Friday, October 31, 2014

Cottonwood Tucson Announces The 2015 InnerPath Workshops Schedule

Cottonwood's Sonoran Desert landscape is a living workshop!
"...a workshop is where you do actually get feedback on your work, not just something where you go and sit for a day."  Octavia E. Butler - American Writer
 Workshop is a very positive word. If you think about your home environment, you might have a workshop area in a spare bedroom, the basement or the garage where you enjoy a hobby or create items for your home.  Sometimes you will come across workshops that are part of a larger business where patrons can gather to enjoy learning a new skill or working on projects, like paintings, ironworks, stained glass, or sewing.

Then of course there are workshops where a small group of people come together for a defined number of hours or days and focus on fine tuning a skill or learning techniques which can be applied to their everyday life. 

Cottonwood Tucson announces the InnerPath Workshops 2015 Dates

You may recall from previous posts about InnerPath, we have always referred to our InnerPath program as retreats, but going forward it will be InnerPath Workshops.  You can see the 2015 dates and pricing here, but today we thought it would be helpful to provide a synopsis of each workshop.

InnerPath Workshop

This five-day intensive workshop is tailored to meet the needs of those individuals who want to make healthy changes in their lives. Whether you are just beginning the journey of self-exploration or someone who has hit a 'road block' in your journey, this program is designed to motivate change and encourage self-growth. Our InnerPath Workshop (formerly Beginnings and Beyond) offers a series of non-threatening, safe, and proven experiential techniques as well as traditional group and cognitive behavior therapies. This workshop includes list work, a powerful tool for releasing 'stuck' feelings from the past.

Women's Workshop

This five-day women's workshop has been designed especially to meet the needs of women who are re-evaluating their relationships, their priorities, and their sense of self. This workshop examines the effects of trauma on women's lives and how it affects their physical, emotional, and spiritual wellbeing. The Women's Workshop moves beyond the mere awareness of problems and focuses on tools to support women in establishing healthy boundaries, examining relationship patterns and letting go of old images and memories that contaminate self esteem. In a beautiful desert workshop, women will learn to make peace with their own personal history and take the steps in order to move into a life of freedom and joy.

Couples Workshop

This five-day workshop helps couples who want to achieve love and healthy intimacy. Many couples long for closeness, but fear a repeat of past abandonment, hurt and anger. Even for couples who have become frustrated with therapy, this intensive workshop can break destructive patterns, revitalize the relationship and teach powerful tools that allow them to attain their goals of love, intimacy and passion.

Developing Healthy Families


Addictions and psychiatric disorders can create chaos in a family. Stress and tension rise, frustration builds and communication turns to anger. Families do not know what to do. This workshop can bring relief to a family in crisis. Our five-day program offers education, new ways of relating, developing a healthy lifestyle and individual strategies to work towards solution and recovery.

Our InnerPath Workshops staff

Rokelle Lerner
Rokelle Lerner is the InnerPath Clinical Director and Workshop Facilitator. She has been part of Cottonwood since 1999 and has received numerous awards for her work with children and families including Esquire Magazine's "Top 100 Women in the U.S. Who Are Changing the Nation." Rokelle has been an advisor and consultant with foreign governments, US agencies, corporations, schools and hundreds of individuals on relationships, boundary issues and addiction. She is also co-founder and consultant to Children Are People, Inc., a program used in thousands of schools throughout the country. Rokelle has appeared as a guest consultant on numerous television shows such as Oprah, Good Morning America, CBS Morning News and 20/20. Her articles and interviews have been featured in the Washington Post, New York Times, Newsweek, Time, People Magazine and Parents Magazine. 
Jana Zeff Martin

 Jana Zeff Martin  is originally from the Chicago area. She followed her family out west and graduated from the University of Arizona with a degree in political science. Previous to working at Cottonwood, Jana was involved with K-6 educational environments and after-school programs. She was an assistant teacher and a director of recreational activities. Jana has been at Cottonwood since 1991. She started as a tech, then worked for several years as an admissions counselor on our inpatient unit, and has been managing the InnerPath program since August of 2003.

For information, please call (800) 877-4520 ext.2141(United States). In Tucson, Arizona, please call (520) 743-2141 or fax us at (520) 743-2188.

We hope you will join us in 2015...each workshops is an experience that changes lives.

Thursday, October 30, 2014

New Study: Bone Fracture Pain Management Ibuprofen Versus Morphine

Have you ever had a bone fracture?

If you answered the above question in the affirmative, then chances are when you were discharged from the hospital emergency department or the orthopedist's office you were provided a prescription for pain. Maybe you have never experienced a broken bone, but one of your family members has had one. Friends and neighbors are always willing to offer advice, particularly if you are dealing with a child who has a fracture. However, it is probably best to follow closely the discharge instructions and keep a close eye on the patient in the first few days watching for swelling, excessive pain, and reactions to pain medication.   

Parents may want to ask questions if their child is prescribed morphine for a fracture

Our readers may remember a blog we published in April 2014 about a 10 year study that examined how and at what frequency codeine was prescribed to children ages 3 -17. Now we have the results of a small study that compared the results of prescribing either ibuprofen or morphine to children who have suffered a fracture.

As you can see from the image on the left, morphine is a schedule II controlled substance, drug class opioid, and codeine is in the same class.

CMAJ publishes article on morphine vs ibuprofen

The Canadian Medical Association publishes the CMAJ and the following article was first made available on-line October 27, 2014: Oral administration of morphine versus ibuprofen to manage post fracture pain in children.

This was a randomized trial with the lead author being Dr. Naveen Poonai who is a pediatric emergency physician at the London Health Sciences Centre in Ontario, Canada.

Study parameters...

  • 134 children took part in the study
  • The children ranged in age from five to 17
  • Each had either a broken arm or leg
  • Each was treated in the hospital emergency department
  • None of the fractures required surgery 
  • Each child left the emergency department with a cast or a sling
  • One-half of the children were randomly selected to receive oral morphine, with the dose being 0.5 milligrams per kilogram of the child's weight
  • One-half of the children received a prescription for 10mg/kg of ibuprofen every six hours as needed for 24 hours
  • The parents were not told which painkiller was provided to their child
  • If the child experience what is referred to as breakthrough pain, then the doctors advised the parent to administer acetaminophen
  • Parents were given a pain log to self-report the pain measurement 
  • Parents were to record pain levels from 0 to 5 immediately before a dose and 30 minutes after administering the pain medicine dosage

Study's results...

While pain reduction for both groups was very similar, more than 50% of the morphine group recorded side effects, while only 31 percent of the ibuprofen group did so. The most common side effects reported were drowsiness, as well as nausea and vomiting. According to HealthDay, one-quarter of all injuries among children are broken bones. And the researchers report that there are limited pain relievers for young children in these situations, which is complicated by the dangers involved with prescribing codeine.

Some final thoughts...

For sure when we read about a study like this, the results appear to be very straightforward, but as Amy L. Drendel, Associate Professor of Pediatric Emergency Medicine at the Medical College of Wisconsin (Milwaukee), who was not involved in the study expressed to FOX News:
“There is very little pediatric acute pain research done in the ‘at-home’ setting where these analgesics are actually used. This provides real-life data about how these medications work in the outpatient setting.”
In the long run this study is good news for all concerned...parents and children. The children have their pain relieved with a non-opioid product and the parents are usually very familiar and comfortable with administering ibuprofen and/or acetaminophen. 

Thursday, October 23, 2014

PTSD: So Many Have An Untold Story

Lyndon B. Johnson taking the oath of office on...
Lyndon B. Johnson taking the oath of office on Air Force One following the assassination of John F. Kennedy, Dallas, Texas, November 22, 1963 (Photo credit: Wikipedia)
"Boomers all had a bit of PTSD. If you had not experienced the assassination, your life would have been different. You wouldn't have felt that vulnerability at such a young age." Sarah Feuerbacher*

Post Traumatic Stress Disorder

Trauma occurs when a life event, usually one that threatens or causes great physical or emotional harm, overwhelms the brain's inbuilt chemical and physiological defenses to stress. Post traumatic Stress Disorder (PTSD) is an anxiety disorder that sometimes develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Post Traumatic Stress Disorder (PTSD) is a topic we often discuss. It comes up repeatedly in the news as we watch events unfold live (like yesterday's apparently lone gunman's attack on a Canadian soldier seeking to reach Canada's parliament), or as we receive updates on historical events that have taken their toll on us as a community.

Two stories separated by more than 40 years...

This week we happened upon two stories that deal with PTSD. Actually there are many news stories that deal with PTSD every day of the week, but it is unusual that one story ties back to the generation that witnessed their president being assassinated in 1963, while the other story is tied to an event that, as a nation, we shared together as a result of our war in Afghanistan...the 2004 death of Pat Tillman. 

Jacqueline Bouvier Kennedy Onassis ~ THE UNTOLD STORY 

On October 28, 2014, Barbara Leaming's latest book will be available in hardcover. It is a biography of Jacqueline Bouvier  Kennedy Onassis' 31 year struggle with PTSD.  NBC's TODAY Show featured Leaming's work on October 22, 2014.

If you are having trouble viewing the video, you can see it here.

Pat Tillman died April 22, 2004, fellow soldier Steven Elliot is haunted by PTSD

While Pat Tillman died in April 2004 it was not until April 2014 that Steven Elliot accepted responsibility for the friendly fire that killed Pat.  Since Pat's death Steven has suffered from PTSD and now works with other veterans. On October 18, 2014, NBC Nightly News profiled Mr. Elliott's story.

If you are having trouble viewing the video, you can see it here. 

We all have an untold story...

*Sarah Feuerbacher is the clinic director at the Center for Family Counseling at Southern Methodist University, in Plano, Texas. Last year, on the occasion of the 50th Anniversary of President Kennedy's assassination,  she was interviewed by HealthDay's Barbara Bronson Gray. Part of healing is sharing one's story...providing a teachable moment and stopping the isolation.

Start the conversation....

Wednesday, October 22, 2014

New Study: Examines Heart Attacks Followed By Depression And Anxiety

An overview of heart disease in the United States

In case you didn't realize it, according to the Centers for Disease Control (CDC) heart disease is the leading cause of death in the United States. Here are the general facts, as the CDC outlines them:

  • About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.
  • Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
  • Coronary heart disease is the most common type of heart disease, killing nearly 380,000 people annually.
  • Every year about 720,000 Americans have a heart attack. Of these, 515,000 are a first heart attack and 205,000 happen in people who have already had a heart attack.
  • Coronary heart disease alone costs the United States $108.9 billion each year. This total includes the cost of health care services, medications, and lost productivity.

Regarding women and heart disease, the CDC drills down a bit further:

  • Heart disease is the leading cause of death for women in the United States, killing 292,188 women in 2009—that’s 1 in every 4 female deaths. 
  • Although heart disease is sometimes thought of as a "man's disease," around the same number of women and men die each year of heart disease in the United States. Despite increases in awareness over the past decade, only 54% of women recognize that heart disease is their number 1 killer.
  • Heart disease is the leading cause of death for African American and white women in the United States. Among Hispanic women, heart disease and cancer cause roughly the same number of deaths each year. For American Indian or Alaska Native and Asian or Pacific Islander women, heart disease is second only to cancer. 
  • About 5.8% of all white women, 7.6% of black women, and 5.6% of Mexican American women have coronary heart disease. 
  • Almost two-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms. Even if you have no symptoms, you may still be at risk for heart disease. 

New study examines connection of depression and anxiety following a heart attack 

If you inquired of any person who experienced a heart attack, mostly likely they would share that their heart attack (myocardial infarction - MI) was a life altering event. The heart attack patient's family members would be quick to agree with that observation. 

This week was the third annual congress of the Acute Cardiovascular Care Association of the European Society of Cardiology.  This event took place in Geneva, Switzerland. 

Professor Pranas Serpytis of Lithuania presented the results of a current study that examined the impact of gender regarding risk factors associated with developing depression and anxiety following an MI.  

Study's parameters...

  • The study reviewed 160 patients who were admitted for an MI to the Vilnius University Hospital Santariskiu Clinics in Vilnius, Lithuania.
  • These patients were interviewed at least one month after the MI
  • Researchers determined gender, age, education and marital status
  • Researchers also gathered information about other health issues like diabetes mellitus, previous treatment for hypertension and previous heart attacks 
  • Occurrence of depression and anxiety were both assessed 

Study's findings...

  • 25% of the patients were depressed following the heart attack
  • 28.2% of the depressed patients received treatment with antidepressants
  • Current smokers were more likely to experience anxiety following the heart attack than those who had never smoked or had quit two years previous
  • They found no association between smoking and depression following a heart attack
  • Patients who were physically inactive tended to be depressed, with 64% of patients with depression admitted they were not physically active
  • Women were more likely to develop anxiety and depression following a heart attack 

Looking forward...

Like most research more questions are generated following a review of the results. Dr. Serpytis offered that more research will need to be conducted as to why women are more likely to develop anxiety and depression post MI. Additionally, he shared with the congress:
“The World Health Organization predicts that by 2020 depression will be the second leading cause of disability and mortality in the world, surpassed only by ischaemic heart disease. Major depression follows MI in approximately 18% of cases and is an important predictor of disability and poor quality of life in the year post-MI.

Patients with depression are nearly 6 times more likely to die within 6 months after an MI than those without depression. The increased risk of death in patients with depression persists up to 18 months after the MI. But despite the fact that post-MI depression is common and burdensome, the condition remains under-recognised and undertreated.”  

Friday, October 17, 2014

Looking Through Google Glass™ ~ Internet Addiction Disorder

Checking-in for addiction treatment...

Checking-in for addiction treatment and/or co-occurring disorders is often a shock to one's system.
The day for check-in frequently occurs after coming to terms with oneself, family members and/or employer that now is the time to get sober and deal with any other mental health issues that may yet to be discovered.

The patient always has questions about "what can I expect when I check-in," like:
  • Will I have roommates?
  • How long will detox/withdrawal take?
  • Is smoking allowed?
  • Can I bring my laptop or tablet?
  • Can I have visitors?
  • Can I make phone calls?
  • Can I check my email?
  • Can I bring my cellphone or smartphone?
Of course, as our world of hardware and software technology advances most treatment centers' admissions teams continually reevaluate the list of what a patient can and cannot bring with them and what restrictions will be placed on access to devices which allow using the internet while in treatment. 

U.S. Navy's Substance Abuse and Recovery Program (SARP) has requirements, too

The U.S. Navy's SARP unit requires that all patients admitting for treatment must abstain from alcohol, drugs, and cigarettes; additionally, all electronic devices are surrendered for the length of the 35 day program. And so it was, in September 2013 when a 31 year old serviceman checked-in for alcoholism treatment.

Soon the doctors treating this young man realized that he was exhibiting withdrawal symptoms that were worse than his withdrawal from alcohol. reports that one of the electronic devices surrendered by the patient was his Google Glass. He explained to the doctors that he had been wearing the glasses for 18 per day for the two months prior to his admittance. The following are the withdrawal symptoms noted in this case:
  • frustration and irritability 
  • involuntary movements to the temple area; involuntary tapping of temple with forefinger, especially when asked questions
  • short-term memory problems 
  • trouble focusing; unclear thought processes
  • viewing dreams as if through the device's gray window

U.S. Navy team identifies first known case of "internet addiction disorder" (IAD)

Dr. Andrew Doan of the Naval Medical Center San Diego's Department of Mental Health and Department of Ophthalmology co-authored a study of this case. The research results were published on-line September 26, 2014, and will appear in the February 2015 issue of Addictive Behaviors: Internet addiction disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program.

The treatment team concluded:
Over the course of his 35-day residential treatment, the patient noted a reduction in irritability, reduction in motor movements to his temple to turn on the device, and improvements in his short-term memory and clarity of thought processes. He continued to intermittently experience dreams as if looking through the device. To our knowledge, this is the first reported case of IAD involving problematic use of Google Glass™.

Going forward...

This is an interesting paper that sheds real time light on understanding internet addiction disorder. Newsweek contributes the following observations:
Internet addiction is commonly linked with cellphones, laptops and personal computers. This is the first reported case involving Google Glass. Though it is a growing problem, Internet addiction does not appear in the Diagnostic and Statistical Manual of Mental Disorders, a book of standard criteria for the classification of mental disorders. Instead, it is included in the appendix as a disorder that requires further study. While some psychiatrists believe it can be a primary problem, others maintain that it is merely a symptom of other psychological issues.
IAD: A disorder that requires further study...