81,000 + New Record Overdose Deaths

The complicating factors surrounding the current COVID-19 situation and substance use disorder treatment and recovery seem insurmountable. Again, this last year, another record number of overdose deaths. 81,000 + (as per C.D.C. Dec 2020 report – Overdose Deaths Accelerating During COVID-19)

There will be money coming to help.

But how will it be allocated? Will it reach the most vulnerable?

For example, there is a baseline, fundamental misunderstanding of community based recovery support.

Independent Recovery Support

Fact: Independent recovery support is an essential part of the continuum. “INDEPENDENT” and authentic recovery support.

These are organizations that are not run by the government, not run by clinical providers, NOT part of the larger state drug and alcohol system or the local county “authority”.

Recovery Community Organizations, Recovery Housing, Recovery High Schools, and Collegiate Recovery Organisations for example.

Short-Changed

When the funding is “run” through the traditional infrastructure (single state authority/Drug and Alcohol Commission) these grassroots organizations get short-changed.

With the exception of a small number of states–less than 5% will ever work its way “down” to street level organizations.

Back in Washington, SAMHSA and the officials are given reports that 20% or more went to “recovery”.

But NO ONE in Washington even knows what that means.

They think putting a peer support staff in the IOP group is funding “recovery support”.

For example, there are very, very clear definitions of Recovery Community Organizations.

There is an Association of Recovery Community Organizations. 150 plus members.

YOU CAN NOT BE A CLINICAL PROVIDER AND BE AN RCO.

It’s literal in the definition of an Recovery Community Organization.

But no one in Washington (or in any given state government) understands that and people just go on blindly.

Thinking the money went to “recovery”.

Funding Needs To Hit The Streets

There will be no progress in this fight until a massive amount of funding hits the street.

Until a massive INDEPENDENT recovery system is funded. And I simply do not see that happening.

It would require too many people to give up too much power.

Solutions

We will need a coalition of wealthy funders, and or social-entrepreneurs.

We need them to come together and fund a scalable model OUTSIDE of the confines of the bureaucracy. youturn exists to be part of that solution.

FAVOR Greenville exists to be part of that solution.

It’s exhausting. But I feel like incremental progress will not get it done.

The post Record Number of Overdose Deaths, AGAIN! appeared first on The Recovery Cartel.

The Momentum Story

What do I mean, Momentum? It starts like this. In 1999, I “hung around” recovery rooms. To get the heat off.

My opinion on recovery was pretty silly at that time.

If I were to summarize my take on recovery in 1999 it would be as follows: “It’s impossible for me to recover.

Recovery is for other people. A select few. Like winning the lottery”.

In 2001 my opinion shifted…dramatically.

Clarity

It wasn’t a moment of clarity. More like simply clarity. It did not come and go–like a moment. It was weird.

All the sudden, it was incredibly clear that substance use disorder was real.

More importantly, it was clear that I could recover. I could live with out drugs and alcohol. I’ve been in recovery since.

2002: Getting Started

In 2002, I started working full time in the drug and alcohol treatment industry and the mental health field.

I always had to work multiple jobs at the same time, because you couldn’t make a living on the entry level salary in this field. You don’t get paid much.

So you work part-time and constantly have side hustles to pay the bills.

I went back to school and got a Masters of Arts degree in Sociology with a concentration in addiction studies. Then I also earned an MBA with a concentration in healthcare management.

I was learning on the fly. I learned a lot. And I adopted the opinions of the industry.

The Traditionalist

I was a hard-core “traditionalist”. There was one way to recover. My opinion had evolved.

In 2004 things started to change a little bit. I became the director of an assertive community treatment team. Working with folks with long-term mental health / co-occurring disorders.

I was “forced” into an immersion/training program in motivational interviewing/harm-reduction.

It was clear that my personal recovery pathway was not the only way.

Questions Arise???

It was clear that many people required harm-reduction. It was clear that many, many people did not have the resources I had.

They did not have the recovery capital that I had.

It was unfair to assume they could follow the same path I took. At the end of the day, I still thought there was only way to recover.

But my opinion was evolving. The evidence was clear and I was a compassionate person.

Clearly, we needed to open our minds.

But I wasn’t sure how to make sense of all of this.

The Kids

In 2007, I started working full time with adolescents and that challenged my thinking even further.

A 16 year-old marijuana smoker is entirely different than a 40 year-old alcoholic.

The model must be different.

I got deeper into motivational interviewing and got trained in family systems.

My opinion evolved.

Clearly, the family was key and there were many ways to “get better”.

The Opioid Epidemic

2007-2012: The opioid epidemic ramps up.

Western Pennsylvania was Ground Zero. People start to die before they even get a chance to recover.

Several “kids” I knew well died. I felt like there was imminent danger all around.

The concept of “hitting bottom” starts to sound like non-sense.

So many things that seemed to be self-evident truths now seemed to be dangerous slogans.

The Company Line

Medication assisted treatment starts to get promoted at that time.

But many people in the rooms, and many professionals, reject the idea of MAT. They reject the idea of harm-reduction.

I simply can not make myself toe the company/industry line.

I start to say things that are not acceptable within in the traditional framework of recovery “thinking”. (ie…multiple pathways etc…).

I stop getting invited to speak at the conferences. My opinion evolved. My opinion was problematic.

It’s All About To Change

As a matter of fact. I start to get downright aggravated with conventional thinking.

2012: I land at FAVOR Greenville and I go next level.

My role as an “advocate” is hard to manage.

When do I speak out? How do I speak out?

I start doing “car rants”. I push back hard against conventional “recovery” wisdom.

It gets… a bit ridiculous. My opinion, has evolved. The pendulum has swung the other way.

2019-2020: My Opinion Evolves “Too Much”

The pandemic crushes me and my family. The stress, the co-occurring mental health.

It becomes apparent that the “pendulum” swung too far the other way as I become borderline obsessed with alternative models.

However, there is a big part of me that needs traditional models.

Both professionally (for referrals etc…) and personally (because it works). It is clear that I do not want the models to go away.

I Want to Add Things

I want to add things to existing systems. NOT destroy existing systems. But I’m not sure I communicate that clearly.

From 2020 through 2021 my opinion evolves again.

When my family needed help I get it through very traditional programming. And I am grateful the programs are there.

I realize that I believe in the conventional pathways. I really do.

There are some bad programs and people out there. Very bad. I mean, really horrible.

BUT, we need rehabs and we need abstinence based programming. And there are really high quality programs available.

WE NEED ALL OF THE ABOVE

My opinion has evolved. It is not “harm reduction” versus abstinence based recovery. It is not “medication assisted treatment” versus more traditional models.

We need all of the above.

I need all of the above and when my family was in need we needed all of the above.

We will continue to need all of the above.

I can admit when I’m wrong.

Maybe not as “promptly” as I should. But I will come around.

I can get “too pushy” with the moderation management vibe.

I don’t take back the message. But I do want to re-evaluate the way in which I deliver the message.

I can be very one-sided. I get fired up and I get on my “soap box”. And my soap box gets out of control. I need to be more balanced.

People Like Me

There are some people, myself included, who need to abstain from all substances in order to reduce harm.

Alcohol is a destructive force that would take over my life if I tried to moderate.

I know this because I tried to moderate for years.

And blackout drunk is not moderating. Sometimes we need to hang up the cleats and walk away from the game.

Better yet, run the other direction.

I Just Want To Be Clear

I believe in abstinence based, 12-step recovery. And I need to do a better job in communicating that belief. In my effort to promote multiple pathways I sometimes go to far.

We need to honor all pathways included the traditional routes of recovery.

Start the process of recovery and don’t quit.

Keep going and keep trying.

People do recover. In all kinds of ways.

Constant forward momentum.

And then there’s the family. That’s a whole other topic….

The post Constant Forward Momentum appeared first on The Recovery Cartel.

The Odyssey of Grief

There were three of us standing there. A grieving father, myself and a colleague.

In the middle of a crowded room with conversation, laughter, and “good” noise in the background. The kind of background noise that sparks excitement and hope. Upbeat. Lively.

I had just finished speaking on the “opioid epidemic”. The mood in our circle did not match the mood of the room.

He was telling the story of his son’s first trip to rehab and the odyssey that followed.

Multiple Attempts

Several return trips to detox and rehab. Two or three runs at medication assisted treatment and a constant battle around attending meetings and therapy.

All of this was compressed into a 2-year time span.

The story ended in an all too familiar way.

A fatal accidental overdose in his early 20’s.

Listen and Say Nothing

Dad talked rapidly and nonstop recounting the events. Repeatedly processing a traumatic event or loss is good.

Telling the story over and over is healthy. It helps move the process along.

We listened and said nothing.

Then he stopped talking and silence entered the circle.

Time morphs in a situation like this. 15 seconds feels like 15 minutes.

My colleague quickly spoke up.

“We have a grief support group and I think we can get you connected to a good therapist”.

We hate to just stand there in silence when another person is in pain.

My Experience

I am a person in long term recovery from an opioid use disorder since 2001.

Also I am a professional therapist with a wide variety of experiences in the mental health and substance use disorder recovery arena. I have seen a lot. Both personally and professionally.

I know first hand the grip of opioids. The psychological craving and physical dependence. The withdrawal that is beyond description.

I know that feeling all to well. I have dwelt in that pain cave on many occasions.

In recovery I have experienced debilitating panic.

The Struggles

I seem to be able to operate on little sleep and on any given day I can go to the dark side. I believe the struggle is real.

The emotional and mental struggle is real.

I have had countless friends in recovery who have gone through similar issues.

I have had family and friends outside of recovery who have struggled with these demons. I’ve always been in touch with the seriousness of these problems.

Thousands Of People

As a professional I have worked in community mental health, intensive case management, assertive community treatment, in-home family services, private practice, intervention services and nearly every level of care in the substance use disorder treatment and recovery sector.

I have seen thousands of people.

Thousands of families dealing with mental health and/or substance use disorders.

I have worked with the most intractable forms of mental illness and substance use disorder.

My Perspective

These personal and professional experiences give me perspective. We know what the numbers say about “deaths of despair”. Unprecedented levels of suicide, overdose, alcohol related deaths. 

It is impossible to ignore the cloud of darkness that has enveloped the behavioral health.

The level of fatalities we face today is nearly incomprehensible.

The tragic death of a patient was always a possibility; but it was NOT a probability. It happened on rare occasions.

It was a monumental event. As suicide and overdose levels escalate, we risk becoming numb to the event.

The New Normal?

A new normal is creeping in. Talking to people about untimely death of a loved one has always been part of the job description, however, I was rarely called onto to do it.

Now I have the conversation at least once a week.

What have I learned about grief and grief counseling?

No Fix to Grief

For the record. Human beings naturally try to fix other human beings. When we see someone with their shoe lace untied, we reflexively say “your shoe is untied”. It’s known as the “righting reflex”. 

That said, it is a bit strange how we automatically provide unsolicited resources to people dealing with loss of a loved one.

The problem with the “fix the grief” strategy is, unlike tying your shoe, there is no way to fix grief.

There is no right way to deal with grief. There is no such thing as grief counseling.

I believe that things are even more complex when the death was untimely and involves suicide or drug overdose. 

Stigma & Judgement

These stigmatizing factors make accessing a “normal” grief support group counterproductive. Many times, parents and spouses come away feeling judged.

In the midst of their own loss and emotional upheaval, people who lose someone to cancer are prone to thinking: “you’re kid did that to himself”.

This thinking will come through loud and clear in the presence of people dealing with loss from substance use or suicide.

We need to become comfortable with the uncomfortable silence that comes with deaths of despair. So that we can be there as compassionate witnesses.

Experts

There are no experts, therefore, we are all experts.

What do we know about grief in general? Not much!

There is scarce literature and research specifically addressing grief.

Grief tends to get woven into trauma.

The DSM-V

Terms like “traumatic grief” and “complicated grief” bump up against post-traumatic stress disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has a diagnosis for every condition. Grief is no exception; see here for DSM-V criteria for “complicated grief.

These comparisons make sense. 

Trauma and grief can reach clinically significant levels, interfering with daily functioning, if unprocessed. Having safe, supportive people around, who listen without judgement, is correlated with better outcomes for both trauma and grief.

“Grief turns out to be a place none of us know until we reach it… Nor can we know ahead of the fact … the unending absence that follows, the void, the very opposite of meaning, the relentless succession of moments during which we will confront the experience of meaninglessness itself.” (p. 188–9) Joan Didion The Year of Magical Thinking (1)

Profound Life Event

Grief counseling is basically the same as any other counseling session. Except the grieving person is going through a much more profound life event.

Perhaps more accurately, grief counseling is basically listening to someone as they recount the worst experience of their life.

Essentially, there is no “right” way to grieve. Much of what we have been told about grief is opinion only. Not fact.

My Thoughts On Grief

1) No Right Way

There is no right way to grieve.

There are no “stages of grief” to “go through”.

Elizabeth Kubler Ross, in her landmark book on grief (On Grief and Grieving) birthed the stages of grief framework.

This was an off-shoot of the work she had done with individuals and families as they dealt with a terminal illness.

Kubler Ross observed that people awaiting death, or the death of a loved one, went through predictable stages: denial, anger, depression, bargaining, and acceptance.

In my opinion, this model works much better with terminal illness than it does with grief. 

There are many reasons to challenge the stages of grief construct including lack of theoretical orientation underlying the stages and lack of empirical evidence. Most troubling, is conceptual confusion, the misunderstanding that people must progress through these stages in a linear manner. 

As if they are required for healthy response to loss.

What if I don’t go through anger? Am I a bad father? Am I in denial?

Grief stages tell us little about how people might cope with the loss; why they might experience varying degrees and kinds of distress at different times; and how, over time, they adjust to a life without their loved one.

Considering the evidence from other studies that contradicts the idea of an “average” normal response to loss, this is a misguiding message. (p. 2693) Bonanno G. A., Boerner K. (2007) The stage theory of grief. The Journal of the American Medical Association 297(24): 2692–2694

2) Silence

Silence is a powerful therapeutic tool. 

You don’t have to be a licensed professional counselor to sit with someone in pain.

You also don’t have to say anything useful.

I don’t think there is special “protocol” for grief counseling.

Essentially, let the person who experienced the loss talk. Your job is to be a compassionate witness.

Bear their pain with them. Try not to break off too many cliches to fill in the uncomfortable silence.

3)  Unique

The unique nature of grief-related to losing someone to suicide or substance use is something that must be acknowledged. 

It’s not like other deaths. As we discussed above.

Fortunately, there are special groups being formed to address these issues.

Unfortunately, these groups are being formed because the death toll rises unabated year over year.

At FAVOR Greenville we host a Grief Recovery After Substance Passing group (GRASP).

GRASP groups are a nationwide model. I recommend you check out their website to learn more.

4) Peer Recovery Models

The potential for peer recovery models applied to grief support.

I challenge the idea of “grief counseling” as a requirement for healthy outcomes.

However, it is clear that some type of psychological support-in the broad sense-is one of the most important factors contributing to healthier outcomes.

A strong social network is another “ It is well accepted that individuals and families who report having good social support cope with stressors more effectively. These findings have also been found to hold true within the context of bereavement following the death of a child”. 

Some evidence exists surround a peer condition for fathers who lost a child to cancer. 

Fathers who were involved with a peer coach had better outcomes than those randomized to control.

5) The Meaning of Suffering.

Making meaning out of loss and suffering is part of the human condition.

Victor Frankl wrote about it in his epic book Man’s Search for Meaning.

Frankl described a process for finding meaning in the worst of conditions. A Nazi concentration camp during World War II.

People who have lost someone to these deaths of despair are experiencing a uniquely horrible form of suffering. One laden with “what ifs” and, for some, the ever present feeling of being judged. Re-traumatizing the person.

Advocacy & Outreach

In my recovery advocacy work at FAVOR Greenville and my online outreach at YouTurn, I am continuously exposed to people in the midst of this great pain.

I meet hundreds of families living this nightmare.

I am stunned with the strength of these families.These are the best people I know.

These are the most courageous people I know. I am lifted up by their willingness to give back and the fury with which they push for change.

There is veracity to their words: “I don’t want to see this happen to another family”.

They tell the story again.

I listen. I say nothing. Yet everything.

The post Grief Counseling – There Is No Such Thing appeared first on The Recovery Cartel.

The “Experts”

I have a major personality defect. I just can not stand to listen to ”experts” who have never worked in this field describe solutions to the problems within this field.

I’m working on this particular defect; because I can probably learn from some of those people.

But it’s very difficult for me.

Some Random Thoughts

10 plus years of unprecedented attention on the “opioid epidemic” (relatively speaking).

I’ve done behavioral health work a long, long time and never thought I would see this amount of attention focused on any addiction-related issue.

It seems, we are working hard to figure out ways to manage the “opioid epidemic”.

And it seems these efforts may be paying off. Overdose deaths dropping significantly in Pennsylvania, West Virginia, Ohio.

But….Public health experts caution us:

Dr. Donald Burke, dean of the University of Pittsburgh Graduate School of Public Health, has his doubts that the region has turned any corners. –

“At this point, I’m not confident it is a permanent change for the good or if we’re just returning to the expected curve,” Burke said. “In our paper in Science a few months ago, we showed overdoses from all drugs, not just opioids, have been growing exponentially for 40 years. Occasionally it speed ups and slows down, but the growth curve always snapped back.”

Take note of what he says about overdoses:

“…we showed overdoses from all drugs, not just opioids, have been growing exponentially for 40 years”.

I’m no fan of Purdue Pharma and I think the Food and Drug Administration.

Mini – Rant

I believe most government bureaucracies are inherently ineffective.

My worst nightmare is an academic bureaucrat with zero experience in the world telling me how to live my life and what is “safe”.

The FDA is just exceptionally ineffective and probably corrupt).

But is the opioid crisis really the issue?

And does this evil corporate villain narrative (even though its true) move the needle on improved outcomes?

More Significant Issues

In South Carolina (and other states) there are more significant issues than opioids.

More people die from cocaine than heroin in SC. The chronic misuse of alcohol kills more people than opioids.

For decades alcohol has topped the list.

We may emerge from the other end of this “opioid crisis” with a plan for better opioid overdose management.

It appears we are making progress in that area.

But we are making zero progress in terms of addressing addiction.

It’s Traditional

We are recycling traditional methods and lamenting the need for more funding for these traditional methods.

I say we focus on inventing new methods or, better yet, rethink the whole approach to addiction and recovery.

Rethink the underlying paradigm of “addiction and recovery”.

Rethink and execute on new ideas.

Stop Focusing

On services for “willing” clients and focus on the real problem: the “unwilling” and ambivalent client.

Stop focusing on “parity” for insurance reimbursement and focus on paving an entirely new business model/reimbursement highway.

Stop focusing on theory and start focusing on practice.

An example of a new method:

Since we know that addiction involves “irrational thinking” and an “unwillingness to get help” (especially if it involves showing up at the local “drug clinic”) let’s game plan for that reality.

Rather than requiring the “willing” client to enroll in services and demonstrate their compliance and adherence to the almighty treatment dictates .

The Engagement Specialist

Allow a 3rd party to enroll them.

Parents for example could call and sign their child up. This could be paid for by insurance.

The parents sign the kid up with a vendor who is an “engagement specialist”.

It becomes the vendor’s job to figure out a way to establish the connection and figure it out.

The company gets reimbursed based on results (engagement rates; linkage rates etc..).

We could work out the metrics for reimbursement. And we could work out the barriers around “confidentiality or regulations”.

We could work out the workforce issues, training and supervision.

Health Coaching

We lean heavy of health coaching models and community outreach workers and avoid traditional “treatment providers”.

Here we don’t call it recovery coaching.

We call it health coaching and integrate the service with outreach for other chronic diseases such as diabetes and heart health.

I could go on and on and on with other similar ideas.

The Status Quo

Many people will read that example and roll their eyes.

Many will begin to spout off a list of reasons “that can’t happen”. There are a bunch of reasons to not do it.

If you have that type of standard reaction just keep doing what you are doing:

You can ride out the status quo. Continue to wait for the client to “hit bottom” and come see your magnificent program.

Keep telling the parent the kid just “has to want it”.

Keep recommending to congress we roll out more money for more programs for more people who won’t show up.

Get ‘er Done

Have at it. Get ‘er done!

But if the example above resonates with you in any way.

If it leaves thinking and pondering better ways to do this work.

Then get in the game and overcome the barriers.

The Herd

Ignore those that are afraid to try anything new. Ignore those that tell you its impossible.

Take some risks and do something different.

No one will “reimburse” you for your new ideas.

No one will pay you for the services. In some cases, they may tell you that you are not allowed to try something new.

Go back to the lab and try again. Find allies and find private funding.

Find people outside the “recovery bubble” who want to help.

Get in the game. The more different the better.

The more non-traditional the better. Be a doer/thinker.

The post Get In The Game appeared first on The Recovery Cartel.

My Time In Witness Protection
Secret Location – Rich Jones

I ventured out into the surrounding area of the Recovery Cartel’s W.P.P.C. (witness protection program cabin).

As you know we are in an undisclosed location deep in the Appalachian mountains.

We are so deep we don’t get cell coverage.

Had to pay $1.5 million for this special wi-fi package that allows me to maintain contact with the rest of the world.

We can only go out in the dark so that the Cartel or the KC Mob or the Hill People can’t get to us!

Getting Soft

It is so cold here. I nearly died of exposure out there tonight.

I had to kill a tauntaun on my way home and gut it with my light saber so I could crawl inside and stay warm until Reggie found me. #rescuedog. Here he is expressing his disgust for my weakness….

I made it but I must be getting soft.

Weapon of Mass Destruction

In the meantime back in the Upstate of South Carolina….

Xanax is a weapon of mass destruction.

Xanax is now a mainstream recreational drug. It’s commonplace in high schools across the Upstate.

Fake Xanax is a killer.

One that is poised for more exposure. As our country pushes down on opioids the cartels will need to make other drugs more addictive… they must come up with a new product line.

Fake Xanax is part of the new product line.

Multinational Corporations

These cartels are multinational corporations with strategy and R & D and product development.

They aren’t just thugs slinging dope.

They innovate and invent new product.

Economics

They are not interested in losing market share IF the opioid market is suppressed.

It’s simple economics…

If people stop buying my pepperoni pizza I’m going to make my double cheese, pineapple pizza more appetizing and see if that can replace market share lost on the pepperoni pizza.

If they are gonna try and reduce demand and push down on opioids/heroin let’s see if we can make Xanax more addictive.

Xanax is the drug of choice for many young people…

The post My Time In Witness Protection & Weapons of Mass Destruction appeared first on The Recovery Cartel.

THE PROBLEM WE CAN’T IGNORE

One problem we face and that we can not ignore. We can never really tell how well a person is doing “in their Recovery”.

We can usually tell if someone is not on solid ground.

Obvious signs like: not attending meetings, not going to therapy, running with old using friends, dope man on speed dial.

LOOKS & SOUNDS GOOD

But what about the person who appears to be on point? The person “working a great program”.

Attending to all aspects of the recovery plan. Everything looks and sounds good.

I believe you can be doing all the right things and still be struck with a strong craving.

Especially where opioids are concerned. Especially during that first year.

❌STOP – WAIT 

Before you say it allow me:

1) I fully understand that sometimes we just have to get through the craving and “not pick up no matter what”.
2) I fully understand that the person can call and “tell on himself” and work through the craving.
3) I also understand that some people feel that the obsession to use will be lifted and they won’t face this type of circumstance.

But I also understand that in many cases, perhaps the majority of cases, the person won’t take action.

I also believe many people aren’t “free” from these moments of weakness.

Especially in the first year.

THAT FIRST SLIP

Some people will give in and make a mistake.

Conventional wisdom tell us to wait and see “if they make it back”.

Then we can use the mistake as a learning tool.

And encourage the person to try again,  to “keep coming back”.

An approach consistent with the “wait until they hit bottom” foundations of our system.

THE SLIP IS FREQUENTLY FATAL

In another day and time we may have been able to get away with this approach.

The mistake was not likely to kill the person on that first “slip”.

But in the day and age of carfentanyl and fentanyl the slip is frequently fatal.

And a person who has been “clean” for a period of time is in the greatest danger because tolerance is low.

Who among us has had a perfect recovery? A spotless trajectory of no lapse or relapse?

Who got this on the first try? Very, very few of us.

THE  ARGUMENT FOR M.A.T.

When I made my mistakes that first year I was not in imminent danger. And I had a chance to make it back.

There was no fentanyl to be had.

Death was always a remote possibility. But not a probability like today.

This where the argument for MAT is most compelling.

ZERO WIGGLE ROOM

Even if a person is following a traditional recovery pathway, perhaps the adjunct of MAT makes sense that first year. When cravings are frequent and relapse deadly.

Even the person working a “great program” could benefit from the added safety net of MAT.

There is just zero wiggle room where heroin and other opioids are concerned.

This year’s Quest diagnostic national survey on “heroin purity” indicated 87% of the time fentanyl is present.

Up from 46% the previous year.

Do you see what is happening?

The post Do You See What is Happening? appeared first on The Recovery Cartel.

An Open Letter to the General Public
By Richard Jones

All the attention on the “opioid epidemic” has sensationalized addiction and undermine the efforts to address it as a public health crisis. Addiction, or substance use disorder, is a healthcare issue. I hope this open letter to the general public clarifies some of the trouble spots.

The typical person with a substance use disorder is NOT living under a bridge, or robbing a convenience store, or “eating out of a dumpster”.

We Walk Among You

Most of the time we “walk among you”. We work alongside you. We go to church with you. Sometimes we actually are preaching at that same church. We fly your airplanes, preside over your legal proceedings, do your surgeries, teach your kids, build your houses, run your government and entertain you.

We are everywhere; and our disorder presents itself in a wide variety of ways.

Unfortunately, you have been on the receiving end of stigmatizing messages where people paint a very bad picture of substance use disorders. There are far too many war stories and dramatizations out there.

Exploitation of Addicts

There are far too many people “in recovery” who are obsessed with painting the worst possible picture of the person in active addiction. TV shows like A & E Intervention (which is essentially criminal exploitation of addicts) certainly do not illustrate the global nature of substance use disorders.

Of course, there is a hard edge to a substance use disorder and sometimes it is destitute. But believe it or not, more often the person is high functioning and moving about society unnoticed.

Consider the Booze

Consider a substance like alcohol. It’s legal, as well as being very commonplace.

It’s frequently misused; and it kills 88,000 people per year. Same can be said with other substances that aren’t part of the “opioid narrative”.

People go on to the end and die 15 years early rather than seeking help.

Basically, nothing “bad enough” happens; because it does NOT look or sound like the cliched caricature of the “scum bag addict”.

We Are Not A Sideshow

Please understand, those reality TV shows and media stereotypes are not telling you my story. They don’t speak for me. Those “recovering people” who are obsessed with promoting their story of destruction do not represent my story.

They do not speak for me and there are many more like me out there.

We would like to represent ourselves in addition to distinguishing ourselves from the crowd. Substance use disorders are a healthcare issue. NOT A SIDESHOW.

Thank you! – Richard Jones, The Recovery Cartel

Rich Jones, Executive Director of FAVOR Greenville

As a senior healthcare and non-profit executive and director since 2002, Richard Jones brings his skills across multiple domains, including mental health services, substance use disorder treatment, and recovery support services.

Rich is a Licensed Clinical Addiction Specialist (LCAS), DOT Substance Abuse Professional (SAP), Certified Clinical Supervisor (CCS), Co-Occurring Disorder Professional (CCDP), Certified Employee Assistance Professional (CEAP), Certified ARISE Interventionist (CAI) and an EMDR Certified Trauma Therapist.

Prior to joining FAVOR, Rich was the Director of Community Recovery Residences for Western North Carolina and Upstate South Carolina for Pavillon Treatment Center. Rich has been in long-term recovery since 2001.

He received his B.S. in Business Management at St. Vincent College, his MA in Sociology with concentration in Addiction Studies at Indiana University of Pennsylvania, and his MBA with a concentration in Healthcare Management at the University of Scranton.

The post Letter to the General Public appeared first on The Recovery Cartel.

CONFESSIONS OF A DOUBLE AGENT-

MY SECRET LIFE AS A MEDICATION ASSISTED TREATMENT (M.A.T) THERAPIST

I’m sure we can find people out there who know much, much more about medication assisted treatment than I do. There are people out there who understand the technical end of medication assisted treatment better than I do. What do I mean by the technical end? The neurobiological process involved with a partial agonist versus a full agonist. The process of initiating the medication, the appropriate dosages, what you can expect in regards to withdrawal symptoms.

There are certainly people who understand more about medication assisted treatment than I do in terms of running a clinic. This includes all the rules and regulations. How many clients can a doctor have on their roster? What are the rules regarding “counseling” and drug testing?

There are people who understand insurance reimbursement and the business model better than I do. There are people who know more about the status of prescribers  and why we seem to have a shortage. There are also people who have personally been involved with medication assisted treatment and they know more about the lived experience of M.A.T. than I do.

However, there are some areas that I understand more than anyone on the face of the planet:

I know what it is like to be an “independent” therapist who specialized in working with people on medication assisted treatment within a recovery culture that was very hostile toward those on M.A.T. And I did in complete secret and silence.

From 2007 thru 2011 I worked with hundreds of M.A.T clients in western Pennsylvania as the opioid epidemic raged. Suboxone was being prescribed at a high rate and it was, relatively speaking, a new phenomenon. These patients were absolutely marginalized by the larger recovery community.

Truth is they were also marginalized by “traditional” treatment providers. I was an active member of Narcotics Anonymous at that time. NA dismissed suboxone as “being high”. They were not welcomed at NA meetings.

This short quote from NA will give you an idea of this problem.

“Our program of recovery begins with abstinence from all drugs, including alcohol.”

Check out this PDF from NA – Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment

I remember watching this unfold and thinking “this isn’t right”.
But I did not have the courage to speak up.

I was too enmeshed in the group. I wanted the approval of people “ahead of me on the path” and had not yet matured in my recovery. I sat silently as people on Suboxone dealt with the stigma within the stigma. It may be slightly better now. This was 10 years ago. It was ugly, it was brutal.

At that time, the common practice was “dose and go”. Physicians from a wide variety of backgrounds were getting “certified” as buprenorphine providers via a 9-hour online training platform.

There were some stipulations regarding counseling but none of the patients were getting any real coaching or support. This is still the case in many practices today, however, I think it has improved. 10 years-ago it was truly the wild west and most patients were getting their script and nothing else.

Of course, this presented massive problems.

As I stated above, I was an active member of Narcotics Anonymous at that time. Attending daily meetings, sponsoring people, chairing home groups. This was western Pennsylvania where the heroin epidemic has been raging for 15 plus years.

There were countless people showing up at these meetings on Suboxone. And the honest truth about the situation is they were completely marginalized and shamed out of the rooms. I am ashamed of how I conducted myself at that time. I would not participate in the bullying that went on around Suboxone.

I didn’t directly make comments about Suboxone being a crutch. I didn’t make comments like “they aren’t really clean”. However, I would sit by silently.

You see, all organizations or groups operate via social following principles. People fall into line and adhere to the group norms. We do this because we want to be accepted and we want to fit in. Evolutionary psychologists tell us that it is a survival mechanism.

As we evolved and we survived a nasty world it was essential that we be part of a tribe. Being a loner or going against the crowd equaled death. Back then it was physical safety we sought via compliance and group think. Today we follow the tribe to ensure psychological safety. Either way it is hard-wired into our thinking.

That’s not an excuse for my behavior, but it is an explanation.

Keep the reality of social following in mind when you consider what it must be like to be a person seeking recovery via medication assisted treatment attending a recovery support group.

Imagine standing outside smoking a cigarette (which is basically medication assisted treatment in its own right) while your “peers” make comments about people on suboxone. The official literature evens states: we are a program of complete abstinence. People would run from the rooms; and we all know how dangerous it is to try and “do recovery” without supportive people in your life.

NOTE: IT IS RIGHT ABOUT NOW THAT SOMEONE BECOMES OFFENDED BECAUSE THEY HAVE SPONSORED PEOPLE ON SUBOXONE OR THEY HAVE BEEN PART OF A WELCOMING RECOVERY GROUP. I WANT TO ACKNOWLEDGE THAT THERE ARE PEOPLE WHO ARE OPEN TO M.A.T. HOWEVER, IN THE INTEREST OF RIGOROUS HONESTY-WE NEED TO ACKNOWLEDGE THAT IN MAJORITY OF CASES YOU ARE A SECOND-CLASS CITIZEN IF YOU ARE ON M.A.T. AND IT WAS 100 TIMES WORSE 10 YEARS AGO….

With this culture firmly entrenched around me I became more and more distraught about what I was seeing where M.A.T. was concerned.

And then people started dying; at alarming rates.

Now at this time I was a therapist working professionally in the clinical treatment realm. I remember thinking: “OK the recovery community is not going to embrace this. Certainly, the professional community would”.

However, as I explored M.A.T. with traditional treatment programs and outpatient therapists I quickly realized no one was working with these patients.

That’s when I went undercover…

When I decided to start a private practice specializing in M.A.T. It was small initially but steadily grew and I became an expert on working one to one with these clients. However, the entire time I kept this quiet. I never openly discussed this with my support group. I never advertised. I never promoted it among my professional colleagues.

HERE’S THE THING: THE STIGMA AROUND M.A.T. WAS SO STRONG THAT I WAS AFRAID TO EVEN ADMIT I WAS TRYING TO HELP “THEM”.

Now, 10 years later, I could care less now what fellow professionals think about me as I try and help people on M.A.T. I still hear professionals say things like “suboxone blocks the sunlight of the spirit”. Now, instead of being intimidated, I am appalled and stunned that these people are permitted to practice. I cannot believe this type of thinking passes the test in terms of treatment or healthcare.

I have also developed a healthier perspective on the integration of M.A.T. into the larger recovery community. First of all, I think things have improved somewhat in terms of groups embracing M.A.T. It is different in 2017 than it was in 2007. Although, the truth remains that the official company line in most groups is “abstinence” only.

In the recovery rooms you will be accepted on M.A.T. if it is “temporary” and your goal is to get off the medication in the near future. It’s more difficult if your treatment plan includes long term medication maintenance.

More importantly, It is clear that self-help groups bear no burden in adjusting the thinking around medication assisted treatment. These groups are voluntary, free, mutual support programs. They do not charge health insurance. They do not promote themselves as healthcare. Therefore, they have no ethical responsibility to adjust the message.

I may not agree with the way M.A.T. is handled but it is the group’s prerogative.

The burden falls on professional recovery services, treatment and healthcare in general. Treatment and recovery providers who refuse to adopt medication assisted treatment as a viable practice must rethink their philosophy. Treatment providers who refuse to include M.A.T. in their practice should not be eligible to treat opioid use disorders.

These organizations should be denied payment or licensure to work with opioid use disorders; they can stick to alcohol and other drugs but they are a major part of the problem where opioids are concerned.

We must find a way to professionally support these folks and acknowledge how difficult it is to follow traditional pathways. We must bridge the gap through recovery coaching. We need to be there when these people are told “you aren’t clean” so that we can talk them through the reality of the situation. We need to pick up the pieces for the dose and go doctors that are still up and running in many communities.

As for our organization, FAVOR Greenville, we welcome you with open arms if you are on M.A.T.

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

Your involvement with our organization comes with zero strings and no hidden agenda. We will help you identify your personal recovery plan and your personal pathway to recovery; with or without medication.
We don’t care how you get better…we just want to see you get better. Let us help.

The post MY CONFESSION OF BEING A DOUBLE AGENT appeared first on The Recovery Cartel.

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

This is my thoughtful response to the Trump announcement.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And fifth, my last point.

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

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

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

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

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

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

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

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

The post Rich Jones Response to the Trump Announcement appeared first on The Recovery Cartel.