Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

I watched the titled Oprah show, yesterday, and was struck on so many, many fronts, but the two I’m going to talk about in this post have nothing to do with the Diane Schuler Story. They relate to the portions of the show that followed that segment.

1.  The first segment, “A Mother’s Fatal Decision,” I want to address starts around minute 25. It is the story of a mom, Carmen, who was driving under the influence, with 7 young girls in her car who’d been at a slumber party. Carmen crashed, three of the girls were thrown from the car, some were not wearing seat belts because they were not in seats – they were in the back, trunk-like area. One of the girls died, 2 were seriously injured, and Carmen is charged with vehicular manslaughter. Her blood alcohol content (BAC) was .132. She is still in the hospital on suicide watch.

11 year old Kayla – one of the passengers, and a friend of the girl who was killed – was Oprah’s guest, answering Oprah’s questions about what happened. Here is what Kayla had to say about how Carmen, the mother driving, appeared, i.e., was she ‘drunk?’ (Note, this is as close as I can get, but it may not be the exact quote as I’m typing from a Tevo recording.)

…before the party, Carmen, she looked fine, … she stood up, she seemed normal… then after the party, …I told Brittany that her mom looks like she’s kind of drunk, and Brittany said that her mom, that if her mom was drunk her eyes would be closed a little, you know like closed a bit, and that her eyes weren’t closed so she wasn’t drunk… I believed her because Brittany knows her mom, you know like knows her mom like really, really, really well.

When Oprah asked Kayla what made her think [Brittany's] mom might be drunk, Kayla answered.

to me it was the way she was talking [Pause]… it’s like hard to explain.

I’d like us to stop here and let this sink in because it drives home the point of the ripple effects of a person’s drinking — not the obvious ones – the crash, the deaths and the injuries, but the less obvious but no less far-reaching ones. These are 11 year-old girls, and they’re tying to figure out whether an adult is too drunk to drive. And, poor Brittany has been trying to keep herself safe with an “I know when she’s drunk” test that measures the extent to which her mom’s eyes are closed. We need to expand alcohol abuse education in schools and in our homes to include the signs a child should look for in an adult that may indicate the adult is impaired and should not be driving; what a child can say to decline a ride; how the child can contact their parent to come pick them up. This is a much different education program than the “why alcohol is bad for you and why you should not partake” message of most substance abuse programs in schools and homes. You see, one in four children in America will be exposed to a family member’s alcohol abuse and/or alcoholism before the age of 18. That not only affects those children but their friends who come into contact with their family members. We need to start TALKING ABOUT ALL of ‘IT’ – openly, fully and often.

2. The next segment [for which I could not find a link] starts around minute 43.  It’s an interview with Ellie, a stay-at-home mom, who’d kept her alcohol abuse problem a secret from her husband and her friends. Ellie went through 3 rehab programs and is so COURAGEOUS for going on the Oprah show to tell her story. She shared the “lines in the sand” that she’d draw (never had a drink before 5 or never had a drink in the morning or never driven the car with my children in the car) as a marker that she wasn’t an alcoholic, but then she’d cross that line and hate herself for doing it but draw another line. Her husband, Steve, joined her and described how in hindsight he’d had inklings that something wasn’t quite right, but how, when you’re in it — even after her 3rd rehab,  you can’t understand why she can’t just stop because you don’t understand addiction. [From my own experiences, you draw your own "lines in the sand."]

In my opinion, this segment also drives home the importance of expanding our focus when it comes to alcohol abuse/addiction/policy making decisions and education to include the impacts on the family. It was Steve finally drawing his line of taking the children if Ellie didn’t stop drinking that prompted Ellie to seek treatment. If we TALK ABOUT it — ALL OF IT — openly, honestly and frequently — sooner rather than later — perhaps we can avoid what’s happened to the people in these segments and to the millions of others who are having their own similar experiences in silence, solitude, secrecy and shame.

Related posts: “And They All Fall Down, This ‘Thing’ They Call ‘Denial’,” “Family Addiction – a Tough Nut to Crack,” “SPECT Scans Showing Impacts of Alcohol Abuse on the Brain.”

by Lisa Frederiksen

There is a wonderful new effort — bring change 2 mind.org – created by Glenn Close, the Child and Adolescent Bipolar Foundation (CABF), Fountain House, and Garen and Shari Staglin of IMHRO (International Mental Health Research Organization). They are working to end the stigma that surrounds mental illness in a way like I’ve never seen before.

This PSA is an excellent example.

And this one!

Check out their website and get involved. As we openly talk about mental illness and alcohol abuse and alcoholism and dual diagnosis (having both a mental illness and a substance addiction), we tackle the shame that keeps us stuck in the fear of the unknown. These are diseases, and as diseases, they are treatable. So let’s start. Let’s talk about it.

by Lisa Frederiksen

One of the repeated concerns I hear when giving my presentations is the lack of satisfactory treatment for a dual diagnosis, which occurs when a person is diagnosed with both a mental illness (PTSD, Anxiety, Bipolar, ADHD, schizophrenia) and a substance abuse problem (alcohol or prescription/illegal drugs) and/or an addiction (alcoholism or drug addiction).  Not only is the common concern about the lack of treatment options expressed, but so it the equally important concern about the confusion surrounding what  effective dual diagnosis treatment should look like.

SPECT Surface Scan Showing ADHD, Courtesy Amen Clinics, Inc., www.amenclinics.com

According to the National Alliance of Mental Illness, (NAMI), “Dual diagnosis services [should] integrate assistance for each condition, helping people recover from both in one setting, at the same time. Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.” Looking at the brain scans to the right, showing  the brain of a person with ADHD in the top set of scans and the brain of a person who abuses alcohol in the bottom set of scans, helps to explain why treating one without treating the other makes effective, healthy, long-term recovery just about impossible.

SPECT Surface Scan Showing Alcohol Abuse, Courtesy Amen Clincs., Inc., www.amenclinics.com

To address the available treatment options concern, I am reaching out to my contacts for their input and will let you know what they tell me, but I also urge anyone who is aware of such a program to please let us know via the comment feature to this post.

To more comprehensively address the questions about what constitutes effective dual diagnosis treatment, I went to the NAMI website and am cutting and pasting content from their website below:

Why is an integrated approach to treating severe mental illnesses and substance abuse problems so important?

Despite much research that supports its success, integrated treatment is still not made widely available to consumers. Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Providing appropriate, integrated services for these consumers will not only allow for their recovery and improved overall health, but can ameliorate the effects their disorders have on their family, friends and society at large. By helping these consumers stay in treatment, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the most sinister and costly societal problems: crime, HIV/AIDS, domestic violence and more.

What are the key factors in effective integrated treatment?

There are a number of key factors in an integrated treatment program.

Treatment must be approached in stages. First, a trust is established between the consumer and the caregiver. This helps motivate the consumer to learn the skills for actively controlling their illnesses and focus on goals. This helps keep the consumer on track, preventing relapse. Treatment can begin at any one of these stages; the program is tailored to the individual.

Assertive outreach has been shown to engage and retain clients at a high rate, while those that fail to include outreach lose clients. Therefore, effective programs, through intensive case management, meeting at the consumer’s residence, and other methods of developing a dependable relationship with the client, ensure that more consumers are consistently monitored and counseled.

Effective treatment includes motivational interventions, which, through education, support and counseling, help empower deeply demoralized clients to recognize the importance of their goals and illness self-management.

Of course, counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.

A consumer’s social support is critical. Their immediate environment has a direct impact on their choices and moods; therefore consumers need help strengthening positive relationships and jettisoning those that encourage negative behavior.

Effective integrated treatment programs view recovery as a long-term, community-based process, one that can take months or, more likely, years to undergo. Improvement is slow even with a consistent treatment program. However, such an approach prevents relapses and enhances a consumer’s gains.

To be effective, a dual diagnosis program must be comprehensive, taking into account a number of life’s aspects: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.

Finally, effective integrated treatment programs must contain elements of cultural sensitivity and competence to even lure consumers, much less retain them. Various groups such as African-Americans, homeless, women with children, Hispanics and others can benefit from services tailored to their particular racial and cultural needs.

To learn more about specific mental illnesses, please click here.

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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source. Please note that scans are courtesy of Amen Clinics, Inc. You may have to secure your own permissions to use and/or reprint.

by Lisa Frederiksen

As you’ve likely read in a prior post of mine or elsewhere, mental illness is one of the key risk factors for a person developing a problem with alcohol abuse and/or alcoholism.

In her September 10, 2009, article, “Common Mental Illnesses May Be More Common Than You Think,” Melissa Healy wrote for the Los Angeles Times, “[a]nxiety, depression and alcohol and drug dependency cases might more than twice as high as researchers have come to believe, a study published today in the journal Psychological Science finds, with 41% of young adults experiencing major depression, half suffering an axiety disorder and nearly one in three exhibiting alcohol dependence by the age of 32.”

ADHD is another common mental illness — especially among children, with 4.5 million diagnosed in the U.S. — and an article by Katherine Ellison in today’s The Washington Post, titled, “Brain Scans Link ADHD to Biological Flaw Tied to Motivation,” reports the results of a study led by Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, “together with scientists affiliated with institutions including the Brookhaven National Laboratory and the Mount Sinai Medical Center.” The study took eight years to complete, and according to this article,

Volkow’s team collected detailed images of participants’ brains with positron emission tomography, or PET, scans after injecting them with a radioactive chemical that binds to dopamine receptors and transporters, which take up and recycle dopamine as it moves between neurons. The imaging showed that, in people with ADHD, the receptors and transporters are significantly less abundant in mid-brain structures composing the so-called reward pathway, which is involved in associating stimuli with pleasurable expectations.

“Stephen Hinshaw, chair of the psychology department at the University of California at Berkeley, praised the study as being “above and beyond the normal rank and file” of incremental progress in the quest to solidify the dynamics of ADHD. “It’s a big deal to get this kind of nonmedicated sample,” he added. Read more…

To view a SPECT Surface scan showing a brain with ADHD, please click here.

by Lisa Frederiksen

September 14-20 is ADHD Awareness Week. Mental illness and age of 1st use of alcohol (or other drugs) are two of the key risk factors contributing to a person’s development of alcohol abuse problems and/or alcoholism. When you look at the images below showing ADHD before and after treatment and compare them to the brain of someone who abuses alcohol, you can appreciate how hard it would be to “think” straight if you were a person with a mental illness, such as ADHD, and a substance abuse problem. You can also appreciate why it’s important to treat both and to monitor treatment along the way. For as the brain starts to recover from one and/or the other, those changes, in and of themselves, can indicate a need to change medications and/or treatment protocols.

For more information about Attention Deficit Hyperactivity Disorder, ADHD — one of the most common mental disorders that develop in children — visit the NIHM website page, “Attention Deficit Hyperactivity Disorder.”

SPECT of ADHD. Courtesy Amen Clinics, www.amenclinics.com

SPECT of ADHD After Treatment. Courtesy Amen Clinics, www.amenclinics.com

SPECT of 56-year old man with daily drinking of 3-4 drinks/day but NOT an alcoholic. Courtesy Amen Clinics, www.amenclinics.com

by Lisa Frederiksen

SAMHSA (Substance Abuse and Mental Health Services Administration) released state-by-state analyses of substance abuse and mental health illness patterns based on the 2006 and 2007 National Surveys on Drug Use and Health (NSDUH). Here are some of the key findings with regards to alcohol use/abuse:

• In 2006-2007, the rate of past month alcohol use in States among all persons aged 12 or older ranged from a low of 30.9 percent in Utah to a high of 63.1 percent in Rhode Island. Two States showed significant increases from 2005-2006 to 2006-2007 in the percentage of all persons aged 12 or older who used alcohol in the past month: Delaware and Massachusetts; and four States showed a significant decrease: Alabama, Arizona, Idaho, and Texas.
• Nationally, almost a quarter (23.2 percent) of all persons aged 12 or older participated in binge use of alcohol in the past month in 2006-2007. Four States showed significant changes in binge alcohol use between 2005-2006 and 2006-2007 among persons 12 or older. Of these, Delaware was the only State to have a significant increase, whereas Idaho, Nebraska, and Texas had declines.
• In 2006-2007, 42.1 percent of all persons aged 12 or older perceived a great risk of binge drinking. Seven of the 10 States (Iowa, Massachusetts, Minnesota, North Dakota, South Dakota, Wisconsin, and Wyoming) with the highest rates of binge use of alcohol in 2006-2007 among persons 12 or older also were States with the lowest perceived risk of binge drinking for the population aged 12 or older. Between 2005-2006 and 2006-2007, there was an increase in the Northeast region among young adults aged 18 to 25 in the perception of great risk of binge drinking from 29.7 to 30.9 percent.
• Past month use of alcohol among persons aged 12 to 20 (underage use of alcohol) ranged from a low of 17.3 percent in Utah to a high of 40.0 percent in North Dakota. Utah (13.3 percent) also had the lowest rate for past month underage binge use of alcohol, and North Dakota also had the highest rate for this measure (29.5 percent).
• States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older in 2006-2007 were primarily Midwestern (Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin) or Western (Colorado, Montana, and Wyoming). The District of Columbia and Massachusetts rounded out the top 10. Among persons aged 12 or older needing but not receiving treatment for an alcohol problem, there was no significant change between 2005-2006 (7.3 percent) and 2006-2007 (7.2 percent) for the Nation as a whole; however, there was a significant decrease in Texas and a significant increase in Hawaii.

The full report is available online at http://oas.samhsa.gov/2k7state/TOC.cfm.

by Lisa Frederiksen

I read a recent article about eGetGoing.com and was struck by the notion of online therapy groups for alcoholics / addicts. I am all for the idea that there are many approaches to addiction treatment, and this idea of online seems to be another way, and one that could prove very effective for some people. Speaking of effective, there is no data, yet, whether this approach works long-term, as it’s just getting started. Quoting from their website, here is how eGetGoing works:

eGetgoing combines proven traditional group treatment methods with the latest Internet technology to bring you the first ever, live, interactive, group treatment online.

• speak (not type) with fellow group members using a headset and a microphone (supplied by eGetgoing)
• see your counselor live in real time on your monitor
• remain completely anonymous
• access your group session from wherever you are

In this dynamic, interactive setting, group members get to talk to each other under the guidance of an experienced counselor as they work together to overcome their dependency on drugs and alcohol. eGetgoing uses a proven treatment approach that is based on the 12-Step philosophy.

Also from their website:

• Immediate access to group sessions;
• Guaranteed Anonymity (see your counselor, speak with your group and remain anonymous);
• Convenient AFFORDABLE treatment
  • 3 months total, two weekly online recovery meetings (24 sessions), additional private counseling if needed, and one year of free aftercare
  • Covered by most major insurance companies
  • Backed by the CRC Health Group Guarantee

by Lisa Frederiksen

By way of background…
If a loved one enters a residential treatment program – it usually lasts around 28 days. At the end of treatment, clients are encouraged to go to an SLE – Sober Living Environment. That can be their home (as long as all alcohol has been removed and all persons in the home agree to abstain from drinking) or it can be a treatment center sponsored SLE (usually a home in a residential neighborhood where other clients also reside, along with an employee of the treatment center).

Now to my experience…
I’d told my loved one of my fears about what might happen if he insisted on coming home as his SLE, instead of following the treatment center’s recommendation and going to one of theirs.

Yet, when the time came, he started doing that “thing” he did, and I started doing that “thing” I did. He with that “I’m so sorry” expression, pressing me to let him come to our home instead of a treatment center SLE, to let him do what he wanted — playing on the notion that if I loved him, I would. And there I was acting on my feeling that I needed to somehow make it okay for him because if I loved him, I should. After all, he’d stopped drinking, gone into rehab — what more could I want or expect him to do? But I wasn’t ready. I was scared – what if I didn’t do what he needed done and he relapsed. And I was enjoying not having the constant worry about “what if…”.

It was us doing the “dance” we’d done a thousand times before. That day, I was furious to find myself even considering doing it, again. I erupted!

I erupted from a place so deep — a place where years of broken promises, lies, disappointments and deceit had festered, until this one. . . more. . . tiny. . . little request proved to be the last straw. I erupted because I simply didn’t know how to feel, let alone say, “No, this isn’t right for me. I don’t care if it’s right for you or the man in the moon. It isn’t right for me!

Instead, I was getting it all mixed up in my love for him and my ingrained belief that I had to do what he wanted as a demonstration of that love. I was getting it all mixed up in my belief that not doing so would be selfish on my part and in my world, being selfish was bad, bad, bad. Suddenly, it all came crashing in, and my fury poured out as we engaged one more time in the dance of manipulation we both did so well – a dance choreographed by years of fear, anger and love.

In dancing, it only takes one partner to change the step and thus the entire dance; it may even end the dance. The same is true in family recovery from this family disease. It just takes one, but if both change and learn the new steps and practice those steps, together, a new dance is created. Sometimes one or both will go back to the old one – that’s normal – it’s what is most comfortable; it’s what they’ve practiced for years. But a new dance is possible. It may be together; it may be solo, but it is possible. It just takes practice.
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To read more about experiences like “the dance” and find the tools that helped me get a grip on my life, please read my book, If You Loved Me, You’d Stop!…

by Lisa Frederiksen

When I lecture at a treatment center or talk with parents and other groups whose work or lives put them in contact with either alcohol or mental health illness or both, the question about mental illness (e.g., depression, PTSD, ADHD, bipolar) and whether there’s a connection between it and alcohol (or any substance) abuse often comes up. In treatment center circles, when a person is diagnosed with both a mental illness and addiction, this is referred to as a dual diagnosis (check this link to one of my previous posts for a more detailed explanation of dual diagnosis).

In doing some research, yesterday, I found a few links that may answer questions for those trying to understand whether there is a connection between mental health illnesses and alcohol abuse/addiction, and if so, what can, might or should be done. Here are three:

- Dual Diagnosis: Information and Treatment for Co-occurring Disorders. This is from Help Guide’s website, a nonprofit organization created following the tragic suicide of Morgan Leslie Segal. According to their site, “We believe that ‘health literacy’ is vital — Morgan’s tragedy could have been avoided if she had had easy access to good non-biased information on her condition [major depression] and various treatment alternatives. Our goal is to provide cutting-edge, professional articles that are easy to look at, easy to understand and above all useful!” There is so much on this site. It is well worth browsing for issues beyond mental health, substance abuse and addiction and dual diagnosis, as well.

- Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery. This is a free publication offered by SAMHSA (Substance Abuse and Mental Health Services Administration), which you can order and have mailed to you, free of charge.  It is written for substance abuse counselors on “the ‘what,’ ‘why,’ and ‘how-to’ of working with clients with depressive symptoms and substance use disorders, covering topics such as counseling approaches, clinical settings, cultural concerns, counselor roles and responsibilities, screening and assessment, treatment planning and processes, and continuing care.” I have not read it, and have just ordered a copy, myself, but it would seem that even though it is written for counselors, it should give you some answers.

- A Consumer’s Guide to Mental Health Services Decade of the Brain NIH. This appears under SAMHSA (Substance Abuse and Mental Health Services Administration)’s National Mental Health Information Center and offers answers to some common questions about mental health illnesses.

by Lisa Frederiksen

This was the headline of an article in The New York Times December 2, which summarized the findings of a 12-month study of more than 5,000 19-25 year-olds funded by grants from the National Institutes of Health. I was struck by a statement in the study’s synopsis, “psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population. Although treatment rates varied across disorders, overall fewer than 25% of individuals with a mental disorder sought treatment in the year prior to the survey.”

Which brings me to what I learned while doing research for my book… according to the HBO.com/Addiction (a collaborative program produced by HBO, The Robert Wood Johnson Foundation, NIDA and NIAAA), “many, if not most people who are addicted to alcohol or other drugs suffer from another mental health disorder at some point” [a condition, when diagnosed, known as a dual diagnosis]. It generally occurs as follows: 1) a person with an untreated minor or major mental illness (e.g., ADHD, bipolar disorder, conduct disorder, depression, post-traumatic stress disorder, schizophrenia) starts drinking to self-medicate; or 2) a person’s alcohol (or other drug) addiction precedes or worsens an existing mental health illness.

All of this, in my opinion, underscores the need for parents to trust their instincts and intervene early if their child presents signs of a substance abuse problem and/or a mental illness. The findings in study after study are solidly behind early intervention as key to helping young adults avoid a lifetime struggle with substance abuse / mental illness or a dual diagnosis.