March 2024- Vol. #21, No. 12

Welcome to the March edition of Tips and Topics and to all the new subscribers. In SAVVY, two staff scenarios raise some clinical supervision and organizational development learning lessons. One has to do with clients who show up late for appointments and the other is when staff feel unsafe with clients. In SKILLS, these two scenarios highlight the skills needed in supervision and organizational interventions to first assess the situation and needs before taking clinical and organizational action. In SOUL, I have decided to down-size and live in a turn-key situation that makes it easier to lock the door and travel free from the responsibility of home maintenance. I quickly offered to buy a townhouse that had just come on the market, then abruptly yanked my offer when considering the downsides. Fools rush in where angels fear to tread, or Opportunity knocks but once. So which is it? David Mee-Lee, M.D.  DML Training and Consulting SAVVY Recently, I was consulting with a Clinical Director about two staff situations that had caused supervisory and organizational development challenges. Scenario 1 It is not unusual with a client population that suffers from addiction, trauma, severe mental illness and co-occurring disorders for them to come late for their assessment appointment. It could be 15 or 30 minutes late and some even two hours. Some staff members have become increasingly frustrated to the point that they simply tell the receptionist to inform the client that they need to reschedule. Tip 1 For any client behavior that is “inappropriate”, antisocial, and especially if annoying, the first step is always to speak with the client in person and be genuinely curious about what happened to cause the behavior. In the behavioral health world and actually in healthcare in general, person-centered care includes, but is not limited to the following practices: Recognize that clients may be overwhelmed, disorganized and dysregulated. They first need to feel respected, accepted and welcomed for making the effort to show up. Recognize our own feelings of annoyance and frustration. Remember that our job is to engage and attract a person into a self change process, not demand compliance with what makes us feel comfortable….it’s not just about us; it’s about them. Develop skills to calm, de-escalate, understand and empathize with the client’s distress and behaviors. Scenario 2 A counselor assessed a client who seemed to get increasingly frustrated with all the assessment questions he had to answer. He started mumbling to himself and his legs were anxiously restless. When asked if anything was bothering him, he said “no”, but continued to appear frustrated. He asked for a pen to write down some information. The counselor started to feel unsafe as the desk was positioned in such a way that the client was near the door, which would block any need to quickly exit. The counselor started feeling that the client could use the pen as a weapon and asked Security to escort the client from the building.            At a systems level, the counselor asked that a panic button be installed in the office. …

February 2024- Vol. #21, No. 11

Welcome to the February edition of Tips and Topics and to Black History Month. In SAVVY, STUMP THE SHRINK and SKILLS, I respond to a question about Alcohol Moderation and its implications for how to work with people not yet ready to embrace abstinence and recovery. In SOUL, it has been five years since losing my wife suddenly. Embracing retirement has opened up opportunities to travel and with companions to make that fun. One special companion has raised my awareness about African Americans and their ancestors….a fitting connection in Black History Month. David Mee-Lee, M.D. DML Training and Consulting SAVVY, STUMP THE SHRINK and SKILLS Earlier this month, I got this message from a Drug and Alcohol Therapist: Have you heard of Alcohol Moderation as a Harm Reduction method of treatment for those with mild to moderate Alcohol Use Disorder (AUD)? I keep getting a lot of negative feedback from 12-Step based treatment programs and the 12-Step members that make up the majority of the staff in these facilities – even medical directors. It’s concerning to me.  I would love to hear your thoughts. My response: Hi: Back in the day, there was Moderation Management and this sounds similar, though I haven’t heard any presentations on “Alcohol Moderation” itself.   Consider someone who has severe AUD but is at Precontemplation or Contemplation stage of change in terms of readiness to consider abstinence, sobriety or recovery. “Alcohol Moderation” can be a useful motivational enhancement strategy: Develop a treatment plan that I would call a Discovery, Dropout Prevention plan that has the client collaborate on if and how they could moderate their use: “I’ll cut back, but I don’t need to totally stop. I can stop anytime”. So then you experiment with the client to do as Alcoholics Anonymous says, “attraction, not promotion”.  Work on attracting the person into recovery as s/he discovers that they may not be able to successfully cut back or stay abstinent for a trial period of time.  This raises consciousness to their “loss of control”. If you go to my newsletter Tips and Topics and in the Search on the right hand side put in Harm Reduction, you can read what I’ve written in previous editions; and also if you put in Discovery, Dropout Prevention and Treatment planning, you should come up with other ideas I have written about. David Tip 1 SMART Recovery has a useful, succinct summary of Abstinence vs Moderation. The SMART Recovery article starts nicely with: “This word “abstinence” can be an intimidating word to many, especially those in the early stages of recovery.” Take a look at the full article, but here are a few highlights in their words: • Why abstinence?…. the simplest, easiest, safest and surest way to keep from repeating past behaviors is total abstinence. This is not to say one may not go thorough a period of “day at a time,” or “week at a time,” or even try a “harm reduction” approach. Still, if you want the easiest way to minimize the problems in your life, go for abstinence eventually. • Is …

January 2024- Vol. #21, No. 10

Welcome to the new year and the January edition of Tips and Topics. In SAVVY, guest writer, Kristin Dempsey explains Harm Reduction and her just released book The Harm Reduction Workbook for Addiction. In SKILLS, Kristin includes some of her favorite exercises that can be used to explore one’s relationship to substances or processes. The exercises are based on the spirit and skills of motivational interviewing. In SOUL, I experienced what it is like to show up to an island village in Ghana unannounced and unexpected only to be treated like a welcome guest. Even with menu ingredients in hand, can you imagine these “guests” (intruders) expecting you to cook and serve them a meal? David Mee-Lee, M.D. DML Training and Consulting SAVVY Kristin L. Dempsey, EdD, LMFT, LPCC, is a psychotherapist, counselor educator, and trainer. New Harbinger, NH asked Kristin to write a book on motivational interviewing. After some discussion, they settled on her writing The Harm Reduction Workbook for Addiction. It is a guide to explore one’s relationship to substances or processes via a number of exercises based on the spirit and skills of motivational interviewing. The book was just released this month. Earlier in the year, Kristin had asked me if I would be willing to check out a PDF galley version of the book and write an endorsement blurb. I was so focused on fun traveling and non-work, that I told Kristin I was staying away from as many projects as possible. I said however that if she agreed, I would have her guest write for Tips and Topics (TnT) and briefly summarize the main points of the book as a way to get the word out. So here is Kristin Dempsey’s content just edited to fit TnT format. Tip 1 Harm reduction strategies are not the opposite of abstinence. Harm Reduction strategies include abstinence. According to the Harm Reduction Coalition, “Harm Reduction is a set of practical strategies and ideas aimed at reducing the negative consequences of drug use.” It is also a social justice movement “built on a belief in, and respect for, the rights of people who use drugs” (National Harm Reduction Coalition, 2023). Harm reduction strategies are not the opposite of abstinence. Increasingly, wellness and recovery are viewed as not a binary of harm reduction vs. abstinence. Harm reduction can be thought of as a collection of strategies that includes abstinence among many other strategies that reduce the potential harms associated with substance use or process behaviors (e.g. gambling, sex, shopping…) For instance, cutting back on drinking can be harm reduction, as is using test strips to check drugs for dangerous additives, such as fentanyl, as is stopping substance use entirely. Tip 2 Harm reduction (HR) aims to engage and support people who use substances. Motivational Interviewing is “how” you do HR. If harm reduction is the “what” and “why” of a philosophy aimed to engage and support people who use substances, then motivational interviewing can be seen as the “how”. Motivational Interviewing (MI) is a conversational approach based on practitioner humility and curiosity. MI …