Filling the Black Hole – The Science of Addictive Behaviors

Metaphorically Speaking

As I was doing my long run last weekend, I chose a hilly route because I was in the midst of training for a half marathon with a very hilly course. When I got to the top of a long hill in my town that I have a choice name for, I felt like a rock star. Mostly because when I turned around the wind was at my back and I was now running at a decline. My pace was good, and low and behold “the runner’s high” kicks in. Ahhh, this is why I run, for the rush of endorphins and feel-good chemicals that flood my brain. However, somewhere between the eighth and ninth mile of my run, I became tired, hungry and a little irritable, ready to go home. I remember thinking “what goes up must come down”. Why do I do it? I do it because the feelings I get when I am on my “high” far outweigh the fatigue, the pain, the injuries and any negative thing associated with running. When I am not doing it, I miss it and crave it. I am irritable. I don’t always get the runner’s high, but I go back for more, seeking that feeling.

The Addicted Brain
I use this metaphorically to explain more about the addicted brain. I see several people in my private practice struggling with addiction of all sorts, whether it’s food, alcohol, drugs, gambling, sex, porn or shopping, we all have our own vice. Addiction has a specific definition: you are unable to stop when you want to, despite being aware of the adverse consequences. It permeates your life; you spend more time trying to satisfying your craving (Dr. Nora Volkow, Director, NIDA). Initially, a person may start taking a drug or drinking hoping to change their mood or emotional state, however they may not be able to stop after a while because their brains become rewired by the substance use. This “feel good” (the brain’s dopamine) response is registered in a certain part of the brain and the process becomes the “brain reward pathway”. With addiction, the person becomes conditioned to the drug-induced pleasure. Repeated use impacts the brain by reducing available dopamine and other brain chemicals and withdrawal occurs when drugs have depleted these brain chemicals. This is what I refer to as “filling the black hole”, or trying to find that feeling of euphoria, calmness or numbness that the substance provides. The addiction is not really to the sex, shopping, eating or substances themselves, but rather to the dopamine and endorphin rewards. Recovery will always be an uphill battle and relapses are part of that battle, but people are doing it every day. Being intentional and knowing our triggers and weaknesses take work and we must start over daily. Online addiction treatment can be your biggest ally in this journey. With today’s rat race, not everyone can find the time for that face-to-face counseling. Online recovery programs are there at your convenience, when you need it most. “What matters is not the features of our character of the drives and instincts per se, but rather the stand we take toward them. And the capacity to take such a stand is what makes us human beings” (Viktor Frankl, The Will to Meaning).

Two Popular Social Media Articles on Addiction Offer Biased Views

Two articles about addiction and its treatment published lately have been widely shared in social media, and they bother me. There’s no question that the authors of both are well-meaning, but each purports to have a clear “answer” to the disaster of addiction. Though unintended, each distorts the big picture in a way that may confuse the people who need help most.

Albert Einstein said, “Everything should be made as simple as possible, but not simpler.” In Johann Hari’s recent article, The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think, he argues that the cause of addiction is no more than the lack of a strong, loving community. It follows that the cure for addiction then must be…a strong, loving community! For Mr. Hari to present this as a breakthrough, he must be unaware that Alcoholics Anonymous, its sister 12 Step tradition support groups, and a number of non-12 Step support organizations are *all* based on creating a welcoming, loving community for the “newcomer” seeking a life in recovery. Long story/short: it’s not news.

And what happens for the person who finds a better community and still struggles with addiction? Is he a failure? No, because Mr. Hari’s analysis leaves out two critical components of addiction: the very real, physical, brain disease – damage caused by too much drugs and alcohol in the blood – and the co-occurring psychological disorders that, in 70% of cases, drive the obsessive behavior we call addiction. If you’re interested, I think my January 2014 blog post (ironically, similarly titled), What is Addiction? Not what you think, offers a better explanation.

While Mr. Hari’s article promotes a simplistic concept which he extrapolated from a study of caged rats, Gabrielle Glaser’s article in The Atlantic Monthly, provocatively titled The Irrationality of Alcoholics Anonymous, goes to the other extreme.

To Ms. Glaser’s credit, her research is deep, she deplores the kind of one-dimensional thinking promoted by Mr. Hari’s article, and she makes a strong argument in support of individualized, evidence-based treatment. But in her zeal for a new generation of pharmacological interventions and a harm reduction (modified use vs. abstinence) approach, she goes too far: declaring war on Alcoholics Anonymous is not the solution to the problem.

The individualized, evidence-based treatment Ms. Glaser promotes is the basis of all Joint Commission-accredited addiction treatment programs. Lionrock Recovery is one of only two Joint Commission-accredited online programs, along with well-known treatment centers like Betty Ford, Hazelden, The Meadows, and Foundations Recovery Network. “Support group orientation” is an important aspect of the “best practices” program on which our accreditation is based. This means that we actively encourage our clients to seek a support group, including AA among others, that makes sense for them.

Addiction treatment and support group meetings are often confused by people outside of the recovery world, and for good reasons which I’ll cover another time. In reality, they have very different dynamics, and they play complementary roles in fostering recovery. The American Society of Addiction Medicine (ASAM), the primary authority on both medically-assisted and evidence-based treatment in our field, codifies this view in its addiction treatment best practices. Despite this, Ms. Glaser asserts that the 12 Step support groups like AA aren’t effective enough to be included in the mix of therapies used for treating addiction.

More than 2 million people participate in 12 Step support groups in support of their recoveries. By this metric alone, Ms. Glaser’s assertion that they offer no value is at odds with her argument for individualized treatment. Further, it gives rise to a practical problem for us in the treatment field: how do we meet the ASAM best practices requirement for promoting support group participation? AA is the oldest, most prominent of the support group organizations. It’s effectively free, and meetings are available around the world, often around the clock. There are alternative support groups for people who prefer a less spiritual focus, but AA is the easiest path because of its critical mass.

Unfortunately, despite some strong research and logical arguments for improving treatment, Ms. Glaser is throwing the baby out with the bath. If her articles discourage people who would benefit from AA from participating, is that a net gain? If her articles offend and turn off people who participate in AA, who might otherwise benefit from medically-assisted treatment, is that progress?

One example from Ms. Glaser’s article really illustrates the point for me. She tells the story of a 38 year-old Finnish doctor who decided to take the drug naltrexone “for the rest of his life” so that he can drink socially, “two, maybe three times a month”. She continues, “By American standards, these episodes count as binges, since he sometimes downs more than five drinks in one sitting. But that’s a steep decline…” Meanwhile, The Centers for Disease Control identifies many health risks associated with this level of drinking, including cardiovascular, liver, and neurological disease, and a host of other problems which you can find here.

Here’s what I’m taking away from her article: in pursuit of a little social activity, it’s okay to take on a lifetime pharmaceutical habit that reduces the potential harm of drinking to only really unhealthy from immediately disastrous, but participating in a semi-religious organization that promotes abstinence, and creates a strong community associated with it, is a terrible idea because it doesn’t work for everyone. Despite my slight over-simplification for effect, quite honestly, her logic evades me here.

That there are many paths to recovery is a homily in our field. Some people will only need a better community, as Mr. Hari argues. For some, the 12 Step tradition will be the wrong way to go. But for others, it will be the key to their recovery. Evidence-based therapy is a great advance, but doesn’t solve the whole problem. Some people will do well by adding the new generation of medically-assisted treatment. For others though, it will just put off the inevitable reckoning that, for them, being completely substance-free will be best. In sum, that’s what we mean when we say “individualized treatment”: there are many paths to recovery.

Addiction is a complicated and lethal problem affecting far too many people. Whether we’re talking about old school AA or cutting-edge addiction pharmacology, absolutist solutions in any direction don’t leave enough room for a client-focused approach to recovery.

Happy New Year’s Gratitude! Count Your Blessings.

I’m convinced that the old sayings are useful advice, but many are so outdated that we don’t understand their meaning. “Don’t put all your eggs in one basket” makes sense in concept, but how many Americans today gather eggs into baskets and carry them to market? “Don’t throw the baby out with the bath” used to make sense too, but there’s no way babies fit down that little drain in the tub, so….what does it really mean?

“Count your blessings” is a lot easier: be grateful for what you have. No technological update required.

Some really annoying things happened to me this morning – call them challenges or obstacles – whatever the case, today, I let them get to me. I got grumpy. And then I remembered: I’m grateful today because it’s my daughter’s sobriety birthday tomorrow.

It will be nine years since she last used drugs or alcohol. Nine years that she’s instead used to build a rich life in recovery. Oh, it’s no fairy tale, but she’s worked her program, been of service, gotten an education, integrated fitness and nutrition into her daily life, built a great group of friends in recovery, achieved a career, and gotten engaged to marry. Brick by brick, she’s built it.

That’s also nine years during which I wasn’t worried every day that she might die in some horrible way. We almost lost her more than once, and her recovery is a huge blessing for all of us in the family – not least for her.

So, I’m smiling now. The day’s challenges didn’t go away, but I did count my blessings. In recovery terms, I made an inventory, and I found reasons to be deeply happy, despite the day’s turbulence. So remember, “never look a gift horse in the mouth!” Uh…I mean, be grateful for the beautiful things in your life, as I am for my daughter’s recovery.

Happy Birthday Ashley!

Square Pegs and Round Holes: Why it’s Okay NOT To Make New Year’s Resolutions

Ahhh….The New Year! Out with the old and in with the new. For many, this conjures images of packed gyms, bright new running shoes, new workout clothes, new planners to “get organized”, diet plans and long lists of changes of what one wishes to accomplish. New Year’s signifies a time to turn the page and start a new chapter.

Are New Year’s Resolutions really necessary? Many of my clients report that they feel compelled to come up with something that they want to accomplish or change. I encourage them to avoid the pressure of listing those things under the stress of a New Year’s deadline. Doing so is like trying to put square pegs into round holes. It doesn’t always feel right and doesn’t always fit, especially when one is struggling with addiction and decompensation that the holidays often bring. In fact, 88% of all New Year’s Resolutions will fail and the reason is in our brain. The prefrontal cortex is the area that is associated with willpower, among many other things. New Year’s Resolutions require an immense amount of willpower being flooded to that region of the brain all at once. We simply are unable to sustain this over a significant period of time (usually past February 1st). This is the equivalence of running a marathon when you have only trained for three miles.

So what do we do instead? In his book The Power of Habit, Charles Duhigg suggests we need to focus more on actions rather than goals. The following are things to consider when changing your behaviors:

Create a Roadmap for Forming Good Habits

Rather than tackling the entire goal you have set, consider working on the habits that will get you there. Instead of saying “I am going to eat healthy every day for two months”, consider starting with small habits such as increasing your water intake, eating protein at breakfast every morning, etc. and increasing good habits as you progress.

Identify Triggers

Once a trigger for a behavior has been identified, it is much easier to change it. Are you drinking more or spending too much time on social media because you are bored? It’s better to replace than suppress. If you want to stop snacking, consider a banana as opposed to a candy bar. Identify your triggers for your behaviors before trying to change them, and use your support system, including online recovery programs.

Anticipating Obstacles

Expect the unexpected. “The best laid plans of mice and men often go astray”. When I was training for my first marathon, it never occurred to me that not only would I get sick, my kids would get sick, work would become insane and living in Ohio means snow! Most things are beyond our control and when we get derailed, the temptation to throw in the towel completely increases. Plan for obstacles and have a Plan B.

Baby Steps

Rather than tackling an entire list of things you’d like to accomplish, consider starting with one or even better, part of a goal. Take baby steps. Instead of saying “I’m going to work out five days a week”, start with 2-3 days and then adjust that goal later. I always encourage my clients to avoid starting something based on a timeline. How about starting on a random Wednesday in March? Let go of the pressure.

Wishing you a happy and healthy New Year!

Unplugging the Holiday Mania

sky clouds lake creekFor some, holidays are a time of joy, spirit, family and friends.  However, for many it can be very overwhelming and stressful. When struggling with recovery, the holidays can add on an entire layer of stress and pressure.  When a client comes into my office for therapy, one of the first areas I try to focus on is identifying how they are “recharging” their own batteries.  Many of us are guilty of putting other’s needs before our own and therefore our self-care practices go out the window.

It is so easy to overextend ourselves this time of year.  Parties, celebrations, mile long to-do lists, overworking, shopping, decorating are all part of the rat race of December.  Reaching for a drink or a substance is extremely tempting in an attempt to self-medicate the anxiety, grief and depression that is so common during this time of year.  Below are a few of the approaches I implement with my clients to help them through these weeks ahead.

Put On Your Oxygen Mask First

Anyone who has flown on a plane before can recall the spiel the flight attendant gives us about putting on our own oxygen mask first before helping the person next to us.  This applies to life; put on your own symbolic “oxygen mask” first.  Otherwise, you aren’t able to help those you care about and are not giving your amazing full potential!  Meditate, read, take a bubble bath, watch Dumb and Dumber, walk, have coffee with a friend…whatever fills your cup, do it!  Aiming for seven to eight hours of sleep and eating healthy/eliminating sugars are all priorities right now. Unplug for at least a few hours each day-no emails, no social media, no phone.


We are often so caught up in our day to day jobs and chores that we forget to unleash our inner nine year old.  Do you remember what it was like to go sledding or tubing?  How about coloring or painting?  Try it, and thank me later.

Bodies in Motion

Newton’s First Law of Motion: A body in motion tends to stay in motion unless acted upon by an outside force.  I am not saying go run a marathon but just aim to get some Vitamin D (which has been proven to improve mood) each day.   A simple walk around the block is all it takes.  Find whatever physical activity you enjoy, put on your baller music and GO.

Find Your Life Line

You don’t have to tackle this alone.  Identify your support system and don’t be afraid to ask for help.  Utilize the online recovery programs, addiction support groups online and AA meetings.  You may need to double up on meetings right now, and that’s okay.

Do’s and Don’ts of Recovery Apps and Technology In Recovery

Do’s and Don’ts of Recovery Apps and Technology In Recovery

recovery apps

Technology has been a regular part of my daily life for as long as I can remember. As the co-founder of Lionrock Recovery a program that merges technology with recovery to deliver online addiction treatment, I am even more intertwined with the tech revolution than ever. As a recovering person, I use recovery apps as tech tools and weapons in the battle against my disease. I feel compelled to raise awareness about technology as it relates to recovery. Welcome to Recovery Tech.

This article is republished from it’s original posting at InRecovery Magazine.

If you are in recovery and have a Facebook account, you may have experienced friend requests from people you don’t know, but who have 47 mutual friends, all of whom are in a Twelve Step program. What about the cryptic status update, “five”, informing you that your friend is celebrating five years sober today? Maybe you are part of a “secret” Facebook group for Twelve Step women (or men). You may have been invited to a Facebook event titled “Sarah Celebrates Four Years Sober!” to which you’re expected to RSVP electronically. All of these examples raise questions about anonymity, one of the guiding principles of all Twelve Step programs.

Recovery Tech

Because they believe online anonymity is virtually impossible, I have heard people warn against the use of electronic social media to connect and share information. While anonymity can be tricky when using various online media platforms, it is not impossible. Thus, I invoke a popular quote from Alcoholics Anonymous (AA) literature: Thou shalt not commit “contempt prior to investigation”. Let’s investigate!

AA has published an article called AA Guidelines: Internet, which addresses at length some great topics about the intersection between AA (or other Twelve Step programs) and the internet. With regard to the use of social media sites, the AA internet guidelines explain that AA will figure out the guidelines by utilizing the group conscience. I say, brilliant! There is no sense in throwing the baby out with the bath water. As technology evolves, so will its uses. While some of these uses may not be valuable to those in recovery, many will be. To download the guide click here.

The guidelines make it clear that individuals are responsible for their own anonymity. Just what you wanted – another responsibility! So if anonymity is an individual concern, individuals must take action on their social media pages to shield themselves from unwanted personal exposure.

What does this look like? Well, it depends on how worried you are about your personal anonymity. To protect your anonymity, let’s look at some of the basic steps:

Check your Privacy Settings. If your profile is public, nothing you publish is even remotely anonymous. If you need help with Privacy Settings, ask for help!
Be cognizant of what type of information your share on your page. If you share information about being sober or sobriety, most people will believe you to be out about your recovery. They may think that it’s okay to tag you.
Require that all pictures, statuses and wall posts in which you appear be approved by you before they are published. This means that you have to say it is okay for anyone to include your name in anything or to post on your page. (See Privacy Settings on your Facebook page.)
Limit your Facebook name to your first and middle names or use an alias. This will add another layer of protection to your anonymity.
Communicate with others that you wish to remain anonymous about your recovery. Despite the fact that this may seem obvious to you, these days it’s not obvious to many people. People cannot read minds. Be clear with others about your needs and wants (channeling Pia Melody)!
If you like, these basic steps will start you on your journey to retaining your anonymity online without having to abstain from your online presence. Again, I invoke a Twelve Step adage: “Take what you need and leave the rest.”

There are many anonymous ways to connect online with other people to discuss recovery and seek support, including online forums, pamphlets, chat rooms, social networking sites, video meetings, online sponsorship, workshops, etc. All of these resources are just a click away. We can easily connect with recovering people all over the world. What a gift!

Before cell phones, a recovering person had to be home to make or receive a call from their sponsor. The cell phone allows instant access to support from any location. Before the internet, you had to speak with a person who had a meeting list or had to have access to a printed list. Now you can easily download a meeting list for Twelve Step groups anywhere in the world.

Technology makes it possible to reach more people and to help each other maintain continuous sobriety. Imagine technology as the vehicle that connects individuals who otherwise might never meet. Like a car, internet technology can be used to safely transport people from one place to another or can be used dangerously, even causing lives to be lost. We are required to learn to safely operate a car before we can use it. The same principle can be applied to modern internet technology.

A growing number of people chose not to remain anonymous about their recovery and who regularly post comments on the internet that reveal their membership in a Twelve Step program. I believe there are many benefits to allowing others to know I am sober. I have found that revealing my group membership has strengthened connections with others. Because people realized that I am in recovery because of my social media presence, I have had private correspondence with those who have reached out to me for help.

While some, such as I, are comfortable with this disclosure, others are not. It is easy to forget about others’ anonymity when tagging friends in posts and photos. Because we follow the guidelines and principles, the Twelve Step way of life works. It is of great importance that we respect the right to anonymity as an integral part of a sober lifestyle for many people.

What No One Tells You About Synthetic Marijuana

What No One Tells You About Synthetic Marijuana

k2 spice synthetic weedWorking in the addiction field, it’s important to know what substances are most commonly being abused. So when I heard about a recent incident at a college bar involving “K2”, I decided to do some research and interview a young woman who was at the bar that night. (Names have been changed to protect identities)

I spoke with Jessica, who witnessed her friend Sarah take one “hit” of what she believed to be Marijuana, and then collapse, hitting her head on the way to the ground, in a popular bar near her university over the weekend.

Jessica described a collegiate looking man in his early twenties who had been smoking a joint in the bar with some friends, leaning over and offering it to her friend Sarah. He turned to Sarah with the joint outstretched and said, “Want some? It’s like weed?” Jessica watched as Sarah took one small inhalation from the joint.

Jessica described the incident for me in detail:

Sarah immediately started to collapse after taking one hit from the joint. I saw her lose consciousness and hit something on the way to the ground. I ran over to her on the floor and started yelling her name and trying to get her to respond to me. I then turned to the guy who gave her the joint and demanded to know what was in it. He told me that it was “Mojo”. When I didn’t know what that was, he said that it was “K2.. like Spice”, synthetic weed.

Sarah was completely unresponsive for 2 minutes. I panicked and told the bar to call the paramedics. After about 2 minutes, her eyes were fluttering and she started making noises; nothing that made sense though. She was mumbling and still not coherent for at least another 5 minutes.

It took her about 10 minutes to come to, and 15 minutes before she was able to have a conversation and, walk out of the bar. She doesn’t remember anything, except blacking out. She has a bruise or two from the fall but is fine other than being a bit shaken up.

I asked Jessica if Sarah regularly engages in risky behaviors, or takes drugs. She described her friend as a normal college student who smokes marijuana occasionally and goes to the bars with friends on the weekends, but nothing more than that. She said Sarah does well in school and was acting out of character by taking weed from a stranger. “We are careful about who we take drinks from at bars because we are aware of the danger of roofies. I think her guard was down because it was weed, and weed is considered relatively harmless”, Jessica told me.

What a lot of people don’t know is that many of the drugs on the streets these days are are being characterized as “synthetic”, or made by chemical synthesis, especially to imitate a natural product, but they do not imitate the natural product. In fact, according to Lewis Nelson, MD, a medical toxicologist at the NYU School of Medicine, “It’s really quite different, and the effects are much more unpredictable. It’s dangerous, and there is no quality control in what you are getting.”

One could argue that there is not much quality control in any street drug purchase. But what alarmed me was the reasonable misconception that the synthetic chemicals in Mojo, K2, Spice etc. produce the same effects in its users, when in fact it’s producing the opposite effect. Dr. Nelson describes patients as exhibiting symptoms typically attributed to amphetamine users – violent, sweaty, agitated, tachycardia, psychosis. Jeff Lapoint, MD, an emergency room doctor and medical toxicologist, explains it perfectly:

“The first rule of toxicology is, the dose makes the poison. I drink a cup of water, and I’m fine. I drink gallons of it in some college contest, and I could have a seizure and die. Synthetic cannabinoids are tailor-made to hit cannabinoid receptors – and hit it hard. This is NOT marijuana. Its action in the brain may be similar but the physical effect is so different.”

Synthetic marijuana is often available at smoke shops and popular because it does not show up on standard drug tests. To record a “dirty test”, a specific test for synthetic marijuana must be administered. This has certainly been a factor in the rising numbers of overdoses, hospitalizations, and even deaths, as a result of this synthetic drug. New legislation has banned some of the chemicals used to create these drugs, but producers wanting to protect their market have responded by substituting still-legal compounds for the ones recently banned.

Mephedrone synthetic drugs research chemicals
Clearly, legislation isn’t the total solution. Public awareness of synthetic marijuana and its dangers is going to be our greatest safeguard. So if you hear someone talking about trying this stuff that’s “like weed”, or you happen to be in a smoke shop where a bag of K2, Mojo, or Spice is being sold, heed the clear warning on the baggy: “not for human consumption”. Ironically, it’s the only accurate part of the label.


My Top Suggestions for Avoiding Relapse on Prescription Medications

My Top Suggestions for Avoiding Relapse on Prescription Medications

In my 28 year career, I have noticed one of the biggest causes of relapse for people in recovery is the abuse of prescription medications. This is even the case for recovering people with decades of abstinence. It is critical that addicts and alcoholics be extremely careful when and if they are being prescribed addictive and mood-altering medications because they can easily trigger a regression back to old addictive patterns. My philosophy is that we need to do more to teach the recovering person what to do “when they have to take medications, not if they have to take medications” because sooner or later most all of us are going to have some medical procedure where medications will be prescribed. And remember, pain is just as much a threat to one’s recovery as pain medication, so we have got to help people get through these difficult situations and maintain their recovery. This article offers some concrete information and suggestions that can help to avoid a relapse.

Many addicts and alcoholics have relapsed following a “legitimate reason” to take prescription medications. Some medications are harmless and do not necessarily pose a threat to one’s recovery, anti-depressants for example, are less likely to trigger cravings. However once the recovering person takes an addictive, mood-altering medication such as pain medications, sleeping pills, anxiety medications, and/or muscle relaxants, there is great risk that the addictive disease will “wake-up”. And once awake the disease will often demand more of the drug and a return to old addict behavior, like lying and manipulating to stay high.

Often times the recovering person is not aware or prepared for the risk. He or she may not know to ask for non-narcotic pain medications. The addict may defer to the prescribing physician’s expertise, assuming that the doctor knows what to do, but many doctors have very little training in how to deal with addiction. They may inadvertently prescribe medication that can start the disease process in motion. It is extremely important to know what medications you are taking and what the abuse potential is and whether the drug is addictive and mood altering. Just because a doctor prescribed it doesn’t mean it’s okay. It is the responsibility of the recovering person to protect their recovery. Ask questions, look the drug up online, get feedback and be accountable before you start taking medication.

Even some over the counter medications contain substances can be dangerous for the recovering person. Many cough syrups and mouthwashes contain a very high alcohol content, and some antihistamines contain stimulants. So read the labels very carefully before you start taking something.

The most commonly abused prescription medications:

  • Opioids—usually prescribed to treat pain;
  • Central nervous system (CNS) depressants—used to treat anxiety and sleep disorders such as the drug trazodone; and
  • Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD).
  • Physicians are very quick to prescribe pain, sleep and anxiety medications and recovering people need to be extra cautious. Even in addiction treatment we are seeing the enormous lobbying of pharmaceutical companies advocating for medication-assisted recovery as the first line of defense.

    Some managed care policies are actually blocking attempts to place opiate addicts in their late teens into residential treatment, mandating that these young people be seen instead by buprenorphine-prescribing physicians in private practice. Hospitals have very strong policies regarding pain and are eager to prescribe pain medications to assure that patients have little or no discomfort. This makes their jobs easier but puts the patient at enormous risk for dependence.

    So here are some suggestions that may help a recovering person avoid a relapse:

    Before you take medications:

  • Find a doctor that knows about addiction, preferably one that is ASAM, (American Society of Addiction Medicine) certified.
  • Be very clear when you tell your doctor that you are a recovering addict or alcoholic and you do NOT want any medications that can threaten your Recovery.
  • Ask about the medication; is it a narcotic? Is it addictive? Is there abuse potential?
  • Do your own research on the medication, look it up and find out for yourself what it is and what it does.
  • Ask for non-narcotics or other safe alternatives if you need medications.
  • Ask for a small amount of the medication with no refills.
  • Contact your sponsor and other members of your support group and inform them that you will be taking medications.
  • Tell them what you have, how many you have and what the recommended dose is.
  • Ask if you can dose in the office rather than take meds home and if you have to take drugs home, ask for a 3-5 day prescription.
  • When you have to take medications:

  • Take only as prescribed.
  • Stay in daily contact with several members of your support system and keep them current on your dosage and reactions.
  • Consider giving the medication to a member of your support system who will be responsible to administer the medication you every day.
  • Talk about it at meetings and other support functions.
  • When the prescription says “Take as needed for pain or other symptoms”, monitor your symptoms and contact your support when you are not sure if you really need it.
  • Stay in close contact with you doctor and comply with doctors orders.
  • Be careful to not re-injure yourself so that you have to take more medications or for a longer period of time.
  • Keep a journal and monitor your thoughts, feelings, cravings and actions. Report any concerning changes to members of your support system.
  • Once the need for the medication is done:

  • Throw away any unused medications. Don’t save them in case you need them later.
  • Share at meetings what issues came up for you while on the medications and how you managed you handled them.
  • In summary; the key to avoiding relapse here is to advocate for your own recovery, be honest and open about your thoughts, feelings, urges and behaviors… and most of all stay accountable. The biggest danger is going underground and not letting the key people in your support system know what’s going on. I have seen many addicts relapse and some even die, because they were unwilling or unable to reach out and ask for help when they were struggling.

    An Open Letter From One Alcoholic

    An Open Letter From One Alcoholic


    Dear Server/Waiter/Waitress (or whatever you prefer to be called these days),

    This is my open letter to you, in attempts to try to understand each other better. First I’d like to say, I appreciate what you do, because I have done your job before, and I know it can suck. That being said, I also have a pretty good idea of what might be going through your head, when you seat a table of us sober folk.

    You see us sit in your section and assume we will be a fun crowd, which of course means ‘drinks all around’! When we start to order sodas, waters, ice teas and milkshakes, one by one, the look of utter disappointment is evident on your face. I actually experience a bit of empathy for you, because we all know, drinks really drive up the bill. But believe me when I say, you should be rejoicing over the absence of alcohol at this table; trust me, we will still tip you well.

    Typically by this point you, the server, have decided that we are not as valuable as the other table that is drinking, so our non-alcoholic drinks come, but only after a longish wait. (Sometimes though, we get lucky and our server is still on board with us.)

    It’s time to order food! Rejoice! You are being kind to us–that is, until we tell you we want separate checks. We agree to split our large group in to 3 checks to make your life easier, (but most of us have served tables before, or still do, and know how easy it is to split a check. After all, everything is touch-screen computerized). Ordering our food goes well, and we seem to be on good terms again. And have no fear; we will still tip you well.

    We spend the next 30 minutes being a bit loud, excessively taking #selfies and #groupies on our phones, while simultaneously checking in on Facebook, and posting to Instagram. We tend to have a lack of awareness that others are also dining in this restaurant. We swear, laugh loudly, ask for more bread and drink refills and frequently change seats so we don’t miss anything at the other end of the table. But rest assure; we will tip you well.

    Food comes, sometimes in a timely manner; often times not. Someone sends their food back (trust me, there is always one, and we are equally as mortified as you are annoyed). But we also are supportive of our table foodie, encouraging her to speak her truth! (This goes way deeper than her poorly cooked burger).  We eat, we are still loud, but trust me when I say; we will still tip you well.

    By this time in the meal, you may have found a soft place for us in your heart, or you may just be ready to part ways. Either way, you bring us our check (all on one bill–what happened to our agreement!?) in a very timely manner. We labor arduously over the confusing bill, making sure everyone knows that there is already an 18% gratuity included. Our bill-master (there is always one poor sap that gets stuck with this job), organizes our cash and cards and sends the neatly organized package off with you.

    At this point, someone busts out some homemade cupcakes, and we sing ‘happy birthday’, to a 30-something who is turning 3, (just go with it). We eat our treats, and take more #selfies and #groupies, and wait and wait and wait for you to bring our cards back. Half of our group (the smart ones who brought cash), have evacuated the table to go outside to smoke their e-cigs. The rest of us wait. The smokers return to the table. After what seems like an eternity, you bring our bill back to us. We sign on the dotted lines, offer you some cupcakes and tip you well (above the included 18%).

    I recognize that we are a wild bunch of folks who may not have the best table manners, but we mean well. We want to get along with you! So when you see us coming in packs, iPhones and e-cigs in hand, try to cut us some slack.

    Until we meet again,


    An Online AA Meeting

    An Online AA Meeting

    couch moved right 2

    Recently Lionrock Recovery started a weekly, online, 12-step meeting. Initially, I wasn’t sure what to expect, who would show up and what would happen. But as I sat comfortably at my computer and logged in to the meeting site, I immediately felt calm, OK and at peace; (the same way I do when I sit in any meeting).

    The meeting began with The Serenity Prayer, and by the time we were all saying “the wisdom to know the difference”, the barrier of our computer screens faded. We read from The Big Book, (of Alcoholics Anonymous), and the leader shared his experience, strength and hope with us.

    As we went around one by one, sharing of ourselves, I felt the same connection I would feel if we had all been sitting in one room together. I suddenly realized that this was a very special gathering. Because once again, people who may have not otherwise met or mixed, were bearing their souls to each other. We were relating to each others alcoholism, and more importantly, sharing the solution. I was quickly reminded that the miracle of AA happens when one alcoholic is relating to another, in any capacity.

    Our weekly group is ever-changing and growing. We have people from New York City, to California. We have people from places in the country that have no AA or NA meetings within a 50 mile radius. We have people with multiple years of sobriety, and newcomers. We are the face of Alcoholics Anonymous, reaching those who may not have otherwise been reachable. We are an open meeting of Alcoholics Anonymous, gathered together with a single purpose; to help the alcoholic who is still suffering, so that we all may recovery from the disease of alcoholism.

    ***If you or someone else is interested in trying out a 12-step meeting, please join us:


    Alcoholics Anonymous (AA)

    Every Tuesday at 6:30pm Pacific, 8:30pm Central, 9:30pm Eastern

    To Join The Meeting, Click This Link:

    Page 1 of 8 123 »