TIPS & TOPICS from David Mee-Lee, M.D.
Volume 9, No. 5
August 2011
_______________________________________
In this issue — SAVVY – A new definition of addiction from ASAM — SKILLS – What the new definition means to you, your program and systems — SOUL – Charley horse — SHARING- Readers’ comments — Until Next Time |
Welcome to the August edition of Tips and Topics (TNT). Glad you can join us. |
SAVVY
______________________________________________________ |
This month, the American Society of Addiction Medicine (ASAM) released a new definition of addiction. In the August 15, 2011 press release, a few of the “talking points” were highlighted:
In SAVVY this month, I will discuss some of implications of the new definition. TIP 1 TIP 2 1. If you just look at the behavior of a person with addiction, you may see a person who lies, cheats, breaks laws and appears to lack good moral values.
2. So if you say a person has the disease of addiction, are they not still responsible for their behaviors? Or in other words are you letting them off the hook by saying they have a disease?
3. If healthcare professionals, facilities and insurance benefits packages only focus on the substance use and related complications, the underlying addiction illness is not treated. As a result, people with addiction keep presenting with complications and can switch in search of other rewarding substances and/or addictive behaviors.
|
SKILLS
______________________________________________________ |
If the healthcare system really embraced this new definition of addiction, what would be some of the implications? TIP Check if you, your treatment team or your community really embraces addiction as a primary disease. Here’s what it would mean to clinical skills, healthcare and criminal justice systems’ change, funding and managed care organizations: |
|
|
|
SOUL
___________________________________________________ |
A “charley horse” is a popular North American colloquial term for painful spasms or cramps in the leg muscles, typically lasting anywhere from a few seconds to a few hours (Wikipedia). A few weeks ago “charley” visited me in the middle of the night -uninvited, unannounced and definitely unwelcome. He visits only occasionally, but always with a jolting, attention-grabbing, wake-up call. Every time, I gain a fresh appreciation for people who suffer pain – especially racking, chronic and debilitating pain. If you’ve ever experienced a “charley horse” you know the helplessness for those few seconds or minutes – all you can do is be riveted by the pain which catches your breath and immobilizes you. I can’t imagine what it would be like to have severe pain almost all day, every day. Well, I can imagine a bit. Fifteen years ago, I had several bouts of severe lower back pain where I could hardly walk. Carrying my brief case or getting in and out of a car was almost impossible. And being there for the birth of my three children, I got to see what labor pains are like…. and from all the swearing…. I got it that they are pretty painful. I don’t minimize the pain of birthing, but it is time limited and we were rewarded with three fabulous prizes at the end of the pain. Fortunately, my back pain is contained by daily, preventive, lower back muscle strength-building abdominal crunches and pelvic tilts; and there have been no labor pains to witness for decades. However when “charley” visits, it all floods back quickly and I remember what a “pain” pain is. I still don’t know the underlying cause of my charley horses, or what I should do about it as it is infrequent and comes and goes quickly – out of sight, out of mind. But with addiction, the physical, emotional, mental, social and spiritual pain does not come and go quickly; it usually worsens without treatment of the underlying cause of those manifestations. And like a charley horse that cannot be ignored, it should not be ignored. |
SHARING
______________________________________________________ |
Last month’s Tips and Topics on Amy Winehouse’s untimely death and Stump the Shrink question grabbed the most attention and reader responses in quite a while.
Here is a comment on the Stump the Shrink question last month about a father wanting advice on how to help his daughter suffering from addiction and my response to their comments. Comment #1 “Tough love and detach…..sure, that is the staid wisdom. But, without financial resources, the tough love won’t help her get into treatment. I’ve met with a prior client who is now very bitter because of past debt of well-meaning treatment efforts. These bills go to collection. Now, although she may need assistance again, she is so bitter about the financial mess she will not benefit from treatment–only resent it. She is not an isolated instance.” My response Thanks for your comments. You make some good points. Without good health insurance or universal healthcare (or independent wealth that can afford to pay out of pocket), people can’t afford the care they need for addiction treatment and every other acute and chronic illness. The bitterness your client and many other patients feel can be re-told over and over – for huge bills when receiving care in emergency rooms; procedures for surgical, cancer, heart and lung conditions, hip replacements…. and the list goes on. Until this country figures out how to commit to universal healthcare, there are over 50 million people without healthcare coverage and many others with inadequate insurance. So your client is not alone. What I would say about addiction clients and their bitterness about treatment costs is the following: 1. That treatment facilities ought to be flexible and individualized in their approach with clients- to collaborate with them on which treatment is best for the client’s outcomes and finances etc. Too often addiction programs plug people into pre-determined programs and fixed lengths of stay. Clients do not feel empowered to question the treatment recommendations and make an informed decision which takes into account their cultural, financial preferences and goals. 2. Increasingly addiction treatment programs will need to look at “value” (i.e. cost of services + quality and outcomes). What does “value” look like for a person who relapses? It looks like an arrangement where it can be worked out so services for the person can be continued, without subjecting him to an unnecessary ‘re-entering’ a program as if he was a brand new client. 3. Addiction clients may be bitter at the costs of care. However as they recover, hopefully they will see that financial loss (along with all the other losses) is all part of the devastating illness of addiction. In retrospect, we hope they will remember all the times they have probably spent equal (if not more) resources on getting drugs, and repairing the costs of this to their family. Let’s hope they start to acknowledge the financial costs due to their illness, the employment income lost from job problems due to addiction, the legal costs they’ve incurred etc. Keeping this context in mind, if the individual can arrest those human and financial costs by entering treatment and recovery, they will make up the financial costs of treatment by arresting their addiction. They will also gain back much of what they have lost socially, physically, spiritually and financially if they keep active in recovery. When viewed from that perspective, the investment in treatment will bring a far greater return on those financial resources than the return on investment in the years and dollars spent on addiction. David Comment #2 “Hello, Dr. Mee-Lee. I am the mother of a 35-year-old son with bipolar disorder and meth addiction. I was especially interested in your last newsletter. I run a NAMI (National Alliance on Mental Illness) support group for families with a loved one with co-occurring disorders, and the letter that you responded to could have been one that any of us could have written during our journey. There were two specifics that I wanted to address. While talking about Amy Winehouse you talked about her family’s need for education. What we have determined in our public behavioral health system is that unless your family member is actively involved with a treatment provider, you are not eligible for education and/or support. Hence why we went to NAMI to see if we could get support. I find that often the family is blamed for “enabling” their loved one when in reality, they are unsure what to do and have little availability for assistance. Also, in my experience, I’ve found many families that found the stigma of substance use even more threatening than mental illness, and would not accept that the substance use was anything more than a person “self medicating” and therefore the result of a disorder rather than a disorder itself. So, just as a client may be pre-contemplative, so are many family members! You also spoke about interventions and I currently am not well-versed in this process. Is there a reference that you can provide me to allow me to research this more? I forward your email to my support group members every month and it often leads us to discussion. I appreciate the information you provide. I only wish the information you do share was more evident in our system of care. Thanks again.” My response Thanks for taking the time to write and you raise some important points about blaming families and how to help families. As regards to Intervention in addiction treatment (and other process addictions), if you go to Google and type in “Intervention in addiction” you will get more information that will help. If not, let me know. David |
Until Next Time
______________________________________________________ Thanks for joining us this month. See you in late September. David |