A Sure-Fire Way to Protect Our Children from Substance-Use-Disorder
Investigative Journalism, professional publications, expert Speakers in the Addictions field, and good old common sense tell us that we will never control the occurrence of Substance Use Disorder in our country by “supply side” solutions only. Although interdiction, strict regulation and law-enforcement are crucial, the demand for drugs will always be met by the supply of both criminal and legitimate entrepreneurs.
We must, as a culture, over time, devote our resources to substantially reducing the demand for all psychoactive chemicals. This will occur over the coming generations, accomplished by our children. We must prepare them for this. What’s known as “resilience” is the key.
Drug use prevention, in part, means equipping all of our children, as they move into adolescence, with the cognitive, emotional and social stability necessary to cope and manage stress in healthy ways. These capacities are brain functions, they are learned, they are a product of the child’s brain’s interaction with the environment, or, more specifically, with the adults in their world.
All too often many of our children find themselves in situations which ill-equip them developmentally to constructively respond to the inevitable stressors of adolescence and young-adulthood. These children are at-risk for the development of substance use disorder, as well as a host of other unhealthy behaviors which cause serious health-related problems.
The situations I’m referring to are ACEs, or Adverse Childhood Experiences, such as, but not limited to (see sources*):
• Child abuse or neglect
• Violence in the home
• Chaotic family conditions
• Unsafe neighborhood conditions
• Cumulative effects of developmental needs not being met
ACEs are environmental conditions likely to create what’s known as “toxic stress”. Toxic stress is the “prolonged activation of the brain’s stress response systems in the absence of protective relationships.”
What occurs as a result of exposure to toxic stress is nothing short of impaired brain development. Children learn to manage stress from attentive adults. Without the continued support of an attentive adult to mediate and buffer stress, children are likely to develop what is called “rapid stress response”.
Rapid stress response is the tendency to react to stress impulsively. Toxic stress actually effects the manner in which genes regulate the development of organs, in this case the brain. This is known as epigenetics. The developing brain of a child or adolescent, exposed to continued high levels of environmental stress, unfiltered or mediated by an adult, will be conditioned to respond in ways that are impulsive, or relief seeking, rather than deliberate and considered. This tendency toward impulsive decision making puts the individual at-risk for developing substance use disorder.
Part 2 of this series will explain resiliency, and the many ways parents and caretakers can actually affect the developing brain of a child in ways that will serve to protect the child from the consequences of impulsive decision making later in life.*Sources for ACEs data
https://www.cdc.gov/violenceprevention/acestudy/about_ace.html
https://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
[post_title] => Resilience
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => resilience
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:28
[post_modified_gmt] => 2019-10-21 20:34:28
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57799
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[1] => WP_Post Object
(
[ID] => 57767
[post_author] => 4
[post_date] => 2017-10-10 13:38:49
[post_date_gmt] => 2017-10-10 17:38:49
[post_content] => The Protecting Access to Medicare Act (PAMA) would save government payors an estimated $670 million, nearly 10 percent of the $7 billion that it currently pays annually for lab tests. In draft form, the proposed reduction in the fee schedule for clinical lab tests will significantly impact labs overall and the smaller, regional toxicology labs to an even greater extent. If the proposed reimbursement reductions are adopted, they will negatively impact how Aspenti Health will be able to provide services to our patients at the height of the opioid epidemic in America.
Aspenti Health ™ is a toxicology lab in Burlington, Vermont. Serving a rural state with a population of just over 600,000. Like most of the nation, we are in the grips of the opioid crisis with people suffering from substance use disorder. The combination of many of our patients residing in hard to reach rural communities and the state's limited economic base offers a host of complexities to care for the patients we serve and their struggles to reach long-term recovery. The Surgeon’s General Report cites “The Treatment Gap” as one of major contributors to the opioid crisis today. Two of the major causes of that gap are the inability to access care and lack of screening for substance misuse. Toxicology labs like Aspenti fill that very gap. Our patient service centers serve as collection locations increasing recovery services, testing access to rural communities, and critical checkpoints in our patient’s substance use disorder treatment plan. The PAMA draft rates would deter toxicology labs from expanding to ease access for those in rural America and only increase “The Treatment Gap” that contributes to this nation's opioid crisis.
Fault in the market representation PAMA used to calculate new pricing models
We believe the data collection process was severely flawed including:
By having a narrow definition of “applicable labs” PAMA excluded most of hospital labs which left the remaining 34% of the lab market to be driven by the data of two major labs representing 80% of the volume. These major labs use their economies of scale to negotiate deeply discounted lab fee schedules in exchange for exclusive contracts with private payers. Using a weighted median vs weighted average further skews the pricing towards the two larger labs.
Smaller commercial laboratories typically have less favorable payor agreements than hospital labs. Therefore, the financial impact is felt far greater to these commercials labs as CMS reduces rates coupled with out of network denials with private commercial payers. We believe the greater financial pressure on smaller, regional labs like Aspenti Health will potentially negatively impact the 3 critical factors to improving patient care – cost, quality & access.
PAMA’s data collection efforts were flawed as the data collection guidelines were not published until after data submission had already commenced.
G code reimbursements are set to decrease by 10% in 2018, and even further in the years to come. CMS stated that data reported to them for definitive G codes reflected reimbursements that were 23-59% lower than Medicare reimbursements for the same codes. However, XIFIN, a leader in the healthcare/laboratory revenue cycle management market, has stated that according to their data, Medicare reimbursements were 15% lower than the commercial market average.
Toxicology Under-Represented
While some types of testing are generalized across the country through standard testing, there are a few forms of more niche fields of laboratory medicine. CMS through the PAMA regulations has appropriately constructed an advisory panel and a mechanism for culling specialized expertise through subcommittees. However, the extent of involvement of area experts appears to be limited to molecular pathology in the advisory panel and the creation of only two subcommittees focusing on Advanced Diagnostic Laboratory Tests and Automated Test Panels (5). The unique nature of the toxicology field, who plays a critical role in the opioid crisis and an ever-expanding incidence of substance use disorders, does not appear to have a representation. It is critical that all specialty laboratory care is represented on the advisory board.
Unique position of toxicology labs in healthcare
Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making (1). In this rapidly evolving era of value-based care and patient-centered outcomes, it is critical that the laboratory is not a derivative function. By using large volume-based laboratories' reimbursements to drive CMS fee schedules (2), a greater emphasis is placed on the transactional system rather than an integrative system of care. Clinical laboratories contribute 2.5% to health care costs but drive 70% of clinical decision-making.
In the field of toxicology, most of testing remains in the hands of small toxicology laboratories who respond to regional needs (3). By potentially driving the closure of these businesses, access to an effective, inexpensive part of treatment at the time of a declared opioid emergency by the White House (4), we may be unwittingly driving increased health care costs through emergency room visits, increased risks for the consequences of intravenous drug use such as hepatitis C and HIV and an astounding number of unintended downstream consequences. This does not align with the intent of PAMA nor does this represent quality patient care.
Call to Action
We cannot stand by and let inaccurate data alter our ability to serve our patients. The immediate solution is for PAMA to delay implementation of the changes until more accurate data from all segments of the laboratory market is collected.
CMS is accepting comments until October 23. Join us in submitting your comment electronically by October 23 to this CMS mailbox:
CLFS_Annual_Public_Meeting@cms.hhs.gov
[post_title] => The Impact of PAMA on the Toxicology Lab Industry
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => impact-pama-toxicology-lab-industry
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:46
[post_modified_gmt] => 2019-10-21 20:34:46
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57767
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[2] => WP_Post Object
(
[ID] => 57752
[post_author] => 13
[post_date] => 2017-10-04 16:01:12
[post_date_gmt] => 2017-10-04 20:01:12
[post_content] => I am not a scientist and I am not a counselor. I am not an expert, but I have learned to be a good listener. I am the Social Impact Coordinator for Aspenti Health, a toxicology lab in Burlington, Vermont which provides substance use testing, a critical part of a patient’s treatment plan. We are much more than a traditional lab. We are patient centric, offer community impact through alliances and partnerships, and we embrace the responsibility of social stewardship to affect positive change.
My position is newly created, and my first task was a needs assessment and one of inquiry. I endeavored to listen and learn of needs – those of our patients, clients of community organizations and the organizations themselves – to identify community challenges, emerging trends and ways to partner.
On my drive home one evening, I was reminded of a blessing in disguise presented during my first-year internship as a Master of Social Work graduate student. I was assigned to an Area Agency on Aging which was an hour from home, a demographic I hadn’t considered working with, and quite honestly, I went into it with a bad attitude.
The Central Vermont Council on Aging utilized “Options Counseling” (OC). It assumes that if we can engage the client in exploring ways to feel more secure in their world, then we can support them in remaining fulfilled. OC allows us to do so in a way that shifts from the “we know what’s best for you” approach, to one that engages the client in exploring their goals and helping to achieve them. It is deeply respectful and highly collaborative.
Eventually, I was given the unique opportunity to meet with older adults in their homes, learn of their needs and try to find a solution. I had studied the many programs available to assist Vermonters, and I was eager to impart my knowledge and better their lives. Oh, how wrong I was. Truth be told, I was not the expert on anything – my clients were. They knew their situation, they knew where they wanted to be, and what they needed was the information necessary to make the best decision possible. With this approach, they remain the true stewards of their destiny, buoyed by the knowledge of what is available.
As I became a little more proficient, I learned that Options Counseling has three parts:
Engagement Through Relationship Building
Identifying Client Preferences
Introducing Participant-Directed Options in an Unbiased Manner
Individuals in early recovery, like the elder community, are often unaware of available programs and resources. They may be juggling drug testing, Medication Assisted Treatment, counseling, and probation and parole appointments as well as 12-step meetings. Schedules are often so heavily laden with imposed commitments, individuals don’t have the opportunity to explore available social service options.
Utilizing what was learned during my internship, we have incorporated a Collaborative Helping Model pilot which utilizes Options Counseling in one of our Patient Service Centers. It is an opportunity to develop deep connections with our patients, understand their concerns and challenges, and when directed, present available options. Out of respect, we present available options only in an unbiased manner, and based on patient preference, we can serve as a potential warm hand-off to those who provide the services our patients desire.
We’ve come to realize and value that social service support for patients with Substance Use Disorder’s need not be restricted to traditional or primary therapeutic relationships; laboratories may be an effective mechanism for increasing awareness to address social needs of individuals.
“Who are you as a person?” I’ve wondered often how many never get asked that question. They may be asked what they need and they may be judged for having that need. When an individual finds the courage to ask for help and who they are is not validated, the message received is the assumption they have nothing of value to offer. My hope is that we will want to know who they are, what they value, and what makes them valuable.
Discovering who they are can help us discover who they may need to know, not just based on their needs but even more based on their talents and abilities. Listening is an art. Compassion is a virtue. Respect for individual vision, however, is perhaps one of the greatest gifts we can give.
[post_title] => You Can’t Help Me If You Don’t Hear Me First
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => cant-help-dont-hear-first
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:59
[post_modified_gmt] => 2019-10-21 20:34:59
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57752
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[3] => WP_Post Object
(
[ID] => 57651
[post_author] => 6
[post_date] => 2017-09-14 11:21:52
[post_date_gmt] => 2017-09-14 15:21:52
[post_content] => Language regarding people with Substance Use Disorder must be clear, accurate and based in truth and compassion.
In order for us as professionals, leaders and deeply concerned individuals to raise consciousness and dispel the stigma attached to people with Substance Use Disorder, we must be as unified and unambiguous as possible. We must speak the same language, to each other and to the public.
I am reminded of an interaction with a colleague at a National Conference four years ago where I used the term “addict” during a conversation a small group of us were engaged in. Afterwards she approached me and pointed out that “we,” our profession, we're trying not to use pejorative or limiting terms any longer. She pointed out that the term “addict” limited the definition of the person to one aspect of the whole person and that “person-first-language” was more appropriate and not stigmatizing. She suggested I use the term “person with addiction” or “person with substance use disorder.”
I have been mindful of the language I choose ever since that afternoon, and I must say that there is a “softly spoken advocacy” present in many of my formal and informal conversations today as a result. This feels right to me.
Here are some examples of suggested changes in language from the Recovery Research Institute’s “Addiction-ary” you may be interested in:
· ABUSER
Stigma Alert
A person who exhibits impaired control over engaging in substance use (or other reward-seeking behavior, such as gambling) despite suffering often severe harms caused by such activity.
The word “abuser” was found in research to increase stigma, which can affect quality of care and act as a barrier to treatment-seeking in individuals suffering from addiction.
Suggested Alternative
Instead, many have recommended the use of “person first language"; instead of describing someone as a “drug abuser” to describe him/her as “a person with, or suffering from addiction or substance use disorder.”
· SUBSTANCE MISUSE
Stigma Alert
The use of a substance for unintended or intended purposes in improper amounts or doses. Term has a stigma alert, due to the inference of judgment and blame.
Suggested Alternative
Instead, many recommend using the terms “substance use” or “non-medical use.”
· CO-DEPENDENCY
Stigma Alert – No Suggested Alternative
Immoderate emotional or psychological reliance on a partner. Often used with regard to a partner requiring support due to an illness or disease (e.g., substance use disorder). Term has a stigma alert, as the term has not shown scientific merit.
These terms surely are most often spoken without malice, but they are, unfortunately, inaccurate at best and they fail to raise consciousness.
As leaders, or deeply concerned individuals, we can contribute a lot to this movement to eradicate stigma. We can do something about the tragedy of addiction every day by simply making mindful choices regarding the language we use.
I cannot think of another return on an investment being as profitable as this.
The link below is to the Recovery Research Institute’s Addiction-ary, a compendium of words and phrases we commonly use on a daily basis.
It’s been created by The Recovery Research Institute of Massachusetts General Hospital and Harvard Medical School. It is fairly exhaustive in scope, and a great resource for both professionals in this field and other concerned individuals.
I hope you find it useful.
https://www.recoveryanswers.org/addiction-ary/
[post_title] => Softly Spoken Advocacy
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => softly-spoken-advocacy
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:11
[post_modified_gmt] => 2019-10-21 20:35:11
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57651
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[4] => WP_Post Object
(
[ID] => 57239
[post_author] => 5
[post_date] => 2017-09-06 09:29:06
[post_date_gmt] => 2017-09-06 13:29:06
[post_content] => In the aftermath of Hurricane Harvey, communities throughout Louisiana and southeastern Texas are now poised to review the damage and heal. As well-demonstrated by Hurricanes Katrina and Rita, the substance use community is a profoundly vulnerable population in natural disasters1 and has been undoubtedly significantly impacted by Hurricane Harvey’s wrath.
[caption id="attachment_57240" align="alignnone" width="840"]Old Weathered and Destroyed Home in Flood Water Disaster in La Grange, Texas after Hurricane Harvey moved in and flooded everyone and matched with the flooding Colorado River.[/caption]
Federal, state and local agencies have been working tirelessly to provide direct care and funds to support treatment through this crisis. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced on August 29, 2017 that affected states can assign previously allocated funds to this crisis.2 This funding source is in addition to state efforts which sought to enhance access to medication-assisted treatment in advance of the coming hurricane. Among other coordinated efforts, disaster support through the State Opioid Treatment Authorities (SOTAs) enable patients to be connected to appropriate services.Nonetheless, despite our collective best efforts, Hurricane Harvey is arguably one of the costliest natural disasters this country has faced in recent times. According to the New York Times, the cost of Hurricane Harvey may be at least $160 billion.3Importantly, ramifications to this community will likely be felt for months or years. Based on our experiences from Hurricanes Katrina and Rita, early days can be “chaotic”1 with failure to establish the basics such as patient identity or dosing requirements for treated patients. However, the consequences of displacement, interrupted daily activities and the stressors associated with disasters have profound and long-term consequences in this community. A study of the impact of substance use disorder rates as many as three years after Hurricane Katrina showed an increase in hospitalization rates for substance use disorder in these communities from 7.13 per 1,000 population for 2004 and 9.65 per 1,000 for 2008.4As any one involved in substance use disorders knows all too well, recovery is rarely, if ever, a quick process.For those able, consider donating to reputable sites that are working to support this mission. A recent article from the New York Times5 cited several avenues to support Harvey efforts including the American Red Cross (800-HELP NOW), which offers broad support, and AmeriCares (800-486-HELP) and Direct Relief (800-676-1638), which both provide medication support to victims.For those looking for resources in this time of crisis, SAMHSA offers a Disaster Distress Helpline where individuals can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with trained crisis personnel.
References:
1) Maxwell JC, Podus D, Walsh D. Lessons Learned From the Deadly Sisters: Drug and Alcohol Treatment Disruption, and Consequences from Hurricanes Katrina and Rita Substance Use and Misuse 44: 1681-1694 20092) Texas, Louisiana may reallocate certain federal funds to provide addiction medication Wednesday, August 30, 2017; https://www.samhsa.gov/newsroom/press-announcements/201708300500; accessed 9/1/17. 3) Swartz M Houston Needs a Hand. New York Times, 9/2/17; https://www.nytimes.com/2017/09/02/opinion/sunday/houston-texas-harvey-government.html?mcubz=0, accessed 9/2/17.4) Moise IK, Ruiz MO. Hospitalizations for Substance Abuse Disorders Before and After Hurricane Katrina: Spatial Clustering and Area-Level Predictors, New Orleans, 2004 and 2008. Prev Chronic Dis 2016;13:160107.5) Caron, C. Where to Donate to Harvey Victims (and How to Avoid Scams), New York Times, 8/28/17, https://mobile.nytimes.com/2017/08/28/us/donate-harvey-charities-scams.html?referer=http%3A%2F%2Fm.facebook.com%2F, accessed 9/2/17
[post_title] => Hurricane Harvey
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => hurricane-harvey
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:19
[post_modified_gmt] => 2019-10-21 20:35:19
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57239
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[5] => WP_Post Object
(
[ID] => 57033
[post_author] => 6
[post_date] => 2017-08-15 17:06:15
[post_date_gmt] => 2017-08-15 21:06:15
[post_content] => Is There Another Drug Use Tragedy Growing in The Shadows of The Opioid Crisis?
Treatment systems, law enforcement personnel, hospital emergency rooms, first-responders, and coroners are all back on their heels, struggling to contain and reverse the worst opioid epidemic our country has ever seen. It’s like turning around a giant ocean-liner: a likely continuation of the present direction before an overall reversal occurs. There is every reason to believe with confidence that we will respond effectively and definitively to this national tragedy, as we have with the public health crises caused by tobacco and AIDS. When we focus as a nation, we accomplish great things.
But as we devote more and more resources to this present challenge, there is yet another disturbing trend developing -- the increasing use of methamphetamine, an extremely potent psychostimulant with its own tragic consequences.
Here are some recent developments:
Seizures of methamphetamine increased from approximately 5,000 kilograms in 2002 to over 40,000 kilograms in 2015 (SAMHSA).
The estimated number of methamphetamine users grew from approximately 314,000 in 2008 to 569,000 in 2014 (National Center for Health Statistics).
Overdose fatalities rose 30% between 2014 and 2015.
Data indicates methamphetamine use is migrating from primarily rural to inner-city areas, and that people with heroin use disorder are using methamphetamine more frequently.
What is it that is causing an increase in use?
It now appears that International Criminal Organizations (ICOs) in Mexico have noted an unmet demand for methamphetamine here in the USA beginning in 2006.
In 2006 the Combat Methamphetamine Epidemic Act went into effect, placing very tight controls on over-the-counter sales of pharmaceutical medications containing pseudoephedrine. This chemical was a necessary ingredient used in the illicit manufacture of methamphetamine in “meth-labs.” This legislation was largely successful, and the supply of illicit methamphetamine in our country dropped precipitously, resulting in unmet user demand.
Since then, Mexican ICOs have been flooding the American drug-market with near 100% pure methamphetamine at record-low prices, the very same way they saturated our communities with high-grade, low-priced heroin and of late, with the most lethal of opioids, fentanyl.
[caption id="attachment_57040" align="aligncenter" width="389"] Methamphetamine also known as crystal meth[/caption]
Here are some suggestions on proactive measures we can take to prevent yet another tragic epidemic in our country:Parents/families and educators:
Educate ourselves, our clients, the general-public and our middle and high school-age students regarding the incredible addiction potential of methamphetamine.
Talk to our children heart-to-heart regarding the dangers of this and other drugs. Always remain available to talk.
Support local, state, and national political leaders who demonstrate their commitment to addressing drug use in America.
Report suspicious local activity to proper officials.
For health practitioners:
Interview at-risk patients regarding possible use of this drug: people with a history of drug-use, especially psychostimulants or opioids, and those with depression, PTSD or ADHD.
Conclusion
Together we can keep our eyes open for early warning signs in our community, our schools, our families and our medical practices.
The opioid crisis crept up on us and exploded like the proverbial “mushroom cloud.” We can prevent future drug-use related epidemics.
Let’s talk to each other, share information and act quickly and definitively as individuals and as a culture at the first sign of another drug-related public health threat in our communities.
Suggested Readinghttps://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdfhttps://www.nbcnews.com/news/us-news/twin-plagues-meth-rises-shadow-opioids-n776871https://www.msn.com/en-us/news/us/its-everywhere-again-meth-surges-in-us/ar-BBDzpPG?OCID=ansmsnnews11https://www.drugfreeworld.org/home.html
[post_title] => Is There Another Drug Use Tragedy Growing in The Shadows of The Opioid Crisis?
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => is-there-another-tragedy-growing
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:25
[post_modified_gmt] => 2019-10-21 20:35:25
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57033
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[6] => WP_Post Object
(
[ID] => 56935
[post_author] => 6
[post_date] => 2017-07-12 10:32:24
[post_date_gmt] => 2017-07-12 14:32:24
[post_content] => I’ve spent almost my entire career as a psychotherapist working with individuals with Substance Use Disorder. I’ve listened for over 30 years, and one of the things I have learned very well is that words have power. Words can actually save lives.
Surgeon General Vivek Murthy’s report of 2016, “Facing Addiction In America” estimates that of the approximately 21 million people in America with Substance Use Disorder in 2015, a mere 10% received treatment. Dr. Murthy goes on to say that “stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help.” In 2015, there were 52,404 fatalities directly attributable to drug overdose! When it comes to addiction, hesitation to seek help costs lives.
Words have immense power. Here are some easy to use guidelines on how to use your words, every day, to dispel this deadly stigma and create compassion for people with Substance Use Disorder.
Person-First-Language
Avoid words like “addict” and “alcoholic”. While seeming benign and without malintent, they nonetheless limit the definition of the entire person to their disease. Use person-first language instead, such as “person-with-an-opioid-use-disorder”, or “person-with-a-substance-use-disorder”. These terms serve to more accurately affirm the entire person, with the medical disorder being only a part of the person’s experience. Including the medical term “disorder” tends to raise public consciousness by emphasizing the medical nature of addiction.
Avoid Judgmental Terms
Avoid terms like “substance abuser” or “drug abuse”. These terms characterize the person with a substance use disorder as abusive, and cause judgmental and punitive attitudes toward them. Person-first language is most appropriate here, as are terms like “substance use” or “misuse”.When referring to Substance Use Testing Results, terms like “dirty” or “clean” should be avoided. These terms bring out judgment and unintentionally invite a punitive response. Medical terms such as “positive” or “negative” test results are more accurate, and tend to encourage a respectful and compassionate response.
Avoid Misleading Terminology
Avoid terms like “recreational use”, or “casual use”. These terms can be misleading and add an inaccurate shade of safety to drug use. This is especially dangerous considering adolescents’ heightened tendency to use a drug if their perceived risk of harm is low. The term “use” is neutral, and therefore not misleading. “Misuse” characterizes either illegal or otherwise problematic use.
In order to raise public consciousness and dispel the stigma associated with substance use disorder, we, as concerned and informed individuals, can contribute to a compassionate approach to addiction and recovery in very impactful ways by being mindful of the words we choose when speaking of addiction, people with Substance Use Disorder, and the services they receive to support health.
Our history clearly attests to our ability to respond to similar emergent situations successfully, when we become motivated and organized. The Surgeon General’s Report of 1964 sparked the initiative that has led to remarkable progress regarding tobacco use and health. And the Surgeon General’s Report of 1989 sparked the equally remarkable response to the AIDS crisis.
I’ll end with one more quote from Dr. Murthy’s Surgeon General’s Report of 2016 : “We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”
Let’s work together and bring about the day when people with Substance Use Disorder are welcomed with compassion into the mainstream of quality health-care in America. The potential gain to our country in cost-saving, productivity over the life-span, and the general health of our population is enormous. Decisions impacting this group must be grounded in medical science, and motivated by compassion if we are to move forward in an effective way as a nation.
And language is one of the keys that will unlock this sea-change and save lives.
Words matter… Let’s raise consciousness together… Together we can do this !!!
Additional Reading
Surgeon General Murthy’s Report:
https://addiction.surgeongeneral.gov/
Stop Talking Dirty, American Journal of Medicine Article:
https://www.amjmed.com/article/S0002-9343%2814%2900770-0/fulltext
Website: New Recovery Movement: The Rationale and Science on Recovery Support Services
https://www.nadcp.org/sites/default/files/2014/GS-2_0.pdf
[post_title] => Would You Like To Help Save A Life?
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => would-you-like-to-help-save-a-life
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:32
[post_modified_gmt] => 2019-10-21 20:35:32
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=56935
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[7] => WP_Post Object
(
[ID] => 56832
[post_author] => 5
[post_date] => 2017-06-28 14:18:32
[post_date_gmt] => 2017-06-28 18:18:32
[post_content] => How in less than the last 100 years have we gone from the most frugal minded citizens to a more wasteful society? My grandmother lived through the Great Depression and it changed her. In fact, it transformed her entire generation. Our depression era loved ones learned how to make the most out of everything and never wasted. Today Americans struggle to balance the conveniences they want; disposable coffee cups, car dependent cities or perfectly green lawns despite water stressed communities against what they know is right. A more thoughtful look at what is needed for the individual and how it effects the whole is gaining attention again. Healthcare is up against these same challenges as we examine our thinking as the Disposable Generation, asking us to think differently and to challenge our waste.
If we physicians engage in defensive decision making, it is sadly not hard to find redundant, excessive and even potentially harmful care. Sometimes, it can be easy to recognize the potential downside: For example, we all know we shouldn’t order a chest x-ray on every child with a cough. Other decisions are subtler.
In 2010, Dr. Howard Brody1 published “Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List,” and started a patient-centered movement on the careful use of health care resources. This initiative has now morphed into what is called the Choosing Wisely Campaign, which has partnered worldwide with 75 societies and 50 consumer organizations, most actively Consumer Reports. These enterprises are asking us to challenge our thoughts and to do the right thing by our patients.
The Choosing Wisely Campaign and other societies have borrowed from the well-recognized five rights of safe medication administration to advocate for selecting the “right test for the right patient at the right time”2. Others have expanded this language to include the “right cost”.3 But, I would submit we should never forget a most important patient right – that we act for the “right reason”.
Remembering the basic tenets of the Hippocratic Oath, we can remember to “make a habit of two things – to help, or at least to do no harm’3. These simple goals ask us to approach each patient thoughtfully and individually. If we are acting under the principle of the Five Rights – Right patient, right test, right time, right cost, right reason – we will be “getting it right” for our nation’s health care, our communities and, most importantly, for our patients.
References:
1: Brody, Howard, Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List, N Engl J Med 2010, 362: 283-285.
2: Lee Hilborne, Choosing Wisely: Selecting the Right Test for the Right Patient at the Right Time. Medical Laboratory Observer, May 18, 2014: https://www.mlo-online.com/choosing-wisely-selecting-the-right-test-for-the-right-patient-at-the-right-time.php
3. Hippocrates Epidemics, Book 1, Section XI (tr. By WHS Jones).
[post_title] => Healthcare for the Right Reason - Choosing Wisely for Every Patient
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => choosing-wisely-campaign
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:47
[post_modified_gmt] => 2019-10-21 20:35:47
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=56832
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
)
[post_count] => 8
[current_post] => -1
[in_the_loop] =>
[post] => WP_Post Object
(
[ID] => 57799
[post_author] => 6
[post_date] => 2017-10-20 16:15:59
[post_date_gmt] => 2017-10-20 20:15:59
[post_content] =>
A Sure-Fire Way to Protect Our Children from Substance-Use-Disorder
Investigative Journalism, professional publications, expert Speakers in the Addictions field, and good old common sense tell us that we will never control the occurrence of Substance Use Disorder in our country by “supply side” solutions only. Although interdiction, strict regulation and law-enforcement are crucial, the demand for drugs will always be met by the supply of both criminal and legitimate entrepreneurs.
We must, as a culture, over time, devote our resources to substantially reducing the demand for all psychoactive chemicals. This will occur over the coming generations, accomplished by our children. We must prepare them for this. What’s known as “resilience” is the key.
Drug use prevention, in part, means equipping all of our children, as they move into adolescence, with the cognitive, emotional and social stability necessary to cope and manage stress in healthy ways. These capacities are brain functions, they are learned, they are a product of the child’s brain’s interaction with the environment, or, more specifically, with the adults in their world.
All too often many of our children find themselves in situations which ill-equip them developmentally to constructively respond to the inevitable stressors of adolescence and young-adulthood. These children are at-risk for the development of substance use disorder, as well as a host of other unhealthy behaviors which cause serious health-related problems.
The situations I’m referring to are ACEs, or Adverse Childhood Experiences, such as, but not limited to (see sources*):
• Child abuse or neglect
• Violence in the home
• Chaotic family conditions
• Unsafe neighborhood conditions
• Cumulative effects of developmental needs not being met
ACEs are environmental conditions likely to create what’s known as “toxic stress”. Toxic stress is the “prolonged activation of the brain’s stress response systems in the absence of protective relationships.”
What occurs as a result of exposure to toxic stress is nothing short of impaired brain development. Children learn to manage stress from attentive adults. Without the continued support of an attentive adult to mediate and buffer stress, children are likely to develop what is called “rapid stress response”.
Rapid stress response is the tendency to react to stress impulsively. Toxic stress actually effects the manner in which genes regulate the development of organs, in this case the brain. This is known as epigenetics. The developing brain of a child or adolescent, exposed to continued high levels of environmental stress, unfiltered or mediated by an adult, will be conditioned to respond in ways that are impulsive, or relief seeking, rather than deliberate and considered. This tendency toward impulsive decision making puts the individual at-risk for developing substance use disorder.
Part 2 of this series will explain resiliency, and the many ways parents and caretakers can actually affect the developing brain of a child in ways that will serve to protect the child from the consequences of impulsive decision making later in life.*Sources for ACEs data
https://www.cdc.gov/violenceprevention/acestudy/about_ace.html
https://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
[post_title] => Resilience
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => resilience
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:28
[post_modified_gmt] => 2019-10-21 20:34:28
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57799
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[comment_count] => 0
[current_comment] => -1
[found_posts] => 28
[max_num_pages] => 3
[max_num_comment_pages] => 0
[is_single] =>
[is_preview] =>
[is_page] =>
[is_archive] =>
[is_date] =>
[is_year] =>
[is_month] =>
[is_day] =>
[is_time] =>
[is_author] =>
[is_category] =>
[is_tag] =>
[is_tax] =>
[is_search] =>
[is_feed] =>
[is_comment_feed] =>
[is_trackback] =>
[is_home] => 1
[is_privacy_policy] =>
[is_404] =>
[is_embed] =>
[is_paged] => 1
[is_admin] =>
[is_attachment] =>
[is_singular] =>
[is_robots] =>
[is_posts_page] => 1
[is_post_type_archive] =>
[query_vars_hash:WP_Query:private] => 604a98d4072c8d4d19f8ebdb4ad63e4b
[query_vars_changed:WP_Query:private] =>
[thumbnails_cached] => 1
[stopwords:WP_Query:private] =>
[compat_fields:WP_Query:private] => Array
(
[0] => query_vars_hash
[1] => query_vars_changed
)
[compat_methods:WP_Query:private] => Array
(
[0] => init_query_flags
[1] => parse_tax_query
)
)
Drug use prevention, in part, means equipping all of our children, as they move into adolescence, with the cognitive, emotional and social stability necessary to cope and manage stress in healthy ways. These capacities are brain functions, they are learned, they are a product of the child’s brain’s interaction with the environment, or, more specifically, with the adults in their world.
All too often many of our children find themselves in situations which ill-equip them developmentally to constructively respond to the inevitable stressors of adolescence and young-adulthood. These children are at-risk for the development of substance use disorder, as well as a host of other unhealthy behaviors which cause serious health-related problems.
The situations I’m referring to are ACEs, or Adverse Childhood Experiences, such as, but not limited to (see sources*):
• Child abuse or neglect
• Violence in the home
• Chaotic family conditions
• Unsafe neighborhood conditions
• Cumulative effects of developmental needs not being met
ACEs are environmental conditions likely to create what’s known as “toxic stress”. Toxic stress is the “prolonged activation of the brain’s stress response systems in the absence of protective relationships.”
What occurs as a result of exposure to toxic stress is nothing short of impaired brain development. Children learn to manage stress from attentive adults. Without the continued support of an attentive adult to mediate and buffer stress, children are likely to develop what is called “rapid stress response”.
Rapid stress response is the tendency to react to stress impulsively. Toxic stress actually effects the manner in which genes regulate the development of organs, in this case the brain. This is known as epigenetics. The developing brain of a child or adolescent, exposed to continued high levels of environmental stress, unfiltered or mediated by an adult, will be conditioned to respond in ways that are impulsive, or relief seeking, rather than deliberate and considered. This tendency toward impulsive decision making puts the individual at-risk for developing substance use disorder.
Part 2 of this series will explain resiliency, and the many ways parents and caretakers can actually affect the developing brain of a child in ways that will serve to protect the child from the consequences of impulsive decision making later in life.*Sources for ACEs data
https://www.cdc.gov/violenceprevention/acestudy/about_ace.html
https://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
[post_title] => Resilience
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => resilience
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:28
[post_modified_gmt] => 2019-10-21 20:34:28
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57799
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[1] => WP_Post Object
(
[ID] => 57767
[post_author] => 4
[post_date] => 2017-10-10 13:38:49
[post_date_gmt] => 2017-10-10 17:38:49
[post_content] => The Protecting Access to Medicare Act (PAMA) would save government payors an estimated $670 million, nearly 10 percent of the $7 billion that it currently pays annually for lab tests. In draft form, the proposed reduction in the fee schedule for clinical lab tests will significantly impact labs overall and the smaller, regional toxicology labs to an even greater extent. If the proposed reimbursement reductions are adopted, they will negatively impact how Aspenti Health will be able to provide services to our patients at the height of the opioid epidemic in America.
Aspenti Health ™ is a toxicology lab in Burlington, Vermont. Serving a rural state with a population of just over 600,000. Like most of the nation, we are in the grips of the opioid crisis with people suffering from substance use disorder. The combination of many of our patients residing in hard to reach rural communities and the state's limited economic base offers a host of complexities to care for the patients we serve and their struggles to reach long-term recovery. The Surgeon’s General Report cites “The Treatment Gap” as one of major contributors to the opioid crisis today. Two of the major causes of that gap are the inability to access care and lack of screening for substance misuse. Toxicology labs like Aspenti fill that very gap. Our patient service centers serve as collection locations increasing recovery services, testing access to rural communities, and critical checkpoints in our patient’s substance use disorder treatment plan. The PAMA draft rates would deter toxicology labs from expanding to ease access for those in rural America and only increase “The Treatment Gap” that contributes to this nation's opioid crisis.
Individuals in early recovery, like the elder community, are often unaware of available programs and resources. They may be juggling drug testing, Medication Assisted Treatment, counseling, and probation and parole appointments as well as 12-step meetings. Schedules are often so heavily laden with imposed commitments, individuals don’t have the opportunity to explore available social service options.
Utilizing what was learned during my internship, we have incorporated a Collaborative Helping Model pilot which utilizes Options Counseling in one of our Patient Service Centers. It is an opportunity to develop deep connections with our patients, understand their concerns and challenges, and when directed, present available options. Out of respect, we present available options only in an unbiased manner, and based on patient preference, we can serve as a potential warm hand-off to those who provide the services our patients desire.
We’ve come to realize and value that social service support for patients with Substance Use Disorder’s need not be restricted to traditional or primary therapeutic relationships; laboratories may be an effective mechanism for increasing awareness to address social needs of individuals.
“Who are you as a person?” I’ve wondered often how many never get asked that question. They may be asked what they need and they may be judged for having that need. When an individual finds the courage to ask for help and who they are is not validated, the message received is the assumption they have nothing of value to offer. My hope is that we will want to know who they are, what they value, and what makes them valuable.
Discovering who they are can help us discover who they may need to know, not just based on their needs but even more based on their talents and abilities. Listening is an art. Compassion is a virtue. Respect for individual vision, however, is perhaps one of the greatest gifts we can give.
[post_title] => You Can’t Help Me If You Don’t Hear Me First
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => cant-help-dont-hear-first
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:34:59
[post_modified_gmt] => 2019-10-21 20:34:59
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=57752
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[3] => WP_Post Object
(
[ID] => 57651
[post_author] => 6
[post_date] => 2017-09-14 11:21:52
[post_date_gmt] => 2017-09-14 15:21:52
[post_content] => Language regarding people with Substance Use Disorder must be clear, accurate and based in truth and compassion.
In order for us as professionals, leaders and deeply concerned individuals to raise consciousness and dispel the stigma attached to people with Substance Use Disorder, we must be as unified and unambiguous as possible. We must speak the same language, to each other and to the public.
I am reminded of an interaction with a colleague at a National Conference four years ago where I used the term “addict” during a conversation a small group of us were engaged in. Afterwards she approached me and pointed out that “we,” our profession, we're trying not to use pejorative or limiting terms any longer. She pointed out that the term “addict” limited the definition of the person to one aspect of the whole person and that “person-first-language” was more appropriate and not stigmatizing. She suggested I use the term “person with addiction” or “person with substance use disorder.”
I have been mindful of the language I choose ever since that afternoon, and I must say that there is a “softly spoken advocacy” present in many of my formal and informal conversations today as a result. This feels right to me.
Here are some examples of suggested changes in language from the Recovery Research Institute’s “Addiction-ary” you may be interested in:
Old Weathered and Destroyed Home in Flood Water Disaster in La Grange, Texas after Hurricane Harvey moved in and flooded everyone and matched with the flooding Colorado River.[/caption]
Federal, state and local agencies have been working tirelessly to provide direct care and funds to support treatment through this crisis. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced on August 29, 2017 that affected states can assign previously allocated funds to this crisis.2 This funding source is in addition to state efforts which sought to enhance access to medication-assisted treatment in advance of the coming hurricane. Among other coordinated efforts, disaster support through the State Opioid Treatment Authorities (SOTAs) enable patients to be connected to appropriate services.
Nonetheless, despite our collective best efforts, Hurricane Harvey is arguably one of the costliest natural disasters this country has faced in recent times. According to the New York Times, the cost of Hurricane Harvey may be at least $160 billion.3
Importantly, ramifications to this community will likely be felt for months or years. Based on our experiences from Hurricanes Katrina and Rita, early days can be “chaotic”1 with failure to establish the basics such as patient identity or dosing requirements for treated patients. However, the consequences of displacement, interrupted daily activities and the stressors associated with disasters have profound and long-term consequences in this community. A study of the impact of substance use disorder rates as many as three years after Hurricane Katrina showed an increase in hospitalization rates for substance use disorder in these communities from 7.13 per 1,000 population for 2004 and 9.65 per 1,000 for 2008.4
As any one involved in substance use disorders knows all too well, recovery is rarely, if ever, a quick process.
For those able, consider donating to reputable sites that are working to support this mission. A recent article from the New York Times5 cited several avenues to support Harvey efforts including the American Red Cross (800-HELP NOW), which offers broad support, and AmeriCares (800-486-HELP) and Direct Relief (800-676-1638), which both provide medication support to victims.
For those looking for resources in this time of crisis, SAMHSA offers a Disaster Distress Helpline where individuals can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with trained crisis personnel.
Methamphetamine also known as crystal meth[/caption]
Here are some suggestions on proactive measures we can take to prevent yet another tragic epidemic in our country:
Parents/families and educators:
In 2010, Dr. Howard Brody1 published “Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List,” and started a patient-centered movement on the careful use of health care resources. This initiative has now morphed into what is called the Choosing Wisely Campaign, which has partnered worldwide with 75 societies and 50 consumer organizations, most actively Consumer Reports. These enterprises are asking us to challenge our thoughts and to do the right thing by our patients.
The Choosing Wisely Campaign and other societies have borrowed from the well-recognized five rights of safe medication administration to advocate for selecting the “right test for the right patient at the right time”2. Others have expanded this language to include the “right cost”.3 But, I would submit we should never forget a most important patient right – that we act for the “right reason”.
Remembering the basic tenets of the Hippocratic Oath, we can remember to “make a habit of two things – to help, or at least to do no harm’3. These simple goals ask us to approach each patient thoughtfully and individually. If we are acting under the principle of the Five Rights – Right patient, right test, right time, right cost, right reason – we will be “getting it right” for our nation’s health care, our communities and, most importantly, for our patients.
References:
1: Brody, Howard, Medicine’s Ethical Responsibility for Health Care Reform – The Top Five List, N Engl J Med 2010, 362: 283-285.
2: Lee Hilborne, Choosing Wisely: Selecting the Right Test for the Right Patient at the Right Time. Medical Laboratory Observer, May 18, 2014: https://www.mlo-online.com/choosing-wisely-selecting-the-right-test-for-the-right-patient-at-the-right-time.php
3. Hippocrates Epidemics, Book 1, Section XI (tr. By WHS Jones).
[post_title] => Healthcare for the Right Reason - Choosing Wisely for Every Patient
[post_excerpt] =>
[post_status] => publish
[comment_status] => open
[ping_status] => open
[post_password] =>
[post_name] => choosing-wisely-campaign
[to_ping] =>
[pinged] =>
[post_modified] => 2019-10-21 16:35:47
[post_modified_gmt] => 2019-10-21 20:35:47
[post_content_filtered] =>
[post_parent] => 0
[guid] => http://localhost/aspenti/?p=56832
[menu_order] => 0
[post_type] => post
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
)
[post_count] => 8
[current_post] => -1
[in_the_loop] =>
[post] => WP_Post Object
(
[ID] => 57799
[post_author] => 6
[post_date] => 2017-10-20 16:15:59
[post_date_gmt] => 2017-10-20 20:15:59
[post_content] =>