Adverse Childhood Experiences Increases Risk for Health and Social Problems

August 31, 2014

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High Rates of Adverse Childhood Experiences Among
Justice-Involved Youth Increase Risk for Health and Social Problems

A study recently published in the Journal of Juvenile Justice reported that justice-involved youth had significantly elevated rates of adverse childhood experiences (ACEs),1 much greater than the insured, mostly college-educated adults participating in the original ACE study in the late 1990s.2 In examining the prevalence of ACEs among 64,329 justice-involved youth in Florida,3 researchers found that they were 13 times less likely to report zero ACEs (2.8% vs. 36%) and four times more likely to report four or more ACEs (50% vs. 13%) than the adults in the original study. Among juveniles in the current study, the most prevalent ACEs were family violence, parental separation or divorce, and household member incarceration, which were all reported by more than two-thirds of them.

Additionally, female youth had a higher prevalence than their male peers on all ACEs. Because high ACE scores have been associated with numerous negative health and social outcomes, including increased risks for substance use, heart disease, and incarceration, authors stressed early detection, intervention, and treatment of ACEs for all youth-and universal trauma assessments for justice-involved youth-to help prevent and address health and social problems including future offending.

Footnotes:
1 Researchers have identified 10 ACEs as risk factors for chronic disease in adulthood: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, violent treatment towards mother, household substance abuse, household mental illness, parental separation or divorce, and having an incarcerated household member. An individual’s ACE score is conveyed as the total number of reported ACEs (a positive response scores one point, regardless of the number of incidents).
2 Felitti, Anda, et. al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
3 Youth included in the current study were those with official referrals – the equivalent of an adult arrest – who had received a full risk/needs assessment between January 1, 2007, and December 31, 2012. Youth with official referrals who were screened but not fully assessed were excluded. Authors urge caution when generalizing results to all justice-involved youth or youth in other states.

Source:
Baglivio, M. T., Epps, N., Swartz, K., Huq, M. S., Sheer, A., and Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2), 1-23. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention


The Goal of Humanity

August 31, 2014

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By Terence T. Gorski
Author

Stopping war should be the unifying goal of humanity. This means we must find nonviolently ways of resolving our differences.

We all carry scares, trauma, and deep fears related to was. Each generation had its own war causing these symptoms to be perpetuated across history. The addiction and mental hath industry should be in the front lines if fining peaceful solutions that cN relapse war.

“If there must be was, let it be in my time so that my children may know peace.” ~ Thomas Pain


Life Goes On

August 29, 2014

thBy Terence T. Gorski

We are all fallible human beings.
We are born without our consent
into an unknown world not of our choosing.

We struggle to build a good life for ourselves and those we love
amidst the difficulties and adversities thrown at us each day.

We live with the full knowledge
that our last human act will be to say farewell
to everyone and everything we ever loved
as we face the unknown specter of death.

Yet somewhere amidst all of this
we find time to experience love and joy.

We have the courage to face our inner demons
and vanquish a dragon or two.
We take joy in the laughter of children and
courage from the words and gaze of our elders.

In rare moments we find the best we have within us and
use it to leave a legacy for those who will follow.

All of human history, it seems,
unfolds over the course of each individual life.
This is both the blessing and the curse.

~ Terence T. Gorski,
June 2, 2014


Trigger Events

August 29, 2014

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The term “trigger even” is commonly used by people struggling to understand what turns on their addictive thinking, ear lying warning signs (drug seeking behavior), and the strong attraction or need to bet involved in high risk situations. Recovering people intuitively understand the idea of relapse because it is linked to the metaphor of a gun. When you are holding a  load gun and pull the trigger it fires. Addiction, especially in early recovery, is very much a like a loaded gun with a sensitive trigger.

When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. One you are in a high risk situation you have put yourself in a HIGH RISK SITUATION which takes you away from recovery support, puts you around people, place, and things that support addictive use and make it easy for you to use. The high risk situation also provides social support to start using and social criticize if you refuse to start using. In a high risk situation there is also usually the false promise that goes like this: “I can use my addictive substance just this once, no one will know, and I can just renew my sobriety tomorrow. That, of course, is a very dangerous way from a recovering addictive to be thinking.

Most recovering people intuitively understand what a trigger is, and can describe exactly what pulled the trigger and what happened after the trigger fired off the movement toward addiction.  The problem is that very few recovering people or professional can tell you what a trigger is.  Events and situations that act as powerful triggers for some people have no effect on others. Even more confusing, on some days a certain situation, like have lunch in a restaurant that serves alcohol, activates a powerful trigger. On other days, haven lunch in the same place with the same people does nothing to pull the trigger that activates craving. Why is this?

Many people mistaken believe that the trigger lives in the external person, place or thing that sets it off. As a result addiction professionals teach recovering people to identify and avoid common trigger events. Rarely do recovery people get a clear explanation of psychobiological dynamics that that make triggers so powerful. Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to many them is through trial and error.

Bob Tyler, in his book Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction, explains it this way:

“If we don’t know what makes a trigger a trigger, the only thing we can teach patients to do is to avoid them. Now, how much success do you think our patients will have avoiding triggers living in this society which is permeated by alcohol and drugs? Probably not very much! Therefore, it is essential that we are knowledgeable about how a trigger actually becomes a trigger so we can teach our patients how to recover from triggers?” Although Bob Tyler talks about “recovering from triggers, and I talk about identifying, managing, and disempowering triggers, our basic concept is the same. Recovering people can learn to identify avoid, manage, and eventual, turn off the ability of the trigger to activate craving and drug seeking behavior. This happens spontaneously as people get into long-term recovery. There are techniques and methods for pan aging and disempowering triggers that can make the process a lot easier.

Trigger Event – Defined

A trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior)” (Gorski, 1988). let’s break down this definition:

  • “internal” occurrences are thoughts or feelings;
  • “external” occurrences involve the five senses: sight, sound, smell, taste, and touch.
  • In order for something to be a trigger, such an event must be connected in some way to the person’s using alcohol to other drugs.
  • The trigger is stronger if the event happen just before, or simultaneous to, the actual use (Gorski, 1988).
  • The most important thing to know about what makes a trigger a trigger is its connection to the use.

Bob  Tyler explains it this way: “A simple way of explaining this is by relating it to classical (or Pavlovian) conditioning. Ivan Pavlov was a Russian scientist who won the Nobel Peace Prize in 1904 for his research in digestive processes. While studying the relationship between salivation and digestive processes in dogs, he would show a dog meat powder and measure the resulting salivation level of the dog – they did this repeatedly. One day, Dr. Pavlov noticed that when he walked into the lab, that the dog started to salivate even before showing it the meat powder. There appeared to be some connection made for the dog between Dr. Pavlov and the meat powder which caused it to salivate. To study this phenomenon, he added a third variable (a bell) and rang it just prior to showing the dog meat powder and measured the resulting salivation level. He did this repeatedly: bell à meat powder à salivation, bell à meat powder à salivation, etc. He eventually found that he could ring the bell, not present the meat powder, and the dog would still salivate. Thus, there was a connection made for the dog between the bell and the meat powder that prompted the salivation (PageWise, 2002). For our purposes, the bell is the trigger for the dog’s drug of choice – meat powder, which caused the dog to salivate for, or crave, the meat powder. The challenge for the addicted is to identify the bells (triggers) that cause them to salivate (crave) their drug of choice. This will allow them to avoid or manage such triggers until the time in their recovery comes to start recovering from them.”

Disempowering (Recovering from) Triggers

There are three phases in disempowering  a trigger:

  • Phase 1: Avoidance: Make a list of the most powerful triggers that were associated with you drinking and drugging and plan to avoid them.
  • Phase 2: Gradual re-introduction with adequate recovery support: If consciously exposing yourself to a trigger it is best to have a friend in recovery to help you prepare, go through the experience with the trigger, be their to help you get out, and then talk about the experience and the thoughts and feelings that it stirred up.
  • Phase 3: Extinction. Phase I is to “eliminate as many of them as you can, for a limited period of time, until stable” (Gorski, 1988). As stated previously, in very early sobriety, you do not go to bars or other using places, you avoid people who use and drink, and you avoid any other triggers you identify.

“The second phase is a gradual reintroduction of the triggers so that the person can learn how to cope with them” (Gorski, 1988). This does not mean to gradually re-introduce the addict into the crack house or their favorite watering hole, but there are some trigger situations that you should be able to eventually participate in. As stated earlier, alcohol permeates our society and you would have to live a very sheltered life in order to avoid it over the long-term. Therefore, in order to lead any kind of normal life, gradual re-introduction to some trigger situations is necessary. This re-introduction process is best done with the addict’s sponsor or with a therapist or group if they have one. Following is an example of this process in my own sobriety.

The following story reported by Bob Tyler gives and excellent example:

“When I was about 90 days sober and still involved in the aftercare portion of my treatment program, we were invited to the wedding of my wife’s cousin in Chandler, Arizona. I thought: “I’d really like to go!” However, I had learned from past experience that decisions I made on my own in relation to my sobriety were typically bad ones. So I decided to leave it completely up to my group and put it out to them. The consensus was that since I was still working a very strong sobriety program, going to daily meetings, and going with my supportive wife, I could probably stay sober if I created a sobriety plan. The group then proceeded to help me put this plan together.

  • Suggestion 1: Carry a Big Book (Alcoholics Anonymous) onto the plane and read it: The thinking was that since flying on an airplane was a trigger for me to drink, it would be difficult to order a drink while holding a Big Book in my hand. The book has an embossed cover so nobody would know what it was and, if they recognized it, they probably have one and I might meet someone in the program.
  • Suggestion 2: Keep you recovery support system close. If traveling, find out where the lo=cal meetings are and make telephone contact with one or more local members. Have a written plan to go to 12-Step meetings each day and have an accountability system built-in.  I was in Arizona. They had me call the downtown Los Angeles Central Office of Alcoholics Anonymous (AA) to get the number of the central office in Chandler, Arizona. I was to get a meeting scheduled for each day I was there and, if possible, schedule a meeting for the time of the reception so if I got into trouble, I could simply leave the reception and go to a meeting. In fact, this actually happened – here’s a funny little story:
  • Suggestion 3: Have an Emergency Escape Plan if Craving Is Triggered: Bob Tyler went to the reception.  “I found myself talking to my wife’s uncle next to the wet bar at his home.” Bob said.  “Suddenly, someone plopped down a bottle of my favorite whiskey onto the bar right in front of me. After recovering from my slight panic, I excused myself and informed my wife  that I was going to a meeting. She was supportive because I had talked with her about this emergency plan before we left.   Fortunately, I got the address and directions to the from AA’s Central Office before I left. This made it easier for me to go.”

After the meeting, Bob went back to the reception where he noticed “everyone was having a great time dancing. This really looked fun to me, but I had never danced sober before. I always had to have at least a few drinks in me first because I was not a very good dancer and cared too much about what other people thought of me. When I had a few drinks, I felt like I danced like John Travolta and you didn’t think so – too bad!” It’s amazing how many recovering people won;t dance in recovery because they fear it will make them feel stupid and activate a craving. Bob is not alone here. So Bob developed a plan:

He waited for a fast song that he liked, and slid onto the dance floor while playing “air guitar” and, and starting to  dance. “A Van Halen song came on,” says Bob, and I was off and running. Little did I know that just after I left for my meeting, the bride and groom arrived, walked across the portable dance floor, and everyone followed tradition by throwing rice at them. You can imagine what happened next. As I attempted to slide onto the dance floor, my feet hit the rice and came right out from under me. I hit the floor, followed by two of my wife’s female cousins (one of them the bride!) who I managed to take down with me – one of them right onto my lap. I rose to my feet with my beet-red face and, as I looked around the dance floor, I could see my wife’s family’s reaction which I perceived as, “There he goes, he’s drunk again” – and I was probably the only sober person there!”

Alcoholics and other addicts carry with them a reputation for doing stupid things when they are drinking or using. AS a result, any time they make a mistake or try to have fun by being silly, many people with just assume they have stated drinking or drugging again. This can activate shame and guilt and bring back painful members. It’s also easy to feel unfairly judged and to question the value of your sobriety. “If this is how people will always react to me, why bother to stay sober?” Needless to say, this kind of thinking a serious warning that needs to be discussed with your therapist and sponsor.

The other elements of his sobriety plan helped Bob get though this situation sober. He called his sponsor each day discussing everything that happened and how he felt about it. He read the Big Book for a half-hour each evening to keep is sober-thinking brain circuits alive and active., and not going anywhere alone. Upon returning, my group and I processed what worked, and what additional program tools I might have used so I could use them the next time I might have to expose myself to triggers.

Through this process of gradual re-introduction, Bob was able to participate in increasingly more activities in my recovery to the point I can now do almost anything without being triggered. This is due to the third phase of the recovery process called the “extinction process” (Gorski, 1988). As mentioned earlier, triggers become extinguished when repeated exposure to them is connected with not using, rather than using.

Addiction professionals can learn to prepare recovering people for living in a society that is alcohol and drug centered.  The trigger management process, or as Bob Tyler Describes it, Trigger Recovery, can help many recovering people improve the quality of their sober life and reduce the fear and risk of relapse.

References:

Gorski, Terence T. (Speaker). (1988). Cocaine craving and relapse: A comparison
between alcohol and cocaine (Cassette Recording Number 17 – 0157).

Independence, Mo: Herald House/Independent Press.

Pagewise, Inc. (2002). This study in classical conditioning is one of the most renown for its incredible results. Learn about Pavlov’s dogs [Online]. Available Internet: http://ks.essortment.com/pavlovdogs_oif.htm.

Tyler, Bob. (2005) Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction

Books by Terence T. Gorski

Gorski’s book Straight Talk About Addiction describes trigger events in detail.

Gorski, Terence T., Addiction & Recovery Magazine, April 10, 1991

Gorski, Terence T.,  Managing Cocaine Craving, Hazelden, Center City, June 1990


TRAMADOL and ADDICTION

August 27, 2014

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By Terence T. Gorski, Author

I was recently asked the following questions about tramadol: Is Tramadol (Ultram) addictive? Are people being admitted to addiction treatment as a result of using it? The reason I ask is because I know a few people in 12-Step recovery who are on it. One says it does nothing. The other likes the effect. They look high. I thought it was non narcotic. Is it? Im confused.

GORSKI BOOKS

Here is my answer:

• Many doctors who are not trained in addiction medicine tell patients that Tramadol is not addictive. THIS IS NOT TRUE! Many patients are treated every day for addiction to Tramadol and the number seems to be growing.

• Tramadol, also known as Ultram, is a common drug of abuse, especially for people previously addicted to opiates. Tramadol is a centrally acting opioid analgesic. This means, for all practical purposes, that it is a narcotic drug.

• Always be suspicious when a recovering addict says they are regularly using a medication that “does nothing.” If it did nothing no self-respecting addict would keep taking it unless  they needed to use it to stay out of withdrawal T

• The withdrawal from Tramadol and other opiates presents as flu-like symptoms, so many people keep using it to deal with symptoms. It’s often not a conscious thing. They just find that if they take it very day they feel better than on days when they don’t take it.

• People can definitely develop tolerance to tramadol. This means they need to take more and more to get the same effect. Recovering addicts are skilled at denying their addiction to Tramadol, especially if a doctor told them that it was not addictive.

• Tramadol produces much lower pain-killing and mood-altering effects than other pain medications such as Vicodin. Tramadol, however, is nothing that recovering people should play around with,

Like other pain-killing medications, tramadol can cause real problems. There are frequent reports of tramadol dependence, even when used as prescribed for pain. In susceptible people, severe and serious addiction can of often does develop. A history of abuse or addiction to other mind altering drugs of abuse is an important risk factor.

If you have withdrawal symptoms when you try to stop, it is best to taper off slowly with a responsible person holding the medication. If you can’t quit, you’re probably addicted. Get evaluated and treated by an addiction professional.

GORSKI BOOKS


NIDA: Addiction Treatment Is Worth The Costs

August 27, 2014

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Substance abuse costs our Nation over $600 billion annually and treatment can help reduce these costs. Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself.

Treatment is also much less expensive than its alternatives, such as incarcerating addicted persons. For example, the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person.

Drug addiction treatment reduces drug use and its associated health and social costs.

According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also stem from fewer interpersonal conflicts; greater workplace productivity; and fewer drug-related accidents, including overdoses and deaths.

Source:
http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost.


Hydrocodone Being Reclassified by The FDA

August 27, 2014

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Dr. Steve Grinstead, an internationally recognized experts on addiction, pain management, and prescription drug addiction announced today that Hydrocodone will be reclassified by the FDA as a Schedule II Drug.

According to Dr. Grinstead , The Food and Drug Administration announced on August 22, 2014 that medications containing hydrocodone with Tylenol now must follow stricter prescribing guidelines. He explains the implications on a video blog.

For the past decade there has been a national debate about rescheduling hydrocodone – it’s been over 15 years since the idea was first proposed. Now it’s finally happening, hydrocodone combination products are being reclassified from the more-permissive Schedule III to the more-restrictive Schedule II category. It’s not immediate but should be official by early October this year.

Many people ask me; what is Schedule II? Well it’s the most restrictive of the medically-legitimate drugs. What the restrictions do is limit the amount available in the drug distribution system to prevent its misuse, or diversion, without unduly compromising patients getting the drug who really need it medically.

This change is really needed as it can be one step to minimize the misuse of the drugs for recreational purposes while still ensuring that patients with severe pain still have reasonable access to the amount of drug needed to control their pain and suffering.

How big is this problem? Well since 2007, more U.S. prescriptions were written for hydrocodone + acetaminophen than any other drug. In 2012, that was over 135 million prescriptions. According to the Center for Disease Control in 2011, drug overdose was the number one cause of injury death in the U.S., killing more people between ages 25 and 64 than in motor vehicle accidents. Of a total 41,340 drug overdose deaths, 22,810 (55%) were due to pharmaceuticals (i.e., not illegal drugs). Of those 22,810 deaths where pharmaceuticals were implicated, 16,917 were due to opioid narcotics. When it was due to other pharmaceuticals being the primary cause, this research shows opioids were present well of half the time.

To learn about managing chronic pain with coexisting disorders including addiction, please check out Dr. Grinstead’s book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. . Other Grinstead publications can be found at www,relapse.org including his book on You will also see some of his other publication pain management including his book Freedom From Suffering.


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