We Still Have a Ways
to Go
Four years ago I was inspired to open a clinic to help
people with substance use issues because of the many, many stories I was
hearing about ineffective and often times, harmful treatment.
While we are making progress with embracing more
person-centered, stage matched interventions; I continue to have experiences
that affirm how far we still have to go.
For example:
I was training a large group of clinicians and practitioners
about person-centered care, and we were having a very spirited discussion about
why drug and alcohol counselors seem compelled to report their clients use to
probation officers. I have worked as a
mental health professional for over 2 decades and mental health clinicians
don’t share this compulsion. In fact, I
can’t recall any MH worker ever thinking that this was their professional
responsibility.
As this discussion progressed, a man raised his hand and
offered a useful perspective. He
commented, “I worked as a probation officer for over 8 years, and throughout
that time, we always thought of addiction providers as extensions of us. There was a strong sense of “we – they” and
the counselors job entailed trying to catch the clients using.”
Why do drug and alcohol clinicians think their job includes
the role of a correctional officer?
No wonder clients “go underground” in treatment and say
whatever they think others want to hear.
Another example:
I was interviewing a young woman who smoked a large quantity
of cannabis daily and her parents were very concerned about her
well-being. She had been in treatment previously
including some very prominent programs.
I asked this young woman why she smoked pot but before she had a chance
to answer her mother jumped and stating, “She smokes because she has a brain
disease, and her disease is controlling of her life”.
I again asked the young woman why she smokes, and she
proceeded to explain that she smokes to relax especially at night before bed.
What unfolded was a discussion about other motives for use and exploration as
to whether this young woman even thought she had a problem.
A few days later her mother called me and shared this
comment:
“My daughter has been in some of the best programs in the
state and I have never heard anyone ever ask her why she uses. She has always been told that she has a brain
disease and they have the fix for it.”
“Kudos to you for asking.”
Paula, your viewpoint is always relevant and your post comes at an appropriate time because I recently have been facing similar issues.
ReplyDeleteLast week I did an assessment on a 20 year old male meth user who had multiple mental health diagnoses. The reason he came in for the assessment was to fulfill probation obligations because he had a positive UA for meth and marijuana and consequently went to jail for a week.
During the assessment he said that he hadn't used for about a month. He wasn't on any medications for his mental health issues except for Adderall for ADHD and never has been compliant with his medications. I asked him if probation had some expectations from him and he said individual counseling. After talking to him my initial feelings were that he had a lot of mental health issues that needed to be addressed. Therefore, my recommendation was that he attend individual counseling 1-2 times a week, have a psych eval and medication compliance.
After the assessment I talked to both his probation officer and his mother for collateral information. I got a lot of information from his mom and she thought that he was still using and that he needed inpatient treatment. She told me she took him to get checked out because she thought something was off with him and he was acting strange. The hospital she took him to was in the Fairview system (where I work) so I am able to access the notes in his chart. He had a UA which was positive for methamphetamine.
After all of this I was really struggling with whether or not I should change my inital recommendation. I sat on this assessment for days and all I had to do was fill in the recommendations. Finally, I came to the conclusion that I was letting the outside parties' information/opinions influence my decision. The UA that he had done was 2 weeks prior to the assessment so even if he wasn't truthful about when he last used as far as I know it was still over 2 weeks ago. My job is to give a recommendation based on the information that the client gives me. My job isn't to catch them in a lie and I don't feel comfortable changing dimension ratings or recommend residential treatment based on what a family member thinks is going on.
Additionally, I think that counselors sometimes use probation as a means to not have to deal with clients that may be challenging. If the client continues to struggle in treatment it's easier for the counselor to play the probation card than it is to actually do the work and figure out what the client needs.