I promised to share readers’ suggestions.
Here are three and some editorial comments:
I read your latest Tips & Topics (May 2013) with great interest. As you know, approximately 90% of clients seeking treatment in community mental health centers have been exposed to trauma. Safety is absolutely enhanced by resisting the urge (from oneself but also the patient) to engage in premature trauma retrieval work. This advice has been repeated over and over by such luminaries in the field as Bessel van der Kolk, Judith Herman, Joan Turkus and Lisa Najavits.
Harry Ayling, LCSW, diehard devotee to Tips & Topics (Harry’s words, not mine).
There has been a lot of attention over the past 15 years on co-occurring mental and substance-related disorders. The more recent refinement of that attention is to be trauma-informed: to be aware of how many addiction and mental health clients present with past histories of trauma. When people with addiction sober up, intense feelings can rise to the surface. It is always a fine balance to know how to address intense feelings which can’t be ignored. Yet, at the same time it is important, as Harry says, to make sure that our clients are safe to deal with trauma; and not cope by returning to substance use or other self-destructive behaviors like cutting.
In Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report, the “Census Bureau released data on health insurance coverage and the uninsured for 2011 on September 12, 2012. Although there are four major government surveys that produce estimates of health insurance coverage, the Current Population Survey (CPS) is the most widely cited and receives national media attention. …. During 2011,an estimated 48.61 million people were without insurance, a statistically significant decrease of 1.34 million from the estimated 49.95 million uninsured in 2010.”http://aspe.hhs.gov/health/reports/2012/uninsuredintheus/ib.shtml
Regardless of your political leanings (right or left); or where you stand on the continuum of individual rights (right to buy health insurance or not) to collective action for the greater good (requiring health insurance of all so as to pool resources to allow universal coverage), the fact remains: There are 40 to 50 million people who do not have health insurance in the USA. This creates huge human costs, as well as significant healthcare costs, as scarce resources are used inefficiently and ineffectively.
As Joan says on this and other related issues, “It does not have to be this way.”
Address the stigma in the 12-step based treatment community against methadone and Suboxone (buprenorphine and naloxone) maintenance for the treatment of opioid dependence (now opioid use disorder in DSM-5). About 95% of treatment programs in the public sector are based on the 12-step philosophy, and are staffed by people who are undereducated about medications, and either covertly or openly biased against medication-assisted treatment.
There is NO scientific controversy that for established opioid dependence, medication- assisted treatment is the treatment of choice. Clients must receive informed consent regarding this treatment option, but in my 25 years of experience in publicly funded treatment in California, this rarely happens. This MUST change, as we are in the midst of the largest epidemic of opioid dependence since heroin use rose in the 60’s.
In the new edition of The ASAM Criteria, there is an expanded section on Opioid Treatment Services (OTS) to include opioid agonist medication like methadone and buprenorphine in Opioid Treatment Programs (OTP) and Office Based Opioid Treatment (OBOT); and opioid antagonist medication like naltrexone. Take a look at the updated website all about the new edition at www.ASAMcriteria.org