Why Intervention May Not Always Be Successful the First Time


Intervention, whereby family and friends confront an alcoholic or drug addict in order to get them to treatment, is an emotionally draining and confrontational undertaking that is not always successful. Even if a competent interventionist has been hired and an appropriate treatment center has been identified, not all interventions will result in admission to a treatment center for recovery from alcohol or drug addiction. Therefore, before embarking on the intervention journey, it is important to set realistic expectations and prepare for the fact that more than one intervention may be necessary to achieve lasting change.

The patient must be ready to acknowledge the problem and want to seek help

To put it bluntly, an intervention will not be successful if the person cannot be convinced to go to treatment. While the need for change may be clearly apparent to everyone around her, keep in mind that her brain has been subjected to toxins that can temporarily (or permanently) reduce her mental abilities even when she is sober.

Intense or long-term ingestion of alcohol or drugs can have a profound affect on the brain of an alcoholic or drug addict. While a normal person can easily see the destructive behavior, connect the behavior to negative consequences, and conclude that stopping the behavior will alleviate the consequences, the addict may not be able to make such elemental connections. Addictive substances can affect reasoning and logic abilities and further destabilize the mental state of a person. She may not be able to see the seriousness of the problem.

It is also possible that the consequences are not dire enough yet encourage change. For instance, if an alcoholic has been able to maintain a job and keep a roof over her head, she may be less likely to acknowledge the seriousness of her situation than if she has been fired due to alcohol-related behavior. Therefore, for some patients, the timing of the intervention may be critical.

Further, addiction means that the person experiences incredibly strong biological cravings for alcohol or drugs. Withdrawal, a painful process during which the body is denied the alcohol or drugs it craves, is often a terrifying prospect. Although most treatment programs will handle withdrawal gently using a medically supervised process called medical detoxification, fear of withdrawal symptoms (or fear of cessation of the feeling association with drinking or taking drugs) can be strong enough to cause a person to acknowledge the need for treatment, yet refuse to go.

Even the most well-known and successful interventionist may not connect with the patient

If you have ever been to psychological therapy, you may know that it is not always easy to find a therapist that fits. Characteristics such as gender, treatment style, personality and social status may attract us to or repel us from a particular therapist.

The relationship between patient and interventionist can be similar to the relationship between patient and therapist. Although the interaction between interventionist and patient is often brief (as opposed to therapy which is long-term), the patient will probably not agree to treatment if she does not feel comfortable enough with the interventionist to trust him. Although a disconnection between patient and interventionist may not have anything to do with the competency or talents of the interventionist, it will have the same effect as using an incompetent or inexperienced interventionist, i.e., a failed intervention.

One major difference between choosing a therapist and choosing an interventionist is that the subject of an intervention is not permitted to make the choice herself. Instead, a family member or friend has taken the choice away from her prior to the start of the intervention. This feeling of being forced to allow a stranger access to an intensely personal situation may overwhelm the intervention regardless of the interventionist. However, selecting an interventionist that the patient can connect with or, more importantly, has already been through what the patient is going through can go along way to encouraging trust between patient and interventionist.

The process of selecting an interventionist should be handled with extreme care. Some of the best interventionists will be former alcoholics or drug addicts who have already walked in the patient’s shoes and can address the addiction-related fears and concerns that family and friends may not even be aware of, never mind be able to address. Since selecting the wrong interventionist can torpedo an otherwise favorable intervention, do not be afraid to explore the personal background and success record of any prospective interventionist.

Source Addiction Treatment Magazine

The Devil’s Playthings

By Lynn Phillips

I don’t normally watch Two and a Half Men, the television sitcom that stars the tabloid pet of the hour, actor and addict Charlie Sheen, but having just watched an episode on its official Website I was fascinated to see that Sheen often appears to have no idea what to do with his hands. When the rest of him speaks, they move vaguely about at his sides like anemones. At moments requiring emphasis his forearms rise up like the parted ends of a drawbridge, the arms of a public speaking newbie encouraged by some mediocre media coach to gesticulate.

It’s not that the rest of Sheen can’t act. He delivers his lines with fine comic timing, and neither his joyless eyes nor the fact that his eyebrows have always knit in the middle interferes with his staying in character, especially since that character – a boozy womanizer – is based on what was supposed to be his former self. But the blundering tension that skitters through his arms suggests that part of this veteran actor, true to the note allegedly tattooed on his chest that reads, “Be Back in 15 Minutes,” is clear out of his skin.

Out of his skin and back in the skin trade. With his recent 36 hour crack and hooker spree in mind, I thought to attribute his loss of focus on the set to his spectacular excesses in the privacy of his orgies. The cause-and-effect structures of human behavior, however, are freighted with ambiguity, and it’s entirely possible that Sheen may require emergency-room calibre endorphins simply to remain in the TV star business.

His employers at CBS seem confused on this point as well, because they have permitted, if not actually encouraged Sheen to, in every sense, blow. And why not? They have a hit show; the eyeball market is increasingly competitive; the stockholders all have kids to send to college: if the star needs to drive off a cliff to stay starry, why take away his keys? Perhaps it was in anticipation of such corporate benevolence that Sheen’s limbs were twitching in advance—you know, with gratitude. (1) More likely, however, what we’re seeing on screen is the stifled impulse to flap his appendages and fly away. The question is: where to?

Yesteryear’s bad boy marathoner, Keith Richards of The Rolling Stones, never had the idle hands problem. Nearly every photograph in his recently published memoir, modestly entitled Keith Richards — Life, (then, in smaller letters… “with James Fox”),  shows him with wrist elegantly cocked, a drink or cigarette or friend or lover in hand, or even more characteristically, with his arms around a guitar, fingering a fret or thinking of playing something he believes in. Like Patti Smith (see my previous column ), Richards did his best to subordinate his drug hunger and death wish to his creative work. 

Whether or not one believes that Richards succeeded as well as he claims, his memoir houses, among other treasures, a remarkably good celebrity addict tip sheet. Pointers Sheen could evidently use.

Tip number one is, don’t fall in love with fame. Richards, rather credibly, says that he saw it as the only means by which a wastrel from South London could get to play the music he wanted and meet blues and rockabilly musicians he idolized. (2) When Sheen finds himself, by way of solicitation, emailing a sex pro that he is “an A-list actor” he might surmise that he’s getting this one wrong.

As Richards tells it, his notorious drug habits began as performance enhancers. Exhausted by the punishing lulls and high-energy demands of road tours, he asked his elders and betters how they kept looking so good every day. The old blues boys told him: “This is how we do it: you take one of these, and then you smoke one of these.” (3) So tip number two is to use drugs for something more than fun. At various points in his career, Richards writes, heroin and cocaine were useful to him, buffering him from the human static around him and letting him focus on his music, helping him to become an observer with enough distance on strong people and feelings to write songs about them. Charlie, are you listening?

As with his music, Richards’s attitude towards drugs was one of both compulsion and connoisseurship.  Even after he blossomed into a world-class drug addict he did his best to maintain high standards, hence his third celebrity addict tip: insist on pharmaceutical grade cocaine. The impurities, he claims, can do you more harm than the drug itself, so if it’s arriving in briefcases, look out.

Tip the fourth is more complicated. It boils down to: don’t try to go through the roof. Although he reports snorting, on one occasion, an immoderately huge line of cocaine, he says that he generally resisted the impulse to keep gobbling up more and more of whatever he was taking in the false belief that another snort or hit would get him higher rather than trashed. In the same vein (sorry)  he claims to have stuck to skin-popping heroin rather than mainlining, and, unlike Sheen, he stayed clear of crack.  

Lastly, whenever he went back on smack after detox, he started off with a weakened pop; avoiding the tendency of addicts coming out of rehab to overdose. According to 22 year old adult film star Kacey Jordan, one of his recent party partners, Sheen ignores all of Keith Richards’ drug pacing and dosage tips. He was hitting his crack pipe two to five times a minute before stomach cramps got him hauled away in an ambulance. “All I heard was “light,” Jordan told Good Morning America, “Light, light light. All night.”  

After many painful failed attempts (he denies having his blood changed as urban legends have it), Richards finally succeeded in beating his addiction once the logistics of procuring drugs on the road while under close surveillance from police became too daunting. When he had to choose between his habit or the band, he chose the band. So, while he broke his addiction in part because of his love of rock ‘n roll, it was also partly thanks to the threat of imprisonment—a sobering consideration for the medical model purists in charge of Sheen’s rehabilitation and courts that keep him in charge of his own money.

One possible clue to Richards’ recovery of over twenty years’ duration is his desire for human connection—not only with friends and lovers, family and fellow musicians, but also with audiences. When he writes about his experience of reaching into a sea of hearts through music—music freely chosen and played with integrity—it’s clear why, when competing for his dopamine receptors the guitar ultimately won priority over the needle.

For the star of Two and a Half Men, it’s hard to imagine a comparably inspiring attachment. He obviously cares about his work, but what he first admired about the young brat packers who preceded him, like Rob Lowe and Tom Cruise, was their large living as much as their craft. (3)

Nor do family attachments seem to compel him viscerally. Kayce Jordan also told GMA that Sheen wanted to rent himself a pleasure dome to house his personal selection of sex workers. The father of five children (the latest pair around two years old), seriously proposed that Jordan babysit his kids when they visited the sex palace. This is an excellent way to convince himself that he is concerned for the welfare of his children while simultaneously making it unlikely he’d ever be granted custody.

If Mlle. Jordan is to be believed, Sheen was ready for his 15 minutes of fame to end. “Yeah,” she reported, “…he wants to retire; just wants to have fun. He’s like, ‘I’m done; I’m done.'”

Well, fast-forwarding to the final chapter, perhaps. “This is somebody with some character [and] logical flaws,” reality tv’s celebrity rehabber Dr. Drew Pinsky told People Magazine in a fit of understatement. Dr. Pinsky described Sheen’s condition as “a life-threatening illness,” and expressed doubt that he could recover without taking considerable time off from his job. But is there really any escape from Sheen’s job when even one’s prospective therapists are trawling for clients with screen credits?

There is no scientific study to back this up, but over the years I’ve noticed that few Hollywood stars maintain any psychological equilibrium in what-have-you-done-lately country without something emotionally sticky to hold on to: rainforests or orphans, gurus or endangered animals, dreaded diseases or gods. You can call these handles and rescue ropes the celebrities’ “higher powers,” though I don’t, just as I don’t think stars do these things “just for the publicity.” People whose existence depends on their ability to project fabulousness and desirability, larger-than-lifeness, seem to need alternate identities that have a sober fabulousness of their own, something that can dilute the drug of objectified desire with vitamin shots of being useful or “good.”

Unfortunately for Charlie Sheen, the only cause that seems to have moved him to action is a failed quest. He was a major 9/11 conspiracy theorist, and lobbied hard for Obama to re-open investigations—to no avail.(5)  Even if you diagnose that particular cause as a paranoid’s folly rather than a patriot’s crusade, it’s significant that Sheen was groping for something more than the infantalization that CBS is currently offering: in-house rehab, more millions to squander on self-entertainment and more work for hire. As Richards’ story shows, if you want to survive your addictions as a creative bad boy, it helps you to get a grip if you’re actually creating. And not actually bad—or behaving like a boy.

Source Psychology Today

Silly Uses of Sleeping Pills

by Matthew Edlund, M.D.

Snorting Sleeping Pills to Treat Your Feet

Not everyone snorts prescription sleeping pills to treat their feet. Aerosmith rocker Steve Tyler podiatric self-management included snorting lunesta (eszopiclone.) When he tried it while performing in South Dakota in 2009 he fell off the stage.

Please don’t do this when you’re judging American Idol, okay?

As fans of the Darwin awards know well, people can and do use drugs in surprising, ingenious ways. One of my better remembered patient encounters involved a Houston undergraduate who liked to get high injecting Vicks Vapo-Rub. He would grab his preferred substance, uncap the bottle, pour the liquid into a syringe, then subcutaneously inject. He never got infected and assured me he became “pleasantly whacked” for a while, though later he felt really tired.
Sleeping pills have different uses, but some are silly and others downright dangerous. Here are a few sleeping pill “uses” you may wish to avoid:

1. Getting high. Steve Tyler is not alone in his predilection for sleeping pills as a way to get “up”, though snorting them has hitherto been unfashionable. Many people use the class of benzodiazepine drugs, of which valium (diazepam), Librium (chlordiazepoxide), and ativan (lorazepam) are just some of the more popular members, to get high. Many of these “highs” occur in conjunction with other drugs including alcohol, opiates, and cocaine.
The problem – though very effective for anxiety disorders, benzodiazepines and drugs that mimic them, like lunesta and ambient (zolpidem,) can become physically addictive. Combined they can make you very dead. Many a celebrity, like the Beatles’ manager Brian Epstein and Australian actor Heath Ledger, died of overdosing on sleeping pills. Often sleeping pill lethality is increased through adding alcohol. Like many addicting drugs, sleeping pills also produce tolerance – you just need more and more of the stuff. Not recommended.

2. To nap. Sleeping pills, especially short acting ones like lunesta and ambient often let people fall quickly into sleep – so fast people use them to nap.
The problem – beyond the issues of dependence and tolerance, short acting sleeping pills have been implicated in hair-raising sleepwalking episodes where people drive their cars for hours or try to jump off buildings. They also leave their users, after a short two hours of exposure, in terrible shape to walk, move, or do anything requiring intelligence, as shown in a recently published study by Kenneth Wright done at the University of Colorado. Short acting sleeping pills hit some of the same benzodiazepine receptors in the brain that long acting ones, like valium, do. Benzodiazepines are famous for causing many accidents and falls, in part because people think they’re better navigators than they really are. Benzodiazepines produce a kind of global Lake Woebegone effect – taking them convinces people their reactions and driving skills are superior – when they’re really impaired.
Plus using sleeping pills for naps vastly complicates obtaining normal sleep at night. Sleeping pills for naps are Not Recommended, except perhaps in movies, weepie novels and some complicated jet lag strategies.

3. “Topping off” other sleeping pills. When you can’t sleep, you get frantic. Many respond by taking more pills. Occasionally they will sleep better that night, and perhaps a couple of nights or even weeks more.
The problem – you’re usually just adding another drug, like ambien, to what is functionally the same class of drug, for example valium or restoril (temazepam.) You’ve blasted the new drug onto the few remaining receptors that don’t already have pharmaceuticals attached, but the effect won’t last. Tolerance hits quickly, and much of the “effect” leading to sleep is the brain simply recognizing there’s a different sedating drug coming in. The overall results on balance, thought, cognition, and memory are generally highly unfavorable. Definitely not recommended.

4. Shifting different sleeping pills from day to day. Perhaps it’s the nature of my clinical practice, but I usually observe this particular strategy happily engaged in by Europeans and globe trotting Americans who notice they sleep “better” when they vary their dosing in ancient Chinese menu style – one pill tonight from column A, two tomorrow from column B, the next night one from column A and column C…
The problem – people will certainly feel a different buzz, but lots of what goes into sleeping pill use is behavioral. The old team at Henry Ford hospital, especially Tim Roehrs and Leon Rosenthal, years ago did a lovely study where they gave habitual sleeping pill users their choice of different colored pills. One color contained what they had been taking for years; the other was placebo.
They took equal amounts of each.
For long term users, placebo=sleeping pill of choice.
So shifting drugs night by night may give the illusion of an effect that is different and “powerful.” Yet beware. Combining different sleeping pills from day to day not only increases tolerance but leads to unpredictable cognitive and physical results as different drugs are detoxified in very different manners and speeds. There are times in the 24 hour day when you get far more or far less stuff working than users think – which can lead to terrible accidents as well as increasing dependence.

The Larger Problem

A major public health difficulty of sleeping pills is that they don’t produce normal sleep. Recent studies of short acting agents like ambien place them more in the category of inducing mini-coma than anything resembling sleep.
Rest is regeneration. You rebuild body and brain through sleep. The natural kind is still best.
The best uses of sleeping pills remain temporary ones. And they’re definitely not to be used for foot pain.

Web Source: http://www.psychologytoday.com/blog/the-power-rest/201101/silly-uses-sleeping-pills

Depression Thwarts Attempts to Quit Smoking

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 3, 2011

New research suggests diagnosed or undiagnosed depression can hinder an individual’s efforts to stop smoking.

In the study, published in the January 2011 edition of the American Journal of Preventive Medicine. scientists determined approximately 24 percent of surveyed callers to the California Smokers’ Helpline currently suffered from major depression and 17 percent of callers had mild depression.

Over half the surveyed callers, depressed or not, made at least one attempt to quit after calling the helpline.

At the two-month mark, however, the success rate of those with major depression was much lower than that of mildly depressed or non-depressed callers. Nearly one in five callers with major depression reported success, but of others, nearly one in three was able to remain smoke-free.

Most quit-lines do not assess smokers for depression, even though mild depression already is known to reduce the success of quitting. This study suggests that major depression reduces the success rate even farther.

That is important because the California quit-line receives a high number of calls from heavy smokers and smokers on Medicaid – two circumstances associated with depression. Since more than 400,000 smokers call U.S. quit-lines every year, the authors believe that up to 100,000 depressed smokers nationally are not getting the targeted treatment they need.

“Assessing for depression can predict if a smoker will quit successfully, but the assessment would be more valuable if it were linked to services,” said lead study author Kiandra Hebert, Ph.D., of the University of California at San Diego.

Hebert said an integrated health care model is a potential solution. Depressed smokers could have better quitting success if they receive services that address both issues. Quit-lines, which are extremely popular, are in a good position to offer such services to a large number of depressed smokers and to pass on the services they develop to quit-lines across the country.

Treatment programs, including quit-lines, report that a growing number of callers have other disorders, such as depression, said Wendy Bjornson, co-director of the Oregon Health & Science University Smoking Cessation Center, who was not involved in the study.

“The results of this study are important. They show the scope of the problem and point to the need for protocols that can lead to better outcomes.”

Source: Health Behavior News Service

Addiction during the holidays: Recovered or not, it’s important to be prepared

by Adi Jaffe

The holidays are a stressful time for everyone. Between gift-giving, travel, and keeping up with all parts of the ever-complicated modern family unit, nearly anyone can find themselves driven towards the nearest coping mechanism, whatever that may be. However, for recovering addicts, or those still struggling with an active addiction, the holidays can be a particularly troubling season that can invite a destructive relapse. As with all mental and physical health issues, education and awareness are a powerful first line of defense. By going over some of the most frequently asked questions about addiction and the holidays, we can attempt to shed some light on these issues for addicts and their families to help combat them before, not after, they become bigger problems (like a relapse).

Why Are The Holidays So Difficult For Addicts?

Obviously, as just mentioned, the pressures of the holidays are difficult for everyone. But for addicts, these same issues of money, family and general stress are amplified, often because they are the same age-old issues that lie at the root of the addiction and the beginning of drug use and abuse in the first place. If the recovering addict has not had the opportunity to openly confront family issues in the past, either with the family itself or with a therapist or counselor, the potential for relapse can be great. A vast amount of research shows how stress can bring even long-dormant behavior back to the surface, which should serve as a warning to substance and behavioral addicts alike (like sex addicts or compulsive gamblers). On the other end of the spectrum, addicts without a stable family or group of friends are often left feeling alone and isolated during the holidays, another powerful source of the shame and boredom that can drive addictive behavior.

What Are Some Of  The Hidden Struggles That Can Intensify Addiction/Trigger A Relapse?

Most often, these struggles emerge from one of two likely scenarios. In the event of a still active addiction, attempts to hide the problem from friends and family and the resulting stress can, paradoxically, intensify the addictive behavior. And whether the addiction has been treated or not, gathering with family in a familiar place can frequently cause someone to face many of the underlying issues that can be the root causes of a drug addiction or compulsive behavior. To paraphrase Tolstoy, all unhappy families are unhappy in their own unique way, and whether one’s particular family is overly judgmental, enabling, angry, or whatever else, it can serve to restart self-destructive patterns of behavior. For some recovering addicts, there may be a family-imposed secrecy around the recovery itself, which can be trying at a time when the whole family is gathering, ostensibly to celebrate one another. Even the house (including the room where an addict used to act out) and certain family members (like that cousin they used to smoke weed with) can be important cues that may re-trigger cravings and old behavioral patterns. Additionally and importantly, if there is a family history of any kind of past abuse, this can obviously serve as a particularly powerful and insidious trigger for addicts, whether recovering or not. In fact, recent research suggests that these old, root stimuli may be much more powerful for drug addicts than re-experiencing the drug itself.

What Are Some Strategies For Surviving The Holidays?

First and foremost, one must be prepared. Since most people at least know and are aware of the potential issues that might arise within their own families, it is crucial not to try to “wing it.” If you know that your family is going to be asking lots of uncomfortable questions, practice some appropriate answers and don’t feel obligated to discuss any aspect of your recovery that you’re not comfortable discussing. If your family is overly focused on achievement or likes to bring up stories from the past that are triggering or shameful, rehearse your reactions to them. If you have a friend or significant someone who can help, do a little role-play trying out different answers and see how they feel as you actually say them out loud. It will never be exactly the same as you practice, but being prepared can go a long way towards taming the body and brain’s natural stress responses. Just as importantly, if you know you’re liable to encounter events or people that formerly facilitated addictive behavior, role play those likely scenarios and know how you plan on turning down or avoiding those substances or behaviors. For instance, figure out how exactly you’re going to tell your cousin you aren’t going to smoke in the basement with him before you have to actually do it. It will sound a lot less forced and strange the second time around and you will have already experienced some of the associated anxiety. If you’re going to be alone, make distinct plans for your activities and do the best you can to find healthy situations to participate in, even if they seem new or slightly uncomfortable at first. For instance, go ahead and join that group of strangers for a Christmas eve dinner or Christmas day movie instead of spending those times along. After all, uncomfortable or not, a new, healthy experience will be vastly preferable to sliding back into the same old destructive patterns of the past.

Should I Use New Years To Confront My Addiction?

Most everyone is familiar with the New Year’s Resolution as a method of planning major life changes. Of course, most everyone is also familiar with the limited success rate of these resolutions, and of the effectiveness of “going cold turkey” in general. Depending on the addiction, there are certainly things that individuals can do to help themselves- for example, research suggests that when trying to quit smoking setting a quit date and beginning to use replacement patches or supplements in anticipation of that date (in other words, while still smoking) can help reduce the amount of smoking while approaching that quit date, making it easier when the day finally arrives. If you’re planning to quit a “harder” drug than nicotine, you may want to set a whole schedule for reducing drug use prior to the quit date itself. The important thing is to be completely realistic in order for the change to stick. If you’re drinking a bottle of vodka a day, attempting to go completely dry within a week can be extremely dangerous to your health, and will not likely result in a permanent change. Once again, education and preparation are key. Prepare for any sort of quitting by looking online on sites like AllAboutAddiction and WebMD, and identify the medical and psychological issues that are likely to accompany your attempt. Look to see if your problem is one that you can handle alone, or if it is recommended that a doctor help you with the process. Remember that your goal should be lifetime change, not a temporary one. Though it might seem counter-intuitive, if your holidays promise to be especially difficult or stressful, you may want to hold off on trying to quit during them and look at them as a time to lay the groundwork for your post New Year quit attempt rather than going for a full on cold turkey try. Such pragmatism may well help you achieve your true goal.