The Vaping Epidemic and Fatal Lung Injuries

Vaping

By Michael Rass

Although e-cigarettes have been around for more than a decade, vaping rates have dramatically increased in recent years, particularly among teens. According to the Child Mind Institute, “e-cigarettes are now the most frequently used tobacco product among adolescents—some 2.1 million middle and high school students were e-cigarette users in 2017—far surpassing traditional combustible cigarettes.”

The Food and Drug Administration announced new steps in September to address the “epidemic of youth e-cigarette use,” issuing “more than 1,300 warning letters and civil money penalty complaints (fines) to retailers who illegally sold JUUL and other e-cigarette products to minors.” The Surgeon General warns that nicotine is harmful to children and young adults. “E-cigarettes typically contain nicotine as well as other chemicals that are known to damage health. For example, users risk exposing their respiratory systems to potentially harmful chemicals in e-cigarettes.”

Vaping products have risen in popularity among teenagers and young adults because they are considered a safer alternative to traditional smoking and provide a clandestine means of using marijuana. In a 2017 state survey, 27 percent of Colorado youths reported using e-cigarette products—the picture is not much different in other states. Vaping is also endemic among young adults in their twenties and thirties.

The popularity of vaping co-evolved with the widespread perception that marijuana use is harmless. In recent months, too many young Americans had to learn the hard way that neither vaping nor cannabis use is without risk, especially when the two are combined.

Colorado is now one of several states investigating severe lung injury associated with vaping. There have been at least nine cases in the Centennial State. Colorado parents Ruby and Tim Johnson told CBS that vaping nearly took their daughter’s life. Piper Johnson was diagnosed with Colorado’s first case of a vaping-related illness. The first-year college student had been vaping for more than two years.

As of October 29, the Centers for Disease Control and Prevention (CDC) reported 1888 vaping-related lung-injury cases in 49 states, the District of Columbia, and one US territory. Thirty-seven deaths have been confirmed in 24 states. Early symptoms of these lung injuries include coughing, shortness of breath, fatigue, chest pains, nausea, vomiting, and diarrhea.

Medically, it’s still unclear exactly what is going on. “Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury, its pathology is poorly understood,” a number of Mayo Clinic specialists wrote in the New England Journal of Medicine in October. They did discover, however, that all of the cases they studied “had a history of vaping, with 71 percent of them having used marijuana or cannabis oils.”

The CDC currently recommends refraining from using e-cigarette, or vaping, products, particularly those containing THC (the psychoactive component of cannabis). Massachusetts Governor Charlie Baker took the drastic step of declaring a public health emergency and banning in-store and online sales of vaping products in the Commonwealth through January 25, 2020. On the same day, California health officials issued an advisory asking residents to immediately refrain from using e-cigarette devices until a statewide investigation into the risks associated with vaping is completed.

The Colorado Department of Public Health and Environment (CDPHE) is investigating all cases reported to them and advises that “the best way to protect yourself against vaping-related illness is to stop vaping.”

“Findings from other states show that most people who got sick used THC-only products or both THC and nicotine products. That is true in Colorado as well, but because the long-term health effects of vaping are unknown and as information on the illness emerges, our best advice is to consider not using vaping products.”

Coloradans who think they may have been sickened by any vaping product should contact their doctor, local public health agency, or poison control at 1-800-222-1222.

Harmony Foundation supports long-term behavioral change. When clients choose our program for recovery from alcohol and drug addiction, they are taught coping skills to help them avoid all addictive substances and embrace a healthy lifestyle. This is why we do not support vaping on campus and provide recovery skills classes that teach healthy choices.

Replacing alcohol or opioid misuse with increased nicotine intake is not a good idea. True recovery goes beyond abstinence from illicit drugs and alcohol. The goal of addiction treatment at Harmony is a comprehensive body-mind-spirit reset. The cessation of substance misuse is only one aspect of that reset.

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LINKS
CDPHE information on vaping and lung illness https://www.colorado.gov/pacific/cdphe/vaping-lung-illness

Surgeon General’s fact sheet on vaping. https://e-cigarettes.surgeongeneral.gov/

Harmony Joins the Voices of Recovery

September is Recovery Month and this year the Substance Abuse and Mental Health Services Administration (SAMHSA) celebrates the 30th anniversary of this addiction awareness campaign. The 2019 theme, “Join the Voices for Recovery: Together We Are Stronger,” emphasizes the need to share resources and build networks to support the many paths to recovery. It reminds us that mental health and substance use disorders affect all of us and that we can all be part of the solution. Recovery Month highlights inspiring stories to help many people from all walks of life find the path to hope, health, and overall well-being.

One of those inspiring stories is Michael Arnold’s recovery from alcohol addiction. Michael’s alcohol use disorder almost killed her but she turned her life around and now works as an alumni relations manager at the Harmony Foundation. “Every day is a day of recovery, of course, but Recovery Month is that much more focused and there is more intention behind the message of hope that we are all trying to put forward, emphasizing that you can recover,” says Arnold.

Recovery Month began in 1989 as “Treatment Works! Month,” which honored the work of substance use treatment professionals in the field. A lot has changed in 30 years of fighting the stigma of addiction. “Every single year it’s getting better—especially now that alcohol and drug addiction is recognized as a disease of the brain,” says Arnold. “More and more people are starting to show more compassion and desire to understand instead of judging.”

Harmony is celebrating Recovery Month with a 50th-anniversary alumni reunion and a special workshop. “It will look at vulnerability, communication, and owning your sobriety,” explains Arnold. “Behind the ‘stronger together’ motto there is a lot of vulnerability for people in recovery and the workshop will discuss that.” Michael’s own motto is “recover out loud!” Her way of dealing with the disease is to help others, sharing the story of her addiction and recovery instead of hiding her past.

“Our addiction wants us in isolation—completely alone,” she says. “Our addiction wants us in the dark. How do we combat this? Together. Together, we can recover. In order to live a healthy life in sobriety, it is imperative to have a community. When we recover together, we become part of each other’s solutions.”

To spread the message that the door to recovery is always open, she has co-authored a book about recovery. “Our book is all about the fact that addiction doesn’t discriminate, and so recovery doesn’t, either. We work together, no matter what your pathway to recovery may be.”

You can be part of Recovery Month, too

One way to help your community rally around treatment and recovery is to encourage
social media user-generated content. Urge participants to use hashtags like #RecoveryMonth, #RisforRecovery, or #Recovery. Encourage them to share their personal stories about recovery and to tag their friends, family, and other members of their community. A local social media campaign is something easy for people to participate in and can foster a positive, collaborative spirit among community members.

SAMHSA’s Recovery Month toolkit provides a lot more information, resources, and ideas on how to get involved. With your help, the millions of Americans affected by mental and substance use disorders, including co-occurring disorders, will be lifted up into a life in recovery, filled with hope, health, and personal growth.

Harmony Foundation Upgrades Mental Health Services

Mental Health Team

by Michael Rass

Harmony has provided addiction treatment at its Estes Park center in Colorado for half a century. In the beginning, Harmony was a place where alcoholic men could “dry out,” attend AA meetings, and then return home. Over the years, this first treatment approach was expanded to include group therapy sessions, the expertise of a physician, and a treatment protocol based on the Minnesota Model.

Beginning in 2008, Harmony expanded its detoxification facilities and revised its protocol to include Subutex detox methods for opioid addicts. More recently, Harmony added the HOPE Program which offers medication-assisted therapy using buprenorphine to clients with opioid use disorder.

Led by chief clinical officer Annie Peters, Harmony has now upgraded its dual diagnosis capabilities. Dr. Peters developed a roadmap for Harmony to become a dual-diagnosis capable facility serving clients with SUD and co-occurring mental health disorders. Dual diagnosis (also referred to as co-occurring disorders) is a term used for patients who experience a mental illness and a substance use disorder simultaneously. Harmony is now fully dual diagnosis capable.

This modern, evidence-based approach to addiction treatment acknowledges the important role mental health conditions play as drivers of substance use disorders. People may misuse drugs and alcohol because of mental health issues like trauma, depression, and anxiety. “If co-occurring conditions aren’t addressed, clients are more likely to relapse because they may be drawn to substance use to self-medicate those issues,” says Dr. Peters.

People with addiction may also have traumatic experiences as a result of their substance use. “When people are using substances, they may find themselves in dangerous, potentially traumatizing situations that cause further emotional pain, which then leads to more substance use,” says Peters. “This is a difficult cycle for people to pull themselves out of without help.”

Traumatic life experiences are extremely common among patients with substance use disorder. Many suffered adverse childhood experiences. “Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse,” writes Canadian physician Gabor Maté in his seminal addiction study In the Realm of Hungry Ghosts.

Because of this strong correlation, trauma-informed care is an important part of addiction treatment. All staff at Harmony have been trained in trauma-informed care. “When people come to treatment, they often have few coping skills to deal with traumatic memories and emotional pain,” says Peters. “Our primary goals are to help them feel safe in the world, manage emotions and situations without substances, and improve their self-esteem and quality of life.”

Trauma-informed dual-diagnosis care begins with a careful assessment. “Every client gets screened for mental health disorders,” says Harmony therapist Gretchen Leezer. “We identify the needs of the patient and establish which ones we can start working on immediately while they are at Harmony and what follow-up treatment they should get once they have been discharged.”

It’s important to address mental health issues as soon as possible, even if the main focus of treatment is the addiction. “When someone comes into addiction treatment with a long history of depression, anxiety, suicidal thoughts, or trauma, we want them to leave here with a roadmap for recovery from all of these difficulties,” says Peters.

Harmony mental health professional Uric Geer likens Harmony’s dual diagnosis approach to a Möbius strip which can be created by taking a paper strip, giving it a half-twist, and then joining the ends of the strip to form a loop. If one side reveals the SUD and the other the mental health disorder, then the twist makes both sides visible whereas a normal paper ring would keep the condition on the inside hidden from view. “If you only treat what’s visible on the outside—the substance use disorder—then an important part of the problem remains hidden and untreated,” says Geer.

The treatment team at Harmony works hard every day to address all relevant needs a client might have. “The culture at Harmony is simply amazing,” says Harmony psychologist Rob Leach. “The leadership has a great vision and the team as a whole is extremely dedicated. They put in great effort to meet clients where they are and develop individual treatment plans. There is great coordination of care. Really listening and meeting clients where they are, creates an atmosphere of trust and that’s crucial for their recovery.”

On Having Fun Without Alcohol

Bar Zero

When I stopped drinking in April of 2005, I wondered if I would ever be able to have fun again outside of the bar scene. I feared I would never enjoy a live concert again, one of my greatest joys in life. As a single person, I had no idea how I’d ever go on a date again. “Who goes on a date and doesn’t drink?” For that matter, “Who goes out to eat at a nice restaurant (date or no date) and doesn’t have a glass of wine with their meal!?” (Did I mention the aperitif, the bottle of wine at dinner, and the after-dinner drinks that turned into shots towards the end of the evening?) I’d ruined all prospects of fun in my life! I determined I would always be, from that day forward; bored, boring, and surrounded by other bored and boring people. I was working in a bar. Most of my friends worked in bars and restaurants. Almost all my friends drank alcohol.

In those first few years as a non-drinker, I struggled to find activities that didn’t involve alcohol. However, more often than not, I participated in events that were drenched in alcohol and drug use and risked my new lifestyle and trajectory towards wellness. As a therapist, I would never have advised this to any of my clients. Why hang out in a candy shop if you are trying not to eat any added sugar? It seems the obvious choice would be to find a broccoli shop instead. But, broccoli shop? How bland, how boring, and how nonexistent! We needed a place that still felt like the candy shop without the candy! Still sweet, still vibrant, still FUN! Ok, enough with the metaphors. I wanted a nonalcoholic bar! A place for connection with other people making similar life decisions, a place without the risk but still social. I pondered that idea for a while, and then let it drop. It took several more years until that thought became a reality, in fact, it wasn’t until 2018 that I told this idea to a friend and she encouraged me not to ponder it anymore but to do it. Thank you, Allison! And, Bar Zero started to become a reality.

Once I started sharing this idea, I learned that so many others in recovery were longing for a space like this. I definitely was not the only one, and several people even mentioned calling it “SoBar,” which was our original name! I heard stories of friends in recovery having discussions about building a space just like this, a place for connection and community building for people in recovery. Many had the same questions I did in early recovery with the general theme being, “Will I ever have fun again?”

Just as this concept was forming and becoming something more than a shared idea, the sober curious movement started catching on. What timing! Now it’s not only those of us who consider ourselves “in recovery” looking for safe spaces, it’s also a new group of people looking for fun and for fewer hangovers yet still going out and enjoying a Friday night on the town! And, the press, the bar and restaurant industry and the general public are talking about not drinking! And, about drinking really tasty, alternative nonalcoholic drinks! They’re calling them “mocktails,” “zero-proof beverages,” “spirit-frees.” They’re being sold by Coca-Cola in a new line of nonalcoholic drinks called Bar None https://www.drinkbarnone.com/. They’re being made by distilleries, even! Non-alcoholic distilled beverages are made by Seedlip https://seedlipdrinks.com/us and starting to become more and more popular across the US after originating in the UK. And, the most fun part, local bartenders are starting to get excited and inspired to make high-end and delicious drinks without alcohol in them! Creativity and talent are showcased by the top bartenders in town and they are getting written up by local publications! https://coloradosun.com/2019/08/02/denver-sobriety-movement/

I’ve happily given interviews to the Denver Post (coming soon), Westword (twice!) https://www.westword.com/restaurants/sobar-could-soon-be-denvers-first-restaurant-for-and-by-the-sober-community-11105915 https://www.westword.com/restaurants/sobar-rebrands-as-bar-zero-with-plan-to-launch-catering-company-11408158, and Dining Out (also coming soon!) People are interested and getting involved with this new way of looking at drinking, or rather, not drinking and it is so thrilling to watch and experience!

Whatever they are calling these new drinks and establishments popping up across the country, I’m so excited to be a part of this shift, this movement! Without shame, without stigma, a lot more people are speaking clearly about what makes so much more sense, connection and a “life” without the booze yet still having a social outlet and space that includes delicious food and DRINKS!

Bar Zero is the space we’ve been craving. We are going to make it a reality. We need help doing that. Bar Zero is a 510 (c) 3 nonprofit organization and we have a long way to go before opening a brick and mortar restaurant. We are creating space for connection and community building. AND, also very excitingly, we are offering on the job training for people in early recovery from substance use problems. We know the “sober curious,” the “gray area drinkers,” those of us in recovery, and our communities at large need a place like this. Please help us bring this to Denver!

Our first Fundraiser is planned for September 11th, 2019 at Dazzle Jazz in downtown Denver. In partnership with Friends and Family, a Colorado nonprofit group for people who work in the hospitality industry, we are putting on a Zero-Proof Beverage Mix-Off! See the details on this amazing event on our website https://barzerodenver.org/ on the event page and join us for a unique and fun evening. Denver’s top mixologists will compete for a spot on the Bar Zero beverage menu. A panel of guest celebrity judges will taste and rate original eye-catching, mouthwatering nonalcoholic drink recipes. And you’ll get to be the judge too, by tasting a collection of awesome Zero-Proof Beverages and helping to pick the People’s Choice Award winner, all while enjoying new food menu creations and pairings by Chef Paul Rose.

Bar Zero’s Mission: Connection through food, intentional community, and professional collaboration for a continued life worth living in recovery.

When Gray Drinking Leads to Long-Term Sobriety

Gray Drinking

by: Michael Rass

Sobriety is no longer just the earnest goal of recovering alcoholics. As of late, it has also become the holy grail of so-called “gray area” drinkers.

According to former social drinker Amanda Kudo that gray area is the “place where you’re not a super-casual, once-in-a-while drinker, but you’re also not a hit-rockbottom, time-to-get-help drinker, either. You’re just there, somewhere in the middle, drinking in a way that is still deemed socially acceptable if not socially necessary.”

Or as health coach Jolene Park put it in her TED talk, “from the outside looking in, my drinking did not look problematic, but from the inside looking out, I knew, the way I was drinking was a problem for me.” Many people like Kuda and Park say they never had a real drinking problem, but they had a problem with drinking.
One of those “gray area” drinkers was British expat Ruby Warrington, currently living in Brooklyn, who— according to the New York Times—”spent her early career quaffing gratis cocktails at industry events, only to regret the groggy mornings.”

“After moving to New York in 2012, Ms. Warrington tried 12-step programs briefly but decided that ‘Ruby, alcoholic’ was not the person she saw in the mirror,” wrote Alex Williams in the Times feature about a new sobriety trend spreading across the nation. “Three years ago she started Club Soda NYC, an event series for other ‘sober curious,’ as she termed them: young professionals who were ‘kind-of-just-a-little-bit-addicted-to-booze.’”
Being “sober curious” has caught on and Warrington wrote a whole book about this latest health fad. “For these New Abstainers, sobriety is a thing to be, yes, toasted over $15 artisanal mocktails at alcohol-free nights at chic bars around the country, or at ‘sober-curious’ yoga retreats, or early-morning dance parties for those with no need to sleep off the previous night’s bender,” wrote Williams.

But there is a serious side to avoiding alcohol use, of course. It is after all an addictive substance without any health benefits that physicians would acknowledge. And while the sober-curious vogue may well be short-lived, reducing or giving up alcohol consumption is certainly laudable since it comes with all kinds of health benefits.
When Jolene Park described her alcohol use as knowing “the way I was drinking was a problem for me,” she was actually paraphrasing the first diagnostic criterion of alcohol use disorder (AUD) in the of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which reads: “Alcohol is often taken in larger amounts or over a longer period than was intended.” And when she said in the same TED talk that she had no trouble stopping but couldn’t “stay stopped,” she was paraphrasing the second AUD criterion in the DSM-5. Two criteria (out of eleven) indicate a mild alcohol use disorder.

Park probably wasn’t aware of the DSM-5 criteria at the time but she read the warning signs correctly and realized that she was “kind-of-just-a-little-bit-addicted-to-booze.” She understood that her alcohol use could escalate further and made the right decision. She embraced sobriety.

She also realized that her alcohol use was a coping mechanism for her anxiety issues and designed a new coping strategy for herself based on connecting with nature and other people, exercise, and meditation. Park now shares this healthy approach to life with other people.

Amanda Kuda also realized that she needed to drink in order to relax. “But there was a bigger part of me that wanted to feel happy, joyful, vibrant, inspired, energized, motivated, fulfilled. Once I realized that alcohol was not only failing to contribute to those feelings, but was actually dragging me further and further away from them, I no longer wanted to drink.” Neither Park, Warrington, or Kuda sought detox or residential addiction treatment for their alcohol problem, and only Warrington briefly tried a 12step program. This low level of care for a mild or moderate alcohol use disorder may not be the right choice in all cases, though. Some patients might require an intensive outpatient program or even partial hospitalization. Only a careful assessment of the patient’s individual needs can determine the appropriate level of care.

Although none of the three “gray-drinking” women made use of a treatment program, they nevertheless realized a core principle of recovery. Stop using and change your life! Real recovery goes far beyond giving up substance misuse. It is a life-changing journey to long-term wellness that should make you feel happy, joyful, and inspired.

IF YOU OR A LOVED ONE IS STRUGGLING WITH SUBSTANCE USE DISORDER, OR YOU HAVE QUESTIONS ABOUT OUR PROGRAMS, CALL HARMONY TODAY AT 970.432.8075 TO GET THE HELP NEEDED AS SOON AS POSSIBLE

Harmony Fights Opioid Epidemic with HOPE

More than two-thirds of drug overdose deaths in the United States in 2017 involved opioids, according to the Centers for Disease Control and Prevention, escalating an epidemic the CDC says “continues to worsen and evolve.” From 2016 to 2017, opioid-related overdose deaths increased 12 percent overall, surging among all age groups 15 and older.

The CDC report’s recommendations for curbing opioid-related overdose deaths include “increasing naloxone availability, expanding access to medication-assisted treatment, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services.”

Naloxone is a medication often used by first responders because it can rapidly reverse opioid overdose. It is an opioid antagonist—it binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain relievers.

Medication-assisted treatment (MAT) is used to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. Medications used for the treatment of opioid use disorder are buprenorphine (Suboxone, Subutex), methadone, and extended release naltrexone (Vivitrol). Some of these drugs are controversial in the recovery community because they are themselves opioids.

The National Institute on Drug Abuse, a US government research institute, clarifies that contrary to what some critics say, “methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.”

The use of these medications should always be combined with behavioral counseling with the ultimate aim of ceasing all substance misuse.

HOPE – Harmony’s Opioid Programming Experience

Harmony has provided all clients with medication-assisted treatment for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce cravings, and give the patient time to heal from the psychological, social, and spiritual wounds of addiction.

“It’s important to remember that MAT is only a small part of the picture,” says Harmony’s medical director Christopher Reveley. “That is why we call it ‘medication-assisted’ treatment, because by itself it is not the treatment. Used alone it has a low probability of being successful.”

At Harmony, HOPE begins with thorough medical and psychological evaluations. Collaboration with the patient, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly support groups led by a professional addiction counselor. These groups address the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid relapse. In this setting, clients support each other and are educated about the process of recovery.

Medication-assisted therapy may help stabilize the patient for these challenges in early recovery. “It gives people an opportunity to step out of the chaos of addiction and consider other ways of being,” says Dr. Reveley. “I never felt that buprenorphine was meant as a lifelong or even long-term solution.” Although there may be exceptions. It all depends on the individual needs of the patient. Reveley remembers a patient who had been on methadone for 46 years. “He tried to taper off a dozen times and relapsed to heroin use every single time. His family was initially very opposed to him being on methadone but eventually they told him ‘this is working, your life depends on it.’ So there are people on either end of the bell curve but in most cases buprenorphine is only a small but important part of the solution.”

Buprenorphine can be an important tool, especially in early recovery from opioid use disorder. The medication offers patients the opportunity to start living a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin and other opioids. People are dying every day from opioid overdoses, especially in the age of the fentanyl scourge. Buprenorphine may provide the buffer that enables them to launch into sustained recovery. It is a buffer that can save people with addiction from a potentially lethal overdose.

Harmony has been treating addiction for 49 years and HOPE is now offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opioid use disorder and needs help, call Harmony at 970-432-8075 and one of our admissions specialists can discuss next steps.

The Insurance Dance with Recovery in Mind by Jim Geckler

Collaboration

We recently received a Facebook post regarding frustration over Harmony’s handling of payments made through insurance. I wanted to use this opportunity to discuss questions and concerns about our partnerships with insurance partners and how we believe it helps benefit access to treatment.

First and foremost, insurance companies make it easier for us to cover some of the cost of treatment, a service that many of us do not plan for when the time requires it. When we consider our personal relationships with insurance partners, how many of us would be able to have yearly physicals, emergency procedures, or access to treatment? As a provider, Harmony works with our insurance partners to provide the appropriate level of care for the appropriate period of time.

Harmony has a 49 year history of providing a residential level of care; this is the highest level of care for people suffering from substance use disorder. We have a responsibility to our clients to stabilize them medically, assess their conditions, provide them with a diagnosis, work with them to create a foundation for sustained recovery, and construct a comprehensive continuing care plan which will support their recovery. The relationships we have fostered with insurance partners has allowed us to work collaboratively to support access to care along the continuum. Under the umbrella of the American Society of Addiction Medicine (ASAM), together, insurance companies and treatment providers alike are held to the highest standards of care for addiction treatment. This common language, reviewed in tandem with insurance providers determines what level of care an individual requires.

Sometimes there is disagreement.  For example, when Harmony feels that a client would be better served by remaining at a residential level of care and an insurance provider feels they would be successful at the next level.  Other times, a client would like to remain in treatment, however our expert clinical and medical staff believe they are ready to move toward self-management of their own recovery at a level of care which empowers them to practice the early skills of recovery they learned here. In most cases, to arrive at a decision to move a client to the next level of care, involves a conversation with our Medical Director and a physician reviewing the case for the insurance company. We work to keep people at the appropriate level of care indicated by our clinical staff recommendations based on the client’s progress.

Harmony has a dedicated utilization review team, clinical professionals who work with our insurance partners, staff, and clients to keep people at the level of care which will provide them the greatest opportunities for success. When it is determined that funding for residential care has ended, we work to inform the client as quickly as we are able. Unfortunately in this situation the determination for a shift in levels of care is immediate, funding ceases that day. In order to ease the transition for clients and families, Harmony is committed to absorbing the expense of an additional night’s stay for clients. This is not common practice and comes at a fair cost. For example, in the month of July, we provided $28,000 in housing and care at no additional expense to clients. We are able to continue to do this through the generosity of our donors. We recognize the challenge and frustration of learning at 4 pm that one no longer has financing for treatment, however we are dedicated to continue to support our clients during this transition period.

There is nothing magical about 28 days of treatment. We have heard the 28 day timeframe used for many years, growing in public awareness with the Sandra Bullock film. The reality is that proven success is driven by long term engagement in treatment within a full continuum of care, at multiple levels  increasing the opportunity  for self-management.

We will always remain committed to providing access to treatment whenever possible, using all means necessary to help individuals receive treatment that can build an early foundation of recovery.  This could look like something as short as a few days or as long as 4 months.  Either way, our partnerships with insurance and our recommendations for treatment will always be the focus in providing individualized care for clients.

Jim Geckler is the Chief Executive Officer for Harmony Foundation.

Caring for the Queer or Transgender Person in Recovery by Luca Pax

The Center for American Progress reports that between 20-30% of transgender people struggle with addiction compared to an estimated 9% of the general population. This statistic is significant for those of us who are transgender, and for those of us who support transgender people in our lives. As family members and care providers, even if we have good intentions in caring for queer or transgender people in recovery, we may need to intentionally adjust our actions, in order to have a positive impact.

What can I do as a provider?

Ask, Affirm
When a transgender person shares an intimate part of their identity with you, honor and affirm their identity by using their correct name, pronouns, honorifics, and gendered or non-gendered terms when referring to them. If you ask someone their gender identity or pronouns, do so in a way that is not interrogative or invasive, but rooted in trust and relationship. Make it a normal practice to share your own gender pronouns, and to ask others’, so that transgender folks are not as singled out, or put into vulnerable situations.

Listen, Believe
If you are given the opportunity to learn more about the identities that your client holds, listen to their self-definition and believe what they share with you. Know that LGBTQIAP+ identities are valid and real, and that people who hold these identities deserve to be trusted in their self-knowledge. Remember that each individual is the expert on their own identity, and challenging or disrespecting a client about a marginalized identity contributes to their lack of safety.

Include, Support
As care providers, our first commitment is to do no harm. Keep this in mind for transgender clients when making room pairings and restroom designations in residential treatment. Consider using inclusive language in your policies and procedures, and in your new client paperwork. Making these changes may require us to deconstruct our own social conditioning about gender norms and stereotypes, in order to best respond to transgender clients’ assessment of their safety. We may also find ourselves in a position to educate, when confronted with discomfort that may arise for cisgender staff or clients.

What can I do as a friend or family member?

Your love and support matters! The 2012 Trans PULSE Project study shows that transgender people with a parent who is supportive of their identity experiences a decrease in attempted suicide rates from 57% to 4%. With a supportive parent, these subjects’ sense of self-esteem increases from 13% to 64%, and their overall life satisfaction increases from 33% to 72%.

Caring for our queer and trans family members in recovery means ensuring that our respect and love for them continues, unaffected by their transition or identities. We can lift some of their burden by explicitly supporting them in the choices they may make to transition or “come out” socially, legally, and/or medically.

As family and loved ones of transgender people in recovery, it is important for us to educate ourselves about what our loved one may be experiencing. It is equally important that we work to maintain clear and healthy boundaries, and that we prioritize our own self-care.

You may consider joining an Al-Anon or ACA group, and utilizing resources from organizations like PFLAG or Trans Youth Education & Support of Colorado (TYES). You may also consider picking up recommended reading like the WPATH Standards of Care, PFLAG’s Trans support publications, and publications by other addiction treatment providers.

For the transgender or queer person seeking recovery, I am here to reassure you that there is community who understands you. Whether you connect with other LGBTQIAP+ folks virtually, through social gatherings, or while receiving therapeutic care, recovering in relationship with others who love and support you is possible.

If you know the pain of isolation, you deserve to discover that freedom is available to you. Connection with people who have walked a similar path as you, and sharing honestly with others, can be your ticket to a life unbound by addiction, and rich in resources that affirm and sustain the health of your truest self.

There will be times when we, as queer or transgender people in recovery, feel very alone. Whether this is a result of an addiction, our environment, or the weight of simply being who we are in a world that often creates no space for us – know that there are people waiting to undertake this work and journey alongside you.

There are many tips online for how you can take small steps throughout your day to regulate and find relief (like 8 Mental Health Tips for Queer & Trans POC, and 5 Awesome, Immediate Self-Care Resources For When You Feel Like Actual Garbage).

You can also get connected to Queer Asterisk Therapeutic Services, a non-profit organization in Colorado run by queer and trans professional therapists and educators who provide queer-informed counseling services, community programming, and educational trainings to promote the inner wellness and social connectivity of queer and trans people. Follow us on Facebook, Instagram, and sign up for our monthly newsletter, to learn more!

Luca Pax (they/their/them), who is nonbinary transgender, holds a BA in Education and Peace Studies from Naropa University, and works as Director of Community Relations for Queer Asterisk Therapeutic Services.

Edited by RP Whitmore-Bard, Communications Specialist.

Queer Asterisk Therapeutic Services advocates for the importance of excellent individual and community-based mental health treatment for queer and trans folks. Our therapists and educators partner with healthcare providers to ensure that queer and trans clients receive the most inclusive, highest quality of care possible.
We have offices in Denver, Boulder, and Longmont, Colorado.

Reference our Etiquette Guide & Glossary of Terms to support your education.

Self-Sabotage: Significance and Strategies

selfsabotage

by Khara Croswaite Brindle, MA, LPC, ACS

“Self-Sabotage is when we say we want something and then we go about making sure it doesn’t happen.” Alyce P. Cornyn-Selby

You may find yourself after the fact, stating you don’t know why you did it. Why you ended the relationship when nothing was wrong. Why you walked out of the job after only a month. Why you picked a fight and got kicked off the team. These are just a few examples of when someone may have engaged in self-sabotage. And the question is, why?

Under the Iceberg
Identified as the founder of Psychology, Sigmund Freud once described the mind as an iceberg. The tip of the iceberg above water was our conscious or thoughts or feelings we are aware of, and accounts for roughly 20% of our mind. The other 80% under the surface represents unconscious, and represents things we are not yet aware of to better understand our behaviors.

Mark Tyrell, Self Help author of “Self-Sabotage Behaviour can come in many forms,” identifies four common reasons one may engage in self-sabotage.

#1 Anticipatory Grief
For some of us, the familiarity of failure is a painful, somewhat predictable experience. We may go through our world anticipating loss, or anticipating when something good, something we enjoy, is going to switch, fall, end, or fail. Perhaps you can relate to the following thoughts of anticipatory loss or end:

  • I’m waiting for the other shoe to drop
  • This is too good to be true
  • What’s the catch?
  • Nothing good lasts for me, when will this go south?

Because these thoughts have a lot of power, you may find yourself engaging in a belief that you don’t deserve good things. Or that you are doomed to suffer and that failing is inevitable. Similar to self-fulfilling prophecy, you may find yourself predicting the outcome, and in this case, it’s negative. With these thoughts in mind, you may find yourself also subscribing in the second reason one can engage in self-sabotage.

#2 Control Freak
If we truly believe something good is going to end badly, we may want to be in control of the outcome. Have you ever found yourself thinking:

  • I’ll just end this relationship now, it’s less painful in this moment than when it ends months or years from now.
  • Better to leave this job before I get fired.
  • I already know they are going to say our friendship is over, so I’ll just stop talking to them and get it over with.

We may convince ourselves that feeling in control of the failure in this moment can hurt less than something that comes on suddenly, out of the blue, or later when our guard is down.

#3 Boredom
The experience of our guard being down and everything feeling predictable can lead to discomfort as well. Predictability can lead to boredom, which can also be a reason to self-sabotage. If we go from feelings of chaos and excitement to monotony and boredom, Mark Tyrell states, as one example, we may find ourselves picking a fight with someone for no reason at all. Perhaps just for the alive feeling we get from adrenaline and excitement. Do you find yourself engaging in any of the following:

  • Picking a fight when you aren’t upset
  • Looking for trouble in new environments
  • Engaging in substance use
  • Relapsing when no trigger is present

#4 Feeling Unworthy
Relapsing when not triggered can also be due to feelings of low self-worth. Maybe you feel you don’t deserve success or happiness and instead, engage by punishing yourself and setting yourself up to fail. This can represent the cornerstone of self-sabotage in wanting something and doing everything in your power to not achieve it, basically going the other direction from success. When explored further, many truly believe they “aren’t worth it” and engage in behaviors that prevent progress due to those negative beliefs.

#5 I’m Unprepared
One final example of self-sabotage to consider is the feeling of being unprepared. Perhaps you don’t feel ready to end a support program and so you relapse to remain involved with probation or the treatment community. An observation of those in the legal system is that they don’t feel they have resources on the outside, so they find themselves committing a petty crime to be reintroduced into the environment that feels most familiar. You don’t yet feel prepared to do this on your own and so you create a reason to not be on your own.

So where do you go from here? For many, just the awareness of why one engages in self-sabotaging behaviors can be a powerful process in exploring needs and change to more positive behaviors. Being aware that you are not alone in the reasons for self-sabotage and talking about the challenges can be a healing journey towards self-love, acceptance, and success.

For additional ideas of how to manage self-sabotage, you can check out Mark Tyrell’s “Self-Sabotage Behaviour can come in many forms,” at http://www.uncommonhelp.me/articles/stop-self-sabotage-behaviour/  

“In order to succeed, we must first believe that we can.” Nikos Kazantzakis

Khara Croswaite Brindle, MA, LPC, ACS, is a Licensed Professional Counselor in the Lowry Neighborhood of Denver, Colorado. She received her Masters Degree in Counseling Psychology from the University of Denver with a focus on community based mental health. Khara has experience working with at-risk youth and families, including collaboration with detention, probation, and the Department of Human Services. Khara enjoys working with young adults experiencing anxiety, depression, trauma, relational conflict, self-esteem challenges, and life transitions.