Addiction Treatment Work Can Be Difficult But Rewarding
by Alison Laurio
In her job as a substance abuse and mental health clinician, Tami-Jo Lind gets to see some positive impacts of the work she and her colleagues do.
"We have an alumni program," she said. "We see people staying clean and sober, and they come back and share their experience. I see a lot of positive things in what I do. We are seeing people who reconnected with their families, who build their self-esteem and their self-worth. They come in hopeless and find out recovery is good."
Social workers juggle many issues when working on the front lines with clients who have addictions. It can take a toll. It can necessitate self-care practices. And it also can be rewarding.
Amanda Flory is a transitional care social worker at Nash UNC Health Care in Rocky Mount, N.C.
"My position is funded through the county, but I wear three hats," she said.
Flory does in-patient transitions at Nash UNC Health Care, a managed affiliate of an integrated system based in Chapel Hill. She is a liaison and participant with the Nash Police Department, assisting patients in the department's HOPE Initiative with treatment help and transitional care; and she works to reduce 30-day readmissions for a county-wide substance use disorder coalition.
Basically, the HOPE Initiative is an angel program, a specific type of police diversion program where people voluntarily go to the police department and turn in any drugs they have with no charges filed against them, Flory said. The police department is a conduit for treatment, and people can get screened and go into detox. The program's funding alleviates barriers to things like residential treatment, which many cannot afford.
"Typically, those require insurance and are out of reach for most people who come in," she said. "To be able to provide that for someone is a huge benefit for them. Otherwise, they could not afford it. In eastern North Carolina, resources are scarce."
So far the program, launched Feb. 9, 2016, has helped 430 people. Flory commonly works with about 20 people at a time, both men and women who are in different phases of the program, she said. Participants are age 18 and older. The average age is 26 to 32, the youngest person was 18, and the oldest was 65.
Flory works on numerous issues for patients, including lack of resources, access to care and ongoing treatment, residential programs, medical-assisted treatment programs if they are insured, and transportation to outpatient programs.
"I help them navigate through the system, putting pieces in place so they can be as successful as possible," she said. "I see success."
Flory believes some people view opioids differently since it was deemed a national health crisis.
"Some people who believed it's a choice, a moral failing, now see it through a more compassionate lens," she said. "Seeing it as a choice was not the case. It's a disease. What we do here is break down that stigma and plant those seeds. It's not a life that anyone would choose."
The program also offers community education to "let people know we're here if they know someone in need."
"In this field, we have to think positively," Flory said. "It doesn't have to be the huge, ranging success. It's the small things. You have to focus where to put your energy. Someone might call and say they're doing well. That's not uncommon. Those are the things that help me."
Lind, a substance abuse and mental health clinician at High Watch Recovery Center in Kent, Conn., also is co-chairman of the NASW-Connecticut Chapter's newly formed addiction committee.
She was one of two members asked to be a co-chair by the board of directors after the board created the committee. The first meeting was set for January.
Need was the motivating factor in its creation, Lind said. "All our communities are responding to the opioid epidemic and the overdoses that are happening."
Overall committee goals at this point include care of social workers, their experiences, why it's a presenting problem and what the response should be, Lind said.
Not Just Opioids
"We'll be exploring how we can best serve the social work population as well as a general population," Lind said. "We would like to talk about addiction in a broad approach, and include gambling, substance use-all types of issues people are running into in the field."
"We can't narrow it down to just one substance. In my opinion, it's not just an opioid epidemic. It's an addiction epidemic that comes in all forms and affects people in different ways."
She listed alcohol, benzodiazepine (Xanax), crack, cocaine, gaming and gambling as addictions that also need to be addressed.
"We shouldn't just focus on one," Lind said. "My personal opinion is the wording is too narrow. My concern is giving funding to just one area. I worry that now that it's impacting white America, help is coming."
Members have already expressed interest in joining the committee, and she said after the first meeting they would define their direction and create goals.
"Everyone is realizing the level of impact it is having on all our communities and people," Lind said. "We're aware of the deadly nature of this and trying to explore the best ways to treat people."
Those include medically assisted treatments and exploring holistic methods and processes like the 12-step, she said. "I think people are desperate and want to do something, and we all are working together to address that. There are various treatment methods, but we don't have a lot of evidence-based information, so there are questions if they're effective in the long term. That's a concern."
The challenges providers can face include access to treatment, health care coverage, quality of care, relapse ratio, impact on families, and encouraging family therapy and family-education workshops where they can see presentations, hear from therapists and hear some personal stories of what other families are going through.
"We encourage families to get involved in the treatment of their individual," Lind said. "Children too, depending on their age. You can't quantify the impact on families. Addiction is pervasive and it's progressive."
The problem of addiction is impossible not to address, she said. "In any form of social work, we are dealing with this problem. Whether it'sa social worker, a community or a family, we have all been touched by the difficulties of addiction. For our chapter to address this makes perfect sense."
Sandra A. Lopez believes the opioid crisis is having an impact across a number of different practice areas.
Lopez is a retired professor with a clinical and consulting private practice in Houston whose interest is trauma training and treatment-informed care.
A recognized national leader and advocate in promoting professional self-care for social workers, she thinks the opioid crisis is having an impact on the entire profession.
"I'm curious if people are finding if they're really prepared for dealing with the crisis of substance abuse and behavioral health, especially if they're in some other practice arenas," Lopez said. "The crisis impacts all arenas. We may have clients who have loved ones who are involved. If the client doesn't mention it, we may not ask."
In school social work, for example, a student may have a parent affected. When chronic pain is an issue, the client might be abusing their prescriptions, she said. "Checking on this is really critical. All social workers need to be knowledgeable about this crisis, how it became an epidemic and how they can become more informed in their settings."
"The manifestations can be something subtle. If they're not totally present in the work world, that may lead us to believe something is happening."
It is something social workers need to add to their repertoire of questions they ask, she said, and depending on a person's expertise and the setting they work in, anyone can have an encounter with that kind of crisis.
A recent speaker Lopez heard reminded her that in our world, alcohol use is a part of peoples' lives. And many people believe "if you're sick, take a pill. If you're really sick, take two."
Lopez has been raising awareness around self-care for more than 15 years, and said there are various ways that burnout feelings can happen.
It's common for a client to have a relapse. If it comes when the clinician has invested a lot of time with a client, there could be a feeling of burnout, she said.
There is ACE-adverse childhood experiences-and a study that found a link between people developing major illnesses and something they've experienced as a child.
"When you're treating someone for substance abuse addiction, it's likely they become connected to something that happened earlier in their lives, something traumatic," Lopez said. "That brings it to us. When someone shares stories or narratives with us, we may find we have a collection of stories over time as well."
Hard To Shake
"The challenge is what do we do with these stories we have in our heads from clients. What do we do with those images."
For example, if a client shares how they were abused as a child and you are listening with empathy, you may have that story stuck in your head, she said.
"It may be hard to shake," Lopez said. "What do you do? It's common as social workers to hear these kinds of stories. They are often very trauma-ridden."
Generally, there are really good things social workers can do after hours, on weekends or on vacations, but she said there are self-care strategies social workers need to think about if they can't forget a story they just heard from a client.
They can think "Wow, that story has me shaken, but I have my own things to do," Lopez said. "I suggest they have some kind of transition ritual between one client and the next so they can regroup in that short time frame."
"What I do when I hear a very difficult story is to allow 10 minutes, leave my office and walk outside, walk around the building. I take deep breaths and self-talk. I say 'that was a difficult story, but you're going to be there for the next person.'"
Or, she recites affirmations like "You're a good person," "You're a good social worker," or "You're not inadequate."
Everyone can develop their own self-messages and techniques because "what works for me might not help someone else,'" Lopez said. "If at the end of the day it still sticks, you may want to process with a colleague. It may mirror something that came into our own lives."
"Self-care is such a critically core piece for social work. It's dealing with the aftermath of our work."
Organizations can play a role that is important, because if those are not in place, self-care practices could be self-defeating, she said.
"Fortunately, I'm seeing more organizations become aware of promoting a self-care environment," Lopez said.
Those can include things like holding a mental health day where supervisors can debrief individuals, or organizations bringing in "self-care goodies" like massage therapists, she said.
"Or, supervisors can say "you've had a hard day and tough cases. It's 1:00, but why don't you take the rest of the day off,'" Lopez said. "Many places don't have the resources to do that. If not, you can bring in a dozen doughnuts and go to the break room and talk. But don't bring up work for 20 minutes."
When things like that are done, people know they're cared for and someone is interested in them, she said. "It's important to spread the word about this issue. I think it's seen as something that's important across our profession."
The Right Fit
Social workers are the right professionals to help with addiction problems because it goes back to the field's roots of advocacy, Flory said. "I think we're advocates by nature. In both micro and macro, we always advocate for the person in front of us and their needs."
The training, schooling and licensure requirements of the field and the person-centered approach is what makes us the best to work with this, Lind said.
"We are the ones dealing with the face-to-face problem every day," she said. "Who better to deal with it than the people working with it every day in their communities."
Social workers, as professionals, generally struggle with self-care, Flory said.
"For me, the struggle is with carving out time for myself, my job and my family," she said. "The thing in this field is, you have to think positively. It's the small things."
A gentleman in his 20s came through the program with the Nash Police Department and went through detox. He connected with a residential health treatment program, and after completing it, went back in the community, Flory said.
The man found a job. He was happy and healthy and has a child, she said. "He's doing really well. It's so rewarding. Some come back from treatment, and it's like they're a new person. They have their life back, and that's a beautiful, beautiful thing."