Favorite quotes; Addiction flare-ups; Winning and what works.

savvy

I have known Dr. Norman Hoffmann for over 30 years as a friend and colleague. Over the years of many presentations I have enjoyed and appreciated, Norm has shared quotes and quips that provide bits of wisdom as well as humor. Recently, as I listened again, I thought it was time to get some of those into print. So here a few of Norm’s favorites and what they mean.

TIP 1

Ponder these quotes and the wisdom they hold as told by Dr. Hoffmann.

1. “For every complex problem, there is a simple answer; and it’s wrong.” Attributed to H. L. Mencken.

• So often people look for a simple answer, or fix, to complicated issues instead of a more comprehensive approach.

2. “The truth is rarely pure and never simple.” A line from the play, “The Importance of Being Ernest” by Oscar Wilde.

• This is similar to the Mencken quote in that things are often more complex than we would like them to be.

3. “If your theory conflicts with folklore, recheck your theory.” This is a comment made by Paul Meehl during a graduate school seminar at the University of Minnesota.

• Folklore is often based on observed associations. The folk explanation for the association might be fanciful, but the association is quite real.

4. “For the great enemy of truth is very often not the lie – deliberate, contrived, and dishonest; but the myth – persistent, persuasive, and unrealistic.” By John F. Kennedy in a commencement address at Yale.

• Myths and misconceptions can often be more damaging than deliberate falsifications.

“Then there are a few for whom I do not know the originator or ones that I have adapted from some recollection.” Here they are:

5. “Left unchallenged our beliefs become our truths.”

• All too often we may have a tendency to go with the myth that is comfortable rather than to consider the truth, which may be disquieting.

6. “If you torture a statistic long enough, you can get it to confess to anything.”

• As one who reads the literature on addiction, I am often disturbed that the numbers underlying the conclusions do not seem to support the contentions of the authors.

7. “Beware of a theory that explains everything, but predicts nothing.”

• One can often come up with any far-fetched idea to explain something, but it is not replicable or predictive.

8. Finally, there is my own favorite contribution: “A computer program can make a diagnosis when it is licensed for independent practice in your state.”

• Too often I find people who want computers to do their thinking for them instead of examining the evidence and thinking for themselves.

TIP 2

Enjoy some vague terms often used in addiction and some fanciful definitions of Dr. Hoffmann.

1. “Heavy drinker”

• Someone who weighs 250 lbs. and drinks.

2. “Problem drinkers”

• People who spill more than they swallow.

3. “alcohol abuse”

• Pouring water into good Scotch.

4. “Data is not the plural of anecdotes”

• This addresses the issue of using memorable examples to support a position rather than actual statistics that might be quite different. (David Mee-Lee: Just because you have lots of examples and stories that support your views and perspectives, doesn’t mean you have valid research data.)

Norman Hoffmann, Ph.D.

President, Evince Clinical Assessments

E-mail: evinceassessment@aol.com

www.evinceassessment.com

Bio:

Dr. Hoffmann is a clinical psychologist who has evaluated behavioral health programs, provided consultations, and conducted trainings for over 35 years. He has worked with private organizations and governmental agencies in a variety of countries. Dr. Hoffmann has developed a number of assessments instruments used throughout the United States, as well as in Canada, Sweden, Norway, and the United Kingdom and authored or co-authored more than 190 publications. Take a look at some of Dr. Hoffmann’s work:

His faculty appointments include the University of Minnesota and Brown University. Currently he is President of Evince Clinical Assessments and adjunct professor of psychology at Western Carolina University.

skills & stump the shrink

Earlier this month, Ian Evans sent me the following message:

I was curious about slips when a client is in residential. Recently some programs we deal with have discharged clients who have drunk or used while on their pass. To me, it seems that residential treatment is the perfect place to deal with this issue. The client is in a structured environment, counselors they are familiar with, and in a treatment facility that can help them figure out what happened, why it happened, coping skills for the future, etc.

            I have heard various reasons why: it being unsafe for other clients, there being state guidelines that someone must be discharged if they use while in treatment, etc. I was curious not only your thoughts on this in general, but also if you are aware of any guidelines for residential facilities in these instances.

            I have reached out to the Department of Health Care Services as well, but to me it seems to make the most sense to allow someone to get treated in treatment rather than discharging and creating policies such as the client needs to check in and go to meetings every day for 2 weeks before they can come back to treatment.

Thanks,

Ian Evans MFTI #78016

Clinician I, Adult Forensic Care Team

Yolo County Department of Health Services, California

Work Cell: (530) 681-8165

Voicemail: (530) 666-8099 ext 1803

E-mail: Ian.Evans@yolocounty.org

TIP 1

Note how our attitudes and actions about substance use while in treatment does not fit with treating addiction as a disease.

Hi Ian:

Your concerns are what I have written and spoken about a lot. Here are some links to what I have written before. You should also look at Appendix B in the latest edition of The ASAM Criteria (2013) pp. 401-410 where we suggest an approach and policy and procedure on use while in treatment. If you don’t have the latest book, I suggest you get it. See www.ASAMCriteria.org for more information.

Here are some links. If the links don’t work, go to www.tipsntopics.com and click on the edition on the right hand side Archives:

A. Tips and Topics, July 2014:

• In SAVVY of this edition, I wrote about the steps to consider when a person uses substances while in treatment.
• In SKILLS, note what taking action means when a person uses while in treatment. It isn’t about discharging a person or transferring to a more intensive level of care.

B. Tips and Topics, October 2012:

• In SAVVY of this edition, I wrote about how we don’t treat addiction flare-ups the same way we treat flare-ups of other illnesses like depression, schizophrenia, hypertension, bipolar or panic disorder.
• I also referenced an interview with William Miller (Motivational Interviewing) who raises the question whether “relapse” is even a useful clinical term.

C. Tips and Topics, November 2012:

• In SAVVY, look at some alternative terms for “relapse” and try those on for size.
• In SKILLS in this edition, here’s what to do when a client uses in residential treatment; when discharge is clinically reasonable and when it is not.

D. Tips and Topics, June 2009:

• In SKILLS, look at what to do when concerned that letting substance-using clients stay in treatment will trigger others and send a message that it is OK to use if there are no “consequences” for use.
• Also see what to do when you get a poor outcome like a flare-up of use in an addicted client – assess and change the treatment plan like we do with other illnesses.

E. Tips and Topics, October 2004:

• In SAVVY, I reference the constructs in ASAM Criteria Dimension 5, Relapse, Continued Use or Continued Problem Potential which first appeared in ASAM PPC-2R (2001) but is available in The ASAM Criteria (2013), Appendix B, pp. 401-410. These help you assess and treat flare-ups of addiction instead of discharging people.
• Also in SAVVY, understand the difference between ASAM Criteria Dimension 4, Readiness to Change and Dimension 5.
• In SKILLS, suggestions on what to do when a person arrives to a group having used alcohol or some other drug; and what to do if there is a positive drug screen.
• Do clients in early stages of change, need relapse prevention strategies? See the answer in SKILLS.

F. Tips and Topics, September 2006 SKILLS section:

• In SKILLS, look at “Things That Don’t Make Sense” and what to do about them. It will reinforce the suggestions of the previous editions above.

Hope this helps, but let me know if not.

David

TIP 2

In a follow up message, Ian raised a common State policy preventing clinicians from treating relapse and flare-ups as assessment and treatment issues.

BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS

Health-Related Services.

Title 9 Section 10572 (e) that states:

“(e) No person, who, within the previous 24 hours, has consumed, used, or is still otherwise under the influence of alcohol or drugs as specified in section 10501(a), shall be permitted on the premises except for individuals admitted for detoxification or withdrawal. The licensee shall have specific written rules and policies and procedures to enforce this provision.”

Ian’s message:

It may be a huge question I am asking here, but do you see any way of working with the State to amend this so that if a client has a slip while on a weekend pass that they are not told they are discharged and must come back in 72 hours or 2 weeks like some programs do? There’s just something about discharging someone from residential treatment for slipping on a weekend pass and having them go back to the very environment they were using in before treatment that doesn’t sit well with me.

Thanks for your time,

Ian Evans

Perhaps you have similar regulations in your State or county. I have pledged to Ian that I will do what I can to raise this sticky regulation with the powers that be to start a conversation for change:

• How can we combat the discrimination and stigma that addiction attracts even in our treatment system?
• How we can we start treating addiction and flare-ups and poor outcomes the same way we treat other chronic conditions, instead of marginalizing clients and patients – discharging them and contributing to already high dropout and premature discharge rates?
• What would it take to change attitudes of the general public, criminal justice and especially treatment providers in general health, mental health and addiction treatment to take addiction seriously as an illness needing care, not punishment, rejection, incarceration and discharge?
• How can we begin to change policies, procedures and regulations to fit the disease of addiction rather concepts of willful misconduct and need for punishment?

Let’s start the conversation.

soul

I’m not really an avid sports fan (except maybe for the New England Patriots National Football League, NFL, team). I am much more interested in the psychology of sports than the actual mechanics of why a person or a team wins. So when I heard that the Golden State Warriors (the San Francisco Bay area National Basketball Association, NBA, team) were about to make history, it sparked my interest. Golden State was about to have the best regular season start (16 wins in a row) in the NBA’s 70-year history.

As I listened to the sports pundits and commentators opining on why Golden State was so successful, I was intrigued by their explanation and analysis, heard on San Francisco public radio station KQED’s Forum with Michael Krasny. If you are into sports and want to listen, here’s the link: http://www.kqed.org/a/forum/R201511230930

• Often, when a team wins the NBA championship as Golden State did last year, players start getting inflated egos and entourages. Humility goes out the window. On this team, players have stayed humble and are “just having fun”.
• A number of the players had been written off in the past as too small to be an effective player; or clearly not a top tier prospect; or late to the game and inexperienced. They all had something to prove and worked hard to debunk the critics. Even with their proven success, they are still “hungry” to win and while confident, are not complacent.
• “Unselfishness” – Golden State, like other teams, have created success by unselfish play consisting of many “assists” and moving the ball around to all players on the floor. The goal was to score a basket: get the points as a team rather than each player trying to be the star, drive to the basket to get the points on their scorecard.

Humility, fun, hard work, confidence but not complacence, unselfishness and team work – sounds to me like a winning formula for life, not just basketball history.

You might be interested to know that the Patriots are one of only two teams out of 32 in the NFL to have a winning start to the season, unbeaten in 10 games so far. I wonder if that is because of humility, fun, hard work, confidence but not complacence, unselfishness and team work too? Some other teams accuse the Patriots of being arrogant and cheaters, but they’re just jealous.

Go Pats!