June 6, 2014

20140606-163003-59403433.jpgby Terence T. Gorski

ADDICTION is a pattern of compulsive use of alcohol and other drugs, described in DSM IV as A Substance Use Disorder.

In this blog I am going to use the term PSYCHOPATHY interchangeably with the terms ANTISOCIAL PERSONALITY DISORDER (ASPD) and SOCIOPATHY. These three terms describe essentially the same personality disorder marked by the following symptoms:
– a lack of empathy,
– a compulsive pattern of challenging authority, breaking rules, and victimizing others;
– the refusal to accept responsibility for the consequences personal behavior;
– the tendency to lie, cheat, steal, and manipulate others with little concern for the consequences; and
– the tendency to avoid responsibility by blame the victim or the enforcer when caught by the consequences of their own behavior.

A PERSONALITY DISORDER is an habitual pattern of believing, perceiving, thinking, feeling, acting, and relating to others that begins in early childhood, persists into adulthood, affects many areas of life and causes problems in social and occupation functioning.

Addictive disorders, described in the DSM as Substance Use Disorders, are not personality disorders. Addiction is a condition marked by:
– the obsession with and compulsion to use alcohol and other mind-altering substances;
– a compulsive pattern of use resulting in a loss of control over the ability to self-regulate the quantity, frequency, and duration of substance use; and
– secondary life and health problems caused by the progressive loss if control.

Psychopathy and addiction, although they share some characteristics, are not the same type of disorder. Some, but not all people suffering from addiction also have psychopathy. Some, but not all people suffering from psychopathy also abuse or become addicted to alcohol and other drugs. These are coexisting or co-occurring disorders that are different in kind.

Psychopathy is a personality disorder. Addiction is not!

There is no evidence that there is any personality style or disorder that causes addiction. People with all variations of healthy personality styles and personality disorders can become addicted.

The research suggests that chronic stage alcoholism and drug addiction creates some symptoms that look like the symptoms of antisocial disorder.

As people stabilize from acute withdrawal and post acute withdrawal (PAW), these symptom rapidly decrease as measured by standard personality tests within the first thirty days of sobriety.

Therefore, it is important to indicate days of sobriety and neuropsychological stability before deciding if antisocial behaviors are long-term personality traits or temporary traits related to the pain and dysfunction of withdrawal.

The diagnostic criteria that separate Psychopathy (Antisocial Personality Disorder), from the other cluster B personality disorders (Histrionic, Narcissistic, and Borderline) are not well established and tend to overlap. It is estimated that about 3-5% of the population suffer from ASPD (which is marked by violating laws and social norm)s, and as many as 20% are socially conforming psychopaths who lack empathy, challenge authority, victimize others, are deceptive, and do not learn from experience.

These socially conforming psychopaths wreak havoc and destruction all around them and destroy lives but are skilled at shifting the blame onto others (flipping the script) and avoiding legal consequences.

Alcoholics and prescription drug addiction have about the same incidence of psychopathy as the general population. In late stage addiction, the severe symptoms of intoxication, withdrawal, and post acute withdrawal can look like the symptoms of ASPD especially in a society that highly stigmatizes addiction.

People who use and/or become addicted to illicit (illegal) drugs are another story. Psychopaths are drawn to illegal drugs by their compulsion to challenge authority, break rules, and find excitement through extreme manipulation and risk-taking behavior. As a result, the incidence of antisocial behavior and psychopathic personality disorders is higher among illegal drug addicts than in alcohol or presciption drug addicts.



On Becoming A Writer

January 15, 2014

Write your life away. It’s important!

By Terence T. Gorski,  Author, Blogger
January 15, 2014

You become a writer much like you become a jogger. You are a jogger when you put on running shoes and start running — and the shoes are optional. You are a writer when you start writing and sharing your work with others — sharing your work is optional. Nobody gets stronger by not lifting weights. In the same way writers don’t get better by not writing or by refusing to publish their work.  Today it is easy to publish yourself by starting a blog. This will get your writing in front of others.  The mechanics of publishing yourself with a blog is so easy and inexpensive that there is no excuse for not doing it — except fear.

In theory, it is easy to start a blog and see if you can build a following.  Every writer should do it. In reality, it’s not the mechanics of posting a blog that stops writers from sharing their work — it is bold naked fear. It is terrifying to put your heart and soul into your writing and then throw it out in public to see what happens. Writers, however, need to develop a thick skin. Everyone can be a critic. It is the rare few that have the discipline and courage to express their personal truth in clear and simple language and put it out for critical review. This is why it is so important for writers to network with and support each other. One writer can help another and both can build a bigger combined audience. The more hot links in your blog, the higher it gets ranked in the search engines. Everybody wins.

It is the voice of writers echoing through the halls of history that allows ideas to take on a life of their own.  Writing is all about the search for truth and expressing what you find in a beautiful way. Truth must be rediscovered anew by each generation. Writers of older generations pass forward their truth to younger generations. We all stand on the shoulders of those who came before. The next generation will stand on our shoulders.

Old writers tell their truth to the next generation. Young writers interpret that truth and express it to their own generation. By doing so they pass it forward once again. Hopefully, the new voices of each generation will build upon and transcend the core message of truth that was expressed by older generations.

“There is nothing new under the sun.
All that is happening now, has happened before
and will happen again.”
~ Ecclesiastes ~

There is, however, one important glitch. Most great writers are not widely recognized until after they die. Don’t let this frighten you, however. Writing won’t kill you. So if you want to be a writer, here’s what you need to do. Write and keep writing. Share your work and keep sharing it. Never stop because writing is important — YOUR writing is important. Write it even if you believe you have nothing important to say — because whether your believe it or not you do. Every person has a story. All true stories express an aspect of truth. Write about what you know. Express your truth. That’s all any of us can do.

I believe that all of recorded history lives in the brain/mind of every living person. Art allows us to feel that flow of history within our own soul. Science allows us to structure knowledge in a way that it can be used. Writing allows us to pass it forward through time and space to future generations. Writing is a form of faith. You have to believe that somehow, to someone, your writing will make a difference. Writing can truly make us immortal. Look at the authors of the Dead Sea Scrolls. We don’t know their names. Their work was buried in the desert for centuries. Yet their voice is known to all humanity and teaches us of their time. Their work shows us our past and, if viewed correctly, will point the way to our future.

Now I want to talk about some important nuts and bolts I’ve learned about writing over my career.

1. When expressing ideas, shorter is better, as long the meaning is retained. The best advice I ever received was to write my first draft and then mercilessly cut unnecessary words and find the “turn of a phrase” that expressed the idea more concisely.

2. Reduce your ideas from paragraphs, to sentences, to phrases, to words and then build them back out again. My best work has come when I have reduced ideas to short bullet points that could be understood, at least intuitive, without being explained. Here are some examples: Craving is a hunger for drugs; Everyone suffers from addiction, either their own or that of someone else. Read these simple phrases and pause after each. See if they communicate a meaning beyond the words used to express them:

  • Early Relapse Warning Signs;
  • Triggers for Craving;
  • High Risk Situations;
  • Self-defeating Thinking;
  • Addictive Insanity 

These short bullet points literally force the minds readers to gather previously unrelated thoughts into an epicenter of understanding. Unrelated ideas become a unified concept. Concepts become the calmness at the eye of the storm of mental confusion. Finding these precise bullet statements is  time-consuming part. It is, in my opinion, the most difficult part of writing about non-physical realities of the mind and spirit. These bullet points make the nonphysical concrete by embodying it in a thought. There is good news.

When the concepts are stripped down to their bare essence and the bullet points are engraved in writing,  you will have a really good set of power point slides. The process of reducing complex ideas to a single word or phrase that encompasses the essential meaning is called conceptual integration. This will be the focus of a future blog, so keep following! There is another problem! Clear concepts are necessary, but alone they are not enough.

3. Good writing must be humanized. All great novels both paint vivid pictures in the mind of the reader and make powerful conceptual points that shoot into the mind of the reader like a bullet of thought that links the imagery with the idea.  The difference between a novel, and a readable non-fiction writing is the primary organizational structure. The novel is built around a blot that progresses as characters grow and develop in response to challenges. The information and philosophical principles of life and living are definitely there but are secondary to the compelling plot line and the characters that you either love or love to hate. Non-fiction is organized around presenting information and ideas. It is humanized by giving examples that areas vivid and compelling as any scene in a great novel. Then comes the hook.

4. The hook is the simple trick that makes people want to read the next paragraph. The hook goes fishing for the reader’s curiosity. If you can make the reader curious about what comes next people will keep reading and you will have written a page turner. Do I do it?

You will have to judge for yourself by checking out my blogs: 

If this were a class, I would ask you to go back, read this blog again, and notice all of the hooks. I would then ask you to determine if I am better at summarizing ideas or illustrating ideas in compelling examples. Share this blog with a colleague who is a writer, do these two assignments, and then discuss them.


Gorski On Charting Featured By Behavioral Healthcare Magazine

January 14, 2014

gorski-on-charting-blog-1-art-work1The blog Gorski On Charting, sponsored by Medivance Billing, is being featured on the Behavioral Healthcare Magazine Website. The blog will be a bi-monthly series. Who ever thought clinicians could actually get excited about using assessment, treatment planning and documentation to become better therapists.

“There is a  coherent process that underlies effective documentation. The relationship between charting and effective treatment is highlighted at every step. This is why treatment professionals can get excited about this system. It explains a complex process in clear and easy to understand language. Charting is linked to what clinical professionals want to do — help their patients to recover.” ~ Terence T. Gorski

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