i have been a counselor for a few years now and i have noticed a shift in my strategies with clients. i used to work very hard to help the client see something new for themselves. this is not so much a focus of mine these days. i have shifted to assisting the client in seeing where they are and reminding them of hope in general.
i don't know if this seem clear, but it is a distinct shift in focus and i have come to believe that hope is paramount in getting clean. all the other emotions come and go, but if there is not a connection to hope, the likelihood of success or even movement dwindle.
most of the guys i work with have the same emotional challenges, but they are layered quite differently with each individual. it's almost like the hundreds and hundreds of plaid patterns that exist. they are all plaid, and yet they are each unique with color, band width, specific pattern, and even texture. it's rarely the same.
i am learning to really appreciate the subtle difference in color and pattern in plaids. i am realizing there is so much i have not understood until now. it is a fantastic and colorful journey.
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
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!
al those wasted feelings for something I no longer have
I never knew that love could hurt so bad
Winter melody, winter melody, winter melody
play for me, just for me,... Donna Summer
i received a call from a probation officer the other day with regards to someone i have been working with. a few months ago during a group session, there seemed to be a shift for several of the members and they went a little deeper into themselves and shared what was going on. there were quite a few tears, quite a lot of exposed feelings and some growth (i hope) ensued.
one of the members was visibly shaken by all this honesty and introspection. he was affected by the whole thing and stopped coming to group. the audacity of people feeling their feelings and expressing that was just like the midday sun burning his heart's eyes. he retreated back into the shade of his mind and changed his course.
unfortunately with probation, one is sentenced to complete tasks if one is to progress. so he is now looking for alternative ways to finish his requirements. he is looking to complete this without the witnessing by a group at all. This is possible, but it requires cash, as individual therapy is more costly than group sessions, for obvious reasons.
this particular individual has a history of frozen feelings and whacked anger issues, and i wonder if all this is simply part of a spectrum of events that are leading to his "thaw". he has been afraid to feel his feelings for quite some time and has made grand gestures and engaged in activities to avoid doing just that. now that he has no access to those things, and has stopped self-medicating, he finds himself closer to his own truth. and when tears and honesty confronted him, he panicked and ran, because that's what he's become accustomed to doing. but he has a wonderful opportunity to take a look at his life, notice the fear, and address it anyway.
we'll see what happens. but i know that witnessing lives change is one of the blessings in my career. change is hard, but just as in any good thaw, it can clean away so much dirt and debris and leave things in much better condition. but damn, in mid-winter, when things are frozen and dry and dead, it is almost impossible to envision an oasis like spring. i hope he can find enough faith and hope to make the journey.
i've been hoping to post today's sound choice for awhile now. i remember this song so well, and it used to pry open my heart with just one bridge. here is donna summer with "winter melody"
the huddle has begun. it's drawn people - about 7 or so each meeting. it has been marketed about 3 weeks now. there are conversations happening and there has been a spectrum of use issues thus far. this is the purpose of this venture. a place within our clinic setting for lgbt patients to develop a sense of community within the divisive nature of their struggles. and people are talking each meeting. but i have rarely known too many gay people to have difficulty talking when they feel somewhat safe. even if it is only to bitch. (although this is not how this hase rolled out thus far.)
the circle starts early next month. it is hoped that this will offer support and insight to folks who are struggling with inspiration and direction in their lives- substance use and abuse being one of the issues at the top of that list. it is thought that the journey with hiv (pre or post diagnosis) can be so engulfing that it can become difficult to pick oneself up, dust oneself off, and move forward. it is hoped that this process will offer some assistance with this piece of life. it's based on journaling and reconnecting with one's internal guide or creative force. it is believed that eveyone has an internal voice, and although they may have different volume settings, they are none-the-less valuable to each of us for our survival. this group is to be co-facilitated by a psych nurse so if an issue of a deeper nature arises, we should have immediate support available. and if no such happenstance occurs, we will have fun remembering our less mature and responsibility-burdened selves.
this seems to represent a shift in direction for our little universe. it feels a privilege to be witness this shift and participate in it. i am truly grateful for the opportunity and anticipate the direction that it takes me.
today's sound choice is soft and soothing for me. it is dashboard confessional with "stolen"
There is nothing like returning to a place that remains unchanged to find the ways in which you yourself have altered. - Nelson Mandela
i had the pleasure of being shadowed at my job last week. it is not my favorite experience. a stranger following you, listening to your dialogues, and offering feedback and criticism to you as part of their job. we are grant-funded however, and the manager of the grant has their responsibilities, just as i have mine. and you never know what you have to learn.
it turned out to be a very pleasant experience. our clinic was cancelled that day as the attending was persuaded to have labor induced and gave birth to twins. so the person responsible for shadowing and i had lunch and talked about the program, and then she sat in on 3 individual sessions i had scheduled for that afternoon.
there is a movement underfoot in our state to examine and reshape the idea of substance abuse treatment and referral in the medical setting. i actually believe it's probably long overdue. the indulgences and over-indulgences of tobacco, drugs, and alcohol do have health implications and they tend to be serious. they also tend to be costly.
tomorrow i will be attending a conference put on by the grant program which is really a brainstorming session. they are expecting 150 persons and have some relevant speakers. i have been asked to join some others and moderate discussions at my table and to report to the larger group. i am fortunate enough to be bringing the HIV perspective to the conversation. and i shouldn't have to tell you how intrinsically linked HIV and substance use/abuse are.
our state traditionally has been ranked 48th in spending for substance treatment. this is not a fact that i am boasting about. it is merely a reading of the importance this issue has in Colorado. so in the sbirt screening process, referral to appropriate treatment modalities is paramount. but i fear they are limited, hard to find, and challenging to discern the appropriate fit. my hope is that tomorrow's dialogue will signal some change in this attitude and create some momentum that collaboration and systemic change needs to happen.
i mean, if we don't believe someone getting clean and sober is important, or that moderation is actually a virtue and saves lives, how likely is any individual to believe it either?
today's sound choice is the highly underated royal crown revue with "something's gotta give" - yes that's a rat pack remake... i certainly had my days of being a rockabilly/swing afficianado... i even learned how to do the lindy hop..
he called and said he needed some help. he had started journaling and realized that he was fucked up. he was smoking so much pot that he wasn't doing a very good job of keeping his thoughts together. he has stopped doing all the coke and meth he was doing. and he felt good about that. but he was smoking crack now and again. he had a friend that came over on monday nights, they would smoke crack, have sex, and make a big mess in his room. he would fall asleep and his friend would end up eating a lot of the food in his pantry, so he would go without sometimes at the end of the week. he smokes pot every day and spends about $40 a week on that. he has a couple of drinks once or twice a week, but he has been very good.
he weighs about 120 lbs. he doesn't remember things very well. he is thoughtful and at one time was a really wonderful musician. but those things have receded. medication, food banks, doctor's appointments, and taking the bus have become his pastimes.
so he said he wanted help with a plan to stop smoking pot. he smokes everyday. several times a day, i am sure. i will be here to help him.
but i asked him if he thought he could give up the crack, too. he said he was too weak to have his friend over and not smoke crack. so he might consider not having his friend over. realistically, however, this is his only romantic entanglement. and he recently also told me he really wants a boyfriend.
thanks b2u for indulging my emotions this week. i am undergoing a culture shock and am doing my best to keep my head above water. but goodness knows i really needed a change and i believe the universe is looking out for me once again. i also find that some of my values may have been slipping back into a more selfish realm, definitely a side effect of fear and insecurity. i hope i am recognizing this in time and can make the necessary adjustments to get back to looking at the world with loving eyes. oh yeah, and a loving heart. i am to be conducting interviews over the next year and making referrals to treatment as well as developing a support mechanism for the clinic i will be working in. i am humbled and thrilled at the opportunity, but feel much more blessed that the team i am working with are already in my corner and have been actively working to bring me on board. in the referrals to treatment arena, the conversation i knew had to happen did just that. it is with reference to an experience that i have worked through, but perhaps not let go. ergo- resentment. and resentments really are poison. i know that the more i hold onto it, the more distorted my perception. honestly, i am working on this. forgiving an abuser has proven not to be a simple thing for me. in turn, however, it sets me up to re-enact that abuse, which is something i very much want no part. but no matter how much i try to cover up and disguise my past hurt, i am pretty sure you can still see the tracks of my tears.
today's sound choice is this season's idol frontrunner- adam lambert with "tracks of my tears"
happy st patricks day to y'all and top o' the morning. another spring has arrived and life seems quite good. i have begun to walk the park as i have taken the entire fall and winter off (and gained significant weight i might add). it was challenging yesterday just for me to get the 3 1/2 miles around.
the peer mentoring training (hiv one on one) starts on saturday. our out of town guests will check in to their hotels on friday. this is exciting and no doubt will be an adventure. we are hosting a party on saturday night and also a farewell dinner on tuesday night. lots of things happening.
on thursday evening i am scheduled to attend the first board meeting for ten. it should be interesting to say the least. i have found myself feeling a myriad of things with regard to this project. the good thing is that i'm learning i'm entitled to my feelings, whether they are helpful or not.
and i still wait to hear about a new gig which will no doubt change my life enourmously. i haven't worked a 40 hour a week job since last year, and it may take some readjusting. and i don't know if i've even approached the land of "i didn't get it", but that may need to be visited, too.
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.
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.
