How To Win America’s Fight Against The Opioid Epidemi

Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

How To Win America’s Fight Against The Opioid Epidemic

Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

Read more in Peggy Compton and Andrew B. Kanouse, “The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of Heroin Use, and the Federal Response” Journal of Pain and Palliative Care Pharmacotherapy 29, no. 2 (2015): 102-114.

National AIDS Awareness Month

Even though the overall number of people with HIV and AIDS has fallen, it is still a disease which predominately affects gay males. An estimated 67% of new HIV cases are transmitted via male-to-male sexual contact, with heterosexual contact accounting for 24%, and 6% due to drug use. Young people are also more likely to be infected. Young people ages 13-24 account for 21% of new AIDS cases. The most at risk individuals are young gay and bisexual men which “accounted for 81% of all new HIV diagnoses in people aged 13 to 24 in 2016, and young African American gay and bisexual men are even more severely affected,” according to the CDC.

Since 1987, the first year Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) was listed on death certificates, over 500,000 people have died in the United States from HIV/AIDS. That’s more than the number of people who have died in the Syrian War. Currently, in the United States, AIDS is the 9th leading cause of death in people 25-44 years old.

The AIDS epidemic reached its peak in 1992, with an estimated 78,000 cases diagnosed annually. Since then, AIDS diagnosis began to steadily decline until stabilizing in the late 1990s at approximately 40,000 cases diagnosed annually. The latest statistics from the Center for Disease Control and Prevention (CDC) show between 2010 and 2015 the estimated number of annual infections declined 8% from 41,800 to 38,500.

Victims of intimate partner violence (IPV) are also at a greater risk for contracting HIV. People who report a history of being a victim of IPV are more likely to engage in risky behaviors – intravenous drug use, prostitution, unprotected anal sex – increasing their risk of contracting HIV. HIV-positive women also report higher rates of IPV than the general population.

The opioid epidemic is responsible for the first uptick of HIV diagnosis attributed to intravenous drug use in two decades. In 2015, opioid use led to 181 individuals being diagnosed with HIV in Scott County, Indiana. Lowell, Massachusetts has also seen a recent spike in HIV cases attributed to opioid use.

One of the biggest obstacles faced by HIV/AIDS patients is a healthcare system which is less than perfect. A recent Times article stated, “no class of medicines is more scandalously expensive than for H.I.V.” In the U.S., HIV medication can cost $39,000 a year, while countries in Africa the same medication costs $75 a year.

The U.S. healthcare system may not be perfect, but HIV treatments are getting better. Experts think it’s possible HIV transmission can be stopped in the United States within 3-7 years. The most current and powerful antiretroviral drugs on the market can lower the amount HIV in a person’s system to a level so low it cannot be transmitted.

The Need for Improvement in Substance Abuse Treatments

 

For decades now, America has been in the midst of a substance abuse epidemic. In fact, recent Pew research indicates nearly half of U.S. adults have a close friend or family member who has been addicted to drugs at one point in their life. The experience is so universal the dataset cuts across sex, race, age, education level, and even partisan lines. In short, it’s safe to assume addiction is as American as apple pie.

Every day, more than 115 people in the United States die after overdosing on opioids. Alcohol abuse has increased by 50% since the start of the century to the point where today, one in eight Americans abuses alcohol. According to a 2017 survey, methamphetamine has become the world’s most dangerous drug, as 4.8% of users required hospitalization in order to avoid overdose.

Though substance abuse has become a worldwide phenomenon, affecting millions of people, treatment for addiction is not nearly as universal. Public health officials have drawn attention to the problem in more recent years, yet only 10.9% of individuals who needed treatment in a specialized facility for a substance use or a dependency concern received it in the year 2013.

It’s an epidemic policymaker’s, mental health experts, law enforcement, and others are acutely aware of. But solving the problem on a wide scale has so far proven to be fruitless. Individual states have taken specific measures, like opening up safe injection sites, which allow those who struggle with addiction to use in a safe space around medical experts. It’s a solution which definitely won’t solve the addiction crisis, but it does work as a harm-prevention space. Other states have taken to suing the pharmaceutical companies themselves, using similar tactics which were used against Big Tobacco nearly 20 years ago.

While these are no doubt necessary and useful tactics which will help presently and in the future (if successful), there are other avenues that largely have yet to be explored. Perhaps the most simple form of aid is given through the Primary Care Provider (PCP).

While all doctors and patients are supposed to share a therapeutic alliance, based on mutual trust and respect, PCPs are in a unique position in the healthcare field. Often, these doctors have known their patients for a number of years, have a big picture view of their overall health over a period of several years, and are able to check in on a patient’s progress with every visit.  

Evidence compiled by a University of Michigan medical team suggests primary care physicians and their teams of nurses, medical assistants, social workers, and pharmacists can — beyond providing basic services every patient needs — also provide effective care for addiction. Including each of these moving parts not only ensures the patient is receiving quality care but also helps to ensure the patient does not fall through the cracks at any point during their recovery.

They achieve this primarily through the anti-opioid medication buprenorphine and counseling — a combination known as medication-assisted treatment (MAT). The researchers have recently published a peer-reviewed paper on the subject, where they pose this is an effective method of treatment. They do not argue, however, that it is an easy process.

“There is a major need to do this,” says Pooja Lagisetty, M.D., M.Sc., the study’s lead author and a University of Michigan primary care doctor who provides MAT to her own patients at the VA Ann Arbor Healthcare System. “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience. But if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible.”

This support must come from other parts of the medical team. As the patient goes through the process, non-physician team members aid with dosing, monitoring the patient, and check-ins by phone and in person. If done successfully, Lagisetty argues this method can achieve similar results to specialized treatment facilities, and it might reach more people.

“Patients might be more willing to seek help in a primary care setting because of the lack of stigma and the ability to address their other health concerns,” she said. It’s also likely to be less devastating to patients financially. All in all, this kind of treatment in Primary Care facilities makes sense.

While it’s unlikely primary care physicians pursued medicine with a desire to focus on addiction treatment, it’s a reality many are going to have to embrace and develop a protocol for as the problem persists or worsens.

There are, of course, a number of other solutions which ought to be tested as America’s substance abuse problems continue to grow. Addressing the issue at its core will require effort from governing bodies, lawmakers, public health experts, mental health experts, and of course, the healthcare system. Until this happens, a collaboration between healthcare providers might be our best bet.

Life After Addiction Treatment: How to Fill the Void During Recovery

The first year of recovery is difficult to manage. Triggers lie everywhere and applying the skills you learned in rehab is easier said than done. When a recovering addict first begins life after their addiction, they may discover a void left from their past life. Whether the void is their past experiences, low self-esteem, or avoiding bad feelings, addicts typically used drugs or alcohol to fill that void.

Now in the absence of those unhealthy “coping” mechanisms, addicts now face those voids alone. Maintaining recovery requires an addict to learn how to fill their life with positive things and not go backwards into their old ways.

The certified counselors at Cold Creek Behavioral Health have put together a list of recovery and coping skills in handling life after treatment.

Recovery Skills

Rehab isn’t the end of addiction, it’s only the beginning of recovery. Once an addict leaves treatment they soon realize that life and all the factors that brought them into their addiction are still there waiting for them.

Although you can’t change everything, you can learn how to handle things better and develop behaviors that’ll help you maintain your recovery.

Learn to Mourn

As strange as it may sound, it’s important to begin your recovery by first mourning the loss of your past addiction. Since your past addiction had been with you for a very long time, it’s important you mourn the loss of it. This can require not only giving up the addiction but saying goodbye to bad friends, places, and the unhealthy habits that led to your addiction. From where you used to hang out to who you were with regularly and on, it determined a lot of your day.

It’s important you recognize that loss but also recognize that although it was something you did—it didn’t define you. Recognize that loss and move past it. Then you can move on and maintain your recovery day to day, drug-free.

Avoid High-Risk Situations and Triggers

Some common high-risk situations are described in treatment as the acronym, HALT:

  • Hungry
  • Angry
  • Lonely
  • Tired

Recognize Your Emotions

Of course, you can’t always avoid HALT situations, but you can be more aware of them. If you take better care of yourself, you’ll be able to recognize your emotions before they send you spiraling. By develop healthy habits, use support groups, and more, many of these situations will be far and few between, rather than consistent occurrences.

Steer Clear of Boredom

For an addict, feeling a sense of boredom is dangerous. This is because it allows your mind to wander and not stay focused on maintaining your recovery. This can even go as far as triggering a relapse. For that reason, it’s important that you stay busy.

Fill your day with activities you enjoy. Find new interests. Keep busy. This will keep you busy and far from the feeling of boredom. It also helps you develop healthy habits. Remember: a routine is critical to helping you stay abstinent.

Fill Your Life with People and Love

A great way to start filling that void is to re-establish old friendships that may have been lost on your path of addiction. Surround yourself with supportive people both help you and make you feel cared for and loved.

Recovery is also a good time for an addict to mend fences with family and friends. Doing this will also help make you feel better about yourself because you’ll be righting your wrongs and maintaining your recovery.

Healthy Habits and Activities Are Crucial

There are many activities you can pick up on the road to recovery, as well. Some of these healthy activities include:

  • Making a to-do list so you can feel a sense of accomplishment as you mark things off.
  • Relaxing and trying to stay stress free
  • Playing video games to relax your mind
  • Reading
  • Doing crossword puzzles
  • Start becoming more proactive by starting a blog or doing volunteer work
  • Play sports
  • Take a class
  • Learn to coo

Other Coping Skills

Some other skills that are very helpful in maintaining your recovery include:

Stress Management

Learn how to handle your stress in healthy ways. Use tools listed above to help tackle your stress one day at a time.

Honesty

Make sure that you are completely honest with yourself and others. One of the key components of drug addiction is creating a culture of deceit—combat that with complete honesty and integrity.

Therapy

Maintaining a regular schedule of therapy sessions can really improve your chances of staying clean—especially in the first year.

No matter what you do, staying busy with some type of constructive activity and surrounding yourself with healthy relationships is a key component to staying sober and not letting old triggers creep back into your life. Maintain realistic expectations and remember: getting and staying sober is a process, a marathon; it’s not a sprint.

How to Prevent an Addict from Relapsing

Preventing a relapse is typically harder than it was getting sober. The reason for this is because maintaining recovery spans a lifetime. There is always a chance that a trigger lies right around the next corner and without support in defeating that trigger, an addict can start their former patterns all over again.

Tips for Helping a Recovering Addict

Fortunately, there are a number of ways to help. For example:

Finding a support group where the addict feels comfortable, can also provide a great deal of help. Being part of a group where members have gone through the same trials and tribulations helps an addict feel less alone in his or her struggle, and more like there is somewhere he or she belongs.

Family support is also of the utmost importance. The family structure is one of the key ways recovering addicts maintain their recovery, but it can also be a trigger source for some. Making sure you’re being as supportive as possible can help them immensely.

Just being around for non-judgmental listening can help tremendously. If an addict feels they can go to you for help when they are feeling triggered will help them in more ways than one and usually helps avert any crisis.

Top Five Barriers to Mental Health Treatment

Today, one in five people in the United States experience a mental health condition which is equivalent to approximately 40 million Americans, but only 41% of adults with a mental health condition actually receive treatment. For Mental Health Awareness Month, King’s University and Social Work Helper are working together to help raise awareness on mental health barriers and challenges many individuals face when contemplating mental health treatment.

When increased concerns about a mental health condition arise, friends, family and/or Google are often the first to be consulted. Varying responses from getting counseling to hospitalization may be suggested as the potential solution, but what roadblocks may be encountered before an intervention can be decided? There are many things to consider on the journey to mental wellness, but there are also several pitfalls to look out for.

1. Stigma

The unfortunate truth is that most people are terrified of being discriminated against in their employment or unjustly targeted by the police because of their mental health status. According to current data, individuals with a mental health condition are more likely to encounter law enforcement than receive professional treatment. Too often, the public’s education on mental illness is learned from misrepresented portrayals of mentally ill individuals as violent criminals by the media.

2. Refusal

Adult patients have the right to refuse treatment. This may become a major barrier and challenge for parents with adult children who need treatment. Current laws require an individual to be a danger to themselves or third party in order to qualify for an involuntary committal. Typically, commitment of a mental ill individual is avoided unless a determination has been made declaring them to be dangerous. Unfortunately, loved ones of an individual struggling with mental illness who have refused treatment have very limited options available to them.

3. Financial

The rising cost of prescription drugs, high co-pays and deductibles in addition to limited and uncovered mental health services may be the deciding factor in whether someone seeks treatment. According to a 2011 study in the journal Health Affairs, the United States spent 113 billion dollars on mental health treatment which was only 5.6% of national physical health-care related spending. Most importantly, the majority of those dollars went to prescription drug costs as the primary treatment for the mental health condition. Even though the Affordable Care Act has pushed the uninsured rate to an all time low, approximately 27.3 million Americans still are without insurance. Also, in surveys measuring the effectiveness of the ACA, responses suggest high deductibles and out of pocket costs still remain the biggest barrier preventing individuals from seeking mental health treatment.

4. Intervention

Some people may give up on pursuing treatment because they don’t believe therapy is working for them. Could it be possible the right type of therapy was not introduced to improve their mental health needs? It could happen. There may be several therapists and/or several medications tried before finding the right combination to yield the best results. When it comes to mental health treatment, there is no one size fits all treatment, and any wellness plan must be tailored to fit the needs of the individual seeking treatment in order to help them achieve the best outcomes. Before choosing a counselor or therapist, there are many factors to consider before making a decision such as their cultural background, spiritual philosophy, and competencies in order to increase the odds of a better fit.

5. Access

Even if the four previous mentioned barriers could be prevented, individuals experiencing a mental health crisis may be wait listed before they can get access to a mental health provider. According to U.S. Health Resources & Services Administration, 60% of Americans live in a mental health provider shortage area because the mental healthcare system does not have enough providers to meet current demand. There are approximately 1,000 patients for every 1 provider, and the US needs to add approximately 10,000 providers by 2025 in order to make pace with the growing demand for services.

Licensed counselors, clinical social workers, psychologists, and psychiatrists are desperately needed to begin closing the treatment area shortage gap. According to the American Psychological Association (APA), “The APA Education Government Relations Office (GRO) continues to seek increased federal support for psychology education and training, particularly for psychologists who work with underserved populations” which includes a loan repayment option for early career psychologists. For more information on earning a psychology degree, visit King’s University Bachelor’s of Psychology Program.

R U There? How Crisis Text Line is Using Technology To Its Advantage

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Nancy Lublin giving a TedTalk on the creation of CrisisTextLine.org

Crisis Text Line was launched quietly with no marketing initiative in late 2013. Within a few months, they were operating in all area codes in the United States which is a faster growth than when Facebook was launched.

Crisis Text Line received more than 6.5 million texts in less than two years, from the date the algorithms were developed. For instance, if a text uses the words ‘rubber band’ and ‘MG’ there is a 99% match for substance abuse. This prompts the counsellor to ask specific questions or highlights the nearest drug centres to the texter.

Data and evidence can make research, policy, policing and school boards better and more effective to helping young people who are being bullied, suffering from eating disorders or being abused. Crisis Text Line believe in open collaboration and sharing the information they have learnt on social media and at conferences in an effort to help inform others’ practice. This data has been made public and available on www.crisistrends.org.

Crisis Text Line serves anyone, and it is free and available to use 24/7. Texters just need to text ‘START’ to 741741 from anywhere in the USA about any type of crisis, and a trained counsellor will receive and respond quickly. Counsellors are volunteers, and they aim to help move the texter from a hot moment to a cool moment. Texts to Crisis Text Line are free from all major phone networks including, Verizon, Sprint, AT&T and T-Mobile which was announced in July 2015. These networks also announced texts to Crisis Text Line would not appear on billing statements allowing texters privacy and confidentiality in moments of crisis.

Whilst Crisis Text Line believes that science and technology make them better able to respond faster and more accurately, they do not think robots make great Crisis Counsellors. This means that every text you send will be viewed by a human.

Crisis Text Line aim to respond to texts within 5 minutes. However, if the service is extremely busy the waiting time may increase. Currently, the system is only able to process 140 characters in one text message. The service can also be reached through Facebook Messenger which is located through Facebook’s Safety checkpoint. Anonymity still applies and Crisis Text Line will not have access to your profile information. If you would like your data deleted via Facebook messenger you should message Crisis Text Line back with the word ‘LOOFAH’, they will scrub your data from the system and ask Facebook to do this too! Although Crisis Text Line provides a free resource for people to access in times of crisis, it is not a replacement for long-term counselling, therapy and/or a friend.

Crisis Text Line was founded by Nancy Lublin, Founder of Do Something, who saw a need for a service to help people in crisis. In her TED Talk, Lublin cites the text of one young person  who stated that, “he won’t stop raping her, it’s her dad, R U there?”. From this, Nancy knew she had to create a crisis text line because young people communicate primarily through texts.

Text messaging is private, no one can hear you, the messages given are just the facts and not communicated through ‘ums’ ‘ahs’, or hysterical crying. This meant that counsellors could act quickly and in some cases trigger active rescues which can save a young person’s life. Crisis Text Line initiate 2.41 active rescues each day. Crisis Text Line does not respond to texts chronologically, and they triage texts based on crisis level. Their goal is to provide a service that will help people in crisis get the best support they can give when experiencing a crisis.

If you are interested in becoming a Crisis Counsellor, you must pass a background check, have a US Social Security number, be at least 18 years old, have computer access with a secure internet connection and be able to commit to volunteering 4 hours per week for one year. The application process is rigorous, and it involves a lot of training that will prepare you for what you might experience.

If volunteering is not something you could commit to, you could also donate. Crisis Text Line is a non-for-profit organisation and any donation would help them to develop their service so that they can reach more people experiencing crisis.

https://www.youtube.com/watch?v=KOtFDsC8JC0

The Number of Mentally Ill in Prison

An activity therapy room is seen at the Psychiatric Inpatient Program at San Quentin State Prison in San Quentin, California in December 2015. Credit: Stephen Lam
An activity therapy room is seen at the Psychiatric Inpatient Program at San Quentin State Prison in San Quentin, California in December 2015. Credit: Stephen Lam

As a clinical social worker in a prison in Michigan, I have seen firsthand how untreated mental illness needs have devastating consequences. It is also a symptom of a larger issue of the effect of untreated mental illness needs in the community.  According to Michigan’s Department of Corrections, 20% of all prisoners are in the mental health services program.  Using the most recent statistics on prison incarceration rates from 2013, slightly over 43,000 people were incarcerated, and 20 percent of prisoners in treatment equates to approximately 8500 prisoners having some type of diagnosed mental illness.

This figure is in stark contrast to a study done at the University of Michigan about mentally ill inmates which stated 65% of inmates in Michigan prisons have a mental illness and did not receive any treatment. The same study also put the number of mentally ill inmates at 30% of the total prison population versus the 20% reported by the Michigan Department of Corrections. It also reported male prisoners are less likely to receive treatment than female prisons.

The U of M study estimated that 77% of the 30% they believed to have a diagnosed mental illness were not receiving treatment which means only 23% of prisoners with a diagnosed mental illness is being treated. This does not necessarily mean the Department is failing to treat them or identify mentally ill inmates in the intake process. Inmates refusing treatment could also be a factor affecting outcomes. Inmates have the ability to say no to any form of treatment given if they are not a danger to themselves or others.

This study also looked at the involvement of mental illness as a factor in the crime the prisoner committed.  It was reported that 20% of the crimes committed were by a person who had a diagnosed mental illness with 65% of those people were not receiving any treatment for their mental illness prior to the crime being committed. I believe this issue was exacerbated when mental health facilities in the state of Michigan were closed down starting in the late 1980’s to 2003. These numbers do not address the issue of co-occurrence involving substance abuse, and the amount of drugs that enter prisons which is another serious problem.

Many people were forced back into the community where Medicaid funding did not keep the pace of the increase of mentally ill reintergrating back into the community.  As a result, people were not receiving treatment they needed and were forced to manage symptoms on their own. This caused other systems like the prisons to pick up the slack when a person with a mental illness committed a crime.

I am certainly not advocating for a return to state-run mental health facilities, but taxpayer money could be better spent on programs and even other levels of care in the community to stop the pipeline to prison for those suffering from mental illness.  The current budget in Michigan for the Department of Corrections is $1.9 billion dollars with $290 million allocated for health care of which mental health services are included with education spending at $13 billion dollars.

Michigan and other states need to create more mental health and drug courts to prevent mental ill individuals from being funnelled into prisons as a solution. Michigan has taken a step in the right direction and in 2013 10 mental health courts were designated in Michigan.

These courts have been reviewed by the Michigan State Court Administration and have found that they reduce prison recidivism rates.  As a social worker who attended one of these courts, the judges, attorneys, and probation officers involved have a greater understanding and empathy of the mental health needs of people in the criminal justice system.

Also, we also need more jail diversion programs as tool to provide relief for mental ill individuals getting in order for them to get the care they need to be productive. I had the privilege of working in a jail diversion program to divert people to services instead of keeping them in jail or prison. Only recently has the federal government started tracking data from many of these programs as well as working on uniform standards across the country.  Many states have different programs at the various levels which include intervention at the law enforcement level, at the court level, or after sentencing.

While I believe that people need to take responsibility for their crimes and poor choices, we should also take responsibility as a community to make sure those with serious needs get the help they need. Many of the prisoners I work with have significant trauma issues which is a contributing factor to complex problems.

Most importantly, we need to fund more programs and services for early childhood education to support families and identify issues early.  I know this will take significant amounts of money but a large majority of prisoners will return the community. Shouldn’t our money be spent in better ways?

Observations of a Danish Social Worker on Social Work Practice in the United States

cancer-patient

I was working as a social worker in Denmark for some at a highly specialised university hospital until I moved to the United States, and I have been wondering about the differences and similarities in working with cancer patient in both places. With 10 years of experience working with cancer patients, their families and palliative care in Denmark, I can see how different Denmark is from the U.S. health and social system. I don’t think it will be fair or even possible to do a one to one comparison of the two countries.

In Denmark, the government plays a major role in providing citizens with fundamental social security and access to healthcare, which dates back to the 1800s. With a comprehensive social security system, most of the welfare state tasks is financed by taxes. In the United States, I have learned most of the social support is provided through non-profit organisations and healthcare is mostly secured by insurance. So with such big differences, I thought it would be interesting to see if there are any common denominators.

In my search for work in the United States a question I often get is do you have experience in working with Afro/American women? In the beginning I wondered a lot about that question, but then it made me really think about how do I define myself as a social worker. Working as a social worker here in the United States at a clinic for low income women with cancer I met many different ethnicities.

Mohammad, a 50-year old man, who was working as a bus driver when I first met him. Originally he was from Iraq, but came to Denmark as a political refugee. He was married and had four children. Mohammad’s wife didn’t speak Danish and she didn’t work. I met Muhammad because he was diagnosed with Colon Cancer and wasn’t able to work much longer.

Being diagnosed with cancer is mostly associated with uncertainty, hopelessness and anxiety of not having any control. Many cancer patients also experience stigma, shame and blame depending on the diagnose. Besides that most people are filled with fear of the disease, many also have concerns of what the diagnose means in relation to work, social life, economy and everyday life. A life threatening disease is an extreme and potentially stressful triggering life event which requires psychological coping.

The best results in our line of work I believe is created by being humble in the approach to the patient and by having a natural curiosity towards the patient’s life story. We must first and foremost see the patient as a person who comes to us for help because they are in a place in their life where they cannot stand alone, and we need most of all take a look at the patient’s individual experience of his or her situation. Whether the individual can adapt to the new life situation depends partly on their degree of resilience.

The first couple of times I met with Muhammad he didn’t say much, I would just talk with him about life in general, so he wouldn’t feel I pressured him into speaking about his situation. In my experience, working as a social worker, a patient in a situation like Muhammad’s is going through a lot of emotions. They may have the feeling of loneliness, lack of understanding from their surroundings, social isolation and financial difficulties.

Moreover they go between accepting the situation, to denial or to have some degree of acceptance. Every time I met with Muhammad I told him you can always come back. I would ask him how his treatment was going and asked about his life in general, this was to not only define him by his diagnose and the disease. Then after a couple of meetings he brought his wife and from there the contact to the family became more frequent. I was Mohammed and his family’s social worker until he died 4 years ago.

Sabrina a young mother of three, was diagnosed with melanoma cancer metastasis to the brain and because of some insurance issue, she had not gotten her treatment and scans. Sabrina’s husband was providing for the whole family and wasn’t home a lot which made Sabrina feel very alone in her situation. Also, Sabrina was going to die and she knew and recognized it.

Speaking with a patient in Sabrina’s situation you need to find out what is most important for her to talk about. Is it emotional support or is it more practical support she needs. First of all, I believe that we should all have an open heart, open mind and listen to the stories the patient has to tell, without race or color in mind.

It is important as a social worker to start a conversation with a patient and imperative to distinguish between the problem and the condition for knowing when to take have a solution-oriented approach, and when we do not need to act, but do something else for the patient. Problems such as financial aid, help to clean, help to care for the children and figuring out what the insurance and pension rules are, can be solved. Conditions are more definable as distressing life events, something the patient has to live with. A burden or a grief to be worn like that I am not able to work longer, I have to die from my children and the disease itself. These circumstances affect the patient on a more emotional and spiritual level.

However, it can be difficult to distinguish between problems and conditions as the patient will often ask questions or talk about the difficult life conditions in a way that invites to problem solving. The patient’s narrative and questions must be recognized and unfolded before we can assess whether it is something we must act on or not. It can be difficult to distinguish in practice, since a situation may contain aspects of both conditions and problems. Here, we must be careful not to solve problems before we acknowledge the losses that the patient has in their changed conditions of life.

I think it’s very important to remember to be truly present with people. We bring knowledge, skills, and compassion to listen in a unique and dedicated way. We need to bear witness to people’s physical and emotional pain without abandoning them or being judgmental in any way. Our role is to create a safe space for the patient to share their joys, regrets, fears, strengths, and sorrows.

I do believe parallels can be drawn between the experiences with patients that I’ve had in the United States and in Denmark. When everyday life is shaken by serious life-threatening disease and families are affected, concerns that arise in both countries are similar in nature regardless of social status and ethnicity.

However, it has surprised me that there is so much focus on ethnicity, especially when I see basically the same problems regardless of race and social status.

It is my experience from what I’ve seen here so far, that here it is more about what ethnicity do you have and what social class do you belong to, that determines how the approach to the patient will be.

A different culture, ethnicity or religion it self does not necessarily accompanied by challenges or the need to have a specific kind of approach.

A cancer – regardless of diagnosis – contains significant psychosocial impacts. In addition to the diagnosis of specific problems, patients often live with fear of relapse, depressed mood, attention and memory impairment, reduced work ability, problems in relationships which, individually or together, may adversely affect rehabilitation and retention of social and cultural status.

It’s essential for a good dialog and contact that we listen with an open-mind and acknowledge the problems coming up during the conversation. Also, it is equally important to see the patient as an individual and avoid judging or being distracted by the patient’s cultural or religious appearance. Otherwise there is a risk that factors such as racism and prejudice will get in the way of the patient receiving the best help.

Domestic Violence Services for Same Sex Couples

In late June of 2015, the Supreme Court of the United States of America made history by legalizing marriage equality for all people within its borders. Even though it is a great moment in history, it may also highlight the challenges and barriers LGBTQ couples and families face in seeking treatment and services for domestic violence.

Domestic violence, also termed intimate partner violence, can be an all too real and very dangerous circumstance of dating and marriage for some individuals. The possible dangers do not change just because it is a same-sex relationship or marriage.

Screen-Shot-2013-09-18-at-2.08.31-PMThere are many domestic violence and women’s centers across America that mainly help heterosexual women and their children escape violent family situations. Many of these centers state they also help heterosexual men in abusive situations and would help LGBTQ individuals seeking services if requested.

However, some of these centers do not openly advertise their help for heterosexual men and LGBTQ individuals, and they may be protected from having to provide services to LGBTQ individuals due to religious freedoms laws being passed in various states around the country.

In 2005, The Journal of Gay and Lesbian Social Services shared a study by Stephen Owens and Tod Burke on intimate partner violence of same-sex couples. The criteria for this study was use of physical force, withholding financial gain, psychological (name calling, manipulation, threats), and engagement in forced and unwanted sexual activity. For more specific examples of abuse, you can check out the LGBT Relationship Violence Power and Control Wheel. The study group contained sixty-six individuals (50% of each gender) of which 56% had admitted to experiencing one or more forms of intimate partner violence.

The prevalence of domestic violence in a sample of 33 men and 33 women currently or previously in same-sex relationships was assessed. Data were collected through a mail survey in the state of Virginia. Of 1000 surveys sent out 66 usable ones were returned (response rate = 6.6%). Analysis indicated that 34 had experienced some form of domestic violence, but significant differences between male and female respondents were not detected. When data from this same-sex sample were compared with those of the heterosexual sample of the National Violence Against Women Survey, intimate partner assault may be more prevalent against gay men than against heterosexual men, but there was no significant difference between lesbians and heterosexual females. Read More

Federal non-discrimination laws and policies aim to prevent agencies from denying or failing to provide services to individuals in a  protected class such as race, gender, religion, etc.  However, LGBTQ individuals have not yet been given federal nondiscrimination protection which has been relegated to state or local bodies to extend protection.

Even though a domestic abuse center claims they will help LGBTQ individuals who are in abusive relationships, there really is no guarantee they will help without a non-discrimination clause against discriminating based on sexual orientation or gender identity. Adding these two areas to any and all non-discrimination policies will give LGBTQ individuals the added security they need when seeking services instead of fearing discrimination based on who they love.

Marriage equality is still controversial, and it will take time for some people to get used to the expanded definition of marriage, but nothing should be offensive about another person needing help. Just as everyone should be entitled to marry the person they love, everyone should be entitled to help when they need it.

7 Things Every Clinician Should Know About Introverts

introvert-extraverts
It’s not unusual for introverts to run across prejudice, even in the clinical setting. They are encouraged by spouses, bosses, and some therapists to be more “outgoing,” “on,” “cheerful,” and “energetic.” They are told that if they put more effort into what amounts to an extroverted way of being, that they will be happier, enjoy more success at work, and please the people around them.

Susan Cain makes the case in her bestselling Quiet that this bias stems from a culture that is predominated by extroverted ideals coupled with a misunderstanding of what constitutes introversion. As a psychotherapist who’s an introvert, I’ve developed an interest in this topic both personally and professionally. Here are some of the observations I’ve made about my clinical practice.

1. Introversion is normal.

Introversion/extroversion is one of the basic dimensions of personality. A preference for an introverted way of being is normal and includes more time for solitude, not wanting to assert oneself in a self-promotional way at work and other social situations, and a preference for, and even preoccupation with introspection.

Introversion is not synonymous with shyness, depression, or schizoid tendencies. It does, however, overlap with Elaine Aron’s concept of high sensitivity. Introverts are not misanthropes. Most have social skills comparable to extroverts.

Introversion and extroversion exist along a continuum and, according to Myers Briggs Type Indicator (MBTI) data, may be normally distributed. Therefore most people (two out of three) will be within one standard deviation of the mean and will have well expressed introvert and extrovert traits. Because of the need to act extroverted in many work and social situations, people who have an introverted center of gravity may wittingly or unwittingly be acting in extroverted manner. Having a better understanding of what it is to be an introvert can empower people to be more authentic and to practice better self-care.

2. You may be an introvert yourself.

Many helping professionals are introverts. They are drawn to counseling work by an interest in the inner workings of the mind and a preference for significant, one-on-one conversations. Even though the work is meaningful, it can be draining. If you are not predominately an extrovert, you will have to work to restore your energy from doing the work to offset exhaustion. Mindfulness can help with this process of energy restoration

3. There are methodological issues measuring introversion.

The most common research method for measuring introversion doesn’t measure introversion but rather the degree of extraversion that is present. Researchers Peter Hills and Michael Argyle are some of the few researchers to identify the anti-introvert bias present in research. They lament, “The view that extroversion is a preferred state has come to be widely accepted among social psychologists. In consequence, introverts are sometimes represented as withdrawn, isolated or lacking social competence, rather than as individuals who seek independence and autonomy.”

4. The culture is biased against introverts

Psychotherapist Ester Schaler Bucholz in her book The Call of Solitude pointed out, “Health professionals are actually not that different from the average person. Like a relative or companion, they may see the self-possessed introspective person as less malleable, less normal.” They differ in how they feel when those skills are expressed and the situations they prefer to express them within. For example, I prefer an in depth conversation to small talk of the cocktail party variety. My appetite for socialization differs in that I feel a strong need for compensatory solitude after most social forays.

5. You probably have a lot of introverts in your clinical practice

Psychotherapist and introvert advocate Laurie Helgoe discusses in her book Introvert Power that introverts are more introspective and curious about their inner life and therefore more prone to present to treatment. This could create a bias since the depressed or anxious introverts are sitting in your consulting room in greater numbers than extroverts with the same degree of symptoms. They don’t have more psychopathology, just more willingness to address it

6. Mindfulness is a powerful tool for introverts

Introspection has its own set of pitfalls: rumination, obsession, and worry. Introverts can get stuck in their stories and may need help getting out of their heads and into the present moment. As the embodied practice of awareness to this moment, mindfulness is an ideal fit for introverts. Mindfulness meditation practice can help them (and everyone) to better navigate the interior dimensions of the mind to foster creative imagination while mitigating rumination.

7. Introverted ways of being can be helpful for introverts and extroverts alike

As a culture, we have gotten out of balance and squeezed quiet and solitude out of our lives. This, no doubt, contributes to the stressfulness of life. We work longer hours, devote more time to children, and have access to 24/7 information and social media. Mindfulness meditation can help to restore quiet solitude in everyone’s lives. Extroverts can benefit from more quiet; introverts desperately need it.

Helping Law Enforcement the Social Work Way

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One story that is trending on news and social media is that of a law enforcement officer who drew his gun on unarmed teenagers.  The same officer was videotaped ordering teenagers to lie on the ground and was viewed physically holding a teenage girl on the ground.  The teenagers were reportedly at a neighborhood pool when an incident occurred and law enforcement was called.

It should be noted that not all of the officers approached the incident in the same manner.  Another officer was videotaped calmly but assertively asking several youngsters about the incident.  His questioning was interrupted by the officer, who eventually drew his weapon.

Comments and opinions on the blogosphere regarding this current event are emotionally charged.  They clearly show biases that originate from the writers’ life experiences and beliefs.  These opinions are often framed in combative ‘them versus us’ tones.  If one expresses concern for the law enforcement officer, another opinion will refute its validity and claim concern for the alleged victims.  If one expresses concern for the victims, another writer will invalidate the comment and express full support for all actions, good, bad, or indifferent by the law enforcement officer.

Unfortunately, these comments do not solve the problem and do not address the needs of the victims or law enforcement officers.

Law enforcement officers and first responders have been found to have a higher incidence of Post Traumatic Stress Disorder (PTSD) than the general population. In the article “What is Post Traumatic Stress Disorder” author Pamela Kulbarsh, R.N. wrote that the prevalence of PTSD ranges from 4-14% among law enforcement officers.  Many articles state that an exact number is difficult to obtain due to underreporting.

Law enforcement officers are repeatedly exposed to threats of death and actual death.  They are expected to make split second decisions that could result in major injuries or loss of life.  Officers are sent to situations with cursory information and expected to provide appropriate solutions.  Gary G. Felt, MA, MHC expounds on this concern in the article “The Relationship of Post Traumatic Stress Disorder to Law Enforcement: The Importance of Education.”

Social workers and mental health workers understand that individuals who experience PTSD symptoms may believe they are under constant threat particularly in situations that are similar to other trauma related experiences.  They may display demonstrate irritability, anger and aggression with little to no provocation.

These events provide opportunity for social work professionals to provide solutions using their knowledge and expertise of social work practice.  Professional social workers, who are entrepreneurial minded, should also view these incidents as opportunities for career growth and advancement as well.

Social workers can provide law enforcement officers with solutions and training to avert the appearance of being overly aggressive, unyielding and unreasonable.  Social workers can also provide strategies that will enable law enforcement professionals to do their jobs while providing them with substantive protection.

Social workers use social work methods and strategies.  Solution enabling strategies include:

Developing appropriate responses to problems based on client needs.

Creatively combining knowledge, values and skills to gain understanding and build relationships.

Respecting and facilitating healthy interactions among individuals, groups and environments.

Assessing, planning, implementing, and evaluating work at every level.

A partnership between social work and law enforcement will create and promote an environment of support and safety for law enforcement officers and the community at large.

Understanding Substance Abuse, Addiction and Treatment

Illicit-Drugs

Substance abuse can include alcohol, tobacco, marijuana, and other drugs, and is prevalent in all ages. For adolescents, the top three most abused substances are alcohol, marijuana, and tobacco in that order. At the end of 2014, it was found that around 2.8 million older adults in the US abused alcohol and there was a 3.3 percent increase in illicit drug use among older adults between 2002 and 2013.

Now clearly, drug or alcohol use is different than abuse or addiction. Typically substance abuse has three criteria: tolerance, withdrawal, and continued use even when there is negative consequences. The withdrawal seems to be a key factor in that many people build up a tolerance and continue drinking even after having had negative effects, but not everyone has withdrawals, which is the separation between use and abuse. Another difference is that those abusing substances or with addictions often need treatment to overcome their excessive use and dependency.

There are countless substances out there but the big ones are alcohol, tobacco, illicit drugs, and other drugs such as caffeine and misused prescription drugs.

Alcohol

Excessive alcohol consumption is a leading cause of death, killing more than three million people each year worldwide. Still, excessive use is not the same as alcohol abuse or addiction. According to the Center for Disease Control and Prevention (CDC) defines ‘alcohol abuse’ as “a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work,” which is different than alcoholism–defined as a chronic disease. About 17.6 million Americans either abuse alcohol or are dependent on alcohol. Although this number seems small relative to the US population, it is actually close to 1 in 12 adults in the US. But keep in mind that it isn’t just adults using alcohol, many underage persons are as well.

Many states are considering changes to their alcohol sales laws; hopefully these changes will lessen the amount of alcohol accessible to underage persons. It will also limit the amount of alcohol-related crimes. However, some of the law changes being proposed seem to be more relaxed about alcohol sales instead such as not asking for ID for people who look older than 40 and allowing sales on Sunday–many states currently have laws prohibiting alcohol sales on Sunday.

Tobacco

Tobacco is another highly addictive drug. Action on Smoking & Health (ash.org) has a very extensive list of tobacco statistics for the US and world. Some of the more glaring statistics are that over twenty percent of deaths in the United States are from tobacco, there are currently 1.1 billion tobacco users worldwide–which is terrifying because tobacco kills up to fifty percent of its users, and that there are over 4000 chemicals in tobacco, 250 of which are known to be harmful to humans.

Although cigarette smoking has declined in adolescents recently, it is still around. Many start trying tobacco at a young age, which is a factor on becoming a regular smoker later in life, especially if their parents or peers smoke as well.

Illicit Drugs and Other Drugs

Other drugs that lead to addiction and abuse are not often thought of as “doing drugs” or even drugs in general. Prescription drug abuse is the next most abused substance by American teenagers other than marijuana and alcohol. These drugs are often obtained from taking a relative’s prescribed drugs without them knowing. Along with prescription drugs, many teens are also using cough syrups as means to get high.

The most popular drug–even though most don’t realize it is a drug–is caffeine.Dr. Harold Urschel, author of Healing the Addicted Brain, said:

“Caffeine is quite addictive in the sense that it is a psychoactive substance. It stimulates certain chemical systems in the brain and this keeps you awake. If you use it on a daily basis, you develop a tolerance, just as you would to pain pills or other drugs. After a while, you need more and more to produce the same effects. Unfortunately, along with waking you up, caffeine also makes you agitated, irritated, and anxious – and those effects increase along with your daily dosage of caffeine. You get acclimated to caffeine’s wake-up aspect, but never to its agitation, irritation, and anxiety aspects.”

Not many people consider or think of caffeine as a drug when in fact it holds the properties of drugs and can become addicting in the sense that some people “can’t function without coffee” or other forms of caffeine.

Treating Addiction

Other than the obvious health issues that come along with substance abuse, there are other problems caused by drug use including overcrowded prisons. Because of the excessive amounts of people either committing crimes as a result of drug use or crimes related to the possession or use of drugs, one suggestion to stop overcrowded prisons is re-evaluating prison sentences for drug-related offenses. But instead of putting a band-aid on the issue, what if there were more efforts into treating these offenders before they get to the point of incarceration?

“Ours is an honorable profession. We serve people who have incredible resilience and drive.” –Jim LaPierre (substance abuse counselor)

The type of treatment used for substance abuse or addiction with the most success varies with each individual. Not only does any given treatment not work the same for any two clients, but each client has a different background and chemical makeup. Kathleen Farkas of the Case Western Reserve University Mandel School of Applied Social Sciences said that “those who have problems with alcohol and other drugs, the age of onset of the problem is important for diagnosis as well as for treatment planning,” saying that some have been dependent on the substance for most of their lives while others began late in life.

 

The Persistent Stigma of Substance Use Disorders

“Stigma is a five dollar word for a two dollar concept. It’s prejudice.”

Stigma, a set of negative stereotypes tied to behavioral health conditions, is not a new problem. Results of a recent survey suggest that views may be changing when it comes to mental illness. Advocacy efforts are getting results, and the public is beginning to recognize that mental illness is, in fact, a health condition.

We need a similar evolution to start when it comes to substance use disorders. Public perception of what it means to be addicted hasn’t shifted significantly. This is a problem.

In a study of Americans conducted by Johns Hopkins University, only 22% of people surveyed were willing to work closely with someone suffering from drug addiction, yet 62% were willing to work closely with someone suffering from mental illness.

Every person struggling to manage a substance use disorder, and every family stigmatized while supporting a loved one, are part of this broader landscape. Our current culture of stigma creates resistance to funding prevention and treatment. Belief that persons with substance use disorders are immoral, not ill, reduces support for behavioral health-centered policy.

Funding for treatment of substance use disorders isn’t commensurate with the scope of the problem. If substance use were recognized by the public as a health issue, it’s likely that prevention would be a higher priority.

We must help each other, and our communities, reshape the distorted image of substance use disorder as criminal and deviant. A person with a substance use disorder remains a person first. Examples of person-first language for substance use are included in this chart shared by Michael Botticelli, Director of Office of National Drug Control Policy. Note: Mr. Botticelli is himself a person in long-term recovery.

Language for addiction

Of course, stigma-free language is only one step and changing a stereotype takes time. We should see this as part of the process of removing structural roadblocks to health. As we break the persistent stigma that clings to substance use disorders, we’ll turn the focus instead to very real opportunities that exist for health and recovery.

Murdered Social Worker Ashley Qualls Featured on the First 48

Ashley Qualls
Ashley Qualls

When the new season of The First 48 began, one of the first episodes on the A&E show featured the case of murdered social worker Ashley Qualls with the investigating detectives from the New Orleans Police Department. Tulane School of Social Work graduate, Ashley Qualls, was working at a substance abuse treatment center when she was gunned down while walking home from work.

Although Ashley was from South Carolina, she moved her family to New Orleans believing they would have more opportunity in a larger city. Each day, she rode public transportation to work, but at night she was forced to walk the 3.5 miles home because public transportation had stopped running. Detectives Nick Williams and Greg Johnson who was featured in the First 48 spoke about how Ashley’s case has impacted them.

According to The Times-Picayune,

“This case touched us in a certain way, because we’re trying to get our city to a certain level, like New York, Chicago, Houston, Atlanta, and have people stop leaving our city,” Williams said. “Here goes a lady trying to make a difference in New Orleans, who’s not even from here. She’s from South Carolina. Not only does she put herself through Tulane to get her master’s in social work, but she goes on to work at the Odyssey House, to do something positive with her career. The tragic part is, this lady doesn’t have a vehicle.”  Read Full Article

Recently, I read about Ashley’s story on another website which stated that “her decision to walk home is what led to her death”. Are you saying that she is responsible for her death because she could not afford a vehicle? This comment appears to be reflective of a larger attitude towards African-Americans who are victims of gun violence.

Often African-Americans are portrayed in the media as people who enjoy receiving unemployment, food stamps, and subsidized housing. This is how the conversation is redirected from better wages, cuts to public services, and sensible gun control.

When hard working people are making the decision to walk home at midnight in order to retain a job, they are literally risking their life on daily basis in order to support their family. When neighborhood schools are closed, this is the same risk many children in minority communities are required to take in order to get back and forth to school each day especially if they are involved in after school activities.

Social workers working in the public sector and nonprofits who can barely support themselves just ain’t right. Thank you Detective Williams and Johnson for not letting Ashley Qualls be forgotten.

Update The unnamed website mentioned above removed the language “her decision to walk led to her death” from their article upon request.

“Anyone with information about the murder of Ashley Qualls is asked to call Crimestoppers at 504.822.1111 or toll-free at 877.903.7867. Tips can also be texted to C-R-I-M-E-S (274637); text TELLCS then the crime information. Callers or texters do not have to give their names or testify and can earn a $2,500 reward for information that leads to an indictment. “ ~ NOLA.COM

Photo Credits: Courtesy of the Times-Picayune and Nelson’s Funeral Home

Living Longer With Palliative Care

November is National Hospice and Palliative Care Month, and it is estimated that 1.5 to 1.6 million patients in the United States received hospice or palliative care services in 2012. Anecdotal accounts indicate that many more who would benefit by this care did not have access to it or had to wait so long that services were provided only during their final few days of life.

Considering that 90 percent of American adults live with a chronic illness before they die, this is an important issue. While some manage well on their own with minimal assistance from healthcare professionals and/or friends and family, others may need more hands-on care and supervision, particularly as their disease burden becomes heavier. We cannot forget that as the population ages, more people with multiple illnesses or conditions will require more supportive care.

livinglongerDoctors, nurses, social workers, chaplains, and allied health professionals play a vital role in educating the public about palliative care and the fact that it is much more than just hospice.  Sharing the same philosophy and patient and family-centric approach, palliative care is the broader umbrella of care for those with a serious or chronic illness and goes hand-in-hand with curative treatment.  Palliative Care is care that may be given while someone is receiving treatment that they hope will either cure them of their illness or prolong their life. Hospice on the other hand is the intensive end-of-life care offered to patients who are projected to have less than 6 months to live and who have elected to discontinue curative treatment.

The other role that health professionals, in particular physicians and nurses, play is in referring patients to palliative care.  When we explore the reasons why health professionals are not referring their patients to palliative care, many reasons surface.  Some of these reasons include the fact that services are not available in their area or that they are afraid of “losing” their patient.  The first reason is valid; the second is not, as most palliative care is consultative.  But the reason that is hardest to understand is when providers do not refer because they believe that a palliative care referral means giving up on life.  In fact, the opposite is true.

As noted above, palliative care goes hand-in-hand with curative treatment.  Most importantly, as an article, published in The New England Journal of Medicine (NEJM) in August 2010 highlighted, researchers have found what many had suspected for some time, that receiving palliative care actually helps patients to live longer.

The researchers evaluated the utility of early palliative care for patients with metastatic non-small-cell lung cancer. Newly diagnosed patients were randomly assigned to either early palliative care in addition to standard cancer care or cancer care alone. The results showed that not only did the patients who received palliative care have a better quality of life; they also lived longer, with a median survival of 11.6 months compared with 8.9 months in the group that did not receive palliative care.  Since this article was published, other smaller scale studies have duplicated these findings.

There are many benefits to the health care system of palliative care because it reduces readmissions, results in few admissions for futile care, and in general, reduces costs associated with serious illness and end of life care.  But, as important as reducing costs is, it pales besides the human imperative to enhance the quality of life of those we care about.  And, no one would disagree that enabling those we love and care for to live as long as possible with the highest quality of life possible is a higher order goal.

Palliative care is an approach that requires close teamwork from healthcare professionals, from nurses and physicians to social workers, pharmacists, dietitians, chaplains, counselors and many more.  Thanks to this teamwork, the needs of the patient and family can be assessed, understood and addressed.  And, thanks to this teamwork, palliative care professionals are helping patients with serious and chronic illnesses live longer and enjoy their lives more.

During National Hospice and Palliative Care month, isn’t it time that all of us who are health care professionals set aside our preconceptions and control issues, make the necessary referrals, acts as teams and focus on the best for patients and their families?

Children From Adversity: Interview with Travis Lloyd

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Children from adversity is a term often used to describe children who have experienced childhood traumas, abuse, and/or stressful conditions which could dwarf their emotional and physical growth. When we think of children from adversity, we tend to imagine children heading down the wrong path towards prison, and we often hear the horror stories of the foster care system going wrong.

What about the successes, and those who defy the odds of escaping their circumstances? Recently, I had the opportunity to interview Travis Lloyd, an artist, and motivational speaker, who had to navigate his way through many foster homes and group homes in order to get where he is today.

The experience and knowledge of a child from adversity is a valuable resource helping professionals should be utilizing more often as a source of expertise. Are we adequately measuring, identifying, and using as resources children from adversity who have escaped their childhood circumstances in order to determine what’s working and what’s not?

Children from adversity who are able to flourish despite their environment often display resiliency and survival skills many researchers still can not predict. Fortunately, Travis is using the skill sets he has developed in order to help others. I ran across Travis on Twitter when I viewed a YouTube video someone tweeted me, and I had to share his story with you.

SWH: Tell us a bit about your background, and what lead to your current role as a motivational speaker.

Travis: I have a story of Achieving Success Against All Odds, which is the mantra that I’ve built my speaking platform on.  This stems from beating the odds of the negative statistics related to foster care.  As far as my young mind could tell, I had a fairly normal life as a child. All of that changed when my parents divorced around the age of 9.  My parents had a rough divorce, as far too many people can relate to.  My father ended up in county jail due to the physical altercations and my mother wasn’t quite able to hold things together so she ended up hospitalized for her emotional instability.  My sister is six years older than me and struggled to cope as a teen.  She ended up running the streets and doing drugs so she went to drug treatment.

I ended up in two foster homes for a couple of months before my mother, sister and I relocated to Iowa, where my mother’s family is from.  Middle school was a struggle between a constantly unstable home life and bouncing in and out of a few group homes.  My aunt and uncle made a difference in my life by taking me out of that environment and giving me a permanent home to live in when I was about 14.  I stabled out in high school, but still struggled with some identity issues when I went away to college.  I started as a business major, but switched to nursing to have a guaranteed good income upon graduating.  I started a career as an ER nurse at the same time as taking custody of my 9 year old nephew.  I wasn’t satisfied working long hours in a high stress environment so I sought other ways to spend my time.  I ended up volunteering for a foster care empowerment program where after only 3 weeks I became the regional program facilitator.  Soon after that, I realized there was a need for people to speak and inspire foster youth and launched my first website.

SWH: When you are sharing your story, what is the reoccurring narrative or feedback you receive from your audiences?

Travis: People often share comments like “your message was very inspiring and encouraged me to stay true to my dreams. I really feel like you touched the hearts of every single person in the room.” I always get a few people who said that they started crying.  Most of these people are the ones who can relate to the childhood struggles or have a close friend or family member who has been through similar things.  They love seeing that “its possible” to overcome and succeed.

SWH: What do you believe are some of the biggest barriers and challenges facing our youth?

Travis: A lack of inspiration for dreaming and a lack of encouragement from the adults in their lives.  There’s a difference between being supportive through providing basic needs versus providing all of the unconditional love and compassion that encourages someone to never see a glass ceiling.  The majority of our youth haven’t had the basics of how to be successfully demonstrated to them.  It’s hard to do something that you’ve never seen before.  And if you don’t have a dream, or feel like your dreams are unrealistic, then what’s the point in staying on the grind?

SWH: How do you feel hip-hop helps you to reach youth who have difficulty opening up to adults?

Travis: I see how drastic of a difference there is with the varied approaches to youth on a regular basis.  I actually still work part time as a mental health crisis worker.  I do psychiatric evaluations for people who are suicidal, homicidal, psychotic, or otherwise in emotional distress.  Sometimes I run into teens who won’t talk to the police officers or any of their friends or family.  When I am able to take off my “professional” hat and talk in their language they almost always start to open up to me.  Sometimes I’ll even spit something a-cappella or encourage them to share something creative of their own.  It is pretty simple.  People open up to people they can relate to. Being able to relate to people from different ages, cultures, and socioeconomic backgrounds is key.

SWH: What future aspiration do you have, and where do you hope this path leads you?

I plan to expand the reach of the message “Achieving Success Against All Odds” into books, audiobooks, hophop CD’s, and training videos.  I recently released my first ever music video for the song “Take Me Away” and plan to produce several more music videos with inspirational messages related to topics that are relevant to youth, social service, child welfare, and mental health advocacy.  As this brand grows, I will expand my company Changing Lives Entertainment to hold hip hop events that make a difference and have a speaker’s bureau for speakers in various markets with similar goals.  Sometime down the road, I will go back to grad school and potentially pursue a doctoral program.  I also have a dream of being the next Dr. Phil.

You can learn more about Travis Lloyd by visiting www.travislloyd.net or visit him on Twitter at @travislloyd

September is National Recovery Month!

“National Recovery Month is a national observance that educates Americans on the fact that addiction treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life”. -SAMHSA

National Recovery MonthNational Recovery Month gives hope to many people who believe a life after the diagnosis is not possible.  This month is vital to challenge some of the negative externalities caused by the stigma on mental illness and substance abuse disorders. Those who live with such conditions deal with discrimination, social isolation, and having a month focused on recovery can be the light at the end of the tunnel.

This month is dedicated to education about prevention and available resources for those struggling with mental illness and substance abuse disorders. Throughout the country, there are programs being done to advocate for those with mental illness.

Recovery month not only lifts people up with positivity, it creates an environment that encourages people to live past their mental illness by taking back their lives. Every day spent as a victim to your mental illness or substance abuse disorder is one day that you’ll never get back but with recovery you can make living with a mental illness worth the fight.

Today hearing recovery stories are becoming more and more popular. People all over the world are standing up again their illness, against the stigma, but most importantly against that little voice that told them they couldn’t have a life passed their mental illness.

There are messages of optimism going around in hopes to help others to find their own path to recovery. Let’s take this month to honor those who have battled mental illness and substance abuse disorders and let’s let them know that recovery is possible and we’ll help them every step of the way.

CSWE Film Festival Series: Finding Refuge

by Maya Navon

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Finding Refuge emerged from an extremely challenging yet life-changing college course. When the three filmmakers entered the course “Producing Films for Social Change,” we had no idea that we were about to begin an emotionally charged, fast-paced, and eye-opening period of our lives. In September 2012, we did not know how to use a camera, edit a clip, or even write a treatment.  Over the course of 3.5 months, we learned each and every aspect of creating a film, from the research stage to post-production, and emerged with a 20-minute piece that we were proud to share.

The idea for Finding Refuge stemmed from a class discussion about the topic of refugees. Armed with this very broad topic, we preceded to contact various refugee organizations. After weeks of trying to find just the right niche in this realm, we finally made a breakthrough with the connection to Natasha Soolkin, director of the New American Center in Lynn, MA. We knew that we wanted to focus on refugee resettlement in the United States; particularly, the various challenges and triumphs newly resettled refugees face when they arrive in the United States. However, we also knew that this topic would have no impact without a personal story. We needed a refugee to share his or her experiences, and it would be no small feat to find someone. Luckily, Natasha had just the person for us who would bring a voice to this issue: Mani.

Once we connected with Mani, the documentary finally took shape. We spent countless hours interviewing Mani and his family, touring his home and office, and getting a glimpse into his new American life. We also spoke to a wide variety of experts and workers in the field of refugee resettlement to gain a broader understanding of the journey from a place of turmoil to a new life in the United States. In a few months we had our final product: a piece shedding light on refugee resettlement through the story of one courageous, hard-working, and resilient man.

Our connection with Mani extended far beyond filmmaker and subject. He touched our lives with his story and made us realize the true meaning of strength. After spending 17 years in a refugee camp, Mani managed to keep his spirit and his thirst for success alive. The perpetual smile on his face reminded us to always stay positive, even in the face of hardship.

http://www.youtube.com/watch?v=b7xgRqqGDD4

Conversion Therapy on Minors Made Illegal in New Jersey

by Polly-Gean Cox, LCSWA

Monday August 19th, Governor Chris Christie of New Jersey declared the practice of conversion therapy on minors  illegal in the state of New Jersey by signing into law bill A3500. Christie was found  in support of the American Psychological Association’s (APA) findings of conversion therapy in which results of conversion therapy were found to pose critical health risks including but not limited to depression, substance abuse, social withdrawal, decreased self-esteem end suicidal thoughts.

“I believe that on issues of medical treatment for children we must look to experts in the field to determine the relative risks and rewards. I believe that exposing children to these health risks without clear evidence of benefits that outweigh these serious risks is not appropriate.  Based upon this analysis, I sign this bill into law.” Read More…

New Jersey is the second state to declare conversion therapy illegal since California in 2012.

So What is Conversion Therapy?photo

According to the American Psychological Association, sexual orientation conversion therapy also known as reparative therapy refers to counseling and psychotherapy to attempt to eliminate individuals’ sexual desires for members of their own sex.  

How Did Conversion Therapy Originate?

In the 1920’s Sigmund Freud’s research on sexuality laid the foundation for future researchers to engage in Conversion Therapy. In the 1940’s and 50 Edmund  Bergler saw homosexuality as a perversion and believed he could “cure gay people with a punishment based therapy. When the original  Diagnostic and Statistical Manual DSM was released in 1952, homosexuality was listed as a mental illness in which aversion therapy, and conversion therapy was considered the best practice treatment method. It wasn’t until 1973, when homosexuality was removed from the DSM as a mental illness. Reparative therapy is no longer used or supported by several mental health organizations and looked upon as a harmful practice.

According to a statement issued by the  National Association of Social Workers:

“Aligned with the American Psychological Association’s (1997) position, NCLGB [NASW’s National Committee on Lesbian and Gay Issues] believes that such treatment potentially can lead to severe emotional damage. Specifically, transformational ministries are fueled by stigmatization of lesbians and gay men, which in turn produces the social climate that pressures some people to seek change in sexual orientation. No data demonstrate that reparative or conversion therapies are effective, and in fact they may be harmful.”

Despite the removal of homosexuality from the DSM, conversion therapy is still practiced by several religious institutions. This therapy is harmful and has dangerous ramifications, and it is considered by many professionals a legalized form of child abuse. I urge the rest of the United States to follow California and New Jersey’s footsteps on this issue because no child should endure this treatment.

Please watch the following video as Sam shares his experience with conversion therapy. Caution this may be difficult to watch. 

[youtube]http://www.youtube.com/watch?v=Qf5dqzcy3bc[/youtube]

 

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