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[post_content] => When I pull into my driveway after work, there is a sense of serenity and joy. The stressors of the day often fade before the garage door even opens. My home is not the house: it is defined by my family and the love and support we share. For many individuals after inpatient treatment for Substance Use Disorder(s), there is no home to return to, or it is the same one which played a significant role fueling their substance use.
One of the first acronyms someone in early recovery might hear is SOBER (Son of a B****, Everything’s Real). It can be a time of terror and uncertainty, extreme loneliness, and not knowing who to turn to for support. Paying bills, making appointments, job applications and many other day-to-day tasks can be overwhelming. Without proper support, the danger of relapse is significant and may lead to tragedy and death.
Katherine Thom, in her SAMSHA (Substance Abuse and Mental Health Services Administration) article, Recovery Homes Help People in Early Recovery, offers hope. She begins by quoting Lori Criss, Associate Director of the Ohio Council of Behavioral Health & Family Services Providers, who explains why the phrase, “People, Places and Things” has so much influence in the recovery community. “Who we spend our time with, where we go, and the things we surround ourselves with all impact who we are and the decisions that we make. Many times, people in early recovery have to give up everything they’ve known… because those people, places, and things put them at risk for relapse or continued use. Early recovery can be painful and isolating. Recovery housing can fill that void with a safe place, compassionate people, and a life full of purpose and fun that doesn’t involve alcohol or drugs,” says Criss (Thom, 2013).
The idea is not a new one. It is gaining traction nationally and here in Vermont. And there is a desperate need to expand access. Recovery homes are an effective and reasonably priced option. They provide a safe environment that empowers residents on their journey of recovery. Empowerment through support to achieve independence is what we as parents try to provide for our children. And the sober home model offers that second chance where one can redefine their life, make a difference, view one’s contribution as valuable, and consequently, feel valuable.
According to Thom, Criss is proposing private-public partnerships to create more recovery homes which offer services for lower socio-economic individuals with Substance Use Disorder(s). Criss suggests, “A responsive system will provide access to affordable, mainstream housing where people can be safely housed and supported in recovery at their own pace. The strength of recovery-focused housing is its ability to provide ongoing peer support while promoting sobriety in a natural home environment” (Thom, 2013).
No one willingly chooses a life dominated by substance use, just as no one willingly agrees to the return of cancer after treatment. We should embrace and treat those striving for a life of recovery as the truly remarkable and deserving survivors they are. Substance Use Disorder is not a choice. It is an illness, period!
Unintentionally, I take for granted just how privileged I am. It is something everyone should have and what every home should feel like.
Learn about the National Alliance for Recovery Residences (NARR) at: National Association of Recovery Residences (NARR) Their mission is “To support persons in recovery from addiction by improving their access to quality recovery residences through standards, support services, placement, education, research and advocacy.”
And learn about the Vermont Association of Recovery Residences at: https://narronline.org/cm-business/vermont-association-of-recovery-residences/
Reference
Thom, K. (2013). Recovery Homes Help People in Early Recovery. SAMSHA. Retrieved October 16, 2017 from: https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/recovery-homes-help-people[
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[post_content] => As we saw in Part 1 of this series, the tendency toward impulsive decision-making as a response to stress is a risk factor in developing substance use disorder. The opposite of impulsive behaviors are behaviors that are consciously chosen as a response to stress because they are likely to result in healthy, or positive, outcomes.
Deliberative, weighed out responses to stress are a product of “executive function processes” carried out by the pre-frontal-cortex. These are learned during childhood and adolescence, primarily. This is the key component to what is known as “Resilience”. When a concerned, committed adult supports a child’s coping with stressful situations, there is an actual effect on the development of the child’s brain, on their learned ability to cope with stress in a productive manner. This skill or function, once developed, can last a lifetime. This is Resilience.
Resilience can be defined as:
[post_title] => Resilience Part 2
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[post_content] => I listened attentively to the speech, pulled over to the side of the road, taking notes.
I heard the President declare there were over 64,000 deaths attributable to drug overdose in 2016, with 2/3 of these being caused by opioids. Overall about 7 deaths per hour. I heard him say that in West Virginia 1 of 5 newborns come into this life with Neonatal Abstinence Syndrome as a health consequence of the birthmother’s addiction to opioids. I heard him elaborate on the importance of Substance Use Counseling being provided to people with addiction who are incarcerated. And I listened as he underlined the inestimable significance of demand reduction over the foreseeable future, the cultural mandate to protect our children by educating them and supporting them, fully equipping them with the cognitive, emotional and social skills necessary to choose healthy behaviors, and avoid the allure of psychoactive chemicals.
I couldn’t have agreed more with every point he made.
What I didn’t hear was the “first and most urgent recommendation” of the Interim Report of the Commission on Combating Drug Addiction and the Opioid Crisis*: to “declare a national emergency under either the Public Health Service Act or the Stafford Act”. This would have created a wide avenue for the quick release of funds to support initiatives, which the declaration of a public health emergency fails to do.
The National Council For Behavioral Health stated “ While the National Council is pleased to see the President recognize the opioid crisis as a public health emergency , the announcement comes without any new funding to respond to the epidemic and the specifics of the declaration are still unclear”.
It’s important to note that the following major recommendations of the President’s Commission’s Interim Report all included funding:
By declaring the opioid crisis as a public health emergency, this past week President Trump joined the millions of voices who cry out from the heartbreak of addiction, who mourn lost lives, and who witness the insidious nature of this disease’s impact on our families and communities.
We can debate whether or not this initiative leverages the full scope of governmental authority to support this crisis. For this, I will defer to my more politically savvy friends. Instead, I remain grateful that our government has symbolically lent its voice to this cause. I am reminded of a recent Aspenti community initiative at the Burlington Airport in which we acknowledge that "the only choice in addiction is how we choose to address it together."
Through this designation, President Trump identified some key avenues for governmental support and focus. These include: - Directing additional grant funding to support opioid-related work - Prevention advocacy for youth - Expanding treatment access to rural settings via telemedicine - Supporting additional safe prescribing practices - Increase Substance Use Disorder (SUD) treatment for those with HIV/AIDS - Encouraging further initiatives centered on alternative, nonaddictive pain medication - Thwarting fentanyl influx into the US from foreign sources - Expanding Medicaid funding to certain treatment centers There are many ways in which the government could choose to exert its influence such as safe and sober housing, gainful employment, or advocacy for medication-assisted treatment. The strategies outlined by President Trump include a few particularly impactful steps including an emphasis on rural access and increased surveillance for fentanyl importation. In addition to limited funding left in the budget this year, all public health emergencies expire in 90 days. With farther-reaching initiatives such as support for the development of nonaddictive pain medications, let us hope for a continued commitment to this work and ongoing renewals to this public health emergency designation. Nonetheless, these initiatives represent first, albeit small, steps in the march towards conquering this disease as an individual, a family, a community and a nation.References:
https://www.nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html, accessed 10/27/17
[post_title] => Key Strategies in a Public Health Emergency [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => key-strategies-public-health-emergency [to_ping] => [pinged] => [post_modified] => 2019-10-21 16:33:43 [post_modified_gmt] => 2019-10-21 20:33:43 [post_content_filtered] => [post_parent] => 0 [guid] => http://localhost/aspenti/?p=57856 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 57835 [post_author] => 13 [post_date] => 2017-10-27 11:08:20 [post_date_gmt] => 2017-10-27 15:08:20 [post_content] => The opioid crisis has changed our communities dramatically across the country. With so many different channels for Americans’ to become addicted to opioids, it’s at the point where those who have taken an oath to do no harm, might be doing the most long-term harm with their prescribing practices. With the addition of the instant life and death consequences fentanyl attributes to the equation, the fight many healthcare entities are now facing is a completely new, complicated and ever-evolving task at hand. As healthcare companies, treatment facilities, recovery organizations, drug testing labs, and everyday communities across the nation we must now rapidly accelerate our views on how we view Substance Use Disorder. At Aspenti Health we have a dedicated social mission focused on this very cause.
After months of coordinated work with community partners and the Burlington International Airport, “The Change Corridor” opened on Monday October 2nd. Proudly attending the opening were our community partners, our congressional leaders Senator Leahy and Congressman Welch and City of Burlington leaders Mayor Weinberger, Burlington Chief of Police Del Pozo, and Gene Richards.With almost no branding insight, “The Change Corridor” is a prime example of how Aspenti Health puts our community first in addressing our social mission. We focus our efforts on the welfare of our patients, collaborations with communities, and most importantly impacting measurable change. We invite everyone to take a few minutes of their day to stop at the airport, open to the public to observe the exhibit and how people react to a heartening message of choice. We invite everyone in the presence of the Change Corridor to reflect on how the messaging and reactions make us feel about our own views on Substance Use Disorder and if they align with other health issues plaguing the nation.
When we choose to engage we can make real change.
[post_title] => How a Lab Ended Up at an Airport
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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
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[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.
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[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.
One of the first acronyms someone in early recovery might hear is SOBER (Son of a B****, Everything’s Real). It can be a time of terror and uncertainty, extreme loneliness, and not knowing who to turn to for support. Paying bills, making appointments, job applications and many other day-to-day tasks can be overwhelming. Without proper support, the danger of relapse is significant and may lead to tragedy and death.
Katherine Thom, in her SAMSHA (Substance Abuse and Mental Health Services Administration) article, Recovery Homes Help People in Early Recovery, offers hope. She begins by quoting Lori Criss, Associate Director of the Ohio Council of Behavioral Health & Family Services Providers, who explains why the phrase, “People, Places and Things” has so much influence in the recovery community. “Who we spend our time with, where we go, and the things we surround ourselves with all impact who we are and the decisions that we make. Many times, people in early recovery have to give up everything they’ve known… because those people, places, and things put them at risk for relapse or continued use. Early recovery can be painful and isolating. Recovery housing can fill that void with a safe place, compassionate people, and a life full of purpose and fun that doesn’t involve alcohol or drugs,” says Criss (Thom, 2013).
The idea is not a new one. It is gaining traction nationally and here in Vermont. And there is a desperate need to expand access. Recovery homes are an effective and reasonably priced option. They provide a safe environment that empowers residents on their journey of recovery. Empowerment through support to achieve independence is what we as parents try to provide for our children. And the sober home model offers that second chance where one can redefine their life, make a difference, view one’s contribution as valuable, and consequently, feel valuable.
According to Thom, Criss is proposing private-public partnerships to create more recovery homes which offer services for lower socio-economic individuals with Substance Use Disorder(s). Criss suggests, “A responsive system will provide access to affordable, mainstream housing where people can be safely housed and supported in recovery at their own pace. The strength of recovery-focused housing is its ability to provide ongoing peer support while promoting sobriety in a natural home environment” (Thom, 2013).
No one willingly chooses a life dominated by substance use, just as no one willingly agrees to the return of cancer after treatment. We should embrace and treat those striving for a life of recovery as the truly remarkable and deserving survivors they are. Substance Use Disorder is not a choice. It is an illness, period!
Unintentionally, I take for granted just how privileged I am. It is something everyone should have and what every home should feel like.
Learn about the National Alliance for Recovery Residences (NARR) at: National Association of Recovery Residences (NARR) Their mission is “To support persons in recovery from addiction by improving their access to quality recovery residences through standards, support services, placement, education, research and advocacy.”
And learn about the Vermont Association of Recovery Residences at: https://narronline.org/cm-business/vermont-association-of-recovery-residences/
Reference
Thom, K. (2013). Recovery Homes Help People in Early Recovery. SAMSHA. Retrieved October 16, 2017 from: https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/recovery-homes-help-people[
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