DOING YOUR OWN RESEARCH

DOING YOUR OWN RESEARCH

If reading this book has raised your level of interest and you want more specific information, or you want the straight story about a new develop­ment, there is no substitute for doing your own research.

Reading both scholarly review articles and original research papers is much easier than most people believe. In fact, one of the first steps in writing this book was gathering such research. Much of the library work for the first edition was done by two college students, neither of whom had any previous experience using a medical library. Should you decide to investigate for yourself, here are some suggestions about where to begin.

Public libraries are not likely to have the sorts of journals and books you will need. Because there is such a vast amount of medical literature pub­lished, most universities with a medical school have a separate library just to house all this information. Find a medical library at a nearby medical school. If for some reason you cannot get to a medical school, check to sec if there is a college or university biology department nearby and use the

library they use.

Next, go to the library and make friends with the reference librarian, because you will need his or her help until you are familiar with the library and the search mechanisms. The most efficient way of searching the literature is to use MEDLINE or PubMed, databases of the National Library of Medicine, a US government institution that allows you  

search almost all the published medical literature on any subject you can think of related to health. You can search by author, title, subject, key­word, institution, and many other descriptors.

In most cases you will find far more information than you need. A good place to start is with reviews. Reviews are documents that consoli­date and summarize the research and literature available in a given area, and they are usually written in less technical language. Reading several recent reviews about the topic you are researching will help you form a base of knowledge about the subject. Practice using MEDLINE by start­ing out with simple concepts; for example, search for marijuana articles. There are hundreds of them, and many of the titles will be so technical that they might seem indecipherable. So tell the computer to select mari­juana review articles. This will reduce the number markedly.

If you have read Buzzed, then you know that one of the active ingredi­ents in marijuana is THC. Try searching for THC and you will get more articles. Refine your search by asking for reviews of THC and you will get articles different from those you did when you searched for marijuana in general. Play with the database and have fun. Search for all kinds of com­binations of keywords, like THC and learning, or THC and adolescent. You will soon have an idea of the enormous amount of information there is about just this chemical. Understand, though, that no one study tells the whole story.

As a final note, we caution you not to accept everything you read as directly applicable to the human condition. Often scientists employ very high levels of a chemical to test for toxic effects in animals, and sometimes the chemical levels they use in/on animals are hundreds or thousands of times higher than a human would ever use, taking into account the weight of the human compared to the animal. Consequently, some of the toxic effects seen in animals may not apply to humans. On the other hand, ani­mal experiments cannot reveal many subtle effects of chemicals, particu­larly psychological ones, and thus animal studies almost certainly miss some important effects that humans will experience. So, as you read a sci­entific paper, remember that it is just a small part of the literature about a drug, and while the data may be true, it is important to understand that data in the context of everything else known about the drug.

CHALLENGING THE FAMILY TO ACT AND ORGANIZE ITSELF

CHALLENGING THE FAMILY TO ACT AND ORGANIZE ITSELF

Test can happen once trust has been built up. The way toward testing should occur in little strides. The advisor's recommendations may come in little measurements, typically confined as far as the skills that relatives have just appeared. By first taking note of that they are capable, he would more be able to effectively push toward testing their reactions to his proposals. The thought of home detoxification ought not be tended to in an express, coordinate way until the point when the relatives are capable and willing to examine the implica-tions of the test. Once more, this requires a development of certainty amongst family and specialist. In a few families, this sort of liking will come right on time over the span of treatment, nearly without exertion or mindfulness. By and large, in any case, building up such an affinity will en-tail a blend of tolerance, determination, and demonstrating by the advisor, with the goal that the errands he in the long run shows can be seen as achievable by relatives. 

The procedure of test is begun by getting the someone who is addicted and other relatives to confer themselves to performing, on a - hone premise, a little undertaking or venture. The errand should address some issue that they are fit for taking a shot at as well as, more critical, one that they will do. The undertakings might be performed either inside the session or at home. An undertaking in the session ought to be a portrayal of what is to occur at home. For instance, on the off chance that one individual from the family is to be a spectator at home, that individual ought to likewise see in the session (i.e., - establishment of the task).1°" Instructions ought to be concrete, obviously engaged, and completely under-remained by the whole family,. The specialist ought to affirm that all individuals acknowledge their piece of the assignment as sensible, regardless of the possibility that they don't completely acknowledge the general arrangement. A dedication by every individual just to his part is very worthy. Every thing must be arranged, with the goal that all individuals know about their own and others' parts. 

By centering, at any rate at first, on a minor as opposed to a huge scale errand, the advisor builds odds of progress later on. A little errand will probably be dealt with ably by the family. This facili-tates promote achievement in consequent undertakings and builds the relatives' trust. A restricted concentration additionally controls the family's desires far from confusing the single undertaking as a panacea or cure-all. At this beginning time in treatment, the advisor ought not enable the family to expect that detoxification will come rapidly or effortlessly. 

At the point when the specialist sets up an underlying assignment, it is not excessively mindful for him to anticipate disappointment. Doing as such guarantees that the out-come, regardless of whether achievement or disappointment, has additionally use in the treatment. In the event that there is disappointment in playing out any part of the assignment, the advisor concentrates on this in checking on it—investigating with the family how this may look like different routes in which they have been unsuccessful. The discourse should then continue from such - shortcomings into ranges where more positive methodologies and arrangements can be created. Victories and recuperations have occurred some place in the family's understanding; these must be evoked, developed, and brought into the administration of treatment. This activity of investigating an underlying disappointment can deliver an extensive sparing of time and exertion in executing the genuine detoxification design.

DANGERS AND MYTHS

DANGERS AND MYTHS

RESEARCH ON HALLUCINOGENS

One myth we want to dispel is that there is no credible scientific research conducted on hallucinogens. Research on hallucinogens (including LSD) can be legally conducted in the United States and Europe. Admittedly, the research history of hallucinogens is colorful and not always credible, ranging from military experiments on unsuspecting subjects to the blithe self-experimentation of Dr. Timothy Leary in the sixties. However, in recent years, research by credible biomedical researchers has expanded, focusing on a variety of topics ranging from what hallucinogen experi­ences can tell us about psychosis to the specific mechanisms by which these drugs act to cause persevering effects on religious insight.

IDENTIFICATION

Users can never really be sure which hallucinogen they are taking. Blotter-paper-like preparations are most likely to be actual LSD because other hallucinogens are not potent enough for an effective dose to be delivered in this way. However, a pill/capsule/powder could be anything, or any combination of things. Laboratory analyses of blood from people admitted to emergency rooms for LSD toxicity indicate that in some urban settings, only about 50 percent of the drug samples that were thought to be LSD by their possessors actually were LSD. Finally, any drug that has been synthesized in an underground laboratory can contain various by-products that arise from poor chemical synthesis.

Hallucinogenic mushrooms represent another identification problem. It takes an educated and practiced eye to identify any mushrooms in the field, and this is always a dangerous proposition. Many mushroom spe­cies, including the aforementioned Amanita muscaria, contain psycho­active compounds that are extremely dangerous or lethal. Other species (Amanita phalloides, for example) contain toxins that produce fatal damage to the liver and kidneys. While simple "home" tests are much touted ("if the stem turns blue, it is psilocybin"), none of these are fool­proof A number of mail-order operations exist that claim to send out psilocybin-containing mushrooms, but the identity of the spores for "grow your own" operations can be very difficult to establish.

Designer Mescaline-like Drugs

Designer" Mescaline-like Drugs

A large number of variations on the structure of mescaline were first "designed" during the original chemical studies of mescaline. The names sound like an alphabet soup: DOM (2, 5 dimethoxy-4-methylphenyliso­propylamine, also known as STP), MDA (methylenedioxyamphetamine), DMA (dimethoxyamphetamine), MDMA (methylenedioxymethamphet­amine, or Ecstasy). All of these drugs are less specific than mescaline and produce strong amphetamine-like effects in addition to hallucinations. As a result, all are more toxic than mescaline and appear much more rarely on the street today. Ecstasy provides a unique profile of effects, dis­cussed in the "Ecstasy" chapter.

'fhe spices nutmeg and mace deserve a final note as we discuss the mescaline-like hallucinogens. Someone who takes several teaspoons of nutmeg (if he can figure out how to avoid the overwhelming taste) might experience a very mild hallucinogenic state that includes perceptual dis­tortions, euphoria, and sometimes mild visual hallucinations and feelings of unreality. The active compounds in nutmeg and mace are myristicin and elemicin, compounds with structures somewhat like mescaline. These compounds are very weak hallucinogens, and the dose required to evoke changes in perception causes a number of unpleasant side effects including vomiting, nausea, and tremors. Furthermore, an aftereffect of sleepiness or a feeling of unreality can persist into the next day.

RESTRUCTURING

RESTRUCTURING

The most basic restructuring move in this therapy—and one empha-sized repeatedly in this volume—is to get the parents or parent surrogates to work together vis-a-vis the addict. If this is not done, the basic triadic conflictual pattern between the IP and parents will persist and treatment will probably fail.

In addition to obtaining parental consensus on goals, there are other restructuring moves that can be implemented, often concomi-tantly. A number of these are demonstrated in the succeeding chapters. Usually they are used as intermediate moves en route to getting the parents to work together more directly. For instance, Haley" (see also Chapter 7) and the Milan group136 often have parents alternate in taking responsibility for the problem person; for example, each parent takes charge for a given period such as a week, or they rotate between odd and even days during the same week. We have not applied this method with any regularity in our work with addicts' families, but it is an option worthy of further exploration.

In cases where, for example, a mother and son are overinvolved, a common strategy is to get the father to take charge of the son (see Chapters 7 and 10). This requires that father and son relate differently in some way, and such an experience must usually be engineered within a session before it can be generalized to the home situation. It may be possible to get them engaged in discussing some common interest, such as work, fishing, and so forth. The mother should be present during this exchange and may need the therapist's subtle support while her husband and son are engaged. For instance, the therapist might sit next to her, keep her from interfering in the father-son interaction, and quietly comfort her with statements such

as, "They need this [talking together"- or, -You know, you are right.

They don't get enough time to talk together as father and son.-

Other tactics may also be used, depending on the specific clinical situation. When it appears that the mother endorses the drug be-havior of the IP, with the father consistently more punitive, it may be possible to force the mother to deal with the negative behavior of the abuser, thus breaking the alliance with him. Alternatively, the thera-pist may meet only with the parents to formulate a strategy to which both parents will adhere.

Another approach is to shift the roles of the parents to, for example, either those of grandparents (rather than overinvolved parents), or of parents to any younger children they might have ("You can let him go because you have these other kids to worry about"). Further, if the parents are retired or near retirement (Chapter 11), the therapist may want to work with them on planning this stage

of their lives.

Because of the nature of the AFP research design, most of our work has been with families in which two adults of different sex were involved, either as parents or in quasi-parental roles. In cases where only one parent is available—usually the mother—the process differs somewhat.'" Here, the therapist may temporarily have to fill a parental role toward the IP, and at other times must assume an almost spouse-like role toward the parent. Often the latter is a way of substituting for the pseudospouse role that has been played by the abuser. The next step is to develop alternative structures and supports for the parent through inclusion of relatives, friends, and so on—in other words, to establish or strengthen the natural support system. In this way the parent will be less dependent on the IP and able to move toward greater disengagement, while the therapist will also be able to gradually disengage. When applicable, another approach is to help the parent get a job or develop more outside activities. Still another, stated above, is to transfer some of the attention from the IP to any younger siblings remaining in the family. Again, joining with the parent is a crucial part of the process, and under no conditions should the therapist become engaged in a direct power struggle with the parent over separation with the IP.

GOALS OF FAMILY TREATMENT

GOALS OF FAMILY TREATMENT

It is best to negotiate the goals for therapy with the family at the very outset of treatment. This is because (1) it provides family members with the sense that treatment will have direction, rather than wander-ing about aimlessly or having as an endpoint the uncovering of personal pain or feelings; (2) it indicates to them that they may get some return for their efforts, that their energies will not be expended fruitlessly; (3) they can take some satisfaction that the therapist at least seems to know what he is doing, thus possibly instilling in them a sense of hope. All of these features serve to both increase the as red herrings by the therapist—as ways of pulling therapy off track and diverting its thrust. Thus the therapist should question their relevance and require that the members who raise them justify their pertinence to the primary goal. (For example, a discussion of the addict's getting a job would only be considered appropriate if it were seen as important in keeping him off drugs.) The general rule is for the therapist to keep sessions focused on drug use until stable im-provement has been achieved.

It is crucial that the therapist form an alliance with both parents or parent surrogates in this stage so that they may take an effective stance toward the addict around the chosen goal. The therapist must keep the parents working together in the early phases, even siding with them against the addict upon occasion. Sometimes therapists, especially young therapists, are uncomfortable in treating a young adult in this manner. For example, such a therapist might feel uneasy suggesting that the parents negotiate a time when their 27-year-old son should be in the house and off the streets in the evening. What one finds, however, is that the IP is often surprisingly cooperative, even though he may protest the fact that he is being treated as a child. This cooperation can be explained as gratitude in many cases. The addict is secretly grateful for the fact that the parents' relationship is being attended to by the therapist. In general, it is very difficult for the addict to significantly improve his situation and remain that way unless there appears to be some tangible evidence that the therapist is addressing the needs of the parental subsystem.

If freedom from drug taking has been maintained for a month or more, it may be possible to shift emphasis to other treatment goals. Two common ones have been mentioned—gainful employment or schooling and getting the addict out of the home. Underlying both topics are issues of separation—either physical separation or separa-tion through increased competence and the resulting independence of functioning. The therapist should be sensitive to the meaning of such separations for the family and restructure therapeutically in such a way that alternative supports are provided for members who are likely to feel the greatest loss.

Similarly, as progress occurs in all the goals relating to the addict, it becomes possible for the therapist to move flexibly toward dealing with other family issues. As is amply demonstrated in suc-ceeding chapters, such a broadening of goals is important at this stage illegal drugs, but it is necessary to get this issue on the docket as early as possible.* Then a process of negotiation can be started as to a date for detoxification and how the family is to prepare for it.

Often questions arise about the feasibility of having the addict become totally drug-free. We have found it critical for the therapist to be committed to this goal and to recognize that as long as the addict is on any drugs, including methadone, he is still labeled as an addict and the basic situation is unchanged (see Chapter I ). It is tempting to think of an addict as similar to a diabetic, implying that he will always need methadone. It is Haley's experience that working from such a

• model with schizophrenics almost never leads to cure.-j- Similarly, the therapist working with an addict is hopelessly hamstrung if he sees his job as helping the family to cope with a handicapped person suffering from an inherently chronic, incurable condition.

It needs to be underscored that the goals are negotiated with the family rather than being foisted upon them by the therapist. Thus the agreed-upon goal must be one that makes sense to them. This process begins by first assessing the priorities and competencies of the client and family, then reaching closure on a realistic and achievable goal. Although the therapist recognizes that the family may be ambivalent about a goal, he seeks to have the goal stated publicly in order to urge the family to action and, in a sense, to call their bluff. If, however, a family is extremely resistant at the outset to the idea of having the IP get off drugs (including methadone), the therapist might be better advised to postpone family treatment and obtain an agreement with them to reconvene when they have decided they do not want an addicted member. Otherwise, the purpose of therapy becomes unclear and the chances for retention of the family in therapy and for any real change are very slight.

Once an agreement has been reached about goals for the IP's drug use, family members may raise other issues or problems. As noted in Chapter 4, some other, crisis-laden issue may even underlie the addict's move to initiate treatment (e.g., he might be about to get married). While these problems may be real, they should be regarded as red herrings by the therapist—as ways of pulling therapy off track and diverting its thrust. Thus the therapist should question their relevance and require that the members who raise them justify their pertinence to the primary goal. (For example, a discussion of the addict's getting a job would only be considered appropriate if it were seen as important in keeping him off drugs.) The general rule is for the therapist to keep sessions focused on drug use until stable im-provement has been achieved.

It is crucial that the therapist form an alliance with both parents or parent surrogates in this stage so that they may take an effective stance toward the addict around the chosen goal. The therapist must keep the parents working together in the early phases, even siding with them against the addict upon occasion. Sometimes therapists, especially young therapists, are uncomfortable in treating a young adult in this manner. For example, such a therapist might feel uneasy suggesting that the parents negotiate a time when their 27-year-old son should be in the house and off the streets in the evening. What one finds, however, is that the IP is often surprisingly cooperative, even though he may protest the fact that he is being treated as a child. This cooperation can be explained as gratitude in many cases. The addict is secretly grateful for the fact that the parents' relationship is being attended to by the therapist. In general, it is very difficult for the addict to significantly improve his situation and remain that way unless there appears to be some tangible evidence that the therapist is addressing the needs of the parental subsystem.

If freedom from drug taking has been maintained for a month or more, it may be possible to shift emphasis to other treatment goals. Two common ones have been mentioned—gainful employment or schooling and getting the addict out of the home. Underlying both topics are issues of separation—either physical separation or separa-tion through increased competence and the resulting independence of functioning. The therapist should be sensitive to the meaning of such separations for the family and restructure therapeutically in such a way that alternative supports are provided for members who are likely to feel the greatest loss.

Similarly, as progress occurs in all the goals relating to the addict, it becomes possible for the therapist to move flexibly toward dealing with other family issues. As is amply demonstrated in suc-ceeding chapters, such a broadening of goals is important at this stage of therapy, whereas it would have been inappropriate in the initial, acute phase of treatment.