“Oh I’m Bipolar, with Borderline Personality features, severe PTSD, not to mention I also have been diagnosed with bulimia, opioid dependency, etoh abuse, trichotillomania and grief/abandonment issues.”
Really?
“Oh yes, but I am on the right combination of 12 meds now and things are going, well, fairly smoothly. You know, except for the blurred vision, constipation, migraines, low white blood cell count, and occasionally passing out.
How long have you had these diagnoses?
“Since I saw my new doctor last month for the first time. Gosh, he is just the Best!”
Among things I find amazing is when I meet a new client for the first time and I ask them what their diagnosis is. He or she might say for example that they have been diagnosed with Bipolar Disorder. I will then go on to ask them what Type, I or II? They will look at me like I have three heads and usually respond with something to the effect, ‘what do you mean? You know the type that goes up and down.’
So let me get this straight, someone gives you a diagnosis and you don’t ask them what they are basing it on? Again, as I always emphasis just because a person has credentials after their name does not necessarily mean they are skilled. TRUST ME on this one. I have been working in the field for over twenty years and some of the most idiotic, moronic statements I have heard have come from the mouths of the so called “Experts.”
Might be nice if they told you specifically what criteria they were basing the diagnosis on, right? People often times feel intimidated or just leave it in their hands. ‘I can’t question them, after all they are the professional.’
Bullshit. Someone gives you a diagnosis look it up, read about it. Get all the information you can about. Self-Efficacy my friends. Be an informed consumer. You may find, ‘Hey, from my research I can see now that I had a substance induced mood disorder, not Major Depressive Disorder like they said I had, and I have been feeling better more every day since detoxing!’
Most important of all, YOU are not a Diagnosis, a Label. You are a HUMAN BEING with XYZ!
When I worked at the Somerville Hospital Detox (closed in 2009) when we did the “Wrap-Up” group at the end of the day we had four questions each patient would answer.
The first one was, “Tell us something about yourself.” Something other than the obvious. Yes we know you are an alcoholic or an addict or you would not be sitting here.
What else are you? “a Musician, Father, Friend, Caring Person, Dreamer, Plummer, Student, etc, etc, etc.
The addiction is a part of you, not the Totality!
Over twenty years I have seen the times when a certain diagnosis was the “Rage” such as ADD in the nineties and now we appear to be in the “Bipolar” era.
In 1994 people that were receiving disability checks for Chemical Dependency were informed that they would be losing their benefits unless they were diagnosed with another mental disorder.
Hence began the mad dash to the doctor’s office to get said secondary diagnosis. Often times these were established by those all knowledgeable in psychiatry - The Primary Care Physician! (Yea, eight to thirty hours in med school qualifies them right? Idiots).
Currently I am finishing up the book “Anatomy of an Epidemic” by Robert Whitaker. Yea, Psychiatry definitely needs to take a good hard look at itself. Pick up a copy. I am sure you will find it to be an eye opener to the say the least!
Website www.willydrinkwater.com
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Wednesday, February 26, 2014
Saturday, February 8, 2014
What's Up for the Addiction Field in 2014
Yes, it has been quite a while since I last blogged. Look for this to change starting tonight. Last year saw the beginning of insurance companies 'changing' what they will pay for, or more importantly, NOT pay for.
One of their goals is to make this year be the year that all opiate detoxifications will be done on an outpatient basis - no more medical addiction treatment units. If a person does have concurrent medical issues in addition to their opiate dependency, then yes they can have a medical bed. But that's it, no addiction program. One hospital in the Boston area has an addiction counselor visit them while they are being medically detoxed. They are limited essentially to providing the patient with aftercare information and possibilities.
I guess that is better than nothing though.
As for detoxification from alcohol and benzodiazepines they are thinking along the same line as the opioids. Unless there is an accompanying medical condition they want this to be on an outpatient basis. This may be more difficult to implement due to the seizure risk in these two types of detoxification.
At least with the opiates their rationalization is there are established methadone and suboxone clinics that can provide this service and there is not the seizure risk that the two aforementioned bring to the table. Although from an observational point of view these clinics tend to promote maintenance (form of harm reduction) as opposed to detoxification. I have yet to counsel someone that told me the day they went on suboxone or methadone the clinic discussed a proposed titration date & plan to get them off.
Hey, we're talking big business, right?
Last year saw 'designer' drugs in the news and they are carrying over to this year as well Drugs such as "Mollies" made their appearance on the Club Scene often with disastrous results: (http://blogs.cbn.com/healthyliving/archive/2013/09/05/new-recreational-drug-molly-popular-but-deadly.aspx). Bath Salts, also known as MDPV are still on the scene and can cause serious mental and physical health issues (http://www.abovetheinfluence.com/facts/drugsbathsalts).
Last summer and again recently overdose deaths have occurred due to street heroin being cut with acetyl fentanyl. Rather than decreasing the potency, acetyl fentanyl is five times the strength of heroin (http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/).
The latest threat is a drug called "Krokodil" which is a form Desomorphine which is a derivative of morphine. Originally started in Russia due to a heroin shortage, this drug 'rots' the body from the inside out. I have read the life expectency of a user of this drug is usually around one year. (http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html?utm_hp_ref=krokodil).
This year should be the year that licensed alcohol drug counselors in the Commonwealth are finally granted their insurance billing rights (projection of December). About time. Those that are licensed as 'Addiction Specialists' (LADC-I) have had to sit on the sidelines while disciplines with minimal (if any) experience have been working with the population. Not a knock on them, at least someone has been working with them. It only makes sense to give the people with addiction issues the option of seeing an addiction specialist among the possible choices.
As far as "Recovery Coaches" I am not too keen on the whole concept for several reasons. I see this as deluding the addiction profession and downplaying the seriousness of addiction. Also, the minimal training required to obtain the designation.
Another issue has been the increase in detoxification beds while transitional programs (usually for thirty days after detox) lagged behind in numbers. Just recently new transitional program starts have been announced. This is a positive note for the longer a person is in treatment, the higher their probability of remaining sober. Prior to these announcements a person could complete detox and not have a transitional bed available to them.
That's it for the episode. Look for this blog to return to a weekly format.
One of their goals is to make this year be the year that all opiate detoxifications will be done on an outpatient basis - no more medical addiction treatment units. If a person does have concurrent medical issues in addition to their opiate dependency, then yes they can have a medical bed. But that's it, no addiction program. One hospital in the Boston area has an addiction counselor visit them while they are being medically detoxed. They are limited essentially to providing the patient with aftercare information and possibilities.
I guess that is better than nothing though.
As for detoxification from alcohol and benzodiazepines they are thinking along the same line as the opioids. Unless there is an accompanying medical condition they want this to be on an outpatient basis. This may be more difficult to implement due to the seizure risk in these two types of detoxification.
At least with the opiates their rationalization is there are established methadone and suboxone clinics that can provide this service and there is not the seizure risk that the two aforementioned bring to the table. Although from an observational point of view these clinics tend to promote maintenance (form of harm reduction) as opposed to detoxification. I have yet to counsel someone that told me the day they went on suboxone or methadone the clinic discussed a proposed titration date & plan to get them off.
Hey, we're talking big business, right?
Last year saw 'designer' drugs in the news and they are carrying over to this year as well Drugs such as "Mollies" made their appearance on the Club Scene often with disastrous results: (http://blogs.cbn.com/healthyliving/archive/2013/09/05/new-recreational-drug-molly-popular-but-deadly.aspx). Bath Salts, also known as MDPV are still on the scene and can cause serious mental and physical health issues (http://www.abovetheinfluence.com/facts/drugsbathsalts).
Last summer and again recently overdose deaths have occurred due to street heroin being cut with acetyl fentanyl. Rather than decreasing the potency, acetyl fentanyl is five times the strength of heroin (http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/).
The latest threat is a drug called "Krokodil" which is a form Desomorphine which is a derivative of morphine. Originally started in Russia due to a heroin shortage, this drug 'rots' the body from the inside out. I have read the life expectency of a user of this drug is usually around one year. (http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html?utm_hp_ref=krokodil).
This year should be the year that licensed alcohol drug counselors in the Commonwealth are finally granted their insurance billing rights (projection of December). About time. Those that are licensed as 'Addiction Specialists' (LADC-I) have had to sit on the sidelines while disciplines with minimal (if any) experience have been working with the population. Not a knock on them, at least someone has been working with them. It only makes sense to give the people with addiction issues the option of seeing an addiction specialist among the possible choices.
As far as "Recovery Coaches" I am not too keen on the whole concept for several reasons. I see this as deluding the addiction profession and downplaying the seriousness of addiction. Also, the minimal training required to obtain the designation.
Another issue has been the increase in detoxification beds while transitional programs (usually for thirty days after detox) lagged behind in numbers. Just recently new transitional program starts have been announced. This is a positive note for the longer a person is in treatment, the higher their probability of remaining sober. Prior to these announcements a person could complete detox and not have a transitional bed available to them.
That's it for the episode. Look for this blog to return to a weekly format.
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