What next...

So there I am working in a Partial Hospitalization Program the other day and one of the patients that I am case managing comes up to me and tells me that a transitional program will not take him because he has had suicidal thoughts within the past two years. Not suicide attempts, suicidal thoughts. My first reaction is, "Are you shitting me!" (thought, but not expressed out loud for the sake of professionalism).

So let me get this straight, because the guy felt suicidal several times when he was drunk, that is a reason to deny him admittance to a transitional holding program???

I know people that every day of their lives feel suicidal but they don't act on it.

So I call the director of this program and we end up playing telephone tag. One voice mail from her tells me, "yes, we do look at each case one by one."

Then to add insult to injury, the next voice mail informs me that they would not take the patient "anyway" due to his "psych" issues and the fact he is on medication and they do not have a nurse practitioner. Furthermore, they only treat addiction.

Lets see, the guy has depression in on an anti-depressant, Celexa. He has outpatient providers for his "Psych" issue and would be coming with a thirty day supply. In the case of a person being on a benzo or something like neurontin which is being used on the street to enhance the heroin high, well yea, one would definitely take it case by case. But Celexa, are you kidding me??

As far as they "only" treat addiction, that is really sad. For the fact is, the majority of people that keep returning to formal treatment have another issue(s) going on that are not being addressed. Maybe not Axis I but I would tend to think at least Axis II (but what do I know. I am only entering my 21st year in the field and have worked literally every modality of treatment; from shelter, to inpatient psych/addiction, to outpatient, hospital detoxes, open detoxes, etc).

I find it to be a sad state of affairs when people working in the field either have all addiction training and limited psych, or all psych training and limited addiction.

Being a teacher on substance abuse and co-occurring disorders with addiction students at a local university, I emphasize to them if your program does not have the trained staff to work with those that are dual-diagnosed, you should at least know of the resources available for this population.

Maybe it is about time that DMH (psych issues) and DPH (addiction issues) truly discusses merging together (such as they have done in New York state).
I understand that each is a 'fiefdom' that does not want to give up power to the other. But would this not really benefit that patient?

My response to a discussion group on "Is Addiction a Disorder of Choice," being discussed on the "Linkedin Addictions Professional Group.

I have not read in these comments (please inform me if I have missed them) the role that co-occurring disorders may play in relapse (self-medication). In Gene Heyman's book, "Addiction: A Disorder of Choice," the research implies that those with multiple relapses more often than not, have a co-occurring disorder also present. Try telling a person with Bipolar Disorder off his meds; that has been awake for three or four days; has attended six meetings to, "just go to another meeting." I realize having worked in this field for nineteen plus years now that a clinician has to be cognizant of "substance induced mood disorder." However, if there is documentation of substantial sober time where "symptoms" of other mental health issues are present, all the twelve step meetings in the world are not going to insure sobriety. I am not twelve step bashing, actually the meetings can still be the main modality with other treatment for the co-occurring disorder. I find that twelve step meetings such as DRA and DBSA meetings can be even more beneficial then traditional twelve step for those with substance abuse and co-occurring disorders. Again, the key is recognizing the co-occurring disorder in the first place.
As far as brain imaging goes, is the imaging the result of sustained use of a particular drug? Would this be the resultant imaging for anyone with continued use? The imaging is interesting, but how does it assist me in helping the client to help themselves to maintain sobriety? It really doesn't. Interesting, but useless from a counseling/therapist aspect.
Disease or not, the issues remain the same to be dealt with.
By William R. Drinkwater, M.Ed, LADC-I, CADAC-II - Adjunct Professor UMASS-Boston/Cambridge College

Healthy vs. Unhealthy

Among the conclusions that I have arrived at after 18 plus years in the field of addiction and mental health, is the concept of Healthy, versus Unhealthy. This concept has formed the cornerstone not only of my interaction with clients, but as a guide in my personal life.

Morals, beliefs, and value systems, can vary from person to person. I have found over the years that young counselors in particular, may not be aware as to how much their own convictions may color how they perceive their clients and their clients needs.

Right or wrong should not come into the therapeutic relationship equation ever.

Although people can differ on issues of morals, values and beliefs (greatly for that matter), usually people can agree if something is healthy or unhealthy.

For example: If a person drinks a quart of scotch for breakfast everyday, perceptions regarding this can vary depending upon the ‘values’ of those making the observation. For instance, if I were an 18 year old and in a college fraternity, my fellow fraternity brothers might view this as a positive; “wow, how can he do that, awesome.” Then again, if I was 25 years old, married with children, people might have a different perception; “what a loser, how can he subject his family to that?”

In both cases, I feel relatively confident that the people making the observation would both agree that what the person is doing is definitely “Unhealthy.”

This is the reason why I try to always think in terms of healthy vs. unhealthy. Whether it be in my therapeutic relations with clients, or, in my relationship with myself.

Ticked Off!

You know, I don't know what ticks me off more. The fact that I keep seeing employment opportunities that call for LICSW's or LMHC's with Substantial Substance Abuse Experience, or, the last time "We" LADC's had a chance to state our case at the State House before the Insurance Committee for third-party billing rights and only about ten of us showed up. That's right, a measly ten people.

Do you think they took us seriously? Obviously not! Those of us that are LADC's should learn a lesson from the LICSW's and LMHC's.

If you want to be taken seriously, then Organize, Organize, Organize. Like they have and continue to do. As it stands at the present time we have a meaningless license. What good is a license if it does not advance our position both financially and increase our professional stature?

It doesn't.

Not to mention the fact that Department of Public Health which licenses us, does not require programs that accept their money to hire us. I am not saying that "all" the positions within a program should be LADC's.

However, it might be nice if the lead roles went to us rather than LICSW's or LMHC's, with "Substantial Substance Abuse Experience."

I mean come on. You licensed us. You require a Master's degree in a behavorial science in addition to a CADAC. Some people have suggested that the reason we still do not have third-party billing rights is due to the number of CADAC's without a Masters' that were "grand-fathered" in.

Well guess what. The same situation was present when the LMHC's were "grand-fathered" in. So...what's the difference?

The LMHC's had a formidable presence at the State House when their third-party billing issue was being discussed, that's the difference.

I understand our profession as addiction counselors is still being looked at through the origins of our beginning. Namely, "Hey, got six months clean? O.K., then we'll make you an addiction counselor."

Those days are long over. As a matter-of-fact, many of us in the addiction profession have been working with dual-diagnosed people for years; from detoxification centers to inpatient psychiatric units.

Maybe the day will come when I read an employment opportunity that says, LADC-I with "Substantial Psych Experience."

Then again, maybe not.