alcoholism

Dealing with addiction

Dr. Jenny Melamed (photo from Jenny Melamed)

“I’ve been in addiction medicine for at least 15 to 20 years now. I spend my time with people in addiction and recovery; that is all the work that I do. I believe in recovery and I believe in remission for the disease of addiction,” Dr. Jenny Melamed told the Independent.

Melamed, who now lives in Vancouver, was born and raised in Johannesburg, South Africa. She moved to Canada with her husband in 1987 – first to rural Saskatchewan, then to Vancouver. Her work with addiction began with a friend’s suggestion to try some work at a methadone clinic. She immediately was drawn to help people in this way and became certified in addiction medicine in the United States, then in Canada and internationally.

“I’ve got lots of initials behind my name,” said Melamed. “I’ve spent most of my time in addiction talking, doing person-to-person counseling. I don’t wear a stethoscope.”

According to Melamed, physicians were among the first abusers of prescription drugs. “It was thought that treating pain with opioids would not be addictive,” she said.

“Opioids are narcotics that act on opioid receptors to produce morphine-like effects, so we were prescribing it and, now, there are so many opioids out there. And we’re having these pill parties, where kids are taking pills from their parents’ cupboards – going to these parties where they’re putting them into these big bowls and they don’t even know what they are taking out. We’re looking at 13- or 14-year-olds that are trying these drugs. They’re finding it young.

“There’s not that much OxyContin available anymore,” she added, “as people are now scared of it.”

Melamed said there is no way to know for sure if a person will become addicted or not. Kids often take more than one possible addictive drug at these kinds of parties, she said, so they will likely not even know which one(s) affected them and what the specific effects were.

“For some people who take their first drink or take their first opioid, they will say that ‘the minute I used X, I felt calm for the first time,’” she said. “For some, it starts immediately. For others, it starts as weekend use at parties. Then, they start to use a little more during the week, and then they start realizing that, when they try to stop, they can’t. They’re actually dependent on this drug and are going through withdrawal. They can’t move away from it.”

Melamed said, “Addiction is a disease of escape. They’re using it to help them cope. I said to a young girl yesterday, ‘Why do you use?’ She said, ‘Sometimes, I just don’t want to feel.’ And that’s what it is. They learn from an early age, and the addiction part of the brain takes over and says, ‘I will help you through this.’

“We all live in a society where there’s a lot of stress and many of us, especially young people that have not developed coping mechanisms, turn to different modes of escape, as they are the easiest thing to do.

“The important thing to remember is that, when you come down from whatever high you used, you still have the stress, if not even worse, as now you’ve got to pay for your drugs. You may have blacked out or overdosed … but, in the spur of the moment, addiction is such an instant gratification that you don’t even think of it. You just think about self-medicating.”

Recovering addicts learn that there is no such thing as a cure from addiction. Addiction may go into remission in the same way that type 2 diabetes can go into remission, said Melamed. If one changes their diet and loses weight, etc., they may not have to use insulin anymore, but, if they gain weight back, change their diet or lifestyle, the diabetes will flare up again.

“So, you get the person who is out with buddies and somebody says, ‘You want to try this heroin?’ not knowing there’s fentanyl in there,” she said. “And they die, because the brain tells them that they can try it just once. And they actually believe that they can go back to being a social user, or a social drinker.

“They don’t understand that this is a chronic disease that is with them for the rest of their life. And, you know, when you say to a 15-year-old, ‘you’re not going to be able to use or drink for the rest of your life,’ it’s a very difficult concept and very scary … and that’s why the AA [Alcoholics Anonymous] concept of one day at a time is really important.”

While only about eight to 11% of people who use a substance become addicted to it, no one knows which substance will entrap them. But, one thing is for certain – it can affect any of us and the problem affects us all.

“I think the first thing we have to understand is that it doesn’t matter what religion we are, what our economic status is – everybody has a risk of addiction,” said Melamed. “We have some very wealthy families in the city who have lost kids to addiction. We have to move it out of the stigma.

“You have the concept of, ‘Oh, he’s a functional alcoholic, just drinks at lunchtime.’ And, we accept that. But, we shouldn’t accept that in any form. And, we also shouldn’t stigmatize it in any form. We need to talk to our children about it and be on top of it.

“In some ways, as a Jewish population, we feel like we’re a little different and protected,” she continued. “We’re not. The conversation has to happen at home. When I gave a talk here, at the Schara Tzedek, about addiction, the room was empty. We believe our kids would never do it.”

There are things you can do at home, in addition to talking with your kids about addiction. Any prescription drugs that are not being used should be returned to a pharmacy for proper disposal, and any medications that are being used on a regular basis should be locked up.

“You also should take a look at why you are using these medications,” she said. “Even as adults, our drug use is inappropriate.”

Melamed said one of the best ways to keep an eye on your kids is by making your home a welcoming space where they and their friends are happy to hang out. That way, they are comfortable being around you and you see what is going on.

“You need to know where your children are, who their friends are and what they are doing,” she said. “And, you cannot assume that, just because they are from the same socioeconomic status, that everybody’s good. It’s really important to know parents, their friends and to know what’s going on.”

Melamed is open to hearing from educators, schools, community groups and others who would like her to come and speak on addiction and its treatment.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Help for substance abusers

Rebecca Denham, director of services for Jewish Addiction Community Service of Vancouver. (photo by Wendy Oberlander)

The first comprehensive effort to reach Jewish individuals suffering from addictions launched this month in Vancouver when the Jewish Addiction Community Service of Vancouver came into being. Its goal is to approach substance abuse issues – specifically alcohol and drugs – within a Jewish context.

The first two services being offered by JACS Vancouver are a support group for families living with substance abuse and navigational support, to help direct individuals and families to the right channels in the support system, whether they want access to recovery programs, counseling or other resources. But those services will expand rapidly to include community education and awareness building.

“We want to teach people how to identify when someone is in trouble with substance abuse, and to get them to the right services,” said Rebecca Denham, director of services for JACS, who will be providing assistance from an office at JHub in Richmond (8171 Cook Rd., Suite 212).

Denham is planning to do this outreach at schools, synagogues and camps by hosting events that promote awareness. “We want to start conversations” she said, “because that’s where it has to begin: people talking about addiction, where they’re seeing it and how substances are being used and abused.”

Calls for assistance are beginning to come in as Denham reaches out to Lower Mainland addiction service providers, psychologists and counselors to inform them that JACS exists and the kind of support it offers.

“We want to let people in the Jewish community know that there will be services that incorporate their traditions and values, and acknowledge that some of their circumstances may be unique,” she explained. If someone needs to enter a treatment facility, JACS would like to ensure they have access to kosher food and rabbinical support, if they want it. When they’re exiting such facilities, JACS can offer help on moving back to the community safely, and on how to attend Jewish events that may incorporate alcohol, for example.

Denham, an Ottawa native with 15 years’ experience in mental health, addiction and youth at risk, moved to Vancouver in 2010 and worked with Jewish Family Service Agency in its mental health outreach program. She is available to take calls for appointments Monday through Thursday, 9 a.m.-1 p.m.

JACS Vancouver will offer some of the programs provided by JACS Toronto, founded some 15 years ago. There are other JACS programs in cities including Winnipeg, Seattle and Chicago, and Denham is looking forward to partnering with Jewish services across North America and emulating some of their successful programs.

JACS Vancouver’s funders include the Jewish Community Foundation, the Betty Averbach Foundation, the Diamond Foundation, the Kahn Foundation, the Al Roadburg Foundation and the Snider Foundation, as well as private donors. For more information, call 778-882-2994 or email [email protected].

Lauren Kramer, an award-winning writer and editor, lives in Richmond. To read her work online, visit laurenkramer.net.

Alcohol use in Canada – data from Health Canada

The following are excerpts on alcohol use from the Canadian Alcohol and Drug Use Monitoring Survey, which was an annual general population survey of alcohol and illicit drug use among Canadians aged 15 years and older that ran from 2008 through 2012. There is much more information contained in this survey, which can be accessed at hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2012/summary-sommaire-eng.php. The Independent was referred to it by Rebecca Denham, director of services for Jewish Addiction Community Service of Vancouver.

In 2012, 78.4% of Canadians reported drinking alcohol in the past year. Similar to previous years, in 2012, a higher percentage of males than females reported past-year alcohol use (82.7% versus 74.4%, respectively) while the prevalence of past-year drinking among adults aged 25 years and older (80%) was higher than among youth (70%).

In November 2011, the Canadian federal, provincial and territorial health ministers received Canada’s Low-Risk Alcohol Drinking Guidelines, which consist of five guidelines and a series of tips. Low-risk drinking guideline 1 (chronic) is defined as people who drink “no more than 10 drinks a week for women, with no more than two drinks a day most days and 15 drinks a week for men, with no more than three drinks a day most days. Plan non-drinking days every week to avoid developing a habit.” Low-risk drinking guideline 2 (acute) is defined as those who drink “no more than three drinks (for women) or four drinks (for men) on any single occasion. Plan to drink in a safe environment. Stay within the weekly limits outlined [in guideline 1].”

In 2012, among people who consumed alcohol in the past 12 months, 18.6% (representing 14.4% of the total population) exceeded guideline 1 for chronic effects and 12.8% (9.9% of the total population) exceeded guideline 2 for acute effects. A higher percentage of males than females drank in patterns that exceeded both guidelines.

The guidelines were exceeded by youth aged 15 to 24 years at higher rates than among adults aged 25 years and older. One in four (24.4%) youth drinkers versus 17.6% of adult drinkers exceeded the guideline for chronic risk, while the acute-risk guideline was exceeded by 17.9% of youth drinkers and 11.9% of adult drinkers.

In 2012, for the first time, CADUMS asked about four harms people may have experienced in the past 12 months due to someone else’s alcohol use. Types of harm include being verbally abused, feeling threatened, being emotionally hurt or neglected and being physically hurt. One in seven (14.2%) Canadians aged 15 years and older experienced at least one of these harms as a result of another person’s drinking. Verbal abuse was the harm reported by the largest percentage of Canadians (8.9%), followed by being emotionally hurt or neglected (7.1%) and feeling threatened (6.3%), while being physically hurt was experienced by 2.2%.

Rehab centre fills gap

Ian Rabb with his dogs Samson and Ariel. (photo from Ian Rabb)

After falling prey to the habit himself, being rescued by his family and brought back home to Winnipeg for recovery, Ian Rabb began giving back – not just to his supporting family and the Jewish community, but to the greater community of Manitoba.

Rabb knew how the system worked from personal experience, had learned its flaws and, after recovery, set about to fix it.

“What I noticed then was a broken system in Manitoba, where there was no continuity of care,” said Rabb. “People didn’t have the ability to have extended stays in any kind of stable environment and, as I started doing my research and working in the program, I was appointed to the board of directors of the Addictions Foundation of Manitoba.”

With help from his brother, Jeff, Rabb determined that the biggest problem was the lack of a safe house where recovering addicts could take their time and realign their lives after completing their residential treatment program, which comprises a couple of weeks of rehabilitation. He opened Two Ten Recovery, a men’s house of recovery, as well as Destiny House for women. Today, there are three homes with a total of 33 beds.

“Our aim is to help people stabilize their lives and get them back to being fully self-supporting citizens, having a better prognosis or outcome when they leave,” said Rabb. “We allow them up to two years in our homes, where they have to be working and self-supporting within three months. Our success rate is at about 83%. What we’ve learned over the last number of years is the longer we can stay connected to someone post-treatment, coming out of a treatment centre, the better our success rates will be.”

It was six years ago that Rabb began hatching a plan to open a 24-hour, full-service drug and alcohol rehab centre. Once the Addictions Foundation closed their detox clinic, it became clear that a detox centre was also needed. Aurora Recovery Centre was established.

“I realized one thing very early on – that there was desperate need for a medical detox program where anyone could access medical services at any time, for any substance, and be provided with a service that would help them get off that substance, ultimately moving to the next step, addiction treatment,” he said.

Another thing that was critical in Rabb’s mind was to eliminate the wait time. “You don’t have time to wait when it comes to addiction treatment,” he said. “When someone’s ready for treatment, they need to be able to access a treatment facility. That doesn’t exist here. There’s months-long wait.

“All across Canada, because of the epidemic of addiction, even private centres are having severe wait times. So, ultimately we’re scrambling for places to send people when they need immediate help.

“The best centre in the world is just south of us, in Minnesota.

It was the first one ever started. Our model (at Aurora) is replicating the Hazelden model of addiction treatment.”

Aurora Recovery Centre is located on 28 acres of land along Lake Winnipeg, just north of Gimli. It will start as a 76-bed primary care centre, with 16 beds devoted to medical detox and emergency situations.

“We will be able to handle the ongoing problems here in Manitoba and hopefully will be busy enough to expand,” said Rabb. “We have lots of acreage there. We’re opening smaller with the plan of creating a full campus.”

To manage the centre, Rabb hired Peter Connelly, a Manitoba-born and -raised clinical director who has worked at the Minnesota Hazelden recovery centre for the past 13 years.

“I really believe that more services are needed, not only in Manitoba, but also in Canada,” said Connelly. “It’s an exciting project. It’s going to provide people who obviously need help with programs, so that’s really my reason for coming back. I certainly have a passion for recovery.”

Apart from the detox unit, which Connelly views as critical, his focus will be on the continuum of care, as he believes that after-care is of vital importance – the available services once clients have completed their in-patient treatment.

“The reality is that in-patient treatment is very difficult,” said Connelly. “It’s about people making a change, about people learning the tools of recovery and taking these tools into the outside world and using them to deal with life, on life’s terms.

“Addicts, alcoholics, need structure. They need to take responsibility and be accountable. Once they finish in-patient treatment, those are the challenges they face, so after-care is critical.”

This is an area that Aurora aims to focus on, with a number of programs that aid patients, including the option of extended-care programming, sober-housing on site, and continued follow-up with clients after they leave the centre.

“We will be developing an extensive out-patient program, so those who’ve been through the program can continue having group sessions and individual counseling after they leave,” said Connelly. “Through a number of programs that we’re developing and have developed, we’ll have clients come back yearly for an annual reunion.”

The facility is privately funded; participants and/or their family members will need to pay for their treatment. But, the cost is all-inclusive, with no added fees. “At the end of your stay, you certainly won’t be getting a bill for additional charges,” said Connelly. The cost is determined on a case-by-case basis, dependent on treatment and other factors.

At Aurora, the aim will be to have no wait time. “This is critical,” said Connelly. “We all have a tendency to procrastinate and the addict/alcoholic has a tendency to change their mind. When someone finally makes a decision they need to go, or a family member helped them with that decision, we need to get them into treatment as quickly as possible.

“As we move forward, I think people will see that the programming we offer is certainly needed. We’ll see what kind of relationships develop from there.”

Aurora began accepting patients on Oct.16. For more information, visit aurorarecovery.com.

Rebeca Kuropatwa is a Winnipeg freelance writer.

New addictions study

Winnipeg’s Jewish Child and Family Services executive director Al Benarroch. (photo from Al Benarroch)

Although the problem of alcohol and substance abuse in the Jewish community is not new, it is often kept hidden and even ignored. A recent study by Winnipeg’s Jewish Child and Family Services (JCFS) hopes to expose the problem and dispel the stigma.

Led by executive director Al Benarroch, JCFS has increased its activity in raising awareness about addictions in the Jewish community over the past five-plus years. These efforts have included giving lectures, writing articles, building JCFS staff’s capacity to address addiction issues, hosting speakers, holding a conference on the topic, and launching and supporting the local chapter of JACS (Jewish Alcoholics, Chemically Dependent Persons and Significant Others), a Jewish 12-step recovery group.

“As a result of all this work, stigma has been reduced and our community has become more open to discuss this significant social issue,” said Benarroch. “Many more Jewish families and individuals are now willing to seek out support and assistance from JCFS.”

These initiatives were mainly funded through grants from the Jewish Foundation of Manitoba and private donors. In 2011, JCFS received core funding from the Jewish Federation of Winnipeg to hire a dedicated staff person to oversee the development of future addiction recovery services.

JCFS has created a standing strategic advisory group on addictions (SAGA), which has prioritized main areas of focus, including the expansion of services and resources for youth and families. The continuum of services could include education (workshops, etc.), the provision of counseling, the opening of a Jewish recovery resource centre, offering Jewish transitional sober housing for individuals leaving in-patient treatment and requiring extended time to foster lasting sobriety and, ultimately, Jewish in-patient recovery services.

With all of these goals in mind, JCFS was faced with a problem: little or no research had been conducted on the incidence and nuances of addiction and addiction recovery in Jewish communities.

“However, anecdotal information and reports from other communities and their agencies mirror the experiences of Winnipeg,” said Benarroch. “Specifically, that there are many Jewish individuals and families struggling with a wide array of addiction issues, and that these numbers and [the] intensity of problems likely mirror the general population.”

Nonetheless, JCFS set about to gather some hard data about addiction in its community. The recent study, Alcohol and Substance Use in the Jewish Community – A Pilot Study, was proposed as the first in a series of studies on this topic.

“This study was a partnership between JCFS and the University of Winnipeg’s (U of W) department of psychology (Dr. Gary Rockman),” said Benarroch. “One of Dr. Rockman’s former students, who was also a former summer student case aide at JCFS, Melanie Baruch, expressed an interest in this topic and in conducting research. Together, I, as representative from JCFS, Melanie and

Dr. Rockman developed a survey that was sent out to a random sample of existing JCFS clients.”

The pilot study on the incidence of addiction-related issues among existing JCFS clients has been completed and researchers have embarked on a second phase, which is exploring the narrative themes of the journey of Jews in recovery. For this phase, Canadian and American Jewish individuals in various stages of the addiction recovery process are being recruited and interviewed.

“It is hoped that this study will shed light on what sorts of educational resources and treatment resources our community can offer to be most effective,” Benarroch said.

A third phase also has been proposed. It would involve an attitudinal survey sent out to Jewish communities across Canada, the United States and abroad, exploring various attitudes that exist within Jewish communities with regard to addictions.

The pilot’s findings

Almost 20% of the respondents to the JCFS survey had used drugs other than those required for medical reasons. Nearly 15% of respondents could not get through the day without using drugs, yet only nine percent of respondents had sought help.

photo - Ivy Kopstein coordinates JCFS’s addictions services — Ivy Kopstein coordinates JCFS’s addictions services. *(photo from Ivy Kopstein)*

“This is an area we would like to explore further – what is preventing individuals from seeking help,” said Ivy Kopstein, the social worker JCFS hired to coordinate its addictions services. “Is it lack of information, stigma, lack of services?”

Respondents had used general, rather than specifically Jewish, services more often, yet 70% said they would attend JACS if they knew it existed.

“This leads us to believe that respondents may not be aware of Jewish-focused addiction recovery services,” said Kopstein.

Almost 24% of respondents reported having a family history of alcohol or drug abuse and 41% reported knowing someone currently struggling with addiction. There was no difference when it came to marital status or education in who reported drinking frequently or infrequently, which is consistent with findings in the general population.

“A common theme when doing research on this subject is the stigma and sensitivity to the problem of addiction,” said Kopstein. “This includes concerns over anonymity, even though confidentiality was clearly expressed at the outset. So, we will continue with education and awareness programs to address the stigma and encourage those affected to seek help.”

Currently, SAGA is working on programs for youth and parents, as well as developing other clinical and cultural services.

“We are hoping to learn what helps individuals enter and maintain recovery and how Jewish culture, community and spirituality enhances (or detracted from) each individual’s journey,” said Kopstein. “This information will provide a microscopic view into recovery, which will assist us in further planning Jewish recovery resources.”

Rebeca Kuropatwa is a Winnipeg freelance writer.