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”.

Why compulsive buying is a dangerous addiction that harms people and families

Who can help but laugh at Isla Fisher’s charming character in the hit movie, Confessions of a Shopaholic?

Based on Sophie Kinsella’s best-selling novels, the story feels lighthearted and fun. We might even see a little of ourselves in Rebecca Bloomwood, who just can’t seem to resist the impulse purchases that, one by one, lead to a series of hilarious misadventures.

But for people who actually live with Compulsive Buying Disorder, life is anything but fun. These individuals deal with the brain disease of addiction, manifesting for them as a frustrating cycle of desire, impulsive action and shame that poses a constant threat to their emotional and financial health.

A closer look at “the smiled-upon addiction”

In our consumer culture, the way we look and the things we own can become deeply intertwined with our self-esteem and social status. Social media’s relentless focus on appearances and material goods amplifies this effect. This may be why Compulsive Buying Disorder, or CBD, is an addiction that we consider less serious than others, including addiction to alcohol, prescription drugs, food, gambling or sex.

What we tend to forget is that ANY addiction is dangerous to our health. We may also fail to see that people can become addicted to more than one substance or behavior over the course of their lives.

Addiction creates a relentless pursuit of our favorite substance or activity. When we get what we crave, we experience a great sense of reward, which may be felt as intense pleasure or relief from the pain life is sending our way.

In the beginning, it feels like we’re making a choice. We enjoy it; we tell ourselves we deserve it. But before long, our drug (or activity) of choice quickly becomes our drug of NO choice. When this happens, we know that addiction has robbed us of choice. The brain pathways involved in reward, decision-making and impulse control have been hijacked by the disease, which then takes on a life of its own.

Like any addiction, compulsive shopping has the power to destroy our finances and damage the close relationships that form the foundation of our lives. We need to stop making light of it and recognize it for the serious issue it actually represents for so many people. Often, these are individuals on the path to recovery who have had some success staying away from alcohol, drugs, food addiction or eating disorders. They have simply shifted their focus from their first “drug of no choice” to a new one.

What are the signs that a compulsive shopper can’t stop?

Mental health experts recognize that compulsive shopping, along with other forms of addiction, is similar to Obsessive Compulsive Disorder (OCD). People who can’t stop buying things – even when they clearly don’t need the things they buy – suffer from poor impulse control. It isn’t a matter of simply loving beautiful objects; they are following a strong inner urge that is relieved only when they complete a purchase.

You or someone you care about may be dealing with Compulsive Buying Disorder if:

  • You think about shopping constantly – especially when you’re feeling bored, anxious, sad, angry or ashamed about yourself.
  • You spend hours and hours looking at merchandise online and in person, searching out sales and new places to find things that interest you.
  • You feel intensely excited when you’re shopping, leading to a sense of euphoria when you make a purchase.
  • You tend to shop alone – or only with people who love shopping as much as you do.
  • Because you don’t really need the things you buy, they tend to pile up. You may hide your purchases, return them (also known as shopping bulimia), sell them or even give them away.
  • After the “buyer’s high” wears off, you often feel guilty and ashamed of your behavior. These bad feelings may even push you right into another shopping episode.
  • Friends and family may be angry with you because shopping takes up so much of your time and attention. It may jeopardize your family’s financial security. Your spouse or partner may threaten to leave you if you can’t get your spending under control.

Compulsive buying can be overcome, one step at a time

At SunCloud Health, we have helped many people build the skills needed to overcome addiction, including the patterns that play out in compulsive shopping. Many times, this disorder occurs in combination with other addictions and mental health issues that may have been overlooked until now. Our caring, supportive staff will take the time needed to understand each issue in context and develop an integrated treatment plan that addresses each of your treatment needs with a unified approach.

You don’t need to spend yourself into bankruptcy or wait until your relationships fall into ruin. You can stop trying to control this brain-based disease with your brain alone – and finally get the help that will fully address your addiction, empowering you to heal.

If you or someone you love needs help with compulsive shopping, please get in touch with us today.

Exploring the pain of opioid addiction in a powerful new musical

GUEST POST by Shale Marks, LCSW, CADC

SunCloud Health’s core philosophy met the artistic world on the evening of April 20, when staff therapists attended the performance of “Contact High: A New Musical” at the Northbrook Theatre.

Sally McQuillen, LCSW and I were honored to meet the cast and creators of this new musical drama, which focuses on the lives of high-school students who are caught in a web of mental health issues that include opioid addiction.

Participating in a talk-back after the show gave us the chance to answer questions from the audience about opioids, recovery and other mental health challenges. Conversations like these are a crucial part of SunCloud Health’s mission, as we actively seek ways to contribute to the community’s understanding of mental health.

A young opioid addict with nowhere to hide

As I sat watching the musical, it struck me how deeply the character named Jean struggled with her addiction. She seemed to ache for connection, not only with herself but also with friends and the community. Like many young people, Jean seemed like a leaf blown by the wind, desperately searching for comfort – yet suffering the extreme discomfort of her disease as it dragged her from one moment to the next. She sought a resting place in a world where it seemed there was no friendly direction, no safe spot to hide.

It struck me that Jean is exactly the kind of person we hope to reach at SunCloud Health. The ache in her heart is the same ache that echoes in the hearts of all of our patients. It reminded me of the commitment we’ve made to our clinical philosophy, which is a tapestry of principles that hold our team accountable to our patients and each other. Our philosophy empowers us to perform what we think of as “soul surgery” for the people we serve.

The healing value of empathy

At SunCloud Health, we are guided by an agreement that places empathy at the core of everything we do. Our agreement states:

“We agree to search for non-pejorative or phenomenologically empathic interpretations of our client’s, our own, and other team members’ behavior. We agree to assume we and our patients are trying their best, and want to improve. We agree to strive to see the world through our patients’ eyes and through one another’s’ eyes. We agree to practice a nonjudgmental stance with our patients and one another.”

As we work with people in group settings, we challenge their belief systems, providing the care, compassion and attention they may have missed in their formative years. We welcome them as therapists who acknowledge our own humanity and fallibility and are ready to guide them as they move forward in recovery.

If we as a community could truly touch empathy, I believe there would be a deeper understanding of the underbelly of addiction. So often, conditions such as PTSD, depression and other mood disorders are the driving force behind substance use. Our ability to acknowledge and treat these conditions is often the first meaningful step toward healing.

Sally and I felt honored to discuss these issues with everyone who came out to see “Contact High” – and we thank show creators Kyle Reid Hass and Jeremy Swanton for inviting us to be part of this unique production, which will soon make its New York debut. I feel certain that this new musical will open hearts and minds with every performance.

At SunCloud Health, our hope is that we can continue to contribute to the community in an authentic way, addressing the power differentials that exist between therapist and patient, government and citizen, parent and child so that we can all move a little bit closer to humility, compassion, empathy and healing.

You can rebuild your life in the wake of emotional abuse

Do you know the difference between a healthy relationship that sometimes includes conflict and an unhealthy one that is marked by emotional abuse?

If you’ve suffered from this kind of abuse in the past or present, this question may be surprisingly hard for you to answer.

That’s because the person who hurt you was supposed to love and protect you. Your trust was betrayed at the most basic level, leaving you confused and disoriented, doubting your own truth.

Your abuser may have been a parent, an authority figure, a lover or a spouse. All this may have happened when you were a small child – or it may be happening to you right now.

Whatever your unique story, the trauma you have faced has had a powerful effect on your life. The first step is acknowledging what has happened to you so that you can begin to heal.

The telltale signs of emotional abuse

Emotional abuse happens when someone attacks and undermines our identity, our emotional reality and/or self-worth. Even though this form of abuse may not involve blood, broken bones or scars, it is just as damaging as any form of physical abuse.

People who inflict emotional abuse have many ways of making us feel small, ashamed, invisible and unworthy. Has someone close to you …

  • Repeatedly attacked you with words?
  • Shamed, criticized or ridiculed you?
  • Made fun of your dreams, wishes and plans?
  • Kept you away from other people you care about?
  • Tried to control your movements or confine you to a certain space?
  • Used fear and threats to control you?
  • Gaslighted you? (Gaslighting refers to manipulating someone by psychological means into questioning their own sanity, cognitions or emotional experience.)

If you have faced these and other emotionally abusive patterns, you may doubt your own self-worth. Many people in your situation also suffer from depression, anxiety, self-injury, addictions and other related issues.

As terrifying and harmful as emotional abuse can be, I want to reassure you of three things.

First, emotional abuse is real. It is a form of trauma that can have long-lasting effects when left untreated.

Second, there is hope for you to recover from the trauma you have suffered.

And third, you are not to blame for what happened to you. The abuse is NOT your fault. And with the right treatment and support, you can reconnect to your truth and lead an empowered life.

Seeing your life experiences in context

The path to recovery will depend on your unique life story. Abuse that happens in early childhood has an especially large impact on us because our brains are still developing. The human brain grows in stages, starting with our most basic operating systems – which govern reactions like fight, flight or freeze – then moving on to the more advanced areas that help us reason and solve problems.

To grow and develop healthy brains and bodies, we need consistent nurturing and support in a setting that provides security. If our families attacked, belittled or manipulated us, our sense of safety and security was seriously compromised. We may have suffered even greater harm if the people raising us were emotionally or physically absent due to drug or alcohol abuse, jail time, 80-hour workweeks or even abusive relationships of their own.

As grownups, we don’t stop needing stability, love and support. If you are suffering emotional abuse as an adult, your brain and body are under full assault. It is crucial for you to seek professional help so that you can see what’s happening and begin the process of reclaiming your life.

Our approach to treating emotional abuse

At SunCloud Health, we will help you see, understand and acknowledge the truth of what’s happened to you. Our treatment plan will be built around your unique life experiences and the effects of the trauma you have faced.

Consistency, nurturance, structure and safety are key for you right now. Most people who have suffered trauma don’t feel safe anywhere, because their bodies are holding trauma energy that’s been trapped there over time. This energy plays and replays in their bodies and minds, making it hard for them to trust authority figures and have mutually satisfying and fulfilling relationships. We understand these patterns and we’re prepared to help you cope with them.

Our caring, supportive staff will create a safe space for you to talk about your life. You will work one-on-one and in group settings with our expert therapists. You will also have the chance to connect with others who are walking the same road towards more safety and meaning in their lives. Releasing the strong feelings hidden deep inside you will create space for the type of healing and learning that will help you move forward.

Recovery from emotional abuse isn’t something that happens overnight, and the path is not linear. But along the way, you will meet people who have succeeded in creating empowered, abundant lives. We’re ready to help you take the first steps.

Call 844-202-4230 or email us here.

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.

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