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Posts Tagged ‘california’

How I stopped drinking, again – Entry 1

September 24th, 2012

Those of you not following All About Addiction on Facebook (you should) or paying attention to our updates on Twitter and such might not have known that I was recently informed that in order to become a psychologist in California (actually, to get registered as a Psychological Assistant, which allows someone to get experience towards becoming a fully licensed psychologist) I was going to have to submit to a 3-year probationary period of drug and alcohol testing. I was completely sober for almost 3 years between January 2002 and about September 2004 following an arrest and jail stint for drug possession and sales (see here for part of the story). In the summer of 2004 I decided to take on the classic “AA Experiment,” meaning that I wanted to see if having an alcoholic drink would bring me back to drug use as so many in my 12-step groups told me it would. I am happy to report, that 8 years later the answer is still no – I’ve been drug free since 2002 but have been drinking alcohol socially since 2004.

Aside from staying drug and crime free, I also received my PhD, published dozens of articles, set up All About Addiction, started writing for Psychology Today, and had my convictions set aside by my judge after completing 5 years of probation without a single dirty drug test or violation of any sort. But the California Board of Psychology wanted more, so they told me I had to test if I wanted to move forward. I was offended, consulted with many other professionals I know about what I should do, and threatened to request additional hearings before eventually succumbing. The bottom line is that the Board is almost all powerful and can ask me to do anything they want. Besides, I am a 9-felony ex-convict asking to become a psychologist – maybe I’ll never live down my past no matter what I do (for my take on stigma, read here). So I have a probation officer again and I have to stop drinking.

Last Wednesday I stopped drinking alcohol – having a final glass of wine with my wife who is being nice and joining me (for now) in not drinking. Ironically, I stopped last week because I thought my meeting with my probation representative was in two days – I was a week off. And apparently I was so concerned about not drinking any more that I only drank half of my glass (my wife didn’t actually touch hers). Still, I have been drinking a drink or two 3-4 times every week for a while now and had gotten used to my glass of wine as post-work stress relief. So I’m wondering what the experience will feel like having to give up my coping tool for at least 2 years.

I talk to addicts and alcoholics on a regular basis and my own social drinking has come up as an issue many times before. I always said it wasn’t a problem and many others have told me I’m wrong – that I am either in the midst of a relapse or that I was never really an addict. The latter point is moot and I can’t prove that at all, but I know that this little experience might be an interesting experiment (the reverse of the initial one if you will) to see if returning to drinking was indeed a cop-out.

Having this website and all, I decided I am going to write about it. I’ll be giving weekly (probably summaries) of my not-drinking experiences and how quitting drinking has affected me in my daily life. If something comes up in between updates I might write an impromptu post to talk about it. I’d love to hear your thoughts as comments here or on our Facebook page.

Week #1 – September 1th-15th (short week since I stopped on Tuesday)

As I mentioned, we never finished those last glasses of wine. Still, Thursday and Friday were stressful workdays (I am now up to about 65 hours of work per week) and I have to say that realizing I won’t be able to have my nightly alcohol serving was a bummer. I had that thought a few times throughout those workdays and on the way home. I know full and well that for me stress is a trigger for alcohol use. Thankfully, I was not actually tempted to open up anything and drink once I got home. This is still early on in the process, so obviously it does not mean that I won’t be tempted soon, but I was happy to find that resisting a drink was not a difficult task even when I would have usually had one.

Also, I realized that my weekly (or so) friendly get-togethers with a couple of guy friends are either going to have to change venues or I’m going to be the only guy not drinking at a Happy Hour. We’ll see. I’m sure they won’t mind but I’m not sure how I will feel. Lord knows some of my clients frequent bars without issue while others are triggered constantly… If I’m right about my lack of alcoholic drinking issues, it shouldn’t be a problem.

More to come!


Posted in:  Education
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Death in rehab- What is wrong with California’s addiction treatment?

September 5th, 2012

We at A3 have long been saying that there is something seriously wrong with the way addiction treatment is being regulated and with the addiction treatment system that has sprouted up as a result. Now, a government report created for the California Senate Rules Committee called “Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results” (see here) supports our notion and extends them in alarming ways. Among the major findings:

  1. Over the past decade, the California department in charge of regulating residential drug and alcohol programs consistently failed to catch life threatening problems [with addiction treatment facilities].
  2. Many addiction treatment facilities in California are providing medical care in clear violation of their licenses and often by under-trained staff.
  3. Addiction treatment providers are accepting patients that are far too impaired (as in sick) for them to handle because they would rather take the money than turn away a patient.
  4. These problems have led to several deaths within the California addiction treatment system in the last decade.

Obviously these findings are extremely disturbing and cases like the one studies in the report of Brandon Jacques, a patient who died while under the care of MorningSide Recovery’s care,  could have been prevented with more attention and transparency in our system. The idea that addiction treatment facilities that are not equipped to handle severe cases are taking them just for the money is sickening and antithetical to the reason for their existence. As far as I’m concerned, such unethical flouting of patient care should lead to an immediate revocation of their license and a ban for the management from the field.

The most distrubing factor to my mind is the fact that many of these providers know that what they are doing is wrong. But they also know that more than 50% of people who are looking for addiction treatment are doing so for the first time and have no idea what to ask, what addiction services they need, or how to assess whether a facility is appropriate. That means they can take advantage of them with fancy websites and the use of terms like “holistic treatment” that mean little and promise much. It’s disgusting and flies in the face of everything our field is supposed to stand for. It’s also the main reason I worked so hard to develop our Rehab-Finder, which while far from perfect and in need of serious work that I can’t afford to put into it, tries to fix these problems by recommending treatment that is appropriate given the specific issues a client is dealing with. We are currently conducting a study with UCLA on the effectiveness of tools like this and I am committed to figuring out a safer way to help those in need find the right addiction treatment for them.

Importantly, the report also makes a number of recommendations:

  1. Allow for medical service provision at addiction treatment facilities but legislate strict oversight and accountability paid for by agency fees.
  2. Medical detox facilities should be required to have medical directors.
  3. Establishing requirements and procedures for death investigations at addiction facilities.
  4. Strict oversight of programs found to admit clients it is not fit to treat including immediate license suspension.
  5. Information sharing between addiction treatment licensing boards and medical boards.

We think it’s time that addiction treatment providers be held to the same standard that other medical facilities are held to. It might help finally close the gap in terms of recovery outcomes. Running as a relatively unregulated industry does not help patients, it does not help move the field forward, and although they can’t see it it does not even help the treatment providers who are behaving unethically since many of them are eventually forced to close and face lawsuits. It’s time to move forward on this.


Posted in:  Education, Rehab-Finder, Treatment
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Proposition 19 defeated – The false hope of change with young support for Prop 19

November 3rd, 2010

MarijuanaWell, no matter the hope for some before November 2nd, voters in California chose not to pass Prop 19 – the legislation that would have made that State the first in the Union to explicitly legalize the sale of marijuana within its borders. I’ve already said that I support the drug’s decriminalization, and I would actually support the decriminalization of all drug use, but as an ex drug dealer myself, I think going for legalization would have been somewhat premature.

Why Proposition 19 failed – Young weed smokers?

One of the interesting notions brought up during this recent debate had to do with the fact that young voters were overwhelmingly supporting the passage of proposition 19. Some writers on the topic were making the assertion that this means the likely legalization of marijuana use in the very near future regardless of the fate of prop 19. I disagree. In fact, many of those who opposed the passage of a legalization law are baby boomers – individuals who themselves smoked quite a bit of weed and were supporting its integration into society along with a host of other libertarian ideas in their youth. But the passage of time changes more than the number of wrinkles on people’s faces, and political opinions and wills are certainly among those things who shift with age. That’s why I personally think we’re a long way from passing any law that, like Prop 19, tries to legalize all aspects of the marijuana trade. I’m all for medical marijuana where it helps, and reducing the drug’s scheduling will go a long way towards that, but I don’t think we’re going to see marijuana getting full legal status anytime soon.

People on different sides of this debate will call these older voters hypocrites, but I say that since around 80% of youths engage generally in deviant behavior (if you define illegal as deviant), I think we should leave the bigger decisions to people with a little more complete brain development and a lot more experience. Besides, could we translate the fact that young voters, who supposedly supported the passage of proposition 19, stayed at home as evidence that marijuana use does reduce motivation even when it comes to passing laws affecting its own consumption? The notion doesn’t bode well for ever passing a law having anything to do with weed. I jest of course… sort of.


Posted in:  Opinions
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Proposition 19 – Marijuana legalization or nothing? The business of weed

October 24th, 2010

On November 2nd, California voters will be asked to determine whether they’d like to change the legal status of marijuana, and for the first time ever, advocates of legalization may actually accomplish their goals. There are a number of reasons why a well-intentioned voter would choose legalization, from the potential billions of dollars in tax revenue to the reduced burden of non-violent drug cases on a mired legal system. Unfortunately, without the opportunity to vote for decriminalization rather than full legalization, these voters are being presented with a false choice between a senseless century-old prohibition policy and a new option designed not to maximize the safety of California’s citizens, but rather to greatly enrich a chosen few.

Proposition 19 – Marijuana legalization and taxation

Proponents of Proposition 19 have many valid arguments working in their favor. Foremost among them is the simple but wide-reaching argument that marijuana users, like users of most other drugs, should not be jailed for their personal use. Study after study shows that the vast majority of those who experiment with drugs do not develop dependence or addiction problems, and that those who do develop such problems benefit far more from addiction treatment than from incarceration. In fact, supporters of legalization often cite Portugal as an example of a country that has reaped great social benefit from treating drug abuse and possession as a public health, rather than criminal, issue. Portugal, however, has never legalized any drug; their possession, rather, has been decriminalized, while the drug trade itself remains illegal. The crucial benefit of this approach speaks to the strength of market forces: by keeping drugs illegal, we keep them expensive enough to provide a disincentive to serious and widespread abuse. If fully legalized, the extreme reduction in cost, along with the clever and predatory marketing of marijuana in less stigmatized formats- cookies, lollipops, teas – could drive use up far closer to the levels currently seen for alcohol abuse, and with 15 million American dependent on alcohol, we all know how that fight is going. Given the high public cost of treatment and the correlated increase in depression, schizophrenia, and other related disorders, the perceived financial windfall of legalization may be nothing more than a cloud of smoke. The increase in use however is almost certain.

Driving while high – Polydrug use and marijuana

There is also the question of road safety. While proponents of marijuana are quick to point to a handful of studies that proclaim low to no risk when operating a motor vehicle, they are often too eager to ignore numerous other studies including simulation studies and research from countries such as Australia and Canada, which keep national databases on accident statistics. In Australia, one such study found a 300% to 600% increase in fatal car accidents when drivers were positive for THC (depending on concentration), and Canadian studies have shown that the combination of marijuana and alcohol can be more dangerous for drivers than the combination of alcohol and benzodiazapines. Given that nearly half of individuals admitted to drug addiction treatment include marijuana among their polydrug use pattern, the notion that newly legal marijuana users would not combine their pot use with alcohol or other drugs seems highly dubious. It certainly won’t help that drivers might suddenly be able to buy their weed brownies in the same place as their Bud Light.

Legalization versus decriminalization – Who really benefits from prop 19?

There is no doubt, however, about the one California group that stands to unequivocally gain from the legalization, not decriminalization, of marijuana- the entrepreneurs that have staked their claim to what they see as potentially a very big business. Decriminalization, by diverting marijuana users from the legal system and focusing our efforts on getting compulsive users into treatment, will both save taxpayer money and do far more for public health than legalization or the status-quo. What it will not do is make men like Richard Lee, Oakland’s major marijuana-sales benefactor and one of Prop 19’s biggest financial supporters, any richer. As California voters cast their ballot in a few short weeks, they should by all means carefully consider making a statement about our nation’s failed drug policies and misplaced law enforcement priorities. They should also carefully consider the solution that isn’t being presented as an option- and why.


Posted in:  Opinions
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Lohan at it again – gets new SCRAM bracelet

May 24th, 2010

Lindsay LohanIt seems that Lindsay Lohan got  herself in some trouble again, this time because she failed to show up to a court hearing and was partying on a yacht in France instead. An irate judge wanted her arrested, but when her lawyer posted bail for her, she got to walk in to court herself and face her punishment.

Lindsay is going to have to wear a SCRAM bracelet that will monitor her drinking through her skin at all times during the day. The SCRAM bracelet provides Lohan’s supervisor with more than 48 daily alcohol tests to make sure that the actress can’t drink at all.

Everyone (almost) knows about Lohan’s repeat visits to different California addiction-treatment facilities (most recently Promises), and it’s important to note that this recent incident doesn’t necessarily mean that Lindsay is having serious drug, or alcohol, problems. All we know is that she has a hard time showing up to court on time and is paying the price.

I think it’s sad that we only get to hear from people like Lindsay when she gets herself in trouble and that we don’t get to hear about her successes, which, given the fact that she hasn’t been arrested since 2007, must exist. True, she’s seemed to have some trouble obeying court orders, but I’d be interested to know how her own personal battle with bad-decisions-brought-on-by-alcohol-and-drugs has been going…


Posted in:  Addiction Stories
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Quitting smoking: Quitlines success

May 22nd, 2010

In the world of extremely difficult smoking-cessation (quitting smoking), telephone-based programs are apparently having some real success.

Quitting smoking with quitlines

According to a recent summary-analysis (we call these meta-analyses) of research done on Smoking Cessation Quitlines (CSQs), smokers who call and participate are 1.5 times more likely to quit! These are roughly the same numbers we see for people who use nicotine replacement therapies (NRTs, like the nicotine patch, gum, or lozenge), which are the most successful therapies we’ve got. Not bad when you consider that most quitlines are free to users.

What do quitlines do?

Once a user interested in quitting contacts a CSQ, they are taken through an assessment procedure. The California one is apparently pretty long, lasting 30-40 minutes. Don’t worry, the first call is the longest. Past this point, the lines’ activities vary greatly depending on the specific provider. Some offer phone-based counseling only, others also mail materials, and some offer recorded messages, on-demand counseling, counselor callback, and even access to medication (like patches, gum, or bupropion). Since state-based ones are free, it’s a good idea to make the call and see what your state offers. If you’re an addiction professional, or a psychologist with clients that want to quit smoking but can’t seem to shake it, this might be a great suggestion for them.

Can quitlines be used for other addictions?

Phone-based interventions have already been used for some addiction problems (mostly problem drinking), but usually as a supplement to face-to-face treatment. Still, given the relatively low cost associated, it seems that establishing such a tool for problem drinkers that doesn’t include a face-to-face interaction could be a viable option. Since it was state-based public health officials that made CSQs happen through lobbying, it seems that any addiction, or mental health, problem that is prevalent enough to warrant such attention (and such expenditures) may benefit from a little quitline love.

Citation:

Lichtenstein, E., Zhu, S.H., Tedeschi, G.J. (2010). Smoking cessation Quitlines: An underrecognized intervention success story. American Psychologist, 65, 252-261.


Posted in:  Drugs, Education
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Criminal health care – Why we should care.

December 17th, 2009

For most people, the discussion of health care within the prison system is a philosophical one. Not for me.

Inmate health care is a disgrace

While in jail, I got to see the conditions firsthand. I saw the guy coughing his lungs out for days asking deputies to send him to the infirmary only to be laughed at. I saw him struggling to catch his breath night after night, gasping for air in between coughs, making it hard for everyone in the 200 person dorm to sleep. I saw him collapse onto the floor, blood dripping from his mouth and collecting as we all started screaming at the officers to send someone in. They did, finally, and we never saw that guy again. I hope he made it.

After many years of doing little, our government is finally recognizing that leaving inmates to die by attrition within their walled caves is inhumane. In California, there’s a plan to ease crowding and therefore relieve inmate health services to the point they can actually function. Maybe Arnold will do something worthwhile after all. Two birds.

What are prisons for?

The thing is that fiscally responsible conservatives can’t have it both ways. Incarceration is not cheap and as our prison population mushrooms it gets exponentially more expensive requiring support services, the construction of whole cities, and bigger, more secure prisons. The U.S. now has the more prisoners per capita than any other country in the world. Forget China’s human-rights violations, we’re imprisoning ourselves.

Prisons are meant to keep our most dangerous criminals away from society. They’re not meant to be the places where drug users die, or where thieves, cheaters, or dead-beat-dads, go to rot (I met them all there). At least not in my book. Addicts and heavy drug users need help, thieves most often need food or some rehab themselves, dead-beats need a good collection agency and a lien on their income. None of these things are performed in inmate housing facilities. All everyone is trying to do there is stay alive in the mess. Since when was the threat of imprisonment our national parenting device?

Why we should care

“Do onto others” is supposed to be our golden rule, right? Christians proclaim it feverishly, as do my fellow Jews, and as far as I can tell, all other religions have their own versions. Even moral atheists recognize that society functions better when people treat each other with respect. So let’s do it.

When someone is hurting so much from drug use, poverty, and discomfort that they’re willing to steal, let’s give them a hand rather than tossing them to the curb. If they do it repeatedly, let’s figure out a better way to help them. If they seem incapable of stopping, we can revisit this argument. My guess is that those initial steps will greatly reduce the frequency of crime in general. “Bad people” will forever exist in the world, evil will stick around, no doubt, but we can’t live our lives in constant fear of it, jailing anyone who seems to cross paths with it.

Anyway, that’s my opinion.


Posted in:  Opinions
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