcendence, The Movie http://en.m.wikipedia.org/wiki/Transcendence_(2014_film)p

strong>GORSKI BOOKS: www.relapse.org


Depression, Cognitive Therapy, and Relapse

July 27, 2014

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By Terence T. Gorski,
Author
GORSKI BOOKS: www.relapse.org

Depression is a serious problem that can lead to relapse in addicted clients.

The following article describes a specific application of cognitive therapy to the treatment of depression that significant reduces relapse rates to depression.

Adaptations of this method may prove effective in treating relapse prone addicts with coexisting depression.
Abstract From Archive of General Psychiatry

The book Depression and Relapse by Terence T. Gorski describes how to apply cognitive restructuring to the treatment of the coexisting disorders of depression and addiction.

DEPRESSION AND RELAPSE

Depression is a significant complicating factor in recovery from substance use disorders. Nearly all substance abusers show significant depression in the first several weeks of recovery.

In most cases, the depression quickly subsides. Others, however, suffer from serious bouts of depression throughout their recovery.

Fortunately, the recovery plans for addiction and depression are closely related. Many of the things that help people stay comfortably sober also help them manage their depression.

This means that a recovery plan that meets the needs of both addiction and depression can be developed. If a person is already in recovery from addiction, this is good news. They already know and have practiced many of the recovery skills needed to manage depression. All they need to do is learn the few additional techniques that are outlined in this book.

Below is the description of a study on the effectiveness of cognitive therapy and recurrent depression.

Preventing Recurrent Depression Using Cognitive Therapy With and Without a Continuation Phase: A Randomized Clinical Trial by Robin B. Jarrett, PhD; Dolores Kraft, PhD; Jeanette Doyle, MA; Barbara M. Foster, PhD; G. Greg Eaves, PhD; Paul C. Silver, PhD

Cognitive therapy (CT) may reduce depressive relapse and recurrence when patients learn and use the associated skills. Reported relapse and recurrence rates after CT discontinuation vary widely. The factors that determine when CT is preventive remain unidentified. We developed continuation-phase CT (C-CT) to teach responders skills to prevent relapse. This is the first randomized trial comparing CT with and without a continuation phase in responders to CT who were vulnerable, given their history of recurrent unipolar depression.

Methods Patients aged 18 to 65 years (n = 156) with recurrent DSM-IV major depressive disorder (MDD) entered 20 sessions of acute-phase CT (A-CT). Unmedicated responders (ie, no MDD and 17-item Hamilton Rating Scale for Depression score 9; n = 84) were randomized to either 8 months (10 sessions) of C-CT or control (evaluation without CT). Follow-up lasted an additional 16 months. A clinician blind to assignment evaluated relapse and recurrence (ie, DSM-IV MDD).

Results Over an 8-month period, C-CT significantly reduced relapse estimates more than control (10% vs 31%). Over 24 months, including the CT-free follow-up, age of onset and quality of remission during the late phase of A-CT each interacted with condition assignment to influence durability of effects. In patients with early-onset MDD, C-CT significantly reduced relapse and recurrence estimates (16% vs 67% in control). When patients had unstable remission during late A-CT, C-CT significantly reduced relapse and recurrence estimates to 37% (vs 62% in control).

Conclusions Findings suggest that 8 months of C-CT significantly reduces relapse and recurrence in the highest-risk patients with recurrent MDD. Risk factors influenced the necessity for C-CT.

Arch Gen Psychiatry. 2001;58:381-388

GORSKI BOOKS: www.relapse.org


Listening

July 25, 2014

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By Terence T. Gorski
Author
GORSKI BOOKS: www.relapse.org

People, regardless of gender, tend to hear what they want to hear. This tendency leads to many conflicts and a great deal of miscommunication.

Solving the problem begins with an honest self-exploration of our own willingness and ability to seek first to understand what others are saying before we seek to be understood.

Listen carefully and with your full attention. Check to make sure you have correctly understood by repeating what you heard and asking if you got it right.

Think before you speak. Be sure you have something worthwhile to say. Then say it clearly, calmly, compassionately, and with conviction.

Yelling makes you seem foolish even if you are right. People seem foolish when they are right at the top of their lungs. Breath deeply and become calm and centered when discussing important issues.

“Seek first to understand, then to be understood.” ~ Stephen Covey

If you want other people to take you seriously, you need to make others feel that they are listened to, understood, and taken seriously. This lead them to trust you and this increases the possibility that they will listen to, understand and take you seriously. Communication that starts with active empathetic listening skills tend to build a cycle of progressive openness and trust the deepens the process of feeling connected to others in recovery.

Trust is the foundation of all honest communication. To gain the trust of others we must me trustworthy within ourselves. Trust is built slowly, step-by-step by shared progressive self-disclosure.

GORSKI BOOKS: www.relapse.org

LIVE SOBER – BE RESPONSIBLE – LIVE FREE


Rethinking Aftercare

July 25, 2014

20140725-090319-32599221.jpgBy Terence T. Gorski
Author
Blog: www.terrygorski.com

The term aftercare was introduced into the alcoholism treatment field in the early 1960’s to describe a loosely structured program filling 28-day Minnesota Model Treatment. It was designed to supplement, not replace the 12-Step Program. In a strict sense, aftercare was never intended as treAtment. The aftercare programs were generally offered as a free service to ease the transition from residential rehab and community-based recovery programs. Aftercare programs had a place but were quickly replaced by continuing or ongoing outpatient treatment program.

Recovery can be enhanced and relapse minimized by building a concrete and specific philosophy for ongoing care and a self-regulated recovery support system. The goal is to connect patients with as many “naturally occurring” community activities that support sobriety as possible.

Effective continuing care programs include a team of professionals who are addiction friendly — including doctors, dentists, lawyers, fitness centers, housing programs, employment counseling, life skills training, etc.

Here are some points to consider:

1. Aftercare is the traditional name for Continuing Care or Ongoing OP Treatment.

2. Aftercare is not the best name for the service because it gives the impression that the “treatment” is over and this is “post treatment support.”

3. Most addicted patients need a long-term period of ” ongoing treatment following residential care. This is because: (1) patients are very ill prior to admission to residential rehabilitation. Addiction is a biopsychosocial disease and the biological symptoms of acute and post acute withdrawal can require several months to go fully into remission. Addiction disrupts brain functioning, especially during periods of high stress. These symptoms of transient brain dysfunction are called Post Acute Withdrawal (PAW) which impairs attention, concentration, conceptual integration, and memory. These problem cause difficulty in learning. In a sense, many addicted people in early recovery have an addiction-related learning disability that corrects itself with long-term abstinence, addiction counseling, proper nutrition, and cognitive restructuring focusing upon the impaired areas of cognitive, emotional, and behavioral functioning.

4. PAW and related learning problems are stress sensitive. When in the structured sober environment, stress is low so clients experience less problems with learning information and skills. The stress of discharge and adjustment to a return to home, work, and establishing a community-based recovery program causes high stress. As a result PAW symptoms become more severe.

5. Discharge from residential care is so stressful because recovering people are leaving a group of fellow clients with whom they have developed close emotional bonds, often for the first time in their lives. The people they shared residential treatment with gave them an instant source of interpersonal support, loving confrontation, and healthy sobriety-based fellowship.

6. Residential rehabilitation is an artificial environment that separates the client from the real demands and stresses of life.

7. Discharge creates a rapid and stressful shift from the structured sober and responsible environment of rehab as they renter the addictive and stressful world that spawned and nurtured the development and progression of their addiction.

8. Upon discharge they experience high levels of stress as a result of powerful social pressures to go back to:
– Old patterns of addictive thinking and feeling;
– Painful relationships that are part of their old addictive social world they are returning to;
– Disconnection from important sobriety supportive people and systems;
– The need to change or end old destructive relationships.

9. People deal with the stress of this transition in different ways. Some people pretend it doesn’t exist and do nothing to prepare for or manage the stress. Some people minimize the stress if the transition by transferring to long-term residential program, which could be the start of life-long institutionalization. Others transfer into sober living or halfway houses. Many people entered a structured Intensive Outpatient Program (IOP) and begin a long-term therapy relationship with a therapist in the community. Other people engage with a case manager, a life coach for building life-skills, or a sober companion to provide support through difficult high risk situations.

Here are some basic principles for successfully managing the transition from residential rehabilitation to continuing community-based recovery.

1. Build sober and responsible life structure including professional addiction counseling and community-based support groups such as 12-Step Programs, SMART Recovery, Women for Recovery.

2. Involve the family in ongoing recovery.

3. Teach people to build a personal world of sobriety and responsibility around them. This can be done by building a strong relationship with a community-based support group (12-Step, SMART Recovery, etc.) which includes a home group, schedule of meetings, a sponsor, friendships with other members; and continuing professional treatment.

4. To build a successful transition between residential rehabilitation and a return to the community-based recovery often starts by building an ongoing recovery plan from day one of residential treatment; having the patient start participating in community-based support groups during residential rehabilitation.

5. Involve the family during residential rehabilitation.

6. Schedule regular Recovery Checkups to revise and update recovery and relapse prevention plans to meet emerging needs in recovery.

Get more information at www.relapse.org


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