Advocacy is one of my core responsibilities as the Executive Director of FAVOR Greenville. It is a new experience for me and I am learning how to effectively fulfill this role. Prior to coming to FAVOR Greenville I worked in very traditional clinical settings. I have been director of a co-occurring community based program, a substance use disorder outpatient clinic, an inpatient residential facility and various recovery residences. I am also a person in long term recovery who found recovery through the most traditional and orthodox pathway possible. However, I have become completely baffled by the one size fits all approach to treatment and recovery. I did not clearly see this when I worked in those traditional settings. When you are in the bubble it is hard to maintain objective clarity. I have been told that I sound angry when I make statements challenging treatment and pushing for change. I’m not angry. I’m concerned and worried about the current state of affairs. But most of all I am 100% baffled by the lack of innovation that exists in the addiction treatment industry. It makes no sense from a patient care standpoint and it makes even less sense from a business standpoint.
There Are Multiple Pathways In Recovery But One Pathway In Treatment:
Nearly all residential inpatient programs are run the same way. The Minnesota Model or some close variation will carry the day. No matter the geographic setting or length of stay or cost or staff credentials. I had a conversation with a person who has worked in treatment since the 1980’s and was told that things are essentially the same now as then. The 80’s were 35 years ago. Of course there are some exceptions but these are few and far between. Furthermore, there is only one recovery pathway promoted in these programs and that is 12-step recovery. There really is no option for a person who wants to pursue an alternative recovery program. Patients who challenge this conventional wisdom are labeled treatment resistant and told failure is inevitable. I have had experiences where people have shared that they were told relapse was inevitable if they did not do “90 meetings in 90 days”. Relapse is NOT inevitable if you don’t do 90 meetings in 90 days and success is not guaranteed if you do. The fact is that recovery is maintained in a wide variety of ways. As a professional organization these programs have a responsibility to explore all possible options for treatment. If addiction is a disease it warrants the full spectrum of treatment options. We should not just rinse and repeat the same approach over and over.
Dr. Richard Saitz, director of the Clinical Addiction Research and Education Unit at Boston University School of Medicine puts it this way: “If you go to a hospital and they don’t have what you need, they’ll make it available or refer you to a place that has what you need. But at drug and alcohol treatment programs you get what they offer. And more often than not, what they offer is group counseling, the twelve steps, and all-around one-size-fits-all approaches to treatment…” (see: Inside Rehab by Anne Fletcher for more).
True Innovation Seems To By-Pass Addiction Treatment:
Rotman Management Magazine states that “every industry has it’s governing beliefs”. For example in retail it’s believed that purchasing power and format predict bottom-line. In telecommunications it’s customer retention. These beliefs tend to drive decisions and many times will be a barrier to innovation. According to Rotman no industry is beyond developing dysfunctional governing beliefs and many believe healthcare is especially vulnerable in this area. The complexity of healthcare coupled with the righteousness of the mission (saving lives) makes any outside challenge and push for change easily suppressed. “You don’t understand patients will suffer if we make these changes” is a trump card that is not easy to overcome. In addiction treatment it is even more pronounced. In this arena we are faced with sacred ground of 12-step recovery. There is no room for critical assessment of the “program” because the “program” is beyond reproach. To paraphrase: “no one fails unless they stray from the prescribed program”. Ostensibly any failure is the fault of the patient.
If cancer was resistant to one type of treatment would we blame the patient or would we seek alternative treatments?
The Governing Beliefs of Addiction Treatment
I have become curious about the governing beliefs of addiction treatment. Of course it is impossible to know exactly what these beliefs are. There is no “keeper of the beliefs”. However, I think I can make an educated guess on what these beliefs may be:
In order for a patient to find recovery he must do exactly as told and surrender to the process. If he does not surrender he needs to experience more consequences and become willing to go to any length. Failure, treatment drop out or “relapse” is not the fault of the treatment program it is the fault of the patient.
There is one generally prescribed pathway to recovery and ideally it involves completion of a 12-step oriented residential rehab program, followed by an IOP program, followed by 90 meetings in 90 days and then ongoing involvement in meetings for the rest of the person’s life.
Relapse means we need to return the patient and “re-do” all previous procedures. The only exception may be the specific facility. In other words, the patient should do another residential rehab/IOP/”90 in 90″. Patients are passed from facility to facility.
The Current System Has Helped Many People
None of this is to say that the current treatment system hasn’t helped people. Many wonderful staff and many wonderful facilities exist. This is simply to say that the vast majority of people fall through the cracks (National Household Survey: 90% of those needing help aren’t getting help). We find ourselves in the middle of an epidemic of epic proportions. The face of addiction is changing. Younger people are entering treatment with more complex and diverse issues. Specific drugs require specific responses. For example: opioid treatment requires something completely different than alcohol treatment.
All of this seems so logical. Alcoholics Anonymous, treatment and the Minnesota Model came on the scene in an entirely different era. The rise of prescription drugs, the legalization of marijuana, the tearing away of the taboo around heroin, and the culture at large makes a new approach absolutely necessary. How could it be any other way?
Acceptance Of The Problem Is the First Step
We stand no chance at a solution until we acknowledge the problem. I am convinced that the very smart, caring and compassionate people who work in this field could come up with a truly innovative solution. But it would require a honest and open-minded exploration of our current state of affairs.
An example: 90% of those with addiction do not get help. Mostly because they “think they don’t need help”. We must find a way to engage this “denial” group. Interventions should be paid for by insurance companies and occur a higher frequency. Other creative ways of engagement should be also be explored. The default setting should not be “wait until they hit bottom”.
Nothing stays the same. All industries evolve. Education even evolves (distance learning for example). Healthcare is being forced to evolve through value based reimbursement. Addiction treatment is sure to follow or be replaced with a new mode of service for those suffering from this insidious disease.
“The starting point is curiosity: pondering why the default exists in the first place. We’re driven to question defaults when we experience vuja de, the opposite of déjà vu. Déjà vu occurs when we encounter something new, but feel as if we’ve seen it before. Vuja de is the reverse—we face something familiar, but we see it with a fresh perspective that enables us to gain new insights into old problems” (Grant, page 27,from the book Originals)
Everything is NOT OK! Times are tough in this struggle to help those with substance use disorders. The Opioid “epidemic” is getting headlines these days. According to the CDC more people die from accidental overdose than any other accidental cause. In America 24 million people meet criteria for substance use disorder. Of those 24 million only 10% will access help at any given time. The financial costs associated with substance use disorders approach $428 billion per year. Many people have found recovery, however, the unfortunate reality is this group represents a very small fraction of the people in need.
Why are we losing the battle against addiction? The answer goes well beyond the standard explanation of evil insurance companies and incompetent government leadership. Having the right target is essential if we are going to solve the addiction epidemic! Right now we are at a crossroads in our country. The attention on substance use disorders is at a higher level now than any other time in our history. Of course this is focused on the opioid epidemic. The most honest thing that can be said is that heroin has become mainstream. Middle class white kids are dying, middle-age men and women are dying. Society can no longer conveniently look the other way.
As I write this blog post the Comprehensive Addiction and Recovery Act is being debated in congress. This bill will earmark money for treatment, medication assisted treatment and (THANKFULLY) recovery community organizations. In addition, congress is in the process of confronting insurance providers around the issue of reimbursement and parity. Certain insurance companies are going to be called on the carpet due to denial of benefits. This is all wonderful news. However, I can’t help but wonder: How does this all lead to more people getting help?
Money For Treatment Is Wonderful: Both CARA and the parity/reimbursement issue will, theoretically, increase access to treatment. However, if you believe the national research, the issue is not access. The issue is lack of problem recognition. The federal government, through the Substance Abuse and Mental Health Services Association (SAMHSA), conducts annual survey (National Household Survey of Drug Use and Health-NHSDUH) that addresses substance use disorders. This includes information regarding how many people have a need for treatment and how many of these people access help. For decades the numbers have been consistent; only 10% of those needing support are engaged in services at any given time. The NHSDUH digs a little deeper and ask those not accessing help: Why did you not get help? The results are astounding.
In 2013 only 1.6% recognized need and could not find help (access problem).
Whereas 95.5% cited “did not feel treatment was necessary” as the reason for not getting help (recognition problem).
Therefore we need to focus on increasing problem recognition: Stating the obvious; if we want to increase the number of people with a substance use disorder receiving help we will need to tap into the 95.5% who did not feel they need treatment. Increasing access for the 1.6% who were willing is great but in reality it is a drop in the bucket. We need to find a way to change the mindset of the 95.5%; not wait until they “magically” move into the “want help” category. It is unacceptable to sit back and wait for people to hit bottom. There is no other disease where you wait for it to get worse prior to intervening.
If this were a business we would be focusing on “untapped market”: This approach is a win-win for all involved. From a business standpoint treatment providers will see increased participation in services if we find a way to tap into the 95.5%. If we intervene earlier less people will die, families will be preserved, businesses will be more productive, healthcare costs will plummet and incarceration rates will fall. Everyone wins if we fundamentally change our current delivery system. As Maia Szalavitz wrote: “The late addiction/recovery author Alan Martlatt used the analogy of comparing the rehab industry to other customer-focused business. A car company faced with declining sales and lack of consumer interest would not complain that customers are “in denial” about the quality of their vehicles. Nor would it try to have the government arrest people who refused to buy their cars. Instead, they’d improve their offerings—or, at the very least, their marketing and consumer outreach”. The substance use disorder service provider needs to find ways to engage this untapped market. This could be done via non-traditional service location (community and in-home). In addition, providers could be less confrontational and willing to meet the patient where they are at. Furthermore, a collaborative recovery planning process makes sense rather than a prescriptive one-size fits all approach.
Making these changes could be relatively simple: There is a precedent for behavioral health services to be delivered in non-traditional ways and non-traditional settings. For example, in some states Behavioral Health Rehabilitation Services are consistently delivered in the home. Services for kids are consistently delivered in the home. Other healthcare is delivered in the home. Why not substance use disorder treatment? This type of change would, however, require the overturning of folklore and myths around addiction: The idea that someone has to hit bottom to find recovery is a cliché. The same could be said for the concept that a person has to want it for themselves in order to recover. There are well researched and tried and true methods to increase motivation and engage a resistant client. Motivational interviewing is a modality that many service providers claim to utilize but few actually embrace. True motivational interviewing involves meeting the client on his or her terms.
When we focus our efforts on engaging everyone in need rather than “helping the willing” you will see immediate and significant results. It is not a stretch to say 20%-30% of the disengaged group could be engaged in a relatively simple way. The return on investment in terms of time and money would be stunning. The example below provides an illustration of this new way of thinking:
We all know the story of the individual who goes off to rehab, is a treatment superstar, comes home, starts IOP and then, for some reason, “quits” IOP and “quits” attending mutual support groups. This happens all the time. This person stays away from counseling and mutual support for a wide variety of reasons; anger toward another member, insurance money “runs out”, they find a job, they get bored with the meetings, etc…
Eventually they have a recurrence of substance use and a profound sense of failure, embarrassment, shame and guilt enters the picture. Some will “come back”. Some have a special relationship with a person in mutual support and that person will “bring them back”.
But the overwhelming majority isolate themselves. As time goes by it becomes more and more difficult to re-engage in the recovery process. If the system was set up for assertive and aggressive outreach a professional service would be utilized to intervene in these circumstances.
A referral could be made by the family, a therapist, a fellow in recovery and a Certified Peer Recovery Support Specialist could begin the outreach process. Phone calls, text messages, community visits and even home visits could be utilized to re-engage the person. An overwhelming majority of these disengaged individuals would be incredibly grateful for the outreach. They will be relieved to learn there are multiple pathways to recovery and many will reinitiate their recovery process. At FAVOR Greenville we know this is true because we have been doing phone coaching for over 2 years. We have seen the way people respond to a warm voice or kind text message.
This is just one example. Certainly there will be more difficult cases. Certainly there will be those that cannot be re-engaged despite extensive efforts. What we need to do is challenge conventional wisdom around the recovery process. We need to get away from the punitive, confrontational mentality that drives so many of our traditional interventions. If we think addiction is a brain disease then let’s act accordingly.
FAVOR Greenville is leading the way in driving innovative and ground breaking approaches that directly confront the current drug epidemic. Our Assertive Community Engagement program (ACE) will be launched in April. We will be providing staff intensive recovery coaching services focused on engaging all those in need. We intend to change the paradigm around the delivery of recovery support services. Stay tuned for details. See www.favorgreenville.org for more information.
Many times when I meet someone and ask “How is it going?” the person will answer “I’m doing well…just really busy”! In addition, I know that I will frequently offer a similar response when I am asked about life. This concept of busyness is an interesting thing to contemplate. Busyness is at the same time something to be proud of and something that creates serious stress and anxiety in people. Our culture values achievement and work is held in high regard. It is logical then to assume that being busy is a positive quality. However, as we become more aware of the dangers associated with stress a new emphasis is arising. There is a rising movement around stress management, time management and “work-life balance”. These concepts promote more serene daily routines.
I have become somewhat obsessed with all the different advice and “programs” that are offered as an answer to the problem of being “too busy”. If you go to the Barnes and Noble self-help section you can find hundreds of titles that address this topic. Google “busyness” and millions of results pop-up with a myriad of solutions to the productivity trap. I have put in some real work evaluating these various solutions. In addition, I have drawn on my own experience in coaching people to summarize the 5 most useful methods of managing “busyness”. So here you go… hope you are not too busy to read this:
Morning Routine: Starting your day with a morning ritual or routine is essential to “slowing things down” and feeling under control. Much has been written about the connection between morning routines and success. Setting the tone by giving yourself time to ease into the day is the cornerstone to managing your time. In this context I am not concerned with content or the specific activities of the routine. Instead I am encouraging you to simply give yourself enough time to not feel rushed. The steps associated with giving yourself enough time in the morning are straight forward; it’s not rocket science:
Go to bed earlier.
Get up earlier.
Wow… I am a freaking genius. This is one of those areas where you “just do it”. People can write books on getting up early but I find that ridiculous. It takes no secret knowledge to get up earlier. I say keep trying to get to bed earlier and keep trying to get up earlier. Don’t overthink it when you fall short and simply try again the next day. Getting up early will eventually become a new habit.
2) Own your schedule: This is an area that also seems very straight forward. However, there are some very practical tips and principles that can help in this area.
Get a calendar: I know this may seem like too simple a suggestion to be found on a life changing blog like this. However, I don’t assume anything so let’s start here. Many people use their state of the art smart phone and its calendar application. That is my recommendation as you probably already carry your phone with you everywhere you go. If you are into paper and pen that’s all good as well.
Remember that NO is a complete sentence: Start prioritizing your commitments. If you feel overwhelmed take some time to scan your appointments and meetings. Assess your schedule to see if there are any meetings that you could have declined or if the time allotted could be lessened. Most people simply give in and ignore this concept. They behave as if they were powerless over the situation; as if they have zero control over their schedule. I would be willing to wager that there are some meetings that you could opt out of. If you are a manager this means you will need to trust other people. You will need to take a chance that things will work out even if you are not at the table. If you are a parent you may need to avoid enrolling little Suzie or Johnny in piano lessons, or Vietnamese cooking classes, or competitive pogo jumping. You will need to trust that your value as a parent is measured over the long term in terms of unconditional love not in the short term in terms of the world’s busiest soccer mom. JUST SAY NO.
Honor commitments to yourself: Set aside time during the week for yourself and honor these commitments. If you have a meeting scheduled with a colleague at work you are unlikely to cancel the appointment just because something else comes up. That is not always the case where time for yourself is concerned. Many times you will simply ignore your own time and put someone else’s agenda in your time slot. I would recommend you actually schedule “down time” where you can engage in self-care. Use these opportunities to spend time outside or to engage in creative activities or just spend time on strategy. The best return on investment would be time spent in silence doing what appears to be nothing in particular. This will take a great deal of determination because spending time in stillness will initially feel like a waste of time. However, if you persevere your efforts will pay dividends.
3) Watch out for the subconscious “craving” for busyness: Remember that we are a society that values busyness. Working hard and working long hours can be seen as a positive. Many people want to be seen as being busy because it can be viewed as a sign of importance. Along the same lines people will feel inadequate if they are not busy enough. This cultural norm is starting to change. The millennials are not at all interested in being perceived as overly busy. As a matter of fact the millennials seem to be perfectly content with being under-whelmed. However, there is a sense among older generations that being stressed and over-worked is a badge of honor. If you have that message encoded within your psyche you will be naturally drawn to over scheduling. Busyness will be attractive to you and it will be difficult to not fall into that over-booked lifestyle. The best way to combat this issue is awareness of the positive associations you have connected to busyness. This allows you to think it through and challenge some of the irrational and unhealthy thoughts associated with these beliefs. One other thing that will help in this area. Stop saying “busy” when someone asks “how you are doing”. “Busy…real busy” is not actually a possible answer to the question “How’s it going”. Make a commitment to yourself that you are going to stop proclaiming your busyness.
4) Watch out for the ever present pull of technology: Today’s world is amazing. You can access information instantly. You can connect with friends and family and share information about your life across a wide variety of platforms. In addition, you can stay continuously connected to the workplace. These advancements are wonderful. When used efficiently technology can contribute positively to your quality of life. However, technology is just as likely to suck up all your free time without you even being aware of it. Maintain an awareness of how technology and social media impact your life. Some people have actually tracked their time in an effort to gauge how much time they spend in mindless technology-based activities. Many have been surprised by the results. I don’t necessarily endorse a detailed time track (because that would take too much time). However, I do advocate a high level scan of how you use technology. Be honest with yourself and assess your relationship with your iPhone, iPad, laptop and make the necessary adjustments.
5) Focus fully on whatever activity you are engaged in: David Allen in his Getting Things Done (GTD) protocol talks about maintaining an attitude that whatever you are doing is the best thing to be doing at that exact point in time. This helps you avoid the brain drain and distraction associated with doing one task while being pre-occupied with another task. For example, if you are writing a blog post concentrate fully on the blog post and don’t spend time being guilty that you are not paying the bills. Without getting deep into the details Allen advocates his GTD system as a means to accomplish this goal. For the purposes of this post I endorse his principles of present focus but encourage a more basic mindset to accomplish this:
Mindfulness: The topic of mindfulness is just straight up getting worn out. It is everywhere in mainstream society. Once something is featured on Oprah and the Ellen show it loses all status as something new and innovative. In all honesty I have gotten tired of hearing about mindfulness. However, you can’t argue with the importance of bringing your full attention to the task at hand. Multi-tasking is ineffective and you will be more effective if you focus. Practice mindfulness on a regular basis so that you can bring it to bear in the domain of managing your time and managing your life.
Take control of your thoughts: If you find yourself engaging in negative self-talk related to task engagement (ie..”I should be doing something different…”) reframe your thinking. Write these “other” activities down in an effort to manage the cognition. Tell yourself you will get to the other tasks at another time.
When in doubt start something: If you cannot decide what task is the best task at a given time just get moving. Don’t overthink. Simply move into action even if it is not the optimal activity or project. Getting yourself in gear will very likely shake loose other thoughts and provide clarity regarding prioritization.
I recently found the best definition of worry. It was in the clinical psychology textbook Worry and its Psychological Disorders by Graham Davey and Adrian Wells.
From page 5: “Worry has been defined as a chain of thoughts and images, negatively affect-laden and relatively uncontrollable; it represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes; consequently, worry relates closely to the fear process”. I like this definition because it captures the elements of uncertainty and fear associated with worry.
In interest of focusing on the solution I would like to offer 15 useful strategies to cope with worry:
Do NOT worry about worry: One of the main differentiators in terms of worry is the phenomenon of WORRY about WORRY. This seems to be equated with more significant worry “issues”. So if you worry…DON’T worry about it… You are normal.
Focus on “Worst Case Scenario”: If you are able to visualize the worst possible outcome of the situation and envision how you would respond you can reduce worry in the present.
Set aside “time” to worry: Sounds weird but put it on the calendar. Maintain a certain day and/or time to “worry” and problem-solve. Bring paper and a pen and start writing down contingencies and potential solutions. This can reduce the random and ongoing “worrying”.
Keep a pen and paper on your nightstand to write down the worries that keep you up at night: Trading on the principle of “getting it out of your head”. Get it down on paper and then go back to sleep.
Find a consultant to process the issue that you are worried about: Try to find someone who is an expert in the area of worry (for example financial problems, addiction in the family, children struggling in school) and see if they can provide feedback. You are trying to focus your “problem-solving” on a specific target. In addition, you may uncover actual solutions.
Worry involves “problem-solving”. Try to identify the “next step” and stop there: The risk with worry is that you go down the rabbit hole of contingencies and potentialities. You tend to project well into the future. For example: you are worried about a particular health issue and you start ruminating on the situation. Next thing you know you are trying to figure out which long term nursing home you can get into based on your retirement fund. Instead focus on scheduling a doctor appointment with your primary care physician and let it go. Wait until the results to become worried about the next steps.
If you have “multiple worries” try to prioritize: My wife just went on a rant about multiple financial things we need to address. Whoa… calm down. Let’s focus on one thing at a time. Ask yourself what is current focus and what is the next step associated with that particular issue. Using Stephen Covey’s priority matrix as a guide I have developed a framework for prioritizing worry (below):
URGENT/IMMEDIATE
NOT URGENT/FUTURE
More Control
QUADRANT 1
Example: On you way to work today your car starts making weird noises. Still running but for how long?
QUADRANT 2
Example: The lease on your current car is running out in 6 months and you are worried about how much the “overage” miles will cost you?
LessControl
QUADRANT 3
Example: You get phone call from your adult son’s girlfriend. They live in another city and you have occasional contact with him. She is concerned he is drinking too much?
QUADRANT 4
Example: Due to his drinking your adult son’s job may be in jeopardy and you are worried that he will lose his job, his apartment and need to move back in with you?
The key to prioritizing and working through worry is to spend your time “above the line” in quadrant 1 and quadrant 2. Lack of control is incredibly stressful and learning to step away from situations you don’t control can have very positive impact. As with all things that involve human beings it is not an exact science. Think of this a guideline.
Watch out for the weird, wacky and wild worries that come out of left field: These are usually generated from our sensationalized news outlets. They show you a story of someone who developed chronic headaches and they speculate it is from cell phone use. The headaches put the person into a depressed mood and he becomes a social outcast living a life of misery. CNN or FOX or MSNBC etc.. use this story to birth a new disorder that is named “Chronic Cell Phonitis Not Otherwise Specified”. They have “experts” from Harvard come on and tell you it is the end of the world as we know it. Then you spend the next 2 weeks on the internet trying to find out the likelihood of catching this illness, ways to prevent this illness and the prognosis if you do catch this illness. You have a worry bucket… Don’t fill it with these frivolous topics. These people are REE-DUNK-ULOUS….
Stay busy: George Bernard Shaw said: “The secret of being miserable is to have the leisure to bother about (think about) whether you are happy or not”. If you can keep moving and keep involved in activities, interactions, meaningful work you will “crowd worry out of your mind”.
Avoid toxic people: If you are worried talking to other people who are worriers and/or negative about life is a recipe for disaster. Limit these interactions and walk away from relationships that leave you feeling drained.
It’s not the event but your reaction to the event that causes you distress: The stoics were the first to articulate the reality that you can choose your reaction to any event. This has been handed down for generations and forms the foundation for Cognitive Behavioral Therapy and Rational Emotive Behavioral Therapy. Essentially you can rationally challenge your thinking. A common approach is the A-B-C-D model:
A= Activating Event (what happened-facts; ex—she ignored me @ the mtg.)
B= Belief About the Event (our interpretation; “she doesn’t like me”)
C=Consequences related to the interpretation (anger toward the person, rude toward the person etc…)
D=Dispute the Belief (what alternative explanation is there; maybe she was distracted)
Clearly understand that worry doesn’t prevent the bad from happening: “The metacognitive model” states that people believe worry will prevent something bad from happening. Research indicates that it is common for people to maintain this underlying belief. It is easy to see how this would drive worry.
Preventative measures for worry. These are activities you can engage in “before” the worry rises up. As the name implies they are routine activities that, when applied consistently, can reduce the intensity of worry and the negative impact of worry.
Prayer and Meditation: Perhaps nothing is more universally talked about as a way to reduce stress, worry and the associated issues as prayer and meditation. Even if you don’t buy the spiritual aspects science tells us that consistent meditation can “re-wire” the brain and create new neural pathways.
The “free” Three: There are 3 “free” activities that have been proven to be highly effective in reducing stress and worry. These are 1) Music-listen as much as possible; 2) Outdoors-being outside even for a brief walk and 3) Laughter-Youtube is great for access to funny videos.
Community: Regular involvement in some type of group or community activity. Human beings are social creatures. Being around others provides a boost to our mood and reduces the negative impact of stress and worry.
Managing worry is an ongoing process. No one is free of worry. If someone tells you he “never worries” then he is either high or lying. Give yourself a break. Find someone you can confide in and, if possible, a group that can support you…
If you are in Greenville SC or surrounding area check out our group opportunities at: www.favorgreenville.org
My wife and I were discussing the state of affairs in America. At least as they apply to our teenage daughters and their peers. In addition, given my line of work, it is hard for us to have any conversation that does not circle back to drug addiction or some other type of sociological dilemma. My wife ask a very simple, yet thought provoking question:
“Rich, if America is such a wonderful place to live with great opportunities, wealth and material possessions… why are we so addicted….why is everyone addicted to something and why are so many young people obsessed with altering their state of mind? WHAT’S SO BAD THAT EVERYONE HAS TO ESCAPE?” Therefore, in this post I set out to explore this issue of addicted America and the potential solutions to this ever expanding problem.
1.) Is America more addicted than the rest of the world? The short answer to this question is “YES-absolutely”. There is no clear ranking in this area due to no universal agreement on what constitutes addiction. However, the evidence suggests America is an over-achiever in terms of addiction. Relative to the remainder of the world all wealthy and developed countries are more addicted than the undeveloped and poor countries of the world. According to the U.S. News and World Report and the World Health Organization about 200 million people abuse drugs worldwide and use is much higher in richer nations. America leads the way in certain areas such as illicit prescription drugs use (for example 80% of the worlds opioids are consumed by Americans) and Americans tend to “be more willing to try a wide variety of drugs”. In terms of alcohol consumption we are “middle of the road” as Russia sets the standard in this area.
One thing is for sure. The toll drug addiction is taking on America is obvious. Overdose deaths have exploded. When you see these statistics it certainly seems that addiction is a more significant issue in America than other parts of the world:
The World Health Organization looks at regions rather than countries. Relative to other parts of the world North America far outranks other regions in terms of drug deaths:
An organization called World Health Rankings does assess country level data. They found that in terms of drug deaths per 100,000 the United States is ranked third worldwide behind only Estonia and South Africa. Therefore, I would answer yes we are living in ADDICTED AMERICA. If you include “process addictions” such as pornography, gambling, compulsive shopping and internet gaming the issue is even more wide spread.
We live in a country that, on balance, is incredibly wealthy. We are not torn apart by civil war, we have leisure time, we have access to clean water, food, and we have endless opportunities. The issue of addiction is impacting all socio-economic classes so you can’t argue that it is poverty that accounts for these problems. Addiction is just as likely to take out an affluent white suburban child as an inner city child. Addiction is not relegated to any certain racial group. It is the one unifying factor across America. Regardless of race, political affiliation, socio-economic class we all love getting high. Why are we so pre-occupied with altering our state of mind and changing our mood?
2.) Is America more addicted now than in the past? For centuries the current generation has suspected that the upcoming generation is going to be the downfall of society. There is a phenomenon called intentional bias where a group can impose their version of reality onto a situation. In this case, there is a danger that the older generation (I guess I’m part of that generation) would look fondly on the past as a kinder, gentler, more sober period of time. Let’s take a look at the facts to see how things stand in terms of addiction.
The war on drugs has been an abject failure: Despite aggressive policies and enforcement actions against every link in the chain of producers, distributors and users, the illicit trade has become more prolific than ever, exacting a painful toll on every area of society it touches. Over $1 trillion has been spent resulting in over 500,000 people in prison for drug offenses and an INCREASE in rates of addiction. Well done America! (ONDCP, 2014)
Illicit drug use in the United States has been increasing: In 2013, an estimated 24.6 million Americans aged 12 or older—9.4 percent of the population—had used an illicit drug in the past month. This number is up from 8.3 percent in 2002. The increase mostly reflects a recent rise in use of marijuana, the most commonly used illicit drug (SAMHSA, 2013)
Marijuana use has increased since 2007.In 2013, there were 19.8 million current users—about 7.5 percent of people aged 12 or older—up from 14.5 million (5.8 percent) in 2007 (SAMHSA, 2013)
On a positive note alcohol use has gone down.Rates of alcohol dependence/abuse declined from 2002 to 2013.In 2013, 17.3 million Americans (6.6 percent of the population) were dependent on alcohol or had problems related to their alcohol use (abuse). This is a decline from 18.1 million (or 7.7 percent) in 2002. (SAMHSA, 2013)
However Opioid use has grown steadily year over year 1991 thru 2012:
Heroin use, dependency and “initiates (newcomers to using heroin) has also grown year over year:
I would argue that the country is becoming more and more “addicted”. Drugs are breaking through taboos and perceived risk is falling. Heroin is very revealing in this regard as it is on the verge of becoming a mainstream drug. The proliferation of prescription drugs and the associated issues makes it all the more challenging. We are living in the era of ADDICTED AMERICA.
3) Why is substance misuse exploding in America at the current time? If you agree that addiction has escalated and is reaching epidemic proportions that next most logical question to ask is…why? I can offer only my humble take on the situation. So for your consideration I offer the following factors as coming together to form a perfect storm:
A pill for everything: Our current culture promotes a pharmaceutical solution for nearly all human conditions. We live in a world that sends the message “take a pill for everything”… and then we are surprised when kids or young adults take pills recreationally. Why wouldn’t they? Prescription drugs have become a mainstream recreational option for kids who want to “party”. Taking a pill to improve your quality of life is completely normal and promoted. This is not to say that medication is unnecessary. Many people need legitimate support. However, over-prescribing is without question common practice.
I recently saw an animated commercial that depicts a woman and a giant pill with Opioid written on it. The pill has arms and legs and can walk around with the woman. The two of them spend the day together at the park, taking art lessons, and going to the pharmacy to pick up their prescription to treat Opioid Bowel Syndrome. I thought I was living in some alternative universe when I saw this commercial. I could not believe my eyes. The not so subtle message is that pills are your friend. It’s going to be very hard to convince young people otherwise. This is a completely different cultural norm. As recently as 15 to 20 years ago prescription drugs were seen as being “hard” drugs. There was a taboo around the use of prescription drugs. Well…that ship has sailed. Prescription pills are mainstream and viewed as safe because they “come from a doctor”. For example, according to National Institute of Drug Abuse 27% of teens and 16% of parents think using prescription drugs to get high is safer than using “street drugs”. Game on.
The Age of Anxiety: Anxiety has been present since the beginning of time, however, it is clear that anxiety has become a modern day plague. There are variety of reasons for this reality. One major contributing factor is the rise of information and the constant stream of negative outcomes lurking around the corner. Parents can request tests for birth defects while the child is still in the womb so the worrying and waiting for results can start before birth. The constant access to news and the sensationalized nature of the news also contributes to the information overload. If a child is kidnapped it is broadcast over all the cable channels and parents go into lock down mode. In the past year we were told of imminent doom. Experts told us that Ebola was going to cause a pandemic, that ISIS was coming for us, that price of oil is too high to sustain the economy. Now the reports are that prices for oil are too low to sustain economic growth. Global warming is going to lead to widespread famine and destroy life on earth. Unseasonable cold temperatures in other parts of the world are cause for a whole other set of concerns. There was a time when there were only 3 networks and the news was only on at 6 pm. There was not 24 hours access. Today you can watch the play by play destruction of the world. That’s a little anxiety producing.
A second contributor to collective anxiety is over-stimulation. The constant connection to technology, entertainment, and organized activities (especially for kids) leads to a packed calendar and endless to do lists. It is very hard to “calm down” when you are continually engaged and pulled into cyber-world. Quiet time is very difficult to come by. In addition, social media is tailor made for superficial image driven virtual interactions that contribute to a continuous feeling of being less than. People can easily fall into a pattern of thinking that they are not doing as well as their counterparts. This produces social anxiety and perceived pressure to “do better”. Add all of this up and it is easy to see that people would be attracted to the numbing effects of psycho-active substances. Taking the edge off is more attractive than ever.
The Age of Disconnection: In his book, Bowling Alone, sociologist Robert Putnam discusses the deterioration of the American community. His thesis is that a major demographic shift has occurred over the past 50 years and this has contributed to a major change in outlook and attitude where community is concerned. Specifically, the “greatest generation” has died off replaced by the baby boomers, the baby busters and now the millennials. This has contributed to a steady disinterest in the traditional institutions that held people together. Putnam is not being negative about these generational shifts he is critical of the institutional responses to the generational shift. There is no problem with a changing attitude, however there is a major problem when society does not adjust along with the changing attitude. For example, the American political institutions, educational system and healthcare system has remained unchanged despite these major demographic shifts. The last time a demographic shift of this magnitude occurred was “the Gilded Age” (1870 thru 1900) and the social problems that arose were unprecedented to that point in American history. Rapid economic growth and industrialization lead to massive immigration and domestic relocation. Crime, poverty, and blatant inequality carried the day.
This impact around these demographic shifts is made more significant by technology. The way people “connect” has fundamentally changed. Our younger generations do not know what it is like to have to find a “land line” to make a call. They have grown up with the internet being a given, even a necessity. Communication via text and the utilization of social media is second nature. In addition, it is possible to be in a room with several other people and to not be there at all:
All of these factors contribute to a fractured, disconnected society. The founding father of the functionalist perspective in sociology, Emile Durkheim, coined the term anomie to describe social disconnection. It has been a generally accepted principle that when people feel disconnected within society problems are sure to follow. It is easy to see how a disconnected society is fertile ground for the spread of drug addiction. Getting high is one way to cope with the void that comes along with lack of community.
The Gilded Age did not end until society developed different institutions in response to these demographic shifts. This was the beginning of a new political structure and the age of the progressive era was ushered in. This was also the period of time where labor unions came on the scene and community agencies such as the YMCA were established. These were intentional efforts to change the “way things were done” to fit the reality of fundamentally different culture. Unfortunately society has been unwilling to make a shift in response to our current dilemma. If you drill down into drug and alcohol services you find the same fundamental organizational structures that have existed for 50 years. There are very few innovative and culturally relevant options.
The Legalization of Marijuana: Regardless of your opinion on marijuana it is clear to see that the legalization of marijuana has created conditions ripe for the expansion of drug use overall. Stating the obvious: legalized marijuana means more people will use the drug and, ostensibly, some of these people will develop dependency. More people using marijuana means more people with problems related to marijuana. I don’t know how anyone can argue that logic. The secondary issue is that legalization of marijuana contributes to a permissive attitude toward other drugs. For example, among young people there seems to be a steady decline in the number of drugs that are “off limits”. I understand this is a “slippery slope” argument and I am not typically a big fan of the slippery slope argument. However, in this case I believe we are on a slippery slope. Perceived risk regarding marijuana is relatively non-existent among teenagers. Everyone, (even if they don’t use marijuana) seems to think marijuana is harmless. Why would this perception stop at marijuana? Prescription drugs are already on the way to being considered non-threatening. Cocaine and heroin are sure to follow. All of this contributes to a very lax and cavalier attitude surrounding drug and alcohol use.
4) What do we do about the addiction crisis? The short answer is “something different”. Let’s follow the lead of our predecessors that brought us out of the dark times of the Gilded Age and create new institutions and structures to address the addiction issue. We need to come up with a culturally relevant response to our changing societal conditions.
We must embrace the reality of multiple pathways to recovery: According to the Partnership for Drug Free America there are around 25 million people living in recovery in America. According to the Alcoholics Anonymous world service website there are around 2 million members WORLDWIDE. Narcotics Anonymous doesn’t have a membership total. NA does, however, report on total number of meetings worldwide. If you factor in average meeting attendance you can approximate total membership. If you are generous in terms of that average attendance you could ballpark another 1.5 million Narcotics Anonymous members. Let’s say that these numbers are understated and for sake of argument you push the total 12-step membership to 5 million WORLDWIDE. That means that are at least 20 million people living in recovery in America that are maintaining that recovery through some means other than 12-step meetings. However, 95% of our rehabs are based on the 12-steps. We need to promote and nurture alternative pathways.
We must move away from a segregated and antiquated addiction treatment system toward integration with healthcare in general: We should treat addiction like any other chronic disease. There is no state department of diabetes. There is no state department of heart health. Why do addicts and alcoholics require their own separate state department? I believe that full integration into a holistic health system is the ultimate answer in this fight against addiction. If we make the care of substance use disorders a routine part of healthcare you will see the stigma fall and the numbers seeking recovery rise. By the way I would make the same argument regarding mental health. I believe that mental health is closer to this being a reality than substance use disorder treatment. Mental health services are already integrated into the larger healthcare systems in many organizations.
We must change the primary service delivery location from office based to community based: This is the most obvious adjustment. We know that 90% of people in need of services do not access services due to denial of the problem. We have traditionally sat back and waited for these people to show up at our clinics. Well that is just straight silly. The 90% non-compliance rate has not changed for 40 plus years of being studied. It’s not going to happen. The 90% are not coming to us…let’s go to them. More on this in later posts.
I realize that there are people who will read these recommendations and write it off as impossible and inappropriate. I hope that is the case because we know that when the traditional institutions push back on ideas the ideas are truly innovative. Maybe these ideas are not the solution. But there is one thing for sure: the current modus operandi is not the solution. I welcome criticism and alternative ideas. But please make sure they are NEW ideas.
I work in a variety of settings with a variety of people who are dealing with a variety of issues. The details of each person’s situation are unique. Some are dealing with addictions, some are dealing with family conflict, some are dealing with stress, and some are experience significant workplace issues. Everyone has their own strengths. Some have very strong support systems and others have no one in their corner. Despite these differences there seems to be one common concern reported by almost everyone I deal with professionally. They are WORRIED. Worried about their job, worried about their family, worried about the financial markets, worried about ISIS, worried about global warming, worried about it being too cold, worried about where they will find their next high, worried about getting caught doing the wrong thing at work, worried about getting into school, worried about what how hard it will be when they get into school, and worried about worry.
This is also the case with many of my personal contacts and it is certainly has been the case in my life. It seems that worry is part of the human condition and it seems as if it has been present in the story of humanity from the beginning of time:
From the Bible, Matthew 6:25: “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear”.
From the Great Philosopher-Emperor Marcus Aurelius, more than 2000 years ago: “Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.” (Meditations)
Benjamin Franklin had his take on worry: Do not anticipate trouble, or worry about what may never happen. Keep in the sunlight.”
…and even Mark Twain acknowledge his struggles with worry: “I’ve had a lot of worries in my life, most of which never happened.”
But despite the prevalence and universality of worry it is a largely misunderstood phenomenon. Worry is NOT a diagnosable condition. In many minds it is synonymous with the anxiety disorders. Although clearly intertwined, worry and anxiety are different issues. Anxiety is part of worry and worry is part of the criteria for Generalized Anxiety Disorder. However, worry is a specific type of anxiety. So in the interest of all mankind I would like to shed some light on worry and ways to combat this mysterious condition.
Understand the difference between worry and anxiety. Everyone knows worry when they experience it or when they see it on the face of a loved one. However, it may be helpful to put some words to it and provide a framework for understanding the difference between worry and anxiety. Worry can be defined as anxious apprehension, and refers to concern about the uncertain outcome of future events (MacLeod, Williams, & Bekerian, 1991). It is common in both clinical and nonclinical populations (Tallis, Davey, & Capuzzo, 1991), meaning you do not have to be diagnosed with a mental health condition to experience worry. It is hard to identify how many people struggle with worry because it falls along such a wide spectrum in terms of severity. The important thing to understand is that worry is a very specific type of anxiety related to FUTURE events. What might happen? Therefore it requires a very specific response in order to deescalate worry.
An example of “anxiety”: I can experience symptoms such as inability to concentrate, nervousness, muscle tension, irritability and not be able to identify the cause. It is a type of free floating anxiety but I do not find myself preoccupied with a certain issue or trying to come up with solutions to a problem or playing out conversations in my head.
An example of worry: I am preoccupied with a meeting I have with my boss on Monday. I am focused on the potential outcomes. I explore different scenarios and I convince myself that the negative possibilities are the most likely to occur. I find myself rehearsing conversations and planning my response to my boss’ accusations. “If he says this…I will say that”.
With this understanding in mind you can focus on the right target. If you are experiencing free-floating, ever-present, non-specific anxiety you need specialized support. There are specific protocols that can be used to reduce the ever-present anxiety and the prognosis is good if you engage the process completely. For more information see www.rjonescoach.com. However, worry in the classic sense can be address through some basic psychological gymnastics where you take control of your thinking. There are several self-help programs available. My favorite is an “oldie but a goodie”. In 1944 Dale Carnegie wrote: How to Stop Worrying and Start Living. Carnegie was not a psychologist or a therapist. The brilliance of his approach was he went to people who overcame worry and interviewed them. Essentially a process of shared experience. A “been there done that” approach to recovery from worry. By doing this he compiled a list of interventions that can be used to address worry. For example in chapter 2 an engineer name Willis Carrier of the Carrier Corporation described his formula for conquering worry. Carrier had been debilitated by worry over his business and was even bed-ridden until he implement the cognitive process described below.
Magic Formula For Solving Worry:
Analyze the situation fearlessly and honestly and figure out the worst case scenario or what is the worst that can possibly happen. Do not avoid confronting this possibility in your mind regardless of how bad it feels.
After figuring the worst case scenario resolve yourself to accept that possible outcome. Visualize yourself going through that event.
From that point on, calmly do all you can to try and improve the condition and reduce the possibility of this worst case scenario. Remember to focus only on what you can affect as there will be much that is out of your control.
2) Beware of worry about worry as this can lead to a more severe anxiety related issue. One of the biggest complications related to worry is the tendency of the worrier to actually “worry about his worry”. The person experiences an internal dialogue full of self-recrimination. “You shouldn’t be worried about this”; “What’s wrong with you, you must be losing your mind”; “What if I always worry like this and never get a good night’s sleep”. It is easy to see the viscous circle that this type of thinking can lead to. You will find yourself in an endless loop that is almost impossible to escape.
There are many factors that contribute to worry about worry. One of the most common is the idea that you “come from a long line of worriers”. “My mom was a worrier and I am going to be just like her”. The idea that worry can be inherited is a myth. Worry is a thinking issue not a biological issue. Another contributor to the worry loop is the media. Especially pharmaceutical companies and their onslaught of commercials. They paint a picture that life should be free from worries. They tell you “If you worry you need this pill to cope”. Then (really quickly) they read off a list of terrible side effects that come along with the medication. We have created a world where negative emotions such as worry are not permitted to exist. You must be crazy if you worry at all. So naturally we all worry about how much we worry. Well done Big-Pharma!
Try to avoid worry about worry. You ARE NOT CRAZY if you worry. Even if you worry excessively. Understand that all human beings worry from time to time and do not allow the world to make you feel like you are defective because you worry. Don’t believe the hype!
3) Embrace the idea that worrying does NOT reduce the possibility of negative outcomes. Worry produces feelings of perceived control and this is a major contributor to chronic worrying. Many people who report worrying say they believe the negative outcome is less likely to occur if they worry about the situation. Stating the obvious, this is patently false. However, worry does seem to serve some legitimate purposes and we should all acknowledge this possibility. In a sense worrying forces us to prepare and problem solve and that can be a good thing. However, there is a fine line between preparing and suffering as a result of worry. Perhaps the best thing to do is to employ a structured process such as the formula described above. This allows for you to problem solve in a predictable and controllable manner. More importantly be aware that there are things out of your control and work to accept that reality.
BONUS: IF YOU WORRY WHY PRAY? IF YOU PRAY WHY WORRY?
It’s the time of the year when “best of” lists abound. Everywhere you turn you see a new list: “Best Movies of 2015”; “Top 10 Football Games of 2015”; “Best Music Performance of 2015” etc… In this spirit I have decided to put forth a couple of really interesting and noteworthy developments from 2015. These are the stories that leave me excited and filled with hope as we move into 2016. They may not seem very significant to most people. However, these issues take on a transformative tone for me. As a person who has worked in the behavioral health field for 25 years it is good to see change on the horizon. Our field seems to have stronger ties to the status-quo than other industries.
So here we go. A few really hopeful stories from 2015!
Addiction and Recovery On A National Stage:
Addiction and recovery garnered significant attention this year. It was good to see some light shined on this issue. As we know, if you include family and intimate friends, addiction touches at least 2 out of 3 individuals. However, the stigma has been so intense that society has turned away from the topic preferring to keep the issue hidden. Sixty five percent of individuals who experience substance use disorders are considered “functioning addicts” furthering our tendency to keep things hidden. However, 2015 saw several watershed moments where addiction and recovery took center stage:
National and Local Media Coverage: 60 Minutes had several episodes focused on addiction and recovery including interviews with Patrick Kennedy and director of the ONDCP Michael Bottechelli. In addition, many of the major news outlets ran stories on the growing opioid epidemic. Fox News had a series devoted to addiction and recovery and many other national, regional and local sources ran stories on a consistent basis. Here in Greenville, South Carolina the issues was covered on a regular basis. The attention that is being paid to this issue can help facilitate long overdue changes in attitude and policy across America. It is unfortunate that the current drug epidemic was necessary to force this conversation.
Celebrity, Athletes and Politicians Became (somewhat) More Open About Recovery: Unfortunately 2015 saw its share of famous people who died from addiction. We know this is a chronic, progressive and fatal condition. Scott Weiland of the Stone Temple Pilots was one the most recent to fall prey to addiction. His story is riddled with rehab stays, attempts at sobriety, and ultimately relapse. However, 2015 also saw more and more people come forward and talk openly about their recovery. Russel Brand, Robert Downey Jr., Samuel L. Jackson, Michael J. Fox, Jamie Lee Curtis, Johnny Depp, and Demi Lovato are counted among this group. Although not all of these individuals have been “perfect” in their pursuit of recovery, all are on the pathway and all seem willing to carry the message of hope.
Addiction Entered America’s Political Consciousness: Chris Cristie talked openly about losing a good friend to addiction. He has been very aggressive about the need for policy change that support treatment and recovery over incarceration. Carly Fiorina shared on the loss of her step-daughter. Hilllary Clinton made addiction treatment reform part of her presidential platform. Perhaps the most significant development was Bernie Sanders stating addiction is a disease not a moral failing on national TV at the most recent Democratic Presidential Debate. Can you imagine this being discussed even 20 years ago?
Again, the conditions leading to these developments are tragic. The national accidental overdose death rate has exceeded the death rate from all other types of accidental deaths. It would be better to have had this discussion proactively. However, all things considered, it was a good year for recovery. This attention could be the impetus for long needed changes in policy. In addition, real innovation could come about as more and more people “outside” the addiction treatment bubble weigh in on solutions.
The Field of Nutritional Psychiatry Gained Some Traction:
I am by no means a nutritional expert. I have, however, witnessed first-hand the connection between diet, behavior and emotional expression. As a nation we are becoming more and more concerned with the food we eat. There is an emphasis on “eating clean”. It is moving out of the counter-culture domain in everyday society. For example, gluten-free items are popping up in mainstream stores. We see more and more emphasis being placed on the brain-gut relationship. Harvard Health Publications puts it this way: “The burgeoning field of nutritional psychiatry is finding there are many consequences and correlations between not only what you eat, how you feel, and how you ultimately behave, but also the kinds of bacteria that live in your gut.” (See more at: http://www.psychiatrictimes.com/cultural-psychiatry/monthly-roundup-top-6-psychiatry-stories-november#sthash.Xy2HBM97.dpuf).
I find these developments to have a secondary benefit: this will provide us another viable alternative to the automatic response of prescribing psychotropic medication. For example, you will see decreasing numbers of children placed on amphetamines and other stimulants. That is a wonderful development. We need to move toward a more holistic response to behavioral health issues.
Value Based Health Care & Value Based Behavioral Health Care:
According to the Harvard Business Review, value-based care maintains the goal of lowering health care costs, improving quality and improving outcomes. It will eventually affect every patient across the United States. Not everyone, however, is onboard yet, because part of the value-based equation is that hospitals will be paid less to deliver better care. Rather than being reimbursed according to procedure the system will be reimbursed according to outcome. There will be built in incentives to provide preventative care and after-care. There will be an emphasis on utilizing the least expensive procedure rather than the most expensive procedure. This is an obvious issue in the general healthcare system. Many times a person is automatically sent for additional procedures. It has been termed down-stream revenue. You enter the system at point A and then are passed through to point B, C, D and E. The costs mount with each stop.
The same thing exists in behavioral healthcare. For example, in the private addiction treatment domain the holy-grail is inpatient treatment. There is an over-emphasis on landing the person in “rehab” as if completion of the residential stay will lead to some type of transformation. However, after-care and follow up care is frequently lacking and the results reflect this fragmented approach to recovery. If value-based health care becomes the norm, the treatment system will need to ensure outcomes for the care delivered. In addition, an individual will need to attempt recovery at the least expensive level of care. There will be an emphasis on using available insurance benefits judiciously and that is a good thing.
This will be a very difficult transition for our behavioral health system. Especially as it relates to addiction treatment. Many people will lash out at a reimbursement system that calls for accountability and community based treatment prior to inpatient. However, this is a necessary evolution in the treatment system.
For self-pay clients the impact will be felt in a positive way as well. It will come via better patient education regarding treatment options and increased accountability. Can you say “money back guarantee”?
Already, there have been efforts to better educate families faced with confronting a chronic, lifetime condition such as addiction. Families will become more astute at utilizing available financial resources for treatment and innovation will lead to real alternatives to the standard 4 to 6 week inpatient stay. All of this is a natural progression in the development of a new value based behavioral health care system.
So let’s rejoice as we move into the New Year. 2016 looks to be a year of change and innovation. The challenges are huge as we work our way through the most devastating drug epidemic in United States history. However, I truly believe that major change is on the horizon and that should make everyone excited. HAPPY NEW YEAR….
Unfortunately we live in a relatively inauthentic world. People are in a constant state of trying to measure up and this makes it more difficult for people to open up in honest and vulnerable ways. When seeking a person to lean on be careful to select someone who will lift you up. At the same time they need to be willing to say the “hard things” that we need to hear. Many times we will automatically look to family or friends for support. However, beware the following personality types. A supportive relationship with these characters may be more trouble than it is worth:
The JUDGER:
This individual will judge the situation and your role in the problem. The JUDGER may not openly tell you how wrong you are but you will be able to sense the judgement in the air. The JUDGER tends to say ridiculous things like “If that was my son I would have kicked him out of the house a long time ago”!!! Which, by the way, is completely untrue. If it was his or her son there would be many reasons why alternative responses are appropriate. When you get off the phone or finish a meeting with the JUDGER you think you are completely inadequate. You also think you and your family are the only family to have these problems. Run the other way when you encounter a JUDGER.
The PUNISHER:
Closely related to the JUDGER the PUNISHER will simply tell you how bad a job you are doing. “I can’t believe you have let this thing go on so long”…. “I have been telling you for years to set limits”… “Just suck it up and make the change”… You will be intimidated by the PUNISHER because they are very aggressive. The PUNISHER can come off like a bully and, just like a bully, they will need to be punched in the face (figuratively) to change this dynamic. You need to assertively reframe the relationship by refusing to take calls and fighting back when the PUNISHER lights you up for a “job poorly done”.
The SIMPLIFIER:
This person will provide you with completely obvious advice. For example, when you share that your son or daughter are struggling with school the SIMPLIFIER will tell you to make sure they do their homework. Their intentions are good. They are not as mean as the JUDGER or the PUNISHER but it can be an extremely frustrating experience. You can tolerate a SIMPLIFIER but should probably time the interactions accordingly. Do not seek out support from the SIMPLIFIER when you are seeking an answer to a specific situation.
The COMISSERATER:
This person will agree with everything you say and will reinforce how bad your current situation is. You have to be very cautious with the COMISSERATER as you will be drawn to the reinforcement and you will initially feel good when the COMISSERATER agrees with you. However, these interactions can quickly become a downward cycle of despair. You will probably not come out of the situation with a new perspective and it is likely that you will fall deeper into the cognitive triad of “I suck, the world sucks, and it always will”. This is a scary place to be. Avoid the COMISSERATER. Believe it or not they are more toxic than even the PUNISHER.
The IMPLODER:
This is usually a family member or old close friend who blows you up by direct ridicule/confrontation and/or breaks your confidence. You inexplicably keep going back for more. Probably because of familiarity and pre-existing relationships. Also you may feel a sense of obligation toward certain people. An example would be talking to your mom about your spouse. You hope the situation can be held in confidence but your siblings wind up hearing about the situation. If it happens once it is a mistake. Twice is a pattern. Three or more times is a pathology. The IMPLODER must be avoided OR you can directly confront the behavior. This may be necessary if it is a family member with whom you need ongoing contact.
The HOLOGRAM:
This is the most diabolical and dangerous of the bunch. This is a fake person who just wants to feel better about themselves at your expense. They will offer advice and sympathy. It will seem to be very helpful but there is no real level of trust. The HOLOGRAM has no concern or empathy and they are “not real in substance”. Unfortunately there are many people out there who fit this profile. In today’s FACEBOOK reality it can sometimes be difficult to find a genuine person. Put the HOLOGRAM on a “no-contact” list and tape that list to your bathroom mirror. Never interact with the HOLOGRAM and allow them to go find a new person to suck the life out of.
BUT MAKE NO MISTAKE:
There are trustworthy and wise people out there. Just take the time to put yourself around people who lift you up. If you are dealing with an emotional situation or a personal crisis the last thing you need is interacting with someone who makes you feel worse after the interaction. Next week we will talk more about where to find a corner man…
Robert Greene, NY Times best-selling author, expressed it well when he wrote all of life is a hologram all that we see in people is not real. It’s not quite as wonderful as FACEBOOK would have you believe. However, we have pulled the curtain back and we know the reality of life backstage. People are dealing with real deal problems and emotional distress is more the rule than the exception. There are worries about kids, worries about parents, worries about school, worries about work, and WORRIES ABOUT WORRY. Workloads are increasing and the fact we are always connected is adding to the problem. Technology has an interesting way of transforming life for the better and the worse simultaneously.
The good news is that if you find an appropriate perspective anxiety and stress can actually become a friend. Both can activate us into action and if kept in proper context the damage of chronic stress is minimal. There are many ways to effectively deal with stress and other emotional concerns. Having someone to talk to is a game changer.
HAVING A CORNER-MAN CAN MAKE ALL THE DIFFERENCE:
The term corner-man comes from boxing and signifies a very special relationship. The corner-man is a “coach or teammate assisting the fighter during the length of a bout”. In life’s terms this means that the corner-man is there to go through the turmoil with you and coach you through the “fight”. Please understand that a corner-man is not an easy find. We have identified 5 essential qualities of a corner-man. The more of these qualities an individual has the more productive the relationship will become.
A good corner-man is supportive, accessible and present but doesn’t solve the problem for you: In boxing the corner-man remain outside the combat area during the fight but is in close proximity to the action. He provides assistance, advice, and instructions but doesn’t try to intervene in the action. A corner-man in boxing waits until the opportune time to provide support, usually between rounds. The same can be said for a corner-man in life. If your corner-man becomes overly involved (for example engages in enabling behavior) the support can become counterproductive and problematic. At the same time your corner-man in life needs to be accessible. For example, if it takes two weeks to get an appointment to see a therapist you need to find a new corner-man. You may keep your therapist, but you may want to get a corner-man.
A good corner-man has some direct experience with the battle: In boxing a corner-man is almost always an ex-boxer, trainer, or coach. Rarely will someone just come in from the sidelines without the lived experience of the sport. The same can be said of a corner-man in life. Your corner-man doesn’t need to have identical experience to your current struggle, however, he should have some history of over-coming something. If he presents himself as void of past difficulties than I would run the other way. That would be the equivalent of having me as a boxing corner-man. Someone will get hurt real bad. It is very much an issue of experience versus theory and we encourage you to lean heavy on the experiential end.
A good corner-man will provide individualized support and instruction: In boxing a corner-man will vary his approach according to the individual needs and characteristics of the boxer. A right handed boxer is not handled the same way as a left handed boxer. A “technician” is handled differently than a “brawler”. Rocky was handled in a different way than Apollo Creed. The same can be said of a corner-man in life. Unfortunately most “helpers” prefer to give rote instructions and a manual on life. They seem to maintain an attitude of “if it worked for me and/or I read it in a book than it will certainly work for you”. The essence of human motivation lies in the unique needs, values, and psychology of each individual person. A one-size fits all approach is destined to yield little positive return.
Occasionally the corner-man has to perform “cut-man” duties: In boxing there will be times when the boxer’s eyes and face will swell due to getting repeatedly punched in the face. This can make it very hard to see the opponent. Sometimes in these circumstances the corner-man will need to “cut” the boxer to relieve the pressure and make it possible for the boxer to see again. Sometimes your corner-man in life will also need to say or do whatever is necessary for you to be able to see clearly. Your vision can become cloudy by repeating a behavior over and over or by a well-defined denial system (ie…getting punched in the face repeatedly). In these cases your corner-man in life may need to cause you temporary pain for long term gain.
Finally, the corner-man is many times the one responsible for “throwing in the towel”: In boxing the corner-man usually holds the responsibility of throwing in the towel to signify the fight is over. This is done when the boxer is getting beaten to a point of danger. Throwing in the towel is usually not received well by the boxer. The fighter will naturally want to continue the fight and go on to the bitter ends. In life it can also be necessary to throw in the towel and get more intensive help. The best example is a person struggling with addiction. Sometimes the corner-man needs to pull the rip-cord and get the person off to rehab or more intensive help.
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I never know exactly how to introduce myself when ranting. Usually I start with professional qualifications but in the spirit of change I am going to do something different and start with personal information. My life is an endurance sport. I have many different things going on and it’s awesome. First off, I have seven (7)…YES SEVEN…kids ranging in age from 23 to 2. And yes, all these kids are with the same woman.
I have worked in the helping professions as a counselor, therapist, coach and administrator for over 23 years. I have started multiple businesses and launched various non-profit organizations. I teach at the university level and usually carry 2 or 3 classes. Some people would call me a workaholic but that is an over-used negative way to look at things. I say I enjoy what I do and prefer work over watching TV. I have a multitude of professional credentials, Master Degree in Sociology and an MBA with a concentration in healthcare management. I am an outstanding coach and therapist. If they kept rankings of these type of things I’m sure I would be ranked in the top 5 worldwide (Just Kidding–sort of).
People say: “How can you handle seven kids and work all these hours and start all these different projects”? I’m not sure how to answer that. I don’t think about it in those terms. We just do what we do and enjoy the ride. It’s all about perspective.
I have been married for 24 years. My wife has gone through some very difficult stuff with me and she has been the best thing that ever happened to me. We will most certainly live out “until death do us part”. And I hope I go first because I can’t imagine life without her.
My father struggled with substance use disorders and was a very unpredictable man. It was confusing and sometimes scary growing up in that home. My mom is awesome and I will always be grateful for the way in which she navigated that extremely difficult situation. I did my best to follow in my father’s footsteps but found recovery in 2001. I know how to overcome a very difficult addiction and I know first-hand what it is like to “put on a front”. I don’t think anyone outside of my immediate family had any idea how poorly I was coping with stress. I believe my personal experience has provided me with even more useful information than my formal education and training. There is nothing like “been there done that” when it comes to helping people overcome difficult times.
The purpose of this blog is provide insight, information and resources that encourage people to free themselves from self-defeating thoughts and behaviors. Stress and anxiety are naturally occurring phenomenon and in some ways they are actually helpful. In the right context they will activate a person and get them moving. However, in today’s world of polished appearances, social media fakeness, and interpersonal superficiality these feelings get suppressed. This leads to numerous physical and emotional health issues. This is not meant to be a life coaching blog. Life coaches tend to give you a list of books to read, pointers on how to get up in the morning and go to the gym and a bunch of YOU CAN DO IT bullshit. This blog is meant to be about real talk, real issues and the reality of human motivation. This blog is meant to be useful.
have been surprised by the results. I don’t necessarily endorse a detailed time track (because that would take too much time). However, I do advocate a high level scan of how you use technology. Be honest with yourself and assess your relationship with your iPhone, iPad, laptop and make the necessary adjustments.
