8/3/2006 11:29:13 AM] [Entrance] [MODERATOR => All] "Welcome to the “Silent Treatment: Addiction in America” web chat, where we’ll discuss addiction issues featured in the newspaper series and www.silenttreatment.info. It’s my pleasure to introduce Thom Forbes, journalist, author and blogger (while you’re here, you might want to check out his blog, www.elephantonmain.com), who wrote the first in a series of five Public Access Journalism stories examining addiction treatment and recovery funded by the Robert Wood Johnson Foundation and now appearing in newspapers nationwide. Tom has a lot of personal experience to share — he’s a recovering alcoholic, as is his wife, Deirdre. His daughter, Carrick, was featured in the “Dateline” show “Saving Carrick” and currently is on methadone maintenance for heroin addiction (her blog, “Living It” is featured at www.blog/silenttreatment.htm). He’s ready for your questions and comments on living with addiction, so fire away by entering your message in box at bottom."

[8/3/2006 11:32:00 AM] [Entrance] [Thom => All] "Thanks and hello everyone."

[8/3/2006 11:32:16 AM] [Entrance] [MODERATOR => All] "Question from Renee, received Aug. 2: What is the best approach to use when working with dually diagnosed adults for whom past attempts at stabilization of their mental illness through medications has been unsuccessful?"

[8/3/2006 11:32:54 AM] [Entrance] [Thom => All] "Since this question came in in advance of the live chat, I had a chance to talk to Dr. Harris Stratyner about it. Stratyner, who runs Madison East at Mount Sinai Hospital in Manhattan and is quoted in my story, is an expert on dual diagnosis patients. To answer your question, he elaborated on what he means by "meeting the patient where he or she is at." He said that it is crucial for the clinician to make a "therapeutic alliance" with the patient, making it clear that they truly do not judge the patient and understand that he or she has two diseases that feed off of each other. You do want to use medications, particularly with major "Axis I" diseases <http://psyweb.com/Mdisord/DSM_IV/jsp/Axis_I.jsp>, he said, but it's best to do it in conjunction with cognitive behavior therapy <http://www.nacbt.org/whatiscbt.htm>."

[8/3/2006 11:33:19 AM] [Entrance] [Pat => All] "Thom - I guess I’m wondering, given your family history, the advice you would give Carrick were she to become a mother. How early is early when kids start using at 12? Looking back, did you see signs of addictive behavior when she was quite young and do you believe, in retrospect, you could have undertaken any form of treatment that could have altered her course? Thanks and best of luck to you and your family. "

[8/3/2006 11:35:44 AM] [Entrance] [Thom => All] "I think Carrick will face the same problem we did knowign the gentic predisposition. It's hard to say what I'd tell her to do other than to listen to her own advice one a kid starts exhibiting signs of use. Don't trust them."

[8/3/2006 11:38:05 AM] [Entrance] [Thom => All] "To elaborate a bit, it's amazing how early kids are experimenting with things nowadays, and I'd encourage parents to always question what they've been doing and who they were with."

[8/3/2006 11:40:51 AM] [Entrance] [Thom => All] "More on the dual diagnosis question from Harris Strayner: "Usually if you speak reasonably to the person, and you don't condemn him by saying, 'Why do you drink? Don't you realize it's bad for you? Don't you realize you're bipolar and take medication?' and instead say 'What do you like about drinking?' and point out that he may be self-medicating, which is very normal, you'll be successful at educating the person, not judging him,' Stratyner said. "That's how you draw in dually diagnosed people." I hope this helps."

[8/3/2006 11:43:01 AM] [Entrance] [Thom => All] "More on the question about early intervention: Carrick was seeign a psychologist at age 5 for some separation issues. She was attending 12 Step meetings with her mother when she was a toddler. Sometimes, as much as you think you're on top of things, people are going to do what they are going to do anyway."

[8/3/2006 11:43:33 AM] [Entrance] [MODERATOR => All] "MODERATOR: Thom, in your story u talk about not seeking help for alcoholism. What would you say was your basis for recovery?"

[8/3/2006 11:45:08 AM] [Entrance] [MODERATOR => All] "From Rachael: Hi Thom, My questions primarily have to do with educating myself about methamphetamine addiction in the U.S., for the purposes of understanding the lives of the growing numbers of meth users who, either by choice or by state mandate, are relinquishing their children to Social Services/foster care . . . 1. Based on your experience as a journalist, do you agree with the Drug Enforcement Agency's recent categorization of methamphetamine addiction as a national epidemic? If so, why, and if not, why not? 2. Scientists have demonstrated that the neuroscience of methamphetamine usage differs greatly from the usage of other drugs such as cocaine, heroine and marijuana. Metamphetamines produce a longer and stronger high, and dismantle dopamine receptors, resulting in severe depression and an inability for users to experience pleasure. It is thought that this deep chemical depression cements the user's addiction in a way that other drugs may not. It also makes recovery a longer and more difficult process. Based on your experiences as a journalist, could you comment on the possible ways that the specific neuroscience of methamphetamines may be altering current generational addiction patterns, and how it might end up producing unique and specific generational addiction patterns in the future? Thanks. "

[8/3/2006 11:45:13 AM] [Entrance] [Thom => All] "Well, I DID receive help, just not through a formal network. I talked to friends who had been in recovery. I read books. I searched my sould (took inventory, as AAers would say). "

[8/3/2006 11:45:20 AM] [Entrance] [RC => All] "Thom - my question is about addiction programs in the workplace. As a supervisor I strongly encouraged one of my employees to go through such a program but it turned out to be mostly worthless...and this was at a Fortune 100 company. The assistance primarily was for outpatient and limited to 30 days. Do you think most companies pay lip service to addiction? "

[8/3/2006 11:46:50 AM] [Entrance] [renee => All] "Thank you for your comments regarding working with dually diagnosed. I do understand that the therapuetic alliance is crucual when working with this population. "

[8/3/2006 11:49:44 AM] [Entrance] [Thom => All] "Hi Rachael. Well, that's a tough one to answer in a chat but I will say that meth is a terrible problem in many areas of the country but it has not hit the New York metro area, where I live, to the same extent as elsewhere. Part of the reason it's so popular is that it's cheaper and easy (if dangerous) to produce. A lot of rhetoric goes back and forth about the extent of the "epidemic" but the bottom line is that there are a lot of people who need treatment who aren't getting it. I don't think that simply throwing people in jail is the answer. I'm not qualified to talk about the neuroscience of meth addiction, but I agree that resouces need to thrown in its direction. "

[8/3/2006 11:51:58 AM] [Entrance] [Thom => All] "Hi RC. If someone has diabetes, are they limited to 30 days of outpatient treatment? If they eat a bunch of cookies, does the company give up on them and say, "we tried, but the patient is not cooperating.' I think that it's a crime how badly insurance companies and corporations, with exceptions so rare that I can't think of any currently, treat people with addictions."

[8/3/2006 11:56:29 AM] [Entrance] [Thom => All] "Back to the moderator's question about the "basis" for my recovery. As with everyone who eventually recovers, I WANTED to do it. Wanting to do it is, in itself, often not enough as addiction is physical as well a psychological, but I was lucky enough to be able to handle withdrawal with relative ease. "

[8/3/2006 11:57:01 AM] [Entrance] [MODERATOR => All] "Thom, the workplace issue is interesting, because there is little activism to change that situtation. Why do you think that is?"

[8/3/2006 11:59:02 AM] [Entrance] [Thom => All] "More on companies and recovery. Not too long ago, people went away for 30 days, or more. Yes, this is costly. But think of all of the expense in lost production you get from workers who are addicts or alcoholics. There are facts and figures to back that up, and I'll be happy to email them to you later."

[8/3/2006 12:01:05 PM] [Entrance] [renee => All] "Thom, as someone who works in addiction field as well as being in recovery, I know that there is still a social stigma attached to being an addict/alcoholic. "

[8/3/2006 12:01:57 PM] [Entrance] [Thom => All] "Why isn't there more activism about workplace issues? First, the insurance lobby is extremely powerful and they are very effective in stopping parity legislation for chemical dependancy. We witness this in recent months in NY State, where "Timothy's Law" finally got to the floor of the state Senate only after it had been stripped of all refererences to chemical dependency. Second, there's still such stigma attached to this disease that those affected are afraid to stand up for their rights."

[8/3/2006 12:02:46 PM] [Entrance] [renee => All] "It is possible that this stigma prevents parity between treatment for addiction and treatment for other medical conditions."

[8/3/2006 12:03:47 PM] [Entrance] [Rachael => All] "Hi Thom, with regard to your earlier comments on meth usage, I agree. I hope that journalists will focus more specifically on meth addiction in the future. Perhaps it needs to hit DC and NYC first. "

[8/3/2006 12:03:56 PM] [Entrance] [Thom => All] "Renee, I responded to the workplace question before I saw your note and I could not agree more. Overcoming stigma is the first step in overcoming discrimination against addicted people, and that is why my familiy and myself have joined the thousands of other people who are putting a face to recovery around the country."

[8/3/2006 12:04:16 PM] [Entrance] [RC => All] "A follow comment on the workplace and question. at my current company (energy sector) they drug test and alcohol test in some positions. If you fail, you're fired...more or less on the spot I believe. I believe it is a strong deterrent for many casual users. Can this kind of system, harsh as it is, help prevent casual users from becoming addicted? Do you see any benefits to testing in the workplace? "

[8/3/2006 12:05:21 PM] [Entrance] [Thom => All] "Rachael, I think you're right about that. We've had some people on our elephantonmain.com website who've talked about entire generations of hard-working families in mid-America being wiped out by meth addiction."

[8/3/2006 12:07:59 PM] [Entrance] [Thom => All] "I don't believe that anything like that will, in most cases, deter an addict. It is a progressive disease. It may deter an addict from being employed at the company in the first place, however, but is that really addressing the societal issue. I'm sure companies will argue, with some legitimacy, that it's not their palce ot solve society's problems, but as they demand more and more of our times and energies, whose is it?"

[8/3/2006 12:09:32 PM] [Entrance] [Thom => All] "RC, I do think that testing is necessary in many cases where people are operating machinery or have others people's lives in their hands. But rather than being punitive, why don't we help the people who fail the tests?"

[8/3/2006 12:13:38 PM] [Entrance] [Thom => All] "For those of you who are interested in stigma issues, I suggest that you check out Faces and Voices of Recovery <facesandvoicesofrecovery.org> "

[8/3/2006 12:14:10 PM] [Entrance] [Steve => All] "The stigma/discrimination issue impacts every facet of this discussion. It seems to me that all historical models for effectively addressing stigma/discrimination contained an element of militancy as well as visibility. Putting a face to recovery is a fundamental beginning but raising some hell should be part of the equation. "

[8/3/2006 12:14:22 PM] [Entrance] [Rob => All] "Hi Thom - This may be a cheap shot at Mel Gibson but I think to some degree society segments addictions and addicts and dismisses the problem when they see celebrities/athletes/authors/politicians blame bad behavior on addiction. Do you think hollywood coverage of addiction has hurt the cause overall? "

[8/3/2006 12:16:02 PM] [Entrance] [Thom => All] "We're all for raising hell in this household, Steve. Deirdre's bumper sticker reads: 'Well behaved women don't make history." Any suggestions?"

[8/3/2006 12:17:14 PM] [Entrance] [Steve => All] "Creative, non-violent disruption of services."

[8/3/2006 12:20:13 PM] [Entrance] [Thom => All] "Rob, I think that it's a mixed bag. It's good when serious attention is paid to people like Patrick Kennedy, who has been a long-time supporter of the rights of addicts. But the stories about Mel Gibson are doomed to be superficial, at least in most publications. We've all done things, or said things, we've regretted when we're under the influence of course. That's not an excuse but it's sometimes a valid explanation. It will be interesting to see how Gibson follows through. I'm an optimist and hope some good will come out of it all."

[8/3/2006 12:21:27 PM] [Entrance] [Thom => All] "Steve, that's an interesting concept. Hwo would you do it and what would be the specific goals?"

[8/3/2006 12:25:38 PM] [Entrance] [Thom => All] "We spent some time at rallies for the passage of Timothy's Law this spring, and learned first hand how intractable politicans can be. I agree that we've got to find a way to take to the streets and make our voices heard. We were very disappointed in the extent of the involvement of the chemical dependency providers in particular."

[8/3/2006 12:26:11 PM] [Entrance] [MODERATOR => All] "Actually, activism is becoming more popular in the recovery world, no?"

[8/3/2006 12:28:37 PM] [Entrance] [Thom => All] "Yes, it definitely is and FAVOR is any excellent umbrella for that. Unfortuantely, though, most people are still afraid to admit that they have this disease and it's sometimes for very good reasons: they'll lost their jobs or be ostracized by friends and family. There IS strength is numbers and I hope this series and website will help to increase those numbers exponentially."

[8/3/2006 12:26:43 PM] [Entrance] [Rob => All] "True, and I see your point but we all know Gibson winds up on cover of Vanity Fair at some point, claiming to be clean and making a clean start. Frankly, it's become something of a career move. Emerging from rehab seems to be the surest way to get a cover story. There's been discussion of stigma but it seems to be the opposite in glitter set--something of a rite of passage or way to gain publicity. "

[8/3/2006 12:29:06 PM] [Entrance] [Pat Nichols => All] "Very few understand and/or accept the disease model. there's the problem."

[8/3/2006 12:30:12 PM] [Entrance] [Thom => All] "Rob, you're right about that. The role of the media is a huge one but is more the subject of a book than a chat."

[8/3/2006 12:31:42 PM] [Entrance] [Thom => All] "I agree, Pat. Even addicts sometimes find it hard to square their behavior with the disease model. That's why they'll say something like "I can quit whenever I want" when it's much more complicatied that that."

[8/3/2006 12:32:14 PM] [Entrance] [MODERATOR => All] "We’re just about out of time. Thanks so much for joining us. This chat will be archived if others would like to check it out later. Thanks again, and come back tomorrow for Dr. Tom McLellan, same time, same channel."

[8/3/2006 12:32:44 PM] [Entrance] [Thom => All] "So long everyone. Thanks for joining us today."

[8/3/2006 12:33:11 PM] [Entrance] [Pat Nichols => All] "Thank you all. Never give up and always have a plan."