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interventions for co-occurring mental health symptoms
wasn’t feeling well today. a day of rest behind me and i don’t feel substantially better. will allow the days events to carry me through. feeling better then the neighbor though i imagine she was just taken away by the police. that is never really a good thing. it was the campus police which always weirds me out because their cop cars say “Mu Police” which always makes me think agents from the lost continent are prowling about.
i am watching the tigers game, up on the whitesox by 2 in the 3rd. planning on doing a little work. I have a training i am doing on wednesday and i swore i would write a handout. as per usual i like to do my creating on my own time in my own forum so that i own the fruits of my labor. plus work is a terrible place to try to create. you need space free of demands to make something new. mostly my work creativity is drug out me responding to situations. allowing solutions to develop.
if your a new reader i am a counselor at a substance abuse treatment agency where i coordinate some of our mental health programming and staff training. i have been trying to increase the counselors comfort in helping individuals with co-occurring mental health disorders because its way to common for me to handle all those folks.
Integrating Co-occurring Disorders Treatment into Substance Abuse Counseling Sessions
Principles:
The client is the biggest expert on their situation. You don’t have to know anything about the disorder to help the client manage it. So tell me about disorder X? What does it mean for you? Is there a time when it has been better then other times? What was that like? What did you do that made it better? Oh, that sounds like a good idea, do you think we could try that again?
There are no magic wands or “experts” who can do substantially more then you can. When I was a young clinician i referred out most tough stuff but when i did follow up contacts i learned that those referrals that were so hard to hustle up rarely yielded results. Appointments don’t get made, eligibility changes, someone doesn’t get engaged, there are endless ways that things go wrong. I began to notice my simple interventions were usually the most helpful thing. If you’ve got them engaged then likely no one can help them more then you can.
Mental illness is a concept with a lot of give and uncertainty. They can be thought of as nothing more then names we give to clusters of symptoms. Breaking down what symptoms are occurring and developing separate management plans for each symptom can be tremendously helpful.
Data is really useful and collecting it is good for you. Documenting negative behaviors decreases their frequency and the data collected can point to management strategies.
Treatments that people believe in are more effective. Treatments that individuals believe will not be effective will not be effective; we call this the Nocebo Effect and it is real and measurable and more powerful then morphine. Present yourself in a hopeful and confident manner, share some brief success stories.
Listening is still the most helpful thing you can do for someone. When someone tells their story to a supportive listener their self efficacy increases. A rising tide lifts all boats. Validate their struggle.
Techniques by Symptom:
Depression: Sunlight and exercise. Reframing. Separating feelings from behaviors. Cognitive approaches.
Mania: Catch it early. Sleep every night. Progressive relaxation.
Impulsivity: Slow things down. Strengthen powers of reflective thought. Keep long term goals in working memory. reward curbing impulses. work on something that happens all the time and then generalize.
Hallucinations/Delusions: Ask if they know if its real or not. If they do tell them don’t attend to them or give them energy. Learn to ignore it. Shift to the concrete. Never feed into it or ask for unneeded details. If they can’t tell its real they have to ask people they trust.
Paranoia: note if they describe it as such, it means they know its not real. If they truly think people are out to get them de-escalate and reassure.
anxiety: cognitive approaches work well as does data collection. scaling and exposure are the classic approaches. de-escalation and teaching self soothing is also key. exercise.
attention deficit: point out there are times they can pay attention. measure them and grow them systematically with rewards.
OCD: cognitive approaches.
suicidal ideation: ask, contract, normalize
SIB: validate as a valid coping mechanism, identify healthier coping mechanisms
Sleep Problems: exercise earlier in the day, cut back on caffeine, routine, progressive relaxation, Trazodone
Nightmares: Propranol,
Finding a doctor: Primary care is not a bad place to start they use less psychiatric medications in lower doses which can be a good thing for patients with addiction. If no insurance contact the Family Health Center (214-2314)and ask for the medical social worker for a referral to Medzou. If you frame it as a psychiatric issue he may not refer.
The Phoenix psychiatrist is reserved for existing patients and MAT evaluations. Good candidates: have no insurance, are alcohol or opiate dependent, have had numerous treatments, are willing to do aftercare with Phoenix for the long haul.
hot & wet
the heat continues here in the show me state. there is a heat advisory until friday at 7:00 pm. we were lucky the last couple of years so i am trying to bear it with good grace. no, that’s not strong enough. i am trying to enjoy it for what it is. been just running the air 24/7. we keep it on 79 here on leslie lane and with lows close to that and humidity there’s no real point. usually i like to let the dogs come and go in the morning at least, but this am i tried it for about 2 minutes and a bitter hot wind was flowing in so i closed her back up.
did spend a little time outside this morning. watered everything in the back. used city water because i didn’t want to fritter away the shade hooking up the hose to the water barrels. i want to do it in the morning because the water can get hot. trevor just got a wooden barrel for his house. i want to upgrade when these go to pot.
friday we went on a bit of a float trip. drove out to overton bottoms with jared and met up with eric and a buddy of his and trevor and a buddy of his although didn’t end up seeing them much. fido came along had a real good time. ended up smelling like a swamp. dove off the canoe twice and did some swimming. we canoed down but couldn’t get through to the river. canoeing through the woods is a rare experience.
yesterday canned pickles with sarah, went to the market and drank coffee with harry. saw the pitiful state of memorial hill and weeded it while the grill got going. roasted a local chicken over a can of ginger ale with some garlic thrown in. smoked it up with apple wood and fresh sage & brined it in balsamic, sugar and salt. roasted some sweet corn & polished off the cabbage/pasta salad.
for our outdoor adventure john and the dogs and i hiked up bear creek. went right the creek bed which gives it more of an outdoor feel dropping out of the sounds of the city and the dogs could be off leash some. fido got confident and started to wander so i leashed him up.
made for a long day so i went to bed early and slept late. had a long involved dream again largely work related. a client from the agency shot me in the shoulder with an electrical gun. hurt like hell but i was stoic about it and told him not to worry about it that i had bated him. i had said “go ahead and shoot me” or something of the sort, new it was the wrong thing to say at the time but dreams. the overall feeling was a stunned bemusement so that appears to be progress. usually my overall feeling is being overwhelmed or annoyed/frustrated. haven’t had a panic work nightmare for many years and several jobs.
this morning made french toast with black bear bakery wheat bread. i had sliced thick as it was crumbly and let air out but the slices were to thick and the batter didn’t seep all the way in so it was a little on the hardy side. french toast is not supposed to taste like its good for you. had a nice flavor though i fresh grated vanilla bean, nutmeg, cinnamon stick & star anise into the batter.
mowed the front lawn before it got unbearably hot. drinking my second round of coffee before gearing up for the next project. i’m going to make some zucchini soup i got out of the tribune. maybe i’ll be early enough on it to serve it with supper. going to do something with the left over chicken probably throw in my annie’s mac & cheese with some grape tomatoes and fried cabbage (if the moths left me any. my cabbage has been almost a total loss. handpicking was inadequate for the task so i am looking for a more aggressive organic solution or i may have to look at poisons or give up on home grown cabbage).
Four “A”s
I am putting together a new group for work and as always I prefer to do my creative efforts at home in my own time. I have always worked that way finding the day to day grind and meeting responsibilities, deadlines and helping people makes work fairly frenetic most of the time and not a great space for thoughtful creative enterprises. I’ve had my best therapeutic insights, come up with a new approach to a stuck problem in just musing on it a bit on my own time. When I was married I would get checked for not leaving work at work but if you enter the helping professions sometimes a little more is asked of you. I don’t fret about work, worry about my clients, or beat myself up over outcomes. I do sometimes brainstorm, ponder, muse, pray for the people who are struggling who cross my paths. Its part of caring about people.
I also like to do my creative thinking at home so that I continue to own my own thoughts. If I were laying this out on my office computer on the clock then there would be every expectation that the fruits of my labor would belong to my employer. Now I am pretty much anti-copyright but I would hate to see a situation where I don’t have access to my own ideas because someone else owns them. So most of my original stuff makes its first appearance here.
The state of Missouri pays substance abuse treatment agencies for two types of groups, education groups and process groups. Education groups you teach something and that is my preferred mode of operation. Education is not a particularly effective intervention for people struggling with drug abuse and addiction. Most of them know drugs and alcohol can be bad and recovery can be a road out when you’ve lost the ability to find your own way. Motivation is actually the name of the game and so education groups have become an opportunity to grow my motivational speaking abilities. Its more akin to preaching then teaching and has been a lot of fun.
Process groups are group therapy. In education groups I make my personality very large and in process I make it very small. I start each group with a check in. Your name and how are you feeling. I point out identifying and resolving feelings is key for recovery. Rather then provide a feelings list (there are many if you google them) I want to stimulate creativity and honest expression I just ban a few meaningless pleasantries: good, fine, OK, & alright. I also ban “tired” as a body feeling and rarely an emotion. Then I define what process means and ask people to do it, sit back and watch. Nod, call on people and ask questions when no one is talking. If everyone didn’t participate I do a check out of what stood out in treatment today?
It works fine, have heard many times, “that was the best process group I’ve been in”. But my new slot is 7:00 pm, much too late for an unstructured member driven process group. So instead I want to do something highly structured that is still a group process activity. I have been kicking around a self help/social change group for many years. This seems an ideal time to kick it off. I am going to call it an Accountability Group and organize it around what I call the 4 “A”s: Awareness, Assessment, Action, and Accountability. I thought about calling it 4 A or AAAA as well. It will be set up on a level system and to go with the 4 “A”s there will be 4 life areas: physical, mental, emotional, and spiritual.
We’ll begin the group with a check in and perhaps expanded introduction. The first week will be all about Awareness which begins the change process. Identification and informal observation.That can last one week to forever. Out of that Awareness we will develop Assessment tools to measure and create a baseline. Usually for two weeks. Out of that data an Action Plan will be developed. Accountability will come from the group as well as mutual support and the sharing of ideas.
I envision a 16 week process and leveling people up as they get things done. Making it easy to start, just be aware but making the next levels having concrete achievements tied into it. After you move through the whole system for all four areas you are ready to start your own 4A group. We’ll develop tools for each level and documentation and accountability systems collaboratively over time.
nuclear power and me (part 1)
The recent events in Japan have had me engaged in thinking about nuclear power in a way that I have not for many years. I have had an intimate connection with nuclear power for pretty much as long as I can remember growing up in fermi country on the eastern shores of lake erie. My earliest memories of nuclear power is the propaganda comics we would get once a year in science class when detroit edison covered the education.
the fermi 2 nuclear power plant went from planning to construction to trying to come online when i was in high school. having had it be a presence for as long as i could remember i never thought to ask why it was called fermi 2. i mostly remember the coloring book with mickey mouse riding in goofy’s jalopy and telling him to air up his tires to save energy. goofy preferred the smooth ride of under inflation. i also learned about background radiation and the unreasonable fear ignorant country people have of things that are new. nuclear power was the promise of the future. even my hot wheels went nuclear. tired of having to go to the imaginary gas station every so often the cars switched to nuclear fuel. a handful of powder and they’d run for life. aircraft carriers ran on it. silly scared people who don’t know nothing.
In 7th grade science class Mr Lowney organic asparagus farmer did his own bit on nuclear. He presented its dangers and promises (fermi 2 was running into billions over budget and years behind schedule at this point) and told us about fermi 1, the day we almost lost detroit. when we moved to debate i was the only proponent. fermi 1 was an experimental fast breeder reactor not the really cool GE Mark 2 reactor we were gonna get. sure there is risk from radioactivity but there is risks in not having electricity too. try running your hospital without it and see who loses more lives. sure waste is a problem but gosh darn it we’re just getting smarter every day. I already knew you couldn’t win debates with teachers but i felt i held my own. the voice of reason.
In 11th grade i had technical writing and we did a speech to persuade. I was eager to do nuclear power because i already knew the material and had already waded through a lot of science for an english class. the pro nuclear position was already taken so i was forced into taking anti-nuke or having to learn something. I prided myself for the easy way out and the little as possible model of formal education. I was crushing a novel a day in that era so i can see how school work was an obstruction. I was also hanging out with scott woodward at the macomb branch library and decided to do some research, bone up on what’s happening since 7th grade (fermi 2 is still over budget and still under construction).
I am horrified by the facts because i had not yet come to understand the sublime in the face of nuclear horror. I read the Monroe Evening News article from the day after the near meltdown of fermi 1 after perusing the day we almost lost detroit and learned about the china syndrome. It was one paragraph long from the second page and said plant operators handled an incident in an admirable fashion according to training. Kudos to them.
Mostly though it was the waste. I learned that spent fuel means that it has become so highly radiated that it can no longer be used. That with its half life it would be two hundred thousand years until it was safe and we have no idea how to safely store this shit for any where of even a fraction of that. I learned there was enough low level radiation waste to pave a coast to coast highway and that every nuclear waste storage facility radiation had migrated into the ground water. I was horrified and convinced. I was anti-nuclear. the first brick had popped out of the right wing wall i had built my political ideals.
Ultimately I would question a system that would devise such a monstrously fiendish boondoggle on us country folk with a taste for walleye. Why did we need a nuclear power plant when we already had the third biggest coal fired plant in the world? How were we selected to be the environmental sacrifice zone? jesus pushed me over the edge with his words “love your enemies and pray for those who persecute you”. bam, like a stroke of lightning i knew war was wrong and i was off to the races. from right wing republican to anarchist within days as i followed the obvious implications of being anti-war. I rejected anarchy as naive and ultimately evolved into a democratic socialist type until my ultimate embrace of decentralization and participatory democracy and that i was really back to being an anarchist. having been everything now i don’t see it changing.
Fermi 2 ultimately got close to opening. in my research i found out about nuclear protesters as not just historical relic but as happening now. Well sort of. I went to some 1o people protests mostly old nuns. I bought some buttons and told them i wanted to help. I waved a sign or two. Wow 12 people with signs or the finishing touches on your 6 billion dollar investment. the plant opened with fits and starts and the 10 people went away. I went to college.
The first gulf war changed my brother john and me. John wanted to hang a banner when i got home from the psych unit afternoon shift he had painted “wage peace” on a sheet and wanted to climb a power tower and hang it the night the bombing started. “high voltage message” and peace was on the front page along with the war. never doubt a small group of dedicated people could change the media message in a small town paper. we went to protests and were part of a million people saying no to war. it was life changing.
After the war we drove down to east liver pool ohio and protested a toxic waste incinerator coming on line with martin sheen and all. Discovered SEAC, the student environmental action coalition and started organizing anti-statist pro-planet radical environmental events. it was great. changed my life. we were all in.At Frankies, this club in east toledo a door man said he was gonna jump off the martin luther king bridge for the anniversary of steven biko’s death. He said he jumped all the time and just swam to the docks, once he did it 7 times in a row. I remembered i’d seen one of his early ones in the paper. We jumped that night and it was cool. my brother was there and thought since it hadn’t been in the paper for awhile we could probably put anything we wanted in the paper with a little planning.
We looked in the calendar and the anniversary of fermi 1 was coming up. we sent press releases and organized a march from international park to the center of the bridge. Joe Mold and I got up and held a banner gave a short speech and took off our shirts and jumped in. no tv, the trucks were late and we felt we risked arrest if we waited. We swam to a sail boat to avoid the cops and sailed away drinking grog and glad we didn’t die in the cold maumee in october.
After I got my masters i was aimless and ended up being a full time field organizer for SEAC, hitching around Iowa, Kansas, Nebraska, and Missouri teaching kids how to cause trouble for a good cause. Jousted with NAFTA, the wise use movement, made a lot of connections, and got my first death threats. the woods is a dangerous place to be antilogging and lead country does not want anti-lead activists cleaning up flood damage. they’ll shoot you for wanting to pick up garbage if you don’t agree with him.
Fermi 2 ran on until christmas day 1993 the turbine threw a blade (a big un) and it ripped around the containment building. shut it down and some water got contaminated. i was home for christmas and john was still in town. better coverage then fermi 1. we both thought they would dilute it and dump it in the lake. really, what else are you gonna do with that stuff??? John was on it. organized some protests and a public hearing and 700 people turned out. started blockading the plant with bodies, people getting arrested.
I was field organizing in the ozarks as things heated up that summer when they wanted to dump the water in the lake. I came home early and called in debts from all the kids whose backyards I had been busting my hump to save and finagled SEAC to sponsor an event The Grassroots National Action Festival, we got the local coalition (CRAFT -Citizens Resistance At Fermi Two, great acronymn), the radical version we had spun off when CRAFT wanted to say no to stupid stuff we wanted to do (Zebra Mussel Alliance), and Green Peace and Earthfirst! who never worked together. we had a lot of energy and we had ruled the local media for months. My mom never really respected our choice to be radical activists until people she watched on tv started to call the house to find out what’s going on. it was beautiful.
I had gotten arrested in a blockade get dragged off scenario. There were two gates and we could only force arrests by blocking both. It got routine. Fermi was getting ready to come back on line so we decided to throw everything we had at it. In the woods we cut down 6 30′ trees and made tripods. We made three barrels filled with cement with pipe through the center big enough for an arm intersecting a piece of rebar. We bought handcuffs, steve merrix got an employee discount at the adult bookstore. we used the tools we had, could borrow, or steal.
The event came. three big protests in three days. we hit detroit edison headquarters with a handful of high profile arrests. We covered the statue of general custer (unfortunate favorite son of monroe michigan) with yarn weaving a web of peace over the nuclear war machine. (fermi 1 was a fast breeder to make bomb stuff and was defended by the Nike nuclear missile base which became a park which we reserved to camp our protesters [it really is all connected]. We brought up as guest speaker a native activist who was opposing a consortium of power companies trying to site a dump on her land. (detroit edison dropped out shortly later). On day 3 we borrowed Mark and Mike’s anti-nuke bus (no we won’t use it for anything illegal, its cool). we loaded up our team, the tripods and the barrels. We had announced we would blockade the plant at 2:00 pm on a sunday afternoon. the police were out in force and lined up by the gates with the media ready for a nice but big typical thing like we’d been doing.
We stopped in the road leading up to the plant and threw up three tripods with activists chained to the top within two minutes while the police looked on in disbelief. We drove the bus up the road pulled on to the main one dixie highway and pulled the bus across both lanes and stopped traffic. We pulled out our barrels and started to block the road, “roads closed folks”. One lady said her son had a little league game so we waved her through. a dude in a truck said he was going to work. “sorry the roads closed”. “I’ve got a tire iron that says its open”. “Hey get a camera on that guy he says he’s gonna hit me” as i handcuffed up to the barrels. The road was closed, the plant was blockaded as promised over a month ago at 2:00 on a sunday afternoon.
to be continued….
medication assisted treatment for addiction
There is a big move in addictions treatment to utilize medications in an attempt to improve success rates in keeping people sober. The following are selections pulled from wikipedia on the most common medications for MAT (medication assisted treatment). Clinical literature and my own experience show that MATs can be a nice adjunct to counseling and social and spiritual supports but are not a replacement for a genuine recovery experience. There are approved MATs for alcohol and opiates with both agonists (activate receptor sites in a similar but safer way then the drug) and antagonists (block receptor sites). For alcohol there is also antabuse which prevents the usual breakdown of alcohol and massively increases the chemicals related to hangover resulting in an immediate negative experience upon consumption. There are significant side effects and contraindications with all of these approaches and everyone in the treatment field or who struggles with addiction would be well advised to do some homework on possible medication options.
Medication Assisted Treatment Medicines (from Wikipedia)
Acamprosate (brand name: Campral):Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic N-methyl-D-aspartate receptors, while gamma-aminobutyric acid (GABA) type A receptors are activated. Alcohol inhibits activity of biochemical receptors called N-methyl-D-aspartate receptors, or NMDARs, so that chronic alcohol consumption leads to the overproduction (upregulation) of these receptors . Thus, sudden alcohol abstinence causes these excessive numbers of NMDARs to be more active than normal and to produce the symptoms of delirium tremens and excitotoxic neuronal death.[9] Withdrawal from alcohol induces a surge in release of excitatory neurotransmitters like glutamate, which activates NMDARs.[10] Acamprosate reduces this glutamate surge.[11] The drug also protects cultured cells in excitotoxicity induced by ethanol withdrawal.[12] and by glutamate exposure combined with ethanol withdrawal.[13]In addition to its apparent ability to help patients refrain from drinking, some evidence suggests that acamprosate is neuroprotective (that is, it protects neurons from damage and death caused by effects of alcohol withdrawal and possibly other insults). Reports indicate that acamprosate only works with a combination of attending support groups and abstinence from alcohol.[3] Certain serious side effects include allergic reactions, irregular heartbeats, and low or high blood pressure, while less serious side effects include headaches, insomnia, and impotence.[4] Acamprosate should not be taken by people with kidney problems or allergies to the drug. FDA concluded: “Campral proved superior to placebo in maintaining abstinence (keeping patients off alcohol consumption), as indicated by a greater percentage of acamprosate-treated subjects being assessed as continuously abstinent throughout treatment. Campral is not addicting and was generally well-tolerated in clinical trials. The most common adverse events reported for patients taking Campral included headache, diarrhea, flatulence, and nausea.”
Buprenorphine (Subutex, Temgesic, or Suboxone [buprenorphine:naloxone 4:1 preparation] – sublingual tablets – Buprenex – for injection – and Norspan – transdermal patch) is a semi-synthetic opioid that is used to treat opioid addiction in higher dosages (>2 mg) and to control moderate pain in non-opioid tolerant individuals in lower dosages (~200 µg).
Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. Trade names for disulfiram in different countries are Antabuse and Antabus manufactured by Odyssey Pharmaceuticals. Disulfiram is also being studied as a treatment for cocaine dependence, as it prevents the breakdown of dopamine (a neurotransmitter whose release is stimulated by cocaine); the excess dopamine results in increased anxiety, higher blood pressure, restlessness and other unpleasant symptoms. Under normal metabolism, alcohol is broken down in the liver by the enzyme alcohol dehydrogenase to acetaldehyde, which is then converted by the enzyme acetaldehyde dehydrogenase to the harmless acetic acid. Disulfiram blocks this reaction at the intermediate stage by blocking the enzyme acetaldehyde dehydrogenase. After alcohol intake under the influence of disulfiram, the concentration of acetaldehyde in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. As acetaldehyde is one of the major causes of the symptoms of a “hangover” this produces immediate and severe negative reaction to alcohol intake. Some 5–10 minutes after alcohol intake, the patient may experience the effects of a severe hangover for a period of 30 minutes up to several hours. Symptoms include flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, postural fainting, and circulatory collapse. Disulfiram should not be taken if alcohol has been consumed in the last 12 hours. There is no tolerance to disulfiram: the longer it is taken, the stronger its effects. As disulfiram is absorbed slowly through the digestive tract and eliminated slowly by the body the effects may last for up to two weeks after the initial intake; consequently, medical ethics dictate that patients must be fully informed about the disulfiram-alcohol reaction.[4] A recent nine-year study found that incorporation of supervised disulfiram and a related compound calcium carbimide into a comprehensive treatment program resulted in an abstinence rate of over 50%.
Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade. In some countries including the United States, an extended-release formulation is marketed under the trade name Vivitrol. Also in the US, Methylnaltrexone Bromide, a closely related drug, is marketed as Relistor, for the treatment of opioid induced constipation. Naltrxone should not be confused with naloxone (which is used in emergency cases of overdose rather than for longer-term dependence control) nor nalorphine. Both nalorphine and naloxone are full antagonists and will treat an opioid overdose, but naltrexone is longer-acting than naloxone (although neither is an irreversible antagonist like naloxazone), making naloxone a better emergency antidote. Its use in alcohol (ethanol) dependence has been studied and has been shown to be effective [1]. Its mechanism of action in this indication is not fully understood, but as an opioid-receptor antagonist it’s likely to be due[citation needed] to the modulation of the dopaminergic mesolimbic pathway which is hypothesised to be a major center of the reward associated with addiction (being one of the primary centers for risk-reward analysis in the brain, and a tertiary “pleasure center”) that all major drugs of abuse are believed to activate. The standard regimen is one 50 mg tablet per day. Initial problems of nausea usually disappear after a few days, and other side effects (e.g., heightened liver enzymes) are rare. Drug interactions are not significant, besides the obvious antagonism of opioid analgesics. Naltrexone has two effects on alcohol consumption.[8] The first is to reduce craving while naltrexone is being taken. The second, referred to as the Sinclair Method, occurs when naltrexone is taken in conjunction with normal drinking, and this reduces craving over time. The first effect persists only while the naltrexone is being taken, but the second persists as long as the alcoholic does not drink without first taking naltrexone. In alcohol dependence, naltrexone is considered a safe medication. Control of liver values prior to initiation of treatment is recommended. There has been some controversy regarding the use of opioid-receptor antagonists, such as naltrexone, in the long-term management of opioid dependence due to the effect of these agents in sensitising the opioid receptors. That is, after therapy, the opioid receptors continue to have increased sensitivity for a period during which the patient is at increased risk of opioid overdose. This effect reinforces the necessity of monitoring of therapy and provision of patient support measures by medical practitioners. Naltrexone can induce early morning erections in patients who suffer from psychogenic erectile dysfunction. The exact pathway of this effect is unknown. Priapism has been reported in two individuals receiving Vivitrol. Naltrexone has been shown to be effective in the reversal of sexual satiety and exhaustion in male rats.[22]The Chicago Stop Smoking Research Project at the University of Chicago studied whether naltrexone could be used as an aid to quit smoking. The researchers discovered that Naltrexone improved smoking cessation rates in women by fifty percent, but showed no improvement for men.[23] Some studies suggest that self-injurious behaviors present in developmentally disabled and autistic people can sometimes be remedied with naltrexone.[25] In these cases, it is believed that the self-injury is being done to release beta-endorphin, which binds to the same receptors as heroin and morphine.[26] By removing the “rush” generated by self-injury, the behavior may stop. Naltrexone helps patients overcome urges to abuse opiates by blocking the drugs’ euphoric effects. While some patients do well with the oral formulation, there is a drawback in that it must be taken daily, and a patient whose craving becomes overwhelming can obtain opiate euphoria simply by skipping a dose before resuming abuse. There are indications that naltrexone might be beneficial in the treatment of impulse control disorders such as kleptomania (compulsive stealing), trichotillomania, or pathological gambling.[28] Clinical trials are ongoing regarding the use of naltrexone in combination with another drug, bupropion, as a weight loss therapy.[29]
Alcohol Dependence and Anti-Depressants
In 2002, Dr. Fulton T. Crews, Bowles Center director, and Bowles Center research associate Dr. Kim Nixon were the first to report that alcohol, during intoxication, has a detrimental effect on the formation of new neurons in the adult rat hippocampus. This brain region is important for learning and memory – in animals and humans – and is linked to psychiatric disorders, particularly depression.
“When used in excess, alcohol damages brain structure and function. Alcoholics have impairments in the ability to reason, plan or remember,” said Crews, also professor of pharmacology and psychiatry in UNC’s School of Medicine. “A variety of psychological tests show alcoholics have a difficulty in ability to understand negative consequences.”
In the new study, senior co-author Crews and co-author Nixon found inhibition of neurogenesis, or brain cell development, during alcohol dependency, followed by a pronounced increase in new neuron formation in the hippocampus within four-to-five weeks of abstinence. This included a twofold burst in brain cell proliferation at day seven of abstinence.
“And when they stop drinking, you can show in a period of weeks, months, years, the brain grows back, there’s a return of metabolic activity, and cognitive tests show a return of function,” Crews said.
“Pharmacological agents such as antidepressants and behaviors such as running, increased physical activity and learning experiences apparently help regulate the process of neurogenesis,” he added. “Our research suggests they could be considered in the treatment of chronic alcohol dependency.”
Holiday Letter 2010
Its been another event filled year here on Leslie Lane. Not all pleasant or easy but each day an opportunity to grow, learn, and be more engaged in the world around us.
We rung in the new year quietly at home. Began the trend of 2010 of not going to social events even if I had said I was going. Even planning in advance couldn’t get me out of the house to socialize this year. But when I got out of the house I got out of the house. In March John, Shadow & Smokey came through picked me up and we drove on down to FLA. We went all the way to the bottom camping at Big Cypress National Wildlife Refuge, moving on to the Everglades, and day tripping down into the Florida Keys. We hit some national forest in the north and some beach on the Florida Pan Handle. It was a great trip and made the oil spill more poignant having just seen the area. Again my biggest impression was the incredibly rich biodiverse Everglades with the near desert like monoculture of our present day agriculture. Night and day the incredible shrinking of life. We are all criminals and murderers. I still bought oranges.
I got home from vaca with a bit of a stiff neck which evolved into intense back and neck pain which was ultimately diagnosed as a pinched nerve from some bulging discs (C-4 & C-5 i think). Physical therapy adjustments seemed to do the trick and haven’t had too much problems with it. It was scary at the time, made me thankful to have two arms that work.
Work-wise the beginning of the year was fruitful. I enjoyed my role of trying to foster a Dual Recovery Anonymous meeting. I also continued working with the Missouri Cadre for Co-Occurring Excellence and enjoyed a strategic planning retreat at a really cool resort. Saw a bluebird thanks to the new license plates (they’re our state bird). Ultimately resigned my leadership position with the Cadre, too much happening at the agency.
In May we celebrated the end of Lost. Until then we had a house full every Tuesday to watch, same as last year. We didn’t do costumes, theme food, or Dharma stuff because we did all that for the season premiere party. We just watched TV together. In retrospect I thought Lost ended pretty good, not perfect but good enough.
Myrtle died this year. That was sad as hell. We dug her a deep hole and planted some Greek Myrtle. She was a beautiful dog, quite a character for her only three years. Dad took some solace in Oni, but to be frank she was a piss poor primary dog. slept all day, pissed on the furniture. mostly my bed and the couch. one night she pissed my bed pretty good and i was headed to bed late and suddenly had to go sleep on the futon in the living room where dad was trying to watch a movie. i grumped some and he took her to the humane society. We followed her on the internet she was in foster care with second chance. Just looked for her and couldn’t find her picture, hope she got adopted.
June was interesting because I seized an opportunity when the agency burned through its contract prior to the end of the fiscal year (huge huge budget cuts once the federal support to state stimulus was used up) and i was granted a few weeks off without pay at my request. gardened up a storm and did some ozark adventure. went to johnson’s shut ins, elephant rocks, all that stuff. had some nice camping with Oni.
2010 was also a year for making new friends in far off places. We had some exchange students from Taiwan who were observing the batterer intervention program i worked at my part time job over for a couple of barbecues. Took them to the Devil’s Ice Box (a local cave) and down to the Lake of the Ozarks for outlet mall shopping with John when he was visiting (saw a lot of John in 2010). They’re enthusiasm was infectious. Also spent a lot of time with Amy’s friend Belen who visited for the summer from Spain. Took her to Jefferson City to see the monuments and we broke into a Catholic Church. Very cool seeing the familiar from fresh perspectives and breaking things down to communicate with very smart women but whom English is a second language. Learned a lot about myself and my world.
Speaking of Amy, I was flattered to be asked to officiate she and Michael’s wedding. It went very well and was a charming affair. The only down side was the AC was on the fritz and I sweated like a pig. Drenched my shirt clean through.
Dad had some health issues early in the year. A lot of unexplained weight loss. Turned out to be celiac disease forcing us to go gluten free. We’ve made a lot of adjustment. Bread is probably the thing Dad misses the most. There’s just no adequate substitute. Corn tortillas come the closest. For me its been good. We eat a lot less processed food. Buy stuff a lot more in its natural condition. No more hamburger helper.
In July work picked up when I switched from doing the co-occurring stuff to being the senior counselor. With state cut backs its been a bit of a mad scramble. We’re trying to make some changes and it seems to be getting doable. Very engaging overall, love my education groups, love being a part of people making good changes in their lives. Not a hint of boredom yet.
Myrtle’s death and Oni’s eviction left a dog shaped hole but only for a couple few weeks. Dad saw an add in the free classifieds and picked Fido up at 4 months. He’s half Bichon Frise (the little teddy bear looking poodle dogs) and half Cocker Spaniel or Cockechon, although he was advertised in the paper as a Cockapoo and that is what Dad will tell you the dog is.
Fido’s first road trip was back to the homeland to meet everyone at the family reunion. He got a little car sick but enjoyed meeting all the people and dogs. He’s continued to liven up the house and we like to walk the piece of the Bear Creek Trail by us.
The Big Muddy was high most of the summer so didn’t float a lot. Did float at the flooded out Overton Bottoms and enjoyed the heck out of canoeing through the woods. Whoop, the brownies need checking…… Not too bad for gluten free.
The Fall was pretty uneventful. Brought a bigger and homemade compost bin on line, thanks Dad and ended up with a pretty decent garden harvest. Brenda, Heather, and John made it out for Thanksgiving which we did up right with all local made from scratch dishes including our pasture raised bird. Ended up using a lot of my holiday energy to pull that off so we are taking a minimalist approach to Christmas. It will be our first Christmas at Leslie Lane breaking the last five or six years of spending the holiday camping or in a hotel.
On Christmas Eve we are going to Outback and perhaps go see True Grit. Christmas morning I’m working. I got permission to show A Charlie Brown Christmas for my ed group and I plan talking about cultivating our inner Linus. Dad is making a ham for the big day and I’m having a former homeless guy over for dinner. Its his birthday and he doesn’t have anyone and a guest will make it all the more festive. Boxing Day we plan on spending with Amy and Michael for more ham and such. Bought a Norfolk Pine and decked it out as the holiday tree as part of my adding more houseplants to the mix. Also picked up a nice Christmas cactus.
The new years is then upon us and i am gearing up for a major new resolution. Details TBA. Hope your holidays are filled with peace and joy light and love.
complaint free me
Last week was long and challenging. I’m working around a couple people’s work schedule and just working more in general. I went in last weekend and got caught up a bit which felt good the first part of the week when i could knock out some little things because i didn’t have the constantly existing backlog. Last session Wednesday I fell behind and then never got a chance to get caught back up. Jamming all day every day and falling a bit more behind. I’m not complaining just painting a context for where i was at friday afternoon when a co-worker asked if she could incorporate acomplaintfreeworld.org bracelets in her group. How it works is you where a bracelet and every time you complain you move it to the other arm. You do that until it stays on one wrist for 21 days. She said its 21 days because scientists say that’s how long it takes to form a habit. I questioned that. Sounds more like folk wisdom. She likes the gratitude angle and I do too. I asked her if gratitude has a downside. If it does we didn’t know it. I discussed venting, and she offered a venting exception, which I pooh poohed. Venting has a dark side, the rehearsal for a blow out. It keeps negative emotions alive when sometimes they just need to pass I told her. I said there has to be a way of letting off steam without complaining and I put it on. I said I would probably have to wear it for years. She said she ordered a 100 for when it wears out. It was late in the day and served as a nice reminder. I would’ve complained twice before leaving work if I hadn’t been wearing it. The bracelet was working. After work started to putter around the yard, beautiful day and a lot of projects to do. learned dad hadn’t eaten yet except for some candy. so i didn’t garden but got right on supper. i was already complaining and switching the bracelet. Dad had talked about cooking together because he had gotten all the stuff for walnut crusted chicken breast and a broccoli side dish out of Wednesdays Columbia Tribune. I washed the dishes and Dad talked about his day. Amy had come over with Olive Oil to play with Fido and Dad told me the blow by blow. Olive stayed over while Amy went to the dentist. she brought a box of tea and a bag of starbucks house blend. I’m pretty thankful for Amy. Comes over twice a week and hangs out with the popster for puppy play dates. I read through the recipes and decided to chop up everything then start the water for the pasta. i was chopping the walnuts when dad came to cook to. said i should crush the walnuts with a pop bottle. I told him advice wasn’t help and swapped the bracelet. i said i would just cook. the chicken called for chicken breasts pounded down to 1/2 ” thick. salt and fresh ground pepper on them. then you dip them in egg white and roll them in corn meal with cayenne. back in the egg white and then roll them in chopped walnuts. fry in olive oil until done. the broccoli dish called for boiling some pasta for 5 minutes, add broccoli, finish boiling pour off all but 1/4 cup add 2 tbsp olive oil and a clove diced garlic. the chicken took a lot longer than i anticipated and my rice pasta fell apart. sliced some maters, a black plum, yellow teardrop, what was supposed to be a green zebra but they keep turning orange (orange zebra?), and a store bought with some cottage cheese. Dad was trying to tell me about amy and michael’s date night, i told him i was busy, he said what, i yelled i was busy, 2 complicated dishes after a long complicated day i could not listen too. i couldn’t move the bracelet my hands were gooked up with chicken gook i totally lost my composure. i took a breath decided to complain again so it was on the right wrist and just get ‘er done. supper was excellent, the chicken really out of this world. the broccoli was tasty as well even dripping in gloppy rice scum. dad was complimentary. said he could see where i was coming from. it was really sweet. saturday though i got going rehashing friday night to sarah and harry. made my point about venting. there wasn’t anything unresolved, we talked about it fine, i was heard, it was acknowledged. the next day gripe was resentment pure and simple, with no need. a few more incidental complaints then i hit a stride. today complaint free, even though dad told me “quit complaining” when i was telling him he shouldn’t be buying the dog junk food treats. that was just telling him my view on our shared beast even if he knew and even if i’d said it before. mostly though i’ve just been a bit more positive. It’d be easy to take out my frustrations on dad, he’s around, it can be frustrating as i start to pick up even more of the upkeep of the house. but it wouldn’t be right. it wouldn’t be what i am about. i am looking forward to hitting day 3 tomorrow and being more grateful and less resentful.
OCD – notes
http://www.medscape.com/viewarticle/447413_6
Spitznagel compared orbitofrontal and dorsolateral patterns of frontal lobe dysfunction implicated in subjects with OCD and schizotypy respectively, in subjects with either condition and in a mixed group with OCD and schizotypy. Results confirmed orbitofrontal type problems, such as difficulty changing cognitive set, in the OCD group only.
Cavedini[48*] on the other hand reported decision-making impaired in OCD compared to controls and panic subjects, with impairment predictive of a poorer pharmacological response for OCD. Jurado[49*] assessed memory for temporal order as well as a ‘feeling-of-doing’ judgement, finding these impaired in OCD; in a second study incidental memory for frequency was impaired in OCD.[50*]
Another interesting aspect of memory is negative priming, whereby ignoring a particular stimulus can hamper subsequent attended processing of the same stimulus. Negative priming is reduced in OCD, consistent with reduced inhibitory function. This is further explored in a study comparing schizophrenia, OCD and controls, which demonstrated differences in negative priming in OCD subtypes of checkers versus non-checkers, with differences varying with response-stimulus interval. A related tack is that of directed forgetting, based on evidence that OCD patients show impaired ability to forget negative material, with limited further support from a study comparing OCD and anxious controls.
hus Pelissier[58*] examined inductive and deductive reasoning in a small comparison of OCD, generalized anxiety disorder and non-anxious controls. OCD subjects showed differences on some tasks in probabilistic reasoning and greater conviction, echoing some of the cognitive distortions found in OCD.
http://www.brainphysics.com/refractory.php
Very few patients with obsessive-compulsive disorder (OCD) ever experience a complete remission of symptoms. Often a clinician stops working with the patient, or the patient stops working with the clinician, once symptoms have been reduced to tolerable levels. Although symptoms may have only reduced by a third, if the person is able to function, this may be considered “good enough.”
Treatment resistant OCD is generally defined by two adequate attempts with SRIs. SRIs stand for a class of medication called antidepressants. They include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). True treatment-refractory OCD can only be determined if a person has tried, at a minimum, three different SSRIs at a maximum dosage for at least 3 to 6 months each (with the TCA clomipramine being one of them). They must have also undergone behavioral therapy while on a therapeutic dose of an SSRI, and lastly, have received at least two atypical anti-psychotics as augmenters while receiving behavioral therapy and taking the SSRIs.The researchers found that the factors associated with refractoriness of OCD were more severe of symptoms, chronic course of illness, lack of a partner, being unemployed, low economic status, presence of obsessive-compulsive symptoms of sexual or religious content, and greater family accommodation of the OC symptoms. However, this was but one small study, and future studies are warranted to verify these findings.
Opiates: Researchers have postulated that the opiod system in the brain plays some role in the OCD circuitry. Several research studies indicate that opiates (like morphine) may be promising treatment for OCD alone or combined with SSRIs.
Cognitive-behavioral therapy: It is imperative that proper behavior therapy is attempted before being labeled treatment refractory. As stated, most OCD sufferers have not received an adequate trial of behavioral therapy, which is ultimately the most effective way to beat OCD long-term. While behavioral therapy and medication both have very similar results, up to 80 percent of OCD sufferers relapse when off medication.
http://www.brainphysics.com/therapy.php
At one time, obsessive-compulsive disorder (OCD) was thought of as a “neurotic” disorder. Sigmund Freud, the father of psychotherapy, devoted considerable attention to OCD, and believed that OCD existed on a spectrum ranging from obsessive-compulsive personality to psychosis.
His treatment of choice was psychoanalytic therapy for OCD, and this was the accepted treatment of the disorder for many decades. Because this approach was met with no success, OCD was considered a rare and intractable disorder.
People who suffer from OCD usually have at least some insight into their behaviors, making the ultimate goal of insight less useful; insight alone is not enough to “cure” OCD.
We now understand that OCD has, in large part, a biological causation (meaning, for example, that OCD behavior is not simply caused by a bad relationship with your mother), and it tends to run in families. Because of the failure of traditional psychological treatments for OCD, cognitive-behavioral treatments are now used in the treatment of the disorder, with very high rates of success.
Mild cases of OCD can be treated with self-help techniques. The book Brain Lock: Free Yourself from Obsessive Compulsive Behavior
The goal of CBT is two-fold: to change thoughts and behaviors. Changes in thoughts and behaviors then lead to changes in feelings. The cognitive portion involves the identification and analysis of irrational thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Ritual Prevention, also called Exposure and Response Prevention (ERP or EXRP), psychoeducation (learning about OCD and how symptoms are maintained), relaxation techniques, and many others.
Exposure and Ritual Prevention is successful 80 percent of the time in significantly reducing obsessions and compulsion, making it the most effective and well-researched treatment for OCD. A person suffering from OCD feels obsessions, which cause extreme anxiety, and is then driven to perform compulsions, which momentarily relieve the anxiety. The goal of EXRP is to expose the OCD sufferer directly to their anxiety-causing obsessions, and then prevent them from performing a ritualistic compulsion to relieve the anxiety. EXRP is a hierarchical process. The therapist has the patient rank their fears from most distressing to least distressing. After the fears are ranked, the patient will then be exposed to each fear as they are ready, starting with the easiest item. The therapist does not force the client do anything the client does not want to do, so great care is taken to be sure the client is ready for the next step. The OCD patient eventually learns that the obsessions are not harmful and the anxiety diminishes on its own over time.
Because even the thought of confronting ones fears can prevent many patients from seeking CBT for OCD, many wonder if it is possible to bypass the behavioral portion of the therapy. Cognitive therapy alone can be helpful if a patient is unable to participate in the behavioral exercises, but the behavioral part of the treatment is the real key to success. Research seems to indicate that cognitive-behavioral therapy for OCD is better than cognitive therapy alone.
The therapist will typically assign daily homework and take periodic ratings of symptoms to be sure the patient is improving. The therapist will push the patient somewhat, because ultimately most people need someone to drive them at least a little for effective treatment, but not more than they can handle. It is a difficult process, but very effective and rewarding. EXRP treatment can be accomplished in seventeen 90-minutes sessions, twice per week.
CBT is also effective for most anxiety disorders and many OC spectrum disorders. Learn more about CBT for OCD…
An interview for a human services class
Looking back over my posts I have really only posted about work. I use my blog not just for public education and edification but for my own researches to be able to put stuff together at home and access it at work. Some of it is pretty popular as well. I hope to put something together this weekend about my experiences with the low car challenge and just talk about something else besides work. My big take home is that I have been working too much and its starving the rest of my life of space. Eventually I will have to deal with that. With that being said a co-worker recently interviewed me for her class on Human Services and I decided to re-post it here. I considered putting in a little edit here and there and then decided to just let it be. Every summation of anything has some possible inaccuracies and I like the thing as a whole. My story is so long and complicated I was most interested in how someone else would wrap it up. Here it is:
For this assignment, I interviewed Michael Trapp, Senior Counselor for Phoenix Programs, Inc., in Columbia, Missouri. Mike has a masters degree in Sociology and holds a RASAC II certificate (Registered Associate Substance Abuse Counselor II.)
Mike has been in the human services field for approximately 20 years. He has worked in a variety of places including: domestic violence shelter, group homes for mental, physical, and/or developmentally disabled persons, activist for environmental issues, and was also a case worker for the project the began studies to legalize medicinal marijuana in California. Mike has worked with a variety of different people and problems during his career and wears quite a different hats within his personal and professional life. He was diagnosed with bipolar disorder after working in human services for 7 years and has also become an ordained minister.
Mike currently provides individual counseling, group education/counseling services, supervises clinical staff, provides mental health specialty services to a special needs population with issues of complexity. Mike says “we try to address all issues as primary because they are interconnected” As far as dealing with people with disabilities, “you don’t have to be an expert on that person’s disability, you just have to be willing to learn. They are experts on their situation, let them teach you.” Mike went on to say that it it good for human services workers to have some basic understanding of persons with disabilities because they will always be there, in every avenue that you could ever work in, they will be there and they will need help. “People feel validated if you know something about their disability, but being willing to learn is the next best thing, I always try to do a bit of homework prior to a session with someone with a disability so I have a basic understanding and it enables me to get a better understanding of where they are.”
One of the biggest challenges and needs is case management because they have specialized needs and services that are required to help them maintain their independence and it takes more effort and time to provide those services, but it’s very rewarding when you are able to help someone. Another challenge is being able to effectively communicate with those who are deaf. Deaf clients are more concrete and do not thing in the abstract, they are used to nodding and indicating that they understand as it is what we expect, however they generally don’t understand everything. In sessions, with interpreter present a deaf client will only pick up about 50% of the information. It isn’t the interpreters job to make sure the client understands, they are there to interpret. It is our job as human service providers to help them understand and to check in with them during the session or conversation to ensure that they understand what is going on. Deaf clients, and autistic clients as well, do not think in words, they think in pictures. So, when explaining something, it is better to paint a picture of what you are describing rather than try to explain that same thing with generalized words. Additionally, it is important to explain words and teach vocabulary when possible. You have to talk on the level of the client, without talking to them. Don’t talk above their head, as they won’t understand and you won’t be effective.
I asked Mike about his own dealing with being diagnosed with Bipolar disorder and how it has affected his career. He said that he felt he was a really good counselor prior to “going insane” although, after he was able to come to terms and handle his disorder (and has since been able to self monitor and cope without the use of medications through different coping techniques and self realization techniques) that he became a better counselor! He admits that he did not freely disclose to his employers of his diagnosis as he didn’t want to be labeled or feared being written off if he became too emotional. However, he did reveal his diagnosis to clients as it helped validate him. He could honestly say that he understood the disorder and what a person was dealing with. He says that he is an expert on his own diagnosis and that even his doctors will admit that they don’t know as much as he does about the disorder. He lives it and feels it everyday, they only know what they have been taught. So, it is easier for clients to relate to him when they find out that he is dealing with a mental disorder as well.
I have known Mike for over 3 years and was shocked when he revealed his disorder to me over 2 years ago. My prior experiences with persons with bipolar disorder had tainted my view of the disorder and honestly scared me a bit. I have to say that I would have never known that Mike had bipolar disorder had he not told me. He has led quite an interesting life, is highly intelligent, a great role model, advocate, and a great friend. He treats clients with respect and dignity and goes the extra mile to help everyone he possibly can. He has changed my views of the bipolar disorder and continues to amaze and surprise me with his efforts and creativity. As I stated before, Mike wears many hats both personally and professionally, and I would have to say that he falls into all 4 categories of functions of human service providers; teacher/consultant, broker, activist, and counselor. I have personally witnessed him taking active rolls in all 4 categories, however if I had to pick the strongest, I would have to probably pick counselor, although it is a hard call with the way he encompasses all aspects of a clients needs by providing advocacy, support, resources, general assistance, counseling, teaching, etc. I feel I am really lucky to work with such a person!
Student 2: I am so glad that your opinion of him did not change when you found out that he had a disability. Many people would have begun to view him differently. (My response to student 2) My opinion of him did not change – although my opinion of what bipolar was all about did!
Student 3: Laura, your interview was inspiring and from what you have written , Micheal sounds very comfortable in his own skin in the profession.
Instructor: I love his advice for working with Deaf consumers! (My response to instructor) Thanks! I thought this was really important to share! He referred to it as if one were translating a foreign language and how so much gets lost in the translations as our words are not the same. I thought that was a great analogy!
Instructor: Yes, And I think it’s helpful to know that even with the use of a qualified interpreter, there still may be issues lost in translation. There are very real and significant communication barriers between the Deaf and hearing individuals. And, because of the historical discrimination and mistreatment, many Deaf people are very suspicious and distrusting of hearing people. They may feel that they are ‘missing’ something or being scammed/taken advantage of.
Student 4: He made some important statements about being in contact with pwd in almost all areas of life. Its good to have some idea of the different disabilities, but also be able to have an open mind about learning and listening to get an idea of the best help that can be given.
Student 5: Laura. It sounds as though mr. Trapp has his plate full, I have a lot of respect for any one who works with drug or alcohol rehab programs, addiction is a hard thing to quit.
Laura Cameron
ethics of family work in a world with domestic violence
Domestic Violence is a common enough occurrence it should be planned for in all family sessions. To not is a serious ethical lapse on the part of the practitioner.
A routine inquiry about domestic violence should be done with everyone who has ever been in a relationship with a man. Routine inquiries can be done with potential perpetrators or survivors but the results of inquiries with perpetrators are suspect. Approaching it obliquely can often yield a more accurate response. “Do you two ever fight?” “What does that look like?” “Does it ever get violent?” Questions should be made without judgment in a matter of fact manner. We also go over arrest information and assault charges can be a good lead in.
Domestic violence is rooted in power and control and there is a strong correlation with traditional gender roles. Men and women believe these myths.
Two Fundamental Principles
- Victim Safety
- Personal Accountability
DV perpetrators do not engage in domestic violence at any higher rates then men who don’t abuse drugs and alcohol. Acts of abuse while intoxicated can be more severe but our actions are governed by our attitudes and beliefs whether we are intoxicated or not. Sobering up in and of itself will not correct issues of domestic violence though the level of violence may decrease power and control will still hold sway until it is conscientiously dealt with over time.
Domestic Violence is Purposeful and Instrumental, meaning its done on purpose and its done for a reason. Those reasons are rooted in male privilege, are often invisible to those who receive them and are difficult to eradicate.
Counselors must help client perpetrators take responsibility for their actions. Facilitate pledges to stay nonviolent. Safety plan trigger situations. Learn basic skills like time outs/cool downs. Be able to be honest about what is occurring.
Domestic Violence is difficult to address in individual sessions and best practice is to refer to a batterer intervention program of at least 6 months. Less intensive interventions should only be instigated when that is not possible.
A nice basic primer is “Why Does He Do That: A Guide to Angry and Controlling Men”
Higher rates of substance abuse are found in domestic violence survivors. The rights of survivors to make choices about continuing or not continuing cannot be abrogated without the clinician putting themselves in the place of the abuser. Survivors know best on how to continue to survive and leaving can precipitate an act of violence. No one wants to be abused that is a myth. Efforts are best focused on validating the survivors feelings, normalizing their experience, safety planning, and referral to specialized services. Co-dependency can be victim blaming and is never appropriate in issues surrounding domestic violence.
The batterer is solely responsible for the violence and for ending the violence. Domestic violence should never be broached by the counselor in a couples session. Couples counseling is not appropriate and potentially dangerous and should be studiously avoided in cases of domestic violence and this includes family conferences.
Multiconstruct 
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