Addiction Management Blog

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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.

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.

How should we help people who struggle with addiction?

Thursday, October 4th, 2012

I have posted this video before, but at some point deleted it because I was not completely happy with the overall quality. That said, it’s not bad, and the content is still very relevant to the site. I am posting it here because I have yet to get back to the camera and do an improved version, and I want to make sure the basic principles of treatment are available to all. One final comment. I have continued to refine how I think about and talk about treatment, and now refer to intervention in 5 actions. Although the video does not specifically use this framework, I do discuss each of the five actions. If you watch the video and then check out the 5 actions link you will be good to go. Enjoy!


Addiction is about three relationships

Friday, June 29th, 2012

There has been a push to understand and define addiction in our society as a brain disease, primarily because of the strong evidence from neuroimaging studies that have identified clear changes in the brain for those who struggle with addiction. At the same time, others have provided evidence that addiction is an adaptive response to underlying, unresolved, adverse childhood experiences (i.e., the ACE Study). We know the truth is that both are right. Roughly 80 percent of those who go down the path of addiction begin  prior to the age of 15. So early life experiences are critical to understanding this problem. Although the ACE study provides significant insight into the roots of addiction, we must also factor in to the equation a wide range of risk and protective factors, as well as genetic vulnerability. While I support incorporating all of these perspectives into our understanding of addiction, I believe how we understand this challenging problem should link directly with how we treat it. For me, this has led to a reconceptualization of how I understand and define this problem, one that I want to share with you.

Addiction is about three relationships with Self, Others, and the All. Let me explain.

The relationship with Self is best characterized by shame. Early adverse childhood experiences (and other risk factors) set-up a belief system that something is wrong with Self, and addictive behavior over time becomes a powerful way to manage the trance of feeling unworthy. To add fuel to the fire, when attempts to stop addictive behavior fail (due to changes in the brain), shame and feelings of unworthiness deepen even more, creating a destructive cycle that results in great pain for the Self and those around the person struggling. The relationship with Others is best characterized by isolation. I have written about this particular relationship in past posts. Isolation occurs because the developmental capacities necessary to initiate, form, and maintain healthy relationships with others become constricted over time, due to spending considerable time with objects of addiction (e.g., alcohol, drugs, porn, food) instead of people. In essence, adults who struggle with addiction are childlike in their ability to be in relationship with others. This makes it hard to hold jobs, parent kids, remain in committed, intimate relationships, and build community. It also helps explain why about 80 percent of those behind bars struggle with addiction, as well as many who return home from war and feel isolated and disconnected from those who have not had similar war experiences. The third relationship is that with the All (e.g., God, Atman, the One, Yahweh, Brahman, Allah), or what 12-step programs call higher power. It is a relationship I have devoted little time to on this blog, but one that I intend to give far more attention to in the future. It is best characterized by Truth and Love. The truth comes from experiencing all that addiction is – both its pleasures and pains. It is no coincidence that at the moment of orgasm, the instant the body feels the sensations from a drug, or the second one realizes they have had a Big Win on the craps table, the words “Oh God” come forth. Going deep into addiction is a search for the All, for truth, and ultimately for love.

These three relationships require attention and healing if we are to be successful at helping those who struggle with addiction. Our interventions should target all three relationships, which I should add, are hardly independent, but linked together in a seamless system. Work on one relationship impacts the others. There are two broad paths or categories of interventions: 1) the path of action, and 2) the path of non-action or contemplation. The first path is what we are accustomed to associating with typical interventions and treatments. The path of action happens in our waking states, when we “do” things. I believe there are five broad actions that are important on this path: motivate, evaluate, manage, resolve and create.  The path of non-action or contemplation is equally important, and involves using meditation practices to detach from objects of addiction and embrace our spiritual nature. If you consider meditation an action, then I guess you could make an argument that perhaps there is only one path. But doing contemplative work in essence is about “just being” which takes us back to a path of non-action. If it sounds a bit confusing, it is to me too. And to round out this discussion, both paths meet in consciousness. More about this to come.

As a parting thought on this topic, engaging all three relationships allows us to incorporate all we know about addiction. We can incorporate insights from neuroscience, medications, and healthy living into our treatments and interventions. And, we can evaluate outcomes more holistically when we consider how our interventions impact and change the three relationships.