Thursday, March 24, 2016

Barriers to Recovery

Question: Why do some people recover from substance use disorders after treatment while others struggle and relapse?

Answer: This complicated question has perplexed people for a very long time. Even in this modern era, it is hard to answer the question with precision. While the American Medical Association considers substance use disorders as chronic diseases, and they are leading causes of death in the U.S., there is significantly less research conducted on treatment outcomes of these disorders when compared to other chronic conditions like heart disease and diabetes. Like most chronic conditions, many factors contribute to whether or not a person will experience a good recovery outcome. These factors interact with one another in complex ways. Here are a few factors to consider:

1) Severity of the substance use disorder (SUD) - Some people have more severe symptoms of addiction (i.e., craving, compulsion, mood instability, cognitive difficulties, dysphoria, and irritability). Functional changes in the brain cause these symptoms. Scientists have developed several medications to treat some of the more distressing symptoms, which continue even after substance use ends. Studies suggest that genetics can affect whether a person is likely to develop a SUD and the severity of the of course of the illness, but this is only a piece of the puzzle.

2) Co-occurring mental health conditions - People who have both mental health conditions and SUD experience worse outcomes with both conditions.

3) Lack of access to quality services - Most people with SUD will need an array of services to help support them as they recover from their condition. In addition to treatment, people may need help with finding and keeping housing, health care, employment, counseling, and recovery support.

4) Connection - People with fewer social connections and meaningful roles in the community tend to have more difficulty with recovery. Conversely, evidence shows that having significant connections to family, friends, and colleagues supports recovery. 

5) Level of stress - High level of daily stress is correlated with high rates of relapse.

These factors may explain why some people have a more difficulty recovering from substance use disorders. An ideal services system should include elements that address all of these factors; treatment to address distressing symptoms of substance use and mental disorders, opportunities to learn strategies for managing stress, making connections to others, meaningful activities, and interventions that serve to lift people out of poverty.

Author: Dr. Cheryl Gagne, posted in BRSS TACS March Monthly Update, 3/21/16

Tuesday, March 22, 2016

Why do some people get the services they need to live --and others who cannot access the services they need, are allowed to die?

"It is God's Will," replied Delegate Hammen's Top Legislative Aide.

I took off work without pay, gassed up my van, and drove to Annapolis to testify on the Recovery Home Residential Rights Protection Act --a bill that would require the Department of Health & Mental Hygiene (DHMH) to adopt regulations for the certification of recovery residences that have staff and provide services to residents who have already gone through detox.

The bill would require these recovery homes to meet certain standards and requirements and prohibit a person from operating a recovery home without certification.

Currently, a person with an acute chronic opioid dependence enters an ASAM level 3.5 to 3.7 (detox) level of care, where they stay for two to four weeks, depending upon how long insurance or Medicaid will pay.  Still in need of residential services, these individuals, if they are willing and if there is an open bed, may be referred into the next level of residential care --ASAM level 3.1 (halfway house).  Halfway houses are regulated by DHMH, and staff must be certified and trained.

But since Maryland does not have enough regulated halfway houses for everyone who meets criteria for needing them, they are referred into "recovery residences" instead.  These are operated by untrained individuals without any credentials, who hire "staff" and provide some level of services --often contracted by an outside provider.  These houses fall under the Department of Housing.

We know there are some really good Recovery Houses --often providing better programs than some state regulated Halfway Houses.  Then there are the houses that pack in as many people as possible, confiscate residents' food stamp cards without providing food, trade sexual favors for rent, kick people out for ridiculous reasons, and allow "staff" to continue to use and sell drugs as long as they collect the rent.

This unregulated system of care allows untrained "staff" to financially, emotionally, and physically exploit the most vulnerable --people with a diagnosed brain disorder, often with co-occurring mental health conditions, typically with low self-esteem --many of whom have lost family support.  They have been assessed as needing residential services to retrain and heal their brain and link them back to a "normal" way of life.  This bill provides quality of care standards for any Recovery House that "hires staff" and "provides services".

Sadly, the Health and Government Operations Committee (HGO) will never get an opportunity to vote on this bill, because Chairman Hammen has chosen to hold it, rather than send it through the process of a subcommittee analysis and a Committee vote.

Not being a voting constituent of Del. Hammen's, nor a lobbyist, I am unable to speak to him about this bill directly.  When I asked Andrew, Chairman Hammen's top Legislative Aide, why some people should get the services they need and therefore live, while others are denied those services and allowed to die, Andrew replied that it was "God's will".

I cannot think of any other mental health disorder or physical disease where the protocol is to send the patient to live with others battling the disease and hope for the best.  We do not deny cancer patient's the treatment they need in order to fight their disease --and we would certainly never tell them that it is God's Will if they die because they were unable to access the services that they needed to recover.

Please call Chairman Hammen's office and tell him that you would like him to assign House Bill 1429 to Subcommittee.  Please call your HGO Committee representative for your county and request that they ask Chairman Hammen to move this bill forward for a vote --as it will save people's lives.  Links to contact information for each Delegate on the HGO Committee is provided below:

Peter A. HammenChair (410) 841-3772(301) 858-3772
Shane E. PendergrassVice-Chair (410) 841-3139(301) 858-3139
Lisa Lowe
Heroin Action Coalition

Sunday, March 6, 2016


What If We Could Walk Into Any Hospital For Detox?

That is a possibility right now because Delegate Morhaim has proposed a bill in the Maryland General Assembly that would mandate that ALL HOSPITALS IN MARYLAND provide substance use disorder (SUD) services --the same way they currently provide mental health services for suicidal patients.

Sadly, this bill is not expected to pass BECAUSE HOSPITALS OPPOSE IT --THEY SAY IT IS TOO COSTLY TO SAVE OUR KIDS LIVES!  Yet, they save the lives of those of us in communities across our state with ANY OTHER life threatening, often fatal, disease or disorder.  

Detox in hospitals is not unheard of!  As many of us are aware, several Baltimore City hospitals provide short-term detox --just long enough to find a halfway house bed. 

Please do these three things this week:

1)  Call your local hospital and ask to speak to the CEO or President.  Tell him or her that you live in their community and you are concerned that the Maryland Hospital Association opposes House Bill 908, requiring All Maryland Hospitals to treat or transfer an individual in need of SUD treatment --treatment that could save their life.  Talk to them about why they need to admit our kids seeking help. Then email me and let me know the name of the hospital and the person you spoke with.  

2)  Call Delegates Hammen and Pendergrass (numbers listed below) and let them know that you want this bill to get a vote in their Committee.

3)  Call the Delegates who represent your district and ask them to vote favorably on House Bill 908, despite opposition from the Hospital Association BECAUSE MARYLANDERS VALUE LIVES OVER PROFITS!

Thanks, Lisa Lowe
Heroin Action Coalition
affiliate of Family Advocates Coalition to End Addiction in Maryland
(F.A.C.E. Addiction Maryland)

Peter A. HammenChair (410) 841-3772(301) 858-3772
Shane E. PendergrassVice-Chair (410) 841-3139(301) 858-3139