Addiction Archives - Mindful Happiness

January 22, 2020 By Admin

Brief Update on America’s Opioid Problems-2020

America’s Opioid Problem-2020; A Brief Update

Unfortunately, Opioid Use Disorder (OUD) is alive and well in 2020. Today approximately 150 People are dying each day due to opioid overdose. The CDC noted that from 1999 to 2017 approximately 399,000 people died in the United States from Opioid overdose. Related to chronic pain, this is one of the greatest failures in American medicine; perhaps, now medical training (as well as all mental health and social work training) will include sufficient clinical exposure to Substance Use Disorders ((SUD). Sufficient exposure goes way beyond Motivational Interviewing. Since many recognize addictions as America’s number one healthcare problem, all healthcare providers and school counselors, social workers, psychologist, etc. should receive proper clinical training in the prevention, intervention, and treatment of SUDs. It is about time!

Although in most parts of the country opioid dependence is still quite common, there is hope. Medically Assisted Treatment is being used, which in the best cases (Vermont’s model) includes medications to help reduce opioid cravings and psychoactive effects AND counseling to resolve mental health and addictions problems that lead to OUD in the first place. I, myself, a long time ago was part of a clinical team that established the first methadone clinic in Vermont under the jurisdiction a community mental health center (The Howard Center). As Clinical Director, and with lots of clinical experience and training in co-occurring disorders and the help of many, we were ready to act. Some thought Vermont did not need such a clinic, but on our first day of operation we had a waiting list of over 100 people hoping to receive these services. There is a risk here: current funding models short-change the clinical psychosocial interventions and enhance the medical interventions. For treatment to work long-term, people need BOTH! Even if people are successful at harm reduction regarding OUD, relapse is just around the corner if they do not receive therapy for pre-existing psychological problems (anxiety, depression, trauma, other addictions, and eating disorders). It is estimated that 90% of clients who do not take MAT medications may relapse. MAT with psychosocial clinical interventions sports a success rate of about 50%, which is great considering the severity of OUD. Let’s not be penny-wise and dollar-foolish; let’s not reduce psychosocial interventions that prevent relapse and enhance long-term health status.

For more information refer to The National Psychologist, 28(1), Winter, 2020, pages 1 and 5.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha

Author of Mindful Happiness

New Edition of Mindful Happiness in Production…Coming soon

October 18, 2019 By Admin

The Failed “War on Drugs” – Let’s Try Treatment On Demand and Fund It

The New York based Drug Policy Alliance (drugpolicy.org) and other sources have provided some important information about our failed drug and alcohol policies. Here are a few astounding facts. The United Stares has about 5% of the world’s population, but it uses approximately 70% of the worlds illicit drug. In Mexico, our drug-users demand may be responsible for the decay of governmental control – the rise of powerful drug cartels. We incarcerate the highest level of people in the world, nearly 25% of the world’s prison population. With the highest incarceration rate in the world, in 2016 we incarcerated 2,205,300 people. Our population, especially the young, appear to have a “death wish” regarding the consumption of mind-altering substances. Are we Americans so, so emotional empty inside and lacking of all capacities for emotion regulation? Why do we need to self-medicate at such dangerous levels? We just experienced a medically-led nation-wide opioid crisis. Our alcohol industry, worse than the losses due to Opioids, lobbies very hard so very little interference occurs in their Big Profit Game. One might suggest the government does not wish to improve the substance-consumption problem. Now we may legalize various uses of marijuana; there are public health consequences here. At this time 33 states allow medical use of marijuana. And, of course we have, vaping! Who profits?

Our current strong addiction to electronic and digital devices is our new epidemic. Addiction to “I-Smart” phones and tablets fuel texting-while-driving, with recent increase in highway deaths and injury. How utterly stupid! We are addicted to these devices (like the nicotine, alcohol, opioid, and vaping problems); the goal of electronic/digital engineers and behavioral psychologists hired by the industry to make sure we never put the device down and stay on it – even when driving. We empty Americans will do almost anything to “connect” to something. Our emotional emptiness and poor self-regulation skills make us vulnerable to unmet emotional needs. We must “feel” connected – because we are NOT. D. W. Winnicott and S. Freud had something to say about these neurotic tendencies of emptiness. So, how many “likes” did you get today? Time to wake up.

It is estimated that the U.S. government spends approximately $47,000,000,000 a year on the “war on drug.”
In 2017 1,632,921 Americans were arrested for drug related violations of law. In 2016 the number was 456,000, with 21% due to substance use problems.
Nearly 660,000 people were arrested in 2017 for marijuana law violations, with about 90% being for simple possession.
Even if the Black and Latino population makes up less than 32% off our total population, we arrested nearly 47% of those populations in our total drug-related arrests.
In 2017 72,000 American died from a drug overdose. We are out-of-control!
It may be possible to obtain $58,000,000,000 in tax revenue from the taxation and control of currently illegal drugs.
President Barack Obama, William Buckley, Milton Friedman, and Noam Chomsky have publicly noted that our “war on drug” is a total failure.

Here is an idea. Let’s get serious about stopping the total deterioration of our nation due to drug and alcohol addictions. Let’s try complete treatment on demand – and fund it at realistic levels. Hopefully, such a change would include evidence-based interventions and recovery-oriented cooperation. Let’s see what the next administration does about our self-destructing, nation-wide problem.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha

Author of Mindful Happiness

New Edition of Mindful Happiness in Production…Coming soon!

May 12, 2018 By Admin

Vipassana for Depression, Anxiety, Trauma, and Addictions

The integration of Vipassana meditation with various forms of therapy has for many years been a standard of treatment worldwide and in Vermont, especially when impulse control and emotion regulations issues are included. Buddhist Psychology offers clear explanations why this intervention may be helpful for so many suffering people. The four most common clinical conditions of depression, anxiety, trauma, and addictions are strongly and positively influenced by regular practice of this form of meditation. Below I have noted in a very basic manner how Vipassana’s effects may be explained via Buddhist Psychology and the dharma.

Impermanence is a focal aspect of Buddhist Psychology, meditation practice, and dharma. This constant of change may be explained best as the rising and falling of all humanly perceived phenomena. Although arising and falling away in conscious awareness include all phenomena, some clarity is needed regarding use of it in clinical practice. Sense impressions, mental events, sensations/feelings/emotions, impulsive behavior, and compulsive cognitions all relate to the clinical conditions noted here. Therefore, any intervention that brings important insight may be useful.
Humans suffer from habitual behaviors and reactions. It is best recognized in attachment to positive sense objects or experiences and aversion to negative ones. Sensory impressions and mental events about them lead to active roles on the hedonic treadmill. When we use sensory information and experience awareness of something that we evaluate as pleasant, neutral, or unpleasant we behave according to samsara – we crave for more or desire aversion from such phenomena. We may not at all realize that our attachment/desire to continue the pleasant – as well as the aversion to continue the unpleasant – is our major cause of unhappiness, pain, and suffering. Likewise the lack off this awareness or insight has the same unpleasant effects – we suffer. We become stuck wanting what we want but cannot always get, and hoping to avoid unpleasant experiences that may be unavoidable in human life. We tell ourselves only if I had…then I would be happy. General dissatisfaction, unfortunate as it is, is the human norm.
The information and processes noted above do NOT include a separate, long-lasting, independently arising entity called the Self. We do need to recognize that I am NOT my depression, anxiety, trauma, or addictions. I am simply aware or conscious of the fact that “I” am experiencing or feeling depression, anxiety, trauma, or addictions. It is only in more advanced Buddhist practices that we work seriously on the “no-self” reality. There are significant consequences in over-identification with either pleasant or painful experiences. Believing that it is “my self” that is trapped disempowers us in many important ways. The Four Noble Truths and The Eight Fold Path can help us.
In very unique ways Vipassana meditation can help us in all of the above. Here are some skills recommended by S. N. Goenka (now deceased). First, anchoring the breath by paying attention to the upper lip and the nostrils as you breathe in and out. In anapana sati we simply pay undivided attention to the feelings/sensations as we breathe in and out. Moment-to-moment bare attention is practiced for at least 30 minutes. To be successful, you must practice letting go of thoughts, emotions, and memories of past suffering. When they arise simply note that it/they have come up, and pay no attention to it/them – hold a non-evlautaive stance and stay with your breath. It will require significant practice before you can do this well. Awareness may then be expanded to the throat and chest areas – just feeling sensations of awareness as you breathe in and out. Second move into about 30 minutes of loving kindness meditation. Third, complete a body scan with attention only from head to toes and back again for about 30 minutes. Just pay attention to the awareness of sensations and feelings as you are guided slowly down and up the body. When distractions come, simply return attention back to the part of your body you are working with now.
Vipassana (Pali for “seeing things as they actually are”) allows us to learn all there is to know in items 1-3 above, and how to benefit significantly from such understandings. Long-term Vipassana practice may eventually bring you to a more stable self-existence, fully focused on your state of meditative awareness without strong reactivity in life. At some point you will become aware of interoception, the ability to feel sensations in your body before they bloom into emotions and behaviors. In the clinical conditions noted, such a skills can be live-saving.

For more information refer to Follette, V. M. and Briere, J. et.al. (2015). Mindfulness-Oriented Interventions for Trauma…New York: Guilford Press, pp. 273-283, 329-342. See also Ariele and Manahemi (1997). Doing Time, Doing Vipassana (Film); and, www.prisondhamma.org.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha

Author of Mindful Happiness

New Edition of Mindful Happiness in Production…Coming soon!

December 30, 2017 By Admin

Very “SAD” Facts about the Addictions Field

A recent issue of the Addictions Professional presented very disturbing news about how clinicians in the field are doing. NOT WELL! Addictions clinicians treat people with addictions but mainly people with co-occurring disorders – addictions with trauma, depression, anxiety and/or eating disorders. Often there is also a co-occurring medical condition. This is very difficult work. People suffering from these conditions often relapse into one condition when they improve in another. Trying to attain a healthier client life in this work is no easy matter, and places huge emotional strains on families and clinicians. It is a profession of the heart.

To begin with it is so sad how poorly the American public understand addictions. I think much of this wrong opinion is based on stigma, shame, and very poor public education about addictions. A recent Harris Poll of 2,184 adults, of which 692 were parents of children between the ages of 6 and 25, noted that 66% of the people polled thought addictions could be cured; nearly all professional groups believe it is a chronic, progressive disease/syndrome that can be managed. Recovery, of course, is quite possible; recovery, however, does not meet clinical criteria of a “cure.” 18% believed that recovery was hopeless once a person relapses after intervention. In reality, relapse is simply part of the recovery process and may indicate by its repetition how severe the addiction is (a brain-based, mind-body-spirit disorder). 55% had an opinion that a person with an addiction could not perform well at work. In reality this situation if quite variable. 42% to 47% of respondents would feel uncomfortable if a significant person (potential in-law, teacher, medical doctors) had an addiction. Well we all know how poorly informed the American public has been and still is about the realities of addictions. What is the problem here?

A recent Quality of Life survey of 650 addictions clinicians found that in 2015 71% intended to work in the field until retirement. That number was reduced in 2016, with only 68% planning to retire from their current work. In 2017 the number went down again with only 59% of current addictions professionals intending to remain in the field until they retired. That is a 12% drop in just three years. Almost 10% noted that they would most likely seek another career. Workloads have increased and salaries have not move very much. 52% of a sample of workers noted that their caseload has increased over the past two years. What about compensation? Not so good! In 2017 71% noted that their current salary DID NOT reflect their training, experience, and job requirements. 35% have quit a job in addictions work. 13%noted that their clinical supervision needed improvement or was not good at all. These numbers are dismal.

At the same time documentation requirements of state and federal government funding, as well as health insurance company funding, have increased dramatically. In my own experience I supervised clinicians working with very difficult addiction clients. Most of them had to spend about 51% of their time documenting the work they did, while only 49% of their time or less was actually working with clients. It was common for people to go back to work on weekends to complete overdue paper/computer documentation. I often joke that to be an addictions counselor you need to fill out more paper and/or computer screens than to transport nuclear waste across state line or to buy a house. I think this may be true! I call this “Organic Bureaucracy,” where record keeping and management functions increase to the detriment of time with clients. Is it not the goal to help client learn skills and stabilize emotions so that they may enter recovery process? This requires TIME!

How about self-care. Surely in such a “strained” field – often called the poor sister or poor brother of health care – where demand for services outpaces staff and funding availability – self-care must be seen as important. Perhaps not! Survey data suggests that only about 1/3 of addictions counselors perceive self-care as a high priority at their place of employment. 25% note that self-care receives little or no attention. 41% note that self-care is an occasional topic in the workplace. I fear that marginal supervisors may be fearful of emphasis on self-care, perhaps suggesting that the job really cannot be done in a healthy way. Lots and lots of “burn-out.”

Let’s HOPE that somewhere up the federal bean stock somebody wakes up. In not, we may see huge shortages of qualified addictions professional. Yes there are other resources, but often far less trained and experienced in helping people work their way out of their addictions and other clinical conditions. Then what?

For more information refer to Addiction Professional (Fall, 2016), pp. 16-18, 20, 40.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha

Author of Mindful Happiness

New Edition of Mindful Happiness in Production…Coming soon!

July 23, 2017 By Admin

Relapse Prevention Plans – Basics (T. T. Gorski) Anthony R. Quintiliani, Ph.D., LADC

Relapse Prevention Plans – The Basics

T. T. Gorski, Anthony R. Quintiliani, Ph.D., LADC

The following information about how to develop effective relapse prevention plans has been paraphrased from the Work of Terrence T. Gorski. It is highly practical and a concrete way to develop your skills in relapse prevention interventions. Intermediate (Marlatt and Gordon) and advanced relapse prevention (MBSR, ACT) strategies will follow in future posts. The core steps are noted below.

Stabilization: After detox and a few days without using substances, the core issue is WHAT do you need to do so you will not use substances today? This is very early abstinence, so best to be highly respectful, gentle, concrete, and proceed slowly with your client.
Assessment of Realities: A primary rationale for assessment is to discover the client’s patterns of problems and related behaviors that most often lead to relapse. Key areas to examine are patterns of use, recovery effort history, sources of emotional dysregulation, and details about repeated self-medication to reduce experienced suffering. You will most likely discover areas involving childhood trauma, various forms of person abuse, unhelpful familial patterns, serious losses, peer group problems, and insults to the integrity of the self.
Education: Key areas of client education include that relapse is a normal part of recovery process; extremes of guilt and shame need to be combatted; identification and counteracting the progressive warning signs; and, instilling a strong sense of hope.
The Warning Signs: It is important to individualize the plan for each client. Although common core categories of unpleasant life experiences leading to self-medication exist, each person’s response to them differs in the details. Your best bet for success is to include both self-help and clinical applications regarding the warning signs of relapse. Help the client take a personal inventory about their known warning signs. Some signs may not be in awareness.
Dealing with Warning Signs: It is important to teach the client skills for managing their warning signs. It is not enough to simply talk about the skills (generic talk therapy); it is important that clients practice the skills – a bit more Behavior Therapy. Behavioral approaches help to concretize ways of being and doing that counteract automatic unhelpful sequences forming from warning signs. Often poor responses come after unhelpful thinking patterns. So it may be helpful to use some Cognitive Therapy to help client understand and counter unhelpful, automatic negative thinking. Rational Emotive Behavior Therapy may be helpful in helping clients modify self-defeating behaviors, and Mindfulness-Based Stress Reduction may be helpful in improving mind-body emotional dysregulation and behavioral urges. If you know how to do Dialectical Behavior Therapy, it can be highly effective here. Last but not least, use whatever might be helpful from AA’s 12 steps. Do not expect that one shoe fits all; do not expect that your favorite approach is the correct approach. A varied and skilled application of various approaches tends to work best.
Recovery Plans: Clients will obtain the best outcomes by participating in both self-help and clinical applications of recovery and relapse planning. A concrete relapse prevention plans, founded on good personal information and scientific interventions, tend to be most successful.
Personal Inventory: It is often helpful for clients to learn how to do morning and evening inventory work. This is similar but not the same as Psychosynthesis, in which people use preview to prepare to deal with expected challenges and joys of the day, and review in the evening to see what worked and what did not. If clients become anxious after evening review, they will be helped by MBSR’s body scanning technique. It may help people enter sleep and remain in sleep.
Family Role: Supportive family involvement is strongly encouraged, but only if it is supportive in nature. Don’t try to force family roles if systemic support is lacking.
Follow-Up: We need to check in with clients to see what is working and what is not working. This should help us to monitor progress and revise relapse prevention plans as needed. A periodic urine screen may be helpful to work with both self-report and evidence of progress.

For more information refer to Gorski, T. T. (2003). How to Develop an RP Plan. At the Addictions Web Site of Terrence T.Gorski. See www.tgorski.com; www.cenaps.com; and, www.relapse.org.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness