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Recovery Support: Collaboration Coordination and Recovery Management

Keith Humphreys

06 Recovery Support

Ask the Expert:  Keith Humphreys, Ph.D is a Professor (Research) of Psychiatry and Behavioral Sciences, a VA Senior Research Career Scientist and a CHP/PCOR associate.

1) Question: What things can a parent do to help an adult child who is in recovery?

Answer: You can start by telling your child that you are proud of him/her and then asking if there is anything you can do to support him/her.  You can also help by giving feedback on the changes you see, for example “Since you got sober, I see your children smiling at you more and I feel closer to you in a way that makes me happy”.  Finally, if your adult child is involved in a 12-step organization, you can attend some meetings of Al-Anon to get a better understanding both of your child’s recovery and how the addiction may have affected you as well.

2) Question: What are other people doing to take care of their mental illness when services have been discontinued?

Answer: It in a time of many state budget cuts, many people with mental illness will experience even more challenges than normal in accessing care.  One option is such situations is to turn to the many mutual help associations that are available, such as Schizophrenics Anonymous and the Bipolar Disorder Support Association.

3) Question: In your experience, what have you found to be helpful to communities to prevent and treat addiction? More specifically, what are some of the best tools and most effective ways to truly prevent substance abuse and drug addiction? Why do you suppose those are helpful?

Answer: Minimizing access to substances, particularly for young people, is an excellent preventive strategy.  One way to do this to work with, or if necessary put pressure on, local merchants to get them to consistently check IDs for sales of alcohol and tobacco.  Police can also be of significant help by closing open-air drug markets if they are present.

In terms of treatment, the most successful communities have “no wrong door” to ask for help and make care accessible through the health care system, schools, social welfare agencies and the criminal justice system.
4) Question: I am a Public Defender and I represent parents who are involved with the child protective services system.  As you already know, a good number of parents are either living with mental illness or living with substance dependency and mental illness.   My question then, is what are the evidence-based treatments and programs that I should advocate for with such parents.   The typical parent is either not engaging with the local mental health system and not taking medication OR is under-engaging with the mental health system.

Answer: There is no simple, quick way to describe effective treatments for every type of addiction and mental health problem and the range of research that has been done on treatment effectiveness, any more than one could quickly and simply summarize all treatments for cancer or heart disease.   And even if it were possible, the question for any one dedicated advocate such as yourself would not be what is possible in the best of all worlds but what is available in the community in which you live.  What I suspect you need is advice from a locally based expert who can tell you about available treatments and also about the quality of local programs.  One very good place to start is to contact the American Society of Addiction Medicine and ask for the names of local physicians who are ASAM accredited and take one of them out to lunch and pick his/her brain.

5) Question: As addiction is a lifetime disease, can an addict be recovered after treatment?

Answer: Treatment helps many people on the path to recovery, but addiction persists after treatment ends and must still be managed by the individual.  Even people who have abstained from a substance for many years may still experience occasional cravings, for example when they see something that reminds them of their drug use.  The good news is that the longer you abstain, the easier it will get to keep abstaining and continue your recovery.

6) Question: Since the beginning of treating chronic non-cancer pain with chronic opioid therapy, there has been a tragic epidemic of opioid abuse, diversion, intentional and unintentional overdoses and deaths and a dramatic increase in those now on continuous methadone therapy. The average age is people in their twenties. The rationale given for the origins of this change in medical practice was to address the under treatment of pain. I'm suspicious, though, that the genesis of this practice change was partly motivated to increase revenues to clinics, emergency rooms, pharmaceutical companies, and methadone clinics. What are your thoughts on this problem and what do you recommend to reverse this epidemic, beyond the trite response of better education of physicians?

Answer: The primary source of the overdose epidemic in the United States is pain clinics and not methadone maintenance clinics.   Profit is clearly a motivator for some of the people involved in irresponsibly dispensing opiates; in other cases it may be ignorance of the risk of addiction and overdose.  Physician training is a good idea but we also need to be monitoring prescribing more closely through prescription monitoring programs, expanding treatment for opiate addiction, training more people in the use of naloxone (a medication that temporarily reverses the deadly effects of an overdose) and getting into the collective habit of safely disposing of our leftover pain medications.

7) Question: What is the current thinking about Harm Reduction treatment as opposed to 12 step, Rational Recovery or SMART Recovery?

Answer: The current thinking is that there are many pathways to recovery, rather than a single right way.  Just as we are glad when someone recovers from cancer no matter what treatment they received, we should be glad when an addicted person recovers no matter what form of help they received.

8) Question: If an employed and responsible family person, who overcame heroin addiction a number of years ago, seeks ongoing recovery support in living non-sober lifestyle, ie., alcohol on weekends, can a recovery center support him in a recovery of his choice?

Answer: This would come down to the individual treatment center one spoke to and I could not generalize.  A parallel issue is that some people think recovering alcoholics are not fully recovered unless they quit smoking, but other people strongly disagree.  It's an active debate in the field.

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