If people had a place to live and other people would allow them to stay there throughout very early recovery, would they go to residential treatment for substance use disorders?
Perhaps some- but I believe that the vast majority of people who go into residential treatment are sent because no one will let them live with them (until they are done w a residential program) Or- because the legal system ordered the to either to treatment, or do time. There are numerous dilemmas and problems with this model and I believe this time has come to for a new approach.
I believe treatment can be very different than this. I saw a glimmer of this in an article in LA Time about the merger of the Betty Ford Center an Hazeldon. The new organization, under the name Betty Ford Center, will open 3 outpatient treatment centers. I am fortunate to work for a health care organization that provides the complete outpatient continuum of care for substance use disorders. It is a more expensive approach than the much more common residential treatment approach. And, the staff of professionals all possess a with minimum of graduate degrees in a behavioral health. It is a staff heavy model of care. It is more compassionate and more effective. Studies bare this out. And being more effective, it is much more cost effective. Costs are just saved down the line; something share holders and investors do not like. Of course, cost effective in health care a tricky thing, and I will leave this issue to others.
The initial foundation of one's treatment is extremely important. I break it down like this:
pre recovery; detox/initial treatment; early recovery. These three phases cover usually about the first 9- 12 months. I have found that the maintenance phase really begins closer around one year. For what its worth, most models of care would say maintenance begins after 2-3 months.
For the next few weeks or so I will be writing on the pre recovery stage. For those of you in recovery- that would be the last period before you stopped. How you were feeling, what you were thinking, and how your body was responding to the chemicals. We will pass on the drama of the BEHAVIOR before the stop.
Please share your stories.
Monday, March 24, 2014
Tuesday, March 18, 2014
Monday, March 10, 2014
BR and the pecking order
I have always found it interesting that what comes most naturally to humans is to rank themselves against/ relative to one another. Being collaborative and equal partners rarely occurs outside of basic survival. We will naturally band together if it is in our best interests, in order to survive- otherwise, well, it's a dog eat dog world. The feminist movement finally had to realize that we rarely play nice when there are outside motivators, like money.
The term pecking order comes from chickens. When you place chickens in a pen together, they will rank themselves, and it is acted out in pecking one another on the head. Then, they all settle down because they know who ranks where- worked out through pecks. We humans are not fair behind, or should I say ahead?
If you want people to work as a team, define an agreed upon, mutual enemy. Or reward, money.
People with substance use disorders do the same thing. And, for what it is worth, so do the clinicians treating them. That is to say, the clinicians rank the patients, and they also rank themselves. 28 years in mental health and substance abuse settings- this never fails to amaze and mortify me. I guess with patients it's understandable- no one wants to be the bottom of the bottom. Which is horribly wrong since substance use disorders don't discriminate... No one is on the bottom, it's a disease.
Alcohol va substances
Cannabis vs them rest
Meth vs cociane
Heroin on the bottom (junkies? a horrible term)
Needles vs smoking, snorting
mft, lcsw, psyd, phd, Md
trainee, intern, licensed
I want to say publicly that the skills I learned at Boys Republic in regards to how to un-due the vertical pecking order, and how to develop social environments that are horizontal- was the best training, the most valuable training in my career. It was a VERY difficult place to work as a person with a graduate degree working on the front lines. But, I am grateful everyday, for all that I learned. And that I left as soon as reasonable.
To Jade, Lisa, Susan, Heidi, Sterling, Diana, Bob and Yvonne: Where ever you may be, wishing you grace and serenity. My "BR" experience is on my gratitude list every day.
The term pecking order comes from chickens. When you place chickens in a pen together, they will rank themselves, and it is acted out in pecking one another on the head. Then, they all settle down because they know who ranks where- worked out through pecks. We humans are not fair behind, or should I say ahead?
If you want people to work as a team, define an agreed upon, mutual enemy. Or reward, money.
People with substance use disorders do the same thing. And, for what it is worth, so do the clinicians treating them. That is to say, the clinicians rank the patients, and they also rank themselves. 28 years in mental health and substance abuse settings- this never fails to amaze and mortify me. I guess with patients it's understandable- no one wants to be the bottom of the bottom. Which is horribly wrong since substance use disorders don't discriminate... No one is on the bottom, it's a disease.
Alcohol va substances
Cannabis vs them rest
Meth vs cociane
Heroin on the bottom (junkies? a horrible term)
Needles vs smoking, snorting
mft, lcsw, psyd, phd, Md
trainee, intern, licensed
I want to say publicly that the skills I learned at Boys Republic in regards to how to un-due the vertical pecking order, and how to develop social environments that are horizontal- was the best training, the most valuable training in my career. It was a VERY difficult place to work as a person with a graduate degree working on the front lines. But, I am grateful everyday, for all that I learned. And that I left as soon as reasonable.
To Jade, Lisa, Susan, Heidi, Sterling, Diana, Bob and Yvonne: Where ever you may be, wishing you grace and serenity. My "BR" experience is on my gratitude list every day.
Sunday, March 2, 2014
Potheads and Stoners
I found the comments made by California governor Jerry Brown on Meet The Press this morning very disappointing. He is either terribly ignorant of the potential problems that can develop from cannabis abuse or he is purposely attempting to minimize the issues so that the voters support legalization of recreational use.
I know well both sides of the arguments regarding legalization of cannabis; economic, civi liberties, 'safer than tobacco and alcohol', and so forth. I'll vote when it's on the ballot. I am most concerned about our general ignorance regarding substance use and the devastating effects this ignorance propagates. We have lost a generation of young men and women to prisons, mental illness, unemployment. These people have become marginalized and tossed aside as immoral, lazy hedonists. Potheads. Stoners.
Wrong. Harken back to the days of using leaches to treat depression and wet frozen sheets to calm those with schizophrenia.
I know well both sides of the arguments regarding legalization of cannabis; economic, civi liberties, 'safer than tobacco and alcohol', and so forth. I'll vote when it's on the ballot. I am most concerned about our general ignorance regarding substance use and the devastating effects this ignorance propagates. We have lost a generation of young men and women to prisons, mental illness, unemployment. These people have become marginalized and tossed aside as immoral, lazy hedonists. Potheads. Stoners.
Wrong. Harken back to the days of using leaches to treat depression and wet frozen sheets to calm those with schizophrenia.
Saturday, March 1, 2014
I can control it, why can't they?
Simply answered? Because people are different. People's bodies are different, people's brains are different and people's understanding and belief about the disease is different. Why do some people become diabetics and others do not? Biology and consumption.
For too many years, and still today, people treat individuals w substance use disorders as if they have a 'defect of character', are 'weak', 'lazy' or 'gluttonous please sure seekers'. This simply is not true. Often, quite the opposite is true.
One of the main factors in determining if someone has a substance use disorder is a decrease in one's ability to purposefully control that use. For example, promising oneself not to use today, only to find themselves high by the afternoon. Or, promising that they would only have one or two- and really meaning it, desiring to just have one drink- only to have blacked out after recalling having 7 drinks. The fun is gone. The intention is to control their use- just a couple, not on weekends, no hard stuff...on and on- only to find themselves in the situation they swore off.
The next significant feature of a substance use disorder is have it seep into other areas of your life, wreaking havoc, and not stopping. They use even when they strongly desires to use/drink less or not at all. Defeat. The compulsive, unwanted behavior continues- seemingly totally within their choice, in-spite of very bad things occurring in their life directly because of the substance use. Loss of relationships, financial issues, legal problems, health problems.
Why on earth would someone choose that? They don't. Choice is a very fragile human faculty. We like to think of ourselves as fully autonomous, self driven folk. Choice is a complex series of interactions within the various systems in the brain. When the cluster of 5 areas of the brain which make up the pleasure pathway is in dis-regulation- broken basically, it re-prioritizes certain chemical reactions; placing perhaps alcohol, cannabis, or opioids (heroin, Vicodin) to the top spot. Higher than food, sex, love... The experience, the manifestation of this is the obsession- the craving...the inability to make what most of us consider basic rational decisions. Like, don't shoot heroin; don't spend money on drugs when you're broke. Don't drink a case of beer, having 2 is just fine.
Why do some people appear to have 'broken' pleasure pathways, and others don't? They can have just a couple and stop; or take a few pain pills after getting their teeth pulled, and not turn into someone who rifles through your medicine cabinet looking for pills? (yes, addicted folks do that all the time when they visit there people's homes).
Well, it's a combination of factors, but mostly genetics. Some resiliency and childhood trauma factors.
Age, access and amount of consumption play a part.
The take away is- substance use disorders are biologically based brain disorders, not a character issue. Loss of control is a key indicator. We need to eliminate the stigma, encourage effective, dignified treatment.
For too many years, and still today, people treat individuals w substance use disorders as if they have a 'defect of character', are 'weak', 'lazy' or 'gluttonous please sure seekers'. This simply is not true. Often, quite the opposite is true.
One of the main factors in determining if someone has a substance use disorder is a decrease in one's ability to purposefully control that use. For example, promising oneself not to use today, only to find themselves high by the afternoon. Or, promising that they would only have one or two- and really meaning it, desiring to just have one drink- only to have blacked out after recalling having 7 drinks. The fun is gone. The intention is to control their use- just a couple, not on weekends, no hard stuff...on and on- only to find themselves in the situation they swore off.
The next significant feature of a substance use disorder is have it seep into other areas of your life, wreaking havoc, and not stopping. They use even when they strongly desires to use/drink less or not at all. Defeat. The compulsive, unwanted behavior continues- seemingly totally within their choice, in-spite of very bad things occurring in their life directly because of the substance use. Loss of relationships, financial issues, legal problems, health problems.
Why on earth would someone choose that? They don't. Choice is a very fragile human faculty. We like to think of ourselves as fully autonomous, self driven folk. Choice is a complex series of interactions within the various systems in the brain. When the cluster of 5 areas of the brain which make up the pleasure pathway is in dis-regulation- broken basically, it re-prioritizes certain chemical reactions; placing perhaps alcohol, cannabis, or opioids (heroin, Vicodin) to the top spot. Higher than food, sex, love... The experience, the manifestation of this is the obsession- the craving...the inability to make what most of us consider basic rational decisions. Like, don't shoot heroin; don't spend money on drugs when you're broke. Don't drink a case of beer, having 2 is just fine.
Why do some people appear to have 'broken' pleasure pathways, and others don't? They can have just a couple and stop; or take a few pain pills after getting their teeth pulled, and not turn into someone who rifles through your medicine cabinet looking for pills? (yes, addicted folks do that all the time when they visit there people's homes).
Well, it's a combination of factors, but mostly genetics. Some resiliency and childhood trauma factors.
Age, access and amount of consumption play a part.
The take away is- substance use disorders are biologically based brain disorders, not a character issue. Loss of control is a key indicator. We need to eliminate the stigma, encourage effective, dignified treatment.
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