Friday, February 16, 2018

Alligator Fever

When reading the following story you may find yourself thinking “What does this have to do with substance use?” Or, perhaps if you have been around the treatment community for a while, you may find this updated old story strangely familiar. Either way, once you have completed reading the story below, follow the simple directions and then process its meaning as a group. Afterwards find out what the real meaning of the story is how it applies to the process of positive change.

Abby and Greg first met 3 years ago and a strong loving bond bloomed almost immediately. After 2 years of dating they became engaged and had set a date for marriage. Abby and Greg’s relationship was loving, faithful and true and as a result they were the envy of all of their friends because of how close and inseparable they appeared to be. They were in love and the future looked bright.

Then one day tragedy suddenly struck. Greg worked as an importer/exporter which on occasion required travel to some exotic places. While visiting an obscure country far, far away Greg contracted Alligator fever, an extremely rare disease that put its victims in to a deep coma-like sleep. Greg was quickly flown back to the US to meet with the best doctors but none could awaken Greg from his viral- induced state of comatose. Abby was desperate and refused to give up on Greg so she did extensive research and found a retired old doctor living overseas who was the only person in the world to have successfully ever brought anyone out of the slumber caused by Alligator fever by performing a simple but controversial surgical procedure. His name was Dr. Sinbad. Abby right away had Dr. Sinbad flown in to do a medical consultation about Greg’s desperate condition.

When Dr. Sinbad saw Abby he was immediately taken aback by her appearance. Abby was extremely beautiful and miraculously she was the spitting image Dr. Sinbad’s long lost love who had died over 30 years ago. Dr. Sinbad was very blunt with Abby. He told her that the controversial surgery was not covered by insurance and it cost over $250,000 to perform, however if she spent one night alone in a hotel with him, he would perform the procedure on Greg at no financial cost.

Abby was disgusted at Dr. Sinbad’s indecent proposal so she went off to find the money herself. Dr. Sinbad said she had 24 hours to think about it before he flew back to his home country leaving Greg in his current state of unconsciousness. Due to the time shortage, Abby went to the only person she could think of who could come up with that kind of money right away, and that was Greg’s brother Ivan. There was one catch however, Greg and Ivan hadn’t talked in years. It turned out that Abby had dated Ivan briefly prior to meeting Greg and when she met Greg it was love at first sight so she left Ivan for Greg three years ago. Ivan hadn’t spoken to either one of them since. Still, Abby turned to Ivan in desperation and she apologized for how things had turned out and for hurting him in the past. She begged Ivan for help. She pleaded with Ivan reminding him that Greg is family. Ivan, who was wealthy, had the money and at one time loved his brother Greg dearly, however he refused to help out Abby and Greg in spite of the seriousness of the situation with Greg his only brother. He couldn’t get beyond the past betrayal and rejection and left Abby to fend for herself.

Abby then felt like she had no choice. She reluctantly consented to Dr. Sinbad’s proposition so that Dr. Sinbad could save Greg’s life. Dr Sinbad kept his end of the bargain and the next day he successfully performed his controversial but effective surgery on Greg to cure him of the coma induced by Alligator fever. Greg woke up and Dr Sinbad then left and went back from where he came from.

When Greg awoke fully and came to his senses he was ecstatic and he and Abby were full of joy to be back together. They were again looking forward to their bright future together. However, not too long after, Greg started asking some questions and he soon discovered that his lifesaving medical procedure was very expensive and not covered by insurance. He pressed Abby to find out how she paid for everything with no money. Abby eventually admitted to Greg what had transpired with Dr. Sinbad as part of their “deal” to cover the cost of his treatment. Abby swore that everything she did was only motivated by her deep love for Greg. Immediately Greg was shocked, infuriated and outraged. He called Abby every hurtful name that he could think of and then he cancelled the engagement. Abby pleaded with Greg to try to get him to understand but he cast her aside with anger and disdain, insisting that she never speak with him ever again.

Abby fell into a deep depression. Abby turned to an old friend Gus for comfort. Gus had been Greg’s best friend for years which is why Abby went to him, thinking he would understand and perhaps he would be able to talk some sense to Greg. When Gus heard the story, he was sickened and he insisted that he and Abby go have a talk with Greg together which they then did. As soon as Gus saw Greg and witnessed his callous attitude he was overcome with anger and he attacked Greg with a baseball bat and beat him brutally, sending Greg back bruised, broken and unconscious to the hospital. Abby tried unsuccessfully to stop the attack but couldn’t. Afterward, however, inside herself she actually felt a little satisfied that Greg got his due for mercilessly rejecting her after all that she did and she even cracked a little smile as Greg was taken away in the ambulance.

Your assignment now is to rank all five characters in order from who you thought was the worst, to the one you though did the least wrong. The character you rate with a 1 is the worst in your opinion, 2- the second worst, 3 the third, and so on up to 5:

Abby              _____
Greg               _____
Dr. Sinbad      _____
Ivan                _____
Gus                 _____

Discuss your answers as a group and include your rationale for your choices

“If you are going to keep your mouth open,
make sure that you are thick-skinned” - Al Ligator


So the question remains: What’s the point of the story? The answer is that the story itself is not all that meaningful. There are really no right or wrong answers to the follow up discussion on who people thought the worst characters were. The goal of this story is to get people thinking about and then discussing VALUES

Values is a crucial topic that should never get old. What we think about, how we feel, and what we choose to do all starts with our own personal set of values – What is most important to us

Consider some of the commonly esteemed values that the Alligator Fever story touched upon:
             Family -
       Friendship -
       Faithfulness -
       Trust -
       Money -
       Health -
       Loyalty  -
       Respect –
       Love -
       Life -
       Other? -

So in essence, as you discussed the characters in the Alligator Fever story whom you barely even know, you were not judging them as individuals, but rather you were prioritizing which values stood out the most to you based on your own priorities.

Closing Exercise & Discussion

Go back through the list of values above and starting at the top with Family, go through each value one by one and complete the following sentence:

 “When it comes to (Value from the list – starting with Family) the kind of person I used to be when I was getting high was ______ (Describe). But today as I am changing for the better, my goal in this area is ______.”

Do this for each of the values above: Family, Friendship, Faithfulness, Trust, Money, Health, and so on – discussing your answers as a group

“Values are the definition of our actions in life” 
― Armin Houman

Additional Links for Counselors 
in Relation to this Topic (Values) - Click below to view:

Thursday, February 1, 2018

Group Glue: Cohesion, Motivation and Insight

Cohesion – n.; the action or fact of forming a united whole;
Synonyms: unity, togetherness, solidarity, bond, coherence

The concept of “the power of the group” is well known and well documented. Just about everyone is familiar with many of the wise sayings about the effectiveness of working together in groups such as:

“The whole is greater than the sum of its parts”

“If everyone is moving forward together, then success takes care of itself”
-Henry Ford

“Nothing truly valuable can be achieved except by the unselfish cooperation of many individuals”  
 - Albert Einstein

Specifically when it comes to substance use issues, the power of the group is quite evident as research has repeatedly shown that group support can be extremely valuable when dealing with an addiction.

In addition, by now you likely have discussed the power of insight and motivation as the key factors that inspire positive change. Insight involves being aware that a change is needed, and motivation obviously is the drive to make that change happen in a successful manner. When insight and motivation are working together, inspiration and positive progress are sure to follow.

How does being part of a cohesive group help with the critical process of developing insight and motivation?

One simple answer is based on just doing the math by comparing one person alone to a group of people together:
Consider the difference between just one person recommending that you change something when compared to a trusted group of people suggesting the same thing all together? – A group can help with insight building when there is a sense of trust and cohesion

Also consider the difference between one single person supporting and encouraging you in a positive manner when compared with a much larger group of people whom you trust doing the same – A group can be a force for motivation when there is cohesion and unity

Therefore a group can be very effective and powerful for building insight and motivation needed for positive change, provided there is a degree of group cohesion.

On the topic of cohesion, consider the following questions for group discussion:

What are some qualities (such as trust, honesty, etc.) that are important for there to be group cohesion?

What are some strengths and other positive attributes of this group when it comes to building group cohesion?

What are some things that this group may need to work on in order to be even better?

ALSO - For five new group activities - Go to:
(Scroll down to "Icebreakers and Group Cohesion Building" about 3/4 of the way down the page)

Wednesday, January 17, 2018

A Breakfast You Can Tolerate

This is a story about a factory. It’s not the best job in the world, but it’s not the worst job either. After several years, the factory starts to have some success and increases its profits. The owner of the factory decides to enhance worker morale by providing free plain bagels in the morning for breakfast. The factory workers are immediately pleased with the free bagels and it becomes a treat to look forward to every morning. The workers happily praise the factory owner for his kindness providing the delightful free bagel breakfast every work day.

After a few weeks since the bagel breakfast experiment is going so well, the factory begins to provide a variety of types of bagels for the factory workers including various flavored cream cheeses. The factory also provides coffee and juice for the factory workers free breakfast. The workers are even happier. Not much later, again since the breakfast program is working so well, the owner hires a part time breakfast cook to make eggs and bacon for deluxe bagel sandwiches. Soon, a variety of flavored gourmet coffee choices are offered as well. As expected, with each added improvement, the factory workers are more and more pleased with the free breakfast program and all of the positive changes.
After a while, the factory gets another huge contract which increases profits even more. Since the free breakfast program is going so well, the owner decides to provide a full breakfast buffet every morning with a full omelet station, as well as added choices of waffles, pancakes, sausage, bacon, fresh fruit, fried potatoes, hash browns, with many choices of drinks, flavored syrups and toppings. The factory workers are ecstatic with this amazing breakfast program which increases morale, attendance and gets workers to work early every day.

After several months at the factory however, things start to change. For one thing, the factory workers attitude declines. The free breakfast buffet was once viewed as a special luxury and treat but soon is viewed as a necessity and some less grateful workers begin to complain about various aspects of the buffet. Other factory workers start treating the breakfast buffet with less appreciation by wasting food and leaving a huge mess behind in the morning.
Around the same time, the factory’s profits start to dwindle due to problems in the economy and the breakfast buffet becomes too much too for the factory owner to afford. As a way to trim the budget the owner goes back to just providing basic bagels and coffee for the workers in the morning. The workers respond with the “Great Bagel Riot” in which several employees end up getting fired for throwing bagels in anger and protest. Some workers even quit in anger and they could be heard grumbling about the owners “cheap, lousy breakfast” as they walked off the job. The owner thinks to himself about how just a few months ago, everyone was so happy with the free bagels and coffee and how things had really changed for the worse rather quickly.
What is the moral of the story? It has nothing to do with breakfast. This story is an illustration of a common substance use related phenomenon of tolerance. Most people are quite familiar with tolerance:

Tolerance, n. – the power of enduring or resisting the action of a drug (Usually occurring over time with regular use)

Questions for Discussion:
Can you explain how the breakfast story illustrated tolerance? (Think about how it took more and more to get the effect desired by the owner) – How can you compare this with substance use?

How has tolerance come into play in your life particularly with substance use? (If you had a high tolerance, please explain without bragging about it)

How does tolerance play a role in the process of substance use progressing to substance dependence and then even possibly addiction in some cases?

Wednesday, January 3, 2018

To Control or Not to Control...Is that the Question?

For most people who have been around the topic of substance use, abuse and addiction, the topic of “control” surely is nothing new. Looking at some of the issues surrounding the topic of control is worthwhile. A lot of attention in the substance use and addiction world is focused on identifying those things in life that we cannot control. It is helpful to realize our limitations when it comes to control and it is also important to learn to take an objective look at evidence in our lives that suggests we are not in control of something (such as substance use, for example) This internal battle surrounding coming to a personal conclusion about control vs. loss of control and substance use is at the heart of any discussion on addiction. Each individual has to learn for themselves based on their own combination of experience, open-mindedness, and wisdom in this area. Someone else telling you that you are not in control of your substance use, for example, has far less of an impact than coming to that conclusion honestly on your own. That in part is one of the goals of substance use treatment programs: to assist individuals attending those programs to come to their own conclusion about substance use and control (or lack of control)
Nevertheless, to just blindly just look at life from the perspective that there is nothing at all that can be controlled can be misleading. To approach life as if we are a leaf floating aimlessly down a stream involves surrendering our power over the things in life that we can and should try to control. Even when it comes to things in life that we seemingly have absolutely no control of in life, it can be extremely helpful to shift our perspective to the aspect of that issue that we can choose to exert a positive influence over. This may sound confusing at first but consider some examples below for evaluation and discussion as a group:

We cannot control other people – Efforts to control others almost always end up in failed relationships and can feel much like banging your own head against the wall –

Still – How can we exert a positive influence over others today? Are there things we can do today to increase the likelihood that others will treat us with respect and trust? Can respect be earned? (Think about attitude for example) –

We cannot control the past -Yes it is true that the past is gone and there is nothing we can do to change it. What’s done is done, as the saying goes.

Still – How can we exert a positive influence over our lives today in spite of our past? Are there things we can do to leave the past in the past instead of dragging the past along with us each day in our present? How can time and positive behavior change help influence putting the past behind us? (Consider example a man who was violent for the first part of his whole life who one day changes and becomes peaceful. Is he making it easier to put his violent past farther behind him?)

We cannot control the fact that life often is not fair – Sadly bad things happen even to good people in this world in spite of our best efforts to prevent these types of things from happening. Accidents, injuries, misfortune, victimization, injustice, poor health, losses and many other unfortunate or even hurtful things can happen even when someone is doing the right thing and it just is not always fair.

Still – How can we exert a positive influence over our reaction to unfair life events? – For example, consider a horrifying accident causing a man to lose both of his legs. That man can spend the rest of his life bitter and angry over the struggles that came with the loss of his ability to walk, thus preventing that man from moving forward with his life until the day he dies. Or, that man can decide to become the best person he can be in spite of his unfair loss by learning to adapt and move on and look for opportunities he can find and goals he can achieve even still as a man without legs. In your situation, how can you move forward in a positive direction in spite of unfair or even hurtful life events that you have personally experienced?


Monday, December 4, 2017

Slices of Truth

The word “manipulative” gets thrown around a lot in the world of mental health and addiction. It can be very unfair to simply just label another person as “manipulative” as if it’s a black or white (yes or no) issue by saying that some people are completely manipulative while others aren’t manipulative at all. Rather, it makes a lot more sense to look at manipulation the same way as we view many other behaviors: as occurring along a spectrum with varying degrees depending upon circumstances, motives and overall intent.

One thing in common is that all of us want to get our needs met.  So if an individual is simply trying to get their needs met that is does not automatically qualify as a form of “manipulation” in the pejorative sense. What qualifies an action or behavior as manipulation is the tactics someone is willing to employ in order to get their needs met. Based on this perspective, if an individual is willing to use unfair or unethical means to get their needs me, then that would then fall under the umbrella of “manipulation” Still, when it comes to what is actually considered to be ethical and fair there can be a debate from one person to another so still there always may be some gray area when determining if a behavior is manipulative or not.  Nevertheless, there are some tactics for getting one’s needs met that are more clear-cut than others from an ethical perspective and therefore are tell-tale signs of manipulation. Let’s consider just one example – The manipulation of information to get one’s needs met in an unfair or unethical manner:

The Manipulation of Information: Twisting, altering, modifying, misrepresenting or selectively withholding information in a deliberate or deceptive manner in one’s own favor in order to elicit or evoke one of the following:
  • To confuse or create a diversion from the truth
  • To elicit strong emotion in others in order to trigger a desired behavior from them
  • To cleverly appear to be a victim to evoke sympathy and assistance from others
  • To make others feel guilt or shame so that they will alter their behavior in a manner that is favorable to one's own insincere motives
  • To delude or mislead others to accept an unfair deal or agreement

Questions for discussion:

How have you been a victim of any of these examples of manipulation? – When describing, try to include how you felt (Try to use feeling words)

Self-searching – Have you ever used any of these tactics? (Group should refrain from passing judgement as just about everyone has been manipulative at one time or another in life)

For a more complete and in-depth group activity focused on manipulation and getting one's needs met - Click here to view (Printable format for group)

Thursday, November 2, 2017

Planning for Inspiration

Most people are familiar with what it is like to start a campfire. If you ever started a campfire yourself, it unlikely that you just aimlessly grabbed some twigs then lit them on fire impulsively, without much thinking or planning. If someone were to lite a fire that way without firewood it is likely that the newly started fire would soon go out due to lack of fuel. Instead, reasonably speaking, when one wants to start a campfire, first he must gather a good amount of twigs, kindling, sticks and finally logs to not only start the fire but then keep it going strong.

Inspiration is just like that campfire. If we don’t plan ahead to keep the fire burning then it can easily go out as quickly as it started. Almost everyone is familiar with this fast burning fire phenomenon. An example would be suddenly getting inspired to lose weight then going to the gym for 2 hours the first few days but quickly stopping when the pain of the workout sets in and the motivation begins to fade. Similarly, the vast majority of people who quit smoking can tell many stories of dozens of quit attempts that fizzled as quickly as they started

Therefore, “inspiration planning” is a key process when it comes to building then sustaining motivation for positive change. As important as it is to become inspired at the start of a change attempt, keeping that inspiration “burning” can often be even more important. Below is a checklist with some key aspects of inspiration planning (or planning ahead to sustain insight and motivation on a long term basis.) Review the following list and check any areas that you feel that you may need to work on. Also, underline at least one area of strength. Discuss this as a group

Maintaining Insight – There are two things to remember when it       comes to preserving insight
  1. Remembering what you have learned from your own experiences and then not forgetting
  2. Awareness of when you may lie or trick yourself with harmful thoughts such as “I’ll quit tomorrow

Establishing External Motivation – This has three key components:
  1. Remembering consequences in a way that will help you stay on the right path 
  2. Incentives – Staying aware of the rewards and benefits of staying the course and making changes
  3. Support- Having people around who can help and encourage you, especially in times of struggle

Sustaining Internal Motivation – Three key factors that can help energize an internal drive for change are:
  1. Values – Continuously working toward prioritizing what is important even when the most valued path isn’t necessarily the easiest or quickest way to relieve stress, struggle or pain
  2. Hope – Keeping a sincere desire for a better life, alive as a reality in your heart and mind
  3. Courage – Having the strength not to give up even when things are fearful, difficult, strenuous or uncomfortable

For a printable format of this information click here

Better: For an extended group exercise based on this information click here

Additional group therapy activity for internal motivation building - click

Monday, October 2, 2017

Three Paths: An Effective Way to Answer the “Is Marijuana a Gateway Drug” Question

“Is marijuana a gateway drug?” – Any substance abuse counselor at this point is probably sick of hearing that redundant and often misleading question. The following explanation is time-tested, reasonable and easy to understand for just about everyone. See for yourself:
First, just in case there is anyone out there who doesn’t understand the question: “Is marijuana a gateway drug?” – Here is clarification of what that question means, starting with the definition:
Gateway - allowing entry, access, or progress to a more extreme form: gateway drug,
Therefore, viewing marijuana as a “gateway drug” would indicate that a person who starts using marijuana first will eventually end up using “harder” (more severe and dangerous) drugs at some point (such as cocaine, benzos, heroin, etc.)

The “Three Paths” Explanation to the Gateway Drug Discussion
First of all, one major mistake that many people make when discussing whether or not marijuana is a gateway drug is by looking at the discussion as if it is a “black or white” (Yes or No) issue. To look at only the two foremost extremes of the issue, by saying that marijuana either definitively is or is not a gateway drug, ignores a lot of the “middle ground”. The “Three Paths” answer to the marijuana gateway question is not as limited or polarizing as simply saying it is or is not a gateway, and it is a much more comprehensive and conceivable way to view this issue, than simply answering the question ”yes” or “no”.
The Three Paths Explained: The fact is that there is usually one of three eventual outcomes when someone starts using marijuana regularly at an early age. (Hence there are three paths one will go down when starting to use marijuana in one’s youth)
Path 1“The Phase”  - Some individuals use marijuana for a time period starting some time in their youth, perhaps then using for many years afterward but then they eventually just stop on their own. Marijuana use in this case was just a phase that started and one day and then ended after the passage of time. This is often due to some form advancement in maturity or increased levels of responsibility or an individual may just simply grow tired of smoking weed and therefore stop. For example, there are many people who smoked weed in high school, college and perhaps into their 20’s or even 30’s who end up just giving it up on their own one day with little or no struggle. Circumstances such as having children, or career advancement can play a role and at other times some people simply “grow out of it” when it comes to their desire to smoke marijuana later in life. Many people reading this article right now can identify with this category or path which in itself contradicts the gateway concept.
Path 2 – “The Lifetime User” – Within this path there are a wide variety of potential variables. The person who ends up on this path uses marijuana on some level for the rest of their lives deep into adulthood and at times beyond. Some of the individuals in this category smoke marijuana to a level that inhibits their full potential to some degree and there may even be some regrettable consequences. However, others in this category may use marijuana and still end up leading what would be considered to be a productive and in some cases even successful lives with no visible or noticeable consequences associated with their marijuana use. The common thread amongst people on this path is that the marijuana use is continued, but it never really leads to any sustained use of harder drugs. In other words, the person on this path never becomes addicted to a more dangerous drug such as heroin in spite of ongoing long term marijuana use. This path too, defies the marijuana-gateway concept. Nowadays, many people may know someone whose life course followed this path.
Path 3 –“The Gateway” – Although the first two paths spurn the gateway theory, this path legitimizes and validates the idea of marijuana as an actual gateway substance. There are those individuals who start at first using marijuana who one day develop some form of lasting dependency and prolonged tolerance. In this case, marijuana eventually may no longer suit its “purpose” thus prompting a person on this path to try other drugs to get the desired level of “high” as marijuana alone over time may no longer do the trick. The individuals on this gateway path therefore often end up addicted to harder drugs such as heroin. Some kids start using marijuana in high school at age 15 or 16 then may use for years, perhaps even for a decade into their 20’s but eventually find themselves sticking a needle in their arm or using some other drugs at some later point in life. The many, many heroin and other “hard” drug users out there who first started with marijuana but then progressed on more severe drugs validate the impossible to ignore reality that this third gateway path does exist for some unfortunate individuals.  Many individuals with more serious addictive issues will testify to this process occurring in their own lives. (E.g. The heroin dependent individual who testifies to the fact that “it all started with weed”)
So what does all of this mean? Is marijuana a gateway drug or not? Clearly, based on the three paths explanation, the correct and rational answer to the marijuana gateway question is that marijuana can be a gateway to other drugs. It’s not that it is or isn’t a gateway drug but that there is the possibility for some people who use marijuana to progress to harder drugs. The gateway phenomenon happens to some people however it does not happen to many others. Some people who use marijuana progress to a more serious level and some do not. Most people would agree that this is a rational and logical explanation to this “debate”. However, this discussion does not end here. There is one more key factor to consider in the three paths explanation: The role of choice.
Finally, Examining the Role of “Choice” in this Gateway Discussion
A young person who is smoking marijuana who hears the three paths explanation to the gateway idea will likely say something like, “I’ll smoke weed now but when I get older I’ll just stop on my own, no problem”  (Choice: Path 1) Or they may say something like “This sounds good to me, I’ll just be one of those successful marijuana users and continue to smoke weed without any consequences and live happily ever after” (Choice: Path 2)  It only makes sense that a young person smoking marijuana would reason this way because few people ever ahead of time envision an eventual  life of suffering with serious and chronically progressive drug addiction. For example, what young marijuana user has ever said anything such as: ““I am just smoking weed right now but one day I eventually see myself moving on to a painful life of heroin addiction!”   (Choice? Path 3). No chooses to live a life of hard core drug addiction.  No one starts using marijuana with the plan that it is going to be a springboard into something worse. In fact it is very common for a young adult who is dependent on heroin to look back on their youth of marijuana use and say “I never saw this coming”.

The truth is that there are many factors that can contribute to an increased likelihood of addiction including genetic predisposition, various psychological and emotional factors, age of onset, trauma history and many other factors which can be beyond an individual’s full control. These factors in combination often play a much larger role with regard to which one of the three paths one follows, as opposed to just choice alone dictating the answer. If the path an individual followed was only dependent upon choosing wisely then very few people would become addicted to drugs like heroin and crack, starting from marijuana, because few if any people would ever deliberately choose that painful path. So the conclusion to the marijuana gateway discussion in short is that there are three paths one can take when using marijuana, however not everyone gets to choose the outcome. 
Key Points:
Ø  Thankfully, most people who smoke marijuana never move on to becoming addicted to harder drugs.
Ø  However, some marijuana smokers, in spite of their best intentions, will in fact become addicted to more severe drugs at some point sooner or later.
Ø  There are many factors that can play a role with regard to the marijuana gateway drug phenomenon including genetics, trauma, family, social and emotional factors, therefore choice alone does not determine the outcome. (A young person simply saying “I will never move on to harder drugs” by itself not enough to prevent that from occurring)