AMUDIM Awareness Event 12-14-2016 Part 3 of 5 Menachem Poznanski

welcome everybody I want to just express my gratitude for the opportunity to be here and speak with you and thank you for all my friends who shut up so there was no one here appreciated and such an honor to be here and such an honor to have such amazing colleagues and to be here with them particularly to see was just uh just a workhorse and he's really caring so much in our community for the Jewish Orthodox community in general and Lisa and Gabi put the program together and Rebecca we spoke so beautifully areso came to join us also and it's such an honor to be here and as as a community member of the five towns I'm honored that we made an event and so many people came to find out about this this very important issue and which shows me how serious we are about our health and about our children and not only about our children but also about the adults in our community that are suffering from addiction so what I wanted to do today was I really wanted to try to share with you a little bit of my my view of addiction try to give you a little bit of a helicopter view of how I see the issue and my my journey with addiction I could tell you that my journey with addiction started 14 years ago when I was working as a Rebbe in an outpatient in a alternative boys high school just around the corner here in tempo group and which is a substance abuse treatment facility and but really my journey with addiction started much earlier than that and so you had mentioned this earlier when I was living in Israel I was in Cola and we had a family member who's to come for lunch and he was in one of these programs for guys that are you know abusing substances and other things and he would come in and he showed us his na ki tag that he had 30 days or 60 days and and we didn't really know any better and we would say things like oh okay it's wrong it's wonderful you're not using drugs but you know now come take a drink and and luckily today that that relative is a very happy functional successful young man with a family but but from that moment I think God I've maybe that was my punishment he filled my life with working with addicts and alcoholics and it's been my great pleasure for the last 14 years specifically what I do mentioned the living room I just mentioned Who I am kind of when what that is the living room was a clubhouse in Brooklyn housed in Brooklyn New York that serves young people all over New York as far as Muncie and Lakewood and everywhere in between and we have an active membership of over 150 young adults we have 30 couples that are in our our little community and basically we do is we provide a community for young adults who are in recovery give them supports and help them connect with the supports that they need along the way so and I've been doing that for 12 years so I have a great joy of knowing hundreds of addicts and alcoholics and I also have the privilege of being a clinical social worker so I'm going to try to give you a little bit of my perspective on addiction that can kind of help you have a view of it Rebecca did a beautiful job giving you a personal snapshot of addiction maybe I can try to give you a little bit of my my vantage point so my objective tonight is to provide you with a little bit of framework to understand substance abuse dependency and addiction and I separate all those things because people always convolute and confuse them right stop this abuse is something that maybe people that are unhealthy do and it's dangerous and dependency is a very very dangerous reality in our world particularly when it comes to substances and then finally addiction and you'll notice I'm making a separation between dependency and addiction and I'm doing so semantically because it will help you later on to better understand the issue finally I want to help you communicate about it in a me about these topics in a meaningful way with your family so I'm going to try to provide you with information that will make you experts to the best of my ability in about 15 minutes so let's let's first start by defining some terms it's really important that we kind of define what we're talking about so when we talk about substance abuse we're talking about the use of a substance or behavior that is not medically or otherwise warranted in the pursuit of pleasure relief fund etc etc so if someone's using drugs that's kind of what that's what that's what we're talking about what so what is substance abuse substitutes is very similar except that there you there there that there is the use of a substance that is not medically or otherwise warranted but this isn't that infringes on the individuals ability to function and have a successful and happy life so anytime that that so anytime I am referring to substance abuse and I think really anytime anyone is turning substitutes they're talking about they're talking about that and dependency is the use of a substance or behavior as the result of a developed need for the substance or behavior physical and/or psychological to cope or even engage in the normative functions of life which means the person develops a need for a drug in order to kind of do regular life things whether it's have fun or cope with challenging situations or go to work or deal with their families etc etc etc so the question is what is addiction we hear the word addiction all the time what is addiction what is an addict so we're going to try to define that for you the most comprehensive the most comprehensive definition that I could think of is that addiction is a multi-faceted illness and disorder which is composed of physiological cognitive and development criteria developmental criteria addiction impacts 10 to 20 percent of the u.s. population and cuts across age race and socio-economic spectrum now normally when I do this kind of presentation I'm speaking to a group of parents and or high school kids who are forced to be there so I asked them to consider the fact that there's about 150 or 200 people in the room and if 10 20 percent of the population have addiction there's a good 10 to 20 people in the room that are addicts and asked them to really kind of consider that and I don't think I have to do that because if you came here I think you have a sense of that but just to even consider that that you know the amount of people that are in this room and the amount of addicts they're in this room to realize that this is an issue that's present and it's in our community whether those addicts are in recovery or active in active addiction which which we're going to talk about some of the things we can do to help those in active addiction now while dependency is a prominent feature of the illness I just mentioned the two terms are not synonymous and that's why I kind of separated them so let's understand addiction so my best my favorite representation of addiction is our friend Cookie Monster so everyone loves cookies and it's not hard to imagine a person who after having one cookie there's some beautiful dis and delicious cookies in the back has a craving for more and maybe even has two or three let's imagine a person who's craving for cookies is so severe that they eat the whole tray so we might call them self-indulgent you might say that they have a lack of self-control but imagine for a moment that this person experiences tremendous emotional distress and that he or she only experiences relief from their distress when eating cookies and that this distress is enhanced when he or she doesn't have their cookies and that the shame of eating an exorbitant amount of cookies and being obese is nothing compared to the distress that they feel in their lives now imagine that this individuals physical craving for cookies is atypical because the craving maintains throughout it has straw is it is as strong after the tenth as it is after the first all right so what this means is if I have if I see a tray of cookies my brain tells me I should have a cookie I have a craving for cookies if I have a second cookie it's because my brain tells me that I want a second cookie but I'm not as hungry so my craving is not as strong a by the time I get to the third my belly's full my craving for cookies is no only self-indulgence but imagine if my craving because it's a typical it's not the same as everybody else he's as strong at the tenth as it is for a regular person who's on a diet avoiding one of those cookies now that might be that might be that might kind of change the equation a little bit suddenly his or her lack of self-control seems like less of a factor in our judgment of them less appropriate for this individual not having the tenth cookie is way more challenging than the normal individual not having the second or even maybe the first self-control willpower can only provide short-term success any long-term success seems to entail life full of tension and self restriction because again they experience the stress they only feel good when they have their cookies in this imaginary person and and they when they have the cookie they feel okay and with applica don't feel okay and the distress that they have is way worse than energy distress they have over the amount of cookies and when they begin to eat cookies the craving is overwhelming this is addiction that's what it's like to be an addict so let's break down my earlier definition so I said addiction is a multifaceted illness and disorder which is composed of physiological cognitive and development of criteria so what did I mean by that so the first thing that means is that addiction is not just it does not just occur in the decision-making areas of the brain people associate addiction as being a choice oriented thing meaning you make choices I choose to eat the cookie for example but the diction doesn't just occur in that area for an addict his use of drugs is natural and instinctual the impulse in craving for more is real and intense and it's a physical sensation they experience in their minds and in their bodies and finally addiction also includes physical and psychological dependencies where the individual experiences painful withdrawal symptoms when they don't have their drugs now it's important to note we're going to talk a lot about opiate addiction and when somebody is an opiate addict and they don't have their opiates then they're very very sick they're physically ill but some one of the things that people miss associate are they confuse is they think that that's the only form of withdrawal but when you get to kind of know how it what it's like to be an addict and work with addicts who find out that addicts that are an active addiction experience withdrawal in many other areas of themselves if they may not experience any physical withdrawal from their substance for example someone who's addicted to marijuana they can't they might not necessarily be it's not very easy to become physically dependent upon marijuana but it's very very simple - it's much easier to become physically psychologically dependent upon marijuana and what happens to somebody who's dependent of marijuana who doesn't have marijuana is they experience tremendous emotional distress when they don't have their marijuana and that distress alone aside from all the other factors that we described compels them to use again so what do I mean by cognitive what I mean is this many addicts exhibit distortions in their thought process that cause them to make some of the bad choices they make even when they make choices those choices are inhibited by learned and developed cognitive patterns these patterns make the choice not to use difficult if not impossible these patterns are addressed and treated min and throughout recovery meaning that even in the areas of the brain that relate to choice the addict is is is is inhibited so he's experiencing this physical phenomenon and he is also experiencing a reduction in his ability to choose and finally cut and finally oops I went too far finally developmental this one's very interesting and I'm actually reading a fascinating book that kind of compares the experience of addicts with the autism spectrum which is that addicts exhibit developmental delays insert or cymatics many addicts exhibit developmental delays in certain areas specifically related to emotion regulation and sensory processing social intelligence can also be inhibited this further makes it difficult for them to thrive without the crutch or some sort of social lubricant this aspect has been it has to be addressed in their recovery and over their lives now one of the things you'll find if you go to an a a meeting or in any meeting or one of these or any Anonymous meeting is that they have a they have a sign on the wall and the sign says live life on life's terms now for many of us living life on life's terms is obvious of course I have to live life on life's terms I can't dictate the terms of life but for an addict this is new information it's an epiphany because they don't always get that automatically and that's the kind of like developmental thing that that that addicts require sometimes just education but also just support that how to help them deal with those challenges or those delays developmentally there's other stuff as well like I mentioned emotional regulation emotion regulation sensory regulation etc etc okay so what we have now is that an addict is dealing with all of those facets all of those of those issues and then we talked about dependency so while dependency is a prominent feature of the zone is they are not synonymous many if not most addicts experience dependency be it physical psychological or both but not every dependent person experiences addiction and it's in the entirety I just described people can become dependent or addicted in the way that we usually use the word addicted to a drug and subject to the dangers of addiction even though they're not an addict in the sense that we that we just described the bottom line is if someone is dependent they need to get help and get clean whether they are an addict or not it's something you have to figure out later so really when we talk about narcan are really talking about fighting for some other kind of intervention we're talking about battling the acute dependency to a substance which compels a person to use again and again and again without even having to deal with any of the other layers of issues that we talked about that relate to addiction so what about appreciat a predisposition to addiction independency everybody always wants to know this is a lot of studies and some of the things that the studies have found is that a history of mental illness a history of learning disabilities impulse control thrill-seekers a family history of addictions Anini disorders and finally victims of sexual abuse and other major life traumas major lights traumas seem to be exhibit a predisposition to developing either dependency or addiction or obviously both so let's talk about the scope of the problem and so we mentioned some of these statistics earlier so today in the right now in the mood and caseload there are a hundred community members that are currently enrolled in an inpatient substance abuse setting that's an enormous number there are two hundred sixty one cases of individuals that have completed treatment are now in early remission early remission is a clinical term that's used to describe someone who is between three months and twelve months before twelve months they're not considered in remission between three and twelve months that consider their earlier mission and sustained remission is considered over - over 12 months of abstinence at the living room we have a we have an active membership of over 150 young adults actively engaged in recovery lifestyle and who have achieved sustained remission so there's a large population and community of active addicts and recovering addicts so substance abuse related and overdose deaths as everyone's mentioned the numbers are relatively unclear but we have a good sense of the numbers particularly because of organizations like a mudan that are doing a great job documenting all these things eighty-six people in the in the in the firm community nationally passed away from a substance abuse or overdose related death from last Rush Hashanah to this past Rosh Hashanah it's an obscene number it's well beyond anything that I've experienced in twelve previous years that I was working in the living room - in total and then this year since this past Russia genre and we're only only a two weeks short of we can have short of Chanukah we have had we've experienced the community experience eight deaths in rehab or detox is is rehab or detox enough this is a very important statistic to kind of consider 86 of the order overs overdose deaths in the past 10 in the past 15 months were individuals who had achieved abstinence but later relapsed which means that the community is doing somewhat of a good job getting people into initial forms of treatment but getting them from the initial treatment - sustained abstinence is really the focus that we really that is is a major area of focus that we need to look at and then finally a really important statistic that's we mentioned which is that 82% of the people that are in treatment and remission from all the numbers that we've described have family support which means families that are supportive of addicts have a much better chance of those individuals seeking treatment and then achieving the remission that we all want so if we talk about education I really felt like it was important to give everybody a little bit of a snapshot of the different layers and types of interventions that exist because people get all these things confused you might call one program that provides one layer of intervention and get confused why another another program who is not dealing with an issue and it's really dealing with a different layer of intervention so we have prevention treatment in 12-step recovery groups those are kind of the three main types of treatment intervention prevention I'm not going to go through the whole thing that includes education mentoring criminal justice reform and crisis support referral treatment includes a litany of process which in which which can include psychotherapy intensive outpatient intensive inpatient detox step-down programs supportive housing recovery supports and then finally have toe step recovery programs and as a member of the community I'm happy to report that we have a very wonderful active 12-step community that runs under the table that nobody even knows about there's there's actually two sheets on the on the table over there that two members of our community both from living young adults who have families made up you know by young adults I mean young family men who are active members one of Na and one of a decided they wanted to put together a list of the local meetings in a a and an NA that are in these that are available in this area and that on that sheet so what you have is an army of people in this community that are actively willing to help people that need help be it from the organization's and then once the person is willing to get help and go to meetings there's a an army of fun people that are that are ready to help and be a support and that doesn't just that doesn't just exist in the five towns it exists in in Flatbush and Crown Heights and Muncie and Lakeland fine let's kind of take a look at the whole picture summarize the whole deal so chronic substance abuse leads to heavier more illicit drug use and dependency and dependency and illicit drug use leads to addiction and a predisposition to addiction or trauma can trigger this whole process all of this can result in emotional and cognitive impairment dangerous risk-taking like driving under the influence or other risk-taking behavior legal trouble and god forbid the thing that were most as scared of is overdose and death so what can we do about it so if I think about the most significant stumbling block that stops us as a community and as individuals from helping addicts or those who are addicts helping ourselves I would say the biggest stumbling block is denial and denial is a maladaptive pattern of thinking that feeds and facilitates abuse dependency and addiction denial is a human reaction to dealing with situations we don't want to deal with but when it comes to abuse dependency and addiction it's a very very dangerous very human reaction and do now manifest itself in two forms the first form is I got this not seeing or admitting to the problem well he's not really an addict or he does not really abuse him he's just having fun isn't he just a teenager he's just experimenting five or six times a week the other form of denial is manipulation of self for others and that's when the individual knows that there's a problem but they're desperately terrified to face the problem to think about the consequences of what looking at the problem in admitting the problem would be and this manifests not only in addicts but also very significantly in their families who will have to consider what their neighbors might think what they what what the consequences of there are or even just facing the reality that their child or family member is an addict so I wanted to give you some pointers for communication the most important thing is to create an environment that encourages honesty if you want to help an addict you have to make sure that they're not engaged in active manipulation dialog is good you don't have to agree and they don't have to like it sometimes you have to tell an addict like it is whether they like it or not and sometimes you have to repeat it at nauseam and many times an advocates help because somebody who loves them tells them enough times I know that you're not okay and you know that you're not okay and as soon as you're ready to admit that to yourself I'm here to help you allow for mistakes set benchmarks to establish a baseline this is a very obviously I'm not talking about someone who's actively addicted to heroin or some other kind of acutely dangerous drug but if a family member is engaging in unhealthy behavior substance abuse for example sometimes it takes ass and it takes asking them a question like this okay I understand that you're not ready to get help but what would it take for you to be willing to admit that you have a problem you know what is it an issue at work is it getting in the way of your score now when we're not again I'm not talking about overtly dangerous drugs and I'm not talking about children I'm talking about adult adults who are of autonomy to do whatever they want who are engaged in behavior they're concerned about many times it's that the most helpful thing you can do is be that healthy and objective voice to them kind of setting that baseline so that when they cross that line they have the opportunity to have a rock-bottom experience which is a moment of clarity consequences are opportunities for them to learn not for you to win I think one of the biggest mistakes that parents and families families make is that an addict finally has a rock-bottom experience and they can't wait to jump all over it and finally be right and what that does is that it sends the addict back into his into his denial back into his place of self-protection and it can really ruin the opportunity and it's critical and critically important to remember that what happens when a problem comes up the first thing you want to do is start with identifying what you see identify the scope of the problem you can ask yourself using the framework we talked about tonight am I looking at substance abuse am I looking at dependency am i perhaps looking at addiction does this person displace some of the other things that we described today differentiate between crisis and concern it's critically important when you're engaging an addict or somebody who's up abusing substances who needs help if you present something as crisis that's a concern you'll know that you're lying if you present something as concern it's a crisis he'll know there he or she I usually say he he or she will know that you're lying it's very important to be very clear about those two things the next thing is somewhat related and this is a super important one which is differentiating between disapproval and what's unacceptable many times when we love addicts there's something that they're doing not addicts or people they're substance abusers there are things that they're doing that we really disapprove of and we present it as if it's unacceptable and when we do so we present ourselves as unreasonable and we shut them down and make it impossible for them to come and ask us for help so it's critically important that we're very straightforward and we differentiate between those two things finally the most important thing is never get in the ring with an addict I counsel people all the time in my private work parents in particular to remember that when it comes to manipulation and addicts like Mike Tyson and if you step in the ring with a net with Mike Tyson he's gonna knock you out there's no question about it thinking that you're gonna out think an addict and get him to raise his bottom and to manipulate him to think that he has a problem or to create a consequence that's not real you'll always lose the most important thing when you deal with an addict is to be very straightforward in their face very subtle and very clear because they can't get around that the worst thing for an addict is to be straightforward keys for loved ones stick to your guns let them know they're not made of Teflon one of the most dangerous things in the lifes invent life in a fanatic this is existent in adolescents in particular but we're not just talking about in lessons tonight is that they think they're made of Teflon they think they're gonna get away with it they think it's not going to happen to them just like us sometimes you don't want to see that something's going to happen to us it's a part of the denial manifestation it's it's critical that if you set a consequence that if you set a boundary that you stick to that but if you over plate or underplayed your card never be scared to admit it and always be willing to start over again you're never locked into any position so if you think that something's going on and you made a certain agreement with somebody you you set a certain baseline and you realize that you made a mistake or you got counselling that made it clear that you made a mistake you don't owe them to stick to what you said if you can if it's because you made a mistake it's important to give yourself that out never ignore but sometimes allow the process to play out obviously a non life-threatening situations sometimes you have to add let addicts learn for themselves you have to let them experience some of the consequences of their behavior before they're willing to get help sometimes families run the tendency of kind of like forcing somebody to get treatment when they're just about there and the family has a tendency to kind of push them forward further than they're ready and what happens is you end up wasting resources and you end up wasting opportunity because the addict spends its entire time and treatment fighting with the fact that it doesn't really have a problem now these situations are very challenging you'll see in a moment what I'm gonna suggest is that anyone who has an addict in their life needs to seek consultation you need to get help and you need to get support so that you can make the right decisions never facilitate it's never appropriate to facilitate the use of anyone else it's never appropriate to let your kids if you were talking about a child use in your house to do anything that directly allows them to use enabling though is a different thing you know enabling is a very it's a dirty word in the addiction world but it's very challenging to completely not enable somebody so I always try to tell people to avoid enabling but specifically and they and I define enabling as anything which indirectly makes use of abuse possible or protects the addict from natural consequences and it's critically important that we try to avoid that seek guidance the healthy and effective response always requires a balanced approach I've seen this again and again if you take an approach that's too severe you're going it's not going to work if you take an approach that's balanced and healthy you have a much you have a better chance of success doing so always requires support and finally also doing so requires seeking support for yourself living with an addict or a family member that's in active substance abuse or addiction is terribly troubling it can it can it can bring about feelings of resentment and fear that can cause a person to do all sorts of things that are that get in the way of successful and effective react responses so it's critically important that you not only get consultation and advice but also that you seek the support you need in order to make sure that you're in tip-top shape to deal with the family member I want to just say that I'm super grateful to have had the opportunity to be here and I hope the information was was useful and I wanted to echo what Rebecca had said is that if we can if we can even have the strong sense that we've saved one person today which I have no doubt that we're going to save hundreds of people today with all the different things that we did today that I'm very comforted this morning when I was working on the speaking off the cuff now this morning when I was working on the presentation it became aware to me that today tonight and yesterday were the earthside of two individuals from our community that died last year and one I was rather close to and I was I was nervous to come up here because I was scared that I was going to start crying because I'm a little bit of a crier and and it was very moving to me and it's moving for me because a it's wonderful to see that the community is acknowledging the problem is real and it's wonderful to see that we're banding together to deal with the issue and and and help save our children and our in our community members thank you so much [Applause]