Category: Addiction

Categories
Addiction Smoking

Can Graphic Imagery Deter Smokers?

Who actually smokes anymore? I find myself saying this every time I see someone light up; especially after all we’ve learned. It’s not like there’s some beneficial properties to smoking chemically treated tobacco!

Anti-smoking laws have been on the rise for years. Truth is, being a smoker is expensive and isolating, not to mention bad for your health. Looks like the ultimate goal is to eliminate smoking in public places once and for all. It used to be that folks could smoke in restaurants or planes, negatively impacting the communal air space. Over time this has changed. As a former smoker, I remember feeling the heat when those first changes were initiated. I remember being resentful and feeling as though my rights were being violated.  My young, feisty attitude screamed, “I can do whatever I want!” and of course, I smoked anyway. I realize now that it wasn’t my “right” to harm those around me. That self-righteousness was really the selfishness of my addiction talking. True to addict form, all I could think about was my next cigarette.

Recently, the FDA released 9 graphic anti-smoking images that are required to be placed on the top half of cigarette packaging by the Fall of 2012. At the same time, Australia will begin enforcing a ban on brand labels on cigarette packaging in an effort to lesson the intrigue and coolness factor associated with smoking. Despite the usual grumblings from the tobacco industry, the FDA is holding firm. Sadly, the graphic images haven’t really impacted the way people are smoking, though. According to a new, German study, smokers that have been deprived of nicotine for short periods of time have a lower response to fear.  “In those who stop smoking, the activity of the fear center has been lowered so much that they are not very receptive to the scary photos,” said study researcher René Hurlemann, of the University of Bonn in Germany.  They came to this conclusion after scanning the brains of 28 smokers and 28 non-smokers using functional magnetic resonance imaging (fMRI)[1].  And researcher Özgür Onur of the University of Köln noted that smokers, particularly after a 12-hour abstinence, were “indifferent to fear.” Onur went on to say, “It seems that they (smokers) are mentally caught up in their addiction, resulting in a lowered receptivity for fear-inducing stimuli.” That’s a problem, particularly when fear is our body’s natural way of keeping us from doing something perilous. 

While the FDA’s imagery may be useful in deterring non-smokers from picking up in the first place, I hesitate to think that it will greatly change the way current smokers look at their legal drug of choice. The teens I come across certainly aren’t deterred. If anything, they are viewing the graphic images as a joke.

Beyond the current results of these scientific studies, the taste left in my mouth is really one of denial seasoned with a nicotine chaser.


[1] https://www.myhealthnewsdaily.com/smokers-brain-fear-center-graphic-cigarette-labels-1693/
Related articles

Image courtesy of the FDA

Categories
Addiction

America’s #1 Health Problem

A new CASA (The National Center on Addiction and Substance Abuse) report on adolescent substance abuse hit the wires today. Their findings were disheartening, stating, “Adolescent substance abuse is America’s #1 health problem.” The report studied smoking, drinking, the misuse of prescription drugs, and illicit drugs. CASA also delved into the science of addiction itself, identifying it as a “complex brain disease with origins in adolescence,” and going on to document how “adolescence is the critical period for the initiation of substance use.” They not only looked at the drugs being used or the age of the user, but at American culture itself—for example, the way the media romanticizes the use of alcohol in its advertising.

Here are some highlights from their report:

  • 90 percent of Americans who meet the medical criteria for addiction started smoking, drinking, or using other drugs before age 18.
  • 1 in 4 Americans who began using any addictive substance before age 18 developed an addiction, compared to 1 in 25 Americans who started using at age 21 or older.
  • 75 percent of all high school students have used addictive substances including tobacco, alcohol, marijuana or cocaine; 1 in 5 of them meet the medical criteria for addiction.
  • 46 percent of all high school students currently use addictive substances; 1 in 3 of them meet the medical criteria for addiction

The ads we see plastered on enormous billboards on the busiest corners in Los Angeles are there to intrigue us. They aren’t just selling a beer, or some whiskey, they’re selling a lifestyle: one that’s full of handsome men and gorgeous women, all ready and willing to party at will. Life looks perfect in those ads, but we all know it is anything but perfect. It sure can seem alluring, though, particularly when we’re young, rebellious, and feeling the pressures of growing up and being “cool.” The intrigue is also directly fueled by the current generation’s perpetually perceived boredom, which stems from our culture of instant gratification. In our current climate, drugs and alcohol are culturally accepted: we have medical marijuana and a pill for every problem.

Our brains are vulnerable in adolescence and at the height of development. In fact, they aren’t fully developed until we’re around 25! As we spoke about in our recent post, once we begin indulging in the use of mind-altering substances, we are essentially performing science experiments on ourselves.

Susan Foster, senior investigator of the study, notes: “By recognizing this as a health problem and respondingto it, we can actually make the difference by improving the life prospects ofteens and saving costs in society.”  This brings us back to what I always say, get involved and start talking to your kids! Teens are under an inordinate amount of pressure: school, peers, hormones, et cetera. At some point, we have to start looking at how those we love are actually managing such an incredible stress load. I once heard a therapist say, “Little people, little problems; big people, big problems.” She was specifically talking about the value in addressing issues when they begin rather than waiting things explode. When we’re trying to preserve and heal family dynamics, it’s far less challenging to deal with an angry 8-year-old than a drug-addicted teen.

Related articles:

Study: Drug Addiction Among Teens On The Rise (newyork.cbslocal.com)

Addiction Starts Early in American Society, Report Finds(nlm.nih.gov)

Categories
Addiction Adolescence Mental Health

Doctor, Doctor, Gimme the News

Image by WhatDaveSees via Flickr

Is your teen playing doctor? Surely, this is an appropriate question for parents of adolescents who are concerned about teens entering a sexually intimate relationship before he or she is ready.

Unfortunately, this is not what I’m addressing. John Lieberman, our Director of Operations sees quite a bit of this and is concerned that “adolescents are literally playing doctor in the worst way, taking both prescribed and over-the-counter medications to treat perceived illnesses and issues.” They are reading information on the Internet, getting advice from peers as to what medications they should take, and they’re often mixing and matching drugs while they’re at it. While some of these Internet sites have some valuable information regarding symptom checks and corresponding information about illnesses, they also present a danger. Any time we look at something from the perception of a layperson, we risk finding and relating to symptoms within the descriptions of many illnesses. That’s what real doctors are for: differentiating reality from the natural misinterpretation from those of us lacking the vital MD title. Pharmaceutical-related overdoses have increased, proving the increasing danger in this behavior, and spurning an all out war against the pharmaceutical industries.

Drugs like Vicodin, Oxycontin, Percocet, and Demoral are all opium derivative drugs. This particular class of drug is highly addictive and can easily lead to an overdose. Xanax, Ativan, Klonopin, Soma, Lunesta and others are benzodiazepines. These, too, can create a physical addiction in a short period of time and in worse cases, cause death. Adderal, Ritalin, and Vyvance are amphetamines primarily used to treat ADHD and are subsequently very powerful drugs that can cause heart attack and stroke, particularly when used inappropriately. The latter are often traded amongst kids in an effort to get high, or even as an attempt to increase their focus at school.

Our kids are playing doctor with quite a varied array of drugs, and this does not take into account the rampant abuse of illicit drugs or alcohol. According to John Lieberman, “Our teens are using very powerful psychoactive drugs during a time in their lives when they are emotionally vulnerable and when their brains are in a major stage of development.” According a 2010 statement by the APA:

“The brain’s frontal lobes, essential for functions such as emotional regulation, planning and organization, continue to develop through adolescence and young adulthood. At this stage, the brain is more vulnerable to the toxic and addictive actions of alcohol and other drugs.”

This isn’t just about playing doctor, kids are also doing chemistry experiments…with their own brains.

This blog was co-written by John Lieberman, our Director of Operations.

Additional links:

Causes of Increase in Opioid Deaths Probed

Be the Wall

Partnership for a Drug Free America

Categories
Addiction Alcoholism Recovery Spirituality

AA and Spirituality

The 12-step model is certainly reliable and is the standard go-to place for most people seeking recovery. It’s certainly the model we refer to first in the recovery world. However, there are times when we come across an alcoholic or addict who is deeply atheist and subsequently hits a wall when they get to Step 2: “Came to believe that a Power greater than ourselves can restore us to sanity.” Can AA work for them too? Most people will say that it can. Some will leave things as-is, and some will need to make some minor language changes in order to match their beliefs about spirituality. Unfortunately, there are some folks devoted to retaining the exact language that makes up the steps, so much so they are unwilling to accept even a minor change.

As reported in The Fix, a Toronto group of atheists in recovery has just run into that very thing.  The group was listed in their local AA directory, they had a fairly large batch of regular attendees, and yet, some in the community still found their modifications of the steps to be a threat to AA as a whole. Apparently, the idea of a non-secular recovery group was too much and a controversy broke out. Los Angeles has its share of non-secular meetings, but to my knowledge, there hasn’t been newsworthy controversy thus far and the groups seem to be thriving.

Here’s the thing, the “only requirement for membership is a desire to stop drinking,” right? To me that means regardless of someone’s religious beliefs, gender or sexual orientation, they have a right to be there. When I got sober, I struggled a great deal with the God concept. Still, I was embraced by my fellow alcoholics and encouraged to find whatever worked for me. I managed to retain my viewpoint on the intangible nature of a power greater than myself whilst still developing a deep spiritual practice and strong foundation for my sobriety. The steps are viable tools for recovery for me even if I need to alter a few things. My sobriety hasn’t been negatively impacted as a result. So, why the resistance from some when it comes to change in AA? Isn’t our ultimate goal to achieve sobriety? Isn’t it a goal to untangle the addict mind and redirect it to a healthy, positive, less self-serving path? Aren’t we supposed to learn to reach out and be of service, giving back what has been so freely given to us? Why, then, would we want to close the doors on our fellow alcoholics?

With all the hubbub, I was interested in what literary changes sparked this controversy. The Fix printed two of them:

Step Two: Came to believe that a Power greater than ourselves could restore us to sanity.

Adapted version: Came to accept and to understand that we needed strengths beyond our awareness and resources to restore us to sanity.

Step Three: Made a decision to turn our will and our lives over to the care of God as we understood him.

Adapted version: Made a decision to turn our will and our lives over to the care of the AA program.

Frankly, I don’t see anything wrong with this. Those working this version are still fundamentally going to get to the same place: they will be come to believe that they cannot do this alone; they will use the power of the group to help them recover.
Whether you’re closely tied to a Judeo-Christian belief system or have roots deeply planted on a non-theistic path, recovery IS possible. The 12-step model IS effective. If you need to work the steps with some literary alterations, do so, as long as you work them.

Related articles:

Fight over ‘God’ splits Toronto AA groups (thestar.com)

Categories
Addiction Anxiety Depression Mental Health Obsessive-Compulsive Disorder (OCD) PTSD Recovery Therapy Treatment

MDMA: Is This Psychotropic Drug Helpful, Harmful, or Both?

Image via Wikipedia

Last time I wrote about ecstasy, it was about the rise in ER visits and the inherent dangers of using a drug that inevitably depletes one’s levels of serotonin and has the potentiality of long-term brain damage. So, when I came across an article talking about using MDMA (ecstasy) to treat post-traumatic stress syndrome (PTSD), my curiosity was sparked. Psychedelic drugs have been used to treat mental illness before, and with some success: In the 50s and 60s, psychology was in a Freudian phase, viewing psychological issues as conflicts between the conscious and unconscious minds. At that time, psychedelics were used to allow patients to face their unconscious minds while awake, which purportedly eliminated the variables of memory retrieval. Still, these methods of treatment weren’t without controversy.  With the influx of street use, and folks like Timothy Leary telling people to “”Turn on, tune in and drop out,” the use of psychedelia to treat mental illness was met with great discernment and fell to the wayside.

Currently, interest in using MDMA and other psychedelics to treat depression, obsessive-compulsive disorder (OCD) and PTSD is gaining traction. MAPS is doing extended research on this subject, and states that MDMA isn’t the street drug we call ecstasy, noting that while ecstasy contains MDMA, it also may contain ketamine, caffeine, BZP, and other narcotics and stimulants. According the MAPS site they are “undertakinga 10-year, $10 million plan to make MDMA into an FDA-approved prescription medicine.” They are also “currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. Companies also cannot profit from MDMA because it is only administered a limited number of times, unlike most medications for mental illnesses which are taken on a daily basis.”

The use of this drug has leaned so far from its psychotherapeutic roots, proving to be one of the most popular, highly sought-after street drugs around. Because of this, the useful aspect of this drug may easily be overlooked, forcing us to question how we can take something that has morphed into a social enigma and call it useful. I’m curious, will sufficient research place this drug at the discerning hands of medical professionals once again? And how do we, as a recovery community accept this when we have kids coming in suffering from the long-term, negative effects caused by this very drug?

Related articles:

MDMA May Help Relieve Posttraumatic Stress Disorder(time.com)

Ecstasy As Treatment for PTSD from Sexual Trauma and War? New Research Shows Very Promising Results (alternet.org)

Clinical Study of MDMA Confirms Benefits Noted by Therapists Before It Was Banned (reason.com)

Neuroscience for Kids

Ecstasy Associated With Chronic Change in Brain Function

 

Categories
Addiction Synthetic Drugs

Spice: Your Synthetic Nightmare

Spice, K2, Cloud Nine, Potpourri: call it what you will, it’s all the same: a legal, synthetic, psychotropic drug lurking at the counters of your local liquor store.  Some use these drugs once and walk away, disillusioned by the multitude of negative effects. The addiction-prone continue, disregarding the negative nuances, anxious to get high.  Addiction is funny that way: the bad never seems bad enough to stop.

Recently, 20/20 did an exposé on bath salts, K2, and Spice, exposing the dangers and widespread concern amidst parents and law enforcement officials. Our medical director, Dr. David Lewis, addressed some of the risks related to these substances, telling 20/20: “If you take a developing brain and you put a tremendously psychoactive substance in the middle of that, that developing brain, what you really have is a chemistry experiment.” Dr. Lewis is all too familiar with the negative consequences manifesting in kids who have been using these drugs, and like parents, he also worries about the ease with which one can purchase K2 and Spice. Lewis says, “These people sell the drugs to our kids, no matter what the consequences are.” When 20/20 sent in hidden cameras with underage kids, the truth of this was caught on tape. The retailers are in it for the buck. Show them the money, and they’ll sell you the drugs, regardless of the 18-and-over age restriction.

Unfortunately, this rampant, devil-may-care attitude is substantiated by Dan Francis, the Executive Director of The Retail Compliance Association, who says, “a ban is dangerous” because it “sends it underground.” He even questions the government, saying,” What is wrong with euphoria and what gave them the right to regulate it?” Nothing is wrong with euphoria if it’s obtained through non-harming activities like completing a marathon, or a 2-hour Ashtanga yoga class. But that’s not what’s happening here—instead shops are selling a chemical recipe for disaster. We essentially have kids purchasing substances that have the capability of eliciting a desire to self-harm or increase the potentiality of suicidal ideation. It would be irresponsible if we ignored it.

Related articles:

Stores Fight Proposed Federal Ban on Spice, ‘Legal Marijuana’ (abcnews.go.com)

Synthetic pot can cause psychosis that can last for months, research shows (thenewstribune.com)

Teens Able to Purchase ‘Legal Pot,’ Despite Potentially Deadly Side Effects (abcnews.go.com)

Categories
Addiction Opiates Recovery Treatment

Saboxone: A Methadone Alternative?

Recovering from opiate addiction is no walk in the park. With something like heroin, symptoms can occur within 12 hours of the last high, causing addicts several days of sheer misery. Some addicts have no other choice but to detox on their own, suffering the miserable consequences of their addiction. In some ways, if they can make it past that second day, they have a good chance for a successful detox.  Some, however, have the opportunity to go to treatment, which provides addicts the benefit of supportive care and medications to ease the pain and discomfort of withdrawal. A common medication used for this is called Suboxone (bupenophine and noloxone) and purportedly shortens the length of the detox while also treating the withdrawal symptoms. It’s also used for long-term maintenance much like methadone has been used in the past, sans the stigmatization. A prescription for Suboxone means you don’t have to stand in a clinic line for your daily dose, but rather, you get your 30-day rx from a physician.

There are three phases to the using Saboxone in opioid addiction therapy. The induction phase, which is a “medically monitored startup” of the medication, begun 12-24 hours after the addict has abstained from opiates and is in the early stages of withdrawal.  This is typically done under observation in the doctor’s office. Next is the stabilization phase, which happens when the patient has “discontinued or greatly reduced” the use of their drug of abuse and is suffering from little to no cravings. Last is the maintenance phase, which culminates in a “medically supervised withdrawal.”

Nothing is ever that simple, though, when it comes to treating addiction.  While Suboxone certainly has its value for assisting with opiate withdrawal and turning people’s lives around, there is a dark side. It is just another opiate after all.  Some addicts will inject it, some will take more than their prescribed dose, if just for a brief bout of euphoria. Suboxone reportedly has a “ceiling effect,” which means it levels off after a certain amount. Additionally, the naloxone component of the drug is supposed to “precipitate withdrawal symptoms” when the drug is injected. Still, the state of Maine has reported some pretty disturbing news events surrounding Saboxone, with reports of the drug being smuggled into prison, hidden behind postal stamps and kids’ coloring pages. Prison smuggling of this drug is widespread, creating problems from New Mexico to Massachusetts.

Despite the reports of abuse and prison smuggling, the use of Saboxone is still proving to be a promising component to treating opiate addiction. Some experts suggest more training for physicians and tighter regulation of the drug in order to address the rate of abuse. This is definitely something the recovery industry will be paying attention to.

Related articles:

Understanding Drug Addiction Withdrawal (everydayhealth.com)

When Children’s Scribbles Hide a Prison Drug

Getting High on Suboxone? The FDA Says It’s Happening

 

Categories
Addiction Alcoholism Recovery Spirituality

I’m Powerless, Are You?

Image via Wikipedia

When I think of the phrase “I’m an alcoholic,” I often think of Popeye and the fervency behind his frequently uttered catchphrase: “I yam what I yam.”  When admitting to being an alcoholic, you’re taking the first step towards admission of powerlessness. It implies an understanding that in claiming that label, one is willing to look at the mind-body connection to their drinking and using. According to the 12 and 12, “Admission of powerlessness is the first step in liberation.” It is the way those of us in 12-step recovery begin to build the foundation on which our sobriety will steady itself; it is “the firm bedrock upon which happy and purposeful lives may be built.

I recently had an opportunity to do a workshop on addiction and pain with a Tibetan nun by the name of Chonyi Taylor. It proved to be a fascinating experience, particularly since there is a burgeoning movement to blend Buddhism with recovery. One of the things that really resonated with me during this workshop was the perspective she shared regarding addiction being a habit.  Chonyi said, “Addiction is a mental habit in which there is no conscious control, which gives short-term pleasure and long-term harm.” Being able to look at my own addiction patterns as habits, and discovering that I can systematically break them by admitting powerlessness and renunciation, is incredibly helpful. Because, frankly, as addicts and alcoholics, we have terrible tendency toward getting stuck, reacting and responding to our triggers the same way over and over again. In essence, we have developed habits. We repeatedly meet negative experiences with the desire to get drunk or high. When we get sober, sometimes the habit of seeking numbing pleasure continues, often presenting as promiscuity, gambling, eating irresponsibly, et cetera. By admitting we’re powerless and that our lives are unmanageable, we are given our first opportunity to free ourselves from our negative, addictive, habitual behaviors.

No matter how you look at it, the message is this: we are required to admit powerlessness, renounce negative behavior(s), write moral inventories, and develop a spiritual path paved with honesty and service work. I’d rather have the opportunity deconstruct bad habits so I can build new, healthy ones, wouldn’t you?

Categories
Addiction Alcoholism Recovery Spirituality

I’ll Take my Anonymity, With a Side of Humility

A recent NY Times article written by David Colman triggered a firestorm of responses by “challenging the second A in AA.” In fact, he disregards his own anonymity by beginning his own piece with, “I’m Dave, and I’m an alcoholic.” Colman says, “More and more, anonymity is seeming like an anachronistic vestige of the Great Depression, when A.A. got its start and when alcoholism was seen as not just a weakness but a disgrace.” He also brings up the vast range of celebrities who’ve used their recovery stories as fodder for books or albums, clearly stating their involvement in 12-step programs, and as a result, violating the 11th Tradition, which states, “Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.”

Now, in the early days, being an alcoholic was certainly heavily stigmatized, and admission to being an alcoholic was tantamount to social death. Alcoholism was often aligned with humiliation and shame, and public disclosure of your newfound life wasn’t always met with acceptance. In fact, anonymity was key to their survival in the public sector. Without it, many risked losing their jobs and destroying their reputation.

Colman is right when he talks about our awareness of alcoholism being much different today than it was 75 years ago when the recovery industry wasn’t even a glimmer on the horizon. At that time, Alcoholics Anonymous was merely a blip on the undercover radar. It was an opportunity for the desperate and demoralized to find shelter from the shame and indecency brought about by their alcoholism. Frankly, that’s still the case, albeit much larger and much more accessible. There is something interminably safe about not having to be anyone or anything other than your first name. When I was getting sober many moons ago, I remember sitting in meetings amongst a celebrity or two. I’ll tell you what, it’s not the movie stars and musicians we admire sitting in those cold, folding chairs. Instead, they’re just some guy or gal trying to stay sober, one day at a time. Anonymity is what’s allowed them to do that, not public disclosure.

And let’s not forget the 12th tradition, which reminds us that anonymity is our spiritual foundation:

“Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities.”

You know what that means? It means not using our recovery for profit. It means that our spiritual life depends upon that. It means that when our egos get involved, we are prone to come crashing down in a fiery blaze. Disclosure is often food for the ego, which will, in time, hinder our spiritual progress. Sobriety isn’t guaranteed:  Do you want to announce your relapse as publicly as you did your recovery? Most don’t. In fact, the more public you are in your sobriety, the more terrifying it is to come back. I’ve seen it too many times.

Regardless of the deluge of articles suggesting the removal of anonymity, I still believe it has extraordinary value. And while I may eradicate my personal anonymity in personal conversations or within these blogs, I do prefer its maintenance more often than not. I see how damaging it can be to AA when someone like Charlie Sheen gets up and spews venom our way. I see how damaging it is when Britney Spears or Lindsay Lohan makes their struggles with addiction public. Some of us just want to stay sober without the glitz and the glam. I don’t know about you, but my using days weren’t glamorous. Why should my sobriety be?

Related articles:

Challenging the Second “A” in A.A. (nytimes.com)

Should Alcoholics Have to Stay Anonymous? (healthland.time.com)

Can AA survive our tell-all era? (salon.com)

Categories
Addiction Feelings Mental Health Mindfulness Recovery Self-Care Spirituality

Resiliance

Resilience: That’s something an addict/alcoholic discovers in their back pocket when they overcome a difficult situation. It’s the ability to bounce back after the multitude of knocks we’re sure to get just by being alive.

In the using days, problems often seemed unsurmountable, so the only way to “deal with it” was to drink or use. In sobriety, that’s no longer an option. Instead, we sometimes try to “deal with it” by shopping, gambling, sex, video games, food, exercise, you name it. In the end, those behaviors don’t really correct the problem.

Sobriety presents us with an opportunity to learn how to live without the crutches of drugs and alcohol. Instead of infusing ineffective “solutions” to mounting troubles, we now have a toolbox equipped with the 12 steps. One by one, step by step, viable solutions will unfold. Before we know it, the hard work pays off, and our proverbial tool box gets filled with a variety of options. Mine has, anyway.

When I come across an aversive situation, I now have choices. I start with the foundation: the 12 steps, remembering I can approach difficulty one breath at time if need be. Or I might  engage the tools of a meditation practice, asking myself, “Am I breathing?”  Try it. You might even discover that you’ve been holding your breath!  Other times, I might engage the tools garnered from my yoga practice, asking myself,  “Am I present?” The majority of the time, however, it’s a combination of all three, allowing me to season my responses/reactions accordingly.

Recovery teaches us to face adversity with an open heart and a present state of mind. It teaches us that our previous acts of avoidance merely created a diversion to feeling better. The wreckage of our past proves when we walk around the issue, the solution feels and often is unattainable.  Here, in sobriety, we learn to “uncover, discover, and discard,” rather than to “run, hide, and duck for cover.”  So, if/when you find yourself faced with adversity, ask yourself this: “Is my reaction helpful or harmful?” If nothing else, you’ve provided yourself with a break and an opportunity to do the right thing.

Related articles:

Kevin Griffin: A Buddhist Approach to Recovery: Step Four — Searching and Fearless (huffingtonpost.com)

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