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I go public in every Psychopharmacology seminar that I teach by stating that I don’t treat substance abuse in any manifestation. It’s noble work, and for those of you doing it, my hat is off to you. It’s not for me though. That famous line from Shakespeare’s Hamlet – “to thine own self be true” – defines why I wouldn’t be good at it. Substance abuse is fraught with manipulation, deception, denial and minimizing. Extracting the truth from a substance abuser is a yeoman’s task for the treating professional. Doing this type of work requires an inordinate amount of patience as the clinician attempts to sift through layers of deceit to determine if the abuser has the motivation to jettison the recklessness that is defining their lives. I’m not wired in such a way to manage these treatment challenges effectively, so I don’t accept these patients.

I have however given considerable thought to how abusers can help themselves – whether they seek professional assistance or not. My comments and suggestions below focus on alcohol abuse, but can be applied to any drug or behavior for that matter, with abuse potential. So as an outsider looking in, here goes:

Step One: Ask, “Do I Really Have a Problem?” Our contemporary recovery culture has set the bar for being an alcoholic very low (much in the same way it has for depression, I might add). Anyone who can have one or two drinks and then return to the activities that define their daily living is almost certainly not an alcoholic. If none of their friends or trusted colleagues has ever pulled them aside and mentioned that their life would be much improved if they quit drinking, they’re probably not an alcoholic. If they can drink without their life going into the toilet, they shouldn’t allow anyone to even attempt to stop them.

Step Two: Tell Key People in Their Life That They Have a Problem and Are Trying to Fix It. It’s possible to get sober without spilling one’s guts at AA meetings. It’s impossible to quit drinking in secret. Alcoholics are very bad at turning down the opportunity to drink, and the world around them is replete with opportunities – cocktail parties, weddings, happy hours, birthdays and wakes. And as an alcoholic, they will seek out these opportunities and give into them. So the alcoholic has to enlist the support of trusted people in their lives by telling them about their problem and how they are trying to fix it. These key people are the ones who will be the alcoholic’s greatest allies pursuant to quitting.

Step Three:  Initial Failure May be a Step Toward Future Success. Falling off the wagon doesn’t have to be a harbinger of doom. If the alcoholic messes up once, this should be embraced as part of the human condition. They get one mulligan and shouldn’t feel the need to share that one failure with anyone. They should soul search why this happened and make a personal vow not to do it again. Screwing up twice though means they’ve got to go public with that failure. Friends and loved ones will likely offer support and praise for being honest. The alcoholic should take that praise and redouble their efforts.

Step Four: Quit Apologizing. The alcoholic will never be able to make adequate amends to those he or she has wronged. Talk is cheap and we all know how much more loudly actions speak. The best amends any alcoholic can make is to stay on the wagon – assuming they’re really sorry for how they’ve behaved.

Step Five: Figure Out What was Enjoyable About Drinking and How to Keep Those Things Alive Through Sobriety. No alcoholic becomes a different person merely by becoming sober. Their core personality remains; they’re just not using alcohol any longer to feel differently and perceive the world in a dissociative state. Anything done while inebriated can be done while sober. An alcoholic who had a streak for adventure, enjoyed dating or making others laugh for example, can keep those very same traits and pursuits alive through sobriety.

Those who drink too much have to figure out the causes for this and how the better aspects of their character can be pressed into service to aid in their recovery.

From The Insider (5.17.12)

Budget Plans

A budget bill may take a little longer than planned. Rep. Harold Brubaker, R-Randolph, the chief budget writer in the House, said Wednesday that plans to try to roll out a House budget bill by next week have been put on hold. Brubaker said that the House’s proposed revisions to the two-year state budget will likely instead be before budget-writing subcommittees and the full House Appropriations Committee the following week. Trying to roll out a budget bill by next week wouldn’t have allowed enough review, he said. “I think the rank-and-file members need to see their budget,” Burbaker said. “They need to be fully informed.”

The House budget-writing subcommittee on Health and Human Services did review some of Gov. Beverly Perdue’s spending proposals on Wednesday, but a separate budget subcommittee meeting was cancelled. Two House budget subcommittee are scheduled to meet today. Legislative Republicans have made clear that Perdue’s proposal to raise the sales tax by three-quarters of a cent will not be included in any budget bill. Legislative leaders also began the short session pushing the notion that, because the two-year budget does not have to be adjusted, Perdue has less leverage when it comes to vetoing a budget bill.(THE INSIDER, 5/17/12).

Medicaid Shortfall

The Senate has approved legislation designed to a close cost overruns in the state Medicaid program that could exceed $200 million. The bill, which now goes to the House, would allow up to $205.5 million to be used to close the gap, with the money coming from five sources of state funds. The five are: $105 million from state agency reversions; $50 million transferred from other unspent pools of money within the Department of Health and Human Services; $20 million from a project revenue surplus now expected to reach $233 million; $20 million from unspent money in the state building Repair and Renovation Fund; and $10.5 million from a Repair and Renovation dollars already allocated to the Department of Health and Human Services. The initial dollars are to come from the unspent pools of money already in the Department of Health and Human Services. State agency reversions fall next on the priority list of money to be used.

The legislation avoids Medicaid provider cuts called for in the budget bill passed last year. The shortfall led to several rounds of backbiting last fall between legislative leaders and Gov. Beverly Perdue’s administration. More recently, legislators and Perdue officials have been in agreement when it comes to addressing the program shortfall. Last week, State Budget Director Andy Willis said that he expected the issue would be resolved harmoniously. Willis also pointed out that previous budgets have seen even larger Medicaid shortfalls.

Sen. Pete Brunstetter, R-Forsyth, said Wednesday that the governor’s office and House leaders backed the proposal. The legislation was approved unanimously in the Senate with little debate. Some of the money will come from pools whose final amounts won’t be known until the close of the fiscal year, but Brunstetter said he had no worries about the sources to be used. The bigger worry, he said, is the final size of the Medicaid shortfall. Right now, it is projected to reach about $150 million, but could grow larger. “That’s the softer number,” Brunstetter said. “It’s just that it is a moving target.”(THE INSIDER, 5/17/12).

More Use of Health IT Needed Among Behavioral Health Providers, Panelists Say
By Ralph Lindeman

Federal subsidies to encourage the use of health information technology—currently available to medical providers—should be extended to providers treating people with mental health or substance abuse disorders, panelists urged at a May 4 forum on behavioral health.

Better integration of behavioral health and physical health is essential for improving overall health outcomes, the panelists said, and one way to help promote this integration is through the use of health IT, two panelists noted. They spoke at a forum on “Behavioral Health: Can Primary Care Help Meet the Growing Need?” sponsored by the Alliance for Health Reform, a nonprofit, nonpartisan health education group.

Mental health and substance abuse providers currently are ineligible to receive health IT financial subsidies made available in the 2009 American Recovery and Reinvestment Act, noted Joseph Parks, chief clinical officer for the Missouri Department of Mental Health.

Behavioral Issues May Be Ignored

Without easy access to a patient’s medical history through health IT, physicians treating patients for physical problems are frequently unaware of any mental health or substance abuse issues these patients may have, Parks pointed out.

To help share treatment information among providers, Parks said his agency makes available to the state’s Medicaid providers all claims data for the Medicaid enrollee they are treating.

“If you think about it, your insurance company knows much more about your medical care than any individual doctor,” Parks said. “Most payers don’t make that information available to the treaters, which is a dumb business decision.”

Agreeing with Parks, Sam Donaldson, president and CEO of Cenpatico, a behavioral health care organization, noted that a bill currently pending in the Senate, the proposed Behavioral Health Information Technology Act (S. 539), would extend the availability of financial subsidies for electronic health records to behavioral and mental health professionals. The bill is sponsored by Sens. Sheldon Whitehouse (D-R.I.) and Susan Collins (R-Maine).

S. 539 also would extend health IT subsidies to psychiatric hospitals, community mental health centers, residential and outpatient mental health treatment facilities, and substance abuse treatment facilities.

“Only 8 percent of these providers have fully implemented electronic records,” Donaldson noted.

The Senate bill, which has bipartisan support, is pending in the Senate Finance Committee, which has not acted on the bill since it was introduced in March 2011.

Parity in Rehabilitation Coverage Lacking

In addition to extending health IT incentives, Parks said another policy area that merits federal attention is requiring health plans to provide more coverage for behavioral health rehabilitation. “If you have a stroke or a heart attack, most benefit plans will give you about three to six months of rehabilitation services,” he noted.

“But you don’t get that after you are discharged from a mental hospital or after hospitalization for a suicide attempt,” Parks said. “Parity means that you get rehabilitation support and community services following a hospitalization for psychosis or a suicide attempt,” he said, adding, “That’s a parity issue that needs to be attended to.”

John O’Brien, senior policy adviser for the Disabled and Elderly Health Programs Group at the Centers for Medicare & Medicaid Services, said the key areas his office is focusing on are:

• integrating primary care and behavioral health;
• developing strategies to achieve parity in the treatment of mental health and substance abuse problems and other medical problems among health plans;
• expanding opportunities for home and community-based services; and
• directing care to children and youth with behavioral health needs.

To help promote recruitment of more mental health professionals, Donaldson said he advocates a federal program “akin to the Peace Corps,” which he described as “a policy at the national level that would pay for schooling and loans” for mental health professionals. In return, they would provide a certain number of years of service to low-income people in need.

Large Segment of Population at Risk

Deanna Okrent, a senior policy adviser with the Alliance for Health Reform, provided an overview of the U.S. population with behavioral health issues, noting that:

• nearly half of all Americans will develop a mental illness;
• 27 percent of Americans will have a substance abuse disorder;
• in 2009, mental health conditions were the fourth most common reason for hospital admissions among children; and
• in 2007, nearly one-third of adults and one-fifth of children had a behavioral health problem.

Also, among people eligible for both Medicare and Medicaid, who are often disabled or elderly low-income enrollees with chronic health conditions, Okrent said mental health issues affect 50 percent of disabled enrollees and 20 percent of the elderly enrollees.

This entry is filed under News.

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Getting to that point of admitting you have a drug or alcohol problem can be reached through various routes. It could be the result of a significant personal event, which many call “hitting bottom.” It may be due to an intervention by a close friend or relative. Once you identify the problem, the next step is doing something about it. Often the best course of action is inpatient drug rehab.

American Psychological Association Quiz

Identifying the problem and its magnitude is a step in the right direction. The APA has an “Are You Addicted?” test composed of 7 questions that can help you self-diagnose. The questions are designed to outline substance abuse behaviors. The mechanics are as follows: If you answer “yes” to three or more of the questions, then you likely have an addiction issue and if you answer “yes” to two or less of the questions, then you have an abuse issue.

Distinction between Addiction and Abuse

The APA test is based on the principle that addiction and abuse are two distinct levels of substance abuse. Addiction is more severe than abuse, but it is important to note that within each general category there are also specific levels of risk.

While substance abuse is threatening and damaging, it defines a person who takes part in reckless behaviors associated with drugs and alcohol, which can cause financial and legal issues as well as relationship strains. On the other hand, addiction refers to the condition in which a person has shown psychological or physical signs of dependency, and a definite tolerance for the drug or alcohol. Withdrawal symptoms are also common to addiction.

At the addiction level, there already exists a chemical dependency, which means that you have significantly less control of your actions. When you come to the honest conclusion that you have indeed reached such a stage, you have to understand that extensive rehabilitation such as inpatient alcohol rehabs and the equivalent treatment for drugs are imperative. Even if you consider your case an abuse level, getting inpatient help now can prevent serious issues later. With drug and alcohol, it is never too early to seek treatment.