Author: Christy Weeks

*This presentation is no longer eligible for a CEU.

In this webinar, participants will learn how to put the spirit, skills, and tasks of motivational interviewing into everyday practice. Motivational Interviewing aims to help people resolve ambivalence and move toward healthy change. Giving up substance use is incredibly difficult, and it is our job to help people find internal drivers and strengths that make that change possible. The workshop will give you the tools to help people uncover their why.

Presented By:
Dianne Asher, LCSW
Lead Counselor – Harmony Foundation, Inc.

Dianne holds a Master of Social Work Degree (MSW) from the University of Kansas School of Social Welfare. Dianne is a Licensed Clinical Social Worker (LCSW) with over 31 years of experience in mental health and substance abuse treatment. She has held several positions in the mental health/substance abuse fields, including Director of Behavioral Health Workforce Development and Dual Diagnosis Specialist/ Qualified Mental Health professional at University Health-Behavioral Health, Consultant/Trainer for Integrated Dual Diagnosis Treatment at the University of Kansas, School of Social Welfare, Case Management/Supported Housing Team Leader, Adolescent Substance Abuse Clinician and Qualified Mental Health Professional at Johnson County Mental Health Center.

She has been trained as a Motivational Interviewing trainer and part of the Motivational Interviewing Network of Trainers since 2002.

The family is our integral unit of resilience and survival in times of stress and the core stabilizer of our communities. Disruption of families by trauma and stress precipitates significant problems such as addiction, post-traumatic stress disorder (PTSD), and other serious physical and mental illnesses. Connectedness and attachment to family and culture of origin correlate with reduced risk-taking behaviors and violence. Facilitating family, cultural, and community ties can, therefore, be protective against the effects of trauma.

Family dynamics and research studies illustrate the effectiveness of including family members and professionals for effective collaboration for the prevention, treatment, and aftercare of co-occurring disorders. Working with family motivation to help loved ones and themselves attain healthy lifestyles must be the cornerstone of an effective, collaborative continuum of care.

In a recent webinar for Harmony Foundation, ARISE Network founder and president Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI, CRS and ARISE senior trainer, supervisor, and interventionist Michelle Holcomb, PhD, LPC–S, CAI discussed the role of the family as key members of the collaborative team to address co-occurring mental health issues. 

Dr. Holcomb started with some food for thought. She asked webinar participants to consider

• How does a person’s experience interacting with their community/environment impact their overall well-being?
• What if these interactions are traumatic?
• How does an individual’s genetic make-up directly impact their overall well-being?
• How does a family impact the well-being of an individual struggling with a mental health and substance use disorder?

Dr Landau then explained that our society faces “growing regional and global concerns from opioid epidemics and the COVID-19 pandemic to the re-emergence of intolerance, human trafficking, global climate change, terrorism, and random acts of violence.” 

People are especially vulnerable during times of change. “On average, traumatic events result in a 30 percent increase of stress-related issues such as PTSD, cardiac arrhythmias, or pulmonary disease; attachment disorder, depression, and suicide; as well as onset or relapse of substance use disorder, behavioral compulsions, or other mental health issues,” Landau said. “The stress families feel with transitions can manifest in physical symptoms. We each have a distinctive stress response. Over 90 percent of visits to primary care are somatic stress.”

Traumatic events have an impact not only on individual people but also on their families. An individual healing journey is influenced by family ties. Dr. Landau explained how:

• Families are a valuable resource and source of support for the management of illness
• Families provide a more accurate picture of the individual’s symptoms, compliance, etc., than the individual alone
• Families are the primary source of many health-related beliefs and behaviors
• If the family is not included in the collaborative team, they become a liability rather than a resource

In the second part of the webinar, Landau and Holcomb talked about co-occurring disorders (also known as dual diagnosis), which consist of two or more of the following:

• Substance use disorder
• Behavioral compulsion
• Physical illness
• Mental illness

For treatment to be effective, it must address a patient’s conditions concurrently, not consecutively. Co-occurring disorders are so prevalent that “dual diagnosis is an expectation, not the exception,” explained Dr. Holcomb.

Co-occurring disorders require multidisciplinary collaboration, but that is often not available. “Specialization has resulted in fragmentation of treatment,” Holcomb said. “Often, the focus is on isolated body parts rather than the whole individual. People are seen as individuals in isolation, rather than as members of a unique social, environmental, and cultural context, but concurrently, advancements in Western understanding have resulted in more holistic approaches to healing and wellness.”

A typical example of that fragmentation is obesity, where many experts treat aspects of the condition without collaborating. The nutritionist treats dietary habits, the fitness coach addresses exercise habits, the endocrinologist may explore the underlying endocrine disorder, etc. in competing and typically non-collaborative services.

A patient might find short-term weight-loss success through an intensive exercise program, weight-loss medication, surgery, or dietary changes but, as with any complex, chronic, relapsing disease or addiction, rarely are those short-term successes sustained,” Dr. Landau explained. “Without addressing the emotional, psycho-social triggers of any complex, chronic, or relapsing disease, acute flare-ups can be expected repeatedly and frequently. Conversely, without addressing the medical issues, acute flare-ups and relapse are also inevitable.”

Collaborative care improves outcomes significantly. A treatment study revealed that “60 percent of patients receiving integrated care achieved substance abuse remission but only 20 percent of those receiving separate addiction and mental health treatment,” Landau told the webinar audience.

Families need collaborative care, too. “If there is an intergenerational history of substance misuse and mental illness, the family is likely to have developed dysfunctional patterns. Hyper-vigilance and fear of social stigma may delay their seeking treatment,” Holcomb said. “To meet these treatment challenges, we need to provide continuing care rather than episodic treatment. We need interdisciplinary collaboration to handle the complexity of the multiple challenges, and we need adequate training in collaboration and involvement of colleagues from other disciplines to arrive at an accurate diagnosis.”

Landau and Holcomb presented their definition of effective, multidisciplinary collaboration:

• The coordinated efforts of conventional, complementary, and alternative practitioners working with the individual and the family.
• The goal is long-term biopsychosocial, cultural, and spiritual health.
• The basis is trusting the individual and family’s intrinsic capacity for healing.
• The goal can be realized when all are connected with resources that enable them to access their inherent resilience, strength, and competence.

“The most significant predictor of treatment success is the provision of an empathic, hopeful, continuous treatment relationship in which integrated treatment and care coordination are provided over time,” they emphasized.

Families need to be integrated into the collaborative approach because they are “a valuable resource and source of support for the management of any illness, and families provide a more accurate picture of the individual’s symptoms and compliance than the individual alone. Without involving families in healing, we lose our most important resource.” 

In conclusion, Dr. Landau briefly introduced Transitional Family Therapy (TFT), an evidence-based therapy that helps access and facilitate family and community links to build a matrix of healing in families and communities by enhancing relational resilience.

Key actions of TFT are

• Empower family, community, and natural support system
• Reinforce connection to family and culture-of-origin
• Focus on individual, family, and community healing and recovery versus pathology
• Resolve unresolved grief and trauma
• Moblize and reconnect the extended natural support system

Harmony Foundation has long utilized a holistic approach to healing addiction and co-occurring conditions such as trauma, depression, and anxiety. All staff at Harmony have been trained in trauma-informed care. Realizing that addiction is a biopsychosocial and spiritual disease, Harmony’s treatment program promotes physical, emotional, and spiritual healing, empowering patients to embark upon a lifelong recovery journey.

If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.

What is the most significant leadership and ethical challenge facing behavioral health? How do you prevent burnout? What do you do to reduce turnover? How can you achieve a healthy culture?

In a recent webinar for Harmony Foundation, Maeve O’Neill, MEd, LPC-S, CHC, CDTLF,  looked at questions concerning ethics, compliance, and leadership in behavioral health, using the research-based work of Brené Brown, who has extensively studied the topics of courage, vulnerability, shame, empathy, and leadership. Brown’s presentation on the power of vulnerability is one of the most-viewed TED talks, with over 60 million views. 

O’Neill has worked in behavioral health for 35 years. Her first ten years were in direct clinical service with all populations, ten years in program management with all settings, and the last 15 years in executive leadership with national organizations specializing in Ethics and Compliance. She is currently the Director of National Compliance at Circa Behavioral Healthcare Solutions.

The webinar explored strategies to engage staff proactively and mitigate burnout risks. O’Neill looked at tools and insights needed to foster a positive organizational culture, emphasizing the importance of ethical practices and compliance within the workplace. 

O’Neill presented a roadmap using the work of Brené Brown’s “Dare to Lead” program to engage staff, empower teams, and enhance organizational culture. 

O’Neill began by talking about healthcare worker burnout, explaining that “burnout is the result of chronic workplace stress due to an imbalance between job demands and resources.” It is characterized by “feelings of energy depletion or exhaustion, increased mental distance from one’s job, feelings of negativism or cynicism, and reduced professional efficacy.”

Actions leaders can take today to support team members’ well-being and retention may include adjusting expectations, shoring up staffing, and getting rid of stupid stuff. A 2020 paper on practices for improving the well-being of clinicians recommended periodic assessments of the following:

1. Clinician well-being, using one of several validated instruments
2. Departmental or business unit-level leadership qualities
3. The efficiency of the practice environment
4. Culture and trust in the organization
5. Organizational cost of clinician burnout
6. Workforce recruitment and retention

Part of creating a culture of trust could be establishing a chief wellness officer position. The role of such a well-being manager should involve “creating a workplace environment where all individuals thrive,” said O’Neill. “Workplace well-being must be a whole-person approach encompassing mental, emotional, physical, social, and financial elements. Leaders need to show up with an open mind and find innovative ways to nurture the well-being and growth of their employees.”

A work culture of “blame and shame, burn and churn, or command and control” is to be overcome. O’Neill introduced Brené Brown’s books Atlas of the Heart, which describes human emotions and experiences and the language used to understand them, and Dare to Lead: “When we dare to lead, we don’t pretend to have the right answers; we stay curious and ask the right questions.”

William White’s 1987 classic The Incestuous Workplace also analyzed workplace dilemmas such as corroding trust, lack of innovation, a shame and blame culture, and other “barriers to courage.” 

The Brené Brown approach includes skill sets such as “Rumbling with Vulnerability” and “Living into our Values.” Leadership should take risks and inspire, explained O’Neill. Feedback should be understood as a function of respect. “When you don’t have honest conversations with us about our strengths and our opportunities, we question our contributions and your commitment. Above else, we ask you to show up and dare greatly with us.”

A leader is anyone who takes responsibility for finding the potential in people and processes and who has the courage to develop that potential. Brown teaches that “daring leaders who live into their values are never silent about hard things.”

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.

“The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health,” wrote Belenko, Hiller, and Hamilton in a 2013 study on treating substance use disorder (SUD) in the criminal justice system. Unfortunately, only a small number of people who could benefit from treatment actually receive it while involved with the CJS. 

In a recent webinar for Harmony Foundation, Jessica Swan, MCJ, MAC, looked at how society responds to justice, mental illness, and substance use disorder. Swan is the executive director of Recovery Consulting. She has extensive experience in clinical addiction counseling, research, development, training, evaluation, and reporting for legal professionals, non-profits, governmental agencies, and communities nationwide. She writes addiction recovery curricula for treatment programs, offers counseling for individuals and families with SUDs, and provides addiction recovery consulting for organizations.

First off, Swan looked at how justice can be defined. As it turns out, it’s not that easy to define. Justice involves “concepts of fairness, equality, freedom, moral behavior, lawfulness, and order,” explained Swan. But we also have to consider the “specific context of time, culture, status, power, and demographic influences such as gender, race, ethnicity, age, and socioeconomics.”

Americans frequently think of justice as punishment, retribution, and correcting “bad” behavior, though. Overall, justice should not just be seen as a collection of laws but as the aspirational goal of justice for all with agreed-upon moral and ethical standards—a way of organizing society.

Swan then talked about justice and health—as “fairness in how people are treated and their ability to achieve the highest attainable standard of physical, mental, and social well-being. Justice is about the law but also about democracy, and it has the potential to be about health.”

Swan explained that five social domains determine health: healthcare access and quality, economic stability, social and community context, neighborhood and built environment, and last but not least, education access and quality.  

The determinants have a significant impact on the demographics of the justice system. The vast majority of the US prison population is male, with drug trafficking the most common crime by a wide margin. A significant share of the prison population is repeat offenders. 

In 2021, 67 percent of the federal prison population was either African-American or Hispanic. Only 30 percent were non-Hispanic white people, who make up 59 percent of the general population. African Americans or Hispanic people comprise only 13 and 19 percent of the US population, respectively.

Many of the prisoners were using drugs and alcohol when they committed their offenses, and many of them have a substance use disorder. Many people in the prison system also present with serious mental illness. However, “research shows that people with mental illness are not more violent than people without mental illness,” Swan said. 

As addiction professionals know well, there’s a strong correlation between substance misuse and mental health disorders. “Adults with co-occurring mental health and substance use disorders make up about two in 100 adults in the US but 15 in 100 adults arrested,” Swan told the webinar participants.

While many of them clearly need help, their mental health conditions actually have a very negative impact on their treatment by the justice system. “People with co-occurring mental health and substance use disorders are less likely to post bond, experience longer rates of incarceration, and are more likely to be placed in solitary confinement where symptoms dramatically get worse,” Swan said. 

While the focus often remains on punishment and retribution, decades of scientific research have shown that “providing comprehensive substance use treatment to criminal offenders while incarcerated works, reducing both drug use and crime after an inmate returns to the community.” Nevertheless, only seven percent of incarcerated people with co-occurring mental health and SUDs receive services for both problems. “Treatment during incarceration can reduce the risk of an overdose after release by 85 percent,” Swan reported. 

Without adequate treatment services, the risks after release from prison remain high. Such individuals are 62 percent more likely to die by suicide and 40 times more likely to overdose than the general population.  

In conclusion, Swan discussed possible solutions. “Incarcerating instead of treating is not a solution. That is justice solely as retribution when mental health and substance use disorders are the actual problems.”

Targeting the underlying issues includes known solutions such as better access to healthcare, improving community well-being, reducing early exposure to violence and accessibility to alcohol and drugs, and actively engaging in efforts to reduce racial inequality in the justice system. Other known solutions are enrolling people in Medicaid as they leave jail and prison, connecting people to services prior to leaving, and providing medications upon departure. 

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (866) 686-7867 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.

Although the use and possession of cannabis continues to be illegal under federal law, so-called “medical” and recreational marijuana use has become increasingly widespread in the United States after 38 states and Washington, DC legalized “medical” cannabis, while 23 states and DC have legalized its recreational use. 

Today, a majority of US states permit the sale of so-called “medical” marijuana for various ailments, although the federal Food and Drug Administration has not approved marijuana as a medical treatment—in fact, the FDA continues to classify cannabis as a Schedule I controlled substance “with no currently accepted medical use and a high potential for abuse.” Because of the continued legalization across the country and the assumption of medical benefits, however, risk perception has plummeted.

In Colorado, cannabis has been legal for “medical” use since the year 2000 and for recreational use since late 2012. In November 2000, 54 percent of Colorado voters approved Amendment 20, allowing the use of marijuana in the state for approved patients with written medical consent notes (doctors cannot actually prescribe “medical” marijuana in any state because it is not an FDA-approved medication). California was the first state to legalize “medical” marijuana in 1996. Washington and Colorado were the first states to legalize its recreational use back in 2012.

While many Americans, including some physicians, believe in the unproven health benefits of cannabis—some of which may or may not exist—few people know the danger of addiction and other mental health impacts of marijuana use. Recent research estimates that approximately three in ten people who use marijuana have marijuana use disorder. For people who begin using cannabis products before the age of 18, the risk of developing a marijuana addiction is even greater.

Few people are aware that the legalization is primarily driven by well-organized multi-state operators selling largely unregulated and unsafe commercial products. Foundry Treatment Center Steamboat CEO Ben Cort has been raising awareness of these issues for years. In a recent webinar for Harmony Foundation, Cort explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the weed people smoked in the 1970s. The reason is the THC content of today’s cannabis products.

Marijuana is a mind-altering drug derived from the Cannabis sativa plant. It has over 480 constituents, with THC (delta9-tetrahydrocannabinol) being the main ingredient producing its psychoactive effect. 

As Cort explained during the webinar, the THC levels in cannabis products have dramatically increased in the last few decades from less than one percent THC in the seventies to well beyond 15 percent in recent years. And that’s just the plants—concentrates can reach much higher levels of THC. 

According to the National Institute on Drug Abuse, “Solvent-based products tend to be especially potent, with THC levels documented at an average of about 54–69 percent and reported to exceed 80 percent, while non-solvent-based extraction methods produce average THC levels between 39–60 percent.”

“The average cannabis product sold in Colorado in 2016 had a THC content of 63 percent,” Cort said. He doesn’t really want to talk about the plant anymore because the people who are treated at Foundry for cannabis use disorder (CUD) have not been smoking the pot passed around in the 1970s.

“Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana,” Cort wrote in his 2017 book Weed, Inc. “You are going to think some of this must be talking about hardcore users on the edge, but it’s not; concentrates are everywhere and have become synonymous with weed for this generation of users.” 

Boomers and Gen X Americans grew up when cannabis was far less dangerous while the risks of cannabis use were publicly exaggerated. Now, the opposite is the case: risk perception is at an all-time low while the product has become much more potent and consequently much more dangerous. 

“We now have a generation that believes cannabis is not harmful and not addictive, but cannabis use disorder is very real and not that easy to treat,” Cort said. “To downplay the significance of addiction to THC shows a lack of understanding of addiction as a whole. Addiction isolates us, destroys our families, and guts our communities from the inside. It keeps us from connecting with one another. Addiction gets in the way of living our best lives.”

THC addiction often requires long stays in treatment and antipsychotic medications, and many patients require a physical detoxification. Traditionally, about ten percent of cannabis users were expected to develop an addiction to THC but that rate appears to have gone up to 30 percent, with dramatically increased potency being the main suspect. 

Cort pointed out that the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists several specific symptoms of cannabis withdrawal syndrome, including irritability, anxiety, depressed mood, and insomnia. He presented the results of a 2020 study that found the prevalence of cannabis withdrawal syndrome to be 47 percent, with frequent users exceeding even that. “Cannabis withdrawal syndrome appears to be common among regular users of cannabis, particularly those in outpatient and inpatient settings and individuals with substance use disorders,” the authors wrote. “Clinicians should be aware of the high prevalence of cannabis withdrawal syndrome to counsel patients and support individuals who are reducing their use of cannabis.”

In his experience, symptoms of cannabis withdrawal syndrome typically peak after 3–4 days, with a strong resurgence of physical symptoms after two weeks. “Normalized use of cannabis by family members makes it hard for some members to relate and feel supported to stop using,” Cort told the webinar participants. “At Foundry Treatment Center Steamboat, we treat families in which cannabis use complicates the ability for people to enter and sustain recovery.”

Harmony Foundation has long utilized a holistic approach to healing addiction. All staff have been trained in trauma-informed care. Realizing that addiction is a biopsychosocial and spiritual disease, Harmony’s treatment program promotes physical, emotional, and spiritual healing, empowering patients to embark upon a lifelong recovery journey.

If you or a loved one are struggling with alcohol or drug addiction or have questions about our programs, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.