Personal Boundaries

personal boundaries

What are personal Boundaries?

Boundaries determine acceptable behavior. Safety cannot exist without boundaries. Imagine driving without any traffics rules, signs or lights! Boundaries simply exist to keep ourselves protected from harm. Personal boundaries work the same way. They are the emotional, physical and mental parameters we set for ourselves. Love and healthy relationships cannot exist without the enforcement of personal boundaries because they protect ourselves from disrespect, exploitation, manipulation, and violation.  

There are many types of personal boundaries. Material boundaries govern whether and how much we give to others, such as money, items, etc. Physical boundaries relate to personal space and how close we let others get to us. Mental boundaries concern our values, opinions and thoughts. Emotional boundaries separate your own emotions from others. Sexual boundaries reinforce your level of comfort with sexual touch and experience. Spiritual boundaries apply to your beliefs and experiences with a higher power. Internal boundaries relate to your relationship with yourself.

Why are they important?

Setting personal boundaries is our way of establishing and communicating self respect, self esteem and self worth. Personal boundaries create individuality and keep us safe from external factors. Healthy personal boundaries are important because they allow you to take care of yourself and not let others define who you are.  

Can you have too many or too little personal boundaries?

Personal boundaries come in three groups: rigid, porous and healthy. Rigid boundaries refer to too many boundaries. Meaning you don’t let others get close to you at all and avoid intimacy. Porous boundaries include too loose of boundaries. For example, sharing too much with others too quickly or tolerating someone crossing your own boundaries. Healthy boundaries are shown in sharing an appropriate amount of info, respecting other’s boundaries, and valuing your own opinion, and not compromising your own boundaries.

How do you know they are being crossed?

Boundaries can be both easy and difficult to detect. For example, someone who doesn’t have many personal boundaries themselves will most likely not be able to detect when they’ve crossed other’s boundaries. The first step in becoming aware of boundary crossing is to become more self aware. Asking yourself questions like the following can be helpful in gaining self awareness: Do I feel angry at certain people? Does something feel off when I am around someone in particular? Do I often times feel overwhelmed and burdened by others needs? Writing down lists and your expectations of others can help as well.

Why do boundaries get crossed?personal boundaries 2

Often times people who lack self awareness tend to be unware of their own boundaries and therefore lack the awareness of other’s boundaries. People who have grown up in households with few boundaries often grow up to have issues with boundaries. Some people cross boundaries to take advantage and manipulate others.

Boundaries are crossed because they can be both confusing and conflicting. Sometimes boundaries are not clear all the time and also vary from culture to culture. Additionally, personal boundaries are often not reinforced enough in childhood and teach children that their own boundaries are not important. For example, parents will pressure their children into hugging a relative that they don’t feel comfortable with. This reinforces the idea that their boundaries are not important and that it is okay for others to do things to them they don’t like and to ignore your own boundaries. Furthermore, because we are all unique and imperfect, boundaries are bound to get crossed from time to time. It’s impossible to know other people’s boundaries all the time and to never cross any. For example, when meeting someone for the first time, you don’t list off all your boundaries right away. Boundaries are learned over time and are usually enforced when they have been crossed. The important thing is that we listen to our own and other’s boundaries and do not habitually or intentionally cross or ignore them.

How do you set them?

personal boundaries 3

Your tone is very important when setting boundaries. The most effective way to set boundaries is with a calm, clear and assertive tone. You can also communicate the clear consequences. More

 importantly knowing your own boundaries is the first step in setting them. Developing self awareness is key. Second, it is imperative that you understand you have a right to your boundaries. Third, let go of how others may react. We cannot control how others react to our boundaries. If someone does not want to respect them or does not care for you because of them, then they may not be a safe person to have in your life. Finally, practice setting boundaries. Role playing with someone can be helpful. The more you set boundaries the easier it will get.

Disassociation and Addiction

What is disassociating?


Most of us have had moments driving where we end up home and have no recollection or idea of how we got there. This is one example of disassociating. To put it simply, disassociating is detaching from reality to some degree. This mental process varies from a mild detachment from external surroundings to a severe detachment from physical and emotional experiences. Disassociating causes a disconnection between an individual and their thoughts, memory and identity. It can be both minor and severe. Most people disassociate to some minor extent. Minor disassociation includes day dreaming, zoning out, or getting sucked into a movie or book. However, others disassociate severely and forget significant memories, their own identity and environments like their own home. These characteristics are illustrated in various dissociative disorders that only affect a small percentage of the population. Dissociative disorders include psychogenic amnesia, psychogenic fugue, and dissociative identity disorder.


Why do people disassociate?

When people disassociate they are splitting off feelings of fear, shame, and anxiety.  It is technically a defense mechanism to protect ourselves from trauma, intense negative emotions and things that are too overwhelming to deal with. At the time it may be helpful, however we don’t actually fully forget things and our bodies remember past traumas. This avoidance coping strategy begins often times in childhood when things are too big or too overwhelming to process. Until disassociation is called out and recognized, most people don’t even know they are doing it.

What are the affects of disassociation?

It is important to remember that disassociation is not all bad. We all have the ability to disassociate and we all do it to some extent. Disassociation is a survival skill and is necessary during times that are too burdening and overwhelming to handle. With that being said, overly disassociating can have negative impacts on individuals and relationships. For example, forgetting important life events can affect relationships and individuals. Furthermore, being out of touch with reality can be isolating and may push others away. Emotions like fear, anxiety, sadness, and anger can come on randomly without the individual understanding why because as much as we disassociate and forget trauma, it does resurface in other ways.

What can you do to help?

There is not set cure for disassociation, however treatment is possible. Variations of treatment models exist for the differing disassociation disorders. Different studies show various treatment 


modalities. For example, some researches believe that memories can be resurfaced in psychoanalysis. Other treatment includes just managing dissociative behaviors with cognitive behavioral 

therapy. Mindfulness and grounding exercises are very beneficial and can help the brain be in touch with the present. Some studies even show that developing a strong and healthy attachmentwith someone like a therapist can shape brain circuits to process memory more effectively. Finally, disassociation disorders can be prevented in early childhood by providing a safe, consistent, and nurturing environment. 

Chronic Impulsivity and Addiction

Chronic Impulsivity

chronic impulsivity

It’s impossible to be in in complete control of yourself 100% of the time. Most of us lack some self control in areas of our lives. It’s part of the human condition to act out of impulse from time to time. Examples include an angry outburst, or overly indulging during dessert, or even impulsively buying that pair of shoes that you don’t need. These occasional impulsive acts usually don’t have a large influence, however if done repeatedly, there can be large negative impacts. Chronic impulsivity is a severe lack of self control and occurs when individuals constantly struggle with impulse control.


Chronic Impulsivity can take on many forms, such as, difficulty controlling immediate reactions, trouble concentrating and completing tasks, and interrupting conversations. Often times, those who struggle with being impulsive, have a difficult time considering consequences of actions. This continuing lack of self control can have profound effects on lives in many ways. For example, someone struggling with chronic impulsivity experience difficulty learning in classrooms and may struggle to move through the education system. Or perhaps, someone may affect their health negatively through impulsive eating.


Some causes of chronic impulsivity vary from poor modeling during childhood to other psychiatric disorders. Males are often times more likely to struggle with chronic impulsivity than females. Chronic impulsivity is not necessarily a mental illness, however it is considered a disorder in the DSM and is a characteristic of many mental illnesses. Impulse control disorders include kleptomania, pyromania, and intermittent explosive disorder. Chronic impulsive behavior is commonly seen in OCD, ADD, ADHD, BPD, ODD, Conduct Disorder, Bipolar Disorder, Schizophrenia, and more. Most of the time those struggling with chronic impulsivity are diagnosed with another mental illness. Impulse control disorders frequently occur with issues involving substance abuse. A lack of impulse control can lead to substance abuse and substance abuse can lead to a lack of impulse control; at one point were even considered in the same category of the DSM. Additionally, similar regions of the brain may be involved in both impulse disorders and substance abuse.


Those who struggle with impulsivity are vulnerable to many negative experiences such as anxiety, low self esteem, anger, depression, dysfunctional relationships, etc. Whether or not chronic impulsivity is the main issue for someone, it is imperative that it is addressed and explored. It’s important to explore whether the lack of impulse control is a symptom of another mental illness like OCD or an indicator of an impulse control disorder.


Therapy and medication can help alleviate the effects of chronic impulsivity and can prevent impulses from happening. A therapist can help an individual understand the root of their impulsivity, develop coping skills to curb impulsive behaviors, and improve self esteem. There is no cure for chronic impulsivity however treatment and recovery is always possible.


chronic impulsivity self control


Family Systems Theory

What is Family Systems Theory?

family systems theory

Family systems theory is a theory of human behavior and was developed to better understand individuals and the complex relationships and dynamics within families. In the 1950’s an American psychiatrist, Murray Bowen came up with the Family Systems Theory. After a long time of observing and analyzing patterns and relationships within families, Bowen noticed that individuals are best understood in the context of their families and families are best understood when they are viewed as a whole unit. Furthermore, individuals within a family are interdependent on one another; their thoughts, emotions and behaviors are heavily influenced by each other. This interdependence between members creates cohesiveness and an equilibrium. This is not to be mistaken for a “healthy” family. All families have a homeostasis or a norm to function consistently. Each individual’s role in a family feed off of each other to make a cycle that can be both detrimental and beneficial.

Family Systems Theory is built off the idea that individual’s personalities, behaviors, and emotions are a result of birth order and the role that they play within the family. It is important to note that families are not just solely based on shared genetics and instead can comprise of anyone who is considered to be part of that unit. For instance, a household may consist of parents, children, grandparents and a non-related member such as a friend. Each family is defined by its own unique members.


Why is this theory important?


Family systems theory is used often in therapy especially when addressing an individual with depression or anxiety. When one family member gets anxious, let’s say for example a mother, the anxiety can spread like an infection and eventually another member feels overwhelmed and tries to defuse the anxiety/tension and often times it is one of the children. This can be accomplished in a number of ways such as through humor or taking on the role as the fixer. The individual that does most of the accommodating becomes absorbed with the family’s anxiety. And these are the individuals that are most vulnerable to depression, anxiety, substance abuse disorder, and more ailments. Thus family systems therapy can be useful for anyone and extremely helpful for those struggling with issues like depression or substance abuse.


There are multiple approaches to family systems therapy. Structural family therapy looks at the patterns and dynamics as they are played out during therapy. Strategic family therapy involves problem solving within the family unit outside of the therapy session. Multigenerational family therapy acknowledges the intergenerational influences on current family dynamics.

family systems therapy

Family Systems Theory and Substance Abuse


When using a family systems lens, mental health professionals view substance abuse as a symptom of dysfunction within the family. Additionally, professionals recognize that the whole family is affected by someone’s substance abuse. Oftentimes individuals in treatment for substance abuse recover independently and are solely focused on as an individual. While this is important, it is also imperative to understand how the individual’s family influences the substance use. If the family members are open, bringing about positive change within a family can have positive effects on those in recovery. For example, oftentimes family members can be enabling to those struggling with substance abuse. A therapist can help members recognize those enabling behaviors and replace them with more helpful ones while gaining insight. Many treatment programs like Thrive, focus on both the individual and the family systems involved to assure that recovery not only occurs for individuals but also the family members.


Young Adult Drug Treatment Program


young adult drug treatment program

Young Adult Drug Treatment Program

What is young adulthood?

Young adulthood, also known as “the in-between age”, is a pivotal stage in life. This stage of life includes anyone ranging from the age of eighteen to thirty-five. Young adulthood is described as rapid changes in emotional, cognitive, physiological, sexual and relational development. For most young adults, this chapter includes features like identity exploration, instability, self-focus, feeling intermediate, and endless possibilities. Individuals in this developmental stage can prosper and thrive or struggle because of the complex transition from adolescence to adulthood.


Young adulthood is unique in the sense that people’s lives can vary drastically from one another. For instance, you may find an eighteen-year-old enlisted in the army, or someone may be getting married and having their first child, another traveling the world, perhaps someone else landed a big job and moved across the country, while others may be living at their parent’s house, going to school or working a minimum wage job. Social media like Facebook and Instagram make it easy for young adults to compare themselves to other young adults which can lead to negative emotions. More often than not, this stage leads to isolation, loneliness, shame, low self-esteem, lack of motivation, etc. Social expectations are confusing in this stage and can be extremely overwhelming for some.


It is not uncommon for young adults to turn to substances and alcohol to cope with the stress of this transitional period and the negative emotions that can come with it. Many emerging young adults who are struggling in this stage have faced past difficulties such as trauma, lack of resources and previous mental health/ behavioral health issues. In addition to large socio-environmental changes such as moving out of your childhood home, the brain is still developing until about twenty-six years old and. This makes young adults even more vulnerable to struggles and challenges. Further more, many mental illnesses emerge during late adolescence and in the early to mid twenties. Unfortunately, if a mental illness, like anxiety, occurs during adolescence, that individual has a 90% chance of having that same mental illness in adulthood.  


mage result for young adult treatment program

Young Adult Drug Treatment Program:

The combination of biology, genetics, past trauma and the big changes that occur during young adulthood can push many young adults into substance abuse and addiction. Treatment programs specifically catered to young adults are common and beneficial to those struggling with substance abuse issues. Young adult treatment programs give individuals the opportunity to relate, connect with other peers in their struggles and create a sense of community. Furthermore, professionals working at young adult treatment centers are experts in understanding and working with young adults struggling with substance abuse and this stage of life. Professionals may focus on a young adult’s fear of independence, their dependence on their parents, and setting goals. An age-specific treatment program provides individuals with the possibility to thrive into adulthood through relating personally to the other members in the program and professionals.   

Check out The Last House for our Young Adult Drug Treatment Program.

Also take a look at Thrive Treatment for IOP services

Failure to Launch and Substance Abuse


failure to launch 

Young adults are having a harder time moving out their childhood homes and are continuing to live with their parents well after high school and college. Now the average age to move out is 27! In fact, out of the 10 million millennials in the U.S., about 32% live with their parents. This phenomenon is called Failure to Launch.


So why is Failure to Launch a big deal you might ask?


Besides a negative shift in the economy such as educational debt, low homeowner ship and rent, low wages, etc., there can also be negative emotional affects on the young adult and the family. Negative emotional affects that affect the millennial include, lack of self efficacy, shame, anxiety, boredom, and lack of motivation. Additionally, having a young adult remaining in the parent’s home can cause dysfunction and stress for the rest of the family system. This isn’t to say that anyone between the ages of 18 and 34 should never live or move back in with their parents. In fact, sometimes it is necessary to move back home. But is important to be aware of the multi layered effects this phenomenon has on the economy, families and inviduals.


Why do people fail to launch into the “real” world?


There are many reasons this phenomenon has taken place. However, it began with the recession. The recession hit which led to higher unemployment rates and tighter credit markets. It was tougher to qualify for a mortgage and millennials instead began to go back to school to receive a higher education. Higher education led to increased school debt, lower wage jobs, higher cost of living, and thus an overall difficulty leaving the nest. Failure to launch can also be enabled by parents by continuing to treat their adults like children which can continue the cycle of this phenomenon.


How is failure to launch connected to substance abuse?


Some argue that continuing to live with your parents well after high school calls for an extension of adolescence. This stage of life typically leads to more boredom and a curiosity to try new things such as substances and alcohol. The increased availability of substances, particularly opiods, leaves these young adults more at risk for developing substance abuse issues.

What can be done?

It’s important to keep the main focus on the young adult and the secondary focus on the family since it is a systemic problem. Education and an understanding of the issues within a family system are crucial as well.

Substance abuse treatment centers, schools and families should emphasize the goals, ambitions and dreams of the young adults. Welcoming these ideas into treatment and daily living can help motivate the individual to find purpose and develop healthy life style choices.

substance abuse



Prison Country: Prisons, Drugs, and a Way Forward

prison country

It’s an easy thing to be tough on crime in American politics. “Don’t do the crime, if you can’t do the time”, “Three-strikes-and-you’re-out”, and other phrases captured the spirit of the time on crime in America, especially in the 1990s. They were not idle words.

An Individual’s Crime, An American Sin

From 1980 to 2013, America’s prison population had tripled, reports The Economist Magazine.[1] You may read this and wonder, what does that mean? It means that the United States, which presently has about 5% of the world’s population, has 25% of the world’s official prison population. A little less than 1% of Americans are imprisoned at any given time. The US has an incarceration rate so high that multiple newspapers have reported problems, including basic questions about how the prison system will care for inmates with Alzheimer’s.[2] More troubling, perhaps, is a substantial for-profit prison system that has evolved to accommodate an escalating political demand for prisons.

An astute reader may ask further, isn’t this old news? It is, but the past is ever with us and The Economist, The Guardian, The New York Times, and others continue to report on the issue because it is not going away and might actually be getting worse. There wonderful piece in The Economist book review on the politics of wrongful convictions and what it’s like inside private prisons in America today.[3] The Guardian also published a riveting excerpt about how prisons in America are effectively being used as alternatives to hospitalization for the mentally ill.[4] The Article notes that:

“The racial inequity of the criminal justice system has been widely noted: it is estimated that one out of every three African American men and one of every six Hispanic men born in 2001 will be arrested in their lifetimes.

But for Americans with serious mental illness, it is estimated that as many as one in two will be arrested at some point in their lives. It’s not just arrests. One in four of the nearly 1,000 fatal police shootings in 2016 involved a person with mental illness, according to a study by the Washington Post. The Post estimated that mental illness was a factor in a quarter of fatal police shootings in 2017, too.”

 Drugs, African Americans, and Modern Incarceration

Perhaps one of the best books on the War on Drugs and race is The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander.[5] Alexander’s argument is essentially that The War on Drugs and Tough on Crime policies devastated African American communities. To put this claim in perspective, African Americans represent roughly 40% of the US prison population and are incarcerated at a rate nearly six times greater than non-Hispanic Whites.[6] This is despite the fact that African Americans are 13% of the total population, according to the 2010 Census.[7]

There are two claims that we will examine by Alexander: that the War on Drugs has dramatically expanded the prison population and that the War on Drugs has disproportionately impacted African Americans.

A report by the Brookings Institute shows that drug offenses constitutes the majority of all incarcerations in U.S. prisons. These can be seen with Federal data in Graph 1, although Drug Crime Admissions were declining in the late 2000s. It should be noted while going through these statistics that there is very little in the way of transparency. These Brookings numbers were published in 2015 but are using 1990s and 2000s data.

Graph 1: State & Federal Prison Incarcerations by Offense Type, 1993-2009

Courtesy the Brookings Institute

Having established that most admissions are for drug offenses, why is there any debate? A consequence of lack of transparency is that most people were looking at the left-hand part of the Graph 2. Some experts concluded that since drug offenses comprised only 20% of the prison population at a given time, that the War on Drugs was not an overwhelmingly significant source of incarcerated persons. This is clearly false when one considers the rate at which non-violent drug offenders are processed by the criminal justice system—there are fewer of them in prison at a given time because their sentences are shorter.


Graph 2: Percent of Current Inmates by Type of Offense: Stock vs. Flow, 2013 and 2011

Courtesy, The Brookings Institute

The second part of the claim is also easy to validate. Using Bureau of Justice Statistics (BJS) figures, we can clearly see that African Americans are incarcerated at much higher rates than any other racial group. Incidentally, these figures are much higher for Africans Americans aged 18-19 than their peers in other racial groups—11 times as high.[8] It is entirely possible that the decrease in African American incarceration could be attributed to more lenient enforcement and sentencing for minor drug offenses, of which young African American men are hit disproportionately hard.

Graph 3: Prison Admission Rates by Race, 2006-2016

Courtesy the Bureau of Justice Statistics

Do Drugs Cause (Violent/Property Related) Crime?

Now that we have talked about some of the biases of the criminal justice system, we ought to ask ourselves: why might drugs cause crime and do they actually cause crime?


We start with the first question because theory better informs facts. In the field of criminology, (spoiler) it is well known that many types of illicit activities are correlated with each other. There are basically two models for thinking about causality: (1) persons who abuse drugs are likely to engage in other crimes to fuel a habit that is costly and (2) the type of person who would abuse drugs will also engage in other crimes because they cannot control themselves.

There is no real consensus as to whether drug abuse causes (non-drug related) crime. The problem is that both theories presented above could be true simultaneously—drugs could be a motivating factor in some crimes but inherent personality traits could be in other crimes. One study suggests that different types of drugs are associated with different crime types: abusers of benzodiazepines and methamphetamines being more likely to commit opportunistic property crime and abusers of alcohol and heroin being more likely to commit violent crimes.[9] In either case, acting under the influence of drugs was noted in over 70% of property and violent crime cases. To top it off, a meta-study found that drug abusers were three to four times more likely to offend than non-drug users.[10]

Conclusions—A Definite Case for Sobriety

Whatever your feelings are on the War on Drugs or substance abuse generally, it is pretty clear that there is a strong case for giving drugs a wide berth in our society. They are strongly associated with large numbers of serious criminal offences even outside the realm of possession. Regardless of causality, if you know or suspect that a friend or loved one is abusing, you should try to intervene as quickly as possible before the situation escalates. The American Criminal Justice System is both massive and often pitiless in the administration of the law, saying nothing of the stigma attached to individuals after release. Should preventative measures fail, your best recourse is to find some sort of alternative sentencing and try to manage your loved one’s dependence.











Wilderness Treatment for Young Adults & Teens

wilderness treatment for young adults

Wilderness Treatment for Young Adults And Teens

Explore. Uncover. Change.  

Wilderness treatment for young adults is also known as adventure-based therapy and outdoor behavioral healthcare. This research-based treatment modality has been in existence for the last thirty years and focuses on behavior modification and interpersonal self improvement in a wilderness setting. Exposing individuals, mostly teens and young adults, to the outdoors provides an opportunity to problem solve, unveil existing problems, gain resilience, courage and self esteem.

wilderness treatment for teens

With the right tools and competent professionals, anyone can benefit from wilderness therapy. Physical activity is prominent in wilderness therapy and that alone can improve physical and mental health. Furthermore, encountering challenges and solving problems in a nature setting can help individuals build skills in dealing with real-life problems on their own.


Although families, couples and older adults participate in wildness therapy, more often than not teens and young adults partake in this form of treatment. Teens with behavior problems, eating disorders, OCD, substance abuse issues, etc., are usually required to stay for eight to ten weeks. In this setting teens and young adults are placed in an emotionally safe environment and given structure with little distractions. Through self efficacy and peer modeling, individuals become empowered once they see they can survive in the wilderness.


Individuals can participate in residential wildness therapy or therapists can even provide sessions for non residential clients in nature settings. Either way folks can learn to defeat unhealthy emotional and psychological patterns while experiencing, camping and exploring nature.


Most residential programs are not covered by insurance and can be very costly. However, other treatment programs and residential facilities can provide certain aspects of wilderness therapy. For example, some treatment centers go on field trips to take hikes or group therapy sessions are held outside.


Wilderness Treatment is a great place to build a foundation prior to coming into our program.  If you would like to learn more about this, please call our intake line.

The Opioid Crisis in Perspective

Opioid Crisis

The Opioid Crisis in Perspective

Tune into any major news network on any given day and its difficult not to hear something about the Opioid Crisis. More people have died from drug overdoses in 2016 year than the total number of Americans in Vietnam.[1] And opioids represented two thirds of those deaths, according to the Center for Disease Control (CDC).[2] The CDC reports that as of 2014, two million Americans were abusing or dependent on prescription opioids.[3] As one drug rehabilitation expert puts it, “No family has been left untouched by the Opioid Crisis.”


Scary numbers but they may leave inquiring minds with basic questions like: What is an opioid? What does an opioid do to you exactly? How can we measure how severe the opioid crisis is? What are major risk factors and signs of use? And what should I do if I suspect a friend or loved one of opioid use? These are questions that we will be exploring this week.


What is an opioid and what do opioids do to you?


Opioid is a catch all term for opiates, or drugs derived from poppy plants that include morphine, and synthetics opioids that mimic an opiates connection to opioid receptors in your body. Most, if not all, of these drugs have legitimate medical uses, but as the CDC points out there have been problems with dramatic over prescription of these pharmaceuticals across the country.[4] “Providers wrote nearly a quarter of a billion opioid prescriptions in 2013—with wide variation across states. This is enough for every American adult to have their own bottle of pills.”[5] These prescriptions were concentrated in narrow geographic areas, such as West Virginia and Ohio. For our purposes, there are basically three classifications of opioid:


  • Prescription Drugs: a broad category of prescription medications that are given out primarily for pain management. Includes drugs such as Oxycodone (OxyCotin®), Methadone, and Hydrocodone (Vicadin®).


  • Heroin: an illegal narcotic that is typically mixed with other drugs and thus puts people at risk for overdose. It is typically injected, but can also be snorted or smoked. Also runs the risk of contracting diseases, such as Hepatitis, through unclean needle sharing.


  • Fentanyl: a pain medication that is fifty to one hundred times more potent than morphine and is also commonly used in combination with either heroin or cocaine for added effect.


These are drugs that connect to Opioid Receptors in your brain, causing a combination of euphoria and sedation. They desensitize these receptors, resulting in an increased tolerance and physical dependency. If left unchecked, these drugs will cause progressively shallower breathing resulting eventually in death from respiratory system distress.


How can we measure how severe the Opioid Crisis is?

The commercial value of opioids, both as a medicine and as a narcotic, is well understood. The British, for example, famously fought two wars with China to export the drug into Chinese territories. These wars—essentially state sponsored drug dealing—were creatively called “The Opium Wars”.[6] Recreational use by American servicemen during the Vietnam War is well documented, as we talked about last week. In Central and South Asia, opioids are quite rampant.  U.S. military planners have said that victory over the Taliban in Afghanistan is impossible without first crushing narco-traffickers.[7] Incredibly large numbers of Indians and Pakistanis are addicted to heroin and other opioids.[8] Clearly, it’s big business. Clearly, it’s also destructive.


As I just pointed out, the CDC noted that about two thirds of drug deaths in 2016 were attributed to opioids. Below are a map and death counts by region provided by the CDC showing how each category drug is distributed across the country. Do note that there is huge variance by county within a given state—just because your home state has low numbers doesn’t mean there aren’t counties or cities with very high rates of abuse.


Table 1: Drug Deaths by Region and Fentanyl Cases Reported by State (2014, 2015)

Courtesy the Center for Disease Control

Opioid Crisis Opioid overdoses
heroin overdose death rates


Are other, more clinical accountings of the Opioid Crisis: the economic and logistical costs. Most opioid users are in their mid-twenties to mid-fifties. These are people in the prime of life. When they die or are near death, they cost the tax payers in terms of emergency services allocated to attempt to save a life or investigate. They also cost local, state, and national governments in the form of lost tax payer revenue. The epidemic has been so taxing that an Ohio city councilman, trying to contain the damage to his town and its emergency services, proposed a “three strikes” policy for opioid revivals.[9] Economists report that drug overdose deaths have cost the U.S. approximately one trillion dollars since 2001, with a rapidly growing rate of loss.[10] Although it may be painful to examine such an emotional issue this way, it is instructive to see how else the Opioid Crisis impacts communities.


What are major risk factors and signs of use?

The CDC has identified major risk factors for both Prescription Opioid and Heroin use. The Risk Factors are as follows:


Prescription Opioids

  • Obtaining overlapping prescriptions from multiple providers and pharmacies.
  • Taking high daily dosages of prescription pain relievers.
  • Having mental illness or a history of alcohol or other substance abuse.
  • Living in rural areas and having low income.

Prescription Opioids and Medicaid Patients

  • Inappropriate prescribing practices and opioid prescribing rates are substantially higher among Medicaid patients than among privately insured patients.
  • In one study based on 2010 data, 40% of Medicaid enrollees with prescriptions for pain relievers had at least one indicator of potentially inappropriate use or prescribing:
    • overlapping prescriptions for pain relievers,
    • overlapping pain reliever and benzodiazepine prescriptions,
    • long-acting or extended release prescription pain relievers for acute pain, and
    • high daily doses.


  • People who are addicted to prescription opioid pain relievers
  • People who are addicted to cocaine
  • People without insurance or enrolled in Medicaid
  • Non-Hispanic whites
  • Males
  • People who are addicted to marijuana and alcohol
  • People living in a large metropolitan area
  • 18 to 25 year olds

Major signs of use for non-heroin opioids include, but are not limited to:


  • Doctor Shopping—frequent changes in doctors, typically for the purpose of receiving new prescriptions.


  • Lack of Motivation—becomes disinterested in work or life more broadly. The lack of motivation is most noticeable in the sense that things that once brought joy are now secondary or below notice.


  • Rapid Depletion of Prescriptions—goes through a month’s worth of prescriptions in a few weeks.


  • Sickness—often a result from a failure to receive sufficient opioids.


  • Social Disconnection—becomes withdrawn from family and friends.



What should I do if I suspect a friend or loved one of opioid use?

Seek help immediately! Time is your enemy and you need to act quickly to become informed. Below are several government agencies that can better inform you and help decide your course of action:



If you are in the LA area, please also consider calling one of our intake counselors. They will help you through the process and will also help refer you to a different provider if needed.


855-998-LAST (5278)






[5] IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013.






Long Term Structured Sober Living


long term structured sober living

Today’s blog is something of an inaugural post. We will be bringing in strongly empirical (factual) evidence to thoroughly and simply explore and validate the claims of substance abuse experts. Today’s post, we will be exploring the effectiveness of structured sober living arrangements. The claim that structured sober living arrangements are effective has two core assumptions:


  • The longer one is sober, the more likely they are to remain sober; and


  • the networks and habits created by structured sober living environments make people more likely to change their behavior and stay sober longer both in and outside of treatment.


The Longer You Are Sober, The More Likely You Are to Remain Sober

This first claim makes intuitive sense to most people. It takes a long time to break a habit, particularly when a habit is tied to an addictive activity or substance. Prolonged sober living decreases the brain’s dependence on the substance in question as it becomes more independent in terms of generating and regulating chemicals, such as dopamine. This claim is easy to validate, as empirical research on the matter shows stark drop-offs in attrition as someone recovering approaches the 6-month mark. A meta-analysis from the late 1990s showed that those in long term treatment experienced a 50% reduction in cocaine consumption if in treatment for 6-months or longer.[1] This finding is particularly instructive given the addictive nature and the scale the cocaine and crack cocaine epidemics in the 1990s.[2]


Long-Term Care Structured Sober Living Creates Better Outcomes

Having established that duration of soberness is critical to maintaining sobriety (duh), we need to consider a means of extending that soberness: structured care. The idea of structured care is fairly intuitive because it centers around behavioral modification and networks of accountability.  If all your friends are drug users who use regularly, you are more likely to be a drug user. If you engage in risk enhancing behaviors, like smoking when you typically smoke while drinking, you are more likely to abuse a substance. Structured care takes those ideas and works them in reverse to break vicious cycles and create virtuous ones.


There are many different factors that put a person at risk for substance abuse and recovery, the most obvious being motivation. By creating a network of like-minded individuals attempting to be sober, everyone’s motivation increases. We all bicycle faster together. Similarly, creating new positive environments to live in reduces dependence on drugs. This has been shown to be empirically true. A famous study with a food and a cocaine dispenser with rats showcased everyone’s worst fear: the rat, when isolated, would continually dispense drugs until starving to death. The second part of the Rat Park Study showed that rats, when allowed to live with other rats, strictly preferred plain drinking water to drug laced water if the drug water was linked to some sort of physical or emotional isolation.[3]


This theory, while unpopular at the time, was proven true by the most unlikely of things: the Vietnam War. Soldiers fighting in Vietnam had notoriously high rates of substance abuse, often a form of maladaptive self-care. The fear was that when the G.I.s returned home, there would be massive drug epidemics. The truth, it seems, was that when the soldiers demobilized and returned to less traumatic and more helpful environments, they had levels of drug abuse consistent with the general population.[4] Environment and behavior are extremely important to controlling substance abuse.



The efficacy or cost effectiveness of long term treatment for heavy drug users is not exactly news, either. The RAND Corporation, a policy research and analysis firm that typically does work for the Pentagon, released a study for the war on drugs in the 1990s. In its study, RAND found that treatment was more effective and less costly than higher mandatory sentences and other law enforcement measures. The study is so thorough and convincing in its analysis that it is used as a case study for students of public policy across the country to this day.[5] Alas, these demand style approaches have not gained traction for political reasons, to the detriment of everyone from government agents to taxpayers and drug users themselves.[6] The topic of incarceration and treatment is something that we will talk about in greater depth next week.