Behind the curve on mental health treatment

As much as most people don’t like to admit it, we all suffer from some level of mental health issue.  In a society that stresses, depresses and then ignores the elephant in the room, we hate to acknowledge any weakness and illness.  These mental health issues can be short term, long term, minor inconveniences or major crises.  They don’t manifest until they begin affecting ones daily living – or another person’s daily living – and usually only after the rationalization and denial processes have begun to wane.

These factors combine with the general public’s perception that mental health, and addiction in particular, are moral failings, and not really objective disease states.  This perfect storm of misunderstanding results in the lack of proper care and treatment of these medical conditions.  People who have active, untreated addiction and mental health issues can not get the assistance they need.  There are too few treatment providers, and too few trained professionals available even when treatment is located.

Part of this is a result of stigma.  People don’t understand mental health disorders, so they ignore them as much as possible.  Part of it is a result of society allowing 12 step programs to operate as the full standard of care for too many years.  The 12 steps, as a free, unorganized, form of treatment have saved more lives than any similar program.  Sure, there are detractors, bit none with any accurate or accountable data.  AA and other 12 step programs were the “go to” treatment for so many years that respectable formal medical care was an afterthought.

More money needs to be spent on the treatment field for all mental health disorders.  New sources of funding need to be developed.  A great example is money and other assets recovered from drug dealer sting operations.  After all, this money was originally spent by the addict and mental health sufferer in the first place.  Several law enforcement leaders have suggested that they have recovered so much money that they can’t spend it all, and would welcome a formal plan to distribute the money to the appropriate channels that can “make whole” the individual who gave it to the dealers in the first place.

 

 

“Incarceration of children should be a last resort”

The State of New York is moving in the right direction by making attempts to reduce incarceration of 16 and 17 year olds.  Currently New York is one of 2 states that allow children 16 years and older to be tried as adults.  Yes, I used the term “children.”  They ARE children.  Think about the decisions you were capable of making at that age.  Not the smartest choices I’m sure.  I know mine were deplorable.  Combine the age of a child who has a brain that is just beginning to engage in rational thought, as it comes to social interaction, with the introduction of alcohol, drugs or a negative environment, and you have the recipe for disaster.

As a criminal defense attorney, I have had several such defendants.  I always struggle with the gravity of their situation, and advocate strongly for the return of their case to juvenile court.  I am rarely successful.  The tough-on-crime era we live in lumps everyone into the same basket.  The interventions by courts to determine the true mental and emotional make-up of a child are sorely lacking.  The brain of a child is still forming.  Any 13 year old (or younger) who can think that it is a good idea to smoke cigarettes, drink alcohol, etc, can obviously think that any violent behavior might also be normal.

Many studies suggest that the brain isn’t fully formed until 25 years old.  We bombard kids with our own poor modeling (drinking to excess in front of them, using illicit drugs etc), violent video games, plus TV and movies portraying substance abuse and violence as appropriate, and then we expect them to behave as perfect law abiding citizens.  We never think about the full effect of our actions when it comes to kids.  They are sponges.  They want to be like us.  I’m not advocating a society of prudes, but rather a society that cares about it’s young – before they act out in ways we disapprove.

Baby boomers: sex, drugs and… more drugs

Aging baby boomers are reportedly using opioid pain relievers more and more to cope.  Sure, we knew boomers were big users of marijuana, but now the opioid epidemic has us realizing that they want a quick fix for pain.  Problem is, those with a predilection for addiction, can’t stop taking the pills once they start.  The all encompassing warmth of an opioid high leads them to doctor shop and pharmacy hop.

It’s harder to peg older adults as abusers initially, because, well… they are old!  Older people are assumed to be suffering more from aches and pains.  Therefore, they get a pass.  That pass can be the first salvo in a long trip down a bumpy road with the potential of a “dead end.”  Physicians, nurses and pharmacists need to spend extra time with boomers, to help explain the dangers of opioid abuse.  Alternative therapies need to be explored as well.  Yoga, physical therapy, massage etc.

We are a country that believes too much in an instant fix and that if you have your health, you have everything.  Well, I hate to break it to everyone, but you will all suffer at some point.  Not every ounce of pain can be taken away by a pill.  Too much faith in an overburdened medical system that may want to throw an Rx at you to get you out the door so they can get on to the next patient is misplaced.  As a drug counselor and attorney, I have seen it in both of my fields, and it needs to be addressed.

“I see how they’re not tuned in to reality. They’re in a different fog than everybody that does not smoke marijuana.”

The conundrum legal marijuana places on educators is problematic. In Colorado, teachers are struggling with the use of recreational marijuana.  They say that even the term “recreational” implies that it is fun, and by implication, safe.  It is yet another example of unintended consequences when a substance that can be abused is introduced into society without proper education and control.  We saw it with Oxycontin, when it was released in 1996, and it was promoted to general practitioners as a safe, low addiction potential, pain medication that could be used for minor injuries.

The increase of marijuana related “incidents” in Colorado middle schools is rising.  Kids see their older siblings using pot with impunity, and pot supply outlets popping up everywhere like liquor stores, and they see no potential down side.  The juvenile brain only gets one chance to develop, and if we let kids believe there are no consequences to marijuana use, the take it and run with it.  Back in the 1970′s I saw the same thing, and I believed that I could use it safely.  It was truly a gateway drug for me and many others.

The fact that new articles start hitting the media that say pot is safer than alcohol, or is a good alternative for heroin and opiate users to transition to, aren’t helping.  Every serious heroin addict I know would not even consider marijuana as a long term solution to using opioids.  It just doesn’t work that way in the real world of addiction.  Pot, in its current potency, is no longer safe no matter how you slice it.  Pot dulls the senses, slows reaction times etc.  It is not safe.

The cost for Colorado, and eventually every state that legalizes pot, is rising.  The hurry to get marijuana out in public results in a renewed health crisis.  We thought the drug war was a “war” and that we could legislate our way out of it with criminal statutes.  We were wrong about that as we now see the public health issues surrounding illicit drug abuse.  We are wrong again, as we see the new public health crisis that legalized marijuana will bring as we speak.

Clermont County Ohio misses the point – building a jail for addicts instead of a treatment center

In this day and age where the public outcry of heroin deaths has reached an all time high, we still have public officials who want to imprison sick people. A public health crisis like the prescription drug/heroin epidemic needs medical treatment options, not jail cells.

Officials state that despite heroin being the root cause of the influx of offenders, they still need to house these sick people in a jail setting. They say there are not enough treatment beds available. Well, the casual observer would say “Why don’t you spend the money on actual treatment centers instead of a jail?” The answer is that people don’t understand that addiction is an illness.

We certainly wouldn’t put a diabetic patient in a cell for not staying away from that extra piece of cake and having their blood sugar go off the chart nearly causing them to die. We wouldn’t jail the lung cancer patient who continues to smoke. When will we wake up to the fact that the ingestion of any substance to change our mood, to the point it results in serious health consequences, is medical situation?

Medical patients need medical care, not lock down. Using a lock and key to keep a situation in control is a temporary solution, even if you do attempt some substance abuse education during the incarceration period. People rarely learn under duress. Force rarely causes true change in behavior, but compassion leads to a deeper understanding and lifelong behavior alterations. We repeatedly try incarceration and get the same results, why don’t we repeatedly try drug treatment? Most people don’t get things down pat the first time the learn something.

Raising taxes on beverage alcohol may reduce binge drinking

Even though the headline may cause many to cringe, the fact is that alcohol abuse is the costliest problem in the world.  Drinking to excess is the underlying cause of more divorces, car accidents, job loss, bankruptcies, foreclosures, liver disease etc.  Alcohol is a poison after all, but we have accepted it in our society as a way to relax and celebrate.  In moderation, it does little or no harm.  But, to 25% of the population, it is a problem.  To 10% of the population it is an addiction.

Now, a study has concluded that raising taxes on alcohol sales may result in a decrease in binge drinking.  Any suggestion that prices be raised on a commodity usually causes alarm.  In this case however, with the harm alcohol causes in our society, it may be warranted.  The taxes raised, should of course be used for treatment of alcohol abuse.

I have long recommended raising taxes on alcohol, but had always been resigned to big alcohol’s hold on the legislature, that it would never happen.  If this study gets some traction, and we continue to discuss this issue, maybe we can make it a reality.  Of course, the current focus is on prescription drug and heroin abuse, so it may take a while until the levels decrease on that drug of abuse, before alcohol is in the spotlight again.  Alcohol will always be the toughest to reign in, especially as marijuana legalization is starting to blossom.

I look forward to your comments on this subject.

‘You will not be arrested for using drugs’

In America, we can only dream of this statement.  It is truly a model for a drug policy that focuses on the public health crisis that drugs pose, instead of making criminals out of sick people.  The Netherlands realize that drugs are abused by people who need help for their condition, not people who intend to harm anyone else.  Victimless drug use needs appropriate treatment.

Addiction affects virtually everyone in the US.  We all know someone who has struggled with untreated drug or alcohol abuse.  Unfortunately, many people still think this is a moral failing and not the disease that it really is.  That fact notwithstanding, why wouldn’t you want to help a person of “low” morals?  If you don’t want to help them get the help they need, isn’t that a reflection of your own substandard morals?

Yes, it is a conundrum that people ill with addiction don’t seek help on their own.  Some do if they live long enough, but most need to be guided toward treatment by family, courts or their own failing physical health.  The stigma of addiction makes this even worse: addicts are ashamed of their inability to stop, and their peers and loved ones condemn them after they do not seek or accept help that is offered.

We need more health care options for addicts, whether they are young kids experimenting; long-term users whose bodies are finally screaming for help; and, everyone in between.  Legislators, law enforcement, prosecutors, judges, health care professionals and the general public need to be educated on the disease of addiction and the importance of effective and available treatment.

We are seeing senseless deaths of minorities at the hands of law enforcement recently, and yet we still get angry at addicts who “just won’t stop.”  Something is seriously wrong with our priorities if we miss the senseless deaths of addicts, yet another marginalized group of people we would otherwise call mom, dad, sister, brother etc.  Stop taking addicts to jail and take them to the hospital instead.

One medical specialty is finally seeing the “painful” light

When I stopped practicing pharmacy, the opioid pain pills were fast becoming the number one prescribed group of drugs in both dollar amount and number of pills. That is a remarkable statement in its own right, but the fact that the FDA and other governing agencies have looked the other way is even more remarkable. Here’s another one: the United States only has 5% of the worlds population, but we consume 90% of the opioids.

The blame goes to many: government, medical professionals and the public. The attached article shows that one group of doctors, neurologists, have recognized that pain relief from these drugs reaches a point of diminishing return after just a few months. It is simple – our neurotransmitters can’t keep up with the longevity of the presence of the medication in the body, and reach a new homeostasis. The final result is a physical addiction or dependence.

These drugs are simply over prescribed and no follow up is done to try alternative therapies. Many doctors neglect the necessity of having a personal relationship with the patient and short cut exams due to time constraints. With a death toll of over 100,000 and counting as a result of this overprescribing, we need the FDA and DEA to step in now and educate doctors by tying their DEA registration to formal instruction on addiction and overprescribing.

Are your kids using and drinking to excess? Communication is the key

As with most human conundrums, communication is the key.  If you need help with someone or something, you need to communicate your needs, intentions etc.  When your children are experimenting with alcohol and drugs, and it is getting out of hand, you need to talk to them.  The attached article describes workable solutions.

I often speak publicly about substance abuse, and I mention modeling frequently.  Parents model behavior to their kids every day.  They don’t think about how kids view their actions, but the kids watch with an intensity not often seen in other areas of their lives.  Kids learn behavior from those they love and respect.  The respect can later come out sideways as the parents struggle with how to get the kids to stop drinking and using drugs.

We parents have to start communicating with our kids early and often.  We need to discuss our behavior with them so the understand why we do the things we do.  We can’t just expect them to pick up the nuances of our use of alcohol, and yes, drugs too, for some of us.  Responsible drinking must be explained and modeled.  Drug use should also be explained, including the illegality, if it applies.

We all learned from someone else.  We all thought we were taught how to behave properly.  Yet, some of us don’t, even after repeated warnings.  Take some time today to talk to your kids.  If necessary, sit down with them and read this article together.  We don’t have all the answers, and showing our kids that we need help will allow them to see that it is all right to ask for help.  Communicate now.  It isn’t a sign of weakness, but a sign of love.

We still don’t think addiction is a disease

The following is an excerpt from a recent article from Madison Magazine of madison, Wisconsin, about the “perfect storm” heroin crisis in a small neighboring town, Mt. Horeb, Wisconsin. I couldn’t have written it better myself, so I will let the author, Maggie Ginsberg-Schutz tell it like it is:

“It’s a perfect storm, all right, and it brews on many different fronts—arguably the most turbulent of which is that so many of us still don’t get addiction. We just don’t see or understand or believe that addiction is a disease, a chronic and progressive brain disease, fatal if left untreated, compounded by stigma and shame, and even further complicated by its tangled relationship with mental health and the fragmented systems serving both. We think addicts should just try harder, be smarter, grow stronger, care more, so they can, simply, stop. But at some point for every addict—whether after years of abuse or that very first sip, toke, bump or hit—the choice to use stops being a choice. Brains are rewired, consequences stack up like prison bricks and free will evaporates. Using becomes a compulsion, then an obsession, no longer about morals or intelligence or willpower, if it ever even was. Take this baffling disease and combine it with crime and consequences and collective misunderstanding and pain and pride and plentiful but isolated resources and you’ve got that whopper of a storm, one that leaves so many people suffering, not actually believing that it can get better. That recovery is even possible. That life could be good again, infused with hope and peace, health and fulfillment, productivity and purpose. Because it can, it does, without a doubt, if you can find that help. It’s just hard to see the rescue crew through the blinding rain after that front rages through and you’re left, in shock, sifting through the wreckage.”

Educate yourself. Educate your friends and family. Educate anyone who will listen, so we don’t lose any more lives to this senseless disease.