What We Take for Granted

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.
– Nora D. Volkow, M.D

Advances in Addiction and Recovery: NADAACNora D. Volkow, M.D., has written an eloquent, state-of-the-science essay on addictions treatment that is a must-read for all people struggling with addictions, for those who love them, for those who treat them, and for those who represent them. Given the statistics on the prevalence of addiction and its impact on everyone’s lives, that would be all of us.

Volkow is Director of the National Institute on Drug Abuse (NIDA) and her essay appears in the Fall 2105 issue of Advances in Addiction & Recovery, the quarterly journal from NADAAC, the association for addictions professionals of which I am a member.

Vokow powerfully expresses the interplay between the felt experience of the person struggling with addiction and the brain science that explains – as simply as I’ve ever read – the complex brain functions that create unbearable feeling states and the resultant behaviors that baffle both the person struggling and everyone else. Given the clarity and compassion with which Volkow expresses difficult concepts, I left a voice mail at NADAAC yesterday asking the organization to please make the full essay available online. It’s currently only available in a .pdf reader which can be reached from here.

I’ve excerpted sections below, about 800 words from the 2600-word essay. I am so deeply grateful to Laurel Sindewald who transcribed the entire essay within hours of my request so I could share excerpts.

To enhance readability, no quotation marks or block quotes are used. The remaining content of this post is comprised of verbatim quotes from “Can the Science of Addiction Help Reduce Stigma?” by Nora D. Volkow, M.D., Advances in Addiction & Recovery, Fall 2015 issue, pages 16-17, 19:

One of the terrible consequences of the slow acceptance of the brain disease model of addiction has been the low rate of adoption of methadone and buprenorphine. Since they are, themselves, opioids, they continue to be viewed as a “crutch,” and do not fit with erroneous but all-too-common perceptions that the addicted person must simply have the strength to endure sobriety, without aid, from day one. This comes from a failure to understand that the brain, which is comprised of the various self-control and reward circuits involved in addiction, is an organ like any other in the body (albeit much more complex), requiring time as well as support to heal. In fact, we do not ask a person who has suffered severe injury as a result of a car accident to walk without aid while their bones engage in self-repair; external support – often, crutches – are needed to take the burden off healing limbs. In some cases long periods of rehabilitation, lasting years, may be needed after accidents, to restore functioning that was lost. Brain diseases are no different.

This ensemble of brain changes [involving not only the reward regions but also several other brain circuits that are involved with executive function including self-control, the processing of negative emotions and memories, and the shaping of behavior through conditioning] could be likened to a broken video game. Because of the conditioning processes described above, the addicted person’s world is like a threatening virtual environment, a landscape calculated to pose maximal threats to their sobriety – in the form of drugs and drug cues – around every corner and lurking in every shadow. Yet the person playing the game must navigate this environment with a broken controller, such that no matter how hard they try to steer clear of hazards, their game-world avatar heads straight for the drug that will lead them to relapse.

I often compare drug addiction to another chronic, relapsing disease, diabetes. In diabetes, the pancreas is not able to make the insulin necessary for our cells to use glucose as fuel. No one thinks that, with sufficient willpower, a person with this condition could push through without medication. Their disease, even if it had behavioral antecedents and may have involved free choices in a person’s past – such as decisions about food or exercise – has a physical basis and requires medical management once it has developed. Fortunately, people often have a basic understanding that the diseased pancreas is the reason people with diabetes require constant medication, and thus no one questions when a person with diabetes excuses themselves before meals to take insulin or requires snacks at odd times. Drug addiction, despite decades of effort, still has not attained an equivalent level of social understanding: Just as the diseased pancreas cannot supply sufficient insulin, the brain affected by addiction cannot supply sufficient self-control, and the addicted person requires medical management – not judgment – to recover and lead a normal life.

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it. The desire to be rid of the drug and its destructive influence on their life and health and relationships is usually quite sincere, but the ability to follow through on the choice not to use the drug has been compromised by their disease. I have seen all too often how the cycle of relapse, and the shame and self-disappointment this disease produces can robe a person of hope and even, in extreme cases, the will to continue living.

Reducing the stigma that still surrounds drug addiction and its treatment requires getting across to the public, including policymakers, physicians, and addicted persons and their families, the complex nature of this condition. The complexity is not only biological but also philosophical, because it affects how we think about our own free will. It requires understanding that something as basic as our ability to make and follow through with choices in our own best interest is rooted in biological mechanisms that can become disrupted by drugs and, in some cases, compromised by a chronic disease.

[End of excerpts from “Can the Science of Addiction Help Reduce Stigma?” by Nora D. Volkow, M.D., Advances in Addiction & Recovery, Fall 2015 issue, pages 16-17, 19.]

How May I Help You?

I wanted to help you. I tried to help you. I thought I could help you.

When I couldn’t help you, I felt heartbroken, baffled, flummoxed, anguished bereft. Why wasn’t my desire to help, my effort to help, working? What was wrong with the help I was offering? Was it insufficient? Ill-conceived? Foundationally flawed and therefore ineffectual? I thought I cared deeply, but did I need to care more? Care better? Would more time, effort, resources, energy, heart and mind have made the difference? Was what I was doing wrong? Was I wrong?

The clichés meant to comfort me distressed me more. I was told, “You can’t change people. They have to want to change,” and “People need to hit rock bottom before they become ready to change.”

Nooooo! Some people are in such a state of distress they can’t see they need to change. They can lack the ability to even conceive of new possibilities for themselves. They can feel too dejected and demoralized to reach out to grasp the hand that’s offered. Some people simply can’t help themselves. The Good Samaritan didn’t leave the wounded by the wayside to die. I won’t either!

Big, wide, soothing bed

The more I gave, the more people didn’t change. They didn’t take care of themselves, didn’t do what was good for them, didn’t step away from disaster. I tried harder and harder and failed more and more. Most of the people didn’t thank me for my efforts. Some of them blamed me for things not being better. If only I were different, if I only did things differently, if only I gave more of this and less of that, then they would be helped. I had just done it wrong. I was wrong.

I dreamed at night of solutions to try in the day. My days filled with effort and emptied of life.

I started remembering the miserable experiments done with dogs using floors that delivered shocks in increasingly smaller spaces. When the whole floor was electrified, the poor dog just laid down, put its head on its paws, and took it.

I was ready to lie down and take my punishment for not knowing enough and not being enough.

Feeling helplessly, hopelessly, powerlessly trapped is a very, very bad scenario for someone with an addiction. The dog has no way out. But I do. I can drink and be free.

Thinking we can and should change people and situations and that if we can’t, we deserve and should be punished, is normal for people with trauma in their histories. It is human nature to wish that things could have been different, to second guess our own behavior and choices, to feel guilty about things that were our responsibility, and to feel the shame of believing we were not good enough or powerful enough to keep what happened from happening.

There’s something compelling about attempting to control people and situations in the present that feels like antidotal balm for what was uncontrollable in the past. The behavior of attempting to wield god-like power over others looks like arrogance, grandiosity, hubris, ego. It’s just sorrow. It’s just desperately trying to get it right this time and not get hurt again.

The good news for me is I know I have a problem. I know I need to change. And I want to.  I don’t want to return to active addiction. I do a billion things to treat myself for what ails me, one of which is attending individual counseling sessions.

I asked my therapist: Why was my help not helping? If it wasn’t my fault, then why was my help not helping?

And because I have tried over the years to share with her what it’s like to be me, and she has tried to hear me and understand, she knew the answer.

Here’s the simple but key quote from the reference she gave me based on this therapy: “[The] present situation exists because of a long chain of events that began far in the past.”

I feel like I’m still letting out a breath I’ve held for over 50 years. I made my bed for the first time in two months.

I majored in history. I was fascinated by the past. I studied it passionately. But I didn’t try to change it. I knew without question that I did not have that power.

Now I understand why I have been confused by the advice, “Let go.” Of what? Power to change anything in the past is not something I ever held.

So. You. I see you sitting in front of me. A billion events, including your own unique, precious, perilous, individual choices along the way – and mine – brought you and me in our current states to this moment right here, right now. I have no power over your past! I have had no power over any choice you have made up until now! I will have no power over your next choice, either! You are you! I am me!

Today, I take full responsibility for what I say and do. Not what you say and do. What I say and do.

You may or may not attribute the responsibility for what you say and do to you. You may attribute it to me. But it’s not a power I have. I see that now.

I tell you something. I’m looking at you and feeling free to appreciate you in ways I never have before. I am so interested in you and how you’ve gotten here.

And I’m so sorry to hear you’re suffering.

I’m open to trying to help. What ideas do you have on how I might be of help? I’ll listen.

Then we can both watch and see what I choose to do next. My intention will be to help – and I so appreciate myself for my desire to help – but what I know, say or do may or may not be of help.

Then we’ll watch and see what you choose to do next.

Thank You for the Good Day

I have felt as if my 1000 days of sobriety were 1000 days of solitude.

As I so hoped, my life did change on October 4.

I listened via live stream – wearing sobriety togs – to all 5 hours of the rally to end the silence about addictions recovery in Washington, D.C. on October 4, 2015. Thanks to UNITE to Face Addiction‘s organizers and participants – including the President via a pre-taped message and the Surgeon General and his staff in full uniform – I feel relieved of an enormous burden.

I’ll stand up for recovery with you.
Vivek Murthy, M.D., U.S. Surgeon General

Selfie Watching UNITE to Face AddictionThe reason I keep my secrets is because I’m afraid I’ll lose you if I tell. I am afraid you will judge what I have done as so shameful that I deserve disconnection. I spent over a year hiding, even from my family, that I had taken the drive of shame to a support group because I couldn’t stop drinking alcohol.

And now the secret is out. I am no longer alone. Everybody knows, or can know, that addiction to alcohol and other drugs is a treatable illness, not a moral failing. I’m not naïve enough to think that stigma is gone. But a D.C. station covered the event, as did The Washington Post. People like Scott Stevens will start to make meaning of the rally and write about it. I do believe social and political change for the better has begun.

Patrick Kennedy: I am an addict. I’ll always be an addict. But I’m an addict in recovery. I count my days. It’s one day at a time.

Lesley Stahl: Is it hard?

Patrick Kennedy: Oh, yeah.

Lesley Stahl: Every day?

Patrick Kennedy: Every day. Some days more than others. But today’s a good day.

60 Minutes interview, 10/4/15

So we’ve had a rally and lots of people in recovery from addictions have shown their faces and they’re smiling so it’s all okay, right?

Even though I felt moved and uplifted during my 5 hours of rally-watching, and even though one would consider me a person in recovery because I have not had a glass of wine or any other alcohol for over 1000 days, tonight, around 5:00 PM, I will long for a drink.

I don’t get off on alcohol. It’s not a pleasure thing for me. It’s not social. I drink alone.

When I drink alcohol, I feel filled with caring warmth that completely eases my sore heart, my tired mind, my hurting body. Nothing, nothing, nothing else in my life today does what alcohol did.

I remember watching my sister lying curled around my nephew when he was a toddler. He scrooched back closer into her body and she shifted to encircle him more closely. I imagine the calm and comfort he felt, the absolute trust he felt in her radiating love and her presence. That’s the only example I can think to offer from within my addiction-changed self that in any way is near what a glass of wine would mean to me tonight.

So I’ve been 1000 days without that. Why wouldn’t the next 1000 day be the same? I so appreciate Patrick Kennedy, who has several thousand days more than I without, not being rah-rah about addictions recovery. A one-day rally in Washington is lovely, but then it’s back to the reality of day after day of the push-pull of want-don’t.

No one should ever have to overcome addiction alone.
– UNITE to Face Addiction

I am one of over 15,000 people in my locale with alcohol and other drug problems. For this all-day, every-day illness, especially for those of us in early recovery, we need all-day, every-day – not one-day, even if it’s a very, very good day – care and support. Because, whether we show our faces or keep silent, not drinking and not using is just hard.

What We Can Do

In July, 2015, I went to a women’s retreat in Tampa and I was asked by a fellow attendee with decades more experience than I have to develop a personal philosophy of recovery. At 2 years and 9 months without alcohol –  and continuing to be plagued by wishing to drink (with less frequency but too often to feel as if I can get on with my life) – my current philosophy of recovery is defined as “what can be done to keep me from drinking.”What we can do for ourselves and together

Since I work with others challenged by addiction, I’ve included “using” to mean using external sources rather than internal sources to handle our inner experiences: illegal substances or legal substances not as prescribed or intended; overeating or undereating food; people, relationships, sex, gambling, shopping, porn and/or other activities or processes.

I have used “we” rather than “I” because, while I am responsible for providing my own 24-7 addictions recovery care, alone, without the help of others? I drink.

Working Hypotheses

  • Pre-drinking or pre-using is a two-fold, heightened internal state: one of strong feelings perceived as unbearable – anxiety, fear, sorrow, pain, grief, loneliness, anger, rage, frustration, joy, agitation, boredom – and a sense of an inability to do anything about them – feeling helpless, hopeless, powerless, overwhelmed, useless, purposeless.
  • Some kind of dynamic exists between the self, addiction, consciousness/awareness/attention, and that heightened feeling state that can result in unconscious drinking or using. This is where will power, determination, commitment, working towards goals, or working to avoid consequences can fail. This is why that heightened internal state must be protected against at all times, at all costs.
  • The primary method we can use to help ease ourselves during heightened states of emotion is 1) become aware that we’re in the midst of that state, 2) calm ourselves just enough to be able to think and become aware of the judgmental statements we’re inwardly making to ourselves that are part of creating the state, 3) refute or transform those thoughts, then 4) further calm and reassure ourselves.
  • Accumulated, unresolved sessions with heightened feelings and negative thinking (“racing thoughts,” “spinning thoughts”) lead to relapse. To counter this power, we strive to find and equip ourselves with individual ways that help us prevent, resolve, work through, counter, or release strong feelings.
  • If we are experiencing strong feelings, most of the time it is not due to outside circumstances but due to inwardly brutalizing ourselves with judgmental self-talk, self-defeating beliefs, and/or pereceiving negative judgments from others, all of which are invoking shame. Brené Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.” In contrast, guilt is “holding something we’ve done or failed to do up against our values and feeling psychological discomfort.” Brown offers this example from her TED talk: “Guilt: I’m sorry. I made a mistake. Shame: I’m sorry. I am a mistake.” (See Lifehacker on the difference between shame and guilt and why it matters.)

Tasks

  • Wrest and liberate our true selves from the past. Address our family of origin issues.
  • Monitor, tolerate, and manage our feelings and thoughts in the present.
  • Occupy, engage and anchor our true selves in the present.
  • Connect with others with common purposes to feel a sense of belonging.
  • Nourish and grow relationships with ourselves and others.
  • Practice radical self-care.*
  • Move from “What is wrong with us?” to “How do we build better lives?”
  • Take time to come to terms with the past, acknowledge personal strengths and limitations, develop our own systems of beliefs and values, and become self-accepting and self-appreciative.

Premises

  • Accept the all-day, every-day nature of this endeavor.
  • Accept the need for on-going physical and emotional self-care to maintain the endurance necessary for the continual effort required to abstain.
  • Accept that healing ourselves will require initiating and maintaining healing relationships with ourselves and with supportive others. While no relationship is perfectly safe, we seek relationships with others with whom we feel worthy and receive enough support and enough safety most of the time.
  • Accept that we are not all-knowing, accept that what we’re thinking may not take all knowledge and all views and all possibilities into account, and consult with others about what we’re thinking before we take action. If we don’t want to tell someone what we’re thinking of doing, that’s a sign that we need to talk with someone about it.
  • Accept that we need help with what we can’t do for ourselves.

Moment-to-Moment Consciousness

  • Pause.
  • Become aware of feeling flooded with emotion – sometimes all we can do is name one of the “big four” feelings: mad, sad, glad, afraid – then reassure and calm ourselves just enough to unsoak the brain so we can think again. (Celebrate this mastery and self-control!)
  • Catch every single self-critical thought. Transform self-critical self-talk into realistic, supportive self-talk. Examples: Negative self-talk: “I am a loser.” Transformed: “I am trying.”
  • Catch every single awfulizing, castrophizing, worst-case-scenario-envisioning, self-alarming, self-terrorizing thought and challenge it. Example: “I am going to die from this!” Challenged: “Right now, I am okay.”
  • From the dire state of believing we are helpless to keep ourselves from feeling overwhelmed, move ourselves to a safer, more objective, discerning place. Example: First thought: “I can’t bear this!” Second thought: “Wow, look how strongly I’m feeling about this. It’s okay. I’ve made it through this before. I’ll make it this time, too.”

On-Going Consciousness

  • Talk about what we’re feeling, thinking and doing with multiple, supportive, trusted others to 1) discharge distress, 2) learn about ourselves as we self-disclose, 3) connect with others through mutual self-disclosure, 4) experience universality by learning of commonality, 5) experience the shame-healing power of non-judgmental acceptance by others.
  • Be a supportive, trustworthy, non-advisory, non-judgmental listener and reciprocate the healing benefits of sharing.
  • Recognize, anticipate, and plan for situations that might trigger drinking or using.
  • Avoid or limit time with people who call us to our pasts, call us to question our value, or trigger shame.
  • Avoid situations and places that might provide environmental cues, triggering a complex decision-making phenomenon over which we have little to no control. (Desensitization might be possible over time but may be impossible in the moment in early recovery.)
  • Use imagination for creative thinking rather than anxious thinking, for fantasizing about recovery experiences rather than drinking or using experiences.
  • Reach out to others to continue to build connections, networks, communities, and relationships.
  • Continue to seek, create, and be open to invitations to new memberships in new or existing communities which are supportive and cohesive.

Consciousness of High Sensitivity

  • Accept the possibility that we might have the characteristic beauties and burdens of being a highly sensitive person.
  • Accept we may have strong, instant, persistent reactivity – rather than discerning responsiveness – to the words and actions of others and to stimuli in our environments.
  • Accept we may have greater difficulty than others regulating our feelings and thoughts.
  • Accept we experience things so strongly – body sensations, body functions, feelings, thoughts, situations, events, smoke alarm beep! perfume! – that we may think we don’t have the capacity to contain the experience within ourselves. What others may experience as physical and emotional discomfort we experience as physical and emotional pain. We have to find individual ways to handle this acuteness. Otherwise, it may become unbearable (see first bullet point) and lead to drinking or using.
  • Be aware enough to put up boundaries between ourselves and difficult others to keep from “catching” their feelings in what could be, for us, risk of emotional “contagion.”
  • Accept we may have the tendency to project or displace our feelings onto others to lighten the load. Example: Internal experience: “I’m feeling like such a loser. Is he/she thinking I’m a loser?” Outward expression to another: “Why are you such a loser?”
  • With those in our inner circles, pre-plan and co-negotiate terms of engagement during heightened feelings states. If we slip and blame or accuse others of our own feelings and thoughts, apologize immediately to preserve personal integrity and to attempt to preserve the relationship.

Limitations

  • In addition to substance use disorders, most people with addictions challenges struggle with the legacy of difficult early lives, trauma, and, frequently, acute levels of anxiety and/or depression. Many have co-occurring substance use disorders and mental illnesses. Luckily, what we can do for ourselves helps with all these conditions. But we have underlying reasons for why we drank or used. Addressing these reasons requires professional help.
  • We need to acknowledge and accept what we cannot do for ourselves by ourselves. Individually, we cannot be our own counselors, psychiatrists, physicians, pharmacists, nutritionists, sponsors, support groups, therapy groups, or communities.

. . . . .

*Radical self-care includes extreme care and training for emotional and physical health, including nutrition, exercise, and sleep. We need to eat recovery-supporting foods in recovery-supporting amounts on a recovery-supporting schedule. We need to exercise and keep moving, i.e. avoid the couch unless meditating. We can ease our ways by accepting that sleep problems are normal for people in recovery and practice radical sleep hygiene to counteract the known challenges.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

I Believe My Life Will Change on October 4

Due to the overwhelming registration responses we received, we have moved this event to a larger location.
News release from the Hazelden Betty Ford Institute for Recovery Advocacy, one of over 500 organizers of UNITE to Face Addiction, the rally in Washington, D.C., October 4, 2015, in support of addictions recovery

When I received an email from my workplace about UNITE to Face Addiction, I began to cry.

No more will I have to do this alone.

Today, I have been without a drink for 1000 days.

1000 Days Sober

They have been the worst 1000 days of my life.

Addiction occurs across a spectrum. Most people recover on their own. I am one of the ones who could not stop drinking on my own, no matter how hard I tried. I am one of the 1 in 15 who can stop drinking through support group attendance. I am also one of the ones who still wants to drink, no matter how hard I try.

That push-pull of want-don’t exhausts me.

But I think what wears me down the most is the feeling of not belonging anymore, and the belief I don’t deserve to. I experience my true self, my inner essence, as compromised by addiction. I feel like I got made into a discardable outlier and I’m trying to find a way to win back membership in the normal distribution. But no matter how hard I try to explain to people who don’t have what I have what it’s like to be me, I just don’t see understanding in their eyes. “Why didn’t you just stop?” “Why do you still have to go to meetings after all this time?” “You can do anything you put your mind to. You put your mind to it and stopped, right?” “Well, you’re okay now that you’ve stopped, right?” “Why can’t you just focus on the positive?”

“Why can’t you be back to the way you were, Anne?”

Oh, oh, if only I could.

With those I know who have what I have, my attempts to sort belief from knowledge about how to feel better and to get better are usually met with resistance, even reprimand. I understand the desperation to hold on to what seems to be working. The consequences of it not working are destruction. But beliefs aren’t helping me. I feel dangerously close to drinking again.

I wish I could find someone to talk to who also sought knowledge.

While I appreciate all the celebrities and public officials who are out about being in recovery from addiction, it’s these people who are sharing their faces and names and stories – who have what I have –  who give me hope.

I’m not idealistic. I think what they’re doing is risky, even dangerous. The fear of people with addiction – addicts and alcoholics – is usually experience-based. I’ve discouraged others in recovery from sharing. In their heart-of-hearts, no matter what they might say, most people believe addiction is a choice. If we wanted to change badly enough, we would. We might say we’re in recovery but the belief is that we could choose not to be at any time. That belief makes interaction with us risky. Hire me? Invite me over for dinner? Let me babysit your kids?

I believe I am suffering because I am under-treated for addiction. Once-per-week individual counseling and support group attendance is not enough to address what ails me, or what ails people who struggle with acute addiction. Many parents get a second mortgage on their homes to pay for rehab for their addicted children. My father hired a team of researchers, of which I was a member, to discover what addiction was, how to treat it, and who was offering that treatment so I could receive it. We found tragic lack of consensus and direction on any of those. Based on our research, I have cobbled together a treatment plan for myself and execute it the best I can. (I sleep each night with a teddy bear because addiction might be an attachment disorder.  What else can a girl in a small town do but everything she can?)

I believe the rally in Washington on October 4 will do wonders for the conversation about stigma and addiction.

What I need for it to do is wonders for the conversation about what truly treats addiction. I’m dying for a drink out here.

I cried so many times when I watched the film The Anonymous People. People like I am walking in local marches?! How brave! And one young woman flashed her sweatshirt at the camera with its one-word logo: Sober.

Words used to describe UNITE to Face Addiction and its mission include “ground-breaking,” “historic,” “transformative.”

Tomorrow night will be held a ground-breaking, historic, transformative event on the scale of a march on Washington in my small town – the first public event ever that celebrates addictions recovery. My boss is the leading advocate for addictions recovery in my small town. She always credits her team, but on this one, she made this event happen.

I ordered a logo-imprinted shirt to wear to her event. I’m trying to get up the courage to wear it to a support group meeting tonight. Some may celebrate with me. Some may accuse me of being the s-word. Out of respect for the reason we meet in secrecy – fear of the consequences of stigma – I will wear a coat over my shirt until I’m inside.

Tomorrow, if I can keep from drinking tonight, I will wear the t-shirt openly and with as much shame-confined pride as I can muster. Given what it’s like to be me, that I’m 1000 days without a drink makes me, well, an outlier. By all rights, according to all the numbers, I should have had a drink by now. I certainly have dreamed of it, longed for it.

On October 4, I will wear the t-shirt by myself while I’m home alone watching the TV, hoping some brave station will cover the brave march on Washington. Maybe after October 4, I’ll wear it to the grocery store or the gym. And maybe in 10 years, people like I am – one in ten Americans – won’t have to wear stand-up, stand-out t-shirts at all. They’ll be getting treatment that’s known to work and feeling better and getting better.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.