New Life 2018

RESOURCE GUIDE

SPIRIT

IN THE DARK FINDING A

COURTING RECOVERY DRUG COURTS OFFER A SENSIBLE ALTERNATIVE TO JAIL FUNDING TREATMENT IN THE AGE OF OBAMACARE PAYING THE BILL

HIGHER POWER IN RECOVERY

A FAMILY AFFAIR BREAKING THE CYCLE OF CO-DEPENDENCY

OUR PHILOSOPHY

New Life Addiction Counseling & Mental Health Services Inc. believes in and promotes total abstinence from alcohol and drug abuse. The program motivates clients through education, self-awareness and participation in self-help groups to develop recovery strategies that promote an alcohol/drug-free life. New Life Addiction Counseling & Mental Health Services Inc. also recognizes alcohol/drug dependence as a family disease. To assist families in addressing their needs and concerns, New Life offers family treatment.

CONTENTS To send a comment or question, write to: New Life Addiction Counseling & Mental Health Services 4231 Postal Court Pasadena, MD 21122 INTERESTED IN MORE FROM NEW LIFE? To learn more about our resources for living a healthy lifestyle, visit www.newlifeacs.com or call (410) 255-4475. New Life Magazine is published by Copyright 2018 by thein uence.org. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved. 6830 West Villard Ave Milwaukee, WI 53218

FEATURES 08 A SOLUTION THATMAKES SENSE Drug courts provide a new path 12 PAYINGTHE BILL Addiction treatment in the age of Obamacare 16 STRENGTH IN NUMBERS Counselor believes in the power of the group 46 MEDICAL MARVEL New Life announces new medical director

50 A FAMILY AFFAIR Dealing with the dysfunction 54 PLAYWITH A PURPOSE Counselor uses varied tools to engage clients 58 SPIRIT IN THE DARK Seeking a higher power in recovery

IN THE NEWS 24 BOOMING PROBLEM Elderly substance abuse issues expected to grow as baby boomers age 26 STARTING YOUNG Insight into adolescent addiction comes as new guidelines urge early prevention 28 FIGHTING FORTHE BRAIN DISEASEMODEL Model can complicate messaging in treatment plans 30 THEMISSING LINK Integrated treatment works best for victims of sexual abuse who are also addicts 32 RECOVERY U More college campuses are dedicating housing to students recovering from addiction

34 LEARNINGTODRINK 36 ARE VACCINESTHE ANSWER? A new vaccine has been shown to prevent overdoses and stop opioid “designer drugs” from affecting the brain 38 FROM SMOKINGTODRINKING develop an alcohol abuse disorder, according to a new study 40 THETURNING POINT New study looks to pinpoint transition from prescription opioids to heroin 44 GENERATIONAL BRAINDAMAGE Drinking during pregnancy presents parents with challenges beyond their own sobriety

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A SolutionThat Makes Sense Drug courts provide a new path

Since 2005, some defendants facing charges for drug possession in Anne Arundel County have been offered the option to choose addiction treatment rather than going to jail. Like other drug courts around the U.S., the Anne Arundel County Drug Court is designed to handle nonviolent criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems. Drug courts have proven to be an effective form of intervention, and are widely recognized as such by the criminal justice system.The first drug court was implemented in Florida in 1989. As of June, 2014, there were more than 3,400 adult and juvenile drug courts active in the U.S. New Life Addiction Counseling and Mental Health Services frequently receives clients referred for treatment by the Anne Arundel County Drug Court, according to Clinical Director Noreen Ammons. Ammons says the drug court concept is valid and valuable as a “rehabilitation rather than punishment” approach to one of the major problems facing society. “Drug courts are great; we need more of them.”

As of June, 2015, the Anne Arundel County Drug Court had served more than 435 participants and has had 164 graduates. In addition to saving lives and deterring victimization and recidivism, the drug court program saves money. According to data developed by the county, housing a jail inmate costs about $100 per day or $36,000 per year. During one typical week in 2015, there were 89 people participating in the Anne Arundel County program. Housing those 89 people in the county jail for one year would cost more than $3 million, according to the county. By contrast, the drug court program costs approximately $330,000 for one year, including addiction treatment costs.

“It is not an easy path.” —Noreen Ammons, clinical director, New Life

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“The program enables the criminal justice system to assist in a drug user’s recovery, as opposed to just picking them up, writing them up, and putting them in jail.” -Jennifer Wheeler, business development and outreach director, New Life

“Victimless” defendants Ammons notes that most of the clients the court refers to New Life are first-time offenders and non-violent ones, and “haven’t put anyone’s life at-risk but themselves.” Once they are in the drug court program, defendants know they are being monitored and if they use drugs and have a positive urinalysis “they are going to have consequences.” New Life staff are in constant contact with the court and regularly provide reports on each client’s process, Ammons says. Drug defendants who are accepted into the drug court program, may or may not be sincere and “serious” about complying with the rules and completing the program successfully in order to have their criminal charges dropped.They show their intentions by their actions, Ammons points out. Those who do not follow the rules – including maintaining sobriety – and complete the process are returned to the criminal court. “So, it is not an easy path,” Ammons says. Ammons would like to see drug courts expanded to give more people the opportunity to access addiction treatment, and avoid having a criminal record caused by substance abuse. Jennifer Wheeler, business development and outreach director for New Life, also considers drug courts a “very positive” trend. Jails and other correctional facilities are not equipped to handle drug users who need detoxification and treatment, she points out.The drug court program enables the criminal justice system to “assist in a drug user’s recovery, as opposed to just picking them up, writing them up, and putting them in jail.” 

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insurance, he points out. Third party reimbursement is important because clients who can afford to pay the entire cost of treatment represent “a select few,” Collins says. They tend to be adults who are well-established in their careers, or younger adults whose parents are covering the cost. Those in their late teens to early 30s make up the demographic group that seems to be the most prone to substance abuse and addiction, and also “the largest population we serve,” Collins says. Jennifer Wheeler, business development and outreach director for New Life, says “we are very pleased” that the Affordable Care Act included a behavioral health option, since it has allowed some previously uninsured persons to have coverage for mental health and addiction treatment services. A signi cant percentage of New Life clients use Medicaid to pay for their care because New Life is a participating provider in the state of Maryland's Medicaid program, according to Wheeler. A number of those are people in their 20s who were previously covered by their parents' insurance, but have reached the age of 26, and “aged out” of being covered as dependents. When an uninsured person who has decided they need treatment contacts New Life, “we encourage them to sign up for Medicaid,” Wheeler says. “The Medicaid enrollment process is quick, and coupled with our nance and billing department, we will get the client in as soon as they are approved.”The sta also works with each uninsured client to set up a viable payment plan. “When someone is ready for hen an uninsured person who has decided they ne d treatment contacts New Life, “we encourage the to sign up for Medicaid,” Whe ler says. “The Medicaid enrollment proces is quick, and coupled with our nance and billing department, we will get the client in as o n as they are ap roved.”The sta also works with each uninsured client o set up a viable pay ent plan. “When so eone is ready for treatment, New Life will certainly look at all reasonable options to help their recovery.” treatment, New Life will certainly lo k at all reasonable options to help their ecovery.”

Regarding Medicaid's reimbursement rates for addiction treatment services, Wheeler says New Life’s executive team considers them“reasonable.” But one problem in serving clients whose only coverage is provided by Medicaid, Wheeler says, is a shortage of inpatient treatment facilities to meet their needs – especially with opiate addiction rates continuing to increase. Medicaid rates are “reasonable” Regarding Medicaid's reimburse ent rates for ad iction treatment services, Whe ler says New Life’s executive tea considers the “reasonable.” But one proble in serving clients whose only coverage is provided by Medicaid, Whe ler says, is a shortage of inpatient reatment facil ties to me t their ne ds – especially with opiate ad iction rates continuing to increase. When the landmark Affordable Care Act became law in 2010, advocates for mental health and addiction treatment hailed it as the start of a new era of equality for those who need care. But addiction treatment professionals say that while the ACA represents a step forward, it is anything but a remedy for all dif culties. Over the years, treatment providers have made great strides in developing care methods to yield positive outcomes. Today, the biggest challenge in providing addiction and mental health treatment may be guring out who will pay for that care. So, most of the questions involving the impact of the ACA, aka Obamacare, involve reimbursement, says Jim Collins, counselor and business development manager for New Life Addiction Counseling Services. One group the ACA does not cover is the voluntarily uninsured, those who “choose not to have the government involved in their nancial life – either because they work for cash or have an illicit means of income,” Collins says. There is also a lack of facilities to provide addiction treatment; just because someone has insurance doesn't mean a particular facility necessarily takes that

Addiction treatment in the age of Obamacare i i e e i e e f b e

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“When someone is ready for treatment, New Life will certainly look at all reasonable options to help their recovery.” -Jennifer Wheeler, business development and outreach director, New Life Addiction Counseling Services

Regarding possible solutions to help make treatment a ordable for more people, Collins would like to see changes in the procedural requirements insurance companies place on treatment providers like New Life. One of the major drivers of addiction treatment costs is patients who relapse, and – in some cases – cycle through treatment multiple times. Collins believes one way to reduce relapse rates would be to adopt more of a “top-down” approach: since insurers are focused on reducing costs, they typically favor starting with less-expensive outpatient care. They see inpatient care as a second option, for patients who have failed at outpatient treatment. Collins says it would make more sense to start with inpatient care, rather than “making clients fail at a lower level of care” before receiving inpatient treatment. In the latter case, patients who need inpatient treatment often have to be placed on waiting lists until a bed is available. “Any number of things” could happen to a client while they are waiting – a health crisis, incarceration or even death. So, “waiting is not the best option.”

“Waiting is not the best option.” -Jim Collins, counselor and business development manager, New Life Addiction Counseling Services.

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No one is ever too broken, too scarred, or too far-gone to create change.

Never stop ghting. Never lose faith.

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New Life Addiction Counseling & Mental Health Services offers an outpatient detox program, so you can transition comfortably into your recovery.

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Counselor believes in the power of the group

“I LOOK AT EACH CLIENT AS AN INDIVIDUAL, WITH THEIR OWN 'CHALLENGES’ THAT THEY BRING INTO TREATMENT.” – TRISH EARNEST, NEW LIFE

Bethesda, Md. Once in recovery, Earnest began to see addiction counseling as a good career ˆt and returned to school to earn the necessary certiˆcation. She completed her supervised clinical practice requirements, and joined the staŠ as a counselor about two years ago. Counseling professionals often say that the really important learning in their ˆeld takes place on the job, rather than in school. One key principle Earnest has learned and applied in her years of practice is the importance of treating each client as an individual. “I do group therapy, but I still look at each person as an individual, with their own 'challenges' that they bring into treatment. We can't treat everybody the same. Clients also need to know you have compassion, empathy and a non-judgmental attitude toward them.”

Trish Earnest, an intake clinician and group therapist at New Life Addiction Counseling Services, has spent her entire career in counseling and teaching roles. But, it wasn't until fairly recently that she found her true calling as an addiction counselor. After graduating from college with a psychology degree, Earnest began her career working with troubled youth in a state-run facility, and also worked as a special ed teacher in a private, religious school. In 1995, Earnest sought treatment and recovery after her long-term addiction to alcohol, marijuana and cocaine. ‚e addiction had led to the breakup of her marriage, a potential home foreclosure and the possibility of losing custody of her two young sons, then ages 1 ½ and 3 years old. To get her life back on track, Earnest completed six months of treatment and aftercare in a program in

“CLIENTS NEED TO KNOW YOU HAVE COMPASSION, EMPATHY AND A NON-JUDGEMENTAL ATTITUDE TOWARD THEM.” – TRISH EARNEST, COUNSELOR, NEW LIFE

Non-judgement is “a big one,” Earnest says. Early in her counseling career, “heroin was a bit of a mystery to me, since I had never used it.” But, seeing the daily struggles of opiate users made her more empathetic toward those clients. “It's been eye-opening.” ‚e ˆrst step in providing help and support is ˆguring out what each client needs.‚at happens at intake. “We have a very extensive intake process. We screen clients on the phone, ˆrst, before they even walk in the door.” When she sits down with a new client, Earnest asks many questions – about their history of substance use, any past emotional or physical trauma, any previous attempts at treatment, family background and their present living situation. “I try to ˆnd out what is motivating them now. Do they go to 12-step meetings? Do they have a sponsor? It's a pretty lengthy and in-depth process, so I can get a picture of where they are in the (recovery) process.” One diŠerence among the clients she works with is that a certain percentage have been mandated by a court to undergo treatment. “‚ey

can still recover, even if some of those who have been mandated to treatment are a little more resistant.” At New Life, working individually with each client includes not only psychological counseling, but also addressing a wide range of other life issues, such as ˆnancial matters, coordinating medication, or helping clients ˆnd supportive housing and other needs.‚at often involves partnering with a variety of public agencies and private service providers, Earnest notes. “We've become a very multi-faceted treatment center in helping clients in all areas of their lives.” One of Earnest's primary roles is leading therapy groups, which provide an eŠective setting for recovery from addiction. “When I have a group that works well together – when they learn to trust each other, talk about issues and help each other move forward toward better lives – that is very gratifying. You don't get that all the time in group, but there is a tremendous amount of power in group work that can provide a lot of support for people.” 17

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Offering a Fresh Start By Beverly Ervin

New Life Addiction Counseling Services recognizes the importance of focusing on recovery as we continue to battle the power of addiction. Recovery often means a fresh start for our clients as spotlighted in this issue. Also take a moment to read about the value of spirituality and the need to have faith in a “higher power” as an aid in recovery. New Life is actively involved in the first local conversation with “Recovery over Dinner” which brings together members of the political, faith and recovery community to continue the conversations and events supporting the many among us in recovery. Wherever you may be on September 25, 2016 show your support for those around you battling addiction and support your local Recovery Walk. Enjoy the Summer issue of New Life magazine. Beverly Ervin CEO

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We offer a safe, con dential atmosphere that promotes the development and maintenance of a healthy, sober lifestyle abstinent of alcohol and drug abuse.

FOR MORE THAN 32 YEARS, WE’VE HELPED COUNTLESS PEOPLE MOVE PAST ADDICTION AND MENTAL HEALTH ISSUES TO EXPERIENCE HAPPY, PRODUCTIVE LIVES. WE CAN HELP YOU, TOO!

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RECOVER TOGETHER

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“Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers.” - Dr. Alexis Kuerbis, CUNY - Hunter College

overall numbers present a problem. “We’re grossly understaffed in being able to handle these problems,” says Dr. Dan Blazer, a psychiatrist at Duke University who has studied the issue extensive- ly. “It’s a problem. I think it’s a problem that’s going to get larger as time goes on and we’re probably already seeing evidence of that.” But there’s also an issue of attitude. Baby Boomers, in general, have a more relaxed view of substance use, and experts fear they may carry those behaviors later into life. “There’s no evidence that they’re going to automati- cally stop when they hit 65 years old,” Dr. Blazer says. “They’ve used them all their life, they say, ‘Why shouldn’t I use them now?’”

Even though elderly people show substance abuse issues in a much lower percentage than other age groups, the problem is more prevalent than many realize. And it appears it’s only going to get worse. Studies vary, but generally show between 2.2 and 9 percent of older adults have an alcohol use disorder, and experts say they’re already seeing a rise in marijuana and opioid abuse issues. With the large population of Baby Boomers aging, substance abuse numbers in the elderly population are expected to continue to rise, presenting serious problems for treatment providers and family members. Researchers say the problem is two-fold: part is sheer numbers, the other is attitude. With the number of older adults in the U.S. expected to increase from 40.3 million to 72.1 million between 2010 and 2030,

Experts say the lifestyle of elderly people presents a unique challenge for physicians and treatment providers. For example, because retired people don’t work, substance use doesn’t present a problem at their jobs, a HIDDEN DANGERS typical red ag for younger people. Experts also say too often doctors fall victim to their own prejudices and don’t ask the right questions that could lead to a diagnosis.

substance use. Although success rates in treatment can be better for older adults, the way they’re treated isn’t necessarily the same. Dr. Sacco says older adults respond better to more collaborative treatment programs that give them options. “For so long it was trying to t older adults into these programs, but now it might be changing these programs to t older adults,” Dr. Sacco says.

“People think this person doesn’t look like a substance user,” says Dr. Paul Sacco, an expert on substance abuse in older adults. “Sometimes physical problems associated with alcohol abuse are assumed to have a different cause in older adults.” Substance abuse can be even riskier for older adults as their bodies become less resistant to the stresses brought on by

PLANNING AHEAD

different for an older adult.” But because Baby Boomers use substances more than previous senior groups have, experts say treatment providers may have to nd new ways to treat an old problem. “Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers,” Dr. Kuerbis says. “All bets are off.”

To mitigate the expected problems as much as possible, experts say we need to train more counselors and physicians on how to best treat older adults, and how to spot potential problems in the rst place. “With just a little bit of education about older adults, I think you could make a very big impact,” says Dr. Alexis Kuerbis, a researcher who also works with older adults. “The rst step is awareness on what might be

“We’re grossly understaffed in being able to handle these problems.” - Dr. Dan Blazer, Duke University

StartingYoung Insight into adolescent addiction comes as new guidelines urge early prevention

Treatment providers have known for years that adolescents are more susceptible to drug use and consequently, addiction. But now they might know why. Researchers recently discovered a specific pathway in the brain that makes adolescents more prone to problematic substance use, which could lead to stronger prevention efforts. By studying how cocaine affected the behavior of young and adult mice differently, researchers found that a mechanism in the brain which regulates specific protein production also controls addictive behaviors. By manipulating that mechanism, researchers were able to mitigate cocaine’s addictive effects. “Now we have a bidirectional switch that can turn on and off the cocaine-induced changes in the brain,” says lead researcher Dr. Mauro Costa-Mattioli of the Baylor College of Medicine.

“ The excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction. ”

- Dr. Mauro Costa-Mattioli, Baylor College of Medicine

One size fits all What’s most exciting about the study is that the pathway does not appear to be specific to cocaine. A second study examining nicotine returned similar results, leading researchers to believe any treatments targeting the pathway would be effective for all substances. “In the case of nicotine, it’s exactly the same thing,” Dr. Costa-Mattioli says. “All the drugs of abuse, they reduce the activity, they hijack or change this mechanism.” Researchers say they’re still interested to see if the mechanism plays a role in the transition from social substance use to more problematic use. But they say simply identifying such a crucial link of the substance use chain could lead to significant prevention methods. “Of course, the excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction,” Dr. Costa-Mattioli says.

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Total improvement Experts say the benefits of implementing early intervention efforts far outweigh the cost. Although limited data exists, studies show investing just one dollar can produce anywhere from a few dollars to $26 in cost savings down the road. “Thus a well-designed, well- implemented early childhood intervention can dramatically benefit the community and society as well as improve children’s and families’ quality of life,” Dr. Volkow says. But the benefits of early intervention go beyond substance abuse. Experts say many of the risk factors for substance abuse are the same indicators for other social, behavioral and academic problems. They say creating a prevention program to address and reduce the risk of substance abuse will pay big dividends across the board. “Interventions designed to reduce early risk factors show benefits in a wide range of areas,” Dr. Volkow says. “Including improved personal and social functioning, better performance in school, and less involvement with the juvenile justice system or mental health services.” 

“ Early childhood intervention can dramatically benefit the community and society as well as improve children ’ s and families ’ quality of life. ” - Dr. Nora Volkow, NIDA director

First eight years To address adolescent drug use, experts say prevention efforts have to start earlier than most would expect.The National Institute on Drug Abuse (NIDA), the government’s top agency on substance use, recently released new guidelines suggesting prevention education should start in the first eight years of a child’s life. Officials acknowledge that early childhood is not a time period normally associated with drug use. But they say factors with family, school and community environments can shape development of certain emotional and behavioral issues that can manifest in substance abuse problems even decades later. “Central to intervening early is the idea of shifting the balance of risk and protective factors in a way that builds a foundation for optimal social development and resilience,” says NIDA Director Dr. Nora Volkow.

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“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility.” – Dr. Nora Volkow, Dr. George Koob, Dr. AThomas McLellan

Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Fighting public opinion can be an uphill battle, sometimes even a futile one. Despite years of progress and scientific advancements, researchers and treatment providers still find themselves having to convince the general public that substance use disorder is a disease. But it’s a message that can often complicate treatment plans as much as it seeks to inform.

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Setting the Record Straight Earlier this year, three of the nation’s leading drug experts wrote a paper seeking to explain, once and for all, how substance use affects the brain in the same way as similar diseases. In an article published in the New England Journal of Medicine, NIDA Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. AThomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction. “The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write. The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception. “A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.

“You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” – Bob Rohret, MARRCH executive director

 Scientific studies attest that a person’s brain chemistry can be altered as a result of addiction.This fact can provide a needed explanation as to why continued use can still be a problem for people who clearly desire to get clean. “When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.” Mixed Messages But as confident as many in the medical community are about the nature of substance abuse disorder, the idea that addiction is a disease presents something of a double-edged sword for treatment providers. “The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” Rohret says treatment providers have to inform those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction. When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actionable steps that lead to more positive outcomes.

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Integrated treatment works best for victims of sexual abuse who are also addicts. Researchers have found a dramatic link between the

“ 1 out of every

occurrence of sexual abuse and substance abuse. According to alcoholrehab.com, “sexual abuse victims are three times more likely to suffer depression, six times more likely to suffer PTSD, 13 times more likely to abuse alcohol and 26 times more likely to abuse drugs than those who have not been sexually abused.” They go on to say that one out of every six women and one in 33 men in America have been the victim of sexual assault or rape in their lifetime.

6 women and one in 33 men in America have been the victim of sexual assault or rape in their lifetime. ” -alcoholrehab.com

Integrated treatment

Treatment centers are beginning to recognize the need for integrated treatment techniques for victims undergoing substance abuse recovery. Since there’s such a high prevalence of sexual abuse among addicts, integrated treatment offers a fuller recovery for sexual abuse victims. Trauma-focused Cognitive Behavior Therapy (CBT) is one common form of treatment. In CBT, individuals are offered psychoeducation, therapy instructing and empowering them to deal with their condition in an optimal way. Stress management tools are also helpful. Individuals can be taught to change their situations or their reactions and how to maintain appropriate personal boundaries. The regulation of emotions can be a challenge for a person who has been sexually abused. In CBT, clients learn what emotions are socially tolerable and they learn how to be flexible enough to permit some spontaneity. Survivors are also taught how to delay emotional reactions as necessary.

Individuals can be taught to change their situations or their reactions, and how to take good care of themselves.

 Integrated treatment for those suffering from substance abuse addiction and sexual abuse greatly increases the chance that this person will remain sober for the long haul.They can also experience greater joy and healing than if they were treated for substance abuse alone. Telling their story One effective aspect of CBT is for the person to do a “trauma narrative.” In addition to telling their story by the spoken word or writing it down, they can also use drawing, painting or other art forms to communicate the trauma.The narrative can then be shared with a safe person, like a trained therapist or substance abuse counselor.The hope is that the survivor will be able to let go of some of the trauma. Healing can then take place. Another facet of CBT is behavior management training. Clients are encouraged to stay calm in an emotionally charged situation, manage their own responses, learn what limits are appropriate, handle challenging questions and learn how to prevent physical confrontations with others. According to the Rape, Abuse and Incest National Network (RAINN), survivors are also encouraged to do what they can to heal themselves. Good sleep and nutrition, exercise, and regular routines like starting and ending the day in a peaceful way are a good place to start for people from this background. Those in recovery are also urged to write down leisure activities they find enjoyable and engage in those activities regularly. Clients are also encouraged to use journaling and inspirational reading to further grow in their recovery. Finally, having a supportive group of friends and family will help an individual recover emotionally from this kind of trauma.

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More college campuses are dedicating housing to students recovering from addiction

House parties, keg stands and spring break. The stereotypical images of American college life may revolve around drinking and party culture, but that image may be changing as more universities look to make campus a welcoming space for recovering addicts to live and learn. In the fall of 2016, a growing number of colleges will debut new Living-Learning Communities (LLCs) speci cally for people in recovery. While LLCs typically occupy a oor of a dormitory and center on a

shared interest or academic eld, these new student housing sections will provide a safe and positive environment for recovering students.

“It’s something I’ve always wanted to see implemented at the university,” says Dr. Gerard Love, a drug and counseling professor at Slippery Rock University in Pennsylvania where a new eight-person LLC will open in the fall of 2016. Slippery Rock of cials hope to offer recovery-related programming at least once a week with topics such as nutrition, team building and spirituality. The hope is that the apartment-style living space will provide students a network to help them focus on both academics and recovery.

W A T

L Y

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“I see them as being leaders here on campus.”

– Kris Barry, University of Minnesota - Rochester

“It’s really just about being around like-minded people and developing that ‘we’ as a support system.”

– Dr. Gerard Love, Slippery Rock University

“Universities are supposed to be about dialogue, and having this is a great opportunity for dialogue,” Dr. Love says. “Bringing this whole notion of addiction out of the shadows and increasing understanding, I think will be a good byproduct of this.”

“It’s really just about being around like-minded people and developing that ‘we’ as a support system,” Dr. Love says. Dr. Love says simply having a recovery space on a college campus could help change perceptions about recovery and remove the stigma surrounding addiction.

Of cials at the University of Minnesota – Rochester will also be opening a new recovery LLC for the fall 2016 semester. Of cials say it’s necessary to provide recovering students with the tools they need to succeed academically and in their personal lives. “Historically, students who are in recovery really struggle to come back to campus without that [supportive housing] program,” says Kris Barry, the school’s health and wellness advocate. The LLC will house six to 10 students and feature evidence-based recovery programming. Of cials say the LLC speaks to the school’s mission as a health-focused university. But more than that, they say they hope to foster a culture of personal growth among all students, particularly those in recovery. “I see them as being leaders here on campus and then taking that and changing the dialogue about addiction,” Barry says. “We know that the traditional college experience can be hostile to the goals of anyone in recovery, and we want to support them as much as possible.”

Boyd Austin says student communities centered on recovery provide a welcome relief for students to explore their university in a supportive and positive way. “It o ers a space, it o ers a culture, it o ers a community of people who are engaging in college in the same way,” Boyd Austin says.

Experts say universities are increasingly adding recovery programs focused on creating a community among students, but ones incorporating housing are still few and far between. “This started about 30 years ago, but it has really taken off in the last 10 years,” says Amy Boyd Austin, president-elect of the Association of Recovery in Higher Education.

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Learning to Drink

Study finds alcohol changes the brain from the very first drink

“ Drugs of abuse basically hijack the normal learning and memory processes. ” - Dr. Dorit Ron University of California - San Francisco

Preventing escalation

The NIAAA-funded study did not establish a relationship between initial use and addiction, or even problematic drinking. But the hope is that further understanding of how alcohol affects the brain initially could lead to better treatment and prevention efforts down the road. “If we can control that step, we may be able to prevent further escalation,” Dr. Ron says. More research is needed to determine which other components of the brain are affected by initial alcohol exposure. Dr. Ron says she believes the changes that occur during first exposure could be reversed with prolonged abstinence from alcohol. But she said the more a person drinks, the harder it is to reverse those changes as the brain forms stronger connections to drinking.

One drink is all it takes. That’s what one research team found when studying how even the first exposure to alcohol can affect a person’s brain. A team from the University of California - San Francisco exposed mice to alcohol and then studied the synapses (connections) in their brains.The team found that even the first drink produced significant changes in the brain’s biological structure, calling the changes a “learning event.” “This is basically the first step,” says Dr. Dorit Ron, one of the chief researchers. “You are basically placing a memory trace.” Dr. Ron says the entire study was based on the idea that “addiction, and not just alcohol addiction, is thought to be a maladaptive form of learning and memory.” In essence, the study showed that first exposure to alcohol primes the brain for further use and lays the foundation for future “learning.” “Drugs of abuse basically hijack the normal learning and memory processes,” Dr. Ron says. “The behavior becomes habit.”

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Predicting behavior

A new study also suggests that the earlier a person starts drinking, the stronger those connections may become. Researchers recently set out to identify which substance people use first in their lives and found the majority of people try alcohol before any other substance.The team also looked at how a person’s age when they start drinking affects substance use later in life. Researchers say the earlier someone starts drinking, the more likely they are to use more than one illicit substance, and they’re also more likely to develop an addiction. “It’s a very nice predictor for polysubstance use,” says Dr. Adam Barry, the study’s chief author. “The later you delay, the closer you are to 21, the less likely you are to be alcohol dependent or dependent on other substances.”

“ Alcohol consumption among youth doesn’t occur in a vacuum. ” - Dr. Adam Barry, Texas A&M University

 strategies that prevent drug use and then applying those in an alcohol setting.” Curbing use Researchers acknowledge there’s a difference between a first sip and a first binge drinking event. But they say age at first use of any kind is still a good predictor of behavior later in life. To combat problematic drinking, Dr. Barry says educators need to address all factors of a child’s life, not just the substance itself. In keeping with new guidelines from the National Institute on Drug Abuse, Dr. Barry and his team recommend beginning substance education as early as third grade. “Alcohol consumption among youth doesn’t occur in a vacuum,” Dr. Barry says. “It’s really just trying to find evidence-based

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HAS BEEN SHOWN TO PREVENT OVERDOSES AND STOP OPIOID “DESIGNER DRUGS” FROM AFFECTING THE BRAIN vaccine ? ARE A new

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Treating addiction with vaccines is a relatively new idea with many unanswered questions

that arise out of a lack of research. But a new study suggests vaccinating against illicit drugs is not only possible, it could be extremely effective. At the Scripps Research Institute in California, researchers were looking for a way to guard against the lethal and addictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substitute or mix-in by drug dealers, so researchers developed a vaccine to try to mitigate its effects. Researchers injected mice with three rounds of the vaccine and then exposed them to doses of fentanyl. They found the vaccinated mice did not display any “high” behaviors even months after the last series of vaccine injections. Researchers say the immune systems of the mice developed antibodies that successfully blocked the drug from reaching the brain. “The results were the best we’ve ever seen for any drug vaccine,” says Paul Bremer, a graduate student at Scripps Research Institute who worked on the study.

VACCINES THE ANSWER

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The results were the best we’ve ever seen for any drug vaccine. - Paul Bremer, Scripps Research Institute

“ WE WERE ABLE TO BLOCK EXTREMELY LARGE - Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

SAFE AND POWERFUL Not only was the vaccine able to stop intoxication (something researchers suggest could aid in opioid addiction treatment), the vaccine also proved extremely effective in blocking the potentially lethal effects of fentanyl as well. While the chemical is not necessarily toxic in itself, it does produce psychoactive effects that can shut down breathing and stop a person’s heart. Researchers say mice injected with the vaccine could withstand doses of fentanyl up to 30 times the normal rate. “It was just a rst generation vaccine, but it did prove to be very potent,” Bremer says. “We were able to block extremely large doses of fentanyl to protect against overdoses.” A SINGLE PURPOSE Researchers say the vaccine would not protect against heroin or oxycodone, and a mixture of vaccines would be needed to protect against all opioids. But that was somewhat by design. To make sure the vaccine would not interfere with any medications a person may take responsibly later in life, researchers targeted speci c molecules so the vaccine would only block fentanyl and its derivatives.

“For unrelated drugs that you would be taking, there would be no effect from the vaccine,” Bremer says. LOOKING TOWARD THE FUTURE Although still in the early stages of development, researchers say the vaccine represents an exciting step forward in drug vaccine research. The lab is beginning more advanced trials on a similar heroin vaccine which should give them a better idea of how successful the fentanyl vaccine could become. But until more testing can be completed, researchers say they were pleased with the progress and excited for the future of vaccines in the treatment of addiction. “This concept of using a vaccine for addiction isn’t just an academic pursuit, it could really be used in practice,” Bremer says. “I think it’s really promising.”

safe and powerful

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Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study

When it rains it pours. The old idiom may be familiar to many drug users who often find themselves battling more than one addiction. While previous research has shown multiple substance abuse disorders often go hand in hand, a new study suggests simply using marijuana can lead to a much higher risk of developing an alcohol use disorder.

Finding the Link Researchers at Columbia University analyzed data from 27,461 people who had used marijuana at the time of first testing, but had no history of alcohol related disorders. When researchers checked back three years later, they found marijuana users were five times more likely to have developed an alcohol abuse disorder.

Researchers said they were surprised the link wasn’t between marijuana use disorder, but simply marijuana use itself. “I think it’s important for people to be aware that there are certain behaviors that come with specific risks,” says Dr. Renee Goodwin, one of the lead researchers. “It would be particularly useful for youth.” Because youth are at a higher risk of experimenting with both drugs and alcohol, researchers said educating them about the total scope of risk is not only important, but could help curb problematic behaviors. “Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder,” Dr. Goodwin says. “Statistically it should.”

“I think it’s important for people to be aware that there are certain behaviors that come with specific risks.” -Dr. Renee Goodwin

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“Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder.” -Dr. Renee Goodwin

Uses In Treatment For those already struggling with marijuana or alcohol use disorders, researchers said the knowledge that the two behaviors are linked could help people see the bigger picture of their addiction, and could prove useful in their journey toward recovery. “In some ways it may seem self- evident, but it may not be,” Dr. Goodwin says. “If you’re trying to quit drinking, it’s good to know that quitting marijuana could increase your chance of being successful.”

Zero relationship to mood and anxiety disorders As marijuana use has increased in the U.S., with some states even voting for legalization, some have wondered what the psychological cost will be to users. To investigate the question further, other researchers at Columbia University also conducted a recent study to determine if a link exists between increased marijuana use and psychiatric disorders. Although the results, published in the journal JAMA Psychiatry, mimicked previous research in showing a strong relationship between marijuana use and other substance abuse disorders, the findings in regards to psychiatric disorders were much different. The study showed no relationship between marijuana use and increased instances of mood and anxiety disorders, only substance abuse disorders. But despite the lack of a connection, researchers still cautioned against public policy that could lead to increased marijuana use. “The lack of association between more frequent cannabis use with increased risk of most mood and anxiety disorders does not diminish the important public health significance of the association between cannabis use and increased prevalence and incidence of drug and alcohol use disorders,” the authors wrote. 

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New study looks to pinpoint transition from prescription opioids to heroin

Stopping heroin use before it begins may be the best remedy for the country’s growing epidemic. A new study looks to pinpoint the times and ways that young people rst use the dangerous drug in hopes of strengthening prevention efforts. For three years, researchers at Wright State University tracked nearly 400 18- to 23-year-olds in Columbus, Ohio, who used illicit prescription opioids but were not opioid-dependent. Of the 362 participants, 27 eventually transitioned to heroin, a rate of 7.5 percent. “We were surprised at the number of people who transitioned to heroin,” says Dr. Robert Carlson, the study’s lead researcher. “We had really no idea of what exactly we’d be able to predict.”

Predicting risk

Researchers found several predictors of increased risk of heroin use, starting with the ways in which the opioids were being used. Those who crushed or snorted the prescription drugs were far more likely to transition to heroin. “It increases the speed at which the drug is hitting the system and makes people much more liable to becoming dependent,” Dr. Carlson says. “If people can become aware that if they even think about starting to use via a non-oral route, they are heading off on a very dangerous path.”

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“We were surprised at the number of people who transitioned to heroin. ” - Dr. Robert Carlson, Wright State University

Racial divide

The new NIDA-funded study targeted 18- to 23-year-olds because they are arguably at the highest risk for substance abuse. The study did not look at other age groups. But when considering the factors that may move a person from prescription opioids to heroin, Dr. Carlson believes age is just a number. “I wouldn’t think the risk factors for transition to heroin would be much different regardless of age group,” Dr. Carlson says. While the risk factors may be the same across age groups, the most deadly effects of heroin use are not. Research has shown that those most at risk of a heroin-related overdose fall in the 25 to 44 age range. It’s important to keep in mind that the vast majority of prescription opioid users will not move on to heroin. And signi cant research is still needed to determine the social, environmental and biological factors that contribute to a person transitioning to heroin. But Dr. Carlson says he’s encouraged by the progress being made and believes the groundwork has been laid to develop effective treatment and intervention programs. “The really exciting thing to come out of this is it really gives us a rm foundation of some variables that could be targeted to prevent transition to heroin and transition to dependence,” Dr. Carlson says. Targeted approach The study also saw a difference in race among those who eventually turned to heroin. Despite roughly half the participants being African-American or Hispanic, all of the individuals who ultimately used heroin were white. Although the study could not determine the reasons behind such a strong racial divide, Dr. Carlson suggests that social networks, generational use and other circumstances could be signi cant factors. National data shows the heroin epidemic has increasingly hit white males the hardest. The Centers for Disease Control estimates that between 2002 and 2013, heroin use among non-Hispanic whites increased 114 percent. Age is just a number

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