PERSPECTIVES

New ways of looking at drug dependence

Unique insights offered by:
Linda Strause, PhD
Professor, University of California, San Diego
Co-Founder & Vice President
G. Randall & Sons
An occasional series of short articles written exclusively for 100 Million Ways by Linda Strause PhD, who specializes in drug dependence and addiction, along with guest contributors. Dr. Strause combines over 30 years in clinical research and as a professor of nutrition at UC San Diego, with her peronal journey: her husband's diagnosis and death from brain cancer. She has been interviewed by KCBQ and by Dr. Jamie Corron of the Center for Medical Cannabis Education. She was recently selected to be interviewed by Authority Magazine for their series, Women Leaders in Cannabis.
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Perspective #13 Opioids and the Holidays: How To Have A Safe and Sober Holiday Season

Dec. 16, 2020
The potential for anxiety around the holidays is real, especially for those struggling with substance use disorders (SUD) or dependence. For many of us the holidays are a happy time to spend with family, friends, and coworkers, but this year things will be different. There will be no big holiday parties, no large gatherings. Instead, we won’t be gathering at all or we will be in small groups to celebrate the holiday season. Not everyone is so lucky to have such positive memories to look back on to carry us through this holiday season. Many of us have hidden conflicts based on past experiences or expectations that may not have been realized. Disappointment and family conflicts can be a source of tension between the realities of our situation and our idealized image of the holiday season. This struggle and sometimes failure to realize these ideals can be an acute source of stress and anxiety.

The first key to surviving the holidays is to have a realistic attitude about the potential for stress, anxiety, and conflict and what triggers these feelings. The holiday season may bring even more triggers, especially if you struggle with SUD, addiction, or dependence on opioids.

The risk of excessive drug and/or alcohol use during the holidays is real and the consequences include the potential for harm such as from motor vehicle accidents or overdose. The US Department of Transportation reports that fatalities related to impairment account for more than 25% of all vehicular crash fatalities in the US with many people dying in December alone.

The increased availability of drugs and alcohol during the holiday season can be difficult to resist. Drinking with friends and family during the holidays is a long-standing tradition in our country and the temptation to indulge is strong. In fact, 25% of the alcohol industry’s profits are earned between Thanksgiving in New Year’s, little more than a month.

This period of heightened use is particularly dangerous for a country where SUDs continue to be a major public health concern. While there is some reason for optimism, that is tempered by the reality that opioid use disorder remains a persistent threat to the health and well-being of all Americans.

Between 2018 and 2019 opioid use disorder decreased from 2 million to 1.6 million Americans. Efforts to increase access to treatment, psychosocial and community recovery have had a positive effect. Pain reliever misuse also decreased significantly from 2018 along with heroin initiation and heroin use among 18 to 25-year-olds. Despite these gains, opioid overdose deaths increased in 2019 underscoring the risk of potent synthetic opioids such as fentanyl and the continued need to engage people in treatment and recovery services.

People who are at risk of opioid relapse must be aware of and on guard against triggers that may tempt individuals to seek relief through harmful substances. It’s somewhat common for individuals to seek treatment in January after overindulging over the holidays by misusing drugs or alcohol, having self-destructive thoughts, and engaging in harmful behaviors. Often these cases are serious, coming to treatment through intoxication, withdrawal, or self-harm, and may require inpatient care.

This can be avoided by following some simple tips and understanding that addiction and dependence are not moral failings, they are disease states that can affect anyone. Be kind to yourself, understand and forgive your failures so that you can work on them is the first and most important step.

If you are concerned about your ability to stay sober over the holidays you must first be realistic about how the holidays can increase stress and anxiety and lead to dangerous behavior. Next, it’s important to take steps before entering the holidays to avoid problems that may trigger a relapse.

First, be kind to yourself. If you have a history of drug or alcohol misuse, it’s important to protect yourself and recommit yourself to recovery remaining centered and engaged with like-minded individuals in your community is essential. Don’t isolate.

Second, be kind to others, even if they are not kind to you. Embrace the holiday season and try not to be too self-absorbed, show kindness to others by taking part in volunteer activities. Get involved and stay engaged.

Third, take care of your physical health. Eat well, get enough sleep, and exercise regularly. Your physical health is tied to your mental health. According to a study published by the Harvard School of Public Health, running for 15 minutes a day or walking for an hour can reduce a person’s risk of major depression by 26%.

Fourth, stay safe. Avoid triggers by avoiding environments where drugs and alcohol are being used. If you find yourself in a situation where you might be tempted, be aware of where the exits are, and be prepared to leave.
Fifth, stay positive. It is entirely possible to enjoy the holidays without misusing drugs or alcohol. Participating in fun wholesome activities that allow you to connect with others in a way that doesn’t involve substances. Cook, decorate, play games, and sing songs. Discover the joy of wholesome pleasures.

This year you may find yourself in a better place than you were in last year, you may find yourself worse off than you did last year. However you find yourself, there’s always an opportunity to take stock of your successes and your failures and get validation and support from friends and loved ones and celebrate or recommit yourself to recovery and lasting sobriety.

Finally, don’t be afraid to embrace harm reduction strategies that can help you through the holiday season. Managing stress can be difficult but studies have shown that high- CBD cannabis or medicinal marijuana instead of harder drugs, can help manage stress and promote relaxation and a more positive mental attitude, but don’t overdo it. Too much THC, in particular, can have the opposite effect, making you feel more stressed, anxious, and less relaxed. So indulge, in moderation, enjoy yourself, your family, and the holiday season.

Perspective #12 Does safe access provide safety from suicide?

Dec. 4, 2020
There are many keys to recovery from addiction or dependence on opioids. One of the most important keys is the key that unlocks the door to a community that can not only nurture and support a person in recovery but also be a source of compassion and understanding. For many people, the first time they seek treatment for their addiction or dependence on opioids, they may not always find an environment that understands the challenges that those in recovery face. What they need is a caring and gentle environment designed to foster a community of recovery and deliver to the individual a model for enduring personal and societal change. By getting the support they need to find success in their recovery, they also have an opportunity to make a positive impact on their community.

How can we build a compassionate community for those in recovery while at the same time criminalizing and marginalizing addicts and those suffering from dependence or addiction to opioids? The answer is, we can’t. In order to break the cycle of addiction and dependence, we must first acknowledge the inherent humanity of those who suffer and struggle to understand that addiction and dependence is a natural part of the human condition under stress and in the absence of community.
One in four patients receiving long-term opioid therapy in a primary care settings struggle with opioid use disorder. A growing body of research points to the value of a holistic approach to recovery. Unfortunately, there are many barriers to access holistic care within a patient's community. Stigma associated with treatment and the limited availability of care can make overcoming these challenges a critical obstacle for engaging patients safely, comfortably, and compassionately to support sustained care.
There are five elements which can contribute to a successful holistic approach to the treatment of opioid addiction and dependence:
1. The stigmas associated with opioid addiction treatment must be addressed by embracing medication-assisted harm reduction treatment along with psychosocial and community interventions in order to engage, support, and reintegrate those suffering from opioid use disorders into their communities.
2. You must commit to combining medication-assisted therapy with supportive psychosocial and community interventions to support long-term recovery. Research shows that patients who are treated with medication and other interventions have better outcomes than those who are not.
3. Pain relief is the most common reason leading patients misuse opioids. Managing pain without the use of opioids including natural products such as cannabis, exercise, or other healthy lifestyle approaches for pain management is key to improving wellbeing and reducing dependency on opioids.
4. Don’t be limited by limitations. Many communities lack resources for effectively responding to the opioid crisis. Embracing alternatives such as Telehealth, or other online resources can help bridge the gap between effective treatments and convenient access.
5. Involving family members in the opioid recovery process is crucial for building long-term stability and community for those in recovery. Difficulty managing family conflicts can be a key contributor to opioid abuse. when family conflicts are resolved, and families are involved in the recovery process not only are those conflicts able to be addressed but the consequences are able to be resolved.
In the fight against addiction, a holistic view of the needs of those who suffer is key to ensuring their recovery. Without access to holistic care, those who suffer face a challenging battle from addiction to wellness. An innovative and integrated approach that focuses on building bridges from addiction and dependence to community and care is the key to empowering patients to overcome their addiction or dependence and lead healthy dynamic lives.

Perspective #11: Wow - What an election? In regards to cannabis, "What does it mean?"

November 25, 2020
Five more states legalized cannabis, in some form, and Oregon became the first state to legalize psilocybin mushrooms for therapeutic use and decriminalize the possession of small quantities of drugs, for personal use. In addition, Washington, D.C. approved a measure to decriminalize other psychoactive substances in the nation’s capital.

These reforms passed decisively as Americans of all political stripes abandon the prohibitionist approach to drugs. With Arizona, Montana, New Jersey and South Dakota all legalizing adult-use, one-third of all Americans will live in a state where cannabis is legal in some form.

Here’s a summary of what was approved on Election Day 2020:

Arizona
Voters passed an initiative legalizing adult-use marijuana for adults 21 years and older. Under the new legalization law, adults will be able to possess up to an ounce of marijuana in public and cultivate up to six plants for personal use.

Mississippi
Activists passed medical cannabis legalization allowing patients with debilitating medical issues to obtain cannabis after getting a doctor’s recommendation. It includes 22 qualifying conditions, such as cancer, chronic pain and post-traumatic stress disorder. Qualified patients would be allowed to possess up to 2.5 ounces of cannabis per 14-day period.

Montana
Voters approved a measure to legalize marijuana for adult use and establish a legal system for cannabis production and sales.

New Jersey
Voters approved a referendum calling upon the state legislature to legalize adult use cannabis. Under legislation submitted to the state legislature after the passage of the referendum, adults 21 and older would be allowed to purchase and possess up to an ounce of marijuana or five grams of concentrates. Adult use retail will not be available right away, but medical cannabis dispensaries would be able to sell marijuana products to adult consumers immediately. A rules and regulations bill will still have to be passed and appointees for the Cannabis Regulatory Commission will have to be selected. Ultimately cultivation, processing and sale will be legal

Oregon
Voters passed two separate initiatives, legalizing psilocybin mushrooms for therapeutic purposes and decriminalizing the possession of drugs. The psilocybin measure will allow adults to access psilocybin mushrooms in a medically supervised environment.

The decriminalization measure removes all criminal penalties for low-level drug possession offenses. Criminal penalties will be replaced with a $100 fine or a health assessment to be completed within 45 days.

South Dakota
Voters legalized both medical and adult-use cannabis. The adult-use measure legalized the possession and distribution of up to 1 ounce of cannabis and will allow the cultivation of up to 3 plants. The medical cannabis initiative allows patients suffering from debilitating conditions to possess and purchase up to 3 ounces of medical cannabis from a licensed dispensary.

Washington, D.C.
Voters approved a local initiative decriminalizing the possession of a wide range of natural psychedelic entheogens, including psilocybin, ayahuasca and ibogaine. Under the new law, possession and use of the psychedelics will be among the District’s lowest law enforcement priorities.

Summary
“This historic set of victories will place even greater pressure on Congress to address the glaring and untenable conflicts between state and federal laws when it comes to cannabis legalization,” Steve Hawkins, executive director of the Marijuana Policy Project, said. “The federal government is out of step with a clear national trend toward legalization.”

“We can put an end to the social injustices and other harms that result from the criminalization of marijuana,” he said. “While cannabis legalization is not the cure-all to end the war on drugs, it is a necessary step and would provide an opportunity for many long-oppressed communities to finally have a chance to heal.”

It is our opinion that regardless of political differences, there is a growing consensus that past drug control policies have failed and need to be replaced with more sensible policies that put public health first and treat drug dependence and substance use disorders as health problems that need to be addressed medically not putatively. Let us know what you think!

Perspectives #10—Cannabis 101: "Everything you wanted to know about cannabis but were afraid to ask"

November 18, 2020
Natural Products And Prescription Drugs According to pharmacology, a drug is a chemical or biological substance used as a medication or in the preparation of medication. Typically the substance is of known structure, which, when administered to a living organism, produces a physiological effect. A prescription drug or medicine, is a substance that may be used to treat, cure, prevent, or diagnose a disease or to promote well-being.

Many natural products contain drugs similar to those found in prescription medication. That doesn't mean they are the same things. What ultimately differentiates the two is potency, purity, and use. One caveat is that natural products may contain other ingredients which may confound or compliment the principal active ingredient by virtue of their synergistic interaction within our body.

There's something calming about sipping a cup of green tea, and it may be the L-theanine. An amino acid found naturally in green tea and some mushrooms, L-theanine is said to alleviate anxiety, improve sleep, and reduce stress. We don't consider green tea a drug and doctors are not prescribing it to their patients, although some may recommend it. Basically, “the dose makes the medicine, the dose makes the poison”.

Cannabis and Marijuana
When we think of cannabis, well - it is more complicated.
● We know that cannabis is a plant and don’t consider it a drug. It’s a plant. It’s a recreational drug. It seems to have medical advantages. It is still illegal.
● Even in states with approved ‘medical marijuana’, doctors are not prescribing it to their patients, but rather recommending it for medicinal purposes. This is because cannabis contains cannabinoids, such as THC and CBD, which have a biological effect on the body and may treat a variety of diseases and disorders.
● There are four approved prescription drugs made with cannabinoids: Marinol, Syndros, Cesamet and Epidiolex. Sativex, a mixture of THC and cannabidiol, is a mucosal spray approved in Canada for pain in multiple sclerosis.
Three have been approved by the U.S. FDA, one has been approved globally.
○ Two are based on THC
○ One is based on CBD, and
○ One containing a combination of CBD and THC.
● These products have demonstrated safety and efficacy based on FDA approved, double blind placebo-controlled studies, the gold standard for clinical research. It should be noted that these products do not completely reflect the potential of cannabinoids due to a limited source and limited variety of whole leaf cannabinoids.

For many most people that use cannabis, it is used either as needed. This is where the line gets blurry and where individuals are ultimately responsible for their use. Cannabis is generally considered to be safe and well tolerated, in low to moderate amounts. But there must be clinical trials to clearly establish safety and efficacy. And clinical trials can’t happen until the federal government changes its illegal status or, at least, allows controlled clinical research to inform patients and clinicians.

Although cannabis is not without side effects and at higher doses may be habit forming, current testing and quality control address a lot of these issues. Consumers should ask for information about the products they are buying, such as the certificate of analysis to know the potency. A better understanding of how people use cannabis to better manage pain, related symptoms, and reduce dependency on opioids and other prescription medications, can help us to improve access to cannabis as a complementary alternative to opioids for chronic pain relief and addiction.

Perspectives #9—Legally Speaking: When Does A Natural Product Become A Drug?

Oct. 22, 2020
A natural product, broadly speaking, is any chemical, compound, or substance produced in
nature. A drug product refers to a finished dosage form, whether a tablet, solution, or any other
form, that contains a drug substance in combination with other ingredients. The substance that
makes the drug product can be the same as the active ingredient in a natural product. Penicillin,
the first antibiotic to be discovered, was isolated from the common mold known as Penicillium.
Penicillin antibiotics were among the first medications to be effective against many bacterial
infections and are still widely used today.
Many plants or foods may contain substances that, when isolated, may be added to other
ingredients, to produce a drug product. As a naturally occurring substance in a plant, that
substance is not considered a medicine. A great example is red yeast rice. Red yeast rice
extract naturally contains monacolin K, which is chemically identical to the active ingredient in
the cholesterol-lowering drug lovastatin. The drug, Mevacor, is prescribed by physicians to
individuals with high cholesterol. However, some individuals may choose to consume red yeast
rice as a part of a healthy diet. Mevacor is a medicine whereas red rice yeast is not.
When it comes to being a medicine, scientists are looking for evidence: good, clean, high quality
data that shows that something is safe and effective (at doing whatever it is we think it does)
and balances benefit over risk. Nothing is without risk, so what we want are medicines that
provide greater benefits than they do risks, that treat illness and restore health without leaving
the patient worse off after treatment.
Ultimately what determines whether something is a medicine or not is how we use it, how we
intend it to be used, and the purpose for which it is used. The pattern of use for a medically
prescribed drug seeks to treat the symptoms or causes of a disease while minimizing any
adverse effects. Medicines are tested in controlled clinical trials to demonstrate both safety and
efficacy. Natural products are often handed down from generation to generation but their
efficacy has not been proven in a controlled setting. Medicines will have health claims on their
labels whereas natural products will not. In general, natural products tend to have less side
effects than prescription medicines.
Medicinal marijuana or adult use? When is it medicine and when is it simply a natural product?
If we apply the definitions noted above, only those cannabis products (using the whole plant)
that have been tested in a controlled setting can be considered medicine. Both Sativex and
Epidiolex, produced by GW Pharma, are approved by the FDA as medicines for MS and two
forms of pediatric epilepsy, respectively. The question remains: How different is your adult use
marijuana from a prescription drug?

Perspectives #8 - Opioid Overdose and Dependence: What it Looks Like, What to Do

October 8, 2020
With opioid use comes the risk of overdose and dependency. Knowing what to look for and what
to do if you suspect someone might be facing such challenges, may save a life.
What does an opioid overdose look like?
Recognizing the signs of opioid overdose is critical to knowing when and how to take action.
Symptoms of an opioid overdose can include;
● Unusual sleepiness
● Slow breathing and heartbeat
● Skin feels cold and clammy
● Pupils in the eye are tiny
● Nails and lips appear pale blue or gray
● Become unconscious, limp, or non-responsive to yelling or other stimulation
What should I do if someone is having an overdose?
Lightly tap, shake, and shout at the person to get a response. If you do not get a response, rub
your knuckles on the person's breastbone. Keep the person awake and call 911. If the person
does not have a pulse or is not breathing, perform CPR. Push down repeatedly on the chest at
a rate of 100 times per minute.
You can also use a prescription medicine, called narcan, which can be given right away at the
first signs of breathing problems or severe sleepiness. Narcan does not take the place of
emergency medical care.
How can I lower the risk of becoming dependent if I am prescribed opioids for pain
relief?
It's important never to take opioids in greater amounts or more often than prescribed. Work with
your primary health care provider to develop a plan for managing your pain.
● Never share or sell prescription opioids.
● Keep them secure from visitors, children, friends and family.
● Do not save unused opioid prescriptions, safely dispose of them through your pharmacy,
your community drug take-back program, or simply flush them down the toilet.
● If you believe you may be struggling with addiction, tell your health care provider and ask
for guidance.

What are the signs of opioid dependence?

People who are dependent on opioids experience withdrawal symptoms when they stop taking
them. People may become nervous or cranky particularly when they're unable to use their pain
meds. Their movements may become erratic and they're sleeping habits may change.
What should I do if I or someone I know becomes dependent on opioids?
If you or someone you know becomes dependent on opioids and is ready to seek help, the first
step is to find a physician or other healthcare professional who can help. Getting support for
yourself as well as a loved one is essential for recovery. It's important to acknowledge that it
may take several attempts at treatment to find the best approach. If you or someone you know
is not ready to seek treatment, a confrontational approach or an intervention is not
recommended and can escalate to violence or backfire in other ways. A loving and compassionate approach is the best way to encourage and support their recovery.

Perspectives #7: Opioids 101 - Everything you want to know but are afraid to ask.

October 1, 2020
The word opioid covers a lot of ground. Opioids includes both prescription medications prescribed by doctors to alleviate pain and illegal synthetic drugs that can be downright deadly.

Opioids are highly addictive and people can become addicted or dependent on them for many reasons. The more you use and the longer you use, the more your brain and body come to believe that the drug is necessary for survival. As your tolerance for the pain-relieving effects increases, you may find you need even more to relieve the pain or achieve well-being, which can lead to dependency.

The opioid epidemic refers to the increase in both prescription and non-prescription opioid drug use for non-medical purposes. The statistics are sobering:
● According to the national survey on drug use and health, 19.7 million American adults over the age of 12 battled a substance use disorder in 2017.
● One out of every eight adults struggled with both alcohol and drug use disorders.
● 8.5 million Americans suffered from both a mental health disorder and a substance use disorder.
● Drug use disorders cost American society more than 740 billion dollars a year in lost productivity, health care expenses, and crime-related costs.

Despite these sobering facts, it's important to remember that prescription opioids can be used responsibly to help relieve pain and when they are prescribed by doctors following surgery or serious injury and other health conditions. These medications can be an important part of treatment but also come with serious risks.

What are the side effects of opioid use?
Prescription opioids carry serious risk of addiction and overdose, especially with prolonged use. Side effects may include;
● Tolerance, meaning that you need more of a medication to get the same pain relief
● Physical dependence, meaning you have symptoms of withdrawal when medication is stopped
● Increased sensitivity to pain
● Constipation
● Sleepiness, dizziness, and confusion
● Depression
● Itchiness and sweating
● Affect on hormones including testosterone resulting in lower sex drive, energy, and strength.

Remember, with knowledge comes personal responsibility. Use it well.

Perspectives #6: Cannabis As Harm Reduction for Opioid Dependency and Addiction

September 30, 2020
  • Cannabis as harm reduction for opioid dependency and addiction: It can be used as a supplement to or substitute for opioids, and can help treat symptoms associated with withdrawal. (link)
We learned in a recently posted blog that there is a difference between dependency and addiction. Dependence refers to a physical dependence on a substance and is characterized by the symptoms of tolerance and withdrawal. Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse.

When it comes to dependencies, wouldn’t it be nice if everyone suffering from opioid dependency could embrace abstinence. We all know that abstinence or going “cold turkey” isn’t easy and is not always an effective treatment option. You may have tried to go cold turkey when you tossed the full cigarette pack into the trash or emptied all the alcohol into your sink. Not very successful you say!

So instead of abstinence, we should consider substituting a safer substance for a more harmful one. This is the basic principle of harm reduction. The American Medical Association is greatly concerned with the increases in opioid-related mortality, specifically related to fentanyl. Suppressing opioid use with Methadone or Buprenorphine may be helpful but they are not without risk and side effects.

Cannabis, on the other hand, is more effective, has fewer side effects, and less risk of dependence and addiction. There are currently over 30,000 patient-years of data, mostly from randomized control trials using a cannabis extract, a sublingual spray called Nabiximols, tested for the treatment of pain. Nabiximols is a combination drug standardized in composition, formulation, and dose. Its principal active cannabinoid components are the cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD). Each spray delivers a dose of 2.7 mg THC and 2.5 mg CBD. Nabiximols has been approved in 27 countries. In that huge data set, there’s been no evidence of abuse or diversion. What’s more, most people who stop using cannabis are able to do so without any formal treatment.

Perspectives #5 Facing the unknown…without opioids

September 16, 2020
Amid the pandemic, amid shelter-in-place, the mental health of Americans is at an all time low. I remember coming back from visiting my 90 year old mother in mid-March. We had planned to attend the theater but the morning of the event, the theater in Palm Desert closed its doors due to COVID-19. I came back home, not seriously concerned. Four days later, the governor of California issued the shelter-in-place orders for the state. It would only be for 2, maybe 4 weeks. Now, 6 months later, there is no clear path forward. The unkwhen or if this will end?

The COVID-19 pandemic, and the resulting economic recession, have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders. In a KFF Tracking Poll conducted in mid-July, 53% of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March, the first time this question was included in KFF polling. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus.

Recognizing the stress is the first step. Clearing the body of stress hormones, such as cortisol and adrenaline, is the next step. This can be facilitated with physical exercise, yoga, Tai Chi, or stretching. Mindfulness and/or mediation, including breathing techniques, can also help us to relax and focus. Instead of turning the pills or alcohol, the controlled use of non-addictive cannabis products helps me to relax and focus on the positive elements of my life. —Linda Strause

Perspectives #4. Losing Family Members

Being in a relationship with an addict is difficult. Getting out of a relationship with an addict can be even more difficult. When we move on from a difficult relationship we sometimes find ourselves looking back, not because we're nostalgic for the hard times, but because we remember the good times. When those lost relationships are family, reconnecting may be even more difficult especially when relationships ended due to the loss of trust and the inability to forgive. That said, trust and forgiveness go hand in hand. Trust is easy to lose but hard to build. When trust is lost, it is only through forgiveness that can we begin to rebuild that lost trust. When we forgive others, we forgive them for what they have done but we don't necessarily forget. If you choose to forgive and allow an individual back into your life, forgive yourself and allow yourself to be forgiven. None of us are as compassionate or as forgiving as we might want to imagine ourselves to be. You are not a saint anymore than the other is a sinner. We are all human and flawed and only through forgiveness and love can we find meaningful relationships in our lives.

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Perspectives' Guest Contributor Elliot Bostick: "The Life Triangle"

Working in accounting, I learned a timeless model. We use this model to figure out why people do what they do. Sometimes, it is used to show mistakes that we have made. Most of the time, it shows the goodness that we created. The accountants call this model the "fraud triangle," but we should call it the "life triangle."

This model does not decide who you are—it explains your actions. You can be a great person. A nice person. A loving person. A successful person. However at one point, you might have made a bad decision that has negatively affected yourself and others. I know I have.

I will give you a look into my own life experiences but please explore this yourself:

Negative action scenario:
—Pressure - Your are working your butt off to finish your shift at work and are stressed
—Opportunity - Maybe a friend wants to hangout and get high afterwards
—Rationale - You deserve this. You have done a lot of good work

Positive action scenario:
—Pressure - Your are working your butt off to finish your shift at work and are stressed
—Opportunity - A loved one wants to grab dinner and watch a movie
—Rationale - You deserve this and earned it

There is greatness in our future. We should choose the life triangle! —Elliot Bodtick

3. Becoming a Mom, and a Caregiver

Becoming a mom changes you. I don’t think we are ever the same once we bring a life into the world. And yet that's the easy part. Being a mom can be the most rewarding, challenging, and loving experience a person can have in their life. Even then, worry and anxiety are unavoidable!

Before children, I slept through the night; that uninterrupted bliss of a good rest. With young children I worried about them falling, choking, or getting lost. With age the anxiety grew. When my sons got their driver's license and became more independent, I wouldn’t really sleep until they got home. I wasn't so much worried about them as I was worried for them. I found comfort from others, that loving touch that says, “everything will be ok” or being reminded that “bad news travels fast,” all helped me to manage my worrying and decrease the associated anxiety.

Having a community means that there is someone there to listen and comfort you. When one child is facing his or her own demons, seeking resources beyond those immediately impacted can provide help not only to the child but to the rest of the family. Much has been written about the stress of caregiving - whether for a spouse, an aging parent, or a child/young adult with an addiction. Learning to cope with being a caregiver means being aware of changes in your level of “compassion fatigue”, making self-care a priority, spending time with friends or with a support group, writing in a journal, and/or speaking with a counselor or therapist. Caring for oneself results in a healthier relationship with your family, a healthier relationship with your friends, and a healthier relationship with yourself. —Linda Strause

2. Experiencing Addiction:
Cannabis As Harm Reduction In Recovery

Everyone's experience recovering from addiction is different because everyone's experience with addiction is unique. Addiction is often related to anxiety, depression, and obsessive compulsive behavior. To resolve the former we must first address the latter. There are many ways for people to become addicted, either by choice or accident. Ultimately it's the compulsive addictive behavior that drives addiction long term and only by breaking those habits can we hope for a successful recovery. This is why recovery ultimately requires a community which supports recovery both implicitly and explicitly by providing the opportunities, activities, and human connections that provide the foundation for long term recovery.

When you are suffering from addiction you often find yourself in the company of addicts, surrounded by people whose compulsive addictive behavior encourages and reinforces your own. One of the ways that I have found success in my recovery is by connecting with the cannabis plant in the same way as I connected with my dealer. I realize that at some level I'm substituting one addiction for another. However, I realized the potential harm is so much less. I'll never overdose from cannabis, I'll never have to compromise myself to get more, and if I want, I can grow my own cannabis each year.

Cannabis has been the key to my recovery. Not only does it help address the issues that drove my addiction but it also provides a community of like minded people who have all found their peace through this plant. I'm always amazed at how much this plant can do for humanity and for the planet. For me, it's part of my harm reduction strategy to be successful in my recovery and continue to feel like I'm a part of a community. —Linda Strause

1. The Evolution of Hope: Managing Hope in Recovery

There are countless ways people become addicted, some by choice, others by accident. Whatever your journey is, addiction reinforces the behaviors which drive the addiction. Breaking the cycle of addiction requires not only changing your habits but also your attitude and relationships with others. Addicts tend to associate with other addicts often struggling with the same feelings and despair over their life and the choices and mistakes that led them to a life of addiction. They may find them praying for a miracle, to be delivered from their addiction, and relieved of their despair. Unfortunately, for addicts, prayers aren't always heard.
According to the national institutes on drug abuse the relapse rate for addicts in recovery is estimated to be between 40-60%, which is similar to rates of relapse for other chronic conditions such as hypertension or asthma. This suggests that success in recovery depends on compliance with the recovery process. For some, recovery is a life-long commitment with each day bringing a renewed commitment to sobriety. Sobriety can mean different things to different people. For some, sobriety means abstinence while for others it means moderation. Finding the right balance means hoping for the best possible outcome and praying for the strength and fortitude to persevere and achieve it. I believe that hope is fluid. When my husband was dying I found that I got upset when someone would ask if I had ‘given up hope’. I decided that there is an Evolution of Hope, as one moves from hoping for a cure, hoping for more time, hoping for comfort, dignity, and peace. Recovery is only possible if you want it and only successful if you realize it's more to do with managing hope or our expectations than it does praying for a miracle or a magic silver bullet.
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Linda Strause, PhD Professor, University of California, San Diego
Co-Founder & Vice President
G. Randall & Sons
Dr. Strause is an advocate for the better understanding of the science and medicine of cannabis. She and her team of cannabis experts at Randy's Club consult with customers and patients from all over the world. They have been integrating medical cannabis since 2010.

Dr. Strause combines over 30 years in clinical research and as a professor of nutrition at UC San Diego, with her peronal journey: her husband's diagnosis and death from brain cancer. She has been interviewed by KCBQ and by Dr. Jamie Corron of the Center for Medical Cannabis Education. She was recently selected to be interviewed by Authority Magazine for their series, Women Leaders in Cannabis.

Call SAMHSA National Hotline at 1-800-662-4357
National Suicide Hot Line 1-800-273-8255
Click on findtreatment.gov for Local Crisis Services
Free Naxalone (Narcan) at www.nextdistro.org

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