Addiction Treatment


Moving From Sick Care to Health Care | The New Addiction Treatment Paradigm

By | Addiction, Addiction Prevention, Addiction Recovery, Addiction Treatment | 10 Comments

Addiction Treatment | From Sick Care to Health Care

I had the recent privilege of attending the 2nd Annual David E. Smith, M.D. Addiction Symposium in San Francisco. The event attracted addiction treatment professionals from all over the nation. We listened to seasoned clinicians and cutting edge thought leaders in addiction science and treatment on topics ranging from pharmacotherapy to spirituality. If I were to sum it all up in a nutshell, the common thread was that we actually are moving from sick care to health care with addiction treatment leading the way.

It’s All About Brain Health, Any Questions?

Good health starts with brain health.

Good health starts with brain health.

Time and time again I heard ultra credible, mainstream people saying that addiction treatment is all about brain health and brain health is all about ensuring the essential nutrients of eating, exercising, thinking, feeling and sleeping well.

Something inside stood up and cheered as I heard for example, the addiction psychiatrist and trend setter, Daniel Amen, M.D. say things like, “Why is psychiatry the only discipline that doesn’t ever look at the brain–the organ it is treating?” and, “Why do I get recommendations for a colonoscopy but never for a non invasive brain scan when brain health is what it’s ALL about?”

Each talk surveyed the literature and as pointed out, the research gets edited and updated about every twenty minutes. But the bottom line was this; every vetted approach works a little bit, however if people are not practicing the good brain health practices of eating, exercising, mindfulness and sleep–fogettaboutit’.

What’s really changed in the way people think and talk about addiction treatment is that we’re getting calls to action–and I mean seriously–people standing up in solidarity and declaring we cannot practice addiction treatment in the compartmentalized, symptom suppression way we’ve been trying for decades. Rings a Herby Bell in my, “experience of one” in addiction recovery…Yes!

Monetize Wellness: NOW

I love my squishy brain...

I love my squishy brain…

As I sit here between thoughts and squeeze my palm sized, squishy brain the Amen Clinics distributes as marketing tools, I realize we really are on the brink of commitment to delivering a new paradigm of healthcare because we’re learning how to market and monetize wellness.

Yeah, there are a lot of fancy ways to get into the practices of this new paradigm–healthcare–and it takes what it takes. How about a “single photon emission tomography scan” or better known as the SPECT scan? A test that takes a snapshot of how the brain is working to determine what practices of–you guessed it; eating, exercising, thinking, feeling and sleeping well will best serve that brain.

So what about all the other high powered, high tech, biochemical/mechanical approaches that we’re so used to hearing about “curing” us? Fantastic stuff all of which can be used for the far end of the sick care spectrum when indicated. But for the remaining 85% plus of the population, let’s evangelize the brain health basics up the yin-yang and develop services and practices that offer healthcare to the masses, shall we?

Live Long and Drop Dead

What we’ve learned the hard way, (and another refreshing, repeated point stressed at the symposium) is the longer people are in addiction treatment, the better. Another way to think about it is that people need to stay in healthcare for life, because nobody gets out alive. How we facilitate this current inconvenient truth remains in the storming and forming phases, but people, we have ignition!

As more people are taught by doctors, (Latin; to teach) to take on the “experiment of one” by practicing good brain health, my mentor and colleague, Mark Sisson‘s adage makes more and more sense; “Live long and drop dead.”

Take a hands-on approach to taking care of your brain

Take a hands-on approach to taking care of your brain

Okay, so while we’re still in the interim space of being sold on the idea that one’s gotta have symptoms before learning to take care of oneself with good brain health practices, it’s an important step toward a better way to be the self-regulating and self-healing humans we already are.

Here’s to the time when we all realize that symptoms are an indication we have not been “in” or practicing healthcare–a time when we’re all taking a hands-on approach to eating, exercising, thinking, feeling and sleeping well–as matters of fact and practice.

A special thanks to Dr. David Smith who has been writing, saying and practicing all of the above for decades and who will be an upcoming guest interview on Sober Conversations. My deepest gratitude to you, Dr. Smith for all of the gifts bestowed upon so many at your symposium. I look forward to learning more from you very soon.


Addiction is a Cultural Phenomenon – A Tragedy near Woodside, California

By | Addiction Prevention, Addiction Recovery, Addiction Treatment | 20 Comments

Recently I was made aware of a proposed, new, residential treatment center right here in my own backyard on the mid-Peninsula of the San Francisco Bay Area. For one reason or another residential addiction treatment is conspicuously few and far between here especially on the mid-Peninsula, which is equidistant from San Jose and San Francisco. The region is San Mateo County very near where Silicon Valley lives and thrives.

Among the 40 million people nation-wide, it is estimated there are approximately 66,000 individuals in San Mateo County alone who need addiction treatment and who fall somewhere on the spectrum of treatment needs from detoxification to continued care. The county now has less than 300 beds for residential treatment. Residential treatment is not indicated for everyone who enters addiction treatment, but certainly more than 300 beds are required in this county to meet the needs of 21st Century addiction treatment care.

The "Great Room" of Stillpath Recovery Center

The “Great Room” of Stillpath Recovery Center

The name of the proposed facility is Stillpath Recovery Center. It is located in an unincorporated 16 acres of San Mateo County above Woodside, California in the coastal mountain range. The owner purchased what was Stillheart Retreat Center where weekend retreats were conducted on this world-class destination of a venue.

I was so enthusiastic to learn about this project, I contacted the owner to ask if I might see the site and learn more about his approach. He was very generous with his time and invited me on two occasions to visit Stillpath and to learn what the project meant to addiction treatment in the Bay Area.

The place is a veritable vortex for healing. Surrounded by the nature from which it and we all emerge, while visiting and now, I cannot get over the quintessential perfection of what such a venue could mean for the Bay Area and addiction treatment/recovery. The site is not visible from the road and clearly far away from any neighboring concerns as the land parcels are quite large in the area.

I learned that the center would follow 21st Century brain science protocols outlined by the American Society of Addiction Medicine. A place for applied brain science, brain health to be practiced and realized right here in my own backyard. From integrated nutrition and functional movement to cutting edge psychological approaches–the stuff of addiction recovery.

The staff would be an integrated, multidisciplinary, communicative team of professionals dedicated to this work. I learned that the cost for such treatment could be reimbursed in large part by insurance through the advent of new coverage available via the current health reform legislation, The Affordable Care and Mental Health Parity acts.

I also learned that Stillpath would add 76 beds to the residential treatment potential to address the embarrassing deficit in San Mateo County not to mention the remainder of the nation.

I asked what I could do to help. The owner asked me if I would attend the next San Mateo County Board of Supervisors session as an addiction treatment and recovery advocate. The project, which had already received approval from the planning commision, (this approval being appealed by the local residents) was on the agenda to be approved or struck down by the supes. All of the concerns including traffic, zoning, water consumption, fire hazards and more were addressed in the planning commission’s approval. I looked forward to standing up for a potentially life saving project and for something that could raise the bar and the self-esteem of addiction treatment in our beautiful, trendsetting Bay Area.

Addiction Treatment? Okay, but…

The Board of Supervisor’s session took nearly 3 hours to come to a conclusion. Approximately 50 to 60 people attended equally representing the applicant, Stillpath Recovery Center and the local residents and their representatives who adamantly opposed the project. After each perspective’s representatives were given time to make their cases beginning with the planning commission’s detailed report for approval, the public was allowed 2 minute testimonials when 30 of us, one after another, stood up and spoke to our concerns and why we were there.

The local residents spoke to the planning commission’s report as being incomplete and largely incredible. One young woman repeatedly called the attorney and other members of the applicant’s team liars. Most of the testimony against the approval had to do with comments, (including one supervisor) relative to statistics about “addicts” smoking cigarettes, which will lead to forest fires and trespassing, “Everyone knows how addicts are, it’s from one addiction to another–they’ll smoke.”…This, in the face of the applicant testifying it would be a non-smoking center where resident’s personal belongings are searched as part of addiction treatment protocol. Another woman stood up and said her own family was involved with addiction treatment and how she believed in it, but…not here, please, not here in her own backyard.

In the opening presentation, Stillpath’s Clinical Director had already clearly addressed and answered questions regarding staffing/resident ratios. She discussed the nuances of the social model proposed incorporating the highest standard of practice concerning medical presence and monitoring.

The other testimonials in favor of the project including me, spoke to the dire need for such a treatment facility especially one we can all be proud of in an area where the best health care in the world for other health issues–including other chronic illnesses–is available.

People spoke to the pristine record of other similar centers and the prospect of this center aligning with outpatient centers and continued care services. A dream come true with a perfect place to live the dream. We spoke to the heart of addiction as many people stood up and talked about the ravages and deaths in their families or how residential treatment saved their lives. We heard from experts in the field to a son who had lost his Dad and a Dad who had lost his son.

We Get Letters That Say, “Not in my Backyard”

Okay...just not here

Okay…just not here

Finally all that needed to be said and heard was complete except closing comments by each side. Closing comments were given by a representative from each side including the attorney for the opposition declaring the proceedings were done all wrong and elaborated categorically. The attorney for the applicant’s side asked for a continuance until the 3 out of 5 supervisors who had not taken the time to visit the site could do so. One of those 3 supervisors spoke up to say she didn’t need to see the site or tour the specifics of what and why the planning commission had already approved the project, that she knew all about it and where it was…

The board then closed the formal proceedings and moved to a vote. Each of the supervisors cited an overwhelming number of letters and emails they had received or heard about asking not to approve the project, IE, addiction treatment is fine, just not in my backyard.

The board voted unanimously to strike down the applicant’s project, Stillpath Recovery Center.

One of the representatives for the local residents was interviewed after the session and was quoted as saying, “I do believe the supervisors really did listen,” she said. “I really think they got it.” 

I really believe the supervisors listened too. And I really believe they, as representatives of the culture, and at some very key and core level, continue to perpetuate the conundrum instead of offering proactive, collaborative solutions in this set of circumstances where the benefits clearly outweighed any mitigatable risks.

Addiction is a Cultural Phenomenon

Addiction is our number one public health challenge in the United States today in epidemic proportions. The cost of untreated addiction in terms of lost productivity, related health issues, and multi-generational social and psychological consequences, is staggering.

The potential residents of the proposed, Stillpath Recovery Center ARE the friends, family, co-workers and neighbors of the people in opposition to its approval. Addiction is a cultural phenomenon, and until we have leadership with vision, ready and willing to champion solutions for this now 21st Century plague of ours, we’ll keep getting what we’re getting; more addiction accompanied by the incessant denial that it lives in all of our backyards.

Surely, the culture that produces addiction can step up to the facts that if we are not all part of the problem, there is no solution.

Absolutely tragic.

scarecrow brain

I’ll Be a Son-of-a-Psychiatrist: Addiction Recovery – It’s a Go-Brainer Revisted

By | Addiction Neuroscience, Addiction Recovery, Addiction Treatment | 15 Comments



My first exposure to the importance of my brain

My first exposure to the importance of my brain

When I was a kid my psychiatrist Dad decided to bring home a human brain from the hospital where he worked. It was one of the specimens donated by a dearly departed soul for physicians to study. Dad decided it was important for me and my older siblings to pay attention to our one and only brain. He said, “I’ve got a surprise for you, now close your eyes, hold hands while I lead you into the Family Room.” He positioned the four of us around the game table as we heard him removing the brain from its container. I can still “smell” the pungent odor of the preservative, formaldehyde as I recall this understandably, vivid memory and my Dad saying, “Okay, open your eyes.” WOW.

Needless to say, I have been fascinated by brains and brain science ever since and as a person in long-term addiction recovery, a very good thing.

Good news for addiction recovery

Good news for addiction recovery

I’m re-reading Dr. Norman Doidge’s great book, The Brain That Changes Itself. He’s one of the people who ushered in and popularized the idea that our brains are like computers in the sense they can reprogram themselves, but unlike computers, our brains can heal themselves. While reading, (actually, listening) I just can’t help but get super excited about the far reaching implications of this work when it comes to addiction recovery.

Here’s what Dr. Doidge and the brain science are telling us:

  • Our brain processing centers have the ability to change
  • We can change the very structure of the brain itself
  • The brain is constantly adapting itself to the environment
  • The brain is always learning how to learn
  • The brain grows and changes itself with proper nourishment and exercise
  • The brain can reorganize its “maps” (programmed routines) in the right environment

The brain is not the fixed, rigidly organized organ we or my Dad once thought, but capable of re-learning and restructuring–actually changing the physical architecture of itself, “from crib to death.”

All of what we have learned works in addiction treatment is related to programs, modalities, therapies and practices that actually reprogram the brain, which just happens to be the target organ for addiction. Our former practices in active addiction established ingrained brain maps, (thanks, Lisa Frederiksen) or the above mentioned, programmed routines that our minds, bodies and spirits became accustomed to, and what most people in addiction recovery will agree, we held onto for dear life–even at the risk of near death.

As we know now, the not-so-healthy former habits came about as strategies for coping with one or more of the risk factors for developing addiction. Once we’re committed to leaving behind these strategies and behaviors that changed our brains profoundly, the task is to find what new practices will change our brains back toward what we all want; peace of mind, good health and productivity. “Just say no” never worked because it was contrary to the brain science and…just wrong.

Reprogrammable brain maps

Reprogrammable brain maps

Addiction recovery requires establishing new brain maps, a lifetime proposition–hey, good news!–of practice and reinforcement that turns out to be what any kind of wellness demands. Nobody gets out alive; it’s just about being well–today. All of wellness is one kind of remission or another…Let me stress again, implicit in this requirement is bolstering brain health and new brain maps with the essential practices of eating, moving, thinking, feeling and sleeping well without which the brain will not change itself in the ways desired. This is why all three phases of addiction treatment; detoxification, rehabilitation and continued care are required for healthy, sustainable remission from active addiction to be possible. Remember, repetition is how the brain learns and changes.

Addiction Recovery | New Practices | New Brains

If the science has shown us anything it’s that there is no one, best way to foster the business of rewiring the brain for better outcomes. What inspires me is the fact that the programs that have proven to help people are just what the brain science ordered. For example, here’s what Dr. Doidge reports about what brain science research tells us followed by the time honored wisdom of Alcoholics Anonymous:

  • Repetition is the mother of all invention – “Keep comin’ back”
  • Brain plasticity (reprogramming ability) is available from the cradle to the grave – “One day at a time”
  • Neurons that fire together, wire together – “Fake it till you make it”
  • Radical improvements in brain function are available at any age – “Now is a good time to start”
  • New brain maps take time to develop – “May you be blessed with a slow recovery”
  • The brain thrives and actually grows when learning – “Learn to change, change to learn”

And the 12 Step process is just one way to take a look at how we’re taking a look at things, (the learning brain) to establish new brain maps and associated practices to reinforce them in order to override the previous brain maps. There are many ways and the key is to find a way that uses an integrated approach catering to the needs of your mind, body and spirit–however that looks. Rewiring the brain mandates it and long-term recovery cannot be possible without it.

In brain science lingo and as seen above, “Neurons that fire together, wire together”, (creating new brain maps). Conversely, when the practice/repetition ceases, “If the neurons fail to link–they fail to sync” and no new brain maps. In that case, the brain fires up the already ingrained maps associated with the old, well practiced behavior–when cued–and relapse ensues.

Different Paths to the Mountain of Evidence Based Research

The self-healing, reprogrammable brain

The self-healing brain

So addiction recovery is not about monolithic, one-way approaches. This is because we all have different experiences and worldviews. What is clear however is that individuals with addiction do have to find ways to establish new brain maps for the reasons outlined above and there are many wonderful interventions to begin the process including:

Implicit in the American Society of Addiction Medicine policy statement, an integrated, multidisciplinary team of providers can help in the initial, stabilization/rehabilitation phases of treatment to assist people in finding their own mind, body, and spirit fitness program in order to reprogram that biological computer of theirs, the self-healing brain. The goal is that these practices get carried into the final phase of addiction treatment; continued care.

As we re-learn to move, eat and think/feel well, we’re really and truly reprogramming our brains. We’re really and truly giving up the habit of the being who we are that’s no longer working for us, for the habit of being who we can be–to become the best versions of ourselves.

I think my Dad was trying to tell me something very important…


Thank you to the sentient beings who help us heal

Thank you to the sentient beings who help us heal

And now I’m going to appeal to your humanity and your heart by saying that there was a huge price to pay to learn more about how we can indeed heal ourselves resulting from brain science research. I’ll have to admit I’m such a baby, the dolphins make me cry, but must say that untold throngs of laboratory animals suffered and gave their lives for this research to come forward. There is nothing more upsetting to me to know that information is available to people, but not accessible for one reason or another–while innocent sentient beings gave their lives in the process.

Let’s uphold the dignity of our humanity and of recovery and the sanctity of those who went before us, (all forms and species) who have made addiction recovery ever more possible in this 21st Century.

Addiction recovery – It’s a Go-Brainer.

Let’s Go.


Addicts and Alcoholics or Just People With Addiction?

By | Addiction, Addiction Recovery, Addiction Treatment, Addiction Treatment Services | 27 Comments

Do you ever breakthrough a threshold, a tipping point where you just leave something behind that used to work, but that’s no longer working for you? Something that has either outlived its usefulness or is no longer pertinent? Yeah, more and more I’m feeling that way about the terms, “addicts and alcoholics” because of the implicit subjugation and negativity associated with them at every stage of recovery.

I did some admittedly unscientific, but revealing research not too long ago by calling random, mainstream, addiction treatment centers/organizations around the country. I did it to get an idea of what standard of care is out there compared to what the evidence based science says, and to get a sampling of what the current “group-think” is in the addiction treatment industry regarding addiction treatment’s third phase of care; continued care.

Honorable intentions, but...

Honorable intentions, but…

After being funneled to a call center where people are generally scripted and salesy…I’d begin by asking about their plan for continued care, IE, what happens after people get discharged from their care. Each and every time for the dozen or so calls I made I’d hear some variation of a plan to “stay in touch.” From ongoing groups, to “recovery monitoring” by phone and drug testing, to alumni groups, etc. I’d then ask what the outcome studies showed for the continued care and invariably I was told on each and every call, “We don’t have long-term studies because addicts lie.” You know, they’re addicts and alcoholics… This, from organizations who really, do not offer or deliver the required third phase of modern addiction treatment; continued care. Huh?

I’m still flinching…

However, self-identifying with the terms addict and alcoholic still has utility for some people, no doubt about it. “Addict” is the root of the word addiction–bet you knew that. The Latin roots addictio and addicere are translated as, “a giving over, surrender or to assign.” Okay, that seems right…a giving over to a behavior I cannot control, I surrender and become assigned to a powerful force I cannot stop. So then it seems fitting and indeed, how it worked for me to surrender to something else, a power greater than myself to help me stop the behavior and get my life back. Self-identifying as an addict/alcoholic worked for me back in the day.

But I know it does not work that way for everybody and I’m wondering if it’s even necessary at all, I mean the identifying with “addict or alcoholic” in the year 2014.

I’ve said it before and I’ll say it again, I entirely appreciate AA and the 12 Step movement and I remain a proud member. Even all the years and years of going to meetings and listening to people identify themselves as liars, thieves, misfits and drunks. All part of the landscape to surrender in that context, but the trick is to see beyond those labels and know that people are much, much more than that. Regrettably, the terms, “addict and alcoholic” are associated with this entry level, cathartic process and therein lies the rub. Bill Wilson testified before Congress in 1967 and said AA has evolved like everything else, to have some good dogma and some bad dogma.

The Terms, “Addicts and Alcoholics” Have Gone Pejorative

So we got us a full fledged conundrum. People identify “addicts and alcoholics” with the symptoms and behavior of active addiction and then the treatment community does not offer what it says is required–continued care-and people relapse. See, I toldja so…they’re just addicts and alcoholics. More unscientific research: Does this piss anyone else off?

How do you spell: ARGH!!#!@?!!?

I think it’s time to surrender to the fact that these two terms, “addict and alcoholic” are part of the bad dogma. And I think to continue using the terms charged as they are, will not work for us if we’re interested in changing the conversation about addiction and helping more people.

We’ve moved from the term, “drug addiction” to the term, “substance use disorder” and we can do the same for the terms, “addict and alcoholic.”

Here’s what you and your family need to know…

I’m wondering what may have occurred nearly three decades ago if, when I was ready to hear it, an addiction expert approached me and said,

“Herby, the symptoms and behaviors you have consulted us about are born out of the fact that you have a brain disorder and disease and as a result, your mind, body and spirit are out of balance. It’s called addiction. Here’s the good news; addiction is treatable and manageable. Your brain, (the target organ of addiction) is not serving you as well as it could and we can help you to help yourself to improve your condition. Looking at your history, we see addiction is well established in your family and that’s one of the risk factors. There are three phases of care: 1. Detoxification and stabilization–a few weeks, 2. Rehabilitation–usually a few months to a year, and 3. Continued care–or maintaining your acquired wellness one day at a time–indefinitely. All three phases of care must be undertaken for addiction to be kept in remission as it is a chronic, relapsing illness much like diabetes and heart disease require diligent follow up. With initial education, treatment and ongoing wellness checks along with your disciplined self-care, you’ll be able to live a long, healthy life. Without treatment, including that for your family members, you and your family are at great risk for the addiction to worsen and the circumstances, quality and very existence of your lives to be in great danger.”

Would it have mattered? Would I still have needed to take on the hard line, bottom line, “I’m an addict and once an addict, always an addict” mantra having heard the above information? Difficult to say, but what does matter is that I don’t think it’s any longer necessary for people to carry a label charged with negativity when we know so much more. I think it matters that people can frame their conditions and healing in a much healthier and mainstream way. Yeah, just words, but we live in the language which is descriptive and generative and if words stop people from getting care, let’s change the words–or a least, talk about it.

It’s not that I don’t have the chronic illness of addiction anymore, it’s just that the terms, “addict and alcoholic” are anachronistic, pejorative and really no longer useful if we’re going to interest more people in the brain science and long-term solutions available to people and families with addiction. In one sense, continuing to use the terms addict and alcoholic is tantamount to labeling a person with diabetes, an “insulin abuser.” Doesn’t sound right, does it?

Yeah, we’ve got to change the conversation about addiction by changing the language we use about it. A great way to start is to re-think the negative and outdated terms, “addicts and alcoholics.” In doing so, individuals and families can focus on the solution rather than worry about the stigma associated with living with a label. What am I suggesting we use to replace those terms? How about, “people?” People with addiction.

What do people think?

Let me know,

Herby, a person in long-term addiction recovery.

Addiction Recovery and – Can We Agree to Agree?

By | Addiction Recovery, Addiction Treatment, Addiction Treatment Services | 13 Comments

Can we? Can we agree to agree about what’s really going on in addiction recovery, its science, treatment, education and prevention and do something about it? Will we? Have we had enough? What will it take?

Gary and Brian Mendell

Gary and Brian Mendell

Here’s what Gary Mendell, who lost his son to addiction through suicide said in his keynote speech last fall on the issue at the Clinton Foundation Health Matters Conference:

“Here we have a disease that’s preventable, but we don’t prevent it. A disease that’s treatable, but we don’t treat it and a disease that’s undeniable, but we continue to deny it. Enough. ENOUGH!! No more research ignored. No more Americans suffering alone because they have a disease. No more wasted lives.” (Watch his short, moving speech here.)

After 8 rehab experiences and ultimately losing his son, Mr. Mendell has been passionately and relentlessly motivated to create the national non profit organization, as a big tent, all encompassing umbrella like The American Heart Association or American Cancer Society to effectively and finally address this issue by, “Uniting and empowering, ending the stigma, advocating for change, researching and innovating.”

Gary asserts that what has been missing in bringing addiction treatment up to 21st Century speed is a central, more powerful voice of solidarity with all of the organized, moving parts to get the job done. He goes on to say that we have the research, the technology, the social will and currency to establish the visibility and momentum we need to affect change–starting now.

He’s confident of this in large part because of Mental Health Parity and Addiction Equity Act that was enacted in 2008 and the Affordable Health Care for America Act, (Obamacare) enacted in 2010. The synergistic forces of these two legislative milestones will bring evidence based, (already existing, researched, and proven) programs into the commercial market because the law mandates it as of January 1, 2014. Addiction services must be reimbursed as is the case for any other chronic illness including heart disease and cancer. This has never been possible before.

Can a unified, national non profit presence like mobilize this herculean effort to get addiction out of the closet and comprehensive, managed long-term care into the mainstream health care marketplace?

Can one man with a broken heart change the world?

Nothing is stopping Gary Mendell. He’s had enough.

What’s stopping US? Have we had enough?

What do you think? Will we?