ACA and Addiction Treatment

25 millionThis is from the Office of The Assistant Secretary for planning and Evaluation regarding the Affordable Car Act and treatment for alcohol and other drug problems:

The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans. The parity law aims to ensure that when coverage for mental health and substance use conditions is provided, it is generally comparable to coverage for medical and surgical care. The Affordable Care Act builds on the parity law by requiring coverage of mental health and substance use disorder benefits for millions of Americans in the individual and small group markets who currently lack these benefits, and expanding parity requirements to apply to millions of Americans whose coverage did not previously comply with those requirements.

There are approximately 25 million Americans who need addiction treatment, yet only around 10% actually receive treatment, and it’s questionable if some of this treatment is actually focused on addiction. Alcohol and other drug problems are responsible for a large part of our national healthcare costs. Heroin addiction alone causes physical problems most people wouldn’t consider — this is from National Institute on Drug Abuse:

Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV (see box, “Injection Drug Use and HIV and HCV Infection”). Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin’s effects on breathing.

In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.

Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization. According to a recent study, treating opioid-addicted pregnant mothers with buprenorphine (a medication for opioid dependence) can reduce NAS symptoms in babies and shorten their hospital stays.

Perhaps, now that insurance will pay for treatment, more people will receive the help they need. Along with access to treatment, treatment itself has to improve. Maybe there will be greater effort to identify treatment that specializes in alcohol and other drug problems, and maybe the medical community will do a better job identifying the problems and prescribing treatment.




Opiates and Benzos – High Risk

benzosHealth professionals in Savannah, Ga have to pay special attention to opiate addiction due the fact we have a military base in the middle of town and another one close by in Fort Stewart. Opiate addiction is not only a problem with wounded soldiers, though, it’s a common problem among all parts of society. Opiates used with other drugs create even more risk. One really dangerous mixture is benzodiazepines and opiates. This is from a NPR article.

When actor Philip Seymour Hoffman died of an overdose in February, the New York City medical examiner ruled that his death was the result of “acute mixed drug intoxication.” Heroin, cocaine and a widely prescribed class of drugs known as benzodiazepines, or benzos, were found in his system.

When someone begins taking opiates or benzos, they seem harmless, because the drugs generate a sense of peace and well-being. What these drugs can do, though, to those who become addicted, is impair judgment. If someone who’s addicted to opiates finds out that benzos can enhance the opiates and give them the euphoria they first experienced with opiates, the person will likely start mixing the drugs with little rational thought or caution. This creates a synergistic effect where the combination-effect is greater than just the sum of the two drugs. If you add alcohol to this mix, overdose risk goes through the roof.

The danger of using drugs that alter the way we think and feel is that a certain percentage are susceptible to addiction. Once a person is addicted, rational judgment is damaged to the point the person makes what appears from the outside to be insane choices. In the addict’s world, though, the choices make sense, because they are focused on maintaining a physical dependence and driven by a psychological craving for the effects of the drugs. This combination overwhelms will power and rationality, even in otherwise strong willed people. It’s baffling to loved ones who have known the addicted person as someone who is smart and disciplined and willful in other areas of life — to see the loved one act insanely when it comes to drugs is perplexing and maddeningly frustrating.

Recovery is about removing the drugs safely, because the withdrawal can be horrible from these drugs, then beginning the long process of allowing the brain and emotions and relationships to heal. The addicted person should be treated like a sick person who needs professional, medical help — they are at serious risk, especially when they combine these drugs.

Outpatient Addiction Treatment

relapse preventionSo, what’s the purpose of outpatient addiction treatment? There are several aspects to addiction treatment, and it’s important to understand the transitional phases. In the beginning, the main goal of treatment is to assess and stabilize. If the assessment shows outpatient treatment is appropriate, then the person is medically assessed to make sure there are no physical complications. Addiction presents itself as an acute, immediate problem, characterized by loss of control, legal problems, relationship problems, financial problems, employment problems, physical problems, emotional problems, etc. Not everyone coming into treatment is dealing with problems in all these areas, but they have problems associated with drug use. When I write “drug use”, I also mean alcohol, which is simply a legal drug, even though it causes more problems, collectively, than any other drug.

Although treatment professionals are presented with symptoms of addiction in the beginning, after a period of assessment and stabilization, treatment shifts to a different client/therapist relationship, an educational/therapy phase. Outpatient treatment doesn’t have the luxury of inpatient treatment where the patients are a captured audience. Outpatient clients go home after group, so it’s important to educate the client on abstinence skills from the beginning. Relapse prevention education should start immediately in outpatient. Once the client enters group, there’s a dual approach of group therapy and education. The client is taught that they are responsible for their recovery, although they don’t have to do it alone — there’s support available. Recovery support can come from different sources: family, employer, 12 Step groups, churches, etc. Clients in addiction outpatient treatment are encouraged to develop relapse prevention plans that best suit them and their situations. Not everyone has a supportive boss, or a job, and not everyone goes to church, and not everyone has a supportive family — so the individual works with the counselor to develop a realistic recovery plan.

As outpatient treatment comes to an end, the client should understand by this point that recovery is a long term process. When the client came into treatment, they presented with an acute, emergency situation with lots of symptoms, but the client learned addiction is a chronic and progressive condition that will only get worse if they don’t manage their recovery long term. Treatment is the difference between dealing with symptomatic problems with symptomatic solutions and dealing with fundamental problems with fundamental solutions. Although outpatient addiction treatment programs deal with symptoms in the stabilization phase, treatment is about applying fundamental solutions to fundamental problems. Too many people deal with the symptoms of addiction and never address the fundamental problems.

Recovery is a Process

processWhen I came to Savannah, Ga in 1993 to start a substance abuse outpatient facility, I’d been working in the addiction field for 10 years. This was still a big change for me. I’d visited Savannah many times through the years, but I’d never lived in Savannah — plus, my wife and I were responsible for creating an outpatient facility from scratch, and this I’d never done. It was frightening and exciting.

Change is like that — frightening and exciting. At the time, we had both learned enough to know that we had to concentrate on the process and not worry so much about the outcome. We could control each day only those things which had to be done for the facility. We bought furniture, put together policies and procedures, set up a financial system, etc. Yes, we made long-term plans, but we could only carry out these plans daily.  Before long clients came to us for help with alcohol and drug problems, and we were concentrating on the purpose of the facility, providing treatment for addiction.

The recovery process is a lot like this — a person can only do what they can do, and they can’t control the outcome. Focusing on the process allows a person in recovery to lessen the anxiety that comes with thinking about forever or all the things that can go wrong. A lot can be said for the saying “One Day at a Time”.

When a person in recovery is in the process of recovery, they’re doing what they can do to make changes one day at a time — they aren’t proclaiming they’ll never drink or do drugs again — they’re saying that today, this minute, they’ll stay sober by doing the things that lead to long-term clean and sober living. Each day of sobriety builds on the others and before long the person has changed and embraces this new way of life.

Of course there are obstacles, and at times recovery becomes very difficult, but by utilizing all the tools of recovery, such as support groups, friends and family, the obstacles are overcome one day at a time, and the person grows from the struggle. There’s something to learn in the good times and the bad times.

It’s cliché by now to say we learn from our failures, but it’s true nonetheless — however, something that’s not talked about enough is what we learn from our successes. Many in recovery are more afraid of succeeding than failing, although that might seem counterintuitive. Succeeding means facing the responsibility of maintaining the success, and this can overwhelm those who’ve been unable to consistently meet their responsibilities. If no one expects much of a person there’s little pressure for him or her to perform at a higher level. In recovery, though, a person has to accept the responsibility of change, has to expect more from themselves, even if some others don’t, if there’s going to be long-term recovery. The good news is no one has to accept the responsibility alone — there’s plenty of help. There are people who understand the process and will help.

So, here I am 21 years later, opening another treatment facility — frightening and exciting, but I’m not doing it alone.

Addiction and Denial

If you know anything about addiction problems, then you know denial is a big part of the defensive system built up over years by the individual with a problem. Denial is also often present among family members and friends of the addicted individual.

Here’s an article that’s very helpful for those who want to understand denial more fully.

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