Wealth, Privilege and Adolescent Addiction

Addictions impact people in every socio-economic class. When they strike families of wealth and affluence- high functioning families- the issues and challenges to getting clinically and culturally competent treatment are great. In this article I explain what families need to look for when seeking out qualified professionals.

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Dr. Paul Hokemeyer in the Robb Report: Wealth & Addiction

Dr. Paul discusses the unique clinical needs of ultra high net worth patients in this Robb Report article:

Courtney Humphries
JANUARY 01, 2015
Some surprising new weapons are in development to aid those battling addiction.

By many standards, Mark held the world in his palm. He had gone to Harvard Business School, was good-looking, with plenty of charm. By the time he was 42, he was a hedge fund manager making $15 million annually and had a wife and two children. But along with his rapid wealth and success came stress and self-doubt. To manage it, Mark began hooking up with women he met online and visiting strip clubs where he paid women for sex. He also slipped into a daily cocaine habit. After a while, the cocaine was the only thing that made him feel in control—the glue that held him together.

Until everything else fell apart. When his wife discovered a text conversation with an escort describing the cocaine used in their last encounter, she left with the kids to their vacation home. Mark, his addictions now unchecked, went on a two-day binge of sex clubs, cocaine, and martinis. When he woke up at a hotel without his wallet and keys, he realized he needed help. He checked into a 56-day treatment program at Caron Renaissance Ocean Drive, a clinical treatment center in Boca Raton, Fla., where he finally began the process of addressing his addictions.

Paul Hokemeyer, PhD, a senior clinical advisor at Ocean Drive, says that Mark’s story (his name and personal details have been changed to protect confidentiality) is typical of the patients he sees. “They have reached a point where they have an enormous amount of financial success, but the quality of their lives is in tatters,” he says. Addiction—whether to alcohol, prescription pills, or cocaine—often goes hand in hand with accomplishment. “The brain has registered that substance as the thing that enables them to succeed in the world,” Hokemeyer says.

Increasingly, scientists are uncovering the biological underpinnings of addiction. Some people are more susceptible to addiction, either because of a genetic predisposition or because of life experiences such as neglect or abuse in childhood. But addiction itself changes the brain. If someone looked inside Mark’s brain, they would see that cocaine had taken over its reward pathways, interfered with decision-making, and robbed him of his ability to make better choices.

Even people who are motivated to quit find that kicking an addiction can take months to years. But scientists are developing innovative treatments that could someday help people like Mark unravel the deep habits that keep them reaching for their next fix. One day, for instance, he could get a cocaine vaccine as part of his treatment, essentially inoculating him from its powerful high.

Vaccines are currently in development for cocaine, nicotine, heroin, and methamphetamine. “It would protect the brain from the large rush of the drug,” says Michael Owens, PhD, a pharmacologist at the University of Arkansas for Medical Sciences, of the meth vaccine he is working on.

Some of these vaccines work much like an infectious disease vaccine: An addicted patient gets a few injections of a molecule similar to the drug, attached to a foreign protein designed to rouse the immune system. The body responds by producing antibodies against the foreign substance. The next time a person takes a hit, these antibodies find and attach to the drug in the bloodstream. The antibody-bound drug molecules have a harder time crossing from the blood into the brain, keeping them from having a strong effect.

The trick is to stimulate the immune system potently. A cocaine vaccine developed by Thomas Kosten, MD, at Baylor College of Medicine is the farthest along in clinical trials. It has shown promise in keeping more people in treatment, but was only able to stimulate enough antibodies to be therapeutic in about half of the subjects. Scientists are also looking at a different kind of vaccine; rather than stimulate the body to produce antibodies, they manufacture molecules called monoclonal antibodies that attach to a specific part of the drug, which are directly infused into an addicted person. Researchers at the Scripps Research Institute in La Jolla, Calif., are developing a monoclonal antibody vaccine for cocaine, and Owens is developing one for methamphetamine. The treatment is expensive to produce, but could be more effective than a traditional vaccine. Owens says an infusion might last three or four weeks.

Like many treatments in development, a drug vaccine is not meant to be a cure for addiction. “It’s not a standalone medication. [The patient] must really be involved in some sort of behavior modification program or cognitive behavioral therapy to deal with the issues that keep them going back to the drug,” Owens says. But it could provide a crucial edge to people who are trying to change.

– See more at: http://robbreport.com/health-and-wellness/prevention-treatment/fixing-fix#sthash.4vyqg0qP.dpuf

Women & Treatment: Models of Success

This article first appeared in Rehabs.com

“A woman is like a tea bag. You can’t tell how strong she is until you put her in hot water.” – Eleanor Roosevelt

Too often when professionals talk about addiction and other behavioral health issues among women, we share only half the story. We lament about the toll they take on our female patients and their family’s well being. We pine over the obstacles to treatment and long-term recovery- and we forget to share the incredible narratives of their success.

Taking Inventory

I must confess that I’m guilty of that which I’m criticizing. As an expert for the Dr. Oz Show and a guest on Katie Couric’s show, I’ve discussed at length the unique challenges women face when dealing with addiction. Just recently, I spoke at a conference in London on this very issue to over 200 professionals from around the world.

In reviewing my remarks, I was shocked to find I’d devoted around 80% of my time discussing women’s vulnerabilities and a paltry 10% discussing their strengths. Fortunately, I realized the errors of my ways before taking the podium and devoted my time celebrating the sharpness of the female mind, the resiliency of her body and generosity of her spirit, traits the give women an upper hand in reclaiming not just their own well being, but also the well being of their families.

And my comments were not based on wishful thinking. The academic research and my clinical experience unequivocally show that women enjoy higher rates of recovery than men and transcend their gender-based challenges with a deep resolve and strength of character. Yes women have challenges, but so does everyone else when they decide to address their addictions. The real news is how extraordinarily well women succeed with their task.

The top reasons for their success are as follows:

Women progress more quickly from using an addictive substance to dependence, addiction and treatment than men. As a result, they get themselves into recovery programs much faster than their male counterparts. This hastened pace with which they seek help spares them and their loved ones years of physical decay and emotional heartache.

Mental Health Issues
Women suffer from higher rates of mood and anxiety disorders than men. These underlying conditions have established and highly effective treatment strategies that can be immediately implemented to provide enormous relief. Once these issues are addressed, women are much more likely to take an honest look at their addiction.

Relationship Oriented
Women are more likely than men to use self-help programs like Alcoholics Anonymous and are also more likely than men to benefit from the group therapy model that’s utilized in treatment. They are quick to ask for help and listen to the advice that’s given. They chose the long term well being of their family over their short term discomfort and are able to subrogate their pride and egos to the good of the family unit.

Higher Rates of Success
Women and men are equally likely to complete treatment, but the women who complete are 9x more likely to be abstinent than women who didn’t. Women have a much greater capacity to stick with the challenges presented by treatment once they make the commitment to change. Even though the first few months of recovery are hard, they see how their efforts are benefiting those around them and stay committed to the task.

Lower Incidence of Relapse
Women in substance abuse treatment are less likely to relapse than men in treatment and have better long-term recovery outcomes. Women are better at following directions then men. Unlike men, they can put their egos off to the side and see how their commitment to change will benefit their family and their selves.

The Female Success Story

Never forget that, in the realm of recovery from addictive disorders, women are models of success, strong cups of tea and inspirational change agents. Moving forward, I’m resolved to do a better job in celebrating these strengths instead of just focusing on their problems. I suggest you do the same.

If you know a woman who’s struggling with an addiction or mental health issue, forward her this article. Based on the research and my nearly two decades working in the field, she’ll take your efforts to heart and be grateful that you care.

Compassion Fatigue

One of the greatest gifts I receive in my work as an addictions therapist is to witness individuals and families surmount incredibly difficult challenges and embrace a life of recovery. Often the breakthrough occurs at the bitter end, when I’m scratching my head in disbelief that they can endure such intense levels of frustration and pain.

Witnessing the thrashing that occurs at addiction’s hands is grueling. I’ve spent countless sleepless nights wondering if a patient will “make it” or “get” the breakthrough they need to begin the healing process. Fortunately, as a professional I’ve been trained to deal with the frustrations that come with this work.

As a young clinician, I had wonderful mentors who taught me to never to give up on the human spirit. “You never know when the seed you planted will take hold,” was the steady advice of Dr. Stanly Evans, a man of enormous integrity and a pioneer in the field of addiction treatment. Another, Sid Goodman, creator of the highly effective Florida Model and Family Restructuring programs, constantly reminds me to be fearless and tenacious in challenging a family’s resistance to change. “You must think systemically,” he constantly instructs me when I’m baffled with what to do in a particular case. “The patient is the family and the family is the patient.” But even with this exceptional support, there are times when I get exhausted, crushed by the weight of a disease that diminishes the dignity and souls of my patients and their families.

What is Compassion Fatigue?

Compassion fatigue is a well-established concept in the realm of health care providers. First observed in nurses who worked in emergency rooms, it describes the sense of helplessness and hopelessness that can overtake a person providing care for someone whose suffering seems never-ending and insurmountable. It’s also a condition that I observe frequently in the families and loved ones of the patients I treat.

Marsha* is an example of a wife and mother whose emotional spirit and physical health were beaten down by the seemingly hopeless addictions that plagued her husband and daughter.

A once beautiful and vibrant woman, Marsha presented for treatment disheveled and profoundly depressed. Coffee stained her blouse, mud caked her shoes and silver roots defined the brittle locks of her auburn hair. Although she had a master’s degree in English and for years taught American literature at a local college, she could barely put together a coherent thought. “I’m just exhausted…tired…no energy.” It didn’t take long for me to realize why. Her 17-year-old, heroin-addicted daughter was expelled from school for selling OxyContin and had been in and out of five $30,000-per-month rehabs in the last three years. As if that wasn’t enough, Marsha’s husband of 27 years was on the verge of losing his middle management job at an insurance company for excessive absences due to his late stage alcoholism. “It seems he loves cheap vodka more than he loves me and our kids” Marsha sighed as she finished telling her story.

Exhaustion, frustration and an overwhelming sense of hopelessness: these are just a few of the symptoms described by people who suffer from compassion fatigue. The following is a more thorough list compiled by the American Academy of Family Physicians.

Common Symptoms of Compassion Fatigue

Abusing drugs, alcohol or food
Chronic lateness
Diminished sense of personal accomplishment
Exhaustion (physical or emotional)
Frequent headaches
Gastrointestinal complaints
High self-expectations
Inability to maintain balance of empathy and objectivity
Increased irritability
Less ability to feel joy
Low self-esteem
Sleep disturbances
You can determine if you are suffering from compassion fatigue by taking a self-assessment test. If you respond with a 1 (very true) to more than 15 questions, it’s critical that self-care is your first priority.

For Marsha, self-care meant finding something to anchor herself to when the gales of her daughter and husband’s addictions thrashed against her. Since she was a child, Marsha had internalized the belief that if she fixed those upon whose love she depended, then all would be well. It was a message she learned as an infant, completely reliant on the conditional love of a narcissistic and anorexic mother. But while her selflessness enabled her to survive her childhood, it trapped her in relationships that crushed her spirit and enabled those she loved to march uninterrupted down paths of self-destruction.

Fortunately, for Marsha and millions of other people like her, there is a way out of these devastating relational patterns. The key of liberation is to acknowledge that your unhealthy response to other peoples’ behavior is a habit – and most importantly – that it’s a habit you can break.

In his best selling book, The Power of Habit, Charles Duhigg, an investigative reporter for The New York Times, distilled habits into three key components. The first of these components consists of a cue. This is the cause of your reaction. The second is a routine. This is the effect. It’s the behavior you engage in or the reaction you have in response to the cause. The third is the reward. This is the benefit you derive or the instantaneous relief you feel once you’ve had your reaction.

In Marsha’s case, the cue for her reaction to save and protect others was the unmanageability of her life, caused by the insanity and chaos of her family’s addictions. The routine she fell into was to become a caretaker extraordinaire. When a crisis struck (and there always was a crisis), Marsha became super mom and super wife. Like a caped crusader she swooped in and solved their problems. The reward she got from her behavior was having a moment, if only fleeting, of mastery and control – and perhaps most importantly – of being validated as a person who mattered.

Unfortunately her habit, while enabling her to survive as child, had outgrown its usefulness. Now instead of adding value, it became deeply rooted in her family’s disease.

How Can We Overcome Compassion Fatigue?

Fortunately, Marsha possessed within her the tools to change. To recover, she needed to become hyper conscious of when her cue arose and implement different routines to address it. So instead of looking to control the externals of her life, she needed to enhance the mastery of her internal, emotional state.

Central to accomplishing this skill was her coming into therapy and talking about what was going on in her life with a person who was completely present for her. Second, she needed to find and cultivate a life outside the stagnate confines of her family. In Marsha’s case, this expansion occurred slowly. Initially and reluctantly she started attending Sunday mass at her community church. A month later she was back at work, teaching English as a second language to families in need. Finally, she was able to get her daughter into a treatment program that had a robust family therapy component as a central part of its curriculum. The work that she and her family were able to do in this program broke the strangle hold of their addictions and liberated them in a spirit of mutual respect, love of self and each other. They were finally able to hear each other out and set boundaries that were clear, consistent and enforceable.

Six months have passed, and is Marsha’s life perfect? No. But, it’s infinitely better than the life she found herself in upon entering treatment. Although her husband did lose his job, he was attending AA meetings and was cobbling together periods of sobriety. Her daughter was clean and living in a half way house in Florida and had just started a part time job in a coffee shop in Delray – a wonderfully robust recovery community. The greatest transformation, however, was that which occurred in Marsha. No longer were her eyes flat orbs surrounded by craters of darkness. In them shown a light of recovery and hope –evidence that her compassion fatigue had been replaced by compassionate strength for her self and others.

*The name and identifying details have been changed for patient confidentiality.

Trauma and Compulsive Spending

How trauma leads to destructive financial choices:
By Erica Sandberg

Child abuse. Warfare. Assault. A devastating accident. If you have endured one or more life-threatening events, you may be more likely to make destructive money decisions.

Researchers discovered that post-traumatic stress alters the way a person thinks and reacts to situations, including financial behavior. A 2012 Cornell University study of veterans, “Do Psychological Shocks Affect Financial Risk Taking Behavior?,” found that service members who lived through combat are more cautious in their financial investments, thereby forfeiting capital gains that could benefit them in their retirement years. The study states that just as unpredictable macroeconomic shocks (such as a stock market crash or a rapid currency devaluation) makes investors risk-averse, profound psychological shocks impact survivors in much the same way.

How trauma can wreck your finances
If you are making negative money choices, especially those hurling you into arrears, and you believe it might be due to past trauma, there are ways you can change course.

Trauma’s neurological impact
According to Paul Hokemeyer, a Manhattan therapist, traumatic events can lead to compulsive and destructive economic behaviors. The root of this phenomenon, he says, is the impact that trauma has on the brain.

These are not conscious, deliberate actions, says Hokemeyer. “Traumatic experiences cause our brain to overreact. They force us into a stress mode where we are compelled to take action as a protective measure.

“In my work as an addictions and family therapist, I see too often how people utilize money and the objects it buys to self-medicate away the emotional pain that is left in the wake of their trauma,” says Hokemeyer. “Oppressive credit card debt is very frequently one of the destructive consequences of their unfortunate legacy.”

So while soldiers who have been through battle tend to shun risk, others who have suffered through different kinds of trauma may respond by being spendthrifts.

As an example, Hokemeyer describes a female patient who, as a teenager, had been exposed to domestic violence. “When she was 15, she heard her parents always screaming and fighting. To medicate, she would go online and look at clothes. That was the way she felt soothed.”

I see too often how people utilize money and the objects it buys to self-medicate away the emotional pain that is left in the wake of their trauma.
— Paul Hokemeyer
Marriage and family therapist
Initially, the girl would calm herself by looking at images. Then she bought something and felt good. As problems at home continued, she bought more. “So here’s a direct relationship between the trauma and the activity,” says Hokemeyer. “But as an adult she didn’t see the connection right away.”

Michelle Black, a credit expert at Hope4USA.com, a credit education and restoration program in Charlotte, North Carolina, says she comes across people on almost a weekly basis who have financial problems due to traumatic circumstances.

“A couple years ago, I was helping a man to rebuild his credit after his wife was killed in a car accident,” says Black. “Naturally, he had unexpected financial expenses from the funeral and decreased income from missing work while he was grieving. However, he also began to use shopping and overspending as a way to temporarily cover up his grief. There is a reason that it is called ‘retail therapy.’ ”

Negative reactions to trauma
What financial decisions might you be making as a reaction to trauma? Responses vary among individuals, says Hokemeyer, but the most common include:

Excess spending. Shopping makes you feel in control and centered. When the trauma is triggered, you shop to self-medicate.
Excess saving. The opposite side of the coin is hyper-vigilance. You consider the world to be an unsafe place, so protect yourself by hoarding possessions or money.
Under-earning. You may be highly educated, talented and capable, yet do not pursue or keep positions for which you are worthy because you feel undeserving.
Over-working. You can’t stop working because the only way you can feel of value is by bringing in as much money as you can. Satisfaction is elusive, though.
Perpetual debt. Owning tangible consumer items is proof of worth (when you may not feel it). Therefore, you reach for things outside yourself and your means. You might also believe, deep down, that you do not deserve wealth, so sabotage it with overcharging.
Of these responses, Pandora MacLean-Hoover, co-founder of the Think-diff Institute counseling center, says uncontrolled shopping is the most typical — and most damaging.

“While spending may provide relief from the emotional injury of trauma, it often creates unmanageable debt,” says MacLean-Hoover. “Therefore, the relief may be short-lived. The burden of debt eventually reinforces negative beliefs that the spending diminished, creating a vicious cycle.”

Black agrees, explaining that the abuse and mistreatment of money after a trauma is a common coping mechanism: “When a consumer’s world gets turned upside down, especially by a sudden illness or accident, financial and credit problems are usually not far behind.”
When a consumer’s world gets turned upside down, especially by a sudden illness or accident, financial and credit problems are usually not far behind.
— Michelle Black
Hope4USA credit expert
Stephen Lesavich, a Chicago attorney and co-author of “The Plastic Effect: How Urban Legends Influence the Use and Misuse of Credit Cards,” also believes that traumatic life events often lead to impulse purchases. “The products and services are used for easing the feelings associated with the negative emotions and may be used to fill an emotional void,” says Lesavich.

Connecting trauma, financial behavior
Can you stop such negative, compulsive responses? Yes, insists Hokemeyer. Crucial to getting your dignity and esteem back is realizing and accepting that a traumatic event has changed the way you deal with money. Yet pinpointing deep-seated issues can be elusive.

“Neurologically, we defend against uncomfortable truths,” says Hokemeyer. Knee-jerk denial is normal. After all, you might not want to accept that you keep yourself in debt or unemployed because something terrible happened to you. Instead, you want to believe that it’s all due to separate, outside factors, he says.

Several psychotherapy methods can help you differentiate between conscious, healthy financial behaviors and harmful ones triggered by the event. The standard approach is cognitive therapy, which is based on the assumption that thoughts, feelings and behaviors are interconnected. With a therapist, you isolate the origin of your inaccurate thinking, determine the emotional response, then work to form new, positive behaviors.

Less widely known techniques are also effective, says MacLean-Hoover. She uses a combination of therapies, including Eye Movement Desensitization Reprocessing (EMDR), which was originally developed to help relieve trauma-induced stress, as well as gestalt and cognitive therapies. In aggregate, these therapies “help people identify why the spending makes them feel better,” she says. “Once people understand why they do what they do, they may embrace alternatives.”

With professional guidance or even with just a mighty will to change, you can switch gears. Black recalls a client whose wife died. “A couple of years later, he was ready to deal with the financial fallout of the trauma,” says Black. “He wanted to put himself in better position so he could buy a home for himself and his child. We were able to help him, but it took about six months of hard work to correct the mistakes of his past.”

Ultimately, “You must train your brain to believe in you. If you sense you have a problem, there is a 99 percent chance it’s true. Trust that feeling and seek proper care to address the issues,” says Hokemeyer.

What to do now
In the absence of formal therapy — or before seeking it — you can try to redirect the feelings of powerlessness into other activities. Do things that “restore a sense of importance,” says MacLean-Hoover, who suggests physical exercise, reading, artwork or socializing with friends as examples of positive ways to redirect spending urges.

Even the process of budgeting can restore a sense of power, says Hokemeyer. It’s a simple defense against irrational, destructive economic choices.

If you suspect a traumatic event is behind your consistently poor financial decisions, Lesavich suggests a process of “checking in” on your emotional state. Awareness breeds strength and the opportunity to make better decisions, he says. “When emotional triggers cause you to make purchases you don’t need or can’t afford, you give your power away to someone or something else.”

Prior to shopping or charging, Lesavich recommends asking yourself the following questions:

How do I feel right now?
What is causing me to react this way?
Why do I feel the need to buy this?
Do I really need it?
How will I feel after I buy it?
How will I feel when I have to pay for it?
It’s self-generated cognitive therapy, helping you connect the cause-to-action dots. Frequently asking and then answering them will guide you to make deliberate, healthy actions not based on past hurts, but on present needs and sensibilities.

You don’t have to let a traumatic event continue to haunt you or harm your economic security, says Lesavich: “By making a choice to not react to them, you will help yourself to create a prosperous financial future for you and your loved ones.”


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