You know, I don't know what ticks me off more. The fact that I keep seeing employment opportunities that call for LICSW's or LMHC's with Substantial Substance Abuse Experience, or, the last time "We" LADC's had a chance to state our case at the State House before the Insurance Committee for third-party billing rights and only about ten of us showed up. That's right, a measly ten people.
Do you think they took us seriously? Obviously not! Those of us that are LADC's should learn a lesson from the LICSW's and LMHC's.
If you want to be taken seriously, then Organize, Organize, Organize. Like they have and continue to do. As it stands at the present time we have a meaningless license. What good is a license if it does not advance our position both financially and increase our professional stature?
It doesn't.
Not to mention the fact that Department of Public Health which licenses us, does not require programs that accept their money to hire us. I am not saying that "all" the positions within a program should be LADC's.
However, it might be nice if the lead roles went to us rather than LICSW's or LMHC's, with "Substantial Substance Abuse Experience."
I mean come on. You licensed us. You require a Master's degree in a behavorial science in addition to a CADAC. Some people have suggested that the reason we still do not have third-party billing rights is due to the number of CADAC's without a Masters' that were "grand-fathered" in.
Well guess what. The same situation was present when the LMHC's were "grand-fathered" in. So...what's the difference?
The LMHC's had a formidable presence at the State House when their third-party billing issue was being discussed, that's the difference.
I understand our profession as addiction counselors is still being looked at through the origins of our beginning. Namely, "Hey, got six months clean? O.K., then we'll make you an addiction counselor."
Those days are long over. As a matter-of-fact, many of us in the addiction profession have been working with dual-diagnosed people for years; from detoxification centers to inpatient psychiatric units.
Maybe the day will come when I read an employment opportunity that says, LADC-I with "Substantial Psych Experience."
Then again, maybe not.
Tuesday, December 1, 2009
Saturday, October 31, 2009
Education in Detoxification Facilities
Why is it that knowing as we do now from research over the years, that the majority of the patients that return to detoxes over and over again have other mental health issues going on, do we persist in only educating them on addiction.
Granted, there are those facilities at the detox level (usually private) that educate on all areas of mental health (such as information on: affective disorders, trauma, grief, abandonment issues, etc) in addition to addiction. Unfortunately, they are far and few between.
Look around Massachusetts and the majority of state funded addiction programs are based on the 12 Step Model. I am not anti-twelve step by any stretch of the imagination. However, for many patients (if not most), twelve-step is not enough in and of itself.
I remember a client in my practice telling how at a meeting he said he was having a difficult time and being told, "just go to another meeting." The fact was he had been awake for four days and had gone to seven meetings (hmmm, maybe his bipolar disorder needed to be addressed, huh?)
Those of us in the addiction field that have worked inpatient psych/addiction, I have found over the years to be much more cognizant of dual diagnosis than those counselors that have not had this experience.
"Just go to another meeting," "Get a Sponsor," is not enough for the majority of people with multiple detoxes under their belts.
When I worked at the detoxification level and did education groups on dual-diagnosis issues I never ceased to be amazed at the number of patients whose jaws would literally drop when I mentioned something about depression, or trauma and the like, and they would have a moment of identification. Education can be very powerful stuff, needless to say.
Until we have DPH (addiction issues), merge with DMH (mental health issues) such as they have done recently in New York State, we will continue to see people enter and re-enter the detox settings.
Granted, there are those facilities at the detox level (usually private) that educate on all areas of mental health (such as information on: affective disorders, trauma, grief, abandonment issues, etc) in addition to addiction. Unfortunately, they are far and few between.
Look around Massachusetts and the majority of state funded addiction programs are based on the 12 Step Model. I am not anti-twelve step by any stretch of the imagination. However, for many patients (if not most), twelve-step is not enough in and of itself.
I remember a client in my practice telling how at a meeting he said he was having a difficult time and being told, "just go to another meeting." The fact was he had been awake for four days and had gone to seven meetings (hmmm, maybe his bipolar disorder needed to be addressed, huh?)
Those of us in the addiction field that have worked inpatient psych/addiction, I have found over the years to be much more cognizant of dual diagnosis than those counselors that have not had this experience.
"Just go to another meeting," "Get a Sponsor," is not enough for the majority of people with multiple detoxes under their belts.
When I worked at the detoxification level and did education groups on dual-diagnosis issues I never ceased to be amazed at the number of patients whose jaws would literally drop when I mentioned something about depression, or trauma and the like, and they would have a moment of identification. Education can be very powerful stuff, needless to say.
Until we have DPH (addiction issues), merge with DMH (mental health issues) such as they have done recently in New York State, we will continue to see people enter and re-enter the detox settings.
What A Recovering Person Should Look For In A Counselor/Therapist
When I worked in the detoxification setting I always emphasized to the patients to learn as much as they could about their addiction and/or other mental health issues (self-efficacy). In that way, when they converse with professionals they have the language of their disorders and can be more easily understood. In addition, the professionals they deal with will understand that here is a patient that understands their need to be a part of the process, and is directing their recovery.
Another suggestion I would make to them is the first time with a new therapist, "interview them," yes, that's right, interview them. Just because they have initials after their name does not mean they will automatically be a good 'fit.'
Questions to ask them may be such as: "What type of therapy, or therapy style do you employ, where did you do your clinical training, do you work with a lot of clients that have my issues, are you comfortable working with people that have my issues, etc."
A mistake that clients will sometimes make is when they feel their relationship with a therapist is not working out, or, is going nowhere, they just stop going.
Big Mistake. You don't show up for two or three sessions, the therapist can essentially just write you off their books. Whereas, if you talk it out with them and you still do not believe you can work with them, then ethically, they have to refer you to somebody else (if you ask them).
Another area that people in recovery sometimes get hung up on is the idea that they have to, or, only want to go a therapist that is in recovery themselves. While this may or may not be advantageous, I would be more concerned with their professional expertise and clinical training.
You want to talk to someone that has been through what you are going through, then go to a 12 Step Meeting and get a Sponsor.
I remember attending the annual Harvard Medical School/Cambridge Hospital, "Treating the Addictions' conference many years ago and hearing a presenter, Dr. Lance Dodes, author of the book, "The Heart of Addiction." It was his contention that a person in recovery seeking a therapist should be more concerned with that person's knowledge of individual therapy then just the addiction issue alone.
At that point of my addiction counseling career, my own thinking was heading in that direction. Another 13 years plus working inpatient psych/addiction has confirmed his contention to myself even more.
Another suggestion I would make to them is the first time with a new therapist, "interview them," yes, that's right, interview them. Just because they have initials after their name does not mean they will automatically be a good 'fit.'
Questions to ask them may be such as: "What type of therapy, or therapy style do you employ, where did you do your clinical training, do you work with a lot of clients that have my issues, are you comfortable working with people that have my issues, etc."
A mistake that clients will sometimes make is when they feel their relationship with a therapist is not working out, or, is going nowhere, they just stop going.
Big Mistake. You don't show up for two or three sessions, the therapist can essentially just write you off their books. Whereas, if you talk it out with them and you still do not believe you can work with them, then ethically, they have to refer you to somebody else (if you ask them).
Another area that people in recovery sometimes get hung up on is the idea that they have to, or, only want to go a therapist that is in recovery themselves. While this may or may not be advantageous, I would be more concerned with their professional expertise and clinical training.
You want to talk to someone that has been through what you are going through, then go to a 12 Step Meeting and get a Sponsor.
I remember attending the annual Harvard Medical School/Cambridge Hospital, "Treating the Addictions' conference many years ago and hearing a presenter, Dr. Lance Dodes, author of the book, "The Heart of Addiction." It was his contention that a person in recovery seeking a therapist should be more concerned with that person's knowledge of individual therapy then just the addiction issue alone.
At that point of my addiction counseling career, my own thinking was heading in that direction. Another 13 years plus working inpatient psych/addiction has confirmed his contention to myself even more.
Sunday, October 25, 2009
The Six Month Rule
I remember when I was first getting started in the addiction counseling field back in the late eighties, early nineties, we had the "Six Month Rule."
The six month rule basically stated that a when a person first leaves the detox, it will take up to six months to tell if any other mental health issues are going on. So, they should go to meetings, get a sponsor, and work the "Steps."
We never took into consideration if they had any previous sober time, or, their entire mental health history when espousing this "rule."
Six months was, well, six months. Some people stated that this was to rule out the possibility of (to para-phrase the DSM), 'substance induced mood disorder.'
O.K. I get it. We also had the phrase, "no one ever died from lack of sleep." This may or may not be true. I have never spent the time to research this further. However, I can tell you that if you keep a person awake for three or four days, they can get pretty crazy, (to say the least).
So what is the thinking in the field now? I believe it was five or six years ago that I read an article by researchers at McLean & MGH that if a person is not a good historian, and/or they have not had any lengthy recovery time, such as six months to a year, then they should be followed by a qualified therapist (the term 'qualified' I will devote my next blog on) for a period of two weeks to two months on a weekly basis in order to see if a psych evaluation is warranted.
No longer is the "six month rule" held by many of us working in the field (especially those of us that have worked psych/addiction). The research of the past ten years shows us that the majority of the people that go into formal treatment 'do' have other issues going on. At the very least we understand that if a person needs a detoxification from their drug of choice, post-detox there is going to be some form of depression. From the simple, "I don't feel like myself," to, "I'm sleeping ten hours a night and I still wake up exhausted."
Another area of concern I have are those people in the field that still espouse the thinking, "They will never be able to work on such issues as trauma until they have six months clean." Research again demonstrates that the opposite is actually true. The National Institute on Drug Abuse (NIDA) had a study of woman with cocaine dependence and trauma issues. They split the women into two groups. While the two groups were detoxed at the same time the post-care set-up was quite different. One group post detox were given strictly addiction aftercare, the other group was given aftercare that included not only addiction, but trauma treatment.
The dropout rate was significantly lower for the group that was being given trauma as well as addiction aftercare treatment.
The six month rule basically stated that a when a person first leaves the detox, it will take up to six months to tell if any other mental health issues are going on. So, they should go to meetings, get a sponsor, and work the "Steps."
We never took into consideration if they had any previous sober time, or, their entire mental health history when espousing this "rule."
Six months was, well, six months. Some people stated that this was to rule out the possibility of (to para-phrase the DSM), 'substance induced mood disorder.'
O.K. I get it. We also had the phrase, "no one ever died from lack of sleep." This may or may not be true. I have never spent the time to research this further. However, I can tell you that if you keep a person awake for three or four days, they can get pretty crazy, (to say the least).
So what is the thinking in the field now? I believe it was five or six years ago that I read an article by researchers at McLean & MGH that if a person is not a good historian, and/or they have not had any lengthy recovery time, such as six months to a year, then they should be followed by a qualified therapist (the term 'qualified' I will devote my next blog on) for a period of two weeks to two months on a weekly basis in order to see if a psych evaluation is warranted.
No longer is the "six month rule" held by many of us working in the field (especially those of us that have worked psych/addiction). The research of the past ten years shows us that the majority of the people that go into formal treatment 'do' have other issues going on. At the very least we understand that if a person needs a detoxification from their drug of choice, post-detox there is going to be some form of depression. From the simple, "I don't feel like myself," to, "I'm sleeping ten hours a night and I still wake up exhausted."
Another area of concern I have are those people in the field that still espouse the thinking, "They will never be able to work on such issues as trauma until they have six months clean." Research again demonstrates that the opposite is actually true. The National Institute on Drug Abuse (NIDA) had a study of woman with cocaine dependence and trauma issues. They split the women into two groups. While the two groups were detoxed at the same time the post-care set-up was quite different. One group post detox were given strictly addiction aftercare, the other group was given aftercare that included not only addiction, but trauma treatment.
The dropout rate was significantly lower for the group that was being given trauma as well as addiction aftercare treatment.
Thursday, October 22, 2009
LADC/CADAC Eligible...????????
Over the course of the past several months, I have encountered this phrase more than once when inquiring about the counseling staff at various treatment facilties where I have interviewed for potential leadership positions.
Hmmm, something seems amiss to me here. I have yet to interview at facilities where they used such phrases as, "LICSW" or "LMHC" eligible.
So why with addiction counselors is it o.k. that they are 'eligible' and not LADC's or CADAC's before being granted a position?
Up until June 25th of this year I was working at the Somerville Hospital ATU where all of us on the counseling staff were LADC's and CADAC's. As a matter of fact, several of us had Masters degrees in counseling as well.
As a member of the Consumer Advisory Board at the Bureau of Substance Abuse Services, at the Department of Public Health, I broached this topic several months ago. Essentially, the answer was this is the way it has always been done. In part, I can understand this from the origin of addiction counselors. Usually, those entering this field were in recovery (or recovered, depending upon their view)had put some clean time together, and decided to enter the field. The amount of time 'clean' greatly varied, from a couple of months, to several years.
Another possibility I dread thinking about is might this be an unspoken arrogance on the part of the bureaucracy, "They should be grateful to have a job."
As it stands now, programs have obtained public money for their treatment facilities without 'specifics' as to the counseling composition and make-up. Usually those that are eligible are going to school for the CADAC/LADC but not always. The other disciplines such as social work and mental health clinicians provide internships that may or may not be funded.
In these situations the interns are being supervised by people on staff that "do" have the certifications and licensing. This is not necessarily true in the case of addiction counselors.
I see the last reason for this as strictly an economic one. Usually, those counseling in the public sector make half what those in the private and hospital sector do.
Having worked in both over the years I can attest to the fact that in the private and hospital sectors, most of the counselors that I have worked with had ten years plus of experience. Granted, this in and of itself is not a guarantee of peak efficiency and counseling skills. But would you rather have your loved one counseled by someone with years of experience that is licensed and/or credentialed, or, a person that has been working in the field for six months and may or may not be getting direct counseling supervision and continuing education?
Personally, I would like to see all treatment programs that run on public money, our tax dollars, be required to publicly file all positions within their organizations and what the funding is per individual positions (not lumped together by category).
Not too long ago, I was working with a patient that was detoxing. I looked at his chart and his last job was working as a 'counselor' at a state funded facility. I asked him how much time he had clean prior to taking the job, he told me six months. Are you in school for addiction counseling, no he replied. Then he told me the main reason that he was hired is that most of the patients coming into the facility where he worked were people that he had "run with" on the street and management figured he could 'settle' any issues that arose during the course of their stays.
Now there's a reason to hire someone, huh?
So long as this attitude remains in the field, addiction counselors will continue to be viewed as members of a para-profession.
Hmmm, something seems amiss to me here. I have yet to interview at facilities where they used such phrases as, "LICSW" or "LMHC" eligible.
So why with addiction counselors is it o.k. that they are 'eligible' and not LADC's or CADAC's before being granted a position?
Up until June 25th of this year I was working at the Somerville Hospital ATU where all of us on the counseling staff were LADC's and CADAC's. As a matter of fact, several of us had Masters degrees in counseling as well.
As a member of the Consumer Advisory Board at the Bureau of Substance Abuse Services, at the Department of Public Health, I broached this topic several months ago. Essentially, the answer was this is the way it has always been done. In part, I can understand this from the origin of addiction counselors. Usually, those entering this field were in recovery (or recovered, depending upon their view)had put some clean time together, and decided to enter the field. The amount of time 'clean' greatly varied, from a couple of months, to several years.
Another possibility I dread thinking about is might this be an unspoken arrogance on the part of the bureaucracy, "They should be grateful to have a job."
As it stands now, programs have obtained public money for their treatment facilities without 'specifics' as to the counseling composition and make-up. Usually those that are eligible are going to school for the CADAC/LADC but not always. The other disciplines such as social work and mental health clinicians provide internships that may or may not be funded.
In these situations the interns are being supervised by people on staff that "do" have the certifications and licensing. This is not necessarily true in the case of addiction counselors.
I see the last reason for this as strictly an economic one. Usually, those counseling in the public sector make half what those in the private and hospital sector do.
Having worked in both over the years I can attest to the fact that in the private and hospital sectors, most of the counselors that I have worked with had ten years plus of experience. Granted, this in and of itself is not a guarantee of peak efficiency and counseling skills. But would you rather have your loved one counseled by someone with years of experience that is licensed and/or credentialed, or, a person that has been working in the field for six months and may or may not be getting direct counseling supervision and continuing education?
Personally, I would like to see all treatment programs that run on public money, our tax dollars, be required to publicly file all positions within their organizations and what the funding is per individual positions (not lumped together by category).
Not too long ago, I was working with a patient that was detoxing. I looked at his chart and his last job was working as a 'counselor' at a state funded facility. I asked him how much time he had clean prior to taking the job, he told me six months. Are you in school for addiction counseling, no he replied. Then he told me the main reason that he was hired is that most of the patients coming into the facility where he worked were people that he had "run with" on the street and management figured he could 'settle' any issues that arose during the course of their stays.
Now there's a reason to hire someone, huh?
So long as this attitude remains in the field, addiction counselors will continue to be viewed as members of a para-profession.
Monday, September 21, 2009
Willyisms
The following are a few thoughts/observations from my years working in the addiction field:
Meet the Patient where they are at, NOT where you want them to be at
Often times the angriest patients are the ones in the most psychic pain
If you work in the addiction field and are in recovery yourself, keep your recovery program separate from your work
No one ever broke out because they stopped going to meetings, you need to help them look at what was going on or not going on just prior
You show me a person with ten plus detoxes, and I will show you a person that has other issues going on aside from substance abuse/chemical dependency
I’m glad you made it back to the detox…not everyone does…
12 Step is not the answer for everyone…
Always have a family meeting at the detox if the patient is willing…the apple does not fall very far from the tree (family dynamics)
You really do not see a lot of addicts/alcoholics sent to long-term inpatient psych facilities. That is where you find their friends and families( without substance abuse issues) that have been trying to make sense out of their loved ones’ use (without supports for themselves)
Said to a fellow counselor (in recovery) after hearing his interaction with a patient at the detox: ‘just because a course of action worked for you, that does not in and of itself mean it will work for the patient you are working with (are you hearing them or just waiting for them to stop talking so you can take on the Expert Role)’
And
‘Hey, are you a professional counselor, or, looking to be a sponsor for all the patients?’
And
‘Hey, nice boundaries, you better see them at the meeting on Saturday after they discharge?’
And
‘I’m concerned, (to a fellow counselor), from how you describe your life everything centers around work and meetings…nothing else’
‘When going to a new therapist/counselor, the first session should consist of the client interviewing the therapist with emphasis on their clinical and academic background, as it pertains to their issue(s)’
‘Clinical usually trumps Academic. However, Academic Greatly enhances Clinical’
‘There is no place for sympathy on the part of a therapist toward the client; empathy and compassion yes, sympathy, no’\
‘I believe every person that works as a therapist/counselor needs not only supervision, but ongoing therapy in order to stay healthy’
They are not ‘bad’ people trying to become ‘good’…They are ‘unhealthy’ people trying to become ‘healthy’
‘Psych is the bastard child of medicine, and, Addiction is the bastard child of Psych’
‘As I see it, the only benefit derived from the advent of HMO’s was the forcing together of Psych/Addiction, to the benefit of the client’
People in Psych, People in Addiction- Never have two groups had so much in common, yet been so separated by a common language (sort of churchillian, no?)
Layman’s definition of Bipolar I & Bipolar II: Bipolar I, “I am God,” Bipolar II, “I act like I am God”
No one grows up wanting to become an addict or alcoholic…I have yet to see it on a resume
Show me a person that espouses the view that addicts and alcoholics ‘want to be the way they are,’ and I will show you a person that more than likely, has rampant addiction issues in their families
Spirituality should not be confused with emotionality
The patient has to want recovery for themselves as much as, or greater than I want it for them
Hope without a plan of action is pretty much dead in the water
So long as my patient/client is breathing, change is possible
I wonder how many drug overdose deaths are suicides without a note
Sunday, September 20, 2009
Suboxone- "Great Tool for Early Recovery, or, Another Drug of Abuse."
Well, the answer is "yes" to both. Suboxone can be either a great tool for early recovery, or, another drug of abuse. What separates the distinction lies in the hands of those prescribing this drug. How so?
Those doctors that make their prescribing 'contingent' upon the patient complying with an 'actual' program of recovery tend to have the best results. Such successful programs include: random urines, a weekly suboxone support group, other outside support groups, one to one counseling, etc. Doctors however that prescribe the drug with an attitude of, "See you in two weeks," do a disservice to their patients. I know of several psychiatrists that come up here to the "Bay State" every couple of weeks from Connecticut to do precisely this. This is quality healthcare? I think not. What this is about is "money" and "money' only.
Those of us working in the addiction field are seeing a rise in the number of people that are 'chipping' (using their opioid of choice off an on). Use suboxone a few days, go off, use their opioid, then back on suboxone. Not to mention the fact that some are keeping half of their supply and selling the other half.
Ask your primary care physician how many hours he or she received in medical school on mental health and addiction. I am sure their answer will startle you. Yet, primary care doctors can receive "certification" to dispense suboxone without having any additional experience in psychiatry. Not a good idea.
Another problem that arose that Massachusetts has put a clamp-down on are the physicians that were double-dipping. They had patients in their regular practice that had MassHealth but they were not accepting this insurance for suboxone. Instead they were charging a cash "assessment" fee in addition to charges for the prescription. Ah, can't do that. Thank God the Attorney General stepped in. Ask anyone in the field, they can tell you who these doctors are/ were. As a matter of fact, ask the patients that were scammed by these immoral hacks.
The maufacturer of suboxone, Reckitt Benckiser, currently has a 1-800 number on their website (http://www.suboxone.com/), that one can access to find doctors in their area that provide suboxone and information on what types of insurance they accept.
Those doctors that make their prescribing 'contingent' upon the patient complying with an 'actual' program of recovery tend to have the best results. Such successful programs include: random urines, a weekly suboxone support group, other outside support groups, one to one counseling, etc. Doctors however that prescribe the drug with an attitude of, "See you in two weeks," do a disservice to their patients. I know of several psychiatrists that come up here to the "Bay State" every couple of weeks from Connecticut to do precisely this. This is quality healthcare? I think not. What this is about is "money" and "money' only.
Those of us working in the addiction field are seeing a rise in the number of people that are 'chipping' (using their opioid of choice off an on). Use suboxone a few days, go off, use their opioid, then back on suboxone. Not to mention the fact that some are keeping half of their supply and selling the other half.
Ask your primary care physician how many hours he or she received in medical school on mental health and addiction. I am sure their answer will startle you. Yet, primary care doctors can receive "certification" to dispense suboxone without having any additional experience in psychiatry. Not a good idea.
Another problem that arose that Massachusetts has put a clamp-down on are the physicians that were double-dipping. They had patients in their regular practice that had MassHealth but they were not accepting this insurance for suboxone. Instead they were charging a cash "assessment" fee in addition to charges for the prescription. Ah, can't do that. Thank God the Attorney General stepped in. Ask anyone in the field, they can tell you who these doctors are/ were. As a matter of fact, ask the patients that were scammed by these immoral hacks.
The maufacturer of suboxone, Reckitt Benckiser, currently has a 1-800 number on their website (http://www.suboxone.com/), that one can access to find doctors in their area that provide suboxone and information on what types of insurance they accept.
Sunday, September 13, 2009
The Closing of the Somerville Hospital Detox
It has been several months now since the closing of the detoxification unit at Somerville Hospital. My feelings regarding this are mixed at best. "What are these patients going to do now?" "Where will they go for detox?"
These questions and others I have been mulling over since the closure on June 25th. Now my thinking has really been focusing on the fact that we as a society, pretty much gave carte blanche approval to people going to detoxes, (once, twice, three, times, hell as many times as you need and/or want). We have institutionalized the whole concept of going to detoxes over the years.
Then come the issues with the people that I worked with, my fellow counselors. To some, the work at the detox unit was more than about having a job. It was their life, 24-7, 12 months a year, year after year after year. Their whole existence was what they did for work. Dedicated, well yea, maybe. Unhealthy, absolutely for sure. When I would hear a counselor say to a soon to be discharged patient, "I better see you at the meeting Saturday," I knew the boundary between professionalism and mutual relationship had been breached, (and we often wonder why the other disciplines often refer to we addiction counselors as a "quasi-profession"). How can one stay healthy without separation from their job? What I do for work is part of my identity, not the totality (at least not yet, and I pray never!)
Having started my career by working three years in an open detox unit, then working inpatient psych/addiction for more than 12 years, I was taken back by the lack of growth in the addiction arena when I first started working the open addiction unit at Somerville.
People with twenty, thirty detoxes under their belts were still being given the same information, "go to a meeting, get a sponsor; you have to have at least six months clean to tell if there are other issues going on." This six month rule was intended I guess to rule out "substance induced mood disorder back in the day. At the present time if a person is not a good historian or has not had periods of extended sobriety, research from McLeans and MGH suggests a person enter individual counseling on a weekly basis for a period of two weeks to two months to see if a psych evaluation is warrantied.
If additional research is correct, 90% of those with addiction issues get sober on their own, usually in their thirties without formal treatment of any kind; then does it not make sense that for the 10% that need treatment, the probability is high that there are other mental health issues going on as well? I think so. From my clinical experience, I have found this to be true more often than not.
So why in the typical detox setting are these possibilities not looked at further? To begin with, most of the counseling staff are in recovery themselves and some can have difficulty thinking in terms outside of their own 'story' and or life experiences. "If it worked for me, damn-it, it will work for them."
The second is due to the divide between DMH and DPH. Each is like a fiefdom unto themselves. The people that pay the biggest price here are those that are dual-diagnosed (chemical dependency with one or more mental health issues going on). DMH is for mental health issues, DPH takes care of the addiction issues; and never the twain shall meet.
A third issue is the actual structuring of detoxification programs. If I asked to get a psych consult for a patient on the unit, I would be asked if the patient was "suicidal or homicidal," if I answered no, then it was left to those planning the aftercare to make an 'appointment' for such services post-detox. Where is the continuity of care? Both issues are presenting, however we only 'deal' with the detox end here. This is quality health care? I think not!
Well, I have gone on for some time now and I feel the need for dinner. In my next blog I will be talking about Suboxone, "Great Tool for Early Recovery, or, Another Drug of Abuse."
These questions and others I have been mulling over since the closure on June 25th. Now my thinking has really been focusing on the fact that we as a society, pretty much gave carte blanche approval to people going to detoxes, (once, twice, three, times, hell as many times as you need and/or want). We have institutionalized the whole concept of going to detoxes over the years.
Then come the issues with the people that I worked with, my fellow counselors. To some, the work at the detox unit was more than about having a job. It was their life, 24-7, 12 months a year, year after year after year. Their whole existence was what they did for work. Dedicated, well yea, maybe. Unhealthy, absolutely for sure. When I would hear a counselor say to a soon to be discharged patient, "I better see you at the meeting Saturday," I knew the boundary between professionalism and mutual relationship had been breached, (and we often wonder why the other disciplines often refer to we addiction counselors as a "quasi-profession"). How can one stay healthy without separation from their job? What I do for work is part of my identity, not the totality (at least not yet, and I pray never!)
Having started my career by working three years in an open detox unit, then working inpatient psych/addiction for more than 12 years, I was taken back by the lack of growth in the addiction arena when I first started working the open addiction unit at Somerville.
People with twenty, thirty detoxes under their belts were still being given the same information, "go to a meeting, get a sponsor; you have to have at least six months clean to tell if there are other issues going on." This six month rule was intended I guess to rule out "substance induced mood disorder back in the day. At the present time if a person is not a good historian or has not had periods of extended sobriety, research from McLeans and MGH suggests a person enter individual counseling on a weekly basis for a period of two weeks to two months to see if a psych evaluation is warrantied.
If additional research is correct, 90% of those with addiction issues get sober on their own, usually in their thirties without formal treatment of any kind; then does it not make sense that for the 10% that need treatment, the probability is high that there are other mental health issues going on as well? I think so. From my clinical experience, I have found this to be true more often than not.
So why in the typical detox setting are these possibilities not looked at further? To begin with, most of the counseling staff are in recovery themselves and some can have difficulty thinking in terms outside of their own 'story' and or life experiences. "If it worked for me, damn-it, it will work for them."
The second is due to the divide between DMH and DPH. Each is like a fiefdom unto themselves. The people that pay the biggest price here are those that are dual-diagnosed (chemical dependency with one or more mental health issues going on). DMH is for mental health issues, DPH takes care of the addiction issues; and never the twain shall meet.
A third issue is the actual structuring of detoxification programs. If I asked to get a psych consult for a patient on the unit, I would be asked if the patient was "suicidal or homicidal," if I answered no, then it was left to those planning the aftercare to make an 'appointment' for such services post-detox. Where is the continuity of care? Both issues are presenting, however we only 'deal' with the detox end here. This is quality health care? I think not!
Well, I have gone on for some time now and I feel the need for dinner. In my next blog I will be talking about Suboxone, "Great Tool for Early Recovery, or, Another Drug of Abuse."
Subscribe to:
Posts (Atom)