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Recovery in Action

Thu, 07 May 2026 16:40:50 GMT

Recovery in Action

What does long-term recovery look like? Perhaps this story can help provide a peek.

I lead several recovery groups during the week. This past week, one of my group members, whom we’ll call John, was talking about feeling frustrated about a personal situation. John was frustrated because of unmet expectations with a medical device he had recently begun using. The device would help him manage a long-standing sensory issue. Leading up to getting the device, he went through a host of emotions, including fear, anxiety, and excitement. The day came last week when the device arrived, he started using it, and it didn’t live up to the expectations he had hoped for. He was down about it. Very sad, angry, and resentful. On one level, it’s apparent why he was feeling these emotions. The device failed to do what he wanted. However, there was a deeper reason for these feelings. He realized that he was hoping the device would help him feel “normal.” The device would help him fit in with friends and work colleagues and, in some ways, make up for the struggles he felt growing up with these sensory issues. There was hope for feeling better about himself, which was instantly dashed.

When people think about recovery, the emphasis is almost entirely on ending the addictive behaviors or ending addictive chemical usage. However, that is just the beginning of the journey. Recovery is about personal change. Recovery requires one to change the approach to processing emotions and thoughts that would lead to addictive behaviors. Recovery demands exploring the driving forces behind difficult emotional states. The addictive mindset creates an environment where emotions are buried, and the addiction serves to numb negative experiences due to those emotions. The recovery mindset allows one to feel the negativity and let it go in a healthy way.

Returning to the group conversation, we discussed the underlying thoughts that drove his frustration, sadness, and resentment, and helped John explore how his past played into the hopelessness he felt last week. At the end of the conversation, John realized how far he had come in recovery. Seven years ago, he would have been drinking and popping Xanax to dull his feelings, never giving a thought to the underlying reasons for how he felt. Today, not only did John courageously explore those reasons, but he was also able to process the thoughts and let go of the feelings.

That is long-term recovery in action.

Kenneth Markowitz MD, IMAC

Effective Boundary Setting

Thu, 05 Feb 2026 17:02:57 GMT

Setting Effective Boundaries

Boundary setting is challenging for people struggling with addiction. It's often a driving force for addiction. Frequently, rather than assertively setting and maintaining boundaries, a person with addiction will bury their feelings and thoughts rather than expressing them or express their feelings and thoughts in aggressive, hurtful ways, resulting in shame about their behavior. The result is turning towards addictive substances or behaviors to manage the buried feelings and/or shame.

An important part of living in recovery is setting meaningful boundaries. Here are some pointers regarding effective boundary setting.

Boundaries are necessary to protect our physical or psychological well-being. When establishing boundaries, it’s important to have a clear understanding of the boundary you're setting. Vague boundaries create confusion and aren’t enforceable. For example, if you are uncomfortable with the way your mother talks to you about the relationship you have with your girlfriend or boyfriend, setting a boundary with your mother that states “I don’t like how you talk to me” is not very helpful. The boundary should state, “I don’t like how you talk to me about my relationship with (fill in the name of your significant other).” If there is a specific relationship topic you don’t want to talk about, then the boundary should be even more specific and should look like “I don’t like the way you talk to me about the way me and (your significant other) handle our finances.” The goal is to be as specific as possible about the issue. That way, you both understand the issue and can manage it effectively.

Once you define the issue, the next step is to determine a consequence for violating the boundary. Consequences should be specific, simple, and easily enforceable. Examples would be ending a conversation or walking out of a room. Continuing with the relationship theme from above, the boundary coupled with the consequence can look like, “I don’t like how you talk to me about the way you and (your significant other) manage our finances. I don’t want to talk to you about this in the future. If you continue to bring up this topic, I will end the conversation.”

Consequences must be enforced each time a boundary is crossed. Intermittently enforced consequences send a message that you aren’t serious about the boundary and that there are times when it may be OK to cross the line and other times when it’s not, which causes confusion. The goal is to be clear about the request you are making, the need for the boundary, and the consistently enforced consequence you will enforce if the boundary is violated.

Boundaries must be communicated effectively. Before having a conversation with the person for whom the boundary is being established, it’s important to plan out how you will deliver the message. Being in the right headspace is important. The goal is to be calm, use an assertive communication style, and choose your words carefully. Find a time when you aren’t stressed to have the boundary conversation. Avoid points in the day when you are hungry, emotional, or tire and avoid places that are distracting.

An assertive communication style is described as using clear and direct language to make your point without trying to convince others of your opinion. Body language is important. Assertive body language traits include a relaxed posture, natural or friendly facial expressions, a confident but not pushy tone of voice, and making eye contact without glaring.

Effective language for boundary setting avoids inviting confrontation. You want to use words that don’t accuse the other person of wrongdoing and put them in a defensive position. Focus on using “I” statements rather than “you” statements. It’s also important to take ownership of your feelings when discussing the boundary.

Putting all these elements together, an effective boundary and way to express the boundary can look like this:

“I get upset when we talk about the way you and (your significant other) handle our finances. I don’t want us to talk about this topic in the future. Please don’t mention our finances in future conversations, or I will end the conversation.”

A final note on boundaries. Presenting a boundary effectively doesn’t mean the person being spoken to about the boundary will abide by it, be happy about it, or accept it without further conversation. It’s important to be prepared for a negative response to your request. Always try to avoid becoming defensive. Listen to what the other person says and, if you continue to feel your boundary is correct, verbally recognize what the person said, assertively reiterate the boundary, and end the conversation. While “testing the waters” will likely happen in future encounters, holding firm to your boundary will show you are serious, and more likely than not, the boundary will be respected in the future.

Kenneth Markowitz MD, IMAC

Ten Recovery Slogans for the New Year

Wed, 31 Dec 2025 16:21:50 GMT

Ten Recovery Slogans for the New Year

Slogans are a big part of recovery. Some people love them, while others… not so much. Nevertheless, slogans can be vital to retrain the way you think and live in recovery. As we welcome in a new year, many of us will be contemplating life changes. Slogans can be an essential part of making those changes happen and sustaining change long-term. In the spirit of New Year's countdowns, I bring you my top 10 recovery slogans and how I think about them.

#10: “Easy does it”: Easy does it reminds me to take things slow or slow things down. My mind during active addiction likes to rush and react impulsively. When I start feeling that impulse to respond abruptly or act impulsively, I think to myself, “easy does it,” to slow things down, think through situations, and react rationally.

#9: “Meeting makers make it”: A friend in my 12-step group loves to remind us of this slogan. I have seen many people come and go over the past two-plus years of my attendance at my local 12-step meeting. The guys who are thriving are the ones who show up consistently. This slogan always serves as a reminder that I need to go to meetings, even when I don’t want to.

#8: “A week between meetings makes us weak”: Related to #9 above, it’s not enough for me to occasionally show up to meetings. I need to be at meetings more than once a week. Some people go to meetings every day. It’s important to know where you are in your recovery and be honest with the amount of support you need.

#7: “You haven’t done that…yet”: This slogan is a humble reminder that just because I didn’t do certain “worse things” during my years of active addiction, it doesn’t mean I’m not capable of doing them if I don’t maintain my sobriety. It only means I haven’t done those things yet. Moreover, it reminds me not to judge the things others may have done because of their addiction.

#6: “Let go and let God”: Control is an enormous part of addiction. I could control anything in my life if I put enough effort into managing it, or so I thought. If I failed to control the outcome, I blamed myself and consoled myself with my addiction. My addiction excluded God from the equation. My recovery wholly embraces the importance of God’s hand in everything. This slogan reminds me to let go of what I can’t control and leave it in God’s hands.

#5: “Accept the things I cannot change”: This slogan is related to #6. To give up control, I need to accept that I don’t control many things in life. I need to feel comfortable letting go of the desire to control everything. Acceptance leads to letting go. Letting go leads to living a peaceful life.

#4: “You're always the same distance from the ditch on the side of the road”: I’m just like many others when it comes to thinking about how long I have been in recovery. I’m still relatively new to recovery. I met many people with decades of recovery under their belt. However, the distance traveled in recovery doesn’t change the distance from relapses and returning to a life of addiction. This slogan reminds me to avoid complacency and remain vigilant when it comes to recognizing and managing addiction triggers.

#3: “Do the next right thing”: I can’t go wrong if I’m always doing the next right thing. The trick is to identify the next right thing. Sometimes, the right thing is hard to identify at first and even harder to complete. I keep coming back to this slogan to remind myself to focus on what is right and not what is convenient or easy.

#2: “The first look is on them, the second look is on you”: This is a sex addiction-specific slogan, but it can really apply to any addiction trigger. The first look is on them, which pertains to the people, places, and things around me. I can’t control an ad using sex to sell a product just as someone struggling with alcoholism can’t control the existence of neighborhood bars. While I may notice the ad and the alcoholic may notice the bar, neither of us has to indulge in their existence and engage in addictive behavior. Therefore, the second look, what I do with what I see in my environment, is in my control and is my responsibility.

#1: “You can’t think your way to recovery, recovery requires action”: I hear many fellow 12-step members say how they tried to read about and think their way to ending their addiction. Recovery requires active participation in changing one’s lifestyle. I remind myself each day to do (not think) one new thing for my recovery.

So, there you have it—ten recovery slogans to live by in 2026. Recovery can happen if you start making the necessary changes. These and many other slogans can help you make those changes. Happy New Year!

Kenneth Markowitz, MD, IMAC

Gratitude in Recovery

Sun, 07 Dec 2025 17:21:48 GMT

Life’s Been Good- Lessons from Joe Walsh

I love classic rock. I found classic rock when I was a teenager. First, I found the Beatles, and only the Beatles, until a good friend introduced me to Led Zeppelin and Tom Petty. Then the floodgates opened. I couldn’t get enough. Like many other teenage boys obsessed with rock, I started playing guitar. Unlike many of those boys, I still play guitar decades later. One of my favorite guitarists and songwriters is Joe Walsh, the famed guitarist of the classic band the Eagles. Joe Walsh also had a very successful solo career. One of my favorite songs from his solo career is Life’s Been Good.

Joe wrote Life’s Been Good for his album titled But Seriously Folks in 1978 while on a recording break with the Eagles. Joe discusses the song’s lyrics as a satire about the absurdities of the rock and roll lifestyle. When I started listening to this song and appreciating Joe’s lyrics, I focused on those elements of rock and roll excesses he detailed. He sang about fame and fortune, and the inability to manage either. I felt a connection to his lyrics, not because I was a rock star, but rather because I found success through many metrics that define success. Yet I didn’t feel like a success. I routinely focused on my failures, on the things that went wrong, and internalized them rather than exclusively using them as a learning opportunity. When Joe Walsh sings “My Maserati does 185, I lost my license, now I don’t drive,” I gravitate to the “losing my license” part of the lyric. Just another failure. That was me in active addiction.

Now that I have found recovery, I look at the song in a different light. Joe doesn’t just talk about the excesses of the rockstar life. He also concludes that “life’s been good to me so far.” Despite all the troubles he brought upon himself, he is still grateful for his life. Gratitude is vital to recovery. When living in active addiction, the gratitude I exhibited was clouded by the frustrations I felt about life, specifically:

· The inability to have life unfold on my terms.

· The inability to solve (i.e., control) everyone’s problems in my professional career and personal life.

· The criticism I internalized, rather than looking at it objectively and using it as a learning tool for future situations.

Thankfully, I have been given a second chance at genuinely living with gratitude. Acceptance precedes gratitude. I can’t genuinely express gratitude without accepting that life doesn’t unfold on my terms. I must accept that many things in life are beyond my control. Once I truly accept my control limitations, I can genuinely express gratitude. Gratitude is part of my daily life. Every day in synagogue, I focus on the good things I have in life and thank God for them. When I do my daily check-ins through journaling or thought work before bed, I make sure to include gratitude as part of the process.

While Joe’s lyrics detailing rock and roll excess once spoke loudly to me, now, the title of his song reveals its true message.

Kenneth Markowitz MD, IMAC

Internet Pornography and My Generation

Mon, 24 Nov 2025 23:05:42 GMT

A generation of men struggling with pornography

A long-overdue movement calling attention to the dangers of internet pornography to our youth is gaining momentum. Unfettered access to pornography is teaching our kids unhealthy lessons about sex and relationships. The average age of pornography exposure in the US is 12 years old, and the sexual content they are exposed to normalizes sexual behavior that is abusive, unpleasant, or painful to many, including those being filmed. Compulsive, problematic pornography use is an issue for our teens. Sexaholics Anonymous teen meetings are gradually increasing in number. For many, pornography’s damage is eye-opening. However, society has already seen the effects of internet pornography on adults. An entire generation of adults lived their late adolescent years when the internet and internet pornography gained widespread use. I am a part of that generation.

I am 50 years old. My generation saw the barriers to pornography indulgence vanish. Before free online pornography existed, one had to rent videos through cable companies' on-demand services or venture out of one’s house to the local video store, adult “bookstore”, or adult theater. If one was heading to a video store to rent adult content, here were the barriers to overcome:

Have a good excuse to leave the house.
Sneak your way into the adult section of the video store or sneak into an adult establishment and pray no one you know saw you.
Browse the selection of videos without making eye contact with anyone else there (and there was always someone else there).
Make the walk of shame to the checkout counter and deal with the checkout awkwardness.
Sneak out of the store and, once again, pray no one saw you.
Sneak the video home and make sure no one else in the house saw what you had rented.
Return the video to the store when done, once again, hoping no one catches you returning the video to the video store or entering the adult bookstore.

Watching pornography was an event with many barriers and, except for the truly determined, didn’t happen regularly. While pay-per-view reduced the physical and emotional obstacles to watching pornography by bringing it into the home, there was no free pornography before the Internet. The videos rented through pay-per-view also appeared on one’s monthly cable bill, and the cable company ensured the embarrassing titles were visible to all who reviewed the bill. The pornographic content on pay-per-view was also tame by internet pornography standards. Therefore, pay-per-view still had barriers.

The internet changed all of this. My generation experienced a new pornography frontier with no rules of engagement or an understanding of the dangers the experience posed. My generation became subjects in an experiment that analyzed the impact of free, easily accessible pornography on the masses. There were no longer any physical barriers to watching pornography. While shame was still a part of the experience, the level of shame (at least for people I talked to) was initially less and easier to push aside. Ultimately, the internet created a candy store of visual sexual content, indulging one’s every sexual desire, seemingly without consequences. Moreover, we entered adulthood at a time when pornography was gaining acceptance in mainstream society. The messages I heard about pornography included:

Pornography empowers women.
Pornography helps men achieve sexual stamina.
Pornography helps educate the masses about sex and sexual techniques.
Pornography can teach men how to satisfy a woman in bed.
Celebrities openly talked about their pornography use and celebrated their usage.

There seemingly were no reasons not to watch pornography. However, as the decades passed, the damage caused by internet pornography became clear.

Patrick Carnes calls the internet “crack cocaine for sex addicts.” The internet both expedites the speed of sex addiction development and intensifies the addiction. The internet allows one to watch pornography for hours a day in secret without cost. We know that for one struggling with a substance use disorder, drug use loses its effect at a certain dose, and increased doses or new drugs must be explored to approach the desired level of satisfaction. The same is true for pornography. Once specific pornography content loses its effect, someone with problematic pornography use starts looking for more intense and extreme sexual imagery, even if that imagery isn’t inherently arousing to the person. This behavior can be very disconcerting for the viewer. Oftentimes, I hear people comment about watching disturbing sexual content, but they keep watching because of the need for more intense content to achieve sexual satisfaction. The dampened shame from the “early pornography watching years” gives way to overwhelming shame as the amount of pornography viewed and the intensity of the sexual acts portrayed increase.

I routinely talk to men my age who are either struggling with or recovering from pornography addiction. The story I hear frequently follows the same pattern and ends with catastrophic results:

“I found pornography as a teen, and when it hit the internet, it was like a pornographic explosion; I couldn’t stop.”
“I started watching for 30 minutes a week, then several times a week, then daily, then an hour each day, which became 4 hours and then all night, every night.”
“I devastated my wife and my kids. I lost all of their trust.”
“I lost my career because of my acting out.”
“Over time, the pornography I was watching wasn’t enough. The stuff I was watching got more intense and extreme. Eventually, pornography led to chat sites, which led to meeting people in person. I was out of my mind.”
“I was arrested for watching illegal stuff online. It all started with pornography when I was in college. The internet was new then and changed the game. That gradually led to more intense and extreme pornography, which led to finding stuff I shouldn’t have been watching and really didn’t even care for. But it was the shock and intensity that hooked me in.”

I recognize that the pornography industry is an easy scapegoat for addictive behavior. It’s easy to blame pornography for one’s unhealthy and destructive choices. Everyone is responsible for their own actions, must take ownership of their behavior, and accept the consequences; no one is forced to watch pornography or continue along the path of damaging behavior. Nevertheless, Internet pornography is effortless to use and easy to hide, which makes developing a pornography addiction easy and overcoming it challenging, especially when one’s usage is decades old and was sprinkled with messaging that encouraged use without understanding the potential dangers. We now know what pornography is doing to our youth and are talking about it. Let’s also remember what it has done to our adults.

Kenneth Markowitz, MD, IMAC

Navigating a Work Event at a Bar

Mon, 06 Oct 2025 02:16:57 GMT

What would a coach do?

How would a coach manage this situation?

I had a coaching client present the following scenario to me:

John (not his real name) mentioned at his last coaching session that he is going to an after-hours event for work. The event is being held at a local bar. John has a history of alcohol use disorder and has been sober and in recovery for 3 months. John is worried about going to the event and wants to discuss the situation and determine the best course of action.

This is a situation in which I am routinely asked for help. It’s an example of having to live in recovery in the “real world”. Living effectively in recovery every day and managing the challenges life presents is important for maintaining sobriety and healthy living.

Work events outside of work hours are common situations. Alcohol is frequently a part of the festivities. Sometimes it’s wine at dinner. Other times, it’s beer at a sporting event or a social gathering at a bar. People recovering from alcohol use disorder must learn to manage these situations.

Where do we start?

When John mentioned the situation, I initially wanted to know if he was required to attend the event. Since John was only sober for 3 months, I didn’t want him to attend. Unfortunately, John was required to be at the event. John has a managerial role in the company, and the event was scheduled to build relationships between management and the rest of the team members. We talked about whether the job was worth keeping and risking his sobriety. Sobriety and recovery must come first. What is the value in maintaining a job that will perpetuate the addiction cycle and likely lead to termination because of poor work performance secondary to effects from the addiction? John felt losing his job would jeopardize his sobriety more than going to this event. So, we started working on the plan for the event.

Where do we go from here?

We focused on being at the event. How long did John have to be there? Could he leave early, especially before people started drinking? Perhaps speeches were being given before people started ordering drinks? Could John just be there for that part and avoid alcohol exposure? John noted it was a social event without any formal program, and drinking would occur from the beginning. He noted he could probably just go for an hour and then excuse himself for family obligations. OK, now we had a timeframe with which to work. John had to be there for an hour, and the goal was to get through the hour unscathed.

What was the plan for John’s hour at the event?

The next step was to develop an effective management plan for the event. Were there any co-workers he knew wouldn’t be drinking whom he could spend the majority of his time talking to? Were there areas in the bar where he could position himself such that, if needed, he could easily excuse himself for a break from the alcohol exposure? We worked through those questions and came up with names of colleagues to socialize with for most of the hour. John was able to figure out how to position himself in the bar to reduce seeing alcohol as much as possible. He also would make it a point to know where the front door is in relation to his location in the bar and make a note of the restrooms upon arriving at the bar. John seemed confident with these plans.

Then we turned to coping mechanisms and sobriety tools. What should John do in case he is triggered? We talked about having a soda in his hand at all times and focusing on drinking it when triggers start, especially if in the middle of a conversation, and he couldn’t excuse himself. We talked about stepping out of the bar for a minute to recover, texting or calling a support team member while outside the bar, quickly journaling on his phone, and thought diversion through mantras. We also talked about hiring a sober companion for the event.

I asked John to list all the pitfalls that existed for this event. Some were obvious, such as being in a bar around people who are drinking. Others were less obvious, such as certain foods to avoid because he used to enjoy them while frequenting bars and drinking alcohol. We also talked about managing co-workers who may “enthusiastically” encourage John to have a drink. I encouraged him to hold firm and not to give in to the coercion. Just say no and walk away.

John felt reassured that he had a good game plan going into the event. He knew how to manage the atmosphere, the alcohol exposure, and how to manage triggers if they surfaced. He knew where to position himself in the bar to sneak away for a quick break from the atmosphere when needed. He knew what to do if triggered. He also knew he wasn’t alone in managing the event. John had a support system behind him. This was not going to be an easy experience to manage. However, John knew he had to manage the event for an hour, and then he could leave.

What are the key points about coaching from this story?

Coaches help clients work through situations and develop a plan that works best for their recovery and sobriety. This holds true for one-off events and for long-term relapse prevention. The goal is to create confidence in maintaining sobriety and living in recovery through support and skills to manage daily challenges. With a coach in your corner, you aren’t alone in navigating the bumpy road of sobriety and recovery.

Kenneth Markowitz, MD, IMAC, CHCQM

Lessons for AI Implementation from Addiction and Recovery

Sun, 14 Sep 2025 04:50:28 GMT

How can addiction and recovery help with AI implementation?

Artificial intelligence (AI) is an incredible invention. I use AI daily. I have three AI platforms that I use for different functions (none of which include writing my blogs). While the answers I get from AI aren't always correct, I find they are frequently on the mark. AI makes many tasks more efficient and cost-effective. For example, vibe coding allows anyone to develop an app without requiring advanced coding skills. It's safe to say that I am a fan.

However, I also realize AI is a double-edged sword. Several recent studies have shown that overreliance on AI can have adverse effects on brain function. Furthermore, several AI experts have recently expressed significant concerns about unchecked AI implementation. Predictions about massive unemployment and the end of society as we know it are becoming louder.

AI is already as intelligent, if not more, than the average person. It's not unreasonable to think AI can take over most jobs within the next 5-10 years. The job takeover will likely increase as robotic technology improves. No one seems to have answers to this potentially devastating problem. Some answers provided focus on how great life will be with tons of free time. If we learned anything from COVID, it is that people generally don’t do well with tons of free time. Tons of free time led to increased criminal activity, addiction, and mental health struggles. People need a purpose and direction for their time. Therefore, mass unemployment and excessive amounts of free time should not be AI implementation goals.

Concerns about the effects of uncontrolled AI expansion sound like the outcomes of uncontrolled addiction. We are aware of the damage caused by the addiction cycle. Loss of family, employment, and freedom, and death are all potential consequences. Clearly, this is not the path society wants to travel with AI. Addiction management may have a solution for AI implementation.

Some addictive substances are impossible to live without. One such addictive substance is food. Everyone must eat. However, for some, eating is a trigger for addictive eating behaviors. How does one continue to remain sober from food addiction while continuing to engage in potentially addictive behavior? The answer comes from harm reduction.

Harm reduction is the idea that exposure to the addictive substance can continue, provided substance usage can occur in moderation. Harm reduction is not a great plan for most addictions. However, when you can’t live without exposure to the addictive substance, it’s the only viable option. Harm reduction for food addiction includes avoiding addiction-triggering foods (like processed sugar) and changing one’s approach to eating. Rather than using food to cope with emotions, healthier coping mechanisms are implemented. Cravings are managed by identifying the source of the craving and substituting the desired food with a healthier, less addictive option that can satisfy the craving. For example, a chocolate craving can be satisfied with dark chocolate rather than a processed sugar-laden, high-calorie candy bar. Learning to live with addiction exposure without re-engaging the addiction cycle is the key to effective harm reduction.

AI implementation can follow a harm reduction path. Rather than devouring society as addiction devours the individual, AI can be implemented to work along with the current workforce. Rather than replacing workers, the focus should be on maximizing the efficiency and productivity of workers and reducing repetitive and monotonous elements of their jobs. AI should complement the workforce rather than replace it.

No one forces a person to become an addict. The choice to engage in addiction or not is always available. The same is true for AI implementation. No one forces a company to eradicate jobs by replacing them with AI platforms. AI dominance is only inevitable if the choice to prevent it is surrendered. Lessons learned from addiction and recovery will hopefully guide employers to make the right choice when implementing AI.

Kenneth Markowitz MD, IMAC, CHCQM

What is Failure to Launch?

Tue, 19 Aug 2025 19:59:11 GMT

What is Failure to Launch?

I was a pediatrician for over 18 years. Throughout my career, I saw the early signs of failure to launch. Failure to launch is a lack of life direction. Frequently, warning signs develop during the teenage or even pre-teen years. The early warning signs can easily be interpreted as “kids just experimenting” or “kids being kids.” Some early warning signs include excessive gaming or hanging out with friends at the expense of schoolwork and in-home responsibilities. However, the early warning signs frequently lead to more concerning behaviors. As failure to launch progresses, drugs and alcohol frequently become part of the picture. Some teens are getting into fights and possibly into legal trouble. Mental health struggles, such as depression and self-harm harm can develop.

A teen struggling with life direction will frequently become a young adult struggling with life direction. Instead of going to college or learning a trade, the behaviors that took root in high school persist and may worsen. Many young adults with failure to launch develop emotional and substance use disorders and behavioral addictions. The boredom that comes from an unstructured day perpetuates the behaviors and emotional struggles.

Failure to launch can be effectively managed. Short and long-term goal setting and accountability are important elements of reversing the downward spiral. Developing and adhering to a set daily schedule is vital. Self-care through healthy eating, sleep and exercise is an important part of feeling good and having the energy to accomplish daily tasks. An early focus on employment, learning a trade or enrolling in school and independent living are key to jumpstarting the process of managing failure to launch.

How does the rest of the family factor into the equation? Frequently, young adults struggling with failure launch need guidance and support from their parents. The guidance sets boundaries and provides achievable goals and expectations. Once established, maintaining boundaries is an essential part of reversing failure to launch. Incentives for goal achievement supplied as small, appropriate rewards also help promote failure launch reversal.

Coaching can significantly help the young adult struggling with failure to launch. Coaching is about action. A coach can help develop both short-term and long-term goals, develop a plan to achieve those goals, and help with daily schedule development. A coach can also ensure that one is striving towards healthy life choices, and help parents set appropriate boundaries and provide proper accountability when needed.

Failure to launch can be a frustrating situation for parents and can be damaging for directionless young adults. Developing a plan of action is key to finding a path towards a productive and healthy future. If you're facing issues with failure to launch or have a son or daughter who is struggling to find their direction, then it’s time to take action.

Kenneth Markowitz MD, IMAC, CHCQM

Relapse Prevention Planning: A Quick Look into the Process

Sun, 13 Jul 2025 22:16:59 GMT

What is relapse prevention planning?

You are struggling with a substance use disorder (SUD) and have made it through a detoxification program. Perhaps instead, you have a behavioral addiction and found a way to stop engaging in your addictive behaviors for a few days or weeks. What do you do next? How do you avoid returning to addictive behavior? Relapse prevention planning is all about managing relapse. Relapse prevention planning is a team effort. My goal is to help each person understand his or her addiction cycle and implement an individualized plan of action to either avoid relapses or effectively manage relapses if they happen.

What exactly is a relapse?

Before addressing the definition of relapse, it’s important to define a “lapse.”

Dennis Daley and Antoine Douaihy, in their book Relapse Prevention Counseling , define a lapse as “an initial episode of substance use following a period of recovery.”

A relapse is a return to unhealthy addictive behaviors and the addiction cycle after a lapse occurs. A lapse may or may not result in a relapse. It typically develops in stages: emotional, mental, and finally, physical relapse. Emotional relapse can begin days to weeks before actual substance use or recurrence of a behavioral addiction.

How do I avoid a lapse and relapse?

This is where relapse prevention planning comes into play. Recovery begins when a person struggling with an SUD or behavioral addiction stops the cycle of addiction. However, as many people know, leaving a detoxification program or stopping addictive behaviors for a short time is not enough to avoid returning to those behaviors. Stopping addictive behaviors is the first step. What comes next is developing a plan that analyzes the underlying reasons for addiction, identifies the triggers for addiction behavior, establishes healthy life and emotional coping skills, and identifies a support system to help avoid relapse from occurring. Below is a general process I take my clients through to develop an effective relapse prevention plan.

Step 1: Admitting there is a problem

Relapse prevention can’t begin unless a person struggling with addiction recognizes he or she has a problem. It’s important to understand what makes a behavior an addiction. Frequently, we talk about the four “C’s” of addiction:

· Un C ontrollable

· C ompulsive

· Results in C raving the behavior/substance

· Is engaged in despite C onsequences (realized or potential)

A person needs a healthy respect for the seriousness of the addiction. It’s important to recognize that addiction has no floor. There are no depths to which a person with addiction won’t sink if addiction remains unchecked. Once the problem is fully appreciated, it’s time to move to step 2.

Step 2: Understanding the Cycle of Addiction

Addiction is a cyclical disease. The cycle feeds into itself and perpetuates the addictive behavior (see above figure). Over time, addiction requires more intense addictive behavior to have the same effect, which leads to worsening of the addiction. Everyone’s addiction cycle plays out differently, and awareness of the cycle helps one appreciate where he or she may be in the cycle. Cycle awareness may help break the cycle once engaged.

After reviewing the cycle, it’s time to break it into individual parts. We focus on identifying triggers, what it feels like to crave the addiction, what defines the addiction ritual that leads to engaging in the addictive behavior, and the emotional aftermath that feeds into the next episode of the addiction cycle. We perform an analysis of everyday activities, special events, and social interactions that could lead to addictive behavior and should be avoided or managed healthily.

Step 3: Creating the plan

Once a thorough understanding of what drives an individual’s addiction has been established, it’s time to create a relapse prevention plan. This includes exploring healthy living habits and coping skills, as well as setting goals for managing life and addiction. Recognizing subtle warning signs, such as increased anxiety, withdrawal, or neglect of self-care, and identifying triggers are crucial parts of the plan. Developing a daily routine and a strategy for handling special events are also important. Managing emergencies and unexpected life disruptions is key to effective relapse prevention. Additionally, identifying members of one’s support team is an essential element of any relapse prevention plan.

The written plan is frequently multiple pages, and having a “cheat sheet” with major bullet points is important to have available at all times, such as in one’s wallet, purse, or in an easily accessible cell phone app.

Step 4: What to do if I Relapse

Unfortunately, relapse is frequently part of recovery. Understanding what to do if a relapse occurs is as important as preventing relapses entirely. Effective relapse management can be the difference between quickly breaking the addiction cycle and spiraling out of control. Relapses aren’t a moral failure, and shame must be avoided. Shame will result in the perpetuation of the addiction cycle. Relapse should be a learning experience where the reasons for relapse are analyzed and modifications to one’s plan are made so future relapse can be avoided.

Relapse prevention planning shouldn’t be done alone. Having a therapist, counselor or certified recovery coach who is adept at relapse prevention planning is key to developing a successful plan. They can also provide a neutral, supportive perspective and help you process any setbacks constructively.

Relapse does not define your recovery; your willingness to learn and adapt does. By creating a comprehensive relapse prevention plan, you’re equipping yourself with the tools, support, and mindset needed to sustain your progress. Be empathic with yourself, celebrate every victory and hold on to hope. Recovery is possible, and with the right plan in place, each new day is another opportunity to move forward.

Ken Markowitz MD, IMAC, CHCQM

Understanding Pornography Addiction

Mon, 16 Jun 2025 13:59:47 GMT

The Dangers of Pornography Addiction

I was listening to an episode of the podcast Diary of a CEO recently with a roundtable discussion about the future impact of AI. At one point, the conversation turned to childhood education in an AI world and the general advice they gave their own children. One of the panelists, Dr. Bret Weinstein, noted that he tells his children to stay away from pornography at all costs. He further said that he would rather his children have a drug addiction than a pornography addiction. Dr. Weinstein's point was in no way to diminish the overwhelming struggles of those suffering from drug addiction. Rather, his point was to emphasize how bad a pornography addiction can become.

Pornography addiction is becoming a larger problem in our society. Every year, the percentage of the population struggling with pornography addiction increases. The current data show that approximately 7% of the US population (11% of men and 3% of women) self-report having a pornography addiction. These percentages are likely significantly higher, as the data is based on self-reporting.

Pornography is Not a Harmless Indulgence:

Pornography allows one to experience sexual pleasure without the personal experience and potential risks of having sex, such as pregnancy and STDs. Therefore, pornography has an inherent appeal for many users. Many users rationalize their use by assuming pornography is harmless, that the people in the videos are paid to perform, enjoy what they are doing, and want to be filmed. One can easily perceive pornography as harmless enjoyment. However, many horror stories have come from the pornography industry over the past decades. Forced, violent sex, being filmed without consent, and having those videos posted on websites has caused serious harm to the mostly women victimized by those producing these films. Pornography is certainly not harmless to those who are filmed having sex. It’s also far from harmless to those watching pornography.

Developing a Pornography Addiction:

Initially, people engage in potentially addictive behaviors because of the pleasure gained from the behavior. Frequently, addictive behaviors are introduced during childhood, a time when the potential dangers aren't appreciated. The average age of pornography exposure is approximately twelve years old. The initial curiosity about pornography leads to using pornography during masturbation. While many people never progress beyond using pornography for occasional enjoyment, others progress to more concerning usage.

Addiction is characterized by the "4 C's." Occasional pornography use moves to more frequent, un c ontrollable, and c ompulsive use. The user starts using pornography as an emotional c oping mechanism, and the pornography use continues despite life-damaging c onsequences. Addiction turns pornography from "harmless fun" to an all-encompassing, life-damaging addiction.

Why is Pornography Addiction Dangerous?

Addiction doesn't remain static. Over time, the desired effect from pornography wears off, leading to a need for more intense sexual imagery to attain the desired effect. Frequently, pornography addiction moves away from videos to more realistic online experiences like chat rooms or live online sex shows. Others may jump from virtual sexual stimulation to in-person experiences. The consequences of uncontrolled pornography addiction can be catastrophic. Some people cross lines into illegal behavior, such as seeking child abuse material and hiring sex workers. Damage to relationships, career loss, and legal consequences are real results of pornography addiction.

Pornography addiction is easy to hide. There are minimal physical signs suggesting a person has a pornography addiction. Behaviors such as sleeping during the day and frequent isolation may hint at a problem, but they are oftentimes dismissed as a symptom of something else. Online pornography use can be hidden by closing a laptop, turning a phone or tablet face down, or powering off a device when someone passes by.

The Internet: Adding Rocket Fuel to the Fire:

The internet plays a special role in pornography addiction. The Internet has removed many of the barriers to accessing pornography. Before the Internet, both physical and psychological roadblocks stood in the way of watching pornography. Pre-internet, if someone wanted to watch pornography, they had to leave the house and sneak into the adult section of the local video store, an adult video store or a XXX movie theater. After avoiding eye contact with the other visitors perusing the titles, there was the "walk of shame" up to the front counter to pay for the video or movie of one's choice, followed by sneaking out of the store and back home, praying one wasn't spotted along the way. One had to be dedicated to making this desired indulgence a reality. The Internet has removed all of these barriers by making free pornography available in the home to everyone, at any time, without anyone being aware of the behavior.

The Internet has also accelerated the rate at which pornography addiction develops and advances by providing unlimited amounts of content satisfying every kink and fetish imaginable. Therefore, a person can spend increased amounts of time each day watching pornography while exploring sexual behavior that they never considered arousing. It can, in turn, lead to new arousal patterns that would never have developed before the Internet. Moreover, internet sites carrying pornography use tactics such as providing short, intense "action-packed" scenes and immediate suggestions for the next video to watch as ways to increase the time people spend watching pornography. These tactics significantly contribute to advancing pornography addiction.

The elements of both pornography and the Internet that advance addiction development are the same elements that make recovering from the addiction so challenging. Blocking and accountability software exist and can serve as a barrier to pornography access. However, someone addicted to pornography can often find ways around the software. Therefore, true recovery from pornography addiction requires absolute dedication and discipline to recovery, which is much easier said than done.

Pornography addiction will continue to exist and increase in frequency. Widespread education about the dangers of pornography and re-established barriers to access are needed. Without a plan to reduce exposure and usage, society is perpetuating an environment that allows future generations to develop pornography addiction. Until change occurs, it is wise to heed Dr. Weinstein's warning about pornography.

The Internet and the Damage Done

Mon, 05 May 2025 01:20:12 GMT

The Double-Edged Sword: How the Internet's Convenience Fuels Addiction

The internet has undeniably revolutionized our lives, boosting efficiency and productivity in countless ways. We connect with people across continents instantly, find answers to questions with a few taps, and even run entire businesses from the comfort of our homes. Shopping is now performed through a few clicks, and entertainment streams directly to our screens. Yet, this powerful tool has a darker side, particularly in its role in fostering and sustaining various addictions.

The digital age has, unfortunately, made it remarkably easy for behavioral addictions to take root and flourish. Issues like sex addiction, pornography use, compulsive shopping, and gambling have seen a significant surge in prevalence since the advent of the internet.

During the pre-Internet era, engaging in these behaviors often involved a series of hurdles, each acting as a potential deterrent. Consider the process of accessing pornography:

Leaving the house.
Getting in the car.
Driving to the local video store.
Discreetly entering the adult section.
Searching for a video, hoping to avoid awkward encounters.
The uncomfortable walk to the checkout counter, minimizing eye contact.
Driving back home.
Returning the video to the store.

Visiting an adult video store added the anxiety of being seen by someone you knew. Similarly, compulsive gambling and shopping involved significant time, effort, and the potential for social shame, all of which served as barriers to the development of addictive habits.

The internet has effectively dismantled these barriers. Now, entering a digital realm of addiction is as simple as turning on a device and clicking a few times. The physical obstacles are gone, replaced by an environment where one can indulge anonymously, secretly, and often without the immediate weight of guilt or embarrassment that existed before. This removal of pre-Internet hurdles eliminates crucial moments of introspection that can halt the progression of addictive behavior. The physical, emotional, and cognitive speed bumps that once existed have been flattened by the internet's inherent anonymity and secrecy.

While the internet provides easier access for those already struggling with addiction, its impact extends further. The unfettered access to addictive content online allows individuals, especially children and teenagers, to encounter this content and potentially develop addictions at a much younger age than in the past. For instance, the average age of first pornography exposure in the US is currently around twelve years old. Online activities are also easy to conceal. Children can hide their online behavior well into adulthood, at which point the consequences of these hidden addictions often become devastatingly apparent.

Furthermore, the internet acts as an accelerant, intensifying and entrenching addictions at an alarming rate. Individuals struggling with pornography addiction may find themselves drawn to increasingly extreme content and expanding their online behavior to chat rooms or live shows. Those battling gambling or shopping addictions can now easily deplete their savings from their couch, night after night.

The internet also presents a slippery slope towards legal trouble. Access to illegal material, illicit online conversations, and age-restricted activities is readily available. The depersonalization that can occur online makes it frighteningly easy to cross dangerous lines in the moment, leading to severe repercussions. Engaging in these behaviors while staring at a screen feels detached from real-world consequences, making rationalization easier. Lax age verification processes are easily bypassed, allowing underage individuals access to inappropriate online activities.

Ultimately, each individual bears responsibility for their online actions. Engaging in illegal, immoral behaviors online or gambling or shopping away the family's life savings, requires personal accountability. Because of the dangerous relationship created when an addicted mind encounters the frictionless accessibility of the internet, developing a healthy relationship with our internet-connected devices and being mindful of our online habits is necessary for safe usage. Some strategies for fostering this healthy relationship include:

Treating phones and computers as tools for specific tasks, rather than devices used for aimless internet exploration.
Educating children about safe online practices and the potential dangers these devices pose.
Utilizing devices with limited capabilities and blocking access to specific websites and apps.
Employing accountability and monitoring software on children's devices.
Removing social media apps and even deleting social media accounts.

While these measures can help reduce the risk of developing or perpetuating addiction, they are not foolproof. The ease with which online addictions can be concealed allows individuals to live secret lives until those lives inevitably unravel with painful consequences. If you find yourself grappling with an addiction that manifests online, seeking help is a crucial step towards preventing further damage to your life.

Kenneth Markowitz MD, IMAC, CHCQM

Professionals and Addiction- Unique Challenges

Mon, 07 Apr 2025 01:25:13 GMT

Professionals and Addiction - Unique Challenges

Unique Challenges of Addiction Among Professionals

Professionals struggling with addiction face distinct challenges that often begin before entering the workforce and intensify throughout their careers. Alongside the life experiences that typically underlie addiction, professionals encounter added pressures that can enable addictive behaviors to thrive. For many, the roots of addiction trace back to childhood, a reality that holds for professionals.

From a young age, many professionals feel immense pressure to succeed. This pressure may be self-inflicted or imposed by parents, siblings, and peers. Some were competitive and goal-oriented children, driven by internal demands for perfection. Others endured external expectations that stimulated self-critical thinking, particularly in moments of failure. These pressures often damage self-esteem, laying the groundwork for addictive thinking. To cope, quick fixes like drugs, alcohol, and pornography can become reliance mechanisms, persisting and intensifying well beyond initial exposure.

As competition escalates along the academic path, the pressure to succeed grows exponentially. During college, the stress of vying for graduate school admission and managing demanding workloads leads to isolation and opportunities to escape through unhealthy coping mechanisms such as blowing off steam with substances or retreating into an internet fantasy world. For the select few who reach graduate school, these pressures culminate in long hours of study, potential self-doubt, and worsening addictive behavior.

Upon entering the workforce, professionals face even greater demands, including long hours, career advancement pressure, and responsibilities to clients or patients. These challenges further entrench addictive behaviors, compounding their intensity over time.

The Double Life of Addiction

Professionals often feel compelled to battle addiction in isolation, fearing that revealing their struggles could jeopardize their careers or reputations. Workplace regulations and professional ethics are perceived as unforgiving, adding to the stigma. The image of confidence and control, essential in their interactions with clients or patients, conflicts with the reality of addiction.

This tension often leads to living a double life: projecting trustworthiness and success by day while managing depression, anxiety, and self-loathing through chemicals or addictive behaviors at night. The smarter the professional, the more elaborate the rationalizations become, tightening the addiction's hold:

"I’m a doctor; I know all about addiction and can control it."

"I know how to use and avoid getting addicted."

"I don’t have a problem—I function perfectly during the day."

"I have to figure this out myself; seeking help would cost me everything."

These rationalizations can sustain the double life for decades, yet this precarious balance inevitably collapses, often with catastrophic consequences.

Hope Through Recognition and Treatment

Professionals have much to lose from addiction. The careers they built through years of rigorous education and dedication can vanish in an instant. Yet gradually, licensure boards are recognizing that therapy and recovery programs serve both professionals and their professions better than punishment or license removal.

Most states now offer specialized programs through medical boards and bar associations to treat addiction and monitor recovery. Early identification and intervention can protect not only careers but also lives.

For more information about resources in your state, explore the following:

Help for healthcare professionals : Federation of State Physician Health Program s

Help for attorneys : American Bar Association

The First Look Is On Them. The Second Look Is On You

Tue, 18 Mar 2025 01:31:26 GMT

The First Look Is On Them. The Second Look Is On You

The phrase “the first look is on them, the second look is on you” is a frequently used mantra in Sexaholics Anonymous. Contrary to what it might imply, “the first look is on them” doesn’t assign blame to others. Instead, it acknowledges that noticing people or things in one’s environment can trigger arousal without intent. This arousal results from learned behaviors that have become almost instinctive. Two important concepts to consider when understanding this idea are the innate character of sexual arousal and the human ability to learn associations.

Sexual arousal is innate and evolutionarily necessary to perpetuate humans as a species. When aroused, a person creates associations with that arousal. Visual cues such as eye and hair color, style of dress, and body language all become linked to sexual arousal. The same is true for input to our other senses when aroused. Much like Pavlov’s dogs, repeated exposure to certain sensations when aroused ingrains the association between sensation and arousal. These associations begin to develop, often without our awareness, at early ages, resulting in almost instinctive arousal when the triggering sensation is experienced. Society further promotes these associations through various means such as TV and movies. Free, unfettered access to pornography certainly plays a large role in creating arousal associations (more on this in a future blog). Over time, arousal becomes automatically triggered when experiencing associated sensations. “The first look is on them” refers to this unavoidable response.

Learned associations extend to all addictions. All addicts experience similar responses regarding their specific addictions. For example, a billboard for a beer company or passing a liquor store can trigger a desire for an alcoholic to take a drink. The triggers are different, but the Pavlovian response is the same. How the person manages that first look is then entirely in their hands. Enter the second half of the phrase: “the second look is on you.”

When an addict is steeped in addiction, the second look leads to negative outcomes. Sexual acting out in various forms, binge drinking, or drug use are inevitable outcomes. However, in recovery, the second look can be controlled by taking action and using the tools learned to control the urge to indulge in addictive behavior. We say “move a muscle, change a thought” because action in various forms can help reduce the need to engage in addictive behaviors. Something as simple as repeating mantras such as “let go and let God” or “pray for them, help for me” can reduce the urge to act on the triggered emotions. Calling a sponsor, friend, or coach and “talking out the urge to indulge” can help dissipate the desire to act out.

Life throws unavoidable situations our way each day. How the addict chooses to react to those challenges can determine whether one gets sucked back into the black hole of addiction or continues to live healthfully in recovery.

Kenneth Markowitz MD, IMAC, CHCQM

Twelve Step Principles Can Help Anyone

Sun, 02 Mar 2025 18:46:59 GMT

The Twelve Step Principles Can Help Anyone

For the past 90 years, Twelve Step programs have been instrumental in helping individuals overcome various addictions. While the Twelve Step literature describes it as a simple program, meaningful completion can be challenging yet profoundly transformative. Recovery using this approach demands time, effort, and self-reflection to understand the root causes of addiction and make lasting personal changes.

A cornerstone of Twelve Step programs is spirituality. While belief in God can facilitate the process, atheists and those with strained relationships with God can also find success. Remarkably, the principles of these programs can benefit even those not suffering from addiction.

Let's explore how Twelve Step principles can foster life-changing growth for anyone by examining the program's structure.

Twelve Step programs are built around twelve principles or steps, divided into four sections, each with a specific purpose. Each successive section builds on the previous one, guiding individuals toward personal growth, sobriety, and recovery. For those struggling with addiction, the first three steps involve acknowledging the addiction and recognizing that recovery requires support from a sponsor—a fellow addict progressing through the Twelve Steps who can offer guidance.

Once the addict understands and accepts these concepts, they can delve into the underlying drivers of their addiction. This involves creating a detailed list of "character defects" and discussing them with their sponsor. These conversations illuminate how these traits contribute to the addiction and provide insights into managing or eliminating them over time. The final steps focus on making amends to those harmed by the addiction, engaging in routine self-evaluation, and participating in community service.

These principles are equally applicable to non-addicts seeking self-improvement. For instance, if you wish to improve your relationship with your spouse, the initial steps require acknowledging the problem and seeking external help from a therapist or coach. Next, identify and understand your role in the issue—what are your "character defects" that contribute to the relationship challenges? Once identified, consider how you will change these traits to prevent them from negatively impacting your relationship. Additionally, addressing any actions that require amends can help your relationship progress. Finally, self-maintenance is crucial to avoid reverting to old habits that previously harmed the relationship.

Twelve Step principles are universal. They can dismantle the barriers to self-improvement, helping individuals accept reality, understand contributing factors, and take the necessary steps for a healthier future.

Kenneth Markowitz MD, IMAC, CHCQM

Purim Seudah Alcohol Safety

Mon, 17 Feb 2025 18:43:37 GMT

Purim Seudah Alcohol Safety

Welcome to my blog!

I will be posting a monthly blog highlighting practical addictive behavior advice and providing specific insights into addiction. This month I’m focusing on safe Purim seudah behavior.

The Purim seudah is a time to get together with family and friends. Many synagogues host a seudah, and traditionally, alcoholic beverages are served. At this meal particularly, alcohol consumption can be on the heavier side to the point of getting out of hand with negative consequences. With Purim about six weeks away, if your synagogue is planning on hosting a seudah or Purim party, it's important to develop an alcohol management plan to keep everyone comfortable and safe. Here are some ideas to consider when planning this year’s festivities.

Consider a dry seudah: I know this is not a popular idea, especially on Purim. However, it is the safest and most family friendly option. Keep in mind that in many states, a synagogue can be held liable if someone leaves a synagogue event inebriated and causes harm or damage because of his or her altered state. Going dry should be considered especially if your synagogue had past issues with inappropriate member behavior due to alcohol consumption.

If alcohol is on the menu at your synagogue's Purim seudah, here are some ways to keep both the non-legal and legal aged members safe.

Keep alcohol out of the hands of members who are under the drinking age. Allowing underage drinking at a synagogue event is illegal and could lead to both civil and criminal consequences. Know the law in your state ahead of time.

Alcohol access can be limited by setting up a bar or table controlled by adults. Don't have bottles of wine or beer on the tables where underage members could have easy access to those beverages. Members of legal drinking age can be given a drink wrist band shown at the bar/drink table or given a drink ticket that gets turned in when taking an alcoholic beverage.

Controlling alcohol consumption for the legal age crowd is also important. In addition to limiting alcohol access as mentioned above, consider only allowing wine and beer and not "hard alcohol" such as liquor. Offer single size servings of alcohol. Allow members to take a glass of wine rather than a wine bottle to their table. Have only single cups of beer or single serve beer bottles available rather than a beer keg.

Limit the number of drinks a person can have over a designated time. This can be achieved with the drink tickets mentioned above. Each ticket can have a time pre-printed on it and can only be used during that window (i.e. the 1 PM ticket can only be used between 1- 1:30 PM. Each member would get one ticket for that time period). Limit the total number of tickets each member will get for the event. End alcohol service at least an hour before the end of the seudah to allow people to sober up before leaving.

Using trained bar tenders, who can monitor attendees for signs of inebriation, is a good way to prevent trouble. Identifying who had a little too much to drink can help avoid inappropriate behavior during the seudah and can help plan how to get that person get home safely rather than having to scramble at the end of the seudah. Have volunteer members available as designated drivers or chaperones who can walk inebriated members home safely, especially if they are leaving the seudah alone.

Announce and circulate your alcohol safety plan to your congregation ahead of your event. Having a plan in place before the seudah allows for a fun time for all and keeps everyone safe.

Have a happy and healthy Purim!

Kenneth Markowitz, MD, IMAC, CHCQM