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Active Addiction - Richard Jones

When I was “out there” in active addiction

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My Experience with “Active Addiction”

I was vaguely aware of what “addiction” was. My job exposed me to the mental health world as I worked within a healthcare system. I was not a clinician so my knowledge remained on a superficial level. However, I was aware that the Diagnostic and Statistical Manual (DSM) was the “book” used to diagnose both mental health and substance use disorders.

I had access to these manuals via my “psychiatrist co-workers” in the health system.

On many occasions, I found myself looking over the criteria for substance abuse and dependency-as it was called at that time; 1998…

I would read the criteria and read it over and over again. I would dissect the words and see if it applied to me. I was not living under a bridge or eating out of a dumpster. I had not been to jail. I was losing my family…but I had not lost my family.

Most of my consequences were internal. There were consequences:

  1. I was never able to sleep.
  2. I was “dope-sick”/experiencing withdrawal on most days but didn’t really know what was happening to me.
  3. I was using opioid base pain pills that I was getting prescribed (from several doctors).
  4. I never bought it off the street. This allowed me to buy into the concept that “it was from a doctor and couldn’t be that bad”.
  5. I was always running out early.
  6. I was always terrified of running out early.
  7. I had suicidal thoughts.

But no one really knew what was going on with me. Not even my family. I was in an internal hell. But it wasn’t dramatic and I wasn’t a “scum-bag, liar, cheater, and thief”.

I was a pretty high functioning person who was quietly, yet desperately, dependent on substances to get through the day. Oh…on a side note: alcohol was ever present and I was probably more dependent on alcohol than any other substance. It was just socially acceptable and therefore I didn’t identify it as the main problem.

Man… I would look at that Diagnostic Manual. I would play with the criteria in my mind.

The manual said “inability to control use” was a symptom.

I would tell myself that really didn’t apply to me because “it wasn’t lack of control. I actually wanted to drink 24 beers and eat 10 Percocet… so I was in control…it was my choice”.

The manual said “can’t cut down” was a symptom.

I would tell myself that I really could cut down if I wanted “I just haven’t decided to yet”…

The manual said “interpersonal problems due to using”.

I told myself that it was “my wife that had an attitude problem” and it really wasn’t on me…

And I looked at this manual over and over…and as time went by I had more and more trouble explaining away the symptoms. But I was always able to do so. Because I was NEVER TALKING TO ANYONE ABOUT THIS.

My mom, my wife, told me to see counselors or “go to AA” and I flat out refused. I was clueless as to what was happening to me…
I turned the book upside down to see if it made more sense from a different angle. I couldn’t figure it out.

Once I went to an EAP counselor and I was just waiting for her to ask me about my use and give me some answers. But all we talked about was “stress” and “career planning”. You see…she wasn’t a drug and alcohol “specialist”. So we didn’t go there.

I just simply never discussed my substance use with anyone despite the fact that it was destroying my life. And it got worse. I did temporarily lose my mind and my family and my sense of purpose and my future….

  • Why did it have to roll on so long?
  • Did I have to “hit bottom”?
  • Did I have to “become ready”?

Or would I have benefited from a conversation.

As you can probably assume…I eventually found recovery and went back to school. I got a graduate degree in Sociology with concentration in Addiction studies, became a therapist, went back and got an MBA with a concentration in healthcare management.

I jumped through a bunch of hoops and got licenses and certifications. Started working in the field in 2001—basically as soon as I entered recovery. And I’ve learned a lot. Both personally and professionally.

Based on all this…What do I believe people need to know:

1). Substance use disorder. – It is a real problem. It’s a brain issue. It’s not bad behavior or just a bad habit. It will get worse and it will not just go away on its own.

2). That said…it takes on many different variations. – Just like other diseases there are different stages or different “species” of addiction. There is no such thing as a garden variety drug addict—as you so often hear people say. The word addict is demeaning and people say addicts are scumbags and liars and cheaters and thieves. That doesn’t help and it’s not accurate. It’s an individualized experience. Don’t buy into the hype.

3). Following logically behind premise number 2. – There are multiple ways to “get better”. There is no one prescribed way to recover. It is an individualized experience

4). I wish someone would have engaged my family in the process. – Families are profoundly impacted and deserve information. Families should be included not removed from the process. Unless their involvement is dangerous for the person needing recovery or for the family members.

5). You are allowed to talk to someone, without making a commitment to quit everything all together and “never take another drink”. This would have been the most beneficial piece of information for me when I was “out there”. I stayed away from “addiction counselors” for years because I wasn’t going to “quit everything”.

6). You don’t automatically need to go to rehab. – There is actually a clinical assessment process that indicates level of care. You would never know that based on the media and based on the behavior of some rehab marketers. But rehab is not always necessary.

7). There are many people in recovery who did not go to jail and/or eat out of a dumpster. – We have allowed ourselves to become caricatures and we promote stereotypes of the scumbag drug addict. I’m sure this chases many people away from recovery. Don’t buy into that… it’s a very diverse crowd.

8). There is medicine available that can support recovery.- Staying alive is first on the agenda. Don’t let uneducated and uniformed people tell you otherwise. It’s not the only option. But it is an option.

9). It may be hard to find people who are willing to “meet you where you are at” in the process of change. – Keep looking. Professionals are wrong when they blindly confront you and prescribe one size fits all solutions. Don’t quit the process based on a bad experience. Find another meeting or another therapist or another program. Be your own advocate.

10). If you are using heroin or “pills from the street” (or apparently cocaine) – In today’s world of carfentanil and fentanyl please understand you are playing Russian roulette every time you use. It is better to seek help even if you are “not sure you are ready for recovery” and let a professional help you figure out options…than it is to continue on until you “hit bottom”. Hitting bottom today means death…too often.

11). YOU CAN GET BETTER…LIFE CAN BE BETTER.

12). YOU WILL BE ABLE TO SLEEP AGAIN…

13). YOU WILL BE ABLE TO LOOK AT YOURSELF IN THE MIRROR AGAIN.

14). YOU HAVE NOTHING TO BE ASHAMED OF. EVERY PERSON ON THIS PLANET HAS A SKELETON IN THE CLOSET. AN ISSUE THEY ARE ASHAMED OF. AN ISSUE THEY STRUGGLE WITH… THIS IS OURS.

YOU ARE HEROIC...

Response to President Trump Rich Jones Recovery Cartel

Rich Jones Response to the Trump Announcement

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President Trump said that the ongoing opioid epidemic — which is killing more than 100 people each day — is the “worst drug crisis in American history” and said his administration is declaring it a public health emergency, pledging the nation’s full resolve in overcoming it.

This is my thoughtful response to the Trump announcement.

First, the public proclamation of a “public health crisis” and the associated attention on the DISEASE of addiction is a positive step in and of itself. That cannot be denied. Given the terrible history of stigma and embarrassment and shame associated with the disease it is miracle we are talking openly about this issue.

The President of the United States talking about it as a public health issue is a major breakthrough. Furthermore, much gratitude for the hard work and commitment of the organized recovery advocacy movement.

I don’t mean the treatment center marketers who call themselves “advocates”. I mean organizations such as Facing Addiction, Faces and Voices of Recovery and the grassroots Recovery Community Organizations (RCO) out there. Good work. People listened.

Second, we have no idea “exactly” what Presidents Trumps means with his announcement. Questions still need to be answered, such as:

  • How will the money roll out?
  • Will the money even show up?
  • What initiatives will be funded?

However, we can gain insight and make predictions based on what was discussed…

Third. I am disheartened because there is no acknowledgement or honest discussion regarding the core issue associated with the crisis…

Medically Assisted Treatment (M.A.T.) was suggested as the cure all. More detox beds also discussed. (Do you know only about 20% of people in South Carolina-and probably nationwide-do anything “post detox”?)

These 2 “solutions” are not comprehensive solutions as they fail to recognize or address the fact that only about 3% of the 90% of the “untreated” people actually want help. Do you get that?

There is a treatment gap that exists due to “willingness” not due to access.

I’m sure increasing access will cut into the 90% untreated somewhat— but not at any significant level. YOU ARE PROVIDING SOLUTIONS FOR COMPLETELY DISENGAGED PEOPLE, assuming that they will all sudden show up.

The proposed solutions assume these folks will also magically follow the treatment plan as dictated by the provider.

“DO YOU SERIOUSLY THINK THAT IS HOW THIS WILL GO DOWN?”

Fourth.  Recommending “access” as the answer to the Opioid Epidemic demonstrates a fundamental misunderstanding of the reality of addiction. This is not surprising given the fact that all of our models and all of our research and all of our “traditional” ideas about addiction are founded on the experience of WORKING WITH WILLING PEOPLE.

BECAUSE UNWILLING PEOPLE ARE IGNORED UNTIL THEY BECOME WILLING!!!!

And fifth, my last point.

The answer to our nation’s problem, President Trump, is that what we need is a massive amount of money and support for community based outreach programs and assertive recovery coaching/peer based support services.

Re-allocation of insurance money from “intensive outpatient programs” that are office based and last 8 weeks to community/home based outreach coaching that last 12 month or 18 months. The cost would be essentially the same. It can be done.

WE NEED THOUSANDS OF RECOVERY COACHES OPERATING
IN INDEPENDENT RECOVERY ORGANIZATIONS.

They need to be accountable to independent RCO’s and operate in collaboration with the existing treatment system but NOT under the jurisdiction of the existing infrastructure. The money should come directly to the organization and not funnel through another entity.

Commercial Insurance should contract with the RCO’s for bundled services. The RCO’s should be held accountable and be reimbursed based on engagement rates and retention in recovery rates — not based on “successful completion of a program”.

I will speak for my organization–we will pay the money back if we suck. if we don’t deliver.

NOW THAT is a novel idea isn’t it… Until we think innovation and “new” solutions we are throwing money out the window…

This is all self-evident. It’s all very logical. Someone please forward this to President Trump…

Recovery Cartel Blog

Parenting​ ​through​ the behavioral ​health apocalypse!

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The Behavioral ​Health Apocalypse!

Before I get to my article on the current state of behavioral health, I would like to make it clear what I intend to do with The Recovery Cartel blog. There are several very important objectives.

1.) I write so that my head does not explode. I have continuous and ever-present thoughts surrounding addiction, mental health, sociology, societal problems etc… And I have very serious observations and opinions regarding society’s response to these issues. If I don’t write about and/or talk about it my head is likely to explode. I don’t want that to happen.

2.) I write for a targeted audience. Specifically, an audience that wants to take a deeper dive into an issue. If you want clichés and the standard company line, I’m not the guy for you. If you want to go deep on the macro-issues and explore causes and conditions then this is the place for you.

3.) I want to explore NEW solutions and try and shatter the existing paradigm. I think we are fighting a battle against substance use disorders and mental health issues using antiquated and illogical techniques.

4.) I intend to write really long posts. Read the whole thing. If that resonates please sign up for my blog posts.

Today I would like to explore parenting through our current behavioral health apocalypse…

Mental health rates among youth and young adults at a record high. Overdose is number one killer of people under the age of 50. The social media explosion and the smartphone era is leading to an entire generation of overwhelmed and disconnected people. In the meantime, substances are evolving.

It seems like more and more powerful drugs are being pushed into the market. The DEA is under the control of big pharma and the prescription opioids are going to keep coming. It’s the perfect storm for this overdose epidemic. We also need to acknowledge the record setting suicide rate and our ineffective systemic response in this area as well. We are a country in the middle of a behavioral health crisis.

It is especially difficult for parents dealing with a child’s behavioral health crisis. Despite more need than ever, there is little specialization in this area. Family based responses are the exception not the norm and parents are cycled through traditional framework which was never intended to address parent to child relationships.

3​ ​problems​ ​to​ ​ponder​ ​as​ ​you​ ​parent​ ​through​ ​this​ ​perfect​ ​storm?

Problem:​ ​Psychological​ ​Beat​ ​Down​ ​Associated​ ​With​ ​Raising​ ​Kids​: It used to be that a parent’s job was to “raise” your kids. Get them to age 18. Maybe early 20’s if they went to college. Get them through the experience relatively well adjusted. Get them through relatively healthy. Prepare them for the future but not prepare their future.

Then Dr. Spock came along and told parents to become friends with their children. Then parents started to live vicariously through their kids. Parents became obsessed with their children’s achievements. Get them on this team and in this activity. Buy them this car and these clothes. Must get them into Harvard. Must see them achieve.

Parents always encouraged their children. Parents even demanded hard work from their kids. But parents in the past did not tie their own self-esteem and self-image to the success of their kids. That all has changed.
Imagine how much more complex and problematic this reality is made by substance use disorders. How the stigma feeds into the already existing sense of failure and inadequacy that many parents feel.

Here’s a common scenario:

When you meet someone at the grocery store:
The first thing they do is tell you about their kid.

Super Parent: “Joe just finished first in competitive pogo-stick jumping and he’s ranked second at
Stanford School of business. How is your kid doing”?

Imperfect Realistic Parent: “Well… he was named president of his unit at rehab… we are hoping he
does 90 meetings in 90 days when he comes home because they told us this is his after-care”

Not​ ​a​ ​very​ ​pleasant​ ​experience…and​ ​in​ ​most​ ​cases​ ​the​ ​imperfect​ ​parent​ ​takes​ ​evasive​ ​action​ ​and avoids​ ​the​ ​question.​ ​ ​Redirect​ ​the​ ​conversation​ ​to​ ​the​ ​broccoli​ ​sale​ ​in​ ​aisle​ ​13… ​ ​and​ ​then​ ​leave​ ​the store​ ​feeling​ ​terrible​ ​about​ ​yourself​ ​and​ ​the​ ​situation.

Solution:

● Work on conscious contact with the facts of life for EVERYONE on this planet. No family is perfect. The “hallmark movie” family is a myth. The perfect Sunday School family is a myth.
Everyone is dealing with some type of struggle. For some it is a mental health or a substance use issue. For others it is a medical condition. For others it is infidelity or divorce. Just look at the rich famous members of the celebrity class. Good God they are completely miserable.

● Bonus advice: Accept yourself and accept the fact you are going to avoid the conversation.
Avoid people who want to vicariously live through their children. Go for it. Its self-preservation.

Problem:​ ​Bubble​ ​Wrap​ ​Generation​ ​And​ ​Addiction​: Participation trophies. Self-esteem training classes.
Medals for everyone. If everyone gets a trophy then no one feels left out. But, if everyone’s a winner then no one is a winner. We created this. My generation. Me as a parent. I feed into this bullshit. I don’t want my kids feeling less than. It’s our fault. It’s not just the millennials. It’s the pre-millennials (I just made that up).

The term helicopter parent is born out of this dynamic.

When addiction, mental health, or emotional issues enter the picture for the bubble wrap generation the helicopter parenting instincts will kick into high gear. Remember, the helicopter parenting dynamic goes way beyond addiction. Helicopter parenting is the norm today. Parents spend all day driving their kids around. As stated above. Getting them involved in swim class, gymnastics, soccer, Chinese checkers tournaments, gluten free baking courses etc… Parents spend all night doing their kids science project with them. Checking the elementary school website for the latest assignments. Planning the bake sale to raise money for the field trip to view manatees for science class. PARENTS ARE CONDITIONED TO BE HELICOPTERS.

THEN ADDICTION AND MENTAL HEALTH ISSUES SHOW UP AND ALL THE PROFESSIONAL GENIUSES IMMEDIATELY TELL THEM TO DETACH. Then mom and dad have trouble detaching and they beat themselves up for not utilizing “tough love” effectively:

“I’m the worst enabler in the world”!

“I know I have made this worse…look at me I’m the poster child for enabling”….

And all this anxiety and emotional energy is wasted on this useless “detachment” battle.

Keep in mind the therapists who are telling you to “detach” are rushing home to make sure that little Suzy gets to her weekly “future astronauts of America club” on time because God knows this will surely get her into Harvard.

100%​ ​Ridiculousness!

Solution:​ This advice is for the “helpers” not just the parents. This is not 1955. Too many times the “advice” given to parents come out of the Al-anon tradition. When Al-Anon was founded the group was not addressing parents of 18 year-old heroin addicts. They were addressing wives of 50 year-old alcoholics. Detach with love was invented for spouses not for parents.

You may get to a point where you can detach but you need to be easy on yourself while on the journey. Have an understanding of the truth around parenting through behavioral health issues. Attend support groups and get educated. Try to avoid groups that make you feel worse about yourself. Definitely avoid therapists who make you feel worse about yourself.

Try and keep perspective. You will eventually be able to set the appropriate boundaries…but is likely to be a process of starts and stops.

Problem:​ ​Today’s​ ​PILL​ ​CULTURE​ ​And​ ​The​ ​7​ ​Minute​ ​Psychiatric​ ​Appointment​: When did the pill culture take over America? According to the Center for Disease Control (CDC) 48.9% of Americans report being on at least 1 prescription drug in the past month; 23.1% report being on 3 or more prescriptions in the past month; and 11.9% report being on 5 or more prescription drugs in the past month. Obviously, these medications are warranted in many cases.

Seventy five percent of doctor visits result in a prescription being issued. We certainly have developed the mentality that a pill is the preferred solution for what ails you in terms of physical health. Is this the same for behavioral health issues? It seems to be the case. Some interesting points to consider from Medco and their America’s State of Mind Report): Click here to read the report

● Overall, the number of Americans on medications used to treat psychological and behavioral disorders has substantially increased since 2001; more than one-in-five adults was on at least one of these medications in 2010, up 22 percent from ten years earlier.

● The most notable increase in the use of these medications (anxiety medications) was seen in children ages 10-19; utilization increased among this age group by almost 50 percent. While younger people showed marked increases, older people showed declines.

● In the United States, an estimated 5.4 million children ages 4 to 17 have been diagnosed with ADHD and the percentage of children with a parent-reported ADHD diagnosis increased by 22 percent between 2003 and 2007 according to the Centers for Disease Control (CDC).

● While​ ​it​ ​is​ ​well​ ​known​ ​that​ ​ADHD​ ​is​ ​prevalent​ ​among​ ​children,​ ​diagnosis​ ​and​ ​treatment​ ​of ADHD​ ​has​ ​in​ ​fact​ ​grown​ ​at​ ​a​ ​much​ ​faster​ ​rate​ ​among​ ​adults.​ ​Additionally,​ ​a​ ​gender​ ​shift​ ​occurs in​ ​adulthood​ ​when​ ​slightly​ ​more​ ​women​ ​are​ ​shown​ ​to​ ​be​ ​using​ ​ADHD​ ​drug​ ​treatments​ ​than men. ​ ​Among​ ​adults,​ ​women​ ​ages​ ​20-44​ ​showed​ ​the​ ​highest​ ​prevalence​ ​in​ ​use​ ​of​ ​ADHD​ ​drugs in​ ​2010​ ​(nearly​ ​2.0​ ​percent)​ ​and​ ​saw​ ​the​ ​greatest​ ​spike​ ​in​ ​their​ ​numbers,​ ​rising​ ​264​ ​percent from​ ​2001-​ ​2010.

We could go on all day exploring these trends. The bottom line is. Pills have become part of everyday culture in America. A pill is the solution for everything from sexual dysfunction to sleep problems to inability to get your work done.

And wonder why Johnny would go to a party and “take a dangerous” drug for recreational purposes. We have told Johnny pills are your friend since he was 3 years old.

We also know that psychiatric services are focused on medication adjustments and not talking through issues. This is just the reality of the situation. In order to make the business model work psychiatrists must see more and more patients.

This lack of attention was chronicled in a New York Times article and has become the generally accepted norm. Here is a link to the New York Times Article: Click here

Parents will naturally be drawn to leaning on expert support. But what do we do when the expert doesn’t have time for us? What do we do when medication becomes the go to option for nearly all issues? What do we do when this is happening in the day and age of Xanax abuse?

Solution:​ ​ ​Parents​ ​must​ ​become​ ​educated​ ​and​ ​system​ ​savvy.​ ​ ​The days of blindly “trusting” the professionals are behind us. This is probably true of all of healthcare. It is definitely true where behavioral healthcare is concerned.

We all need to become our own advocate. If a provider is offended you ask questions or want more information start looking for a second opinion. Unfortunately, psychiatric services can be hard to find. Therefore, sometimes you must stick out with a sub-par provider. Never discontinue medication without doctor advice. But look around at other options.

Become educated about solutions that lay beyond the 7 minute psychiatric appointment. Solutions that lay beyond medication. Talk therapy, alternative therapy, mutual aid groups, life coaching, exercise, nutrition are all things that can contribute to emotional health. Your service provider may not suggest options. Unfortunately, people tend to stick to their favorite treatment modality.

Try to find someone who can serve as a case-manager or a coach regarding system navigation. Practical advice and feedback is invaluable. It can be especially beneficial to find someone who has “been there done that”.

If you are able to develop a plan of attack for these three problem areas you will be ahead of the game. This is a most difficult period of time to raise kids.

We all need support and useful information. I hope you sign up for ongoing Recovery Cartel posts.

I will be going after this issue in depth in future posts as well….

Behavior change - The Right Reflhard Jones Recovery Cartel

Behavior Change -Truth and Understanding…

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Understanding behavior change

Understanding the process of human behavior change is a difficult thing for most of us. We are conditioned by cultural messages of “pull yourself up by your boot straps” and “just do it”.

Our heroes are often people who overcame great odds through shear will and determination.  Motivational speakers rip us a new one and tell us to get up earlier and never give in.  Self-help gurus tell us that self-talk and surrounding ourselves with the “right people” will make the change stick.

They tell us to bring our game to a new level.  Of course, there is some truth to all these things.  However, in reality, it is a complex process that varies from person to person. It is especially ironic that behavior change is so misunderstood given the fact we know and understand quite a bit about human behavioral change.

The issue of behavior change is even more pronounced given the neuro-biology of addiction. Addiction adds fuel to the existing ambivalence around changing substance use behavior.  The individual is impaired or, “not thinking straight” and this makes the change even more difficult.

With the best of intentions we will confront people in addiction and offer advice.  We demand they change.  We push remedies and solutions. We do this because we want to help.  It is very natural and it is known as the righting reflex.  However, in the overwhelming majority of cases our efforts to influence change produce the exact opposite of the stated intent.

Instead of driving the person toward recovery, these efforts drive the person deeper into the behavior.  When you argue with someone about the seriousness of their substance misuse issue they argue back.  As they argue back and debate their position it reinforces the “rightness” of their position.  The more we say something out loud the more we believe it.

 UNDERSTANDING THE RIGHTING REFLEX:    

In terms of behavior change the righting reflex is the “common human tendency to try and make things right”.  You are out with your girlfriend and she is talking about her toxic relationship with her mother.  She is going on and on about “every phone call turning bad”.

You can tell she is upset. You care for your girlfriend.  So you offer some unsolicited (obvious) advice:

“Why don’t you just hang up on her the next time she starts in on you”.

Your girlfriend instantly looks at you like you are a monster from the Texas Chainsaw Massacre series.

She tells you “I can NOT BELIEVE HOW INSENSITIVE YOU ARE”

….and then she immediately rushes home and calls her mom to report your behavior, pounds a carton of ice-cream, and spends the night bashing you with her mother joining in along the way.

Although the above situation may be humorous, the scenario with addiction is dead serious.

Remember addiction is a brain disease that makes processing, analyzing, and integrating information even more difficult.  We are pre-disposed to defend our addiction and justify our actions.  We are primed for an argument.

We will debate you to death if it means we can hang onto our substance use.  When someone approaches us with instructions, unsolicited advice, or confrontational statements we will enter into fight or flight and it is unlikely we assimilate anything that is said.

Behavior Richard Jones

 Note: This does not mean you ignore bad behavior. This means you convey your boundaries and plan your intervention in a strategic way. You avoid the arguments and stick to your expectations and the associated bottom lines. 

Mean what you say, say what you mean, 

but don’t say it mean. 

Theory of Change: People change for a wide variety of factors. Many times, I would argue most times, these factors are not the obvious factors.  For example, we say to ourselves “you would think Rich would quit drinking given the fact he is going to lose his job”.

What we don’t know is the value Rich places on his job and the impact this may have on him.  Unfortunately, the same could be said for the threat of lost marriages or losing custody of children.  Even the threat of jail leaves many unphased.

However, I believe in the human spirit.  I believe all people, no matter how low they have gone, have desires and values they hold dear.  They may not be able to access this easily as it is buried under layers of guilt, remorse, shame, and learned helplessness.  But it is there.

The good is there and their personal values are there.  Change will arise when the tension between your stated values and your current behaviors becomes unbearable.

If I value my family or believe my family is important and I become aware that using is detrimental to my family and I continue to use; the internal tension can provoke change.  IF I AM ABLE TO GET IN TOUCH WITH THAT TENSION.

Many times, we will run from that tension and use to avoid the tension or numb the emotional pain.  This is where interventions, support groups and professional support can help the person access his or her true nature.

The internal tension between stated values and behavioral reality is known as COGNITIVE DISSONANCE.

behavior Richard Jones

We will also “argue with ourselves” regarding these beliefs or values and the supporting information.  We can talk ourselves out of the dissonance.  We can question our own reality.  This is very pronounced where addiction is concerned.

We believe that the essence of coaching and counseling is facilitating a trusting relationship with the person in need.  If we have a relationship we can process events, explore behaviors, and highlight the existing tensions.

If I break out into a speech along the lines of “change or die” I am highly unlikely to ever see the person again.  He or she will isolate and continue to talk themselves out of the need for change.  We believe it is much better outcome to keep a connection.  We also believe that the process of change is accelerated in the context of a therapeutic relationship.

Obviously, it is difficult for family members or friends to provide that therapeutic relationship. Finding competent supports for the individual in need is essential to the process.  However, family members and friends can develop a realistic view of what works in behavior change. This awareness may save you a bunch of time, energy and emotion.  Be strategic about supporting behavior change.

Deliver Boundaries and Information In a Matter of Fact/Calm Manner:  Perhaps the best thing family members can do is to provide clear and consistent information and boundaries around the substance use.  Try to deliver the information and expectations in a rational non-emotional way.

There are generally accepted “stages of change”.  Many times, we will act as if the person is in “preparation” or “action” when they are actually in pre-contemplation or contemplation.  If we move faster than the person in need we will sabotage the process.

behavior - stages of change

None of this is easy and everyone makes mistakes.  It’s an emotionally laden experience and many times we will not think before we speak.  Just remember your main goal is to move the process along.  Sometimes this requires a calm approach when you feel compelled toward a more confrontation process.

Come see us soon at FAVOR Greenville family groups or check out my live stream…

Just Say No Recovery Cartel Blog Richard Jones

“Just Say NO”

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I LOVE FAKE HARMONY.

I am a master of manipulating a situation so that “everyone stays calm”. If I am not careful this will happen in all parts of my life. Work, family, friends. This is a learned behavior and a natural result of growing up in an alcoholic home. In a war-zone. If you upset the apple cart in my childhood home; all hell is going to break lose.

Just say know - Recovery Cartel Blog Richard Jones

Classic: Don’t Talk…Don’t Feel…Don’t Trust….

However, fake harmony is the enemy of setting boundaries. As I reflect on my life and the experiences I have had with families in the throes of a loved one’s addiction, I come to some pretty clear conclusions:

Setting boundaries is essentially the art of saying NO. Every boundary is essentially a form of saying NO. Sometimes very straight-forward:

“Can I borrow $100″… “NO you cannot”…

Sometimes it’s not as direct.

For example, a family member who drinks too much becoming verbally abusive when they drink… The boundary maybe you leave or it maybe they leave. But essentially it comes down to NO..

”You can’t treat me that way”…

So… what gets in the way of the boundary.

It’s not “what” to do. Most of the time we know that we should say NO. It’s “how” do we do it. Or maybe more accurately…why can we not do what is so obviously necessary and set this boundary?

1.) FEAR: We operate from fear of what is going to happen if we say no. We have scenarios that detail what is going to happen and we play them over in our mind. Fear controls us.

2.) JUST SAY YES: We plan on saying NO but in the moment, we allow the person to bully us into saying YES. They use intimidation, manipulation, and sometimes subtle techniques to keep us from saying NO. Example, give you the cold shoulder. Example, get you off task talking about other issues. Example, debate you to death. You give in just to shut the other person up and have some peace.

3.) PLEASE LOVE ME: We want the person to love us…or at least like us. So, we say YES as a way to not lose love and affection. In these cases, we tend to keep talking even after the boundary is set because we want the person to be happy about the boundary is set and life to be wonderful. They aren’t going to be happy. You just told them NO.

4.) I DID IT: Straight up guilt… We tell ourselves “it’s our fault”. The guilt clouds the rational decision making.

I’m a big fan of number 3… I need everyone I care about to like me and I need there to be peace in all my personal relationships. The reason being, I grew up in a home where unrest, discord, tension, resulted in really bad things. For me there is no in between.

Everyone is happy and everything is either really good…or the stuff is about to hit the fan.

In essence, I was always afraid of “destructive conflict” because I never knew there was “constructive conflict”. My response was to manage the situation and use my people skills to avoid direct confrontation. Of course, this approach has a short shelf life. It is unsustainable.

Constantly ignoring your own feelings does not change the reality of the situation.

How do you set boundaries in the face of these underlying issues. I would propose the following:

1.) For the fear based boundary challenges: There is a technique called “fear setting”. This is not for everyone because it can be a heavy duty emotional exercise. Fear setting involves getting in touch with the “worst case scenario” and trying to “sit in” the experience. Using guided imagery you can walk yourself through a mental exercise where the worst case scenario is played out. The idea being, if you can face this fear. You can set and maintain the boundary.

2.) For the “debater” and the “intimidator” challenges: The technique is called “hit and run”. Also structure the conversation. Make sure you have the conversation under conditions that naturally limit time for “discussion”.

Over the phone so you can employ the “I have to go now” technique. Or set the expectation at the beginning that you can only talk briefly. Be careful not to set the boundary talk in a circumstance where you can be held hostage. You don’t want to be a captive audience and enter in an extended debate concerning these issues.

3.) For the “we want them to love us” challenge: The technique is called “suffer in silence” and essentially boils down to this: learn to stop talking. How do you get comfortable with something that is initially uncomfortable? You “sit in” or “lean in” to the experience.

Try and be grateful for the opportunity to “learn from this discomfort”. You have to re-frame the experience in a way that is positive. If you don’t you will instinctively run from the uncomfortable feelings. Feelings will not kill you. Feelings will not physical harm you. Feelings will pass. Practice and keep track of improvement in this area.

Eventually you will become a boundary setting NINJA!

Recovery Cartel Blog - Richard Jones

Like my beloved Melissa. She can drop the hammer and slice you up with a boundary and you don’t even know what hit you.

4.) How to handle guilt:

Here is a Rich Jones original method for addressing guilt.

It involves confronting the irrational thinking involved in your assessment of the situation. Journaling can be very useful. At the top of the page write out the boundary.

Example: “I just told Rich “no” to paying for his rent another month”.

Followed by: This makes me worthy of guilt because…. And let the words flow.

Get into a process of free association around this topic. Then put the journal down. Go for a 5-minute break and come back and read your reasons for feeling guilty. Let me know if the reasons are rational!!! This will condition your brain to confront the irrational thoughts associated with feeling of guilt.

Remember, setting boundaries is a skill. Or maybe more accurately, a habit. A habit is merely a behavior we engage in on a repeated basis. If you practice this skill you will get better and better at setting boundaries.

It may never be easy. But it will become manageable.

Recovery Cartel Blog

70,000 DEAD? Really – We gotta talk!

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This is a Manifesto and a Plea for Honesty.

As the data rolls in from 2016 it appears the death toll from overdose could actually exceed 70,000.  Let’s talk about the “Elephant in the Room”. Let’s get real… Let’s have a debate. Let’s have a difficult conversation. Are we allowed to disagree?

Is there room for dissenting opinions? I could be wrong. Maybe our current approach to the addiction crisis is the best approach. I don’t think it is, but hey, I’m open-minded. Or do I get kicked out of the club for not toeing the company line?

One thing for sure: 70,000 dead is disgusting. Sickening that we accept this and do not respond in radical ways.

For me, this has become a moral issue. At this point we have a moral and ethical responsibility to address this issue at its core. We hold tight to an antiquated approach that has never been shown to be effective. We just never addressed it before because of the stigma. Addicts are allowed to be mistreated because they are scumbags. The difference in 2017; death rates and media attention have made it harder to ignore.

Furthermore our current systemic approach is an approach that does not even touch 90% of those in need…let alone help them. Is this okay? Is this acceptable?

I don’t think we need more awareness. I think we need more solutions.

Thoughts:

1.) Rehab is not the gatekeeper of recovery.

People figure it out on their on own, people find recovery in many ways. More treatment access is not the answer. You continuously hear “get them into treatment” …as if that’s a solution.

See this article on Myth of Rehab as Gatekeeper of Recovery from the Recovery Research institute.

  • Can we empower rather than preach to the patient/family in need?
  • Can we move our focus away from the “automatic” rehab response?
  • Can providers and membership organizations please police your ranks and get rid of the marketers who spend all day everyday intimidating and bullying people into treatment centers?

2.) Intensive outpatient programs can be effective for people who are motivated and people who complete the entire program.

However, some studies suggest that up to 50% drop out in first 3 months and we know that motivation levels vary greatly. Most people with an addiction issue are not motivated. Outpatient clinics could be more individualized. In the private treatment domain IOP’s have been transformed.

Sober living homes use IOP’s to maximize reimbursement. These programs are actually referred to as rehab by many and most lay people do not understand the difference between an IOP and an inpatient treatment center.

The Florida Model is problematic. IOP is especially useless for people who have been through IOP before. 9 hours a week, delivered in 3 hour groups, 3 times per week, is not the most efficient use of time or money.

Check out this NBC INVESTIGATION by Meagan Kelly from June 25. 2017

The Community Based Experience could be so much more impactful.

  • Could those 9 hours of therapy be delivered in more creative ways?
  • Who dictates this?  – Insurance?  – The provider?
  • Why do we deliver IOP in this prescriptive way?

3.) 12-Step facilitation is effective for people who are willing to do 12 step programs.

The studies around this type of therapy are interesting. There is clearly a benefit but they ignore the reality that 90% of the folks are completely disengaged. We base our approach on the small receptive percentage of the small percentage (10%) that show up for treatment.

  • Should we offer more alternatives?
  • Should we force feed people?
  • Should we wait until they hit bottom and surrender or should we explore all options?

4.) Medication Assisted Treatment comes with all kind of baggage that is not discussed.

The stigma within the stigma. People in MAT are marginalized within recovery rooms. There is an effort for the fellowships and recovery rooms to be politically correct and welcoming. However, the message is loud and clear.

From Narcotics Anonymous Information Pamphlet:

NA and Medically Assisted TreatmentNA and People on Medically Assisted Treatment –
As we stated previously, NA has no opinion on the practices of any organizations or practitioners outside NA. However, within the context of NA and its meetings, we have generally accepted principles, and one is that
NA is a program of complete abstinence. By definition, medically assisted therapy indicates that medication is being given to people to treat addiction. In NA, addiction is treated by abstinence and through application of the
spiritual principles contained in the Twelve Steps of Narcotics Anonymous…..

….Our hope is that those who receive medication to treat addiction will come to meetings and listen to people who are recovering. Through listening and through asking questions before and after meetings, attendees may gain a better understanding of NA and what it has to offer. NA offers a community and a lifestyle that support staying clean, and NA may be compatible for addicts on medically assisted protocols if they have a desire to become clean one day. We understand that addicts whose path is medically assisted treatment may hear many messages in NA meetings. Some NA meetings make no distinction as to whether those receiving medication to treat addiction may share in a meeting, while other NA meetings limit the participation of those who are taking this type of medication.  Click here to download this NA Pamphlet

More Questions to Consider:

  • Can we hang our hopes on MAT without professional recovery coaching to bridge the gap?
  • Shouldn’t we develop a way to integrate MAT into recovery?

5.) The family must be mobilized.

Instead of detachment we can teach responsible influence and individualized family recovery planning.

  • Can we use programs like FAVOR FAMILY RECOVERY to guide people thru a systematic response to loved one’s addiction?

6.) It’s not about money.

Money is not evil. If a program or person is actually making an impact they should be compensated. However, there are really bad providers making a massive payday on the backs of the suffering.

  • Is there a way to incentivize programs away from the rinse and repeat model?
  • Can they be held accountable for rinse and repeat and give money back when services are proven ineffective?
  • Can value based healthcare be applied to addiction treatment services?

7.) Finally… can we get beyond the concept that we can only work with a “willing” client.

The evidenced based practice of motivational interviewing and stages of change theory is promulgated throughout the entire treatment system. However, no one really follows its tenets.

“YOU CANNOT BE A MOTIVATIONAL INTERVIEWING PRACTITIONER AND PRESCRIBE ONLY ONE PATHWAY OF RECOVERY. ITS IMPOSSIBLE.”

The vast majority of our interventions are focused on the preparation and action stages of change even though the vast majority (you could argue 90%) of those with addiction are in the pre-contemplation and contemplation stages of change. NON-SENSE.

  • Can we empower and financially compensate programs that are effective in connecting to unwilling people?
  • Or are we going to hold tight to the idea that a person must hit bottom?  Many of us die on the way to the bottom!

Final Thoughts – Assertive engagement strategies work.

I run a high quality professional recovery coaching organization. We are one of 9 CAPRSS accredited programs in the nation. We are a member of the association of recovery community organizations. We have served over 17,000 people and we have provided more than 40,000 hours of recovery coaching.

The majority of those hours to people who do not necessarily “want” recovery. We serve the “unwilling”. We are engagement experts.

We believe this type of independent, autonomous organization (not affiliated with a treatment organization) is the future of professional recovery services. We know how to do this.

I’m sure there are other new solutions out there as well. Ours is just one of many new ideas. We need to champion new ideas. Adding equine therapy to your program is not innovation. I’m talking brand new ideas. Ideas that make the status quo cringe.

Tell me I’m wrong. Tell me how and where I’m off base. Let’s talk about this.

Richard Jones is the President and Chief Operating Officer of FAVOR Greenville. FAVOR Greenville offers a new and innovative response to the baffling problem of addiction by focusing on assertive engagement, family empowerment and non-traditional community partnerships. WE ARE THE FUTURE. THE PARADIGM SHIFTS HERE… JOIN US.

Family Recovery - Richard Jones

21st Century Family Recovery

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Family Recovery in the 21st Century

Early in my career I was a staunch supporter of the primacy of individual recovery.  Influenced by my own recovery experience I was certain the family had little to do with recovery success.  If someone slipped up or relapsed or otherwise “failed” in their recovery effort it was simply due to a lack of willingness.  The family system held no sway. Family recovery was an issue best left to others.

I can still hear myself saying it:

“Addiction is the individual’s problem and not a family systems issue”.

Of course, as a professional I held tight to the company line and provided the family education on addiction and I would support referrals to Al-Anon support groups.  However, I firmly believed that the individual was responsible for his or her recovery and the family was essentially an after-thought.

The family could support from a distance, learn how to be less “co-dependent”, reduce enabling behaviors, start “taking care of themselves”, and otherwise stay out of the way.

Fortunately, I had professional supervision and experiences which directly challenged this view.  I found myself in the role of clinical director of drug and alcohol services working primarily with adolescents with substance use disorders.  We developed a true adolescent specialty program and the integration of family therapy was integral to our success.  In addition, we received intense consultation and supervision by a licensed martial and family therapist.  This process fundamentally changed me.  For the better.

It is going to require an intentional and intensive focus on family engagement to change the culture around the family recovery experience.  Some inpatient rehab programs hire a family specialist to run a “family program”.

Usually, a weekend experience for family members while their loved one is in rehab.  Perhaps some phone calls with a loved one occur while the person is in rehab. However, when you evaluate the entirety of the “rehab experience”, I would guess the “family component” comprises at best 20% of the focus.  With occasional exceptions, family work is an adjunct to the rehab stay and never really given its due.

On the outpatient level, we may see more integration of family therapy but the majority of family support comes thru attendance to Al-Anon family groups.

If other family recovery self-help groups are available, they may be a referral source as well.  These groups are helpful, however, they were developed to support wives of recovering alcoholics.  Specifically, wives of white middle class men.

The terminology and the advice that sprang out of this process, detach with love for example, may have worked well for these early groups.  However, things have become much more complex.  Furthermore, there should be a clear distinction between 12 step self-help groups and professional services.  The latter demands a comprehensive family orientation.  The former does not.

Duncan Stanton and Thomas Todd describe this phenomenon in the following manner in their book The Family Therapy of Drug Abuse and Addiction:  

“these (treatment) modalities met with varying degrees of success…However, nearly all of them address addiction as primary problem in the individual, that is, one that is located either in the “body” or in the “personality”.  Little attention has been given to the interpersonal process, except as it applies to peer group, or as it is dealt with in certain family oriented self-help groups such as Al-Anon or Families Anonymous”.(pg. 1)

As time has passed I have placed greater and greater emphasis on the value of “Family Recovery“.  This has culminated in a distinct set of protocols and a process we have used over the past 7 years in various settings.  We have swung the doors of our programs wide open to families regardless of the recovery status of their loved ones.

We operate with a few basic principles that have guided our family programming from the very beginning.

1) We believe that there is merit in family recovery in and of itself.

Family members experience profound health concerns when substance use disorders are present. These include chronic stress, physical problems, sleep difficulties, depression and anxiety.  Even if the person suffering with a substance use disorder never makes a change the family deserves special focus and support to deal with these issues.

2) The family has tremendous power that can be harnessed and focused in a way that increases the likelihood their loved one will seek recovery. 

Frequently, when family members start to change the person with a substance use disorder will start to change.  Family systems theory tells us that if you move one part of the family you move the entire family.  Like a mobile above a baby’s crib it is impossible to move one part without impacting the whole.

3) Family members are frequently the first point of contact in the process of recovery initiation.

Family members constitute a more willing customer base.  They will call for information and options well before their loved one darkens the doors of our center.  They are open to feedback and, in many cases, begging for information and options.  Therefore, FAVOR Greenville sees the family as a ready-made channel for engagement of those in need.

4) Family recovery coaching is a unique discipline and the shared experience of families in recovery can be capitalized on in a manner consistent with basic peer support services.  

With these principles in mind, my most recent endeavor (FAVOR Greenville) started family programs in 2013 with a simple open “Family Recovery Group”.  The group was modeled on basic group facilitation processes of universality, mutual support and mutual respect.  Our initial group attendance was 12 people.

We held these groups every Monday night at 6:30pm.  The group exploded in attendance based nearly entirely on word of mouth.  In 2016 this group averages 54 people per week with a high this past month of 103 people in attendance.  The group has become more didactic and educational in nature.  However, we start each group with questions from the week and we make sure the topic of education/discussion is generated by the group.  There are usually 10 to 15 new people at group and an equal number of “veterans” who have been in attendance since the group started.

Over time an interesting phenomenon arose.  The group was intended for any and all family members.  Spouses, children, siblings and parents together in one group.  However, the group quickly morphed to 90% parents.

In response to this we developed our second family recovery group.

Every Thursday night at 6:30pm we hold our S.O.S. (Significant Other Support) group.  This group focuses on spouses or adult children.  This group has a different tone than the parent group because the dynamics are different spouse to spouse versus parent to child.  This group has operated for 2 years and average attendance is 20 people.

We have just added an off-site Family Recovery Group in our neighboring town of Spartanburg SC.  Many people from Spartanburg had been making the trip to Greenville.  However, it became clear that the community needed a satellite group.  We launched this group in 2016 by forming a partnership with a local church.  We rent the space and facilitate essentially the same group.  Average attendance at that group has been 20 people.

Furthermore, we are scheduled to start a Family Recovery Program in nearby Laurens County in September 2017 in partnership with the Laurens County Hospital Foundation.

We also have a children’s program for children of parents in recovery and/or children of parents struggling with active substance use disorder.  This is a curriculum based program and we run it periodically based on community response/need.  We have had 103 children complete this program.  Along those same lines we have added two teen recovery groups serving teens in any stage of the process from prevention to recovery.  We have had 207 teens attend our groups.

Another distinct area of family recovery support at FAVOR Greenville is our family recovery coaching.

These are parent to parent; spouse to spouse; family to family coaching relationships put in place to supplement the various groups provided at FAVOR Greenville.  We actively recruited family members who had been “working a recovery program” and developed a specific curriculum to supplement our regular coach academy.

These family members completed a specialized training academy to become FAVOR Family Recovery Coaches.  To date we have trained 53 family coaches and currently have 29 active Family Recovery Coaches who volunteer on average 5 hours per week to coach and support other families.

We have been over-joyed with the Family Recovery Coaching programming.  We have provided over 8,000 hours of family recovery coaching since initiating the program.  The family coaches are incredibly enthusiastic and grateful and this is reflected in the way they engage our families in need.  This has been magical to watch.

Overall, it is important to note, 48% of the service hours delivered at FAVOR Greenville are delivered to family members in need. 

The distinct difference with our program is the following:  Family recovery is not an add- on or adjunct to service; family recovery is front and center and a cornerstone of the center.  We have found that family members want to be included in the process and they make great volunteers and supporters.

FAVOR Greenville will continue to place formal emphasis on family recovery and we believe our program will expand in the area of family recovery as we move forward in our mission. 

What have we learned over the years in our work with families?

1). Parental experience in dealing with addiction is 100% different than spousal experience.

This cannot be over-stated.  It is important for family programs to provide specialized services and information for parents.  We must maintain an awareness of the influence that Al-Anon has on traditional family work.  Al-Anon sprung up as a support group for spouses of those in Alcoholics Anonymous and many of those principles do not translate smoothly to parents.

It is a completely different experience for parents as they struggle with setting boundaries and reducing enabling behaviors.   It is not a simple set of instructions and the conversation must be delivered in a way that is acceptable to the parent.  For example, do not tell a parent “you are sick and just need to take care of yourself”.  The result of such a statement will be complete disengagement.  This is a reality that must be acknowledged and accounted for.  We must become more individualized and engaging in our work with families.

2).Families can become skilled in responding to addiction. 

It is possible to teach family members basic skills that can be useful in responding to their loved one’s addiction.  We can help them develop basic recovery messaging.  We can help them be strategic about when and how to bring up crucial conversations.  It is even possible to teach basic motivational interviewing principles and skills.

Families love information and they are empowered when they feel more competent.  I am not saying that a family member can serve as a loved one’s counselor.  However, he or she may be able to provide really helpful and tangible support.  The idea of complete detachment and “staying out of it” is looking less and less appropriate the more I work with families.  It has been said that 1 family member wields the power of 8 professionals.  Let’s teach families ways to capitalize on that power.

3). Professional Peer Family coaching is a real discipline.

We have been training family coaches for 3 years now and there is nothing more powerful than a family to family supportive relationship.  The practical shared experience and the exceptionally strong sense of empathy is beyond comparison.  It is one of the most therapeutic supports available for family members in need.  We need more family coaches and we need to honor family recovery professionals.

 4). In that same vein, professional family coaching and family mentor-ship is a key part of the recovery continuum. 

The workforce that fills this role can be drawn from family members who have their own experience, friends who walked the path with an addicted individual, and allies of recovery to include therapists, counselors, tech staff, and others; as long as this group is able to display sufficient empathy toward the unique struggles of the family.  We believe it is possible to develop trained and credentialed specialists

 Despite this progress we know that we have not even scratched the surface of what can be done with families.  The reality is family members have to be front and center in this fight against addiction.  It is not sufficient to merely state “addiction is a family disease”.

We have to do programming that reflects a belief in addiction as a family disease.  Furthermore, like many things in addiction treatment field our fundamental assumptions around family recovery need to be re-evaluated.  Terms like co-dependency, enabling and detachment all require a second look.  This seems self-evident given the manner in which they came to guide family services and the changing face of addiction since that time.

Recovery Cartel Blog

Top 2 Questions from Family Recovery Group

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Family Recovery Group:

FAVOR Greenville conducts 4 family groups per week with at least 140 people in attendance in any given week. We have served over 6,000 family members the past 4 years. With that in mind we will explore some of the more common themes that arise from the group discussion.
An instructional manual for family members based on the most common Family Recovery Group questions. Two questions per day:

1) What the hell is wrong with my loved one? Substance use disorders occur on a continuum. One of the most challenging issues is getting someone to realize they “have a problem”. There is no x-ray or blood test that will definitively reveal the presence of “addiction”. The closest thing we have to a definitive diagnosis comes via the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We also know that not everyone who “parties hard” is addicted.

recovery blog recovery cartel

We also know that addiction is more than bad behavior. There is a fundamental “brain change” that occurs when addiction enters the picture.

This has been hotly debated and many people challenge this assumption.

There are some who believe addiction is a moral choice, there are some who believe it is a problem of connection, others who believe it is a learning disorder, and some who believe that it is a spiritual problem.

There are also people who believe addiction is a combination of all of the above.

There is probably much we do NOT know about addiction. We essentially stopped learning in the 1970’s when the Minnesota Model took over treatment. However, I think it is important for people to realize that the brain is impacted. Regardless of how you semantically describe the process; something changes in the brain. This contributes to compulsive use and obsessive thinking about the substance and use despite consequences:

recovery science

This image displays the depressed dopamine levels that occur with chronic substance misuse. I’m not a neurologist but I would prefer the brain on the right over the brain on the left. The absence of dopamine prohibits the experience of pleasure resulting in the addictive behaviors described above.

Dr. Kevin McCauley in “Pleasure Unwoven” uses the example of a diabetes Type 2 to illustrate the disease of addiction.

Diabetes Type 2 is a chronic, lifestyle disease you “give to yourself” based on choices you make regarding substances you put in your body.

Addiction is a disease you “give to yourself” based on choices you make regarding substances you put in your body.

family recovery

What can I do about this?

The best way to answer this question is to describe the treatment and recovery process. However, I would like to take a moment and discuss crisis response. It is likely that you have experienced potentially life-threatening situations and dangerous behaviors when dealing with a loved one’s addiction. If this is the case you need to take action to ensure everyone’s safety.

In most areas, this means contacting 911 and/or emergency services.

If a person is out of control and a danger to themselves or another person you have no choice but to make this call. Believe it or not, sometimes legal involvement can be a blessing in disguise.

There are multiple options and ways to attack this issue. Most people have heard about “rehab” and many equate this to recovery. Rehab does not equal recovery. There are different levels of care associated with the treatment process and a thorough clinical assessment can help determine the recommended level of care.

The single most difficult part of the process is getting your loved one to recognize the problem and follow through on the services. Interventions can help with this. Family recovery groups can help you as you work through this issue. However, interventions require serious commitment on the part of the family.

Recovery Cartel Bog

If you are not able to put together an intervention team you may be able to solicit some support outside the family. Perhaps someone else can talk to your loved on? Sometimes we listen to others while we ignore those close to us. Developing a recovery message is also an important part of the process.

A recovery message comes from a place of love rather than confrontation. It is important to communicate that you are concerned with your loved one’s health and this is not meant to be punishment.

Putting together the team can be a difficult process. It’s important that everyone be on the same page. All significant people in the person’s life need to be in agreement. Sometimes you can accept “lower level” of care if it means everyone can come together.

For example, you may agree that the person will start at an outpatient level of care rather than an inpatient rehab level of care. Quite frankly, if you are able to get the person to a clinical assessment you have made some good in-roads. It’s not all about rehab. Please understand many people recovery without rehab.

Special Note: there is no such thing as “tough love”. You may need to work on the appropriate expression of love. But you do NOT need to be tough. Love involves setting boundaries. You DO NOT have to be mean in order to make your loved one get help.

It is important to get good support and advice when working through these things. I have heard people give families the most outrageous advice. Things like: “Kick the bum out”; “Don’t even give him a baloney sandwich”; “Don’t talk to them at all”; “Cut all ties”. This may be appropriate in extreme cases but it should not be applied across the board. Everyone’s situation is different. Every case is individualized. Please select your support system carefully. It can get real ugly out there.

Special Note Number 2: Beware the treatment center predators. If you call a 1-800 phone number they may try and bully you into getting your loved one into treatment “today or they will die”. Try to find a therapist or a person with some independent training to help you decide what to do. The rehab “pimps” are everywhere.

Remember, recovery is a process so taking care of yourself along the way is extremely important. It is okay to focus on getting your loved one help. It is unrealistic to think you will “walk away” from them and “detach” completely. We would encourage you to explore all options, including family intervention/coaching support. However, it is important that you try and take care of yourself along the way.

We will continue this series and talk about other common questions including options for self-care.

Stay tuned….

University of South Carolina Med Students-Recovery Coaching Class-2017

Difficult and Overwhelming at Times

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This line of work can be difficult and overwhelming at times.

I have actually heard some public officials who work in our addiction treatment industry say “don’t talk about the opioid crisis it will frighten people”.  Classic denial at the system and institutional levels.

We need to talk about it. We need to be open about the depth of the problem. What will it take to stem the tide of addiction in our community, the region and the nation. When the final numbers are tallied, the Center for Disease Control (CDC) projects overdose deaths will exceed 60,000.  At this point overdose is the number one killer of people under the age of 50.

Here in Greenville County overdose deaths topped the state at 79.  Over 700 overdoses were reversed. It is likely that we are just beginning to see the epidemic manifest itself in the Upstate area.  I hope I am wrong about this.  In the meantime, we have alcohol continuing its rampage atop the list of destruction. Over 70 of our most serious health conditions can be traced directly to the misuse of alcohol.  It is not a stretch to say that substance use disorders constitute the greatest public health challenge in American history. 

We have support in place via treatment and recovery services. We have outstanding self-help groups available. We have an increase in options for treatment and we have made concerted efforts at breaking through the stigma. Yet the death rate continues to climb and our facilities are full. Many times, with the same clients over and over again. Recent research indicates that 70% of the people in treatment are repeat customers and only about 20% follow through on any programming following completion detox.  We know we need to push the envelope of innovation where substance use disorders are concerned. We need to work hard at forging partnerships and we need to look outside the box to find these partnerships.

One such transformational collaboration has been unfolding over the past 2 years with University of South Carolina School of Medicine at Greenville Health System campus. The med school has welcomed FAVOR Greenville with open arms. We have presented on the topic of recovery on several occasions. Shared our stories of success and our struggles with addiction.  It has been a great opportunity to expose future physicians to authentic recovery principles.

The relationship went to an entirely new level with initial FAVOR Greenville Recovery Coach Academy specialized week-long training for medical students. This 30 hours coaching curriculum is the only such training in the nation.

The comprehensive nature of the education and the collaboration makes the experience exceedingly unique and a model for healthcare across the country.  We believe returning treatment services to healthcare will be a key part of winning the war on addiction. Fully integrated addiction treatment services will make a major difference in turning this thing around.  We are very grateful for USC-Med School @ GHS and especially Lauren Demosthenes for making this possible.

We also believe that this symbolizes a much need paradigm shift.  The med students in this class were exceptionally compassionate and open to helping people with substance use disorders.

It made me think: “perhaps these are the partnerships and healthcare is the pathway to transformation”. 

If the medical field truly embraces addiction as a healthcare issue, the stigma will take a direct hit. As it currently stands, we know that most doctors do not address substance use disorders directly for a wide variety of reasons.  The group we trained seemed to be wide open to having the necessary conversations.  Most importantly, there was zero stigma or judgement in the classroom and this is a very hopeful development.

Over the next year, these coaches will serve as volunteers and support FAVOR Greenville as we work toward connecting with participants across multiple healthcare venues.  The potential benefits are limitless.

“It makes us wonder…what exactly will we accomplish if healthcare becomes the first line of defense in the war against addiction.”  

1.INCREASED IDENTIFICATION and EARLY INTERVENTION:

The most obvious benefit is INCREASED IDENTIFICATION and EARLY INTERVENTION. Healthcare workers are on the front lines of this addiction crisis. They are faced with the obvious and subtle effects of addiction all day, every day. Therefore, empowering healthcare staff with the tools to identify and engage patients in the recovery process is essential. There are efforts underway to implement Screening Brief Intervention and Referral to Treatment (SBIRT) within many healthcare facilities. SBIRT is evidenced based and, if utilized, can make a difference. Getting buy in and full implementation is another story. This has historically been a very difficult process.  We believe increased knowledge of recovery options and partnerships with recovery organizations can help fill in the gaps that exist in the SBIRT system.

2. ADDICTION IS A DISEASE:

If we actually handled addiction in the healthcare system, rather than off at a designated (sometimes isolated) drug and alcohol clinic, the stigma will be reduced. It is also more likely that addiction will be viewed as a disease by the general public. Hospitals and healthcare systems; this is where disease is addressed. Of course, there will always be a need for some specialized rehabilitation centers; just as there is specialization in other areas of healthcare. However, we could eliminate at least 50% of the “treatment centers” and roll those services into the healthcare system.

3. TRUE HOLISTIC CARE:

If done well, co-occurring mental health and co-occurring physical health issues could be addressed within the same system as addiction. This seamless coordination could improve overall outcomes.  There would be a synergistic relationship where physical health contributes to improved behavioral health and vice versa.

4. VALUE BASED HEALTHCARE:

Although it is not a guaranteed thing in today’s uncertain political climate, value based healthcare seems an unavoidable reality. This would be a transformational development if applied to the addiction treatment world. Creating an environment where programs were held accountable for patients returning to treatment over and over (rather than rewarding programs for rinse and repeat) would change things over night. Challenging and disrupting the current business model may be the single most important challenge we face. If addiction services were housed within healthcare it is more likely that value based healthcare would be applied to treatment services. This is reason enough to move toward healthcare  integration. Recovery Cartel Blog

5. EVIDENCED BASED TREATMENT:

Much of professional addiction service is guided by conventional wisdom and traditional values. Some of this is very helpful. Some of this is very problematic. Most centers operate from a 12-step only model that lacks evidence. The move toward alternative programming has been hampered by pre-existing practices that are very entrenched and difficult to move. There is too much tradition to impact significant change. If we moved addiction service to healthcare it would increase the likelihood of evidence based treatment because healthcare is not beholden to any traditional framework. We could start over and we could promote multiple pathways to recovery.

6. WE COULD ELIMINATE THE “HUSTLERS”:

As we know we live in the age of “instant expert”. If you are clean and sober for a couple of weeks and you can get a treatment center to pay for your Facebook ads you can become a marketing machine.  The industry is full of hustlers, and the hustle is working.

Recovery Blog - Scams

 

The people who are considered experts in this industry are, in many cases, harmful actors with little knowledge and lots of con. It stands to reason that, If healthcare was responsible for inpatient treatment services, and we could eliminate much of the private treatment market. And these hustlers would have to go back to selling junk bonds.

 

 

As stated previously, it is likely we will always need some form of rehabilitation.  However, our current approach has shown itself to be inadequate as best.  The rising death toll, the dismal retention in services, the low treatment engagement rate, and the 70% rinse and repeat reality make this clear.

Why not transform the system by bringing professional clinical addiction services under the umbrella of healthcare?

Or we can keep doing what we are currently doing, over and over, and expect different results.

Will we try something fundamentally different when 100,000 people a year die?

Would that warrant a shake up?

 

 

Transform recovery

TRANSFORM THE RECOVERY WORLD

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6 PRINCIPLES THAT WILL TRANSFORM THE RECOVERY WORLD

“Cartel–an arrangement between parties to promote a mutual interest or goal… “

I believe it will take a RADICAL reshuffling of the current treatment approach & public policy to make a dent in this crisis. I say this because all our efforts, so far, have fallen short as indicated by the astronomical increase in over-dose deaths.  If it’s a disease the primary indicator of successful care would be keeping people alive. Right?

All that we have done to this point has been predicated on our pre-existing approach/philosophy. All our money and resources have been funneled through our pre-existing system of care.

It’s going to take a massive shake to transform and usher in change. Our institutions will double down on current practices. Because that is what institutions do. They exist to sustain themselves. It’s a sociological fact.

The change could come via the free market.  If treatment providers saw the wisdom of a new business model.  However, that would only happen if current business dried up. “If it’s not broke don’t fix it”…. seems to be the prevailing philosophy.  And I don’t see it drying up soon. Too deep a problem.  Too much demand.  Plus 70% repeat business makes the model self-sustaining.

The solution will come via “outsiders” AND NON-CONFORMISTS.  Independent thinkers, people from other industries, progressive healthcare providers, and risk takers.  Partnerships that, on paper, make little sense but in practice lead to transformational ideas.

THESE PARTNERSHIPS WILL PRODUCE RADICAL IDEAS. People will actively push back on the ideas.  When that happens, it indicates that the proposed idea is probably the right type of idea…bureaucratic objection especially, is a litmus test for a great idea.  Almost as promising as when a treatment provider tells you “that’s not the way we do it”….   then you are on the right track.

It’s going to take a cartel…A RECOVERY cartel.  Like any good cartel we need to have our organizing principles and our mutual goals…  From my perspective the CARTEL holds the following principles near and dear.

Within the CARTEL we embrace the concept of “keep coming back”. For us, this is not just a cliché or a theoretical ideal. For us, it is the measure of our success and the single most important aspect of the recovery process. We know that people who stay engaged in a recovery process, regardless of the specific pathway, tend to get better. Even if you struggle along the way your life starts to improve. Even if you “mess up” and use, things begin to get better. Furthermore, we believe that the vast majority of people that continue to work a recovery program do eventually sustain long term recovery.

On a very practical level this means we will never preach to you or judge you. It means that we are all on equal footing in terms of our recovery. It means there is no hierarchy of recovery or right or wrong way to do recovery. We don’t count days. We don’t prescribe specific pathways. We just want to see your life improve. We just want to see families get put back together. We will meet you where you are in this process. If you are still using our goal is to help you figure out next steps and how this behavior fits in with YOUR personal values. Not ours. We have no agenda other than your welfare.

We believe substance misuse is a healthcare issue. We offer you a place to discuss it as a healthcare issue. It is not a moral failing. If you are struggling with substances you probably have considered stopping. You may have tried before. We believe we can provide you with new information, supportive coaching and unconditional positive regard.

Our core recovery principles include the following: 

1.  You are in recovery if you say you are in recovery.

Admittedly this philosophy is NOT exclusive to the CARTEL. Many other recovery community organization have adopted this perspective. I have been in situations where the definition of recovery has been a hot topic of debate. I have been in situations where people have contested the merits of the term “in recovery” versus the term “recovered”. I have little tolerance for such things.

Entering into recovery is a difficult process. If we make people stand at the threshold and question if they “qualify” it is only going to drive people away.  Therefore, for our purposes remember…you decide if you are in recovery. No need to fill out an application or get your passport renewed.  You’re in.

We hope to assist you in the journey and we know that recovery is process not an event. If we offer advice and support it is in the spirit of guidance and it comes with unconditional positive regard. We stand in radical non-judgment of your journey. However, we will tell you if your ship is sinking. We will just do it in a very loving and caring manner. No shame. No punishment. No judgement.

We want to welcome you to recovery, regardless of how you define recovery!

Recovery Cartel Blog Transform Recovery

Recovery is NOT a contest…

2. There are multiple pathways to recovery.

Again, this may not be earth shattering. As a matter of fact I hope people read this and say “of course there are multiple pathways.  My fear is, there are many who believe that there are only specific ways to recover and any effort outside of that framework is futile, inferior and doomed for failure. I used to think that way. What a horrible outlook on recovery that was.

Bill Wison Co-Founder Alcoholics Anonymous

“Rather we shall reflect that the roads to recovery are many.”  – Bill Wilson Co-Founder, Alcoholics Anonymous

People find recovery through countless avenues. Research indicates that the majority of people with a diagnosable substance use disorder will recovery via a process of “natural” recovery. In other words, they will find ways to eliminate their substance abuse and live a productive life without formal intervention and formal “recovery programs”.

I do not dispute this research. However, I have concerns with waiting for people to “figure it out”. In this age of overdose, we need to be very aggressive, assertive and effective in promoting recovery. That said, the key part of the message needs to be multiple pathways exist and you can invent your own pathway. We just believe that you can get that done more effectively if you have a coach or a mentor to help you figure that out.

Recoveryism is a term that has been used to describe the phenomenon that exists where people hold the position that their personal path of recovery is the “best path of recovery”.  Actually, many believe that their personal pathway of recovery is the ONLY pathway of recovery.

This is a most dangerous form of tribalism. Can you imagine how many people have been alienated or chased away via such attitudes?  There is no legitimate place for this in the recovery world and certainly should be ZERO tolerance for this in the professional community.

3. You should not be required to “quit” prior to becoming involved in a professional program. The person who is “not sure” what they want to do with substance use, has a right to, support, coaching, and direction.

Change happens across a predictable and universal process.  The stages of change have been well researched and validated over and over. They apply to anyone making a behavioral change including someone dealing with a substance use disorder.

The Cycle of Change

Many people struggle with commitment to change and a constant process of “thinking about” change (ie. Contemplation stage). This is completely natural.

Most programs require “willingness” and will only work with the person in the action stage of change.  We believe, instead, that working with a person in contemplation is just as important as working with the person in preparation or action.

We also believe that many people in contemplation will move to preparation and action if they have people to talk to about the issue. Processing information about the change moves the person through the change process. Isolation does not.

Therefore, we would love to see you even if you are not sure you want to quit. Even if you are not sure you are an addict. Even if you want to come to just get the heat off for a little while. We will help you get the most out of your experience.

4. We believe family recovery support is also a primary part of the process.

Family recovery stands on its own merit and should be available regardless of the status of the addicted loved one.  Some type of recovery plan is essential for all family members. We know that family members can benefit and experience improved mental health, reduced stress and ostensibly better overall physical health. Therefore, the primary purpose of family recovery is improved health and welfare of the in and of itself.

However, we have observed an interesting phenomenon. When the family takes “care of itself” the addict frequently follows suit.  This has been validated by a wide variety of resources.  ARISE intervention model teaches this very philosophy. It was in my ARISE certification training that I first heard the statistic “1 family member is as powerful as 8 professionals”.  Additional studies have been done on the impact of the family. Behavioral couples therapy for example has been shown to deliver around 66% success in getting the addicted individual into services.

Very important: Tough Love is an oxymoron. YOU NEED TO FOCUS ON APPROPRIATE EXPRESSION OF LOVE. NOT TOUGH LOVE.  Sometimes, setting limits and boundaries is the appropriate expression of love.

We do not believe in complete disengagement. Many things you hear about family role in recovery are dangerous.

WE HOPE TO DISPEL THESE MYTHS.

5. We believe that recovery is a process not an event

We know that, statistically speaking, it takes on average 4 or 5 genuine attempts at recovery before “it sticks”.  This isn’t to say relapse is a necessity. It is not. However, relapse is nothing to be ashamed of and should be met with loving compassion. There is a need to make “returning to recovery” as easy as possible.

We also believe that professional services that specialize in re-engagement are essential to the continuum.  There is a glaring hole in our professional service structure and we need to provide long term support. We need to re-vamp our system to support long term, chronic disease management rather than episodic acute care.

6. And finally…we believe RECOVERY will bitch slap addiction if we allow it to.

If we come out of the shadows and conduct ourselves as responsible members of society the community will embrace us. If family members become open about their struggles the community will embrace them. There is power in numbers.

However, our efforts in this area have been set back by “advocates” who reinforce the stigma when they speak for recovery. Much work has been done on messaging and identifying the most effective way to carry the message. Market studies have been done. Focus groups have been conducted. There is productive way to share the message of recovery and there is a counter-productive way to carry the recovery message.

A public lead meeting or online speaker meeting is not the way to promote recovery. This type of spectacle works for those already in recovery. However, we are not trying to preach to the choir. We are trying to reach the masses.  If the goal is true advocacy then please adopt some type of intentional recovery messaging.

If the goal is to fill your treatment center than keep doing what you are doing.

However, in the interest of “rigorous honesty” please give up the word advocate.

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