INTERVIEWER: What would you consider the greatest risk in the life of the patient with co-occurring addiction and mental health challenges?
DR. STENSON: Such individuals face a number of challenges but perhaps the greatest risk would be a preventable, premature death. When diagnosis is delayed and treatment not provided, risk factors such as suicide, accidental death, and illness development significantly increases. An individual’s quality of life can be significantly improved with proper diagnosis and treatment.
INTERVIEWER: What things would you consider as most important to add to the patient’s lives to increase resiliency?
DR. STENSON: Becoming a partner and meaningful participant in the individual’s treatment can greatly add to an individual’s resiliency. Knowing that their treatment team understands the many challenges they face can be internalized and applied to the day-to-day coping skills and resiliency.
INTERVIEWER: If you were to ask a patient further down the line in recovery what had the most impact on their success, what information would you pass on to individuals still in more difficulty stages of recovery?
DR. STENSON: Learning to accept and cope with discouragement and demoralization is often a key element in moving through the stages of recovery. Recognizing that one is not alone with these feelings and experiences is very important. It is interesting how often acceptance breeds hope and optimism. Realizing that such symptoms as low energy are part of an illness and not part of the moral weakness can assist a great deal in making gradual improvement.
INTERVIEWER: What might be some of the main ways the media and society at large misjudge individuals with co-occurring disorders?
DR. STENSON: First of all, painting such individuals with the same brush is a common misjudgment. Lumping individuals together and drawing simplistic conclusions is common. Each individual is unique and deserves access to an individualized treatment plan. Demonizing or vilifying such individuals is a sale’s or scare tactic used by the media who might have other agendas. Viewing individuals on Social Security disability as lazy, manipulative, and a risk to the Federal budget would be such an example.
INTERVIEWER: What kind of information may be helpful to the families of individuals experiencing co-occurring disorders?
DR. STENSON: Organizations such as the National Alliance for the Mentally Ill (NAMI) can provide a wealth of support and information to such families. Programs such as Al-Anon can be very helpful when codependency issues are central themes. It is important to understand that each of these organizations may not have a complete understanding of individuals with co-occurring disorders and that incorporating components of each may be necessary. Information at the SAMHSA website is more specifically tailored for families dealing with co-occurring disorders. At C.O.R.E., we either attempt to manage both the substance abuse and mental health needs of our clients or assure that they have access to the required community resources.
INTERVIEWER: What has been your personal background in dealing with addiction and mental health issues among loved ones?
DR. STENSON: One advantage of society’s more open information exchange is the realization that most families are touched in some way by individuals with substance abuse, mental illness, and co-occurring disorders. When close friends or family members have requests for help or are in need of an intervention, I do my best to assure that appropriate direction is provided.
INTERVIEWER: What local services can you identify that would be beneficial for family members or patients dealing with co-occurring challenges?
DR. STENSON: At C.O.R.E., an individual must first suffer from opioid addiction to be eligible for services. We work hard to treat each patient with respect and to help them deal with this very serious illness and co-occurring disorders. The third Wednesday of each month at 11 a.m., I conduct a workshop open to anyone interested in opioid addiction and related problems. Patients, family members, friends, staff and community members provide very positive feedback of the utility of this workshop. The historical and scientific background to our treatment model is explained and patients are encouraged to hold their heads high and to become strong advocates for their treatment to hopefully improve future access. In achieving our goals, we often are in close communication and cooperation with county ACCESS, community hospitals, and many other community based organizations and resources.
INTERVIEWER: What roles do medication, psychotherapy/counseling, holistic treatment and spirituality play in recovery from co-occurring issues?
DR. STENSON: This question underscores the importance of an individualized treatment plan and approach. Patients at C.O.R.E. are encouraged to see themselves as the ultimate expert in their disorders and treatment. Excellent care requires that the treatment staff maintain an open mind regarding the treatment needs of each patient. In the field of opioid addiction, our field forefathers suspected that patients suffered more from a deficiency than from a toxicity. Subsequent research and experience has largely supported this concept. Methadone and buprenorphine have proven to be excellent medications to treat this deficiency and are often life-saving, life-altering medications. The medications effectiveness must be supported by quality interventions addressing the therapy, counseling, spirituality, and other needs brought to the table. Each individual’s “story” must be told and needs addressed. Holistic concepts are great, can be very helpful and meaningful, but too often hype, misrepresentation, poor quality control and related factors can lead to scams. It is important that treating staff stress the importance of good communication about various products that are promoted as holistic, organic, herbal, etc as some have no foundation in science and are financial scams. Wellness oriented life-style changes that include nutrition, exercise, and stress management are very positive and important.
INTERVIEWER: Do you feel additional supports such as AA, NA or other meeting groups are helpful in aiding recovery?
DR. STENSON: These programs are incredibly important and sadly, too often, under-utilized. Frequently, patients on normalizing doses of methadone or buprenorphine report unpleasant experiences at AA/NA when their treatment was shared. This is gradually changing as more AAs and NAs gain awareness of the highly effective, non-conscious altering effects of proper dosing of methadone and buprenorphine. We encourage our patients to become familiar with brochures such as, “The AA Member-Medications and Other Drugs” (page 5, point 3 states “No AA Member Plays Doctor”) and NA’s “In Times of Illness.” In that all our patients have doctor directed, highly researched and effective treatment, they can meaningfully work the steps and participate as sponsors, sponsees, secretaries, treasures, greeters, coffee monitors, birthday chip presenters, etc. Hopefully more participation will occur in the future as these points are more generally understood and accepted.
INTERVIEWER: Is it always necessary to completely cut out contact with triggers for either relapse or increased self-criticism?
DR. STENSON: A good offense is often related to having a good defense. It is important to take a careful inventory of triggers and have an active plan to eliminate or avoid as many as possible. It is also important to understand that triggers can be unexpected or even subconscious at times (a TV scene, an odor, a sound, etc) so impossible to completely cut out. I work to help individuals anticipate these likelihoods and have a craving coping strategy in place. This often includes the reality that intense craving usually lasts about 10 minutes. By building a time frame, not only does craving often fade but the individual then acquires more impulse control skills and ability to think through the entire consequences should one give into craving. This becomes part of a process of re-sensitizing oneself to the enormous consequences of relapse, including the real possibility of accidental death.