John M. Talmadge, M.D.

A Blog Covering Many Topics

Blog Titles

There are all sorts of topics discussed here. Although there is no index as such, you can scroll down the page and find my thoughts on these topics. Be patient, scroll down, and you'll find:
How Can a Psychiatrist Be Helpful?
What My Work Includes...
Three Articles on Addiction
The Happiness Poster
Back from the Break!
Painkillers: New Guidelines
Explaining Alcoholics Anonymous
The Painter and the Poet
Dr. Talmadge Speaks at Solutions Banquet
The Wisdom of Playing "Small Ball"
Dr. Talmadge Joins UpToDate Advisory Board
Mindfulness in 8 Weeks
Insurance Companies Lie to Consumers
Be Positive in 3 Ways
Mindfulness Meditation Improves Health
What Are Marijuana "Dabs"?
Pain Pill Addiction Basics
Research on Marijuana
Random Facts on Happiness
Recognizing Bullshit!
Learn About Your Brain…
CASA Report on Addictions
Your Brain on Pornography
Families, Pressure, and Stress
Talk About Meditation Without Being Annoying
New Video: Why Doctors Hate Electronic Records
Never Underestimate the Power of a Single Intervention
Adderall Time in Texas
Spiritual Reflection, Contemplation
Job Burnout Basics
60 Minutes: Managed Care & Mental Health
Mindfulness and PTSD
Stages of Change: A Summary
Mindfulness as an Alternative to Medication
Talk Therapy? Medication
The Adderall Phone Call Trend
Should Children Take Antipsychotic Medication?
Whole Brain Teaching
Drug Overdose Deaths
Bogus: Dr. Oz
One Nation, Under Sedation
Female Veteran Suicides
New Brain Discovery? Lymph?
Brain Scan Scams? Amen!
Child Development and Brain Health
Texas Holdem Poker, Human vs. AI (Two Parts)
Painkiller Overdoses on the Rise
Traumatic Brain Injury (TBI)
Kevin McCauley MD on Addiction
Aging Brain? Not So Bad…
Network Adequacy: Not Adequate!
Best Therapists = Best Outcomes
Treatment: Know What to Ask
Being Mindful: Getting Started
The Brain: An Introduction
Cognitive Distortions!
Yoga for PTSD in the Military
Notes on Club Drugs
SMART Training for Teens
Science on Will and Willpower (2 Parts)
Addictionary: The Language of Addiction
Facebook, Twitter, and LinkedIn
Genetics, Weird Facts, & Placebos
Mindfulness and Relapse Prevention
Being Mindful and Positive
Change Your Brain
Brain Scams: Don't Buy the MRI
Beliefs Shape Our Reality
Changing the Brain
What Is a Disease?
Painkillers, Narcotics, Addiction
Do 12 Step Programs Work?
Finding and Identifying the Effective Psychiatrist
Neuroscience of Belief
Be a Better Spouse or Partner
Talmadge's Treatment Philosophy
Thoughts and Reflections

How Can a Psychiatrist Be Helpful?

Research shows that psychotherapy can help, medication can help, and intelligent problem solving helps. Psychotherapy is not for everyone, and medication is not for everyone, but the vast majority of people who want help can find it. One of my favorite expressions is, “You have to do it yourself, but you can’t do it alone.”

Over the years I have developed a style that I call “sober conversation.” The word “sober” does not apply just to alcohol and addictions. To be sober is to be serious, to focus on what is most important, and to try to get it right. I believe in the importance of what we care about, and in this regard I have seriously studied the specific problem of human will. I call it “the problem of human will” because we are often confused about what we will ourselves to do, or not to do. When I work as a psychotherapist, I am most interested in what people care about, how their beliefs and assumptions about life have been formed, and where they feel stuck or at odds with themselves. Sometimes we have conflicting feelings about the same thing. For example, someone wants to take life in a certain direction, but he or she feels conflicted about it. Or someone tries to solve a problem, not realizing that it’s part of a bigger problem, or a different kind of problem. My definition of psychotherapy is that it is a form of personal consultation, focused on the situation of the client, with the goal of solving problems and feeling better.

Not everyone is cut out for in-depth or long-term conversation. Some people like to come for a few visits, and some like to keep going for weeks, or even months on a weekly basis. Some people prefer to come two or three times a week because they want to do the work and get on with whatever is next. Some people come for an hour, and some come for an afternoon.

Psychotherapy does take time, because the process is basically two people getting to know each other in the context of a specific purpose. Psychotherapy at its best is about taking life seriously, getting it right, and feeling the satisfaction that comes from clarity of thought, commitment to integrity, and comfort with the complexity of one’s own emotions and ideas. Some say that psychotherapy is a dying art, and this may be true. Psychiatrists today (and perhaps psychologists as well) do not receive the extensive training in psychotherapy that we did thirty years ago. Many psychiatrists and psychologists are not interested in psychotherapy. And many psychotherapists are not really very good or very well trained. Today there are thousands of people who call themselves “life coaches,” and anyone can hang out a shingle and call himself a “life coach.” There are several private organizations that offer “certifications,” but there are no license requirements, there is no government regulation, and no educational standard that is generally accepted. For these reasons, I think the concept makes sense, but in practice let the buyer beware -- caveat emptor!

Medications can be very helpful in treating some specific psychiatric problems. Today we have excellent medications for anxiety, depression, mood swings, insomnia, attention deficit disorder, and other conditions. Bipolar disorder, for example, is a devastating condition that can be very effectively managed with medication, restoring individuals to a life of normalcy and stability. I have absolutely no doubt about the value of psychiatric medications. I also believe that what is most important is getting the right diagnosis and the correct strategy for intervention and treatment. I see many people who have been misdiagnosed, and even mistreated, because they have not been well assessed. Assessment can take time, and I never jump to conclusions about diagnosis. After knowing someone for a few weeks, together we may decide that we see the condition in a different way.

Psychiatric medications are powerful, effective tools when used properly, but they also have side-effects, and they are expensive. Getting the right medication for the right diagnosis is extremely important. And there is an old saying from Hippocrates, creator of The Hippocratic Oath: “It is more important to know what sort of person has a disease than to know what sort of disease a person has.“

What My Work Includes...

My work includes general psychiatric problems like anxiety, depression, attention deficit disorder, substance abuse, family conflict, childhood behavior, stress, and other issues. Many people know me through my work as a specialist in the treatment of alcoholism and other addictions or chemical dependencies.

My approach to psychiatric practice reflects many years studying human nature and working to help people who are having a hard time in life. By the time most people see a psychiatrist, they are worried, or they are sad, or they are very confused about something I will just call “the problem,” or “the complaint.” Let me make some general comments about my approach, and then I will discuss my thinking on the use of medications.

People seek psychiatric help for a variety of problems, but everyone wants the same result: to feel better, to think more clearly, to rediscover satisfaction and happiness, and to regain a sense of self control and personal freedom. The problem may be related to mood, energy level, motivation, sleep, worry, relationships, anger, troubled behavior, obsessions, compulsions -- it’s a long list. People who drink too much, use drugs, or misuse prescription medication are often using these chemicals to find relief. Alcoholism and substance abuse are widespread in our culture.

Dealing with life is rarely easy.

Most persons first try to solve the problem or deal with the complaint on their own. Frustrated that things aren’t improving, they may seek advice from others. Sometimes a person hides the problem or lives in silence with the complaint. They may read a book, go to a support group, consult the internet, or try a new religious practice. We all have problems and complaints, and we all do the best we can to solve the dilemmas of life. When someone calls me about consultation, I almost always hear them say that they have a problem, they have tried to solve the problem, and they are looking for someone who knows how to help make things better.

One of the individuals consulting with me said, “I feel like I’m in a box, and the directions for getting out of the box are printed -- on the outside of the box.”

A successful airline pilot, a Vietnam combat veteran, said, “Doc, I’m out of altitude, airspeed, and ideas.”

Often the person seeking help has waited so long that demoralization has begun to set in, and they are beginning to lose hope. This doesn’t mean that the individual is suicidal or, in fact, any more unhappy than many of the people at the workplace or in the neighborhood. It means that they are resigned to always feeling this way, never feeling any better than this. Demoralization means a state of mind in which a person considers accepting fate, giving up, and abandoning the idea that things can get better.

Fear, anger, resentment, feeling constantly wounded, feeling overwhelmed, feeling unappreciated, feeling worthless -- all of these emotions are part of our lives. But when we feel negative all the time, or most of the time, most days, then we need help. There are very few emotional problems that defy intelligent therapy and reasonable efforts toward a solution.

When I meet someone for the first time in consultation, I have three major concerns. First, I want to get to know the person and hear about the problem are the complaint. My first question usually is simply, “How can I help?” or “What brings you to see me?” Second, I want to explore the individual’s point of view or understanding of the problem, including what solutions have been attempted. Third, I want to consider what we can do, working together, to improve the situation. I tend to focus more on results than on reasons. I’m not always sure about why things happen, but I am very focused on what we can do now. Sometimes I explain in detail how the brain works, and sometimes I discuss how life works. The process of recovery involves growth, change, and even personal transformation.

Three Articles on Addiction

Painkiller Misuse in U.S. Doubled in Decade
Over 4 percent of adults reported non-medical use of drugs like OxyContin in 2012-2013, and the problem worsens.

Read the entire article here.

More bad news from the U.S. drug wars: Misuse of prescription opioid painkillers by American adults more than doubled from the early 2000s to 2013, a new government study says.

Rates of addiction to powerful painkillers such as OxyContin and Vicodin also swelled during that time, according to the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Who Gets Addicted to Prescription Drugs?

It's hard to know how many people in the nation are hooked on prescription drugs. That’s because only overdoses can be easily tracked. But based on those numbers, experts think that more than 8 and half million Americans abuse such meds. And they often start young. About 8% of high-school seniors said they used the painkiller hydrocodone for nonmedical reasons during the past year.

There’s no way to know who will become addicted. Some people use prescription pain pills -- and even misuse them for a short time -- but don’t become hooked.

Read the entire article here.

What Is Medical Marijuana?

Medical marijuana is any part of the marijuana plant that you use to treat health problems. People use it to get relief from their symptoms, not to try to get high.

Most marijuana that's sold legally as medicine has the same ingredients as the kind that people use for pleasure. But some medical marijuana is specially grown to have less of the chemicals that cause feelings of euphoria.

See the slide show on medical marijuana here.

The Happiness Poster

In an article titled "Questioning the Science of Happiness," the author (Trent Gillis) uses the following graphic, which is quite intriguing:

Poster on the science of happiness

Back from the Break!

For the past several weeks I've taken a break from the blog, and I've been working on the Mindfulness and Positive Psychology Program for The Brain Performance Institute at The Center for BrainHealth. The Institute will occupy the new building, which is under construction on the site adjacent to CBH on Mockingbird Lane here in Dallas.

My recent explorations in mindfulness include the study of "mind wandering," something we all recognize in our daily lives. When our minds wander, our attention is shifted from the task at hand to something else. Have you ever looked up an important concept on the web, or on Wikipedia, only to find yourself wandering off into some other corner of the internet? That's an example of mind wandering.

Another relevant concept is that of "mindlessness." Some research scientists describe mindlessness as "being on automatic pilot," or "not being fully present." An example commonly experienced is our tendency to drive down the highway without really paying attention to our driving. If you've ever missed your exit on the freeway, you have experienced mindlessness, or mind wandering.

One interesting aspect of "mind wandering" is that the phenomenon may also be linked to creativity. Relaxing and letting my mind wander sometimes produces good ideas. In July I will be presenting a series of talks and seminars on these topics. If you're interested, let me know, and I'll keep you updated!

Painkillers: New Guidlines

Federal health officials have called for doctors to stop prescribing chronic pain patients so many of the drugs. The alert has been highlighted by Statistics suggest that 1 out of every 150 patients prescribed long-term opioid painkillers die of a condition related to their prescription within three years of its start.

Opioid painkillers such as OxyContin and Vicodin are now prescribed to as much as 4% of the U.S. population — 250 million prescriptions — with their use quadrupling since 1999. Some 1.9 million Americans are now addicted to, or dependent on, the painkillers. And from 1999 to 2014, about 165,000 people died of overdoses. Almost all of the opiate-related drugs on the market for pain are as addictive as heroin.

According to the National Institute on Drug Abuse (NIDA), the abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise. For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.

Graphic: Increase in Opioid Rx 1991-2013
Increase in Opioid Prescriptions 1991-2013

Opioid medications can produce a sense of well-being and pleasure because these drugs affect brain regions involved in reward. People who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed. For example, extended-release oxycodone is designed to release slowly and steadily into the bloodstream after being taken orally in a pill; this minimizes the euphoric effects. People who abuse pills may crush them to snort or inject which not only increases the euphoria but also increases the risk for serious medical complications, such as respiratory arrest, coma, and addiction. When people tamper with long-acting or extended-release medicines, which typically contain higher doses because they are intended for release over long periods, the results can be particularly dangerous, as all of the medicine can be released at one time. Tampering with extended release and using by nasal, smoked, or intravenous routes produces risk both from the higher dose and from the quicker onset.

The Centers for Disease Control released a dozen opioid prescription guidelines in the Journal of the American Medical Association (JAMA). They will not have the power of law but will guide insurance company recommendations to doctors and Veterans Administration prescriptions for retired military patients, with the aim of curbing dangerous prescribing practices. "Primary care clinicians find managing chronic pain challenging," according to JAMA, and "evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose."

The guidelines are based on three principles. First, opioids should be a last option for these patients, with aspirin-related drugs and exercise preferred. Second, when given, doses should start out low and only increase slowly. Third, patients should be monitored and a plan for getting them off the drugs should start with their prescription. The guidelines also call for getting naloxone, a drug used to counteract overdoses, into the hands of more doctors, nurses, police, and emergency personnel.

Explaining Alcoholics Anonymous

Last week I attended an Alcoholics Anonymous meeting, one devoted to people who are brand new to AA. For many years I've said that we as a fellowship need to improve our outreach to newcomers. In previous posts and elsewhere on my site (as in the FAQ Frequently Asked Questions section) I state that I am not an evangelist for AA. It doesn't work for everyone. Nonetheless, AA is a powerful movement helping many alcoholics and addicts. I credit AA with helping me find sobriety over 30 years ago, when not much else was available to help alcoholics. Here are some thoughts on the subject of newcomers to AA.

Treatment centers advertising alternatives to AA, or pitching their approach to people who people who (for whatever reason) are opposed to AA, generally don't do a very good job when it comes to staying sober after rehab. Although these programs may offer all sorts of amenities like yoga, hiking, spa treatments, and leisure activities, they do almost nothing regarding follow-up and aftercare. After a few weeks that are more like a vacation than serious treatment, individuals return home with few tools and no plan for what happens next. The reason that better treatment centers endorse AA, and encourage membership, is that AA is widely available and often very helpful.

The logo of AA: Unity, Service, Recovery

In every town or city, almost without exception, AA is easy to find. In smaller communities, there is usually an AA meeting within driving distance nearby. In Dallas, for example, there are hundreds of meetings every week, and at least 20-30 every day. Some meetings have 10-20 people, and some have as many as 100 or more. I once belonged to a meeting that had fewer than 12 members, and we met every week for years.

Old-timers — recovering alcoholics who have been AA members for many years — are familiar with a statement quoted at almost every AA meeting: "ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism."

Newcomers to the program of Alcoholics Anonymous often arrive with misconceptions about the program. With the rise of the internet, it's easy to find critical statements about AA, but unless you've attended a few meetings you may not know much about the program itself.

One common misconception is that attending a meeting means "baring your soul" or "having to talk." This is not the case. If you happen to be called on, or asked if you want to share something, you can just say, "I'd just like to listen," or "Thanks, but I'll pass." I've said this myself in many meetings.

And here is a good tip if you're flying solo rather than attending your first meetings with a friend or someone who has invited you. Show up a little early. Old-timers usually arrive early, looking forward to chatting before the meeting and welcoming newcomers. Old-timers also tend to hang around after the meeting to visit with friends and answer questions. Come a little early, and stick around a few minutes after the meeting. You will get a lot more out of the experience if you don't head for the door the minute the meeting ends.

At the end of most AA meetings, we "circle up," and most meetings end with a prayer like the Lord's Prayer or the Serenity Prayer. People gather in a circle and hold hands. If this totally turns you off, that's okay. Even if it feels awkward or doesn't fit your sense of style, it's not the worst experience in the world. It's not as bad as sitting on a barstool dreaming about the life you wish you had instead of the life you actually have.

Here are a few comments about the basics of AA, how it works, and why. The questions, quotations, and bullet points are taken from a brochure, "A Newcomer Asks," published by AA General Services. Additional comments are my own.

Newcomer Asks Pamphlet Image

• The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions.

At every AA meeting, a little basket is passed around the room, and members put in a couple of dollars to support that particular meeting in that particular location. Although very few people arrive intoxicated, many first time visitors have had a drink in the last 24 hours. The message is simple: if you want to get sober, we can help. Honesty, having an open mind, and willingness are the keys to success.

• A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes.

For over 70 years, Alcoholics Anonymous has remained true to this original statement. Although there is often discussion about God — "the higher power" or "the power greater than ourselves" — there is never any discussion or debate about theology. The emphasis is on recognizing that in the great scheme of things, something out there is bigger than we are, and that spiritual experience is part of human nature. Agnostics and atheists are welcome in AA, and many recovering alcoholics are not "church people." The basic idea is that if someone claims that "God does not exist," that person probably has given a lot of thought to the question. An open mind is all that is required to understand why AA's believe in a power greater than the individual.

• Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

For the better part of the past century, AA members have remained true to this simple principle. This is why members do not get side-tracked on other causes, concerns, or social projects. It's all about helping others who struggle with alcohol.

Alcoholics Anonymous asks and answers some basic questions often heard from newcomers.

Am I an alcoholic?

"If you repeatedly drink more than you intend or want to, if you get into trouble, or if you have memory lapses when you drink, you may be an alcoholic. Only you can decide. No one in A.A. will tell you whether you are or not."

Notice that the answer says you may be an alcoholic. Although there are medical and psychological definitions of addiction and alcoholism, AA takes a very practical position. If you think you have a problem, maybe you do. If other people are concerned about your relationship with alcohol, maybe that's worth thinking about. If alcohol seems always to be there when you get in trouble, it's valuable to ask whether you have a drinking problem.

What can I do if I am worried about my drinking?

"Seek help. Alcoholics Anonymous can help."

Alcoholics Anonymous is not an addiction treatment program, and the meetings are not group therapy. To our misfortune, many individuals come to AA after having a somewhat negative experience in a treatment center ("rehab"). The rehab experience is a very mixed bag. Although some treatment centers are excellent, many are not. Many treatment centers are very expensive, with a spa-like atmosphere and lots of amenities like horseback riding, indoor swimming pools, and great food. Some of these centers do not mention AA at all, and very few residential rehabs provide a smooth transition back to the real world and everyday life. Some treatment centers even advertise that they are not 12-Step based, although their success rates are poor.

AA helps in many ways, however, both "in the rooms" (at meetings) and in everyday life. Although AA does not try to explain exactly "why" the fellowship is helpful, psychologists and psychiatrists generally agree that participation in AA has many benefits.

— AA offers hope to people who are suffering because of alcohol. Our greatest enemy when we are suffering is demoralization. When we are demoralized, we consider giving up. We believe that our condition is hopeless. AA demonstrates that we can recover, and AA offers a way back to sanity and health. Hope is very powerful.

— AA encourages the alcoholic to recognize that we all have problems, that the experience of suffering is universal, and that we are all simply human beings struggling with human problems. Universality, as it's called, is fundamental to any therapeutic group process. We all have problems, and together we can forge solutions.

— Learning about the disease is essential to recovery. AA does not get into neuroscience or psychology, but the program helps people understand that the alcoholic really is powerless over alcohol (as well as drugs when it comes to those of us who have abused multiple chemicals). AA also helps us understand that alcohol affects every aspect of our lives, especially our family, our work, and what we care about most. Being a drunk doesn't make anything better in life.

— Altruism, or generously giving to others, is the foundation of the program. The old saying is "service above self, and principles are more important than personalities." In a newcomer's meeting, the attitude is welcoming, friendly, supportive, non-judgmental, and altruistic.

— Alcoholics Anonymous is like a big family. Many people form relationships in AA that help correct the damage suffered during our early years, or the trauma suffered from bad life situations. A good sponsor is like a good aunt or uncle who helps guide the process of recovery. Deep and loving friendships are forged in AA.

— Learning how to live a normal life, socializing with others in the absence of alcohol or mind-altering chemicals, is an essential part of AA. It's rather amazing for the newcomer to see that recovering alcoholics have a lot of fun, enjoy life, and know how to have a party without getting hammered.

— AA folks tend to stick together. Cohesiveness, bonding with others, makes for good health and peace of mind.

— In AA, people learn to see what works by imitating others, not in a false or phony way, but rather through the coaching process. Someone may say, "Try this. It works for me." A newcomer may develop new patterns of behavior because the newcomer sees that there's a different way to act around other people. Although you will hear "fake it until you make it," there is nothing fake or phony about AA. The old saying simply means that if you imitate someone you admire, you can change your own presentation of yourself.

— In AA, it's okay to let your true feelings come out. Sometimes people laugh, or cry, or even express anger about what's gone on during the day or during a lifetime soaked with booze. Being able to sit with a sponsor and have a good laugh or cry is a therapeutic experience. It really can help.

If I go to an A.A. meeting, does that commit me to anything?

"No. A.A. does not keep membership files, or attendance records. You do not have to reveal anything about yourself. No one will bother you if you don’t want to come back."

This is absolutely true. Alcoholics Anonymous emphasizes a philosophy of attraction, not promotion. This is why you don't see advertisements or billboards or 800 numbers for AA. It's an organization based on helping others who want what AA offers.

What happens if I meet people I know?

"They will be there for the same reason you are there. They will not disclose your identity to outsiders. At A.A. you retain as much anonymity as you wish. That is one of the reasons we call ourselves Alcoholics Anonymous.
What happens at an A.A. meeting? An A.A. meeting may take one of several forms, but at any meeting you will find alcoholics talking about what drinking did to their lives and personalities, what actions they took to help themselves, and how they are living their lives today."

Most newcomers are surprised by how many good and decent people attend AA meetings. Sometimes they run into old drinking buddies who also have decided to sober up. After a month or two, most people will have new friends in AA, and this is a powerful source of support and companionship.

How can this help me with my drinking problem?

"We in A.A. know what it is like to be addicted to alcohol, and to be unable to keep promises made to others and ourselves that we will stop drinking. We are not professional therapists. Our only qualification for helping others to recover from alcoholism is that we have stopped drinking ourselves, but problem drinkers coming to us know that recovery is possible because they see people who have done it."

As I've already said, AA is not a "treatment program," and it is not "therapy." Most people who attend AA get professional help from a therapist, psychiatrist, or counselor on a private basis outside of AA. Membership in AA is about gaining support, understanding, and the plain old love that is the power of the fellowship. I have attended AA meetings since 1983, and the friends I have made there are beyond description. These are friends from all walks of life and all sorts of backgrounds.

Why do A.A.s keep on going to meetings after they are cured?

"We in A.A. believe there is no such thing as a cure for alcoholism. We can never return to normal drinking, and our ability to stay away from alcohol depends on maintaining our physical, mental, and spiritual health. This we can achieve by going to meetings regularly and putting into practice what we learn there. In addition, we find it helps us to stay sober if we help other alcoholics."

Being "cured" of any illness is a relative concept. For example, cancer patients describe themselves as "cancer survivors," and sometimes say that their disease is "in remission." What they mean is that the disease may come back, and they continue to take care of themselves in much the same way that recovering alcoholics take care of themselves."

On a personal note, I attend AA because I have many friends there, I want to help newcomers, and I get a lot out of the meetings. There are times when I am busy or I would rather sit out on the porch in a lawn chair, but I've never come out of an AA meeting regretting that I invested the time in my health a recovery. Not everyone feels this way about AA, of course. It takes awhile to get to know people and to get the rhythm and deeper benefits of the program. In that way, it's not much different from joining any other social organization like the Rotary Club, the Lions Club, or the Elks Lodge. At first you don't know many members, and gradually you are befriended and become part of the regular crowd.

When you find a meeting that feels right, plan to attend that meeting regularly. Having a "home group" is like having a regular group for your weekly bridge game or your weekly service group. You get to know the people. Just bouncing from group to group is certainly okay when starting out, but getting a comfortable home group that feels right is an important step in staying sober.

How do I join A.A.?

"You are an A.A. member if and when you say so. The only requirement for A.A. membership is a desire to stop drinking, and many of us were not very wholehearted about that when we first approached A.A."

How much does A.A. membership cost?

There are no dues or fees for A.A. membership. An A.A. group will usually have a collection during the meeting to cover expenses, such as rent, coffee, etc., and to this all members are free to contribute as much or as little as they wish.

Is A.A. a religious organization?

"No. Nor is it allied with any religious organization. There’s a lot of talk about God, though, isn’t there?"

"The majority of A.A. members believe that we have found the solution to our drinking problem not through individual willpower, but through a power greater than ourselves. However, everyone defines this power as he or she wishes. Many people call it God, others think it is the A.A. group, still others don’t believe in it at all. There is room in A.A. for people of all shades of belief and non-belief."

Can I bring my family to an A.A. meeting?

"Family members or close friends are welcome at “Open” A.A. meetings. Discuss this with your local contact."

What advice do you give new members?

In our experience, the people who recover in A.A. are those who:
(a) stay away from the first drink;
(b) attend A.A. meetings regularly;
(c) seek out the people in A.A. who have successfully stayed sober for some time;
(d) try to put into practice the A.A. program of recovery;
(e) obtain and study the Big Book, Alcoholics Anonymous.

How can I contact A.A.?

"Look for Alcoholics Anonymous in your local telephone directory. These telephones are answered by A.A. volunteers who will be happy to answer your questions, or put you in touch with those who can. If there is no A.A. telephone service close to you, write or phone the A.A. General Service Office."

There are several websites that are specific for North Texas. For example, the Preston Group has its own website. A directory for the hundreds of AA meetings in the area can be found here at

The Painter and the Poet

The painter is Pablo Picasso, and the poet is Wallace Stevens:


Wallace Stevens, "The Man with the Blue Guitar" (excerpts)


The man bent over his guitar,
A shearsman of sorts. The day was green.

They said, "You have a blue guitar,
You do not play things as they are."

The man replied, "Things as they are
Are changed upon the blue guitar."

And they said then, "But play, you must,
A tune beyond us, yet ourselves,

A tune upon the blue guitar
Of things exactly as they are."


I cannot bring a world quite round,
Although I patch it as I can.

I sing a hero's head, large eye
And bearded bronze, but not a man,

Although I patch him as I can
And reach through him almost to man.

If to serenade almost to man
Is to miss, by that, things as they are,

Say it is the serenade
Of a man that plays a blue guitar.

Dr. Talmadge Speaking at 21st Solutions Annual Banquet

I'm brushing up on my public speaking skills and, for the first time in years, I'm probably going to write a speech before I deliver it. This spring I will be the guest speaker at the 21st Annual Banquet celebrating the success of Solutions Outpatient Services, and this is quite an honor. I haven't homed in on an exact title or a topic, but this is an event that brings together hundreds of people from the recovering community, the world of alcohol and addiction treatment, and the professional world.

Lois Jordan, Bill Jordan, and Mary Donna Noack have been among my best friends and most treasured colleagues for over twenty years. Lois and her husband Bill started working with alcoholics and addicts before the field was even well known, much less fashionable. To see the biographical sketches of the great people at Solutions, click here.

Their practice, Solutions Outpatient Services, remains one of only a handful of facilities that remain owned and operated by its original owner. Solutions Outpatient Services is an Intensive Outpatient Program (IOP) licensed by the Texas Department of State Health Services to treat alcohol and drug problems. In September 2013, Solutions extended its services to include Soul Food, an adult IOP for the treatment of anorexia, bulimia, binging, and compulsive eating. Soul Food has quickly developed the same highly acclaimed reputation as Solutions’ substance abuse IOP.

As Lois says, "If there is one word to describe Solutions, it would be Family. Solutions is Family owned, Family run, the staff is Family, the clients become Family, the family members become Family, and the professional community is embraced as Family. Individuals and their families come to us so broken by addictions that they cannot even imagine that they can heal." That's pretty special. You don't see language like that in corporate brochures or typical business advertising!

She also writes: "At Solutions, we not only help clients and their families gain the tools to deal with their addictions and codependency, but more importantly, we give them the tools to live life in a meaningful way. We believe that addiction is about an unhealthy relationship with a mood and/or mind-altering substance and/or behavior. Therefore, we help clients develop relationships with themselves, their Higher Power, their families, their 12-Step communities, and their community-at-large in a meaningful and sustainable way."

Congratulations to Lois, Bill, Mary Donna, Deborah, James, and all of those who have contributed to the success of Solutions over the past twenty years!

The Wisdom of Playing "Small Ball"

About 20 years ago my professional life encountered hard times. Four hospitals where I worked had simply folded and closed their doors under the pressures of managed care and reduced Medicare funding. The costs of practice continued to rise, and economic pressures on families increased as various “bubbles” began to burst in major economic sectors—real estate, technology, oil & gas, and so on. I was driving a car with 275,000 miles on it and no air conditioning. One afternoon I visited a lawyer friend, a fellow soccer dad with whom I had founded the Dallas Inertia FC, a soccer team for middle-aged men, telling him that I needed advice. Quoting a pilot I had known in Vietnam, I told my buddy Hank that I was out of “altitude, air speed, and ideas.” Hank had practiced law for years, and I admired his work ethic and positive attitude.

Hank said that he had been through similar times in his law practice. The solution, he said, involved learning how to play “small ball.” He explained the concept in simple terms. “If you’re not big and strong,” he said, “then you have to be fast, quick, and agile.” If you can’t compete with a big company (like a hospital system), it’s important to find a strategy related to your signature strengths. This conversation took place several years before Martin Seligman at U Penn popularized positive psychology and confirmed much of what Hank was telling me about using the skills and talents that come with our basic makeup.

Always the baseball fan, he described the ascendance of the 1951 Chicago White Sox, a team with weak hitting and very few big innings. Under manager Paul Richards, the strategic focus became speed and strong defense. When you have trouble scoring, Richards declared, you have two options: keep the score low (defense) and advance your base runners at every opportunity (speed). He cited the legendary Dodger trio of Sandy Koufax, Maury Wills, and Don Drysdale. Pitching kept their team in almost every game, and Wills stole over 100 bases in the 1962 season. 

I’ve worked with some professional athletes who describe their success in similar fashion. One PGA pro has a reputation as a “grinder,” one of those golf pros who doesn’t win majors, but who consistently finishes in the money and makes a very good living. “You don’t have to be a world-beater,” he says. “Sure, it’s deflating to the ego when you see what some other people are able to do, but that little white ball doesn’t care whether your name is in the paper. And that paycheck for a 15th place finish turns into cash that’s good at any bank.”

Some people scoff at sports metaphors, but on that afternoon the advice sounded good to me. Over the next two years I changed my approach to practice entirely. I discovered that I didn’t need a big salary or a high-visibility office with a lot of overhead. I realized that seeing someone on short notice (speed) and using creative intervention strategies (agility) produced consistently better results. Beyond the immediate benefits financially, I found professional practice much more stimulating, enjoyable, and satisfying. The principle of small ball brings with it a significant multiplier effect.

In the past twenty years I have never hired office staff, nor have I paid someone else to answer my phone. I used small ball skills to develop highly successful programs for a local non-profit community mental health center. When others noticed our success, I was recruited to the medical school to replicate the strategy in our mental health services for veterans. As a professor in the Department of Psychiatry, I began to teach these skills to young physicians. Our treatment programs have been honored as the outstanding teaching services at the medical center. There are many teachers and practitioners I admire, and I’ve had many experiences of professional envy. When you’re a grinder, or just a good base runner, it’s natural to be jealous of those who are just simply better at the game. What I try to remember is to use the talent I have, not the talent I wish I had.

Few single individuals become rich or famous playing small ball, but prosperity isn’t measured in dollars alone. What counts in life is the importance of what we care about, what we really love, what motivates us to show up for practice. Playing small ball doesn’t mean thinking small or dreaming small. It reminds us that the important step is to show up for practice and to keep our heads in the game, so that good things happen, one day at a time.

Dr. Talmadge joins UpToDate Advisory Board

This week I was honored to be selected as an UpToDate Advisory Board member. The nomination and selection process involved interviews with hundreds of physicians worldwide. I should add that this is not a paid position, and I have no financial ties to the publisher or the organization. I have used UpToDate for many years, like over one million other doctors around the globe. It's the #1 subscription resource for physicians. I will be a consultant in psychiatry and addiction medicine.

What is UpToDate?

UpToDate is an evidence-based, physician-authored clinical decision support resource which clinicians trust to make the right point-of-care decisions. More than 6,300 world-renowned physician authors, editors, and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care and quality. More than 1.1 million clinicians in 180 countries and almost 90% of academic medical centers in the United States rely on UpToDate to provide the best care. That trust has been earned because of the integrity of our recommendations, including the fact that we never accept funding from pharmaceutical companies, medical device manufacturers or other commercial entities.

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Watch a video by the founder of UpToDate, Bud Rose, and hear the inspiration behind why UpToDate was developed.

UpToDate topics are viewed more than 26 million times per month, and our 2014 subscriber survey found that clinicians find the answers to their question over 92% of the time. This success reflects the breadth (23 specialties) and depth of our clinical content (over 10,500 topic reviews, each of which answers multiple clinical questions).

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UpToDate is the ONLY clinical decision support resource associated with improved outcomes. More than 60 research studies confirm widespread usage of UpToDate and its association with improved patient care and hospital performance. One, a study by researchers at Harvard published in the Journal of Hospital Medicine in 2011, showed that hospitals using UpToDate experienced shortened hospital stays, fewer deaths and better quality performance than non-UpToDate hospitals.

Mindfulness in 8 Weeks

My friend and colleague Kay Colbert is starting a mindfulness group based on her extensive training in Mindfulness Based Stress Reduction, or MBSR. I'll be joining her for the sessions!

From The Harvard Gazette: Participating in an eight-week mindfulness meditation program appears to make measurable changes in brain regions associated with memory, sense of self, empathy, and stress. In a study in Psychiatry Research: Neuroimaging, a team led by Harvard-affiliated researchers at Massachusetts General Hospital (MGH) reported the results of their study, the first to document meditation-produced changes over time in the brain’s gray matter.

“Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day,” says study senior author Sara Lazar of the MGH Psychiatric Neuroimaging Research Program and a Harvard Medical School instructor in psychology. “This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing.”

Previous studies from Lazar’s group and others found structural differences between the brains of experienced meditation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

About the study:
Magnetic resonance (MR) images were taken of the brain structure of 16 study participants two weeks before and after they took part in the eight-week Mindfulness-Based Stress Reduction (MBSR) Program at the University of Massachusetts Center for Mindfulness. In addition to weekly meetings that included practice of mindfulness meditation — which focuses on nonjudgmental awareness of sensations, feelings, and state of mind — participants received audio recordings for guided meditation practice and were asked to keep track of how much time they practiced each day. A set of MR brain images was also taken of a control group of non-meditators over a similar time interval.

Be Positive in 3 Ways

Some intriguing research suggests that positive psychology can help you weather the routine ups and downs of life and also build resilience for times of greater difficulty.

Here are three ways to capture the benefits of positive psychology.

Express gratitude. Speaking (or writing) our appreciation means that we have taken action. Acknowledging the good defends us against circumstances or situations that are not so good. As the research scientists at Harvard say, "When you acknowledge the goodness in your life, you begin to recognize that the source of that goodness lies at least partially outside yourself. In this way, gratitude helps you connect to something larger than your individual experience — whether to other people, nature, or a higher power."

(For more daily quipples, check out the artist at

Language experts refer to a declaration as "a speech act," meaning that by stating something authentically and clearly, we have taken action. A thought, after all, is simply something inside your head, inside yourself. Putting it out into the world can make a difference. Last year I received a handwritten note in the mail, and the writer thanked me for something we had done together almost thirty years ago. She described how our work together had influenced her life, and she added that after that crisis she turned things around and accomplished great things. I remembered how things were, and what happened. What was wonderful, though, was knowing that the time was well invested. Her appreciation certainly made my day. She expressed gratitude.

Set aside a few minutes every day and think about aspects of your life for which you are grateful. "Write them down if you like," say the Harvard experts. "Be specific and remember what each thing means to you."

Leverage your strengths. To maximize the payoff regarding your strengths, you first need to identify them. Professor Martin Seligman of Penn calls these "signature strengths." These are the assets that you count on when the chips are down, when life really matters most. Research shows that many of us lack a useful understanding of our strengths. "If something comes easily to you, you may take it for granted and not identify it as a strength," they say. For example, you may be "good with people," or "a compassionate listener," or "really sharp when it comes to numbers." If you are not sure of your strengths, you can identify them by asking someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.

Strengths are closely linked to happiness: gratitude, hope, vitality, curiosity, and love. These strengths are so important that they’re worth cultivating and applying in your daily life, even if they don’t come naturally to you. Our strengths—again according to Professor Seligman—count in five important areas.

  • Positive emotional experiences
  • Engagement in life
  • Relationships
  • Meaning, and the significance of our lives
  • Accomplishment or Achievement
If you're looking for areas of life where gratitude may be appropriate, these five are a good start.

Savor the “good.” Most people are primed to experience the pleasure in special moments, like winning a ballgame or getting an "A" on an exam. Simple pleasures, on the other hand, can slip by without being noticed. Savoring means placing your attention on pleasure as it occurs, mindfully enjoying the experience in the moment. Appreciating the treasures in life, big and small, helps build happiness. (Mindfulness is a state of active, open attention on the present. When you're mindful, you observe your thoughts and feelings from a distance, without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience.)

Multitasking is the enemy of savoring. Try as you might, you can’t fully pay attention to multiple things. If you’re reading the newspaper and watching TV during dinner, you’re not getting the pleasure you could from that meal — or the newspaper or television program. If you’re walking with a friend on a beautiful path but staring at your cell phone, you’re missing the moment.

We need to live more in the moment. Living in the moment is a state of active, open, intentional attention on the present. When you become mindful, you realize that you are not your thoughts; you become an observer of your thoughts from moment to moment without judging them. Mindfulness involves being with your thoughts as they are, neither grasping at them nor pushing them away. Instead of letting your life go by without living it, you awaken to experience.

Cultivating non-judgmental awareness of the present generates great benefit in terms of health. Mindfulness reduces stress, boosts immune functioning, reduces chronic pain, lowers blood pressure, and helps patients cope with cancer. By alleviating stress, actively focusing on living in the moment reduces the risk of heart disease. Mindfulness may even slow the progression of other diseases as well. And science shows clearly that mindfulness is one of the best antidotes for physical pain.

Research on Mindfulness suggests that learning the skill of "Being in the Now” can actually change the way our brains process information so that there is more activity in brain centers involved with processing positive emotions, and more interconnections between right and left hemispheres and the cortex and limbic systems. Mindfulness training results in improved relationships, life satisfaction, and pain relief.

Mindful people are happier, more exuberant, more empathetic, and more secure. They have higher self-esteem and are more accepting of their own weaknesses. Anchoring awareness in the here and now reduces the kinds of impulsivity and reactivity that underlie depression, binge eating, and attention problems. Mindful people can hear negative feedback without feeling threatened. They fight less with their romantic partners and are more accommodating and less defensive. As a result, mindful couples have more satisfying relationships.

Being grateful and being mindful go hand in hand.