MEET THE FOUNDER Addisu Mengesha &how he aims to help addicts



factors that lead to addiction

• Study says economic downturn leads to increase in substance use disorders • Discrimination remains largely ignored as a cause of substance abuse





CONTENTS To send a comment or question, write to: Fresh Start Comprehensive Center 11 E Mt Royal Ave. Baltimore, MD 21202


8492 Baltimore National Pike Suite #205 Ellicott City, MD 21043

FEATURES 06 WHERE HELP IS NEEDED Founder aims to help addicts wherever they are, whatever their needs may be 12 BAD RAP Baltimore’s “heroin city” reputation unfair, according to the Baltimore Sun 14 BOOM, BUST, ANDDRUGS Study says economic downturn leads to increase in substance use disorders 16 EFFECTIVE SOLUTION Baltimore PD explores treating, not jailing, low-level drug offenders 20 IT’S ABOUTMORE THANDRUGS Pamela Gibson explains the many possible factors leading to addiction

INTERESTED IN MORE FROM Fresh Start? To learn more about our resources for

26 CHANGETO METHADONE REIMBURSEMENT State proposal aims to reduce repayment Discriminiation remains largely ignored as a cause of substance abuse 34 THE ALPHABET OF RECOVERY Fresh Start uses cognitive therapy to help patients break unhealthy patterns 36 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 28 COPINGWITH DISCRIMINATION

living a healthy lifestyle, visit or call (443) 671-1414.

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Where Help is Needed Founder aims to help addicts wherever they are, whatever

their needs may be Addisu Mengesha is making a dent in Baltimore’s opioid epidemic with Fresh Start Comprehensive Center (FSCC), by offering dozens of integrated services - 34, to be exact - under one facility. As the name suggests, FSCC clients receive specialized/focused care across a complex range of issues that contribute to their addiction. Whether a person struggles with unresolved trauma or psychological issues, homelessness or financial instability, long- term improvement requires more than simply abstaining from mood-altering chemicals.

“In most cases everything is interlinked.” -Addisu Mengesha, founder, Fresh Start Comprehensive Center 6

The process begins with counseling. “Counseling can help identify the root causes and what their other needs are -- housing, training...” says Mengesha. “In most cases everything is interlinked.” Mengesha noticed early on when he founded FSCC, however, that without housing, a client is hard-pressed to fully take advantage of the other resources offered. “If they don’t have a place to live or income, they aren’t coming into counseling,” he says. So for the client’s first 90 days of treatment, they are encouraged to stay in FSCC housing free of charge. “We don’t make money for ourselves for that, but it helps our clients immensely,” says Mengesha. Being of service

Solving problems is a common routine for Mengesha in creating an environment conducive to recovery. A challenge for many, he says, is the amount of time and level of commitment they are willing to put into early recovery. After the worst of withdrawal symptoms subside, it’s not uncommon for a client to feel “cured” and go back to old behaviors, leaving the center prematurely. “You can’t stay for just two weeks and expect to be cured,”Mengesha says. “Those are the people we see coming back to treatment again and again.” But not everyone gets it on the first try, so Mengesha leads staff in creating a welcoming, non-judgmental environment where clients feel comfortable returning if necessary.The last thing he wants is for a person relapsing to shy away from help when it is readily available. This is what sets FSCC apart from other treatment centers, according to Mengesha. He saw too many treatment models focused on the financial bottom line rather than genuinely caring for clients, which is what led to him founding his own center in the first place. Baltimore has a dire need for addiction services, so Mengesha doesn’t base his bottom line on finances, but rather on service to the community in which he lives.


Chasing the storm Mengesha has never struggled with addiction himself, but like most of Baltimore’s population, he has seen its impact on society. He says he wanted to find a way to help his community the best he can, and having a background in leadership(he holds PhD in Management) prompted him to start up the treatment center he runs today. “Seeing so many people out of jobs, helpless, they couldn’t come out of their addiction problems,” he says. “I wanted to be able to help them, although I never had the experience myself.” But with an experienced clinical staff and a genuine desire to lend a hand, Mengesha is making headway in the Baltimore treatment industry, and is determined to provide services to the areas that need it the most. “There is an immediate need here,” he says. “The state identifies counties that need similar services,” and Mengesha is prepared to follow the need. He has opened a new facility in Howard County.

“Seeing so many people out of jobs, helpless, they couldn’t come out of their addiction problems. I wanted to be able to help them.” -Addisu Mengesha, founder, Fresh Start Comprehensive Center


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Bad Rap “Heroin City” reputation unfair, according to the Baltimore Sun

“A long-standing challenge is the lack of well-paying jobs,” asserts Marbella and Rentz. “It is simply more lucrative to sell drugs.”

Conflicting stories In the year 2000, the DEA found Baltimore to have the highest per capita heroin addiction rate in the country. Of Baltimore’s 645,000 people, the city’s Department of Health estimates there to be 60,000 drug addicts with about 48,000 addicted to heroin. Such numbers, though, “are imprecise given the nature of the drug market and the difficulty of surveying heavy heroin users.”, warn Baltimore Sun reporters Jean Marbella and Catherine Rentz in a detailed investigative report. The National Geographic documentary Drugs, Inc. used the 60,000 addicts data to “support their sensationalizing-sounding assertion that Baltimore is the Heroin Capital of America,” says The Sun’s Rodricks. “Since then city health officials have come up with what they believe to be a far better-and much lower-estimate, based on an extrapolation of data collected in a comprehensive federal survey.That estimate is about 11,000 heroin users.” (2014.)

”Despite all efforts, Baltimore can’t shake its reputation as a degenerate, violent Heroin City” claims Dan Rodricks of The Baltimore Sun. The Drug Enforcement Agency found Baltimore to be the city with the worst of America’s heroin problem in the year 2000, but heroin has plagued the area since long before then. Director of the Washington/Baltimore High Intensity Drug Trafficking Area program Tom Carr told ABC News Baltimore’s heroin problem began in the 1950’s. “It’s an old heroin town.There is an appetite for heroin in Baltimore... It’s accepted by all too many people down there as something that’s normal behavior,” says Carr to ABC News. “It’s almost a rite of passage for some.” Baltimore, Heroin Capital, USA - that’s what ABC News calls the beleaguered city in a two part report – The city still has a growing problem with heroin users and dealers.The problem is so bad, it sustains a large and profitable underground market.


A more recent statistic, compiled by The Baltimore Sun from Mayor Stephanie Rawlings-Blake’s 2015 heroin task force and a 2014 study by the RAND Corp. done for the White House, found the number of heroin users to be around 19,000 with about 9,500 chronic users. This group, the collective effort finds, spends an estimated $165 million on drugs a year.Though The Baltimore Sun acknowledges the inexact way these numbers are generated, it reports that when it comes to the amount of money spent on heroin, “experts say the actual valuation is likely much higher because of money spent by the occasional user.” Show me the money A large part of the problem stems from the fact that people are “making eye-popping sums in their chosen profession of heroin dealing,” says Marbella and Rentz of The Baltimore Sun. Searches of stash houses have found sums of money in the tens and hundreds of thousands of dollars.That level of money is maintained by top earners,The Baltimore Sun finds. ‘Corner boys,’ a name for people who sell on the street, make as little as minimum wage according to economists, write Marbella and Rentz. Unfortunately, according to The Baltimore Sun, there is a vicious cycle of the lowest paid people in the drug trade resorting to being “corner boys,” which then leads to arrests and convictions, thus making them less appealing to legitimate sources of income, so they end up going back to selling drugs, most likely near their homes.

Oftentimes, these individuals are heroin addicts themselves. ABC News reports how much it can cost to keep up the habit. Some recovering addicts, the report found, were spending $50 or $140 dollars a day. “A long-standing challenge is the lack of well-paying jobs,” assert Marbella and Rentz. “It is simply more lucrative to sell drugs.” It’s all where you live The website reports heroin consumers and dealers are growing every year and are concentrated in lower income neighborhoods.The Fix reports and attributes an element of the distressing heroin problem to the city’s location. It’s in the middle of the East Coast and a port town, making it an easy and quick stop for traffickers heading up and down the coast. In 2013, writes The Fix, custom agents seized 128 pounds of cocaine making its way to Baltimore from Panama and China. Neighboring states have similar problems. Vermont Gov. Peter Shumlin (D) made the heroin issue a big part of his 2014 State of the State address and Massachusetts Gov. Deval L. Patrick (D) called the heroin issue an emergency, writes The Washington Post. “The state’s heroin problem is likely a lot worse than most Marylanders think.That’s one of the conclusions from the state’s emergency task force on heroin and opioids,” says Marbella of The Baltimore Sun. Maryland Gov. Larry Hogan (R) said he would declare a state of emergency to end the heroin problem.

 task force. “I think it’s just going to shine more light on the subject. It’s going to make people pay more attention to it.” 13 “Every state on the East Coast has declared a state of emergency except Maryland - and Maryland has the worst problem,” Hogan told reporters as governor-elect during a state Republican Party convention. “We’re going to do it,” says Hogan about organizing a heroin specific

Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University


Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”

“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

“I think they’ve found jail doesn’t help. They come out worse than when they went in.” —Sen. Katherine Klausmeier

Effective Solution Baltimore PD explores treating, not jailing, low-level drug offenders

Devastating problem According to estimates by the Baltimore Sun, there are 19,000 heroin users in Baltimore.The police have found heroin to be a factor in a heightened city homicide rate. Overdoses have increased statewide, doubling since 2010. Heroin was the cause for 578 Maryland deaths in 2015, according to the Sun. Maryland’s State Attorney’s Office for Baltimore and the Behavioral Health System Baltimore have both signed off on the initiative, known as the Law Enforcement Assisted Diversion program (LEAD). “Criminalizing individuals with addiction issues is not the answer,” says Baltimore’s health commissioner Leana Wen to the Baltimore Sun. “We must treat addiction as a disease and not a crime or a moral failing. LEAD is an innovative, evidence-based strategy that diverts people with addiction away from arrest and incarceration and instead gives them the medical treatment they need.”

Low-level drug offenders in Baltimore might soon find themselves headed to substance abuse treatment instead of jail. Facing a growing number of heroin users, the Baltimore Police Department has teamed up with the non-profit organization Open Society Institute-Baltimore to revamp how the city works to tackle public safety. An arrest record can hurt a person’s opportunities for getting a job, education or housing. Without an opportunity to re-enter society, it’s possible drug offenders will re-offend, and again enter the criminal justice system.The police department will only consider treatment options for nonviolent offenders.Those committing serious offenses, like dealing drugs, would continue to face jail time.

“What is unusual about this program is that there is no arrest at all.”

—Diana Morris, director at Open Society Institute- Baltimore

Healing at-risk offenders Faced with a growing group of heroin users, Gov. Larry Hogan sought a new solution. Hogan organized a task force which called for more treatment for addicts both while in prison and after they are released—a time of increased relapse and overdose vulnerability, according to the Sun. “I think they’ve found jail doesn’t help,” Sen. Katherine Klausmeier, a participant on Gov. Hogan’s task force, says to the Baltimore Sun. “They come out worse than when they went in.”

LEAD is part of a state- and nation-wide reevaluation of the current approach of administering drug abusers into the criminal justice system. Instead, the program aims to divert low-level drug and prostitution offenders with substance abuse problems into community-based treatment and support services, like housing, job training and mental health support, according to the Baltimore Sun. Similar to alternative approaches around the country, LEAD includes access to Drug Court. Drug Court, according to the National Association of Drug Court Professionals (NADCP), allows for an eligible drug-

 important because it allows those who have addiction problems to not have the arrest on their record or go through the revolving door of the criminal justice system.” 17 addicted person to be sent to Drug Court instead of the traditional justice system case processing. Drug Courts keep individuals in treatment long enough for it to work, writes the NADCP, while supervising the offenders closely. “What is unusual about this program is that there is no arrest at all,” says Diana Morris, director of Open Society Institute-Baltimore, to the Baltimore Sun. “That’s

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It is our vision to help all of our clients through their recovery process by using the following two track formula: • Offer choice/encourage client • Address client’s overall life, physical and mental health • Treatment/Peer Support • Family education



OUR MISSION The mission of FSCC is to assist adults in the process of recovery on a broader scope with a repertoire interventions and supports in a community based context. Specifically, the goal is to support recovery processes by utilizing the basic commonalities between mental illness and addiction. The mission will be achieved by providing a range of community based, intervention, treatment and support services. We are here to help you, call us today! (443) 671-1414

It’s About More Than Drugs Pamela Gibson explains the many possible factors leading to addiction Pamela Gibson supervises counselors at Fresh Start Comprehensive Center and monitors proper care for every patient. She begins by forming a treatment plan that meets the specific needs of a client and then motivates them without pushing unrealistic expectations. Patients are encouraged to give direct input on their goals for treatment and recovery. Most clients begin with the goal of ending their drug use, but eventually seek to improve other aspects of their lives that were also impacted by their addiction. Counselors work with their patients to explore possible factors of substance abuse.They function under the disease model, teaching clients that their drug use is not as simplistic as a bad choice they’ve made. It’s an important step for overcoming the disease: understanding that addiction is not just about the drugs.

“Living in a poor urban neighborhood can feel like a war [zone] sometimes.” -Pamela Gibson, program administrator, Fresh Start Comprehensive Center


Other influences Children brought up in environments where substance use is prevalent are more likely to mimic the behavior. Peer pressure from family and friends, especially during teen years, heightens susceptibility to drug use which can last into adulthood. Gibson also believes socioeconomic factors are significant contributors. A lower quality of life may lead to more direct exposure to harmful substances, because high-stress environments could promote self-medicating. “Living in a poor urban neighborhood can feel like a war [zone] sometimes,” Gibson says. “It’s hazardous living in a place where you’re constantly exposed to drugs or dangerous activities.They feel trapped and don’t have the financial means to get out of it.” Though circumstances of underprivileged environments can contribute to use, Gibson warns against forming any blanket judgements about drug users, emphasizing that she’s worked with clients of all backgrounds and economic status. “It’s important to understand that addiction is a disease which can affect anyone. I’ve seen people from all walks of life going through the struggles of addiction,” she says.

Traumatic roots Trauma is at the root of most addiction, according to Gibson. A trauma is an experience that negatively impacts a person’s sense of safety or stability.The disturbance produces physical, emotional and psychological distress. “For 99% of our patients, drugs serve an emotional purpose,” Gibson explains. “They’re self-medicating to cope with a severe situation they have been through.” Several studies have found traumatic experiences increase the likelihood of addiction, specifically if endured during childhood. Gibson believes the stigma surrounding substance abuse leads some sufferers to ignore their addiction and suppress the emotional root that led them to use in the first place. “How can we expect addiction patients to acknowledge their trauma when we live in a society that doesn’t even properly

acknowledge PTSD for our war veterans who have experienced so much trauma,” Gibson says. Once desensitization occurs, internal and external harm magnifies without users being aware about the severity of their problem.Though the addiction and trauma are not consciously linked by the sufferer, substance abuse can serve as a temporary way to numb pain, create a sense of empowerment and relieve anxieties. Repression of pain is a common thread in patients. Even those who are battling suicidal thoughts have revealed to Gibson that their true wish was to end overwhelming pain rather than actually hurt themselves. Counselors at Fresh Start Comprehensive Center help clients uncover possible underlying traumas beneath their drug use. They teach systematic techniques to manage impulse responses in a healthy way which allows clients in the long run to take control of their own recovery.

Breaking misconceptions While common threads exist within the disease of addiction, Gibson’s primary focus is serving the individual. She views substance abuse patients as a population with unique characteristics and needs that are often not met by treatment centers. Gibson has worked in the mental health field for 14 years. After receiving her Master’s degree in rehabilitation counseling from Coppin State University, she began working with all types of patients, except for those suffering from addiction. “I was very misinformed at the time,” Gibson recalls. “I thought addiction patients would be too difficult to work with. But as soon as I took my first position at a methadone clinic, my clients dispelled every assumption I had.” She discovered that substance abuse clients were highly intelligent individuals, educated on matters that are commonly taken for granted. Creativity is another trait she found in her patients.

In some cases, drug use has little to do with choice or background. Opioid addiction can be the involuntary side effect of using prescription medication. Gibson cites the case of a firefighter who had been given pain medication for an arm injury sustained while rescuing others from a fire.Though his prescription was for thirty days, he formed a lifetime addiction to opioids. It’s a pattern among opioid users. Prescription medication can activate addictive tendencies, causing them to keep using painkillers or turn to street drugs such as heroin.

“They’ve had to be creative to survive the kind of life they’ve led for so long.” -Pamela Gibson 22

“They’ve had to be creative to survive the kind of life they’ve led for so long,” she says. Her experience has taught her that treatment programs weren’t typically catering to the specific needs of clients. She felt inspired to join with Addisu Mengesha and his vision for Fresh Start Comprehensive Center. She now serves as program administrator for the center, ensuring that procedures are in compliance with state regulations and programs are up-to-date. She also connects clients to any additional services or resources available that could aid in their treatment. The center focuses on compassion, engagement and personalization for each patient. They provide mental health services, grief counseling, domestic violence counseling and trauma counseling. Counselors also go on-site to locations where people are experiencing trauma, such as natural disasters, to offer crisis services. Currently the center is also working to provide housing and form new connections for resources across the city. Providing a complete and integrated approach to treatment is vital to Fresh Start Comprehensive Center, aiming to treat each client as more than a number. “They’re more than addicts,” Gibson says. “They’re mothers and fathers.They have hobbies and interests, just like anyone else.They need to be treated that way.” 23

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INTERVIEW 3 Change To Metha done Reimbursement

State proposal aims to reduce repayment

A Maryland state agency has proposed reducing reimbursement to health facilities that use methadone to treat addiction. The proposal comes from the Behavioral Health Administration, which runs Maryland’s public mental health and substance abuse system. Currently, methadone payments are reimbursed by Medicaid for counseling and drug disbursement together. The proposal calls for the current $80 per week reimbursement to drop to $42, and would require treatment facilities to seek other funding sources for treatment. It would also separate counseling services reimbursement based on the kind of counseling. While some state officials say counseling can help patient health outcomes, some methadone treatment clinic operators say the proposal could hurt patients who might not be ready to receive counseling services. Methadone, according to the U.S. National Library of Medicine, is used to “prevent withdrawal symptoms in patients who were addicted to opiate drugs and are enrolled in treatment programs in order to stop taking or continue not taking the drugs.”

Operators: Resources Already Low

Counseling & Drug Treatment The proposal follows recommendations by the governor’s task force. The number of available and equipped counseling programs was one of the issues discussed. “This doesn't affect anyone’s bottom line if they are providing counseling,” Doug Mayer, spokesperson for Gov. Larry Hogan, tells The Baltimore Sun. “The overall effort is to ensure that it’s not just methadone, that it is counseling as well, which is an important part of treatment.” Treatment centers and providers were involved in drafting the proposal, and received letters about the proposal when it was announced. “Providers are among the stakeholders involved in the development of this proposal,” Christopher Garrett, spokesperson with the Department of Health and Mental Hygiene, tells The Baltimore Sun. “It is not something the state conceived of in a vacuum, without input from the community or the provider industry.” “Equipping the patient through counseling doesn't necessarily mean a provider will lose money, even a small provider,” Garrett says to The Baltimore Sun. “The goal is for the patient to get better and to graduate from the need to receive services from the provider.” “This doesn't affect anyone’s bottom line if they are providing counseling.” —Doug Mayer | Spokesperson for Maryland Gov. Larry Hogan Garrett notes that a wide variety of counseling is available to patients.

Drug treatment provider operators tell The Baltimore Sun that some clinics don't have the staff or resources to provide more intensive counseling, and clients might not be ready or willing to get counseling right away. Putting clients in programs to comply for reimbursements may end up hurting the client. “What this proposal will do is bankrupt every methadone clinic in the state,” Rev. Milton Williams, president of the Turning Point Clinic, tells The Baltimore Sun. “It is an effort to shut down methadone clinics in Maryland.”


The proposed fee reduction is seen by some treatment professionals as too much of a risk to the revenues of vulnerable treatment centers. “This could be extremely destructive,” Barbara Wahl, Concerted Care Group Business Operations director, tells The Baltimore Sun. “This is the last thing our patients need right now.” re Concerte

Wahl says the proposal may leave treatment centers with fewer options to provide care, not more. Wahl says the proposal may leave treatme e, not more.

“I think the spirit of the proposal is in the right place,” Wahl says to The Baltimore Sun. “It encourages more counseling, which is what we want to provide. It is just the way they want us to provide it that may be more burdensome than what they intended it to be.” The Department of Health and Mental Hygiene is still taking recommendations on the proposal and is accepting public comments on the issue. Some clinics, reports The Baltimore Sun, are planning protests against the proposal. Wahl says to The counseling, which is what we want to provide. It is just the way they want us to provide it that may be more burdensome The Department of Health and Mental Hygiene is still g recommend accepting public c orts The Baltimore Sun, protests against the proposal. 27

Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

“Generally there is good scientific support, but the evidence is mixed for different groups

and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa


overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is

But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.”


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Comprehensive Education

We have to look at whether ones choice to use or not is a direct result of their lack of skills to resolve problems as they develop. Addiction and recovery are best looked at in terms of degrees of diminishment or enhancement of voluntary control (aka as harm reduction). Once educated and given the tools, each person has a responsibility to: • Recognize their vulnerability for A&D disorders • Manage their own health • Act proactively to prevent the onset of such disorders • Recognize the presence of the disorders • Act decisively to arrest and manage the disorder


The Alphabet of Recovery Fresh Start uses cognitive therapy to help patients break unhealthy patterns

Fresh Start Comprehensive Center uses cognitive-behavior therapy (CBT) to equip clients with techniques that can control their tendencies for addictive behavior and also provide useful strategies for a lasting recovery. According to the National Institute on Drug Abuse, CBT is based on the theory that treatment for maladaptive behaviors should focus on learning processes.The goal is to improve a person’s ability to recognize harmful triggers and execute skills to better handle the situations leading to their drug use. Thoughts and beliefs can influence mood and behavior. By creating more adaptive and flexible thinking, a person becomes more capable of handling reaction-inducing situations that could potentially lead to dangerous activities. “Self-monitoring” helps recognize when to apply these strategies. Fresh Start’s counselor James Rogers use a form of CBT called rational emotive behavior therapy (REBT), which follows a concise model for self-monitoring that is easily applicable when clients need it most. “Changing the way you perceive the situation is what can stop unhealthy reactions.” -James Rogers, counselor, Fresh Start Comprehensive Center 34

Learning your ABC’s REBT uses a framework that shifts illogical or unrealistic thinking into more rational outlooks.The ABC method taught to patients gives manageable steps to handle triggers. In this model, “A” stands for activating event, which can include a fact, event or behavior.The event triggers a person’s belief, the “B” component, as a response. In the final “C” component, emotional and behavioral consequences arise from the belief. If a belief results in severe negative emotions, such as anxiety, depression, guilt or hurt, it can be considered an illogical belief.These emotions are harmful and inhibit regular functioning in the individual. By internally immobilizing the person, such severe emotions don’t encourage change or growth. In contrast, healthy negative emotions such as sadness or remorse are essential to proper functioning and allow room to alter behavior. REBT reconstructs the cognitive patterns that lead to irrational beliefs. When working with his clients, Rogers challenges them on notions they state as truth. By testing the validity of a thought, he hopes patients can realize the illogical nature of beliefs that result in negative emotional responses and lead to unhealthy coping mechanisms. Once clients become aware of the process, they can eventually recognize their own patterns and break them. “I want to focus on those three years.” -James Rogers Giving patients control An important aspect of REBT is empowering patients to create their own change. “It’s not a situation that causes a reaction,” Rogers explains. “The notions you hold about that situation create an emotional and physical response. Changing the way you perceive the situation is what can stop unhealthy reactions.” For his clients, this unhealthy reaction is substance abuse. After years of reliance on a drug, it can be difficult to embrace control over one’s own life. One way to relearn control is by figuring out what’s worked in the past. “If a client comes into my office and says I’ve used for 20 years with only three years clean within that time, I want to focus on those three years,” Roger says. “It tells me that they know how to stay clean. Now we just have to find a way they can extend those three years.”


Bend But Don’t Break Yoga is being used to help people maintain recovery and avoid relapse

Yoga is no longer exercise your annoying, health-conscious friend won’t stop talking about.The ancient practice is now being used to help people recover from addiction. While scholars estimate yoga was developed sometime around 300 to 400 B.C., the practice hasn’t stopped changing over the last 2,000 years. A new wave of yogis are now helping people in recovery connect their spiritual and physical sides through yoga by combining the practice with more traditional 12-step elements. “It’s just a way of coming back to a sense of wholeness,” says Nikki Myers, a yoga therapist who helped develop the 12-step yoga system. “We use yoga as a process in order to bring that reintegration.”

Myers says she developed the system primarily as a means of relapse prevention. She says a typical 12-step yoga session would begin the same way most 12- step meetings do, with a focus on sharing and discussion of important recovery topics. Once the “meeting” portion of the session is over, the group will then move into a series of yoga poses designed to help participants focus on their physical recovery. “A focus needs to be on the body- based piece as well as the cognitive piece in order for wholeness to really be manifested,”Myers says. “Once you include those things, the whole idea is that these will begin to offer us a set of tools that we can use both on the mat in the yoga practice and off the mat when the triggers of life show up.”

“It’s just a way of coming back to a sense of wholeness.” - Nikki Myers, yoga therapist


The right tools Myers says the idea that yoga can provide a set of tools is critical as the practice of yoga is much more than the poses themselves. She says there’s also a focus on breathing techniques, a meditation of sorts, and a connection to one’s physical reactions that can prove vital when faced with difficult circumstances. Myers recalls how one woman who participated in 12-step yoga later found herself in a very stressful situation at home with her kids misbehaving and everything going wrong. She said she could feel the negativity boiling up inside her. It was the kind of stress that had triggered her to drink in the past, but the woman said in that moment she was able to relax and calm herself by focusing on her breathing and remembering the feeling of tranquility she had experienced in class. “It had a way of creating a space, giving her tools to create a space between her reactions and instead take a different neural pathway,”Myers says. “These are the kind of tools that we’re looking to have people use.” “A focus needs to be on the body-based piece as well as the cognitive piece in order for wholeness to really be manifested.” - Nikki Myers

Not a replacement Myers is quick to point out that yoga is not a substitute for traditional 12-step support, but rather an additional measure that some people may find helpful. She says some people have pushed back against the practice, but others have been enthusiastic about its power, with classes spreading across the country and even internationally. Myers says she hopes that one day 12-step yoga will be as common as other treatment programs. But she says as long as people are maintaining sobriety and finding wholeness within themselves, she’ll be proud of the difference her system has made. “We’ll tell people, ‘Notice this in your body, what it really feels like,’” Myers says. “Healing only happens in safe space.”

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