[Vision2020] Drunks, drugs, and the empathy factor

[Saundra Lund]

Hi Andreas,

Thanks for giving me the opportunity to broaden horizons! 

You wrote:
"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."

Really?  When was the last time you had to refer an addict to Boise,
Seattle, Portland, Salt Lake City, or further away for appropriate care
because there weren't local treatment resources???

Maybe part of our communication difficulty is a difference in terms.  I
absolutely consider "appropriate care" to be a vital "resource" (and a basic
one at that), but perhaps you weren't considering that in your assertion
that there are far more resources for certain (and *only* certain, I'll
point out) disorders?

The fact of the matter is that for many suffering from neurobiological
disorders, there simply aren't the basic resources available locally
(wherever "local" happens to be with the exception of major metropolitan
areas) that there are for addicts.  Sheesh -- there are addiction treatment
resources available on just about every street corner (I'm exaggerating
slightly), but that's simply NOT the case for those suffering from
neurobiological disorders.  I know of many, many people -- both locally and
nationally -- who have to travel great distances to received appropriate
diagnoses and treatment for neurobiological disorders, but I don't know of
any addicts who have to do the same for chemical dependency diagnosis or
treatment.

I find it interestingly limiting that you only address those with
schizophrenia, clinical depression, and severe anxiety.  Yes, those are some
significant neurobiological disorders, but there are many other you don't
mention:  attention deficit disorder (ADD), early onset bipolar
disorder/bipolar disorder (EOBP/BP), autism & autistic spectrum disorders
(ASD), Alzheimer's Disease, traumatic brain injury/disorders (TBI), cerebral
palsy (CP), pervasive developmental disorders (PDD), Tourette's Syndrome,
obsessive-compulsive disorder (OCD), learning disorders (LD), and a whole
host of other neurobiologically-based disorders/diseases.

Please talk to families who have a member with Alzheimer's Disease or autism
and then reassess your statement about the availability of resources.  For
that matter, *please* talk to families who have a child diagnosed with COS
(childhood onset schizophrenia) or EOBP (early onset bipolar disorder) and
then tell them about resources.  Based on your statement, I think it would
be a real learning experience for you.

Now, I've hit on something else that might be part of our communication
difficulty:  your comments seem to be only about the adult population while
I'm unwilling to ignore the pediatric and adolescent populations  :-)  The
fact of the matter is that for those populations (well, for adolescents,
anyway), getting diagnosis and treatment for chemical dependency is far,
*far* easier than getting diagnosis and treatment for many
neurobiologically-based disorders.  Other resources, too, are incredibly
scarce, and children in alarmingly horrifying numbers are being turned over
to state care because of the lack of resources.  They are just being thrown
away -- turned out on the streets -- due in part to the paucity of
resources.

You also wrote:
"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."

Again, you are referring to adults -- the picture is far different for the
pediatric and adolescent populations with neurobiologically-based disorders.
And, quite frankly, I get rather frustrated at good folks for whom these
populations remain invisible!

I'm glad you've had little difficulty getting SSI/SSDI for your clients with
Axis I disorders.  However, I can tell you that's *not* the case for kids
suffering from neurobiological disorders (I'm happy to refer you to
resources to help educate you if desired), and my experience when I worked
for Health & Welfare was that a fair number of qualified adults had to go to
h*ll and back again to get disability or Medicaid.  And, of course, there
are *always* those professionals don't like to admit who fall through the
cracks or simply give up because they don't have access to (or don't know
about) advocacy or even know that they might qualify for SSI/SSDI.

You also wrote:
"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."

I'm very glad to hear that!  Years ago, I ran the federal Section 8 Housing
Assistance Program in Whitman County.  During my tenure, we instituted a
local preference for folks with CMI (chronic mental illness) to move them to
the top of the waiting list, an accomplishment I was very proud of.  Back
then, we had more than a few CMI folks coming over from Latah County because
of the lack of housing and other resources here, so I'm pleased to hear that
the situation has improved since then!

But, I'd also like to point out something that may not be the case locally
but is certainly the case nationally:  minimally, one-fifth (a conservative
estimate, depending on which statistics you buy) of those who are homeless
are, in fact, mentally ill and homeless *because* of the lack of resources
for mental illness.

I'd also like to suggest that your perception about resource availability
might be influenced by the population at Sojourners' Alliance and your own
experiences.  You did clarify that you're referring to folks with severe
mental illness who become homeless, and I appreciate that -- as well as
applaud -- the vital need Sojourners' Alliance fills.  However, I do have a
couple of things to add . . . 

There is a whole segment of those with even severe neurobiologically-based
disorders who never become homeless or a part of the "system."  I suggest
that their -- and their families' -- very real perceptions and "real life"
experiences with the serious lack of resources might differ significantly
from yours.  OTOH, in the last decade or so, I've never talked to an addict
who didn't know that there was help available (even if they didn't want it),
especially no-cost resources.

You also wrote:
"Where the problem really lies is in getting dual-diagnosed (mental
health/substance abuse issues) clients the help they need."

I don't substantially disagree with that statement, but I see things a
little differently:  it seems to me that the *real* problem for the
pediatric and adolescent populations (and even the adult population to some
extent) with neurobiologically-based disorders is in even *getting* an
appropriate diagnosis  :-)  And, without a diagnosis, there are no
resources.  OTOH, it seems to be fairly straight-forward to get a substance
abuse diagnosis and even treatment.

Finally, you wrote:
"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."

Of course, much of what you wrote about addicts applies to those with all
sorts of neurobiologically-based disorders.  They can be very challenging to
work with.  They often have poor coping skills *because* of their
neurobiologically-based disorders, disorders which can also have significant
negative impact on psychological and social health -- it's hard to develop
normally when the brain isn't working right.  Too, it's not unusual for them
to meet up with folks like yourself or the criminal justice system, only in
those cases, it's into a CJ system that's completely and often tragically
unprepared for the specific issues those with neurobiological disorders
face.

And, of course, the costs of *treating* neurobiological issues are far less
than putting out the fires a lack of treatment causes:  regardless of who
picks up the cost, time in the hospital is MUCH more expensive  (often over
$1000 *per day*) than providing appropriate treatment to avoid the need for
hospitalization.

And, since you brought up the challenge of those with dual diagnoses, I have
to point out the obvious:  how many of those folks would have *avoided*
chemical dependency in the first place had there been adequate resources for
their neurobiologically-based disorders???

I think this a particularly compelling point with respect to the pediatric
and adolescent populations who often spend formative years without diagnoses
. . . and resources.  The cost to them as individuals and to us as a society
is simply unacceptable.

I think there's a kind of disconnect that sometimes happens between
clients/consumers (and their families) and professionals, and I'm wondering
if that might be the case here?  Your perception, Andreas, of the
availability of resources seems to be very different than the perceptions of
those with neurologically-based disorders and their families.

And I think, too, that sometimes professionals lose sight of the big picture
and are unaware of the specific roadblocks faces by folks with whom they
don't have a lot of dealings.

My original statements were:
"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.  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.  Most unfortunately,
that's what's happening now, particularly with children."

I stand by those statements.  The reality is that as chemical dependency
costs have SKYROCKETED (due, in part, to the profit motive treatment
provides), health care costs have increased.  In response (also due, at
least in part, to the profit motive), insurance companies have looked for
ways to "control'' costs.  And, the easy solution has been to chip away &
chip away & chip away at the benefits available to those who have
non-addiction neurobiological disorders.  In fact, it's not unusual to find
employers who offer medical insurance that *excludes* treatment for
neurobiological disorders *but* offers addiction treatment even if just
through EAPs.

And, even when insurance is part of the benefits package, those with
neurobiologically-based illnesses like schizophrenia, autism, Alzheimer's,
bipolar disorder, etc. are very often limited to the same number of visits
and inpatient days as those being treated for addiction.  And, that's
assuming they can even *get* a diagnosis, which isn't so tough for something
like depression but is MUCH more difficult for things like COS, EOBP, ASD,
PDD, etc.

IMHO, that's a very real problem and huge injustice.  A person suffering
with schizophrenia *never* had a choice or any control whatsoever over
whether or not to have the disorder.  Yet they are often limited to the same
number of visits and treatments options as addicts, and if their disorders
require more intensive treatment or "tune ups" to keep them as healthy and
happy and productive as possible -- too bad, so sad.

We *certainly* don't limit the number of times someone with heart disease
can see the doc, even when they don't follow the prescribed treatment that
includes lifestyle changes!

And, the fact of the matter is that those suffering from serious
(non-addiction) neurobiological disorders will *always* need access to
medical care for successful treatment and management.  Addicts, OTOH, may
*never* need medical treatment to recover, a fact illustrated by the success
of 12-step programs, programs which cost the participants nothing, and the
success of some to recover with no formal diagnosis or treatment whatsoever.
I'm not aware of anyone suffering from schizophrenia or autism, for instance
who has been able to "recover" with nothing more than a 12-step or self-help
program, are you???

I would encourage you, Andreas -- and anyone else who has bothered to read
this far (bless those of you who have, if there are any) -- to broaden your
horizons!  Continue, of course, to advocate for those with whom you work
(your clients) and care, but PLEASE don't remain blind to the plight of
those -- and their families -- who never, ever had a choice about being
affected by neurobiological disorders for which there are no cures, only
treatment and management.  In a very real sense, those are the folks who are
being harmed by the cutting of health care benefits and other resources due
to the skyrocketing costs of addiction treatment.


Saundra Lund
Moscow, ID

The only thing necessary for the triumph of evil is for good people to do
nothing.
Edmund Burke

-----Original Message-----
From: Andreas Schou [mailto:ophite at gmail.com] 
Sent: Thursday, 24 February 2005 8:29 AM
To: Saundra Lund
Cc: Joan Opyr; David M. Budge; Vision2020 Moscow
Subject: Re: [Vision2020] Drunks, drugs, and the empathy factor

> 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