As many of you know, this is the last letter that I will post in an annual report.  I will FINALLY be retiring at the end of January and while I certainly love what I do, I am looking forward to time with the grandchildren and fun in the sun.  As I look back over my years in the field of alcoholism and other drug prevention, advocacy and support services, I feel good about where we have come and where the field is heading. 

Twenty years ago, addiction was whispered about; shame was attached to the condition.  There was much finger pointing and those who suffered from alcoholism and/or other drug addiction were ostracized.  Even those working in the field of addiction did not believe that “recovery was possible.”  Honestly, it has only been with in the last ten years that people have been more open about their addiction or its prevalence in their families.  Those who continue to work in the field can look forward to

• More research confirming mental health conditions, alcoholism and/or other drug dependency as brain disorders capable of being treated.
• Increased recognition that treatment for mental health conditions needs to be integrated into physical health and vice versa.  Treatment of the total person is a key element of recovery and physical healing. 
• The implementation of parity legislation that will provide treatment for alcoholism and other mental health conditions at the same levels as physical health conditions.
• The expansion of treatment modalities that include “Recovery Oriented Systems of Care,” a strategic approach to providing a continuum of care for those most vulnerable.
• The expansion of recovery efforts including a new openness about the disease and the strength of its survivors.

CARE of Southeastern Michigan has expanded services over the past years and will continue to work in ways that offer individuals and families opportunities for growth and healing.  It is my hope that YOU will continue to support this fine agency in ways that allow its evolution. 

Most Sincerely,

Why take a parenting class?

This seems like a dumb question.  Parents would take a parenting class if they are having trouble with their children.  Some examples include

• They can’t get them to eat their peas.
• Children are throwing tantrums.
• They can’t get their children to do their homework.
• Somehow their teen child has gotten in trouble at school.

You may be surprised to know that these are all the wrong reasons to take a parenting class! 

To get a clearer picture of what I am talking about, think to the future.  Parents can ask themselves two questions:  What kind of a relationship do you want with your child twenty or thirty years down the road? and What kind of characteristics do you want your child to exhibit?   Most parents will say that they want to have a friendly caring relationship twenty or thirty years down the road.  Most parents say that they want their children to be capable, kind and able to support themselves.  These are noble goals but are not achieved without hard work, over time, on the part of the parents. 

Take the following true/false quiz to access your knowledge of what the experts say is “important” steps in parenting.

1.  It is important that my child feel special.     
2. I need to do everything to make sure my child has a high self esteem.
3. I need to give my child as many choices as possible so that he learns to make good decisions.
4. Rewards are an important way for me to motivate my child.

Number 1.  While some experts feel that is important for a child to feel special most agree that it is more important for a child to learn that all people are unique and that he is not more special than anyone else.  He needs to learn to fit into a world where character and contributions are valued above being special.      

Number 2.  Actually a “healthy” self esteem is what is important.  An overly inflated or high self esteem can give a child an unrealistic vision of his abilities, an elevated confidence and a public presence that boarders on arrogance.

Number 3.  Too many choices confuse a child.  Choices need to be provided based on age, ability and reasonableness.  Giving a young child a choice between 10 toothbrushes doesn’t make sense.  Neither does it make sense to give a teenager the choice of a curfew, drink a beer or have sex at an early age. 

Number 4.  Stephen Glenn, one of the earliest experts says clearly that if a child is over the age of seven, gold stars don’t work.   Motivation follows success.  If a child has few opportunities to be successful, tangible rewards will not move the bar.  Glen does suggest encouragement in the form of words, hugs and smiles.   

Wow.  Parenting is serious stuff.  It is not about making a child do what we want him to do.  It is about raising capable, contributing people.  It is about the long haul.  This is why parents will want to take a parenting class. 

Kids Don’t Scare

Each year around graduation, school yards are filled with wrecked cars, evidence of drunk driving gone bad.  News articles are printed about kids that die from alcohol poisoning .  Horror stories shared by recovering addicts attest to the consequences of underage use.   While these and other scare tactics (fry your brain on drugs) have been widely used in the field of substance abuse prevention, research shows that they are not effective. 

Ineffectiveness of Fear Appeals in Youth Alcohol, Tobacco and Other Drug (ATOD) Prevention is a summary of the research regarding the ineffectiveness of the use of fear appeals in the substance abuse prevention field.*   Examples of the research show:

• …research and experience have demonstrated that they (fear tactics) are either counterproductive or ineffective, and that students learn better with a low fear appeal message and with a credible communicator (National Institute on drug Abuse, 1997).
• By itself, information about the dangers of drugs and alcohol….has little or no effect on use. (Hawkins & Catalano, 1992).
• ….overly strong threats may be counterproductive as the receiver defensively avoids attention, denies personal vulnerability or distorts the message (Ray & Wilkie, 1970).
• Increased drug knowledge cannot be a measure of program effectiveness…(Tobler, 1986).

The research goes back decades so why do we continue to reinvent this old wheel that is proven ineffective?  I think the answer is simple…..it is easy.  We get a crashed car, throw it on the lawn and feel we have done our duty.  We parade out the person in recovery, sometimes only weeks out of treatment, to tell his heart retching story and we have done our duty.  What really works to reduce underage drinking and other high risk behaviors takes a lot of effort.

Researchers from the University of Washington have examined what works to protect children against developing problem behaviors including alcohol and drug use.   The evidence based research uses the medical model that a doctor uses to predict the likelihood that a problem (disease) will develop and the intervention that needs to occur to reduce the risk.   The Hawkins and Catalana model focused on four domans – the individual, family, school and community when assessing risk and protective factors.  To implement strategies that reduce underage use of alcohol and other drugs people in these four domains must work together to give children opportunities to be success, feel accepted and be involved in meaningful ways.  This takes work and commitment.  Reducing alcohol and drug use is accomplished over time when coordinated, thoughtful, and research based strategies are implemented over and over again.    Fear doesn’t work. 

To find out more about the Ineffectiveness of Fear Appeals go to CARE’s website at http://www.careofsem.com/resources-youth.html or google Hawkins and Catalano. 

I reviewed my last letter written shortly after the beginning of the year and gosh, things are pretty much the same.  State and federal budgets are still in flux; collaborative efforts by those concerned about the prevention, intervention and treatment of those with substance use disorders (alcoholism and other drug dependency) continues;  and efforts to educate new legislators, and community members including parents about the “science of addiction” is made a priority on most of our agendas.

Some of these efforts include:

• A collection of signatures of those supporting the Recovery Bill of Rights will be delivered to Lansing in July.  Read the Recovery Bill of Rights following this letter.
• Greater Macomb Project Vox (voice of recovery) will hold its 3rd Annual Dinner Cruise on July 28.  You can register on the CARE website, www.careofsem.com. 
• The Celebrate Recovery Rally will be held in Lansing on Tuesday, September 13.  Those of you with big pockets may wish to donate to cover the costs of this worthwhile event.  I would love to hear from you. 
• The state conference on substance abuse disorders will be held on May 13th on Belle Isle, Detroit.

In addition, mental health agencies and treatment centers are working hard to grapple with impending changes due to health care reform.  Most agree that the final outcome will be positive for clients and the community-at-large but there is much work to be done.

Consider getting involved.  Is the phrase, “it takes a village” overused?  I think not.  

And so a new year begins that will surely bring many changes.  New government leadership both at the state and federal level, implementation of health care reform and a teetering economy presents both opportunities and challenges.  It calls for creativity and a sense of resiliency.  It will call for making hard decisions.

Particularly in the field of mental health the changes are sure to have great impact on the way the system delivers services and the way in which it is funded.  Of particular interest for those of us serving those with substance abuse disorders (alcoholism and other drug addiction) is the intersection of prevention, treatment and recovery.  As a woman who has lived with the impact of substance misuse and addiction, I am excited about the endless possibilities.
 

• Prevention (preventing the condition), treatment and recovery professionals will continue to unify their messages on significant public policy issues including alcohol and liquor taxes, legislation regarding drinking ages of use, laws on drunk/drugged driving, funding of treatment, etc.
• Combined efforts will continue to address the stigma and discrimination of laws that impede recovery such as the denial of student loans, obstacles to employment and housing for those convicted of drug related crimes.
• The strengths of community involvement has been validated through the work of coalitions and as their combined voices continue to identify the problems related to community norms that support unhealthy drug related activity; raises awareness of the dangers of alcohol and drug use; and promotes responsibility and appropriate consequences.
• “Recovery Oriented Systems of Care” will continue to stress the need for the delivery of services that provide care over a continuum and address the needs of the entire family. 

It will no longer be “same old, same old.”  We will be challenged to work together – prevention coalitions, treatment providers and recovery organizations to build a stronger community, a safer place to live and raise our families, and a healthier place to thrive and grow.    

I was going to get this “message” out before Thanksgiving.  The Wednesday before Thanksgiving is the number one drinking event of the year.  According to those that keep these kinds of statistics, it bypasses St. Patrick’s Day and New Years Eve! 

The holidays are a time when people drink too much and results it in fights, broken promises and accidents.   Note what I have heard over the years:

• We have our kids open their presents on Christmas Eve because than we party and are too hung over the next day to do too much.  Do they think the kids don’t notice? As adults, how will they remember the holiday?
• When leaving the restaurant, I fell and broke my teeth.  Do you think this person connected the broken teeth to the fact that he was very intoxicated?  Do you think that he recognizes that his pain was directly caused by her use?
• My fourteen year old got picked up at 2:00 am and was issued a minor in possession.  Do you think the parents made the connection that they were not adequately supervising their daughter because of their own late night (partying) activity? 
• My mom and dad got in a fight and the police came.  Do you think the parents attributed their encounter with the law with their use of drugs?  Do they share their child’s sense of shame of having the police show up at the door?
• My son had to come to CARE because he was caught smoking marijuana.  Do you think that their son’s use of marijuana has anything to do with the fact that they also smoke it?  Are they concerned that his use may inhibit his ability to get a good education, maintain a job or form a healthy adult relationship? 

CAREs’ clinical department slows down over the holidays.  Some of us think that people do not want to address their problems at a time when families are supposed to be sharing a time of closeness and well being.  But, I can tell you that right after the first of the year, the need for treatment of alcoholism/other drugs and other related services goes way up.  What a shame.   

So this message is too late for Thanksgiving but there is still time to change our behavior for the December holidays.     

Tell me it isn’t so!  Where did summer go?  Everyone is asking.  Although we, typically, pose the same question every year, we still seem surprised when the weather begins to cool and the leaves start to change.  Halloween is just around the corner and then you know what follows.  My daughter told me, once, that she loves Halloween and it is her favorite holiday – you can decorate but don’t need to buy presents or spend time with relatives….hmmmm.  Don’t ask what you don’t want to know. 

I have noticed other changes that may be for the best.  I have noticed that we are being more open and honest about issues that effect our children.   Most specifically, we are recognizing  that “disaster is an outcome of denial” and parents must step up to the plate or they sacrifice their children’s future.  When parents deny or ignore their children’s high risk behaviors, chances are they will continue them and, ultimately, find themselves in situations that have long term consequences.  I can give you several examples.

• A parent who claims that her child is just experimenting with marijuana and/or alcohol is risking the child’s future by not facing the fact that most likely, by the time a parent becomes aware, the child is in trouble.
• A parent who is called to the hospital at 11:00 p.m. because her twelve year old has overdosed while attending a teen party has not provided adequate supervision and risk’s the child’s very life. 
• A parent who is smoking marijuana or drinking with their teen is not being a responsible parent but contributing to the delinquency of a minor, perhaps, leading to long term addiction. 

I could go on and on…..accepting the child who drinks and drives; allowing teens to become intoxicated at the summer block party (wedding, graduation party);  renting hotel rooms for the graduates.

And while we would like to blame the schools, their friends or society at large, the hard truth is that parents ARE responsible for their children’s behavior.  So, those in the field are saying it now:  parents make the difference.  We were afraid to offend parents years ago.  By not confronting the lack of parenting, we sacrifice our children.

I should clarify.  I do not think, by any means, that there are perfect parents – they only exist on bumper stickers.  And we try to do our best but sometimes our best is not very good.  This occurs because, sometimes, we do not know better.   This occurs, sometimes, because we don’t know how to set and enforce rules and boundaries.  It occurs, sometimes, because we put our own needs first.

So, this article Is in your face and “up front and honest.”  Some parents will say, I need to take a parenting class – CARE offers them.  Some parents will say that I have a lot of nerve.  Whatever parents say, I am happy that “a times are a changing” and no longer are we trying to hide unhealthy behavior.  At least that is true for some of us.

Many of you have heard from me, reminding you that September is Celebrate Recovery Month and encouraging you to attend the Celebration Walk in Lansing on September 14.  The event is meant to accomplish two things.  Truly celebrate recovery and to let the legislature know that those who suffer from alcoholism and/or other drug addictions need adequate treatment and other services to support their recovery.  Funding needs to be available for these services.

But today, my staff and I are not celebrating.  A grieving family just left my office.  They spoke about the services that CARE was able to provide for their son, age 24, but they mostly spoke of their great lose.  They buried their son on Tuesday.  He died of an overdose in a motel room.   

What can one say to a grieving family who just buried a beautiful 24 year old boy?  He had gone through detoxification, spent a minimal amount of time in a residential treatment center and had been referred to an out patient program.  He was homeless, living in his car and literally crying for help.  If I looked hard, there might be lots of blame to go around.  But I don’t want to look hard.  Instead, I want to recognize the grief and loss of the family and share the reality, from my viewpoint.

Alcoholism and other drug addictions are ugly conditions affecting the entire family.  They may be “brain disorders” and designated as a disease but they are like no other disease.  In most cases, the death of someone who dies from addiction leaves family members feeling empty, guilty, ashamed, regretful and confused.  It pits members against each other and begs for the understanding of society.

It also is a reality check for those of use that know that alcoholism and other drug addiction can be managed, we have seen it, but we also know that a great number of people are not able to manage their disease.  Science still needs to tell us why some people respond to treatment and some do not.  Of course, that being said, some people respond to treatment for cancer and some do not. 

As I look to September and the Celebration event in Lansing on September 14, I need to focus on the very real goal – to work toward effective prevention programs and adequate funding for comprehensive treatment and services.  Won’t you join me?   Visit the Project Vox website at www.projectvox.com for more information.

 I found a picture from 1946 of a family member at the age of about 18 months with his loving aunt and uncle.  The uncle was smoking a cigarette and giving the young child a sip out of a beer bottle as the aunt watched on.  We know now that smoking in the presence of children is unhealthy for them.  We also know that giving children alcohol is definitely a hazard to their future health.  So we don’t smoke in front of our children any more and we don’t give them alcohol, right?  This is what my Letter from the Director was going to be about.

But after showing the picture to several co workers and friends, and discussing my thoughts with them, I was discouraged to hear that it has been their observation that not much has changed.  They say, it is still common practice to smoke in the presence of children and share alcohol with them!  Children are still being exposed to situations that will impact their future health and lifestyle choices.

This brings me to speak about the healthcare reform bill passed by Congress that includes a plan to spend $15 billion on disease prevention.  Some advocates want the money to be spent on disease-specific interventions targeting problems like smoking and diabetes.  Others are asking that the money be used to address broader community health initiatives. 

Kenneth Warner, Ph.D. dean of the School of Public Health at the University of Michigan chaired  a committee that released the 2009 report, Prevention of Mental, Emotional and Behavioral Disorders Among Young People, concludes that prevention of addiction and mental illness has been proven to be scientifically feasible, but only public-health approaches are demonstrably effective. 

Basically what this means is that programs that address single issues are not as effective as those that address issues across a broader spectrum.  The report noted, “There is growing evidence that well-designed prevention interventions reduce a range of problems and disorders and that these efforts are sustained over the long term.  These programs often help children, families, and schools build strengths that support well-being.  A focus on prevention and wellness can produce multiple benefits that extend beyond a single disorder.”  Proven strategies include:
 

• strengthening families by targeting problems such as substance use, or aggressive behavior; teaching parenting skills, and helping families deal with disruptions such as divorce, poverty and mental illness 
• strengthening individuals skills and improving cognitive processes and behaviors
• preventing specific disorders such as anxiety or depression by screening at risk individuals and offering treatment and interventions
• promoting mental health in schools
• promoting mental health through health care and community programs

We may see more support for prevention programs as President Obama's administration rolls out the new Successful, Safe and Healthy Students program, slated to replace the Safe and Drug-Free Schools grants.  It is designed to have a broader focus creating an “improved school climate that reduces drug use, violence and harassment and improves school safety and students’ physical and mental well-being.”

So what does this all have to do with the picture of my 18 month old family member?  Maybe not much,
other than the fact that the seeds of addiction are planted at an early age and as I have done the work of prevention for almost 23 years it saddens me to hear that some 18 month old child, today, may be the victim of second hand smoke and alcohol fed into his body.  Hopefully, the next 23 years, with increased awareness, education and public funding we will see a greater change.  

Wow.  We are almost halfway through the year….o.k.  so I am pushing it a bit but really we are well on our way to summer.  Every day I read the paper and think, “I need to write about that in my “Letter from the Director.”   So here is just a mumbo-jumbo of stuff.

• I just finished reading The Swan Thieves and an old man in the story said to a younger man, “and at some point we just stop caring.”  I think he was referring to the fact that as we age, some of us become less passionate.  We feel that we have worked hard to improve society and our efforts have been useless.  I hope this never happens to me (but no guarantees!).  I have looked at movements over time and recognize that change takes time and it is only through the efforts of many, over time, that real change occurs.  At least we don’t entertain ourselves by watching gladiators anymore!
• We were made aware that a doctor in Oakland County is selling Medical Marijuana documentation/cards for $400.  And if he receives a referral, he will kick back the referring source $100.  Also K2, a substance that is marketed as potpourri or incense is on the scene.  A chemical is sprayed on the potpourri substance that when inhaled through smoking gives a high similar to marijuana.  While Michigan is moving to make the substance illegal, currently, it is legal to sell/purchase K2.  I guess my thoughts, here, is that we keep chasing the golden ring.  It is like trying to treat a disease after it has taken hold.  Of course, we need to try to STOP bad things from happening but isn’t  it wiser to PREVENT bad things from happening?      
• “Can we get to where we need to go if we must begin from where we are?”  Many of CARE staff work with clients who have so many problems and very few supports, that they must wonder, “are we really doing any good?”  We can connect people to resources and encourage their progress but we also need to be realistic.  People who have many strokes against them may never be able to obtain what we wish for them.  Saying this, I did run into women that participated in several of our programs over time.  She is currently in the second year of a nursing program and said, “CARE is the home of angels.  You saved my life.”  Now that goes a long way to keep us on the job. 

We are well into the New Year and as I look back over the past decade I feel confident that those of us, working in the field of the prevention and treatment of alcoholism and other drug disorders, have made progress. 

• Science has confirmed that alcoholism and drug dependency is a brain disease that needs to be treated as a chronic condition, treatable and manageable.
• People who are in active recovery from alcoholism and other drug dependency are becoming advocates for treatment and education.  They want the community to know that recovery is possible.  They want the community to know that alcoholism and other drug dependency is a disease and not a moral issue.
• The federal government has passed long awaited legislation that assures parity (equal payment) for the treatment of mental health/substance use disorders as well as other physical conditions. 
• Michigan is now a smoke free state!  Effective May 1, 2010 smoking will not be allowed in restaurants, bars or workplaces.  It has taken years of advocating for this legislation to actually see it become law.  It confirms that advocacy and educational efforts can produce change.
• Those who are working to prevent alcoholism and other drug dependency have recognized society’s need to change the way it thinks about drinking patterns and consumption. 

This is where we are now.  With people still dying or being maimed by intoxicated drivers; parents still believing that “all kids drink,” and children still being raised in families stressed by the unhealthy use of alcohol and other drugs, there is much still to do.
We all know that it is much easier to prevent something bad from happening then to fix it after the fact.  How do you fix the family of a women killed by an intoxicated driver?  How do you fix a young person addicted to prescription drugs?  How do you fix children raised by a mom and dad who fight every week end complicated by their drinking?       
We, first, need to help individuals and families to recognize that one in five families is impacted by addiction and addiction starts with acceptance of unhealthy behaviors.  Unhealthy behaviors occur when we let people drive after they have been drinking.  Unhealthy behaviors occur when we allow kids to drink.  Unhealthy behaviors cause many divorces, bankruptcies, lost jobs, and incarcerations. Many illnesses and accidents including falls can  be directly attributed to drinking and other drug use. 
We need to help individuals and families see that addiction does not just happen to others.  It is in our homes; it effects those we love.  So this is where we are, facing the next decade.  Prevent it so we don’t need to cure it.      

Where We Need To Be

You know how song lyrics can get stuck in our head and we repeat them over and over again.  Well, sometimes the same thing happens with words or slogans.  I continue to ponder the following:

• Can we get to where we need to be if we must begin from where we are?

My belief is that “where we need to be” is a place where we can prevent addiction and provide meaningful treatment for those that need it thus minimizing the negative impact of drug dependency on individuals, families and society as a whole.  Can we get there from “where we are?”  Some days, I think the answer is “absolutely yes” and some days I think the answer is “positively not.” 
Over the last 33 years, CARE has worked hard to decrease and minimize the pain brought on by alcoholism and drug dependency.  We have done a lot of education over the years to bring attention to the issues surrounding drug abuse and dependency.  We have educated the public about the perils of teen use and yet kids continue to overdose and die from heroin; they die in drunken driving accidents and one Warren youth, just recently was convicted of second degree murder for beating a man to death who stole his marijuana.
We have done a lot over the years to bring attention to the fact that raising children surrounded by love, boundaries and healthy parenting skills increases the likelihood that children will have successful addiction free lives.  Yet, many parents continue to think that parent education is not for them.  In reality, parent education is beneficial for all parents….and their children.  To not learn effective parenting means that parent are likely to over parent or ignore important red flags.  Parenting is truly an art.  Parents also tend to deny the fact that their own alcohol and drug use impact their children’s choices.
A person in attendance at a Project Vox meeting (the voice of recovery) used another phrase that jumped out at me, “we don’t deny the problem; we ignore it.”  Wow!  A light bulb went on.  Our work has been successful!   People know that issues around addiction and healthy parenting and they can no longer deny the accuracy of the message.  Now, they just chose to ignore them!  Is that too harsh?  I don’t know. 
And so the question remains, “can we get to where we need to be if we must begin from where we are?”  I think we are in a much better place than we were 33 years ago.  We are at a place where we openly speak about addiction as a health concern.   Science has taken great steps to lay the platform for effective treatment.  Research shows parents who are actively engaged in healthy parenting techniques raise drug free kids.  We are no longer in the days of “seen but not heard.” 
So over the next 33 years, we just need to get people to stop ignoring the issues but they can no longer deny them!