What’s Up with Civil Commitments for Substance Abusers?

There are times when we cannot act in our own best interests and others need to intervene. When people are deemed to be a danger to themselves or others a judge can order treatment. Most people are aware of involuntary commitments to psychiatric care especially in the case of suicide or homicide. But civil commitments to substance abuse treatment is less frequently ordered. The opioid crisis has led to a surge in petitions for civil commitments. Too many people have died of opioid overdoses and families are desperate for help to keep their loved one alive. Listen in to this opiate support recovery group discuss their experiences with civil commitments.

Discussion Guide:

Have you ever been involuntarily committed to treatment because you were thought to be a danger to yourself or others? What was the process?

Do you believe that involuntary commitments are helpful? Can it keep people safe?

Are involuntary commitments appropriate for opiate dependent people to ensure they don't die of overdose?

Not all counties offer civil commitments for substance abusers. Does your town have a commitment process for substance abusers?

If you were involuntarily committed to treatment in your town, are there programs in your area that are skilled, accessible and affordable? Do you trust a judge's opinion on where they may send you?

What could go wrong with involuntary commitments?

Supplemental Reading:

Maria Cramer, Worse Than Jail: Addicts Civilly Committed Say DOC Abused Them and Failed to Treat Them, https://www.boston.com/news/local-news/2017/07/14/worse-than-jail-addicts-civilly-committed-say-doc-abused-them-and-failed-to-treat-them

Are Narcan Parties a Thing?

Have you heard the rumor that groups of people are having Narcan parties? It is alleged that thrill seekers want the experience of dying and are using Narcan to pull them back from death. Is it fact or fiction? Listen in to this opiate recovery support group as they give their opinions on the subject.

Discussion Guide:

Have you heard of "Narcan parties" also known as "Lazarus parties"?

People who abuse substances are risk takers. They never know if they will die from their next fix. Have you pushed the limits so far that you have depended on someone else to bring you back with Narcan?

Do you think the people who would participate in a Narcan party are suicidal, thrill seekers or both?

Who would be more likely to use Narcan to bring them back from the dead? An opiate dependent person or a non-dependent person?

What does Narcan do to a person who is addicted to opiates upon their regaining consciousness?

Have you ever known a drug dealer to offer Narcan with their heroin or opiates? What would the purpose be?

How will the so called Narcan parties hurt opiate addicts and add to the stigma against them?

Who benefits from the reports of these parties?

Supplemental Reading:

Chris Elkins, Are Narcan Parties Really a Growing Trend? http://www.drugrehab.com/2017/05/12/are-narcan-parties-a-growing-trend/

Don’t Forget Funding for Methadone

The 21st Century Cures Act, approved by the US Senate, designated $1 billion in grants for states to fight the opioid epidemic. It will provide significant funding for Buprenorphine and Vivitrol. Both of these medications are effective and can be prescribed from a doctor’s office. But what about Methadone? Methadone treatment should also be expanded. The World Health Organization places Methadone on its list of "essential medications." Listen in to this opiate recovery podcast as they discuss their reaction to this news.

Discussion Guide:

Why do you think the majority of the funding will go to Buprenorphine and Vivitrol?

Have you experienced a stigma against Methadone in favor of Buprenorphine or Vivitrol?

There are costs and benefits for each of these medications. What are they?

Do you have an opinion about where federal funding is best allocated for opioid prevention and treatment?

Supplemental Reading:

Jessica Gregg, Don’t Forget Methadone, https://www.thefix.com/do-not-forget-methadone

 

Do Employers Have a Duty to Accommodate Workers Who Have a Past or Current Substance Use Problem?

You can't be under the influence of a substance and expect to keep your job. Or, can you? It gets complicated with the legalization of marijuana. Listen in to this opiate recovery support group as they discuss their experiences and opinions on employment and substance use policies.

Discussion Guide:

Have you experienced discrimination as a result of a drug or alcohol screen on the job?

Have you had a positive experience with an employer who offered resources or sick leave in order to accommodate your needs and preserve your job?

Federal and state law dictates how employers are to treat employees who have an active substance use problem, and how to treat someone with a history of addiction. What are the laws in your state?

Are you familiar with the American with Disabilities Act (ADA)? The ADA covers businesses with 15 or more employees and protects workers with a history of illicit drug use under certain conditions. Do you know what the conditions are?

Under what conditions is alcoholism treated as a disability?

Does your employer have a written drug and alcohol policy in place? Have you read it? Would you feel safe to disclose your drug use history and progress?

What is your opinion regarding the handling of medical marijuana in the workplace? Should it be accommodated even if you are under the influence?

Suppmental Reading:

Lisa Nagele-Piazza, Accommodating Workers with a History of Substance Abuse, http://www.shrm.org/resourcesandtools/legal-and-compliance/state-and-local-updates/pages/accommodating-workers-with-a-history-of-substance-abuse.aspx

One Member Shares His Experience of a Near Relapse

One of our members faced a tough time in his recovery. His recovery was challenged by someone who came to his home with the intention of selling a substance to him. Listen in to this opiate recovery podcast as they give support to this member. They walk through a process to better understand the situation and develop a relapse prevention plan.

Discussion Guide:

Describe a situation that caused, or nearly caused, a relapse.

What was your intention at the time? What did you want to have happen?

What was your belief about the situation? What were the automatic thoughts that came to your mind? Can you identify faulty thinking?

What were your feelings? What emotions caused you be vulnerable at the time?

What was, or could have been, the negative effect of a relapse to yourself? To others?

What is your prevention plan? Identify the steps you will take to avoid a future relapse.

 

We Can Learn About Prevention From Iceland

20 years ago Icelandic teens were among the heaviest-drinking youths in Europe. Today, Iceland has one of the cleanest-living teens. The percentage of 15 and 16 year olds who had been drunk in the previous month dropped from 42 in 1998 down to 5 percent in 2016. The percentage who have ever used cannabis is down from 17 percent to 7 percent. Teens smoking cigarettes every day fell from 23 percent to 3 percent. This could serve as a model for other countries. The turnaround of teens in Iceland was radical and evidenced based. Listen in to this opiate recovery support group as they discuss the findings and whether they think this model would work in the US.

Discussion Guide:

How do you think Iceland brought down the substance use of teens?

As a teen, did you engage in a wide range of recreational activities?

If not, would you have turned to drugs if there were other means to enjoy yourself?

Can you think of other protective factors against substance use?

Would you recommend changing laws, curfews, parent-child interactions, etc?

Why would the protocol in Iceland not necessarily be effective in the US?

Supplemental Reading:

Emma Young, Iceland Know How to Stop Teen Substance Abuse – But the Rest of the World Isn't Listening, http://digg.com/2017/teen-substance-abuse-mosaic

Is It Hard for You To Ask for Help?

Many people have difficulty asking for help. Especially when it pertains to an embarrassing or shameful situation. People who realize they need help for an addiction can be reluctant to reach out. Listen in to hear our opiate support group talk about their experiences of asking for help.

Discussion Guide:

Is it easy for you to ask for help? If not, which of the following ways would make it easier? What are the pros and cons of each?

1. Write your request in a letter or email

2. Talk to someone you trust

3. Discuss your struggle with a stranger

4. Reach out to a medical professional

5. Search for online resources

6. Seek out someone who has been in your position

7. Call a helpline

Supplemental Reading:

Beth Leipholtz, 7 Ways to Ask for Help When You're Struggling with Addiction, https://www.thefix.com/7-ways-ask-help-when-you-re-struggling-addiction

What I Learned From a Police Officer Ride-a-long

Group facilitator, Gail, was given the opportunity to witness first-hand what it is like to be a police officer in Duluth, MN. It was an exciting ride as she witnessed a drug bust and got a glimpse of the opiate scene in that community. Listen in to this opiate recovery support group as they share their experiences with the law.

Discussion Guide:

Has your clinic been under scrutiny by the police and licensing bodies for poor behavior?

Are you aware of improper, unsafe, or illegal activity within your clinic that puts the clinic or other patients at risk? If so, have you intervened and informed the clinic staff?

If you saw such behavior, would you know who to report it to?

As a person who purchased illegal substances from drug dealers, do you have bad feelings toward them?

Did anyone suffer injury, overdose or death from a substance that you provided? Do you regret it?

If so, how do you cope with other's suffering because of something that you had a hand in?

Should the police set up stings to get drug dealers off the street?

What are your thoughts about the criminalization of drugs? What are the pros and cons for each class of drugs?

If you were aware of a drug dealer who mixed fentanyl and carfentanil with heroin to unsuspecting buyers, would you intervene?

 

What’s the Purpose of Support Groups?

Should you talk about your addiction war stories? Some people believe that telling your addiction history is not helpful. They fear that it could cause cravings and relapse to themselves and others. On the other hand, isn't your support group the appropriate place to talk out your trauma? It can be healing. Listen in to this opiate recovery support group as they discuss the rationale and goals of support groups.

Discussion Guide:

Have you felt that some of your group members have glorified their drug related behavior in the past?

If so, has that triggered a craving or relapse for you?

What are the pros and cons of telling your story to other group members?

What do you think the rationale and goals of support groups are?

What is the most helpful thing that you have experienced from your support group?

Supplemental Reading:

Group Interventions for Treatment of Psychological Trauma, http://www.agpa.org/docs/default-source/practice-resources/group-interventions-for-treatment-of-trauma-in-adults.pdf?sfvrsn=2, see page 32-33.

Is It OK to Stay on Maintenance Medication for Life?

A podcast listener asked the group a question. Do any of them want to stay on a maintenance medication indefinitely? He feels a subtle pressure to wean off his medication by his treatment clinic and wonders if this is true for others. Is it OK to stay on Medication Assisted Treatment forever? Listen in to this opiate support group talk about their progress, intentions and hopes for the future.

 

Discussion Guide:

If you are on a maintenance medication for opiate recovery, have you thought about whether you want to wean off your medication?

Have you experienced pressure from your clinic, or others, to either stay in Medication Assisted Treatment, or pressure to wean off?

What is your personal preference for how long you should stay on MAT?

How do you handle the stigma against MAT?

Do you believe there is any long term harm from staying on MAT indefinitely?

Are you familiar with the Tapering Inventory tool? If not, see Tapering From Methadone (below)

 

Supplemental OpiateSupportGroup.Com Podcast Listening on When or Whether You Should Stop MAT:

Ask The Expert: Dr. Mary Wenzel http://www.opiatesupportgroup.com/ask-the-expert-dr-mary-wenzel-addiction-specialist/ 

Should You Stop? Criteria for Ceasing Medication Assisted Treatment http://www.opiatesupportgroup.com/should-you-stop-criteria-for-ceasing-medication-assisted-treatment/

What You Should Know About Methadone http://www.opiatesupportgroup.com/what-you-should-know-about-methadone/

Tapering From Methadone http://www.opiatesupportgroup.com/tapering-from-methadone-2/