Case Management or Coaching? Start with Caring and Concern

By David H. Kerr                           

What may be missing in our system of help for people with addiction?

Here’s today’s equation:

degrees + certification = qualified to help a person with addiction. 

What's wrong with this equation?  Do we also measure caring or concern or understanding in our pursuit of quality and excellence?  Is addiction now a brain disease to be fixed by assessment, labeling (character disorder, socially maladjusted, co-occurring etc.), and prolonged medication, counseling and “case management?”  Should people be referred to as “cases?”  We used to call someone “a mental case” and I’m hoping that we’ve grown out of this phrase.  I suggest that we replace the cold phrase “case management” with a phrase like “soul coaching” or just plain “coaching.”  We’re working with people and their very lives are often at stake.  Let’s call them people or “souls” rather than cases as in a case of beer.   

Real caring though often needs a balance of confrontation when the truth of a person’s statement is suspect.  My standard approach to a person seeking my help:  “I can do nothing for you if you are not willing to help yourself i.e. you must be your own counselor.”  My next question is “so what have you done so far?”  “You have to learn to play the game of life, clean and sober.  If you understand this then I will be your “coach” and mentor, not your “counselor.”  Understand this as stated in the words of the great philosopher O. Hobart Mowrer, “you alone must do it but you can’t do it alone.”  You should understand that recovery is a lifestyle and its process will take time and dedication every day for the rest of your life to ‘become you – your best self’.  Do you understand this?” 

Addicts are not helpless and if you think they are, look at the ingenuity they need to have to maintain a $300/day habit.  While used on the “streets” for bad purposes, this trait can be put to good use as part of their new clean and sober lifestyle.

I want to talk today about the way to work with a person suffering from addiction. It's really not all that complicated.  Before getting to that let's look at the system of health care in place right now.  First a person wanting to help a person with addiction must have a master's degree in a related field.  Usually this means a degree in social work or a master's-level in counseling or PhD in Psychology.  You get the idea. Then after the degree is attained you must become certified.  In New Jersey this means obtaining CADC (Certified Alcohol and Drug Counselor) followed by LCADC or Licensed CADC. With this and possibly no experience, you are ready to hang out the proverbial shingle and help someone suffering from drug addiction.

There is nothing wrong with degrees & certification and it’s laudable if not sometimes a challenge with the cost of higher education, to obtain this level of credential.  Most addicts in recovery have accumulated much debt and the tens of thousands of dollars for further education would make certification prohibitive.  It took me five years to obtain my MA since I was then, 1968, living with active addicts in Lincoln Park, Newark several months after the Newark rebellion and race riots in the summer of 1967.  During this time, I learned the hard way that my kindness was seen as weakness and I was mugged at knifepoint and gunpoint six times and lost all of my money.  My co-founder and cousin, Rich Grossklaus was mugged as well over 12 times and nearly lost his life on one occasion.  But in my experience in the field since 1965, I have clearly seen something else that is most effective in helping a person with addiction.  It’s so obvious that it’s sometimes neglected.

Far more important than a degree are the following traits: understanding, caring and concern.  Addexperience and common sense to these traits and the person with addiction will feel your help and will likely listen to you.  If you put these three traits + experience and common sense on one side of the scale and degrees and certification on the other side, the understanding, caring, concern and experience will tip the scales dramatically, far out weighing the degrees and certification.  Yet, what measures do we have for these essential traits?  One of the reasons that many if not most recovering addicts are successful in helping people is that they have much experience in the field and offer much compassion and understanding as well. They see themselves in the face of the person sitting in front of them looking for help and guidance. That person looking for help feels their concern, understanding and knowledge, expressed with sincerity and true caring.  Many of these people, often with no degrees, are highly capable and competent and have at least equal skills to help recovering people when compared to the graduate with an MA or MSW.  Why not allow them to present their knowledge to the certification board and qualify them with LCADC status based on their experience, knowledge and a recommendation from a qualified experienced professional?

Here is my formal suggestion to the Certification Board: 

Offer an equivalent recognition to the LCADC for a person in recovery and urine tested clean and sober for 10 years.  A person who’s coaching and advice to addicts has been monitored and guided by a counselor with an LCADC, for ten or more years.

In this way, we would bring back into the field competent and caring outstanding experienced role models in recovery.  These are the very people who have stood tall in the face of great personal loss and have come back to dedicate their lives and effectively help others like themselves.     

This spirit of caring is the same motivation that recently caused a perfect stranger, with no mental health credentials, to help another person avoid taking his own life by way of jumping off a bridge.  These two men are now friends as seen in the article below published in the Washington Post, May 8, 2017.  Please read the powerful true story below!  This same story has worked with addicts and alcoholics who are helped to stay on the road to recovery by the caring of another human being, often a perfect stranger.  In AA they call this person a “sponsor;” a sponsor to the one trying to change his/her lifestyle of steady personal destruction that often leads to overdose, liver disease, loss of family and friends and early death. 

Today we have begun to use the word “coach” which I believe is a better and more accurate term to describe the self-help process of regaining self-respect, self-esteem, family and friends and finally, long term recovery.

*******

Here’s the article from the Washington Post:

MENTAL HEALTH

The simple words from this stranger convinced a suicidal man to keep living

May 8, 2017, the Washington Post

https://www.washingtonpost.com/news/inspired-life/wp/2017/05/08/the-unlikely-friendship-between-two-strangers-after-one-saved-the-other-from-taking-his-own-life/?utm_term=.3da29379c380

Colby Itkowitz Washington Post

Meanwhile, the beat goes on….

NEWARK

Police make 27 drug arrests, seize guns over the weekend

Steve Strunsky For The Star-Ledger May 16, 2017

Police made 27 drug arrests in Newark over the weekend as part of crackdown in response to residents’ complaints, the city’s public safety director announced Monday.

The director, Anthony F. Ambrose, said that in addition to the arrests, police also recovered three firearms, 787 bags of heroin, 109 vials or bags of cocaine, 40 bags of marijuana and $4,694 in cash. The street value of the drugs totaled $11,120, Ambrose said.

“We are pleased to announce that this operation, which came about as a result of reports from concerned citizens, is producing tangible results that reduce crime,” Ambrose said in a statement.

On Saturday, Ambrose said, officers arrested Stephone Cook, 45, of Newark, on weapons and drug possession charges after stopping a vehicle at Nye Avenue and Clinton Place, based on an outstanding warrant, and then smelled marijuana and spotted a .45 caliber handgun inside the vehicle.

Siddiq Hooper, 38, and Paris J. Armwood, 21, both of Newark, were arrested on similar charges Sunday, Ambrose said, after they fled from police responding to a report of suspicious activity near Chelsea and Tremont avenues.

The two dozen people arrested on drug charges were from Newark, Belleville, East Orange, Nutley and Hamburg, Ambrose said. The tally was for arrests and seizures between Friday and Sunday, Ambrose said.

Steve Strunsky, NJ Advance Media,

The Legend of GM2C David A. Purcell and His Purple Heart

A Sad Yet Still Heartwarming Story From World War II

By JIM PURCELL

I call this the 'legend' of my uncle, David A. Purcell (1925-1944), because it has only been a story handed down to me, since I was born in 1966 and never met him. But, I thought it was a tale worth writing down someplace that would be around for a long time, and this website will be around for a very long time.

According to my mother, the late Ruth Purcell, she attended a memorial service for my Uncle David that was held in early 1945, in Newark, New Jersey. It commemorated the brief life of her fiancee's brother. Of course, my Mom's fiancee was my father, James, Sr., who was still fighting the war in Europe at the time in the United States Army.

My mother attended the memorial service with my father's Mom, Grace Purcell, who was the widowed mother of the Purcell family, in Newark, which included my Dad, my Uncle Charles, Uncle David, Aunt Marie (Rizzolo) and Aunt Susan (DiEdwardo). My Uncle David was the youngest of the family and was, according to both his sisters and my mother, the life of the party. He was a frequent joke-teller who, according to my favorite aunt, Aunt Susan, worked very hard "...at trying to get every girl in Newark to fall in love with him and not being serious about anything."

U.S. Navy landing craft bringing troops ashore during Anzio

According to my aunts, one thing that everyone in their family had was love of the country that accepted them. My family were Irish immigrants, and they came to this country with an open heart. This was true of all of the Purcell children. "This was our country, and we loved it. We respected our Irish roots, but were always American first and damn proud of that," my Aunt Marie once said.

I once had a photo of my uncle, sadly that photo was the one printed in the Newark Star-Ledger reporting that he was listed as missing following the Battle of Anzio (January 22, 1944). Somewhere along the way in the past 30 or so years since I received it, I lost the press clipping. It was a black and white picture of David, who was a handsome youth in his blue Navy uniform. He was fit and had my father's look to him and, according to everyone who knew him, he had black hair and blue eyes (much like my own brother, also named David).

At the time of the memorial, David had previously been listed as missing in action for a year. Following that year, at that time, service members were assumed killed in action if that absence occurred during a battle, particularly one at sea. So, the family paid what respects it could to a child and sibling who did not have a body sent home.

Why had David joined the Navy in the first place? He was young enough to wait to get drafted. He didn't have to volunteer, my mother once said. But, my Aunt Susan informed her one year, during Thanksgiving 1973: "Because he had to do something to defend his country and he couldn't stay at home... was the way he saw it...and he loved the sea." People from Newark don't mince words, not now and maybe not ever. Mom got that, a tear in her eye, and nodded.

David was a gunner's mate second class, according to U.S. Navy records. The American Battle Monuments Commission reports his name and rank, the date he went missing, and the cemetery in Italy where he is buried only. The rest of the story will be filled in from conversations I have heard and was a part of about David. However, I am re-telling the story as I remember it. And, this is one story that I have not forgotten over the years.

So, my Mom is standing next to my grandmother at the church (I think she said it was St. Rose), and my grandmother was finally letting the tears come. My grandmother was a big woman, who worked very hard to stay off welfare mopping floors and cleaning offices after my grandfather, David, died in the late 1920s-early 1930s. She kept her family together through the Great Depression and each of her children worked at small jobs to help the family as well, no matter how little money they brought home. They did after-school or before-school work, but everyone worked. It was "family first." And, it was an achievement for a household that size to stay together during the Depression, but the Purcells had and were darn proud of it.

David's friends were at the memorial, accompanied by their girlfriends. So were some of my uncle's teachers from high school, where he was a member of the track team (like my Dad had been before he transferred to St. Benedict's as a sophomore). My grandmother and mother were in the back of the church. Mom said it was a beautiful day, and the light coming through one of the windows of the sanctuary shone on David's picture and gave it a very nice look.

As my grandmother was in her grief, my mother noticed as a few young ladies, unaccompanied, were in the pews crying nearly as hard as my grandmother. Then, one or two more such young ladies came in, and finally one or two more. My grandmother started to notice as one or two more young, grieving ladies came into the sanctuary. My mother said my Gram stopped crying and offered a wide smile before the first fight broke out closer to the front of the sanctuary.

Two of the young ladies began to scuffle not far from my uncle's picture, followed by some more, who become incensed and began to argue. My mother had no idea what was happening. She stayed at my Gram's side, but there was a change in my father's mother. With her eyes wet with tears she was smiling broadly...and began to laugh.

There was no attempt by my Gram to break up the fight, which mystified my mother. Apparently, my uncle, before he had shipped out, had promised to marry several young ladies in Newark before he went off to serve in the Navy. Accordingly, several young ladies began to argue with each other at his memorial. Mom said my Gram told her, wiping her eyes, "If David hadn't have been killed in Italy, he might damn well have been killed here by jealous boyfriends and angry fathers." The two laughed a little. My grandmother lingered on the large photo of her fallen son, and quietly left the sanctuary.

According to both my aunts Sue and Marie, it was not enough for anyone in the family that the U.S. Navy sent a Purple Heart and no body home. So, my aunts traveled, after the war, to Italy and Anzio. They discovered every fact they could find about my uncle's passing, and at one point were given names of U.S. Navy officers that served with my uncle at the time of his death (no letter from the chain of command ever, reportedly, was received by any member of my family). So, after going to Italy and finding out there was no body for their brother anywhere, they proceeded to find the officers, whose names they were made aware of by the Navy.

According to my aunts, my Uncle David was killed while he was ferrying U.S. Army soldiers from ship to shore aboard a landing craft. My aunts said my uncle's chain-of-command informed them that they were, for whatever reasons, running short on personnel to guide landing crafts from ship to shore. So, David had to make multiple trips. According to my aunts, this was not a common thing for sailors. But, it was what it was. So, on his second trip ashore, while approaching the beach, David's landing craft was struck by enemy indirect fire. He delivered his charges ashore and was heading back to his ship (which ship it was I have found no records of) and his landing craft was struck again, creating a fireball and sinking the landing craft.

My father and his family were never the same. According to my Aunt Sue, "He was our light. And, when he died, that light went out." Still, despite creating some mess at his memorial service, David at least left my grandmother with a smile to remember him by that day.

UPDATE: After further research, I discovered that Uncle David served on LCI 32. He was killed in action during World War II along with fellow shipmates: George L. Marsh, Dilbert B. Mallams, Earl W. Rubens, Olindo P. Martelle, Jack Elkins, Thomas J. Brown, Paul L. Nardilla, William L. Nisbit, Charles W. Seavey, John F. Guethloin, Robert H. Jackson, Warren B. Johnson, Eugene L. Sales, Herbert Starke, George A. Cabana, John W. Finch, Charles J. Gilbride, Ralph Harding, John E. Campbell, Lawrence M. Kennedy, Hamp L. Richardson and Ralph DiMeola. For the historical registry, please click HERE and go to PAGE 25 of The 1091 Flagship of the USS LCI National Association, Issue #62, dated January, 2008.

Further Update: Gunner's Mate Second Class David Purcell is listed among the dead and missing from LCI 32, which was sunk of Anzio, Italy on January 26, 1944 by a mine in ELSIEITEM. For more information, CLICK HERE.

Misdirected Help?

We often offer Help To and For people in need, 

but what we should do is to offer help With those in need.

This approach works especially well with addicts and others whose goal is to build self-esteem and self-worth

By David H. Kerr               

Many people and agencies have been providing services to and for addicts, inmates and/or those with mental health issues, and this includes those with all of these issues combined.  In fact, when an issue is found, a label will be pronounced and this is in line with the psychoanalytic approach and a way to secure funding to help “a client.”  In my experience, this is exactly the wrong approach for many, but especially for addicts who must learn to take charge of their life, their families and their recovery.  They need to be encouraged to know their own strengths, even their greatness as well as the contribution that they can and will make not only to themselves but to others, i.e. their family and the community.  You might call this inspirational help and coaching.

In my experience, it is better to learn how to offer help with those in need than to those in need.  It is simple if you can truly care for the person whom we inappropriately call “client[1].”  This doesn’t mean babbling sympathy but some empathy, concern and understanding is critical.  Also, our present approach is often to fire many questions at a person coming for help, so that we can put together an appropriate (fundable) state &/or insurance approved "Initial Assessment," complete with an approved label - i.e. "emotionally disturbed" or "addicted with co-occurring issues," etc., etc.  Also, be very aware of the temptation to prescribe help via drugs.  I recommend working for six months with a person with addiction before offering a prescription even for drugs like suboxone.  In many cases, this dulls the interest by the person with addiction in making any substantive personal change, and with those addicted, a substantial personal change is usually essential.

We shouldn’t be throwing help at a client.  Rather we should be drawing strengths and direction from the person asking for help.  We should be creating an equal or one to one relationship with a person so that information is shared with, not dumped on the person in need of help, guidance and direction.  All of this information must come from the person with addiction.  We help a person by developing a relationship; by demonstrating caring; by coaching and by encouraging and promoting what he/she has that is positive.  Self-esteem and self-worth should be the goal.  The “what can you do and what have you done to help yourself” approach is most effective with addictsand also with the co-occurring recovering people with whom I have worked.  No inflicted labels but rather a caring, guided and sometimes necessarily confrontive[2] approach that puts you in the role of friend and coach rather than counselor.  More importantly, it allows them to better understand the role they must take in their own self-improvement.  Remember that addicts are not helpless or stupid.  In fact national tests show them to have above average intelligence[3].

Work together with the person with addiction showing empathy, not sympathy.  Promote truth in your relationship, and encourage self-learning and self-worth.  Recovery is a long road, and treatment, engagement and coaching will help the person with addiction learn to climb and feel more secure, especially during the first five years of lifestyle change.

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[1] I do not like the names (labels) we call people with addiction.  Use their first names instead.  Talk to the person with addiction as a friend/colleague and reason with him/her in normal conversation.  You’re not there to do for him what he must do for himself.

[2] People with the disease of addiction have often had to learn to “stretch the truth” or to flat out lie to receive your money for their drugs.  Criminal addicts have perfected “the language of the lie,” often to the point of believing their lies as truth.

[3] {http://www.cnsproductions.com/drugeducationblog/dr-darryl-inaba/1198}

INTELLIGENCE AND ITS RELATION TO ADDICTION

Posted on November 28, 2011

“A new longitudinal study into the relationship between measured levels of intelligence, and addiction shows a marked tendency toward more addiction behavior among those with higher IQs -- twice as much for men, and a three times greater likelihood among women. Also a look at new research on brain physiology and its relation to pain.”

Call Us: (800) 888-0617  CNS Productions inc a leader in drug education since 1980.   Paul J. Steinbroner was born March 18, 1949 in Los Angeles. In 1983, he founded CNS Productions, a publishing and distribution company specializing in topics related to addiction, neuropharmacology, and brain chemistry. He is the publisher of Uppers, Downers, All Arounders, a textbook on theneurochemistry and neuropharmacology of psychoactive drugs. Paul Steinbroner has also produced over fifty films and videos on this subject.

The Challenge of Addiction Treatment Today

 What help really works for hard core drug abusers? 

By DAVID KERR

Maia Szalavitz[1] is a thoughtful, respected and long-time writer in the field of addiction and I support most of her 8 points as listed below and seen in her article in the Huffington Post; “The Rehab Industry Needs to Clean Up Its Act. Here's How.” Here’s the link:
CLICK HERE. 

Though I disagree (in blue below) with some of her points, she presents a concise summary of what she sees needing to change in our field and she knows from her own personal history using heroin and cocaine.  Here is part of what she has to say:

“I have covered addiction as a journalist for nearly three decades, and also have my own history of heroin and cocaine addiction, and of receiving treatment. With the input of longtime leaders in and critics of the field, here are my views on what needs to change.

1. Remove 12-step-related content from treatment — or at least, stop charging for it

2. Ensure access to maintenance treatment for opioid addiction

3. Fight corruption and unethical practices

4. End the reliance on criminal justice system referrals

5. End humiliation and confrontation

6. De-emphasize residential treatment

7. Create truly independent accrediting bodies that are consumer-friendly—and national standards of care

8. Expand harm reduction”

I have a problem with three of her eight points but she missed a major point as described below.  Also I would add to her eighth point: “Expand all treatment.”

I disagree with her points #1, #4 and #6.

 #1.  The AA 12 step approach is a marvelous group process where recovering substance abusers are accepted by their peers, finding a mentor and/or coach who guides the new candidate for years through the process of recovery.  Why would we want to end a process that has clearly helped many addicts for years and years?

#4.  I don’t think that treatment programs in New Jersey, for example, rely on criminal justice referrals.  Rather they see the desperate need of those addicts caught in the criminal justice system who need treatment rather than incarceration.  According to the Human Rights Watchreport, 10-17-16, “ every 25 seconds someone in America is arrested for possessing drugs for personal use.”

To make matters worse, many of those failing to meet bail requirements are incarcerated since treatment beds are usually full with a waiting list.

What’s the alternative?  Recovery help and treatment must be available to all people in all cultures.  Should we just bypass the treatment of addicts whose disease causes illegal drug use and associated crime?  In New Jersey, residential treatment programs have contracts with Corrections and Parole and they are showing positive results over years with the legally supervised treatment and follow up support of hard core criminal addicts.  Many studies have shown that this treatment enhances the likelihood of continued recovery with fewer relapses over time.  It makes no sense to arrest and incarcerate but provide no treatment to some addicts just because of their background and previous record while offering treatment for the same crime to others with little or no criminal record.  Many of these “others” are those who are part of the growing heroin epidemic in the suburbs.  Punish some and help others based on their skin color, criminal background and/or lack of bail money?  Not the right direction.

#6. Residential treatment is part of the continuum of help for many if not most hard core addicts.  Very, few of the thousands of addicts I’ve known could ever begin to put their life back together without removing themselves from the temptations of “the streets” and their neighborhood i.e. “the hood”. 

Here is an alternative model for Treatment and Recovery, call it the

Long Term Continuing Care Recovery Model

Help and caring for hardcore long-term addicts must be long-term (years.)  Also, the life supporting connections between treatment and the community neighborhoods to which recovering addicts re-enter after treatment, must be strengthened. 

The full recovery model of help for hard core criminal addicts often looks like this:  The detoxification phase followed by the residential phase followed by the reentry phase {followed sometimes by the out-patient phase} and then the most critical, the follow up coaching phase.  These are all part of the essential many year recovery continuum of care for hard core addicts.  I emphasize the word “caring” in this continuum. 

One of the most effective ways to measure quality in a program is to notice the level of concern and caring shown by all staff, not just counselors.  Assuring a caring staff must be the first step to assuring a quality staff and a quality program.  The best measure of a caring staff often comes from comments by the residents.[2]

The reentry phase of this continuum can be very challenging and it is not always the recovering person’s fault.  If we think of the cause of addiction as much from an addiction seeking culture as from a disease, we can begin to understand how difficult it can be to help people who must return after treatment to their home environment that is loaded with temptation.  Yes I know and believe the studies supported by Nora Volkow, NIDA, demonstrating that addiction is a brain disease.[3]  However, I attribute the present day growing problem of heroin addiction in the suburbs more from copy-cat and cultural behavior rather than so many people suddenly developing a “disease.”  AA talks about changing “people, places and things,” to stay clean and sober but this is often not possible in a drug seeking culture and as a result, addiction spreads.  Today, if you want to help and coach an addict towards recovery sometimes your most formidable enemy is our present day growing feeling that “heroin is ok.”  Some are saying under their breath; “yeah right, now that white people are using heroin, it’s ok;” and this has a ring of truth to it.

Peer support is often critical for hardcore criminal addict recovery

I founded a TC in Newark in 1968 called Integrity House. I retired from this work in March, 2012.  The TC concept has come a long way since the early 1960's.  We recognize the impact of the recovering peer, clean and sober for years, as a role model for change in our residential and out-patient programs.  We recognize the need for changing our system of care from long-term residential help to long-term support and coaching so that self-realization and the new drug free lifestyle has a chance to become internalized and practiced over years.  I have not found much long-term recovery success for hard core criminal "lifestyle addicts" without years of interaction with positive peers, and without support and coaching[4].

That said, most hardcore criminal addicts that I have worked with need to start and become part of a culture of safe, clean and sober living in a residential setting.  Each participant has a role in helping him/herself and others while learning, practicing and finally internalizing a new positive and ethical lifestyle. In my experience, the Therapeutic Community is the most effective tool, demonstrating a positive culture of right living for many months in treatment and for years thereafter following the long-term recovery continuum model.  

I have found that they must give help to others to get the full measure of help for themselves. 

A properly functioning TC must be sensitive to others needs and wants and what will help and what will hurt.  I've found that those addicts I have worked with over the years need a combination of understanding, love and straight honest talk and finally the role modeling of others like them, clean and sober for many years.  What I didn't expect to find, as I began to know them in the mid-1960’s, was a deep understanding of their own motives and behavior to help themselves as well as their strong need for help and guidance from others in long-term recovery. Finally I have found that they must give help to others to get the full measure of help for themselves.  Addicts in recovery for years make some of the best counselors I’ve ever met and this is with or without a degree! 

Let’s not mandate a degree since the bi-product may be to eliminate the recovering peer from our system of treatment.[5]

My experience supports the idea that a durable recovery is best insured by a counselor and/or peer who can feel a deep understanding and sincere sense of love and caring for others.  I have seen that recovering addicts who attain a degree are seen as role models to others in recovery!  On the other hand, I have found that the most effective people to inspire change are often former addict role models with a strong history of recovery, with or without a degree.

Growing addiction in the mainstream society is setting a bad example for our children

It is difficult today to help someone in a residential or outpatient treatment program to pursue a lasting recovery, when they leave treatment to return to our present drug consuming culture.  Addiction today is part of our culture whether it be from middle class in more affluent suburbs or ghetto pockets in the inner-city. If we want to make a serious impact on this personal and cultural malaise, we have to look at our own addictive behaviors and negative role modeling!  It's what we as parents do that is having a noticeable impact on the behavior of our children.  Growing addiction in mainstream society is setting a bad example for our children.  As a result, many have fallen into the deep hole that takes “adolescent recreational use and abuse” down the path of lifetime addiction.

Let's work together and with the media to develop more effective prevention plans that will be part of our culture and that will help our children grow up healthy.  These plans must start with changing our own habits and negative role modeling and personal substance abuse that will be mimicked by our children!

---

 [1] Maia Szalavitz is a columnist for The Influence. She has written for Time, The New York Times, Scientific American Mind, the Washington Post and many other publications.

[2] Be careful though not to base staff evaluations on resident comments!

[3]  http://www.memoirsofanaddictedbrain.com/connect/nora-volkow-the-disease-model-and-moi/

 [4] While I never used drugs, I lived with active addicts in Newark while starting Integrity House and learned much from what they said and how they lived.

[5] Most addicts in recovery owe fines and are just beginning a stable life in the workforce.  They will not be able to afford to pay for a degree for years if not decades!