Saturday, March 25, 2017

The one you hate

The one you hate

"There she was in my group, 40 minutes late but a week early for our scheduled appointment. Group days are always hectic but I fit her into my schedule thirty minutes before lunch because we had a few things to go over before she met with the team doctor and she had  to keep her last scheduled appointment. She hijacked the group immediately giving her peers unasked for advice and complaining about her roommates in treatment until I cut her off and dismissed the group. One on one she complained for 40 minutes about the incompetent care she was receiving adding it was not necessarily my incompetence she was referring to while clearly sending the message that it was. I know this game well so when I was satisfied I had given her a fair say I redirected the conversation to her goal and trying to break them down to manageable objectives. she parried by switching the topic and refusing to commit to any course of action. I confirmed the date of her doctor's appointment and that I would provide transportation before she left.  A week later she didn't answer my calls, didn't show up at the agreed upon meeting place and missed the appointment then showed up the next day at my office angry that she was making no progress."

In close to five years working in the the recovery field most recently as the substance abuse specialist on a community mental health team I am happy about the direction of my life. I wake up in the morning tired but I don't dread going to work, I look forward to it. My favorite part of my job is the face time with clients and as a rule the more I get the less tired I am at the end of the day. But every now and then a client comes in that makes me dread the upcoming appointment and I even wish they wouldn't show up. Sometimes it's because they are negative, sometimes they are just plain mean, and it's hard to see if I'm doing any good at all. At past jobs I had the reputation of being able to manage the "difficult" clients. I'm not certain that reputation has followed me to my current position where the people we work with are often struggling with profound mental illness and the percentage of "difficult" clients is much higher. I can honestly say that while sometimes I do dread an upcoming appointment with a client I have managed not to hate any of my clients. I'm no saint but I've found a few things to keep these challenges from getting me down.

While it's okay to blow off steam it's not okay to be openly disdainful of a client. Even if it's just among friends and colleagues 

A client can be so frustrating that you need to give voice to the complaints burning in your gut to a supervisor or trusted colleague but don't let it go on for too long. Nobody gets paid to do an easy job, a miner doesn't get anywhere by complaining about the stone and I don't get anywhere complaining about the symptoms of disorders who's very existence provided me with employment. While Goodwill Hunting moments of tears and hugs do happen from time to time most of the time change takes hard work an a lot of time for us and even more for the clients.

See past the symptoms to the pain.

The people I work with are suffering. Often the pain isn't physical (though sometimes it is) and it's hard to see. Isn't that what the unpleasant behavior is for, to hide the fact that they are suffering, vulnerable? The behaviors are frustrating to me but to the client they are isolating and as bad as it is to suffer it's worse to suffer alone. When I can see the clients pain my judgement of their symptoms melts away. It can be a powerful experience when this happens and the client can sense it too. When judgment is replaced with acceptance suspicion turns to trust. It can make all the efforts leading up to it worthwhile.

Just because it's hard to see doesn't mean your not doing any good.

I don't believe that some people "just aren't ready to change." At least not the ones who have managed to come to my office.  They may not be ready to change in the way I want them to, they may not understand what is required to change, I may not have what they need to change, but it's not because they don't want or just aren't ready to change. I strongly believe that if a client is truly getting nothing from our contact they will ask for another counselor or stop coming altogether. It might be that my office is the only safe place for them to be unpleasant or at least the only place they don't feel judged for being that way.


Suspending judgment in the face of a barrage of insults and attacks on your competency and character takes energy, if you don't have any you won't be able to do it. Use those vacation days, sick days if you have to, illness doesn't have to come from a virus. I found I need to see a therapist and do so no less than once per month. Our jobs are difficult, sometimes even dangerous and we need to be at our best to do it right. If you find yourself in this field you care about people. Remember you are people.

Wednesday, March 22, 2017

The Drug Holocaust part 2

The Drug Holocaust 2

A year ago I tried to make the argument that the attempts to control the supply of illegal intoxicants led primarily by the U.S. Government for the last 100 years has been incorrectly characterized as a "drug war" and should and perhaps someday will more accurately be characterized as an "addict holocaust." After all doesn't a war require that both sides fight to some extent? The war on drugs while sold as a war on suppliers has been a war on minorities and on the poor. While pictures of sad and unkempt dealers on the news followed by pictures of cellophane wrapped products sitting on a table with uniformed law enforcement standing at attention behind continue to be commonplace we never see videos of captured cops standing next to armed addicts being forced to read a manifesto denouncing their role in the war. It is the government that attacks and the poor who suffer, the poor and addicted who suffer most of all. Sometimes it seems like we are finally ready to try something else. There are programs popping up here and there attempting to replace the ineffective punitive models of the past and present that were effective enough to lead us to what might be the worst addiction epidemic ever. Everyone knows that heroin use has increased dramatically but few know so has alcohol use as has death from alcohol related diseases. Hard to blame that on pain pills. But even as these new encouraging models appear the dehumanizing effects of the old (and current) way are so powerful that progress may be impossible.

Consider this headline from 

Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

You may have to cut and paste the link to read the article and if that doesn't work there's a link to it on the Grey's Recovery Facebook page.

The article is not as terrible as the headline makes it sound. The ethical guidelines discussed are more about connecting a patient with drug treatment than leaving them to die because they continue to shoot heroin.

"Daly says that the guidelines are not some kind of moral test. Instead, they are meant to help doctors connect patients with a primary care physician or set them up with addiction counseling."

"This is not the patient proving to the medical team that they are worthy of a new valve, that they are worthy of the surgery," Daly says. "We wanted to make sure that that could not happen."

But it could happen. It does happen, it will continue to happen. For those of you working in the field ask your clients what their last emergency room visit was like. If you work in a traditional abstinence based program the treatment your clients receive will shock you. If you work in a methadone clinic you will be appalled. See you can't wage a war on a substance. A substance can't be your enemy. You can only wage a war on the people who use that substance and the enemy in any war must be less than human.

Why isn't the answer to the question "How many times should you replace the same heart valve?" as simple as saying "as many times as you can"? Why isn't a cheaper more effective solution to the problem even discussed? The cardiac problems of IV opiate users aren't caused by the drug they are caused by the "war" on the drug. Impure products and dirty needles cause the infections mentioned in the article. A cheap solution that would be more effective than any surgery would be to make needles free and easily accessible and to provide a safe supply of opiates.

The new administration has made it clear that not only do they plan to continue the failure of the drug Holocaust and plan to make matters worse by resuming the prosecution of cannabis users. I expect minimal resistance by those affected with the addiction disorder as the sit in the recovery group I run and argue for even harsher drug policy. The holocaust has not only devastated individuals, families, and communities across the globe, it has produced Hitler's willing executed and the end no longer appears to be in sight.