Indiana University Students: Anxiety, Depression and Drug Use (and how to fix them)

Since moving to Bloomington, home of Indiana University, a few things have become clear. One – everyone here wears red clothing, drives a red car or paints a room in their house red. They don’t mess around with school pride.

Second thing I’ve noticed is the super-driven nature of IU students. They are high achievers and have big goals. Awesome. Big goals are great. Unfortunately, these same students are often not equipped for the challenges of living on their own and the intense academic load. Anxiety, depression and drug use are common here (as with most other big schools). Since there are so few counselors/psychotherapists in the area, I see a heavy load of students, especially when the pressure starts to creep in around mid-September. The partying picks up, parents are gone and classes start to dial-up intensity. It’s a toxic mix.

A great place to start is IU.

IU offers respite in the form of their counseling center (CAPS) but it’s a) triaging a problem, b) only short term and c) often doesn’t get to the underlying issues which are often years in the making. Don’t get me wrong, CAPS does a great job and the best they can considering how underfunded they are. The first two sessions for each semester are free. Each following session is $30. They generally have a waitlist so I recommend that students sign-up early.

CAPS also offers psychiatric care for those needing medical attention, like help or oversight with medication. The wait list is often even longer since there are fewer psychiatrists than counselors. Psychiatric visits are not covered under student health fees so insurance or out of pocket payment is expected.

For those struggling with more serious drug issues, IU offers OASIS/Journey. Students that sign-up for Journey get an assessment to determine the best level of care. Staff then decide between two evidence-based interventions in both group and individual settings, the Journey Program operates under 3 phases, designed to provide progressively more attention based on the student’s need.

Students referred from the Office of Student Ethics are charged $200. Alcohol and drug charges are applied separately. If a student was found responsible for both an alcohol and drug policy violation within the same incident, they get billed $400. For non-offense participants,they get charged a one-time fee of $25.00 after their first visit.

If IU doesn’t have the availability or discretion you and your family needs, reach out to me. If I can’t help, I’m happy to provide insight into other providers in the area who can.

The best thing for parents to do is start searching for professional support either through IU or the community in July and August. Getting appointments set and providers lined-up will be much easier when the semester has not started. Once the semester starts, a good counselor will work closely with parents and the school to ensure that everyone is aware of progress and prepared in case the students experiences more severe issues.

Hopefully, your son and daughter will not need any of this but if they do, act early and expect everyone to act as a team.

Opioid Epidemic: John Oliver Sums it Up Best on HBO

Don’t Think Pain Meds and Heroin is Really a Big Deal? Check Out What the Surgeon General Just Did…

Surgeon General Writes to Every Doctor in U.S. About Opioid Epidemic

Opioid abuse is not like other problems. With very little use, pain meds and heroin can quickly become an addiction. This addiction has unusual drug dealers. Some are intentional (Big Pharma like Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis) that exploit our pain and desperation. Other’s are likely well-meaning like primary care doctors most of whom are manipulated by the pharmaceutical companies to write prescriptions.

If you or a loved one is prescribed pain meds, take this seriously. Use as little as possible and work closely with your doctor. If you can’t stop, get help immediately. The longer someone abuses opioids, the harder it is to get back on track.

Missouri: Only State Not on Prescription Drug Monitoring Program

It was a mystery for the last few years – why were so many people going to Missouri to get their prescriptions (…mostly opioids like Vicodin/Lortab or Oxycodone)? Mystery solved. As of 2012, Missouri was the only state in the United States that did not participate in a national registry for prescription drugs.

Just in case you forgot where Missouri is

Just in case you forgot where Missouri is

Let’s dive a bit deeper…

What’s The prescription drug monitoring program?

Better known as PDMP, it’s an online database that collects data on controlled substance prescriptions dispensed within each participating state. It can act as an early warning system for prescribers to avoid dangerous drug interactions and to ensure quality patient care. 

PDMP is also a tool that also can be used to intervene in the early stages of prescription drug abuse, as well as to assist providers in preventing prescription drug abuse and enable providers of pain medications to know if they are treating someone who has been “doctor shopping”  (going from doctor to doctor for multiple prescriptions).

PDMP does not impact the legal prescribing of drugs by a provider – it simply makes it possible to spot a potential problems or trends.

Why Missouri Doesn’t want PDMP?

Well, Missouri kind-of does want PDMP. In 2012 the state came oh so close to enacting PDMP. But while proponents say most Missouri citizens and legislators support participation in PDMP, it has been blocked by lawmakers like State Senator Rob Schaaf, a family doctor who argues (…inaccurately in my humble opinion) that allowing the government to keep prescription records violates a patient’s personal privacy. He’s probably referring to HIPAA and/or HITECH which are privacy laws that protect a patient’s health records. After successfully combating the 2012 version of the Missouri legislative bill, Dr. Schaaf said of drug abusers, “If they overdose and kill themselves, it just removes them from the gene pool.” Dr. Schaaf is seemingly more focused on individuals liberty (…for prescription drugs) than on life. Fortunately, he appears to be in the minority within Missouri.

How to access the PDMP information

It’s not so easy. You’ve got to be a doctor, part of the legal system or law enforcement to get access. The PDMP data is stored by specified statewide regulatory, administrative or law enforcement agency as designated by state law. The agency distributes data from the database to individuals who are authorized under state law to receive the information. Information is shared across state lines when needed. 

Program Review: Kolmac Clinic

In May 2014 Dr. Marino visited The Kolmac Clinic with six locations spread around the Washington DC, Maryland and Virginia region. This is your classic substance abuse program geared towards adults. Kolmac has been around since 1976 and slowly increased the depth and breadth of services with a consistent focus on drug abuse treatment. 
 
What They Do
 
Kolmac offers IOP levels of care in group format. Initially patients will attend three hours of group IOP sessions five times a week. Next, individuals step down to less frequent group meeting, ending with just once weekly group. Kolmac noted they are a CBT program and encourage patients to use AA for outside support. Providers who refer to Kolmac often are able to continue outpatient therapy or decide to transfer to Kolmac until the initial treatment course has reduced in frequency. 
 
Kolmac also provides outpatient detoxification. Each location is staffed with medical providers and mental health providers. Patients are able to go through detox during the day and return home in the evenings. 
 
Who They Serve
 
The Kolmac Clinic provides outpatient rehabilitation and treatment programs for adults with alcohol, drug, and other substance abuse problems. Because Kolmac is an outpatient treatment center, patients can receive rehab help without taking leave from work or family responsibility.
 
Locations

Kolmac Clinic has six locations in Washington DC area. Unfortunately the program does not offer services in Virginia, but has locations in downtown DC and Maryland. Each site boosts group treatment tailored to the population in need. For example, the Towson, MD site has a larger population of young adults and targets programming to this population. The K St location specializes in corporate executive’s substance concerns. 

During the visit to he K St location, the office appeared dated and office presentation seemed less important (e.g., stain on rug, old furniture). Staff appeared friendly, but often passed through the waiting room (in the middle of the office) without acknowledging guests waiting for appointments.

Fees + Insurance + Financing

The daily charges are $400 for detoxification, $193 for rehabilitation, $120 for the initial clinical evaluation and $100 for continuing care. Most insurance plans cover part or all of the costs at Kolmac. The exact out-of-pocket expense for the patient varies accordingly. Patients interested in treatment with us should call with insurance information and our staff will explain costs.  Once the patient has scheduled an appointment our staff will verify the insurance coverage.  Payment plans are available if needed.

The clinic accepts all insurances except Tricare and state funded plans (e.g., medicare and medicaid). 

Reviews

There is quite the mixed bag of reviews found online. With an agency the size of Kolmac, this is to be expected. There generally are either really terrible reviews or really great reviews without much in between. This is one of those clinics we HIGHLY recommend visiting first before you make a decision about starting treatment with them. 

Contact Information 

Best way to reach them is through their online contact form found here or their general number at 301.589.0255. 

Final Thoughts
 
Overall, the staff at Kolmac seemed friendly and knowledgeable. Staff also seemed genuinely interested in learning about resources and referral options in the community. 

Is CRAFT the Best Unused Substance Abuse Treatment?

Community Reinforcement Approach and Family Training

Today I’d like to introduce you to one of the most effective treatments/interventions for substance abuse that is rarely used and even-more rarely discussed. It’s called CRAFT and is a behavior therapy approach designed primarily for those with substance abuse issues. Developed by Nate Azrin in the 1970s, his technique focused on operant conditioning to help people learn to reduce the power of their addictions and enjoy healthy lifestyle. CRA was later combined with the FT (…family training), which equips family and friends with supportive techniques to encourage their loved ones to begin and continue treatment, and provides defenses against addiction’s damaging effects on loved ones.

The first part of this acronym – Community Reinforcement Approach (CRA) was originally created for individuals with alcohol issues. Clinicians later went on to apply it to a variety of substance use disorders for more than 35 years. The clinical premise is based on operant conditioning (…type of learning in which an individual’s behavior is modified by its antecedents and consequences), basically, CRA helps rearrange the client’s life so that healthy, drug-free living becomes more interesting/stimulating and thereby competes with substance use.

CRA is designed to be a time-limited intervention. The time limit is decided upon between the clinician and client. For example, a set number of sessions (for example, 16 sessions) or time limit (for example, one year) may be decided upon either at the very beginning of therapy or within the early stages of therapy.

One major goal of CRAFT is to increase the odds of the substance user who is refusing treatment to enter treatment through close support of family members, as well as improve the lives of the concerned family members. CRAFT clinician and participants teach and reinforce the use of healthy rewards to encourage positive behaviors. Additionally,  it focuses on helping both the substance user and the family strengthen their relationships which is often torn apart.

In the model, the following terms are used:

  • Identified Patient (IP) – the individual with the substance abuse issues that is refusing treatment
  • Concerned Significant Others (CSOs) – the relevant family and friends of the IP.

Three goals

When a loved one is abusing substances and refusing to get help, CRAFT is designed to help families learn practical and effective ways to accomplish these three goals:

  1. Move their loved one toward treatment
  2. Reduce their loved one’s substance use
  3. Improve their own lives

This comprehensive behavioral program accomplishes these objectives while avoiding both the detachment espoused by Al-Anon and the confrontational style taught to families by the Johnson Institute Intervention.

CRAFT and these traditional approaches all have been found to improve CSO functioning and increase CSO-IP relationship satisfaction. However, CRAFT has proven to be significantly more effective in engaging treatment-resistant substance users in comparison to the Johnson Institute Intervention and Al-Anon (or Nar-Anon) facilitation therapy. 

CRA Breakdown of Treatment

The following CRA procedures and descriptions are typical recommended clinical content areas for the substance user:

  1. Functional Analysis of Substance
    • explore the antecedents of a client’s substance use
    • explore the positive and negative consequences of a client’s substance use
  2. Sobriety Sampling
    • a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence
  3. CRA Treatment Plan
    • establish meaningful, objective goals in client-selected areas
    • establish highly specified methods for obtaining those goals
    • tools: Happiness Scale, and Goals of Counseling form
  4. Behavior Skills Training
    • teach three basic skills through instruction and role-playing:
    1. Problem-solving
      • break overwhelming problems into smaller ones
      • address smaller problems
    2. Communication skills
      • a positive interaction style
    3. Drink/drug refusal training
      • identify high-risk situations
      • teach assertiveness
  5. Job Skills Training
    • provide basic steps for obtaining and keeping a valued job
  6. Social and Recreational Counseling
    • provide opportunities to sample new social and recreational activities
  7. Relapse Prevention
    • teach clients how to identify high-risk situations
    • teach clients how to anticipate and cope with a relapse
  8. Relationship Counseling
    • improve the interaction between the client and his or her partner

Communication 

With CRAFT, CSOs are trained in various strategies, including positive reinforcement, various communication skills and natural consequences. One of the big pieces that has a lot of influence over all the other strategies is positive communication. 

Here are the seven steps in the CRAFT model for implementing positive communication strategies.

  1. Be Brief
  2. Be Positive
  3. Refer to Specific Behaviors
  4. Label your Feelings
  5. Offer an Understanding Statement – For example, “I appreciate that you have these concerns, … [or] I understand that you really want to talk right now, and that this feels urgent, … [or] I would love to be there for you.”
  6. Accept Partial Responsibility – This step “is really designed to decrease defensiveness on the part of your loved one. … It’s not about accepting responsibility for things you are not responsible for. … [Rather, it’s to] direct you towards the piece that you can own for yourself. … [For example, ] what you can take responsibility for are the ways that you communicate,” etc.
  7. Offer to help

Take home message – Help decrease defensiveness on the part of the loved one that you are speaking to, and increase the chances that your message is really going to be heard—so, increasing the ability that you have to really get across the message that you want. 

Consequences with specific limits/expectations being in place is essential in terms of communicating your message, but it’s also really important, maybe even more so, to be consistent in following through with those consequences and rewards.

Al-Anon 

As an organization, Al-Anon does not currently adopt, hold, or promote the view that CSOs can make a positive, direct, and active contribution to arrest compulsive drinking, which is the opposite premise of CRAFT. Al-Anon is a fellowship with a focus on helping families and friends, themselves, without promoting a direct intervention process for alcoholics. Because “no one ever graduates” from Al-Anon, it can be viewed as an open-ended program, not time-limited.

Al-Anon view

Regarding the CSO’s relationship to alcoholism and sobriety, the view from the Al-Anon organization can be summarized:

  1. PowerlessnessAl-Anon‘s First Step promotes a powerless view for families and friends, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
  2. Disease viewAl-Anon writes, “As the American Medical Association will attest, alcoholism is a disease.” Al-Anon also states, “Although it can be arrested, alcoholism has no known cure.”
  3. Three C’sAl-Anon has a dictum called “the Three C’s—I didn’t cause alcoholism; I can’t control it; and I can’t cure it.”
  4. Loving detachment. Al-Anon “advocates ‘loving detachment’ from the substance abuser.”
  5. Family illnessAl-Anon writes, “Alcoholism is a family disease,” and “we believe alcoholism is a family illness and that changed attitudes can aid recovery.”

Summary

CRAFT is not perfect and is not easy to implement partially due to lack of clinician training and also because of having multiple people involved (ie. IP, concerned others, and clinician). Programs, agencies and clinicians may not even be aware of CRAFT if you ask so if you or a loved one are in need of a non-residential approach that’s well researched and effective, find a substance abuse therapist able and willing to use it. 

Philadelphia Prep School Drug Ring: Affluence and Substance Abuse (and really good business planning)

Two young men, 25-year-old Neil Scott and 18-year-old Timothy Brooks, developed what they allegedly called the “Main Line Take-Over Project” (the Main Line referring to a group of affluent towns and cities outside Philadelphia). Their business plan: Take over the drug trade at some of Pennsylvania’s best schools. The team also had at least eight employees with a sophisticated business infrastructure. Scott and Brooks would allegedly push their dealers to each move at least one lbs of pot per week, and offer incentives like lower drug prices and the ability to buy drugs on credit if they successfully hooked new customers.

Montgomery County authorities announced April 20th that they were able to destroy this ambitious effort. They confiscated marijuana, hash oil, cocaine, ecstasy as well as cash and weapons and arrested the pair allegedly at the center of it.

“They were in business to make money, and they were going to do whatever they needed to do to make sure that no one threatened their business,” Montgomery County District Attorney Risa Vetri Ferman said.

Officials claim Scott ran the operation by shipping pot from California to Pennsylvania, while Brooks supervised sub-dealers at area high schools.

And these weren’t just any schools. They include the prestigious Haverford School ($35,000/yr tuition), from which both Scott and Brooks graduated. Also included were Conestoga, Radnor, Harriton and Lower Merion – each of which have some of the highest SAT scores in Pennsylvania.  According to the district attorney’s office, all had students tied to the drug ring. College students involved hailed from Gettysburg, Haverford and Lafayette Colleges.

Authorities seized stacks of cash and some semi-automatic weapons
Authorities seized stacks of cash and some semi-automatic weapons

In brief comments Tuesday, Scott’s lawyer Tom Egan said his client’s “main concern … is how the mandatory minimums are going to operate if he’s indeed guilty of the offenses.”

Greg Pagano, Brooks’ attorney, spoke more extensively regarding his client, who went to the University of Richmond in 2013 on a lacrosse scholarship then left after one semester. He said Brooks had gotten injured, after which he was at home, “idle and suffering from some depression” when he got involved with Scott “at a very susceptible, low point in his life.”

“He’s willing to accept responsibility for what he did,” Pagano said of Brooks, whom he said “was involved in this conspiracy for a very, very short period of time.”

In a news conference and release, authorities laid out what they described as an elaborate operation to build up business. This effort included things like offering incentives to sub-dealers, such as lower drug prices and being able to buy them on credit.

Including Scott and Brooks, eight people have been arrested in the case, an arrest warrant is out on another, and there are petitions for two juveniles. All but two of those arrested attended local schools such as Lafayette College, the Haverford School and local public high schools. They face a host of drug, criminal conspiracy and other charges.

Reflecting on the areas where this alleged drug scheme operated, Seth Williams — the district attorney for Philadelphia, which is near the schools in question — said in a press release, “The days of, ‘It can’t happen here’ are long gone.”

The arrests follow an investigation that began in January. Authorities say seized text messages showed the suspects’ plans to expand the business, with Scott giving Brooks business advice on how to expand marijuana sales in local high schools and Brooks encouraging sub-dealers to “efficiently distribute drugs at their schools,” Ferman’s office said.

Authorities assert the discovery of a loaded .223 caliber AR-15 assault rifle, in addition to a semi-automatic pistol and another rifle, suggest the drug ring’s leaders had the capability to use force.

Ferman admitted she’s bothered by the fact Scott — who left Connecticut College after three semesters of study after being sanctioned for using marijuana and creating fake IDs — and Brooks both attended Haverford, then allegedly did what they did.

“You’re dealing with kids from one of the finest institutions probably in the country,” she said. “To take those skills and turn it into this kind of illegal enterprise is very distressing.”

California Fight Over Affluenza Defense

California lawmaker, Mike Gatto, is proposing a new law that would ban the use of “affluenza” as a defense in criminal trials. In December, a Texas teenager was spared jail time in a fatal drunk-driving crash. The teen’s defense team’s supporting evidence was that he was incapable of understanding consequences for his choices due to affluenza

The Los Angeles-area state Assemblyman introduced a bill this week that would prohibit considering a person’s privilege when sentencing – basically, environmental conditions impacting a defendant’s behavior should be ignored. 

“The fact that a defendant did not understand the consequences of his or her actions because he or she was raised in an affluent or overly permissive household shall not be considered a circumstance in mitigation of the crime in determining the punishment to be imposed,” the bill states.

The bill is a response to a controversial Texas case. In December 2013, State District Judge Jean Boyd sentenced a 16 y/o Ethan Couch to 10 years probation for drunk driving and killing four pedestrians and injuring 11 after his attorneys successfully argued that the teen suffered from affluenza and needed rehabilitation, and not prison. The defendant was caught on surveillance video stealing beer from a store, driving with seven passengers in his father’s Ford F-350 pick-up, speeding (70 MPH in a 40 MPH zone), and had a blood alcohol content of .24‰, three times the legal limit for an adult in Texas, when he was tested 3 hrs after the accident. Traces of Valium were also in his system. Dr. G. Dick Miller, a psychologist hired as an expert witness by the defense, testified in court that the teen was a product of affluenza and was unable to connect his behavior with consequences due to his parents teaching him that wealth buys privilege and insulates him from repercussions. The rehabilitation facility near Newport Beach, California (Newport Academy) that the teen will be attending will cost his family an estimated $450,000 annually.

Back to Gatto – He said he is trying to prepare for the next time someone attempts to hide behind the affluenza defense. 

“People often think of the Legislature as too reactive,” Gatto told the L.A. Times. “Up until last year, for instance, it was not illegal to commit rape if the victim thought the rapist was her husband or boyfriend, and people said how did you let this stay on the books so long? We’re trying to be proactive.”

The bill, introduced Tuesday, January 14, may be debated in committee as early as February.

Program Tour: Pros and (Not Many) Cons of Edge Learning Community

Findings of a Summer Day Tour at Edge Learning and Collegiate Community in Chicago

Among the towering buildings and rattle of platformed trains in downtown Chicago is a vibrant support community for young adults called Edge Learning Community. I met with their Director of Business Development, Chris McClaughlin, on a toasty Summer day recently. He was kind enough to meet me in the downstairs lobby  – a modern but elegant entry convenient to one of the major stops for the Chicago Transit Authority (map here).  

Up we went to their expansive and deceptively large common area. Sleek, clean furniture juxtaposed the industrial feel of the exposed brick walls and weathered hardwood floors. This was just the beginning of an exceptional space and community.

To the left, Chris escorted me to their rooftop ‘backyard’ area complete with grass (actually astro turf), outdoor projector for movies, lounge chairs and hot tub. Sweet views of Chicago were the bonus. The space felt way more private than you would imagine. Despite giant glass and steel over shadowing the old building on multiple sides, one has a sense of serenity. Not a bad start to a tour.  

After talking about some of the history of the buildings and infamous Chicago characters, we cut through the inside common area out onto another patio on the West side. This was a super-call outdoor bar and grilling area which felt more like a bistro than therapeutic program. Chris pointed out the buildings where Al Capone had secret get-a-ways, we talked about the history of the city and then, after the late-morning sun started to cook us, we got around to talking about the program. It’s center around what they refer to as Core Competencies: Whole Brain Thinking (Rational & Irrational Thinking); Creativity and Continuous Learning; Effective Communication; Leading within Teams; Community Stewardship; Sustaining Healthy Relationships; Self Care; and Management of Resources and Technology. Rather than cutting and pasting from their site, I recommend going to their site to read through the details.

After lunch in the kitchen/dining room, we toured the rooms that, to be honest, felt way more like high-end apartments with large kitchens. High ceilings and plenty of space for single or multiple students make each room a great space for studying, hanging-out and even cooking. Chris and I spoke about the limitations of many programs that only accept young adults in recovery. Edge is well-prepared and works often with folks struggling with addiction but they don’t think of themselves as a substance abuse program. It is not for those in the very early stages of recovery. It is definitely not for those that do not have basic internal locus of control and responsibility for their behaviors. The heavy lifting of support for each resident is performed by coaches who, for all intents and purposes are therapists as shared with me by their clinical director Jason Wynkoop. They are highly trained and competent to work with young adults struggling with organization, recovery, mental health issues and behavioral support needs.

Our tour and day ended high above Chicago talking about Edge, it’s program and the bright future they have since so many older, more established programs are just not meeting the current needs of students today. To summarize, here are some Pros and Cons to consider. If you need more insight, contact us. We’re happy to share what we know to help you make the best decision.

Pros

Aesthetics: Fantastic common areas (no crappy This-End-Up blocky wood sofas that smell like dog). Mature, hip and nicely appointed apartments with great views . As a side-note, I had no idea This-End-Up was still in business until I researched the link for this review. Wow.

Location: If you are freaked out by silence, if you can’t stand wilderness, and if you prefer the hyper-rhythmic flow of the city, Edge is where you need to be, especially if you are in college and need support.  It’s close to huge parks, museums, great restaurants, entertainment and tons of public transportation. Cars are definitely not needed here.

Independence: For those needing collaborative but not overbearing support from super competent professionals, Edge is your place. There is an expectation you are in school and keeping busy during the day.

Cons

Model: It’s not a bad thing but if you are looking for a super traditional transition program this may not be for you (or your son or daughter). Their collaborative approach rocks for some but may feel overwhelming to those that just want a bed for their head.

Location: If the cacophony of big city life wears you down, this is not the program for you. Edge’s DNA is inseparably tied to the fast-paced hustle of 2.715 million neighbors. Fit is a big deal when looking for support during the already stressful (and fun) time of college and young adulthood.

To be honest, there just aren’t many Cons – nothing here is inherently bad. Quality, in this case, is clearly defined by fit. For those ready for the interdependence of young adulthood we highly recommend visiting Edge for one of their informational meetings/weekends, talking to alum and getting a tour before committing to Edge. Once you know it’s the right place for you, you’ll experience the intense, positive support of this fantastic, innovative community.