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With Co-occurring Disorders Be Extraordinarily Careful

With Co-occurring Disorders Be Extraordinarily Careful

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COD – Co-Occurring Disorders

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.

Recovery Cartel Blog - Circus

The Circus Has Come to Recovery Town

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✌️✌️✌️The Demi Lovato overdose has really brought out a bunch of “experts” to tell us the ins and outs of addiction. Who are the gatekeepers that arrange this stuff? How do they pick the “expert”… have any of them actually worked with a person with SUD or with families?

It may not matter because the media is looking for a cliche and a sound bite. And those are easy to come up with. The “expert” can deliver that.

But is all this attention and noise thrown Demi Lovato’s way good for her? Or good for society? I guess it’s good for the “experts”.

The Circus Has Come To Town

It a freaking circus. My home page is Yahoo News and here are a couple of stories that popped up over the last few days (I’m paraphrasing)
1) Demi Lovato overdosed because she bought into the “moderation” lie. With some idiot proclaiming with authority the abstinence only dogma. Like they know everything about Demi Lovato and why she overdosed.
2) Demi Lovato overdosed because she “gave up”… well damn…. they seem to have figured that out from some song she recorded about 6 months ago….geniuses.
3) Demi Lovato overdosed because of a “negative body image”…..HOLY MOLY! There must be Jedi therapists out there who can evaluate people from afar and make precision diagnosis.

Y’all depress me. You aren’t experts. You don’t know anything about Demi Lovato. Y’all should turn down the interview. It’s not a sideshow. It’s someone’s life. And it’s damaging to all people seeking recovery.

When a celebrity has a recurrence of cancer is it publicly announced and scrutinized? Do they evaluate “where it went wrong” what the celebrity patient did wrong leading to the recurrence?

This is par for the course for the media. But the “recovery experts” should not contribute. It’s not good. It’s not “awareness”. This is not “advocacy”. It’s a circus.

Pandemic - Richard Jones

Letter to the General Public

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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

Richard Jones Recovery Cartel

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.

Response to President Trump Rich Jones Recovery Cartel

Rich Jones Response to the Trump Announcement

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

This is my thoughtful response to the Trump announcement.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And fifth, my last point.

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

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

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

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

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

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

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

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