crazy is in the eye of the beholder

healthcare reform and recovery

Here is a brief synopsis of some changes in the new healthcare reform bill passed this week with regard to substance use and mental health disorders. of course, this is merely an overview, but it does give an indication as to the fresher perspective (and much needed) and possible new approach to these very abundant needs. this information was produced by the Legal Action Center.


The Legal Action Center is the only non-profit law and policy organization in the United States whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas.

For three decades, LAC has worked to combat the stigma and prejudice that keep these individuals out of the mainstream of society. The Legal Action Center is committed to helping people reclaim their lives, maintain their dignity, and participate fully in society as productive, responsible citizens

Big thanks to Tonya Wheeler at Advocates For Recovery for sending this out.

federal healthcare bill becomes law, includes major ADDICTION AND MENTAL Illness Prevention, Treatment and Recovery Provisions


Today, President Obama signed into law H.R. 3590, the “Patient Protection and Affordable Care Act.” The new law, approved by the U.S. Senate on December 24, 2009 and the U.S. House of Representatives on March 21, 2010, is expected to expand healthcare coverage to tens of millions of Americans that are currently uninsured, resulting in 95 percent of the legal population being covered.
The new federal healthcare law includes a number of provisions aimed at improving coverage for and access to substance use disorder and mental illness prevention, treatment, and recovery services, a result of strong bi-partisan support in Congress and by the Obama Administration in addition to a unified and coordinated effort by advocates for people in need of substance use disorder and mental illness prevention, treatment and recovery support services.

The following is an overview of key components of the final legislation, including critically important addiction and mental health provisions included in the new law. The below also highlights provisions in the House-approved reconciliation bill, which would amend certain provisions of the new law unrelated to the addiction- and mental health-specific provisions listed below. The reconciliation bill is expected to receive a Senate vote later this week.


Major substance use disorder and mental health provisions in the new law include:

F0B7 Substance use disorder and mental health (SUD/MH) services in the basic benefit package. The final bill requires a basic benefit package for all health plans in the individual market and small group markets. All such plans will be required to cover mental health and substance use disorder services.
F0B7 The requirement that all plans in the health insurance exchange adhere to the provisions of the Wellstone/Domenici Parity Act. The final bill requires all group and individual plans to comply with Wellstone/Domenici, which requires that SUD/MH benefits be provided in the same way as all other covered medical and surgical benefits.

F0B7 The requirement that newly-eligible Medicaid enrollees, including childless adults, receive adequate health coverage that includes SUD/MH coverage. The final bill expands Medicaid eligibility to all Americans up to 133 percent of federal poverty and requires that all newly eligible parents and childless adults receive basic benefits, including SUD/MH services that must be provided at parity.
F0B7 SUD/MH in chronic disease prevention initiatives. The final bill creates a national prevention council with the ONDCP Director as a member and SUD listed as a national priority for that council’s report to Congress. SAMHSA is required to be consulted on issues related to preventing SUD and mental illness.
F0B7 SUD/MH MH workforce in health workforce development initiatives. The final bill includes the capacity of the MH and “behavioral health” workforce as high-priority topics in the bill’s National Workforce Strategy section.
F0B7 SUD prevention, treatment, and MH service providers to be eligible for community health team grants aimed at supporting medical homes. The final bill lists SUD and MH service providers among entities eligible for community health team grants.
Additional key provisions of the new law will:
F0B7 Expand Medicaid coverage to all Americans below 133 percent of the federal poverty level. This will expand coverage to an additional 16 million Medicaid beneficiaries, including childless adults for the first time in many states. 

F0B7 Create health exchanges for individuals and small employers to pool risk and purchase insurance. The exchanges seek to improve individual and small group insurance coverage by requiring transparency, mandated benefits and other types of consumer protections.


F0B7 Provide sliding scale subsidies for individuals and families up to 400 percent of the federal poverty level to purchase or take up offers of health coverage.
F0B7 Prohibit insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on gender or health status, and placing annual or lifetime caps on insurance coverage.
F0B7 Require individuals to carry health insurance or pay a financial penalty. The individual mandate seeks to ensure that risk is pooled among both healthy and non-healthy individuals, lowering costs and reducing the opportunity for people to wait until they are sick to access care.

F0B7 Close the Medicare “donut hole”. This provision in the House-approved reconciliation bill seeks to lower out of pocket prescription drug costs for Medicare beneficiaries.


F0B7 Allow adult children to remain on their parents’ insurance until their 27th birthday.


F0B7 Create a national high risk pool for adults with preexisting conditions. Adults with pre-existing medical conditions will be able to buy into a national high risk pool until the health exchanges are implemented.
F0B7 Reduce the federal deficit by $138 billion over the next 10 years and $1.3 trillion over the following 10 years. According to Congressional Budget Office estimates, the new law and House-approved reconciliation package pending in the Senate will result in significant reductions to the federal deficit.


Legal Action Center is continuing to analyze the new federal law and will release more analysis in the coming days and weeks. The full impact of many provisions will remain unclear until details are worked out through the regulatory process.
Please contact Gabrielle de la Guéronnière (gdelagueronniere@lac-dc.org) or Dan Belnap (dbelnap@lac.org) at 202-544-5478 with any questions!

joy

reactions from around the world (on election night 2008)

Do the one thing you think you cannot do. Fail at it. Try again. Do better the second time. The only people who never tumble are those who never mount the high wire. This is your moment. Own it.
Oprah Winfrey

someone i have come to know as a colleague in hiv work approached me yesterday with a query about a job offer. it would be connected with substance abuse at an hiv clinic. it also would include a decent salary, healthy benefits including retirement and health care. i was instantly humbled. there are two caveats i see in this. the first and most obvious was the big emotional hug and nod i received from this person. i received a validation that was completely unsolicited and was also heartfelt. i was told that the small organization loved working with me, and loved my approach to my work (i'm tearing up a bit as i type here). gosh, this feels good- whether or not the position comes through.

the other possible gift is that i could do participate in working with a mental health professional around treating substance abuse and mental health issues in accord. this particular item is of immense interest to me. in colorado, the fields mental health and substance abuse are treated separately. a person goes one place to deal with one and another to address the other. however, figures show that more than 50 percent of people with a mental health issue have substance abuse issues as well. additionally, it is shown that over 1/2 of people with substance abuse issues have active mental health issues too.

it has always confounded me that there aren't more processes geared toward and designed around this very large number of dually diagnosed. anyway, a good day for me. i am posting a set of pics sent to me called reactions from around the world. it has been a full week since these were taken. but the feelings from that night still glow inside.

anhedonia

Definition of Anhedonia
Anhedonia: Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences. Anhedonia is a core clinical feature of depression, schizophrenia, and some other mental illnesses.

An anhedonic mother finds no joy from playing with her baby. An anhedonic football fan is not excited when his team wins. An anhedonic teenager feels no pleasure from passing the driving test.

"Anhedonia" is derived from the Greek "a-" (without) "hedone" (pleasure, delight). Other words derived from "hedone" include hedonism (a philosophy that emphasizes pleasure as the main aim of life), hedonist (a pleasure-seeker), and hedonophobia (an excessive and persistent fear of pleasure).

anhedonia is a brain condition that can be brought about by prolonged stimulant abuse. the brain forms many extra dopamine receptors in response to it getting flooded by huge bursts of the chemical on a regular basis. it is fooled into thinking there is so much available that it needs to form more receptors to handle the flow.

once a person tries to stop their meth or cocaine use, the brain does not automatically understand this. the extra receptors are still active. they are like munchkins waiting for the arrival of glinda. and when glinda (the big dopamine dumps) doesn't come, they panic and cause the brain to react in a highly agitated and negative fashion.

being used to big highs and big lows, the brain can initially only understand that it doesn't feel anything close to what it's used to. it only feels nothing. it doesn't remember happiness or pleasure. it only feels empty.

this is anhedonia.

if you or someone you know is in early recovery, this can easily be a by-product of getting clean or sober. there is no real quick fix. the brain takes time to heal. plenty of liquids, good sleep, and antioxidants and free radicals can be helpful though. and so can a friend with a great sense of humor.

it can be quite a challenge to comfort a friend while they are in the throes of anhedonia. they may easily become emotional about the loss of pleasure. they may not remember the pleasure they had, even yesterday. they may convince themselves they have never felt such a thing as good. and they may be frightened they will never feel it again.

their brain may be fooling them into a relapse.

for more information on anhedonia and relapse, consult with a mental health or substance use professional in your area. if none are available try findin one through nimh. a person can definitely weather the storm that is anhedonia. i found help through a higher power.

(oh, yes--- and a sponsor, too!)

what's cookin'

You say that we've got nothing in common
No common ground to start from
And we're falling apart
You'll say the world has come between us
Our lives have come between us
But I know you just don't care

from breakfast at tiffany's by deep blue something

sunday morning...

i feel like being lazy, but i know i cannot do such. i have much to do. best friend coming to town on the 16th and i have to host. i have little free time these days, but it's of no real complaint. i can see some light at the end of this financial tunnel that i have found myself travelling in. it's far from over, but it is changing. and i'm thankful for that.

i spent a full week with clients and am feeling a little spent emotionally. i have been working with a homeless man who has schizo-effective disorder (currently untreated) who has re broken a never healed wrist three times. his drinking is more than problematic and he leaves a visible wake of damage with his unbridled and unchecked angry bursts. the first time we talked he discussed his spells (seizures) from which he emerges confused. he has become adept at covering them up with his rage now, or diverting attention to chaos. i wept inside as we chatted. my hope is to steer him to addressing his mental health in order to fix other parts of his life.

i also met a man directly from the bus from prison. he has spent the last 9 out 10 years inside. he has been diagnoses as bi-polar and has anger bursts as well. he is currently medicated, but i have concerns about his ability to restrain himself during an emotional break. he has the habit of blaming everything outside himself for his troubles and struggles to listen without having a big reaction when an opposite perspective is brought into the conversation. i did manage to help get him into a halfway house situation with substance use monitoring in place, in lieu of the crack hotels that are usually offered for a person in a re-entry position such as he.

along with this recent and very very questionable pop-up crisis and the ensuing 850 billion buyout, part of the negotiation package has been the passage of legislation which will direct insurance companies in overhauling their policies to discontinue discrimination for mental health and substance abuse issues. this is a quietly joyful celebration for insured individuals, but it certainly doesn't address the continent sized group of individuals' need for access to comprehensive care, i.e. a great proportion of our current homeless population.

but it's sunday, and i'm at rest. i thought i'd start a new periodic tradition here. i am, after all, a bit of a foodie. i love food intrinsically. a bit of a snob, but with a hearty sense of comfort food, i will try to share some recipes that warm my heart as well as fill my belly. i hope you try some of them, and pass them along. this one is about as simple as it gets. and it's a favorite at every family holiday event.

food is love, after all. have a peaceful and perhaps plentiful sunday.

chili cheese eggs

6 eggs/ 6 slices white bread
8oz cheddar cheese grated/ 1 3/4 c. milk
1 can chopped grn chilis/ 1 med. onion chopped.
salt and pepper

butter 2 qt. casserole. trim crusts from bread and cube. mix eggs and milk together.

layer bread, chilies, onions, and cheesein alternate layers. pour egg mixture over layers (you can add salt and pepper to egg mixture). refrigerate overnight. take out 1/2 hour before baking begins.
bake 1 hr@ 350 degrees.

serves 6-7.

forget regret

"One day at a time - this is enough. Do not look back and grieve over the
past, for it is gone: and do not be troubled about the future, for it has not
yet come. Live in the present, and make it so beautiful that it will be worth
remembering."

so much easier said than done. but i'm gonna try. well, i am typing this on sunday night. i am avoiding chopping some jicama for a salad i am taking to a SIN BBQ tomorrow. I look forward to getting out of the house and having some fun. i haven't cooked at home in quite a while.

i watched the national memorial day tv special and got a big lump in my throat. so many of our citizens fall into line in order to preserve the lifestyles and the ideals that i so often take for granted. i would never have been accepted into the service, but i never wanted to be, either. but the ones who give so freely of their time. and so freely of their hearts, their bodies, and their souls, really do merit acknowledgement from me. and i don't take the time or put the effort forth enough.

so often, i see scruffy men along the roadsides with cardboard placards etched in marker saying things like " homeless veteran- can't work- anything will help". my first reaction is always to look at their faces to discern the evidence of substance use. this is a nasty habit of mine and one of complete hypocrisy. i self-medicated for years, so where do i think i get the free pass to judge anyone else's? and yet i do. i rarely give money and i tell myself that i don't want to enable their addiction. but i think that is just a lotta bull. i don't take the time to recognize their humanity. i don't take a moment to honor their service and their dignity.

i realize that today is memorial day and not veteran's day, but i had this on my mind. i have things to work on certainly. maybe today is a good day to start...

this is the day

it is a simple concept. and it is what happens every 24. a brand new day. a way to start fresh and to reinvent myself and the way i look at the world. this is the day that more will be revealed. it ain't always easy to have this approach. same shit another day, is also an approach i have plenty of practice with. or more appropriately different shit, another wasted day.

but those weren't what i had in mind when i started typing. it starts here and it is my first endeavors of the morning which help to dictate how the rest of the day proceeds. do i start by getting grounded? by exercising? by meditating? by praying? by thinking of doing for others? if the answer to any of these is no, then i need to rethink my tactics.

i have learned through experience that leaving my life and my moods and my habits to chance and not steering them, puts me in a much more precarious position with regard to sanity. i have to train my mind, because it will run like a wild appaloosa if it is not harnessed. i know that with diligence, my moods will be steadier, my heart will be more open, and my deeds will demonstrate more thoughtfulness. this is how i prefer to live my days.

have you heard of "one day at a time?" of course you have, but have you tried it? i mean, really tried it? yeah? what do ya think?

my 72 year old uncle is in town from chicago, and after i work today, i will head to my cousin's house to see him. we haven't spoken in 7 years. i have some amends to do, but it should be fine, because he requested specifically that i come today. he has heard about the course my life has taken and wants to acknowledge his feelings (and mine). this is the day that more will be revealed. this is the day that may hold healing for the all the members of my family that are present for this.

i believe this is the "disinfected" version of this song. if you know "the the" then you get that the original album which hosted this song was titled "infected". matt johnson had shaved his head by the filming of this version and moved into his next phase of his journey. the original version of this song is from 1983. i guess it's a trip down memory lane for me today. i welcome you to come along if you like. lyrics posted below the youtube post. click on the post title above to see what matt's up to these days.

Well... you didn't wake up this morning
Because you didn't go to bed
You were watching the whites of your eyes
Turn red
The calendar, on your wall, is ticking the days off
The calendar on your wall is ticking
the days off
You've been reading some old letters
You smile and think how much you've changed
All the money in the world
Couldn't bring back those days.
You pull back the curtains, and the sun burns into your eyes,
You watch a plane flying across a clear blue sky.
THIS IS THE DAY -- Your life will surely change.
THIS IS THE DAY -- Your life will surely change.
You could've done anything -- if you'd wanted
And all your friends and family think that you're lucky.
But the side of you they'll never see
Is when you're left alone with the memories
That hold your life together like
Glue

walking wounded

Post traumatic stress disorder (PTSD) is the term for a severe and ongoing emotional reaction to an extreme psychological trauma. The latter may involve someone's actual death or a threat to the patient's or someone else's life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping.

It is important to make a distinction between PTSD and Traumatic stress, which is a similar condition, but of less intensity and duration.

i am posting on trauma today to speak to an acquaintance i have made in blog-world and i hope this is anything but sad. he experienced a pretty traumatic experience a couple of months back and i am only offering this perspective in reference to some things i have noticed, which he may very well be aware of anyway. it is by no means a judgement or a bitch. it is only offered with respect, because i experienced my own share of horrifying traumas and never realized that my reactions and behaviors afterwards (for up to years btw) were connected and resultant. sometimes people think the world is against them and become combative in response, and sometimes people assume they are to blame for everything. it is not exactly the same for everyone, but it does have an effect. i think that understanding what it is firstly, and then how it works are very crucial pieces to working through trauma and ptsd. of course there is always the saying: if it don't fit, don't force it.

as for me, in case you haven't already considered it, enduring these situations and experiences can and oftentimes does lead to substance use and addiction. the memories and reliving of traumas can easily lead one down the path of self-medication. and oftentimes a person gets stuck in that mode. drug and alcohol abuse and addiction have a closely knit relationship to trauma. and a common belief (and my own personal take) is that hiv creates trauma and that many of its carriers endure these very issues. this is true from my personal experience, although hiv was not the original trauma, it was an addendum trauma, which is also very common. a trauma survivor will engage in behaviors that perpetuate additional traumas.


what i have uncovered, is this syndrome, this disorder, went unchecked in my life for years and has left a crevasse as deep as the grand canyon in its wake. i always felt that i needed to be tough and that i had to handle all the negative self perceptions i took on as a result of terror. many of these i actually still hold on to at my core. it also became almost impossible for anyone to get beyond the emotional fortress i built to protect myself. i would re-enact bits and pieces throughout the years and destroy any good things i had created in my life. my friends and family can certainly attest to this fact.

but i am sure of at least one thing in my particular case. once i understood the ramifications of what has transpired in my past, and that my feelings were more reactionary than independent, it became more possible to move towards forgiving myself and my abuser. i began to let go of the shackles that those incidents had placed on me. and this has moved me much closer to being present and being able to participate in life today. i stress the importance of a trained and licensed professional. this can and did make all the difference in the world and paved the way for a 12 step program or any other process to actually work in my life.

one thing i personally believe to be true for many gay men:
we are queer! we have lived with and through fear!(remember the 80's?) we are walking wounded! we are survivors! we are healers! we are shamans!

i love my tribe!

this is an excerpt from an article from athealth.com

and then a clip of the corrs:




here is a link to find out a bit more about trauma and there are several more good ones on google as well. click here