Spiritual Awakening; From Pain to Wisdom

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“You embrace the pain that comes from knowledge and laugh at the bliss born out of ignorance. You accept that pain is a side effect of doing what you love, knowing that pain is merely the hard center of love that must be embraced, softened and transformed into wisdom.” ~ G. W. McGee

One of the signs of a spiritual awakening as defined by G. W. McGee, a former Navy Intelligence Specialist turned philosopher, asserts that we find ourselves preferring to ‘be slapped with the truth than kissed with a lie’.  There develops a real appreciation for truth that trumps any amount of pain or suffering that’s necessary to achieve it. People in AA are well aware of this fact. Regardless of consequences, they face the reality that addictions have caused great pain to themselves and others.  They follow the 12 Steps and engage in a new responsibility to truth and begin to practice it in all of their affairs.

As William Goldman tells us through Westley (Dread Pirate Roberts) in The Princess Bride, “Life is pain, Highness. Anybody who tells you otherwise is selling something.

When we accept that there is always pain in life, the wisdom gained through even the most difficult experiences becomes attainable.  Regrets begin to slip away when we awaken to the certainty that God is with us through every suffering and heartache.  We face the truth and embrace the existence of unconditional love.  This is spiritual awakening.

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Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast

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Removing Barriers To Care for Youth

I have been writing about encouraging trends in mental health (and substance abuse) treatment for children and adolescents for the past several weeks.  Most notably, the evolution of Adverse Childhood Experiences (ACEs) screening/assessment information and Trauma Informed Care protocols gives new hope for the most vulnerable among us.

But even as I celebrate these advances in the way we understand and care for kids who suffer and struggle, the systems which would bring them relief continue to slowly (painfully) creep along, stall out, and then start to crawl a little more.

The good news that we have developed incredible tools, scientific breakthroughs and individualized treatment models which offer a brighter life for untold thousands of children is tempered by legislative and societal hesitation to embrace and fund them for delivery.

Slow and Steady May Win the Race…But At the High Cost of Human Suffering

Consider how long it has taken for us to offer mental health and substance abuse treatment services to children and adolescents at a level similar to other illnesses.  In 1996 Congress passed the Wellstone/Domenici Mental Health Parity Act (MHPA) which basically asserts that insurance companies cannot charge more for mental health/substance abuse than medical/surgical coverage when (or if) it is offered in the benefit plan.

It was not until 2008 that The Mental Health and Addiction Parity Rule (MHPAEA) was passed to fill in obvious gaps. MHPAEA requires health insurers and group health plans to provide the same level of benefits for mental/substance use treatment and services that they do for medical/surgical care.

Finally, on March 29, 2016 the Final Parity Rule related to MHPAEA  was passed.  It requires Medicaid and Children’s Health Insurance Program (CHIP) managed-care plans to cover mental health and addiction treatment at the same level as medical and surgical care.  It has taken 22 years to get to this point.  And it’s still far from perfect. States have the authority to limit and restrict benefits.

While states like Texas have stepped forward to fully fund their programs others have not.  Insurance companies continue to deny coverage and to treat substance abuse disorders (SUDS) and mental illness (MI) as if they were non-essential.  Managed care companies fight providers every step of the way as services are attempted to be provided for kids who suffer.  The ideal of the Final Rule was to offer the same quality of comprehensive care to SUDS/MI as is offered to diabetes patients (including home health care benefits).

That just is not happening even though a nearly flawless model is provided by American Society of Addiction Medicine (ASAM) Placement, Continued Stay and Discharge Criteria which individualizes and guides treatment based on the severity of illness.

Charting a Way Forward

In 1989, I was chosen as one of the professionals that would help develop the ASAM guidelines for children and adolescents.  Dozens of us met in Cleveland, Ohio with the National Association of Addiction Treatment Providers core group.  We were challenged with the task of creating a system which would provide individualized treatment protocols for kids who were struggling with SUDS and dual diagnosis MI.

The plan was then coordinated with a similar adult model.  In 1992, ASAM unveiled the final draft to government officials, insurance providers and treatment professionals of every stripe in Atlanta.  We believed that we were ending a one-size-fits-all approach to these illnesses with a comprehensive one which truly addressed the needs of the individual patient/client.  It was an exciting time and universally accepted as the new Best Practice.

Unfortunately, most everyone went back home and continued the same old ways of operating.  A few of us made major programmatic changes and the results were incredible.  But mostly, we had just given insurance companies more efficient ways of denying coverage. Twenty years after the Atlanta unveiling, I ran into Dr. David Mee-Lee, MD who was one of the originators of ASAM at a conference.

We shared some reminiscences and I asked him what he was presenting.  He sighed, telling me he was promoting the use of the ASAM Criteria remarking; “After 20 years they still don’t get it…but they will.” David has the patience of Job.

Many Factors Influence the Underutilization of SUDS/MI Services by Parents and Children.

Despite the Final Rule of The Mental Health and Addiction Parity Act (MHPAEA), Medicaid and Children’s Health Insurance Program (CHIP) making it possible for people from all socio-economic levels to access mental health and substance abuse services for children and adolescents, the American Academy of Child and Adolescent Psychiatry (AACAP) continues to estimate that only 15% to 25% of children with psychiatric disorders receive specialty care.

Furthermore, The Department of Health and Human Services reports that only 6% to 8% of kids who could benefit from alcohol treatment, and 9% to 11% of those who could benefit from drug treatment are able to access treatment. Substance Abuse and Mental Health Services Administration (SAMHSA) informs us that;

  • An estimated 3 million U.S. children ages 12 to 17 had a substance use disorder in 2014.
  • About 1 in 10 kids ages 12 to 17 (11.4%) had a major depressive episode (MDE) in the past year. Among adolescents with MDE, only 41.2% received treatment or counseling for depression in 2014.

Insurance Companies, HMO’s and Managed Care continue to deny coverage based on the same levels provided to medical/surgical benefits. According to a 2017 column in the conservative Chicago Tribune, about 59 percent of providers in Illinois surveyed said Medicaid managed care organizations “always” or “often” denied coverage for inpatient treatment for addiction and mental health issues during the past year.

Gatekeepers to Treatment

Special patient advocate groups have had to be formed to help consumers fight the adversarial benefit gatekeepers. A friend of mine who works in the insurance industry told me that “We still hire people to say “No” when behavioral health claims are first received regardless of circumstances. Usually people won’t appeal and the company is saved millions.”

The vast majority of SUDS/MI treatment providers still offer consumers the same kind of treatment they were offering three decades ago…usually at higher costs than ever to payors.  I recently called a local inpatient treatment facility which only provides care for those who have health insurance or can afford to pay out-of-pocket.

Their program neither offered trauma informed care nor used ACEs assessments.  It was basically a 12 Step Recovery based program with daily group and individual counseling sessions even though it described “every service we provide is designed to produce the most clinically appropriate solutions to the serious problems facing our patients.”

That said, Memphis is a leader in providing care to kids who suffers SUDS/MI at little or no cost to consumers.  There is a long- term inpatient facility and community based outpatient organization which admit and serve children readily.  Treatment protocols could be more current, but they are forging ahead to meet critical needs unlike any others I have known.

Other factors which are affecting the ineffective delivery of services include stigma, cultural barriers, access to region-wide rather than local distribution of providers, and a shortage of child/adolescent psychiatrists.  Sometimes it is difficult to find treatment even though it might be nearby.  Here is a good resource to make the search easier: https://findtreatment.samhsa.gov/

What We Can Do To Help Right Now

SAMHSA released a statement in June 2018 which reports that opioids are responsible for one in five deaths for young adults.  We have to do something.  We are not powerless players in this country and can influence legislation to make things happen quickly.  We can join advocacy groups, volunteer as mentors and help people find treatment options.  Here are some points of action for you to consider:

  • The Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 is in the Senate Finance Committee scheduled for markup on 6/12/2018. It will then (hopefully) move forward.  This Act provides sweeping changes that would alter the way we deal with SUDS/MI. Dr. Nora Volkow, Director of National Institute on Drug Abuse just announced that HEAL is being kicked off at current funding levels of $500 million.  It is a light at the end of the tunnel.  Contact your congressional representatives and Senators.  Encourage them to support HEAL.
  • Talk to pediatricians and other doctors you know. Pediatric primary care providers (PCPs) are in a unique position to take a leading role in this effort because families often turn to them first for help with mental health concerns. Although there are a number of systemic, cultural, and individual barriers to accessing mental health care, promising interventions and integrated behavioral health care models have emerged that can be implemented in the primary care setting to help PCPs close the enormous gap between mental health needs and access for children and families experiencing poverty.
  • Encourage legislators to change Juvenile Justice treatment of Medicaid eligibility requirements. When kids enter jail or prison, many states terminate their Medicaid enrollment, meaning they must reapply once back home or in the community.  This often leads to gaps in coverage and delays in access to treatment.  There is a House bill that would prohibit states from terminating Medicaid enrollment for youth under 21 who are incarcerated.  It would also require states to re-determine their eligibility prior to release so coverage is immediately available when they return to the community.
  • Building Blocks for a Healthy Future is a website where parents, caregivers, and educators can find great tips and tools that help children make healthy decisions as they grow up. Pass this information on to friends, family and associates.
  • National Children’s Mental Health Awareness Day raises awareness about the importance of emphasizing positive mental health as part of a child’s overall development from birth. This year’s national observance focused on the importance of an integrated health approach to supporting children, youth, and young adults with serious emotional disturbance who have experienced trauma. For more information and downloadable graphics, visit the continually updated Awareness Day 2018 page.
  • The Safe Schools/Healthy Students initiative is a program designed to prevent violence and substance abuse among our nation’s youth, schools, and communities. The Safe Schools/Healthy Students Initiative takes a comprehensive approach, drawing on the best practices and the latest thinking in education, justice, social services, and mental health to help communities take action. To date, SS/HS has provided services to over 13 million youth and more than $2 billion in funding and other resources to 386 communities in all 50 states across the Nation. For more details about the SS/HS Framework and how it can be used to assist communities engaged in this work, click here.

So let’s get started.  We still have a long way to go if we are serious about abating this life or death healthcare crisis. You are a critical link in making the changes necessary. Please help save our suffering children.


Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast

The Addiction Epidemic: Re-ordering Strategies for Substance Abuse Disorders from Intervention to Prevention

[et_pb_section fb_built=”1″ _builder_version=”3.0.47″ custom_padding=”23px|0px|54px|0px|false|false”][et_pb_row _builder_version=”3.0.47″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_padding=”9px|0px|40px|0px|false|false”][et_pb_column type=”4_4″ _builder_version=”3.0.47″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.0.101″]More than 64,000 Americans died from drug overdoses in 2016, including illicit drugs and prescription opioids…nearly double in a decade. An estimated 88,000 people (approximately 62,000 men and 26,000 women) died from alcohol abuse in the same year. We lost 152,000 people.  This makes alcohol and drug abuse/addiction the third leading preventable cause of death in the United States. Only heart disease and cancer took more lives.

Congress approved and the President signed a bill funding $7.4 billion for addiction in 2018.  But are we allocating our resources well? Are we addressing this health crisis in new and effective ways? It is a good and meaningful try to be sure.  The problem is that we continue to allocate much more money and effort into putting out fires as opposed to preventing them.

Chattooga River

Chattooga River

Are We Focused on the Real Problem? Insights from the Chattooga River

In my role as an addiction professional, I used to speak before groups of mental health, substance abuse and adolescent treatment providers on a fairly regular basis. One of the stories I liked to tell is that of a hiker in the Blue Ridge Mountains who had wandered onto an active emergency situation at a Class IV rapid on the Chattooga River.

There were ambulances, EMT’s, police officers, a coroner and lots of onlookers trying desperately to pull the dead and dying from still-treacherous waters below the rapids.  The victims were young people who were beaten by rocks, lungs full of river, no longer able to help themselves.  Knowing that he would only get in the way, the hiker hustled upstream.  There he found another frantic situation indeed.

The whitewater of Bull Sluice was enveloping kayaks, canoes and swimmers. Specially trained First Responders and Experienced Whitewater Guides were using all of their skills in efforts to get people out of harm’s way to little avail.  So the hiker went around the bend and up to a point where he heard cries for help and found several river guides and volunteers throwing floating devices on ropes, wading into swift water, hauling kids and boats up to shore from an area just above the Class IV treachery.   Many were being rescued but some were swept away.

There was still little room for him to be of any use, so the hiker ran along the bank to find a group of youngsters swimming in the river.  Some neighbors and volunteers from the down river site were trying to talk them into getting out of the water…warning of the perils downstream.

Several of them paid attention and followed the urgings of their warnings and headed in for dry land.  Finally, a few hundred yards further on, the hiker found a bend in the river where it seemed to be warm and inviting.  A group of kids were changing into swim wear and heading toward the water with rafts and inner tubes.  There were no adults supervising, warning or rescuing.  The situation was so ostensibly innocent.

He approached the young people, told them of all he had witnessed and talked about finding another way to enjoy the afternoon that might not be so life-threatening.  He showed them the way to a little private cove where still water, a diving well and nice beach waited.  Everyone took him up on the offer and enjoyed a safe day of adventure.

From the Intensive Care to Early Screening:

Our Inverted Focus (or Looking for Cures in All the Wrong Places)

I think my subtitle is a little cutesier than it should be. It makes me think of the 1980 Country song “Lookin’ for Love” by Johnny Lee making it hard to resist.  Anyway, my story about the Blue Ridge Hiker is what I believe is an upside-down pyramid of attention, emphasis, funding and research in dealing with the opioid/addiction epidemic.  The following are the categories of treatment intervention as I have experienced them in decades of direct service in the field of Substance Abuse Disorders (SUDs).

Tertiary Intervention: Most of our precious time and resources has been given to what I call tertiary intervention.  Like the hiker approaching the chaotic rescue efforts downriver, we have spent most of our time giving CPR to the dying and burying the others. Tertiary Interventions include;

  • Emergency Response Teams (First Responders, LEO’s, Emergency Rooms, Hospitals, Intensive Care)
  • 24 hour hospital based Short Term Medical Detox Centers
  • Criminal Justice System
  • Universal availability of naloxone

Secondary Intervention: These are Medically Managed Services for adolescents and adults.  In my story, it is the discovery of direct whitewater rescue.  Secondary Interventions include;

  • Hospital based 24-hour nursing care and daily physician care for severe, unstable patients who cannot manage life without these intensive services.
  • 24 hour Intensive Inpatient Services Withdrawal Management centers with counseling, physician, nursing and medication management services.
  • Residential treatment centers with flexible programs to meet individual treatment needs depending on severity of illness.

Primary Intervention: Services at this level help those who do not require round-the-clock care.  The hiker in the little tale finds swimmers and adventurers above the rapids but in some degree of real trouble.  Primary Interventions include;

  • Partial Hospitalization Services for adolescents and adults, this level of care typically provides 20 or more hours of service a week.
  • Intensive Outpatient Services for adolescents and adults, this level of care typically consists of 9 or more hours of service a week.
  • Outpatient Services for adolescents and adults, this level of care typically consists of less than 9 hours of service a week.
  • Opioid Treatment Programs. (OTP) utilizes methadone or buprenorphine formulations in an organized, ambulatory, addiction treatment clinic for clients with severe Opioid-Use Disorders to establish a maintenance state of addiction recovery
  • Drug Courts

Primary Prevention: Early Intervention for Adults and Adolescents, this level of care constitutes a service for individuals who, for a known reason, are at risk of developing substance-related problems, or a service for those for whom there is not yet sufficient information to document a diagnosable substance use disorder. This represents the final stop for our hiker.  Primary Preventions include;

There is practically universal accord that our methods of dealing with drug and alcohol abuse have failed to achieve the desired results.  The efforts to stem the tide of addiction by declaring a war on drugs (which was really a war on people engaged in it) proved almost fruitless.

The problem is that despite good intentions, and an allocation of massive funding, we are continuing to pour resources into the least effective means of turning the tables on our nationwide epidemic. Policy makers and leaders have decided to ignore the facts and double down on a status quo method of dealing with a healthcare crisis which has been raging for almost 20 years. And the status quo has made virtually zero impact (statistically speaking) on outcomes.

The Comprehensive Addiction and Recovery Act (CARA) of 2018 heralds a new era which will “Expand prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations—to prevent the abuse of methamphetamines, opioids and heroin, and to promote treatment and recovery.  However, it authorizes funding at the roughly the following levels nationwide;

  • Inpatient, outpatient and OTP treatment at $4.1 billion
  • Criminal Justice at $1.59 billion
  • Prevention at $221 million (4.4 million per state)
  • Recovery Support Services (FAVOR, recovery high schools, recovery housing) at $7 million or $140 thousand per state (not even enough to fund services in Upstate South Carolina for example)

 
[/et_pb_text][et_pb_tabs active_tab_background_color=”#d29f38″ inactive_tab_background_color=”#d4cfc4″ admin_label=”Approaches” _builder_version=”3.0.101″ saved_tabs=”all”][et_pb_tab title=”The Iceland Approach” _builder_version=”3.0.101″]

Iceland Teens

There is a place on the planet which has used effective local initiatives in the form of policies to discourage drug use while offering solid alternative programs.

Iceland built an anti-drug plan that focuses largely on providing kids with after-school activities, from music and the arts to sports like soccer and indoor skating to many other clubs and activities.

They coupled this approach with banning alcohol and tobacco advertising, enforcing curfews for teenagers, and getting parents more involved in their kids’ schools to further discourage drug use.

Researcher Harvey Milkman says of Iceland’s approach, that it’s “a social movement around natural highs: around people getting high on their own brain chemistry … without the deleterious effects of drugs.”

As a result, Iceland, which had one of the worst drug problems in Europe, has seen adolescent consumption fall. The number of 15 and 16 year-olds who got drunk in the previous month fell from 42 percent in 1998 to just 5 percent in 2016, and the number who ever smoked marijuana dropped from 17 percent to 7 percent in the same time frame. In a similar time period, from 1997 to 2012, the percentage of 15 and 16 year-olds who participated in sports at least four times a week almost doubled — from 24 to 42 percent — and the number of kids who said they often or almost always spent time with their parents on weekdays doubled, from 23 to 46 percent.
[/et_pb_tab][et_pb_tab title=”The Vermont Approach” _builder_version=”3.0.101″]In another approach, the State of Vermont has developed a comprehensive health care policy which has changed the outcomes for opioid disorders dramatically using medication assisted treatment programs.

It is called the “hub and spoke model” which was developed by the American Society of Addiction Medicine. The results have been encouraging. Vermont is doing much better than nearby states.

It was the only state in New England that in 2015 was below the national average (of 16.3 per 100,000 people) for drug overdose deaths.
[/et_pb_tab][et_pb_tab title=”The Los Angeles Approach” _builder_version=”3.0.101″]One of the most dramatic approaches to dealing with the Drug Crisis can be found at Homeboy Industries in Los Angeles. Here, and in a multitude of spin-off organizations, comprehensive employment and life redirection strategies have been used to help gang members, previously incarcerated individuals and families to overcome violence and addiction.

They are unconventional.  Established by Rev. Gregory Boyle, they tell that at Homeboys, hope has an address.  He tells us that, “Homeboy Industries has been the tipping point to change the metaphors around gangs and how we deal with them in Los Angeles County.

This organization has engaged the imagination of 120,000 gang members and helped them to envision an exit ramp off the “freeway” of violence, addiction and incarceration. And the country has taken notice. We have helped more than 40 other organizations replicate elements of our service delivery model, broadening further the understanding that community trumps gang — every time.”

Every member of Homeboys must test clean on drug screens to be a part of the community service.  Their unusual program is based on a spiritual model of unconditional love.

 
[/et_pb_tab][et_pb_tab title=”The Memphis Approach” _builder_version=”3.0.101″]Memphis is using ACE’s.

Infographic created to share information about what adverse childhood experiences are, how prevalent they are and their impact.Web jpg

The Adverse Childhood Experiences (ACE) Awareness Foundation of Memphis “informs the community about the role of emotional trauma in mental, physical, and behavioral health, and implements innovative models that provide preventable and sustainable solutions to reducing toxic stress in family systems.

The Foundation launched and provides strategic oversight to the ACE Task Force of Shelby County, the Universal Parenting Places, and the Parenting Support Warm Line.” Although not an addiction or substance abuse disorder specific program, ACE’s used in the comprehensive way Memphis is developing will stem the tide through screening and direct services.  The fact is that pain drives addiction and SUDS. Drugs and alcohol are abused by people who have childhood experiences and trauma that the rest of us cannot imagine.

They are seeking relief and a hiding place.  When a community like Memphis gathers its schools, juvenile justice system, LEO’s, pediatricians, colleges, churches, other human service providers, parents and families together, you can be sure that something incredible will happen.

There is new research telling us incredible things about the way addicted brains work.  Drugs have been found to hijack dopamine systems making ‘getting high’ an almost unavoidable consequence.  Also, the adolescent brain, when exposed to drug use has little chance to form good cognitive processes. The idea that addiction is a moral failing has been practically eliminated.  With that in mind, it is even more important that we begin thinking outside of the box.
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It’s Up to Us…Here and Now:

Just think…152,000 people lost from this preventable disease or disorder.  People in our lives will die.  We have a lot of work to do.  Funding and programs will only go so far.  Certainly, we have to encourage a change in the way budgets are allocated.

Prevention first…at the very top priority…is the best and most worthwhile model to embrace. We cannot keep repeating mistakes of the past and expect different outcomes.  But there is a spiritual, community reality that we must embrace as a foundation for how we deal with the problem of addiction and substance abuse disorders.

The one who suffers is not someone else but is each and every one of us.  If we are going to get beyond all of this, there is no other way to look at it.  Our wounds are shared.  We are all in this together.  Here and now, and in each and every moment, we should be asking the question ‘What can I do to help’.

Then we will find an answer.

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Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.

In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.

His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.

Contact Bob Jones on Linkedin

Bob Jones’ blog An Elephant for Breakfast

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