All Joshua

FRONT COVER Summer 2017 Issue All Joshu SUMMER 2017 ISSUE

meet our CEO

PRIMARY CARE & the scoop on other services we provide

& his strong message

Tough Times Don’t last... Tough People do...

HEALING is not an overnight process. It’s a daily cleansing of pain, it’s a daily healing of your LIFE

CONTENTS INTERESTED IN MORE FROM All Joshua Outpatient Treament Center? To learn more about our resources for living a healthy lifestyle, contact us!

All Joshua Outpatient Treatment Center 2568A Riva Rd #202, Annapolis, MD 21401

08 ALL JOSHUA MISSION STATEMENT A comprehensive array of services 12 AMESSAGE FROM THE CEO Mike Robinson shares some words of wisdom 16 HEALING, FROM THE INSIDE FIRST Rosemary Porter on switching career fields 20 SMALLER IS BETTER A personalized approach to helping clients 24 CHOSEN BYTHE PROFESSION Jessica Hilton finds a home in All Joshua 28 PROLONGINGTHE PAIN Study suggests painkillers may be having the opposite effect in the long run 30 A LICENSETOHEAL Diagnosing a duality

32 BOOM, BUST, ANDDRUGS Study says economic downturn leads to increase in substance use disorders 36 MORETHAN SKINDEEP Implant represents revolutionary approach to treating opioid addiction 38 COPINGWITH DISCRIMINATION Discrimination remains largely ignored as a cause of substance abuse 42 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 46 A PLACE OFTRUST James Boykin on helping clients recover reversing the opiate effect 52 FEATURED STAFF Meet the team! 56 AN EXPERIENCED HAND Consultant brings program expertise 50 2 NEWTOOLS Robert Ball talks about

(443) 211-7447

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I've Found That RECOVERY Meansbeing HONEST Aboutwhat I WANT ... aboutwhat I NEED ... aboutwhat I Feel ... andaboutwho I AM Letushelpyouget backhealthy

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All Joshua Mission Statement All Joshua, LLC, is a comprehensive provider of addiction treatment and mental health services for males and females, age 14 and older. Our mission is to strengthen

We treat the family, individuals and community with an understanding that addiction coincides with circumstances of individuals seeking treatment. Substance abuse treatment services at All Joshua range across a continuum of three major categories of care: pretreatment services (education/ prevention), outpatient treatment, and inpatient treatment (including residential treatment).

At All Joshua, our goal is to provide individuals, families and communities with conscientious guidance for success. Our continuum of care fosters growth and facilitates sustainable change for individuals, families, and communities. All Joshua strives to be the premier strength-based provider of holistic and seamless systems of care for adults and families across the region. We seek to address the various physical, social, psychological, and psychiatric treatment needs of our clients in a comprehensive and culturally competent manner.

communities through innovative, recovery-focused strategies that connect individuals with treatment opportunities that result in positive choices. We offer substance abuse treatments to individuals discharged from social systems such as the child welfare system, treatment institutions, and penal or correctional systems. All Joshua offers more than just treatment. We employ a staff of highly skilled and credentialed healthcare professionals. Our staff implements an eclectic model of evidence-based treatment modalities toward the goal of improving health and wellness outcomes in measurable and observable ways, matching people to the appropriate level of care in providing wide categories of supportive services.

All Joshua provides a comprehensive array of services including: • Outpatient Substance Abuse Treatment - including Intensive Outpatient Treatment, and DWI/DWI Education; • Suboxone Medication Management for opioid addiction treatment – prescribed by licensed physicians certified to prescribe Suboxone; • Mental Health Services – individual, group, couple, and family therapy provided by licensed practitioners, social workers, medical marijuana and vivitrol providers and counselors; • Domestic Violence Program – separate treatment services for victims and perpetrators; • Anger Management – a 12-week group treatment with a summary of core concepts. • Job Readiness Programs – to enhance employment opportunities of clients; • Clinical Case Management – to provide and coordinate needed services in the community; and • Primary Care – educating and providing for the physical well-being of our patients. • Medical Marijuana and Vivitrol Providers Our mission is to strengthen communities through innovative, recovery focused strategies that connect individuals with treatment opportunities that result in positive choices. For more information, visit our website at www.alljoshua.org or feel free

Our values are broadly shared by practitioners who take responsibility for the care of our patients, and have worked within the substance abuse treatment, public health, and criminal justice system. Our primary care physicians are well-versed in available treatment resources for patients who have been diagnosed with substance abuse, mental health or co-occurring disorders, and the entire interdisciplinary team takes responsibility for continuity of care. This is particularly important in the early stages of treatment, to prevent drop-out and encourage participation. At All Joshua, the clinician’s responsibility to the patient does not end with the patient’s entry into formal treatment; rather, the physician is a collaborative part of the treatment team. It is important to understand each one of the varieties of rehab options available, so you can pick the appropriate rehabilitation approach for your program as well as your loved one. We strive to connect individuals with treatment opportunities resulting in lifelong positive choices, and integrated substance abuse treatment.

to contact us at 443-221-7447 or 443-221-7656. Michael Robinson, Founder

“If you are aware of your weaknesses and are constantly learning, your potential is virtually limitless. ”

Where you can have a voice in the national discussion on addiction and recovery

A message from All Joshua CEO Mike Robinson When you’re in the midst of a war, tell me what are you willing to do to win the battle? What moves or strategies are you willing to put into action to guarantee the victory? Are you willing to risk the chance of becoming a prisoner of war by doing things contrary to the plans of our enemy? Are you willing to go the road less-travelled in order to get to the destination that has been mapped out by our supervisors even though it may be booby trapped and your life has the potential to be a casualty? Or will you risk the chance that your knowledge is greater than the wisdom of the Brigadier General who already has gone through similar battles to secure the victory for you? Hear the words of wisdom

If you’ve never had these questions posed to you, or if you’ve never been in a fight for your life, then you need to hear the words of wisdom out of the mouth of more than a conqueror. Allow the words that Mike Robinson has to share from his testimony, and unashamedly show the wounds that were self-inflicted, as well as the scars of the battle. If you dare take the step towards freedom versus continuing to be a prisoner of circumstances, as well as one of your own making, the life-giving words of Mike and his professional team will enable you to become Unshackled (the title of the book by Mike Robinson, published in 2004), and move from a place of confinement to a wealthy place of praise.

“Are you willing to go the road less traveled, to get to the destination?” -Mike Robinson, founder and CEO All Joshua

Merva Crawford, a member of the All Joshua board of directors, brings more than 30 years of executive management experience to the agency. Crawford, who has an MBA from Howard University, has been director of retail operations at the Smithsonian National Zoological Park for more than three decades. Crawford met All Joshua founder Mike Robinson several years ago, through a mutual friend. “I am very impressed with and have bought into the agency’s philosophy, which is to offer individual intensive services that meets basic needs while enhancing the quality of life of all individuals.” “I hope to offer my experience and expertise to this exemplary organization that is strengthening the community by using innovative strategies to connect their patients to individualized treatment. All Joshua is a success story for the community it serves.” Merva

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Healing, From the Inside First Offic manager moved from general practice to addiction treatment After Mike Robinson founded All Joshua Outpatient Treatment Center in 2015, one of the first persons he hired was office manager and medical assistant Rosemary Porter. A native of Manchester, Jamaica who emigrated to the U.S. with her family 14 years ago, Porter first met Robinson about six years ago when both were employed by an inpatient treatment center in Rockville.

“It’s a matter of learning to understand folks, and appreciate and know them for who they are.” – Rosemary Porter, office manager, All Joshua

Medical career Porter didn’t start her healthcare career in the treatment field. After earning her degree as a medical assistant at Americare Allied Health in Wheaton, Md., she worked for a Family Practice physician in Prince Georges County. At that point, the opiate problem was just starting to develop into what would become a national epidemic. “I didn’t realize opiate addiction was such a big problem until I saw it for myself, interacting with all of the addicted patients who came to the clinic,” she recalls. “Many of the clients became addicted to pain medication and then street drugs. Some got on pain medication because one of their family members was using it.” Although she didn’t start her career in the addiction treatment

they wouldn’t have jobs, or would have lost their kids, without the help of suboxone.” A career in the helping field She notes that founder Mike Robinson’s experience in the field is one of the treatment center’s major assets in helping clients. “I know his history in terms of where he started. Because he has experience (in the addiction and recovery field), a lot of clients can relate to him much better. It does make a difference when talking to someone who can relate to you. And, he’s a very likable person; whenever he speaks they all listen.”

field, Porter says she had no trouble making the switch from a general practice medical clinic. “I’ve always liked working with people. Working with addiction is no different. It’s just a matter of learning to understand folks, and appreciate and know them for who they are, no matter what situation they may be in.” One of the most important, recent developments in addiction treatment has been the introduction of suboxone, an FDA-approved medication which helps addicts who are trying to quit using by blocking the effects of withdrawal, and reducing cravings. Porter became a believer in the benefits of prescribing suboxone “after listening to patients talk about how much it has changed their lives and their family’s lives. Some have said

“You can really see results, in being able to help people get better.” – Rosemary Porter

Looking ahead, Porter would like to return to school to further her education, and possibly become certified as an addiction counselor. “I do like working in this field; you can really see results, in being able to help people get better.”

All Joshua is a new addiction agency in Annapolis. We provide medication-assisted (suboxone) and

therapeutic addiction treatment - individual and group - plus classes that address DUI safety and prevention, domestic violence (DV), anger management and like skills training. All Joshua embraces a philosophy of recovery and

possibilities, where counselors and individuals work together to help each individual move forward in his/her life, making positive and healthy choices and maintaining a clean, sober and productive

lifestyle. We want our clients to succeed and will work hard to help them achieve success. 2568A Riva Rd #202, Annapolis, MD 21401 443.221.7447 19

Smaller

is better A personalized approach to helping clients

In the addiction treatment field, bigger isn’t necessarily better. Before she joined the All Joshua staff in March as a therapist, Paige Fulton worked at a larger addiction treatment facility, which seemed to be “more of a system, a mill to push clients through,” she says. That’s not the case at All Joshua, Fulton says, noting that one advantage of a smaller agency is the lower client-to-staff ratio, and the ability to provide more personalized care. “Even as we grow, our primary focus is still how is the client going to get well?” A native of California, Fulton spent years working as a horse trainer, a career which came with a side-benefit that would prove useful later in her career: “There was a lot of sports psychology involved, teaching people to ride and figuring out how to interact with them.”

“Our primary focus is, how is the client going to get well?” – Paige FuLTON, therapist, All Joshua

Fulton also had a longstanding interest in mental illness, which led to her returning to school to earn a master’s degree in psychotherapy from the Wright Institute in Berkeley, Calif. Later moving to Annapolis with her husband and step-daughter, she earned certification as a drug and alcohol counselor at Anne Arundel Community College. At All Joshua, Fulton provides both individual and group counseling. “Many of these people have been through other (treatment) systems over and over, and they need a more personal approach.They need someone to actually care, not just go through the motions.That is the purpose of psychotherapy – we really want to help people heal.”

Treating co-occurring disorders Fulton appreciates the client-centered approach to care at All Joshua. What that means is “asking them what they need, and how I can help them.” she says. Rather than acting as an all-knowing, authority figure, the counselor or therapist seeks input from the client. “People usually know what can help them, so we need to give them a chance to talk and listen to them. When they come to us, they are typically in a lot of pain and trauma, and have had no one to talk to about it.”

Since denial is often part of the disease of addiction, counselors often work with clients who – at least initially – don’t think they have a problem and don’t need to be there. So, it’s important to “try to meet them where they are ‘at,’ and try not to push it and not ‘b.s.’ them.There has to be a part of them that wants to get better.”

Helping the client see clearly “I experienced this with a client just the other day,” Fulton notes. “She did not want to be here, insisted she doesn’t have a problem, and thought it was only due to stupidity on her part that she got ‘caught’ driving under the influence. So, I just brought some things to her attention, pointed out that she didn’t just ‘make a mistake.’ I noticed that when she filled out the intake questionnaire, one of her answers was ‘I need to change.’ So that gave us something to work with.” “Many of the clients we see don’t recognize that the life they have been living isn’t quote-unquote ‘normal.’They are so entrenched in that way of living they don’t realize that their life doesn’t have to be chaos.” Fulton says the quality care provided at All Joshua begins with founder Rev. Mike Robinson. “What I noticed when I first came here is that

Mike Robinson really has a heart, he knows the clients, and they recognize that. He pays attention to what they say and actually listens to what is happening in their lives. He’s not just focused on their addiction.That’s what I try to do too. It’s important not to just focus on the addiction, because the addiction becomes so intertwined with other parts of their lives.” Fulton is planning to enroll in the University of Baltimore to finish her credits to earn LCPC and LADC certification, to continue helping people break free of addiction and start new lives.

“The addiction becomes so intertwined with other parts of their lives.” – Paige FulTON 21

Where you can have a voice on the national discussion on addiction and recovery

Make Your OWN RECOVERY the 1st PRIORITY in Your life

2568ARivaRd#202 Annapolis, MD21401 Phone: (443) 221-7447

Chosen by the profession All Joshua counselor has found a home

Jessica Hilton, one of the addiction counselors at All Joshua, likes to say she didn’t choose the addiction counseling profession. It chose her. Hilton, who joined the All Joshua staff in June, had a longstanding interest in the science of what makes people “tick,” and mental illness, which had touched her family decades ago, when Hilton was a child in Pasadena, Md. “The differences between people always fascinated me,” she recalls. Hilton went on to earn a psychology degree at the University of Maryland and took a counseling job at an inpatient rehab center. “My supervisor encouraged me to get my addiction counseling license. I had no expectation of using it; then, my boss came to me one day and said, “I need you to counsel.”

Along with her formal training, Hilton is also qualified through personal experience; she is a recovering alcoholic who has been sober since 2010. Looking back at her own history, Hilton recalls “the first photographic evidence,” of herself tasting beer as a four year old. She began drinking heavily at 13, and by high school, had become a daily drinker. Still, she was able to earn a community college degree and hold down employment in a flower shop, while raising a son and daughter. Then, “by 2010, my ability to be a parent, wife, employee and student was gone,” she recalls. “So I made a few phone calls. My plan was to take some time off and then go back to drinking like a lady.” But her plans changed after she attended her first Alcoholics Anonymous meeting on September 22, 2010, an important date in her life. Hilton found sobriety and recovery through dedicated commitment to participating in AA, which has continued to help to this day. Weekly sessions with a therapist for the first five years of recovery also helped.

“What I love about Joshua House the most is that their heart is in the right place.” - Jessica Hilton All Joshua Counselor

Learning to be an adult Because of her early embrace of daily drinking, “I didn’t know how to be sober because I had never done that as an adult. I was 27 years old, and ‘adulting’ should have happened a long time before and it didn’t. So, I was afraid to be sober.” “But I was fascinated by people I met in AA who claimed to be just like me and had the same problems I did, but were happy, and could do things that I couldn’t. I stayed around long enough to learn to do those things.” Revitalized, Hilton finished her bachelor’s degree in psychology, earned certification as an addiction counselor, and was hired at Serenity Acres in Crownsville, where she worked for two years. Hilton learned about All Joshua through a co-worker who

encouraged her to apply there. Coming to All Joshua proved to be the right move. “What I love most about All Joshua is that their heart is in the right place; they’re very patient-oriented and care very much about what they are doing. It’s a wonderful team and everyone loves coming to work because our mindset is that what we are doing is a community service,” says Hilton who conducts both group and individual therapy sessions. Like many counselors who are themselves in recovery, she feels her experience has made her a more effective counselor. “It gives me the ability not just to sympathize but also to empathize and understand clients. I know how they think and I know their pain and their suffering.” “Because of my disease, I’ve become a much stronger person.” - Jessica Hilton Feeling no shame Today, Hilton also feels she is a much better parent. “I’m so blessed because my children were only six and three when I got sober, so they don’t remember me drinking. I am blessed that they don’t know that person. “There’s no shame in my game,” she notes. “I wouldn’t be who I am or what I am today without having had that experience. Because of my disease, I’ve become a much stronger person.” Even though she didn’t choose the field, Hilton now feels she has found a life’s purpose. “I just want to keep helping people, helping them live. I want to see the light in their eyes when the miracle happens. I believe every person who is struggling with this disease is worth helping. If I can do that, I don’t need anything else.”

OPI ATE + OPI OID ADDICTION What is the difference between Opiates and Opioids?

OPIATES

OPIOIDS

Opium Natural Pain RemedIES

SYNTHETIC PAIN MEDICATIONS

VS.

Oxycodone

Thebaine

Hydrocodone

Morphine

Oxymorphone

Codeine

Hydromorphone

Heroin

What Medications Treat Opiate & Opioid Addiction?

Naltrexone

These medications act directly upon the opioid receptors; more specically the mu receptors. Because the effects of these medications vary at the receptor level, there can be different clinical effects during treatment.

ReVia | Depade | Vivitrol

Methadone Dolophine

Buprenorphine

Suboxone | Subutex

A FULL AGONIST binds to the receptor and activates it by changing its shape, inducing a full receptor response.

A PARTIAL AGONIST binds to the receptor and activates it with a smaller shape change in the receptor that induces a partial receptor response. 26

INSERT 2

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“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain increase has to do with cells that form part of the immune system. He says if those areas could be isolated or their eects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of eects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” e team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to patients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could aect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar eects,” Dr. Grace says.

ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is eective in the short term, doctors don’t always consider the potential consequences for pain down the road.at’s why a team of researchers based out of the University of Colorado - Boulder set out to study how morphine treatment aects chronic pain, and found some troubling results. e team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to ve weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine eectively doubled the length of their chronic pain. P

Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston University looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.

ey found that 87 percent reported suering from chronic

pain, with 50 percent of those people rating their pain as severe.ey also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention eorts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”

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A License To Heal Diagnosing a duality

In treating drug and alcohol addiction, one of the major challenges for providers is diagnosing and treating (or referring for treatment) clients with co-occurring addiction and mental illness. As clinical director at All Joshua, licensed clinical social worker Pam Smelser brings several decades worth of experience and expertise in treating mental illness. Smelser spent 36 years working for the Maryland Department of Social Services, helping children and families. In that role, she saw first-hand the impact of mental illness and addiction. “At least half – maybe as much as 80 percent – of the child welfare cases that come to the attention of state authorities involve addiction and/or mental health issues. I’ve learned how interconnected those things are. We’re all on a mission to save lives,” says Smelser. Treatment is hard work

“In treating addiction we have to find out what are the issues that led people to that door. And treating addicts is hard work: you have to have the training and experience to understand that people don’t become addicts because they want to be. And they don’t come to recovery easily or stay in recovery easily.” The basis for the treatment process that follows is an initial, evidence-based assessment of the client’s level of willingness to commit to recovery and what

stage of change they are in and hold people to that. “It is a contractual relationship, no matter how you slice it. And like any kind of helping en- deavor, it’s a fluid process of constant assessment and reassessment.” When she met All Joshua founder Mike Robinson in 2015, Smelser was impressed with his approach. “He wants to serve the whole man or the whole woman, not only treating the addiction, but also finding what has been going wrong in your life and how can we work with you to help you move through life in a healthier, better direc tion. Mike’s goal is to develop complete case-management services downstream.” “Treatment is a fluid process of constant assessment and reassessment.” - Pam Smelser, All Joshua clinical director 30

Shaping a new agency Smelser appreciates the chance to play a role in shaping the direction of a new agency. “We have just completed the massive documentation process required by the licensing authorities.That causes you to think about what you do and how things connect; Mike has made it clear to us that it is truly about the whole person, and truly about saving lives.” “When people come in, we treat them with respect and dignity. And we get them in as quickly as possible; we don’t have any time to waste.” While addiction is one of the most serious public health problems facing society, Smelser says she is optimistic that increasing awareness will lead to more resources to help more people access treatment and recovery. “At the county and state level, we have committed leaders from both parties who have said ‘This is a life-threatening crisis, and we need to meet it.’” “When people walk in the door, we need to be there to help them.” “When people walk in the door, we need to be there to help them.” - Pam Smelser

Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University

Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”



“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

"All Joshua is a great place to grow. I learned a lot about myself and my addiction to drugs.... the staff helped me to be strong and not give up on myself... I went into All Joshua with plans to better myself and till this day I'm clean and sober.”

”Every day, in every way, I am getting better and better.”

Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government ocials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ] [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali, FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the

edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.

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Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And ocials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.

INTERVIEW 4

Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

“Generally there is good scientific support, but the evidence is mixed for different groups

and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.

INTERVIEW 4 The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused

by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is

But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.”

2568A Riva Rd #202, Annapolis, MD 21401 (443) 221-7447

We believe in an integrated method of treatment that explores not only drug related problems but helps to build life skills for the future.

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Bend But Don’t Break Yoga is being used to help people maintain recovery and avoid relapse

Yoga is no longer exercise your annoying, health-conscious friend won’t stop talking about.The ancient practice is now being used to help people recover from addiction. While scholars estimate yoga was developed sometime around 300 to 400 B.C., the practice hasn’t stopped changing over the last 2,000 years. A new wave of yogis are now helping people in recovery connect their spiritual and physical sides through yoga by combining the practice with more traditional 12-step elements. “It’s just a way of coming back to a sense of wholeness,” says Nikki Myers, a yoga therapist who helped develop the 12-step yoga system. “We use yoga as a process in order to bring that reintegration.”

Myers says she developed the system primarily as a means of relapse prevention. She says a typical 12-step yoga session would begin the same way most 12- step meetings do, with a focus on sharing and discussion of important recovery topics. Once the “meeting” portion of the session is over, the group will then move into a series of yoga poses designed to help participants focus on their physical recovery. “A focus needs to be on the body- based piece as well as the cognitive piece in order for wholeness to really be manifested,”Myers says. “Once you include those things, the whole idea is that these will begin to offer us a set of tools that we can use both on the mat in the yoga practice and off the mat when the triggers of life show up.”

“It’s just a way of coming back to a sense of wholeness.” - Nikki Myers, yoga therapist

The right tools Myers says the idea that yoga can provide a set of tools is critical as the practice of yoga is much more than the poses themselves. She says there’s also a focus on breathing techniques, a meditation of sorts, and a connection to one’s physical reactions that can prove vital when faced with difficult circumstances. Myers recalls how one woman who participated in 12-step yoga later found herself in a very stressful situation at home with her kids misbehaving and everything going wrong. She said she could feel the negativity boiling up inside her. It was the kind of stress that had triggered her to drink in the past, but the woman said in that moment she was able to relax and calm herself by focusing on her breathing and remembering the feeling of tranquility she had experienced in class. “It had a way of creating a space, giving her tools to create a space between her reactions and instead take a different neural pathway,”Myers says. “These are the kind of tools that we’re looking to have people use.” “A focus needs to be on the body-based piece as well as the cognitive piece in order for wholeness to really be manifested.” - Nikki Myers

Not a replacement Myers is quick to point out that yoga is not a substitute for traditional 12-step support, but rather an additional measure that some people may find helpful. She says some people have pushed back against the practice, but others have been enthusiastic about its power, with classes spreading across the country and even internationally. Myers says she hopes that one day 12-step yoga will be as common as other treatment programs. But she says as long as people are maintaining sobriety and finding wholeness within themselves, she’ll be proud of the difference her system has made. “We’ll tell people, ‘Notice this in your body, what it really feels like,’” Myers says. “Healing only happens in safe space.”

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443.221.7447

2568A Riva Rd #202, Annapolis, MD 21401 More than just treatment

2568A Riva Rd #202, Annapolis, MD 21401 443.221.7447

A Place of Trust Clients find a comfort level at All Joshua James Boykin, an employee at All Joshua in recovery from addiction, met program founder Mike Robinson several years ago, when Robinson was employed as a counselor with another treatment program.

At the time, Boykin was reentering the community after being paroled. “In meeting Mike Robinson through that program, I could see how sincere and real he was. He made me feel comfortable. And I could get real with him, I didn’t have to hide anything about what I had been going through,” says Boykin, who is in recovery from an addiction to PCP and marijuana. A native of the Washington, D.C. area, Boykin moved to Annapolis in 1988. After a conviction for drug trafficking, Boykin served time in Roxbury Correctional Institute. After his release, he worked in landscaping and other jobs, eventually going through addiction treatment in 2005. Boykin eventually returned to active addiction, until 2015, when he tried treatment again – and spent six months in an intensive outpatient program.

Now employed as a security guard at All Joshua, Boykin tells his own addiction and recovery story to encourage treatment clients who are following in his footsteps. For those trying to get clean and get started in recovery, a sense of trust in the program is important, and that’s what Joshua House provides, Boykin says. “You can be yourself in this program, with these particular counselors. At All Joshua, addicts seeking recovery come to realize that “This man is trying to help you; you don’t have to keep trying to cover up [drug use].”

“You can be yourself in this program, with these particular counselors.” -James Boykin, client and employee All Joshua House 46

Boykin helps some of the younger treatment clients with his self- disclosure and his comments in the group therapy sessions that are part of treatment. “Everybody can speak on their personal situation. The group picks a topic and we discuss it; maybe what you share in the group will help the next guy. They’re just asking you to be honest.” In his role as an employee at All Joshua, Boykin welcomes new clients when they are being admitted. “When I see new people come in, I try to help them feel comfortable. “If you want help, Mike Robinson is here to help you. He has that impression on you – he’s a giving guy who will help you any way he can.”

He tells newcomers to the program who are battling addiction that they can have the sense of trust needed to “open up and tell people what is really going on with you,” Boykin says. In other programs, “I’ve seen plenty of guys who are on parole or probation who feared they’d be locked up if they tested ‘dirty.’ That makes people step back from being honest.” Boykin cites “realness and honesty” as one of the qualities that distinguishes the All Joshua treatment program. He enjoys sitting down with Robinson and the other counselors at All Joshua. “You can tell they are sincere about helping you.” In itself, recovery from addiction is not a comfortable process. But establishing a certain feeling of comfort encourages treatment clients to be honest about themselves and their past and current situations, which increases their chances of a successful recovery. “When you sit down with someone and they share things about themselves and you share things, that breaks the ice,” Boykin says. “Mike’s honesty about himself made me be honest about myself, and when he said ‘Let me tell you how this is going to work for you.’ That goes a long way.” “Mike made me feel comfortable to be able to talk about things that were going on with me. Now, I feel like I want to give back to all the younger guys that come through (All Joshua). I’m not a counselor but I can talk to them while they are waiting to be seen. They share what is going on with them, and I share what is going on with me. We can get through this thing together.”

“If you want help, Mike Robinson is here to help you.” -James Boykin

2568A Riva Rd #202, Annapolis, MD 21401 (443) 221-7447

Remember... You are the most important person in your recovery

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Tools Reversing the opiate effect

Ball took an indirect route into the practice of addiction medicine. The family practice specialist became interested in the addiction medicine sub- specialty when he was providing primary care to patients infected with HIV at Whitman Walker Clinic in Washington, D.C. A high percentage of those patients were intravenous drug users who contracted the virus from using contaminated needles. Intravenous drug users tend to be a challenging population to treat, for several reasons, says Ball, a graduate of Howard University College of Medicine. Non-compliance is a complicating factor, with the difficult, addict lifestyle often causing patients to miss medical appointments and neglect taking prescribed medication. And, intravenous drug users often have other health problems, such as high blood pressure and COPD (chronic obstructive pulmonary disease), putting them at-risk of heart attack and strokes, says Ball.

Robert J. Ball, M.D., an addiction medicine specialist at All Joshua, provides medication-assisted treatment – in the form of suboxone and vivitrol – to clients who are in the early stages of recovery from opiate addiction. The two FDA-approved medications are designed to ease opiate withdrawal symptoms and prevent cravings that can lead to relapse. Suboxone (generic name buprenorphine) is widely used as a replacement for methadone. Vivitrol is an injectable form of naltrexone.

“It’s a big-time advantage that our medication clients can get counseling while they are waiting.” - Robert J. Ball, M.D., staff physician, All Joshua

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