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

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.

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."