The Parable of the Poisoned Arrow

Whoever coined the phrase, “there are no stupid questions”, probably never interacted with a Zen Master.  I say this because I was recently involved in an interchange with a Zen teacher that, in retrospect, should have resulted in my receiving a hearty whack from him with an awakening stick.  As usual, after his dharma talk, he opened the floor for questions, and I asked him about the purpose of the ego – specifically, “if it is so problematic, why is it the norm instead of enlightenment?”

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Treating Men with Co-Occurring PTSD and SUD

The co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is of increasing concern to treatment professionals. Estimates of PTSD prevalence rates among persons presenting for substance abuse treatment range from 35 to 50% (Boden et al., 2012). This is clinically significant because persons who present with co-occurring PTSD and SUD exhibit high symptom severity in both disorders and worse treatment outcomes, including higher relapse rates, than those with only one of the conditions (van Dam, Vedel, Ehring, & Emmelkamp, 2012).

KindesmisshandlungFurthermore, men experience lifetime rates of trauma which are significantly higher than that experienced by women (60.7% as compared to 51.2%) (Najavits, Schmitz, Gotthardt, & Weiss, 2005). Studies have shown that men with PTSD are at greater risk to develop SUD with lifetime rates of alcohol use disorder estimated at 51.9% and other substance use disorders at 34.5% (Najavits et al., 2005). Given these numbers, evaluating which approaches are most effective in treating men with co-occurring PTSD and SUD is of paramount importance. As such, the purpose of this article shall be to address the following effectiveness-based question through survey of the research literature: For men who present with co-occurring PTSD and SUD, what interventions are most effective in improving treatment outcomes by reducing symptoms of both disorders.

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Assessment Protocols for Adults with Substance Use Disorders

According the Substance Abuse and Mental Health Services Administration (2013), an estimated 23.9 million Americans are current illicit drug users. These numbers raise serious concerns given the devastating consequences of addiction borne by individuals, families, communities and society as a whole. Furthermore, The National Institute on Drug Abuse (2012) estimates that addiction costs the nation in excess of $600 billion annually. Given this, it is important to evaluate instruments and measures utilized by treatment professionals to assess and diagnose substance use disorders. The purpose of this paper shall be to undertake such an evaluation of two widely used assessment protocols – the Substance Abuse Subtle Screening Inventory (SASSI) and the Addiction Severity Index (ASI) – by appraising the reliability, validity, feasibility, accessibility, and overall appropriateness of these measures in screening and assessing adults with substance use disorders.

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The Case for the Decriminalization of Drugs

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Abstract

The United States incarcerates more of its citizens than any other country in the world.  Of those incarcerated, a shockingly disproportionate number are Black men.  Section I of this analysis explores how United States drug policy has evolved as a means to exercise racial control by mass incarceration under the guise of the so-called “war on drugs”.  The problem is explored from various ideological perspectives and within the ethical frameworks from which drug policy has developed.  Who gains and who loses from current policy is discussed as a means to understand how the policy persists.  Historical and symbolic racism are offered as root causes of the social problem.  In Section II of this analysis, current trends in drug policy are explored with particular emphasis on drug decriminalization and legalization.  Drug policy reforms in Portugal, Colorado, Washington, and Seattle, including use of harm reduction strategies, are offered as possible frameworks for social advocacy and reform.  A shift away from a criminal justice paradigm and towards a model of public health in drug policy is recommended.

(This article was completed in April 2014 and submitted by the Site Administrator in partial fulfillment of the Master of Science in Social Work at the Kent School of Social Work, University of Louisville)

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Exercise and Relapse Prevention

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Some researchers have stressed the importance of helping individuals in early recovery to develop “positive addictions” such as increased physical activity and/or meditation.  And even though lifestyle modification is one of the main components of Marlatt’s relapse prevention model, this element has received the least attention in substance abuse treatment programs.  Nevertheless, engaging in regular exercise provides a number of potential benefits including allowing individuals to experience positive mood states without the use of drugs; helping to reduce depressive symptoms which have been tied to risk of relapse; improving sleep and cognitive functioning (each of which have been identified as being disrupted in early recovery and predictive of relapse); and increasing self-efficacy while decreasing stress-reactivity.

The following presentation describes the results of a single subject design research project undertaken by the Site Administrator investigating the impact of aerobic exercise on perceived stress.  It was recorded by the Site Administrator in March 2014 in partial fulfillment of the Masters of Science in Social Work degree at the University of Louisville.

Mindfulness Meditation and Substance Use Disorders

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A Systematic Review of Literature

(This systematic review of the literature was written in March 2014 by the Site Administrator in partial fulfillment of the Masters of Science in Social Work at the University of Louisville)

In 2010, between 153 million and 300 million people aged 15-64 worldwide used an illicit substance at least once in the previous year (UNODC, 2012).  According to the Substance Abuse and Mental Health Services Administration (2013), in America alone, an estimated 23.9 million persons age 12 and older are current illicit drug users.  Of these, an estimated 22.2 million persons aged 12 and older were classified with substance dependence or abuse in the past year (SAMHSA, 2013).  These numbers raise serious concerns because addiction has far reaching health and social consequences.  It is estimated that there were between 99,000 and 253,000 deaths globally in 2010 as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma (such as vehicle accidents) (UNODC, 2012).  Additionally, drug abuse leads to maladaptive behaviors that interfere with the individual’s ability to function normally in the family, at work, and in the community at a cost to the nation in excess of $600 billion annually (National Institute on Drug Abuse, 2012).  Given the prevalence of addiction in the population and the toll it takes on individuals and society, the development of effective treatment interventions is of utmost importance.

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Stepping Out of Automatic Pilot

airplane-taking-offI have come to view the years I spent in active addiction as my having been trapped in state of perpetual unconsciousness.  That is not to say there was no mental or emotional activity.  On the contrary, whether I was getting high or not, my mind raced incessantly and my emotions swung to extremes.  I say that I was unconscious because all of this mental and emotional activity occurred without much if any apparent effort on my part as if it all were happening automatically.  I have since learned that these reactive patterns were conditioned in me from a very young age and were likely reinforced by both genetic and other biological factors.  Initially, alcohol and drugs soothed the perpetual state of anxiety (or, dissatisfaction, discontent, dis-ease, or dukkha, if you will) which pervaded my existence.  However, these powerful chemicals ultimately turned on me as they acted upon vulnerable reward, memory, and motivation circuitry in my brain to ensure that I would fall into the vicious downward spiral of addiction.  Thus the trap of addiction is complex and composed of myriad personal and environmental risk factors which conspire to form the trance of automaticity.  And so, for me the process of recovery has essentially entailed an awakening to the causes and conditions of these automatic reactive patterns.  More importantly, it has also been about learning to step out of and interrupt these patterns through cultivation of mindfulness.

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Re-thinking the War on Drugs

war_on_drugs2-2cba2Substance abuse and drug trafficking are unquestionably major social concerns that merit the attention of government.  Unfortunately, U.S. drug and crime policies have emerged which are grossly ineffective in terms of reducing demand.  Still worse, these same policies which were born out of animus for minority groups and immigrants, have wrought disastrous consequences for individuals, families, and communities by establishing a system of mass incarceration that has laid waste to the promises of freedom and liberty enshrined in our Constitution.  After briefly reviewing the history of the so-called “war on drugs” and considering its substantial ongoing costs to society, it will be clear that immediate action along the lines of policy overhaul and redressing individual harms is necessary.  Ultimately, the social work profession is required as a matter of professional core values and ethics to lead the way of reform and rehabilitation.

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Step 12: A Spiritual Awakening

Step 12:  Having had a spiritual awakening as the result of these steps, we tried to carry this message to addicts and to practice these principles in all our affairs.

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The promise of the 12th step is that by the time we have reached this point in our program of recovery, we will have experienced a “spiritual awakening”.  Exactly what that means and what that entails will certainly vary from person to person.  However, the Big Book of Alcoholics Anonymous characterizes it as a “personality change sufficient to bring about recovery”.  Thus the essence of a “spiritual awakening”  for anyone is marked by a shift in attitude — or as Dr. Silkworth put it, “an entire psychic change” — brought about by working the preceding eleven steps and then implementing the foundational principles associated with each of them in one’s life.

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