No One Is Responsible, Yet We Are All  Responsible. 

February 28, 2015

No one person is responsible for the powerful network of recovery, yet paradoxically, we are all responsible when we share our courage, strength, and hope and our knowledge of the effective principles and practices of recovery. 

No one person is responsible for the powerful network of recovery, yet paradoxically, we are all responsible when we share our courage, strength, and hope and our knowledge of the effective principles and practices of recovery. 

Through the power of out group conscience, we can participate in doing things together that none of us could do almone. 

“Recovery is and probable will remain a group activity.” ~ Terry Gorski, February 28. 2015 

Seven Strategic Steps Towards Effective Chronic Pain Management

February 18, 2015

By Stephen Grinsted

Below are seven strategic steps that I believe are necessary for people undergoing chronic pain management to learn in order to overcome obstacles for obtaining appropriate and effective chronic pain management. The rational and more in depth explanation for each of the following steps can be found in my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. Please watch m y video below and then read the remainder of my post.

Developing an Initial Multidisciplinary Pain Management Plan: The first step of effective pain management is utilizing a multidisciplinary assessment protocol. The patient needs to objectively examine their current pain management program. They should list each of the medications and non-pharmacological pain management interventions they are currently using and answer pertinent questions about each one. They also need to list their professional and personal support system, identifying the strengths and weaknesses of each.

Looking At Pain Objectively: This component explores how to increase the patients’ understanding of their pain and how to use that knowledge to improve their pain management. They need to learn the different aspects of pain—acute and chronic—and the bio-psycho-social components of pain as well as the difference between pain and suffering. They should learn about the stress-pain connection and how to rate their stress and pain levels accurately. Finally they need to explore how their thinking, emotions, behaviors, and social relationships change when they’re having a “bad” pain day.

Understanding and Managing Depression: Since depression frequently affects people in chronic pain, in this component patients need objective and easy to understand information about depression and what constitutes effective depression management. They should learn how to accurately rate the type and level of depression symptoms they experience and then develop their own personal six-step depression management plan.

Exploring Effective Use of Medication: This component starts with educating patients about some common, and possibly misunderstood, terms like medication abuse, dependency, pseudo addiction, and addiction. Patients need to learn how to use a Red Flags checklist to see if they have a problematic relationship with their pain medication. They also need to learn the role of denial and finally explore the benefits and disadvantages of using appropriate pain medication.

Developing An Effective Pain Management Plan: In this component patients are exposed to the concept of a Pain Management Agreement and how to deal with urges/cravings that could tempt them to use pain medication in an inappropriate manner. They should develop a nonpharmacological (non-medication) pain management plan and learn to utilize a pain journaling process to increase their pain management skills.

Exploring Biological versus Psychological/Emotional Symptoms: This component focuses on explaining ascending versus descending pain signals and exploring and scoring the patients’ biological and psychological/emotional pain symptoms. Patients also need to look at how their TFUARs (thinking, feeling, urges, actions, and social reactions) change on a bad pain day and how to manage their TFUARs more effectively.

Finalizing the Pain Management Plan: This component ties everything together by teaching patients to identify and rate their bio-psycho-social-spiritual pain management goals. Then they should learn how to improve their existing pain management foundation and test this new plan to make sure it is effective.

If you want to learn more about effective pain management for someone undergoing chronic pain management with coexisting disorders including addiction check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.

For anyone wanting advanced skill training in working with patients suffering with chronic pain and coexisting disorders I’m presenting a dynamic three day Addiction-Free Pain Management® Certification Training coming up in April 9-11, 2015 at our office in Sacramento. Space is limited so check it out and REGISTER NOW!

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Understanding the Terrorist Radicalization Process

February 18, 2015


This is directly reposted from the Department of Defense (DOD) – Defense Human Resource Activity: I decided to post this blog on the radicalization process because the problem of terrorism appears to be growing and we all need accurate information about how people are recruited to a terrorist cause and the steps taken to motivate them to reject previous belief systems and to embrace new, radical, and often deadly beliefs, even when, on their face, they are absurd and irrational.

We must all understand the raprocess so we can recognize it early and stop the process before the radicalized individual does horrible damage.

The basic message we need to give is clear: the promises of radicalization are false and will lead to horrible inner pain and eventually death. ~ Terence T. Gorski 

Here is the DHRA Report: The Radicalization Process

There has been much research, writing, and theorizing about what causes or motivates people to become terrorists. The one consistent finding based on extensive empirical research is that there is no “terrorist profile” that can be used to predict who or even what type of person might become a terrorist.

Research clearly rules out the early theory that participation in terrorist actions is associated with some sort of personality or mental disorder, that only “crazy” people commit horrible acts of terrorism. Studies have shown that the prevalence of mental illness among incarcerated terrorists is as low or lower than in the general population. Although terrorists commit horrible acts, they rarely match the profile of the classic psychopath. They are also not necessarily from a lower socioeconomic status or less educated than their peers.1

Social scientists, law enforcement organizations, and intelligence agencies all agree that terrorists are the product of a dynamic process called radicalization.

Brian Jenkins, one of our country’s most senior terrorism scholars, defines radicalization as “the process of adopting for oneself or inculcating in others a commitment not only to a system of [radical] beliefs, but to their imposition on the rest of society.”2 The compulsion to use violence to impose their beliefs on the rest of society, or to punish others for their “evil” actions or beliefs is the final stage in the radicalization process.

The commitment to violence is what distinguishes a terrorist from other extremists. This process occurs over time and causes a fundamental change in how people view themselves and the world in which they live. The exact nature of this process is still poorly understood. Researchers have developed a number of different theories and conceptual models that seek to explain the process by which an individual becomes radicalized, but these theories have not been empirically tested.

Most see three to five stages from beginning to end of the process, from initial exposure through indoctrination, training, and then violent action. However, different researchers conceptualize these stages differently and use different terminology to identify or explain them.

There is broad agreement, however, that many people who begin this process do not pass through all the stages and become terrorists. Many people who become extremists stop short of the violence that is typical of militant jihadists.

Our focus here is on violent jihadism, and specifically on several aspects of the radicalization process about which there seems to be some consensus. While the researchers have not identified causes of terrorism, they have identified three vulnerabilities that may provide sources of motivation or make one more likely to endorse violence. These vulnerabilities are:

1. Perceived Injustice or Humiliation: Violent attack may be perceived as an appropriate remedy for injustice or humiliation.

2. Need for Identity: An individual’s search for identity may draw him or her to extremist or terrorist organizations in a variety of ways. The individual may be searching for a purpose or goal in life that defines the actions required to achieve that goal. A violent act may be seen as a way to succeed at something that makes a difference. The absolutist, “black and white” nature of most extremist ideologies is often attractive to those who feel overwhelmed by the complexity and stress of navigating a complicated world. Without struggling to define oneself or discern personal meaning, an individual may choose to define his or her identity simply through identification with a cause or membership in a group.

3. Need for Belonging: Many prospective terrorists find in a radical extremist group not only a sense of meaning, but also a sense of belonging, connectedness, and affiliation. One researcher argues that “for the individuals who become active terrorists, the initial attraction is often to the group, or community of believers, rather than to an abstract ideology or to violence.” 3

There is also some consensus on two factors that facilitated the radicalization process.. These are:

1. Spiritual Mentor: About 20% of the homegrown terrorists examined in one study had a spiritual mentor, a more experienced Muslim who gave specific instructions and direction during the radicalization process. Such a mentor might be associated with a mosque or be accessed via the Internet. The mentor keeps the radicalization process on track. About a quarter of the terrorists in one study had a perceived religious authority who provided specific theological approval for their violent activity. 4

2. Internet: The increased radicalization of American Muslims is driven in part by a wave of English-language websites designed to promote the militant jihadist doctrine. These websites are not run or directed by al-Qaida, but they provide a powerful tool for recruiting sympathizers to its cause of jihad, or holy war against the United States, according to experts who track this activity. Jihadist websites and chat rooms provide indoctrination and training to aspiring jihadists and enable them to establish contact with like-minded individuals in the United States or with terrorist groups abroad. “The number of [active] English-language sites sympathetic to al-Qaida has risen from about 30 seven years ago to more than 200 recently,” according to the head of a Saudi government program that works to combat militant Islamic websites.5

Terrorism is not random violence for its own sake. It is violence guided by an ideology that provides the rules for one’s behavior. “Ideology is often defined as a common and broadly agreed upon set of rules to which an individual subscribes, and which help to regulate and determine behavior.”6 The rules often link behaviors to anticipated long-term positive outcomes and rewards. This is the basis for the suicide attacks that are characteristic of violent jihad. By fulfilling one’s duty to God by killing infidels, one allegedly gains access to paradise.

The ideology that supports militant jihad is very different in its substance from other forms of extremism or terrorism such as white supremacy groups or eco-terrorism, but they all have four features in common. All terrorist movements are: 5

1. Polarized: They have an “us vs. them” mindset.

2. Absolutist: The beliefs are regarded as truth in the absolute sense, sometimes supported by sacred authority. This squelches questioning, critical thinking, and dissent. It also adds moral authority to framing us vs. them as a competition between good and bad (or evil).

3. Threat-Oriented: External threat causes in-groups to cohere. Good leaders know this intuitively. They persistently remind adherents that the “us” is at risk from “them.” Because the “us” is seen as being good and right in the absolute sense, this works not only to promote internal cohesion but also opposition to all nonbelievers.

4. Hateful: Hate energizes violent action. It allows principled opposition to impel direct action. It also facilitates various mechanisms for moral disengagement, or dehumanization, which erode the normal social and psychological barriers to engaging in violence. This is an important point, as it is the active support for violence that distinguishes the simple extremist from the terrorist.

The section on The Militant Jihadist Terrorism Threat describes the threat. One empirical study of 117 homegrown jihadist terrorists in America and the United Kingdom has identified the following observable manifestations of the radicalization process. This may be useful for identifying how far along individuals are in the radicalization process. 4

At an early stage, one comes to trust only the interpretations of an ideologically rigid set of religious authorities. These role models and scholars one looks to as guides have a significant impact on how others interpret what their faith demands of them.

Also at an early stage, one adopts a legalistic interpretation of the Muslim faith. There are rules that must be followed, not just for practice of the faith, but also for virtually every aspect of one’s daily life. For example, playing music, taking photographs, or women laughing in the street may be considered sinful.

At the final stage of radicalization, these rules include an obligation for all believers to undertake violence against infidels in order to advance the faith.

As they radicalize, Muslims come to perceive a fundamental conflict between Islam and the West. The idea of loyalty becomes critical: they have obligations to Islam alone and cannot have any kind of duty or loyalty to a non-Muslim state. Even participation in the democratic process in one’s own country violates religious principles that the rules are made by Allah, not by man.

This rigid interpretation of Islam leads to a low tolerance for any alternative interpretations or practices. After changing one’s own beliefs and practices, one feels compelled to impose the newly found beliefs on other family members and close friends. Any deviation by others from this rigid interpretation is seen as a personal affront. This is usually expressed by telling others that they are not good Muslims, which can sometimes lead to violence. It causes some individuals to separate themselves from and come to hate other Muslims who previously had been an important part of their lives.

In the latter stages, radicalization usually includes political as well as religious beliefs. Radicals believe the Western powers have conspired against Islam to subjugate it politically and corrupt it morally. They want to restore the caliphate that once united the Muslim world and ruled according to Allah’s dictates.

Remember that in the United States, expression of radical or extremist views is not illegal. It is illegal only when it reaches an advanced stage of supporting or engaging in an act of violence or other illegal behavior. For an individual who holds a U.S. Government security clearance or some other position of public trust, however, a stricter standard of allegiance to the United States applies. Advocacy of militant jihadist views as described in The Militant Jihadist Terrorism Threat is clear evidence of an absence of loyalty to the United States and is grounds for denial or revocation of a security clearance or access to other sensitive information or installations.

1. Randy Borum, “Understanding Terrorist Psychology,” in Andrew Silke, ed. The Psychology of Counter-Terrorism. Oxon, UK: Routledge, 2010.
2. Brian Michael Jenkins, “Outside Experts View,” preface to Daveed Gartenstein-Ross & Laura Grossman, Homegrown Terrorists in the U.S. and U.K.: An Empirical Examination of the Radicalization Process. Washington, DC: FDD’s Center for Terrorism Research, 2009.
3. Martha Crenshaw, “The Subjective Reality of the Terrorist: Ideological and Psychological Factors in Terrorism,” in Robert O. Slater & Michael Stohl, eds., Current Perspectives in International Terrorism. Hampshire, UK: Macmillan, 1988, p. 59.
4. Daveed Gartenstein-Ross & Laura Grossman, Homegrown Terrorists in the U.S. and U.K.: An Empirical Examination of the Radicalization Process. Washington, DC: FDD’s Center for Terrorism Research, 2009.
5. Randy Borum, ibid., p. 9.
6. Randy Borum, ibid., pp. 10-11.
7. Donna Abu-Nasr & Lee Keath, “200 Web sites spread al-Qaida’s message in English, The Washington Post, November 20, 2009.

Parent of Addicted Children: Getting The Help You Need

February 18, 2015

When you have children they don;t come with an instruction manual. This is unfortunately because the world is becoming  more complicated, many experts disagree on  the best approaches to parenting children to help them grow into some and responsible people. All of the while parents are doing there best to raise some responsible children, powerful cultural forces backed by billions (yes I said billions) of dollars are work full time to undermine their efforts in the pursuit of profit. These cultural forces have consolidated into four powerful industries working against responsible parenting. These are:

1. The alcohol industry;

2. The pharmaceutical industry which is the root of prescription drug addiction;

3. An illegal drug yet high accessible illegal drug industry; and

4. The rapidly growing legal marijuana industry.

The combined influence of these four addiction-promoting industries has been to make drinking, drugging, and getting high appear to be safe an normal. The present people who get addicted as the exception rather than the rule.

The message of these GET ADDICTED STAY ADDICTED INDUSTRIES is very simple.

“It’s normal to want to get high by drinking socially and using drugs recreationally. Th regular and heavy use of alcohol and other drugs/medication is normal and harmless. Successful people can handle it with no problems. Those who can;t handle it have something seriously wrong with them. The drugs aren’t the problem. The problem is that you are too defective to engage in recreational alcohol and drug use. Tis means you mentally ill or a criminal and should be locked up away from us social and recreational users who have it together and can enjoy using with getting into trouble.”

I have been following the Kathy Toughinbauch Blog 

Sobriety Dates and Relapse

February 16, 2015

By Terence T. Gorski, Author

I received this letter from Deb H. And decided to share it and my response because I receive many similar questions.

Hi Terry.

I am familiar with a recovering person who was in stable sobriety from alcohol for twenty-two years and then developed a legitimate severe pain disorder. The person was prescribed Norco for pain and used it as prescribed with positive pain control for 5 years. In the fifth year he began a progressive loss of control of the Norco. This was his 17th year of absence/sobriety from alcohol.

What happens to the previous recovery? Is it all list? What happens to the sobriety date? What went wrong that caused the person to have relapsed like this?
Thank you,
Deb H

Terry Gorski’s Response: People with long-term recovery do not lose all of the benefits of their previous sobriety when they relapse. Once the person breaks the new addiction cycle and stabilizes most of the information and recovery skills rapidly return. Unfortunately, so does debilitating shame and guilt.

It is important for them do write a detailed recovery and relapse history which identifies the recovery skills that were helpful and the indicators they missed that they were getting in trouble with the pain medication. They also need to ask if they really sought out addiction-free pain management methods to lower their us of pain Meds as they learned how to use the other pain management methods.

The issue of “Sobriety Date” can be confusing. I suggest they carry three dates: My original sobriety date was ______. I relapsed after _______ length of sobriety. I am currently continuously sober for _______.

Perhaps the only thing this person missed was learning Addiction-free Pain Management Methods. This is understandable because most Doctors have no idea how to use non-medication pain management either in conjunction with or as a substitute for pain management. See Grinstead’s Addiction-free Pain Management for a whole new world of non-addictive pain management methods. ON THE INTERNET:

God and the Sunrise

February 15, 2015


By Terence T. Gorski, Author

Once, in the early morning just before sunrise, I was standing with a student waiting for the sun to come up. I was teaching a class on relapse prevention at a conference center in Arizona. I got up early to watch the sunrise. A young man, one of my students, walked up next to me. We both gazed toward the east waiting for the sun to come up

“Do you believe in God?”  the student suddenly asked.

The question surprised me. Before I could answer,  the first rays of the sunrise broke over the eastern horizon – pushing away the darkness of night and blanketing the sand-colored rock with an incredible mist of swirling colors.

I looked at the young man and for a moment. Then I turned back to watch the brilliantly colored rays role gently role toward us. They seemed, at first, to be boiling above the hot desert sand. As the sun rose higher in the sky, the multicolored mist turned into a blazing ball of silver and gold. it was so bright we had to squint our eyes and look away.

“Well – Do you believe in God?” The boy asked again. I had forgotten he had asked the question. His voice was so insistent and his face was so serious that I knew I had to answer

“Yes,” I Said. “I believe in God. There is certainly someone or something bigger and more powerful than me – Someone who capable making much better sunrises than I ever could. I believe in God very strongly when I watch his powerful works unfold all around me.” The boy seemed satisfied with my answer.

We gave one last glance at the rising sun. We turned and walked back into the conference room. Even though the rising sun was incredibly beautiful, there was no time to waste. We were learning about how to help addicts and their families recovery. As we settled in and I began the class, I could feel the presence of God in the room and I realized that the work we were doing in the classroom was just as powerful and awe-inspiring as the sunrise we had just experienced

The Books of Terence T. Gorski

Anger Management

February 14, 2015


“Anger management is a critical skill for all addiction professionals. These online courses from SAMHSA are important resources.” ~ Terence T. Gorski (The Publications of Terence T. Gorski)

SAMHSA Newsletter on Anger Management Courses

Everyone experiences anger from time to time. It’s a normal emotion. But intense or prolonged anger can jeopardize employment, relationships, education, and even freedom. Those who struggle to control their anger are increasingly finding their way to behavioral health professionals for assistance. It is precisely for this reason that SAMHSA has created resources and a new a online course to help.

We see it in our schools, workplaces, families, and out in public – the person who yells, hits, or throws things – and sometimes sparked by something as small as a missed parking space. In a culture where time is short, anger can surface quickly and with intensity. And anger can erupt into physical violence.

– The Centers for Disease Control’s 2010 National Intimate Partner and Sexual Violence Survey, found that one in ten 9th to 12th graders had been physically hurt on purpose by a boyfriend or girlfriend.

– SAMHSA’s 2012 National Survey on Drug Use and Health: Mental Health Findings revealed that nearly 19 percent of youth receiving mental health services have trouble controlling anger.

– In 2009, the Bureau of Justice Statistics’ National Crime Victimization Survey reported more than a half million nonfatal violent crimes took place at work.

– Prisons and jails are even worse, where 38-50 percent of inmates experience persistent anger and irritability. When the problem results in an arrest or other disciplinary action, there often is a referral or requirement to engage in some therapy or treatment to help manage the intense emotion and prevent additional similar experiences.

The Anger Control Plan
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

1. Take a time out (formal or informal).
2. Talk to a friend (someone you trust).
3. Use the Conflict Resolution Model to express anger.
4. Exercise (take a walk, go to the gym, etc.).
5. Attend 12-step meetings.
6. Explore primary feelings beneath the anger.

Typically, when someone gets angry, there are responses that are physiological (becoming flushed, burst of energy and arousal, etc.), cognitive (thoughts that occur in response to an event), emotional (feeling afraid, discounted, disrespected, impatient, etc.), and behavioral (sarcasm, swearing, crying, yelling, throwing, etc.).

Problem anger occurs when someone experiences anger as a chronic irritability or a full-on rage – as an emotion experienced too intensely or too often. The consequences of long-term anger issues can lead to arrest, injury (self or others), adverse effects on important relationships, job loss, or treatment program ejection. Some groups have a higher risk of experiencing problems with anger, including individuals with substance use disorders, traumatic brain injury, post-traumatic stress disorder, and personality disorders.

Working with Angry Clients

“Anger management” is currently the most searched term on the SAMHSA website. This reality speaks both to the need for support around this issue and the practical benefit of SAMHSA resources like the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook and the newly launched Anger Management for Substance Abuse and Mental Health Clients course. The course is especially designed for anyone working with a person who struggles to control anger, but particularly substance abuse and mental health clinicians.

The Five Steps of the Conflict Resolution Model
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

Step 1: Identify the problem that is causing the conflict.

Step 2: Identify the feelings that are associated with the conflict.

Step 3: Identify the impact of the problem that is causing the conflict.

Step 4: Decide whether to resolve the conflict.

Step 5: Work for resolution of the conflict: How would you like the problem to be resolved? Is a compromise needed?

The online course takes approximately two to three hours to complete and uses a cognitive behavioral approach to working with angry clients. It covers a range of topics including how people respond to getting angry (passively, assertively, aggressively, or passive-aggressively), how to manage anger with people with traumatic brain injury or post-traumatic stress disorder, and how to assess anger and readiness for anger treatment. The course also includes a description of the cognitive behavioral therapy approach, treatment model overview, and other important information about anger management. The course is based on the Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish) and the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook (also available in Korean and Spanish).
In addition to behavioral health service providers, the course may also prove useful for human resource and other managers, school teachers and administrators, those working in the criminal justice system, or anyone experiencing anger issues. Upon completion of the course, certification is provided for continuing education credit.

Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish)

Anger Management for Substance Abuse and Mental Health Clients Participant Workbook (also available in Korean and Spanish)

Resources on the Internet

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