Author - admin

Former Cardinal Newman star who’s NFL career was cut short is now saving lives

Philadelphia, PA (CBS12) — Chris T Jones took Philadelphia by storm in 1996. The receiver from Cardinal Newman High School and the University of Miami seemed to be on the path of to be a superstar wide receiver. But it all fell apart for him. Now. instead of being an NFL legend, he’s helping others.. whose lives are falling apart

Jones works as a supervisor for Behavioral Heath of the Palm Beaches,a drug rehabilitation program, helping those that have lost their way get back on their feet. It’s a process that the West Palm Beach native has lived through himself.

In 1996, Jones was one of the best receivers in the NFL, and was poised to sign a big contract to stay with the Philadelphia Eagles. One day during the preseason he was offered a 5 year, 15 million dollar contract.

I turned it down that day,” says Jones. “And that evening, we were playing the Baltimore Ravens, and I got tackled (and injured my knee), and I didn’t even have to be in there.

Jones never got his big contract, and his knee never was the same. Then another similar hit two preseasons later ended his NFL career.

“I had days that I went into depression from the drinking, abusing the medication, hanging out with the wrong crowd.”

But over time, Jones found a way to deal with that depression. “You ask yourself why me? But I’m a faith based individual, and I turned to God, and I guess that’s not my calling.”

Jones has found that calling now. He may not have been able to pick himself off that Veterans Field turf, but now he’s helping to pick up those that have hit rock bottom. A much more admirable feat than scoring touchdowns.

Despite playing just one full season in the NFL, Chris T. Jones remains in the NFL record books. He and receiver Irving Fryar combined for 158 catches, which remains tops in Eagles history for a receiving tandem.

 

Read more...
Eliminating Stigma From the Inside Out

Eliminating ‘Stigma’ From the Inside Out

Eliminating Addiction Stigma 

We seem to be constantly trying to change the public\'s perception of substance use disorders and of people with substance use disorders. At best progress is slow. The terms “stigma” and “shame” have a lot in common. “Stigma” may be what is inflicted upon us by others. “Shame” is what we carry. 

We\'ve been trying to change the world. That\'s hard to do. It\'s easier to “have the courage to change the things we can.” Is it possible that we create at least some of the “shame” that feeds the stigma? It\'s possible that we do.

Let\'s take a look:

What we do is treat a chronic disease (substance use disorders) with a series of episodic interventions (an acute care model) and we can\'t understand why people feel like failures (shame) when the symptoms of the disease become active. We leave our patients with the belief that the only measure of success is lifelong abstinence so when a relapse (another word that conjures up shame) occurs they need to start all over. This leaves people with a drawer full of white chips and several “walks of shame.”
This is also the image that we present to the public.
Maybe we have to change.

Chronic diseases require monitoring over the course of a lifetime. It is recognized that symptoms may become active at any point in time and shame is not attached to the reoccurrence of symptoms. People with hypertension are not shamed when their blood pressure becomes unstable.
The word “relapse” is not applied to the recovery process for any other chronic disease. “Relapse” is a word that is shrouded in shame. 

“The lapse/relapse language within this phrase is historically rooted in morality and religion, not health and medicine, and comes with considerable historical baggage. The lapse/relapse language in the alcohol and drug problems arena emerged during the temperance movement and was linked in the public mind to lying, deceit, and low moral character—a product of sin rather than sickness (Bill White blog, 2016).”

We treat patients with substance use disorders intensely for about a month and then they graduate. They often become members of an Alumni Association.
Let\'s say that we treat patients with an average age of 30 to 35 years. They can generally expect to live another 30 to 35 years. The only measure of success that we give them is lifespan abstinence.  So we set up an expectation that a person with a chronic disease will be symptom free for the 30 to 35 years that they will spend in recovery.
Does that even make sense?
And when symptoms do reoccur we start the process all over again, only this time with have a patient with even more shame.  We treat another acute episode. This is another way that we create failure.

Episodic care leads patients to say things like “I\'ve been to treatment three times. “Doesn\'t that sound like “I\'ve failed three times?” Yes, it does.

I\'ve stopped asking “how many times have you been in treatment?” I simply ask for a history. 

The messages we send/ the messages we allow:

We continuously send messages. Sometimes they convey that you better get well fast and in the way we want you to do it. We have made statements like “come back when you\'re ready,” or “you need to do more research.”
These messages imply things like “you\'re not worth my time right now.”
Similarly, I\'ve often heard the expression,” I\'m not going to work harder on your recovery than you are.”
On the other hand, we generally expect a patient to be in denial and ambivalent about recovery. So we expect a patient who is in denial of their disease and probably doesn\'t really want to be in treatment in the first place to work hard? We can\'t have it both ways. 

We also allow patients to diminish themselves. Ever heard people in treatment or recovery refer to them selves as “convicts” or “inmates?” I have, and too many times I\'ve just ignored it.
The disease beats them down. We don\'t have to help it.
Today, I intervene in the conversation. 

Are labels necessary?

Are we developing the quality of humility or creating more shame? It\'s a tough call. There may be a fine line between being humble and feeling shame. Does a person have to surrender and say, “my name is……., I\'m an ………?”
Using labels may depend upon the mutual support group that a person prefers. Labels are more regularly used in 12-step recovery meetings than at SMART meetings (if unfamiliar with SMART go to: (www.smartrecovery.org ). There is flexibility at both.
I suggest giving patients the option.

Do we believe that treatment works?

A lot of people, including professionals who work very hard to help others, perceive that treatment for substance use disorders is not very effective. The same can be said for people in recovery. It seems like failure is expected.
It may be argued that minimizing stigma and shame will result in better outcomes. Well, there we go again. Chronic diseases do not have outcomes.
Treatments for acute conditions have outcomes. Treating a cold makes it go away. It\'s over. Chronic diseases hang around.
When we measure the effectiveness of treatment by looking at the status of the disease over time, we measure up very well. 

How did we get here & how do we fix it? 

Maybe we got here because we are all a part of the culture that shaped our thinking. Are we over the temperance movement hangover yet? We may have accepted the stigma and shame far too easily. 

On the surface, the changes we need to make do not seem that difficult, but changing how we\'ve been shaped takes time, effort, and practice.

Stigma and shame keeps people from coming to treatment and it keeps people from coming back if they need to. I suspect that there will be people who read this and say something like we can\'t help people until they are willing to change. A better question may be “are we willing to change?” Do we have “the courage to change the things we can?” 

Michael Weiner, Ph.D., MCAP is the Director of Alumni Services at Behavioral Health of the Palm
Beaches/Seaside. He has been a Director, Trainer, and Researcher for Behavioral Health of the Palm
Beaches since 1999.
Dr. Weiner has regularly published in professional journals and presented at professional conferences.
 
Comments and/or questions can be e-mailed to mweiner@seasidepalmbeach.com.
Read more...
silver-platter.jpg

People Who Do Not Deserve to Have a Problem: Issues Related to “High-End” Care

Seaside Palm Beach opened the doors to “high-end” treatment for substance use disorders in 2009. I would like to share the experience of having been the first Director, and as a person who has maintained his involvement with Seaside to this day.

When Seaside opened it was the only substance use disorder treatment program in Florida describing itself as “high-end.” It’s possible that we were the only one on the east coast. The number of programs currently describing themselves as “high-end” has grown considerably in Palm Beach County alone. 

It’s worth taking a moment to ask what exactly “high-end” care is. Although there is clearly no precise definition, adjectives used to describe this manner of care have included “executive,” and “luxurious.” The term “high-end” connotes “expensive,” “wealthy,” “rich.” It may not be politically correct to openly use these adjectives, nevertheless, they exist.

Discussing the reasons for the exponential growth of high-end care is not the purpose of this article; discussing the lessons learned since 2009 is.

Seaside Palm Beach is one of four treatment facilities owned and operated by Behavioral Health of the Palm Beaches (BHOPB). BHOPB’s experience in providing quality residential care for substance use disorders dates back to 1996. In 2009 providing high-end care was new for us, but providing high-quality residential care wasn’t. Seaside was planned by people who had years of administrative and clinical experience with the provision of quality care. Even so, there were lessons to be learned along the way. Sharing knowledge acquired through experience and research with our professional community has always been an integral aspect of BHOPB’s mission.

Selecting and Preparing Staff

When staffing Seaside, we looked for the most highly qualified, credentialed, and experienced staff that we could find. We searched from within our organization and externally. It didn’t take long for us to see, and to recognize within ourselves, that we held attitudes that were negatively impacting the delivery of care.

We had staff providing services who made less money in a year than our residents made in a week or a month. In fact, residents whose income was dependent on investments sometimes had more income during their stay than the staff member did. Residents often owned homes in attractive locations around the world while a staff member may have been struggling with rent (p.s. we do pay staff well). I could go on.

Staff, who ordinarily would go the extra mile for a resident, didn’t. Negative remarks about residents could be overheard among staff. Staff whom had demonstrated remarkable empathy in the past all of a sudden became unable to demonstrate that essential quality. How could they? Residents were perceived to be people who did not deserve to have a problem.

Residents were being talked about as people who lacked “humility.” How do people with extreme wealth demonstrate humility? As F. Scott Fitzgerald allegedly remarked to Ernest Hemingway, “The rich are different than you and me.

Staff who had been trained to help residents look deeply into themselves, now had to look deeply into their own selves. It became obvious that residents coming from wealth had to be treated as a sub-culture (NAADAC, 2009). As F. Scott Fitzgerald allegedly remarked to Ernest Hemingway, “The rich are different than you and me.

We needed to do cultural sensitivity training with current and perspective staff. No one can change until the need to change is recognized.

We did locate some staff who did come from wealth and made the choice to give back by helping others.

What do High-End Patients Look Like?

This may be a good time to mention that residents seeking treatment at Seaside were and are significantly older than residents at BHOPB’s other centers. The average age at Seaside is approximately forty-eight years. At BHOPB’s other facilities it ranges from early to mid-thirties. There are numerous reasons for this. The most obvious is that it often takes some time to accumulate wealth.

Seaside residents tend to be proud people. They do not respond well to confrontation, particularly when it comes from a staff member perceived to be very young. Maturity should be a sought after characteristic for on-site staff. 

Age and wealth are correlated factors. Wealth is likely to have enabled substance abusers to avoid the consequences of abuse.

It is also likely that wealthier residents have not been confronted in the workplace. They don’t get referred to management, they are management. Sometimes the wealthy substance abuser is simply too powerful to confront. Confrontation as a therapeutic tool needs to be used very carefully.

It is also likely that the Seaside resident comes from a sub-culture who could not possibly be addicted. After all, they don’t deserve to be. They feel the stigma more than any other sub-culture. “With everything you have, how could you let this happen?”

They are more likely to be referred for mental health care as opposed to care for a substance use disorder.

Want to know who else didn’t think that people from this culture could have a problem. We didn’t. I feel certain that there have been patients whom I’ve treated over the years whom I perceived to be not in need of intense services because of the privileged culture they came from. Possibly I recommended people from this culture to a lower level of care than was necessary.

We Are Products of the World We Live In

When we opened our doors in 2009 we did not expect residents coming to us who had more substance use related physical deterioration than we had previously seen. There were more frequent occurrences of high blood pressure, unstable blood sugar, impaired liver and pancreas functioning, and organisity than we had previously experienced. There were ambulatory problems, particularly among women.

Having to treat chronic pain as a co-occurring disorder was also more likely. Consequences like pancreatitis are painful. So are things like falls and neuropathy. The list is long.

Severe alcoholism often requires a longer period of withdrawal management.

Since the issues mentioned above are more likely to occur, lengths of stay for withdrawal management and treatment are likely to be longer. This was recognized by the American Society of Addiction Medicine (ASAM 2013) when their recommendations included five levels of withdrawal management.

It is important that expected lengths of stay be talked about at the outset.

As part of its pre-treatment assessment process BHOPB asks each patient, including Seaside patients, to complete the Millon Clinical Multiaxial Inventory-III (MCMI III). The resulting personality profile is used to help the therapist and the patient identify both problem areas and strengths to focus on during the course of treatment.

The initial three scales (Disclosure/Desirability/Debasement) can give the therapist some insight into how the patient presents for treatment. They are referred to as “validity” scales. Patients being treated at BHOPB represent a cross section of patients who have been presenting themselves for treatment since BHOPB’s opening in 1996. Wealth may well be represented in this randomly chosen sample of 100 patients being treated in 2010. If you look at the first three scales in Figure #1

BHOPB Patients

[embed:render:full:node:1602]

You will notice that “Disclosure,” and “Debasement” are high relative to “Desirability.” A reasonable hypothesis would be that BHOPB patients are self-debasing (low self-esteem, self loathing) and are willing to tell you about it. This pattern on the “validity” scales tends to falsely elevate scores on clinical scales. In other words, BHOPB patients may not be as impaired as their personality profiles would indicate. Whatever their issues are, the issues are probably complicated by low self-esteem.

A major goal of treatment would be to increase the patient’s self-esteem. Continued low self-esteem could be counted on to be a relapse issue.

Now look at Figure # 2. For Seaside patients, “Desirability” is elevated when compared to “Disclosure” and “Debasement.” This pattern is totally opposite that seen in Figure # 1.

Seaside Patients

[embed:render:full:node:1603]

This “validity scale” pattern is indicative of patients who are suppressing clinical issues. The remaining clinical scale scores will be artificially low. Therapists will have to pull teeth to get issues to work on from these patients.

This is not to say that Seaside patients are lying. They may be totally unaware of where to start.

Ironically, it’s easy for the therapist to follow them into the trap. At the end of a busy day it may seem delightful to have a patient without problems walk through the door.

Perhaps this is another argument for lengths of stay. It will take these patients a longer time just to scratch the surface.

Are “High-End” Patients More Narcissistic? If all you do is look at Figure # 2 you might conclude that they are. However, it’s probably worth stopping to think that the MCMI III was normed on a broad range of people, not just a “high-end” group of people. Are patients seeking “high-end” care using self-centeredness and grandiosity as a means of avoiding issues, or are they really that important?

These are not people who think they are God; people have been treating them that way. OK, that’s an exaggeration, but not by much.

Point is that a sense of self centeredness and grandiosity may not be a means of avoiding issues for this population. It may be who they are.

In that case, it would not be an issue to work on.

What is Powerlessness and Unmanageability to this Group?

We’ve treated people at Seaside who have been pushed out of companies they may have started. When this occurs there’s usually a financial package, a golden parachute that goes along with the departure. Golden parachutes have ranged up to $40,000,000.

There are other times when there isn’t a severance, but the person is simply not involved in the company. Their name may remain on the door, but they are basically ignored and everyone knows it. However, the person is still receiving a very significant financial benefit.

Question becomes would a salaried therapist recognize this as powerlessness and unmanageability? A skilled, mature therapist who recognizes the downside of wealth would. It could be said that the head of a company has taken a bigger fall than a salaried person losing a job. Having spent time with a high-end population, I know this to be true.

There have been instances when relatively young people have sold companies and have looked forward to a life of leisure. They soon realize that playing golf goes only so far.

Of course people who have experienced wealth have also experienced powerlessness and unmanageability. Therapists need to be trained on where to look for it. They also have to be trained to empathize with a patient who has made more money than the therapist can imagine. This is not always possible, skilled therapists have to be selected.

Abandonment/Attachment Issues

There’s no evidence that high-end patients differ from more traditional patients seeking treatment for substance use disorders when it comes to abandonment issues/attachment issues. Having observed high-end patients for a considerable period of time I’ve come to believe that their abandonment/attachment issues are just different.

We’re used to seeing patients who have been abandoned by sexual abusers, substance abusing parents, parents who left the household, etc.

High-end patients may never have felt that they were abandoned by a parent. The parent was never available. They were brought up by a series of nannies some of whom they became attached to. Inevitably, that nanny was replaced.

As they got older it was a matter of moving from one boarding school to another.

It’s harder to identify abandonment/attachment issues when patients believe that the issues are not there. After all, everyone else they knew was brought up in a similar fashion.

So a therapist should never conclude that abandonment/attachment issues don’t exist. Therapists need to learn where to look for them.

What Does High-End Recovery Look Like?

Traditionally, patients completing treatment for an addictive disease would be recommended to do 90 in 90: 90 12-step meetings in 90 days. It’s likely that they would be referred to a lower level of care such as intensive outpatient, and would likely be referred to a one on one therapist as well. This certainly doesn’t describe all discharge plans, but it’s close.

Sometimes there is resistance, but options are limited by financial issues, insurance coverage, ability to be given time to blend recovery and work.

Some people just don’t like the 12 step recovery process.

I know all of the arguments. I’m a person whose life has been saved by Alcoholics Anonymous (AA). However, I can understand the resistance.

We can’t push 12-step recovery down someone’s throat.

The problem is that there is no other form of support for recovery that is as available as 12-step recovery. It’s also free. “Free” is a wonderful thing, 12 step recovery is a wonderful thing, but what about people who have more options and more resources.

Some “high-end” patients might have a therapist or team of therapists available to them 24/7. Is this as good as 90 in 90? It may be, but it’s not free. In fact, it could be incredible.
I’m aware of a patient who traveled with a personal therapist and a nurse. Sober coaches and sober companions are really good sources of support.

Fact is that patients with wealth have more options than other people. I can only wish that all of these forms of support were available to everyone, but they’re not.

What happens on some occasions is that a wealthy patient is being case managed by a person who has resentments. It may be a person who is thinking “I got sober with AA, why can’t she?”

Summary and Conclusion

At Seaside, we’re going on our 6th year of providing care to people who are frequently referred to as “high-end,” “executive” or exclusive in some way, shape or form. BHOPB’s mission has always included the sharing of experience, strength, and hope with our professional community. “High-End” programs seem to be popping up everywhere. So we are sharing what we have learned.

One thing is to pick and train staff very carefully. If a salaried staff person tells you that they don’t have resentments toward people with extreme wealth they’re either in denial or out right lying. It’s important to recognize it.

It is also important to look for staff who can relate to, or come from wealth themselves. Believe it or not they exist. Maturity should be a sort after quality when choosing staff.

High-end people come to us with patterns of denial, issues and character traits that are not all that different than our more traditional patients. They are just displayed differently and a trained therapist needs to know where to look.

The world is not fair or equitable. It’s not the fault of the patient. It’s important to accept that people with resources may have a path to recovery that is different than those we’ve seen in the past. The objective should be to bring everyone up, not to bring a fortunate person down.

Most of all, these are people who deserve to be cared for. Addictive diseases do not discriminate. If anything, they hit a person with wealth much harder. Being able to avoid consequences is not always a good thing.

We are also treating people who are smart, creative, and often become passionate about recovery. Sometimes they are in a position to help others.

Mostly what I’ve learned, people are people.

Read more...
silver-platter.jpg

People Who Do Not Deserve to Have a Problem: Issues Related to “High-End” Care

Seaside Palm Beach opened the doors to “high-end” treatment for substance use disorders in 2009. I would like to share the experience of having been the first Director, and as a person who has maintained his involvement with Seaside to this day.

When Seaside opened it was the only substance use disorder treatment program in Florida describing itself as “high-end.” It\'s possible that we were the only one on the east coast. The number of programs currently describing themselves as “high-end” has grown considerably in Palm Beach County alone. 

It\'s worth taking a moment to ask what exactly “high-end” care is. Although there is clearly no precise definition, adjectives used to describe this manner of care have included “executive,” and “luxurious.” The term “high-end” connotes “expensive,” “wealthy,” “rich.” It may not be politically correct to openly use these adjectives, nevertheless, they exist.

Discussing the reasons for the exponential growth of high-end care is not the purpose of this article; discussing the lessons learned since 2009 is.

Seaside Palm Beach is one of four treatment facilities owned and operated by Behavioral Health of the Palm Beaches (BHOPB). BHOPB\'s experience in providing quality residential care for substance use disorders dates back to 1996. In 2009 providing high-end care was new for us, but providing high-quality residential care wasn\'t. Seaside was planned by people who had years of administrative and clinical experience with the provision of quality care. Even so, there were lessons to be learned along the way. Sharing knowledge acquired through experience and research with our professional community has always been an integral aspect of BHOPB\'s mission.

Selecting and Preparing Staff

When staffing Seaside, we looked for the most highly qualified, credentialed, and experienced staff that we could find. We searched from within our organization and externally. It didn\'t take long for us to see, and to recognize within ourselves, that we held attitudes that were negatively impacting the delivery of care.

We had staff providing services who made less money in a year than our residents made in a week or a month. In fact, residents whose income was dependent on investments sometimes had more income during their stay than the staff member did. Residents often owned homes in attractive locations around the world while a staff member may have been struggling with rent (p.s. we do pay staff well). I could go on.

Staff, who ordinarily would go the extra mile for a resident, didn\'t. Negative remarks about residents could be overheard among staff. Staff whom had demonstrated remarkable empathy in the past all of a sudden became unable to demonstrate that essential quality. How could they? Residents were perceived to be people who did not deserve to have a problem.

Residents were being talked about as people who lacked “humility.” How do people with extreme wealth demonstrate humility? As F. Scott Fitzgerald allegedly remarked to Ernest Hemingway, “The rich are different than you and me.

Staff who had been trained to help residents look deeply into themselves, now had to look deeply into their own selves. It became obvious that residents coming from wealth had to be treated as a sub-culture (NAADAC, 2009). As F. Scott Fitzgerald allegedly remarked to Ernest Hemingway, “The rich are different than you and me.

We needed to do cultural sensitivity training with current and perspective staff. No one can change until the need to change is recognized.

We did locate some staff who did come from wealth and made the choice to give back by helping others.

What do High-End Patients Look Like?

This may be a good time to mention that residents seeking treatment at Seaside were and are significantly older than residents at BHOPB\'s other centers. The average age at Seaside is approximately forty-eight years. At BHOPB\'s other facilities it ranges from early to mid-thirties. There are numerous reasons for this. The most obvious is that it often takes some time to accumulate wealth.

Seaside residents tend to be proud people. They do not respond well to confrontation, particularly when it comes from a staff member perceived to be very young. Maturity should be a sought after characteristic for on-site staff. 

Age and wealth are correlated factors. Wealth is likely to have enabled substance abusers to avoid the consequences of abuse.

It is also likely that wealthier residents have not been confronted in the workplace. They don\'t get referred to management, they are management. Sometimes the wealthy substance abuser is simply too powerful to confront. Confrontation as a therapeutic tool needs to be used very carefully.

It is also likely that the Seaside resident comes from a sub-culture who could not possibly be addicted. After all, they don\'t deserve to be. They feel the stigma more than any other sub-culture. “With everything you have, how could you let this happen?”

They are more likely to be referred for mental health care as opposed to care for a substance use disorder.

Want to know who else didn\'t think that people from this culture could have a problem. We didn\'t. I feel certain that there have been patients whom I\'ve treated over the years whom I perceived to be not in need of intense services because of the privileged culture they came from. Possibly I recommended people from this culture to a lower level of care than was necessary.

We Are Products of the World We Live In

When we opened our doors in 2009 we did not expect residents coming to us who had more substance use related physical deterioration than we had previously seen. There were more frequent occurrences of high blood pressure, unstable blood sugar, impaired liver and pancreas functioning, and organisity than we had previously experienced. There were ambulatory problems, particularly among women.

Having to treat chronic pain as a co-occurring disorder was also more likely. Consequences like pancreatitis are painful. So are things like falls and neuropathy. The list is long.

Severe alcoholism often requires a longer period of withdrawal management.

Since the issues mentioned above are more likely to occur, lengths of stay for withdrawal management and treatment are likely to be longer. This was recognized by the American Society of Addiction Medicine (ASAM 2013) when their recommendations included five levels of withdrawal management.

It is important that expected lengths of stay be talked about at the outset.

As part of its pre-treatment assessment process BHOPB asks each patient, including Seaside patients, to complete the Millon Clinical Multiaxial Inventory-III (MCMI III). The resulting personality profile is used to help the therapist and the patient identify both problem areas and strengths to focus on during the course of treatment.

The initial three scales (Disclosure/Desirability/Debasement) can give the therapist some insight into how the patient presents for treatment. They are referred to as “validity” scales. Patients being treated at BHOPB represent a cross section of patients who have been presenting themselves for treatment since BHOPB\'s opening in 1996. Wealth may well be represented in this randomly chosen sample of 100 patients being treated in 2010. If you look at the first three scales in Figure #1

BHOPB Patients

[embed:render:full:node:1602]

You will notice that “Disclosure,” and “Debasement” are high relative to “Desirability.” A reasonable hypothesis would be that BHOPB patients are self-debasing (low self-esteem, self loathing) and are willing to tell you about it. This pattern on the “validity” scales tends to falsely elevate scores on clinical scales. In other words, BHOPB patients may not be as impaired as their personality profiles would indicate. Whatever their issues are, the issues are probably complicated by low self-esteem.

A major goal of treatment would be to increase the patient\'s self-esteem. Continued low self-esteem could be counted on to be a relapse issue.

Now look at Figure # 2. For Seaside patients, “Desirability” is elevated when compared to “Disclosure” and “Debasement.” This pattern is totally opposite that seen in Figure # 1.

Seaside Patients

[embed:render:full:node:1603]

This “validity scale” pattern is indicative of patients who are suppressing clinical issues. The remaining clinical scale scores will be artificially low. Therapists will have to pull teeth to get issues to work on from these patients.

This is not to say that Seaside patients are lying. They may be totally unaware of where to start.

Ironically, it\'s easy for the therapist to follow them into the trap. At the end of a busy day it may seem delightful to have a patient without problems walk through the door.

Perhaps this is another argument for lengths of stay. It will take these patients a longer time just to scratch the surface.

Are “High-End” Patients More Narcissistic? If all you do is look at Figure # 2 you might conclude that they are. However, it\'s probably worth stopping to think that the MCMI III was normed on a broad range of people, not just a “high-end” group of people. Are patients seeking “high-end” care using self-centeredness and grandiosity as a means of avoiding issues, or are they really that important?

These are not people who think they are God; people have been treating them that way. OK, that\'s an exaggeration, but not by much.

Point is that a sense of self centeredness and grandiosity may not be a means of avoiding issues for this population. It may be who they are.

In that case, it would not be an issue to work on.

What is Powerlessness and Unmanageability to this Group?

We\'ve treated people at Seaside who have been pushed out of companies they may have started. When this occurs there\'s usually a financial package, a golden parachute that goes along with the departure. Golden parachutes have ranged up to $40,000,000.

There are other times when there isn\'t a severance, but the person is simply not involved in the company. Their name may remain on the door, but they are basically ignored and everyone knows it. However, the person is still receiving a very significant financial benefit.

Question becomes would a salaried therapist recognize this as powerlessness and unmanageability? A skilled, mature therapist who recognizes the downside of wealth would. It could be said that the head of a company has taken a bigger fall than a salaried person losing a job. Having spent time with a high-end population, I know this to be true.

There have been instances when relatively young people have sold companies and have looked forward to a life of leisure. They soon realize that playing golf goes only so far.

Of course people who have experienced wealth have also experienced powerlessness and unmanageability. Therapists need to be trained on where to look for it. They also have to be trained to empathize with a patient who has made more money than the therapist can imagine. This is not always possible, skilled therapists have to be selected.

Abandonment/Attachment Issues

There\'s no evidence that high-end patients differ from more traditional patients seeking treatment for substance use disorders when it comes to abandonment issues/attachment issues. Having observed high-end patients for a considerable period of time I\'ve come to believe that their abandonment/attachment issues are just different.

We\'re used to seeing patients who have been abandoned by sexual abusers, substance abusing parents, parents who left the household, etc.

High-end patients may never have felt that they were abandoned by a parent. The parent was never available. They were brought up by a series of nannies some of whom they became attached to. Inevitably, that nanny was replaced.

As they got older it was a matter of moving from one boarding school to another.

It\'s harder to identify abandonment/attachment issues when patients believe that the issues are not there. After all, everyone else they knew was brought up in a similar fashion.

So a therapist should never conclude that abandonment/attachment issues don\'t exist. Therapists need to learn where to look for them.

What Does High-End Recovery Look Like?

Traditionally, patients completing treatment for an addictive disease would be recommended to do 90 in 90: 90 12-step meetings in 90 days. It\'s likely that they would be referred to a lower level of care such as intensive outpatient, and would likely be referred to a one on one therapist as well. This certainly doesn\'t describe all discharge plans, but it\'s close.

Sometimes there is resistance, but options are limited by financial issues, insurance coverage, ability to be given time to blend recovery and work.

Some people just don’t like the 12 step recovery process.

I know all of the arguments. I\'m a person whose life has been saved by Alcoholics Anonymous (AA). However, I can understand the resistance.

We can\'t push 12-step recovery down someone\'s throat.

The problem is that there is no other form of support for recovery that is as available as 12-step recovery. It\'s also free. “Free” is a wonderful thing, 12 step recovery is a wonderful thing, but what about people who have more options and more resources.

Some “high-end” patients might have a therapist or team of therapists available to them 24/7. Is this as good as 90 in 90? It may be, but it\'s not free. In fact, it could be incredible.
I\'m aware of a patient who traveled with a personal therapist and a nurse. Sober coaches and sober companions are really good sources of support.

Fact is that patients with wealth have more options than other people. I can only wish that all of these forms of support were available to everyone, but they\'re not.

What happens on some occasions is that a wealthy patient is being case managed by a person who has resentments. It may be a person who is thinking “I got sober with AA, why can\'t she?”

Summary and Conclusion

At Seaside, we\'re going on our 6th year of providing care to people who are frequently referred to as “high-end,” “executive” or exclusive in some way, shape or form. BHOPB\'s mission has always included the sharing of experience, strength, and hope with our professional community. “High-End” programs seem to be popping up everywhere. So we are sharing what we have learned.

One thing is to pick and train staff very carefully. If a salaried staff person tells you that they don\'t have resentments toward people with extreme wealth they\'re either in denial or out right lying. It\'s important to recognize it.

It is also important to look for staff who can relate to, or come from wealth themselves. Believe it or not they exist. Maturity should be a sort after quality when choosing staff.

High-end people come to us with patterns of denial, issues and character traits that are not all that different than our more traditional patients. They are just displayed differently and a trained therapist needs to know where to look.

The world is not fair or equitable. It\'s not the fault of the patient. It\'s important to accept that people with resources may have a path to recovery that is different than those we\'ve seen in the past. The objective should be to bring everyone up, not to bring a fortunate person down.

Most of all, these are people who deserve to be cared for. Addictive diseases do not discriminate. If anything, they hit a person with wealth much harder. Being able to avoid consequences is not always a good thing.

We are also treating people who are smart, creative, and often become passionate about recovery. Sometimes they are in a position to help others.

Mostly what I\'ve learned, people are people.

Read more...
Clock

The Times They Are a-Changin’ …

The culture of recovery is changing. If you haven\'t heard anybody say something like “My name is Michael and I\'m in long-term recovery,” you will soon. If you haven\'t been fortunate enough to see the documentary Anonymous People (Williams, 2012), see it soon. I first became aware of it when the American Society of Addiction Medicine (ASAM) gave it their 2014 Media Award. You can view it on Netflix or purchase it from Amazon. It\'s only one of the things that points to a cultural change.

As far as I can tell, several very important things are happening at the same time.

Right here in Florida I have seen tremendous changes since I came to work for Behavioral Health of the Palm Beaches (BHOPB) in 1999. At that time the “Florida Model” seemed like a great idea. By separating the place where patients were treated from where they resided it was possible to provide higher levels of care for longer lengths of stay. It worked well for everyone.

As we moved forward, several things began to change the culture of recovery for the better.

Seaside Palm Beach opened in 2009. The demographics of the patient population were very different. Highly individualized treatment required skilled case management. Transporting residents was taking away from the treatment day.

Four years later ASAM published the third edition of their Criteria for placing patients in appropriate levels of care (Mee-Lee, Shulman, Fishman, Gastfriend, & Miller, 2013). There were now very distinct differences in the criteria for residential care as compared to other levels of care.

Sometime later, Florida\'s Department of Children and Families (DCF) began to encourage organizations providing a residential level of care to provide treatment at the same location. At the present time, almost all people being treated at BHOPB\'s four centers, including Seaside Palm Beach, are treated and reside at the same dignified location. Guess what? It works really well.

There are more than twenty-three million people in long-term recovery.

Here in Florida, and nationally, one of the things that our culture is beginning to accept is that there are more than twenty-three million people in long-term recovery and that we come from all walks of life. We can have an impact on local and national politics and economies. People are actually beginning to sell us stuff.

I\'ve been around long enough to know that companies selling any type of insurance used to run from us like we had the plague. More recently, some people have figured out that twenty-three million people are a market that no one wants to ignore. I\'ve always thought it to be ironic that as long as drugs were flowing into my body everyone was willing to sell me insurance.

Have you seen Renew magazine? I was impressed because it\'s about time that a magazine for people in recovery is as nice as any magazine on the bookstore shelf. It\'s as well done as magazines about cooking, mechanics, cars, etc. It\'s not hidden, not kept under the counter. I feel good about knowing that we\'re twenty-three million strong and we do buy nice magazines. People are not just talking about recovery, they\'re bragging about it!

We can also be a force for change. Do you suppose that the health care system has treated us differently because we let them? What would the voice of twenty-three million people sound like? We vote! We have an impact on the economy.What would the voice of twenty-three million people sound like?

Did you know that September was National Recovery Month? By going to the Faces and Voices of Recovery website you can see that there are many activities celebrating recovery all over Florida. Since many people from outside of Florida get well here, you can also find activities celebrating recovery all over the United States and beyond.

Now that Faces and Voices has announced its intent to merge with Young People in Recovery (YPR), the impact will be multiplied.

Twelve Step recovery is very strong in Florida. There are more than 350 meetings listed in Palm Beach County alone. Twelve Step recovery keeps us on track. Faces and Voices and similar movements make us proud. I\'m just beginning to realize that there is a difference between “anonymous” and “secret.” I respect the Twelve Step tradition, but I\'m fine with telling anyone that I\'m in recovery. It is a little different than how I\'ve been introducing myself at meetings, but it is working and it doesn\'t seem to define my entire being.

I was recently talking with a friend at a local clubhouse. He doesn\'t really like the way many other people think and feel about people in recovery. My thought is that what the rest of the world thinks will take some time to change, but the way we think and talk about ourselves can change very quickly.

I\'ve recently become a lot more aware of the language I use. In the past, I\'ve asked many people “How many times have you been in treatment?” Did I mean “How many times have you failed?” When I\'ve asked “Are you clean?” have I implied that they\'ve been dirty? It really bothers me that a person like me, who has worked in the treatment field for a long time, may have been contributing to the problem. It\'s time for us to change too.

Our country is beginning to truly treat addiction as a chronic disease.

Culturally, in Florida and as a nation, we are really just coming out of an era in which addiction has been criminalized. It\'s been treated as bad behavior—immoral and punishable. Our prisons are full. So maybe we have to take another look at whether or not we\'ve gotten away from treating a chronic disease. Come to think of it, the question “How many times have you been in treatment?” is never asked of a person with any other chronic disease. My friend, who has diabetes, has always been in treatment; it\'s been continuous. A person who is diabetic has an endocrinologist, and a person with heart disease has a cardiologist.

An addictionologist is a physician who is certified by the American Board of Addiction Medicine (ABAM). Most addictionologists are members of ASAM or physicians who are ASAM members likely to be moving toward certification. In any case, ASAM members are likely to be well schooled in addictions medicine.

How come a person in long-term recovery doesn\'t have an addictionologist? How come a person in long-term recovery doesn\'t have an addictionologist? Currently, whenever possible, we are referring people who are leaving Seaside Palm Beach to addictionologists. It is making a difference. There are many board-certified addictionologists in Florida and elsewhere. They can be found at www.abam.net. ASAM members and information regarding membership can be found at www.asam.org.

Perhaps the most important thing that those of us who work professionally in the treatment field need to change is our expectation regarding addiction treatment being effective. I\'ve been asking many professionals the question “Who relapses more frequently, addicts or diabetics?” and the only person who immediately got it right was a nurse who works with diabetics.

When a plan for recovery is followed addicts get well at an amazingly high rate (Baxter, 2012; DuPont, McLellan, White, Merlo, & Gold, 2009; McLellan, Lewis, O\'Brien, & Kleber, 2000; McLellan, 2002). Studies published in professional journals indicate that 75 to 80 percent of people treated for an addictive disease, who follow every step of their plan for recovery, are stable after one year. If this is news to the people reading this article, what expectations are we passing on?

Changing how we treat and feel about addictive diseases isn\'t going to happen overnight; not in Florida, not nationally. We\'re not Fed-Ex. But we have a right to be proud of who we are and what we have overcome. We are fighters and survivors. We are also people who keep it by giving it away. Our pride in how we live our lives will influence others. It\'s time to let go of whatever shame there may be and stop keeping what we have a secret.

Share the secret! Give it away! Be proud!

Read more...