Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery.

Category Archives: Kim

A Positive Step in Curbing Opiate Addiction

Everyone knows the drill: within seconds of entering a doctor’s office for a routine check-up, someone sticks a thermometer in your ear, pumps up a blood pressure cuff, records your respiratory rate and takes note of your heart rate.

These are your vital signs; if any one of your vitals is abnormal it serves as an indicator that there may be an active illness or disease state present.

Although the four vital signs were the standard of care for decades, in the 1990’s, level of pain was added as the fifth as part of a Veterans Administration initiative and became a Joint Commission standard in 2002. One problem at the outset with this movement is that pain, which is subjective, was referred to as a “sign.” Signs on the other hand, can be measured objectively, like the four original vital signs in medicine. If a thermometer indicates that the temperature is 96, then that’s what it is.

Regarding pain, the patient reports subjectively a number to rate their experience of it, typically between one and ten. Unfortunately, instead of taking the appropriate steps to determine the underlying cause of the pain or considering other alternatives, many doctors simply write a prescription for opiates; they do so without informing the patient, or even being aware themselves, of the risks involved with taking pain medication.

It has long been believed that this subjective assignment to pain and the doctor’s willingness to supply opiates is a contributing factor in today’s epidemic of pain killer abuse.

The American Medical Association (AMA), our nation’s largest medical society, seemingly agrees and now recommends dropping pain as a vital sign.

To its credit, the organization admits to culpability in this nationwide problem, saying physicians played a key role in starting the opioid epidemic by overprescribing pain medication, and now must do their part to end it. Another large piece of the problem is the lack of addiction training in medical schools and residency training programs across the country.

By improving physician training, improving prescribing practices, raising patient awareness through honestly describing risks and benefits of pain medication in the informed consent process, we can positively impact the opioid epidemic that is killing hundreds of thousands of Americans unnecessarily. Moreover, we can do so in a way that protects access to opioid pain management for those people for whom these medications are truly appropriate.

A New Form of Bulimia: Pump Eliminates Need to Purge

Decades ago, patients had their mouths literally wired shut. Then came the era of the balloon inserted and inflated in the stomach to mimic the sensation of fullness. Then we moved into radical surgery that rerouted the gut altogether. The most recent attempt to achieve weight loss is the lap band, considered less invasive and still far short of a fail-proof miracle cure for most people.

Never let it be said that companies are asleep at the wheel when it comes to creating new, and ever more bizarre, devices to “help” the morbidly obese.

Acquiring rapid approval from the Food and Drug Administration this week, the AspireAssist is being touted as the new solution for those who have failed to lose weight. After all, it is minimally-invasive, reversible; it’s a simple procedure that offers quick recovery; it has proven results in clinical trials and is affordable. How great is that?

Now, let’s talk about what is actually true. This is a pump that allows people to consume food, and then mere minutes later drain it from their stomachs straight into the toilet. Many experts are calling it a bulimia-assist device. And well they should. The individual gets the same result without having to engage in that pesky, far more dangerous act of vomiting.

The makers of the device also tout that another “real benefit” of it is that people get to engage in “a healthy, normal lifestyle.” It seems they have skipped over the part about having to go to the bathroom after every meal and dump out undigested food from the stomach directly into the toilet.

The evacuation takes from five to ten minutes, should be executed after every large meal, and can “easily” be accomplished in a public restroom.

There is nothing normal about this.

In a statement, the FDA cautions that the device should not be used by those with eating disorders. Now what does this organization in its infinite wisdom think that, at the very least, a sizeable minority of those with severe obesity are struggling with? Cancer?

Many of those whose weight would classify them as obese have a very real eating disorder – most will go undiagnosed and untreated. These are exactly the people who will go to great lengths to get such a device installed. A quick fix; it’s every addict’s dream, indeed, every American’s dream.

The only thing this company is doing right is advocating lifestyle counseling while using this product. Imagine what results we would see if we offered ongoing individual therapy, lifestyle counseling provided by nutrition and exercise specialists and lifelong supportive group therapy without the “purge device.”

What does it say about our country’s obsession with thinness and its widespread disdain for people of size that the FDA so rapidly approved this device, essentially a bulimia-assist product for the “treatment” of those classified as obese based on their BMI?

Our healthcare system is short-sighted, symptom-focused and very broken. When we start to understand people first and foremost as human beings and view their “symptoms” in that context, perhaps we will deliver care to people in ways that enhance their health (physical, mental, emotional, social and spiritual) sustainably. And, at a fraction of the cost that we are currently dumping down the toilet due to our broken system.

Bill and Bob Were Right all Along

The Big Book, essentially the “bible” for Alcoholics Anonymous was first published in 1939. From that year until the present day, spirituality, in the form of developing a working relationship with a Higher Power, has been considered an essential component of addiction recovery in the 12 step program.

Bill Wilson and Dr. Bob Smith, the founders of AA, could only guess at the power of prayer, but now we know:  they were right.

“Craving” is one of the criteria that physicians use to diagnose addiction. A strong desire for alcohol or drugs can persist for years after people become clean and sober. That is why AA members continue to recite abstinence-promoting prayers that are designed to reduce cravings.

Researchers from NYU Langone Medical Center set out to explore the brain physiology in AA members, the first study of its kind. They sought to determine what transpires in these people’s brains when exposed to alcohol-craving triggers.

The researchers recruited 20 long-term AA members; each reported no cravings for alcohol during the previous seven days. The subjects were placed in MRI scanners and then shown images that involved alcohol consumption. These pictures were displayed twice: first after asking the participant to read neutral material from a newspaper, and again after the participant recited an AA prayer promoting abstinence from alcohol. All participants reported some degree of craving for alcohol after first viewing the images, yet the craving diminished after reciting an AA prayer. Importantly, the MRI data revealed that there were actual changes (increased activity) in parts of the prefrontal cortex in those who prayed. This is the region of the brain that is responsible for attention and emotion.

Whereas previous research examining the role of prayer on drinking behavior found that alcohol abusers who reported a spiritual awakening drank less after treatment for alcoholism, this study proves that physiological changes actually occur in the brain as a result of prayer.

I trust that more and more will be revealed as new research emerges on the neurobiology behind why participation in 12 step communities works for long-term sobriety. Until that time, those of us with experience helping others recover using a bio-psych-social-spiritual approach will continue to do what decades of recovery has proven works.

The Biggest Loser: Every Contestant Loses in the Long Run

Finally, after all these years, the reality show “The Biggest Loser” has offered the American public something of actual value; this comes in the form of a surprising new medical discovery made by studying the 14 contestants who participated in the 2009 show. Surprising and new to everyone except those of us who work in the eating disorder field!

If you are not familiar with the show, it focuses on people who are very overweight to start with, then helps them shed many pounds. The winner is, naturally, the one who loses the most weight during the season.

Of course, what they fail to disclose to the viewing audience is how these people fare after the show wraps. Turns out, not so well. All but one out of the 14 contestants studied regained weight in the six years after the competition. In fact, four of them are heavier now than before the competition.

A casual onlooker would immediately conclude that these people were simply weak-willed and could not resist “bad” foods, and that would be incorrect.

In part, their weight gain is the result of their resting metabolism, which determines how many calories a person burns when at rest. Originally, the contestants had normal metabolisms for their size, but by season’s end, their metabolisms had slowed radically and their bodies were not burning enough calories to maintain their thinner sizes. This is a normal occurrence when vast amounts of weight are lost in short amounts of time; in other words, this transpires after the body experiences prolonged periods of starvation. But the problem is, their metabolisms never recovered. They became even slower over time, as if the body was fighting back against this weight loss.

As far as I am concerned, this study merely added to the evidence that DIETS, specifically extreme diets, are far more the problem than people being overweight.

So instead of focusing on a population of people, such as those who participate in “The Biggest Loser,” we should look at people who have lost weight in a sustainable, healthy, slow method and look at their metabolic rates over time. These would be people who have lost weight WITHOUT starving their bodies to do so. My bet is we would not see the metabolism rate differences or certainly not to the same degree as those engaging in extreme dieting.

I’m continually blown away that expert researchers can’t see this. It is just so ingrained into our medical and lay culture that if it isn’t fast it isn’t American. If you can’t lose 40 pounds in 2 months, why bother?

Sadly, the biggest offenders in this regard are medical professionals who encourage their overweight patients to go on these extreme diets, unfortunately because it is so “shameful” to be fat in our society.  It is so regrettable that it gets beaten into every doctor’s head that fat is always bad and unhealthy, which is just plain wrong.

Positive Change in the Modeling Industry

I am forever astounded by the shocking inability of the high-fashion industry to learn and change. Those in the clothing business, along with their cohorts in the advertising world, clearly remain committed to using ridiculously skinny models in advertising campaigns.

The latest offender is Gucci. A recent ad displayed a young female model who was waiflike and frail in appearance. Her expression was one of gloom and the impression of gauntness was accentuated by dark makeup around her eyes. Even the young male model in the ad with her appeared unhealthily thin.

Fortunately, this did not go unnoticed by the Advertising Standards Authority of Britain. The regulator ruled that the ad was “irresponsible” and that the model looked “unhealthily thin.” The authority went on to say that the still photograph of the model, which appeared in an online video posted on the website of The Times of London, should not appear again in its current form.

Naturally, Gucci defended the ad claiming that the models were “toned and slim,” and noted that whether a model was unhealthily thin was more of a subjective issue.

Britain is not the only country taking action. Last year, the French Parliament took steps to prohibit modeling agencies from hiring dangerously thin models. The measures were intended to prevent young models from becoming excessively thin to secure employment and to stand against images of unhealthily thin females featured in fashion magazines.  Additionally, the government now requires altered photographs of models to be clearly labeled.

Not only do proactive steps like these make the industry safer for models in Europe, but importantly, they have far reaching benefits to every girl and woman who looks at these ads.

Taking steps to regulate what image gets projected to the world that depicts our society’s ideal female figure is a long-awaited action for many of us who see the ravages of deadly eating disorders on a daily basis.

One factor that we know increases the risk of these terrible diseases is unhealthy media images. Although we can’t change genetics, nor can we change other devastating traumas and negative life events experienced by many of those with eating disorders, this is something we can and ought to address. In fact, legislation has recently been introduced in California designed to protect the health and well-being of professional models. This pending bill clarifies that all modeling agencies must operate under the Talent Agency Act which provides necessary worker protections for models. It also clarifies that models are employees of the brands they represent, rather than independent contractors, ensuring that models are granted worker protection rights that all employees have in the U.S.

All eyes are on California; this could be a very positive first step.

Suicide in College: The Tide Needs To Turn

At this year’s Academy Awards ceremony, Lady Gaga sang a song entitled “Until It Happens to You.” The song shed light on the very real problem of rape on college campuses across America, a message made even more dramatic by the many female rape survivors appearing on the stage with the singer.

I respect any and all attempts to bring attention to this growing problem. There is another very real problem on college campuses that deserves similar attention: student suicide.  In the past year, 8% of students seriously considered suicide and 1.3% attempted to end their lives. Today, suicide is the leading cause of death in college students, second only to vehicle deaths.

Although we want to be shocked by this statistic, are we really? Consider the society in which these young adults grew up: one of relentless pressure to be perfect, popular, or “better” than others; one that is far more focused on performance than support, applauding strength rather than identifying and healing vulnerabilities. All this in a world rife with any number of traumas, ranging from physical or sexual abuse to emotional abuse, bullying, or emotional neglect.

As teenagers, many current college students spent untold hours each day on social media, following instagram and twitter, checking Facebook posts. To what end? So they could compare themselves to others and discover that they were not as pretty or skinny as the next girl, or conclude that they were a social pariah because they were not invited to this or that party?

Adolescents rarely walk away from social media sites feeling more positive about themselves.

And then for many, male and female alike, there is the ongoing stress of academic achievement. Excellent grades must be maintained in order to get that all-important scholarship, and therefore, matriculate at the equally important “good” school.

During these formative years, when healthy coping skills should be learned in the context of face to face supportive human relationships, it is not unusual for young people to instead depend on a skewed relationship with food, an addiction to self-harm, a dependence on drugs or alcohol, or fall victim to depression or anxiety.

Eventually, by hook or by crook, these high school graduates end up in college and things get … easier? Not likely; the additional stressors inherent to the world of higher education only exacerbate the previously established unhealthy coping strategy. Add that to an environment that is unfortunately synonymous with binge drinking and drug use, and the odds of suicide only escalate.

Now, more than ever parents need ongoing involvement with their children. There needs to be more talking, more time spent in the presence of one another, and less texting. From the time their children are babies, parents teach them by their example how to deal with pressure, stress and intense emotions. Babies, toddlers, children and then teens are exquisitely attuned to their parents’ feelings, reactions and behaviors–far more than they pay attention to their parents’ words. When we live our lives emotionally, spiritually, physically and in our relationships in a positive fashion, we have a much greater chance of instilling the same in the next generation.

Strategies such as healthy exercise, talking things out with a trusted friend, prayer, eating well, getting enough sleep, knowing when help is needed and where to go  to get it—each has value. The truth is, if a young person does not learn early on how to cope, he or she will turn to whatever is at hand, readily available, when facing difficult times in college.

As parents, we must do the best we can through the examples we set regarding how we live our lives, how we treat ourselves and others, how we accept ourselves in our shortcomings and strengths, how we love unconditionally, how we grow, how we feel, and how we heal from difficult experiences. When we help our kids find strength in knowing when to ask for help, when we cultivate the belief that we deserve it and all need it at times, we give them a better chance of turning to places of safety, strength and hope during a time of need, a time of stress, and the new frontier that college is for each of them.

Barbie: Stepping Out in a Whole New Body

Throughout her tenure as one of America’s most iconic dolls, Barbie has exhibited great versatility in her hairstyles, outfits, and professions. However, in one important area she has not deviated one millimeter from the traditional Barbie script:  her body.

From top to bottom, Barbie’s chest has remained shockingly large, her waist extremely small, her legs impossibly long, while at the end of those stilt-like limbs, she has a pair of tiny feet that literally translate into a shoe size of three, a fact that remains as improbable as the rest of her. And, speaking of bottoms, does Barbie even have one?

But the winds of change are currently blowing through Barbie’s perfect hair.  Effective this month, Barbie is shedding her impossible body mold and easing into the real world. She will now be available in what the company is calling “plus”-sized editions as well as tall and petite. In reality, the “plus” sized doll is actually average sized; this, in and of itself, is more than a little troubling. Diversity-minded Mattel will also offer seven skin tones, 22 eye colors and 24 hairstyles.

Of course, the adage that you cannot please all the people all the time is alive and well. While many are lauding Mattel’s move, certain professionals in the medical as well as behavioral health fields have expressed concern that this type of doll will only serve to reinforce the obesity epidemic in our country.

Sadly, not unlike the American public, most medical professionals are obsessed with diets and body mass index (BMI). They seem oblivious to the obvious fact that diets don’t work—never have, never will. They are equally blind to the fact that BMI in and of itself is a poor indicator of health. And they are most blind to the myth that skinny equals all that is good, attractive, sexy and healthy in the world, a concept that is forever perpetuated by diets and BMI.

In our culture, people assign all sorts of unfounded meanings to what an individual’s body looks like; unfortunately, it is rarely positive. Most often, a person of average size or above average size is stigmatized and viewed as being “less than,” grotesque, lazy, weak, or bad.

I think the new diverse Barbie is one of the few examples of something that has the potential to powerfully impact the brokenness and sickness in the eyes of our society — the eyes that are used everyday to negatively view, criticize, and hate our own bodies  as well as those of others.

If the new doll helps people accept themselves, and possibly even celebrate themselves, exactly as they are, we could experience change. We might see less disordered eating, misery, and the many mental and medical health problems that stem from people, particularly women, trying to be something they are not.

The new Barbie may have the capacity to help shape and heal the eyes of America. If it allows us to see beauty in a range of sizes, shapes and colors or helps even one girl or woman accept and appreciate her own body, then she is a winner.

America’s Game, America’s Addiction

The only thing hyped as much as the Super Bowl are its commercials. It was a highly publicized fact that a single 30-second advertisement would cost $5 million this year. That is serious money.

So, it would stand to reason that companies would only advertise if the message was geared to a huge audience, such as beer drinkers, automobile buyers.  Nearly halfway through the game, viewers were treated to an ad for constipation, specifically, opiate-induced constipation.

Constipation aside, is the opiate-consuming audience really that large? The answer is yes; in fact, opiate pain killer use is at an all-time high and deaths due to overdose now stand at epidemic levels throughout the United States, with the MVP being Oxycontin.

Just consider:

Sales of prescription painkillers in 2010 were four times higher than a decade earlier; according to the American Society of Addiction Medicine.

Health care providers write more than 250 million prescriptions for opioid painkillers each year, according to the U.S. Centers for Disease Control and Prevention.

Opioids are legitimate medications with legitimate indications for usage, such as certain surgical procedures, chronic and acute pain, or terminal illness. The problem is that they are being used frivolously, dangerously, without informed consent and for reasons that do not necessitate opioid-based pain management.

We have an epidemic of over-prescribing which has led to tremendous growth in prescription pill addiction. What we need now is a focus on access to good care for those currently addicted, education and accountability for physicians prescribing it, and education/awareness to the American public about the risks associated with use of opioid-based meds—the least of which is constipation. The worst and all-too-common risk remains addiction and death due to overdose.

What a sad state of affairs we have in our country that drug companies market to the general population about a drug that alleviates a side effect of pain medications. We are an over-medicated country and adding another drug to take care of a side effect of others hardly seems close to a solution.

I suppose if we don’t acknowledge that there’s a problem (Step1!), we are not in a position to even consider looking for healing, change, health or hope (Step 2). We stay stuck in our current ways of doing things, looking to pills (some of which have death as a side effect if we are honest about it) as our solution, our higher power, our God.

Medical Terrorists: Unethical and Uninformed Doctors Armed with Prescription Pads

It is an honor to be a physician. It is an even greater privilege to use my knowledge and ability at Timberline Knolls to help very ill girls and women recover from addictions, eating disorders, and other mental health issues.

Although I would prefer to believe that all professionals in the medical field have a deep understanding of the great privilege and responsibility that comes with being a doctor; that is unfortunately not the case.

Last month, an extraordinary blog entitled ”Killers in White Coats: Pill Mill Doctors Ignoring the Oath for Greed” appeared on a website, The Fix. It was written by a woman named MaryBeth Cichocki. MaryBeth is a registered nurse in Delaware; importantly, she is a mother, a mother of a son who was addicted to prescription drugs.

Galvanized by concern for her son, she launched an investigation into legal pill mills, where prescriptions were provided to anyone who had the cash to pay for them, with little attention to the risk factors and grave danger associated with the development of addiction. Each month Marybeth’s son, Matt, received prescriptions for a deadly combination of drugs that included Percocet, methadone and a generic muscle relaxer.

She filed a formal complaint against the so-called pain management clinic to the State Board of Medicine. The response: ”We find no fault with the prescribing methods of this practice.”

Throughout the blog, she repeatedly referred to the Hippocratic Oath, which was written by Hippocrates and is known to be the oldest binding document in history. It is a sacred oath that is still recited in medical school graduations. At the University of Chicago, we recited it during our White-Coat Ceremony at the very beginning of medical school, to highlight the seriousness of this oath and our responsibilities even as student doctors beginning our training.

The public at large is fairly familiar with the dictate to “do no harm,” but the promise also includes the statement: ”I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”

Those in white coats who recklessly prescribe opiate-based medications without assessing addiction risk have quite intentionally deleted any memory of the Hippocratic Oath. They exist as the antithesis of all that true physicians stand for. They do harm every time they place pen to paper on a prescription pad, and dole out a potentially harmful medication, often times with no mention to the patient of abuse potential. Although some of them lack understanding and awareness of addiction, some are fully aware but press on all the same, motivated by one thing:  money.

People throughout the United States are extremely focused on terrorism these days and rightly so. However, we might want to ramp up our concern regarding the attack on an epidemic number of Americans by medical terrorists. The unethical, uninformed doctor with a prescription pad is spared the devastating outcome that families and friends are left to recover from–the untimely death of a son, wife, daughter or friend who succumbs to addiction and ultimately dies due to drug overdose.

Marybeth’s son was one of these victims; Matt overdosed and died.

The time has come for each of us in the medical community to take responsibility for the medications we prescribe, the amounts we prescribe them in, the risk assessments we perform on our patients and the informed consent we are obligated to give them. Knowing when not to prescribe and what the alternatives are to narcotic pain medications is our responsibility.

First and of greatest importance: do no harm.

Walking Strong into the New Year

So…2015 will soon come to a close. As I look forward to a new year, I often reflect on the past 12 months to consider what I have learned, how I have grown.

I always thought I knew what unconditional love was, and then I had Samuel. There is absolutely no condition placed on my love for him; it is a constant, abiding love. It is a nearly tangible emotion that says every second of every day, “I would lay down my life for you.”

I know now that the abundant love I have for this child is only a small reflection of how God loves you and me. It is a humbling truth.

To my extreme delight and fascination, Samuel has recently confronted a challenge brand new to his little-boy repertoire: walking. He is highly committed to mastering this skill. Simply standing is its own reward; he gets to view the world from an elevated perspective. Achieving equilibrium can be dicey, but nothing is quite as adventurous as taking that first, then second step. Every possible emotion is displayed on his little face—joy, trepidation, curiosity, expectation.

Naturally, David and I, as well as his older siblings, provide the enormous encouragement he both desires and deserves.

Walking often proves a tough business, so more times than not, a fall is inevitable; there have been scrapes, bruises, and the occasional bloody lip, but this fazes him not in the least. He gets right back up and gives ambulation another shot, usually without blinking an eye, and sometimes even with a big smile on his face.

How much is my son’s desire and difficulty with walking similar to our journey in recovery? Consider… we also started down on the ground, be it in a pit of depression, the bottom of a bottle, with heads in a toilet or consumed with very low or high numbers on a bathroom scale. But, we got clean and sober, or said a final goodbye to any number of things: an eating disorder, addictive drugs, self injury or the relentless pain of trauma.

With help, we stood up and also noticed that the world looked different from this unimpaired perspective. Through unconditional love, we found the courage to stand strong when we faltered.

Finding new balance, we took a tentative step in this new reality, then we took another. We were similarly fearful, yet filled with anticipation as to what this new journey might bring. Not unlike a child, we took our lumps along the way, maybe even returned to the ground for a time, but just like Samuel, we got back up and started over.

My son’s goal is fairly simplistic: he wants to go from point A to point B on his own two feet. Although adult issues are far more complex, at the end of the day, isn’t that what we all want? We want to be strong, competent, and capable of managing everyday life. We want to experience the world on our own two feet. We want to be able to take in the help and love that surrounds us in order to grow.

Learning to walk and walking out recovery are only different in one regard. For Samuel, those crawling days will soon be gone; he will be an official member of the walking world in no time. In fact, he will ultimately retain no memory of the months spent on “all fours.”

But, our memories will remain clear and that is a true blessing. Only by remembering where we have been can we fully appreciate where we are today. Each one of us has moved from A, a place of darkness, pain, loneliness and death, to B, a life of potential, health, freedom and abundance.

So…as 2016 unfolds, respect the past, live in the present, and know that the future is full of promise and possibility. And most importantly, be aware of just how much you are loved — without condition.

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