Wednesday, June 30, 2010

Ready to be Happy

I just finished reading an article that John Bowe wrote for the on-line version of the New York Times, Formerly Unsober (4/12/10). He describes his experiences with alcohol. He never had a DUI and hadn’t yet “impregnated a Hooters waitress”, but he’d had his usual four glasses of wine the night before. He had long been using alcohol to help him sleep—the uninsured man’s anxiety medication-- and hoping not to run into his neighbor as he carried his bottle-laden bin out to recycle.

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In a moment of clarity, he was blessed with the liberating thought, “I’m ready to be happier now.” It was the last time he drank (except for a small glass of port, which he states he quite regretted drinking).

The line I love best in this article: “I am going to pursue every single aspect of this existence as fully as I possibly can.” Hence, no more booze.

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A common theme among our patients who come to The Coleman Institute for an alcohol detox is the question “How is this serving you?” Whatever thoughts are leading to the actions, they need to be examined so the behavior can change.

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At The Coleman Institute, not only can we safely guide you through an alcohol detox, we can steer you toward some good therapy. Call us if you are ready to ‘pursue every aspect of your existence as fully as you possibly can.’

Joan Shepherd - FNP

Monday, June 28, 2010

Arguing with Reality

Yesterday Beatrice came for a follow up visit. She’s been off opiates for a few weeks after completing an Accelerated Opiate Detox, so lots of feelings and emotions are busy rising to the surface for her. Like many people, she struggles with how to deal with things that don’t feel good to her.

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But that’s a KEY point: she recognizes that they don’t feel good to her! That awareness in itself is a huge milestone!

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Here’s an example: she is returning to work after some time off because she went to a 10-day treatment program. She dreads returning to her job, she says, because she hates it. I urged her to break that down a bit.

Is it the people you work with?

Is it the actual job that you do?

Is it the commute?

Is it the lack of ergonomic desk furniture available?

She hates answering the phone, which is a bit of a bummer since she’s in customer service.

Break that down, I urged.

They get mad at me.

I feel bad because I have to tell them what they owe, and often they are in financial straits.

(Of note, as a result of looking some realities head on, Beatrice herself has made the decision to put her house on the market, narrowly escaping foreclosure; she just can’t afford the mortgage payments. While there are many emotional attachments to this home, it is a huge relief.)

So then we play the “Why?” and “Is It True?” Games.
Why do you feel bad about telling people they owe money?

Because they can’t pay it.

And Is It True that you are responsible for that?

No.

Is it possible that—just like your experience of embracing reality when you stopped using opiates—these people may experience their own sense of being set free by the truth?

I hadn’t thought of it that way….

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Beatrice and I came up with her homework assignment: She is placing a little card on her desk, and these are Byron Katie’s words: WHEN YOU ARGUE WITH REALITY YOU LOSE, BUT ONLY 100% OF THE TIME.

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Her plan is to read this to herself just before she answers each call. Certainly the purpose is not to share this epiphany with angry or anguished callers. It’s a small step for Beatrice, but it is a lesson in moving forward bit by bit, toward a life where she owns responsibility for creating her own happiness.

Great stuff is happening every day at The Coleman Institute.

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Joan Shepherd - FNP

Friday, June 25, 2010

Cancer Prevention

Many of our TCI clients return to us as family practice patients. They find it helpful to work with a PCP who can manage primary care needs and help to navigate them through any future surgeries that may require the use of narcotic medications. Besides that, we’ve grown to include a second nurse practitioner who has a fabulous background in cardiac surgery and emergency medicine.

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One of the things we offer for our patients is a free monthly workshop on a topic of interest in primary care. Last month we talked about cancer prevention, based on the work of Dr. David Servan-Schreiber and his book Anti-Cancer: A New Way of Life.

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Dr. Servan-Schreiber , himself a cancer survivor, describes the conditions necessary for a cancerous tumor to grow: a weakened immune system, an inflammatory response and a good blood supply bringing fresh nutrients to the tumor.

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When he received all he could from the medical community in terms of surgery, chemo and radiation, he was left wondering what else he could do to improve the odds of prolonging his life. His research is fascinating.

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Many common plants, herbs, fruits and vegetables have the exact qualities necessary to undermine the very conditions mentioned earlier. Mushrooms boost the immune system, green tea and components of various types of berries prevent the development of blood supply to tumors. It is also important to avoid foods that increase inflammation and to balance the intake of Omega 6s and Omega 3s. Avoiding the myriad of synthetic chemicals in our environment and food supply, and choosing organic whenever possible also helps keep one’s ‘terrain’ less cancer-friendly.

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If you are local, I hope you’ll join us for upcoming workshops. See the Hamilton Family Practice www.HamiltonFamilyPractice.com website for details on the topics and schedules. If you are looking for a primary care provider, we are accepting new patients and would enjoy continuing to contribute to your good health.

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Joan Shepherd - FNP

Tuesday, June 22, 2010

Lose Yourself?


I like thought-provoking lyrics but there is one rhyme from rap artist Eminem that takes the proverbial cake. It comes from his acclaimed hit “Lose Yourself” from his blockbuster movie “8 Mile”. ‘Em’ (as he is sometimes called) raps, “His palms are sweaty, knees weak, arms are heavy, there's vomit on his sweater already, mom's spaghetti, he's nervous, but on the surface he looks calm and ready.” Now, one might ask, how can you talk about vomit in a rap/pop song, make it a hit, and win an Academy Award as well? Talent! Plain and simple, which Eminem has flowing out of him rushing like the waters of Niagara. He spits rhymes that gives a bird’s eye view into his feelings about the world and his life growing up as a poor, white kid just outside of Detroit. The story of Eminem has been well chronicled so I’ll leave that to those who have already done so. I would, however, like to highlight an article about him I found on the website www.globalgrind.com entitled, “Eminem’s 12 Step’s to Recovery” by Steven Horowitz.


In the past few years, Eminem had a well publicized addiction with pain killers which resulted in his lackluster album Relapse. That album was more about his drug addiction, selfish behavior, and other problems that continued to mire his life than fans wanted or expected. Now, in 2010, he has returned with a new album simply called Recovery. Horowitz makes some interesting parallels between the material on Em’s new album and the 12 Steps of Recovery, specifically Narcotics Anonymous.


Each song contains the essential message of the 12 Steps such as “Going through Changes” which has Em rapping about how far down he had gone due to his drug abuse ala Step 1. In “Cinderella Man: Em gives props to God noting the high improbability of his continued existence without the help of God, which echoes Step 2. “Not Afraid” mirrors Step 3 and the action step of surrender. The album continues revealing hints of Steps 4-12 proving that Eminem is a man on a mission of personal change and maturity. Is his recovery complete? Musically? Perhaps? But, as for the man himself, he’s just getting started.


I think it is important for the addiction community to pay attention to the ways pop culture both helps and hinders the recovery process through different types of media such as music, television, and movies. For all the cultural junk out there, I was glad to find this uplifting article on globalgrind.com. Thankfully, this article highlights the fact that an artist like Eminem, who has massive power, money, and influence, is using his musical platform to speak truth to a world that is hurting.


While Eminem is not looking to become the most world-renowned Addictions Counselor, he is achieving something similar by giving voice to his pain and sharing it so that others may identify and possibly learn from his mistakes. It is not easy to lay your soul open before a global audience. Just like the idea of ‘up-chucking’ mom’s spaghetti, confession certainly is messy and often not much fun. But that is part of the journey of recovery. Eminem has been given a gift of new life and sobriety. Let’s hope he continues to use that to help others because in the words of the oft quoted white rapper, “opportunity comes once in a lifetime!”


Chris Newcomb – Aftercare Coordinator

Thursday, June 17, 2010

Hugs not drugs - Oxytocin – My new drug of choice


Thank goodness I gave up alcohol and drugs over 25 years ago. But I have a confession to make – there is a drug I am still using – and enjoying it! It is Oxytocin, the “love hormone”. As I continue to learn more and more about how the brain works, I am realizing that there are actually good drugs that do function well in our lives. The first one that comes to mind is our friend Endorphin. Our brains natural painkiller and energy booster, Endorphin works really well to promote a sense of well being, energy, good sleep, and many other positive effects. All we have to do to get these good effects is work out on a regular basis.

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Now I am becoming a big fan of Oxytocin. Sometimes it is called the cuddle drug, or the bonding hormone, or even the love hormone. We have known for a long time that Oxytocin is released during labor and seems to be one of the main causes of the intense bonding between both parents and their babies. Levels go up dramatically when moms give birth. And amazingly Oxytocin levels go up in the dads too. Now it has been shown to be involved in a whole number of other situations. Oxytocin levels rise when we care for another person or animal, when we get or receive a massage or a hug, when we feel gratitude, when we feel or act in a generous way. Another words Oxytocin is a big part of how and why we feel love – not just romantic love, but platonic and brotherly love.

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And what does Oxytocin do? It has been shown in experiments that Oxytocin causes an increase in trust and generosity, an increase in empathy and a decrease in fear. It helps us relax and feel calm. Oxytocin may be the main reason why people with pets live longer and why support groups help people with cancer and addictions. Oxytocin relaxes us and decreases stress hormones. I don’t think it is a coincidence that people all over the world automatically started to hug each other at 12 step meetings. It feels good. It releases Oxytocin.

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So why are Endorphins and Oxytocin good for us when addictive drugs are harmful to us? I think one reason is that they are released in the right amounts, but I think that that a bigger reason that these natural chemicals are good for us is that we have to work for them. We have to earn them. You do have to work out in order to get your endorphins. You do have to do things in order to get your Oxytocin. You have to be vulnerable and you have to trust. You have to make some effort to get your Oxytocin.


The amazing thing about Oxytocin though is that it is one of those things that the more you give, the more you get. There is some evidence that the more we make Oxytocin the more sensitive we become to its effects – if we put more effort into love we actually feel more good loving feelings. Somehow we know this intuitively.

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So what can we all do to get more Oxytocin? Well there are lots of things but here are a few suggestions for starters:

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· Hugs are a good start

· Hold a baby

· Smile at a child

· Give or get a massage, or even a foot rub

· Keep a gratitude list

· Do some volunteer work

· Spend time Meditating and Praying

· Go for a walk

· Forgive someone and forgive yourself.

· Make amends to someone you have hurt

· Etc, etc

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Best wishes on your Oxytocin journey.

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Dr Peter Coleman

DEFECTING ON YOUR DEFECTS



Step 6, “Were entirely ready to have God remove all these defects of character”


Defect: The lack of something necessary that causes failure



Step 6 is not a popular one amongst recovering alcoholics and drug addicts. As with all the 12 Steps, Step 6 pushes the addict to another level of effort and self-discovery. However, this does not come without pain. Change is never easy. But the rewards are worth it!


I think the key word in this step is “ready”. There is something to be said about being ready to do something. For example, if I am not ready to jump out of a two story building that is on fire, then I should be ready to die! There are some things that are not worth waiting for so, let’s get to stepping ladies and gentleman, here we go!


The other key word in this step is God. Now I don’t mean that from a theological point of view. I mean the concept of a higher power. Remember that the entire 12 step system is based on the notion that the individual has failed in their efforts to kick the habit and therefore need a power greater than themselves to restore them to sanity. Along with Step 4, this step is a test of that earlier commitment made in Step 2 and 3. Many questions arise when confronted with this step. For example, when will my higher power remove my character defects? Another popular one is how will I survive without my character defects? Finally, my favorite is do I have to be ready to my higher power remove all of my character defects or just a few of them? As they say, ‘it only takes one excuse and any one will do”!


Essentially, Step 6 is about asking your higher power to take away those personal traits, attributes, and characteristics that cause you to fail in interpersonal, work, and social situations. On the surface, it sounds like a great idea. However, when you look under the surface you see how much work is involved and the pain that goes with it. It is hard to give up impatience. It is painful to give up resentment. It hurts to let go of procrastination but in the end you’re only hurting yourself! You get my point.


However, nowhere in the step does it say that it will hurt or be painful. I think we make it painful because the natural nature of an addict is rebellion. Step 6 is our way of saying, “I give up. I’m not rebelling any longer. I submit to your way of doing things.”


Finally, the important part to remember is that once character defects are removed, they are replaced with character assets! These are desirable qualities like love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control. These are the type of qualities that make people attractive on the inside. That attractiveness can’t help but overflow out into the world affecting all those who come into contact with this new creation of a person. Why would you want anything less?


Chris Newcomb – Aftercare Coordinator

Wednesday, June 16, 2010

Junk Food Detox

At this point, The Coleman Institute does not have an Accelerated Junk Food Detox. Perhaps we’ll consider it for the future…The following is a blog entry from the Institute for Integrative Nutrition:

Did you know that eating junk food can change the chemistry in your brain? A recent article on CNN.com reports on scientific findings that junk food is addictive. Addiction comes in many forms, and food addiction is nothing new. The article states “high-calorie foods affect the brain in much the same way as cocaine and heroin. When rats consume these foods in great enough quantities, it leads to compulsive eating habits that resemble drug addiction”. Food is made more addictive when it is stripped of its nutrients, and we end up eating bad food not because we’re hungry but because we think we need it.

Morgan Spurlock demonstrated fast food addiction in his documentary film, Super Size Me. During his 30 day fast food binge, Morgan began to experience the addicting effects of subsisting on an all fast food diet; in particular, he craved his daily fix of fast food at every meal and felt ill when he did not get it.

Just like drug addiction, this study explains that when eating too much junk food, we overload the “pleasure sensors” in the brain. The junk food makes us feel good for a short time, but once the pleasure sensors crash, we need more and more of the food to feel that sugar “high” again. Imagine your body needing a certain amount of junk food just to function normally?

It’s not surprising that processed, chemicalized foods alter brain chemistry. What’s surprising is that fast food is still the number one choice for many people. How do we help people overcome fast food addiction? Awareness is the first step. People need to be informed of the harmful effects of fast food. Transitioning to a diet of whole foods is the key to helping a junk food junkie overcome the addiction.

Can we program ourselves to become ‘addicted’ to healthy, nutritious foods instead of high-calorie, processed, junk foods?

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Joan Shepherd - FNP

Sunday, June 13, 2010

“Perseverance to Rock Bottom?”

My friends know that I have a sometimes odd sense of humor. You know, kind of like laughing at a funeral or coming upon a train wreck when you don’t want to stare but you can’t look away. Yes, I laugh at inappropriate times and at inappropriate things. Why? I laugh because life is funny not because I intend to be rude or disrespectful. There is so much to laugh about. So, this month while covering a somewhat depressing topic I’ve included some laughter-inducing material to make the medicine go down much easier and with a little more tasty goodness to it!
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There is a really funny website called www.verydemotivational.com. The site has hundreds of mock posters which give a word in bold letters below a picture and then define that word in a humorous way. Like anything else, you must use discretion as some are not all that funny, some are corny, and some are tasteless. But the bulk of the content is hilarious.

In addiction, when people are actively using alcohol and drugs, they must persevere in order to get their fix. They have to get money, find a dealer, and negotiate the price before they can take the hit that clears their minds of life problems. In another sense, it takes just as much perseverance to get into and stay in recovery from drugs and alcohol. So, for our first exhibit, I give you this poster:

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Now, is that not hilarious! Obviously the driver is not the sharpest tool in the shed as he/she are heading straight into a huge tornado. But isn’t that how we are with our addiction(s)? Don’t we look right into the eye of the storm (read: police, poor health, lost jobs, broken relationships) and push the pedal to the floor anyway instead of turning around and hightailing it out of there?

The reality is that addicts do not turn around from addicition until they have hit rock bottom! Which leads us to our second poster...










This poor guy has really hit skid row! Now, obviously, this poster is not all that funny. Even though it is a somber poster, it can teach us something about relapse and rock bottom. The truth is there is always a bigger bottom if you want to find it. The trick is to not go looking for it. Rather, we must learn to forge our sobriety out of the hard work of vigilance, attending meetings, working the 12 Steps, and making phone calls to other members of the program.

Although the first poster is funny, it is also true in active addiction. Perseverance really is the “courage” (read:stupidity) to ignore the obvious wisdom of turning back. So, the lesson here is to apply the true definition of perseverance which is, “steady persistence in a course of action” to our recovery one day at a time and to stop looking for a deeper, more painful bottom. Oh yeah, and don’t forget to laugh too!!!

Chris Newcomb – Aftercare Coordinator

Thursday, June 10, 2010

Suboxone – miracle or menace?

There is more and more talk on the internet and in addiction medicine circles about Suboxone. It was approved by the FDA and released onto the market about 6 years ago. Initially it was looked on as kind of a miracle drug because it makes people feel good and prevents them from having withdrawal symptoms. Sales are reportedly now over three billion dollars per year. But the longer it has been on the market, the more problems doctors and their patients are starting to see. Frankly, I am not at all surprised by this. It is a highly addictive drug, so when patients take it they feel good. But, like all addictive drugs, after a while it doesn’t work quite so well. There are side effects and often patients need to increase their dose. I talked with a patient recently who was on a full dose of Suboxone but she was getting withdrawal symptoms even on the full dose.

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The benefit of Suboxone is that it sticks to the receptors like glue so it relieves withdrawal well and it is difficult for patients to over-ride it and get high. The problem with Suboxone is the same thing as its beneficial effect - it sticks to the receptors like glue so that it takes forever to fully get off of it. I had one patient recently whose withdrawal symptoms didn’t even start for the first 7 days. Then they kicked in with full force and the patient had to go back to using. Many patients cannot even taper down off their Suboxone over long periods because they feel so awful and the withdrawal symptoms last for so long. If they are able to fully quit Suboxone, they continue to have some withdrawal for well over 2 months.

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Most patients relapse back to street opiate use soon after stopping their Suboxone. Fortunately we have a good solution to help patients get through this period without relapsing. We use Naltrexone implants after patients detox off their Suboxone so their brain can be protected while the brain heals.

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Dr Peter Coleman

Monday, June 7, 2010

Over 5 alcohol detoxes this month.

It is delightful to see how much benefit our patients are getting from our outpatient alcohol detox program.

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We have been offering the outpatient alcohol detox program for over 2 years now, and it really is going beautifully. Patients get screened over the phone to make sure they are suitable candidates for the program. If they are suitable, they are instructed to stop drinking before midnight and arrive at the clinic about 8.30 am. Once there, they receive a full history and physical, blood work and a breathalyzer. They then get IV fluids and full mineral and vitamin replenishment. For withdrawal, they are given Clonidine to stabilize their autonomic system and Phenobarbital to treat the withdrawal and prevent seizures.

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Patients just love the outpatient alcohol detox program. They usually feel good very quickly and frequently have very few withdrawal symptoms. They love not having to be put into a hospital and woken up all night by nurses and other staff. Instead they can detox at home with a friend or family member taking care of them.

The program is working very well. This month we treated a patient who was drinking so much that, even 12 hours after his last drink, his BAC was still over 0.22. We calculated that his level must have been over 0.4 the previous night – almost a fatal level. He required a lot of Phenobarbital but he remained calm and comfortable throughout the whole detox.

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Of course part of his treatment was to talk with Chris Newcomb, our aftercare coordinator, because detox without treatment is very unlikely to be successful. Fortunately he agreed to the treatment program we all recommended. Hopefully he will stick with it.

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Dr Peter Coleman

Saturday, June 5, 2010

Drug Seeking in the ER

Many patients we treat at The Coleman Institute for opiate addiction have been unable to get off medications prescribed by their doctors. In some cases, doctors have refused to continue to prescribe, leaving patients without a legitimate means to get their prescriptions, pitching them into withdrawal. Unfortunately, going cold turkey is such a painful process people find other ways to get their medications. Frequently they show up in emergency rooms or go doctor-shopping.

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Being addicted to opiates is a monkey on your back. People are surprised after going through a detox how their bodies adjust to pain as they are able to manufacture their own endorphins again. Many of our patients are able to function normally using non-steroidal anti-inflammatory medications. If you recognize yourself in this clip, consider coming to The Coleman Institute for a consult.

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Joan Shepherd NP


Wednesday, June 2, 2010

“BALK, BALK, BALK” or “BWOK, BWOK, BWOK?”

I am a carnivore. I love animals, they are tasty. In particular, I prefer chicken, turkey, and cow. I am not a big pig fan but will eat the occasional hotdog at the ballpark, if necessary. I don’t, however, wish to see animals hurt or tortured (disclaimer so you’ll read the rest of the article). However, in order to eat, something must die whether it is vegetable or animal. Thankfully, it’s not me!


What might carnivorous activities have to do with recovery you ask? Well, let’s see if I can make that connection in the next three paragraphs! As mentioned previously, I have an affinity for chicken. There is nothing like a chicken sandwich from a famous fast food retailer (ahem…Chik-Fil-A) with some fries and an ice cold drink! But on a deeper level, our little feathered friends can be helpful to our recovery.



Whenever someone is teased about lacking intestinal fortitude (i.e. guts) to do something, they are often labeled a “chicken”. You know, it’s the whole ‘Chicken-Little-the-sky-is-falling,-I-am-a-wuss’ scenario. Furthermore, some folks go as far as including sound effects such as, and forgive the rough translation, “bwock, bwock, bwock!” It is even more effective if said sounds are accompanied by a wing flipping action (hands tucked with thumbs attached under the armpit and flipping wildly back and forth…kids get permission from your parents before trying such a dangerous behavior) much like the bird that is being imitated! These sounds are immediately understood by the accused. They indicate weakness and ‘wussi-hood’ (a term I made up for this article that one does not want applied to oneself to be sure as it indicates complete, pathetic weakness)!



Much like the proverbial “bwock-ing” accompanying fear of the unknown, the A.A. Big Book teaches that most addicts, before they enter recovery “balk”, that is, reject, refute, or argue with the suggested 12 Step approach to long-term sobriety. It says, “At some of these we balked. We thought we could find an easier, softer way. But we could not” (Big Book, p. 58). This “balk” is much like that “bwock” not only in sound but in meaning. Just as someone might “bwock” with fear at the thought of skydiving, so to; many addicts “balk” in fear at the effort it takes to get clean. “Balk-ing” is really just excuse-making. It is a way to get out of owning your responsibilities and being held accountable to your actions. In a word, it’s chicken.



You might be thinking, “Yeah that’s funny and all but you try kicking an addiction.” You’re right. It is funny! And you’re right that kicking an addiction is no joke. But here’s the catch, it’s not you that is chicken, rather, it is the addict within you who is afraid. It balks like a true Chicken Little because it is scared of how good the 12 Steps are and how effective they have been in the lives of sober addicts all over the world. So the next time you don’t feel like doing something your sponsor suggested, or going to a meeting, or anything else recovery-related, just remember to kick your inner chicken. Tell him that he’s done for and you’re not going to be a victim to his poultry pandering any longer. Because after all, chicken is white meat and white is the color of surrender. Time for ‘Chicken Little’ to quit while he’s behind!



Chris Newcomb – Aftercare Coach / Coordinator