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Terrorism and Recovery: Coping Skills
Transcript of Alcohol MD Web Conference Conducted
November 8, 2001

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Posted On: November 08, 2001          Updated On: April 13, 2002
© Terence T. Gorski, 2001

AlcoholMD
Presents a Transcript of a Live Web Conference on

 Terrorism and Recovery: Coping Skills
Conducted On November 8, 2001
<Read It On the Alcohol MD Website>

Terence Gorski1 and Gabrielle Antolovich2
1Trainer, Consultant, CENAPS Corporation, Homewood, Illinois; Founder, Clinical Director, Relapse Prevention Certification School
2Executive Director, National Counsel on Alcoholism and Drug Dependency for the Silicon Valley; Editor, New Times; Editorial Board, AlcoholMD, San Francisco, CA

It is a pleasure to be here and have the opportunity to discuss the issue of the domestic terrorism and how the recovering community and individuals in recovery are responding.

The recent terrorist acts in New York and Washington have caused deep trauma for everyone in America, and the subsequent scare about terrorist incidents, including the Anthrax scare, has just added tensions upon this. At times of national stress and pressure and emergency, recovering people are especially vulnerable to being upset or damaged by the events.

One of my concerns is that many recovering people have severe problems with post acute withdrawal (PAW) that could lead to relapse. When somebody is suffering from PAW, their ability to think clearly is disrupted. It also disrupts their ability to manage their feelings and emotions. They have difficulty managing stress and, as a result, their behavior can easily go out of control. So, they're prone to emotionally numb out or emotionally overreact, and this, of course, can adversely affect their recovery program.

I'm also concerned because a large percentage of recovering people are trauma victims and if someone has a previous history of trauma, these terrorist acts have probably activated unresolved symptoms of post traumatic stress disorder (PTSD). Even if a person does not experience severe symptoms of PTSD, most people who witness this event, even on television, are going to suffer from symptoms of elevated stress related to what is called Critical Incident Stress reactions.

Once these symptoms of PTSD or Critical Incident Stress reactions surface, it's real easy for recovering people to defocus from their recovery and start focusing on the terrorism and the national disaster. It's real easy for them to disconnect what's going on from their need for a recovery program, and they can lose a focus on what they need to do to stay clean and sober.

Addiction mental health professionals are anticipating an increase in the number of people seeking treatment for mental health services as well as alcohol and drug abuse services as a result of these terrorist events. It's real important that the alcohol and drug treatment professionals become very active in letting the recovery community get involved with understanding what Critical Incident Stress is, what PTSD is, how this can adversely affect their recovery. Then help them understand some practical steps they can take to manage these stress reactions, get refocused on their recovery and how can they use some of the recovery tools that they've already learned in the process of their recovery to manage their reactions and responses to this.

I'd like to bring Gabrielle in for a moment and ask her if she's become aware of these events having any kind of an impact at all on recovery people in her community.

GABRIELLE ANTOLOVICH: Absolutely. In fact, our agency is the only agency in our county that does not do treatment, so we actually are supporting the treatment community and also the recovery community.

One of the first things we noticed was that people were going to meetings in droves. They were going to Alcoholics Anonymous, to Narcotics Anonymous meetings. At lunch time and the early evening sessions, they were packed. Everyone was in their feelings in the early part of it.

Since then, I've noticed that people are starting to act out. They're not only acting out in their workplace, people are being angry with each other. It's like more stress is going on and we're forgetting that September 11th is still having an impact on us. Partially, we're told to forget it, so we're taking care of things, but as time goes on we forget the incidents of the trauma without realizing that the stress is still there.

So we're finding we're getting a lot of phone calls from clients saying they need anger management classes. People are saying that they need more of that. More people are either stuffing their feelings or being over emotional, and not being themselves. And I think that sort of says a lot.

Even in our own workplace, we're working on a daily level to remember what are the real stresses on us. There seems to be this looming stress that's hovering over us. I myself was watching CNN compulsively everyday and I've had to wean myself off that and just keep in touch with what's going on in the news so that I'm aware of it, but not so impulsive about having to see CNN over and over again.

I'm in recovery myself. I have 23 years of recovery from addiction, and I'm still vulnerable to what's going on around me, so I'm working on stabilizing myself. This is important for stabilizing what's going on in our own work area so that we can be there for the rest of the community that's still going haywire. We need to remind people that the stress is still there.
TERRY GORSKI: Well, you know, Gabrielle, what you're saying is really typical of some of the things that I have observed as I've traveled around the country since September 11th. I got back onto the training and conference circuit. My first trip, I left on the 15th of September on the nation's airport, and I've been talking with professionals and recovering people around the country in one (1) or two (2) different locations just about every week.

First, I'd like to share the three classical ways that treatment professionals have responded to this in their role as counselors and therapists and within the treatment program. The first response has been a response of absolute denial. "Nothing is going on." "Nothing's different." "I'm not upset." "This won't affect my recovery; I'm not even going to pay attention to this."
And in some treatment programs, the counselors have not even allowed their clients to bring it up. If the client brought it up, they've been confronted about defocusing for their recovery.
The second response is the total opposite of that where the treatment professionals themselves have become obsessed with the incident. In some residential recovery centers, for the first three or four days, the treatment staff and the patients were locked on to CNN or MSNBC 24/7. They stopped all treatment activities and just got obsessed with the national emergency.

Then the third response, and I think the healthiest response, were the professionals who attempted to use good recovery principles and good therapeutic principles to integrate and appropriately respond to the emergency. What these professionals did first was recognize that they were being affected by the events, and they got off by themselves as a staff to sit down, support each other, and make sense out of what was happening. These professionals very quickly realized that they were going through a form of Post Traumatic Stress Disorder, but it actually is not a disorder yet. It's what's called a Critical Incident Stress Reaction, which we'll talk about in a moment. They recognized that, they talked about it, and then they talked about what's the best way to deal with this with their clients.

The treatment professionals who were on top of this recognize that you have to avoid the two extremes. You can't ignore this because it is legitimately a national emergency. There is a danger. There is a risk. This is not a normal time. But, there are tremendous mixed messages coming at us. "Go back to your day-to-day living, but you might die of anthrax or be on a bridge that goes up, but go to Disneyland, play golf, spend your money, have fun." Now, that's reality. So, what the treatment providers realized they needed to do is they have to address that because it's a real stress or a potential relapse trigger, and at the same time, they can't allow the recovering people to defocus from their recovery. So, how do we use the discussion of the terrorist incidents to help people redirect and refocus on using their recovery tools to cope with the stress?

GABRIELLE ANTOLOVICH: Well, one of the things that came up fairly recently is people reminding each other that we have this added stress and all of us have a certain amount of stress we can handle before we go over the edge. That level has been lowered now; the bar has been lowered because we've got this general stress that we can't ignore. We have to support each other.

In a strange sort of way, people are now turning more to supporting each other as people, developing friendships, trying to be understanding, compassionate about themselves and each other.

TERRY GORSKI: What is a critical incident stress reaction and what are it's stages? A critical incident stress reaction is actually a psychological response that happens as a result of a traumatic event.

Stage One of the Critical Incident Stress Reaction is the traumatic event (slide 2). This is an event outside of the range of normal experience that produces a threat of violence, injury, death or destruction. In other words, I'm there or I'm involved and I feel threatened, or else I'm witnessing the violent act. I'm witnessing the injury or the death. I'm witnessing the destruction. There's no doubt that the events of September 11th meet this criteria. For the first time in the history of the world, we have large amounts of the population who have experienced a traumatic event via television. People have been traumatized, not simply by experiencing the event live as many people did, but by watching the instant replays of the trauma, including people jumping to their death off of buildings. People watched it over and over and over again, electronically imprinting the trauma memories into their brain neurology.

The second stage of the Critical Incident Stress Reaction is Critical Incident Shock (slide 3). We actually go into shock. There is a stress overload. The stress of the moment becomes more than our conscious mind can handle, and it exceeds the ability of our brain to deal with the electronic stress impulses.

The primary activators are a sense of fear and terror that is beyond our ability to comprehend. The horror of this was so big we couldn't get our hands around it. We couldn't give it a meaning. We couldn't put it in a context. This triggers us into a psychological state called Disassociation. We disconnect from ourselves. There's a feeling of being separate from our body. A feeling of disconnecting from everything that came before. We almost have a feeling like we're living a novel or living out a movie. Some people as they watched the events felt they were watching a movie, and it took them a long time to realize that this was real.

The person also goes into a cognitive shutdown. Their brain shuts down. They have difficulty thinking clearly, logically and rationally and assembling meanings and assigning things. They just like go on autopilot and they emotionally numb out. They lose connection with the normal rise and fall of human emotion.

GABRIELLE ANTOLOVICH: I could give you a list of people I know that fit into each of these categories, and how that's impacted their lives. People have a tendency to disconnect from themselves already because they've been through shock or they've been raped or experienced incest or car crashes. It's amazing how people are saying "I feel as if I'm going backwards. I feel as if I'm going back to a time where I felt this before."

TERRY GORSKI: You know, in a school of therapy called Transactional Analysis they talk about these old memories - - these flashbacks returning and they call it rubber-banding through a past experience. It's also called having a flashback or going back. The memories come back visibly. As I said when I first started talking, the people who are really vulnerable to this are people who are suffering from Post Acute Withdrawal. They're brains are already neurologically unstable. There are brain chemistry imbalances that get aggravated by stress.

Secondly, those who have had previous unresolved trauma, previous sufferers from Post Traumatic Stress Disorder, will activate flashback experiences to that. Additionally, people with other mental disorders, such as depression, anxiety, schizophrenia and so on, are also at risk for relapse.

The shock activates an automatic response (slide 4). Not a conscious thought through rational response, but a sort of automatic arational reflex. There are two types of responses people experience: a trained response and an untrained response. I want to talk about the trained response first because there's a lot of misunderstanding about this.

Many of the rescue workers who arrive on the scene are trained to deal with crisis. On a professional level, their training is very good. Here's what happens. They train professionally, hit the scene, experience the critical incident; then wham, they disassociate.

But there is an adrenalin rush that goes along with this: a heightened state of alert or awareness to emergency. A trained professional, if he or she has been combat trained, trained to respond to emergencies, or crisis intervention trained, is trained to treat that adrenalin rush as a trigger that activates a focus attention on the next little thing they need to do. As that ability to focus on the emergency response gets activated, the practice behavior of their emergency response goes online. You will hear emergency rescuers, emergency people, people in the trauma centers who have been trained in emergency responses, say they went on automatic pilot. Their brain just clicks off and they start moving. They went to work, awareness of their fear and everything went away, and they just got lost in the activity of responding.

GABRIELLE ANTOLOVICH: How long can a person sustain that? This is an unusual situation where the rescuers had to work night and day and could be going for a year.

TERRY GORSKI: Well, we're going to talk about that in a moment, but that response can be sustained for extremely long periods of time. It's not unusual for people to keep running on adrenalin for periods of 12, 18, 20 hours. But, when they hit an exhaustion response, they just collapse and drop out. They experience an acute episode of PTSD symptoms at that point, but it's not really PTSD. It's what a lot of the literature talks about as combat fatigue: acute collapse in the midst of an ongoing stressful situation. You can't call it posttraumatic because you're still in the trauma. They run out of energy. 

The literature on Critical Incident Stress says that when somebody has to deal with emergency and they collapse into these states of exhaustion or they're working towards that, you actually need to do a special kind of intervention called critical incidents. It is not a critical incidents debriefing, it's a critical incidents defusing where you have to sit down with the person, let them ventilate what's going on, and then the therapist has to get actively involve to reconnect them with the fact that first, this is normal; second, it's okay to feel this way; third, you can handle this; and fourth, you need to rest. They something to eat, someone needs to make sure they are hydrated, to make sure they're getting plenty of protein, and then let them talk through it enough or vent enough so that they click their mind off, click out of that shock response, and sleep for a while. After that, they will probably be able to get up and get refocused on what they need to do. When somebody is in the middle of this, the goal is for them is to do their job. The goal of the people who are helping is to get people back so they're in a state to respond to the emergency.

Now, the problem with emergency workers is they are trained to deal with the professional component of responding to the stress. They typically do not receive training in how to respond to the human psychological and emotional needs that they're going to experience. They have not gone through a training process where they're taught how to understand this. They're not taught how to defuse themselves. They're not taught how to recognize that the critical indicators are about to collapse. If they get taken off duty, they'll go home or go into a rest area. They won't be able to turn their brain off. They won't be able to turn their stress off. They don't have stress tools. They don't have a personal defusing procedure. I like to think about this as a psychological first aid kit. We are not giving our emergency workers a psychological first aid kit to help them get bandaged up to get through the incident and move on.

The same thing is true for people watching the event. You get locked to your screen and, since this is so far out of the range of experience, you don't have the foggiest idea how to take care of yourself. You forget basics like: turn off the television, go to work, think about something else, take a warm bath, meditate, pray, reality test, reach out for help and support.

Thus, even in the trained professional responses, many professionals who are trained in this haven't been trained in how to deal with their own extremely personal human reactions to this.
Since September 11th, I've had the opportunity to visit with some people from England, Ireland, and Israel. In Israel, for example, there is a great deal of cultural awareness of the personal responses to terror. Most people have identified a set of behaviors that they use to help them cope on a day-to-day basis, and to allow them to create and sustain a sense of a new normal, a normal related to living in an emergency situation.

The untrained response is very different because when you're not trained and you move into a situation beyond the scope of your normal experiences, you get the adrenalin rush, but you don't have the foggiest idea what to do (slide 5). You do not have a psychological perspective that gives you a frame of reference that allows you to organize any kind of a response. As a result, the feeling or judgment that emerges is one that leads to helplessness. You feel like there's nothing you can do, nothing you can say, no way to respond. When that helplessness kicks in, the primitive survival parts of the brain go into overdrive, and we start kicking into primitive survival defenses. This is where I think you're going to see why a lot of the people begin acting out.

When the brain says you're going to die; you must live, and the primitive brain stem survival responses kick in. You are then going to go into one of three responses (slide 6). You're going to fight, and if the fight response is activated, anger and rage begin to surface, which just floods the body with chemicals. Now you're going to seek out a target. In the first week or so after the attacks in New York City and Washington D.C., there was a tremendous backlash against Arab Americans. Since a racial group was easily identifiable in this incident, the Arab American community became a target.

If you look back at Oklahoma City, Timothy McVeigh was just a normal ordinary white American, so there was no target group and we did not see a backlash like this. However, anytime there is a target group, the anger fight response results in acting out against the target, which attacks that feeling of helplessness. If I can attack the target and hurt them, that will make me feel less helpless. That will give me the illusion or the perception of being in control. And now, once I'm back in control I can survive.

The second part of the model to be understood is the flee response (slide 7). Some people click into fear and panic as their primary emotional state, and this prompts them into a fleeing response that takes two forms. One form is "I'm going to run away and hide out." You'll see people who, in the midst of the emergency, will dig in and actively hide. They will evade rescuers. The other form of the fleeing response will involve pathological rescue seeking where a person needs a rescuer, someone to take care of them. They will latch onto a rescuer. "What do you want? You want money? You want my life? You want me to go bed with you? I don't care. Anything, just save my butt." This rescue seeking is showing itself in a lot of ways with the number of Americans who are willing to trade way all civil liberties to the government in exchange for the promise of protection which, of course, the government can't give. The government doesn't have the power to protect us from this. People are going in looking for a rescuer, trying to hook up with someone who can take care of them, trying to find a powerful caretaker who they indenture themselves to, or they're just hiding out. They don't want to get involved. They're actively avoiding engagement in any situation where they could be at risk.
You see any of these folks, Gabrielle?

GABRIELLE ANTOLOVICH: Absolutely. It's interesting that so many clients are fleeing and panicking back to the treatment program that they got treatment from, even if it was a while back.

TERRY GORSKI: Well, they're going to look for the first rescuers who gave them the best help before. I've heard a lot of people refer to the fight response as the Bubba response. Activating the fighting response very often is linked to racist responses, old and trained military responses, old deeply entrenched fighting and schoolyard brawling responses. The fleeing responses are hooked more into responses to fear. These are the primitive survival responses surfacing and it's not a casual thing, and it's not something that's minor. This is a very major thing. The brain chemistry of survival is designed to override and overwhelm and turn off the conscious rational brain.

And as we all know, to stay in recovery a recovering person has to use intellect over emotion. They have to have a way of thinking and understanding and responding to their recovery and to life based on a value system that overrides the primitive pleasure seeking addictive responses that have been driving them. Now when these survival responses come on line, guess what comes right along with it? The beast of addiction. When you open the gates of Hell, out come a variety of demons. The demon of fear, the demon of anger, the demon of depression, and, if you're previously addicted, the demon of addiction.

The third response is the freeze reaction, which is based upon extremely immobilizing depression (slide 8). I get depressed. My seratonin levels just drop right off. I can't respond. It's often an agitated type of depression where I can't do anything, but I can't rest or sit still either. I can't sleep and I'm so tired I can't stay awake, and I can't focus. I'm immobilized. I'm just stuck. There is an active process of giving up, a resignation, a deeply entrenched sense of hopelessly, helplessness. There's no way out. I have no future anyway. Why bother? Anything I'm going to do is only going to make things worse.

I've heard people say I don't even understanding why I got sober. I should have never had my kids. What kind of world am I leaving my kids? What's the point of anything? Why bother to go to work? They have a sense of a foreshortened future.

GABRIELLE ANTOLOVICH: Absolutely. I'm sure this is why people are taking more sleeping pills and anti-anxiety pills and just questioning the meaning of life now. In fact, I remember on September 11th, someone asked, "Are we still going to come to work?" This is an immobilizing reaction.

TERRY GORSKI: These are very well researched biophysiological responses that affect feeling and behavior. These things are very real. Now they're very deadly because with addicts these particular reactions or responses are hooked directly into the desire to drink and do drugs. They're hooked right into to craving responses.

Next, let's discuss the normal trauma resolution process (slide 9). It is estimated that of people who are involved or witness a trauma, 90% will have serious Critical Incident Stress responses that need to be resolved. There's no good data on this. We're in a new range of territory. But, I have heard speakers from the National Association of Critical Incident Stress Management saying that they're best guess at this moment is that 70% of the people who witnessed these events on television develop serious Critical Incident Stress responses. Since 90% of Americans witnessed these events repeatedly on TV, we're going to be looking at 60% to 65% of the population, including children, that are going to be having Critical Incident Stress Reaction. Of the people who have CIS response, about 60% will move through and resolve it pretty much on their own. Forty percent (40%) of the people won't. They'll get stuck in it and develop Post Traumatic Stress Disorder.

There are predisposing factors that help somebody to resist and cope. These are determined by levels of resiliency or the ability to bounce back after a trauma. Some people have very high levels of resiliency; some have very low levels. Some of the resiliency is just physical predisposition, a lot of it is psychological past history. How much stress have you had in your life? How functional was your family? Were you traumatized previously? What were your levels of psychological coping like before the trauma? People who were raised in healthy families evolve good coping skills, are naturally and normally physically able to tolerate stress. They are fairly healthy. They rebound very quickly.

The second factor is social. What is the strength of your support network? What are the strengths of your social relationships? How close are you with other people who you're bonded with who are going to help you work through this, and how stable are they? Then the traumatic event hits; this destructing event outside of normal experience. The terror, helplessness, and hopelessness kicks in. Then a person goes into acute shock, which we talked about earlier: the stress overload, the psychic numbing, the mental shutdown, the dissociation.

In normal trauma resolution, once a person returns to a safe environment, there's a rebound (slide 10). The stress goes down; the person lets down their guard. The first thing they notice is confusion and questioning. They struggle to find meaning in this. What does this mean? Part of being glued to the television is a healthy need to resolve through hunting for information, trying to find out what's going on, what's happening. Once you find out what is happening, the next question is "Why did it happen? What's the meaning of this? What's the significance of this?" With natural disasters, such as hurricanes, tornadoes, and floods, people have an easier time with the moral resolution. However, acts of terror and violence are perpetrated by human beings, which makes the resolution more difficult. Knowing that these acts were consciously perpetrated by one human being against another causes us to question our entire belief system regarding humanity and human beings. It also brings us to a spiritual crisis because we end up directly questioning our spirituality. What kind of a god would allow this to happen? How could there be a good that would allow this to happen?

The next thing that happens is emotional flooding. The feelings come back. We tear up. We want to cry. We start to shake. We start to tremble. A lot of people don't like to talk about these types of things, but at this point, too, vivid memories of the experience come back. A person begins to get fragmented memories, very vivid flashbacks of an incident here, an incident there, a response there. They develop a very disturbed sense of self-image. In this disturbed self image the first thing that begins to surface is survivor guilt. Why did I survive when so many people died? Why me? What right do I have to be happy?

Next, the person begins to feel guilty because on one level they've enjoyed the adrenalin rush of this, so there is guilt for responding in the way that they did. I have a friend of mine who worked in the military and was called back to active duty. He called me quite upset about the second night after this happened, and he said, "Terry, I don't know who else to talk to. I've got to talk to you about it." I said, "About what?" He said, "This was a horrible thing, but I just had the most exciting day of my life." He felt guilty for enjoying the process of going through this, which is fairly common. You know, when troops are in combat, it's a horrible experience on one hand, but it's an extremely exciting, gratifying experience on a very primitive level.

After the rebound, they need to go into an expression state. They need to talk about the trauma. When you're doing Critical Incident debriefing, the best debriefer is any caring human being who can just sit there and listen in a receptive, nonjudgmental way as a person talks through the experience, keeping the person talking about the facts. It's kind of like the old Detective Friday. "What are the facts, ma'am, just the facts?" You know, the debriefing procedure, "Where were you when this happened? Tell me. Then what did you do, then what did you do, then what did you do? What happened that allowed this to end for you? How did you get away from it? What's the thing that stands out for you the most? What did you do during this experience that you feel the best about? What did you do that made you feel the worst about yourself? What did you see and hear that was something that gave you hope, and what did you see in this experience for you that was something that shocked you or hurt you deeply?"

People just talk through and they begin creating, they begin integrating the sequential memory, and as they put these memories into the conscious brain and file them in there, there's a deep resolution process. This requires supportive people and it requires telling the story over and over again. For recovering people this is very much like the telling of their AA story where one person in the program's told me over and over again, "You don't know what you're story is until you've told it about ten times, because every time you tell it, some new fragment of a memory that you've never considered pops into your mind and forces you to deal with it on a deeper and deeper level of meaning."

Then the final step is resolution (slide 11). As you talk it through, there's a release of the physical stress. Your body relaxes. There's an emotional integration as you express the feelings, put the feelings into words, talk them through, let people know that's going on. Then there's a warm supportive human being on the other end of it. You work through the cognitive evaluation.

There are two parts of you working on this. One part says, "I shouldn't be bothered. Well, yes I should be." You begin getting yourself together and understanding and accepting your response and being okay, and then you begin moving into an expanded sense of self where you begin moving from a victim stance to a survivor stance. Where you begin to realize you have survived. You go through this and that's okay. And there's a reason why you survived. If you survived, there must be a reason, and you begin searching for that particular reason. Then you can integrate this experience and you can move on.

How long does this take? It takes anywhere from six weeks to three or four months to go through the process. The problem is that most of us are not professionals at dealing with this process. We have never had the opportunity to think about or talk about how to effectively and efficiently cope with stressful reactions, to cope with trauma, to cope with difficult times (slide 12). So we don't have a frame of reference. We don't have a tool kit. We don't have a psychological first aid kit to guide us, and we get stuck.

When we get stuck we experience what's called Blocked Trauma Resolution (slide 13). The trauma can't be resolved until we're out of the crisis and in a safe environment.
Emergency workers are not going to go through the Trauma Resolution Process until they're off the site and not going back. They need to get into a safe, supportive environment in order to begin defusing and refocusing. Otherwise, the normal trauma resolution gets blocked. Imagine if the crisis workers or the people who witnessed this response, go home to a dysfunctional family, home to an alcoholic or addictive spouse, to someone who's mentally ill, or go home alone because they've already destroyed their marriages and their relationships. There's no one for them to talk to, or else they talk to somebody who's condescending, punitive, judgmental, because without a safe environment, expression of resolution can't occur, and this blocks the trauma.

When the trauma gets blocked, there's a failure to resolve; we rebound from the shock in a nonsupportive or hostile environment that blocks our expression we get stuck in the rebound stage (slide 14). We push the feelings and the memories back down, refocus, pull out some of these compulsive skills to keep ourselves going and moving, but then the screaming need to resolve surfaces and we have flashbacks; re-experiencing the trauma through intrusive memories, nightmares and sensitivity to triggers (slide 15).

The affect of the attacks is with each of us. I was in a high-rise hotel, staying on the 20th floor, about two weeks after the 11th. I had done a lot of talking, a lot of working through, and thought I was handling it pretty well. The hotel room was one of these modern ones with floor-to-ceiling windows opening up where you could see the panorama of the city. I walked into the room, dumped my luggage down; the lights were off and it was dark, and I looked out at the lights over the city and all of a sudden I had this vivid three-dimensional fantasy of a large airplane coming right at that window. It wasn't a hallucination. I knew it was just a vivid memory, but all of a sudden I went through the entire fantasy of what it must have been like and I went from the outside of those horrible scenes I saw on television to imaging myself inside the building as that plane came crashing through, and it was very difficult, very difficult.

Fortunately, I had the tools I needed to get through it, but imagine if I didn't have someone to call. If I didn't know what was going on so I could make sense out if it, or I didn't have good feeling skills, and I'm now alone, dead tired, in a hotel where the only support place to go is the bar down in the lobby. It could have easily been a relapse trigger.

People who don't deal with this, start avoiding the triggers that are setting this off (slide 16, 17). They begin shrinking their world down, and numbing themselves off. They blunt their feelings, narrow their perception. They disconnect from themselves. They start blocking the memories and they go into this depressed alienated mode of existence. Yet underneath, they're tensed and aroused. They can't sleep restfully. They have difficulty concentrating. They're easily startled. They easily overreact. They're hyper vigilant, and they're very sensitive to anything. They overreact to anything that makes them think about the experience.

If somebody gets into PTSD, it becomes far more serious. If there's a history of PTSD, that person will need to move from understanding what's wrong with them. That's not just a Critical Stress reaction anymore, it's a Post Traumatic Stress Disorder and the person may need counseling, especially now if this is linked to and related to an addiction problem.

The first step is to recognize that something is wrong (slide 18). Alcoholics Anonymous says, "Admit that we're powerless over alcohol or why has it become unmanageable." In this case, recognize that something is wrong. We're experiencing a Critical Incident Stress reaction. This is not normal and something's wrong that's affecting my life. We need to do something, and it's going to be something different. There is a threat here. The second thing is we have to manage the immediate threat. The first step towards managing the threat is that we have to separate fact from fantasy. Separating fact from fantasy is critically important because many people are walking around responding to a three-dimensional fantasy about what's happening. When you connect with your immediate situation, you're going to do a threat assessment, and say, "Am I really in danger right now, or is it just a fantasy that I'm in danger right now?" For most of us, the level of threat that we're in is relatively speaking very low.

For example, consider the Anthrax threat. Last year, nearly 300,000 Americans died from the flu during flu season. How many of us are living in terror of catching the flu? How many people don't even go to get a flu shot because they're not that concerned? How many people died of Anthrax? So far, the Anthrax-related deaths do not make even a statistical blip. An estimated 350,000 people die each year from the consequences of poor diet and lack of exercise, which leads to obesity and heart disease problems. More people die from smoking, but yet they're not afraid to put a cigarette in their mouth. They die from overeating, but they're not terrified of eating a cupcake. So, we have to put this in perspective.

Then the second part of this is that whatever the threat is, we need a survival plan. It's reasonable to ask yourself, "How should I handle my mail? Should I be flying?" I check everyday to see if there's a real threat. I have a Website for the State Department. I e-mail some of my friends. I check CNN and MSNBC on the Internet to see what's going on with travel, to see what's going on with the bioterrorism. The Anthrax is not going to keep me off a plane, but if one of my destination cities is having an outbreak of Small Pox you better believe I will not be getting on a plane and flying there.

Next, we need to manage the stress overload (slide 19). Most people are saying, "I'm in danger!" when, in fact, they're really not. What they're dealing with is a stress overload. That starts by breaking contact with the triggers. Like you said, Gabrielle, you finally learned to just turn the television off.

I tend to check the news morning and evening, maybe sometimes at lunch, you know, to see if something's going on. I watch, but I don't watch the whole thing. I just click in to see if there are any emergency announcements. We want to get information on what's happening so we can stay informed. A lot of people go to the extreme and don't get the information they need to make informed decisions. That backfires because the lack of information raises stress.

We need to make a plan that we believe is going to work to reasonably protect ourselves. I live in Florida where there's a hurricane risk. So, I have a reasonable survival kit: a few gallons of water in the garage, some stored food, an electrical generator. It is the same type of emergency response supplies and equipment you would have if there were a real risk of an earthquake in California or hurricane in Florida. Those things are reasonable. Then you do the best you can. You put one foot in front of the other, live one day at a time, and do the best you can sticking to your plan and balancing that or leading your life. You have to develop a trust that things will resolve themselves. As a society, as a nation, as a world we've been through far worse than this, and this too will pass. You begin applying recovery principles.

The disassociation is a big problem (slide 20). It's not really that you're in threat, but we're feeling disassociated or disconnected from ourselves, and that makes us feel strange. It makes us feel like that's our old selves. So we've got to recognize that we are disassociated. "I'm spaced out by this. I'm disassociated by this." That's a normal thing. We have to affirm to ourselves that it's normal, this is going to pass.

Then we have to do things to center ourselves. The first thing is to breath. That sounds really stupid, but the first way to break out of a disassociation episode is to take a series of very deep breaths, then let them out. You allow yourself to relax on the exhaling of the breath.
Next, you have to focus and connect with the immediate sensory experiences in your environment. "What am I hearing? What am I seeing? What am I smelling? What I touching? What am I tasting?" It's called reality testing.

Then we move into a special form of reality test where we actually query ourselves. "Now, who am I right now? Who am I? Who am I with? Am I alone? Am I in danger? Where am I, and what's the situation?"

A lot of people, after presenting this lecture at conferences, come up to me absolutely in terror, saying, "You know, I'm just absolutely terrorized. I'm afraid to do anything. I could barely drag myself here. What do I do?" I said, "Well, first of all, let's figure out what's really going on."
"Well, there are these terrorists. They're going to kill me."

I said, "Well, let's do a threat assessment. Do you believe right now that Osama bin Laden is sitting in a cave somewhere in Afghanistan with a candle or a flashlight and a list of people he wants to see killed and your name is on the list?""Well, no, that's stupid."
"All right. Are your family members' names on the list?"

"No."

But, you know, I'm sure that some people's names are on that list. George W. Bush, our Congressman, our senators. Those individuals have a real threat. Most of us don't. We are not specific targets, but we could be accidental secondary casualties.

Then the second thing we have to ask ourselves is "Are we or our loved ones living in a target area or working in a target area?" People working in the Sears Tower in Chicago have a bona fide reason to be concerned. There is an above average risk of that building being targeted. But, once again, the above average risk areas right now are locked down with above average areas of protection. Again, we've got to do a reality test. Since the 11th, this country has done a very good job protecting its citizens. We contained the Anthrax thing: four deaths, eight additional people got it. Looks like it's over. No new cases in eight days. Good job CDC (Center for Disease Control). That's a very good job. That could have been much, much worse.

The emergency people at the World Trade Center evacuated 15,000 people in less than 18 minutes. Do you realize how incredibly good that is as a disaster response? Our personal responders are good. We've got the best people in the world protecting our airports and protecting us. With that reality test, we can get reconnected with what's really going on, and we can feel pretty good about it as a nation.

Then the next thing is that you have to work on the feelings of helplessness (slide 21). Identify what can you control. I suggest recovering people go back to one of the basic tools of recovery called the Serenity Prayer. "God grant me the courage to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." When you use that prayer in your recovery, what do you do? You sit down, you take a sheet of paper and you write down the things that you can control in this situation. People in recovery run into two problems: they put things on the list they believe they can control, but can't, and they believe they're out of control with things that they can control.

There are two things each and every one of us can control if we're willing to learn how. One thing we can control is what we're thinking in the moment. We can slap ourselves upside the head, kick ourselves in the butt, and gain control of the thoughts we run through our head. We can also control what we do. Just because we feel like doing something doesn't mean we have to. Just because we're scared and don't want to go out, it doesn't mean we have to sit on our butt watching CNN instead of going to an AA meeting. We can get our butt out and go. If we go to the meeting and people there are obsessing or it's not healthy to us, we can find a different meeting. If we don't like how our sponsor's dealing with this, we can find a different sponsor.

Identify what you can't control which is other people and events. I can't control whether we're going to drop a bomb on Afghanistan, whether a terrorist is going to blow up my airplane, but I couldn't control whether or not my airplanes crashed before. We have to realize our airways are safer.

Then do a reality test with other people where and talk about threat assessment. Talk about what we believe we can control. We talk about what we believe we can't control, and this is that third step of the Serenity Prayer, the wisdom to know the difference, which is, in fact, developing judgmental skills for surviving in a dangerous environment. However, the environment was no more dangerous on September 11th than it was on September 10th. The level of threat was the same. The only thing that changed was our awareness of the threat. We actually have a safer America today than we had on September 10th even though people are more scared.

The next step is focusing our energy on doing what we can do. What can I do? I decided to study what's going on. I decided to study how to talk to my kids about this. I decided to talk with people about this. I decided to talk with the significant people in my life how to deal with the kids, decide to put controls on television, etcetera.

When we have focused on doing things that we can that will work, then we must accept the limits. If I can't control it, I've got to believe that there's somebody out there that's going to be able to do it.

The next step, the sixth step, is reality testing (slide 22). We already talked about that. How serious is the risk? What can I control? What can't I control? Then how do I decide what to do? We need some decision rules to guide our responses because it's never going to go back to normal. We have to develop a new normal for living and with an awareness that the world is more dangerous that we thought. What was the old normal? Being asleep at the wheel. Being delusional. Believing, as a nation, that we were immune. Being in denial of death, injury and danger. Now we've got to join the rest of the world in recognizing we're subject to the human condition, we're subject to dying, getting hurt, illness, war just like anybody else. We have to put our efforts into sorting out what this means. The people who have dealt with this the best have made a decision, "Well, it was a near death experience. What should I do differently?" They're hugging their kids, spending more time with their kids, reevaluating their love relationships. Yes, we're selling more Valiums. More people are getting married. I think you're going to see the birth of more children. You're going to see another mini blip in the baby boom because people are beginning to see what's really important.

Then the sixth question there, what can I do to get support? This means stepping up the recovery program, but because people haven't received the guidance on how to apply this in their program, a lot of people are bouncing off the walls with it and using addictive responses to cope.

Last, we have to make a threat management plan (slide 23). This is really important, which is why I want to focus on it. We have to get skilled in doing day-to-day threat assessments. For most of us, there is isn't a real threat. Realistically, I am more likely to get hit by lightening than I am to get hit by terrorists. So, how serious is it? In my case, it's really relatively low. I saw in the paper where the Las Vegas odds makers figured out that if you were flying when the planes hit the World Trade Center and the Pentagon on the 11th , your odds of being in one of those planes was one out of 760.

You've got to reality test with other people. Constantly finding people you trust who are informed, who are doing these things, but who are really realistic about it. Then you need to consciously think through your threat management plans, and have your contingency plans. I have a plan for if I get stranded. My biggest risk is that something will happen, they'll shut down the airports again, and I won't be able to get home. So, I travel with extra cash. I have emergency communication plans for getting through the Internet and so on. I've set up ways that we're going to communicate in case something happens. Those are all reasonable things that bring about some peace of mind.

On AlcoholMD.com and also on my website, www.tgorski.com, (slide 24) I have placed several articles and guides for talking to your kids about the terrorist responses, psychological response to terrorism, etcetera.

Let's take some time now for questions.

GABRIELLE ANTOLOVICH: Well, I just wanted to say that our agency puts out an edition newspaper (New Times) and we actually published your piece on how to talk to your children. That is something that we got a lot of calls about. It's okay for adults to deal with it, but what do we do about the children. I found what you wrote about that very helpful.

TERRY GORSKI: I put that together because my son was having problems in that area. We managed to get him through it, but I really studied out what to do.

QUESTION: Gabrielle, the focus in the terrorism issues has been on the alcohol and sedative hypnotic prescription drugs. In New Times you're going to also be talking about narcoterrorism and how Osama bin Laden has been using heroine as an agent of Holy war, flooding both Britain and the United States with heroine. Could you comment on the heroine issue in addition to the alcohol and prescription drug issue?

GABRIELLE ANTOLOVICH: I did some research and discovered that bin Laden himself has said that he sees heroine as part of his Holy war against the west, and that he wants to produce a much purer form of heroine to really get people hooked. It appears that the drug dealers actually use bin Laden's terrorists as protectors so that they can get their drug deals through the countries and across borders. It's a symbiotic relationship where they're helping each other with their own agendas. It is logical for them to do this, because heroine is a highly addictive drug, it makes him a lot of money so that he can continue his terrorist activities, but at the same time undermine people in the country that he's targeting.

TERRY GORSKI: If this is a war on terrorism and it's not just a war on Arab terrorists, our biggest risk from terrorism, which didn't even make a blip in America, has been terrorism coming out of South America, especially Columbia. Right now we have the (phonetic)fark down in Columbia that are a horrible terrorist organization. The primary source of revenues for the terrorist activity is the drug trade, and the same is true for bin Laden and Al Quada and the other seven or eight terrorist groups that are operating in the Middle East, and numerous groups that are operating in South America.

Within the United States, street gangs reek terror in our poverty communities all the time; drive-by shootings and so on. We have people under active terror in our poor neighborhoods that doesn't even make a blip. We don't even think about it. Most of that is related to terror created by our failed national strategy for dealing with the drug problem. My real concern is that, as we are getting into our national frenzy to stamp out terrorism, we are going to do it at the expense of the things that would really make a difference. Already in Florida, $36 million will be cut from offender treatment programs in the state, which is going to increase dangerousness in the community tremendously. Let's not forget that the most effective way to stamp out drug abuse is through effective prevention and treatment, and that should be our first line of defense. Also, we must focus on keeping the people in recovery from relapsing.

QUESTION: It's been a very interesting presentation, Terry. I appreciate the work that you've done. On the day of the terrorist attacks, I happened to be chairing an Al-Anon meeting. I decided that I would continue to chair on the topic that I had selected rather than on the reference of the day. It was fascinating to me to see that while people referred to what happened in the morning, they did, in fact, continue to look at the particular topic I had selected.

However, what I noticed of myself was that it became very difficult for me to take care of my bills. I'm sitting at my desk right now trying to do my bills still from that period of time. I missed paying one and ended up paying interest on the credit card because of it. So I would like to ask you if this is typical of what happens when we get into this area?

TERRY GORSKI: This is typical of Critical Incidents Stress reaction because what happens is when you're in a challenging or stimulating situation, you know, where there's something in the environment that you have to respond to, you can typically do pretty well. But, when you sit back and you're in a quiet, safe surrounding like when you're going to pay your bills or whatever, this is when the need to resolve starts to surface. You're going to have to spend some quiet time in meditation, such as prayer, reflection, and/or reading, a time where you can allow yourself to relive the experiences, to make sense about them, to journal about them, have quiet conversations with people you trust. If you don't schedule the time to take care of this, the need to resolve will begin moving into areas of quiet or maintenance activities that aren't as interesting or challenging, and disrupt your ability to do it.

The first thing that goes is the maintenance. I can't balance my checkbook. I don't want to make my bed in the morning. I don't want to do the routine acts of living. The routines acts of maintenance go first because we sit down and then we can't attend to the tasks because this need to resolve is surfacing. What a lot of people find is they simply say I'm going to schedule some time each day, 15 minutes, 20 minutes, 30 minutes, where I'm going to go be by myself and reflect upon the day and just let come into my mind what will, and know that at the end of that time I'm going to call somebody who I trust or talk to somebody I trust about what surfaced in my mind as a result of that period of reflection.

Start off the reflection time by focusing yourself. Ask yourself some questions or give yourself some topics to reflect upon related to your feelings about what's going on. Often your mind then knows there's going to be time to deal with that, and it will leave you alone to do other tasks. The unconscious mind works that way.

LINDA MOORE: There are no more questions at this time. On behalf of AlcoholMD and our sponsors, DrugAbuse Sciences and Haight Ashbury Publications, we would like to thank Terry Gorski, Gabrielle Antolovich and each of our participants here this evening. This has been a stimulating and very important discussion. We invite each of you to return to the website for the full text of this session.

November 8, 2001

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