SunCloud Health offers integrative, intensive outpatient and partial hospitalization for adolescents and adults of all genders – “Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery”.

Amid the Opioid Crisis, the Addiction Crisis Rages On

At SunCloud Health, we are very concerned about the record level of deaths caused by opioid overdoses. At the same time, we are mindful that the opioid epidemic is part of a much larger problem – the addiction epidemic.

It is crucial to remember that addiction is a brain-based illness that is not caused by a specific drug or substance. (Here is the official ASAM definition of addiction.)

When we focus on the drug and not the underlying problem, we’re in danger of missing the bigger picture.

Understanding the ways addiction plays out in our lives

As we’ve seen, addiction to opioids can kill – and kill quickly. Addiction to these drugs has claimed the lives of hundreds of thousands of people nationwide. And while worried parents are focused on the dangers for their children, the truth is that people of all ages from all walks of life can become addicted.

While we can’t turn away from this reality, we need to realize that other addictions kill, too. People who suffer from food addiction can lose their lives, though the pattern usually works more slowly and subtly than with opioids. Alcohol addiction claims 3 million lives worldwide each year, far more than opioids.

Lethal overdoses can also come from mixing highly addictive substances such as benzodiazepines – sold under brand names like Xanax, Klonopin, Ativan and more – with other drugs, including opioids. The news is filled with tragedies involving deadly combinations like these.

When we realize how many ways lives can be lost, we begin to see that the story doesn’t begin and end with saying, “Opioids will kill you.” In and of themselves, these drugs don’t kill, and in fact, they have many beneficial medical uses. Opioids kill only when someone develops an addiction to them. Addiction is the deadly root cause that we must address – in all of its various forms.

How people recover from addiction

At SunCloud Health, we have successfully worked with hundreds of people facing addiction to drugs, alcohol and specific behaviors such as gambling, eating, or relationships, sex and love. In helping them recover, we focus on the underlying brain disease of addiction rather than their drug or behavior of no-choice per se. (We refer to substances this way because we know that when someone is addicted, they can’t stop by will power or choice alone.)

Effective recovery begins with exploring the unique history of the person suffering from addiction. We look at the individual’s life from a biological, psychological, spiritual, and social perspective. Details of family history, including any sources of trauma, are taken into account.

People suffering from addiction have often been hurt in other ways before turning to their drug of no-choice for reward or relief. If you grew up in environment where you were abused, ignored, criticized or neglected, you have a greater-than-average chance of developing mental health issues later in life, including addiction. We take all these factors into account as we create a treatment plan to help you.

At SunCloud Health, you will benefit from a skilled and caring staff that views you as a whole person. We know that you are more than just your addiction. Even with your current struggles, you have many strengths. We will show you how to tap these strengths as you work to get your life back on track.

Specialized help for people who have more than one diagnosis

Sometimes, people who are dealing with addiction have more than one mental health condition. You may have heard the term co-occurring disorder or dual diagnosis before. These terms simply mean that there is more than one issue to deal with – and they must be seen as part of a total pattern within the person’s life.

At SunCloud Health we specialize in helping people who are suffering from multiple diagnoses. Many are affected by mood disorders, post-traumatic stress syndrome, eating disorders and other serious issues. They may misuse alcohol and drugs, or develop addictions to work, love and sex, gambling, shopping and other activities.

If you’re reading this article and feeling worried about yourself or someone close to you, now is the time to reach out. You’ve already taken the first step by seeking information and understanding. Take the next step by making a confidential call to 844-202-3161, or email us here. We are ready to support you or your loved one.

Young man’s death by opioid overdose shows the dangers of experimenting with pain medications

Recently I was sipping a warm beverage, enjoying my morning reading when I came across a story that touched me deeply.

It began as a simple message of thanks from a woman whose family was going through a very painful time. She wasn’t sure how they would get through the holidays without the smiling presence of her 19-year-old nephew, who had died just days before.

“I know people are curious about what happened, and mostly, they’re asking for the right reasons,” she wrote. She had decided to share all the details in hopes of helping others.

How a late-night hangout went wrong

Her nephew, whom I’ll call Chris, spent the last night of his life much like any other college student might. He and his friends stayed up late, eating pizza and playing video games in the basement.

At some point, one of the friends offered Chris a pill that was stamped with the name Percocet, a prescription opioid commonly used to relieve pain.

Chris had no history of drug use. He was a star athlete, a loving son and brother, a strong presence in his community. No one knows why he and a friend decided to take the pills that night. Maybe it was simple curiosity. Or the fact that they trusted the buddy who offered them the drug.

Both young men died almost instantly, according to first responders who rushed to the scene later. Chris’s mom found them both the next morning, and when she couldn’t wake them, she dialed 911.

An opioid that’s 80 to 100 times stronger than morphine

Medical personnel say the pills were most likely laced with fentanyl, a synthetic opioid that has caused thousands of overdoses and deaths across the country in 2018 alone.

“We are still waiting for medical reports,” Chris’s aunt wrote, “but we’ve been told the the pills may have been up to 50% fentanyl. According to the detective working on the case, that’s enough to kill 10 men.”

Just knowing that fentanyl is a powerful opioid doesn’t begin to explain why it’s so lethal.

This man-made drug is 80 to 100 times stronger than morphine. It was originally developed to treat the worst pain suffered by cancer patients. In powder form, it looks so much like heroin that users can’t tell the difference. Drug dealers often pass fentanyl off as heroin, and due to the difference in strength, thousands of users have lost their lives.

“There can be no experimenting” with prescription drugs

Chris had big dreams. He wanted to be a father someday. He looked forward to playing football and baseball in college, hunting and fishing with his grandfather, and enjoying more time with his close friends.

“One bad choice was all it took to end this beautiful life,” his aunt wrote.

And she went on to raise a key point that really resonated with me.

Kids experiment with prescription drugs because they assume they’re safe. If they weren’t, why would the doctor prescribe them in the first place?

The idea that pills or capsules that look like they came from a family medicine cabinet could be laced with a harmful substance might never occur to young people who are just hanging out, looking for a little fun.

“You can’t see fentanyl. You can’t smell it,” Chris’s aunt pointed out. “The only way to be safe is to remember: there can be no experimenting.”

This is the wisest advice you can possibly share with your loved ones. And if you are concerned that a member of your family is playing around with opioids or prescription drugs, we are here to help you start the conversation.

Spring Break

Spring Break is prime time for our teens to have fun and travel to places such as Mexico and Costa Rica, where alcohol and drugs are more easily accessible to  underage populations (legal drinking age in Mexico, for example is 18). As parents we are responsible for overseeing our children’s plans and monitoring their activities–covering the bases of who, what, where and when. Spring break for many teens includes travel with other families, or other organizations, with the typical teen delighting in the fact that their  parents are NOT going! As a parent we may face the tough decision of setting a boundary and saying no to a spring break trip that lacks supervision or safety we would be comfortable with. The backlash of anger, depression, despair that our teen might display certainly sways some parents into just saying yes. If we say no, it is ideal to offer another suitable spring break alternative. If or when we say yes, we do so ideally under conditions that we truly believe will keep our kids safe. As a parent I’m better equipped to make that decision if I personally know the family who will be supervising my teen. If it is a family that shares my family’s values, and respects the boundaries I set with my teens around underage and illegal (in our country) consumption of alcohol or drugs, I’m comfortable sending my teen away with them. If I don’t know the supervising adult, or if she herself drinks to excess or uses illicit drugs on vacation, I would be complicit in to some extent in sending my teen abroad with at best intermittent or impaired supervision.  I also encourage parents to pay attention to the number of teens going and the supervisor to teen ratio (keeping it in 1:3 or 1:4 neighborhood). When I’m assured that my teen will have supervision and safety on the trip, I let go and trust in the years of training my family has given her–really from in utero to now, 15-20 years depending on the age of your teens. One thing I learned in my years of practice as a psychiatrist is that kids pay much closer attention to what we do than what we say. Toddlers, tweens and young adults (old adults too) tend to practice what they’ve  learned. Their learning starts at home and in the community, with the explicit and implicit messages we send. The nonverbal messages impact us the deepest, many times at a subconscious or even unconscious level. Family and community culture impacts the beliefs and behaviors of developing young people. The way we live, the things we do and don’t do, and the things we focus our collective attention on impacts those who are dependent on us–much more profoundly than our words do. If we focus on health, self care, interdependent and mutually fulfilling relationships, balance, giving back and loving our community, the chances that our kids will follow suit are higher (not absolute, just higher). How we live on vacation as a family impacts how they will live on vacation as emerging adults. If vacation is a time to connect with family and friends, engage in nature, engage in service work, the meaning of vacation will be different than it is when vacation is a chance to be perpetually wasted. This is also a time for us to reflect on why teen do turn to alcohol and drugs to deal with uncomfortable emotions such stress, peer pressure, pain and sadness, loss or other forms of trauma. By being aware of what our teens are experiencing and feeling, we can support them in finding healthy and constructive ways to address these challenges without resorting to self-destructive behaviors. When our kids are living healthy, balanced lives where they feel loved and supported by their families and loved ones, they are significantly less likely to turn to drugs and alcohol.  In this respect, prevention really does start at home. Yet the reality is Spring Break can be a tempting time even for the most well-adjusted teens.

It’s very important to talk with our teens about drugs because:

  • they may hear wrong information about drugs from their friends, the media or other adults
  • they (or you) may be concerned about someone else who is using drugs
  • they may be using drugs and might need help to stop

Values

The world places a high value on certain things–money, happiness, thinness (sadly), comfort and security, to name a few. However, in our fervent efforts to pursue such conditions in our lives, we often neglect an essential underpinning to any living experience worth having: values. When we live unconsciously, blind to our values our lives become unbalanced. The same is true for people who profess to value certain things, but their actions tell a very different story.

Lack of balance is rife throughout our society. The business man striving so hard to get to the top in order to make huge amounts of money–for noble reasons that are applauded by society–to pay the mortgage and keep his kids in private school. The woman, who could easily be married to this man, who must be “perfect”: thin, industrious, beautiful, with equally perfect children involved in every possible after school sport and activity.

The truth is, this lack of balance is sustainable for a while. But soon, our business man, having sacrificed time with his family, time in the gym or stress-relieving sports to spend more time in the office, begins to rely on alcohol earlier in the day, and even more at night, simply to relax. And our woman, unable to cope with her many self-imposed demands, starts taking Adderall to keep up with her hectic schedule.

Even this offers a modicum of sustainability. But in the end, when we lose balance and succumb to self- destructive and addictive behaviors designed to sustain us in our unbalanced, achievement at all cost-oriented lives, we can find ourselves in a place we don’t want to be.

Without a single doubt, I lived this way as a young woman. In the end, no achievement would ever be enough to sustainably anesthetize the pain that arises from living a life disconnected from real values. In college and medical school, when I was fully in the throws of an eating disorder and getting more deeply sucked into alcohol, my only priority was becoming a doctor. Various moments of clarity, fostered by loved ones and strangers alike, helped me to see that left unchecked, my eating disorder would kill me before I’d ever graduate from medical school. My priorities were off, and my life was unmanageable–despite the fact that I was still showing up, and meeting the demands, of school. From as far back as I can remember, it never occurred to me that my health and wellness needed to be my first priority.

In my recovery I have gained a whole new respect for the necessity of balance. This concept grew in importance as my life got more and more abundant–a career doing what I love, a dog (another living thing to love and take care of), marriage to a man that I love with step-children I also love, and most recently, the grandest gift I’ve experienced in recovery, motherhood.

My work has been, and always will be, tremendously important to me. I have personally worn the chains of addiction, which is why I choose to spend my professional life helping others to gain the freedom that I enjoy. Today, I am firmly and consciously rooted in my values, with my own recovery and health topping the list. My behaviors and choices reflect my values (most of the time!).

Beginning SunCloud is one example of this in my life. Not only is it consistent with me keeping a positive work/family balance, it has given me the latitude and opportunity to fulfill a long-held dream: to create a fully integrated treatment center that offers the comprehensive care required to help people truly heal, one that values health and wellness first and foremost for every single patient and family–a place with values that are aligned with mine.

The Problem With Parity:  It Doesn’t Exist

The American public willingly exists under many myths: the tooth fairy is real; love always lasts forever; one size fits all.  Belief in such myths is basically harmless.

This one is not: the myth of mental health parity.

Far too many people labor under the notion that insurance coverage for mental health issues is equal to that for problems of a physical nature. After all, wasn’t that legislated by the federal government a while ago?

Here’s the answer:  no.

Every single day, we on the outpatient side of things, fight insurance companies to provide just one more day of care for those struggling with severe depression, an eating disorder, or substance addiction with co-occurring bipolar disorder or post-traumatic stress disorder. What does this translate into in real terms? Approximately $400 at the outside. And yet, a recent patient of mine, who was also a physician, told me about a surgical procedure in which the doctor elected to use a new semi-synthetic mesh product to close a patient’s abdomen, without making a single phone call to an insurance representative. The cost: $10K.

Due to much coverage by the media lately, there is now widespread awareness of opiate addiction throughout our country. This increased awareness is extremely positive on many levels. Yet again, a severe disconnect remains in the minds and hearts of insurance companies.

A patient of mine nearly died from an opiate addiction. On his current insurance plan, the co-pay for narcotic pain medications such as vicodin, oxycodone and morphine is literally nothing; it is essentially free. However, a prescription for suboxone, a medication that actually treats opiate addiction, requires a co-pay of $80 a month. Mind you, this is only after I, as his physician, spent 15-20 minutes on the phone with the insurance company to get the authorization required to treat him with this potentially lifesaving adjunct to his treatment.

Several roadblocks already exist for those with the disease of addiction. The stigma associated with substance abuse is very real and frequently proves a huge deterrent to accessing treatment, especially for those in the military. Moreover, instead of viewing addiction as a genuine illness, too many people continue to perceive it as a moral failing. Denial, a core symptom of many mental illnesses, keeps untold numbers of individuals from treatment. Add to this, a health care system that sets up serious barriers to both the patient and the treatment professionals and you have a perfect storm in which people remain addicted until they die, often due to overdose.

All of us need to be conscious of this ongoing injustice and question it whenever we can. Additionally, we must be grateful for groups like the Kennedy Forum, NAPHS, REDC and the Parity Implementation Coalition for working specifically and diligently on this issue of lack of parity. Only through both awareness and action will we witness much-needed change.

Gratitude- Not Always Easy To See, but Always There- by Dr Kim.

Thanksgiving has come and gone with Christmas fast approaching. Many referred to this as the season of giving, which is certainly a fine concept. I like using this holiday as a season to intentionally practice gratitude, a practice that we may embrace right now and then continue to develop a day at a time far into the New Year.

All of us, even in our darkest times, have at least something for which we are thankful. The fact that I am writing these words and you are reading them indicates that we are far more blessed than many in the world today. We are literate, safe, warm in the winter months, and have access to food, clean water and clothing.

When I first entered recovery, gratitude was extremely difficult to find. I would try so hard each day to dig up even one thing to appreciate in my life. On very challenging days, the only thing I could consider to be grateful for was I could breathe. And some days, even that did not feel like a blessing.  That was a dark time, indeed.

Today, I can easily name two handfuls of wonderful things without even breaking a sweat! My life is rife with positive experiences, events and people. I had blessings in my darkest times as well, but I was blind to them. Like so many, I was robbed of my vision by the diseases that threatened to take my life, and the traumas that created them. I had not yet developed eyes attuned to seeing the light. Today not only do I have such vision, best of all, I get to help men and women who come to SunCloud to develop theirs. They are exactly where I was.

And there within lies one of the beautiful aspects of the power of gratitude; if given a chance, it leads to hope. By and large, we are thankful for certain things because there was a time when we didn’t have them. Years ago, I did not have my husband; I did not have my step-children or my son. My life was defined by addiction and misery.  I could not have possibly imagined a future that was not only freedom from addiction, depression and ill health, but a life experience filled with abundance.

And neither can those who walk into our treatment program.

But all of us at SunCloud can imagine it for them.  We can create and hold a positive vision of their future lives within our hearts. Essentially, we serve as holders and see-ers for our patients. We stand in a symbolic line of hope for them because they cannot stand for themselves.

We know one simple and powerful truth:  if these hurting people engage with us and allow us to help them, their bodies will heal, their minds will unwind, their souls will flourish. Hope will ignite. They will take their rightful place in that line, a line that leads to a future of health, healing, joy and abundance.

“Both, And”… Not, “Either, Or”.

More from Dr. Kim and SCH On The Compatibility of 12-step and MAT

The initial step of any successful treatment is patient engagement, establishing trust and hope, and collaboratively designing a treatment plan that the individual buys into. The evidence base for opioid use disorders has consistently shown that opioid replacement therapy (classically referred to as “harm-reduction”) yields far better outcomes and mortality rates than so-called “abstinence-based” approaches. In part, this is due to much higher treatment retention rates when patients receive appropriate medications for the physical aspects of the illness.   Instead of being consumed by cravings and withdrawal symptoms, individuals have a better chance to form trusting relationships with treatment providers who can help them, and peers in recovery who can support them unconditionally along the way.

For as essential as medication can be for many people in treatment, it alone is usually insufficient to keep a person in long-term, sustainable recovery. There must be additional treatment components to address the myriad facets of the illness.  We must address depression, bipolar disorder, anxiety disorders, eating disorders and post-traumatic stress disorder, all of which commonly co-occur with addiction.  Evidence based-treatments targeting the emotional, social, environmental and spiritual domains of addiction include (but are not limited to) CBT, motivational interviewing, DBT, nutritional therapy, and 12-step facilitation (a topic often wrought with resistance from professionals and lay people alike).

There are many reasons why people resist going to a 12-step group; most are related to misconceptions of the fundamental tenants of the 12-step approach or a previous experience with unhealthy groups or individuals. The goal of 12 step participation is ongoing sobriety, along with sustained social, emotional and spiritual growth. The 12 steps serve as guiding principles of recovery for those with any type of addiction and the 12 traditions serve to guide the behaviors of groups as a whole.

One of the most relevant traditions with respect to MAT/12 step model controversy is the single-ness of purpose tradition, which encompasses the idea that “We have no opinion on outside issues.” Medication is considered an outside issue in healthy 12 step groups.  Sponsors are not doctors. And for those who are doctors, their role as a sponsor is simply to share their experience, strength and hope regarding one area: how they work the steps to thrive in life and remain sober. Much of the push back against medication use by some individuals in 12-step groups is predicated on the definition of sobriety.

Those opposed to MAT claim that relying on medication is simply addiction shifting; in order to be genuinely “clean [do we refer to cancer patients as clean or dirty???],” they believe medication cannot be used. The truth is, for a person with an opiate addiction, part of being sober means authorizing an expert addiction doctor to manage his or her medications rather than a drug dealer on the street.  This is no different than an individual who takes an anti-depressant to treat clinical depression. Some people will need anti-depressants for their depression regardless of how well they work all 12 steps.

Often the implication from opponents of MAT is “if you didn’t go through hell like I did, then you don’t deserve to be in this meeting with those who did.” The implicit message is that those with addiction must endure more suffering to learn their lesson and finally recover. “Inclusion based on degree of suffering”? This makes no sense. Everyone with the disease knows pain.   Additionally, at its very heart, this mindset is judgmental and stigmatizing, which is antithetical to all that 12-step recovery stands for. Meetings are intended to be a safe, accepting place where unconditional acceptance of individual differences regarding the path of recovery is paramount.

Recovery doesn’t happen in a vacuum.   ‎Recovery happens in community, not just any community, but a healthy, compassionate, accepting, and well-informed community, not one based on intolerance and judgment.

Pain as a Vital Sign

The death rate from overdose of prescription narcotics now exceeds that of automobile accidents; and the number of overdose deaths from prescription pain relievers has more than quadrupled since 1999. In order to understand the drastic rise in prescription opioid and heroin addiction over the past two decades, it’s important to consider contextual changes that have taken place simultaneously.

In 1996 the American Pain Society introduced pain as a 5th vital sign, and the Joint Commission adopted it as a standard in 2001. So, in addition to the objective vital sign which serve as indicators of a patient’s health status (respiratory rate, temperature, blood pressure, and pulse), medical professionals are required to ask if patients are in any immediate pain. If the answer is yes, they ask patients to assign a number to their pain on a subjective scale of 1 to 10 with10 being the most painful.

It’s no coincidence that when pain was introduced as a vital sign, the number of opiate pain reliever prescriptions rose dramatically, pain clinics began to pop up in cities all over the country and the rates of opiate addiction (and overdose deaths) began to skyrocket. Yet, many people fail to connect the dots between increase in exposure to prescription opiates and the rise of the heroin epidemic. Inappropriate and negligent prescribing of opiates has been a major culprit in the increase of addiction and a major contributor to relapse among those who have achieved sobriety.

Fortunately, a few weeks ago the American Medical Association in Chicago recommended that pain be dropped as a vital sign. In response to this resolution, critics have argued that with this change, patients’ pain will be ignored, and it will make it harder for pain to be assessed and treated.

If this change makes it harder for pain to be treated in the irresponsible way that we’ve been doing it, then I am all in favor. But for critics to suggest that advocates of this reform are in favor of disregarding or ignoring pain is really missing the mark. With the fast-paced speed of our healthcare system, rooted in our “fix it” (and quickly!) culture, “treating” pain has become synonymous with writing narcotic pain med scripts.

With an average office visit for a primary care patient lasting only 15 minutes, physicians are rarely afforded the time to administer the comprehensive psychosocial evaluations, pain treatment history, addiction risk assessment and psychiatric evaluation that were initially recommended by the American Pain Association as an integral part of pain assessment—a necessary step prior to treating or prescribing. Further, most physician receive precious little in the way of addiction training as medical students, and become doctors who are unequipped to assess addiction risk or identify early (even late) warning signs. What we are left with is a system in which physicians rely solely on the number a patient assigned (1-10) to their pain in order to determine the course of treatment, and most jump to opioid pain medication as the first line solution. Unfortunately, “treatment” often comprises spot treating symptoms, while neglecting to attend to the whole person, and failing to consider long-term consequences of a “Band-Aid,” one-size-fits-all approach to healthcare.

Of course physicians are not ultimately to blame in this equation. Really, this issue speaks to some of the broader problems with our healthcare system today: the separation of mind and body, the lack of adequate training in addiction, behavioral health, and alternative therapies, the emphasis on symptoms rather than wellbeing, and even the reimbursement system which rewards quantity over quality of care.

The debate should center less on what is or is not considered a vital sign, or how we are assessing pain, and more on how we are responding to it. Pain, just like emotion, is our body’s way of communicating a need. What if we were to listen to this message and hone in on the function of our symptoms? If we are too quick to numb, distract from, or extinguish symptoms, we may miss the smoke signal that our body is sending us; potentially putting ourselves in danger or at risk of creating secondary problems down the line.

As with most experiences, pain is multidimensional. According to the Cleveland Clinic, “psychological factors always play a role in pain – they may increase it or diminish it and can even eliminate it all together.” The Cleveland Clinic also notes “many chronic pains are due to changes in the nervous system rather than due to illness or damage to the body.” Since we know that trauma often leads to neurobiological and neurochemical changes in the body—to include abnormal regulation of opioid neurotransmitters— it makes sense that we should attempt not only to identify the root causes of a patient’s pain but also to look at pain from a bio-psycho-social-spiritual framework.

Particularly problematic would be to write a prescription for opioids for the trauma survivor whose pain may have a large psychological component. The opioids would likely mask the underlying issues while potentially introducing the patient to a host of new problems—since she is already more vulnerable to developing an addiction due to the lasting physiological and emotional impact of her earlier trauma.

The bottom line is strong medicine comes with strong side effects. Opioid medications are not an appropriate first line of treatment for many patients with pain.

Imagine an approach to treatment in which an integrated team worked together to create a patient-centered care plan with a rehabilitative emphasis. What if your primary care doctor worked in collaboration with a psychiatrist, physical therapist or musculoskeletal specialist, and psychotherapist to provide coordinated care with an emphasis on sustainable, long term, health outcomes that matter to the you? What if your doctor took the time needed to assess your history and risk factors? What if your doctor had the training to do so and also the knowledge about alternatives to just writing another prescription?
If we could spend more time unifying around a comprehensive approach to treating pain, and less time worrying that people will lose access to opiates, I imagine opioids would no longer be making headlines and would no longer be followed by the word “epidemic.”

And I believe we can do so in a way that does not interfere with those patients who need long term opiate medications being able to get them.

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.

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