In its latest installment, Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?, primary author J. Welsey Boyd and Eric Metcalf delve into the sensitive time when one’s drug use has become troubling, but has not yet reached the diagnostic criteria for addiction.

Is all drug use bad? How do we know if we need help and when or how to seek it? What can we make of the fact that two states recently legalized marijuana? Boyd sets out to draw a road map for these tough questions for both the substance user and his/her loved ones. A medical doctor and Ph.D., he uses his impressive list of credentials — including faculty psychiatrist at Harvard, staff psychiatrist at Boston Children’s Hospital Adolescent Substance Abuse Program, and co-founder/director of the Human Rights and Asylum Clinic. The end result is a useful guide — but with a few flaws.

Because the “almost” concept may seem foreign to someone who hasn’t read one of the previous books in the series, Boyd spends time going over exactly what this means. He writes that to qualify as an almost addiction, a behavior must fall outside of what is considered normal, but, at the same time, not meet criteria for a DSM diagnosis; that it’s causing identifiable problems; that it might progress to a full-blown condition or, at least, cause substantial suffering; that an intervention should be able to help; and that stopping the behavior will improve quality of life. The benefit of identifying drug-using behavior as “almost addicted,” he writes, is that it offers an opportunity to stop and turn your life around before a problem progresses into full addiction, which is much more difficult to treat. He compares the value of this early intervention to that of spotting glucose intolerance and pre-hypertension before they turn into diabetes, heart attack, or stroke.

There is a case study in each chapter to help reader determine if a drug use is an “almost addiction,” as well as to illustrate the points raised in each section in a relatable, anecdotal way. The book gives an overview of the classes of drugs and their effects, as well as the definition of addiction and how it differs from abuse. Later, it explores possible roots of addiction, including the role of one’s family history, a drug’s effects and initial appeal during a hard time, and self-treatment for a mental health issue.

One section is geared toward family members and friends who are concerned about another’s drug use. Boyd notes that almost addiction is especially hard to see in successful people, as the effects are not nearly as obvious as those of full-blown addiction. Even health professionals miss it a lot between their time constraints and the sensitivity of the issue, he writes. He also stressed that there are things you can and can’t do to help: for instance, you can cease enabling the behavior, but you can’t force a person to seek treatment.

Next, Boyd presents materials and resources aimed directly at the almost-addicted reader, including information on helping oneself and figuring out when it’s time to find professional help (there’s a helpful, if simplistic, chart on page 223). Boyd talks about the non-physical aspects of drug use, such as how it’s woven into a daily routine, and prepares the reader for what the recovery process could look like, and what to do afterward to continue living a drug-free life.

While Almost Addicted is, overall, a valuable addition to the literature on drug use and abuse, it does have a few issues. For starters, it is at once meant for an audience of almost-addicted readers and for an audience of concerned loved ones. Granted, Boyd does try to divide guidelines into separate sections, but it’s still difficult to distinguish the approach he intends for each group.

Boyd also attempts to mention and include all drugs, yet concentrates overwhelmingly on marijuana. Pot is becoming more and more accepted, though, and instead of scapegoating it as the source of all drug problems (which seems simplistic at best), I wondered why Boyd didn’t focus more on prescription drugs—especially since this is the fastest growing area of abuse and addiction.

Finally, there’s a bit of a problem in the last part of the book, where Boyd recommends seeing a primary care doctor to begin the recovery process: The suggestion comes after an entire section on how primary care practitioners don’t have time, motivation, or expertise to notice, let alone care about, the almost-addicted population.

Boyd himself identifies one problem with his “almost addicted” framework: “I wish I could offer some completely black and white advice about using drugs that would be applicable for everyone, but doing so would probably be intellectually dishonest,” he writes. “You’ll have to decide where to draw the line on what kind of presence that drugs — legal or not — can have in your life.”

Regardless of these issues, Almost Addicted is still a well-researched and cited work with information and advice for those who are verging on succumbing to addiction. The emphasis on early intervention, before one experiences traumatic consequences, is not only valid, but an essential concept that will hopefully push our notion of drug treatment forward.

Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
Hazeldon Publishing (Harvard Health Publications), 2012
Paperback, 264 pages
$14.95

You think you are being verbally abused by your partner. In fact, you suspect that you are in an impossible situation, living with a partner who doesn’t honor you, wants to change you, or at least wants always to be in charge at your expense.

It’s hard to admit it. It’s terrible to give up the image you once had of your guy as a loving, strong, smart and caring mate. But it’s been a long time since you saw him that way. Instead, you find yourself always braced for the next verbal assault; the next incident where you are found lacking in some way or to blame for things being the way they are. You feel ashamed and sad and angry but stuck. It’s hard to believe it. You don’t understand what happened. You even sometimes think it is all your fault.

Why do women stay with men who put them down? The reasons are varied and complicated.

It’s not uncommon for partners to be completely taken by surprise. Often, people who abuse do nothing of the sort while dating. If the person in pursuit makes any negative comment, it is quickly explained away. There are apologies and promises. He may even cry. Once married, the situation turns. Now that he has her, he doesn’t feel the need to keep himself in check. Afraid that she will in any way have the upper hand in any discussion, he begins a campaign to keep her off balance. The wife is mystified. She wonders what she did wrong. Where did the fun guy she married go? He tells her it’s all her fault. If he is artful about it, she wonders if he is right and works overtime to fix it – not understanding that he doesn’t have any intention of fixing it.

Other women think they can see the insecurity inside the person who is always asserting control. She tries to help him. She agrees with him that life has been unfair to him. She sides with him against the world, not understanding that in his eyes the world includes her. When he turns on her, she tries to be understanding and to explain the situation to him. Once in a while, he even accepts her help, which gives her the false impression that things are changing. What she doesn’t understand is that his insecurity is bigger than his love for her. It is bigger than rational thought. It is bigger than his desire to have a mutual, equal partnership.

Still other partners think the problem is one of communication. Couples therapists and counselors will tell you that the most frequent presenting problem is “we can’t communicate.” Often enough, what that means is that one of the partners doesn’t really want to communicate if communication means sharing decision-making and power. From his point of view, she stubbornly won’t understand when he is being perfectly clear that he’s the one in charge. She is sure that the therapist will help him recognize that he needs to hear another point of view. After all, he is a rational person, right? She thinks he wants the relationship to succeed as much as she does. She doesn’t get it that a need for control isn’t rational and, yes, he wants the relationship to succeed, but only on his terms.

Other women are too scared, insecure, embarrassed, or dependent to leave. Her confidence is shot. Over time, she’s been worn down and worn out. She may have given up trying to have friends since he always objects to her spending any time with them. She may have lost any say about the finances, even if she is making the bulk of the money. She is so convinced of her own powerlessness, she doesn’t think she can make it on her own or that she can find a better match. Feeling unlovable, worthless and helpless, she sinks into a low-grade, or not so low-grade, depression that keeps her stuck.

What to Do if You Are Being Verbally Abused

After soul-searching, you admit it. You are in a relationship that is making you feel bad about yourself. You don’t want to give up on it but you also can’t stand the idea of spending the rest of your life fearing that you’ll be torn down whenever you begin to feel good about yourself or whenever your opinion differs from that of your spouse. You know it isn’t good for you. Just as important, you know that it isn’t good for your kids to grow up believing this is the way people who love each other treat each other.

7 Reasonable Responses to Unreasonable Verbal Abuse

1. Give up on the idea of trying to change him. You can’t. There are important but mistaken reasons why he is the way he is. It may be grounded in his own upbringing, his insecurities or in a narcissistic personality disorder. You can’t do his therapeutic work for him. But – if he wants to change himself, there’s hope. Unless he has a history of being violent, you could ask him to get into some therapy before your relationship is beyond retrieval.
2. Never match his verbal abuse with that of your own. It won’t teach him a thing. It will only confirm in his mind that you are the irrational one. Instead, take the high road. Calmly tell him that you are sorry he feels that way about you but that you don’t share his opinion. Tell him that you love him too much to put him down.
3. Set limits. If your partner calls you names, treats you with disrespect and sarcasm, or loses it when you act only like the equal person you are, calmly tell him you expect to be treated the way he would treat someone he values, admires and respects. If he keeps it up, tell him that you will leave the conversation if he doesn’t stop. If he doesn’t stop, calmly leave the room, telling him you are giving him space to think about his behavior; you’ll be back in an hour or so. (Caution: Don’t do this if he is likely to escalate. See No. 7.)
4. People who need to control their partners often try to prevent them from having a life separate from the couple. You can’t leave if you have nowhere to go. Maintain your own support system. Make sure you spend time with your friends and stay in touch with family members you love. Friends can remind you that you are a valuable person when you start to feel like your partner is right that you aren’t.
5. If you think things won’t improve or will only get worse, start a savings account for yourself. Put enough money away that you always feel it is a choice whether or not you stay. Have at least enough for a bus ticket to your family or a friend’s. Better yet, save enough to pay rent for a few months so you never have to feel trapped.
6. Get counseling if you think your relationship is salvageable. If you’ve tried your best but you and your partner haven’t been able to forge a loving, mutually supportive relationship, find a couples therapist to help you. If your partner won’t go because of his pride, stubbornness, or his conviction that you are the only one who needs “fixing,” go yourself. You need the support. Your counselor may be able to help you identify ways to make counseling a little less threatening to your partner so he might join you.
7. If your partner has escalated from verbal to physical violence – leave. There are domestic abuse programs in almost every city in the U.S. Counselors there can help you figure out where to go and what to do. If you are in a rural area of the U.S. or in a country without such help, go online. Make sure you use a computer your partner can’t use. Some people become violent when they see that their partners have tried to reach out for some help. In the U.S., you can call the National Domestic Violence Hotline at 1-800-799-7233. For more information about their services, click on thehotline.org

Enabling is “removing the natural consequences to the addict of his or her behavior.” Professionals warn against enabling because evidence has shown that an addict experiencing the damaging consequences of his addiction on his life has the most powerful incentive to change. Often this is when the addict “hits bottom” – a term commonly referred to in Alcoholics Anonymous.

Codependents often feel compelled to solve other people’s problems. If they’re involved with addicts, particularly drug addicts, they usually end up taking on the irresponsible addict’s responsibilities.

Their behavior starts as a well-intentioned desire to help, but in later stages of addiction, they act out of desperation. The family dynamics become skewed, so that the sober partner increasingly over-functions and the addict increasingly under-functions.

This builds resentment on both sides, along with the addict’s expectation that the over-functioning partner will continue to make things right when the addict doesn’t meet his or her responsibilities.

The Al-Anon program suggests that you don’t do for the alcoholic what he or she is capable of doing. Yet, codependents feel guilty not helping someone, even when the person caused the situation and is capable of finding a solution. It’s even harder for codependents to say no to requests for help. The pressure to enable can be intense, particularly coming from suffering or angry addicts, who generally use manipulation to get their needs met.

Examples of enabling include: giving money to an addict, gambler, or debtor; repairing common property the addict broke; lying to the addict’s employer to cover up absenteeism; fulfilling the addict’s commitments to others; screening phone calls and making excuses for the addict; or bailing him or her out of jail.

How to Stop the Enabling Behavior

Often addicts aren’t aware of their actions when intoxicated. They may have blackouts.

It’s important to leave the evidence intact, so they see how their drug use is affecting their lives. Consequently, you shouldn’t clean up vomit, wash soiled linens, or move a passed-out addict into bed. This might sound cruel, but remember that the addict caused the problem. Because the addict is under the influence of an addiction, accusations, nagging, and blame are not only futile, but unkind. All these inactions should be carried out in a matter-of-fact manner.

Stopping enabling isn’t easy. Nor is it for the faint of heart. Aside from likely pushback and possible retaliation, you may also fear the consequences of doing nothing. For instance, you may fear your husband will lose his job. Yet, losing a job is the greatest incentive to seeking sobriety. You may be afraid the addict may have an auto accident, or worse, die or commit suicide. Knowing a son is in jail is sometimes cold comfort to the mother who worries he may die on the streets. On the other hand, one recovered suicidal alcoholic said he wouldn’t be alive if his wife had rescued him one more time.

You may have to weigh the consequences of experiencing short-term pain vs. long-term misery, which postpones the addict’s reckoning with his or her own behavior. It requires great faith and courage not to enable without knowing the outcome. Although enabling can prolong the addiction, not all addicts recover, even despite counseling and going to many rehabs. This is why the 12 Steps are a spiritual program. They begin with the recognition that you’re powerless over the addict. The desire for sobriety must come from him or her.

To avoid unnecessarily suffering the consequences of an addict’s drug use, it’s vital you begin to reclaim your sense of autonomy and take steps wherever possible not to allow the addict’s drug use to put you in jeopardy. Allowing the addict to drive you or your child while under the influence is life-threatening. On the other hand, taking on the role of designated driver gives the addict free license to use or drink. The spouse might refuse that enabling role by taking a separate car. If the addict is charged with DUI, it might be a wake-up call.

Always have a Plan B to cope with addicts’ unreliability; otherwise, you end up feeling like a victim. Sometimes, Plan B might be going to a 12-Step meeting or just staying home and finishing a novel. The important thing is that it’s a conscious choice, so that you don’t feel manipulated or victimized.

It’s a good idea to follow through with plans, whether it’s keeping counseling appointments or social engagements that the addict refuses to attend at the last minute. This precludes the addict’s attempt to manipulate the family.

Having some recovery under his belt, one husband resolved to remain on vacation with the children when his alcoholic wife suddenly decided she wanted to return home. He later remarked, “It was the first time in years that my mind was free of obsessing about her.”

In another situation, an alcoholic husband picked a fight an hour before guests were arriving for dinner. He threatened to leave unless they were uninvited. When his wife refused, he stormed out and hid in the bushes, while his wife enjoyed herself. Feeling ashamed, he never repeated that ploy.

Enabling has implications for all codependents, because they generally sacrifice themselves to accommodate others’ needs, solve others’ problems, and assume more than their share of responsibility at work and in relationships.

Common examples are a woman looking for a job for her boyfriend, a man paying his girlfriend’s rent, or a parent meeting his child’s responsibilities that the child can do or should be doing. Learning to be assertive and set boundaries are often the first steps in stopping enabling. See my book How to Speak Your Mind – Become Assertive and Set Limits.

Email me if you’d like to hear an interview I gave on enabling.

Verbal abuse takes many forms: from loud rants to quiet comments; from obvious put-downs to not-so-obvious remarks that undermine the partner. What all the methods have in common is the need to control, to be superior, to avoid taking personal responsibility, and to mask or deny failures.

The myth in Hank’s and Mary’s relationship is that he is much, much smarter than she is. She does admire him, but not as much as he admires himself. He trumps anything she says with a stronger, maybe louder opinion. He calls her ideas naïve or ill-informed or even idiotic. Mary thinks he may be right. Since marrying Hank 3 years ago, her self-confidence has plummeted.

Jake, on the other hand, hides his need for control in his relationship with Marilyn under sarcasm, jokes and puns. “Why,” he says, “doesn’t Marilyn understand I’m just joking?” Why? Because she is the object of those sarcastic remarks, “jokes” and puns. He both publicly and privately keeps her off-balance by joking about her insights, her goals, and the things she cares most about. She has come to question her judgment about her ideas and about him. Lots of people think he’s funny. Maybe, she thinks, he doesn’t mean it. Maybe, she tells herself, she needs to have a better sense of humor.

Frank can’t stand to be seen as responsible for any failure. When he makes a mistake, his mantra is “I may be wrong but you are wrong-er.” If his wife says he has hurt her feelings, he claims not to remember having said what he said or having done what he did. He tells her she is “too sensitive.” He whines about being a scapegoat for other people’s problems. He doesn’t seem to get that he is the perpetrator, not the victim.

Al isn’t subtle. His wife and kids never know what to expect when he comes home. Will loving, caring Al be at the door with treats for the kids and something nice for his wife? Or will the Al who flies into rages, who threatens them with physical abuse and swears and calls them names show up? The whole household walks on eggshells. Even when loving-Al is around, things can change in an instant if he is the least bit frustrated. Last week when his 5-year-old spilled milk at the dinner table, he yelled at her for an hour. When his wife tried to intervene, he backhanded her. Everyone got real quiet. Then – the storm blew over and Al left for the rest of the evening.

If you recognize yourself in any of the above scenarios, you are being verbally abused. Make no mistake: Although verbal abuse doesn’t leave visible scars, it does do damage. The victims’ self-esteem is eroded. Children who watch one parent being put down and diminished by the other develop a skewed and sad view of how relationships are supposed to be.

6 Signs You Are Being Verbally Abused

1. Like Mary, you feel you just can’t win. No matter how carefully or kindly you try to work out a problem, your partner says things that make you feel like you’re in the wrong.
2. Your self-esteem and self-confidence are shot. Your partner isn’t your greatest fan but your greatest critic. He often tells you that his comments are “for your own good.”
3. When you say he has hurt your feelings your partner, like Frank in the scene above, tells you that you are too sensitive. When you point out that he has said something inappropriate or hurtful, he accuses you of trying to make him look bad. You notice that he rarely takes responsibility for his part of a problem. Somehow he manages to convince himself and even you that anything that goes wrong is your fault.
4. You often are the brunt of jokes that make you feel bad. The guy who is fun and fun-loving outside the family unleashes a more vicious or undermining humor inside. Other people don’t believe you that the guy they know is so different from what you experience. Like Marilyn, you find yourself constantly questioning yourself.
5. You have to walk on eggshells at home. Your home isn’t a sanctuary for you and your kids. It is the place where you are most afraid and embarrassed. You and the kids stay away as much as you can. When you are there with your partner, you all do everything you can to make sure nothing happens that could set him off.
6. If you’re not very careful, the verbal abuse escalates to physical altercations. Even if you are very careful, what starts with words can end up with physical aggression toward you or destroying things, especially things you value.

Whoever made up that rhyme about “sticks and stones will break my bones but names will never hurt me” was just plain wrong! Words do hurt. They can break a person on the inside just as surely as a whack with a stick bruises the outside. People who are subjected to verbal abuse suffer. People who are subjected to it over time can get so used to it that they lose their sense of themselves as people worth loving. If you see yourself in any of these stories, know you are not alone. There are things you can do. Part II of this article will discuss them.

Codependency underlies all addictions. The core symptom of “dependency” manifests as reliance on a person, substance, or process (i.e, activity, such as gambling or sex addiction). Instead of having a healthy relationship with yourself, you make something or someone else more important. Over time, your thoughts, feelings, and actions revolve around that other person, activity, or substance, and you increasingly abandon your relationship with yourself.

Recovery entails a 180-degree reversal of this pattern in order to reconnect with, honor, and act from your core self. Healing develops the following characteristics:

• Authenticity
• Autonomy
• Capability of being intimate
• Integrated and congruent values, thoughts, feelings, and actions

Change is not easy. It takes time and involves the following four steps:

1. Abstinence. Abstinence or sobriety is necessary to recover from codependency. The goal is to bring your attention back to yourself, to have an internal, rather than external, “locus of control.” This means that your actions are primarily motivated by yourvalues, needs, and feelings, not someone else’s. You learn to meet those needs in healthy ways.Perfect abstinence or sobriety isn’t necessary for progress, and it’s impossible with respect to codependency with people. You need and depend upon others and therefore give and compromise in relationships. Instead of abstinence, you learn to detach and not control, people-please, or obsess about others. You become more self-directed and autonomous.

   If you’re involved with an abuser or addict or grew up as the child of one, you may be afraid to displease your partner, and it can require great courage to break that pattern of conceding our power to someone else.

2. Awareness.It’s said that denial is the hallmark of addiction. This is true whether you’re an alcoholic or in love with one. Not only do codependents deny their own addiction – whether to a drug, activity, or person – they deny their feelings, and especially their needs, particularly emotional needs for nurturing and real intimacy.You may have grown up in a family where you weren’t nurtured, your opinions and feelings weren’t respected, and your emotional needs weren’t adequately met. Over time, rather than risk rejection or criticism, you learned to ignore your needs and feelings and believed that you were wrong. Some decided to become self-sufficient or find comfort in sex, food, drugs, or work.

   All this leads to low self-esteem. To reverse these destructive habits, you first must become aware of them. The most damaging obstacle to self-esteem is negative self-talk. Most people aren’t aware of their internal voices that push and criticize them — their “Pusher,” “Perfectionist,” and “Critic.”¹

3. Acceptance.Healing essentially involves self-acceptance. This is not only a step, but a life-long journey. People come to therapy to change themselves, not realizing that the work is about accepting themselves. Ironically, before you can change, you have to accept the situation. As they say, “What you resist, persists.”In recovery, more about yourself is revealed that requires acceptance, and life itself presents limitations and losses to accept. This is maturity. Accepting reality opens the doors of possibility. Change then happens. New ideas and energy emerge that previously stagnated from self-blame and fighting reality. For example, when you feel sad, lonely, or guilty, instead of making yourself feel worse, you have self-compassion, soothe yourself, and take steps to feel better.

   Self-acceptance means that you don’t have to please everyone for fear that they won’t like you. You honor your needs and unpleasant feelings and are forgiving of yourself and others. This goodwill toward yourself allows you to be self-reflective without being self-critical. Your self-esteem and confidence grow, and consequently, you don’t allow others to abuse you or tell you what to do. Instead of manipulating, you become more authentic and assertive, and are capable of greater intimacy.

4. Action.Insight without action only gets you so far. In order to grow, self-awareness and self-acceptance must be accompanied by new behavior. This involves taking risks and venturing outside your comfort one. It may involve speaking up, trying something new, going somewhere alone, or setting a boundary. It also means setting internal boundaries by keeping commitments to yourself, or saying “no” to your Critic or other old habits you want to change. Instead of expecting others to meet all your needs and make you happy, you learn to take actions to meet them, and do things that give you fulfillment and satisfaction in your life.Each time you try out new behavior or take a risk, you learn something new about yourself and your feelings and needs. You’re creating a stronger sense of yourself, as well as self-confidence and self-esteem. This builds upon itself in a positive feedback loop vs. the downward spiral of codependency, which creates more fear, depression, and low self-esteem.

   Words are actions. They have power and reflect your self-esteem. Becoming assertive is a learning process and is perhaps the most powerful tool in recovery. Assertiveness requires that you know yourself and risk making that public. It entails setting limits. This is respecting and honoring yourself. You get to be the author of your life – what you’ll do and not do and how people will treat you.²

The four A’s are a roadmap. Learn all you can about recovery. Join a 12-step program and begin keeping a journal to know yourself better. Codependency for Dummies lays out a detailed recovery plan with self-discovery exercises, tips, and daily reminders. Your recovery must be your priority. Most important, be gentle with yourself on your journey.

1. To help you, I wrote a handy ebook, 10 Steps to Self-Esteem — The Ultimate Guide to Stop Self-Criticism.
2. Because being assertive is so fundamental to recovery, I wrote How to Speak Your Mind — Become Assertive and Set Limits.

Bill Wilson, the founder of Alcoholics Anonymous, was influenced by Carl Jung. In correspondence, Jung wrote Wilson that the cure for alcoholism would have to be a spiritual one — a power equal to the power of spiritus, or alcohol.

The 12 Steps are that spiritual remedy. They outline a spiritual process of surrender of the ego to the unconscious, or a higher power, and very much resemble the process of transformation in Jungian therapy.

The following is a description of that process. However, the fact that it is described in a linear fashion is misleading, because the Steps are experienced both simultaneously and in a circular manner. Although the same process is applicable to recovery from addiction to a substance (e.g. alcohol, drugs, food) or a compulsion, such as gambling, debting, or caretaking, the focus of this article is on alcohol and drug addiction and the family members in a codependent relationship with the alcoholic or addict.

Facing the Problem

The beginning of recovery is acknowledging that there is a problem involving drugs or alcohol, that there is help outside oneself, and the willingness to utilize it. This also represents the very beginning of trust in something beyond oneself (such as a therapist, sponsor, or the program), and the opening up of a closed family system. Invariably, it takes years to face the problem.

With growing understanding of the problem, denial further thaws. In Step 1: “We admitted we were powerless over alcohol — that our lives have become unmanageable.”¹ The addict begins to understand she or he is powerless over the drugs or alcohol, and the codependent begins to understand that she or he cannot control the substance abuser. The struggle not to drink and the codependent’s vigilant watching the addict begin to slip away. Gradually, attention starts to shift from the substance, and, for the codependent, the substance abuser, to focus on oneself.

There are deeper levels of working the First Step. The first stage of coming out of denial is to acknowledge that there is a problem; second, that it is a life-threatening problem over which one is powerless; and third, that actually the problem lies in one’s own attitudes and behavior.

Surrender

The acknowledgment of powerlessness leaves a void, which formerly was filled with mental and physical activity trying to control and manipulate the addiction or the addict. Feelings of anger, loss, emptiness, boredom, depression, and fear arise. The emptiness that was masked by the addiction is now revealed. It is an awesome realization when you acknowledge that you or your loved one has a life-threatening addiction over which you are powerless, subject only to a daily reprieve. Now, with a modicum of trust, one acquires a willingness to turn to a power beyond oneself. This is Step 2: “Came to believe that a Power greater than ourselves could restore us to sanity.”

In the book Alcoholics Anonymous, it states: “Without help it is too much for us. But there is One who has all power — that One is God.” (p. 59). That power can also be a sponsor, therapist, the group, the therapy process or a spiritual power. Reality itself becomes a teacher, as one is asked to continually “turn over” (to that Power) an addiction, people, and frustrating situations. The ego gradually relinquishes control, as one begins to trust that Power, the growth process, and life as well.

Self-Awareness

What has been happening up until now is an increasing awareness and observation of one’s dysfunctional behavior and addiction(s) – what is referred to as “insanity” in the Second Step. This crucial development signifies the genesis of an observing ego. Now one begins to exercise some restraint over addictive and undesirable habits, words, and deeds. The Program works behaviorally as well as spiritually.

Abstinence and forbearance from old behavior are accompanied by anxiety, anger and a sense of loss of control. New, preferable attitudes and behavior (often called “contrary action”) feel uncomfortable, and arouse other emotions, including fear and guilt. From a Jungian perspective, one’s “complexes” are being challenged:

“Every challenge to our personal habit patterns and accustomed values is felt as nothing less than the threat of death and extinction of our selves. Invariably such challenges evoke reactions of defensive anxiety.” (Whitmont, p. 24)

Group support is important in reinforcing new behavior, because the emotions triggered by these changes are very powerful and can retard and even arrest recovery. Additionally, resistance is experienced from self, family, and friends for the very same reasons. The anxiety and resistance may be so great that the addict or abuser may go back to drinking or using.

There is help in Step 3: “We…turn our lives over to the care of God as we understood God.” This is the practice of “letting go” and “turning it over.” As faith builds, so does the ability to let go and move toward more functional behavior.

1. Other words, such as “food,” “gambling” or “people, places and things” often are substituted for the word alcohol.

Or maybe you’re a bundle of nerves. You are so anxious you just want to hide. You’re nervous about your job. You’re scared to speak up even when you know you should and could. You are so anxious that you are anxious about being anxious.

Or maybe the issues are about relationships. You don’t have one or the one you have isn’t the one you want. You and your partner are fighting all the time. Every day seems to be “same fight, different day.” Trust has become a huge issue. Neither one of you can relax into your relationship. You each wonder where the love and sweetness and tenderness have gone.

And then there are family issues: The mother you can’t get along with. The father who expects too much or too little of you. Siblings who are mean-spirited, favored, or so self-centered that you feel constantly taken advantage of. Parents who are fighting. Parents who are splitting. Family you are expected to like but who are entirely unlikeable – and here comes another painful family event.

Any of these types of issues can stretch a person beyond his or her ability to cope. Any of them can challenge the most creative, caring, and responsible person, You’ve tried your best. You’ve tried to look at a brighter side, to be rational, to be smart about whatever it is. But you still can’t figure things out. You still feel alone in your troubles and without the inner resources or the outer supports to change things. This is when people often go to therapy. You wish you could. But you have no insurance and you know it can be costly. The situation seems hopeless.

It’s not. Serious, yes. Hopeless, no.

Inexpensive and Alternative Treatment Options

There are many ways to get the help you need, therapist or no. Before you give up on the idea of getting some therapeutic help, consider these alternatives.

Sometimes therapy is free or low-cost.

Depending on your problem, there may be funded or subsidized therapy available to you. Many communities have women’s centers that offer free services to women who are being abused. Many have free services for adolescents. And an increasing number of communities have men’s resource centers to help men with anger management, relationship or vocational problems. Go online and check.

Employee Assistance Programs (EAP).

Many businesses and companies offer a limited counseling benefit. Usually the company provides three to six sessions. If you need further help, the counselor will refer you to a local therapist. Check with your human resources department to see if there is an EAP counselor at your workplace. Often even a couple of focused sessions is enough to offer some relief.

Sliding scales and free slots.

Many mental health clinics and many therapists in private practice have sliding fee scales so that people can pay what they can afford. Ask your doctor if he or she knows who offers this service. Call some of the therapists in your area and ask. Many therapists keep a number of slots at a lower rate as their way of giving to their community.

Support groups.

Often a support group can be very therapeutic. By talking to people with a similar problem, you will feel less alone. Often there are people in the group who are a little ahead in their healing and who can offer you good practical advice as well as emotional support. Local hospitals, libraries, churches, and schools often offer support groups for grief, parenting issues, managing chronic illness, etc.

PFLAG (Parents and Friends of Lesbians and Gays) offers support to those supporting family members and friends who are coming out. There are also support groups online and in the community for gays, lesbians, and transgendered people who need information and advice.

Parent education classes.

Not all problems are mental health issues. Parenting is difficult. Often people new to parenting or new to a stage of parenting could just use some additional information and the reassurance and advice that can come from parents who have been there and done that. Often such groups are offered through the school system or through local parent centers.

12-step Groups.

Alcoholics Anonymous, Al-Anon (for families of problem drinkers) and Alateen (for teenage family members) offer support to people who are struggling with alcoholism and to their families. Other spinoffs include Overeaters Anonymous, Narcotics Anonymous, Clutterers Anonymous and Parents Anonymous. If you think a 12-step program is for you, search your issue and “anonymous” and you are likely to find a group.

The National Alliance on Mental Illness (NAMI) has chapters throughout the U.S. They often offer support groups for those struggling with mental illness as well as for family members.

Online support groups.

Name a problem and there is probably an online support group for it. Here at PsychCentral, there are over 100 such forums and groups. Members are not professionals. They are people who are grappling with the same issue you are. Their compassion and understanding can help you feel less alone. Often members offer experience and wise suggestions.

Are you a veteran? Every branch of the service has a program for military personnel and their families. Call your local Veterans Administration office for information.

Are you a teen? Many high schools have free counseling available through the guidance department. Often the guidance counselors are themselves counselors and can be very helpful with both individual and family problems. Sometimes they know which therapists in town have free or nearly-free services and where you can go for further help.

Are you in college? Check to see whether the health services at your school include a mental health department. Often the health insurance you pay for at school can enable you to see a local therapist for at least a few sessions.

Hotlines and warmlines.

There are important hotlines and warmlines in almost every country. In the U.S., the National Suicide Prevention Lifeline (1-800-273-8255) is available 24/7. The Boys Town National Hotline is also available 24/7 for teens (girls as well as boys). Google “hotline” and your problem and you are likely to find a number to call.

Houses of worship.

Spiritual leaders often have had training in counseling as well as in the practices of their faith. See if your church or synagogue or house of faith offers such help. If your spiritual leader isn’t comfortable dealing with secular problems, he or she may be able to refer you to someone who can.

Journaling or writing letters you will never send can be an important method for self-help. Don’t get put off by having to put something down. You’re the only one who is going to see it. Writing out what troubles us often helps us put our feelings into perspective. Often enough, a solution will come as you work to make your problems clear.

Bibliotherapy is a fancy name for reading a book. Whatever your problem, someone else has probably written about it to share their journey of healing. Sometimes we learn best from reading how someone else did and did not address issues. Search for your issue at one of the major online bookstores and you can find what you are looking for.

Prayer, meditation, chanting.

Anything that helps you relax and get out of yourself for a bit can do wonders for your state of mind. Turning your problems over to God, your higher power or the universe can help relieve the pressure and begin the healing.

Get off the screens and go outside.

Mother Nature is a great therapist. Stop spinning about your problem with online friends who are in the same spin and go for a long walk instead. Open your senses to the outdoors and you may be able to cut your problems down to a more reasonable size.

Talk to a trusted friend or family member.

You know who they are. Many of us have a friend or relative who is wise and loving and supportive. Don’t waste your time on anyone else. People who are critical or judgmental will make you feel worse. Reach for the people in your life who will listen with their hearts and who will validate your strengths.

Take care of yourself.

Getting enough sleep, eating right, and making sure you get a little exercise each day can do wonders for your troubles. You may not feel like doing any of it. But doing it, whether you feel like it or not, can help you start to feel a bit better. You will have taken a step toward self-care and self-love that is the basis for any therapeutic action.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction gives a taste of the Prinsen’s gutsiness at the outset, as she begins by acknowledging that she herself has played a part in her family’s difficulties. In this, her first book, the author tells the searingly honest and remarkably brave story of her family’s battles with mental illness, charting the ongoing chaos they’ve faced following Sean’s service in Bosnia.

After his discharge, Prinsen tells us, her husband returns home to the States and is given a prescription for narcotic pain medication to help him cope with the pain of a neck injury he suffered during military training. It is here that things begin to quickly spiral out of control, as Sean becomes addicted to his pills and begins to self-medicate with additional over-the-counter medications and alcohol. His behavior throws the entire family into disarray.

“Alcoholism is an enigma,” Prinsen writes, “— as complex as it is puzzling. It follows no rules and has no boundaries. Like a giant vacuum, alcoholism goes after everything and everyone in its path. It is a family disease — everyone in the family gets sick.”

Because Sean is reluctant to speak about the trauma he experienced in the military, or to share the truth about his depression with anyone, Prinsen assumes that her husband is simply suffering from addiction. It takes many years for her to understand and recognize the nature of PTSD and to connect the dots between the trauma Sean experienced in Bosnia and his subsequent depression and substance use.

“For so long, in the early stages of Sean’s addiction, I didn’t understand the destructive interplay between Sean’s PTSD, his depression, and his substance abuse,” she writes, explaining:

… Only he understood the desperate need to escape from the crippling flashbacks and the intrusive thoughts that blindsides him without warning, bringing with them the full force of the emotions that he felt in the original traumas. Only he understood the exhausting anxiety that kept him on high alert for ‘danger’ 24/7 and the need for something — anything — to keep that anxiety at bay. Only he understood how the pills helped him get through a night that would otherwise be plagued by the alternating horrors of nightmares or insomnia.

Sean’s PTSD continues to go undiagnosed, until he finally reaches crisis point. One night, in 2007, Sean suffers a complete breakdown and attempts what is known as “police-assisted suicide.” He becomes threatening and aggressive, arms himself with a loaded weapon, and calls the police to the house, almost as a challenge.

Prinsen recalls the horrific events of this evening, as she and her two young children are forced to witness Sean’s breakdown and frightening behavior, fearing not only for his life, but for their own. Sean survives, is arrested, and is subsequently jailed. Then, incredibly, after his release, the same thing happens again exactly a year later, as he suffers a repeat breakdown and once again challenges the police to come and get him, putting his family’s lives at risk in the process. By this point you’d be easily forgiven for wondering why on earth Prinsen doesn’t just leave, but it’s here that the relevance of the book’s title becomes clear. Prinsen adopts the military philosophy of “No One Gets Left Behind” and refuses to abandon Sean, no matter what anyone else tries to convince her, or how tempting it might sometimes seem. Looking back, she realizes that she plays a codependent role in the relationship, too.

But Prinsen doesn’t let her husband off the hook lightly, either, and always holds him fully accountable for his actions. “It took me many more years to fully grasp the reality that abuse isn’t just physical,” she writes. “Sean was a master at manipulating my emotions to get just what he wanted, and as difficult as it is even today to say the words — that is abuse.” Sean also used threats of suicide and self-harm to keep her from leaving or setting healthy boundaries, she tells us, recognizing it as a form of abuse. His “screaming, the holes in the wall, the slammed doors, and the broken objects” are also “definitely abuse.”

Later, Prinsen recounts, with brutal honesty, how she at times longed for her husband’s demise:

Sean stayed in our home, but I was finally starting to understand that Sean would never get help until he hit rock bottom. He needed to fall hard if he was ever going to get up again. I did something then that I’ve since found out is common behavior for the loved ones of addicts: I began to systematically pray for my husband’s downfall. I didn’t want him to get hurt. I didn’t want him to injure someone else and live with the regret. I didn’t want him to suffer lifelong consequences. I just wanted him to suffer enough to want to get help for himself.

It is rare to find these sorts of frank admissions in a personal memoir, let alone a first book, and it is this fearless honesty that makes Prinsen’s story so powerful. One can only imagine how difficult it must have been for her to put all of this into writing, knowing that her husband, friends, and family would all be able to read it. At one point in the story she finds herself wondering, “What will people think when they see this in the newspaper?”

In addition to sharing her own raw experiences, Prinsen also follows every section of the book with a short factsheet, providing the reader with a brief summary of the fundamental topics covered and links to further resources. These factsheets might easily have seemed disruptive or out of place, but Prinsen keeps them concise and informative.

The author also raises some vital ethical and political issues, questioning the morality of a government that puts soldiers in situations that destabilize their mental health, then prosecutes them as criminals. “How can we expect our veterans to come back to their homes and be ‘normal’ again after they have seen humanity at its worst?” Prisen recalls thinking angrily as she and Sean walked out of court one day. She feels sick when considering that Sean, who had never had any trouble with the law before he was deployed to Bosnia, was now a twice-convinced criminal. “What kind of a country is this to condemn and shame its own soul-wounded soldiers in such a way?” she asks. “Why don’t we just help them?”

Blind Devotion lives up to its name as a remarkable testament to the unquestioning power of love against all other odds, including the most destructive forms of mental illness. This is a story of survival, with protagonists who are determined to conquer their personal demons and triumph, no matter what. Prinsen’s writing will appeal to every reader, regardless of whether or not they’ve had to deal with PTSD. For the hundreds of thousands, if not millions, of military families who can relate to her experiences firsthand, hearing Prinsen speak about them so openly and shamelessly will surely be a relief.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction
Hazelden, September, 2012
Paperback, 348 pages
$14.95

An estimated 23 million Americans struggle with addiction. Many of these addicts seek AA or NA as part of their road to recovery. A number of rehabilitation centers focus on the 12 steps and urge those in recovery to continue attending meetings on a regular basis to maintain their hard-earned sobriety.

The 12-step program is responsible, in part, for saving many lives. This cannot be debated, but neither can the reality that the program is not effective for everyone. Those recovering from addiction recover in different ways, and the underlying spiritual elements of AA and NA can be confusing and uncomfortable for some.

Deborah’s story is common: Drugs and alcohol, once something she could control, began to define her life after a time. It is also important: It sheds light on the reality that recovery does not necessarily have to be found within “-Anonymous” programs. In fact, some of the principles of the steps can be frightening for people.

Deborah has been sober for over seven years, although she still and will forever describe herself as “a recovering addict.” This is the general consensus in regard to addiction recovery. Similar to chronic mental or physical illness, the nature of addiction requires those living with it to constantly monitor mood changes, life events, and triggers that may spawn relapse. Addiction is, in fact, categorized as a mental illness.

Deborah has two children, both under the age of 15, and she has been married for 23 years. She works part-time as a nurse and spends her spare time hiking and with her family and a close group of friends, many of whom also are in recovery. While this may sound like the stuff of a normal, everyday life, it was not always this way.

Deborah describes the impact of her addiction on her family:

My children were young when I was active in my addiction. I don’t believe they understood what was going on, though my husband worked to be honest with them. He told them I was sick and would become well. When I was an addict, my family, while important, were not as important as drugs. I felt I needed drugs in order to function, and I did function for some time. I managed to complete my nursing degree, but it all fell to pieces. Addiction nearly killed me, and I needed help. I finally realized, after five years of serious addiction, that I could not do it on my own.

During her stay in a rehabilitation center, Deborah was taught that the 12 steps were an important part of her success. However, she struggled with some of the core principles, the spiritual principles in particular. She is not alone.

The basic text of Narcotics Anonymous states as part of its 12 steps:

We admitted to God, to ourselves, and to another human being the exact nature of our wrongs… We were entirely ready to have God remove all these defects of character… We sought, through prayer and meditation, to improve our conscious contact with God as we understood Him, praying only for the knowledge of His will for us and the power to carry that out.

I presented these excerpts to Deborah; she was already well aware of them. In fact, she’d spent a very long time working to understand them and to apply the steps to her recovery journey. While the steps do make a point of mentioning that a person is to understand God “…as we understood Him,” implying that the program does not require a person to be religious nor adhere to any specific principles, the words do still feel stifling to those of other belief systems.

Deborah spent the better part of a year attending the meetings at least three times a week. She obtained a sponsor, a commonly recognized hallmark of the program, in order to work toward completing the 12 steps.

Nevertheless, as hard as she tried to work the program, she felt confused.

My sponsor, an exceptionally kind woman, worked to help me understand the concept of a ‘Higher Power.’ We spent hours over coffee discussing my innate reluctance to approach recovery in this fashion. It became difficult for us, as the months passed and I remained uncomfortable with the ideas, to maintain a healthy relationship with her. I realized then, after I had a year of sobriety under my belt, that the program would not work for me. I had initially assumed that because it has worked for so many people, it would work for me if I tried hard enough. I had to find another approach to my recovery. I had to find my own way.

After deciding to leave the program, Deborah and her family were anxious:

I had spent a long time thinking about what direction I would take. Instinctively, I knew the program would not work for anymore. My husband was understandably nervous. He urged me to stay and give it more time, but I had put enough time into trying to fit the mold. Yes, I was afraid, but not because I thought leaving would cause relapse. I was afraid of recovering alone.

Although she decided the 12 steps were not for her, Deborah recognized the difficulty — if not impossibility — of recovering alone:

It was sort of scary at first, but I was certain I was not the only one who needed to approach recovery in a unconventional way. I was surprised to find support groups that focused on recovery without any of the spiritual elements. I met fantastic people, and while we had meetings, we also took a different approach. We hiked together and found different outlets, doing things we had never done before. I actually skydived this year, something I never would have done otherwise.

Addiction is an isolating disease. While 12-step programs undeniably help many addicts, other options do exist for those who feel they do not fit in. The goal for addicts is ultimately to find a life free of addiction, no matter the route taken to get there.

References

Bill W. (n.d.). In Wikipedia. Retrieved September 14, 2012, from http://en.wikipedia.org/w/index.php?title=Bill_W.&oldid=511410040

Egan, Pamela. (n.d.). 23 million Americans addicted to drugs and alcohol. Pamela Egan: Nurse Practitioner, Diabetes Education and Health Columnist. Retrieved from http://www.pamelaegan.com/articles/addiction/

J., Deborah (surname intentionally withheld). September 14, 2012. Personal interview with author.

Narcotics Anonymous. 2008. Narcotics anonymous. (6th ed.). Chatsworth, CA: Narcotics Anonymous World Services, Inc.

In her book, Campion discloses the events leading up to every parent’s worst nightmare: the death of her daughter, Luce. Campion describes the heartbreak of witnessing her daughter’s descent into depression and drug use, and the helplessness and guilt she felt as both a psychiatrist and a mother. Sshe and her family were unable to prevent Luce from the early death which seemed inevitable from a young age. In her painfully honest account, Campion also explores her history and that of her family in trying to figure out what may have contributed to Luce’s death.

“Luce looked at me straight on. ‘It really sucks. I get the manic-depressive gene from you, and the weird drug reactions from Dad.’”

Campion talks of her own battle with depression and reveals her youthful suicide attempts. She also talks of her husband’s alcoholism, and the trials her family has endured because of addiction and the trauma of losing Luce. Campion confesses that she didn’t fully realize the scale of the problem until it hit her own family:

I didn’t know then that major depression strikes about one in ten women every year. According to U.S. public health data, among adults experiencing a major depressive episode, fifty-six percent thought that it would be better if they were dead, forty percent considered suicide, fifteen percent made a plan, and ten percent an attempt. Suicide is the eleventh leading cause of death among adults and accounts for well over thirty thousand deaths per year. I would learn only later that what we now call bipolar and unipolar major depressive disorders had surfaced with regularity in my family for several generations.

Much of the book comes across as Campion’s attempt to make sense of her loss and move on from it. Guilt is a recurring theme throughout the book. As Campion recalls trying to help her daughter, she comments that “Every decision I’d made during her illness could be used to flagellate myself.” Any parent will be able to identify with the agony Campion faces as she repeatedly asks herself what she could have done differently.

Looking back on that time, the hardest thing to do is recapture how dense my ‘not-knowing’ was. From today’s vantage point, it is hard – no, impossible – to ignore what would be revealed a few months later in the full-blown manifestation of Luce’s manic-depressive illness. I want to flog myself for not considering what seems so plain in hindsight: her excessive confidence, single-minded purpose, intense energy, and powers of persuasion could indicate a manic episode. Why didn’t they raise my suspicions? Some psychiatrist! Or was I, her mother, just too tempted to welcome her new bright optimism, focus, and appetite for life after years of confusing doubt… The guilt of failing my own child swells up in me like a flooding river, dirty and cold, hauling dangerous debris.

The book serves not only as an incredibly revealing, painfully honest account of a parent’s loss but as a reminder of the importance of family. It is clear from the start how important Campion’s family is to her, and how much the family relies on each other throughout their struggles:

Every single one of us had been traumatized… I thought the best way to heal was to give each other warmth, to huddle close, in order to withstand the real world’s harshness.

Indeed, Campion examines in great depth the effect the tragedy had on each family member. It is this systemic analysis of her story, taking into account the role of each individual family member, which doubtless evolves out of Campion’s professional experience as a psychiatrist. Campion wonders how and why the family were able to stay so strong and reliant on each other during their experiences, and ponders the importance of attachment:

Equally mysterious, and possibly closer to the truth: I have a strong affiliative need that I think is hardwired in most humans and other mammals, expressed in loyalty to their tribe or pride. As if the family was the basic organism whose survival may be more essential than any individual’s, the whole being greater than the sum of the parts.

While this powerful memoir will appeal to anyone who has lost a close family member, it also serves as an important reminder to all mental health professionals that they are not immune from any of the conditions which might plague their clients.

Did I think I was any better than those patients and their families, that I deserved to be spared? By virtue of what? I knew better, except that, deep down, I must have hoped that all the energy I had spent battling addiction and mental illness for years would count in my favor. As if I could bargain with fate, buy protection for my contributions. But destiny is crueler than any mafia goon.

This will be familiar territory for any professionals who might be wounded healers themselves, particularly those who have dealt with their own loss, trauma, addiction, or depression while still attempting to see clients. Campion talks of her own battle to carry on working, until she realizes that it would be unethical, and refers her clients elsewhere:

Another patient told me, on the tenth anniversary of her own suicide attempt, ‘I have been able to resist all those years because you’ve been on my side. But since your daughter died, you’re not as strong and I think I’ll kill myself.’ Her words stabbed me, but she was right and I convinced her to work with another doctor.

Although the book is at times so searingly honest that some readers may find it hard to take, this is ultimately a story of redemption. Writing this book undoubtedly was cathartic for Campion, and a therapeutic means for her to reach some kind of closure over these awful experiences. In the end, it is the simple capacity for happiness and hope which seem to have saved Campion from the same demise as her daughter:

I have been blessed with an innate ability for joy that bubbles easily in me except during the severe depressions I’ve had four times in my life. Even after months of low moods, I recovered completely and regained a buoyancy that reminds me of my grandmother, who soothed us with bedtime stories during the war… I have worked hard to deal with traumas and temper my neurotic traits, but that inborn undeserved talent for enjoying life is a gift I can only give thanks for and celebrate… Luce had no such luck.

Hope triumphs, even through the unknowable. And, for that, we must all be grateful.

Through the Unknowable: Family Life with Depression, Alcohol and Love
By Elsa Campion, MD
Vantage Press:  March 16, 2012
Paperback, 162 pages
$13.95

For seven years, from kindergarten through sixth grade, they’ve walked through the same halls and lived by the same rules with pretty much the same kids around them. In the final year, they’ve been the “big kids” of the school, assisting as reading buddies for the kindergarteners and serving as role models for all of the younger students. Now it’s on to middle school. Now it’s on to being a preteen.

Early in my career, I taught English in what was then known as junior high. I’d watch those new seventh graders enter each year with their new backpacks and scared faces. They looked sooo young compared to the ninth graders who were the bosses of the school.

They’d often get lost trying to find their classes in a much bigger school. They’d get confused by a rotating schedule of classes. They’d forget how to find their lockers. Since four elementary schools converged in one middle school, they had to reestablish their friend groups and find new people to share a table with in the lunchroom. They had to get used to having four or five or more teachers instead of one or two. And they had to learn how to take homework much, much more seriously. No wonder they looked scared. No wonder the absence rate in the first few weeks was sky high.

Parents can do a great deal to help with the transition. When kids enter a new environment with some sense of what to expect, they are more likely to be successful and less likely to be overwhelmed. Help your child manage by taking some steps before school starts.

Getting Comfortable

• Visit the new school. Help your child figure out the layout. Some schools are organized with each grade being in a different section of the school. Others are organized by department with the English department in corridor A and the math department in corridor B. Still others are organized by “teams” of teachers working together with a set group of students in a block of classrooms.Find out how the school is organized. Then see if you can get a tour with an older student or school personnel. Walk around until your child has a sense of where to find classes, the library, the gym, and the cafeteria. Remind him that it will look different when there are hundreds of kids crowding the halls.
• See if your student can meet some of her teachers or the guidance counselor. Often staff are setting up classrooms in the weeks before school starts. Most are happy to take a couple of minutes to shake hands and say hello. Don’t overstay your welcome. These people have a lot to do. But just knowing what a few teachers look like can make your student feel more comfortable.
• Clothes. Yes, clothes. For a middle schooler, the idea of going to school looking decidedly uncool is terrifying. Help your child think about how he wants to present himself that first day. That doesn’t mean that you need to spend a lot of money on new clothes. It does mean looking together at what your child has and what he needs to feel self-confident. Check out back to school sales. But also remember that “Sal’s Boutique” (the local Salvation Army store), thrift shops, and yard sales can be treasure troves of fashion.
• Mornings. Ugh. Most middle schools start far earlier than elementary school. Two weeks before school starts, get everyone used to going to bed and getting up earlier. It’s a huge adjustment for some families. But a tired kid isn’t going to do well in school. Set up a healthy sleep routine from the start.

Essentially a sequel, Twelve Principles picks up where Twelve Steps left off. As Carnes breaks it down, the first book is for addicts currently in recovery: it teaches them how to use the twelve steps to overcome their addiction. Upon finishing the steps, though, something else is needed—a method of integrating the twelve principles into one’s life for sustained sobriety.

In the introduction, Carnes is quick to point out that the principles are not rules. The latter has a different, more negative connotation, and does not fully encapsulate what a principle means. Carnes writes:

Principles represent a higher level of learning and thinking than rules or guidelines do. A rule is something to follow, usually in the precise way prescribed, but a principle is something to reflect on, implement, and live into. Rules are typically remembered and recited verbatim; principles are experienced in our hearts, guts, and brains. (Italics in text)

1. Acceptance
2. Awareness
3. Spirituality
4. Responsibility
5. Openness
6. Honesty
7. Courage
8. Commitment
9. Responsiveness
10. Trusting
11. Meaning
12. Generativity

Each principle gets its own chapter, with Carnes dedicating roughly equal attention to all. The book is divided into four sections: “Making Sense” contains the first five principles, “Creating Congruence” the next four, “Growing Vision” gets the next three and “Living Into the Principles” composes the final two.

A Gentle Path Through the Twelve Principles is more or less constructed like its predecessor: after some preliminary information in each chapter, the book turns into a workbook where individuals literally work through the principles.

Chapter 2, “Awareness,” contains some interesting exercises to use as examples. Carnes commences by writing:

Addiction gives us tunnel vision and narrows our attention to those things that satisfy its demands, creating a poverty in our inner and outer lives. Recovery expands our attention—first beyond our addiction, then beyond our fear and stinking thinking, and ultimately far beyond ourselves, into deep awareness.

When an individual is addicted, he loses virtually all sense of awareness, finding himself consumed by physical and psychological urges that will not dissipate until acted upon. When sober—as well as in the process of sobering up—it is important, and according to Carnes, vital, to cultivate awareness. In this way, after accepting and surrendering, through the first principle, to “the irrevocable realities of our life,” it becomes necessary to truly understand them.

The exercises for this principle are fascinating because of the way they demand the individual to confront his demons. When Carnes asks readers to list the worst and best moments of their lives, he is forcing them to relieve those times, both terrible and glorious. But this is not without purpose: Carnes wants the individual to meditate on and reconsider the severity (or lack thereof) of those moments. He asks: “Did it force you to take action or make a decision? What was that action or decision? Did it change your life for the better? In what specific ways? Did it change anyone else’s life for the better? In what ways?”

What Carnes is doing by forcing the individual to undergo this line of questioning (as well as several more) is getting him to become aware of those moments. Instead of merely remembering them and then feeling either happy or sad, Carnes tries to get to the root of those feelings. Why did it make you happy? Why did it make you sad? In so doing, awareness is cultivated and the addiction is understood on a higher level.

Just as he was for A Gentle Guide Through the Twelve Steps, Carnes should be praised for his newest contribution. He saw a void, and he filled it intelligently and perceptively. None of the exercises or discussions is unnecessary, uninteresting or redundant.

Carnes is one of the foremost experts in his field, and he is someone worth learning from. For anyone who is in need of professional advice on how to live post-addiction, A Gentle Guide Through the Twelve Principles is a great place to start.

A Gentle Path through the Twelve Principles: Living the Values Behind the Steps
By Patrick J. Carnes, PhD
Hazelden: June 26, 2012
Paperback, 280 pages
$15.95

Normally, specific parts of the brain are tuned into each another at certain frequencies, say the researchers. This rhythmic activity produces brain waves and allows information to be processed in order for us to react.

The team used the analogy of an orchestra to explain how this works. They say that brain activity can be compared to the performance of an orchestra in which string, brass, woodwind and percussion sections are joined together in rhythms dictated by the conductor. In a similar way, specific structures in the brain tune in to one another at certain frequencies. Their rhythmic activity creates brain waves, and the tuning of these brain waves normally allows information to be processed that guides our behavior. But cannabis causes disturbances in systems involved in concentration and memory, the team found.

The primary psychoactive ingredient of cannabis, known as THC, activates cannabinoid receptors, which are found in many brain areas. In the research, the team measured the electrical activity from hundreds of neurons in rats when given a drug similar to THC which also stimulates cannabinoid receptors.

This showed that the effects on individual brain regions were subtle, but brain waves across the hippocampus and prefrontal cortex were completely disrupted. These two brain areas are vital for memory and decision-making, so the rats were no longer able to accurately navigate a maze. Both areas are also involved in schizophrenia.

Findings are published in the Journal of Neuroscience. The authors write that these results show a possible mechanism behind the cognitive impairment caused by cannabis that was described by Dr Frederick T. Melges and his team back in 1970. Dr. Melges called the effect “temporal disintegration,” and described it as “difficulty in retaining, coordinating and serially indexing those memories, perceptions and expectations that are relevant to the goal one is pursuing.”

More recent studies suggest that THC given intravenously to healthy volunteers can induce several psychotic symptoms of schizophrenia, so the authors believe that THC studies be used to model broader aspects of the disease, not just cognitive dysfunction.

Dr. Jones commented, “Marijuana abuse is common among sufferers of schizophrenia and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers. These findings are therefore important for our understanding of psychiatric diseases, which may arise as a consequence of ‘disorchestrated brains’ and could be treated by re-tuning brain activity.”

Co-author Michal Kucewicz added, “These results are an important step forward in our understanding of how rhythmic activity in the brain underlies thought processes in health and disease.”

The researchers conclude, “These tools will continue to shed light on the neural mechanisms of working memory and decision making in health and disease.”

A 2012 review of current knowledge shows that the endocannabinoid system in the brain has a major role in schizophrenia. “Data reported so far clearly indicate the presence of a dysregulation in the endocannabinoid system in animal models of psychosis as well as in schizophrenic patients,” the review says.

Its authors, led by Professor Daniela Parolaro of the University of Insubria, Italy, add that animal models suggest that adolescence is “a highly vulnerable age for the consequences of cannabis exposure on different domains (such as cognition and social behavior) that are altered in psychotic disorders.”

They suggest that drugs which target the cannabinoid system are “a new therapeutic possibility for psychotic disorders.” However, they warn that drug studies so far have not had straightforward results, with different types of drug showing different effects.

But despite all these limitations, cannabidiol, a compound found in cannabis that activates cannabinoid receptors, has shown fairly consistent antipsychotic properties in animal tests. Recent studies indicate that cannabidiol may be as effective as antipsychotics in treating schizophrenia.

The benefit of cannabidiol appears similar to that gained from atypical antipsychotic drugs, and so far it is considered a safe and well-tolerated compound. Future studies will need to compare its antipsychotic effects against standard drugs for schizophrenic patients.

References

Kucewicz, M. T. et al. Dysfunctional Prefrontal Cortical Network Activity and Interactions following Cannabinoid Receptor Activation. Journal of Neuroscience, published online October 25, 2011.

Zamberletti, E., Rubino, T. and Parolaro, D. The endocannabinoid system and schizophrenia: integration of evidence. Current Pharmaceutical Design, published online June 7, 2012.

Several factors play a part in addiction, including family and social environment, overall mental health, genetics, and family history of addiction. It often is not the case that those with a family history choose not to abuse alcohol or drugs. Many individuals exposed to substance abuse and addiction grow up to be addicts, even if their drug of choice is different.

A history of trauma may contribute to the development of addiction. This trauma can include any form of abuse or exposure to any traumatic events. If the trauma is not addressed, individuals may try to suppress their feelings. This leads to poor coping skills and poor stress management. Using drugs can be a form of stress management.

The early use of drugs also may be a factor. Research has shown that individuals who begin to experiment at a young age have a higher chance of addiction later in life. This is why it is important to notice early the signs of substance abuse in teens and young adults. Most individuals begin abusing at least one substance before becoming full-blown addicts. Recognizing these early signs may allow parents to intervene before their teen moves from abuse to dependence.

Below are several warning signs indicating that your teen is abusing alcohol or other drugs:

• Changes in appetite or sleep patterns.This could be characterized by a marked increase or decrease in either or both. For example, individuals abusing amphetamines may show a diminished need for sleep and food. Those abusing marijuana may sleep more and have an increased appetite.These effects may vary depending upon the drug being abused. If you are interested in the effects of specific drug use, you may want to conduct some online research or call your local drug and alcohol commission or mental health clinic for more specific information.
• Deterioration of physical appearance. Typical teenagers are very concerned about the way they look to peers and friends and may be very specific about clothing, makeup, and overall hygiene. Individuals abusing substances often start to focus less on their physical appearance as their substance use increases.
• Withdrawal from social or important activities. You may notice your teen stops showing interest in things he or she once found pleasurable. For example, they may start missing school or participate less in sporting events or other social activities. They may also stop attending family functions or gatherings such as church because their drug use has become more important, or they may be embarrassed and try to hide their use from others.
• Unexplained need for money or secretive about spending habits. Individuals abusing drugs may begin asking for money without a clear reason. Generally an abuser will not ask for very large amounts, but rather small amounts over periods of time. They may also become more secretive about spending habits. For example, he or she may claim to need more for something than they actually need and pocket the extra money.
• Sudden change in friends or locations. The abuser’s friends or hangout spots may change. For example, a teen may start hanging out with a different crowd of friends. You may notice where they hang out may change as well. They may suddenly think their old friends are no longer “cool.” They also may start to break curfew or lie about where they are hanging out.
• Increased interpersonal or legal problems. Individuals abusing substances may start having more interpersonal problems, i.e., increased arguments with parents, friends, or other authority figures. They may begin to get in legal trouble for shoplifting or other crimes and cited for possession or underage drinking.
• Change in personality or attitude. This one can be a little tricky. Given the raging hormones of teenagers, personality and attitudes can change regularly. In someone abusing substances, this will look a little different. The mood swings would be unlike typical teenage attitudes. Depending on the substance being abused, you may begin to notice marked hyperactivity or extreme happiness followed by a “crash” where the mood becomes just the opposite. The individual may appear very lethargic or more irritable than usual. Thinking and behaviors may become irrational and unpredictable.
• Neglecting responsibilities. If your teen is normally very responsible and there is a change in that behavior, this may be a sign. Substance abuse often begins to take precedence over other things that were once deemed important. As a result, responsibilities are often neglected and the teen becomes more and more irresponsible over time.
• Using despite knowing it is dangerous. Most teens are very aware of the negative effects and possible consequences of substance use. If your teen is using despite this knowledge, this is a sign of abuse.

If you notice any of these signs, it may be time to talk to someone – starting with your teen. Approach them in a non-confrontational, non-threatening manner. Remember, the object of the conversation is to get them to talk to you, not for them to shut down.

If you suspect drug use, even if you think it’s just a little – start talking. If you realize your teen does have a substance abuse issue, don’t be afraid to seek help. Drug use is typically an “escape” for teens. It’s important to seek help for the drug use, but more important, to find the cause of it. You may wish to seek out a private counselor or find your local drug and alcohol treatment facility. Most facilities are well-equipped to work with teenagers with substance abuse issues.

Substance abuse is something that can and likely will get worse over time. Be proactive and remember that a short conversation could be the one thing that keeps your teen from full-blown addiction.

As stated above, the most important of the traditions is the one that urges anonymity. On this, the authors quote from the foreword of the first edition of the book, Alcoholics Anonymous:

When writing or speaking publicly about alcoholism, we urge each of our Fellowship to omit his personal name, designating himself instead as ‘a member of Alcoholics Anonymous.

Very earnestly we ask the press also, to observe this request, for otherwise we shall be greatly handicapped.

We are not an organization in the conventional sense of the word. There are no fees or dues whatsoever. The only requirement for membership is an honest desire to stop drinking. We are not allied with any particular faith, sect or denomination, nor do we oppose anyone. We simply wish to be helpful to those who are afflicted.

Given the importance placed on anonymity throughout AA’s history, it is somewhat startling to note the disconnect between the group’s intentions and the intentions of certain famous individuals. Often celebrities seemingly use AA or similar organizations as a pawn—part of a public plea to save face and get people to stop slandering them. This line of thinking is in direct contrast, as well as a slap in the face, to the integrity of all AA members.

Moreover—and perhaps I am alone on this—I was not aware of the existence of the twelve traditions before reading this book. As I saw it, AA used its twelve-step program to combat alcoholism; the twelve traditions, however, were never in my mind.

The traditions act as something of a constitution or a charter. They implore members to find solidarity behind ideas such as: not having an opinion on outside issues so that the group can never be drawn into public controversy; not promoting, but simply taking in those who come; having each group be autonomous; and ensuring that the sole requirement for membership is a stated desire to stop drinking.

The twelve traditions have worked quite well for the group. The authors write:

The general feeling of unity we have in AA today is remarkable, especially since the membership is made up of people who acknowledge false pride and resentment as major personal problems. Right from the beginning, however, the AA pioneers envisioned in the Big Book that, ‘Every alcoholic who journeys will find a Fellowship of Alcoholics at his destination.’ This has been true for decades, and it’s now possible to find a welcoming AA group throughout much of the world.

The central reason AA has been such a success, the authors write, is because of its rock-solid traditions. Although the members comprising the group may change, what binds them together will not. It is for this reason that the authors beg those who pervert the traditions to refrain from doing so.

Living the Twelve Traditions in Today’s World is a well-researched, well-written history and explanation of AA. Mel B. is a longtime AA member who has authored several notable recovery books, and Fitzpatrick is one of the leading archivists and historians specializing in the creation of AA’s twelve-step movement. The authors do a commendable job of combining historical records, firsthand accounts, primary knowledge, and excerpts of speeches to create a compelling narrative that not only details the reasons for the traditions’ development, but also their importance to the success and integrity of AA.

Living the Twelve Traditions in Today’s World: Principles Over Personality
By Mel B. and Michael Fitzpatrick
Hazelden: July 3, 2012
Paperback, 240 pages
$14.95