Feb 8 Tip: Learn about effective treatment for addiction

February 8 Compassionate Living Tip from Interfaith Paths to Peace

From the NY Times: Learn about effective treatment for addiction

http://well.blogs.nytimes.com/2013/02/04/effective-addiction-treatment/

Effective Addiction Treatment

By JANE E. BRODY

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you're not alone. And chances are, it's not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published by the National Center on Addiction and Substance Abuse at Columbia University concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care." The report added, "Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered "a form of medical malpractice."

The failings of many treatment programs - and the comprehensive therapies that have been scientifically validated but remain vastly underused - are described in an eye-opening new book, "Inside Rehab",  by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed "Sober for Good."

"There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches," A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher's book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher's exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers "about science-based practices that should form the basis of addiction treatment" and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

"The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually," she wrote.

Contrary to the 30-day stint typical of inpatient rehab, "people with serious substance abuse disorders commonly require care for months or even years," she wrote. "The short-term fix mentality partially explains why so many people go back to their old habits."

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr  "to serve as a model to demonstrate what comprehensive 21st century treatment should look like."

"While some people are helped by one intensive round of treatment, the majority of addicts continue to need services," Dr. Willenbring said. He cited the case of a 43-year-old woman "who has been in and out of rehab 42 times" because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

"We have some pretty good drugs to help people with addiction problems, but doctors don't know how to use them," he said. "The 12-step community doesn't want to use relapse-prevention medication because they view it as a crutch."

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program's personnel, who should have "at least a master's degree," Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility's approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don't choose it just because it's the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. "It should be more than movies, lectures or three-hour classes three times a week," Ms. Fletcher said. "You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all."

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, "To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems."

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

 

Feb 7 Tip: Read the poem "Looking, Walking, Being"by Denise Levertov

February 7 Compassionate Living Tip from Interfaith Paths to Peace

Read the poem "Looking, Walking, Being"by Denise Levertov

http://www.poetry-chaikhana.com/

Looking, Walking, Being by Denise Levertov

"The World is not something to
look at, it is something to be in."
-- Mark Rudman

I look and look.
Looking's a way of being: one becomes,
sometimes, a pair of eyes walking.
Walking wherever looking takes one.

The eyes
dig and burrow into the world.
They touch
fanfare, howl, madrigal, clamor.
World and the past of it,
not only
visible present, solid and shadow
that looks at one looking.

And language? Rhythms
of echo and interruption?
That's
a way of breathing.

breathing to sustain
looking,
walking and looking,
through the world,
in it.

Feb 6 Tip: Consider the tension between Prophecy and Mysticism

February 6 Compassionate Living Tip from Interfaith Paths to Peace

Read Fr. Richard Rohr's thoughts on the tension between prophecy and mysticism

http://myemail.constantcontact.com/Daily-Meditation--Prophets-and-Priests----Methodology----February-5--2013.html?soid=1103098668616&aid=m1FgMb67vh0

Historically, mysticism was often seen as the opposite of prophecy. There was the prophetic strain, which was working for social justice, making a difference, solving problems, fixing the world, and bringing about the Kingdom of God. Then there were these other “mystified” people who locked themselves in hermitages and monasteries and didn’t care much about the suffering of the world. This would be the priestly strain of theology. Now we know that was a radical misunderstanding from both sides.

When we read the prophets, we see that without exception they talk about an intimate and loving relationship with Yahweh that led to radical social critique. Jeremiah talks about a love that “seduces him and that lets him be seduced” (Jeremiah 20:7). The normal language of the prophets Amos and Hosea is an intimate language of divine encounter that always overspills into social concerns. They blast a common understanding of Judaism and temple worship which puts them in direct tension with the priestly class. It seemed to lead to the “murdering” of the prophets according to Jesus (Matthew 23:31-35).

In the Jewish Scriptures—the priests are invariably competing with the prophets and the prophets are critiquing the priests—and this tells me it must be a necessary and creative tension. Maybe both sides get refined because of it. Today, however, we have mostly priestly concerns, or as Jeremiah put it, “the sanctuary, the sanctuary, the sanctuary” (Jeremiah 7:4), and little concern for immigrants, health care for the poor, earth care, or even minimal peacemaking. The patterns never seem to change, since the “priests” control the home front and the “prophets” invariably work at the edges.

Adapted from Following the Mystics Through the Narrow Gate
. . . Seeing God in All Things (CD, DVD, MP3)

Feb 5 Tip: Learn about "Compassion's Edge States"

February 5 Compassionate Living Tip from Interfaith Paths to Peace

Learn about "Compassion's Edge States" with Roshi Joan Halifax

http://www.onbeing.org/program/compassions-edge-states/4980

It's easy to feel overwhelmed by all the bad news and horrific pictures in the world. This is a form of empathy, Joan Halifax says, that works against us. The Zen abbot and medical anthropologist has bracing, nourishing thoughts on finding buoyancy rather than burnout in how we work, live, and care.

Feb 4 Tip: Encountering Grief

February 4 Compassionate Living Tip from Interfaith Paths to Peace

Encounter Grief through a 10-minute Guided Meditation

http://www.onbeing.org/blog/encountering-grief-guided-meditation/4983

At the end of her interview with Krista Tippett at the Chautauqua Institution in New York on July 11, 2012, Zen abbot Joan Halifax led the audience through this "guided meditation on encountering grief — grief as something ordinary, part of life and humanity."

Feb 3 Tip: Learn about 4 Chaplains Sunday

February 4 Compassionate Living Tip from Interfaith Paths to Peace

Learn about 4 Chaplains Sunday

http://www.immortalchaplains.org/Story/story.htm

A convoy of three ships and three escorting Coast Guard cutters passed through "torpedo alley" some 100 miles off the coast of Greenland at about 1 a.m. on February 3, 1943. The submarine U-223 fired three torpedoes, one of which hit the midsection of the Dorchester, a U.S. Army troopship with more than 900 men on board. Ammonia and oil were everywhere in the fast-sinking vessel and upon the freezing sea.
The four Chaplains on board, two Protestant pastors, a Catholic priest and a Jewish rabbi, were among the first on deck, calming the men and handing out life jackets. When they ran out, they took off their own and placed them on waiting soldiers without regard to faith or race. Approximately 18 minutes from the explosion, the ship went down. They were the last to be seen by witnesses; they were standing arm-in-arm on the hull of the ship, each praying in his own way for the care of the men. Almost 700 died, making it the third largest loss at sea of its kind for the United States during World War II. The Coast Guard Cutter Tampa was able to escort the other freighters to Greenland. Meanwhile the cutters Comanche and Escanaba, disobeying orders to continue the seach for the German U-Boat, stopped to rescue 230 men from the frigid waters that night.
A convoy of three ships and three escorting Coast Guard cutters passed through "torpedo alley" some 100 miles off the coast of Greenland at about 1 a.m. on February 3, 1943. The submarine U-223 fired three torpedoes, one of which hit the midsection of the Dorchester, a U.S. Army troopship with more than 900 men on board. Ammonia and oil were everywhere in the fast-sinking vessel and upon the freezing sea.     Stained glass windows from the Chapel at West Point The four Chaplains on board, two Protestant pastors, a Catholic priest and a Jewish rabbi, were among the first on deck, calming the men and handing out life jackets. When they ran out, they took off their own and placed them on waiting soldiers without regard to faith or race. Approximately 18 minutes from the explosion, the ship went down. They were the last to be seen by witnesses; they were standing arm-in-arm on the hull of the ship, each praying in his own way for the care of the men. Almost 700 died, making it the third largest loss at sea of its kind for the United States during World War II. The Coast Guard Cutter Tampa was able to escort the other freighters to Greenland. Meanwhile the cutters Comanche and Escanaba, disobeying orders to continue the seach for the German U-Boat, stopped to rescue 230 men from the frigid waters that night.   Stained glass window from the Chapel at Fort Snelling, Minnesota The four Chaplains were Father John Washington (Catholic), Reverend Clark Poling (Dutch Reformed), Rabbi Alexander Goode (Jewish) and Rev. George Fox (Methodist). These four Chaplains were later honored by the Congress and Presidents. They were recognized for their selfless acts of courage, compassion and faith. According to the First Sergeant on the ship, "They were always together, they carried their faith together."  They demonstrated throughout the voyage and in their last moments, interfaith compassion in their relationship with the men and with each other. In 1960 Congress created a special Congressional Medal of Valor, never to be repeated again, and gave it to the next of kin of the "Immortal Chaplains." The four Chaplains were Father John Washington (Catholic), Reverend Clark Poling (Dutch Reformed), Rabbi Alexander Goode (Jewish) and Rev. George Fox (Methodist). These four Chaplains were later honored by the Congress and Presidents. They were recognized for their selfless acts of courage, compassion and faith. According to the First Sergeant on the ship, "They were always together, they carried their faith together."  They demonstrated throughout the voyage and in their last moments, interfaith compassion in their relationship with the men and with each other. In 1960 Congress created a special Congressional Medal of Valor, never to be repeated again, and gave it to the next of kin of the "Immortal Chaplains."

Feb 2 Tip: Watch the spiritual comedy film "Ground Hog Day"

February 2 Compassionate Living Tip from Interfaith Paths to Peace

Watch the deeply spiritual comedy film, "Groundhog Day."

http://www.transparencynow.com/groundhog.htm

Groundhog Day:
Breakthrough to the True Self

An example of an exceptional work of moral fiction is the apparently minor comedy, Groundhog Day,  which shows us a character who has to be exiled from normal life so he can discover that he is in exile from himself. In the movie, actor Bill Murray plays Phil, an arrogant, Scroogelike weather forecaster who spends the night in Punxsutawney, Pennsylvania, where he is to do a broadcast the next day about the annual ritual of the coming out of the groundhog. He wakes up the next morning, does his story and is annoyed to discover that he is trapped in Punxsutawney for a second night because of a snowstorm that comes in after the groundhog ceremony.

When he wakes up in his guest house room the next morning, lo and behold, it is the morning of the day before all over again. Everything that happened to him the previous day -- the man trying to start a conversation at the top of the stairs; the old high school acquaintance recognizing him on the street, the ritual of groundhog day -- it all happens again.

And, once again, due to inclement weather, he is forced to spend the night. When he wakes up the next morning, it is the same day as yesterday and the day before, with the same oncoming snowstorm keeping him stuck in town and the same events repeating themselves like a broken record.

And so it goes, day after day, as this misanthrope of a human being finds himself trapped in Punxsutawney on groundhog day in what science fiction would refer to as a time loop. If he does nothing different, events will repeat themselves as they were on the original day. But if he changes his behavior, people will respond to his new actions, opening up all kinds of possibilities for playing with the unfolding of events. Either way, with each "new" day, he alone remembers what happened in previous editions of the same day.

At first Murray's character responds with bewilderment. Then he despairs and begins to treat life as a game: he risks his life and gorges on food, expressing both his sense of hopelessness and his growing recognition that, no matter what he does, time will reset itself and he will wake up as if nothing had happened.

In one scene, which turns out to be central to the movie's theme, he expresses his despair to two working class drinking buddies in a local bar.

One of his two inebriated companions then points to a beer glass and sums up the way he is responding to his situation: "You know, some guys would look at this glass and they would say, you know, 'that glass is half empty'. Other guys'd say 'that glass is half full'. I bet you is (or I peg you as) a 'the glass is half empty' kind of guy. Am I right?"

But as the days pass endlessly into the same day, this half-empty character finally finds a purpose in life: learning everything he can about his female producer, Rita, played by Andie MacDowell, so he can pretend to be her ideal man and seduce her. When that fails, and his efforts net him slap after slap, day after day, his despair deepens and he begins to spend his days killing himself. He kidnaps the groundhog and drives over a ledge into a quarry; he takes a plugged-in toaster into the bath; and he jumps off a building, always waking up whole in the morning.

In desperation, he reveals his plight to the female producer and she stays with him (without sex), in his room, through the night. Once again, he wakes up alone in the same day.

But, enriched by this experience of intimacy, and by the fact that someone actually liked him for who he is, he finally figures out a constructive response -- he begins to live his life in the day allotted to him, or, rather, he begins to live the life he never lived before. Instead of allowing circumstances to impose themselves on him, he takes control of circumstances, aided by the fact that he has all the time in the world and the safety of knowing what will happen next.

He begins to take piano lessons from a music teacher who is continuously surprised at how proficient he is, since she always believes it is his first lesson. He learns how to be an ice sculptor, which is the perfect art form for him since everything he does will have melted away when he wakes up anyway. And he becomes more generous.

Then, an encounter with death -- an old vagrant dies in his day -- has a deep effect on him. At first, he can't accept the man's death and, in at least one subsequent edition of the day, he tries to be good to the old man, taking him out to eat (for a last meal) and trying, unsuccessfully, to keep him alive.

When he stops trying to force death to relent, his final defenses fall away and his compassion for the old man transfers to the living. He begins to use his knowledge of how the day will unfold to help people. Knowing that a child will always fall from a tree at a certain time, he makes it a point to be there and catch the child every time. Knowing that a man will choke on his meal, he is always at a nearby table in the restaurant to save him.

Slowly, he goes through a transformation. Having suffered himself, he is able to empathize with other people's suffering. Having been isolated from society, he becomes a local hero in Punxsutawney.
Now, he sees the glass as half full, and the day as a form of freedom. As he expresses it in a corny TV speech about the weather that he gives for the camera, at the umpteenth ceremony he has covered of the coming out of the groundhog:

"When Chekhov saw the long winter, he saw a winter bleak and dark and bereft of hope. Yet we know that winter is just another step in the cycle of life. But standing here among the people of Punxsutawney and basking in the of warmth of their hearths and hearts, I couldn't imagine a better fate than a long and lustrous winter."

In other words, having accepted the conditions of life and learned the pleasures afforded by human companionship, he is no longer like all those people who fear life's travails, and try to use the weather forecast, by human or groundhog, to control events. He accepts "winter" as an opportunity.

Finally, the female producer falls in love with the good person he has become and she again spends the night (although he falls asleep so, again, there is no sex.) They wake up in the morning. She is still there and it is the next day.
In a last bit of irony, the couple, (who get to know each other, in the Biblical sense, once the new day begins), decide to settle down in Punxsutawney. Like Maxwell Klinger in the last episode of MASH, Murray's character will end up living in the one place he couldn't wait to escape.

What is so powerful about Groundhog Day is the way it lets us experience what it would be like to make a breakthrough like this in our own lives. The movie shows us a character who is like the worst in ourselves. He is arrogant and sarcastic, absorbed in his own discomforts, without hope, and cut off from other people. Like us, he finds himself in an inexplicable situation, seemingly a plaything of fate. But, unlike us, he gets the luxury of being stuck in the same day until he gets it right. Whereas most of us go semi-automatically through most of our (very similar) days, he is forced to stop and treat each day like a world onto itself, and decide how to use it. In the end, he undergoes a breakthrough to a more authentic self in which intimacy, creativity and compassion come naturally - a self that was trapped inside him and that could only be freed by trapping him. Like many of the heroes of fiction, he can only escape his exile from himself by being exiled in a situation not of his choosing.

In telling this story, the movie hits on a message that is commonly found elsewhere and that appears to express an essential truth. When we get beyond denial and resentment over the conditions of life and death, and accept our situation, it tells us, then life ceases to be a problem and we can become authentic and compassionate. Murray's character makes two such breakthroughs: first he accepts being condemned to being stuck in the same day, then he accepts the fact that everyone else is condemned to die.

Inevitably, the movie also has mythic resonances and literary counterparts. Murray's character is like all kinds of saviors and heroes in well-known stories, secular and religious, who experience some combination of suffering and courage, until they go through a transformation to a new state of knowledge. Among the religious and mythic elements we can recognize in the story: he fights off his demons; he is changed by an encounter with death; he experiences a kind of rebirth; he appears to people to exist in time but he also exists outside of normal time; he manifests deep compassion; he is in the world but not of it, suffering with a special knowledge that he uses to save those around him; and he is given a second chance in life by the love of a beautiful woman. He condenses images of Buddha and the Beast, Scrooge and Jesus.

But the movie keeps myth and archetype, as well as message, blessedly in the background. It also employs only a little visual spectacle and only the barest minimum of fantasy, in the form of the ever-repeating day, to tell the story. It is effective because it is understated, allowing Murray and the theme to engage us.

Perhaps it gets  a little too sweet as it moves toward a conclusion, but that is forgivable. At the end, it saves itself from going over the top by revealing that Murray's character still has some of the old, calculating, self inside him. As he and his new mate walk out of the guest house into the new, snow-covered day, he exclaims, with his new enthusiastic wonder at life: "Its so beautiful -- Lets live here."
Then, after the obligatory kiss, he adds: "We'll rent to start."

Happily-ever-after is very nice, the character slyly tells us. But in the real world it's important to keep your options open, just in case you need to beat a quick retreat.