Substance Abuse / Co-Occurring Disorders & 12 Step Programs
When I educate patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for your Co-Occurring Disorder.
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are dual-diagnosed utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. In addition, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
However, for those that are truly dual-diagnosed more often than not these meetings will not be enough in and of themselves for maintaining sobriety and balance.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was the client had been awake for five days and had attended eight meetings. What he really needed at that time was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now is that people can become extremely paranoid, psychotic, and suicidal if they have been awake for three or four days in a row.
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
Example: “Bring the body the mind will follow.” Not if the mind is on Jupiter.
I recently had a patient I was working with inform me that his AA sponsor was telling him to get off the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I inform them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/). In their own words: The Depression and Bipolar Support Alliance is a non-profit organization providing support groups for people with depression or bipolar disorder as well as their friends and family.
The largest group within these meetings is “Double Trouble.” This group is for people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people not only talk about their addiction issues, they also discuss other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to other support groups and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I had a suggestion for them. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials needed to start a group of your own. They liked that idea (Hopefully they have done so).
Sunday, February 21, 2016
Monday, September 7, 2015
What Stigma?????
I can remember growing up in the sixties in an extremely affluent town in Connecticut. There were no alcoholics - only problem drinkers or those who could not hold their liquor. A sign of the times I guess, the country club attitude, or perhaps a combination of both. If you had a loved one with a mental health issue they were just “eccentric” Un-huh, that’s why every spring when they would go off their meds then run through the streets naked. Just eccentric.
No alcoholics, No mental health issues – therefore, no stigma.
God forbid, if you had a loved one that died of cirrhosis from alcoholism in those days. You begged the doctor to put anything down on the death certificate but that! Maybe call it a heart attack or some incurable disease.
As if your neighbors and friends did not know the truth. It was just not discussed. Well openly anyway.
Zoom ahead to now. Addiction is more openly discussed in families and social settings than ever before. Yet at times one can see that stigma is still prevalent and often ignored or downplayed. How else can one explain that up until a few years ago if a person was civilly committed in Massachusetts (Section 35) for mandated addiction treatment they would be sent to a correctional facility? That’s right a correctional facility, not a treatment facility.
I am glad to see that this ‘stigma’ piece has changed.
There are still those in our society that mumble, ‘you know those people want to be that way.’ I always find it interesting when these people change that attitude when it is a member of ‘their’ family is suddenly having an addiction issue. I guess it is just not the same thing.
Those people want to be that way? You know, I have yet to see it on a resume, ‘Professional Addict/Alcoholic.’ Yea I’m sure when they were growing up they were thinking, ‘you know, someday I want to become an addict/alcoholic; homeless, jobless, walking the streets, drinking a half-gallon of vodka a day.’ Yup, that’s what I want to do.
People who make those types of statements show their ignorance, they are part of the problem – not the solution.
There are other areas of mental health often times shrouded in stigma and secrecy. Why else would a family not talk about ‘Uncle Tony’ who has not worked in two years due to his depression, or, no one talks about the times when Grandma would make everyone a Sunday morning breakfast clothed only in an apron because she was in a full-blown episode of mania.
In the case of depression, one might hear encouraging words from family such as: ‘what do you have to be depressed about, just pick yourself up by the bootstraps, you know if you only had a job...
Gee, those motivating statements should do the trick. I do not understand how ‘putdowns’ of that type can be considered motivating. Yet I will hear family members say these statements during a meeting with their loved one.. Can someone explain to me how that works?
Yet these are statements that patients/clients tell me they can go through on a daily basis. There are support groups for the friends and families of those with addiction and/or other mental health issues.
Often times the patients/clients I work with tell me their families are not willing to attend such groups to learn about their illnesses due to the beliefs I stated previously.
The suggestion I make to them in that case is, look directly at them and say something to the effect, ‘you say you love me, and that you care about me, yet you won’t attend a group to learn about my illness…’ Some fellow therapists have told me this is unethical for me to suggest – so be it. I advocate for my patients/clients, bottom line.
We need to continue to have dialogue and education on addiction and mental health issues; we need to do away with ‘blanket’ statements that allow us to turn our heads away from those that are in need. We “all” need to be part of the ongoing solutions.
There is no place for ignorance and stigma if we truly care about our fellow human beings.
Tuesday, September 1, 2015
Therapist? Then You Need A Therapist…
Counter-transference, secondary trauma, boundary issues, etc. Issues such as these can build up and ‘burn out’ a clinician if not addressed over a period of time. When I am teaching a new group of addiction counseling students at UMASS-Boston this is one of the first topics I discuss with them.
The need to obtain a therapist for themselves.
Why, what is the big deal if I am already getting supervision? While supervision can be beneficial it will not necessarily address the underlying issues in depth. Time constraints, vulnerability, and the issue of not wanting to appear ‘unable’ to perform one’s duties can play into the limitations of supervision only.
I can recall instances over my years in field when I was extremely grateful to have my own therapist.
One time I was performing an intake with a 26 year old female recently to the U.S. from a Latin American country. When I got to the section of the intake asking about family and after asking her a question about her father her face became expressionless, her voice dropped an octave and she stared straight ahead and said ‘When I was seven years old men banged down the front door of our house and started beating my father up…I was hiding in a closet, the type that has slants in the door and I could see everything they were doing…they knocked him to the ground before they killed him…’ In the back of my mind I was screaming ‘are you f@#king kidding me!’ Toward the client I expressed appropriate empathy and spoke of wanting to line up clinicians that specialize in trauma issues.
For the rest of the day I was useless. I could not get her story out of my mind. When the day was over I was still thinking about it…walking to my truck, still thinking about, start my truck up, still thinking about. I turned my truck off, grabbed my cell phone and called my therapist. ‘Hey, do you have some time to see me this afternoon? I really need to talk about a situation that happened today. What, you have a full schedule? Well, I’m coming by anyway.’ (He found time for me).
Without dialogue with my therapist I probably would have taken this ‘situation’ home where directly or indirectly it would have affected my family – not to mention increasing distress to myself.
I always try to leave work at work.
Another time I had picked up a new client that had recently been released from prison after serving a term for vehicular manslaughter. I asked him how it felt to be out and he said he didn’t care if he had ever gotten out. He had been drunk driving and the passenger in his car had been killed in the accident. After more dialogue I learned that the passenger had been his twelve year old son he had been driving to a hockey game.
Another phone call to my therapist…
Willy is an educator at UMASS-Boston & Cambridge College where he teaches Substance Abuse & Co-Occurring Disorders as his principle course. He presents from a clinical, academic, and personal perspective. Recently he has started guest lecturing nationally at Universities, Colleges, and to Professional Organizations. His style is high energy, entertaining, and informative due in part to his previous life as a comedian and comedy writer.
Tuesday, June 9, 2015
Substance Abuse / Co-Occurring Disorders & 12 Step Programs
When I educate patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for your Co-Occurring Disorder.
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are dual-diagnosed utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. In addition, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
However, for those that are truly dual-diagnosed more often than not these meetings will not be enough in and of themselves for maintaining sobriety and balance.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was the client had been awake for five days and had attended eight meetings. What he really needed at that time was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now is that people can become extremely paranoid, psychotic, and suicidal if they have been awake for three or four days in a row.
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
Example: “Bring the body the mind will follow.” Not if the mind is on Jupiter.
I recently had a patient I was working with inform me that his AA sponsor was telling him to get off the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I inform them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/). In their own words: The Depression and Bipolar Support Alliance is a non-profit organization providing support groups for people with depression or bipolar disorder as well as their friends and family.
The largest group within these meetings is “Double Trouble.” This group is for people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people not only talk about their addiction issues, they also discuss other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to other support groups and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I had a suggestion for them. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials needed to start a group of your own. They liked that idea (Hopefully they have done so).
Share on LinkedInShare on FacebookShare on Google PlusShare on Twitter
Friday, April 3, 2015
The New “Breed” of Addiction Counselors
The primary course I teach at the University of Massachusetts-Boston is ‘Addiction & Co-Occurring Disorders.’ This is in the Addiction Counselor Education Program which leads one to being eligible to become a certified and/or licensed addiction counselor. One of the first videos they see features Kim Mueser from Boston University (https://www.youtube.com/watch?v=cnUv-869AS8) discussing, ‘Sequential, Parallel, and Integrated Treatment.’
Many (if not most) of the addiction counseling students I encounter these days want to learn more about: CBT, DBT, EMDR, Affective Disorders, Personality Disorders, Trauma & Relapse, Smart Recovery, etc. They are more open to critical thinking and empirical studies (which either confirms or repudiates their views).
If they are in recovery themselves many understand now that what works for them may not work for someone else. Treatment should be based on the patient/client’s ‘story’ not on theirs. Do you really want to set-up an expectation based on what works for you? Then if they fail what do you say, ‘Ah, you didn’t work it the way I laid it out for you.’
When I began in the field some twenty-five years ago Twelve Step was the “Answer.” Considered by many to be the “only” answer. While Twelve Step can always be the base of a person’s recovery or at least part of the answer (if counselor and client decide together it is a good fit) it may not be enough in and of itself.
Try telling someone with a severe trauma history that well, you should get some clean time before you address those issues. Oh that should work out well. Let’s see, they are not self-medicating the flashbacks, they are in agony, and you think a meeting in and of itself will be enough? (check the NIDA studies on this topic)
Please note I am not attacking Twelve Step Programs. Many of us that are dual-diagnosed utilize Twelve Step as our base but we are also involved with other types of groups (guess I am out of the closet now, huh? lol).
Over the years the other disciplines would look at us as a ‘para-profession’ (many still do). You know, those addiction counselors think that Twelve Step is the answer to everything and conversely many in the addiction field looked at psych and felt all they wanted to do is get everyone on medications.
Maybe the attitude was also the result of the early days of addiction counseling; “Oh, you have six months sober, we’ll make you a counselor now.” While the times have changed with the establishment of addiction counseling education programs the attitude about us is still pervasive.
Addiction Counseling Education Programs such as the one I am involved in offer my course as an elective, not a requirement. Conversely, the other disciplines offer maybe one or two addiction courses (if that) and those are electives as well.
Something is wrong with this picture. I suggest to my students that if they really want to learn about addiction and mental health they should work for a year or two with the street people and/or inpatient psych/addiction. Get your clinical from the ground up.
Willy is available for Presentations on Substance Abuse & Co-Occurring Disorders. He presents from an academic, clinical, and personal perspective. For more information you can email him at: william.drinkwater@umb.edu.
Many (if not most) of the addiction counseling students I encounter these days want to learn more about: CBT, DBT, EMDR, Affective Disorders, Personality Disorders, Trauma & Relapse, Smart Recovery, etc. They are more open to critical thinking and empirical studies (which either confirms or repudiates their views).
If they are in recovery themselves many understand now that what works for them may not work for someone else. Treatment should be based on the patient/client’s ‘story’ not on theirs. Do you really want to set-up an expectation based on what works for you? Then if they fail what do you say, ‘Ah, you didn’t work it the way I laid it out for you.’
When I began in the field some twenty-five years ago Twelve Step was the “Answer.” Considered by many to be the “only” answer. While Twelve Step can always be the base of a person’s recovery or at least part of the answer (if counselor and client decide together it is a good fit) it may not be enough in and of itself.
Try telling someone with a severe trauma history that well, you should get some clean time before you address those issues. Oh that should work out well. Let’s see, they are not self-medicating the flashbacks, they are in agony, and you think a meeting in and of itself will be enough? (check the NIDA studies on this topic)
Please note I am not attacking Twelve Step Programs. Many of us that are dual-diagnosed utilize Twelve Step as our base but we are also involved with other types of groups (guess I am out of the closet now, huh? lol).
Over the years the other disciplines would look at us as a ‘para-profession’ (many still do). You know, those addiction counselors think that Twelve Step is the answer to everything and conversely many in the addiction field looked at psych and felt all they wanted to do is get everyone on medications.
Maybe the attitude was also the result of the early days of addiction counseling; “Oh, you have six months sober, we’ll make you a counselor now.” While the times have changed with the establishment of addiction counseling education programs the attitude about us is still pervasive.
Addiction Counseling Education Programs such as the one I am involved in offer my course as an elective, not a requirement. Conversely, the other disciplines offer maybe one or two addiction courses (if that) and those are electives as well.
Something is wrong with this picture. I suggest to my students that if they really want to learn about addiction and mental health they should work for a year or two with the street people and/or inpatient psych/addiction. Get your clinical from the ground up.
Willy is available for Presentations on Substance Abuse & Co-Occurring Disorders. He presents from an academic, clinical, and personal perspective. For more information you can email him at: william.drinkwater@umb.edu.
Tuesday, October 21, 2014
Big Pharma, Opiates, & Physicians
Several months in Boston we had a rally against the new opiate on the market, “Zohydro.” Basically, Medical Grade ‘Heroin.’ We had the head of the Massachusetts AFL-CIO getting the crowd whipped up and chanting “Down with Big Pharma, Down with Big Pharma!”
While well intentioned, it is never going to happen. Big Pharma essentially laughed this off. Why not when you have the power to get the FDA to go against the ruling of its own select committee on the issue.
I see the issue in another way. Ask your Primary Care Physician how much training he or she had in medical school on mental health and addiction. The answer will probably flabbergast you. So this is what all doctors have received regardless of their speciality after med school. With the possible exception of psych.
Yet they can write scripts for opiates and other psycho-active drugs. You have all seen the TV ads for various psycho-active medications with the ending of the ad saying ‘So ask your physician if it might be right for you.’
What my primary care? The ads do not say to see your primary care for a referral to a psycho-pharmacologist. Just go see your doctor (PCP).
To get back to the ‘opiate’ issue however. Why could we not institute a plan such as the following: A primary care physician before writing an opioid script would have the patient submit to a urine tox screen to see what is already on-board. These screens would not only be qualitative, they would also be ‘quantitative.’
This would be done for all regardless if they have a prior history of drug or alcohol abuse/dependence. In this way the issue of discrimination is taken out of the equation right at the get-go. The scripts would be for one month at a time.
Doctors not complying could be held liable in the case of overdose deaths. Which by the way, the number one cause of opiate overdose deaths in the United States is not from illegal opiates such as Heroin, it is from legally prescribed opiates.
We are the number one country in the world for the consumption of opiates. A recent CNN story on prescription drug abuse: (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose).
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for close to three weeks. For those of you interested, the number is roughly 274,302,000,000.
While Big Pharma is a concern I see the issue as more of a need for true physician education on addiction and mental health. Again, ask your primary care physician how many hours they had in medical school on addiction and mental health. Most of that training is academic, not clinical.
Even well intentioned doctors sometimes inadvertently set people up for addiction such as when they prescribe ninety percocets at a time after a surgery. “Here, take three a day for thirty days then just stop." "Just stop?" Are you kidding me? Why was the person not titrated down over the course of that month? Then when the patient asks for more the physician may think they are med-seeking.
Yea, Big Pharma is a concern, but what about the prescriber…
Monday, April 21, 2014
Zohydro, Overdose Deaths, Chronic Pain...
Let me start this blog with a statement from a recent CNN story on prescription drug abuse (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose).
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for three weeks. For those of you interested, the number is 274,302,000,000.
Yup, that’s right, over 274 billion pain pills.
The number one cause of accidental death in the United States is “legally” prescribed opiates.
Now we have to deal with Zohydro? A pure, man-made form of hydrocodone.
Things are not bad enough now? Any doctor can prescribe this drug. Not necessarily a doctor that specializes in chronic pain management or pain management for the terminally ill. Your primary care physician can prescribe this highly addictive medication.
I have a major issue with that. Ask your primary care physician how many “hours” they had in medical school on mental health and addiction. I feel confident their response with startle you. Maybe thirty hours at best. Out of that thirty hours maybe four to five hours actually ‘talking’ to those that are afflicted.
I feel compassion for those that want the drug for their terminally ill loved ones. I do, I understand. I was witness to my father’s agonizing death for ten months when pancreatic cancer was ending his life. So I get it. His pain was eased with morphine which has more regulations than Zohydro and is more difficult to find its way to the street.
In this article entitled “Why long term use of opioids is not the answer,” the author explains why trying to manage pain with just opiates is not the answer (http://www.kevinmd.com/blog/2013/03/long-term-opioids-answer.html)
We have an opiate epidemic particularly here in the Northeast. I understand and agree with the stance that my state of Massachusetts took recently when they tried to bar the sale of Zohydro (which was denied).
When my friend Joanne Peterson the founder of “Learn to Cope” (http://www.learn2cope.org/) tried to explain her stance on this issue she found herself personally attacked by those in favor of Zohydro. One person when talking of those with terminal illness referred to her as caring too much about “junkies.” Junkies? You mean someone’s son, someone’s daughter, mother, or father? Hey enough of the ‘ad hominem abusive.’ If you want to debate fine, stick with the facts though.
Do you think anyone grows up wanting to be an addict? I have yet to see it on a resume.
How about the well-intentioned doctor that was not taught to titrate a person down when prescribing pain killers after a surgery. ‘Here are ninety Percocet’s, take three a day for thirty days then just stop.' Really? Good luck on that. Even people with no prior addiction history can end up addicted.
Zohydro may legitimately benefit those with terminal illness. However at what price? An increase in the overdose death rate when it inevitably hits the street? Again, the number one cause of accidental death in the United States is overdose death caused by legitimately prescribed opiates. While I agree wholeheartedly agree with those that want Zohydro to be made tamper-proof I see the even bigger issue as regulation on those that prescribe.
Maybe if the physicians prescribing opiates such as Zohydro could be held personally liable for damages due to misuse then maybe they would limit the number they prescribe and the circumstances under which they do prescribe them.
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for three weeks. For those of you interested, the number is 274,302,000,000.
Yup, that’s right, over 274 billion pain pills.
The number one cause of accidental death in the United States is “legally” prescribed opiates.
Now we have to deal with Zohydro? A pure, man-made form of hydrocodone.
Things are not bad enough now? Any doctor can prescribe this drug. Not necessarily a doctor that specializes in chronic pain management or pain management for the terminally ill. Your primary care physician can prescribe this highly addictive medication.
I have a major issue with that. Ask your primary care physician how many “hours” they had in medical school on mental health and addiction. I feel confident their response with startle you. Maybe thirty hours at best. Out of that thirty hours maybe four to five hours actually ‘talking’ to those that are afflicted.
I feel compassion for those that want the drug for their terminally ill loved ones. I do, I understand. I was witness to my father’s agonizing death for ten months when pancreatic cancer was ending his life. So I get it. His pain was eased with morphine which has more regulations than Zohydro and is more difficult to find its way to the street.
In this article entitled “Why long term use of opioids is not the answer,” the author explains why trying to manage pain with just opiates is not the answer (http://www.kevinmd.com/blog/2013/03/long-term-opioids-answer.html)
We have an opiate epidemic particularly here in the Northeast. I understand and agree with the stance that my state of Massachusetts took recently when they tried to bar the sale of Zohydro (which was denied).
When my friend Joanne Peterson the founder of “Learn to Cope” (http://www.learn2cope.org/) tried to explain her stance on this issue she found herself personally attacked by those in favor of Zohydro. One person when talking of those with terminal illness referred to her as caring too much about “junkies.” Junkies? You mean someone’s son, someone’s daughter, mother, or father? Hey enough of the ‘ad hominem abusive.’ If you want to debate fine, stick with the facts though.
Do you think anyone grows up wanting to be an addict? I have yet to see it on a resume.
How about the well-intentioned doctor that was not taught to titrate a person down when prescribing pain killers after a surgery. ‘Here are ninety Percocet’s, take three a day for thirty days then just stop.' Really? Good luck on that. Even people with no prior addiction history can end up addicted.
Zohydro may legitimately benefit those with terminal illness. However at what price? An increase in the overdose death rate when it inevitably hits the street? Again, the number one cause of accidental death in the United States is overdose death caused by legitimately prescribed opiates. While I agree wholeheartedly agree with those that want Zohydro to be made tamper-proof I see the even bigger issue as regulation on those that prescribe.
Maybe if the physicians prescribing opiates such as Zohydro could be held personally liable for damages due to misuse then maybe they would limit the number they prescribe and the circumstances under which they do prescribe them.
Thursday, April 10, 2014
Substance Abuse / Co-Occurring Disorders & 12 Step Programs (Re-post)
When I educate my patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for a co-occurring disorder.
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
Wednesday, March 12, 2014
Enabling Them to Death
But the fact of the matter is they are actually aiding and abetting their loved ones addiction to continue.
To not allow them to pay the consequences for their actions is to become an accomplice with their addiction.
I remember having to inform a patient in a program I was working in that we were going to have to discharge him due to his urine screen coming back positive for opiates.
The first thing he said after I informed him of the positive screen and that we would be discharging him from the program was, “Why are you throwing me out of the program?!”
I’m throwing you out of the program? You knew what the policy was when you started the program, you chose to use opiates; therefore, you threw yourself out of the program. I had nothing to do with your decision.
If the person can acknowledge that fact, then they have an opportunity to get honest with themselves and move forward.
Co-Dependency can occur when a person with an active addiction begins to manipulate family and friends in order to keep their addiction running. For instance they might say they need money to get to work. Rather than giving them cash you might want to consider purchasing them a transportation pass instead.
I always have a concern when I see the manipulation/enablement dance. It is not healthy for either side nor productive towards truly helping a person to enter recovery.
You do not find a lot of alcoholics nor addicts in long-term mental facilities; this is where you can find their families and friends that have been trying to make sense out of their loved ones actions. They want to believe that this time will be different even though they are downplaying what they are actually experiencing and seeing.
It is so important for families and friends to seek help from addiction professionals and community supports such as Alanon when dealing with a loved one that has addiction issues. (Massachusetts: http://www.ma-al-anon-alateen.org/meetings.html)
In Co-Dependency one plus one equals one, rather than two. “I can’t live without him! I can’t live without her!” You mean you really would not want to, right? “NO, I CAN’T!!!” “They make me happy.” The question is can you be o.k. without being in a relationship? A healthy relationship with 'self' should come first, agree?
Many times I will find couples where one is an earth person (Non abuser of drugs/ alcohol) coupled to a spaceman (Active alcoholic/addict).
In these relationships one finds the Classic Enabler/Manipulator Dance. If the relationship was founded on this dynamic than it may well be over if the ‘spaceman’ gets into recovery.
I have had clients in early recovery tell of their partner getting on their case a couple of weeks into their recovery by saying things like, “All those years you put me through Hell,” “Now you are Captain AA/NA and I’m supposed to just forget the past!” What I have found in this instance often times is what the person is most upset by is the fact they lost their job as the “Enabler” and now they do not know where they stand in the relationship.
If the dynamic began later in a relationship both may decide to work things out and I would definitely refer them to a couples therapist with addiction experience.
Friends and Families at times ‘want’ recovery more than their loved one wants it for themselves. By not enabling them, hopefully, they will ‘want’ it for themselves and become vested in their own recovery.
Wednesday, February 26, 2014
The Diagnosis Rage
“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
Twitter https://twitter.com/#!/WillyDrinkwater
LinkedIn http://www.linkedin.com/pub/william-r-drinkwater-m-ed-cadc-ii-ladc-i/16/549/708/
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
Twitter https://twitter.com/#!/WillyDrinkwater
LinkedIn http://www.linkedin.com/pub/william-r-drinkwater-m-ed-cadc-ii-ladc-i/16/549/708/
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.
Sunday, September 22, 2013
Back to Teaching, YES!
A couple of Wednesdays ago I returned to UMASS-Boston to start the Fall semester. Out of all the modalities within the addiction/psych field that I am engaged in, this is far and away my favorite.
My students range in age from 18-88 (really, 88!) My Wednesday class is a practicum class in which I have five students. We meet every other week. In class they will present weekly from the journals that they keep what they have been encountering and participating in at their practicum sites. I will also call their site supervisors from time to time to get their 'read' on how the student is progressing. This class is usually one that they take towards the end of the program.
When I arrive to the campus I usually will head over to the student union building hit the cafeteria, grab a large ice tea with lemon, then head over to my 'perch.'
Tuesday, September 3, 2013
Return to my Psych/Addiction Roots - “Inpatient”
A couple of weeks ago I filled-in for the head of social work in the locked psych/addiction unit across the hall from the partial hospitalization day program that I usually work in.
After starting my career working for three years in a public detox where I was always fascinated by the patients that never slept, those that seemed to never get out of bed, and those that would be carrying on conversations with, well, people that were not there, I found myself spending the next fourteen years working the locked units.
My compassion and empathy are on ‘over-drive’ when I work on these units. I more often than not find myself drawn to the people with Bipolar Disorder that are either in a manic, depressed, or in a mixed state of mind.
Being a person with Bipolar Disorder (Type II) I can understand probably better than most of the staff what they are going through.
This is not to say that I believe “only” people with Bipolar Disorder can work with those that have Bipolar Disorder. Quite contrary, I feel the need to be careful so as not to disclose or share my personal experience in order to maintain a therapeutic relationship as a professional, rather than a ‘mutual’ one.
You have to love my brethren though. Talking to a patient that was in the tail-end of a manic episode, everything he was talking about made perfect logical sense. That is until his concluding remark to me. ‘Willy, do you think they will release me Friday? I have to be at the Boston Commons by 4pm on Saturday to catch the flight back to Jupiter!’
‘Hmm, maybe we should play that by ear regarding Friday, o.k? o.k.’ There is something about the camaradiere that staff share on an inpatient unit that you will not find in any other area of the Psych World. Due to the possible volatility of the patients at a moments notice, staff watches each others backs constantly. Sort of a professional hyper-vigilance. At every facility I have worked over the years all the staff was on a first name basis (yes, even the doc's). A nice human to human touch
So here I am wrapping up a weeks work inpatient with an hour and a half to go and it happens. A new admission decides that he does not want to be on a 'locked' unit and he literally, 'loses it.' Next thing I see in the hallway are two mental health workers on either side of the patient holding him as he is trying to break free from them and crash the locked-door. I'm thinking, 'wonderful,' as I race down the hallway to help them contain the patient. Most of my assistance is holding him from behind so he can't twist to the sides to get away. After what feels like an hour (real time probably 5-10 minutes) the patient calms down to the point where one of the mental health workers can get him to talk rationally.
I felt relieved that he did not have to go into restraints and was willing to take medication to further calm down. Nothing 'sucks' more on an inpatient unit then to have to do a four-point restraint. When I first began in the field if the patient was in an open area on the unit acting out staff would be assembled for what was termed in those days a 'show of force.' Really? A show of force? Now there is language just destined to escalate a situation, right? It's us, against them. That is why in the early nineties I changed it where I worked at the time to a 'Show of Support.' You know, human to human (and yes, I am taking credit for that phrase). I did enjoy getting back to my roots again though. I like to joke that I know I am doing a great job inpatient when it takes the patients a couple of hours to realize that I am a staff member due to my wild sense of humor. 'Hey, where did you get the staff name tag from? What? Your a staff member? You can't be, you are as crazy as we are!'
No, I am a human being just like you are...
After starting my career working for three years in a public detox where I was always fascinated by the patients that never slept, those that seemed to never get out of bed, and those that would be carrying on conversations with, well, people that were not there, I found myself spending the next fourteen years working the locked units.
Being a person with Bipolar Disorder (Type II) I can understand probably better than most of the staff what they are going through.
This is not to say that I believe “only” people with Bipolar Disorder can work with those that have Bipolar Disorder. Quite contrary, I feel the need to be careful so as not to disclose or share my personal experience in order to maintain a therapeutic relationship as a professional, rather than a ‘mutual’ one.
‘Hmm, maybe we should play that by ear regarding Friday, o.k? o.k.’ There is something about the camaradiere that staff share on an inpatient unit that you will not find in any other area of the Psych World. Due to the possible volatility of the patients at a moments notice, staff watches each others backs constantly. Sort of a professional hyper-vigilance. At every facility I have worked over the years all the staff was on a first name basis (yes, even the doc's). A nice human to human touch
So here I am wrapping up a weeks work inpatient with an hour and a half to go and it happens. A new admission decides that he does not want to be on a 'locked' unit and he literally, 'loses it.' Next thing I see in the hallway are two mental health workers on either side of the patient holding him as he is trying to break free from them and crash the locked-door. I'm thinking, 'wonderful,' as I race down the hallway to help them contain the patient. Most of my assistance is holding him from behind so he can't twist to the sides to get away. After what feels like an hour (real time probably 5-10 minutes) the patient calms down to the point where one of the mental health workers can get him to talk rationally.
No, I am a human being just like you are...
Saturday, August 10, 2013
A Reunion That Took Over 25 Years To Happen
In September of 09' there was a celebration at the "Paradise" Rock Club in Boston for all of us that had worked in one capacity or another for the "Rock" of Boston, WBCN-104FM.
That evening I left with my wife early and I missed seeing several of my old buds.
Last Sunday my wife Yvette and I attended the Boston "Comic-Con" held at the Seaport World Trade Center. Our two sons with several friends have a highly successful entertainment/pop culture website/blog (www.omega-level.net) and we were visiting them at their table.
We decided to walk around and take a look at some of the other exhibits. Yvette turned to me and said, 'Oh look over here, Billy West is going to be here in about half-an-hour for an autograph session.'
My heart started racing. I walked up to the people preparing the area for his arrival with a beaming smile and said, 'so Billy will be arriving in a little while?' A woman turned towards me, smiled back, said yes, then asked if I was a fan. I chuckled and replied, yes. Then I told her how we had worked together at WBCN in the eighties and that I had not seen him in more than twenty-five years.
She then remarked what a great surprise it would be for Billy to see me! She followed that by saying I will bring you and your wife right up front to chat with him before we let the crowd in.
For those of you who may not know who Billy West is think: "Ren & Stimpy," "Doug," the "Red M&M," "Fry & the Professor" on Futurama," "Cheerios Honey Nut Bee," "Warner Bros Cartoons," etc, etc, etc. Billy is one of, if not, "the" premiere voice talent in the world!
As we waited my wife seemed a bit uneasy. I asked her, anything wrong? Well, I am just concerned for you that maybe, you know, maybe he won't remember you. Those were pretty crazy days, right? He'll remember I fired back. I was on the Big Mattress crew for almost four years. Then I felt a slight uneasiness. I had not even remotely thought about that possibility until she broached it. Now my brain was spinning.
Ten more minutes passed (which seemed like hours) and then he arrived. Yvette and I were brought right up to his table as he was about to sit down.
He turned towards me and said, 'Hi, I'm Billy.' I smiled at him and said, 'Billy, Willy Drinkwater, it's been more than twenty-five years.'
"Willy!" "Oh my gosh, have a seat!" We started talking about some of the wild times we had at the station and around the Boston scene in those days gone by. At one point he turned to Yvette and told her how I was one of the few that he always liked. That I was there for all the right reasons, not looking to just promote myself and that I wanted to learn.
After chit-chat for another ten minutes I felt it best to wrap-up our discussion so his 'other' fans could see him.
Billy & I both made life changing decisions in 1985. Those that know us understand what I am referring to.
Billy went on to become an internationally known and respected voice talent, and I took my sense of humor and incorporated it into counseling and teaching.
Geez, it was Great to see him again!
Friday, May 10, 2013
Psycho-active Prescriptions & Your Primary Care Physician
I'm Back...
Let me start this blog with a statement from a recent CNN story on prescription drug abuse (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose). In the United States, we now prescribe enough pain pills to give every man, woman and child one every four hours, around the clock, for three weeks.
We have a population of 311 million people – you do the math. (Don’t bother, I already have. The number is: 39,186,000,000 billion).
This is just the pain-killers.
Why? I feel in large part this is due to the limited training our physicians are receiving in medical schools across the country on mental health and particularly with regards to addictions. Having been a preceptor for a medical school in the Boston area I can tell you first hand that the training is roughly thirty hours. Yup, that’s right thirty hours with most of that academic rather than clinical with patients. Ask them the next time you see them. I feel confident their answer will blow you away.
Not to mention the number of patients PCP’s see every day in order for their practice to survive.
Do you really want your PCP to be prescribing you a psycho-active prescription with that limited a background?
The insurers may think this is fine. I mean, after all, the person is an M.D. right? The real reason they do not mind this practice is that it saves them the cost of having the person referred to a specialist, a psychiatrist, a psych nurse practitioner.
Even in the case of say, anti-depressants, are you making sure they are connected to a therapist? It might be nice if they have an unbiased person that can detect changes from appointment to appointment (for better or for worse).
I am sitting in a conference right now being put on by Harvard Medical School in conjunction with the world renowned McLean Hospital and they are espousing the view that PCP’s do not get enough education on addiction and mental health (I’m on my lunch break, don’t worry, lol).
Soooo, what are we going to do about this????
In the case of PCP’s prescribing psycho-active drugs I would like to see an across-the-board policy whereby before writing ‘said script,’ the patient is given a urine tox screen. Does it not make sense to see what if anything is already on board and the amount? By doing this across-the-board one would find it difficult to claim they are being discriminated against due to a past or current addiction history. Scripts would be for one month at a time with a new tox screen being done before a new script is given. Scripts would be for one month at a time.
The prescribing PCP at the time of the first script would provide the patient with numbers and agencies where they can obtain a therapist.
Before the next script could be written (second one) the patient would be required to provide proof they are currently in therapy. The patient would have to have signed releases so both therapist and prescriber can communicate and update each other.
Let me start this blog with a statement from a recent CNN story on prescription drug abuse (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose). In the United States, we now prescribe enough pain pills to give every man, woman and child one every four hours, around the clock, for three weeks.
We have a population of 311 million people – you do the math. (Don’t bother, I already have. The number is: 39,186,000,000 billion).
This is just the pain-killers.
Why? I feel in large part this is due to the limited training our physicians are receiving in medical schools across the country on mental health and particularly with regards to addictions. Having been a preceptor for a medical school in the Boston area I can tell you first hand that the training is roughly thirty hours. Yup, that’s right thirty hours with most of that academic rather than clinical with patients. Ask them the next time you see them. I feel confident their answer will blow you away.
Not to mention the number of patients PCP’s see every day in order for their practice to survive.
Do you really want your PCP to be prescribing you a psycho-active prescription with that limited a background?
The insurers may think this is fine. I mean, after all, the person is an M.D. right? The real reason they do not mind this practice is that it saves them the cost of having the person referred to a specialist, a psychiatrist, a psych nurse practitioner.
Even in the case of say, anti-depressants, are you making sure they are connected to a therapist? It might be nice if they have an unbiased person that can detect changes from appointment to appointment (for better or for worse).
I am sitting in a conference right now being put on by Harvard Medical School in conjunction with the world renowned McLean Hospital and they are espousing the view that PCP’s do not get enough education on addiction and mental health (I’m on my lunch break, don’t worry, lol).
Soooo, what are we going to do about this????
In the case of PCP’s prescribing psycho-active drugs I would like to see an across-the-board policy whereby before writing ‘said script,’ the patient is given a urine tox screen. Does it not make sense to see what if anything is already on board and the amount? By doing this across-the-board one would find it difficult to claim they are being discriminated against due to a past or current addiction history. Scripts would be for one month at a time with a new tox screen being done before a new script is given. Scripts would be for one month at a time.
The prescribing PCP at the time of the first script would provide the patient with numbers and agencies where they can obtain a therapist.
Before the next script could be written (second one) the patient would be required to provide proof they are currently in therapy. The patient would have to have signed releases so both therapist and prescriber can communicate and update each other.
Saturday, January 5, 2013
Post Holidays – Welcome 2013
Jeez, the month of December is over and I realized today that I did not write one single blog the whole month.
No excuse other than not making the time to do so.
I let life (particularly work) get in the way. The hospital where I have been working relocated us twice during the month; each move with its own set of nuances and complications (viewed as challenges – not problems by yours truly).
A wonderful, inspirational buddy of mine had made the suggestion prior to these moves to, “get yourself a latte machine or a basket of good teas…” Sue, I took your suggestion and all I have to say is, “Merci beaucoup.” Nothing quite like a good mug of tea with a squirt of lemon and a dollop of honey, eh?
Last evening colleague Vicki Glow and I were on the Jordan Rich Show, WBZ-Boston, 1030AM radio (nice range, 38 states). The topic was ‘prescription drug abuse.’ Of course due to addiction being such a multi-faceted issue the conversation weaved in and out the designated topic. Look for Vicki & me to do more this spring.
This past week found me interviewing with a hospital closer to my home for a position similar to my current one but with more opportunities to grow and develop as a professional. All parties involved are excited about the possibility of my coming on board (patient states, lol). Pending HR approval I should be receiving an offer in the mail this upcoming week (based not on my ego – based on the nurse manager asking me how soon I can start, again, lol).
I start back to teaching the first week in February and really look forward to it as always. I have been researching both the ‘pro’ and ‘con’ side of the “Suboxone” debate. In a future column I will present both sides of this controversial issue with corresponding links to articles that look at both the empirical studies and clinical observations.
This should raise quite a ruckus I imagine.
Well, I need to get back to working on my website and attend to a couple of syllabuses for February.
To my French Canadian Friends, “Jusqu'à ce que nous nous revoyions!
Peace, Out
Willy
No excuse other than not making the time to do so.
I let life (particularly work) get in the way. The hospital where I have been working relocated us twice during the month; each move with its own set of nuances and complications (viewed as challenges – not problems by yours truly).
A wonderful, inspirational buddy of mine had made the suggestion prior to these moves to, “get yourself a latte machine or a basket of good teas…” Sue, I took your suggestion and all I have to say is, “Merci beaucoup.” Nothing quite like a good mug of tea with a squirt of lemon and a dollop of honey, eh?
Last evening colleague Vicki Glow and I were on the Jordan Rich Show, WBZ-Boston, 1030AM radio (nice range, 38 states). The topic was ‘prescription drug abuse.’ Of course due to addiction being such a multi-faceted issue the conversation weaved in and out the designated topic. Look for Vicki & me to do more this spring.
This past week found me interviewing with a hospital closer to my home for a position similar to my current one but with more opportunities to grow and develop as a professional. All parties involved are excited about the possibility of my coming on board (patient states, lol). Pending HR approval I should be receiving an offer in the mail this upcoming week (based not on my ego – based on the nurse manager asking me how soon I can start, again, lol).
I start back to teaching the first week in February and really look forward to it as always. I have been researching both the ‘pro’ and ‘con’ side of the “Suboxone” debate. In a future column I will present both sides of this controversial issue with corresponding links to articles that look at both the empirical studies and clinical observations.
This should raise quite a ruckus I imagine.
Well, I need to get back to working on my website and attend to a couple of syllabuses for February.
To my French Canadian Friends, “Jusqu'à ce que nous nous revoyions!
Peace, Out
Willy
Wednesday, November 7, 2012
“The Whizzinator!”
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.
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.
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!”
Subscribe to:
Posts (Atom)