The Blog

Renewed Faith in Insurance Coverage for Addiction Treatment

By Sarah Benton, MS, LMHC, LPC

Throughout my career, I have worked at various outpatient and residential treatment centers for mental health an addiction- some insurance based and some self-pay.  I have witnessed staff conduct utilization reviews advocating for additional days of treatment for clients who were desperately in need—sometimes successfully and sometimes not.  Given the amount of money that insurance companies spend on repeated client relapse/detoxification, ineffective treatment and other medical complications related to relapse and untreated addiction one would think that they would become more open-minded to what treatment they are covering.  At times, it doesn’t feel that Parity Laws (those that mandate for equal coverage of both medical and mental health care) are being implemented.

I recently became the Director of Clinical Services at Aware Recovery Care (ARC), home-based addiction treatment program serving all of Connecticut.  This year-long program provides in-home care facilitated by Certified Recovery Advisors, Care Coordinator nurses, administers drug testing and sets clients up with outpatient therapy, psychiatry and family therapy in their local community.  Individuals can attend residential treatment first and then step down to ARC as their aftercare plan or begin initially with the ARC program.  The home becomes the treatment center, and clients receive a 52-week curriculum and care tailored to the needs of individual and his or her family system.  The miracle is that Anthem Blue Cross recognized that covering a year of comprehensive addiction care (in-network) for individuals in their home environment (where many struggle to remain sober) is a worthwhile investment for them.  I have witnessed this insurance company make this process easy for clients and for ARC, in that we do not need to fight them every month to get approval for more services—as it is expected that each client will receive the entire program.  I know- it sounds like I am making this up- but it is real!!!  Anthem Blue Cross is also planning to cover a year of the ARC program in other states starting with New Hampshire.  These events are giving me a glimmer of renewed faith in the insurance industry—that they are acknowledging the addiction epidemic and are willing to take a chance on covering non-traditional services in order to help their members increase chances of recovery.

Maybe this will become a new trend and other health insurance companies will begin viewing addiction treatment as a long-term investment.  The truth is, covering comprehensive services for at least the first year of an individual’s sobriety can increase their chances of long-term recovery and decrease their chances of relapse.

For more information about the ARC program, please visit Awarerecoverycare.com

July 29, 2016 0 Comments

What Type of Addiction Services Do I Need?

By Sarah Benton, MS, LMHC, LPC

There is an endless and overwhelming amount of information on the Web about addiction treatment options.  Many people have no idea where to begin or what type of care that they or their loved one may need.  There is common terminology that is important for those seeking treatment and their loved ones to understand when reaching out for help.

Often, insurance companies will not cover treatment for individuals requesting a higher level of care, such as residential, without unsuccessful attempts of staying sober at a lower level of care.  It can also be helpful to obtain a substance abuse assessment by an outpatient addiction therapist in order to help determine a treatment plan that is appropriate.  However, if an individual is physically addicted to alcohol it is imperative that they receive medical attention before abstaining from alcohol.  This person could be seen and assessed at any local Emergency Room and many addiction programs require that an individual is medically cleared by an ER before they admit that person for further treatment.  ERs can sometimes be helpful in finding an available detox bed for the individual as well.  Additionally, contacting your Primary Care Physician for referral suggestions can be a great place to start.

The following levels of care are listed in order of the lowest to the highest level of care:

Outpatient services:  This is the lowest level of care and often the most desirable for those who want to seek out discreet addiction care.  Outpatient care may involve receiving treatment from a therapist, psychiatrist (prescribe medication), psychiatric nurse practitioner, or addiction counselor in private practice or who may be part of a clinic.  They may or may not be in network with insurance providers.  Some outpatient clinics may also provide therapy groups and alcohol/drug testing, which can lead to a more comprehensive treatment plan.  Additionally, it is recommended that individuals attend mutual help meetings in addition to receiving these types of services (i.e., A.A., SMART Recovery, Celebrate Recovery, Women for Sobriety). The outpatient level of care can be a starting point for many alcoholics or those questioning their drinking and if they find that they are still relapsing, then it is clear that they may need to utilize a higher level of care.  Insight Counseling in Ridgefield, CT is a reputable outpatient clinic (also provides teen and young adult IOP) that specializes in treating clients with addictive and mental health issues.

 Intensive outpatient program (IOP):  An IOP is a program that is also generally run out of a clinic or hospital and generally is about 3 hours per day, allowing for individuals to also attend part time work or school.  Some IOP programs are in the evening, allowing for those being treated to maintain full time work.  These programs typically involve group therapy, along with individual therapy, case management and medication management.   These programs can last for various lengths of time (weeks-months), as individuals are able to engage in work, volunteering or academics simultaneously.  They are both insurance based and self-pay.

Partial Hospitalization program (“day treatment”):  These programs are run out of clinics or hospitals and allow an individual to attend treatment throughout the day while living at home.  Individuals who are attending a partial program generally need to take time off from work or are not currently working in order to attend, as the hours can run from about 9:00am-3:00pm.  These programs involve mainly group therapy, along with individual therapy/case management and medication management (if needed).   Individuals attend partial programs for generally about 2 weeks depending on the program, their insurance and ability to self-pay.  The intention is to then step individuals down to an outpatient treatment plan upon discharge from the program.  If an individual is continuing to relapse during or after attending a partial program, than this may indicate that they need a higher level of care such as detox or rehab.  McLean Hospital in Belmont, MA, offers many of levels of care including partial hospitalization.

Intensive case management or community outreach programs:  These types of programs involve a variety of program structures.  However, many bring their services directly to the client and are able to meet them in various locations (i.e., at their apartment, coffee shop, college, etc.).  These programs also range in the level of intensity depending on the clinical needs of the individual and the fee is often determined by the number of weekly clinical contact hours.  The services may include care coordination, sober coaching, vocational counseling, family coaching, etc.

Sober living:  There are many sober living houses around the country, with a large concentration in California and Florida.  Sober living is the lowest level of residential care as they generally do not offer any clinical services in-house- but alcohol/drug testing is standard.  Individuals will often be connected with therapy and medication management outside of the house.  Many sober houses require that those residing there will be engaged in at least 20-25 hours of activities outside of the house per week.   Houses are usually gender specific.  Insurance does not pay for sober living, and there are a range of prices for this type of housing.  An example of a national chain of inexpensive sober houses is Oxford Houses and their website provides directories of the various houses around the country.

Transitional sober living programs:  Individuals are generally expected to stay in this type of program for several months, as this is intended as a bridge from treatment to the real world.  Many of these programs require that the individual has attended a rehab program at some point in the past. Some are connected to residential treatment programs, and offered as a step down option and others are independent programs.  These programs require that individuals will be living at the program, engaging in various forms of treatment such as individual, group therapy and medication management as needed. More comprehensive case management, structure and vocational coaching services are often provided in this level of care than traditional sober living. Additionally, it is expected that they will seek out vocational and/or academic pursuits that they can then continue once they leave the program.  Insurance does not generally pay for this form of treatment.  East Coast Recovery Services– The Strathmore House in Boston, MA is a new transitional sober living program option.

Residential treatment (“rehab”):  All residential treatment programs require that an individual live at the program during treatment, but it is not locked.  There are many types of programs and locations to choose from in terms of this type of care, as well as various price points.  These programs typically involve attending group therapy much of the day, individual therapy sessions, and medication management (if needed).  Some programs offer alternative forms of treatment such as equine therapy, wilderness excursions, acupuncture, yoga, massage, expressive therapy and many others.  Some programs do take insurance, but many are self-pay.  Many rehab programs are 28-30 days minimum in length, and it is crucial that comprehensive aftercare is established in order that the individual continue to receive some form of care upon discharge—rehab is not sufficient to “fix” alcoholism.

Detoxification (“detox”) and Inpatient treatment:  This is the highest level of care and individuals are placed in a locked unit generally in a hospital setting.  Most alcoholics are placed in this type of care in order to be medically monitored while they are detoxifying from alcohol.  They will meet with a therapist/case manager, psychiatrist and may attend minimal groups.  However, this level of care is not intended to be “treatment” for alcoholism, it is the beginning of the process in that it leads to physical sobriety, but true recovery is a longer journey.  Some detox programs are part of a residential rehab program.  Some alcoholics will end up in an inpatient treatment program as a result of suicide attempts while under the influence of alcohol/substances or other safety issues.  Individuals are held in these types of programs until they are physically and psychologically stabilized.  Insurance generally pays for this level of care for alcohol detox and the length of stay is based on the medical necessity and insurance coverage.

January 23, 2016 0 Comments

“Fools Rules” for Justifying Drinking

By Sarah Benton, MS, LMHC, LPC

One of the symptoms of an alcohol problem or Alcohol-Use Disorder is when individuals start to make “rules” around their drinking. These rules may offer a false sense of security that their drinking is under control. The origin of many of these “rules” is from the societal stereotypes about alcoholism and the belief that if one does not exhibit the behaviors or image of the “typical alcoholic” then he or she “must not have a problem.” Sadly this stereotype has been a powerful influence on the minimization of alcohol problems in our society.

It is important to define what the “Fool’s Rules” are, so that individuals can be honest with themselves about their relationship to alcohol.

 1. I always drink socially and don’t drink alone.

2. I don’t drink in the morning.
3. I’m drinking by choice, not because I have to.
4. I only binge on the weekends, I don’t drink during the week.
5. I can sometimes control the quantity I drink.
6. I can take breaks from drinking (i.e., 1 week, month(s), etc.)
7. I drink the same amount as my friends.
8. I’m a connoisseur of fine wines, champagne and craft beers.
9. I’m only hurting myself, not my loved ones.
10. I do well at work or academically therefore, I don’t have a problem.
11. I have never blacked out or passed out.
12. I never miss obligations due to my drinking or hangovers.
13. I never drink and drive (but I have to use Uber, cabs, sober friends to get home safely.)
14. I drink for fun and not to “self-medicate.”

Some of these rules are also myths that many believe and use as a way to assure themselves and others that they do not have a problem.  The bad news is that they may create a false sense of security, because those with Alcohol-Use Disorders may not be daily drinkers; they may only drink socially; they may be able to take breaks from drinking; they may only drink expensive liquor and may be successful personally and professionally.

Over time, the belief in these rules can be the justification that individuals use when defending their drinking habits to others.  Individuals “hang on” to the fact that they have some parameters which lead them to believe that their drinking is under control, but often “if you have to control something then it is out of control.”

Additionally, rules may be set and then broken once in a while or regularly, leading to new or adjusted rules.  This is referred to as “drawing lines in the sand” that are crossed and then recreated.  This behavior is a clear sign that an individual has some type of drinking problem and should have an assessment with an addiction specialist.  Creating rules for drinking and breaking and/or changing them can be an important process in determining if we have an alcohol problem.  The NIAAA website RethinkingDrinking.org is a resource that can support individuals in assessing their drinking patterns, create low-risk drinking goals and assess if they are consistently adhering to them.

For an entertaining and informative discussion about “Fools Rules” and more, please visit my podcast with Liz Jorgensen “Straight Talk from the Sober Chicks” at Insight Counseling available on I-tunes.

January 23, 2016 0 Comments

Not Just One Way to Get Sober!

By Sarah Benton, MS, LMHC, LPC

There are many views and opinions about what is needed for alcoholics to maintain long-term sobriety/recovery.  There are therapeutic coping skills, the medical model, evidence-based research, 12-Step model, SMART Recovery, Celebrate Recovery, alternative treatments, wilderness therapies, spiritual/religious practices and more… The good news is that there are many resources and ways for individuals to receive support and to get sober.  The downside is that individuals may become overwhelmed by options.  Each of these recovery models can be applied on a continuum—ranging from moderate to strict to fundamentalist.

In my personal and professional experience, I have observed clients and loved ones acquire sustained recovery in differing ways.  It has also been interesting to see how they have found ways to apply different recovery principles and coping skills to suit their beliefs, personality and lifestyle.  For some, an extreme and strict framework has been needed and for others, a moderate approach has been more appropriate.

Throughout the treatment, therapeutic and recovery process individuals learn many coping and relapse prevention strategies as well as life skills and spiritual principles intended to improve their prognosis and quality of “sober” life.  I have often compared this process to a buffet, where an individual views all of the options, samples some things they may or may not like and then settles on what they prefer. In other words, “take what you like and leave the rest.”

 In fact, the most effective way to maintain sobriety is to engage in strategies that are realistic and that an individual is likely to engage in long-term.  As therapists, we can make suggestions, but it is important to view each individual as unique and to know that they will have their own journey that will allow them to experience what they may or may not need to change along the way.  When treatment centers, addiction professionals, recovery coaches or spiritual leaders are only open to one way to view or to engage in the recovery process, it is important for individuals to be honest themselves about if that view is the right “fit” and if it is resulting in sustained recovery.  If not, then there is always the option of integrating various pieces of that approach with additional strategies.

For example, George begins individual therapy with an addiction specialist and has been sober for 1 month.  He expressed that he wants to learn different coping and relapse prevention skills and has decided to attend both Alcoholics Anonymous (A.A) and SMART Recovery meetings in addition to therapy and other self-care strategies (exercise, meditation, etc.).  The therapist recommends that the client should only attend A.A. and not SMART Recovery and that he should just follow the suggestions of the 12-Step program and then he would not need these other parts to his recovery plan.

The problem: This addiction specialist seems to have experience with the 12-Step/A.A. model, but does not appear to be open-minded to other recovery strategies and models.  It is possible to integrate differing recovery models and to find a plan that will work for individuals that suits their unique needs.  There also may be parts of some self-help programs such as A.A. and SMART Recovery that may work in combination for some individuals.  The strict version of either model may not be the best for all, and “fundamentalist” views on sobriety may turn some individuals away from ceratin approaches. Either way, if the therapist observes that an individual is having relapse issues, then the recovery plan and level of care should be revisited.

It can also be the tendency of those in early recovery to engage in “extreme” behaviors and struggle to find balance in their lives.  Therefore, it is even more important that these individuals strive towards an approach that will allow for consistency—recovery is a marathon and not a sprint!

For a fun and informative discussion about this topic and more, please visit my I-Tunes podcast with Liz Jorgensen “Straight Talk from the Sober Chicks” at Insight Counseling

 

January 23, 2016 0 Comments

Sober Summer: A Survival Guide

By Sarah Benton, MS, LMHC, LPC

For those trying to cut back on their drinking or for sober alcoholics, the summertime and the many celebrations that accompany it can be full of temptation. Many sober alcoholics will report that the warm weather, the outdoor bars, family gatherings, vacations, the beach, sporting events, etc. can bring back memories of “the good ole’ days.”  However, the memory of alcoholics is much like Teflon: all of the negative experiences seem to slide away and they are left with a romanticized version of their drinking days. It is really important for sober alcoholics to stay connected to their recovery program, attend therapy, receive treatment for co-existing conditions (anxiety, depression, etc.) and work at re-programming their association with these triggering occasions. Recovery from alcoholism allows individuals to replace their drunken memories with new sober experiences. They begin to gain confidence in their social skills and to realize that their sober life is full of excitement and wonder—but now they can actually be in the moment and remember it.

For normal drinkers, this time of year may not pose a problem. But for problem drinkers, this may be a time when their drinking either stands out or they simply blend in with the crowd. Many alcoholics report that any occasion can be an excuse to drink and that it is easy to blame their belligerence on the event. Because social drinkers may drink more than usual during these summertime festivities, they may feel that they can “let go” and drink the way that they really want to drink without holding back. For those who may have tried to hide their drinking or drank privately at home before or after an event, this may be an opportunity to feel that they will fit in with these heavy drinking scenes. However, many still end up humiliating themselves drunk when others are drinking heavily and vow once again that they will never drink that much again. Those in denial of their friend or loved one’s problem may also blame the event or the “open bar” at the wedding as the reason the problem drinker drank too much. In fact, some feel that a wedding is not considered a quality wedding unless there is an open bar. The irony is that the more alcohol is served, the less the guests focus on the event and the more “forgettable” the occasion becomes.

In addition, we live in a technological age where computers and text messaging have become the norm in terms of communication. Therefore, it is concerning that when given the opportunity for face-to-face communication, many avoid the discomfort of talking socially to someone whom they don’t know by having a few drinks. Social events can be opportunities to connect with others, meet people, and to enjoy the moment, but when alcohol is placed in the equation those possibilities may be lost. The truth is that one way to gain confidence socially is to avoid drinking, sit with the discomfort and practice talking to a stranger.

 Here are some tips for sober summertime fun!

1. Set limits in terms of the amount of time spent in heavy drinking environments.

2. Bring along a friend or other loved one to a social function for additional support.

3. Choose not to attend events that would increase chances you may drink.

4. Leave the event early.

5. Be sure to have transportation options that will allow you to leave the event early if necessary.

6. Have a friend who you can call for support during the event and take a “time out.”

7. Avoid spending time with “toxic” relationships.

8. Practice stress reduction techniques during this time of year (i.e., exercise, meditation, massage, etc.).

9. Spend time with your friends in activities that would not involve alcohol.

10. Be honest about your emotions with others.

11. Avoid “people pleasing,” as this involves trying to keep other people happy while neglecting your own needs.

12. Let go of other’s expectations and opinions. If you have a healthy relationship, then they will respect your personal choices.

13. Engage in summer activities that you enjoy that do not involve alcohol and invite friends along.

June 30, 2015 0 Comments

Critique of Gabrielle Glaser’s Atlantic Article “Irrationality of AA”

My friend recently forwarded me the April 2015 Atlantic Magazine article “The Irrationality of Alcoholics Anonymous” by Gabrielle Glaser http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/. Given the title of Glaser’s latest book “Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control”, it is clear that she has a strong opinion about the subject. However, she may not have the adequate personal nor professional experience to defend it.

As an author and therapist, I make every effort to be open-minded when learning, speaking and writing about topics. However, it does not appear that this was her objective in writing this piece. If I did not have personal and professional experience with alcoholism and in treating alcoholics, then I would not have felt so compelled to respond to this article. I am also concerned that individuals and loved ones of those who are questioning their alcoholism, know they are alcoholic and/or are seeking help may be misguided or confused about what evidence-based treatment options exist after reading her piece. Additionally, that they will needlessly be biased against Alcoholics Anonymous (A.A.)., when there are many ways to make mutual-help programs such as A.A. work in combination with other treatment modalities.

She begins the article with the case example of J.G a lawyer who has struggled with alcoholism and relapses. He endorsed that he “for years used alcohol to soothe his anxiety”, stated that A.A. led him to “feel utterly defeated” but did not discuss how he had sought out appropriate treatment for his anxiety issues—which A.A. is not intended to treat. She then writes “The 12 Steps are so deeply ingrained in the United Stated that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get sober” and “The problem is that nothing about the 12-Step approach draws on modern science”—UNTRUE. Evidence-based treatment indicates that clients should be also treating their underlying mental health issues simultaneously, referred to as co-occurring disorders or dual diagnosis. (note the work of McLean Hospital/Harvard psychiatrists Dr. Roger Weiss and Dr. Hilary Connery’s book “Integrated Group Therapy”) These individuals should be receiving a combination of individual/group therapy, medication management as needed, spirituality (as understood by that individual, even if atheist or agnostic), self-care (exercise, adequate sleep, etc.) and attending mutual help groups such as A.A., SMART Recovery (cognitive behavioral therapy and abstinence-based) or Women for Sobriety. Yes, there are other options for mutual help group other than A.A., but in my experience, many individuals have benefited from attending both (Women for Sobriety encourages A.A. attendance).  Additionally, The National Department of Health and Human Services, Substance abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-Based Practices and Programs lists 12-Step Facilitation Therapy includes A.A.principles and strategies.

In addition, there has been a great deal of research which indicates that spirituality (a vital component of 12-Step Programs such as A.A.) has proven to be valuable in the healing process from addiction, mental and physical health issues. Columbia University’s National Center on Addiction and Substance Abuse (CASA) program’s report “So Help Me God: Substance Abuse, Religion and Spirituality” offers such research. Dr. Herbert Benson, founder of the Benson-Henry Institute for Mind/Body Medicine at Mass General Hospital in Boston, MA has written and researched the power of meditation and other spiritual practices such as the “faith factor” and “relaxation response” and their healing effects on medical/mental health issues including stress-related medical issues, chronic pain, infertility, cardiac disease and many more. He offers frequent courses through Harvard Medical School as well.  Dr. Jon Kabot-Zin is the Executive Director for Center for Mindfulness at the UMASS Medical School in Worcester, MA and has been a leading researcher about the effectiveness of mindfulness meditation and mind/body healing. Again, the spirituality referred to in A.A. can include whatever “works” for an individual (nature, connection with people, the universe, religion, meditation, etc.) but also may include evidence-based practices.

Another reason that A.A. may be less effective for some, is that their mental health or healthcare providers may not be effectively integrating A.A. into their treatment plan- which may also include discussion, questions and application of the program and how it correlates to other aspects of their care.

Glaser also expresses misconceptions about hitting a “bottom” when she writes that “AA (should be abbreviated A.A.) truisms have so infiltrated our culture that many people believe heavy drinkers cannot recovery before they ‘hit bottom.’ Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma.” The researchers she may spoke with may be correct about those specific medical conditions, but Glaser clearly does not have a true understanding of what a “bottom” is. For example, many individuals reach an emotional bottom without many tangible losses, some receive an intervention and the “bottom is raised” allowing them to receive help before a tragedy occurs and others receive help for addictions only after they have had major losses (i.e., divorce, unemployment, legal issues).

Glaser did not demonstrate a clear understanding of the symptoms of alcoholism or “Alcohol Dependence” (as per DSM-IV TR diagnostic manual) or “Alcohol-Use Disorder” (as per DSM-V diagnostic manual). If she did, then she would have also realized that the Moderation Management debate ended abruptly on March 25, 2000 when the founder of that movement Audrey Kishline had a severe drinking relapse leading her to be arrested for a DUI after her vehicle hit and killed a father and his 12-year-old daughter (she admitted she began to engage in “non-moderate” binge episodes). Kishline herself concluded in her own words when interviewed by Dateline NBC:
Murphy: “Do you still believe a person can be a moderate controlled drinker?”
Kishline: “As long as they’re not truly an alcoholic.”
Murphy: “But what’s that line?
Kishline: “Nobody knows where it is.” Including Audrey Kishline. And now she wants everyone to hear her cautionary tale loud and clear.
Kishline’s statement that an alcoholic cannot be a “moderate controlled drinker” is profound. There is a continuum of drinking issues that require different types of treatment, and I have written a Psychology Today.com blog in the past defining each.  Specifically, a “problem drinker” or individual with “alcohol abuse” (DSM-IV TR diagnostic manual) or who has a “moderate versus severe Alcohol-Use Disorder” (DSM-V diagnostic manual) may decrease their heavy drinking patterns or “phase out” of a heavy drinking phase if given sufficient reason (i.e., negative consequences, graduating college, life milestone, believe drinking is excessive, etc.). In fact, Dr. Mark Willenbring, whom Glaser interviewed and quoted, reported in a 2008 Wall Street Journal article that National Institute on Alcohol Abuse and Alcoholism research indicates 72% of individuals pass through a heavy drinking phase, most often between the ages of 18-24.  While these individuals may mimic alcoholic drinking behaviors, the majority are able to self-correct to low-risk drinking patterns. However, this differs from an individual who is alcoholic as they may have tried many ways to control their drinking or obsess about additional strategies to be able to “drink normally” in the future. It is the mental obsession to become a “controlled” or “moderate” drinker that is factor in the progressive cycle of addiction. The idea “if you have to control something, then it is out of control” is applicable in this case. In the past, I have treated clients through the application of harm reduction/moderation techniques (only if determined to be clinically appropriate) because the individual is questioning his or her relationship to alcohol and believes that they may be able to adhere to low-risk drinking limits. My question to those who are most likely alcoholic but are preoccupied with keeping alcohol in their lives (with or without professional help) is “considering the negative consequences that you have experienced or could encounter (i.e., impact on others, risks, possible progression of a disease) if you did not have an addictive relationship with alcohol, then wouldn’t you choose to abstain—because the risks would not outweigh the benefits of drinking?” When alcoholics take a drink of alcohol, this sets off a physiological “craving” in their brain to drink more and they lack a “shut off” to control their intake—much like an individual who has a binge-eating disorder and cannot have “just 1” of certain types of food. Alcoholics also have a mental obsession about when they can have another drink, the next time they will be able to drink or about the fact that they are not drinking.

Glaser inaccurately explains that “in order to understand” the reason that the US standard of care for alcoholism is an abstinence-based model “you have to first understand the history”…and then begins writing about “religious fervor and prohibition”. But really- this is NOT a religious or political issue. The reason the abstinence-based model is the standard of care for alcoholism is scientific and practical. Alcoholics have an acute, progressive and fatal disease and if they could safely and efficiently moderate their drinking then they would not be addicted!
Glaser seems fixated on the drugs Natrexone and Baclofen (that debate has lost traction) as being the solution for alcoholism. She idealizes addiction treatment in Finland at “Contral Clinics” and interviews co-founder Dr. John Sinclair, whose research with rats led him to conclude that abstinence from alcohol versus moderation for alcoholics is leading alcoholics to relapse due to the “alcohol-deprivation effect”. Therefore, he is advocating for moderate drinking for alcoholics. I do not believe that I even need to address his bizarre theory further. The most valid piece of that interview is his support of using Naltrexone/Vivitrol as part of a treatment plan for an alcoholic (in the US the expectation would likely be that the individual was abstaining from alcohol). However, Sinclair’s belief is that the drugs should be prescribed for alcoholics to “take an hour before” drinking to decrease their cravings to consume alcohol in a high-risk pattern. Glaser seemed unaware that Naltexone is frequently prescribed as an anti-craving medication. She quotes an outdated JAMA 2006 research study indicating that “less than 1% of people treated for alcohol problems in the Unites States are prescribed naltrexone or any other drug shown to help control drinking”. She also attempts to tarnish the reputation of Hazelden and other 12-Step model treatment centers writing that “The Minnesota Model: Alcoholics and addicts can help each other. That may be heartening , but it’s not science.” I guess she missed the Butler Center for Research page on Hazelden’s Website and the NY Times article that interviewed Dr. Marvin Seppala, Medical Director at Halzeden. While these drugs may not be prescribed frequently to “control” drinking, according to Seppala, “27% of patients leave on some form of anti-craving medication” that he believes are most important to prescribe in the first 12-18 months of sobriety. However, a valid concern noted by Dr. Harry Haroutunian, physician director at the Betty Ford Center in Rancho Mirage, CA is “When you medicalize the disease and pay a lot of attention to the biology, it’s easy to get a patient to say, ‘Well, my cravings are gone, there’s nothing else I have to do,’…we try to use the principles of the 12-Step program as a source of strength during times of craving, to deal with the inevitable stressors. We want patients firmly involved with that.”

The most troubling piece of this article is when Glaser (who claims to be a low-risk drinker and not alcoholic) asks her doctor to prescribe naltrexone to her and is denied because “I don’t have a drinking problem”. She then unethically and possibly illegally orders it off the internet to take before drinking as an “experiment” to see if she would drink less. She states that “I had never found wine so uninteresting. Was this a placebo effect?” My friend who forwarded this article to me and in the past has attended residential addiction treatment, has relapsed, has attended A.A., has addressed dual diagnosis issues and now engages in a recovery program that he defines as “fellowship, spirituality and vigilance in recovery” responded to this part of the article stating eloquently that “The non-alcoholic trying naltrexone and reporting diminished cravings is meaningless…tantamount to a healthy patient taking a new medication to decrease Fibromyalgia pain and reporting pain relief when they never had pain to begin with”.

Glaser goes on to make the false connection that “as the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s (should be abbreviated A.A.’s) view that counseling could be delivered by people who had themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health (no hyphen needed) professionals. No other area of medicine or counseling makes such allowances.” WHAT? The A.A. Preamble states “There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. Our primary purpose is to stay sober and to help other alcoholics to achieve sobriety”. A.A. members are not “counselors for each other”, do not profit from treatment centers who may decide to integrate a 12-Step philosophy into their treatment and does not have an opinion about who should be providing counseling/therapy services for members or alcoholics in general. She then interviews “Jean” who “At age 50, Jean went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day…confessed her habit to her doctor” was referred to an addiction counselor and then to A.A. Jean complained about many aspects of A.A. and was then referred to Dr. Mark Willenbring (who believes in moderate drinking for some alcoholics) for behavioral therapy, medication and is able to “occasionally have a drink”. Is it possible that she was not an alcoholic, but was experiencing a heavy drinking, stress-related phase that has now resolved?

I do agree with Glaser that far too many individuals die from alcoholism each year and do not receive appropriate treatment. She is expressing hope that the Affordable Care Act will offer change in the addiction treatment industry. However, it is going to take more than universal healthcare and this article to re-think addiction treatment. There are also innovative and less traditional forms of addiction care that are growing in popularity, effectiveness and were not mentioned in her article (aside from having alcoholics try to find ways to drink moderately). I explore some of these another past Psychology Today.com blog and they include: case management, sober coaching, interventions, therapists with integrated dual diagnosis treatment approaches, collaborative outpatient treatment teams, evidence-based dual diagnosis care, trying different mutual-help groups (A.A., SMART Recovery, Women for Sobriety), lifestyle changes, self-care…

My eyes were further opened to the fundamental problem with the perspective advocated in Glaser’s article, when I received feedback from another friend and addiction professional. He states “For over 15 years, I have been exposed to addiction on several levels; as a police officer, a mental health/addition counselor, and for the past 8+ years working directly with addicts/alcoholics in my current role as a Director of the Teen Challenge Men’s Program in Brockton, MA. Most importantly, I have personally recovered from a severe opiate addiction that almost took my life. Addiction is an all-consuming disorder that will eventually interrupt and cause damage in each area of the life of an individual. Addiction not only causes chaos in human physiology, but also warps our emotional, spiritual, relational and mental well-being. A significant part of recovery most certainly involves a strong group dynamic. It also involves the surrender of the individual to the addiction and a willingness to let others step in and help. Higher rates of depression may well be present in addicts/ alcoholics, but the author seems to give little thought to what may be the primary cause of this…While not perfect, A.A. has proven itself to have many of the fundamentals right. The suggested alternative seems to represent everything that is wrong with western medicine; treating the symptom and not the root cause. Telling the individual to pull themselves up by the bootstraps, take a pill or two and then perhaps one day they can drink again is a reckless alternative. A.A. has become a fellowship of millions of individuals who commit to be a part of each other’s lives, repair past damage, focus on sobriety and enjoy one day at a time. This seems to me a way to live that is far from irrational.” He so precisely captures that successful recovery from an addiction does not simply involve a surface level solution—it encompasses healing on a much deeper level internally and interpersonally.

In conclusion, I ask that readers remain open-minded about valid forms of addiction treatment that are evidence-based, safe and comprehensive. There are many well-informed writers, addiction professionals, treatment options and it is a matter of finding and connecting with them in order to achieve full recovery from addiction and mental health issues.

March 25, 2015 7 Comments

The Power of Connectedness and Recovery

Recently, I have seen an increase in articles posted online, specifically on social media about addiction and how bad this issue is becoming. I found and read an article on Facebook by Johann Hari titled “The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think”—He wrote the article for Huffingtonpost.com.  The article was quite interesting and frankly very bold. Hari claims that addiction is not caused by the use of a substance alone, but that isolation causes individuals to cross the invisible line into addiction and therefore the solution must be for addicts to have community with people they love and care about.
Having spent many years in recovery and helping alcoholics and drug addicts I can understand the despair Johann must feel in wanting to help drug addicts. Although Hari will most likely never read this, I thought I would share my experience and opinion of the cause and solution for any and all, alcoholics and drug addicts. Again, this is just my experience…
I got sober in June of 2001; needless to say my life was a mess. To this day, I have no idea how I was blessed with the merit to get and stay sober for this long. I often say that I was very lucky, in that I was immediately connected with people in a recovery program who knew what the solution was and how to share that solution with me. I was blessed to have the desire to stay as close as I possibly could to these people.
Through the years of staying connected to these people and creating my own connections with others, I have come to believe that the only reason I ever used alcohol or drugs was that I was disconnected. Disconnected from what may you ask? I’m still not sure but here are some of the things I have learned. One of the first things I learned in my journey of recovery is that I must always have the desire and do the next right thing. Now, people may wonder… “What’s the big deal, of course I want to do the next right thing”. I have studied this simple but powerful saying over the last 10 plus years. I have talked with countless people about what it means to them and how this has helped them. This is what I have understood so far.
Doing the “next right thing” enables us to connect! Connect to what? Honestly I really do not know. Power I guess. Some unseen thing happens when we do the next right thing. And when we do the next right thing, when we have a choice to do the next wrong thing, we are able to connect even more. This connection is compounded as we continue, day after day to make the right choices.
This was a very profound realization for me because for most of my life I simply reacted with hardly any restriction in what my immediate desires where. I was walking around entirely consumed with what I wanted and felt I needed.
Reacting out of my own selfish desires year after year as my life progressed from childhood to adolescence and into manhood created a great deal of emotional pain. Using alcohol and drugs worked really well at masking that pain. Thus using alcohol and drugs became my solution, not my problem! Drugs and alcohol allowed me to connect. I do not know how but in hindsight that was what happened. I was usually in emotional pain (consciously or unconsciously) and I would use alcohol and drugs to feel better.
When I stopped using alcohol and drugs, my solution was taken away from me and fortunately I replaced it with a connection to power. One of the most amazing things about this simple concept is, it really does not matter if you believe it or not. For example, I have watched countless people take this action and have it work for them. Many, if not all of them, had no idea they were even doing it, as they were in so much emotion pain that they were willing to do whatever they were asked to do. These individuals were not trying to collect points for being a good person, they were not trying to please anyone, they just were sick and tired of living a life of pain.
So, in a way I do agree with Johann that the solution for addiction is connectedness but I would say that we as drug addicts and alcoholics must learn that connection with our actions can create our experiences. It is only our actions that can enable us to connect to people and when we connect with the people in our lives we are not only doing the next right thing—we are making the world a better place…and that is true Power!

Written by Josh Benton

March 8, 2015 1 Comment

Non-Traditional Addiction Services That Work

Published blog on Psychology Today.com by Sarah Benton:

Navigating addiction treatment services can be an overwhelming process, especially when you or your loved one is in crisis. In a past Psychology Today.com blog, I described the traditional levels of care that exist in our healthcare system. However, it is also important to understand that there are non-traditional forms of addiction/mental health treatment that are being utilized more frequently and are becoming more mainstream. It is recommended that in order to determine what type of addiction/mental health services would be clinically appropriate that you or your loved one receive an assessment/consult/guidance from a qualified addiction professional or a Primary Care Provider (PCP). In 2014, my husband Josh Benton and I started Benton Behavioral Health Consulting, that offers both clinical and non-traditional forms of treatment and can also assess and refer clients to other resources that provide services that may include:

Case Management

Case management provides non-clinical care that differs from therapy in that it involves supporting the client beyond face-to-face meetings. These services are unique in that they can be performed in person or remotely. Additionally, case managers bring cohesion to an individual’s treatment plan and are the bridge that connects the individual, family and care providers. Case managers provide a variety of services that include: arranging sessions in an office, at the client’s home, in a coffee shop/restaurant or even while engaging in athletic activities (i.e. hiking, walking, indoor/outdoor rock climbing, etc.), monitoring an individual’s treatment progress from the initial point of assessment to intake in a treatment center to communicating with the client’s clinical team in treatment center to assisting in the creation and follow-through of aftercare recommendations, administering urine screen tests, providing care coordination that includes facilitating ongoing communication between the client and other members of the outpatient treatment team (i.e., therapist, psychiatrist, PCP), being the point of contact for the client which may allow families to set more appropriate boundaries with their loved one.

Recovery Coaching

Recovery coaching is a more flexible and less formal non-clinical support than traditional therapy and can be part of a case management plan. It can also compliment therapeutic work by assisting in the client’s implementation of goals established in therapy/psychiatry sessions. Coaches are also available for less structured communication that can include in-person, remote and bringing/escorting clients to mutual-help meetings (12 Step, SMART Recovery) while addressing treatment goals.  Coaching services can include but are not limited to: Providing 12-Step based coaching and integration into life experiences beyond the scope of a traditional “sponsor”, vocational/academic coaching and support, communicating with the client’s outpatient treatment team (i.e., therapist, psychiatrist, PCP, etc.) in order to reinforce the application of therapeutic coping skills into daily life.

Interventions

Interventions can often help to accelerate the process of an individual reaching his or her “bottom”. The process of intervention asks, encourages, or demands that the identified patient (IP) change their behaviors in many ways, stop using substances, enter treatment, attend mutual-help groups, therapy, etc. The process of intervention does exactly the same thing for the members of the intervention group as it should encourage that the family to change their behavior by encouraging positive decision making, attending self-help support groups (Al-Anon, ACOA), engaging in therapy, etc. It is ideal for all loved ones to recognize the need for changes for their own sake, even though the changes are often made with the specific goal of getting the IP into treatment.  If the IP agrees to go to treatment, it will only be the beginning of a lifelong healing process for the IP and loved ones. The IP is not “cured” when they come home, and they will need to make many changes in their life that will impact all loved ones. For more information about interventions, you can view my past Psychology Today.com blog “The 411 about Addiction Interventions” https://www.psychologytoday.com/blog/the-high-functioning-alcoholic/201208/the-411-addiction-interventions

Therapeutic and Recovery transports

Getting a loved one or yourself admitted into an addiction or mental health treatment facility can often be stressful and confusing. Additionally, family and friends may not be the most appropriate people, nor available to transport a loved one to a treatment facility, back home or to another program. Therefore, therapeutic and recovery transport services are a valuable resource in terms of streamlining this process and bringing peace of mind to both the individual seeking services and loved ones.

Therapeutic and recovery companions

Individuals with addiction and/or mental health issues may need to have supervision and companionship for a short or longer period of time with an experienced professional. Therapeutic and recovery companion services pair a client with a companion who is of the same gender and for those with addictions, is also in recovery. These companions can accompany clients to necessary appointments, help them adhere to a daily schedule, provide oversight, notify family and the treatment team of any concerns, and attend and/or bring them to 12-Step/mutual help meetings.

March 3, 2015 0 Comments

Failed New Year’s Resolutions to Cut Back on Drinking: Time to “Think about Your Drinking”

Published blog post on Psychology Today.com by Sarah Benton

Was your New Year’s resolution to cut back or to stop drinking? Have you been able to stick to it or are your struggling? If you have succeeded, how are you feeling?

If someone has an alcohol problem or is alcoholic then it may not be as simple as setting a “resolution” to solve the issue. In fact, when an alcoholic stops drinking on their own, they often feel worse than when they were drinking-not exactly positive reinforcement. However, this makes sense considering that alcohol masks underlying conditions and emotions, so when an alcoholic stops drinking those symptoms rise to the surface.

Alcoholics who are trying to either “cure” themselves or prove to themselves that they do not have a problem may attempt to give up alcohol for religious reasons such as Lent or for secular reasons such as a New Year’s resolution. However, it is important that they ask themselves how they are feeling during the time that they stopped drinking and if they are still obsessing about alcohol, using another substance or engaging in addictive behavior as a substitution (ie, food, gambling, sex). Or are they counting down the days until they can drink again? In contrast, a normal drinker who takes a break from drinking is indifferent about their choice, will usually feel healthier not drinking and does not obsess about the fact that they are not drinking- they just don’t drink. In fact, even a problem drinker who wants to cut back on drinking will be able to self-correct and return to low risk drinking limits (women: under 7 drinks per week, no more than 3 per sitting men: under 15 drinks per week and no more than 4 per sitting). However, a red flag is that alcoholics may attempt to cut back but will not be able to adhere to these low risk drinking limits.

If you or someone you know is taking a break or cutting back on drinking as a New Year’s resolution then maybe it is time to “Think about Your Drinking”. Here are some questions to help you or a loved one to get honest:

Examining Your “Relationship” with Alcohol:
o Why do you drink? How often do you drink? Can you go more than a week without drinking?
o Have you tried to control your drinking and if so, how much time do you spend thinking about drinking   or about how not to drink too much?
o Can you imagine your life without alcohol?

Friendships:
o What activities do you and your friends like to do together?
o Do you have friends who do not drink?
o Can you socialize or go to parties without drinking?

Interests:
o What is your favorite thing to do?
o Do you have interests, activities and hobbies that do not involve drinking?
o Does drinking alcohol distract you from taking part in these things?

Work and Academics:
o Does drinking interfere with your work or academic performance?
o Do you excel professionally or academically and use your success as an excuse to drink?
o Is alcohol your reward for doing well?

Family:
o Do you hide your drinking from your family?
o Do you have different drinking habits when you know you will be around your family than when you are with your friends?
o Do you have a family history of alcohol problems?

The NIAAA “Rethinking Drinking” online program is a resource to help people to cut back and assess their drinking: www.rethinkingdrinking.niaaa.nih.gov/

January 22, 2015 0 Comments

Parenting High-Functioning Teens Around Drinking and Drugs

Many parents have questions and concerns about their teenager’s alcohol and drug usage, including how best to set limits and rules within the household.  These issues may become concealed and more complicated when these individuals are high-functioning—in that they are performing well in school, are engaged in extra-curricular activities, socialize with friends and appear healthy.  Adolescence is also a time period of experimentation and identity formation as well as “rebellion”.  Therefore, it can be challenging to find a balance between creating realistic rules, encouraging honesty and finding humor and joy in parenting teenagers.

Elizabeth Driscoll Jorgensen, Founder and Owner of Insight Counseling in Ridgefield, Connecticut (insightcounselingllc.com) has over 26 years of experience specializing in adolescent psychotherapy and substance abuse counseling. She is a nationally recognized expert in substance abuse counseling, engaging resistant teens and motivating them to change. She is a popular (and humorous!) speaker on parenting pre-teens and teenagers and has presented nationally, including at Harvard University and Dartmouth College. She is also a recipient of two Congressional Awards (1994 and 2008) for her work as an educator and community prevention activist.  Given Liz’s expertise and years of experience, I wanted to ask her questions that many readers may have.  This is the first of a 2 part interview with Liz Jorgensen that will be posted separately:

1. What is the most common challenge that parents come to therapy asking your guidance with related to alcohol and drug usage?

When parents call for help, it is usually after a period of time that they have had strong ‘gut feelings’ that something was not right with their teen, or even after they have caught their teen a few times with alcohol or marijuana and believed their child’s nonsense excuses.  I feel that parents often believe that they don’t have the right to seek help based solely on their own fear or intuition. I coach parents about this often with the following advice, “You can always apologize to your child for dragging her in to talk to a therapist, but you can’t take back the possible risks of waiting.” I also remind parents that they didn’t hesitate to act on their ‘gut feelings’ when their child was young—suspicions about their child’s safety or honesty regarding alcohol and other drug use are also potential threats.  I also encounter many parents who mistake the widespread use of alcohol and marijuana among teens as an inevitability that they cannot influence—this is not true, as teens need and want limits.

2. Is it more challenging for parents to address alcohol and drug issues with a “high-functioning” teen versus lower functioning (having more difficulty fulfilling daily expectations)?

Yes, absolutely. When a teens’ grades are faltering or they are not able to retain their functioning, parents can give their child rational feedback about this connection to their drinking behaviors. High-functioning teens who drink will often defend their behavior with the explanation “I am on high honors!” “My GPA is a 4.0”, etc. Parents need to keep the emphasis on safety, and on their love and concern, which is consistent regardless of a child’s grades. In fact, there is mounting evidence that highly driven teens sometimes see alcohol use on the weekends as a reward for their hard driving work all week (similar to the rationalization that high-functioning adults use to excuse their drinking!)

Parents need to set and maintain safety limits regardless of a child’s functioning in other areas. I use the following example to illustrate this. If your child began refusing to wear a seat belt or drive safely because “I am on high honors!” most parents would laugh and take the car keys. The issue of drinking is exactly the same. Keep it as a safety issue in your own head and describe it as such to your child.

In general, I want parents to remember that even if their teen is brilliant and highly accomplished, their brain is not fully “online” and functioning optimally until they are at least 21-24 years old. The pre-frontal cortex (the seat of all higher order planning, impulse regulation, emotional regulation and other important functions) is the last part of the brain to develop and it literally doesn’t work in teens when they are behaving irrationally and impulsively in order to get something that they want.  Parents need to be the “pre-frontal cortex” for their teen, make the safe decision for them and then ’walk away’ from the crazy, intense arguments that may ensue.  Smart kids cannot regulate their emotions and behaviors any better than average kids- they just make better excuses and lies!

3. What general and statistical information about alcohol and drug usage is most useful for parents to know and for parents to pass along to their teenagers?

When parents are attempting to influence their ‘high-functioning’ teens, hard facts need to be repeated over and over again. All teens assume they are ‘smarter’ than adults (in some ways) and they are very skeptical about data they don’t want to believe.  I tell parents to keep it ‘short and sweet’ and challenge teens to look up the facts themselves and come back with a factual argument.

Binge drinking rates are higher in affluent areas in the U.S.—that is a fact. The adolescent brain is especially vulnerable to damage of the gray matter when teens binge drink. Gray matter does not grow back and there are multiple studies that show a real impact. Parents need to define “binge” the way researchers do: three or more drinks per drinking event for teen girls and 4 or more drinks for boys. I remind teens that a drink is one 12 once beer, or one 1.5 once ‘shot’ of hard liquor. Most teens cringe, because their drinking is often much higher than this amount.

The other data I tell parents to share is the “delay and prevent” method.  We know undisputedly that the longer teens delay drinking behavior the less damage is done to their developing brain and the less likely they are to become addicted. Instead of getting into a power struggle, or circular argument about teens drinking at all, I beg them to delay their use. It’s harder to argue against!

4. Is there such a thing as “normal” alcohol and drug usage for minors?

This is the toughest question to answer well, and one that I receive often. “Normal” if defined by an average or a social norm is not good at all, as currently binge drinking is a norm for teens who drink. That being said, even if parents are very clear with rules, expectations and boundaries, teens may try alcohol as a “normative” experiment—precisely because drinking behavior is so prevalent and “OK” among teens and many parents. Parents who ‘catch’ their child breaking a set rule or expectation now have a unique chance to guide and teach their child to act wisely DESPITE the immense social pressure to binge drink.

5. What type of leverage or incentives can parents use to help their teens to make positive choices with alcohol and drugs?

Parents need to be absolutely clear about their expectations for sobriety from alcohol and all other drugs and they need to share their love and worry about what could happen to their child, rather than threats of consequences. Guilt is the best protective device ever invented to help parents keep teens safe (“I love you with all my heart and I couldn’t bear if something happened to you”). That being said parents need to articulate their expectations very clearly but in a manner teens can hear. For example, “I know you are attending a homecoming event tonight where there may be alcohol that is snuck in.  We expect you to stay away from any alcohol or drug use even if your friends are drinking and  call or text us to get you if it gets crazy.“  I share the idea of a family contract and a family safety password at all my workshops. The family contract says things like “We promise not to abuse alcohol or other drugs ourselves and we will do everything we can to keep you safe and let you have freedom socially” and then families can customize their individual expectations. The safety “password” says that at any time, for any reason your child can call or text you using the password and that means “Come get me/us now. Things are not good”.   The other part of the safety password agreement is that parents promise not to “freak out” when they do pick their child up and that their teen’s honesty and good judgment will be rewarded either by no consequence or a milder consequence depending on the situation. Teens do often respond to this and use it in the correct manner.

The second part of this 2 part interview will follow- stay tuned!

January 10, 2015 0 Comments