Addiction Management Blog

Archive for April, 2013

New book out today! Craving: Why we can’t seem to get enough

Tuesday, April 30th, 2013

cravingI am excited to announce that a new book is out today from my colleague, Dr. Omar Manejwala. He is the former Medical Director of Hazelden (one of the oldest and most respected treatment organizations in the world), and current Chief Medical Officer of Catasys, an innovative health management company focused on treating substance abuse problems. I was fortunate to receive an advanced copy of his new book, Craving: Why we can’t seem to get enough, so I have had the past month to review it thoroughly. If you struggle with addiction, or care about someone who does, then I strongly encourage you to get this book!  Why?

First, craving is a universal experience we all share and it also happens to be at the heart of addiction. In healthy doses, it is part of what makes us human. But when cravings become so intense that they lead to out-of-control behaviors, then they are not such a good thing. In fact, they cause significant pain and suffering. For those who have never experienced addiction, imagine holding your breath and then starting to think about air. How long before your desire to breath becomes an intense craving for air? How long until the craving for air becomes almost unbearable? You may think this example has little to do with addiction, but the regions of the brain that control your breathing, heartrate and other survival functions happen to be the same areas of the brain that get hijacked by addiction. By reading Dr. Manejwala’s new book, you will be treated to a very lucid and beneficial explanation of the science of craving. If you are afraid of brain science, have no fear, he makes it very accessible!

2013_0409_omar_manejwala_600x300Second, once you understand cravings more clearly, you will be in a far better position to do something about them. Perhaps what I like most about this book is that he provides an approach to deal with cravings that links back to the science of what we know about them. For example, part of the experience of craving is biological. Cravings are not just obsessive thoughts in your head, but are deeply rooted in physical and chemical changes that take place in the brain and body. Think back to our example about holding your breath. Is your need for air all in your head? Of course not. While we don’t require alcohol or drugs to survive like air, cravings have a similar intensity and feel because of what takes place physically in the body. So interventions focused on addressing the physical aspects of craving are critical. And at the same time, part of what makes cravings so painful is that once they start, they feel like they will never end until acted upon.

The best news of this book is that cravings can be overcome! Dr. Manejwala outlines a wonderful tool box of interventions that address both the physical aspects of craving, but also the painful obsessions that precede addictive behavior. You will learn about the benefits of self-help meetings, meditation, exercise, and being accountable to others. There are also some tools that you likely have not heard about, which is a testament to the comprehensive and holistic approach taken throughout the book.

Third, I really appreciate his view that “Courage is, in fact, the most essential quality of recovery, because without courage, none of the other needed practices are possible.” I couldn’t agree more! Dealing with addiction and all its complicating and co-occurring problems is not for the faint of heart. Those who engage in the process of overcoming addiction and are willing to face their most intense cravings, are among the best examples in our society of courage.

While I have a lot more to say about this book, Dr. Manejwala and I plan to discuss it over a video chat in the next week or so. Stay tuned for the broadcast and in the meantime, checkout the latest on the book on facebook and order your copy today.

Addiction & Homelessness, Part II

Monday, April 29th, 2013

books-stackIt was early summer and I was deep into my counseling internship at the behavioral health clinic. I was lucky enough to have a giant corner office with many windows overlooking downtown Portland – room enough to conduct both my individual sessions and run groups. It was so big that I decided to bring in two of my own bookcases to fill out the space. Lucky for me, a relative who happened to be a retired psychologist, had a ton of books to donate to my cause. I figured my clients would walk into the room and see all those counseling-related books and be less concerned that I was an intern. I just hoped they didn’t ask me whether I had read them all because then I would have to fess up.

I chose a late night to get the books into my office. The clinic had a hand-truck to make life easier, but it was still a lot of boxes to move. As I was unloading books from my car, a young man in his early thirties came strolling up and casually asked me for $25. While I have been asked for money many times, never has someone on the street asked me for $25! I was taken aback, but even more, just really curious. I told him I would consider his request if he explained to me exactly why he needed the money. Without knowing at all what I did for a living, he said, “I have been in drug treatment for the past month…a couple of days ago, was kicked out and have nowhere to go… I’m homeless and need the money to buy a bus ticket to San Francisco where my parents live.”

Made sense to me. “Why did you get kicked out of drug treatment?” I asked.

The question made him squirm. He looked down at the pavement and said nothing. I could sense he felt shame. Then in a soft voice he said flatly, “I was caught on my bed with another man.”

I replied non-judgmentally that it seemed like a dumb reason to get kicked out of treatment, and that I would help him. I gave him my business card from the clinic and said to come see me the next morning when I could access funds to help him. Because he had nowhere to sleep I pointed him in the direction of a nearby shelter. The next morning when I stumbled tiredly into the clinic, he was sitting in the lobby waiting for me. It was a busy day. I had two evaluations back-to-back and the first client was also in the waiting room. I had him come back to my office where we chatted briefly about the money. I said I would make some calls, fill out some paperwork, and we could reconvene in my office around 11am to finalize things. He thanked me for my efforts and said he would be back then.

But he never returned.


Around 3pm that afternoon I got a call from the county coroner. He had a body and the only item found on it was my business card. The man had overdosed just blocks from my office. My heart sank and my mind raced. What had gone wrong? How could this have happened? What had I missed?

I will never fully know the answers to these questions, but I suspect that he overestimated the amount of drug his body could handle after being clean for a number of weeks while in treatment. I don’t think he was suicidal, but perhaps I missed something. To this day I regret not taking more time to assess his risks for relapse and overdose, but I didn’t know then what I know now.

For me, homelessness will always have a face.


Addiction & Homelessness, Part I

Wednesday, April 24th, 2013

Young-person-homeless-hun-007In recent months my travels have taken me to Philadelphia and New York City (NYC), two of the most amazing cities in America. While I have enjoyed staying at comfortable hotels and dining on delicious food, it has been impossible to ignore the significant number of homeless people on the streets, begging for money and food. In fact, many have approached me and asked for help. As someone who has spent a career treating those who struggle with addiction, my stance has always been that giving money to the homeless essentially equates to giving them the means to engage in addiction – because of course they will use the money to buy alcohol or drugs! And this stance has been so easy to implement. All I have to do is walk on by, pretend not to notice, and feel good knowing that I am doing my part not to further addictive behaviors in the homeless.

But then I discovered Wayne Teasdale’s enlightening book, A Monk in the World: Cultivating a Spiritual Life, and my resolute stance on (not) giving to the homeless began to crumble. He put names and stories to the faceless and awakened me to how the homeless mirror many of my own insecurities. Very few who become homeless have chosen this lifestyle. Various risk factors conspire – much like addiction – to bring about the unfortunate state of homelessness. Behind every person wrapped in newspaper, sleeping on a park bench on a cold night, is a story.

In America approximately 500,000 individuals experience homelessness (100,000 are chronically homeless) on any given night. A report by SAMHSA indicates that more than a third had chronic substance abuse problems and many also suffer from mental illness. A study conducted in Philadelphia and NYC on the chronic homeless – my two recent destinations – revealed that most were male and over 90% Black. In January of this year, for the first time ever, NYC recorded over 50,000 individuals showing up at shelters, one in ten being children. Homelessness is a growing and omnipresent problem that I now see everywhere – now that I am actually seeing.

Homeless chart

So what to do about the homeless?

For the first time in my life I am now engaging the homeless. Instead of walking by and ignoring their pleas for help, I am stopping and doing my best to listen to their stories. This past weekend in NYC I met Nelson. He suffered from a vascular disorder that injures blood vessels called Hemangioma. He came to NYC a few years ago from a South American country in hopes that doctors could help him, and they did. As we chatted on the street, he pulled out a stack of family photos and told his story. He was incredibly grateful to be alive and reminded me that relationships are at the center of a good life. Our conversation also highlighted the incredible discrepancies between those – like myself – that invest significant amounts of time, energy, and money on materialistic things, and those that have nothing.

In addition to Nelson, there have been others recently whom I have engaged and listened to their stories. At the same time, I don’t stop for everyone. My relationship with the homeless is still evolving. I don’t mind giving money anymore. But what I have learned in the brief time that I have opened to this problem, is that money alone is not the answer. A permanent solution to homelessness will require a transformation in our society, a systems approach that understands how to intervene at the root of the problem.

For now, I will no longer ignore or be afraid of the homeless. I will embrace the vulnerabilities they mirror in myself, and take the time to listen to their stories.

Addiction and the Perennial Philosophy

Saturday, April 13th, 2013

perennial_philosophy_coverWe have known for a long time that among the most powerful ways to overcome addiction is through spiritual interventions. The essence of such approaches is that addiction is a problem of the ego, of our lower self, of the body. By harnessing the powers and energy from our higher self, from the part of us that is unchangeable and connected to the source (God, Buddha,  Allah, Atman …your choice), we can overcome most anything in life. This philosophy is at the heart of twelve-step programs, but it really goes far beyond recovery. In fact, it is about our ultimate work on this earth – awakening to our true nature.

I will admit I have been slow to all of this. I was not raised religious and the rare times I made it to church were with friends on holidays primarily for the food. Even more, I was raised in a family that valued science, and awakening to our true nature was not something that fit well into randomized clinical trials. So it took many years of wandering before I stumbled upon the Perennial Philosophy, something that made a lot of sense to me.

Perhaps you too have heard about it, or maybe not. Although I am sure there is a more elegant way to describe it,  I understand it like this. If you ventured back in history and gathered up all the wisdom on how to live life from all the great mystics and enlightened beings from all the world’s religions and spiritual traditions, and then boiled down their essential message, they would all speak universal truths, which is the Perennial Philosophy. It is the commonality in all religions, it’s what links them all together no matter how different they may appear on the surface. For me, this is very much like the scientific method. We have a bunch of researchers, who over time, using a variety of techniques, study a phenomena from various perspectives and all arrive at the same conclusion, informing reality as we know it!  Of course science is not perfect because it is conducted by people who can make mistakes, but history has shown that it is pretty darn good at helping us understand the world.

UntetheredSoulMech-#1.inddSo for me, the Perennial Philosophy bridges the gap between science and spirit, and has been a game-changer in life. If awakening to our true nature is our primary purpose on this earth, then it sure simplifies a lot of things! My to-do list is now much, much smaller. And so many things that I believed to be critical to a good life, things that I had to have, now seem not so important. Less really is more! What exactly is the Perennial Philosophy? There are two ways you can discover the answer. You can use your lower self, your ego, and read all about it. A good place to start is Aldous Huxley’s well-known The Perennial Philosophy. Or you can read about it in many of Ken Wilbur’s books, or get a nice summary on Wikipedia. But in all honesty, this method is a bit like reading all about a cool place you want to visit. It will give you some background, the lay of the land, but in the end it is not the cool place, is it? To really experience and understand the cool place you read about, you have to visit the cool place!

If you really want to understand the Perennial Philosophy you have to experience it through your higher self, through contemplative practice. There is no other way. Meditation, in all its forms, is the primary vehicle for developing a contemplative life, although there are other ways. With practice, you will discover the self behind the self. The part of you that has always been there, that does not change with your thoughts and feelings, and is capable of pure awareness. If this all sounds a bit warm and fuzzy, check out the bestselling book The Untethered Soul. I will admit, it has been a very slow journey for me. Perhaps the most important thing I have learned thus far – if you never take trip, if you never go inside and really see what is there – you are missing out on something very cool, beyond cool, actually.

Vacation is over, a lot of new posts coming!

Wednesday, April 10th, 2013

I cannot believe it has been since October of last year that I have written a blog entry! Yes, I have been busy, but aren’t we all busy? I don’t think it is a very good excuse. Addiction continues to be among our most serious public health problems, and we need to do as much as we can to help those who suffer. This site has been my small contribution, but over the past few months I have felt an increasing desire to do more.

Since switching this site to a new host server in 2007, request for pages has grown from about 2000 per month to well over 60,000 (and growing). I find this incredible, and am grateful for all of you who visit! It also tells me that there is a real and growing need for help, and that despite there being thousands of addiction-related sites out there, most of them fall short of offering helpful solutions.

I don’t claim to have all the answers, but I have spent the past couple of decades working as a licensed professional counselor, researcher, graduate school teacher, consultant, and friend to those who suffer, and over the years have developed a very broad, comprehensive and unique way to think about addiction and treatment. Perhaps one of the most influencing factors on my present work is my doctoral degree in systems science. Most of my family and friends still ask what the heck I studied all those years, but systems science essentially is about the science of solving complex and challenging problems. And in my opinion, what better problem than addiction to  address through the lens of systems science!

So, what can you look forward to in the months to come?  I get so many requests to blog about newly published books, cool new shows on addiction, and even apps that can help those who struggle with addiction, my problem is finding the time to do it, but I promise you I will!  And, if you are not finding what you need on my site, please email me, as I am always open for suggestions on how to improve it.


So what’s up with the stars!  I love photography and shot this a couple of weeks ago. Taking pictures reminds me of the importance of slowing down, focusing, and paying attention to what is right in front of me, in the present moment. Next time you are outside and the stars are shining, look up and take in the beauty of the sky. And thanks again for visiting the site, I promise, no more vacations.