While I was driving home from Plymouth tonight after teaching my mind kept thinking of all the overdose deaths we have had in the Commonwealth of Massachusetts.
We are one of fifteen states where the number one cause of accidental death is drug overdose (opiates); number two, car fatalities. In the other thirty-five states the inverse is true.
One of my students tonight asked when I thought addiction counselors would be required to know more in the field of psychology. I told him that is already the case for those of us that are LADC-I's. In addition to our training in addiction, we are also required to have a Masters in a behavioral science (psych).
I heard a few weeks ago that the proposed bills before the state house of representatives and senate are now out of committee that pertain to LADC-I's being granted vendorship. Meaning that discussion can now take place on the house & senate floors.
The information sheet on these identical bills is as follows:
An Act To Improve Access to Alcohol and Other Drug Clinical Services
S473 - Senator Steven Tolman, Senator Kenneth Donnelly, Representative James O'Day
H332 - Representative Martin Walsh, Senator Jack Hart, Representatives James O'Day,
Louis Kafka, Nick Collins, Sean Garballey, Kathi-Anne Reinstein
What These Identical Bills Do:
Both require insurers to reimburse for the services of an Alcohol and Drug Counselor-I. Insurance reimbursement will permit individuals and their families who suffer from, or are affected by alcohol and other drug abuse or addiction, to choose the human services professional most appropriate to treat their substance abuse
Rationale:
In Massachusetts, according to a National Survey of Drug Use Health Survey, Massachusetts ranked 4th highest for adult binge drinking, and 5th highest rate of illicit drug use in the country. An Alcohol and Drug Counselor-I is uniquely qualified to treat individuals and their families with substance use disorder due to the specific education and skill required for alcohol and other drug counseling
Licensure:
Alcohol and Drug Counseling is a licensed behavioral science profession in the state of
Massachusetts. The Department of Public Health is the licensing agency for Alcohol and Drug Counselors.
Education:
A Licensed Alcohol and Drug Counselor-I
• is required to have a masters degree in his/her discipline, which includes a
practicum and three years full-time, supervised work experience.
• practices according to guidelines set by MA Department of Public Health and according to nationally mandated standards for practice - including examination and certification procedures, code of ethics, and standards of education.
Cost:
* Reimbursement for Alcohol and Drug Counselors is cost-effective:
An Alcohol and Drug Counselor-I can provide clinical services more inexpensive compared to some other licensed professionals currently reimbursed by insurance companies.
Dishearteningly however is the fact that these two bills will more than likely not be decided upon before the end of the spring term and will have to wait until the fall.
How many more overdose deaths need to occur before those of us that are specifically trained in addiction are allowed to enter the arena?
I am not saying that the other disciplines currently involved are not making a difference. What I am saying is that we LADC-I's are not being allowed to participate in this current crisis.
When politics are placed above human life something is terribly wrong.
Wednesday, February 22, 2012
Tuesday, February 14, 2012
The Success of Failure
Three to five days for detoxification, then maybe a thirty day transitional facility if a bed is available, then maybe a halfway house if a bed is available.
Some people speak of the fear of success. I on the other hand choose to ‘flip’ it and say the success of failure.
What the heck do I mean by that? Simply put, our system for addiction treatment more often than not, sets people up for failure and a return to treatment.
Detoxification is looked at strictly in terms of a person’s vital signs; not their mental status in areas such as craving, anxiety, depression, etc. We are told this can be treated by outside providers (yea, if they make it there in their state of mind).
So when a person leaves detox and ends up back in a month, some people are amazed they ‘broke out’ after being ‘treated’ for their addiction. I have heard staff make comments such as, “Jeez, what is wrong with them that they are back again, or, what are they stupid?”
Nice, real f-ing nice. Great compassion and empathy. Maybe, just maybe, it has more to do with the system we have in place than the individual trying to ahem, ‘make-it!’ If you can’t help an addict, then don’t…I’m sure many of you catch my drift here, huh?
Hearing staff make these comments I always confront them with the suggestion ‘why don’t you think about what you can do differently this time to help them; otherwise you are just another part of the problem – not the solution.’
When I break out I know I can return to treatment and there will be people there that care about me more than I care about myself. Hence, the ‘Success of Failure.’
Unfortunately over time several factors come into play. Facilities become hesitant to admit those that are accumulating numerous admissions; at the detoxification, transitional, and halfway house levels. The rational is, ‘well, they have gotten as much as they can from our program so what difference will this admission make.
Families begin to feel burned-out, especially if they have not been getting help for themselves (one does not find a lot of alcoholics or addicts in long-term mental facilities; that is where one can find the friends and families that have been trying to make sense out of their loved ones addictions!)
Now we find the person without family and program supports, drinking a half-gallon a day in Central Square, homeless and hopeless. They no longer try to rationalize, minimize, or justify their use; “I drink because I am a drunk and this is how I am going to die.”
End of story.
The only chance to instill hope again is to get them into detox and show them our humanity, compassion and empathy.
It’s a shame the system cannot get it right in the first place, huh?
This is why I keep writing and advocating for the ‘underdog.’ I can remember when part of being an American was cheering for the underdog.
Some people speak of the fear of success. I on the other hand choose to ‘flip’ it and say the success of failure.
What the heck do I mean by that? Simply put, our system for addiction treatment more often than not, sets people up for failure and a return to treatment.
Detoxification is looked at strictly in terms of a person’s vital signs; not their mental status in areas such as craving, anxiety, depression, etc. We are told this can be treated by outside providers (yea, if they make it there in their state of mind).
So when a person leaves detox and ends up back in a month, some people are amazed they ‘broke out’ after being ‘treated’ for their addiction. I have heard staff make comments such as, “Jeez, what is wrong with them that they are back again, or, what are they stupid?”
Nice, real f-ing nice. Great compassion and empathy. Maybe, just maybe, it has more to do with the system we have in place than the individual trying to ahem, ‘make-it!’ If you can’t help an addict, then don’t…I’m sure many of you catch my drift here, huh?
Hearing staff make these comments I always confront them with the suggestion ‘why don’t you think about what you can do differently this time to help them; otherwise you are just another part of the problem – not the solution.’
When I break out I know I can return to treatment and there will be people there that care about me more than I care about myself. Hence, the ‘Success of Failure.’
Unfortunately over time several factors come into play. Facilities become hesitant to admit those that are accumulating numerous admissions; at the detoxification, transitional, and halfway house levels. The rational is, ‘well, they have gotten as much as they can from our program so what difference will this admission make.
Families begin to feel burned-out, especially if they have not been getting help for themselves (one does not find a lot of alcoholics or addicts in long-term mental facilities; that is where one can find the friends and families that have been trying to make sense out of their loved ones addictions!)
Now we find the person without family and program supports, drinking a half-gallon a day in Central Square, homeless and hopeless. They no longer try to rationalize, minimize, or justify their use; “I drink because I am a drunk and this is how I am going to die.”
End of story.
The only chance to instill hope again is to get them into detox and show them our humanity, compassion and empathy.
It’s a shame the system cannot get it right in the first place, huh?
This is why I keep writing and advocating for the ‘underdog.’ I can remember when part of being an American was cheering for the underdog.
Sunday, January 29, 2012
"Are You In Recovery?"
“Are You In Recovery?” This is a question posed to me at least a half-dozen times a week by either a patient or a client.
Some people in the field adamantly believe one should never state either way. Others think in terms of case by case. Still others believe in telling their whole story if they are in recovery.
Me, first I will ask them why they feel the need to know this. Most will say they feel only someone that has been through what they have can help them. After such a response I will ask them what is their understanding of counseling and their expectations of therapy.
Many times after their responses I will suggest they find a twelve-step group and acquire a sponsor they can identify with if that is what they are looking for.
I explain that my role is not to develop a mutual relationship with them, a friendship (although the relationship can be friendly). We are not going out for coffee after the session nor are you going to learn all about me.
I view the issue on a case by case basis. I may say, yes I am in recovery. That is as far as I go with disclosure. I further state that what works for me may not work or be appropriate for them. If I tell them what 'works' for me it may induce in them an expectation that they will automatically have the same results.
Suggestions are based on what works for the majority of the people I see on a regular basis and current research. To state what ‘works’ for myself is not fair to them. What, if they cannot do it my way then they cannot remain sober? Just not fair – nor true.
Their story should be the basis of the counseling sessions – not mine. When teaching I always emphasize to my students that if one utilizes Motivational Interviewing correctly, they will never have an opportunity to tell their own story.
The role I play is that of a guide, a sort of psych Sensei. Through mutual dialogue I pose questions to them based on what they are saying to me. The answers are for themselves to hear, not necessarily for me to hear. Many times I will assign readings to increase their self-efficacy; with discussion at the beginning of the next session.
Yea, I am in Recovery. Now let’s move onto the important presenting issue, “YOUR RECOVERY.”
Some people in the field adamantly believe one should never state either way. Others think in terms of case by case. Still others believe in telling their whole story if they are in recovery.
Me, first I will ask them why they feel the need to know this. Most will say they feel only someone that has been through what they have can help them. After such a response I will ask them what is their understanding of counseling and their expectations of therapy.
Many times after their responses I will suggest they find a twelve-step group and acquire a sponsor they can identify with if that is what they are looking for.
I explain that my role is not to develop a mutual relationship with them, a friendship (although the relationship can be friendly). We are not going out for coffee after the session nor are you going to learn all about me.
I view the issue on a case by case basis. I may say, yes I am in recovery. That is as far as I go with disclosure. I further state that what works for me may not work or be appropriate for them. If I tell them what 'works' for me it may induce in them an expectation that they will automatically have the same results.
Suggestions are based on what works for the majority of the people I see on a regular basis and current research. To state what ‘works’ for myself is not fair to them. What, if they cannot do it my way then they cannot remain sober? Just not fair – nor true.
Their story should be the basis of the counseling sessions – not mine. When teaching I always emphasize to my students that if one utilizes Motivational Interviewing correctly, they will never have an opportunity to tell their own story.
The role I play is that of a guide, a sort of psych Sensei. Through mutual dialogue I pose questions to them based on what they are saying to me. The answers are for themselves to hear, not necessarily for me to hear. Many times I will assign readings to increase their self-efficacy; with discussion at the beginning of the next session.
Yea, I am in Recovery. Now let’s move onto the important presenting issue, “YOUR RECOVERY.”
Wednesday, January 18, 2012
Return...
Over the past several weeks I have had several friends ask me why I have not blogged in a long, long, time. I could go with a routine line such as, "I've been too busy," or, "I've been involved in other projects."
The truth is multi-faceted. From a feeling at times of general malaise regarding the whole field of addiction of which I am a part, to not believing I can make a difference. Last week I began to read a blog by a new friend that chronicles her personal journey in the arena of mental health. Her blog has motivated and inspired me to hit the keys again to state my thoughts and feelings on addiction and all of mental health for that matter.
Lately I read of a treatment facility that has a ninety percent "success" rate (of course how they derived at that number and what exactly is their definition of success is never stated); to the seemingly almost instant prescribing of medications such as anti-depressants and mood stabilizers upon completion of a detoxification (or while still in detox for that matter).
We live in the ‘give me a pill and fix me right now’ society.
Yes, I understand about taking a good bio/psych/social and noting 'mood' throughout their history (when using and not using); Yes, I understand about substance induced mood disorder and all the ramifications; Yes, I understand it is important to look at family of origin patterns that may be present. As far as I am concerned, medication is all too often seen as the first line of action, rather than based on a case by case consideration.
One area I have a difficult time understanding is why most addiction treatment units do not have groups on such topics as nutrition and exercise. Talk about two areas that can affect mood, huh?
Recently I was presenting a group at one of the facilities where I work and asked the patients how many experience anxiety. Three-quarters (15 out of 20) raised their hands. Next I asked those that had raised their hands whether they smoked and drank coffee. Not surprisingly 13 did both, while the remaining two did not smoke but did drink coffee. I am not stating that nicotine and caffeine are the causation of their anxiety. However, I definitely believe that the ingestion of nicotine and caffeine is not helping to alleviate their anxiety by any stretch of the imagination.
When I further asked them about their diets the majority of them just laughed. Before groups I remind them that I can arrange nutrition consults while they are in the program. It is a rare occurrence for anyone to take me up on my offer. Without an actual group(s) on nutrition they remain ignorant of the benefits.
The same goes for exercise. The benefits of exercise on mood has been empirically proven over the years. One just has to “Google” addiction & exercise to see the vast research on this modality. So why are the majority of addiction treatment units not offering groups on this topic? I have no idea as to this possible answer.
Motivation back in place I will blog at least once a week. Thanks for the read.
The truth is multi-faceted. From a feeling at times of general malaise regarding the whole field of addiction of which I am a part, to not believing I can make a difference. Last week I began to read a blog by a new friend that chronicles her personal journey in the arena of mental health. Her blog has motivated and inspired me to hit the keys again to state my thoughts and feelings on addiction and all of mental health for that matter.
Lately I read of a treatment facility that has a ninety percent "success" rate (of course how they derived at that number and what exactly is their definition of success is never stated); to the seemingly almost instant prescribing of medications such as anti-depressants and mood stabilizers upon completion of a detoxification (or while still in detox for that matter).
We live in the ‘give me a pill and fix me right now’ society.
Yes, I understand about taking a good bio/psych/social and noting 'mood' throughout their history (when using and not using); Yes, I understand about substance induced mood disorder and all the ramifications; Yes, I understand it is important to look at family of origin patterns that may be present. As far as I am concerned, medication is all too often seen as the first line of action, rather than based on a case by case consideration.
One area I have a difficult time understanding is why most addiction treatment units do not have groups on such topics as nutrition and exercise. Talk about two areas that can affect mood, huh?
Recently I was presenting a group at one of the facilities where I work and asked the patients how many experience anxiety. Three-quarters (15 out of 20) raised their hands. Next I asked those that had raised their hands whether they smoked and drank coffee. Not surprisingly 13 did both, while the remaining two did not smoke but did drink coffee. I am not stating that nicotine and caffeine are the causation of their anxiety. However, I definitely believe that the ingestion of nicotine and caffeine is not helping to alleviate their anxiety by any stretch of the imagination.
When I further asked them about their diets the majority of them just laughed. Before groups I remind them that I can arrange nutrition consults while they are in the program. It is a rare occurrence for anyone to take me up on my offer. Without an actual group(s) on nutrition they remain ignorant of the benefits.
The same goes for exercise. The benefits of exercise on mood has been empirically proven over the years. One just has to “Google” addiction & exercise to see the vast research on this modality. So why are the majority of addiction treatment units not offering groups on this topic? I have no idea as to this possible answer.
Motivation back in place I will blog at least once a week. Thanks for the read.
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