How Families Can Handle A Loved One’s Addiction

How Families Can Handle A Loved One’s Addiction

  Solemn, Pensive, Upset, Doubt, Depressed

So you’re ready for your loved one to get help for addiction, but he or she isn’t open to the idea. You’re not alone. Most addicts are unwilling patients. Usually, a life-altering event – such as a court order, divorce, loss of job, or hospitalization – pushes the addict into seeking treatment. There are ways that family and friends can help their loved one realize they need treatment before such devastating events occur.

From the Addict’s Point of View

The National Institute on Drug Abuse defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” The addiction changes the structure of the brain and how it works, leaving addicts powerless and unable to make rational decisions and realize the severity of their disease. Addicts depend on drugs to function and make excuses to justify even their worst actions. Even in the face of losing a job, ruining relationships, and other negative consequences, addicts may still deny a problem exists and may resist treatment.

While the initial decision to try drugs or alcohol may be voluntary, when addiction takes over, the person’s ability to exercise self-control becomes significantly impaired. Through brain-imaging studies on addicts, experts have shown how drugs physically change the areas of the brain that are necessary for judgment, decision making, learning, memory, and behavior control.

From the Family’s Point of View

Addiction affects family and friends as much as it affects the addict. Family and friends may grow resentful of the addict or live in fear of the addict. Relationships with significant others and children are often in conflict. Many couples argue over money because the addict may lose his or her job, miss hours at work, make poor financial decisions, or spend a lot of money on drugs or alcohol.

Friends and family can suffer emotional trauma as the addict may yell, talk down to, insult, or manipulate them. Physical violence can occur in the household of an addict. Addicts may also engage in infidelity. All of these issues can lead to breakups, legal separation, or divorce.

How to Help

The first way to help your loved one is to get educated about addiction. Realize that addiction is a debilitating disease, and treat it as such. Educating yourself can help you provide support, patience, and understanding. Get support from groups or individual sessions with a mental health professional.

You can’t control your loved one’s behavior, but you can control how you react to the addiction and ensure you’re not enabling him or her. While you should certainly help your loved one in positive ways, such as looking for a job or choosing a treatment center, set clear boundaries around behaviors you deem unacceptable. For example, don’t allow him or her to hang around when they’re high or drunk. Likewise, don’t allow the addict to borrow money.

“Setting and enforcing boundaries not only allows loved ones to resume control of their lives, practice healthy detachment, and safeguard their own health and well-being but also helps the addict face the natural consequences of their actions,” says Psych Central. Staging an intervention works in many cases and can be a highly effective way to break through the addict’s denial and get him or her to agree to treatment.


Through intervention, friends and family get the addict’s attention and help their loved one understand the consequences of his or her destructive behavior before more serious consequences arise. A professional known as an interventionist helps to assess the situation, recommend treatment facilities and long-term after care plans, and ensure that the process remains productive and healing. There are specific steps that should be taken before, during, and after an intervention.

Your loved one may agree to receive treatment, but you and your family still need to seek professional help as well. Living with an addict can cause emotional trauma, especially in children, and as such, families of addicts should seek counseling. Each individual can attend counseling, or everyone can attend counseling as a family. When addiction recovery and therapy begin, the family can begin to heal and move toward a brighter, healthier, and happier future.

By guest author Adam Cook. Mr. Cook is the founder of Addiction Hub, which locates and catalogs addiction resources. He is interested in helping people find the necessary resources to save their lives from addiction. Adam’s mission is to provide people struggling with substance abuse with resources to help them recover.

Sharon Valentino, Psychotherapist, Behavioral Health
Your life does not get better by chance, it gets better by change.
Valentino Therapy
Licensed Marriage and Family Therapist (51746)
Serving individuals & couples in the San Francisco Bay Area
Psychotherapist, Registered Addiction Specialist, Certified Addiction Treatment Counselor, Masters Counseling Psychology,
Stress, Anxiety, Relationships, Depression, PTSD, Pain, Family & Couples Issues, Parenting Teens and Pre-Teens. Tech execs & engineers.
p: 415.215.5363
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Addiction: Can You Really Make a New You for 2018?

New Year, New You: Putting Your Addiction Behind You

You may have been derailed, but now you’re in the process of getting your life back on track. It’s time to break out of your comfort zone and live the life you’ve always dreamed of. Here are a few ideas to make those dreams a reality while continuing to enjoy recovery and sobriety.

Take a trip. Recovery is the perfect time to enjoy life. Not only will you meet new people and see new things, you’ll gain a fresh perspective on the world. When you’re in the middle of your addiction, you lose sight of everything except your next fix. Traveling gives you something exciting to prepare for and will help you discover things about yourself you’ve never known. Recovering addict Carl Towns explains in this inspiring post how travel has helped him remain sober.

Get a dog. The reasons to get a dog in your recovery are almost endless, but for now, we’ll stick to the basics. Having a dog will give you a new sense of responsibility, something which you may have robbed yourself of when using. Dogs also provide unconditional love, another aspect of your life that you may have missed. Having a four-legged friend around encourages physical activity and can even be a great way to meet new people—people who will become positive influences on your life. Another notable benefit of having pets is that being with these creatures alleviates stress and anxiety and can stave off depression. Even if you’re unable to have your own dog, you can consider dog walking and even make a little money while enjoying some canine companionship.

Start your own business. Starting your own business gives you something to look forward to each day. It puts you in control of your own financial fate and holds you accountable for how you choose to spend your time and money. You might, for example, start with a pet-sitting or dog-walking service. As you struggle with regaining trust from others and yourself, this is a great way to lead into your new role as an active member of society. Additionally, starting your own business gives you an opportunity to pursue your passions, become a mentor, and create stability for yourself and your family, according to Entrepreneur.

Expand your social network. When you were using, you may have kept company that encouraged, or at the very least didn’t discourage, your bad behavior. Now that you’ve regained clarity, it’s time to expand your social network to include people who will build you up instead of bring you down. As a former user, you may find it easier to connect with new friends who don’t have any preconceived notions about you based on past actions. Networking isn’t only good for your personal life. Expanding your social circle is a great way to positively influence your business.

Face your fears. Often, we use drugs and alcohol as a way to hide from the things that scare us the most. Now that you’ve climbed out of that hole, it’s time to face your fears head on and with a clear mind and strong body. No matter what you’re afraid of, take it one step at a time. If you’re afraid of being alone, for example, spend the night away from home. Once you learn to control your reaction to fear triggers, they will no longer control you.

Living with addiction feels like being trapped in a bubble. Now that yours has been popped, don’t force yourself into another invisible prison by being too scared or ashamed to accomplish your goals. You’ve already done the hardest part by stepping above your vices. The key is to stay in motion and never lose sight of your end goals, no matter what they may be. Your life from today forward is a blank canvas; only you can paint it.

This post was guest written by Adam Cook of

Image via Pixabay


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Let’s Get Serious About Alcohol Abuse

Let’s Get Serious About Alcohol Abuse.

Really Serious.

Most people who drink too much are not honest with themselves about what they are doing and how it is affecting them and others. This doesn’t surprise you, but it is usually surprising and unpleasant to alcoholics.
This article is only about reality which, in my practice, is the hardest part of recovery.
I’ve written many times about how to beat alcoholism.
This time I’m only writing about reality.
It may be hard to read, but please hang in until you get to the bottom, because reading this and those charts at the bottom can turn your life around. Actually, they can get you to decide to get your life back. Or, help you save a loved one.
Yes, I said alcoholic above. Few people who come to me call themselves alcoholics. They say they drink too much and they’d like to cut back but they “can’t see themselves never being able to drink again”. This is a direct quote since it is what I have heard, verbatim, so many times for so many years. I still hear it, almost every day.
I’ve treated a lot of people who are addicted to substances. Alcoholics have many similarities to those who abuse drugs but they are also unique in many ways as noted below.
You might be surprised to hear that my alcoholic  clients, past and present, have a lot in common with each other. See if any of these apply to you or your loved one.

  • Most of my clients who are alcoholics do not drink enough water to be healthy, for proper brain function.
  • Most of my clients who are alcoholics complain they don’t want to drink adequate amounts of healthy, pure water because it will make them go to the bathroom more often, so I wonder if that worse than dying of alcoholism?
  • Most of my clients who are alcoholics complain a lot. They blame people and situations. They blame their former therapists and rehabs. They even blame their current therapist for lack of immediate success – even when they will NOT follow their own jointly derived Treatment Plan.
  • Most of my clients who are alcoholics don’t “want to be told what to do”. This includes being angry with worried friends and family who offer comments and advice. Is it easier to blame others and come up with excuses than to save your career? Your friendships? Your driver’s license and freedom to drive? Your life?
  • Most of my clients who are alcoholics are in danger of harming their brain. Many already have. Most talk around in circles about what they know they could/should do and why they won’t do it. Many already have trouble sticking to the point and have flights of ideas where the slightest of details send them off on one or several tangents that  repeatedly go way off subject. It’s hard to listen to them or have a conversation. It tends to make listeners anxious and want to get away. Family members may say GET TO THE POINT in frustration and fear because of the damage they are seeing.
  • Most of my clients who are alcoholics don’t want to try a few different AA meetings to see if any seem compatible. They tend to judge the other attendees and think they have nothing in common with most, or all, of them – yet they have everything in common.
  • Most of my clients who are alcoholics blame their past, but a majority also claim it is too painful to talk about in detail or process – so it festers. Some claim we don’t talk about it enough, even though the bulk of the sessions are, of necessity, taken up dealing with the latest auto accident, trip to ER or jail/DUI, or fall, or blackout, pass out, fainting, tripping accident or other dangerous and life threatening events.
  • Most of my clients who are alcoholics adamantly refuse rehab or visiting a physician who specializes in using drugs that help control cravings, to reduce or stop drinking. However, be prepared, because we will discuss options and alternatives each visit.
  • Most of my clients who are alcoholics do not have and cannot maintain satisfying romantic relationships because their first love is alcohol. It takes the place of, and crowds out, the possibility of respect, love and partnership with a sober person. Sometimes, however, a romantic interest can be a catalyst for change, even if it is only a flirtation or hope of repairing a current relationship.
  • Most of my clients resist any type of tracking how much they drink, let alone charting or writing it down. They resist paper tracking, or putting a cup or spoon on the counter or table with each drink consumed for a graphic example of how many drinks they’ve really had each day. They don’t want to know and they don’t want me to know.
  • Most of my clients who are alcoholics don’t have enough to do to occupy their minds, they have little or nothing to hope for, and they have nothing interesting to put in their hands besides a drink.
  • Most of my clients who are alcoholics are smart, interesting, sensitive people who anyone would really want to help immediately upon meeting them. Many are very funny, wry or insightful – except about themselves.
  • Most of my clients who are alcoholics have managed financially one way or another, they certainly are not destitute, though their finances and happiness could be much better if they devoted themselves to anything with as much energy as they devote to the booze.
  • Most of my clients complain of feeling depressed, yet they pound their body with a strong depressant – alcohol – and wonder why they’ve been feeling more and more depressed as they drink more and more not to feel so depressed.
  • Most of my clients who are alcoholics are in serious denial about what the amount of alcohol they consume is doing to them.
  • Virtually all of my clients, past and present, greatly underestimate the BAC (read below), which could cost them their freedom or their lives.
  • All of my clients deserve a better, happier, healthier life – which they can achieve as soon as they get serious about their disease.

Without even considering the 14 million people living in the US who qualify as alcoholics, most people are not realistic about what even moderate drinking does to them.
Anyone with a history of “over-drinking”, or the genetic component of having alcoholics in your family, are at considerable risk of going from believing they are light drinkers to actually being addicted.

  • You can’t get a good night’s sleep because you’ve seriously disturbed your ability to do so. Though it can help you to go to sleep for the light drinker, it also assures you will wake up in 2-4 hours and often decide it’s a good idea to drink more to get back to sleep a second or third time. This makes it difficult to cut back or stop drinking. Without quality sleep you have trouble with clear, concise thinking and decision-making.
  • Here’s what scares me and causes a lot of conversation with my clients: even small amounts of booze can inhibit your REM sleep which can damage or even kill your brain cells and the body organisms that provide the brain with vital materials to use for energy, critical nutrients and energy to think and conduct normal life affairs.
  • Even your excuses don’t make sense to others. Judgment is impaired, unnecessary things are said or brooded on, and decisions are made to just stay home and drink or, worse yet, that you are fine to drive.
  • The majority of my clients are on some kinds of drugs for health issues. These interact dangerously with alcohol, especially acetaminophen, pain meds, sleeping, meds and certainly antidepressants, etc. Shockingly, clients absolutely ignore this very high risk to their health, safety and their very lives.
  • Since your immune system is impaired for about 72 hours after a night of heavy drinking, you damage your body’s ability to fight off disease and sickness. Drinkers often get sick for this reason. Imagine what this means for chronic abusers. It’s common for drinkers to be nutritionally deficient, since alcohol lessens desire to eat in a healthy manner and even blocks the absorption and use of vital nutrients in your body. Some physicians who specialize in addiction are concerned about folic acid deficiency since it helps build DNA and is needed for proper cell division. Alcohol blocks its  ability to be absorbed and also neutralizes it in your blood. Therefore, doctors have alcoholics take supplements of folic acid daily to counteract this and lower cancer risk. Add folic acid only if your Dr. advises it.

Heavy or chronic drinking can harm every organ in your body.
There many long lists of diseases and problems proven to be associated with heavy drinking. Only a few of them are:

  • Seizures, falls, fainting
  • Relationships damaged or destroyed
  • Stroke leading to death or paralysis
  • Hemorrhaging
  • Infertility
    Hypertension – How many alcoholics do you know that are also on high blood pressure meds?
  • Cardiac disorders and death
  • Alcoholic hepatitis, an ugly disease
  • Stomach, oral, breast, liver, and colon cancer
  • Anemia
  • Bone marrow suppression
  • Ulcers
  • Pancreatitis
  • Osteoporosis
  • Sexual dysfunction
  • Severe sleep disorders, primary insomnia, sleep apnea and long term sleep disturbances (reliance on meds)
  • Liver damage and death from liver disease
    Your BAC is your Blood Alcohol Content and it is the amount of alcohol present in your blood. When rehab or the police (or your own hand held device) give you a breathalyzer test, samples of air are taken from deep within your lungs, giving reliable enough estimates of your BAC to be used in court, even if a blood test isn’t used.
    Be kind to yourself. Therapy helps.
Sharon Valentino, CA LMFT, MA, ChT, Psychotherapist
Licensed Marriage and Family Therapist (51746)


3030 Bridgeway, Suite 108, 
Sausalito, CA , 94965, phone 415.215.5363
Serving the San Francisco Bay Area
Follow my primary Blog:
 for updates on this and other matters than may interest you and can help you live more of the life you want.

Alcohol & Drug Counseling, Assessment, and Prevention Service at Washington State University
Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach by Linda A. Dimeff, John S. Baer, Daniel R. Kivlahan, and G. Alan Marlatt. 1999 and the work of Dr. Pat Fabiano at Western Washington University.
Substance Abuse and Mental Health Services Administration’s National Clearinghouse for Alcohol and Drug Information and the Iowa Alcoholic Beverages Division. One drink = 1oz. 80 proof spirits =3 oz. glass of 12% wine = 12 oz. of 5% beer.
BAE – Blood Alcohol Educator
An interactive, educational program, available in English and Spanish, developed in conjunction with the University of Illinois that informs the public about Blood Alcohol Concentration (BAC) levels and how alcohol affects you.
Alcohol Studies Database
Contains over 70,000 citations for journal articles, books, book chapters, dissertations, conference papers, and audio-visual materials dealing with Alcohol research
U.S. Department of Health and Human Services – Substance Abuse and Mental Health Services Administration Government site for prevention of substance abuse. Includes news, research and resources.

Addiction Treatment and Your Health Coverage Addiction – How to Get Help

Addiction Treatment and Your Health Coverage – How to Get Help

Addiction was not truly considered a diagnosable and treatable mental illness by the U.S. medical community until about forty years ago. And while we no longer see an addict’s need to use as a failing in good judgment, stigmas still cloud the public image of people who need specialized substance abuse treatment to stop.
According to the 2012 National Survey on Drug Use and Health, over 21 million Americans struggled with a dependence on drugs or alcohol last year, but less than 2.5 million received treatment at a specialty facility. The report also points out that a full quarter of those that needed treatment did not receive it because they lacked health insurance.
While addiction affects nearly 24 million people over the age of 12, only 11.2% of those individuals receive treatment from a private facility (SAMHSA, 2009). It’s not uncommon for private recovery facilities to cost in the tens of thousands of dollars.
Fortunately, under the new healthcare laws, addiction treatment is deemed “an essential health benefit” that commercial health plans must cover. In fact, the number of patients seeking treatment for drug and alcohol problems could more than double over the next year as the rolling healthcare reform measures come into effect.
You can and should get cost-effective and valuable addiction treatment when it’s needed. Educating yourself on your health plan, your state’s laws, and the steps to get care make that an achievable goal.
Understanding Your Addiction Treatment Coverage
Addiction is legally defined as a diagnosable medical condition, but the stigma that accompanies drug or alcohol abuse has historically made it difficult to get care: families or individuals may be hesitant to push for their rights, and some health plans have financial incentives for denying treatment, so they may twist words around in a health policy in order to misrepresent what’s required of them.
Though insurance companies may not always advertise this fact, as of now, 43 U.S. states require commercial group health insurers to cover addiction treatment. If you or a loved one is in need of either detoxification or rehabilitation treatment, it’s critical to know how your insurance policy is worded and exactly what rights you’re entitled to as a policyholder.
Start by looking at your health plan. Wording in that policy should define a full continuum of addiction care, which, according to the National Alliance for Model State Drug Laws, includes “intervention, detoxification, inpatient rehabilitation, outpatient treatment, and intensive outpatient, family, and codependency treatment.”
Keep in mind that The Mental Health Parity and Addiction Equality Act of 2008 makes it illegal for insurance companies to discriminate against patients because of addiction. (The MHPAEA does not require your insurance to cover specific addiction disorders or treatments, but it does require that coverage for mental and substance abuse disorders be offered at parity with standard medical conditions.)
If you aren’t clear on your specific treatment options and rights, you should take two steps:
-Contact your insurance company to clarify the policy with them.
-Check the NAMSDL website to find your state’s lead agency for administering addiction treatment services: this differs by state, but that agency should be able to clarify the exact laws and policies.
Working with patient advocacy groups like NAMSDL or the Substance Abuse and Mental Health Services Administration (SAMHSA) can also be useful. SAMHSA is comprised of subject-matter experts that advise the Department of Health and Human Services, and as such they’re able to provide consumers with a wealth of information on their rights in regards to health care.
Another option is to contact a third party association, like Addiction Treatment Services, that can help you find a health insurer providing clear and affordable coverage for addiction treatment. Keep in mind that these third parties do not offer specialized options, discounts or services that cannot be found through each insurer directly.
Given the state laws regarding all commercial group health insurers, trying to navigate a difficult insurance situation while also struggling with addiction may sometimes be too much to handle: switching to a policy that does uphold those state laws could be easier than fighting with your current insurer. On the other hand, as will be explained later, there are ways to stand up to a reticent insurer, and it’s through that advocacy that the stigma associated with addiction treatment can and will change.
Know the Standard Coverage Levels in Your State
With the exception of Arizona, Georgia, Indiana, Iowa, Idaho, Oklahoma, and Wyoming, all states currently require commercial group health insurers to cover addiction treatment services as they would any other prescribed medical treatment. To find out more about the current laws regarding coverage of substance abuse treatment in your state, contact your state’s insurance commission or the National Alliance for Model State Drug Laws.
Most commercial group health care policies include provisions for detoxification treatments that require hospitalization or in-house care as well as out of house care. To give you an idea, many providers say coverage and reimbursement rates average out to 70-75% of total costs per patient.
Inpatient Care Costs and Coverage
Some health insurance policies cover 100% of inpatient costs for an unlimited number of days, though certain plans limit the number of days or require copayments. It is critical that policyholders understand their coverage plans regarding inpatient care, as some plans will expect patients to contribute approx. 10-50% copay. In this case, residential treatment can be overwhelmingly expensive. In a 2011 survey of over 44 private treatment providers nationwide, these average costs were reported:
– Medical detox: $1,707 per day
– 28-day residential treatment programs: $19,067
– 10-week intensive outpatient programs: $6,863
If you’re insurance policy does not currently cover the inpatient care that you or a loved one is in need of, discuss your financing options with both your doctor as well as the treatment facility you’ve been referred to. Because rehabilitation centers have extensive experience fighting for patients’ rights and negotiating with insurers, they’re often able advise you in securing fair coverage.
Outpatient Care Costs and Coverage
This all sounds very expensive remember that for the majority of the country’s 20 million patients struggling with substance abuse, treatment doesn’t require inpatient treatment. In one study of Californian claims for substance abuse treatments, for example, 27% of insured patients only needed between $1-100 worth of services, while 20% needed $1000-2,500 worth of care.
Rehabilitative care can overlap with detoxification — most policies include the 20-visit-per-year provision, as well as requiring copayments. Rehabilitative care encompasses counseling but does not usually include home residential care. (Some policies allow you to add a rider, at additional cost, for the latter type of treatment.) Outpatient care will usually include a blend of prescribed treatment medications that will help addicts reestablish and maintain their brain chemistry and function as well as ongoing behavioral therapy sessions.
Obviously, treatment approaches and their costs vary as widely as the range of substance abuse issues they target. Depending on a patient’s abuse habits and their medical histories, treatment periods can be as short as three months or can be considered lifelong commitments. Usually, patients require an individualized blend of treatments that include medication and behavioral therapy to cope with the major stages of recovery — from withdrawal to maintaining sobriety once it’s achieved.
How the Affordable Care Act Can Expand Your Coverage
While those are certainly high costs, even with coverage, both insured and uninsured Americans should review their health plan before 2014. As of October 1st, citizens will be able to apply for insurance through the Health Insurance Marketplace. Not only will this allow people to comparison shop for health insurance, but also as part of the Affordable Care Act, policies through the Marketplace guarantee an essential benefits package comprised of 10 items. One of those items is coverage for both drug addiction and alcohol abuse treatment.
Though not everyone qualifies to get insurance through the new law, you can use to find out whether you’ll qualify, and you can calculate potential cost savings through the Kaiser Family Foundation’s online calculator. Because the Parity Act, mentioned earlier, is encompassed within the ACA, and because both pieces of legislation preserve state laws, these changes to health care should continue making it easier and more affordable to get coverage for drug and alcohol addiction treatment.
Keys to Holding Your Provider Accountable
As stated earlier, it’s essential to familiarize yourself with your healthcare plan and check your state laws before approaching your provider about expanding your coverage. You’ll be a stronger force to be reckoned with if you know your rights as a policyholder. For instance, if your insurer refuses to cover costs that were not pre-authorized, your state might very well have a law prohibiting this denial of service — In Pennsylvania, for example, the law states that “there’s no need to authorize or pre-certify treatment for alcohol and/or drug problems through your health insurance plan.”
You can also consult with state legislators, the state insurance department, or the Office of the Attorney General if your insurance company is denying you coverage or discriminating against you because of a need for addiction treatment. If you’re already in touch with an addiction treatment center, they can also be a good resource: the Hazelden Center, in Minnesota, for instance, states on their website that they “will work closely with insurance companies to streamline the process and ensure that the patient receives the maximum benefit available.”
While it’s not always an easy discussion, it’s important to stand up for your rights when working with your healthcare provider. Addiction treatment has been stigmatized for years, causing many who might have benefitted from this treatment to go without. Your fight for coverage helps further the cause of drug and alcohol abuse patients nationwide and paves the way to better coverage and health care for everyone.
Prevention and Addiction Treatment Resources
Individuals and families struggling with addiction need to count on a support network of treatment centers and prevention and recovery advocates. Turning to these organizations is an essential part of recovery, and also the best way to become involved in the effort to raise awareness of the hardships and dangers of addiction.
Please explore the resources below to learn more about the organizations helping addicts every day
Substance Abuse and Mental Health Services Administration’s (SAMHSA) 
SAMHSA’s Strategic Prevention Framework Components
SAMHSA’s National Registry of Evidence-based Programs and Practices
SAMHSA’s Behavioral Health Treatment Services Locator
Hazelden’s Resources for Treatment and Criminal Justice/Alcohol and Drug Prevention
Al-Anon Family Groups
American Society of Addiction Medicine (ASAM)
Alcoholics Anonymous
Faces & Voices of Recovery
Narcotics Anonymous
The National Center on Addiction and Substance Abuse at Columbia University
National Council on Alcoholism and Drug Dependence
Substance Abuse and the Affordable Care Act
(Valentino Therapy was contacted by Mark Griffon at the Addiction Treatment and Recovery Resource to post and publish this important information. We have used their material, as requested, and added some of our own. The hope is that it will help those suffering, which includes their loved ones.)

Be kind to yourself. Therapy helps.
Sharon Valentino, CA LMFT, MA, ChT, Psychotherapist
Licensed Marriage and Family Therapist (51746)




3030 Bridgeway, Suite 108, 
Sausalito, CA 94965, phone 415.215.5363
Serving the San Francisco Bay Area

Follow my primary Blog:
 for updates on this and other matters than may interest you and can help you live more of the life you want.

Is Trichotillomania an addiction?

Is Trichotillomania an addiction? Really? Clearly, it is a disorder. I’d say it is an addiction in the sense that it can be treated very effectively in the same ways that addiction to substances can be treated. And it usually centers around the belief that the puller “just can’t stop” even though they want to. Sufferers often refer to it as an addiction.

Pulling your hair out?
Maybe it’s trichotillomania?
It’s pronounced trick-o-till-o-mania.

I’ve seen a number of clients who suffer from “Trich”. It is often a devastating, embarrassing condition.

What is it? There are many manifestations but the most common are pulling out your hair – often from your head, arms, hands, legs, eyebrows and eyelashes, even hair in your private regions, sometimes putting it in the mouth or swallowing it. Swallowing can be dangerous and need medical attention, in some cases emergency attention.

Trichotillomania has several close cousins such as skin picking, nail-biting, scratching, gnawing or rubbing to soreness, OCD and more.

People generally report feeling great stress or tension and find that they get a release from pulling out hair. There is often some amount of sting or pain when hair is pulled and they report they feel a little calmer after specifically feeling that. Others say they pull when they are bored. Most suffers do not pull in the presence of others or they try to hide what they are doing.

Many of my clients have said they “can’t help themselves”; some say it is even pleasurable.

Lots of people pull their hair out until baldness is clearly noticeable, and then hide it with scarves, hats, over combing, etc. There’s often irreversible damage to the hair growth and the quality of the hair.

The new DSM-5 now gives these diagnostic criteria:
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).
E. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).

There aren’t many studies that are large enough in scope, but pulling appears to have a genetic component, possibly brought on by stress at a fairly early age, since it often develops or becomes active, or becomes more so, just before or after puberty. However, each sufferers’ experience is unique to themselves.

Is there hope for Trich suffers?  Some report help from drugs, a number of which seem effective for some, but psychotherapy, or therapy combined with drugs seems to be very effective for a number of people.

How can it be treated? Here are my methods, which I customize for each person. Talk to your own health care provider about what steps they take to aid sufferers.

I want to discover as much as possible about when it happens, who might be present, what body part is hair pulled from, is there a particular time of day, a place or event that triggers it? What was upsetting or the cause just before, and what is the feeling during the pulling and afterwards? Do you feel ashamed and pull secretively? Have you employed anything in the past that helped you stop pulling?

Then we take these steps to achieve the goals:

Become much more aware of when and how often the pulling happens. Often, keeping a log is necessary in the beginning.

I encourage a visit to your primary care physician, especially if you are willing to discuss trying one of the drugs that may help. Regardless, your doctor needs to know what is going on with you and be able to rule out other factors that may be present.

Initially, many clients do not have the goal of stopping immediately, so some find an acceptable alternative is using a small piece of fur, rug, carpet, a doll’s hair or anything with a surface that allows pulling and gets the hands away from the problem area, which is usually their head. A few insist they “need” the pain, but will substitute holding an ice-cube until it hurts – which I don’t like for many reasons.

Therapists work to control the behavior by creating an incompatible action, so identifying several things to do, as an alternative is very important. If one fails, or does not appeal on a certain day, it helps to have an arsenal of others. Clients need to be very actively involved in identification of alternative behaviors b/c if a therapist, parent or significant other makes or supplies the list; it is unlikely to be helpful as helpful.

For ideas, here are some that clients have come up with: computer games, sewing, play a guitar, knitting, basketball, bike riding, jewelry making (one started a side income business), chewing gum, sunflower seeds, corn on the cob, crunchy foods that need two hands – like peanuts in the shell and pistachios. Many of my clients have been teens or young adults who list Mike and Ike’s, taffy, Gummy Bears, Hot Tamale candies and items that require considerable chewing but really only employ one hand to eat – yet rapid chewing itself is often a stress reliever. A good one is active gardening, but so are model building, carpentry, and painting, working with clay, needlework, making something such as carpentry, gingerbread houses and so many more. These are called Habit Reversal Training (HRT) or Distraction Techniques.

A Band-Aid on the fingertip(s) of the primary pulling fingers is very helpful, and sleeping in lightweight gloves helps those who pull in their sleep. These are called Barrier Assistance.

When at work or school some people like to play with a tension relieving ball, or having a small “goal” figure to finger and play with. I urge getting a small car that you’d really like to own, a tiny plastic palm tree if you want a tropical vacation, a little airplane, an infant or a house figure, etc. These have the added advantage of an object with multiple surfaces and edges to finger, but also can remind of goals that would be enjoyed more after mastering this problem.

An additional, very effective technique I use is: Wait a Minute. It allows you to wait just long enough to calm yourself before acting, or changing direction, and consists of using Breathing Training to calm the urge. A well-documented method quickly relieves both anxiety and tension. The easiest way to start is to make yourself comfortable where ever you are and place a hand over your stomach, covering your belly button. Breathe in and out, deeply – yet comfortably, relaxing until you feel your hand rising and falling quite a bit with each breath. This is Abdominal Breathing (which is what we all should be doing all day for optimum physical and emotional health). Continue as long as you reasonably can and allow the calm within you to make decisions, instead of the tension. Oddly, this is more calming than pulling, as many of my clients have told me over the years – to their great surprise. Some while say you must breathe in to a count of 4 or 5 hold your breath for 4 or 5, etc. I say no. Just breathe as slowly, deeply and calmly as you can without adding rules or counting that add to your tension about doing it right.

Progressive Muscle Relaxation is very effective for most if used before pulling, or to interrupt pulling in progress. It’s slightly different for Trich sufferers than the type you may commonly read about. Each time you want to pull take the hand you pull with and tighten, curl your fingers, make a fist and then tense your fingers as hard as you can for as long as you can. Then abruptly release them and feel the relief, which is similar to pulling’s tension and release. Do the same with the pulling hand’s wrist, then forearm, and arm – each in turn.
After that, go ahead and use the more traditional PMR, (which is very effective for insomnia also) and goes like this: You will tense specific muscle groups, one at a time and then relax them. This will give you a sense of calm and peace – more so every time you use it. It’s progressive since it addresses each muscle area, relaxing one at a time. Start with your scalp and forehead – Wrinkle your forehead, try to make your eyebrows touch your hairline for 4 or 5 full seconds. Relax. Then do the same with your eyes: then nose afterwards. Breathe deeply and calmly in the way most comfortable to you. Next, tense your lips, cheeks and especially your jaw – tighten the centers of your mouth back into a ridiculously tight grin or grimace for 4 or 5 seconds. Relax. Feel the calmness. Then, put your arms tightly out in front of you. Clench your fists as hard as you can for at least 5 seconds.  Relax and breathe. While your arms are still out, pretend there’s a wall in front of you and push it hard with your arms for 5+ seconds. Relax and remember to breathe. Then bend your elbows and tense your biceps (upper arms) for 5+ seconds. Relax into deep breathing. Pull your shoulders tightly up to your ears for 5 seconds. Relax. Arch your back tightly and hold it stiffly for 5 seconds. Relax to feel the anxiety and tension leaving. Tighten your stomach next for 5 seconds. Relax. 
 Then tighten your hips and buttocks for 5 seconds. Breathe and let go. Now tighten your thighs by pressing your legs together as tightly as you can for 5 seconds. Relax. Bend your ankles toward your body as far as you can and tighten your feet for 5 seconds. Relax. Lastly curl your toes as tightly as you can for 5 seconds. Relax. Now – see if any muscle areas might still hold tension and go back to relax that particular area 2 or more times until it lets go of all the tension and stress it has held. Breathe and sense the calm you now feel. This will increase each time you do this exercise. It doesn’t take long after the first 2 or 3 times you do this. It can be repeated many times a day, as needed.

Meditation is an elegant and transformative way to calm yourself of any tension, including the type that leads you to pull. Learn how to do it your way, as there are many methods. I particularly enjoy the Deepak Chopra’s guided mediations because they are very professionally done, he is a master and they rarely take more than 12-15 minutes of my busy day – yet, they make a world of difference – plus he “minds the time” for us. Find what appeals to you. You will come to crave the type of peace it provides.

Psychotherapy. Now we come to Self Psychology, Behavioral Therapy, Cognitive Behavioral Therapy and many more.
“Behavior therapy (HRT), emotional regulation, and acceptance together represent the most promising treatment for trichotillomania (Walther, Ricketts, Conelea, & Woods, 2010).
Therapy can make the difference for many sufferers since some are soothing memories of pain, loss or hurt (even PTSD), others engage in faulty thinking (cognition) that harms their ability to be truly happy and relaxed in life. Others have learned “I can’t help myself” thinking in this and other important areas of life, which invites all sorts of undesirable outcomes. Some don’t realize how much tension they hold and that this is not normal – that it can be released. Others lack self-esteem and let tension build over time, believing they can never get what they want out of life because they aren’t good enough.

I haven’t listed all the techniques I’ve used over time, but have tried to post the more successful ones.
I’d be interested to hear what you may have used, not listed here, that lead to good outcomes.

Be kind to yourself. Therapy helps.
Sharon Valentino, CA LMFT, MA, ChT, Psychotherapist
Licensed Marriage and Family Therapist (51746)
Valentino Therapy @
3030 Bridgeway, Suite 108
Sausalito, CA 94965
Serving individuals & couples in the San Francisco Bay Area
Psychotherapist, Masters Counseling Psychology, Stress, Anxiety, Addiction Specialist, Relationships, Depression, PTSD, Pain, Family, Couples & Relationship Issues

Can Carbs and Sweets Turn You Into an Addict?

Can Carbs and Sweets Turn You Into an Addict?


Sounds crazy?
Apparently so.
Information has come out lately refuting the old wisdom that food is not addictive and that fatties should just exercise self-control.  Self-responsibility was the term often used.
More recent research indicates that processed foods (sodas, cake, candy, white bread, cookies, potato chips) can addict people, cause them to crave more of those foods and make them go looking for them with some vigor.
CBS News last week quoted Dr. David Ludwig’s (Director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital) press release about his research, “Beyond reward and craving, part of the brain is linked to substance abuse and dependence, which raises the question as to whether certain foods might be addictive.” His study, using milkshakes made the point and documented the strong cravings some time afterwards for more, or similar.
Adding to that and commenting on the study, Dr. Christoph Buettner, an associate professor of neuroscience at the Mount Sinai Medical Center in New York City, said, “Food activates similar areas in the brain as drugs do, that is already accepted.” Buettner, who was not involved in the above research, added, “The strength of this study is that it shows that the kind of diet you eat can influence this.”
WebMD and several magazines jumped on this new data as well with comment or stories of their own. It seems to be time to learn more and educate ourselves.
So what’s next? Cold turkey or a measured taper off to beat addiction?
Or will food addiction clinics pop up around the country to help sufferers beat the addiction?
I doubt that this is something that is easy to beat alone.
The new research was published June 26 in the American Journal of Clinical Nutrition.


Be kind to yourself. Therapy helps.
Sharon Valentino – Valentino Therapy, LicensedMarriage and Family Therapist (51746), MA, CHT, LMFT, Psychotherapist, Masters Counseling Psychology                                                                                                            Stress, Anxiety, Addiction SpecialistRelationships, Depression, PTSD, Pain
Serving individuals, couples, groups and families in the SF Bay Area and online for CA residents                                                                                                                                       Web: 


addiction (Photo credit: Alan Cleaver)


How Loved Ones Can Help Addicts

How to Support Someone With an Addiction or in Recovery

Self-Care Comes First

  • Take care of yourself first.
  • Take extra care of yourself at this time.
  • Set a stellar example of someone who takes care of themselves properly: eat very healthy foods & drinks, do not abuse any substances, no junk food that the addict observes, as that is a strong statement of lack of consistency.
  • Engage in some spiritual practice: meditation, prayer, yoga, nature, walking, join a church, etc.
  • Get clear that your life and your relationship with the addict will never be the same again.
  • If you do not practice unwavering self-care, don’t expect your addict to do so.
  • Get in therapy or a therapeutic support group or Al-Anon & stay there, as you will need a lot more support than you think. You will need it longer than you think.
  • Get a massage and a haircut, update your look & clothing. Be proud of your appearance. This is not the time to be sloppy in sweats. Appearance improves your mood. People will notice. Your addict will too, but may not comment.
  • Get moving. This is critical for your body & mind. Invite your loved one to join you. Go alone.
  • See your Dr. for a check-up. Stress does ugly things to your body & defense systems.
  • Find a way to get healthy, adequate sleep or you won’t have the energy to be strong & give help. Also, even you can’t “think straight” without consistent, sound sleep. Get help if you need to.
  • You will often feel like giving up, but will still worry & be in anguish.
  • Get clear: You cannot motivate anyone. You can’t even motivate yourself sometimes.

There Will Be Problems – Big Ones

  • Your addict will tell you lies – both large and small ones. The small ones will be ongoing and you will start to lie to yourself that what s/he says “might” be true.
  • Your loved one will consistently need to RUN AWAY, using the substance that provides that escape. No substance? Then s/he will run away physically and/or emotionally. You will feel they are trying to keep you away, and they are.
  • Running away is the essence of substance abuse. It’s avoidance. They have experiences, feelings and other problems that they are running away from because they have not learned to “feel the feeling” and then let it go – even if only for a few minutes. This is the main thing that distinguishes them from others. It is what causes them the most problems. It will continue to until someone teaches them how to recognize, feel and realize their discomforting feelings. It usually takes a professional.
  • The addict may not think they have a problem, or that it can’t be managed.
  • Your loved one may give lip service to never using again, but in their heart they think they can and will manage it better in the future.
  • You will come to doubt yourself and even your senses sometimes.
  • The addict is probably not afraid of dying, though they fervently wish it were not a long, painful process. Sweet, quick escape is what they sometimes even look forward to.
  • Many addicts feel that, even if it doesn’t show, they are moving in the right path and they don’t want to change anything, and you, especially, are not going to tell them what to do.
  • All addicts don’t want you to change anything and interfere with their privacy and freedoms. *
  • All addicts are very concerned that you want to control them, get too involved in their lives and their recovery. *
  • Your loved one isn’t very comfortable discussing the deep, personal issues with a professional. They particularly do not want to discuss them with you.
  • Many times your addict will use you.
  • Often, your loved will want nothing more than to get away from you. That will include getting physically away from you.

How to Help

  • There is no one way, no easy way, no fast way to help an addict.
  • Learn to set boundaries and stick to them. It may save a life, as an addict rarely sets any boundaries for themselves whatsoever.
  • Help your addict find joy. This is critical. Try to reconnect them with things they used to enjoy, while realizing their enthusiasm cannot be the same until they are well down the road to recovery and regaining health.
  • You will never persuade an addict to get sober. The decision and determination, which is the hard part, must come from within themselves.
  • Do not lecture, admonish, exaggerate your stress and ability to deal with the situations, especially do not yell, or criticize.
  • Realize that addicts are very tuned in to hypocritical behaviors in others, but not themselves.
  • Do not, under any circumstances, allow the addict to use in front of you.
  • Never buy for the addict or allow the substance to be in your presence, or your home, if you live together.
  • If you allow others to use AT ALL in front of your loved one, then you are part of the problem.
  • If you try to establish homeostasis (an organism’s natural need to go back to the familiar), you will encourage things going back to what they were like before addiction really took hold; you will put your addict in great danger. That was the very situation, interactions, tolerances, exposures to others using, the stressors, the looking the other way – the many behaviors that produced the ability for the addiction to get a firm grip.
  • If you tolerate someone’s using, or your own, do not expect your addict to respect you or listen to you about them getting well.
  • If there is a stressful situation involved in being around you (for whatever reason), the addict will want to use more or they will need to escape you. Two tough choices for all involved.
  • Do not put up with bad behavior. Name it and say it doesn’t work for you. That is enough. Saying it will likely need to be repeated. If this continues, you may need to take calm, thoughtful action. Be a model of how to deal with such situations, because your addict will copy you – either behaving quietly, yet firmly, or behaving distressfully, loudly, threatening… with little follow-through, drama, etc. They will copy you and return the favor and they will repeat those behaviors – positive or negative – with others.
  • AA’ers have said to me, “He came to treatment too soon. He was still wearing a watch”. Yes, it is true that hitting bottom is usually the catalyst. That bottom might be finally selling your watch, as there is nothing else left to sell. Sometimes, it is causing great embarrassment to oneself or losing a relationship or losing health in a serious way. Sadly, in my experience, it is rare to see someone ready to change until there has been some quite negative consequence to his or her behaviors.
  • Do not protect your addict from negative consequences due to actions that have already occurred. It may be your only hope for change.
  • Do not tell your loved one that s/he is an addict, it is a problem, bad things are happening and they need to change. They already know this. This knowledge is a great impetus to use even more.
  • If you want your addict to change, then you will have to change too. Be prepared.

How to Support Treatment

  • Encourage it and then let it go (whether an intervention is involved or not). You can’t make anyone “get it”.
  • Offer to be involved only to the extent your loved one will allow – don’t push.
  • Don’t be surprised when your loved one blames you. Some of it will be true in some way, or you wouldn’t still be involved with them. Have an open mind.
  • Expect your addict to tell hurtful lies about you in treatment, to AA, and others to justify their own behaviors. This will generally pass in time when they get honest with themselves and others. You will never forget it though.
  • Be honest, not brutal, don’t criticize or humiliate your loved one in treatment or in session.
  • You can only say what it has been like for you, without exaggeration.
  • This is something I look for in session: Are you behaving with drama, exaggeration, attack, anger, getting loud, crying much more than might be expected, threatening to leave, end the relationship or walk out of session, making the other person wrong, controlling or manipulating the session, interrupting, taking on the persona of the hurt/damaged one, are you the martyr? Look at these and see if it is getting what y
  • Change does not come quickly. Try to be patient.

* After many years providing addiction therapy, I feel comfortable with using the word “All”, as these are the things I’ve never found an exception to. * This was written for my Psychotherapy Group: Dealing With A Loved One’s Addictions

Be kind to yourself! Therapy helps.      Sharon Valentino, Valentino Therapy, Licensed Marriage and Family Therapist (51746), MA, CHT, LMFT, Psychotherapist, Masters Clinical Psychology Counseling

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Illegal Drug Addiction and Substance Abuse

Illegal Drug Addiction and Substance Abuse (Photo credit: