Are 12-step programs the only way to recover from drugs and alcohol? (part 1)

This commentary was inspired by a comment on a Facebook post by The Addict’s Mom asking the question “Do you believe that recovery can only happen in a 12 step program?” My response got so long, that I decided to post it to my blog instead.

There is no one “right” thing that works for everyone. There needs to be more attention paid to alternatives. One reason 12-step is “pushed” is because it is free. Treatment plans, motivated by $$, include connection clients with community (read free) resources for post treatment support. Insurance has shaped the current treatment models, and even the legal system has bought into this notion that 12 step is the answer.  It is good that the legal system is recognizing that treatment is essential, but again, 12-step and 12-step based program as not the only effective treatment modalities. [Read more…]

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It’s a family dis-ease

I have seen some examples recently that remind me how much families are affected by mental illness and addiction.  The family intentionally or unintentionally does a dance around the mental illness sufferer or addict.  This is often labeled as enabling, but I have found it to be exacerbated by the lack of education, intervention, support and resources for the family members.

In some cases, the “identified patient” (IP) , the addict or severely mentally ill person has declined treatment, or will not comply with treatment recommendation such as AA, abstinence, therapy and/or medications.  Many families do not know what to do that this point, where to turn, who to ask. Families of addicts are told to attend Al-anon or Nar-anon and “work on themselves.” This is a very good recommendation, but they often need more: education, options, resources, coaching. Sometimes, they just want to ask questions like what can the addicted person expect in treatment? In AA or NA? What will change for them and us if our “IP”  takes medication, or gets sober or whatever.  A professional if better prepared to answer these questions more objectively and help the family develop a game plan, goals and initiate self-care whether or not the IP is getting treatment.

Even when the “IP” is getting treatment, family members feel left out or that they are walking on eggshells. They do not know if they can ask questions, let alone what questions to ask and how to ask them. They are reluctant to express their own concern and feelings, even optimism.  This is especially true of families with young adults who still live at home. They may understandably want to limit the family’s ability to “butt” in by not signing releases of information. At the very time the family can help, the young adult, addict or mentally ill, will decide to exert their independence.  I’m not talking about crashing boundaries here, but understanding how to communicate and realizing how all family members are affected. In fact, it is often a time to establish or reestablish boundaries, and redefine private vs. secret. It’s a time to visualize mental illness into mental wellness.

Yes, family members do need to do things to take care of themselves, but they often desperately want to know how to help the IP, and don’t want to be told to” butt out, it’s their problem. ” If they can learn healthy ways to help and support the IP while taking care of themselves, the process is less painful.

In response to this need, I will be launching my Recovery Coaching products and services over the next few months. In short, the goal is to teach families how to recover from the impact of addiction or mental illness in their family. How to return to or create equilibrium. How to set goals as a family and as individuals that promote health and a peaceful spirit.

Additionally,  many recovering addicts/alcoholics get to a point in their recovery when they no longer need therapy, but need help to envision the next step in their life journey. They may need to work on certain areas within their recovery that do not get addressed in 12-step meetings, such as mindfulness, nutrition, “secondary” addictive behaviors such as food or love.

So what can you do today? Well, you just did something by reading this post.

What else? Talk to the “IP” in your family, and simply remind them “I love you and I care about you.”

How about telling yourself: “I love you and I care about you.”

Start to learn about mindfulness: Take a few moments to sit quietly and focus on where you are in the moment. Notice where you are sitting, what is around you. Observe or witness your thoughts: who are you thinking about and how does that change when you sit quietly and simply breathe. Close your eyes, count 5-4-3-2-1 slowly, then open your eyes.  You may be surprised and delighted how centering and refreshing a mini-mind-vacation can be.

To your mental wellness!

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Who’s the problem with your healthcare?

Probably that would be the insurance company. I have been on hold for 10 minutes now, 10 minutes that I could be doing something else productive; 10 minutes that I could be doing some research or treatment planning for you. But no, I have to stay on the phone to beg for 6 or 8 sessions from the insurance company to help you.  And this is when you opt to use your out of network benefits, which you pay more for: you have a higher co-payment every session.

The insurance company will do it ‘s best to get information from me to justify your treatment; meaning, they don’t trust the therapist who is sitting right across from you to judge what might help you best. I know this, I worked for CIGNA a number of years ago. I finally got so appalled by what I had to ask, and how I was unable to authorize treatment that I had to leave. And take a pretty big pay cut. That should tell you something. (PS, I have been on hold for 17 that’s SEVENTEEN minutes now).

So here’s the point: Members need to speak up to the insurance companies and to their Human Services Departments. Probably a little more calmly than I did to Rosa, who took my clinical information and was somewhat insulted that I asked what her credentials were.  The price of your coverage goes up at whatever rate the insurance companies deem; oh, and your co-pays usually go up as the price of your coverage goes up, and often, covered services decrease.

I heard on NPR  a few weeks ago some excerpts from hearing about Blue Cross Blue Shield in CA. I was so shocked that the insurance company representative speaking could report with a straight face that her salary with in the millions, with just her bonuses in the $750,000 range. Is it the actual health care that costs, or the administration of it?

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Just can’t stay mute on this one

Okay, that’s it! I have spent my entire professional career as an addictions counselor and therapist being very politically neutral in public.  I just can’t do it anymore. Maybe I will change the name of the blog to Rouge Therapist Conversations, or The Politically Incorrect Counselor.

Here’s what got me fired up enough to run to the computer with my hair still in a towel from the shower. I have been, like most of us, listening to the debates and reports and evaluations of the Health Care Bill and Reforms with interest and usually, confusion. What the Hell is it really? How will it affect me personally, as a direct purchaser of my own health insurance? How will it affect my clients? How will it affect my business?  How is Mental Health coverage affected? And what idiot thinks that Medicare actually works so well that we should model everyone’s coverage after it?

Ok, quick digression: I heard a program on NPR that talked about Medicare fraud. I was shocked and appalled. I suspect if they could manage the $64 BILLION in fraud yearly, of which last year ONLY  $4 Billion was recovered, I’m thinking they could pay the providers a living reimbursement. Here is an opportunity to develop a program of client advocacy, to help those covered by medicare who are most susceptible to fraudulent use of their information to understand what it means.  To help clients take an active interest in their health care and really know what is happening to and for them. To help them monitor their care and navigate the Medicare and Health Care System maze.  How about that for a good use of AARP lobbying and money. I think I will suggest it to them, as a members (you get your invitation at age 50, but that is another digression).

Ok, back to today. I am listening to NPR’s program “Tell Me More.”  Yet another discussion about Health Care Reform and how it is and could play out in the Senate is the late Ted Kennedy’s seat is not won by a democrat. And here’s what blew me away: the abortion coverage issue.   Clearly I need to read up some more on this , but apparently some anti-abortion senator from  somewhere in the mid-west wants to separate out the abortion coverage. In other words, if you want the abortion coverage, you have to write a separate check for it. HUH????????

Who the heck thinks a woman PLANS to have an unplanned  pregnancy and get an abortion. What misogynist thought that one up? That has got to be one of the most absurd things I have ever heard.

Oh, I’d better pay for this coverage just in case  I need it?  Better to use your money to pay your bills, or save it , or purchase birth control. Better to put the government money toward compassionate education about sex, sexuality, family planning and birth control.

I would truly hope this absurdity doesn’t actually pass; I’m just floored that a discussion like this would actually come up.

All righty then, my blood pressure is back to normal, and the hair dryer is plugged in.

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starting over

Ack! Didn’t do so well with my last goal. However, a do-over is OK, and I start again, blogging daily.  

I stopped at my local all service printing/mailing center to drop off some packages.  While  chatting with the ower,  he mentioned that he and his wife were heading for their 45th anniversary.  On further thought, he mentioned that they had been dating for 3 years before they got married. He smiled and said “she was 16….she was hot.”  Then his smile broadened just a bit and he said she was still hot. Wow!   Maybe I should go back and find out what the secret is.


As the season changes, the days get shorter and the weather cools. Well, got downright cold in NJ last week, cold enough to snow where I live.  It’s a good time to remember to take care of yourself.  Get enough sleep. Dress for the weather. Eat well. Of course, this one is a subject of debate.

There are some basics to think about that can have an impact of your health and more.

~ Buy locally when you can, organic if possible. This supports local farmers and economy and uses less resources.  Fresh from the farmer, at the farm or farmers markets really does taste different from fresh in the supermarket. 

~Eat seasonally. There is a rich fall bounty, and many of the foods are warming to warm you from the inside. Cooler weather brings to mind yummy soups and rich stews.

~Eat less meat and more vegetables.

~Whole grains are the “good” carbs. Not sure what whole grains are?  Ask a holistic nutritionist or someone who eats them.  My friend Kathy is a great resource:

~Add probiotics to your diet. You can get these in supplements, but also in foods like yogurt, kefir and kombucha.  You can find kefir, a fermented daily drink in some grocery stores and in health food stores. Kombucha, a fermented tea drink, can also be found in health food stores, and a friend found it also in her local asian market.

When we feel better physically, we feel better emotionally. When we feel better emotionally, we feel better physically.

To your health!

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Why our health matters

I heard part on an interview with Dr. Andrew Weil today.   He has a new book, “Why Our Health Matters” and I am very much looking forward to reading it.  It’s been a while since I read any of his books, but I often see his articles and read them with interest.

Dr. Weil talked with Diane Rehm about his opinions about health care reform,  insurance, and most importantly, about learning to prevent disease.  I really liked that approach.  Making lifestyle changes does not insure we will never get sick, but can reduce the risks of many illnesses and diseases.

Just changing how we eat can make a big difference in our health. I am not a nutritionist, but I do know that if I eat certain foods,  I just don’t feel right. The better I eat, the better I feel.  I’ll bet you have had similar experiences. Dramatic and drastic changes in how we eat are not always easy, but there are simple and gradual changes that can have a signficant impact over time.  One suggestion is to avoid as much processed and fast food as possible. This is sometimes a challenge in our busy lifestyles, but can provide big rewards.

Think about taking a cooking class if you aren’t sure how to cook from “scratch”; it is often easier than you think, and you can learn shortcuts like preparing ahead so you always have better, healthy choices for meals and snacks.

Although I missed part of the show, I didn’t hear any mention of mental health, and it’s impact on our overall health.  From my chair, I see significant changes in overall health as clients learn to reduce stress, become mindful and develop a positive outlook . I’m not talking about faking happiness, but really learning to be happy, and accept to good and the bad with grace.

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Empowerment through choice

It’s about choice. Especially when it comes to mental health care. We have become captives of our health plans, thinking that we can only choose from within the network. On the medical side, there are more choices, but not always when you get to specialists. On the mental health side, it gets even more complicated, which is a shame, since most folks seeking therapy, at least initially, are especially fragile and vulnerable.

To be an empowered consumer, you need to be informed. Know your benefits. If you aren’t sure, then call your insurance carrier, and ask questions. Some information you need know:

What is my coverage for mental health, inpatient and outpatient? Does this include family therapy?

What is my coverage for substance abuse and alcoholism treatment, inpatient and outpatient?

What level of therapist is covered: psychiatrist, psychologist, social worker, licensed professional counselor, addictions counselor?

How many sessions per year? Is there a lifetime maximum?

How are biologically based diagnoses covered?

Do I have out of network services to cover a therapist who is not in your network?

What is my deductible for in-network services? Out of network services?

What are my co-pays for in-network services? Out of network services? If it is a percentage, what does that translate into in dollars out of my pocket?

Do the sessions have to be pre-certified or pre-authorized? If so, how do I get more sessions authorized?


Some very good therapists are in the networks. Not all therapist are in all networks.  Some are not in any network. It is not easy to pick a therapist. You have more choices than to have to pick a name from a list. Many people prefer to go to someone who has been recommended to them by a friend, co-worker or family member. That therapist may not be in your network, but may be the best fit for you. That’s about choice, and about empowerment. And sometimes, we need to pay a little extra for the choices and empowerment.  It is almost always worth it.

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