Opioid addiction Archives - Page 6 of 6 -

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.

Faces and Voices in Recovery Partnering with Members of Congress to Offer Comprehensive Addiction Resources

Faces & Voices of Recovery, in collaboration with the Addiction Policy Forum and the House of Representatives Bipartisan Task Force to Combat the Heroin Epidemic developed a comprehensive addiction resources toolkit to help the families impacted by the heroin and opioid epidemic. This week, Members of Congress will unveil this toolkit on their websites and in their district offices and will train their office staff to provide key resources to families and individuals in their communities facing addiction. This toolkit is a resource that every recovery community organization, treatment center, doctor’s office, library as well as every family and individual should have access to.

More Americans die every day from drug overdoses than from car accidents – an average of 129 people per day, with six out of 10 deaths related to opioids. This toolkit was developed in response to the fact that a majority of those who need help with addiction issues are not receiving it. In 2014, only 11 percent of the approximately 22.7 million Americans who needed treatment for substance use received it, according to the Office of National Drug Control Policy.

“We are honored to partner with Members of Congress to offer individuals, families and communities important resources that will help them find support to achieve long-term recovery. We have offered our expertise for this toolkit and are pleased that Members of Congress understand the importance of making this information easily accessible and available in each Congressional district across the nation.” -Executive Director Patty McCarthy-Metcalf

Leading national and community organizations contributed to this comprehensive set of resources that includes resources around prevention, drug treatment, recovery support and general information for families, community organizations, schools, and parents concerned about addiction and seeking support. The groups who contributed to this guide include: Community Anti-Drug Coalition, the National Council, the National Association for Children of Alcoholics, the Partnership for Drug-Free Kids, Shatterproof, Faces & Voices of Recovery, Legal Action Center, National Institute of Drug Abuse, and the Office of National Drug Control Policy.

In preparing this toolkit, Faces and Voices of Recovery strengthens it’s mission and dedication to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs, our families, friends and allies into recovery community organizations and networks, to promote the right and resources to recover through advocacy, education and demonstrating the power and proof of long-term recovery. Faces & Voices of Recovery is the parent organization of the Association of Recovery Community Organizations (ARCO) which unites and supports the growing network of local, regional and statewide recovery community organizations (RCOs). ARCO links RCOs and their leaders with local and national allies and provides training and technical assistance to groups. ARCO helps build the unified voice of the organized recovery community and fulfill our commitment to supporting the development of new groups and strengthening existing ones.

Link to Tool kit: http://media.wix.com/ugd/bfe1ed_439f2d84f59c4461a4eef39a7b00596d.pdf

Category Archives: Opioid addiction

A Call for Clinical Humility in Addiction Treatment

Faces and Voices in Recovery Develops an Addiction Recovery Toolkit