Category Archives: Family Dynamics

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

Recovery Coaches to the Rescue

Posted on April 1, 2016 by Melissa Killeen

avengers-age-of-ultron It is 5:30 am and a band of FBI and local sheriff authorities pull up to a New Jersey suburban house in a development not far from Philadelphia. Adorning Kevlar vests, and windbreakers with the yellow letters FBI on their backs, they storm past a toy doll stroller in the sidewalk. They bang on the door with their fist, demanding “Open up this is the FBI”. After a few more wraps, a bleary eyed woman about 40 years old opens the door a crack and peers out. With a burst of energy, five FBI agents and two local police enter her foyer, issue her a search warrant and spew out demands, only one she actually hears, “Your husband is under arrest for child pornography, where are the computers?”

Emily, (all real names in this story will be withheld for privacy purposes) is dazed. She is in her bathrobe, and slippers, her hair is mussed, her eyeglasses crooked. She is barely awake. She glances at the stairs. She sees her two children at the top of the stairs, as a troop of agents make their way up to them. The agents ascend, as her girls descend squeezing towards the wall making way for the army of six foot, 250 pound men barreling past them. They are asking “Mommy, what is happening?” A sheriff from the local police department asks where her husband is. She says he is at work; he works the midnight shift at a local hospital. The Sheriff gets on his walkie-talkie and bursts out some demands, heralding a similar event at her husband’s workplace.

It is 6:00 am, and Tom is just wrapping up from his shift as a nurse. His supervisor walks up to him and a force of blue windbreakers flank him on either side. “Tom,” his supervisor says, “these gentlemen want to see you in my office”. As they turn to go to the office to FBI agents take Tom at the elbows and nearly lift him off his feet. He arrives in the supervisor’s office, is placed in an arm chair and the door slams. Tom hears the words he has feared for the past two decades. “You are under arrest for the possession of, and the suspected distribution, copying, or advertising of images containing sexual depictions of minors.” For some strange reason, Tom is relieved. He thinks “It’s over, it is finally over.”

It is Monday night, a steady stream of middle aged men drift into a hospital conference room, and take a seat. One of them opens a gym bag and starts to place books, pamphlets and tri-fold fliers on the table. A clear plastic envelope stuffed with one dollar bills is placed next to a thin loose-leaf binder. He sits down, opens the binder, checks the time on his cell phone and says, “Welcome to the Monday night meeting of Sex and Love Addicts Anonymous, my name is Ken, and I am a sex and love addict.” The seemingly normal cohort of men reply, “Hi Ken”.

The Monday night meeting of Sex and Love Addicts Anonymous begins. The reading is on Step Three; made a decision to turn our will and our lives over to the care of God, as we understood God. During the share a newcomer tells his story about what brought him into the rooms tonight. He is not sure he can be helped. He knows he has been a porn addict for all of his adult life. He says he has just been found out and he has no idea what will happen next, to his life, to his marriage, to his kids. He was advised to go to a 12 step meeting, and luckily he saw this meeting listed.

The members of this unlikely band of brothers looks at Tom. His head is down. His focus is on the ravaged cuticles of his right thumb. As he raises his thumb to his mouth, a tear rolls down his cheek. They know how he feels. Each one of them have felt this same despair. Joe raises his hand to share. Joe is almost 45, yet one would think he is no older than 35. His Goorin Brothers Slayer cap is on backwards, his flannel plaid shirt is unbuttoned revealing an LA Dodgers vintage t-shirt. Appropriately ripped skinny jeans end in Vans pull ons. He gets current, talking about his therapist, his groups and what the third step means to him. Then he looks directly at Tom. “I know there is no cross talk in this meeting, so let me just say this, Tom, can we talk after the meeting?”

Joe knows what has happened to Tom. Tom need not even say the word ‘legal’ for the subliminal message to be delivered. Joe knows because it happened to him, less than two years ago. The Cop Knock. The end of life as he knew it. The opening up of a new world. A new life without any more hiding.

Relief.

Joe and Tom walk to the café and Joe buys Tom a coke and a sandwich. It is the first thing Tom has eaten in two days. The café is empty, so they find a corner table and sit down. After just a few minutes, Tom’s experience from the last week is told. Joe’s head was nodding the whole time, but he lets Tom talk.

Before an hour was up, Joe had given Tom the name of three men, Michael, Steve and Mike. Also, the number of an attorney and of a therapist that specialized in treating offenders. As they walked out of the hospital, Joe said the first call should be to Michael. Michael will coordinate everything. And Joe was right, Michael coordinated everything.

Michael answers the phone at 9:15, and Tom was on the line. Michael was already prepared by Joe’s call, just minutes before. By 10:00, Michael assembled the team and briefed us all. The attorney appointment will be made by Tom. The therapist introduction will be on the phone, and the first group therapy meeting is tomorrow and Joe will bring Tom. Mike and Steve will call Tom daily for support. I am assigned to work with the wife.

Every one of us responds to this call. It initiates a recruitment effort that rivals the Avenger’s response to Ultron’s threat to eradicate humanity. This team is committed to respond to any sexual addiction crisis- the family affected by a patriarch’s incest, the individual devastated by sexual abuse, or the man that has heard the “Cop Knock”. We know they feel alone, whether they have been abandoned by their family, abused by loved ones or in this case, arrested for an illegal act. Tom needs his Avengers team to help him, because this is territory he is not familiar with. But this team is very familiar with it; the family dynamics, the law, the courtroom, treatment and therapy, prison and re-entry. We have walked this path, and emerged on the other side, as healthier and better people for the experience. So we are there, in order to keep our sobriety, we are doing service to give back what we have freely received.

Posted in Addiction, Family Dynamics, internet addiction disorder, Pornography, pornography addiction, Recovery Coaching, Sex Addiction | Tagged incest, pornography, recovery coach, Sex Addiction, Sex and Love Addicts Anonymous, sexual abuse, SLAA | Comments Off