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: 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: 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: Nromagna

As difficult as it is to love someone in the spiral of addiction, adjusting to life with a person in recovery is no small task either. Many of us found we lost ourselves while loving an addict/alcoholic. Now we start our own journey - one in which we focus on self.

Having a partner or spouse enter into recovery from addiction is one of the biggest changes a couple can go through. For the non-addicted it generally involves a mixture of relief, hope, a lot of conflicting emotions and a ton of fear.

We expect that they’ll come to see what we’ve seen all along – that their drug of choice was ruining not only their lives but ours as well. Many of us became so involved in their needs that we lost sight of our own. Regardless of where our loved ones are in their journey, it’s important that we take stock too.

How Are “Affected Others” Affected?

Clinicians refer to those impacted by another person’s addictions as “affected others.” This is a hopelessly generic and sterile bit of language that unwittingly minimizes the experience of we who bear witness to the spiral of addiction. Our experiences are diverse and deeply personal. Some of us felt responsible and others outraged.

We experienced the progressive loss of the person we loved. In the throes of addiction our partners became progressively unavailable to us.

• We may have shouldered additional responsibilities
• We may have been burdened with severe stress emotionally, financially, occupationally, and relationally
  
• Many of us lived in fear for what seemed an eternity

We worked to maintain some sense of order – some type of manageable status quo. Now everything is different and we find ourselves struggling to adjust.

We know how to stand in the middle of a storm and create order but aren’t sure what to do when everything is okay. We know to protect those we love…and then we learn that we may have done them a disservice in so doing.

Owning Our Part in Things

To start with, we need to accept that though we too made mistakes, we did the best we could at the time.

• We come to understand that protecting an adult from the natural consequences of their actions is to “enable.” Many of us unwittingly facilitated or assisted in the downward spiral of addiction by compensating for the insanity our loved ones created. We gave them a soft place to land. We nursed them back to health. We lied/covered for them. Enabling almost always feels like the right thing to do. In fact, it usually feels like the only choice.

Many of us felt a sense of betrayal in learning that our sacrifices hurt instead of helped. As a clinician I find that most things about addiction are counterintuitive and I urge folks to be proud of their positive intentions. Beating ourselves up is unhealthy and guilt creates obstacles to change.

“I did then what I knew to do. Now that I know better, I do better.” – Maya Angelou

Overcoming Self-Doubt and Embracing Uncertainty

Affected others tend to have many common traits/characteristics. Perhaps the most notable of these is that we struggle endlessly with self doubt.

This is not especially surprising, because many of us had our doubts preyed upon. We were told our concerns were unwarranted, our fears unfounded, or that it was we who had a problem for suggesting there was something wrong.

However, because we doubt, we tend to cope in unhealthy ways:

• We often stuff our feelings and thus develop resentments (repressed emotions, most notably pain and anger)
• Now that our loved ones are entering recovery, many of us resent that what they would not hear from us; they gladly receive from complete strangers. We feel unheard.

For both the addicts and we who love them, one of the most important and difficult lessons to accept is powerlessness.

1. Those in recovery move (often slowly) toward acceptance that their lives cannot be manageable if they continue to drink or drug.
2. Those affected by addiction must also learn to accept this lack of control.
   

Getting into the Solution

Moving forward, there are a plethora of unknowns:

• Will our loved one stay clean/sober? Will we stay or go? ...There’s rarely a clear course of action.
  

But if we can learn to overcome self doubt, reduce unhealthy coping strategies and accept our powerlessness over addiction, we get to be on the same page with ourselves, and this makes life vastly more manageable.

Some strategies to adopt as you strive to cope with the relational challenges of the early recovery period are:

1. Mindfulness
2. Journaling
3. Depersonalizing
4. Accepting Powerlessness
   

Mindfulness

Mindfulness is the key to all changes in self. Mindfulness simply means paying attention to our thoughts and feelings and ensuring that our actions are consciously chosen.

• What we do automatically is often self limiting. What we do deliberately can be liberating.

When we notice self doubt we have the opportunity to ask ourselves, “Do I truly doubt this or am I simply uncomfortable with how I feel about it?” We sometimes go searching for answers that do not exist because we want a course of action that won’t hurt anyone and/or makes everyone happy. If we are painstakingly honest with ourselves we know the truth regardless of what it feels like and are free to act upon it.

Journaling

Journaling, depersonalizing, and processing with close friends are excellent strategies to identify and cope with our feelings in healthy ways. Journaling literally helps us get “on the same page” with ourselves, which makes it far easier to share our needs and share them with others.

Depersonalization

To depersonalize is simply to imagine someone we care about in a similar situation. Because we have great empathy for others, we tend to understand what they feel and we generally have a sense of what would be helpful to them in dealing with it. We’re free to do this for ourselves and we are free to overcome our fears of vulnerability and allow close friends to actively support us.

Accepting Powerlessness

Powerlessness is the lesson that must be at the forefront of our consciousness moving forward. For as much as we rail against it, there are an infinite number of people, places, and things that we simply cannot be in charge of. For the affected other, much of our stress comes from attempting to control a person who is out of control. In the short term, we use simple tools like the Serenity Prayer to separate what we can do from what we cannot in order to maintain a healthy perspective.

Image Copyright: Dean812

Wondering about your use of Ativan (lorazepam) or any other benzodiazepine? Well then, take this 2 minute benzodiazepine addiction self test and find out if you have an addiction, and if so, how serious it is.

Ativan (Lorazepam), like all the benzodiazepines, is extremely addictive.

It’s not recommended for long term use (not for more than 2 to 4 weeks). The longer you use it and the higher your daily dose climbs, the more dependent you become - and as your daily dose goes up, so too does your risk of negative side effects: like memory disruption, thinking problems and over-sedation.

Have you been on Ativan for a while? Wondering if you’re maybe addicted or know you’re addicted but not sure how serious things have become? Well, read on then and take this very quick and easy self test to find out.

Ativan Addiction Facts

• In some cases, people experience withdrawal symptoms after having used at therapeutic doses for as little as a week.
• Ativan is not designed for continuous long term use - In general, using any benzodiazepine for longer than 2 to 4 weeks increases your risk of addiction and withdrawal problems.
• Ativan quickly loses its effectiveness as a sleeping aid (due to tolerance development) and there is no evidence that Ativan helps with anxiety after 4 months of continuous use.¹

• Once dependent, you need to slowly taper down your daily dosage to minimize withdrawal symptoms. A cold turkey detox is dangerous and very needlessly uncomfortable. Make sure to read the complete guide to safe benzo tapering before you even think about getting started.

Benzodiazepine Addiction Self Test²

The following self test is based on the Bendep-SRQ (SV), which is a clinically proven valid and reliable instrument to measure for the presence and severity benzodiazepine dependence.³

Consider each statement and then beside it:

• If you feel you that it not true for you, make a check-mark in the Not True column.
• If you feel that it is partly true, true or absolutely true, make a check-mark in the True column.
  

Interpreting the Results

OK, for your scores:

1. A check mark in the Not True column equals a 0 score
2. A check mark in the True column equals a 1 score

The results of this test will reveal your addiction severity across 3 measures:

1. Problematic usage (the severity of problems caused by Ativan usage)
2. Preoccupation (how focused you are on getting and taking this medication)
3. Lack of compliance with your doctor’s instructions

High scores in any one subset indicate the presence of an addiction. High scores in all subsets indicate a severe addiction.

Problematic Use

Add up your scores from questions 3, 6, 8, 10 and 13

If you score:

• 0, you have very low problematic usage
• 1, you experience moderate problems from your use
• 2, you experience a high degree of problems from your usage
• 3, 4 or 5, you experience a very high level of problems from your usage

Preoccupation

Add up your scores from questions 1, 2, 5, 11 and 12

If you score:

• 0, you have no or a very low preoccupation with Ativan
• 1, you have a low preoccupation
• 2, you have a moderate preoccupation
• 3, you have a high preoccupation
• 4 or 5, you have a very high preoccupation

Lack of Compliance

Add up your scores from questions 4, 7, 9, 14 and 15

If you score:

• 0, you have no or low non compliance issues
• 1, you have a high degree of non compliance
• 2, 3, 4 or 5, you have a very high degree of non compliance

Image Copyright: Auzigog

There are 4 styles of relationships in a marriage. None are all good or all bad - the trick is in finding a balance! Learn about the 4 different styles and about how you can incorporate all into your romantic relationship.

Not too long ago I was talking to a friend about a young couple we know. I was saying how cute they are, being young and in love. Although they are in their twenties, they are like two teenagers, she hangs on to his every word, and he follows her around like a puppy dog. My friend was much more cynical. She said that they are in trouble. You can't have a marriage like that. She is too dependent on him. She goes out of her way to be home when he comes home. He gets anxious when she comes home late. My friend said that they are on the road to self destruction.

My friend has a point. My friend has been married for quite a few years, and has two children. If she were to run her life in the same way as the young couple she might be in big trouble. So who is right? Am I correct in saying that they have a healthy relationship, or is my friend right in saying that they have an unbalanced relationship? Or maybe we are both right? Or maybe even both wrong?

Obviously not a simple question. To really understand what makes up a healthy marital relationship, we need to get a good idea of the types of relationships.

The young couple was showing signs of being "in love." We all know what that means, though many do not know what that does not mean. Being in love does not necessarily mean that you have the full repertoire of love or loving behaviors. It really means being infatuated (hugging) and it is only one of four basic styles of relationships.

The 4 Styles of Romantic Relationships:

The four styles are called...

1. Hugging
2. Supporting
3. Leaning
4. Standing

Hugging

The names are taken from exercises illustrating the styles. You can try it yourself. Take a partner and hug each other. This is illustrative of that infatuation relationship. "I love you. I need you. Hold me and tell me that you'll never let me go!"

It is stuff of teenage music. It is certainly not a bad thing. In fact, as we get older we often long for those days, early in our relationship when the fire was burning and the feeling of always wanting our partner powered each waking moment. It is the feeling of holding each other tight.

But what happens when we are always holding each other tight? How will it feel when one side wants to go in one direction and the other partner in a different direction? There is a great danger of feeling abandoned and lonely. If the hugging is so successful that you feel like one entity, there is a danger of losing a real part of your "self."

Supporting

But you might say, "infatuation doesn't even last for a long time. It fades away after a few months or a year." That's true. Most people change their relationship style. Some faster, and some slower, but it does happen. So we need to understand the other styles.

The second is called supporting. This is when one side of the couple supports the other. I worked with a couple like this. He is good at his job and likes it, but is not interested in much else, and she is really good at running the finances, the house, the social life, etc.

While it was a great arrangement at the beginning of the marriage, this type of relationship became the only way that they related to each other. She supported him in all of the tasks that he didn't really want to do, just because she was actually better at most things. She would call all the shots, in every area of life that they shared.

She actually liked to be in charge, so they could not see anything wrong with this style of life. But it became a burden. She complained that he had it easy and all of the work of running their life, except for bringing in the dough, was on her. When she said that he felt like a heavy load on her back I asked them to play out the roles in reverse. I suggested that he get on his hands and knees and for her to take off her shoes and stand on his back and asked her if that would illustrate the way she feels. Would it give him a feeling of what it felt like to be in her position?

She agreed and was eager to show him what it is like. They did it and I asked them what it felt like. On the bottom, he said that she was a bit heavy, and he certainly could not do it for long. Did he feel safe? He said yes. He wasn't going to do anything wild, but since he was in control, nothing much would happen to him besides getting very tired.

What about her? I did not have to ask her how she felt. She wanted off right away. She was scared. He could move too fast and she would fall. She was afraid that he would get up and she could fall and break her neck. I asked her, "If you had to stay there what would you need him to do?" She answered, "I would do everything I could to keep him in that position so I wouldn't wind up on the floor."

Is this the way he felt in the relationship? Well, yeah. In fact, the one who is being supported is in a much more precarious position. The side that is doing the supporting gets tired, but the side that is being supported lives with more anxiety.

Leaning

Now you will tell me, "Nobody wants to be supported. We are supported by our parents when we are children, but we don't want our partners to be our parents. But we all need someone we can lean on."

I'll tell you, "Let's try it!"

Take your partner and stand facing each other. Put your hands on your partner's hands, palm on palm. Lean on your partner and take a few steps backwards. It is not as bad as hugging; after all you can look around, learn new things, and talk to other people.

It is not as bad as supporting since you are both equal, nobody is being taken advantage of.

But do you feel safe?

What will happen if one partner decides to walk away? The other will fall flat on his or her face. Not a good scene.

Standing

So we come to the last metaphor: standing.

Each partner is standing on his or her own two feet and they are holding hands. This is the ideal for a good relationship. Or is it? Each partner can decide to go and do what he or she wants and the other is not going to fall or be damaged. They can share both good and bad experiences. The trick is to be standing on your own two feet. So it sounds ideal, right

This is what my friend was talking about in regards to the young couple. They cannot be hugging all the time; they need to stand on their own two feet.

Finding a Balance Between the 4 Styles

But here's the problem: Life is not like that. Life is full of trouble and problems. There are times when we need to be supported. And, yes, we all need someone we can lean on. But not all the time. The trick is not to always lean, but to say, "if you want to, you can lean on me." And life without hugging can get pretty dry and boring. We need some regular dosing of infatuation, adolescent type excitement, even after decades of marriage.

Here’s the solution. We need to use all the styles. There are times when every one of us needs support. Never get stuck in one pattern. Try the exercises and learn to recognize the feelings, and if leaning, supporting or even hugging gets to be too much, take care to alter your patterns.

There are times when you both need to be supported. Make sure you switch off and have times when each of you feels supported.

• There are times when you need to lean on your partner.
  
• When it gets too much and in danger of becoming a regular pattern, add some hugging to the mix.
  
• If one of you are feeling smothered from too much hugging, maybe some support is called for.
  

But the default position, the home base, the goal to get back to is the standing style. Just don’t be afraid to use the others when ever needed.

Image Copyright: White Ribbons

Bipolar or schizophrenia...is a pastoral counselor really a valid option? Yes! Pastoral counselors are trained mental health professionals that ALSO have training in interjecting spirituality into the therapeutic process.

Is a pastoral counselor qualified to handle serious mental illness?

The DSM (the manual which mental health professionals use in diagnoses issues) covers a broad range of mental health conditions, such as:

• Personal concerns (such as relational problems or an occupational problem)
  
• Less permanent disorders (such as adjustment disorders or oppositional defiant disorder)
• Serious mental illnesses (such as schizophrenia or bipolar disorder)

While it is always important to be careful in the selection of a mental health professional, this is particularly the case when looking for someone to help address a serious mental illness.

So should a pastoral counselor be considered for counseling around a serious mental illness?

What Is a Pastoral Counselor?

Before addressing this question, it is important to understand who a pastoral counselor is.

• Pastoral counselors are qualified mental health professionals that also have specialized qualifications and training to integrate the spiritual dimension into their therapeutic practice.
  

As a result, pastoral counselors are able to help someone who has a serious mental illness utilizing the same approaches that another counselor or therapist would use.

However, this does not mean that all pastoral counselors will be able to help someone with bipolar disorder or another type of serious mental illness. Depending on the severity of symptoms (present or historic), some pastoral counselors may feel that they are not able to provide sufficient coverage for potential emergencies.

Similarly, a pastoral counselor may focus their training and experience on particular issues or diagnoses and may therefore chose not to work with people who have a serious mental illness. These reasons could also be the case for other (non-pastoral) counselors. 

The Benefits of Pastoral Counseling

Studies have shown that for people diagnosed with serious affective disorders (such as bipolar disorder) there is a positive correlation between resiliency/long-term functioning and spirituality (both a well developed spirituality and engagement in spiritual practices) - as such pastoral counseling is well situated to help someone with these types of serious mental illness over the long-term course of dealing with their illness.

Especially around serious mental illnesses, counselors (including pastoral counselors) will usually work as part of a team of mental health professionals, including a psychiatrist.

A Pastor Is Not Necessarily a Pastoral Counselor

It should be noted that when we talk about pastoral counseling we are referring to counseling from a trained mental health professional -  not necessarily counseling offered by any pastor, where the pastor is not a qualified mental health professional.

Seeking the counsel of a pastor may be helpful, but should not be seen as a substitute for getting quality mental health care, whether from a pastoral counselor or another type of professional.

When you get quality mental health care, including from a trained and qualified pastoral counselor, it is possible to move towards greater peace and wholeness even when impacted by a serious mental illness.

Image Copyright: Helga Weber

Thinking about quitting but not sure if you’re ready? Want to quit but worried about the withdrawal symptoms and your pre-medication anxiety? To stop or not…how to make up your mind!?! Well, read on to find a list of common quitting pros and cons, and then make your own list – and then make a decision, once and for all.

To quit or not to quit…?

If you’ve been using benzos daily for more than a few weeks you’ve probably developed a physical dependency and will likely experience withdrawal symptoms when/if you try to quit.

On top of this, you started using benzos for a reason, likely for anxiety or insomnia, and though benzodiazepines lose their effectiveness over time, you may also feel worried about going back to life without your familiar meds…how will you deal with anxiety or insomnia without strong medication?

However…

On the other hand, there are lots of very compelling reasons to stop using medications that do you great harm, especially meds that become less and less effective over time.

So, you have to decide whether or not to quit, and if you decide to quit, you also have to work up the motivation to actually do it now – because as you surely know, it’s a whole lot easier to push off for the future what feels too difficult today.

Weighing the Pros and Cons

Well, there are two sides to this situation, and you may find that when motivation to quit goes hand in hand with apprehension about the process, it can be hard to come to a firm decision about what to do.

To make it easier for you, here’s a list of many of the common advantages and disadvantages associated with quitting benzos. After you read through the article, divide a piece of paper in half and make up your own list of pros and cons, using any from the article that make sense to you, as well as any personal reasons not included within.

At the end of this easy exercise, you may find it easier to come to a decision about your future on or off benzos.

Pros - Reasons to Quit¹

1. They probably don’t work very well any more - Because of how quickly you develop a significant benzodiazepine tolerance, after a while you wind up taking these pills just to get to a normal un-medicated state of functioning. According to the National Institute on Drug Abuse (NIDA) there is little evidence to prove that benzos work for insomnia after as little as 2 weeks of continuous use - and after 4 months of use, they likely don’t help with anxiety either.² And if that’s not bad enough, there’s evidence that the long term use of these medications actually worsens anxiety symptoms^.3
2. No more feeling drugged or emotionally distant all the time – Many people find that benzos separate them from their normal emotions and from true connections with loved ones. Do you want to look back at your life some years down the road and regret all the time you spent emotionally detached from those closest to you?
3. No more side effects – Do you ever experience benzo side effects? Would you miss them terribly!? Some common side effects include: memory problems, fatigue, stomach problems, headache, irritability, etc. And to make matters worse, though you become quite tolerant to anxiolytic effects of these medications, you do not develop the same degree of tolerance to some of the negative effects. So as you continue to increase your dose, you may find that side effects get progressively worse.
4. No more worries about drug interactions – Mixing benzodiazepines with alcohol or other sedatives can result in a serious amplification of intoxicating effects. As your benzo doses get higher over time, your risk of dangerous consequences for small mistakes goes up in kind. Some examples of dangerous consequences include: falls and broken bones, traffic accidents and even fatal overdose.
5. Your original problems (anxiety or insomnia, etc.) may no longer even trouble you – Do you still need to take benzos at all? Many people start taking to these medications to deal with an anxiety or insomnia problem and then, over time, the circumstances that created these problems disappear and the problems go away…but if you’re still on medications, you don’t even realize that you no longer need them! And what’s worse, since withdrawal symptoms typically include anxiety, insomnia and others, when you try to quit you feel this rebound anxiety, you think you still really need the medications, and you give up on your quitting attempt. So don’t get discouraged by feelings of anxiety at first. These are very likely just withdrawal-related and likely to dissipate within a couple of weeks.
6. You can always take these medications again, if you find you really need to - So there’s no reason to think that making a decision to quit today means you’ll never be able to use these effective medications ever again. In the future, however, you’ll probably want to limit your use to very short periods, so you don’t wind up dependent yet again.
7. A slow and structured tapering plan minimizes withdrawal symptoms - By slowly reducing your dose every couple of weeks over a number of months you greatly reduce the severity of withdrawal symptoms. So if a worry of withdrawal keeps you using, you may be using for little reason. Read the Guide to Benzo Withdrawal to learn more about planning a safe and comfortable detox.

Cons - Reasons to Just Stay On

1. Worries about withdrawal symptoms (cold turkey benzo withdrawal symptoms are notoriously difficult). Fortunately, you can minimize withdrawal symptoms by using a structured slow tapering plan.
2. Worries about a re-emergence of the anxiety, insomnia or other challenges that caused you to seek out medication in the first place. Fortunately, in many cases rebound anxiety is just a temporary symptom of withdrawal, which will fade away quickly.
3. Feeling worried that you won’t be able to cope with difficult or stressful events without access to pills, when needed. Fortunately, you can always take these pills again, if needed. Quitting today doesn’t mean you have to quit forever.

Deciding on Change

Made a decision yet?

Quitting benzodiazepines takes courage. It’s often easier and less scary to just continue to use these meds, but when you examine the situation carefully – you may see that continuing to use makes very little good sense.

So think about it and make your own decision (don’t get pushed into it).

• If you’re not ready to try today, think about revisiting the issue in a few weeks or months – to make sure you’re still on benzos for all the right reasons.
• If you are ready to quit, get educated, talk to your doctor to make a plan, and then get started! Remember, there’s no rush and by taking it slowly you can reduce the discomfort.

Image Copyright: Anthony Will

Done wrong, a benzodiazepine detox can turn into months of agony. Done right, by slow taper, it’s very manageable. Read on to learn more about what to expect, how to taper, how to minimize your withdrawal symptoms and how to cope with those you do experience.

Benzos – amazingly effective until they aren’t, until you need more and more and you still don’t feel OK - until the only reason you still use them is because you just can’t stop.

Sound familiar? It doesn’t have to go on like this.

People who break free from benzodiazepine addictions tend to feel a lot better: Studies show that quitting leads to improvements in cognitive performance, mood and sleeping, and since the prolonged use of a benzodiazepine often causes as many anxiety problems as it’s supposed to solve, quitting generally makes very good sense.

But though quitting is sensible, it’s certainly not easy, especially if you don’t start with a reasonable understanding of the process and a solid plan for success.

So read on to learn more about...

• The nature of benzodiazepine withdrawal symptoms (when they arise, why you get them, what they feel like, how long they last, etc.)

• Why a dangerous cold turkey detox makes no sense at all
• Different tapering methods and schedules (including how and why you might want to switch to long-acting diazepam)
• How to cope with withdrawal symptoms (self-help, medications, counseling etc.)

Benzodiazepine Withdrawal Symptoms

Not everyone quitting benzos will experience withdrawal symptoms and most people experience only a few, not the complete list of possible symptoms.

Typical withdrawal symptoms include:¹

• Sleeping problems
• Feeling anxious or tense
• Panic
• Depression
• Confusion
• Paranoia – thinking other people want to do you harm
• Feelings of disassociation
• Abnormal sensory perception (noises sound loud, colors seem odd, etc.)
• Shaking, or more rarely, convulsions
• Muscle aches, pains and spasms
• Irritability
• Symptoms that mimic flu

See the end of this article for a comprehensive list of less commonly experienced withdrawal symptoms.

Why Do You Get Withdrawal Symptoms?

All benzodiazepines work by increasing the activity of the neurotransmitter GABA. Since GABA is an inhibitory transmitter, which slows or stops the firing of other neurotransmitters, by increasing GABA activity you quiet the brain’s overall activity level. GABA is the brain’s natural sedative, and benzodiazepines simply enhance its functioning.

GABA suppresses excitatory neurotransmitters like dopamine, serotonin, epinephrine (noradrenaline) and acetylcholine. These excitatory transmitters play important roles in memory, muscle movement, alertness, emotional regulation, heart rate and blood pressure and hormonal secretions. When taking benzodiazepines you quiet your whole brain’s activity level. This reduces anxiety and insomnia, but also causes changes to many of the body’s essential systems. This is why taking chronic high doses of benzos can cause such a variety of health problems and why people experience such a wide array of withdrawal symptoms after stopping.

Benzodizepine users quickly develop a tolerance and start needing increasingly larger doses to achieve any desired effects. Because of this, most prescribing guidelines advise against the use of benzos for more than 3 or 4 consecutive weeks.

With tolerance:

1. The GABA and benzodiazepine receptors compensate for the medication’s continual presence by becoming less responsive to the medication (so less GABA)
   
2. The excitatory systems that are naturally controlled by GABA also adapt by becoming less responsive to GABA inhibition (So less GABA and the GABA that's left doesn't do as much)
   

So once you’ve developed a tolerance you need large doses of benzos to just get the GABA system functioning at a ‘normal’ level. If a person with a benzo tolerance suddenly stops taking their medication, GABA activity drops substantially and this causes equally substantial increases in the activity of the brain's excitatory dopamine, serotonin, noradrenalin etc. systems.²

In some cases, as your tolerance rises, you can start to experience withdrawal symptoms on a steady dose, and you need to up your daily dosage to keep these withdrawal symptoms at bay.

Do All Benzo Users Get Withdrawal Symptoms?

According to the benzodiazepine dependency advocacy group Reconnexion, between 50% and 80% of people who use benzos for 6 months or longer will experience at least some withdrawal symptoms after stoppage.

The duration of withdrawal symptoms can also vary a great deal, but people who have longer histories of use are more likely to experience longer withdrawal periods than people with shorter use histories.³

You are more likely to have difficult withdrawal symptoms when quitting:⁴

• After a very long period of use
• When trying to come off a very high daily dosage
• When you have been using potent, fast acting benzodiazepines

When Do Withdrawal Symptoms Start to Occur?

You will start to feel withdrawal symptoms sooner if using a shorter acting benzo, like Xanax, and later, if using a long acting benzo, like valium.

• Users of short acting benzos may start to experience withdrawal symptoms within 2 days of the last dose
• Users of longer acting benzos may start to experience withdrawal symptoms between 2 and 10 days of the last dose⁵

Withdrawal symptoms may persist for a few days or weeks. Some people experience withdrawal symptoms that persist for months or even years after cessation of use.

How to Quit? Taper Down or Cold Turkey?

Taper. Without a doubt.

If you have been using benzodiazepines on a daily basis for more than three weeks, you should not stop using suddenly – you need to taper down instead.

1. A cold turkey detox can be dangerous, or even deadly, and it increases the odds of an agonizing and lengthy withdrawal.
2. A slow taper maximizes safety and minimizes discomfort.

You may have an impulse to try to power through quickly and tough it out. Although this is understandable – it's a very bad idea.

Tapering Methods

Tapering should be slow and gradual (months, not weeks) - it doesn’t really matter how long it takes (it probably took you a long time to build up your tolerance) and what’s most important is making steady progress towards your goal while minimizing your discomfort along the way (see below for example tapering schedules).

By tapering you can

• Minimize your withdrawal symptoms - by reducing at a rate that’s comfortable to you
• Stay in control – you decide how fast you want to go forward and you don’t have to endure strong withdrawal symptoms if you don’t want to

You can do:

1. A direct taper – where you make steady reductions off whatever benzo you’ve been using
2. A substitution taper – where, if you’ve been using a short-acting benzo like Xanax, you first switch off to a longer acting benzo like diazepam, and then once stable on the diazepam, start to taper down

The Benefits of a Substitution Taper (to Diazepam)

Many clinicians recommend switching to diazepam prior to initiating a tapering program.

1. Diazepam has a very long half-life (between 20 and 100 hours). Because of this, benzo levels in the bloodstream remain very constant and you avoid the peak and valley levels seen with shorter acting benzos like alprazolam. These more constant benzo levels facilitate neural recovery (the brain ‘heals’ faster) and minimize withdrawal symptoms.
2. Diazepam has very low tablet strengths, and this low potency allows you to easily make very small dose reductions. For example, It’s quite easy to take one fewer 2mg diazepam per day – it’s much harder to shave 0.1 mgs of Xanax off a 0.5 mg tablet.⁶

Because of diazepam’s long half-life, and difficulties in finding exact equivalent dosages between benzos, it is generally recommended that you switch over to diazepam gradually, in a step-wise fashion over a period of weeks, and then once stable on diazepam, start your tapering from there.⁷

Roughly Equivalent Diazepam Dosages

Because of the wide variations in half-life and thus variations in how people respond to different benzodiazepines (influenced by factors such as age and hepatic impairment) it’s quite difficult to provide an exactly equivalent diazepam to other benzodiazepine dosage.

According to the Victorian (Australia) Gov. drug withdrawal practice guidelines, as of 2009, 5 mgs of diazepam was approximately equivalent to:⁸

• Alprazolam (Xanax, Kalma) 0.5 mg
• Oxazepam (Serepax, Murelax) 30 mg
• Clonazepam (Rivotril) 0.5 mg
• Nitrazepam (Mogadon, Aldorm) 5 mg
• Flunitrazepam (Hypnodorm) 1 mg
• Lorazepam (Ativan) 0.5 mg

So, for example, if you wanted to switch from 2mgs of Xanax to an equivalent amount of diazepam you would need to take 20 mgs of diazepam.

1. However, this is just a rough guideline and you won’t necessarily feel exactly the same on a theoretically equivalent dosage of a different benzodiazepine.
2. So, what you need to do, is transfer gradually off your current benzo to diazepam, and then dial in a minimum dose of diazepam that keeps withdrawal symptoms at bay but doesn’t leave you feeling over sedated. Once stable on this dose, you can start your tapering regimen.

Example Tapering Schedules

• Reduce your dose by 10% every 1 or 2 weeks until you’re at 20% of your original dose, and then taper down by 5% every 2 to 4 weeks⁹

Or, a more aggressive approach, endorsed by the Oregon State College of Pharmacy¹⁰

• Taper by 25% per week for the first 2 weeks and then start a 12.5% reduction per week for the next to 6 weeks (note, tapering usually gets harder as you progress to smaller doses). This aggressive approach may not be suitable for people who have tried and failed in the past with a tapering regimen. For such people a 6 month tapering regimen is recommended.

As a general rule, it doesn’t really matter how slowly you taper and it’s a good idea to stabilize at a dosage before moving further down. Reductions tend to get harder in the second half of the process, so it’s OK to slow down as you need to, as you approach the finish line.

However, you should definitely avoid:

• Taking extra pills in times of great stress
• Going back up to an earlier plateau, if a new dosage seems difficult
• Using other substances that mimic the GABA effects of benzos (this obviously corrupts the tapering process)

Avoiding Alcohol during Benzo Withdrawals

Drinking may worsen your withdrawal symptoms (especially the morning after) but there’s another important reason to avoid alcohol until you feel better.

1. You experience withdrawal symptoms because your GABA system is all messed up and it needs to normalize before you’ll feel better
2. Alcohol increases GABA activity, just like benzos do
3. So if you drink, you slow your brain’s healing and there’s a risk that you’ll just start to drink more and more as you taper further as a way to compensate, without really allowing your brain a chance to heal

And if you do this, at the end of it all not only is your GABA system still out of whack – now you’ve got an alcohol problem too!

Coping with Withdrawal Symptoms: Self Help

To minimize your symptoms:¹²

• Strive to eat a healthy diet with lots of fresh fruits and vegetables. Drink lots of water
• Avoid caffeine
• Exercise (as much as you can...you can’t do too much)
• Rest up as well as you can
• Keep a recovery diary and chart the progress you make
• Ask for help and support from friends or family for things like household chores and general responsibilities
• If interested, explore alternative healing, such as acupuncture or Chinese medicine¹¹
• Avoid using alcohol or drugs. They may help in the short term but will exacerbate symptoms over the long run
• Avoid making major decisions or adding unnecessary stress to your life while going through withdrawals
• Relax in a hot bath
• Practice relaxation techniques, like deep breathing exercises
• Meditate and practice mindfulness
• Learn Cognitive Behavioral Therapy (CBT) techniques (with a therapist or in a group, or on your own through a self help program or books) and learn to challenge negative thoughts and harmful inaccurate beliefs

Keeping Things in Perspective

Staying focused on how bad you’re feeling won’t help you feel better, and the more you obsess about your symptoms, the worse you’ll perceive those symptoms to be – in fact, sometimes worrying about how you’ll feel after dose reductions causes more negative symptoms than the dose reduction itself!¹³

One trick you can use to minimize the worry is to accept that after each dose reduction you might catch a touch of ‘Benzo Flu’

Think objectively about how you feel after a dose reduction and compare these symptoms to how you feel when you catch a cold or flu. Are they comparable? When you get a flu do you worry a lot about how terrible you’re feeling or do you just accept that you’ll feel crummy for a few days and that you’ll feel better in time.

With benzo withdrawal symptoms it’s pretty much the same thing. You may feel crummy for a short time after a dose reduction, but you’ll feel better quickly enough, so why not just think of your symptoms as a case of benzo flu – and since you know that this flu will pass quickly enough, you don’t need to get too stressed about how bad you feel.

Should You Consider Counseling?

You should, ideally, seek a doctor’s medical supervision to help you with the withdrawal process, but on top of this, should you also seek out some form of counseling support?

Anxiety is the most commonly experienced benzo withdrawal symptom. This anxiety is temporary and will go away as your body readjusts, but if you find it very uncomfortable you may find counseling helpful.

• A counselor or psychologist can help you learn behavioral and cognitive behavioral techniques to manage anxiety. These techniques can be learned in a handful of sessions and can be practiced and implemented as needed, on your own.
• You may also find a community or online support group helpful. It can be reassuring to hear from others who are going through or have gone through similar experiences. People in support groups, or even within online support forums, can provide helpful information and support.

Basically, this is a tough process, and if you’re having trouble coping with your withdrawal symptoms, it’s entirely reasonable to seek out extra helpful support and advice.

Medications That Can Ease Withdrawal Symptoms

Your doctor may prescribe you medications that can reduce the severity of some withdrawal symptoms. Medications sometimes prescribed include:¹⁴

• Propranolol – to help reduce tremor and sweating (for up to about 3 weeks)
• Non-benzodiazepine sedatives like antihistamines or sedative antidepressants – to help reduce insomnia (short duration, about 2 weeks)
• Carbamezepine (and other anticonvulsants) – to reduce the risk of convulsions

Less Common Withdrawal Symptoms

In addition to the more commonly experienced withdrawal symptoms from the list above, some people may experience one or more of the following:¹⁵

• Agoraphobia
• Tiredness and lethargy – heavy limbs
• Breathing problems or tightness in chest
• Blurry vision, sore eyes, sensitivity to light or seeing spots
• Becoming very sensitive to sounds, or hearing a ringing in ears
• Dizziness or feeling like the ground is moving
• A lack or co-ordination or balance
• Feeling like things aren’t real (depersonalization)
• Heart palpitations
• Digestive problems, diarrhea, constipation or nausea
• Nightmares
• Headaches or a sense of tightness in the head
• Urinary problems – urgency, incontinence
• Excessive sweating
• Psychotic symptoms (hallucinations)
• Anger or rage
• Changes in libido
• Change in appetite, loss of taste, weight gain or loss
• Menstrual changes
• Difficulty swallowing, soreness in mouth and tongue
• Intrusive thoughts or memories
• Hyperactivity
• Feelings of numbness or pins and needles
• Increased emotional reactivity
• Suicidal thoughts
• Impulsive behaviors
• Many others

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Here’s how it works: take a pill each morning and know that for the rest of the day even a sip or two of alcohol will make you feel horribly ill. Need to quit drinking? Is disulfiram a good option for you? Read on to learn more about this FDA approved alcoholism treatment medication.

Disulfiram: Take a tiny pill each morning and know that for the rest of the day even a sip of alcohol will make you feel terribly ill…sound like something that might help you stay motivated and sober?

In America, disulfiram is marketed under the trade name Antabuse. Disulfiram won’t help you quit drinking, but once you’ve managed to stop it can help keep you from relapsing since you’ll know that even a small amount of alcohol will have very negative consequences.

Disulfiram is an FDA approved alcoholism medication that has been in use for more than half a century.

It may help you to maintain your sobriety but it has some downsides, such as:

• You have to remember/decide to take this pill each day
• You run the risk of a bad reaction from accidental alcohol ingestion (through cooking sauces, some medications etc.)
• It won’t help you with alcohol cravings
• It can cause liver damage
• If you drink on it and have a very severe reaction you could die

How Does It Work?

1. When you drink, your body converts the alcohol into acetaldehyde and then quickly converts this acetaldehyde into acetate and then into carbon dioxide and water.¹
2. Acetaldehyde is highly toxic and a known carcinogen – and it causes much of the hang-over pain you feel the day after drinking.
3. If you take disulfiram and then drink alcohol, this process gets interrupted after the first step. You still convert the alcohol into the toxic acetaldehyde, but then the process stops, and levels of acetaldehyde in the body quickly rise to between 5 and 10 times their normal post drinking levels.

So imagine the worst hang-over you’ve ever had...and then multiply that by 5 to 10. This occurs within minutes of combining disulfiram and alcohol and the symptoms will last for between an hour and a few hours.

Disulfiram + alcohol will cause symptoms such as:

• Severe headache and neck pain
• Nausea and vomiting
• Dizziness
• Flushing
• Tachycardia
• Sweating
• Dry mouth
• Blurry vision
• Weakness
• Breathing problems
• Very low blood pressure
• Confusion ²
  
• Chest pains
• Convulsions
• Coma

Combing alcohol and disulfiram can result in a very serious and sometimes fatal reaction. Never take this medication before consulting with a doctor. People with certain underlying conditions, such as liver, heart or kidney problems (and many others) probably can’t use disulfiram safely, especially since you can inadvertently set off a reaction through exposure to trace alcohol in foods or even in colognes or perfumes.³

How Well Does It Work?

It works pretty well.

There are no magic-bullet medications for the treatment of alcoholism, but medications help, and when combined with behavioral therapies, they generally offer people the best shot at lasting recovery.

Because of the risks of use and because it does not reduce alcohol cravings, disulfiram is now prescribed less commonly than newer alcohol treatment medications, like acamprosate or naltrexone.

But although prescribing is down, disulfiram is still an effective medication, suited particularly for newly abstinent and highly motivated people.

• A 2011 Cochrane Review of 11 clinical trial studies on the effectiveness of disulfiram revealed that most studies found that over the short term disulfiram was more effective than placebo and other addiction treatments for helping people achieve longer periods before relapse and for helping people reduce their total number of drinking days.⁴
• Another large German study found that disulfiram worked better than acamprosate, particularly for patients with a long history of alcoholism.⁵

What Are the Risks?

Disulfiram is a serious medication, but if used as directed, and under a doctor’s care, it’s pretty safe for most people.

• Disulfiram used to be more dangerous, but today's commonly used dosage is much lower than it used to be and now patients with heart disease and some other medical problems don't get prescribed this medication.
• Disulfiram can be hard on the liver, and your doctor will want to monitor your liver enzymes over the course of your use of this medication. If you have very compromised liver functioning you may not be a good candidate for disulfiram. Disulfiram can cause hepatitis, but this occurs rarely, only in about 1 in 25 000 people.⁶
• Disulfiram may worsen psychosis

Is It Right for You?

A panel of clinical experts at SAMHSA concluded that disulfiram is most effective/appropriate when:

• The patient is highly motivated to stay abstinent and well informed of the risks and necessary routines of use
• The patient is capable of staying abstinent for at least 12 hours
• The patient’s treatment is being closely monitored by an addiction treatment professional
• No medical conditions or allergies preclude its use
• The patient does not have significant impulse control problems or significant cognitive impairment

Think it’s what you need? Well, don’t take this medication lightly and never take without a doctor’s supervision, but if it sounds like it might help you stay sober, one day at a time, talk to your doctor about your appropriateness for a prescription. 

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So you’re drinking too much and you want to change – you have 2 choices, either cut down or quit entirely. While abstinence is the safest course of action it’s not for everyone, and some people want to at least try to cut down before conceding to a need for complete sobriety. Do you want to become a more moderate drinker? If so, here’s how to do it….

OK – your drinking is causing you some problems in life and you know you have to do something about it. Maybe it’s for health reasons, or maybe it’s for family or work – but the time has come to make some changes and get back under control.

Now, the first thing you really need to decide when thinking about getting your drinking under control is:

Are you going to quit drinking entirely or are you going to cut down your drinking to a more moderate consumption?

Both are reasonable and effective plans, but while abstinence will work for everyone, not everyone will have good results with striving to cut down - If you are an alcoholic (alcohol dependent) you have very low odds of having success with anything other than abstinence.

1. If you decide on abstinence, then things are quite clear. Try to stop drinking, and if you can’t do it on your own, get some professional addiction treatment and make use of community based support groups, like AA and others.

2. Shooting for success with moderate drinking, however, is a bit trickier. If you have a drinking problem and you just sort of ‘try to cut down’ without making a clear plan on how you’ll do it, your odds of success aren’t great. For the best chances of actually achieving and sustaining moderate drinking, you need to plan for how much and how often you’ll drink (put it writing) and you’ll need to learn and use some new strategies to ensure you don’t exceed your limits.

3. If you decide on moderate drinking, take cutting down seriously and make use of strategies for minimizing your consumption. If you find over a test period of  weeks or months that despite your best efforts you consistently fail to achieve your moderate drinking goals, then accept that moderate drinking may not be achievable for you, and proceed with abstinence as your best course of action.

Cutting Down Your Drinking

If you decide on moderate drinking, the first thing to do is to write down your goals:

1. Write down a list of your reasons for slowing down your drinking
   
2. Decide on how much you and how frequently you’ll allow yourself to drink. Your goals are your own and you must determine what’s best for you, but for moderate drinking you may want to consider the US established safe drinking levels of no more than 4 standard drinks in a session and 14 standard drinks per week for men, and no more than 2 standard drinks in a session and no more than 7 standard drinks per week for women¹. You should also have at least 2 alcohol free days per week. Write down your alcohol goals on the same piece of paper as your list of reasons for cutting down. Put the piece of paper somewhere you’ll see it every day – to remind you of your commitment and goals.
   
3. Keep an alcohol diary for the first few weeks. Write down every drink you have on a day by day basis and compare your weekly actual drinking to your goals of moderate drinking. If after a few weeks, you find that you are able to stick to your goals and have cut down your drinking, then congratulations and carry on the good work. If after a few weeks, you find that your efforts have not resulted in a substantial reduction in drinking, then you may want to consider abstinence as a better choice for you.
   

Tips for Cutting Down and Achieving Moderate Drinking

Moving from heavy to moderate and binge to responsible drinking can be challenging and for best odds of success you’ll want to take advantage of some proven strategies that can make this transition a little easier.

Here are some strategies that may help you to achieve your goals:

• Keep no or very little alcohol in your house.
• When out drinking socially, try alternating between alcoholic and non alcoholic drinks, and try not to have more than one standard drink per hour.
• Be careful about generous pours! A brimming glass of strong red wine can actually equate to several standard drinks, and when you’re at a party and you’ve got a host circulating and topping up glasses every few minutes – that single glass of wine or two you recorded yourself having might have actually equaled many times that amount in standard drinks measures. Familiarize yourself with standard drinks measures, and when possible, pour or mix your own drinks.
• Make sure you eat before or while you drink. Food in your stomach slows the absorption of alcohol and can reduce the intoxication you feel – which will help you to maintain your resolve to drink in moderation. Also, try having a large glass of water before drinking alcohol. You don’t want to be quenching a thirst with alcohol.
  
• Avoid situations that trigger urges to drink. If you know that watching Monday Night Football with friends is always a beer soaked affair – then maybe it’s not the best social outing for you as you try to gain control of your drinking. Achieving moderation and changing your habits is tough enough – you don’t need to make it harder than it already is by putting yourself in the way of overwhelming temptation.
  
• Think about how you’ll handle strong urges to drink. Will you call your spouse for support? Will you get out of the situation and head to the gym? Will you do deep breathing exercises and wait for the urge to pass? Plan in advance for the temptation that’s sure to come and you’ll be better able to overcome those urges and continue to follow your sensible drinking plan.
  
• As someone that used to drink a lot, know that people will sometimes offer you a drink when you don’t want one and that sometime they might even pressure you to take one. Plan in advance how you’ll turn down these unwanted drinks.²
• Reward yourself for your drinking cuts. Take the money you’re saving on all the alcohol you used to buy and do something fun with friends or family – it’s all a part of learning to have fun without alcohol.³

Image Copyright: Cagrimmet

A complete introduction to marijuana addiction treatment – Find out whether you need it, about treatment options and how to choose the right type and about therapies, medications and supplements that work.

How about a quote from comedian Steve Martin to start things off ...

"I used to smoke marijuana. But I'll tell you something: I would only smoke it in the late evening. Oh, occasionally the early evening, but usually the late evening - or the mid-evening. Just the early evening, mid-evening and late evening. Occasionally, early afternoon, early mid-afternoon, or perhaps the late-mid-afternoon. Oh, sometimes the early-mid-late-early morning. . . . But never at dusk." - Steve Martin¹⁶

Sound familiar!?!???

Marijuana is the world’s most widely used and abused illicit drug. A lot of people use it recreationally and never have much difficulty with it, but about 10% of people that smoke marijuana develop an addiction at some point.

Of those people that become marijuana dependent:

1. Some manage to quit on their own
2. Some seek help and manage to quit
3. Some never quit

If you smoke marijuana and you don’t want to quit…you probably won’t find much of interest here.

If you smoke marijuana and you want to quit or cut down, but you’ve never tried on your own – that’s probably something you need to do first before you consider getting professional help (check out this free online CBT based marijuana treatment program).

If you smoke marijuana, you want to quit or cut down, and you’ve tried on your own without success…then read on, pay attention and learn more about:

• Different types of marijuana treatment programs
• How to know what kind of treatment you need
• Evidence based marijuana addiction therapies
• Over the counter (OTC) marijuana addiction treatment medications
• Experimental marijuana addiction treatment medications

Should You Get Marijuana Addiction Treatment?

It's up to you. We’re not here to debate the evils/merits of pot. If you’ve smoked enough to be contemplating treatment you likely know for yourself what the drug gives…and what it takes.

People commonly seek treatment when:

1. They are unable to stop for significant lengths of time, even when motivated
2. And when the negative consequences significantly outweigh any benefits

 Examples of negative consequences include:

• Health complaints
• Thinking or memory problems
• Poor work or school performance
• Legal issues
• Financial problems
• Anxiety or paranoia
• Problems with motivation/inability to achieve goals
• Pressure from friends/family/employer

Where to Get Marijuana Addiction Treatment

If marijuana’s a problem for you, and if you can’t stop on your own, it is entirely reasonable to seek outside treatment help.

1. You probably have more treatment options than you realize
2. Treatment doesn’t always mean rehab and in a lot of situations it needn’t be costly or intensive

Some basic treatment options include:

• Getting individual substance abuse counseling
• Getting family or relationship counseling with an emphasis on changing substance use patterns
• Joining an intensive outpatient program (usually, evenings and weekends)
• Joining a day treatment program (an all day, more intensive version of an intensive outpatient program)
• Going to a residential rehab
• Going to a psychiatric hospital
• Joining a community support/self-help organization, like NA
• Moving into a sober living environment, like a halfway or three-quarter house

So you have a number of options, but which is right for you? To find out, it makes a lot of sense to meet with a professional for a substance abuse assessment and for treatment recommendations.

The Benefits of a Professional Assessment

You can save a lot of wasted time and effort (and heartache) by getting into an appropriate level of treatment right from the start.

You have a better chance of starting with an appropriate level of treatment after getting an assessment from a professional substance abuse counselor.

During an assessment, a professional will:1

• Define the specific nature of the problem you’re looking to solve
• Evaluate your readiness/motivation to change
• Evaluate your addiction severity              
• Identify barriers to treatment and recovery
• Identify secondary conditions/disabilities that may influence the treatment process
• Identify client strengths that can enhance the recovery process
• Gather information on your living arrangements and socioeconomic status to determine options and eligibility for various programs

Then, based on the results of the assessment, your resources and what’s available locally, the counselor can give you specific recommendations on what you need and where you can get it.

It doesn’t take long, it doesn’t cost much (comparatively) and it decreases the likelihood of wasted time and effort…all in all, it’s a good idea.

Marijuana Addiction Therapies

Whether you get individual therapy or get involved with a more structured treatment program, you’ll probably receive a variety of different types of therapies and interventions, such as skills training (anger management, refusal skills etc.) relapse prevention training, an introduction to community self-help groups, and many others.

So you can expect a variety of interventions, but you may want to make sure that any program (or counselor) you choose also makes use of evidence based therapies - therapies that have been proven effective for people addicted to marijuana.

Three therapies that are research proven effective, specifically for people with marijuana issues, are:

1. Cognitive Behavioral Therapy
2. Motivation Enhancement Therapy
3. Contingency Management

Cognitive Behavioral Therapy (CBT)

In a CBT for marijuana addiction program you learn skills that help you maintain abstinence. Examples of these skills include: marijuana refusal skills, coping techniques for cravings, learning to minimize your exposure to dangerous situations, general problem solving skills and many others.

Research tested marijuana addiction CBT programs are generally about an hour in length, once a week, for between 6 and 14 weeks. Marijuana CBT can be delivered through individual or group therapy sessions.

Motivational Enhancement Therapy (MET)

People often have at least some ambivalence about serious life changes (although a big part of you wants to quit using…there’s another part of you that still likes getting high or finds smoking after a hard day relaxing).

Ambivalence can derail treatment efforts, so transforming ambivalence into resolve greatly improves your chances…but how do you do this?

In MET, you explore your current behaviors and also your personal values and your short, middle and long term goals, and then you evaluate your behaviors to see where they mesh and where they clash with your values and your hopes and dreams for the future. In doing so you generate your own personally relevant reasons to seek change and you become more committed to taking the steps needed to realize this change.

MET typically occurs over 1 to 4, 45 minute sessions.

Contingency Management (CM)

It may seem like a strange idea…to win a prize for doing what you’re supposed to do – but research shows that it can help a lot to keep you on the right track.

Programs that offer contingency management motivational incentives give voucher ‘prizes’ to clients who meet treatment goals, like perfect attendance or progressive clean urine tests. Research shows that having this reward incentive as a bonus for staying clean and sober increases a person’s odds of achieving lasting recovery.

Which one works best?

All three types of treatments are proven to work, but MET and CBT works better than MET alone, and MET, CBT and CM all together seem to work best of all.²

Marijuana Addiction Treatment for Teens

Adults are more likely to initiate treatment of their own accord – teens are more likely forced into the process.

And unfortunately, though you can force an adolescent into a treatment program, you can’t make anyone want to change – that has to come from within.

For this reason, Motivational Enhancement Therapy (MET) or similar, is often a core component of marijuana addiction treatment for teens.³

OTC Marijuana Addiction Medications

Marijuana treatment medications that you can buy without needing a doctor's prescription.

N-acetylcysteine (NAC)

NAC is a cheap and safe FDA approved antioxidant supplement that greatly increases the amount of the amino acid L-cysteine that gets to the brain. People have been using NAC for a long time to treat kidney and liver diseases, among a number of other conditions. More recently, researchers have found NAC helpful in the treatment of psychiatric conditions like impulse control disorders, bipolar, OCD and addiction – even marijuana addiction.

In one study, teens given 8 weeks of NAC as a part of a marijuana addiction treatment program were almost twice as likely to give clean urine samples as teens given a placebo medication.⁴

Valerian Root

Valerian root can help with insomnia during the initial withdrawal phase.

Valerian root has been used as a sleeping aid for hundreds of years and it is endorsed by the American Academy of Family Physicians and recognized by the FDA as ‘Generally Safe’.⁵

As an adjunct to any OTC, prescription or herbal sleeping aid, you should also take steps to improve your sleep hygiene (avoiding stimulation before sleep, maintaining a regular sleep schedule, keeping your sleeping area clean and inviting, shutting off extra lights, avoiding caffeine etc.)

Experimental Marijuana Addiction Medications

The FDA has yet to approve any marijuana addiction treatment medications. However, it always makes sense to talk to your doctor about your medication options. Research continues and as the knowledge base increases, prescribing practices may change. As of April 2013, medications that show some promise as treatments include:

Oral THC

Taking small doses of synthetic THC, in a pill form, may help to reduce the severity of marijuana withdrawal symptoms. In laboratory and outpatient experiments, people given oral THC reported fewer/less severe withdrawal symptoms and no adverse effects. At higher doses, oral THC eliminated all withdrawal symptoms.⁶

Oral THC is currently available as dronabinol (Marinol), which is FDA approved for the treatment of AIDS related anorexia and weight loss and for chemotherapy related nausea and vomiting.⁷

The Canadian Society for Addiction Medicine recommends the short term use of dronabinol to help with withdrawal symptoms in early recovery.⁸

Buspirone

Buspirone is an anxiolytic (anti-anxiety) medication, similar to medications like benzodiazepines (valium, Xanax etc.).

Initial studies on buspirone show that people given buspirone as a part of a marijuana addiction treatment program experience fewer drug cravings and marijuana withdrawal symptoms.

When researchers compared buspirone to a placebo, they found that marijuana dependent subjects given buspirone had fewer failed urine tests and achieved a first cannabis-negative urine sample sooner than marijuana dependent subjects given a placebo medication.⁹

Buspirone is normally prescribed as a medication for anxiety. Though many anxiolytics, like benzodiazepines, have a high potential for abuse, there is no evidence that buspirone has any abuse potential.¹⁰

Lithium

There is some limited evidence that the bipolar mood stabilizer, Lithium, may work well to reduce the severity of marijuana withdrawal symptoms, without causing significant adverse reactions.¹¹

Zolpidem (Ambien)

People often have insomnia during the marijuana withdrawal phase. A study done on marijuana withdrawal insomnia revealed that people given zolpidem got more sleep and better REM sleep than subjects given a placebo medication. The subjects given zolpidem did not suffer next day cognitive impairments or other significant side effects.¹²

The Canadian Society for Addiction Medicine recommends that doctors prescribe zolpidem to patients looking to manage marijuana withdrawal insomnia.

Marijuana Addiction Treatment Facts and Stats

So, is it weird to get treatment for an addiction to marijuana?

Although some still argue against marijuana’s addictiveness, the volume of people seeking treatment for marijuana addiction argues strongly against this supposition.

• As of 2008, people seeking help for marijuana as a primary addiction accounted for 17% of admissions to publicly funded treatment programs. This is third only to alcohol at 40% and opiates at 20%¹³
• The average marijuana dependent treatment seeker used marijuana on a daily basis for more than 10 years.
• The average treatment seeker tries to quit marijuana without assistance 6 times before seeking professional help.
• People seeking marijuana addiction treatment are more likely than the general population to also have a co-occurring psychiatric disorder. In fact, people who smoke marijuana weekly or more are 7 times more likely than people from the general population to have a mental illness¹⁴
• Most people seeking marijuana addiction treatment also abuse other drugs or alcohol¹⁵