DR. STENSON: This question underscores the importance of an individualized treatment plan and approach. Patients at C.O.R.E.

are encouraged to see themselves as the ultimate expert in their disorders and treatment. Excellent care requires that the treatment staff maintain an open mind regarding the treatment needs of each patient. In the field of opioid addiction, our field forefathers suspected that patients suffered more from a deficiency than from a toxicity. Subsequent research and experience has largely supported this concept. Methadone and buprenorphine have proven to be excellent medications to treat this deficiency and are often life-saving, life-altering medications. The medications effectiveness must be supported by quality interventions addressing the therapy, counseling, spirituality, and other needs brought to the table. Each individuals story must be told and needs addressed. Holistic concepts are great, can be very helpful and meaningful, but too often hype, misrepresentation, poor quality control and related factors can lead to scams. It is important that treating staff stress the importance of good communication about various products that are promoted as holistic, organic, herbal, etc as some have no foundation in science and are financial scams. Wellness oriented life-style changes that include nutrition, exercise, and stress management are very positive and important. INTERVIEWER: Do you feel additional supports such as AA, MA or other meeting groups are helpful in aiding recovery? DR. STENSON: These programs are incredibly important and sadly, too often, under-utilized. Frequently, patients on normalizing doses of methadone or buprenorphine report unpleasant experiences at AA/NA when their treatment was shared. This is gradually changing as more AAs and NAs gain awareness of the highly effective, non-conscious altering effects of proper dosing of methadone and buprenorphine. We encourage our patients to become familiar with brochures such as, The AA Member-Medications and Other Drugs (page 5, point 3 states No AA Member Plays Doctor) and NAs In Times of Illness. In that all our patients have doctor directed, highly researched and effective treatment, they can meaningfully work the steps and participate as sponsors, sponsees, secretaries, treasures, greeters, coffee monitors, birthday chip presenters, etc. Hopefully more participation will occur in the future as these points are more generally understood and accepted. INTERVIEWER: Is it always necessary to completely cut out contact with triggers for either relapse or increased selfcriticism? DR. STENSON: A good offense is often related to having a good defense. It is important to take a careful inventory of triggers and have an active plan to eliminate or avoid as many as possible. It is also important to understand that triggers can be unexpected or even subconscious at times (a TV scene, an odor, a sound, etc) so impossible to completely cut out. I work to help individuals anticipate these likelihoods and have a craving coping strategy in place. This often includes the reality that intense craving usually lasts about 10 minutes. By building a time frame, not only does craving often fade but the individual then acquires more impulse control skills and ability to think through the entire consequences should one give into craving. This becomes part of a process of re-sensitizing oneself to the enormous consequences of relapse, including the real possibility of accidental death. INTERVIEWER: What role does adding positive activities to your daily life play in recovery and increasing long-term reintegration into life? DR. STENSON: This important because the benefits are is often overlooked in treatment planning. With opioid addiction and mental illness, the reward mechanisms of the brain are often impaired, either as a consequence of the drugs of abuse or underlying genetically determined causes. Developing or rekindling hobbies, interests, and related positive pursuits assists the treatment therapeutic talk and medication interventions. Initially, the reward of mending a hold in a pair of pants or reading an article may not compare with the high of a drug, but over time, such positive activities grow in pleasure and become much more meaningfully integrated into long-term success. INTERVIEWER: With all the talk about the biological nature of addiction and mental health, can people still recover even if a LOT of family members have long histories with addiction, mental health concerns, or both? DR. STENSON: Absolutely, especially if you define recover in a broader sense. A paraplegic may not recover the ability to walk but they certainly can recover a deeper appreciation of life, themselves, and lead a full life. The same analogy can be applied to co-occurring disorders. Many times over the years, I have had patients who have come from the worse of genetic and social backgrounds share that they feel these have heightened their sense of meaning and appreciation of life. Sometimes overcoming or coping with the biggest adversities has the greatest rewards. A number of staff persons over the years have emphasized this point and many become highly effective counselors. INTERVIEWER: If you were going to recommend a family member for treatment

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