[Vision2020] Drunks, drugs, and the empathy factor

[David M. Budge]

Andreas,

While I was with Community Counseling Centers of Chicago we were 
fortunate to have a medical director who implemented a system of 
integrated cross disciplinary case management to address mental illness 
as well as other conditions such as addiction.  Our client base included 
a large number, approximately 2600, homeless individuals referred to us 
from the many various shelters and community based medical centers in 
Chicago.  Accordingly, at the time, we considered ourselves quite 
successful on the diagnosis side. 

On the treatment side we had the common mixed results that come with 
keeping homeless people on their meds.  Otherwise we did a terrific job 
using case management and coordination with various housing agencies to 
promote community/social reintegration . But we had less success with 
our substance abuse programs.  We followed a modified 12 step model and 
found it to be ineffective in the long term management of relapse. As 
you probably know, relapse then would interfere with administration of 
Rx protocols.

It has been some time since I was activity engaged in the industry and I 
was never a clinician but, rather, a board member.  The question I have 
is if the community based mental health is space doing anything for 
substance abuse research that is different from traditional 12 step-like 
programs? Also, what initiatives, if any, are coming from state agencies 
such as Medicaid to coordinate publicly funded mental health 
organizations with subtonic abuse organizations into overall case 
management?

db



Andreas Schou wrote:

>>One more thing:  I don't mean to attack addiction, but I find it absolutely
>>REPUGNANT that there are more resources out there for folks suffering from
>>addiction than there are for people suffering from neurobiological disorders
>>over which they never had any control.  
>>    
>>
>
>As someone who works with both people suffering from neurobiological
>disorders and addicts, I can tell you that the resources for those
>suffering from schizophrenia, clinical depression, and severe anxiety
>disorders far exceed the resources available to addicts. In those
>areas where addiction resources are more readily available, it's
>because addicts themselves have organized twelve-step programs.
>
>Of particular note are the people at Adult Mental Health at Latah
>County Health and Welfare (shout-out to Doug Salata) and Disability
>Action Center (shout-out to Janesta). Between the two, I've had very
>few problems getting people with Axis I disorders the help they need
>to get out on their own, with a consistent income (often SSI/SSDI) and
>a place to stay. In fact, Sojourners' Alliance has higher success rate
>with the severely mentally ill than with the homeless population as a
>whole. 80% of our schizophrenic clients this year (we've had five)
>have graduated to subsidized housing.
>
>Where the problem really lies is in getting dual-diagnosed (mental
>health/substance abuse issues) clients the help they need. Often, the
>substance abuse providers will diagnose mental health as their
>"primary" issue -- because they have little experience dealing with
>mentally ill clients -- and the mental health providers will diagnose
>substance abuse as their "primary issue." So you'll see a client
>that's both mentally ill and a methamphetamine user get a diagnosis
>like this: Bipolar II secondary to borderline personality disorder
>with methamphetamine abuse. And, whammo, all of the sudden a client
>who clearly needs help (but who may not want it) has a diagnosis with
>which they can't get any help, whether or not they might someday
>realize that they need it.
>
>  
>
>>Of course, I'm a bleeding heart
>>liberal who wants to help all those who want it, and that includes addicts.
>>BUT, when employers start limiting health benefits (in part) because of the
>>high costs of treating addiction, then I think we have an obligation to make
>>sure those who have illnesses/disorders/diseases over which they have no
>>control DON'T wind up with the short end of the stick.  
>>    
>>
>
>Addicts are often hard to work with. Often, the addiction has covered
>for poor coping skills for years. The costs of not treating addiction
>are, however, much greater than the costs of treating addiction. If
>addicts don't receive the help they need (and since addiction, unlike
>many psychiatric disorders, can't be treated with a pill, the costs in
>terms of staff time are greater), they end up meeting either myself or
>the criminal justice system. The costs of providing effective
>outpatient treatment to addicts are far lower than the costs of
>providing a room here at Sojourners' or a bunk in state prison ... or,
>failing either of those, having the person burglarize your business to
>steal money to buy meth.
>
>-- ACS
>
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>  
>
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