Tips and Topics
Vol. 9, No. 4July, 2011
Welcome to the July edition of Tips and Topics (TNT). A special welcome to our new subscribers this month; you have joined the many TNT readers since 2003.

Senior Vice President
of The Change Companies®
SAVVY
My son, Taylor, is 27 and a singer-songwriter (not his day job). Amy Winehouse, was also 27 and a singer-songwriter (definitely her day job). Taylor is alive and well. Amy is dead.On Saturday, July 23, 2011, “the once-successful and often-troubled singer” was found dead in her North London home. A suspected overdose took her life. Amy had battled drug addiction for years. She had entered treatment in late 2007 for drug problems, including admitted heroin use. Unnamed friends reported that Winehouse was in the midst of a week-long drinking binge. There were other reports she was seen buying cocaine, heroin, ecstasy and ketamine the night before her death.

“In May, the singer checked into rehab to treat her ongoing substance-abuse problems just before she was set to go on a comeback tour of Europe. In June, she had a disastrous gig in Belgrade, during which she appeared to be heavily under the influence, slurring her words and repeatedly walking offstage. After initially canceling the subsequent two shows, the entire tour was scrapped.

Winehouse rocketed to international fame on the strength of her 2006 album ‘Back to Black’ and its singles ‘Rehab’ and ‘You Know I’m No Good.’ At the 2008 Grammys, she won five awards, including Record of the Year, Song of the Year and Best Female Pop Vocal Performance for ‘Rehab,’ Best Pop Vocal Album and Best New Artist.

Sadly, the fame only seemed to compound her already-present battles with substance abuse, eating disorders and depression. She was hospitalized multiple times for alcohol and drug use, which allegedly included crack cocaine, heroin, ecstasy and prescription pills, and was often featured in the tabloids looking disheveled and incoherent. Despite several stints in rehab, she seemingly was never able to kick her habit.”

Sources

spinner.com/2011/07/23/amy-winehouse-dies
huffingtonpost.com/2011/07/23/amy-winehouse-dead singer_n_907753.html#s314557&title=Rehab
huffingtonpost.com/2011/07/24/amy-winehouse-dies-mom-janis_n_907997.html?icid=maing-grid7%7Cmain5%7Cdl2%7Csec1_lnk3%7C80701

The 27 Club

Amy Winehouse’s sad death at 27 is an “age that sounds familiar to anyone who knows their history regarding gone-too-soon musical artists. The so-called 27 Club tragically has some notable members in addition to Winehouse: Jimi Hendrix mixed sleeping pills with wine and died at 27. Rolling Stones guitarist Brian Jones died at 27 after drowning in a swimming pool.” Also gone at that age: Jim Morrison, Janis Joplin, and Kurt Cobain who are musicians usually included in the 27 Club.

“Of course, this club of tragic coincidence is one that no one wishes existed….Sadly, there’s proof that rock stars are more likely to become members. A 2007 study by researchers at Liverpool John Moores University determined that North American and British music stars were “twice as likely to die a premature death as ordinary citizens of the same age,” according to an Associated Press article.”

Sources

washingtonpost.com/blogs/celebritology/post/amy-winehouse-jimi-hendrix-kurt-cobain-and-the-27-club/2011/07/23/gIQAiLAhVI_blog.html
en.wikipedia.org/wiki/27_Club#Musicians_usually_included_in_the_27_Club

The Rehab Song

Rehab” is a song by Amy Winehouse from her second studio album, Back to Black, written by Winehouse and released as the album’s lead single in the United Kingdom on 23 October 2006. The lyrics are autobiographical; describing the protagonist’s drinking habits and refusal to enter rehabilitation clinics.

The song received widespread critical acclaim and enjoyed commercial success in Winehouse’s native England and abroad. The tune won the 2007 Ivor Novello Award for Best Contemporary Song. “Rehab” won three Grammy Awards in 2008, including Record of the Year, Song of the Year, and Best Female Pop Vocal Performance.

Winehouse’s subsequent public battle with substance abuse and the song’s popularity contributed to its numerous appearances in the mainstream media.”

Source

http://en.wikipedia.org/wiki/Rehab_(Amy_Winehouse_song)
The Lyrics

Here they are. In SKILLS, I’ll break down some of the lyrics, and suggest what lessons we can learn to help clients and their families affected by addiction and co-occurring conditions.

“Rehab”

by

Amy Winehouse

They tried to make me go to rehab but I said ‘no, no, no’

Yes I’ve been black but when I come back you’ll know know know

I ain’t got the time and if my daddy thinks I’m fine

He’s tried to make me go to rehab but I won’t go go go

I’d rather be at home with ray

I ain’t got seventy days

Cause there’s nothing

There’s nothing you can teach me

That I can’t learn from Mr Hathaway

I didn’t get a lot in class

But I know it don’t come in a shot glass

They tried to make me go to rehab but I said ‘no, no, no’

Yes I’ve been black but when I come back you’ll know know know

I ain’t got the time and if my daddy thinks I’m fine

He’s tried to make me go to rehab but I won’t go go go

The man said ‘why do you think you here’

I said ‘I got no idea

I’m gonna, I’m gonna lose my baby

so I always keep a bottle near’

He said ‘I just think you’re depressed,

this me, yeah baby, and the rest’

They tried to make me go to rehab but I said ‘no, no, no’

Yes I’ve been black but when I come back you’ll know know know

I don’t ever wanna drink again

I just ooh I just need a friend

I’m not gonna spend ten weeks

have everyone think I’m on the mend

It’s not just my pride

It’s just ’til these tears have dried

They tried to make me go to rehab but I said ‘no, no, no’

Yes I’ve been black but when I come back you’ll know know know

I ain’t got the time and if my daddy thinks I’m fine

He’s tried to make me go to rehab but I won’t go go go

SKILLS
I read through Amy Winehouse’s lyrics. I don’t know her references to certain people, nor the circumstances prompting her song. With the wonders of the Internet, I discovered some e-mail chat from fans who explained what she meant.

Source

songmeanings.net/songs/view/3530822107858633377/#73015231332

Are the fans right? I don’t know. However their comments spark interesting points to jump off from -regarding clinical skills around addiction, co-occurring mental and substance use conditions.

TIPS

Clinical Tips from the “Rehab” song

Fan No. 1: “On the November 5, 2007 ‘I Told You I Was Trouble: Live in London‘ DVD Extras there’s such a good bit about this song that made me love it even more. After she broke up with Blake (former husband, Blake Fielder-Civil), she went on a bender and ended up staying at her Dad’s for a few weeks. Her record company came round and tried to make her go to rehab. Her Dad said she was fine and she didn’t want to go. They kept asking her so eventually she went just to shut them up. She was talking to the man and telling him her situation and he just said “you’re not an alcoholic, you’re just depressed” so she said thanks and walked out the door.”

  • All concerned family and friends must get together to create a consistent consensus message which will be eventually presented to their loved one. They must also come to agreement on what practical limits will be set IF the identified person will not accept treatment. This preparatory work is done before a traditional Intervention session is conducted. In that session all concerned parties are physically present.
  • In Amy’s situation, her record company was concerned so requested she go to rehab. In the past so had her father. But at this time he was either not concerned about her drinking, or was avoiding any confrontation about her bender. Therefore from Amy’s point of view: “I ain’t got the time and if my daddy thinks I’m fine. He’s tried to make me go to rehab but I won’t go go go.”
  • Family members and significant others (like Amy’s record company) can keep pushing for a person to go to treatment. However if a coordinated Intervention team and plan is not in place, clients are likely to do the bare minimum just to get people off their back. (Amy, under pressure, then agreed to go for an appointment.)
  • Amy’s first appointment was a reluctant one. She was greeted at “rehab” by an intake person who fed into her “denial” and her low interest in accepting she had an addiction. If it is indeed true the intake worker said: “You’re not an alcoholic, you’re just depressed”, he was too quick to make that assessment, perhaps in an ill-fated attempt to engage Amy. Likely he might have thought by downplaying her drinking, he could get her to stay. If so, it backfired. She left believing there was no need for “rehab”.
  • A person may well be drinking because s/he is depressed; because s/he has a co-occurring drinking and depression condition; and/or because her/his drinking is causing depression and other depressing consequences like a relationship break-up. When someone comes to an intake appointment, this is not a comprehensive asssessment  to determine complex differential diagnoses.  What is the goal of intake? To ascertain if there’s enough of a problem and a need for more time to conduct further and fuller evaluation of the differential diagnosis and possibilities of a co-occurring illness. To definitely rule out an addiction problem right in the intake appointment is premature, especially with the complexity of well-publicized problems like Amy’s.

Fan No. 2: “She said that she wrote this song on a whim walking down the street talking with Mark Ronson (Producer). She ended up writing the song about how she drinks because she constantly f_ _ _ _s up her relationships. So when her label told her to go to rehab they asked her why she tended to drink and she said because she f_ _ _ _ _d up in the relationship (my guess is she cheated) and her boyfriend was going to find out so she decided to head off being sad by drinking a bunch. She also said they were going to make her fill out this questionnaire that was going to take 40 minutes and she just got up and left, she didn’t have the time.”

  • Drinking and drugging to cope with sadness, guilt, depression and/or shame is common with addiction. It is easy for the addicted person and the family to understand this “link” or “cause” and excuse the drinking, especially when there’s been a recent life stressor like a relationship breakup. Even if this “cause” has some merit, to explain away a person’s substance use on this basis really does nothing to arrest the addiction and solve problems.
  • Amy felt guilty; she was aware of how she messed up her relationship; this fueled her drive to head off being sad by drinking. While I don’t know the facts of the relationship breakup, it is quite possible that her drinking and drugging significantly contributed to the relationship difficulties, not just the other way around. Cause or effect?
  • In early stages of readiness to change, people frequently do not have the time for assessment and treatment. After all, in their eyes, there is not an addiction problem which needs “rehab” anyhow. So to have to fill out an intake questionnaire that might take 40 minutes to assess a problem she believes she doesn’t have is good reason to get up and leave. To be told she has to be in “rehab” for 70 days or 10 weeks does not attract people into recovery.
  • Take a look at your intake procedures. Examine whether the paperwork demands on you and clients are cumbersome, time-consuming and customer unfriendly. Does a fixed program-driven length of stay turn ambivalent clients away? For reluctant clients this may be all they need to find fault and a reason to leave.

Fan No. 3: “When she wrote “Rehab” she wasn’t a real alcoholic nor a hard drug user. It all began in 2007.”

  • Let’s say it’s true that in 2007 Amy was just at the beginning of her addiction when her record company wanted her to go to treatment. This shows how quickly addiction can progress. In just four years, she went from drinking to cope with sadness and guilt, perhaps to frequent intoxicated performances, to the recent European incident of being booed off the stage for her incoherent performance, and now to death.
  • If, when she wrote “Rehab”, Amy already was more progressed in her addiction, this shows how potent someone’s denial system can be. It reveals her parents’ lack of understanding on how to be supportive and intervene in her addiction.

Fan No. 4: “I think she knows she is more than an occasional drinker, though, as she has said, “The problem isn’t exaggerated. I’m a terrible drunk.” and (when asked how she injured her hand) “I probably walked around the block trying to get to the hotel and fell. I have no idea. I hate that. The blackouts. Happens too often.”

  • Ambivalence about seeing an addiction is common in all clients. Amy seemed to recognize her drinking was getting out of control e.g. having too frequent blackouts and physical injuries.
  • Help for those around her: If only her parents, her record company and friends could have been helped to team up and work together! They watched her dig herself deeper into addiction. If only….. she could still be alive.
  • “Winehouse’s mom, Janis, saw her daughter just a day before her death, and told the Daily Mirror that her dying “seemed only a matter of time. She seemed out of it. But her passing so suddenly still hasn’t hit me,” she told the paper, saying that Amy told her that she loved her, and that she’d treasure those words forever.” It seems her parents felt helpless to intervene, that her dying “seemed only a matter of time”.  If they had done all they could and were peacefully detached then maybe that is fine. We possibly won’t ever know. Imagine if they really felt hopeless because they were never “educated” that intervention can work. How sad!

Source

huffingtonpost.com/2011/07/24/amy-winehouse-dies-mom-janis_n_907997.html?icid=maing-grid7%7Cmain5%7Cdl2%7Csec1_lnk3%7C80701

Fan No. 5: “The ‘Ray’ she means is Ray Charles…..in relation to her he was a druggie too and they tried to get him help and stuff…and send him to rehab. Mr. Hathaway……she means Donny Hathaway, the soul jazz musician who suffered from severe depression….Amy said she’s clinically diagnosed depressed in an interview.”

    • There are many brilliant musicians who’ve done creative work while still deep in their addiction. However these same talented people have testified to how they did so much better work once they sobered up and entered recovery. Check out Eric Clapton, Elton John, James Taylor and Bonnie Raitt to name a few.
    • “There’s nothing you can teach meThat I can’t learn from Mr Hathaway”

      Amy apparently felt her addiction problems were a “result” of depression rather than a primary illness needing addiction treatment. Donny Hathaway suicided at the age of 33, found dead on the sidewalk below the window of his 15th-floor room in New York’s Essex House hotel.

    • We’ll never know whether Amy Winehouse suffered from co-occurring depression and addiction which could have responded to integrated mental health and addiction treatment. But it sure would have been worth a try to give her a chance of recovery.

Source

huffingtonpost.com/2011/07/24/amy-winehouse-dies-mom-janis_n_907997.html?icid=maing-grid7%7Cmain5%7Cdl2%7Csec1_lnk3%7C80701

SOUL
I was in Australia earlier this month, and attempting to make a call back to the USA. I needed to set up an appointment. When I was connected, the receptionist kept hanging up on me. I could hear her clearly. Obviously she couldn’t hear me. She must have thought it was some stalker or prank caller. I persisted a few more times thinking it might just be a poor connection- after all it’s a long way from Sydney to San Francisco.

Next I tried using a different company’s calling card. Still no success. “Hello, hello, hello!” she said, becoming increasingly annoyed; then she hung up on me. Now I was the one becoming annoyed: “What’s wrong with this cell phone? This calling card has been working fine, why all of a sudden won’t it work? Is it the phone; is it the calling card connection; have I run out of calling minutes?”

In the scheme of life, being unable to get through on a call is not a catastrophe. Being in Sydney (one of the great cities of the world) is not exactly being stranded in a desert or on Gilligan’s Island. It was interesting to note my reactions. I started to feel helpless about how to contact people; how to be heard; how to get my need for an appointment met. I kept calling, trying to make contact, and kept running into a stone wall and deaf ear.

What now? I scurried to the instruction book of the unfamiliar cell phone I was using; I searched those pages for an explanation – no luck. Then I remembered! The universal rule of electronic equipment! When something is not working, reboot. Turn off the machine, phone or computer and start up again. Bingo! It worked and I was back in business.

How sweet it would be if all of life’s problems could be fixed in a minute, just by turning off the switch and rebooting. For many, including Amy Winehouse, alcohol and other drugs temporarily turns off the switch. The problem is that when the switch gets turned back on, life isn’t usually consistently better. And all too often, as with Amy, life doesn’t reboot at all.

I don’t know if all the people surrounding Amy didn’t hear her cries for help. She sure didn’t hide her addiction. And yes, people had urged her to go to “rehab”. But what a tragedy and waste of such creative musical talent for her and the other 27 Club members.

Then what about all the other ‘regular’ people like you and me, and the people we serve? What is it like for them to be reaching out and not be heard; feeling helpless to get their needs met; unable to make contact; hitting stone walls and deaf ears?

“Hello, hello, hello!”

STUMP THE SHRINK
From time to time, families in distress write to me about their loved one. Here is one such recent message.

How you would answer this father in need? What would you suggest the parents do? It seems they have tried previous treatment, support and even housing but their daughter is still struggling to get into recovery.

The email:

“I have a daughter who I believe has mental health issues that have created large mood swings, depression and I am sure other issues. Regardless, she has chosen the life of drugs to offset depression.

What do you suggest? Her mom and I have exhausted our resources in two rehabs. I am flying back to where my daughter now lives to visit her in a crisis center while she detoxes.  She moved there to run from her issues here and just repeats them there.  Her mom is at a point where she can no longer provide care, support, harborage, etc.

Help!

Thank you.”

My response:

I am sorry to hear about your daughter’s illness and all your efforts.  I understand how exhausting and devastating that can be for her, and you as parents. It sounds like you have done a lot to try to help her. As parents, you only have control over what you do (though what you do can sometimes create an opportunity for change in your daughter.)  What do I mean by “what” you do? You can emotionally support her and be there for her. However….if she is not at a stage of readiness to see she has an addiction problem, you can only look at what leverage you have, what things you have control over.

For example, I would recommend:

–> Don’t take care of her financial problems (if she has any) unless she is willing to try addiction treatment.  (You may not even be in a position to help financially anyhow.)

–> Some families set limits and discontinue doing things they have done in the past to “bail” their loved one out. Maybe they have rescued them from other situations caused by their addiction – legal, work or money problems. The aim here is not to punish the loved one, but rather to not reward and reinforce negative consequences of addiction by taking care of the problem for their family member e.g. bailing them out of jail, covering their unpaid bills, lying to their employers on their behalf etc… Such intended loving help (the rescuing, bailing out actions) only sends the message that it is OK to continue to use and not get help.

–> When you first take care of your own emotional, physical, financial health, and set limits, you will be attending to your own well-being. As a result, you will actually be taking care of your daughter. In addiction treatment we call that healthy detachment. I recommend you try an Al-Anon meeting for families of people with addiction- if you have not yet already tried that.

Until Next Time

Thanks for reading. See you in late August.

David