Suicide Alcohol Abuse Link

A recent report in the Center for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report (MMWR) confirmed what many of us in the substance abuse field have long seen, the connection and link between suicide and alcohol abuse. Here at Cottonwood we see many patients who have made suicide attempts, sometimes multiple attempts, in states of intoxication but who never struggle with suicidality when sober. The report does not touch on non successful suicide attempters but indicates that 24% of those who die from suicide showed evidence of alcohol intoxication.

It is not surprising to me that the CDC was able to clearly establish a link. The rates are lower than I expected , though they were higher than the CDC researchers expected. One important finding was that alcohol involvement was a factor across all populations and age groups. It highlights the need for all suicide prevention programs and all mental health centers to address substance abuse problems as a major part of treatment. Unfortunately this is not usually done to to funding issues and historical precedent. I am very happy that I work at a facility that takes both mental health problems and substance abuse problems as truly co occurring.

Thought for the day

We cannot address mental health problems without addressing the substance abuse problems that are highly prevalent and co occurring.

Michael Jackson Opioids Addiction

Like most people I was sad to hear of Michael Jackson's untimely death. I really did not care much for his music and didn't listen to it but he did have remarkable talent and charisma.

What is especially saddening to me is to learn that he was addicted to opioids. As I have discussed before in this blog oral opioids (pain pills) are the biggest drugs of abuse now with the exception of alcohol and tobacco and are increasingly being used now even by young adolescents. I haven't heard anything about the toxicology reports on Michael Jackson but I will not be surprised if it is determined that opioids were somehow implicated in his death.

Whether or not opioids were a cause or factor it is also sad to me that he didn't receive treatment. Either he stayed in denial or was enabled by those around him to continue his addiction. It does show again that addictions know no bounds and transcend all socioenomic demographics.

Thought for the day,

May God bless all those family members whose lives have been torn apart by addictions.

NIDA Alcohol Smoking and Substance Involvement Screening NIDAMED

The National Institute on Drug Abuse (NIDA) has released a new program designed to help physicians be more proactive and more proficient at asking patients about and screening for alcohol and other substance abuse problems. Overall, we as physicians have not been very good about screening for these disorders despite taking care of the many medical and surgical/trauma complications from substance abuse that we see everyday. It has never really been clear to me why this is the case as we know that those with substance abuse use an inordinate share of medical resources. It has been somewhat of a mystery to me why we have been so poor at this. There are signs of changes. For instance the American College of Obstetrics and Gynecology has recommended substance abuse screening for all patients. Trauma centers must screen for substance abuse in order to maintain accreditation.

One problem maybe is that physicians as a group don't really know how to ask about alcohol and drug abuse problems. The National Institute on Drug Abuse has now provided a way to make that task easier. Through their NIDAMED resource center there is now an interactive web based program, the NIDA Alcohol Smoking and Substance Involvement Screening (NIDA-Modified ASSIST) which guides the physician through initial screening questions and then with follow-up questions. If the initial screening questions are negative the program ends but if there is an initial yes answer the program moves forward. Not only are the follow-up questions computer program driven but it also provides recommendations for what interventions may be appropriate. The questions and recommendations also can be used in a printed form. I have looked at these and they look pretty good. Another feature is that this program can be integrated into the electronic medical record (EMR) which is becoming increasingly necessary today.

So I recommend that physicians take a look at the NIDA Alcohol Smoking and Substance Involvement Screening which can be found through NIDAMED at www.drugabuse.gov

Thought for the day

The web is amazing.

Depression, Diagnosis, Addiction, Recovery part 2

I am doing a series on depression and discussed how psychiatric diagnoses are phenomenological ( based upon clinical signs and symptoms) and how this is similar to other conditions such a migraine and Parkinson's. But phenomenological diagnoses are simply approximations and may include different "entities" within the same diagnosis. These approximations are useful though as they give us a common language, help make predictions regarding prognosis and types of treatment and provide diagnostic criteria for research purposes so that groups of people and treatment responses can be studied. In psychiatry these diagnoses are listed in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, or DSM-IV-TR. One of the limitations of DSM-IV-TR is that diagnoses are categorical, that is listed as discrete and separate problems while in reality there are many overlaps. What is missing is the dimensional character of many problems, that is symptom problems that may be associated with many categorical diagnoses that are measured on a spectrum from mild to severe. Despite these limitations DSM-IV-TR is quite helpful.

One of the main things to understand about categorical diagnoses is that all of the diagnoses do not carry the same "weight". That is some diagnoses are much more reliable than others and probably do represent discrete "entities" and some do not. A characteristic of this type of diagnosis is that the greater the severity of the problem the more stereotyped it is in presentation and more likely does represent a certain entity. For example binge drinking in college may turn out to be a number of things from a transient problem to the beginnings of a more severe problem. There is no way to predict who may go on to develop alcoholism. So binge drinking is not a reliable diagnosis or a single entity. End stage alcoholism is different. It looks the same in most people. The same signs and symptoms are present, the same health problems are experienced and it is very predictable that death will ensue if the person does not stop drinking. The same goes for eating disorders Many people with a variety of problems may engage in the purging behavior of bulimia but severe malnourished life threatening anorexia nervosa is different. It does appear to be an entity all of it's own whose signs and symptoms are the same from person to person.

Depression is also one of those diagnoses that occur on a spectrum. I will talk more about that tomorrow.

Thought for the day

Happy Monday!

Men, Mentoring, Leadership, Role Modeling

I talked yesterday about the difficulty in finding ways to educate young people in an effective manner to reduce risk of drug use and addictions and indicated that the first line of defense are parents who are not addicted to alcohol,tobacco,or drugs as well as a peer group that is antidrug. In addition it has been found that tobacco use generally precedes other drug use and that delaying the onset of smoking behavior can reduce overall drug use. We still don't know yet though how to best educate teens and young adults that will actually reduce drug use. There is another factor for young men, however,and that is the role of fathering, mentoring and role models.

Men tend to follow leaders and other men more than ideas and ideals. The role of fathering is critical for development of emotional health and well being and many families are left without a father as role model or leader to assist in helping the young man channel normal masculine energy. There is tremendous physical and sexual energy that if unchannelled can lead to problems. In someone with a sense of powerlessness it leads to attempts to control others, particularly women. If a young man has a lot of anger it can lead to abusive and antisocial behavior, and fears and anxieties become depression and addictions fairly easily.

So in order to reduce teen and young adult drug and alcohol abuse it is not enough for us to say that the schools need to be doing something but the responsibility lies with us to see in what ways we are leading, mentoring, or fathering a young man in our lives.

Thought for the day

"What is man that though are mindful of him?"

The Psalmist

Addiction, Recovery, Cottonwood, Nursing

I have talked before about the great staff we have at Cottonwood. Today I want to introduce you to one of our wonderful nurses, Brian Law, RN

When asked to write about yourself, it always proves to be a difficult task. You don't want others to get the wrong impression of you and, as I've always found, it is a royal pain just figuring out what to begin with. (So lets keep it simple and start at the beginning... Mostly due to the fact I can't think of anything more witty to start with!)

I was born 28 years ago in a sunny little town feared by many (mostly due to it's 120 degree weather) known as Yuma, Arizona. I am a July baby, and as many native Arizonan women know, being pregnant in a town whose weather is known for the immediate evaporation of any form of fluid isn't an easy task, but somehow mom did it. I spent most of my childhood doing three basic things: 1) Getting into trouble with my “gifted” friends, 2) Playing a major role in my baby brother's upbringing (in his first 3 years of life he consistently and stubbornly referred to me as “not the momma”), 3) Reading lots and lots of comic books. The heroes that existed in comic books had a huge influence on me. I never really took to their unique sense of fashion, but their dedication to helping others in need was something I seem to really take to heart. The combination of that, and my experience with the upbringing of my baby brother Branden really made it so I wanted to dedicate myself to a career that enabled me to help others.

Knowing that I wanted a career that enabled me to help others was easy. Finding a career that enabled me to help others turned out to be very hard. First and foremost, capes aren't cheap and honestly makes anyone below 6 feet tall look fat and stumpy. All kidding aside though, I spent years at the University of Arizona searching for my fated career. In high school, I was good at everything and tested very well. In college, I really didn't excel because I felt lost and not knowing what my ultimate career goals just compounded that feeling. It took a near death experience to help me find what I wanted to do with my life. In the end, all it took was my Mazda truck flipping 5 times and over a quarter of a mile on the I-10 heading east towards Tucson to place me on the right path. I still don't have any memory about what occurred the 5 hours after the accident but what I do remember clearly is how the nurses at the hospital helped me out. It was seeing those nurses in action that inspired me to join this profession and what fuels me still in this career path. Today, I aim at excelling in this profession and the idea of helping more and more people drives my passion in and for this career and what led to me work at Cottonwood for nearly 3 years now.

Addiction, Recovery, Therapeutic Recreation

As I have said before one of the nice things about working at Cottonwood is being associated with the great people we have here on staff. I want to introduce you today to Richard Patterson, MS, CTRS, our Therapeutic Recreation Specialist.

Hello. My name is Richard Patterson. Everyone calls me Butch, a nickname that was given to me by the nurse in the hospital where I was born. I was the biggest baby in the nursery.

I have worked at Cottonwood for some 14 years. I am a recreation therapist by training and the Coordinator of Recreation Therapy Services. People often tell me I have the BEST job at Cottonwood as there is kickboxing, Rocks and Ropes, outings, Challenge Course and "Funstitute". People see the results but not the preparation that goes into making these activities not only fun but therapeutic.

What part of the job do I enjoy the most? It is being present when someone recognizes they can have fun without the aid of mood altering chemicals or feeling guilty for being happy. It is looking at the face of someone who has just completed the 45 minute kickboxing workout (butt boxers included) without any rest stops. It's hearing the joy in an individual's voice when they complete their first rockclimbing wall.

What is my favorite activity? Whatever I am doing at the time. If I had to put it down I guess it would be Rocks and Ropes because it gives patients so many opportunities to gain insight into their own behavior and problem solving.

Favorite Saying

"Man does not cease to play because he grows old; man grows old because he ceases to play".

Full-Time Position Available Adult and Extended Care Units Counselor Cottonwood de Tucson

Full-Time Position Available Adult and Extended Care Units Counselor Cottonwood de Tucson

Cottonwood de Tucson is a highly acclaimed treatment facility specializing in effective inpatient dual diagnosis, chemical dependency and behavioral health programs. We currently have a full-time position available working with our Adult population at both our inpatient treatment and extended care facilities.

The desired candidate must have an AZ license in good standing with the AZ Board of Behavioral Health and a minimum of two years experience working with adults in chemical dependency and/or behavioral health group therapy. Previous work with trauma and eating disorders is highly preferred.

Along with the opportunity to contribute to the well being of others in an atmosphere of caring and support, we offer a competitive salary and benefits package.

For consideration, send your resume along with salary requirements to:

Human Resources Director
Cottonwood de Tucson, Inc.
4110 W. Sweetwater Drive
Tucson, AZ 85745
Fax: (520) 743-2133
E-Mail: bcox at cottonwoodrecovery dot com

Addiction,Opioids, Prescription Drug Abuse, Risks

We see a lot of different problems at Cottonwood. One thing in common though is that the problems of addiction have caused destruction in the lives of our patients and their families. One recent situation is particularly sad to me because it seems like such an unnecessary waste of life. The details may be changed but the story is true.

A young woman entered treatment here recently for addiction to prescription pain pills. The event that prompted her admission was that she had been at a party with her twin sister where both of them were using a variety of prescription medication including pain pills and sedatives. Both of them fell asleep but her sister never woke up. Their mother blamed the patient for her sister's death and she came into treatment not only with a serious addiction but with extreme guilt and remorse as well. It is a terrible tragedy.

Prescription drug abuse is very common, particularly among those 18-35. In 2007 4.6% of these young adults had an addiction to prescription pain pills or sedatives. The most commonly used drugs are the opioid pain pills Oxycontin, Oxycodone, Lortabs, Vicodin and Methadone and the sedatives Xanax, Klonopin, and Valium. Abuse of these drugs now are (second only to tobacco and alcohol) the most commonly abused drugs for teens and young adults surpassing marijuana use. One reason is the increasing availability of the medication. Most are stolen from family members or diverted from friends and they are easy to purchase (though expensive) on the street. Another reason for increasing use is that many people consider these medications to be "safe" and are unaware of the high risk of addiction as well as the risk of death if taken in sometimes even moderate overdoses. The use of the sedatives increases the effect of the opioids and raise a greater possibility of creating a very negative outcome.

Prescription drug abuse is likely to continue to increase and I hope we can get the message out that they are not "safe" drugs.

Thought for the day

"In peace I will both lie down and sleep, for you alone O' Lord make me to dwell in safety

The Psalmist

Addiction,Recovery, Therapeutic Fitness, Wellness

I would like from time to time introduce you to my colleagues and co-workers. We have the best staff that I have ever been involved with and I am proud and honored to work these very caring people. Today I would like to introduce our Therapeutic Fitness Consultant Deb Tobias.

Hi! I am Deb Tobias.

Growing up in the trees of Upstate New York with five brothers, one sister and eventually a single, hard working mother, left me with many hours and days of exploration, solitude, acceptance and patience. What my teachers labeled as day dreaming was actually me observing those around me. How they reacted, how they thought and how they moved. I spent many hours observing how the human spirit affected ourselves and those around us. I spent many years and still do, observing what kind of impact negativity, unhappiness and imbalances have on ourselves and those we love so dearly. Shortly after attending Business school and working for Corporate America, I realized that I hadn’t navigated my own life very well in finding my life purpose and happiness. I perused my dream of helping people discover how strong they truly are both mind and body.

Everyday at Cottonwood I come back to my “roots”. I see people struggle with diversity, addiction and searching for a purpose and a reason. We are all one big family on earth and we must help each other and our environment. We cannot do this without love, tolerance, forgiveness, acceptance and self awareness. I have been very blessed by God in my life with two beautiful daughters and my other children, my dogs, Lucky and Zoey. I have also been blessed with a wonderful job at Cottonwood de Tucson where I get to share, explore and help navigate individuals toward a beautiful life of balance. Personal Training is not just about working a muscle. The connection between mind and body is so significant that you cannot move one without the other. This is true in the Gym and it is true in life. I am so very happy and blessed to share in helping individual’s everyday find the connection and truly start down the path of finding their higher power and life’s purpose. Everyday is a gift and every step is a step towards health, peace and joy.

Addiction, Recovery, Higher Power, Choice, and Community

I mentioned yesterday that I would say a few things more about free choice. I think that much of our lives are predetermined or certainly out of our control but we always have the gift of free choice in how we respond to circumstances, face moral dilemmas, and cope with our weaknesses. This certainly applies to addiction and recovery. The genetic tendency towards alcoholism is predetermined, the ability to stop at one drink is beyond the alcoholic's own power, the chances of relapse high and yet there are numerous choices in recovery to be made that affect whether or not one will pick up that first drink. Does one stay in community, obtain a sponsor, keep away from high risk situations, call someone for help in time of need, etc.? These are free choices that one can make that will greatly infuence what will happen.

Yet at the same time I believe that on our own we are unable to consistently make the right choices. This applies to all of us, not just those in recovery. We will continue to do the things we don't want to do and won't do the things we ought. This is our predetermined state. Alone we are incapable. We must appeal to a higher power to enable us to continue to do right and steer us back on track when we go wrong.I also think that whether or not one believes in God, that that higher power must include participation in a community of those who recognize that we are all in the same boat and that it takes the community to help us survive. So of all the choices we make I believe that most important one is the choice to belong to a community of those who are attempting to live how we would like to live, whether that community is AA, church, a men's group, women's group etc.

Thought for the day

" God is not willing to do everything, and thus take away our free will and that share of glory which belongs to us".

Pets, Addiction , Therapy, and Recovery

It is Friday so I thought I would provide another personal update. I haven't said much about my dog, Buddy. Buddy is 11 years old. He is a black and brown shepherd mix of some sort. That is Buddy on the left. The other dog is Labbie who passed away last year. I never can get Buddy to sit still for a picture. He always runs straight towards me when he sees the camera!

I found Buddy as an abandoned puppy. He was all mangy and my wife nursed him back to health. At the time we already had three dogs so we had no intention of keeping him. We wanted to find a good home for him. We didn't want to name him so we would not become attached to him so we just referred to him as Buddy or little Buddy. Well, we didn't look that hard for a home for him and after awhile we knew he was with us to stay. Although he is getting older he still has the energy and playfulness of a puppy. He has had to adjust to some loneliness as his two cohorts, Labbie and Muffin (both 14) died this past year. I am not one who can deal with grief by immediately going out and getting a new dog so we still have not decided whether or not to get another one.

He still doesn't know what to make of Pounce the cat who avoids him at all costs.

Thought for the day

" Toward what end am I now making use of my soul? Each day question and cross examine yourself".

Marcus Aurelius

Addiction, Recovery, Guilt, Shame, and Remorse

Every day in my work I deal with those who are struggling with overcoming addictions who are also suffering from guilt, shame, and remorse for their actions and consequences of behaviors engaged in while under the influence of alcohol and drugs. These emotions can be a barrier to recovery and need to be dealt with effectively for healing to occur. While many times we think about guilt and shame as being the same thing I see them as two different emotions that must be addressed differently.

In my view guilt is a healthy emotion and shame a negative one. To me guilt is the awareness of having done something that causes harm to someone else for which we are deeply sorry, wished we hadn't done what we did, would want to take it back, and want to not engage in the harmful behavior again. Guilt I see as best dealt with by openly acknowledging what we have done and experiencing the painful grief of remorse. I think of it as a positive emotion as it provides both the desire and motivation to make the changes that we need to make.

Shame I think of as an unhealthy emotion and one that is best dealt with by getting rid of it entirely. I view shame as that aspect of ourselves which wishes to hide our failings yet at the same time engage in self criticism and beating ourselves up. This emotion is toxic as it leads to no significant change in our behavior. We stay stuck in a cycle of self focus and do not turn ourselves away from ourselves to others. In a way it is a selfish and self centered emotion. To deal with shame and to rid ourselves of it I think we need to fully acknowledge our failings and then refuse to spend time in self criticism.

By recognizing the difference between these emotions we can then move more quickly to a healing place and recovery.

Thought for the day

" Admitted to God, to ourselves, and to another human being the exact nature of our wrongs".

Alcoholics Anonymous

The Examined Life and Recovery from Addiction

Yesterday I wrote about the examined life and about recovery, how self examination, self awareness is needed and that this has been noted by philosophers who lived over 2,000 years ago. Jacob Needleman, a professor at San Francisco State University has written a marvelous book, Why Can't We Be Good, which very forcefully makes the point that despite our best efforts we consistently fail to live up to the standards of right and wrong that we all know to be true. He argues that this consistent failure of all of us leads to genuine harm and destructive actions to others, much of which we are unaware. In his search for some solution to this problem he ends up with the idea that only continued self examination, self awareness of our faults, weaknesses, and motivations can allow us to change. He also makes the point that with this self awareness we are then open to a power greater than ourselves which can then allow us to better live lives of integrity and goodness.

I believe that Needleman is right. I believe all of us have this difficulty regardless of addiction to chemical substances or not. Self examination and self awareness of the need for a power greater than ouselves is a requirement for us to be the kind of people who can bring more good than harm out of our time here on earth.

Thought for the day

"For what I am doing, I do not understand, for I am not practicing what I would like to do but I an doing the very thing I hate. For the good that I want, I do not do, but practice the very evil that I do not want. Who will set me free?".

St. Paul