Oct 25, 2014

Separated Orphan Twins

In 2014 my work focused on addiction, specifically on the heroin epidemic claiming so many lives across the U.S. My new book SHARP Stop Heroin and Rescue People reflects that work.

That work helped me to focus more on the question of integrated care. Poor social choices and bad public policy have caused mental health and addiction care to develop like separated orphan twins.

Mental health and addiction are both biopsychosocial, with biological, psychological, and social aspects that continuously reinforce each other and cannot be easily separated, but the treatment systems are separated. Over the course of decades, each system figured out how to emphasize and advocate for its particular service delivery style, treatment philosophy, and culture of care.

This has caused clinicians to develop blind spots. People come away with a different diagnosis and different treatment depending on the system they walk into.

The separation has affected the overall health of the population using mental health and addiction services. We see this in the resistance of addiction treatment systems to medicine-assisted addiction treatment. We also see this in the tendency to overmedicate people in the mental health system.

The separation from mainstream healthcare also allows for a certain amount of medical shunning. People with mental health and addiction problems can be self-destructive, edgy, difficult, noncompliant, willful or just plain strange. Separated systems make it easy for medical doctors to minimize their own accountability, and kick responsibility over to someone else.

The mainstream medical system is not some add-on or accessory to psychiatric care or addiction treatment. It’s the other way around.

Oct 1, 2014

The Smell of Heroin and Snake Oil

There's a quaint old-fashioned smell of snake-oil around addiction treatment in Kentucky. Kentucky is the center of the heroin epidemic, but its top investment in addiction care isn't, formally speaking, addiction treatment. It is a housing program with peer support, group meetings, and workbooks.

Recovery Kentucky, the program that builds recovery centers across the state, uses a non-medical model from the Healing Place in Louisville, a model that is used in other states to side-step the formalities of science-based addiction care. The program is not physician-supervised, and does not follow a medical model. People with chronic pain or medication needs cannot be served in the program.

For heroin, the National Institute of Drug Abuse recommends Medication Assisted Treatment and cognitive behavioral therapy. Recovery Kentucky uses neither. It relies on peer group meetings, and  "trudging."
“Trudging is an important part of the Recovery Kentucky Program. When an addict is in the midst of their addiction, they will go to any extreme to get their drug of choice. Once they have entered into the program, they are asked to have that same dedication to achieving their recovery. All recovery centers have their MT classes in off-site locations that the clients walk to and from. Clients generally walk two-to-four round-trip miles a day, based on location. The only time participants do not trudge is if the weather or conditions pose a danger to them—not an inconvenience but a danger, such as an ice storm or tornado. Recovery Kentucky participants can be seen walking in the heat of summer, the leaves of fall, the snow of winter, or the rain of spring. “
Now don't get me wrong. There are people who respond well to this sort of program. I have met many people who have rebuilt their lives after their experience in Recovery Kentucky.

But only about one in three or four individuals who enter these facilities make it through the program  The rest wash out in the first few weeks of the program. They do not make it to the point of entry to "Phase One" (which is actually the fourth step of Recovery Kentucky's five-phase program). All of Recovery Kentucky's success statistics are based on people who have made it to this fourth step in their process.

Kentucky needs programs that help the other 70 to 75 percent of people who are stuck on heroin, the ones who cannot trudge through the Recovery Kentucky process. And fast. When people fail programs like these, they always relapse --- and relapse is when heroin is most fatal.


Designed not to be treatment
The Healing Place Huntington is far from the first center to try a "regulatory arbitrage" approach to get around expensive licensure requirements by employing a non-medical model, thus asserting in fact not to be a treatment center as defined by state regulatory codes.

Recovery Kentucky Guidelines