Press Trivializes the Treatment Process and Devalues the Suffering

I read this morning that Casey Johnson, heiress to the Johnson & Johnson fortune, died alone in her Los Angeles apartment after a well-publicized life of drugs and partying. I feel sad to hear yet another story of a celebrity who succumbs to addiction after cycling in and out of a series of boutique rehabs.

If you follow the news the story is familiar. Train wrecks of pop check into posh $100,000-a-month beachfront rehabs, where they demand - and appear to receive - special indulgence. In my mind this kind of press trivializes the treatment process and devalues the suffering that I see every day as a therapist at Cottonwood Tucson. In the morning paper I read of the rich and famous going to treatment to save face and then go to work and treat less famous patients who struggle to save their lives. Too often, the news media leave general public with the notion that treatment doesn't work.

I know better. As an "in the trenches" clinician, I see overwhelming evidence that treatment does in fact work. While miracles can be hard to quantify, the Substance Abuse and Mental Health Administration's National Outcome Measures show that treatment results in improvement in every life domain, including: abstinence from alcohol and other drugs, decreased symptoms of mental disorders and improved functioning in all major areas. The same study reports that those who have completed treatment also have decreased involvement with the justice system and are better able to find and keep safe and stable housing for their families.

That's what miracles sound like when measured in the dry, public sector language of the National Institute on Drug Abuse. For a more personal take on the value of treatment, please consider the words of a grateful mother who recently sent a thank-you note to one of the family therapists at Cottonwood:

"We are still floating. None of us will ever be the same.
Our son is doing great - happy and clean out in
California. He told me the other day that he had gotten
a sponsor. The sound of his laughter has returned to us.
We have gotten a miracle."

I wish you could have had one too, Casey.

Jeffrey C. Friedman, LISAC
Primary Therapist
Cottonwood Tucson

Narcissists & Their Relationships (Part II) by Rokelle Lerner

The Many Faces of Narcissists
Narcissists must have a constant supply of admiration and attention. In this article, I'll examine two general types of narcissists that utilize different methods to obtain this supply. I want to remind the reader that narcissism is caused by emotional and developmental trauma in childhood and their inner world is typically empty and bleak.

Cerebral Narcissists
Cerebral narcissists will try to impress others by their erudite knowledge and command of the language, which is employed not just to impress, but also to obliterate anyone who stands in their way. The body and its maintenance are a burden and a distraction. For example, this man or woman often prefers celibacy (even if he or she has a spouse).

Arrogance is the most obvious quality of this narcissist, and ruthless ambition is most apparent as they climb to the top. The cerebral narcissist is convinced that he or she is unique and should only associate with other special or high-status individuals. In fact, when accused of making mistakes, you can bet that their reaction will be explosive and malicious.

There is a profound lack of empathy for others, and contempt is shown for inferiors, who are barely recognized as human. Decisions are made without thought to the consequences for those affected. When this narcissist experiences a loss of admiration he/she will become emotionally abusive. His or her verbal acuity is such that no one stands a chance at combating an assault by a cerebral narcissist.

Although this description is hardly flattering, such a person can be charming and have qualities widely admired in our society. Intelligence, status, and power attract attention. There can be the 'appearance' of a genuine sense of benevolence towards others--though mostly in manipulative and patronizing ways.


Somatic Narcissists
A somatic narcissist uses her/his body, looks, and sexuality to romance, charm, and seduce. She is seductive and obsessive-compulsive when it comes to her body. They often think they look younger than they are; a youthful appearance is the primary source feeding their false self. Some somatic narcissists will emphasize their pride in their youthful looks by either dressing in clothes that were popular in their golden youth or wearing the styles of people much younger then they. (Ashmun 2004) Imagine the pressure of living with this self-absorbed narcissist, where a "bad hair day" might mean the demise of a relationship!

Somatic narcissists have no qualms about sharing the vivid details of their sex life, their divorce, their therapy discussion, or their underwear selections. These men and women cannot (or will not) respond to the cues of discomfort around them as they continue to prattle on about themselves.

Somatic narcissists have a marked intolerance for any imperfection in their partner. Once imperfection is acknowledged, it means the end of the fantasy of perfection.

While cerebral narcissists may tend to end their relationships with cutting words or a long diatribe of reasons, somatic narcissists tend to end their relationships with a flurry of high drama. Narcissists will make sure that their partners know how they've suffered in the relationship and, ironically, how they haven't received the compassion and empathy they deserve.

Rokelle Lerner is one of the most sought after speakers and trainers on relationships, women's issues and addicted family systems. She has inspired audiences throughout the world with her ability to address difficulties with insight, humor, and astounding clarity.


She has received numerous awards for her work with children and families including Esquire Magazine's "Top 100 Women in the U.S. Who Are Changing the Nation."  Rokelle has been an advisor and consultant with foreign governments, US agencies, corporations, schools and hundreds of individuals on relationships, boundary issues and addiction. She is also co-founder and consultant to Children Are People, Inc., a program used in thousands of schools throughout the country. Rokelle has appeared as a guest consultant on numerous television shows such as Oprah, Good Morning America, CBS Morning News and 20/20. Her articles and interviews have been featured in the Washington Post, New York Times, Newsweek, Time, People Magazine and Parents Magazine.

Rokelle has published the best selling books, Living in the Comfort Zone: The Gift of Boundaries in Relationships, Affirmations for Adult Children of Alcoholics and Affirmations for the Inner Child. Her latest book is The Object of My Affection is in My Reflection: Narcissists and Their Relationships. Ms. Lerner facilitates the InnerPath Retreats for Cottonwood de Tucson in Arizona.

Narcissists & Their Relationships by Rokelle Lerner

In 1958, Bill Wilson in the newsletter The Grapevine said, "the first job in recovery is sobriety, the second is emotional recovery." We all know that sobriety is quite different than recovery. Recovery means finding a way of living that works; physically, emotionally and spiritually. Sadly, many can get sober, but are still left with behaviors that don't disappear with treatment or sobriety. In fact, sometimes the qualities of entitlement and contempt are worse after treatment than before. It's for this reason I wrote a book on narcissism and how it relates to addiction recovery.

We are all aware of the term "King Baby." Although the image conjured up by this phrase is someone who's arrogant, snobbish, demanding, and aloof, the truth is that these are the very men who feel painfully inferior inside. In fact, the more a person displays this "kingly" behavior, the more second-rate he feels. These addicts/alcoholics are hiding tremendous shame with their pride. Feelings of entitlement, grandiosity, and contempt are a part of the disease of addiction. For someone living with a narcissistic addict or alcoholic, the devastation caused by addiction coupled with narcissistic traits feels insurmountable.

An addict has difficulty coping with the normal frustrations of life. The "king," however, because of his feeling of omnipotence and impatience, is constantly creating unnecessary roadblocks by storming ahead despite the cost. The narcissistic alcoholic shouldn't have to be bothered with recovery and may see the fellowship as trivial and boring; that is, unless he's in charge. He has little staying power for sobriety and expects quick results. Since recovery is one day at a time, and the surrender to the notion of powerlessness is tantamount to recovery, the prognosis is questionable, but not hopeless. There's always the chance that he'll pick up a sponsor who has some good recovery from addiction as well as entitlement.

Bob Brissette in his lecture at Hazelden in 1971 gave the following description of "king baby."
"Like babies, alcoholics assume that the world is our little private oyster. We tyrannize our homes, our wives, and our children: we demand meals to be served before there has been an opportunity to prepare them. Then we throw tantrums if everything isn't done thoroughly. We demand that food be of our choice, not the family's choice. We demand that our TV program be tuned in, not the family's program. And we deserve this, we tell ourselves--didn't we work hard all day down at the office? What if we did have five coffee breaks, a three-martini lunch that lasted 'til 2:45, and a couple of long, warm counseling sessions with that pretty girl employee who told us how kind and understanding we were. He's adept at twisting knives, cutting people up and humiliating them and making them frightened and insecure about their jobs. And he does this because it makes him feel better; it makes him feel more powerful."

I would be remiss if I didn't point out that the king baby has a female counterpart called the "Queen." Although we rarely speak about this female counterpart, some women possess these characteristics in spades. We all know those females that sweep into the room a half-hour late and demand that everyone must drop what they're doing and notice her. Her great need is to be the constant center of attention wherever she is. Frequently she speaks and laughs in a loud voice and assumes that what she has to say is absolutely fascinating--but it isn't. If the queen feels like granting you a sexual favor, you are expected to be grateful to her to your death for having had the privilege of romancing her. She demands absolute respect from her family and children. She whines and whimpers when all of her demands are not met promptly. (And whining, by the way, is anger coming through a tiny opening.) She feels entitled to proper gratitude for your having the privilege of serving her.

The queen is in deadly competition with her daughters. When they get to be teenagers and mom is starting to sag a little, an ugly, hateful battle develops between the queen and her children. Like the king, she sees other people as things, not as human beings or equals. To her, people are objects to be terrorized, bullied, and manipulated into loving, serving, and being loyal to her.

If you're reading this and diagnosing yourself or your loved ones as narcissists, please stop! Everyone is a bit narcissistic and only a caring, empathic therapist can make this diagnosis. Also, we need to have compassion for those that have this disorder. For the most part, narcissism is developed from an upbringing of trauma and neglect. However, since entitlement is such a part of the disease of addiction, emotional recovery means that we must do a fearless inventory on how our behavior affects others. Only then do our relationships begin to thrive.

Rokelle Lerner is one of the most sought after speakers and trainers on relationships, women's issues and addicted family systems. She has inspired audiences throughout the world with her ability to address difficulties with insight, humor, and astounding clarity.

She has received numerous awards for her work with children and families including Esquire Magazine's "Top 100 Women in the U.S. Who Are Changing the Nation." Rokelle has been an advisor and consultant with foreign governments, US agencies, corporations, schools and hundreds of individuals on relationships, boundary issues and addiction. She is also co-founder and consultant to Children Are People, Inc., a program used in thousands of schools throughout the country. Rokelle has appeared as a guest consultant on numerous television shows such as Oprah, Good Morning America, CBS Morning News and 20/20. Her articles and interviews have been featured in the Washington Post, New York Times, Newsweek, Time, People Magazine and Parents Magazine.

Rokelle has published the best selling books, Living in the Comfort Zone: The Gift of Boundaries in Relationships, Affirmations for Adult Children of Alcoholics and Affirmations for the Inner Child. Her latest book is The Object of My Affection is in My Reflection: Narcissists and Their Relationships. Ms. Lerner also facilitates the InnerPath Retreats for Cottonwood de Tucson in Arizona.

Labryinth As A Spiritual Experience

The patients at Cottonwood de Tucson built a labyrinth recently on a Sunday afternoon. The weather was beautiful and the group was excited to get out-of-doors and play a while in the desert.

From a pile of rocks and a design drawn in the dirt, they pieced together a seven-circuit labyrinth that measures 21' in diameter. A walk into the center and back out again covers a distance of 56 yards.

The labyrinth design is 3,200 years old, originating on the Island of Crete. After the construction was finished, the group learned how to incorporate a labyrinth walk into their spiritual practice. The labyrinth walk can be used for prayer, meditation, or just plain-old-fashioned relaxation. We walked the new labyrinth in silence, amazed how a light sprinkle of rain fell on us as we began.

A few days later a patient reported seeing a double rainbow while walking the labyrinth. As he reports it: "My therapist suggested I walk the labyrinth to help me work on finding my Higher Power. First I see the rainbows. And then it rains, and minutes later, the sun comes out. So, I just threw my hands up and said, "OK. I get the message!"

Charles Gillispie, MFA, LISAC

Cottonwood de Tucson

4110 W. Sweetwater Drive

Tucson, AZ 85745

(800) 877-4520

Email: cgillispie@cottonwoodrecovery.com

www.cottonwoodrecovery.com

Recovery from Addiction Is A Process

I Learned How Easy It Can Be to Relapse

A young lady was having a wonderful last day at Cottonwood de Tucson's Rocks & Ropes Program. She was attempting climbs rated with difficulty levels of 6.5 and 7. She had completed 5 climbs and was very sure of herself. She told me she wanted to try a Level 8 climb. We found one and she started climbing with me belaying. As she climbed higher she said "the handholds are too small and too slippery."

She continued climb and with some effort she got two thirds of the way up the wall where she got stuck. After several attempts to complete the climb she finally asked to be lowered. From being happy, self confident and self assured, in just 10 minutes she had become fearful, angry, sullen, withdrawn and depressed.

After a few minutes we discussed what had happened on the wall. She said, "I am very judgmental of myself. When I came to Cottonwood and when I couldn’t do something I would give up on everything. At the end of that climb I went right back there. I learned how easy it is to relapse."

We then discussed that recovery is a process and not a terminal event, and the importance of having a plan to handle setbacks, be they family, school, social or recreational in nature.

Richard "Butch" Patterson, MS, CTRS
Recreational Therapist
Cottonwood de Tucson
4110 W. Sweetwater Drive
Tucson, AZ 85745
(800) 877-4520
www.cottonwoodrecovery.com

Family Members: Codependent or Grief Stricken?

Codependency Labels Like Codependent or Addict ~ Are they Needed?

Cottonwood de Tucson is a unique treatment approach to recovery, putting health and wellness as the central component of healing from addiction and disorders. It feels incongruent to promote people thinking about themselves as a disorder, such as when family members introduce themselves in small group situations and give themselves a title. For example, a family member may say, "My name is Cathy, I am a codependent." Titles are useful when they reflect a disorder that is chronic, progressive, and life threatening, such as the case of addiction, where using the label assists in recovery. It is not as useful when the focus of treatment is on an overused set of caring behaviors, as is the case when family members take on a label of "codependency."

The threat of loss of a relationship is a threat to one's current life balance, which creates fear and sadness. Parents, spouses, children, friends, and extended family are sources of social relationship that provide contexts within which to maintain balance. To prevent loss people engage in controlling behaviors, hyper-vigilance, and manipulation. Attempts to maintain attachment with people who are needed, or who have moved from available to unavailable, is normal. Understanding a normative reaction to loss experienced by people in social relationships is necessary: Pathologizing that reaction is harmful. In the addictions field we continue to pathologize the normative reaction to social loss with the label "codependency," putting it in the category of illness, rather than as grief work from an ambiguous loss.

The reaction to loss that is widely experienced by friends and family members of persons who are addicted to mind altering substances is profound grief. It has characteristics of flawed interactional patterns because the loss is ambiguous. If a person dies, the grief is unambiguous: the social role the deceased played is no longer occupied and the deceased cannot fulfill obligations or promises. The spouse who becomes addicted to mind altering substances often ceases to fulfill obligations or promises, but physically the social role is still occupied. "Codependency," describes a set of skills that were learned in that close relationship, become unsuccessful, and are vigorously pursued because members of the network have not yet identified and grieved their loss. To address these behaviors, fear and uncertainty need to be addressed.

Persons with emotional attachment to those who are addicted need to:

Recognize the loss of the role that the addicted person can no longer fulfill.

Grieve the loss of the original relationship.

Reorganize such that the addicted person is no longer central to the member's well being.

Identifying and grieving are the key issues in correcting "codependent" behaviors. That understanding is achieved through education, which is why the family program at Cottonwood de Tucson is so successful. Once the education has taken place, family members can:

Detach with love.

Recognize the limits of the relationship with the addicted person in their lives.

Take care of their own needs for balance and attachment in relationships where trust and balance are more available.

Learn to set limits for their own well-being.

Learn to distinguish between caring and obsession.

Codependent-type behaviors are logical responses to ambiguous and chronic attachment loss. Codependent-type behaviors are learned, and can be unlearned.

Vicki Loyer-Carlson, Ph.D., LMFT
Daniel Cook, LMSW
Ed Rusnak, MS, NCC, LISAC
Cottonwood de Tucson
4110 W. Sweetwater Drive
Tucson, AZ 85745
(800) 877-4520
www.cottonwooddetucson.com

Treating Internet Addiction at Cottonwood de Tucson

Rose Hoban's article titled Internet Addiction: Latest Obsession brings up an interesting topic that is indeed emerging as a challenge for behavioral health professionals. In that article Hoban references Psychologist Louise Nadeau's statement that "addiction is marked by two phenomena...the first is that a person has a behavior he or she can't control", and the other being "that the behavior causes a series of problems in many spheres of your life." She continues that "You're having problems with your work, you're having problems with your social network, you're having problems also with your mental health."


I think a big contributor to Internet addiction is the advancement of technology. As technology advances computers are becoming more affordable for persons who 5 years ago would not have dreamed of having a computer in their home. If you remember the evolution of the television, 25 to 30 years ago families were fortunate to have just one in their home. However, as the prices of televisions have dropped tremendously from 25 year ago, today most homes have 2, 3, or more. The same is happening today with computers. As the prices have dropped, computers are gaining more of a presence in homes. Today, it is uncommon to not have a computer in your home and homes with kids often will have a computer in the child's room as well. So with the accessibility of computers increasing, Internet addiction is becoming more prevalent in society. The other draw to the Internet is that it offers immediate gratification. Rather it's gambling, shopping, pornography, or gaming just a click of the mouse and an addict can be engaged in their addiction.

While Hoban's article states Psychologist Louise Nadeau is doing more study to develop a standard of treatment for Internet addiction, I can add that flooding is not a treatment intervention I would recommend. Flooding is a therapeutic technique sometimes used by professionals where they "prescribe" the behavior with which the client is struggling. The idea is that the client will become overexposed to the behavior such that it no longer brings them pleasure and they stop. This technique would only feed the addiction and work to strengthen it, as noted in the article where the man spent 2 weeks in the airport's Internet cafe and never went on his vacation. With Internet addiction, I feel it is up to the professional to look at the need the behavior is meeting for the client, evaluate with the client the legitimacy of the need, and then seek an alternative behavior to meet the legitimate needs of the client. This is putting it in simple terms, but a lot of work would need to be done to extinguish the behavior associated with Internet addiction.


Eric Parrish
Clinical Director of Extended Care
Cottonwood de Tucson
4110 W. Sweetwater Drive
Tucson, AZ 85745
(800) 877-4520


http://www.cottonwooddetucson.com//

Farewell Letter to My Addiction

My sponsor asked me to write a farewell letter to my addiction. This is what I wrote.

Farewell, Dear addiction, you were there for me when I needed you most. When my mother died you were my comfort. When I was scared you made me feel safe. When I was alone you were always there for me. You comforted me through pain and sorrow and you were always around to help me celebrate my victories. I never gave you credit for all the times you stayed with me when I was at the bottom of the heap. You gave me a voice and although it was not a voice heard by anyone but me it was with me constantly, chattering away non-stop like white noise. All these times you were there for me. You gave me the ability to be invisible, a gift that served me well and probably saved my life. However, and there is a huge however, all these things you gave me came with a price. I was never allowed to grieve because I hid with you behind closed doors. I never developed courage because you told me that the substance I craved would take away all fear and protect me. I isolated and had no meaningful relationships because the wall between me and others (which you helped me build) was ten feet thick and made with stones of fear held together by mortar made of resentments, lies, shame and guilt. You told me I was unworthy or others weren't good enough and most of the time I was unable to see a person's true self because I was kept enveloped in a fog. The fog you created for me to keep me safe, in the shadows, unseen. My pain and sorrow grew because I never worked through it. And every time I felt some hope you were there to whisper in my ear, "You don't have to go there, stay here with me I will keep you safe. I am comfortable and I am your life." I listened to you thinking you were my closest friend. And then one day I heard a voice. A hand reached out to me. Gradually I stepped into the light. I saw a glimpse of you smirking as I fell back into your waiting arms time and time again. I heard you laughing as I told others about you. You thought I would never break free and sometimes I thought you were right. But there is something much stronger than you and that is God. I saw the light and I heard someone's sweet voice say, "You can have this - you can be free." All those years when I thought you were my friend you were scheming behind my back, slowly you robbed me of my dignity, joy, and faith and you did it with a smile and a lie. I always believed you until I saw the light and I saw the difference between the lie and the truth. So here we are. It has taken a long time. You and me are looking for different things. You want me bound, desperate and alone and I want release. I want to be free. I want to grieve, feel fear, grow courage, experience pain, hunger, happiness, love, disappointment, joy. I thank you and I release you. Go to wherever addictions go when they are no longer needed or wanted, when they have finally been exposed to the light. It's okay to leave I'm stronger now. I can see through the fog, I have seen the truth, I've experienced the light of God. We weren't made for each other anyway. I was meant to live and walk with a source greater than you, I was meant to be, to feel, I was meant to live unchained. Go attach yourself to another. You and I know longer exist together. I release you with love but I do release you completely. But know this, I will be watching. If I see you deceiving others I will share the light with them. I will expose you and your lies. So, you lier, cheat and thief, farewell, skedaddle, adios, arrivederci, ciao, auf Wiedersehen, so long, good bye, adieu, hit the road Jack and don't come back!

~ Anonymous