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January 2011

Substance Misuse Counseling 101 for Parents

Understanding some basic principles of substance misuse counseling will help you as parents develop an approach to intervening with your child.

Substance misuse is a problem that involves the interaction among physical, emotional, social (friends), and environmental (family, school) variables. In the course of our normal daily interaction with our kids, we’re usually aware of any physical, social, and environmental issues. Since children are often not able to articulate their emotional struggles well, we need to look at their behaviors as possible signs of conflict.

People use drugs for reasons. And our behavior, no matter what age, reflects choices we make based on how we think and feel. Also, as humans we tend to move towards rewarding activities and away from uncomfortable activities. Problems with drinking and drug use are associated with the harmful choices we make, often as ways of helping us feel better in the short run. Chemically, alcohol and drugs offer available options ways to self-medicate the uncomfortable feelings of daily life.

The Ongoing American Tragedy Update

Several weeks have passed since I first wrote about the Tucson atrocity (AN ONGOING AMERICAN TRAGEDY) expressing dismay at what I described as an ongoing American tragedy: How the American public’s ignorance about mental illness and the shame and stigma associated with mental illness and mental health treatment directly contributes to the lack of appropriate treatment that could reduce the vulnerability of the mentally ill and the likelihood for them to commit these crimes.

I’m encouraged that the predictable blame game has seemed to run its course and some of the national debate has shifted a bit towards turning to a more responsible discussion of the woefully inadequate mental health and addiction treatment system in the United States and what needs to be done with the architecture of this system to reduce the likelihood of another attack.

As information became available about the perpetrator’s drug abuse issues, the silence about the drug abuse use part of the problem has been deafening.

Let me fill you in on the field of addiction psychology’s version of the blame game. It occurs thousands of times every day when decisions about who will provide the care for a mentally ill person who also abuses alcohol and/or drugs. Or, alternately, when a substance abusing person with serious mental health issues needs treatment.

Substance abuse and addiction never exist in a vacuum. Although I’m simplifying here for illustration purposes, addictions are a result of the interaction among our biological and emotional makeup and social/environmental influences. Problems that addictions cause are associated with the negative choices we make, often as ways of helping us feel better in the short run.

As humans we tend to move towards rewarding activities and away from uncomfortable ones. People with mood problems (depression, bipolar disorder), anxiety (panic attacks, excessive worry, obsessive-compulsive rituals) and schizophrenia (unwanted systematic delusions and beliefs) sometimes turn to alcohol and drugs as available options to self-medicate their brain disorders that create constant and intense emotional pain for them.

Professionals refer to this common and intertwining nature of mental health and addiction problems as a co-occurring disorder. Unfortunately, our treatment system forces us to split the person’s problems up in order to find the appropriate treatment program. Treatment programs are usually more prepared to address either the mental health problem or the addiction. This makes finding adequate, comprehensive care extremely difficult.

Our field has come a long way since the mid 1980’s, when, as an on-call clinician looking for an emergency hospital admission for a person who likely would be out on the street without immediate treatment, I’d have to stand by on the phone while administrators [a.k.a. those paying for the care] would literally argue over who had responsibility for the care. And I’d often be on the other end having to deliver bad news to the client: the comprehensive care he/she really needed wasn’t available. I then had to make a makeshift plan for the person to ensure the person’s safety for that moment until we manufactured a Plan “B”. These administrative “turf” battles are rare now and the dichotomy between mental health care and addiction is better today, but not much.

It’s evidenced daily by the responses in hospital emergency rooms when a mentally ill intoxicated person shows up, or when police are called to homes when a mentally ill family member is acting scary and threatening. “He’s drunk, he needs to sober up”; “He’s high on drugs. What do expect us to do?” are the usual responses of first responders. Parents and family members of those with co-occurring disorders live with the fear, dread, shame, guilt, and helplessness associated with these scenarios that are regular occurrences for them.

When someone has diabetes, cancer, or heart disease, their condition usually can be treated comprehensively with the necessary multidisciplinary approaches available. Good luck to the person with an emotional problem and corresponding substance abuse problem looking for quality, comprehensive care. It rarely happens. Part of this is due to the above dichotomy in care, but the major problem is due to the unwillingness of insurance companies and shortsighted employers who purchase insurance plans for their employees to provide funds necessary for the adequate care of mental health and addiction problems.

The Mental Health Parity and Addiction Equity Act of 2008 provides insurance for employed people. People with severe co-occurring disorders can’t keep jobs, so not much help there. President Obama’s Patient Protection and Affordable Care Act of 2010 is a step in the right direction, but the reality is that insurance rarely provides enough coverage for the seriously mentally ill and/or the chronic disease of addiction.

DJ Jaffe, a national advocate for the seriously mentally ill, displays insight and irony in his Huffington Post depiction of “Mom [as] the new mental institution, given the responsibility to see their loved one stays well but not the ability to enforce medication compliance or get the mental health system to take action….Mrs. Loughner never wanted Jared to become a headline for hate. This is the mental health system we have in America. It caters to the well not the ill”

It takes an enormous amount of courage to ask for help for an addiction or mental health problem. It’s usually even more difficult for parents and family members (and yes,especially the Mom’s!) to reach out for help for their loved one. I’m hoping the national debate will allow more people in the mainstream of America to learn more about the true nature of mental health/addiction problems and treatment, reduce the shame and stigma associated with asking for and receiving help, and give our moms and all the members of our families a better chance to be productive members of our families and society.

What happened in Tucson is a horrendous tragedy. What’s happening on a daily basis to the millions of Americans with co-occurring disorders who are not able to receive proper care is a tragedy we can actually do something about.

An Ongoing American Tragedy

by Barry Lessin

January 13th, 2011

This post is not like any other post I’ve written.

I feel the need to respond to the Tucson AZ chapter of an ongoing American tragedy. I’ve been waiting for my feelings and thoughts to settle down a bit before I responded because I needed some time to think through what happened and put it into a context that makes sense to me. It’s very hard to do since much of what is being discussed in the media about it doesn’t make too much sense to me.

Not to belittle the traumatic and senseless loss of life from yet another mass murder by an untreated severely mentally ill person, but the predictable 24/7 media carousel that horrific events such as these generate is disgusting and intolerable.

The issues surrounding the killing spree that are thrown out to us from our many screens, if we choose to watch or listen, focus mostly on all the sources of blame for the tragedy: the hateful political climate, right wingers, left wingers, schools, parents, guns, public apathy, inadequate involuntary commitment and treatment laws, among others.

Hidden in there somewhere is an American tragedy affecting millions of us, but seemingly few want to acknowledge. The public’s ignorance about mental illness in general, how violence is associated with mental illness specifically, and the shame and stigma associated with mental illness and mental health treatment—directly contributes to the lack of appropriate treatment that would lower the likelihood for many vulnerable mentally ill people to commit these crimes.

This tragedy goes ignored, so unfortunately attacks like the one in Tucson occur on a fairly regular basis in the United States in a variety of public, private, and corporate settings and across varying political climates throughout our country’s history.

A commentary I read by Paul Heroux in the Philadelphia Inquirer this week helped put the tragedy in perspective for me. He verbalizes what I see as a blazing red neon warning sign, but what few people fail to recognize as a constant in these tragedies when he says “How much we know about mental illness can tell us how prepared we are to deal with [such attacks]”. We’re never prepared because the issues of mental illness and its treatment are virtually ignored by those in control to make changes.

He also discusses the recent issue of the Harvard Mental Health Letter (HMHL) that reviews the various factors that contribute to violent behavior in the mentally ill. According to the HMHL, those with schizophrenia or bipolar disorder are three to four times more likely to be violent if they also have a substance abuse problem. In addition to substance abuse, Heroux explains, “genetic and environmental factors, such as poverty and early exposure to violence, have also been found to be partly responsible for violent behavior”.

Since substance abuse is a trigger for violence in the mentally ill, research cited by the HMHL suggests, “adequate treatment of mental illness and substance abuse may reduce violence”. It also recommends long-term interventions including a variety of treatment approaches including cognitive-behavioral therapy, conflict management and drug and alcohol treatment.

Events like Tucson are especially painful for those like myself who provide treatment and counseling for the tens of millions of Americans with mental illness and drug and alcohol problems. The woefully inadequate resources and thoroughly broken system within which we try to work to take care of these people is often overwhelming and disheartening.

I’m actually a fan of the principle of managed care, which can be an effective tool for managing healthcare costs. In the United States today however, managed care is a euphemism for a system designed to ignore, neglect and abandon people with the chronic illnesses of schizophrenia, depression, and addiction.

Sadly, the trend is towards eliminating and restricting care. For the past several years, I’ve seen more and more people in my practice whose employers no longer choose to pay for health insurance that includes mental heath care. The people with more serious mental health issues will fall through the cracks, creating more Tucsons.

I’ve written elsewhere here on Parents of Addicts Resource Center about the need to continually educate and inform people about what mental health problems are and what treatment is, in order to help lower the ignorance quotient that keeps the stigma barriers so high. I’m hopeful that maybe this time (or the next time?) the powers that be will start to address the power of stigma that fuels the tragedy to continue.

PARC Branches Out to the West Coast: Guest contributor to "Banana Moments"

I'm pleased to share with you that I've been asked to be a guest contributor to Banana Moments, a website devoted to helping parents cope more effectively with family life in the "network culture".

My first blog post as a guest contributor is one that originally was posted on PARC last month: How Do I Know If It's a Problem?

Banana Moments also publishes Family Business Quarterly, whose objectives according to founder Joanna Jullien, is "to help parents rise above the noise and the fray of the daily, weekly, monthly press of information and life's stresses of family business. Banana Moments offers insights and inspiration to reinforce your own family values and help you lead children in this network culture..."

What's exciting for me is that Banana Moments' focus is on prevention, as opposed to my normal focus on actual treatment or counseling. Contributing to Joanna's site gives me the opportunity to reach an audience and be proactive, educating readers about parenting before problems reach the stage when they need to see someone like me.

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