December 2019

Thinking beyond medication; “Just give me medication”; consumerism and loving yourself In SAVVY, ASAM’s revamped definition of addiction and finding the balance between medication and psychosocial treatments. Consider effective alternatives to medication. In SKILLS, what to do with requests for medication for chronic pain and addiction. In SOUL, Santa, shopping and self-love. Adam Roa on “How to Truly Love Yourself”. savvy We live in a society and culture where the first intervention patients and physicians often think of is medication. I joke that some people don’t want to pay their co-pay if their doctor doesn’t give them a prescription for a medication: “He didn’t do anything. They didn’t give me a pill for my symptons. I’m not going to pay for this visit!” In addiction treatment, the opioid crisis and the knowledge that addiction is a brain disease, has contributed to a focus on medication in addiction treatment. For some, this focus on medication has resulted in neglect of psychosocial treatments that are essential in achieving long-term recovery.  In September, 2019, the American Society of Addiction Medicine revamped its 2011 definition of addiction.“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.” “….complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences” reminds us that addiction is not just a ‘brain’ disease, but like all chronic medical diseases is biopsychosocial in its etiology, how it manifests in people’s lives, and in what is essential in treatment to promote long-term recovery. TIP 1 Find the balance between medication as treatment versus medication and psychosocial services Too many treatment providers are not using effective medications for Opioid Use Disorder and other manifestations of addiction (alcohol and nicotine). They need to balance their focus on psychosocial treatments with consideration of medication for their clients and patients. But the reverse is true too where too many prescribers are seeing addiction treatment only as using medication. While there are effective medications for alcohol, nicotine and opioid use disorders, the hunt is on for medications effective with stimulant use disorders. In a December 16, 2019 editorial comment by William Haning, MD, DFAPA, DFASAM, Editor-in-Chief, ASAM Weekly, Dr. Haning presents a balanced view of a December 11 article by Phillip O. Coffin, MD, MIA; Glenn-Milo Santos, PhD, MPH; Jaclyn Hern, MPH; et al. in JAMA Psychiatry that suggested a medication, mirtazapine, is effective in the management of methamphetamine use disorder. Here’s what Dr. Haning said:  “…. it would be hard to imagine a mood-altering medication that has not been considered or deployed in the effort to reduce rates of methamphetamine use: bupropion, selegiline, n-acetyl cysteine, ondansetron, modafinil… and then re-deployed, as mirtazapine was a decade ago and is again now.”  Then he goes on to comment on how effective these medications are or not (remember addiction as a biopsychosocial disease):  “….they generally have some benefit over placebo, though …

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.

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.

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?”

August 2019

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

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.

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.

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.

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.

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.

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.