It takes a village to treat addiction: whatever works!

Very frequently I am asked, "What is your take on addiction treatment?" This is what think.

The disease of addiction is bigger and overwhelmingly stronger than many of us - patients and treatment providers alike. At the end of untreated addiction, there is deterioration in all areas of life, and subsequently, death. Every addict has a mistress in their addiction. And she is a very cold hearted mistress. The addict will do anything to be with her: steal from anyone; lie or betray anyone; even loved ones and themselves. Addiction is a life-long chronic condition that is lethal if untreated. It needs to be treated with respect ...  and by all means necessary.

The majority of my patients do well in an individually-based and customized treatment environment. I meet every client in that moment exactly where they are. What I like about this approach is that in my office, I can provide complete confidentiality. I am sad to say, but confidentiality can not be guaranteed in group settings - someone always "squeals." Privacy is very important for all my patients. Unfortunatelyl, "addict" is still a dirty word in the English language. For that same reason, I ask all my clients to consider the consequences of using insurance in paying for addiction treatment: what are the long term effects of having "addiction" on your medical record?

Very often, my clients have symptoms of depression and anxiety that either pre-date their addiction, or were developed as a result of it. Over the years, I developed very strong professional relationships with psychiatrists in the Bay area, and I can provide each client with a high quality referral for medical evaluation. Not every one needs it, but it is good to have this option available. A word of caution: from my experience, it is important to actually go and see a specialist for psychiatric medications evaluation: either a psychiatrist or Board Certified Addictionologist. Symptoms of addiction can be very complex to manage, and I have seen too many mistakes made by regular physicians resulting in grave consequences.

Addiction treatment also takes time. Over 90% of all clients entering twenty-eight day programs relapse, often shortly after release. Why? Because they were taken out of the world for four weeks, kept safe, taught addiction basics, and then let out to that same world that they could not deal in the first place. From my fourteen years of treating addiction, the long-term outpatient treatment model works better. In this approach, clients are learning new tools for the world where they need to use them. Success rate for this treatment model - a combination of individualized therapeutic services ( individual, couple's, family therapy) and medication - is closer to 70%.

Of course, there are clients who respond well to external structure of 12-step meetings and group settings to stay clean. If that is what works for them, then I definitely recommend that they should do just that.

It takes a village to treat addiction. Whatever works!



Santa does NOT want you dead!

It has been a while since I blogged: I have been very busy. As I like to say, "I save the world for a living, daily, one person at a time," and clearly, in tough economic times the world needed some serious saving =). And then, as every year, THE HOLIDAYS came!

So I thought that I should say something about it.

Since I started practicing, I have learned not to leave town at the end of December. It is a common knowledge, of course, that holidays mean an increase in depression, anxiety, substance abuse and suicide attempts. Every year there is also a study published somewhere that disputes this claim. Yet, in my experience, at the end of December I get at least one call, or two, or three, which immediately propel me to call 911, direct police to a caller's location, go to ER, or yell on the phone, "Get off the bridge now!" Thanks to the holiday season, I sadly know of many ways to that people harm themselves, and I have unfortunately developed a collection of many harmful objects given to me for safe keeping so that they could not be used.

This year, there have already been three calls. Every year, I repeat to myself, "I just want this to stop!"

Santa means presents, joy, giggles, happiness. Santa does not want you dead! Or your loved ones. Santa -and I=)- do not want you to be sad, lonely, having dark thoughts and hurting yourself. If any of these feelings, or behaviors start to occur, contact someone: a friend, a family member, me. And if you see the symptoms in someone else, please reach out! Warm human contact and care are the best medicine for despair and broken heart, trust me.

And remember, under any circumstances: Santa does NOT want you dead! And neither do I, because as long as you are alive, I can help you.

Happy holidays,

Lubov V. Smith, LMFT


A new website ... and a new look

I've decided to give my website a new look. I also want to take advantage of the new tools available on the web to see if I can integrate my blog thoughts with my work site. Tell me what you think!


Money lenders of love. A sad story.

I want to write about money-lenders of relationships. No, I am not talking about dollars and cents here-yes, I am talking, again, about love.

Remember that universal story about the money lender that loaned money to people in need under the highest percentage? And then he collected, sometimes with brutal force; and afterward-he hoarded it. He never shared. Not for a moment this man could imagine giving away any of his precious gold coins. He never bought anything for himself, never took care of anyone.. He died alone, desperate for human care, surrounded by bags of useless money.

Now picture a relationship. You meet someone, you fall in love, you say "I love you", and the person says, "I cant' say it back. I am not mushy that way." And he/she doesn't. Ever. Or, may be, on special occasions, once every 10 years. Like that money lender, he/she collects from you, without giving anything back. Those are usually unequal, cold relationships. They leave the other person feeling insecure, off balance, starved for affection. Of course, after along time it is possible to learn to live with it-humans, we are adoptable creatures, but it's not really fun.

Do these relationships last? Rarely.. Eventually the starved party meets someone else who recognizes the glimmer of emotional hunger in them, says the magic words, and he/she bolts out.

The money lender gets left, bewildered, saying something like, " But she/he knew I loved him/her, why ?!"

When I work with money lenders, this is the moment when I ask them, "How? How did she/he know about your love if you didn't say it? Through ESP? Really?" The response I get usually involves words "should, actions, I am that way."

That way does not work.

These people behave like there is, somewhere, a giant bank, where the "I love yous" are stored. And all of us have accounts, with a limited amount on them. And once we spend/say "I love you", the accounts will be empty. So they dole it out, rationing, like there will be a word famine on love at any moment. So sad. Such an inept way to live life. Lonely in death.

Am I dramatizing? A little. I like to exaggerate to drive a point home.And, just in case,  I am not one of those Marin county "love saves everything " therapists either =).

I am a therapist that believes that ,like everything else worthwhile, relationships need to be cared for and maintained. Saying " I love you," as much as you can, is a part of that maintenance. That's how your loved one knows - for sure.

Have you said your I love you today? =)


All you need is love? ... and a good therapist.

Relationships - we all have them: with our family, friends, at work, with the One. We are surrounded by them daily. All of us relate. Yet, most of us have no clue how.

Take a long term marriage, for example. How many of us said at least once, "It's bad, because we have been married for a long time"? Huh? So long time equals poor results? Imagine saying that about your career, "I suck at my job because I have been doing it for a years". Why is it, that in everything else, with time invested, we excel, yet, in love, we usually get worse with time?

Yes, I just brought up the "L" word!... Love. "I love you", the most important, profound and misused expression in ,at least, English language. Ideally, in the beginning, we use it to let the One know, "You are the most important, wonderful, exceptional person I have ever met". Later on, it's used to say/mean, "I am tired", or "Leave me alone", or " You are annoying", and two of my all time favorites: "Shut up" and "God, I hate your guts, but I am too chicken to tell you about it." What a change!

Where did that wonderful thing go?!

I get to wonder about things like that every day, for a living. For every person who comes to my office I get to translate: what does their "I love you" mean? Together we look for what happened, is the situation solvable, is it worth solving-some relationships are DOA-dead on arrival; how to solve it. It is always fascinating to me: we all look for love, we all want it, yet, we pay so little attention to it when we get it! What if we did it to our favorite car? Or a child? Why do we expect love to last without any efforts?

"All you need is love", as the song goes..Right!..getting love is easy. Keeping it-in any relationship, that's the challenge.Is it doable? Yes. Is it easy? No. Keep in mind: everything we know about intimate relationships we learn from our primary caretakers - they don't have to be our parents - by the age of five. And it's not a conscious learning process, it's more like an imprint on a brain. Sometimes takes a life time to unlearn.Or, a really good therapist =).

So, until next time: start small - just begin paying attention: what does your "I love you mean?'