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Untreatable (Terminally Unique, Pt. 8/21)
Published in Terminally Unique. Tags: Podcasts, Recovery.
“Untreatable” is the eighth part of a project called Terminally Unique. It features what was originally the fourth chapter from a piece I first published in 2013 called Believed to Be Seen. For more background on what this series is, I suggest starting from the beginning with the introduction titled “A New Pair of Glasses.” And now, to continue on, here is “Untreatable”…
“When a well-packaged web of lies has been sold gradually to the masses over generations, the truth will seem utterly preposterous.” —Dresden James
“Our 1992 Survey showed that only 5% of newcomers to A.A. are still attending meetings after 12 months. This is a truly terrible statistic.” These words are widely attributed to Ron Whitington, Chairman of A.A. Australia’s General Service Board, who is suggested to have been quoted as such from the A.A. Around Australia quarterly newsletter in 1994. Alcoholics Anonymous’ 1989 Triennial Membership Survey is also widely claimed to suggest that very same 5% success rate. Yet while “no one among us has been able to maintain anything like perfect adherence to these principles,” reads The Big Book, it is also “a statistical fact that alcoholics almost never recovered on their own resources.” If the underlying message of this data is to be believed, such assertions as these would appear to distort the reality of Alcoholics Anonymous’ success rate. But what is the truth?
It’s important to remain equally cautious about the “statistical facts” represented as evidence against A.A.’s success rate as those that represent its effectiveness. Take for example the 2011 Alcoholics Anonymous Membership Survey, in which “more than 8,000 A.A. members” participated. Considering that A.A. estimates there are more than two million members worldwide, this means the survey extrapolated data that was collected by less than one-half of one percent of the organization’s total members. The sample size is simply too small to represent much of anything, and its findings are meaningless. What is to be made of the 5% statistic, though?
The basis for the number can be followed back through a few key sources: Rational Recovery, a prominent abstinence program, and a Harvard University report titled “Why People Drop Out of A.A.” Nearly all public reference to the Harvard report funnels back through Rational Recovery’s literature though. As for the other point of evidence, the newsletter featuring Chairman Whitington’s statements is also unavailable. (Alcoholics Anonymous Australia’s National Archivist did however relay the following in response to an inquiry I made about the validity of the statement, “One problem with the survey was that there was only a 3.24% response rate to the questionaire so in the world of statistics this is so small response that it really could not be used. There have been later surveys done in 1996, 2000 and 2005 and phamplets with these results have been produced. Again the reliability and validity of these questionaires have not been tested and the response rates make them iffy. Remember 20 year old information is just that.”) Does this mean the 5% success rate is bogus? That it’s the result of misinformation and misinterpreted data from years gone by, continually resurrected to promote an anti-A.A. agenda?
When recognizing how meaningless the self-reported A.A. membership information might be, it is hardly a risky assumption to suggest the 1989 survey was every bit the questionable representation of the large group the 2011 version is. This is not even to question how a survey of actual A.A. members might somehow elaborate on the recovery trends of non-A.A. members. But the Harvard report and the 1989 survey themselves do not really stir debate here as much as the most important piece of evidence analyzing A.A.’s ongoing retention rates, which came following the 1989 member survey in an internal report titled “Comments on A.A.’s Triennial Surveys.”
Serving as “an analysis of the 1989 survey plus a review of comparable findings of previous surveys,” this report observed trends within Alcoholics Anonymous, using an average of five years of results to “show the probability that a member will remain in the Fellowship a given number of months.” After one month that rate was 19%, meaning 81% of new members did not last a single month; 10% at three months, meaning 90% left the program; and 5% at twelve months; supporting the revelation that 95% of newcomers to A.A. leave the program within their first year. “Individuals may rebel against this result as contradicting our time-honored statement that ‘half get sober right away, another 25% eventually make it’,” continues the report. “That statement applies to observations made at an earlier time, and there is no reason to doubt that changes in society and in A.A. since that time could create a different circumstance today. Like other findings of the survey, this may be a challenge to the membership to ‘change the things we can’t’.”
However eye-opening this information might be, this confusion of perceived success or failure rates only adds another detour for those seeking help in recovery to fester over, creating additional barriers to religious-debate and court-ordered conversion. No doubt the success rate of A.A. as perceived by its members is grossly exaggerated, but in reality any 5% accusations do little more than serve as a distraction by condemning A.A. for defending its process through a host of mock-truths. What might be a better question to ask is why do its members still rely on such heavily defensive statements as “Rarely have we seen a person fail who has thoroughly followed our path,” when its own statistical data suggests otherwise?
If lack of retention equates failure, and failure means that 95% of individuals who have attended A.A. stop attending within a year, such an implication suggests that everyone who left A.A. ended up no better off than they were when they sat in on their first 12 Step meeting. Such assumptions don’t allow for the possibility that within the 95% group, some might have left to pursue other more personally suitable recovery methods, some may have had their court-ordered attendance end, some might not have agreed with the principles of A.A., or some simply did not feel they needed to continue attending. Failure here might as well be considered to be a return to drinking because that’s the picture such an accusation paints, whether or not it is true.
Because of the “spiritual” nature of The Program, there is no conclusive evidence to suggest A.A. helps individuals achieve abstinence, just as there is no conclusive evidence to show that it cannot. Getting angry at A.A. members for promoting idealistic statements that defend their own personal beliefs is about as off the mark as debating how a program that has not made any foundational revisions to its treatment process since the invention of penicillin is supposed to help those seeking progressive recovery. But what is certain, is that Alcoholics Anonymous is only one of many methods for achieving recovery that all have around the same level of success, which are less than the rates of those who successfully pursue abstinence on their own, without any help whatsoever.
Coming in sharp contrast to commonly held beliefs of what it means to be an alcoholic, and supplying further evidence suggesting how significantly flawed the disease-concept is, is the widely documented fact that the majority of alcohol abusers and problem drinkers who look to quit their addiction actually do so without the help of professional treatment or mutual aid groups. Such information refutes the thread of confusion that has spanned nearly a century, weaving its way through public and private discourse, promoted by the most widely used recovery method in America and co-signed by the federal government. After all, the disease of alcoholism is so tremendously complicated that quitting drinking can’t possibly be as easy as making a personal decision to stop drinking. Right?
In 1995 the Harvard Medical School reported that a significant number of problem drinkers recover on their own, a suggestion that was later re-emphasized in the October 1995 Harvard Mental Health Letter which stated that “80 percent of all alcoholics who recover for a year or more do so on their own.” Further, “at least 50% of alcoholics eventually free themselves although only 10% are ever treated.” While it is impossible to corral definitive information in the field – equally as impossible as quantifying an individual’s spiritual growth – such conclusions are also backed by the likes of Swiss sociologist and researcher Harald Klingemann and his contemporaries who have made repeated parallel conclusions. In 2001 Klingemann assessed that 75% of those seeking recovery do so through self-healing or “spontaneous recovery,” while upwards of two-thirds of problem drinkers successfully achieve moderation. “We will see that our new attitude toward liquor has been given us without any thought or effort on our part. It just comes!” Religious conversion aside, The Big Book might have been onto something here.
Many who quit drinking do so on their own accord after negative life events prompt them to make the decision to do so. Be it legal consequences, health problems, physical accidents, excessive blackouts, financial issues, or other such harmful patterns, the majority of those who abuse alcohol only to make the decision that they are going to quit, do so on their own and are successful in doing so for a prolonged period of time. Just as important as recognizing that this information speaks in favor of a self-healing approach, it is equally essential to avoid neglecting treatment based on individual needs by giving consideration to the effectiveness of various treatment models. Even if only 10% of those who need help with their alcohol addiction actually seek it, by that time most are in a state – whether they be emotional annihilated, mentally unstable, physically withdrawn, or any combination of the three – where an outside influence is crucial to re-establishing a healthy base.
The American professional treatment process is largely built around a strong 12 Step foundation with mutual aid methods widely incorporated into inpatient (hospital, recovery center) settings. Out of necessity due to escalating health care costs, the trend is shifting toward an accommodating system that does not boast immediate financial burden on those seeking assistance (essentially, fewer people are able to pay thousands of dollars to attend glorified 12 Step meetings). As the use of outpatient treatment resources increases, so too have the number of services that employ alternative recovery methods.
One of the most underused modes of treatment also speaks to the continued stigma attached to those with alcohol dependencies in the country. “Brief interventions” remove the relationship from that of an individual and an alcoholism treatment specialist by localizing aid with a primary health care provider. Usually brief interventions last a few visits, with the physician first assessing the extent of the patient’s alcohol-related problems (including physical harm and social issues), and then relaying evidence of what further drinking consequence will entail. Once the severity of the individual’s drinking habits has been established, the physician and patient work together in developing a strategy for changing drinking patterns. Supportive evidence of the benefits of brief interventions dates back to studies first conducted by Yedy Israel and David Fleming in the 1990s. These studies separately concluded that such treatment reduced drinking and further alcohol-related problems, yet the stigma associated with the disease concept has helped distance addiction from basic health care.
Due in part to a profit-driven treatment paradigm however, such brief interventions remain something of an anomaly in the U.S. One of the most basic challenges facing the healthcare system with regards to alcohol abuse is simple education among its care providers. Similar to alcohol abuse specialists, there remains spotty standardization in the general care field regarding alcohol dependency, leaving many physicians ill prepared to assess and treat the widely-recognized dual diagnosis factors that often accompany dependency issues. However effective brief interventions may be – and however boldly they might speak to the importance of honoring individual empowerment in the field of dependency recovery – the legal system’s insistence on recognizing specialized treatment models (specifically 12 Step programs) continues to direct individuals through a formal recovery process rather than recognizing alcohol abuse for what it is: a health concern.
Due to the federal insurgence of funding for the disease-concept of alcoholism, what we’re left with is over 13,000 national programs specializing in some form of treatment for alcohol dependency. Not unlike countless other industries, the marketplace boasts both widely recognized name brands such as the Betty Ford Center, Hazelden, and Passages, as well as alternative brands that tout specialized services, like the St. Jude Program. Such businesses typically promote specialized inpatient service care based on one (or a combination) of the recovery methods. While numerous unique techniques have been developed in the country, the following remain the predominant outpatient models for achieving recovery from alcohol dependency in America:
12 Step Programs: Twelve-step treatment, as first constructed by Alcoholics Anonymous, relies on mutual aid groups that offer support primarily through a spiritual approach to recovery. Twelve Step groups rely on the submission of personal control, the examination of past behaviors, reliance on a “sponsor,” the action of making amends, and helping others under the model’s larger ideology. Some groups reshape the framework to speak to their particular faith (Millati Islami is one example of a group that reconfigured the 12 Steps to support Islamic tradition), while others avoid implied religiousness altogether. While A.A. estimates a user base of “over 108,000 groups” in “approximately 170 countries, with an estimated membership of over two million,” 12 Step programs are distinctly prevalent in America, as opposed to internationally where it remains a fringe model of recovery.
Women For Sobriety (W.F.S.): Established in 1976 by sociologist Jean Kirkpatrick, W.F.S. is “the first national self-help program for women alcoholics” and remains a dedicated “self-help program for women with alcohol and/or drug addictions.” W.F.S. recommends daily recommittal to the Thirteen Affirmations of its “New Life Program,” which is based on such fundamentals as positive thinking, metaphysics, meditation, group dynamics, and the pursuit of health through nutrition. Included in these Thirteen Affirmations are statements promoting self-recognition (“I have a life-threatening problem that once had me”), self-confidence (“I am what I think”) and self-esteem (“I am a competent woman and have much to give life”). (When contacted, a W.F.S. representative estimated that there are 150 groups nationally, while noting that such groups remain supplemental to personal growth. Women For Sobriety also offers chat rooms and an online forum for its members.)
Secular Organizations for Sobriety (S.O.S.): Alternately known as “Save Our Selves,” S.O.S. is a non-profit network of mutual support groups founded by James Christopher in 1985 in response to the religious fundamentalism of A.A. In contrast to 12-step recovery, S.O.S. offers six guidelines for sobriety that include self-identification as an alcoholic (or addict), daily reaffirmation, and personal responsibility for sobriety. S.O.S. now boasts over 20,000 members in 1,000 groups worldwide.
Moderation Management: Founded by Audrey Kishline in 1994, Moderation Management is the only group of those included here that explicitly serves to promote “controlled drinking” rather than abstinence. Moderation Management is recommended for users of alcohol who are not dependent drinkers or non-hazard drinkers who look to achieve reduced drinking in their lives. Espousing ideals including “self management,” “balance,” “moderation,” and “personal responsibility,” Moderation Management asks its members to begin with a 30-day period of sobriety before starting the “Nine Steps Toward Moderation and Positive Lifestyle Changes.” While Moderation Management meetings are not widely accessible, resources, forums, and meetings are all available online.
Motivational Enhancement Therapy (M.E.T.): Developed by clinical psychologists William Miller and Stephen Rollnick, M.E.T. is a therapist-administered treatment approach that does not lead individuals through a step-based program, but instead seeks to mobilize and support personal strengths through continual feedback. M.E.T. begins by assessing the severity of an individual’s drinking habits before developing a life strategy based around personal drinking goals.
Rational Recovery: Influenced by cognitive behavioral therapy and the work of Albert Ellis, Rational Recovery places tremendous importance on its Addictive Voice Recognition Technique (A.V.R.T.), “a very simple thinking skill that permits anyone to recover immediately and completely from addiction to alcohol or drug.” Developed by social worker Jack Trimpey in 1986, Rational Recovery adamantly opposes the “12 Step monopoly” of Alcoholics Anonymous and its “one day at a time” ideology, denying the disease concept, and denouncing labels such as “alcoholic.” Instead offering alternative guidance through The Small Book (later rendered obsolete by Rational Recovery: The New Cure for Substance Addiction), the program promotes permanent, planned abstinence through the recognition of an individual’s “addictive voice.” Rational Recovery does not support mutual aid groups, though they do exist.
SMART Recovery (Self-Management and Recovery Training): SMART Recovery offers an evidence-based form of mutual aid support that incorporates ongoing research and developing techniques into its approach. Splitting from Rational Recovery in 1994, SMART was founded with the mission of “teaching [individuals] how to change self-defeating thinking, emotions, and actions; and to work towards long-term satisfactions and quality of life.” SMART Recovery promotes scientific evidence as its main authority, using a “4-Point Program” which strives to help “individuals gain independence from addiction,” including motivational construction, coping with urges, and managing thoughts and behaviors. As of 2011 there are more than 600 SMART Recovery meetings held globally, in addition to over two-dozen weekly online meetings.
Any discussion regarding the effectiveness of one particular model must be prefaced by a quick note on “relapse.” Any number of factors that have little to do with treatment can contribute to an individual’s return to drinking, ranging from cravings to social anxiety to environmental stresses to relationship problems to negative life events to depression. Whether individual planned relapse-prevention follows 12 Step treatment’s typical recommendation of “changing everything” in one’s life to accommodate sobriety, seeks a middle ground through alternative activities to “high-risk” settings (think: Oktoberfest vs. “Oksoberfest”), or is merely written off as a non-factor as it is under Rational Recovery, it’s estimated that roughly 90% of all alcohol dependents who seek treatment are likely to experience at least one occurrence of relapse over the following four years. It’s important not to take that figure as gospel though, because whether conversation be aimed at 12 Step treatment or alternative recovery models, there is a lack of experimental evidence to support any single program’s general effectiveness.
Most evidence regarding particular treatment centers or models is typically self-reported, understandably speaking to that particular method’s comparative superiority, and typically using anecdotal evidence as its definite support. Where Alcoholics Anonymous touts numerous stories (such as a pair of salesmen “who produce as much as five normal salesmen” once recovered using A.A.), Rational Recovery reported a 65% success rate in 1996, based on a group of 250 individuals who had enrolled in its Addictive Voice Recognition Technique course. Likewise, the upscale treatment center Passages touts a 91% success rate based on internally prepared figures. The St. Jude Program recognizes itself as “the only program in the United States that has an independent research company independently verify and measure long term sobriety rates,” relating a 62% success rate of sobriety “for the last 20 years.” This is a startling figure when compared to the previously mentioned data, although the “independent research company” they are using, the Baldwin Research Institute, also happens to be “the parent company of the Saint Jude Country Retreat” – itself financially motivated by the promotion of the St. Jude Program’s high success rate.
Additionally, any assumptions regarding a recovery method’s general success rate disregards the likelihood that outcomes differ greatly from one treatment center, group, or practitioner to the next. The lack of national standards leaves discussion surrounding success rates generally moot as there are simply too many variables that are not controlled in the treatment environment. While relapse and selective sobriety rates remain flimsy indicators of any given program’s value, research has revealed numerous generalized aspects of recovery models that tend to increase the overall effectiveness of treatment.
In the 1990s Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) was designed to offer additional insight into the effectiveness of “Cognitive Behavioral Coping Skills Therapy,” “Motivational Enhancement Therapy,” and “Twelve Step Facilitation.” With some $27 million in federal funding, Project MATCH remains the largest and most expensive alcoholism treatment study on alcohol treatment that has taken place to date, developed to assess characteristics that might help predict which treatment methods are best suited for different types of drinkers.
Over 1,700 individuals previously diagnosed as alcohol dependent (without any other substance dependencies) were recruited from outpatient clinics and similar facilities for the study. These individuals were then randomly assigned to one of the treatment methods which were administered over the course of twelve weeks, and alcohol behavior was then monitored over the course of the following year. While the research did suggest a number of conclusions – individuals who had been more severely dependent on alcohol achieved better results with 12 Step programs than with cognitive behavioral therapy alone, for example – in its aftercare sample, Project MATCH showed no difference in the effectiveness of the three methods during the year that followed.
Subsequent research was critical of the conclusions which stated that “all three treatments evaluated in Project MATCH produced excellent overall outcomes.” “Are Alcoholism Treatments Effective? The Project MATCH Data” by Robert Cutler and David Fishbain thoroughly analyzed the information before making the contrasting assertion that “most of the improvement which is interpreted as treatment effect is not due to treatment.” In his 1997 Science News article “Alcoholics Synonymous,” veteran psychology, anthropology, and mental health-issues reporter Bruce Bowen elaborated on the questionable nature of the study’s findings. “The lack of a nontreatment control group that received as much regular attention and support during the 1-year follow-up as the group given treatment makes it impossible to tell whether any of the Project MATCH interventions had a specific impact.”
Bowen also gauged feedback from other professionals and addressed how the study neglected those who voluntarily enter treatment (rather than those who enroll under the order of courts or employers). Addressing feedback from psychiatrist George Vaillant, Bowen explained that “researchers need to examine differences between alcoholics who succeed in recovering and those who fail, rather than limiting themselves to a search for contrasts among professionally run treatments,” something which no individual program’s “success rate” will ever speak to. “Project MATCH was poorly designed, to say the least,” added psychologist G. Alan Marlatt in Bowen’s article. “Everybody can now project their own views about alcoholism onto this study.”
“No single treatment approach is effective for all persons with alcohol problems,” reads the directive on the Project MATCH report. “A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients.” Regardless of the breadth of its conclusions about the effectiveness of different treatment models, this statement challenges yet another of the roadblocks of the American recovery system: limited implementation of self-matching. Similar to the importance of recognizing individuality in determining the severity of alcohol dependence, that same unique personality must be considered when assessing which treatment method might be best suited toward each individual. This dilemma was at the core of MATCH’s unanswered aim, recognizing that no single treatment method is appropriate for everyone – as A.A.’s 5% figure clearly speaks to – as each person’s situation is accompanied by unique values, beliefs, and drinking goals that will all impact future use.
Self-matching is the process where individuals seek out a form of treatment they feel will be most beneficial to them, often in collaboration with therapists or physicians. Considering that people are more likely to carry through with a course of treatment they have chosen for themselves, as opposed to one chosen for them, it would only make sense that self-matching is widely-practiced. Unfortunately, such measures are not typical to legal and employment interventions which usually fail to entertain personal preference.
One of the most glaring issues that affects the outcome of treatment is something that was not overtly factored into Project MATCH. Paramount to consideration for individuality might actually be the factor of dual diagnosis among alcohol dependents, and how that tends to impact treatment’s effectiveness. Also recognized as “co-morbidity,” dual diagnosis represents the co-existence of an underlying mental illness or behavioral problem in addition to alcohol dependency. Dual diagnosis reports have shown that up to 80% of alcohol dependents suffer from neurotic disorders, up to half suffer from some form of personality disorder, and up to 10% suffer from severe mental illness. Frederick Goodwin, onetime director of the Alcohol, Drug, and Mental Health Administration, co-authored a report suggesting that at least one-third of alcoholics have been given a dual diagnosis; psychologist Michael Hogan counters this relatively low figure with an estimate of 60%, a figure which was also reported by The New York Times in 2011.
Obviously there are indefinite variables related to the prevalence and nature of dual diagnoses, but when considering such high rates among alcohol dependents when formulating an individual’s treatment plan one of the primary considerations that needs to be given is whether an individual’s psychiatric issues are independent of alcohol abuse, or if they are symptomatic of alcohol abuse. This separation is crucial. Serving as Principal Investigator of the US National Co-morbidity Survey, Harvard Medical School’s Ronald Kessler led a team which released a 1994 report revealing that, “for over 80 per cent of respondents, the[ir] mental illness disorder predated substance misuse.” Such an assessment is vital with regards to how the 12 Step model works to confuse related mental health symptoms, and how medication is handled within recovery treatment.
Bill Wilson was outspoken regarding what he felt to be the real causes of alcoholism (none of which were “drinking alcohol”). Two of the main causes of alcoholism he spoke to were “emotional maladjustment” and innate “character defects,” claims which remain widely accepted within the A.A. fellowship. “Our liquor was but a symptom.” As far as The Program is concerned, there remains hope for those who suffer from mental and behavioral disorders as well as the disease of alcoholism, as A.A. boasts of its familiarization with mental illness, “For years we have been working with alcoholics committed to institutions.” Considering such findings as Dr. Kessler’s in understanding that the majority of mental issues predate, and are only exacerbated by, alcohol misuse, for the most part these mental, behavioral, and emotional issues generally recede once individuals have experienced prolonged sobriety. This is where A.A. espouses its healing powers, “Since this book was first published, A.A. has released thousands of alcoholics from asylums and hospitals of every kind. The majority have never returned. The power of God goes deep!” When the body is able to return to a balanced state, mental disorders become less volatile, and oftentimes less pronounced. A.A. takes credit for these changes, undermining any change in well-being experienced due to the mere absence of a chemical depressant.
Not unlike the religious aspects of A.A., this would not be an issue if 12 Step programs were not so hardwired into the American treatment system. The World Health Organization recognizes depression as “the leading cause of disability worldwide,” characterized “by sustained sadness and loss of interest along with psychological, behavioral and physical symptoms.” The National Institute of Mental Health (N.I.M.H.) suggests that “depression is caused by a combination of genetic, biological, environmental, and psychological factors.” Textbook definitions aren’t tremendously important here other than to note the vague nature of what’s determined as clinical depression. The definitions are important when considering the 1994 US National Co-morbidity Survey however, which determined that minor and severe depression are two of the most commonly diagnosed mental disorders among problem drinkers. Definitive conclusions regarding depression within the treatment landscape are difficult to assess, especially considering the nature of prolonged depressant dependency, yet the past two decades have seen pharmaceuticals arise as the preeminent complement to treatment programs to combat “self-medicating.”
The U.S. is one of only two countries in the world that permit direct-to-consumer advertising of pharmaceutical drugs (New Zealand is the other). In 1997 the Food and Drug Administration (F.D.A.) installed relaxed measures which had previously required pharmaceutical companies to detail a list of side-effects in commercials and infomercials, contributing to a boom in the promotion of name-brand drugs to the public. In 2008 nearly $5 billion was spent on such marketing. Much as A.A. has created a need for spirituality to combat the disease of alcoholism, pharmaceutical companies have manufactured an accelerated demand for their products. It is no wonder that antidepressants have become the most prescribed medication in the country, with one in ten Americans taking prescription medications to combat depression.
While mental health services are used by some 13% of Americans, the effectiveness of antidepressants is still widely questioned. A 2008 analysis led by Irving Kirsch revealed that a “meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment.” In fact, upwards of 80% of the effectiveness of medications such as Prozac come from this placebo effect. Mental health assessment and management plays a strong role in the recovery process for many, but the treatment for such disorders remains largely as generic as the one-size-fits-all approach of 12 Step recovery.
As anxiety and depression are two of the leading clinical diagnoses attached to alcohol dependency, it would only make sense that antidepressants are widely prescribed to assist with formal recovery. One of the most immediate concerns of this approach is that a known side-effect of various antidepressants include such unstable caveats as suicidal thought and action, questionably compounding emotional despair of those deeply trapped in their dependencies. Recognizing that alcohol misuse is associated with high rates of completed suicides – more than 75% of all suicide attempts involve either alcohol or some other drug – it would seem downright irresponsible to broadly prescribe such a violently unstable medication to such an already unstable population.
This is not to understate the importance and care demanded by the genuine necessity for medications, but only to reinforce that the business behind the pharmaceutical industry is still a business; marketing products to doctors and patients alike has created a tremendous disparity between the perceived necessity for medication and the actual need. Only making the already-nuanced prescription drug component of recovery that much more complicated is the under-examined emergence of focused medications aimed at curbing alcohol dependency.
The use of drugs in the treatment of alcohol addiction dates back to the late 1800s when opium would be used to help calm withdrawals. Despite being more than a century removed from such early practices, medicating addiction remains underused and widely misunderstood. While reactions remain clinically similar to antidepressants, in that the effects of each drug are unique based on a person’s individual chemical makeup, the majority of the hesitancy to promote pharmacotherapy as a direct aid in the treatment of alcohol dependency largely comes down to the slow approval and widespread use of newly developed drugs.
In the 1950s Bill Wilson became an enthusiastic champion of L.S.D., believing that a psychedelic experience could be the breaking point for non-believers to achieve the necessary spiritual awakening required of A.A. As radical as Wilson’s beliefs about the drug were – in fact, his experimental enthusiasm was what eventually distanced Wilson from the organization he co-founded – researchers Teri Krebs and Pal-Orjan Johansen have since identified that “a single dose of L.S.D. had a significant beneficial effect on alcohol misuse.” Similar testing has shown that ibogaine (a naturally occurring psychoactive substance) may benefit some in the treatment of alcohol dependence, if only it weren’t for the sticky legal restriction of being a Schedule One controlled substance in the U.S. While such instances as these make for interesting social debate on the legality of potent recreational drugs, this sort of fringe treatment is hardly what is at the heart of developing medicinal pharmaceuticals.
As of 2012 there are three drugs that have been approved by the F.D.A. for pharmaceutical use in the treatment of alcohol dependence in America: acamprosate (Campral), disulfiram (Antabuse), and naltrexone (Trexan), all of which have confirmed positive effects in the long-term treatment of alcohol addiction. Despite being legal in Europe since 1989, acamprosate was only approved by the F.D.A. in 2004, and works to reduce cravings by balancing brain chemistry, working to ease withdrawal symptoms such as anxiety and insomnia. First approved for use in the treatment of alcohol dependence in 1951, disulfiram is an aversive medication that creates an enhanced sensitivity to alcohol, working through the enzymes that metabolize alcohol to produce a variety of negative physical effects when consumed.
While it was given F.D.A. approval for use in the treatment of alcohol dependency in 1995, naltrexone was previously approved a decade earlier for the treatment of opiate addictions, and has since become the most widely prescribed of these three medications. The aversive drug minimizes the physical desire to continue drinking by blocking opioid receptors in the brain, reducing any associated pleasurable effects of alcohol use. Naltrexone has been prominently promoted through the work of David Sinclair, using it as the basis for his “Sinclair Method” of treatment. Unlike disulfiram, which discourages use of alcohol altogether (subsequently exhibiting little benefit over placebos in controlled studies), naltrexone capitalizes on the drug’s abilities as an opiate antagonist and works alongside drinking, discouraging the effects that would otherwise contribute to prolonged harmful use. Aside from these three drugs, benzodiazepines (Valium, Xanax) are also widely used to help with alcohol withdrawal, as is the anti-convulsant topiramate, which has been shown to act similar to naltrexone by decreasing the pleasurable effects of alcohol.
While all of these drugs have shown some proven benefit in the treatment of alcohol dependency, there has been considerable variation in conclusions made about each, with dubious evidence supporting their widespread employment. Without such broad medical incorporation, these drugs remain underused due to similar problematic conclusions as those experienced by antidepressant users: While general positive effects are recognized, each drug affects users differently; the key difference here being the decade-long marketing push which has crafted the perception that antidepressants all help. By looking to the past for an understanding of how alcohol dependency treatment has shifted in the country, where specialized treatment was once unheard of it is now central to a multi-billion dollar industry, the nature of how depression treatment has evolved in recent years might very well speak to a future of prescription-driven treatment for alcohol addiction.
Reconsider that 12% of adults claim an alcohol dependency at some point in their lives, while only 10% of those who need some support in overcoming their addiction actually seek it. Despite this limited population of dependent alcohol users relative to those who seek no treatment, the country is still able to sustain some 13,000 treatment facilities. Whether it be the stigma of being labeled an alcoholic or the personal denial of a drinking problem, the untreated community poses a massive potential market well-suited for the discrete and theologically non-confrontational method of treatment that medication provides. The disease-concept of alcoholism continues to generate a market for treatment that has proven to have scattered effectiveness, so why wouldn’t it also contribute to convenient ulterior medicinal treatment funded by the same lobbyists that have impacted antidepressant regulation, eventually marketing a revolutionary “new” model of alcohol treatment? Why go through the detox process when a doctor can give you pill that prevents unwanted side-effects of withdrawal, compiled by another prescription to aid in the moderation of negative side-effects of future problem drinking? As excessive drinking becomes not only increasingly widespread, but increasingly socially tolerable, would it not seem natural for a new line of drug to be lobbied for, aimed at the 90% of dependent users who go untreated, promising to help “casual” or “social” drinkers (both far more acceptable terms than “hazard” and “problem”) curb nasty spells of heavy use? Any thoughts on the future are, of course, speculative, but at what point does this pattern of genetic, cultural, and societal victimization stop and we actually accept that most people don’t seem to need private enterprise and government stepping in to help them quit drinking?
The S.A.M.H.S.A.’s 2007 National Survey on Drug Use and Health reported that 9.4% of the U.S. population aged twelve or older needed treatment that year for an illicit drug or alcohol problem (about the same portion of the population that uses antidepressants). All too often addiction goes untreated, and by the time many individuals do seek treatment, their addictions have reached a point of severity that requires some form of formal intervention – be it assistance from a local physician, support from a mutual aid group, or monitored detoxing at a treatment center – to help guide them back to health. While the vast majority of individuals with blossoming alcohol dependencies may be able to turn their lives around with minimal outside interference, it is entirely unrealistic to suggest that everyone can.
For instance, many have not developed the self-esteem to help drive them towards a sense of personal empowerment: to sheepishly borrow a phrase from The Big Book, some might be “constitutionally incapable” of taking steps on their own no matter how educated they become on the matter. Others have families to support, are burdened by legal stipulations or stressful living situations, or are working empty menial jobs to get by: Many people who need help do not have the immediate ability to make a change on their own volition, let alone educate themselves about what their options for help really are. So, when the national precedent has been set that A.A. is the only outlet that can help defend against the $7.99 12-pack of high gravity malt liquor at the supermarket, they do not argue and accept the outlet at face value; millions have, and millions more likely will. People who do not believe they can make a difference in their own lives are not likely to do so.
The prevailing system of aid in the U.S. has mutated into a hybrid model of support that funnels actual support through the country’s business sector, blurring distinction between well-intentioned individuals and manipulative profiteers. Intent is often not black and white, leaving it difficult to conclude what those first A.A. members hoped to accomplish by pushing for the widespread adoption of their organization’s fundamentals. While he stands as one of the primary characters in promoting the development of modern profit-driven treatment models, Senator Harold Hughes himself was hardly above realizing the confusing nature of what he was building. “The alcohol and drug industrial complex is not as powerful as its military-industrial counterpart,” he said in 1974. “But nonetheless, there are some striking similarities.”
Since that time an army of both trained and untrained counselors, therapists, scientists, administrators, government officials, judges, lawyers, lobbyists, researchers, and authors have entered the field of alcohol treatment, each projecting their personal ideals onto an already impossibly complicated system, often prompting ideological clashes not in the name of scientific discovery, but for the sake of personal righteousness. What now remains of the very alcohol and drug industrial complex that Hughes both predicted and aided is a system that markets its own need to exaggerate perception of its indispensable role in the personal recovery puzzle, prompting further market penetration and the continuation of federal and state funding.
In 2003 the National Survey of Substance Abuse Treatment Services reported that 26% of treatment centers were operated by private for-profit organizations. “On the survey response date, March 31, 2003, there were about 259,000 clients in facilities operated by for-profit organizations and about 610,000 clients in facilities operated by non-profit organizations.” So as to avoid confusion, a necessary distinction is to be made: non-profit organizations are still income-driven businesses, and those 610,000 clients represent a fine source of income. As Jack Trimpey wrote in Rational Recovery: The New Cure for Substance Addiction, “If you let your eyes follow the bouncing dollar, you may notice that addiction treatment benefits those who treat far more than those who are treated.”
This system has encouraged the emergence of thousands of smaller-statured Dr. Drews and Dr. Phils who remain free to project myths about how successful their personal brand of treatment methods are. This flourishing population of treatment profiteers prey on the general lack of knowledge about recovery, while fueling misconceptions about the real qualifications of their unstandardized facilitators. Actual recovery is not the goal of the recovery system, because if individuals become enabled to find well-being in their lives without the aid of products, therapy, and treatment, these thousands upon thousands of treatment-based establishments that service this unwell population will be without a customer base. And without customers businesses simply cannot stay in business. And since the disease concept of alcoholism has failed to reclaim “addiction” as a medical concept, its treatment methods remain myriad, and alcoholism remains a distant and untreatable enigma.
What we need is a cost-effective, standardized model that offers hazard drinkers a stepped system of care, beginning with minimally intrusive interventions including basic health education, only graduating to more intensive and expensive treatment methods as required. What we need is reform to combat decades of directionless legislation aiding professional incompetence, leaving the well-being of countless vulnerable individuals in the hands of those ill-equipped with the knowledge, skills, and credentials necessary to provide a full range of evidence-based treatment. What we need is treatment and therapy that is responsive to individual circumstance and need, able to assess, treat, and medicate co-morbidity when it exists, and standardized proficiency implemented to help recognize when it does not. What we need is an environment encouraging a therapeutic alliance between patient and caregiver, rather than an unregulated model for healing that constructs problems to spur further unnecessary treatment. What we need is integration of alcohol addiction prevention into routine health care, removing its stigma, and separating disease-concept from disease-treatment. What we need is an educated legal system that promotes educated wellness over complacent ideals. What we need is to remove focus from success rates, instead developing an evolving process that speaks to the issues that have led to individual relapse. What is needed is ethically-centered treatment that is based on transparency from educators and legislators alike. What we need, what we need, what we need… we are not likely to get. And what remains is a complicated smokescreen layered by decades of inefficiency and wayward motivation.
Treatment can be tremendously helpful if administered by caring, responsive practitioners. Mutual aid groups, 12 Step included, can also make a huge difference in the recovery process, inviting personal interaction into a world that is many times otherwise lonely and cold. But the sacred information that is standing in the way of individuals and recovery does not exist in some expensive resort facility any more than it does a dingy A.A. hall or a website on the Internet. So, in lieu of an actual treatment process that wholly places paramount value on personal wellness, it might not hurt to ask “How did people overcome alcoholism before treatment facilities?” in moving forward.
The biggest influencer on how long an individual remains sober does not come down to the relative success rates of various treatment methods, or how many mutual aid group meetings a person attends in a certain number of days, or whether or not someone dependent on alcohol has asked their Flying Monkey Ninja God to keep them sober in the morning. The most influential key to remaining sober is individual action, focused honestly on a goal, and repeated with sincere desire. If A.A. meetings help, it would be foolish not to attend. If they do not, and attendance is not legally mandated, then there should be no reservations in exploring the various other ways in which many people have found sobriety in their own lives. If walking by a neighborhood liquor store every day is enough of a trigger to spur thoughts of drinking, quit walking by the store. Take consideration for what has helped others, but don’t feel bound by established beliefs simply because they’ve been promoted as truth enough times that they start sounding true.
The United States Federal Government classifies alcohol as “one of the most dangerous drugs and the drug most frequently abused in the United States.” If we drink alcohol we have to start acknowledging that we are not victims of disease, but that we have accepted the risks of drinking it and are then liable for the outcome. We have become a culture of casual hypocrites though, failing to take responsibility for the actions we personally take. Therein lies the most imposing force standing in the way of sobriety, or personal recovery, or whatever it is we might be seeking: ourselves. To encourage individual recovery means recognizing that there are not enough “steps” in the world to ever stop someone from surrendering to a base instinct if the individual does not have the drive to make a lasting change in their life. To encourage individual recovery means to entertain the idea that there is more power to be found within individual accountability than previously imagined. As the saying goes, the difference between who you are and who you want to be is what you do.
Continue reading and listening to Terminally Unique here.
[“Untreatable” was originally published February 12, 2013 as the fourth chapter of Believed to Be Seen. The track opening and closing the episode is called “styles.”]

domain: psychology


text:
- Get More Information Here:
- Building Defect Lawyers Gold Coast
By Simon Volkov
Heir advance can refer to two different methods of receiving cash through inheritance. The first method involves transferring property rights to a funding source in exchange for lump sum cash. This type of cash advance is not a loan and heirs are not responsible for repayment of advanced funds.
The second heir advance method involves receiving annuity payments through an irrevocable life insurance trust. Decedents establish estate planning protocol that gifts payments to heirs over several years or as a one-time lump sum payment. Heirs can sell future annuities in whole or part to a funding source. This type of transaction often requires court authorization.
Funding sources are usually private investors, but some cash advancing companies and lending institutions engage in this type of funding as well. Locating a source usually involves considerable research as this is a specialized niche.
Those who engage in this practice often require heirs to be entitled to assets valued at $5,000 or more. Heirs assign property rights to the funding source, but this does not guarantee the cash advance provider will receive the property.
Since funding sources are at risk for not receiving inheritance property used as collateral they assess fees for providing advanced funds. Fees usually range between 25- and 40-percent of the assets’ appraised value. When possible, heirs should comparison shop to obtain the best probate loan rate.
Distribution of inheritance property does not occur until estates undergo the entire probate process. It is not uncommon for assets to be suspended in probate for several months. In cases where heirs contest decedents’ last will or when third party claims are filed against the estate, probate can extend for years.
If decedents die without leaving a Will the probate process requires additional time. Courts must confirm an estate administrator to manage estate settlement proceedings. Rightful heirs must be identified to ensure appropriate distribution of assets according to state probate laws.
Estates without a valid Will are referred to intestate estates. Although probate law varies by state, inheritance property is most often distributed to the surviving spouse and direct lineage relatives such as siblings, parents, and children. Heirs entitled in intestate inheritance gifts often find it challenging to locate a funding source.
If the estate is comprised of real estate secured by a mortgage note the estate is required to remit installment payments to prevent foreclosure. The estate is also financially responsible for keeping homeowner’s insurance premiums and property taxes current. When estates do not have sufficient funds the court can order the property sold.
When decedents owe outstanding debts, but do not have sufficient funds to pay, the court can order property sold. This can be problematic if assets were used to secure an heir advance. Due to associated risks, funding sources require heirs to undergo an application process.
Cash advance applicants should be prepared to provide a copy of the decedent’s Will and death certificate; estate administrator or probate attorney contact information; and a current copy of their personal credit report.
Funding sources review credit reports to determine if applicants have pending bankruptcy petitions; child support or spousal alimony obligations; or outstanding liens or judgments. These obligations can interfere with property transfers when probate settles and often prevent heirs from obtaining cash advances.
Once inheritance advances are approved, funds are provided within 1 to 3 weeks. Cash advance recipients are not responsible for repayment of advanced funds should the estate be unable to transfer probate property upon estate settlement.
Funding sources are prohibited from pursuing the estate or heirs for restitution unless it can be proven that heirs provided untruthful information to obtain the heir advance.
About the Author: Simon Volkov is a private investor and probate liquidator who provides heir advance funding to qualified recipients. He specializes in buying probate real estate in SoCal, Nevada, Arizona, and Washington. Learn more about the process involved for obtaining inheritance funding at SimonVolkov.com.
Permanent Link: isnare.com/?aid=748581&ca=Finances

domain: law


text:
Are you looking for Mortal Kombat 11 APK for Android and PC? You are at the right place because APK file is available here free of cost to download and install on your device. Moreover, there is a complete installation guide below to download and install this game on your PC, Android, and iOS. Stay with me!
Table of Contents
Download Mortal Kombat 11 APK
Many people from different parts of world love video games to play on their devices. Mortal Kombat is one of the oldest games and Mortal Kombat 11 is the 11th version of this game. If you want to download the APK file of this game on your device, then you don’t need to worry because the APK file is given below to download and install on your device. This game is not available for PC officially, so, you can download the APK file and install on your PC with the use of Android Emulator. It means this APK file is available for Android and iOS users. I hope you will enjoy all the features of this game on your device. Stay here with me to download the APK file.
I hope you will enjoy all the features of this game free of cost. There are many new characters also added in this game. As you know, with the latest version, there are many new things included by the officials of this game. The graphics of the game are also improved and you will enjoy new scenes as well. Do you know it? In this modern era, if a game has not featured with high graphics, then no one will play the game. So, you should know that the graphics of this game are excellent. Moreover, the user interface is also very friendly for the people. Overall, you are going to enjoy a lot playing this game.
Installation Guide For Android Users
Before downloading the APK file on your Android device, there are different things you should know for the proper installation. Let me discuss a complete installation guide.
- First of all, you have to Allow Unknown Sources from the Settings of your Android.
- Connect your device with WIFI.
- Click on the given button above to download APK.
- Now, open the folder where you stored APK.
- Tap on it and a box will occur on the screen to get permissions. These permissions will all about to access your device resources.
- Provide all the resources and installation will start successfully.
I hope you will enjoy all the features of this game on your Android device in your free time. However, if you face any issue in downloading or installation process, you can leave a comment in the comments section. I will guide you more for installation.
Installation Guide for PC Users
If you want to download and install this game on your PC, then you can download it free of cost from given link above. For this purpose, you have to follow the guide step by step:
- First of all, you have to download Bluestacks on your PC.
- After downloading Bluestacks on your PC, you have to install it.
- Now, download the Mortal Kombat 11 from given link above.
- Drag and drop the file of the game in Bluestacks.
- It will be installed successfully.
There are many features in this game you can enjoy free of cost. It is one of the oldest game available in the market. Now, there is 11th version of the game is available to download and install on Android, iOS free of cost.
Related: Mortal Kombat 11 Characters
We are a lover of this game and providing the APK file of the game for the purpose of education. All credit goes to the officials of this game. Moreover, I will not responsible for any misuse of this game. There is no need to root your Android device to download and install the APK file but you can download and install it as a simple app manually. Keep visiting for latest updates! Thanks!

domain: hobby


text:
You can get rid of dead skin cells and the fine hairs on your face with dermaplaning, a simple and safe exfoliation procedure. It is not to be confused with dermabrasion, a medical procedure that is not commonly used anymore. Contrary to dermabrasion, dermaplaning is a simple shaving of the skin with the delicate use of a 10-inch scalpel that curves into a sharp point and that feels like the lick of a cat’s tongue.
Dermaplaning has become popular in recent years because there are very few if any, adverse effects. There are no chemical peeling agents used, and the hair does not grow back heavier or darker than its original look before the treatment. The most common benefits of dermaplaning include all of the following:
- Deep Penetration
- Removal of Soft Facial Hair
- Promotes Smooth Skin
- Safe Procedure
- Works on Any Type of Skin
- Can Be Done Frequently
- Diminishes the Appearance of Fine Lines
The dermaplaning procedure is painless and suitable for all ages. It exfoliates dead cells that have built p and is only done on the face. Have your skin rejuvenated with this procedure today at Medical Aesthetics of Virginia, a leading facial spa in Norfolk, VA. You are sure to be pleased with the healthy glow on your face after the treatment.

domain: health


All of our employees receive extensive initial training, as well as continuous field training throughout the year. Most of our installers have been working in industry for a very long time, and have served our company for several years. Many of our employees have been with the company for 15+ years! We’ve been correcting basement waterproofing problems similar to yours since 1961!
Frequently Asked Questions
Weeping Tiles are a system of drainage tubing that is laid at or under your foundation wall at the footing to draw the water away from your home and toward the sewer or drains. When a basement is waterproofed, a weeping tile system is key to keeping the basement dry because the water is drawn away from the foundation. If your home has a sump pump, it drains into the weeping tiles drain and away from your home.
New technologies have added a sleeve or sock to the tubing so that any sediment that is in the water does not clog the weeping tile tube. The tile system is laid at the foundation and the space above is filled in with gravel so that water can filter through to drain away.
City Wide Group installs 4” ABS flexible piping from Big O., as they use this technology.
Your drainage system only requires a sump pump if the weeping tile system installed has no other gravity fed drainage source. In some locales, sump pumps are also required by the Building Code. Sump pumps are installed in a gravity fed “pit”, once the water level rises to a certain height, the sump pump automatically turns on and discharges the water outside of the house to the exterior grade. Sump pumps are electrically powered, and sometimes need battery backups. A rainstorm that’s strong enough to cut your electrical power is definitely the kind of storm that will fill the pit and require it to be working during such time.
Exterior foundation waterproofing preserves the structural integrity of your foundation, and does not allow any water or moisture to seep through the block, brick or concrete. Moisture presence in your foundation can lead to deterioration over time, and result in costly foundation repairs or complete foundation rebuilds. Waterproofing internally can be a lot less expensive, and works more as a diversion process for water. Water is still able to enter through the foundation, but is diverted underneath the floor area into an internal weeping tile system.
Water is able to seep into your basement through cracks in the walls or floor, but there are plenty of other places it can seep through. Look for weak spots around your basement, such as mortar joints (spaces between bricks or concrete blocks), tie rods that reinforce masonry, the juncture where the walls meet the floor, the top of your home’s foundation, or window wells. If there are congested and/or blocked weeping tiles or no weeping tile system installed around the perimeter of your home’s footing, the water simply has no where else to go but inside any of these entry points.
Ultimately, the price will depend on the solution. Some variables that influence the cost of waterproofing foundations include: complexity of excavation, spacing between foundation and neighbouring property, concrete, interlock, asphalt, flagstone removal and replacement, depth of foundation, soil conditions, shrubbery & trees.
Black mold, or Stachybotrys chartarum, is one of the leading causes of poor indoor air quality in homes. It is commonly found in damp or flooded homes, and requires constant moisture in order to grow. Foundation waterproofing will prevent any further moisture/water penetration into the basement and will stop any further mold growth.
You’ll receive a phone call from one of our representatives; they will set up an appointment at your home, to meet you in person, ask questions about the leak, and examine your basement. Whether you have wet basement walls, an obvious leak, black mold or some other problem, our team of professionals will be qualified to assess it. We will explain what’s going on at your home clearly and we’ll give you a free estimate either the same day or within 1 business day.
The best way to keep water out of your basement is to keep it away from your home’s foundation, and there are several ways to do this. Keep the ground around your house sloped away from it, and free from shrubbery or plants that might prevent sunlight from drying out the soil. Install gutters and downspouts, keeping them regularly clean of debris, and make sure they drain well away from the foundation (either by piping it underground or extending the gutters away from your home). Keep your home’s window wells covered so they don’t collect water.
Frequently, wet basements occur in homes that lie in low-level areas at the bottoms of slopes or hills, but the everyday shifting or settling of your home may also cause leakage. Other potential causes may be poorly-mixed foundation concrete or improperly designed drainage systems. Tree roots may also grow into the weeping tile system and block water flow. Finally, weather can be a factor.
A wet basement might seem like a small problem, but it can lead to much bigger ones. A leaking basement, or a basement that generates a lot of moisture, can attract black mold or cause structural damage to your home’s foundation. A leaky basement also runs the risk of soaking any belongings you store there, and destroying your basement finishes. Basement waterproofing can steady your home’s property value and provide peace of mind.
Leaking basements present a few very obvious indicators, like pools of water on the floor or water trickling down the walls.
But there are a number of other ways water damage can show itself as well:
- An increase in mold or mildew
- Musty odors & damp spots on the walls or floor
- A white, chalky substance on the walls
- Cracks in the walls or floor
- Peeling paint or bubbling wallpaper
- Rust on appliances or other metal objects
- Wood rot
- Warped paneling or trims
City Wide Group offers a “lifetime transferable” warranty on basement waterproofing. What does this mean exactly?
The City Wide Group believes in “doing the job right the first time” and striving to achieve top notch customer satisfaction. We are confident with our work and our experience to be the ONLY Company in Toronto & GTA to offer a true LIFETIME WARRANTY. When you have The City Wide Group waterproof your foundation, we warrant that your will never have any water or moisture seepage present in the area waterproofed for the life of the house. You are provided with a warranty certificate, which is transferable to an unlimited number of resale home buyers.


When you think of a land conservancy, it’s not often that you think of the city. When protecting the natural world, it’s often the wilderness, the rural, and bucolic that becomes the focus of many a conservation group.
But for the Bay City-based non-profit Saginaw Basin Land Conservancy, it’s their conservancy projects in the region’s urban areas, in addition to the 6,000 acres of rural land already under their protection, that has garnered regional and, even more recently, national attention.
Baltimore Oriole on Saginaw Bay Birding TrailThe SBLC’s mission to convert approximately 1,500 vacant parcels in Saginaw from overgrown lots to wildflower prairies, creating natural habitats for pollinators, is currently featured in the Fringe Cities: Legacies of Renewal in the Small American City exhibit at the Center for Architecture gallery in New York City.
"We’re a small non-profit based in Bay City, so this is all slightly surreal but also somewhat validating. We work hard on our projects here, in Saginaw, and around the region," says Zachary Branigan, executive director for the SBLC.
"It’s humbling and somewhat of an honor. It’s not every day that a small non-profit from Bay City gets recognized on a national level so it’s huge for us. And it’s good for morale."
The exhibit itself focuses on four American cities and their efforts to solve problems wrought by the United States and its federal urban renewal programs of the mid-20th century. MASS Design Group, which curated the exhibition, selected Easton, Pa., Spartanburg, S.C., and Poughkeepsie, N.Y. in addition to Saginaw.
Immature Bald Eagle in Tree at Michigan Sugar Trails on Middlegrounds Bay City 2It’s the latest in a string of recognition for the conservancy’s Saginaw project. The Saginaw Basin Land Conservancy was also recently featured in an article in the U.S. News & World Report.
"I hope it helps us increase the delivery of our mission," Branigan says. "It can be a reward for our hard work but also a jumping-off point."
Learn more about the Land Conservancy on its Facebook page and website.
Got a development news story to share? Email MJ Galbraith here or send him a tweet @mikegalbraith.


text: Here are five things worth knowing today: 1. A former group of Google employees recently launched Otto, a start-up aimed at making existing trucks on the road driverless, CNBC reports. The start-up, which comprises ex-Google, Apple and Tesla employees, has developed a kit of sensors, software and enhancements that can be outfitted to existing trucks, according to the report. Otto is testing the technology on highways and recently completed an autonomous demo on a public highway, according to CNBC. 2. U.S. shippers are running out of warehouse space needed to maintain the inventories they’ve built over the past year, according to a JOC report. The initial fear was not having enough trucks to keep up with inventories; however, demand for warehousing and demand for distribution space is fueling a construction boom, but developers can’t build fast enough, according to the report. JOC has more. 3. The Atlantic looks at how truck driving has transitioned from one of America’s steadiest jobs to the most grueling. The article, written by sociologist Steve Viscelli, examines how the industry has led to the rise of independent contractors in an effort to help large carriers keep costs down. The Atlantic has more. 4. Caitlin Welby, a 34-year-old yoga teacher by training, is the CEO and president of RFX Forward, a transportation, trucking and logistics company. According to a Civil Eats article, Welby and her team just launched a new initiative called Permatrucking to transform the culture at RFX and make drivers healthier. According to the report, Welby began teaching lunchtime yoga classes and held weekly management meetings that began with gratitude circles and meditation, and at town hall meetings, employees were invited to discuss issues while eating organic food. Read more at Civil Eats. 5. Trucking company Sun Valley Inc. has been named the Hutchinson/Reno County Chamber of Commerce Small Business of the Month for May, The Hutchinson News reports. The company, which started up in 1994, employs 39. Owner Keith Bauer told the Hutchinson News that he operates 35 trucks and owns about 100 trailers. According to the report, the city of South Hutchinson recently gave the company $1.5 million in bonds to build a warehouse, which will allow the company to store loaded trailers and offer customers more flexibility.

domain: news


text:
This year’s “Summer Pops” will feature Leonard Bernstein’s Symphonic Dance Music from West Side Story and John Williams Star Wars Trilogy. We will continue to pay tribute to our City’s Centennial with a salute to our National Anthem, your favorite Sousa marches, and a special guest appearance by the Clarinet Fusion, an area clarinet choir founded by Walnut Creek Concert Band member Karyn Weber. Clarinet Fusion presents a diverse program with music specially arranged for the unique combination of Eb soprano clarinet, Bb Clarinet, Alto Clarinet, Bass Clarinet and Contra Bass Clarinet.
Clarinet Fusion was founded by Karyn Weber as a quartet/quintet in the fall of 2009. The group performed several concerts each year until spring 2012, at which time they grew the group to a choir. The first performance as a choir was summer 2012.
Clarinet Fusion is made up of advanced amateur clarinetists living as far north as Martinez, south as San Jose, east as Brentwood, and west as Oakland.
Members play in multiple performing groups, including: Danville Community Band, Walnut Creek Concert Band, Contra Costa Wind Symphony, Diablo Valley College Symphonic Band, Quintaire Woodwind Quintet, Ohlone Community Band, Ohlone Wind Orchestra, Ohlone Clarinet Choir, Castro Valley Chamber Orchestra, Pleasanton Community Concert Band, Livermore-Amador Symphony, Brentwood Concert Band, Tri-Valley Rep Theatre (Livermore), Star Struck Theater (Fremont), California Repercussions Band, Hayward Municipal Band, Oakland Symphony Orchestra, Prometheus Symphony Orchestra and more.
Clarinet Fusion was selected in both 2013 and 2014 by the San Francisco Symphony as 1 of 16 ensembles to participate in their Chamber Music Workshop program, for which they were mentored by a clarinetist of the symphony and performed on stage at Davies Symphony Hall for family and friends.
Our conductor, Dr. Lawrence Anderson is a retired Director of Bands, University of California Davis and a fellow clarinet player.

domain: artistic


text:
The Acer Liquid Z530 and Liquid Z630s have arrived in India and are set to retail exclusively via Flipkart. The former can be bought from midnight November 6, while the latter will be available through a flash sale on November 12. Both are going to be manufactured under the Make in India initiative starting from December 2015.
The company has set up a factory in Pondicherry for this purpose and intends to produce 1 lakh units per month. The Acer Liquid Z530 and Liquid Z630s are its first smartphones in a while, with the brand traditionally being associated with computers.
Acer is probably hoping to get in on the overstuffed affordable handset segment in India with its new offerings. It’s touting the 4G-ready Liquid Z530 and Liquid Z630s as selfie-focused phones. The dual-SIM handsets ship with an 8MP rear and front-facing camera. The unit on the back comes with LED flash and the one in front is equipped with an 84-degree wide-angle lens.
Taking a closer look at the specs of the Android 5.1 Lollipop-based Liquid Z530, the device is priced at Rs 6999 and carries a 5-inch IPS OGS 720p screen. Under the hood, it’s powered by a 64-bit 1.3GHz octa-core processor and a 2420mAh battery. It contains 2GB of RAM and 16GB of internal space, expandable till 32GB via microSD card.
Also Read: Acer unveils new Windows 10 laptops in India
Moving on to the Liquid Z630s, the handset costs Rs 10999 and comes with an AcerExtend app to wirelessly connect with PCs or laptops in the vicinity. It flaunts a 5.5-inch IPS OGS HD display with the brand’s Zero Air Gap screen. The smartphone further houses a 1.3GHz octa-core SoC, 3GB of RAM, 32GB of ROM, Android 5.1 Lollipop and a 4000mAh battery.
Once again, the Acer Liquid Z530 and Liquid Z630s will be up for sale via Flipkart. Registrations for the latter begin from November 5 till 11.


text:
Places Discussed (Cyclopedia of Literary Places)
*Rome. Center of the Roman Empire, where the play opens at Emperor Titus’s royal court. The entrance of the emperor’s sons through different doors opens the play and denotes the division and divided loyalties that will plague Rome, preparing the audience for the political strife that ravages the court. In contrast, the tribunes and senators of Rome, along with Marcus, the brother of Titus, appear aloft on the balcony, in order to underscore the tradition of a once mighty and proud Rome that remains “above” the fray of petty squabbles and familial strife. Into this contrasting setting appears Titus on the main stage in his triumphal entrance to the city, bringing both prisoners and Roman dead, as he moves to the trapdoor, which functions as the burial site for those slain in battle.
Later in the play, the trapdoor becomes a pit dug in the countryside of Rome, used by the sons of the evil queen to hide a murder and to ensnare two of Titus’s sons. Thus the location of the play is less important than the symbolism of where characters perform. In and nearby the court of Rome may be the referenced sites, but the playhouse stage reveals more, offering the medieval concept of theatrum mundi, or “world as a stage,” which measures all things vertically, from hell below to heaven above, as mankind “frets and struts his hour upon the stage,” as Macbeth says in another of Shakespeare’s plays.
(The entire section is 247 words.)
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Titus Andronicus is frequently linked to a kind of drama known as "revenge tragedy." In this genre, once a person vows to avenge a wrong done to him or someone in his family, there is no turning back. The cycle of revenge, filled with violent and bloody incidents, is not complete until everyone who committed the wrong or was associated with it in any way has been punished. Forgiveness is an alien concept in revenge tragedy.
Cycles of revenge continue throughout the world in the late twentieth century. One faction or ethnic group within a nation oppresses or harms another. The oppressed group strikes back or waits until it reaches a position of power, then avenges the wrongs done to its members years ago. In some countries, people are presently fighting to avenge crimes that were committed against their ancestors decades or even centuries ago.
Group solidarity, an admirable trait in itself, is one ingredient in maintaining these cycles. Family solidarity is also, in itself, a virtue. The Andronici stand shoulder to shoulder against the world. They adhere to the Roman tradition that an attack on one member of the family is an attack on everyone related to them. They have intense disputes among themselves, but once an Andronici is threatened or harmed by someone outside the family, they close ranks. Their enemies behave similarly. Tamora allows, even encourages, her sons to rape Lavinia. This is partly because Titus has, in her view,...
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Bibliography and Further Reading
Broude, Ronald. "Four Forms of Vengeance in Titus Andronicus." Journal of English and Germanic Philology LXXVIII, no. 4 (October 1979): 494-507. Broude sees four kinds of revenge in the play: human sacrifice to pacify the spirits of dead warriors, family vendettas, human justice, and divine vengeance. He regards Titus as the man chosen by the gods to carry out their revenge and help restore human justice in Rome.
Brower, Reuben A. "Titus Andronicus: Villainy and Tragedy." In Shakespeare: The Tragedies, edited by Robert B. Heilman, 28-36. Englewood Cliffs, N.J.: Prentice-Hall, 1984. Brower focuses on Timon as an undeveloped tragic hero. He suggests that Timon represents a noble man subjected to unspeakable suffering, whose cries for justice remain unanswered. A principal failure of the play, Brower contends, is that it offers Timon only a grim set of possible responses: he can go mad, increase his suffering by rigidly adhering to "the very qualities that made him a hero," or become indistinguishable from the evil people who have tormented him.
Charney, Maurice. "Titus Andronicus." In All of Shakespeare, 211-18. New York: Columbia University Press, 1993. In this chapter from a book written for students, Charney discusses the play's chief characters and principal themes. He argues that Lavinia still has a crucial role even after her tongue is cut out and she can no longer speak; that while the audience...
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Bibliography (Cyclopedia of Literary Characters, Revised Third Edition)
Bessen, Alan C. Shakespeare in Performance: “Titus Andronicus.” Manchester, England: Manchester University Press, 1989. Dessen follows the stage history of the play, noting that the watershed performance was the highly successful 1955 production by Peter Brook, starring Laurence Olivier and Vivien Leigh. Dessen also addresses the numerous staging problems involved in a production of Titus Andronicus.
Bowers, Fredson T. Elizabethan Revenge Tragedy, 1587-1642. Princeton, N.J.: Princeton University Press, 1940. Although somewhat old, this book is still useful and enjoyable. It traces the origins of the revenge tragedy to the plays of Seneca. Bowers shows how Titus Andronicus follows a pattern first formulated in English by Thomas Kyd in The Spanish Tragedy.
Hamilton, A. C. “Titus Andronicus: The Form of Shakespearean Tragedy.” Shakespeare Quarterly 14 (1963): 201-213. Suggests that Titus’ fault is in attempting to be godlike in the sacrifice of Alarbus. The rest of the play makes him increasingly human.
Rozett, Martha Tuck. The Doctrine of Election and the Emergence of Elizabethan Tragedy. Princeton, N.J.: Princeton University Press, 1984. Argues that the Calvinistic doctrine of predestination and election was influential upon Elizabethan tragedy....
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domain: library


Ford was recently announced that it will promote its new Police Interceptor at the upcoming Auto Show in Chicago. Although it was not mentioned, it was clear that a new police vehicle is based on the Explorer model for 2016, which is now officially confirmed in this new factory images and new PR announcement. The new Ford Police Interceptor has a standard 4×4 drive, and the production of the car will be in the Ford factory in Chicago.
The police version is equipped with sleek interior, stronger brakes, modified suspension and all the necessary police equipment, while engines are 3.7-liter V6 with 304Hp and 378 Nm of torque, and the 3.5-liter EcoBoost V6 with 365Hp and 474 Nm. It should be noted that both variants are mated to six-speed automatic transmission.


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Understanding your role in detecting, reducing and preventing the development of antimicrobial resistance (AMR) is key to combating this growing threat. Once we realize how our actions can impact AMR, we can then take appropriate actions to stop and reduce its development and spread.
In 2015, the CRE strain of KPC (Klebsiella pneumonia carbapenemase) took the lives of seven patients at the National Institutes of Health Clinical Center near Washington, D.C. According to the CDC, the first reported CRE case occurred in a North Carolina Hospital in 2001, and since then, cases have been identified in 41 states.
Welcome to bioMérieux Connection, your source for learning and discussion of medical diagnostics and scientific news, advancements, important issues, and much more. Our team is dedicated to serving you the most relevant and pressing stories from leading experts in medicine, microbiology, and other scientific fields.


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domain: agronomy


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Hi all! So it's June. Lmao, ok. Since when? Let's not get into how scary it is that half the year has already blown by, and let's get into the mid year book freakout tag! This is a tag where you can scream about your favourite books of the year so far, and be shamed … Continue reading Mid Year Book Freakout Tag
Hi all! I've been tagged! Yay! Been a while since I've done a tag -- actually its been a while since I've posted on this blog -- so I'm glad to be back! Thank you so much to Caidyn @ BW Reviews for tagging me! Everyone please go check out his wonderful blog! 1. What … Continue reading 30 Interesting Questions
Hi all! It's been a hot minute since I've done a tag and when I saw this one over at the lovely Fadwa @ Word Wonders' blog, I just knew I had to do it! This is such a cool book tag, and it was a hard one too! It took me like over an … Continue reading The Scavenger Hunt Challenge
Hi all! A new book tag up today! I was tagged by the very lovely Charlotte @ Ink Slippers Reads for this book tag and I'm so glad because it looks like so much fun! I actually love spring cleaning -- I do it at least four times a year. I just get into one of … Continue reading Spring Cleaning Book Tag!
Hi all! It's been a minute since I've done a book tag, so thank you very much to both Jami @ Jami's Shelves and Sakhile @ Sakhile Whispers for tagging me! This tag is also an original book tag by Jami and it's so freaking cool! Everyone please go check out Sakhile and Jami's amazing blogs! … Continue reading Book Tag: Books I Want to Read But Don’t Want to Read
Hi all! I haven't done a book tag in quite a while and I was thinking about doing one, and then the very lovely Destiny @ Howling Libraries tagged me in one! Thank you so much Destiny! Everyone please go check out her awesome blog! This tag makes me feel like I'm being interviewed by … Continue reading The Book Interview Tag
Hi all! This is the very last post in the ABC Book Challenge series! I can't believe I finished this 26-post (25 for me, haha) series! What a ride! As always, I originally saw this post over on Jacquie @ Rattle the Stars‘ blog — please go check out Jacquie’s incredible blog! Here we go! MEMORABLE TITLES … Continue reading The ABC Book Challenge | “Z”


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In both friendship and music, Bart Skils and Weska are an inspired combination. Their third EP on Drumcode ‘Something More’ continues their collaborative purple patch.
A transatlantic connection that’s so far birthed the excellent ‘Polarize‘ and ‘Shades of Summer‘ EPs, plus a remix of the Sven Väth classic ‘Spectrum‘ under his Metal Master alias on Cocoon, Bart Skils and Weska are gradually developing into one of techno’s most exciting partnerships.
Something More‘ continues their on-point production flow. The title track is destined for festival stages, mixing up sharp drumlines, celestial pads and a soaring male vocal that balances the wistful and euphoric on a knife’s edge. Meanwhile, ‘Palm Strings‘ is a sleek beast, as rolling percussive loops rub shoulders with an atmospheric melody line, before a powerful bass riff takes the energy up to eleven.
Here’s what Weska had to say about the EP:
“Bart and I have become close friends over the years and genuinely love making music together. Despite living on different continents, making music is seamless. We’re always on the same page creatively so we’re constantly bouncing ideas off one another. ‘Something More’ and ‘Palm Strings’ is a pair of these ideas that came fully to life and we couldn’t be happier with the results.”
Listen to the tracks below.


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KANAB, Utah – An Arizona woman is dead after she and her husband got lost hiking “The Wave,” a popular natural rock formation on the Utah-Arizona border.
Elisabeth Ann Bervel, 27, and her husband, both from Mesa, Ariz., had won the lottery for permits to make the hike about seven months ago. July 22 was their five-year wedding anniversary.
“They did really come prepared,” said Kane County Sheriff Lamont Smith. “They each had a hydro-pack of water; they took vitamin water with them.”
“‘We were prepared, we just weren’t prepared for getting lost,’” Bervel’s husband told Smith.
Smith said the couple followed the BLM’s guide to hiking The Wave, which includes GPS coordinates and landmarks to navigate the desert. But when the Bervels got turned around and in the extreme heat, Bervel collapsed. By the time medics arrived, she had died.
“She was just too far into the heat,” Smith said.
The trail out to The Wave is rugged. Only 20 people are allowed to make the trip each day, mostly because it’s protected land, but that means it’s easy to get turned around without a well-worn trail.
"It's unmarked and it's in the middle of the desert,” said Utah hiking expert Adam Provance of The Wave. “If you aren't careful with all the heat that bakes off that rock it's easy to get dehydrated."
The same thing happened to a California couple hiking the trail July 3.
But it doesn’t keep people from making the trip, since once the lottery picks you, you go. That’s what the Delahaye family said prompted their hike to the desert formations. But the weather was in their favor.
“It’s easy,” said Bernard Delahaye. “It’s less than three miles to go and three miles to come back, and today it was not very hot, so it was easy.”
Despite the short distance, Smith said, the sheriff’s office gets dozens of calls for search and rescue in the area. He hopes that the BLM and local governments can come up with a solution to keep the area open, but still safe for hikers.
Brevel leaves behind her husband and two sons, ages 5 and 4.


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A rectal cancer diagnosis can leave you feeling lost and confused. Even if your case is particularly advanced or complex, Yosef Nasseri, MD, FACS, FASCRS, can provide expert, personalized care with minimally invasive options at his offices at Cedars-Sinai, located in the Beverly Grove neighborhood of Los Angeles, California. To learn more about rectal cancer and develop your treatment plan, call the office in Beverly Grove, or request a consultation online today.
Rectal cancer is characterized by uncontrolled cell growth originating in the lower part of your colon. Your rectum is the final five to six inches of the large intestine that ends in your anus.
Most cases of rectal cancer begin with the appearance of polyps along the inside of your rectum. Polyps are small growths that often aren’t cancerous but can develop into cancer. Once they become large and cancerous, you might notice symptoms that prompt you to seek a diagnosis.
Dr. Nasseri is a nationally-recognized expert in rectal cancer surgery and minimally invasive methods of treatment. Other physicians refer challenging cases of rectal cancer to him, including patients with prior abdominal surgeries and obese patients.
Rectal cancer may or may not come with symptoms, even in its later stages. Possible symptoms of rectal cancer include:
If Dr. Nasseri suspects that rectal cancer is a possibility, he may order a colonoscopy. A colonoscopy is a diagnostic procedure involving a thin, illuminated tube with a camera on the end. Dr. Nasseri uses it to view the inside of your rectum and look for polyps. If he finds any suspicious tissue, he takes a biopsy for analysis in a laboratory.
For rectal cancer, Dr. Nasseri often recommends several treatments for your plan. Your treatment depends on the stage of your cancer, your age, your general health, and other factors. In your case, he might recommend:
Dr. Nasseri may recommend robotic surgery to remove the cancerous tissue from your rectum. Robotic surgery allows him to keep as much healthy tissue as possible intact and help you avoid a colostomy.
Chemotherapy is a treatment for many types of cancer. It involves one or more drugs that target and kill cancer cells.
Radiation therapy is often recommended at the same time as chemotherapy. It uses powerful beams of energy to target and kill cancer cells.
For top-quality rectal cancer diagnostics and treatment, call Yosef Nasseri, MD, or request an appointment online today.

domain: medical


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Former driver Carl Edwards says he’s “having fun, enjoying life” and doesn’t have plans to return to racing.
Edwards talked with host Claire B. Lang on “Dialed In” on SiriusXM NASCAR Radio on Wednesday night.
Edwards shocked the sport when he announced in January 2017 that he was leaving. He returned to his home in Columbia, Missouri.
“I’m basically just doing what I told everybody I was doing, spent a lot of time with friends and family and traveling a lot, farming a lot and really enjoying it,’’ Edwards told Lang.
Asked about any return to racing, Edwards said: “I don’t have any plans to come back. I do miss a lot of people.’’
Asked about any potential political ambitions, Edwards said: “You never know. I think like probably almost every person listening to this channel right now, I really believe in, I believe in America, I believe the Constitution is the set of rules that let us have all this success and freedom. I care about that being there for generations to come. If sometime in the future there is a chance for me to help that cause, try to lend some assistance to not letting us get off track, then heck yeah, I would consider, but, no, there is not some campaign started. I’m not going to be doing anything anytime soon.’’
Edwards made his Cup debut in August 2004 at Michigan International Speedway, finishing 10th in a race won by Greg Biffle.
Edwards won 28 Cup races in 445 starts. Every retired driver who has at least as many wins and is eligible for the Hall of Fame has been inducted. Jeff Gordon is eligible for the first time this year. Edwards and Tony Stewart will be eligible for Hall of Fame consideration next year.
Edwards’ 28 wins includes the 2015 Coca-Cola 600 and 2015 Southern 500. He won four Cup races at Bristol and Texas, his highest victory total at any track. Edwards also won 38 Xfinity races in 245 starts.
At the end of the interview Wednesday, Edwards was asked if he had any final words for fans.
“I think I would just say thank you to everybody,’’ he said. “Thank you to the fans, the competitors and everyone, the tracks and NASCAR. That part of my life was just spectacular. I wouldn’t trade one second of it for anything. And then I would say, I just hope everybody out there is enjoying what they’re doing and you’re getting the most out of every day and really having fun.’’