Recovery Management extends therapeutic reach

Lambert's PieYesterday’s post on addiction counseling as community organization got me thinking about something I’d heard from a Scott Miller presentation.

Miller argued that treatment outcomes are sue to the following factors in the following proportions:

  • 40%: client and extratherapeutic factors (such as ego strength, social support, etc.)
  • 30%: therapeutic relationship (such as empathy, warmth, and encouragement of risk-taking)
  • 15%: expectancy and placebo effects
  • 15%: techniques unique to specific therapies

Part of his argument was that we can’t control that 40% related to client and external factors, and we spend tons of time and capital arguing about the 15% related to specific therapies. He argues that we should spend much more time on the 45% we have more control over, hope and the alliance.

Here’s what I was thinking—that recovery management attends to that 45% plus the 40% Miller says is out of our hands. Bill White calls on us to shape those external factors. The attention to family, community, social, vocational, educational and other factors extends our reach.

Its worth noting that Physician Health Programs do this too, by creating social peer support (caduceus groups) and support within the workplace.

 


Filed under: Uncategorized Tagged: addiction counseling, community organization, external factors, Scott Miller, Therapeutic relationship

Addiction Counseling as Community Organization

1401469_393603577435766_284227393_o

A few recent posts have put Bill White’s paper on Addiction Counseling as Community Organization on my mind.

First, was a post where I wondered if we were at risk for recovery capital becoming a proxy for class. I worried that this could lower expectations for people with lower socioeconomic status and be used as a justification for different standards of care.

Then, a study on the power of access to transportation as a factor in exiting poverty. This got my gears turning about the impact of these kinds of external factors on addiction treatment outcomes.

Next was a post with a rather heated exchange in the comments that discussed socioeconomic class differences in responses to treatment and what to do about them.

And then, a friend shared this study on racial disparities in treatment outcomes:

More than one-third of the approximately two million people entering publicly funded substance abuse treatment in the United States do not complete treatment. Additionally, racial and ethnic minorities with addiction disorders, who constitute approximately 40 percent of the admissions in publicly funded substance abuse treatment programs, may be particularly at risk for poor outcomes. Using national data, we found that blacks and Hispanics were 3.5–8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment. Only Asian Americans fared better than whites for both types of treatment. Completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability.

And, of course, addiction treatment isn’t the only aspect of health that’s affected by class. Just today, The Atlantic posted the following:

Brookings economist Barry Bosworth crunches the data on income and lifespans for the Wall Street Journal, and the numbers tell three clear stories.<

  1. Rich people live longer.
  2. Richer people’s lifespans are growing at a faster rate.
  3. The problem is worse for women than for men.

What do we do about this? Do we lower our hopes and expectations for people with lower socioeconomic status?

The Health Affairs article on disparities calls for more services:

States could also offer providers incentives to address barriers to completion of outpatient treatment. For example, homelessness and low education are particularly prevalent among blacks and Hispanics and are contributors to lower completion rates in these groups. Future research might explore whether broadened access to resources such as supported housing and vocational training are cost-effective strategies for improving outcomes and reducing disparities. Efforts to improve the tracking of individual patients could increase retention and improve outcomes, particularly for homeless populations.

Bill’s emphasis is a little different. He calls on us to raise our expectations of ourselves and the system while focusing on recovery and the community as the locus of healing. (Rather than emphasizing treatment at the expense of wellness and glorifying ourselves.) [emphasis mine]

Addiction treatment must always adapt to the evolving context in which it finds itself. Such redefinition may push treatment toward the experience of retreat and sanctuary in one period and toward the experience of deep involvement in the community in another. I would suggest that the focus of addiction counseling today should not be on addiction recovery-that process occurs for most people through maturation, an accumulation of consequences, developmental windows of opportunity for transformative or evolutionary change, and through involvement with other recovering people within the larger community. The focus of addiction counseling today should instead be on eliminating the barriers that keep people from being able to utilize these natural experiences and resources. Our interventions need to shift from an almost exclusive focus on intervening in the addict’s cells, thoughts and feelings to surrounding and involving the addict in a recovering community.

6a00d8351b273153ef01156f302741970c-800wiIn another paper. Bill White identified 4 tasks of treatment and recovery:

  1. Recovery from the other genetic, biochemical, social, psychological, or familial influences which initially contributed to the development and trajectory substance problems
  2. Recovery from the adverse psychosocial consequences of the substance use
  3. Recovery from the pharmacologic effects of the substances themselves
  4. Recovery from an addictive culture

When I saw this list for the first time, I was struck by the intuitive truth it organized and articulated. I was also struck by how it illuminated the scope of the treatment and early recovery—”social, psychological, familial . . . psychosocial consequences . . . addictive culture”.

That paper on Addiction Counseling as Community Organization was really an early step in the development of his concept of Recovery Management, which is explained more fully here. In this paper, Bill shifts the language to “community renewal.”

A major focus of RM (Recovery Management) is to create the physical, psychological, and social space within local communities in which recovery can flourish. The ultimate goal is not to create larger treatment organizations, but to expand each community’s natural recovery support resources. The RM focus on the community and the relationship between the individual and the community are illustrated by such activities as:

  • initiating or expanding local community recovery resources, e.g., working with A.A./N.A. Intergroup and service structures (Hospital and Institution Committees) to expand meetings and other service activities; African American churches “adopting” recovering inmates returning from prison and creating community outreach teams; educating contemporary recovery support communities about the history of such structures within their own cultures, e.g., Native American recovery “Circles,” the Danshukai in Japan;
  • introducing individuals and families to local communities of recovery;
  • resolving environmental obstacles to recovery;
  • conducting recovery-focused family and community education;
  • advocating pro-recovery social policies at local, state, and national levels;
  • seeding local communities with visible recovery role models;
  • recognizing and utilizing cultural frameworks of recovery, e.g., the Southeast Asian community in Chicago training and utilizing monks to provide post-treatment recovery support services; and
  • advocating for recovery community representation within AOD-related policy and planning venues.

It can be overwhelming. But, the alternative is despair.


Filed under: Uncategorized

Addiction Counseling as Community Organization

1401469_393603577435766_284227393_o

A few recent posts have put Bill White’s paper on Addiction Counseling as Community Organization on my mind.

First, was a post where I wondered if we were at risk for recovery capital becoming a proxy for class. I worried that this could lower expectations for people with lower socioeconomic status and be used as a justification for different standards of care.

Then, a study on the power of access to transportation as a factor in exiting poverty. This got my gears turning about the impact of these kinds of external factors on addiction treatment outcomes.

Next was a post with a rather heated exchange in the comments that discussed socioeconomic class differences in responses to treatment and what to do about them.

And then, a friend shared this study on racial disparities in treatment outcomes:

More than one-third of the approximately two million people entering publicly funded substance abuse treatment in the United States do not complete treatment. Additionally, racial and ethnic minorities with addiction disorders, who constitute approximately 40 percent of the admissions in publicly funded substance abuse treatment programs, may be particularly at risk for poor outcomes. Using national data, we found that blacks and Hispanics were 3.5–8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment. Only Asian Americans fared better than whites for both types of treatment. Completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability.

And, of course, addiction treatment isn’t the only aspect of health that’s affected by class. Just today, The Atlantic posted the following:

Brookings economist Barry Bosworth crunches the data on income and lifespans for the Wall Street Journal, and the numbers tell three clear stories.<

  1. Rich people live longer.
  2. Richer people’s lifespans are growing at a faster rate.
  3. The problem is worse for women than for men.

What do we do about this? Do we lower our hopes and expectations for people with lower socioeconomic status?

The Health Affairs article on disparities calls for more services:

States could also offer providers incentives to address barriers to completion of outpatient treatment. For example, homelessness and low education are particularly prevalent among blacks and Hispanics and are contributors to lower completion rates in these groups. Future research might explore whether broadened access to resources such as supported housing and vocational training are cost-effective strategies for improving outcomes and reducing disparities. Efforts to improve the tracking of individual patients could increase retention and improve outcomes, particularly for homeless populations.

Bill’s emphasis is a little different. He calls on us to raise our expectations of ourselves and the system while focusing on recovery and the community as the locus of healing. (Rather than emphasizing treatment at the expense of wellness and glorifying ourselves.) [emphasis mine]

Addiction treatment must always adapt to the evolving context in which it finds itself. Such redefinition may push treatment toward the experience of retreat and sanctuary in one period and toward the experience of deep involvement in the community in another. I would suggest that the focus of addiction counseling today should not be on addiction recovery-that process occurs for most people through maturation, an accumulation of consequences, developmental windows of opportunity for transformative or evolutionary change, and through involvement with other recovering people within the larger community. The focus of addiction counseling today should instead be on eliminating the barriers that keep people from being able to utilize these natural experiences and resources. Our interventions need to shift from an almost exclusive focus on intervening in the addict’s cells, thoughts and feelings to surrounding and involving the addict in a recovering community.

6a00d8351b273153ef01156f302741970c-800wiIn another paper. Bill White identified 4 tasks of treatment and recovery:

  1. Recovery from the other genetic, biochemical, social, psychological, or familial influences which initially contributed to the development and trajectory substance problems
  2. Recovery from the adverse psychosocial consequences of the substance use
  3. Recovery from the pharmacologic effects of the substances themselves
  4. Recovery from an addictive culture

When I saw this list for the first time, I was struck by the intuitive truth it organized and articulated. I was also struck by how it illuminated the scope of the treatment and early recovery—”social, psychological, familial . . . psychosocial consequences . . . addictive culture”.

That paper on Addiction Counseling as Community Organization was really an early step in the development of his concept of Recovery Management, which is explained more fully here. In this paper, Bill shifts the language to “community renewal.”

A major focus of RM (Recovery Management) is to create the physical, psychological, and social space within local communities in which recovery can flourish. The ultimate goal is not to create larger treatment organizations, but to expand each community’s natural recovery support resources. The RM focus on the community and the relationship between the individual and the community are illustrated by such activities as:

  • initiating or expanding local community recovery resources, e.g., working with A.A./N.A. Intergroup and service structures (Hospital and Institution Committees) to expand meetings and other service activities; African American churches “adopting” recovering inmates returning from prison and creating community outreach teams; educating contemporary recovery support communities about the history of such structures within their own cultures, e.g., Native American recovery “Circles,” the Danshukai in Japan;
  • introducing individuals and families to local communities of recovery;
  • resolving environmental obstacles to recovery;
  • conducting recovery-focused family and community education;
  • advocating pro-recovery social policies at local, state, and national levels;
  • seeding local communities with visible recovery role models;
  • recognizing and utilizing cultural frameworks of recovery, e.g., the Southeast Asian community in Chicago training and utilizing monks to provide post-treatment recovery support services; and
  • advocating for recovery community representation within AOD-related policy and planning venues.

It can be overwhelming. But, the alternative is despair.


Filed under: Uncategorized

Should we lower the bar?

Lowering_The_Bar_Cover_2010.09.22USA Today ran a story about problems in the monitoring of impaired physicians.

Many states lack rules to ensure that medical facilities alert law enforcement or regulatory agencies if they catch employees abusing or diverting drugs, so those staffers often are turned loose to find new jobs without treatment or supervision. Disciplinary action for drug abuse by health care providers, such as suspension of a license to practice, is rare and often doesn’t occur until a practitioner has committed multiple transgressions.

“We certainly see gaps in the system; the examples are many,” says Joseph Perz, an epidemiologist at the U.S. Centers for Disease Control and Prevention.

The challenge in addressing the problem is finding a “balanced approach,” Perz adds. “We recognize that addiction is a disease and we recognize the value in … (rehabilitating) a provider. At the same time, we need to be thinking about the potential harm to patients. That balance is difficult.”

One disappointing part of the story is that they failed to discuss the fact that, once they get into physician recovery programs, physicians have extraordinary treatmet outcomes.

The paper posted the following question on twitter: “Thousands of drug-addicted doctors, nurses escape notice, endangering patients, report reveals. What should be done?”

Thank goodness this isn’t actually the approach we take with addicted doctors:

Too bad it is the approach we’ve taken with other patients.


Filed under: Uncategorized

Should we lower the bar?

Lowering_The_Bar_Cover_2010.09.22USA Today ran a story about problems in the monitoring of impaired physicians.

Many states lack rules to ensure that medical facilities alert law enforcement or regulatory agencies if they catch employees abusing or diverting drugs, so those staffers often are turned loose to find new jobs without treatment or supervision. Disciplinary action for drug abuse by health care providers, such as suspension of a license to practice, is rare and often doesn’t occur until a practitioner has committed multiple transgressions.

“We certainly see gaps in the system; the examples are many,” says Joseph Perz, an epidemiologist at the U.S. Centers for Disease Control and Prevention.

The challenge in addressing the problem is finding a “balanced approach,” Perz adds. “We recognize that addiction is a disease and we recognize the value in … (rehabilitating) a provider. At the same time, we need to be thinking about the potential harm to patients. That balance is difficult.”

One disappointing part of the story is that they failed to discuss the fact that, once they get into physician recovery programs, physicians have extraordinary treatmet outcomes.

The paper posted the following question on twitter: “Thousands of drug-addicted doctors, nurses escape notice, endangering patients, report reveals. What should be done?”

Thank goodness this isn’t actually the approach we take with addicted doctors:

Too bad it is the approach we’ve taken with other patients.


Filed under: Uncategorized

National Prescription Drug Take-Back Day 2014

Takebackday.jpg

The non-medical use of prescription drugs ranks second only to marijuana as the most common form of drug abuse in America. As such, the National Prescription Drug Take-Back Day was created by the U.S. Drug Enforcement Administration (DEA) with a goal to provide a safe way for people to discard unused prescription drugs.

The Centers for Disease Control and Prevention have classified prescription drug misuse and abuse as a national epidemic; citing a 102% increase in prescription drug related overdose deaths from 1999 to 2010. Data from the National Survey on Drug Use and Health (NSDUH) shows that nearly one-third of people over the age of 12, who used drugs for the first time in 2009, began doing so by using a prescription drug non-medically. By participating in this nation-wide event, the DEA is contributing to public safety by helping to rid communities of drugs that could lead to accidental poisoning, overdoses and abuse.

During the fall 2013 Take-Back day, Americans turned in more than 647,000 pounds of prescription drugs at more than 4,000 sites operated by the DEA. Combined with results from prior events, the DEA and its partners have collecte
d more than 3.4 million pounds of expired, unused and unwanted prescription drugs.

You can turn in your unused or expired medications for safe disposal on April 26 between 10:00 a.m. – 2:00 p.m. For more information on this program, including a Take-Back Site Locator and a Partnership Toolbox, visit the Drug Enforcement Administration website.

Managing our worst fears for our addicted and alcoholic children

My 3 SunzThis is an encore post from My3Sunz

She reached out in desperation – “my son’s been arrested and may go to prison!” When I met up with her I recognized the anguish and sleepless, ringed-worried-eyes, once worn myself. This is the look of a parent whose love for their drug addict child and powerlessness leaves them broken.

First there was the guilt – she missed the phone call from him. She had decided to go to the class she signed up for and, then there was regret – she should have stayed home! Martydom mixed with obsessive spurts of energy focused on detective work; late night internet research for arrest records and prisons. Soon she self-consumed into fearful isolation – projecting the worst outcomes. Driven to fuel the fears, news articles: “Life in solitary, Inmates Hunger Strike; Violent, predatory offenders” to name a few. Undeniably a drug addict turned to criminal activity to support his disease, but NOT this and NOT THERE! He is her child, her son – my son, your child, and our hearts break open – we want to rescue. I know this well, I have the T-shirt.

How could I help? What could I do? My co-dependent nature is to rescue and smooth over the fear and sadness because I feel unease in these situations…I wanted to say “it will all be OK!” But that’s not the truth, it might not be OK, so instead, I listened. How does one go from helplessness to powerlessness, the latter being a state of surrender & acceptance, fueled by trust versus fear? Was she ready? Would I be of help or further complicate matters? For me, it took hard work in my 12-Step Program of Al-Anon.

I shared my own experience of being frightened for my sons’ fate. Like when I read about the prison riot which made front page news. I immediately went to that scary place visualizing my son’s vulnerability in what I conjured up. A mother’s worst nightmare – my imagination ran wild! How I then turned it over to my God Box, realizing no amount of worry or fret was going to influence the outcome of this! I later learned he missed the riot because he “skipped” breakfast – all validating why I have to let go and let God! This was a change in the way I reacted to fears about the future and I was given positive feedback – projecting would no longer serve me, reaching out would.

New to Drug Testing: Medical Professional Panels

Image of Medical ProfessionalsWeek #50

The other day, I found myself wondering how different types of employers work to deter drug use. I recently visited my family physician for my annual checkup. After the examination, he took a pad of paper and wrote me a prescription for some allergy medication. I happened to be working on a new piece of literature regarding medical professional testing and I began to wonder, “What’s keeping him from writing a prescription for himself?” Fortunately for patients like me, and for the employers of healthcare professionals, there are drug testing panels aimed at monitoring and deterring drug use among those professions with prescriptive authority.

Despite their knowledge and training, medical professionals are just as at risk for substance abuse as the general public. Drug abuse by these highly technical and deeply trusted professionals can impact their ability to make good decisions and to otherwise function at their full capacity. This, in turn, puts the patient, the medical professional and the employer at risk.

Because of the potential drug use by medical professionals, the ease of access provided by their roles and the immense liability it can bring to an organization, Quest Diagnostics has developed a comprehensive and customizable panel that tests for both illicit drugs, and for other drugs that are readily available to medical professionals. Read our brochure to learn more about these specialized drug testing panels and how they can help keep both physicians and their patients safe.

As a new employee at Quest Diagnostics, there’s hardly a day that goes by that I don’t learn something new about the world of drug testing. Like some of you, I have a lot to learn about the industry. During my first year of employment, I’m going to write this weekly column highlighting drug testing procedures, products and processes as I discover them. To learn more about my journey, you can read my introductory post.