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.
Saturday, October 31, 2009
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.
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