AA Meeting in Mt. Joy

To start off, the experience I had at this meeting was quite interesting. Having a dad who attended these meetings as a requirement in order to be put on a transplant list, he would always elaborate on how they were, what he talked about, etc. However, I never expected the interactions to be so intimate. The amount of trust I encountered in this environment was phenomenal. I found it even more interesting how they let me into their circle and didn't mind that I was there.

I would say that all people at this meeting were between 25-40 years old. There were 12 men there and 5 women. The majority of which were white. I inquired with a few of them how long they have been at this particular AA program and all of which had been at the same program for over 3 months. The meeting was run by a supervisor who I didn't really get to interact with other than my introduction to her when I got there. The supervisor started off by asking if anybody had anything to share and introduced me as the guest for the evening. There was about a 35-40 minute session of experiences they have had since their last meeting. It varied from relapse, support, and trying times. The variety of stories in which they told were very intriguing. They seemed very trusting in each other and didn't have a problem opening up with the group (even with me there). At one point, I was asked by one of the participants if I have had any experiences or have been affected by alcohol. I then took the time to elaborate on my experiences with my father and his struggle with alcoholism. I felt at this point they saw me more as just a student, and that perhaps they could relate to the feelings I felt. After this, I felt more apt to chime in when stuff was being said. I believe I participated four to five times throughout the rest of the session. The last 20-25 minutes were spent discussing goals for the following week. They included goals to recovery, preventing relapse, etc. Overall, I found this to be an amazing experience considering I was very nervous to go to begin with.

Sometimes the difference between a happy life and a sad life is often one step away

Personally, everybody in this meeting seemed to be being helped by the meetings. None of them had ill-feelings towards being there and all seemed to be fighting hard to beat their addiction. Although it was a small sample, it seemed as if their intentions were genuine. The discussions were intimate and the amount of trust in the room seemed to be very high. I believe the supervisor has a nice format in place and a core group of participants who are open to helping others and themselves.

 I would say that this all relates to the material in class about addictions. I saw the sides of addiction and the struggles that they were encountering. Knowing what my dad went through, it is nothing to be taken lightly. I think one of the fundamental things about addiction we don't understand is why we just CAN'T quit. From my experiences and having the experience to go to this AA meeting, I can say I understand how hard it can be. Also, it does seem like the AA sections in our book seem to closely parallel the one used in practice at the AA meeting I went to. They are very intimate and trusting, yet there still seems to be work to be done. It's a process, one in which people battle throughout their lifetime.


This experience gave me an appreciation to people battling their addictions and the steps they take to better themselves and be a positive influence on the people around them. These meetings seem to start to provide a light at the end of the tunnel through the battle of addiction.

Motivational Interviewing

Motivational interviewing can be defined as a way for therapy to be client-centered in which providing a direct method to increase motivation to solve problems that lie in the psychological path (Van Wormer & Davis, 2008). This process was created by William Miller and his students at a school in Norway in 1983 (Motivational Interviewing, 2011). Motivational interviewing is focused on a respectful stance with a focus on building a rapport in the initial portions of the counseling relationship (MI, 2011). Motivational Interviewing is composed of three essential parts: 

• First, MI is a particular kind of conversation about change 
• MI is collaborative (person centered, partnership, honors autonomy, not expert-recipient)
• MI is evocative (seeks to call forth the person's own motivation and commitment) (MI, 2011).

It can be said that Motivational Interviewing is based on the spirit on three key elements. This includes collaboration between the client and the therapist, evoking or drawing out the the clients' ideas about change, and    emphasizing the autonomy of the client. (MI, 2011). In doing this, it creates an environment where the client can open up and not feel judged or put back in a corner. By emphasizing the autonomy of the client it creates a situation where they feel like they have control. In overcoming an addiction, a sense of control can go a long way in determining future success. 

There are also four distinct principles that guide Motivational Interviewing:

1. Expressing Empathy

• In expressing empathy, you get to look at the clients' problems through their eyes. By looking at it through this lens, one can get a better understanding of what the client is going through in their day to day struggles.

     2. Support Self-Efficacy

• This is focused on getting the client to come to the realization that they have it in themselves to change for the betterment of their lives. 

     3. Roll with Resistance

• This stresses that there will be resistance with change but you must roll with this. Never falter in your belief in the client and in return they will see the positive impacts that this has in the long run for their overall good to overcome their addiction.

     4. Develop Discrepancy

•  When clients recognize that their current behaviors place them in an internal conflict with their values or interrupt the goals they have set for themselves, they are more likely to notice this and go about change. The counselor must not use strategies that could develop discrepancy between this (MI, 2011).

This shows the battle against and towards change.

All of this shows the complex, yet simple set-up of motivational interviewing. It is a simple technique that can have long-term substantial success. However, how does this compare to the components of the addiction cycle?

This method I believe have a strong impact on the addictions cycle. By holding the person accountable and remaining their autonomy, it can be used for all stages of the addiction cycle. I think it is most useful in the dependence stage. Once the client realizes that their life is worth more than a substance and can see further into the future than just until they get their next fix, the motivational interviewing holds a huge benefit. By having a person tell you that you have to quit, makes little difference because it's not a whole-hearted decision. However, by doing it by investigating and getting deeper into your own internal feelings, than you are changing for the betterment of yourself. As stated previously, I believe this provides the best of the strengths-based approaches to create a change in an individual. However, as is everything, not all treatments are for everybody.

 The fact that this counseling technique uses full autonomy provides, I think, the best option for all users. It has been shown to work with alcoholics and other substance abusers through numerous sources I've looked at. As I look into a future working with at-risk children, this could be extremely useful. By using this technique, I could create an environment in which the client can be open and rational in their pursuit of being clean. This approach allows for the client to come to a conclusion themselves. The duration of which may vary, but the end results remain the same. A clean person is a happy person. I could see myself using this approach if needed. I did a little research on each of the strengths-based approaches and I would say this one by far goes about it the best way. It allows for the client to entrust in somebody, but at the same time make psychological gains in their fight to overcome addiction.

Video I found on Motivational Interviewing (demonstration):

http://www.youtube.com/watch?v=URiKA7CKtfc

References:

http://www.motivationalinterview.org/Documents/1%20A%20MI%20Definition%20Principles%20&%20Approach%20V4%20012911.pdf. Cited as: (MI, 2011)

Van Wormer, K., & Davis, D. R. (2008).  Addiction treatment: A strengths perspective.  Pacific Grove, California:  Brooks/Cole Cengage Learning. 

Behavioral Addictions: Compulsive Gambling

Compulsive gambling (also known as pathological gambling) can be defined by the uncontrollable urge to keep gambling despite the toll it takes on your life. If you're prone to compulsive gambling, you may continually chase bets, lie or hide your behavior, and resort to theft or fraud to support your addiction (PubMed, 2012). 

Symptoms of Compulsive gambling include: Concealing gambling, making higher and higher bets to earn back losses, lying to family and friends about whereabouts when out gambling, making unsuccessful attempts to cut back or quit, and many, many more (Mayo Clinic, 2011; PubMed, 2012).

It has been hard to determine at what point gambling becomes an addiction rather than a "bad habit." A deciding factor in this is when people who compulsively gamble make it become a way of life. For example, a person who takes time out of their day to gamble instead of going to spend time with their family (Mayo, 2011). Furthermore, people that are willing to commit crimes in order to feed their gambling addictions (PubMed, 2012). While these are concrete examples of when a habit becomes an addiction, there are subtle examples too as to when this happens. Making unsuccessful attempts to stop or cut back on gambling is a prime example. Many people don't see it as a problem and when they are unable to cut back, they just keep gambling in order to make up the money they have lost. They do not see it as a problem, but as a second job (Mayo, 2011; PubMed, 2012).   
Recently there has been a psychiatric test and history evaluation to diagnose compulsive gambling. Other tools like the Gambler's Anonymous 20 questions can help with the diagnosis (PubMed, 2012). 

The prevalence of compulsive gambling has been hard to estimate due to the erratic nature of the behavior and the fine line between habit and addiction. The best estimates seem to put about one-half of 1% (0.42-0.6%) as compulsive gamblers at sometime during their lifetime (Massachusetts Council of Compulsive Gambling, 2008). As a measure to how significant of a problem this is, here are some prevalence rates of other addictions/behavioral disorders in the United States (couresty of Massachusetts Council of Compulsive Gambling, 2008).

• Opioid use disorder (e.g., oxycontin, morphine): 1.4%⁷

• Cocaine use disorder: 2.8%⁷

• Amphetamine use disorder (e.g., methamphetamine): 2.0%⁸

• Anti-social personality disorder: 3.6%⁸ 
• Obsessive-compulsive disorder: 1.6%⁹ 
• Schizophrenic disorders: 0.6%¹⁰

• Anorexia nervosa: 0.6%¹¹

• Bulimia nervosa: 1.0%¹¹

As you can see compulsive gambling holds a close tie to other disorders/addictions. It has almost the same prevalence rate as Schizophrenia, Anorexia, and Bulimia. This should put into context how big of a problem this is in the United States specifically, but also the effects it has worldwide. Since this seems to be a growing issue in society, treatment options have been made to help people who have this addiction.

Most people with Compulsive Gambling problems refuse to admit that they have a problem. In order to treat a patient, they most times need to be pressured into seeing that they have a problem. Treatment plans include the use of Cognitive Behavioral Therapy (CBT), Gamblers Anonymous (GA) which is a 12-step treatment plan just like Alcoholics/Narcotics Anonymous (PubMed, 2012). These have been shown to yield surprisingly good results with compulsive gamblers and their relapse rate is much lower than a lot of other addictions. A new form of treatment, however, has been shown to have some positive biological effects on the body. Antidepressants and Opiod antagonists (like naltrexone) have shown to help the body rid itself of compulsive gambling tendencies (PubMed, 2012). However, these have not been through extensive trials so they are rarely used, except in extreme cases of compulsive gambling. Above to the right you can see a flow chart of compulsive gambling and recovery. 


While these treatments are often effective, there seems to be many complications with compulsive gambling. Anxiety, depression, dependence of alcohol (an extremely high co-morbid rate with compulsive gamblers), financial, social, and legal problems, etc. (PubMed, 2012). These complications can often end up leading the compulsive gamblers into other form of rehabilitation which many people do not know. 

Overall, I found researching this to be very fascinating. I didn't realize how in-depth it was and just how low people will go to be able to gamble. I think the most shocking piece of information I read was the high co-morbid rate with compulsive gambling and alcohol abuse. I suppose this is exasperated by the fact that depression rates are also high in compulsive gamblers. In saying this, many depressives end up with alcohol problems. Compulsive gambling seems as if it is a perfect storm in which other problems surface and require separate treatments. Finally, I think the medication route that is beginning to be used is fairly fascinating. By using medication, it almost is saying that there is a biological component to gambling and is not strictly environmental. I tried to research and find some neurological components to gambling but I was unable to find anything concrete enough to put into the blog. 

Until next time....  

-Derek



References:

Massachusetts Council of Compulsive Gambling. (2008).Prevalence of problem gambling. Retrieved from http://www.masscompulsivegambling.org/paths/what_prevalence.php

Mayo Clinic. (2011, January 19). Compulsive gambling. Retrieved from http://www.mayoclinic.com/health/compulsive-gambling/DS00443/DSECTION=symptoms
(For this website, they had a "next" tab which you paged through the causes, treatment, etc. Only thing in citation that would change is the subject at end of the URL).

PubMed. (2012, February 13). Pathological gambling. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH000248.

The History of Heroin

By definition, heroin is processed from morphine which is derived from the opium poppy. It was first produced in a British morphine lab in 1874. In 1898, a pharmaceutical company named Bayer promoted heroin as a non-addictive painkiller and cough medicine for kids and it was also used for as a treatment for morphine addiction. One may find this ironic considering that heroin is actually processed from morphine, which is a derivative of the opium poppy. While Bayer was making quite the profit off of this new "miracle" drug, they deliberately refused to tell the general public that when heroin is metabolized in the liver it turned into mostly morphine. The use of heroin as a treatment for various ailments was intact until 1914 when the Harrison's Narcotics Tax Act was passed in 1914 to control the sale and distribution of heroin. However, this did not stop doctors from prescribing heroin to people. This led to people continually using heroin and creating a network of people who had become dependent and addicted to heroin.

 http://www.novusdetox.com/heroin-effects-history.php

Heroin can be found in many different forms, colors, etc. based on what it is cut or laced with. Pure heroin is rarely sold on the streets, mostly due to the fact the drug dealers would not make as much money by dealing pure heroin. By lacing heroin with powder (either white or brown) it can distort the pure color of heroin (http://www.novusdetox.com/heroin-effects-history.php).

On the street, heroin goes by many names: smack, h, skag, and junk. Heroin is usually injected, by can also be snorted and smoked. Heroin users tend to shoot up nearly four times a day. By injecting heroin, it provides the quickest and biggest high (effects felt in 7-8 seconds). While the other two methods are not as strong, it seems that all three ways of using heroin are highly addictive.

As you can see in major cities, injecting seems to be by far the most used method, with sniffing/snorting coming second, and very few people smoking heroin.

http://www.narconon.org/drug-information/heroin-information.html

So, why do people become addicted to heroin? Heroin acts in a way in which it is carried to the brain and crosses the blood-brain barrier. Once there, it activates the endorphin receptors to release more endorphins. This in turn creates an overwhelming state of euphoria. Below, you can see how opiates can affect our brains.

Heroin has numerous short-term and long-term effects. Short term effects include: a "rush," nausea and vomiting, suppression of pain, and decreased breathing. Long-term effects include: addiction, infectious diseases like HIV/Hepatitis B/C (because of the sharing of needles), infection of the heart lining, and collapsed veins (http://www.narconon.org/drug-information/heroin-information.html). While I have discussed the history, logistics, biological, and side-effects of heroin I have to this point failed to mention its prevalence in the United States. 

According to the CIA's website, there are approximately 2 million heroin users in the United States, of which they estimate 600-800 thousand of them being hardcore users. They do go on to suggest that most of these are older individuals but the use among younger populations has begun to rise exponentially in the past few years ( https://www.cia.gov/library/publications/additional-publications/heroin-movement-worldwide/consumption.html). Approximately 30-40% of the United States' heroin comes from Mexican growers and refiners. The remaining percentage seems to be mostly coming from Colombia, who is also a main supplier of cocaine in the United States (http://www.novusdetox.com/heroin-effects-history.php). 

Heroin happens to be one of the most penalized drugs out there today. On a Federal level, a first time offense using heroin can land you a year in prison and a $5,000 fine. However, a first time offense selling or distributing heroin can land you a maximum of 15 years in prison and a $25,000 fine. On a State level, a first time offense using heroin is a felony and will get you up to 7 years in prison and up to a $50,000 fine. Selling or distributing heroin usually results in 10-15 years in prison with a $100,000 fine (www.legalmatch.com/law-library/article/heroin-state-and-federal-penalties.html). Most all heroin convicts are encouraged to go to NA meetings and complete the program. While there is no Heroin Anonymous, NA has been shown to have great results over the time of its existence. 

Personally, all of this information is mind-boggling. I didn't realize the prevalence of heroin in our society and how it has crept into younger populations. In fact, it is very disturbing knowing that heroin usage has increased in the United States. Although the penalties for heroin are among the strictest, there still is not enough being done to keep it out of our country. Overall, it seems to be a big detriment to our society and better policing needs to be done before it is ingrained into our society's fabric just like marijuana and cocaine seem to be. Until this happens, there will become more addicts and more lives ruined due to a substance. On a smaller scale, the effects this has on families is probably far worse. When you become reliant on a substance, it takes priority and distorts reality as to what is more important. Broken homes and broken hearts seem to be the only thing that comes out of severe drug addiction. Although progress is being made in NA meetings and there are success stories, there seems to be far more stories of failure and relapse.  

References:

http://www.novusdetox.com/heroin-effects-history.php

http://www.narconon.org/drug-information/heroin-information.html

http://www.legalmatch.com/law-library/article/heroin-state-and-federal-penalties.html

https://www.cia.gov/library/publications/additional-publications/heroin-movement-worldwide/consumption.html