Addiction and Psychological Pain

June 19, 2021 by

During the many years I spent working in the addiction and mental health field, first as a neuroscientist and later helping empower people to facilitate their recovery (healing), I rarely heard the word ‘trauma’ being used.

Few practitioners I met mentioned that the person with the substance use problem might be self-medicating to ameliorate psychological pain. And yet in society, there were plenty of people visiting their doctor and obtaining a prescription of benzodiazepines such as librium, which are highly addictive substances, or antidepressants, which also produce problems, to help them deal with unpleasant psychological states of anxiety or depression.

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‘What’s Wrong With You? Nothing. What Has Happened to You? Something.’ by Dr Michael Cornwall

June 18, 2021 by

I believe strongly in the words of this title. This blog first appeared on the Mad in America website and I posted it on this website in May 2014.

‘Licensed Mental Heath professionals are trained and are required to find out what is wrong with people.

Unfortunately, 90 percent of the people who could benefit from professional mental health services, in my opinion, are suffering from feeling something is wrong with them. They already feel bad about themselves, like they are failing in life. They often feel a lot of guilt, shame and self-loathing. They are often already judging themselves.

They may have been overwhelmed  by losses, by life events, or have not had their crucial needs met, or have been unloved, neglected, bullied, abused or mistreated by family and others. Because of what has happened to them, they may struggle to not identify themselves as someone who’s lot in life is to be rejected or harmed by others.

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‘Lost Connections’ by Johann Hari, Part 2

June 17, 2021 by

In my last blog, I described Johann Hari’s enthralling and inspirational book Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions. This has to be one of the most important books I have read in the mental health field since I first started working in this arena over 40 years ago.

Johann asks himself, given all his new knowledge garnered during his research for the book, what he would say to his teenage self just before he popped his first antidepressant drug—he took the drugs for 13 years—if he could go back in time.

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‘Lost Connections’ by Johann Hari

June 16, 2021 by

One of the most interesting books I have read on mental health is Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions by Johann Hari. Johann points out that depression is NOT caused by a chemical imbalance in the brain, as is argued by drug companies and many biologically-oriented psychiatrists and  doctors.

Moreover, there is little, if any, scientific evidence that ‘antidepressants’ alleviate depression. [Some credible scientists suggest they give a temporary relief to a minority of users.] Johann talks about social factors that cause depression and considers new socially-related ways of alleviating the problem.

Johann describes seven forms of disconnection that cause depression:

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Factors Facilitating Recovery: (Gaining) Recovery Capital

June 15, 2021 by

Here’s the last of the 11 factors facilitating recovery that I wrote about in my book Our Recovery Stories: Journeys from Drug and Alcohol Addiction. Just because it is last, does not mean it is the least important factor. In fact, it is one of the most important!

Recovery is better predicted by someone’s assets and strengths, rather than their ‘pathologies’, deficits and weaknesses. People can make progress by identifying and building on their personal assets and strengths. Interventions to facilitate recovery must focus on helping individuals build their recovery strengths, more often referred to as ‘recovery capital’. 

Recovery capital is the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery [1]. It takes three main forms:

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Anna’s Moment of Clarity

June 14, 2021 by

In two recent blog posts starting here, I focused on a qualitative research project we conducted with family members who have been indirectly affected by substance use problems.

Years after this research was conducted, I received a story written by Anna, who lives here in Australia, which relates how her family coped with her brother’s heroin addiction. I published Anna’s Story on  Recovery Stories and recently updated it in my eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction. Anna’s story highlights the need for family members to accept that they cannot take ownership of their loved one’s addiction. They are not responsible for the addiction and they cannot do recovery for their loved one.

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Recovery Stories Weekly, Issue 2

June 13, 2021 by

Welcome to the second of my Recovery Stories Weekly reviews. My blog posts during the past week covered a wide range of topics:

Factors Facilitating Recovery: Overcoming Stigma: Stigma can impact on a person with a substance use problem, or someone on a recovery journey, in various ways. It can create feelings of shame, blame, self-disgust, self-hatred and hopelessness, and impact badly on self-esteem and self-efficacy.

Voices of Loved Ones Indirectly Affected by Substance Use Problems: Family members face initial confusion about the nature of the substance use, imbalance as the problem takes over, a barrage of negative and contradictory emotions, the stigma associated with substance use, and problems associated with the treatment system.

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The Drug Experience: Cocaine, Part 3

June 12, 2021 by

Dan Waldorf and colleagues were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their research emphasises the importance of one’s personal and social identity in influencing drug use. (895 words)

In the last two Briefings, we focused on the most comprehensive ethnographic study of heavy cocaine users, conducted by Dan Waldorf and colleagues in Northern California. They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

This research challenged many of the prevailing myths. In the present Briefing, we look at the process of giving up use of cocaine. Waldorf and colleagues interviewed 106 quitters—30 of these had received some form of treatment, whilst 76 stopped using cocaine without treatment.

When respondents were given a list of personal reasons for quitting, the most common (47% of sample) was given as health problems. The next most cited reasons were financial problems (41%), work problems (36%) and pressure from spouse and/or lover (36%). Only 7% cited actual arrest, although 28% cited fear of arrest as a reason for quitting.

Respondents were also given an open-ended summary question on the most important reason or reasons to quit. A total of 61% mentioned some form of psychological problem or stressful state caused by cocaine as the most important reason to quit. The next most common reasons were financial problems (23%), and severe or recurrent health problems or concerns (19%).

There was great diversity in actions that respondents took to quit using cocaine. Some made a number of attempts to stop before they actually succeeded. They despaired over the hold the drug had over them and had great difficulty in maintaining a resolve to stop using.

However, over a half of the sample stopped using on their first try, although this was not always easy. Two-thirds of the untreated cases stopped on their first attempt, whilst only one in five of treated cases did so.

More than 40% of all quitters reported making some sort of geographic move as part of their successful attempt to quit. Two-thirds of these people said they moved to another city or state, at least in part to help them stay away from cocaine.

The most frequently used strategies for stopping to use cocaine were social avoidance strategies. Nearly two-thirds of the quitters said they had stopped going to places where cocaine was being used, or had made conscious efforts to avoid seeing cocaine-using friends. Over 40% had also sought out new friends who did not use cocaine.

More than 75% of the sample became more concerned about their physical health whilst quitting, and acted upon these concerns. Two-thirds improved their eating habits, and a half undertook new programmes of physical conditioning.

Over half of the quitters sought out new interests, with 39% participating in sports to help them avoid using cocaine. Similarly, 55% of the sample used informal help, such as family or friends, to stop using cocaine.

Only 17% of the sample started using other drugs after quitting cocaine. Of those that did, the majority used only marijuana, which almost all had used before and during their cocaine use. Whilst 21% drank more alcohol, most drank less after giving up cocaine.

Most of this diverse sample had used cocaine heavily for a good number of years—but few were ever merely cocaine abusers. Moreover, their use had not led them to becoming stigmatised. The majority worked regularly, maintained homes, and were responsible citizens:

‘… a commitment to their everyday lives gave them a stake in normalcy and bonded them to the conventional world.’

The sample were different to heroin addicts in other studies, many of whom came from disadvantaged backgrounds, had been criminalised and stigmatised, and had few private resources (e.g. education, jobs).

For many of the present sample, prolonged use of cocaine stopped being fun and started disrupting, rather than enhancing, everyday lives. Since these lives had meaning and value, the difficulties caused by cocaine became powerful spurs for cessation.

The researchers were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their strategies were in general fairly common-sensical social avoidance strategies, designed simply to put distance between themselves and the drug.

Most of the quitters were able to manage the cravings they experienced after stopping cocaine use. They realised that cravings were only transitory—distractions caused them to subside. New interests and activities provided such distractions. Many quitters found cravings:

‘… little different from yearnings one might feel for an old lover – one feels the desire, but with time it subsides and one thinks of him or her less and less.’

These findings emphasise the importance of one’s personal and social identity in influencing drug use. A commitment to a conventional identity and everyday life helps form the social-psychological and social-organizational context within which control and cessation of drug use is possible.

It is commonly stated that drugs come to dominate identities and lives. This was true in the most problematic cases in the Waldorf study.  However, for the bulk of the sample, identities and lives usually dominated drug use. This is a critical fact that must be remembered when we try to help people overcome problems caused by drugs and alcohol.

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

> pdf document

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The Drug Experience: Cocaine, Part 2

June 12, 2021 by

While cocaine is portrayed as having a very high addiction potential, the majority of people who use the drug do not have a problem. Research by Dan Waldorf and colleagues reveals a number of social and social psychological factors that influence how a person uses a drug. (887 words)

Cocaine is often portrayed as having a very high addiction potential, and that most people who use it are risking serious physiological and psychological harm. Whilst some cocaine users do develop difficulties, the majority do not.

The most comprehensive ethnographic study of heavy cocaine users was conducted by Dan Waldorf and colleagues in Northern California. They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

These researchers showed that about a half of interviewees maintained a controlled pattern of cocaine use, some of them for even up to a decade. According to Waldorf, controlled use can be defined as either, ‘regular ingestion without escalation to abuse or addiction, and without disruption of daily social functioning’, or ‘a pattern in which users do not ingest more than they want to and which does not result in any dysfunction in the roles and responsibilities of daily life.’

Based on their observations, Waldorf and colleagues described the ideal type of controlled users:

  • ‘Controlled users tended to be people who did not use cocaine to help them manage pre-existing psychological problems, and did not also abuse other drugs, especially alcohol.
  • Controlled users generally had a multiplicity of meaningful roles which gave them a positive identity and a stake in conventional life (e.g., secure employment, homes, families). Both of these anchored them against drifting toward a drug-centered life.
  • Controlled users, perhaps because they are more anchored in meaningful lives and identities, were more often able to develop, and stick to, rules, routines, and rituals that helped them limit their cocaine use to specific times, places, occasions, amounts, or spheres of activity.’

This research suggests that a stake in conventional life and identity are central for understanding continued controlled use. Such stakes seem to keep a person’s drug use from overtaking their life and identity. They also facilitate an individual reasserting control after a period of problematic use (I will discuss this issue in a later Briefing).

The fact that these social and social psychological factors mitigate against cocaine misuse and related problems suggests that not everyone need develop a problem with cocaine, even when using heavily as this population was.

At the same time, it follows that those people with the least stake in conventional life may be at the highest risk for problematic cocaine use. Cocaine, and in particular crack, have had a marked impact in poor neighbourhoods, causing problems to many individuals and communities.

Obviously, these forms of social control are not fool-proof for maintaining controlled use. Some people with a large investment in conventional life did lose control of their cocaine use and develop serious problems. Waldorf and colleagues report that:

‘… after scouring our other interview transcripts, we could not put our fingers on any one magical ‘factor X’ that explained why some people get into trouble and others did not.’

Other researchers in the US and other countries have reported controlled use of cocaine by a significant proportion of users (see Decorte, 2000 for review).

Waldorf and colleagues recognise that some well-intentioned parents and policy makers might not want to broadcast findings about controlled use for fear of facilitating the denial of some misusers or increasing the risks for some new users.

However, they contend that the:

‘… considerable possibilities for exercising control over cocaine use can be seen as cultural resources that can facilitate personal capacities for control and social capabilities for harm reduction.’

The researchers made the very good point that if the only frameworks in society for interpreting one’s drug-using behaviour are addiction and abstinence, then the idea that one can and should exercise control can atrophy. The interviews revealed that one important reason that control was possible for so many of the participants was that they believed that it was possible. They believed that cocaine was ‘not necessarily addicting, that it could and should be used in a controlled fashion.’

Whilst cocaine is often portrayed as a powerful reinforcing psychoactive drug, we sadly do not often hear that its powers are also mediated by users’ norms, values, practices, and circumstances. We underestimate the powers of social, social psychological and cultural aspects, whilst overestimating the pharmacological power of the drug.

Waldorf and colleagues point out that heavy cocaine users have taught us:

‘… that beyond the drug itself, how users think about and behave towards drugs matters a great deal. Cultural norms matter. Subcultural practices matter. How closely we look out for each other matters. The uses to which we put consciousness-altering substances matters. The personal and social resources of users matter. The values placed on productive daily lives matters. And, of course, the social distribution of opportunities for productive lives matters…’

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

The Taming of Cocaine: Cocaine Use in European and American cities by Tom Decorte. VUB University Press, Belgium.

> pdf document

> Part 3

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The Drug Experience: Cocaine, Part 1

June 12, 2021 by

Exploring the dynamic world of heavy cocaine use as revealed in a provocative, high-quality study by Dan Waldorf and colleagues. This research, conducted in the US in the 1980s, challenged many of the prevailing myths about cocaine. (875 words)

There is a good deal of misinformation about cocaine, which does little to help society tackle the problems that excess use of this drug can produce.

In their book Cocaine Changes: The Experience of Using and Quitting, Dan Waldorf and his colleagues state that they set out to study cocaine users and present their world as they see it, without making moral judgements about the drug-using behaviours.

The research involved interviewing 267 current and former heavy users of cocaine from Northern California. The sample did not include people in treatment programmes or in prison, as is common in other research. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

Nearly all the respondents first tried cocaine when it was offered by a trusted friend. Many of the sample reported that they did not get high the first time they snorted cocaine. They had to learn both to experience and then to appreciate the subtle euphoric effects of the drug.

The majority of respondents increased their use gradually—there was no uniform progression or pattern. The slow escalation was likely due in part to the general greater availability of the drug. Two other factors were often cited as contributing to escalating use: a slow increase in tolerance for the drug, and the seductive and insidious nature of the drug itself.

The tolerance reported with cocaine appeared to be somewhat different to that observed with opiates. Whilst some users reported increasing their doses of drug, they did not generally report decreased effects of the same dose. Rather than needing more of the drug to get the same effect, they reported wanting the same effect again and again.

Many participants ‘… agreed that cocaine’s euphoric effects offered not only a sense of well-being, but a feeling of mastery or power that was so reinforcing it often led them to use more frequently than they planned or expected.’

The researchers described four relatively discrete patterns of use. Hogs showed a consistent, very heavy daily use. This pattern of use caused more dramatic effects, greater compulsion, as well as marked painful ‘comedowns’ and depression.

Nippers used regularly, often every day, but only in relatively small amounts. These users kept their drug use subordinated to work and family responsibilities, and often avoided the negative effects associated with heavy use.

Bingers used cocaine heavily and then lay off the drug for days or weeks. Use was often constrained by personal finances or by prolonged negative effects. Some bingers found their binges getting longer and longer. Ceremonial or occasional users used the drug on special social occasions.

The researchers reported a considerable movement by individuals from one form of use to another. Although some users followed a downward spiral from experimental use to addiction, as many others nipped and then binged and then nipped again. Others moved from heavy binge use or sustained abuse to ceremonial use.

One striking aspect of the study was the proportion of people who used the drug on a controlled basis—approximately 50%.

Long-term daily use of cocaine or regular heavy binges often led to problems. The most frequently mentioned were nasal irritations, insomnia, paranoia, strained relationships with wife or husband, depleted savings, hangover days at work, and periodic sexual difficulties. The most frequent and severe problems were reported by the heaviest users.

Some of these problems were reported as serious, but many were not. Most of the respondents appeared to find most of the problems manageable most of the time. They seemed to get pleasure from cocaine, and accepted the problems as part of the territory.

Most of the sample agreed that moderate use of cocaine can be an exceedingly enjoyable experience —it produced euphoria, more energy, a certain intellectual focus, enhanced sensations, an increased sociability and social intimacy.

However, daily use or regular binges transformed the experience of the cocaine high. The initial euphoria slowly and subtly became dysphoria, feelings of well-being turned into feelings of being unwell and unhappy. Feeling energetic was replaced with feeling apathetic.

These changes in physical feelings were accompanied by transformations in social experience. The person used the drug in isolation, rather than in social groups as was done initially.

Some heavy users noted psychological transformations. The world that had once been good to live in became a place that was far less hospitable—paranoia increased and depression sometimes developed.

A shift in the balance between positive and negative effects of cocaine occurred. The shift to the negative often resulted in considerable psychological pain, and a questioning of the rationality and desirability of continuing to use the drug.

At this time, those people with conventional stakes in families, homes, jobs, communities and identities tended to find the resources and resolve to abstain or reduce their drug use.

Those with fewer such stakes and social supports were more likely to feel indecisive and helpless to overcome their cocaine use problem.

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

> pdf document

> Part 2

 

 

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Ruby’s Healing Story

June 12, 2021 by

It’s hard to believe that it is over seven years ago since I launched Sharing Culture, an educational initiative to facilitate the healing of intergenerational trauma. [I don’t upload new content on the website now, but the content is still there for viewing.]

It is also over seven years since Michael Liu and I went out with Professor Marion Kickett to her home country in York to film her describing her life, country, culture, spirituality, family, education and resilience. Marion is a Noongar Elder from the Balardong language group, who is Director of the Centre for Aboriginal Studies at Curtin University in Perth.

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Should Recreational Drug Use Be Criminalised?

June 11, 2021 by

Douglas Husak, a Distinguished Professor of Philosophy at Rutgers University in the US, combines hard fact and rigorous moral reasoning in his cogent analysis of the drug law debate in his excellent book Legalize This! The case for decriminalising drugs. In this two part series (from Background Briefings section of website), I summarise his arguments to help the reader decide how they feel about the central question of the justice of drug laws. While Husak argues about the situation in the US, much of what is said is relevant to the UK and to many other countries.

Husak points out that we need to ask the right question when looking at drug policy. He emphasises that the onus has always been on those who want to change drug laws to justify why there should be changes. In fact, the onus should be on those who support current policy to justify their position. This rarely happens.

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Factors Facilitating Recovery: Overcoming Withdrawal Symptoms

June 10, 2021 by

People who decide to stop taking drugs or drinking alcohol after using or drinking for long periods of time, need to be aware that they might experience withdrawal effects which can be irritating, debilitating and even life-threatening.

Many of these withdrawal signs, which can be psychological and physical in nature, are generally opposite to the effects the person experienced when the drug was being taken. For example, abrupt withdrawal from long-term use of Valium (diazepam) and other benzodiazepines, drugs which are prescribed to alleviate anxiety and insomnia, can lead to pronounced anxiety, insomnia, agitation, intrusive thoughts and panic attacks.

In addition, people withdrawing from benzodiazepines can experience physical withdrawal signs, such as burning sensations, feeling of electric shocks, and full-blown seizures. The duration and strength of these withdrawal signs is in part dependent on the amounts of drug having been used and the duration of time the person has been using the drug. 

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Voices of Loved Ones Indirectly Affected by Substance Use Problems, Part 2

June 9, 2021 by

Continuing the qualitative research project conducted by Gemma Salter, a talented undergraduate student working with me back in 2004. The research involved interviewing nine parents and one grandparent (who had assumed the role of parent) of people with a drug and/or alcohol problem. The participants were recruited from West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea and Drug and Alcohol Family Support (DAFS) in Blaenau Gwent, South Wales.

…. It doesn’t take long for the effects of stress to manifest itself in physical and psychological health problems. Physical symptoms come in the form of eating and sleeping problems, high blood pressure, stomach problems, irritable bowel syndrome and tension aches. Some parents are prescribed antidepressants by their GPs.

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Voices of Loved Ones Indirectly Affected by Substance Use Problems

June 8, 2021 by

Continuing to look back at my career in the addiction recovery field and what I have learnt. After reading the excellent book Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey in 2003, I made the decision to start a research programme involving qualitative analysis of interviews. The first piece of research, which focused on the effects of substance use problems on the family, was conducted by Gemma Salter, a third year undergraduate. Gemma was awarded the prize for the project of the year in my Psychology department.

Gemma’s research involved semi-structured interviews (lasting 42 – 129 minutes) with nine parents and one grandparent (who had assumed the role of parent) of people with a drug and/or alcohol problem. The participants were recruited from West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea and Drug and Alcohol Family Support (DAFS) in Blaenau Gwent, South Wales.

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Factors Facilitating Recovery: Overcoming Stigma

June 7, 2021 by

This is eighth post in this particular Series, which comes from my book Our Recovery Stories: Journeys from Drug and Alcohol Addiction. It ties in nicely with a previous blog, Nothing to mourn; just a drug addict, by Dr David McCartney.

Stigma can be defined as social disapproval of personal characteristics, actions or beliefs that go against the cultural norm. It can occur at a variety of levels in society, i.e. individuals, groups, organisations and systems. A person can be labelled by their problem (e.g. addiction to drugs and/or alcohol) and they are no longer seen as an individual, but as part of a stereotyped group, e.g. a junkie, alkie, etc. Negative attitudes and beliefs toward this group create prejudice which leads to negative actions and discrimination. 

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Recovery Stories Weekly, Issue 1

June 6, 2021 by

I thought I’d start a weekly column linking to the blog posts and other content loaded on Recovery Stories in the past week. I’ll also include any other news. It will give readers a chance to catch up on what has been going on.

I started blogging regularly again on Recovery Stories on 29 March 2021 after a six year hiatus. The original content, generated from May 2013 and including over 700 blog posts, had still been available during my break. Since my return, I’ve added 60 blog posts, along with other content. I have also launched the eBook Our Recovery Stories: Journeys from Drug and Alcohol Addiction on the 9th April 2021. So here is this past week’s content:

Blog: this week’s posts on my blog.

‘Hope is the Word That Can Free Us From Addiction’ by o2b3: A short story about recovery from the days of our online community Wired In To Recovery.

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A Parent’s Story

June 6, 2021 by

I met Mike Blanche in around 2003 and he was the first person to help me understand the impact of a person’s substance use problem on family members. Mike was an inspiring figure who had played a key role in the setting up of Drug and Alcohol Family Support (DAFS) in Blaenau Gwent in South Wales. He organised a conference, Families in Focus, at which the following talk was given. We first posted this talk on our SubstanceMisuse website back in 2003.

‘Good morning ladies and gentlemen. I am a mother and I have been invited here today to talk about my experiences as a service user. I have a son who is living at home with my husband and myself. He is addicted to drugs.

He first started dabbling with substances when he was still in school. At first it was ‘glue sniffing’, but it wasn’t long before he started experimenting with cannabis. When I tried to approach him to warn him of the dangers of drug abuse, his typical reaction was to say, ‘Don’t worry Mam, I can handle it.’

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Bill White’s Norman E. Zinberg Memorial Lecture, 2012

June 4, 2021 by

Researcher, historian, practitioner and recovery advocate William (Bill) L White has been the most prolific writer in the addiction recovery field. Bill’s fascinating book Slaying the Dragon: The History of Addiction Treatment and Recovery in America is a classic. You can see the Table of Contents here.

As many can testify, Bill is an amazing public speaker. Here is the Norman E. Zinberg Memorial Lecture, Experiencing Recovery, he gave at the Harvard Addiction Conference in 2012. Bill’s lecture is on YouTube, divided into ten parts:

Part 1: Early History of Recovery in the U.S.

Bill describes just how far back recovery goes historically in the US—to Native American Indians in the 1730s! (13’36”)

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Youth Suicide & Self-harm: Indigenous Voices, Part 2

June 4, 2021 by

“Culture has become life-giving medicine for our people, closing the wounds of the past and standing us strong to face the future.

Our Elders have been fundamental in this process. They are our wisdom keepers. They have seen the changes, so dramatically incurred in their lifetime. They are the vital bridge between the modern world and Aboriginal culture. They are the leaders of our communities, to whom we continue to rely on for guidance and counseling.

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