Peer support is an evolving discipline. It’s a relatively new discipline. Standards are still being defined.
Like any other profession: there is great variability in terms of quality.
Completion of a training doesn’t equal effectiveness as a coach. We need time, supervision, and structure to hone our craft. It takes time to get good at coaching.
💥💥💥 “If you hone something, for example a skill, technique, idea, or product, you carefully develop it over a long period of time so that it is exactly right for your purpose”.
Our goals are:
✅ help advance the evolution of peer support. Specifically, develop assertive engagement specialists. Refine that specialty. ✅ enhance the experience with technology ✅ redefine “family recovery coaching” ✅ establish ourselves as the nation’s premier provider of peer support services.
ABOUT RICH JONES MA, MBA, LCAS, SAP EVP & EXECUTIVE DIRECTOR, HERITAGE CARES
Executive Vice President (EVP) at Heritage Health Solutions, Inc. Chief Strategy Officer Co-Founder at Youturn, CEO at Wellness Partners Group CEO/President at Jones Solutions Group Former CEO at FAVOR Greenville
Some of my favorite people in the world pictured above. This crew is part of our first cohort of medical students trained as recovery coaches with the University of South Carolina School of Medicine Greenville – in June of 2017. Here they learn about addiction and come to understand that Substance Use Disorders have different variations or severity indicators. They are classed as mild, moderate, or severe.
But before we sign off on the “more access to treatment” narrative, we should think this “addiction crisis” through a little bit.
When we say 10% of people in America need help with a substance use disorder this does NOT mean 10% of people in America are “addicted”.
Not A Medical Term
The word “addicted”is not even a medical term. The terminology is “substance use disorder”, and as mentioned above, it ranges in severity from mild to moderate to severe.
The closest terminology to “addiction” would be“SUD severe”.
Clearly, substance use is a disorder that should be treated across the spectrum, from mild to severe.
However, we tend to focus only on the severe part of the spectrum.
The mild and moderate folks are essentially ignored until they become severe; and even then only a fraction of the severe group ever seek help.
Treatment Mismatch
This creates a treatment mismatch. Over time we have developed practices to serve this exceedingly small slice of the substance use disorder pie. Those with “severe” disorders who actually show up for treatment.
Nearly every traditional service is inappropriate for those in the “mild” category.
Moderate conditions may be a better fit but many times this is also a treatment mismatch.
People are placed into the existing stream of care regardless of their particular needs.
SUD support services are not client centered because they can’t make the business work; and you can’t help people if you are out of business.
REALTALK:
The business model drives client placement and the provider has no choice but to “fit” the patient into the model that is reimbursed.
Putting someone who meets criteria for “mild”into rehab or intensive outpatient groups will cause more harm than good.
The same could probably be said for those in the “moderate” range. They can’t relate. They are less likely to follow through on recommendations.
The label “treatment resistant” will be placed on the person as they struggle to make sense of this bizarre situation.
The Resistant Label
I have seen this first hand with the college athletes in my practice.
They make a mistake or use bad judgement and they are hit with a positive urine drug screen.
Then they go for an assessment at a local “drug and alcohol clinic”.
They are then pigeonholed into programming that makes the situation much worse.
For example, they are place into intensive outpatient groups.
The groups take them away from the most positive group in their life: the team.
They will be labeled resistant if they don’t come to group and held accountable. That is totally Ridiculous!
A New Programming Model
Fortunately, the schools I work with are amenable to innovative thinking.
This is primarily a payer issue to fix. They could make this different overnight.
If there was willingness to make some bold moves.
No treatment provider is going to make a move until we have a business model that supports a new programming model.
Excessive Juuling – ???
I saw an article the other day where a teenager was sent to “rehab” for excessive use of his “Juul”.
I’m sure that excessive “juuling” can be dangerous but it is not appropriate to roll this kid through inpatient.
Maybe the article was fake news. I never know. Things are so outrageous.
The Medical Process
If we nest addiction treatment in healthcare it is much more likely the mild and moderate issues will be addressed.
If we can make it a routine part of the medical process.
The healthcare system will still need to send people with “SUD severe” for specialty care.
100% & 5%
There will always be a need for rehab. Just not so many destination rehabs (that’s a secondary gain from the shift). More community based services and more local treatment.
We can not rely on the paradigm and practices that come out of working with the most severe to guide our work with the entire SUD population.
We are basing 100% of our model on 5% (at best) of the problem.
Things today are not quite like the “Good Old Days”, but there are still echoes in the air!
One of the main reasons people struggle with accepting addiction as a brain disease or disorder is because we act like such complete a**holes when we the disease is active. We do nasty things.
Sometimes its dramatic and very obvious like breaking the law, neglecting children, stealing from loved ones, abusing people.
These are the hardest situations to reconcile.
Very hard to have sympathy for someone who hurts a vulnerable person, those in the middle of active addiction.
Sometimes the behavior is more subtle; but still way outside the bounds of acceptable human interaction.
CONSEQUENCES & PUNISHMENT
Our behavior in active addiction leads to the desire for consequences and punishment to be levied.
In the obvious ways like jail, losing jobs, losing our kids, etc…
However, it has also contributed to the punishing nature of many treatment and recovery approaches.
Simply put, people want to extract a pound of flesh from the addicted person.
IT IS YOUR TURN TO SUFFER
The addicted person made many people suffer so now it’s their turn to suffer.
This is why the industry can basically do whatever it wants in terms of housing and services.
The general attitude is “those bastards are lucky they have a roof over their head. Who cares if they are working for $1.43 an hour at the sausage plant and living 7 people to a bedroom”.
LIARS, CHEATERS & THIEVES
Even the addicted individual himself joins in the punishment.
I’ve been in group situations where people just one upped each other on how completely horrible they were in active addiction.
We call ourselves “liars, cheaters and thieves”. We think that people being hard and being confrontational is a good thing.
I get it. I really do.
THEY JUST DON’T WANT IT
I understand how things have evolved and how we have progressed to this point.
A point where we can ignore 90% of people in need because they “haven’t hit bottom”. They “don’t want it”, RIGHT???
These concepts work for the everyday person on the street.
Interestingly, this framework also worked for families for years but that has changed quite a bit.
FAMILY SUPPORT BASED ON ALANON
Remember, historically, the foundation for family support was based on Alanon which was (and still is) mostly wives dealing with chronic alcoholism.
Again, it was very natural for these wives to be somewhat hardened and “done” with their husband.
I get that as well. My wife certainly fit that criteria.
The program that was developed would reflect that dynamic. This may be a challenging fit, however, for parents.
I will make the following observations however:
1 – NOT GOING TO WORK
It’s just not going to work.
We can not punish or arrest or lecture or confront or debate our way out of the addiction crisis.
If it was a behavioral issue perhaps that would work. But we all agree this is a brain disease… right?
2 – OTHER WAYS OUT THERE
There are other effective ways to talk about to people about their issues.
An alternative approach requires more effort and it requires creativity.
It requires a willingness to talk differently, lecture less and be open to new ideas.
It means dealing with challenging people with a great deal of patience.
3 – CONFRONT & BREAK THROUGH DENIAL
Eighteen years ago when I started as a clinician I was literally taught to “confront and break through denial”.
However, I blew that shit off early on. I could see right away the damage that did.
The “hot seat” for example.
People who facilitated that group had to have a willingness to re-traumatizing people. I refused to do it and they kept me anyway because I was absolutely freaking exceptional at my job.
Then I got promoted and changed all that bullshit. Good times.
THE GOOD OLD DAYS
I do believe the culture of confrontation is slowly changing. However, if you pay attention, you can still see and still hear the ongoing influence of the good old days.
BONUS RECOVERY CARTEL INTEL REPORT
Please check out this article from Los Angeles Magazines blog, April 23, 2018.
To paraphrase the institute for therapeutic change any service is better than no service but no service stands out as the best.
For the most part, this is true. There are outliers on either end.
Some programs/people/service providers are far superior to the rest of the field.
That is probably due to the exceptional skills of a few top performers who work there. The SUD field has always been full of these isolated pockets of excellence.
However, the approach or method or “level of excellence” has never been scaled or replicated.
Mainly because we haven’t found a way to clone the “masters” who run the show in these settings.
Remember, scaling a method or an approach doesn’t mean you open up a couple of more centers in your region or even a few scattered across the country.
Scaling means exponential growth and exponential reach. Millions; not thousands.
Walmart Providers
There are also outliers on the other end.
Horrible providers and therapists and programs and services.
People who should not even be in a room with another human being let alone being in a professional helping field.
Pop-up; Walmart providers are commonplace.
Miserable people burned out holding on way too long. Unfortunately, these programs/people exist.
I Am Amused
However, for the most part the majority of providers are adequate. Providing a variation of a service/program that has been around for 40 years.
If people engage they will probably start to get better. Not everyone. But many will improve.
As much as I hate slogans: these programs seem to ‘work if you work them’.
At least in terms of initial improvement and quality of life they will make an impact. Furthermore, in terms of keeping people alive, there are more options than ever.
I am amused as I see the latest “Recovery Coaching Certification” or “Family Recovery Certification” advertisement.
Or the announcement for the opening of the latest state of the art treatment center; this one will have acupuncture while you ride horses.
It’s called Equi-puncture.
Solutions Still Based On “Willingness”
All the hype and debate around MAT is foolish as well.
We know it works “if they work it”.
The latest “app” misses the mark as it only helps the person who inputs the data or enables the “tracking system”.
Because each and every “new solution” that is proposed assumes “willingness” on the part of the participant.
All of these “evidenced based programs” or “traditional tried and true approaches” are based on a participant who shows up and, for the most part, follows recommendations.
Debating the “best approach or best practices or evidenced based practices” may be entertaining and may make good content for this week’s task force meeting.
But it’s literally a red-herring. An inane exercise which makes us feel as if we are making progress.
But The Facts Remain:
90% of those in need never touch these “evidence based” programs. Hasn’t changed for decades. Probably won’t if we keep focusing on “evidenced based practices” to help the willing.
The “system” that already can’t respond to 10% engagement (waiting lists exist for everything: including MAT) would literally implode if we reached even 25% engagement.
Therefore, the “hit bottom” and “you have to want it” foundations of our system, serve a purpose.
It goes to follow then that: the system which would be able to serve increased engagement doesn’t even exist yet. Furthermore, this new system will be unrecognizable by current standards.
It will be as different from the current treatment system as an iPhone is from a pay phone.
The endless 12-step speaker meetings on facebook imploring us to “call now”.
You really think this is going to engage an ambivalent participant?
These approaches will SCARE some people into treatment.
But it’s actually going to increase stigma and make the rest of America run the other way.
FACT: The entire American economy is built on making people buy things they don’t actually need. Yet we can’t even make more than 10% in need come get something they desperately need.
There Is A Way
I spend less and less time with people in the recovery bubble.
I spend less and less time with people in the industry.
I spend more and more time with people from other industries and this is why I believe there is a way to change these outcomes.
The goal: 90% of those in need of SUD services engaged in professional support services.
This means at least another 20 million people.
Probably more as we will also engage the “risky” user who hasn’t even been identified.
QUESTION EVERYTHING
Question everything you have been told about treatment, recovery services, insurance, ect..
That system was put together by people who are less informed than we are and certainly no smarter.
Many act as if this “System” is “divinely inspired and comes from God!
They act as if we must do things this way.
We are much more knowledgeable than they were in 1970 when they cranked this thing up.
Stone Cold Truth – Really?
Over my 18 years in recovery and professional treatment/recovery services there have been countless times when I realized I was wrong about something.
Something that a year earlier I would have sworn on as dogma and stone cold truth.
Thank God my views evolve and I remain curious. I read. I read a lot.
I read on topics outside the bubble.
I’m not interested in addiction or recovery conferences or webinars. It’s all recycled information.
I ask questions. I change my mind.
More, More, More
It’s ironic that serving 20 million more people will not be based on more beds or more MAT or more insurance parity.
These areas are a very small part of the plan. Almost an afterthought.
These are ideas that are part of a vision. There is nothing threatening about ideas. Is there?
We will figure out how to get to that vision… by starting with identification of how NOT to get there.
More likely legislators with influence over FDA. Probably FDA directly.
IT’S THE ILLUMINATI ???
I’m not saying there is some Alex Jones Illuminati type stuff going on; but if you think our government is pursuing justice and truth you are silly and naive.
And this crony capitalism is not confined to any one party. Sometimes it has nothing to do with political party. It’s the regulatory body itself independent of legislators.
TRUTHS AND NORMS
This false evidence presented as real shows up in all societal institutions.
Religions, legal system/prison system, school system, military and all the other major institutions of society have their own galvanizing indisputable truths. This is what makes the institution function.
Furthermore, from a functionalist perspective, these institutions reinforce the facts put forth by other institutions because it holds everything together. Society “functions” better when all agree on “truth and norms”.
EXAMPLE #1 – RELIGION
Example: Religion has always been used to reinforce civil norms and encourage obedient behavior. In all religions and all countries it’s part of the equation. Sometimes very overt. Sometimes more covert and deceptive.
EXAMPLE #2 – DRUG LAWS AND THE INDUSTRIAL PRISON COMPLEX
Another Example: drug laws are used to perpetuate the industrial prison complex.
—The United States locks up a lot of people.
Our prison population rate of roughly 700 per 100,000 is the second-highest of 222 countries tracked by the Institute for Criminal Policy Research.
Private correctional facilities were a $4.8 billion industry last year, with profits of $629 million, according to market research firm IBISWorld. Yet we “must protect our youth from the evil drug dealers”. ALL SUPPLY SIDE INTERVENTIONS ARE DOOMED TO FAIL.
EXAMPLE #3 – THE ADDICTION TREATMENT SYSTEM & THE RECOVERY MOVEMENT
—Another example: the indisputable “truths” which hold together our addiction treatment system ($46 billion industry) and our evolving centralized “recovery movement”.
TAKE NOTE: APF and their underlings are trying to “control” the movement; including the allocation of funding.
If you think ALL the “experts and gatekeepers” at the front of our “Recovery Movement” are putting forth pure objective unbiased info you are truly naive.
NOTE: I have great respect and admiration for many people and organizations in the Recovery space.
Even if I don’t agree with the others I know they aren’t bad people. They simply have an agenda and think they know best.
WE ALL DESERVE TO KNOW THE RULE OF THE GAME
APF tried to sneak in $10 million in Self Funding through legislation that we all fought for. Money that the entire “Recovery Movement” fought for.
By and large the “Recovery Movement” has been silent. Aside from some brave voices who are willing to walk their own path. Everyone else appears to be toeing the company line.
As a matter of fact I am starting to think I must be foolish for being upset about this.
It appears everyone else in the “movement” is cool with APF’s private deal. One thing for sure. This new recovery “thing” is certainly not a movement. It’s an evolving system and a burgeoning industry.
Or more accurately, an off shoot of the treatment system. History repeating itself.
That’s fine. But we all deserve to know the rules of the game.
PUNCHED IN THE GUT
APF doesn’t represent FAVOR GREENVILLE worldview.
When FAVOR GREENVILLE advocates for legislation and recovery money WE DO NOT support any of it being allocated to “literature and training”.
We had no idea that was part of the plan. This isn’t the first time FAVOR GREENVILLE has been punched in the gut.
In February 2018 I participated in an event in Washington DC that was broadcast-with the surgeon general; and some members of congress.
At that event we (the recovery movement) officially requested $220 million.
Shortly after that event Faces and Voices/ARCO sent out an email celebrating the fact that Sheldon Whitehouse (senator) seemed on board and the $220 million request stood.
STAND UP FOR ITSELF
The recovery movement was finally going to stand up for itself and not just advocate for more money for treatment and the legacy provider system.
As the legislative process unfolded APF sent a letter to Congress proposing allocation of money in CARA 2.0 legislation.
It detailed where APF recommended the money go.
The amount allocated to recovery support (places like FAVOR; recovery housing etc…) was $7 million of a $4 billion proposal. $7 million instead of $220 million.
Furthermore, the APF letter that was sent to congress included a section that stated this request is supported by over 100 recovery organizations nationwide including the following: it then listed all the ARCO members. Including FAVOR Greenville
OVER-SIGHT OR MISCOMMUNICATION ???
I would have never signed off on those changes.
We were never ask about our support for that allocation. Not by APF; Not by Faces and Voices national.
I never said I agree with the APF document.
I never got the opportunity to review the document ahead of time. And when I did review it (after it was sent to Congress). I didn’t agree with much of it.
Perhaps it was oversight. Perhaps it was miscommunication.
CANNOT CONCEIVE
However, I can not conceive any circumstance where I would have the hubris to speak for another organization without written consent.
NO ONE SPEAKS FOR FAVOR GREENVILLE AND OUR AFFILIATES EXCEPT ME AND OUR BOARD CHAIR.
On one hand we are very frustrated at FAVOR GREENVILLE.
On the other hand it is good to have clarity and realistic expectations surrounding national advocacy.
NO INTENTION TO FUND
There is no intention to fund independent recovery supports.
It would not be politically expedient for APF and their associates to pursue such radical ideas. They will bank on toolkits and blueprints and resource lists. Much safer and acceptable to the status quo.
WE INTEND TO GAIN PROMINENCE
At FAVOR GREENVILLE we intend to gain prominence nationally based on merit and performance and winning in the free market. We know we won’t be invited to any advocacy awards dinners and we may be kicked out of the “club”.
However, we have realized that the the world outside the recovery bubble loves us and is willing to be part of the solution. Corporations, healthcare systems, benefits administrators, and the technology industry are willing partners.
WE KNOW WE CAN DELIVER
They judge us based on performance and value add. That makes us hopeful because we know we can deliver.
I would have stayed in the treatment system If I wanted to struggle with arbitrary gatekeepers and “experts”. It’s hard to abdicate authority to people who have never executed in the actual delivery of professional recovery services.
We have no intention of following people/organizations/protocols which operate mainly on theory.
Or worse organizations that just repackage the 60 year old treatment system.
I have little time nor tolerance for theory over practice.
I will follow the lead of people who add value and get things done effectively on the ground in direct service.
ACCESS TO UNLIMITED INFO
In modern society we have access to unlimited info. The isn’t 13th century feudal system where we have no info and we just need to accept that the king’s rule is “divinely ordained”.
Read. Educate yourself. Check out other sides. Access your own critical thinking. If you are in the “Recovery Movement” take time to investigate. Don’t blindly follow the herd.
For that matter. Challenge me as well. I’m not an “authority”. I just have an opinion.
Tell me how I’m wrong. Tell me where you differ.
Let’s talk!
RICHARD JONES MA, MBA, LCAS, SAP EXECUTIVE DIRECTOR 864-764-8504 (cell)
THIS IS AN OBSERVATION BY RICH JONES | RECOVERY CARTEL
It sounds sarcastic and provocative but it’s truly an observation. And the points I make are unassailable.
I challenge someone to tell me what I’m missing.
With the facts below in mind, understand that the long standing manifestation of treatment/“rehab” is unsustainable.
The approach used to get customers is so insanely one dimensional and insulting to the average human being that it is unsustainable.
ONLY 10%
No wonder only 10% ever show up for treatment.
The reason it has lasted this long is the stigma.
No one in the outside business world wanted in on this industry because it’s a stigmatized patient group. No one creative considers involvement because those “scum-bag” addicts are an afterthought.
A NEW BUSINESS MODEL
Historically, if an outsider does decide to get in they just followed the rehab formula because it was a proven business model.
No one bothered thinking about creative destruction and inventing a new business model.
As stigma is reduced and awareness raised more and more outsiders will become involved. And things will change.
A new business model will emerge.
Marketing in the addiction Treatment/Recovery industry is really only focused on filling rehab beds and appears to fall into one of 8 categories/strategies; or a combination of these strategies:
8 CATEGORIES / STRATEGIES
Hire someone/maintain team to do face to face business development to outpatient, doctors, etc…. focus on legacy relationships, brand and reputation to fill beds. Use outpatient clinics to funnel clients as appropriate. This is mostly used by the large legacy programs and integrated massive systems.
Digital media (Facebook, Instagram etc…) with the apparent strategy being create a persona or use pseudo-celebrity/actually celebrity to basically tell his/her 12 step story over and over….while encouraging people to call now for help.
Digital media where these same personas, pseudo celebrities/real celebrities diss other pseudo celebrities etc…. while encouraging people to call now for help.
Digital media where these pseudo celebrities etc….tell parents they are enablers and killing their kids….while encouraging people to call now for help.
Google ad-words at hundreds of thousands of dollars per year.
Annual conferences (NAATP, C-4 etc….) where people talk about the latest innovation in treatment and ethical marketing practices. While encouraging one another to “keep us in mind if you think you have a fit for our program”….
Some guy in doctor scrubs on television in the lowest production value commercial in the history of TV encouraging people to call now if you or a loved one need help.
Body brokers.
With the exception of number 1 and number 6. The content of the marketing message, despite the platform or avenue of delivery, is essentially
“You’re hopelessly addicted. You’re in denial about that. Call now and get help. Or you’re gonna die”….. or
“You’re loved one is hopelessly addicted. Get your shit together and stop enabling. Call now or they are gonna die”…..
Number 1 works because the narrative of “we are the expert healthcare providers/treatment providers and state of the art etc….” and “we are really you’re one best option” has never really been challenged.
Legacy and brand is hard to overcome.
Number 6 is just an excuse to visit a posh resort and play golf. 😎😎😎😎
This is an industry that is going to get completely turned upside down as soon as the knowledge of the issue (and the associated opportunities) escapes the Recovery Bubble. Begging for disruption….moral imperative to do so.
Who is thinking about the behavioral health crisis in a visionary way in hopes to solve the epidemic.
Overdoses and suicides #1 and #2 in injury related deaths respectively. Anxiety, depression record setting levels.
Consider this…
Flat-Earth?
In order for people to discover the new world they had to allow for the possibility that the world was not flat.
Einstein proposed particle theory at a time when all scientists were certain light was a wave.
The American Revolution (1775-1783) took many ideas from the early civilizations of Greece and Rome and combined them with the Christian Bible to revolt against an authority that was unbending by embracing a completely new concept: a modern representative republic.
Gutenberg invented the printing press around 1440 changing the way that information is disseminated and changing the world. Before this monumental creation books were copied by hand and humans were limited in their ability to transform their lives/move beyond their immediate sphere.
The industrial revolution, the assembly line, the invention of the automobile ushered in a new era of urbanization and economic growth.
Steve Jobs decided it was possible to put the power of a mainframe computer in our pocket.
The internet has made instant access an everyday mundane experience.
Elon Musk is trying to solve the LA traffic problem by tunneling under the city. It looks like it will work.
We could go on and on… in each case the world changing development required visionary thinking.
From the CASA Columbia “Analysis of the National Household Survey on Drug Use and Health”.
Please take a moment and cogitate on the picture in this post.
Observe if you will the 2 “poles” of the continuum.
In theory we address the entire continuum of substance use; but does our practice/approach match the diversity and stages of substance misuse? Of course not.
In American society we approach substance misuse primarily in the following 2 ways:
“Just Say No! Don’t Do Drugs” (focusing on the 12.7% “not using”). These are our prevention programs.
“Wait Until You Hit Bottom”; admit you are an alcoholic or an addict and come to treatment (focusing on the 15.9% “addicted”).
This is our reality. Substance misuse is not discussed until IT HAS TO BE DISCUSSED. Until it cannot be ignored.
And even then we do a horrible job connecting to that 15.9%.
From the CASA Columbia Addiction Medicine Report:
While about seven out of 10 people with hypertension, major depression or diabetes get treatment for their medical conditions, only about one in 10 people with addiction involving alcohol or drugs other than nicotine do, leaving a treatment gap of 20.7 million individuals. The proportion of individuals in need of addiction treatment who actually receive it has changed little since 2002, when 9.8 percent of those in need received treatment.
Failed at Engagement
IT HASN’T CHANGED SINCE 2002. 16 YEARS.
I would say that indicates we have failed at engagement.
If we can start touching the people who are in the non-risky and risky categories we can make a difference.
But they are NOT going to come to your clinic.
They are not going to listen to the “Just Say No” presentation at school.
If they are in the risky category the “documentary on addiction” is not going impact them.
They are not going to go to a meeting and admit powerlessness.
Quite frankly, meetings are NOT designed for the “risky user”; they are designed for the “real alcoholic/addict”.
They are NOT going to come to an intensive outpatient program unless they have to, i.e. DUI, and then they are going to go through the motions.
This is What We Need
Information, non-judgmental information, that does not involve a diagnosis.
That does not involve a prescriptive “program”.
Does not require “admission” to a certain type of problem.
This is what we need. Engaging information. Professionally delivered.
With a nod toward healthcare rather than a nod toward rehab.
The word recovery may even be problematic for the “risky user”category. They just aren’t there yet.
Carpet Bomb with Information & Connection
If we carpet bomb the country with information and connection at a “stage appropriate” level, I believe that will lead to more people in the “addiction”‘ category seeking treatment.
If we “touch” people along the way as they progress toward addiction they will be more likely to seek help once they do cross that line. OR even before they cross that line.
The challenge is doing so at a “stage” appropriate level.
Engaging Content and Engaging People
We can’t talk to the public the same way we talk to one another.
This goes way beyond using the term “substance use disorder” versus the term “addiction”.
Avoiding the term “substance abuse” is not going to win the day in this regard.
Engaging content and engaging people talking about health and wellness will make more of an impact.
Almost Impossible
“Identification” is hard enough for a person who has crossed that line into “addiction”.
It will be almost impossible for the “risky user”.
Unfortunately many of these “risky users” are being sent to rehabs that were designed for the “addicted” person.
Causing more harm than good?
Embrace Harm Reduction
This is also going to require that professional providers embrace a harm reduction point of view.
NOT in terms of M.A.T. or needle exchange etc… but in terms of reduction in use; less dangerous use etc…
Increasing community tenure. Getting away from knee jerk referrals to inpatient rehab.
Many of you are cringing while reading this.
Noble and Important Work
I love everyone who works in this field. Y’all are doing noble and important work.
But the logic of my argument is beyond reproach. Don’t kill the messenger.
If we are ever going to slow the rampage of addiction we will need to implement these type of comprehensive interventions.
Emphasizing quality of life and health/wellness over “recovery”.
Over the past few decades, practitioners and researchers increasingly have recognized the link between substance abuse and mental disorders. Some studies suggest co-occurring disorders are present in up to 60% of addiction treatment admits.
Defined as the presence of at least one substance use disorder and at least one axis 1 mental health diagnosis or axis 2 personality disorder. Some states have aggressively pushed COD services.
Clinical credentials reflect this commitment to COD services—for example:
I am a Certified Co-Occurring Disorders Professional from my days in Pennsylvania.
Treatment Improvement Protocol
There is also a SAMHSA guide called TIP 42 (Treatment Improvement Protocol) that serves as guidelines for COD services.
When it came out in 2010 (?) there were also TIP 42 trainer the trainer courses.
I am a Certified TIP 42 trainer (talk about an obscure credential).
Facilities in PA could also become accredited as COD INTEGRATED (the highest standard) or COD COMPETENT clinical facilities.
The hope was that COD services would become the norm. This “movement” has lost much of its momentum.
I am of the opinion that the mismanagement of COD issues is the second most dangerous issue facing individuals and families seeking help.
Behind only straight up body brokering.
The 4 Quadrants
COD comes in many different manifestations
Q1—Quadrant 1: LOW Mental Health/Low Substance Use Disorder Q2—Quadrant 2: LOW Mental Health/High Substance Use Disorder Q3—Quadrant 3: High Mental Health/Low Substance Use Disorder Q4—Quadrant 2: High Mental Health/High Substance Use Disorder
1-800 CALL-CENTER
The problem is when someone calls your average addiction treatment “helpline” or “treatment line” hey will almost automatically be pushed toward rehab. (They almost diagnose the problem with little or no MH training or education.)
You hear it all the time.
A mantra of get them into detox, rehab, long term residential care.
There may be a sense that having a psychiatrist on staff will take care of the possibility of a COD.
That’s woefully inadequate.
If it is a Q1 or Q2 issue it would be no harm no foul. Much of that can be handled.
Very Specialized Care
If it’s a Q4 issue you need very specialized care. The most troubling is a Q3 (high Mh/low SUD).
Many times a family member will call an addiction treatment program with a Q3 situation because it looks like SUD may be the problem.
When in fact it is a symptom of the primary mental health issue.
A great example of this is breakthrough mania associated with bipolar type 1.
The mania frequently involves a wide array of risky, impulsive, dangerous behaviors that could include out of control drug or alcohol use.
More Harm Than Good
And it is possible that taking a person with true bipolar type 1 and plugging them into your standard addiction treatment setting results in more harm than good.
Again….having a psychiatrist on staff does not mean it’s competent the effectively work with co-occurring Disorders.
Require Competency
To be COD competent require competency in skills training, working with families and case-management directly related to the mental health issue.
Telling a Quadrant 3 client that their aftercare plan is attending an intensive out-patient, and go to 90 meetings in 90 days, is….. well problematic at best.
Be Extraordinarily Careful
YOU OR YOUR LOVED ONE IS HIGH MH (Q3 or Q4) you are better off in a MH primary facility if there is no COD competent program.
I fully understand that access to integrated COD and competent COD facilities is lacking.
And many people can’t afford top notch COD care. In those cases you may need to piece together a solution.
Please understand if you call one of the “get help now” phone lines you will be steered to addiction treatment. If Q3 or Q4 is your loved one’s reality you must be extraordinarily careful.
