Category Archives: Alcoholism

A Call for Clinical Humility in Addiction Treatment

Posted on May 26, 2016 by Melissa Killeen

by William White and Chris Budnick, video featuring Chris Budnick

The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help. The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3, below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

The challenges for each of us who work in this special service ministry and for william_l_white_portrait_1 the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU

My name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993.

There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.” “We can’t help her tonight.” She was killed within hours of this decision leaving behind a 2-year-old daughter. I told the officer that we pledge to do better.

This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

I’m sorry for all the barriers you confront when trying to access help.

I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.

I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.

I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.

I am sorry for creating unrealistic expectations of you.

I’m sorry for provider success statistics that have misled you and your family.

I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.

I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.

I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.

I am sorry for my arrogance when I’ve assumed that I am the expert of your life.

I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.

I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.

I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.

I’m sorry for turning you away from treatment because you’ve “been here too many times.”

I’m sorry for not referring you to different services when you have not responded to the services I offer.

I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.

I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.

I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.

I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.

I’m sorry for letting society maintain the belief that you used again because you chose to.

I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.

I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.

I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.

I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.

I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.

I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.

I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.

I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

– Chris Budnick, Licensed Clinical Addiction Specialist

This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling. WW

I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse. Truly such client-centered treatment can change the course of recovery for many. MK

Endnotes:

This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick have authorized this reposting.

Posted in Addiction Recovery Posts, alcohol, Alcoholism, Drug Abuse, Family Dynamics, Gambling, Health, internet addiction disorder, mental health, Opioid addiction, Parents, Recovery Coaching, Relapse, Research, Uncategorized | Tagged addiction treatment, chestnut.org, Chris Budnick, RCNC, recovery communities of north carolina, recovery management, recovery orientated system of care, William White, www.williamwhitepapers.com | Comments Off

How Adverse Childhood Experiences affects long term health – a TED MED Talk by Dr. Nadine Burke Harris

Posted on May 19, 2016 by Melissa Killeen

Dr. Nadine Burke Harris, during her TED MED talk presents the results of the Adverse Childhood Experiences (ACE) study and the substantiated affects the study has brought forth on how childhood trauma can affect the quality of one’s health and length of a person’s lifespan. The San Francisco based pediatrician explains that the repeated stress of abuse, experience of neglect and living with parents struggling with mental health or substance abuse issues has real, tangible effects on the development of child’s brain. The ACE study concludes that those who’ve experienced chronic, and high levels of trauma are at triple the risk for heart disease, addictions and lung cancer. She gives an impassioned plea for clinicians to use the Adverse Childhood Experiences questions during the intact of all patients and confront the prevention and treatment of trauma, head-on.

Posted in Addiction Recovery Posts, alcohol, Alcoholism, Drug Abuse, Family Dynamics, Health, mental health, Parents, Recovery Coaching, Research | Tagged ACE Study, Adverse Childhood Experiences questionaire, CDC, Kaiser Perminente, Nadine Burke Harris | Comments Off

The Sobering Center’s Recovery Coach—George Shea

Posted on April 14, 2016 by Melissa Killeen

The Houston Recovery Center

The Houston Recovery Center and the Sobering Center, is located at 150 N Chenevert St, in Houston, Texas. The Sobering Center employs recovery coaches, case managers and Emergency Medical Technicians (EMTs). At first I thought a Sobering Center was a unique set-up for drunks to “just to sleep it off.” This is how it works: Houston police bring in intoxicated people to the Sobering Center in lieu of jail. Sounds like an easy solution for an alcoholic, yes? But this facility provides much more than an alternative to incarceration for individuals who are intoxicated and on the streets. Inebriate adults remain in the Sobering Center for 5-6 hours and have a recovery coach assigned to them. This recovery coach will suggest detox, rehabilitation treatment and recovery coaching support. The clients begin to develop options for greater self-care and self-determination. Case workers can guide the client toward more stable living arrangements. EMTs check their vitals regularly. At the end of six hours the client is free to walk out and will continue to receive weekly recovery coaching services or the client can elect to participate in a detox and treatment program. What is extremely comforting is, if admitted to the Sobering Center, no one will receive a police record, or an arrest record.

How did Sobering Centers Start?

There is a decade-long, upward trend in emergency department (ED) overcrowding and increased jail time for nonviolent offender populations. Homeless, alcohol-dependent people have accounted for a significant portion of this escalating trend. Law enforcement is the first point of contact with intoxicated individuals and the last contact is jail, or the emergency department, so police departments and hospital emergency physicians have been begging for an intervention. As a result, the Sobering Centers were born.

There are Sobering Centers all over the country, so the concept is not new. Some may be in your city. There is The Sobering Center in San Antonio, the Sobering Center/Inebriate Reception Center in San Diego, The Sobering Center in Redding, California, the San Francisco Sobering Center, the CARE Connection Sobering Center in Santé Fe, New Mexico, and the Dutch Shisler Sobering Support Center in Seattle, Washington. The Dutch Shisler Sobering Support Center has been open for over twenty years, and the San Francisco Sobering Center, opened in late 2003 and has provided over 10 years of care for the homeless population in the Mission District.

Houston Recovery Center’s Sobering Center has had 14,000 admissions since they opened their doors in 2013. That is an average of 100-150 people a week. Prior to the Houston Center’s opening, police were making about 17,000 arrests a year for public intoxication, racking up between $4 and $6 million in police costs alone. The Sobering Center has reduced that number significantly; from June 2013 to June 2014, Houston police booked just shy of 2,500 people on public intoxication, according to an August, 2014, Houston Chronicle article.

What is the role of a recovery coach at a sobering center?

The Center’s recovery coaches and case managers offer the option to sober up for 5-6 hours, 24/7/365. A recovery support specialist is available at any time to have that conversation with anyone sobering up at the Center. There are always three recovery support specialists on duty along with a medically trained technician and a case manager. They walk through the dorms to ensure the clients are okay. The EMT checks on the client’s vitals every thirty minutes. Once a person wakes up, the Recovery Support Specialist’s magic can begin.

Once such magician is George Shea

George is a recovery coach that admits clients into the Sobering Center. After a medical intake with an EMT and an assessment with a clinician, George shows the client to the dormitory and assigns the client a bunk. He stays engaged in conversation with the client, if they can remain awake. This conversation is purposeful, to gather information and to find out if the Sobering Center can help them. George is there to find out if there is a problem, or if they want to speak to a counselor so they can find rehabilitation help. If they want to go into treatment, the Sobering Center has connections with several detox centers, and rehabs. If they need a roof over their head, the Center is affiliated with several facilities including a Salvation Army facility and the Star of Hope Mission that is right next door to the center. These are all specifically low- or no-cost options for the individual.

Yet, some clients leave the Sobering Center without seeking treatment. Any client who has visited the Center can sign up for follow-up recovery coaching calls and receive recovery coaching face to face. George calls clients once a week and asks them to complete various tasks such as formulating their recovery plan. George works with building the recovery capital of these clients, which includes providing clothing, finding housing or arranging for medical treatment.

George interviews every client before they leave the Center. Paperwork is completed to capture the demographic of the client, and George, again, informs them that detox and treatment are available if they need or want to take advantage of the resources. George is not forcing anyone to make these changes, but he can help. George often relates his story in this process.

George’s Story

George grew up in Houston, in an alcoholic family. He began using at 12, and started losing interest in school, and gaining more interest in drugs and alcohol. Eventually he got kicked out of the house at 18, and dropped out of high school. His mother died when he was 20. The family imploded. He was employed as a DJ at a local radio station, and the DJ lifestyle made it easy for him to use. Eventually, his stepmother initiated a family intervention targeting his dad. During family week at the treatment center, his family initiated another intervention, this time with George as the target and he stayed at the same facility for 6 weeks. He left treatment but relapsed immediately with intravenous drug use. He moved to San Diego, California, and limped along, either in feast or famine, in-between addiction and work.

He couldn’t keep a job or a relationship. His DJ-ing exacerbated the addictive behaviors. He was fortunate to have a small inheritance, but that also fed his addiction. In his late 40s, his health was deteriorating, he was losing his teeth, he had symptoms of diabetes, and finally had enough. He was living in a dilapidated house in Seattle that was going to be torn down. He felt so much shame. He lived an addicted life and continuously put up a front that he was okay. Finally he reached out to his family and asked for help. They said to they would help him, but he had to go to treatment and live in a halfway house in Houston. He had his last drink sleeping in his car outside of a Mexican restaurant, the night before he entered treatment.

In March 2009, he threw himself into recovery. He became active in a home group, and started doing service. Because of his broadcasting skills, he began producing a recovery radio show. His show is a mix of music and message. The message is that a life in recovery is a positive testament to who you are. The program link is: www.live365.com/stations/docjabbo . When George heard about recovery coaching, he knew he wanted to be a certified Recovery Support Specialist. He completed the CCAR Recovery Coach Academy training at the Center for Wellness and Recovery (http://www.wellnessandrecovery.org/) and started working at the Sobering Center.

One Life Saved . . .

George says his role is limited because he has these people for only a short period of time. He gives it his best shot. George gets the full spectrum of clients, some in full denial of their addiction, some aware of their addiction but with interest in changing and others in the middle, wanting to take action but not able to sustain any meaningful sobriety. The amount of brutality experienced by people living on the streets was truly an eye opener for George. Sometimes he hears from a client he helped. Like this guy from Michigan, his name is Richard, and he came into the Center about two years ago. He opened up to George about how he had ruined his life, and lost his wife and children. Richard is a craftsman who works with his hands but was homeless. In the past two years, George had gotten him into several detox and recovery programs, and yet Richard would relapse and come back to the Sobering Center. Richard would commit that he is on board to get sober, then he’d relapse, and come to talk to George. Richard is now enrolled in Cenikor, in their two-year treatment program. Cenikor is a well-respected treatment program with locations in Texas and Louisiana, where the clients live at the facility, work for the program, and as residents receive job training and career planning. George sees something in Richard that he doesn’t see in many of his clients. Richard may fall, but he keeps getting back up. That gives George a feeling of hope for him. And perhaps George’s coaching is making a difference in Richard’s life.

Posted in Addiction, Alcoholism, Recovery Coaching | Tagged alcoholic, Alcoholics Anonymous, CARE Connection Sobering Center Santé Fe NM, Dutch Shisler Sobering Support Center, houston recovery center, houston texas, recovery coach, Recovery Support Specialists, San Francisco Sobering Center, sobering center, Sobering Center/Inebriate Reception Center San Diego CA, The Sobering Center Redding CA, The Sobering Center San Antonio TX | Comments Off