Addiction Management Blog

Archive for the ‘Change’ Category

A call for increased treatment and education for those behind bars

Sunday, October 20th, 2013

I have written before about the criminal justice system and addiction, but it has been awhile and my thoughts continue to evolve on this topic. So, time for an update!

First, as a society we should be embarrassed by how many of our citizens are in jail/prison due to problems associated with untreated addiction. We have the highest incarceration rate of any country in the world with approximately 2.3 million behind bars. If we add those on probation and parole the number jumps to almost 7 million under correctional supervision! And I have not even mentioned the 70K juveniles we are grooming for later prison life. What is so troubling about these statistics is that they are primarily the result of mandatory sentencing laws put in place in the 1980s to enforce the war on drugs (which I have also written about).

US in Prison

Most now realize the war on drugs has been a miserable failure. Putting people behind bars when the drivers behind their crimes are addiction-related is costly and fails to address the underlying problem(s). We know that many will get out and that recidivism rates are quite high. One recent study indicated that more than 1 in 4 offenders return to prison within three years. And we know that when addiction goes untreated it most often returns, leading many who get out of prison right back in.

While I believe we need to evolve our drug sentencing laws, and there is evidence that things are changing for the better, this post is not about that. It is also not about the proliferation of drug courts that offer an alternative to jail/prison. Instead, I want to comment on what we can do for those who are behind bars right now (and will be in the future). In short, I think we should make use of their time in jail to prepare them to succeed in life once they get out. What do I mean by succeed? Here are a few outcomes I think we as a society should support:

  • Stay clean and sober, manage co-occurring disorders, and maintain physical health by working a comprehensive addiction management program (5 Actions!)
  • Use personal talents to benefit society (Action 5) (Dave’s Killer Bread is a good example)
  • Develop a spiritual life
  • Keep learning and growing as a person
  • Obey society’s laws
  • Seek out (or increase) appropriate help when times become stressful (as they do for all of us at times)

I am sure you can add to this list, but it is a good start. How do we accomplish such lofty goals? In short, we develop a technology-based intervention system that individualizes behavioral health treatment and education for a fraction of what it would cost to utilize humans (nothing against humans). The treatment component would be based on the 5 Actions I have outlined on this site, and the educational part of the system would be built by those who have a track record of delivering online education. Why this has not already been done actually surprises me!

The details of how to construct and implement such a system are beyond this post, but I do want to provide you some thoughts on why I believe doing this is more than possible.

  • Studies show fairly consistently that timing is critical for helping people with many problems, including addiction, depression, and other life issues. Those in prison have nothing but time, and are in a place where we can take advantage of a motivational window of opportunity.
  • Computers memory is superior to humans and can track far more information about a person’s life, and leverage points for change.
  • New treatment interventions can be quickly programmed into the system, where there is a much longer learning curve for humans.
  • Delivery of interventions can be more consistent (i.e. therapists stray from intervention protocols fine-tuned by researchers, often thinking they are doing good, but in the end have less than optimal results).
  • Online systems can track outcomes in real-time and make adjustments accordingly. Most treatment today does not include any formal outcome or evaluation of process, let alone changing therapy based on adaptive outcomes.
  • Relationship with a relational online system can last indefinitely, whereas human counselors are less consistent and change jobs frequently (i.e., the turnover rate in addiction treatment programs is higher than in fast food restaurants).
  • Online treatment is significantly less costly than human treatment.
  • Studies show people are more apt to disclose sensitive issues to a computer than a human – issues like:  sexual abuse, domestic violence, child abuse, shaming behaviors (cutting, eating disorders, sexual disorders) – all can be addressed in a user-friendly, less threatening environment than with humans in many cases.
  • An online intervention system can link and communicate more consistently with other important stakeholders in a person’s life, including: primary care physicians, specialty providers, medication providers, legal system, pharmacies, insurance providers, complementary and alternative care providers, mental health and addiction programs (if necessary), and employers. Computer system can keep track of all these relationships, the flow of information between them, and manage information privacy and disclosures.
  • Online systems are flexible and can consult with humans when necessary – so human’s time can be used most efficiently (i.e., expert humans are not replaceable, they are just in limited supply).
  • And perhaps most important, the system can be utilized to manage ongoing treatment and educational goals both in and outside of prison seamlessly, and help manage parole and probation responsibilities.

Would it be easy to develop and implement? No. I think it would require a lot of work on behalf of many stakeholder groups. But I believe it is what we need to do as a society if we care about our future and the future of our children.

I also made a couple of brief videos on how I would utilize the 5 Actions framework in an online system for those behind bars. Excuse the coffee breaks, it is early Sunday morning.


 

Hitting Rock Bottom: New docu-drama about addiction needs your help!

Monday, June 3rd, 2013

I don’t think I have ever done this before on a post, but here goes. I need your help.

Not long ago I was contacted by some folks who have been working hard on a show called Hitting Rock Bottom. It tells the real stories of people who have struggled with addiction, hit rock bottom, and found a way out. Unlike reality television that often turns tragic stories about addiction into entertainment, this show has a far more noble and broader reaching aim. The creater and Director, Corey Snyder, who has been in recovery for the past five years and also happens to be a very talented film maker, wants to instill hope (and action) in those who still struggle. He portrays challenges with addiction through docu-drama storytelling that utilizes actors to dramatize real stories. He and his team have already completed the first four episodes of season one which you can watch right now for free on the Hitting Rock Bottom homepage. Each episode is a few minutes, so watching them all will not take you that long.

HRBThe first season tells the story of Daryl Brown, a very likable young man who sets out in life with no idea of what is ahead for him. The show is more than engaging, and realistically captures the underlying risk factors that contribute to going down a path of addiction. It is real, scary, and unfortunately a story that plays out far too often.

Fortunately, the story of Daryl has a positive ending, but that is where I need your help!

The show is need of funding to finish filming the first season and complete the story of how Daryl overcomes addiction. It’s the best part of the story and has the potential to motivate many struggling souls to seek help. To complete the season, the crew are presently running a fund-raising campaign on Indiegogo. The goal is $57,500 which will cover all costs to finalize filming the remaining episodes. Even with these funds, many involved in this project are giving their time and energy to see this project to its successful completion. By contributing whatever you can, be assured that your donation will go towards a project that has the potential to transform how we understand, treat, and address addiction in this country. Also, there are only 13 days left in the campaign, so please contribute now. And be sure to check out some of the cool perks at various donation levels.

Thank you.

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

New book out today! Craving: Why we can’t seem to get enough

Tuesday, April 30th, 2013

cravingI am excited to announce that a new book is out today from my colleague, Dr. Omar Manejwala. He is the former Medical Director of Hazelden (one of the oldest and most respected treatment organizations in the world), and current Chief Medical Officer of Catasys, an innovative health management company focused on treating substance abuse problems. I was fortunate to receive an advanced copy of his new book, Craving: Why we can’t seem to get enough, so I have had the past month to review it thoroughly. If you struggle with addiction, or care about someone who does, then I strongly encourage you to get this book!  Why?

First, craving is a universal experience we all share and it also happens to be at the heart of addiction. In healthy doses, it is part of what makes us human. But when cravings become so intense that they lead to out-of-control behaviors, then they are not such a good thing. In fact, they cause significant pain and suffering. For those who have never experienced addiction, imagine holding your breath and then starting to think about air. How long before your desire to breath becomes an intense craving for air? How long until the craving for air becomes almost unbearable? You may think this example has little to do with addiction, but the regions of the brain that control your breathing, heartrate and other survival functions happen to be the same areas of the brain that get hijacked by addiction. By reading Dr. Manejwala’s new book, you will be treated to a very lucid and beneficial explanation of the science of craving. If you are afraid of brain science, have no fear, he makes it very accessible!

2013_0409_omar_manejwala_600x300Second, once you understand cravings more clearly, you will be in a far better position to do something about them. Perhaps what I like most about this book is that he provides an approach to deal with cravings that links back to the science of what we know about them. For example, part of the experience of craving is biological. Cravings are not just obsessive thoughts in your head, but are deeply rooted in physical and chemical changes that take place in the brain and body. Think back to our example about holding your breath. Is your need for air all in your head? Of course not. While we don’t require alcohol or drugs to survive like air, cravings have a similar intensity and feel because of what takes place physically in the body. So interventions focused on addressing the physical aspects of craving are critical. And at the same time, part of what makes cravings so painful is that once they start, they feel like they will never end until acted upon.

The best news of this book is that cravings can be overcome! Dr. Manejwala outlines a wonderful tool box of interventions that address both the physical aspects of craving, but also the painful obsessions that precede addictive behavior. You will learn about the benefits of self-help meetings, meditation, exercise, and being accountable to others. There are also some tools that you likely have not heard about, which is a testament to the comprehensive and holistic approach taken throughout the book.

Third, I really appreciate his view that “Courage is, in fact, the most essential quality of recovery, because without courage, none of the other needed practices are possible.” I couldn’t agree more! Dealing with addiction and all its complicating and co-occurring problems is not for the faint of heart. Those who engage in the process of overcoming addiction and are willing to face their most intense cravings, are among the best examples in our society of courage.

While I have a lot more to say about this book, Dr. Manejwala and I plan to discuss it over a video chat in the next week or so. Stay tuned for the broadcast and in the meantime, checkout the latest on the book on facebook and order your copy today.

Whose Will: A new book about addiction, courage, and hope

Tuesday, August 28th, 2012

I had the recent pleasure of speaking with Willie Harris, the author of Whose Will: Ordinary Person, Extraordinary Life, a riveting account of his personal struggle with addiction and path back to a spiritual and connected life.

Like most, the roots of Willie’s problems with alcohol and drugs began early in life, in a family awash in addiction, violence and trauma. His alcoholic father abused his mother, nearly killing her twice, and perpetuated his own traumas on Willie by passing down  the unfinished business of the previous generation. But even amidst the hell of family life, Willie told me, I personally had a spiritual connection that I cannot explain.  At ten years old, he would lay on the top bunk of his bed and talk to God. His mother thought something was wrong with him, and would often ask, who are you talking to?

But the connection did not insulate him from experiencing an early life of pain, misery and self-destruction. By 18, his world was spiraling out of control. The inability to appropriately process emotions, including rage, hurt and fear, set the stage for the perfect storm. Drinking, drugs and partying eventually landed him on the streets, where the brutal reality of his life eventually became the source of his awakening.

Although treatment played a role in turning Willie’s life around, it was the 12-step program that allowed him to take an honesty inventory of his life and begin to take responsibility for the role he played in his own undoing. The program also helped him understand the answer to the question  – why do I do these things to myself? He had a mental obsession with substances that was different than other people. He said, it overrides normal thinking. Once he understood he could not put substances into his body without serious repercussions, the path out of hell became much clearer.

He credits the 4th step of AA – Made a searching and fearless moral inventory of ourselves – as being a significant turning point in his life. By looking at me, I was able to forgive other people. I was able to go back and make amends, and every time I did I got better.

Today, Willie leads a simple, but spiritually grounded life. He is a successful businessman, happily married with two wonderful children, dedicated to his church, and to spreading the word that it is more than possible to overcome addiction. I was most impressed with his motivation and efforts to develop programs for teens, that can be taught in schools, to proactively help challenged kids better process and cope with painful emotions. I could not agree more that it is a tremendous need. It was an honor to speak with Willie and learn more about his story. I very much encourage you to get his book (www.whosewill.com) and be inspired.

Be the change you want to see…and hang in there, it’s not easy!

Monday, December 21st, 2009

Change is tough. Really tough. Whether dealing with an addiction or making a change in an organization to improve treatment, we are wired to keep doing the things we have always done and resist the new. My last post provided an academic framework for how we should get evidence-based practices commonplace in real-world treatment and educational settings, but doing so often means going against the grain – big time! It means being a change agent in an organization that often does not want to change. It means knowing you have science on your side, and continuing to work at breaking down the walls of ignorance – even when all your peers seem to be against you. Why? Because those who struggle with addiction deserve the absolute best when it comes to treatment and getting help. And when they seek out help from those who are not aligned with science, the outcomes simply are not as good. 

A collegue of mine a few years into her work as an addiction’s counselor emailed me recently about her efforts to enact change within her organization:

“With regard to my attempts to enlighten others on topics such as housing first initiatives and pharmacological treatment for alcohol dependence, I am finding that scientific findings are no match for anecdotal evidence based upon meaningful personal experience.  My colleagues/superiors are either entirely skeptical or they simply minimize the validity of addiction interventions that are non-traditional or abstinence based.  The resistance seems to derive from defensive beliefs that the research methods are somehow flawed, the purpose and designs are somehow biased, and the results are somehow over-inflated, over-reported, or just misinterpreted. It is so disheartening. Beyond that, there is the very real challenge in finding funding for medications and housing. I was also told I have to terminate a client who continues to relapse though I adamantly oppose.  My attempts to advocate for this client with, I believe, sound rationale are ignored and viewed as my unwillingness to accept supervision, etc.  All of this leaves me quite shaken.  Yet I love working with the folks I work with.  For now anyways.”

It’s no wonder that the turnover rate for addiction counselor’s is higher than in the fast food industry! Not only is it challenging helping patients, but the job is made even more difficult when working in organizations that resist change, resist embracing findings from research, and fail to acknowledge the limitations of personal experience.

changecover1So what to do? We need to be smart about how we go about making changes, in our life, and in organizations. We need to be aware that change is a process, often with many underlying factors that can influence outcomes. And we need to recognize what science tells us about change. This includes understanding the limitations of the widely adopted Stages of Change Model (see #11).

If you are contemplating a personal change, you might benefit from reading The First 30 Days by Ariane De Bonvoison. A very readible approach that focus on optimism and eliminating fear. If your challenge is implementing change within treatment organizations, a great place to start is The Change Book – A Blueprint for Technology Transfer and the Change Book Workbook.  There are other great resources specific to personal and organizational change, but the key message is that it is a lot harder than people think. It takes perseverance, commitment, and discipline. I applaud my colleague for continuing to push what is right her treatment organization.