09/29/14

Psychoactive Science or Sideshow

© Randomshots | Dreamstime.com - Medicine Wagon Photo

© Randomshots | Dreamstime.com – Medicine Wagon Photo

There is a growing call to permit research into the therapeutic benefits of a variety of psychoactive drugs currently classified by the DEA as Schedule 1 controlled substances. The editors of Scientific American called for the U.S. government to move LSD, ecstasy, marijuana and others into Schedule 2, with cocaine, methamphetamine, fentanyl and Ritalin. They point out that such a move would not lead to decriminalization, “but it would make it much easier for clinical researchers to study their effects.”

Schedule 1 controlled substances are “drugs with no currently accepted medical use and a high potential for abuse.” They are seen as the most dangerous drugs, “with potentially severe psychological or physical dependence.” Schedule 2 controlled substances are “drugs with a high potential for abuse, less abuse potential than Schedule 1 drugs, with use potentially leading to severe psychological or physical dependence.”

British researchers have also called for greater access to “classical hallucinogens” such as psilocybin (magic mushrooms, another Schedule 1 drug) and LSD for research into treating depression.

Classical hallucinogens alter the functioning of this system [serotonergic], but not in the same way current medications do: whilst there are identified receptors and neurotransmitter pathways through which hallucinogens could therein produce therapeutic effects, the neurobiology of this remains speculative at this time.

These drugs are all caught in a catch-22, de facto ban on their use in medical research because of their Schedule 1 placement. “These drugs are banned because they have no accepted medical use, but researchers cannot explore their therapeutic potential because they are banned.” Three United Nations treaties extend similar prohibitions to rest of the globe, further complicating their reclassification as Schedule 2 drugs.

British psychiatrist David Nutt has argued that the U.N. charters are outdated and restrict doctors and scientists from studying hundreds of drugs.  He likened this “research censorship” to the Catholic Church banning Galileo from teaching or defending heliocentric ideas in the 1600s. Nutt suggested the Catholic Church banned the telescope, but the ban was actually on books that taught Copernican beliefs.

Nevertheless, he called the laws, which do not discriminate between research and recreational drug use relics of another age. “These laws serve no safety value. . . . The licenses and bureaucracy surrounding them can increase the costs of research tenfold, further limiting what is done.”  Dr. Nutt commented on how LSD and other hallucinogens like psilocybin had potential to explore and treat the brain. “Other therapeutic targets for psychedelics are cluster headaches, OCD and addiction.”

The argument for reclassifying psychoactive substances like marijuana, LSD, ecstasy and psilocybin from Schedule 1 to Schedule 2 has its pros and cons for me. The above discussion presents the case for reclassification, permitting future research into these substances. IF the ideal of rigorous, methodical research into the therapeutic potential of these drugs is followed, all is well.

But we are now in the midst of an epidemic of prescription drug abuse that came through the very same gauntlet of review and approval that these known recreational drugs would pass through to become medicinal agents once they were reclassified. And while there are potential therapeutic applications for marijuana, the current state of medical marijuana looks more like the older sideshow of patent medicines, where you could get cocaine toothache drops, heroin for cough relief, and Mrs. Winslow’s Soothing Syrup (which contained morphine) for teething discomfort.

UntitledIf special interest groups can be held off from bringing about a new age of snake oil salesmanship, then reclassifying these substances and permitting legitimate scientific research makes sense. Done correctly, it might even demonstrate that some of the existing curative claims for medical marijuana and other substances were false. But if these psychoactives achieve FDA approval for any reason, they could be prescribed “off label” as is currently the case with other FDA approved drugs.

Do you think these Schedule 1 drugs should be reclassified as Schedule 2 drugs?

 
09/26/14

Our Papa Who Art in Heaven

© Master2 | Dreamstime.com - Lord's Prayer In Internal Passageway Photo

© Master2 | Dreamstime.com – Lord’s Prayer In Internal Passageway Photo

Verses 9 to 13 in the sixth chapter of the Gospel of Matthew are familiar to anyone in Christian churches as “The Lord’s Prayer” or the “Our Father.” Emmet Fox said it was “the most important of all Christian documents;” the best known and most often quoted of all the teachings of Jesus. Easily memorized, it has been recited publically and privately from the early days of the church. “It is indeed, the one common denominator of all the Christian churches.” The Lord’s Prayer is a model for our praying—“Pray then like this.” (Matt. 6:9) It also has parallels to the principles of recovery embedded in Twelve Steps.

In Matthew 6:1, Jesus cautioned his hearers against public displays of righteousness. Essentially he said that if you make a public display of being pious, you aren’t really being spiritual. He then proceeded to look at the three main aspects of Jewish piety: giving to charity (2-4), prayer (5-15) and fasting (16-18).

Matthew 6:5-8 begins: “And when you pray, you must not be like the hypocrites.”  Here is the second thing to unlearn if you want to practice true spirituality—don’t make a big show out of praying! In fact, find a way to pray in secret. God sees you. Also, don’t babble on and on, thinking that because you have a lot to say, God is impressed with your eloquence—He isn’t. Then Jesus drops a bomb: “Your Papa knows what you need before you ask him.”

New Testament scholars suggest that when the Greek word for Father appears in the Gospel prayers, the Aramaic word  ’abba was originally used in conversation. ’Abba was the equivalent of an infant babbling “Papa” to his father. To his audience, Jesus was suggesting an uncomfortably familiar form of address to God in prayer. Pious Jews wouldn’t even spell God’s name completely, and Jesus was referring to him as ’abba! One commentator said “Christians should consider God as accessible as the most loving human parent.” The hypocrites used flowery, eloquent language when they prayed. Jesus says don’t be like them—come to papa, who already knows what you need.

“Our Father in heaven, hallowed be your name.” Our Father links the person praying to all other believers. I am reminded here that the first word of the First Step is also plural, We, connecting the individual alcoholic to all others in A.A. The intimacy of praying to ’abba is counterbalanced by His presence in heaven. We can come into the presence of the creator of the universe, knowing He is our ’abba. We can approach the God of the universe in all our prayers.

In the chapter “We Agnostics,” of Alcoholics Anonymous, Bill W. wrote that alcoholics were faced with a crisis they could not postpone or evade. They were confronted with the question of faith. “God either is, or He isn’t. What was our choice to be?” Wilson went on to say that deep down in every person was the fundamental idea of God. Faith in some kind of God was a part of being human. “We found the Great Reality deep down within us.”  The God of heaven was near to us. In Him we live and move and have our being (Acts 17:28). Bill ended his essay with the following declaration: “When we drew near to Him He disclosed Himself to us!”

“Your kingdom come, your will be done, on earth as it is in heaven.” When Jesus heard that John the Baptist was imprisoned, he began preaching as John had in Matthew 3:2, “Repent, for the kingdom of heaven is at hand.” (Matt. 4:17)  So here in verse 6:10, we are to pray that God’s will be done as perfectly on earth as it is in heaven. Leon Morris said: “In heaven God’s will is perfectly done now, for there is nothing in heaven to hinder it, and the prayer looks for a similar state of affairs here on earth.” Not our will, but God’s will be done.

I hear an echo of surrender to the will of God in A.A.’s Third Step here, where the individual is called to submit their will and life to the care of God as they understand Him. In the entry for August 26th, Twenty-Four Hours a Day said that if we still cling to something, we must sincerely ask for God’s help to let go of it. “We must say: ‘My Creator, I am now willing that you should have all of me, good and bad.’” The last paragraph of the “Step Three” essay in Twelve Steps and Twelve Traditions says:

In all times of emotional disturbance or indecision, we can pause, ask for quiet, and in the stillness simply say: “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Thy will, not mine, be done.”

We’re not finished yet with our look at the Lord’s Prayer, but will stop here for now. Part of true spirituality is recognizing that we can approach the Creator of the universe in prayer as simply and as easily as an infant approaches his or her “papa.” And our attitude in prayer should be for God’s will to be done. I often use the Serenity Prayer in counseling to help people discern the will of God in their life. When I do, I encourage them to not only say it, but to work and apply it. Because if they do, then God’s will shall be done on earth.

Do you approach God in prayer as if you are approaching a loving Father?

See the second part of this reflection on the Lord’s Prayer in “A Daily Reprieve.”

This series is dedicated to the memory of Audrey Conn, whose questions reminded me of my intention in seminary to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

09/24/14

The Making of an American Tragedy

image credit: iStock

image credit: iStock

Psychiatrist Peter Breggin said that diagnosing millions of children with ADHD and then treating them with stimulants and other psychoactive chemicals is an American tragedy. “Never before in history has a society attempted to deal with its children by drugging a significant portion of them into conformity while failing to meet their needs in the home, school and society.” According to Dr.Breggin, the ethical scientist and physician, the concerned parent “must feel stricken with grief and dumbfounded” that our society has allowed this to happen to our children.

In October of 2011, the American Academy of Pediatrics (AAP) overrode the FDA and approved diagnosing children as young as four with ADHD and medicating them with Ritalin. The lead author of the report said: “Because of greater awareness about ADHD and better ways of diagnosing and treating this disorder, more children are being helped.” Dr. Breggin said this action was an outrage: “This endorsement of drugging younger children by the American Academy of Pediatrics is an outrage.”

According to Dr. Breggin, the scientific literature shows that 50 percent or more of children this young will become depressed, lethargic, weepy—along with being more manageable when given medications such as Ritalin, Adderall and other ADHD medications. Studies show that stimulants will permanently change brain chemistry in the children, cause shrinkage of brain tissue and predispose them to cocaine addiction in young adulthood. He also feared this endorsement by the AAP would open the door for every other psychiatric drug being prescribed to children that young.

These new guidelines will encourage prescribers to throw caution to the wind with toddlers, opening a Pandora’s box of drug intervention for children. Many young children will have their brains bathed with powerful and often toxic chemicals in the early years of their central nervous system development.

But the problems didn’t stop there. Susanna Visser, who oversees the CDC research on ADHD, presented a report at the Georgia Mental Health Forum in May of 2014 that suggested at least 10,000 2 and 3 year-olds were being medicated for ADHD. “It puts these children and their developing minds at risk, and their health is at risk.” Effective non-drug treatments were often ignored.

Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they are getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child.

As liberal as the AAP guidelines for ADHD are, they do not even address diagnosis in children 3 and younger—let alone the use of stimulant medications—with that age group. Children under 4 are not covered in the guidelines because “hyperactivity and impulsivity are developmentally appropriate for toddlers.” Dr. Lawrence Diller, a pediatrician, said: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Sheila Matthews attempted to put “the insanity of drugging 2-3 year olds” in perspective. She noted that the average weight for male toddlers at three years was 29.5 pounds; female toddlers averaged 28.4 pounds. “By this age, only 80 percent of the child’s brain has fully developed.” Kids at this age are learning to arrange things in groups, to put things in size order, remembering what they did yesterday, learning to say please and thank you, and recognizing themselves in the mirror. “In a nutshell, 2-3 year old toddlers are being labeled with an alleged mental illness that is not based in science or medicine and then “treated” with extremely addictive, mind-altering drugs before their brains are even fully formed.”

Psychiatrist Allen Frances said: “Treating babies with stimulants is based on no research, is reckless, and takes no account of the possible harmful long-term effects of bathing baby brains with powerful neurotransmitter drugs.” He hoped that the CDC report would fuel a backlash of parental and professional protest as it becomes clearer how absurdly overused is the ADHD diagnosis and stimulant medication. “It is also particularly outrageous that so many of the thought leaders promoting the excessive use of stimulants have such close ties with pharmaceutical companies.”

Dr Breggin lamented that instead of meeting the normal needs of our children, we are suppressing them with drugs. The average parent or teacher has no idea that what is presented as medical treatment “is actually a form of medical child abuse.” What they see is a more manageable child and assumes this is for the best. Instead, it is the making of an American tragedy.

Do you think the drugging of young children and toddlers is a form of medical child abuse?

09/22/14

Won’t Money Spoil This Thing?

image credit: iStock

image credit: iStock

In November of 1937, Bill Wilson and other early A.A. members were asked this question by Albert Scott when they met with him and others in a meeting held in John D. Rockefeller’s private boardroom. The then unnamed fellowship was looking for financial support from Rockefeller for their idea to develop a small specialized hospital to treat alcoholics. In the end, only $5,000 was approved to pay off the mortgage of Dr. Bob Smith’s home and provide a weekly draw of $30 for both Bill and Dr. Bob. Bill was bitterly disappointed at the time because he had envisioned a chain of treatment hospitals staffed with paid A.A. workers.

That wasn’t the end of Bill’s vision for the professionalism of the A.A. way. In his essay on the Sixth Tradition, Bill said “We tried A.A. hospitals—they all bogged down.” He related other outside attempts of education and reform that ultimately led to the conviction A.A. should not endorse any related enterprise, regardless of how good it seemed. “We of Alcoholics Anonymous could not be all things to all men, nor should we try.”

This “school of hard knocks” resulted in the formal acknowledgement of its non-professionalism within the Twelve Traditions. Tradition Six reads:  “An A.A. group ought never endorse, finance or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” This primary purpose, embodied in Tradition Five, was “to carry its message to the alcoholic who still suffers.” Tradition Seven further voiced what was called A.A.’s “collective poverty” in stating that: “Every A.A. group ought to be fully self-supporting, declining outside contributions.”

The clear language of Tradition Eight states: “Alcoholics Anonymous should remain forever nonprofessional.”  Bill began his essay with this paragraph:

Alcoholics Anonymous will never have a professional class. We have gained some understanding of the ancient words, “Freely ye have received, freely give.” We have discovered that at the point of professionalism, money and spirituality do not mix. Almost no recovery from alcoholism has ever been brought about by the world’s best professionals, whether medical or religious. We do not decry professionalism in other fields, but we accept the sober fact that it does not work for us. Every time we have tried to professionalize our Twelfth Step, the result has been exactly the same: Our single purpose has been defeated.

It isn’t too hard to find someone critical of Alcoholics Anonymous or Twelve Step recovery these days. One of these critics is Dr. Lance Dodes, author of The Sober Truth. Dr. Dodes has professional credibility. He is a trained psychoanalyst; a retired assistant clinical professor of psychiatry at Harvard Medical School; the former director of the substance abuse treatment unit of McLean Hospital and more.

Listening to his interview on NPR, you will here him claim that: “the success rate of AA is between 5 and 10 percent.” And then he stated that the studies that have claimed to show that AA is scientifically useful are “riddled with scientific errors.” Further, A.A. is also “harmful to the 90 percent who don’t do well.” Significantly, he noted where A.A. describes itself as a “brotherhood” (or fellowship) rather than a treatment.

A.A. is not treatment, but often gets lumped in with the Rehab industry, as within the subtitle of Dodes’ book: “Debunking the Bad Science Behind Twelve-Step Programs and the Rehab Industry.” Dr. Dodes is just the newest in a long line of critics of both A.A. and the addiction treatment industry. His dismissed studies supporting the usefulness of A.A. as “riddled with scientific errors,” and declared that: “AA probably has the worst success rate in all of medicine.”

Another long time Twelve Step recovery critic is Stanton Peele. Dr. Peele has been around since 1975, when he was the co-author of Love and Addiction. His latest book is Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program. I’ve read several of his other books and found some of his thinking useful. One idea from The Diseasing of America that I’ve used regularly over the years was his distinction between three generations of “disease” (physical ailments, mental disorders, and addictions). You can read his recent thoughts on addiction and recovery in these blog posts on The Fix: “The New Recovery” and “Do Not Fold, Spindle, or Mutilate People into AA.”

Because of its traditions, (Tradition Ten: “Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversies.”) A.A. will not respond to these criticisms. So if you want more information on A.A., you’ll have to go to some open A.A. meetings and see for yourself what A.A. is all about. They don’t charge admission; it’s free. You can also subscribe to this blog and receive a free copy of my ebook, “The Age of Miracles is Still with Us,” which examines data from periodic membership surveys by A.A.

If you want to know more about what Drs. Dodes and Peele think about A.A., try their latest books: Recover! for $16.66 or The Sober Truth for $20.50 on Amazon.

Has the professionalization of Twelve Step recovery in the Rehab industry brought unfair criticism onto A.A.?

 

09/19/14

Where is the Repentance?

image credit: iStock

image credit: iStock

“When someone says they’re sorry but they don’t back their words up with real and lasting changes in their behaviors, sorry becomes meaningless. It is not enough. . . . It’s more often due to the pain they’re in or the pain they fear rather than any genuine remorse.” By saying: “I’m sorry” this person often thinks they are entitled to amnesty, forgiveness and full restoration of relationship—without having to make amends, without suffering consequences, or working to rebuild trust.

Tearful, weepy confessions of sin and wrongdoing have passed for true repentance on too many occasions, deceiving spouses, parents, friends, and even pastors and church leaders. And as Leslie Vernick noted in her July 22nd, 2014 newsletter, if the “sorry” one isn’t readily offered forgiveness, the hesitant one can be labeled as ungracious, ungodly, rebellious or hard-hearted. After their tears, the offender needs to be asked: What amends will you make? What will be the fruit of your repentance?

Even within one of the classic New Testament passages teaching forgiveness, the call for repentant fruit is evident. In Luke 17:3-4, Jesus told his apostles: “If your brother sins, rebuke him, and if he repents, forgive him, and if he sins against you seven times in the day, and turns to you seven times, saying, ‘I repent,’ you must forgive him.” Their response was “Increase our faith!” They felt Christ was asking for the impossible.

There is no limit to the extent of forgiveness you should offer to someone who sins against you; and it should be granted without hesitation. BUT such forgiveness should be preceded by repentance—by the offender turning around or retreating from their wrongdoing. So there is a two-fold process in true repentance—saying “I’m sorry” and turning away from the sinful behavior (repentance). Saying: “I’m sorry,” without turning from wrongdoing is pseudo-repentance.

In his Commentary on a Harmony of the Evangelists, John Calvin said of Luke 17:3-4 that “Christ does not order us to grant forgiveness, till the offender turns to us and give evidence of repentance.” In an aside Calvin added that in doing so, it appears that Christ is commanding us to shut our hearts against the obstinate (unrepentant) and refuse them pardon.

He thought there were two ways in which offenses could be forgiven.  The first was to give up the desire for revenge and not cease to love the one who did you an injury. You might even repay kindness for the injury. Yet you could entertain an unfavorable opinion of the person, as they deserve. “For when God commands us to wish well to our enemies, He does not therefore demand that we approve in them what He condemns, but only desires that our minds shall be purified from all hatred.”

The second kind of forgiving is when you receive a brother or sister into favor, being convinced that the remembrance of their offense is blocked out in the sight of God. “This doctrine is very necessary, because naturally almost all of us are peevish beyond measure; and Satan, under the pretence of severity, drives us to cruel rigour, so that wretched men, to whom pardon is refused, are swallowed up by grief and despair.” Here Calvin said a question arises: “As soon as a man by words makes profession of repentance, are we bound to believe him?”

First, the passage relates to the daily faults in which even the best people need forgiveness. What would be the consequence if at the second or third fall, the hope of forgiveness was cut off?

Second, Christ does not deprive believers from exercising judgment, so that they are to believe every slight expression of remorse. He only desires that we are merciful and willing to stretch out our hand to the offenders “provided there be evidence that they are sincerely dissatisfied with their sins. For repentance is a sacred thing and therefore needs careful examination.”

Third, someone could expose himself to suspicion regarding the sincerity of his repentance through light and unsteady behavior. We may grant pardon if he asks, “and yet may do so in such a manner as to watch over his conduct for the future.” This is done so that our forbearance and meekness in granting forgiveness may not become subject to his ridicule.

In summary, then, Calvin suggests that with the daily faults that we are all prone to exhibit, we should be ready and willing to grant forgiveness to others. But an offender should show signs of repentance before receiving forgiveness for other offenses. There should be evidence that they hate their sin. Finally, we are not ordered by Christ to forgive as soon as someone says they are “sorry.” Granting forgiveness can wait until the offender demonstrates their repentance.

The offender’s repentance is more than just saying “I’m sorry.” There can and should be a turning aside from the offense. There should be clear evidence that they are repentant. And if the person is unrepentant, we can refuse to offer this second kind of forgiving.

Even with sincere repentance there may be some failures by the offender. The one who was sinned against needs to realize this and not too quickly judge the offender unrepentant and refuse forgiveness—provided there is evidence of they are “sincerely dissatisfied with their sins.”

We do not have to believe every slight expression of remorse. We can offer forgiveness in a way that includes some accountability, some watchfulness over the offender’s behavior in the future.

We are not required to then become friendly with an offender when offering them forgiveness. We should surrender our desire for revenge, perhaps even repay kindness for the injury. Here God wants us to be free of all hatred. Yet we may still reserve an undesirable opinion of the offender; they may still be an enemy even after receiving forgiveness from us.

Do you think John Calvin’s suggestions could alleviate pseudo-repentance if they were applied more readily?

 
09/17/14

Counseling Inside or Outside the Church

Stanton Jones, a psychology professor at Wheaton and the co-author of the book Modern Psychotherapies, described an encounter he had with Jay Adams while he was in graduate school at Arizona State University in the 1970s. With the publication of Competent to Counsel in 1970, Adams initiated what has become known as the Biblical counseling movement.  Jones asked Adams if he had any advice for him as a Christian studying psychology.  Adams responded by suggesting that he drop out of graduate school. “If you want to serve God as a counselor, you can only do so by going to seminary, studying the Word of God rather than the words of men, and becoming a counselor.” Jones didn’t take the advice.

This exchange illustrates what has been a split among conservative Christians over the care (cure) of souls. David Powlison wrote an article in the Spring 2007 issue of the Journal of Biblical Counseling entitled: “Cure of Souls (and the Modern Psychotherapies)” that looks at this divide from the perspective of a Biblical counselor. Dave is the Executive Director of the Christian Counseling and Education Foundation (CCEF), which was founded by Jay Adams. He is also the senior editor of the Journal of Biblical Counseling. Powlison’s article is made available here by CCEF, where it was included as an appendix to his book: The Biblical Counseling Movement: Its History and Context.

Powlison proposed that two acronyms refer to the divide between what has been traditionally known as Christian Counseling (VITEX) and Biblical Counseling (COMPIN). His thinking is that the traditional labels have given rise to objections from both sides. Biblical counseling can imply that “whatever [its] advocates believe and do comes with the full authority of the Bible” and anything else is unbiblical. What do you do when biblical counselors refer to Biblical Counselors as psychoheretics? Christian counseling suggests that: “what [its] advocates believe and do is distinctly Christian.” But what if what they teach is at odds with their professed faith? Powlison rightly noted that: “In both cases, the reality beneath the label is a complex maybe/maybe-not.”

Both sides say that Christians can learn something from psychology; and both say the Bible gets the final say. But the stalemate comes with how each position tends to see the role Scripture in counseling. Does it provide control beliefs for a Christian model of counseling, while secular psychologies make a VITal EXternal contribution? Or is Scripture a COMPrehensive INternal resource for the construction of a Christian model of counseling, where secular psychologies “do not play a constitutive role in building a robust model.”

Powlison went on look at the intellectual, methodological, and institutional characteristics of evangelical counseling; and how these characteristics will be shaped by either a VITEX or a COMPIN vision of counseling.  He structured this within three sections addressing epistemology (what knowledge matters most for helping people), motivation theory (how do we fundamentally understand people) and the social structure of how to educate, license and oversee counselors.

He concluded by stating his firm commitment to the view of counseling he has labeled COMPIN. He did not think that the VITEX epistemological priorities could help the church to understand and help people. He called for the development of a systematic theology of counseling, a paradigm that would: 1) guide our interaction with the people entrusted to our care; 2) guide our interaction with the secular models of counseling; and 3) become institutionally incarnated. “We need a fresh practical theology of the cure of the souls.”

So will your counseling be primarily within the church community, or outside of it? The COMPIN model is a paradigm for counseling WITHIN THE CHURCH community. It could also be done in a private practice or parachruch context, but would not be well received in secular counseling situations. And its credentials would probably not meet the educational requirements for most licensures outside of the church. On the other hand, VITEX has the ability to “integrate” with secular counseling programs and credentialing organizations and is a model for Christians who will be counseling OUTSIDE THE CHURCH. The secular structure required for this integration will not provide a solid foundation for a biblical understanding of human nature and motivation or developing a fully orbed biblical counseling epistemology.

I generally advise Christians seeking a career in counseling to get a both-and education—especially if they see themselves only counseling within the church. Get at least a masters degree in counseling from a secular or VITEX institution, and a certificate or a masters degree in counseling from a COMPIN organization like CCEF or a seminary like Westminster Theological Seminary. The COMPIN training will temper the paradigm bias of secular and VITEX counseling programs. And the VITEX training will help the Biblical counselor develop a more effective “apologetic” for reaching individuals in the church who have a secular view of the issues that brought them to counseling.

Would you pursue a both-and counseling education if you wanted to counsel within a church setting?

09/15/14

Homegrown Epidemic

The White House reported that the Centers for Disease Control and Prevention (CDC) identified prescription drug abuse as an epidemic.  The 2012 National Survey on Drug Use and Health (NSDUH) reported that 4.9 million people, 1.9% of the population, abused prescription drugs. Nonmedical use of psychotherapeutics, particularly pain relievers, was the most commonly used illicit substance after marijuana. “In our military, illicit drug use increased from 5% to 12% among active duty service members from 2005 to 2008, primarily due to non-medical use of prescription drugs.” Drug induced deaths have almost doubled since 1999 and are now second only to motor vehicle fatalities.

At the end of 2013, Genetic Engineering & Biotechnology News (GEN) published a list of the top 17 abused drugs of 2013. The table below combines most of the given statistical information in the list of abused drugs and presented them in rank order, from one to seventeen.

There is no surprise that seven of the listed drugs are either prescribed for some kind of “pain” condition or are opioids (OxyContin, Suboxone, Opana, Fentora [fentanyl], Percocet, Soma, Vicodin). Vicodin is now classified as a schedule 2 controlled substance. Soma is now a schedule 3 controlled substance. Suboxone  (schedule 3) is an opioid approved for opioid drug treatment.

Three of the medications are used to treat ADHD (Concerta, Ritalin, Adderall); all three are in the top 8 most abused drugs. Four of the drugs are benzodiazepines (Xanax, Klonopin, Ativan, Valium; schedule 4).  Two medications are sleep aides (Ambien, Lunesta). One, Zoloft, is an SSRI used to treat depression.

Drug

Rank

2012 Sales

2011 Sales

Patent

Use

OxyContin

1

2.7 billion

2.8 billion

until 2025

pain

Suboxone

2

1.4 billion

1.2 billion

until 2020

mainten

Concerta

3

1.1 billion

1.3 billion

invalid

ADHD

Ambien CR

4

671 million

661 million

until 2020

sleep

Ritalin

5

554 million

550 million

expired

ADHD

Zoloft

6

541 million

573 million

expired

depression

Lunesta

7

447 million

420 million

until 2014

sleep

Adderall XR

8

429 million

533 million

expired

ADHD

Opana

9

299 million

384 million

until 2025

pain

Xanax

10

274 million

308 million

expired

anxiety

Klonopin

11

194 million

211 million

expired

anxiety

Fentara

12

161 million

186 million

until 2019

pain

Percocet

13

103 million

104 million

expired

pain

Ativan

14

30 million

25 million

expired

anxiety

Soma

15

27 million

46 million

expired 1/12

pain

Valium

16

8 million

11 million

expired

anxiety

Vicodin

17

N/A

168 million

expired

pain

Suboxone is likely on the list because of its use by opioid abusers and addicts as a “back up” to forestall withdrawal when the opioids aren’t available. However, along with other opioids it can be combined with benzodiazepines for a heroin-like euphoria. The combination of these two classes of drugs has increasingly become one of the signatures of accidental overdose deaths worldwide. The 2012 NSDUH reported that 4.8% of the population over the age of 12 had used pail relievers illicitly within 30 days of being surveyed.

In their own right, benzodiazepines have a long history of abuse. Valium was the best selling drug in the Western world from 1968 to 1981. It wasn’t until 1975 that the U.S. Justice Department required that benzodiazepines be listed as schedule 4 drugs under the Controlled Substances Act. As Robert Whitaker noted: “This designation limited the number of refills a patient could obtain without a new prescription, and revealed to the public that the government had concluded that benzodiazepines were, in fact, addictive.” The 2012 NSDUH reported that 2.3% of the population over the age of 12 had used tranquilizers illicitly within 30 days of being surveyed.

Attention-deficit disorder did not appear as a “disease” in the Diagnostic and statistical Manual until 1980. In 2007, the CDC reported that one in every twenty-three American children between the ages of four and seventeen is taking an ADHD medication. Concerta, Ritalin and Adderall are all schedule II controlled substances; classified to be as potentially addictive as OxyContin, Opana, Fentara, Percocet, and Vicodin. Concerta and Ritalin are the brand names for the generic drug, methylphenidate.  The 2012 NSDUH reported that 1.3% of the population over the age of 12 had used stimulants illicitly within 30 days of being surveyed.

The medications on the GEN list of abused drugs include some of the most commonly prescribed classes around: drugs for pain relief, anxiety, ADHD, and sleep problems.  The Daily Beast reported that: “The US, which holds 5 percent of the world’s population, is responsible for 75 percent of global prescription drug use.” So the chances that at some time in your life you will be prescribed one of these 17 drugs for a legitimate medical reason is high. Be careful in how you use them and most especially, how long you use them.

Do you think it is overstating the problem to say that prescription drug abuse is an epidemic? 

 
09/12/14

I Think Satan is a Behaviorist

image credit: iStock

image credit: iStock

I’m convinced that Satan is an eminently rational being. He understands human nature better than we do. Think about this.  Even when tempting Christ, he zeroed in on the potential weaknesses of His human nature: hunger after forty days of fasting; the agoraphobic insecurity of suddenly standing on the very pinnacle of the temple; an option to sidestep the way of the cross which Christ was destined to endure in order to redeem a fallen world. This was exquisite, methodical, purposeful temptation aimed at the human nature of Christ.

He is not insanely or irrationally continuing to fight against God even though he knows from Scripture that he is a defeated foe (Luke 10:18). He knows he can never separate us from the love of Christ (Romans 8:35). He realizes if we resist him, he will eventually flee (James 4:7). He recognizes that we can do all things through Christ who strengthens us (Philippians 4:13). Despite all this, he prowls around like a lion, seeking someone to devour (1 Peter 5:8). This is not insanity; it is intentionality. There is a method to what seems to be madness. His continued efforts in temptation have a purpose.

I think the answer is that Satan is a behaviorist; a stone-cold Skinnerian of the nth degree. Through temptation, he intends to elicit learned helplessness in the life of believers.

Learned helplessness is a principle of behavioral psychology. When an organism (human or animal) repeatedly endures a painful or unpleasant stimuli from which they cannot escape, they eventually become unable or unwilling to avoid further pain or unpleasantness—EVEN IF they could escape from it.

So what would this look like? Imagine an experiment where a dog is placed within a two-sided wire cage with a middle wall. The middle wall can be raised to completely block access to one side; or have the top half of the wall lowered completely. Each side of the cage is independently wired to give a very uncomfortable, but not deadly shock to the dog. Then the experimenter begins to shock the side of the cage in which the dog is.

The dog quickly learns to jump to the other side of the cage to avoid the shock. Then the middle wall is raised and locked. And the side containing the dog is shocked; and shocked; and shocked repeatedly. Ultimately the dog will just lie there and wine and wriggle a bit when the shock occurs. Then the wall is lowered, but the dog continues to lie on the side receiving the shock. This is learned helplessness.

So that is what temptation is all about. It is aimed to convince those who believe in Christ—those who can claim the truth of all the above-mentioned Scripture passages and more—that all they can do is lie there like a dog in the midst of their struggles against sin. Satan teaches the reality of Romans 7:15-24a, but leaves off the hope of 24b and 25: “Who will deliver me from this body of death? Thanks be to God through Jesus Christ our Lord! So then, I myself serve the law of God with my mind, but with my flesh I serve the law of sin.”

If our response to the inescapable pain of sin is learned helplessness instead of perseverance, then our faith and service to God is overcome. This is the purpose and goal of temptation. We are robbed of faith; and God is robbed of what is pleasing to Him—our turning to Christ for deliverance. If all we can do is stand and face towards the direction we know God wants us to travel, then eventually we will endure, because we can do all things through him who strengthens us.

Do you sometimes feel this sense of “learned helplessness” in your spiritual life?

 

09/10/14

Is ECT Brain Disabling?

I’ve only had a couple of up-close-and-personal experiences with people who have had electroconvulsive therapy (ECT). Both were residents of a long-term addiction treatment facility for women. One woman was in her late 20s who didn’t appear to have suffered any serious side effects after her ECT treatment. But the ECT didn’t seem to have a clearly positive effect on her depression. Actually, her mood seemed rather flattened afterwards.

The other woman had been a resident for a few months and suffered a severe depressive episode for which she agreed to have ECT. A small group of the residents gathered around her when she returned from her stay and ECT treatment at Western Psychiatric Institute and Clinic (WPIC). The other residents were supportive, asking how she was doing; telling her they were glad to see her, etc. She responded in a quiet, timid manner, thanking them for their support. As the group broke up and we entered the facility, she whispered to me: “Who were those people?”

Since then, I’ve read some of the material of the opponents to ECT, particularly Peter Breggin, who has a long history of activism against ECT. Dr. Breggin, has gathered an incredible amount of information on the website ECT Resources Center.

So I was interested when I saw an online article in the Pittsburgh Post-Gazette in December of 2013 on ECT treatment at WPIC, “Electroconvulsive therapy a surprisingly common treatment for mental illness.” The psychiatrist who treated the woman in the article said that ECT “is the most effective antidepressant still out there.” The article was clearly positive about the use of ECT, but a sentence stood out to me: “Doctors are still not sure why ECT works.” Yet, Dr. Breggin wrote on his website:

ECT works by damaging the brain. The initial trauma can cause an artificial euphoria which ECT doctors mistakenly call an improvement. After several routine ECTs, the damaged person becomes increasingly apathetic, indifferent, unable to feel genuine emotions, and even robotic. Memory loss and confusion worsen. This helpless individual becomes unable to voice distress or complaints, and becomes docile and manageable. ECT doctors mistakenly call this an improvement but it indicates severe and disabling brain injury.

A 78-year-old Beaver Falls woman, who had been treated for a bipolar disorder since the 1960s, was the featured patient in the Post-Gazette article. The reporter, Mark Roth, was permitted access to observe her ECT treatment. He wrote that she was unconscious and her muscles were paralyzed from anesthesia, “It was over in 8 seconds. . . . For her and for anyone watching, it was far less dramatic than they might have imagined.” After her series of 10 shock treatments, the woman felt that ECT helped her tremendously. She said that ECT made it possible for her to climb out of the deepest depression she had ever experienced.

The comment of ECT being “far less dramatic” was an allusion to the 1975 movie “One Flew Over the Cuckoo’s Nest,” where Jack Nicholson’s character was held down by attendants as he went through ECT treatment and the resultant seizure.

The modern use of anesthesia and muscle relaxants means that physical restraint, as portrayed in the movie, no longer occurs. But as Dr. Breggin pointed out in a debate with Dr. Helen Lavretsky, anesthesia makes it more difficult to initiate a seizure, so the patient has to have a greater shock than was given in the past. Listen here to the debate with Dr. Helen Lavretsky located on the ECT Resources Center website.

Dr. Lavretsky said that ECT was rarely performed, but Dr. Solia of WPIC, said that was a common misconception, at least at WPIC. He said that WPIC was one of the largest operations in the nation, performing “more than 300 electroshock procedures per month.” An assembly line procedure had “one set of patients being prepped with IV lines as another one is getting the treatment and still others are coming back to consciousness in a recovery area.”

There hasn’t been any follow up to the Post-Gazette article, even though the original article did say it was the “first of five parts.” In preparing my own article, I read the comments to the original article and I think I understand why. What was supposed to have been a positive public relations story about the ECT clinic at WPIC became a lightening rod that attracted strong negative attention. The majority of comments were negative like the following:

Not everyone’s ECT experiences are as positive as this article suggests. After my ECT I lost all memories of the year of my life before the treatments. This caused social and professional problems, as you can imagine, and also considerable personal pain. I also acquired some cognitive deficits with which I continue to struggle. (Sonia)I found ECT severely traumatizing, rendering profound memory loss that continues to manifest itself even 1 1/2 years later. I continue to suffer with cognitive defects and emotional pain that interfere with my work, social and personal life. I have repeatedly encountered others with very negative experiences. ECT does have positive results in some, but there are many for whom the treatment fails and wreaks havoc. (Kelly)

At least some of the individuals thought the article sounded like a “PR piece.” Cheryl asked: “Why not write another piece of equal length, focusing on the points of view medical professionals and former patients and their families who have the opposing viewpoint.” Don’t continue to wait for that to happen. I don’t think there will be any follow up articles. Just go to Dr. Breggin’s ECT Resources Center and get credible information on the problems with ECT.

Is ECT the most effective antidepressant, or is it a brain disabling injury masquerading as treatment?

09/8/14

A Little Dab Will Do Ya

"Drop of cannabis oil" by Ryan Bushby(HighInBC) - http://upload.wikimedia.org/wikipedia/en/e/e2/Drop_of_cannabis_oil.jpg. Licensed under Creative Commons Attribution 2.5 via Wikimedia Commons -

Drop_of_cannabis_oil.jpg. Licensed under Creative Commons Attribution 2.5 via Wikimedia Commons –

In the 1950s, the ad slogan “A little dab will do ya,” referred to a hair cream called Brylcreem that was supposed to tame a man’s wild hair and make him instantly attractive to women. These days, with the growing acceptance of medical and recreational marijuana, the slogan also applies to a byproduct of marijuana called Butane hash oil (BHO) or wax.

BHO is made by mixing butane with marijuana, and then processing the mixture so that the plant’s cannabinoids are stripped away by the butane from the plant debris. The end result can look like honey or wax. If the amateur chemist doesn’t evaporate their BHO correctly, a lot of impurities are left behind.  Johnny Green, a marijuana activist said: “I’m not a doctor, but I can’t imagine that smoking poorly purged butane hash oil is good for your health.”

If the BHO is properly purged, the end result is far purer than raw marijuana. Green said that the highest concentration he has ever heard of THC in marijuana was in the high 20%s. “I have seen a lot of butane hash oil that has ranked in the 80%s and even the 90%s according to reputable testing laboratories.” Concentrations of THC at these levels can cause psychosis and even brain damage, according to DEA special agent Gary Hill. But there is another serious health problem here—butane is extremely flammable.

image credit: Therapeutic Health Center. BHO shatter, Permafrost wax

image credit: Therapeutic Health Center.
BHO shatter, Permafrost wax

The Seattle Times reported: “Federal and state authorities in Washington state have filed charges against seven people in connection with a series of suspected hash-oil explosions and fires.” Two of the men injured in the explosion had previously denied to the police that they were making hash oil. They also had medical marijuana cards. The Times article mentioned a separate suspected hash oil explosion that knocked a building SIX INCHES off its foundation.

In Colorado, the burn unit at the University of Colorado only had two previous admissions for hash oil injuries in 2012 when Wayne Winkler was admitted. In 2013, the burn unit admitted 11 burn patients from hash oil fires. By May of 2014, they had admitted ten. At this rate, they will triple their 2013 burn admissions in the first year that recreational use of marijuana is legal in Colorado. You can see a video report on hash oil explosions in Colorado and hear Wayne’s tearful testimony of what happened to him here.

This danger even has marijuana activists like Johnny Green concerned. In addition to the risk that rookies bring to themselves and others, he said it makes the entire movement look bad. In a blog post to “The Weed Blog,” he said:

Consider this a public service announcement. I don’t know if I have hammered this point home enough, but if you are not an expert at making butane hash oil (BHO), PUT EVERYTHING DOWN, TURN OFF THE STOVE, GET YOUR HEAD OUT OF YOUR BUM, AND EXIT THE KITCHEN. Making BHO is a very dangerous thing, and if you slip up in any way, you will no doubt light something on fire, including yourself.

The emphasis above was in the original article. Embedded in the Weed Blog article is a short YouTube video of a homemade attempt to make hash oil gone wrong.

Legalizing marijuana for either medicinal or recreational use will mean easier access to marijuana and lead to a pattern of hash oil explosions like those noted here. States being lobbied by pro marijuana interests should slow down and simply watch what happens in Colorado and Washington state. At the very least, they can learn from the mistakes these earlier “progressive” states have made in drafting their marijuana legislation.

One excellent example is in Colorado. Colorado’s marijuana law allows adults 21 and over to grow up to six plants at home; and hash oil cooks will often use their own plants to make it. Brian Vicente, who helped write the marijuana law in Colorado, said the law’s vague wording that allows processing marijuana plants permits home hash oil production. He did add that he thought the hash oil fires would decline as people realize the dangers and start going to pot shops instead of trying to make their own hash oil at home. That sure was reassuring.

Doesn’t home hash oil production remind you of the problems with small time meth labs?