Friday, February 22, 2019

Pleasantville

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Pleasantville, New Jersey Profile: Heroin and Alcohol Are Drugs of Choice

Located near Atlantic City, and teeming with casinos and other, gambling-related ambiance, Pleasantville, a N.J. town with 20,492 residents, is in a war for its soul with legal purveyors of alcohol, and illegal dealers of heroin and prescription opiates.  Heroin and opiate abuse in New Jersey, in general, are connected to the criminal underworld, according to law enforcement officials, who are working to disable dangerous legal, and illegal, drug trafficking.

But the local, legal entertainment environment, with hotels and casinos, and a party-all-the-time culture, is like a plague for Pleasantville, according to the New Jersey Drug and Alcohol Abuse Treatment Report, published last summer, in June of 2017. Those factors made Pleasantville, despite the optimistic name, one of the top five towns in N.J. for local residents with very unpleasant susbstance abuse disorders.

There were 1,146 patient admissions in Atlantic County, home to Pleasantville, in 2016, for alcohol abuse alone, and 2,940 admissions for opioid abuse treatment locally. Forty three of those alcohol abuse admissions were in Pleasantville, alone, and 162 local admissions were for opiates, like heroin, the state report said.  But the statistics need to be looked at in the more human context of deaths from drug-related addictions, experts caution.

“Despite the huge rise in annual opioid deaths,more people still die from alcohol use. The Centers for Disease Control (CDC) estimates that 88,000 people die each year from alcohol nationally. This doesn’t diminish the opioid crisis’ importance, but it does underline that no matter what happens with opioids, the use of legal alcohol for the same purpose is both a larger and longer-lived problem. This should prompt us to look more deeply at what’s driving substance use disorders,” says Peter Loeb, founder of Lionrock Recovery, one of the nation’s leading recovery program providers, which furnishes online substance abuse support to residents in Pleasantville, N.J., in an interview with The Recover Site.  “Mental illness carries great stigma in our society, but people with substance use disorders typically aren’t even viewed as ill. They’re viewed as hedonistic or lazy. The reality is that most people with an SUD are self-medicating anxiety. Their anxiety can be generated by bio/psycho factors like mood disorders or by experiencing trauma. The problem is that they self-medicate with substances generally associated with pleasure. Society focuses on their choice of medication rather than on what’s driving its use. We don’t call type 2 diabetes ‘sugarism’, nor lung cancer ‘tobaccoism’,” says Loeb.

Rehab

Patients enter rehab in Pleasantville for a number of reasons. According to the state government report on substance abuse, mentioend above, 43 local patients entered rehab for alchol abuse disorder in 2016.  Nine entered rehab for crack or cocaine addiction. A total of 162 patients went to rehab locally for heroin addiction. Other opiates drove 29 patients to treatment in 2016. Marijuana and other drugs sent 72 patient to therapy, according to the state report. Sometimes, help is as close as a phone call away, depending upon one’s willingness to change.

“We’ve discovered that nearly half of our clients are only willing to get help with their SUDs online. They tell us that the privacy and convenience of connecting with their counselors and peers by secure43 video conference moved them to get help. Because of this innovation, most come to us pre-crisis, before the devastation of waiting for rock bottom,” says Loeb.

The population of Pleasantville, N.J. continued to grow by 6.5 percent, notes the 2010 census report. That’s an increase of 1,237. The majority of the population is American racial minorities. The racial constitution of the city was 24.33% (4,926) White, 45.94% (9,303) Black or African American, 0.83% (168) Native American, 2.42% (490) Asian, 0.03% (6) Pacific Islander, 22.00% (4,454) from other races, and 4.45% (902) from two or more races. Hispanics were 41.06% (8,314) of the population.

The Census Bureau’s 2006–2010 American Community Survey showed that (in 2010 inflation-adjusteddollars) median household income was $39,560 and the median family income was $48,873. Males had a median income of $32,494  versus $29,961 (+/- for females. The per capita income for the borough was $18,527. Nearly 12.2% of families and 18.2% of the population were below the poverty line, including 24.7% of those under age 18 and 32.3% of those age 65 and above.

The town was ranked as number four in the state for the number of residents who entered into a substance abuse treatment program in 2016, according to the state government of N.J. There were 308 admissions for substance abuse treatment that year from Pleasantville, slighly ahead of nearby Hamilton Township, with 286 admissions, and somewhat lower than and Atlantic City with 1297 admissions, Egg Harbor Township with 659 admissions, and and Galloway Township with 325 admissions.

The local environment is something of a microcosm of the whole state, which in general is influenced by Atlantic City and its culture of debauchery, experts said.

“As of May 2017, there were 76,509 treatment admissions and 74,291 discharges in 2016 reported to the New Jersey Department of Human Services, Division of Mental Health and Addiction Services by substance abuse treatment providers,” wrote Suzanne Borys, Ed. D., Assistant Division Director, of the New Jersey Department of Health Services, division of mental health and addictions, in a recent memo. “These reports were submitted through the web-based New Jersey Substance Abuse Monitoring System (NJSAMS).”

In-Patient and Outpatiet Treatment Centers

Details on the local level of treatment in in-patient centers is not readily available, but the state government does provide statistics on the kind of therapy frequented on a county-wide basis.

According to the recent state report, a total of 30 percent of the county’s substance abuse patients were in treatment at intensive outpatient centers. Another 20 percent were seeking simple outpatient care. Approximately 18 percent were on some form of opioid maintenance. Only 8 percent of patients sought out detox centers. Just 7 percent attended long-term residential treatment. Another 9 percent attended short-termresidential treatment. Three percent chose a halfway house for their treatment regime.

Assessement of Substance Abuse Disorders

Peter Loeb, the founder of LionRock Recovery, noted that many patients take a long time to come around to the point where they are assessed for a possible substance abuse disorder. There are many social reasons for that, and some biological and some psychological factors.  “The stigma of addiction, though very real society-wide, is most keenly felt by the person struggling with it. Shame drives most denial and is a huge barrier to treatment. The counter to this problem is a combination of trust and privacy, and a move away from treating SUDs as an acute disorder rather than a chronic illness driven by biopsychosocial factors,” says Leob.

Local mental health providers can assess a prospective patient’s readiness to change and the severity of one’s substance abouse disorder with a few simple diagnostic questions. These include the following:

– How many days of heavy drinking have you had in the past year?

This helps assess, advise, and assist at-risk drinkers or those who already have alcohol use disorder.

– Have you used any tobacco products in the last year?

Smoking and drinking behaviors are often paired, due to the social element of substance abuse, like alcohol abuse. Advising the patient to quit can be beneficial, and determine their readiness to abandon destructive behaviors.

– How many times have you used illegal drugs or prescription drugs for non-medical reasons during the past year?

This assessement question was developed by the National Institutes of Health and is a validated screening tool. If the patient has not used during the past year, the clinician can reinforce that behavior and offer supportive counseling. But if the question is answered in the affirmative, it is a sign they patient may be a candidate for therapy. 

There are, literally, hundreds of potential screening tools that a local caregiver or clinician can utilize when working with a new patient in Pleasantville, N.J.

“Specific instruments are available to help counselors determine whether further assessment is warranted, the nature and extent of a client’s substance use disorder, whether a client has a mental disorder, what types of traumatic experiences a client has had and what the consequences are, and treatment-related factors that impact the client’s response to interventions,” according to a substance abuse treatment guide developed by the federal government. “Screening is a process for evaluating the possible presence of a particular problem. The outcome is normally a simple yes or no. Assessment is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis.”

Experts note that screening and assessment should be framed with a perspective that affirms a particular patient’s cultural relevance and strengths. Understanding the cultural basis of a client’s health beliefs, illness behaviors, and attitude toward treatment provides a foundation for the clinician for building a successful treatment program for the patient.

Screening is just the beginning of the recovery program for the patient and fast-fixes should not be expected. Continuing support must be provided, which includes a number of factors, like linking patients with resources for recovery and continuing education tools.

“Like other chronic health conditions, substance use disorders typically require long-term involvement with the health care system and parallel informal networks,” says Loeb. “Recovery-oriented services and supports (ROSC) include provision of continuing care following treatment, education regarding self-care, regular check-ups and linkage to community resources. Increasingly, technology is being used in a ROSC to improve access to services through e-therapy, to assist with information sharing, to increase quality and efficiency through use of electronic health records, and to support recovery through social networks. Proficiency with technology will become all the more critical as health care reform is implemented and integration with primary care occurs.”

Adds Loeb: “Because of a number of factors, treatment for SUDs mostly focuses on treating the acute phase of addiction, commonly called a ‘bottom.’ “Hitting rock bottom” is a surrender, and it usually occurs only after devastating destruction of a person’s life at personal, family, and work levels. The prevailing wisdom has long been that before this event, a person struggling with addiction ‘isn’t ready to get help.”

Patients should not expect to see just one clinician during their treatment. There will be providers with different skill sets and approaches in any successful plan.  “A multi-disciplinary workforce is also viewed as critical to delivering quality care in a recovery-oriented services and support. The workforce may include prevention staff, treatment counselors, nurses, doctors, a marriage and family therapist, a psychologist, peer coaches, etc. In a ROSC, organizations are guided by a set of values, goals, elements, core functions, and outcomes to achieve the ROSC’s mission. To promote the health of individuals, families and communities, a public health approach is adopted. Substance use disorders are biopsychosocial conditions,” says Loeb.  “These conditions are influenced by various social determinants of health—for example, the social and physical environment, income, education, and life skills. Only by understanding these determinants and applying strategies to influence them can the disease be impacted.”

 

After assessment, patients in recovery should expect the following steps:

– Pre-Intake

This is where additional information is gathered from you by a clinician or a social worker and a case file is developed for you. You may be asked to gather certain types of information, telephone numbers and contact e-mails for family members, insurance information, and a medical history. A local facility will guide you through the process.

– Intake

Next comes the intake interview, mostly commonly done by a clinical psychologist or clinical psychiatrist.  The reason for the intake interview often includes establishing and diagnosing any problems the client may have.[1] Usually, the clinician diagnoses the patient using criteria from the first two DSM axes. Some intake interviews also include a mental status examination. During the intake, the clinician may determine a detailed treatment plan for the patient.

– Detox

Detox is shorthand for “detoxification.” This is is the physical removal of drugs/toxic substances from the body, which is primarily carried out by the liver. Additionally, it can refer to the period of withdrawal for the patient  during which his body returns to normal (also called homeostasis) after long-term use of an addictive substance, like alcohol or heroin. 

– Inpatient Treatment

Inpatient treatment is a kind of treatment in which a patient is provided with 24/7 care at a residential facility. Psychiatric and physical health assistance are part of this treatment. Patients will stay often reside at inpatient treatment facilities for months at a time.

– Outpatient Treatment

An outpatient program does not compel you to live at the residence of a treatment facility. In fact, you could complete your treatment in the comfort of your own home or a sober living facility.

There are partial hospitalization programs (PHP), where patients are typically required to sit with a counselor or participate in individual or group therapy meetings for 5-6 hours a day, up to five days a week. The level of demand and involvement varies.There are also Intensive outpatient programs are a level below PHP programs and are considered to be less therapeutically intensive, i.e. allowing patients to work or attend school during the day while regularly participating in evening therapy sessions. There are also OP programs, or outpatient treatment programs, which is less intense and less structured than the other options, listed above. This usually involves regular weekly meetings and up to 2 hours of therapy at a time for the patient. Therapy is treated as continuing care for the patient.

 

– Aftercare

This is what it sounds like – continuing care after you have had your primary therapy and plunged into the recovery process. This may involve regularly scheduled meetings with doctors and regular therapy sessions.

– Sober Living

Sober living is an option that many choose. It is a kind of half-way house between being back at home and in the community and being in a community of care. Patients who reside at the sober living facility must follow strict rules, and adhere to treatment guidelines, and attend regular therapy sessions, and cooperate with other patients in adopting a sober lifestyle.

Completing all of these phases of treatment is something that is recommended by mental health practioners, who note that they are, according to research reports, a common reason for success in recovery. Therapy and recovery are potentially life-changing, not just for you, but for other members of your family or friend network.

My family has battled drug and alcohol addiction all my life. I lost my sister in 2010, after her lifelong struggle with drugs and alcohol. I’m grateful that my oldest daughter has more than a decade in recovery, is now married and a mother of two. I witnessed the highs and lows of addiction and recovery, and the strengths and weaknesses of traditional treatment, and I found myself drawn to the fight against it. Lionrock is my revenge against addiction,” concludes Loeb, who, like many who have experienced addiction first-hand, founded his own treatment facility.

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