Morning Zen

Helping Ellie Save America from Addictions and Mental Illnesses: Using Practical Science and Community Engagement Across America

October 07, 2018

On Friday, August 17, I tuned into Assistant Secretary Dr. Elinor McCance-Katz’s SAMSHA’s stakeholder call.  Most all of the questions and comments came from families dealing with serious addictions, mental illnesses, and the lack of any meaningful help.

The Assistant Secretary has a huge challenge, and anyone could clearly hear her compassion to help. I could also hear her fierce determination, which no doubt comes from the pain of losing people.  I recognize that pain and frustration—as a clinician helping my pediatric patients in the system, and personally as a child of parents and as a sibling of my brother who suffered from addictions and related terminal physical illness.

The Assistant Secretary was very kind to the callers facing extreme challenges trying to find effective treatment and recovery for their loved ones. Boy, howdy, I know about that challenge.

I kept thinking during the call, “Ellie needs help. Ellie needs help. She cannot do this on her own, even with all the power, control, and money that she has at her disposal at SAMSHA.”

I’ve got road rash and some successes trying to do what she passionately wants. The Road Rash involves Wyoming that made the one of largest per capita expenditure in the U.S. to fight addictions: $50 million for half-million people in Wyoming in 2002 (Embry & McDaniel, 2002). The service providers were supposed to use the best evidence-based practices at the time; they said they did, but site visits detected verbal gas emissions.  We did learn some important things: Advertising that treatment and recovery worked got people to enroll in treatment. We did not advertise the horror of drugs; we advertised hope and recovery.

The meth epidemic migrated to Pima County (Tucson), Arizona a few years later where we live.  We didn’t go after the money. We went after community mobilization using marketing about proven prevention, intervention, and treatment that community stakeholders could implement using existing community people, existing programs, and community partners. That plan was articulated in the Arizona Medical Association Journal (Embry, Lopez, & Minugh, 2005). Five of us were on a steering committee (a medical director, the captain of the counter-narcotics of Southern Arizona combined law-enforcement, a senior agent of the DEA, the executive director of a leading mental-health agency, and myself. We met every week, and we worked every week with a large coalition of community entities and advocates, including local media. We had TV ads on the after midnight inviting people to treatment, with real stories of recovery.  We also taught most of those providers a slew of simple yet well-proven strategies that had been funded by NIDA, NIMH, and other entities to increase treatment efficacy, recovery, or prevention in the first instance.  This was pretty much a DIY effort in Tucson, with great community mobilization and low cost but effective strategies.

We had some interesting measures, one of which were positive/negative drug tests used by businesses in the community. We also looked at arrests and re-sentencing. We even did drug testing of the ecology of neighborhoods using drug swipes of bus benches and other places where we saw visual evidence of drug use. Schools used some of Johns Hopkins work on the Good Behavior Game to reduce the early risk factors and lifetime addictions (Kellam et al., 2014).  We had an impact on meth, which we reported at the National Prevention Network (Embry, Neri, & Capin, 2008).

The key to all this was selecting practical, proven things that community members could promote, implement and spread widely to address the addictions and related psychiatric disorders without huge resources. Most all of the strategies were funded and studied by National Institute on Drug Abuse and other federal agencies, and cost little in training, time and money to implement but had widely replicated benefits:

  • Emotional Writing (J. W. Pennebaker, 1999; James W. Pennebaker & Seagal, 1999).
  • Brief motivational interviewing and mapping (Bernstein et al., 2005; Grenard et al., 2007; Stein et al., 2006; Tait, Hulse, Robertson, & Sprivulis, 2005).
  • Goal Mapping (visit Texas Christian University for extensive bibliography)
  • Acceptance and Commitment Therapy strategies, especially for people with hallucinations (Patricia Bach & Hayes, 2002; P. Bach, Hayes, & Gallop, 2011; Gaudiano, Nowlan, Brown, Epstein-Lubow, & Miller, 2012; Montgomery, Kim, & Franklin, 2011; White et al., 2011).
  • NIDA’s Prize Bowl Procedure (administered for sobriety, engagement in treatment and recovery related activities) (Ainscough, McNeill, Strang, Calder, & Brose, 2017; N. M. Petry, Alessi, Olmstead, Rash, & Zajac, 2017; Nancy M. Petry & Roll, 2011).
  • Community Reinforcement and Family Treatment (CRAFT) (Godley, Garner, Smith, Meyers, & Godley, 2011; Manuel et al., 2012; Meyers, Roozen, & Smith, 2011; Meyers, Smith, Serna, & Belon, 2013). This is especially important for desperate family members and is the most proven strategy to help distressed families.

After listening to the Assistant Secretary’s Stakeholder call, I dialed up the people who were the leaders in our Meth Free Alliance about a decade ago in Pima County: the medical folks, the faith-based community, and law enforcement. They are in, and they were telling me that the opiate crisis in Tucson is worse than our meth epidemic. I’ve been so busy thinking about all the heavy Opiate impacted places our prevention work is happening: Ohio, West Virginia, New Mexico, etc. I forgot about my own community. We’ve got the same opiate plague.

Ellie is going to need a lot of help. She cannot do it alone, as there will never be enough clinicians, skilled people to prescribe and monitor the medications, treatment beds, or let alone money. Let’s pitch in and help America save our futures. Every community can mobilize around low-cost, sustainable, tested and proven strategies to treat, intervene, or prevent these terrible epidemics. Isn’t that what we’ve always done in America?

So, what has to happen to help Ellie help every American family and community?

  1. Create easily replicated, tested-and-proven treatment and intervention recipes that community groups anywhere in America can implement—from the hollows of West Virginia to sunny inland California, from the remoteness of Montana to the suburbs of Florida, from the once great industrial sites in Ohio and other states to the farmlands in Kansas where I grew up. There is no state immune, no city or county immune, no family immune from the opiate epidemic and related ills.
  2. Create the meta-coalition of talent and resources to disseminate the knowledge and cost-effective recipes.
  3. Create sustainable family supports in every community that are responsive to the culture of the community. Our families need support, education, and more support.
  4. Create the social-media campaign that drives home the successes in treatment, intervention, and prevention for all to see, hear, and know about.
  5. Engage people of every age to spread the solutions, just like we did to end the polio epidemic.

Remember, this is not about a specific drug per se. There will always be an addictive substance of the moment. The amazing thing is that proven strategies that prevent, intervene or successfully treat are virtually the same—no matter what the name is of the drug of abuse.

Let’s all pitch in to help Ellie. She cannot do this by herself, no more than Jonas Salk could administer the polio vaccine to every child at risk for polio. It took about 800,000 volunteers to mobilize in every community in the US to banish polio.

Upcoming Zen posts will focus on details for each specifically well-proven strategy. Hang on Ellie, the practical science cavalry for every community is on its way.

Ainscough, T. S., McNeill, A., Strang, J., Calder, R., & Brose, L. S. (2017). Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis. Drug Alcohol Depend, 178, 318-339. doi:10.1016/j.drugalcdep.2017.05.028

Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting & Clinical Psychology, 70(5), 1129-1139.

Bach, P., Hayes, S. C., & Gallop, R. (2011). Long-Term Effects of Brief Acceptance and Commitment Therapy for Psychosis. Behav Modif. doi:10.1177/0145445511427193

Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49-59. doi:doi:10.1016/j.drugalcdep.2004.07.006

Embry, D. D., Lopez, D., & Minugh, P. A. (2005). Stop the Methamphetamine Epidemic. Arizona Medical Association Journal, 16(4), 30-34.

Embry, D. D., & McDaniel, R. (2002). Reclaiming Wyoming:  A Blueprint for Substance Abuse Prevention, Intervention and Treatment. Cheyenne, WY: State of Wyoming, Substance Abuse Division.

Embry, D. D., Neri, D., & Capin, T. (2008). Community Mobilization to Address Meth Using Social Marketing and Evidence-Based Kernels of Change. Paper presented at the National Prevention Network, Indianopolis, ID.

Gaudiano, B. A., Nowlan, K., Brown, L. A., Epstein-Lubow, G., & Miller, I. W. (2012). An Open Trial of a New Acceptance-Based Behavioral Treatment for Major Depression With Psychotic Features. Behav Modif. doi:10.1177/0145445512465173

Grenard, J. L., Ames, S. L., Wiers, R. W., Thush, C., Stacy, A. W., & Sussman, S. (2007). Brief intervention for substance use among at-risk adolescents: a pilot study. J Adolesc Health, 40(2), 188-191. doi:S1054-139X(06)00303-X [pii]

10.1016/j.jadohealth.2006.08.008 [doi]

Kellam, S. G., Wang, W., Mackenzie, A. C. L., Brown, C. H., Ompad, D. C., Or, F., . . . Windham, A. (2014). The impact of the good behavior game, a universal classroom-based preventive intervention in first and second grades, on high-risk sexual behaviors and drug abuse and dependence disorders into young adulthood. Prevention Science, 15(Suppl 1), S6-S18. doi:10.1007/s11121-012-0296-z

Montgomery, K. L., Kim, J. S., & Franklin, C. (2011). Acceptance and commitment therapy for psychological and physiological illnesses: a systematic review for social workers. Health Soc Work, 36(3), 169-181.

Pennebaker, J. W. (1999). The effects of traumatic disclosure on physical and mental health: the values of writing and talking about upsetting events. International Journal of Emergency Mental Health, 1(1), 9-18.

Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243-1254.

Petry, N. M., Alessi, S. M., Olmstead, T. A., Rash, C. J., & Zajac, K. (2017). Contingency Management Treatment for Substance Use Disorders: How Far Has It Come, and Where Does It Need to Go? Psychol Addict Behav. doi:10.1037/adb0000287

Petry, N. M., & Roll, J. M. (2011). Amount of earnings during prize contingency management treatment is associated with post-treatment abstinence outcomes. Experimental and clinical psychopharmacology, 19(6), 445-450. doi:10.1037/a0024261

Stein, L. A. R., Colby, S. M., Barnett, N. P., Monti, P. M., Golembeske, C., Lebeau-Craven, R., & Miranda, R. (2006). Enhancing Substance Abuse Treatment Engagement in Incarcerated Adolescents. Psychological Services, 3(1), 25-34.

Tait, R. J., Hulse, G. K., Robertson, S. I., & Sprivulis, P. C. (2005). Emergency department-based intervention with adolescent substance users: 12-month outcomes. Drug and Alcohol Dependence, 79(3), 359-363. doi:10.1016/j.drugalcdep.2005.03.015

White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behav Res Ther, 49(12), 901-907. doi:10.1016/j.brat.2011.09.003

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About the Author

Dennis Embry

Dennis Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. Dr. Embry serves as a National Advisory Council member and Chief Science Advisor to the Children’s Mental Health Network. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America.

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