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    Factors Families Should Consider Before Employing A Drug Treatment Program for A Loved One [List]

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    What happens in drug rehab matters a lot, which is why we need to carefully select which one we end up enrolling ourselves, or our loved ones into. The first one that pops up may not necessarily be the best one for your situation which means browsing your options is an important part of the process. Unfortunately though, researching inpatient drug treatment programs for yourself or a loved one can lead you down an internet rabbit hole.

    We’ve outlined 14 questions that are designed to give you more control over the decision process. Instead of being sold or coerced on the phone, you can use these questions to draw out the most important and relevant information from whichever drug rehab, addiction treatment, or detox facility you are considering. Remember, information is power, and these questions and explanations will equip you with the know-how to find the best rehab match for your unique situation.

    1) How long have you been in business? Who is the founder, and who is the current owner? If the founder is no longer the owner, why did they leave?

    Asking about the facility’s background is important because you want to choose a rehab that has experience, and also one that is run by a person who genuinely cares. If the founder has left, that doesn’t mean you should automatically rule out the rehab, but you should ask more questions about the new owner. What is their interest? What is their background? If the new owner is equally passionate about recovery, that’s a good sign, but if they are just a business person, you should be cautious.

    2) What crimes, if any, in the United States and abroad, have your founder and/or partners been accused and/or convicted of? How many current lawsuits are pending against your center?

    This is important information that you should be aware of before putting your time and resources on the line.

    3) What is your staff to patient ratio? And how many patients does each primary therapist have on their caseload?

    The more staff per patient, the better your odds of having more personalized care.

    4) What is your daily rate for month one? Does it change for months 2 or 3?

    Financial questions like these are important and ask the facility to clearly respond to you in writing.

    5) Do you detox on-site or off-site?

    Many small treatment centers operate an on-site detox, which is allowed by law but higher risk, to increase revenue. The Substance Abuse and Mental Health Services Administration recommends caution with rehabs offering on-site detox because these freestanding facilities may or may not be equipped to fully assess and treat complex cases. If the rehab you’re interested in does provide on-site detox, ask about the amount of medical staff on hand, the treatment protocol for yours, or your loved one’s drug of choice, and whether or not there will be help available 24/7. If the addiction is moderate, this may be appropriate.

    For alcohol, benzodiazepine and “G” detox, please seek a hospital-based detox as these substances lead to more dangerous withdrawal.

    6) What role do interns play in the delivery of clinical services to patients at your program? In regards to your clinical team, what percentage of them are full-time, and per-diem?

    Many treatment centers will cut costs by bringing in clinical interns as their “counselors” who are required to “donate” thousands of hours in order to get licensed. While appropriate for a very low or no-cost program, a clinical team builds their wisdom and experience by practicing over years.

    7)  Are you an actual treatment center, with a building and staff? or are you a call center fronting for a lead generation company?

    Do not sign up with a call center, continue searching and contact treatment centers directly. If you connect online with an unscrupulous phone center the odds of you being “sold” to the highest bidder as a piece of commerce is high. Which makes you wonder; If you are “sold” on the phone and send your loved one to a rehab that lacks clinical care, or has nobody else similar to your loved one present – will it really be the best match?

    8) What is your smoking policy? What about Vaping? Do you offer a Nicotine Cessation Program?

    Please consider choosing a no-smoking facility, and giving up smoking at the same time that you are treating your main addiction. You will have more support and guidance for smoking-cessation now, while you’re in rehab than when you go back.

    10) What are your cell-phone, iPad, and laptop policy?

    Treatment centers that allow the free or easy use of digital devices often have a low level of clinical care and a basic program. It’s best to participate in face-to-face interactions and real-world activities during treatment, rather than using your devices.

    11) Given the recent wave of problems with rehab fraud around urine testing, and fraudulent lab billing, what is your UA policy, and what do you require the family to pay?

    Learn more about drug testing fraud here.

    12) What is your refund policy if/when my loved one leaves treatment against clinical or medical advice?

    This is known as an “ACA” or “AMA” exit. Many unscrupulous providers will often keep pre-paid fees due to the patient “storming off” or being “bad.” Addicted humans sometimes leave treatment, so a thoughtful refund policy is a necessity. This should be spelled out clearly in their Financial Agreement, but if not, get the refund policy in writing.

    13) What is your policy on a patient who relapses? What do you do with him or her?

    Different rehabs have different responses to relapse. Some rehabs offer ‘refresher’ courses where the addict can come back for a short time if they feel they’re approaching relapse, and some offer alumni support group meetings.

    14)  What is the male/female ratio of your community presently? What is the average age range of your community presently? Can you describe the current community members’ “drug of choice” at this time?

    Since group work is very important. You need to make sure that your loved one will feel like they are part of the group, not alienated or labeled as ‘different.’ Try to find a rehab working with a group of similar people that you’re loved one can really connect with.

    We hope you’ve found this resource helpful, and informative. Since the priority is getting yourself or your loved one into an appropriate, well-staffed, and safe treatment environment, it might be a good idea to consult with an experienced Interventionist if you’re still feeling uncertain. They can help you decide what services are necessary and which ones aren’t, and craft a personalized treatment plan to get your family going in the right direction.

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    Dr. Suzanne Grevelink is an independent health care industry analyst & speaker and entrepreneur. She has successfully completed many health care events and in-demand as a speaker, regular contributor.

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    Health

    Study Shows Immune Cells Against Covid-19 Stay High in Number Six Months After Vaccination

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    A recent study by Johns Hopkins Medicine researchers provides evidence that CD4+ T lymphocytes — immune system cells also known as helper T cells — produced by people who received either of the two available messenger RNA (mRNA) vaccines for COVID-19 persist six months after vaccination at only slightly reduced levels from two weeks after vaccination and are at significantly higher levels than for those who are unvaccinated.

    The researchers also found that the T cells they studied recognize and help protect against the delta variant of SARS-CoV-2, the virus that causes COVID-19. According to the U.S. Centers for Disease Control and Prevention, the delta variant — currently the predominant strain of SARS-CoV-2 in the United States — causes more infections and spreads faster than earlier forms of the virus.

    The study findings were first reported online Oct. 25, 2021, in the journal Clinical Infectious Diseases.

    “Previous research has suggested that humoral immune response — where the immune system circulates virus-neutralizing antibodies — can drop off at six months after vaccination, whereas our study indicates that cellular immunity — where the immune system directly attacks infected cells — remains strong,” says study senior author Joel Blankson, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine. “The persistence of these vaccine-elicited T cells, along with the fact that they’re active against the delta variant, has important implications for guiding COVID vaccine development and determining the need for COVID boosters in the future.”

    To reach these findings, Blankson and his colleagues obtained blood from 15 study participants (10 men and five women) at three times: prior to vaccination, between seven and14 days after their second Pfizer/BioNTech or Moderna vaccine dose, and six months after vaccination. The median age of the participants was 41 and none had evidence of prior SARS-CoV-2 infection.

    CD4+ T lymphocytes get their nickname of helper T cells because they assist another type of immune system cell, the B lymphocyte (B cell), to respond to surface proteins — antigens — on viruses such as SARS-CoV-2. Activated by the CD4+ T cells, immature B cells become either plasma cells that produce antibodies to mark infected cells for disposal from the body or memory cells that “remember” the antigen’s biochemical structure for a faster response to future infections. Therefore, a CD4+ T cell response can serve as a measure of how well the immune system responds to a vaccine and yields humoral immunity.

    In their study, Blankson and colleagues found that the number of helper T cells recognizing SARS-CoV-2 spike proteins was extremely low prior to vaccination — with a median of 2.7 spot-forming units (SFUs, the level of which is a measure of T cell frequency) per million peripheral blood mononuclear cells (PBMCs, identified as any blood cell with a round nucleus, including lymphocytes). Between 7 and 14 days after vaccination, the T cell frequency rose to a median of 237 SFUs per million PBMCs. At six months after vaccination, the level dropped slightly to a median of 122 SFUs per million PBMCs — a T cell frequency still significantly higher than before vaccination.

    The researchers also looked six months after vaccination at the ability of CD4+ T cells to recognize spike proteins atop the SARS-CoV-2 delta variant. They discovered the number of T cells recognizing the delta variant spike protein was not significantly different from that of T cells attuned to the original virus strain’s protein.

    Although the study was limited because of the small number of participants, Blankson feels it pinpoints areas that merit further research.

    “The robust expansion of T cells in response to stimulation with spike proteins is certainly indicated, supporting the need for more study to show booster shots do successfully increase the frequency of SARS-CoV-2-specific T cells circulating in the blood,” says Blankson. “The added bonus is finding that this response also is likely strong for the delta variant.”

    Along with Blankson, the members of the study team from Johns Hopkins Medicine are study lead author Bezawit Woldemeskel and Caroline Garliss.

    This study was supported by the Johns Hopkins COVID-19 Vaccine-related Research Fund.

    The authors do not have financial or conflict of interest disclosures. 

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    Health

    Poverty, Racism and the Public Health Crisis in America

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    Although extreme poverty in the United States is low by global standards, the U.S. has the worst index of health and social problems as a function of income inequality. In a newly published article, Bettina Beech, clinical professor of population health in the Department of Health Systems and Population Health Sciences at the University of Houston College of Medicine and chief population health officer at UH, examines poverty and racism as factors influencing health.

    “A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe,” Beech reports in Frontiers in Public Health. “Racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. The U.S. has one of the highest rates of poverty in the developed world, but despite its collective wealth, the burden falls disproportionately on communities of color.” The goal of population health is to achieve health equity, so that every person can reach their full potential.

    Though overall wealth has risen in recent years, growth in economic and financial resources has not been equally distributed. Black families in the U.S. have about one-twentieth the wealth of their white peers on average. For every dollar of wealth in white families, the corresponding wealth in Black households is five cents.

    “Wealth inequality is not a function of work ethic or work hour difference between groups. Rather, the widening gap between the affluent and the poor can be linked to unjust policies and practices that favor the wealthy,” said Beech. “The impact of this form of inequality on health has come into sharp focus during the COVID-19 pandemic as the economically disadvantaged were more likely to get infected with SARS CoV-2 and die.”

    A Very Old Problem 

    In the mid-1800’s, Dr. James McCune Smith wrote one of the earliest descriptions of racism as the cause of health inequities and ultimately health disparities in America. He explained the health of a person “was not primarily a consequence of their innate constitution, but instead reflected their intrinsic membership in groups created by a race structured society.”

    Over 100 years later, the Heckler Report, the first government-sanctioned assessment of racial health disparities, was published. It noted mortality inequity was linked to six leading causes of preventable excess deaths for the Black compared to the white population (cancer, cardiovascular disease, diabetes, infant mortality, chemical dependency and homicide/unintentional injury).

    It and other reports led to a more robust focus on population health over the last few decades that has included a renewed interest in the impact of racism and social factors, such as poverty, on clinical outcomes.

    The Myth of Meritocracy

    Beech contends that structural racism harms marginalized populations at the expense of affording greater resources, opportunities and other privileges to the dominant white society.

    “Public discourse has been largely shaped by a narrative of meritocracy which is laced with ideals of opportunity without any consideration of the realities of racism and race-based inequities in structures and systems that have locked individuals, families and communities into poverty-stricken lives for generations,” she said. “Coupled with a lack of a national health program this condemns oppressed populations such as Black and Hispanic Americans, American Indians, and disproportionately non-English speaking immigrants and refugees to remain in poverty and suffer from suboptimal health.”

    Keys to Improvement

    The World Health Organization identified three keys to improving health at a global level that each reinforces the impact of socioeconomic factors: (1) improve the conditions of daily life; (2) tackle the inequitable distribution of power, money and resources; and (3) develop a workforce trained in and public awareness of the social determinants of health.

    The report’s findings highlight the need to implement health policies to increase access to care for lower-income individuals and highlight the need to ensure such policies and associated programs are reaching those in need.

    “Health care providers can directly address many of the factors crucial for closing the health disparities gap by recognizing and trying to mitigate the race-based implicit biases many physicians carry, as well as leveraging their privilege to address the elements of institutionalized racism entrenched within the fabric of our society, starting with social injustice and human indifference,” said Beech.

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    Culture

    What Do You Know About Disability Cultural Competence?

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    Recently, I had the opportunity to give a webinar on disability cultural competence to social service workers, but was met with many blank stares. As a disabled social worker myself, I often notice that the disability community is not recognized as a cultural group. Disability is also not considered as a social identity in diversity considerations, despite the ways the community feels about it. Frankly, our field has a long way to go when it comes to developing disability cultural competence. Let’s see if we can change that.

    Why the We Need to Prioritize the Disability Community

    You may be asking yourself, why all the focus on disability? Well, the disability community comprises 26 percent of the adult U.S. population – that’s one in four Americans according to the Centers for Disease Control. Among children under the age of 18, estimates suggest that 4.3 percent of the population is disabled according to the U.S. Census from 2019. This means that social services workers are interacting with the disability community all over! It’s also important to note that disability transcends race, ethnicity, gender and other social identities, as seen in the graphic below (courtesy of Courtney-Long, Romano, Carroll, et al., 2017). So we need to remember to be intersectional in our  practice – these are not siloed communities.

    Courtesy of Courtney-Long, Romano, Carroll, et al., 2017

    Importance of Disability Identity

    I’d like to transition now to talking about the importance of having a disability identity. Some people identify as disabled from a cultural perspective. Some people are not even aware that this is an option and you can open their eyes to the world of disability as a resource for them. In other words, for some, this is a missed opportunity to connect to a supportive network. For others, it’s a choice not to identify as disabled either due to stigma, internalized ableism or other beliefs. The idea is that developing a strong disability identity is super helpful with your long-term well-being. And in order to do this, you have to both connect with the disability community and with disability culture. So what is that?

    What is Disability Culture?

     

    In short, disability culture is the “sum total of behaviors, beliefs, ways of living, & material artifacts that are unique to persons affected by disability.” It’s essential for social service workers to be tuned in to disability culture so they can leverage it to connect with their clients. And let’s be clear, disability culture does NOT consist of disability service programs. Where we really see disability culture come alive is on social media sites, such as Twitter and Instagram. You can follow some of the major disability culture hashtags to see the dialogues and debates that are hot in our community right now, such as: #DisabilityTwitter; #DisabilityVisability; #DisabilityAwareness; #IdentityFirst; #DisabilityLife; #Spoonie,#SpoonieLife, and more.

    You may notice that the last two hashtags included the word “spoonie.” This derives from “spoon theory,” which is an actual theory based on a metaphor about how much mental and physical energy a person has to accomplish their activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The disability community talks about how many “spoons” they have as a unit of measurement of energy – and sometimes refers to themselves as spoonies. Please note that in teaching you this, I am helping you to develop your disability cultural competence.

    How Build Disability Cultural Competence

    Other ways to build up your disability cultural competence are to check out the Disability Visibility Project, which tells the stories of diverse members of the community in wonderful ways. And there are a range of organizations, such as Sins Invalid, which founded the disability justice movement. You can also read the 10 principles of that movement in this short document. This will help you to tune in to the disability pride movement. We have a pride month and a pride flag too, it happens in July.

    When it comes to engaging in disability competent practice, we need to develop knowledge about disability culture and disability history. We can also consider taking the following steps to round out this competence:

    First, we need to examine our own attitudes about disability and engage in reflective practice around that. You can consider your own implicit bias about the disability community through Harvard University’s Project Implicit test about ableism, or through social worker Vilissa Thompson’s guide to checking your own ableism.

    Second, developing disability cultural competence over time also includes a careful look at the terminology we are using and respecting disabled people’s choice of identity-first language in many cases. You can read more about that here and throughout that site. The Harvard Business Review also has a thoughtful essay on why you need to stop using particular words and phrases. It’s a great resource and helpful read for many.

    Third, we also need to think respectfully about disability etiquette and how ideas play out in different parts of the disability community. One should presume competence about us – all of us! We ask that you respect our bodily autonomy, speak to the person and not their companion/interpreter, ask before you help, be sensitive about physical contact/equipment contact, don’t make assumptions about capacity, listen to us, don’t assume you know better and if you are in doubt about what to do, ask! Writer Andrew Purlang sums up his disability etiquette request as follows:

    • Don’t be afraid to notice, mention, or ask about a person’s disability when it’s relevant — but don’t go out of your way!
    • Offer to help, but make sure to listen to their response, respect their answer, & follow their directions
    • Don’t tell a disabled person about how they should think about or talk about their own disability
    • Don’t give unsolicited medical, emotional, or practical advice
    • Don’t make a disabled person responsible for managing your feelings about their disability, or for your education on disability issues
    • If you make a mistake, just say you’re sorry and move on. Don’t try to argue that you were right all along.

    Now What?

    Taken together, these steps, learning disability culture, and examining our own attitudes about disability, go a long way towards the development of disability cultural competence. But none of it will do any good if we are not fighting for disability access and disability inclusion, which are central issues for the disability community. Many people think that issues of access were solved by the passage of the Americans with Disabilities Act of 1990. But the implementation of that law is fraught and embattled, and there is lots of work to be done on the access front. Take a look at these simple guides below. They will go a long way in helping to engage the disability community and making us feel welcome! Above all, remember our movement’s rallying cry, “nothing about us, without us!”

    Website Accessibility

    Accessible Social Media Guide

    Meeting Accessibility

    Webinar Accessibility

    Public Event Accessibility

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