ASAM – DSM-4 & 5 – SAMHSA – NIH

DSM – IV, DSM-V, ASAM and Other Concepts

This epistle was provoked by current machinations relating to current ASAM, DSM-V, SAMHSA, NIH and other behavioral health diagnostic concepts.  The collective analysis of these creations has resulted in a personal “Peter Principal”.   I am unable to understand what went through the minds of the people creating these programs.  Their creations are based on 40 years of ineffective substance abuse treatment and results.  The new perspectives seem to suggest that more complex processes will provide better solutions.

One of the first sayings I heard when I started AA/NA meetings was: Use the “KISS” principal.  (Keep it Simple Stupid)

Note: While I’m thinking of AA, the following information might be enlightening. When the two founders of AA started the organization in 1936, they developed certain traditions that are unique to AA.  These traditions prevent any organizational activities that would interfere with the main purpose of AA – which is to assist individuals to improve their behaviors.  There are approximately 2 million participants in AA; but, the organization has no regular employees or officers, owns no property and doesn’t advertise.  Each meeting is self supporting and voluntarily staffed.  These traditions are so KISS oriented they are profound.  No other organization that I know of operates in this fashion.

We human beings find this KISS principal too simplistic.  We need more creative solutions.  We need solutions that require training and education to understand.  We need to feel we provide unique solutions because we are so much brighter than other species.

There are hundreds of diagnostic creations that clinicians have developed to determine how individuals should be managed to provide positive treatment results.  A key question might be: “were these developed because other tools weren’t effective.”  If so, we have quite a collection of ineffective tools.

A key to changing individual behaviors is to convince an individual, or client, that they need to change their behaviors.  Diagnostic results and presentation are key elements, when convincing a person that changes are needed.  They need to be accurate, comprehensive, understandable, objective and self diagnosis.

KISS tools:

AA/NA membership requires that a person just “wants to stop using alcohol/drugs.”  Fortunately, the individual has taken the first step toward behavior improvement.  They are at a meeting of like folks – who support accountability – and get results – comparable to organized treatment.

Although the CAGE questionnaire has been endorsed by some Federal agencies and contains four meaningful questions, the results presentation to the client may not be definitive enough to be consistently accepted by the client.

I believe, the Interview Techniques processes presented by Dr. Jon Weinberg in 1972 is a practical KISS tool.  This tool determines if alcohol/drug use has negatively affected any of the individual’s life areas.  (Occupational, Financial, Health, Social, Legal or Family)  If any of these life areas have been negatively affected, it is clear evidence that client actions have resulted in serious life consequences.

The direct correlations between alcohol/drug use, abuse or addiction and the negative life area consequences are hard to dispute and can be convincing.  TEAM treatment processes can also use “life-area” TEAM members to enhance treatment results.

Below, I have enclosed information about DSM-V, ASAM, SAMHSA, NIH and other diagnostic concepts. This information has been included to provide examples of how our non-KISS tools have become so complex that they are hard to understand and will provide the same statistical results as their predecessors have for the last 40 years.

ASAM States: “Addiction is a primary, chronic disease”.

DSM-V States: Every drug, including alcohol, has a separate “disorder” classification.  Each disorder can be mild, moderate or severe.  There are approximately 100 disorders and treatment categories.  This mental disorder bible also claims that legal issues should no longer be used as diagnosis criteria. (If you have 5 dwi’s, don’t fret.)

ASAM vs DSM-V: If addiction is a disease, it seems implausible that you can be a little bit addicted.  Kind of like being a little bit pregnant.  If addiction is a clinically defined collection of circumstances, how does the patient become convinced they need a variety of treatment modalities?

SAMHSA: This agency has now defined drug addiction as a “Behavioral Health” issue.  In a 262 page document, this agency describes how clinicians can determine which of the 100 DSM-V disorders should be used and how to diagnose mild, moderate or severe abuse and dependence.

It is this addict’s opinion: government and treatment entities have created new imaginative processes that try to justify previous efforts and the trillions of dollars spent with no statistical improvements.  This eliminates the need to be Accountable.  This also supports the need for more funds and creations.  Statistics support my conclusions.

The Illustrations shown below support issues noted above.

Drug Problem when I was a kid

Teen Self Assessment Results

CAGE and Weinberg’s Life Areas

ASAM – DSM-IV – DSM-V

SAMHSA Review of DSM-V Criteria

A Review of the Disorders that need to be considered

The Link below will provide you with a PDF that contains the information included in this post.

 http://www.teamfixes.com/wp-content/uploads/2017/05/Post-DSM-V-ASAM-2017-V1-1.pdf

Student Interventions – IMPACT

Major Idaho Schools have been saving lives and improving student behaviors for the last several decades.  When students’ behaviors change significantly, an Intervention is scheduled with the Student, Parents, a local clinician and the school teacher or counselor.

The link below will lead you to a document that describes these efforts.

http://www.teamfixes.com/wp-content/uploads/2017/05/Student-Interventions-IMPACT.pdf

 

Interventions can change things

 

TEAM Objectives vs Business Needs

A recent experience with a law firm that was attempting to provide reasonable alternatives to incarceration for their clients provided evidence that TEAM treatment support needed some fixes.

In this case, the law firm and the judge were convinced that an intense monitored treatment program would provide a suitable remedy for the client.

The client was living with his brother who was a farmer in a suburban community.  A local outpatient treatment center agreed to support the treatment plan.  Weekly outpatient group meetings were not possible due to the client’s location; but the center agreed to weekly counseling sessions.  Outpatient treatment centers and local counselors were not available to the client where he lived.  The Client was provided with a Treatment Manual that included lesson content normally discussed in group sessions and during 12 Step meetings.  Forms and envelopes were provided and the client was instructed to mail the forms describing the prescribed activity information completed during the week.  Communities near the clients residence had some weekly 12 Step meetings and once a week a phone based counseling session was completed to discuss treatment progress.

In addition, the client’s brother was supporting the client’s efforts and was provided with access to the client’s web based case management site.  The brother was able to enter weekly activity comments.  This activity took little time and access was limited to activity input.

iMResponsible.com processed all weekly information received from the client and his brother into their web based case management software.  The case data was provided to the referral sources in a timely manner and for the first couple months all participants were satisfied.

At this point, clinical case data was not being entered into client’s, web based, case management system.  Electronic transfers of data could not be accomplished as the clinical data was mostly paper.  The software applications of the clinic were principally used to provide state agencies with information needed for billing purposes.  The explanation from the clinic was that there was no revenue stream to cover the costs of the clinical tasks involved.

Without a local clinical partner, it was necessary to discontinue client support and to notify the referral sources that the program was being discontinued.  It is my understanding that the client was later classified as not meeting judicial requirements and was then jailed.

This example is one of several that illustrate similar conditions and results.

Current revenue streams are the catalysts that predicate client treatment conditions.  A supplemental issue affecting treatment results are agency required tasks that are not appropriate or cannot be completed as required.  These circumstances create the basis for violations.  Who, then, is guilty of the violation?

Additional articles will be provided with examples and remedies.

Diagnostic Tools – Assessments and Fun

The PDF Link shown below will provide you with a document that summarizes the design rationale and the basic processes of the Compu-Tools self diagnosis or assessment tools.

http://www.teamfixes.com/wp-content/uploads/2017/04/Compu_Tools-Diagnostic-Tools-2017.pdf

The Image below shows how much fun it is to provide computer support:

 

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