Archive for the 'New York Times' Category

Worse than ever: Pain pills and heroin use

Apr. 28th 2015

More people are dying from opioid overdoses than traffic accidents, yet no one seems to notice or want to address it. As commented on in the April 17th issue of The New York Times, “Serving All Your Heroin Needs”:

 

Meanwhile, the victims – mostly white, well-off and often young – are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.

 

Look at the numbers: 24,000 deaths from opioids. While the pain pill machine goes about its business of producing more and more addicts, no one says a thing.

 

For parents who do stand up and speak, the response is underwhelming. I attended an event at a large suburban high school billed as a community forum to examine the problems of recreational drug use, prompted by the drug death of a 17-year-old. Her father, Tom, spoke very movingly and passionately about his loss, but the audience was almost devoid of parents.

 

Why? Is it fear of hearing a contemporary bare his soul about a parent’s worse nightmare? Is it hoping that ignoring the problem will make it go away – soon they’ll be off to college anyway? Who knows? But the absence of any passion – any demand for action – was striking.

Stimulant use among 26-to-34-year-olds doubles in four years

The Sunday Times had a second story, this one on abuse of ADHD medications, titled “Workers Seeking Productivity in a Pill are Abusing A.D.H.D. Drugs.” Stimulants like Adderall, Vyvanse, and Concerta are migrating from school settings to the workplace. They’re now in play in demanding professions:

 

These lawyers said they and dozens of young colleagues at their firms had casually traded pills to work into the night and billed hundreds of extra hours a year in the race for partnerships.

 

Overuse leads to rapid heartbeat, acute anxiety, hallucinations, sleep deprivation, and addiction. Just the type of professional you want working on your case or in your firm or client base. Outside of the workplace, these pills are “Mommy Crack,” great for staying thin and multitasking on the home front.

 

Again, this phenomenon starts in high school, where students sell pills or give them to friends to help with academic focus and performance. They’re great for answering the four or five extra SAT questions needed to break 700 and pulling all-nighters for studying and exams. Whether it be weed, alcohol, uppers, or downer, students in every high school know who is selling or providing drugs and drinks, but are unwilling to name names out of fear of being ostracized or to protect their sources.

Silence and indifference

In any case – at the parent or student level – we have created a culture of silence and indifference not seen since the AIDS epidemic. We are beginning to make the connection between binge drinking and date rape among high school and college students, but a similar connection must be made between pharmaceutical companies’ and doctors’ profits and drug dependence and deaths. In both instances, the big businesses supplying the alcohol and pills pay less than 5% of their collateral damage and can never atone for their increasing death toll.

 

Not to minimize the AIDS epidemic, but what we’re dealing with here is on a very large scale. The Band Plays On, with alcohol and opioid deaths exceeding 100,000 per year. When will enough of us join together to stop this growing tragedy?

Becoming addicted to pain pills

Perhaps understanding how opioid dependency develops will be the first step in generating more public support for taking on the drug industry.

 

For those of you unfamiliar with how someone becomes dependent on pain pills, here is how it happens. People have an injury, surgery, or dental work and are given a prescription for 30 pain pills. After just a few days, it takes more pills to obtain the same level of effect in dampening pain. Most patients learn to tolerate their pain and supplement with over-the-counter medications. But then once they near the end of their supply, there is the problem of stopping. Stopping abruptly leads to uncomfortable physical symptoms, so most people taper off. But addicts are not like most people, and they don’t stop.

 

The dependency cycle

 

The dependency cycle begins when a person ups the dose, decides it’s too uncomfortable to quit, or in fact likes the physical and psychological effects from the pills. These narcotics can give a euphoric sensation of withdrawing from the world. Users will continue to seek prescriptions until their doctors decide to cut them off. From there, they turn to doctor-shopping and online ordering, or worse.

 

Switch to heroin

 

Many users – or addicts – switch to heroin because it’s cheaper and more readily available. It also can produce a really powerful and pleasurable body jolt the first few times. This motivates the addict to “chase the high” – trying to reproduce the feelings from that first time by increasing the amount, potency, or by mixing with other drugs. Very dangerous and a big reason for all the deaths. A similar process occurs for other narcotics.

 

Over-prescribing

 

Painkillers are meant for acute pain, not chronic pain, as are most other drugs, such as anxiety or sleeping medications. But remember, this starts with the doctor handing out the initial 30-pill prescriptions or samples provided by Big Pharma, enough to hook some patients, as the drug companies know all too well. And it’s no secret that doctors are liberal with the scripts – even doling out Norco (acetaminophen and hydrocodone) by the handful to newly-postpartum nursing mothers. It’s hard to keep saying no when it’s always offered.

Transforming public opinion and policy

Attacking the supply side seems like a good first step, but that means overcoming deeply entrenched social stigma, leaving the shadows, and finding the courage to tell our truths – namely that these problems don’t exist in a vacuum. With opioid-related overdose deaths occurring every four minutes, we can no longer pretend that these “dirty” deaths are only happening to strung-out junkies living on the streets in the inner city. They are happening to us, our families, and our friends. Fortunately, new generations are stepping forward to start conversations aimed at transforming public opinion and policy.

To Tom, the father who spoke out at the community forum, you are not alone, and we will not forget your daughter.

Marijuana: Family and advisor responses and recommendations

Mar. 31st 2015

Part II

As emphasized in Part I, it’s important to acknowledge the positive and enjoyable aspects of pot use to establish credibility with young adults. After all, they know many of us older folks smoked in our early days and we did indeed inhale, unlike one of our presidents.

 

However, to reiterate, marijuana’s downside is that repeated use impairs learning and executive/problem-solving brain functions. With many regular users chasing higher THC concentrations (up to 27 percent), being able to identify at-risk and dependent users becomes an imperative. Note that, in contrast, medical marijuana is effective at 9 percent THC in very small quantities (two or three times a day) – one way to identify those truly in need of pain relief vs. those gaming the system.

The survey says

Another important part of any discussion with young adults is putting marijuana use in the context of other substance use, including alcohol.

  • Surveys show within a two-week period, 13 percent of college students had 10+ drinks in one night and 5 percent had 15+ drinks in one night.

Potheads are quick to point out this comparison (binge drinking at 18 percent vs. regular pot use at 9 percent) while also noting the difference in post-use effects – namely no vomiting or hangover. But let’s not fall into the trap of arguing which type of substance is superior. Going down that rabbit hole with Alice (a.k.a. your client, son, or daughter) leads you to a land of never ending rationalizations and justifications.

 

By the way, these drinkers and smokers are two separate groups, so the total for male students with substance use symptomatology is at least 27 percent. Add in the one in nine in 2013 who used Adderall without medical supervision and smaller numbers using other drugs, and you can understand why we keep harping on the fact that this problem can no longer be ignored.

 

A recent New York Times article on 12 hospitalizations due to ingestion of “bad Molly” on the Wesleyan campus led police to discover 600 Xanax and at least 15 other prescription drugs in room searches. Noted one expert at Columbia College:

 

“Where did this kid get such a bizarre collection of drugs? … It’s very frightening, because these drugs can cause fatal reactions.”

 

Great question. The answer is everywhere. This type of use by different groups – the drinkers, smokers, and stimulant freaks – is prevalent on all campuses and upon graduation will either become part of your client base or potential work force. 

Evaluation

Clients come to us suggesting we evaluate a young adult to see if there is substance dependence. But good luck conducting an assessment based on self-reporting. All we hear is minimization and excuses. Reports from concerned family members are rejected as overreactions or one-time “experimental” events. When marijuana comes up for discussion, the attitude is “It’s legal or should be legal.” Without objective external evidence, convincing a young adult to cut back or seek help can be fruitless, particularly if they have access to trust funds or are employed.

 

Be aware that for an evaluation to be accepted in court in our state, at least three outside collateral sources are needed to verify information about the subject’s drug use. Identifying and then even suggesting talking to these collaterals can be contentious, to say the least.

 

As mentioned in Part I, by understanding marijuana’s effect on the body and why people like it, family offices and advisors can tailor an approach that focuses on education, establishes behavioral standards and performance expectations, and puts policy in place for family members.

Recommendations

For the office, drug testing is the most reliable and prudent approach to ensure you are not putting your reputation and fiscal integrity at risk. If a person wants to smoke dope or use other drugs, they can work at a coffee shop, but not for you or the families and clients who rely on you.

 

For your clients, there are two complementary tools: education (scientific advances, including brain scans) and behavioral expectations and standards.

 

Education: the science of brain scans

Showing younger generations how brains of pot smokers compare to the brains of non-smokers is an excellent educational tool. When accompanying accurate information on how weed affects the body – both the fun and unfun sides – scans can be persuasive. Another tactic is to find a respected family program, like Hazelden’s, where teenagers and their parents can learn more about substance dependence and how it is linked to brain changes.

 

Behavioral expectations and standards

Aside from the educational approach, the critical piece has to do with behavioral expectations and standards. Start with solid baseline information on aptitude, skill level, and any learning concerns. Assuming you or the parents you are advising have this information, assess whether there are underperformance or behavioral concerns that warrant evaluating the reason for the differences between expected and actual results. This may require educational or other testing to explain the disparity.

 

As you continue on, it’s necessary to come to an agreement or otherwise establish goals for the young adult in question. It is through a thoughtful goal-setting process with measureable standards that dysfunctional behavior can be identified, particularly if there is some indication drug testing is a necessary part of the process.

 

Note the connection to the Social Impairment diagnostic criteria for substance use disorders:

 

Social Impairment is the second grouping of criteria (Criteria 5-7).

  1. Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home.
  2. The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  3. Important social, occupational, or recreational activities may be given up or reduced because of substance use. The individual may withdraw from family activities and hobbies in order to use the substance.

Setting measureable goals and expectations can provide the factual basis to support findings relating to social impairment, an area of vulnerability for pot smokers. When facts become apparent, it’s a good time to introduce drug testing. Tests can now be justified to parents and families who might previously be concerned about an unwarranted invasion of privacy.

 

present in an alcoholic as you would in someone whose drug of choice is marijuana. For example, take impairment criteria 3 and 10, more common to binge drinkers:

  1. The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects.
  2. Tolerance is signaled by requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed.

The people consuming 10-15 drinks in one sitting will have a high tolerance and spend a great deal of time recovering from the effects of doing so. Each drug presents its own set of challenges and impairments. By DSM standards, one is not better or worse than another. Disordered use is disordered use.

Three points

1. Take action or problems will get worse
Don’t let under performing, slacker, next-generation family members meander through their formative years without a plan to investigate drug or learning concerns. (Otherwise they become dependent – in the full sense of the word – 30-, 40- and 50-year-olds.)

  • Of course, this assumes the family office and governance documents contain expectations as to performance.

If not, and each branch handles these issues individually, you will be an observer of the long-term effects of drug use and living proof of affluent “falling generations.”

 

2. The code of silence

Don’t expect siblings, cousins, or friends to blow the whistle on heavy pot smokers (or other drug users or drinkers, for that matter). There is a fierce unwritten code not to rat out substance users.

  • If you do hear something, follow it up because it usually means the person of concern is in way over their head.

However, even if the information is persuasive, you will need to determine if it carries the same weight with the deciders (i.e., parents or grandparents) before you proceed. They will often either be in conflict or more concerned about reputation and succession, and thus eager to shoot down stories from their heir’s friends.

 

3. Cross-addiction

Simplistically, the brain reacts to most drugs in the same way. It doesn’t distinguish between weed, alcohol, coke, and other substances in terms of their addictive nature. So when someone comes out of treatment and says, “They told me I can’t do vodka, but I can have beer and weed,” that’s a lie. Ask them to sign a release so you can see their discharge summary with their diagnosis. This type of misinformation is a lot more common than you would imagine.

Not going away

We hear from our friends in Denver that home prices are skyrocketing due to an influx of younger folks of independent means who seem to be moving in so they can enjoy legal bud. Who knows if this is fact or old folks’ imagination, but what we know is weed is not going away. It’s going to be more pervasive and impactful on communities, including the families we serve and the people we employ. Doing nothing is not an option.

Marijuana: The fun side, the downside, and why family offices and advisors should take note

Mar. 19th 2015

Part I

Fully or partially legalized in many states, a solid majority of teens and young adults believe marijuana should be universally decriminalized, viewing weed as a relatively harmless drug in comparison to alcohol. Its use is widespread among affluent young in high school and college. For example, at one local school I hear students toke up to obtain a better grasp on abstract concepts in their advanced physics class.

 

As of 2013, one in 11 male college students are daily smokers. With marijuana use and acceptance on the rise, we advise diffusing this momentum with facts on how it affects the brain (both positive and negative) and a behavioral-based management strategy.

Why bother worrying?

As pot becomes increasingly legitimized across the country, now is a good time for family offices to get up to speed on the implications for clients and office operations. You might think, “Why bother?”

  • And, indeed, that is a fair question if your approach is to oversee investments, disburse and account for income, advise on estate planning, and leave personal conduct issues up to the individual.

Marijuana can be viewed as just another substance that clients may choose to use as part of their lifestyle. Some regular smokers even tend to be “laid back” and therefore less time-consuming and demanding compared to other clients.

When it becomes a problem

Conversely, other regular smokers may be more difficult to deal with in family meetings.

  • They ask disruptive questions and go off on tangential trains of thought.
  • They are susceptible to harebrained investment schemes, being easily talked into being the deep-pocket “lead partner” to show their family they can be successful – despite being chronically high.
  • You may also have unhappy grandparents when they discover their beloved granddaughter is moving to Colorado to raise goats after they “invested” several hundred thousand in her private school education.

So identifying the source of this behavior, understanding what marijuana does to a user and why so many find it so appealing may be helpful in responding to these unhappy senior family members. If your office or family leadership is also concerned about encouraging young adults to develop competitive skill sets and lead productive lives, as well as avoiding addictive behavior patterns, then I suggest you read on.

Consuming THC – the delivery system

THC is marijuana’s primary psychoactive ingredient. Levels today can exceed 25 percent, as compared to 3 percent in the ’90s. And as users ingest higher concentrations of THC at more frequent intervals, the chances of addiction and other disorders increases. In addition, there are many other psychoactive chemicals (cannabinoids) that are fine-tuned through plant breeding to create different strains to increase potency and appeal to consumer tastes.

 

Note that CBD and related cannabinoids are cultivated for their medicinal properties, lack any noticeable psychoactive affects and are generally sold in pills or other edibles. Exception: Pot for treating pain has THC, one reason why so so many young adults carry generalized pain diagnoses in medical marijuana states.

 

There are four stairways to heaven:

 

Burning: pipe, joint

  • Hits the lungs in minutes, lasts about two hours, but is an irritant.

Vaporizing

  • Solves the irritation problem and is hard to detect. Oil can go into an e-cig chamber.

Eating

  • THC is processed through the liver, resulting in a delayed high.

Dabbing

  • Placing concentrated hash oil against a heated surface and inhaling the smoke. These extracts have up to 90 percent THC levels and result in a rapid and very intense high.

Brain scan information[i]

From brain scans, we now have a good understanding of how pot affects various areas of the brain and the ensuing feelings:

 

In your brain:

  • Basal Ganglia: Controls many of the brain’s reward system, the part that makes you feel high
  • Amygdala: Responsible for paranoia and anxiety in smokers
  • Hypothalamus: Gives stoners time warp and munchies
  • Hippocampus: Pot mimics a temporary brain lesion, which is why smokers can’t recall so much of their high
  • Cerebellum: Nexus of motor control, especially coordination and timing, becomes sluggish under effects of cannabis
  • Brain Stem: Charged with autonomic functions like breathing and heart rate, devoid of cannabinoid receptors, which is why virtually no one fatally overdoses on pot

The last fact, that THC does not lead to overdoses, is one reason why potheads believe weed is far superior to alcohol.

 

In your mind:

  • Euphoria: The brain’s reward circuit kicks into action and intensifies feelings – usually a pleasurable experience.
  • Dysphoria: Opposite effect, for those already anxious, fearful, or worried about the increasing heart rate. Reported by 40-50 percent of users.
  • Distortion Perception: THC’s affect on the amygdala and release of dopamine induces state of absorption, can make things more vivid, and result in sound and visual distortions.
  • Time Lag: THC speeds up internal clocks so stoned people overestimate how much time has passed while high.
  • Memory Impairment: Short-term memory affected due to neural interactions and modifications.

Oh, to be back in college, or not!

 

Similarly we, have a good understanding of the physiological impact on the body:

  • Dry/cotton mouth: Lagging salivary gland response time slows the secretion of spit.
  • Bloodshot Eyes: With lowered blood pressure, capillaries in the eyes widen and blood fills the void. Dilated pupils can also make it difficult to focus on nearby objects.
  • Increased Heat Rate: In as little as 10 minutes, heart rate can spike to 160 and stay elevated for a few hours.
  • Drowsiness: THC can interfere with REM and stage-four sleep for up to five days.
  • The Munchies: Causes the hypothalamus to produce enzymes that increase hunger and messages that let your body know you’re full.

THC is stored in fat cells and is released into the blood stream for two to four weeks or more, depending on amount and intensity of prior use – one reason why professional athletes flunk drug tests while in training camp.

Have a real conversation

The best way to have a real conversation about pot is to acknowledge what’s good about getting high: It lubricates social interactions, dissipates boredom and stress, and enhances perception and euphoria. Just saying it’s all bad does not resonate with younger people and causes most to end the conversation or stop listening to the lecture.

 

For some, the not-so-good aspects include amplified anxiety, lack of motivation, and expense. Allowing people to express these experiences while also talking about the enjoyable aspects helps take the conversation to a deeper, more nuanced level.

 

For regular users, one in six teenagers and one of 11 adults become substance-dependent, with many adolescents seeking help when psychosis takes hold. With the brain developing into the mid-20s, young people who smoke early and often are more likely to have learning and mental health problems due to structural changes in the amygdala (processing memories and emotions) and the nucleus accumbens (decision-making and motivation).

 

As one expert, Dr. Hans Breiter, noted:

 

If I were to design a substance that was bad for college students, it would be         marijuana.”

 

It’s also bad for office staff as THC can impair focus, working memory, decision-making, and motivation for about 24 hours. Not exactly the qualities family offices and advisors are specifying in their job descriptions.

 

As with alcohol, moderate marijuana use among young adults might be professionally and socially acceptable. But its side effects and legality call into question how families and family offices should treat it. So as recreational marijuana use becomes legalized, de facto legalized or decriminalized in more states, it’s crucial for families and family offices to be proactive when dealing with their psychoactive offspring and clients. In Part II, we’ll talk more about how to go about this and what approaches and policies are most effective, including education and setting behavioral standards and performance expectations.

 

[i] The following information on the science of the weeds impact on the body is taken from a December 2014 article in New York Magazine titled “Your Grandmother’s Guide to Pot.”

 

Preparing the next generation

Jan. 27th 2015

Rethinking advice for parents

A recent article in The New York Times by Ron Lieber with the headline “Growing Up on Easy Street Has Its Own Dangers revealed the shocking news that many adult children of the moneyed class are not self-sufficient functioning adults. The article states:

 

There is an emerging consensus among academics that children of the affluent have higher rates of depression and anxiety and elevated levels of substance abuse and certain delinquent behaviors.

 

OMG! If this is news to you, what planet are you living on?

 

Ever since the ’60s, members of wealthy families have been self-reporting high rates of addiction, behavioral health disorders, abuse, and generalized dysfunctions in memoirs. Aside from personal stories, Joanie Bronfman’s 1987 dissertation, The Experience of Inherited Wealth: A Social-Psychological Perspective, documents what is common knowledge among the next-generation affluent: Yes, Houston, we have a problem!

 

But almost every wealthy family, when asked, will not admit to significant concerns about substance use disorders or underperforming, economically-dependent younger generations. Those of use on the inside – either because we are in recovery or in the helping professions – see a reality that is far different than the public façade. Not only are there high levels of substance dependence, but increasingly, financial conflict with parents and trustees stemming from the inability to independently sustain the lifestyle and social standing experienced as children.

Great expectations

As commented on in the New York Social Diary (your link to society), over the last 20 years there is the growing phenomenon of new wealth supplying their children with an endless supply of money to live the high life and impress their friends. While this assures those of us in the recovery business an endless supply of clients, old money’s younger generations feel enormous social pressure to compete and maintain prominence.

 

This group, having grown up in an environment of surplus, expects to live in a similar manner as adults and be supported by family money in doing so. Their parents often inherited in their 40s or even earlier. But now, with increasing longevity, the next generations are facing shortfalls and not happy about it. Lacking the skills or inclination to earn significant incomes in the job market, they are pressuring parents and trustees to pony up. While resorting to violence is obviously an extreme measure, cutting off access to grandchildren and threatening litigation with the attendant disclosure of family secrets is becoming more common.

 

Few take responsibility for slacking off in high school and college and consequently failing to develop marketable skills or spend within their means. Accepting a lower social profile or adopting a reduced standard of living is not an option. Resentments surface and demands increase, often fueled by excessive alcohol and prescription medication abuse.

Reaching a crisis level

We continue to identify substance abuse and behavioral disorders as the No. 1 risk to wealth preservation and next-generation well-being. While drinking and drugging have always been part of high-end culture, intensifying external social and media influences are leading to increased use and at younger ages. It’s beginning to reach a crisis level; parents are overwhelmed and outgunned, and we are not using our expertise to help them respond.

 

In my view, the primary task for family offices, advisors, and professionals is to support parents in setting limits, requiring accountability, and limiting communication tools, as well as being role models rather than peers. Advice on involving the younger group in philanthropy, family meetings, and business/economic exercises is secondary and can detract from the more important goals of learning life skills, developing academic and career interests, and differentiating from “the family.”

 

Let’s devote 2015 to assisting our clients in educating themselves on the risks to their children and responses that allow them to successfully navigate an increasingly hazardous culture.

The family office and advisor guide to ayahuasca, rue seed, and shamans

Nov. 12th 2014

What the shaman is up with these people?

A recent article in the Times on ayahuasca highlighted a growing phenomenon on the use of this drug and a rue seed alternative sweeping the high-end community.

 

In a world increasingly dominated by screen time, not dream time, its not surprising that many people, having binged on yoga, are turning to a more dramatic catalyst for inner growth.

 

It’s said to be a spirit-enhancing, mind-altering, insightful experience leading to profound revelations and improved relationships.

 

It first came to our attention when a wealth advisor commented to us about a client who makes frequent trips to the rain forests and Peru. How often can someone visit Machu Picchu and travel the Amazon? And why is she so thin? Now it’s being alluded to at family meetings during sharing time as life-changing, with details provided in private conversations for the curious.

           

Talk of “journeying” and “shamans” – with offers to join in – are also pervading summer downtime at second homes and on the beach.

 

“Just try it once; it won’t hurt, we’ve done it many times; wait until you meet our shaman!”

 

Among upscalers, it’s hard to resist invitations from higher-caste friends to join in, given the dullness and intensity of corporate life and the opportunity to bond with the wealthy.

Lines in the sand

Right now lines in the sand are being drawn between family members who use or want to use the drugs and those appalled at the naiveté and self-serving justifications of the proponents. The former group usually has several heavily-invested participants who have journeyed multiple times, swear to its therapeutic benefits, and swear it is safe and non-addictive. In fact, advocates assert ayahuasca cures addiction (attested to by Lindsay Lohan, no less), as does the rue herb.

 

Dissenters are depicted as closed-minded and rigid for suggesting that users are simply drug-seeking under the guise of a spiritual or therapeutic experience. Those in recovery are dismissed as overbearing scolds and misguided for questioning the legitimacy of the claims and objecting to participation by next-generation family members. And it’s becoming increasingly difficult to counteract the momentum of the one-two punch sales pitch of the devotees and purveyors of these drugs.

What is really going on? What is the attraction?

Using drugs to gain insight into personal or relationship concerns and enhance spirituality has a great deal of appeal, particularly after years of failed therapy. Many inheritors have been on a life-long search for ways to overcome chronic dysthymia, attachment disorders and anxieties stemming from poor parenting and an inability to connect with others. With a full understanding of the risks, experimenting may lead to insight for some people. However, after doing so once or twice continued use can easily transition into drug seeking – using for the sake of using. As psychologist Terry Hunt says, “Once you get the message, hang up the phone!”

 

But that’s not happening.

All the perks without the stigma

Now at later stages in life, a “spiritual person” comes along offering a supposedly safe, therapeutic herb that provides a heavy-duty escape from reality – the first time they feel like real people. It’s an experience they want to repeat over and over again, and share with others. For many who experimented with hard drugs (or wanted to) in their younger days but are stuck settling for a few cocktails, glasses of wine or Xanax, journeying is the high they are seeking without the stigma of LSD, PCP, or MDMA. They consider themselves on a spiritual journey, the perfect antidote to the ennui of the affluent lifestyle. And what’s the going price? As much as $2,500 per day for a house call – drugs (whoops, herbs) included.

‘Have I told you lately that you’re crazy?’

Inspired by an article in a NYT Sunday Review with the same heading: “Have I told you lately that you’re crazy?”, it’s time to present an alternative view, examining the very real risks and potential damage from using these drugs.

 

“It’s safe!” (Not!)

 

Ayahuasca is said to be a psychedelic affecting dopamine receptors in particular and can penetrate deep within the brain. It causes many users to vomit, which is why a rue seed herb is offered as an alternative, particularly to newcomers. The latter is a stimulant, acting on the limbic system (the reactive, fight-or-flight, primitive area of the brain) and depressing the executive control area of the brain. It also causes altered visual perception and gait. Alcohol is given to help bring users down off the high. Both last for six hours or more and require oversight by a “minder” – often the shaman – to make sure the user does not wander off or trip out.

 

We are talking about heavy-duty drugs. Like LSD, ayahuasca has the potential to create flashbacks. The larger problem is that stimulating the limbic system while deregulating the executive frontal lobe can lead to impulsive decisions and destructive communications. There are also reports of disorganized thought process from multiuse. But hey, what’s more important than expressing feelings and acting on gut instinct? For vulnerable people, taking these drugs even one or two times can lead to a marked personality change (e.g., blowing up a Type-A personality).

 

Take them 10, 20, 50 times and it’s a recipe for permanent brain alteration, even for the most resilient.

 

It’s a tea or herb concoction.”

 

These drugs are described in medicinal or culinary terms – tea and herbs – to overcome the stigma associated with hard drugs. However, when any mind-altering drugs are ingested, the body converts them into molecules that pass through the brain barrier and react with brain cells.

  • The brain does not distinguish between ayahuasca or rue seed and meth, cocaine, PCP or LSD – the reaction is similar. Nor does it care whether you got them from a dealer, an ostensible healer, or the Pope.

Both drugs have major impacts on the body and mind – that’s why the shaman babysits users.

 

No, ayahuasca and rue seed are potent drugs, regardless of how they are described.

 

“It’s a permitted spiritual practice, exempt from drug laws.”

 

That’s the line for first-time initiates who may be concerned about getting into trouble with the law. Passing use off as spiritual – and therefore legal – is bogus unless the participant is a member of a recognized religious group authorized to use ayahuasca in ceremony. Promoters tend to skip over the fact ayahuasca is a controlled substances and is therefore an illicit drug. (One reason why users go to South America.) The rue seed alternative in its various forms, flies under the DEA radar for now, although a very potent drug.

 

“It’s non-addictive.”

 

The real measure of addiction is whether drugs impact brain cells in the pleasure center (dopamine, serotonin receptors) limbic system and frontal lobe. As discussed earlier, since the reactions when taken are similar to other drugs that alter the brain, the conclusion is that ayahuasca and rue seed do indeed modify cell structure, unless proven otherwise. Take them enough times and there will be significant and permanent alterations. By the way, anticipating the next journey, common among many repeat users, is indicative of addiction.

 

It acts like other mood-altering addictive drugs, so why take the risk?

 

“It’s therapy.”

 

Prospective participants are told shamans are therapists. Some even come with university degrees (but no credible credentials or license certifications). It’s a two-for-one deal. But wait! What kind of therapist prescribes the same treatment to every patient after a five-minute conversation and then drops fame-names of clients as a selling point.

 

That’s not a healer, that’s more like a sales pitch.

 

Don’t ask, don’t tell approach to medical issues

 

A lot of these insight-seekers are not young people. (Many would be eligible for social security if they had ever worked.) Some have heart problems (e.g., a-fib, weak valves, high blood pressure, etc.). But why take a medical history, that’s so allopathic! Just crank that old beater up to 120-130 BPM for a few hours. And then “journeyers” wonder why their meds don’t work or they are at the Mayo clinic for major surgery. (Note to advocates: This is another criterion for addiction – taking a drug that you know could give you a coronary or a-fib problems and doing so anyway.)

 

Inexcusable in so many ways.

 

“It cures addiction.”

 

The first question to ask anyone touting this cure is “Show me your supervised drug screens!” because addicts are notorious liars. Both ayahuasca and rue seed act on the very areas of the brain affected by use of alcohol and other drugs. Actually, rue seed triggers intense cravings for anyone in remission from a substance use disorder. So no, it does not cure addiction and is just another form of addicts tripping out on a mind-altering substance.

 

This is the most bogus of all claims: giving someone addicted to controlled substances another psychoactive substance to cure addiction.

 

“It cures depression.”

 

How about encouraging participants to stop taking their antidepressants because their un-medicated self is just fine? Then they wonder why family members stop visiting and friends are so busy. You can be sure participants did not discuss this “cure” with their psychiatrists or other prescribers.

 

No, you are not fine!

 

Multigenerational use

 

Apparently, parents are advocating multigenerational use to become closer to their children. Whoa. What a way to avoid the hard conversations about the multiple marriages and being too self-absorbed for effective parenting. Get high together and all is forgiven.

  • And who doesn’t want to take parent-approved heavy drugs? Come on down!

Talk about playing with fire! Many adult children are in families with histories of alcoholism and drug dependence. Prolonged and intense use of any drug can trigger the addictive gene, despite apparent parental immunity.

 

Does it get much crazier?

Alternatives to seeking meaning and improved relationships through drug use

Participants are reported to say things like “I was never able to talk to my sister about our differences until we went on a journey together for six hours.” Well, did you ever try? Spend six hours with any competent therapist (yes, they do exist) and you will likely explore in depth any ill feelings between relatives or friends – and actually remember the conversation and what happened during the session. Moreover, drug-induced insight does not necessarily lead to behavioral change (e.g., more time with and an improved relationship with the sister).

Do no harm

It seems every few years, a new mind-altering phenomena spreads like wildfire through trust-funders and the newly-minted affluent. Remember Swami Rama, the Rajneeshee, Ram Dass, cults, EST? The list goes on and on. These guides to enlightenment are completely unregulated and hold no licenses yet are purporting to fix major trauma and behavioral health issues. The first rule of any healer is to do no harm. From observation and reports, the harm done to some participants far outweighs any asserted benefits: destroyed relationships, distorted thinking, drug cravings, and untreated depression. Keep at it and we are likely to see drug-induced psychosis.

 

Unfortunately, the wealth and prestige of many of these journeyers keeps them insulated from contrary opinions and negative feedback on personality changes or distorted thinking. Like any good addict with unlimited resources, they have little incentive to stop. Contradictory information isn’t going to change their minds, but it should give pause to anyone thinking about joining the club. Perhaps by alerting family offices and advisors to this very underground and growing phenomenon, proselytizing can be minimized and support provided for the contrarians who are telling their friends and relatives, “YOU’RE CRAZY!”

NYT recognizes John A’s vision for estate planning

Nov. 10th 2014

This past weekend, I was thrilled to see John A. Warnick featured in The New York Times for his accomplishments in creating the Purposeful Planning Institute. In the article, “Focusing on the Human Element of Estate Planning,” John A receives well-deserved recognition for taking the initiative (and risk) to focus estate planning on transmitting family values rather than merely asset preservation.

 

“What we stand for is making sure the planning has a deeper purpose and meaning to it than just being driven by taxes,” Mr. Warnick said. “The challenge is to get those core planning disciplines — lawyers, C.P.A.s, wealth managers — to start with ‘why’ instead of immediately marching into ‘how.’ ”

 

John A began thinking about how traditional estate planning was missing a key element – the impact on beneficiaries – after receiving an irate call from a 21-year-old complaining about a delayed distribution.

 

But this particular call got Mr. Warnick, then a lawyer at a large law firm in Denver, thinking about how estate planning was missing the human component. The emphasis was on transferring the most money to heirs free of estate tax and then insulating that money from creditors. “I said, ‘There has to be a better way to do planning so all this tax-efficient, elegant trust planning doesn’t hurt people,’ ” he said. “I saw well-intentioned, technically precise plans reap negative unintended consequences.”

 

In my experience working with families and trustees dealing with addicted and/or dysfunctional beneficiaries, far too many trust documents lack effective provisions to prevent the “negative unintended consequences” he is talking about. So, again, congratulations to John A helping parents write estate plans that help rather than hurt their heirs.

Granny’s on pills, Pops is a drunk, our kid’s back home, and we’re sunk…

Nov. 3rd 2014

Singing the Sandwich Generation blues

With parents living longer, it’s no secret that many are overdoing it with alcohol and popping mind-altering substances at an alarming rate. A recent article in the Times, “More Older Adults Struggle with Substance Abuse,” highlights a growing problem for many adult children trying to figure out what to do with a sometimes-dysfunctional parent or relative. These using seniors certainly don’t want to be told they need help, but you can hardly sit idly by when you’re the one left to deal with the negative consequences – both on the family and on finances.

 

The Times article talks about seniors going to treatment and what a wonderful life they have in recovery. Big deal! What wishful thinking! Our parents may need help, but they’re not going to get sober just because we think it’s a good idea. Let’s look at a few common scenarios:

Dad

He has a few drinks, becomes obnoxious, and staggers around.  His children don’t want their kids near him. None of the kids wants to confront Dad because he is old and deserves some pleasure in life (read: If confronted, he is very likely to cut them out of the will). But when Mom privately confides Dad becomes physically abusive at times, doing nothing becomes less of an option.

Mom

She’s becoming more confused and forgetful. Is it dementia? Or has she been riding down at the WA ranch, combining wine with Ambien? She did mention going to her doctor to discuss what to do about waking up at night…

Auntie

The family recluse, she has acute cellulitis but refuses hospitalization because she won’t be permitted Valium on demand. When her trustees are contacted to exert pressure to go to the hospital, they become flustered and defensive, saying they don’t judge a beneficiary’s lifestyle.

Younger Brother

He’s overweight, out of work, and gains sympathy (and subsidies) from Mom because he’s diabetic. While his preference is for a six-pack a day, due to a recent fall, he’s on pain medication and showed up in stupor at a recent wedding.

Older Sister

She’s been smoking weed for forty years – one reason she can’t string two thoughts together. After privately touting it to the next generation as superior to alcohol, she’s now soliciting family members to join with her in “journeying” on herbs with her shaman.

Stepmom

Dad’s third wife is close to your age and has been overheard – after several drinks –  muttering, “I never thought the SOB would live this long.” She’s way too far into wine at fundraisers and a danger to the public when driving home. Your formerly-robust father is fast becoming elderly and more dependent on this women.

You

You are the responsible one – the one who either feels obligated to assist your relatives or was told by Mom and Dad to do so, particularly as they aged.

 

If none of these scenarios is familiar, you are the lucky one. For many of us, these are constant worries that show no signs of disappearing. But what to do?

Finding leverage points

As mentioned, people with problems (PWP) don’t seek help simply because they are asked to. If they do, it’s usually only to placate and create the appearance of taking action, when they have no intention of changing.

  • But with doctors handing out pills for minor pains and inconveniences; marijuana becoming the preferred drug for teens*; and alcohol embedded in our culture, legalized impairment is fast becoming the family norm.

It can seem an insurmountable task to eradicate substance use and addiction altogether, but it doesn’t have to be an all-or-nothing approach. Sometimes, the best thing we can do is help our PWP, especially seniors, manage the process to keep everyone safe and minimize damage.

 

As our readers know, we advocate utilizing planning documents with language aimed at encouraging PWPs to alter their behavior. Without advance planning (see below), we use medical concerns, video feedback, environmental interventions, and incidents as opportunities to motivate change. The idea is to identify or create leverage to encourage the PWP to see a doctor, therapist, or even enter an inpatient setting for evaluation or treatment.

Indirect methods

Rather than tackling the concern over alcohol or drug use head on, indirect methods can be successful as a means of accomplishing your ultimate goal. By indirect method, we mean using an event or activity seemingly unrelated or indirectly related to substance use to initiate the change process. While these are not proven recipes for success, they’ve worked on some occasions.

 

MEDICAL OPPORTUNITIES

 

These include attending annual checkups, memory-loss exams, brain scans, hospitalization for conditions unrelated to using, and accessing health care records and information.

 

Routinely attend medical and other health appointments with the PWP

 

These are a great source of information, particularly if the PWP signs a release so you are privy to medical records and can speak with providers. This is good practice regardless of the medical condition. By monitoring prescriptions, you are already in the loop if pill abuse becomes a problem.

 

Hospitalization or day surgery for unrelated conditions

 

Seniors with drinking or drug problems sometimes confuse the hospital with the Hotel California and are unhappy to find cocktails banned and pill use regulated. The hospital is very likely to put your PWP on a detox protocol to prevent serious withdrawal symptoms. Ask for this protocol because many people don’t stay in the hospital long enough to complete withdrawal.

 

Brain scans for falls, spills, and memory issues

 

The scan can be initiated at the suggestion of a physician when the PWP has a fainting spell or other symptoms that might be “brain-related.” A scan may show deterioration due to alcohol or drug use.

 

Exploring behavioral side issues (e.g., depression, ADHD, gambling, Internet)

 

Encourage your PWP to seek help for a mental health problem and then raise the topic of addiction with the therapist at an opportune time (“Oh I see this antidepressant medication does not work if you drink regularly. What can be done about that?”)

 

Professional evaluation/in-patient evaluation

 

If your loved one expresses concern about health or behavior and may be open to an evaluation at a place like the Mayo Clinic, encourage her/him to do so. Be sure a medical release is signed so you can express your concerns to the staff. Or, if the PWP is willing to be evaluated by an addiction program, have the name of one or two quality programs to recommend, as well as several addiction specialists.

 

ENVIRONMENTAL STRATEGIES

 

These proactive suggestions can be very effective, although some may find them too invasive or Machiavellian. But when other relatives or vulnerable adults are at risk, you may be compelled to take action.

 

Videotape feedback

 

Many PWP are unaware of how they present themselves or simply don’t remember negative incidents. Video footage from family gatherings and celebrations is very useful for blackouts and for convincing relatives there really is a problem.

 

Video evidence can be helpful if a PWP has control of assets and a conservator or guardian proceeding is contemplated. This technique is also used by family-employed security personnel to record interactions with drug dealers or if the PWP drives under the influence.

 

Granny cams

 

Video cameras installed in parents’ homes are used for documenting behavior, as well as making sure all is well. While painful to see, suspected abusive behavior by out-of-control Dad and the Third Wife will be corroborated.

 

Obtaining permission to install cameras can be a problem. Using security concerns as a pretext is often effective. Of course, it is important that you control access to the recordings. To do so, you should pay for the installation and ongoing costs.

 

Helpers in the home

 

Having an ally involved in the PWP’s daily life can be very useful. Depending on the financial situation and relationships, you can pay the helper directly or assure the helper that s/he will be paid even if the PWP finds out the helper speaks with you.

 

Family hire staff and fire enablers

 

When there is concern about regular use to the point of intoxication, passing out, and danger to self or others, you can hire staff to protect that addict from self-destructive behavior, encourage the addict to use less, and perhaps enter treatment. This can be done with both new and existing staff. Staff that is helping the addict access alcohol and drugs must be either re-educated or terminated.

 

PUBLIC INCIDENTS

 

Using-related embarrassments at weddings, country clubs, cocktail parties, etc., can be used as leverage. However, the addict usually has an excuse for what happened.

 

“I tripped on the stairs.”

“I ran into an old buddy from college and drank more than I should have.”

“I accidentally drank wine after taking my Xanax, and it’s the medication.”

 

Keep your eye on the behavior, not the rationale. Do not accept it. Addicts like to argue intent and happenstance. These become even more effective leverage point if the family member has a job where reputation is important, particularly if there are fiduciary responsibilities.

 

FAMILY PRESSURE

 

When everyone in the family is on the same page and working together, they can be effective in encouraging change.

 

Family educational and informational activities

 

Education on addiction ranges from individual sessions to seminars to weekend workshops. The PWP may or may not be invited to attend. Genograms with information about previous generations are opportunities to engage the PWP in discussions about genetic predisposition. For affluent families, discussing addiction in the context of risk to wealth preservation can also resonate.

 

Limiting visits

 

Limiting time with or avoiding a PWP grandparent can be effective so long as the other grandparent is on your side. Even with a sympathetic grandparent, the hard question is: Do you tell your dad or mom the reason for your actions, or do you simply remain silent?

 

TALK ABOUT IT

 

The “talk about it” approach, at a minimum, benefits responsible adults and children because it explains behavior and relieves the burden of secrecy. It also changes the dynamics of the family system, which may inspire the PWP to consider seeking help.

 

Name the behavior

 

Most immediate family members don’t talk about their PWP with relatives, close friends, or even their children out of concern for privacy or shame. But when we cover up the problem, we become part of the problem. And our children – who know there is something wrong – mistrust us, and even more importantly, misunderstand the power and danger from alcohol use. This is exactly what happened to me with my grandparents.

 

So Brother at the wedding is not “tired from working too hard” but a long-term substance abuser. Auntie is more than simply sick, having been victimized by her psychiatrists who prescribed her benzos for years. These are cautionary tales for our children, and once we start talking about our concerns with the larger family, support staff, and friends, a lot of the shame and stress goes away.

 

Be forthright and frank

 

Many of us fear offending others, but it’s OK to say: “No, I don’t want you talking to my children or other relatives about weed or journeying.” Or, “No, it’s not OK to come to meetings high. We are no longer putting up with this craziness.”

 

PLAN AHEAD

 

By participating and overseeing the estate planning process for your parents, the goal is to create sophisticated, anticipatory documents that allow for shifting of power, control, and access to medical and financial information to you or trustees.

 

Anticipate the problem with documents

 

Make sure effective documents are in place so that when the PWP gets out of hand, the documents provide a means to take control of assets and loving situations.

  • For siblings or next-gens, this usually means having Mom and Dad insert provisions into succession planning documents (e.g., trusts, business, inherited property, and charitable entities) that effectively address behavioral disorders.
  • For parents, this means putting provisions into documents when they are younger and committed to their estate and health plans that will ensure their intent is carried out. Use trust protectors, co-trustees, and other safeguards so modification is difficult, if not impossible, when issues arise later in life.

Similarly, health care directives and powers of attorney for decision-making and control of assets outside living trusts are useful when parents deteriorate or when using behaviors begin to escalate.

 

Living situation

 

No seniors want to be told they may no longer drive or live alone in their home. It’s easier to make the transition if plans are made well in advance to move to a community designed for independent elders, with additional support services available. Then, it’s time to put the plan in place when concerns about driving or even drinking too much come into play.

Don’t turn a blind eye

The disease of addiction will eat away at the body of the family as swiftly as any cancer. Turning a blind eye to substance use by seniors in our family is, at best, unproductive, and at worst, dangerous or even deadly. It isn’t as easy as wishing for change and having it be so, but adopting some of the ideas or plans in this article can help put recovery – or at least an improvement in behavior and family dynamic – in motion.

*For information about young-adult using and “failure to launch,” see these related blogs:

Teenage popularity: blessing or curse? Why affluent adolescents fail to launch

Young-adult addiction: College students hit the bottle, the bong, and sometimes the books

Teenage popularity: blessing or curse?

Jul. 29th 2014

Why affluent adolescents fail to launch

Being athletic, attractive, socially admired and sought after seem like the perfect solutions to overcoming the angst and insecurities common in the early teen years. It might feel as though you’ve dodged a bullet if your child is one of the popular kids, but watch out.

This temporary teenage high is more of a flash fire than a slow burn and many end up in “failing to launch” as adults.

Fast-forward a decade, and the once-popular kids are often struggling with substance abuse and low achievement, looking back on the glory days, with parents providing a helping hand for living expenses.

Popularity as a problem predictor

This might come as a surprise, but popularity is actually a better predictor of future problems than teen substance use itself, according to a study from the University of Virginia and discussed in Jan Hoffman’s New York Times article “Cool at 13, Adrift at 23”:

“Pseudomature behavior is even a stronger predictor of problems with drugs and alcohol than levels of drug use in early adolescence.”

But why? Why, when they seem to be on the road to success, does stable young-adulthood so often elude them? Let’s explore some answers.

Emotionally unprepared

Early stardom, hosting the all-nighter, and attaining “Queen Bee” status carry their own stressors.

“The teenagers who lead the social parade in middle school – determining everyone else’s choices in clothes, social media and even notebook colors – have a heavy burden for which they are not emotionally equipped.”

Once you’ve won the big game, become party central, or bedded that special somebody (probably following an over-the-top prom invitation), it’s hard to maintain the pace without raising the stakes to dangerous levels.

For me, playing left wing on varsity in eighth grade and winning the big game at 15 were incredible highs. So was beating the competition for class rank and making it into an Ivy League college. But that euphoria passes quickly, and it’s easy to turn to alcohol in an attempt to recapture the endorphin rush.

Most young teens lack the perspective and sophistication to handle early peak experiences. It overwhelms them, even as they pretend that everything is under control. It’s not easy feeling insecure on the inside while presenting a bulletproof exterior to fend off the competition at any age, let alone at 16.

Early success and attention can be scary – and there’s no one to talk about it with because most adults think success breeds happiness. Under the guidance of aware adults or a strong internal compass, some maintain self-discipline until their brain develops abstract concepts and they gain a perspective on their experiences, but this is more the exception than the rule.

There’s only one Missy Franklin for every 10 Justin Biebers.

The lifestyle

Being “special” is an especially well-trodden path for children of affluence. Kids who come from families with money – who have the trendiest name-brand clothes, the latest technology, the fastest cars, etc. – often find themselves at the epicenter of their social circles. Their peers want to be around them; they’re put on the A-team in athletics; teachers and administrators buckle under the weight of the family’s prominence. Out here in the Land of 10,000 Lakes – these are the Boat People – kids with lake homes who drive jet skis and migrate to houses with absent parents and accessible alcohol.

Some skate through – never pushed to build real-world, employment-worthy skills. Others are on the track for high-prestige schools and run into trouble post-college.

Athletics

For the budding athlete, there are varsity induction rituals like hazing and end-of-season celebrations – all of which involve heavy drinking. Prowess on the field and in the gym creates a sense of invincibility and many opportunities for binging. This includes girls, ever eager to show they can outshine the boys.

With winking disapproval from administrators and parents, the relationship with alcohol (and eventually other drugs) becomes ritualized.

Dubious role models

The attractive, the good-looking, and the superficially sophisticated not only look up to older role models as trendsetters but are often partying with high-status students three to four years older. And it’s usually the more exploitative elders who are interested in the younger crowd. Some juniors and seniors get off on introducing the underclassmen (particularly girls) to alcohol, drugs, and of course sex. It’s a game for them, and they don’t care who gets hurt.

‘Best friend’ parents

Many upwardly-mobile parents are pleased their sons and daughters are tight with the in-crowd and overlook the danger signs, including their own inability to see how they are living vicariously through their children.

Large houses with absent or benign-neglect parents become party central. Many parents would rather have their kids use at home than drink and drive, so there’s a lot of “staying over” for the night at a friend’s house and arriving home at noon the next morning. Moms call school with excuses for missing homework and postponed exams.

Does this sound familiar? If so, you are courting big trouble.

Affluent young adults and substance use disorders

Many are surprised to hear that over 20 percent of affluent young adults assess as needing substance use treatment. Our teens under discussion here comprise a good portion of this group.

It’s a simple but vicious cycle for the affluent:

  • Their kids are the popular kids.
  • The popular kids are the kids who grow up too fast and with few limits.
  • The kids who grow up too fast are the kids who end up needing alcohol and drug treatment.

(Most of the remainder are college students with genetic histories of addiction in their families who party hearty in college and trigger their gene.)

Not cool anymore

As these kids age up into their twenties, they think that these “pseudomature” activities will help them maintain their position, but in reality they inhibit true maturation. They get stuck living in their middle-school world, their emotional and intellectual growth stunted by alcohol and drug use. While they’re acting grown-up, their “less-cool” peers are actually growing up – and passing them by.

They are doing more extreme things to try to act cool, bragging about drinking three six-packs on a Saturday night, and their peers are thinking, ‘These kids are not socially competent,’ ” Dr. Allen said. “They’re still living in their middle-school world.”

Yes, getting wasted at 24 at the family compound with buddies is no longer just “having a little fun.” Unlimited access to alcohol and drugs with few consequences begins to take its toll – a bitter irony for parents, as the very things they aspired to for their kids sowed the seeds for future dysfunction.

Individuality and confidence

This is one of those situations where the risks associated with popularity and higher socioeconomic status can sink your child. However, this all-too-familiar ending is by no means inevitable. But it takes parents who are really on their game – stars in their own right – who understand the dangers being overinvested in their children’s successes, particularly as surrogates for their own unfulfilled dreams. These parents can help their preteens and teens understand and accept that popularity isn’t the end-all be-all.

“Parents can reinforce qualities that will help them withstand the pressure to be too cool, too fast. … Adolescents who can stick to their own values can still be considered cool, even without doing what others are doing.”

One key task is to keep the dialogue going on how your child feels about being the center of attention. That means taking the time available when your child wants to talk, not when you want to talk. And be a parent – not a friend or cheerleader.

  • Look out for pseudomature behavior and bad-influence older friends.
  • Provide structure and accountability.
  • Homework first.
  • No overnights.
  • Don’t allow the demands of practice and friends to override family time.

It will likely put a dent in your child’s popularity, but far better to suffer through a few teen years in the middle of the pack than all of adulthood in stunted adolescence.

Recovery coaches

Jul. 16th 2014

A powerful resource in attaining stable sobriety

We have long recognized recovery coaching as a critical component in sustaining the gains made in treatment when a family member returns home after an inpatient stay.

Coaches perform a wide range of services, from assuring clients attend therapy appointments to homestays as sober companions. 

But most importantly, for recovering addicts, having the always-available, empathetic, and supportive ear of someone who is committed to their success can make all the difference in achieving a substance-free life.

In our work on behalf of families, we often include a recovery coach as part of the overall post-treatment recovery plan, along with a case manager, therapist, addiction-certified psychiatrist, and drug-testing monitor. They not only support the person in recovery but act as liaison to the case manager and family.

But now coaches are playing a new role, hired by people who want to sober up without going to inpatient treatment.

With growing self-awareness as to when drinking or prescription drug use is out of control, many are now taking action on their own to avoid major problems down the road.

Inpatient treatment not an option

A recent article in The New York Times, “A Guide’s Sobering Effect,” discusses how affluent mothers are hiring coaches as part of their efforts to stop using and stay clean.

Why this alternative to going to rehab?

  • Work demands preclude time away.
  • Fear of losing their children if they go inpatient for 28 days.
  • Reliable support to attend meetings and appointments.
  • Privacy (A.A. members gossip).
  • Protection of reputation (there still is a double standard re: women addicts).
  • Avoid building a medical or insurance record.
  • Relapse prevention after inpatient or outpatient treatment.

In short, recovery companions are “more anonymous than A.A.” and can seamlessly blend into social and professional circles, sometimes as administrative assistants, trainers, or friends.

Challenges in early recovery: thoughts, feelings, behaviors and STRESS

In early recovery, having a companion can help manage addictive thoughts, feelings, and behaviors. Here are three excerpts from the article:

  • “It’s not the actual substance that defines addiction, it’s the feelings underneath.”
  • “Addiction is a disease of isolation.”
  • “She taught me to write my feelings down and think things through instead of heading down the path of destructive impulses to quiet down the white noise in my head.”

An empathetic approach, guidance, and role modeling help create a positive attitude in the client and the hope that the future will be better without drugs and alcohol.

Predictors of recovery

Data shows that addressing the emotional side of recovery supports long-term abstinence. This includes:

  • Building coping skills for stress and relapse-inducing situations.
  • Identifying situations with potential for relapse. (Men report positive feelings prior to relapse, women negative emotions and interactions.)
  • Managing the environmental cues (people, places, and things) that trigger the desire to use.
  • Resisting declining motivation after inpatient treatment.
  • Helping resume normal activities within recovery and still maintaining balance.
  • Managing stress.
  • Upholding a commitment to abstinence.
  • For at least six months after treatment, attending recovery activities, limiting workload and social activities, and avoiding stressful situations.

Coaches help their clients with all of the above, which is why they are key to improving recovery rates and why we find them so valuable in our work with families.

Level of service varies

And it’s hardly a one-size-fits-all approach. The person in recovery (or the family) can choose the level of service – from once-a-day check-ins and weekly visits to 24-hour live-in company (no, they are not nannies). We see coaches play many different roles:

  • responding rapidly to client needs,
  • offering intensive support,
  • stabilizing individuals in crises,
  • helping fight the day-to-day urges,
  • handling logistics,
  • accompanying the individual through potentially stressful and unsafe situations, and
  • acting as intermediaries with family member.

Recovery companions provide both the oversight and the peer support integral to long-term success. They work collaboratively with treatment teams and are closely supervised.

Qualifications

What do we look for in a coach?

  1. At least five years in active recovery, vetted with background checks, and solid references. (Some recovery services will staff a recovery companion with six months or less of sobriety.)
  2. More skills than having just gone through A.A. themselves – they need to be trained in relevant educational fields.
  3. Appropriate boundaries. This is perhaps most important, as we don’t want the coach borrowing money, etc. That is one reason why they need to be well-compensated. Not only is the job demanding, but good pay reinforces the professional relationship.
  4. The coach also should have a supervisor or other professional s/he is accountable to. In other words, s/he should work for an organization either as an employee or independent contractor for oversight purposes.

Our take

It’s terrific that these women are developing a new approach to getting off alcohol and drugs – one that allows them to remain in the community and become sober. In our work with clients we find that recovery coaches are invaluable resources for sustaining abstention. They tell us what’s going on with the family member in recovery and are the first to know when there is a potential or actual relapse.

So when thinking about substance use disorder treatment, keep in mind what happens after leaving rehab and the benefits of recovery coaches.

For more information on how coaching/companion services fit into an overall post-treatment plan to improve recovery rates, check out our article, “Case Management for Families Dealing with Addiction Recovery: Dual-Track Method.”

Pregnant women popping pills

Jun. 16th 2014

From Tylenol to Vicodin, an uptick in opioid prescriptions during pregnancy

To do pregnancy the “right” way, to follow all the rules and recommendations, requires sacrifice on the part of the expectant mother. The list of no-nos is long: caffeine, alcohol, ibuprofen, sushi, deli meat, soft-serve ice cream, runny egg yolks, skiing, stomach-sleeping . . . just to name a few.

One of the hardest parts for me when I was wading through my first pregnancy (besides forgoing the soft-serve and stomach-sleeping), was being limited to acetaminophen for the various and sundry aches and pains I encountered as my hips widened and my ligaments stretched. Having found Tylenol to be quite ineffective in my younger years, my M.O. was to grin and bear it. Advil or bust, was my attitude. But not all pregnant women have the same tough-it-out mentality. And when they complain to their physicians, they’re getting something a lot stronger than Tylenol.

An alarming rate

Despite a dearth of research regarding the impact of opioids on fetal health and safety, doctors are prescribing opioid narcotics to pregnant women at an alarming rate, primarily to treat back pain and abdominal pain.*

In both studies, the opioids most prescribed during pregnancy were codeine and hydrocodone. Oxycodone was among the top four.

There’s speculation as to whether these script-happy doctors have done their due diligence, as fewer than 10 percent of medications approved by the FDA since 1980 have sufficient data to determine fetal risk. In fact, opioid use in the first trimester may double the risk of fetal neural tube defects. The question of addiction in just-born infants is also an issue to be addressed, as prolonged use while pregnant can lead to dependence – in mother and child.

America’s pain-averse mentality

A miracle cure in pill form has come to be expected for whatever might ail us – and that mentality doesn’t simply disappear during pregnancy. After all, taking painkillers is certainly an easier solution than suffering through it or seeking more time-consuming alternative help, such as physical therapy or acupuncture. But it still boggles the mind how women who try to be so careful in so many ways will eagerly accept an opioid prescription. “If the doctor’s giving it to me, it must be safe . . . right?”

Recklessly over-prescribed

Ultimately, this seems to be merely another manifestation of the trend of opioid painkillers being recklessly over-prescribed – and to inappropriate patients. It’s a main contributor to pharmaceutical and opioid abuse and addiction in the U.S., and now there’s yet another subgroup to whom these pills are becoming more – and more easily – available.

*For more information, see Catherine Saint Louis’s April 13, 2014, article, “Surge in Narcotic Prescriptions for Pregnant Women,” in The New York Times.