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The Need for Improvement in Substance Abuse Treatments

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For decades now, America has been in the midst of a substance abuse epidemic. In fact, recent Pew research indicates nearly half of U.S. adults have a close friend or family member who has been addicted to drugs at one point in their life. The experience is so universal the dataset cuts across sex, race, age, education level, and even partisan lines. In short, it’s safe to assume addiction is as American as apple pie.

Every day, more than 115 people in the United States die after overdosing on opioids. Alcohol abuse has increased by 50% since the start of the century to the point where today, one in eight Americans abuses alcohol. According to a 2017 survey, methamphetamine has become the world’s most dangerous drug, as 4.8% of users required hospitalization in order to avoid overdose.

Though substance abuse has become a worldwide phenomenon, affecting millions of people, treatment for addiction is not nearly as universal. Public health officials have drawn attention to the problem in more recent years, yet only 10.9% of individuals who needed treatment in a specialized facility for a substance use or a dependency concern received it in the year 2013.

It’s an epidemic policymaker’s, mental health experts, law enforcement, and others are acutely aware of. But solving the problem on a wide scale has so far proven to be fruitless. Individual states have taken specific measures, like opening up safe injection sites, which allow those who struggle with addiction to use in a safe space around medical experts. It’s a solution which definitely won’t solve the addiction crisis, but it does work as a harm-prevention space. Other states have taken to suing the pharmaceutical companies themselves, using similar tactics which were used against Big Tobacco nearly 20 years ago.

While these are no doubt necessary and useful tactics which will help presently and in the future (if successful), there are other avenues that largely have yet to be explored. Perhaps the most simple form of aid is given through the Primary Care Provider (PCP).

While all doctors and patients are supposed to share a therapeutic alliance, based on mutual trust and respect, PCPs are in a unique position in the healthcare field. Often, these doctors have known their patients for a number of years, have a big picture view of their overall health over a period of several years, and are able to check in on a patient’s progress with every visit.  

Evidence compiled by a University of Michigan medical team suggests primary care physicians and their teams of nurses, medical assistants, social workers, and pharmacists can — beyond providing basic services every patient needs — also provide effective care for addiction. Including each of these moving parts not only ensures the patient is receiving quality care but also helps to ensure the patient does not fall through the cracks at any point during their recovery.

They achieve this primarily through the anti-opioid medication buprenorphine and counseling — a combination known as medication-assisted treatment (MAT). The researchers have recently published a peer-reviewed paper on the subject, where they pose this is an effective method of treatment. They do not argue, however, that it is an easy process.

“There is a major need to do this,” says Pooja Lagisetty, M.D., M.Sc., the study’s lead author and a University of Michigan primary care doctor who provides MAT to her own patients at the VA Ann Arbor Healthcare System. “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience. But if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible.”

This support must come from other parts of the medical team. As the patient goes through the process, non-physician team members aid with dosing, monitoring the patient, and check-ins by phone and in person. If done successfully, Lagisetty argues this method can achieve similar results to specialized treatment facilities, and it might reach more people.

“Patients might be more willing to seek help in a primary care setting because of the lack of stigma and the ability to address their other health concerns,” she said. It’s also likely to be less devastating to patients financially. All in all, this kind of treatment in Primary Care facilities makes sense.

While it’s unlikely primary care physicians pursued medicine with a desire to focus on addiction treatment, it’s a reality many are going to have to embrace and develop a protocol for as the problem persists or worsens.

There are, of course, a number of other solutions which ought to be tested as America’s substance abuse problems continue to grow. Addressing the issue at its core will require effort from governing bodies, lawmakers, public health experts, mental health experts, and of course, the healthcare system. Until this happens, a collaboration between healthcare providers might be our best bet.

          
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How Should Social Work Respond To The United States Leaving The Paris Agreement?

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“Logic clearly dictates the needs of the many outweigh the needs of the few” – Dr. Spock (Star Trek)

This quote is at the heart of a complex political debate; Dr. Spock doesn’t think it’s that complex.  Social justice is one of the tenants of social work practice. This often places social work on the wrong side of Dr. Spocks quote.

Frequently, social workers are providing for or advocating for the needs of the few. Dr. Spock had some help in posing this quote. The question originates from the philosophy of Utilitarianism. John Stewart Mill argued that society is a collection of individuals and that what was good for individuals would make society happy.

You can see this gets messy… and quick. This philosophy was recently put to the test with President Donald Trump’s decision to withdraw from the Paris Climate Accords. A 195 country agreement to reduce carbon emissions and offer assistance to developing nations to do so as well. Mr. Trump makes a case for economic justice that our involvement in the Paris Accord forces us to over-regulate businesses. He also argues it places an unfair burden on The United States contribution to developing nations. Trump asserts both factors create undue pressure on some of the most economically vulnerable areas in the country. Taking a strict stance stating he “Does not represent Paris…I represent Pittsburgh”. He believes the needs of local Americans outweigh the need to cost-share climate change with the globe.

Should the United States share in the cost of global warming at the cost of our local economies? The economic impact is up for significant debate. The best analysis of this complex issue is provided by FactCheck.org. I’ll let you read it but the economic rationale for leaving the Paris Accord seems questionable. The report he cited on the economic impact ignores many factors including the growth in the renewable sector.

From the social work perspective, this creates an interesting dilemma. The virtues of Globalism versus the “America First” Populism will remain a challenge. How do the local needs of the “Rust Belt” and “coal country” interact with the global energy economy impacted the Paris Accords?

The issue of Global Warming challenges social work to think about where our “systems thinking” begins and ends. Is our profession concerned for the global good or just the area’s they serve? In a recent speech, the UN Secretary-General argued the poor and vulnerable will be hit by climate change first.

Also, what is not in question is the economic impact in the Rust Belt and Coal Country of the United States. This also depends on where you are placing “The needs of the many”. The loss of manufacturing and energy jobs has had a significant impact on services in these areas.  These voters were activated by a hope of a potential change in their economic future. These parts of the country who rely on manufacturing and energy have been economically depressed. There is fear further government regulation and lack of money in these areas will make this worse.

Even if the move out of the Paris Climate Accords does fix local economies, it creates another complex systemic problem. Again thinking about where does our “systems” thinking end? I touched on this in my post about Facebook’s global vision for the world. The debate on globalism is a complex one, but The United States leadership on climate change is not.  Have we put ourselves at disadvantage by not being a leader willing to partner in climate change?

Are countries going to want to “make a deal” with us about innovation and technology in the energy sector? How will the impact on the global economy affect our local economy? Seems like this blog post has more questions than answers.

To attempt to answer this, I again consult the National Association of Social Workers Code of Ethics.  Section 6.04 in social action says…

 (c) Social workers should promote conditions that encourage respect for cultural and social diversity within the United States and globally. Social workers should promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people.

No easy answers when thinking about dedicating United States funds which may help globally but detract from the local action. This also brings about thoughts of our core value of competence. That whatever we do to help the most vulnerable citizens in the Rust Belt, I hope it based on sound evidence.

Those policies are based on science and evidence-based practices to try to help these local economies. Whatever we do globally it places the people we serve in the healthiest and most prosperous situation.  It’s not just social workers who are thinking about the impact but physicians are weighing in as well …

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The Need for Improvement in Substance Abuse Treatments

Published

on

 

For decades now, America has been in the midst of a substance abuse epidemic. In fact, recent Pew research indicates nearly half of U.S. adults have a close friend or family member who has been addicted to drugs at one point in their life. The experience is so universal the dataset cuts across sex, race, age, education level, and even partisan lines. In short, it’s safe to assume addiction is as American as apple pie.

Every day, more than 115 people in the United States die after overdosing on opioids. Alcohol abuse has increased by 50% since the start of the century to the point where today, one in eight Americans abuses alcohol. According to a 2017 survey, methamphetamine has become the world’s most dangerous drug, as 4.8% of users required hospitalization in order to avoid overdose.

Though substance abuse has become a worldwide phenomenon, affecting millions of people, treatment for addiction is not nearly as universal. Public health officials have drawn attention to the problem in more recent years, yet only 10.9% of individuals who needed treatment in a specialized facility for a substance use or a dependency concern received it in the year 2013.

It’s an epidemic policymaker’s, mental health experts, law enforcement, and others are acutely aware of. But solving the problem on a wide scale has so far proven to be fruitless. Individual states have taken specific measures, like opening up safe injection sites, which allow those who struggle with addiction to use in a safe space around medical experts. It’s a solution which definitely won’t solve the addiction crisis, but it does work as a harm-prevention space. Other states have taken to suing the pharmaceutical companies themselves, using similar tactics which were used against Big Tobacco nearly 20 years ago.

While these are no doubt necessary and useful tactics which will help presently and in the future (if successful), there are other avenues that largely have yet to be explored. Perhaps the most simple form of aid is given through the Primary Care Provider (PCP).

While all doctors and patients are supposed to share a therapeutic alliance, based on mutual trust and respect, PCPs are in a unique position in the healthcare field. Often, these doctors have known their patients for a number of years, have a big picture view of their overall health over a period of several years, and are able to check in on a patient’s progress with every visit.  

Evidence compiled by a University of Michigan medical team suggests primary care physicians and their teams of nurses, medical assistants, social workers, and pharmacists can — beyond providing basic services every patient needs — also provide effective care for addiction. Including each of these moving parts not only ensures the patient is receiving quality care but also helps to ensure the patient does not fall through the cracks at any point during their recovery.

They achieve this primarily through the anti-opioid medication buprenorphine and counseling — a combination known as medication-assisted treatment (MAT). The researchers have recently published a peer-reviewed paper on the subject, where they pose this is an effective method of treatment. They do not argue, however, that it is an easy process.

“There is a major need to do this,” says Pooja Lagisetty, M.D., M.Sc., the study’s lead author and a University of Michigan primary care doctor who provides MAT to her own patients at the VA Ann Arbor Healthcare System. “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience. But if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible.”

This support must come from other parts of the medical team. As the patient goes through the process, non-physician team members aid with dosing, monitoring the patient, and check-ins by phone and in person. If done successfully, Lagisetty argues this method can achieve similar results to specialized treatment facilities, and it might reach more people.

“Patients might be more willing to seek help in a primary care setting because of the lack of stigma and the ability to address their other health concerns,” she said. It’s also likely to be less devastating to patients financially. All in all, this kind of treatment in Primary Care facilities makes sense.

While it’s unlikely primary care physicians pursued medicine with a desire to focus on addiction treatment, it’s a reality many are going to have to embrace and develop a protocol for as the problem persists or worsens.

There are, of course, a number of other solutions which ought to be tested as America’s substance abuse problems continue to grow. Addressing the issue at its core will require effort from governing bodies, lawmakers, public health experts, mental health experts, and of course, the healthcare system. Until this happens, a collaboration between healthcare providers might be our best bet.

Continue Reading

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Social Work and Helping Professions Must Take Action to End Child Separations at Border

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Today, House Judiciary Committee Ranking Member Jerrold Nadler (D-NY) led more than 190 House Democrats in introducing the Keep Families Together Act, H.R. 6135, legislation to end family separation at the U.S. border.

On June 8th, 2018, Congresswoman Carol Shea-Porter (NH-01), Congresswoman and Chair of the Congressional Social Work Caucus Barbara Lee (CA-13), Congresswoman Susan Davis (CA-53), Congressman Luis V. Gutiérrez (IL-04), and Congresswoman Karen Bass (CA-37) released a joint statement on the Trump Administrations zero tolerance policy which is separating children from their parents as an immigration deterrent strategy.

“The Trump Administration’s policy of separating children from their parents is terrifying and frankly, abhorrent. Reports indicate that very young children– who are already fleeing dangerous conditions at home including domestic violence – are being taken from their parents. Families are often separated by hundreds of miles, and children are being housed in inadequate facilities. As social workers, we understand the profound impact that family separation has on a child’s developmental growth and on our society. These heartless policies instill a sense of helplessness and despair in children and could result in long-term trauma and health repercussions.

The American Academy of Pediatrics has stated that the separation of children from parents, and detention in DHS facilities that do not meet the basic standard of care for children, pose a significant threat to their long-term health and well-being. Their findings have led them to recommend that children in the custody of their parents should never be detained or separated from a parent unless a competent family court makes that determination.

Every passing day of separation has grave consequences for these children’s well-being. These are innocent children who have done nothing wrong. Forcing them to suffer at the hands of the US government is inhumane and un-American. We are taking all actions possible to end this brutal policy and reunite children with their families”, says social work members of Congress.

A release issued by the National Association of Social Workers also stated the “zero tolerance immigration policy that would prosecute families who attempt to cross the border and forcibly separate children from parents is malicious and unconscionable”.

In an effort to end child separations at the border, the Keep Families Together Act was developed in consultation with child welfare experts to ensure the federal government is acting in the best interest of children. The bill is supported by the American Academy of Pediatrics, Kids In Need of Defense (KIND), Coalition for Humane Immigrant Rights of Los Angeles (CHIRLA), Children’s Law Center, Young Center for Immigrant Rights and the Women’s Refugee Commission.

Key Elements of the Bill

  • Keep Families Together:  The bill promotes family unity by prohibiting Department of Homeland Security (DHS) officials from separating children from their parents, except in extraordinary circumstances.  In these limited circumstances, separation could not occur unless parental rights have been terminated, a child welfare agency has issued a best interest determination, or the Port Director or the Chief Border Patrol agent of Customs and Border Protection (CBP) have approved separation due to trafficking indicators or other concerns of risk to the child.  It requires an independent child welfare official to review any such separation and return the child if no harm to the child is present. It imposes financial penalties on officials who violate the prohibition on family separation.
  • Limit Criminal Prosecutions for Asylum Seekers: The majority of the parents separated at the border are being criminally prosecuted for illegal entry or re-entry.  This bill restricts the prosecution of parents who are asylum seekers by adopting the recommendation of the DHS Office of Inspector General.  The bill delays prosecutions for asylum seekers and creates an affirmative defense for asylum seekers.  It also codifies our commitment to the Refugee protocol prohibiting the criminal punishment of those seeking protection from persecution.
  • Increase Child Welfare Training: The bill requires all CBP officers and agents to complete child welfare training on an annual basis. Port Directors and Chief Border Agents, those who are authorized to make decisions on family separations, must complete an additional 90 minutes of annual child-welfare training.
  • Establish Public Policy Preference for Family Reunification: The bill establishes a preference for family unity, discourages the separation of siblings, and creates a presumption that detention is not in the best interests of families and children.
  • Add Procedures for Separated Families: The bill requires DHS to develop policies and procedures allowing parents and children to locate each other and reunite if they have been separated.   Such procedures must be public and made available in a language that parents can understand.  In cases of separation, it requires DHS to provide parents with a weekly report containing information about a child, and weekly phone communication.
  • Establish Other Required Measures:  In order to inform Congressional oversight and promote public understanding of the use of family separation, the bill requires a report on the separation of families every six months.

In addition to Senator Feinstein, the bill is also cosponsored by 31 senators, including Senators Chuck Schumer (D-N.Y.), Dick Durbin (D-Ill.), Patty Murray (D-Wash.), Patrick Leahy (D-Vt.), Kamala Harris (D-Calif.), Bernie Sanders (D-Vt.), Jeff Merkley (D-Ore.), Brian Schatz (D-Hawaii), Ed Markey (D-Mass.), Jack Reed (D-R.I.), Richard Blumenthal (D-Conn.), Michael Bennet (D-Colo.), Cory Booker (D-N.J.), Tom Carper (D-Del.), Amy Klobuchar (D-Minn.), Mazie Hirono (D-Hawaii), Elizabeth Warren (D-Mass.), Bob Menendez (D-N.J.), Tim Kaine (D-Va.), Angus King (I-Maine), Catherine Cortez-Masto (D-Nev.), Bill Nelson (D-Fla.), Ron Wyden (D-Ore.), Bob Casey (D-Pa.), Mark Warner (D-Va.), Jeanne Shaheen (D-N.H.), Chris Murphy (D-Conn.), Tammy Baldwin (D-Wis.), Kirsten Gillibrand (D-N.Y.), Tom Udall (D-N.M.), Martin Heinrich (D-N.M.) and Maria Cantwell (D-Wash.).

We must urge Congress to allow a vote on this important piece of legislation to help minimize trauma being inflicted on children and families. Sign the petition to support the Keep Families Together Act here.

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