May 2023 – Vol. #21, No. 2

Welcome to the May edition of Tips and Topics and to all the new subscribers.

In SAVVY, there is preoccupation with medication as the main and most effective treatment in physical and mental health and addiction. But there are a variety of non-medication lifestyle interventions that can be as effective as medication, if not even better.

In SKILLS, engage with clients to embrace an exercise mindset, use the power of placebo to build hope, and work with families to improve relationship time.

In SOUL, Tucker Carlson, previously a ratings star for Fox News, sent a text message to a producer on January 7, 2021 when he was watching a video of people fighting on the street in Washington. In this age of polarization and demonizing those with whom we disagree, Carlson shares some surprisingly good and insightful advice.

David Mee-Lee, M.D.
DML Training and Consulting

SAVVY

Society, psychiatry and addiction medicine are, in my opinion, too focused on medications as the answer to any ailment. Watch any TV show and you will likely see at least one advertisement for a prescription or over-the-counter medication. Rarely do you see anything promoting lifestyle change.

While scientific advancements in neurobiology, brain function and neurotransmitters have given rise to effective pharmacotherapies, they have also seduced too many into seeing medications as the most important intervention in mental health and addiction.

To balance the scale of therapeutic interventions, this month’s edition highlights some recent findings on lifestyle interventions that can be supportive of what medications do and in some cases, are superior to medication.

Tip 1

Exercise and physical activity can improve anxiety, depression, addiction recovery, and other health outcomes. For depression, exercise may be more effective than counseling and leading medications.

Here are the Headlines:

    • The Addition Of Simple Exercises To Treatment May Improve Recovery From Substance-Use Disorders, Study Indicates

The Washington Post (4/26/23, Reynolds) reports a study “found that incorporating simple workouts such as jogging or weight training into treatment improved the likelihood of recovery from a variety of substance-use disorders, including to cocaine, opioids, cannabis and alcohol.” The study was published online April 26, 2023 in PLOS One. The study’s findings “build on other research, some with animals, showing that exercise changes our brains and thinking in ways that can reduce drug cravings and relapse and might even stave off addictions in the first place.”

    • Exercise For Treating Depression As Effective As Standard Drugs, Psychotherapy, Review Suggests

The Washington Post (3/15/23, Reynolds) reports, “Exercise as a treatment for severe depression is at least as effective as standard drugs or psychotherapy and by some measures better, according to the largest study to date of exercise as ‘medicine’ for depression.” The new research “pooled data from 41 studies involving 2,265 people with depression and showed that almost any type of exercise substantially reduces depression symptoms, although some forms of exercise seemed more beneficial than others.” The review findings were published online February 16 in the British Journal of Sports Medicine.

Researchers are calling for exercise to be a mainstay approach for managing depression as a new study shows that physical activity is 1.5 times more effective than counseling or the leading medications.

    • Exercise Appears To Significantly Decrease Suicide Attempts, Systematic Review Suggests

Healio (4/3/23, Bascom) reports, “Exercise significantly decreased suicide attempts,” investigators concluded in the findings of a 17-study, 1,021-participant systematic review and meta-analysis published online ahead of print in the June issue of the Journal of Affective Disorders.

    • Supervised Exercise Programs May Be Tied To Significant Reductions In Symptoms Of Depression Among Children And Teenagers, Systematic Review Concludes

HealthDay (1/6/23, Thompson) reported, “Supervised exercise programs are associated with significant reductions in symptoms of depression among children and teenagers,” investigators concluded in the findings of a 21-study systematic review and meta-analysis “involving more than 2,400” children. The findings were published online Jan. 3 in JAMA Pediatrics. Additionally, the systematic review “revealed a greater benefit from exercise among children who had already been diagnosed with depression or another mental illness.” Anish Dube, MD, MPH, Vice Chair of the American Psychiatric Association’s Council on Children, Adolescents, and Their Families, stated that “‘in a sense, physical activity itself is similar to an intervention that we would call behavioral activation,’ in which patients engage in meaningful activities to subvert...depressive lethargy.”

Tip 2

For children and adolescents consistent and good sleep supports health, happiness and mental well-being.

    • Study Highlights Importance Of Good Sleep For Adolescents’ Mental Well-Being

MedPage Today (4/5/23, DePeau-Wilson) reports, “Sleep problems throughout the transition from childhood to early adolescence were associated with psychopathology symptoms, highlighting the importance of good sleep for adolescents’ mental well-being,” investigators concluded in a study revealing that “among over 10,000 kids, those with more severe sleep problem profiles had a higher risk of concurrent internalizing symptoms.” The findings were published online April 5 in JAMA Psychiatry.

    • Consistent sleep may be key factor in supporting children’s health, happiness

CNN (3/16/23, Holcombe) reports, “One of the keys to keeping your child happy and healthy is making sure they get enough sleep consistently,” according to a new study published in JAMA Network Open. For the research, investigators “monitored 100 children ages 8 to 12 living in New Zealand,” and “the children alternated between a week of going to bed one hour earlier and one hour later – with one week at normal time in between the two.” Investigators “covered many aspects of well-being, including an assessment of how the children felt physically, and psychologically, in their relationships with parents and peers, and how they felt about school.”

Tip 3

In anxiety, mindfulness can be better than medication and breathing exercises may even be better than mindfulness.

    • Practicing Mindfulness To Relieve Anxiety May Be Just As Effective As Escitalopram, Research Indicates

The Washington Post (1/23/23, Morris) reports, “Practicing mindfulness to relieve anxiety can be just as effective as medication,” research indicates. The findings of a 276-participant study published online Nov. 9, 2022 in JAMA Psychiatry “showed that people who received eight weeks of mindfulness-based interventions experienced a decrease in anxiety that matched those who were prescribed escitalopram.”

    • Breathing Exercises May Improve Mood, Reduce Anxiety Better Than Mindfulness Meditation, Study Says

The Washington Post (3/16/23, Sima) reports, “A study in Cell Reports Medicine showed that just five minutes of breathwork each day for about a month could improve mood and reduce anxiety – and these benefits may be larger than from mindfulness meditation for the same amount of time.”

SKILLS

Tip 1 

Engage clients in embracing an exercise mindset to improve physical, emotional and social health.

    • Exercise mindset, perception can have impact on health outcomes

The Washington Post (3/22/23, Reynolds) reports that a “new study of mindsets and exercise...shows that learning how much we actually move by tracking our steps could help us start thinking of ourselves as active people, which can pay health dividends, even if we don’t start exercising more.” The research suggests that people who “had been given inflated steps responded almost identically to those receiving accurate counts.” Investigators “suspect this signifies that many of us see little subjective difference between 7,000 and 9,000-ish steps, but plenty of difference between 7,000 and 4,000.” The findings were published in the Journal of Medical Internet Research.

Tip 2

Use the power of placebo to retain patients in treatment and improve their sleep.

    • Use Of Open-Label Placebo Alongside Methadone For OUD Tied To Greater 90-Day Retention Rates, Better Sleep Quality Compared With Use Of Methadone Alone, Small Study Indicates

Harvard Medical School’s News & Research explained placebo medication:

“The researchers found that participants who knowingly received placebo pills in addition to standard-of-care methadone treatment were significantly more likely to remain in treatment than were participants who received methadone treatment alone. Participants who received placebo pills also reported better sleep quality.

"The clinical implications of our intervention have great potential impact, as retention in treatment is a serious challenge for the field of addiction medicine,” said Belcher. “We’ve demonstrated it’s feasible to administer a placebo in addition to standard-of-care methadone in a community-based opioid treatment setting without adding a significant burden to clinic procedures, and the low-cost, low-risk nature of this intervention could provide an appealing strategy to target early methadone treatment adherence.”

It had long been assumed that deception or concealment is necessary for placebo effects to occur — “tricking” a patient to believe an inert pill contains active medication. But, a growing body of evidence from randomized controlled trials with irritable bowel syndrome, chronic low back pain, and other conditions has demonstrated that no such deception is necessary for placebo treatment to alleviate symptoms. Additionally, conditioning study participants to placebos by having them pair the placebo with an active medication — thereby potentially associating the placebo with a relief in symptoms that may be caused by the active drug — has been shown to treat symptoms of insomnia, ADHD, post-surgical pain, and more.”

Healio (4/19/23, Rhoades) reports, “The use of open-label placebo alongside methadone for opioid use disorder” (OUD) “was associated with greater 90-day treatment retention rates and better sleep quality compared with the use of methadone alone,” researchers concluded in a 131-participant randomized clinical trial, the findings of which were published online April 12 in JAMA Network Open.

Tip 3

Provide family counseling to improve parent-child relationships and encourage longer family mealtimes.

    • Longer family mealtimes tied to healthier meals for children

MedPage Today (4/3/23, Monaco) reports, “Longer family mealtimes may be one strategy to get kids to eat healthier, according to a randomized clinical trial that found an improvement in the balance of foods eaten at the table.” Results show that “on average, longer family meals induced kids to eat 3.32 more pieces of fruits and 3.66 more pieces of vegetables than those who ate during their regular mealtime duration, the researchers explained in JAMA Network Open.”

    • Teens with closer relationships to parents have lower chance of substance abuse

HealthDay (3/23/23) reports, “Teens who report better relationships with their moms and dads are healthier both mentally and physically and less likely to abuse drugs or alcohol as young adults, according to researchers.” The study also reveals that these teens “reported lower levels of stress and depression, as well as lower use of nicotine, alcohol, cannabis and other drugs.” The findings were published in JAMA Network Open.

SOUL

I don’t watch cable news shows much at all. They usually thrive on berating anyone on the “other side”; and building viewer ratings by whipping up polarizing points of view that demonize and dehumanize people.

Tucker Carlson had a huge following on Fox News before he was let go recently. Reportedly, he “made an inflammatory, racist comment in a text message to a producer about a video that showed a group of "Trump guys" attacking "an Antifa kid," writing in the message that "it's not how white men fight," according to the New York Times.”

The message was sent on January 7, 2021, and Carlson wrote:

"A couple of weeks ago, I was watching video of people fighting on the street in Washington. A group of Trump guys surrounded an Antifa kid and started pounding the living s**t out of him. It was three against one, at least. Jumping a guy like that is dishonorable obviously. It's not how white men fight. Yet suddenly I found myself rooting for the mob against the man, hoping they'd hit him harder, kill him. I really wanted them to hurt the kid. I could taste it."

He continued: "Then somewhere deep in my brain, an alarm went off: this isn't good for me. I'm becoming something I don't want to be. The Antifa creep is a human being. Much as I despise what he says and does, much as I'm sure I'd hate him personally if I knew him, I shouldn't gloat over his suffering. I should be bothered by it. I should remember that somewhere somebody probably loves this kid, and would be crushed if he was killed. If I don't care about those things, if I reduce people to their politics, how am I better than he is?"

I was impressed with the insightful wisdom that arose from Tucker’s text. Here’s what I gleaned from his text that is a good start to decreasing our country’s polarization:

    • “.....this isn't good for me. I'm becoming something I don't want to be.” - The importance of self-reflection to take stock of whether hate, violence and lack of compassion and empathy are taking us over.

    • “Much as I despise what he says and does, much as I'm sure I'd hate him personally if I knew him, I shouldn't gloat over his suffering.” – Certainly we may disagree vehemently with another’s beliefs and priorities. But violence and causing pain and suffering to those with whom we disagree is never justifiable.

    • “I should be bothered by it. I should remember that somewhere somebody probably loves this kid, and would be crushed if he was killed.” - Dehumanizing others is the start of a slippery slope of lack of empathy that can lead to violence and death.

    • “If I don't care about those things, if I reduce people to their politics, how am I better than he is?" – Righteous indignation, demonizing others for their differing opinions pushes us apart.

Self-reflection and concern about what we are becoming; causing no harm; remembering others’ humanity; and empathy can start to bring us back together again. Who would have thought that Tucker Carlson’s texts could spark some healing.

Until Next Time

Thanks for joining us this month. See you in late June.

David

April 2023-Vol. #21, No. 1

What to do for a client with a history of addiction who is socially drinking? Twenty years of Tips and Topics. What’s next?

Welcome to the April edition, the start of year 21 for Tips and Topics.

In SAVVY, STUMP THE SHRINK and SKILLS,  two clinical vignettes about clients with a history of moderate to severe Alcohol Use Disorder and three DWIs (Driving While Intoxicated) raise assessment and engagement questions to be considered.

In SOUL, I started publishing Tips and Topics April 2003. On this 20th anniversary, I look back at what the initial goals were; whether I lived up to those; and what’s next for Tips and Topics.

Savvy, Stump the Shrink, and Skills

This April edition of Tips and Topics marks the start of my twenty-first year of writing each month about whatever is on my mind. Much of the inspiration for what goes into each edition comes from readers and subscribers of Tips and Topics….and that is no different this month. A subscriber just sent me this message:

I have two issues that I would like to know your thoughts on. 

1. I am wondering how you think a history of a moderate to severe substance use disorder (SUD) should be treated for diagnosing and treatment? For example, a client reports a history of a moderate alcohol use disorder 3 years ago but the last 12 months he reports drinking socially.

2. Secondly, what are your thoughts on a client who reports 3 driving while intoxicated (DWI) charges 2016, 2017, and the last one 2018. Then reports that during the last 12 months drinking socially? In addition, collateral information indicates concerns about his alcohol use due to the DWIs.

Thank you for your time.

Tip 1

Resist the impulse to jump to conclusions before doing a more in-depth assessment and history-taking.

In these vignettes, it is natural to conclude that if someone is “drinking socially” after a previous diagnosis of moderate or severe SUD or multiple DWIs, that they must be relapsing and heading for trouble. But here are some Assessment and Engagement Questions to consider.

Assessment Questions:

  • Have you been given a formal diagnosis of a substance use disorder or alcohol use disorder e.g., in a medical record; or has any healthcare professional said that you have addiction or are an “alcoholic”? – Just because there is a “history of a moderate to severe SUD”, it is easy to label someone as having addiction without having done a careful diagnostic criteria review. Similarly, while three DWIs would likely indicate a SUD, it is good to check that he met diagnostic criteria.
  • If you were told you have an addiction illness, who gave you that diagnosis and were they trained in addiction diagnosis and treatment? – A physician or other healthcare professional may document that the person has an SUD but may not be skilled in understanding diagnostic criteria and erroneously label someone as having a SUD when it may have actually been a severe substance-induced or substance-related event e.g., a young person who overdosed on alcohol at a party.
  • If the client indicates that he did have a diagnosis of “moderate alcohol use disorder 3 years ago”, it is worth checking on what diagnostic criteria were met back then by reviewing what alcohol related problems were showing up 3 years ago. – This serves to assess how clear the client is that he indeed had an addiction to alcohol and to check if the diagnosis was accurate; or whether it might have been a developmental phase of alcohol use as a young person; or a coping mechanism for other co-occurring issues like trauma, other mental health challenges or even physical health problems like chronic pain.
  • If it becomes clear that the client does indeed have alcohol addiction illness and recognizes that, then review what addiction treatment and/or self/mutual help the client has participated in. – He may have been diagnosed but never engaged in treatment or recovery groups; and may not be knowledgeable about addiction.
  • If the client did have formal addiction treatment, assess what worked and what didn’t work to initiate and maintain sobriety. – Did he get good education about addiction; did he attend regularly; was there continuing care and ongoing monitoring? Or was he simply “graduated” from a program with poor linkage to ongoing care?
  • Whether the client had treatment or not, how long were any periods of abstinence and how did he achieve those? – It is always good to support self-efficacy (the optimism and confidence that a person can change) by complimenting the client on whatever length of abstinence was achieved and to evoke solutions and skills that worked for whatever the period of abstinence. “You didn’t use for 6 weeks? That’s great, how did you do that – who did you hang out with, what did you do with any cravings to use, where were you staying during that time?
  • What does the client mean by “drinking socially”? Is that once a week; or beer or wine with a meal; or drinking just at times of celebrations like birthdays? Does he get drunk, blackouts or has he been told that he behaved inappropriately when drinking?
  • What other drugs besides alcohol does he use; and remember to include tobacco? How much does he gamble?– You want to assess the breadth of his addiction in substance use and other addictive behaviors.

Engagement Questions:

  • Regardless of what others have told you, do you yourself think you have alcohol addiction? If so, why and if not why not? – This indicates what stage of change the client is at and his level of interest in changing or not.
  • Is there any help you need at this point with your alcohol use? If yes, what help do you want; if not, help me understand your thinking.
  • Is social drinking something you want to continue? How will you monitor your drinking so that it doesn’t become a problem in your physical, emotional or social life? – Given his past history with alcohol, you want to engage the client in a “discovery, dropout prevention” plan to discover or not whether he indeed still has a problem with alcohol.

Tip 2

Involving family, friends and other collateral sources in the assessment and treatment of addiction is always important. 

The person suffering from addiction is often the last person to realize how out of control their addiction illness has become. The survival defense mechanism of “denial” serves to solve the cognitive dissonance a person in active addiction faces:

  • How could I be causing all these physical, emotional and social problems and doing this to myself through my substance use or addictive behaviors? It must be my partner’s fault, or my boss, or the police who are harassing me. (Minimization, projection of blame, rationalization).

This is why involving collateral sources, relatives and friends in assessment and treatment is important:

  • To get as accurate information as possible about the frequency, quantity, and effects of drinking on all significant others, including the identified client.
  • To engage and educate significant others about addiction – how it has affected their lives and how they can help or not help to promote recovery for all people affected.
  • To support and assist significant others as they live with either active addiction in their loved one; or learn how to recover with their loved one when and if addiction recovery begins – What boundaries and limits do the significant others have around their loved one’s drinking? How hopeful or discouraged are they? If recovery has begun, how is their loved one reintegrated into a family that adjusted to exclude him or her from family and parenting decisions or even from routine daily activities like family meals?

The Bottom Line:

  • Can a person with moderate or severe Alcohol Use Disorder later socially drink? – Usually once a person has crossed the line into verified addiction illness, it is not likely that a person can return to social drinking free of negative effects on physical, emotional and social functioning.
  • But before assuming that social drinking will inevitably not go well, it is important to verify that there was indeed an accurate diagnosis of a SUD. 
  • Involve significant others in the assessment and treatment of their loved one’s addiction. This is to both assure as accurate information as possible and also to guide significant others on how to help their loved one and themselves.
  • If a person does indeed have alcohol addiction but wants to try social drinking, motivational enhancement therapy and motivational interviewing is needed to engage the client with a “discovery, dropout prevention” plan. The focus is to keep the client involved in treatment and help them discover whether they can safely return to social drinking or not. You may be clear that they cannot, but our work is to have them see and experience that for themselves.

Soul

This edition of Tips and Topics marks the 20th anniversary of publishing what I called back then an “e-zine” – “a magazine published only in electronic form on a computer network.” As I start this 21st year, I reviewed the three original goals that launched Volume 1. No. 1 in April 2003 to see if they are still relevant in 2023.

The first reason I started Tips and Topics was that clinicians have ongoing clinical questions that need answers. I coined STUMP THE SHRINK to highlight the questions I still receive and that prompted even this very April edition. This is still a very relevant goal that underpins Tips and Topics.

The second goal, to help people apply new-found knowledge, drives the SKILLS section. It’s useful to be SAVVY about various topics, but if they can’t be implemented skillfully, the new knowledge soon fades and clinicians fall back to their familiar, and sometimes ineffective practices.

I remember speaking to my therapist soon after completing my psychiatric specialty training and starting a private practice. I was interested in getting referrals of patients wanting psychotherapy not just medication. My therapist said, just let the other psychiatrists know you want such referrals. My rookie, unconfident mentality said “But why would they refer me patients when they would want to keep them in their practice?”

My therapist said “Firstly, not everyone wants to do psychotherapy and are more interested in medication management; and secondly, just because someone has been doing psychotherapy for a long time doesn’t mean they are any good at it.” As I grew in professional confidence and also grew ‘longer in the tooth’, I observed the truth of that for some of my colleagues.

The third reason for publishing Tips and Topics was because I want to make a difference in our field. When I decided over 25 years ago to work for myself from home in full time training and consulting, it was a big risk with a family of three kids to support. In a freelance independent business, your next invitation to train or consult depends essentially on whether you are effective in making a difference in the practices and policies of your audience. There was no guaranteed direct deposit in my bank account every two weeks; no paid sick time or vacation; no health insurance benefits or retirement contributions.

I said that if I couldn’t make it, I could always get a “real” job like being a medical director for a treatment system or some other salaried position. Fortunately, by the ‘grace of God’ and the gratitude of my audiences, I never did have to take that salaried position. That tells me I succeeded in my third goal.

What’s Next?

While these three goals are still relevant and while it still is fun to pull together Tips and Topics each month, you will keep receiving it, if you wish. I don’t send this out unsolicited to random people on mailing lists – everyone in the over 7,300 people on the mailing list should have opted in. If someone else put them on the list unbeknownst to them, they can and should Unsubscribe if they want, just as anyone can do if and when Tips and Topics becomes irrelevant to you.

If you have been a subscriber over the years, you’ll know that the SOUL section is a hodge podge of whatever is on my mind that month. Some readers have told me they read the SOUL section first, not always interested in the SAVVY and SKILLS content. I suspect the SOUL section will become even more hodge podgey as I proceed more heavily into retirement mode…..there are so many interesting insights and ideas that percolate when freed from the daily grind of catching planes, Uber or Lyft, checking into hotels late at night; and all that goes with a busy training and consulting practice.

So stay tuned for some emerging thoughts on ponderings like:

  • What is the balance between digging deep into past trauma and counterproductive coping patterns versus focusing on the Here & Now of living joyously and optimistically?
  • If trauma (in the broadest sense) is baked in on a cellular level affecting people’s fight or flight triggering responses, what is the mix of psychotherapy, body work and corrective experiences needed to allow a person to live unshackled from the past?
  • Is Law of Attraction a law of the universe as fundamental and real like we accept the Law of Gravity as real and fundamental?
  • How can you be at peace when there are physical, emotional, social and spiritual challenges swamping you?

Tips on subscribing and using Tips and Topics

  • Feel free to forward Tips and Topics to whomever you wish. But if you have people you want to invite to subscribe, please have them sign up for themselves at the website where you will see at the top in red the place to “Sign Up Now!” This way they will get into the system more easily. Here’s the link to do that:

https://tipsntopics.com

  • Make sure that the email address you use is one that won’t kick Tips and Topics into Spam or Junk Mail as many work emails are programmed to do. So you may sign up, but never receive it in your InBox.
  • On the right side of the Home Page is a “Search” window in which you can search 20 years of Archives; and also click on any previous edition. Scroll down past the Google-sponsored search findings to the previous editions of Tips and Topics to hopefully see content that is relevant to your search. For example, type into Search “discovery, dropout prevention” and you’ll see all previous editions where I have written about that.

Thanks for reading Tips and Topics and for the comments you send that help me know what speaks to you or not. 

Now on with the next 20 years…..or not.

March 2023 – Vol. #20, No. 12

The bear, wolf, fox and rabbit – a joke that teaches; Feeling good – it’s your responsibility; My son, Taylor’s take on money, career, Dad and the SKILLS and SOUL that drive him.

Welcome to the March edition of Tips and Topics.

In SAVVY, the joke about the bear, wolf, fox and rabbit highlights the need to teach our clients (and ourselves) to be assertive and abandon a “victim” mentality. It’s about taking responsibility for your own happiness.

In SKILLS and SOUL, my son, Taylor writes about his take on a discussion he and I had about how his relationship to money and career and how it was impacted differently by his relationship with his mother versus me. He shares his SKILLS and what drives his SOUL.

Read More

February 2023 – Vol. #20, No. 11

Teen mental health – sadness, suicide and social media; An Uncle’s Wisdom on Love, Work and Play; Some Reflections Four years after I lost my wife.

Welcome to the February edition of Tips and Topics.

In SAVVY, I share some recent news items on teen mental health, especially with teen girls versus boys. Statistics on sadness, suicidal feelings, thoughts and attempts and social media use.

In SKILLS, I reflect on “wisdoms” I shared with my 21 year old niece…wisdoms that I wished I had known at 21 about Work, Love and Play.

In SOUL, my ever evolving grief process and that of my children has been reflections on our past family relationships. They provide an opportunity to remember how life was when Marcia was alive with us. They also allow for healing old wounds that haven’t served us well.

Read More

January 2023 – Vol. #20, No. 10

Responses to the story of the Judge and the Grieving Team; It’s time to retire “graduation” and “treatment completion”; My four words for the year ahead.

Welcome to the January edition of Tips and Topics.

In SAVVY, It’s time to retire terms and concepts like “graduation” “treatment completion” and embrace terms like “transition” and “commencement” after having done an initial piece of work on the path to recovery.

In SKILLS, what to say to Orient Participants to entering Drug Court and about “graduating”. Rename the Graduation or Treatment Completion Ceremony.

In SOUL, my four words to encapsulate the year ahead. What words do you see?

Read More

December 2022 – Vol. #20, No. 9

The story of the Judge and the Grieving Team; What does “going high” mean (keep an open mind on these excerpts).

In SAVVY, STUMP THE SHRINK and SKILLS,  this is the story of the Judge and the grieving Treatment Court team. Relapse and a deadly overdose is sad at any time for anyone with addiction. But it is all themore stinging when the participant has been in long-term recovery and then relapses and dies.

In SOUL, I feel sad, confused, and sometimes hopeless about the way we deal with our political differences. But keep an open mind to review what solutions Michelle Obama offers when she explains what “going high” means.

Read More

November 2022

Dr. Ken Minkoff on “Welcoming” and “Skills-based learning” when serving people with complex needs; 70th birthday and 50th wedding anniversary and Thanksgiving week

In SAVVY, guest writer and psychiatrist, Ken Minkoff, M.D., highlights the importance of designing services expecting to see people with co-occurring mental health, substance use and other complex needs. But most importantly, organizing ourselves and services in a welcoming manner in everything we do.

In SKILLS, Dr. Minkoff addresses another important principle in helping people with complex needs, what he calls “Adequately supported, adequately rewarded, skills based learning for each condition.” As simple as you may think this needs to be, it needs to be even simpler!!!!

In SOUL, I reflect on what would have been my wife’s 70th birthday, our 50th wedding anniversary. Thanksgiving Day is an opportunity for pain or joy.  I choose to make it a week of Thanks and Giving.

Read More

October 2022

Clients who don’t want inpatient treatment – What to do; Individualized, accountable care; Right turns on red.

In SAVVY, STUMP THE SHRINK and SKILLS, Amber asks a couple of questions about what to do when clients are recommended for inpatient treatment but decline and only want outpatient services. This edition explores how to meet the client where they are at, but also hold them accountable to the outcomes of whatever plan they agree to work on, even in outpatient services.

In SOUL, I am grateful for the “Right turn on red” law and ponder why we can’t have an “everybody wins” attitude to lots of challenges and problems.

Read More

September 2022

Brief But Spectacular take on telling the whole story; Solutions Journalism; COVID and Things are always working out for me.

Welcome to the September edition of Tips and Topics from Australia.

In SAVVY, watch David Bornstein make the case for Solutions Journalism to activate people to be powerful players in a participatory democracy.

In SKILLS, be part of telling the whole story, not just focusing on the problems. “It is as if your parents were always criticizing you about what you were doing wrong and never letting you know where you have possibilities to grow.”

In SOUL, I have adopted more robustly the attitude of “Things are always working out for me”. A number of events on my Aussie trip would seem to contradict that. But as I reflect on the events midway through my trip, and my week of COVID, I’m sticking with my story.

Read More

August 2022

Jaclyn’s story about a mother and son in her own words – Applying the therapeutic alliance to any relationship; What is ‘young’ anyway?

In SAVVY, SKILLS, SHARING STORIES & SOLUTIONS, I depart a little from our usual format to let you enjoy and learn from a mother’s story about how she applied the principles and practices of the therapeutic alliance to restore her relationship with her son. Not only did it rebuild the relationship but it empowered Leo to reach his full potential.

In SOUL, I am choosing to focus more on the joy of living than on my biological age. Even though I hit 73 this month, I don’t feel anywhere near that. How about you?

Read More

July 2022

How smart are you about SMART Recovery and its Family & Friends Program? Wisdom on coming together from social media

In SAVVY, we all know about AA and other 12-Step programs. But Joe Gerstein, Founding President of SMART Recovery, gives us an update on this complementary alternative community mutual assistance organization started in 1994.

In SKILLS, Joe explains how SMART Recovery runs and what skills and goals are the focus; as well as how the Family and Friends Program is integrated with CRAFT [Community Reinforcement And Family Training].

In SOUL, I share some of my favorite quotes and images from social media that helped me think about how to come together in an era of division and information bubbles.

Read More

June 2022

Helping families with addiction – Residential treatment is not the gold standard; Intervention, Tough Love or CRAFT?; Exercise training is hard work. How do those athletes do it?

In SAVVY, STUMP THE SHRINK and SKILLS, I share a colleague’s request for recommendations for a residential program on behalf of a family affected by addiction. The family wanted their son in long-term residential treatment. But is residential treatment the gold standard? We have to use the whole continuum of care to give long-term, life long addiction treatment if necessary.

What should be done for a son who the parents are financially supporting and who doesn’t follow through with treatment?

In SOUL, I recently started strength and core exercise training. Better late than never, but it is hard. I have a new found admiration for all those athletes who workout everyday to reach their peak performance

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