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."
6 comments:
curious where you got that statistic that 90% of addicts get clean in their thirties on their own Willy? Let me know
In my experience over the past couple of years clients are not failing in treatment. Treatment is failing the client.
As far as comment that "Treatment is failing the client," I could not agree with you more. Unfortunately, it is not often that those of us working clinical get asked our opinions on the structure of treatment. I do not think this is a case of 'management' thinking we are capable or expert enough;I think it comes down to this just being the case and status quo for so long. Even health care needs to think outside of the box.
I meant to say, "I do not think this is a case of 'management' thinking we are NOT capable or expert enough (hmmm, Freudian? lol)
Diane that 90% statistic I have heard over the years from the "Big Guns" in the addiction field. However, in Gene Heymen's new book entitled, "Addiction: A Disorder of Choice," he cites several studies that over the years have come to this conclusion (I believe the studies were conducted by NIDA, Harvard, and Yale). If you like, I will go back through this book and find the quote(s). Better yet, I suggest buying this book. It definitely has caused a ruckus as of late in the field.
I am with Diane on this one;
Where *exactly* did you find the statistic that "90% of those with addiction issues get sober on their own, usually in their thirties without formal treatment of any kind"?
Which "Big Guns" have said this? In academia, it is hardly acceptable to make such claims and back them up by saying "Well, some other researchers whose names I will not mention have come to this conclusion by means on which I will not elaborate."
In the post above you state that you will find the appropriate quotes from a book you find worthwhile.
Where are they?
Post a Comment