November 2019

Lessons learned from my journey to India and Japan; travel tips; Laughter Meditation; Sharing Solutions

In SAVVY and SKILLS, I share some observations from my trip to India and Japan; and implications for Behavioral Health.  

In SOUL, what I learned from Laughter Meditation in Pune, India.

SHARING SOLUTIONS about behavior design for addiction professionals.

savvy

From November 1 -25, I was ‘on the road’ in India and Japan. The International Society of Addiction Medicine (ISAM) conference was in New Delhi, India this year, so I added a little touristing to Kerala, a southern state on India’s tropical Malabar Coast, with an Arabian Sea shoreline as well as a week in Tokyo, Japan. So while it is fresh, here are some observations and lessons learned from my fascinating journey in these two populous and very different countries and cultures.

TIP 1: Observations in India and implications for behavioral health services and systems

1. Overall, I had only brief health issues with a cough and sore throat for 48 hours in India (who wouldn’t, with New Delhi Air Pollution Air Quality Index (AQI) reaching in to the 600s, which is the most severe “hazardous” levels.) Out on the houseboat on the waters of Kerala, I got one mosquito bite that made me wonder if I might now get malaria as I took no anti-malarial medication. Ten days later, I had some diarrhea and feared “Was this the start of a malarial attack?” 

Houseboat on the waters of Alleppey, Kerala, India 

Both these health episodes lasted no more than 48 hours. But in those 48 hours, the fear of the unknown, the worry of more serious developments, and the pressure to not be sick on a vacation were all more energy-draining than the actual maladies. 

Implications: Promoting positive expectations and a sense of hope is a major principle of change. When I was in the throes of my symptoms, I struggled to have positive expectaions and hope, which made the situation worse. In our work with people, instilling a sense of hope is an important determinant of successful change and help. 

Reference: “Obtaining Consensus in Psychotherapy: What Holds Us Back?”Marvin R. Goldfried, Stony Brook University American Psychologist 2019, Vol. 74, No. 4, 484-496  

2. India is trying to encourage use of technology so, for example, for the entrance fee to the Taj Mahal, there was reduced price for using a credit card versus cash, the opposite of what you might think. 

Taj Mahal, Agra, India 

Implications: Developing countries struggle to use technology to improve efficiency. But so has behavioral health. Contingency Management (CM) is one of the most effective and evidence-based psychosocial treatments for substance use disorders. In over 100 randomized controlled trials and 7 meta-analyses, CM significantly enhances outcomes. Yet addiction treatment has not widely implemented this evidence-based practice.

Disclosure: I am an investor in DynamiCare’s personalized digital coaching program that includes easy-to-use random breath and saliva tests submitted through our app, verified treatment attendance check-ins, a supportive Recovery Coach, rewards for healthy progress, and a dashboard for supporters. CM leverages the power of incentives for recovery and is the foundation of DynamiCare’s rewards-based approach. Technology targeting substance use.    

3. The concept of safety was quite a contrast between India and Japan. It was not unusual to see families of 4 or 5 on a motorcycle weaving in and out of the chaotic road traffic. Whereas in Japan, while walking along the sidewalk, I’d encounter a ramp leading from a parking station. In the USA, you might be lucky to have a flashing orange light triggered by an approaching car to prevent you from stepping in front of the exiting car.

Family of 4 (not my photo) 

In Japan, three nicely uniformed men with Star Wars-like wands were stationed at the car exit to direct pedestrians when it was safe to continue on the sidewalk. 

Implications: The concept of safety is different in countries but also in families. Children of trauma, abuse and addiction have a different concept of what safety is and what a ‘normal’ family environment is.

TIP 2: Observations and lessons learned in Japan 

1. My first two nights in Japan were in the very comfortable Intercontinental Hotels Tokyo Bay. Besides the grand view of the Bay, I was surprised to find the toilet seat was comfortably warmed. If you’ve ever sat on a toilet seat in the night of winter, you’ll appreciate this nice amenity.What surprised me though, was that warmed toilet seats are very prevalent in Japan. I even found them in public toilets in railway stations and highway bus rest stops. The fancy hotel, I could understand. Public toilets? That was a pleasant surprise. 

Implications: Comfort and consumer friendliness in Japan is not just in the fancy hotels. Apparently it is a cultural norm for all. How much do we value comfort and consumer-friendliness in the USA – not just in hotels but more importantly in our public programs and services. If you are paying out of pocket for some high-priced private treatment program, you can expect the ‘warmed toilet seat’ so to speak. But what do we give our less advantaged, publicly served clients?

Wearing comfortable yukata at onsen (hot springs), Kusatsu, Japan

2. Besides the warm seats, I was surprised as to how clean the public toilets were in Japan’s highway rest stops and railway stations. They may have been as clean as your home’s, if not cleaner, because workers were cleaning consistently throughout the day. 

Implications: The comfort and attractiveness of the public amenities sets a tone that speaks to the power of cultural expectations. I saw very little, if any graffiti in public places. How do our agency and treatment waiting rooms and furniture look? Do they send a message of respect, comfort and welcoming for our clientele?  

3. On bus tours, I was with some European tourists and noticed that we were always the last to be back on the bus at the appointed time after a rest stop or tour break. The Japanese were prompt and very respectful of the timeframes. The same phenomenon was true for all train and bus departures. I thought this typified German trains (set your watch by the train scheduled departure), but apparently this is even more true for Japan. 

Implications: The cultural expectations that are set and modeled are strong influencers on people’s behavior. In the USA, any tension between individual rights versus what is right for the greater good, usually skews towards individual rights. In Japan and other countries, it usually skews towards consensus for the collective good rather than the individual.

skills

There are more comprehensive travel tips on the internet. But here are some personal favorites that you might find helpful. 

TIP 1: A few travel tips for International travel 

1. Local foreign currency – I never use travelers’ checks or change US dollars at Money Changers. I don’t want to pay high-priced fees. So I opened a Schwab Bank High Yield Investor Checking® Account that gives you a VISA card to use at ATMs to withdraw local currency. I’m not advertising Schwab. It just happens to be the one to which I was introduced. Other companies have similar cards where you get the current money exchange rate with no fees and Schwab reimburses any ATM fees. The foreign ATMs ask you to agree to pay an ATM fee before they spit out local currency. Accept those fees knowing you get them back if you have this kind of account and card. 

2. Japan Apa Hotels – If you are going to the Tokyo Olympics in 2020 or to Japan anytime, check out the Apa chain of hotels. No, these are not run by the American Psychiatric Association or the American Psychological Association. But they are a chain of numerous hotels designed for tourists and others who don’t need the large, spacious American hotel room and suite. They are very compact, maybe about 10 feet by 18 feet; or I estimated 1.75 length of a queen sized bed and 1.5 width of the same bed. But they have everything you want at your fingertips and everything you need for a comfortable stay at reasonable prices. (No, I don’t get any royalties for recommending them.)

All switches and buttons at your fingertips 

 3. Take fewer clothes than you think you need – I tend to make the same mistake and take more clothes than I end up wearing. Take a few outfits you like and preferably washable, quick-dry materials that can dry overnight in the hotel airconditioning. You’ll save expensive hotel laundry fees; travel lighter without heavy bags to cart and check in; and will look just as good. As a friend said on our Kenya trip, “It’s not a fashion show.” 

4. Get a local SIM card for your phone – Unless you are some executive that needs to have your particular mobile number available for all back home to use to contact you, a local SIM card is usually way less expensive than paying for the international plan from your home phone company. You then have internet access on the street to use Google Maps to get around, not just free wifi that you get in the hotel or a store that advertises “Free wifi” to get you to shop there. 

5. WhatsApp – This is a great app to install and use to text, call and even video talk to anyone around the world. Even if you get a local SIM card, you can designate your home mobile number as the contact number so your contacts will still be able to get to you, even though the local SIM card gives you a local phone number others won’t recognize. 

6. Tipping – Check the internet to understand tipping before arriving in the foreign country. Then you will know what to tip for the hotel worker who carries your bag to your room. Have small amounts of currency available in advance. Of course you can always just tip the percentages or amounts you do at home, and that is a nice gift for those on very low salaries. But that is usually way more than necessary. Also in Japan, there is no tipping. And it can even be an insult to tip there if it implies that the worker is not well paid and therefore needs a tip. So check out tipping Do’s and Don’t’s before arriving in the country. 

7. Currency and language apps – There are a number of apps to install on your smartphone to help you quickly convert foreign currency amounts; communicate with anyone from another country by speaking or typing in what you want to say; and convert kilograms to pounds, or kilometers to miles.

Enjoy the world – I do.

soul

For three days, I enjoyed the peace and quiet of the OSHO International Meditation Resort, Pune, India. Besides a taste of the Kundalini and Vipassana Meditations, I experienced a Laughter Meditation that “helps you to start enjoying the small things of life – childlike, liquid, mirrorlike.” 

Here are three observations from my hour meditation: 

1. I tried not to force myself to laugh. I wanted it to go with the flow – then someone would let out a loud guffaw and hilarious shriek and I’d immediately start chuckling, smiling, then an outright, full-throated laugh. Watching a comedy show with family and friends works too. 

2. When I did want to get a laugh going, I smiled broadly like you see in a clown’s face. 

That would work. I was soon smiling and laughing. This is best done in your room by yourself at home rather than at your work desk. But a toned down version in public can also brighten your day and someone else’s. 

3. At times, I was tired and started yawning. I discovered that an easy way to start smiling and laughing is to yawn. Try being mad and frowning while having a good old, wide as you like, yawn.

You may not have the opportunity to participate in the OSHO Laughter Meditation, but you can try out these three practices first, in the safety and privacy of your home.

Funny thing, that laughter meditation!

sharing solutions

Behavior Design for Addiction Professionals

Have you ever wondered how you managed to end up with a bunch of stuff you didn’t really need because you got sucked into some online super sale? Or, found yourself going down the digital rabbit hole and spending far more time online than you had planned? 

If you’re like most people, the answer is a resounding “yes.” 

The reason is simple: Behavior design is at work! 

Behavior design, a relatively new field, sets forth principles and systems that influence human behavior. In other words, behavior design gets people to take action, intentional or not, desired or undesired. 

Digital tech and online marketing have used behavior design with phenomenal success, and ways to get people to take specific action have been honed razor sharp: Buy now . . . click. Subscribe . . . click. Like . . . click. 

The good news is that results from high-tech’s application of design principles have profoundly expanded and deepened our general understanding of what makes people tick . . . and click. What we’ve learned about behavior design applies in low-tech contexts too, including in addiction treatment and recovery support. 

Behavior design can significantly help us up our game, optimize outcomes, and do better for more people. 

Want to know more? 

Over the last few years, I’ve worked with my colleague Deborah Teplow at the Institute for Wellness Education (IWE), to introduce addiction professionals to behavior design, and help them integrate it into their work. We’ve gotten great feedback from practitioners, so in 2020, we’ll be offering an array of programs on behavior design for addiction professionals.  

Get on our mailing list so we can keep you up to date. 

Deborah and I hope you’ll join us!

October 2019

Two STUMP THE SHRINK questions on passive compliance and substance use while in treatment; customer-focused and friendly

Welcome to the October edition of Tips and Topics (TNT). This edition combines SAVVY and SKILLS to address two STUMP THE SHRINK questions that encompass several relevant attitude, knowledge and skills issues.

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September 2019

What are social determinants of health? Aging providers and the next generation

Welcome to the September edition of Tips and Topics (TNT). My heartfelt thanks to the many readers who took the time to write and share their support and feelings about the August all-SOUL edition.
This month in SAVVY, the focus is on social determinants of health.
In SKILLS, it is important to assess and include social determinants in treatment planning, not as an afterthought or “discharge planning” task.
In SOUL, a guest contributor asks “how do we capture our faith, skills and experiences in order to share and pass them along to the next generations of professionals?”

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August 2019

All SOUL – grief, loss, and moving forward. Perspectives from my children and me.

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July 2019

Behavior Contracts – the good, the bad and how to move away from them; Surpises about food and the environment

In SAVVY, we focus on the advantages and disadvantages of Behavior Contracts.
In SKILLS, I invite you to delete Behavior Contracts from your clinical toolkit.
In SOUL, I was shocked to learn that that a quarter of the world’s greenhouse gas emissions come from putting food on the table.

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June 2019

What to do about addiction clients with prescribed, potentially addictive medications; Pickleball anyone?

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about psychiatric prescriptions for benzodiazepines and amphetamines in addiction treatment.
In SKILLS, assessment needs a skilled clinician who is savvy about addiction and mental illness who can evaluate specific diagnostic and treatment questions.
In SOUL, I was introduced to Pickleball and now exercise could actually be fun for me.

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May 2019

Lying and dishonesty in Treatment Courts and what to do; using ACCEPT with dishonesty; update on my grief process.

Welcome to the May edition of Tips and Topics (TNT). A special welcome and thanks to those readers who have been with me from the beginning and wrote to express their appreciation through all the years.

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about lying and dishonesty in Drug Courts – what is the role of sanctions?

In SKILLS, what is the role of treatment and judges and court teams when participants lie? Using ACCEPT as a structure to guide what to do.

In SOUL, I update where I am in my grieving process. It helps me to reflect and I hope helps you understand grief too.

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April 2019

What to do with poor outcomes: ACCEPT; my top 10 “Unvarnished Truths”

Welcome to the start of the 17th year of Tips and Topics (TNT). Most of you were not a reader from Day 1 when I started writing TNT, April 2003. If you were, please write and let me know.
In SAVVY, I’m introducing an acronym to help think through what to do when a client, patient or participant is not doing well in treatment – ACCEPT © David Mee-Lee 2019.
In SKILLS, what is a poor outcome for your client in addiction treatment?
In SOUL, whether you are thinking about retirement or not, “21 Unvarnished Truths about Retirement” is a worthwhile list from which I highlight my favorites.

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March 2019

Guest writer Tips on Sports Betting; one more SOUL on losing my wife and grief

SAVVY and SKILLS – March is Problem Gambling Awareness Month, which is why this edition comes to you earlier than usual, so you can be aware. Having a guest writer was good for me as I continue in the acute phase of grieving over the loss of my wife a few weeks ago.

SOUL – A bit more on grief and loss this month and then I’ll leave that alone for a while – in Tips and Topics, not my life.

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January 2019

Addressing racial disparities; Unconscious bias and Nonviolent Communication; Africa and a cultural experience

Welcome to the New Year and the January edition of Tips and Topics (TNT). In this edition, the focus in SAVVY is on race relations, unconscious bias and the foundation for nonviolent communication.
SKILLS raises consciousness about systems barriers and biases which work against racial equality and ways to break down walls.
SOUL is about the adventure in Africa this month that will place me face to face with a very different culture.

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December 2018

Hope for working together for the greater good; Stump the Shrink and more Tiny Habits; That’s service.

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