Spiritualitys Role in Adolescent Addiction Treatment Treating the

Spirituality’s Role in Adolescent Addiction Treatment Treating the Whole Person Paul Citro, MBA, LADAC, NCACI 1

Background �Licensed addiction counselor and have worked in both residential and intensive outpatient settings since 1987 �Worked with both adolescents and adults �Director of adolescent services of a 24 bed residential chemical dependency treatment center (Cumberland Heights ) in Nashville, Tn for the past 4 yrs. �I am addicted to working with teens and working with others who do the same. �I work with the most creative and energetic staff I have ever worked with. 2

Continued background �I have found some of the staff who have the most influence on the teenagers in our organization are the clinical associates. �When one our teens has an ah-ha moment somewhere I will hear the name of one of clinical associates as part of the discussion. �Working with teenagers requires a high level of energy all day long. �I sincerely appreciate all the dedicated professionals here who work with teens and young people everyday – you literally change lives for the better every day! 3

Before we begin, � I recently had a teen who used Dextromethorphan (DXM) exclusively so I wanted to brush up on it. � He stole his DXM from; two Walgreens stores, Kroger, Wal-Mart, and a Target store � At one point pitched his tent and camped in the woods behind Wal-Mart so he didn’t have so far to go after he stole the cough medicine. � He informed me it took him just 20 minutes to ride his bike to the Walgreens on the edge of town and 90 minutes if he walked. He had the details down. � He had been caught stealing, kicked out of and banned from all the stores mentioned. He had racked up about 20 arrest for theft public intoxication and illegal substances. � In my research I found this “Web Forum” for users of DXM and other drugs; 4

Web Community Dialogue about DXM on Grasscity. com �“Community member # 1” has a fairly offensive sign-on name �Community member # 2 was “oldschool grower” has a marijuana bud as his web icon. Here is their conversation; �“Community member-1” i cant find robotussin xtra strength. preferably are there any good, strong pills/gelcaps? cough syrup tastes like sh*t. (i find it hard to keep it down. ) �(oldskoolgrower) That's your body telling you that abusing DXM is bad for you. �“Community member-1” says the guy who is OBVIOUSLY doing weed. . . and DXM isn't bad for you, just the other active ingredients 5

DXM-Web community continued �(oldskoolgrower)I'm not going to argue facts with you. Overdose of DXM can cause serious problems with neurotransmitter balances in the brain. Comparing cannabis use, which causes no long term harm to body or brain, with the abuse of artificial chemicals just makes you look foolish. Extremely foolish. I didn't tell you NOT to do it. I just told you WHY your body tries to reject it. We all do things that are bad for us but we should do them with open eyes and knowledge of the dangers inherent to them. 6

DXM-web-community continued �“Community member-1” ok, i agree that weed is probably less harmful than DXM, but it's my body i'm Blank_ing up, and i want to blank__ it up the least by not intaking too harmful products such as (asm) (some other ingredient in the cough syrup). plus, i cant find any weed dealers near me. . . which is why i'm trying dxm, a relatively cheap, over-thecounter drug. 7

Internet websites and the popular media normalize substance use �These websites and the popular media normalize substance use in ways we never had to deal with as teenagers. 8

Recent article in the LA Times �In the wake of a video showing Miley Cyrus smoking a bong, “sales of salvia divinorum jumped” at some Los Angeles-area head shops, according to TMZ, which spoke to several of the legal outlets over the weekend Recent article from LA Times (December 14, 2010) 9

Article goes on to report Troubled pop star Miley Cyrus celebrated her 18 th birthday by experimenting with a bong…. The Disney star is shown with the bong to her head before catching a case of the giggles. "I'm having a little bit of a bad trip, " Cyrus says , "I want more of that __blank” The bong is reportedly filled with the natural herb called salvia which has psychedelic qualities. Possession of salvia is legal in California. 10

How popular is this star �Headlining the event (4 th of July Show) she sold over 50, 000 tickets to a sell-out record-setting crowd in 10 minutes. �Not many artists can do that- �Now that’s influence… 11

Purpose of this session �To give a profile of typical teens who presents to addiction treatment �Spiritually what do they present / what’s the impact their addiction has had on their spirit / spiritual life? �What Interventions can be used in treatment or in counseling to assist in their spiritual growth/awakening �What are some realistic desired or hoped for outcomes 12

Typical teens who we see present for treatment � Opiate addiction – teenagers just like adults are entering treatment in large numbers with prescription opiate addiction most often bought on the street � Tn has the distinction of being second and just behind West Va in prescriptions written per capita. 17. 3 � Heroin – in waves depending from what part of the country kids come from � Other prescriptions: meds for ADHD, benzos or anything that can be swiped from a medicine cabinet or Wal. Mart, stolen from Walgreens or bought at school. These are becoming increasingly more available � Marijuana and Alcohol are the old standards 13

Teen addict profile; some new drugs �Inhalants: Dust-off, Reddi-whip, glue �New herbs & bath powders & drugs of abuse: K-2, Party Powders –Charge… incense 14

Our landscapers had planted this attractive plant – a mother spotted “Salvia” in our flower beds 15

Co-Occurring Disorders � Bipolar - Anxiety disorder - Panic disorder -Depression -ADHD � Just like adults -some kids have a clear history and true diagnosis of these disorders and can benefit from medicines --� others were given these diagnosis during an acute stage of intoxication or physical withdrawal � Some of the kids we see are overprescribed meds and often we find that their parents encourage this in their search for a quick fix for their problem child. � When we see kids buying/selling/snorting/ stimulant meds- We see girls with eating disorders lobbying the doctor for specific amphetamine based ADHD meds by name 16

Other issues �Cutters �Self harmers - burning - carving-tatoo �Disordered eating (primarily teen girls) �Choking 17

Choking �Came out of the blue on our treatment unit �The referral mentioned that one of our new kids had choked himself a month prior to admission �It was a new one for us �Here is how this teen explained it to us; 18

The Choking Game �A teens chokes himself or each other as a way to get high--- without the risk of getting caught with alcohol or drugs- zero costs and it can be done anywhere. �Adolescents cut the flow of blood off to the brain, in exchange for a few seconds of feeling lightheaded. It can become a very compulsive behavior 30 -40 x daily �When they release the pressure , blood that was blocked then floods the brain all at once. This sets off a warm and fuzzy feeling – 19

Spiritually what addicted teens present when entering treatment Detox /Discomfort / depression / a low drained spirit Acute withdrawal needs that take priority as physical recovery must come first Its extremely difficult to feel spiritual when your throwing up breakfast and all muscles and bones ache 20

After detox and withdrawal �Teens are wired to rebel and push back away against whatever spiritual, religious and social beliefs they were taught growing up �I have worked with a 17 yr old teen who was adopted by a Jewish family (he doesn’t identify Jewish despite his mothers wishes) who it turned out was a skinhead - In treatment he decided he wanted to be baptized as a Christian �Family counseling has been interesting 21

Adolescent spiritual extremes It is a normal part of this “Middle Adolescence” phase of development to push back from parental authority This time in their life is about achieving independence Question authority-parental, societal and organized religion Need for peer approval increases while the value of parents opinions decreases 22

A natural movement toward spiritual independence �Atheism �Agnostic �Buddhism �Native American practices �Rastafarian (promotes the spiritual use of marijuana) That’s often the extent of the insight into this religious movement �Many teens are just “searching” and don’t know where to begin 23

Spiritual Extremes �We have a teen in treatment who wear rosary beads as a necklace �His parents are atheist bankers/ when they come to visit he’s wearing somebody's rosary beads �He enjoys NA meetings, mindfulness meditation groups and anything outdoors-he is a seeker �It has been fun seeing him explain to his parents about spirituality �As awkward as this has been whatever he comes up with is definitely “his own” 24

Five boys (you never know) � 5 -boys wanted to be baptized Christian while in treatment �Of the boys 2 - Jewish and 1 -atheist ? �Much discussion ensued about their motives , , , � �Although not something we would ever encourage in treatment yet it offered opportunities to point these teens into steps # 1, 2 and 3 – 25

Teachable moment --5 -boys � 1) “We admitted that we were powerless over our addiction, That our lives had become unmanageable. ” � 2) “We came to believe that a Power greater �than ourselves could restore us to sanity. ” � 3) “We made a decision to turn our will and our lives �over to the care of God as we understood Him. ” 26

Powerlessness and Unmanageability-(an opening for a personality change / spiritual experience) �When a teen is in serious pain of withdrawal it becomes a golden opportunity offer an alternative �Question how did their own willpower and intellect failed them – Introduce the disease of addiction �(Admitted we were powerless, , ) �We deal with Teens and addicts who both have a forgetful memory and think; “it will never happen to me” 27

The Minnesota Model �The Minnesota Model is described by Mc. Elrath in 1997 as being "inextricably interwoven with the program, practice and philosophy of Alcoholics Anonymous (AA) � The AA movement conferred the belief that alcoholism is a physical, mental and spiritual illness and developed the Twelve Steps, which outline a spiritual solution 28

Spirituality and Recovery from the prospective of the “Minnesota Model” Offered the disease concept of chemical addiction Offered that the ultimate goal is personality change or change in basic thinking, feeling, and acting in the world. Within the model, this change is referred to as a “spiritual experience. ” How does this relate today with teenage alcoholics and addicts 29

Ways to create opportunities in our regular schedule for spiritual awareness � You never know when a person is going to be ready to surrender their own will and intellect so we build simple interventions into our daily schedule � Simple rituals (moment of silence / Serenity Prayer) to open and close sessions -Into Action- section in AA Big Book offers a simple guide to meditation pg 86 & 87 � literature you have placed in your office or out in the lobby –use 12 steps and pull out all the stops. AA Big Book, NA , Meditation books, Are the 12 -steps kosher? Abraham Twerski, Darren Littlejohn; The 12 step Buddhist � Reading a teen oriented meditation book to open up counseling sessions 30

Practical interventions Peer modeling / group therapy ( group discussion/2 nd step work) our program is a 30 minimum 120 day maximum -- the community helps do the work for us � Education groups (spirituality group) � Offer Non-denominational spiritual service � Encourage questions and develop spiritual seekers � Offer opportunities for elaboration and clarification of a power greater than yourself 31

Spirituality vs Religion �Remember many people automatically think religion when one speaks of spirituality Introduce 12 -step model through: �Meetings �Formal written step-2 work / group presentation �Recovering peers – encourage sponsorship �NA/AA Literature , Hazelden pamphlets 32

Higher Power �Many teens are more aware of what their Higher Power is not than sure of what their Higher Power is�Often teens seem to eventually come around to a concept of a higher power that resembles what they grew up believing �The difference is this time around they can take full ownership of their spiritual life 33

A new Higher Power that’s not self will and not drugs �Not Drugs! Not themselves! Can help them stay clean & sober! 34

Education through practice �Teens learn through doing – they don’t want to talk about it! �Attend 12 -step meetings –take or send your clients to meetings 90 x 90 is not unreasonable �Introduce step work in residential, IOP or weekly outpatient �Open/close sessions with a Moment of Silence and/or Serenity Prayer �Spiritual Experience, pg 569 AA Big Book Speaks about a “Spiritual awakening” most often being the educational variety – kids learn through doing/practice 35

Meditation �Provide regular opportunities for meditation groups �We begin the day and end the day with quiet time and meditation pg 86 & 87 AA Big Book � Our meditation practices vary from guided imagery to mindfulness meditation �This may be the only time in their day they slow down and check in spiritually 36

Labyrinth �Use what's available in your community: labyrinth is a metaphor for the journey to the center of your deepest self and back out into the world with a broadened understanding of who you are. 37

A walking meditation–“Sought through prayer and meditation, ” 11 th step 38

Labyrinth, simply put; The labyrinth is a path of prayer, meditation, and discernment. 39

Labyrinth- a spiritual path 40

Art Therapy 41

Simple Art assignment �Draw yourself and your Higher Power on this paper �That’s all the instruction �Process / discuss �This is a great forum to learn about how your teen relates /or not to her Higher Power 42

Equine 43

Equine – Use metaphors; Are there characteristics that are similar with the horse and your Higher? 44

Similar characteristics �I hear words like; � Strength �Confidence �Wisdom �Intelligent �Loving �Beautiful 45

Traditional Spiritual Counseling �We have two pastoral care counselors (male and female) who do everything from grief counseling to hearing 5 th steps �Know resources in the community – enlist your local clergy to hears 5 th steps or offer other kinds of support �These may be the only people a teen will share certain things with �They offer listen and support and can provide safety and wisdom 46

Service work- getting outside of yourself This ignites that basic human desire to be useful and can allow the teen to feel worthy of acceptance from a HP This can be serving meals at the local shelter, yard work at one of the recovery houses, or volunteering to sort clothes local Goodwill thrift Store – truly a spiritual gift Service work can offer freedom from self will 47

Be part of a community /have fun �Present and encourage scheduled and non-scheduled opportunities to play �Laughing and smiling are spiritual activities �Teens aren't going to buy into sobriety unless they discover they can still have fun –sober dances, clean and sober holiday celebrations, rafting, canoeing, sober music �Nashville has vibrant and active young recovering community I have no problem finding teens (with two years sober time) to come out to share their experience, strength and hope to our kids in treatment. 48

Desired Outcomes �A teen to be able to demonstrate abstinence from mood altering substances and regular use of basic spiritual practices; �Be able to be able to clearly describe the difference between spirituality and religion �Prayer & Meditation – (pg 86 & 87 in the AA Big Book) �Journaling �An active member of the 12 -step community / meetings 49

Desired Outcomes �Eliminate hopelessness and increased faith in something outside her/himself Teens ability to forgive self and grow self esteem �Teens to show definite improved relationships and connection to family �letters - 50

Thank You 51