Drug addiction has been a major cause of HIV, premature death and social disability in Vietnam. HIV/AIDS spread rapidly in Vietnam, with the first HIV infection detected in December 1990, and 116,565 officially reported cases over the next 16 years (December, 2006). However, estimates of the actual number of people living with HIV/AIDS are far higher and range from 218,000 to 308,000. Among these, 85 percent are thought to be males and 52 percent injection drug users (IDUs).

In 1999, I “retired” from my company that I’d founded and led since 1974, full of energy to go out and save the world. My future was secured—health benefits paid for life and a comfortable earn-out from the company, spread over many years, based on the continued earnings of the company. In 2000, I returned to my beloved China and Asia to help them start 12 Step programs and develop alcoholism and drug abuse treatment services in Beijing and Shanghai. I got great joy and energy from this pro bono effort.

In March 2003, I got a telephone call from the controller of my former company stating that the company was going bankrupt and in two weeks I’d lose all of these benefits. After the shock settled in, I asked the usual questions like, “How could this have happened when I left the company financially sound?” A more imminent question though came up, “How will we now support ourselves and replace these benefits?” That’s a good question but not the right one. The right question I came to after some soul searching was “What brings you alive? How do you want to spend your time now?” Sitting over my desk was the Rumi saying, “Let yourself be silently drawn by the pull of what you truly love.” But, I asked myself “What did I now truly love?”

Lately, I have been asked to present numerous times on boundary violations by alcohol and drug abuse counselors. State ethics boards are reviewing cases involving counselors selling cocaine to patients, fraud in billing, changing diagnoses to allow payment for services and sexual violations with patients, among other accusations. We have been teaching classes on ethics for decades. Why, then, do we continue to have what seems to be an increasing number of claims against counselors? What are we not teaching? What needs to be done?

Andy Rooney begins every Sunday night on 60 Minutes with something like, “And now a few minutes with Andy Rooney.” He then launches into a commentary about something he usually wants to gripe about. Well, here are a few minutes with David Powell about my current gripe—Blackberrys.

Ok, I will admit it, I have a Blackberry. For years, I’d watch people on planes turning on their Blackberrys (or similar devices) as soon as the plane’s wheels hit the ground, checking their emails. I swore I did not want a Blackberry because I’d turn into a “Crackberry” addict. I succumbed. I too compulsively switch it on when we land. I admit it; it is a time-saving device. Now, instead of pulling into an airport or hotel searching for a “hot spot,” I can now stay current with my emails, announcing that I have won $10 million in a lottery in Nigeria, or keep up with the latest deals on
Viagra. Whatever would I do without such news!

However, there is something about this instant news world in which we live that bugs me. When did we become so important that we have to be constantly available by phone or email? What happened so that we can no longer sit in a conference or a classroom, learning about the latest and greatest new breakthrough in addiction treatment or evidence-based practices, without being accessible to the world? What happened to agencies where counselors have to be on call 24/7? Don’t we have back-up for staff any more? Are we running so short staffed that a counselor cannot even go to a conference or training without being available all the time?

Now, I do a lot of training. I know what you are doing during my brilliant lectures when you look under your tables and are fumbling with something. No, not that. It’s your Blackberry; you’re texting someone something about that seemingly is so important that you cannot pay attention to the class. It was bad enough years ago when someone in the front row of my class (in a school that will remain anonymous) pulled out her Ladies Home Journal and read through­out the class. That’s just plain rude (or I was really boring, which is very possible). Now, it seems like we all have a license to text anyone, anytime, anywhere, seemingly doing so under the desk where no one can see.

How about the student in the Wi-Fi classroom, supposedly taking notes (as if the 20-page PowerPoint handouts given out is not sufficient). What he is really doing (come on now, be honest! This is an honest program) is texting someone or surfing the web for the latest deals on hair styling products—something I rarely need to do any more.

Or, you know what really bugs me, is when we announce at the beginning of every class or lecture to “please turn off your cell phones or put them on vibrate” and the phones ring during the most emotionally-laden part of my lecture. Some get up and walk out of the room to take the call, mumbling into the phone as they walk out “hold on please, I will be right with you.” Some have the audacity to talk into their cupped hands so no one else in the classroom will hear them—yeah, right!

Quite frankly, I don’t want to hear your conversation with your wife about the fight you had with her last night. I really don’t care where you are going for dinner tonight with your secret, clandestine date who you just met last night at the conference. If your child is in trouble at school, what are you doing in a classroom at that time anyway? Go to school and help them. I’d much rather have you pay attention and soak up all the pearls of wisdom I am imparting. After all, didn’t someone pay your tuition to attend this class? Maybe learning has become secondary to “getting our tickets punched for hours for credentialing.”

On a more serious note, New York Times Magazine recently featured an article on multi-tasking, which stated, “There is a big misconception that multi-tasking is a more efficient way to work and accomplish tasks, yet many multi-taskers are wondering why they don’t have more time and balance in life. The truth is multi-tasking gives you the illusion of being more productive, but really slows down everything you do.”

It cites the research of David Meyer, director of the Brain, Cognition and Action Laboratory at the University of Michigan, who said that multi-tasking actually disrupts listening and learning. Distract-ability while multi-tasking, execution of the first task (listening in class) usually leads to post­ponement of the second one (texting) or vice versa. There is a bottleneck at the central, amodal stage of information processing. The neural network of frontal lobe areas acts as a central bottleneck of information processing that severely limits our ability to multi-task. The brain has a core limitation in its ability to concentrate on two things at once, despite our pride that says we can.

Studies at Microsoft have demonstrated that people can easily be distracted while performing multiple tasks, and it takes them time to readjust to the primary task after being distracted. If it’s this bad at Microsoft, it has to be worse in a classroom, despite how engaging I may be as a trainer.
In other words, while texting during training you are actually not taking in as much as you think you are, on either task. You’re wasting your money. We obviously all should know by now that talking on the phone (or worse, texting) while driving is dangerous.

Some possible solutions:
1. Training centers, conference organizers, summer schools—set up a Blackberry free zone. Don’t allow cell phones, Blackberrys, etc. in the lecture hall. Have students check them at the door. If an important call comes in, the administrator of the training can come into the classroom and notify the student of the important message.
2. Turn off the email notification on your Blackberry, at least as long as the class runs. You can do it on planes when it is mandatory. Why can’t you do it in a classroom?
3. In supervision, both supervisor and supervisees, turn off the phones. Off, not on vibrate. If you have not arranged for coverage while you are in supervision, you have another management problem: insufficient staff; inadequately or poorly trained staff to cover for you; or, maybe, we just think we are so important or essential to the agency that we must be on call all the time.
4. Use technology on your own terms, not its.
5. Establish hours and days of avail­ability and communicate them to your colleagues. Being on call 24–7 will burn you out. Is it any wonder why people burn out in our field?
6. Establish priority levels based on the type of communication. For example: emails are generally low priority communications, unless
you really care about winning that lottery in Britain. SMS is for medium priority communication. Phone-cell to cell phone is for higher priority communi­cation, but only if it is a real emergency. Most clinicians do not need to know the daily activities of staff on an instantaneous basis.
7. Enjoy a better work/life balance.

In sum, get a life! Try detoxifying from instant news and 24–7 messaging, and pay attention in class. After call, isn’t learning what you’re there for. I hope Andy Rooney would be proud of this article, which I wrote while listening to my I-pod, eating lunch and watching the World Cup on television.

David J. Powell, PhD, President, International Center for Health Concerns, Inc., is an internationally recognized lecturer, trainer and author. David has played a significant role in the develop­ment and operations of the Oya Bahadir Yuksel 

For the past two years I’ve overseen an adolescent substance abuse treatment center in southern Turkey, near the Syrian border. The boys are between the ages of 13-20, with solvents and inhalants as their primary drug of abuse. We have developed the treatment program and implemented a clinical supervision system for the new profession of addiction counselors at the Center.

Working with teenage boys is a challenge—and I thought raising my own two teenage daughters was interesting! Since the 1990s, there has been an explosion of information on brain development. For centuries, science thought that brain development was complete by adolescence. Emerging science has taught us that brain maturation may not be complete until about age 25. The immature brain has less brake on its “go system.” Regions of brain serving primary functions (motor/sensory systems) mature the earliest. Temporal/parietal association cortices (language/spatial attention) mature next. Higher order functions, such as prefrontal/lateral temporal cortices that modulate basic attention, mature last.

Brain development triggers puberty, increases efficiency in energy utilization and gives rise to cognitive development and neuro-biological functioning. For the adolescent brain, there is often a preference for physical/sensory activities, higher levels of excitability, activities with peers that trigger high intensity/arousal, and novelty. At a less optimal level, adolescent brain development may have difficulty balancing emotions and logic in decision-making, and considering negative consequences for their actions. This leads to a greater tendency to risk-taking behavior and impulsiveness. Thus, the immature brain equals lower brain power, and an absence of judgment. Drugs can further hijack these activities as well as dopamine activity.

Effective treatment approaches
Because of the impact of drugs on the adolescent brain, over the past two years, in the development of the Turkey treatment center, I have learned that treatment needs to address a number of key issues:
1. We need to discuss with youth the science of neurobiology and addiction, as well as the implications of using as a teen.
2. Provide a milieu that is teen-friendly, marked by structure, rules, recreation, sensory activities, peer community and novelty.
3. We need to teach skills that are not optimized yet by the teen brain, such as, impulse control, “second thought” processes, social decision-making, how to deal with risky situations and how to take healthy risks.
4. Since over 50 percent of the youth who relapse did not expect substances to be in use in the situation where they relapsed; did not think about using beforehand; and use was done in the presence of new friends, treatment needs to prepare teens for these situations.
5. 12 Step programs work well with teens because they provide an abstinence model that allows the teen’s brain to deal with the toxicity of drugs. 12 Step programs further promote “novelty,” new approaches to life. They offer structure (the Steps), a spiritual component (reasons to live), as well as fellowship, friendship and sponsorship, i.e., role modeling.
6. Research has shown that Cognitive Behavioral Therapy and Motivational Interviewing (MI) approaches are particularly helpful with adolescents because they offer immediate, relevant and specific problem solving and solutions that are realistic and concrete.
7. MI is especially helpful because it de-emphasizes labels; emphasizes personal choice and responsibility; focuses on eliciting the client’s own concerns and solutions; and provides goals that are negotiable and client-centered.
8. The recipe for a healthy teen brain includes a good balanced diet, vitamins, exercise, sufficient sleep, social connections, positive thinking, help to others and new ways of learning.

Supervision systems
In the Turkey treatment program, we established a system of clinical supervision that entails the following elements:
1. Weekly clinical supervision by the chief clinical officer, a psychiatrist. This was done through direct observation of counselors followed by post-session group supervision with other members of the clinical team.
2. Peer clinical supervision conducted by team members every other day. This was done in small groups of four to five staff members.
3. Direct observation, as able, from behind a one-way mirror at the Center.
4. Weekly review of programmatic and clinical issues between the psychiatrist and myself. Due to language and distance, this was done asynchronistically through email.
5. When possible, live supervision and training via the Internet and Skype.

Given the nature of an adolescent treatment program, there are unique issues that arise in clinical supervision:
• Duty to warn situations. What do to in a culture that has unclear “duty to warn” regulations? How to respond when the teen asks that their “secret” not be shared with anyone else, especially their parents?
• Determining supervisee inexperience, impairment or incompetence, in an environment where substance abuse treatment and adolescent programming is new.
• Providing culturally-responsive supervision. Given the cultural differences between American and Turkish models of treatment, how do we design a management, treatment and supervision system that reflects cultural variables?
• The age-old question of counselor recovery status, in an environment where there are very few recovering counselors, and almost none with experience working with adolescents.
• Dealing with supervisee counter transference toward addicted teens, especially for those who manifest significant family pathology and potentially dangerous home situations.
• Facing counselor boundaries and limitations when working with a difficult patient population. When is a relapse just a slip? How many readmissions should the Center offer an adolescent?


In sum, I have learned a great deal about working with adolescents with long histories of drug abuse, physical and sexual abuse, in an environment where training and clinical supervision has rarely been provided. For further information, contact David Powell at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .