Rambling through Treatment

Rambling through – Interventions – Treatment – Enabling – Case Management

Don’t expect any profound treatment miracles to expose themselves as I move through this ditty.  I was preparing a 5 Step marketing piece and began to reflect on things that negatively affect behavioral healthcare treatment.  The following things came to mind; but, I was unable to create a smoothly flowing framework.  So bear with me.

In an ideal world, all our treatment chores would be completed in a timely and effortless manner.  Unfortunately, this is a pipe dream or a conclusion that one would reach after using the wrong kind of drugs.  The gist of today’s message is – “we should minimize the obstacles that prevent “ideal” treatment circumstances”.

Communications, administrative stuff, rules and regulations, emergencies, fatigue, eating, sleep and more – all interfere with flawless goings on.  The 5 Step program design is intended to reduce the impact of these nuisances and provide our Team members with some efficient solutions.

This author believes most individuals want to end each day feeling good about what they accomplished.  They do their best in completing tasks that were presented.  The issues addressed in this article are not intended to be criticisms.  The points made, herein, reflect real world happenings that can affect what we are trying to accomplish.

The other issue that came to mind is: administrative tasks can be a pain in the ass.

Don’t Worry!  I got this under Control!!

For example, I have just completed a fruitful session with an individual and it is important that I document the elements of the session so that my other team members know how we are doing.  I judiciously began my administrative task and an emergency pops out of the woodwork.  Then, ongoing daily tasks prevent me from getting back to my unfinished administrative duties.  These are real world issues and result in less than optimum treatment conditions.  Case management data entries are often done – when possible.  If group activities or external partners are included as treatment elements, getting these case entries into the system may also take some time.

Also, when administrative time is available, the first thing that needs to be completed is the paperwork – to get paid.  Government and Organization processes have been most creative.  They have provided thousands of new code options to make our lives easier and more efficient.

As I compare the data entry tasks for behavioral treatment clients, with regular medical care, I find that the behavioral efforts are more complex and time consuming.  My last two visits with my cardiology team have been 5-10 minutes of silent computer review by the professional and then approximately 5 minutes of a one sided discussion and then a closing silent computer spectacle – that results in a visit summary.

Automating verbal and text input data, using efficient forms, shifting priorities to our clients or patients and simplifying electronic data transfer and integration processes is a start.

Experience with Treatment Processes – (Sensitivity – Empathy)     

Our experience with treatment endeavors has lead us to a bias for AA/NA 12 Step programs.  The principal reason for this focus is that these organizations’ team members believe in individual responsibility and accountability.  Enabling continuing destructive behaviors is not part of their program objectives.

Our experience with counselors and other professional clinicians provides a different set of insights.  To continuously work with a client a degree of sensitivity must be established to provide meaningful dialogue.  Based on human nature, degrees of empathy may also occur.  These relationships will, obviously, be different as we move from clinician to clinician and from client to client.  Perspectives and skills are needed to insure that a tough love atmosphere is part of all treatment programs.

Interventions – Treatment – Enabling

 Helping – can be – Hurtful   

38 years of association with treatment efforts that are related to legal/illegal drug use and dependency have resulted in a few conclusions:

  1. Ignoring that drug dependency is a disease and runs in families’ = kills’ people.
  2. Enabling destructive behaviors is common with family members = kills’ people.
  3. The K.I.S.S. principal needs to be adhered to – or – results will deteriorate.
  4. Keeping it simple means – staying unaffected by alcohol and drugs.
Trauma – DSM-5

Treatment for DSM-5 “trauma – disorders” would be classified as a supplement to the iMResponsible.com programs.  A principal focus of our programs is an effort to stay focused on daily behaviors that need to be changed.  Treatment for trauma disorders is important; however, it is our position that “trauma” treatment results are improved when an individual is sober, stable and working a solid program.

The DSM-5 has defines these trauma disorders as Stressor-Related Disorders :  Anxiety Disorder, Trauma- and Stressor-Related Disorders Acute Stress Disorder, Adjustment Disorder, Posttraumatic Stress Disorder, Reactive Attachment Disorder and Dissociative Identity Disorder.  Physical or medical issues – such as brain trauma, etc., must also be considered.

Interventions

TEAM Interventions conducted to develop righteous and doable treatment plans provide the client with a feeling of group support.  The Intervention also provides the TEAM with an indication that definitive objectives have been established.  “Enabling” behaviors by friends and family are minimized as TEAM objectives are definitive and have been agreed to by all participants.

As an aside, all 5 Step clients do not win.  It has been proven, however, that a TEAM Intervention will assist those who fail to meet treatment contract conditions.  This assistance takes place when the next crisis occurs.  Personal denial is reduced or eliminated and the next try at wellness is enhanced.  20 years of Interventions in Idaho schools has statistically proven that the percent of student violations has reduced since these Intervention practices were initiated.

Enabling

Enabling ones’ destructive behaviors to continue from Intervention – through Treatment is normally a family issue.

 John Southworth has been an Interventionist for several decades and was one of the developers of the 5 Step Intense monitoring solutions.  Last week we met, went to an AA meeting and then had lunch.  John showed me a “no name” copy of a letter he had just received – thanking him for his efforts – with the senders – father.  The letter advised John that the father had died and was found by the family as they visited their vacation home.  John explained that the “father” was participating in an intense treatment and monitoring program that John had recommended.  All was going well.  The client and his wife convinced treatment management that all was going well and they could manage their behaviors in a less intense program.  This new program did not work. The patient died.  John indicated that family enabling is the most consistent anti wellness effort he runs into.

During our discussion, John also indicated that finding treatment facilities that had a treatment priority, higher than the bottom line priority, was becoming more difficult. It seems that business tasks, administrative requirements, regulations, HR matters and finances share time and resources with treatment.

www.southworthassociates.net/

Gotcha’s keep coming up – Even in a well designed Program!

Summary:

The combination of administrative, strategic and relationship conditions associated with each client and clinician affect the results of treatment.  Based on the subjective nature of counseling, it is also difficult to determine when clinical actions are resulting in degrees of dependency or independence.

In our view, anything that interferes with the clients’ acceptance of personal responsibility for treatment tasks is suspect.  The 5 Step program has been designed to emphasis “objective” analysis of treatment elements.  Clients’ become more responsible at case communications and data entry.  TEAM members are provided with forms that enable efficient and effective submission of case information.  Communications via mobile devices are automatically entered into iMR case files.

 Monitoring processes provide quantifiable evidence of how an individuals’ program is working.  These processes also provide an accurate treatment effectiveness score.  This beats the heck out of emergency phone calls just before the reports are due.

One Step at a time!  One Day at a time!  One Life at a time!

I am Responsible!

Team Enabling Tough Love

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