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Don’t quit Ambien before you know what you’re up against and have a plan for success. Learn about 2 tapering methods and one method of rapid detoxification (with flumazenil) as well as about the brain changes associated with zolpidem addiction and the treatments you need to counteract these changes.

When you have insomnia, you're never really asleep, and you're never really awake (from the movie Fight Club).⁹

For those that can't sleep, Ambien, used intermittently and at therapeutic doses, isn’t too dangerous.

At higher doses though, things change. It starts to light-up a wider array of benzodiazepine receptors and it starts to feel a lot more like a typical benzodiazepine, like Valium or Xanax.

Basically, at higher doses, it gets you high.

So when you take higher doses for a while, it’s easy to grow both physically dependent and addicted, and once dependent and addicted you’ll need to:

1. Taper down slowly to minimize withdrawal symptoms
2. Get some form of addiction treatment, to learn to manage cravings and avoid relapse

Read on to learn about the withdrawal symptoms you can expect and about how to minimize withdrawal symptoms through one of three tapering and detox methods.

Ambien Addiction = Benzo Addiction

According to the Council for Information on Tranquilizers, Antidepressants and Painkillers (CITAP) – Ambien (zolpidem) and other drugs of the Z class are simply benzodiazepines by another name.¹

Though they look different chemically, at high doses they act similarly in the brain - and the withdrawal management, tapering and treatment recommendations for Ambien addiction and benzodiazepine addiction are essentially the same.

Ambien Withdrawal Symptoms

If you’ve been using this medication daily for longer than 2 weeks, you should not stop using suddenly. Stopping suddenly is hard on the body and generally results in very unpleasant withdrawal symptoms.

Typical Ambien withdrawal symptoms include:

• Shakiness and tremor
• Moodiness
• Bouts of depression and crying
• Anxiety, nervousness and panic attacks
• Lightheadedness and flushing
• Sweating
• Nausea and vomiting and other digestive complaints, like stomach cramping
• Muscle cramps
• Insomnia (having a hard time falling or staying asleep)
• Tiredness
• Seizures (more rare)²

Tapering Down

Due to the very real risk of seizures, once dependent, you should never stop using Ambien very suddenly, nor should you reduce your daily dosage too quickly.³

Once dependent, to quit Ambien, you must choose one of the following three primary options:

1. Taper down slowly off Ambien
2. Switch over to a longer acting benzodiazepine like diazepam (at an equivalent dose) and then taper down from that
3. Detox off Ambien in an inpatient facility while receiving a continuous flumazenil infusion

In most cases, doctors will advise that you slowly taper down your dose, or switch to an equivalent dosage of a longer acting benzodiazepine, like diazepam, and then taper down from that.⁴

Straight Ambien Taper

The simplest method is the straight Ambien taper.

You should consult with your doctor when making a tapering plan, but don't get pressured into a rapid reduction - after all, what's the hurry? Consider taking your time and know that spaced gradual reductions cause fewer withdrawal symptoms and less rebound insomnia.

As a conservative starting point, you might consider a 10% reduction every 2 weeks. Or, you can try a slightly more aggressive tapering plan, such as reducing by 10% per week, knowing that you can always slow things down if it becomes unmanageable.

Tip for Success – Stay in control of the process and the pace. It’s your body and you know what’s manageable and what’s not. Don’t let an outside ‘expert’ impose a schedule that doesn’t work for you. It’s OK to pause reductions during times of great stress or when withdrawal symptoms get too severe - but try to avoid retreating to a higher dosage after a reduction. For the best chances of success, you can slow down, but never go backward.

Switching to and Tapering from Longer Acting Benzodiazepines

Ambien is a fast acting sedative, with a half life of roughly 2 hours (a little less for children and a little more for elderly users). After taking Ambien your blood plasma levels will peak at approximately 2 hours post ingestion.⁵

Although fast acting sedatives work great to get you sleeping quickly and alert by morning, they result in highly variable plasma concentrations - and this isn’t ideal for a tapering situation.

As an alternative, you can switch from Ambien to an equivalent daily dosage of a long-acting benzodiazepine, like diazepam, without feeling any withdrawal symptoms. Once stabilized on this longer-acting medication, you can start tapering off just as you would for a straight Ambien taper.

Tapering from a medication with a longer half life results in more stable blood plasma concentrations. This is a good thing because:

1. Stable plasma concentrations eliminate the intoxicating highs and the worst of the lows (withdrawal symptoms). You need to learn to live without the highs and you won’t mind minimizing the lows.
2. You taper slowly to give your brain a chance to heal and adapt. Stable blood plasma concentrations facilitate this healing.

To maximize your odds of tapering success, consider:

1. Waiting until a period of low work/life stress to start your tapering regimen - Since withdrawal symptoms can include low mood/anxiety, insomnia, fatigue, etc. you probably don’t want to tackle the first days of tapering during an especially busy or chaotic time of year.
2. Consider taking some time off work for the first few days or week or so, to get used to the tapering experience while minimizing demands on your time and energy.
3. Tell a few close friends and family about your tapering regimen. You’d be wise to make use of their support and they may appreciate an explanation for what might otherwise seem like unusual behaviors.
4. Consider joining an in-person or online support group or community of others also tapering from Ambien or benzos.¹⁰

Before you start read our complete guide to tapering off benzodiazepines

Using Flumazenil

In extreme cases, such as when a person can’t or won’t taper, there is always the option of hospitalization and rapid detoxification with a continuous flumazenil infusion.

Flumazenil works as a benzodiazepine agonist (among people with benzodiazepine tolerance). When administered continuously, it allows for the abrupt discontinuation of Ambien and a rapid detoxification.⁶

Controlling Withdrawal Symptoms with Medications

In some cases, your doctor may prescribe medications during tapering to help alleviate symptoms of withdrawal, such as to:

• Help minimize the risk of seizures
• Help with rebound insomnia
• Reduce palpitations
• Reduce the severity of psychiatric withdrawal symptoms, like anxiety or depression⁷
  

Psychosocial Addiction Treatment

People addicted to Ambien have 2 problems.

1. They are physically dependent on the medication
2. They are addicted to the feelings it provides (the high)

A successful tapering regimen gets you past your physical dependency, but it doesn’t do anything to treat your addiction to getting high – for this you require addiction treatment.

Brain Changes = Cravings

By getting dependent and addicted to Ambien you change your brain in 2 fundamental ways:

1. Your dependency alters the functioning of your benzodiazepine/GABA systems. You remedy this by slowly tapering down and allowing your brain the time it needs to heal and revert back to a ‘normal’ state of functioning.
2. Your addiction alters the structure and functioning of a number of neural systems, such as executive functioning (thinking, planning, impulse control etc.) memory and reward systems.

Though a slow taper reverts your GABA/Benzodiazepine systems back to normal, it does not heal the many brain systems altered by addiction – these changes are long-lasting or irreversible.⁸

And one consequence of these lasting brain changes is the experience of persistent cravings.

Because of the way addiction hijacks the functioning of the brain’s reward, thinking and memory systems, a wide array of situations and stimuli can trigger intense cravings, for long after you quit, without you even realizing what triggered your sudden urge to use.

Examples of situations and states that can trigger cravings include:

• Anger or stress
• Environmental cues that remind you of drug use
• Certain moods, such as feeling celebratory or bored
• Social cues (for example, running into a friend you once used with)

So, for long after you quit, you keep experiencing cravings, and if you fail to resist your cravings just once, you can easily fall right back into active use and addiction.

It’s not an easy thing to overcome, and that’s why addiction treatment can help a great deal.

Addiction treatment teaches the skills you need to minimize your exposure to situations that trigger cravings, how to deal with the cravings that do arise, how to develop a support network, how to handle life stresses and even how to handle yourself should you ever slip-up and fall back into use.

You can get addiction treatment:

• From a therapist or substance abuse counselor
• Through an intensive outpatient program
• By going to rehab or enrolling in a day treatment program
• By joining a therapy group

And you can further increase your odds of success by participating in a community self-help support group, like NA.

Image Copyright: Bruckerrlb

Here’s one very compelling reason to quit opiates sooner rather than later.

Need a good reason to seek treatment for an opiate addiction?

Well you might find the inspiration you’ve been looking for in a new study out of the Kaiser Center for Health Research that links just three to four months of high dose opiate use with a significantly increased likelihood of erectile dysfunction…50% higher!!!

The Study

The researchers examined the medical records of 11 327 men with back pain who were enrolled with Kaiser Permanente in Portland Oregon. Many of these men received prescriptions for opiates to control their pain.

The study looked to investigate:

1. Did getting prescribed opiates increase a man’s likelihood to request erectile dysfunction (ED) medication, such as sildenafil, tadalafil or testosterone replacement within 6 months?
2. What factors influenced an increased likelihood to require ED medication?

The Results

Over a 12 month time period around seeing a doctor for back pain

• 6.7% of men not prescribed opiates received a prescription for an ED medication
• 12.5% of men prescribed low dose opiates for 120 days or longer (or 90 days or longer with 10 or more prescription refills) received a prescription for an ED medication
• 19.3% of men on higher doses of opiates (120 morphine equivalents or greater per day) for 120 days or longer (or 90 days or longer with 10 or more prescription refills) received a prescription for an ED medication
• Having depression and taking sedative hypnotics, like benzodiazepines, also increased a man’s likelihood of requiring an ED medication
• Surprisingly, neither obesity nor smoking were associated with an increased likelihood to require an ED medication

Commentary

The study authors recommend that primary care physicians weigh the risks of sexual dysfunction when making prescribing decisions and that patients receive information about these sexual risks and about possible alternative therapies, such as cognitive behavioral therapy and physiotherapy exercises.

Opiates are known to decrease testosterone levels. The study authors suggest that this is the most probable explanation for their negative influence on erectile functioning.

Image Copyright: Cotidad

Don't take it personally. Children and their relationships to their parents change as they go through different developmental stages. Being aware of this allows a parent to adapt to this as well as to not take things personally when they shouldn’t.

Imagine the following situation:

Your son is a teenager and has been writing badly about you in a social media forum (such as Facebook) for quite a while. He has been using foul language and misrepresenting how you treat him. Anger is coming from your 13 year old that you are having a hard time understanding. You wonder why he hates you and feel very hurt by the words he is writing.

Why Is This Happening?

For a moment let's take you out of the middle of what is going on. Parenting is dynamic.

Certainly things are different from the time your child is born (and they are dependent on you for everything) to when they are an adult (and if things are healthy they are independent).

Through it all you remain their parent, although this changes a lot in a couple of short decades.

Testing Limits and Becoming Independent

Your son is now a teenager. What are the important developmental tasks for him to engage in at this age?

It is a time when he begins to be more independent. Teenagers test limits and learn ways of being in the world without all the protections they had as a younger child. It is while doing this that a person has to "rebel" and discover their own ways of interacting in the world.

Fortunately, the values you have provided up to age 11 will remain influential in their life.

Changes in Social Relationships

Another change that happens is that his primary social circle is changing. As a teenager, his friends play an important role in his life. Whereas before he would have come to you first with a problem, it is now normal that he turns first to his friends. In this sense, it is not a reflection on you that he is talking to friends and not you about struggles he is having.

Opening a Dialogue

Now, back to your concern. Does he hate you? What is his real concern? Is it you or things that he is pushing against?

As a parent it can be hard to distinguish between these. To really do this, a parent has to set aside their own ego and enter into dialog without being concerned about what you might hear. Open dialog, to the extent you can, is the key.

Finally, know you are not in this alone.

A good parent does not have to be the center of their child's life. A good parent has to know that their child is safe and is developing into a healthy responsible adult. This is part of constructing and maintaining peace and wholeness in your home.

Image Copyright: John O Nolan

Many people find that heavy marijuana use causes reversible thinking and memory problems. By focusing on the cognitive improvements of the first weeks of recovery, you can find the motivation to continue to work to avoid relapse.

Withdrawal symptoms are hard to take. Perseverance through discomfort comes easier if you know that it’s for a good reason, and you can see that you are making progress.

Many marijuana users find that longtime heavy use compromises thinking abilities. Fortunately, in most cases, thinking abilities return to a normal level within a month or two of quitting.

Here’s a way to spin improvements in cognitive abilities (a very good thing) into increased odds of staying quit (another very good thing):

1. A lot of people find quitting tough, especially when dealing with lingering withdrawal symptoms, like insomnia.
2. To counteract some of the negatives (like the lingering withdrawal symptoms…which you probably can’t avoid noticing) you should try to focus on how quitting improves your life – such as by noticing specific improvements in thinking abilities.

3. Unfortunately, we aren’t very good at noticing changes when they occur very slowly or gradually (as opposed to withdrawal symptoms, which come on very suddenly and noticeably).

4. If you pay more attention to how your cognitive abilities improve over the first couple of months after quitting, you can use these encouraging gains as motivation to continue your efforts.
5. To help you notice improvements, you should make a list before you quit (or in the early days) of the very specific ways that marijuana compromises your thinking abilities. Then revisit this list every week or so after quitting, to evaluate your progress, and to underscore that your improvements result from quitting marijuana.
6. To help you make this specific inventory, review the list you'll find below of common cognitive side-effects and circle whichever you identify with. 

Cognitive Side Effects of Heavy Marijuana Use

Researchers at Lund University Hospital interviewed 400 heavy marijuana users to develop a list of cognitive deficits/complaints that are associated with chronic serious use.¹

Has your marijuana habit diminished your intellectual capacity?

To find out and to create a framework for monitoring improvements after you quit, circle any of the following which apply to you. Then, over time, as you maintain marijuana abstinence, revisit this list to see how much improvement you’re making.

Note: This is a complete list of all cognitive symptoms reported by a large pool of heavy users. It is very unlikely that all will apply to your experience. Simply circle those that do (that you answer yes to) and disregard those that do not.

Verbal Skills

Compared to your pre-marijuana days:

• Are you less able to remember and use specific and precise words?
• Do find it more difficult to take an active part in discussions going on around you?
• Do other people have difficulty understanding what you’re trying to express?
• Do you have more difficulty understanding what other people are trying to express to you?
• Do you feel like you’re removed from others (as if you were in a glass bottle)?
• Do you find it more difficult to describe your feelings?

Memory

Compared to your pre-marijuana days:

• Are you more likely to forget meetings and appointments or commitments you’ve made?
• Do you have a harder time remembering your past?
• Do you have more difficulty estimating the passage of time?
• Do you find it harder to remember the plot of a book or movie as it unfolds?

Cognitive Flexibility

Compared to your pre-marijuana days:

• Do you have more difficulty maintaining comlex ideas in your head during a discussion?
• Is it harder to stay focused or to concentrate for long period of time?
• Once you get focused on one thing is it harder to suddenly shift your focus to something else?
• Do you have a harder time understanding other people’s viewpoints?
• Do you find that you talk TO other people rather than talk WITH other people?

Learning and Using Information

Compared to your pre-marijuana days:

• Are you more likely to keep making the same mistakes over and over again?
• Are you less able to assess your own behaviors and see where you’re going wrong in life?
• Are you less able to find appropriate solutions to problems you’re having?
• Do you care less about life-mistakes you make?
• Do you feel more like a failure than you used to?

Analytic-Synthetic Ability

Compared to your pre-marijuana days:

• Have you become more rigid in your opinions or in expectations of others?
• Do you have more difficulty sorting between important and extraneous information?
• Do you have more trouble classifying information correctly?
• Do you have more difficulty interpreting nuance and shades of grey within information?

Time-Space Abilities

Compared to your pre-marijuana days:

• Do you have more difficulty creating routines?
• Do find it more difficult to structure your day?
• Do you find you notice relations between others less than you used to?
• Do you find it harder to maintain a mental map?
• Do you find that you’re less aware of your surroundings?
• Do you feel more like you don’t belong within ‘normal’ society?

Focusing on Improvements

So, did you answer YES to any of the questions above?

If so, write down (or print off) a list of your specific marijuana-related cognitive problems.

• After quitting, revisit this list every week or so, and think about what progress/if any, you’ve made on specific items since quitting.

You should find, by about 6 weeks or so, that you’ve made dramatic improvements in problem areas. The trick is in managing to stay quit for long enough to reach this 6 week milestone!

When withdrawal symptoms get intense and when you start feeling stressed or bored, it’s easy to fall back to familiar patterns of getting high. By paying attention to the specific improvements you make during initial recovery, you can enhance your motivation to persevere and increase your odds of long term success!

Image Copyright: Erin Leigh Mcconnel

Parenting a teen can be frustrating. Parents often get frustrated and when they are not thinking clearly may resort to issuing an ultimatum. There are serious cautions around this and better strategies for parents to try.

Parents often struggle with how to draw and enforce boundaries for their teenage child.

For example, consider the following situation:

Imagine your 16 year-old daughter wants to go to a party on a school night – something that you are totally opposed to.

On the night of the party, she walks out the door so you tell her to think about what she is doing. She gives you a look. In reply, you tell her that if she can’t obey the rules then she can’t stay in the house.

She responds angrily to you, and you tell her to not come home if she walks out now.

Not only does she walk out but she doesn’t come home that night nor the next day.

You are worried about her.

She’s been a discipline problem and now you feel boxed in.

Feeling Boxed In

• If you don’t enforce your threat, how can you protect her from bad choices anymore?
• How can you avoid being disrespected by her?
• Is there still a way to not ask her to leave and still get her to change her behavior?

Making threats, especially when angry, is not generally a good idea. This is especially the case when trying to parent a teen.

The problem in this particular situation is that you created a "no win" situation:

Neither you nor your daughter are getting an outcome that is really a win. You find yourself in a situation of having to choose between equally unacceptable options. You are now left not being able to provide the basic care that is a responsibility of parenting; yet you want to do this while also providing reasonable structure.

Avoiding Ultimatum Situations 

Here's a suggestion for situations like the one described above:

Avoid giving teens an A or 'not A' with consequences type of choice.

1. Many parents give this type of choice to children. If they chose A (the desired outcome), all is well. If they chose 'not A' then either the consequences kick in or it weakens the parenting.
   
2. This is especially problematic when the consequences are broad and not really likely or able to be enforced (such as NEVER coming home).

A Better Idea

• A better solution in such situations is to offer the child (especially a teenager) a range of choices, preferably with all of them being acceptable to you as the parent.

A Failed Ultimatum - The Aftermath

However, back to the situation described at the start of this article. You would have a range of options available to you:

1. If your teenager is truly out of control, in a dangerous way, you could talk to your local child welfare office about them being identified as "a child in need of services".
   
2. You could see how your child does in another environment - spending the summer with an out of town relative is an opportunity that may be appropriate, especially if it is timely.
   
3. You could entertain the idea of the teenager returning home conditionally upon discussing boundaries for that - and to be most effective this does need to be a discussion. With as difficult as the relationship may have become, you may want to use a marriage and family therapist to help facilitate that conversation.
   

Considering a Marriage & Family Therapist

If you decide to seek out a marriage & family therapist, that person may even prove helpful over the longer term.

1. Going this route is not just giving in, it still expresses love and caring, and it has the possibility of laying groundwork for the future.
2. With everyone working at it and developing new ways of relating, it is possible to get through these times and establish ways for peace and wholeness in your child's life as well as in your lives.
   

This does not mean that you will be free of the challenges that occur during the teenage years, but you will be able to navigate these in a way that is better for everyone involved and can result in “win-win situations”.

Image Copyright: Taylor Dawn Fortune

Protect yourself and those you love - Take this 4 item suicide behaviors questionnaire and find out if you’re considered ‘at risk’ to commit suicide.

Here's a grim and saddening fact: today, an American is more likely to die from suicide than from a motor vehicle accident.¹

So just as you take precautions to stay safe on the roads (you buy cars with airbags, you buckle up, etc.) you should also take precautions to protect yourself, and those you love, from an even greater risk of death: You make mental health a priority, you get help when it’s needed and you never ignore the warning signs of self harm or suicide.

As a starting point, ask yourself: are you or a loved one deemed ‘at risk’ of suicide?

Probably not something you'd know offhand; fortunately, you can find out by answering the following 4 questions as truthfully as you can.

4-Questions: The SBQ-R Suicide Risk Assessment²

The SBQ-R is an abbreviated name for The Suicidal Behaviors Questionnaire – Revised. It is a clinically valid and reliable test that is used to quickly identify people who are at increased risk to commit suicide.³

Instructions

Answer each question as honestly as you can. Circle one answer only for each question.

~ ~

Question 1. Have you ever thought about or attempted to kill yourself?

(circle one only)

• 1 = Never
• 2 = It was just a brief passing thought
• 3a = I have had a plan at least once to kill myself but did not try to do it
• 3b = I have had a plan at least once to kill myself and really wanted to die
• 4a = I have attempted to kill myself, but did not want to die
• 4b = I have attempted to kill myself, and really hoped to die

~ ~

Question 2. How often have you thought about killing yourself in the past year?

(circle one only)

• 1 = Never
• 2 = Rarely (1 time)
• 3 = Sometimes (2 times)
• 4 = Often (3-4 times)
• 5 = Very Often (5 or more times)

~ ~

Question 3. Have you ever told someone that you were going to commit suicide, or that you might do it?

(circle one only)

• 1 = No
• 2a = Yes, at one time, but did not really want to die
• 2b = Yes, at one time, and really wanted to die
• 3a = Yes, more than once, but did not want to do it
• 3b = Yes, more than once, and really wanted to do it

~ ~

Question 4. How likely is it that you will attempt suicide someday?

(circle one only)

• 0 = Never
• 1 = No chance at all
• 2 = Rather unlikely
• 3 = Unlikely
• 4 = Likely
• 5 = Rather likely
• 6 = Very likely

Scoring

You circled one answer for each question. Each answer you circled has a number beside it, such as 1, or 2, or 2a or 2b etc. To add up your total score, simply add up the 4 numbers beside your answers.

For example:

(Question 1 = 3a) + (Question 2 = 2) + (Question 3 = 2b) + (Question 4 = 3)

Total score 3+2+2+3 = 10

Are you at risk? - Interpreting Scores

• For adults in the general population: People with a score of 7 or greater are considered at risk of suicide

• For adults in a psychiatric inpatient program: People with a score of 8 or greater are considered at risk of suicide

Image Copyright: banlon1964

Your partner's in recovery... now what? Tips on rebuilding a relationship while making your own needs a priority: building trust - one day at a time, setting measurable goals to work toward, taking care of yourself... rather than your partner.

While sobriety is a major milestone it is only the beginning of building a better life.

Sobriety isn't a magic answer to all your problems - it only offers you the opportunity to stop making things worse. A person in early recovery often feels like things keep getting worse, but in truth, abstinence just lets you see clearly what a wreckage your life has become.

Fortunately, it also gives you an opportunity to start making it better.

Rebuilding Takes TIME!

Recovery is a process of transformation in which we seek to become something greater, healthier, and happier than we’ve ever been. Unfortunately, for as many years as it has taken folks to get into recovery, they’d like to make up for lost time and be all better by next week.

As my friends in AA say, “Time takes time. “ Very few good things happen in a hurry and healing always takes longer than we’d like.

The pitfalls for the affected other (people affected by a loved one's drinking or drugging) are many. Some of us try to convince ourselves that things will be fine now that our loved one is sober. We want to believe that sobriety is once and for all. We hope that being clean will return them to the person we once knew.

Setting Goals and Making Progress

People in early recovery often tell me that they want to get back to where they were. I point out that where they were is where they were just before everything went progressively toward hell!

So we come to accept that going back is not an option and that building new relationships with new boundaries and clear expectations is key.

• I encourage both the recovering addict and affected others to set reasonable goals and expectations. It’s important to define growth and success clearly and overtly. In the absence of distinct goals and milestones, “getting better” remains a vague and incredibly difficult vision to achieve.

Rebuilding Not Resurrecting

While their external behavior may be very different, folks in early recovery have the same character flaws they had when they were using. They are generally impulsive, impatient, and very moody. As affected others we must be careful to avoid climbing aboard this emotional roller coaster and compensating for their deficits.

Remember your own needs:

• It is we too who are changing. Hopefully we develop the resolve to be true to ourselves independent of what our loved ones choose. We are free to have limitations, needs, wants and feelings and we are free to express them.
• We have the right to not walk on eggshells and to overcome our fears of holding our loved ones accountable.

In couples and family counseling I am often asked, “What do I have to be careful not to do or say? I don’t want to push them back to drinking/drugging.” I’m quick to point out that affected others are not that powerful and that accountability doesn’t work that way.

The ONLY person who is responsible for drinking/drugging is the addict themselves.

Rebuilding Trust (One Day at a Time)

In addictions counseling I frequently hear outrage that, “My partner still doesn’t trust me!” I ask how long they were active in addiction? They usually respond with a high number of years. I ask how long they’ve been sober? They explain a few months. I raise an eyebrow at the contrast and they usually get it.

Our recovering loved ones have the same fear we do – that they will return to using/drinking. The difference is that they have 100% control over whether they stay sober and we have none. Worse still, there’s no guarantee of sobriety beyond today.

Building Trust - One Day at a Time

• Addicts & affected others alike tend to view trust as this all or nothing, once and for always thing. Making this kind of commitment again is terrifying. It needn’t be this way. Just as the person in recovery is free to make only 24 hours of commitment to sobriety, so too can we make our commitments one day at a time.
• Trust is earned through consistent integrity. We’re looking to see that we can depend on our partners to do what they say they will. We are also mindful that sooner or later we must deal with everything that was swept under the rug. It’s hard to imagine mustering the courage to try again after failing so many times in the past.

Courage is not the absence of fear. It’s the choice to refuse to allow fear to stop you. We want to love again, but how are we to love others when we remain ambivalent or worse toward ourselves?

Self Care Is Key

There’s a world of difference between caring for and taking care of. As affected others we are brilliant in our ability to be caregivers to everyone but ourselves. That simply must change. Ideally, our loved ones get sober for themselves not for us (if they’re doing it for us they will resent us later and their sobriety will be tenuous). What then shall we do for ourselves?

We need conviction, commitment, and support; these make life manageable:

1. We develop conviction that we will be responsible for identifying our own needs and ensuring that they are met.
2. We make meaningful commitments to our daily self care and make consistent choices to invest in our well-being.
3. We need the encouragement and support of friends and family. We too have the opportunity to experience transformation.

I urge affected others to avail themselves of the wealth of good literature and support accessible through 12 step programs like Al-Anon, Nar-Anon, Adult Children of Alcoholics and others.

Image Copyright: Khamal Zharif

All couples have differences. When the partners come from different cultures the differences are more pronounced. Learn about the 4 styles of intercultural relationships and about how to cope with (and celebrate!) differences.

We've come a long way in this country in terms of racial and cultural integration.

I teach in a two-year college in Manhattan that serves mostly urban minorities. Most of my students report that they have no problems being in an interracial or intercultural relationship. However, almost all of the students who have been in such relationships report having problems either from their parents or from the reactions of general society when they go out.

This, of course, is not only between Caucasian and African-American couples but also between Hispanic and African-American couples, Chinese and American Indian couples, Caucasian and Malaysian couples - and any other type of intercultural or interracial union.

Since society still holds onto some traditional prejudices there are therefore still special challenges in building healthy intercultural relationships. More importantly, many of the strategies used by successful intercultural marriages can be used by people in intracultural (from the same culture) marriages. In fact, whenever two people establish a long-term intimate relationship there are always differences in "culture", and each side has to negotiate how much of their own family's culture needs to be put into the new relationship.

In a recent article appearing in the Journal of Marital and Family Therapy, by Gita Seshadri and Carmen Knudson-Martin¹, interracial and intercultural marriages were analyzed and four successful coping strategies were described. Three of them are applicable to all couples, even couples who are from the same race and culture (see the end of the article for these!) But before we get to the various coping strategies, first we need to understand the basic structures that all couples adopt to deal with differences.

These 4 structures are:

1. Integrated
2. Coexisting
   
3. Singularly Assimilated
4. Unresolved
   

Four Systems for Dealing with Differences

1. Integrated Couples

When each partner validates the other's point of view and there is open communication about what is liked and disliked about each culture then the couple is on the way to being integrated.

If Kim (from a Korean background) is married to Rodney (Caribbean) they might have had very different diets in their parents' homes. If they are mutually interested in the background of the partner, and Rodney learns and cooks galbi and Kim learns and cooks plantains then we might say that they are acting in a manner of an integrated couple. In other words, integrated couples show mutual curiosity and consistently validate the partner's point of view.

Of course, validation can happen even if they don't agree - they can still cook the galbi, even if he decides it's not to his liking.

In an intracultural relationship the discussion might be about how to celebrate the Fourth of July.

2. Coexisting Couples

In coexisting couples each side respects the other but is not really willing to get involved with the other person's style of living. This is often the style that people adopt when they marry somebody of another religion.

In coexisting couples the basic message seems to be that what he/she does is nice or cute, but just leave me out of it (It also includes a message that what he or she does is okay because I can ignore it.)

3. Singularly Assimilated Couples

Some couples seem to work on the assumption that one spouse's culture is better or "more correct" than the other, and he will adapt to her family's customs and culture – or she will adopt his.

This is sometimes extremely useful. For example, in a couple where one partner came from a lower economic-class home and the other from a middle or upper-class home, there will be aspects of life that they might see as more correct due to what is expected and accepted in their present social standing.

This is also true for cross-cultural couples. While it is perfectly acceptable in some cultures to reach across the table to get the food you want, in American culture it is usually accepted that a person asks for the food to be passed to him or her. If you're raising a family in the United States it is probably helpful to consider American table manners as "right" and to consider foreign table manners as inappropriate.

On the other hand, consider that in one culture it might be considered brazen to talk to the person sitting next to you on the airplane, and in another it is thought of as good manners. In a singularly assimilated couple both partners accept the “rulings” of one culture as better or more appropriate than the other.

4. Unresolved or Conflictual Couples

There are people who just don't know what to do with the different cultures they're bringing into the marriage. Many times they will just ignore the differences and leave those issues as "unresolved."

At times conflict will arise around these unresolved issues. If we go back to the example of whether it is appropriate or not to talk to somebody sitting next to you on the plane, a simple friendly conversation could be perceived in a way that would evoke dangerous jealousy.

Three Strategies for Coping with Differences

In truth, while most couples gravitate toward one of the aforementioned structures, they tend to have some sort of combination of all four, and differences will always arise, from time to time.

So regardless of how a couple structures their relationship, they will still always need to learn to cope with and resolve differences.

There are three main strategies for coping with differences. These three strategies are:

1. Creating a “We”
2. Framing Differences
3. Emotional Maintenance

1. Creating a “We”

One successful way of dealing with daily differences is by creating the sense that as partners in this relationship we are something special and unique. This is called creating a "we".

• This can be done by forcing a sense of friendship. If you cultivate the feeling that we are good friends, we have fun together, we forget our mistakes - and there are some negatives that get ignored out of friendship, there will be a sense of togetherness that will help ease any conflict.
  
• Another flavor of the "we" comes when the partners share some sort of common ground. If they can point to a value system which unites them then the differences in background and culture and family traditions can become secondary. It might not make a big difference if I really don't like her food because we are both devout (fill in the religion of choice), and that's so much more important.
  
• Similar to the idea of common ground is the idea of similar goals. Common ground refers to values and foundational beliefs while goals refer to something that has to be worked toward and will happen in the future. This can be a financial goal, such as buying a house and paying off the mortgage or a social goal, such as getting a candidate elected.
  
• The last way of creating a "we" is somewhat simple, but seems to engender a very strong sense of "we". This is by working together over time with commitment. Spending weeks, months, and years keeping family first and staying loyal and faithful to the family builds a very strong feeling of mutual commitment.

2. Framing Differences

It is also useful to have a framework for viewing differences instead of ignoring them. Here are some of the strategies that have been found to be helpful.

1. View the differences as secondary in the relationship. Recognize that there are differences but that the other aspects of the relationship and the people in it are much more important.
2. Sharing differences as an attraction. Especially when it is an interracial relationship - "Sure I love pink, but chocolate is even better!"
3. Flexibility, respect, and understanding. When confronted with cultural differences, even if you cannot accept them into your own life, it is important to understand that other people might have different ways and to respect that. If you're going to your in-laws' house, and they come from someplace in the Middle East and don't always use a knife and fork for their meals, it is important to respect that - or at the very minimum, to not make fun or denigrate the custom.
4. Differences are something to learn about. Even better than flexibility, respect and understanding - if you show a genuine curiosity and openness to learn about the differences that your partner is bringing into the relationship you will likely foster a great deal of positive feelings.
5. Celebration and appreciation of the partner's culture...And one step up from curiosity is to celebrate the differences.

3. Emotional Maintenance

Even the best of couples experience difficulties and conflict -  so how does one maintain stability when the boat is rocked by different cultural perspectives too?

For this there are three main strategies: communication of emotions and or insecurities, making adjustments, and finding support.

1. Communication of emotions and or insecurities. It important to talk about the perceived differences. Being open and honest can help with understanding.
2. Making adjustments around culture. Even though this is the core characteristic of couples who are not conflictual, making adjustments can sometimes be very trying. In a couple where she is from Argentina and he is from Great Britain, she might have to "cool it" a bit but he might need to learn how to be a little more excited.
3. Finding support as a couple. Talking to friends who are in similar situations can be extremely helpful to give perspective on any particular difficulties. And then there are times where friends are not enough and it is useful to engage a professional coach or therapist.

Improving Your Relationship!

Look at your relationship. See where you and your partner fall in the categories of integrated, assimilated, coexisting or conflictual.

Then look at the tools you use to make the relationship work. You can then decide on how to increase the sense of "we", how to view and deal with the differences, or perform some sort of emotional maintenance.

Image Copyright: Guilherme-Pavan

Children with ADHD face a variety of challenges when they first leave home. What can parents do if they start to see signs of substance abuse in their newly independent young adult children?

Adolescents and young adults with ADHD can face many challenges when they first leave home, but once living independently, what can parents do if they suspect substance abuse or addiction?

Individuals with Attention Deficit-Hyperactivity Disorder (ADHD), especially if not effectively treated, can experience a range of difficulties. Parents can be glad when they find their way in life, especially when they find an occupation that matches their passion and skills. People with ADHD can have very successful lives in their own way and be able to earn a reasonable living, even if they were not successful in school.

Here's some information on helping your adult child find success by avoiding the substance abuse that too commonly accompanies under-treated ADHD.

Self Medicating

Some people with ADHD or ADHD-type symptoms will use substances (including cocaine) as a way of self-medicating because of the way that these substances can make them feel that they are being more focused. Thus, there is reason for concern if you learn that your teenage child has used cocaine (or another illegal substance).

If you're worried about possible drug use and not sure what to do, start off by evaluating the effectiveness of any current ADHD treatment and then by trying to assess the current level of substance use or abuse.

Assessing the Effectiveness of ADHD Treatments

Where is your child at with respects to the treatment of their ADHD?

If you think about it, you know your child has ADHD but are there any indications as to whether your child got and/or is still getting effective treatment for it?

• If they never really succeeded in school this may indicate that your child did not have treatment that was as effective as was needed.
• If your child’s current occupation/school choice is of the kind that is less likely to be affected by ADHD symptoms, then this could cause you to wonder about why such work was chosen, and about the current state of ADHD symptoms management.
  

If your child is not effectively managing ADHD symptoms, then this would be a clear red flag and possible contributor to having or developing a problem with addictions.

Assessing the Level of Substance Use or Abuse

The other aspect is that it may be hard for you to determine the degree to which your child has a problem with cocaine and/or other substances. 

Warning signs of a problem include:

• Having someone come to you with concerns about your child
• Signs that your adult child's peer group accepts substance abuse as normal
• Your child admits to occasional use but minimizes the importance
  

Greater concern would exist if someone like a sibling was concerned enough to raise the issue to you, violating the confidence of your child with ADHD, especially if this is out of character for the sibling. 

How Serious Is the Situation?

The question is what effects are being experienced as a result of the use? This information (which you probably will not know right away) will indicate where your child is at on the spectrum of substance use and its associated problems. 

Willingness to Accept Help

If use isn't perceived to be a problem, they may not be ready for assistance - both in terms of being honest enough with a professional to get a real picture of where they are at and in terms of receptiveness to being impacted by the intervention.

Helping Your Newly Adult Child

While recognizing that the problem is not your problem, you can make gentle inquiries and encouragement to your child. But remember that this is their problem and not your problem at this stage.

• It may well be that the best initial course of action is to address the treatment of the ADHD. If this can be done in a setting or with a clinician who can also assess then address the substance use, this would be preferable.
  

At least basic screening would be helpful at this stage, especially if you are still closely involved with your child, financially and emotionally. It is possible to begin a journey that will help your child and you discover wholeness and peace.

Image Copyright: _DJ_

Yale University researchers say that alcoholics who display abnormal activity in the prefrontal cortex during an MRI brain scan are as much as 8 times more likely to relapse.

Recovering alcoholic? Worried about relapse?

Well, you might find this interesting then - researchers at Yale University say that after scanning your brain in an MRI machine they can predict your odds of relapse.

Apparently, people who show excessive brain activity in parts of the prefrontal cortex during a relaxation exercise are as much as 8 times more likely to relapse within 3 months as people with more normal activation in that area.

The Study

• The Yale team recruited 45 alcoholics about to start a residential treatment program and 30 non-alcoholic control subjects.
• Each subject was given an MRI scan, and during the scan each was asked to imagine recent very stressful situations, as well as to imagine themselves in a very serene and relaxing situation, such as on a tropical beach.
• The researchers then followed the study subjects for three months after the successful completion of treatment.

The Results

• Subjects who displayed high activity in certain areas of the prefrontal cortex experienced more alcohol cravings after the completion of treatment than subjects with more normal relaxation responses and this translated into an 8.5 fold greater likelihood of relapse and an 8.7  fold greater likelihood of a return to heavy drinking.

Commentary

Chronic alcohol abuse can damage the prefrontal cortex, and since this area of the brain manages decision making, emotional regulation and impulse control, it is unsurprising that abnormal prefrontal cortex functioning increases a person’s risk of relapse.

Lead researcher Rajita Sinha, Ph.D commented on the significance of the study findings, saying, "The patterns of brain activity we observed may one day serve as a neural marker that could help clinicians identify alcohol-dependent patients in recovery who are most at risk of relapse. Our findings may also have implications for the use of medications and behavioral treatments that restore prefrontal function, as they could potentially benefit people at high risk of relapse."