A Spoonful of Wisdom Helps the Medicine Go Down

Community alert: Where is Mary Poppins when we need her? Mary, grab your umbrella, duty calls. Our children are in danger of impaired mental and physical development from improper and inappropriate use of drugs by themselves and their parents. The reported number of babies being born addicted is growing. The unreported number of opiate-addicted babies may be partly due to the fear that women who give birth to them are in danger of having their children seized by child protection agencies. I hear that ”vaping”—a new delivery system for flavored nicotine—is invading (invaping?) our youth culture. The first line of defense is prevention. There needs to be a massive educational effort dealing with the dangers in using many deadly drugs—beginning in middle school and including whole families. This is a multi-generational and multi-cultural threat to be ignored at our peril. Another community alert: Funds are becoming available for this important effort from the federal government though state and local agencies and entities. Don’t miss opportunities to use financial and social resources to maximize efforts in community communications.

As a nation, we are involved in an opiate epidemic. Fortunately, we have a new depth of focus on the science of addiction. From this has come medication-assisted recovery. These medications are primarily directed at reducing constant craving and the pain of withdrawal. There is now a medication that prevents death from overdose, but we need to get ahead of that ultimate intervention. The first medically-assisted response came from facing the heroin menace many years ago. Methadone was introduced as a treatment for heroin addiction. The Substance Use and Mental Health Services Administration (SAMSHA) provides the following: Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. Controversy over methadone maintenance has plagued the progress in providing service to recovering heroin addicts. The patients are best served by accessible and convenient clinics to obtain their daily dose. The process of obtaining permits is stalled or stopped because of unfounded fears so NIMBY (not in my backyard) prevails. In today’s environment, it is important to have recovery-ready communities with attitudes and actions to benefit the health and well being of all of its residents. Live informed instead of in fear.

Dip your spoon in the alphabet soup of knowledge about medication-assisted recovery.  In a previous blog I wrote: There are professionals with knowledge of the science of addiction who can prescribe appropriate drugs. Methadone, buprenorphine, naloxone, and naltrexone can all be effective in treating opioid addiction. Nalaxone HCI (NARCAN) can prevent overdose deaths. Medications are often an important part of treatment, more so when combined with behavioral therapies. All lead to the essential ability to think clearly and responsibly. Recovery from addiction leads to physical and mental well-being and alternatives to prolonged medicinal drug use.

Bill White, author and provider of education and motivation to those seeking recovery from addiction writes in a blog titled: The Role of Medicine in Addiction Treatment, “Imagine that the vast majority of organizations specializing in treatment of your condition have no affiliation with a hospital or other primary healthcare facility. Imagine the existence of FDA-approved medications specifically for treatment of your condition, but that you will not be informed about nor have access to these medications as part of your prescribed treatment. These are precisely the circumstances encountered today by the majority of people entering addiction treatment in the U.S.”

The opiate epidemic presents opportunity to educate about prevention, treatment, and recovery. Publications and dialogue must continue to inform and encourage understanding of the science of addiction and that a substance use disorder (SUD) is a treatable mental health issue with recovery possible.  The brain says we are doing fine on drugs—until the body betrays us. Our recovery-ready communities have an important role to play in providing reason and resources to support hope, health and healing. All are within our grasp—if we extend our reach.     Merlyn Karst

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House-Help-Home

hope

Driven by the opiate crisis, there has been a lot of talk and some beginning action on funding and outlining needs to help communities to become Recovery Ready. This includes housing and alternatives to incarceration. Overcoming stigma and the overreaching attitudes related to NIMBY are constant barriers to sensible, social, and economical, solutions. I offer several examples beginning with a recognized example of successful sober/recovery living program Oxford House™ was born in 1975 when thirteen men living in a county-run halfway house that was closing needed a safe living place to continue their recovery. It has continually focused on providing opportunity for long-term recovery. From it’s beginning, Oxford House™ has drawn on three legacies inherent in American history: individual liberty, participatory democracy, and entrepreneurial freedom. This focus has paid off. Today, there is a national network of 2,200 Oxford Houses (17,490 beds) with continued expansion and recovery outcomes second to none.  Sober living is essential but recovery living for the long term is the goal. We are pleased to have several Oxford Houses on the front range of the Rockies.  Available are housing, help, hope—and healing.

I discovered an article in the Washington Post Magazine, dated November 1989. It was titled: The Oxford House Experience and the opening paragraph reads: Roommates Wanted: To live in a group house in a good neighborhood. Must be recovering addicts or alcoholics wiling to work hard, pay their own way—and help each other stay clean. It tells the story of the beginning of Oxford House and the struggle to establish group homes in “good” neighborhoods—or any neighborhoods for that matter. The attitude about NIMBY (not in my backyard) was dramatically apparent.  Even Mr Rogers may have hesitated. Finally, help was on the way. The 1995 Supreme Court case, City of Edmonds, WA v. Oxford House, Inc. established that Oxford House residents are a protected class under the Federal Fair Housing Act and entitled to accommodation with respect to locating Oxford Houses in areas zoned for single families. This Act has and can have broad implications in dealing with NIMBY activity.

In the early 90’s, after retiring from corporate life, I became acquainted with Nancy Clark’s Alternative Sentencing Program (ASP) in Orange County, California. I bought into the program and the promise of wellbeing for others and myself, and became administrator for a number of years. Our Recovery Centers housed dozens of residents in shared apartments with limited freedom. They could to work, go to school or enjoy fun, fellowship, wit, and wisdom in mandatory meetings. Subject to testing, no alcohol or other drug use was permitted.  Outside smoking was allowed. Docile about no drinking, they would commit mayhem for a cigarette. Residents paid fees, learned responsibility, accountability, and the worth of freedom.  Though NIMBY attitudes existed, these residents were part of a quiet, civil, community. Many were involved in community service. Our role in the justice system was to provide a safe environment, education, supervision, and reporting. The social and economic value to the County was significant in face of the costs of incarceration.  We provided reason and resource to reduce recidivism.  Counties and communities along the front range are providing alternative sentencing programs. It allows work and pursuit of education and skills training. Programs may involve house arrest, electronic or GPS monitoring, and court supervision.  Drug offenses may require recovery support services.
Fee Schedules and information about application and access to alternative sentencing programs are available on the internet.

During this time, drug courts were beginning to be established. Our drug court was a mutual resource and benefit to our program and several of our residents. I appreciated drug court graduations. There were no caps and gowns just claps and grins. Today drug courts are made up of judges, prosecutors, defense attorneys, community corrections, social workers, and treatment service professionals. There is focus on the family and their health and welfare.  As of June 2015, the estimated number of drug courts operating in the U.S. was over 3,000. That number is substantially larger today. Many counties in Colorado are being well served by our drug courts .

The history I have related is relevant today as we build recovery ready communities. As we work to provide housing and recovery support services for recovering persons, we need to change language and attitudes. A section of the Comprehensive Addiction and Recovery Act, (CARA2.0) indicates funds may be used on to conduct public education and outreach on issues related to substance use disorders (SUD) and recovery and reduce the stigma associated with SUD. Funds may be used to build connections between recovery support services and networks, including treatment programs, mental health providers, treatment systems, and other recovery supports. Grants to recovery community organizations to enable such organizations to develop, expand, and enhance recovery services are available.  Recovery community organizations can mobilize resources within and outside the recovery community to increase long-term recovery. They should be wholly or principally governed by people in recovery who reflect the community served.” Under the Act there is a National Youth Recovery Initiative: Funds may be used to develop, support, and maintain youth recovery support services, including maintaining a physical space for activities, staff, social activities—and to establish recovery high schools. Initiatives should be coordinated with other social service providers (mental health, primary care, criminal justice, substance use disorder treatment programs, housing, child welfare, and more. It will support development of peer support programs, and other activities that help youth and young adults achieve recovery from substance use disorders.

The recognition of the need for funding is evident but the stated recognition of the comprehensive needs out lined in CARA 2.0 is also very important. Recovery community organizations have opportunities along with the need to be aware, wary, and wise in determining means and motivation of those who will serve. Politics and recovery are local.

Merlyn Karst

 

Infrastructure

Infrastructure –Building Recovery after Addiction….. Merlyn Karstimg_0572

An article written by John F. Kelley, Ph.D in Psychology Today prompted this blog.  His article is titled: Let’s Build Roads to Recovery and asks about what kind of roads we must build. Kelley points out that while our nation’s transportation infrastructure is in need of repair, upgrade, and expansion, deaths from transportation-related accidents continue to be dwarfed by addiction and drug overdose. Sound roads and bridges are one key facet of American safety and well being.  Just as roads and bridges transport us from one location to another, a strong public health infrastructure serves as the framework to transport those suffering from active addiction to a place of safety and recovery. Congressional forums indicate that our leaders are paying attention. Infrastructure must include effective recovery support programs.

The President’s opioid task force has recommended expanding the use of recovery coaches and reinforcing the value of services like peer-to-peer programs, skills training, and supportive housing.
The Comprehensive Addiction and Recovery Act 2018 CARA 2.0 Act will Grants to recovery community organizations to enable such organizations to, expand, and enhance recovery services. “Recovery community organizations” are nonprofits that mobilize resources within and outside the recovery community to increase long-term recovery and that are wholly or principally governed by people in recovery who reflect the community served.

A founding group met in St Paul in 2001, and during the construction and building of our campaign to show the faces and give voice to the millions in the recovery community. We determined that our primary messages would be delivered though the power of our stories. We were committed to examine many roads to recovery. I am of an age to remember dual-lane highways and not much infrastructure. Highways often sported a series of Burma Shave signs that carried rhyming messages encouraging road safety. A series of signs on the road to recovery might say:  Sick and Tired?  Using dope? Recovery Works.  Health and Hope.  Addiction Kills.  Causes Strife.  Recovery Provides. Better Life. You’re invited to think of others.

Now there are multi-lane highways, with lots of choices for the journey of recovery.  One choice may be roads less traveled. Peer coaches can guide those looking for more access to on-ramps that lead to more roads to recovery—and once on, not taking off-ramps to relapse.  Traveling the recovery road requires stops for fellowship fill-ups and spiritual refreshment. It’s a good idea to pull into an overlook for a new vista.  How about bridges?  How do we learn which bridges to cross and which ones to burn? Is the next bridge a bridge too far?  Could it be a bridge to nowhere?  There could be a navigator in the passenger seat to help answer those questions. It can be a form of personal G.P.S.—Guided by Peer Support.

It is said that recovery is a process not an event.  It is about the journey, not the destination. We may ask the question many times—are we there yet? These are thoughts to consider; however, there is a need for stops and stay-overs to contemplate where we were, enjoy where we are, and determine where we are going.  When my words fail me or the words of others would serve better, I share them.  Bill White is a mentor and is an educator with words worthy to share. He has helped me think about the language we use. Talk about digging our own potholes!  In a recent blog, Bill wrote about addiction, recovery, and personal character.  I found his views about remission and recovery to be very important. Bill’s blogs can be found on the Faces and Voices of Recovery blog site.

On the recovery journey, we arrive at a state one might call “remission.” Many may settle for that and be comfortable. With infrastructure support, there is more to be gained by continuing the journey and not settling for remission but pursuing recovery. It is a term appreciated and well used by those with the lived experience of having survived addiction. As author Bill White says, “Recovery depicts the process of moving through and beyond remission to refill oneself, develop depth of character, and propel one towards relationships and contributions that reach beyond the self.” And further  “recovery in this view requires replacing the ‘I’ language of alienation with the ‘we’ language of human connection—shedding the ‘selfie culture’ and embracing a culture of humility, tolerance, interdependence, and community.” This most assuredly recognizes the value of evolving and improving the content of our character.  We can go from the past caricatures by others to the proud character developed during the recovery journey.

To all who begin the journey to recovery —have a safe and enjoyable trip and remember: There is comfort in ritual and fellowship and sharing the jumbled joys of the journey with others.  —— Merlyn Karst

Training Scholarships Available

PCA_PracticeLogo_Final

The Office of Behavioral Health has dedicated some funds specifically to increase the peer support workforce in Colorado. There is a stipend available for a short time to individuals that intend on taking Peer Coach trainings and provide support to others in their communities. This is a statewide opportunity and will be available only as long as funds last.

Attached please find a copy of the Stipend Request. PCA has filled in a form to include our Core Recovery Coach Training as well as the Credential Part 2 (consisting of 3 shorter trainings) which will provide the required amount of trainings to qualify for the State Peer and Family Support Credential.

In case you were curious what all the hoopla about recovery coaching lately is about, I thought I’d share a vid from one of our community partners – Springs Recovery Connection. They have compiled a pinpoint perfect explanation of the challenges and the benefits of recovery coaching.  Take a moment and check it out. Share it if you agree it’s a gem.

 

Peer Stipend - PCA courses

You can  download the actual form or find out what trainings PCA has scheduled at www.pcacolorado.com

You can find out more about the State Credential at www.copeercert.com

 

 

Infrastructure –Building Recovery after Addiction

infrastructure

An article written by John F. Kelley, Ph.D in Psychology Today prompted this blog.  His article is titled: Let’s Build Roads to Recovery and asks about what kind of roads we must build. Kelley points out that while our nation’s transportation infrastructure is in need of repair, upgrade, and expansion, deaths from transportation-related accidents continue to be dwarfed by addiction and drug overdose. Sound roads and bridges are one key facet of American safety and wellbeing.  Just as roads and bridges transport us from one location to another, a strong public health infrastructure serves as the framework to transport those suffering from active addiction to a place of safety and recovery. Congressional forums indicate that our leaders are paying attention. Infrastructure must include effective recovery support programs.

The President’s opioid task force has recommended expanding the use of recovery coaches and reinforcing the value of services like peer-to-peer programs, skills training, and supportive housing.
The Comprehensive Addiction and Recovery Act 2018 CARA 2.0 Act will Grants to recovery community organizations to enable such organizations to, expand, and enhance recovery services. “Recovery community organizations” are nonprofits that mobilize resources within and outside the recovery community to increase long-term recovery and that are wholly or principally governed by people in recovery who reflect the community served.

A founding group met in St Paul in 2001, and during the construction and building of our campaign to show the faces and give voice to the millions in the recovery community. We determined that our primary messages would be delivered though the power of our stories. We were committed to examine many roads to recovery. I am of an age to remember dual-lane highways and not much infrastructure. Highways often sported a series of Burma Shave signs that carried rhyming messages encouraging road safety. A series of signs on the road to recovery might say:  Sick and Tired?  Using dope? Recovery Works.  Health and Hope.  Addiction Kills.  Causes Strife.  Recovery Provides. Better Life. You’re invited to think of others.

Now there are multi-lane highways, with lots of choices for the journey of recovery.  One choice may be roads less traveled. Peer coaches can guide those looking for more access to on-ramps that lead to more roads to recovery—and once on, not taking off-ramps to relapse.  Traveling the recovery road requires stops for fellowship fill-ups and spiritual refreshment. It’s a good idea to pull into an overlook for a new vista.  How about bridges?  How do we learn which bridges to cross and which ones to burn? Is the next bridge a bridge too far?  Could it be a bridge to nowhere?  There could be a navigator in the passenger seat to help answer those questions. It can be a form of personal G.P.S.—Guided by Peer Support.

It is said that recovery is a process not an event.  It is about the journey, not the destination. We may ask the question many times—are we there yet? These are thoughts to consider; however, there is a need for stops and stay-overs to contemplate where we were, enjoy where we are, and determine where we are going.  When my words fail me or the words of others would serve better, I share them.  Bill White is a mentor and is an educator with words worthy to share. He has helped me think about the language we use. Talk about digging our own potholes!  In a recent blog, Bill wrote about addiction, recovery, and personal character.  I found his views about remission and recovery to be very important. Bill’s blogs can be found on the Faces and Voices of Recovery blog site.

On the recovery journey, we arrive at a state one might call “remission.” Many may settle for that and be comfortable. With infrastructure support, there is more to be gained by continuing the journey and not settling for remission but pursuing recovery. It is a term appreciated and well used by those with the lived experience of having survived addiction. As author Bill White says, “Recovery depicts the process of moving through and beyond remission to refill oneself, develop depth of character, and propel one towards relationships and contributions that reach beyond the self.” And further  “recovery in this view requires replacing the ‘I’ language of alienation with the ‘we’ language of human connection—shedding the ‘selfie culture’ and embracing a culture of humility, tolerance, interdependence, and community.” This most assuredly recognizes the value of evolving and improving the content of our character.  We can go from the past caricatures by others to the proud character developed during the recovery journey.

To all who begin the journey to recovery —have a safe and enjoyable trip and remember: There is comfort in ritual and fellowship and sharing the jumbled joys of the journey with others.  —— Merlyn Karst- Colorado Recovery Vanguard

It Takes a Villain

overdose mapIt Takes a Villain … authored by Merlyn Karst

Definitions of villain generally contain the word evil. Evil is called malicious, causing misfortune, and harm. Villainy is the state of being evil. In religion, ethics, philosophy, and psychology “good and evil” constitute a very common dichotomy. Evil is usually considered to be the opposite of good, in which good should prevail and evil should be defeated. Over the years the war on drugs has evidenced this common dichotomy. There are good drugs and bad drugs.  There is danger in taking drugs that are used just to feel good or not feel at all. How the drugs are used is what can make them bad. Walt Kelly’s cartoon character Pogo once said., “We have met the enemy, and he is us.” No blame, no shame. We need information and education.

We are now facing an opioid epidemic. The misuse and abuse of a beneficial drug has created a national crisis.  Through ignorance and/or subterfuge we ignored known brain science that told us of the possibility—if not probability—of the addictive nature of opiates.   In1996, Purdue introduced OxyContin, time released oxycodone, for chronic pain patients—marketed as non-addictive.  The rest is history and history is still being tragically made.  Sam Quinones is the author of Dreamland—The True Tale of America’s Opiate Epidemic. In the book, He chronicles the history about prescription drugs and destroyed communities that brought us to this crisis. Quinonus recently testified to the Senate Health, Education Labor and Pensions committee. He emphasized that solutions lay within communities and counties. He spoke of opportunities to deal with incarceration as an opportunity treat addicts. Most importantly he spoke of recruiting persons and families to share of the power of their stories to overcome stigma associated with addiction.

We know that as prescription pills become harder to get and more expensive, black tar heroin from Mexico becomes readily available. Now illicit drugs and synthetics like Fentanyl are linked to more overdoses than any other drug, including painkillers. Ironically, the availability of a “good” drug, Nalaxone HCI (NARCAN), can prevent overdose deaths. There are professionals with knowledge of the science of addiction who can prescribe appropriate drugs. Methadone, buprenorphine, naloxone, and naltrexone can all be effective in treating opioid addiction.  Medications are often an important part of treatment, but essential to be combined with behavioral therapies. All lead to the essential ability to think clearly and responsibly. Recovery from addiction leads to physical and mental well-being and alternatives to prolonged medicinal drug use.

Previously and presently, there are stories from Ohio and elsewhere showing community councils and coalitions are fighting back. These stories have the power to persuade us to give full attention and that must action be taken.  Crisis presents opportunity.  It has been written that it takes a village to raise a child. For our children and all of us, all the nation’s villages must face and overcome the crisis of the evil that is drug misuse and addiction. In the Colorado Betty Ford Children’s Program, illustrated books for children, portray addiction as a scary villainous character that destroys families.  We must defeat the villains who provide drugs and the villainy that may result in death. Armies have been raised to fight real or perceived evil. We gather by the thousands to march against whom and what we perceive as evil. We identify or invent villains. From these marches may emerge a movement.  It should be noted: A march does not a movement make. Marches provide dynamics, but movements provide policies and purpose Faces and Voices of Recovery, and Young People in Recovery, national organizations, represent a movement involving millions in or seeking long-term recovery.  Perseverance and sustainability are critical to individuals and to these movements.

The recent Congressional agreement will increase funding for the National Institutes of Health by $2 billion and raise spending meant to address the opioid and mental health crisis by $6 billion over the next two years. We should know what other evil drugs are being developed by other lab villains.  Our Colorado “villages” are populated with agencies and persons with knowledge about effective use of funds, at the local level. Funds—not trickled down, but a long and dependable flow down— with fiscal oversight and with few ties that bind. The plan includes public prevention programs, and law enforcement activities related to Substance use disorder (SUD) under mental health programs. Critical to sustainability will be the need the long-term benefit of shared lived experience of peers in recovery and recovery support services.  There are resources available along the front-range who provide Peer Coach training leading to a Colorado Peer and Family Specialist Certification (CPFS). Among those are: Peer Coach Academy, Advocates for Recovery, and Springs Recovery Connection. The economic and social value is immeasurable.   We can defeat the villainy of drug addiction but movements need motivation and motion. So—let’s roll.

 

 

 

Where There is Will, There are Ways

merlyn beaconwritten by Merlyn Karst

The always present and pervasive question: Is drug addiction a mental illness? Yes, because addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the alcohol and/or other drugs. The resulting compulsive behaviors that override the ability to control those behaviors result in repeated but ignored consequences. Scientists weigh in. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. The recognized mental health issue is known and medically recognized as a Substance Use Disorder (SUD). In 2008, The Mental Health Parity and Addiction Equity Act (MHPAEA) was passed by Congress. Foundational in its language and acceptance was recognition of addiction as a successfully treatable disorder when accompanied by recovery support.

When considering addiction in all its forms, too often there will be little understanding and a lot of blame and shame. The many voices say it’s about willpower. It is said addicts are lazy; have a moral failing; on their own, have the ability to turn their lives around; care only for themselves.  And on and on—sound familiar?  Familiar it may be, but so very wrong.  A strong will is important. Addiction takes it away—and it can be recovered.  Addiction is “a biologically based brain disease, like major depression,” explains Michael Weaver, MD, medical director of the Center for Neurobehavioral Research on Addiction at the University of Texas Health Science Center in Houston. “But willpower and resolve can play important roles in helping people overcome cravings.” The most important thing you need to know about willpower is this: “You can nurture and strengthen it if you tend to it in the right ways. Having the willpower to change behavior takes learning, practice and support.” The advent of medically assisted recovery is now playing a major role in overcoming craving that allows the brain to function normally and take advantage of “learning, practice, and support.” The key to finding the positives in a recovering person using willpower for good comes from peers in recovery and recovery community support. With help, hope and support, the will to recover can prevail.

 

A Peer Recovery Coach has struggled with the same challenges a person with SUD has and succeeded in meeting them with hope and health—and with that positive will and self-control the person would like to have.  The Peer Coach has value to offer through “lived experience.” He/she has, no doubt, suffered the shame and guilt that accompanies addiction and keeps the person trapped in a destructive and sometimes fatal SUD. A peer coach is a helpful guide to a recovering person’s life of accountability, responsibility, and well-being.  Yes, where there is a will, there is a way.  True, and if there is will, there are many ways to recovery.  Biblically speaking: seek and ye shall find.

 

So, having one’ s willpower restored and using it to change behavior, does take “learning, practice, and support.” In early recovery, as they investigate the many paths to recovery,  “newcomers” are encouraged to look outside of themselves for a power greater than themselves. Fortunately, many hear this in a place of safety and comfort—surrounded by fellowship and ritual.  They quickly realize the importance of learning from those with lived experience and hearing and feeling the power of their stories.  From this will come the courage and confidence to change.  They will also receive a generous infusion of hope. Where will is an informed and functional part of the brain, there are many paths to change. Merlyn Karst