Changing the Face of Addiction and Mental Illness Treatment
The Face of Addiction
There are thirty million addicts and forty-three million with mental illness in the United States. This costs the taxpayer $600 billion every year and the total is growing. A recent article in the New York Times, by Haeyoun Park and Matthew Bloch Jan. 19, 2016, showed deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin. Our prison system is overwhelmed, sixteen percent of people in state prisons and eighteen percent of people in federal prisons admitted to committing their crimes to obtain money for drugs. See the figures and report here.
Addiction and mental illness have no rules and they do not discriminate. It does not care what your status is in society. Addiction does not care if you are wealthy or poor or what’s your drug of choice.
In 2010 there were 40,393 Drug-Induced Deaths where is the focus on this statistic? In 2013 there were 43,982 Overdoes deaths.
According to the National Alliance on Mental Illness 50.5% of addicts struggle with mental illness. 1 in 5 adults experiences mental illness in a given year. Approximately 1 in 25 adults in the U.S.—10 million, or 4.2%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.
We have all heard about the war on drugs and billions of tax dollars have been funneled into end run programs designated to target the source of the drugs but not the various levels of behavioral victimization. These addiction control tools used by the cartels to build their vast network of distribution are applied at every level of their organization. A high-level addict is very controllable; a low level addict is the system by which the whole business plan of the cartels is based upon. The money has been spent with the intent of wiping out the source of the drugs by crushing the cartels, destroying the poppy fields in Afghanistan and arresting those who distribute and sell drugs. They have produced ad campaigns and created slogans, such as “just say no” and “drug abuse is life abuse”. You may have also seen the TV ads, such as the one showing the egg frying in a pan, where they say “this is your brain on drugs”. Since 1971 when the war on drugs was declared by President Nixon we have spent over one trillion. All we have to show for the expenditures are 2.3 million people behind bars for violation of drug laws. Targeting the victims of addiction with sobriety restoration through appropriate programs is a more effective course.
A study by the Treatment Advocacy Center in 2010 suggest that at least 16 percent of inmates in jails and prisons have a serious mental illness. In 1983 a similar study reported that the percentage was 6.4 percent. Thus, in less than three decades, the percentage of seriously mentally ill prisoners has almost tripled. http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf
The Courts along with Parole and Probation are overwhelmed and often treat everyone the same. I have seen cases where probationers have become productive and even got full time jobs only to lose the job because of demands from a parole officer or court appointed counselor. This in most cases re-triggers the addict’s addiction cycle.
All of this money and effort spent on the war on drugs has had little to no effect on drug use in in the US or the world for that matter. In all categories the drug use has steadily climbed every year since the war on drugs was declared.
The average cost of incarcerating an American prisoner varies from state to state. States like New York pay around $60,000 to keep its citizens behind bars per year.
In a 2012 Pew study show the impacts of incarceration reach far beyond former inmates to their children and families.
54 percent of inmates are parents with minor children (ages 0-17), including more than 120,000 mothers and 1.1 million fathers.
2.7 million children have a parent behind bars—1 in every 28 children (3.6 percent) has a parent incarcerated, up from 1 in 125 just 25 years ago. Two-thirds of these children’s parents were incarcerated for non-violent offenses.
What if that one trillion dollars were spent on treatment? Let’s look at it from a pure business model of supply and demand. As stated in the first paragraph by treating those using drugs on a regular basis you cut down the demand and you reduce the supply. With no demand the supply is wasted. The supply becomes redundant without addicts.
Most current treatment plans consist of twenty-one to ninety-day inpatient treatment, followed by a few months of outpatient treatment. What we are doing clearly is not working, since statistics show eighty percent of those coming out of rehab fail in the first year. These eighty percent fail or relapse five or six times before they stay clean or die.
Then we must realize that eighty-nine percent of those who need treatment, never get treatment.
The Failure of Current Treatment
The most visible problem with treatment programs is they are too short and clients are isolated during treatment. They are not taught to survive in real life. Treatment is applied far from the real world. Then they are sent right back to their old world, where they got into trouble in the first place. In the real world they are confronted by the same triggers and circumstances they thought they left behind. Some are put on disability or other entitlement programs enabling them to continue to be idle and dependent. They don’t have a chance.
Many people I see in our outreach program are so heavily medicated by the treating physician they can’t even function.
The absence of normal emotions such as those a non-addictive personality, most importantly inner strength, honor, caring what your impact on the people within their families, as well as a wholesome self-identity. The addict is in a fog and numb so they are incapable of experiencing even the true emotions, such as joy or even love.
The problem with many of the medication used to treat depression and anxiety is they impact all of the senses. It’s like pruning the whole tree because of one bad branch. Then we see those who are on Seboxone, Vivitrol or Methadone and how the addicts become chained to these drugs because of the fear of withdrawals. These medications should not become replacements or a crutch and should be used selectively, for a short time in conjunction with long term counseling to provide the recovering addict with a sense of personal and public responsibility. This gives the recovering addict usable tools to walk away from the enticement of the drug which is in most cases is not having to think about their life as unfolds within their addiction.
A life of addiction, pain and struggles cannot be rebuilt quickly and addiction treatment is not a quick fix or one and done. It takes years for treatment to be truly effective. Addiction is part of deep rooted pain, and struggles, which were created over a lifetime and cannot be replaced in three to six months. To solve these issues, we must look at the cause of their addiction and source of their pain; otherwise verbalized as the “why”. It is important to address the “why” they started using in order for them to heal or recovery successfully.
Jail and prison are not the answer either; I have heard both authorities and the general public say, “They can do time standing on their head” or that “It is easier inside than out”. Jail and prison can create more issues and harden them, adding the label of felon. For teens it’s even worse, twelve-year-olds are housed with seventeen-year-olds who have already become hardened criminals. For many of these young teens when they are released from prison they end up back in jail or prison because home life is worse than prison.
Some prison systems have curricula called “Retained Jurisdiction” or “Riders”, which are programs to help rehabilitate inmates during their prison stay and incorporate some of the thinking outlined below. The problem is these tools are often “Hung on the gate on the way out”. We need to make sure they are able to retain and use these tools in everyday life. Plus, the hardened addict or criminalized addict learns only one absolute in prison. Meals, clean housing, structure and a firm understanding of their standing inside are available. Prison is not a deterrent to addiction, it is merely a holiday from the stress of living as an addict outside of prison.
With all that is going on with our Healthcare System we are facing a crisis. The costs are going up and too few doctors to serve a growing population. On top of all this we are seeing more and more people struggling just to cope with life.
Look at what is happening around us, 27% of teens are using drugs, over 50% admit to abusing alcohol and overdoses are on the rise for all ages. Every day 22 Veterans take their own life. If you have ever tried to get help, it is near impossible, because there is no room or it just is not affordable and your insurance doesn't cover "That". Then add in the stigma of addiction or mental illness and you know where we are headed. Remember when cancer was the "C" word, no one wanted to talk about it, now if you get cancer everyone rallies around you and they start crowd funding for you. We need to do the same for the "M" word and the "A" word. Until we recognize mental illness and addiction as an illness instead of a weakness there is little hope.
Automated and self-directed tools can be part of the solution. If you give people access to resources that will not judge them if they tell the truth about what they are struggling with they can begin to heal.
What Should Treatment Look Like
Treatment should look more like how we treat chronic illness, such as cancer or diabetes. Just like these diseases, if not properly treated addiction can be deadly. Forcing anyone into treatment rarely works, the client must want to get well. When working with an addict they must want something more than the drugs, alcohol or food they have been using. They need some desire, motivation and hope. This could be anything, a paycheck, their health, family and friends. The goal is to help them to find and keep the hope alive and keep the scales of recovery weighted in the right direction with tangible implements.
The Role of Inpatient Treatment
The Inpatient treatment and detox center plays a big role in getting the client started on this journey and is the first big step for the client. Whatever their motivation, this first step shows the desire to heal. We need to get their head clear and get them off ALL drugs and alcohol for them to have a fighting chance. When they are clean from ALL mind altering substance for sixty days we have a clean slate to work with, and the real treatment can begin. There is a term in standard use for the first few weeks of sobriety referred to as the “Pink Cloud.” This feeling of euphoric well-being is a common behavior in stage one of the recovery process. Why sixty days? This is when the "Pink Cloud" begins to fade; the pink cloud is that great feeling during early sobriety, the feeling of “I got this”. It can take weeks to taper off SSRI’s (Selective serotonin reuptake inhibitors) or anti depressives to get out of the client’s system and have the serotonin in the body return within the client’s normal level. Once this happens the potential recovering addicts are starting to see reality and feel the world around them as a sober person does.
Some treatment centers and doctors want to automatically put clients/addicts on medication to reduce the cravings, depression and anxiety. A clear head is important because many times mental illness is developed as part or as a result of long term addiction. Counselors and team leaders need to know what we/they are dealing with. Some clients/addicts need it, but most don't, they need to see who they are and learn to deal with their feeling and issues that have been buried for years. The client/addicts need to be taught the skills to identify these issues and manage them. If you just medicate the client, which by the way is just another drug and a replacement problem, you more than likely cover up the real issue and you won’t get to the “Why” they started.
The Role of Outpatient Treatment
The addict becomes a willing client. This is very important step in the process. No matter if the client chooses a 12 step program, clinical program or private coaching or a combination, they key is consistency and longevity. The doctors and counselors should have a clear head to work with now so they can create a long term treatment plan with customized to the client. A plan with small steps is preferable, with obtainable goals so they don't feel overwhelmed. The moto should be, one bite at a time, one achievement at a time, over two to three years. If you tell them treatment may be two to three years, they may run the other direction.
Now that the client has a clear head, we need to get a new baseline to build on so we are treating the person not effects of medication or addiction. The problem is there are currently no blood tests or X-rays in use to determine where to start or how to treat an addicted client, other than an MRI’s, and PET/CT. These tests are not considered the normal part of a treatment plan and so are not covered by insurance. Other than that tool, which are currently out of our reach, all we have to go on are the answers the client gives us and the behaviors we observe. We need to be able chart their progress and that is difficult since the client doesn’t always understand what they are feeling when we ask the question and they don't always tell us what they are really struggling with. Look at traditional medicine, when you are being treated by a medical a doctor, at every visit, they check blood pressure, temperature and pulse, and so they can eliminate anything new from the baseline. With addiction, it is tough to establish a baseline and then identify what are new issues, and be able to compare them throughout the course of treatment.
Changing Behavior Through the Use of Technology
A big part of the treatment plan should include changing the behaviors and triggers. To put it in simple terms, this involves changing the brain and the thinking process, replacing old habits and triggers. We need to reroute the pathways in the brain (retrain the brain) so that when a trigger happens they automatically go to the new reaction and not the old reactions. This will begin to reverse the damage caused by the past, but to do this we need a way to do this monitor and change these twenty-four hours in the day.
We have known for years there is an area of the brain, called the Limbic System, which is responsible for addictive behaviors. One of the areas within the Limbic System is the caudate nucleus, and this area is partly responsible for voluntary movement, learning, memory, sleep, and social behavior. As part of the treatment of addiction and mental illness we need to focus on the voluntary responses in the brain and rewire them, get them back on track. This can be done with the right tools. This is not a new treatment method, over the past twenty years, behavior therapy has been shown to be extremely effective in treating obsessive-compulsive disorder (OCD). There are multiple studies showing the effectiveness of a combination of counseling and self-treatment, used at UCLA for past twenty-five years, which they call this approach "cognitive-bio-behavioral self-treatment." (Proven by PET/CT scans) Dr. Gorbis, an Assistant Clinical Professor at UCLA, used this method to achieve an eighty percent success rate with minimal relapse rates, this is much higher than other methods. This falls into the category of Neuroplasticity, which was first theorized by Dr. Hebb in 1949, and proven by and among many others. Most notable are Dr. Schwartz, Dr. Doidge, Dr. Lewis, and Dr. Mc Gonigal and references from “You are Not Your Brian” “The Mind and The Brain” “The Brain That Changes Itself”
A form of self-directed Neuroplasticity should be part of addiction and mental illness treatment and the best method is to use technology, and put it into the hands of the client. The enables them to self-report and modify behavior when issues come up, no matter the time of day or night. Then these issues can be identified and monitored in real-time instead of reported on once or twice a month. These tools can monitor moods, track progress and identify triggers and help the client see the issues and change their reactions. This is not much different than how we retrain the brain after a stroke or trauma. We have known for years about Neuroplasticity and circuit retraining, now we can use this knowledge to retrain the addicted brain. This is especially important, since we know most addictions have suffered from abuse, neglect and trauma.
As discussed in Psychology Today February 5th, 2013 We used to think that the brain, once damaged, could not repair itself. Breakthroughs in neuroscience have shown that this is not true. Though individual neurons might be damaged beyond repair, the brain attempts to heal itself when damaged by making new connections or new neural pathways as work-arounds for the damage. This is called neuroplasticity, neuro (brain/nerve/neuron) and plasticity (moldability).
What does neuroplasticity mean for addiction treatment? When we develop a habit, the brain creates a path in itself in support of that habit. As we engage in the habit over and over again, the pathway becomes well-worn or stronger. This is similar to lifting a weight. If you lift a weight over and over, the muscle will get stronger. In many ways, addiction can be explained as a neuroplastic event. The brain gets trained to do a particular behavior – use drugs or alcohol or gambling – eventually to the exclusion of all else. BUT, in treatment, we can retrain the brain, that is develop a new pathway that supports recovery. With intensive psychotherapy and other holistic interventions, we strengthen the new “recovery” loop within the brain. The brain then learns to enjoy recovery, those things that give us pleasure in our sober lives – family, work, interpersonal interactions. We retrain the brain and thus change our lives.
Life Recovery Solutions (LRS) is taking this to the next level and has been developing technology (Life Connect) to modify behavior by monitoring and managing the progress, behaviors and triggers for every hour of the day. We now have established methods that have been in proven to that work for those struggling with addiction, mental illness and to modify criminal behavior for those on Parole and Probation. It is a form of self-directed Neuroplasticity should be part of any treatment program. By using an App on a smart phone, we can put more effective treatment in the hands of every client, so they can self-report and modify behavior no matter the time of day or night. These tools will monitor moods, track progress and identify triggers to help the client change their reactions. These issues can be identified and monitored in real-time instead of reported once or twice a week. These reports can be used by professionals to watch for changes and receive alerts for particular signs and then take the necessary action.
This is especially important because of the growing number of people suffering from depression, mental illness, eating disorders or drug addiction as a result of neglect, abuse and/or trauma.
LRS uses the smart phone, a perfect vehicle to deliver technology because of its ease of use and most people, these days, don’t leave home without it. We have all become comfortable using smart phone apps to pour out our hearts; proved by looking at social media and texting.
Our technology works with most addictions and mental illness as well as modifying criminal behavior.
Educating the Client and Family
Treatment should include interviewing an education and involvement of family and close friends. The family and friends need to understand addiction and how to support the recovery without enable old behaviors. Stop the blame, begin to understand the role the family and friends played in the addiction and to role they play in the recovery and healing. We are not just dealing with addiction, in most cases we are dealing with abuse, trauma, or neglect. Now we are or may be dealing with criminal behavior and the shame of failure.
Treatment Plan Should Include the Beginning
Where to begin. Start with the family, look at the family history of addiction, abuse and neglect. Stop the cycle. If addiction started at a young age it can halt their emotional maturity and must begin hear. Some have spent too much time in jail or prison and most have never held a job. This should be part of the pictures and used to create the basis for a successful treatment protocol. The doctors and counselors should now have enough detailed information to be able to customize a treatment plan for the client, without assuming anything or using a cookie cutter. The primary goal should be tailored to get them back on their feet and heal their pain and the pain of others and give them their life without getting overwhelmed.
The client needs to be able to live, survive and pay for treatment because entitlement programs are not usually the best option. A large part of treatment and staying well is to develop a sense of pride and be able to say “I worked hard for this and I earned it”. There are programs available to help train and mentor people so they can become productive in the workforce, some I have listed below. I am not in favor of giving clients a false or premature diagnosis so we can bill insurance or be put on SSI, so they can receive yet another label.
Many centers are now dual diagnosis to provided treatment for co-occurring or co-morbidity, which is important if the client really needs it, we must remember we are dealing with a person. Don’t just give them a label. When you give a diagnoses of anxiety, mania, depression or even schizophrenia before the addiction is under control, you maybe treating them unnecessarily. It’s the old chicken and the egg; did the addiction cause the mental illness or vice-a-versa, does it matter now. I am not saying no one ever needs medication, many do, but medicating should be the last resort not the first step.
The best thing is to get the client working and busy. This can solve the big problem and the need to support the client financially during their treatment. In most cases we don’t want the family supporting the addict as this creates, dependency, tension and resentment. This can lead to many clients on welfare or disability. This only furthers their dependence on the system and does nothing to rebuild them.
I would rather we create work programs so they are not sitting on the couch playing video games between treatments session. Sitting on the couch with others in their situation is a recipe for disaster. If they don't have marketable skills, we need to train them and not everyone need to go to college. Until they are trained, there are many public works projects we can put them to work on to help them build a work ethic and pride. We all have seen the workers along the freeway cleaning up, these are from our local jails getting some fresh air. There are many public projects which the taxpayers already pay for, which do not require a lot of training, such as painting, street sweeping, snow removal, etc. We need to have an office in every city where anyone can walk in in the morning and get a job slip for day labor work and get paid at the end of the day. These jobs could be public or private jobs. The only stipulation is you are able to pass a drug test.
Teach the Whole Person
This program and tools are not just about learning to stay clean and sober, it’s about rebuilding years of damage so it doesn’t repeat with the next generation. Treatment needs to include a complete education; job skills, how keep a job, coping skills, character building and conflict resolution. We need to teach them how to survive in the real world and in the workplace. If you just toss them back into situations where they will use the same skills they have always used, which they are quite skilled at and they will fail. There are great examples already in place of how to do this--which should be supported.
Light Works Project http://www.lightworksproject.com/
Union Gospel Mission https://www.uniongospelmission.org/,
Steps Reentry http://stepsreentry.org/index.html,
Inland Northwest Fuller Center for Housing - www.INFullerCenter.org
Defy Ventures. http://defyventures.org/ The Last Mile https://thelastmile.org/
All of these are examples of private organizations who take these broken and hurting people and rebuilt them. We can also look at Mental Health Court for habitual offenders, these programs contain some of the elements required to make a difference.
The Life Recovery Academy
Once some gets out of rehab and or jail they need to go back to school, but not in the traditional sense. We need to create a Life Recovery Academy to catch their thinking up to their physical age. When you lead the lived many of those struggling have lead you will find their thinking is many years behind. You will also find they are extremely bright and some say that is part of the problem.
What we propose at the Life Recovery Academy is a new way of learning and is focused not just on education but on transformation. The school will not follow the current education practices. It will not be built like a school, there will be no straight halls or paths, Imagine WhoVille from Dr. Success. Throughout the building and grounds there will be significant statements and quotes on the floors, wall and ceilings. Some of these statement and quote will be from the students and staff. We want them to own their education. Every school will have counseling onsite. We will bring back wood shop, auto shop and metal shop. Everyone one will take computer classes and public speaking classes. We will partner with local companies to provide them with a career path. These could be in technology or construction.
Because so many of the kids and young adults struggle with so many thing, one being a very active mind we will change how the classroom functions. Many of the classes will not have chairs at desks, some with have exercise ball to sit at and other will have stand up desk. This will help them stay focused on learning and not day dreaming.
Each student will be given the opportunity to teach a one-hour course on something that suites them. This will give them confidence and show them what they really know. These are not book reports; these real lessons all students are required to learn. The students are just teaching them.
No one will be allowed to hide in the shadow or focus inward on what they are struggling with. Imaging the power of this with anxiety, OCD and depression.
Housing is always an issue for the struggling with those struggling with addictions and/or mental illness. The client will need housing and there are solutions available, however, the big limitation is the public understanding of the need and the impact it has long term on their community. Some communities have the attitude of "not in my back yard”. What the public doesn’t realize or want to admit, it is already in their backyard. Loss of productivity, criminal behavior, medical treatment and death. Every time an addict is released from jail or relapses they sleep on couches of friends and family until they wear out their welcome and end up homeless. Our backyards are their homes. Now they turn to crime. Then they return to jail, the cycle continues.
Imagine how difficult it is to find housing if they have a criminal record and/or no full time employment, few landlords are will rent to them. Then there is the shortage of affordable housing in some area because of the attitude of “not in my back yard”. If it is already in our backyard and if we want to solve the problem, we must be part of the solution. There are solutions available but in most cities it will require zoning changes and one of those solutions includes Tiny Houses. A two hundred square foot Tiny House doesn’t sound like much to most, but when all you have is a cardboard box it is paradise. If we were to build Tiny House Villages, where we could put four to six houses on a standard size lot and rent each for $300 to $400 per month. Then these villages could include other services such as laundry, childcare and counseling services so they could be self-sustaining. Those living in the villages could be part of their own solution by providing childcare, lawn services etc.
There is no need to raise taxes, what we need to do is to reassign the money spent on the war on drugs and other well-meaning but failed government programs to fund new progressive technology sound methods. The greater problem is in how the demand for doing something by the public was formally misconstrued by the lack of public involvement on the methods used on the war on drugs. This can be eradicated easily without losing job structure. No new taxpayer money needs to be allocated. However, limit those expenditures to keeping the cartels from bringing in the drugs until we have a handle on the recovery of the addicts in our society. The expenditures would be to interrupt the free flow of the drugs until the flow is reduced by the lack of use by clients who are no longer addicts.
Did you know, the best estimates are that for every dollar spent on drug treatment the financial return of four to seven dollars in cost savings to society?
Our goal is to reduce the addiction rate by healing those who are prone to addictive behavior and then provide the tools to those struggling with addiction to stay clean and sober. We also strive to reduce the recidivism rate for parolees, if we could cut it in half just by putting the tools in their pocket so they could learn new habits and be able to focus on the future.
We want to put more mothers and fathers back in the home with their children where they belong to start the healing. If we strengthen the family, we increase the possibility of having fewer addicts and mentally ill and therefore fewer criminals.
This is not just something that has happened to other people, I have seen all of this up close and personal. I have seen the damage mental illness and addiction does to a family and how that damage lives on for generations. My dad attempted suicide three times when I was ten and for forty years I blamed myself. My brother died at thirty-seven and my nephew was only thirty-nine. Both struggled with addiction their entire life before it took their lives. Now they have left behind broken homes, new addicts who are repeating the process. We lost a good friend who took her life in a moment of despair and no one saw it coming. If she was using Life Connect we would have seen her pain and been there for her.
What Can You Do? Get involved... Contact Ed Stevenson at (208) 771-2161 or firstname.lastname@example.org
In summation, we do have new solutions, we just need to put them in place. If we work together we can change the face of addiction and mental illness. We will then be able to save lives and families by getting those needing help, early help, and provide new more effective solutions that everyone can live with. Just think, if we put the tools to a successful recovery in your pocket we can reduce the recidivism rate by hundreds of thousands every year. Using this same technology, we can prevent those struggling on parole from re-offending because of a minor infraction so they get to stay home, get a job and raise their children. This reduces the effects on the children and reduces the chance of them becoming addicts or criminals
We can save the lives of those who are struggling with deep dark thoughts and feel life is too tough and want the pain to go away. We can help them get rid of that pain.