Confronting the Addiction Voice on the Road to Recovery

Richard D. Lewis
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Part 3 of “Addiction, Biological Psychiatry and the Disease Model”

Part 1 of this series critically examined how the disease model of addiction, including current forms of accepted treatment protocols, intersects with the genetically based “mental illness” theory and practice propagated by Biological Psychiatry. Part 2 analyzed the serious limitations, and sometimes harmful effects of the domination of addiction treatment by the Twelve Step (disease model), and how Biological Psychiatry has both seized upon and expanded the culture of addiction in this country by promoting its related “disease/psychotropic drug model”. What follows will be a presentation of some alternative methods for overcoming addiction problems that focuses more on individual choice and skill building (within a social support setting) as opposed to becoming subservient to any group or “higher power” or accepting any labels denoting personal defects or some type of disease process.

In recent years (and on the MIA blog) many people have written about the nature of “hearing voices,” including what can be learned from this phenomena and how to gain more control of its effects on thoughts and behaviors and on one’s overall life process. For certain people their “voices” were thought to come from outside themselves and represent something unknown or even scary, especially when it involved concepts of “good vs. evil.” Others have suggested that people can eventually become aware that their “voices” represent certain internal personal or moral conflicts that can often get expressed or represented by familiar people in their own lives, such as a critical mother or father, or on the positive side, a more inspirational voice of a key figure from their present or past. The ultimate goal for such people is not necessarily to make the “voices” go away but instead to more deeply understand what they represent in their lives and what they can learn from their presence. And in some cases people are actually encouraged to talk back to or even confront their “voices.” This can become a way of gaining self-empowerment and also as a way of redirecting their thoughts and behaviors in a more positive and healthy direction.

In a similar vein the “addiction voice” (along with the “negative voice,” the “procrastination voice” etc.) is one of many other “voices” that people can choose to identify as part of the normal human process of “internal self-dialogue.” In this case the “addiction Voice” is a particular form of self-dialogue related to conflicting choices over what repetitive thoughts and behaviors will either benefit or harm us, or perhaps end up dominating our lives at any given time. We may all be familiar with this particular voice; you know the one that says “you’ve had a hard week …; you deserve to reward yourself…; You can just do a little…; this time will be different….”

In opposition to the “disease model” of addiction, cognitive/behavioral therapy approaches have historically focused more attention on a person’s thought patterns that actually precede a choice to continue an addictive behavior, rather than on any underlying disease process. In 1986 Jack Trimpey, a social worker from California who conquered his own longstanding alcohol problem after dropping out of Alcoholics Anonymous (AA), developed something very new and revolutionary in modern addiction treatment. He adapted and modified some principles of Albert Ellis’ Rational Emotive Behavior Therapy (REBT) to start Rational Recovery (RR). He viewed this as a clear alternative to the disease model of continuous recovery promoted by AA, an approach that he stated clearly never worked for him and many others he had encountered in Twelve Step programs.

Trimpey developed “Addictive Voice Recognition Therapy” (AVRT) which encouraged people to first recognize that they have an “addictive voice,” and then develop the skills to outsmart it and put it in its place. This meant that people could use both their own willpower together with various cognitive skills to rationally examine any thoughts justifying further substance use, and then ultimately choose, once and for all, to stop permanently. Therapy or any group attendance was not essential in this process, and in later years he determined that it would only get in the way of permanent recovery.

In 1989 Jack Trimpey published the The Small Book ; this promoted the new Rational Recovery approach together with the an alternative form of group meetings which first started in California and gradually spread across the country. These groups were still tiny in number compared to Twelve Step groups but their presence created an immediate stir in the recovery community. Rational Recovery together with the important writings of Stanton Peele, such as The Diseasing of America (1989) and The Truth About Addiction and Recovery (1991) sent powerful shockwaves throughout the entire Twelve Step disease oriented movement and treatment industry (see Part 2 of this blog series for a critical analysis of Twelve Step theory and practice).

In 1994 Smart Recovery was formed as a split off from Rational Recovery due to Jack Trimpey’s desire to maintain control of the RR’s (AVRT), which he patented and wanted to personally financially profit from its growth. Smart Recovery has since gone on to become a non-profit self-help group in the tradition of AA, but of course with a program opposed to the Disease Model and employing many addiction breaking skills modified from Rational Emotive Behavior Therapy. Smart Recovery.com can be accessed online and provides many helpful resources, including online meetings, for those in need.

Jack Trimpey, in this writer’s view, has since gone on to become quite dogmatic in his views and has adopted a “one road” and “my way or the highway” approach to recovery that reminds one of the very Twelve Step programs that ironically led him to create an alternative to AA. Some people have also questioned some of his political views, and I would certainly question the fact that he has had (in the mid 90’s I questioned him about this at a presentation near Boston) no criticism of the abuses related to psychotropic drugs. Nevertheless, he remains a very good read due to his no nonsense style of writing and his AVRT approach to challenging and defeating self-destructive thought patterns.

There have been other groups and individual writers who have questioned the disease model of addiction and provided useful alternatives to Twelve Step philosophy. These books can be found in most libraries or the self-help section of any bookstore. There are also numerous recovery related blogs online that can be accessed with the simple click of a finger. What follows will be this writer’s attempt at combining some of Jack Trimpey’s AVRT approach together with other cognitive behavioral techniques, including some of my own additions and modifications for breaking all types of addictive behaviors.

Confronting the Addiction Voice

People with addictions are usually “of two minds.” That is, one side of them knows they have a problem and is contemplating stopping, and the other side wants to continue the behavior. Speaking for the “old self” that wants to continue the addictive behavior is the “addiction voice.” The “addiction voice” is very demanding and manipulative and thinks in the short term very much like a child; “I want what I want when I want it.” It speaks for a more primitive part of the brain that desires to only repeat behaviors that provide immediate pleasure regardless of the long term consequences.

The “addiction voice” can be clever at times but ultimately it is very stupid when it is finally put to the test of rational thinking. The “addiction voice” will usually have “kernels of truth” in what it says, such as, “you’ve had a tough week… you deserve to reward yourself and get rid of your stress…” but of course there will be major “lies of omission” in the content of its seductive thought patterns. It will not want you to think beyond the next few hours, and it will not tell you of the ultimate consequences of your choice to engage in an addictive behavior. Two questions the “addiction voice” will not want to answer are the following: “How long will I feel good?” and “What price will I pay for my choice?”

These questions are like holding up the cross before the addiction Devil. But these questions must be asked, and yes, answered accurately and truthfully in order to successfully change addictive behaviors. Put the benefits (of the substance or behavior) on one side of the scale and the negative consequences on the other. If and when the negative consequences significantly outweigh the benefits, it’s clearly overtime to end the behavior in question.

The “rational voice” or “voice of sobriety” represents the “new you” that knows it is time to make a change and permanently stop the addictive behavior that is causing so many problems in your life. While the “addiction voice” has major “lies of omission” in its content, the “rational voice” has all the truth and facts on its side. The “new you” knows the true answers to the two questions posed above. If one were to take out a microscope and carefully examine one’s true relationship with the identified addictive behavior, it is clear that in the final analysis any enjoyment will be very short-lived and the price paid will be extremely high when the dust settles. The “addiction voice” is always more focused on the “euphoric recall” of short term pleasure memories, and has “selective amnesia” when it comes to all the negative consequences related to the addictive behavior.

Recovery (here defined as: permanently ending an addictive behavior pattern) usually involves a person going on a detective mission learning the modus operandi (or mode of operation) of their “addiction voice”, that is, how does it set up the crime (convince you to start the addictive behavior), carry out the crime (keep you engaged in the addictive behavior), and cover up the crime (make excuses and rationalizations for the behavior after the episode ends). The more knowledgeable a person becomes about these specific aspects of their thought patterns supporting their addictive behavior, the better chance they have to end it once and for all.

When confronting your “addiction voice” treat it like a hostile witness, as if you were a prosecuting attorney tearing apart the testimony of a key witness in a very important trial. The “addiction voice” deserves no respect; it is up to no good and wants to harm you. Early in your battle with the “addiction voice” you might give it some “tactical respect”; that is, if you feel particularly vulnerable at any given moment, you might employ some “thought stopping” techniques and distract yourself with another activity or engage in contact with a supportive person. But ultimately we will all end up (sooner or later) in a conversation with the “addiction voice,” and strategically we have nothing to fear, because the truth is on our side.

Once again the “addiction voice” can only tell “lies of omission” and distort the nature of your relationship with the substance and/or behavior. Even in the most desperate of circumstances when a person is down and out and has a bad case of the “f… it’s,” the “addiction voice” might say “you couldn’t feel any worse than you do now and at least you will get a few hours of pleasure or numbing if you engage in the behavior.” Even this is a bold faced lie, because when all is said and done you most certainly WILL do more damage and END UP feeling worse; a careful examination of your own past experience will tell you this over and over again.

The “addiction voice” doesn’t always just rush in the front door and say “Let’s go get some cocaine, or let’s go gamble.” Quite often it will try a “side door” or “back door” approach. That is, it might suggest you go to a certain location or visit a certain person you haven’t seen for a while, “you know just to see how they are doing.” Now of course that person 50 percent of time will have one of your drugs of choice, and once you are there and these substances are now likely offered to you (sometimes for free if you haven’t been around for a while) your “addiction voice” will now say “Gee, you can’t really pass this free opportunity up, and after all you can do just a little, just this one time…” Knowing all these “side door” and “back door” approaches can also help people avoid various addiction “triggers” that can contribute to a relapse.

The “addiction voice” will most likely never completely go away, but as your state of permanent abstinence continues it should talk at you less often, perhaps even weeks or months may go by without a significant discussion/confrontation with your “addiction voice.” As your combative skills develop and you are successful in confronting it over and over again, so will your overall confidence grow stronger in the direction of having a life totally free of addiction. You will definitely make other mistakes in life, but relapse does not have to be one of them.

It can be helpful to make a distinction between “addictive thoughts” on the one hand and major “urges and cravings” on the other. Mere thoughts are normal given that the past addictive behavior may have continued for years; there may be literally hundreds of associations with these old behaviors in your everyday life. These types of thoughts may often come in one’s mind and be pushed out quickly with seemingly little effort. Major “urges and cravings,” however, are more serious and need to be dealt with quickly and decisively, otherwise they can become more dangerous. “Urges and cravings” are actually addictive thoughts that a person ends up playing with for an extended period of time.

The longer you give a “dark thought” or any “addictive thought,” (advocating for a self-destructive behavior), permission to circulate in your brain, the more dangerous it becomes. Those types of thought patterns (and by the way, no one is immune from having them) should not be allowed any credibility to rent space in our heads; for the longer we think about them the more likely we are to act on them; the eviction process needs to start as soon as they enter one’s conscious thoughts.

Confronting and defeating the “addiction voice” is one of the most powerful weapons we can use against addictive behaviors. Even in Twelve Step programs there are occasional references made to people knowing how to talk back to the “Shit Fairy on your shoulder” or the “monkey on your back” that promotes “Stinkin’ Thinkin’.” It has yet to be proven, but I believe regardless of what approach for recovery a person chooses to use, those people who get better skilled at both recognizing and confronting their “addiction voice” are going to have the most success at achieving permanent abstinence.

As an aside, similar things can be said about confronting the “negative voice” and the “anxious voice” for those people experiencing chronic depression or anxiety. And yes, sometimes the “negative voice” and the “addiction voice” can seem like they are working together. That is, if you start thinking too negatively about life it can be easier for the “addiction voice” to convince you that a drink or a drug looks good, or that gambling makes perfect sense. In the long run it is important to learn how to manage ALL these “voices” in order to maintain a safe and productive lifestyle.

In addition to the above mentioned cognitive skill building, there are other necessary and related components to ending addictive behaviors. Stanton Peele in his book, 7 Tools to Beat Addiction (2004), identifies the following important tools:

1) Values: Building on Your Values Foundation.

2) Motivation: Activating Your Desire to Quit.

3) Rewards: Weighing the Cost and Benefits of Addiction.

4) Resources: Identifying Strengths and Weaknesses; Developing Skills to Fill the Gaps.

a. Support: Getting Help from Those Nearest You.

b. A Mature Identity: Growing into Self-respect and Responsibility.

c. Higher Goals: Pursuing and Accomplishing Things of Value.

My last point regarding different cognitive approaches briefly focuses on a psychodynamic analysis of the potential danger of not coming to terms with early trauma experiences. Dr. Lance Dodes in his interesting book, The Heart of Addiction (2003), makes the following powerful observation: “Virtually every addictive act is preceded by a feeling of helplessness or powerlessness. Addictive behavior functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, of regaining control-over one’s emotional experience and one’s life.”

According to Dodes this can be true even when the actual behavior is self-destructive in nature. Dodes’ analysis goes on to relate how this feeling of powerlessness prior to an addictive behavior is closely related to similar feelings that actually first originate out of earlier trauma like experiences. He goes on to explain how vital it is for a person with an addiction to make these connections in their own life experience in order to work towards finally gain control over their behavior. My own experience working in the counseling field tells me that unresolved trauma issues can sometimes lead to core low self-esteem that can contribute to thought patterns that justify or “trigger” a relapse back into addiction, even after a significant period of abstinence. Trauma work can be an important and sometimes necessary part of the process of successfully ending all addictive behaviors.

Overcoming addictions and other forms of extreme states of psychological distress requires working on two fronts of battle; both the “cognitive” AND the “physical.” Having already focused mainly on the “cognitive” front, let’s take a quick look at the “physical” side of the transformation process. I would definitely add the following activities that seem to have some scientifically proven benefits: regular exercise, including walking, running, yoga, weight resistant training, together with frequent meditation. These CANNOT be underestimated in their overall importance as part of any recovery program. These are all proven antidepressants combined with anti-anxiety qualities without the harmful side effects and major withdrawal syndromes.

While the focus of Part 3 of this series was clearly on developing cognitive skills, it is not in any way meant to diminish the significance of combining cognitive skill building with physical skill building (and meditation involves both the mental and the physical at the same time). Many of you may recall one blogger on this site devoted an entire blog to the powerful benefits of walking for his withdrawal program from psychotropic drugs, especially benzos.

Research so far has determined that no particular recovery method or therapy approach has proven more successful than another. Developing a positive working relationship with both caregivers and other social supports has been identified as perhaps the most vital factor leading to successful outcomes. The “Many Roads, One Journey” approach may best describe how each person seeking an end to their addiction should view their own recovery process. So find good social support and then fill up your tool box with as many tools and weapons as possible; find the ones that work best for you, and then go to work; your life may depend on it.

In Part 1 of this series I stated: “Addiction and extreme states of psychological distress can become more humanely treated through some reforms, but they will never be fully eradicated, or humanely treated on a broad scale, until the material conditions from which they have emerged are transformed in a truly revolutionary way.” To more forcefully make this point, if every community in this country practiced “Open Dialogue” and had Soteria House type programs available for everyone in extreme psychological distress; and with addictions, if everyone who had a problem was exposed to the best help possible in the most supportive environments with all the best treatment methods available, would all this significantly eradicate the symptoms labeled as “mental illness” or those labeled as major “addictions?” I believe the answer is “no, it would not.” Yes, some people would definitely benefit and resolve their problems, but the reality is that all these reforms will NOT eliminate the daily trauma experiences endlessly spewing out of this system. Poverty, racism, patriarchy, and other forms of mental and physical violence that are so endemic to modern capitalist society will all still be here. This system has a way of crushing human resilience even where there are great efforts to sustain and build it up. We must never forget this. We must continue to fight for reforms, but only as part of the struggle for more fundamental revolutionary transformation. There is much work to be done.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

18 COMMENTS

  1. I like this, “This system has a way of crushing human resilience even where there are great efforts to sustain and build it up. We must never forget this. We must continue to fight for reforms, but only as part of the struggle for more fundamental revolutionary transformation. There is much work to be done.”

    to the barricades!

    Now the English psychologist and writer who echoes this is David Smail. Here is his website: http://www.davidsmail.info/introfra.htm

    where it says:

    “Hardly any of the ‘symptoms’ of psychological distress may correctly be seen as medical matters. The so-called psychiatric ‘disorders’ are nothing to do with faulty biology, nor indeed are they the outcome of individual moral weakness or other personal failing. They are the creation of the social world in which we live, and that world is structured by power.
    Social power may be defined as the means of obtaining security or advantage, and it will be exercised within any given society in a variety of forms: coercive (force), economic (money power) and ideological (the control of meaning). Power is the dynamic which keeps the social world in motion. It may be used for good or for ill.
    One cannot hope to understand the phenomena of psychological distress, nor begin to think what can be done about them, without an analysis of how power is distributed and exercised within society.”

    As for, “Addiction,” Dorothy Rowe wrote that many things give us short term pleasure (alcohol, drugs, sugar, gambling, sex, wibbling away time on facebook). They can be used to take our minds of the things that frighten us. But this does not need to be called addiction.

    All succesful, “Addiction,” programmes help us deal with the fears that drive the addiction and make more realistic and sensible uses of the things that give short term pleasure (or so I hope) whatever technique they use.

    Maybe addiction should really refer to those drugs which cause us real craving, like tabacco, or have painful and dangerous withdrawals such as many find with anti-dpressants.

  2. Richard,

    Great topic and post.

    I am another another one of those folks who tried AA and felt like it was not a match – for several reasons. One of the main things I didn’t feel was helpful for me was the intensity of the meetings.

    I used to attend AA meetings with no intent on drinking, only to find myself buying a 12 pack of beer on the way home… to try to calm down from the intensity. It was a one-size-fits-all program that fit too tight around the collar. At least for me.

    I met with a support group once a week for a couple of years. The thoughts I used to have about *not drinking* when I used to drink were replaced with thoughts about *drinking* for the first couple of years. They were at times tough, but they had one thing in common – they always *passed*.

    For the next 24 years, I didn’t think about *drinking* or *not drinking*. I just don’t drink. That’s all. And I don’t spend a lot of time with it.

    And it’s worked for me for the past 26 years.
    I don’t think any group or program has earned any monopoly.
    Whatever works is what works.

    Duane

    • And I’m convinced there are folks out there who have been hospitalized for (what used to more appropriately was called) a breakdown, who found their own special ways to fully recover.

      Often without any professional help whatsoever.
      They just moved on.
      Unfortunately, we don’t hear from them on this site.

      IMO, it’s because they realize that to continue to talk about the past tends to keep a person stuck.

      Duane

  3. Richard,

    I just posted a response to your critque of my post on Cindy’s blog about the war on psychotherapy and I am reposting it here since you asked me to read and comment on your articles here.

    Hi Richard,

    I recently read your latest addiction article and having done lots of research on this from trauma and other perspectives, I was VERY IMPRESSED with it in terms of its empathy toward those suffering from “addiction,” which includes ALL OF US, in this alienated Capitalistic materialistic, often oppressive environment. I have been meaning to write a comment on your blog commending you for such an excellent, compassionate approach to “addiction” and its many causes that debunks the disease, biopsychiatry fraud that hijacked the movement. The expansion of addiction “disease” in the pseudoscience DSM V is just another greedy power/money grab per usual to the great detriment of its many victims. I do think AA can be a useful adjunct especially for men once one learns the truth and facts about “addictions,” given their long term practical experience, but I also think their powerlessness permanent disease approach and some practices that amount to bullying and cult status can be very harmful if one is unable to pick the wheat from the chaff. There are now 12 step groups for overeating (OA), nicotine addiction (NA), Debtors, Codependents, ACOA’s, Emotions and on and on. Choose your poison!

    I have suffered from various addictions from childhood on including smoking, overeating, workaholism, shopping, perfectionism and others, so as you say, none of us is immune. I have finally learned that certain junk foods with sugar, salt and fat have been manufactured to addict us like cigarettes that has helped me to overcome these plagues by avoiding them and adopting a more healthy diet like EAT TO LIVE and using abstinence to quit smoking since there is no other way for me (that includes sugar and junk food). See books like THE END OF OVEREATING by Dr. David Kessler.

    For the many who suffer from PTSD, “addiction” is one of its many typical symptoms, so I despise the mental death profession’s attempts to demonize people who self medicate with alcohol/drugs and other “addictions.” Dr. Loren Mosher exposes the abject hypocrisy of the mental death profession railing against alcohol and illegal drugs as criminal as opposed to their supposed good drugs from which they can make a profit in his famous resignation letter in disgust from the APA that can be found online.

    You have certainly done your homework by including many of the latest approaches to “addiction” that I found in my own research like Stanton Peele’s excellent work like THE TRUTH ABOUT ADDICTION AND RECOVERY and the book you cite, Trimpey’s SMALL BOOK (and also THE FEAST BEAST for overeating), and others you include in your very thorough article.

    Other great books that challenge the AA or medical disease model are HEAVY DRINKING by Fingarette and ADDICTION IS A CHOICE by Schaler. Since the bogus biological/psychiatric addiction treatment industry makes billions, such whistleblowers have taken a great deal of heat and abuse for challenging the mental death addiction industry.

    Another enlightened expert on addiction is Dr. Mate Gabor in his great book, THE REALM OF THE HUNGRY GHOSTS, whereby like you, he understands that abusive, unjust social conditions from childhood on often create the conditions for addiction though he too admits we are all addicted in one way or another including himself given our oppressive capitalistic environment. He exposes the crime and hypocrisy of demonizing and criminalizing such abused, traumatized people.

    http://www.amazon.com/Realm-Hungry-Ghosts-Encounters-Addiction/dp/155643880X/ref=sr_1_1?s=books&ie=UTF8&qid=1363560768&sr=1-1&keywords=the+realm+of+hungry+ghosts

    The book, THE PLEASURE TRAP, is another great book about how certain substances like certain foods, drugs and other experiences can hijack certain parts of our brains and cause us much long term grief for these short term pleasures as you point out in your article.

    Anyway, per your request, I did not find one word or thought in your article that made my blood boil like Cindy’s glib statement in passing that “of course, therapists had to use the DSM for insurance purposes” without any acknowledgement of the huge harm in doing so.

    Therefore, I think you are off the mark for saying that I am being counterproductive with this criticism of Cindy’s post because many experts and survivors on this blog and elsewhere like Dr. Paula Caplan agree that BOGUS DSM STIGMAS ARE THE MAJOR IF NOT THE SOURCE OF HARM FROM THE MENTAL DEATH PROFESSION that lead to all the other evil harm and destruction of people’s lives. Given that biopsychiatry in bed with BIG PHARMA promotes the evil lies that these VOTED IN junk science DSM stigmas are genetic, chemical imbalances, faulty brain wiring and other self serving LIES, and the fact that electronic records are going to be adopted more frequently, to glibly pretend that doling out such stigmas in not harmful is unbelievable coming from someone who claims to be part of the solution rather than the problem.

    I have mentioned elsewhere that if all else fails, the approach taken by Gary Greenberg (who has posted here) in his book MANUFACTURING DEPRESSION may be part of the solution. He claims that he explains the problem of insurance requiring a less than ideal DSM diagnosis for payment and offers to fill out the paperwork for insurance if the client desires while requiring payment up front. Many patients opt to forgo insurance once they understand the problem. This may not be ideal, but many clients CAN afford to pay and would do so if made to understand the harm of bogus DSM stigmas. Then, perhaps therapists could use a sliding scale to avoid using stigmas on anyone given one’s ability to pay. Again, this isn’t an ideal solution, but better than blindly pretending along with psychiatrists that DSM stigmas as a way to get paid is appropriate or even a “necessary evil.”

    I apologize for anything I have said here that is politically incorrect, but I’m not as much worried about political incorrectness as doing anything that would aid and abet biopsychiatry’s death sentence DSM stigmas to push the latest lethal drugs and torture treatments on patent while robbing the stigmatized of all human, civil, democratic and other rights.

    I understand that Cindy probably has good intentions, but we all know that the road to hell is paved with good intentions and being sucked into biopsychiatry’s death trap is definitely hell on earth as any survivor would acknowledge.

  4. Richard,

    Per your request, I commented on some concerns I had about your first article under the article itself so that I could refer to the article as needed and I thought that made more sense for future readers since we were already mixing up blogs on this post enough already.

    Donna

  5. “Smart Recovery has since gone on to become a non-profit self-help group in the tradition of AA”

    I see a vested interest in smart online, tom horvath is ceo of smart, yet he has his own private fee paying clinic, http://www.practicalrecovery.com/dr-horvaths-story/

    Smart online is just another way for him to recruit more customers, at least jack trimpey is honest about his site.

    Don’t say anything on smart against a/a or you’ll be banned, now come on can’t you see what he’s up to?

  6. Richard,
    I work in the state of New Jersey. In 2010 Division of Mental Health and Division of Substance Abuse and Addiction were combined into one department. There was an RFP from DMHAS for three Respite houses in NJ (New Brunswick, Haledon which is near Paterson, and in Ocean County; the last one will be run by Drenk Behavioral). The funding is coming from this source and we’ll also have to bill Medicaid. I was working to start a Soteria House in New Brunswick. While I could collaborate with the Respite house, I have concerns about how the Medicaid billing would influence treatment options. Any advice?

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