Understanding the Impact of Stigma

✌️Understanding the impact of stigma in the mental health and substance use disorder world(s).

I posted something the other day. It said “I had a panic attack today etc…”

After I made this post, I had these moments where I thought to myself:

“My goodness Rich … why would you post that ..”.
“What are people gonna think”?
“You’re supposed to be a leader”…
“You’re supposed to have your shit together”..

I was able to recognize these thoughts. And handle it.

Mental Health Struggles

But if that’s what I’m thinking as a provider, an advocate, a person in recovery and a professional in the field…. imagine what people in “regular” professions without the awareness and education think…

I learn about this stuff constantly. And I know that mental health struggles are the rule, not the exception. Yet I still get up in my head.

Maybe it’s just me. And the rest of you have it in check… but I think the stigma around these issue is so strong.

Unconsciously impacting us. Scripts of inferiority running through our minds.

The Same Secrets

The solution, the way I see it, is not a well orchestrated public relations campaign on mental health awareness and/or substance use disorders.

That certainly helps. But the solution is… We all talk about it!!!

It becomes commonplace and routine topic. As they say…

The big secret is. We all have the same secrets.

The post The Impact of Stigma 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.

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No More Stigma

We constantly hear phrases like “no more stigma” and we hear people talk about “stamping out the stigma”.

For the last 10 years, especially the last 5 years, the amount of attention placed on substance use disorders in public sphere has been startling. At least when compared to the previous 200 years when we refused to even acknowledge substance use disorders existed.

Of course, much of this has been fueled by the attention placed onto the “opioid epidemic”.

We must acknowledge that the attention is driven by the fact that a great percentage of these deaths are young white middle class kids. This is tragic given the devastation substance use disorders have wrought for decades in our minority communities. Furthermore, the issue goes way beyond opioids.

Alcohol kills 88,000 a year and overdoses on other substances are climbing as well.

But the fact remains. We are in an era of unprecedented recovery events and stigma reducing initiatives are common place. We have rallies in the park, we have marches on the capital, we have documentaries, we have Facebook pages, we have celebrities speaking out, and we have massive concerts for recovery.

Therefore, a couple of obvious questions come to mind:

1) What is stigma in general and how does it apply to people with substance use disorders and their families?

Stigma is “an attribute, behavior, or condition that is socially discrediting.” (E. Goffman, Stigma; Notes on the Management of Spoiled Identity (New York: Simon & Schuster, 1986).

Stigma develops and takes root “when elements of labeling, stereotyping, separation, status loss, and discrimination co-occur in a power situation that allows the components of stigma to unfold.” (B.G Link and J.C. Phelan, “Conceptualizing Stigma,” Annual Review of Sociology 27 (2001): 363–385, at 367).

In order for stigma to take shape there has to be an “in-group” that can define the behavior of the stigmatized group or the “out group” as deviant. You can not have abnormal behavior if you do not have “normal” behavior.

The in-group will identify socially undesirable characteristics or behaviors as being unacceptable and justification for the stigmatization and discrimination of the group.

As time goes by the attitudes of the in-group toward the out-group become ingrained and encoded at level where the stigmatizing attitudes are automatic for those within the in-group. As if they are not even aware of the discriminatory or stigmatizing behavior.

It is just there and it guides all interactions, policies, and attitudes toward the stigmatized group.

When we look at this operational definition of stigma it is easy to see how it applies to people with substance use disorders. For all of history people with substance use disorders have been “socially discredited”.

Getting locked away in insane asylums, the criminalization of substance use disorders, inadequate insurance coverage, the acceptance of a failed treatment response, and the denial of equal opportunity housing and employment are all examples.

In addition, all the elements of shaping stigma are present where substances use disorders are concerned. Labeling of those with substance use disorders is extensive and degrading.

Of course, we have the official diagnostic labels which we all acquire if we seek help. They stay with us in our “permanent record”.

But even worse are the unofficial labels. Labels we frequently give ourselves: drunks, junkies, alcoholics, addicts, pot-head, meth-head, crack-head. The more we say these the worse picture we paint of ourselves and the more marginalized we become.

Stereotypes run rampant. The stereotype of the dude with the brown paper bag, the guy robbing the liquor store and on and on.

The in-group that promulgates the stigma is extensive and wide ranging in terms of membership. Obviously, people who do not have a substance use disorder tend to judge those that do. There is a default setting that substance use disorders are a choice.

Policy makers and government officials certainly support the moral model as the intervention of choice is incarceration.

However, what is even more interesting are some of the other in-group members. Healthcare workers, educational workers, and even treatment professionals conduct themselves as an in-group. Derogatory comments and negative attitudes are more commonplace than you may think among these helping professions.

Perhaps the most stunning source of stigmatizing behavior comes from recovering people themselves.

A strange phenomenon of punishing language and labeling exists within recovery rooms. Indeed, some of the time the recovery experience is peppered with confrontation and demeaning interactions.

All of this adds up to a firmly entrenched stigma toward those struggling with substance use disorders. In addition, family members of those with substance use disorders endure the stigma in their lives.

No one brings a casserole when your loved one is diagnosed with a substance use disorder.

2) Are the stigma reduction efforts working? Have we made any progress?

Clearly these are subjective questions. I believe we have made progress in terms of reduction in shame and overall awareness of substance use disorders and recovery. Our willingness to more open about our recovery is paying dividends.

In addition, when people with high social status (for example: celebrities) come forward as part of the stigmatized group significant progress is made.

Despite this progress, the stigma surrounding substance use disorders and people in recovery remains very strong. Around 60% of Americans believe substance use disorders are a choice.

A World Health Organization study across 14 countries found that drug addiction ranked number 1 among the 18 most stigmatized social problems, including criminal behavior.

Fear and shame keep many people from seeking help. Family members dealing with a loved one’s addiction live in a place of shame and embarrassment. In addition, public policy and the actions of the powerful “in-group” continue to capitalize on the stigma.

For example, our systemic response to substance use disorders remain an abject failure and this failure is accepted by the public because of stigma. Another example, think about insurance reimbursement and the criminal behavior of some insurance companies.

These institutional behaviors only fly in a world where most people think substance use disorders are a moral issue.

3) What else can be done to reduce stigma?

I don’t think awareness events alone are going to end stigma. No concert, or rally, or community forum will end stigma. I think recovering people and their families are going to end the stigma.

One to one. In the home. In the community. In school. In church. In the workplace.

We must also remember that the way we talk about selves, and the way we conduct ourselves, and the way we interact with the world outside can make all the difference. Social media allows us to put our recovery message on public display. That can be very helpful, but it can also be very counterproductive.

We have to be thinking about the everyday person out there who we may be able to touch. If your goal is to change stigma, maintaining awareness of how the message “plays in world” is very important.

People are watching and they are watching with the default setting of “see those addicts are losers ”.

Of course, I’m saying this to myself as well. We have a very serious responsibility. We need a new public relations plan. We need to re-brand ourselves. Stop separating ourselves from the rest of society.

All of this pre-supposes that you think we need change. If you think the “status quo is working just fine” then none of this will make any sense to you.

If you think 160,000 preventable deaths a year indicates a failed approach. Then perhaps this will make sense.

Most people outside of the “recovery bubble” care little about addiction and/or the “epidemic” until it hits them in the face. We spend most of our time preaching to the choir. Our rallies and our conferences and our events are made up of “all of us” and our “treatment allies”.

Our celebrity advocates are all people in recovery and that’s admirable on one hand. Limiting on the other hand. All our public actions are like big giant “closed” meetings.

Look at an example on the other end of the spectrum:

The AIDS movement made progress when people not directly impacted by AIDS (example—celebrities like Princess Diana) became compassionately involved.

We separate ourselves from the rest of humanity by the way we talk (“addictive thinking”, “normies”, “earth people”, “one of us”, etc…).

We put ourselves in a separate box. Our secret knowledge and the knowledge of our secrets.

Substance use disorders thrive as we isolate ourselves. Our “public health response” to this epidemic has failed miserably but nothing changes because the general public could care less until it hits them in the face.

Then they come into our bubble and join the isolation. We will never move the needle on stigma reduction, policy change, practice change etc… until the everyday person out there supports our cause

The post Stigma Kills: 3 Points To Consider…. 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.