Man, I have to tell you, what people think they can get away with when they are actively using never ceases to amaze me.
I get a call from a case manager in Boston I have known for quite some time and the second she hears me say “hello,” she literally “loses it” on the phone laughing.
O.k. I think to myself, some people find me funny, but all I said was hello.
Finally she begins to wind-down. I’m like, ‘ah Nancy what is going on that’s so funny,’ and she loses it again!
Now I’m thinking, Nancy has finally gone over the edge; too many days working in our field.
‘Willy, oh my gawd! (Boston accent) You’ll never believe what happened a half an hour ago here! Unbelievable!
She begins to tell me the tale while trying to hold back her laughter. ‘You have heard of Whizzinators, right?
I say ‘yea I know what they are.’
For you un-informed folks, the ‘Whizzinator’ is an item that men can buy when they are trying to beat a urine tox screen test. They are a prosthetic device that looks like real male (ahem) genitals. The person trying to ‘beat’ the test will get a clean urine sample from someone, load the device with the sample, then pack it down the front of their pants prior to taking the test.
The people supervising the test watch them when they are giving the sample (not a job for me, no thank you).
Nancy continues when we were doing the screens this morning this young, freckled, fair skinned kid from ‘Southie’ got bagged using one.
So I say, ‘yea?’
“Willy! It was a black one!! She ‘loses’ it again laughing and this time so do I.
He told us afterwards it was the only one they had left. (raucous laughter)
Nancy, maybe he went ‘tanning?’ (laughter continues!)
Yup, it never ceases to amaze with what people think they can get away with.
Wednesday, November 7, 2012
Tuesday, November 6, 2012
It’s Their Fault!!
It’s his fault, her fault, the boss’s fault, my mother’s fault, my dad, my cousin, my dog…
Stop!! Enough of the ‘blame game.’ What was your role in all of this?
Well, they made me angry and upset. You mean you ‘allowed’ them, gave them ‘permission’ to get you angry and upset?
What is that supposed to mean? Quite frankly, when we say someone made us angry the fact of the matter is we allowed them and gave them permission to press our buttons.
Granted, easier said than done when dealing with family members and friends in particular who usually know all the right things to say (actually, the not so nice things to say) that can (if we allow them to) place us in a state of mind that can turn reactive and emotionally charged.
One healthy option is to utilize ‘positive confrontation’ when a person says something to try and get you to react.
It works like this. A person says something nasty to you. Instead of reacting, you can respond back with, ‘geez, what is going on with you that you would make that kind of a comment to me, I’m concerned about you.’
Or, ‘geez, you say you love me and care about me, then why would you say something like that? What is going on with you, I’m concerned.’
Usually by showing you are concerned rather than reacting back, ‘argument over before it can begin.’
Sometimes when working with people I will hear a client say, “You know, I am the way I am because of the environment I was raised in!”
Congratulations, you are halfway there. When you have that type of realization it gives you one of two choices; continue to ‘use it’ as your excuse for drug and alcohol use and behavior, or, work on those issues so you can come to resolution on them and move forward in a healthy manner.
If you are not quite there yet for ‘positive confrontation,’ then I suggest you just walk away from them and say nothing to fan their fire further.
Usually we do less harm by walking away then by reacting back.
Stop!! Enough of the ‘blame game.’ What was your role in all of this?
Well, they made me angry and upset. You mean you ‘allowed’ them, gave them ‘permission’ to get you angry and upset?
What is that supposed to mean? Quite frankly, when we say someone made us angry the fact of the matter is we allowed them and gave them permission to press our buttons.
Granted, easier said than done when dealing with family members and friends in particular who usually know all the right things to say (actually, the not so nice things to say) that can (if we allow them to) place us in a state of mind that can turn reactive and emotionally charged.
One healthy option is to utilize ‘positive confrontation’ when a person says something to try and get you to react.
It works like this. A person says something nasty to you. Instead of reacting, you can respond back with, ‘geez, what is going on with you that you would make that kind of a comment to me, I’m concerned about you.’
Or, ‘geez, you say you love me and care about me, then why would you say something like that? What is going on with you, I’m concerned.’
Usually by showing you are concerned rather than reacting back, ‘argument over before it can begin.’
Sometimes when working with people I will hear a client say, “You know, I am the way I am because of the environment I was raised in!”
Congratulations, you are halfway there. When you have that type of realization it gives you one of two choices; continue to ‘use it’ as your excuse for drug and alcohol use and behavior, or, work on those issues so you can come to resolution on them and move forward in a healthy manner.
If you are not quite there yet for ‘positive confrontation,’ then I suggest you just walk away from them and say nothing to fan their fire further.
Usually we do less harm by walking away then by reacting back.
Friday, November 2, 2012
You lost your sober time…
This is a statement I have heard a person say to someone that recently “broke out” by drinking and/or drugging again.
What a horrible, asinine, stupid remark to make to a person that started using again.
They lost their sober time? Are you kidding me?
No matter how much ‘clean’ time a person had, the fact that they “broke out” does not eradicate the time they were clean and the experience they garnered during that time.
I don’t care if it was a day, a week, a month, a year, or more.
When a person is in recovery they are doing healthy things, or at the very least, avoiding unhealthy things.
One of the suggestions I make to people that find themselves in this predicament is to think about what was working for them to a point, pull that to the present time, then think about what they can ‘add’ on to fortify their recovery.
If you do not anything different, you can expect the same result(s) again (or worse for that matter!).
For some people this can mean finding a good therapist, a trauma or grief group to join; maybe looking at that depression they have been battling for years.
But to say, “You lost your sober time,” is not very helpful at all.
Ever heard of empathy my friend?
What a horrible, asinine, stupid remark to make to a person that started using again.
They lost their sober time? Are you kidding me?
No matter how much ‘clean’ time a person had, the fact that they “broke out” does not eradicate the time they were clean and the experience they garnered during that time.
I don’t care if it was a day, a week, a month, a year, or more.
When a person is in recovery they are doing healthy things, or at the very least, avoiding unhealthy things.
One of the suggestions I make to people that find themselves in this predicament is to think about what was working for them to a point, pull that to the present time, then think about what they can ‘add’ on to fortify their recovery.
If you do not anything different, you can expect the same result(s) again (or worse for that matter!).
For some people this can mean finding a good therapist, a trauma or grief group to join; maybe looking at that depression they have been battling for years.
But to say, “You lost your sober time,” is not very helpful at all.
Ever heard of empathy my friend?
Friday, October 26, 2012
The Move...
Well it is Friday morning, at 6:45am. I am sitting in my office, this office, for the last time.
I’m not leaving the program. It is being relocated three blocks down the street from where we are now. Yesterday I packed up most of my ‘stuff’ for when the movers come by on Saturday. Still, I wanted to come in early today (we usually start around 9’).
Why so early? I don’t know, a lot of reasons I guess.
The first one being to spend some time with our house cat, “Parker” (or Pahhka, she is from Boston, lol). She is actually a neighborhood cat that spends more time with us than she does with her own family. Sometimes she even has slumber parties with those that live in our dorm. Great cat, about 18 pounds and a hunter that quite often brings us her ‘kills.’ Loving & Fierce. I like that.
Another reason is I am going to miss this office. Thirty foot by eight foot with two large windows that open. This time of the year I can glance out every so often to admire the beautiful foliage that lies outside these windows and take a big deep breath and smile.
My new office down the street is twelve by twelve with two small windows that you cannot open set about six feet off the ground. I don’t like change; most people don’t; even times when it can be for something healthier than the present situation they may find themselves in.
I am not looking forward at all to this change. I can take this change as another reason to push ahead with even greater effort on my own plans; teaching, lecturing, getting out on the national scene as a presenter on, “Substance Abuse & Co-Occurring Disorders – A Clinical & Personal Perspective.” I have several other offerings as well. I want to get to a point where I can live part of the year up in Nova Scotia.
Stress can beneficial if it motivates one for ‘change.’
Time to finish packing, get ready for groups, and, oh yea, find “Pahhka!”
I’m not leaving the program. It is being relocated three blocks down the street from where we are now. Yesterday I packed up most of my ‘stuff’ for when the movers come by on Saturday. Still, I wanted to come in early today (we usually start around 9’).
Why so early? I don’t know, a lot of reasons I guess.
The first one being to spend some time with our house cat, “Parker” (or Pahhka, she is from Boston, lol). She is actually a neighborhood cat that spends more time with us than she does with her own family. Sometimes she even has slumber parties with those that live in our dorm. Great cat, about 18 pounds and a hunter that quite often brings us her ‘kills.’ Loving & Fierce. I like that.
Another reason is I am going to miss this office. Thirty foot by eight foot with two large windows that open. This time of the year I can glance out every so often to admire the beautiful foliage that lies outside these windows and take a big deep breath and smile.
My new office down the street is twelve by twelve with two small windows that you cannot open set about six feet off the ground. I don’t like change; most people don’t; even times when it can be for something healthier than the present situation they may find themselves in.
I am not looking forward at all to this change. I can take this change as another reason to push ahead with even greater effort on my own plans; teaching, lecturing, getting out on the national scene as a presenter on, “Substance Abuse & Co-Occurring Disorders – A Clinical & Personal Perspective.” I have several other offerings as well. I want to get to a point where I can live part of the year up in Nova Scotia.
Stress can beneficial if it motivates one for ‘change.’
Time to finish packing, get ready for groups, and, oh yea, find “Pahhka!”
Thursday, October 18, 2012
Thoughts from the past several weeks...
Here I am half-way through the fall semester and knock-on-wood, everything is going relatively smooth. The students are energetic, engaging, and the time is ‘flying’ by.
Personally, the career is moving forward. I have been ‘talking’ for some time now about getting a web site up and running. Seemingly ‘good’ excuses have been greatly delaying this enterprise. Time is now; even if it is a rudimentary one just to get it going. My private practice has been growing and expanding, and there is the possibility of a regular radio show not too far off in the near future. Life is good.
Both my sons moved out at the beginning of the fall (yea! the water bill dropped by more than 50%!, lol). I have heard from friends that have gone through this phase of life that this can be a relationship ‘buster’ for many couples. The kids are gone, now where do we direct our energies? Many couples had not maintained an intimate relationship during those years; everything was for the ‘kids.’
I am very fortunate. Some evenings when Yvette and I are alone at home we just look at each other and start laughing. We don’t know why, we just do it. Don’t get me wrong, we love our boys. It is just that it has been so long since we only had to answer to each other. They are still in our lives, live close by, and drop in for dinner a few times a week. Sunday is game day with the boys and their friends (our ‘other’ kids) dropping in to watch the game – Good Time. Yvette loves cooking for the ‘crew’ and we all hang-out together. Nice, Really Nice.
Last week I went down to Connecticut to see my sister whose health is failing. I always feel strange returning to my old home town. I never returned to live there once I started college in Massachusetts (was there for 18 years – have been in Boston for the past 38 years).
It is either Stephanie Brown or Claudia Black; both excellent writers on the alcoholic/chaotic home that wrote, ‘you grow up, swear you will never become like them, you become just like them, then run away from home and become an orphan.’
Most of the patients I work with have siblings. If they grew up in a home with addiction/mental health issues I will often times hear that their siblings have scattered to the four winds; where is your sister these days – she’s in Alaska, where is your brother- oh, he’s in Texas.
People have said to me, “I know I have issues but staying around family just intensifies them. I’m crazy, but they are even crazier!” Call it a survival tactic if you will. How can a person deal with their ‘stuff’ if they are constantly surrounded by other family members and their ‘stuff? They can’t (at least not effectively in the beginning of treatment that is). This ‘survival’ mode can cause problems when dealing with the world outside of ‘family of origin.’ I will discuss this in more detail in a future blog.
So what else is going on? Well, I am wicked missing Nova Scotia. Vacation there this past summer has fueled my desire to be there more; the sense of community, the pace of life (there isn’t one, lol), the beauty to be found everywhere around one.
Maybe I’ll start a private treatment facility up there some day. If (when) I get more dates to expand my speaking engagements nationally and this becomes my primary source of income. Then one can live anywhere they like so long they have access to an airport that is relatively close by.
Well, time to go outside and admire the beautiful foliage.
a la prochaine…
Willy
Personally, the career is moving forward. I have been ‘talking’ for some time now about getting a web site up and running. Seemingly ‘good’ excuses have been greatly delaying this enterprise. Time is now; even if it is a rudimentary one just to get it going. My private practice has been growing and expanding, and there is the possibility of a regular radio show not too far off in the near future. Life is good.
Both my sons moved out at the beginning of the fall (yea! the water bill dropped by more than 50%!, lol). I have heard from friends that have gone through this phase of life that this can be a relationship ‘buster’ for many couples. The kids are gone, now where do we direct our energies? Many couples had not maintained an intimate relationship during those years; everything was for the ‘kids.’
I am very fortunate. Some evenings when Yvette and I are alone at home we just look at each other and start laughing. We don’t know why, we just do it. Don’t get me wrong, we love our boys. It is just that it has been so long since we only had to answer to each other. They are still in our lives, live close by, and drop in for dinner a few times a week. Sunday is game day with the boys and their friends (our ‘other’ kids) dropping in to watch the game – Good Time. Yvette loves cooking for the ‘crew’ and we all hang-out together. Nice, Really Nice.
Last week I went down to Connecticut to see my sister whose health is failing. I always feel strange returning to my old home town. I never returned to live there once I started college in Massachusetts (was there for 18 years – have been in Boston for the past 38 years).
It is either Stephanie Brown or Claudia Black; both excellent writers on the alcoholic/chaotic home that wrote, ‘you grow up, swear you will never become like them, you become just like them, then run away from home and become an orphan.’
Most of the patients I work with have siblings. If they grew up in a home with addiction/mental health issues I will often times hear that their siblings have scattered to the four winds; where is your sister these days – she’s in Alaska, where is your brother- oh, he’s in Texas.
People have said to me, “I know I have issues but staying around family just intensifies them. I’m crazy, but they are even crazier!” Call it a survival tactic if you will. How can a person deal with their ‘stuff’ if they are constantly surrounded by other family members and their ‘stuff? They can’t (at least not effectively in the beginning of treatment that is). This ‘survival’ mode can cause problems when dealing with the world outside of ‘family of origin.’ I will discuss this in more detail in a future blog.
So what else is going on? Well, I am wicked missing Nova Scotia. Vacation there this past summer has fueled my desire to be there more; the sense of community, the pace of life (there isn’t one, lol), the beauty to be found everywhere around one.
Maybe I’ll start a private treatment facility up there some day. If (when) I get more dates to expand my speaking engagements nationally and this becomes my primary source of income. Then one can live anywhere they like so long they have access to an airport that is relatively close by.
Well, time to go outside and admire the beautiful foliage.
a la prochaine…
Willy
Monday, October 1, 2012
Week 3 of Classes
Well the semester is rolling along now. After three weeks the students are settled in, I have deciphered their handwritten emails and phone numbers (lol), explained my expectations of them, and what their expectations should be of me.
The main course I teach is “Substance Abuse & Co-Occurring Disorders.” For a class of 55 (initially it was supposed to be 30-35) they are attentive and hopefully learning there is more to addiction than, ‘just don’t drink, get a sponsor, and go to meetings’ for those with co-occurring disorders.
I am NOT knocking 12 Step programs by any stretch of the imagination. Many dual-diagnosed people (myself included) initially found their sobriety in the traditional 12 Step programs and continue to utilize these as their base of recovery.
However, usually they are not enough in and of themselves. Dual Recovery Anonymous and Depression Bipolar Support Alliance meetings, one to one therapy, exercise, nutrition, and medication on a CASE by CASE basis if warranted. These can help to bridge the gap found more often than not between addiction and other mental health issues.
This fall I am teaching four courses, working days full-time in a Partial Hospitalization Program, expanding my private practice, working on getting my website up, finishing a book, etc., etc., etc.
Due to my hectic schedule it is more important than ever to stay vigilant regarding exercise and nutrition. I try to hit the gym every two days (preferable is every other day). When this is not possible I will at do at least a hundred push-ups (sets of twenty) and crunches during lunchtime in my office at work. Before classes I will take a nice twenty minute to half an hour walk around the campus. At UMASS-Boston this means down by Dorchester Bay; the smell of the ocean, IPod on with some classical music playing. I need to find those down moments even with a heavy schedule.
Hey, if I am not taking care of me, how can I realistically help others to help themselves? Otherwise, is that not the old “Do as I say, not as I do” philosophy?
Not really healthy, huh?
In the spring I am working towards presenting nationally on ‘Substance Abuse and Co-Occurring Disorders: 'A Clinical & Personal Perspective.' When I talk with addiction counselors from around the country I am amazed how many of them have never had any education on the co-occurring disorder piece. This to me is pretty scary.
Since my trip “Down East” to Nova Scotia this year with my wife I have been, and will continue to make time, for “Down Time.” Being with all her relatives and enjoying the way of life there I cannot wait to go back.
I am planning now for a couple of trips down there; one in the spring and then one in the summer. Also in the works may be a trip to Quebec City (Attention Sue, lol).
Today I am feeling fortunate and blessed; a family that loves and cares about each other, friends that can count on me as I can on them, and an ever expanding career.
Not too shabby, lol.
Peace, Out…for now.
The main course I teach is “Substance Abuse & Co-Occurring Disorders.” For a class of 55 (initially it was supposed to be 30-35) they are attentive and hopefully learning there is more to addiction than, ‘just don’t drink, get a sponsor, and go to meetings’ for those with co-occurring disorders.
I am NOT knocking 12 Step programs by any stretch of the imagination. Many dual-diagnosed people (myself included) initially found their sobriety in the traditional 12 Step programs and continue to utilize these as their base of recovery.
However, usually they are not enough in and of themselves. Dual Recovery Anonymous and Depression Bipolar Support Alliance meetings, one to one therapy, exercise, nutrition, and medication on a CASE by CASE basis if warranted. These can help to bridge the gap found more often than not between addiction and other mental health issues.
This fall I am teaching four courses, working days full-time in a Partial Hospitalization Program, expanding my private practice, working on getting my website up, finishing a book, etc., etc., etc.
Due to my hectic schedule it is more important than ever to stay vigilant regarding exercise and nutrition. I try to hit the gym every two days (preferable is every other day). When this is not possible I will at do at least a hundred push-ups (sets of twenty) and crunches during lunchtime in my office at work. Before classes I will take a nice twenty minute to half an hour walk around the campus. At UMASS-Boston this means down by Dorchester Bay; the smell of the ocean, IPod on with some classical music playing. I need to find those down moments even with a heavy schedule.
Hey, if I am not taking care of me, how can I realistically help others to help themselves? Otherwise, is that not the old “Do as I say, not as I do” philosophy?
Not really healthy, huh?
In the spring I am working towards presenting nationally on ‘Substance Abuse and Co-Occurring Disorders: 'A Clinical & Personal Perspective.' When I talk with addiction counselors from around the country I am amazed how many of them have never had any education on the co-occurring disorder piece. This to me is pretty scary.
Since my trip “Down East” to Nova Scotia this year with my wife I have been, and will continue to make time, for “Down Time.” Being with all her relatives and enjoying the way of life there I cannot wait to go back.
I am planning now for a couple of trips down there; one in the spring and then one in the summer. Also in the works may be a trip to Quebec City (Attention Sue, lol).
Today I am feeling fortunate and blessed; a family that loves and cares about each other, friends that can count on me as I can on them, and an ever expanding career.
Not too shabby, lol.
Peace, Out…for now.
Monday, September 17, 2012
Back to School…
Ahhh… I went back to school this past week. Not as a student; I have the privilege to be an educator at two university/colleges in my area. I teach in their addiction counseling education programs. The ages range from 18-88 (yes, 88!).
When I have a student that tells me he does not know how to use the internet or email system I refer him to our 88 year young “Wonder Guy.” At first, the student will be taken back. Then they usually will say something to the effect, ‘well, if he could learn how to, I guess I can to…’
I spent all morning Tuesday before my first evening class trying to locate my “Smurf” lunchbox. Alas, no luck. However, I did find an old “Transformer” one – good enough. So I packed it with a couple of Met-Rx bars, some hard-boiled eggs, and bottled water. Then off to work.
What I love the most is seeing minds open up: students discussing the material, their experiences, hopes, and aspirations. Most of the students are older, working, have family responsibilities, etc. My main course is, “Substance Abuse & Co-Occurring Disorders.” The majority of the students are in recovery themselves and the co-occurring disorder piece is new to most of them and they have had limited experience from either a clinical or academic viewpoint.
I give them ‘High Kudos’ for making the time to further educate themselves; not only to their benefit, but the population that they are either already serving, or, will be shortly.
When they arrive to my classroom I usually have the “Rolling Stones” or “AC/DC” cranked-up to welcome them. Many look around in amazement. “Hey, you’ve had a long day at work, come on in, have some coffee, kick your shoes off, and I will get this class going in a little while.”
I am not above them. I am there to educate them, answer their questions, sometimes debate with them, and always to share my humanness with them. It is all about ‘human to human.’ Not, I am above you, I am the teacher.
Yes, I am their teacher. This is a great responsibility and I take it seriously. But I educate with a comic flair due to my previous life in comedy. This helps to maintain their attention and enthusiasm (yes, I really am human, lol). The class is four hours long so I feel the need to make it fun as well as educational.
When people complete my course I always tell them my responsibility does not end there. I want them to feel free to call me anytime they have a question or want to run something past me.
I am very fortunate, I love what I do for work and people say it shows.
Truly Blessed.
Thursday, September 6, 2012
Addiction Guy – Back from Nova Scotia
After a refreshing week in Nova Scotia with my wife I have returned ‘locked & loaded’ for the fall semester of teaching.
I love Nova Scotia and I cannot believe the number of years that I let slip by before returning there for a vacation. There was no excuse really. My wife and her older brother own the home that was their parents.
Maybe it was the fact that the last time I went “Down East” was to bury my father-in-law whom I loved deeply. Or, maybe it was my thinking it was just too far to go. I don’t know.
What I do know however it that I truly love it there. It is the kind of environment that automatically ‘slams’ on the brakes for a person (yes, even me, lol).
Some friends are amazed that I do not go out of my mind from boredom with so little to actually do there; reading a couple of good books, going for walks on country roads, going out to enjoy such dishes as lobster Nova Scotia (which is lobster stuffed with lobster in a thick lobster bisque).
Bored? I think not. This is a place where I can charge the batteries and get some deep restorative peace and tranquility.
To start the day I would head to the local YMCA (Yarmouth) to work out. After that, anything we decided to do; which could include doing nothing.
Cousins are numerous and close by to where we stay. People down there just walk into each other’s homes as they are announcing their entrance. Some might find this practice a bit un-nerving. We don’t. They have a sense of community; something that back home can be missing when our pace of life gets steam-rolling along at a higher and higher level (if we allow it to).
It reminded me of growing up in the sixties when people in the neighborhood knew everyone in the neighborhood and would get together on a daily or at least a weekend basis.
I have a friend from college that lives outside of Quebec City. I love seeing her photos on her Facebook page; beautiful shots from around the rural area where she lives. Wonderful photos of sunsets and nature shots of all types and kind, of her friends and family. I can feel her joy of being alive.
I mention her because I love her attitude that life is about living, not just about working. It is revealed through her photos.
Yes, this fall will be busy. I will stay cognizant of the true need for ‘down time’ throughout the semester and schedule such time with my wife.
We both have the same need to get to the ocean from time to time…Life, Living…
I love Nova Scotia and I cannot believe the number of years that I let slip by before returning there for a vacation. There was no excuse really. My wife and her older brother own the home that was their parents.
Maybe it was the fact that the last time I went “Down East” was to bury my father-in-law whom I loved deeply. Or, maybe it was my thinking it was just too far to go. I don’t know.
What I do know however it that I truly love it there. It is the kind of environment that automatically ‘slams’ on the brakes for a person (yes, even me, lol).
Some friends are amazed that I do not go out of my mind from boredom with so little to actually do there; reading a couple of good books, going for walks on country roads, going out to enjoy such dishes as lobster Nova Scotia (which is lobster stuffed with lobster in a thick lobster bisque).
Bored? I think not. This is a place where I can charge the batteries and get some deep restorative peace and tranquility.
To start the day I would head to the local YMCA (Yarmouth) to work out. After that, anything we decided to do; which could include doing nothing.
Cousins are numerous and close by to where we stay. People down there just walk into each other’s homes as they are announcing their entrance. Some might find this practice a bit un-nerving. We don’t. They have a sense of community; something that back home can be missing when our pace of life gets steam-rolling along at a higher and higher level (if we allow it to).
It reminded me of growing up in the sixties when people in the neighborhood knew everyone in the neighborhood and would get together on a daily or at least a weekend basis.
I have a friend from college that lives outside of Quebec City. I love seeing her photos on her Facebook page; beautiful shots from around the rural area where she lives. Wonderful photos of sunsets and nature shots of all types and kind, of her friends and family. I can feel her joy of being alive.
I mention her because I love her attitude that life is about living, not just about working. It is revealed through her photos.
Yes, this fall will be busy. I will stay cognizant of the true need for ‘down time’ throughout the semester and schedule such time with my wife.
We both have the same need to get to the ocean from time to time…Life, Living…
Sunday, August 19, 2012
"Rampage In The Kitchen"
This incident happened many years ago when I was working in the ‘locked’ inpatient psych/addiction scene. We had a patient whom I shall Timmy throughout this story.
Timmy was a regular at our facility; as he was at many other facilities throughout the area since his early adolescent years. At this point in time, he was 33 years old.
When he arrived to us this time he had lost a substantial amount of weight. He was down to a svelte 400 hundred pounds. During a lengthy commitment to one of our state facilities he had shot up as high as 600 pounds. They decided at that point to more closely monitor his food intake (good idea huh?)
His primary diagnosis was schizophrenia coupled to recent episodes of binging and purging. He I.Q. had been tested out over the years to be that of an eight to ten year old; his behavior was indicative of this range.
Timmy liked to hang-out with me on the unit and tell me all his jokes and stories (he knew I was still performing on the comedy scene a couple of evenings a week). I would laugh heartily after almost every joke or story he would tell me; not so much due to the content, but rather for the way he would crack himself up!
At this particular hospital the patients would order their meals for the following day when they were having breakfast the day before.
I had come in to work a day shift on the morning of the incident (7am start). Breakfast usually arrived around 8:30.
On this particular morning the patients were pulling their trays from the food cart and heading into the dining room. Timmy had just sat down and had lifted the cover off the top of the tray when I could hear him in an uproar.
I raced over to him. Timmy what is the matter? Willy, I ordered Coco Puffs and they didn’t send them up! I told him I would call down to kitchen and have them sent up. He was annoyed but seemed satisfied with my response.
I went into the staff room and phoned down to the kitchen to request that “Coco Puffs” be delivered to our unit. They informed me that they were out but that they were expecting a shipment that afternoon so he would be able to have them the next morning for breakfast.
I had a feeling (and not a good one) of what was going to happen next when I went back to tell him the news. As I did so I could see his face get beat-red and he started to breath heavily. I’m sorry Timmy, I said to him. He did not respond he just kept staring at his tray.
As I walked back to the front desk area that is when all hell broke loose. Timmy had decided that if he could not have what he wanted for breakfast, then no one could have breakfast.
He jumped up and started racing around the dining area flipping over everyone else’s trays and knocking over tables and chairs. As the patients ran out of the dining room I knew I had to take some sort of action.
The dining area had three columns on the outside edge of the main area. Knowing his intellectual age level and his love of humor I did the following: I would jump out from behind a column and yell, ‘pick-a-boo,’ and wiggle my fingers at him with my thumbs in my ears then jump back behind the column. After about the third time doing this he stopped his rampage and he yelled to me, ‘Willy don’t make me laugh!’ After several more times doing this he began to laugh uncontrollably.
I figured it should be safe to enter the kitchen with him in that state of mind and it was. ‘Timmy, why don’t we go down to your room and talk for a while. What do you say? ‘O.k. Willy, we can do that.’
So ended the ‘rampage.’
I could not help chuckling later on that day thinking that for Timmy the Coco Puffs slogan in addition to, “I’m Coo-Coo for Coco Puffs,” could also be in his case, “I’m Coo-Coo WITHOUT Coco Puffs.”
Peace, Out
Timmy was a regular at our facility; as he was at many other facilities throughout the area since his early adolescent years. At this point in time, he was 33 years old.
When he arrived to us this time he had lost a substantial amount of weight. He was down to a svelte 400 hundred pounds. During a lengthy commitment to one of our state facilities he had shot up as high as 600 pounds. They decided at that point to more closely monitor his food intake (good idea huh?)
His primary diagnosis was schizophrenia coupled to recent episodes of binging and purging. He I.Q. had been tested out over the years to be that of an eight to ten year old; his behavior was indicative of this range.
Timmy liked to hang-out with me on the unit and tell me all his jokes and stories (he knew I was still performing on the comedy scene a couple of evenings a week). I would laugh heartily after almost every joke or story he would tell me; not so much due to the content, but rather for the way he would crack himself up!
At this particular hospital the patients would order their meals for the following day when they were having breakfast the day before.
I had come in to work a day shift on the morning of the incident (7am start). Breakfast usually arrived around 8:30.
On this particular morning the patients were pulling their trays from the food cart and heading into the dining room. Timmy had just sat down and had lifted the cover off the top of the tray when I could hear him in an uproar.
I raced over to him. Timmy what is the matter? Willy, I ordered Coco Puffs and they didn’t send them up! I told him I would call down to kitchen and have them sent up. He was annoyed but seemed satisfied with my response.
I went into the staff room and phoned down to the kitchen to request that “Coco Puffs” be delivered to our unit. They informed me that they were out but that they were expecting a shipment that afternoon so he would be able to have them the next morning for breakfast.
I had a feeling (and not a good one) of what was going to happen next when I went back to tell him the news. As I did so I could see his face get beat-red and he started to breath heavily. I’m sorry Timmy, I said to him. He did not respond he just kept staring at his tray.
As I walked back to the front desk area that is when all hell broke loose. Timmy had decided that if he could not have what he wanted for breakfast, then no one could have breakfast.
He jumped up and started racing around the dining area flipping over everyone else’s trays and knocking over tables and chairs. As the patients ran out of the dining room I knew I had to take some sort of action.
The dining area had three columns on the outside edge of the main area. Knowing his intellectual age level and his love of humor I did the following: I would jump out from behind a column and yell, ‘pick-a-boo,’ and wiggle my fingers at him with my thumbs in my ears then jump back behind the column. After about the third time doing this he stopped his rampage and he yelled to me, ‘Willy don’t make me laugh!’ After several more times doing this he began to laugh uncontrollably.
I figured it should be safe to enter the kitchen with him in that state of mind and it was. ‘Timmy, why don’t we go down to your room and talk for a while. What do you say? ‘O.k. Willy, we can do that.’
So ended the ‘rampage.’
I could not help chuckling later on that day thinking that for Timmy the Coco Puffs slogan in addition to, “I’m Coo-Coo for Coco Puffs,” could also be in his case, “I’m Coo-Coo WITHOUT Coco Puffs.”
Peace, Out
Tuesday, August 7, 2012
The Girl With The Basketball
I remembered her from a couple of previous stays at our detox. When she came into treatment I always wondered why she would have a basketball with her. After her assessment was done I decided to sit with her and listen to what she had been up to recently, and maybe ask a few questions of my own.
So Melissa, what brings you into detox this time, I asked her. “I guess two grams of heroin a day qualifies me for treatment, huh?” She then let out a slight chuckle. Yea, that’s a pretty good habit you’ve got going there, (or should I say quite an unhealthy habit).
What have you been up to besides the obvious, I asked her. She responded, “Just hanging around Boston, booting and shooting hoops.”
You know, the last couple of times you were in I meant to ask you, what’s up with always having a basketball with you? Usually opiate people just want to nod off after they boot. I could sense uneasiness before she answered. “When I’m high I like to shoot hoop all day at the playgrounds around Boston.” Why? “B-Ball lets me feel o.k. with myself and everything else.”
How long have you been doing that? “Since my high school days.” Did you play basketball in high school? “Yea, I was on the varsity squad from freshman year on.”
Where did you grow up, from your southern accent I can tell it wasn’t around The Boston area.
“I grew up in South Carolina.” “How did you end up in the Boston area?” “One of my teammates from college was from around here so I came back with her after graduation.
Then when my habit grew, she asked me to leave, I can’t say I blame her though.”
Teammates? So you played college ball? There was a pause on her part and then a silence that seemed like hours. The look on her face was distant, as if she were in another time and place. Then she responded, “Those were the best times. We were National Champions in 19--and 19--.” A slight smile came across her face, and then she looked down at the desk.
Part of me was questioning the validity of her statements. However, the longer I worked at the detox the more incredible the power of addiction became apparent to me. Never discount anything a patient says to you until you check it out.
What was family life like, I asked her. Her head came up from staring at the desk; she looked me right in the eye, and said, “Hell, a living fucking hell. My daddy use to like to tuck me in at night a little too much, if you know what I mean.” I just nodded my head; she didn’t have to explain anything further.
So what do you think Melissa, are you open to maybe a half-way house as part of your discharge plan this time? “I don’t know Willy, I don’t think I can take the rules and all the bullshit that goes with being in a half-way house.” Melissa, this is what, your third time here, it seems to me that you really don’t have anything to lose by trying a half-way house, huh?
“I don’t know,” she stated again. I’m thinking that a half-way house might give you a chance to work on your trauma issues in a safe supportive environment, right? I could sense her brain working through what I had just said to her. I was hoping that the fear of change would not sidetrack her.
I am still amazed after all the years I have in the field to see people not make changes due to their fears. They often times will stay in an unhealthy situation simply because they know what to expect, or, what not to expect from day to day. I will have XYZ amount of misery today but that’s what I expect. Sort of the certainty of uncertainty.
Melissa did go to a woman’s half-way house when she left us. To this day I do not know what became of her after that. I would like to think that she got herself squared away; maybe she is even coaching a woman’s basketball team somewhere.
By the way, I did check out her basketball background and son-of-a-gun, Melissa was on two National Championship NCAA teams in Women’s Basketball.
So Melissa, what brings you into detox this time, I asked her. “I guess two grams of heroin a day qualifies me for treatment, huh?” She then let out a slight chuckle. Yea, that’s a pretty good habit you’ve got going there, (or should I say quite an unhealthy habit).
What have you been up to besides the obvious, I asked her. She responded, “Just hanging around Boston, booting and shooting hoops.”
You know, the last couple of times you were in I meant to ask you, what’s up with always having a basketball with you? Usually opiate people just want to nod off after they boot. I could sense uneasiness before she answered. “When I’m high I like to shoot hoop all day at the playgrounds around Boston.” Why? “B-Ball lets me feel o.k. with myself and everything else.”
How long have you been doing that? “Since my high school days.” Did you play basketball in high school? “Yea, I was on the varsity squad from freshman year on.”
Where did you grow up, from your southern accent I can tell it wasn’t around The Boston area.
“I grew up in South Carolina.” “How did you end up in the Boston area?” “One of my teammates from college was from around here so I came back with her after graduation.
Then when my habit grew, she asked me to leave, I can’t say I blame her though.”
Teammates? So you played college ball? There was a pause on her part and then a silence that seemed like hours. The look on her face was distant, as if she were in another time and place. Then she responded, “Those were the best times. We were National Champions in 19--and 19--.” A slight smile came across her face, and then she looked down at the desk.
Part of me was questioning the validity of her statements. However, the longer I worked at the detox the more incredible the power of addiction became apparent to me. Never discount anything a patient says to you until you check it out.
What was family life like, I asked her. Her head came up from staring at the desk; she looked me right in the eye, and said, “Hell, a living fucking hell. My daddy use to like to tuck me in at night a little too much, if you know what I mean.” I just nodded my head; she didn’t have to explain anything further.
So what do you think Melissa, are you open to maybe a half-way house as part of your discharge plan this time? “I don’t know Willy, I don’t think I can take the rules and all the bullshit that goes with being in a half-way house.” Melissa, this is what, your third time here, it seems to me that you really don’t have anything to lose by trying a half-way house, huh?
“I don’t know,” she stated again. I’m thinking that a half-way house might give you a chance to work on your trauma issues in a safe supportive environment, right? I could sense her brain working through what I had just said to her. I was hoping that the fear of change would not sidetrack her.
I am still amazed after all the years I have in the field to see people not make changes due to their fears. They often times will stay in an unhealthy situation simply because they know what to expect, or, what not to expect from day to day. I will have XYZ amount of misery today but that’s what I expect. Sort of the certainty of uncertainty.
Melissa did go to a woman’s half-way house when she left us. To this day I do not know what became of her after that. I would like to think that she got herself squared away; maybe she is even coaching a woman’s basketball team somewhere.
By the way, I did check out her basketball background and son-of-a-gun, Melissa was on two National Championship NCAA teams in Women’s Basketball.
Friday, August 3, 2012
Thoughts from the Summah so Fahhh
Let’s see, another legislative session ended at the State House in Boston on July 31st and once again, LADC-I’s were not granted vendorship rights (third party billing).
I guess since the overdose deaths dropped to under 600 people last year, why would the Commonwealth want the people they license as addiction specialists, to join the other disciplines in the battle against overdose deaths. Only makes sense, right?
Many of my former students recently took the CADC exam. Congratulations to those that passed and to those that did not, try to not become disheartened. Many of you are discussing the formation of study groups before the next exam. Please let me know how I can help out. I am a firm believer that once a person completes a class with me, my obligation does not end there.
Some of you may have noticed that I never talk about where I work Monday through Friday.
I can’t. We were required by the company to sign a corporate agreement several months ago whereby we can never discuss where we work in any form of “social media.” It said something about dismemberment if we did.
That’s too bad. We do some wonderful work (patient’s comments; although I would not disagree with them, lol). The people I work with are tremendous. I would mention them by name, but, you know, I can’t.
I was thinking the other day if you had told me twenty-six years ago where I would be at this point of my life, I would have laughed at you. Amazing what a ‘little’ sobriety will do for a person.
Vacation time for my wife and I be here shortly; the last week in August. Usually we head Down East to Maine. This year we will go farther Down East to my wife’s family homestead in Nova Scotia. It has been way too long. A couple of good books, taking walks on country roads, having “Lobster Nova Scotia” (lobster stuffed with lobster), basically ‘kicking back.’ The environment is one that mentally ‘slams’ on the brakes for you.
I have been getting my course materials ready for the fall. I will be teaching four courses so like a good boy scout, ‘I will be prepared.’
I love teaching. Those of us that teach should be life-long students. Nothing worse than a tenured teacher that has been running with the same syllabus for twenty-years (ah, information changes or gets updated).
There are several projects I have been working on and this fall should see several of them come to fruition. Several career moves will be coming up in September also.
I am back into hard-core workouts again; hour and a-half on the trend-mill on an incline (pulsing 140-150) then crunches, then lifting (every other day). I also do 100 push-ups everyday (first set 40, then sets of 10 until I reach 100).
Well, that’s it for now. Later tonight I will be writing a story about an inpatient patient I had once that went a rampage until I injected a little levity into the situation.
As my oldest son would say,
Peace, Out
I guess since the overdose deaths dropped to under 600 people last year, why would the Commonwealth want the people they license as addiction specialists, to join the other disciplines in the battle against overdose deaths. Only makes sense, right?
Many of my former students recently took the CADC exam. Congratulations to those that passed and to those that did not, try to not become disheartened. Many of you are discussing the formation of study groups before the next exam. Please let me know how I can help out. I am a firm believer that once a person completes a class with me, my obligation does not end there.
Some of you may have noticed that I never talk about where I work Monday through Friday.
I can’t. We were required by the company to sign a corporate agreement several months ago whereby we can never discuss where we work in any form of “social media.” It said something about dismemberment if we did.
That’s too bad. We do some wonderful work (patient’s comments; although I would not disagree with them, lol). The people I work with are tremendous. I would mention them by name, but, you know, I can’t.
I was thinking the other day if you had told me twenty-six years ago where I would be at this point of my life, I would have laughed at you. Amazing what a ‘little’ sobriety will do for a person.
Vacation time for my wife and I be here shortly; the last week in August. Usually we head Down East to Maine. This year we will go farther Down East to my wife’s family homestead in Nova Scotia. It has been way too long. A couple of good books, taking walks on country roads, having “Lobster Nova Scotia” (lobster stuffed with lobster), basically ‘kicking back.’ The environment is one that mentally ‘slams’ on the brakes for you.
I have been getting my course materials ready for the fall. I will be teaching four courses so like a good boy scout, ‘I will be prepared.’
I love teaching. Those of us that teach should be life-long students. Nothing worse than a tenured teacher that has been running with the same syllabus for twenty-years (ah, information changes or gets updated).
There are several projects I have been working on and this fall should see several of them come to fruition. Several career moves will be coming up in September also.
I am back into hard-core workouts again; hour and a-half on the trend-mill on an incline (pulsing 140-150) then crunches, then lifting (every other day). I also do 100 push-ups everyday (first set 40, then sets of 10 until I reach 100).
Well, that’s it for now. Later tonight I will be writing a story about an inpatient patient I had once that went a rampage until I injected a little levity into the situation.
As my oldest son would say,
Peace, Out
Monday, July 30, 2012
Listen To The Patient...
I worked the inpatient psych/addiction scene for close to fourteen years before re-entering the detox and day treatment scene. This story is from those inpatient days.
Phil was a guy that would come in a couple of times a year. He would go off his anti-psychotic medication (stelazine) and then go on a two, three day bender drinking; which would cause him to lapse back into a state of paranoid schizophrenia.
This last time I worked with him was no different. It had been a beautiful summer and Phil thought it was too nice not to have a couple of beers. Well, this couple of beers escalated in a day or so, to drinking around the clock. We are talking a case a day plus. Per usual he had stopped his medication from day one of this episode.
By the time he came in he was in an ever increasing state of paranoia. He was convinced that the F.B.I. was watching him and they had tapped his phone; that is what the voices were telling him anyway. As was typical with a patient in this state of mind they cannot be convinced otherwise. I would acknowledge to him that I believed he was hearing voices; but that I was not.
I had built a good rapport with him over the years and he would seek me out on the unit when in the throes of another extreme episode of feeling paranoid.
Phil had been assigned to one of the new psychiatrists on the unit at the time. One that had been schooled in all the “new” anti-psychotic medications; hence he started Phil on one of these newer medications. When that first one did not work he tried another and after several days with no effect, a third.
In the meantime, Phil’s state of paranoia was ever increasing without relief. I could sense his agony going through this process. He had asked the doctor several times to go back on stelazine and the doctor kept putting him off on that being an option.
Finally after a week or so of this ‘experimentation,’ Phil was ready to explode.
I went to the doctor with this info and his response was, ‘if we need to, we will have a ‘show of force,’ and then restrain him if necessary.’ After this compassionate statement I let him know that those of us working the unit referred to a ‘show of force,’ as a ‘show of support,’ rather the arcane, negative, ‘show of force.’ He seemed put-off by my remark, too bad I thought. I am there for the patient, not for some pompous ass, using Phil as a guinea pig.
The next day Phil came to me, ‘please Willy tell him just to put me back on stelazine.’
So once again I went to the doctor to tell him of Phil’s desire to be started back on stelazine. He responded to my statement by saying, ‘stelazine had a lot of possible side-effects.’ Side effects doc, he has been on stelazine for ten years now, don’t you think he would have experienced them by now?
His first remark back to me was, ‘my name is Doctor XYZ, which I would appreciate if you would use in the future when addressing me. I made no comment back. The rest of the “doc’s” except this one wanted us to call them by their first names; they respected our observations, counselors and nurses alike. We were a ‘team’ that looked out for each other on the unit; we watched each other’s backs.
He went on to say that “he” knew what was best for Phil.
I had had enough. O.k. “Doctor XYZ,” let me tell you what is going to happen. Phil is riding the edge right now and it is only a matter of time before he goes off. I’m pretty sure you have noticed that he is quite a large man. Say, what, about six-foot four, roughly two hundred and sixty pounds. I’m fairly certain that when I go back and inform him that you do not plan on putting him back on stelazine, he is going to go after you…and you know, by the time we can get the Code team together…
“All right,” he said, “I will talk with him now about the ‘possibility’ of going back on stelazine.” He was perturbed at me; I didn’t care.
Well, he put Phil back on stelazine and he stabilized enough in three days to return home.
Listen to the patient…
Phil was a guy that would come in a couple of times a year. He would go off his anti-psychotic medication (stelazine) and then go on a two, three day bender drinking; which would cause him to lapse back into a state of paranoid schizophrenia.
This last time I worked with him was no different. It had been a beautiful summer and Phil thought it was too nice not to have a couple of beers. Well, this couple of beers escalated in a day or so, to drinking around the clock. We are talking a case a day plus. Per usual he had stopped his medication from day one of this episode.
By the time he came in he was in an ever increasing state of paranoia. He was convinced that the F.B.I. was watching him and they had tapped his phone; that is what the voices were telling him anyway. As was typical with a patient in this state of mind they cannot be convinced otherwise. I would acknowledge to him that I believed he was hearing voices; but that I was not.
I had built a good rapport with him over the years and he would seek me out on the unit when in the throes of another extreme episode of feeling paranoid.
Phil had been assigned to one of the new psychiatrists on the unit at the time. One that had been schooled in all the “new” anti-psychotic medications; hence he started Phil on one of these newer medications. When that first one did not work he tried another and after several days with no effect, a third.
In the meantime, Phil’s state of paranoia was ever increasing without relief. I could sense his agony going through this process. He had asked the doctor several times to go back on stelazine and the doctor kept putting him off on that being an option.
Finally after a week or so of this ‘experimentation,’ Phil was ready to explode.
I went to the doctor with this info and his response was, ‘if we need to, we will have a ‘show of force,’ and then restrain him if necessary.’ After this compassionate statement I let him know that those of us working the unit referred to a ‘show of force,’ as a ‘show of support,’ rather the arcane, negative, ‘show of force.’ He seemed put-off by my remark, too bad I thought. I am there for the patient, not for some pompous ass, using Phil as a guinea pig.
The next day Phil came to me, ‘please Willy tell him just to put me back on stelazine.’
So once again I went to the doctor to tell him of Phil’s desire to be started back on stelazine. He responded to my statement by saying, ‘stelazine had a lot of possible side-effects.’ Side effects doc, he has been on stelazine for ten years now, don’t you think he would have experienced them by now?
His first remark back to me was, ‘my name is Doctor XYZ, which I would appreciate if you would use in the future when addressing me. I made no comment back. The rest of the “doc’s” except this one wanted us to call them by their first names; they respected our observations, counselors and nurses alike. We were a ‘team’ that looked out for each other on the unit; we watched each other’s backs.
He went on to say that “he” knew what was best for Phil.
I had had enough. O.k. “Doctor XYZ,” let me tell you what is going to happen. Phil is riding the edge right now and it is only a matter of time before he goes off. I’m pretty sure you have noticed that he is quite a large man. Say, what, about six-foot four, roughly two hundred and sixty pounds. I’m fairly certain that when I go back and inform him that you do not plan on putting him back on stelazine, he is going to go after you…and you know, by the time we can get the Code team together…
“All right,” he said, “I will talk with him now about the ‘possibility’ of going back on stelazine.” He was perturbed at me; I didn’t care.
Well, he put Phil back on stelazine and he stabilized enough in three days to return home.
Listen to the patient…
Friday, July 20, 2012
“When You Leave Work – Leave Work.”
I am into my twenty-fifth year working in the psych/addiction field. Early on in my career, the title of this blog was not always easy to accomplish. As a matter of fact, it took several years before I was able to accomplish this on a regular basis. Even now, there are days that can be difficult to disengage from when I leave work at the end of the day; particularly if the transference/counter-transference game had been in play. Sometimes I will call my therapist on an exceptionally trying day to see if he has an open slot. The last thing I want to do is take the ‘day’ home with me.
In the early days of my career I would take it home every night. I would share the ‘joy’ of the day with my wife and her usual response would be, “I don’t know how you do it.” I would blame it on my parochial education with its emphasis on the ‘Seven Works of Mercy.’ (Bury the dead, visit the imprisoned, feed the hungry, shelter the homeless, clothe the naked, visit the sick, give drink to the thirsty). Damn those Nuns! I bought into the whole empathy, compassion deal. Oh well, guess there are worse things to espouse.
If I am not taking care of myself, how can I help others, to help themselves (do as I say, not as I do?) Keep taking work home with you and it is only a matter of time before ‘burn-out’ creeps in. I have seen this occur many times over the course of my years in the field; instances where really good clinicians have, well, ‘hit the wall’ and burned out.
I have especially seen this happen when the clinician is in recovery themselves. Slowly and insidiously the line becomes obscured between being in a professional relationship with the patient, and the relationship becoming a mutual one.
What they do for work becomes their ‘program.’ Good luck to those that are on this path. Burnout is more than likely right around the corner. I have heard clinicians say to a patient about to discharge, “I better see you at the meeting this Saturday!” Yup, I smell burn out coming; only a matter of time. Not to mention the line into co-dependency begins to rear its pervasive head.
“Well what am I supposed to do? There are always former patients at the meetings I go to." How about starting a ‘two-hat’ meeting? A ‘two-hat’ meeting is one that is attended only by those who work in the field and are in recovery themselves. These meetings are not listed. If you go to meetings that former patients attend, how can you maintain a professional role if they need to re-enter treatment? You cannot realistically do so.
Another way people ‘burn out’ is not taking care of themselves; nutrition, exercise, hobbies and outside interests.
Personally, I have been a roll the past several months preparing material for lecture, growing my social network, trying to finish up a book I have been writing, expanding my national contacts, writing this blog, etc.
Over the course of doing this I lost sight of nutrition and exercise. Before I knew it my weight shot up from 210 to 228, my waist went from 35’ to 40.’
I slammed the brakes on this a couple of weeks ago. I ‘make’ time in my schedule once again to hit the YMCA at least three times a week. As far as nutrition, I eat clean & healthy six days a week. Friday is my anything goes day. The reason for this is quite simple; I have no intention of going through the rest of my life without Italian pastries, pizza, ice cream, pasta, etc.
In the two weeks since re-starting a healthy regiment I have gone from 228 down to 220 and my waist is 37.’ Two, three weeks more, I should be back to my former self.
So long as I have been eating clean & healthy six out of the seven days of the week, and have been working out, this one day does not affect my weight.
Diet should be a way of eating for life; not a quick fix. Ask most people that have been on ‘quick’ weight loss diets and they will more often than not, tell of gaining back the original weight and then some once they stop the ‘diet.’
Another tool to help prevent burnout is having a therapist. I mentioned earlier that I have a therapist. Usually the first half of the session is about work; essentially a form of supervision. The second half is about my own issues that are outside the realm of work (not that I really have any, lol).
Once I leave work, I leave work. I am not my job. It is a ‘part’ of who I am, not the totality. Nor is it the ‘most’ important part of life, I reserve that designation for my family and friends.
Peace, Out
In the early days of my career I would take it home every night. I would share the ‘joy’ of the day with my wife and her usual response would be, “I don’t know how you do it.” I would blame it on my parochial education with its emphasis on the ‘Seven Works of Mercy.’ (Bury the dead, visit the imprisoned, feed the hungry, shelter the homeless, clothe the naked, visit the sick, give drink to the thirsty). Damn those Nuns! I bought into the whole empathy, compassion deal. Oh well, guess there are worse things to espouse.
If I am not taking care of myself, how can I help others, to help themselves (do as I say, not as I do?) Keep taking work home with you and it is only a matter of time before ‘burn-out’ creeps in. I have seen this occur many times over the course of my years in the field; instances where really good clinicians have, well, ‘hit the wall’ and burned out.
I have especially seen this happen when the clinician is in recovery themselves. Slowly and insidiously the line becomes obscured between being in a professional relationship with the patient, and the relationship becoming a mutual one.
What they do for work becomes their ‘program.’ Good luck to those that are on this path. Burnout is more than likely right around the corner. I have heard clinicians say to a patient about to discharge, “I better see you at the meeting this Saturday!” Yup, I smell burn out coming; only a matter of time. Not to mention the line into co-dependency begins to rear its pervasive head.
“Well what am I supposed to do? There are always former patients at the meetings I go to." How about starting a ‘two-hat’ meeting? A ‘two-hat’ meeting is one that is attended only by those who work in the field and are in recovery themselves. These meetings are not listed. If you go to meetings that former patients attend, how can you maintain a professional role if they need to re-enter treatment? You cannot realistically do so.
Another way people ‘burn out’ is not taking care of themselves; nutrition, exercise, hobbies and outside interests.
Personally, I have been a roll the past several months preparing material for lecture, growing my social network, trying to finish up a book I have been writing, expanding my national contacts, writing this blog, etc.
Over the course of doing this I lost sight of nutrition and exercise. Before I knew it my weight shot up from 210 to 228, my waist went from 35’ to 40.’
I slammed the brakes on this a couple of weeks ago. I ‘make’ time in my schedule once again to hit the YMCA at least three times a week. As far as nutrition, I eat clean & healthy six days a week. Friday is my anything goes day. The reason for this is quite simple; I have no intention of going through the rest of my life without Italian pastries, pizza, ice cream, pasta, etc.
In the two weeks since re-starting a healthy regiment I have gone from 228 down to 220 and my waist is 37.’ Two, three weeks more, I should be back to my former self.
So long as I have been eating clean & healthy six out of the seven days of the week, and have been working out, this one day does not affect my weight.
Diet should be a way of eating for life; not a quick fix. Ask most people that have been on ‘quick’ weight loss diets and they will more often than not, tell of gaining back the original weight and then some once they stop the ‘diet.’
Another tool to help prevent burnout is having a therapist. I mentioned earlier that I have a therapist. Usually the first half of the session is about work; essentially a form of supervision. The second half is about my own issues that are outside the realm of work (not that I really have any, lol).
Once I leave work, I leave work. I am not my job. It is a ‘part’ of who I am, not the totality. Nor is it the ‘most’ important part of life, I reserve that designation for my family and friends.
Peace, Out
Sunday, July 15, 2012
Thoughts on ‘Things’ I Find Maddening!
Many of you are aware of my “past life" as a comedy writer and stand-up comedian. My wife (of thirty-two years) occasionally reminds me when my comedic ego arises that “if you were that funny…you would still be doing it.”
Nice, real nice, lol. I hate her brutal honesty (not really).
I find it maddening when people say, “Have a nice day!” As George Carlin said, to paraphrase, ‘Maybe I have had ten nice days in a row and I just want to have a shitty one.’ Please, allow me to be in the space I am in, all right? It is up to me to determine what kind of a day I want to have. Am I not entitled to have the kind of day "I want?"
I find it maddening when I have to interact with people that are always ‘cheery.’ Everything is always “Wonderful!” In the meantime their house just burned down, a family member has an incurable disease, and they just learned that their son has a drug addiction. Ah, reality check please.
Jesus, what medication(s) are you on? I’ll have to contact my primary care physician that had sixteen hours in medical school on mental health and ‘get me some of that!’
If people do not want me to, or allow me to experience true sadness including downer days, how can I experience “True” happiness? Not the ‘plastic’ variety that our society often espouses as being correct & proper.
I find it maddening when the first question out of a patient’s mouth is, “How do I get on suboxone and SSDI/SSI?” On the same note, when patients are talking amongst themselves, coaching newbies on how to go about this, ‘you need to do this, this, and this.’ Then to compound this further, they brag about how they work under the ‘table’ to really maximize their profits!
I can remember when these ‘benefits’ were viewed as a temporary state of being and once a person had their substance abuse and mental health issues in order they would ‘get-off’ SSI or SSDI. It seems like this does not occur all that often anymore. Maddening, truly maddening.
I find it maddening when I see all the motivational books offered out there emphasizing how ‘their method’ is the answer to achieve “Happiness!” Especially a certain ‘Dr. DWD. If you know who I am talking about then you have probably bought one of his books; hence, making him really, really, happy (good work, lol).
Reminds me of all the “Self-help” books out there. To paraphrase another comedian, Steven Wright; ‘if you are into self-help, why would you feel the need to buy a book on self-help from SOMEONE ELSE?’
I find it maddening when people look at their therapist as almost a ‘status symbol.’ “Hey how long have you been seeing your therapist?” For ten years now. “Ten years, what are you working on?” Oh, nothing really, I just go there to talk about my week. “Talk about your week? What, you don’t have any close friends you could talk with?” Nice.
I find it maddening when people look down on alcoholics, addicts, and those with other mental health issues; well, until it is about one of their loved ones and their attitude suddenly changes to one of ‘caring.’
I find it maddening when people try to proselytize others to their religion and concept of “God.” I suggest they read Joseph Campbell’s “The Hero with a Thousand Faces,’ or, “The Power of Myth.” Then we can have dialogue. A person made the mistake the other day to ask me if, “I have found Jesus?” Being of comic bent my response was, “Wow, I didn’t realize he was missing! Have you called all the local area hospitals?”
Another time I kept having the same proselytizers’ ring my doorbell at least once a week for several months. Finally I had enough of this. The last time they came to my door…I answered it naked. Boy you should have seen them scamper off my porch in a hurry. “Hey, this is how God made, come back!”
Maybe my wife is right, good thing I left the comedy scene, huh?
I find it maddening when therapists and counselors believe that their method(s) are the only ones that a client or patient can benefit from; instead of individualizing treatment choices to meet their needs. Or, when a ‘Super’ counselor/therapist spends the whole session telling the patient/client what ‘worked’ for them. Good going, now you have set-up an ‘expectation within them that they have to do it your way. What happens if they can’t do it your way? Oh well, they have to keep trying I guess (Maybe you should be listening to “their” story, not telling yours).
These are a few of my maddening things (gosh, sounds like a line from a Julie Andrew’s song in the “Sound of Music” does it not? (Ah, for those of you old enough to remember the movie, lol).
So, I am just spouting off here and not being a part of the solution on these things I find maddening? No, I lecture, I teach, I advocate for change, I belong to organizations that foster change. That is what I do.
Oh, before I forget…
“Have A Nice Day!!!”
Peace, Out…for now
Thursday, July 12, 2012
"The Young Stripper"
From the moment I spotted her, something about her just did not fit in with our usual crowd at the detox. She looked, well, like a model, one that had come upon hard times that is. My guess based on her gaunt appearance was that she had been using cocaine and/or heroin (later my guess would be confirmed after reading her chart - both, plus alcohol). Most of the patients in our facility had multiple detoxes under their belts. If you averaged out the number of stays amongst the 28 patients that we held, usually the number would run between 10-20 stays per person.
She was young, nineteen I learned later that afternoon, and this was her first detox. Her name was Melissa and she had grown up in a wealthy, affluent suburb of Boston. After I checked in with the patients that I had been working with throughout the week, I decided to sit with her and listen to her story.
Melissa had attended a private high school in Boston and her father, a prominent Boston Physician, wanted her to go to an Ivy League School for either pre-law or pre-med. She was not interested in either however. Her passion was to found in the dramatic arts. As she expressed to me, the stage was everything to her. It made her feel alive and one with the world.
This caused great tension in her home as she finished her senior year in high school. Her mother was constantly caught between her and her father. She had applied to a University in New York for the Dramatic Arts and after receiving mail of her acceptance, was determined to attend. This increased the tension in the house with her father stating that he would not financially support her endeavor what-so-ever.
She told him that was fine by her. She had a half scholarship and would just get a part-time job once she was there for the remainder.
This is where the trouble began however.
Once she had settled into College that fall, she began to look for work. This proved not to be as easy as she had initially thought. After a month or so of looking with no luck, she began to get panicky. Her mother was sending her money behind her father’s back; this still did not cover all her expenses.
Then one day she happened to overhear a few of her new aspiring actress friends talking about dancing to help pay the bills. When she questioned them further, she realized that they were talking about exotic dancing, stripping. At first she was mortified but when they told her the type of money they were making, this faded away rather quickly with some rationalization on her part.
Unfortunately, like many women that initially enter the dancing profession, (I know some will question my choice of calling it a profession), she began to get caught up in the after-work lifestyle. She frowned upon having sexual relations with the customers which several of the ‘dancers’ did; partying with them was o.k. to make additional money however.
For Melissa it began innocently enough, (or so she thought), a couple of lines, a couple of drinks, that should help in keeping them coming back. She told me how she loved the attention of the men that watched her dance: she was in control, (or so she thought she later stated to me). These men were so different from her father. He was always criticizing her, always questioning her judgment. She felt like she could never do anything right in his eyes. Although these men looked at her lustily, it was positive attention in her eyes.
The lifestyle began to catch up with her. After several months of dancing she was finding it more difficult to get up in the morning for classes after late night partying.
Her studies began to suffer and the calls from her mother trying to persuade her to come home and re-think her future were beginning to wear on her. She understood without being told that her father was pressuring her mother to make these calls.
The stress and strain of school, dancing and partying at night, and the family issues were beginning to wear her down. At this point she began to snort heroin... When I asked her why heroin, she told me that people had told her that when you use heroin, you haven’t a care in the world, well, except getting more heroin that is.
She told me that she realized that booting heroin would be the next step in her addiction and she wanted to put the brakes on before hitting that level. She had taken a leave of absence from school and would live with a couple of girlfriends from High School while trying to put her life back together. She entertained thoughts of returning to college after some sobriety time.
The only person that knew she was at the detox was her mother, (or so she thought). I was working a Saturday night when there was a knock at our front door. It was a couple in their late forties. As I let them in the man turned to me and stated, “I am Doctor such-and-such, from the xyz hospital in Boston, and I demand that you bring my daughter Melissa out to me now!”
I looked at him directly and said, “Well, first of all, this isn’t xyz hospital in Boston. Secondly, all the people admitted here have to be of legal age to make the decision to be here. Thirdly, it’s their choice if they want to see or not see someone.”
“Therefore, before you further make an ass of yourself with your condescending attitude and bravado, I suggest you calm down and have a seat. Another outburst and I will have the police here in less than two minutes to escort you out.”
I looked at his wife who was crying at this point then back to him. “If your daughter is here, I will have to ask her first if she wants to see you.” He was about to speak and before he could do so, I spoke, “This is not a two way dialogue, think of it as a lecture, you are a guest in my house right now and my rules apply, not yours, understand?”
He gave me a slight head-nod while gritting his teeth.
I left them at the front desk and entered the main door of the unit to find Melissa. She had been near a window that allowed her to hear the whole conversation that we had been having by the front door. “What should I do”, she asked me. “Well, you may as well confront him here and get it over with. Besides, I will be right by your side and once the ‘chat’ is over, they will be leaving.” “Just don’t leave me with him to talk, O.K.?” “O.K.,” I replied back to her.
I brought her out to meet them, immediately she went to her mother and hugged her. She then turned towards to her father and gave him a downward eye nod. The father looked at me and asked for a room to meet with his daughter alone. I told him that Melissa did not want that. His affect began to grow angry, I reminded him that he was a guest in my house and to remember my previous offer to call the police.
He began by telling her he knew this would happen, if she had only listened to him, she wouldn’t be in her current predicament. She stood there eye-to-eye with him. When he finished, she started to speak.
If you had really cared about me and not your God-damn image, you might have supported me in whatever endeavor I chose. Yes, this predicament is of my own making, and you know what, the solution will also be of my own making, not yours! The father went on to tell her how he gave her everything a girl could possibly want. When he finished, she said, yes everything, except your time and your understanding, but then again, I guess you save that for your patients huh? Then she went on to wrap up the conversation by saying, “You know what, I really don’t care how my present situation has affected you and your image; I do feel horrible by how it has affected Mom though.
Melissa began to turn away but before doing so, she told her mother the visiting hour times and that she would prefer next time if she came alone. She then went through the main doors back into the detox unit.
The father went storming out of the detox while the mother stayed behind with me. She asked me, “How is Melissa doing?” I told her, “so far, so good.” The easy part is the physical detox I told her, the difficult part for Melissa will be to change the thinking and patterns of behavior that had made it seem o.k. to “use” as a solution for life’s issues.
A car horn outside started to beep several times. Melissa’s mother said, “I better be going or there will be a price to pay.” I told her, “Take It Easy, call me if you would like updates.” She gave me a smile of resignation and said, “Thank You,” then walked down the stairs and out the door to the waiting car.
Melissa decided to go to a half-way house rather than move in with friends from high school. She was determined and motivated to get back to life on a healthy track.
She was young, nineteen I learned later that afternoon, and this was her first detox. Her name was Melissa and she had grown up in a wealthy, affluent suburb of Boston. After I checked in with the patients that I had been working with throughout the week, I decided to sit with her and listen to her story.
Melissa had attended a private high school in Boston and her father, a prominent Boston Physician, wanted her to go to an Ivy League School for either pre-law or pre-med. She was not interested in either however. Her passion was to found in the dramatic arts. As she expressed to me, the stage was everything to her. It made her feel alive and one with the world.
This caused great tension in her home as she finished her senior year in high school. Her mother was constantly caught between her and her father. She had applied to a University in New York for the Dramatic Arts and after receiving mail of her acceptance, was determined to attend. This increased the tension in the house with her father stating that he would not financially support her endeavor what-so-ever.
She told him that was fine by her. She had a half scholarship and would just get a part-time job once she was there for the remainder.
This is where the trouble began however.
Once she had settled into College that fall, she began to look for work. This proved not to be as easy as she had initially thought. After a month or so of looking with no luck, she began to get panicky. Her mother was sending her money behind her father’s back; this still did not cover all her expenses.
Then one day she happened to overhear a few of her new aspiring actress friends talking about dancing to help pay the bills. When she questioned them further, she realized that they were talking about exotic dancing, stripping. At first she was mortified but when they told her the type of money they were making, this faded away rather quickly with some rationalization on her part.
Unfortunately, like many women that initially enter the dancing profession, (I know some will question my choice of calling it a profession), she began to get caught up in the after-work lifestyle. She frowned upon having sexual relations with the customers which several of the ‘dancers’ did; partying with them was o.k. to make additional money however.
For Melissa it began innocently enough, (or so she thought), a couple of lines, a couple of drinks, that should help in keeping them coming back. She told me how she loved the attention of the men that watched her dance: she was in control, (or so she thought she later stated to me). These men were so different from her father. He was always criticizing her, always questioning her judgment. She felt like she could never do anything right in his eyes. Although these men looked at her lustily, it was positive attention in her eyes.
The lifestyle began to catch up with her. After several months of dancing she was finding it more difficult to get up in the morning for classes after late night partying.
Her studies began to suffer and the calls from her mother trying to persuade her to come home and re-think her future were beginning to wear on her. She understood without being told that her father was pressuring her mother to make these calls.
The stress and strain of school, dancing and partying at night, and the family issues were beginning to wear her down. At this point she began to snort heroin... When I asked her why heroin, she told me that people had told her that when you use heroin, you haven’t a care in the world, well, except getting more heroin that is.
She told me that she realized that booting heroin would be the next step in her addiction and she wanted to put the brakes on before hitting that level. She had taken a leave of absence from school and would live with a couple of girlfriends from High School while trying to put her life back together. She entertained thoughts of returning to college after some sobriety time.
The only person that knew she was at the detox was her mother, (or so she thought). I was working a Saturday night when there was a knock at our front door. It was a couple in their late forties. As I let them in the man turned to me and stated, “I am Doctor such-and-such, from the xyz hospital in Boston, and I demand that you bring my daughter Melissa out to me now!”
I looked at him directly and said, “Well, first of all, this isn’t xyz hospital in Boston. Secondly, all the people admitted here have to be of legal age to make the decision to be here. Thirdly, it’s their choice if they want to see or not see someone.”
“Therefore, before you further make an ass of yourself with your condescending attitude and bravado, I suggest you calm down and have a seat. Another outburst and I will have the police here in less than two minutes to escort you out.”
I looked at his wife who was crying at this point then back to him. “If your daughter is here, I will have to ask her first if she wants to see you.” He was about to speak and before he could do so, I spoke, “This is not a two way dialogue, think of it as a lecture, you are a guest in my house right now and my rules apply, not yours, understand?”
He gave me a slight head-nod while gritting his teeth.
I left them at the front desk and entered the main door of the unit to find Melissa. She had been near a window that allowed her to hear the whole conversation that we had been having by the front door. “What should I do”, she asked me. “Well, you may as well confront him here and get it over with. Besides, I will be right by your side and once the ‘chat’ is over, they will be leaving.” “Just don’t leave me with him to talk, O.K.?” “O.K.,” I replied back to her.
I brought her out to meet them, immediately she went to her mother and hugged her. She then turned towards to her father and gave him a downward eye nod. The father looked at me and asked for a room to meet with his daughter alone. I told him that Melissa did not want that. His affect began to grow angry, I reminded him that he was a guest in my house and to remember my previous offer to call the police.
He began by telling her he knew this would happen, if she had only listened to him, she wouldn’t be in her current predicament. She stood there eye-to-eye with him. When he finished, she started to speak.
If you had really cared about me and not your God-damn image, you might have supported me in whatever endeavor I chose. Yes, this predicament is of my own making, and you know what, the solution will also be of my own making, not yours! The father went on to tell her how he gave her everything a girl could possibly want. When he finished, she said, yes everything, except your time and your understanding, but then again, I guess you save that for your patients huh? Then she went on to wrap up the conversation by saying, “You know what, I really don’t care how my present situation has affected you and your image; I do feel horrible by how it has affected Mom though.
Melissa began to turn away but before doing so, she told her mother the visiting hour times and that she would prefer next time if she came alone. She then went through the main doors back into the detox unit.
The father went storming out of the detox while the mother stayed behind with me. She asked me, “How is Melissa doing?” I told her, “so far, so good.” The easy part is the physical detox I told her, the difficult part for Melissa will be to change the thinking and patterns of behavior that had made it seem o.k. to “use” as a solution for life’s issues.
A car horn outside started to beep several times. Melissa’s mother said, “I better be going or there will be a price to pay.” I told her, “Take It Easy, call me if you would like updates.” She gave me a smile of resignation and said, “Thank You,” then walked down the stairs and out the door to the waiting car.
Melissa decided to go to a half-way house rather than move in with friends from high school. She was determined and motivated to get back to life on a healthy track.
Wednesday, July 11, 2012
"Stand Off At The Detox"
Weekends were usually laid back at the detox and this one was no exception. It had been a warm, beautiful, summer day when I came in to work the evening shift. After listening to report until around 3:30, it was time to check everything out around the detox.
On the weekends we ran with one counselor and one nurse (for 28 beds). Usually by late Friday afternoons we would have a full-house so additional staff would not be needed to do admissions. Once in a while we would have an open bed or two and we would do a couple of admissions however.
After getting supper out with the aid of a couple of patients that were waiting to get their beds at a half-way house, I kicked back in the main area of the detox to chat with a couple of them and watch the BoSox on the tube.
After a while I went down to the basement to check on the patient laundry. The counselors and the nurses were responsible for everything around the detox; from admissions, to doing the laundry, to making the beds, helping to serve meals, aftercare placement, etc.
When I came up from the basement, Margaret my nurse partner for the evening was nowhere to be found. I figured she was probably in the woman’s dorm chatting with the new female patient.
That morning we had gotten a new woman patient in from the local emergency room that had asked for detox. We had two rooms for the women; one was a four person room, the other, a two person room. This new admission was solo in the two person room.
These two women’s dorms were inside a larger dorm room that housed six of the sickest male patients and was overlooked by the med room window.
I went back to the main room and hung-out with several of the patients. It had not occurred to me to take a stroll through the detox to check-up on Margaret. We were an open-unit, meaning that a patient could ask to leave at any time. We would grant their request, after a chat to try and get them to re-consider their decision.
So there I was in the main room playing cards when Ray, one of our male patients came stumbling towards the table where I was. He was one of our patients that would be with us every other week from the local shelter. When he came in we would wait for him to sober up before doing his admission; usually the next day.
Ray had just come in that afternoon from the local shelter and was still exhaling the cheap vodka that he drank when hanging out with other alcoholics down by Harvard Square. “Hey, what’s up Ray,” I said as he came near the table.
He was trying to tell me something, but his speech was slurred and almost incoherent. He said something about Margaret. I said yea Ray, Margaret is working tonight, and he shook his head.
“What you don’t believe me?” I asked him. “No, no, no,” he said back to me.
Then what is it Ray? “Maagareeet wants meeee to get yoooou!” Suddenly, I noticed the seriousness of his eyes. Oh Christ I thought, “Where is she Ray?” “Sheeee’s in the Dooooorm.”
As I raced into the dorm that housed the women’s rooms I began to wonder how long had it been since I had last seen Margaret; probably a good hour or so.
Margaret called out to me in a firm, controlled voice, “Willy, can you come in here please.”
As I entered the dorm room Margaret had our new female admission from that morning pinned to the wall. I could see that Margaret’s left hand and arm were pinning the patient’s right arm and hand high up on the wall. In the hand of the patient was a razor blade.
I raced over to relieve Margaret’s hold on the woman’s arm. As I took over the pin, Margaret was able to carefully pry the blade away from her without any of us getting cut.
“Jesus Margaret, how long have you been in here holding her?” She figured it had been roughly an hour or so. "I kept calling out to you, but between the door of the room being almost closed, and the main door of the dorm being closed you couldn’t hear me." "I was finally able to get Ray up after yelling to him numerous times and told him to find you and get you in here."
"I came in here to give Sarah her medication and found her about to cut herself, she jumped up and told me not to try and stop her or she would cut me also. That’s when I pinned her to the wall."
Margaret was a strong woman, but this patient was also. As Margaret came down from her adrenaline rush, she was exhausted. We became much closer after this incident. We also started to check in with each other much more frequently when working shifts together, about every ten to fifteen minutes.
We called the hospital we were affiliated with and Sarah was transferred to their inpatient psych unit. Being an open unit we would not have been able to provide her with the supervision and help that a case like hers required.
This could have turned into a really ugly incident. Thank God for my little stumbling buddy Ray. Drunk or not, he knew he had to get me to help Margaret.
On the weekends we ran with one counselor and one nurse (for 28 beds). Usually by late Friday afternoons we would have a full-house so additional staff would not be needed to do admissions. Once in a while we would have an open bed or two and we would do a couple of admissions however.
After getting supper out with the aid of a couple of patients that were waiting to get their beds at a half-way house, I kicked back in the main area of the detox to chat with a couple of them and watch the BoSox on the tube.
After a while I went down to the basement to check on the patient laundry. The counselors and the nurses were responsible for everything around the detox; from admissions, to doing the laundry, to making the beds, helping to serve meals, aftercare placement, etc.
When I came up from the basement, Margaret my nurse partner for the evening was nowhere to be found. I figured she was probably in the woman’s dorm chatting with the new female patient.
That morning we had gotten a new woman patient in from the local emergency room that had asked for detox. We had two rooms for the women; one was a four person room, the other, a two person room. This new admission was solo in the two person room.
These two women’s dorms were inside a larger dorm room that housed six of the sickest male patients and was overlooked by the med room window.
I went back to the main room and hung-out with several of the patients. It had not occurred to me to take a stroll through the detox to check-up on Margaret. We were an open-unit, meaning that a patient could ask to leave at any time. We would grant their request, after a chat to try and get them to re-consider their decision.
So there I was in the main room playing cards when Ray, one of our male patients came stumbling towards the table where I was. He was one of our patients that would be with us every other week from the local shelter. When he came in we would wait for him to sober up before doing his admission; usually the next day.
Ray had just come in that afternoon from the local shelter and was still exhaling the cheap vodka that he drank when hanging out with other alcoholics down by Harvard Square. “Hey, what’s up Ray,” I said as he came near the table.
He was trying to tell me something, but his speech was slurred and almost incoherent. He said something about Margaret. I said yea Ray, Margaret is working tonight, and he shook his head.
“What you don’t believe me?” I asked him. “No, no, no,” he said back to me.
Then what is it Ray? “Maagareeet wants meeee to get yoooou!” Suddenly, I noticed the seriousness of his eyes. Oh Christ I thought, “Where is she Ray?” “Sheeee’s in the Dooooorm.”
As I raced into the dorm that housed the women’s rooms I began to wonder how long had it been since I had last seen Margaret; probably a good hour or so.
Margaret called out to me in a firm, controlled voice, “Willy, can you come in here please.”
As I entered the dorm room Margaret had our new female admission from that morning pinned to the wall. I could see that Margaret’s left hand and arm were pinning the patient’s right arm and hand high up on the wall. In the hand of the patient was a razor blade.
I raced over to relieve Margaret’s hold on the woman’s arm. As I took over the pin, Margaret was able to carefully pry the blade away from her without any of us getting cut.
“Jesus Margaret, how long have you been in here holding her?” She figured it had been roughly an hour or so. "I kept calling out to you, but between the door of the room being almost closed, and the main door of the dorm being closed you couldn’t hear me." "I was finally able to get Ray up after yelling to him numerous times and told him to find you and get you in here."
"I came in here to give Sarah her medication and found her about to cut herself, she jumped up and told me not to try and stop her or she would cut me also. That’s when I pinned her to the wall."
Margaret was a strong woman, but this patient was also. As Margaret came down from her adrenaline rush, she was exhausted. We became much closer after this incident. We also started to check in with each other much more frequently when working shifts together, about every ten to fifteen minutes.
We called the hospital we were affiliated with and Sarah was transferred to their inpatient psych unit. Being an open unit we would not have been able to provide her with the supervision and help that a case like hers required.
This could have turned into a really ugly incident. Thank God for my little stumbling buddy Ray. Drunk or not, he knew he had to get me to help Margaret.
Friday, July 6, 2012
The Young Iron Worker
This case is back from when I was beginning in the field of addiction in the early nineties.
Paul (as I shall call him throughout this story) was a twenty-five year old iron worker that had picked up a nasty cocaine/alcohol habit. He came to us in need of detox and had been referred by his E.A.P. (employee assistance program).
This combination was quite common at the time. I had observed many of my friends on the comedy scene with this combo back in the eighties; coke, do your set, come off stage, drink your way down. This would go on some nights two or three times; especially weekend gigs with multiple shows. We would joke that the last one to do coke would be the designated driver (not that funny when I look back now).
I digress however, back to my story.
Paul at the time was one of the younger patients. In the early nineties it was extremely rare to have a patient under Paul’s age. Most of the patients in those days were in their thirties; old timers were people in their mid to late forties (my how times have changed).
During the course of his assessment it was decided that I would be his counselor.
He was upset for many reasons; his job was on the line, his family was upset with him, his wife of three years told him to leave and was undecided if she would allow him back.
So here he was, in the detox, not knowing what lay ahead of him, and feeling totally despondent about his current plight.
My main theme with him was that by coming into detox he had slammed the brakes on his addictions and that little by little he could work his way out of his predicament. I told him to “Hang in there.”
Paul was the type of patient that as his counselor I never had to prompt him in groups to participate or ask questions. He was open to any and all suggestions. When AA commitments came in the evening he could be found chatting with the group before and after the meetings. He spent his free time reading the “Big Book” of AA and calling the people he had met from the commitments that had come in to speak.
Then one day the ‘boom’ dropped on him. The bell rang down at the front door of the detox. As I opened the door there in front of me was a constable (not too hard to tell by his badge on the front of his shirt). “Good afternoon fine Sir,” I said, “how may I help you?”
“I’m here to serve a restraining order to a Mr. XYZ” (my patient Paul).
“May I come in? He asked. I responded, “Actually, no you can’t.” He seemed a bit put-off, by my remark. “We have to protect the privacy of our patients; I can’t even tell you if he is here or not.”
“His wife told me he was here,” he informed me. I responded, “Well that is interesting but the fact is, he could be here, he could have been here and left, I just don’t know.”
Before he could respond I fired back at him, “look, this is what I can do. I will go back inside and if that person is here, which I will have to check on first to see if he is, I will tell him of your presence here at the front door and suggest he meet with you.”
“Is this o.k. with you?” He looked at me and muttered, “Do I have a choice?” I responded with, “ah, no you don’t.”
Going back inside I found Paul and explained the situation to him. He went into shock, “a restraining order…how could she?”
I suggested before we try to tackle that question why don’t we go to the front door together and get the restraining order; which we did.
Essentially, the restraining order was based on her fear of him when he was using. He admitted that often times especially when coming down from cocaine he could become verbally abusive and start throwing stuff around.
Try to look at this as a chance, an opportunity, to work on yourself I suggested to him. He did not like hearing that but accepted that it was probably the best thing for him to do.
The next day he came to me after he had made a phone call to a new AA friend. Have you heard of the XYZ halfway house? I told him yes and that it had a great reputation. He said, “Well, I would like to get an interview there.” I told him I would gladly make the phone call to set-up an interview.
He went on the interview the following week and was accepted. He was on a two week wait list. In those days we had four beds at the detox that people could use while waiting for their placement (those days are long gone unfortunately), as long as they helped out around the detox.
During the wait he went to court to see if his wife would file to have the restraining order extended. Upon her learning of his plans to attend a six month program she decided not to request a continuance of the restraining order.
She made no promises however that they would get back together again upon his completion of the program. He understood. “Regardless of what happens between us, I need to take care of business.”
The time came for him to leave for the halfway house. I bade him farewell and good luck, emphasizing how much he had worked on himself and suggested he keep working as hard on himself as he did during his stay with us.
He thanked me and the rest of the staff and left to a waiting taxi.
Usually, after people leave the detox we seldom know what happens to them unless they return again for our services.
Several years after Paul left us I was with my wife at a city wide block party when I noticed three people walking towards us; a young couple and an older woman.
The man spoke first, “Willy, how are you man!” I took a closer look, “Paul, how the heck are you?” He was beaming, “doing great.” He had graduated from the halfway house, and was in good standing with his union. “Willy, I would like you to meet my wife and mother-in-law.” Now I found myself ‘beaming.’
We spoke a couple of minutes longer and then parted ways. As they turned and started to walk away I could hear his wife ask him, “Who was that?” He told her, “That was the guy who told me to hang in there…”
Paul (as I shall call him throughout this story) was a twenty-five year old iron worker that had picked up a nasty cocaine/alcohol habit. He came to us in need of detox and had been referred by his E.A.P. (employee assistance program).
This combination was quite common at the time. I had observed many of my friends on the comedy scene with this combo back in the eighties; coke, do your set, come off stage, drink your way down. This would go on some nights two or three times; especially weekend gigs with multiple shows. We would joke that the last one to do coke would be the designated driver (not that funny when I look back now).
I digress however, back to my story.
Paul at the time was one of the younger patients. In the early nineties it was extremely rare to have a patient under Paul’s age. Most of the patients in those days were in their thirties; old timers were people in their mid to late forties (my how times have changed).
During the course of his assessment it was decided that I would be his counselor.
He was upset for many reasons; his job was on the line, his family was upset with him, his wife of three years told him to leave and was undecided if she would allow him back.
So here he was, in the detox, not knowing what lay ahead of him, and feeling totally despondent about his current plight.
My main theme with him was that by coming into detox he had slammed the brakes on his addictions and that little by little he could work his way out of his predicament. I told him to “Hang in there.”
Paul was the type of patient that as his counselor I never had to prompt him in groups to participate or ask questions. He was open to any and all suggestions. When AA commitments came in the evening he could be found chatting with the group before and after the meetings. He spent his free time reading the “Big Book” of AA and calling the people he had met from the commitments that had come in to speak.
Then one day the ‘boom’ dropped on him. The bell rang down at the front door of the detox. As I opened the door there in front of me was a constable (not too hard to tell by his badge on the front of his shirt). “Good afternoon fine Sir,” I said, “how may I help you?”
“I’m here to serve a restraining order to a Mr. XYZ” (my patient Paul).
“May I come in? He asked. I responded, “Actually, no you can’t.” He seemed a bit put-off, by my remark. “We have to protect the privacy of our patients; I can’t even tell you if he is here or not.”
“His wife told me he was here,” he informed me. I responded, “Well that is interesting but the fact is, he could be here, he could have been here and left, I just don’t know.”
Before he could respond I fired back at him, “look, this is what I can do. I will go back inside and if that person is here, which I will have to check on first to see if he is, I will tell him of your presence here at the front door and suggest he meet with you.”
“Is this o.k. with you?” He looked at me and muttered, “Do I have a choice?” I responded with, “ah, no you don’t.”
Going back inside I found Paul and explained the situation to him. He went into shock, “a restraining order…how could she?”
I suggested before we try to tackle that question why don’t we go to the front door together and get the restraining order; which we did.
Essentially, the restraining order was based on her fear of him when he was using. He admitted that often times especially when coming down from cocaine he could become verbally abusive and start throwing stuff around.
Try to look at this as a chance, an opportunity, to work on yourself I suggested to him. He did not like hearing that but accepted that it was probably the best thing for him to do.
The next day he came to me after he had made a phone call to a new AA friend. Have you heard of the XYZ halfway house? I told him yes and that it had a great reputation. He said, “Well, I would like to get an interview there.” I told him I would gladly make the phone call to set-up an interview.
He went on the interview the following week and was accepted. He was on a two week wait list. In those days we had four beds at the detox that people could use while waiting for their placement (those days are long gone unfortunately), as long as they helped out around the detox.
During the wait he went to court to see if his wife would file to have the restraining order extended. Upon her learning of his plans to attend a six month program she decided not to request a continuance of the restraining order.
She made no promises however that they would get back together again upon his completion of the program. He understood. “Regardless of what happens between us, I need to take care of business.”
The time came for him to leave for the halfway house. I bade him farewell and good luck, emphasizing how much he had worked on himself and suggested he keep working as hard on himself as he did during his stay with us.
He thanked me and the rest of the staff and left to a waiting taxi.
Usually, after people leave the detox we seldom know what happens to them unless they return again for our services.
Several years after Paul left us I was with my wife at a city wide block party when I noticed three people walking towards us; a young couple and an older woman.
The man spoke first, “Willy, how are you man!” I took a closer look, “Paul, how the heck are you?” He was beaming, “doing great.” He had graduated from the halfway house, and was in good standing with his union. “Willy, I would like you to meet my wife and mother-in-law.” Now I found myself ‘beaming.’
We spoke a couple of minutes longer and then parted ways. As they turned and started to walk away I could hear his wife ask him, “Who was that?” He told her, “That was the guy who told me to hang in there…”
Thursday, June 28, 2012
The Vietnam Vet
Jonathan was one of our regulars; he had well over fifty admissions since coming home from Vietnam in 1970. He was another casualty from a war that we are still trying to understand and heal from. When he came back he had gotten married to his High School sweetheart who was a nurse at a local hospital, and had tried to settle down.
After a couple of years of heavy drinking and bouncing from job to job his life began to fall apart. First his wife left him, then his drinking burned out his family and he ended up homeless, living in the shelters around Boston.
He was a quiet, polite guy who always helped out around the detox. One of our counselors at the time was a Vietnam Vet who had also served in the Marine Corps, “In Country,” as Jonathan had.
Jonathan would talk to him often. However, if the topic of Vietnam came up he would give a little smile then walk away. He would refuse to discuss any aftercare plans that included programs with the VA. There were benefits available to him, but he wanted nothing to do with them. So he lived back and forth from the shelter to the detox.
At this point in my career I often worked overnight shifts a couple of times a month. On one of these nights I had just come back upstairs from doing patient laundry in the basement. Jonathan was sitting at a desk where we often did admissions having a cup of coffee and a cigarette. It was about 3’ in the morning. Patients often who were detoxing would get up in the middle of the night for coffee and a smoke. We never shoo’d them back to bed like many facilities would do.
There is something to be said for sitting with a patient at this time of the morning. They have just gotten up and the alcoholic defenses one would normally encounter in the daytime were not present. This was the first time that I had such an experience, but it would not be the last.
As I sat there with him, I watched as he stared off into the distance, swirls of blue smoke drifting towards the ceiling. After several minutes, I made the remark to him, “Geez Jon, it feels like you are not even here.” He took another long drag from his cigarette and slowly exhaled. “No, you’re right, I’m far, far away.” I thought for a moment and deciding to take a chance, and said to him, “Are you back over there?” I waited with a knot in my gut for the response. He kept looking straight ahead as he extinguished his smoke he had just used to light another one up.
“Yea, I’m over there,” he responded. “A lot of good men were killed for nothing…I should have been one of them.” “I’m not sure I understand what you mean?” “I don’t know if you or anyone can ever understand,” he said without changing his distant gaze.
Next there was a pause that felt like an eternity. Then he went on, “my platoon had been In Country for three or four days when we were involved in a heavy firefight with the VC.” He paused for a moment then went on, ‘we called for air support to get us out. I jumped onto one of the helicopters with four of my buddies and we started to lift off the ground. When we were about twenty feet off the ground we were hit by rocket fire. As we started to crash I was thrown clear.’
For the first time since sitting with him he faced me, “I was the only one that survived.” I felt goose-flesh take over my body; I was speechless.
As he finished that statement he began to uncontrollably sob, wretch, and rock back and forth in his chair.
It was type of sobbing that comes from a person’s soul and one feels like it will never end. I knew right away that this was probably the first time he had ever told this story to another human being.
Over the years I have had the privilege of people bearing their souls to me. Others have told me that I have something that allows people to open up and tell their tales. I do not know why this is so, but, I don’t need to know I guess. This is and can be both a blessing and a curse. I thank God every day for my sense of humor. Without it, I would be a “Dead Man Walking.”
Jon did go on to get services at the VA after that night, and yes, we did see him once and awhile back at the detox; not with his previous frequency however.
After a couple of years of heavy drinking and bouncing from job to job his life began to fall apart. First his wife left him, then his drinking burned out his family and he ended up homeless, living in the shelters around Boston.
He was a quiet, polite guy who always helped out around the detox. One of our counselors at the time was a Vietnam Vet who had also served in the Marine Corps, “In Country,” as Jonathan had.
Jonathan would talk to him often. However, if the topic of Vietnam came up he would give a little smile then walk away. He would refuse to discuss any aftercare plans that included programs with the VA. There were benefits available to him, but he wanted nothing to do with them. So he lived back and forth from the shelter to the detox.
At this point in my career I often worked overnight shifts a couple of times a month. On one of these nights I had just come back upstairs from doing patient laundry in the basement. Jonathan was sitting at a desk where we often did admissions having a cup of coffee and a cigarette. It was about 3’ in the morning. Patients often who were detoxing would get up in the middle of the night for coffee and a smoke. We never shoo’d them back to bed like many facilities would do.
There is something to be said for sitting with a patient at this time of the morning. They have just gotten up and the alcoholic defenses one would normally encounter in the daytime were not present. This was the first time that I had such an experience, but it would not be the last.
As I sat there with him, I watched as he stared off into the distance, swirls of blue smoke drifting towards the ceiling. After several minutes, I made the remark to him, “Geez Jon, it feels like you are not even here.” He took another long drag from his cigarette and slowly exhaled. “No, you’re right, I’m far, far away.” I thought for a moment and deciding to take a chance, and said to him, “Are you back over there?” I waited with a knot in my gut for the response. He kept looking straight ahead as he extinguished his smoke he had just used to light another one up.
“Yea, I’m over there,” he responded. “A lot of good men were killed for nothing…I should have been one of them.” “I’m not sure I understand what you mean?” “I don’t know if you or anyone can ever understand,” he said without changing his distant gaze.
Next there was a pause that felt like an eternity. Then he went on, “my platoon had been In Country for three or four days when we were involved in a heavy firefight with the VC.” He paused for a moment then went on, ‘we called for air support to get us out. I jumped onto one of the helicopters with four of my buddies and we started to lift off the ground. When we were about twenty feet off the ground we were hit by rocket fire. As we started to crash I was thrown clear.’
For the first time since sitting with him he faced me, “I was the only one that survived.” I felt goose-flesh take over my body; I was speechless.
As he finished that statement he began to uncontrollably sob, wretch, and rock back and forth in his chair.
It was type of sobbing that comes from a person’s soul and one feels like it will never end. I knew right away that this was probably the first time he had ever told this story to another human being.
Over the years I have had the privilege of people bearing their souls to me. Others have told me that I have something that allows people to open up and tell their tales. I do not know why this is so, but, I don’t need to know I guess. This is and can be both a blessing and a curse. I thank God every day for my sense of humor. Without it, I would be a “Dead Man Walking.”
Jon did go on to get services at the VA after that night, and yes, we did see him once and awhile back at the detox; not with his previous frequency however.
Tuesday, June 26, 2012
The Dead Father
He had been on the unit, or I should say in bed for the first three days he was with us. Usually when a patient is unable to get out of bed for two or three days it can be attributed to chronic alcohol use or, a really bad cocaine crash (awake for days using). In this case it was the result of alcohol.
Since stays at the detox lasted three to five days only, I decided to go to his room and maybe bedside I could begin to do his paperwork.
He was in his early forties but the years of chronic alcohol abuse gave him the look of a haggard man in his late sixties. After asking him if it would be o.k. to sit by his bed and ask him a few questions, I took a seat.
As I was asking him various questions to complete the Bio-Psych-Social I could sense an intense sadness permeating from his being.
I asked him, “Have you ever had any sober time?” He replied “yes” he had a year once. I then queried him further, “what was it about that year that you were able to stay sober?”
His look became distant; all expression was gone from his face. It took him several minutes for him to look back at me. Then he responded, “well, we found out that my father was terminally ill…I was sober for the six months leading up to his death, then for six more months after.”
He then looked down at his bed and began to uncontrollably sob and rock back and forth. Through his lamentations one had the sense the agony was coming from the depths of his soul. This went on for a period of a couple of minutes (though when you are with someone going through this, it can feel like hours).
I then asked him when his father had passed away. Next, the shocker when he told me the year and it was thirteen years prior! There I had been thinking it was probably a fairly recent event and it was thirteen years ago.
He then went on to tell me that this was the first time that he had ever talked about it to anyone. In a way I felt privileged that this person had allowed me into his being.
He had not been able to maintain sobriety for more than a couple of days when he broke after a year clean. The issue of his father’s passing was on his mind every day; all day.
Part of his aftercare plan was to hook him up with a therapist that works in the area of unresolved grief issues. No longer did he want to live with the belief that men don’t cry, men don’t grieve.
Since stays at the detox lasted three to five days only, I decided to go to his room and maybe bedside I could begin to do his paperwork.
He was in his early forties but the years of chronic alcohol abuse gave him the look of a haggard man in his late sixties. After asking him if it would be o.k. to sit by his bed and ask him a few questions, I took a seat.
As I was asking him various questions to complete the Bio-Psych-Social I could sense an intense sadness permeating from his being.
I asked him, “Have you ever had any sober time?” He replied “yes” he had a year once. I then queried him further, “what was it about that year that you were able to stay sober?”
His look became distant; all expression was gone from his face. It took him several minutes for him to look back at me. Then he responded, “well, we found out that my father was terminally ill…I was sober for the six months leading up to his death, then for six more months after.”
He then looked down at his bed and began to uncontrollably sob and rock back and forth. Through his lamentations one had the sense the agony was coming from the depths of his soul. This went on for a period of a couple of minutes (though when you are with someone going through this, it can feel like hours).
I then asked him when his father had passed away. Next, the shocker when he told me the year and it was thirteen years prior! There I had been thinking it was probably a fairly recent event and it was thirteen years ago.
He then went on to tell me that this was the first time that he had ever talked about it to anyone. In a way I felt privileged that this person had allowed me into his being.
He had not been able to maintain sobriety for more than a couple of days when he broke after a year clean. The issue of his father’s passing was on his mind every day; all day.
Part of his aftercare plan was to hook him up with a therapist that works in the area of unresolved grief issues. No longer did he want to live with the belief that men don’t cry, men don’t grieve.
Thursday, June 21, 2012
O.K, the patient has just told you to "Go F@#K Yourself!" Now what do you do?
Let's begin with what not to do. First off, do not 'react' back. I have seen and heard inexperienced counselors do this and there is no telling where this will lead to; usually not to a very healthy place indeed. Phrases such as, "How dare you say that to me, should be avoided like the plaque."
I will get in the 'respect' factor in a little while.
Secondly, when an eruption like this starts I usually drop my head slightly (keeping my eyes on them) and hold my arms at my sides (in a non-threating manner) turning slightly sideways (defensive position) making sure I am at least an arm’s length away (another defensive position). I lower my voice almost to the point of it being inaudible and 'child-like.' Lowering the voice causes them to concentrate more on what I am saying in order to hear what I am saying.
I want the person to feel they are in control and I am non-threatening. This can greatly enhance the de-escalation process.
If the eruption began in and around the patient community I will ask them if we can talk in my office or another room. Usually they will.
When the person begins to 'come down' I will say something to the effect, "Wow, I am really concerned about you. You seem really angry and upset, is there anything I can do to help you out, do you want to talk?"
I like to use the following analogy, if you see a dog get hit by a car and you race to assist the animal, the first thing you should do is take off your belt and muzzle the injured creature. The reason being that in the process of trying to help him, he may feel pain and snap at you; much like the example above.
Alcoholics and Addicts can be hypersensitive; especially in early recovery. Therefore, as a professional in order to effectively help them, I must never personalize what they say to me (easier said than done sometimes). If you cannot do this then maybe you are in the wrong field.
Now as far as the 'respect' factor, when they are at a point of being able to truly hear me, I might say something such as, "you know, when you told me to go F-myself, I really wanted to know what was going on that you would disrespect yourself by making that kind of comment to me, thereby disrespecting me.
Psychic and emotional pain can definitely cause people to 'strike out' at others. Some of the’ reasons' patients may do this are many-fold; from the patient that is experiencing trauma flashbacks, to the person about to move on to another program and they just cannot say goodbye so they 'blow out' of the program instead.
It is important to not allow ones-self to get caught up in their drama, and maintaining a clear rational mind in order to focus on what is in that person’s best interest.
I will get in the 'respect' factor in a little while.
Secondly, when an eruption like this starts I usually drop my head slightly (keeping my eyes on them) and hold my arms at my sides (in a non-threating manner) turning slightly sideways (defensive position) making sure I am at least an arm’s length away (another defensive position). I lower my voice almost to the point of it being inaudible and 'child-like.' Lowering the voice causes them to concentrate more on what I am saying in order to hear what I am saying.
I want the person to feel they are in control and I am non-threatening. This can greatly enhance the de-escalation process.
If the eruption began in and around the patient community I will ask them if we can talk in my office or another room. Usually they will.
When the person begins to 'come down' I will say something to the effect, "Wow, I am really concerned about you. You seem really angry and upset, is there anything I can do to help you out, do you want to talk?"
I like to use the following analogy, if you see a dog get hit by a car and you race to assist the animal, the first thing you should do is take off your belt and muzzle the injured creature. The reason being that in the process of trying to help him, he may feel pain and snap at you; much like the example above.
Alcoholics and Addicts can be hypersensitive; especially in early recovery. Therefore, as a professional in order to effectively help them, I must never personalize what they say to me (easier said than done sometimes). If you cannot do this then maybe you are in the wrong field.
Now as far as the 'respect' factor, when they are at a point of being able to truly hear me, I might say something such as, "you know, when you told me to go F-myself, I really wanted to know what was going on that you would disrespect yourself by making that kind of comment to me, thereby disrespecting me.
Psychic and emotional pain can definitely cause people to 'strike out' at others. Some of the’ reasons' patients may do this are many-fold; from the patient that is experiencing trauma flashbacks, to the person about to move on to another program and they just cannot say goodbye so they 'blow out' of the program instead.
It is important to not allow ones-self to get caught up in their drama, and maintaining a clear rational mind in order to focus on what is in that person’s best interest.
Monday, June 18, 2012
Humor in Recovery & Health in General: Part II
In the first part of this series, the benefits of humor and laughter were cited from the research I conducted several years ago while working on my master’s thesis.
In this second part, I will present the results from research I conducted with therapists in the field on if and when they use humor in their private practices, and what types.
When asked if they employ humor when working with their clients: 48% stated they frequently use humor; 48% stated they sometimes use humor; 4% stated they rarely use humor; 0% stated they never use humor.
On ‘when’ they utilize humor: 80% use humor for stress relief; 68% to ‘reframe’ an issue; 64% when encountering issues of denial; 48% to break an ‘impasse’; 48% issues of self-esteem; 48% for educational issues; 40% for reality testing.
Another 32% stated they also utilize humor for the following:
1. Negative outlooks
2. To point out irony
3. Relational connections
4. Anytime I can
5. Encourage the therapeutic alliance
6. Ice-breaking
7. To strengthen the alliance
8. Get back on course
9. Re-direction
As far as the types of humor they employ: 80% situational; 60% witticisms; 48% anecdotes; 36% stories; 28% puns; 20% jokes; 16% parodies.
Definitions for the above:
Situational: Humorous situations from your own experience. Situational humor does not require that you memorize a punch line because it is based on a situation that
itself is humorous. It is a situation you personally have experienced.
Witticism: A remark that is amusingly clever in perception and expression.
Anecdote: A short account of a particular incident or event of an interesting or amusing nature, often biographical.
Stories: Self-explanatory
Pun: The humorous use of a word or phrase so as to emphasize or suggest its different meanings or applications, or the use of words that are alike or nearly alike in sound but different in meaning; a play on words.
Joke: Something said or done to provoke laughter or cause amusement, as a witticism, a short and amusing anecdote, or a prankish act.
Parody: Any humorous, satirical, or burlesque imitation, as of a person, event, etc.
So as we can see from the information above, it appears (at least in this research) that all therapists employ humor in their practice to some extent; the amount, when employed, and the type utilized differs often from therapist to therapist.
Humor can be beneficial in other ways to people in recovery. More than once I been speaking with a person in early recovery and they tell me the tale of being at a recovery meeting and being absolutely mortified by hearing members joke and laugh about a situation they found themselves in when actively ‘using.’ They failed to see any humor in what was being ‘joked’ about!
Well, I can understand and be empathetic towards their initial shock. However, (as I explain to them) this is quite common. Why? Humor can allow an otherwise extremely painful issue that no one wants to talk about; be talked about. Think of humor in this instance as a positive coping mechanism. By giving the issue a voice (even if initially they utilize 'Dark' humor to do so), they reinforce why would not want to return to the previous behavior and subsequent consequences that would entail.
When can humor be seen as a negative? I have had instances when working with a patient or client on a one-to-one basis when they will use humor as a ‘mask.’ I will ask them a question and if they feel uncomfortable, they will deflect the question by telling me a joke, making fun of the question itself, or tell me something amusing that either they or a friend did.
Another form of humor that needs to be handled with kid-gloves is that of sarcasm.
The definition of sarcasm is: Harsh or bitter derision or irony; A sharply ironical taunt; sneering or cutting remark; mocking, contemptuous, or ironic language intended to convey scorn or insult. Furthermore, it is from the Latin sarcasmus, which means ‘to rend (tear into strips) the flesh.
I am sure that many of us have heard the ‘colloquial’ phrase when a person yells at another in a derisive way, “Boy he ripped him a new…” That is sarcasm at its best (err, worst actually).
When leading groups and the issue of trauma comes up, almost to a person, they will state that the verbal abuse they underwent was significantly greater in damage that the physical abuse.
Can sarcasm then ever be beneficial? Often times I have found from a clinical perspective that men will employ sarcasm as a “safe” way to bond with other men. In our culture, most men have a difficult time telling another man that they ‘love’ them without feeling ‘weirded out’ (word used by patient). So long as the sarcasm is a two-way street, I have found it can be a plus.
In this second part, I will present the results from research I conducted with therapists in the field on if and when they use humor in their private practices, and what types.
When asked if they employ humor when working with their clients: 48% stated they frequently use humor; 48% stated they sometimes use humor; 4% stated they rarely use humor; 0% stated they never use humor.
On ‘when’ they utilize humor: 80% use humor for stress relief; 68% to ‘reframe’ an issue; 64% when encountering issues of denial; 48% to break an ‘impasse’; 48% issues of self-esteem; 48% for educational issues; 40% for reality testing.
Another 32% stated they also utilize humor for the following:
1. Negative outlooks
2. To point out irony
3. Relational connections
4. Anytime I can
5. Encourage the therapeutic alliance
6. Ice-breaking
7. To strengthen the alliance
8. Get back on course
9. Re-direction
As far as the types of humor they employ: 80% situational; 60% witticisms; 48% anecdotes; 36% stories; 28% puns; 20% jokes; 16% parodies.
Definitions for the above:
Situational: Humorous situations from your own experience. Situational humor does not require that you memorize a punch line because it is based on a situation that
itself is humorous. It is a situation you personally have experienced.
Witticism: A remark that is amusingly clever in perception and expression.
Anecdote: A short account of a particular incident or event of an interesting or amusing nature, often biographical.
Stories: Self-explanatory
Pun: The humorous use of a word or phrase so as to emphasize or suggest its different meanings or applications, or the use of words that are alike or nearly alike in sound but different in meaning; a play on words.
Joke: Something said or done to provoke laughter or cause amusement, as a witticism, a short and amusing anecdote, or a prankish act.
Parody: Any humorous, satirical, or burlesque imitation, as of a person, event, etc.
So as we can see from the information above, it appears (at least in this research) that all therapists employ humor in their practice to some extent; the amount, when employed, and the type utilized differs often from therapist to therapist.
Humor can be beneficial in other ways to people in recovery. More than once I been speaking with a person in early recovery and they tell me the tale of being at a recovery meeting and being absolutely mortified by hearing members joke and laugh about a situation they found themselves in when actively ‘using.’ They failed to see any humor in what was being ‘joked’ about!
Well, I can understand and be empathetic towards their initial shock. However, (as I explain to them) this is quite common. Why? Humor can allow an otherwise extremely painful issue that no one wants to talk about; be talked about. Think of humor in this instance as a positive coping mechanism. By giving the issue a voice (even if initially they utilize 'Dark' humor to do so), they reinforce why would not want to return to the previous behavior and subsequent consequences that would entail.
When can humor be seen as a negative? I have had instances when working with a patient or client on a one-to-one basis when they will use humor as a ‘mask.’ I will ask them a question and if they feel uncomfortable, they will deflect the question by telling me a joke, making fun of the question itself, or tell me something amusing that either they or a friend did.
Another form of humor that needs to be handled with kid-gloves is that of sarcasm.
The definition of sarcasm is: Harsh or bitter derision or irony; A sharply ironical taunt; sneering or cutting remark; mocking, contemptuous, or ironic language intended to convey scorn or insult. Furthermore, it is from the Latin sarcasmus, which means ‘to rend (tear into strips) the flesh.
I am sure that many of us have heard the ‘colloquial’ phrase when a person yells at another in a derisive way, “Boy he ripped him a new…” That is sarcasm at its best (err, worst actually).
When leading groups and the issue of trauma comes up, almost to a person, they will state that the verbal abuse they underwent was significantly greater in damage that the physical abuse.
Can sarcasm then ever be beneficial? Often times I have found from a clinical perspective that men will employ sarcasm as a “safe” way to bond with other men. In our culture, most men have a difficult time telling another man that they ‘love’ them without feeling ‘weirded out’ (word used by patient). So long as the sarcasm is a two-way street, I have found it can be a plus.
Tuesday, June 12, 2012
Humor in Recovery & Health in General: Part I
Prior to entering the field of psych/addiction my life consisted of writing comedy bits and song parodies for the Charles Laquidara morning show at WBCN-104.1 FM in Boston, as a member of the “Not before Breakfast Big Mattress Players.” Evenings would find me out on the Boston Comedy scene; From “Stitches Comedy Club” in the Paradise Rock Club on Comm-Ave, to working the once a week restaurant comedy ‘Hells.’ My pal George MacDonald always referred to those once a week shows as a place, “Where the jokes never work, the audience never laughs, and the show never ends...”
I also had a once a week comedy show that I hosted at a Mexican restaurant in Saugus while being a comic bartender there.
So naturally, my comedy background would take over when I had to choose a thesis topic for my Masters in Counseling Psychology.
The title of my thesis was, “A Contemporary View of the Efficacy of Humor as a Therapeutic Component within Addiction Counseling Relationships & Health in General.”
In my review of literature I found that many of the benefits of laughter & humor that had been viewed as strictly anecdotal over the years had been empirically researched and found to be valid.
Over the past several decades empirical research data has indicated the direct benefit of humor in areas such as:
1. Reducing stress, anxiety, and tension
2. Promoting psychological well-being
3. Raising self-esteem
4. Improving interpersonal interactions and relationships
5. Building group identity, solidarity, and cohesiveness
6. Enhancing memory (for humorous information)
7. Increasing pain tolerance
8. Elevating mood
9. Increasing hope, energy, and vigor
10. Counteracting depression and anxiety
11. Enhancing creative thinking and problem-solving
12. Increasing friendliness and helpfulness
13. Intensifying mirth
14. Being contagious (induces mirth in others)
15. Increasing interpersonal attraction and closeness
16. Exercising respiratory muscles (www.aath.org)
At the present time current research on all scientific fronts is looking to the possible benefits of humor in additional areas such as:
1. Reducing respiratory infections
2. Treating asthma
3. Enhancing positive lifestyle choices
4. Improving diabetes
5. Increasing longevity
6. Improving immune function
7. Raising endorphins levels
8. Treats cancer
9. Fights off infections
10. Lowers blood pressure
11. Reduces heart disease
12. Exercise benefits equal to jogging
13. Leads to significant weight loss (www.aath.org)
I utilize my sense of humor when I am working in the addiction field; whether I am presenting an educational group in the day program where I work, or, when meeting with a client one on one.
I will go more into depth on this in part II of this series of blogs.
Both the word “humor” and “humanity” have that “h-u-m” beginning. No accident I believe. Humor is one of the characteristics that separate us from the rest of the animal kingdom (well, with the possible exception of dolphins – the research goes on in this area however, lol).
Humor allows my clients to feel they are on equal footing with me; I am not above them. I am there to work for them and with them. I personally have found that it can greatly enhance the therapeutic relationship.
In Part II I will discuss the research I conducted with therapists working in the field. The types of humor they employ and when they employ it. I will also discuss the cautions a therapist needs to be aware of when utilizing humor in the therapeutic relationship.
P.S. If you enjoy my blogs please pass on my link to your friends. http://willydrinkwater.blogspot.com/
I also had a once a week comedy show that I hosted at a Mexican restaurant in Saugus while being a comic bartender there.
So naturally, my comedy background would take over when I had to choose a thesis topic for my Masters in Counseling Psychology.
The title of my thesis was, “A Contemporary View of the Efficacy of Humor as a Therapeutic Component within Addiction Counseling Relationships & Health in General.”
In my review of literature I found that many of the benefits of laughter & humor that had been viewed as strictly anecdotal over the years had been empirically researched and found to be valid.
Over the past several decades empirical research data has indicated the direct benefit of humor in areas such as:
1. Reducing stress, anxiety, and tension
2. Promoting psychological well-being
3. Raising self-esteem
4. Improving interpersonal interactions and relationships
5. Building group identity, solidarity, and cohesiveness
6. Enhancing memory (for humorous information)
7. Increasing pain tolerance
8. Elevating mood
9. Increasing hope, energy, and vigor
10. Counteracting depression and anxiety
11. Enhancing creative thinking and problem-solving
12. Increasing friendliness and helpfulness
13. Intensifying mirth
14. Being contagious (induces mirth in others)
15. Increasing interpersonal attraction and closeness
16. Exercising respiratory muscles (www.aath.org)
At the present time current research on all scientific fronts is looking to the possible benefits of humor in additional areas such as:
1. Reducing respiratory infections
2. Treating asthma
3. Enhancing positive lifestyle choices
4. Improving diabetes
5. Increasing longevity
6. Improving immune function
7. Raising endorphins levels
8. Treats cancer
9. Fights off infections
10. Lowers blood pressure
11. Reduces heart disease
12. Exercise benefits equal to jogging
13. Leads to significant weight loss (www.aath.org)
I utilize my sense of humor when I am working in the addiction field; whether I am presenting an educational group in the day program where I work, or, when meeting with a client one on one.
I will go more into depth on this in part II of this series of blogs.
Both the word “humor” and “humanity” have that “h-u-m” beginning. No accident I believe. Humor is one of the characteristics that separate us from the rest of the animal kingdom (well, with the possible exception of dolphins – the research goes on in this area however, lol).
Humor allows my clients to feel they are on equal footing with me; I am not above them. I am there to work for them and with them. I personally have found that it can greatly enhance the therapeutic relationship.
In Part II I will discuss the research I conducted with therapists working in the field. The types of humor they employ and when they employ it. I will also discuss the cautions a therapist needs to be aware of when utilizing humor in the therapeutic relationship.
P.S. If you enjoy my blogs please pass on my link to your friends. http://willydrinkwater.blogspot.com/
Wednesday, June 6, 2012
The Boy in the Basement
The bed count at our detox was 28. Out of these, we would usually keep four beds for ‘holding.’ A holding bed was one that a patient might get if he or she were accepted to an aftercare program but had to wait for an opening at that program.
These patients would help around the detox; assisting the weekday chef in preparing and cooking meals, helping those of us on staff with the laundry, and the general clean-up of the facility.
Tim was one of our “holding” patients. He usually could be found helping the chef with food prep and running across the street to get food supplies from the local deli. When one conversed with him, he always had a smile but would seldom answer in more than a couple of words. I use to wonder what was really going on in his head, or, was he really just that quiet.
With all of our patients, I would read their histories, talk with them, and try to see just when their addictions started them on the path of self-destruction. From this I would try to work with them on possible aftercare plans to assist them in keeping their addictions in remission.
Easier said than done.
Tim’s life story had major holes. A history is only as detailed as a patient will allow. A good counselor will try through compassion & empathy to build trust with a patient so they will fill-in the missing pieces. This can be critical to their sobriety. Does this person have another mental illness that may be preventing him or her from obtaining and/or continuing sobriety? Has the person been a victim of trauma, grief, abandonment; untreated affective disorders?
Tim never spoke of his father. He would speak affectionately of his mother. One time he briefly spoke of an older brother that left home at sixteen. When I tried to ask him a little more about his brother, he just smiled and walked away. At the time I really did not think too much of it. Many of our patients would say very little about their families. Either their addictions had burned-out their relationships with them, or, their own shame, remorse and guilt would not allow them to think of their families.
One Monday morning I came into work and Tim was already helping-out in the kitchen area. The first item on the staff agenda when we came into work was to hear the report from the previous two shifts. It gave us a “feel” for what had been going on. Had some patients been going through a hard time emotionally, physically? What had the general mood of the detox been?
While we were listening to report that morning Tim zoomed past us to go down into the basement to get some canned goods for that day’s food-prep.
It could not have been more than a couple of minutes when we heard this un-godly screaming and sounds of slamming and pounding from the basement. I jumped up and with another counselor and we raced to the basement. The door that led to the supply room was quirky and sometimes would latch behind one after entering through it. This was the reason we kept a key on the inside, pegged on the outer side of the door jamb. In addition, there was another passageway out. He was screaming too loud to even try to tell him about these possibilities.
He was screaming, hollering, and trying to kick the door down as if he were being chased by the devil himself. My partner and I soon realized that we had left our keys on the staff desk in our haste to get downstairs. I told my partner to go back up and grab his keys while I tried to keep him calm.
Tim kept screaming, “You’re just like my f*#@+g father! “Let me out you f*#@+g bastards, let me out! “I’ll f*#@+g kill everybody if you don’t let me out."
“Tim, take it easy, take it easy,” I told him. As my partner returned with the keys I could hear Tim slump to the floor. By this point in time, all the staff had raced to the basement.
When I opened the door, Tim was sobbing on the floor. The type of sobbing that comes from the bottom of a person’s soul. I waved everyone out and sat next to him on the floor.
The sobbing continued for quite a while. Slowly it began to dissipate and then, stopped. As he began to take long deep breaths, he stared straight ahead. I could tell he was no longer in the detox; his mind was far away, at a previous place in time. In a monotone voice he started to speak;
'When I realized that I was locked down here I freaked out. When I was really young my father was a heavy drinker and after dinner at night he would lock me in a basement closet until breakfast the next morning. He would tell me not to yell or scream or my mother would pay the price. One time I did start yelling until I heard my mother beg me to stop, for he was beating her because of my yelling.’
That’s why my brother left home at sixteen. He was the first one to get the “special” after dinner treatment. When he left, I guess I was naturally the next choice.
I have been in the field for over twenty years now and there are still stories like this one that rise to surface once in a while from my subconscious. Just when I think I have heard it all…another story presents itself…
These patients would help around the detox; assisting the weekday chef in preparing and cooking meals, helping those of us on staff with the laundry, and the general clean-up of the facility.
Tim was one of our “holding” patients. He usually could be found helping the chef with food prep and running across the street to get food supplies from the local deli. When one conversed with him, he always had a smile but would seldom answer in more than a couple of words. I use to wonder what was really going on in his head, or, was he really just that quiet.
With all of our patients, I would read their histories, talk with them, and try to see just when their addictions started them on the path of self-destruction. From this I would try to work with them on possible aftercare plans to assist them in keeping their addictions in remission.
Easier said than done.
Tim’s life story had major holes. A history is only as detailed as a patient will allow. A good counselor will try through compassion & empathy to build trust with a patient so they will fill-in the missing pieces. This can be critical to their sobriety. Does this person have another mental illness that may be preventing him or her from obtaining and/or continuing sobriety? Has the person been a victim of trauma, grief, abandonment; untreated affective disorders?
Tim never spoke of his father. He would speak affectionately of his mother. One time he briefly spoke of an older brother that left home at sixteen. When I tried to ask him a little more about his brother, he just smiled and walked away. At the time I really did not think too much of it. Many of our patients would say very little about their families. Either their addictions had burned-out their relationships with them, or, their own shame, remorse and guilt would not allow them to think of their families.
One Monday morning I came into work and Tim was already helping-out in the kitchen area. The first item on the staff agenda when we came into work was to hear the report from the previous two shifts. It gave us a “feel” for what had been going on. Had some patients been going through a hard time emotionally, physically? What had the general mood of the detox been?
While we were listening to report that morning Tim zoomed past us to go down into the basement to get some canned goods for that day’s food-prep.
It could not have been more than a couple of minutes when we heard this un-godly screaming and sounds of slamming and pounding from the basement. I jumped up and with another counselor and we raced to the basement. The door that led to the supply room was quirky and sometimes would latch behind one after entering through it. This was the reason we kept a key on the inside, pegged on the outer side of the door jamb. In addition, there was another passageway out. He was screaming too loud to even try to tell him about these possibilities.
He was screaming, hollering, and trying to kick the door down as if he were being chased by the devil himself. My partner and I soon realized that we had left our keys on the staff desk in our haste to get downstairs. I told my partner to go back up and grab his keys while I tried to keep him calm.
Tim kept screaming, “You’re just like my f*#@+g father! “Let me out you f*#@+g bastards, let me out! “I’ll f*#@+g kill everybody if you don’t let me out."
“Tim, take it easy, take it easy,” I told him. As my partner returned with the keys I could hear Tim slump to the floor. By this point in time, all the staff had raced to the basement.
When I opened the door, Tim was sobbing on the floor. The type of sobbing that comes from the bottom of a person’s soul. I waved everyone out and sat next to him on the floor.
The sobbing continued for quite a while. Slowly it began to dissipate and then, stopped. As he began to take long deep breaths, he stared straight ahead. I could tell he was no longer in the detox; his mind was far away, at a previous place in time. In a monotone voice he started to speak;
'When I realized that I was locked down here I freaked out. When I was really young my father was a heavy drinker and after dinner at night he would lock me in a basement closet until breakfast the next morning. He would tell me not to yell or scream or my mother would pay the price. One time I did start yelling until I heard my mother beg me to stop, for he was beating her because of my yelling.’
That’s why my brother left home at sixteen. He was the first one to get the “special” after dinner treatment. When he left, I guess I was naturally the next choice.
I have been in the field for over twenty years now and there are still stories like this one that rise to surface once in a while from my subconscious. Just when I think I have heard it all…another story presents itself…
Thursday, May 17, 2012
For A $100.00 A Day, You Can Support An Addict…
O.k. Maybe the title of this blog seems a little bit outrageous. Primarily, this was to get your attention (worked, huh?).
In a group I was presenting the other day I asked the question, ‘how much’ did you spend daily on your habit? This $100.00 was one answer I received; although most thought this to be a low estimate.
So, let’s do the math. $100.00 a day X 365 days in the year, makes for a grand total of $36,500. Hmm, X 10 years we are now up to $365,000! Ah, I would like to buy a house please.
Nice chunk of change, huh?
I have found over the years that when people are actively using seldom do they have enough money for anything other than their drug(s) of choice.
Looking back to my full-time days on the comedy scene (stand-up/comedy writer) I can remember times when a buddy that made $1000.00 to $1500.00 for a weekend at the local comedy clubs would take a swing by the radio station where I worked the morning show to ‘borrow’ a couple of bucks to get back to their apartment.
Money all gone.
Amazing how fast the money can go is it not? Hotel rooms, cocaine, plenty of booze, friends (actually using buddies), etc, etc, etc.
For some people financial ruin can expedite their getting into recovery. This reminds me of the patient one time that said to me, ‘thank God I never got bagged for a DUI when I was actively drinking years ago.’ My initial thought which I kept to myself at the time was, ‘yea, thank God, if that had happened maybe you would have gotten into sobriety sooner, huh?’
Families need to proceed with extreme caution when a loved one with an active addiction issue asks them for money. What is the money for? “Oh, I need it for transportation to the detox.” Really? I’ll be more than happy to drive you there instead.
I do not doubt for a second that some families truly believe that by giving their active loved ones money they are helping them.
However, this more often than not has the opposite of the desired effect. If I ‘bail’ them out of having to face their own consequences from using, then in effect I am condoning their use and aiding and abetting their addiction to keep going.
This co-dependency can run for years; they manipulate us – we enable them.
Not healthy for either party.
In a group I was presenting the other day I asked the question, ‘how much’ did you spend daily on your habit? This $100.00 was one answer I received; although most thought this to be a low estimate.
So, let’s do the math. $100.00 a day X 365 days in the year, makes for a grand total of $36,500. Hmm, X 10 years we are now up to $365,000! Ah, I would like to buy a house please.
Nice chunk of change, huh?
I have found over the years that when people are actively using seldom do they have enough money for anything other than their drug(s) of choice.
Looking back to my full-time days on the comedy scene (stand-up/comedy writer) I can remember times when a buddy that made $1000.00 to $1500.00 for a weekend at the local comedy clubs would take a swing by the radio station where I worked the morning show to ‘borrow’ a couple of bucks to get back to their apartment.
Money all gone.
Amazing how fast the money can go is it not? Hotel rooms, cocaine, plenty of booze, friends (actually using buddies), etc, etc, etc.
For some people financial ruin can expedite their getting into recovery. This reminds me of the patient one time that said to me, ‘thank God I never got bagged for a DUI when I was actively drinking years ago.’ My initial thought which I kept to myself at the time was, ‘yea, thank God, if that had happened maybe you would have gotten into sobriety sooner, huh?’
Families need to proceed with extreme caution when a loved one with an active addiction issue asks them for money. What is the money for? “Oh, I need it for transportation to the detox.” Really? I’ll be more than happy to drive you there instead.
I do not doubt for a second that some families truly believe that by giving their active loved ones money they are helping them.
However, this more often than not has the opposite of the desired effect. If I ‘bail’ them out of having to face their own consequences from using, then in effect I am condoning their use and aiding and abetting their addiction to keep going.
This co-dependency can run for years; they manipulate us – we enable them.
Not healthy for either party.
Wednesday, May 16, 2012
Seizure At Dinnertime
Have you ever been walking along with a friend and for no apparent reason, your friend falls? Did you just burst out laughing, unable for a couple of seconds to even ask them if they were o.k.? This is often referred to as 'shock' humor. Sometimes when something is shocking we use humor as a coping mechanism. For many of us this is an automatic response and can be embarrassing.
It had been a long day at the detox and I had been asked to stay on a little later to help get supper out to the patients. The food at the detox was actually quite good. We had a cook that would come in and Monday through Friday. Then on the weekends we counselors would heat up and serve meals that the cook had prepared in advance for the weekend.
The patients would pick up a tray to put their food on then proceed to an open window of the kitchen to get the hot item being offered. Next, they would go to several tables that had other items such as salad, chips, and the assorted condiments.
Well on this particular night the line had been moving along quite nicely. Bob one of our frequent flyers at the detox had just placed his tray on one of the side tables to make himself a salad. As he placed tongs into the large salad bowl to help himself he suddenly went into a seizure.
The result was he went straight back and the salad tongs flew upward spewing salad everywhere. I remember diving towards him to prevent his head from hitting the floor and screaming for staff. As I was kneeling next to Bob with several other staff members, I glanced up and looked right at two other patients that had been behind Bob at the salad table. One of them turned to the other and said, “Boy, that really was a tossed salad Fred, huh?”
I wanted to burst out laughing but the gravity of the situation at that point in time would not allow me to do so. Shortly afterwards however I was able to laugh once we knew Bob was o.k.
There is a reason that the masks of comedy and tragedy are always shown together. They really are closer than most of us realize. A slight turn in one direction or another and either can be the result.
It had been a long day at the detox and I had been asked to stay on a little later to help get supper out to the patients. The food at the detox was actually quite good. We had a cook that would come in and Monday through Friday. Then on the weekends we counselors would heat up and serve meals that the cook had prepared in advance for the weekend.
The patients would pick up a tray to put their food on then proceed to an open window of the kitchen to get the hot item being offered. Next, they would go to several tables that had other items such as salad, chips, and the assorted condiments.
Well on this particular night the line had been moving along quite nicely. Bob one of our frequent flyers at the detox had just placed his tray on one of the side tables to make himself a salad. As he placed tongs into the large salad bowl to help himself he suddenly went into a seizure.
The result was he went straight back and the salad tongs flew upward spewing salad everywhere. I remember diving towards him to prevent his head from hitting the floor and screaming for staff. As I was kneeling next to Bob with several other staff members, I glanced up and looked right at two other patients that had been behind Bob at the salad table. One of them turned to the other and said, “Boy, that really was a tossed salad Fred, huh?”
I wanted to burst out laughing but the gravity of the situation at that point in time would not allow me to do so. Shortly afterwards however I was able to laugh once we knew Bob was o.k.
There is a reason that the masks of comedy and tragedy are always shown together. They really are closer than most of us realize. A slight turn in one direction or another and either can be the result.
Wednesday, May 9, 2012
Another Detox Opening, Why???
I know some of you may have read this title and thought to yourself, “Jeez, is this guy for real? Of course we need more detox beds!”
We here in Massachusetts have learned that our Department of Public Health plans to do just that; another detoxification unit with a floor staff of limited experience due to the fact that the money tends to go up into administrative roles rather than to those ‘working the floors.’ By improving the quality of the detoxification centers maybe we would find that we actually have enough – Better treatment, the higher the probability of continued recovery.
I can’t imagine the ‘evidenced based results’ being that great from the current structure of our detoxification centers in the way they are operated at the present time. Again, 'the longer a person is in treatment, the better the chance of their staying in recovery.'
People are lucky if they can get into a transitional program for thirty days post detox. So a detox stay of three to five days will insure recovery? I think not.
The fact of the matter is the insurance companies are now discussing ‘outpatient’ detoxification from opiates. Some have already started to do this. Most of our detoxifications at the present time (our state) are for heroin; either alone or in combination with other drugs.
‘Don’t talk about problems if you are not willing to discuss possible solutions.’
I am willing.
Instead of more detoxification centers, why are we not thinking in terms of sixty or ninety day programs? Again, the longer a person is in treatment, the better their chances of staying in recovery. Maybe community service could be tied in as a part of the program – we give to you, you give back to us. Or base the programs on the half-way house model.
The Department might say, “Well, we are not in the half-way house business.” Well, then justify to me why we are not changing the way detoxification centers operate.
These longer term programs could allow for patients first entering to have an ‘outpatient’ detoxification while starting the program.
The detoxes we currently have open could then be utilized for the more compromised or ‘risky’ patients; such as those on benzodiazepines or alcohol.
I believe there is a high probability that by having these longer term programs we would see a decrease in the need for “acute” detoxification beds for everyone as we presently have.
More detoxification beds?
How about we work together to improve the ones we have and establish longer term programs that will decrease the need for such in the first place.
We here in Massachusetts have learned that our Department of Public Health plans to do just that; another detoxification unit with a floor staff of limited experience due to the fact that the money tends to go up into administrative roles rather than to those ‘working the floors.’ By improving the quality of the detoxification centers maybe we would find that we actually have enough – Better treatment, the higher the probability of continued recovery.
I can’t imagine the ‘evidenced based results’ being that great from the current structure of our detoxification centers in the way they are operated at the present time. Again, 'the longer a person is in treatment, the better the chance of their staying in recovery.'
People are lucky if they can get into a transitional program for thirty days post detox. So a detox stay of three to five days will insure recovery? I think not.
The fact of the matter is the insurance companies are now discussing ‘outpatient’ detoxification from opiates. Some have already started to do this. Most of our detoxifications at the present time (our state) are for heroin; either alone or in combination with other drugs.
‘Don’t talk about problems if you are not willing to discuss possible solutions.’
I am willing.
Instead of more detoxification centers, why are we not thinking in terms of sixty or ninety day programs? Again, the longer a person is in treatment, the better their chances of staying in recovery. Maybe community service could be tied in as a part of the program – we give to you, you give back to us. Or base the programs on the half-way house model.
The Department might say, “Well, we are not in the half-way house business.” Well, then justify to me why we are not changing the way detoxification centers operate.
These longer term programs could allow for patients first entering to have an ‘outpatient’ detoxification while starting the program.
The detoxes we currently have open could then be utilized for the more compromised or ‘risky’ patients; such as those on benzodiazepines or alcohol.
I believe there is a high probability that by having these longer term programs we would see a decrease in the need for “acute” detoxification beds for everyone as we presently have.
More detoxification beds?
How about we work together to improve the ones we have and establish longer term programs that will decrease the need for such in the first place.
Too Far To Go
With his nineteen years on the earth, Nick was one of the younger patients. This was his second attempt at trying to get clean and sober. He had previously sought treatment less than a year before.
When asked on admission how long he had stayed sober for after his first admit he stated, “Oh, for about twenty minutes after I left.”
His drug of choice was heroin, and he was up to about a gram a day. Also in the mix was a history of depression with an anxiety disorder.
I began a group one afternoon where I was discussing the support programs available for people that are dual-diagnosed, meaning that they have chemical dependency as well as another mental health issue(s). As usual, Nick could be seen slumped in his chair barely listening, just waiting for the time to pass until dinner.
When I began to talk about a specific program for people to consider he sat upright in his chair, looked at me and said, “Willy, you know where I live? That program is about forty miles from my house, how do you expect me to get there when I don’t even have a car?”
I smiled at him, “Nick, gee I don’t know. How were you able to get a ride the other night to a town fifty miles away to score a bundle of heroin?”
“Touché,” he said.
“I didn’t mean it as a touché,” I told him. The point I am trying to make is what are you willing to do for your recovery? You know what you were willing to do to keep your addiction going, but what are you willing to do now to keep it in remission?”
He looked at me, let out a little sigh, and then went back to his previous slumped position in the chair.
Those of us on staff learned several months after his discharge that he had died of a heroin overdose.
We can teach and educate people on the tools of recovery, coping skills, relapse prevention; we can work with them on setting up a viable discharge plan, we can attempt to motivate them, but, in the end…the decision is theirs alone.
When asked on admission how long he had stayed sober for after his first admit he stated, “Oh, for about twenty minutes after I left.”
His drug of choice was heroin, and he was up to about a gram a day. Also in the mix was a history of depression with an anxiety disorder.
I began a group one afternoon where I was discussing the support programs available for people that are dual-diagnosed, meaning that they have chemical dependency as well as another mental health issue(s). As usual, Nick could be seen slumped in his chair barely listening, just waiting for the time to pass until dinner.
When I began to talk about a specific program for people to consider he sat upright in his chair, looked at me and said, “Willy, you know where I live? That program is about forty miles from my house, how do you expect me to get there when I don’t even have a car?”
I smiled at him, “Nick, gee I don’t know. How were you able to get a ride the other night to a town fifty miles away to score a bundle of heroin?”
“Touché,” he said.
“I didn’t mean it as a touché,” I told him. The point I am trying to make is what are you willing to do for your recovery? You know what you were willing to do to keep your addiction going, but what are you willing to do now to keep it in remission?”
He looked at me, let out a little sigh, and then went back to his previous slumped position in the chair.
Those of us on staff learned several months after his discharge that he had died of a heroin overdose.
We can teach and educate people on the tools of recovery, coping skills, relapse prevention; we can work with them on setting up a viable discharge plan, we can attempt to motivate them, but, in the end…the decision is theirs alone.
Friday, April 27, 2012
How Effective Is A.A.??????
I belong to several addiction discussion groups on ‘LinkedIn.’ I really love (not really) when I see a discussion topic posted like the title of this blog.
Geez, talk about opening up Pandora’s Box! The discussion will usually start out fairly civil; at least for the first two or three comments anyway.
Then the ‘Ad Hominem Abusive’ (attacking the person rather than the argument) statements begin to roll. These people will try to veil their snide emotional remarks and comments with what they believe to be logical, rational statements.
They will quote statistics without reference, try to ‘impress’ the group discussion by citing their vast knowledge and experience. Others will go with the old narrow, “Well it worked for me” scenario.
Enough already people.
First of all, we know that A.A. does not take surveys or keep statistics on this type of information. Secondly, due to this fact, A.A. effectiveness cannot be viewed or measured on an “evidence based system.”
Therefore, effectiveness is of a subjective nature, not an empirically based one.
This is not to say that twelve step programs are not effective for many people – they are and can be. On the other hand, this does not mean they will work for everyone nor does it mean that they can be effective in and of themselves.
In a previous blog (http://willydrinkwater.blogspot.com/2012/04/substance-abuse-co-occurring-disorders.html) I mentioned the fact that I work primarily with those that have substance abuse coupled to co-occurring disorders; such as depression and bipolar disorder. Rarely will my clients benefit from traditional twelve step programs alone. Many will utilize them as their ‘base’ of recovery; however they may also be involved with individual & group therapies, twelve step programs such as DRA (dual recovery anonymous), nutrionists, psychopharmocologists, etc.
The question should be, “Is A.A. effective for the client; can it be effective for the client?”
Treatment plans should be ‘individualized.’ Not one size fits all, right? For instance, Cognitive Behavior Therapy does not conflict with A.A. As a matter of fact, in most instances it complements A.A. It can help a person to look at their value system and assist them in making needed changes.
Loyalty on the part of a therapist/counselor to a particular modality of treatment such as A.A. coupled to an indifference to the other modalities or mix of modalities can result in the client not being effectively served.
What is in the CLIENT’S BEST INTEREST.
Geez, talk about opening up Pandora’s Box! The discussion will usually start out fairly civil; at least for the first two or three comments anyway.
Then the ‘Ad Hominem Abusive’ (attacking the person rather than the argument) statements begin to roll. These people will try to veil their snide emotional remarks and comments with what they believe to be logical, rational statements.
They will quote statistics without reference, try to ‘impress’ the group discussion by citing their vast knowledge and experience. Others will go with the old narrow, “Well it worked for me” scenario.
Enough already people.
First of all, we know that A.A. does not take surveys or keep statistics on this type of information. Secondly, due to this fact, A.A. effectiveness cannot be viewed or measured on an “evidence based system.”
Therefore, effectiveness is of a subjective nature, not an empirically based one.
This is not to say that twelve step programs are not effective for many people – they are and can be. On the other hand, this does not mean they will work for everyone nor does it mean that they can be effective in and of themselves.
In a previous blog (http://willydrinkwater.blogspot.com/2012/04/substance-abuse-co-occurring-disorders.html) I mentioned the fact that I work primarily with those that have substance abuse coupled to co-occurring disorders; such as depression and bipolar disorder. Rarely will my clients benefit from traditional twelve step programs alone. Many will utilize them as their ‘base’ of recovery; however they may also be involved with individual & group therapies, twelve step programs such as DRA (dual recovery anonymous), nutrionists, psychopharmocologists, etc.
The question should be, “Is A.A. effective for the client; can it be effective for the client?”
Treatment plans should be ‘individualized.’ Not one size fits all, right? For instance, Cognitive Behavior Therapy does not conflict with A.A. As a matter of fact, in most instances it complements A.A. It can help a person to look at their value system and assist them in making needed changes.
Loyalty on the part of a therapist/counselor to a particular modality of treatment such as A.A. coupled to an indifference to the other modalities or mix of modalities can result in the client not being effectively served.
What is in the CLIENT’S BEST INTEREST.
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