Tag Archives: recovery

What Does It Mean When We Call Addiction a Brain Disorder?

When the 2016 Florida Legislature allocated funds for the formation of the Palm Beach County Sober Homes Task Force, my first instinct was that the State of Florida was looking at the conundrum we here in South Florida were facing through the wrong shade of glasses. To target “sober homes” was simply feeding into the local movement to eradicate addicts in recovery from living amongst society, a long-standing issue which required the U.S. Department of Justice to intervene nationally under the Fair Housing Act and the Americans with Disabilities Act.

The “problem” that we were all experiencing was not “sober homes” [a term, by the way, which has taken on a pejorative meaning, and therefore now rightfully distinguished as either a “Recovery Residence” or a “flop house”], but rather the economy created within the health care sector for delivery of clinical services; the “churn and burn” of patients’ insurance benefits. Law enforcement and government regulators were unable at the time to grasp the vast underground network that was truly the foundational underpinning of everything that was going wrong. Flop houses were merely the effect; the cause was the demand from “health care entrepreneurs” for bodies to put through the machine to bill insurance and make money and the failure of the entire system to sufficiently develop a standard for treatment and post-treatment recovery that health insurance would be required to pay for as being “medically necessary.” This disconnect was further exacerbated by old school, traditional ways of recovery, such as AA and sober living providers, for whom “treatment” was not available decades ago, and who today understandably question the “medicalization” of addiction treatment and care.

As one of the original appointees to the Task Force, it was a pleasant surprise to find that the Palm Beach State Attorney’s Office inherently understood this as well. Their focus was on the entire health care industry serving those afflicted with Substance Use Disorder, and would NOT allow itself to be used as a puppet to develop more sophisticated exclusionary zoning tactics that for far too long had been used to ostracize addicts from cities and make access to care difficult at best. The empaneling of the Palm Beach Grand Jury to study the entire industry simply underscored and emphasized Dave Aronberg’s commitment to fact-finding.

The “Proviso Committee” of the Task Force were made of up health care practitioners, government officials, and industry representatives, who themselves, as a committee, would examine the modern paradigm of addiction care and associated recovery organizations to make recommendations to the Florida Legislature on how to effectively address where the wheels came off the wagon in Palm Beach County and to prevent similar issues developing statewide. Mr. Aronberg noted early on both that “we can’t arrest our way out of this problem” and that addiction treatment and recovery communities have been a long-standing, respectable, and honorable part of the fabric of Palm Beach County.Early on, the Task Force came to recognize the disparate opinions within the field itself. While some felt strongly the focus should be on recovery support services, others leaned towards a medical model of care (to include MAT). Advocates on both sides seemed (and appear to continue to be) at odds over what is the “right” way to address the current opioid epidemic, and well as how to define “best practices” for our future. Even those on the medical/clinic side seemed to debate whether addiction was rightfully classified as a “disease” or a “brain illness.”

As our science has evolved (rather quickly, it seems of late), Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), which is part of the National Institutes of Health (NIH), attempted to address the medical side of addiction care and the role that recovery support services has, in her article published in Scientific American entitled “What Does It Mean When We Call Addiction a Brain Disorder?” In the article, she writes:

Yet the medical model of addiction as a brain disorder or disease has its vocal critics. Some claim that viewing addiction this way minimizes its important social and environmental causes, as though saying addiction is a disorder of brain circuits means that social stresses like loneliness, poverty, violence, and other psychological and environmental factors do not play an important role. In fact, the dominant theoretical framework in addiction science today is the biopsychosocial framework, which recognizes the complex interactions between biology, behavior, and environment.

Critics of the brain disorder model also sometimes argue that it places too much emphasis on reward and self-control circuits in the brain, overlooking the crucial role played by learning. They suggest that addiction is not fundamentally different from other experiences that redirect our basic motivational systems and consequently “change the brain.”

Some critics also point out, correctly, that a significant percentage of people who do develop addictions eventually recover without medical treatment. It may take years or decades, may arise from simply “aging out” of a disorder that began during youth, or may result from any number of life changes that help a person replace drug use with other priorities. We still do not understand all the factors that make some people better able to recover than others or the neurobiological mechanisms that support recovery—these are important areas for research.

But when people recover from addiction on their own, it is often because effective treatment has not been readily available or affordable, or the individual has not sought it out; and far too many people do not recover without help, or never get the chance to recover. More than 174 people die every day from drug overdoses. To say that because some people recover from addiction unaided we should not think of it as a disease or disorder would be medically irresponsible. Wider access to medical treatment—especially medications for opioid use disorders—as well as encouraging people with substance use disorders to seek treatment are absolutely essential to prevent these still-escalating numbers of deaths, not to mention reduce the larger devastation of lives, careers, and families caused by addiction.

My takeaway from this is article is that my layperson opinion remains unchanged – medical treatment and recovery support services are the “yin” and “yang” of the same medallion. They cannot be separated but rather should be integrated into a continuous model towards sustainable recovery. Each path is different, as each person’s genetics as well as upbringing and life-experiences are unique. We are each a small universe onto ourselves. Therefore, it is my opinion that the billions of dollars being thrown into the “medical” side of the equation but failing entirely to fund the “recovery” side is to simply a band-aid. While I recognize and appreciate American hesitancy to adopt a welfare state for anyone, including the disabled, we must therefore double our efforts to fund and explore brain science so that effective modalities can be implemented which provide people seeking recovery with an accelerated jump start. Medication-Assisted Treatment is but one of those more recent efforts. But we can do more, and as a nation, should spend more, doing so.

Recommitting to the Mission

Dear Friends and Subscribers:

First, Happy Holidays to all. This is my favorite time of year, mostly because this is when the new Star Wars movies come out.

But it is also a time of reflection, appreciation, gratitude, and recommitting ourselves to your own life’s purpose and mission.

As we all move into 2018, while the treatment and recovery residence business communities have taken their unfair share of lumps in the press (since it is widely accepted as fact that far more good comes from the Recovery Business Community, than bad), we must continue to press on to change the narrative that people with Substance Use Disorders are not second-class/disposable human beings; that while “recovery” may begin in treatment, it is only fully realized in a supportive recovery community setting; and that we are all in this together – the afflicted, the first responders, citizens, government officials, parents, normies, lawyers, doctors, legislators, DCF, AHCA, DOH, and on and on.

But to that point of “recommitment of purpose,” I must admit a rather large failing that I have. I tend to want to see only the good in people and therefore tend to trust more than perhaps I should.

I have been deceived, actually lied to, manipulated, and used as a tool by clients who (I came to learn too late), never really wanted to heal our nation, but rather whose sole and exclusive purpose was to make money off of the pain.

That said, if I was ever to get a tattoo, it would say “It’s ok to do ‘well’ by doing ‘good’.”

I am a firm believers that profit motivation drives innovation, creativity, and the new discoveries that have always made our state and nation the greatest place on Earth.

I fully, 100%, support the private sector as the solution to getting our way out of this addiction crisis, which is far beyond a public health emergency. It is a national crisis that simply shows no sign of receding. It may sadly become to new “normal,” much like mass gun shootings in malls, movie theaters, churches, and schools.

However, and lately, I find myself getting worn down from it all. I become, admittedly, cranky. I become cantankerous. I become distrustful. I become jaded. I become angry and mean and resentful.

Then I am reminded of that saying attributed to the Buddhist faith that: “Holding onto anger is like drinking poison and expecting the other person to die.”

Maybe I missed out by not being addicted and going through recovery.

I find that those friends who have had to endure the life crucible of addiction and recovery to be at a different and oftentimes better place that I am. And very likely the reason why the Recovery Community is the best “community” that I have ever encountered in my lifetime as a native third-generation South Floridian.

As the New Year and holidays are upon us, I wish each of you nothing but the best and only ask in return that you, too, recommit yourself to the purpose and mission and privilege of working with and among these most exceptional people.

The Positive Economic Impact of the Treatment Industry and Recovery Community

The health care industry is the job engine of many parts of the U.S., aided by funding as a result of the Affordable Care Act.

Florida, California, Texas, and other states are no different, specifically and including the number of well-paying jobs for professionals and para-professionals in the drug and alcohol treatment industry.

While some cities would prefer not to have treatment providers and recovery residences in their jurisdiction, that really cutting off the proverbial nose to spite one’s face.

We don’t have the numbers (yet) but no one will doubt the major economic driver that the treatment and housing industry is for the South Florida region.

According to a newly-released report by the New York Times in relation to Republican efforts to “repeal and replace” the Affordable Care Act:

“Whatever happens, the economy of every state will be affected. Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs.”.

Similarly, universities such as Florida Atlantic, University of Miami, and Nova Southeastern, that have strong social work and other behavioral clinical programs, rely upon the robust treatment industry and recovery community for employment for their graduating students.

An economic impact review by the American Hospital Association concluded that workers’ earnings combined with their spending on groceries, clothing and the like generate millions of dollars per year in economic activity and helped create thousands of jobs beyond their own. “The goods and services hospitals purchase from other businesses create additional economic value for the community. With these “ripple effects” included, each hospital job supports about two additional jobs, and every dollar spent by a hospital supports roughly $2.30 of additional business activity.”

Similar results apply to the robust treatment and housing industry within Palm Beach County and throughout Florida, as well as the rest of the nation.

In the effort to regulate the treatment and housing industry, we have used chemotherapy to rid the scourge of bad players from the playing field. However, in doing so, we may have found that many good providers have been scared off too, fearful that regulators and law enforcement are using this is a pre-text at the behest of the electorate, where one may be able to “beat the rap” but will be unable to “beat the ride.”

In the meantime, recognition of the positive economic benefit that this industry has on Florida and the entire nation should be further studied, recognized, and supported.

The alternative is to eliminate the entire system, and to leave those suffering with no alternatives whatsoever.

The Wearable Medical Tech Industry Keeps Going

Happy Fall to everyone. With the release of the new iPhone 6 and the new Apple Health App, the “wearable tech” market is really gaining traction. Along with the exercise bracelets which are now ubiquitous, many other tech companies will soon be releasing their own gadgets to compete on what is expected to be the next big thing.

I was reading this morning the following at Politico.com: http://www.politico.com/story/2014/09/health-applications-wearables-congress-111299.html

As the market for the devices grows, however, the companies that make them and collect the data are coming under increasing scrutiny over privacy and security issues, because everything from heartbeats to insulin deficiencies will be stored on the devices and possibly on the cloud. Under the old Health Insurance Portability and Accountability Act (HIPAA), these devices – Fitbits, Jawbones and the like – aren’t covered. But some regulators and lawmakers believe that at least some of them should be regulated like other medical devices.

The tech industry is trying to stay one step ahead of the regulators, and Apple is leading the way.

Again, it is only a matter of time before someone sits down to create the app to monitor sobriety, blood levels, and the like. You could be the one…..

Top 10 Reasons to Register for the FARR Annual Conference

1. If Recovery Residences don’t demonstrate that we have successfully organized under the FARR umbrella, well-funded and highly organized NIMBY forces will kick our butts in the next legislative session.

2. We’re now beginning to set the agenda rather than simply react to those fueled by stigma and ignorance. This requires unity, solidarity and scale. Join us and help make a difference!

3. Responsible and ethical service providers within the recovery residence and IOP sectors must group together now so that all stakeholders can distinguish the “good guys” from the “bad guys”.

4. This is your trade association! Your voice and active participation matters. Sitting idly by, pointing fingers and lamenting the sad state of affairs isn’t going to change much, is it? Let’s get connected!

5. Those of us who are “fighting the good fight” on behalf of this sector need your support. Surely it’s not too much to ask for a one day & $95.00 commitment to support those who volunteer hundreds of their own?

6. Conference content is timely, on task and addresses important issues impacting all sectors along the care continuum. Together we can shape the future of ROSC here in Florida.

7. State legislators and local, municipal leaders are betting on their belief that as a group we’re too self-centered to gain organized momentum. Don’t let them gloat next session with a smug “told you so”.

8. FADAA represents the ‘managed entities” here in Florida. These are potential referral sources for many recovery residences. DAF, CARP, BARC, Henderson, New Horizons, Operation Par, Stewart Marchman to name but a few.

9. Aren’t most of us all about the value of peer-to-peer interactivity? This conference is a very real opportunity to network with your peers and engage in dialog concerning issues that directly impact the entire spectrum.

10. In the substance abuse treatment continuum, it all comes down to “reputation, reputation, reputation”. Florida has developed a national reputation as the Wild, Wild, West. Together, we become a force to restore our good name.

If you are interested in attending, you can register here. Get a conference schedule here and I hope to see you at my townhall discussion about the “Legal Challenges with Rent Assistance.”

How to Reconcile Integration with Anti-Kickback Laws and Market-Based Compensation

“Many hospitals are hiring and contracting with doctors to boost referrals and serve members in their coordinated-care networks. But how to pay those doctors has become a legally perilous area under the federal Stark and anti-kickback laws and the False Claims Act, with whistle-blowers, their attorneys and the Justice Department watching these transactions closely. Halifax and other recent big-dollar whistle-blower cases involving allegations that hospitals violated Stark self-referral rules in paying physicians highlight the huge stakes for hospitals, which are at risk for triple damages under the False Claims Act. Those damages are based on total billings, making the potential damages in these cases enormous.”

“The tough part for hospital leaders is that these legal pressures are at odds with public policy and market forces pushing health systems toward greater integration to improve care coordination and reduce costs. The federal government hasn’t reconciled its goal of encouraging integration with its desire to prove that it’s tough on fraud and abuse. As a result, systems pursuing integration will need to be even more vigilant because they’re stepping closer to the line where traditional Stark law enforcement might come into play.”

Read the full story here:
http://www.modernhealthcare.com/article/20140308/MAGAZINE/303089982/caught-between-competing-pressures?AllowView=VXQ0UnpwZTVDZlNXL1I3TkErT1lBajNja0U4VUNlWlZFQk1JQmc9PQ==&utm_campaign=am

The Future of Substance Abuse Treatment

I just received the attached from Addiction Professional Magazine, which, in my opinion, is a must read about the antiquated system of substance abuse treatment models that are employed and how existing RESEARCH needs to be reviewed and implemented.

Quote: [Integration] is not a gift to the mental health and substance abuse field. We¹re not being given something just because it’s fair, just because it’s our time, or just because there¹s a Democratic administration. You can¹t run the rest of healthcare if you don¹t manage substance use and mental health.

Me: Housing is an integral part of this equation as well. The best treatment outcomes occur when safe and secure housing exists. It’s a human necessity.

This is a great article that discusses Integration:
Integration demands highest standard of care